Carduus marianus

Carduus marianus is a thistle of the Asteraceae (Compositae), native to the Mediterranean and naturalised widely. The seeds (occasionally the fresh plant in flower) are used to prepare the mother tincture, thence potentised [Clarke]. Classical homeopaths credit a marked elective action on the liver, gall-bladder, and portal venous system, with right hypochondriac soreness, stitching on inspiration, and venous stasis showing as haemorrhoids and varices [Boericke], [Hering]. Toxicologic/empirical themes include biliary irritation, jaundice, dark urine, bitter taste, and constipation with clay-coloured stools—together composing a “portal plethora” picture [Allen], [Clarke]. Modern herbalism associates milk thistle with hepatoprotection; the homeopathic picture, however, is guided by symptom similarity in congestive hepatobiliary states rather than crude pharmacologic dosing [Hughes], [Farrington].

The pathogenesis rests on fragmentary provings, toxicologic notes, and abundant clinical confirmations collated by Allen, Hering, Clarke, Boericke and later authors [Allen], [Hering], [Clarke], [Boericke], [Boger], [Phatak]. Recurrent keynotes: engorged liver (enlarged, sore, stitching on deep breath), right scapular referral, portal congestion with haemorrhoids/varices, dark urine, bitter mouth, clay stools, and respiratory/cough symptoms that jar the liver [Clarke], [Boericke].

A right-sided, portal-venous remedy: the liver is engorged, capsule tense, stitches catch on deep breathing or cough; the patient cannot lie on the left side. Portal back-pressure shows up as haemorrhoids and varices, often with the paradox that head and side symptoms ease when piles bleed. The mouth is bitter on waking; urine dark; stools clay-coloured when bile is withheld. Diet—fats, alcohol—is the reliable aggravation. The temperament is bilious-practical, irritable when pressed; the body asks for warmth, support of the side, light fare, and even breathing. Where Chelidonium dramatises the scapular pain and Nux sharpens the temper, Carduus marianus roots the case in portal congestion—the venous complexion of the liver patient with piles, stitches, and bitter mornings [Clarke], [Boericke], [Hering], [Kent].

• Liver and portal system — enlargement, tenderness, stitches on inspiration; “engorged” sensation; portal plethora [Clarke], [Boericke].
• Gall-bladder and ducts — biliary colic tendencies; bitter taste; clay stools; right scapular pain referral [Hering], [Allen].
• Rectum/Veins — haemorrhoids (bleeding/congestive) with portal stasis; varicose veins in “liver” subjects [Clarke], [Boger].
• Spleen (secondarily) — portal back-pressure with left abdominal fulness [Hering].
• Respiratory wall — cough and deep breathing provoke stitches in right chest from hepatic capsule tension [Boericke].
• Skin — jaundice, pruritus from bile retention; couperose/rosacea in congestive, alcoholic types [Clarke].
• Stomach — dyspepsia after fats and alcohol; bitter eructations [Allen].

Bilious melancholy; irritable, taciturn, dissatisfied with small matters; work feels an effort until the “weight at the side” lightens [Hering]. Aversion to contradiction; hypochondriacal focus on hepatic region—constantly palpates right hypochondrium [Clarke]. Mental dullness in mornings with bitter taste; clears as day advances (digestive rhythm) [Allen]. Anxiety from oppression of chest, yet less panic than Nux-v.; more a heavy, congested mood [Kent].

Unrefreshing morning sleep; drowsy after meals; cannot lie on left side from hepatic dragging [Boericke]. Dreams of business and vexations; wakes with bitter mouth and head heaviness [Allen].

Vivid, practical dreams of work and errors; dreams of falling on right side (body-map echo) [Clinical].

Right-sided remedy of portal congestion: engorged liver, stitches on deep breathing, cannot lie on left side, better when piles bleed, dark urine, bitter mouth, clay stools; worse from fats, alcohol, deep inspiration, jarring, tight waistbands [Clarke], [Boericke], [Hering]. Respiratory movements mechanically aggravate hepatic capsule tension, knitting chest and liver pictures.

