A Physiological Approach to the Materia Medica

Introduction
In some recent discussions at the Royal London Homoeopathic Hospital, the idea was put forward that the kidneys and adrenals, acting in concert, provide the mechanism for the awakening forces to manifest in the physical body. These awakening forces are considered
as a function of the astral body by the Anthro-posophical school.
It was postulated that these enlivening or awakening forces are an equal and opposite reaction to the excretory function of the
kidney. Furthermore it appears that the sodium ion, which plays
a relatively minor role in the plant kingdom, assumes very
much greater importance in the animal kingdom through its
role in the awakening process. We know, for example, that the
sodium ion plays an important part in neurological function and
neuro-muscular transmission as well as cardiovascular function.
The adrenals and kidneys are responsible for the maintenance of
electrolyte and acid-base balance and therefore should be of great
importance in the function of the astral as well as the vegetative, or
etheric functions. Potassium is the predominant cation of vegetative
function; hence its preponderance in the plant kingdom and intracellularly in the animal kingdom.
If one studies the homoeopathic materia medica critically, it becomes clear that the idea that homoeopathic prescribing is based solidly on toxicological studies or proving, is inaccurate. It appears that many prescribing indications are based on the observation that a given remedy seems. To benefit patients with certain, sometimes ill-defined, groups of symptoms and characteristics which are given pride of place
as mental and general symptoms. It seems likely therefore, that
many of these symptoms are not toxicological phenomena but reflections of underlying pathophysiological disorders which, empirically improve when a particular remedy or group of
remedies is given. Furthermore, since the higher potencies do not
apparently contain any of the original substance of a remedy,
one can postulate that they do not act in the physical world directly,
but in fact work through the subtle worlds of Ideas and Forms
and through them manifest in physiological and pathological
processes. Indeed it is common prescribing practice to give the
higher potencies on constitutional grounds and the lower potencies
for local symptoms with gross organic changes.
It was therefore felt worthwhile to look at adrenal physiology and pathology in the light of some of these ideas and see if there is any possible relationship between the known diurnal variations of adrenal function and various homoeopathic remedies, particularly with regard to time aggravations. The remedies considered here are:
The Proteus group which includes Natrum mur., Conium, Cuprum, Ignatia and Secale; Chamomilla; The Bacillus No. 7 group which is mainly composed of the Kali salts in conjunction with one of the halogens; and finally Cactus grandiflora. Before considering these remedies, a brief outline of adrenal physiology and
pathological syndromes may be helpful.
The adrenal cortex produces steroid hormones which may
be classified as glucocorticoids, mineralocorticoids and androgens according to their predominant action. Small quantities of oestrogens are also produced.
The most important glucocorticoid is cortisol. Serial estimations of plasma levels show that there is a diurnal variation of output which is maximal at around 9-11 a.m. and at its lowest around midnight. This variation is due to the diurnal variation of the excretion of ACTH by the pituitary in response to the biological clock function of the limbic system. Control of cortisol excretion is by a negative feed back mechanism with the secretion of ACTH by the pituitary. The effects of
glucorticoids may be summarized as follows:
1 Intermediary metabolism Protein catabolism, hepatic glycogenesis and gluconeogenesis are all increased with the result that the blood glucose rises. There is, in addition, a peripheral anti-insulin effect.
Some of these actions as well as other glucocorticoid effects are
mediated via increased synthesis of RNA with a resultant increase
in the formation of various enzymes.
2 Permissive action
Small amounts of glucocorticoids are needed for glucagon and catecholamines to exert their calorigenic actions.
3 Cardiovascular system and skeletal muscle
Glucocorticoids are essential to the normal working of skeletal muscle.
Adrenal- ectomy results in early fatigue. In vitro, glucocorticoids
have a positive inotropic effect on the myocardium, but the in
vivo significance of this is unclear. Cortisol does however seem
necessary for the normal responses of vascular smooth muscle to
catecholamines. Cortisol also increases the blood pressure and the glomerular filtration rate by an obscure mechanism independent
of electrolyte changes.
4 Nervous system
Adrenocortical insufficiency results in the appearance of slow
waves on the EEG, personality changes including irritability, apprehension and inability to concentrate, and increased
sensitivity to olfactory and gustatory stimuli, The convulsive
threshold is decreased by excess glucocorticoid administration.
