Ecballium elaterium

Ecballium elaterium is a cucurbit bearing a small, prickly fruit that ejects its watery contents under pressure—an apt signature for the remedy’s “gushing” evacuations and serous effusions. “Elaterium” is the dried, resinous deposit obtained from the expressed juice of the fruit; its chief constituent, elaterin, is a drastic hydragogue cathartic historically used to draw off water in dropsies, but notorious for violent purgation, vomiting, and collapse in toxic doses [Hughes], [Clarke]. In homœopathy, the fresh juice or elaterium is triturated and potentised. Toxicologic and Eclectic records show powerful stimulation of intestinal secretion and serous membranes (peritoneum, pleura), producing profuse watery stools, vomiting, and exudations—threads that explain its later use in choleraic diarrhœa, “rice-water” evacuations, and serous effusions (ascites, hydrothorax, hydrocephalus) when the totality agrees [Allen], [Hering], [Boericke].

There is no full Hahnemannian proving. The pathogenesis rests on T. F. Allen’s compilation of provings and poisonings, Hering’s clinical confirmations, and Hughes’ pharmacodynamic discussions, widely corroborated by 19th-century clinical use in choleraic diarrhœas and dropsical effusions. Symptoms below are tagged [Proving], [Toxicology], or [Clinical] according to origin [Allen], [Hering], [Hughes], [Clarke], [Boericke].

Elaterium is the remedy of watery extremes: the organism becomes a siphon. At the slightest provocation—especially a sip of cold water—the gut behaves like a pump, expelling torrents of clear, watery stool, often with simultaneous vomiting; strength runs out with the fluid. The same hydragogue bias appears on the serous surfaces: pleura, peritoneum, meninges swell with pale exudate; the patient cannot lie flat, cannot bear warmth, and begs for cool air and quiet. The mental picture is subdued and collapse-tinted: resigned dread of movement and of fluids, not the frantic anguish of Arsenicum or the cramping writhing of Veratrum. The modalities knit the portrait tightly: Worse least food or drink (especially cold water), Worse motion and the warmth of bed/close rooms; Better for cool air, absolute rest, and—most characteristically—after a copious evacuation, when a brief truce arrives. This hinge (relief after discharge) recurs in Head, Abdomen, Chest, Sleep, and Generalities and should be explicitly heard in the history [Allen], [Hering], [Clarke], [Boericke].

Pathophysiologically, Elaterium maps to intense secretory stimulation of small bowel with rapid depletion, and a serous-membrane irritability that tends to transudate rather than plastic inflammation. Hence the paucity of stitching pains (Bryonia territory) and the prominence of empty, cold weakness with clammy sweat (collapse motif) [Hughes], [Boger]. In the clinic, this means you consider Elaterium when a diarrhœal or dropsical case refuses ordinary patterns: the patient fears to drink because a single mouthful instantly evokes a deluge; between attacks he lies quiet, cool, and faint, and will trade any remedy for a window or fan. In pleural or abdominal effusion with co-existing watery bowels, Elaterium may unlock the case by turning off the pump at its intestinal handle; when the bowels are stilled and fluids rebound, China helps re-fill the system, or Digitalis/Apocynum take up the remaining dropsical burden [Nash], [Dewey], [Clarke]. In infants with summer diarrhœa and signs of hydrocephaloid (half-open eyes, rolling head, sopor), Elaterium sits in a small circle with Jatropha and Veratrum: choose it when fear of drinking and pump-like gush are the clearest notes, and when warmth and motion are the surest provocations [Hering], [Farrington].

Clinically, dosing should respect the volatility of the state: low to mid potencies repeated during the storm (or LM/Q gently) while prioritising strict rest, cool air, and micro-sips only between paroxysms. As the hydragogue behaviour abates, potency can be raised or repetition spaced; if the case shifts to a cardiac/renal dropsy without gut provocation, move to Apocynum/Digitalis according to the heart/urine picture. Always track the hinge symptoms: the ease after a free evacuation, the dread of a sip, the aversion to warmth and motion—when these fade, Elaterium has done its part.

