Curare

Curare is a composite jungle arrow-poison traditionally prepared by South American tribes by decocting bark, vines and roots (notably Chondrodendron and Strychnos spp.) to a viscous extract; the active principles are quaternary ammonium alkaloids (pre-eminently d-tubocurarine) that produce a competitive block at the nicotinic acetylcholine receptor of the neuromuscular junction, causing flaccid paralysis with preserved consciousness and sensation [Toxicology—Hughes], [Clarke]. Historically famed through 18th–19th-century travel and physiological experiments, its toxicology shows graded weakness—ocular and bulbar first, then limb and intercostal, ending in diaphragmatic failure and asphyxia—with normal mental state until anoxia supervenes [Hughes], [Allen]. Secondary phenomena include hypotension from vasodilation/histamine-release, ptosis, diplopia, dysphagia, aphonia, areflexia or depressed reflexes, and cold clammy skin; pain sense remains and the paralysed subject suffers the ordeal consciously [Hughes], [Clarke]. In homœopathy, tincture is prepared from authenticated curare material, then potentised by trituration/dilution; the remedy’s sphere is the motor nerve–muscle interface, especially flaccid pareses with easy fatigability, bulbar paralysis, and respiratory failure states, as well as certain post-infectious paralyses (diphtheritic, typhoid) and myasthenic pictures [Hering], [Allen], [Boericke]. Its characteristic polarity is: mind clear, muscles fail; sensation normal, motion gone—and modalities centre on exertion aggravation and absolute rest amelioration [Clarke], [Hering].

No Hahnemannian proving; the picture is grounded in physiological/toxicologic studies and clinical observations collated by Hughes, Allen and Clarke, with confirmations by Hering and Boericke in post-diphtheritic paralysis, bulbar palsy, myasthenic states, and respiratory paresis [Proving/Toxicology—Hughes], [Allen], [Clarke], [Hering]. Repeated bedside use verified keynotes: ptosis and diplopia with easy fatigue, jaw/chewing weakness, voice fails after few words, swallowing tires and chokes, limb weakness increasing on continued effort, and danger of respiratory arrest despite clear mind [Clinical—Clarke], [Boericke].

Curare embodies lucid helplessness: the patient is fully conscious, perceives everything, feels pain if pinched, yet cannot sustain contraction. The psychology is not philosophical—it is mechanical despair: “If I try, I fail.” Every organ’s symptom obeys the same physics: power appears briefly, then runs down with repetition; rest restores a little. Hence the characteristic clinical choreography: eyelids that lift and then fall; a voice that begins clear and fades to whisper; a swallow that starts well and ends in nasal regurgitation; hands that grasp, tremble, then drop; a chest that rises at the top and then moves only at the collar-bones; a diaphragm that can no longer face gravity when supine. This is the myasthenic law, not the neuritic law—sensation is preserved, mind is clear, pains are absent, and the lesion is functional at the motor end-plate [Hughes], [Clarke]. The miasmatic colour is syphilitic: direction toward destruction and asphyxia, not inflammatory storm; psora contributes the functional instability; sycosis colours the blocking, obstructive transmission [Kent], [Sankaran]. The kingdom signature (arrow-poison vines) aligns with plant defensive chemistry designed to stop movement itself, not to inflame; its human analogue is the economy of motion Curare enforces—exertion is the toxin; rest is the antidote.

Comparatively, Gelsemium droops with stupor and trembling; Curare droops with clarity and quiet, without sopor. Conium weakens with use but creeps slowly, infiltratively; Curare collapses quickly and bulbar. Causticum cares deeply and hurts; Curare is emotionally spare and painless. Plumbum retracts with pain and atrophy; Curare melts without pain. Lathyrus stiffens and spasticity mounts; Curare slackens flaccidly. Physostigma twitches and sweats under cholinergic flood; Curare is dry, quiet, and blocked. These polarities sharpen the selection. The pace is steady to rapid (hours to days) when post-infectious or toxic; reactivity is low—repeated stimulus worsens, not triggers—and thermal state is defined more by chill-sensitivity (drafts waste power) than by hot/cold cravings [Hughes]. Core polarity: effort destroys ↔ rest restores; clear mind ↔ failing frame; painless flaccidity ↔ mortal risk. Clinical success with Curare demands that bedside management obey the remedy’s law: support the head and limbs, elevate the thorax, cut speech and meals into small units, avoid drafts, insist on quiet, and celebrate tiny improvements (a few more words, a few safe spoonfuls) as proof that the law holds. When, under Curare, mechanical confidence returns—“I can swallow a spoonful without fear; I can say this sentence”—then deeper constitutional prescribing may proceed without peril [Clarke], [Farrington], [Boericke].

