(Cimicifuga rac.) “Bugbane.” N.O. Ranunculaceae.
Little or nothing is known of the physiological action of actaea as measured by modern methods of precision.
In non-homoeopathic literature such authors as Ringer, Phillips, Wood, Shoemaker and Farquharson refer to it as a remedy used in chronic and subacute rheumatism (chiefly muscular), in other muscular pains, in dysmenorrhoea in rheumatic subjects, and for chorea of rheumatic origin. One of these authors states that the drug is less used than formerly and that it has not secured the confidence of the profession. This statement is borne out by the fact that neither actaea nor its active principle, macrotin, is mentioned in the 1924 edition of Cushny (“Pharmacology and Therapeutics”0. The reason for this lack of confidence appears to be two fold. It has been used in cases to which the name muscular rheumatism seemed appropriate without proper individualization, and has thus been given to patients presenting none of the characteristics calling for the remedy. Further, to the cases which happened to be suitable, the doses prescribed (m x-xx) were unnecessarily large, That any of the cases were relieved is evidence that infinitesimal doses are not always necessary if the homoeopathicity is definite.
The stress of actaea’s action falls on muscular tissue, both striped and plain, and it causes irritation very similar to that produced by some of the “poisons” of rheumatism” without accompanying fever. Consequently it is prescribed for muscular pains in various situations-back, neck, intercostal, ocular and orbital and scalp muscles, and uterine and pelvic muscle tissue. Translated into the patients consciousness this means pains in the various parts of the body, chiefly of an aching character, with tenderness on being touched (e.g. soreness of scalp on sometimes shooting pain of scalp on brushing it) or sometimes shooting pain (e.g. intercostal or infra-mammary pains). The pain when typical, has other features and it is these other features. present in patient and drug which are the indications for the remedy. On whatever part the patient lies he feels soreness or aching, and this induces restlessness; the parts lain on may twitch or even jerk, and he tosses about because he cannot get comfortable. Nevertheless, movement is painful and though sore and aching the patient lies still as long as he can because motion increases his pain or starts the cramps. If the muscles say of the right loin (quadratus, latissimus or psoas) are effected any movement involving this area may cause a sudden painful momentary contraction or cramp jerking the body backwards or the leg (thing) forwards and causing the patient to cry out or to emit a grunt as if the diaphragm were suddenly contracting and drawing air unexpectedly through the glottis. This is a somewhat complex condition, for it suggests a hypersensitiveness of the nervous system, almost imperceptible impulses causing reflex contractions or cramps in legs, nates back (Possibly diaphragm) and neck. If the whole of the muscles of the spinal column are affected on both sides, a sudden cramp may cause the back to be arched or the body to rest on heels and shoulders in short a slight degree of opisthotonos may occur. This condition now and then occurs in lumbago. The parts lain on are sensitive to pressure (of the weight of the body) but as muscular spasm are lessened or are absent. In any case each spasm lasts only a few seconds.
In virtue of its power to lessen nerve irritability or sensitiveness, actaea may act as a valuable palliative in spinal meningitis, but as it has no power to cause definite inflammatory symptoms it cannot be expected to have any curative action in such cases.
The hypersensitive nervous condition, resulting in the jerking of muscles, single or in groups without the pain, may be present as in chorea, and the drug has some value in controlling the muscular jerks of this distressing affection.
In any of these conditions aggravation during the night and from damp and cold are important modalities calling for this drug whether the cold be local or general.
Mind.- Excitement and fear are aggravating features and the patient tends to be mentally depressed the degree varying from depression of spirits through sadness and gloominess to melancholia, especially at the menopause. Weeping is not conspicuous in actaea cases.
Sleeplessness is an added symptom and if this is accompanied by gloom the patient sitting or walking about in silence even if it be a puerperal melancholy or mania, actaea may be thought of. If the patient is persistently silent and melancholy, some other remedy may be better indicated, but if the symptoms change and the melancholia alternates with some physical condition such as pains diarrhoea or headache; or if the patient is sleepless and sensitive to cold and damp and is restless with or without muscular pains, actaea may be expected to do good . Paraphrenia and confusional states with delusions of poisonings would also suggest the drug.
