Gratiola officinalis

Gratiola officinalis (classically placed in Scrophulariaceae; modern authors: Plantaginaceae) is a bitter, acrid marsh-plant native to Europe. In old physic it was a drastic hydragogue and emetic for dropsies—its crude action producing violent gastro-enteritis with profuse watery stools, colic, vomiting, prostration and diuresis; “Hedge-hyssop” thus stood with Elaterium, Jalap, Gamboge among the purgative drastics [Hughes], [Clarke]. These toxicologic features—explosive, watery evacuations; borborygmi as of water; rectal burning and tenesmus; frontal bilious headache; great abdominal distension; urinary outflow increased—are faithfully reflected in the homœopathic pathogenesis collated by Allen and Hering [Allen], [Hering]. The tincture is prepared from the fresh herb gathered in flower; potencies carry a clear signature to the stomach–bowel tube, portal–hepatic area, rectum/anus, and kidneys, with secondary effects upon mind (peevish hypochondriasis) and head (gastric–frontal pain) [Clarke], [Boericke].

No large Hahnemannian proving. The picture derives from toxicologic records and provings compiled by T. F. Allen, confirmed clinically by Hering, Clarke, and Boericke. Cardinally verified: explosive watery diarrhœa (often after eating or drinking), stool sometimes frothy/greenish, expelled with force; much borborygmus as of water; rectal burning and tenesmus; frontal bilious headache with gastric distress; gurgling and colic about the navel; urination increased; peevish hypochondriasis; aggravation from cold drinks/fruit, smoking, and motion; amelioration in open air, by rest, bending forward or pressure to abdomen, and after evacuations [Allen] [Proving/Toxicology], [Hering] [Clinical], [Clarke] [Clinical], [Boericke].

The essence of Gratiola is hydragogue irritability of the stomach–bowel tube: gurgling like water in a bottle, emptiness with distension, and—decisively—a watery, often frothy stool that follows immediately upon eating or drinking, commonly provoked by iced water, fruit, tea or even a sip. This torrent is expulsive and burning, with tenesmus and rawness of the anus; it recurs with motion or rising, and rests with rest, pressure/bending forward, warm applications, and open air—so long as the patient can keep still. The portal system is enlisted: a frontal bilious headache weighs upon the intellect and promptly lifts when the bowel empties, an “outlet-law” that guides prescription and management. The mind is the bowels’ echo: peevish, hypochondriacal, self-absorbed, suspicious of foods and sips; once a stool is passed, the temper clears. Children with “summer complaint” rehearse the pattern in miniature: fruit or cold drink—then gurgle, rush, relief; a warm cloth, quiet air, and sips at rest steady them. Adults abused with drastic purgatives or habitual tea–smoking likewise fall into the remedy’s orbit—drugged rectums, proctitis, burning anus, and a gut that answers every sip with a stream.

The pace is subacute, stormy after meals, often morning–forenoon and post-prandial. The thermal state is mixed—heat of head in close rooms, but desire for fresh air—set against a kinetic law: open air better, walking in it worse. The polarities are striking: emptiness vs distension; craving of drink vs fear of the post–drink rush; desire for air vs dread of moving to get it; morose guarding vs relieved cheer after an outlet. Differentials refine: Croton tig. explodes instantaneously where Grat. gurgles first; Elaterium/Jatropha collapse with rice-water gush where Grat. is more bilious with frontal headache and less collapse; Podophyllum pours painlessly in the morning; Aloe leaves insecurity and mucus; Arsenicum overlays fear, burning and restlessness; Colocynth brings violent pressure-seeking colic. Management must copy the remedy: strict rest during flares; warmth and pressure to the belly; open air without walking; light, warm sips only; avoid fruit, iced drinks, tea, and tobacco; loosen belts.