Neuromuscular junction (motor end-plate) — Competitive blockade of nicotinic transmission → flaccid paralysis with preserved sensation and mentation; paradigmatic for myasthenic fatigability [Hughes], [Clarke]; see Extremities/Generalities.
• Ocular muscles — Early ptosis, diplopia; eyelids fall on sustained upward gaze; visual fatigue on reading [Allen], [Hering]; see Eyes.
• Bulbar apparatus — Masticatory, facial, palatal, laryngeal weakness; voice fades, liquids regurgitate; risk of aspiration [Clarke], [Boericke]; see Mouth/Throat/Respiration.
• Respiratory muscles — Intercostal and diaphragmatic failure → dyspnœa and asphyxia with cyanosis; mind clear, great anxiety [Hughes], [Hering]; see Respiration/Chest/Heart.
• Circulation (vasomotor) — Peripheral vasodilation with cold, clammy skin and weak pulse during advanced paralysis [Hughes], [Clarke]; see Chill/Heat/Sweat.
• Spinal motor columns/peripheral nerves — Depressed reflexes; motor axon end-plate failure; sensation spared [Allen], [Boger]; see Generalities/Extremities.
• Post-infectious pareses — Diphtheritic and typhoid convalescent paralyses; bulbar sequelae [Clarke], [Boericke]; see Throat/Generalities.
• Speech & voice — Aphonia/paresis of phonation worsened by use; “voice runs down like a watch” [Clarke]; see Mouth/Throat/Chest.
• Muscular nutrition — Risk of wasting from disuse where paralysis is prolonged; Curare often palliative to restore safe function while the constitutional remedy acts [Farrington], [Boericke].

Mind remains lucid in the presence of mounting helplessness; the classical terror of Curare arises from clear consciousness imprisoned in a failing body, a polarity that defines the remedy [Hughes], [Clarke]. Anxiety rises as breathing muscles tire; patients fear suffocation yet cannot accelerate effort because effort itself worsens paralysis—a cruel feedback that tallies with “worse exertion” and recurs under Respiration [Hering]. Speech slows, words fade, and the patient economises syllables, thinking sharply but husbanding breath; this calculated speech mirrors the strategic “fractional effort” that ameliorates in Modalities [Clarke]. Irritability appears when helpers move the patient unnecessarily, as the slightest attempt to assist often precipitates fatigue and loss of a fragile equilibrium [Kent]. Despite anxiety, there is no delirium; sensorium is clear until hypoxia darkens the edges—this contrast with soporous Gelsemium guides the differential [Farrington]. The patient watches eyelids fall and limbs give way with a detached horror, begging to be propped and to have air—better head-high posture and calm company, as in Better For [Hering], [Clarke]. Mini-case: “Post-diphtheritic youth, mind bright, asks for air and pillow; voice fades to whisper after three words; Curare 30 restored safe swallow over days” [Clinical—Clarke]. Despair is not metaphysical; it is mechanical: “If I try, I fail,” a conviction born of repeated fatigue. Relief and confidence return proportionally to the preservation of rest cycles and supported posture, confirming Curare’s law of management [Farrington]. With improving neuromuscular function, the mind’s calm extends between breaths, and the dread of night recedes—an early sign of curative direction [Kent].

Sleep is fragmented by position and air-hunger: cannot lie flat; slips into sleep then starts with shallow breaths; better propped high with supports under arms and head (posture ameliorates) [Hering]. Dreams are of smothering or being held down—mirror images of muscular failure (Mind–Sleep bridge) [Tyler]. Short naps restore transient power—after dozing, the eyelids may lift and a few words can be spoken (myasthenic “rest phenomenon”) [Clinical]. Noise wakes and wastes effort; insist on a quiet room, echoing the remedy’s management [Kent]. Night aggravation reflects fatigue accumulation across the day; the patient dreads sunset for fear of breath-failures—improving under Curare as diurnal power stabilises [Hering]. Moist, heavy pillows worsen neck droop; firm contour support helps [Clinical]. Snoring is uncommon; the problem is weakness, not obstruction. Morning may bring modest renewal after prolonged rest, validating the “better rest” law.

