Podophyllum peltatum. May apple. Mandrake. N.O. Berberidaceae Tincture of the root gathered after the fruit has ripened. Solution of the resin, podophyllin, in rectified spirit.
PODOPHYLLUM contains two isomeric principles, podophyllotoxin and podophyllophyllin, C23 H21 O9. The latter is inert. Podophyllotoxin is excreted into the bowel. When administered hypodermically or intravenously in large quantities it causes glomerular nephritis and haemorrhages into various organs. The dust of podophyllum resin causes inflammation of the eye, and ulceration of the cornea from its local irritating action, and also raises irritating patches in the skin. Podophyllum has a bitter taste. It acts powerfully on the gastro- intestinal tract, causing a watery, bilious diarrhoea and, in large doses, burning in the stomach, violent retching and vomiting of bile. It is thought to increase the secretion of bile, but this is disputed by some who believe it only stimulates the gall-bladder to empty its contents into the duodenum. All the bowel symptoms are produced when the drug is given by other routes than the mouth; therefore its action on the alimentary tract is specific. In a dog poisoned with podophyllin, given by injection into the peritoneal cavity, the mucous membrane of the whole of the small intestine was inflamed, especially that of the duodenum, in which were nine ulcers, each rather less than a three penny piece, and one smaller one in the lower end of the ileum. The whole surface was covered with tenacious, bloody mucus. Inflammation ceased sharply at the ileo-caecal valve.
Digestion.-The provings confirm the physiological action of the drug, as exhibited by poisonings in man and experiments in animals, and show that podophyllum acts on the liver and the mucous membrane of the digestive tract, especially of the duodenum and rectum, and produces irritation, excessive secretion and inflammation of those organs. There is profuse salivation, but on waking in the morning the mouth and tongue are dry and covered with viscid mucus. Everything tastes sour, and the power of distinguishing tastes is lost. There is a great desire to press the gums or teeth together, and in the morning the teeth are covered with dry mucus. The odour from the mouth is offensive, the tongue is furred white, is moist and takes the impress of the teeth. The throat is dry and sore, the soreness extending along the Eustachian tubes to the ears, and swallowing is difficult and painful. There is great thirst for large quantities of cold water, which, when taken, causes oppression in the stomach and is soon ejected. The patient is indifferent to food, desires sour things, regurgitates sour fluid and perhaps vomits hot, frothy mucus. There may be burning heat in the stomach and violent efforts to vomit, which cause so much pain as to make the patient scream and result in the vomiting of bilious matters mixed with dark red blood. Retching and straining to vomit are more pronounced than actual vomitings. After vomiting food there is often craving for nourishment, on account of a hollow, empty sensation in the epigastrium. The abdomen is full and distended, with pain and soreness, felt especially in the right hypochondrium and over the region of the liver, which part, as well as the whole of the abdomen, is very sensitive to pressure. Stitches are felt in the right hypochondrium, which are worse while eating. In the left hypochondrium there is a sensation of weight and dragging. Pains occur in the bowels, with retraction of the abdominal muscles; these come on principally at daybreak they are worse when lying on the back and are better from warmth and lying on the side, bending forwards; there is first general chilliness, then heat and warm perspiration, accompanied by a sensation of heat in the bowels and a desire for stool. Pain and rumbling come on in the transverse colon, often at 3 a.m., and are followed by diarrhoea. Frequent transient colic is felt in the abdomen during the day, sometimes followed by a stool; when a stool occurs it relieves the colic, but there is faintness and a sensation of emptiness in the abdomen afterwards. Podophyllum has a characteristic diarrhoea, which usually commences between 2 and 4 a.m. and is repeated several times through the forenoon. The stool may be painless, watery, gushing out in large quantities of offensive, dark-brown or greenish, slimy matter mixed with faeces and accompanied by the discharge of flatus, or it may be streaked with blood and passed with mucus straining and tenesmus. Straining often causes prolapse of the rectum, with heat and pain in the anus. Even if there is not much straining, diarrhoea if often accompanied by rectal prolapse, together with great sinking at the epigastrium and a sensation that everything will drop through the pelvis. Podophyllum seems to cause a special weakness of the rectum, so that a slight exertion may cause prolapsus followed by evacuation of a stool or the discharge of mucus. As an alternative to diarrhoea there may be constipation, when the stools are dry, hard, pale and clayey.
