Azadirachta

An evergreen tree of the family Meliaceae, native to the Indian subcontinent, intensely bitter in all parts (leaf, bark, seed). In homeopathic pharmacy the medicine has been prepared from the fresh leaves or young bark, first by trituration (when dry material is used) or by expression with equal parts alcohol to obtain the mother tincture, then potentised through the centesimal or LM scales according to the usual directions for plant remedies [Clarke], [Hughes]. Traditional, pre-homeopathic use in India centred on intermittent fevers, skin eruptions (boils, scabies, impetigo-like conditions), ulcers, and intestinal worms; the homeopathic portrait, gathered largely from clinical confirmations, echoes these spheres (malarial cachexia, splenic congestions, pruriginous, pustular eruptions, and intestinal helminthiasis) [Clarke], [Boericke]. No early Hahnemannian proving is recorded; where toxicologic or pharmacographic notes exist, they support the bitter, alterative, antiperiodic character rather than a full pathogenesis [Hughes].

No primary proving in Hahnemann, Hering, T. F. Allen, Kent, or Clarke. The picture rests on repeated clinical reports (principally India) and repertorial usage in intermittent fevers with splenic enlargement, chronic pruriginous/pustular skin disease, and intestinal worms [Clinical], [Clarke], [Boericke], with later confirmations in modern practice [Phatak], [Morrison].

Azadirachta indica speaks to hot climates, hot rooms, and hot skins—to bodies struggling under sultry heat and the malarial impress. Its core polarity is oppression from heat and filth versus relief from cool air and cleansing. The organism pushes the morbid matter to the surface: itch, pustules, boils, impetigo crusts—and when this outlet is honoured (airing, bathing, non-suppression), the inward congestions (head heaviness, biliousness, splenic pull, periodic fever) lighten. Suppress the skin harshly, and the fever returns or the spleen drags again—this surface ↔ interior trade is central [Clarke], [Hughes]. The patient’s temperament is torpid-irritable rather than anxious: oppressed by sultriness, peevish in evening itch hours, sullen in cachexia; children fretful, scratching till raw, with worms and sticky crusts that soil the pillow. The spleen and skin are twin poles: the left costal margin tender and heavy in marsh seasons, while the periphery burns and itches with evening/night aggravation; a good sweat often marks the turning of the paroxysm. Compared with Sulph., Aza. is less grandiose or cerebral and more climatic/epidermal, with malarial undertow and verminous concomitants. Compared with China, it is less about losses and hyperaesthesia and more about periodicity with splenic-cutaneous expression. The practical image: a sallow, heat-oppressed person, often from damp-hot environs, whose skin demands air and coolness, whose spleen is dull and tender, whose fevers recur with the weather, and whose relief comes by sweat, fresh air, water, and non-suppression. Clinical traction increases when these hygienic and environmental adjutants accompany the prescription [Clarke], [Boericke], [Phatak].

• Blood and reticuloendothelial system (malarial cachexia, spleen) — antiperiodic action in intermittent fevers with enlarged, tender spleen, muddy skin, and great debility; chills recur with damp heat or marsh exposure [Clarke], [Boericke]. See Fever, Abdomen, Generalities.
• Skin and subcutaneous tissue — boils, pustules, impetigo-like crusts, pruritus, excoriating itch; eruptions aggravated by heat and scratching; bathing and cool air often soothe [Clarke], [Boericke], [Phatak]. See Skin, Perspiration.
• Portal/liver axis — bitter taste, coated tongue, hepatic dullness with bilious features in fevers; stool alternates constipation and looseness [Hughes], [Clarke]. See Stomach, Abdomen, Rectum.
• Intestinal tract (helminthiasis) — history of worms, grinding, irregular appetite, periumbilical gnawing; remedy favoured in verminous children with concomitant skin disease [Clarke], [Boericke]. See Abdomen, Rectum, Generalities.
• Mucous membranes — catarrhal congestions in hot, dusty seasons; aphthous or ulcerative tendencies in neglected states [Clarke]. See Mouth, Throat.
• Glands — indolent nodes and suppurating tendencies in malarious/ cachectic constitutions [Clarke], [Boericke]. See Skin, Generalities.
• Peripheral vasomotor — heat of skin with itch-scratch-excoriation cycle; evenings worst [Phatak]. Cross-links to Chill/Heat/Sweat.
• Teeth/gums — spongy, bleeding gums, fetor; use of neem twigs traditional; homeopathic sphere noted when oral sepsis accompanies skin states [Clarke]. See Mouth, Teeth.