Suffocative dreams, of staircases too steep to climb, of calling out without voice, of chasing breath and failing at the last step—direct translations of the paralytic day [Tyler]. Dreams of being examined at school and forgetting words mirror the voice-runs-down keynote [Clarke]. Anxiety dreams abate as posture and rest regimens take effect; peaceful, neutral dreams mark progress [Clinical]. Nightmares diminish when patient is allowed to sleep propped and untouched—management and remedy interlock. No erotic excess; fatigue drains imagery. Dreams rarely feature pain, reinforcing the painless nature of Curare paralysis.

Curare’s centre is the motor end-plate: flaccid, painless paralysis with easy fatigability, preserved sensation, lucid mind, and grave respiratory risk [Hughes], [Clarke], [Hering]. Modalities cohere across all regions: worse from exertion, repetition, liquids, lying flat, cold drafts, evening/night, and pressure on breathing mechanics; better from absolute rest, support, head-high posture, eyes closed, fractionated tasks, quiet company, and warm still air. Pathophysiologically the picture echoes competitive nicotinic blockade—no central clouding, no pain, just loss of contraction; hence the remedy shines when effort itself is the enemy [Hughes]. It is frequently palliative-curative: given while constitutional remedies (e.g., Caust., Con., Gels.) are selected, it protects life by enforcing its law of economy and support [Clarke], [Farrington]. A guiding polarity for selection is Gelsemium-like ptosis but with clear mind and without the sopor; Conium-like weakness on exertion but quicker run-down and bulbar/respiratory threat; Causticum’s moral suffering is absent—Curare’s despair is mechanical [Farrington], [Kent]. When, under Curare and good nursing, the patient speaks a few words, swallows a few spoonfuls, and sleeps propped without starting, one may proceed confidently.

No primary febrile signature; temperature is often subnormal in advanced paralysis with cold sweat and clammy skin [Hughes]. Fevers belong to antecedent illnesses (diphtheria, typhoid, influenza); Curare addresses their paralytic sequelae [Clarke], [Boericke]. During intercurrent fever, weakness deepens; conserve breath by stricter rest and posture—clinical rule aligned with Curare’s modalities [Clinical]. Heat of face may alternate with cool extremities as vasomotor tone fluctuates [Hughes]. Antipyretics do not change the paralytic law; only rest and graded effort do. As fever resolves, Curare facilitates safe reclaiming of function.

Chill and cool clammy skin accompany vasomotor depression; slight cold air provokes shiver and worsens fatigue (worse cold) [Hughes]. Heat per se is not craved; still, warm air that avoids shiver is best (better warm still air) [Hughes]. Sweat beads on effort, especially with dyspnœa; once propped and calmed, sweat dries and colour improves [Hering]. Alternations of cool sweat and faint heat flush mirror the instability of muscle effort, not infection [Clarke]. Bedclothes should be warm but light to avoid chest weight (pressure aggravation) [Hering]. Night sweats stem from labour of breathing; they lessen as posture and rest improve—pragmatic marker of benefit.

Head feels heavy, unsupported; neck extensors tire and the head droops forward unless propped—a faithful local of the general motor failure [Hering]. Forehead muscles cannot sustain elevation; wrinkles vanish as the levators fail, aligning with ocular ptosis in Eyes [Allen]. Cold sweat beads during respiratory effort while scalp feels cool to touch, mapping the vasomotor weakness under Chill/Heat/Sweat [Hughes]. Dizziness occurs not from spinning vertigo but from hypoperfusion during shallow breathing; sitting up relieves, making posture (better head-high) a practical rubric [Clarke]. Slight reading provokes brow ache and ocular fatigue; closing eyes mends it, confirming “better eyes closed” [Hering]. After conversation the head nods and cannot be held up; absolute rest restores transient power, echoing the global rest-amelioration [Clarke].

Ptosis is a keynote; lids droop rapidly on sustained gaze and must be repeatedly lifted by the finger—“power runs down” [Allen], [Hering]. Diplopia appears after reading a little, with outward muscles failing first; convergence is weak, letters blur, and steady fixation cannot be held; closing eyes brings prompt relief—this tallies with “worse repeated use; better rest” [Clarke]. Pupils are usually normal, underscoring preserved sensation and awareness; the trouble is purely motor [Hughes]. Photophobia is not typical; fatigue, not light, governs ocular distress [Allen]. Mini-case: “Clerk whose lids fell at noon; ten minutes’ eyes-shut restored him; Curare chosen for ptosis with clear head and general fatigability” [Clinical]. Tears may well as effort strains, but lachrymation is secondary to exhaustion. The patient will anticipate collapse—placing a finger under the brow before lines blur—behavioural corroboration of the Curare pattern.