Dosing: in acute watery diarrhœa with the “sip→gurgle→torrent” sequence, 3x–6x or 6C every 1–3 hours, spacing with improvement; if the keynote is brilliant and the patient reactive, 30C may be used (once to t.i.d.). In drug-proctitis or recurrent “after-meal” flux, 6C b.i.d.–t.i.d. for a few days often restores tone; follow with China for debility or Sulphur for chronic ground. Avoid crude purgatives; Gratiola tends rather to antidote their mischief. When a patient says, “Every sip sets my bowels running; my head eases only after stool; if I keep still with a warm cloth and bend forward, I am better,” the prescription is almost made. [Allen], [Hering], [Clarke], [Boericke], [Hughes], [Boger], [Phatak], [Nash], [Dewey].

• Stomach & Small Intestine — irritant, cholagogue–hydragogue picture: nausea, waterbrash, colic, gurgling, watery stools immediately after eating/drinking; see Stomach/Abdomen/Rectum. [Allen], [Clarke].
• Rectum & Anus — tenesmus, burning, rawness; expulsive watery stool with soreness; proctitis after drastics; see Rectum/Skin. [Hering], [Boericke].
• Portal–Hepatic — bilious frontal headache, bitter taste, right hypochondrial soreness with flux; “bilious diarrhœa”; see Head/Abdomen. [Hughes], [Clarke].
• Kidneys & Bladder — diuresis with clear urine; vesical urging coincident with bowel storms; see Urinary. [Allen], [Boericke].
• Mind (Hypochondria) — peevish, suspicious, self-absorbed when abdominal symptoms abound; see Mind. [Clarke], [Farrington].
• Head (Frontal) — pressive, bursting forehead pain linked to gastric/intestinal irritation; see Head. [Allen], [Clarke].
• Skin–Mucosae — smarting of outlets; anal pruritus and excoriation after flux; see Skin/Rectum. [Hering].
• Children & Summer Diarrhœas — watery, frothy stools with much rumbling; worse fruit/cold drinks; see Abdomen/Rectum. [Clarke], [Boericke].

A peevish, hypochondriacal tone governs the patient, whose attention narrows to the abdomen and its noises. He is fretful, suspicious, fault-finding, especially when distension and borborygmi are at their height; yet the ill-temper melts after a free evacuation—this tallies with the amelioration “after stool” already noted [Clarke]. Anxiety rises with each threatening gurgle, lest a sip of water betray him into a rush to stool; he plans his movements to avoid the grand aggravation from eating/drinking and from motion (Modalities cross-link) [Allen]. There is mental dulness with the frontal headache of gastric origin, a heaviness of spirit that improves in the open air if he can remain still (Head/Stomach echoes) [Clarke]. Vexation or contradiction rekindles griping and urgency, a psychical trigger observed in sensitive dyspeptics [Farrington]. He shrinks from company during attacks for fear of incontinence; confidence returns as the bowels quiet. Suspiciousness may extend to food: distrust of fruits, iced water, and tea develops from repeated lessons (Food & Drink). Children become cross, toss about and cry with colic, then laugh again once the watery stool has cleared the belly (Abdomen/Rectum). Apprehension mounts on rising in the morning because motion itself precipitates; relief comes with rest and when the day passes without a faux pas (Generalities). No profound melancholy or moral alienation belongs here (contrast Sepia); rather, a gastric–intestinal irritability colours the mind in exact step with the bowels.

Sleep is broken by early-morning urgencies and by the fear of moving lest the bowels run—a direct echo of the modality “worse from motion” [Allen]. Children are fretful until a stool; then they fall asleep. The patient sleeps best in open air or cool room if he need not walk to get there (Generalities). Dreams of water and of failing lavatories are common in nervous types. First sleep may be short; the second part of the night is restless with rumbling. After a free stool he dozes, waking lighter in head (Rectum/Head). A late heavy supper guarantees a bad night (Food & Drink).

Dreams of flooding rooms, leaking vessels, searching for a privy and then awakened by a rush to stool; of fruit and iced drinks that betray him—dramatic of the remedy’s triggers (Food & Drink). Dreams cease as the bowel quiets after a day of prudence.

