While many remedies are useful in the treatment of painful uterine contractions, only two have been shown to produce contractions at regular intervals simulating labor. Both were introduced into homeopathy from American Indian medicine, and both are still used primarily for complaints of or in relation to the female reproductive cycles of pregnancy, childbirth, and menstruation. Because their symptom pictures closely resemble two major subtypes of dysfunctional labor, they are also useful standards against which other possible remedies can be measured, and can reasonably be tried when other more specific indications are lacking.
Tincture of the root, Caulophyllum thalictroides, N. O. Berberidaceae, blue cohosh or “squaw root.”
1. UTERINE DYSFUNCTION
The muscle fibers of the mammalian uterus have the unique ability to relax isometrically at their contracted length, such that each contraction further reduces the volume of the organ. In labor, rhythmic contractions of this type, centered in the fundus or upper segment, accomplish the splendid athletic feats of effacing the lower segment, dilating the cervix, and pushing the baby into, through, and out of the vagina. After labor, similar contractions expel the placenta and any remaining clots and placental fragments, compress the decidual vessels, and thus minimize further blood loss.
The symptomatology of CAULOPHYLLUM is dominated by abnormal uterine contractions of an easily recognizable type. While often extremely painful and distressing to the patient, they are centered primarily in the lower segment, and tend to be sharp and spasmodic in character, brief in duration, and very unstable, often flitting about or into the bladder, groins, and thighs. Above all, they fail to dilate the cervix, which remains thick and spasmodically closed, and in emptying the uterus, which reverts after each contraction to its former length, like any other muscle.
Such contractions are commonly seen in prolonged or difficult labors that get “stuck” in the dilatation phase, when the vaginal exam reveals so little objective progress that it feels awkward to have to break this news. In such cases, both midwife and patient may have been misled by the intense pain and accompanying exhaustion to conclude that the labor was progressing normally.
2. MUSCULAR WEAKNESS AND NERVOUS EXCITEMENT.
Almost invariably, the contractions of CAULOPHYLLUM are associated with a sense of marked weakness or muscular exhaustion, sometimes to the point that the patient can hardly move or speak. At the same time, there is usually evidence of trembling, shivering, or some other form of nervous excitement, such as retching or vomiting. In both respects, its closest analogue is GELSEMIUM, which often succeeds where CAULOPHYLLUM seems indicated but does not help
3. NEURALGIC AND ARTHRITIC PAINS.
CAULOPHYLLUM can also relieve neuralgias in various locations, especially the bladder, vagina, and intestines. Like the uterine pains, these too are short, sharp, spasmodic, and tend to fly about from place to place. The remedy also has a rheumatic tendency, and can be helpful for pain, swelling, and stiffness in muscles and in the smaller joints (e.g., fingers, toes).
4. MISCELLANEOUS SYMPTOMS.
Weakness and excessive relaxation of muscles and supporting structures may affect the suspensory ligaments of the uterus to the point of actual prolapse. Occasionally the remedy has produced or relieved an irritating vaginitis with profuse discharge.
CAULOPHYLLUM patients are apt to be thitsty, chilly, and sensitive to the cold, with a marked intolerance of coffee. Moreover, women needing the remedy often appear rather delicate and nervous, with rapid changes of mood. But the mental and emotional symptoms of CAULOPHYLLUM are rarely as vivid or distinctive as those of IGNATIA or PULSATILLA. The flavor is simply what would be expected in someone exhausted and overwrought from a tremendous effort upon which she has staked too much, and for which she finds herself insufficiently prepared.
CAULOPHYLLUM should at least be considered and will often be useful in typical or early cases of uterine dysfunction in which the predominant flavor is one of muscular weakness and nervous excitement, and there are no other more specific indications pointing to other remedies. This syndrome may be encountered during labor, including premature or false labor; after labor, around expulsion of the placenta and the immediate post-partum period (after-pains); during and after miscarriage or abortion; and in difficult menstruation and dysmenorrhea, from the teen years through menopause.
The remedy corresponds to the whole range of conditions in which general weakness and excitability of the female reproductive system loom as major predisposing factors in chronic infertility, repeated miscarriages, and a tendency to premature or dysfunctional labors, or to postpartum complications secondary to uterine atony (retained placenta, postpartum bleeding, subinvolution, etc.).
