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DIGITALIS - The Essential Features

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1. DIGITALIS - The Essential Features
The following is a full and exact copy of Digitalis contained in Materia Medica Viva, Volume 10.

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Materia Medica Viva

DIGITALIS

Digitalis purpurea. The foxglove.
N.O. Scrophulariaceae.
Tincture of the second year leaves.

 

THE ESSENTIAL FEATURES

Digitalis is primarily a heart remedy. It should be considered when the pulse is abnormally slow and later in the pathology, fast or irregular, intermittent; where there is heart disease, with great weakness, and the patient can hardly talk, and is losing strength to the point that he feels faint. Cold skin and irregular respiration will often point to such cardiac pathology. All this can be accompanied by deathly nausea and emptiness in the stomach; weakness and dilation of the myocardium; and prostration from the slightest exertion.

Digitalis will be indicated if you have been told by the patient that when the problem started (whether acute or chronic), the pulse was very slow, even down to 40 beats per minute. Hahnemann says that Digitalis 'greatly slows down the pulse in its primary action', and this initial slowing down of the pulse rate is a guiding symptom of Digitalis in almost all cases, no matter what the pathology.

It must be understood that here the heart is in a precarious state, is really very weak, and therefore it can be expected that later in the evolution of the case (under stress or exertion) the heart rate will suddenly increase, to the extent of extreme tachycardia, arrhythmia and auricular fibrillation. For example, the pulse may be very slow when lying down, but on sudden motion, even the slightest, it can become quick, dicrotic and irregular. If the patient sits up, raises his hand or turns his head, the pulse races.

 

This is a 8 minute-long video from one of Prof Vithoulkas' live courses at Alonissos, where he describes some elements of the Digitalis essense of materia medica and clinical uses.

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The greatest indication for Digitalis is in failure of compensation, cardiac muscular failure and when atrial fibrillation has set in, especially when it comes after rheumatic fever. There is arrhythmia of several kinds: irregular and unequal pulse; 'Distension of the arteries, sometimes more and sometimes less'; extrasystoles, in irregular distribution or after every normal beat of the heart; intermissions of irregular kind and length of time; 'the slow and small pulse frequently intermits for a shorter or longer time'.

An interesting symptom is a feeling as though the heart had stood still, with great anxiety and a feeling of a need to hold the breath. This usually follows after careless, violent motion, especially moving the arms upward. If a patient expresses a feeling that his heart will stand still as soon as he moves even slightly, and when this still occurs even if he holds his breath in an attempt to prevent it, then this is a strong indication for Digitalis. (Gelsemium, on the contrary, has a feeling that his heart will stand still as soon as he stops moving.)

Baehr describes such an attack, which often very much resembles angina pectoris: 'The patient feels his heart stand still for a moment, with inexpressible anxiety and sudden fainting; this is followed by some violent and quick beats. One patient described them like this: as though the heart had torn itself loose, and were freely swaying to and fro like a pendulum, hanging from a thin thread'.

Digitalis will be also indicated when the liver is affected, again either from an acute or a chronic condition; for example jaundice with induration or hypertrophy of the liver, if the heart is also involved with bradycardia, or jaundice complicated with any heart dysfunction. Typically the patient has to walk about in agony, with precordial anxiety, and with urging to urinate. He has a bluish appearance of the face.

The patient can eat very little, but in one or two hours he has an empty, 'gone' feeling in the stomach, with fainting and trembling, and has to eat immediately. There is hypoglycaemia due to a dysfunction of the liver, and also hypotension. There is great weakness and the desire to be alone. Digitalis is also indicated in urinogenital problems when there is swelling of the prostate gland, especially after gonorrhea. There is suppression of urine; frequent urging to urinate, with much effort, but only a few drops are evacuated.

The genitalia are often in a state of 'great irritability accompanied with great weakness', meaning that male patients tend to have arousal and ejaculation against their will. They have frequent, painful erections disturbing their sleep (compare Staphysagria). There is an 'exaltation of lascivious fancy', especially in older men suffering with enlarged prostate. Sexual imagination is greatly stimulated, with lascivious mental images around the clock, and semen discharged at night, often followed by pain in the penis or urethra, and especially by a feeling of weakness and lassitude.

