To the psychic picture also belong the increased libido and erotic dreams; however, there is sexual weakness. By the paradox of sexual excitability in these sensitive people many symptoms of anxiety may be explained in the phosphorus type.
According to the classification of v. Grauvogl, phosphorus corresponds to the oxygenoid constitution because characteristic for this is the consumption and hyperesthesia and moreover the aggravation of complaints from alterations of air electricity, particularly the weather. This modality is especially characteristic for phosphorus. Nevertheless, v. Grauvogl does not include phosphorus under the remedies for the oxygenoid constitution.
Increase of tissue destruction with insufficient building up, unnatural hunger, ravenous hunger at night, sudden congestion and sweats, hectic types of reaction show, if one seeks an exponent for the phosphorus type, from the endocrine system that there is a predominance of the thyroid. That there is a close connection between the thyroid and phosphorus should not be surprising.
The sudden alterations in blood distribution, the tendency to congestions and vertigo, may possibly be associated with the acceleration of metabolism under the leadership of the thyroid. Naturally, a direct action upon the vessels and the arterial blood may explain such symptoms. Here belong rush of blood to the head, congestion, pulsation and burning headache, which are improved by cold; warmth in any form (room, food) aggravates the headache; the face shows circumscribed redness and heat. All sensory impressions and mental efforts aggravate the headache.
It is chiefly the behavior of general sensation, hunger and thirst that are characteristic. The marked hunger has a certain spasmodic nature. Soon after eating, the hunger returns. The patient must arise at night to eat. Before or during the headache ravenous hunger exists. Many complaints, especially the nervous, are improved by eating but improvement does not last long. The patient can sleep better when he has eaten something. The hunger is spasmodic and at other times there is an aversion to food, or the patient desires food but will not eat it when it is brought to him.
The severe thirst for cold water is similar in nature. The quenching of the thirst relieves only momentarily; the thirst reappears when the water has become warm in the stomach and then vomiting often occurs. Correspondingly there is a desire for cold, refreshing, moist food.
TENDENCY TO BLEED
A tendency to bleeding goes throughout the entire picture of phosphorus. The reduction of coagulability of the blood with diminution of the fibrinogen and the involvement of the capillaries up to fatty degeneration of their walls in poisoning shows this trend in the end effect. The striking reduction of CO2 content of the blood and the nonoxidation of the otherwise so oxygen avid phosphorus in the arterial blood gives the bright red color to the hemorrhage although a perfectly satisfactory explanation is not obtained thereby. In hemorrhagic diathesis, particularly purpura hemorrhagica, phosphorus is an important remedy. Easy bleeding from wounds, bleeding from the nose, lung, stomach, intestine, kidney, uterus, from granulations, ulcers, tumors and polypi, into the skin, mucous membranes and serous surfaces as petechia and suggillations are indications of phosphorus which, because of their final character, are naturally indications only in conjunction with other signs of therapeutic value.
Phosphorus in homoeopathy has always been considered an important remedy for spinal cord diseases. With the great number of subjective symptoms one does not know whether they are to be ascribed to general weakness in the neuromuscular system or to the domain of organic disturbances of the motor and sensory centers. In this respect one need not expect any action when column degeneration is completed but only in the beginning, the stage of development, can it be considered therapeutically. In this same sense the following sensory and motor irritative and paretic manifestations can be evaluated only as the fleeting transition from functional to organic disturbances: the bodily and mental exhaustion proceeds up to the highest grade of paralytic weakness, which the arms and legs show particularly, trembling on the slightest occasion; can hardly hold objects; the gait is trembling, uncertain, stumbling; numbness and formication up to complete anesthesia, especially in the finger tips, increasing motor and sensory paresis in the fingers and toes. Muscle trembling and tendon contractions are also mentioned by Lewing as precursors of the paralysis. How far the external pains of various types are referable to neuralgias may be left undecided, but in any case they are aggravated by cold and relieved by warmth, details which will be noted in contrast to the head and gastric symptoms. The neuralgias associated with the teeth are likewise improved by warmth. Beginning bony processes in the alveoli may cooperate here.