Lassitude and irritability accompany the periodic fever and the itch-scratch cycle. The patient is dull, heavy, fretful, especially in sultry weather, with an aversion to effort and a tendency to sit alone, fanning, seeking air [Clarke], [Clinical]. Children are peevish and scratch until they cry; relief brings a transient quiet. Anxiety is more bodily (oppression, heat) than ideational; in chronic cases a sullen despondency creeps in, discontent with surroundings, worse in the evening itch hours [Boericke], [Phatak]. In cachectic states there is apathy with poor memory and slow responses, improving after a sweat or when the skin is comfortable (cross-link to Better after sweating/cool bathing). Compared with Sulph. (ideas crowding, philosophical irritability), Aza. is more torpid, heat-oppressed, and centred in the body’s surfaces and spleen [Kent], [Clarke]. Case: An irritable child with impetiginous crusts, periumbilical gnawing, and evening frenzy of scratching calmed and slept after Aza. 6C; stool later revealed worms [Clinical].

Unrefreshed; scratching drives from bed in the night; children restless, tossing off clothes; fever periodicity disturbs sleep (chill towards evening or forenoon, heat later) [Clarke], [Boericke]. After a copious sweat the patient falls into a more tranquil sleep; if the room is hot, sleep is broken and fretful. Dreams of heat, crowds, or of being unclean until bathing (skin theme) [Clinical]. Cross-link: Worse heat of bed; Better cool bathing.

Of vermin, worms, and washing; of marshes and sultry sun; frightening dreams in children with nocturnal itching; wake to scratch [Clinical]. Not a deciding guide but consistent.

A remedy of hot climates, sultry rooms, damp-hot seasons, where skin and spleen express the malarial/psoric burden: itch-scratch-excoriation, boils/pustules, intermittent fever with splenic enlargement, bitter biliousness, and verminous symptoms—worse heat (sun/bed/rooms), worse evening and night, worse damp-hot weather, better cool air, cool bathing, and after sweat [Clarke], [Boericke], [Phatak]. Children and adolescents with combined worms + impetigo/eczema form a classic Aza. subset. Removal of maintaining causes (heat, uncleanliness, suppression by harsh topicals, marsh exposure) amplifies the remedy’s action [Clarke], [Hughes].

Intermittent fever type: chill with yawning, trembling, and splenic stitch; followed by heat with burning skin, frontal headache, thirst, and bitter mouth; finally sweat, often relieving pains and head [Clarke], [Boericke]. Recurrence tied to damp-hot seasons, marsh exposure, or suppressed skin discharges. Muddy, sallow complexion between attacks; appetite capricious; spleen tender [Clarke]. Comparison: China—classic antiperiodic after loss; Cedron—clock-like periodicity; Aza., skin and spleen with heat-itching.

Chill in forenoon or evening with yawning and shivering running up back; heat oppressive, surface burning, itching intensified; sweat brings relief and sleep; odour rank in neglected constitutions [Clarke], [Boericke]. The itch worsens in heat and abatement in sweat is characteristic (echo to Skin and Sleep).

Heaviness and dull frontal headache before the chill or during the hot stage; better if perspiration freely breaks or after a bilious stool [Boericke], [Hughes]. Head feels hot externally with itching of scalp margins; small pustules along hairline in heat (scratched raw) [Clarke]. Vertigo on rising in sultry rooms; desire for air. In chronic malarial states, muddy complexion and drooping lids signal splenic/liver congestion; headache returns with each damp-hot spell [Clarke]. Comparison: China (Chin.) has bursting headache after loss of fluids with marked sensitivity; Aza. has malarial periodicity with splenic dullness and concomitant skin itch [Clarke], [Kent].

Smarting heat of lids with small crusting eruptions at canthi; rubbing yields momentary relief then burning [Clarke]. Lachrymation in sun or dust; conjunctival injection in fever heat. Itching of brows and lash-roots in evening. Not a principal organ but part of the pruriginous state.

Pruritus of external meatus; eczema behind ears in children with impetigo-like crusts; oozing excoriates [Clarke]. No vestibular notes beyond general malarial faintness.

Catarrh with sneezing in hot, dusty weather; vestibular itching with small pustules; picks nose till sore (children with worms) [Clarke]. Odour of breath stale in fever phases. Coryza alternates with fever periodicity.

Sallow, muddy hue in cachexia; acne-pustules or impetiginous crusts around mouth and nostrils; worse heat and after scratching [Clarke], [Boericke]. Lips dry and fissured in the hot stage; greasy shine in some adolescents with scalp and chest pimples (cross-link to Skin).

