Phytolacca decandra. Poke root. N.O. Phytolaccaceae. Tincture of fresh root dug in winter, or of fresh leaves or ripe berries. Solution of the resinous extract of phytolaccin. The tincture made from the root is the one used medicinally, but the provings and poisonings are from all the above sources.
A BOY, aged 6, who an hour previously had swallowed from one to two drachms of the tincture, was found in a tetanic convulsion; his extremities were stiff, the hands firmly closed, the feet extended and the toes flexed, eyes reddened, pupils contracted, lower lip drawn down, teeth clenched; there was general muscular rigidity and opisthotonos; pulse soft, breathing difficult and oppressed, audible mucous rales. The muscular rigidity gradually increased and the chin was intermittently drawn down to the sternum and released again. After cupping and cold applications he went to sleep for twenty to twenty-five minutes, and on waking there were slight jerking and twitching of muscles, especially of legs, and he had pain in the back of the head and stomach. Next day he was well, with the exception of being sore and stiff” (C.D.P.). Another boy who has eaten a number of the berries “was found in great agony with pain in the stomach, nausea and vomiting; his throat felt sore and dry, the fauces were dark and congested, and the tonsils swollen. After vomiting he had severe purging, with dark brown, thin stools, and burning, griping pains in the umbilical region. His vision was dim, tongue coated white, and he had spasmodic jerking of arms and legs” (C.D.P.). A woman who “had taken phytolacca in a “blood-purifying” mixture “had severe rheumatism for several months, suffering intense pain in the joints and in the bones of the face and head. She was also covered from scalp to soles with an eruption of erythematous blotches, irregular in shape, slightly elevated and of a pale, red colour, very sore and painful, itching only on desquamation and terminating in a dull red or purple spot, each spot passing through its phases in about thirty days; there was no fever; `nodes were found on examination at the painful spots. The roof of the mouth was similarly affected. Syphilis was absolutely excluded, and no mercury had been taken” (C.D. P.).
These cases of poisoning show that phytolacca affects the nervous system, the throat, the digestive system, and the last case quoted suggests implication of the fibrous tissues and periosteum.
THE PROVINGS, as usual, both define and amplify the results of the poisonings.
In the alimentary system we find that the mouth fills with saliva, which is yellowish, ropy, and has a bitter taste; ulcers are seen on the inside of the cheeks, and there are shooting pains in the molars of both jaws, but mostly on the right side; the teeth ache, are sore and feel elongated and, characteristic of phytolacca, there is an almost irresistible inclination to bite the teeth together; the tongue feels rough, has blisters on both sides and is coated white, with very red tip; there is great pain at the root of the tongue on swallowing. The throat is dry, sore, rough and dark red; the tonsils and uvula are swollen; thick white or yellow mucus covers the fauces. With the soreness in the throat is a similar soreness in the Eustachian tubes, a sensation of obstruction and dull hearing with a rushing noise. Severe pain shoots up the Eustachian tubes on swallowing; this, with the pain at the root of the tongue on swallowing and the feeling of a lump in the throat, causes extreme dysphagia. The patient is hungry, although he has nausea, and hunger returns soon after eating. There are cutting pains in the pit of the stomach, which is tender, and a sickly feeling with eructation of watery fluid. Dull, pressive pain is felt in the splenic region, which is worse while sitting or walking, and relieved by lying on the left side. Digging pains are left in the right hypochondrium. Diarrhoea occurs, with a sickly feeling in the bowels, cramps and griping, and with copious discharge of blood, mucus, and what looks like scrapings from the intestines. One prover had in the middle of the night a neuralgic pain shooting from the anus and lower rectum, along the perinaeum to the middle of the penis.
Sexual.-Sharp pains run up the spermatic cords and are followed by continued soreness. In four cases of poisoning in women the menses were suppressed, in other bearing-down and involuntary straining occurred, accompanied by haemorrhage from the vagina. In one prover, who was even months pregnant, plainly- felt uterine contractions occurred and returned at intervals over a period of two days, threatening abortion. Pains were felt in the region of the right nipple, which passed through to the back and were worse on deep inspiration and from bending the shoulders backward.
