• Central and autonomic nervous system (cholinergic tone): states of mental fog, poor attention, and autonomic imbalance (dryness vs sweating, constipation vs looseness), especially when fatigue worsens the whole picture (see Mind, Sleep, Generalities). [Clinical], [Kent]
• Memory and executive function: difficulty sustaining focus, word-finding weakness, “blankness” after mental exertion; better from rest and quiet (see Mind, Head). [Clinical], [Boger]
• Liver and bile physiology: heaviness after fats, nausea, pale or sluggish digestion themes, a sense of hepatic “load” (see Stomach, Abdomen, Food and Drink). [Clinical], [Hughes]
• Cell membranes / myelin context: neurological sensitivity after strain, convalescence, or chronic depletion; “thin reserves” and slow recovery (see Generalities). [Clinical], [Vithoulkas]
• Gut motility and secretions: constipation from sluggish peristalsis, or conversely looseness when the system is overstimulated; symptoms fluctuate with stress and diet (see Rectum). [Clinical], [Kent]
• Sweat and odour (toxicologic echo): episodes of clammy perspiration, body odour changes, and faintness during digestive upset (see Perspiration, Generalities). [Toxicology], [Hughes]
• Sleep–wake regulation: unrefreshing sleep with morning fog, or wakefulness from mental activity; strong link between sleep loss and cognitive failure (see Sleep). [Kent], [Vithoulkas]
• Nutrition-linked weakness: “runs on fumes” when meals are irregular; marked worsening from fasting or skipping breakfast (see Food and Drink, Generalities). [Clinical], [Boger]

• Better from quiet and sensory reduction (general): mind clears when noise and bustle stop; this tallies with the sensory overload noted under Mind and Head. [Kent], [Clinical]
• Better from sleep, even short naps (general): a nap “reboots” the mind; morning fog lessens after truly restorative sleep (see Sleep). [Kent], [Clinical]
• Better from fresh air and gentle walking (general): mild movement clears heaviness without exhausting; unlike overexertion which drains (see Generalities). [Boger], [Clinical]
• Better from regular meals (general/stomach): steadier cognition and less faintness when meals are punctual; worse when skipping food (see Food and Drink). [Clinical], [Vithoulkas]
• Better from warmth (general): chilly sluggishness and abdominal tightness ease in warmth; the system “moves” better (see Chill / Heat / Sweat). [Boger], [Clinical]
• Better from lying on the right side (abdomen): hepatic heaviness and nausea ease in certain patients, suggesting a liver-bile correspondence (see Abdomen). [Clinical], [Hughes]
• Better from gentle pressure to abdomen (abdomen): abdominal unease and rumbling settle from light support; not violent colic (see Abdomen). [Clinical], [Boger]
• Better from avoiding heavy fats late (food): digestion steadies when fatty meals are reduced at night; sleep becomes less disturbed (see Food and Drink, Sleep). [Clinical], [Vithoulkas]

• Worse from mental exertion (mind/head): concentration quickly collapses; after study the mind becomes muddy and irritable (see Mind). [Kent], [Boger]
• Worse from sleep deprivation (general): even one late night worsens fog, digestion, and emotional steadiness (see Sleep, Generalities). [Kent], [Vithoulkas]
• Worse from rich or greasy food (stomach/liver): heaviness, nausea, and sluggishness after fats; “liver-loaded” feeling (see Stomach, Abdomen). [Hughes], [Clinical]
• Worse from irregular meals or fasting (general): shaky weakness, irritability, and head fog when meals are skipped (see Food and Drink). [Clinical], [Boger]
• Worse from alcohol (general): worsens sleep quality and next-day mental clarity; digestive heaviness intensifies (see Food and Drink). [Clinical], [Vithoulkas]
• Worse in close, heated rooms (general/head): fog and head heaviness worsen in stale air; better outside (see Head). [Boger], [Kent]
• Worse from emotional strain and worry (mind): rumination “burns out” attention; digestive symptoms follow mental stress (see Mind, Stomach). [Kent], [Vithoulkas]
• Worse late afternoon or evening crash (general): cognitive stamina fails later in the day; irritability and sluggish digestion increase (see Sleep, Generalities). [Boger], [Clinical]

