This remedy was incorporated into the homoeopathic materia medica in 1864 by the Italian physician Rubini. His monograph contains a large number of proving symptoms which the author and his spouse had experienced (during the proving) and clinical indications which prompted him to consider it almost a panacea for heart diseases. Later fragmentary reprovings were added by Henke, Lembke, Clarke, Burt and Fitsch, recorded in Hughes Encyclopedia.
The important symptoms agreeing in most provings are of vasomotor character: Palpitation, throbbing headache with congestions ……
and the well-known sensation of constriction in chest. A later proving of Cactus (10 to 80 drops of the tincture of Cactus) produced: Sensation of warmth and stupefaction in head, leading to pronounced pressing pain in both ears and severe congestion to face. The pain in ears at times appeared in waves, increasing and decreasing, aggravated by sudden motion. While these symptoms were very prominent and harmonized absolutely with the other provings, the pain was only slight in left side of neck, and later similar in left side of chest during the night.
Rubini claims, on the basis of these symptoms, that Cactus in a certain sense is related to Aconitum. Hale agrees with him to some extent, but considers Digitalis in closer relationship, which we consider questionable. Perhaps Cactus’ action is closer to Glonoine than Aconitum, which also characterizes the greater dissimilarity of the Digitalis group.
Interesting now is the question as to what clinical application has been made of the indications which the provings suggested.
In most cardiac patients the lost compensation of circulation is very important. For this purpose remedies are necessary which act directly on the weakened cardiac muscle and its regulating nervous mechanism and which are able to act promptly and thoroughly. They might be designated as “ergotrope heart remedies”.
When one of these remedies of the Digitalis group succeeds in establishing compensation, the object is attained, and in the case of a per se healthy cardiac muscle (only temporarily damaged by over-loading) nothing more can be desired. However, it is different if we have to do (as in most cases) with a pathologic process in the cardiac muscle proper causing insufficiency. Here it would be primarily necessary (or at least after the acute danger has been eliminated) to act directly as to this condition with remedies which might be called histotropics (attracted toward the tissue).
This is especially necessary in acute inflammatory cardiac disease because here ergotropic agents (Stedman’s Medical Dictionary: Ergotropy: Energizing of the plasma and tissues of the body by the injection of nonspecific proteins, either animal or vegetable, so as to increase the power of resistance to pathogenic agents in general) can accomplish very little, unless an established decompensation justifies or indicates their use. Yet, in these conditions the final course depends more upon speedy cure of the inflammatory process.
But also in chronic inflammatory, of degenerative cardiac diseases (aside from the always necessary ergotropic treatment) action on tissue changes is paramount, be it in the sense of a still possible involution, or at least arrest or retardation of further development. Aside from these groups we have the prominently vasomotor remedies which hardly have any influence on cardiac insufficiency, and are also, like Nitroglycerine, useless. However, a number of them, like Aconitum, are not indicated in chronic diseases of the cardiac muscle, but are valuable in acute inflammations.
What about Cactus? Have organotropic actions been ascribed to it, and are the indications laid to them correct? The proving symptoms do not in the least furnish this proof which would be evaluated in the sense of cardiac insufficiency, and also toxicologically no such thing seems to be known. In spite of this, clinical recommendations for its use in the treatment of cardiac insufficiency are not lacking.
Dr. Kroner, especially, has apparently made much use of it in cardiac insufficiency. He says (without stating the source) that it primarily increases the cardiac work-capacity, and secondarily causes a kind of decompensation. Hence it could also be used where Digitalis in large doses was indicated. But he must admit that the action of Cactus is here less reliable than that of Digitalis, and, therefore, not much time should be lost in using it, unless pronounced subjective Cactus symptoms are present.
According to Royal, even in hydropericarditis, Cactus is indicated when the symptom of constriction is present.
