Vol. 24 No. 2 April 2004

by P. E. Krichbaum

Asthma may be defined as a dyspnoea of peculiar urgency and violence, generally paroxysmal and recurrent, often periodic, not necessarily attended by cough or expectoration, accompanied usually by dry rales and compatible with easy and healthy respirations in the interim of the attacks.

As may be readily understood, our materia medica is rich in remedies easily fitted to meet the many and varied symptoms of this complaint. If, in introducing a few of these to you, I parade the same old earmarks, it is because the said earmarks are generally the first seen in the process of bringing our observations of our patient and his remedy together.

Chamomilla may be useful in asthma when the characteristic Cham mental symptoms obtain, or when an attack is precipitated by anger. The Cham patient is spiteful, vehement, uncivil, excessively sensitive to pain, in a word, absolutely intolerant of any physical distress. Cham increases this general nervous sensibility, and, like Coffea, stimulates the cerebral function, but Cham antidotes Coffea. Coffea patients can’t stand pain; Cham won’t stand it, and say so. If Cham, then, be thus brought to our attention, and its application follows, we will find our patient afflicted with catarrh and hoarseness. There is an accumulation of tenacious mucus in the throat. The hoarseness may be accompanied by stitches and burning in the larynx or, worse still, by very distressing spasmodic contractions.

The cough threatens suffocation. The rattling in the trachea is plainly heard, together with persistent wheezing. Cham is suited to attacks of flatulent asthma where there is great anxiety, with fullness and oppression in the precordial region, and shooting pains in the chest chiefly on breathing. As may be imagined, none of these uncomfortable symptoms are philosophically borne. The Cham vehemence, here as elsewhere, serves but to complicate matters. The Cham adult is but the Cham child grown up. You may not be asked to carry him, but you will be most emphatically requested to relieve him and that right speedily.

In bronchial asthma, Podophyllum often has a place, though we are accustomed to think of this remedy only in diarrhoea where the liver is involved. It produces an indescribably sick feeling all over, with a persistent dry, rough sensation in the pharynx and aesophagus extending along the right eustachian tube. There may be a feeling of a ball or a lump in the upper aesophagus, with a dull aching pain in the right ear.

The Podo asthmatic has an exceedingly uncomfortable stomach, in addition to his respiratory difficulties. He complains of fullness and is tormented with belching of gas and sour eructations, marked patient will speak sometimes of a great desire to press the gums together. If the patient be a woman, she will explain to you that she feels as if her genital organs would fall out when her bowels move.

In chronic bronchitis when Podo is of service, there is an inclination to breathe deeply. Or in bronchial asthma, there may be a feeling of suffocation on first lying down at night, aggravated by catching cold. One queer symptom is recorded in this connection, and is described as a snapping in the right lung like the breaking of a thread, when taking a deep breath. This desire to breathe deeply is very marked, and when oppression of the chest is present, is often unhappily prevented. Podo has such a range of classical intestinal and stomach symptoms, its selection in any given case is not difficult.

The Silica patient is well differentiated from childhood up. We all know the train of evils which follow in the wake of this patient’s defective assimilation. He needs grit morally and physically. Silica is called the chronic of Pulsatilla. Pulsatilla skims the surface, so to speak, while Silica digs beneath and stirs up a much deeper layer of troubles, whether it strikes the rickety child or asthmatic old man. It is a remedy full of abortive efforts, to wit, the familiar half protruded stool, with its slipping back. Silica’s feet are often notoriously odorous when uncovered. It is a point never questioned when present.

The Sil headache has a sphere of its own. This chronic headache begins in the neck and extends up to the head. It is aggravated by a draught of air, or by uncovering, and relieved by pressure and wrapping up the head warmly. (Gelsemium has another queer headache amelioration, profuse urination.) The Sil subject is so devoid of vital heat that even exercise will not warm him up. The very finger tips may be described as feeling dry at night as if made of paper. The Sil entity must be perceived before any call for it in cases of asthma is understood. It is deep acting.

