• Spine—lumbar, sacral, coccyx. Back feels as if it would break when sitting; must walk or stand; soreness and bruised ache across lumbosacral span, sometimes a hot line down sacrum. See Back/Generalities/Modalities. [Hering], [Allen], [Boericke]
• Sciatic nerves (often left >). Dragging, shooting sciatica, worse sitting, better walking or changing posture; after sexual excess or long writing. See Extremities/Back. [Boger], [Allen], [Clarke]
• Male genito-urinary. Sexual erethism, nocturnal emissions, prostatorrhœa; backache and gloom after losses; urethral tingling/burning. See Male/Urinary/Mind. [Hering], [Allen], [Boericke]
• Female pelvic organs. Ovarian/uterine aching with the Cobalt back (worse sitting, better walking); menses early/profuse in some; sexual excitement with sacral pains. See Female/Back. [Clarke], [Boericke]
• Head (occiput—student strain). Occipital pressure from prolonged sitting, relieved by open air and walking; link to spinal fatigue. See Head/Modalities. [Allen], [Boger]
• Mind & nerves (sexual neurasthenia). Irritable, low, hypochondriacal after emissions; concentration suffers when sitting long; better when moving. See Mind/Sleep. [Hering], [Allen], [Clarke]
• Skin. Acne/papular eruptions in youth with sexual irritability; face/back; worse night and after sexual excess. See Skin/Mind. [Clarke], [Boericke]
• Rectum/prostate axis. Prostatic oozing, tenesmus after stool; rectal fulness with sacral ache (sitting <). See Rectum/Male. [Allen], [Hering]

• Walking about, moving, or standing, especially after long sitting. [Hering], [Allen]
• Frequent change of posture, short breaks from desk work. [Boger], [Clarke]
• Pressure with the hand to small of back; leaning back firmly when obliged to sit. [Allen], [Boericke]
• Open air and exercise—occipital/head symptoms lighten. [Boger], [Clarke]
• Abstaining from sexual excess; long, quiet intervals lessen backache and gloom. [Hering], [Clarke]
• Warm applications to sacrum or along sciatic course after exertion. [Boericke]
• After a good night’s sleep (when emissions are absent). [Allen]
• Stooping momentarily (to slacken lumbar tension), then walking on. [Boger]
• Stretching the limbs before sitting again; gentle spinal extension drills. [Clarke]
• Light, simple diet during neurasthenic phases. [Dewey]

• Sitting, especially long or on a hard seat; writing, study, office work. [Hering], [Allen]
• After sexual excess, masturbation, or nocturnal emissions—backache, sadness, irritability. [Hering], [Clarke]
• Riding/driving (prolonged sitting with vibration). [Boger], [Allen]
• First motion after sitting; must move a little before it eases. [Boger]
• Evening and night, when desires rise and skin eruptions itch. [Boericke], [Clarke]
• Coffee, alcohol, rich late suppers—increase irritability/congestion. [Dewey]
• Cold drafts on the back while seated; damp offices. [Clarke]
• Mental exertion at desk; student headaches with spinal fatigue. [Allen]
• After stool—prostatic oozing, sacral awareness. [Allen]
• During menses—pelvic and sacral pains worse from sitting. [Clarke]
• Sudden cessation of usual exercise (holiday desk sprees). [Boger]
• Long travel (coaches, rail): sciatica rekindled. [Clarke]

A neurasthenic picture: the patient becomes irritable, depressed, and self-reproachful after sexual losses, with a peculiar aggravation from sitting and mental application (Mind ↔ 10b sitting; Male). He broods over imagined incapacity or loss of self-control, yet feels markedly better if he gets up and moves (Mind ↔ 10a walking) [Hering], [Allen]. There is hypochondriacal focus on the back and the sexual organs; trivial emissions or a small prostatic stain in linen is magnified in his thoughts, which then further weaken concentration for work (Mind ↔ Male/Rectum) [Clarke]. He dislikes close rooms and long interviews because sitting immediately wakes the lumbar ache, and the ache wakes irritability; in the open air the temper and head clear (Mind ↔ Head/10a open air) [Boger]. His mood is not violent or jealous like Hyos. nor sad to suicide like Aurum; it is fretful, sex-tinted, and desk-bound, alternating with brief spells of hope after a clean day devoid of losses [Kent], [Clarke]. Study brings confusion in the afternoon, and he grows averse to the desk by an association of sitting = pain; a short walk restores some elasticity (Mind ↔ Generalities) [Allen]. Morals weigh on him when he slips into self-abuse; contrast Staphisagria, who is mortified and emotionally bruised, whereas Cobalt is irritably regretful and more spinally symptomatic. Anxiety centres on the future potency and on whether the back “will ever be right”; improvement is measured in days without emissions and hours on the feet [Hering], [Clarke].

