Potassium carbonate. (K2CO3).
CARBONATE OF POTASH is not much used in ordinary practice, though it occasionally figures in prescriptions as an antacid, and was at one time used for whooping cough and (externally) for pruritus. It appears to have a direct depressant action on muscular tissue when administered intravenously, lessening the force of the heart’s action and ultimately arresting it in diastole. At first it stimulates metabolism by increasing the oxidation of proteids and fats. The excretion of urea is increased and that of ammonia lessened, but the total nitrogen excretion is increased.
It is interesting to note the difference between the orthodox and the homoeopathic schools in their estimation of the therapeutic value of the alkaline carbonates and bicarbonates. According to the orthodox school (vide Cushny, sub voce)they owe their pharmaco logical action entirely to the non-metallic ion, which is so much the more powerful that the metallic ion can be neglected. The active constituent is the hydroxyl (OH), of their alkaline action. In homoeopathic pharmacy, on the contrary, the hydroxyl is dissipated by successive dilutions of the metallic ion remains, so that the effects of the potentized metal are available for therapeutic purposes. This is why in homoeopathic practice only the dilutions, from 6c. upwards, of the alkaline salts of potassium, sodium and ammonium are commonly used.
Kali carbonicum, under which name this remedy is known in homoeopathic literature, has been proved by Hahnemann and some of his associates. It causes general weakness, anaemia and sensitiveness, and affects the respiratory organs, muscular tissue and, to a lesser extent, the digestive system. Dryness of mucous surfaces or a thick, sticky secretion is induced, e.g., in mouth, nose and larynx. The pains caused by kali carb. are sharp, sticking or shooting pains in various parts of the body, especially in the chest walls back and extremities. They rapidly change their site. They may be so severe and sudden as to make the patient cry out, and they are worse at night. In the last named (.e., the limbs) cramps occur, chiefly in the calves; or a feeling of heaviness and powerlessness may be experienced. Warmth relieves the pains, and they change their site to a cold area. The right side of the body is more affected than the left (scapula, calf, thigh, chest. &c.). Left-sided symptoms are often associated with cardiac lesions.
Kali carb. is a remedy of which the curative sphere can best be realized by studying the provings in extenso. It has not many focal lesions to its credit, but it is of great value in many anomalous chronic, and even deepseated disturbances of health such as are common enough in real life, but which are chiefly functional, and are difficult to place in any formal scheme of classification. Such cases to-day are put down to some form of toxaemia, the sources of infection being one or more of many. Some other conditions are as follows.-
Respiratory System.-Chronic nasal and post-nasal catarrh may require this remedy, if there is accumulation of secretion during the night, which dries and forms crusts which are hawked or coughed up in the morning. The detachment of these sometimes causes the discharge to be blood-stained. These chronic colds are liable to alternate with headaches, especially if the flow is stopped by cold winds, the arrest of the catarrh appearing to be the cause of the headache.
Conditions in which a moderate degree of hoarseness, and weakness of the voice amounting to aphonia are present may require this remedy. The cases will probably be associated with congestion of the fauces, nasopharynx and larynx, producing a peculiar kind of catarrh. The secretion may be described as adhesive and cohesive. The mucus adheres closely to the mucous membrane and requires violent and probably prolonged coughing to dislodge it. When at last it is loosened, being cohesive or solid it is liable to be projected to a distance from the mouth by the violence of the cough. It is not ropy, drawing into strings, like that produced by the bichromate (kali bich.). This description applies also to the mucous secretion of the trachea and upper bronchi. The cough, besides being forcible, is paroxysmal, dry and suffocative, and an important indication for kali carb. is the time modality, “cough worse from 3 to 4 a.m.”. Difficulty of breathing, apparently due to a spasmodic or asthmatic element, is another feature of cases requiring the remedy, and in most cases chest pains are associated. They are of the typical sharp, shooting character, worse on deep breathing and in even after lying down, on talking or lifting heavy articles; and one of their favourite sites is over the base of the right lung. The heavy coughing may produce a sore, bruised feeling in the chest walls.