5 Gastro-intestinal system
Glucocorticoids appear to alter the mucosal resistance to the irritant
actions of gastric secretions.
6 Water metabolism
Glucocorticoids are necessary for the excretion of a water load.
This may be due to the reduced glomerular filtration rate which
occurs in adrenal insufficiency or there may be a direct effect of
cortisol deficiency on the distal tubules, making them permeable
to water.
7 Resistance to stress (Trauma, fear, anxiety etc)
Stress results in an increase in ACTH secretion and consequently
a rise in glucocorticoid levels. This rise is essential for survival. Part
of the effect is the maintenance of vascular reactivity, but precisely
why glucocorticoids are essential for resisting stress is unknown.
The most important of the mineralocorticoids is aldosterone,
though cortisol does have a mineralocorticoid effect as well as
its glucocorticoid effect.
The primary effect of aldosterone is the reabsorption of
sodium from urine, sweat, saliva and gastrointestinal secretions.
In the kidney potassium and hydrogen ions are excreted in
exchange for sodium ions. The control of aldosterone secretion
is through the renin-angiotensin system. Changes in the circulating
fluid volume are reflected in changes in the renal artery pulse
pressure. These changes may be amplified by high catecholamine
levels. A low renal artery pulse pressure results in the secretion
of renin by the juxtaglomerular apparatus. Renin acts on
angiotensinogen to form angiotensin, which in turn acts on
the adrenals to increase the output of aldosterone. The aldosterone
action of retaining salt and water restores the extracellular fluid
deficit and hence the stimulus to aldosterone production is
removed. Angiotensin itself is an extremely potent vasopressor; at
least in vitro.
Adrenocortical Syndromes 1 Adrenocortical insufficiency (Addison’s disease)
Addison’s syndrome is the result of diminished mineralocorticoid
and gluco- corticoid function. It is characterized by weakness,
weight loss, pigmentation, vomiting, diarrhoea, hypotension, hyperkalaemia, hyponatraemia, hypoglycaemia and hypochloraemic acidosis.
Other important features include abdominal pain, salt craving,
irritability, restlessness, loss of concentration, enhancement
of sensory modalities and very rarely, an ascending paralysis with
or without sensory disturbances.
2 Cushings Syndrome: Adrenocortical hyperfunction
This is characterized by obesity, a moon-faced plethoric appearance,
hirsutism, abdominal striae, hypertension, oedema and
glycosuria. In addition there is great fatigueability and weakness
and a range of psychological disturbance from irritability and
emotional lability to euphoria and toxic psychosis. Very severe
cases may develop hypokalaemia and a metabolic alkalosis from
the mineralo- corticoid effects of cortisol, associated with a
proximal myopathy mainly affecting the thighs.
3 Hyperaldosteronism
Conn’s syndrome is characterized by diastolic hypertension and
sodium reten- tion without oedema, excessive potassium loss
in the urine, and: a low plasma renin. It is associated with an
ascending muscular weakness, severe headaches, tetany
secondary to the hypokalaemic alkalosis and polyuria secondary
to a hypokalaemic nephropathy.
An even rarer condition, clinically at least, is Barter’s Syndrome of hypokalaemic alkalosis with a high rennin and high aldosterone levels
as a result of juxtaglomerular apparatus hyperplasia. It is quite possible that disorders of other mineralocorticoids such as D.O.C.A. may exist.
Adernal Medullary Physiology
The adrenal medulla is, in effect, a sympathetic ganglion in which
the postganglionic neurons have lost their axons and become
secretory. Adrenaline is the major catecholamine excreted.
Noradenaline is also excreted but in much smaller quantities. Most
of the circulating noradrenaline is secreted by sympathetic nerve endings.
Effects of Catecholamines Central nervous system
Arousal is mediated by the catecholamine effect of reducing the threshold of the reticular neurones in the brain stem. Any
increase in blood pressure also increases the excitability of the
reticular formation. This group of neurones occupy the mid ventral
part of the medulla and midbrain and are made up of myriads of
small neurones arranged in a network. Located in it are centres
which regulate respiration, blood pressure, heart rate and
other vegetative functions. In addition it contains ascending
and descending components which play an important role
in the adjustment of endocrine secretions, the formation of
conditioned reflexes and the regulation of sensory input,
learning and consciousness.
