Rauwolfia serpentina — proving
Rauwolfia serpentina [Rauw.]
THE FACULTY OF HOMOEOPATHY, PROVINGS SECTION 1954/55 REPORT ON RAUWOLFIA SERPENTINA BY DR. W. LEES TEMPLETON
(British Homoeopathic Journal, vol. 00, no. 00, Xxx, 0000, page no. 155-167)
DURING the war we were often asked by radio and poster "Is your journey really necessary?" and with appropriate changes we might well ask today, "Are provings really necessary?" though I should prefer to alter the wording and ask "Are they really worth while?" Are they worth the time, the effort and the money expended? The answer to this query rests with you and a simple test might well be applied and to which I would like an answer today - have you used the symptomatology of previous provings made by the Faculty in prescribing and with what effect, if any? Have you used them at all? I was led to be so unusually provocative by an article in a recent JOURNAL (not the BRITISH HOMOEOPATHIC JOURNAL, probably, if I might suggest, because the BRITISH HOMOEOPATHIC JOURNAL was so long in appearing), on "Accidental Provings of Cortisone" with a criticism (suggestive criticism, I admit) of adequate provings, though whatjs adequate seems to me as difficult to decide as to what is a healthy individual, especially as the author predicates that we all, from birth onwards, are in conflict with adverse forces in addition to the inherited psoric, sycotic, luetic taints and the acquired toxicoses, sensitizations, allergies, that our conflict with hostile influences, both endogenous and exogenous, together with wear and tear render invalid the claim at any given time to full and equivocal health. Yet, this observer proceeds to offer, as a contribution, a generalized collection of so-called accidental provings with the Cortisone picture of a tendency to roundness of vision and obesity of torso (how many of us can plead guilty), a liability to fall prey to infections, altered function of digestion, circulation, menstruation and other bodily activities and (which seems an understatement), possibly a change of personality.
We have undertaken this year to test out a drug. Rauwolfia serpentina, on what we regard as average healthy young individuals, male and female, who have given us a full personal history of illnesses, family history, and on whom we have used the sedimentation rate as a fair measure of toxic or tissue destructive diseases. In this imperfect world one must have some latitude in deciding even what shall be accepted as a healthy individual, whether on physical, psychological, physiological, biochemical or biophysical standards. The virtue of using "imperfect" individuals as provers is that the symptoms produced in them are much more likely to resemble those of the more imperfect, the sick, upon whom the drugs will be used in a presumably curative sense. Numbers? One finds that small groups are perhaps much better than large masses. One may, I feel, assume that a small group, not handpicked by any standard may be taken as a cross section of a larger number. The time factor is another point of query. How long should this be? How can one say? Time of administration? Duration of time given to interrogation? Well, before breakfast for administration, an average of six months for duration and as much time as possible for interrogation. I hope the criticswill be satisfied with these replies.
But there is one other: Hahnemann is quoted as having the genius of being able to isolate the essence of the remedy from hundreds of symptoms. I, having no such genius, would ask for your collaboration today and when you are listening, write down or remember which symptoms seemed to come through the provings of Rauwolfia, which is
the thread which seems to run through the mass of symptoms apparently unrelated and, above all, to which other remedies it seems to bear a resemblance. That would, I feel, be of the utmost value in giving one a composite picture of the drug, the essence of the remedy, and which is so often never realized until the mass of symptoms are read or
heard. Then, and then only, is it possible sometimes to recognize the essentials of the remedy, eventhough it may take many years of use (I emphasize use) to give it clothing and colour. I offer you but the bare bones. It is for you to give them flesh and blood.
I have decided this year to give you the symptoms of the provings before describing the side effects from orthodox pharmacology. PROVINGS OF RAUWOLFIA SERPENTINA
Faculty of Homoeopathy Research Unit, Session 1954/55
Number of provers, 6. Number of controls, 4. (One or two others fell by the wayside and are not included if incomplete).
Preparations (supplied by Messrs. A. Nelson & Co.). 3x, 6x, 12c and 30c. MENTALS
Poor judgment, lack of concentration, weariness (better for violent exercise), irritable, depressed, better alone. Cant be bothered, forgetful, unreceotive. sluggish mentally "as if had a shock". Needs driving, everything an effort, difficult to get going, dazed things unreal, day-dreaming, tired mentally and physically or on top of the world and over-enthusiastic. Abrupt with people, almost rude, difficult to enthuse, spells words wrongly, uses wrong letters in writing, forgets where placed things, for what he has done. Hazy, senses numbed, a disappointed feeling. Not interested, not alert, slow getting down to things. Mental exhaustion, utterly spent. Too tired to be sociable, so better alone. Desperately tired.
HEAD
Frontal extending to vertex and occiput. As if would burst (c.f. Glonoinum), worse combing hair, sore, pressure top of the head, worse coughing. "Creeping crawling" sensation on falling asleep. As if head would float off whilst walking. Weight on vertex pressing inwards. Heavy, stabbing ache right temple extending to left on waking. Constriction scalp. Brain feels sore, worse cold wind, "blurred" vision. Stabbing pain left side neck extending up to occiput. Aching pressure as from circular band over eves: like tight band forehead. Aching across eves on waking, better cold hand, cold water, fresh air, pressure, sharp, right eve on waking. Frontal ache better open air, neck upwards. Worse on looking upwards.
EYES
Heavy, tired, aching, sore, burning, sore edges like sharp pinpricks. Sore itching, tired, "sticking" both canthi, worse cold wind and reading. Sore tired, smarting, stinging, heavy, worse moving eyes side to side.