The nervous symptoms are worse from mental and bodily effort and fear, and the great sensitivity of the psychical symptoms toward many fine influences has previously been mentioned. In the field of spinal cord action also falls the sexual irritation and weakness so far as they are not psychically conditioned; moreover; some symptoms from the sphincters, as the sensation of the anus being open, paralytic weakness of the bladder. Clinically, phosphorus is given for most diseases of the spinal cord, in particular progressive spinal paralysis, tabes, myelitis and multiple sclerosis. It is self-understood that by employment based merely on a diagnosis, only very little success may be expected and further in individual selections only where the symptoms of the system disease itself indicate possibilities of regulation. In respect to the cord degeneration of pernicious anemia, phosphorus is to be seriously considered by virtue of the similarity to the total disease.
EYES AND EARS
Phosphorus is an important remedy for internal diseases of the eye. That phosphorus physiologically plays a similar role in the retina as in the central nervous system may be concluded from the previously cited phosphorus excretion from the frog retina through illumination. In homoeopathic materia medica, the color vision, particularly red and green vision, is mentioned. In retinitis and glaucoma, phosphorus is especially indicated, and in retinitis albuminurica the nephritis adds itself in a confirmatory manner. Gray and foggy vision and improvement of vision at twilight have given occasion for employment in beginning cataract, in turbidity of the lens and choroiditis. Rapid increase of shortsightedness at puberty is a constitutional indication.
Auditory paralysis is observed in phosphorus poisoning. As characteristic for the indication in internal auditory diseases is the difficulty in heating the human voice, the echoing and droning of the patient’s own voice, and that of others, as though the ears were stopped.
As the important action of phosphorus on the respiratory organs we found from pathologico-anatomic sections at autopsy relatively little point of departure. In older animal investigations (cited by Sorge, l.c.) hepatization and tubercle-like formations are described. On the nasal mucous membrane old catarrhs with painful dryness, frequent, sneezing and easy bleeding are described. Clinically, bleeding nasal polypi are reported. In blepharo-conjunctivitis phosphorus is frequently the choice.
The pharnygeal catarrhs of phosphorus have tenacious, light colored mucus; the;mucous membrane is dry and glistening. The larynx is very sensitive to contact and cold air; painful burning occurs in the larynx on speaking or there is severe prickling. The huskiness is worse evenings, also after use of the voice. In milder cases there is a sensation in the larynx “as if stuffed with cotton or velvet”. The peculiar inflammation makes speaking impossible through rawness, dryness and pain, or occasions inaudible speech. Thereby a constant stimulus to cough exists in the larynx and there is a hard, dry, painful cough. Phosphorus is also frequently employed in laryngeal tuberculosis. Since this is usually secondary, the same indications hold as exist for the use in pulmonary tuberculosis.
Inflammation and dryness in phosphorus have a tendency to descend into the trachea and bronchi.
Through the entire symptoms of the upper air passages goes the aggravation from cold air; aggravation from speaking and laughing in the cough. The cough is aggravated by going from the warm into the cold. The hard, dry, painful cough may arise from the larynx as well as the upper air passages or from sensations at the pit of the stomach. The expectoration is slight, tenacious, is detached with difficulty and at times is bloody.
Cough belongs to the nervous component of phosphorus; cough provoked by strong odors or by the appearance of strangers, cough from confusion. As so frequently we find here also the crude symptom from the receptive organs simultaneously sublimated again in the reflex symptoms.
Congestion is characteristic for the lungs and this may be of an active (direct capillary effect) or passively conditioned from the right heart. An important symptom is the oppression, the feeling of heaviness as from a heavy weight on the chest, constriction as if from a firm bandage, with feeling of anxiety and weakness, burning pains and heat rising to the head. Another characteristic is sticking in the left chest, better only lying on the right side. The aggravation from lying on the left side is generally considered as an indication for phosphorus, particularly in pneumonia. Phosphorus is a leading remedy in all types of pneumonia. Thereby one need not go so far as Fleischmann from the Austrian homoeopathic school for whom phosphorus was the sole remedy in pneumonia. It is reported that it is suitable especially in the stage of hepatization, but it may be used at resolution of lobar pneumonia. The typhoid form of pneumonia is especially suitable for phosphorus when dusky facies and delirium are present. Phosphorus is also suitable for infarct and pleuro-pneumonia, the frequent sticking pain being a special indication.
