• Liver and biliary tree. Hepatic torpor with tenderness, catarrhal jaundice, cholestasis, biliary colic radiating to the right scapula; clay-coloured stools and dark urine; tongue coated yellow. See Abdomen/Rectum/Skin. [Hering], [Clarke], [Farrington]
• Gall-stones and cystic duct spasm. Griping/cramping under the right costal margin shooting to back; nausea, bitter taste, relief from hot drinks. See Stomach/Abdomen. [Boger], [Kent]
• Right lung and pleuro-pneumonia (basal). Right-sided bronchitis/pneumonia with dusky, oppressed chest, short cough, thick yellow sputum; stitching pains to scapula. See Chest/Respiration. [Clarke], [Boger]
• Gastro-duodenal mucosa. Bitter eructations, nausea at the sight/smell of food, heavy epigastrium; craving for very hot drinks (milk) that ease. See Stomach. [Allen], [Boericke]
• Neural/reflective scapular pain. Constant ache beneath right scapular angle—neural reflex from hepatobiliary irritation. See Back. [Hering], [Boger]
• Pancreatic/biliary interface. Right epigastric soreness with greasy stools; pain backward to spine/scapula—overlap with pancreatic dyspepsia. See Abdomen/Back. [Clarke], [Farrington]
• Skin and conjunctiva. Jaundiced tint, pruritus from bile acids; sallow, earthy face; ocular icterus. See Skin/Eyes/Face. [Hering], [Clarke]
• Portal venous congestion. Haemorrhoids with biliousness, secondary to hepatic stasis. See Rectum. [Boger], [Boericke]
• Right-sided headaches/cranial congestion. Right frontal or temporal heaviness with yellow tongue, worse motion, better pressure/hot drinks. See Head. [Kent], [Clarke]
• Somnolence with hepatic states. Daytime drowsiness, languor, yawning—bile toxaemia picture—better after hot milk. See Sleep/Generalities. [Hering], [Nash]

• Very hot drinks—especially hot milk—sipped slowly. Relieves nausea, biliary spasm, and right scapular ache; classic bedside observation. [Clarke], [Boericke]
• Warmth in general: hot applications to right hypochondrium; hot water bottle over liver. [Hering], [Boger]
• Lying on the painful side (right) or bent forward. Splints the chest in right basal pneumonia; eases stitch to scapula. [Clarke]
• Pressure and firm bandaging around right costal arch during colic. [Boger]
• Slow, gentle motion after first rest (stiffness eases), but not jarring. [Kent]
• Belching and passing stool/flatus when hepatic congestion is high—relieves pressure. [Boericke]
• Warm room; avoiding draughts in chest complaints. [Hering]
• After a short nap in day-sleepy states; a brief doze may refresh temporarily. [Nash]
• Milk, warm (even when other foods nauseate) is tolerated and soothed. [Clarke], [Allen]
• Eating small, warm, simple meals rather than heavy/fatty dishes. [Farrington]
• Support of the right elbow/back (rests) for scapular neuralgia. [Hering]
• Sun warmth on the back in spring catarrhs with biliousness. [Tyler]

• Right-sidedness in general; especially under right scapula. The constant tender point provoked by motion, deep breath, or cough. [Hering], [Clarke]
• Cold drinks, cold food, and cold air (chills the stomach and liver; nausea and colic return). [Allen], [Boericke]
• Fatty, rich foods and pastry (liver overburdened). [Farrington], [Clarke]
• Motion (initially), jarring, and deep inspiration in pleuro-pneumonia; stitches shoot to scapula. [Boger], [Clarke]
• Morning on waking—nausea, bitter taste, yellow-coated tongue worse; stool pale. [Allen]
• Springtime and damp, chilly weather (catarrhal liver and chest). [Tyler], [Clarke]
• Stooping or turning quickly (draws on the right costal arch). [Boger]
• Pressure of tight clothing across hypochondria; corsets/belts. [Clarke]
• Touch over gall-bladder/liver—tender, bruised. [Hering]
• Exertion and climbing—oppression of right chest increases. [Kent]
• Suppression of haemorrhoids/skin eruptions—biliary symptoms flare. [Boger]
• Coffee and alcohol—increase bilious headaches and nausea. [Clarke]