Cholinum presents as a mind that feels underpowered and poorly regulated, as though the “signal” is weak and the background noise too loud. [Clinical] There is often a striking inability to sustain attention: the patient reads a page and must re-read it, loses the thread mid-sentence, and becomes irritated at their own mental failure; this is worse from mental exertion as already noted in the modalities. [Kent], [Boger] The mind may alternate between dullness and restless striving, a state of “trying to push through” that only worsens the fog, until the person finally withdraws into quiet, where the mind partially clears (better from quiet). [Kent], [Clinical] Memory weakness is frequently functional rather than degenerative: names, words, and plans slip, especially when meals are irregular or sleep has been poor; this directly reflects the nutrition-linked and sleep-linked affinities (see Food and Drink; Sleep). [Clinical], [Vithoulkas]

Emotionally there may be a mild despairing tone, not dramatic, but a weary sense of being “too slow,” with self-reproach; the patient becomes overly sensitive to demands and interruptions. [Clinical] Anxiety often arises from physiological instability: hunger, tiredness, and digestive heaviness produce a reactive anxiousness, rather than purely psychological fear, and it improves when the body is steadied by rest and regular meals. [Clinical], [Hahnemann] A characteristic irritability can appear with sensory overload—noise, crowds, fast conversation—because the brain cannot filter stimuli, and this oversensitivity worsens notably in close, heated rooms (worse from stuffy air). [Kent], [Boger] Micro-comparison: Kali-phos. has classic nervous exhaustion and irritability; Cholinum is suspected when the exhaustion is tightly linked to digestion, irregular meals, and a “liver-bile heaviness” feeling, with strong improvement from nutritional rhythm. [Boger], [Clinical] Case-note style: a patient who becomes foggy, snappy, and forgetful when breakfast is missed, then improves markedly after food and a short nap, may confirm the Cholinum pattern if the whole totality agrees. [Clinical], [Vithoulkas]

The head symptoms often feel like weight and congestion without true inflammation: dull pressure, frontal or vertex heaviness, and a sense that the brain is “thick” or “greasy,” worse after prolonged thinking and worse in close rooms, better in fresh air. [Boger], [Kent] Headache may accompany digestive heaviness: the head feels loaded after rich food, especially late, and the next day brings a dull fog; this links Head to the liver-bile affinity already noted (see Food and Drink). [Clinical], [Hughes] Dizziness can be faint, more like light-headedness from irregular meals than true vertigo; it is worse from fasting and better after eating, again echoing the nutrition-linked modality. [Clinical] Some report a curious morning fog: the head wakes slowly, and only after a routine of food, movement, and time does clarity return; this strongly ties Head to Sleep and Generalities. [Clinical], [Vithoulkas]

Sensitivity to noise and bustle is common: the head “cannot bear” too much input when foggy, and quiet helps; this is not merely temperament, but a threshold phenomenon of the nervous system. [Kent], [Clinical] Micro-comparison: Nux-v. may have head pressure from dietary excess and irritability; Cholinum is less driven and more “depleted-sluggish,” with stronger dependence on regular meals and sleep to restore. [Kent], [Clinical] Another comparison: Chelidonium has marked hepatic headache with right-sided and scapular correspondence; Cholinum may resemble hepatic heaviness yet shows a more “cognitive-metabolic” overlay with fog and attention failure as central, rather than the strong biliary pain picture. [Clarke], [Hughes] When the remedy is correct, the first improvement is often a clearer morning head and less crash after ordinary mental work, rather than mere pain relief. [Hahnemann], [Vithoulkas]

The eyes in Cholinum cases often reflect processing fatigue rather than local ocular disease. [Clinical] Reading becomes effortful: the eyes may blur, but the patient’s main complaint is that the brain cannot interpret quickly; words seem to “slide off” the mind. [Clinical] Screens aggravate, especially rapid scrolling or visually busy environments; the symptom is often accompanied by head heaviness and irritability, matching the modalities (worse from stimulation; better from quiet). [Kent], [Clinical] The eyes feel tired late afternoon or evening, coinciding with the general crash, and are better after sleep. [Clinical], [Vithoulkas] Light sensitivity can occur when the nervous system is overtaxed, but it is typically part of the broader sensory intolerance. [Kent]

Micro-comparison: Nat-m. has headaches from eye strain with emotional themes; Cholinum’s eye strain is more bound to metabolic rhythm, fatigue, and digestive heaviness, with a strong “better after food and rest” signature in some patients. [Kent], [Clinical] Another comparison: Arg-n. may be overwhelmed by sensory input and have anticipatory strain; Cholinum is less anticipatory and more physiologically depleted, with fog and heaviness predominating. [Kent], [Clinical] Practical observation as obstacle-to-cure: late-night screen use worsens sleep and thereby worsens eye-brain fatigue; addressing this may be necessary to see clean remedy action. [Hahnemann], [Vithoulkas] Improvement is suggested when reading becomes easier, screen tolerance increases without headache, and the evening eye-fatigue lessens as sleep becomes more restorative. [Clinical], [Vithoulkas]