Gratiola stands where water and motion rule the bowels. Three generals make its portrait: (1) explosive watery stool, often immediately after eating or drinking a few mouthfuls or sips; (2) gurgling and colic as of water in the intestines, with tenesmus and outlet burning; (3) aggravation from motion, rising, walking, fruit, iced water, tea, and smoking; amelioration in open air (if quiet), by rest, bending forward/pressure, warm applications, and after evacuations. The portal–head axis shows a frontal bilious headache relieved as the bowel drains; urinary flow may increase, and relief follows micturition too. This is not the sunken collapse of Veratrum alb. with rice-water and cold sweat, nor the odour-intolerant Colchicum, nor the instantaneous “shot-gun” Croton tig.; it is the “sip → gurgle → torrent” remedy with hypochondriacal peevishness, the diet-triads (fruit/tea/iced water), and the outward signs (loosened bands, bent forward, hand pressing navel). In children’s summer diarrhœa the chair by the window (air) with a warm cloth to the belly (heat) and a careful rest may decide quickly; in adults abused with drastics, Gratiola restores tone and ends drug-proctitis [Allen], [Hering], [Clarke], [Boericke], [Hughes], [Phatak].

In enteric attacks a slight chill with goose-flesh precedes the flux; heat follows, with sweat on forehead during straining; after stool a transient weakness and chill return—no typhoid picture [Clarke]. The head heat in close rooms belongs to the portal–head syndrome (Head). No great thirst except for sips which provoke the intestine (Stomach).

Chilled by drafts in close rooms; heat with headache; sweat on attempt, especially about brow during tenesmus; sweat does not relieve unless associated with evacuation (Generalities). Cold, clammy extremities in children during the rush may alarm, but reaction is prompt.

Headache is gastric–portal: a pressive, bursting frontal pain, “as if the forehead would split,” with bitterness, nausea and borborygmi; it is markedly worse in warm rooms and after eating or drinking, and improves in open air if the patient keeps quiet, mirroring the general modalities [Allen], [Clarke]. Stooping increases the weight in the forehead and provokes giddiness, so he bends forward at the abdomen while guarding the head (Abdomen cross-link). The head often throbs before stool, and lightens after a free watery evacuation (Rectum; outlet-law) [Clarke]. Tea, fruit, and iced water are notorious for renewing both headache and stool, a bedside diet-rule (Food & Drink) [Hughes], [Phatak]. Children with “summer complaint” hold the head and cry until the rush of water relieves (Rectum). If the headache is right-sided, sun-periodic, with vomiting of bile, compare Sanguinaria; if throbbing, congestive, with red face and photophobia, compare Belladonna; in Gratiola the head is second to the stomach and bowel.

Heaviness of lids with frontal oppression and nausea; objects swim when the bowel-hurry rises, a cerebral echo of the abdominal storm. Light irritates in warm rooms during headache, yet fresh open air calms both head and stomach, provided walking be avoided (Head/Generalities). No primary catarrhal conjunctivitis belongs here; lachrymation may attend nausea. Vision dims momentarily on rising in the morning when a stool is imminent—again that kinetic aggravation (Modalities).

Ringing or rushing in ears during the straining of tenesmus; passes after stool (Rectum). No otorrhœa tendency; ear symptoms are circulatory and sympathetic.

Aversion to the odour of cooking and of tea in close rooms; scent provokes nausea in concert with the gastric element (Stomach). No corrosive coryza; sneezing may jar the belly and precipitate griping (Abdomen).

Pale, drawn face during colic, lips dry yet water feared; flush returns after stool; sometimes a greenish or sallow tint accompanies the “bilious” state [Clarke]. Children’s faces look pinched, then relax as soon as the “water” is off (Rectum). Sweat about the brow during tenesmus is common. No oedema of face (contrast Arsenicum with collapse).

Bitter, sickish taste; much waterbrash with nausea; saliva increased preceding the rush to stool, all of which recedes after evacuation (Stomach/Rectum) [Allen]. Tongue coated yellow-white in the bilious phase; clean in children with purely watery flux. Cold drinks tempt the mouth but betray the bowels (Food & Drink).

Grinding in children during colic may be noted; not a dental remedy. Teeth feel long with frontal headache in adults; pressure of jaw aggravates head-weight (Head).

