Angostura vera

Angostura vera (syn. Galipea officinalis) is a South American evergreen tree of the Rutaceae, yielding the bitter “Angostura bark” historically shipped from the Orinoco basin. Hahnemann introduced the remedy and warned against the occasionally substituted “false Angostura” (Strychnos bark) whose strychnine-rich toxicity can simulate tetanic phenomena and likely coloured early [Toxicology] descriptions of violent spasms and hyperaesthesia [Hahnemann], [Hughes], [Clarke]. The true bark contains intensely bitter alkaloids and aromatic principles that stimulate the stomach and nerves; the homeopathic tincture is prepared from the dried bark and potentised. Classical authors emphasised a selective influence on the spinal cord and medulla (tetanoid rigidity, trismus), periosteum/long bones (caries, painful ulcers), and mucous membranes of the stomach with marked bitterness and craving for coffee, together with an idiosyncratic supersensitiveness to touch [Hering], [Allen], [Clarke], [Boericke].

Primary symptoms derive from [Proving] material by Hahnemann and colleagues, expanded by Allen and Hering; numerous [Clinical] confirmations concern trismus, tetanoid stiffness of neck/back, jaw cracking, spinal snapping on motion, caries and necrosis of long bones with fistulae, exquisite sensitiveness to touch, and gastric debility craving coffee [Hahnemann], [Allen], [Hering], [Clarke], [Boericke], [Boger].

Angustura vera frames a hair-trigger nervous system mounted upon a tendon-tight, bone-tender chassis. The essence is the paradox of exquisite oversensitiveness to the slightest touch or jar—which instantly provokes spasm, snap, or out-of-proportion pain—yet relative relief from steady, firm pressure, from gentle continued motion after first stiffness, warmth, and even coffee, which uniquely soothes the sinking and steadies the tremulous mind [Hering], [Hughes], [Clarke]. The axis of expression runs from masseter/jaw (trismus, cracking on chewing) through the spinal column (opisthotonic draws, snapping on first motion, firm-surface preference) to the long bones and periosteum (caries/necrosis with hypersensitive ulcers and fistulae). Around this axis whirl minor satellites: gastric atony with intense bitterness, nervous palpitations, startle-dreams, and tendon-short sensations in calves and hamstrings.

The miasmatic colouring is psoric in its reflex hyperexcitability and touch-pain, shading syphilitic when periosteal/bone destruction and fistulous tracks appear. Psychologically the patient is timid-irritable: anxious that a movement will “snap the back” or lock the jaw, yet craving the stimulation (coffee) that briefly restores confidence. Compared with congeners, Cicuta convulses more violently and sinks deeper; Strychninum is more generalised in reflex convulsibility with less jaw-crack and bone focus; Nux-v. bristles with anger and cannot endure coffee; Caust. stiffens without hyperaesthesia; Ruta/Phosph./Sil. attend to bone, but Ang. supplies the touch-triggered tetanoid hallmark. The clinical portrait often declares itself at the first handshake: the patient recoils from contact, prefers a firm chair, a warm room without draught, and moves gingerly until “the first tightness is over,” then manages with slow, steady motion. When these polarities recur across Mind, Mouth, Spine, Extremities, and Generalities, Angustura vera stands out with unusual clarity.

• Spinal cord and medulla. Tetanoid states; opisthotonic arching, reflex hyperexcitability, spasms from light touch or jar; back muscles rigid; “spine snaps and cracks on motion.” See Back/Extremities/Generalities. [Hering], [Allen], [Clarke].
• Masseter/temporomandibular apparatus. Trismus; cracking of the jaw when chewing; painful mandibular movements, sometimes with fear to open mouth. See Mouth/Teeth/Head. [Hering], [Boericke].
• Periosteum and long bones. Caries/necrosis, especially tibia/ulna/femur; fistulous ulcers with extreme bone pains from slight touch. See Extremities/Skin. [Clarke], [Hering].
• Gastric mucosa. Atonic dyspepsia, excessive bitterness of all food and drink, craving for coffee; flatulence after slightest food. See Stomach/Abdomen. [Hughes], [Allen].
• Tendons and ligaments. Stiffness as if tendon too short; strong tension across nape and lumbar regions; cracking of joints on motion. See Back/Extremities. [Boger], [Phatak].
• Nerves (hyperesthesia). Oversensitiveness to touch, pressure, and jarring; pain out of proportion to lesion. See Generalities/Skin. [Hering], [Clarke].
• Mouth/Throat. Dryness, constriction, spasmodic swallowing difficulties in nervous states; fetor from carious teeth when jaw is clenched. See Throat/Mouth. [Allen], [Boericke].