EAR, NOSE AND THROAT
Heat and redness of the right ear, burning right ear. Pinna hot to the touch with burning right side of the face. Burning both ears, Sharp pain left ear.
Dry lips, metallic taste mouth. So dry lips desquamating,.dry around mouth and lips. Sickly taste mouth. Heat of the face. Dry skin face, pulsating, throbbing toothache, worse warm food or drink. Hot flushes face with sweat, worse 6 to eight PM. Right side face and ear hot and red. Left normal, worse 5.30 PM, Iios dry and cracked. Aching, throbbing gums, worse four PM Dry nose, dry tongue sticks to roof of mouth, tooth marked tongue. Crack middle lower lip.
Dry burning throat and tongue worse night. Sore throat worse saliva. Very dry, as if swollen, parched and dry throat. Sore soft palate. Cough hurts larynx. Dry burning, better sweets, sips cold water, worse AM Sore on waking. Dry, worse singing. Amazing, tremendous "vibrations" left side neck (carotids), uneven flutter leading to violent throbbing so violent thought others must see it (c.f. same sort of vibrations foot). Nose streaming, sore "congested" sneezing, better out of doors. Never thickened up (like a rhinorrhoea). Gluey. Slight "sniff" for weeks, worse cold wind, worse stooping, worse entering warm room. Stuffiness nose all the time with sneezing, blocks up alternately. Blows but nil comes (c.f.Sticta).
URINARY
Burning tip of meatus on passing urine. Cutting pain left cord. Burning after micturition. Stinging and irritation after stool and in perineum. Very pale profuse urine. Very frequent, 5 to nine PM and 3 to seven PM RESPIRATORY
Cough from cold air. Shortness of breath keeps on trying to take a deep breath. Pain sharp beneath left breast on laughing. Tightness chest evening. A deep inspiration "sensation" from epigastric region extending to the gums. Breathless PM, constriction upper chest like a pull from epigastrium through to the back on coughing. Breathlessness extreme on running even a few yards. Feels sick and breathless. Heart beats into throat, better relaxing. Sore ribs better folding arms into axillae and rubbing gently. Strained pain chest. Breathless as if he had run miles. Stabbing pain right lower chest (epigastrium) alternating left to right. Aching chest wall after exertion. Compelled to take deep breaths after cycling. Sharp pains nipple region. Pain lower chest on singing. Short of breath on climbing stairs or cycling, cramping sharp pains lower chest in front and lower sternum. Cramping pain both nipple regions. Coming slowly, going slowly, worse exertion,
HEART
Beating forcible and loud on climbing stairs or sudden exertion. Loud forcible beats after cycling up hills (never before). Pulsation felt in teeth. Constriction area apex beat. Griping pain apex beat area, griping pain, sharp, stitching pain heart after exertion upstairs, e.g. from front to back chest coming suddenly going suddenly, worse sudden exertion, rushing upstairs. Conscious of heart beating region above clavicle and little fingers (worse thinking about it), or reclining after exertion. Sharp pain region apex beat. Stitching left hypochondrium extending to heat. Beating felt occiput and temples. Palpitation heart, beating in throat after running few years, felt sick and breathless sharp pain below left breast. Sharp prickling pains right nipple region coming and going quickly. Sharp pain region of heart with guick beats worse bending down. Short of breath (unusual). Sharp stitching pain under heart four PM. Sharp nagging left breast quick go similar right chest. Sharp shooting pain under left breast with feeling of suffocation. Pain under left breast with breathlessness on going upstairs and pain above right breast extending to neck, jaw, and down right arm, worse turning head to the right, moving left arm produced pain right arm. Worse bending. Pain right side chest on relaxing after hurrying, dull ache right chest with slight cough. Pain right chest worse housework or effort of lifting. Pain in and out left chest coming and going every few seconds on walking and shopping.
STOMACH, ABDOMEN. RECTUM
Pain right groin, and right iliac fossa. Diarrhoea (had to get out of bed for this). Very hungry all day, next day off food completely. Pain left groin, averse tea, desire fruit drinks.
Sharp pain abdomen, 5.30 PM to 6.30 PM, feels hard like stone, colicky pain below the navel 7 to ten PM, terrific, better doubling up, pressure, heat, with great weakness "as if part of inside would drop you", 7 to eight PM better loose stool, heaviness and discomfort abdomen, worse six PM, blown up with few mouthfuls of food, worse 6.30 PM, followed by profuse diarrhoea with great weakness and nausea. Hunger 10 minutes after food. Pain right to left abdomen, waves coming and going, urge to stool frequent, but great straining necessary. Hard then loose up to 6 daily. Wind after meals, "tense” navel, fullness and nausea area of navel. Hunger 1 hour after bring meal. Ache right to left. Much straining with stool, small stool followed by big stool. Soft stool 1 hour followed by watery stool, stabbing shooting left hypochondrium. Nausea in Underground, not every warm. Eructations tasting of food 2 hours p.c. Loose stool followed by watery stool 1 hour later. Loose stool 1 hour p.c. Constant ineffectual desire for stool. Fullness bowels tension. Stool "bitty". Upper abdomen tense, congested. Stitching pain 2 hours p.c., better sitting, eating, hot tea. Pain umbilicus worse cough, stool, stretching, rising up in bed. Abdominal muscles feel strained, worse stool, nausea whilst eating. Averse sugar in tea. Violent spasm wind immediately p.c. 6.30 PM, hunger pain left hypochondrium. Stabbing pain 2 hours p.c. 4 PM two stools one hour after the other, often beginning (1) formed then (2) loose then (3) watery, severe pain navel radiating 1 hour p.c., across epigastrium, better bending. Severe straining and pain whilst beginning stool. Stitching pain epigastrium, on waking, better out of bed. Wandering pains just above nave,. Two stools with feeling of looseness all day. One firm stool 1 hour later loose one. Cramping pain waking from sleep left lower abdomen as if hand gripped intestines and relaxed slowly. Abdominal discomfort better lying on stomach. Hunger for savoury things. Thirst for cold water evening (6 tea cups). Eating between meals. Must eat. used to like. sweets now off and desires savouries. Desire to eat even after full meal.