For women with a history of this kind, CAULOPHYLLUM should be considered preventively. CAULOPHYLLUM 6 or 12 may be given daily for the last 2-4 weeks of pregnancy, and will often help to facilitate a speedier and more efficient labor, if the typical features are present (or have been in the past). A similar regimen may be used to reduce the risk of dysmenorrhea, miscarriage, or premature labor, where these conditions have occurred repeatedly in the past, or are threatening or imminent. The remedy may be given in a single dose daily for weeks at a time, or more often if need be; as always, the dosage must be adapted to the particular situation.
The proven effectiveness of CAULOPHYLLUM in such situations has led some to advocate giving it routinely in the last month of pregnancy, especially to primigravidas, for whom the excitement of giving birth for the first time might itself conceivably be regarded as a risk factor. Many reputable observers claim that such a regimen does in fact shorten the average length of labor and reduces both the level of discomfort and the risk of complications. On the other hand, using remedies routinely without definite indications and over a long period of time must carry a higher probability of adverse reactions than would taking no remedies at all. This is the sort of dilemma that must ultimately be resolved by the patient herself.
CAULOPHYLLUM is also effective in the treatment of established uterine dysfunction during or after labor, miscarriage, or menstruation, if the typical symptom-picture is present. In such cases, the fundus feels relatively flabby even during the contraction, and the usual signs of generalized muscular weakness and nervous excitement are also present. But it tends to work best in the early stages; in more advanced cases, other more distinctive symptoms will often point to another remedy, such as GELSEMIUM.
In acute situations, CAULOPHYLLUM 12 or 30 may be given every 15 to 30 minutes if need be, and tapered off as soon as there is definite improvement.
It is sometimes useful in the treatment of neuralgias and arthritis or rheumatism, particularly of the fingers and toes, when they arise during or after pregnancy, childbirth, miscarriage, menstruation, or menopause. It is also occasionally effective in the vulvovaginitis of little girls, with a profuse, irritating discharge.
It is difficult to present individual cases of this remedy, which tends to be most useful in the lower dilutions, such as the 12th, and preventively, in common situations, or before they have progressed too far. Because it has few distinctive mental or emotional features, and even its well-known physical symptoms are relatively nondescript and very much what would be expected under the circumstances, its action is most often solid and workmanlike rather than memorable. Yet I would not want to be without it.
Tincture of the root, Actaea racemosa or Cimicifuga racemosa, N. O. Ranunculaceae, black cohosh or black snake root.
1. UTERINE DYSFUNCTION.
Like CAULOPHYLLUM, CIMICIFUGA produces abnormal uterine contractions closely resembling those of dysfunctional labor, and its other symptoms are likewise intensified during and after pregnancy, labor, and menstruation.
The contractions themselves are similarly brief, sharp, and spasmodic, and just as painful as those of CAULOPHYLLUM, often darting about from side to side, or down the hips and thighs, and also tend to be felt predominantly in the lower uterine segment and the cervix, which remains closed and fails to dilate.
The remedy also resembles CAULOPHYLLUM in other important respects. It too has neuralgias, rheumatic and arthritic pains, trembling, nervous and emotional agitation, and an overall sense of mutability, of symptoms traveling from place to place, or changing from one to another or back and forth.
2. DEJECTION, FEAR, AND MENTAL FRAGMENTATION.
Yet from minutest details to their overall flavor or style, the symptom-picture of CIMIICIFUGA is fundamentally different, and indeed, when fully developed, not easily mistaken for that of any other remedy. This “essence” is perhaps most readily approached through the mental and emotional state, which has two important and interrelated features.
By far the more obvious and easier to recognize is a feeling of moroseness, gloom, or dejection, readily apparent on the behavioral level as a persistent negativism, defeatism, or pessimism that sees the worst side of everything, often with a fixed presentiment of failure or misfortune about the pregnancy, the labor, or the parenting to follow. “I can’t do it” or “I can’t go through with it” would be an accurate verbal rendition, doubtless easily overlooked in the throes of a difficult labor, when such sentiments are rarely absent.