Bilious states bring mental dulness, heaviness, and fretful irritability, with inability to fix attention; the patient answers shortly, then lapses into drowsy apathy—a toxic biliary fog matching the remedy’s hepatic affinity. He is anxious about his condition yet too languid to act, preferring to sit propped, sipping hot milk—a behaviour that echoes the modality already noted (better for hot drinks). There is aversion to talk, confusion of ideas on waking with bitter mouth, and an easily provoked temper curiously relieved when a warm drink “goes down” and the right hypochondrium softens. Hypochondriacal foreboding accompanies jaundice: fears of serious illness, of not recovering, with sallow face and yellowness of eyes. Compare Nux-v. (bilious irritability with hypersensitivity and gastric spasm; craves stimulants) and Lyc. (hepatic anxieties with 4–8 p.m. aggravation, flatulent self-consciousness) to sharpen Chel.’s sleepy, hot-drink-seeking profile. Case: a peevish man with new jaundice sat leaning to the right, refused cold water but asked for very hot milk, complaining only of a dagger-ache under the right scapula—Chel. 200C cleared the fog by next day. [Hering], [Clarke], [Kent], [Nash]

Heavy, right-sided frontal or temporal headache accompanies bilious attacks—worse mornings, worse motion or stooping, better firm pressure and hot drinks, often with yellow-coated tongue and bitter taste. Vertex feels weighted; the occiput drags backward toward the scapular pain. The face is earthy, sallow; eyes look dull and yellowish. Nausea or the smell of cooking aggravates; fresh air is craved yet draughts chill and provoke chest stitches. Compare Bry. (frontal pain worse least motion, dry tongue; but Bry. thirsts for cold drinks), Iris (intense bilious migraine with sour vomiting), and Lyc. (right-sided headache with gas and 4–8 p.m. worse); Chel. stands out by right scapula referral and > hot milk. [Allen], [Clarke], [Boger], [Kent]

Scleral icterus is common: the eyes look yellow, heavy-lidded, with gritty burning and photophobia in catarrhal states. Neuralgic stitches shoot to the right temple or right scapula in ciliary irritation. Vision dims on rising; a brownish haze passes; lachrymation in wind but worse in cold air (cross-linking “worse cold air” modality). Pupils may be sluggish; lids feel heavy as if wanting to close—matching bile-drowsiness. Compare Merc. (acrid discharges, metallic taste), Phos. (photophobia with burning, but thirst for cold), and Card-m. less typical for eyes. [Hering], [Clarke], [Allen]

Ringing with head congestion; dull right-sided earache during biliary colic; external ear cool while face is sallow and hot. Otitis catarrh better for warm applications along the right jaw; worse in damp weather. Ear symptoms often abate when liver pain eases after hot drink, exemplifying the reflex axis noted under Affinities. [Clarke], [Hering]

Bland catarrh during spring damp with sallow face; morning coryza with bitter taste and coated tongue. Nostrils sore from flatus of bitter odour; sense of smell blunted in jaundice. Sneezing provokes a stitch to the right scapula; warm rooms help, but cold air excites cough (echoing “worse cold air”). [Clarke], [Allen], [Boger]

Earthy, sallow complexion with yellow sclera; cheeks sometimes flushed over a dirty base; lips dry with bitter mouth. Expression is tired, drowsy, and a little anxious. The right angle of the jaw and parotid region may ache reflexly in gall-stone states. Compare China (sallow with hollow eyes after loss of fluids) and Nat-s. (greenish hue in damp aggravation) for nuance. [Hering], [Clarke]

Bitter taste, especially on waking; mouth full of sticky saliva; tongue thickly coated yellow, with red tip and edges or toothed margins. The tongue feels stiff and large; speech is slow and sleepy. Hot milk tastes good and soothes nausea, while cold drinks offend (explicitly mirroring modalities). Aphthous patches at times in bilious fevers. Compare Merc. (salivation with metallic taste) and Nux-v. (coated posterior tongue with irritable gut). [Allen], [Hering], [Clarke]

Dull aching in right upper molars during gastric–biliary storms; teeth feel elongated and sensitive to cold air/liquids, better warm rinses. Grinding at night from visceral discomfort may occur; gums pale and slightly jaundiced. [Allen], [Clarke]

