Strychnos nux vomica. Poison nut, Vomit nut. N.O. Loganiaceae. Tincture and trituration of the dried ripe seeds.
NUX VOMICA seeds contain strychnine and the nearly allied alkaloid brucine, the more active principle being strychnine, C21H22N2O2.
Strychnine has a powerful stimulant action on the central nervous system, especially on the spinal cord, throughout the whole vertebrate kingdom. In small doses strychnine improves the appetite, makes the patient feel stronger and more buoyant and renders the special senses more acute. In large doses the same effects are present but are overshadowed by more prominent symptoms. First, there is a feeling of stiffness in the muscles of the neck and face, then reflex action is so much increased that a slight touch or even a current of air evokes a sudden start or violent movement. The increased reflex movement is accompanied by restlessness; tremor or involuntary twitches are seen in the limbs and then a sudden convulsion occurs in which all the muscles of the body are involved, but in which the stronger muscles, the extensors, prevail. The head is drawn back and the trunk arched backwards (opisthotonos) and the facial muscles contract into a grin, the risus sardonicus. Contraction of the respiratory muscles fixes the chest, rendering breathing impossible, and the patient becomes cyanosed. At the beginning of the convulsion the muscles are tonically contracted, hard and firm, but soon tremor ensues and after a few intermittent contractions the convulsion is over and there is complete muscular relaxation. Immediately after a convulsion reflex irritability is low, but it soon becomes exaggerated again, till a second convulsion occurs exactly resembling the first. As a rule, after a few convulsions, death takes place from asphyxia due to respiration failing to be re-established when the spasm passes off. Sometimes reflex irritability and convulsions gradually diminish and the patient dies of asphyxia from gradual paralysis of respiration. The mind remains clear during both convulsion and interval. After very large doses no convulsions occur, but the patient dies almost immediately from asphyxia due to paralysis of the central nervous system.
The action of strychnine is principally on the spinal cord, and the convulsions are of purely spinal origin; the peripheral nerves and the muscles are unaffected. The portion of the reflex are affected appears to be the synapses of the neurons, intercalated between the posterior roots and the anterior cornua. The response to external stimuli is first a reflex action which, like the normal reflex action, is co-ordinated and purposive, though exaggerated, and varies in strength with the strength of the stimulus, but when the latter is responded to by a convulsion the normal co-ordinated movement gives place to a universal uncoordinated movement in which contraction is always maximal; a stronger stimulus produces no greater effect. The action of strychnine is to remove resistances to the passage of impulses through the spinal cord and thereby to extend the area over which an impulse acts, and at the same time to abolish co-ordination, for which the presence of resisting influences is necessary.
An exception to the greater sensitiveness of the special senses from small doses of strychnine being due to its action on the nervous system occurs in the case of sight, where probably the increase in the field of vision and increased sensitiveness to light are at all events partly attributable to its acting on the cells of the retina and not to cerebral changes.
Stimulation of the spinal cord by strychnine is followed by depression and paralysis. The medulla oblongata, including the respiratory center, is first slightly stimulated and then paralysed. The heart is not directly affected, but may be slightly slowed by stimulation of the inhibitory centre. During the convulsions the blood-pressure is greatly raised, but falls again afterwards.
Strychnine causes a flow of saliva and increased appetite. It is absorbed from the intestines and increases the movements of the bowel, perhaps from an action on the ganglionic pleura the bowel wall. It is absorbed rapidly, from 10 to 20 per cent. is excreted in the urine and the rest is oxidized in the liver. Only a very slight degree of tolerance is developed, however long may be the period during which it is administered. Cases of poisoning by the seeds or tincture of nux vomica display the same symptoms as those related above as produced by strychnine, but some of the autopsies showed, in addition congestion or inflammation of the mucous membrane of the stomach, duodenum and first part of the jejunum, the duodenum being the part most affected.
Of nux vomica show the early stage of its action on the nervous system, the stage of increased reflex excitability and of hypersensitiveness of the special senses. They also show the marked influence nux has on the digestive system, not so much from causing inflammation as from producing irregular and spasmodic action, an irregular, perverted peristalsis. This same character of irregular and spasmodic action is witnessed also in the genito-urinary and respiratory systems. Co-incidently with disorders of these functions are symptoms referable to the mind and head.