Hyperexcitable, tremulous, and easily startled; the least contradiction or emotional ripple brings trembling through the limbs—an echo of the spinal over-reactivity found elsewhere [Hahnemann], [Hering]. There is inward restlessness with inability to keep still, yet any movement risks spasm, creating a tense polarity (desire to move vs. fear of provoking stiffness) [Clarke], [Boger]. Anxiety about health with fear that the jaws will set or that the back will “snap” on rising; this anticipatory fear aggravates the very spasms dreaded, mirroring the Worse-emotion modality [Hering]. Hypochondriasis about bones—fears of decay or fracture—occurs in chronic cases with caries; irritability and intolerance of noise or touch predominate [Clarke]. Memory is weak during gastric sinking; coffee is craved and may lift spirits transiently, cross-linking Mind and Stomach [Hughes], [Allen]. A peculiar mixture of timidity and sudden anger appears; the patient is oversensitive to social “touch” as well as physical touch, relieving when alone and warm [Clarke], [Boericke].

Sleep light, with startles at the least noise or touch; first sleep disturbed by sudden jerks, jaw set for a moment; fears to lie where the back can be jarred—prefers firm bed and supported neck [Hering], [Allen]. Dreams of falling and teeth breaking on chewing—somatic echo. On waking, stiffness is at its worst (first motion) and gradually yields to gentle movement and heat—bridging to modalities [Boger].

Vivid, anxious, of being struck or jarred, of teeth cracking, of falling from a height; wake in a tremor that runs down the spine; dreams abate with warm room and quiet days [Clarke], [Hering].

Supersensitiveness to touch and jar—pain and spasm from trifles—defines Ang.; first motion cracks and aggravates, gentle continued motion and warmth relieve; firm steady pressure steadies, while light contact provokes [Hering], [Clarke], [Boger]. A “nervous tetanoid” remedy: trismus, jaw cracking, opisthotonic drawing, tendon-tight sensation, with a second axis in periosteal/bone disease (caries of long bones, fistulae) where pain is out of proportion to lesion and worst from the slightest touch; ulcers better warmth and quiet [Hering], [Clarke], [Boericke]. Gastric atony with bitterness and coffee-craving completes the triangle (nerve–bone–stomach). Differentiate from Nux-v. (coffee agg., irascible, hepatic), Cicuta and Strychninum (convulsions but more generalised and stimulus-provoked without bone keynote), Caust. (tendon contractures with paralysis, not hyperaesthesia), and Ruta/Phos. (bone pains with different modalities) [Kent], [Farrington], [Boger].

Chill from the least draught; gooseflesh in warm room if someone taps the chair—touch-triggered shiver [Hering]. Heat flushes with trembling on excitement; sweat slight and clammy, not relieving. The fever picture is nervous rather than septic; modalities govern its management (warmth, stillness, firm support) [Clarke].

Chill: on exposure and on touch/jar; teeth chatter; jaw may seize.
Heat: partial, face and head with throbbing and spinal tension; worse slightest movement.
Sweat: slight on exertion or fright; does not relieve tension; better follows return to warmth and quiet. [Hering], [Allen].

