Arnica montana. Leopard`s bane. N.O. Composite. A tincture from the root or fresh flowers.
SMALL space is allotted to arnica in modern textbooks of orthodox pharmacology, and it appears to have been ignored or dismissed without investigation. Yet the poisoning show it to be an agent of considerable power. Pains in the abdomen-general or epigastric-commonly follow its consumption in large doses, hiccough, nausea, vomiting, diarrhoea, fainting and collapse, with or without perspiration, are common features. In case the condition was described as cholera-like. One modality of the abdominal pain is that it is not relieved by hot applications, and there may be tenderness on pressure, the case “simulating peritonitis:; very marked sleepiness was a feature in some of the cases.
General nervous agitation, anxiety, great weakness, convulsive movements and tremors, show its effects on the nervous system.
Where the dose is moderate the face may be flushed. hot and perspiring; if excessively large the skin is cold and dry, the face drawn and pale, the eyes sunken and glassy, and the pupils dilated and insensible.
Accompanying the gastro-intestinal symptoms there is, in some cases, distinct disturbance of vision-dulness of sight (not due to mucous on the cornea), diplopia, inability to judge distances, blurred vision and seeing lights or bright objects and hemianopsia (seeing only half the field of vision). This eye complex suggests some disturbance in the nerve centres controlling accommodation and the extrinsic muscles, and in the cerebral vision centres.
In the poisoning cases there does not seem to be time for mental effects to assert themselves, though in one case, where the vision was much disturbed, the victim on waking could not recognize the room he was in.
Skin.-The irritant powers of arnica on the skin are undoubted and should be classed with the poisonous symptoms, although in cases of extreme hypersensitiveness to the drug, minute or infinitesimal quantities sufficed to induce its effects. They may be caused by the ingestion of minute doses, by inhaling or olfaction of the oil or tincture, and by local applications. That the effects on the skin may be regarded as specific is shown by the fact that they were manifested in the skin areas far removed from the site of application. Control experiment has shown that similar applications of spirit of wine (unmedicated alcohol) do not induce similar effects.
The features of arnica dermatitis are as follows:-
(1) Diffuse erythema, bright, burning, biting, with slight oedema (raised edges) and spreading.
(2) On such a surface papules, small vesicles or bullae may develop. THe blisters may burst, leaving an oozing surface. Or diffuse weeping of the red area may occur, and cracks or fissures develop, like acute eczema. This acute condition may in parts resemble erysipelas and in parts eczema.
(3) Small pustules or boils may be present and may come in recurrent crops.
(4) Dusky mottled patches, not inflammatory but due either to areas of capillary congestion (e.g., occurring early in independent parts) or to slight ecchymoses.
The tests made with arnica on the human body, healthy and diseased confirm the results seen in poisoning cases. In so far as they may be classified, three chief groups of disorders may be mentioned: (a) gastro-intestinal or alimentary system disturbances; (b) circulatory disturbances; (c) nervous disturbances.
(a) The digestive-system disturbances are shown by the following symptoms: Nausea, salivation, eructations, disgust or loathing of food, of gnawing hunger, cramp-like pain or “pressure” in stomach region, flatulent distension of abdomen, intermittent pain in the right hypochondrium (interpreted as having its seat in the liver or duodenum), heartburn, diarrhoea (chiefly in morning after eating), cutting pains in bowels, tenesmus, and swelling of haemorrhoidal veins.
(b) Circulatory symptoms were: Palpitation (especially during night, disturbing sleep), “rush of blood to the head,” stronger pulse, slight epistaxis or traces of bright blood on blowing nose, and praecordial anguish.
(c) Nervous Symptoms.-These are as follows: Confusion and fulness of head, sparks before eyes, great drowsiness, but sleep disturbed by vivid dreams, general tiredness or weariness amounting to exhaustion, unilateral headache, with or without vertigo, worse in the morning, fibrillary contractions of various isolated muscle-bundles especially about the jaws, spinal hyperaesthesia, pressure causing involuntary startings in muscles of neck and back, girdle pain at level of epigastrium.