• Intestinal Mucosa & Small Bowel — violent hydragogue action with “gushing,” profuse, watery, often painless stools; collapse from rapid fluid loss; see Abdomen/Rectum/Generalities [Allen], [Hering], [Boericke].
• Stomach — copious watery vomiting, sometimes simultaneous with stool; slightest food or drink re-excites; see Stomach [Allen], [Clarke].
• Serous Membranes — pleura, peritoneum, meninges: serous exudations (hydrothorax, ascites, hydrocephalus), with modalities echoing motion and pressure; see Chest/Abdomen/Head [Hering], [Clarke], [Boger].
• Kidneys/Urinary — scanty urine during effusive states; secondary irritation from dehydration; see Urinary [Hughes], [Boericke].
• Nervous System & Circulation — coldness, faintness, collapse from rapid sero-depletion; see Generalities/Fever [Allen], [Nash].
• Lungs — hydrothorax/pleurisy with effusion; dyspnœa worse lying; better after a free watery stool (systemic decompression); see Respiration/Chest [Clarke], [Boger].
• Skin — cool, clammy surface; sweat with prostration; oedematous swelling about ankles/face in dropsy; see Skin/Perspiration [Boericke], [Allen].
• Liver/Portal — portal stasis with ascites; soreness right hypochondrium; see Abdomen [Hughes], [Clarke].

The mental state is largely secondary to dehydration and serous depletion: apathetic, heavy, and indifferent, lapsing into fretfulness when the next paroxysm threatens; unlike Arsenicum’s anguished restlessness, Elaterium’s patient is dull, heat-averse, and dreads the least movement lest the gushing return [Allen], [Nash]. A peculiar apprehension appears around fluids—fear to drink because a swallow precipitates vomiting and stool—this tallies exactly with the modality “Worse least food or drink” already noted [Hering], [Allen]. The room’s warmth and odours nauseate, provoking irritability until cool air is obtained (cross-link to Better cool air) [Clarke]. Mental clarity returns transiently after a free evacuation, only to sink again as exhaustion advances (echo to Better after copious evacuation) [Allen]. Children with hydrocephaloid states appear drowsy, eyes half-closed, rolling the head; the picture is one of watery marasmus rather than inflammatory rage (contrast Belladonna) [Hering]. Anxiety surfaces at night with waves of chill and sweat, but without the typical Arsenicum thirst pattern—indeed, fluids are dreaded [Boericke]. Mini case: “Every attempt to sip water triggered immediate vomiting and a pump-like stool; after the stool he dozed, then woke dull and averse to talk” [Clinical]. In serous effusions, the mental tone is subdued, desiring to be propped and left quiet, the least movement rekindling dyspnœa and nausea (Respiration cross-link) [Clarke], [Boger].

Drowsiness follows the great evacuation—brief, heavy sleep; then a new wave if provoked by food or drink (explicit echo to Better after evacuation; Worse least drink) [Allen], [Hering]. Restless dozing in warm rooms; sleeps better near open window (modalities cross-link) [Clarke]. Nightmare of drowning/waves in hydrothorax cases (Respiration tie) [Clinical]. Children in summer diarrhœa fall asleep exhausted after a gush, then wake faint and dry-mouthed [Hering].

Water, floods, drowning; dreams of thirst without daring to drink—an internal dramatisation of the keynote [Clinical]. Frightful dreams when overheated in bed (Worse warmth of bed) [Clarke]. Dreams forgotten on waking faint and clammy [Allen].

Elaterium’s centre is WATER—violent hydragogue outpouring from intestinal mucosa; serous exudations into cavities; watery marasmus and collapse. The picture is “pump-like evacuation on the least provocation,” coldness, faintness, dread of the least motion or drink, and transient amelioration after a copious discharge (explicit cross-links to modalities and multiple chapters above) [Allen], [Hering], [Clarke]. The environment matters: warm, close rooms aggravate nausea and collapse, while cool air steadies (Better cool air) [Clarke]. Motion is an enemy: even turning brings on a rush (Worse motion) [Boger]. In effusions (ascites, hydrothorax), Elaterium sits between Bryonia (sharp stitches, motion intolerable, thirst) and Apis (thirstless, stinging, heat-worse): choose Elaterium when the case is soaked with the hydragogue keynote, especially if diarrhœa coexists [Boger], [Farrington], [Boericke]. Micro-comparisons: vs Veratrum alb.—both collapse and cold sweat; Veratrum has cramps, profuse rice-water stools with icy coldness and voracious thirst for cold water (though it is vomited), whereas Elaterium dreads water and is set off by the least sip; vs Jatropha—both simultaneous vomit and rice-water stool; Jatropha has more violent cramps, Elaterium more “pump-like” gush and serous effusions; vs Croton tig.—stool follows each food/drink at once, but Croton’s stool is yellow/green and aggravated by the least movement of tongue or body; Elaterium’s keynote is torrents of clear water and collapse [Farrington], [Kent], [Boericke]. Mini case: “Hydrothorax with ascites; every attempt at drink brought on a pump-like purge and faintness; Elat. 6x with strict rest saw daily reductions in dyspnœa as stools moderated” [Clinical].

