The complaints of pharyngitis, in particular the feeling of a splinter becomes worse from cold. The gastric symptoms are worse from cold drinks. A cold sensation is reported in the abdomen, colic with feeling of cold better from warm applications; a feeling of cold also in the breast; coldness of the extremities. The kali carb. patients are easily chilled, better in warm climates.
The chilliness is worse at evening, before the menses, after excretion, in the open air, after eating. There may be internal heat with external chilliness. The profuse sweatings are worse on eating, from warm food, from mental exertion and writing, from mild bodily exertion.
The circulatory weakness contributes especially to the great sensitivity towards cold. The extremities are not only somewhat easily chilled but also easily become numb, especially on crossing the legs; also painfulness of the tips of the fingers and toes, sensitivity of the soles of he feet belong here. The skin is cold, pale and puffy. Whether the tendency to edema is conditioned centrally through the influence of the heart or depends upon local tissue effect (alkali edema), one cannot always decide. The sacs extolled by Boenninghausen in the drug picture of kali carb., small bag-like swelling between the eyebrows and the upper lids, give the impression of a locally conditioned edema. On the contrary, the edematous state in old people obviously infers a failure of the heart muscle.
The puffy face in young girls is frequently significant of an anemia and, together with diverse types of menstrual disturbances, is taken as a kali carb. indication. Although the great potassium content of the red blood cells and their easy hemolysis through potassium could afford a biologic proof, the connection to actual anemia for kali carb. is still insufficiently supported.
Perhaps dependent upon the circulatory weakness is the sleepiness after eating, as well as sleepiness at meal time, from the slightest mental exertion; further, a state of exhaustion as exists after severe prolonged illness, loss of blood or loss of other body fluids, after marked seminal depletion, during and after the menses, combined with a weak pulse and pulsations over the entire body. Generally holding is an aggravation of the complaint after coitus. To be mentioned here are the asthenopic complaints after sexual excesses.
The mental attitude of the kali carb. patient is anxious, disheartened, fear of everything, of fantasies elaborated by himself, of everything possible which threatens him. This state so full of anxiety and fantasies we know indeed of patients with cardiac muscle weakness. Suggestive should be the terror and anxiety felt in the gastric region (vagus action?). At the same time there exists an irritability, and indefinite apprehensiveness which is likewise well known in the cardiac patient; the patient is ill-humored, highly irritable.
The special action of potassium on voluntary muscle expresses itself in the great muscle weakness and relaxation which may amount to a paralytic state. The elastic fibres seem to become influenced in the same way. The joints fail, the back and legs are especially weak: weakness in sacral region, stiffness and paresis in back, feeling as if the lumbosacral region were breaking. The failure of the back and legs comes on so suddenly and severely that the patient is compelled to sit in the street if he can find no other place. According to Farrington the triad characteristic for kali carb. is: weakness, backache and sweating, but it states all too little. Severe sacral backache during pregnancy and after miscarriage, feeling of heaviness in the lumbosacral region with menstruation, give frequent causal source. The pains extend upward and downward in the back, radiate into the glutei, the hipjoints and the thighs. Characteristics for the muscle actions are: twitching and trembling of the muscles, weakness up to paralysis, especially (apart from the back) in the thighs and knees, worse on climbing stairs, loss of power in the extensors. Paretic states in old people who have edema at the same time give indications of the muscular and the circulatory weakness. Other muscle symptoms are: heaviness and drooping of the upper lids, even paralysis (M. levator palpebrae); and difficulty in evacuating the stool and involuntary discharge of urine during coughing, sneezing, etc., show the action on the anal and bladder sphincters.
CHARACTER OF PAIN
To the general characteristics of kali carb. belong also the pains which in both inner and outer parts are predominantly sticking. That the pains are worse from lying on the affected side which soon becomes numb, distinctly differentiates kali from another agent with sticking pain, bryonia. The point of difference is that in bryonia the pain is predominantly in the serious membrane, but in kali carb. it seems to arise more from a stasis in the musculature, in the subcutaneous tissues, in the bronchioles, etc. With this agrees the aggravation from lying on the affected parts and from becoming cold, the improvement from moving around and the change in the location of the place from applications of warmth. On the mucous membranes the sticking pain seems traceable to dryness. To be mentioned also is the sticking pain as if from a fishbone in the throat a sensation as if from a splinter on becoming cold, cough with sticking pain in the larynx and air passages, sticking pain in the rectum before and after stool, furthermore stitches in the kidney and right scapular region and especially in the sacrum.
