Tincture from the root of Bryonia alba and Bryonia dioica (the red bryony). N.O. Cucurbitaceae.
IN large doses bryonia is a drastic purgative but is is not used in medicine for this purpose.
It possesses very extensive pathogenetic powers irritating or inflaming many organs and tissues mucous membranes of the alimentary canal and respiratory system, the liver and lungs, serous and synovial membranes the internal ear and certain glands. A febrile condition is also produced by the drug.
(1) MUSCULAR AND FIBROUS TISSUES.- Pains described as “like rheumatism, ” soreness of the bellies of muscles, tenderness around joints shooting, aching and tearing pains in almost any part of the body are induced by bryonia. They have the distinguishing feature of being worse from any movement. The joint condition closely counterfeits acute rheumatism pain, swelling even redness being caused, and the correlated symptoms of tenderness when pressed or touched is noted in the finger- joints, &c there is a tendency for the right side to be more affected than the left. In the upper limb it is conspicuously so. Numbness and tingling (“as if gone to sleep”) suggest involvement of nerve sheaths. Another modality is increase of pain in a hot room, or when the patient becomes overheated. This modality is a general one with local exceptions, as will be seen later on.
The conspicuous bryonia pains are felt in the lower limbs as in the upper, but in the former one or two features come out more strongly.
(a) That of weakness or staggering unsteady gait, due doubtless to the legs having to support the weight of the body, and it is felt both on going up and down stairs. In one instance, however, the weakness was distinctly less when going downstairs. In several instances the pains were felt when sitting or lying, which may appear inconsistent with the strong bryonia characteristic of relief from rest. Hahnemann draws attention to these as alternating symptoms. Another possible explanation of the apparent inconsistency is that the symptoms which are distinctly worse on movement are muscular, and those more noticeable when at rest due to involvement of the fibrous tissues. (b) A second feature very prominent in the lower extremities is the aggravation from (or sensitiveness to) touch or pressure in any form, ex.gr., in the sole or heel when treading, or in the abdomen.
External chest and Back.- pains of a similar character occurring in the muscles of chest back and head call for no special notice notice. Like the limbs the right side is chiefly affected. Inspiration naturally aggravates the pains, being a muscular effort; the same sensitiveness to touch is noticed; and the same exceptional feature of relief from moving; stooping aggravates. The verbal description does not always enable the reader to distinguish between muscular and pleural pains.
pain in the nape is frequent, at the point of muscular insertions into the occipital bone. Chest pain on turning, in the side on which the patient is not lying is a not worthy symptom.
It should be pointed out here that though parts are sensitive to touch and pressure, pressure which sets inflamed or painful region at rest give relief whether in the chest or elsewhere.
(2) ALIMENTARY CANAL.- The digestive system symptoms produced by bryonia, experienced by many provers, are too numerous to record in detail here Reference may be made to the various records, such as the Materia medica Pura, Allen’s Encyclopaedia, Hughes’ Cyclopaedia, Clarke’s Dictionary, or Cowperthwaite. For our purposes a summary must suffice one encumbering the description with too much detail and repetition.
Pathologically different degrees of irritation, going on in certain parts to ulceration, form the chief lesions, and dryness one of the outstanding symptomatic features.
Lips.- Burning of the lower lip and tender cracks and small vesicles are common; also, near the angle of the mouth, spots which bleed.
Teeth.- Bryonia causes pain in the teeth in various sites especially the left upper molars. They re liable to be induced by hot or cold air or substances taken into the mouth and are relieved by lying on t painful side, which (in such a case) is equivalent to saying are relieved by external warmth. some of the pains in this region (? neuralgic) are relieved by “chewing .” The teeth may feel long or loose and the gums may become spongy.
Mouth and Throat.- The palate feels dry the mouth sour or dry and sticky so that the tongue sticks to the palate. Small painful blisters or pimples or aphthae form on the tongue. The latter is coated with a very white fur. There is thirst without fever, especially in the morning. The taste may be insipid, bitter or putrid, worse in the morning and relieved by eating.