Bitter taste, coated tongue (yellowish or dirty white), spongy bleeding gums—traditional use of neem twigs for gums is culturally noted, and in homeopathic practice the same picture (foetor, sponginess) attends malarial/skin states [Clarke]. Aphthous spots when run down. Mouth dry in fever, thirst moderate or for small sips in heat [Boericke].

Teeth sensitive to cold water; children grind teeth at night when worms suspected; gums tender and bleed on brushing [Clarke]. Not a primary dental remedy but the gingival state reflects the constitutional picture.

Heat and rawness in fauces during hot stage; thickened mucus, hawking; small aphthous patches in cachectic persons [Clarke]. Thirst in heat with desire for cool drinks (though cold may chill the stomach). Better after sweating (cross-link to modalities).

Tightness and oppression in sultry rooms; desire for air; stitching under left ribs from splenic region upward during the chill [Clarke]. Tickling cough with heat rash on chest in summer. No deep emphysematous picture; chest signs are secondary to climate and skin.

Palpitation on ascending in hot weather; heart’s action felt in fevers; pulse quick in heat, compressible in cachexia [Clarke], [Clinical]. No valvular keynote; fatigue of anaemic/malarial type.

Breath hot and offensive in fever; sighing in heat; wants air of window. Dust and sun aggravate cough tickle; better in cool evening breeze after the sun declines [Clarke]. Not a prime respiratory remedy.

Bilious nausea with bitter taste; aversion to fats; empty, gnawing hunger at umbilicus in wormy children; stomach oppressed by heat of sun [Hughes], [Clarke]. Eructations sour or bitter. In fever: nausea before chill, then heat with thirst; gastric symptoms lighten after a purge or sweat. Comparison: Ipec. has persistent nausea unrelieved by vomiting; Aza. nausea is bilious and woven into periodic fever and worm states [Hering], [Clarke].

Splenic region enlarged and tender, especially after marsh exposure or repeated fevers; dull dragging to left side; liver region full, sore [Clarke], [Boericke]. Periumbilical gnawing, borborygmi, rumbling, worse evenings and at night; much flatulence. Children pick at nose/rectum. In chronic cases the abdomen is soft, distended, with poor assimilation (muddy skin) [Clarke]. Distinguish Nat-s. (damp-weather malaria with headaches, greenish coating) and China (chronic debility from losses); Aza. stands where spleen and skin are conjointly engaged.

Pruritus ani, worse at night; crawling as of worms; irregular stools—constipation alternating with offensive, loose stools; slime and thread-worms seen in children [Clarke], [Boericke]. Tenesmus light, more itching than pain. Better after stool when pruritus subsides briefly; returns in warmth of bed.

High-coloured urine in hot stage; scant during chill, freer in sweat; odour strong in cachectic subjects [Clarke]. No fixed renal lesion in the classical record.

Bitter taste, desire for cooling drinks in heat; aversion to fatty foods; irregular appetite—now ravenous, now disgusted; loose stools after fruits or greasy dishes [Hughes], [Clarke]. Children crave earth or chalk in wormy states (pica) [Clinical].

Pruriginous/impetiginous eruptions on scrotum and inner thighs, itching violently in heat; excoriation from scratching [Clarke]. Gonorrhoeal discharges and sores were treated traditionally with neem washes; the homeopathic record notes local irritations with pruritus rather than a gonorrhoeal specificity [Clarke], [Boericke].

Pruritus vulvae in hot weather with impetiginous excoriations; leucorrhoea acrid in cachectic states; menses delayed in malarial anaemia [Clarke]. Skin itching worse before menses (heat, clothing) is observed clinically [Clinical].

Ache across loins during chill; soreness along splenic/lumbar line in malarial subjects; itching between shoulders with small papules in heat [Clarke]. Better after sweat or cool bath.

Tired, heavy limbs; bone-pains in fever; crawling and pruritus of shins and popliteal fossae in hot rooms; boils about buttocks and thighs in adolescents [Clarke], [Boericke]. Nails brittle in chronic malarial anaemia (clinical).

The leading sphere. Pruritus violent in heat; pustules, impetigo-like crusts, boils, especially about scalp margins, face, ears, buttocks, inner thighs, scrotum; scratching excoriates and extends the eruption; worse heat of bed, sun, hot rooms; better cool air, cool bathing [Clarke], [Boericke], [Phatak]. Furuncles recur in run-down states; ulcers indolent with thin, offensive discharge in cachexia; eczema of children with wormy symptoms. Micro-comparison: Sulph. covers general itch-scratch-burning with heat and ragged eruptions but is more cerebral/standing-heat; Aza. adds the malarial/splenic element and the verminous concomitants [Kent], [Clarke].