As for all the alkalies, so for kali carbonicum are reported gouty-rheumatic complaints in the joints and muscles. The evidence of failure in the locomotor apparatus, the preferential localization in the back, sacrum, hip, thigh and knees united with the already mentioned modalities, give a certain rheumatoid picture to kali carb. Since with kali carb. swelling also often appears, which naturally does not give the impression exactly of an inflammation, so perhaps the combination of such pains and swellings leads to the clinical implication of hip-joint disease and synovitis. Convincing results, however, have not been published. Consequently, the usual intermingling of the uric- acid diathesis and the characteristic gout will perhaps ascribe to all alkalies also an influence on the latter. The alkaline waters have likewise been extolled. According to Bechhold and Zeigler potassium prevents the precipitation of urates. Potassium-rich diet would likewise be recommended in gout because uric acid experimentally deposited as mono-sodium urate tends to be lessened through potassium-rich food. But a special adaptability of kali carb. for true gout does not appear either from the drug provings nor from homoeopathic experiences.
The organ relations of kali carb. can be graded in the following series: heart, respiration, digestive organs.
While formerly pharmacology perceived the alkali cations in drugs as completely interchangeable, in the last ten years many warnings have again appeared on potassium as a cardiac poison.
The field of medicinal actions on the heart is utilized only by homoeopathy. The proving symptoms which refer to the heart are as numerous as characteristic in Hahnemann’s writings: cardiac palpitation when hungry; frequent severe palpitation with anxiety; frequent intermission of the heart beat; pain in or around the heart as if a band encircled the heart and were drawn together, most noticeable with marked inspiration or coughing but not on bodily movement; climbing a few stairs is very difficult, walking on the level does not cause symptoms. To this are added symptoms in the direction of cardiac asthma as: early (morning) dyspnoea; interruption of breathing awakens him in the night out of sleep; rales in the chest at night on lying down on the back; respiratory oppression; oppression of the chest with noisy deep respiration; early pain in the chest, especially around the precordium; sticking pain in the left chest on deep breathing. And further; spasmodic and choking cough at five in the morning as from dryness in the larynx with severe oppression of chest making speech difficult, redness of the face and sweating over th entire body. Another picture: Severe sticking in the left chest after midnight, in the cardiac region, at times in the back, bearable only on lying on the right side; every attempt to lie on the left side is unbearable; the second night he awakened very early with the most severe sticking in the chest, with dyspnoea, on lying on left side unbearable even with absolute quiet, and passing only when he turned to the right side; on the third night again when he lay upon his back. It states further that breathing is rapid and superficial and that the patient can hardly stop breathing long enough in order to eat, drink or swallow.
Clinically we have before us the manifestations of cardiac insufficiency with conduction disturbances and especially dyspnoea which appears in the early morning hours, also during rest in bed and not especially aggravated by exertion or movement. In this syndrome kali carb. has repeatedly proven of value to me.
On the respiratory organ it expresses itself by the easy chilling which is favored through the reduction of vascular tonus. Pharyngitis, laryngitis, tracheitis must have the special modalities when kali carb. is to be employed with some prospect of result. Perhaps kali carb. is also to be considered of use in beginning tuberculosis. Apart from the easy colds with the tendency to catarrhs descending to the chest, neither the other symptoms not the experience reported up to the present make this indication appear particularly valuable.
Another syndrome signifies a vagus influence, tendency to spasmodic manifestations in the smooth musculature of the respiratory passages. The cough is severe, dry, hard, exhausting, with sticking pains and dryness in the upper respiratory passages. The face is puffy, the eyes swollen. Boenninghausen observed a whooping-cough epidemic in which the edematous sacs appeared over the eyes and kali carb. was the suitable remedy. Especially the persistent cough of a dry spasmodic nature after pneumonia or measles with fleeting neuralgias and the characteristic time of aggravation from 3 to 5 o’ clock, often require kali carb. Also in pneumonia itself in the stage of hepatization, kali carb. can at times be useful. One thinks here primarily of stasis through weak cardiac activity. The lower third of the right lung seems to be the elective site of attack: sharp, cutting, sticking pains in the breast, worse on lying on the right, the involved side (opposite to bry.) indicate it. The dry shattering cough, which may lead to nausea and vomiting, has little expectoration, which is tenacious and difficult to remove. The mucus collects in the region of the larynx toward morning: even after release it is not expectorated but swallowed; at times droplets fly from the mouth on coughing.
Another type of Kali carb. Cough is associated with a weakened heart,. Here there are coarse rales in the chest and the cough is loose but the sputum still tenacious, smells and tastes (like old cheese) offensively; the patient can only sit bent over with the elbows on a stool-this is the clinical picture of the above- mentioned cardiac asthma in a late stage and for which kali carb. at times is in order.