Gastric and Abdominal Symptoms.- The pains are various and are described as griping shooting, tearing crampy or colicky; they occur at any time of day or night and are notably brought on by on by or aggravated soon after, food.
A much quoted symptom is pain as of a stone (or weight) in the epigastrium, causing irritability (nux, puls.), or sensation of something heavy lying in the abdomen soon after food.
Tenderness and soreness from pressure or on coughing or breathing, are contrasted with the more crampy (colicky) pain (which is relieved by walking and by drawing up the legs). It is also relieved by hot applications and by passing flatus. Abdominal distension and rumbling or gurgling are liable to come on after every meal. “Voracious hunger without appetite” seems to or there may be large appetite. Aversion from milk though if taken it is appreciated and agrees, is a peculiar symptoms; and desire for wine or coffee may be present.
The eructations of bryonia are tasteless acid or markedly bitter-soon after food.
All forms of movement are liable to aggravate the abdominal tenderness, viz.,moving the body walking, breathing deeply, coughing, &c; pressure similarly aggravates. This form of pain is liable to be associated with irritation of some of the viscera, especially with irritation or defiant inflammation of their peritoneal covering.
Stool.- The characteristic stool of bryonia is hard, large and dry, giving pain during expulsion. Diarrhoea may come on in hot weather or after getting overheated, usually in the morning.
Liver.- Prominent among the effects is sharp severe pain in the hepatic region, worse on pressure, on coughing and breathing. With this there may be a pale, sickly or yellow complexion. At other times a red, hot or puffy spot appears over the malar bone. In animals poisoned the liver was always found engorged and sometimes friable.
(3) RESPIRATORY SYSTEM.- Beginning with the ocular mucous membrane there is a certain amount of conjunctivitis, which is worse from warmth; some photophobia, together with lachrymation, is also present. The accompanying heat and feeling of dust in the eye are worse on moving the eyeball. Next there is inflammation of the nostrils, and there may be frequent bleeding of the nose in the morning in association with suppressed menstruation. A dry cough is resent, apparently arising from tickling in the throat or epigastrium; the cough causes sharp pain in the sides of the chest soreness in the windpipe and a bursting headache. It is worse on coming into a warm room, which gives a suffocating feeling as from an irritating vapour, and is worse after eating and drinking. After coughing some phlegm may be raised, and the expectoration may be blood-stained or brown in colour.
In some cases of shortness of breath, and quick breathing with severe stitches in the chest pressure with the hand or by lying on the painful side gives relief. Palpitation, with a hard, full, rapid pulse, goes with the last named group of symptoms.
Such experiments as have been made show the respiratory mucous membranes to be “extremely injected,” in some animals evidence of hepatization or of oedema of lungs is found, corresponding symptoms having been shown during life. In one case of chronic poisoning in an old woman and one experiment on a rabbit a false membrane was produced, long strips being expectorated by the woman and peeling off the throat in the case of the rabbit. though it had remained apparently in vigorous health it dies suddenly from suffocation. A membrane was found lining the larynx, trachea and bronchi to the third ramifications. some membrane was also present in the mouth. Death apparently resulted from a piece of detached membrane acting as a valve.
Irritation of pleura was also noted in a rabbit. From poisoning by eating bryony berries (B. dioica) a child of three became giddy, delirious and comatose. Excessive vomiting preceded the coma; she died in less than twelve hours. Symptoms such as convulsions, delirium lividity cold perspiration only occur in acute cases with vomiting and sometimes diarrhoea, due to the irritant acrid property of the bryonia. serious and synovial Membranes.- On post mortem examination the pleura (as just stated), the arachnoid and the pericardium have been found reddened. Fluid has been found in the pleural cavity. The pain tenderness and swelling of the joints, especially of the small joints, point to synovitis.
