Clinical Cases Materia Medica

Presentation of Pulsatilla

pulsatilla

A discussion of the characteristics of the homeopathic remedy Pulsatilla.

[Read at the monthly Clinical Meeting of the Homoeopathic Post- Graduate Association, Bombay, on 29th January 1940.].

pulsatillaPulsatilla is one of the polychrest remedies in homoeopathy and acts mostly on the blood vessels, mucous and synovial membranes and organs. Pulsatilla, Ignatia and Sepia form a trio in homoeopathy known as the woman’s remedy, i.e., they are most commonly indicated in women.

Farrington says: “The relation of Pulsatilla or Sulphuric acid calls for particular notice. The latter remedy follows the former in gastric troubles. Puls is also antidotal to Sulphuric acid. When this acid has been used for the cure of the appetite for liquor, Puls has been proposed as the remedy best suited for the diarrhoea which ensues.”

“It is one of those remedies which we are apt to select by the predominance of the mental symptoms,” viz, mild, yielding, tearful disposition, “Pulsatilla patients are never irascible although at times peevish.” “Thus in the case of a child with gastric troubles Pulsatilla may be used when it is peevish, pale, chilly and satisfied with nothing. This is not the Nux vomica or Chamomilla condition as both these remedies have decidedly more violence with their anger.”

It would not be out of place if we compare some important remedies which have mental symptoms in common.

1. Sepia : “Differs from Pulsatilla in the presence of irritability and anger.” “There is also indifference to her household affairs, to which she was formerly attentive.” Pulsatilla cries when telling her symptoms and Sepia when asked her symptom.

2. Nat. mur. : Also has a tearful disposition but under Nat.mur. consolation aggravates, while under Pulsatilla the patient seeks consolation.

3. Ignatia : Here the patient is “sad and hides her grief from others.”.

4. Stannum metallicum : “Likewise has this tearful disposition. The patient is very much discouraged or is tearful over his chest symptoms. He fears that he will go into a decline.”

“Pulsatilla is especially suitable for chlorotic, anaemic women when they complain constantly of a feeling of dullness, but inspite of this find relief for many of their symptoms in the open air.” “It acts on the right heart more than on the left, consequently despite the chilliness which arises from the anaemia, the open air acts as stimulus to the venous circulation and this improves the symptoms depending upon the sluggish flow of blood.” So Pulsatilla is of great use when there is this sort of disturbance in the venous circulation. Pulsatilla patients are easily led and persuaded and touchy ; relieved by slow gentle motion (Ferrum-reverse of Arsenic) ; better by lying on painful side, like Bryonia; by cool place and drinks (although patient is not thirsty); aggravated in a warm room ; also aggravated by lying on left side like Phosphorus; aggravated at the beginning of motion (Rhus., but Rhus. wants motion in warm dry air while Pulsatilla is ameliorated in cool open air).

Dr. Nash describes it as a “changeable remedy, pains travel from one joint to another; haemorrhages flow, and stop, and flow again, no two stools alike, no two chills alike, no head nor tail to the case mixed.”

“Many of the complaints are associated with weakness of the stomach and indigestion, or with menstrual disorders.” “Pulsatilla like Nux vomica is a great remedy for disorders of digestion.” There is “bad taste in the mouth, especially in the morning, or nothing tastes good, or no tastes at all.” “Great dryness of the mouth in the morning without thirst.” “The stomach symptoms are worse in the morning and the mental symptoms in the evening.” “Stomach disordered from cakes, pastry, rich food, particularly fat pork”- fat meats generally, fats. The stomach symptoms are ameliorated by walking slowly in open air. In dyspepsias Pulsatilla has to be studied with other important remedies.

1. Nux vomica : In Nux vomica heartburn is more characteristic, while in Pulsatilla waterbrash predominates. With Nux vomica warm food agrees best ; with Puls cold things. The mental symptoms of the two remedies differ widely.

2. Bryonia : bad taste with coated tongue and thirst. Pulsatilla no thirst.

3. Antimonium Crudum : here the tongue is very characteristic. It “is coated white as though it had been white-washed. Vomiting predominates over the other symptoms.”