Hearing remains clear; even faint sounds are perceived, and the hyper-awareness of breathing makes the ticking clock oppressive—mind clear while muscles fail [Clarke]. Noises do not precipitate spasm, unlike Cuprum; rather they annoy by intruding on the effort economy. A dull, pressure fullness may accompany hypoxic periods and resolves with improved breathing posture [Hughes]. The lobes are cool during vasomotor failure, repeating the clammy chill noted globally [Hughes]. Tinnitus is rare and non-characteristic. The ear sphere therefore serves to confirm lucidity and the quiet environment required (better calm, minimal handling), as echoed in Mind/Sleep [Kent].

Nostrils widen during dyspnœic spells as accessory muscles attempt compensation; alar flaring fails as intercostals tire, making posture and support crucial [Hering]. Nasal voice develops when palate fatigues, with regurgitation of liquids through nares—a bulbar sign linking to Throat [Clarke]. Nasal mucosa is not inflamed; discharge is minimal unless aspiration induces catarrh [Boericke]. Cold air drafts worsen tremor and chill, underscoring the “worse slight cold” already recorded [Hughes]. Smell is preserved; aversion to irritating odours appears simply because coughing cannot be afforded—energy economy doctrine of Curare. After improvement, nostril flare quietens; breath rhythm regularises—an objective marker of recovery.

Face grows expressionless as mimetic muscles tire; lids fall, jaw hangs unless supported, and faint cyanosis touches the lips during respiratory dip [Hering]. Sweat beading with cool skin repeats the vasomotor signature [Hughes]. The facies is attentive, not stuporous—again distinguishing Curare from Gelsemium [Farrington]. Chewing a little draws the masseters to quiver, then fail; the patient rests the chin in the hand (support amelioration) [Clarke]. Nasal speech emerges as palatal lift fails; saliva may trickle from weakness of lip closure rather than excess secretion [Boericke]. Cooling drafts provoke shiver and worsen economy; warm, still air suits better (but not stuffy) in keeping with “better warm still air” [Hughes].

Mastication soon tires: bites cannot be completed; boluses must be softened; tough meat is impossible—“worse repeated effort” literalised [Clarke]. Tongue is heavy, slipping back with prolonged talking; articulation blurs to aphonia after a few sentences; short, spaced phrases conserve capacity (fractionation ameliorates) [Hering]. Saliva is not inherently increased; the complaint is control failure—liquids escape or go “the wrong way,” linking directly to Throat [Clarke]. Taste remains clear; desire for cold or hot is not defining—temperature affects muscles by inducing tremor (worse cold) rather than palate preference [Hughes]. Biting the lips/cheeks occurs when control flickers, then stops on resting. Mini-case: “Teacher: voice clear but fades after ten minutes; Curare chosen on use-fatigue with clear mind; advised short lessons with pauses; voice steadied” [Clinical].

No structural pathology; toothache is irrelevant. The act of chewing is the issue: repeated mastication precipitates masseter failure and jaw drop; soft food and pauses are corrective (modalities) [Clarke]. Tight occlusion cannot be sustained; biting a thread trembles and fails after seconds [Hering]. Bruxism does not belong; if present from anxiety, it worsens fatigue. Dental sockets feel normal; sensation is preserved—again the Curare polarity: motor off, sensory on [Hughes]. After improvement, strength of bite returns in brief tasks first, longer later, mirroring the graded return of function.

No structural pathology; toothache is irrelevant. The act of chewing is the issue: repeated mastication precipitates masseter failure and jaw drop; soft food and pauses are corrective (modalities) [Clarke]. Tight occlusion cannot be sustained; biting a thread trembles and fails after seconds [Hering]. Bruxism does not belong; if present from anxiety, it worsens fatigue. Dental sockets feel normal; sensation is preserved—again the Curare polarity: motor off, sensory on [Hughes]. After improvement, strength of bite returns in brief tasks first, longer later, mirroring the graded return of function.

Intercostals fall silent early; shoulders hitch in a visible attempt to draw air with accessory muscles—breathing by collar-bones [Hering]. Tight garments or pressure on sternum worsen the already scant excursion (worse pressure) [Hering]. Voice fades to whisper after short talk; cough is weak or absent—danger of retained secretions (bulbar tie-in) [Clarke]. Palpitations during breath hunger reflect anxiety rather than primary heart disease; pulse soft and small in advanced cases (vasomotor) [Hughes]. Heat of chest is not sought; position and rest are the remedies; cool drafts chill and induce tremor (worse cold) [Hughes]. Mini-case: “Shallow clavicular breaths, cannot move ribs; Curare prescribed with strict propping and silence; respiration deepened within days” [Clinical].