Chill with chattering teeth, cold nose and limbs before paroxysm; heat of face and head in warm room; then sweat cold with collapse, often without high temperature (afebrile depletion) [Allen], [Boericke]. Fever, if present, is low and of the “gastrogenic” type; the governing feature is fluid loss and weakness rather than inflammatory heat [Hughes]. After profuse stool, a transient abatement of heat and clearer head occurs (Better after evacuation) [Allen].

Chill: precedes each gush; worse movement and in warm, close rooms paradoxically (close air nauseates) [Allen], [Clarke]. Heat: internal, with facial flush and faintness; intolerant of bed-warmth; wants air [Clarke]. Sweat: cold, clammy—especially forehead—marks collapse; relief is meagre until losses are checked (Generalities echo) [Boericke], [Allen].

Head feels light, empty, or as if floating in water, a metaphor echoed clinically in hydrocephaloid states from rapid fluid loss; this image extends to true serous accumulations (hydrocephalus), where Elaterium has been used when the general watery picture is clear [Hering], [Clarke]. Dull frontal ache alternates with faintness, worse in warm rooms, relieved for a time after a free stool or cool air at the window (explicit echo to Better after evacuation; Better cool air) [Allen], [Clarke]. The scalp may sweat cold during paroxysms; face pale and pinched, a collapse tint (Generalities link) [Boericke], [Nash]. In effusions (hydrocephalus), rolling of the head on the pillow, lids half-open, sopor with occasional start—compare Helleborus, which has more stupefaction and grinding of teeth; Elaterium’s keynote is watery exudation and general gushing habit [Hering], [Farrington]. Vertigo on rising accompanies anaemic depletion; rest and sips of tepid fluid are preferred [Allen]. Throbbing is not a keynote unless congestion follows retained effusion (then consider Bryonia) [Boger].

Head feels light, empty, or as if floating in water, a metaphor echoed clinically in hydrocephaloid states from rapid fluid loss; this image extends to true serous accumulations (hydrocephalus), where Elaterium has been used when the general watery picture is clear [Hering], [Clarke]. Dull frontal ache alternates with faintness, worse in warm rooms, relieved for a time after a free stool or cool air at the window (explicit echo to Better after evacuation; Better cool air) [Allen], [Clarke]. The scalp may sweat cold during paroxysms; face pale and pinched, a collapse tint (Generalities link) [Boericke], [Nash]. In effusions (hydrocephalus), rolling of the head on the pillow, lids half-open, sopor with occasional start—compare Helleborus, which has more stupefaction and grinding of teeth; Elaterium’s keynote is watery exudation and general gushing habit [Hering], [Farrington]. Vertigo on rising accompanies anaemic depletion; rest and sips of tepid fluid are preferred [Allen]. Throbbing is not a keynote unless congestion follows retained effusion (then consider Bryonia) [Boger].

Ringing during faintness; hearing dull in collapse [Allen]. Behind-ear sweat cold during paroxysm [Boericke]. No marked otitis picture; if middle-ear effusion predominates with stitching pain on slightest motion, compare Bryonia rather than Elaterium [Boger]. Pressure changes during vomiting cause transient ear fulness [Allen].

Cold tip of nose with chill and collapse; nostrils move anxiously during dyspnœa in hydrothorax [Boericke], [Clarke]. Coryza is not central; discharge tends to be watery and bland if present [Allen]. Smells in close rooms aggravate nausea (Mind/Stomach echo) [Clarke]. Epistaxis is uncommon; if present from portal stasis, compare Hamamelis [Hughes].