Tension as if a band were drawn across forehead; occipital drawing into the nape with each attempt to straighten, tallying with the spinal affinity [Hering]. Vertigo on rising, as if the back could not carry the head; slightest jar shoots through head and spine [Allen]. Scalp hyperaesthetic—cannot bear combing or draughts; cold air brings shiver and sets teeth on edge—again echoing the Worse-cold air modality [Boericke]. Headaches are pressive, worse first motion and touch, relieved by firm binding and warmth. Startling noises provoke a jerk through the head and neck—miniature tetanic reflex [Clarke].

Lids twitch under effort; visual blur with nervous tremor; cannot fix gaze long without neck tension [Hering]. Photophobia in cold wind; eyes feel dry though water does not help; better warmth and rest [Allen]. Supraorbital bone tender to touch in chronic periosteal states—micro-link to bone affinity [Clarke]. No deep intraocular disease is characteristic; symptoms are functional and neuro-muscular.

Sudden noises shock and send a shiver down the spine; ears overly sensitive to jar [Hering]. Humming on chewing or when the jaw cracks; Eustachian tug from masseter spasm [Clarke]. Neuralgic stitches behind the ear with cold draughts, better warmth and firm scarf-binding—modality concordance [Boericke].

Sneezing may precipitate a whole-body jerk or back snap; tip of nose cold in draught; catarrh scant but coryza easily induced by chilling when perspiring [Hering]. Nasal bones tender to light touch in some carious subjects; pain disproportional to inspection [Clarke]. Smell is not a keynote; any anosmia reflects concurrent catarrh, not specific action.

Twitching of facial muscles; risus sardonicus-like tightening during trismus attacks (mild) [Hering]. Cheeks pale with circled eyes in chronic bone cases; slightest tap on malar bone is intolerable—hyperaesthesia hallmark [Clarke]. Face alternately flushed and pale from nervous storms, worse evening, better quiet warmth.

Trismus: difficulty opening mouth, masseters seize; jaw cracks and snaps when chewing, with fear it will dislocate; teeth feel elongated and painful on light contact—distinctive for Ang. [Hering], [Allen], [Boericke]. Tongue dry, trembles on protrusion; speech jerks with neck spasm. Taste intensely bitter; saliva scant. Coffee is desired, often improves the sinking faintness and mental gloom briefly (peculiar modality) [Hughes]. Fetor when teeth are carious; gums sore to the lightest probe—again the touch-hyperaesthesia [Clarke].

Painful on slight touch; chewing causes cracks in the temporo-maxillary joint; cold air striking the teeth sends a convulsive shiver [Hering]. Caries and crumbling in neglected cases with bone affinity; dental work is difficult due to reflex spasms; better steady pressure with the jaws gently supported [Clarke].

Spasmodic constriction; difficult deglutition from nervous tightening, rather than inflamed soreness; swallowing cold water provokes shiver or momentary jaw seize; warm drinks relieve [Hering], [Boericke]. Sensation as if the pharynx would close on first mouthful; improves as confidence returns—psychomotor overlay typical of the remedy [Clarke].

Trembling about the heart with palpitation on the least excitement; precordial region sensitive to touch; a knock at the door causes a leap through the spine [Clarke]. Stitches in chest on first movement; better warmth, worse draught. Voice may tremble from laryngeal muscle tension; short breath during jaw or back spasm [Hering], [Allen].

Palpitation with spinal startle; irregular beat from emotion; no structural lesion indicated in classical texts; the state is neurofunctional and tracks with better warmth, quiet, and coffee (in some) [Clarke], [Boericke].

Breathing jerks with spinal twinges; deep inspiration risks back “snap” and is avoided; cold air provokes cough or shiver; warm, still air palliates [Hering], [Boericke]. Nervous asthma-like tightness with no mucus; relief as jaw and nape relax.

Gnawing gastric atony with great bitterness; empty, sinking faintness calls for coffee, which for once comforts (peculiar) [Hughes], [Allen]. Distension after a little food; belching relieves; cold drinks chill and aggravate spasm, whilst warm drinks soothe—echoing Better-warmth [Boericke]. Nausea from excitement; eructations tremulous; cannot bear tight clothing over epigastrium (touch-worse) [Hering]. Hunger soon after eating in nervous cases, yet food sits like lead in chill and draught.