Though there is no definite proof that kali carbonicum produces pneumonia, it has been given in the stage of hepatization, especially where sharp “sticking” pains, which catch the breath and suggest extension to the pleura, are present. The base of the right lung is the site of predilection for a kali carb. pneumonia. When the leading general indications are present kali carb. is of great use after pneumonia, where a lack of resistance exists and the lung breaks down and there are fever and emaciation, cough, and profuse, purulent, offensive expectoration, tasting of bad cheese. This may be associated with tubercle or with streptococcic infection. Cases of emphysema, bronchiectasis and pleural adhesions may have kali carb. features. If, after pneumonia, there be present over- sensitiveness to chills, changes, cold and damp air, and the patient be constantly getting ” a cold on the chest,” kali carb is one of the most likely remedies. Relief from the warmth of a fire or the sun would confirm the choice. In Hahnemann’s day it was much used, on his recommendation, in cases of phthisis pulmonalis.
Though not much used for whooping-cough in the present day, it should be kept in mind should kali carb. characteristics be present in a pertussis case. It is also useful to mention here a symptom much relied on as an indication for this remedy, because it was first brought forward as a “key-note” in connection with whooping-cough, viz., a puffy, baggy condition of the upper eyelid, described as being between the lid and the eyebrow-it is a kind of sagging-not oedema as in renal cases. It may occur in violent paroxysms of cough and then is possibly due to subcutaneous emphysema. However originating, it may serve as a reminder of kali carb. and should cause the prescriber to consider whether the rest of the patient’s condition corresponds with the rest of the pathogenesy of the drug. The rarity of the symptom would add to its value as a guide when it is present.
Circulatory System.-With the respiratory troubles heart symptoms may develop or they may cause the difficulty of breathing. The pulse is feeble and quickened, palpitation shaking the while body is brought on by the slightest effort, and systoles are missed or are too feeble to be felt at the wrists. Blood-pressure is lowered. Some of the kali carb. cases have fatty degeneration of the cardiac muscle. Cardiac dropsy, even amounting to anasarca, has been successfully treated by the remedy; there is cardiac dyspnoea, the patient cannot walk any distance nor can he lie down; he must be propped up to breathe comfortably or must sit leaning forwards. There is aggravation from lying on the left side and the asthmatic attacks are worse from 2 to 5 o’clock in the morning. Flushes of heat and throbbing in the vessels in any part of the body have led to its prescription for menopausic symptoms. The stitching pains in the chest have led to its use in pericarditis and endocarditis, but the heart symptoms of kali carb. subjects are mainly myopathic rather than valvular.
Neck, Back and Limbs.-Stiffness of the neck and lumbar muscles is present; the pains in the loins are sharp and lancinating (shooting) in character. Similar pains in the limbs occur and they may cause restlessness at night in bed. All these pains are worse from movement, from cold, damp air and in the early morning, and are relieved by the warmth of fire or sun. In place of the shooting pains there may be heaviness and a weak, powerless feeling, with numbness, especially in the arms. Cramps, too, are present in the thighs and calves, worse at night or in the early morning and when standing.
Pain from the hip to the knee, especially if on the right side and accompanied by a feeling of weakness as if the thigh would give out on walking, is characteristic of kali carb.
The relationship of kali carb. provings and of patients possibly requiring the remedy, to the movement modality, requires some consideration. It does not frankly conform either to the rhus or the bryonia type. Most of the symptoms are definitely worse during and after movement, especially (like rhus) on first movement. The aggravation extends beyond such efforts as walking, to semi-voluntary movements, such as respiration, coughs, &c. The pains may persist even during rest, and they may compel movement to relieve a long-held position, and may he more noticed at night or when otherwise at rest and unoccupied. In this sense there may be an element of aggravation during rest. That that main aggravation is from movement is shown by the following examples; (a) Headache is worse from walking, stooping, moving the head, jaws and eyes, or even from the movement of a carriage; (b) in the liver region there is pain on walking ; (c) in the chest there are pains on breathing, lifting and talking, and palpitation is worse from the least exertion; (d) the backache is worse from walking and from breathing (but it may persist during rest); (e) there are shooting pains in the right scapular region on breathing; (f) the feet are heavy and the toes painful on walking; (g) rheumatic pains in the back, chest, shoulders and arms, are worse during and after movement, and the pain of “spinal irritation” is relieved by lying; (h) weariness and faintness come on as soon as the patient moves; (i) even aggravation from eating may in part be attributed to the fatigue of the effort. Eating leads at once to drowsiness, it seems ” as though the mere effort of mastication an deglutition, and in the early secretion of the gastric juices put an extra strain on the system, which it resents” (C.E. Wheeler, loc. cit.).
