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Arsenicum Album - The Essential Features

Index
1. Arsenicum Album - The Essential Features
2. Generalities and Keynote symptoms, Clinical, Relationships and Cases
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Materia Medica Viva

ARSENICUM ALBUM


Acidum arseniosum
English: White arsenic, Arseniuous acid, Arsenic Trioxide
French: Arsenic, Oxyde blanc d'arsenic, Acide arsenieux
German: Arsenik, Arsenige Saure

Mode of preparation: 5 centigrams are put into a vial with 4 grams of distilled water; the arsenic is dissolved by heating it, and water is added as it evaporates. Then 4 grams of alcohol are added to this and mixed well. One drop is then added from this preparation to one thousand drops of a mixture that is equal parts water and alcohol. Ten drops from this solution are added to a bottle containing ninety drops of alcohol. This is the second attenuation, and all the succeeding attenuations are made in this way. A second method used by Hahnemann was to triturate one grain of white arsenic with 100 grains of sugar of milk, making three triturations in succession, so that afterwards he would be able to make the remaining attenuations the liquid way.

THE ESSENTIAL FEATURES


Arsenicum is a classic remedy; its general characteristics are well-known to all homeopathic practitioners. Originally proven by Hahnemann himself, Arsenicum has since been exhaustively described in every materia medica. The classic description in Kent's materia medica covers all the essentials in both the acute and chronic states: Anxiety, Restlessness, Aggravation by cold, Worse after midnight, Thirsty for sips, Periodicity, Alternations of symptoms, Ulcerations, Burning pains, etc. A mere cataloguing of symptoms can be misleading in actual prescribing, however, unless the image is rounded out by an understanding of the essential dynamic process and stages of development of the remedy, particularly in comparison with other similar remedies.

The essential process underlying the Arsenicum pathology is a deep-seated insecurity. From this insecurity spring most of the key manifestations known in Arsenicum. The insecurity is not a lack of confidence on a social or professional level, but rather a more fundamental sense of vulnerability and defenselessness in matters relating to disease and death. From even the earliest stages the Arsenicum personality is dominated by this insecurity.

Arising from the insecurity is the Arsenicum dependency on other people. Of course, Arsenicum is a prominent remedy listed under the rubric "Desires company." In reality, the Arsenicum person has more than a mere desire for company; it is an actual need for someone to be present near him. Arsenicum surrounds himself with people because of his insecurity concerning his health and his unaccountable fear of being left alone to face possible health hazards. The need for company is not necessarily a need for interaction with people, such as in Phosphorus. Arsenicum needs people nearby more for reassurance and support in case something happens to him.

 

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For this reason the Arsenicum patient becomes very possessive - possessive of objects, of money, and especially of people who are near, such as a wife or husband. The Arsenicum person does not readily employ a give and take dynamic in his relationships. He is much more selfish; he tends to be a "taker." In a relationship he will give support to another person, but primarily with the expectation of receiving support in return. It is in this sense that Arsenicum is a selfish remedy.

The possessive quality of Arsenicum extends to physical possessions as well as people. He is reluctant to give money or material objects away; he is even stingy with his discharges! (The discharges in Arsenicum are scanty; they are not "generous," not profuse. Should the discharges become really profuse and thick, great relief is afforded his constitutional symptoms.) He may appear to be generous on occasion with his money or possessions, but he gives with the expectation of receiving in return, and he will be upset if the anticipated returns do not materialize. The same possessiveness leads to a compulsive collecting nature. If there is anything that he believes might be of some value, even some insignificant little item, he will carefully store it somewhere where he will be able to find it easily later. He does not want to throw anything away, does not want to waste anything; miserliness and avarice are the results of this attitude. Yet Arsenicum does not have the fear of poverty that might be expected. On the contrary, he feels secure that he has enough in case of need due to his avaricious nature.

