Clinical Cases

Spigelia Anthelmia Cases

The authors present two cases of Spigelia with more than one year follow up, along with homeopathic methodological considerations.


Spigelia is a vegetable remedy belonging to the Loganiaceae family of trees, which comprises several hundreds of species, some of which are lethal because of their high content of strychnine ( 1 ). In East countries, Spigelia was employed for headache, neuralgia, and as an expeller of intestinal worms ( 1 ).

In Homeopathy, Spigelia is known as a specific cardiac and neuralgic remedy (2 , 3 ). Here we discuss two cases observed in homeopathic surgery at the L. Sacco Hospital, University of Milan, which lead to an excellent outcome, in complete agreement with the natural essence of the remedy ( 2, 4 ).

Some authors do not agree with the view of basing a homeopathic prescription principally on physical symptoms, even when they fit the remedy’s nature. At the end, we will discuss this topic, in the light of homeopathic philosophy.

Case #1 Headache – April 2008

Interview with the patient:

O.M., a 62 year old male, came to homeopathic surgery. He has been suffering for 9 years with migraine, which was fully elucidated in the Cefalea Center and diagnosed as primary headache, tension-type ( International Classification of Headache Disorders )( 5 ). The patient suffered 2-4 attacks/month, lasting 24-48 hours which were poorly controlled by difmetre ( Solvay-Pharma ); indeed , the patient often used fans to fight the pain.

The patient contracted Poliomyelitis when he was 18 months old, which resulted in a left somatic paralysis. He was operated on for an inguinal hernia on the left side.

Q: You came to me primarily for headache, tell me more about your main disturbance.

A: I suffered from Cefalea (migraine headache) since 1999. All examinations made in Cephalea Center have excluded any severe neurologic problems, but I cannot control the headaches anymore, since it worsened in the last five years.

Q: How many episodes of cefalea do you have in a month?

A: I suffer 2-4 main attacks monthly, which last up to 48 hours in spite of the use of difmetre. The pain slowly decreases after 1-2 tablets of metacen.

Q: What about the pain’s intensity? Could you score the average pain intensity on 100 mm Visual Analogue Score ( VAS )?

A: (The patient scores 9 mm on VAS ( 6 ).)

Q: How do you describe your cephalea?

A: I feel the pain as a weight, I have to hold my head tightly. I feel better when I get around, better outdoors, for example when I walk in open air.

Q: Do you remember any health problems you had in the past ?

A: Yes, off course. Some years ago I had persistent fever accompanied by a thoracic stinging pain and I went to the emergency department. The doctors performed an echocardiogram which showed an acute pericarditis. I had to stay in hospital for 2 weeks.

Q: Have you had any disturbing consequence of poliomyelitis?

A: Sometimes my hands are swollen. I very often experience a tingling sensation in my hands, especially at night. My right leg muscles are often stiff and hard. It happens that my hands cannot hold anything and things drop from my hands.

Q: Do you notice any other recurrent problems?

A: I have had several episodes of blister eruptions on my left eye; my family doctor sent me to the ophthalmologist who made a diagnosis of herpes zoster ophthalmicus. These episodes were unbelievably painful.

Q: Other problems?

A: I ‘m always tired, I think weakness is another problem.

Q: What about your character?

A: I’m very impulsive, and I sometimes get angry. In spite of my handicap, I’m not a lazy person. I work with my body, I love sports especially if outdoors. I love walking in open air.

The patients said he is quite independent, not sensitive to people’s opinions or criticism. He loves to read and he is a chilly person. I was satisfied with the information provided by the patient and arrived at my prescription:

Spigelia Anthelmia 200k, 4 drops twice a day.

Repertorisation ( Radar 10 )

Head pain as a weight. (Spigelia 2°)

Head constriction band or hoop ( Spigelia 2° )

Head pain, walking in open air ameliorates. (Spigelia 1° )

Generals- walking in open air ameliorates. ( Spigelia 1° )

Generals- amelioration in open air. ( Spigelia 1° )

Face, eruptions, herpes. ( Spigelia 1°)

Extremities, swelling. ( Spigelia 1° )

Extremities, formication hands. ( Spigelia 1°)

Tingling sensation in the hands (Controlla). Spigelia 1°

Generals -neurological complaints. Spigelia 1°

Generals- on side left. ( Spigelia 2° )

Chest inflammation, heart pericardium. ( Spigelia 3°)

Eye pain neuralgic. (Spigelia 2° )

Mind Impatience. (Spigelia 1° )

Mind Anger. (Spigelia 2° )

Mind desires activity. (Spigelia 1° )

Moreover, you can note there is a left side predominance and Spigelia is a left side remedy ( 1, 2 )

First update one month later, May 2008

A: I’m surprised, doctor, my headache has improved very much, progressively in this month, and even my general health has improved!