The phosphorus cough in lung affections is so severe that it shakes the entire body, and the patient must hold the chest with his hands. The thirst for ice cold water is characteristic.
The suitability of phosphorus for pulmonary tuberculosis proceeds even from its predisposing constitutional type. To this is added the tendency to hectic fever and the bleeding. The euphoria of phosphorus poisoning may be compared with that of severe tuberculosis.
Phosphorus is often in place even in persistent catarrhs of the respiratory passages when they recur at each chilling and tuberculosis is feared especially as arising, after acute diseases. Always characteristic for the cough is the occurrence on going from the warm into the cold. If a florid tuberculosis is in progress, then extreme caution with the doses of phosphorus is in place. I myself believe in many still afebrile cases a hemoptysis must be brought into association with the first phosphorus medication even with high potencies and I now use more of the phosphate in the form of calc. phosphor.
Many of the chest symptoms cited perhaps belong to the cardiac action. That an action occurs on the cardiac muscle is indeed shown in the final fatty degeneration. In this as well as in myocarditis phosphorus is to be placed alongside of arsenic. Affections of the right heart and the disturbances in pulmonary circulation arising out of it come into special consideration for phosphorus. The subjective symptoms have already been mentioned in the lung affections: pressure in the cardiac region, severe palpitation, worse from movement and lying on the left side, worse evening or the patient awakens at night with it; congestion to the chest, feeling of suffocation, the more severe symptoms of stasis with rales, dyspnea, anxiety bloody expectoration. Modalities, as thirst for very cold water, thereby can guide to the remedy. By other suitable symptoms phosphorus may be considered in endocarditis in the course of febrile diseases. Accidental cardiac murmurs during puberty and with rapid growth makes the entire type suitable for phosphorus. The close connection of phosphorus to the thyroid also explains the use in goiter heart and in vegetative cardiac disturbances.
The phenomena from the digestive canal are known in broad trends from acute and chronic poisoning. Inflammation of varying grade causes the following trend: gums swell, bleed easily, ulcerate.
These symptoms as well as the simultaneous tearing pains in the jaw accompany phosphorus necrosis. The tongue and likewise the oral mucosa are markedly coated, now clayey white, now yellow, or dry, wrinkled and bleeding in fever.
The pains in the stomach are of diverse types, and perhaps the burning which extends to the throat and into the intestines is the most frequent. Educations and vomiting of sour fluid, mucus or bile occur. These general gastric symptoms state nothing in themselves. But the desire for ice cold water and the transient improvement from it, further the vomiting of water as soon as it has become warm in the stomach, the aggravation from warm food, indeed in a warm room, are the characteristic trends.
The vomitus may also be bloody, an indication for ulcer particularly in combination with spasmodic contractions and attacks of cutting pains which are transiently relieved by eating. In the coffee-ground vomiting of carcinoma and burning, phosphorus stands beside arsenic as a choice.
The symptoms of an ulcer or a severe gastritis naturally need not be present but there may be more nervous dyspeptic complaints as burning pain after eating, sour and frequent empty eructations, belching and regurgitation of the food soon after eating, distinction of the stomach and abdomen; a weakness or sensation of relaxation in the stomach may suggest phosphorus if the modalities concur, particularly the peculiar behavior of hunger and thirst. A clinical indication is the postoperative vomiting after chloroform narcosis.
On the intestine the symptoms entirely correspond to complaints of mild dyspepsia up to the most severe ulcerative processes; empty and relaxed feeling in the abdomen, or retraction as if from a heavy weight, abdomen painful on contact, rumbling and colic in the abdomen, flatulence, colic, drawing, cutting, sticking; severe manifestations are tympany, a gurgling from gas goes from the stomach through the intestine and is accompanied by involuntary stool; this may be observed in intestinal tuberculosis and typhoid. Diarrheal stools of the most diverse types have been described, but particularly those which accompany the most severe intestinal processes; painless, copious, very exhausting diarrheas, markedly offensive, gushing, yellow, watery, or white or green, slimy stools with fat or sago-like inclusions, bloody stools as broth, involuntary on each movement. With the failure of control of the intestinal activity appears a sensation as if the anus remained open, a symptom which because of its rarity and peculiarity is useful. A paretic state of the intestine can make the evacuation of the intestine difficult. More rare with phosphorus is a constipation with long, hard, small stools which are difficult to evacuate, “like a dog’s stool, thin as a pencil. This stool should be white and this permits one to deduce a relationship to disturbance of the liver.