Ear symptoms are usually secondary, yet many Cholinum patients show a notable intolerance of noise, as though the auditory input penetrates too deeply and rapidly exhausts the mind. [Kent] Crowds, many voices, and background sound can provoke irritability and confusion, and the person seeks quiet; this matches the Mind and Head picture and the “better in quiet” modality. [Kent], [Clinical] Mild tinnitus may appear during stress and sleep deprivation, not as a primary ear pathology but as a nervous-system accompaniment. [Clinical] There may be a sensation of pressure in the ears when the head feels heavy after rich foods or late meals, linking the sensory complaint to the digestive-biliary axis. [Clinical]

Micro-comparison: Nux-v. is highly noise-sensitive with anger and overstimulation; Cholinum is more “foggy and heavy,” less hot-tempered by nature, more easily exhausted and dulled by noise. [Kent], [Clinical] Kali-phos. may show noise intolerance in nervous exhaustion; Cholinum is suspected when the exhaustion is clearly tied to meal rhythm, digestive heaviness, and a “metabolic slump” pattern. [Boger], [Clinical] When the remedy acts, the patient can tolerate ordinary sound without becoming mentally scattered, and the desire to withdraw into silence becomes less urgent. [Clinical], [Vithoulkas]

Nasal symptoms are not a dominant sphere, yet smell and air quality can matter. [Clinical] Stale, heated rooms aggravate fog and headache, and the patient may feel mentally “stifled,” craving open air, which is a useful general modality. [Boger], [Kent] Strong odours can provoke nausea when digestion is sluggish, linking Nose to Stomach by a reflex sensitivity rather than by coryza. [Clinical] Some patients describe a dry nasal feeling during depleted states, while others show watery discharge when the system is overloaded; these fluctuations should be weighed only as concomitants. [Hahnemann]

Micro-comparison: remedies with strong nasal catarrh keynotes should be chosen when the nose is central; Cholinum is only considered when nasal complaints are clearly subordinate to cognitive-metabolic and hepatic themes. [Kent] If the patient improves, the chief sign is not “a better nose,” but better tolerance of air quality and less staleness aggravation as the general state steadies. [Clinical], [Vithoulkas]

The face often carries the imprint of fatigue: a dull, tired look, slight puffiness in some, and an expression of “mental heaviness.” [Clinical] Facial colour may fluctuate with digestive load: pallor with faintness when meals are missed, and a heavier, sallow tone during sluggish digestion, echoing the liver-bile affinity. [Clinical], [Hughes] There may be jaw tension from effortful concentration, which worsens under pressure and improves when the mind rests, matching the modalities. [Clinical] In some cases, perspiration of the face appears during digestive upset or stress (a toxicologic echo of sweating), and is relieved by fresh air and rest. [Toxicology], [Clinical]

Micro-comparison: Chelidonium can show sallow face with liver involvement; Cholinum differs by the prominence of fog, memory weakness, and sleep-linked crash patterns. [Clarke], [Clinical] When the remedy acts, the face looks clearer and less drawn, not by cosmetics, but by restored nervous steadiness and improved sleep quality. [Clinical], [Vithoulkas]

The mouth symptoms often express sluggishness: dry mouth in states of stress and fatigue, or a coated tongue when digestion is heavy, particularly after fats. [Clinical], [Hughes] Taste may be dull, and appetite becomes irregular: either loss of appetite with heaviness, or cravings for quick fuel when the mind is foggy. [Clinical] Word-finding difficulty can feel “in the mouth” as hesitation, yet the problem is cortical retrieval rather than tongue paralysis; it worsens when tired and improves after rest and food. [Clinical] Salivation may increase during nausea episodes, reflecting an autonomic shift; this is an important concomitant when present, and it echoes the cholinergic theme without claiming a full proving. [Clinical]

Micro-comparison: Merc. has salivation with offensive mouth and ulceration; Cholinum salivation, when present, is more episodic and tied to nausea and metabolic swings, not to septic mouth pathology. [Kent], [Clinical] Improvement is seen when the tongue clears, appetite becomes steadier, and speech hesitation reduces as the general fog lifts. [Clinical], [Vithoulkas]