Head.-One form of headache in kali carb. patients is felt mostly in the forehead and temple, chiefly on the right side. Vomiting may occur with it without any great nausea, but in some cases of vomiting of pregnancy, great nausea may accompany the headache and vomiting. A sensation of something (” in the brain”) being loose in the head and striking against the skull is described, and has been a useful guide to the remedy. A general headache may also be present extending into the eyes, brought on by walking in the open air. Other headache modalities have just been referred to. The scalp is dry and the hair falls out. Vertigo on turning the head is a frequent indication, and a tearing pain in the right orbit.
Sleep.-After about 1 a.m. up to 4 or 5 o’clock, sleep is broken; the patient is restless and has anxious dreams, and talks or starts in his sleep, Eating at once causes drowsiness.
Digestive System.-In digestive troubles requiring this remedy the patient generally has a slimy feeling and an unpleasant taste in his mouth, and the tip of the tongue may have sore pimples or papillae on it, and the complexion is pallid with a tinge sallowness. The gums recede and pyorrhoea may bring on caries, offensive breath, and toothache, worse from contact, especially of extremes of hot and cold substances. The parotids become inflamed and tender. Swallowing is difficult on account of a shooting or sticking pain in the pharynx and a feeling like a fish-bone in the throat; pain between the shoulder-blades is felt as the food travels down the oesophagus. Food easily passed into the larynx. The patient feels as if the stomach were swollen and heavy, burning acid “risings” occur. In spite of this there is longing for acids; as also for sugar; also there is often aversion from heat. The abdomen feels cold externally and internally, a not very common symptom, round also in the pathogenesy of thuja. The swollen or bursting feeling of the stomach and intestines occurs immediately after all kinds of food- the patients describe it as “everything turns to wind”. Fulness in the right hypochondrium and pain extending thence up the right side of the chest to the shoulder suggest the consideration of kali carb., especially when associated with bilious attacks and difficult breathing at or about 3 a.m. Recurring attacks of colic are often curable by kali carb. Given on the basis of all the patients symptoms (rather than for the attack only) and administered in the interval.
There is usually constipation in these patients, with large, but not necessarily hard stools, or the faeces may be small agglomerated lumps, like sheep;s dung; defecation is difficult on account of lack of expulsive power, and may be preceded for an hour or more by colicky pains. Diarrhoea may occasionally alternate with constipation, or chronic diarrhoea in patients with a preponderance of kali carb. symptoms may require the drug. Burning, shooting and itching at the anus may be present, with or without piles. When they are present they are often large and bleeding, or large, burning, inflamed and thrombosed.
Urinary System.-Renal symptoms are not usually found in these cases, but there may be nocturnal pyknuria, accompanied by delay in establishing the flow, the patient waits and strains before the urine will pass, as with some cases of enlarged prostate. The association of chronic cystitis would be further indication for this remedy. A scanty, thin gleet and pain during and after micturition indicate kali carb., in contrast to natrum muriaticum, the dysuria of which occurs only after the act is completed.
Sexual Organs.-The functions of the reproductive organs are affected in the direction of increased excitement in both sexes, but the sexual act is followed by abnormal depression and weakness, and by aggravation of all the patient’s general symptoms.
Menstruation is apt to be premature, prolonged, and or profuse, and the flow clotted; leucorrhoea is frequently present and is often acrid, and with it and during the period there is very severe backache, and bearing -down pain the abdomen and vagina. These are more indicative of the remedy than is the menorrhagia. The patient feels ill for a week before the period, and is liable to be constipated at this time, if not usually so.