Q: How many attacks did you have?

A: Only one, but less serious than before ( the patient signed a 4 mm VAS ), I did not take difmetre but only nimesulide.

Q: Tell me more.

A: I feel well, less tired and calmer than before.

Prescription Spigelia MK

July 2008

Patient: My big problem, the headache, is gone. I only had a mild attack one month ago then no more. I ‘m feeling very well, with good energy, more willpower. I feel quite calm, less impulsive.

Q: What about herpes?

A: I had one episode which resolved spontaneously in one day during the first month after starting the remedy.

Q: What about dropping things, motion and general stability?

A: I have improved, I feel stronger, stable when I walk and even my hands hold things firmly, I rarely drop objects.

Prescription – since remedy is confirmed, same potency, only one dose a day.

October 2008

Q: How do you feel?

A: Well, I had one mild cephalea attack since July which I resolved taking the remedy more often.

Q: The other problems?

A: I don’t know, I resolved my main problem…..In general I’m much better than before I met you. I started a special training to participate in a regional championship for disabled people.

I called the patient in Febraury 2009, the patient suspended the remedy and he reports he is very well and the headaches have disappeared. I called the patient again on November 2009 and he confirmed all the improvements. I therefore considered the patient definitively cured.

Case #2, Neuralgic pain- April 2007

Interview with the Patient:

This 65 year old patient presents with high blood pressure and coronary disease.

He suffered from hypothyroidism and was treated with replacement therapy. Four years ago he suffered an event of cerebral ischemia involving the left hemisphere. He also developed a severe cephalea with facial neuralgic pain.

The patient reported that, in spite of his various health problems such as hypertension and coronary disease, his big problems arose after the cerebral damage. Indeed, his gait became unsteady, wavering and he hurt himself walking. Above all, headache and facial pain began and compromised his quality of life.

Q: What exactly happened when you had the cerebral attack?

A: I don’t know, I suddenly lost my senses and I woke up in the Hospital.

Q: Tell me about your headache.

A: Every day the pain arises on my forehead, then it localizes at my eyes which become very painful; even my face is painful as if an electric sword has hit it.

Q: Have you some accompanying symptoms?

A: Yes I mostly have nausea and I sometimes vomit.

Q: Describe your symptoms.

A: The pain usually arises slowly in the morning and in the same way it disappears in the evening. I very often have nausea and sometimes vomit with the headache. Moreover, when the pain is present, I feel a sort of electric blade inside my face.

Q: Have you any modalities which ameliorate or aggravate the pain?

A: I avoid touching my face or head when I have pain because touching increases the pain. The pain is relieved when I hold the head with my hands or when I press the head against something hard.

Q: When is the pain stronger? Did you ever wake up at night because of the cephalea?

A: Yes often I wake up at night, usually around 11 pm.

Q. Could you score here your average pain?

A: Patient score 9 on Visual Analogue Score.

Q: Other Problems?

A: I have had a thyroiditis with 2 small nodules discovered on the left thyroid lobe. Now I take replacement therapy with levothyroxine 100 mg per day. I am also affected by prostate enlargement, diagnosized 3-4 years ago by the urologist.

Q: Have you any urinary complaints?

A: I have difficulty urinating. I have to make an effort but very little urine flows out…. often drop by drop and I notice my underwear has urine stains. Moreover I had 2 episodes of prostatitis.

Q: Any other problems?

A: I have dizziness sometimes during the day, often in bed, when I lie down or when I turn on my side. I also have dizziness when raising my head after stooping.

Q: How often do you have dizziness?

A: Every day at least 1-2 episodes.

Q: What about your character?

A: I’m a nervous person and I easily get angry, especially when people offend me. Lately my sleep is not good and I suffer from sleeplessness and often wake up during the night.

Repertorisation ( Radar 10 )

External throat, goiter. ( Spigelia 1°)

Face pain, neuralgic. ( Spigelia 2°)

Face pain, touch aggravates ( Spigelia 1°)

Head pain, pressure ameliorates ( Spigelia 2°)

Bladder, forcible stream ( Spigelia 1° )

Bladder, urination dribbling ( Spigelia 1° )

Chest, heart complaints in the heart ( Spigelia 3° )

Mind, anger ( Spigelia 2° )

Mind offended easily ( Spigelia 2°)

Extremities gait tottering ( Spigelia 1°)

Generals, faintness in heart disease. ( Spigelia 2° )

Generals, midnight before. (Spigelia 2°)

Generals, turning in bed. ( Spigelia 1° )

Generals, side, left. (Spigelia 2° )

Vertigo, lying aggravates. (Spigelia 3°)

Vertigo, turning aggravates. (Spigelia 1°)

Vertigo, raising head aggravates. (Spigelia 1° )

Two remedies, i.e. Spigelia or Conium, could be used. At the end, I prescribed Spigelia Anthelmia 200k, 4 drops twice a day, because this remedy fits better with the symptoms and the patient’s mentality.