The skin symptoms are sufficiently described under poisonings, by which means the dermatitis was rendered most evident. The pustular rash was, however, also brought out by some of the provings.
The muscular symptoms are not as conspicuous as might be expected from its clinical value in this sphere. A dull, bruised sensation in various parts, pain and tenderness around joints, pains in back as if rising from long stooping-these, however, were fairly frequent.
With any of these groups-and the groups are not necessarily isolated one from the other, but may be conjoined as parts of a general condition-headaches, lassitude and drowsiness may be associated.
The provings bring out general features which deserve especial considerations, namely:-
(a) Bruised pain and sensitiveness of the whole body, or in many parts at the same time. This bruised feeling is worse on motion. At the same time the circulation may be excited, pulsations being felt all over and vertigo being present; stitches, muscular twitchings and burnings occur in different points.
(b) Pronounced weakness comes on, amounting to faintness, from the heat of the sun, from motion, talking, &c.; but a long walk in bright cold weather may ameliorate.
The mental symptoms correspond with the physical weakness- indisposition and inability for continuous work of any kind, especially mental work or talking, inability to concentrate (thoughts wander); indifference; easily started, sullenness (will not speak); or there may be excitability and a quarrelsome, contradictory, unreasonable mood.
Head.-The head pains are of different kinds: burning, shooting (stitches), aching (dull or bruised); heavy confused feeling, jerking, or like a nail in temple. One-sided pain, especially the left, is common. These occur in any situation have a number of modalities which will be referred to in the next section.
The eyes ears and nose present no very distinctive symptoms, but share in some of the pains found in other parts of the body. Epistaxis of dark fluid blood should be kept in mind, and a little bright blood is seen when blowing the nose.
The mouth is dry, with nasty taste as of rotten eggs, or it may be putrid and slimy; or bitter, especially on waking in the morning. The breath may be foetid.
Burning and scraping in throat are produced, extending down the oesophagus.
Digestive Symptoms.-The chief effects have already been noted. Pressure in region of stomach, worse when lying and spasmodic pain deep in epigastrium, worse from eating; constipation with ineffectual urging; distention of abdomen with relief from emission of flatus (offensive or like rotten eggs); pain as if sore internally-when coughing, blowing nose or putting down the foot-these with general bruised feeling should be added to the symptoms already mentioned. The stools tend to be thin and watery, or with mucus or blood from piles, worse at night, with weakness after an action, necessitating the patient’s lying down.
Genito-urinary System.-Excess of triple phosphates in the urine has been developed by this drug, and incontinence of urine has occurred especially at night. Menorrhagia is perhaps a clinical symptom.
Respiratory System.-Stitches are common in the chest, especially the left side, worse on coughing or moving and relieved by pressure. The arnica cough seems to start from a tickling feeling in the lower part of the windpipe and is either a heavy cough shaking the whole body, or a dry, short cough, worse in the morning after rising. Breathing, movement and coughing aggravate the chest pains.
Circulatory System.-Apart from symptoms resembling those of strain or traumatism, that of feeble, irregular pulse, and pain in the region of the heart as if the part were squeezed (like that due to cactus and lilium) are the chief arnica effects.
Limbs and Back.-Stitches and bruised sensation are very conspicuous and definite in any and every part, strikingly resembling the effects of injury in some form. They are worse on motion, on first movement especially, on breathing (back and lower ribs), from jolting, towards evening (foot). The whole body aches, making the bed feel too hard.
Sleep.-Drowsiness with yawning (like nux mosch). and vivid, anxious, alarming dreams are noted; also dreams of graves and of being struck by lightning.
Febrile symptoms may be present in the shape of morning chilliness, especially on moving in bed; general shivering, while the head and face are hot and red and the rest of the body cool. Perspiration if present is liable to be sour and offensive and worse at night.