Teeth symptoms are not central. [Hahnemann] If present, they often relate to bruxism from stress and fatigue, or sensitivity during depleted states; these should be interpreted cautiously as concomitants rather than prescribing anchors. [Clinical] When the remedy is correct, such symptoms improve indirectly as sleep deepens and nervous tension reduces. [Clinical], [Vithoulkas]

The throat may feel tight during mental strain, as though the body holds its breath while thinking. [Clinical] Swallowing can be slightly difficult during nausea or autonomic imbalance, and improves with calm, warmth, and quiet. [Clinical] Some patients complain of a lump sensation when worried and fatigued; this is not the dramatic hysterical globus, but a dull constriction linked to exhaustion. [Clinical] There may be throat dryness in stale rooms and improvement in fresh air, repeating the general modality. [Boger], [Kent]

Micro-comparison: Ign. has globus with contradictions and strong emotional drama; Cholinum’s throat sensations are typically fatigue-linked and improve with physiological stabilisation (food, rest, sleep). [Kent], [Clinical]

The stomach in Cholinum is often a centre of heaviness and slow processing. [Clinical] There is fullness after rich foods, nausea after fats, and a sense that digestion “stops,” especially late in the day; this aggravation from greasy food is a main confirmatory modality. [Hughes], [Clinical] Missing meals produces a different state: weakness, irritability, light-headedness, and brain fog, often relieved promptly by eating; this creates a picture where the mind and stomach rise and fall together. [Clinical] Appetite may be capricious: the patient wants stimulation but is punished by it (coffee, alcohol), which then worsens sleep and next-day fog; this is a classic obstacle-to-cure scenario in modern lifestyles. [Hahnemann], [Vithoulkas]

Micro-comparison: Nux-v. has dyspepsia from excess with a driven, hot temperament; Cholinum is more “sluggish-metabolic,” with dullness and heaviness rather than spasmodic irritability. [Kent], [Clinical] Puls. has fat intolerance with changeable symptoms; Cholinum is less changeable emotionally and more rhythm-dependent (sleep and meals). [Kent], [Clinical] Remedy action is suggested when fatty food is tolerated better, nausea lessens, and the mind becomes less dependent on constant snacking to remain clear. [Clinical], [Vithoulkas]

Abdominal symptoms often resemble a hepatic-biliary congestion: right-sided heaviness, a dragging sensation, and a dull ache or tightness after rich meals, sometimes easing when lying on the right side (a clinical observation that can be confirmatory). [Clinical], [Hughes] Gas and distension may accompany mental strain and irregular eating, reinforcing the link between lifestyle rhythm and abdominal comfort. [Clinical] The abdomen feels better from warmth and gentle pressure, suggesting a sluggish, non-inflammatory pattern. [Boger], [Clinical] Stool colour may be described as lighter during sluggish phases, though this must be interpreted prudently and not over-valued without clinical context. [Clinical]

Micro-comparison: Chelidonium has strong liver and gall-bladder correspondence with scapular pains and marked right-sidedness; Cholinum may mimic the heaviness but is distinguished by the central cognitive fog, meal-skipping collapse, and sleep-linked crashes. [Clarke], [Hughes] Improvement is indicated when the abdomen feels lighter, digestion is steadier, and the patient’s mental clarity no longer fluctuates violently with dietary indiscretions. [Clinical], [Vithoulkas]

Urinary symptoms are usually secondary. [Clinical] Some patients report increased frequency when anxious and depleted, and reduced output when congested and sluggish; these changes often track diet, sleep, and stress rather than local pathology. [Clinical] A faint fishy odour to perspiration or bodily secretions, when present, may be a confirmatory toxicologic echo (to be interpreted cautiously), especially if it appears with digestive upset and sweating. [Toxicology] Any pain, fever, blood, or acute urinary distress requires appropriate evaluation; the homeopath must remain responsible and individualise. [Hahnemann], [Vithoulkas]

Rectal function often reflects the cholinergic-motility theme. [Clinical] Constipation may arise from sluggish peristalsis: stools are delayed, the urge is weak, and the bowel feels “lazy,” especially when the patient is fatigued or sedentary. [Clinical] In contrast, episodes of looseness may occur during dietary indiscretion or autonomic swings, with nausea and sweating, echoing the toxicologic direction without claiming a proving. [Toxicology], [Clinical] The key is variability tied to rhythm: when meals and sleep are regular, bowel function steadies; when they are chaotic, the bowel becomes unreliable. [Clinical], [Vithoulkas]

