Aconitum - The Essential Homeopathic Features, Anxiety Attacks, Sympathetic Element
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Aconitum caule simplici; Aconitum vulgare
English: Large blue wolfsbane, Monkshood, Aconite, Helmet flower, Friar's cap.
French: Aconit napel, Napel, Aconit.
German: Napel Sturmhut, Eisenhut, Blauer Sturmhut
Natural order: Ranunculaceae
Family: Jussieu [vegetable substance] - Polyandria trigynia, L.
Mode of preparation: The juice of the fresh herb is prepared and mixed with equal parts of alcohol, yielding the mother tincture.
THE ESSENTIAL HOMEOPATHIC FEATURES
In the beginning years of my practice I used Aconite only for acute inflammatory conditions, like everybody else in the homeopathic world, because of the wrong assumption that Aconite was indicated only in acute, febrile conditions. It was only later that I discovered that it was also very useful for what could be called chronic conditions, especially chronic phobic or anxiety states. Since that time we have been using it at the Center of Homeopathic Medicine in Athens quite frequently for such chronic conditions with very good results.
Actually Hahnemann had made a similar observation when he wrote: "Although aconite, on account of the short duration of its action, might seem to be useful only in acute diseases, yet it is an indispensable accessory remedy in even the most obstinate chronic affections, when the system requires a diminution of the so-called tension of the blood-vessels."
The Reactions of Aconite
There are remedies for which the causative factor is of paramount importance in determining their indication; Aconitum is one of them.
The central theme that runs through Aconitum is an excessive excitability in the nervous and vascular systems. These systems can easily be upset by different stimuli. Modern civilization is rife with innumerable stresses — disappointments, grief from loneliness, loss of a lover, child or parent, fears, frights, failure in work or on examinations, financial insecurities, financial ruin, stresses from the weather, chemical and medical stimuli, enviromental pollution, etc. — which, if sufficiently severe, can shock an individual. An Aconitum case will not develop from all of these stresses, only from some specific ones. Aconite, for instance, is well known for producing inflammatory conditions from sudden exposure to cold, dry winds, but it has become increasingly apparent that there is another stimulus, namely sudden fright, that can also produce an Aconite state.
It is, of course, not necessary to have a history of a sudden fright to prescribe Aconite, but, if such a causation exists in the case under study, then this remedy must be seriously considered. The rest of the symptomatology will, of course, affect the final decision.
During Kent's time Aconite individuals were typically vigorous and plethoric, and he vividly describes them as such. Today's typical Aconitum cases have changed to a great extent. Of course, some of them still fit his description. They are usually sympathetic, vital, and extroverted people, yet, despite the apparent robustness of their appearance, they are exquisitely sensitive to a mental shock.
Aconite individuals will not develop their symptomatology when the shock is caused by financial ruin, an exam failure, a grievous love affair, etc. They have a specific vulnerability to sudden stresses that can create a simultaneous overexcitement of both the circulatory and nervous systems. In simpler terms we can say that an Aconite state may develop if the organism is subjected to the shock of "fright" or of "freezing." "Frightful" shocks obviously affect or stimulate the nervous sytem first and, secondarily, the vascular system, while in "freezing" it is the vascular system that is primarily affected, through vessel contraction, and the nervous system that is secondarily affected or excited.
What is important in both cases is that the systems can easily be overexcited. This actually means that the person who develops a constitutional Aconitum state under such specific stresses must have certain inherent predispositions for weakness of the nervous and vascular systems imprinted in his DNA. Not everyone who undergoes similar types of shocks will develop the same symptomatology, and, therefore, not everyone will need the same remedy.
The Reactions of Aconite
It must be understood that when we speak of an Aconite constitution being exposed to "sudden cold winds,'' we are referring to a sensation of being "extremely chilled;" he feels as if he has come very near death and reacts violently. Conversely, if an Aconitum constitution faces the possibility of dying, the experience is a "chilling death experience" for him. It is interesting here to note and understand the underlying mechanism that evokes an Aconitum state, the sudden mobilization of the vascular system — sudden intense constriction or dilatation — as a result of a strong stimulus.
The weakness of Aconitum lies in the easy mobilization of these systems, their predisposition to tumultuous upheaval. Such vascular systems, as Kent observed, are often encountered in plethoric or vigorous individuals; however, as I previously intimated, today's Aconitum patient is far less likely to possess such vigor. His robustness has been compromised by the hazards of modern civilization: poor diet, environmental pollution, constant use of chemical drugs, etc. As the plethoric Aconitum becomes more and more rare, we see fewer of the Aconitum febrile conditions of old, and instead are increasingly confronted with the mental and emotional disturbances characteristic of the newer Aconitum constitution.