Traumatism.-It is surprising that a drug with such well authenticated powers should have been neglected outside homoeopathic circles. Before Hahnemann`s time it was known as a “vulnerary.” This is still perhaps its greatest sphere-certainly it is best known as such. The term is a wide one and in the case of arnica must be interpreted at its widest.
The drug is not only valuable for actual cuts or bruises to facilitate healing or remove pain or restlessness due thereto; strain of ligaments from overstretching of tissue (sprains of joints), overstretching or actual bruising of muscle tissue, and soreness, tenderness, pain, and even impaired function from over- use of muscles all come under its soothing and healing influence. Instances of such over-use are the effects of an unduly long walk, the strain of muscles involved in parturition, including actual bruises so induced, over-strain of the muscular tissue of the heart from hard running or boat-racing, and strain of the voice from speaking, especially out-of-doors, or from singing. In the last-named instances it is where the muscular vocal apparatus or the vocal cords themselves suffer that the drug is useful, rather than where catarrhal effects are prominent. Arnica is also of some value as a prophylactic to lessen the effects of traumatism or shock due to parturition or surgical procedures, and for such conditions as post operative retention of urine and the painful startings of a fractured limb. It will also aid in checking venous oozing from lacerations, operations, &c. Indeed, it appears to have some haemolytic power favouring ecchymosis or other haemorrhages. Consequently, such conditions would confirm the choice of arnica as a remedy whether they were due to traumatism, sepsis or a typhoid state.
With respect to this drug for traumatism Kent says that high potencies are better than low, and that external applications of the drug are not necessary.
For sprains involving ligaments and tendons, if arnica leaves any stiffness or weakness and if there is sensitiveness to damp, or the chief pain is on first moving, rhus tox. may be required, and later calcarea carb. If the bone and periosteum are the chief sufferers ruta comes first.
Another point of interest and importance is that arnica (especially if given in a high dilution) will often benefit conditions due to an injury inflicted long before.
Chronic pain, stiffness, “neuralgia,” tenderness due to old injury may require the drug.
The inquirer into homoeopathy should not suppose that it is claimed that arnica produces actual cuts, bruises, or lacerations, though equally unreasonable beliefs have been attributed to homoeopaths. How far the drug goes in altering the physical or chemical condition say of a muscle is not known; it is known that it produces sore, bruised feeling in provers- effects closely resembling those due to injury or over-use of muscular tissue; and it is known that its exhibition will relieve such a condition, whether due to traumatism or to other causes, if the similarity between the drug effects and the patient`s condition is sufficiently close.
Dermatitis such as arnica has been shown to produce (p.188), when it is due to other causes should be treated by arnica. It may resemble acute eczema or erysipelas, with (or even without) bulbae. Crops of pustules or boils–especially if slow in maturing–may also call for it.
Mental Symptoms and States.-The mental symptoms induced in provers have been mentioned on p. 191; they are mild symptoms such as may be associated with any traumatic, rheumatic, intestinal or other conditions. THey may be found quite early, as in cases which develop into serious maladies.
Kent (loc. cit) gives a long and graphic description of the mental state indicating arnica in such conditions, and we would refer readers to that account for further details, and in meantime we give a statement more or less embodying his teaching.
It is possible to classify the different mental symptoms somewhat as follows:-
(1) When the Patient is quite Conscious.-(a) He objects to being approached lest he be hurt-he is very sensitive to pain; (b) he objects to being approached lest he should have the effort (he is weary) and the bother of talking. Thus (in the language of provers) “he wants to be alone” for a double reason; this makes him morose and irritable. Another mental state in this category is grave fear; of serious illness, as present or impending, e.g., of heart disease.
(2) When the patient is Semi-conscious or between Waking and Sleeping.-In this state there may be night terrors-waking up with a feeling of horror, apparently of cardiac origin. The patient is convinced he is about to die suddenly. This may be repeated during the same night or in successive nights. Such cases have happened soon after some shock, such as a railway accident, when the victim in imagination again goes through the real horrors he felt or saw (cf. opium).