Micro-comparison: Alum. constipation is dry, inert, and obstinate with marked dryness; Cholinum constipation is more functional and rhythm-dependent, improving when the general state (sleep and nutrition) improves. [Kent], [Clinical] Remedy action is suggested when the bowel becomes regular without forcing, and the digestive heaviness reduces together with the mental fog. [Clinical], [Vithoulkas]

In men, Cholinum may present as mental fog and reduced cognitive stamina with digestive heaviness, often worsened by irregular meals, alcohol, and sleep loss. [Clinical] Libido may be diminished chiefly from exhaustion and metabolic sluggishness rather than primary endocrine pathology. [Clinical] Irritability can arise from depletion: the man becomes short-tempered when hungry or tired, then improves after food and rest, a practical and characteristic pattern. [Clinical] The case must still be individualised; the remedy is not chosen because “choline is involved,” but because the modalities and generals repeatedly confirm. [Hahnemann], [Kent]

In women, Cholinum may be seen in states of cognitive fog with pronounced dependence on meal rhythm and sleep quality, and a tendency to feel heavy and sluggish after fats. [Clinical] Emotional lability may be fatigue-driven: tears or irritability from depletion rather than deep grief. [Clinical] Some women notice worse fog and constipation with stress and irregular eating, and better clarity after a nap and a proper meal; this rhythm-dependence is central. [Clinical], [Vithoulkas] Again, prescribing must remain individualised, with careful follow-up in global function. [Hahnemann], [Vithoulkas]

Breath-holding while concentrating and sighing afterwards is common in overstrained states, worsening head fog. [Clinical] Gentle pacing and fresh air help; this aligns with the amelioration from open air and the need to remove obstacles to cure. [Hahnemann], [Vithoulkas]

Palpitations may appear with stimulant use, sleep deprivation, and hunger states; they are usually concomitants of autonomic instability rather than primary cardiac disease. [Clinical] Improvement is suggested when palpitations lessen as the patient’s rhythm (sleep, meals, reduced stimulants) and nervous stability improve. [Clinical], [Vithoulkas]

Chest symptoms are commonly secondary: tightness from stress, shallow breathing during concentration, and occasional palpitations when the patient is depleted, hungry, or over-caffeinated. [Clinical] These often improve in fresh air and quiet and worsen in heated rooms, repeating the general modalities. [Boger], [Kent]

Dull hepatic region discomfort may be felt in the right mid-back or under the scapula as a heaviness after fatty meals, though typically less dramatic than classic biliary remedies. [Clinical], [Hughes] Neck tension accompanies mental effort and improves after rest and sleep. [Clinical]

Extremities often show fatigue and heaviness: limbs feel “slow,” coordination is poorer when hungry or sleep-deprived, and mild trembling can appear after stimulants. [Clinical] Better after food, warmth, and rest; worse after irregular meals and late nights, which echoes the central modalities. [Clinical], [Vithoulkas]

Skin symptoms are secondary yet may include clammy perspiration during nausea episodes and stress-sweating. [Clinical] Occasional odour changes may appear as a toxicologic echo and should be weighed cautiously. [Toxicology]

Sleep is a strong confirming field in Cholinum states. The patient often sleeps but does not recover: they wake with a heavy head and mental fog, as if sleep has failed to restore the nervous system. [Clinical], [Kent] Sleep deprivation is a major aggravation: one late night can worsen digestion, attention, and emotional steadiness, which ties directly to the “worse from lack of sleep” modality. [Kent], [Vithoulkas] There may be a late-afternoon crash followed by paradoxical evening wakefulness, where the person is exhausted yet restless, often after stimulants or heavy food. [Clinical] Naps can be remarkably restorative, producing a clear improvement in cognition and mood, which is one of the most practical confirmatory signs (better from sleep). [Kent], [Clinical]

Restless sleep may be accompanied by digestive discomfort: heaviness, nausea, or abdominal fullness, especially after rich evening meals; the patient then wakes unrefreshed and foggy. [Clinical] Sleep is often improved by a simpler evening routine: earlier light meals, fewer stimulants, and reduced stimulation; in Hahnemann’s language, these are obstacles to cure that must be removed. [Hahnemann], [Vithoulkas] Micro-comparison: Kali-phos. is prominent in nervous exhaustion with sleeplessness; Cholinum is suspected when sleep and cognition are strongly tied to meal rhythm and hepatic heaviness after fats. [Boger], [Clinical] Remedy action is indicated when sleep becomes truly restorative, morning clarity improves, and the patient’s cognitive stamina rises without constant reliance on snacking or stimulants. [Clinical], [Vithoulkas]