Digestion.-As the symptom of the digestive system are those which give to nux its most frequent application in therapeutics it will be well to commence with them. The mouth is dry, without much thirst, but saliva accumulates in the fauces and causes hawking and retching. The tongue is coated a thick white, and sometimes there are blisters on it. Small aphthous ulcers are frequent on the inside of the lips and cheeks, the gums are ulcerated and a decayed tooth, or a whole row of teeth, may have stinging pains in them, especially after eating, or on exposure to cold air, or from taking cold food. Food and drink taste natural but there is a foul, sour odour from the mouth, worse in the morning and after food. The throat feels raw as if scraped, there may be spasmodic, constrictive pain from the mouth to the stomach, and stitches run up into ears on swallowing. The patient is thirsty for milk, but has an aversion from meat, from his usual food and drink, tobacco coffee and water. There are bitter, sour eructations, or waterbrash, with heartburn. The patient is usually hungry, but has nausea, especially in the morning, after eating and drinking, and from smoking; it is frequently accompanied by retching and vomiting of the food last eaten, or of sour mucus, which sometimes is intermixed with blood. He may feel faint with nausea. The epigastrium is bloated and tender, a sensation of pressure, as of a stone in the stomach, comes on an hour or two after a meal, or there may be violent pain of a cramping character. There is tightness about the waist, and the patient wants to loosen his clothing. The stomach region is sensitive to pressure. Pains extend to the scapulae, up the chest, or drown the back to the anus, with urging to stool. The stomach pains are due to irregular peristalsis of the stomach wall, and are set up by indigestible food, spices, alcohol, and the abuse of drugs, especially in persons of sedentary habits, and in those addicted to too luxurious and profuse a diet or to debauchery.
Irregular peristalsis produces in the abdomen griping and pinching pains, flatulence is incarcerated under the short ribs, and the abdomen becomes distended, especially after eating; loud rumbling and gurgling occur. The pains may come on periodically in the morning, after eating, or in the evening after lying down, and make the patient bend double. They cause a sensation as if diarrhoea would come. There is a feeling of weakness in the abdominal rings, especially the left. Stitching pains or throbbing are felt in the region of the liver, which is painful from contact or motion, and jaundice may be present. Jerking and twitching occur in the abdominal muscles. The characteristics action of nux on the rectum is to cause constipation with frequent, but ineffectual desire for stool (anac., sil., sulph.). This is a result of the irregular peristalsis caused by the drug, whereby one portion of the bowel will urge on the contents while another constricts and prevents their passage. Constipation and diarrhoea may alternate. After a stool has passed there is a sensation as if more remained behind but could not be evacuated. Sometimes the excessive urging to pass something results in the discharge of mucus and bright red blood, with faeces or without them, but with a feeling of constriction or contraction in the rectum. Urging may be so violent as to cause prolapse of the rectal mucous membrane, but it ceases after passage of stool, with great relief to the patient. Sometimes a diarrhoea stool is passed suddenly and unconsciously from a spasm being reflexly caused by taking food into the stomach.
Urine.-With disturbed digestion or liver function the urine is scanty and high-coloured, with reddish or brickdust sediments, its passage is made painful by spasms of the sphincter vesicae, so that it can be passed only in drops, with burning and tearing in the neck of the bladder, thus there may be painful, ineffectual urging to urinate. Sexual desire is too easily excited, erections occur on the slightest provocation, emission occurs too readily during coitus, and nocturnal emissions are frequent.
In women there is pressure towards the genitals, especially in the morning; the breathing down may be so severe as to cause prolapse, from spasm, not from relaxation, as with sepia. Menses are too early and profuse, the flow is dark, there are cramping pains with discharge of clots, the patient is over-sensitive to nervous impressions, and faints easily. Metrorrhagia may occur at the climaxis or as the result of too high living; also thick yellow leucorrhoea. Labour pains are spasmodic, and are accompanied by urging to stool or to urinate, they are felt mostly in the back and may be so violent as to cause fainting, but are at the same time inefficient. After-pains are violent and protracted, and the lochia are scanty and offensive.
The headaches of nux vomica are usually associated with digestive troubles, and are brought on by the same causes, viz., over-eating, alcohol, mental over-work and anxiety, and lack of sufficient exercise. The whole head feels full, congested, as if intoxicated, with dizziness, which occurs especially in the morning and after dinner. Headache occurs in the morning in bed, even before the eyes are opened, it may be felt in the forehead or in the occiput, and is a sore, bruised pain, as if the head had been beaten. This morning headache gradually disappears after rising. Another headache is a pressure on the vertex, as if the skull were being pressed as under, or as if something heavy were being pressed down into the head. The brain seems to shake when the patient walks in the open air. Constipation usually accompanies headache, and may be the cause of it. Head symptoms are worse from mental exertion, exercising in the open air, after food, from wine and coffee, better after rising in the morning in a warm room, lying down or sitting quietly. Headaches are accompanied with heat and redness of the face, which appears puffed, and nausea or vomiting (sick headache) are frequent concomitants. The scalp is sensitive to touch and to wind, and the patient likes to be warmly covered (sil.).