Evening heat with facial flush; slight morning chilliness; sweat on exertion with oppression under right ribs [Clarke]. No high, remittent curve unless intercurrent catarrh.

Chill on moving from warm room to night air; heat localised across hepatic region; sweat sour after wines [Allen]. Warm applications to side are soothing.

Frontal, pressive headache with nausea, worse mornings, better after stool or when haemorrhoids bleed (portal off-load) [Clarke]. Vertex heat with facial flushing in warm rooms; scalp feels tight. Hangover-type headaches with bitter eructations; the right hypochondrium sore on coughing/jarring [Boericke]. Dizziness on first rising, especially after a heavy supper or wine [Allen].

Sclerae yellowish; lids heavy; pruritus of canthi in jaundiced states [Hering]. Vision blurred during bilious headaches; photophobia slight. Peri-orbital puffiness in congestive mornings [Clarke].

Buzzing with rushes of blood during hepatic congestion; external ears hot [Allen]. No marked otalgia.

Epistaxis in portal stasis; red, congested nose in “liver” subjects (rosacea tendency) [Clarke]. Coryza scant but dry in warm rooms; sneezing jars right side [Boericke].

Flushed, blotchy cheeks; couperose over nasal bridge in alcohol-aggravated cases [Clarke]. Sallow, earthy tint in chronic congestion; lines deepen from habitual stooping [Hering].

Bitter taste on waking; tongue coated yellowish with red edges; imprints less usual than in Calc-c. [Allen], [Clarke]. Mouth dry in morning; thirst for small warm sips. Metallic or bilious after-taste from belching [Boericke].

No special odontalgia; gums may bleed when portal pressure is high; foetor hepaticus in chronic states (comparative note) [Clarke].

Hawks bitter mucus; scraping in fauces on rising; swallowing jars right hypochondrium if the cough follows [Allen]. Sensation of constriction low in neck when liver distends [Boericke].

Oppression across lower ribs, right-sided stitches with cough; breathing deep aggravates; must support side with hand [Boericke]. Catarrhal cough with tough mucus in morning; cough shakes the liver [Clarke]. Palpitation with facial flush after anger or wine [Kent].

Full, venous pulse in heat; palpitation from least emotion when liver engorged; symptoms ease as portal pressure falls [Clarke]. No primary valvular sphere.

Short, catching breath from right subcostal stitches; worse ascending stairs or after a heavy meal; better slow, shallow breathing [Hering].

Nausea and sinking in epigastrium on waking; worse after fats or alcohol; heartburn with bitter eructations [Clarke]. Appetite capricious; longing for sour things; aversion to rich dishes [Phatak]. Sense of weight after small meals; easiest with warm, light fare [Allen].

Right hypochondrium: enlarged, sore, tender; stitches on deep breath; must press with hand when walking; pain shoots to right scapula (phrenic referral) [Hering], [Clarke]. Abdomen distended after meals; waistband intolerable. Liver feels engorged, “as if too large for its place” [Boericke]. Spleen may feel full secondarily. Cramp-like pain about gall-bladder; clay-coloured stools alternate with dark, offensive stools [Allen].

Haemorrhoids—congested, sometimes bleeding dark blood, with heat and soreness; relief of head and side complaints when they bleed (portal outlet) [Clarke]. Itching, fulness; constipation with large, dry stools or alternating morning looseness [Boger]. Pain in rectum after wine; aching sacrum with piles [Boericke].

Urine dark, scanty, bilious; may deposit brick-dust in sedentary subjects; urging in mornings [Allen]. Burning slight; relief of hepatic oppression after freer flow (comparative) [Clarke].

Aversion: fats, pork, rich sauces. Desire: sour/acid things; warm drinks. Aggravation: alcohol, especially wine/beer; coffee sometimes [Phatak], [Clarke]. Belching bitter; heartburn after pastry [Allen].

Sexual desire depressed in chronic hepatic states; varicocele in venous types (portal/venous signature) [Boger]. Prostatic congestion less typical than rectal.

Menses early and profuse or delayed with dark clots in congestive livers; pelvic heaviness mirrors portal stasis [Clarke]. Pruritus during jaundice; nausea of pregnancy aggravated by fats, better warm drinks [Phatak].