Metabolic Effects
The metabolic effects of catecholamines may be summarized as:
1. Stimulation of glycogenolysis in the liver and skeletal
muscle hence increasing the blood sugar
2. Mobilization of free fatty acids
3. Increase in the metabolic rate
Cardiovascular System
The effects of these two catecholamines on the cardiovascular system and smooth muscle differ in that adrenaline has both α and β) effects while noradrenaline has primarily an α effect.
The table below summarizes some of the effects of adrenaline
and noradrenaline: (See table below)
The physiological stimulation to catecholamine secretion by the
adrenal medulla is through the central nervous system, though
hypoglycaemia is another potent stimulus. There is a diurnal variation of secretion.
Catecholamine secretion is low in basal states, but adrenaline
secretion and to a lesser extent noradrenaline secretion is further
reduced during sleep. It is claimed that rage (“anger out”)
is associated with an increase in noradrenaline levels and
fear (“anger in”) with increased adrenaline levels. Also it appears
that noradrenaline secretion is greatly increased by emotional
stress with which the individual is familiar, while adrenaline
levels are increased when facing the unfamiliar.

Phaeochromocytoma
Phaeochromocytomas usually secrete adrenaline in excess but
may secrete noradrenaline. The clinical features produced are:
headaches, excessive perspiration and palpitations with either
paroxysmal or sustained hypertension. Commonly it is
associated with pallor, nausea, tremor, weakness, nervousness
and epigastric pain. Less common features include chest pain,
dyspnoea, flushing, numbness, visual blurring, tightness in
the throat, hyperglycaemia, weight loss and rarely postural hypotension.
Homoeopathic Drug Pictures
The clinical syndromes ascribed to the disorders of the adrenal cortex
and adrenal medulla represent the extremes of malfunction. It
is not at all unlikely that lesser degrees of malfunction are
common and may well account for many of the symptoms of
which patients complain, without there necessarily being gross
clinical or biochemical changes. If this is borne in mind it becomes
possible to see the homoeopathic drug pictures in a different way.
B. Proteus Group
The outstanding features of the drug picture of B. Proteus are the
sudden onset of symptoms, the “brain storms”, arterial spasm,
severe migrainous headaches, irritability, anger, dyspeptic symptoms in tense individuals, cramps and convulsions. The picture is one of spasmodic excessive sympathetic drive. Some of the remedies associated with B. Proteus are Natrum mur.,Ignatia, Conium, Cuprum and Secale.
Natrum mur.
The drug picture here appears as a combination of mild hypoadrenalism and compensatory excessive sympathetic activity. There is the emaciation, weakness, forgetfulness and salt craving
of the former with the nervous irritability, tachycardia,
palpitations and constrictive sensations of the latter. The
hammering, throbbing headaches worse at 10 a.m. or worse sunrise to
sunset correspond to the diurnal variations of both catecholamine
secretion and corticosteroid secretion. Interestingly enough
the rather low grade fever of Natrum mur. with its thirst for
cold water during the chill and coldness un- relieved by heat also
has a 10 a.m. aggravation.
Ignatia
Ignatia also has the hyperadrenergic picture but with less of the weakness or “Addisonian” element. Like Natrum mur. it is used for the
effects of grief, prolonged worry and stress but there is more of a
hysterical element in the drug picture: the rapid alteration of
mental and physical symptoms, globus hystericus, fainting and the
contradictoriness of many of the symptoms such as a sore throat
relieved by swallowing solids and emptiness in the stomach relieved
by eating.
Conium
Conium is a deep-acting antipsoric and at first sight appears
to have little relationship to the other remedies in this group. However, chemically, the plant extracts from which many homoeopathic remedies are made are very complex and this may be the reason why such a wide range of symptoms is covered by one remedy. Conium
has the wasting, irritability and impaired concentration, weakness, lymphadenopathy and impaired response to stress of hypoadrenalism. It also has breast, testicular and prostatic tumours
in its prescribing indications.
Although the amounts of androgens and oestrogens secreted by the adrenals are not usually considered significant, in disease states they may well play a crucial part. The classical ascending paralysis of hemlock poisoning is occasionally seen in Addision’s disease associated
with a marked hyperkalaemia. The time aggravations of Conium
are night and early morning.