- Case 1. A young woman in her second pregnancy appeared to be sailing through her labor without any problems, except for her bizarre and persistent conviction that she wouldn’t be able to finish. In this fashion she achieved full dilatation, and the baby’s head was halfway down the vagina, before her labor came to a halt, her prophecy seemingly fulfilled. As if by magic, a single dose of CIMICIFUGA put everything right again, the birth following within a few minutes.
Sometimes the dejection seems almost tangible or palpable to the patient: she may use words like “I feel as if I were enveloped by a black cloud,” and convey by her gestures or body language that an actual physical presence is meant. Indeed, this kind of somatization or extension of mental states into physical symptoms is a striking feature of the remedy in all its guises. The “black cloud” sensation in particular has been verified repeatedly in headache, depression, and many other circumstances.
But, underlying these depressive phenomena, strange and disabling fears may also be revealed — e.g., the fear that something terrible is going to happen, that she will die or be poisoned by the remedy you are about to give her, or that she will lose her mind and never be the same again. Sometimes these fears may only be hinted at by speech, gestures, actions, or physical symptoms incoherent or freaky enough to make the people around her fear for her sanity as well.
In either case, the CIMICIFUGA state implies the threat or actuality of a mental breakdown, in which the indefinable substratum or framework of experience dissolves away, leaving behind a mere jumble of fragmented thoughts and feelings, a truly pitiable state, justly to be feared by doctor and patient alike.
- Case 2. A young woman who became pregnant again soon after an abortion was still not in labor after 42 weeks, when the threat of a hospital birth seemed to unnerve her. Recalling that the pain of her abortion had been unbearable, with the even greater intensity of labor still to come, she could not dispel the premonition of a breakdown. When she appeared at the office a few days later, already six centimeters dilated, she was indeed out of control: wild-eyed and capable of mere fragments of speech, her gestures disconnected and woeful. Although remaining psychotic throughout labor, she progressed rapidly with the help of CIMICIFUGA 200, and made a complete recovery soon afterwards.
An alarming and sometimes prophetic fear of insanity, arising out of some unforgettably painful or tragic experience of pregnancy, labor, abortion, or menstruation in the past, is in my experience a valid and important keynote of this remedy, repeatedly verified in practice, and often helpful in explaining other symptoms as well. On the other hand, it cuts so deep as to be well guarded by most patients, even from themselves, and will seldom be volunteered or elicited readily.
- Case 3. An intelligent and sensitive woman had her second child at home without any difficulty, but at six months of age the child developed acute leukemia and died, suffering horribly from both the disease and the chemotherapy that nobody could bear to withhold from her. She was soon pregnant again and had another successful home birth, but one week postpartum developed a severe, disabling arthritis in one wrist that had no definite keynotes or modalities and failed to respond to any of the usual remedies. Although no one dared voice the obvious fear that her new baby would also die, I tried CIMICIFUGA 200 as a last resort, purely on the inference, and her wrist cleared up as if by magic.
3. FRAGMENTATION AND ALTERNATION OF PHYSICAL SYMPTOMS.
Much the same fragmented quality is characteristic of the physical symptoms. While the pains and nervousness of CAULOPHYLLUM are just as severe, they tend to be rather finely-textured and delicate, and to change into or follow one another quite easily, resembling PULSATILLA in this respect. The corresponding symptoms of CIMICIFUGA, on the other hand, are coarser, involving larger fragments or “chunks” of experience that replace one another abruptly and in a seemingly jumbled or random fashion.
Thus a labor pain might begin with all the proper focus and intensity, only to disappear before reaching its peak, or pass off into a disabling obturator neuralgia or sciatica, or be replaced by negativistic or psychotic behavior. Like IGNATIA, LILIUM TIGRINUM, and PLATINA, CIMICIFUGA is one of the principal remedies for physical symptoms that alternate back and forth or with mental states.
4. NERVOUS EXCITATION AND CHOREA.
The nervous system is likewise as hyperexcitable as with CAULOPHYLLUM, and just as prone to trembling, convulsions, and so on; but again the movements tend to be coarser and jerkier, and often involve the basal ganglia and extrapyramidal system, (chorea, athetosis, grimacing, etc.).