Furthermore, we may, in general, say that whenever there is sudden exposure to cold and, at the same time, an immediate, violent inflammatory reaction in any system or organ, we should think of Aconitum. The poison is deadly, the effect immediate and the result violent — such are the characteristics of Aconitum.
The Fear of Imminent Death
The Aconitum picture seems to especially develop after violent events events in which the patient experiences a fear of imminent death; such as, when someone is threatened with a pistol during a robbery.
Automobile accidents and earthquakes are other types of stresses that can especially provoke an Aconitum state. The 1982 earthquake in Athens provided ample example of this observation. There were many Aconitum cases seen after this earthquake whose fears reached panic proportions; these fears were accompanied by trembling, restlessness and exhaustion from the constant anticipation of another earthquake. Aconitum 30C provided quite a bit of relief for these individuals.
Other situations or types of stresses that can induce an Aconitum stare are: entrapment in an elevator, riding on a train through a dark tunnel and suddenly experiencing an electrical blackout (The mere anticipation of such events may be sufficient stimulus.) Informing a patient prior to major surgery that it may end fatally for him, seeing one's child in a precarious position and sensing that death is near. This last causation is illustrated by the following case report.
"A little girl was accidentally wounded by a pistol. Her mother suffered mental shock, paleness and faintness, especially on attempting to sit up; great concern for the result. Relieved after a dose of Aconite." - J.C. Morgan, M.D.
The important element in all of these situations is the sudden fear that death may come to the individual or to his beloved ones at any moment. Aconitum contains this element strongly in its causation. In febrile states this very same idea overwhelms an Aconitum case. The fever is so severe, so sudden that the patient is convinced that he is not going to survive, that he will die soon.
In the acute state, as mentioned, the fear is that "they will suddenly die at any moment." In chronic states the fear is that death is nearing; it is a fear that death will occur within the next few months (up to a year or so). Only seldom will Aconite predict death at a precise moment; such as, "I am going to die when the clock strikes eight." They are absolutely sure that because of their condition they are not going to live very long. They make preparations for death, such as writing their will, etc. If one does not know that this element belongs to Aconitum pathology, one might think that the patient is just being prudent in making such preparations, but in such cases the driving force is the fear of dying, a fear which is not justified by the pathology of the case. This conviction of imminent death has nothing to do with reality and must be taken as a symptom.
The Mental-Emotional Structure
Let us now review Aconitum as it is seen in the patient of today. Because Aconite cases of today so seldom present with the traditional physical inflammatory reactions of old, it is critically important to understand the remedy's inner mental-emotional structure that its current indications might be better recognized.
The shocks in an Aconitum case penetrate the entire body and mind and send the whole organism into a shudder, into extreme trembling with tremendous restlessness, unrelieved by any change of position, and an agonizing fear of death. Phobias, especially of death, that persist for years can result. It produces a fear that death will come on suddenly, when least expected; this phobic state is not constant, but rather one that comes in fits. The fear is most accurately expressed as a "fear of impending death." We witness this kind of picture today in patients suffering from phobic neuroses. From time to time, with or without small provocations, acute states erupt with the above characteristics.
In the provings Aconitum has produced a sudden tumultuous stimulation of the vascular and nervous systems, bringing about fear, heat, flushing, strong palpitations or arrhythmias and eventually coldness - blueness, small pulse and death. Vertigo and, often, one-sided numbness of the face or body can result. The numbness can be severe or can resemble a tingling state; it may affect the whole body. Aconitum patients will suffer from episodic spells of any or all of the above symptoms; that is, the pathology takes the form of separate crises which last from but a few moments to a few hours.
The attacks are not regular, nor are they constant; they come in fits, in sudden acute crises and can come at any time and as a consequence of any stimulus. The most important point is that in almost all cases we see a tremendous fear of death, which sometimes reaches panic proportions, in addition to the feeling that death is imminent. A Physician attending an Aconitum patient in a crisis may hear the patient saying that he has "come too late," that he will "die soon," this being another expression of the presentiment of death. The books say,
“Predicts the time of death”, and while it is not always expressed in exactly these words, the patient's comments will have the same implication. A similar fear of death during pregnancy or during labor can be seen and is a keynote for this remedy. In chronic conditions the patient will not make such specific predictions; he just has a general presentiment that death will come soon and suddenly. For instance, a woman may fear that she will die before she can bring up her children. This is an almost clairvoyant perception; in fact this remedy often has clairvoyant experiences and in particular clairvoyant dreams.