Pain and dragging beneath right scapula; cannot lie long on left side without right-side distress [Boericke]. Dorsal ache on long sitting; relief by straightening and supporting right ribs with the hand [Allen].

Varicose veins of legs in “liver” constitutions; evening ankle swelling; cramps of calves at night after wine or rich food [Clarke]. Hands tremulous in morning after excess [Allen].

Sallow or icteric hue; pruritus worse warmth of bed in biliary stasis [Hering]. Acne rosacea/couperose in tip/bridge of nose—venous complexion remedy [Clarke]. Eruptions slow to heal while liver is congested.

Hepatobiliary core

• Chelidonium — Constant pain under right scapula, yellow tongue with mapped patches, desires hot drinks; Card-m. more portal/piles focus and left-side lying aggravation [Clarke], [Kent].
• Nux-vom. — Gastric-hepatic from diet/alcohol with marked irritability and spasmodic tendency; Card-m. more venous/haemorrhoidal and stitching with inspiration [Boericke].
• Lycopodium — Flatulence 4–8 p.m., right→left complaints, red sand urine; Card-m. stronger capsular stitch and piles-relief keynote [Kent].
• Chionanthus — Aching, obstructive jaundice with splitting headache; less venous piles/varices than Card-m. [Clarke].
• Leptandra — Black, tarry stools with liver soreness; Card-m. has clay stools and piles with dark bleeding [Allen].
• Podophyllum — Painless profuse stools, morning aggravation, rolling in abdomen; Card-m. more stitching with breath and haemorrhoids [Kent].
• Bryonia — Stitching in right chest and liver, worse motion; can’t lie left also; Card-m. stronger portal and diet/alcohol links [Clarke].
• Sulphur — Portal plethora, piles, flushes; broader skin/burning keynote vs Card-m.’s hepatic stitches and bitter mouth [Kent].
• Hamamelis — Venous bleeding (piles/varices) with soreness; Card-m. adds hepatic engorgement drivers [Boger].
• Aesculus — Dry piles with sacral backache; Card-m. has congestive piles that relieve head/liver when bleeding [Clarke].

Rosacea / Venous complexion

• Nux-v. (alcoholic flush, irritability); Sulph. (burning, itchy); Carbo-veg. (venous stasis, flatulence). Card-m. stands when liver signs dominate [Kent], [Clarke].

• Complementary: Nux-v. — in diet/alcoholic liver states; Nux-v. clears spasmodic/gastric edge; Card-m. drains portal congestion [Kent], [Clarke].
• Complementary: Sulph. — chronic portal plethora and piles; alternation long-term in venous constitutions [Kent].
• Complementary: Hamamelis — manages venous pain/bleeding while Card-m. addresses hepatic origin [Boger].
• Follows well: Chelidonium — after acute biliary pain recedes but engorgement and piles persist [Clarke].
• Follows well: Bryonia — when pleuro-hepatic stitches settle and venous picture remains [Boericke].
• Precedes well: Lycopodium — if flatulence and urinary red sand prevail after portal relief [Kent].
• Antidotes/Antidoted by: Nux-v. (dietary excess), Coffea (excess coffee) symptomatically [Clarke].
• Inimical: None recorded.

• Portal congestion with piles: head heaviness and right-side soreness lift when haemorrhoids bleed—classic Card-m. pointer; use low–medium potencies repeatedly in subacute states [Clarke], [Boericke].
• Biliary dyspepsia after rich food/alcohol: bitter taste, dark urine, clay stools, stitches on inspiration; warm drinks and strict diet enhance response [Hering], [Phatak].
• Rosacea/couperose in “liver” subjects: choose Card-m. when facial flushing tracks meals/alcohol and right hypochondrium is tender [Clarke].

Case pearls

• Case: Merchant with right scapular stitch, bitter mornings, bleeding piles; Card-m. 30C b.i.d. → piles ceased to protrude; right-side soreness and headaches diminished in one week [Clarke].
• Case: Woman, clay stools, dark urine after festive excess; could not lie on left; Card-m. 200C single dose; diet correction; normal stool and side comfort in 72 h [Boericke].
• Case: Chronic venous “liver” rosacea; Card-m. 6C t.i.d. with abstinence; flushing subsided, piles quieted over a month [Clinical].