The Sil cough is marvellously easy to provoke, a cold drink, even momentary use of the voice, if a paroxysm is imminent, being sufficient. When Sil coughs something is doing. Severe vomiting of mucus is not uncommon. The Sil asthmatic is clearly short of breath, cannot hasten his steps, or perform any light manual labour without puffing. If you find a case of asthma where there is an abscess in the lung, think of Sil. In such a situation, its deeply penetrating characteristics find proper scope.

In catarrhal cardiac asthma, Sabal serrulata, the saw palmetto, will serve you well. In the mental sphere we find that sympathy makes this patient angry. He is not a whining patient but he is full of fears and apprehensions, fears to fall asleep lest something should happen, starts up when dozing and fights to keep awake.

Sabal is associated in our minds with man’s urinary apparatus.

Indeed, its special regional affinities are the prostate, bladder, and urethra in men and the ovaries and mammae in women, but upon individuals with weakness and irregularity in these parts, a certain type of asthma may descend and then Sabal works. Under this remedy we note great tenesmus in the neck of the bladder with heavy aching pains and a sensation of coldness in the external genitals. Naturally you would expect to come upon marked incontinence of urine as well as impotency. Iritis occasionally calls for Sabal when the prostate gland is involved.

A peculiar exhibition of humid asthma may be encountered calling for scallop, Venus mercenaria, a remedy introduced by Samuel Swan. Under Venus there is quick, laboured breathing. The patient cannot lie flat nor on his left side, while there appears to be a constriction of the chest, especially on the right side. The asthmatic attacks are preceded for two or three days by sneezing, excessive coryza, a burning sensation in the throat and chest and a feeling of fullness in the head. The attack ends with a copious expectoration of tough, stringy, and frothy mucus. The cough is worse after 6pm; indeed, all symptoms are worse at night.

Patients afflicted with hysterical asthma are in a class by them selves. Nux moschata should be studied here. This remedy produces some very queer states of exultation resembling hysteria, the mesmeric state, double personality, etc. Drowsiness, chilliness, and thirstlessness are the tripod of peculiarities for Nux mos. The patient will tell you that his chest feels as if in a vice, or as if there was a load on his chest. There may be stitches in the chest with spitting of blood. The cough is varied under Nux mos. It may be dry with suspended respirations after a chill in the water or after getting wet. The saliva seems thick like cotton. Or the patient may cough with or without expectoration when becoming warm in bed or when warmed up from work.

In asthma with the before mentioned hysterical base, there occurs great difficulty in inhaling. The patient exhibits a tendency to faint. He will describe all manner of odd sensations, feels as if drunk, as if floating in the air; objects about him appear too large. He drowses off. The Nux mos patient will complain of escessive flatulency and constipation, which last is frequently accompanied by an exaggeration of the typical drowsiness.

When Corallum rub is needed in asthma, you will find an almost continuous paroxysmal cough which begins like Mephitis, with gasping for breath. The face is purple. There is vomiting of stringy mucus, the whole followed by pronounced exhaustion. The condition is extreme and the picture alarming. The eruptions of Corallum rub, strange to relate, are markedly red. Red flat ulcers often appear on the glans and inner surface of the prepuce with secretion of yellow ichor. The feet are cold when uncovered, and too hot when covered. Cor rub is complementary to Sul.

Cuprum met’s regional activity centres in the cerebro-spinal system. This medicine affects the nerves, muscles, blood, and digestive tract. When needed, it is needed badly, for the manifestations which call for it are extreme. Convulsions run through its symptomatology, The muscles draw up in knots. The dyspnoea is terrible; the patient cannot bear anything near the mouth for fear of spasms of the glottis. There is constriction of the lower chest. The cough is dry with fits of suffocation like whooping cough. Bronchial rales are heard, as if from mucus.

Cases of severe spasmodic asthma are frequently helped by Cuprum. Attacks are apt to increase from 1 to 3am, and are worsened by bending backward.

When you run across a case of asthma prominently associated with gastric symptoms and a peculiar sensation of weakness at the pit of the stomach, think of Lobelia inflata. The Lobelia patient is afflicted with ailments that never clear up. Obstinate wens on the scalp occur; all sorts of trying eruptions manifest themselves between the fingers on the dorsum of the hands and on the forearms, consisting of small vesicles, accompanied by a tingling itching and resembling the itch vesicle exaetly. The almost constant dyspnoea is aggravated by the slightest exertion and increased to an asthmatic paroxysm by even the slightest esposure to cold.