Cuprum
The keynote of Cuprum is spasm and cramps. Like Natrum mur.
and Ignatia there is the mental and physical exhaustion from
loss of sleep and prolonged stress associated with attacks
of anxiety. However the spasm element is more marked, giving
rise to asthma, angina, abdominal colic, gangrene, menstrual colic,
nocturnal asthma and sensations of praecordial anxiety. It is one of
the remedies used in whooping cough, particularly if the cough
is relieved by cold water and has a marked nocturnal aggravation.
It has also been used in epilepsy and classically in cholera when
cramps are a predominant feature. Cramps are known to
be associated with disorders of salt and water metabolism and,
theoretically at least, disorders of mineralocorticoid function.
Secale
Secale is the crude extract of ergot and is a veritable pharmacological
rag-bag containing histamine, tyramine, quaternary ammonium
compounds and acetylcholine as well as the ergot alkaloids. In this
it is not unlike another member of the Proteus group-Apis. This extract
also contains very potent vasoactive amines. Secale is often used
in conditions of poor peripheral circulation such as Raynaud’s
syndrome, and intermittent claudication, particularly where
there is a marked aggravation from heat when the limb itself is cold
to the touch. Emaciation, anxiety and debility with a good appetite
and an excessive thirst, angina and hypertension are features which
may be related to disturbances of salt and water metabolism and
catecholamine secretion.
Chamomilla
This remedy is not usually included in the Proteus group.
Nevertheless, it has several features in common with it.
The Chamomilla state may be described as irritable, angry, hot, thirsty and numb. There is usually a marked heat aggravation.
Characteristically there is an aggravation at 9 a.m. and
9-12 p.m. There are vasomotor disturbances, classically the one
red and one pale cheek in the feverish child, colic, spasmodic
dysmenorrhoea, acute duodenitis and a very low pain threshold.
Running through the remedy is this sympathetic overactivity
and the morning aggravation following the normal rise of the
catecholamines and adrenal steroids. The evening aggravation
is often associated with the child with an upper respiratory tract
infection when there is earache, fear and anger in a child who has
refused all food for some hours. Pain, fear, and hypoglycaemia are
all potent stimuli to catecholamine release.
Baryta mur.
This remedy is not widely prescribed. It has features in
common with both Natrum mur. and Baryta carb. It is also regarded
as complementary to Conium in the treatment of glandular
swellings. It has muscular fatigue, lassitude, palpitations, systolic
hypertension, tachycardia and anxiety, particularly about the
future. On the other hand, it has the tendency to chronic recurrent
infections, chronic bronchitis and generalized arteriosclerosis
which one associates more with the Baryta radical. Arteriosclerotic
psychiatric disorders, particularly when associated with increased
sexual desire are said to becharacteristic. Baryta mur. then,
appears to represent a later stage of Natrum mur in which the arterial
system in particular has taken the brunt of the degeneration. The time
aggravations are in the morning and after midnight.
Aurum mur.
Like Baryta mur., Aurum mur. Has hypertension, arteriosclerosis,
anxiety and restlessness; but here it is the heart which appears to
have suffered rather more than the peripheral arteries. There is
congestive heart failure with its oedema and venous congestion,
palpitations, tachycardia and a marked heat aggravation. The
main time aggravation is, not surprisingly, at night.
Apis mellifica
Apis is complementary to Natrum mur. The mental symptoms are
apathy, indifference, inability to concentrate, tearfulness, jealousy
and rage. There is also oedema and violent inflammatory
reactions, angioneurotic oedema and burning stinging pains.
There is an aggravation from heat and a time aggravation for
the fever in mid-afternoon. There is thirstlessness with the fever.
Chemically Apis in its crude form contains several potent vasoactive
amines. Homoeopathically it is interesting to note that it is
used in clinical situations such as angioneurotic oedema in which
adrenaline or steroids are used in allopathic dosage.
Bacillus No. VII Group
Bacillus No. VII: The keynote for this nosode is “mental and physical
fatigue”. There is a general diminution of both nervous and
muscular tone. There tends to be a bradycardia, hypotension,
myocardial degeneration, chronic airways obstruction and
sluggish gastro-intestinal and genito-urinary function. Even
the thought of doing anything leads to exhaustion. The patient is
intensively chilly and sensitive to draughts. The onset of the state is
slow and insidious. The asthmatic element has a time aggravation of
2 a.m. The more commonly used remedies related to this bowel
nosode are the Kali salts. In this group there is very little of the
sympathetic overactivity which runs through the Proteus group.