Mucus rises with nausea; swallowing cold water immediately stirs the intestines to gurgle and run, reflecting the master modality “after drinking” (Stomach/Abdomen) [Allen]. Throat otherwise sound.

Anxious oppression accompanying colic; the patient fears to take a deep breath lest the intestines gurgle and run (Abdomen). Cough jars the belly and precipitates tenesmus; the chest itself is structurally sound. Short breath in close rooms during headache, relieved by open air if at rest (Head).

Palpitation during straining and anxiety; pulse soft and quick in the diarrhœal heat; settles as bowels settle. No constrictive bands (cf. Cactus); circulation sympathetic to gut.

Sighing, then holding the breath against a pain-wave; open window craved during nausea but walking to it is dreaded—again the conflict of open air better vs motion worse (Modalities). No asthmatic paroxysm belongs here.

The stomach is irritable, empty and yet offended by the least ingesta: nausea with waterbrash, bitter eructations, sinking/emptiness and cramp, quickly followed by explosive watery stool—often immediately after eating or drinking, or after cold water, fruit or tea (master keynote) [Allen], [Hughes], [Clarke]. The patient craves open air and small warm sips taken at rest, and dreads motion which shakes stomach and bowels alike (Modalities). Vomiting, when present, is bilious, not the green prostrating gush of Veratrum; retching relieves little until the bowels have cleared (Differential). Epigastrium feels empty yet distended; belts are intolerable; loosening bands gives notable comfort (Abdomen link) [Clarke]. Children spit up water and rush to stool after fruit. If the smell of food alone suffices to cause collapse with cold sweat and rice-water stools, think Veratrum or Colchicum; if a drink or bite is the precise trigger of watery stool with borborygmi, think Gratiola.

A cardinal sphere. Abdomen distended with wind and gurgling as of water in a bottle; colic about the navel, cutting and griping, with sense of emptiness and yet of tightness to bands (paradox); every sip provokes gurgle → urgent rush to stool, exactly mirroring the grand modality (worse after eating/drinking) [Allen], [Clarke]. Bending forward or pressing hand upon the hypogastrium gives relief; motion, rising, walking, riding renew the storm (Better pressure/bending; worse motion) [Hering]. Right hypochondrium sensitive; a “bilious” ache over the liver accompanies flux and frontal headache (Portal affinity) [Hughes]. Much flatus precedes and accompanies the evacuation; after the “torrent,” a felt emptiness and crumpled belly remain (Rectum/Generalities). Fruit, iced water, and tea are reliable provocatives; warm broth in sips is tolerated (Food & Drink). If colic is relieved only by very hard pressure with great anger and restlessness, Colocynth will outrank; Gratiola is quieter, with water-gurgle, and a mechanical trigger through the act of taking.

Watery, sometimes frothy or greenish stool, expelled with force, “like a hydrant,” with much flatus; immediately after eating or drinking; tenesmus and burning follow; anus raw, itching and sore—this quartet defines the remedy [Allen], [Hering], [Boericke]. The urge may be irresistible on rising in the morning or after the least motion; the patient distrusts his rectum and clings to the chair (Modalities). Relief and mental ease follow an evacuation, but weakness may ensue. Piles become painful and bleed when the flux alternates with constipation; suppression of accustomed hæmorrhoids invites a gastric–intestinal crisis (Generalities) [Boger]. Proctitis from abuse of drastics (Gamboge, senna) falls within the sphere; Gratiola often corrects the drugged bowel (Relationships). If stool is painless and copious in the morning, think Podophyllum; if instantaneous and ballistic, think Croton tig.; if rice-water with collapse and cold sweat, Veratrum album; if yellow, gushing, with gagging at food odours, Colchicum.

Urination increased—clear, copious, with urging that often coincides with rectal desire; after a free flow the belly is easier (Urinary–Abdominal hinge) [Allen], [Boericke]. Burning at urethral orifice may attend the acrid state of outlets. In children, nappies are drenched during “summer complaint.” No renal colics belong here; the action is hydragogue rather than lithic. If urinary offensiveness and gouty wandering pains dominate, compare Benzoic acid (Differential).