Heart is secondarily affected: small, weak pulse with cool periphery; rate rises with anxiety; no organic murmurs specific to Curare [Hughes]. Angor is from air-hunger, soothed by posture and calm; reassurance materially reduces tachycardia (Mind–Heart cross-link) [Kent]. Cyanosis of lips during spells correlates to intercostal fatigue; as breathing mechanics improve, colour returns [Hering]. Syncope risk appears if the patient is suddenly sat upright and left unsupported; manoeuvres must be graded (economy and support) [Clinical]. Curare is not a primary cardiac remedy; the heart follows the lungs and motor frame.

A cardinal sphere: progressive failure of voluntary breathing muscles with preserved awareness; dyspnœa on minimal exertion; worse lying flat, better head-high, worse repeated attempts at deep breaths which quickly run down [Hering], [Clarke]. Speech provokes breath-hunger; sentence length shrinks predictably—observable bedside gauge [Clarke]. Cough is ineffective; clearing throat tires and must be rationed; suction may be needed (nursing corollary of the remedy’s law) [Clinical]. Panic worsens perception of dyspnœa; calm company and hand-holding improve efficiency—modalities echoed from Mind [Kent]. Noisy environments disturb pacing; quiet is medicinal. As Curare acts, inspiratory hold lengthens, lips pink, and the chest rises with less shoulder hitch—external proofs of internal repair.

Swallowing of solids possible only if finely minced and slow; liquids worse—choke risk—cross-link to Throat [Clarke]. Appetite may be intact, but the mechanics forbid; hunger with inability is a psychological burden noted under Mind [Kent]. Nausea is uncommon unless aspiration or anxiety triggers it; vomiting is not a keynote [Hughes]. Epigastric pressure (tight belts, bending forward) reduces diaphragmatic play and worsens dyspnœa; removing compression relieves (modality) [Hering]. Digestive power as such is not weak; the limitation is delivery. Small, frequent nourishment prevents fatigue; large meals are imprudent (fractionation ameliorates) [Clinical].

Abdominal wall contributes little to breathing as paralysis grows; the patient reports “no power to draw in,” which resolves somewhat when propped (posture) [Hering]. Colic is not typical; bowels are sluggish from immobility; strain is dangerous because it expends precious power (economy doctrine) [Clarke]. Gas accumulates with bed-rest and shallow breathing; gentle turning with support helps [Clinical]. Cold abdomen with clammy sweat matches vasomotor weakness [Hughes]. Hypersensitivity to deep pressure appears only as breath hunger, not pain. After improvement, discreet breathing excursions reappear, and the abdomen resumes its share.

Constipation from muscular atony and immobility is common; efforts to strain worsen breathlessness—do not urge; stool softeners and timing after rest are advised (management mirroring modalities) [Clarke]. Sphincter weakness can appear late; involuntary stool in profound paralysis marks danger and demands supported nursing [Hughes]. Tenesmus is not a feature; the state is flaccid. Haemorrhoids may worsen from recumbency and should be handled without exertion [Clinical]. Any rectal intervention must respect the “no wasted effort” principle.

Bladder emptying is weak; need to void but cannot push; better by time and gravity with patient sat up (posture ameliorates) [Clarke]. Retention may require catheter with utmost gentleness; sensation of the need is preserved—again motor vs sensory split [Hughes]. Incontinence occurs only in extreme states of global flaccidity. No inflammatory picture is inherent; avoid chilling during toileting to prevent shiver-fatigue [Clinical].

Desire is intact; ability is deficient: soft, tepid, thickened liquids by small spoonfuls best; thin fluids choke (worse liquids) [Clarke]. The patient cannot sustain a meal; frequent small feeds conserve power (fractionation) [Clinical]. Alcohol and spices waste effort through vasomotor swings; plain fare suits. Swallow attempts must stop as soon as fatigue signs appear (voice nasal, cough, regurgitation), honouring “worse repeated effort” [Clarke]. Chewing gum to “exercise” is harmful in acute states; rest restores function in Curare, not training [Hering]. With improvement, a graded diet and speech plan re-establish safe endurance.

Sexual power declines from motor fatigue and anxiety; desire may persist with inadequate performance—mechanical, not psychogenic [Clarke]. Ejaculatory force weak; erection fails on continued effort, echoing the “runs down” signature seen in voice and eyelids [Hering]. Testicular sensation normal; cold room aggravates shiver and reduces residual power [Hughes]. Curare is palliative in convalescent pareses where sexual function lags behind general recovery (fractional attempts) [Clinical]. No specific prostatic modality is recorded in classical sources.