Ears.- Stitches in the meatus affected by change of temperature a blocked sensation tenderness of cartilage of ear, cracking noises at every step and in cold air, roaring singing and other noises in head and intolerance of noise are the chief aural effects.
Vertigo occurs in the same provings as these ear symptoms, but not necessarily in closer connection with one another than with other symptoms. They are recorded at this point, however, for clinical reasons.
The giddiness is worse on rising from sitting or lying -even on raising the head with faintness on suddenly rising. The patient feels as if falling backwards or as if moving in a circle, or as though the object were reeling around him.
Glands.- The parotid glands share the effects of bryonia, becoming painful and tender and the breasts are still more markedly involved they may become tender, swollen and red, threatening abscess; the pain is worse on movement and deep breathing. The flow of milk may become diminished or suppressed.
The kidneys only appear top feel the effects of bryonia secondarily to febrile and other affections due to the drug.
Skin.- The same is to some extent true of the skin its yellow colour is probably of hepatic origin. Perspiration is easily excited by exertion, even in cold air; it may have a sour, oily odour; the contiguous folds of skin perspire and become irritated.
Fever without local inflammations may occur, beginning with chilliness of extremities, great thirst (lasting through all the stages of the attack) followed by dry, burning heat in face and generally, and towards morning,
The patients is drowsy, looks heavy, with dusky, “besotted” face, and objects to talking or being roused. In a few cases a persistent “lateral motion of the lower jaw” is noted as a characteristic-it is not chewing (Kent).
Sleep.-The bryonia patient tends to be restless and wakeful or wide-awake before midnight and (perhaps as a consequence) drowsy and yawning all day. His dreams are chiefly about his daily business or about domestic affairs.
BRYONIA has a very wide clinical sphere and its used have been fairly outlined in the foregoing statement of its pathogenic powers. Reference based thereon will now be made to its employment in various named diseases or diseased conditions following the order already adopted.
(1) MUSCULAR AND FIBROUS TISSUES.-In the first place are general pains commonly described as rheumatic or gouty. even acute rheumatism is well within the sphere of influence of bryonia, and this condition is not only paralleled by the drug in its local features, it has the bryonia modalities concerning movement and heat in a most pronounced degree. These modalities will be referred to later. The fibro-muscular pains in chest, neck, and back have the same modalities and a similar origin; it may be a chill after being over heated, it may be an outbreak of acute symptoms on a chronic “rheumatic” or gouty condition, due perhaps to a gastro-intestinal disturbance or to influenza, or it may be due to an injury or overstrain.
The right side is more conspicuously affected than the left. When the lower extremities are involved weakness and unsteadiness are added to the pains. When the fibrous tissues are more involved than the muscular, going downstairs may be more trying than going up (as in rhus cases); when inflammation in the joints calls for bryonia, going up is more difficult.
Any of these symptoms may come on when the weather suddenly changes to hot after a spell of cold. After “taking cold” the symptoms take some hours to develop.
(2) THE DIGESTIVE SYSTEM.-Bryonia is useful in “dyspepsia,” due to gastric catarrh : in congestion of the liver and hepatitis, in gastralgia, in gastro-enteritis and diarrhoea, even with dysenteric symptoms, and in constipation. Heartburn, nausea, vomiting, eructations or hiccough are common bryonia symptoms. The stomachic discomfort is compared to a weight or a lump or stone in the epigastric region. Nux vomica and pulsatilla both have a similar symptom. A bad taste in the mouth is another symptom common to the three remedies. In bryonia cases the taste is mostly flat and insipid or sour; or it may be perverted and things taste different from their real flavour; with these again thirst for large quantities which give relief is experienced. In pulsatilla cases the disposition is less irritable, though the patient is sensitive to pain even if it may not be severe, and thirst is not conspicuous, even if there be a rise of temperature. Nux vomica and bryonia patients are worse in the mornings (though sometimes at 9 p.m. aggravation is found in a bryonia case) and pulsatilla cases are worse in the evenings. The state of the bowels also will often help in choosing between these there allied medicines.
