• Pleura and Lungs: Direct action on pleural and bronchial serous membranes, reducing friction and pain [Hale].
• Respiratory Muscles: Relieves spasmodic restriction of breathing [Allen].
• Serous Membranes: Influence extends to pericardium and synovial membranes [Hughes].
• Digestive Mucosa: Mild irritant and stimulant effect [Hale].
• Musculoskeletal System: Rheumatic pains linked to serous inflammation [Hering].

• Warmth and warm dry air, easing pleuritic pain [Hale].
• Lying on the affected side to limit pleural motion [Allen].
• Rest and stillness, avoiding respiratory movement [Hering].

• Cold, damp weather aggravating rheumatic and pleuritic symptoms [Hale].
• Motion, especially deep inspiration, which increases sharp chest pain [Allen].
• Sudden changes of temperature [Hering].

No striking mental proving symptoms recorded. In pleuritic states, there may be irritability and restlessness from continual pain, with a mental focus on limiting movement to avoid aggravation [Hale].

Headache may accompany febrile pleurisy — a dull frontal pain with heat and pressure, worse from coughing or taking a deep breath [Allen].

No direct proving symptoms, but in pleuritic fever there may be injected conjunctivae and photophobia from general febrile state [Hale].

No direct proving symptoms recorded.

Dryness and obstruction in acute febrile states; coryza rare in proving [Hale].

Flushed cheeks during fever; pallor during collapse stages of pleuritic illness [Allen].

Dryness of the mouth with thirst for warm drinks; tongue coated white or yellow in acute chest conditions [Hale].

Dryness and rawness in upper throat preceding or accompanying chest symptoms [Allen].

Loss of appetite with early satiety; nausea in febrile stages. Gastric symptoms often secondary to respiratory illness [Hale].

Distension and discomfort from diaphragmatic involvement in pleurisy; splenic or hepatic side pains possible from extended serous inflammation [Hering].

Scanty, high-coloured urine during fever [Hale].

Occasional diarrhoea in acute febrile stages, with yellowish stools [Allen].

Short, rapid breathing from pain on inspiration. A key characteristic is inability to take a full breath without sharp pain [Allen]. The respiratory distress is primarily mechanical, due to inflamed serous surfaces, rather than obstruction from secretions.

Palpitation and precordial oppression possible when pericardium shares in the serous inflammation [Hughes].

This is the grand centre of action for Asclepias tuberosa. The chest pain is sharp, stabbing, and distinctly pleuritic — worse from deep breathing, coughing, or the least movement of the ribs [Allen]. The pain may be localised to the lower ribs or the axillary line, sometimes extending to the shoulder or upper abdomen from diaphragmatic irritation [Hering]. Breathing is shallow and rapid to avoid pain, and the patient may instinctively lie on the affected side to still the motion of the pleura [Hale]. There is often a sensation of dryness or rawness in the bronchi, with a tight, dry cough. The expectoration, when present, is scanty, mucous, and difficult to raise [Allen].

Pain in the interscapular region during coughing or deep breathing, reflecting pleural irritation [Hering].

Rheumatic aching in the large joints during damp weather; may accompany or precede chest symptoms [Allen].

In acute febrile cases, skin hot and dry at onset, later becoming moist as diaphoresis sets in [Hale].

Disturbed by chest pain; the patient seeks positions that immobilise the thorax [Hale].

Typical pleuritic fever: chilliness, then heat with dry skin and flushed face, followed by gentle perspiration as pain subsides [Allen].

Chilliness marked at onset; heat stage prolonged in severe cases; sweat relieves tension [Hale].

Thirst for warm drinks; aversion to cold water in acute stages [Hale].

Acts prominently on serous membranes of the thorax, especially the pleura, producing inflammation with sero-fibrinous exudation. Symptoms resemble early or mild pleurisy and certain cases of dry bronchitis with pleuritic pains [Hale, Hughes].

• Bryonia alba – Pleuritic pain worse from the least motion, but Bryonia is more irritable, dry, and constipated, with a stronger thirst for large quantities of cold water.
• Apis mellifica – Serous membrane inflammation with stinging pains and absence of thirst; Asclepias has sharper, localised pain and thirst for warm drinks.
• Kali carbonicum – Stitching chest pains worse at 3–4 a.m.; more chronic pleuro-pneumonic tendencies.
• Phosphorus – Pleuritic pain with burning heat and tendency to haemorrhage; mental state more fearful and impressionable.

• Complementary: Bryonia alba, Apis mellifica.
• Antidotes: Camphora, Nux vomica.
• Inimical: None noted.
• Follows well: Aconitum in early inflammatory stage.

Extremely valuable in early pleurisy, dry pleurisy, and pleurodynia when the keynote modality of pain worse from deep inspiration is present. Also useful in certain cases of dry bronchitis with pleuritic pains, and in rheumatic conditions that alternate with chest complaints [Hale, Allen].

Mind:

• Irritability from pain
• Desire for quiet and rest

Head:

• Headache during chest illness
• Heat in head with fever

Chest:

• Pain, stitching, pleuritic
• Pain, worse from deep inspiration
• Pain, compelling patient to lie on affected side

Respiration:

• Difficult breathing from pleuritic pain
• Shortness of breath on motion

Extremities:

• Rheumatic pains in large joints
• Pain, worse in damp weather

Generalities:

• Worse cold, damp weather
• Better warmth and rest

Hale E.M. – New Remedies: detailed account of pleuritic action and modalities.

Allen T.F. – Encyclopedia of Pure Materia Medica: proving symptoms of chest, pleura, and fever.

Hughes R. – Cyclopaedia: pharmacological notes on serous membrane affinity.

Hering C. – Guiding Symptoms: extension to back and shoulders.

Boericke W. – Pocket Manual: clinical uses in pleurisy.

Kent J.T. – Lectures: modality analysis.

Clarke J.H. – Dictionary: historical and clinical context.

Lippe A. – Keynotes: notes on pleuritic pains and modalities.

Farrington E.A. – Clinical Materia Medica: comparative chest remedy indications.

Hughes R. – Manual of Pharmacodynamics: relationship to Bryonia and Apis.