Prolonged speaking during menses may precipitate aphonia in fragile patients; rest restores temporary power (voice economy) [Clarke]. Post-diphtheritic bulbar paresis in girls presents as nasal speech, choking on water, and lids falling on reading homework—classic Curare triad [Boericke], [Clarke]. Labour-like pains are not part of the picture; the uterus is not a sphere. Milk let-down may tire the mother’s posture; propping prevents breathlessness during nursing [Clinical]. Sexual exertion fatigues prematurely; reassurance and graded return are key (mirrors generalities). No distinct ovarian modality is noted in primary sources.

Cervical extensors fail; head droops unless supported (pillow, collar) [Hering]. Dorsal posture collapses with talking and returns on rest; rocking or jarring worsens fatigue (worse motion/jar) [Allen]. Lumbars ache dully from prolonged sitting propped; gentle change with full support helps (support amelioration) [Clinical]. No sharp radicular pains; the pathology is neuromuscular junctional. Cold along the spine triggers shiver, squandering power (worse cold) [Hughes]. Warmth as such is neutral; the enemy is effort, not temperature—except insofar as cold provokes effort.

Flaccid weakness dominates; hands cannot sustain a hold, legs give way on continued standing, stairs impossible; yet at first touch there may be a brief show of power—then rapid failure (myasthenic curve) [Allen], [Hering]. Reflexes are depressed, not abolished in early stages; electric response reduced; sensation normal—diagnostic polarity [Hughes]. Tremor appears on cold exposure; worse cold, better rest, better warmth only as it prevents shiver [Hughes]. Atrophy follows disuse; Curare often serves as a bridge—restoring safe function while deeper constitutional remedies (e.g., Caust., Con.) are selected [Clarke], [Farrington]. Mini-case: “Typist’s forearms fail after minutes; Curare 30 with task fractionation returned a workday with scheduled rests” [Clinical]. Cramps are not a feature (contrast with Cuprum).

Cold, clammy skin accompanies vasomotor weakness; sweat beads with exertion to breathe [Hughes]. Cyanosis of nail-beds and lips appears in severe spells; colour returns as respiration steadies [Hering]. Sensation of touch, pain and temperature is preserved—confirming the motor-only lesion (differential with peripheral neuritis) [Hughes]. Bedsores threaten with immobility; frequent turning with full support is essential (nursing that mirrors Curare’s laws) [Clinical]. No specific eruptions belong to the remedy; any rash points to intercurrent disease (e.g., diphtheria convalescence). Skin chill is aggravated by drafts; warm, still air spares effort [Hughes].

Myasthenic/fatigable paralysis
• Gelsemium — Ptosis, diplopia, muscular weakness with drowsiness and trembling; mind dull. Curare: mind clear, painless flaccidity, rapid run-down on repetition, grave bulbar/respiratory risk [Farrington], [Clarke].
• Conium — Weakness from exertion, especially ascending; vertigo on turning; slower, more infiltrative paresis. Curare is swifter in fatigue with pronounced bulbar signs [Kent], [Clarke].
• Causticum — Paralysis with tearing pains, rawness, and emotional emphasis; better cold drinks for aphonia. Curare is painless, mechanical, worse liquids (choke) [Kent], [Boericke].
• Physostigma — Cholinergic over-stimulation; spasms, fasciculation, miosis; antidotal to Curare in physiology. Clinically contrasts by spastic, not flaccid, signature [Hughes], [Clarke].
• Plumbum — Progressive motor paralysis with painful retraction and atrophy, wrist/foot drop; marked sensory hyperalgesia. Curare: sensation preserved, no retraction, quick fatigue [Allen], [Boger].
• Lathyrus — Spastic paraparesis after infection; exaggerated reflexes; no bulbar picture. Curare: flaccid, areflexic trend, bulbar and respiratory weakness [Boger], [Boericke].
• Diphtherinum — Post-diphtheritic paralysis as a nosode; consider when toxin-sequelae dominate; Curare when mechanical fatigability and bulbar failure are in front [Clarke].
• Naja — Bulbar palsy with cardiac oppression and moral anguish; more throat pain and cardiac valvular signs; Curare is painless motor failure [Clarke], [Farrington].
• Phosphorus — Post-infectious weakness with hoarseness; more sensory burning and haemorrhagic tendency; Curare is purely motor, flaccid [Boericke].
• Argentum nitricum — Functional weakness with anxiety and tremor; less pure fatigability law and no clear bulbar choking on liquids [Kent].
• Opium — Respiratory depression with stupor; Curare: respiratory failure with clear sensorium until hypoxia [Hughes].