Flatulent rumbling with abdominal wall hypersensitiveness; the least jar hurts as if bruised; better firm binder and heat [Clarke]. Colicky twitches when startled; rectus abdominis in spasm couples to lumbar tension. Hepatic region tender to percussion in some, without inflammatory signs—reflecting periosteal-like surface hyperalgesia [Hughes].

Stool difficult from muscular spasm and fear of strain; fissure pains out of proportion to lesion; the act may trigger sacral rigidity; better warm fomentations and quiet [Hering], [Clarke]. Diarrhoea from nervous shocks is occasional; more often constipation from spasticity and inhibition.

Strangury from reflex tension; must wait long before urine flows; trembling during micturition after fright [Hering]. Urine scant in chill; passage improves in warmth and mental quiet. No deep renal signature.

Craves coffee (often ameliorates) and warm drinks; aversion to cold water during spasmodic phases; bitterness of all food and drink a keynote [Hughes], [Allen], [Boericke]. Appetite poor yet desires stimulants; gas after the least food; eructations ease the “loaded” feeling.

Erections spasmodic and short-lived; seminal emissions after erotic dreams with spinal exhaustion; coitus may provoke back spasm in cold room—thermal/touch polarities repeated [Clarke], [Boericke].

Nervous dysmenorrhoea with crampy back drawing into thighs, worse slightest touch or jar on the pelvis; better heat and perfect stillness [Clarke]. Vaginismus-like tightening from fear and hypersensitiveness; warm baths and gentle reassurance relieve—psychosomatic facet within the Ang. terrain [Hering].

A leading seat. Rigid nape and lumbar spine, with feeling the back will break on straightening; spine cracks and snaps on first motion; slightest touch or jar goes through the whole column as a shock; opisthotonic drawing in severe states [Hering], [Allen], [Clarke]. Sacral region sore to light pressure but steadied by firm support; warmth loosens. Cannot bear a soft mattress; prefers firm surface and quiet—clinically invaluable [Boger]. Sudden start in first sleep arches the back; confirms Worse night/first sleep.

Tendons feel too short; calves and hamstrings draw on attempting to walk; first steps bring cracking in joints, then motion eases—paralleling many “first-motion worse, continued motion better” states [Boger], [Phatak]. Trembling of hands from excitement; writing sets a quiver up the forearm; percussion on ulna intolerable in caries [Hering], [Clarke]. Fingers stiff in cold air; toe and tibial periosteum exquisitely tender; chilblain-like sensitivity to draughts. In bone disease, pain from the lightest touch but better firm steady pressure—paradox typical of this remedy [Clarke].

Hyperalgesic skin; the slightest touch excites pain or even spasms; bruises feel enormous compared with their look [Hering]. Ulcers over carious bone; edges irritable, bleed easily to gentle wiping; granulation tardy; warmth comforts [Clarke]. Eruptions after cold wind; touch-excited twitchings close to lesions.

Tetanoid / Spasm from Touch or Jar

• Cicuta — Violent convulsions with profound coma; eruptions; less jaw-crack and bone tenderness; Cicuta is more epileptiform [Hering].
• Strychninum / Nux-v. — Reflex spasms; Nux irritable with gastric hyperaesthesia and coffee aggravation (opposite to Ang. craving). Ang. shows touch-triggered spasm with coffee palliative [Hughes], [Kent].
• Caust. — Contractures with paresis and rheumatic stiffness; lacks the touch-hyperalgesia and jaw-cracking of Ang. [Kent].

Periosteal/Bone Affinity

• Ruta — Periosteal pain and strain injuries; worse cold/damp but not so touch-hyperesthetic; no trismus.
• Phosphorus — Bone pains, necrosis of jaw but marked bleeding/faintness; Ang. stronger for long bone caries with tetanic overlay [Clarke].
• Silicea — Fistulous tracks over bone with chilliness; less immediate spasm from touch.

