Lilium tigrinum. Tiger lily. N.O. Liliaceae.
THE pathogenesis and therapeutic properties of lilium will be considered together. This remedy is used only on homoeopathic principles, and not, even so, as extensively as its therapeutic powers would justify. If has been fairly well proved, an unusually large proportion of the provers being women. It is probably this which has led to its being considered a woman’s (or gynaecological) medicine and has therefore led to the undue limitation of its employment.
The early writers on the drug regarded the “uterine condition” as the centre from which the rest of the symptoms, subjective and objective, radiated. It is more likely that they own a common (undetermined) cause or causes. Kent (“Materia Medica,” p. 656)in his introductory generalization puts in first- he writes,”Lilium is especially suited to hysterical women who suffer from uterine…cardiac…and nervous manifestations,”thereby permitting the inference that the rest of the symptoms are subsidiary to , if not dependent upon, the female sexual disturbances. It would probably upon be more correct to put the “nervous manifestations” first in importance and the uterine last for the reasons that the mental temperamental states are those which furnish chief indications for lilium as a remedy, and given these indications it may be as useful in men as in women.
The subjects for whom it is chiefly useful are neurasthenics-in women about the menopause and in men at a later age. The nervo-mental equilibrium is unstable-possibly due to disturbed endocrine balance.
Such persons, men and women, are likely to be irritable-a term too wide to be very valuable in the diagnosis of the remedy. They are hypercritical, noticing the slightest departure from accuracy of statement or quotation, from correctness of deportment or from duty or what is expected of others; a strong effort is needed to repress caustic comment, undue blame, or “Snappy” retort. There is lack of control of words and thoughts and sometimes a distinct blunting of the mental powers. Such persons are the selves by no means free from mistakes in writing or in speaking or from lapses of memory, such as those for which they blame others memory, such as those for which they blame others. They are at times heavy and listless and liable to sit brooding over their past or over present difficulties, real or imaginary, which they feel themselves totally unable to face. They may be resentful, if not actually violent, if disturbed- disposed to curse or strike those offending in this way. This brooding may be of a melancholic nature, frequently religious in character, the patient entertaining fanciful or extreme notions, or despairing of final salvation, though having led an upright life. Not only are these patients annoyed or aggravated behaving their brooding disturbed (as already stated) but this is so much the case that attempts even at sympathy or consolation aggravate.
The patient may be one whose emotions are easily acted upon chiefly through some mental or moral impressions, and here the sexual element may come in- may obtrude- for such patient so not necessarily encourage sexual thoughts and feelings. The physical results of such emotion or excitement may be tremors, flushes. and in particular, palpitation or irregular cardiac action-beats being missed or imperceptible at the radial pulse, and followed by violent systoles to make up.
If a sexual factor is conspicuous it is usually00 that of excessive excitement and pre-occupations, chiefly in women. The reproductive organs in men though less frequently affected, do not altogether escape. In one case in a medical man, the proving brought on sexual excitement which has been dormant for many years. The excitement may lead to an orgasm, beyond the control of the sufferer in the daytime, or at night during sleep.
In men the lilium neurasthenia usually comes late in life, when the influence of the sex glands is waning. In women t is said that nymphomania of a lilium type may develop. In both sexes the lilium syndrome may follow excesses of one kind and another, either sexual or of a physical or mental kind die to worry, mental of a physical or mental kind, due to worry, mental strain, irregularity of hours and high pressure generally.
In women most of these mental symptoms are worse before or during the menstrual period or at the menopause.
Some cases of vaginismus occurring before the menopause are accompanied by sexual neurasthenia, due perhaps to the impossibility of normal intercourse furnishing an outlet for the nerve impulses which should culminate in the natural orgasm. Lilium will be useful in such cases, both for the vaginismus ( if still existing) and the neurasthenia if the rest of the symptoms indicate it.
The heavy, listless phase may alternate with or be replaced by over-activity, physical or mental, sometimes, t is said, encouraged with the object of repressing thoughts or banishing memories. It causes a feeling of hurry and pressure, but the patient may become unable to it and unable to concentrate, to follow a train of thought or to recall a name or idea-the effort must be abandoned.