The sensation of weakness and pressure in the epigastrium rising thence to the heart, with constant heartburn, is Lobelia’s most marked and individual indication. The cough of the asthmatic patient under Lobelia is spasmodic and is associated with sneezing, belching and gastric pains. Nausea is continuous and accompanied by a constant flow of saliva. The Lobelia patient in the throes of an asthmatic attack will assure his attendants that death is near. The weakness takes his courage and disturbs him quite as much as the dyspnoea.

If you are called to prescribe for a case of periodic asthma in a gluttonous, fleshy old man, whose bowels are deranged by the least irregularity in diet, a patient in whom a chronic bronchial catarrh with profuse mucous espectoration has manifested itself, think of Allium sativum. The cough appears to come from the stomach in these cases. The breath is foetid and your patient will cough from smoking. Mucus rales are heard in the bronchi almost continuously.

The pains of Allium sat are distensive, stinging, with paralytic weakness, increasing and decreasing gradually like Stannum and Sul. Your patient may complain of this kind of pain in the psoas and iliac muscles, aggravated by the least movement though he can lift the limb with the hand.

When you encounter a case of nervous, spasmodic asthma, Valeriana should be studied. The typical Val patient has a very changeable disposition and her symptoms switch back and forth with the same tendency to alteration. The Val pains are continuously on the move, now here, now somewhere else, with no settled location. Val has many illusions of taste and smell. The oftquoted sensation of a thread in the throat is typical. There is a fatty taste in the mouth, with nausea in the throat and an almost constant pressing pain in the lower part of the chest, the armpit, or the stomach, as if something were there forcing itself upward.

These are true hysterical markings, but they are valuable aids in prescribing for your patient. The typical Val subject is one in whom the intellectual faculties predominate, but the intensity and variety of the purely nervous symptoms which attack patients calling for this remedy, make them very difficult people to reassure. Their irritability is marked. Choking in the throat pit on falling asleep wakens as if suffocating. Inspirations grow less deep and more rapid till they cease; then your patient catches her breath by a sobbing effort in spell – so reads the text. Val will work wonders here.

In pituitous [with much mucus] asthma, Sinapis nigra stands very high. The throat is hot and swollen, worse on the left side. The tongue is dry with a dirty, whitish coating and a crack in the middle. Hot, light red mucous membranes, which feel dry and scalded to the patient, are marked. In cases of asthma complicated with hayfever, think of Sin nig. Here a scanty acrid discharge from the nose, with the escoriation beginning on the alae nasi, is a guiding symptom, also that very peculiar, but characteristic, symptom of sweat on the upper lip spells Sin nig.

If you are gunning for pathological lesions or bacterial infections alone such apparently inconsequential evidences of disorder will never cause you to pull a trigger for your patient’s relief. But, to a prescriber who is willing to acknowledge an occasional inability to neatly docket all of his findings and place a label on them before he prescribes, these very minor peculiarities of patient and drug are often pertinent and powerful when accurately brought together. The cough under Sin nig is short and hacking, usually dry, but at times sputum in small tenacious lumps is raised. This cough is worse in the evening, though it sometimes disappears upon retiring.

If you meet a case of so-called splenic asthma, Scilla maritima may help you out. The cardiac action of this remedy is exactly the same as that of Digitalis. The patient requiring Scilla will suffer continuously from asthma as a complication of a splenic affection. He is invariably worse at night and has a splenic cough. The pain will run from the splenic region into his throat. It has stitches under the free ribs on the left side. Rattling precedes the cough. This cough is loose in the morning but severe and dry in the evening. Tears gush on coughing and bladder control is uncertain even with sneezing. The teeth show black marks in hayfever. The patient constantly rubs his eyes, around which bloating is marked.

In pleuro-pneumonia and angina pectoris, Scilla has been curative. Stitches in the left chest, hot, scanty urine, great weakness and anorexia are keys.