4. Ipecac : “Is a first class remedy in these gastric catarrhs caused by chilling the stomach with ice water, or by eating pastry or other indigestible substances. The tongue is clean. It seldom has the thick coating belonging to Pulsatilla or Ant.cr. and nausea predominates over every others symptoms.”.

5. Arsenic : is complimentary to Pulsatilla when gastric catarrh arises from “chilling the stomach with ice cream or ice water.” It is peculiar while Mercurius should have characteristically moist mouth with intense thirst.

“Headache in school-girls who are about to menstruate. Headache accompanying menstruation,” or “associated with suppressed menses”. “not caused from them but associated with them.” “One sided headaches and one sided complaints are peculiar to Pulsatilla.” Headaches ameliorated by cold applications and pressure.

There is no remedy like Puls to antidote Sulphur when Sulphur has been used every spring to “cleanse the blood.” A great remedy for affections consequent on the abuse of Iron. When inflamed parts look bluish like Lachesis, Pulsatilla will promptly bring the condition under control provided Pulsatilla temperament is present.

In fevers Pulsatilla has been found very effective. Patient is chilly (afternoon 2 p.m.; Nat.-mur., chilly forenoon.) ; hands and feet numbed (Cedron, whole body numb), heat in the afternoon and no thirst. But thirst may sometimes be present during heat (Ignatia has thirst only during chill). The sweat in Pulsatilla is one sided and usually on the left side. It is also used after abuses of quinine.

Three characteristic symptoms of Pulsatilla are.

1. chilly.

2. aggravated by heat and.

3. thirstless.

Patient feel chilly, covers himself, in a short time begins to perspire, removes the blankets, wants the windows open and after a little while he again feels chilly and covers himself. This is the type of chill seen in the Pulsatilla patient. (Nux Vomica : the least uncovering aggravates).

It has been greatly used for after-effects and mistreated cases of meals and according to Pulford, as a preventive of measles, three times daily. In the initial stages of measles other remedies as Aconite, Gelsemium, Bryonia, Ferrum phos. should be taken into consideration as Puls will not help the condition. In its action on mucous membranes Pulsatilla gives rise to “thick, green, yellow catarrhal discharges.” “The catarrhal discharges are bland except the leucorrhoea which is excoriating. Remember, however that Pulsatilla has a bland leucorrhoea in keeping with the general state.”

Pulsatilla is more useful in nasal catarrh when the cold is ripe than when it is acute. In nasal catarrhs (chronic) Pulsatilla vies with Cyclamen which has good many symptoms in common with Pulsatilla, e.g., loss of taste and smell is common to both. But the differentiating point is that in Cyclamen there is spasmodic sneezing and aversion to open air. But Pulsatilla is sometimes indicated in acute nasal catarrh. (Arsenic, Carb.v., Cepa, Euphrasia). In Arsenic and Cepa the nasal discharge is acrid. In Euphrasia there is acrid discharge from the eyes and bland, watery from the nose. In Nat.mur. there is loss of taste and smell like Pulsatilla but in the case of Natrum muriaticum the aggravation is in A.M. while in Puls it is in P.M. The characteristic discharges of Puls are found from every mucous outlet of the body. Puls is therefore our sheet-anchor in old catarrhs with thick yellow discharge and amelioration in open air. It is said that Pulsatilla prevents whooping cough. Loose cough is more liable to be amenable to Pulsatilla than dry cough. The expectoration of Pulsatilla taste bitter while that of Stannum is sweet and, that of Kali- Hydriodicum and Sepia, salty.

Invaluable in purulent ophthalmia when Argent. nitr.fails. Also in cases of otorrhoea after measles. In suppressed gonorrhoea Puls is indicated. and Pulsatilla will restore gonorrhea. Puls is indicated if orchitis or epididymitis ensues. In such cases Pulsatilla will restore the discharge and reduce pain. Here it has to be compared with the following remedies.
1. Clematis is an excellent remedy for gonorrhoeal orchitis when the testicle is indurated and is as hard as stone.”

2. Mercury is called for when the glands are swollen and when what little discharge remains is greenish, and when there is phimosis.”