Cold water, iced drinks, fruit, salads, tea, and smoking are notorious provocatives (master modalities) [Hughes], [Phatak]. Warm, light broths in sips at rest are borne. Alcohol and spices inflame the portal–head syndrome. After eating even a small quantity, gurgling begins and a watery stool follows—timing is decisive (Rectum). Salt meats are disliked during attacks; the stomach feels empty yet protests at food.

Sexual sphere not central; occasionally irritation of prostate and urethra with frequent urination during bowel storms (Urinary). Hypochondriasis in sedentary men with tea-smoking habits and “loose bowels after breakfast” calls for attention (Mind/Food & Drink). For sexual exhaustion or prostate dribble see Selenium or Ferr-pic., not Gratiola.

In women, watery diarrhœa before and during the menses, with gurgling and tenesmus, worse from fruit/cold drinks, better after stool, is a useful indication [Clarke]. Leucorrhœa thin, acrid, making the vagina sore, may alternate with rectal soreness (Skin/Rectum). Suppressed menses from chill may be followed by “bilious diarrhœa,” again showing the portal–pelvic branch of the remedy; outlet restored, the head eases (Head/Fever). Pregnancy with excessive salivation and waterbrash that ends in sudden watery stool after sipping may require Gratiola rather than the stillness-amel. of Gossypium (Differential). No uterine bearing-down keynote (cf. Sepia/Fraxinus).

Dorsal aching as if from stooping over the basin; lumbar weakness during tenesmus; sacral soreness after repeated stools; all subside with rest (Rectum). No sharp sciatica; the back is a victim of expulsive effort.

Weak, trembling legs after each watery stool; knees give on rising; the patient sits quickly to prevent the bowel-rush (Rectum/Generalities). Hands cold and moist during the urgency; cramps in calves with dehydration are occasional (Fever/Generalities). No migrating arthritic pains as in Benzoic acid.

Outlets smart: anus sore, burning, itching after flux; perineum excoriated in children (Rectum) [Hering]. Skin otherwise cool, pallid; sweat on forehead during straining (Face). No nettle-rash picture; if urticaria alternates with rheumatism think Formica.

Aetiology / Triggers (after eating/drinking; fruit/iced water/tea; smoking)

• Croton tiglium — instantaneous gushing stool on eating/drinking, with ballistic propulsion and anal burning; has more borborygmi and tenesmus, less instantaneous snap. [Allen], [Clarke].
• Jatropha — rice-water gush, vomiting and purging with collapse; less prostration; more bitter, bilious tone and frontal headache. [Hughes], [Farrington].
• Elaterium — copious watery stool with great gurgling and prostration; often in summer cholera; is less collapsed, more after food/sips and with portal–head signs. [Hughes], [Allen].
• Gamboge — single large explosive evacuation daily with much flatus, afternoon; has repetition and precise trigger by sips/bites. [Allen], [Clarke].

Stool quality / Rectum

• Podophyllum — painless profuse morning stool, fetid; prolapse; painful tenesmus and immediate after food timing. [Farrington], [Boericke].
• Aloe — urgency, insecurity, jelly-like mucus; sense of stool remaining; has watery torrent, raw anus, fruit/iced-water <. [Boger].
• Arsenicum — burning pains with anxiety, restlessness, thirst for sips; prostration great; less anxiety, more “sip→stool” reflex. [Kent].

Gastric–Head (bilious frontal headache)

• Nux vomica — irritable, gastralgia, after debauch/coffee; stools scanty; watery stools with gurgling; tea/fruit <. [Kent], [Farrington].
• Sanguinaria — right-sided sun headache with bilious vomiting; frontal weight linked to bowel rush; open air at rest helps. [Clarke].

Colic and relief by pressure/bending

• Colocynth — violent colic > hard pressure, with anger; stools not necessarily watery; milder temperament, with “water-gurgle” and sip-trigger. [Farrington].
• Magnesia phosphorica — spasmodic pains > heat/pressure; less watery flux; hydragogue diarrhœa. [Boger].