Hinsdale, in recommending Cactus, goes so far as to state that in patients suffering from a heart disease one should always first think of Cactus. However, he demands that the sensation of constriction (as an almost absolute special indication) must be present, or at least any kind of heart pain. From the report only, it is not quite clear how these indications are related to pronounced decompensation.
Congestive pulmonary catarrh due to cardiac defect, a pronounced cardiac muscle insufficiency, Wapler-Donner treats with Cactus. These statements are not shared by Mayerhofer, Snader, Cowperthwaite and Baltzer who do not credit Cactus with essential action in cardiac insufficiency. Our experience does agree with these authorities, even if occasionally a case should prove the reverse. And this brings up an important problem which in the discussion regarding the cardiac symptoms of homoeopathic remedies has not always found the deserved consideration.
There exists an uncommonly large number of remedies which in this sense develop ergotrope cardiac action. Their occasional proof does not sufficiently justify their praise. That demands at least a great reliability in their action. It is just here that we have the weighty competition of Digitalis, which so often is not appreciated by homoeopathic physicians, though in adequate doses with the similarly acting Strophanthus acts so splendidly on heart insufficiency as does no other remedy.
It is therefore difficult to see why Cactus should recommended for cardiac insufficiency, even though someone has occasionally seen a favorable action from its use. There is only one reason for giving it here, i.e. where the leading constriction symptom is present, as Snader so correctly points out.
Though a questionable ergotropic action of Cactus must be denied, the question remains: Has it histotropic action on the heart? Almost all authorities who have investigated Cactus mention good results from it in acute inflammatory cardiac pathology, especially in endocarditis. Kroner has pointed out that Digitalis has no such action.
On principle it must be said that allopathy is very poor in remedies which have a direct, specific action on cardiac inflammatory processes. Here is a splendid opportunity for homoeopathy to bridge the gap with reports of important and incontrovertible remedy action. recommendations are not lacking for Aconitum, Spigelia, Kalmia and Cactus; however, such advise is only feebly proved; a few case reports are not convincing when debating a disease of such irregular course where the prognosis is rather uncertain.
It is true that Stiegele (in a study of Kalmia on six well-observed cases) endeavored to give a workable basis, but no continuation of the study followed, and that number of cases is too small to offer sufficiently convincing argument. Hence, it must be emphasized that whenever a remedy is recommended for inflammatory cardiac conditions, scientifically it is a novum which can only demand consideration upon presentation of a large, successive number of patient.
The province of cardiac dynamics has already been studied scientifically with such excellent results that there is nothing epochal for homoeopathic practice to present. Here it is in order for homoeopathy to show its histotropic action on inflammatory cardiac conditions. It is not impossible that she could bring the proof also for Cactus, for in its symptomatology it has unquestionably related traits of Aconitum and also of Spigelia….
These two remedies are always praised in these ailments when indicated symptomatically.
We now have the third and last question: What is the vaso motor action of Cactus? The proving symptoms are here as valid as possible, though they naturally do not suggest any histotropic action. Since these symptoms are of two kinds-congestive and constrictive-they may suggest possibly two spheres of indication. The first belongs to the realm of so-called vasomotor neurosis, a collective concept embracing the diverse constitutional endocrine and other pathologic conditions.
Aside form rather uniform symptomatology such as congestions, headache, palpitation, perspiration, etc., they have this in common that they do not present a serious finding, perhaps only pulse frequency and occasional blood pressure variations. Or a vasomotor cardiac defect might enter the question, but only when there is no cardiac insufficiency, and the vasomotor symptoms are prominent. Perhaps recommendations of Cactus in cardiac insufficiency are based on these just mentioned conditions. Hale and Snader have found Cactus valuable in just such nervous cardiac disturbances, inclusive of Basedow’s disease and climacteric complaints. However, it seems that Cactus helps especially in congestive neurosis.