BACK AND EXTREMITIES
Stiffness muscles of back (sacrolumbar) on waking, pain left hip after sitting in one position, aching wears off, worse "putting the weight of body on the leg", worse standing, worse crossing one leg over the other, worse straightening leg after being bent for time, difficult to move quickly after resting, worse going upstairs 2 to seven PM, thrice between 6.30 and 7.30 PM, lateral aspect thigh, in the bone, coming quickly and going quickly down to ankle five PM. Stiffness left knew, worse up and down stairs. Leftsacro iliac on waking, worse after sitting, 1st movement, leaning back, leaning forward, better halfway, better walking, worse taking stride, better hard pressure (corner of table). Right foot frozen cold all evening, pins and needles and tingling 3rd and 4th fingers AM Pain left shoulder moving head right or left. Aching calf muscles worse standing or walking. Sickly pain behind knee worse leg bent. Aching lower back, dull better pressure movement, worse sitting. Sudden sharp pain right wrist right thigh, right biceps, worse swinging it, right arm and fingers, worse grasping. Sharp pain sacroiliac, worse bending and sitting. Pain crest of ilium. Pain behind knee, inner side, worse standing, better extension, worse sitting, worse weight of body, better taking weight off leg. Pains right elbow, palm, sole, foot (pins and needles right), right groin, base big toe upwards.
Stiffness calves getting out of bed wears off. Twitching left calf (c.f. side effects) on getting into bed. Pain base left thumb, stiffness with sense of warmth little finger, had, arm, axillae, better cold. Stabbing right shoulder, better movement. Ankles hot itching, swollen night, worse heat. Pain left loin worse standing, better pressure. Pain behind right knee worse walking and pressure. Thighs and buttocks aching. Sharp pain behind knee, tired, weak, worse standing, heavy legs. Cramp right leg, knee to ankle and left. Sharp pain sole of foot, right shoulder. Shooting pain left forearm, right leg, knee to ankle, worse standing. Like pin pricks running through body, waist, big toe (right.)" Pulling" in various muscles, buttocks up and down, heavy legs, pinched left arm, right axilla, worse rising from sitting. Pin pricks and pulling arms, legs. Sharp stabbing pain left scapula coming and going guickly, thigh to toes, right shoulder, left leg, sitting, "pinching" buttock, sharp stabbing pinpricks, left toes upstairs. Dull ache lumbar region extending bend of the knees, worse standing. Legs heavy, worse walking "as if would give way". Twinges right wrist, worse movement. Cramp both feet PM, legs like cotton wool, worse upstairs, thigh muscles tight and stiff, better stretching, aching base of scapula and lower ribs. Tender pelvic brim, tight stiff pain buttocks and knee joints, worse sitting, thigh stiff and heavy after exertion. Aching sacrolumbar worse sitting, better movement. Shoulders heavy, biceps stiff, weakness legs. Left thumb hot red burning "as if electric radiator played on it". Aching thighs and knees. Sharp spasmodic sudden coming and going pains lower dorsal right. Red fiery hot burning knuckles right hand, rest of hand cold. Aching shoulder, fingers, better movement. Darting pains stinging pains thigh. Heaviness base of spine. Weakness legs, worse cycling and walking. Sharp stabbing right lumbar region. Aching sacro iliac knees, ankles, feet, wears off. Stabbing pains inner side upper arm extending elbow. No modalities. Left arm like needles being stabbed in and out quick "come and go”. Like thread of pain right upper arm to base ofthumb, right little finger hot and red. Sharp shooting pains limbs, right to left like sparks. No modalities. Jobbing in and out right upper or. stitching throbbing left calf muscles on getting into bed. Dull ache knee joints and lumbar region, worse sitting and standing. Pain veins ankle. worse weight of body or pressure pain calf and ankle. Left ankle as if strained or kicked. Can't bear weight of body on it, worse running and standing (malleoli). Soreness left axilla, right arm, wrist, thighs, hip joints worse touch. Aching deltoids ”as if strained". Pulsating right palm and index finger. Feet and base of heels ache as though from much. standing. Constant ache, rheumatic, outer thigh and left ankle, worse prolonged weight of body. Aching back of knees AM. better rising, pulsation little finger, knees ache, worse cycling and walking, better rest and warmth. Occasional aching or sharp right and left deltoids left shin as if kicked, worse pressure. Sharp shooting right thumb, dorsum left foot worse pressure. Tired ache legs as if strained, left ankle weakness legs, cycling, shooting pains, left knee, ankle, right index finger as though kicked. Third finger "slow come slow go", knees ache worse standing. Dull aching fingers, arms, toes, muscles, across shoulders, back upper arms, calves, "as though been on rack" (cf.pulling).