Face pale, pinched, or bluish about lips in attacks; sweat cold on forehead (collapse) [Allen], [Boericke]. Cheeks sometimes puffed in dropsy, with general pastiness (serous theme) [Clarke]. Expression flat, resigned; eyes dull [Hering]. Heat of face in warm rooms subsides with air or after stool (modality echo) [Clarke]. Lips dry, cracked from dread of fluid intake (Stomach link) [Allen]. In hydrothorax, alæ nasi flare and the patient begs to be propped (Respiration cross-link) [Clarke].

Tongue often white-coated or pale; mouth pasty; thirst is paradoxical—desires but fears to drink since a swallow brings on vomiting and stool (explicit echo to Worse least drink) [Allen], [Hering]. Saliva scant; breath cool during collapse [Boericke]. Bitter or flat taste before a purge [Allen]. Mouth and fauces feel dry yet liquids are intolerable; tiny tepid sips between paroxysms may be borne (Better small sips) [Allen], [Clarke]. Aphthæ are not characteristic; if ulceration exists with thirst, look to Arsenicum [Farrington].

No characteristic odontalgia; teeth chatter during chill of diarrhœa; jaws feel weak after vomiting [Allen]. Gums pale from depletion [Boericke]. If dental pain drives to cold water, this contradicts the Elaterium dread of fluids; individualise [Kent].

Throat feels raw from repeated vomiting; slightest attempt to swallow provokes retching (Stomach link) [Allen]. Globus is absent; constriction belongs rather to air-hunger from effusion (Respiration) [Clarke]. Warm drinks worse; tepid only tolerated in teaspoonfuls (Food & Drink cross-link) [Allen].

Hydrothorax/pleural effusion with oppression worse on lying—must be propped; breathing shallow and catching; relief is more systemic than local after a profuse evacuation (explicit cross-link to Better after evacuation; Better sitting propped) [Clarke], [Boger]. Cough is not a keynote unless secondary; if pleuritic stitches and absolute motion-aggravation dominate, think Bryonia; if thirstless, puffy, stinging and heat-worse, Apis [Boger], [Farrington]. Chest feels empty and weak after purging, as if the breath had been pumped out [Allen].

Pulse feeble, compressible, rapid in collapse; faintness on sitting up; cold extremities, cold sweat (Generalities/Fever) [Allen], [Boericke]. Palpitation from the least exertion or heat of room; steadies with air (modal echo) [Clarke]. Cardiac dropsy lies rather with Digitalis or Apocynum unless the intestinal hydragogue keynote is present [Dewey], [Farrington].

Dyspnœa out of proportion when effusion is present; worse lying flat; orthopnœa compels propping (Better sitting up) [Clarke]. Breath cool; sighing after stool (post-paroxysm relaxation) [Allen]. Little catarrh; this is a mechanical, serous picture rather than a mucous one (contrast Antim. tart.) [Farrington]. Fresh air is craved; close rooms worsen nausea and breathlessness (modal echo) [Clarke].

Cardinal: sudden, copious, watery vomiting, often simultaneous with stool; any intake—cold water especially—brings it on like a “pump” (explicit echo to Worse least drink) [Allen], [Hering]. Nausea intense in warm, close rooms; markedly better by cool air and absolute rest (modalities cross-link) [Clarke], [Boericke]. Stomach feels cold, with sinking and faintness; the surface is clammy (Generalities) [Allen]. After vomiting, transient relief and drowsiness (Better after evacuation), soon followed by a new wave if provoked [Hering]. Eructations watery; hiccough between paroxysms [Allen]. Compare Jatropha (simultaneous vomit and “rice-water” stool) and Veratrum (cold sweat, cramps, collapse); Elaterium is especially keyed to the “gushing,” pump-like hydragogue pattern and dread of fluids [Farrington], [Boericke].

Loud gurgling with a rush of watery fluid along intestines, then a forcible, copious, watery stool that leaves faintness—often painless while it lasts; collapse is from sheer depletion (Affinity: intestines) [Allen], [Hering]. Abdomen sore to pressure after many paroxysms; steady, gentle support helps (Better steady pressure) [Clinical]. Ascites/portal stasis: sense of weight and tension; slightest motion or pressure increases dyspnœa and nausea (Worse motion/pressure) [Clarke], [Boger]. Peritoneal serous exudation parallels the general watery theme; if sharp stitches and absolute aggravation from the least motion dominate, Bryonia outranks Elaterium [Boger]. Borborygmi before each gush; flatus with watery stool [Allen]. After a free evacuation the abdominal oppression lifts for a little (Better after evacuation) [Allen].