(3) When the Condition of Stupor is Approaching.-The patient may be sufficiently conscious to wish to explain himself, but be unable to find words to express his meaning and giving up the effort lapses into somnolence. Or he may be able to speak and misjudges his state of illness, under-estimating its gravity instead of exaggerating it, and resents the presence of doctors or solicitous friends-another phase of “wants to be alone.”
As the malady advances more the patient begins to answer a question correctly, he lapses in the middle of a sentence into muttering delirium or unconsciousness (baptisia).
When a patient has arrived at this mental state he is well on in a typhus-like (typhoid) state, whether it be actual typhus, enteric, malignant malaria, yellow fever, or sepsis (surgical, puerperal or other). The usual concomitants in the shape of muttering delirium, fever, rapid, weak pulse, dusky skin, possibly with ecchymoses, or congestive patches, dry tongue, sordes, &c., some or all of these will now be present.
Several remedies besides the one under consideration produce a disease-picture closely resembling this typhoid state-baptisia, arsenic, ailanthus, crotalus or lachesis, bryonia, rhus tox., muriatic acid, and carbo veg. The malady out of which the typhus- like state has sprung may be some guide. In typhus fever probably baptisia or arsenic will be called for; for septic pneumonia or endocarditis arsenic or one of the serpent poisons. Nash (loc. cit.) regards loss of control of the sphincters and petechiae as specially indicating arnica, and lays stress also on the symptom “everything on which the patient lies seems too hard”-in other words the sensitive, bruised feeling is very marked. This symptom, however, is indicative of several other drugs also, and is only of value during the stage of illness when the patient is more or less conscious. Its value again would be lessened if he were really on a hard or lumpy bed! Another symptom, though not found exclusively in the arnica pathogenesis, is of diagnostic importance-“dark-red, hot face and head, while the rest of the body is cool or cold”; and the occurrence of crops of “blind” boils would be confirmatory, as would other cutaneous conditions such as are described on pp. 188-189.
A careful study of the materia medica is advised in a case showing typhus-like symptoms. Some well-marked extraneous symptoms may decide the choice of remedy.
It is of interest to know that arnica has actually been found useful in Western America for malignant malarial conditions, and kent regards it and lachesis as superior to quinine. He extends his recommendation of arnica to zymotic diseases, e.g., scarlet fever where the rash does not come out well and the spots are of a dusky hue-a condition we call malignant scarlet fever.
The pathogenesis also suggests a resemblance to some of the features of yellow fever, but we are unaware whether arnica has been so used. In most cases a more markedly haemolytic drug would be required.
Dreams.-Closely akin to mental symptoms are dreams, and some of those of arnica have been referred to already (pp.192 and 195). Other kinds of dreams indicating it are “recurrence of the same kind of dream,” and waking up suddenly, screaming with fright,” also “dreams of being reproached for immoral conduct.”
Digestive System.-The provings and poisonings have led to the use of arnica in dysentery, but there are other drugs which are more suited to the acute stage of either variety. When in advanced cases the patient has lost control of sphincters and is getting drowsy or delirious, arnica should come in for consideration. The arnica patient dislikes both meat and milk, and vomiting of dark uncoagulated blood may be present. The breath and stools are of a putrid offensive odour; tenderness, tympanites and distension will confirm the choice.
Atonic dyspepsia with eructations tasting of rotten eggs, voracious appetite, and undigested food in the stools, which are very foetid and dark, if found in a patient with the milder arnica mentality, would require this remedy.
The use of arnica in parturition has been referred to and its success for “after-pains” has led to its being given by routine after labour, where the labour has been long or in older woman in their first pregnancy. Where the tissues are rigid, arnica should be given before and after delivery. It will ease the pains, induce restfulness, relieve retention of urine if present and, if given early, will assist in preventing puerperal sepsis. It is very useful where the movements of the child in utero are felt excessively.