Hawking of bitter mucus; dryness on waking though saliva is sticky; scraping feels better from warm sips. Swallowing cold liquids chills the chest and renews right scapular stitch (cross-link to “worse cold drinks”). Pharyngeal catarrh with sallow skin and coated tongue gives a reliable bilious ensemble. [Clarke], [Hering]

Classic biliary nausea: disgust at smell of food, worse mornings; bitter eructations, water-brash, and heaviness at epigastrium with burning to right hypochondrium. Craves very hot drinks—especially hot milk—which relieve, while cold drinks or fatty foods aggravate. Vomiting of bitter, yellow-green fluid in attacks; retching bends the patient forward, hand to right costal margin, the pain shooting under the right scapula (reflecting the hallmark). Compare Ipec. (clean tongue, incessant nausea), Nux-v. (spasm, anger), Ant-cr. (after fats, eructations); Chel. is guided by hot-drink amelioration and scapular reflex. [Allen], [Clarke], [Hering], [Boger]

Right hypochondrial fullness and soreness, worse touch and tight clothing; the liver feels enlarged and tender, with stitches shooting to the right scapular angle. Gall-stone colic grips the epigastrium/right costal arch, forcing the patient to press and bend forward, relieved by very hot applications and hot drinks; stools clay-coloured, urine dark, flatus offensive. Pancreatic border pains (right epigastrium straight back) suggest Chel. in “dyspeptic pancreas” with steatorrhoea (greasy stool). Compare Lyc. (flatulent liver, 4–8 p.m. agg.), Card-m. (liver soreness with gastric catarrh), Lept. (black bile stools, liver soreness), Pod. (profuse, painless, morning stool). [Clarke], [Farrington], [Boger], [Kent]

Urine dark, saffron, or brownish, staining linen; biliary pigment evidence; scant during cholestasis, later more free. Burning in urethra at close of micturition may occur, reflex from bile acids; kidney region tender from portal–renal load, better as jaundice clears. [Clarke], [Hering]

Stool pale, clay-coloured or like putty; may be dry, hard, difficult, with inert rectum from biliary insufficiency; alternate loose, yellow stools in catarrhal jaundice. Haemorrhoids from portal stasis—sore, worse sitting long, partly relieved as liver decongests. After stool, right scapular pain may abate (reflex relief). Compare Aloe (fullness and prolapse), Nux-v. (ineffectual urging), Lept. (dark, bilious stools). [Boger], [Clarke], [Boericke]

Right testicular drag in hepatic colic; sexual appetite blunted in bilious phases; nocturnal emissions leave right scapular ache more noticeable on waking. Prostate congestion in sedentary, bilious men improves with hepatic relief. [Clarke], [Boericke]

Menses delayed/scant with sallow skin, jaundiced sclerae; right ovarian pains with liver tenderness. Pregnancy nausea better hot milk suggests Chel.; pruritus vulvae with jaundice. Puerperal biliousness with right scapular stitch is strongly guiding. Compare Sep. (bearing-down, indifference), Lyc. (right ovarian–liver line with gas). [Clarke], [Farrington], [Kent]

Short, laboured breathing in right basal processes; sighing before a sharp stitch; deep breath excites scapular pain. The need to open a button and lean forward is characteristic in colic–chest overlap. Cold air aggravates, confirming modalities. [Clarke], [Boger]

Palpitations with hepatic congestion and chest oppression; pulse soft, easily accelerated after meals; anxiety is dull, not panicky. The heart feels “covered,” heavy; palpitation worse when biliary colic rises, better as it passes with warm sips. [Clarke], [Hering]

Right-sided bronchitis or pneumonia (right lower lobe) with stitching pains radiating to the right scapula; cough short, suppressed, or painful, with thick yellow expectoration; oppression worse cold air, better warm room, lying on right side (splinting) and hot drinks. The voice is low and drowsy; breath short on ascending. Compare Kali-c. (right lower-lobe stitches 3 a.m., sharp pleuritic pains), Bry. (dry pleurisy, better pressure but wants cold), and Phos. (burning chest, thirst for cold), contrasting Chel.’s hot-drink and hepatic link. [Clarke], [Boger], [Kent], [Boericke]