Summer diarrhœa (children)

• Chamomilla — hot, green chopped-egg stools, child frantic; watery/frothy, less rage; fruit/iced water <. [Hering].
• Veratrum album — rice-water, cold sweat, collapse; lacks profound collapse; portal–head features present. [Allen], [Hughes].

Borborygmi / gurgling

• Ferrum phos. — subacute catarrh with rumbling; less explosive stool; “bottle-gurgle” then torrent. [Boger].
• Argentum nitricum — loud rumbling with anxiety and flatus; stools loose with sweets; fruit/iced water/tea, sip-trigger, tenesmus. [Clarke].

• Complementary: China (Cinchona) — rebuilds after colliquative watery losses; follows when weakness and tympany persist. [Nash], [Clarke].
• Complementary: Nux vomica — after abuse of drastics and tea/coffee; steadies portal irritability that predisposes to states. [Kent], [Hughes].
• Complementary: Colocynth — for residual colic > pressure once watery flux has ceased. [Farrington].
• Follows well: Aconite in acute summer gastro-enteritis to calm vascular storm before completes the bowel picture. [Dewey].
• Follows well: Elaterium/Jatropha — when collapse phase has been met and the case settles into “sip→stool” pattern of [Hughes].
• Precedes well: Aloe — lingering rectal insecurity after episodes. [Boger].
• Precedes well: Sulphur — to constitutionalise in recurrent summer fluxers. [Kent].
• Related/Compare: Croton tig., Elaterium, Gamboge, Jatropha, Podophyllum, Aloe, Arsenicum, Veratrum a., Colocynth, Nux-v., Sanguinaria, China.
• Antidotes (drug-effects): Nux, , and Camphor for over-action or crude-drastic mischief. [Allen], [Hering].
• Inimicals: none recorded; avoid alternation with near-congeners (Gamb., Croton, Jatropha) without fresh indication. [Boger].

• Post-prandial or post-sip watery diarrhœa with “bottle-gurgling” and anal burning; tea/fruit/iced water triggers ⇒ 6C q2–4h; diet warm, light; rest and pressure. [Allen], [Clarke], [Hughes].
• Children’s summer diarrhœa—frothy watery stool after fruit; borborygmi; relief after stool— 3x–6x; warm flannel to belly; avoid cold drinks. [Boericke], [Hering].
• Drug-proctitis / abuse of drastics (Gamboge, senna): burning anus, tenesmus with watery stools— 6C b.i.d.; follow with Nux/China as needed. [Hughes], [Boger], [Nash].
• Bilious frontal headache that lifts after stool in a patient with “sip→stool” reflex— 30C p.r.n.; insist on open air at rest. [Clarke], [Farrington].

Mind

• Hypochondriasis with peevish, fault-finding mood during abdominal distension—clears after stool; gut–mind hinge. [Clarke].
• Anxiety of bowels; dread to eat or drink lest urge follow—anticipatory fear. [Allen].
• Irritable from contradiction; vexation renews colic and urgency—psychic trigger. [Farrington].
• Aversion to company during attacks; fear of incontinence—social withdrawal. [Clarke].
• Suspicious of fruit/iced water/tea after repeated mishaps—diet dread. [Hughes].
• Better mental state in open air if kept still—environmental relief. [Clarke].

Head

• Headache, frontal, bursting, with gastric distress; worse warm rooms/after eating or drinking; better open air (at rest). [Allen], [Clarke].
• Headache relieved after stool—outlet-law. [Clarke].
• Stooping < head; must support abdomen while guarding head—kinetic link. [Allen].
• Bitter taste with frontal ache—portal–head sign. [Hughes].
• Tea/fruit/iced water bring headache with flux—diet modality. [Hughes], [Phatak].
• Child clutches head during colic; eases post-evacuation—paediatric pearl. [Hering].

Stomach

• Nausea with waterbrash; slightest ingestion brings urgent watery stool—master gastric. [Allen], [Boericke].
• Emptiness with distension; bands intolerable; loosening clothes >—mechanical. [Clarke].
• Worse smoking, tea, fruit, iced water—provocatives. [Hughes], [Phatak].
• Warm sips in rest >; cold drinks <—temperature law. [Hughes].
• Vomiting bilious, secondary to bowel storm—sequence. [Allen].
• Open air > nausea if no walking—environment nuance. [Clarke].