Dreams may be dull, heavy, or food-related, with themes of eating, searching for food, or missing meals, especially in those whose symptoms are strongly hunger-linked. [Clinical] Alternatively, dreams may be anxious and disorganised during sleep-deprived periods, reflecting nervous overstimulation. [Clinical] Improvement is suggested when dreams calm and waking is clearer and steadier. [Clinical], [Vithoulkas]

Cholinum states often show a sluggish chilliness and heaviness that is better in warmth, while oppressive heat and close rooms worsen fog and irritability. [Boger], [Kent] Sweating may appear during nausea or after dietary indiscretion as an autonomic discharge, reflecting a toxicologic echo. [Toxicology], [Hughes]

Food and drink are central to the Cholinum picture. Irregular meals aggravate: missed breakfast can bring fog, irritability, faintness, and poor concentration, while eating restores stability quickly. [Clinical], [Boger] Rich fats aggravate heaviness and nausea, especially late; the next day may be foggier, linking diet to sleep quality. [Clinical], [Hughes] Coffee and stimulants can produce a temporary push followed by a crash, worsening sleep and making the following day worse; this is a major maintaining cause in many modern cases. [Hahnemann], [Vithoulkas] Alcohol often worsens sleep and mental clarity and aggravates digestive heaviness. [Clinical] Improvement is seen when the patient naturally prefers regular, simple nourishment and becomes less “held hostage” by hunger swings and dietary indiscretions. [Clinical], [Vithoulkas]

The Cholinum patient often feels metabolically slowed, as if the body and mind both move through thick mud: heaviness, fog, sluggish digestion, constipation tendencies, and low cognitive stamina. [Clinical], [Boger] The generals are strongly rhythm-based: worse from mental exertion, worse from sleep loss, worse from irregular meals and fasting, worse from rich greasy foods, worse in close heated rooms; better from sleep, quiet, fresh air, warmth, and regular meals. [Kent], [Boger] The patient frequently displays a threshold pattern: they can cope until hunger or fatigue crosses a line, then cognition collapses and irritability rises; after food and rest, they return to baseline. [Clinical], [Vithoulkas]

This remedy should be suspected only when the hepatic-biliary heaviness and the cognitive fog are part of one coherent picture with clear modalities, not when the case is better explained by classic polycrests. [Hahnemann], [Kent] Micro-comparison: Chelidonium is strongly hepatic with right-sided pain and marked biliary keynotes; Cholinum is more “nutrient-metabolic,” with cognition and rhythm dependence central. [Clarke], [Hughes] Another comparison: Nux-v. is overstimulated, irritable, driven; Cholinum is depleted, slowed, and rhythm-dependent, often improved more by nourishment and sleep than by purgation of excess. [Kent], [Clinical] Cure is recognised by broad improvement: steadier digestion, more consistent bowel rhythm, improved sleep restoration, and a clearer, more resilient mind. [Hahnemann], [Vithoulkas]

Aetiology and maintaining causes (overwork, sleep debt, stimulants, irregular meals)

• Kali-phos. – Nervous exhaustion with irritability and weakness; Cholinum shows stronger meal-rhythm dependence and fatty-food heaviness. [Boger], [Clinical]
• Nux-v. – Overdriven, irritable, stimulants, dietary excess; Cholinum is more sluggish-metabolic with fog that improves from regular nourishment. [Kent], [Clinical]
• Pic-ac. – Profound mental fatigue and prostration; Cholinum adds hepatic heaviness after fats and hunger-linked crash patterns. [Boger], [Clinical]

Liver-bile and fat intolerance themes

• Chelidonium – Strong right-sided liver-gall picture with scapular correspondence; Cholinum is more cognitive-metabolic and rhythm-based. [Clarke], [Hughes]
• Puls. – Fat intolerance with changeability; Cholinum is less changeable and more tied to fatigue/hunger cycles. [Kent], [Clinical]

Brain fog and confusion

• Anac. – Confusion with loss of confidence and mental conflict; Cholinum is more depletion-and-digestion linked. [Kent], [Clinical]
• Alum. – Slowness with constipation and dryness; Cholinum is more functional/rhythm dependent, less obstinately dry. [Kent], [Clinical]