Gastro-intestinal conditions brought on by eating oysters, vegetable salads dressed with vinegar, sour, unripe fruits, new bread, coffee, and by a chill after amenable to bryonia. The likes and dislikes as regards diet must receive attention as indications for the remedy; in such cases they are perverted in the sense that the patient is liable to crave for things which disagree and which he knows disagree and still craves, ex. gr., he may desire cold drinks, while warm fluids relieve and cold ones aggravate; or he craves acids which disagree. His desires are liable to change suddenly, and he may refuse things he thought he fancied.
In general, want of appetite and aggravation of symptoms from eating at all, from greasy dishes and rich foods, are bryonia characteristics, any of which may influence its choice.
When a gastro-duodenal catarrh extends up the common bile- duct, as after a so-called “bilious attack,” blocking the duct and causing temporary jaundice, with its usual accompaniments, no remedy is more useful than bryonia.
The liver may be more definitely involved by infection from the gall-bladder-cholecystitis and mild cholangitis with hepatic enlargement and tenderness, jaundice, pyrexia, headaches, sweats an delirium; all these conditions call for bryonia.
In this connection the constipation and diarrhoea caused by the drug should be mentioned. The usual habit of a bryonia patient is that of constipation with large, dry, hard stools, tending to be pale in colour, requiring an effort at expulsion, for which there is little spontaneous desire, and causing some degree of pain in passing, on account of hardness and size. If mucus is present it is passed separately after the solid evacuation.
The diarrhoea is only an occasional feature in bryonia cases (while the constipation is habitual); it is brought on by some irritant or by a chill; is liable to be urgent, especially in the morning; it may be a large, exhausting, loose stool, possibly with bile, mucus or even blood. In the latter event there may be colicky pain and straining, or the stool may be soft, unformed and very offensive; or with undigested portions of food. Here again the modalities must be carefully considered in choosing the remedy.
Headache.-Headache is present in so many bryonia patients that it deserves a special paragraph to describe its varieties and modalities.
(a) An intense headache with sharp, shooting pain, extending to the eyes, which are tender on moving them, is common with indigestion or hepatic cases. The scalp is tender to touch, to brushing the hair or pulling it; is greasy and has sour sweat during sleep. The pain is worse in a hot room and from movement, but is relieved by support or uniform tight bandaging and by cold bathing.
(b) a neuralgic headache, often unilateral, affecting chiefly the left side, is another variety. The pain is superficial, runs in lines, possibly following nerve distribution, and is relieved by warm applications.
(c) a dull, throbbing headache, more or less general, increasing to a bursting feeling, as if the head would burst- especially frontal, the whole head feels hot, the face is flushed and heavy, the patient is drowsy and resents disturbance. This variety is commoner at the onset of a febrile illness.
Any of the varieties is worse from stooping, movement aggravates the first and third kinds, and so does heat.
(3) RESPIRATORY SYSTEM.- The area affected by bryonia has been dealt with under the section of Pathogenesis. Therapeutically it is useful in the results of a common cold “travelling down” into the trachea and bronchi. The raw, tearing pain in the windpipe, felt on coughing, when it may amount to severe pain reflexly bringing tears to the eyes, which is experienced in some of these chest colds, is an indication for bryonia, which quickly brings relief.
Muscular pains in the chest wall-pleurodynia-are removed by the drug, whether they are part of a “cold on the chest” or occurring independently.
True pleurisy also finds its appropriate remedy in bryonia, both in the early stage, when the shallow breathing and sharp pains relieved by lying on the affected side are conspicuous, or later, when effusion (serous) has taken place. It is not likely to be a chief remedy in empyema unless the characteristic modalities of the drug are present. Bryonia is a sheet anchor in lobar pneumonia, especially for the typical pneumococcal variety. The power of the drug to inflame lung tissue is clearly manifest in the poisonings. Its irritating effects on the liver, serous membranes and synovial membranes have been utilized in the therapeutics of the liver, of pleurisy, and of peritonitis its symptomatology justifies the use of bryonia, as do the clinical results. Here, as would be expected, aggravation from pressure is conspicuous. It has also been a prominent drug in the medicinal treatment of appendicitis where operation did not seem called for or where it was not easy to obtain.