In the broader sexual sphere, Digitalis seems to raise the desire for sex but takes away the potency; Digitalis people can resort to masturbation. Arousal is easy, yet the patient feels tired and unable to find a partner. 'Several times at night a feeling as though a pollution [ejaculation] should occur but none came; great sexual desire but no ability to perform coition'. In women this state of easy arousal, but without deep satisfaction, can lead to compulsive sexuality, 'nymphomania'. After intercourse or ejaculation, Digitalis can have reactions ranging from unconsciousness to irritability.

Digitalis will be indicated in deathly nausea, for any reason.

 

Anxiety and Fear

The Digitalis anxiety can be so intense as to be agonising. It is somewhat vague in character, but very intense in degree, and it comes on in paroxysms. It may be connected with a depressed state of mind, fear of death, or fear of psychosis. A characteristic symptom is an anxiety of conscience, coupled with massive self-reproach (compare Cyclamen). 'Internal anxiefy, like pangs of conscience, as though he had committed a crime or as though he were about to be reproved'. 'Anxiety as though he had committed something evil'.

Alternatively, the anxiety is directed towards the future rather than to the past, with evil foreboding and apprehensions. 'Anxiety, with great dread of the future, worst every evening with sadness and weeping, which brings relief. 'Fearful apprehension of a sad character, with great depression, extremely aggravated by music'.

The severe feelings of anxiety are often coupled with great restlessness, also with nervous insomnia and a feeling 'as if he should fly to pieces', as Kent says. The anxieties are referred to the epigastrium, the region of stomach and heart, where they are din lost physically felt as a fear of death. 'Apprehensiveness that seems to come from the epigastrium'. 'Every shock, like bad news, strikes in the epigastrium'.

A characteristic symptom from the proving is: 'Weakness at stomach, like a sinking, as though life should become extinct'. Also: 'Nausea with inclination to vomit, as if she would die... with extreme depression of mind and apprehensiveness'. Another form of manifestation is during the sleep, as frightening dreams of falling. 'Frequent waking at night in fright, by dreams of falling from a height or into water'.

The patient fears death, evil, psychosis and misfortune; he wants to be alone when tired, and feels despondent that his senses are dull. Fear of death while walking has been reported. This leads to melancholia, dull lethargy with a slow pulse; and particularly anxiety at twilight.

 

Depression

Digitalis patients have a disposition to depressed moods. They do not like company, and they have no desire to talk or to do anything; they sigh constantly, which seems to relieve a little. 'Tearful sadness about several things in which he didn't succeed'. Digitalis is sensitive, not only to moral impressions, but to music and sensual impressions. On the other hand, the sadness of these people is often coupled with a considerable excitability, as could be observed in severe anxiety.

The gloomy mood is attended by peevishness and inclination to quarrel. 'Great irritability; everything affects him very much, especially sad things, and the merest trifle may excite an inconsolable despair in him'. This 'sad irritability' is sometimes felt physically too, in the form of a 'sensation of sickness' that mostly affects vision. 'He is sad and has a feeling as though he were very sick; all objects look to him as if he had a fever, he seems to have the altered sense of vision as in fever'.

This 'sad excitement' may result in trivial symptoms, such as stammering when talking in public or to strangers, but can also lead to very acute pathological states, including delirium, hallucinations, manic episodes, psychotic states of confusion, even attempts to commit suicide. 'Raving excitement alternating with melancholy' (Bonninghausen). Baehr relates a case that was cured with Digitalis; the patient suffered with 'delirious mania' and complete insomnia, and could only with difficulty be prevented from jumping out of the window. 'Anxiety and sadness, with sleeplessness at night, owing to pains at heart, from unhappy love'.

The intellectual capacities are markedly impaired in Digitalis. Memory becomes weak; the patient forgets everything immediately, with internal and external heat of the head. Digitalis patients often feel a strange dullness in the head that somewhat resembles intoxication. The ability to think is restricted, but this does not correspond to the patient's subjective experience; he rather feels that his brain is more active than before. Imagination may be extraordinarily vivid. These states of mental weakness also correspond with a severe physical exhaustion, especially with a tendency to faint. 'General weakness as if all the parts of the body were fatigued'.

 

Generalities

A remarkable sensation is an internal jerking as if a current of electricity passed through the body.

Digitalis is worse in the warm air of a room, but coldness may also provoke a number of symptoms. But most remarkable is an aggravation of all complaints by motion, especially by sudden and violent movement, whereas rest ameliorates, especially lying flat on the back. Lying on the left side aggravates, especially the heart symptoms.

