Rheum Palmatum

[rhabarbarum, rhubarb, natural order, polygonacea]

This plant is a native of China and Mongolia. The exact plant from which this root is obtained is not known. The best rhubarb conies from a plant growing in the very heart of Thibet.

We use four kinds of rhubarb : Russian, Canton, Himalaya and the native rhubarb. This drug is easily adulterated. Good rhubarb should be bitter, aromatic, and it should grit between the teeth ; it must not have any brown specks externally or internally.

Hahnemann has left us a few interesting provings of this drug. It was reproved by Dr. Schneller of the Vienna Provers' Society (alloeopathic) in 1844.

These provings show that the main range of action of this drug is the intestinal canal; the symptoms of vascular erethism which this drug excites, are incidental to the irritation of the stomach and bowels.

Schneller commenced his provings with two grains of a watery extract, increasing this dose every day by two grains. In all, he took three hundred and eighty grains.

After the first two doses, the prover experienced, beside the peculiar, nauseous taste, frequent and empty eructations, fermenting and shifting of flatulence through the bowels ; a peculiar tension and pain in the right umbilical region, which was relieved by discharge of very fetid flatulence.

After larger doses the eructations were less, but the tension and bloating of the abdomen increased; five or six hours after taking the medicine he was attacked with colic, which was sometimes very speedily relieved by papescent stool, and sometimes passed off very slowly. On some days he had several evacuations ; on other days, on the contrary, he passed but a small quantity of hard feceS.

.After six grains, the urine became more scanty and darker than usual, hotter, and its odor was not unpleasantly aromatic ; a prickling slight stinging were experienced in the urethra.

After twenty-six, and more, grains: feeling of sickness; loathing, desire to vomit, pressure at the stomach, rumbling in the bowels; bad, papescent taste, frequent spitting of a frothy, white liquid, with diminution of the appetite; urine scanty, reddish-brown, turbid, and warmer than usual ; stool increased, always papescent, never serous, attended with some tenesmus ; frequent palpitation of the heart and oppression of the chest; pulse fuller and accelerated, especially in the evening; in- creased sensitiveness to emotions.

The last two doses, of thirty-six and thirty-eight grains respectively, increased the above-mentioned symptoms to a high degree. The prover could scarcely refrain from vomiting; the distended abdomen was sensitive; stitches in the right hypo- chondrium, griping in the umbilical region; emission of flatulence was attended with relief; increase of the alvine evacuations, dark urine, general feeling of illness.

HHEUM. 703

chilliness, depression of the physical strength, tension in the back, loss of appetite, dullness of the head, vascular erethism and irritability of disposition.

These symptoms gradually disappeared, the stool became hard and scanty, the urine remained dark one day, and in three days all these symptoms had disappeared.

These proviugs correspond with Hahnemann's pathogenesis of rhubarb in every particular. They show that it is particularly in derangements of the biliary system that rhubarb promises to be a useful agent. The headache which this drug causes, the peculiar manner in which it affects the sight and deranges the gastric func- tions, the pains which it excites in the bowels, are traceable to a primary irritation of the biliary functions.

The action of rhubarb is chiefly manifest in the chylo-poietic system, and its action upon the brain and special senses will be found to be subordinate to its action upon the functions of the liver and of the gastro-intestinal lining membrane.

Wibmer defines the action of rhubarb in the following words : "The root of rhubarb is an excellent remedial agent, occupying an intermediate place between cathartic salts and resins. It stimulates the functional activity of the stomach and bowels, and promotes at the same time the secretion of mucus and intestinal fluid, hence it is a purgative tonic ; the purgative effect never takes place tumul- tuously, with great rapidity, is very rarely accompanied by nausea or colic, is never watery, nor does it ever weaken the digestive process or the muscular power of the stomach and bowels ; on the contrary, these functions are strengthened rather by moderate doses of the drug.

Khubarb moreover increases the secretion of bile and urine, and tinges the last mentioned fluid ; it likewise increases and often tinges the perspiration, which shows that it is taken up by the blood and fluids. It is likewise apt to increase the natural temperature and to accelerate the circulation. Although the diarrhoea which it excites is often succeeded by constipation, yet constipation cannot properly be attributed to rhubarb as an effect of direct action."

There is no doubt that massive doses of rhubarb cause diarrhoea of a peculiar order. Small doses, but sufficiently large to call forth the organic reaction with its inherent characteristic forms, do not cause diarrhoea, but a sjjecies of costiveness which is not constipa- tion, properly speaking, but a sort of difficult stool arising from weakness of the intestinal fibre and consequent diminution of the peristaltic motion. Hahnemann defines this action of the rhubarb in the following note :

704 RHEUM.

"It is not easy and liquid, copious, or painless diarrhoeic stools which constitute the primary action of rhubarb in the bowels ; the action consists in a colicky, rather ineffectual urging to altered fecal discharges. The rhubarb evacuations being mostly fecal stools, this drug is not suitable in fall dysentery (although it produces colicky pains similar to the pains felt in dysentery), for the additional reason that the remaining symptoms of rhubarb differ from those which characterize this epidemic."