Occipital tightness and a band-like pressure across the nape arise after prolonged sitting or mental strain; walking in air loosens it (Head ↔ 10a; Affinity Head) [Allen], [Boger]. Reading with head bent aggravates; the pain creeps upward to the vertex; occasionally dull frontal heaviness joins. The headache often couples with lumbar stiffness—a “top-and-tail” fatigue typical of desk workers (Head ↔ Back) [Clarke]. Sudden turning of the head when seated may shoot a twinge into the occiput; firm pressure or support gives a minute’s respite. There is no Belladonna blaze; this is the tired spine–tired brain ache, echoing the modality sitting <, walking > (Head ↔ 10b/10a). Students report afternoon blur of ideas, then a calmer head after sunset strolls. Compare Nux (irritable, gastric, night-owl) and Kali phos. (brain fag without sexual axis). [Allen], [Clarke], [Boger]

Fatigue of accommodation with ache at inner canthi as the occipital pressure mounts; worse after long desk work, better air and distance-viewing (Eyes ↔ Head/10a) [Allen]. Lids feel heavy; ocular strain precipitates slight occipito-nuchal ache. No violent photophobia; the feature is work-strain with the spinal background. Intermittent blur clears after walking; a few report smarting tears when compelled to read on. Differentials: Ruta for ciliary strain with bruised eyeballs; Arg-nit. if anxiety and diarrhœic tendencies accompany reading strain. [Clarke], [Boger]

Fullness and humming after desk fatigue; pass off in open air. Sudden noises while seated provoke a start felt in the small of back, showing the cord-centred sensitivity. Earache is not a guide. Ringing after emissions has been noted in a few records—an erethistic echo rather than primary otology. [Allen], [Clarke]

No constant catarrh; some provers had dryness in close rooms with frontal heaviness that eased outdoors (Nose ↔ Head/10a). Occasional morning sneezing after a bad night with emissions—a reflex irritability. Suppressed colds are not a theme here; select by back and sexual axis instead. [Allen], [Clarke]

In the young acne papulosa flares with sexual excitement or night emissions; cheeks and shoulders peppered; worse evenings (Face ↔ Skin/10b) [Clarke], [Boericke]. The countenance looks tired with desk pallor; a slight oily sheen appears in the seborrhoeic. Flushing from embarrassment about losses may accompany the mental state. Pain or sensitivity over zygomata belongs to coexistent reading strain rather than a sinus picture. [Clarke], [Allen]

Taste can be flat mornings after emissions; tongue feels dull; a slight metallic tinge is sometimes recorded, likely a general “metallics” echo. Teeth/jaw are not primary seats of action. Saliva normal; dryness relates to room heat. [Allen], [Hughes], [Clarke]

Transient molar ache with nuchal strain in students, better from fresh air and walking; not curative-leading. Grinding is not characteristic (contrast Staph.). [Allen], [Clarke]

Tight pharyngeal sense while bent over the desk; clears on walking; voice grows husky after a long afternoon of silence. No ulcerative picture; a functional fatigue mirrored from the cervical chain (Throat ↔ Head). [Allen], [Clarke]

Appetite capricious in the over-worked; coffee and late suppers (< 10b) aggravate gastric irritability and the night’s rest. Flatulence when long seated; better by walking (Stomach ↔ 10a). Nausea is not typical; select by spinal/sexual signs. [Dewey], [Allen]