Eyes.-The margins of the eyelids itch and burn, the canthi are reddened and itch, rubbing relieves the itching, movements of the lids are hindered by stiffness of the muscles. Ecchymoses occur in the sclerotics. The retina is hyperaesthetic, giving rise to photophobia, and vision is cloudy and impaired. There may be paresis of the ocular muscles.
Ears.-Sounds reverberate in the ears, which are hypersensitive to noises, and there is itching in the ears and through the Eustachian tubes, which compels the patient to swallow.
Nose.-The sense of smell is too acute, and odours may even cause the patient to faint. There is an acrid discharge, while the nose feels obstructed. Coryza is dry at night and fluid by day, is worse in a warm room and better in cold air; there is frequent sneezing in the morning in bed.
Face.-The face, when there is headache or fever, feels hot, as if sitting before a hot fire; at other times it is pale, yellow, or florid, with a yellow ground, and yellow around the mouth, eyes and nose; this will be most apparent when there are liver or digestive troubles. Neuralgic pain in the infra-orbital branch of the trifacial nerve is typical of nux. The facial muscles twitch, and when the dose is large trismus occurs.
Respiration.-In the respiratory sphere nux vomica causes hoarseness and roughness in the larynx, which provokes a fatiguing dry cough that is worse after midnight and in the morning. Each cough excites a bruised pain in the abdominal walls and a shattering pain in the head, as if the skull would burst. The cough is worse from mental effort and physical exertion, after eating and drinking, lying on the back, cold, on awakening, from tobacco and alcohol, and is relieved by warm drinks. The chest feels oppressed, as by a heavy load, and breathing is tight, from spasmodic constriction of the lower part of the thorax.
Back and limbs.-In addition to the reflex spasms and the paralysis of muscles already mentioned, there is a bruised feeling in the limbs and joints, worse during motion, and various drawing and darting pains are experienced. The arms go to sleep, the legs become numb and dead, cramps occur in the calves and soles at night, the legs tremble when walking, and the fingers and toes become red, burn and itch, as if frozen. Drawing pains are felt in the back in bed, and are such that the patient cannot turn over without first lifting himself up with his hands to a sitting posture.
Sleep.-The patient is sleepy in the evening, goes to sleep till 3 or 4 a.m., when he wakes up full of ideas that keep him awake for some hours till he at last falls asleep again, and when aroused at the proper time feels headachy, cross and tired.
Chill, Fever, &c.-The nux vomica patient is a chilly person, dislikes cold,and wants to be in a warm room and well covered, he has difficulty in getting warm in bed night. He takes cold from the slightest draught of air, and exposure to cold winds will give him colic or neuralgia. With the nux fevers the chill begins in the back or extremities, the limbs ache, the nails finger tips and hands are blue, the patient yawns a great deal. To this stage succeeds long-lasting fever, in which, however hot the patient may be, he cannot bear to be uncovered, he cannot move or uncover in the least degree without shivering; there is a tendency to jaundice with fever. The sweat that follows is light, it relieves the pains in the limbs. A sour, offensive sweat occurs after midnight or in the morning. Heat and sweat are often intermingled. During the apyrexia there are gastric and bilious symptoms, and marked weakness, and the patient sweats easily at all times, on the slightest provocation.
Skin.-There are no marked skin symptoms caused by nux, but there may be burning itching all over the body, especially if there is jaundice, and ecchymoses and small boils may occur.
The mental symptoms of nux are a counterpart of the physical hypersensitiveness. The patient is extremely irritable, every harmless word offends; he can bear no opposition or interference; noise, smells, light and music are unbearable, and he is intolerant of the slightest pain or bodily ailment. With these mental states there is great disinclination to work and an inclination to hypochondriasis. Sometimes homicidal or suicidal impulses are present, but they are rarely put into effect, as the patient has no illusions, and is able to exercise self-control when he rouses himself.
Nux vomica is one of the most frequently used medicines, not so much on account of its having a very wide range of action, but because the complaints for which it is indicated are so common. These are mainly disorders of the digestive system caused by improper food and faulty modes of living. The patients requiring nux are usually those of sedentary occupation-business men who have anxious and important matters to attend to and who do not take sufficient exercise or relaxation, men who are zealous and energetic, easily excited, nervous and unable to take things calmly. They become constipated and resort to purgatives, lose their appetite and try to stimulate it with strong-tasting rich foods or resort to alcohol. Indigestion, sleeplessness and headache are the result. Too great indulgence in wine and rich food, and also debauchery, will of themselves bring about the same condition. His ill-health affects the morale of the patient, and he may become hypochondriacal, unfit for work, even spiteful and malicious.