For so-called “simple” pericarditis it has been used with advantage, but the records of its use in septic peri-and endo- carditis are not encouraging.
Fevers.-Bryonia has a well-earned reputation in some of the exanthemata, where the rash fails to appear at its normal date or in its normal colour or intensity, and where the patient is at the same time more ill than normal, with a tendency to wandering or mild delirium, weak, irregular pulse and high temperature.
A similar condition may occur as the result of the sudden suppression of secretions or excretions-milk, perspiration, lochia, gonorrhoea, &c. Bryonia should be studied and if its symptomatology corresponds with that of the patient it may be relied on to do good, probably by bringing out the rash or restoring the discharge. In relapsing fever – “famine fever” of true spirochaetal origin – bryonia holds its own and a little more. Before the spirochaetal cause of this condition was know, it was used with success in epidemics an Germany and in Ireland, and in recent years in India. Whether it can complete with antimony used intravenously we have no statistics to prove. It does not appear to cut short the fever so rapidly. We look forward injections are not available. The early delirium of bryonia fever patients is more marked from 9 p.m. It is liable to dwell on the business of the day, or the patient may misjudge his surroundings and asks “to be taken home.”
The ear affections amenable to bryonia are chiefly of middle-ear origin, consisting of sharp pains; and of internal ear sources in the shape of aural vertigo. The characteristics of bryonia giddiness will be found on p. 260.
Glands.-Pains in the breast prior to or during menstruation find a remedy in bryonia, and if the “pictures” correspond (drug and disease) the associated menstrual pains will be relieve as well as the mammary pains.
In the early stage of acute mastitis, where the breast is very hard and tender, this remedy must be thought of.
Excessive [perspirations with the characters already mentioned call for bryonia. They may form part of the acute rheumatism complex. Ailments traceable to sudden arrest of perspiration (by cold, excitement, anger, &c.) may also be amenable to out drug.
Menstrual and uterine disorders in the shape of dysmenia in rheumatic subjects, suppressed menstruation,inducing vicarious epistaxis or other discharges, or acute ovarian pain or ovaritis (especially right-sided), may require bryonia in their treatment. The abdomen in dysmenia requiring it, is likely to be distended and sore, and sensitive generally to touch and is easier from lying on the back with the knees drawn up. The flow is free, early and dark in colour.
“GENERAL” SYMPTOMS.-Polychrest remedies like bryonia remedies like bryonia require especial care in the study of their “general” symptoms.
Mind.-The leading feature is irritability, amounting to anger, at any small opposing or disturbing circumstance. The tendency to heaviness, confusion, inability to concentrate and undertake work, physical or mental, is not a chronic condition, or is a warning of some impending illness; it is temporary. But the temperamental state which is easily upset in some form by controversy, disappointment or anger is a constitutional individuality, and is one of the indications for bryonia; it is permanent.
Movement and Rest.-This may be regarded as the leading modality of bryonia, if rightly understood; it bears upon most of the symptoms of a patient who requires it. It is expressed a
FROM MOVEMENT WITH CORRESPONDING RELIEF FROM COMPLETE REST”; “the longer he moves the more be suffers.” Some even of the mental irritability of a bryonia patient is due to annoyance at having to talk or make some kind of effort involving movement.