Digitalis patients are inclined to lose their appetites completely, and if they eat anyway this will rather aggravate their symptoms. But most marked is a very violent disgust to odours of food which provokes a deadly nausea (compare Cocculus, Colchicum). Digitalis is one of the remedies with loss of appetite and disgust of food, but much thirst. But it should be noted that feelings of canine hunger have also been observed in the pathogenesis. During a proving of Digitalis on himself, Baehr woke in the morning with a violent sensation of hunger. After a while it was replaced by complete loss of appetite, 'as though the stomach was extremely full and its contents were standing up in the throat'. The sequence, hungry on waking, soon afterwards complete loss of appetite, even disgust from smell of food, has also been used as a keynote of Digitalis.

 

Vertigo and Head

Vertigo with fainting and weakness. 'Vertigo, with an anxious feeling as though faintness would occur'. Vertigo with trembling, especially when going upstairs; with weakness of the lower limbs. Vertigo with a slow pulse, especially on rising from sitting or lying. Dizziness with constant ringing in ears.

A dull feeling in the whole head, with restriction of the ability of thinking; sometimes also with an ecstatic or intoxicated feeling as if the brain activity were rather expanded than restricted.
Strange sensations inside the head: 'Feeling as though the brain were beating like water against both sides of the skull and were about to burst it, a pulse-like sensation'. An 'undulating headache' with the same sensation, ameliorated while lying down or stooping, worse when standing or bending backward. Sensation as though something fell forward inside the head on stooping. But particularly: 'A sudden cracking noise in the head, during the midday nap, with frightened starting up'. This 'cracking sensation' has also been described as 'metallic', or 'as if brain were made of fine glass and shattered at a blow', or 'a report like from firing of a pistol'. Sometimes it occurs during sleep, sometimes after retiring, preventing sleep.
An 'uneasy tensive sensation in the sinciput' may occur when the eyes are turned to one side without moving the head.
Rush of blood to the head but often with pale face; a heavy pressive headache as from congestion and fullness.
Throbbing headache in the forehead or at the bottom of the orbitae. 'The Digitalis headache... has the character of megrim; it occurs all of a sudden, in violent paroxysms, seems to be caused by a sudden rush of blood into the head, is usually half-sided and seated in the forehead'.
Half-sided headache 'like an internal itching'.
Pressive headache in forehead and temples which is aggravated by exerting the mind and thinking.
'A pressive pain by jerks, now in the temples, now in the whole head'. A peculiar symptom was elicited in a case of Ballard, quoted in Clarke's Dictionary: the patient had headache and dizziness, and after drinking he complained about a 'bad feeling about the head'. After drinking cold water the pain would seat itself in the forehead and extend down the nose. Pain externally at the head, especially pressive-stitching or tearing-stitching pain at the side of the forehead and at the temples.
'The head constantly falls backward, while sitting and walking, as if the anterior cervical muscles were paralysed and had no support'.

 

Eyes
Digitalis has a great number of disturbances of vision:
Vision of colours is altered. Green or yellow vision; faces look pale like corpses; in the morning all objects look as though they were covered with snow. Sees flashing gleams in brilliant colours, red, green or yellow; during the twilight. Or else: rainbow colours surround a candle flame like a halo.
Flickering scotoma.
Dark bodies like flies seem to float before the eyes, especially if one tries to observe distant objects.
On covering or closing eyes, brilliant bodies seem to jump before them.
A darkness like a cloud or fog, passing by before the eyes, impairs the vision; sometimes only in upper part of visual field. 'In the evening when walking, it seems as though the upper part of the visual field were shaded by a dark cloud'.
Dimness of vision like a veil before the eyes; with burning pain in the bow of the right eyebrow.
Double vision, even triple vision.
The movements of the eyes may be affected in a peculiar way: 'Inclination of both eyes to turn to the left; if he forcibly turned them to the right, they hurt, and then he saw on this side all the near objects twice or thrice'.
An interesting symptom is also an 'altered sense of vision', which is not identical with the visual disturbances quoted above. Two observations from the provings: 'The external objects presented themselves in a false gleam; he didn 't see them actually twice, but still they were not seen in their true light'. 'All the objects look as if he had a fever, as though he had the altered sense of vision as in fever'.
The pupils may either be dilated or contracted, often their reaction to light is reduced.
Inflammation of the Meibomian glands, hordeolum internum: pale red swelling of margins of lids; if the lid is everted, yellowish-reddish strings extending downward are seen; burning of margins of lids and photophobia. Agglutinated eyes in the morning.
Ophthalmia following after coryza that suddenly ceases. Inflammatory redness of conjunctiva and lids; sensation as from sand or coarse dust in the corners of the eyes; pressive pain or piercing stitches in the eyes; photophobia; constant lachrymation, aggravated by bright light and cold air; profuse suppuration in the canthi.
Violent stitches darting through the eyes, in the afternoon while lying down. Blue discolouration of the eyelids and other peripheral parts (as the lips, the nails); cyanosis.

