Cocculus indicus. Indian coccle. Menispermum cocculus. N.O.Menispermaceae. A tincture is prepared from the powdered seeds, which contain a crystalline principle, picrotoxin, C15 H16 O6H201 which is a powerful poison.
COCCULUS owes most of its properties to the alkaloid picrotoxin, which resembles cicutoxin, and its physiological action has been considered under the article on Cicuta. Shortly stated, it may be said that picrotoxin acts pre-eminently on the motor nervous tract, and affects first the voluntary muscular system, producing tetanic contractions and paralysis, and then the sensorium, causing vertigo and confusion. Its action on the medulla oblongata gives rise, through the agency of the nervous system, to respiratory and circulatory disorders. A prover of picrotoxin experienced nausea, with tendency to faint, violent intestinal pain and purging, dysenteric diarrhoea and excessive secretion of urine, cramps and paralytic sensation, and there was a sensation in the bowels as if they would protrude at the left inguinal ring.
THE PROVERS OF COCCULUS INDICUS, and those intentionally or accidentally poisoned by eating the seeds, display the same general symptoms, which are all referable to the action of the drug on the cerebro-spinal nervous system.
Mind.-Cocculus causes stupefaction and cloudiness of mind, the patient is slow of comprehension and the mind works slowly, so that he is long in answering questions, forgets what he has just said, and an idea once in his mind cannot easily be shifted to give place to another train of thought, time seems to pass too quickly. All the symptoms of intoxication have been produced by the drug. Mania with irresistible desire to sing has been observed. Or the the patient is anxious, everything worries him, he expects speedy dissolution, is easily offended and very sensitive, so that he is started by slight noises or touch.
Vertigo is a very marked symptom and is usually associated with nausea, vomiting and faintness; it is worse from movement, and may be brought on merely by lifting the head from the pillow.
Head and Nervous System.- The head feels empty or hollow, or as if constricted by a ligature, or as though there is a board strapped across the forehead. it trembles from weakness of the neck. In bad cases of poisoning there is unconsciousness, and violent tonic and clonic convulsions occur which endanger the continuance of respiration and cause distortion and jerking of the limbs. Trismus occurs and tetanic stiffness of the whole body, which gives place to momentary jerks, and meanwhile the forehead and whole body are covered with a cold sweat. Pinching of any part will immediately cause convulsive jerks. In poisoning to a less degree the limbs feel stiff, as if paralysed, especially the lower limbs. Dragging, constricting and cramping pains occur in the arms and legs, the small of the back gives out, in the arms and legs, the small of the back gives out, in walking the knees give way, the thighs ache and soles of the feet “go to sleep.” The hands tremble when eating, worse the higher the arm is raised; they are numb and alternately hot and cold.
Digestion.- The stomach and abdominal symptoms are of cerebral or spinal origin. There is extreme aversion from food, especially from acids, and a desire for cold drinks and beer. Nausea is very pronounced and is accompanied by faintness and vertigo. It is aggravated by any movement, especially by riding in a waggon. Various cramping and griping pains are felt in the stomach. The abdomen is enormously distended with flatus, which causes violent colic, worse about midnight and from coughing, and produces a sensation as if an inguinal hernia were about to protrude. Passing flatus gives no relief. There is diarrhoea of soft, thin, putrid smelling stools, which are followed by painful and prolonged tenesmus. Large and frequent discharges of urine occur.
Sexual.- Abdominal colic and distension are worse during the menses, which come on too soon and were associated with great weakness, nausea, and often fainting. The menses may be suppressed and their place taken by leucorrhoea, and in this case also cramps in the chest, nausea and fainting are common.
Sleep.- The patient desires to sleep but is unable to do so, as on closing the eyes he starts up on account of a frightful sensation as from a hideous dream.
Respiration.- Breathing is quickened and laboured, and there is pressure on the chest, with a sensation of want of breath as from obstruction at the throat-pit.
Circulation.-The pulse is usually accelerated, full and strong, and the carotids pulsate strongly.
The face is earthy-looking and has a painful expression, or it may be hot and red. The eyes may be staring, the eyeballs turned upwards or rolling about, and the pupils dilated : this will be when there is unconsciousness or convulsions.
Alternations of heat and chilliness are felt. Sensations of emptiness and hollowness of internal organs are experienced.
Nervous System.- Cocculus is of proved value in both organic and functional diseases of the nervous system. It has been useful in paralysis from disease of the spinal cord, in cerebro-spinal meningitis, and has cured left-sided hemiplegia. It has also been used in epilepsy, but has not the reputation in this disease that cicuta has, and it is curious that although their alkaloids are so similar, cicuta has had a much larger therapeutic employment in convulsions and convulsive states than cocculus.
The greatest sphere of usefulness of cocculus is in hysterical spasms and in nervous affections arising from want of sleep. Great weakness, nausea or vomiting and a tendency to fainting or unconsciousness are usually present when this drug is indicated. It is a remedy for hysterical paralysis, for abdominal spasms and colic with depression of spirits in nervous women; for vomiting central, not gastric, origin, such as the vomiting of migraine and of sea-sickness, for which latter it is probably the best remedy in the pharmacopoeia. If given at the beginning of a train journey or sea voyage it will often ensure a comfortable passage.
In cases of spinal weakness which have been brought on by overwork or anxiety, especially if with these there has been loss of sleep, cocculus is very useful; there seems to be a complete loss of power in the lower extremities, with giving way at the knees and a sort of paralytic numbness in the hands and feet, and even weakness of the voice. Whether this condition is due to spinal anaemia, or to softening or sclerosis of the cord, cocculus will be indicated. It has proved of value in post- diphtherial paralysis and in chorea. It is a good remedy for nervous insomnia that has been brought on by night watching or other cause where the normal habit of sleep has been interrupted and a habit of sleeplessness contracted, and for the states of nervous weakness and exhaustion, even to melancholia or other disease brought on by the same cause.
Sexual.-Cocculus is valuable in many cases of dysmenorrhoea when there are severe abdominal cramps, nausea, vomiting and fainting; also for menstrual headache, with vertigo and vomiting.
(1) Vertigo, with nausea and faintness.
(2) Spasms and paralyses, organic and functional.
(3) Abdominal distension with flatulent colic.
(4) Cerebral vomiting; sea-and train-sickness; migraine.
(5) Dysmenorrhoea, associated with abdominal distension and colic, vertigo, nausea, vomiting and fainting.
(6) Hollow sensations in internal organs.
(7) Prostration, easy fainting.
(8) Effects of sleeplessness.
(9) Complaints occur usually in women.
From touch, pressure, jar, motion, travelling, evening and night (especially midnight to 2 a.m.), hot or cold air, eating and drinking cold things (tearing in limbs), open air, sun, warmth of bed, smoking.
From sitting still in a room.