Follow up – May 2007

Patient was surprised that the pain had disappeared two weeks after starting the remedy.

Q: Has the pain completely gone?

A: Yes.

Q: What about dizziness?

A: It is less frequent than before. It is rare during the day and it sometimes occurs in bed.

Q: Could you give more detail?

A: Now I have some days without any dizziness and, in case it happens, it doesn’t last as long.

Q. Can you walk easier than before without hurting yourself?

A: Yes my walking has improved.

Q: Tell me about your urinary problems.

A: A little bit better, I am rising less often during the night.

Q: But what about the urinary flow?

A: Almost the same.

Q: What about sleep?

A: Now it is good.

Prescription Spigelia MK

July 2007

Q. How do you feel now? Do you still have those improvements?

A. Yes, in two months I only had a mild episode of headache which was solved by taking the remedy more times, as you told me.I feel more lucid and can concentrate. My gait is more stable than before.

Q: What about dizziness?

A: Dizziness has progressively gone. I can have a whole week without any symptoms.

Q: What about urinary problems?

A: I have greatly improved ; the urine flows more freely and I have to strain less than in the past.

Prescription: Spigelia XMK

November 2007

Patient: My life has greatly improved. I feel much better than in the past, firmer in my legs, my ability to walk is acceptable now. I rarely have vertigo, and these are short episodes. Now when I am going to sleep I am not afraid. I rise only one or two times a night. I do not have to strain to achieve an acceptable urinary flow.

Prescription: no remedy. Take it if problems occur.

February 2008.

The patient missed the scheduled ambulatory visit, so I called him. He told me he was very well and he would schedule a new update visit, but he was not convincing. I thought I would never see the patient again.

I called him on June 2008. He was very kind with me but he told me he did not take the remedy for months because he does not need it anymore.


Homeopathy is continuously debated. The question is about the symptoms and the technical parameters to use for the final homeopathic prescription. ( 4, 7, 8,9,10,11, 12 ).

Sankaran pointed out the importance of considering the generals and mental symptoms which precede the clinical manifestation of the disease and their use in finding the remedy ( 12 ). Sankaran stated (12) that mental, general and peculiar symptoms are expressions of the patient’s central disturbance. In both the patients presented here, the aforementioned homeopathic parameters have been taken into account.

Both the patients were prescribed Spigelia, which addressed symptoms in different organs and systems as well as the modalities. Sankaran ( 8, 9, 12 ) stated that modalized physical symptoms, together with general symptoms, are of great value for the final prescription, as much as the mental symptoms.

Sankaran and others ( 8, 9, 12 ) usually base their homeopathic prescription on the mental origin of symptoms and delusions instead of researching the remedy in clinical rubrics. Moreover, they claim it is worthless to find or confirm the remedy in clinic rubrics when there are clear mental symptoms to guide the homeopathic prescription.

In spite of Sankaran’s reports ( 8, 12 ), in our and in other’s experience, the remedy seems to maintain a strong nucleus of action even taken in high potencies ( 2,

10,13 ). Its action is also physical, because of its affinity for organs ( 2, 7 ,13 ). Sankaran (12) stated that this is a residual of the toxicological properties of a remedy, but in his opinion it is worthless.

Spigelia is known as a heart remedy as well as a neuralgia remedy ( 1,2 ). These two actions are equally present in the clinical cases presented here, even if the mental status, especially in the first patient, was not completely typical for Spigelia. On the other hand, that is the basis of clinical homeopathy ( 14 ).

In both the cases we could not apply all the parameters suggested by Sankaran ( 8,9, 12). The patients ‘s kingdoms and miasmatic prevalence did not appear so clear in these patients and we had to base our prescription mostly on classical parameters ( 13 ), i.e., symptoms covering different organs, the remedy’s characteristics and trophism and mental affinity between the patients and the chosen remedy. On the other hand even if the miasmatic dimension of the cases was not fully elucidated, the cases showed cures according to the Vijaykar dictates ( 15 ). This does not mean that a prescription is only based on physical symptoms, since the patient’s mental status must always be taken in account. However, it should be recalled that there are patients who are reluctant to describe their mental symptoms. In such cases, general symptoms, the totality of symptoms and the remedy affinity might be enough to choose the correct remedy. (13) After a one year follow up, the aforementioned patients had still responded very well to the homeopathic treatment, not only for the local symptoms or disease, but also for their general status, even though very few mental symptoms had been collected in both cases.