Cardinal keynote: constant pain beneath the inferior angle of the right scapula, dull or stitching, radiating from the liver/gall-bladder; worse deep inspiration, jarring, cold air; better pressure, warmth, and hot drinks. The right trapezius and rhomboids are ropey; patient props the right elbow or lies on that side to splint. This reflex pathognomonic pain separates Chel. from most hepatics. Compare Dios. (colic with drawing back but more umbilical), Coloc. (cramping > pressure but central), Lyc. (right hypochondrium to back with gas). [Hering], [Boger], [Clarke]

Cold hands and feet with warm trunk; heaviness in thighs; right shoulder stiff with scapular ache. Knees weak on stairs in chest–liver catarrh; cramps in calves at night in jaundice; chilblain tendency in spring damp. Limbs often yawn and stretch with drowsiness. [Clarke], [Boericke]

Jaundice with itching (bile acids), worse at night and heat of bed; sallow, earthy appearance in chronic cases. Eruptions dull, yellowish; warts and corns classically cauterised by crude latex—homeopathically, skin clears as bile clears. Yellow sweat at times on face/forehead. Compare Nat-s. (damp-agg., greenish hue), Sulph. (itch, heat, morning stool). [Hering], [Clarke], [Boericke]

Great daytime drowsiness, irresistible napping after meals; yet night sleep is unrefreshing, disturbed by right scapular ache or cough. Falls asleep sitting up with cup of hot milk in hand (cross-link modality). Dreams of business and anxiety about illness; wakes early with bitter mouth, yellow tongue, and nausea—worse morning, consistent with modalities. [Hering], [Nash], [Clarke]

Of work unfinished; of journeys undertaken unwillingly; of heat and pressing clothes across the ribs; of yellow rooms and sticky liquids—imagery echoing bile themes. Nightmares lessen when a warm drink is taken before bed. [Allen], [Clarke]

Bilious (catarrhal) fevers: chill with yawning and bone-weariness; heat with sallow face, bitter taste, and right scapular stitch; sweat late with relief. Alternation of hepatic and chest signs is common (e.g., fever with right basal crepitation and clay stool). Worse damp, spring, better warmth. [Clarke], [Boger], [Boericke]

Chill: from draughts/cold air; shivers run to the right shoulder region. Heat: internal in right hypochondrium with dusky face; worse cold drinks. Sweat: often on waking toward morning, may be yellowish, relieving oppression. [Clarke], [Hering]

Craves very hot drinks, especially hot milk; sips relieve nausea and colic. Desires warm soups; aversion to cold drinks and fats which aggravate; bitter taste on waking; disgust at cooking smells. Coffee and alcohol aggravate bilious headaches. Some report desire for cheese in convalescence but poorer tolerance during attacks. [Clarke], [Allen], [Boericke]

Right-sided remedy with cardinal scapular pain reflecting hepatobiliary spasm/congestion; better very hot drinks (hot milk), warmth, pressure, and lying on right side; worse cold drinks/air, fat food, tight clothing, motion initially, spring damp, and mornings. Drowsiness, sallow skin, yellow tongue, bitter mouth, clay stool and dark urine complete the picture. The liver–lung axis is distinct: right basal chest processes with biliary signs. As reaction improves (stool darkens, bile flows), the scapular pain fades and the mind clears. [Hering], [Clarke], [Boger], [Kent], [Boericke], [Farrington]

Hepatic/Biliary (colic, jaundice, clay stools)

• Lyc. Right hypochondrium with gas, 4–8 p.m. worse, desire for sweets; lacks > hot milk and the fixed right-scapula keynote. [Kent], [Clarke]
• Nux-v. Spasmodic, irritable, coffee/alcohol history; more gastric than biliary; not fixed scapular referral. [Clarke]
• Card-m. Hepatic soreness with gastric catarrh; less scapular neuralgia, more portal stagnation veins. [Farrington]
• Lept. Sore liver with black bile stools; less right-scapular constancy. [Hughes], [Clarke]
• Pod. Profuse, painless, morning diarrhoea; colic central; lacks hot-drink amelioration. [Boger]
• Dios. Colic radiating in various directions, > bending backward; Chel. is > forward and fixed scapula. [Boger]