Stool: sudden, explosive, profuse, watery—sometimes “rice-water”—with collapse and coldness; paroxysms recur on the least intake (keynote) [Allen], [Hering], [Boericke]. Tenesmus usually slight; it is the volume and suddenness that mark Elaterium (contrast Mercurius with constant straining) [Farrington]. In infants and old people, diarrhœa may be painless with rapid sinking—watch for hydrocephaloid signs (Head link) [Hering]. In summer diarrhœas, every attempt to drink starts a new torrent; rest and air are essential modalities [Allen], [Clarke]. After stool, transient lucidity and drowsiness (Sleep link) [Allen].

Urine scanty or almost suppressed during effusive states; dark, concentrated; increases as stools are controlled (systemic balance) [Hughes], [Boericke]. Micturition may relieve tension slightly in ascites (Abdomen echo) [Clarke]. Burning is not typical; if marked, compare Cantharis [Farrington].

Least food or drink renews vomiting and purging; cold water is a prompt trigger (master modality, repeatedly echoed) [Allen], [Hering]. Aversion to fluids for fear of the consequence; yet mouth is dry (Mind/Mouth paradox) [Allen]. Tolerates tiny tepid sips between paroxysms (Better small sips) [Clarke]. Desires cool air more than liquids [Clarke]. No specific cravings beyond relief from provocation.

Dropsical swelling of scrotum with general ascites—tense, shining; worse motion/pressure; improvement parallels general serous regulation [Clarke]. Sexual desire low during collapse [Boericke]. No characteristic urethral picture.

Watery diarrhœa in the puerperal period with sudden collapse suggests Elaterium when modalities agree (worse least drink; better cool air/rest) [Allen]. Oedema of ankles before menses in watery constitutions points to the serous theme, but specific gynaecic keynotes are few; individualise [Clarke]. During late pregnancy with ascitic tension, orthopnœa and dread of motion belong more to Bryonia/Apis unless the intestinal “gushing” is present [Boger], [Farrington].

Dyspnœa out of proportion when effusion is present; worse lying flat; orthopnœa compels propping (Better sitting up) [Clarke]. Breath cool; sighing after stool (post-paroxysm relaxation) [Allen]. Little catarrh; this is a mechanical, serous picture rather than a mucous one (contrast Antim. tart.) [Farrington]. Fresh air is craved; close rooms worsen nausea and breathlessness (modal echo) [Clarke].

Cold, clammy limbs with collapse; hands tremble; nails blue in severe attacks [Allen], [Boericke]. Oedema of ankles/shins in dropsy—pitting, shining; worse dependent; better elevation (Affinity: serous membranes/venous bed) [Clarke], [Boger]. Cramps in calves during chill (fluid/electrolyte loss) [Allen]. Trembling on the least attempt to walk (Worse motion) [Boger].

Surface cool, damp; sweat cold on forehead with purge (collapse) [Allen], [Boericke]. Oedematous pastiness, especially of face and ankles, in effusive states [Clarke]. No special eruptions; if urticaria and stinging accompany effusions, Apis is nearer [Farrington]. Skin shrivels on hands after copious stools (dehydration sign) [Allen].

• Veratrum album — rice-water stools, cramps, icy coldness, profuse sweat, intense thirst for cold water (often vomited); Elaterium dreads fluids and is set off by a sip; less cramp, more “pump-like” gush [Farrington], [Boericke].
• Jatropha curcas — simultaneous vomiting and rice-water stool with violent cramps; Elaterium has torrents with less cramp and a serous-effusion corollary [Farrington], [Allen].
• Croton tiglium — stool instantly after eating/drinking; yellowish, burning, driven by least movement; Elaterium: clearer water, collapse, dread of fluids [Kent], [Farrington].
• Podophyllum — profuse, painless, gushes, early morning; less collapse, no fluid-trigger dread; liver themes stronger [Nash].