The Complaining, Reproaching and Wailing
Aconite patients have a disposition to weep; they moan, and complain bitterly, with fears, despair, and loud whining. Here are a few examples: He has a feeling as if something is kicking in his heart and an overwhelming fear arises. In this state he does not want to do anything, and, if forced to do it, he will have the tendency to break the things he is handling. Any kind of outside pressure gives him the impression that he is going to have a brain stroke or heart attack.
In the past she loved her family, children, husband, etc., but now she avoids them because they irritate her and she cannot tolerate any contradiction from them. Anything that the husband does is wrong. She does not know why she is behaving like this, but she cannot avoid it. She tries to suppress her anger, but she feels such rage inside that she wants to kill somebody. Although she loves her husband, she wants to kill him.
Here it should be noted that Aconitum patients have a desire to be the first in whatever they are doing; it is difficult to suppress this inclination. If they do try to suppress it, a boastful attitude usually results. A similar result - appearence of another deeper disturbance - applies when discharges are suppressed. The suppression of anger can also have adverse consequences. Also, if any of their desires are not appeased immediately, they fall to pieces. Great impatience is characteristic of the remedy; time seems to pass too slowly while waiting.
The Anxiety Attacks
Picturing an Aconitum individual with the intense fears, pounding tachycardias, arrhythmias, or other intense symptoms, one might expect to see a plethoric and intensely communicative patient in the consulting room, but this is not the case. When he is not in a crisis situation, he will be calm and quiet. He will appear fairly normal. Even his descriptions of the crises will not be very intense. However when the crisis comes, the violent intensity, panic, and fear surface to an unbelievable degree.
These sudden attacks of anxiety are of such an intensity and so overwhelming that they normally cannot be controlled at all. They are like a storm coming on, a storm which overcomes the psyche and produces a terrible state of panic-stricken fear. But despite their anxiety these patients will still try to control their fears, and if their efforts are successful a kind of internal trembling and shaking occurs sometimes, invisible to others. In this situation, even during the crisis, it is not necessary to see the patient restlessly running around or tossing about - it may be enough to perceive the sense of agony and despair exuding from such patients to prescribe this remedy.
Chronic Aconitum conditions are typified by intense exacerbations interspersed with completely normal intervals. It is as if Aconitum cannot go on having attacks all the time because the attacks are too strong, too terrifying for the patient to survive a constant onslaught.
The anxiety state of Aconitum can be reflected in many symptoms/syndromes. Here are some examples:
Flickering before vision makes him anxious on the street, he thinks he constantly jostles the passers by.
He needs to press his heart and at the same time breathe deeply because he is afraid his heart will explode.
Inconsolable anxiety, sad wailing; peevish and impatient.
Anxiety is transiently ameliorated by drinking cold water; followed by apathy; with cold sweat.
Anxiety as though a great misfortune would happen to him. Increased anxiety, followed by total apathy.
Anxiety which does not allow him to remain in one place, he must constantly walk about.
Anxiety and peevishness,with fine stitches in the side of the chest, then palpitation at the pit of the stomach, and pressive headache. Inconsolable anxiety and piteous howlings, with complaints and reproaches about unimportant matters.
Pitiful anxious complaints, with fears, despair, loud wailing, weeping, and bitter reproaches.
He cannot banish anxious apprehensive thoughts, even in gay company
Suddenly, as he is walking or sitting, a sudden feeling of faintness and intense weakness overtakes him that may last for one or two days.
The Sadness and Indifference
Aconitum can show a completely different picture which is far less known than the anxiety and restlessness. Many homeopaths would never think of Aconitum when they see a person who is very sad or apathetic and indifferent to everything.
In this particular state of mind he whines and howls piteously and weeps without cause. Music is unbearable to him because it makes him sadder. He desires to be left alone, shuns other people, does not want to talk and if someone asks a question he answers only with a yes or no. It is as if he has lost all affection for anybody and he becomes indifferent to his relations, friends and persons he normally loves. He sits buried in thought. He may even think about committing suicide by jumping from a high place or from a train.
This state of mind appears sometimes after a long period with very severe anxiety attacks. It seems to be a kind of reaction, as if he could not endure his panic anxiety any longer and therefore found an escape in a state of emotional indifference or a suicidal mood.
Here it is important to note the polarity that appears quite often in Aconitum cases. Most patients have fear of death and agonising restlessness, but a few will manifest the opposite extreme and actually desire death. Sometimes the two states alternate. A similar opposition can be seen in fevers. In such instances rather than the usual restlessness and fear that accompany high temperatures, we witness indifference, exhaustion and sleepiness or a stupid, groggy feeling.
All of the above symptoms do not necessarily have to be seen in one individual for him to be given Aconitum. Some people will have fear of death, vertigo, fear of fainting, and tachycardia; others may have trembling, arrhythmia, perspiration, unilateral numbness (e.g. numbness of half of the face,) etc.