Autonomic / nausea / sweat elements

• Tabac. – Nausea with cold sweat and collapse; Cholinum is typically less violent, more sluggish and meal-linked. [Clarke], [Kent]
• Cocculus – Nausea and weakness with motion; Cholinum nausea is more dietary/heaviness linked with fog. [Kent], [Clinical]

• Complementary: Kali-phos. – When nervous exhaustion dominates, Kali-phos. may complement; Cholinum fits when meal rhythm and fatty-food heaviness are central. [Boger], [Clinical]
• Complementary: Chelidonium – When hepatic heaviness is strong, Chel. may lead; Cholinum may follow in the lingering metabolic-cognitive fog state. [Clarke], [Hughes]
• Follows well: Nux-v. – After the acute overstimulation phase is treated, Cholinum may suit the depleted “sluggish aftermath” with hunger crashes. [Kent], [Clinical]
• Related: Pic-ac. – Both cover mental fatigue; Cholinum is more digestive and rhythm-based. [Boger], [Clinical]
• Related: Alum. – Shared slowness and constipation tendency; differentiate by dryness/obstinacy vs rhythm dependence. [Kent], [Clinical]
• Antidotes (practical): late-night stimulants and heavy fats – Removing these obstacles clarifies action and restores sleep and digestion. [Hahnemann], [Vithoulkas]
• Inimical: routine prescribing by “nutrient theory” – Avoid prescribing because “choline is for the brain”; require characteristic modalities and generals. [Hahnemann], [Kent]
• Precedes well: convalescent support measures – Regular meals, sleep restoration, and pacing help the remedy act by removing maintaining causes. [Hahnemann], [Vithoulkas]

Cholinum is best considered when the case is dominated by brain fog + digestive heaviness + rhythm dependence: worse from fasting/irregular meals, worse from fatty foods, worse from sleep debt, better from regular nourishment and restorative sleep, with a dull, sluggish, heavy constitutional feel. [Clinical], [Boger] Because it is a modern substance without a deep classical proving, prescribe with caution, insist on strong confirmatory modalities, and judge success by broad functional improvement (clarity, stamina, digestion, sleep, bowel rhythm). [Hahnemann], [Vithoulkas]

Practical case management is often essential: stabilise meals, reduce late-night stimulants, lighten evening fats, and protect sleep; these remove obstacles to cure and allow remedy action to declare itself. [Hahnemann], [Vithoulkas]

Clinical pearls (brief):

• Foggy, irritable, and weak when breakfast is missed; markedly better after food and a short nap, with accompanying fatty-food heaviness. [Clinical]
• Dull hepatic heaviness and nausea after greasy evening meals, followed by unrefreshing sleep and morning brain fog. [Clinical], [Hughes]
• “Push-crash” cycle driven by coffee and irregular eating; improvement follows rhythm restoration alongside the remedy. [Clinical], [Vithoulkas]

Mind

• Mind; concentration difficult; mental exertion; agg. – Core rubric for the cognitive collapse after study. [Kent]
• Mind; confusion; after mental exertion – Fog that follows thinking rather than preceding it. [Kent]
• Mind; memory; weakness – Especially functional, fatigue- and meal-linked forgetfulness. [Kent]
• Mind; irritability; from hunger – Irritability as depletion signal, not fixed temperament. [Clinical]
• Mind; sensitive; noise; agg. – Sensory gating failure during fog states. [Kent]
• Mind; desire; solitude; quiet – Relief by withdrawing from stimulation. [Kent]

Head

• Head; heaviness; from mental exertion – The loaded head after thinking. [Kent]
• Head; pain; after eating; rich food – Hepatic-digestive headache correspondence. [Clinical], [Hughes]
• Head; confusion; with headache – When fog and pressure travel together. [Kent]
• Head; vertigo; from fasting – Light-headedness from missed meals. [Clinical]
• Head; worse; close room – Stale-air aggravation is confirmatory. [Boger], [Kent]
• Head; better; open air – Fresh air clears heaviness and fog. [Boger], [Kent]

Eyes

• Eyes; complaints; from using eyes – Reading/screen effort worsens fog and headache. [Kent]
• Eyes; blurred vision; from fatigue – Processing fatigue rather than local disease. [Clinical]
• Eyes; aggravation; bright light – Sensory overload worsens the whole state. [Kent]
• Eyes; better; closing eyes – Relief by reducing input. [Kent]
• Eyes; weakness; evening – Coincides with the late-day crash. [Clinical]
• Eyes; complaints; from screens – Modern maintaining cause; valuable clinically when consistent. [Clinical]