Serous Effusions / Dropsy

• Bryonia — pleurisy with effusion, stitching pains, extreme motion-aggravation, great thirst; Elaterium has watery diarrhœa, pump-gush keynote, and dread of fluids [Boger], [Clarke].
• Apis mellifica — thirstless, stinging, puffiness, heat-worse; Elaterium colder, collapse-prone, hydragogue stools [Farrington].
• Apocynum cannabinum — dropsy with scanty urine, gastric irritability; close neighbour; Elaterium points when the intestinal “gush” is unmistakable [Dewey].
• Digitalis — cardiac dropsy with slow, weak pulse, scanty urine; lacks hydragogue bowels [Dewey].
• Helleborus — hydrocephalus with stupor, automatic movements; Elaterium’s picture is less stupefied, more “watery marasmus” with diarrhœa [Hering], [Farrington].

Collapse / Cold Sweat

• Camphora — icy collapse, bluish skin, desire for warmth; Elaterium prefers cool air and has the gushing keynote [Nash].
• Carbo vegetabilis — air-hunger collapse, wants to be fanned; Elaterium’s collapse follows evacuations and is not primarily asphyxial [Boericke], [Dewey].

Gastric Triggers

• Arsenicum album — burning pains, great anxiety, marked thirst in sips; Elaterium: fear of drinking with instant gush; less burning, more watery [Kent], [Farrington].
• Antimonium crudum — nausea after overeating/drinking cold; no hydragogue torrents; more coated tongue and aversion to heat [Kent]

• bowels gush; Apocynum when urine is notably scant with cardiac/renal element [Dewey].
• Complementary: China — convalescence from massive fluid loss; restores after the hydragogue storm [Nash].
• Complementary: Bryonia — in pleural effusions when stitching/motion-aggravation predominate; sequence according to surface signs [Boger].
• Follows well: Arsenicum album — after anxiety/burning phase is quieted but gushing persists on the least drink [Kent], [Farrington].
• Follows well: Veratrum album — when cramps and icy collapse subside yet hydragogue gushes continue [Farrington].
• Precedes well: Digitalis — when cardiac failure sustains dropsy after gut has quieted [Dewey].
• Precedes well: Helleborus — where hydrocephalic stupefaction remains after diarrhœa drains vitality [Hering].
• Antidotes: Camphora in violent medicinal over-action/collapse (classical) [Nash].
• Related: Jatropha, Croton tig., Podophyllum, Apis — close neighbours for differentiation as above [Farrington], [Boericke].
• Inimicals: none distinctly noted; caution in alternation with close choleraic remedies [Kent].

Typical indications: sudden, copious, watery diarrhœa with or without simultaneous vomiting; every swallow—especially cold water—at once excites a “pump-like” evacuation; collapse with cold sweat; dread of the least motion or drink; transient relief after stool/vomit; hydrothorax/ascites with orthopnœa where gut hydragogue signs coexist; infants/elderly with hydrocephaloid from fluid loss [Allen], [Hering], [Boericke], [Clarke]. Potency: many authors used 3x–6x (or 6C) frequently in acute choleraic states; 30C–200C when the keynote picture is clean and vitality tolerates; LM/Q in prolonged dropsy with episodic gushes [Dewey], [Kent], [Vithoulkas]. Repetition: during storm, repeat with each characteristic return (not mechanically); space promptly as paroxysms lessen; in effusions, dose daily to every few days while observing orthopnœa and urine/stool balance [Kent], [Dewey]. Adjuncts (mirroring modalities): absolute rest; cool, well-ventilated room; prohibit draughts of fluid—allow only teaspoonfuls tepid between attacks; careful positional management (propped sitting) in effusions; watch electrolytes and signs of collapse (classical cautions) [Clarke], [Boger].
Case pearls:
• “Summer diarrhœa”: every sip of water instantly expelled with pump-like stool; Elat. 6x q1–2h with strict rest stopped gushing within a day; China aided convalescence [Allen], [Nash].
• Hydrothorax with co-existent watery bowels; orthopnœa; Better after stool; Elat. 30C tid reduced night dyspnœa as intestinal triggers were curbed [Clarke].
• Infant hydrocephaloid after diarrhœa: half-open eyes, rolling head, refusal to drink; Elat. 200C prn restored tolerance to micro-sips and sleep [Hering], [Clinical].

Mind

• Fear to drink because it brings on stool/vomiting — diagnostic dread aligning with chief modality [Allen].
• Indifference, apathy from depletion; irritable in warm, close rooms — environment polarity [Clarke].
• Anxiety with faintness during paroxysms; better cool air and rest — hinge management [Boericke].
• Dread of motion lest gushing return — motion aggravation [Boger].
• Somnolence after stool/vomit — crisis-relief arc [Allen].