Another group of patients may experience a type of extreme psychogenic dyspnea, similar to that of Lobelia but more intense, which causes them to inspire deeply, loudly and with great anxiety. We may also see flushes of heat involving parts of the body, especially the head. There are also allergic eruptions surfacing after flushes of heat. The time of aggravation in general is during the night, especially from midnight to 4 A.M. There is generally an aggravation from sudden changes of temperature. Once the chronic state of Aconitum has become established, the acute exacerbations or crises can be precipitated from either sudden dry cold, dry heat, overheating, or warm rooms.
The Sympathetic Element
These patients are very sympathetic. They need company and are usually extroverted, but they do not like consolation. They express their feelings easily. The sympathetic element leads to a state of anxiety about others. They are very concerned about their relatives and friends, and they react exaggeratedly when something happens to someone about whom they care. They erupt emotionally when they hear news of something bad happening to a friend. The reaction is out of proportion to the significance of the event. Because of that element, Aconitum patients do not like to hear bad news. One should not be misled into prescribing Aconitum simply because a patient has such a symptom. The whole picture must be seen to justify the prescription of this remedy — the intense crises with panic, fear of death, tachycardia, perspiration, etc. Prescribing solely on a symptom such as "anxiety about others" is an example of "one-dimensional" prescribing which is not only misleading but erroneous. Even if only one symptom exists upon which to prescribe, it must be viewed in a three-dimensional context if there is to be any hope for success in keynote prescribing. To glean an impression of what is meant by three-dimensional prescribing let us consider the differential diagnosis of one symptom — anxiety about others — and the corresponding remedies:
The Aconitum sympathy is reactive. It consists of an emotional eruption or explosion; such as, " Oh, my God! What shall we do!" Such reaction arises especially when the patient is suddenly faced with a severe health problem or, even worse, an accident concerning one of his relatives. Aconitum is especially afraid of accidents and consequently over-reacts when hearing of one. The anxiety about others is very intense and disproportionate to the reality of the situation. Stoicism is not Aconitum's long suit; his reactions are immediate and exaggerated.
Sulphur will not show such anxiety. He will worry only in special situations. Sulphur is anxious about his children. It is very seldom that he worries about anybody else, being in essence quite self-centered. If his child is late coming home, he starts to worry. He will be unable to sleep, will walk up and down imagining that the child has had an accident or some other mishap. When his son or daughter drives into the driveway, all of his concerns evaporate and he goes back to sleep.
Phosphorus will have a completely different kind of anxiety. He shows great affection and concern for everybody, even recent acquaintances. He becomes especially concerned and attentive if he hears of their having a health problem. His involvement is genuine, his sympathy for them great. Phosphorus does not display the imaginative worry that Sulphur does; he suffers only when he actually encounters a situation in which another person is suffering, and then he empathizes intensely.
A Phosphorus mother has to get up in the night to see whether her little baby is breathing, or is alive. A Phosphorus patient who is confined to the hospital will not be able to tolerate the pain of his roommate; he will persistently ask the nurse to do something to alleviate his pain. The same is true in Causticum, because of the extreme sympathy towards the pain of others that the two remedies have.
Arsenicum is also anxious about others. In this case it is an inner anxiety. The objects of his anxiety are those who are close to him— father, mother, brother, etc. These people provide him with a sense of security; thus, he himself feels threatened when they are not well. It is a self-motivated anxiety for others; he wants them to be well so that they can help him.
Baryta carbonica has a sweet concern about the people who are looking after her. She is very concerned that something may happen to them though she feels completely inadequate in doing anything about the situation. Baryta carbonica will display a lot of silent sympathetic concern which others can feel, but underneath there is a terror that something may happen to the individuals that take care of them or protect them. This is a genuine concern but one arising from a feeling of insecurity, inferiority and helplessness. They fear that they will be left completely unprotected, unable to fend for themselves if something happens to their protector. They resist even thinking of such a possibility.
Cocculus has a passive anxiety about others — a type of anxiety that makes him stay in the hospital the whole night, attending one of his relatives and not sleeping for an instant. His anxiety that this relative may die is so great that he does not allow himself to relax. Cocculus does not think; instead he acts almost instinctively when one of those he loves is in danger. He seems not to feel the tiredness while in the grip of his anxiety for others and their welfare. His anxiety, though, is limited to those he loves.
Causticum has a more general anxiety or rather compassion about others, that is so great that he suffers when he hears or he even reads that others are suffering, or are under a kind of suppression by authorities or injustice. It is enough for him to read in a newspaper or to see in television that people, even in a foreign country, are starving and he is affected so deeply that he has to weep and he gets extremely excited.