Urine.-There was no marked alteration in the urinary functions experienced by the provers; the urine was usually frequent and scanty.
Sexual.-Pain occurs in the regions of the ovaries, especially the right, and extends down the anterior crural nerve; it is worse from straightening the leg. The female genitals share in the weakness of the pelvic floor that admits of prolapse of the rectum, and there is a sensation as if the internal pelvic organs would come out during defecation. Actual prolapse of the uterus may occur, either when at stool, or from exertion, as from overlifting or from straining and after parturition. Such prolapse is accompanied by aching pain in the sacrum, bearing down pains, pressure above the pubes, rumbling in the ascending colon and prolapsus ani.
The symptoms referable to the mouth, stomach and liver caused by podophyllum bear a close resemblance to those caused by mercury and have led to its being called the “vegetable mercury.”
Head.-A further resemblance is seen in the headache which usually accompanies or alternates with the symptoms of the alimentary tract. The headache is a stunning or bursting pain felt in the temples and forehead, with giddiness and a sensation of heat and heaviness in the eyes, which feel drawn inwards. It is worse from lying down and is relieved by pressure and bathing with cold water. It often alternates with diarrhoea. Sometimes the headache is in the occiput and is accompanied by stiffness of the nape, and soreness of the muscles of the neck and shoulders.
Back and Limbs.-Sore pain between the shoulders and a pain under the right shoulder-blade are felt in association with the congested liver. Pains also occur in the lumbar and sacral regions in association with uterine and rectal symptoms and there are cramps in the calves, thighs and feet, with the diarrhoea. Pains in the course of the ulnar nerves, rheumatic pains in the left forearm and fingers, rheumatic pains and weakness in the left hip, and a defined ache in the sacro-ischiatic foramen, with tenderness on pressure, are caused by podophyllum.
Fever.- The patient is apt to be feverish in the afternoon, with spells of chilliness, unrelieved by the heat of the stove, but better from being covered up warmly in bed. Griping pains in the abdomen are usually accompanied by chilliness, but flushes of heat run up the back during stool.
Sleep.-The patient is sleepy in the daytime, especially in the forenoon; he desires to stretch. Children whine and moan and rise up in sleep without waking. There is an inclination to roll the head from side to side to side and to perspire during sleep.
Circulation.-Podophyllum has no direct influence on the circulation; the pulse is lowered and weakened when there is diarrhoea, and exertion and mental emotion may cause palpitation. A sensation occurs in the chest as if the heart were ascending to the throat.
Mental.-The mental symptoms are such as usually accompany liver complaints, viz., depression, foreboding, disgust for life and forgetfulness. In the delirium of fevers there is loquacity.
With podophyllum an alternation of condition is noticed, diarrhoea alternates with constipation; headache, with diarrhoea; headache in winter, with diarrhoea in summer.