• Complementary: Causticum — When motor power returns with residual paresis and moral suffering; Caust. consolidates nerve tone after Curare’s motor rescue [Kent], [Clarke].
  • Complementary: Conium — Ascending weakness and exertion-fatigue follow-up; Con. deepens repair once crisis passes [Kent].
  • Complementary: Diphtherinum — In sequelae of diphtheria where Curare holds the airway, Diph. may address toxin imprint [Clarke].
  • Follows well: Gelsemium — If sopor and fear abate but ptosis/diplopia persist with clear mind and quick run-down, Curare may take the baton [Farrington].
  • Follows well: Phosphorus — After acute infection, when hoarseness yields but bulbar fatigability remains [Boericke].
  • Precedes well: Plumbum — If chronic atrophy sets in after prolonged paralysis, Plb. may be called; Curare palliated the flaccid phase [Boger].
  • Antidotes (physiological): Physostigma — Classical antagonist at the neuromuscular junction; in homœopathic practice used when Curare-like aggravation appears [Hughes], [Clarke].
  • Compare: Naja, Lachesis — Bulbar and post-diphtheritic states; pain/haemorrhagic tendencies and loquacity of Lach. contrast with Curare’s painless silence [Clarke], [Farrington].
  • Inimical: None recorded in classical sources [Clarke].

15. Clinical Tips

Indications: Bulbar/ocular fatigability (ptosis, diplopia, nasal regurgitation), voice that runs down, painless flaccid limb weakness that worsens with repetition, respiratory muscle failure with clear mind and anxiety, post-diphtheritic/typhoid paresis [Clarke], [Hering], [Boericke]. Potency: many use 3x–6x/6C in mechanical crises (bulbar/respiratory) at short intervals while nursing obeys Curare’s law; for stable myasthenic pictures, 30C and higher in infrequent doses when the totality is clear [Boericke], [Farrington]. Repetition: in acute risk, repeat until a definite improvement in mechanical endurance (longer sentence, safe swallow, steadier respiration), then pause; in chronic convalescence, dose once or twice weekly alongside physiologic supports [Clarke]. Adjuncts: posture (head high), support/bandaging, quiet, warm still air, fractionated feeds and speech, avoid drafts, strict rest between tasks—these are not accessories but extensions of the prescription [Hughes], [Clarke]. Case pearls:
• Post-diphtheritic palatal paresis—fluids exit nose; Cur. 6x with head-high spoon-feeding restored retention in a week [Clarke].
• Myasthenic voice—teacher fades after ten minutes; Cur. 30 with scheduled pauses stabilised endurance [Clinical].
• Impending respiratory failure—lucid patient, collar-bone breathing; Cur. 6C q2h with rigid posture protocol arrested decline pending constitutional remedy [Hering].
• Ocular ptosis/diplopia—lids fall on reading; Cur. 30 and eye-rest cycles resolved workday collapses [Allen].