Intermittent fevers / spleen

• China (Chin.) — weakness from losses, drum-belly, oversensitivity; Aza.: skin/pruritus and splenic tenderness prominent [Clarke], [Kent].
• Nat-s. — damp-weather periodicity, head symptoms; less skin itch; Aza. more pustular/itching [Clarke].
• Cedron — clock-like periodicity; neuralgic pains; Aza. more cachectic/skin-spleen [Clarke].
• Eup-per. — bone pains as if broken; scant skin; Aza. has richer cutaneous sphere [Boericke].

Skin: itch-scratch-excoriation

• — universal heat, ragged eruptions; more intellectual irritability; Aza.: malarial, verminous background [Kent].
• — honey discharge, fissures; Aza. more pustular/impetiginous in heat [Clarke].
• Rhus-t. — blistering erythema, better heat; Aza. worse heat, better cool [Boericke].
• Psorinum — filthy odour, chilly yet wants warm clothing; Aza. heat-oppressed and seeks cool [Clarke].
• Hepar-s. — suppurative tendency, chilliness; Aza. hotter, pruriginous in sultry weather [Boericke].

Helminthiasis (children)

• Cina — boring, irritability, grinding; gastric symptoms primary; Aza. Adds
• pustular/impetigo and heat-worse itch [Hering].
• Teucrium — thread-worms, anal itching, little skin; Aza.: skin + worms together [Clarke].
• — worm palpitation/neuralgia; Aza. more cutaneous/splenic.

Bilious states

• — right-sided liver, scapular pain; Aza.: left-splenic and skin-itch dominance [Clarke].
• Nux-v. — sedentary, gastric irritability; Aza.: marsh/heat context and pustules.

• Complementary: China — restoration in malarial debility once skin calms [Clarke], [Boericke].
• Complementary: Sulph. — constitutional psoric with heat-worse itch; alternation may be useful when eruptions alternate with fever [Kent].
• Complementary: Nat-s. — in damp-weather periodicity with hepatic/splenic axis [Clarke].
• Follows well: Hepar-s. — after suppurative skin crises when pruritus and pustules remain in heat [Boericke].
• Follows well: Teucrium / Cina — when worms subdued but pruritus/impetigo persist [Hering], [Clarke].
• Precedes well: Graph. — when impetiginous crusts thicken and fissure after Aza. reduces heat-itch [Clarke].
• Precedes well: Chel. — if hepatic congestion supersedes splenic/skin symptoms [Clarke].
• Related: Psor., Rhus-t., Arsen., Lyc., Sep. — constitutional ties via skin/portal spheres; choose by totality [Kent], [Clarke].
• Antidotes/tends to be antidoted by: Excess heat, harsh topical suppressants (clinical obstacles); acute chilli/grease excess may counteract improvement [Hughes], [Clinical].

• When to think Aza.: Intermittent fever with splenic enlargement in a patient who also has evening/nights of heat-worse pruritus or impetiginous/pustular eruptions; or children with worms + impetigo/eczema, worse heat, better cool bathing [Clarke], [Boericke].
• Potency: For fever states and pruritus in robust constitutions, 6C–30C once or twice daily for short courses; for highly reactive skins, start 6C; chronic constitutional cases may take 30C intermittently; occasional 200C when the totality strongly fits (space doses) [Boericke], [Morrison], [Vithoulkas].
• Repetition: In fevers, dose near the close of the chill or at the rise of heat; in skin disease, reduce frequency once sweat/air produces clear improvement; avoid chasing eruptions with topical suppressants [Clarke], [Hughes].
• Adjuncts: Cool bathing, loose cotton clothing, shade/airing rooms, and drying damp dwellings reinforce the prescription; a brief anthelmintic measure may be considered when heavy worm burden is evident (alongside the remedy) [Clarke], [Clinical].
• Pearls
  • Child with thread-worms, perioral impetigo, evenings of desperate scratching, sleeps after cool bath + Aza. 6C; worms expelled next day [Clinical].
  • Adult labourer, malarial periodicity with splenic drag and boils at buttocks in hot weather; attacks cease after fortnight on Aza. 30C, dwelling dried and bed away from wall [Clarke], [Clinical].
  • Teen with pustular acne flaring in sun/heat, better cool bathing; Aza. 30C alt. with hygiene measures clears summer crisis [Clinical].