 

Ears
Hissing before both ears, as from boiling water. If this symptom occurred in the context of partial deafness, Digitalis 'not seldom' effected a cure, as Hahnemann writes in a footnote.
Cracking in the head, on falling asleep, or else during sleep and waking from it. Single stitches behind the ear, externally.
Glands at and behind ear painfully swollen.

 

Nose
Epistaxis of bright red blood; also in connection with cyanosis.
Headache extending down the nose, after drinking cold water.
Very sensitive to odours of food which provoke extreme nausea.
Coryza 'in a high degree', with cough; can hardly speak, loses sense of smell. A striking symptom in coryza is violent and frequent sneezing.

 

Face
Pale, even bluish face, bluish hue under the pallor; eyelids, lips and tongue blue. The face may remain unusually pale even with congestion to the head.
Bloated face, pale or livid, also with distension of veins around the eyes, at the ears and lips and upon the tongue.
Black, inflamed, suppurating comedones in face.
Dry, even parched lips.
Convulsions on one (left) side of face.
Drawing and stinging pain in face, worse by external warmth; among other conditions, Digitalis cured a prosopalgia following herpes Zoster in face.

 

Mouth
Profuse salivation. The saliva may taste sweet, and/or it may smell very badly. Or else: bitter taste, especially bread tastes bitter.
Accumulation of saliva in the mouth, with spitting and violent nausea when swallowing it.
Salivation with soreness in the whole buccal cavity, also of tongue and gums. A sensation in the mouth as if softly roughed up, as though the buccal cavity were covered with velvet inside; with insipid and slimy taste. Tongue pale, coated white, or else coloured bluish; also with swollen veins upon it. With the Digitalis vomiting, the tongue is often totally clean. Swelling of lips and tongue, with foetid salivation and anuria.

 