Buttocks bruised on sitting, cf.left leg as though wants oiling, coldness tips fingers. Plus reaction on being heated. Sharp stabbing pain both wrists, worse night. Burning soles feet (wanted to bathe in cold water) sore and hot.
SLEEP
Dreams of travelling, jumbled, "that she was being killed", "of mother being drowned", "that tonsil had burst", "tooth broke off", "that jaw was broken", "of being stung by wasps". Very sleepy, could sleep eternally, can't get enough sleep_or awake with overactive mind. Restless, clothes off bed. SKIN
Irritation like hair on skin, cracked heels, skin face dry, flacking of skin, of face, hands as if dusted with talc powder, dry skin, very dry. GENERALS
"Out of the world" feeling. Weak physically and mentally. Slow in word and deed. As if got a temperature, but hadn't, worse warmth of room and fire, better open air, worse warm weather and muggy weather (usually opposite). Weak all over after bath, worse travelling underground as if would suffocate. Weakness, poor memory, as if got temperature, better air, hot and flushed, sweating and sinking as if afraid, face flushed and hot, looked it and felt it as if got fever, hot, uncomfortable all PM. woke hot, better standing by open window to get cool, worse warm room, better open air but soon chilly, burning cheeks, cold hands. Very hot in heated room. Wants to fly to the open window. Trembling anticipation as if infection coming on. Weak at the knees (as if afraid), "detached" feeling, "day dreaming", "fear of vomiting", "fear of being ill". Weakness with periods of utter exhaustion.
Rauwolfia serpentina
Indian literature records the use of preparations of the roots ofthe Rauwolfia species for the treatment of dysentery, snake bites and fever (? malaria), and in more recent times as a sedative for insomnia and insanity. The genus Rauwolfia belongs to the Apocynaceae and contains somewhere near 40 to 50 species. Preparations of these roots were found to have definite hypotensive effects when tired on animals in addition to hypnotic and sedative effects. The action ofthe root preparations are thought to reside in the content of alkaloids of which at least 15 have been isolated, two ofthe most active being rescinnamine and reserpine, substances related to yohimbine, known to medicine as an aphrodisiac. It has been suggested that the hypothalamus is the site of its activity, but this is still unproved, but if so, the effect in lowering blood pressure is probably considered to be due to a direct depression ofthe blood pressure regulating centers in the hypothalamus. It has been suggested that the drug acts mainly by protecting, from abnormal tensive stimuli, these centres in the brain. Fall of blood pressure is always associated with slowing ofthe pulse and the depth of respiration is increased, but the rate remains unaltered. Intestinal mobility is increased in dogs but notin monkeys or rats, yet diarrhoea may occur and often does in humans.
There are quite a number of so-called side effects. Whether they are to be regarded as toxic effects is a matter of opinion as is also whether one is justified in accepting these side effects so-called as crude provings. One would only feel justified if they corresponded with the symptomatology of provings with minimum doses.
Diarrhoea is common, but patients do not complain and stated that they indeed felt better. Depression occurs in a certain percentage (15 percent, in one series). Some complained of fatigue, lack of energy, drowsiness, muzziness, loss of interest, loss of libido, feeling of being strung up inside (cf.ours) and vague general malaise. Some complained of flashing lights followed by temporary amaurosis. Buzzing or fullness in the head was another description and nasal congestion by others. Some had nausea and occasional vomiting. Diarrhoea occurred in 24 percent, of one series and necessitated cessation ofthe drug, as did two cases of severe depression and one case of attempted suicide by gas. Increased appetite was also noted.
It was interesting to note that patients with angina of effort were not relieved, butthose with precordial discomfort occurring at rest were ameliorated, as were palpitations, vertigo and tinnitus. Other side effects noted by another observer were nausea, anorexia (more frequent) or looser stools, headache, dizziness, heaviness ofthe legs and urticaria. Others note depression, fatigue, heaviness ofthe limbs, mental excitement, dryness ofthe mouth, weakness in another group was prominent as well as drowsiness, diarrhoea, anorexia, and one observer reported twitching ofthe limbs.
Recent American reports of side effects are concerned with mental depression states, emotional upset, one suicide, one attempted suicide, all after two months’treatment. The early signs are noted as excessive fatigue, loss of interest and initiative, inability to concentrate, insomnia, excessive nervousness, with a later development ofthe paranoid state.
An average description of so-called toxic effects from a series of over 20 cases is as follows:
Excessive drowsiness and sleepiness.... 6
The Rauwolfia species are named after Leopold Rauwolf, a German botanist, 1582. Fourteen alkaloids have been isolated and it was known to have been used in Europe 300 years ago for anxiety states. Patients seem to feel relaxed and free from previous anxiety and tension (only with reserpine).
Dogs lost some of their active interest in surroundings. Rhesus monkeys showed alteration in behaviors and attention. Whereas previously striking would produce anger and aggressiveness, now amiably tolerant. Natural interest in other animals and curiosity lessened. (Rodents showed ptosis of eyelids) a Dog (p.13) showed augmentation of secretory and excretory motor activity ofthe gastro-intestinal tract (increased volume and HCL content) in human (boy) accidental overdose produced flushing all over. Effect antipressor in those who respond. Nothing at all in those who don't.
Factors determining responsiveness not clear. Two corollaries from this: areas ofthe mosaic of essential hypertension. Mechanisms obscure but distinct Reserpine and Methonium drugs.
So we are putting the therapeutic cart before the etiologic hours. Side effects nasal congestion and cough, are not related to the hypotensive action. Importance of blood pressure taken as average, home or hospital as opposed to casual consulting room figures. No evidence of endocrine action as result of inhibitory effects on hypothalamus which — is generally considered to be site of action.