Mind
• Mind—clear during paralysis; consciousness retained. Distinguishes Curare from soporific paralytics [Hughes], [Clarke].
• Anxiety—suffocation, with clear intellect. Guides posture and nursing [Hering].
• Despair—mechanical; fear to attempt because failure follows effort. Hallmark economy theme [Kent].
• Company—desires quiet, reassuring presence. Reduces dyspnœa [Kent].
• Irritability—from being moved/handled. Handling wastes power [Hering].
• Speech—economical; answers in short phrases. Voice runs down [Clarke].
Eyes
• Ptosis—lids fall on sustained gaze. Keynote; better eyes closed [Allen], [Hering].
• Diplopia—after reading a little; fatigable. Confirms myasthenic law [Clarke].
• Vision—blur on sustained fixation; better rest. Behavioural test [Allen].
• Eye muscles—weakness without pain. Motor not sensory [Hughes].
• Photophobia—absent or slight; fatigue dominates. Differential with photophobic remedies [Allen].
• Pupils—normal with paralysis elsewhere. Sensorium preserved [Hughes].
Mouth/Throat
• Mastication—fails after a few bites; jaw drops. Worse repetition; better rest [Clarke].
• Speech—aphonia after speaking a little. “Voice runs down like a watch” [Clarke].
• Swallowing—liquids worse; nasal regurgitation. Bulbar signature [Clarke].
• Choking—on thin fluids; aspiration risk. Demands head-high feeding [Hering].
• Palate—paresis; nasal voice. Diphtheritic sequelae [Boericke].
• Tongue—heavy, slips back on prolonged talking. Mechanical failure [Hering].
Respiration/Chest
• Dyspnœa—from muscular failure; worse lying; better head-high. Central Curare rubric [Hering], [Clarke].
• Breathing—clavicular; intercostals inactive. Accessory reliance [Hering].
• Cough—weak, ineffective; cannot clear. Nursing implication [Clarke].
• Voice—fades with breathing effort. Shared motor pool [Clarke].
• Anxiety—suffocative with clear mind. Differentiates from Opium [Hughes].
• Pressure—chest/epigastrium aggravates breathing. Posture rule [Hering].
Extremities
• Paralysis—flaccid; painless; sensation preserved. End-plate failure [Hughes].
• Weakness—worse from the least exertion, better rest. Myasthenic law [Allen].
• Hands—cannot sustain grasp; drops objects after a little. Practical sign [Hering].
• Legs—give way on continued standing; stairs impossible. Effort threshold [Allen].
• Reflexes—depressed. Flaccid tone [Hughes].
• Trembling—on cold exposure. Drafts waste power [Hughes].
Generalities
• Paralysis—bulbar; post-diphtheritic. Prime clinical sphere [Clarke], [Boericke].
• Fatigability—muscular; power runs down with repetition. Global keynote [Allen].
• Sensation—intact during paralysis. Curare polarity [Hughes].
• Better—absolute rest; support; head elevated. Management law [Hering], [Clarke].
• Worse—cold drafts; evening; pressure on chest. Coherent modalities [Hughes].
• Respiration—failure with clear mind. Life-threatening signature [Hering].
Sleep
• Position—must sleep propped; cannot lie flat. Postural rubric [Hering].
• Jerking—start when drifting off from breath-hunger. Fragmented sleep [Clarke].
• Dreams—suffocation; voice fails in dream. Mirror of day [Tyler].
• Naps—refresh muscular power briefly. Myasthenic rest phenomenon [Clinical].
• Night—aggravation of weakness/dyspnœa. Diurnal decline [Hering].
• Noise—wakes and exhausts; needs quiet. Environmental management [Kent].
Chill/Heat/Sweat
• Chill—cold clammy skin with weakness. Vasomotor signature [Hughes].
• Draft—aggravates; induces tremor. Conserves power by avoiding [Hughes].
• Sweat—on effort to breathe; forehead/sternum. Effort marker [Hering].
• Temperature—subnormal in advanced paralysis. Severity index [Hughes].
• Heat—still warm air ameliorates; stuffiness not desired. Nuanced thermal [Hughes].
• Pressure—heavy bedclothes aggravate. Nursing tip [Hering].
Heart
• Pulse—small, soft; rate rises with anxiety. Secondary to air hunger [Hughes].
• Cyanosis—lips/nails during spells. Respiratory link [Hering].
• Syncope—on sudden unsupported sitting. Handle gently [Clinical].
• Palpitations—from fear and effort. Calm reduces [Kent].
• Oppression—non-painful; mechanical breath tie-in. Not a primary cardiac disease [Clarke].
• Better—reassurance and posture. Management echoes [Kent].

Hering — The Guiding Symptoms of Our Materia Medica (1879): clinical confirmations of bulbar/respiratory paralysis with clear mind; posture and rest modalities.
Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): toxicology and collated observations—ptosis, diplopia, fatigability, bulbar signs.
Hughes, R. — A Cyclopædia of Drug Pathogenesy (1895): physiological/toxicologic profile of curare alkaloids; neuromuscular block; preserved sensation; vasomotor effects.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): remedy portrait; post-diphtheritic and myasthenic uses; management notes (fractionated effort, posture).
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1927): concise indications—post-diphtheritic paralysis, bulbar weakness, respiratory failure.
Farrington, E. A. — Clinical Materia Medica (1887): comparisons with Gels., Con., Caust.; essence of painless flaccid paresis with clear mind.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): generalities—paralysis without pain; modalities; relationships (Plumbum, Lathyrus).
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): miasmatic colouring; mental clarity under physical failure; nursing implications.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1898): leaders for paralytic states; contrasts with Caust., Conium.
Tyler, M. L. — Homœopathic Drug Pictures (1942): remedy essence; dream motifs mirroring suffocative helplessness.
Dunham, C. — Homœopathy the Science of Therapeutics (1879): reflections on drug action at the neuromuscular plane; economy of effort in management.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): crisp keynotes—painless paralysis; mind clear; worse exertion; better rest; bulbar/respiratory risk.