Urine.-Weakness, pain and soreness are felt in the region of the kidneys, the urine is sometimes increased and sometimes diminished; in one case it contained albumin.
Back and Limbs.-Nearly all the provers felt sore all over, from heat to foot, rheumatic pains were general and much stiffness and heaviness were felt in the limbs. Stitching pains from without inwards are frequent in various parts of the extremities. Pains are always in various parts of the extremities. Pains are always in outer parts, ex. gr., neuralgic pains in the outsides of both thighs; pains running down the outside of the lower limb from hip to ankle; dull aching and tenderness along the top of the right shoulder and upper edge of the trapezius; aching and tenderness as from a bruise in the outer muscles of the right upper arm. Pains occur in the periosteum, especially of the tibia; they are worse at night in bed. The neck is stiff, worse on the right side and in bed at night. Pains felt in the back of the neck run down the spine; there may be severe pains between the scapulae, worse when walking, and a constant dull aching in the lumbo-sacral region, worse from motion. The glands on the right side of the neck are swollen and hard.
Head.-Pains in the head are mostly in the temples and forehead and extend to the orbits, they are sometimes occipital; they are apparently in the periosteum or fibrous tissues of the scalp and are worse in damp weather and from motion. The frontal pains often come on after eating. They are dull, pressive or bruised.
Ears.-Shooting pains occur in ears, and in one prover there was increased acuteness of hearing with the headache. In another prover pustules and boils behind the right ear which had healed, returned and suppurated while he was taking phytolacca.
Eyes.-There are dull, aching pains in the eyeballs, that are worse from moving them, from light, especially gas light, and from reading. The eyes are tender on pressure, the lids swollen and reddish-blue in colour. Burning and smarting as if from sand in them provoke a great flow of tears; the soreness of the eyeballs is aggravated by the pressure of the lids on closing them. Itching in the inner canthi and aching pains around the margin of the orbits occur. The pupils are contracted and vision is dim.
Nose.-There is a feeling in the eyes and nose as if a cold were coming on and alternate obstruction and discharge from the nose, usually discharge of liquid mucus from one nostril at a time. “A sensation in the right nostril as of tickling with a feather.”
Respiration.-Roughness is the larynx and trachea causes frequent desire to cough, and there is a feeling as of breathing through a sponge, a suffocating feeling in the throat and lungs, and expectoration of tough mucus. The cough is worse from exposure to cold air and better in a warm room and after going to bed.
Face.-The face is usually pale, but sometimes after dinner there are heat and redness, with a sensation of fulness in the face. The bones of the face are painful at night and a peculiar pressure and tension are felt in the parotids.
Circulation.-The pulse is quickened, full and hard, or full and soft; constructive feelings and occasionally, shocks of pain are felt in the cardiac region.
Sleep.-The patient is generally drowsy but sleep at night is restless and pains awake him and drive him out of bed; he is chilly in the morning and cold sweat collects on the forehead.
Skin.-In addition to the erythematous nodular eruption already mentioned, a lichenoid eruption may occur on the calves, worse at night. The skin is cool, shrivelled and lead coloured.
The patient is easily prostrated; sitting upright from a lying position makes him faint and giddy.
Digestive Tract.-The very prominent throat symptoms caused by phytolacca have procured it a place as a remedy for various kinds of sore throat, but chiefly for follicular tonsillitis and mild forms of diphtheria. In these cases it is indicated by the dark red and swollen tonsils and mucous membrane, dysphagia, with pain shooting into the ears and to the base of the tongue, the eruption of herpetic whitish or grey spots on the fauces and tonsils, which run together and form a dirty pseudo-membrane like wash-leather, and swelling and tenderness of the glands behind the angles of the jaw. With these local conditions are associated headache, backache, wandering rheumatic pains and, usually, high fever. It is not suitable for the more malignant type of diphtheria in which there is a very putrid odour and generally not much fever. It is useful for chronic follicular pharyngitis occurring in public speakers, when they feel much burning discomfort in the throat. It is also an important remedy for the ulcerated sore throat of scarlet fever: its power to cause erythema and albuminous urine are additional reasons for its employment in the sore throats of that diseases.