Respiration
Hoarseness, mostly in the morning on waking; after nocturnal perspiration sometimes so great that speaking is impossible. Painless hoarseness. Tenacious mucus in the throat which is loosened by coughing. Or else: 'In the morning, mucus in the throat, easily detached but usually coming into the pharynx when trying to hawk it up, so that he has to swallow it'. Respiration is often irregular and performed by a series of deep sighs. Dyspnoea or oppression of chest compelling to breathe deeply, but even that does not seem to supply enough oxygen. Some descriptions of this very characteristic symptom: 'Distressing tightness of breathing, for many days, he frequently had to take a deep breath, yet it seemed to him that he had not enough air, especially on sitting' (Hahnemann). 'Very annoying shortness of breathing, while sitting as well as while walking, worst toward evening and in the evening. Constant desire to take a very deep breath, but on attempting to do so it seems as though the chest could be only half filled. In addition, there is a cough, especially when breathing deeply, which only seldom produces sputa consisting of lumpy, hardened mucus. All clothes seem to be too tight, but loosening them does not ameliorate' (Baehr).
Digitalis may be indicated both in quick and short and in deep and slow respiration; the characteristic feature is the feeling of air hunger which cannot be appeased. In the Chronic Diseases we find: 'Respiration difficult, slow and deep', but also: 'Breath short, wanting; unable to hold it long enough, is quickly compelled to inspire anew'.
An important sensation in the context of this lack of air is a feeling as though the internal parts of the chest had grown together; cannot get enough air, has to sit up. This symptom has been confirmed several times. Because of these and some other symptoms, Digitalis is frequently indicated in asthma. A cured case of Baehr, the symptoms of which have a been introduced into the materia medica and repertories: 'A 20-year-old sculptor had asthmatic attacks. Tightness of breathing came on all of a sudden, usually in the forenoon between 10 and 12 and in the afternoon between 4 and 6, with a sensation as if the thorax were constricted, with anxiety allowing no rest, but without heat. When the dyspnoea is at its height, sometimes a sensation as though the sternum were torn. Lying quietly in a horizontal position relieves after a while'. There are also Digitalis cases (as quoted above) where sitting up ameliorates; but an amelioration in horizontal position, especially when lying on the back, is more characteristic of the remedy. The feeling as though something had grown together in the chest may also indicate Digitalis in other complaints, for instance in neuralgic pain of the thorax in consequence of exposure to cold. In a recent case (see Miiller, Archiv fur Homoopathik 1993/2) this sensation was described: '...as if something were glued together in the chest and were torn apart on rising; or as though a steel spring pressed itself through the cover of a mattress'.
The dyspnoea of Digitalis may be accompanied by a painful feeling of weakness and lassitude in the chest; such a 'weak sensation' usually has its origin in the epigastrium, ascending from there into the chest. Another characteristic symptom of Digitalis is a gasping respiration, especially on falling asleep. As in Lachesis, the breathing may be arrested in the moment of falling asleep, returning suddenly with a gasp that wakes the patient. 'Gasping respiration, each breath seems as though it would be the last'. The Digitalis cough is best characterised by a quotation from Bonninghausen's book about whooping-cough: 'Hollow, deep spasmodic cough, excited by roughness and scraping at the palate and in the trachea; dry in the morning, in the evening with scanty, difficult expectoration of yellow, gelatinous slime of a sweetish taste, sometimes also with a little dark blood. Aggravation: midnight and morning. Being heated. Eating. Cold drinking. Speaking. Walking. Open air. (Warm air in a room.) On waking. Bending body forward'. After eating, the cough may be so violent that food is vomited. Dry cough, with infrequent expectoration consisting of hard balls of mucus. Pain in the thorax, especially in the region of the heart, resembling rheumatic pain, may also be cured by Digitalis. They may begin at the left margin of the sternum, changing from there to the right side and back again.

 

Heart
In the 'Essential Features' some important heart symptoms of Digitalis are already discussed, especially the bradycardia, the intermissions and extrasystoles, the aggravation from motion and the sensation as though the heart would stand still as soon as one moved, often followed by a fluttering sensation at the heart. There are, however, a great number of heart symptoms in Digitalis, because there is a close affinity of this remedy to the heart.
Irregular pulse, both in respect of the power of the expansion of the arteries and in respect of the frequency. For example: 'Slow pulse of 50 beats, which are absolutely irregular, between 3 to 4 soft beats a full and hard one'. 'With a frequency of 78, beating strong from twelve to twenty times, and then very weak for four or five times'. 'Great slowness and irregularity of the pulse'. The slow and small pulse often intermits for a shorter or longer time. Slowness of pulse, especially in the beginning of a diseased condition, is typical for a Digitalis case, and this slow pulse is often unusually hard and strong. 'Single violent and slow beats of the heart, with sudden strong heat in the occiput and transient fainting, all of this lasting only a moment'. (The strengthening of heart contraction with decrease of pulse frequency is the desired action in allopathic use of Digitalis.) But Digitalis may also have a slow pulse that is small and even thread-like, and the remedy may also be indicated in racing, flaying, hardly perceptible pulse. In any case, there is very often some kind of arrhythmia, especially pulsus bigeminus. Absolute arrhythmia; heart beat and radial pulse may not be synchronous.
A description by Baehr: 'Some quick beats are followed by a series of fuller and slower ones, of indefinite number. The intermissions... seldom fill a time of two pulsations; usually only one pulsation is missing after 3, 5 or 7, even 15, 16 or 18 beats - as if the heart wanted to have a break'. A characteristic observation from a proving: 'Pulse 60 when sitting, 72 when standing, the slightest motion made it immediately more rapid; noting the pulse while leaning backward in a reclining chair and then raising myself to slowly sitting upright, the pulse became in a moment jerky and very much smaller and weaker'. Or else: 'The least muscular exertion renders the heart's action laboured and intermittent'. Anxiety at heart is also an important symptom of the foxglove. 'Pressing constrictive heartbeats, with anxiety and spasmodic pain in sternum and beneath ribs, increased on bending head and upper part of body forward'. Or else: 'Stronger and almost audible pulsations of heart, with anxiety and constrictive pains behind the sternum'.
Sometimes there is also a feeling as if the heart were grasped by a hand which presses it slowly together (compare Cactus), especially on each intermission of the pulse.
There are also less violent manifestations of precordial anxiety, e.g. a 'dull and disagreeable feeling' or an 'uneasiness' in the region of the heart (Possart). Sudden attacks of violent and irregular palpitation, with a feeling of impending death and fearful anguish; aggravated by the slightest motion. Also: sensation of uneasiness and palpitations of the heart when climbing even a little; before the proving, these ascents had not had any action upon the organism.
Palpitation of the heart originating in grief, with pain in left side of chest and down left arm; also with numbness of the fingers.
Attacks of palpitation with great mental depression, self-reproaches, anxiety and fear of loss of reason.
Heart murmurs: blowing, 'bruit de souffle' (whistling noise); dull rushing and rumbling.