As the disturbance on this level progresses the miserliness becomes more pronounced. As mentioned, the patient hoards everything that may have any conceivable future value. He cannot bear to part with anything he has collected: boxes, useless odds and ends of repair materials, scraps of paper, as well as truly valuable objects are carefully stored away ( Mercurius ). Of course, the patient himself will never offer this symptom, rather he wonders at the wastefulness of others around him. Furthermore, if any of his possessions become damaged, he is greatly alarmed. For example, if the roof of his house leaks and causes even some trivial damage to his furniture, it is a major catastrophy to him. He may even become ill from his reaction to this event, as if something of himself were ruined.

Although capable of enjoying life very much, his enjoyment is quite restricted, restricted by the extent and specificity of his desires. It is as if he clings to life and its pleasures with a sticky tenacity. His greed frequently is satisfied only by the best of everything. Arsenicum often gauges the value of things (people, pursuits, pastimes, etc.) according to their usefulness to him, the extent to which they satisfy his needs and desires. And, having determined what it is he needs, he will then pursue his goal with rigid determination. For example, in the interest of attaining better health he will attend to his diet in a very meticulous, almost hypochondriacal way, severely curtailing the range of allowable foods. Or an Arsenicum woman may choose a mate because he is clean and has a good, secure job, her choice being based more on the feeling of security he evokes than love. Security and comfort is of primary concern.

The Arsenicum patient perceives events in the world from a purely personal standpoint. His philosophy is: look after yourself first, everything else comes second. If something happens to someone else, the Arsenicum person will think first of what it means to himself. For example, if an auto-accident occurs, the Arsenicum patient will not rush instinctively to help. He may not think at all of the other person, but only of the implications to himself. Sometimes he will not go near the scene for fear of facing bloody situations that will stimulate his anxieties and fears for his own well-being. In contrast, the Phosphorus patient's heart will automatically go out to the victim; he readily puts himself in the place of the other person. The selfishness of Arsenicum is completely different from that seen in Sulphur, Medorrhinum, or Platina, for there is no egoism per se; rather, the Arsenicum patient is totally preoccupied with his own fears, needs and insecurities.

Next we consider the well-known Arsenicum trait of fastidiousness. Here it is important first to reiterate that in homeopathy we do not prescribe on the basis of beneficial traits, but only on pathological qualities. Thus, if someone is neat and orderly as a manifestation of an orderly approach to life, this would not be considered a limitation, or a symptom. The same could be said about a perfectionistic quality of an intensity akin to normal orderliness. On the other hand, we see people who are compulsively fastidious, obsessed by the need for order and cleanliness to the point of expending inordinate energy, constantly cleaning and straightening. An Arsenicum housewife will be seen following after the guests who are entering her house, immediately repolishing the already meticulous floor so that even the slightest stepmarks will not be visible. An Arsenicum visitor will get up and straighten a picture which is hanging on the wall slightly askew. This same individual may not be able to restrain himself from repositioning a tablecloth in a restaurant which is not hanging symetrically. He will spend quite a bit of time symmetrically arranging his shoelaces; otherwise he will be bothered by their asymmetry. This excessiveness characterizes the Arsenicum fastidiousness.

This passion for neatness will also be reflected in Arsenicum's personal appearance. Even if he has owned a suit for many years, so neat and clean does it seem on him that one is left with the impression that it was recently purchased. He attends to his clothing with great care and precision; on arriving home, for example, he will carefully and neatly fold his clothes and put them away so that on the following morning he will be sure to find them in an immaculate condition. He enjoys rendering such care and spends an inordinate amount of time at it. The wardrobe of the Arsenicum is something beautiful to look upon: everything is aligned with unbelievable precision. Such uncompromising attention to detail results in the well recognized immaculate, perfect appearance of Arsenicum. Perfectionism is another characteristic. He cannot overlook an error or inadequacy in his work, no matter how insignificant; he is compelled to continue working until he is satisfied with the results. It is this inner drive for perfectionism that leads him to be very critical, very censorious of others. He readily criticizes anything done by anyone else, and his keen perception readily brings any existing imperfection to light. He is exhaustively fault-finding: the stove is burning too high, the light in the room is too low, his shoes are not in the right place, etc.