3. Rhododendron : under this remedy the testicle tends to atrophy, sensation as if it were being crushed.

Pulsatilla is the common remedy for enormously swollen testicles from mumps in a boy (a form of metastasis). Here Puls, is to be studied along with Carbo veg., Abrotanum and Rhus tox. In the case of Carbo veg., you have a carbo vegetabilis patient. In the case of Pulsatilla it changes location but not the disease, while Abrotanum changes both, e.g. arthritis developing after acute dysentery. “Pulsatilla has complaints from exposure to rain ; getting feet wet (Dulcamara)” ; a prominent wet weather remedy ; tooth- ache types of ear-ache (Chamomilla.). Puls is indicated in girls in derangements at the age of puberty when menstrual flow has not established itself normally. “Catamenia too late and scanty, or suppressed, particularly by getting feet wet.” “The changeable characteristics in the flow of menses, viz., they stop, and flow, stop and flow again, etc.” should be borne in mind. In delayed or suppressed menses Sulphur will follow when Pulsatilla proves ineffective. Also fairly often required in the mornings sickness of pregnancy and during labour when the pains are slow, weak and ineffective ; and also in the after-pains after delivery. “In girls at puberty, milk in the breasts ; a premature establishment of milk. In non-pregnant woman, milk in the breasts”, (mammary glands affected by Pulsatilla before, during and after pregnancy). Pulsatilla is many times the remedy in simple retained placenta (here competing with Sepia. Sabina, Secale and Caulophyllum. Puls is indicated when mechanical irritation. e.g. carrying books, excites flow of milk. The pains in Pulsatilla are accompanied with chilliness. The more severe the pain the harder the chill. Pains come suddenly and leave gradually in the case of Pulsatilla There are certain remedies indicated in the manner in which the pains appear and disappear, e.g.[The Remedies and Modalities of Facial Neuralgia”- J.A.Lathoud- The Journal of the American Institute of Homoeopathy, January, 1937, P.40.- L.D.D.].

(1) Pains appear and disappear suddenly, e.g., Belladonna, Cactus grand., Mag phos., Nitric acid, Rhodium, Sepia, Strychnine.

(2) Pains appear and disappear gradually e.g. Argent nit, Platina, Stannum.

(3) Pains appear suddenly and disappear gradually, e.g. Pulsatilla

(4) Pains appear suddenly but disappear in a variable fashion, e.g. Verbascum.

(5) Pains which appear gradually and disappear in a variable fashion, e.g. Calcarea carb., Cinchona, Silicea.

RELATIONS OF PULSATILLA : Kali mur. is its chemical analogue.

(1) Complimentary remedies of Pulsatilla are : Sulphuric acid and Lycopodium, Kali bichromicum, Kali mur., Kali sul., Sepia, Silicea., Stann., Zincum met.

(2) Its antidotes are : Asafoetida, Chamomilla, Coffea, Ignatia, Nux vomica, Stann.

(3) Silicea and Kali sulph are the chronic of Pulsatilla in nearly all ailments.

(4) “Follows and is followed by, Kali mur.”.

(5) “Ailments : from abuse of chamomile, quinine, mercury, tea- drinking, sulphur.”.

(6) “One of the best remedies with which to begin the treatment of a chronic case (Calcarea, Sulphur)”.

(7) “Patients, anaemic and chlorotic, who have taken much Iron, Quinine, Mercury, Tonics even years before.”

(8) “Follows well : after Kali bichromicum, Lycopodium, Sepia, Sil, Sulphur.”

Now I will describe a few cases treated with Pulsatilla :-.

No.1. A Case of Headache.

About a year back, a young person, aged about 22 years, came to me complaining of headache in both the temporal regions for one week. The pain was better by tightly bandaging the head and cold applications ; there was also slight yellowish discharge from the nose. On questioning further, it was found strong desire for drinking cold water ; no other derangement was detected in him.

Pulsatilla 200, one dose, was given on 15th Nov. 1938. Next day his headache was better but he began to complain of severe pain in both his feet. On being questioned he said that the pain in both the feet was his chronic complaint for the last four years. Placebo was given for several days, after which the pain in the feet disappeared and there was no recurrence of the headache nor of the pain in the feet.

No.2. A case of Measles.