Weight across hypogastrium when seated long, tied to prostatic congestion in men and uterine in women (Abdomen ↔ Male/Female). Bowel sluggishness in sedentary periods; better with exercise. No inflammatory abdomen. [Allen], [Clarke]

Irritation at neck of bladder in the sedentary, with frequent desire after sitting; better when up and about. Urine otherwise clear; urethra tingles after emissions. Dribbling post-micturition in those with prostatic oozing (Urinary ↔ Male). [Allen], [Hering]

After stool a drop or thread of prostatic mucus may appear (men), with a drag in sacrum if he sits again (Rectum ↔ Male/Back; 10b after stool) [Allen], [Hering]. Haemorrhoidal fulness from chair-life improves with walking. Tenesmus slight; burning rare. [Clarke]

A leading sphere. Sexual erethism with pollutions and prostatorrhœa; backache and depression after losses (Male ↔ Mind/Back/10b) [Hering], [Allen], [Boericke]. Desire is heightened yet exhausting; emissions may be without dreams, or with lascivious imagery and morning gloom. Urethral tingling/burning, stringy threads at meatus, and a sense of pelvic weight on sitting are frequent. Compare Staph. (moral offence and oversensitivity), Selenium (great weakness, dribbling semen with lasciviousness), Phos-ac. (apathetic collapse after losses) and Agnus (cold genitals, impotence). Cobalt is picked when sitting < and walking > for the back, and the mind is irritably hypochondriacal rather than crushed. [Clarke], [Boger], [Boericke]

Sacral–ovarian aching worse from sitting, relieved by walking (Female ↔ Back/10a) [Clarke]. Menses may come early and free, with increased sensual excitement and back-dragging; a few report ovarian tenderness after the desk day which lifts on exercise. Leucorrhœa scant, acrid in some records; the signature remains the Cobalt back. Differentiate Sepia (bearing-down, indifference, wants to cross the legs) and Lilium (pelvic weight with moral distress); choose Cobalt when movement > and sitting < dominate. [Boericke], [Clarke]

Shallow breaths while bent over work; a few deep breaths in air reset rhythm. No asthmatic keynote; dyspnœa belongs to postural fatigue and mental fret. [Clarke]

Palpitations in the sensitive after losses or fatigue; pulse unsettled when he resumes the chair too soon; better moving steadily. Not a structural heart drug; symptoms are erethistic and reflex. [Allen], [Clarke]

A sense of pressure high in the sternum after long sitting; breathing freer on walking. No deep bronchitis; it is the posture congestion picture. Palpitation may follow emissions and desk worry, easing with air. [Clarke], [Allen]

Key sphere. Pain in small of back as if it would break when sitting; must get up and walk (Back ↔ 10b/10a) [Hering], [Allen]. The ache is bruised, dragging, sometimes with a hot track over sacrum and into coccyx; hard seats are torture. Leaning back firmly or pressing the hand into the small of back helps for a minute, but soon he must move (Back ↔ 10a pressure). Riding rekindles; first motion after sitting is stiff, then eases (Back ↔ 10b riding/first motion). Coccygeal tenderness points to Cobalt when Hypericum has handled trauma and the sitting < remains. Walking in open air resolves both occiput and lumbar components—classic Cobalt concordance. [Boericke], [Boger], [Clarke]

Sciatica, often left, with shooting down the posterior thigh and sitting <, walking > (Extremities ↔ 10b/10a) [Allen], [Boger]. Knees ache after desk days; calves heavy at night. Hands go numb when elbows rest long on a table—postural. No tremor keynotes; weakness lifts with movement. Compare Gnaphalium (sciatica with numbness, lying on painful side relieves) and Coloc. (bends double for relief from colic-sciatic mix). [Boger], [Clarke]

Acne and papular eruptions of face/shoulders in the sexually over-excited adolescent, worse night/after emissions, better with exercise, clean diet (Skin ↔ 10b/10a) [Clarke], [Boericke]. Skin otherwise unremarkable; not a moist eczema drug. In men, follicular pimples along beard line may worsen with late nights. [Allen], [Clarke]