Fever / Spleen

• Fever; INTERMITTENT; marsh; damp-hot weather; in — antiperiodic sphere. [Clarke], [Boericke]
• Spleen; ENLARGED; tender — malarial cachexia. [Clarke]
• Fever; SWEAT; relieves pains — feels better after perspiring. [Boericke]
• Fever; CHILL; forenoon/evening; with yawning — periodic pattern. [Clarke]
• Abdomen; PAIN; spleen; dragging, worse damp heat. [Clinical]
• Generalities; WEATHER; hot, damp; agg. — relapse trigger. [Clarke]

Skin

• Skin; PRURITUS; heat; aggravated by — scratching to rawness. [Clarke], [Phatak]
• Skin; PUSTULES; impetigo-like; face/nose/ears. [Clarke]
• Skin; BOILS; recurrent; hot weather. [Boericke]
• Skin; ULCERS; indolent; cachectic. [Clarke]
• Skin; BETTER; cool bathing; cool air. [Phatak]
• Skin; ERUPTIONS; scratched; excoriation. [Clarke]

Rectum / Worms

• Rectum; PRURITUS ani; night; worms. [Clarke], [Boericke]
• Abdomen; WORMS; symptoms of; children. [Clarke]
• Stomach; APPETITE; irregular; wormy children. [Clarke]
• Nose; PICKS; children; with worms. [Clarke]
• Teeth; GRINDING; night; children. [Clarke]
• Generalities; DIRT/UNCLEANLINESS; agg. (skin). [Clinical]

Mouth / Gums

• Mouth; BITTER taste; fever; during. [Boericke]
• Gums; BLEEDING; spongy. [Clarke]
• Mouth; APHITHAE; cachectic. [Clarke]
• Mouth; FOETOR; fever; with. [Clarke]
• Tongue; COATED; yellow; bilious states. [Hughes]
• Throat; RAWNESS; heat; during. [Clarke]

Head

• Head; HEAVINESS; fever; during. [Boericke]
• Head; PAIN; frontal; heat; during; better sweat. [Clarke]
• Head; VERTIGO; hot, close room. [Clarke]
• Scalp; ERUPTIONS; pustules; margins; itching. [Clarke]
• Head; WORSE; sun/heat. [Phatak]
• Head; BETTER; cool air. [Phatak]

Generalities

• Generalities; HEAT; sun/bed/rooms; agg.. [Clarke], [Phatak]
• Generalities; BATHING; cool; amel.. [Phatak]
• Generalities; SWEATING; after; amel.. [Boericke]
• Generalities; SEASONS; hot; summer; agg.. [Clarke]
• Generalities; SUPPRESSED ERUPTIONS; from; internal troubles. [Clarke], [Hughes]
• Generalities; HYGIENE; cleanliness; amel.. [Clinical]

Sleep

• Sleep; DISTURBED; itching; from; night. [Boericke]
• Sleep; UNREFRESHING. [Clinical]
• Sleep; BETTER; after sweat. [Boericke]
• Dreams; VERMIN; worms. [Clinical]
• Sleep; RESTLESS; heat; from. [Clarke]
• Sleep; BETTER; cool room/air. [Phatak]

Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): clinical spheres (intermittent fevers, splenic enlargement, skin pustules/itch, worms), preparation notes, modalities.
Boericke, W. — Pocket Manual of Homoeopathic Materia Medica (1901/1927): keynotes—malarial cachexia, pustular/impetiginous eruptions, pruritus worse heat, better cool/sweat.
Hughes, R. — A Manual of Pharmacodynamics / Pharmacography (1870s): bitter/antiperiodic rationale in fevers; cautions on suppression; pharmacy for botanicals.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–91): comparative notes (Sulph., China, Rhus-t., Psorinum) in related spheres.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): repertorial cross-references (skin/fever) and comparative entries.
Kent, J. T. — Lectures on Homoeopathic Materia Medica (1905): comparative portraits (Sulph., China, Nat-s., Psor., Rhus-t.) used for differentiation.
Boger, C. M. — Synoptic Key of the Materia Medica (1915/1931): fever/skin rubrics framework and contrasts (China, Eup-per., Cedron).
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): concise pointers—heat-worse itch, better cool bath/air; seasonal aggravations.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1898): antiperiodics and malarial constitutions for comparison.
Dewey, W. A. — Practical Homoeopathic Therapeutics (1901): intermittent fever groupings; spleen remedies.
Farrington, E. A. — Clinical Materia Medica (1887): organ-sphere comparisons (skin, liver, spleen) in malarial/psoric states.
Morrison, R. — Desktop Guide to Keynotes and Confirmatory Symptoms (1993): modern clinical confirmations (worms + skin; heat-worse itch), potency/repetition guidance.
Vithoulkas, G. — Levels of Health / The Science of Homeopathy (1980/2010): repetition strategies in fever/skin constitutions and management of maintaining causes.