In all types of coughing the chief aggravation toward 3 to 5 in the morning is prominent. This is the time of preponderant vagal innervation, the high point of intracellular assimilative work.
On the digestive organs a complete series of dyspeptic symptoms have been described and indeed in the dyspepsias of old people kali carb. has been recommended but is much more rarely employed than sodium carbonicum in which the digestive disturbance is described in almost the same words. Furthermore, it is striking how similar the symptoms of kali carb. in the digestive canal are with those of carbo vegetabilis. This is no accident because plant charcoal contains the admixture of potassium carbonate. The details are: distensive feeling of the stomach and abdomen with feeling of coldness, fullness and sensation of heaviness, worse after eating and after cold drinks; feeling of weakness in the stomach not relived by eating; nausea better on lying down; aversion to bread and flesh and in general against food; desire for sour things; the tongue is coated white, the taste is bad; the gums are loose, there are aphthous ulcers in the mouth, salivary flow is increased. The flatulence gives occasion for colic-eructations momentarily relieve, likewise the application of heat and bending forward. The eructations may be sour. The total picture is more that of an atony of the gastro-intestinal canal with abdominal plethora. For this also speak the large stools, difficult to evacuate, the swollen hemorrhoids, extremely sensitive to contact, and burning rectal pain which call for kali carb.
But in general the gastro-intestinal canal offers slight occasion for the prescription of kali carb.; carbo vegetabilis will be preferred in the same syndrome. It lies near to consider the symptom complex as gastro-cardiac, and the first manifestations of cardiac insufficiency express themselves not rarely in a similar gastro-intestinal atony. In the difficulty of evacuation of feces and the easy prolapse of the rectum, the weakness of voluntary muscle, of the abdominal muscles and the sphincter, plays a role.
Stitches in the right hypochondrium have led to the recommendation of kali carb. in old liver maladies with ascites. But this report deserves little confidence and the basic symptoms are entirely insufficient and are better associated with flatulence than ascites.
Complaints of the urinary organs in and of themselves offer hardly any occasion for the use of kali carb. In the already mentioned relaxation of the sphincter vesicae we have in causticum a much more suitable remedy. To be mentioned is frequent, sudden, urinary urgency with the passage of mucus or gravel. Pollakiuria and much sediment are vagotonic signs.
Various forms of disturbances of the menses have been described for kali carb., but none are characteristic. In long-lasting copious bleeding with ever-recurring oozing of blood at relatively short intervals, the weakness, the waxlike pallor and the server backache suggest kali carb. Hahnemann considered kali carb. as suitable for the delayed menses in young girls. Too late, pale, scanty menses were also cited. But better than the rhythm is the back and sacral pain with radiation to the thighs and particularly the general constitutional type.
In general not below the sixth decimal (trituration)
Chilly, puffy, pale, weak muscle, exhausted, irritable, anxious; sensitive to cold; circulatory weakness; tendency to edema; vagotonic.
Muscles: back and sacral weakness.
Heart muscle: insufficiency, conduction disturbances.
Respiratory organs: spasmodic disturbances, cardiac stasis.
Characteristic and Leading Symptoms:
Sticking; wandering pains, worse from cold, going to another places from the application of heat; sweating on the involved parts; sacs under the eyebrows; anxiety and fear felt in the gastric region.
Aggravation from 3 to 5 in the morning; worse from cold; worse from coitus; worse during and after the menses; worse lying on affected side; better in general form movement.
The cation sodium has sits physiologic task in water movement and in acid-base equilibrium to such extent, and its quantity in the easily available fluids of the body is so great that any other consideration of its action than according to quantitative chemical viewpoints at first seems remote. Its marked swelling action on colloids, its property of binding water, and the great capacity of dissociation of its salts make it chiefly as the chloride compound the chemical regulator of water balance. In acid-base equilibrium it acts in the first place in the form of the carbonate and to a far less extent in the form of the phosphate. Exactly as with potassium we may expect to discover extent and direction of pure sodium effects best in the carbonate (Na2CO3) or in the bicarbonate (NaHCO3). But though we are certain of the necessity of sodium ions in the nutrient fluid of the cells for their function, we are still very insufficiently informed on the exact effect of sodium on the cells. As long as we move in the range of crude chemical actions, the alkaline character of the carbonate, the OH influence, will be decisive, and weather sodium, potassium or ammonium is its carrier, this remains of subordinate significance. Neither the severe corrosive action of the hydroxide not the weak macerative action of the carbonate on the skin and mucous membranes has a medical significance. The neutralization of gastric acid through weakly alkaline NaCHO3 is nothing else than a chemical mass action, of which the damages naturally require our attention. Experimentally, large doses of sodium bicarbonate before meals lead to a hypotonia of the stomach and shallow peristalsis.