Majority of patients treated with Rauwolfia for hypertension undergo alteration in mood with a feeling of relaxation, tranquillity, well-being with abolition of anxiety and agitation. Others, however, show lethargy, drowsiness, lack of interest and initiative. Suicidal in 2 cases, but 5 out of 7 had previous history of psychological illness. Rauwolfia acts or seems to act as trigger or precipitant in patient previously predisposed. Effects thought to be on hypothalamus (cf. Stewart, Glasgow), why not clear. Patients treated with Rauwolfia are relieved of normal inhibition and of excessive preoccupation with the opinion of other people (cf. Anxiety for others). Have a desire to confess troubles (p.839 Schroeder and Parry, ibid).
Used for tranquillizing effect in hypertension (Yohimbe-like drug). Can cause in predisposed individuals nervousness, insomnia and agitation. (Cf.Home provings in predisposed? sensitive persons). Even Parkinsonism induced by drug, recurrence of peptic ulcer (cf.proving). Severe mucous colitis with some ulcers in one (parasympathetic action). Psychotic behavior with agitated depression occurred in 5 with no previous psychotic history.
Ibid.
Side effects in 53 patients.:-
Nasal stuffiness 83 per cent.
Sedation 75 per cent.
Excess appetite 75 per cent.
Dreaming and nightmares 42 per cent.
Laxative 28 per cent.
Depression 17 per cent.
Muscle-ache and cramps 9 per cent. —
Headaches 8 percent.
Chilly sensation 6 per cent.
Short of breath 6 per cent.
Dizziness 6 per cent.
Urinary urging 4 per cent.
Frequency of mental depression nor coincidental.
Produces peripheral vasodilation of an allergic type (cf. our isolated flushings).
Rauwolfia may relieve abnormal inhibitions (Took anything from his wife previously, now threw a dish of tomatoes at her.
Salesman avoided calling on customers. (Excessive preoccupation with opinion of other people).
Ideas lost their drive - "a new man". Regained confidence.
Chronic worrier-now no longer "bleeds”. ’I do what I can and that's that." Diminution of anxiety (Don't care attitude).
Unable to remember what he had actually done, as opposed to what he meant to do (had to stop medicine), cf. Provings.
Another "careless" of business details, gave up the medicine.
More sociable, more outgoing, less reserved, less inhibited. Stiffness in nose.
Sinus bradycardia without alteration in EEG suggests decreased sympathetic preponderance whilst increased gastro-intestinal activity suggests either increased parasympathetic or decreased sympathetic hypothalamus where autonomic functions are integrated most likely region.
Sleep also could be due to suspension ofthe sympathetic centres in the hypothalamus (hence action of Reserpine could thus act by causing partial suspension of this centre). Established physiological concept that emotional response is mediated through hypothalamic centres and that the dampening of this response is normally due to cortical inhibition exerted on the hypothalamus. By analogy reduced emotional response of monkey to threatening situation could be attributable to hypothalamic inhibition in this case by drug action.
Fall in blood pressure referable to fall in peripheral resistance rather than in cardiac output.
Side effects always sedation, nasal stuffiness, weight gain, diarrhoea, nightmares or depression. The sedative action will not make people sleep. It simply makes them sleepy and even so they can attend to business or watch a television show without falling asleep, but do doze in church (?implication). Some lyrical about their sense of well being - "I've never felt so well", "nothing bothers me now", "I just don't give a damn". Rauwolfia they say is good psychotherapy in pill form (change?). It decreases neurotic symptoms in all patients and reduces the blood pressure in young labile neurotic hypertensive with tachycardia.
Flushing of whole body in large percentage (intravenous); calmer, sleepier, stuffy nose, relaxation in large percentage and dyspnoea in small percentage (p.57). No ECG changes in spite of bradycardia. Reserpine cuts through the metabolic degradation to a yohimbine-lime substance having sympatholytic properties (p.59), (p.67). "All in feeling’ in 34 per cent nasal obstruction, nasal discharge, even purulent sinusitis and hemorrhagic sinusitis in 24.8 per cent. Aching legs, 14 per cent, loose stools 9.8 per cent, dreams 9 per cent, dyspnea 7.3 per cent (at rest), sighing respirations, paroxysmal nocturnal dyspnoea (like cardiac asthma), but not due to cardiac disease (p.78) nasal obstruction, lethargy, muscle aches and pains, especially legs, dyspnoea at rest with sighing respiration (cf. Iqn.). Dyspnoea in some patients, often awakened after 2 to 3 hours with dyspnoea which resembled paroxysmal nocturnal dyspnoea due to cardiac failure (patient had no demonstrable cardiac disease) suggested that Reserpine acts on respiratory centre and therefore central in origin (cf.barbiturate poisoning, HCN?), (p.79) studies suggest that a central site of action on the nervous system highly likely as shown by the blocking of respiratory and pain reflexes by Reserpine (inhibition ofthe digital vasoconstrictive reflexes following inspiration, pain or electric shock).