A suppressive therapy usually does not ameliorate emotional status or affect sleep and does not improve the patient’s energy ( 15 ). We think it is useful to consider both homeopathic prescriptions as like partial similar remedies ( 8, 14, 15, 16 ).

Moreover vithoulkas ( 7 ) and others authors ( 2 ) advise that the prescription of a small remedy, which covers few symptoms ( often local), will, if the remedy is correctly addressed on patient’s modalities, obtain a general response which is much better than you expected: and mental symptoms may improve under the small remedy’s action.

The two patients presented in this report showed a marked improvement even mentally, which indicates that the homeopathic remedy did not exert only a suppressive response ( 12). In addition, a minimum follow up of more than one year may be considered satisfactory. ( 14, 16 ).

Note: These cases are from homeopathic surgery, Luigi Sacco Hospital-University, Milan, Italy.


Dr. Salvatore Piraneo graduated from University of Milan School of Medicine in 1981. He was initially involved with phytotherapy and Bach Flower remedies. He graduated as a homeopath in July 2000 from the Dr. Roberto Petrucci School of Homeopathy in Milan, Italy. From 2001 he has been running a Homeopathic Surgery in a University Hospital in Milan, Italy.

Francesco Pagano is associated with the surgical department at Luigi Sacco Hospital

Janette Maier is a Professor of General Pathology, University of Milan


1. Vermeulen F. Prisma. The arcana of Materia Medica illuminated. Similars and parallels between substance and remedy. 2002 Emryss bv Publishers Haarlem, The Netherlands.

2. Henk van Hootegem. Heart decompensation, adult-on diabetes. Small Remedies Seminar. Centrum voor Homeopathie, Hechtel 1990, 212-221.

3. Allen T.F. Handbook of Materia Medica and homoeopathic therapeutics. 2001, B.Jain Publishers (P) LTD. New Delhi.

4. Dam K. and Lassauw Y. Interview with George Vithoulkas. Homoepathic Links 1992,5, 8-9.

5. The International Headache Society. The International Classification of Headache Disorders 2nd Edition. Cephalalgia, 2004; 24(Suppl): 1-160.

6. Gould D. et Al.Information Point: Visual Analogue Scale ( VAS ). 2001 Blacwell Science Ltd, Journal of Clinical Nursing, 10, 697-706.

7. Vithoulkas G. Techniques for succesful repertorization. Archibel Medical Software, online

8. Sankaran R. Interviewed by M.Bhatia. Homeopathy, July 2007.

9. Sankaran R. The evolution of my practice. Homoepathic Links, 2007, 20, 11-14.

10. Geukens A. Constitutional versus situational presciption. Homeopathic Links, 2009,22, 139-144.

11. Mansoor A. Scientific methodology of repertorization. Homoeopathic Links, 2009, 22, 176-178.

12. Sankaran R. The spirit of Homeopathy.Mumbai: Homoepathic Medical Publishers, 2001.

13. Piraneo S. et Al. Pemphigus vulgaris.Case report with three-year follow up. Homeopathic Links 2009,156-157.

14. Van der Zee H. Complementing the simillimum. A case of Parkinson’s disease. Homeopathic Links, 2010, 23, 36-40.

15. Thakar M. Meeting the”Lion of homeopathy”.An interview with Dr. Praful Vijaykar. Homeopathic Links, 2003, 3, 155-161.

16. Golden Isaac. An Energic model of homeopathy. Homoepathic Links, 2007, 20, 86-92.

About the author

Piraneo Salvatore

Dr. Salvatore Piraneo graduated from the Univ. of Milan School of Medicine in 1981 and did a specialization in general surgery. Since 1982 he has worked in University Hospital in Milan. Dr. Piraneo graduated as a homeopath in July 2000 (Dr Roberto Petrucci School of Homeopathy - Milan), Since 2001 he has run a Homeopathic Surgery in University Hospital in Milan. He also works in a hospital where he is responsible for several medical trials in homeopathy. Dr. Piraneo has authored numerous articles on homeopathy and his interests include phytotherapy and Bach Flower remedies.


  • The author’s potency and dose selection deserve comment. He starts with a fairly high potency (200C) of the remedy in liquid dilution given daily, and the potency is raised to 1M after one month, then 10M after 3 months. It may be noticed that the patients in both cases report no slowing or reversal of improvement, rather a remarkably rapid progress.

  • Spigelia causes brain and spinal irritation as reflex of rheumatism or worms,irritation of heart causes valvular inflammation,respiratory paresis so in potency act as calm down palpitations and dyspnoea plus neuralgic pains esp left eye as heart is left sided.non professionals beware of using mother tinctures as their cumulative effect acts as poison,oleander like poison even can kill a rat.

Leave a Comment