The curious symptom, “irresistible inclination to bite the teeth or gums together,” has led to phytolacca being given with success in the dentition troubles of children, such as gastric disturbances, colic and diarrhoea, jerking of limbs and convulsions, all of which are symptoms produced by the drug. It is useful for ulcerated sore mouth in the same patients. The rheumatoid pains of phytolacca which, like those of mercury, are worse at night and from damp and movement, suggest it as a remedy for those pains when of syphilitic origin, and phytolacca has been found very useful for syphilitic pains, especially if due to periostitis or periosteal nodes.
The third case of poisoning related above shows the close similarity of phytolacca to these states, and also to erythema nodosum, for which, also, it has been successfully given. It is a remedy for neuralgia when the pain is a bruised, sore feeling and runs down the outside of the limb from hip to heel, with the modalities of worse at night, from damp and from movement. It has cured “a very severe and obstinate pain in the heel, only relieved by keeping the heels higher than the body” (Royal). Phytolacca is the remedy for intercostal rheumatism from exposure to cold and damp, for rheumatic headaches, rheumatic stiff neck, rheumatism of the dorsal muscles, and for subacute rheumatism of the long bones and the tendinous attachment of muscles. In antidotes mercurial bone pains. It is the fibrous tissues that are affected and parts close under the skin such as the tibiae, scalp, shoulder-blades and ends of the fingers and toes. The pains are shooting, jerking, flying from one place to another and are worse at night, from movement and in stormy weather. Rheumatic swellings are hard, tender and hot. When considering the influence of phytolacca on rheumatic pains, it is interesting to note that caustic potash is present in the ash of the plant to the extent of 45 percent.
Breasts.-The symptom, “pain in the right side of the chest, in region of nipple, passing through to back,” has led to the employment of phytolacca to relieve the pain from sore nipples in nursing mothers when, on putting the child to the breast, pain shoots through to the back and radiates over the body. Clinical experience has extended this use of the drug to swellings and inflammations of the breasts, and it has become a principal remedy for inflammatory swelling of that organ, for threatening abscess during lactation, for tender lumps found in the breasts at other times, for irritable mammary tumours, and even for malignant tumours, the growth of which it has in many cases checked. It is a good medicine to give when the breasts become sensitive and painful during the menstrual period.
Nose.-Phytolacca is useful for nasal catarrh when one side of the nose is stopped up and there is a fluid, acrid discharge from the other. It has been used in syphilitic ozaena and in catarrhal laryngitis with hoarseness and burning in the larynx and trachea.
Eyes.-Swellings of the meibomian glands and inflammations of the fibrous coverings of the eyeball, the sclerotic and cornea, have been benefited by it.
Skin.-Phytolacca is useful for ulcers, boils and carbuncles with burning pains, worse at night, and for syphilitic eruptions and ulcerations.
Circulation.-It should be considered in subacute endocarditis and pericarditis and for cardiac pains occurring in hearts damaged by previous attacks of rheumatism.
A tincture of the berries has been used to reduce obesity.
(1) The leading weather modality is aggravation from rain or cold, damp weather.
(2) Shootings, like electric shocks, rapidly changing site.
(3) Indifference to life, expecting to die.
(4) Vertigo and faintness when rising from recumbent posture.
(5) Sore throat, accompanied by pain on swallowing.
(6) Follicular tonsillitis diphtheria speakers’ sore throat.
(7) Pains in fibrous tissues, worse at night, from movement.
(8) Subinflammatory affections of fibrous tissues periosteum, sheaths of muscles and tendons, eyeballs.
(9) Soreness and stiffness of muscles.
(10) Irresistible inclination to clench the teeth.
(11) Pains shooting through from nipple to back and radiating through the body when nursing.
(12) Inflammations, nodosities and tumours of the mammary glands.
(13) Syphilitic and mercurialized subjects.
From damp weather, exposure to open air, at night, in morning, right side, cold room, hot drinks (throat), menstrual periods, touch, pressure (pain in joints, ulcers), riding (nose, breathing), gaslight (eyes), swallowing, vomiting (headache), lying on right side (liver pains), motion, standing, walking.
From pressure of hands (pain in breasts), rubbing (pain in hip), vomiting (nausea), open air (eyes), lying on left (painful) side (spleen pain).