It would not seem that there is any specific relationship between the degree of hypotension produced and the symptoms of depression or whether indeed the symptoms so produced should be accepted as crude provings. One cannot but admire the courage (and we are worried sometimes about our provings effects) of those who lower blood pressures from such levels as 204/130 to 110/78 or 230/140 to 92/64, not would it be surprising if depression resulted. I have not been able to find any detailed account ofthe symptoms of e.g., delusions and nightmares. How annoying it is from our point ofview that this sort of detailed symptomatology is neglected. That depression is feared is shown by the dictum of one expert that he is now unwilling to give Rauwolfia to any patient with a significanthistory of depression and to regard the onset of unexplained depression as an indication to stop the administration ofthe drug. I am hoping our President may be able to give us some details ofthe type of depressive attacks so produced, the __
sort of detail which one can feel is justified in being accepted along with provings or even as provings. It is interesting, too, that in some series there are those who show the usual lassitude, sleepiness, etc., and others for no known reason show the opposite (also exemplified in our provings), namely, tension, anorexia, abdominal discomfort (in the provings actual pain). Cases of anxiety and depression showed a high percentage of improvement.
And so, having considered the provings and the so-called side effects in that order, we must now try and pick out, or shall we say first agree that the general picture does correspond. Knowing that the provings were made with a single blind in that I did not know which were having the drug and which were not, and that the literature was purposely
not studied until after the provings had been analyzed, I think it would be fair to admit that the general picture does correspond and with doses from 3x to 30c. That is remarkable in itself, as showing the effect of potencies or small doses.
For example, in both provings and sleepiness. Afeeling of tranguillity. Depression, lassitude and exhaustion. Diarrhoea, excessive appetite, dreams and nightmares. Muscle aches and pains: dyspnoea.
Bust as we know that such generalizations are useful in putting a patient into a group such as the Acids we must have much more detail before we can match the symptoms ofthe individual patient. Have we then such detail from the provings (with whatever help we can derive from the published side effects, especially from the pharmacological
point ofview)? I think we have.
Take the Mentals.
Lack of concentration is marked but not specific, though the weariness better for violent exercise reminds us of FL acid and Sepia. The sluggishness, unreceptiveness, can't be botheredness, lack of interest lack of will to enthuse, everything an effort, can't get down to it, are matched many times by what we hearfrom our patients (and are perhaps explained by the so-called tranguillizing effect of larger doses ofthe drug) so that the previously anxious worrier does not care a damn now, where he was too inhibited to be sociable now, he does not mid. "Nothing bothers me now" is typical. The difficulty nowadays is that modern descriptions, even modern states of mind are new and are not matched, at least notin the same terms by the older provings, hence the value say, ofthe sense of frustration in the ACTH provings which I have found extremely useful when the hurt of Staphisagria frustration is not present. Here the guide is: "Do not feel things as I used", "daydreaming", "numbed senses and head", sluggish, weary, desperately tired, utterly spent, "must drive myself to work" (how often one has heard that and maybe given and failed with Phos. acid), but it does remind one ofthe acids and might now be considered (that is the value of fresh provings) an addition to one's repertory, especially if led to thinkof it as one often is,.not by mentals but by locals and, then, reading the mentals find they do agree. Indifference to conseguences seems to come into the picture as also lack of interest and initiative.
Head symptoms are not especially noteworthy, though "as if head would burst" (like Glonoine) adds to our list, the floating upwards ofthe skull (cf.the opening and shutting of Cannabis ind„ which one finds present in hypertension), the stabbing pains which seem to be a general of Rauwolfia, and betterment for open air, another general maybe, and the constriction ofthe forehead as from circular band reminding one of Carb.acid, another useful tip. —
Nasal congestion runs through all the side effect reports, but the provings are more detailed. They are stuffiness, blocked sensation, with occasional sneezing but very little discharge. One prover had a constant sniff (as he described it) which was worse for stooping, cold air and entering a warm room. The general picture was like that of Sticta, which, as you know, blows and blows but nothing happens (useful guide
Dryness of Iios, face, tongue (sticks to roof ofthe mouth), throat were marked, cracking ofthe lips with a crack middle ofthe lower lip like Drosera. Throat parched as if swollen, burning, better sweets (Sanguinaria worse) and sips of cold water. Isolated areas of heat and redness of face and ears like Sulphur, e.g.. or Belladonna, hotto the touch, mostly marked on the pinna. Pulsating carotids so violent thought must be seen, may be linked with similar pulsating vibrations in the extremities and teeth, as well as similar sensations in occiput and temple.
Heart and respiratory symptoms are so intermixed that they are better considered together.
Shortness of breath is prominent especially on exertion, though of such a nature that dyspnoea would not normally be expected. Forcible loud heartbeats, consciousness of heart, constriction apex beat (areas of both nipples are common sites) with extension like angina to right arm and jaw. Heart beating in the throat with sick feeling as well as breathlessness. Above all the pains in the heart are sharp, stitching, shooting, prickling, nagging pains which come and go guickly and mostly without any specific exertion (cf. at rest, side effects), but also on sudden exertion like rushing up stairs. Extension from chest to gums is present in another, with shortness of breath demanding effort to take a deep breath (cf. sighing respiration). The description reminded one ofthe pains of Kali carb., stitching pains, especially without modalities.
These should be compared with the side effects of dyspnoea at rest, sighing respirations, paroxysmal tachycardia which, if nothing else, are confirmatory in localization, though without any distinguishing features. Our pseudo-anginal picture is matched with their pseudo-cardiac asthmatic nocturnal attacks, but these are pictures which could be matched in the symptoms of patients, especially in those without organically demonstrable disease though cases of cardiac oedema have been at least aggravated by the administration of Rauwolfia.