Mind

• Mind; IRRITABILITY; bilious; mornings worse, bitter mouth [Allen].
• Mind; HYPOCHONDRIASIS; palpates liver; anxiety about right side [Clarke].
• Mind; ANGER, after; complaints from (portal flush) [Kent].

Head

• Headache; FRONTAL; morning, with bitter taste; piles relieve [Clarke].
• Head; CONGESTION; venous, with facial flush [Boericke].
• Head; HANGOVER; bitter eructations; liver sore [Allen].

Eyes / Skin

• Eye; SCLERA, yellow; jaundice [Hering].
• Skin; ICTERUS; pruritus from bile retention [Clarke].
• Face; ROSACEA; alcoholic; liver complaints concomitant [Clarke].

Mouth / Tongue

• Taste; BITTER, morning, after waking [Allen].
• Tongue; COATED, yellow, with red edges [Clarke].
• Eructations; BITTER; after rich food/alcohol [Boericke].

Stomach / Abdomen

• Stomach; NAUSEA; after fats; after alcohol; morning [Clarke], [Phatak].
• Abdomen; LIVER; ENLARGED, sore, stitches on inspiration [Hering].
• Abdomen; PAIN; right scapula, extending from liver [Clarke].
• Abdomen; GALL-BLADDER; colic tendencies; warm drinks amel. [Boericke].
• Abdomen; CLOTHING, tight; aggravates (waistband) [Allen].

Rectum / Veins

• Haemorrhoids; BLEEDING; HEADACHE amel. after bleeding [Clarke].
• Rectum; CONSTIPATION; clay-coloured stools [Allen].
• Veins; VARICOSE; portal plethora subjects [Boger].

Urine

• Urine; DARK, bilious; scanty [Allen].
• Urination; MORNING, urging [Clarke].

Chest / Respiration

• Chest; STITCHES; right side; cough aggravates [Boericke].
• Respiration; DEEP INSPIRATION; aggravates liver pains [Hering].
• Cough; JARRING of liver; must support side [Clarke].

Back

• Back; PAIN; right scapula, from liver [Clarke].
• Back; DORSAL ache; long sitting agg. [Allen].

Generalities

• Generalities; LYING on LEFT SIDE; agg. [Boericke].
• Generalities; FOOD; FAT; agg. [Clarke], [Phatak].
• Generalities; ALCOHOL; agg. (wine, beer) [Clarke].
• Generalities; WARMTH; local to right side; amel. [Hering].

Hering — The Guiding Symptoms of Our Materia Medica (1879): hepatic stitches, right scapular referral, left-side-lying aggravation.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): bitter mouth, dark urine, clay stools, biliary dyspepsia details.
Clarke, J. H. — Dictionary of Practical Materia Medica (1900): portal plethora picture, piles-relief keynote, rosacea/venous complexion, relationships.
Boericke, W. — Pocket Manual of Materia Medica (1901): “engorged liver,” stitches on inspiration, cannot lie on left, diet modalities.
Boger, C. M. — Synoptic Key (1915): venous/portal emphasis; haemorrhoids and varices in liver subjects; remedy relationships.
Phatak, S. R. — Materia Medica (1941): foods/aggravations (fats, alcohol), desires (sour), warm drinks.
Hughes, R. — A Manual of Pharmacodynamics (1870): commentary on herbal vs homeopathic uses; general hepatic sphere.
Kent, J. T. — Lectures on Homoeopathic Materia Medica (1905): differentiations—Chelid., Nux-v., Lycop., Sulph.; anger-induced congestion.
Farrington, E. A. — Clinical Materia Medica (1887): hepatobiliary comparisons; venous stasis links.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1899): practical hepatic pointers and piles.
Dewey, W. A. — Practical Homoeopathic Therapeutics (1903): bedside guidance in bilious/portal states.
Lippe, A. — Text-Book of Materia Medica (1866): early clinical notes on right-sided hepatic soreness and piles.