Gall-stone colic

• Coloc. Violent cramping > hard pressure, > doubling; more umbilical; no hepatic jaundice keynotes. [Boger]
• China. Flatulent, post-haemorrhagic states; distension, not scapular ache; chilly, sensitive. [Clarke]
• Berb. Radiating kidney pains, bubbling; urine involvement more marked; hepatic features secondary. [Boger]

Right-sided Chest

• Kali-c. Sharp pleuritic stitches, 3 a.m. aggravation, back weakness; lacks hepatic–biliary ensemble. [Kent]
• Bry. Dry pleurisy worse least motion, thirst for cold; Chel. wants warmth/hot drinks. [Clarke]
• Phos. Burning chest, haemorrhagic tendency, craves cold; Chel. is warm-seeking with bile signs. [Kent]

Bilious Headache with Bitter Mouth

• Iris. Gastric-migraine with sour/burning vomiting; no right-scapular keynote. [Allen]
• Sang. Right-sided headache, flushed face, sick headaches; but gastric burning and vasomotor storm > vomiting, not bile picture. [Clarke]

Clay stools, dark urine (catarrhal jaundice)

• Merc. Salivation, metallic taste, slimy green stools; more catarrhal mouth; not hot-drink >. [Clarke]
• Nat-s. Greenish hue, damp aggravation; stools often loose; lungs keyed to damp. [Kent]

Somnolence with Hepatic States

• Op. Profound stupor with retention; Chel. has bile fog with irritability, hot-drink >. [Kent]
• Gels. Dullness and heaviness but without bile ensemble or scapular pain. [Tyler]

• Complementary: Lyc. (gastric–hepatic right-sidedness, 4–8 p.m. axis), Nux-v. (spasm–irritability in bilious), Sulph. (restores reaction in chronic liver stasis), Card-m. (portal stagnation). [Kent], [Clarke], [Farrington]
• Follows well: Bry. in right pleuro-pneumonia when bile picture appears; Lept. in catarrhal jaundice shifting to scapular ache. [Clarke], [Boger]
• Precedes well: Lyc. or Sulph. in chronic hepatic constitution after acute relief with Chel.; Calc-s./Kali-s. for lingering catarrh. [Kent], [Boger]
• Antidotes/antagonisms: Nux-v. for coffee/alcohol aggravations; Puls. for fat intolerance sequelae; crude celandine topical effects antidoted by Camph. in idiosyncrasy. [Clarke], [Hering]
• Related (family/chemistry): Sang. (Papaveraceae, right headaches), Op. (Papaveraceae, stupor; opposite thermal drinks). [Hughes], [Clarke]
• Intercurrent: China for post-colic weakness; Berb. if renal radiation dominates; Coloc. if cramp predominates without bile signs. [Boger], [Farrington]
• Inimical: None classically fixed; avoid capricious alternation with Lyc.—let the case declare sequence. [Kent]

• Gall-stone colic with the “dagger” under right scapula: Chel. 200C promptly, repeat per reaction; add hot applications and very hot sips; look for stool darkening as a good sign. [Boger], [Clarke]
• Catarrhal jaundice (clay stool, dark urine, yellow tongue): Chel. in medium/high potencies; stop on improvement; follow with Lyc./Sulph. if chronic terrain persists. [Clarke], [Kent]
• Right basal pneumonia/bronchitis with hepatic signs: Chel. when cough is short/painful, stitch to scapula, yellow sputum, > warm room, > lying on right. [Boger], [Clarke]
• Diet counsel during acute phase: small, warm, simple meals; avoid fats/cold beverages; allow hot milk if craved—these echo the remedy’s modalities. [Farrington], [Clarke]
• Case pearls

• • Biliary colic, clay stool, dark urine, constant right-scapula pain, only hot milk tolerated → Chel. [Clarke]
  • Right lower-lobe pneumonia, short cough, > lying on right, stitch to scapula → Chel. [Boger]
  • Bilious headache right-sided, bitter mouth, yellow tongue, > hot drinks → Chel. [Allen]
  • Haemorrhoids from portal stasis in a sallow patient improved once Chel. restored bile flow. [Boericke]