Respiratory System.-Chest pains, either sharp stitches or dull aching like a bruise or like rheumatism, traumatic or otherwise, are benefited by arnica, especially if worse from motion or form coughing; their presence on the left side would support the choice of the remedy.
A dry cough, worse in the morning, from tickling beneath the sternum and shaking the whole body suggests arnica, and the remedy has been praised for whooping-cough where each paroxysm is preceded by anticipatory crying (in children). The sensitiveness to touch may be present in these case. Pleurodynia or even pleurisy with arnica generalities will be helped or cured by it, possibly also a certain stage in septic pneumonia with low muttering delirium.
Skin-The pronounced irritant effects of arnica on the skin have led to its use in erysipelas and acute eczema; and it has always been a favourite remedy for crops of small boils, especially where they are very painful but do not mature well. In anomalous skin irritations, combining different kinds of rash in the same (acute) case, often called gouty, arnica is invaluable, and also for an irritable rash of small vesicles or pustules on an inflamed base,. situated on the nape and in adjacent hairy scalp. For gouty pain in joints with inflamed skin and sensitiveness extending to a distance, where the patient is very nervous of being approached, arnica should be given.
Nervous System.-Arnica does not correspond to any definite nervous disease, but it has been used with success for pain in the spinal column, with tenderness, especially in the cervical region or between the scapulae, and “stitches” in dorsal region extending to the right axilla, and worse on movement. It has been given after cerebral haemorrhage to expedite absorption and limit extension of resulting paralysis, and is said to be more useful in left-sided cases.
Fever.-Its use in malarial fever has been mentioned. If there is chilliness and shivering with a dusky, red, hot face and head, the rest of the body cool, the chilliness being worse on the slightest uncovering (as by moving in bed), coupled with a general bruised feeling and some offensive sweat, worse at night, arnica may be given with some confidence of benefit. It is not indicated in typically regular types of intermittent fever,but may become valuable again in the typhoid states already dwelt upon as developing in malignant malaria.
Eyes.-Blurred vision, after injuries or due to over-strain of accommodation, and not due to errors of refraction, indicates arnica. Retinal and subconjunctival haemorrhages may require it.
(1) Results of almost any form of injury to almost any tissue or organ.
(2) A sore, bruised sensation in any part of or all over the body in many diseases, traumatic or spontaneous, preventing lying still in bed.
(3) Sharp superficial shooting pains, “stitches” in any part of body or limbs.
(4) General sensitiveness of parts and of nervous system, fear of being touched or approached.
(5) Heat of head and dusky face with coolness of body.
(6) General weakness, going on to prostration.
(7) Tendency to stupor with loss of sphincter control in typhoid states.
(8) Oozing of thin dark blood from capillaries, after injuries; or from mucous surfaces in low states of system; after parturition, &c.
(9) Crops of boils and dermatitis.
(10) Promotes absorption of recent inflammatory effusions and extravasations of blood.
The modalities of arnica are not very strongly marked.
The left side has symptoms in temple, chest and false ribs, fingers, half the pubic eminence, hip, tibia, outer side of foot, little toe, &c.
The right side has symptoms in half the head, in brow, cheek, back, wrist, hand, thumb, calf, outer malleolus.
In the morning .-There are headaches on waking and later when out walking, pain in the spine on rising, chilliness; dry cough.
In the evening.-Yawning and rheumatic pains are produced.
At Night.- There are headaches like a nail boring into the head; diarrhoea; involuntary stool and urination (while asleep or unconscious).
Walking going upstairs (headache); movement (vertigo, soreness of eyelids, stitches in chest); spinal pain (on rising or bending head), wrist pain, various pains are worse from inspiration.
Movement (sore feeling from lying on one part, but the relief is only temporary)
There is not general heat modality, but radiant heat aggravates headache and hot applications do not relieved abdominal pain.