It not only refers to easily understood symptoms like muscle or joint-pains and maladies, but to cough, nausea, movements of eyeball, &c. When the movement is of a jarring nature, like a false step or a stumble against a stone, it is especially emphatic (berb., bary. carb. and bell., rhus0. There are, however, some bryonia symptoms which qualify the rigidity of the rule. In the Materia Medica Pura, pains and cramps (hips, &c.) are recorded as being better when walking, or as present when sitting or lying. Again, shooting pain in the wrists when at rest, but not going off on movement. This symptom (apparently Hahnemann’s own) illustrates the importance of accuracy in observation and care in application, for it also states that the pain comes “when the hand becomes warm,” the temperature modality (see later) thus over-riding, as it were, the strong movement modality.
Pressure and Touch.-Some contradiction appears to exist in the interpretation of his condition. Some authors describe “relief from pressure” with exceptions in favour of acute abdominal conditions, whole others give “aggravation from touch and pressure.”
The explanation seems simple: inflamed or damaged parts are sensitive to touch or pressure-abdomen, breast, inflamed joints, &c.-“aggravation from pressure or touch.” Pressure, or perhaps more correctly, “support,” which puts parts at rest, gives relief. An instance of this is “lying on the painful side or part.”
Temperature.-The “general” attitude towards warmth of a bryonia patient is aggravation from warmth in the sense of a warm room, especially if close, from hot weather, particularly at the onset of it, getting overheated (open windows are desired). This refers to the patient’s feeling of discomfort, malaise or faint feeling, and to some local symptoms like cough, oppression of breathing. &c. On the other hand, many local conditions of bryonia patients are relieved by local applications of heat- abdomen, joints, pleurodynia or pleurisy. The “relief from warm drinks” is a local exception to the “general” state, while the simultaneous “desire for cold drinks” conforms to it. Kent says, “I sometimes wonder whether bryonia has a greater element of relief from heat or… relief from cold.” Discrimination therefore is necessary.
Time.-Some of the digestive disturbances, headaches, &c., of bryonia are subjects to morning aggravations. On the other hand the chill and fever are liable to evening exacerbation-about 9.p.m., lasting on with the pyrexia until the morning remission takes place. A general fatigued, bruised feeling may have the same time aggravation (9 p.m.)
Weather.-Warm or damp weather aggravates a bryonia patient – a “genera” symptom.
Eating and Foods.-Digestive symptoms are worse after food- nausea, eructations (bitter), gastric and abdominal pains (as of a “stone in the stomach”); appetite disappears on beginning to eat; excessive hunger but cannot take food when offered; distention after every meal.
Aversion from milk, but it is relished and digested when taken, is another modality.
Desires wine, coffee, sour salads, oysters, &c., which disagree, as do cold fluids after the patient has been overhead.
Cough, breathing, headache are all worse after eating even a little.
In fevers large quantities of cold water are desired to relieve that thirst-compare relief from warm drinks in dyspepsia.
(1) Pains in muscles, fibrous tissues, mucous, synovial and serous membranes.
(2) Inflammation of the above, e.g., rheumatism, acute or chronic, acute arthritis, pleurisy, pericarditis (rheumatic), pleurodynia.
(3) Respiratory diseases: “Cold on chest,” coughs, bronchitis, pneumonia (lobar).
(4) Digestive and liver disturbances.
(5) Dryness of mucous surfaces-lips to anus.
(6) Headache-throbbing or bursting (frontal).
(7) Free perspiration and profuse urination relieve.
(8) Thirst for large quantities.
(9) Fevers with gradual onset-tiredness, headache, apathy, chilliness, aching &c., with onset of tendency to wandering, &c., as in early typhoid.
(10) persons of dark hair and complexion, bilious tendency, firm, fleshy and or choleric, irritable temperament.
(11) “Vicarious” haemorrhages.
Movement – a general modality(see exceptions, p.267); warmth and warm and close rooms (general); eating (all digestive symptoms). Evening, 9 p.m. (chill, fever, delirium); pressure (inflamed tissues); suppressed rashes or discharges.
Rest (general); pressure (local-setting part at rest, headache); drinking large quantities (febrile states); warmth (exceptions in local inflammations and neuralgias); eructations (epigastric pain).