Mind

• Irritability with sleepiness (bilious states). Typical bile-fog mood; clears as bile flows. [Hering]
• Indifference to work; aversion to mental effort. Biliary toxic impression. [Clarke]
• Anxiety about health with sallow face and yellow eyes. Jaundice ensemble. [Clarke]
• Answers shortly, then drowsy. Sedated temperament in hepatic attacks. [Nash]

Head

• Headache, right-sided, with bitter taste and yellow tongue. Bilious key. [Allen]
• Headache, worse motion/stooping, better hot drinks and pressure. Practical modality. [Clarke]
• Heaviness of head with sallow face. Portal–bile stagnation. [Boericke]

Stomach

• Nausea, morning, with bitter eructations; disgust at food odours. Biliary nausea. [Allen]
• Desire for hot drinks—hot milk relieves. Hallmark. [Clarke]
• Vomiting of yellow-green fluid. Catarrhal bile. [Boericke]

Abdomen/Liver

• Pain, liver region, radiating to right scapula (inferior angle). Pathognomonic rubric. [Hering], [Boger]
• Liver enlarged, sore to touch; clothing intolerable. Portal congestion. [Clarke]
• Gall-stone colic, better heat and hot drinks, better pressure/bending forward. Management rubric. [Boger]

Rectum/Stool

• Stool clay-coloured, putty-like. Bile arrest. [Clarke]
• Haemorrhoids with bilious symptoms. Portal stasis. [Boericke]
• Constipation with inert rectum in jaundice. Functional tie. [Boger]

Chest/Respiration

• Pneumonia, right lower lobe, stitch to scapula. Lung–liver axis. [Boger]
• Cough, short, painful, thick yellow expectoration; worse cold air, better warm room. Management cue. [Clarke]
• Must lie on right side to ease chest pain. Splinting posture. [Clarke]

Back

• Pain beneath right scapula, constant. Signature of the remedy. [Hering]
• Backache worse deep inspiration/jarring; better pressure/warmth. Modality echo. [Boger]

Skin

• Jaundice with itching. Bile in tissues. [Clarke]
• Sallow, earthy complexion. Chronic liver stasis. [Boericke]
• Yellow sweat/face. Minor, confirmatory. [Clarke]

Generalities

• Right-sidedness of complaints. Core polarity. [Kent]
• Worse cold drinks/air; better warmth and hot drinks. Central modality. [Clarke]
• Drowsiness after meals; somnolence in hepatic states. Systemic effect. [Hering]

Hahnemann — Materia Medica Pura (1821–1834): early notices and methodological background to plant provings.
Hering, C. — The Guiding Symptoms of our Materia Medica (1879–1891): right-scapular keynote; hepatic and chest confirmations.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–1879): provings; bilious nausea, tongue, stool data.
Hughes, R. — A Manual of Pharmacodynamics & Pharmacography (1867–1868): alkaloid/toxicology links to hepatobiliary and mucosal effects.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): modalities (hot milk), right-sided chest–liver portrait, relationships.
Kent, J. T. — Lectures on Homoeopathic Materia Medica (1905): essence—right-sidedness, scapular reflex, warmth-seeking.
Boger, C. M. — Boenninghausen’s Characteristics & Repertory (1905) & Synoptic Key (1915): gall-stone colic, right basal chest rubrics, modalities.
Farrington, E. A. — Clinical Materia Medica (1887): hepatic comparisons (Card-m., Lept., Lyc., Nux-v.); diet and management.
Boericke, W. — Pocket Manual of Homoeopathic Materia Medica (1901): concise keynotes—hot drinks, clay stool, right scapula; chest notes.
Dunham, C. — Lectures on Materia Medica (1879): biliary–gastric correlations and practical prescribing hints.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1899): drowsiness, hot-drink amelioration pearls.
Tyler, M. L. — Homoeopathic Drug Pictures (1932): seasonal/spring catarrh, warm-seeking commentary.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): distilled keynotes—hepatic–scapular axis, modalities.
Vithoulkas, G. — Materia Medica Viva (1990s): modern essence and differential sharpening for hepatobiliary polycrests.
Morrison, R. — Desktop Guide to Keynotes & Confirmatory Symptoms (1993): quick clincher signs—right scapula, hot milk, clay stool.