 

Stomach
Complete loss of appetite, with disgust of odours of food, with a clean tongue; also with an indescribable sensation of emptiness in the stomach. Sometimes there is a desire for bitter food. Or else: violent sensation of hunger on waking, soon followed by complete loss of appetite with a sensation as though the food stood up in the throat.
Violent thirst, especially for cold and sour drinks.
Extreme nausea: deathly, 'as if he should die'; in recurrent attacks; especially in the morning on waking; with inclination to vomit and actual vomiting.
'Sensation of fullness and nausea, with a clean tongue'.
The nausea is usually coupled with a tremendous sensation of weakness in the stomach, 'like a sinking, as if life were becoming extinct'.
This 'deathly' feeling is very characteristic, and a footnote in Hahnemann's Materia Medica Pura says: 'All patients used the same expressions for this complaint'. Great mental depression and sensations of apprehension in the epigastric region may also accompany the nausea.
A characteristic of Digitalis is also nausea remaining after vomiting. Vomiting of mucus and food, the things eaten are wrapped in white mucus; with amelioration of the bellyache. 'Vomiting, first of food, then of bile'.
A sharp burning, extending from the stomach into the oesophagus and lasting the whole day.
Indigestion with nausea in the morning, frequent vomiting, bitter taste, loss of appetite, thirst, diarrhoea, vertigo and frontal headache.
Great sensitivity in epigastric region, producing frequent deep sighs. Stitching pain, beginning in the pit of the stomach and extending to the sides and to the back.

 

Abdomen
In this region, Digitalis especially affects the liver. Sensitivity, pressing pain, swelling and induration in the liver region are frequent symptoms, but especially icterus. Jaundice with spasms and with grey, ashen stools. Icterus with slow pulse. Unaccustomed sensation of fullness in the abdomen, with loss of appetite but also if a there is a good appetite.
In the left side of the abdomen a feeling as if something pressed itself through the muscle wall. Sensation of soreness in the abdominal ring, left side, as though a hernia were protruding. Digitalis has been prescribed in incarcerated hernia.
Abdominal pain constrictive, or as though the bowel were twisted, with tremendous, death-like weakness and sinking feeling at the stomach. 'Increased movings in the intestinal canal, passing over into a slight cutting pain. This cutting pain later extends to the lowest part of the abdomen, to the pubic bone, and there changed to a pressing and dragging that was felt down through the pelvic cavity as far as the testicles' (Hartlaub and Trinks, Materia Medica Pura). Or else: cutting pain in the abdomen, with urging for stool.

 

Rectum and Stool
Bright, clay-like, grey or even white stools, usually soft and pasty, are a characteristic of Digitalis.
Diarrhoea, also violent, of an ashen or chalky colour; pappy, watery or 'faeces mixed with mucus'.
Before a diarrhoeic stool, pressive or cutting abdominal pain that disappears with the stool.
Diarrhoea, immediately followed by renewed urging in the rectum. Constipation; stools sluggish, completely lacking for days; difficult and scanty; grey, clay-like.
Frequent urging for stool, also with urging to urinate; very small and soft stools, hardly relieving the urging.