Headache is not unnaturally associated with these symptoms, it may be a tearing frontal headache over the eyes, but is mainly occipital or extending from the nape to the vertex, a tingling feeling with giddiness. There may be a hot pain extending to the right malar bone. The headaches are worse about 5 a.m., and may be unilateral especially on the left side. It is sometimes “described” as “indescribable” (!)-a feeling of confusion as if the patient would “go crazy”. Indeed, fears are noticeable in the lilium case, of being alone, of losing her reason, of having a mortal disease or of some other calamity, or of being eternally lost. These fears or obsessions may be accompanied by severe depression and weeping or by indifference.
Next in indication value are some general symptoms: (a) Many symptoms (physical) are left-sided; (b) there is aversion from hot rooms, with benefit to mental and most bodily symptoms from a walk in the open air; (c) aggravation from crowded rooms, meetings, theatres or churches, especially in the case of headache and dyspnoea; (d)the pains occur in small spots and shift about (puls.); (e) the type of patient is plethoric, stout and nervous, especially women at the menopause or during pregnancy and the puerperium.
Circulatory System.-This sphere ranks next in importance. Palpitations form emotion has been noted. Flushes., tremors, pulsation (throbbing) all over the body (or any part of it); faint feeling; embarrassed, anxious feeling in the cardiac region with shortness of breath may be present. Or severe pain about the heart, as if it were grasped tightly or “in a vice”; or alternately grasped and realized. This pain may wake the patient suddenly at night, and is worse when lying down, bending forward or stooping. This would probably be accompanied by general cold sweat and rapid irregular pulse. In cases of angina pectoris and tachycardia lilium should be studied. A sensation of weight on the left side of the chest would assist in the choice of the remedy, particularly if aggravated by lying down especially on the right side. The local conditions-abdominal and pelvic-are likely to be accompanied by cardiac weakness and irritability such as have just been referred to. Some of the chest oppression and tightness may be a nervous sensation, relieved by deep breathing or sighing.
Digestive System.-The appetite is excessive, and the patient who requires lilium is likely to have a craving for meat. Thirst may form the first feature in one of the spells of depression and mental hebetude. Gastrointestinal cutting pains coming on in paroxysms, apparently due to flatulence and relieved by passing it, or much flatulent distension without the pain may occur. Burning in the rectum and smarting in the anus and up the rectum are associated with a bearing-down or straining feeling which is brought on or made worse by standing.
Constipation is the usual state of the bowels, in neurasthenics requiring lilium. Two other states, however, may occur, morning diarrhoea and dysentery. The former is characteristic of sulphur, aloes, lilium and rumex. It is a very urgent early morning diarrhoea, forcing the patient to hurry out of bed, when he has difficulty in restraining the action. The stool is dark, offensive or bilious and is preceded by griping and pressure in the rectum.
Headache may be present at the same time, with a hollow, empty sensation in the stomach and bowels, and burning of the hands and feet. If any cardiac crisis be present the hands and feet may be cold and clammy, but apart from such a crisis they are hot and burning at night, and the patient seeks a cool place in the bed for them, as if the case where sulphur is indicated.
The dysenteric condition is less common and less well known, but it is vouched for by Kent from repeated experiences. It is said to resemble that of merc. corr., with griping, violent straining, the passage of small amounts of mucus and blood and followed by burning in the rectum.
An evacuation is followed by little or no relief to the desire for stool. Such a dysenteric condition is said to be associated with uterine conditions and vesical symptoms which come naturally under consideration at this stage.
Genito-urinary Sphere.-There is frequent urging to urinate, day and night, not relieved by lying down, and followed by a sensation of oppression in the chest if the call is not responded to-this occurs in both sexes. Dysuria-burning and smarting-is often present, described as “like passing boiling oil”; or the pain may be chiefly after the flow of urine has ceased. The kidneys are not noticeably affected. The remedy has been recommended for mild cystitis.
The pelvic sexual organs in women have hitherto occupied the most prominent place in the pathogenesy and therapeutics of lilium. It is quite open to question whether they deserve it, and it seems probable that the symptoms have, at any rate, been misinterpreted.