One outstanding symptoms ofthe side effects from the administration of Rauwolfia has been, as you have seen, diarrhoea, but what sort of diarrhoea? What, in other words, distinguishes it from others. The provings I think do produce a definite picture of this and it is that the first stool may be firm, though only produced after much straining, but this is followed by a second some hours later which is softer and looser, and this may be followed by another which is diarrhoeic. This gives what others showed a constant urging, a constant ineffectual desire or afeeling of looseness lasting most ofthe day. Hunger was a feature noted in both provings and side effects, such descriptions as appetite incredible, hunger 10 minutes p.c., with the opposite, an aversion to food, heaviness and discomfort ofthe nature of "blown up with a few mouthfuls” (the same contrast as Lvc. hunger with easy satiety), stitching pains 1 to 3 hours after eating, better eating, all of which are matched in the side effects by peptic ulcer aggravation and even ulcerative colitis which so often has the persistent urge and constant feeling of rectal insecurity. Aversion to sweets and desire for savouries came through in more than one proving and there was a possible time aggravation not confined to the digestive tract of from 5 to ten PM (cf. 4 to eight PM. Lvc.)
But of all the systems which seemed to give a number of positive symptoms the locomotor system gave most. This fits the side effect picture of muscle aches, cramps and pains which are guite prominent in most description and for which no physiological not pharmacological explanation is give.
As will have been noted, there are stiffness and aching localized in several provings to the sacroiliacs, to the muscles ofthe calf, behind the knees and in the fingers and toes, the latter being of what one might describe as of a gouty nature, hot, red and throbbing. The stabbing pains without modalities come and go quickly, are described often as pricking and darting. One modality which is reiterated is (especially when referring to the lower extremities), worse when putting the weight ofthe body on the limb and when standing, but the actual effort of weight bearing seems to be especially distinctive.
Sleep was affected. "Could sleep eternally” was one description. Dreams of’being killed’, of’mother being drowned" are noted corresponding to the general nightmare symptoms ofthe side effects.
Skin symptoms were few and corresponded to the dryness noted in face and lips and mouth. Hands "as if dusted with talc powder" or flaking ofthe skin ofthe face confirms the impression.
Generals rather emphasized a reaction to temperature "As if got a temperature" was guoted in several, worse heat, worse warm room, worse warm fire, muggy weather, worse hot bath, better open air, better standing by open widow to get cool, "wants to fly to the open window”, all agree on this reaction and remind one of Cannabis sativa and Chel, in which dyspnoea is better by sitting by the open window and which one has found to be useful in practice. Here it was not so much dyspnoea as afeeling of suffocation. There seemed to be a time aggravation in several systems of from three PM to ten PM, again a useful link with the 4.8 PM aggravation of Lycopodium.
This has not been an easy proving to analyse: I am still hoping that, since the onlooker sees most, that we may obtain tonight a sufficiently succinct picture of this drug so definite that you may find it of use in practice. Only if one gets a picture is this possible. As examples I have already tired the drug out in two cases, perhaps prematurely.
The symptoms of pain lower extremity worse for putting the weight ofthe body was so striking that when I heard a patient, a Pagets disease pretty widespread, say just this, pain ankle for weeks, better rest, but worse when I put my weight on it, I felt I must try it, I gave her Rauwolfia 30t.d.s.. 3 days. I called in fear and trembling to ask how was it. "A good deal better" and she had tried a few analgesics before she got the Rauwolfia. The second was a case with an acute enteritis with fever which, when somewhat improved, said, "Yes, I'm better, but (I hate that But!) I have now a fairly normal stool in the morning after breakfast (that is his normal), but I am uneasy thereafter and when I ultimately go again, it is loose or even watery and once was streaked with bloody mucus and I get a pain before stool in the LIF. (He didn't say LIF, butthat's where it was.) Normal stool, even firm, then uneasy till later, maybe hours, after when he goes again and the stool is diarrhoeic. One dose Rauwolfia 30, one stool AM only and practically no discomfort LIF., but, whether post or propter within a few hours of taking the dose he was overcome with an unusual lethargy, cant be bothered doing anything, not sleepy exactly, but lethargic simply. Sat down mind-morning and read the paper. (Never does this sort of thing.) Felt as if in a dream and lightheaded, though not giddy, opening and shutting (though not painful like Cannabis indica). Not even his conscience bothered him, though he knew he should have been working, was this an aggravation.
I only offer these as showing the possibilities of matching the symptoms even of a newly-proved drug. The picture was in my mind, but it may show, too, what are the symptoms which are outstanding in my mind and which seemed to be helpful. I should now like to hear which symptoms seemed to be prominent in your mind and what would seem to you to be its relationship to other drugs, and if you do not wish to speak, might I have your written comments and opinions.
RAWVQLFINA SERPENTINA
MIND
Weariness, better violent exercise. Irritability, depression, better alone. Cant be bothered, everything an effort, difficult to get down to things, unreceptive, dazed, daydreaming, things seem unreal, out ofthe world, detached. Rude, abrupt, makes mistakes in spelling, forgetful for what has done. Tired, utterly exhausted, lack of interest and drive, unsociable.