A child, about 2 years old, was entrusted to me for treatment in 1936 after a severe rash of measles had appeared on the body. The child had temperature 104, and was drowsy. There was a bland yellow discharge from the nose, eyes and both the ears ; there was no thirst. Bronchitic signs were present and the voice was slightly changed ; no other symptoms could be obtained from the parents, e.g., time of aggravation of fever etc. Pulsatilla 30, in 3 doses, was given 2 hourly, on the following indications : (1) yellow discharge from the mucous outlets, which was bland, (2) thirstlessness and (3) drowsiness during heat. The next day temperature came down to 100 F and the child was free from drowsiness; on the third day, the temperature dropped down and in a week’s time, the child made an uneventful recovery.

No. 3. A Case of Remittent Fever.

On July 24th, 1939, a child aged about four years was seen by me for fever. There was slight cough, temp. 100F, onset of fever sudden. Child drank about 2-3 teaspoonfuls of water, only once, and had no nutrition after that, not even water; used to cry when covered by warm wraps and refused to be in bed. A day before fever, the child was exposed in bed. A day before fever, the child was exposed to rains; no other history could be obtained from the parents. Child was very quiet. Thirstlessness, aggravation by warm wraps and exposure to rains were the symptoms to base the prescription. Pulsatilla 30 was prescribed in a single dose.

July, 25th- temperature 99.8F. in the morning. Placebo was prescribed ; in the evening it rose to 100.4F.

July, 26th- 100.8F. in the mornings, Pulsatilla 30 was given again in the evening ; 101F., in the evening.

July, 27th- Child drowsy, temperature 104F. throughout the night.

July, 28th- Temperature 102F. in the morning ; placebo prescribed ; rose to 104F. at night.

July, 29th- Temperature 102F. in the morning ; Pulsatilla 200, one dose, was given. Temperature began to drop down slowly and came to 98.2F. the following morning and did not rise again.

No.4 A Case of Pyelitis (B. Colic).

This was the case of an infant, aged about 6 months. The infant was vaccinated when it was five months old. In Jan. 1936, the infant began to get fever about 100F. with few bronchitic signs. It was treated allopathically for the first 2 days, with diaphoretic mixture and euquinine. This had no effect on the fever and the temperature used to go up to 102F, twice in 24 hours, once at 10.30 A.M. Pyelitis is one of the obscure causes of fever in infants and children and even in adults. The essential thing for correct diagnosis is to suspect it and get the urine examined.- The urine, on examination showed albumin and pus. The case was again “taken,” with the following symptoms :

1. Agg. of fever at 10.30 A.M. and 1.30 A.M.

2. Drowsiness, during heat.

3. Vomiting, on coughing.

4. No thirst at all.

5. Aversion for milk.

6. Urine, turbid.

7. Urine, albuminous.

8. Urine, offensive.

9. Frequency of urine.

10. Kidney.

Pulsatilla stood very high on repertorization. It was given in the 30th potency, (single dose), on 12th Jan., 1936.

13-1-1936. Temperature dropped to normal, so placebo was given.

18-1-1936. Again the temperature rose. Pulsatilla 30,repeated.

19-1-1936. Temperature, normal.

27-1-1936. Temperature rose again to 102F. Pulsatilla 30, was again repeated.

28-1-1936. Temperature remained the same in the morning.