The peculiar, sago-like or tallow-like inclusions in the stool are perhaps traceable to pancreatic disturbances. Even if the pancreas is not particularly involved in the picture of poisoning, still here too a fatty degeneration may be present.
In phosphorus poisoning sugar is often observed in the urine. The marked thirst likewise suggests diabetes, and phosphorus stands beside arsenic in this connection. But phosphoric acid will be used more in diabetes than phosphorus itself.
The liver cells are involved in all their functions by phosphorus. Icterus in febrile diseases, in particular pneumonia, is a further indication for phosphorus. Of the subjective symptoms in the region of the liver are mentioned feeling of fullness, sensitivity contact and sticking pains. Acute yellow atrophy and liver cirrhosis are such profound destructive processes that in spite of the most extensive similarity to phosphorus not much can be expected. If catarrhal icterus, in which a hepatitis may be presumed, is present and threatens persistent parenchymatous damage, one may be sufficiently early with phosphorus. The fatty and amyloid degenerations of all parenchymatous organs are to be valued to a certain extent only as end-symptoms showing that an organotropic connection of phosphorus exists for these cells in general and that the effect of phosphorus approaches the grade of such deep and profound diseases.
URINARY AND SEXUAL ORGANS
Likewise acute and chronic nephritis and hematuria are indications with the differentiating symptoms. The urine shows nothing characteristic, only at times is turbid, white and milky.
On the female sexual organs there appears in the symptoms primarily a tendency to bleeding. The menses are too copious, bright red, too early and last too long. Accompanying symptoms are: a sensation in the back as though it would break, ice cold hands and feet, dark circles under the eyes, nausea and apprehensiveness. In the progressive consumptive processes, in which naturally caution must be used in giving phosphorus, the periods may also be absent and bleeding from the nose or hemoptysis appear in place of them.
As an inflammatory manifestation is to be mentioned the occasional appearance of an oophoritis with severe pains during the period and in the region of the ovary. The pains radiate down the inner side of the thigh. Further there may be copious leucorrhoea of different types, yellow, white, watery, excoriating or milky.
The extremely increased sexual irritability and tendency to masturbation in both sexes has been mentioned above among the nervous symptoms. There may be aversion to coitus and anesthesia in the vagina, and in the male, at times the increased libido, with impotence, ejaculatio paraecox and frequent spermatorrhea.
SKIN The manifestations in the skin in phosphorus are strikingly few in contrast to arsenic. Petechia and ecchymoses have been mentioned. The homoeopathic symptom register mentions yellow- brown patches at various sites of the body. Possibly by this, pityriasis versicolor is meant, the appearance of which in tuberculous patients, particularly in the pulmonary form, is quite common. The indications would then be selected from the clinical picture. On the other hand damage to the adrenals by phosphorus could explain such pigmentation.
Finally one finds mentioned patchy, falling out of hair with desquamation on the bald spots. Alopecia areata is frequently taken as an addition for phosphoric acid.
The general impression of a phosphorus patient is, apart from the previously indicated constitutional signs, naturally dependent upon the existing consequences of the disease present. So a hectic spot or an earthy color of the face of the severe tuberculous patient or the edematous swelling of the renal or cardiac patient can give expression to the external picture.
Type : Asthenic, rapidly, growing; delicate, sensitive, hyperesthetic; in need of support, mentally animated but rapidly exhausted up to apathy.
Rapid change, “wavering”; fear of being alone, anxious in the evening and before and during storm; markedly increased libido but sexual weakness.
Consumption and hyperesthesia characterize phosphorus as an oxygenoid remedy.
Basedow trend; increased tissue destruction with insufficient tissue building; ravenous hunger; congestions, hectic types of reaction.
Ravenous hunger, at night or soon after eating; thirst spasmodic.