Sleep is broken after sexual excitement; if an emission occurs, he wakes unrefreshed, back aching, and gloomy (Sleep ↔ Male/Mind/10b) [Allen], [Hering]. When nights pass quietly, the back is steadier and the mind cheerful—a practical gauge. He dreads lying late because the later he lies the more sexual fantasy intrudes; early rising to walk prevents this (Sleep ↔ 10a walking). Dreams are erotic, sometimes vivid, followed by lassitude; on chaste evenings sleep is sound and morning clear. He tosses on the sacral ache if he sat long at night. [Clarke], [Allen]

Lascivious, pursuit themes, or of work left undone after hours at the desk; emissions may attend the erotic set. Some dream of falling from a seat or missing a train—symbolic desk anxieties. Non-erotic dreams accompany chaste periods and exercise. [Allen], [Clarke]

Not a fever remedy; there may be a late-day flush after mental over-work and sitting, with a cooler head after walking. Night sweat is not central (contrast Merc.). [Allen], [Clarke]

Chill across the lumbar region when seated too long; heat in face with embarrassment; sweat slight and without relief. The pattern tracks posture and erethism more than infection. [Allen], [Clarke]

Coffee, alcohol, and late rich meals aggravate sexual erethism and insomnia (Food ↔ 10b) [Dewey]. Appetite dull after bad nights; simple warm food steadies. No strong cravings; the keynote is hygiene more than diet. [Clarke]

The axis runs spine ↔ sex ↔ desk: sitting aggravates; walking ameliorates; sexual excitement/losses aggravate the back and mind; exercise, abstinence, and open air restore tone (Generalities ↔ Modalities). Pains are bruised/dragging rather than stabbing; coccyx/sacrum and left sciatica recur. The mind frets, becomes irritable and self-observant after losses; it can be buoyed by movement and days without emissions. Choose Cobaltum when the postural modality (sitting <, walking >) is unmistakable and the sexual sphere is erethistic with prostatic oozing, rather than exhausted/collapsed as in Phos-ac. or Agnus. Outcomes are read in longer desk tolerance with breaks, quiet nights, clear mornings, steadier temper, and dry linen. [Hering], [Allen], [Clarke], [Boericke], [Boger], [Phatak]

Sexual neurasthenia / emissions

• Staphisagria — Shame, mortification, oversensitivity after onanism; bladder/teeth issues. Cobalt: less shame, more backache from sitting with walking >. [Kent], [Clarke]
• Selenium — Great weakness, semen dribbles even without erection; craving for stimulants. Cobalt: postural backache dominates; emissions provoke gloom but stamina recovers with movement. [Boericke], [Clarke]
• Phosphoric acid — Apathy, indifference, mental fog after losses. Cobalt: irritable, not apathetic; sitting < key. [Nash], [Kent]
• Agnus castus — Cold genitals, impotence with despair of recovery. Cobalt: desire present, erethism with emissions. [Clarke], [Boericke]
• China — Debility from loss of fluids, hypersensitivity; less spinal posture axis. Cobalt centrality is lumbo-sacral. [Nash], [Boger]

Back/coccyx/sciatica

• Rhus toxicodendron — Stiffness worse first motion, better continued motion; aching from strains/damp. Cobalt: sitting per se is the big aggravation, with coccyx and sex-link. [Boger], [Kent]
• Hypericum — Coccyx trauma, shooting up spine; extreme nerve pain. Cobalt: chronic sitting backache without necessary trauma. [Clarke], [Boericke]
• Kali carbonicum — Stitching back pains, weakness, 3 a.m. modalities. Cobalt: dragging sacral ache tied to emissions and sitting. [Boger], [Kent]
• Gnaphalium — Sciatica with numbness, better lying on the painful side. Cobalt: better walking, not lying. [Boger]
• Colocynthis — Sciatica better bending double/pressure; colic-temper. Cobalt lacks abdominal colic; postural key. [Farrington]

Headache (student/desk)

• Nux vomica — Irritable night-worker; gastric element, coffee abuse. Cobalt: smoother if he walks; sex-spine nexus stronger. [Kent], [Clarke]
• Kali phosphoricum — Brain-fag, prostration; no sexual erethism. Cobalt: sexual-spinal overlay. [Boger]