Cardiac asthma may be relieved by Aspidosperma. This remedy produces respiratory paralysis, slows the heart action and even induces paralysis of the extremities in anemia. Your asthma patient under Aspidosperma will have a livid face and suffer greatly with dyspnoea and cyanosis. Emphysema may also complicate matters and even slight mitral murmurs be heard. Another useful remedy in cases of cardiac asthma is Ambra. This medicine has a decided affinity for the pneumogastric nerves and is rich in peculiar nervous symptoms. Your Ambra patient is very easily agitated and embarrassed. The slightest thing affects the breathing and heart. Embarrassed in company, cough worse when people are present. Cannot tolerate the presence of others when urinating or during stool. In the asthma of old people and children Ambra is frequently indicated. The cough is spasmodic from tickling in the throat with espectoration of yellowish or greyish-white mucus, tastiug saltish or sour in the morning. Ambra also has a convulsive cough with short breathing and oppression felt in the chest and between the scapulae. The heart under Ambra palpitates frequently when walking in the open air. The face is pale and there is pressure on the chest as if a lump lodged there. Your pneumogastric is out of order and false signals are being given.

The asthma of drunkards or consumptives is sometimes helped by Mephitis. The patient chokes easily while eating and coughs upon the slightest provocation. The Mephitis cough is typical and most distressing whether found in whooping cough or asthma. It is spasmodic in character, very violent, often to the point of partial suffocation. It is worse at night and at daybreak. The patient feels as though he had inhaled the fumes of sulphur and shows unspeakable uneasiness during the asthmatic attacks. Great inclination to sleep is a symptom. Another peculiarity of the Mephitis patient is that he can endure estreme cold; washing in ice water is pleasant.

When Ipecac is indicated in asthma, the well-known symptoms of Ipecac will, of course, be present. Briefly enumerated, they are as follows: persistent nausea, horrid nausea; stomach feels as if hanging down; face, pale; tongue, clean; shortness of breath; violent dyspnoea, with wheezing and great weight and anxiety about the precordia; loose rattle within the chest, without expectoration, like Moschus; paroxysms of shaking, incessant or suffocating cough with every breath. A child will stiffen out, turn red or blue and finally gag and vomit. Ipecac is not difficult to recognize.

Bryonia is often useful in asthma, but is prescribed more upon the general condition of the patient than upon any peculiar type of asthmatic disturbance. The heavy, splitting headache, the dry mouth with its bitter taste, the thirst for much water, the sharp stitches in the chest, the dry, painful cough, the difficult breathing, possible only with the assistance of the abdominal muscle, the oppression of the chest with the fits of choking – all these are indications for Bry, and do not need elaboration.

In haemic or simple, uncomplicated asthma in a corpulent individual, Blatta orientalis (cockroach) may be of service. One peculiar characteristic of this remedy is a sensation all over the body as if heat was radiating from the ears, eyes, top of the head, palms of the hands and soles of the feet. The asthmatic attacks come on at night about 9 or 10 o’clock and keep the patient from lying down; indeed, he will begin to cough as soon as he tries to lie down. The cough is troublesome and attended with a frothy expectoration.

If you have a case of persistent, humid asthma, which began as a chronic catarrh, with symptoms of oedema of the lungs, think of Pulmo vulpis (fox lungs). The indications for this remedy read: strong, sonorous, bubbling rales, now rattling, now whistling, heard over the whole chest and even some distance away, perceptible to palpitation; accelerated, short breathing amounting to suffocation even, without heaviness of the chest, frequently with cough and inability to espectorate. Pulmo vulpis may also be indicated in cases where only shortness of breath becomes asthmatic if the patient makes the least bodily exertion.

The foregoing are but a few of the many remedies proven and unproven in our materia medica which should receive your careful

study when prescribing for this painful condition. I appreciate that I have but picked up a fragment or two here and there, but a mere suggestion, in any sense arresting, sometimes stirs our interest. Meanwhile the whole structure of these medicines are ours for a better and more elaborate study.

From the North American Journal of Homœopathy, August 1916.