Digestion.-The indigestion takes the form of nausea, which is yet accompanied with a craving for food that when taken causes fulness and weight in the stomach, or a cramping pain there, with heartburn and sour eructations, and may end in vomiting, which will relieve. The tongue is covered with a white fur or has a dirty coating at the base, and there is a sour or bitter taste. The patient is often very hungry twenty-four hours or so before an attack of dyspepsia. Nux is a good remedy for the vomiting of drunkards and that of pregnancy. It is useful for gastralgia that is worse in the morning before breakfast, worse from food and better from warm drinks. It checks the excessive peristalsis and the vomiting resulting from obstruction of the pylorus. It is useful also in gastro-duodenal catarrh with the usual gastric symptoms and pain over the liver, which is enlarged and tender, and is associated with a yellowish hue of the skin and scanty high-coloured urine containing bile and depositing a brick-dust sediment. Nux has been of service in gall-stone colic, in flatulent colic of the intestines,in colic whether due to exposure to cold, indigestion or suppressed haemorrhoidal flow.
Constipation is nearly always present in the gastric disorders requiring nux, and is of the kind where there is frequent urging, which proves to be ineffectual, or a small motion is passed leaving behind a sensation that there is more to come. It is useful in dysentery when there are nausea, backache and much ineffectual straining with finally the passage of faeces, mucus and blood, which immediately relieves the tenesmus. Painful, blind haemorrhoids, accompanied with constipation, should be treated with nux. Hernia, especially on the left side, and when occurring in babies, is an indication for this remedy.
The headaches for which nux is suitable are usually caused by or accompany disorders of digestion, or are the after-effect of a debauch. They come on usually in the morning, immediately on waking, and are either ill-defined as to place or are frontal, vertical or occipital. They are congestive, with giddiness, flushed face and constipation, there is a sensation as if the head would burst, or a feeling as if a stone crushed the vertex, or an intoxicated sensation. The headaches are worse in the morning from mental or physical exertion, from eating, wine and coffee; and better from lying down quietly in a warm room. Nux is useful for a vertex headache occurring at the menopause, it is also remedy for a neuralgic headache which is usually supra- orbital and recurs every morning (cedron, nat. mur., spigelia) and for a unilateral headache caused by excessive use of coffee. It has been used for apoplexy when the attack has been preceded by vertigo, buzzing in the ears, nausea and urging to urinate, and has occurred in plethoric individuals who have been free livers.
Eyes.-Nux is a medicine for amblyopia, especially when occurring in drunkards or when caused by tobacco; it is useful in ciliary and supra-orbital neuralgia, in conjunctivitis and in asthenopia from retinal hyperaesthesia; there is photophobia, with flashes of fire before the eyes when looking towards a bright light, and pain shoots to the top of the head. It hastens the absorption of the ecchymoses that sometimes suddenly appear beneath the scleral conjunctiva.
Ears.-Nux is a remedy for Eustachian catarrh when there is itching along the Eustachian tube, with a frequent desire to swallow, which is accompanied by stitching pains in the ears.
Mouth and Teeth.-It is of great service to heal the small ulcers inside the lips and mouth and about the gums which often occur with disordered stomach and also for toothache with swollen face, the pain being worse from eating and from cold taking cold things into the mouth, and better from warm drinks.
Face.-It is useful for intermittent neuralgia of the infra- orbital branch of the facial nerve, coming on usually in the morning and relieved by warmth.
Urine.-Nux vomica is indicated in spasmodic affections of the urinary tract, such as the irritable bladder of gout or alcoholism, there is strangury, straining to pass water, which either does not flow or comes spasmodically in driblets, with pain at the neck of the bladder and down the urethra. It may also be used in paralysis of the bladder with constant dribbling and for the dribbling of urine in old men with enlarged prostate, as well as for irritability of the bladder caused by the use of a catheter, when the desire to micturate is counteracted by spasm of the sphincter. It is of value in relieving the pain of ureteral colic, which it does by moderating the spasm of the involuntary muscular fibres of the ureter and thereby assisting the passage of a calculus to the bladder.
Sexual- In the male sexual nux is indicated for the bad effects of masturbation and sexual excesses, such as impotency from premature ejaculation of semen, spermatorrhoea and too frequent nocturnal emissions; also for gonorrhoea after the abuse of copaiba and cubebs, there is a discharge, burning on urinating and frequent urging to stool.