Chief Trends: Tendency to bleeding of all types (capillary endothelial damage; reduction of coagulability).
A dynamic fever (delirium sopor).
Protoplasmic poison effect.
Special : Functional and organic spinal cord processes; disturbances of sexual function.
Eyes: retinitis, hemorrhages, glaucoma.
Respiratory passages: pharyngitis; tenacious mucus. Laryngitis: larynx sensitive to contact and cold air; huskiness, worse evenings, sensation of cotton in the throat; cough worse from cold air and in going from warm to cold rooms, from speaking, laughing.
Pulmonary congestion, sensation of oppression from the right heart; aggravation from lying on the left side; pneumonia especially adynamic forms.
Pulmonary tuberculosis; constitution, hemorrhages (caution!), euphoria.
Heart: particularly right heart, with disturbances in pulmonary circulation, myocarditis.
Congestions: Worse on left side, worse evening.
Accidental murmurs in rapid growth.
Digestive tract: inflammatory, easily bleeding up to ulcerous processes; gingivitis to necrosis of jaw leading.
Gastric symptoms, worse from warmth; thirst for ice cold water, finally, vomiting from it; ravenous hunger with transient improvement from eating; gastric ulcer or duodenal ulcer.
Dyspeptic, inflammatory or ulcerous gastro-intestinal processes. [Much gurgling and colic, involuntary stools, hemorrhages (typhoid, tuberculosis, etc.); sensation of anus remaining open; copious painless, very exhausting diarrhea.]
Tallow or sago-like inclusions in stool; relation to diabetes.
Liver: strong affinity; icterus especially as an accompanying symptom (pneumonia).
(Degenerative liver processes, yellow atrophy and cirrhosis are not important in spite of the pathologico-anatomic similarity).
Urinary organs: nephritis, especially with hematuria.
Sexual organs: tendency to masturbation; increased libido with impotence.
Menses: excessive: sensation as if the back would break; oophoritis and polypi.
Skin: petechia, ecchymosis; patchy falling of hair.
DOSE : The potencies from the 3-30th are common In active tuberculosis the 10D seems best because of less severe primary action.
Provings of Acidum phosphoric. are found:
1. Hahnemann: Chron. Krankheiten, 2 Aufl., Bd. 5, 1839.
2. Heinigke: Allg. Hom. Ztg. Bd. 79, p. 157.
3. Schelling: Allg.Hom.Ztg., Bd. 84, p.43.
GENERAL NERVOUS SYMPTOMS
Corresponding to its inertness phosphoric acid lacks the varying, erethistic, sensitive, exalted character of phosphorus, and is at the same time a relaxed phosphorus.
The mental and bodily weakness and exhaustion stands in the foreground in phosphoric acid. States of exhaustion from overwork, after diseases, from sorrow and grief, from excesses in venery, especially masturbation, or from lactation, night sweats, diarrhoea, in general exhaustion after excessive demands upon the vital functions, are held as especially suitable for acidum phosphoricum. As with phosphorus the exhaustion from too rapid growth is a noteworthy indication.
Puberal states with frequent seminal emissions of an atonic type and sexual weakness give the psychic and somatic picture of phosphoric acid especially distinctly. Palpitation and irregularity of cardiac action in too rapid growth, dark circles beneath the eyes, pale face, dilated pupils, weakness, paresis and burning of the back and sacrum, weakness of the legs, then above all phosphaturia which so often appears in sexual neurasthenic syndromes are the bodily phenomena. Poor comprehension and concentration, poor memory, indifference, dullness, inability to perform mental work, lack of ideas, moreover depression, apathy, dissatisfaction with one’s self, aversion to speaking, in particular homesickness, indicate the psychic state in phosphoric acid. But nervous excitation with sleeplessness and sensitivity to all noises is also observed as an accessory action of too large and long maintained doses of phosphates. Such nervous unrest and depression need not be considered a contradiction to the depression which prevails in the picture of phosphoric acid; the sleepiness during the day, particularly morning and evening, the nocturnal disturbance of sleep with restlessness and dreamy sleep or sleeplessness in the symptomatic picture of phosphoric acid are just as little contradictory. A brief sleep may often remove the fatigue and be sufficient to refresh in phosphoric acid.