I thought the dose had no action and I committed an error in repeating Puls 30, on the 28th morning, with the result that there was severe aggravation for three days. Child became more drowsy ; temperature rose to 104F. and inspite of the ice, it remained at 104F., for three days. I waited for three days with great anxiety and then on 1-2-1936 the temperature dropped down and the child was better in every way. Again after a week, the child got fever ; the urine was again examined and founds to contain pus, but this time there was no vomiting on coughing, e.g. the cough was much less. Pulsatilla 200, was prescribed and the temperature dropped down but the child got stomatitis. I thought of giving the child a deeper acting remedy to prevent the relapse of fever. Sulphur 30. was, therefore, given in one dose. I now thought the case would recover, but the temperature rose again on 26-1-1936 to 101F., as usual the urine was turbid and contained pus. Thirst was absent and change of posture aggravated the child. Puls, 200 was given again and the temperature dropped down next evening. As Sulphur did not take hold of the case and as there were early relapses I changed the deep acting remedy. Silica, 30, was given in one dose on 28-1- 1936, particularly as the trouble had come on after vaccination but the child again and the temperature dropped down after two days. But on 13-3-36, there was pain in the left lower extremity and slight movements of the left lower limbs would make the child cry with pain. There was no evidence of acute inflammation nor any cause for pain could be accounted for. So I consulted Dr. Dhawale. He diagnosed the case as that of scurvy and advised administration of orange juice. This was done and the pain disappeared in about two days time and never recurred again. But the child could not be free from fever. After a week or so the old symptoms would come up. I therefore went on gradually from 200 to MM of Pulsatilla But the child became very irritable. It always desired to be carried by somebody in the house, all the 24 hours! Would sleep only on Dr. Dhawale. On his advice, Chamomilla, 30, was given to antidote the effects of Pulsatilla ; and then that symptom disappeared completely! In 1937 the same child was attacked by measles, in about a week’s time the rash and the other symptoms disappeared under Pulsatilla, 30, but the temperature kept on and the following symptoms were noted.

1. Abdomen distended and child passing flatus frequently.

2 Child, cross, early in the morning.

3 Cough.

4 Liked open air.

5. Agg. of fever in the evening.

I thought that some other deep acting remedy, complementary [complementary medicine would act only when indicated by the presence of its characteristic symptoms. -L.D.D.] to Pulsatilla should be chosen and then alone the temperature would drop. Taking into consideration the flatulence and the early morning crossness of the child, Lycopodium, 30 was prescribed in one dose and the temperature dropped at once. Child is now completely free from any kind of trouble. Here I have to thank Dr. Dhawale for the ungrudging help he gave to me in treating this case.

DISCUSSION.

DR. R. R. PAI. : I would like to know whether Dr. Patwardhan has used Pulsatilla as a prophylactic against measles.

DR. R.P. PATWARDHAN : Yes, I have used it when there was a case of measles in my family, to prevent the disease in other children who had not their turn till then and they did not catch the infection from the patient.

DR. J.N. KARANDE : Pulsatilla is a very useful remedy in gynaecology as well in pediatrics. I have found its mental symptoms to be the leading ones, change of symptoms being another characteristic which leads one to the selection of this remedy. Earache, ameliorated by cold, when found in children, is very often successfully met with Pulsatilla. It has also helped me in pyelitis, when indicated.

Dr. L. D. DHAWALE : Pulsatilla is usually ameliorated by motion ; but when indicated on other symptoms, it has been reported to have helped pleurisy with stitching pains in the side of the chest during motion, cough or breathing. I have used it in pulmonary tuberculosis in a male patient, with a good sway, covering a long range, in potencies from the 30th to DMM. The symptoms would then alternate with Bryonia, in the same way.

I have used it in this epidemic of whooping cough in various cases even when complicated by broncho-pneumonia. The trouble was accompanied with yellow nasal discharge. In some cases it was followed with success by Bryonia when the typical thirst for large quantity of water ushered in.

I have also found it to be a good remedy in cases of high-blood pressure as it has a marked action on circulation.

In a case of a menstrual disturbance associated with a severe upset in the digestion-before, during and after menstruation, it helped the patient when an allopathic line of treatment from various quarters proved of no avail. The remedy is not only indicated when the menses are scanty but also in cases of metrorrhagia. It has got such a strong action on the mucous membranes that even the menses, which are generally scanty, are slimy.

In the male generative organs it is indicated in gonorrhoea with a thick, yellow discharge from the urethra and it is also indicated in troubles resulting from suppressed gonorrhoea.

But do not forget Clematis erecta which I have used with marked success in cases of suppressed gonorrhoea associated with ilio- scrotal neuralgia with severities of a varying nature, when allopathic aid from the best hands proved useless!

I have also used Pulsatilla successfully in a case of hydrocele which was markedly better with application of ice. Temperamentally he was of a timid nature, a statement made by his wife and accepted by the husband without contradiction.

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R.P. Patwardhan

R.P. Patwardhan
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