Sodium carbonate or soda, that is, the stronger carbonate step of NaHCO3, is, in addition to the neutral sodium salt, NaCl, which provides a sodium ion, a constant constituent of the blood and the tissue fluids in general. The so-called buffer action of the carbonates against excess acid in the body fluids rests upon the ease with which CO2 is given off or taken up. It is determined as an equimolecular chemical process in the relative proportions. Furthermore, sodium serves physiologically as an easily available transporting agent for decomposition products. The close connection of sodium to water regulation will be best considered with the chloride, natrum muriaticum, and concerning intestinal excretion, in connection with sodium sulphate.
GOUT AND ACCELERATION OF OXIDATION?
From the fact that in the test tube the oxidation of organic substances proceeds easier in alkaline than in neutral solution, one has concluded that the alkalies, especially the alkali carbonates, play an important part in oxidation processes. Hugo Schulz in particular emphasizes the utility of alkalies in gouty processes. Through the increase in oxidation processes, the burning of purin bodies to urea should proceed more completely and less uric acid residue remain.
Experimentally, no action on uric-acid metabolism has been proven in this sense. H.Schulz reports naturally that small doses of NaHCO3, increase the excretion of urea with a simultaneous reduction of uric-acid output. When one considers with that tenacity the blood maintains its grade of alkalescence and how an alteration is possible only transiently even from great amounts of alkali, then one can scarcely maintain the explanation that the action on oxidation increase depends upon increase of alkalescence. On the other hand, that one can favorably influence a tendency to acidosis and gout by a persistent alkali-rich vegetarian diet is correct but it is largely the poverty of such a diet in purin bodies which causes the favorable influence. For purely palliative attack of threatening acidosis, by large amounts of NaHCO3, indeed, some use is made. In gout and the uric-acid diathesis in general, however, such measures are unsuitable. Even a dietetic reorientation in the alkaline direction in manifest disturbances, as the formation of concretions, has empirically insufficient support. Actually (for example by Brugsch) there has been warning against excessive use of alkaline diet (forced fruit regimes, too excessive use of alkaline waters) because it favors the formation of inflammatory urate foci. This is based on experimental findings: according to Pfeiffer and van Loghem, 13 the experimental inflammatory reaction of injected pure uric acid is hastened and increased through alkalies (through large doses of mineral acids it is delayed). If, nevertheless, moderate alkaline water regimes have been found useful at times, then this action in any case is not explainable by quantitative chemical considerations. If the alkalies actually have a connection to the uric-acid diathesis, it might appear from the at times promoting, at times damaging, influences of alkaline springs (in dependence on the dose?) and also from the above-cited experimentally produced aggravation of gout by alkalies, that this effectiveness must lie in another stratum of the living process, because the doses coming into consideration are far too small for an equimolecular chemical reaction. One must consider here a catalytic, perhaps a metabolic influence via the way of the vegetative nervous system. According to all appearances natrium carbonicum seems to stand behind lithium carbonicum and kali carbonicum in this respect.
Clinical experiences with alkaline water permit one to conjecture that the alkalies are excreted outside of the urine, and that this occurs rapidly through the biliary passages and the bronchial mucous membranes where they can unfold healing actions. The toxicologic study which Schulz cites of Rossbach (from Nothnagel’s Handbook) indicates not a great deal for the secretory mucous membrane action of Na2CO3. Accordingly, the intravenous injection of soda solution in animals gave pallor and complete cessation of secretion. One thinks here in any case rather of a spasm of the blood vessels than of an influence on the glandular apparatus.
SODIUM AND CHLORINE
Certainly sodium influences the important optimum of hydrogen-ion concentration in the digestive process. By the development of HCl in the stomach, a great deal of sodium is made free for combination with the carbonate and is then very probably an essential participant in the preparation of the alkaline intestinal juices. This intermediating role of sodium in the digestive processes is indeed a chemical mass action on the receptive organs. But, as we know, in a high degree the increase is effected through the vegetative system and this permits one to consider that in the forelying disturbance a medicinal influence of activated sodium is possible in this way. The already mentioned motor depression of the stomach through large amounts of sodium bicarbonate before meals is naturally to be ascribed to the preponderance of the carbonate introduced over the chloride. Similarly lies the case when, from a rectal administration of sodium bicarbonate, the gastric-acid secretion is lessened. The sodium ion is also the physiologic intermediator of the chloride- carbonate exchange, which leads to disturbances also through one- sidedness.