Arsenicum patients are greatly aggravated both psychologically and physically by the disorderliness of a messy room. Children with acute high fevers, for instance, will ask that their bed be straightened, covers hung properly and that the room be in order before they can feel restful, this despite the fact that they have a 40 degree (centigrade) fever and feel exhausted. This desire for neatness perhaps represents an obsessive attempt to temper the anxious insecurity felt inside by creating order and cleanliness in the external enviroment.

This passion for order and cleanliness can be so great that in more mentally disturbed cases serious obsessive behavior concerning dirt and microbes can result. These people will wash not only their hands, but also their clothes many times over. Some slight contact with another person may precipitate an intense feeling of uncleanliness. Their concern about being contaminated may cause them to avoid physical contact with others. These individuals may suffer a similar sense of uncleanliness as a consequence of contracting some physical disease, especially a skin rash. If a doctor tells them, for instance, that they are suffering from a fungal infection, they will immediately feel dirty inside [their body] and begin a paroxysm of frequent bathing. No amount of washing, however, will eradicate the feeling. They are very easily disgusted, not so much when eating at a friend's home, as in the case of Sulphur, but more by seeing or coming into contact with dirt.

The fastidiousness of Arsenicum can be compared to that of other remedies. While the Arsenicum fastidiousness arises as a consequence of anxiety and insecurity, the fastidiousness of Nux vomica arises more from an excessive compulsion for work, from overly conscientious attention to details, and from an exaggerated sense of the need for efficiency. The Natrum muriaticum fastidiousness is similar to that of Nux vomica, but it is more specifically concerned with the scheduling of time.

In studying remedies it is crucially important to have an appreciation of the stages of development of the pathology. Otherwise, if we see a patient at a given stage, we may miss the remedy simply because we are looking for symptoms that are characteristically found at a different stage. Also, an understanding of the stages of a remedy enables us to more readily discern the essence of the remedy and to differentiate it from other similar remedies.

In the early stages of Arsenicum we see a relative preponderance of physical level symptoms with less emphasis on the mental disturbances. Particular physical complaints - burning pains, restlessness, chilliness, aggravation from cold, frequent colds, periodicity, thirst for frequent sips of water, and aggravations occurring after midnight, especially from one to two AM (and one to two PM) - may be the primary symptoms with which to work. Upon inquiry, one will probably discover at least some of the following characteristics: fastidiousness, miserliness, a certain degree of insecurity, discontentment, restlessness coupled with weakness, censoriousness, and irritability. The irritability is seen primarily in the morning upon waking, morning being a difficult time for Arsenicum. In more advanced stages the anxiety is also frequently aggravated in the morning. At this stage, particularly if the complaints are more functional and not involving much physical pathology, it may be difficult to separate Arsenicum from Nux vomica. One must then search carefully for the psychological tendencies. Arsenicum will tend to be more insecure, needing the support of other people, whereas Nux vomica will be more self-reliant and impulsive.

In the second stage, as the illness penetrates deeper, the anxiety of Arsenicum becomes more pronounced and an anxious restlessness ensues. The anxiety tends to be most pronounced after midnight and in the morning on waking. The Arsenicum person may awaken in a panic during the hours of 12 to 2 AM. He may say that he is anxious even while asleep. Arsenicum will also at this stage display a prominent fear of being alone. There will be a constant need for company, particularly at night. The fears of Arsenicum are tremendously heightened while alone. His senses become more acute, especially his hearing (though less than that encountered in Coffea and Nux vomica). A fear of robbers is most characteristic of Arsenicum (also Natrum muriaticum). The anxiety of Arsenicum causes great internal anguish, and it is out of this anguish that the familiar restlessness of Arsenicum arises. The restlessness is not just a physical process; it is primarily a mental restlessness, an attempt to allay the deep-seated anxiety. The restlessness compels the Arsenicum individual to pace to and fro, to move from chair to chair, from bed to bed, but the motion and the changes in position do not ameliorate his symptoms nor his anxiety; on the contrary, his moving about totally exhausts him. The greater the suffering, the more the anguish; the more the restlessness, the more the exhaustion. Similarly the anxiety, which can easily reach the level of anguish will drive the patient from person to person, constantly seeking reassurance and support. Earlier in the course of the pathological development of Arsenicum the restlessness can appear periodically, rising and falling over periods of weeks.