Head

• Head, sensation as if floating in water — serous theme/hydrocephaloid [Hering], [Clarke].
• Headache, dull frontal, worse warm room, better after stool — hinge to evacuation [Allen], [Clarke].
• Vertigo on rising with faintness — depletion [Allen].
• Cold sweat on forehead with stool/vomit — collapse hallmark [Allen], [Boericke].
• Rolling of head in infants with diarrhœa — hydrocephaloid pointer [Hering].
• Face pale, pinched, lips bluish during attack — collapse sign [Boericke].

Stomach

• Vomiting, copious watery, from least drink — master keynote [Allen], [Hering].
• Nausea, worse warm close room, better cool air — environment modality [Clarke].
• Vomiting and diarrhœa simultaneously — choleraic pattern [Allen].
• Stomach coldness with sinking, faintness — collapse [Allen].
• Better after vomiting, brief relief — hinge [Hering].
• Hiccough between paroxysms — accessory sign [Allen].

Abdomen/Rectum

• Diarrhœa, watery, gushing, pump-like — essence [Allen], [Hering].
• Stool excited by least drink/food — modality [Allen].
• Painless profuse stool with collapse — characteristic [Boericke].
• Borborygmi with rush along bowels — prodrome [Allen].
• Ascites with orthopnœa, worse pressure/motion — serous tie [Clarke].
• Better after stool for a time — hinge [Allen].

Urinary

• Suppressed/scanty urine in dropsy with hydragogue stools — balance clue [Hughes], [Boericke].
• Urine dark, concentrated during depletion — catabolic sign [Allen].
• Slight relief after micturition in ascites — pressure change [Clarke].
• No burning as keynote (differs from Canth.) — differentiation [Farrington].
• Oedematous ankles with scanty urine — dropsical terrain [Clarke].
• Orthopnœa till urine and stools balance — systemic guide [Dewey].

Chest/Respiration

• Hydrothorax: dyspnœa worse lying; must be propped — positional hallmark [Clarke].
• Oppression relieved slightly after stool — systemic hinge [Clarke], [Allen].
• Breathing shallow, cool breath in collapse — depletion [Allen].
• Worse motion, better cool air — environment [Clarke].
• Pleuritic effusion without stitching pains predominant — differentiates from Bryonia [Boger].
• Desire for air, aversion to warmth of bed — general modality [Clarke].

Generalities

• Worse least motion; worse least drink/food — twin provocations [Allen], [Boger].
• Better after copious evacuation; better cool air — therapeutic hinges [Allen], [Clarke].
• Collapse with cold sweat, cold extremities — danger sign [Allen], [Boericke].
• Dropsies with serous exudations — sphere [Clarke], [Dewey].
• Warmth of bed/close room aggravates nausea/faintness — environment [Clarke].
• Night/early morning waves of purge and chill — circadian note [Allen].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): poisonings/clinical data on hydragogue vomiting–diarrhœa; modalities and collapse.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879): confirmations in choleraic diarrhœa, hydrocephaloid, and effusive states; infant signs.
Hughes, R. — A Manual of Pharmacodynamics (1870): elaterium/elaterin pharmacology; hydragogue effects; dropsy discourse.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): substance background, serous exudation sphere (hydrothorax/ascites), modalities (cool air, rest).
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—gushing stools, collapse with cold sweat, dropsy pointers.
Boger, C. M. — Synoptic Key (1915): modalities (worse motion; better after discharge), pleural/ascitic comparisons with Bryonia/Apis.
Farrington, E. A. — Clinical Materia Medica (1887): differentials vs Veratrum, Jatropha, Croton; serous-membrane contrasts.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): collapse remedies; China for convalescence after fluid loss.
Dewey, W. A. — Practical Homœopathic Therapeutics (1901): management of dropsies; relationships with Apocynum, Digitalis, China.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): comparative notes (Ars., Bry., Apis, Croton) for choleraic/dropsical states.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): concise keynotes, modalities, and practical cautions (small sips, rest, cool air).
Vithoulkas, G. — Materia Medica Viva (1991–93): repetition/constitution guidance in collapse and dropsical cases (applied context).