• Urinary Organs: Strong action on kidneys and bladder; changes character and odour of urine markedly [Hering].
• Metabolism: Affects uric acid balance; linked to gout and lithic-acid diathesis.
• Joints: Rheumatic and gouty inflammation, especially with shifting pains.
• Heart: Palpitations, organic disease associated with gouty heart.
• Digestive Organs: Offensive breath and eructations from metabolic derangement.
• Skin: Gouty tophi; eruptions associated with uric acid overload.

• Rest and quiet.
• Warmth, especially wrapping up in bed.
• Passing urine (relieves head and joint symptoms).

• Cold, damp weather [Clarke].
• Motion aggravates joint pains.
• Taking wine or rich food.
• Change of weather, especially to cold.

Mind is dull, sluggish, and easily fatigued, with a tendency to forgetfulness [Hering]. There is a general gloominess, irritability over trifles, and an aversion to exertion. Patients often feel weighed down by bodily symptoms, especially the offensive discharges. The mental state is closely linked with the physical—improvement in urine character often brings mental clarity.

Head feels heavy, with pressing pains in temples and forehead, often worse from motion. Headache associated with gastric disturbance and uric acid excess is common [Allen]. Head feels hot, face flushed during urinary derangements.

Burning in eyes; conjunctiva injected during acute urinary inflammation. Vision sometimes blurred during headaches.

Ringing or humming noises in ears in connection with circulatory disturbance from gouty states.

Offensive nasal catarrh; thick discharge with foul odour. Coryza may accompany rheumatic or urinary complaints.

Face flushed during fever; pale and sallow in chronic gouty states. Expression often weary and drawn.

Tongue coated white or yellow; offensive breath, especially in the morning, linked to disordered digestion and uric acid excess [Hering]. Metallic or bitter taste.

Toothache of rheumatic origin; pains shift from teeth to other joints.

Dryness in throat; sensation of rawness when swallowing.

Loss of appetite; nausea, sometimes vomiting. Eructations very offensive, like bad eggs. Fullness and discomfort after meals.

Abdomen distended, sensitive over liver region. Colicky pains before urination. Tenderness in hypogastrium.

The most marked action is here. Urine dark brown or high-coloured, often with a strong ammoniacal or pungent odour described as “horse’s urine” [Hering, Clarke]. Quantity may be diminished; passed with difficulty or burning. Sediment copious, reddish, or white, containing urates. Urinary odour so offensive it permeates the room. Changes in urine accompany improvement or aggravation in other symptoms.

Constipation alternating with loose stools. Offensive, putrid-smelling stools.

Pain in testicles and cords in gouty diathesis. Sexual desire diminished.

Menses too early, too profuse; offensive leucorrhoea.

Dyspnoea aggravated on ascending stairs. Breath very offensive in gouty subjects.

Palpitations with anxiety, especially in patients with gouty heart disease. Heart feels enlarged, oppressed [Allen].

Oppression of chest, shortness of breath on exertion. Cough with offensive expectoration in gouty or rheumatic constitution.

Pain in lumbar region, worse from standing or walking. Sensation of soreness over kidneys.

Rheumatic and gouty pains shifting rapidly from joint to joint. Joints swollen, hot, and tender. Chronic gout with chalky deposits around joints [Hughes]. Knees stiff, ankles swollen, pain worse on motion.

Skin sallow; in chronic gout, tophi form on ears and joints. Offensive perspiration.

Unrefreshing sleep; wakes with offensive taste in mouth. Restless from joint pain.

Fever with offensive perspiration and urine. Flushes of heat during gouty attacks.

Chilliness alternating with flushes. Sweat offensive, stains linen.

Aversion to meat; rich food aggravates. Desire for acidic drinks. Wine aggravates markedly.

Offensiveness is a keynote—urine, breath, stools, perspiration [Hering]. Uric acid excess links urinary, joint, cardiac, and digestive symptoms. Symptoms shift rapidly in location, especially pains.

• Colchicum – More acute gout, great aversion to food; Benzoic acid more urinary odour and shifting pains.
• Lithium carbonicum – Gout with heart involvement, but less offensiveness.
• Ammonium phosphoricum – Urinary sediment but less characteristic odour.
• Sulphur – Offensive discharges, but more skin and heat symptoms.

• Complementary: Lycopodium in chronic gout; Nitric acid in offensive discharges.
• Antidotes: Wine and rich food aggravations are antidoted by the remedy itself in chronic cases.
• Follows well: After Colchicum or Ledum in gouty cases.

• Especially useful in gout with cardiac involvement.
• Chronic urinary disorders with strong odour, especially in elderly.
• In children, foul-smelling urine with rheumatic tendencies.

Mind:

• Irritability over trifles.
• Gloomy mood with physical complaints.

Head:

• Headache from uric acid excess.
• Head hot with flushed face.

Urinary:

• Urine, odour, ammoniacal.
• Urine, odour, like horse’s urine.
• Urine, high-coloured, with sediment.

Extremities:

• Gouty pains, shifting.
• Swelling, hot joints.

Generalities:

• Offensive discharges.
• Gouty constitution.

1. Hering C. – Guiding Symptoms of Our Materia Medica: Urine odour, gouty constitution.
2. Allen T.F. – Encyclopedia of Pure Materia Medica: Proving records, urinary specifics.
3. Clarke J.H. – Dictionary of Practical Materia Medica: General description and modalities.
4. Hughes R. – Cyclopaedia of Drug Pathogenesy: Uric acid pathology, joint involvement.
5. Boericke W. – Pocket Manual: Summary notes on offensiveness.
6. Farrington E.A. – Clinical Materia Medica: Gout and urinary action.
7. Lippe A. – Keynotes and Red Line Symptoms: Shifting gout, odour.
8. Nash E.B. – Leaders in Homoeopathic Therapeutics: Clinical pointers for gout.
9. Kent J.T. – Lectures on Materia Medica: Metabolic constitution.
10. Dewey W.A. – Practical Homoeopathic Therapeutics: Grouping with gouty remedies.