The restlessness of Arsenicum invites comparison with other restless remedies. In Arsenicum the restlessness occurs in conjunction with anxiety and desperation. The desperation forces him to move from place to place with the hope that he will find some relief. Again, the restlessness tires the patient and leads to exhaustion. There may be periodicity to the restlessness: the patient will move about for a while and then be able to rest until the urge to move again asserts itself. The restlessness is, of course, most intense during the night, especially after midnight.

While the restlessness of Arsenicum is generally due to anxiety, a purely physical restlessness also occurs. This type of restlessness may often create confusion with Rhus toxicodendron. Both remedies can have a craving for milk, and both can have a desire for water in small quantities frequently. Both are aggravated by cold. Generally, Rhus toxicodendron is restless because the pain and stiffness are ameliorated by movement; turning, stretching, bending and moving about offer relief. In Arsenicum no relief is afforded by restless movement; the restlessness, provoked by the suffering, actually aggravates by bringing about exhaustion. Rhus toxicodendron patients repeatedly move from place to place because they hope to find a more comfortable position; one of the most typical examples of this tendency is to stretch and move the legs in bed at night - they do not know where to put their legs.

Sulphur and Medorrhinum may have a similar restlessness of the legs and, likewise, a difficulty in knowing where to put their feet, but they do this because they are trying to find a cool place for their overly warm feet (and burning soles).

Another remedy that must be differentiated from Arsenicum is Tarentula hispanica. The restlessness of Tarentula arises from a great hurriedness that pervades all aspects of life. They want everyone to hurry; they become irritable if they see someone moving slowly. Naturally, in a very advanced stage where the patient is out of control, one can have a very difficult time diagnosing the remedy. Tarentula, Stramonium, Nux vomica, Arsenicum, Hyoscyamus - all, as they shout, break things, and run about the room, can appear similar. Were one to attempt to distinguish Tarentula from these other remedies on the basis of an amelioration from music, one would have to be very circumspect. Tarentula's restlessness can be aggravated by music (as can Natrum carbonicum); the restlessness can increase in concert with the rhythm of the music.

Causticum is a remedy which can have much restlessness. This restlessness is a result of the stiffness and is worse during sleep. There is especially a restlessness of the lower extremities which is worse in the mornings. Another remedy with geat restlessness of the lower extremities is Zincum metallicum; as the Zincum patient sits in a chair, his legs will jump continuously.

The anxiety prominent at this stage of pathology focuses predominantly upon the patient's concern for his health. The idea of deterioration, of the ephemeral, of being deceased, or death is unbearable to him. Normally he pushes such ideas away from his mind, but if circumstances force them upon his consciousness, he then becomes most anxiously fearful of death and disease. He becomes absorbed by this concern and can talk about it endlessly, completely engrossed about even the most insignificant symptom. Arsenicum's fear is not so much of the consequences of a degenerating condition of health, but the fear of the ultimate state of insecurity - death. He develops an intense fear of death which can at times reach tremendous dimensions of panic. These "anxiety attacks" occur most frequently between 12 and 3 AM, but can appear any time as well. In the Repertory Arsenicum appears in the rubric "fear of death when vomiting." This symptom is but a reflection of a far more encompassing tendency - every symptom, no matter how insignificant, can provoke fear of death and then panic.

In the midst of his panic, the patient will thrash about in despair, weeping and imagining that he must die, that there is no hope. With this syndrome he will quite likely be rushed to the nearest hospital's emergency room. He arrives restless and trembling with fear. He restlessly turns his head to and fro; he writhes and constantly moves his limbs and shivers as from cold. His breath quivers. All of these symptoms are the expressions of an anguished fear of death (Compare Psorinum, Kali arsenicosum ). Eventually these panic episodes can occur without even the smallest provocating symptom.