Other mental symptoms which may call for this drug are: suspicion, fears (e.g. of death), onset of mental symptoms after sudden disappearance of pains; and hypochondriasis, especially if of a sexual origin.
Headache is a manifestation for which this drug is useful; it can frequently be identified as of a rheumatic type, but it is not necessary to stop to inquire if that word may be properly used to describe it.
The headache for which it should be prescribed is aching or shooting chiefly on the crown; the eyeballs are often involved, and as in bryonia and when moving the eyes about. Again, as in bryonia patents, the scalp is tender to the touch-as when the hair is brushed. Not seldom the pain extends down the neck with some stiffness of the cervical muscles.
The scalp may feel cold, or a sensation of internal coldness may be present, but in spite of this the headache is better from the cool open air. This is a noteworthy point, because, as already mentioned, the patient as a whole is usually worse from cold-general or local. Thus this local symptom forms an exception to the general modality “aggravation from damp cold.”
Diseases of Women.-Actaea has been used empirically in dysmenorrhoea, hysterical states associated with menstruation, and prolapsus, or at any rate a sensation of “bearing down” of the pelvic organs towards the vaginal orifice. The old common american name of “black cohosh” indicates its popularity for such cases. It has already been stated that the drug irritates the unstriped muscle of the uterus, and it is said that it may go so far as to produce abortion.
The kinds of gynaecological conditions for which actaea may be used with a likelihood of success are the following:-
(a) Patients subject to rheumatism of other parts who get irregular crampy pains at the period; pains in the hypogastrium, sacral region and buttocks, associated with a sore bruised feeling; or pains in the pelvic region, front or back, shooting from side to side. To serve as indications for actaea these symptoms should be associated with the mental and nervous characteristics alluded to, and with the temperature modality, which last, however, is not a supreme excluding condition.
The menstrual flow in actaea cases is usually scanty or moderate, but may be profuse; severe pain all through the flow- the more the flow the greater the pain, this is characteristic, as in most cases menstrual pain is relieved after free flow has set in.
(b) Irregular labour pains and “after pains,” “shivering” in first stage of labour, sudden crampy pains in hips during labour, and pains down the thighs in depressed or restless and irritable patients, with aching muscles.
(c) Nervous restlessness of pregnancy (“fidgets”) and of many chronic uterine conditions; menopausic depression with muscular symptoms and sleeplessness.
(d) Prolapse.- In the writer’s experience a “bearing down” feeling often exists without any measurable prolapse, causing the sensation that the pelvic contents (the patient’s “inside, ” in her own language) will come out by way of the vagina. When this symptoms is due to a subtle, intangible departure from the normal either of nutrition or innervation, drugs may be expected to remove. Actaea, in subjects with the characteristics of mind, nerve and muscle already dwelt upon, will relieve or cure such prolapse. l When actual gross Prolapse or flexion exist, due to extensive traumatism or long-standing cicatricial contraction, to expect drugs to cure is to invite disappointment. It is true however, so improve her condition as to enhance the success of the necessary plastic operations. Both these statements are founded on many years observation.
(e) Inframammary pains, worse on the left side are an indication for actaea.
Pain in the cardiac region extending over the chest and down the left arm, which feels numb and as if bound to the side often associated with palpitation, call for actaea.
(1) Actaea appears to irritate muscular tissue and to heighten the impressionability of nervous tissue. Articulations are not much affected.
(2) This is shown by pains in a variety of sites; the pains in a variety of sites; the pains are (a) bruised and sore; (b) crampy or definitely cramps; (c) shooting jerking without pain may be present.
(3) The sites are back neck scalp eyes, intercostals, uterus, & c.
(4) Such pains are often denominated rheumatism, or lumbago, torticollis, headache, &c according to site.
(5) Changeableness or alternation of symptoms or groups of symptoms (as in pulsatilla cases)
(6) The mental and nervous indications are: Depression, possibly amounting to melancholia; fearfulness; suspicions; sleeplessness; restlessness.
(7) The reproductive sphere is notably affected, and actaea is useful in dysmenorrhoea, in parturition, in these the above- mentioned indications for the drug must be present.
Damp cold, general or local (except the head); motion at night excitement pressure.
Cool open air (headache).