HEAD
As if would burst, cf. Glon.: as if head would float off, cf. Cannabis indica. Pressure worse coughing. Constriction scalp, aching as from circular band forehead, better cold application and fresh air. Creeping, crawling scalp on falling asleep, cf.Cocaine, pressure. EYES
Sore aching tired eyes, worse movement side to side. EARS
Heat, redness, burning ofthe pinna hotto the touch, cf. Bell. FACE
Heat flushed (worse 6 to eight PM), dryness ofthe skin. MOUTH
Sore dry tongue, palate, lips, metallic taste, throbbing gums, cracks lower lip. THROAT
Dry burning, worse swallowing saliva, better cold water worse on waking, (cf. Lach.) RESPIRATORY
Cough hurts larynx, from cold air, cf. Rumex. Shortness of breath, keeps on trying to take deep breath (cf. Ignatia). tightness, constriction on running a few yards, feels sick and breathless. As if had run miles when only run few yards, aching chest after exertion. Sharp pains region of nipple, cramping pains lower sternum, worse exertion. HEART
Loud forcible beats on climbing stairs or on SUDDEN exertion. Pulsation into neck (carotids), throat and teeth. Constriction region aped beat sharp stitching pains coming and going suddenly from front to back (cf. Kali bich.). on hurrying with feeling of suffocation, on going upstairs, pulsation occiput, temples, extending from hypogastriumto the heart. Sharp pains right side extending to jaw and right arm.
STOMACH
Heaviness and discomfort worse six PM. blown up with few mouthfuls, worse cough. Hunger 10 minutes after a meal, cramping pains as if hand gripped intestines, better lying on abdomen. Eructations tasting of food. Abdomen, colicky pains region of navel better pressure and doubling up, "as if inside would drop out". Fullness bowels, tenseness.
Aversion to sugar. Desire for savouries and cold drinks.
RECTUM AND STOOL
Early morning diarrhoea (had to get out of bed), cf. Sulphur. Urging to stool freguent but great straining necessary or ineffectual. Formed stool followed by uncertainty, then loose stool followed by watery stool. Feeling of looseness all day. BACK AND EXTREMITIES
Stiffness and aching worse after resting, better for change of position, worse first movement, pain in lower limbs worse for weight bearing, e.g. putting the weight ofthe body on the leg. Worse standing, worse 6 to seven PM, worse position half-way between flexion and extension. Better pressure. Sensations of pulling (as if on rack), darting, throbbing, stabbing, stitching, shooting, jabbing, coming and going guickly, cramping, hot burning, especially ofthe small joints ofthe hands. Pins and needles pricking along the length of one limb. Pains behind the knees (cf. Causticum). Burning soles of feet (wishes to bathe in cold water), cf. Ledum.
SLEEP
Disturbed with dreams of travelling, of being killed, of drownings, jumbled. Sleepy, "could sleep eternally". SKIN
Irritation "like hair on skin", cracked heels, dry skin ofthe face, flaking of skin offace, very dry skin. Hands as if dusted with talcum powder. GENERALS
AS if got a temperature, worse warmth of room and heat ofthe fire, better open air. Worse muggy weather, hot bath, travelling underground, "as if would suffocate". Hot flushed sweating, better standing by the open window, cf. Cannabis sativa and Chelidonium. Wants to fly to the open window. RELATIONSHIP
Compare Lycopodium, Lil.tig., Nat, mur., Morgan Gaertner and its associated remedies. Hell, Lvc., Lachesis, Merc. Sulph., Chelidonium and Chenopodium. ADDENDUM TO RAUWOLFIA PROVINGS Mr. President,
I should like to give, as an addendum to Dr. Templeton's careful and exhaustive survey ofthe provings and toxicology of Rauwolfia, the results ofthe Bowel Flora Study on the provers.
The specimens were examined at fortnightly intervals and a total of 75 investigations were made: 47 on provers and 28 on controls. There was a significant incidence of Morgan-Gaertner bacillus and its related Coliform Group. In the former, a change from B.proteus was noted under the influence of Rauwolfia - a very unusual and rare occurrence and was thought to be highly significant. There was a fairly high incidence of dysentery bacillus.
Among the Control series there were 2 unexpected changes to non-lactose fermenting organisms, in comparison with 4 in the Provers (proportionally 2/7 would have been expected).
Dr.Templeton asked if any particular thread ran through his Provings and Dr. McCrae has suggested Lycopodium - not only does it apparently lie in the same Emanometer group as Rauwolfia, and it is one ofthe chief drugs in the Morgan-gaertner group, which I had independently associated with the Provings, but its symptomatology is remarkably similar.
That there is such agreement between the results of three entirely different methods is surely very remarkable, and confirms the usefulness and scientific accuracy of each.
The symptomatology ofthe Rauwolfia provings seems to be similar to the picture which Dr. Paterson has come to associate with Morgan-Gaertner. The suicidal depression, the fear of disease, the irrita bilitv and the apprehension are among the outstanding mentals. The congestive headaches, with flushing often found in relation to high blood pressure, with unsteadiness in walking and vertigo going on to blindness are comparable to those ofthe provings. The circulation is sluggish with varicose veins; congestion ofthe alimentary tract with catarrh and mucus, excessive hunger; occasional morning diarrhoea; renal colic; fibrositis, particularly around the finger and knee joints, the peculiar 4-8 PM time aggravation has already been mentioned and is typical of Morgan-Gaertner.
Among the drugs which the late Dr. Paterson came to associate with this nosode we find drug pictures similar to the Rauwolfia:
Hellebore: The apathetic depression as if in a dream. Cant think. Slowness.
Lycopodium: The apprehension, the weakness of memory, mistakes in spelling; insatiable appetite, ease of satiety. Right-sidedness, 4-8 PM aggravation.
Lachesis: Sense of suffocation, flushings; left-sidedness.
Merc, sulph. Intense dyspnoea; tenesmus and straining at stool; early morning diarrhoea. Chelidonium: Scapular pain.
Chenopodium: Scapular pain. Apoplexy right, hemiplegia with aphasia. (Boericke).