The Arsenicum patient feels more secure if he has the attention of a physician, and, being a hypochondriac, he seeks the opinion of many doctors. He becomes dependent on the physician, telephoning frequently, demanding reassurance and advice for even the most insignificant symptoms. The homeopath is bound to feel the weight with which the Arsenicum patient clings to him. No patients in our materia medica are as clinging and demanding of relief from their anxiety as are Arsenicum, Kali arsenicosum, Calcarea carbonica and Nitric acid.

Arsenicum will exaggerate many of his symptoms in his imagination, blowing them out of all proportion. Even in the face of such apparently commonplace complaints as headaches, lumbago, fevers, etc., the thought readily enters his mind, "I have cancer and I am going to die!" Again, his fear will bring him promptly to a physician. Even if all the tests are negative, he will not be consoled; his anguished fear and restlessness will continue to lead him to more and more doctors. He fears cancer because it is the disease most readily identified as fatal in today's society. It is not really the possibility of cancer, but the prospect of death that causes him such anguish. The fear is not that he will contract cancer in the future, rather he fears that he has cancer at that moment (compare Agaricus ). In point of fact, malignancy is an actual element of Arsenicum, and, analogously, Arsenicum's fear is malignant, similar to a cancer eating at the mind of the patient.

A recognition of the peculiar characteristics of the Arsenicum anxiety about health is imperative as there are other remedies which also display anxiety about health of an at least equal if not greater intensity. The Repertory lists these thoroughly and in relative strengths, but it is unable to describe the particular distinguishing qualities which are so important in separating one remedy from another. If one only knows the fact that a particular remedy has "anxiety about health" without knowing how to differentiate it from the others, one will find great difficulty in selecting the precise remedy that fits the patient. This cannot be done by a simple process of repertorization; it requires a minutely detailed knowledge of materia medica.

Other remedies possessing a strong anxiety about health are Phosphorus, Kali arsenicosum, Nitric acid, Lycopodium, Calcarea carbonica, Kali carbonicum, and others. Calcarea carbonica has a strong anxiety about health which is primarily focussed on the possibility of insanity, cancer, and/or of contracting an infectious disease. Calcarea carbonica fears the condition or disease itself as opposed to the possibility of death. Calcarea is most apt to despair over having an incurable disease and of being unable to recover; death is a prospect which he can accept with relative equanimity.

Kali carbonicum has anxiety that he will get a disease in the future whereas Arsenicum fears he has cancer now. Kali arsenicosum has a particular anxiety about heart disease; he does not fear death as much as Arsenicum does. The Kali arsenicosum patient will say, "If I must die, it is O.K." If one begins to talk about his heart, however, he will begin to express anxiety.

Phosphorus feels anxiety about his health, but primarily when the subject is raised to him. Many Phosphorus fears revolve around health -his own or that of his relatives, but the Phosphorus anxieties are not as obsessive. The Phosphorus patient is suggestible. He hears of someone who has died from a bleeding ulcer, and then he imagines himself to have the same condition. He does not withhold his anxiety; he will engage the nearest person and animatedly express his concern. He will immediately go to the doctor who reassures him that he does not have an ulcer. The anxiety then disappears as quickly as it came; he leaves the doctor's office very relieved, saying to himself, "How silly I am!" With the next and slightest provocation, however, the anxiety will return. By contrast, Arsenicum album, Kali arsenicosum and Nitric acid are not so easily pacified. Their anxieties are inconsolable.

The Nitric acid patient, unlike Phosphorus, always has anxiety about his health - an anxiety about any possible ailment, not only cancer, infectious disease, insanity, or heart disease. He may read in a magazine about someone with multiple sclerosis, and he says to himself, "Oh, that explains it! That must be what I have." Then, instead of expressing his anxiety, he carries it around inside. Eventually, he may very secretively make an appointment with a doctor, but the doctor's assurances fall on deaf ears. He is convinced of what he has and cannot be consoled. Later, he may read another article, and the process begins again. The Nitric acid anxiety about health is not so much the fear of death that we see in Arsenicum; it is more a fear of all the consequences of a long-term degeneration, with the expense, dependency on others, immobility, etc.