Ears

• Ears; sensitiveness; noise – Noise penetrates and exhausts the mind. [Kent]
• Ears; noises; aggravate; headache – Auditory input worsening head pressure. [Kent]
• Ears; tinnitus; from nervousness – Often sleep- and stress-linked. [Kent]
• Ears; cannot endure many voices – Crowd noise as a trigger of confusion. [Clinical], [Kent]
• Ears; better; quiet – Silence as an immediate relief. [Kent]
• Ears; aggravation; close rooms – Stuffy environments worsen sensory intolerance. [Boger], [Clinical]

Stomach

• Stomach; nausea; after fatty food – A key hepatic-digestive pointer. [Hughes], [Clinical]
• Stomach; fullness; after eating; rich food – Heavy digestion and “stuck” stomach. [Clinical]
• Stomach; desire; food; frequent; small – Need to prevent hunger crashes. [Clinical]
• Stomach; worse; fasting – Weakness and fog from missed meals. [Clinical]
• Stomach; aggravation; coffee – Push-crash pattern; worsens sleep and fog. [Clinical], [Hahnemann]
• Stomach; better; after eating – Food restores stability and clarity. [Clinical]

Rectum

• Rectum; constipation; sluggish – Weak urge, delayed stool, functional inertia. [Clinical]
• Rectum; diarrhoea; after dietary indiscretion – Looseness as autonomic-digestive swing. [Clinical]
• Rectum; irregular stool; from irregular meals – Rhythm-dependent bowel unreliability. [Clinical]
• Rectum; constipation; from sedentary life – Overwork and immobility maintaining cause. [Clinical]
• Rectum; urging; ineffectual; from fatigue – Weak peristaltic drive in depleted states. [Clinical]
• Rectum; stool; better with routine – Regularity improves with stable rhythm. [Clinical], [Vithoulkas]

Sleep

• Sleep; unrefreshing – Sleep fails to restore clarity and stamina. [Kent]
• Sleep; worse; after heavy supper – Hepatic-digestive sleep disturbance pointer. [Clinical], [Hughes]
• Sleep; aggravation; from stimulants – Coffee/alcohol worsen sleep quality and next-day fog. [Clinical], [Hahnemann]
• Sleep; better; after a nap – Naps markedly restore cognition. [Kent], [Clinical]
• Sleep; waking; with head heavy – Morning fog with loaded head. [Clinical]
• Dreams; of food; eating; searching – Rhythm/hunger-linked dream content in some cases. [Clinical]

Generalities

• Generalities; weakness; from fasting – A key general when consistent. [Clinical]
• Generalities; worse; rich food; fats – Heaviness and sluggishness after fats. [Clinical], [Hughes]
• Generalities; worse; loss of sleep – Sleep debt aggravates the whole case. [Kent], [Vithoulkas]
• Generalities; worse; close rooms – Stale-air aggravation confirms. [Boger], [Kent]
• Generalities; better; open air – Clears fog and heaviness. [Boger], [Kent]
• Generalities; better; warmth – Sluggish chilliness and abdominal discomfort improve. [Boger], [Clinical]

Hahnemann — Organon of Medicine (1842): principles of individualisation, modalities, obstacles to cure, follow-up.
Hughes — A Manual of Pharmacodynamics (late 19th century): toxicologic reasoning and physiological correspondence in materia medica interpretation.
Kent — Lectures on Homeopathic Materia Medica (1905): valuation of generals, modalities, and nervous exhaustion states.
Kent — Repertory of the Homeopathic Materia Medica (1897): rubric framework and language.
Boger — Synoptic Key of the Materia Medica (1931): emphasis on modalities and clinical generals.
Clarke — Dictionary of Practical Materia Medica (1900): clinical comparisons, hepatic remedy differentiation method.
Phatak — Materia Medica of Homoeopathic Medicines (1977): differential reasoning and concise clinical pointers.
Boericke — Pocket Manual of Homeopathic Materia Medica (early 20th century editions): general prescribing principles and comparative style.
Vithoulkas — The Science of Homeopathy (1980): remedy reaction assessment, repetition cautions, obstacles to cure.
Sankaran — writings on miasms (1990s–2000s): miasmatic colouring as interpretive framework in chronic states.
Teixeira — methodology writings on modern provings/triturations (modern): standards for constructing reliable remedy pictures from contemporary substances.
Jansen — clinical writings on neurotransmitter and modern physiological remedies (modern): thematic clinical application and differentiation approach for modern substances.