It is perhaps relevant to remember that potassium as the predominant intracellular cation plays an essential role in all the vegetative functions of the body and in clinical terms disorders involving potassium metabolism are often associated with musculoskeletal, cardiovascular
and renal dysfunction. Potassium metabolism is integrally connected
with sodium metabolism and hence the mineralocorticoids and
renal function.
The urinary excretion of water and most electrolytes is normally greater during the day than at night. During the evening and night the excretion
of sodium, potassium bicarbonate and chloride ions gradually
diminishes, the pH of the urine falls and its concentration rises.
The process is reversed in the morning. The mechanisms responsible
for this diurnal rhythm are not fully under- stood. However, it
is known that there are diurnal variations in the glomerular
filtration rate, anti-diuretic hormone and of course the
adrenal steroids. Variations of aldosterone secretion cannot
fully explain these phenomena since the excretion of sodium
and potassium are under normal circumstances parallel. Reversal
or abolition of this diurnal rhythm occurs commonly in
the four most frequent causes of generalized oedema, cardiac
failure, hepatic failure, nephritic syndrome and malnutrition. It
may also be reversed in chronic renal failure, small bowel
insufficiency, Addison’s disease and following head injury.
Kali carb.
The early morning aggravation (2-3 a.m.) of this remedy is
characteristic. This applies particularly to the pulmonary
oedema, asthma and nocturia. It is most often of use in the older
age groups in obese, oedematous chilly subjects. Heart failure,
facial odema in the mornings, profuse sweating, backache,
weakness and weariness and a general aggravation from cold
weather are among the features of this remedy.
Kali bich.
Although this remedy is perhaps thought of most commonly
in association with catarrhal secretions and punched-out
ulceration, it does have in its drug picture references to
albuminuria, nephritis, heart failure particularly in renal
disease, and aggravation from heat and in the early morning.
Weakness is a feature common to all the Kali salts.
Kali brom.
Kali brom. has the typical weakness and time aggravations
of the Kali radical in association with acneiform and psoriasiform
skin eruptions and the psychiatric disturbances of depression,
night terrors and loss of libido associated with the bromide ion.
Polyuria with intense thirst is also described.
Kali iod.
Kali iod. is usually associated with the acrid discharges of its halogen
component though it also has asthmatic symptoms, pulmonary
oedema, exertional dyspnoea and pleural effusion in its drug
picture. As one would expect, there are both nocturnal and heat
aggravations.
Cactus
Cactus is not listed with any of the bowel nosodes. It has some
of the spasmodic element of the Proteus group, manifesting
as typical angina pectoris, spasmodic dysmenorrhoea and
constrictive sensations in the chest and abdomen. The typical
time aggravations are 11 a.m. and 11 p.m. However from the
point of view of its use as a cardiac remedy, the drug picture
suggests a much later stage than, for instance, Cuprum met.
There is cardiac decompensation with an enlarged heart going
on to congestive cardiac failure associated with the mental
symptoms of depression and anxiety about the heart disease. In
this situation the catecholamine output is, as it were, flogging the
dying myocardium into trying to maintain its function, while the
reduced renal perfusion results in secondary aldosteronism and
hence salt and water retention; thus aggravating the situation.
Conclusions
The above discussion does of course contain a large speculative element. It is very difficult to elucidate, even with
the most advanced biochemical and endocrinological techniques,
minor variations in physiological functions. It is even more
difficult to prove that giving a homoeopathic remedy alters
these processes. Nevertheless this approach may provide
another way of looking at the homoeopathic materia medica.
Most of the materia medica as found in the standard text books
is presented either in a somewhat disorganized anecdotal form
or by anatomical systems or in drug pictures. All of these
methods have some value but in general fail to convey, and bring
together in a coherent form, the underlying “spirit” of the drug,
the toxicological data and the relationship of the remedy to
pathophysiology.
I feel therefore that we should begin to consider the remedies
from three viewpoints. Firstly the toxicology of the remedies,
the provings. It may be useful to extract the observed provings
from the hearsay. Secondly a general philosophical approach
to underlying themes running through, groups of remedies,
plant families, organ remedies and related elements. Finally
I feel we should combine these two approaches and
consider them in relation to what is currently known about
physiology and pathology. We need therefore, a new approach
to the materia medica founded on Pharmacology, Philosophy
and Physiology.
Source:
The British Homoeopathic Journal