In women it is useful for prolapsus uteri caused by straining and lifting, there is a bearing-down sensation, accompanied by urging to pass stool and urine. It will cheek the premonitory symptoms that would issue in abortion, stop the morning sickness of pregnancy and relieve the backache, as if the back would break, which often occurs in a pregnant woman, and is worse as soon as she lies down, she feels she must get up and walk about. In labour, nux is to be given when the pains though violent are inefficient and cause fainting, they extend to the rectum, causing desire for stool, and to the bladder, with frequent call to urinate. It has been given for violent after- pains. It is useful for dysmenorrhoea when the menses are too soon and too copious, are accompanied with violent cramping pains with urging to pass stool and urine, and when the patient is oversensitive, inclined to faint, and has nausea with chilliness. The flow is dark, comes irregularly, ceases at night and there are some clots. The pains extend from the hypogastrium over the body, are aggravated by a current of cold air and are relieved by hot-water bottles and pressure.
In the respiratory sphere, too, it is in spasmodic affections that nux has proved of value; for spasmodic asthma associated and dependent upon indigestion, and for a dry cough excited reflexly from the stomach or liver, and which shakes the head painfully and strains the abdominal muscles. It is useful in whooping-cough associated with a splitting headache.
Circulation-In palpitation after eating, from drinking coffee, or from mental over-exertion nux will act as a sedative, and it is equally useful in false angina caused by indigestion, suppressed haemorrhoids, tobacco or alcohol.
Nervous System- Intercostal neuralgia,better from lying on the well side, is ameliorated by nux, as is also cervico-brachial neuralgia with stiff neck, worse in the morning, after eating and from touch. Muscular twitching, spasms, cramps and jerking of the limbs on going to sleep, or from any slight impression, are indications for nux. It is of value in convulsions with tetanic rigidity and opisthotonos, with intervals of relaxation, convulsions that are renewed by the slightest touch, and when there is full consciousness throughout. Such conditions may occur in children and others from indigestion, is of service in partial paralysis, with gastric symptoms, in drunkards, in delirium tremens, and as an intercurrent remedy in locomotor ataxia and multiple sclerosis, bit it must be remembered that the action of nux of the spinal cord is functional, and that organic changes are, so far as is known, not caused by it. It should be though of for obsessional states, especially of violence, and for alcoholic confusion and toxemia.
Back and Limbs-The rheumatic affections for which the drug is suitable are those of the larger joints and the large muscles of the back. It is valuable for lumbago, when the pain is as if bruised or broken, is worse in bed and the patient cannot turn over without first sitting up. The joints are pale, swollen and tense, there are numbness and twitchings in their neighborhood and the pain is worse from jar or cold.
Skin-Acne of the face from indigestion, urticaria with gastric disorders, and crops of small boils, are curable with nux.
Fever-It is indicated for intermittent fevers of the kind described above, when the chill begins in the extremities and back, when the heat is prolonged and the sweat light, and when the patient desire to be covered up during all the stages.
Given in material doses, strychnine and nux vomica are used as a general and stomachic tonic, as a stimulant to the central nervous system in almost every form of paralysis, in blindness from commencing atrophy of the optic nerve, and in chronic alcoholism.
Nux vomica antidotes the abuse of aromatics, drastic, purgatives, narcotics, effects of coffee and alcohol and mercurial tremors.
(1) Increased reflex excitability.
(2) Convulsions, tetanic, with complete retention of consciousness.
(3) Hypersensitiveness of all the senses.
(4) Faintness, from slight impressions.
(5) Must be covered and kept warm in all stages of fever.
(6) Gastric disorders, from rich food, alcohol, condiments, drugs, coffee, sexual excesses, overwork, anxiety, sedentary occupation.
(7) Headaches, from the same causes and associated with gastric troubles.
(8) Constipation, with frequent ineffectual urging.
(9) Urging to stool and urine in abdominal and pelvic complaints.
(10) Spasmodic constrictions in excretory passages: ureters, gall-ducts, intestines, bronchi.
(11) Sensitiveness to cold and cold winds.
(12) Tetanic spasms from slight stimuli. Twitches, jerks, cramps.
(13) Complaints on walking and in early morning, 3 to 4 a.m., sleeplessness after those hours.
(14) Thin, irritable, impatient, choleric persons, with dark hair, who make great mental exertion and lead sedentary lives.
(15) Persons addicted to wine, coffee, pepper, condiments, drugs.
From open air, motion, mental exertion, 3 to 4 a.m., in morning, cold water, dry weather (except facial neuralgia), sunshine (headache), warm room (fainting), wind, eating, coffee, cold food, wine,touch, coughing, pollutions, after stool (fainting), during and after menses, on waking, noises.