Kali carb. has been advantageously used in mild puerperal fever cases, where the shooting pains (with appropriate modalities) and weakness are prominent. It is useful for subinvolution, and has gained a reputation in uterine myomata, in which it is said to check bleeding and reduce size. It may be counted upon where ineffectual labour pains are so severe as to be almost intolerable, the lumbo-sacral region and hips suffering chiefly; also for weak, anaemic conditions after haemorrhages, leucorrhoea and other losses; or after miscarriages. Vasomotor disturbances, such as flushings, palpitation, vascular throbbings in any part, occur in the pathogenesis of kali carb. and it is correspondingly useful in menopausic disturbances.
It is sometimes very valuable in the vomiting of pregnancy, but is should not be prescribed for the emesis only, but upon the totality of the patient’s (other) symptoms.
Mind.-The patient (often a woman) is fearful of some illness coming on, or of the issue of an existing malady, and for this or other reasons is particularly averse from being left alone. Kali carb. subjects of either sex are extraordinarily irritable and quarrelsome, and at the same time full of fears-vague fears of the future and of death. Any poignant emotion may induce nausea.
General Symptoms.-Clinical experience has shown that kali carb. is most useful in old people inclined to obesity, and who have dark hair and sallow complexions; its subjects are often anaemic, weak, with a feeling of powerlessness of certain groups of muscles. They are sensitive to cold air and wet weather, and to every atmospheric change; and they readily and constantly take cold from the slightest exposure. They are chilly, shivering people, and are weakest and most ill during the morning hours, and from the exercise of normal functions (ex. gr., sexual intercourse), from walking (Causing too easy sweating), &c. Cold sweats, especially nocturnal or after fatigue and hectic fever may be present. On the other hand, many of these patients are usually unable to perspire. Exaggerated reflexes: there is surface sensitiveness to a light touch (as with lachesis and china), and starting whenever touched, especially on the feet. The soles of the feet, the abdomen and elsewhere are abnormally ticklish. The limbs are painful in the parts rested against any object, and the tips of the toes are painful on walking and from the pressure of the boots (surface tenderness).
Noises and vibrations (ex. gr., slamming of a door), seem to cause sensations of pain and an indescribable “feeling of fear,” located in the epigastrium; this, though difficult to interpret, is an important indication for the remedy.
Kent, from his experience (Mat. Medorrhinum, p. 616) issues a warning against the prescription of kali carb. in advanced tuberculosis, chronic gout and “old cases of Bright’s disease,” lest serious aggravation should be produced. Finally, the symptoms and states calling for kali carb. are often insidious in their onset.
(1) Often suited for old, fat flabby subjects with dark hair.
(2) Great sensitiveness to cold air and wet, cold weather; constantly taking gold.
(3) Surface sensitiveness to a light touch; and sensitiveness to noises with vibration, causing a curious feeling in the epigastrium, composed of pain and fear; abnormal ticklishness.
(4) The nervo-muscular pains are characteristically sharp, sudden, darting pains; they may persist during rest, and are worse when lying on the affected side (bryonia pains are the reverse).
(5) Aversion to being left alone; lack of will power and of courage; irritability and quarrelsomeness.
(6) Weakness, when walking (feels must lie down); when eating; after menstruation and coition.
(7) Backache severe, making patient cry out; after illnesses, from walking, before and during menstruation, relieved by support; backache, sweat (from pain) and weakness are an indicative trio; lumbago and sciatica.
(8) Cough and asthma with aggravation, 1 to 5 am.; relief from sitting bent (asthma).
(9) Expectoration of tough masses, forcibly ejected after violent coughing; cough like whooping-cough.
(10) Menorrhagia (with backache).
Of symptoms between the hours of 1 and 5 a.m. (cough, dyspnoea, sleeplessness,,mental symptoms, &c.), lying on affected side, eating (toothache, flatulence), solitude, walking, after coition (weakness), before menstruation (backache), loss of fluids, rest (?), movement, cold winds, draughts.
Support (back); sitting bent forward (asthma); warmth of fire.