Lycopodium has a marked anxiety about health. The Lycopodium anxiety can be about any type of illness, like Nitric acid, but it is an anxiety that springs from a basic cowardice. It is not a fear of death, but a fear of the pain and torture of illness. He has a fear that he will not be able to cope with a serious illness, that he will fall apart and reveal a lack of courage to others.

The above distinctions should serve to illustrate that the simple rubric "anxiety about health" is actually full of a wide variety of shades and subtleties which are crucial to the precise choice of a correct remedy. This assertion, indeed, is true of every rubric in the Repertory.

As previously mentioned, The Arsenicum patient is dependent upon his possessions and the people in his life. Kent says: "He dreads solitude and wants company because in company he can talk and put off the fear." Thus, at this, the second stage, because of the increasing anxiety, the Arsenicum fear of being alone becomes especially pronounced. Yet the Arsenicum person is discerning about those he wishes to have with him; he wants efficient, reliable people and people who care about him nearby. Interestingly, this need to be with other people may generate the impression that he cares for them, but essentially this impression is a false one. His own need, the appeasement of his anxiety, is preeminent in his mind. An Arsenicum woman, for instance, may go with her husband to his shop, not to help him with his work, but merely to avoid being left home alone. For it is when alone that the crippling fear becomes overwhelming.

Arsenicum is listed in the rubric "anxiety for others," but actually, as one would expect from the foregoing description, this anxiety is caused by the fear of losing someone close to him, someone upon whom he is dependent. Consequently, he will show little concern over someone who is a stranger to him.

Other remedies are prominent for anxiety about others. One of them, Phosphorus, is so sympathetic and suggestible that he can lose all sense of himself in his concern over someone else, whether a close friend or a stranger. If an Arsenicum person were to meet someone new to the area, he would welcome the company and the opportunity for some conversation. However, if the person were to mention some personal difficulty, such as an inability to find a hotel, the Arsenicum individual would limit his response to a courteous expression of consolation and, perhaps, a few suggestions; his inner, perhaps subconscious, attitude would basically be, "Well, you have your problems, but what about the problems I have?" The Phosphorus patient, on the other hand, would become excited and say, "You haven't a hotel? Oh, my goodness! We must do something about that! Here, we'll go right now to the directory and try calling a few."

Sulphur also has anxiety about others. In this instance, it is an active imagination which leads to the anxiety. A Sulphur father, for example, might lose sleep worrying about his daughter coming home two hours late from a date. It is not the Arsenicum anxiety over losing his daughter or the Phosphorus sympathetic anxiety. The Sulphur individual will lie awake inventing endless possibilities about what might have happened. He will allow his imagination to exaggerate the significance of the situation beyond all realistic dimensions.

To review the stages of the Arsenicum pathology: the first stage emphasizes the physical symptoms, the fastidiousness, and the miserliness; in the second stage there is increasing emphasis on the insecurities, dependency, anxiety about health, anxiety over losing others, the fear of being alone, and the fear of death; gradually the fear of death becomes an obsessive, anguishing fear - the cental issue of the person's life. Then the third stage supervenes.

In the third stage, the constant fear and anxiety finally exhaust the patient; he eventually surrenders to his exhaustion and subsequently falls prey to a state of despair. Arsenicum appears in bold print in the rubric "despairs of recovery." There are two reasons for this despair: the first is the realization that certain symptoms he suffers may be permanent. Even if these symptoms are relatively minor, he may still experience profound despair. Secondly, he may come to despair as a consequence of the toll exacted by the weight of the constant anxiety and fearfulness that have pervaded his life. His chronic mental suffering can cause him to begin to loathe his life and to despair of ever being able to comfortably enjoy life.