Jaw / Trismus

• Cupr. — Cramps and trismus with general convulsions; metallic spasms; Ang. adds jaw cracking and spinal “snap.”
• Arnica — Locking after dental trauma; Arn. has bruised soreness without the hair-trigger hyperaesthesia of Ang. [Boger].

Gastric Bitters / Coffee

• Nux-v. — Coffee aggravates, irritable, gastric spasm; Ang. desires coffee and is soothed by it.
• Ign. — Emotional shocks, globus; coffee often aggravates Ign.; touch-spasm less prominent [Kent], [Farrington].

Touch-Hyperaesthesia

• Hepar-s. — Pain from slightest touch but with suppurative tendency and chilliness; Ang. has spasm and bone themes, not pus.
• Cham. — Cannot bear pain, angry child; lacks trismus/bone caries centre.

• Complementary: Ruta — For periosteal strain/overuse; Ang. covers tetanic, touch-provoked stiffness overlay. [Boger].
• Complementary: Silicea — Chronic fistula over carious long bones; Sil. consolidates after Ang. reduces touch-spasm state. [Clarke].
• Complementary: Phosphorus — Bony states with constitutional drain; alternate on indications when bleeding/sensitivity predominate.
• Follows well: Arnica after contusion/dental trauma when hair-trigger hyperaesthesia and jaw cracking persist. [Boger].
• Follows well: Coffea in nervous insomnia with startle where coffee palliates then fails—Ang. stabilises.
• Precedes well: Caust. where residual contracture remains after hyperaesthesia subsides.
• Antidotes: Camph. and warmth for chill/shock states; Nux-v. for gastric drugging (clinical). [Clarke], [Hughes].
• Inimical: None decisively recorded in classical sources.

• When to think Ang.: Any case where slightest touch or jar sparks disproportionate pain or spasm—post-dental trismus; “snapping spine” on first movement; jaw cracking with chewing; long-bone caries/fistula exquisitely touch-sensitive; gastric bitterness with coffee-desire. Track improvement by reduced touch-reactivity and ability to rest on a firm surface [Hering], [Clarke], [Boericke].
• Potency & repetition: 6C–30C once to thrice daily in subacute neural/tendon states; 200C weekly for entrenched tetanoid patterns or bone pathology, then space by response. In ulcer/caries work, intercurrent Sil./Phos. on constitutional signs may consolidate results [Boger], [Clarke].
• Adjunctive measures: Warmth, quiet room free of draughts, firm supports (collar or lumbar roll), slow graded movement, dental splinting where indicated; avoid sudden manipulations. Coffee may palliate in selected subjects—respect idiosyncrasy (if coffee aggravates, reconsider Nux-v./Ign.) [Hughes], [Kent].
• Case pearls:
  • Post-extraction trismus with jaw crack on bite; Ang. 30C q8h → jaw opens, spasm subsides in 36 h [Hering].
  • “Snapping spine” first movement morning; firm mattress, Ang. 200C weekly → first-motion fear gone by week 2 [Boger].
  • Caries tibia with fistula, pain from light dressing; Ang. 30C b.i.d. + warm soaks → tolerable dressing, healthier granulation in 10 days [Clarke].
  • Nervous gastralgia with bitterness and coffee-desire; Ang. 12C t.d.s. → sinking less, steadier mood [Hughes].

Mind

• Startled from the least noise; trembling from trifles—reflex storms ease in warmth/quiet. [Hering].
• Irritability from contradiction; anxious about health, fears jaw/back will lock/snap. [Clarke].
• Timidity with sudden anger; oversensitive to sensory impressions. [Hahnemann], [Clarke].
• Desire for coffee alleviating mental gloom (peculiar). [Hughes].
• Restlessness yet fears to move (spasm on motion). [Boger].