“Bearing down,” the feeling that the pelvic and, in this case, the abdominal viscera would protrude at the vulva, is a marked symptom, and with it aching in the sacrum, up the back to the neck and through to the pubes may be present. It has been described (or interpreted) as a state of relaxation, a passive condition. In reality it is a forcing and it is not constant. Like the rectal tenesmus it is intermittent. The patient intermittently experiences the feeling that the abdominopelvic contents (“all her inside”) are being forcibly expelled right down to the vulval orifice, and that she must sit down and support herself with her hand or a bandage. It may not be relieved by lying down, as a passive prolapse would be. The feeling occurs with or quite independently of real prolapse or retropositions of the uterus, and with or without pelvic inflammation. One medical woman prover reported severe pain, interpreted as in her uterus, occurring in paroxysms of about an hour and passing off “without leaving any lameness.”
While the pain was present the prover could not bear to move or to be touched, or bear the weight of the bedclothes. the “anteversion” made so much of by old observers is the normal position of the uterus, so that the symptoms (quite real) were not due to mal-position of the uterus. The bearing down is not seldom associated with rectal tenesmus and is really a spasmodic (involuntary) muscular effort, described in one case as “like light labour pains.”
A sensation as of a foreign body in the rectum may be experienced, and if the fundus uteri retroposed and felt per rectum the sensation is put down to this.
the abdomen is distended, may be pendulous and there is a dragging feeling, relieved by support or by passing water. In addition to the bearing down, there are sharp pains, especially in the ovarian regions, or either side separately. The suprapubic region may be very sensitive to touch.
There is also a feeling of heat and fulness in the vagina with voluptuous itching, creating desire for intercourse and, if frequent, bringing sexual thoughts into undue prominence. Leucorrhoea, yellow or brownish and excoriating may be present or follow the irritation. A hyperaemic condition may accompany these symptoms, but in lilium cases they are more reflex and nervous than mechanical or inflammatory. Menstruation under lilium may be too early and accompanied by pain in the loins and small of back. The flow is usually dark, scanty, premature and offensive, and ceases on lying down.
The urinary symptoms are of the same type as the rectal, urging to micturate and to defecate, pyknuria, during the daytime, constant desire to pass urine with small result, burning in the urethra after.
These genito-urinary symptoms are mostly associated with palpitation, vertigo, pain about the heart, and are conspicuous about the menopause, but may occur during pregnancy or after parturition. In support of the view that they are not chiefly mechanical or inflammatory (though these states may co-exist) is the fact that the abdomino-pelvic bearing down, though worse at first on walking, returns more severely when the patient is at rest and compels walking again. Also it may alternate with the mental symptoms.
The sharp pains differentiate the case from a sepia condition. Most often they appear to be uterine and may be relieved by pressure of the hand on the hypogastrium. Sometimes the pains are located in the ovarian regions, if unilateral they are usually left-sided.
Ocular symptoms.-These symptoms have been utilized clinically in cases attributed to ciliary spasm or fatigue, aching pains from sewing or other close work, gradually increasing until the aching becomes constant. It is worse from light, especially if artificial, and is relieved by closing the eyes and gently pressing on the eyeballs. the lids look irritable and the edges are scurfy and they smart; lachrymation is inconvenient.
(1) Hurried feeling, to accomplish duties to which the patient feels totally unequal; aimless hurry.
(2) Irritability if disturbed; hypercriticalness.
(3) Loss of memory; errors in speaking.
(4) Religious melancholy; indifference; weeping.
(5) Fears: Of being alone, of losing his or her reason, of having a mortal disease or of some other calamity.
(6) Intense sexual excitement, amounting almost to nymphomania.
(7) Forcible “bearing down,” as if body contents would be forced through the vaginal orifice, not relieved by lying down; associated with rectal and vesical straining.
(8) Similar rectal and vesical tenesmus in men.
(9) Palpitation, irregularity of heart’s action, with missed beats; spasms of pain about heart, like angina, as if heart were grasped.
(10) Pains in small spots, moving from place to place; pains chiefly left-side.
(11) Vaginismus, prolapsus, ovaritis, tenesmus.
(12) Diarrhoea (early morning); dysentery; dysuria, burning on micturition.
(13) Asthenopia, ocular pain relieved by pressure and closing eyes; photophobia.
In a warm room (faintness), at night (chest); after 5 p.m.; motion, especially in the evening (neuralgic pain in the head); lying on right side (weight in left side of chest), moving, on rising (diarrhoea, sacral pain, bearing down), after eating (chest).
From fresh open air (headaches), sitting, or supporting vulva with hand (bearing down or prolapsus), lying left side, rubbing and pressure (angina).