It is to this stage that Arsenicum cases of anorexia nervosa belong. These cases have a withered, wrinkled, old appearance; they are prostrated, feel cold all over, and suffer from an inability to eat or to retain any amount of food. They think that food is not good for them, that no type of food is healthy enough. There is much delusionary thinking in these cases. Delusions may alternate with a state of sleepy, partial confusion. They speak seldom and abruptly, giving foolish answers and making irrelevant associations. They seem confused and have the feeling that they are going insane.

In the final stage the Arsenicum loathing of life becomes absolute; the sadness is tremendous, and suicidal depression may supervene. This depression must be taken seriously for Arsenicum is one of the truly suicidal remedies. During this stage he avoids meeting friends because he imagines that he has offended them in the past. He lies in bed, occupied with thoughts that aggravate his depression and torment his mind night and day. He feels he is incurable, and thoughts of death constantly occupy his mind. The Arsenicum patient may develop despair and a suicidal disposition quite suddenly after a severe fright or shock or even during asthmatic attacks. A sudden fear may can come that he may be forced to commit suicide Also, a depression that is similar to that of Natrum sulphuricum may result from a blow to the head.

More rarely, a manic, paranoid state may develop in the last stage, with suspicion being the dominant characteristic. He suspects that people are plotting to kill him. He stares with a wild suspicious look. The patient may suffer from a fear that he will kill people upon whom he depends. In this stage he may avoid talking to people and may become obstinate and withdrawn. Finally, he may enter a state of complete tranquility, yet in this state he is completely out of touch with reality and refuses to talk to anyone.

The stages that have been described clearly illustrate the steady progression of pathology into increasingly deep layers of the organism. The pathology initiates on the physical level, progresses to a state of anxiety and insecurity, then to fear of death, and finally to despair, loss of interest in life, suicidal disposition, and a paranoid, delusionary state. In the final stages one may encounter great difficulty in accurately prescribing Arsenicum without the knowledge of its stages of development. Many of the usual symptoms of Arsenicum may be missing - restlessness, fastidiousness, desire for company, fear of death, anxiety, thirst, etc. It may be difficult to separate Arsenicum from other remedies at this stage, but if the case is taken carefully, the full dynamic process of the disease will become clear.

Acutely, Arsenicum corresponds to fevers, sometimes very high, of all types, but mostly septic fevers. During fever Arsenicum can display several interesting symptoms. Delusions may arise: he sees thieves in the room and hides under the bed; he imagines that the house is full of thieves or that the bed is full of worms. He may pick at the bedclothes. He may moan and lament loudly, screaming with pain. In manic states or in fevers with delirium, the Arsenicum patient may demonstrate a strong desire to be held.

It is interesting to note here that patients who never experience fever (apyrexia, even in severe acute ailments), frequently require Arsenicum for their chronic or acute conditions.

In Arsenicum, acute diseases have the same anxiety, restlessness, and even despair which characterize the chronic state. The restlessness and anxiety can be tremendous, compelling the patient to get up and move about. He moves from chair to chair and then drops exhaustedly into the bed, only to rise yet once again until he finally lies, completely prostrated, in bed. He is exhausted, thirsty for sips of water, and chilly -yet with a hot face.

I recall the case of an Indian woman suffering from a ureteral colic. Even in that tropical climate the patient was under four blankets. The nurse was fanning her face and supplying little sips of water for which the patient pleaded moaningly. She was restless, moaned in anguish, and rocked her head restlessly. Arsenicum 200C pacified the patient within three to four minutes. In such severe acute conditions, the restlessness exhausts the patient, and he will often fall into a stuporous, "cadaverous" state, only to become restless again upon recouping a little strength.

Arsenicum may be contrasted with the early stages of Belladona. Both remedies manifest high fever and a hot face with cold extremities. However, even though the Belladona's extremities are cold to the touch, the patient himself feels either warm or of normal temperature sensitivity.

Index
1. Arsenicum Album - The Essential Features
2. Generalities and Keynote symptoms, Clinical, Relationships and Cases