 

Urinary Organs
Digitalis has often been given successfully in oedema and hydropsia, especially if the dropsical condition had something to do with heart problems. As Hahnemann points out in a footnote, difficult urination is an important feature of the remedy, also in oedematous conditions.
Frequent urging to urinate, also with much effort, but fruitless, or evacuation of only some drops. In these cases, the urine is usually high-coloured, reddish or dark brown, and burning on urination.
Incessant urging to urinate, especially during the night, compelling to stand up; with dizziness as soon as one rises.
Difficult discharge of urine, as from a narrowed place in the urethra; '...a pressive burning sensation in the middle of the urethra as though it were too narrow there'. Or else: a contractile pain in the bladder which makes urination difficult. Or: urination difficult, as if there were no urine in the bladder, but all the same much urging.
A characteristic throbbing or cutting pain at the neck of the bladder when urinating, as though a straw were being thrust back and forth; especially at night.
Retention of urine because of enlarged prostate gland, with constant urging.
Another action of Digitalis in the urinary system is that the urging does not disappear after urination, even if it was profuse. 'Constant urging to urinate, remaining after urination'. 'Urging toward the bladder, soon causing a sensation as if it was overfull, but this did by no means disappear, although she frequently discharged urine'. Or else: increased desire to urinate after a few drops have passed, compelling patient to walk the floor in distress, although motion increases desire. (Compare: nausea remaining after vomiting; urging for stool that returns immediately after diarrhoeic stool.) Urine with a sediment like brick-dust.
Less frequently, Digitalis has a profuse secretion of urine, sometimes accompa-nied by cutting-drawing pain in the bladder. 'Incessant urging to urinate, and every time a scanty discharge; but notwithstanding this, on the whole the amount discharged was very profuse, for 24 hours'. 'Frequent and profuse discharge of pale yellow, watery urine'. After such a diuresis, retention of urine may again prevail, accompanied by nausea and vomiting.

 

Male Genitalia
Complaints from enlargement of the prostate; difficult urination, with burning, cutting, or throbbing pain; residuary urine remaining in the bladder. Because of this enlargement the genitalia are often in a state of '/b>great irritability with great weakness', i.e. the patients tend to have erections and ejaculations against their will, but also great relaxation of the parts with impotence.
'Incessant irritation of the genitals; frequent, almost painful erections were disturbing sleep at night'. Sexual imagination is stimulated a lot, the prover has 'lascivious images' in his head all day and night, and semen is discharged at night. 'Several times at night a feeling as though a pollution [ejaculation] should occur but none came; in the morning, a glutinous moisture at the orifice of the urethra'.
Great sexual desire but no ability to perform intercourse.
An itching irritation in the glans penis, especially if connected with frequent urging to urinate.
Digitalis has also been given successfully in hydrocele, even when the swelling was excessive. Jahr relates: 'The scrotum looks like a bladder filled with water'.
The ejaculations are often followed by pain in the penis or urethra, and especially by a feeling of weakness and lassitude.

 

Female Genitalia
Digitalis has been used when the menses failed to appear, also when the first menstruation was much retarded, especially if vicarious bleeding from the lungs was present; in menorrhagia where the bleeding sometimes lasted without interruption for weeks; in painful menses with severe pain in the abdomen and small of the back; in hydrometra; in oedema of the labia pudendi, making urination very difficult.
It is especially indicated if the following concomitant symptoms are present: very slow pulse, also with intermissions; bright-coloured stools; sexual fantasies day and night.
Sudden flushes of heat, irregular pulse, palpitation of heart from least motion; during climacteric period.

 

Extremities
Cold limbs.
Pain in all joints as if broken, especially after siesta.
Relaxation, paralytic weakness and prostration of all limbs, but especially in the lower extremities, as after a long journey.
Taut and painful swelling, first of the legs, afterwards of the hands and forearms.
Heaviness and paralytic weakness in whole left arm; can hardly raise it, can not even make a fist because it hurts so.
Sharp pain in the left arm, with tingling in the fingers, especially in connection with heart complaints.
A 'thrilling' sensation in the elbow joint as though the arm were growing numb and the nerve were pressed upon.
Violent tearing at the right forearm, more external, during rest and motion.
Annoying feeling of prostration and weakness in the carpus and the forearm.
Swelling of one hand with its fingers, especially at night. Trembling of the hands.
The fingers grow numb frequently and easily. 'Numbness and anaesthesia of the last three fingers and half of the ball of the right hand'.
Coldness of one hand, with warmth of the other.
Powerlessness and paralytic weakness of the lower limbs, especially in the knees.
Tendency to stagger when walking, especially if there is small, weak, slow and intermittent pulse.
Oedematous swelling of feet and legs, also painful; especially during the day, disappearing again at night; in context of loss of menstrual bleeding.
Sensation in the legs as though a red hot wire suddenly darted through them.
Lassitude of the legs, has to extend them constantly.