Too long has the constriction phenomenon of the Cactus symptom dominated the scene. As mentioned, Snader repeatedly pointed out the failure stemming form one such indication. If that symptom were really the predominant leading symptom over- shadowing all others, then Cactus would constitute a very extraordinary remedy in angina pectoris. Of course, not every pain in this disease can be called “Constrictive”, but in no other location do patients so designate the sensation of pain as here. Therefore, recommendation of Cactus in stenocardia was not lacking in homoeopathic literature-many quoted authors have spoken in this sense-but the results in therapeutic trials have given very little encouragement.
Also this puts a question of a principal kind, and that is one which concerns the “almost absolute value of the genuine homoeopathic indication.” One hears too often, and especially from followers of the strictly Hahnemannian course (as all homoeopathic physicians should be. S.W.S.). the view that a homoeopathic remedy of proper choice and dosage will unfailingly show its action, so to say, in the sense of a natural law, as long as the human body still has the power to respond to the remedy stimulation.
Never has a statement (though on a weak basis) been asserted- ……for a century-like this, even though the opposite proof is more easily obtained than the positive. Or, how would it be possible that Charette (La matiere pratique, Paris, 1928) carefully gathered typical proof for his materia medica from the total literature, instead of easily quoting from his own practice?.
At times it is difficult to get the leading symptoms, and that is true especially for Cactus. Here two differing reasons must be considered in this uncertainty. First of all: The provings are not the result of a sufficiently large number of healthy individuals, only eight single provings have been (cf. Hughes). These did not at all agrees as to the sensation of pain-constriction. Hence the emphasis on this symptom was perhaps a little hasty, and later, as it has practically almost been customary in remedy proving, been passed on in good faith from one author to another. Thus, finally, was created that unavoidable idea association of Cactus and constrictive pain against which Snader voiced his objection.
But, even if this symptom were incontest correct, there would still be insurmountable difficulties in the simile sense for an experimentum crucis. They lie at times in the different organic substratum of such a symptom. Even though the constriction symptom is referred to the chest, and generally means the heart, yet it is of different importance, whether it is due to a transient vasomotor event in the coronary vessels or to organic changes, be they of arteriosclerotic or luetic origin, or even thrombotic or embolic.
Here belong also the often coinciding equal disturbances of the gastro cardiac symptom complex, heart sensations due to valvular defects, and especially functional anomalies (tachycardia, arrhythmia, etc.). From these differences we naturally find also different reactions to remedies, hence frequent failure from Cactus.
However, it must be remembered also that the disappearance of such a symptom cannot be credited as a sure therapeutic success. Very instructive in this respect is an American work (W. Evans and Cl. Hoyle, The Comparative Value of Drugs Used in the Continuous Treatment of Angina Pectoris) which treats of the question of possible therapeutic action in angina pectoris. Ninety patients with occupation angina were observed for 22 years and treated with the known angina pectoris remedies and frequent interposition of placebos.
There followed 27% of splendid relief, 10.5% were less influenced, while 33% were reported unchanged and 29% had aggravation. This proves how careful we must be in the evaluation of prescribed remedies especially in angina pectoris, …..and that disappearance of the “Constriction” symptom can only be credited to the medicament if it shows up with great regularity in the majority of cases. Since such regularity is not experienced from Cactus, single success with it can not be evaluated very highly. Therefore, it may be time to get away from the “force association” sensation of constriction attributed to Cactus, or at least not to consider it infallible, until a proving of sufficient thoroughness has been undertaken.
Summing up everything it may be repeated that Cactus has no ergotropic action which would make it a rival to the Digitalis group. Its reputation of histotropic action on inflammatory cardiac conditions must still be considered unproved, but should be reproved. Its vasomotor action appears to be its most prominent feature, and so promises most quickly gained results. but it must be remembered that the congestive syndrome gives a more sure indication than the constrictive, which latter has been improperly accentuated. All in all, Cactus is a heart remedy of restricted sphere of action and must not be over rated. ROSTOCK, GERMANY.