DYSPEPSIA Khubarb will prove a capital remedy for certain forms of dyspepsia or weak stomach, if the following symptomatic indications, developed by our provings, come into play : Loss of appetite. Hunger, but no appetite. Sour taste in the mouth.

Yellow coating on the tongue. The mouth feels dry, yet he has no desire to drink. Feeling of repletion in the stomach, followed by drowsiness. Contractive sensation in the stomach, with nausea.

Sensation of nausea in the stomach and bowels. These symptoms may be accompanied by various consensual symptoms, headache, weariness, alteration of temperature, disturbed sleep. Pathologically we may designate these symptoms as dyspepsia, cardialgia, weak digestion, depending upon abnormal conditions of the hepatic func- tions, and these abnormal states again depending upon exciting causes of a physical or moral nature.

BILIOUS DIARRHCEA — The provings which have been recorded by Hahnemann and his disciples fully demonstrate the homoeopathicity of rhubarb to various forms of diarrhoea, more especially bilious diarrhoea. One prover has recorded the following symptom: Fetid, sour-smelling diarrhoeic stools, with griping and shuddering. This symptom enables us to prescribe rhubarb for the

SOUR DIARRHCEA of children, or for the fetid diarrhoea with which they are often troubled during the period of dentition, especially in hot summer weather. There is always some congestion about the head, fever, and a dark-colored, smarting urine, with diffi- culty of passing it; the children have to press hard.

A baby, five months old, has had diarrhoea for four days. The passages looked like chopped eggs, smell sour, and turn green upon standing ; tenesmus, crying and drawing-up of the thighs upon the abdomen ; sour smell from the mouth ; occasion- ally, vomiting of sour, cheesy substance. The umbilical region is sensitive to pressure, the anus looks red and is sore. Prescribed one grain of the first trituration of rheum every two hours. Cured in twenty-four hours. (Kafka in Prager Monat. Shrift. iii., 72.)

The pathogenetic effects of rhubarb in the healthy.organism point

in unmistakable language to the symptomatic characteristics of the-

KHEUM. 705

diarrhoea which comes within the curative range of rhubarb. We have : Cutting in the umbilical region. Cutting drawing in the left lumbar region below the short ribs and anteriorly in the left side of the hypogastrium, directly over the pubic bone; shifting of flatu- lence through the bowels. Violent cutting in the region of the lumbar vertebrae, as if the cutting were felt within the bones, increased by stool.

Papescent, sour-smelling stool ; during its passage the patient experiences a shuddering, and after the evacu- ation the urging is again felt, with pinching in the bowels. Fre- quent urging to stool, after which a thin, soft, fetid evacuation takes place, with colic ; immediately after the evacuation a sensation of tenesmus, nothing can be passed in spite of straining, although an urging to stool is experienced ; this is followed by another passage after a little while ; on rising from the seat, the urging which had been appeased gradually, is again felt with renewed violence ; the pains in the bowels likewise increase, which had set in during the passage of the feces.

Stool mixed with mucus. Stool, the first part of which is soft, the remainder hard, with violent cutting in the bowels. Painful sensation in the anal region as after long-lasting diarrhoea.

BILIOUS DIARKHCEA. — These symptoms, in connection with the urinary symptoms, among which we distinguish urging with less copious discharge than usual; burning in the kidneys and bladder; yellow, also reddish-yellow color of the urine, etc., certainly show that rhubarb is eminently adapted to the treatment of certain forms of bilious diarrhoea where such symptoms constitute characteristic indications ; the condition of the brain, appearance of the tongue, consensual feelings in the extremities, etc., go to complete the group. Nor must it be supposed that, because rhubarb is chiefly recommended for children, it is not therefore suitable to full-grown individuals ; if this were the case, our provings would be in a great measure useless, for children are unable to give a full description of their abnormal sensations in accordance with homoeopathic pathogenesis.

We have already stated that the alterations which this drug causes in the urinary secretions confirm its specific curative powers in derangements of the biliary system ; we derive additional con- firmations from the action of rhubarb upon the circulation. In bilious attacks, colic, diarrhoea, etc., febrile symptoms, chilly creep- ings followed by flaslies of heat, are generally present. Our provers

VOL. II. — 4A..