Head / Mouth / Teeth

• Trismus; masseter spasm; jaw cracks on chewing. [Hering], [Boericke].
• Teeth sensitive to slight touch or cold air; feel elongated. [Allen].
• Headache from jar; band-like pressure, worse first motion. [Clarke].
• Tongue trembles on protrusion; speech jerks with neck tension. [Hering].
• Taste bitter, everything tastes bitter. [Allen], [Hughes].

Back

• Spine cracks/snaps on first motion; opisthotonic drawing. [Hering], [Allen].
• Back sore to light touch; better firm support and warmth. [Clarke], [Boger].
• Stiff nape; cannot bear soft pillow; wants hard bed. [Boger].
• Jar aggravates pains throughout spine; sudden movement excites spasm. [Hering].
• Fear to straighten lest something “break.” [Clarke].

Extremities

• Tendons feel too short; contractive calf/hamstring pains on starting. [Phatak], [Boger].
• Periosteal pain of long bones; caries with fistula; pain from light dressing. [Clarke], [Hering].
• Trembling of hands from emotion; joints crack on first motion. [Allen], [Boger].
• Touch and jar aggravate; firm bandaging steadies. [Hering].
• Cold air stiffens limbs; warmth loosens. [Boericke].

Stomach / Abdomen

• Bitterness of all food and drink; empty faintness craving coffee. [Hughes], [Allen].
• Flatulence after a little food; belching relieves. [Allen].
• Epigastrium tender to light touch; tight clothes intolerable. [Hering].
• Colic from startle; abdominal muscles twitch. [Clarke].
• Better warm drinks; worse cold water. [Boericke].

Generalities

• Supersensitive to touch, jar, slight pressure—pain/spasm from trifles. [Hering], [Clarke].
• First motion aggravates; gentle continued motion ameliorates. [Boger].
• Better warmth; worse cold air/draught. [Boericke].
• Trembling from emotion; nervous, tetanoid constitution. [Hering].
• Prefers firm surface; soft bed aggravates. [Boger].

Skin / Ulcers

• Ulcers over carious bone, edges irritable, bleed to slight touch. [Clarke].
• Hyperalgesic skin; bruises feel enormous; light stroke excites twitch. [Hering].
• Cold wind brings chaps and neural twitches. [Boericke].
• Dressings must be warm and steady; light dab aggravates. [Clarke].
• Fistulous tracts slow to granulate; warmth comforts. [Clarke].

Hahnemann — Materia Medica Pura (1821): primary proving; warnings on false Angostura; nervous hyperexcitability, bitterness.
Hering — The Guiding Symptoms of Our Materia Medica (1879–): trismus, spinal snap, touch-hyperalgesia; clinical confirmations.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): proving data; jaw cracking; gastric atony with bitterness.
Hughes — A Manual of Pharmacodynamics (1893): pharmacology of bitters; coffee peculiarity; toxicological context.
Clarke — A Dictionary of Practical Materia Medica (1900): bone caries/fistulae; touch/jar aggravation; relationships; modalities.
Boericke — Pocket Manual of Homoeopathic Materia Medica (1901): keynotes—trismus, spinal rigidity, coffee desire, hyperaesthesia.
Boger — Synoptic Key of the Materia Medica (1915): first-motion worse, continued motion better; firm-surface preference; bone/tendon notes.
Phatak — Concise Repertory of Homoeopathic Medicines (1977): “tendons too short,” extremity modalities; practical generals.
Farrington — Clinical Materia Medica (1887): comparisons in spasmodic/bone states (Cic., Nux-v., Caust., Ruta).
Kent — Lectures on Homoeopathic Materia Medica (1905): comparative remarks on coffee, Nux-v./Ign., Caust., and nervous constitutions.
Nash — Leaders in Homoeopathic Therapeutics (1898): nervous leaders and startle states; corroborative generals.
Tyler — Homoeopathic Drug Pictures (1942): temperament and clinical portrait; notes on practical handling (firm support, warmth).