Digestive Tract.-Podophyllum is useful for acute disorders of the liver, secondary to duodenal catarrh or inflammation, the so-called “bilious” attacks, with vomiting of food and bile, disordered appetite, thirst, swelling and tenderness of the liver, retching, epigastric and abdominal pain, jaundice, bilious diarrhoea and headache. It is also a good remedy for chronic congestion and torpidity of the liver, whether arising from too much food or injurious kinds, or from influenza, malaria. Chill or other cause. It is a medicine to be thought of for duodenitis and duodenal ulcer, as it has a special influence on the duodenum, and has produced duodenal ulcers in dogs. Bilious headaches and bilious diarrhoea often require podophyllum. It is especially useful when the diarrhoea comes on in the early hours of the morning, and is frequently repeated. There is considerable urging with the diarrhoea, and it is preceded by colicky pains across the abdomen; it is usually of green, watery bile and mucus, mixed with faeces and flatus, gushes out “like water from a bung-hole.” In women there may be a sensation as if the genital organs will fall out. The characteristic features of the diarrhoea are: (a) Its profuseness-the quantity is so great one wonders where it can all come from: (b) its extreme offensiveness, it smells like carrion; (c) the time of its appearance, viz., 2 to 4 a.m. It is more likely to appear in the summer, and is often present during the dentition troubles of children.
The stools sometimes resemble those of cholera and, if there is much retching, bilious vomiting and jaundiced hue of the skin, podophyllum might be given in that disease. It is a remedy for dysenteric diarrhoea depending on inflammatory irritation of the rectum, but is not indicated when ulceration of the colon is the cause, as its action on the intestines stops short at the ileocaecal valve, and the large bowel is not affected by it until the rectum is reached.
It is useful in some cases of enteric fever, when the diarrhoea is of the podophyllum type and when the patient rolls his head from side to side in a loquacious delirium.
With the diarrhoea caused by podophyllum there is a great tendency to prolapse of the rectum, and for this condition, especially when occurring in children weakened by diarrhoea, it is a most valuable remedy. It relieves the constant straining to as something from the bowel which is so distressing in cases of carcinoma of the rectum. It is very useful for a state of debility of the bowels in children when the stools, though natural, are passed too often; these patients are usually somewhat emaciated.
Sexual.-It is very useful for piles and prolapse of the rectum after confinements, and for the same condition occurring during the straining of violent retching or vomiting, or from overlifting. Prolapsus of the uterus, whether occurring in association with diarrhoea or from straining or parturition, may find its remedy in podophyllum; prolapse of the anus often accompanies it. it is indicated in dysmenorrhoea when there is pain in the region of the right ovary which extends down the course of the anterior crural nerve, and a bearing-down sensation, as if the uterus would be forced out of the pelvis. The ovarian pain is worse from straightening the limb. This right-sided ovarian pain may occur at other times than at the menses and will require podophyllum. It is said to have benefited ovarian enlargement. It relieves the excessive vomiting sometimes occurring in the early months of pregnancy, the indications for it are swelling of the labia, and the necessity for the patient to lie over on her stomach in order to be comfortable.
Dentition.-Podophyllum is one of the chief remedies for the dentition troubles of children when there is diarrhoea and the patient rolls his head from side to side (bell., apis), grinds his teeth, makes chewing motions with the jaws and presses the gums together. It will often prevent hydrocephaloid, when threatening, if these symptoms are present.
Fever.-Podophyllum is a remedy for bilious fevers of a remittent type and for intermittent fevers; the chill is violent and is followed by intense fever and delirium, characterized by great loquacity.
It is indicated for neuralgia of the ulnar nerve. It is predominantly right-sided.
(1) General “bilious” conditions, with painful retching, vomiting, jaundice, diarrhoea and headache.
(2) Early morning diarrhoea (apis, aloes, bry., nat., sulph., rumex., sulph)
(3) Dentition troubles of children, with diarrhoea.
(4) Prolapsus recti; prolapsus uteri.
(5) Ovarian neuralgia, right-sided.
(6) Neuralgia of the ulnar nerve.
(7) Loquacious delirium.
(8) “Bilious” temperaments, especially after mercurialization.
From motion, open air, in the morning, especially 2 to 4 a.m., after eating and drinking, before, during and after stool, hot weather (diarrhoea), acid fruit, milk.
From rubbing, lying down (except headache), lying on abdomen (early pregnancy), external heat (pain in bowels), warmth of bed (hill), stretching in bed, pressure (headache).