70b* RHUS RADICANS.

report : Warmth over the whole hody ; heat of the body with rest- lessness ; hurried pulse ; from time to time one cheek is pale, the other red, or both cheeks are pale ; alternate chills and heat, for a couple of minutes, accompanied by a feeling of weariness, anxiety, indifference to everything, even those things which she was habitu- ally fond of : cool sweat in the face, especially around the mouth and nose.

The sleep and spirits are correspondingly disturbed : While lying in bed, the side upon which he is lying inclines to go to sleep ; he feels drowsy ; restless sleep, he fancies that he is walking about, half dreaming, half waking ; gloomy and depressed spirits ; delirium (in a case reported by Brocklesby and quoted by Hahnemann).

We make a deep-red, yellow, strongly aromatic tincture of the root.

RHUS RADICALS.

[CLIMBING IVY; POISON IVY. NATURAL ORDER, ANACARDIACE^E. ]

Stems climbing by means of innumerable radicating tendrils ; leaflets ovate, smooth, entire; flowers racemed in axillary panicles. A vigorous, woody climber, ascending trees and other objects ten to forty or fifty feet, common in damp woods in Canada and in the United States. The stem becomes one to two inches in thickness, covered with a grayish, scaly bark, and throws out all along its length myriads of thread-like rootlets, which bind it firmly to its support. Leaflets three, of a dark and shining green, the lowest rarely angular.

Berries dull white. Flowers greenish. May and June. (Wood.)

If not supported, the radicans is about six feet high, and the branches recumbent ; the stunted radicans might be mistaken for a toxicodendron, if it were not for the stem which is crooked. Some- times both varieties may grow up from the same stalk. Professor Bigelow states : "Among the plants which grow abundantly around Boston, I have frequently observed individual shoots from the same stalk having the character of both varieties."

The poison of the rhus radicans produces effects analagous to those of rhus toxicodendron, and provings bring out this similarity still more clearly. It has been customary to use the two remedies interchangeably; although it cannot be denied, that a critical study

RHUS RADICALS. 707

of their respective symptoms permits of differentiation. (See Halm. Monthly, August, 1869, for a comparative study of rhus tox. and rhus radicans.)

Horsfield, in his dissertation on the effects of rhus radicans, which was published in Philadelphia in the year 1798, gives the following effects of the leaves of this plant :

"A slight degree of itching or sensation of heat, which gradually increases, followed by redness or inflammation of the skin ; in some, very extensive ; in others, confined to round circumscribed spots, or to longitudinal streaks. The inflamed parts become elevated and tumefied ; small vesicles appear on the surface, containing a pellucid fluid, which gradually increase in size ; the fluid soon becomes yel- low, and, after some time, takes on the color and consistence of pus. After the vesications are completely distended, they break, and some of the pus being discharged, by drying on the surface, forms a yellow incrustation, which gradually becomes brown. The itching and vesications which take place in the incipient state, frequently disappear and return several times successively.

"The poison appears to have a peculiar capricious disposition to attack peculiar parts. In most cases the eyes are specifically affected ; in some, the legs and thighs. A peculiar and distressing itching of the scrotum and prepuce is one of the most general and character- istic symptoms of the disease. In some it causes erections, and the labia pudendi are affected.

Its peculiar tendency to affect the eyes is most strikingly observed in persons who, by reading much, become susceptible of the eruption : in most of these, if its progress is not stopped, blindness of a shorter or longer continuance is the certain consequence.

"It has been observed that the eruption, when it is re-excited, has a peculiar tendency to affect the parts which were previously affected."

In the above-mentioned dissertation by Horsfield, the following- interesting case of poisoning by rhus radicans is described : "In the summer of 1797, a boy of about twelve years of age, and possessing a very high degree of what is termed the melancholic temperament, was exposed to the action of rhus radicans. He was attacked with the following symptoms : redness and swelling of the hands and face, followed by fever, unusual drowsiness, thirst, and great consti- pation ; the eruption gradually extended over the whole body, much resembling the progress of inoculated small-pox ; a swelling and very

708 RHUS TOXICODENDON".

troublesome itchiness accompanied the eruption through the whole of its course.

"One of the most singular, and at the same time one of the most universal, concomitants of the eruption, when it exists in a violent degree, is a sympathetic erethism of the arterial system, and this occurs in a more or less degree in every case. The general symp- toms, when this fever comes on, are a quick, frequent, full and tense pulse ; loss of appetite and sickness at the stomach ; white- coated tongue ; burning of the palms of the hands and soles of the feet; headache, throbbing of the temporal arteries, and delirium. The eruption is not unfrequently succeeded by a great number of small boils, swelling of the tongue, ulceration of the mouth, and swelling of the lymphatic glands."