 

Sleep
Restless and unrefreshing sleep, with frequent waking as from a fright. Frequent starting from sleep, especially from dreams 'of falling from a height or into water'. 'Frequent waking, as from anxiety and as if it were time to rise'. 'Sleep disturbed by disagreeable dreams full of failed plans'.
Nightmares immediately in the first sleep; he wakes bathed in sweat and with palpitation of the heart. This proving symptom induced Oehme to give the remedy in several cases of nightmares, with great success.
Tossing about during sleep, unable to keep lying on any spot; always lies in a horizontal position on his back.
Unable to fall sleep if he lies on the left side; as soon as he turns around he falls asleep.
Insomnia with violent palpitation of the heart and pulsation in the left ear.
'Frequently great sleepiness', even 'somnolence', lethargy.

 

Fever, Chill and Perspiration
Coldness of the skin, especially of the extremities. Internal and external coldness everywhere, with clammy sweat and great sensitivity to cold.
But also: general aggravation from 'warm air in a room'. Coldness beginning in the remote extremities and spreading from there over the whole body.
Coldness in the whole body which is also felt externally; with a warm face, subjectively as well as objectively. 'Chill over the whole body, with heat and redness of face'. However, the face may also remain pale or bluish in spite of the feeling of warmth.
Internal coldness. Internal chill in the whole body, and at the same time unusual warmth externally, which can be felt on touch. Shivering and chill over the whole back.
Warmth over the whole body, with cold sweat on the forehead; sudden sensation of warmth over the whole body, followed by weakness of all parts of the organism.
Night sweat; profuse, cold perspiration.
Flushes of heat during the climacteric period, with palpitation of the heart and irregular pulse.

 

Skin
General pallor of the skin, also with a bluish hue.
Cyanosis, because of heart problems; icterus.
A peculiar corrosive itching of the skin on several parts of the body, provoking scratching. Scratching relieves the itching but it soon returns. If the desire to scratch is resisted, however, the itching increases more and more and finally changes to an 'intolerable burning stitching pain, as from needles'.

 

CLINICAL


Amaurosis. Angina pectoris. Asthma. Bright's disease. Cyanosis. Delirium tremens. Fever. Gonorrhoea. Headache. Heart, affections of. Hydrocele. Hydrocephalus. Impotence. Jaundice. Lungs, congestion of. Memory, lost. Meningitis. Noises in head. Paraphimosis. Prostate, enlarged. Ptyalism. Spermatorrhoea. Toothache. Urinary disorders. Vision, disorders of. Water retention.

 

RELATIONS


Antidoted by: vegetable acids, vinegar, infusion of galls, ether, camphor, Serp.
It antidotes: wine, Myric. (jaundice).
Compatible: Bell, Bry., Cham., Chi., Lye, Nux-v., Op., Phos., Puis., Sep., Sul., Verat.
Incompatible: Chin, (increases the anxiety); Nit-s-d.
Compare: Apocy., Ars., Bell., Bry., Camph., Con., Kalm., Lycps., Zinc, Verat.
Acon, (anxiety),
Ant-t. (deathly nausea),
Lach. (sleep),
Crataegus (weak heart),
Nat-m. (frequent and intermittent pulse),
Phos. (genital symptoms),
Spi., Sul., Tab. (deathly nausea),
Gonorrhoea, Sul. (prepuce indurated; Dig., puffed, infiltrated with serum)
Paraphimosis, Coloc.
Palpitation with diarrhoea, Ant.
Act on base of brain, Lob., Tab.
One hand cold, the other hot, Chi., Pul., Ip., Mosch.
Fainting before stool, Sul. fafter stool, Nux-v., Crot-t.).
Food eaten comes up by mouthfuls, Ferr., Phos.
Every shock strikes in pit of stomach, Phos., Mez., Kali-c, Calc.
Cracking in head, Aloe.
Headache extending into nose, Dios.

Index
1. DIGITALIS - The Essential Features