On the physical no less than the mental level, the replacement or alternation of large, discontinuous chunks of experience without pattern or warning makes the CIMICIFUGA picture not merely changeable or unstable, but disjointed and freaky, both to the patient herself and to everybody near her. The fundamental impression is one of disintegration, of experience coming “unglued” or disarticulated in Humpty-Dumpty fashion, without any corresponding assurance of restitution in the future.
5. PAIN: HEADACHE, NEURALGIA, RHEUMATISM, ARTHRITIS.
Among the numerous and frequently disabling pains of CIMICIFUGA, the headaches tend to be located in the occiput, extending down the neck, or ln the vertex, “as lf the top of the head would fly off.” No less intense are the neuralgias, typically described as “darting,” or “like needles pricking,~ or Hllke electtlc shocks here and there ” These too may occur anywhere, and change abruptly from one place to another without continuity or warning. Between pains or independently, patients also mention a rheumatic sensation of bruised soreness, whether generalized or in certain bones, muscles, or joints.
6. MISCELLANEOUS SYMPTOMS.
In general, CIMICIFUGA patients tend to be chilly, and most symptoms are aggravated in cold, damp weather, except the headaches, which are often better from cold. Miscellaneous nervous phenomena, such as nausea, insomnia, and palpitations, are quite common, as might be expected. As with CAULOPHYLLUM, the symptoms of uterine dysfunction may be accompanied by bearing-down sensations or even frank prolapse, and by abnormal or dysfunctional bleeding.
Because of its unique combination of uterine dysfunction with evidence of physical and mental fragmentation, the fully-developed picture of CIMICIFUGA will seldom be mistaken for that of any other remedy. As much as its uterine symptoms resemble those of CAULOPHYLLUM, their freaky and disjointed arrangement, often in alternation with other symptoms, will usually set them apart. Though as restless and fearful as ACONITE, as arthritic as BRYONIA, as volatile as PULSATILLA, and as morose as SEPIA or NATRUM MUR., its “essence~ or flavor remains equally distinct from all of these.
Probably its closest analogue is IGNATIA, which is also motivated by dejection and fear, and displays a similar alternating tendency, with a comparable inventory of headaches, neuralgias, and elusive female symptoms that never quite add up or stay put. But IGNATIA symptoms are derived from grief and disappointment, and therefore appear contradictory or anatomically impossible, whereas those of CIMICIFUGA culminate in insanity or the fear of it, and therefore give the impression of fragmenting or dissociation. Both stylistically and down to its minutes” details, there is no other remedy even remotely like it. On the other hand, it is relatively unknown, seldom thought of, and in less advanced cases may easily be overlooked.
CIMICIFUGA should be considered in cases of uterine dysfunction where nervous agitation and neuralgic or rheumatic pains accompany or actually demonstrate the characteristic mental and physical fragmentation, as described above. Such a pattern can be seen during prolonged or difficult labor, or afterward, with complications such as retained placenta, postpartum bleeding, subinvolution, etc., as well as in false or premature labor, and during or after abortion, miscarriage, menstruation, or menopause.
The remedy may also be used preventively, where similar episodes have occurred in the past, or appear imminent or threatening. Finally, it is an important remedy for the treatment of long-standing chronic complaints (headaches, arthritis, neuralgias, depression, infertility, repeated miscarriage or premature labor) that began in the same way, but have never resolved.
When indicated, CIMICIFUGA 12 or 30, t.i.d. or g.i.d., can be very helpful in threatened miscarriage or premature labor, if necessary for days or weeks at a time. CIMICIFUGA 200, 3 doses 12 hours apart, repeated weekly as needed, often works well for prevention of miscarriage or premature labor where these have occurred in the past.
In acute situations, such as actual miscarriage, difficult labor, or postpartum depression, CIMICIFUGA 12, 30, 200, or higher may be given up to every half-hour, or even oftener, preferably for at least 4 to 6 doses before changing it. But the proper dosage is as open-ended as the choice of the remedy itself, and must be adapted to the circumstances, above all to the response.
As yet I have given CIMICIFUGA only to adult women, and then only if the symptoms originated in relation to a pregnancy, childbirth, miscarriage, abortion, menstruation, or menopause. But even with these limitations (in large part my own), it remains a deep-acting “constitutional” remedy of surprising range and extraordinary power, and deserves a far wider acquaintance.
and so long as you have this in mind, you will grow.
— J. T. Kent’s Aphorisms