Prostate/urethra

• Sabal serrulata — Enlarged prostate with urinary obstruction. Cobalt: prostatorrhœa and tingling after emissions, not gland enlargement. [Boericke], [Clarke]
• Chimaphila — Tenesmus, must stand with feet apart to urinate. Cobalt: post-sexual prostatic oozing; sitting < back. [Boericke]

Skin (acne of youth)

• Sulphur — Dirty, itching, hot, worse heat of bed; general psoric blaze. Cobalt: acne linked to sex erethism and sitting life. [Phatak], [Boericke]
• Kali bromatum — Acne with sexual repression/night terrors. Cobalt: less mental terror, more postural spinal signature. [Clarke]

• Complementary: Staphisagria — moral/nerve layer of sexual injury; Cobalt completes the spinal/postural layer. [Kent], [Clarke]
• Complementary: Phosphoric acid — when apathy and prostration persist after emissions; Cobalt for the erethistic phase and sitting-backache. [Nash]
• Complementary: Sabal serrulata — prostatic congestion/enlargement terrain; Cobalt for prostatorrhœa with spinal modality. [Boericke]
• Follows well: Hypericum — after coccyx injury has been calmed but sitting-ache remains with sexual axis. [Clarke]
• Follows well: Nux vomica — in students after gastric/coffee irritability is tempered and the Cobalt back remains. [Kent], [Boger]
• Precedes well: Kali carbonicum — if stitching back weakness at 3 a.m. persists after posture/sex axes are improved. [Boger]
• Precedes well: Selenium — when dribbling and great weakness outlast the Cobalt phase. [Boericke]
• Compare/Related: Agnus, China, Phos-ac., Rhus-t., Gnaph., Coloc. — see Differentials. [Clarke], [Boger]
• Antidotes (practical): Nux (coffee/alcohol excess); regimen—exercise, abstinence, desk breaks—potentiate Cobalt action. [Dewey], [Clarke]
• Inimical: None classically fixed; avoid routine alternation with Selenium unless weakness type changes. [Kent]

• Desk-worker’s back with sexual erethism. Cobalt 6C–30C once or twice daily in the acute spell; space/stop as sitting tolerance and morning spirits improve. [Boericke], [Clarke]
• Prostatorrhœa/threads after stool with sacral ache. Dose 12C–30C in the evening for a few days; insist on walking breaks, abstinence, no late coffee. [Allen], [Dewey]
• Left sciatica worse sitting, better walking, especially after travel or study binges—consider Cobalt before Gnaph./Coloc. if the sexual axis is present. [Boger], [Clarke]

Case pearls (one-liners):
• Student, occipital band, sacral “breaking” on the chair, emissions alternate nights → Cobalt 30C nightly × 5; walking regimen: desk tolerance doubled, emissions ceased. [Allen], [Clarke]
• Commercial traveller—rail sitting rekindles left sciatica; better walking; prostatic thread after stool → Cobalt 12C b.i.d. × 7 with breaks: sciatica quieted. [Boger], [Allen]
• Young man, acne flares after pollutions, lumbar ache sitting; abstinence + Cobalt 30C: skin and back steadied. [Boericke], [Clarke]

Mind

• Irritability after emissions/sexual excess. Links mood to sexual axis. [Allen], [Clarke]
• Hypochondriasis about genital losses. Magnifies prostatorrhœa. [Clarke]
• Aversion to sitting at desk; better walking. Behaviour confirms modality. [Boger]
• Dullness from long study; clears in open air. Desk-fatigue hallmark. [Allen]
• Anxiety about potency/future. Sexual worry profile. [Clarke]
• Fretful, not apathetic, after losses. Distinguishes from Phos-ac. [Nash]

Head

• Headache, occipital, from sitting and study. Student band. [Allen], [Boger]
• Headache better walking in open air. Modal key. [Boger]
• Tight band at nape with lumbar stiffness. Top-and-tail link. [Clarke]
• Worse bending over books. Postural. [Allen]
• Confusion afternoon at desk. Chronobiology. [Allen]
• Head/neck stiffness on first motion after sitting. Matches back. [Boger]

Back

• Pain in small of back as if it would break when sitting. Grand keynote. [Hering], [Allen]
• Coccyx painful on sitting; hard seats intolerable. Seat-specific. [Boericke]
• Better walking/standing; worse riding/driving. Transit modality. [Boger], [Clarke]
• Sacral heat-line or bruised soreness. Sensation detail. [Allen]
• First motion after sitting aggravates. Start-up stiffness. [Boger]
• Pressure with hand relieves momentarily. Palliative sign. [Allen]

Extremities (Sciatica)

• Sciatica left, worse sitting, better walking. Classic Cobalt sciatica. [Boger], [Allen]
• Legs heavy at night after desk day. Work-weight. [Clarke]
• Numb hands from leaning at desk. Postural nerve pressure. [Allen]
• Knee aching in evening after sitting. Circadian/posture. [Clarke]
• Calf soreness with sacral ache. Chain symptom. [Allen]
• Travel rekindles sciatica. Aetiology rubric. [Clarke]

Male/Urinary/Rectum

• Emissions (nocturnal) with backache and gloom. Central sexual link. [Allen], [Hering]
• Prostatorrhœa/threads after stool. Small confirmatory sign. [Allen]
• Urethral tingling/burning after emissions. Irritative tail. [Allen]
• Desire increased yet exhausting. Erethism. [Clarke]
• Frequent desire to urinate after sitting. Postural bladder neck. [Allen]
• Backache after coitus/masturbation. Causation rubric. [Hering]

Female

• Sacral/ovarian aching worse sitting, better walking. The Cobalt back in women. [Clarke]
• Menses early and profuse (some). Flow modifier. [Boericke]
• Sexual excitement with sacral drag. Axis sign. [Clarke]
• Leucorrhœa acrid, scant. Minor adjunct. [Boericke]
• Pelvic weight from desk posture. Aetiologic hint. [Clarke]
• Backache during menses worse sitting. Circadian/periodic link. [Clarke]

Skin/Generalities

• Acne papulosa worse night/after emissions. Terrain clue. [Clarke], [Boericke]
• Worse sitting; better walking/air. Master generality. [Boger]
• After sexual excess—general aggravation. Causation. [Hering]
• First motion after rest aggravates; then eases. Kinetic pattern. [Boger]
• Open air ameliorates multiple complaints. Global modality. [Clarke]
• Hard seats aggravate markedly. Concrete selection point. [Allen]

Hering — The Guiding Symptoms of Our Materia Medica (1879): sexual erethism; emissions with backache; sitting <, walking >; coccyx/sciatica notes; clinical confirmations.
T. F. Allen — Encyclopædia of Pure Materia Medica (1874–79): proving data—occipital desk-headaches; prostatorrhœa/threads; urethral tingling; posture modalities.
John Henry Clarke — A Dictionary of Practical Materia Medica (1900): synthesis—spino-genital axis; desk aggravation; acne of youth; regimen guidance.
William Boericke — Pocket Manual of Homœopathic Materia Medica (1906): keynotes—back “would break” on sitting; emissions; sacral/coccyx pain; left sciatica; acne.
C. M. Boger — Synoptic Key of the Materia Medica (1915): modalities—sitting <, walking >; riding <; student strain; left-sided sciatica pointers.
Richard Hughes — A Cyclopædia of Drug Pathogenesy (1891–95): substance background/toxicology of metals; irritative erethism context.
S. R. Phatak — Concise Materia Medica (1977): miasmatic colour; concise keynotes—sexual excess, backache sitting <, walking >; acne.
James Tyler Kent — Lectures on Materia Medica (1905): comparative insights—Staph., Phos-ac., Rhus-t., Kali-c. in back/sex states; miasmatic framing.
E. B. Nash — Leaders in Homœopathic Therapeutics (1899): sexual-debility contrasts (Phos-ac., China); mental tones after losses.
W. A. Dewey — Practical Homœopathic Therapeutics (1901): dietary/hygienic counsel—avoid coffee/late meals; exercise/abstinence in neurasthenia.