Abdomen

• Gurgling as of water in a bottle; borborygmi precede stool—signature sound. [Allen].
• Colic about umbilicus, better bending forward/pressure—posture law. [Hering].
• Distension with flatus; belts intolerable; loosening bands >—mechanical. [Clarke].
• Right hypochondriac soreness with flux—portal link. [Hughes].
• Motion (rising, walking, riding) <—kinetic aggravation. [Allen], [Hering].
• Fruit/iced water/tea set abdomen going—diet triggers. [Hughes], [Phatak].

Rectum / Anus

• Watery, frothy/greenish stool, explosive, with tenesmus and burning—cardinal. [Allen], [Boericke].
• Immediately after eating or drinking—timing keynote. [Allen], [Clarke].
• Raw, itching anus after flux; excoriation in children—outlet soreness. [Hering].
• Proctitis from abuse of drastics—drug rubric. [Hughes].
• Alternate flux and constipation with painful piles; suppression of piles → gastric storm. [Boger], [Clarke].
• Urgency on rising in morning; motion <—kinetic. [Allen].

Urinary

• Urination increased with bowel storms; relief after copious flow—twin-outlet. [Allen], [Boericke].
• Burning at meatus during acrid states—outlet irritation. [Boericke].
• Child wets freely during summer diarrhœa—paediatric tie. [Clarke].
• Urine clear; not offensive (≠ Benzoic acid)—differential. [Boger].
• Urging coincident with rectal tenesmus—concomitance. [Allen].
• After urination, abdominal tension less—drainage law. [Clarke].

Skin / Sensations

• Anus excoriated; perineal rawness in infants—local skin. [Hering].
• Burning of outlets after watery stool—caustic stream. [Allen].
• Forehead sweat during straining—autonomic sign. [Clarke].
• Pallor with cool skin during rush, reaction afterward—circulatory wave. [Clarke].
• No nettle-rash alternation (≠ Formica)—discriminator. [Farrington].
• Itching anus at night after fruit—diet after-effect. [Phatak].

Generalities

• Worse after eating or drinking; worse motion/rising/walking—grand generals. [Allen], [Hering].
• Better open air (if quiet); better rest; better pressure/bending; better warmth to belly—ameliorations. [Clarke], [Boericke].
• Fruit, iced water, tea, smoking—reliable triggers. [Hughes], [Phatak].
• After stool (and after urine) better—outlet-law. [Clarke].
• Morning/forenoon and after midday meal—timing. [Allen].
• Drug-abuse bowels (drastics) predispose—terrain. [Hughes], [Boger].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): toxicology and proving fragments—explosive watery stool after eating/drinking; gurgling; tenesmus; frontal headache; modalities.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879): clinical confirmations—children’s summer diarrhœa; outlet burning; pressure/bending relief; motion aggravation.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): substance background; portal–head syndrome; open air vs motion; dietary provocatives; management notes.
Hughes, R. — A Manual of Pharmacodynamics (1870): drastic hydragogue history; tea/fruit/iced water aggravations; portal action and bilious states.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—watery stool with tenesmus; proctitis; diuresis; burning anus; relationships.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): miasmatic colouring; suppression of piles; differentials (Aloe, Benzoic acid); chronic terrain.
Farrington, E. A. — Clinical Materia Medica (1887): differentiations—Croton, Elaterium, Colocynth, Veratrum; psychical triggers; paediatric pointers.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): constitutional shading—psoric–sycotic irritability; relationships with Nux, Sulphur, China.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): concise keynotes—fruit/iced water/tea <; after eating/drinking stool; itching anus; timing.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): China in colliquative states; use after hydragogue diarrhœa.
Dewey, W. A. — Practical Homœopathic Therapeutics (1901): acute gastro-enteritis management; sequencing with Aconite and choleraic remedies.
Tyler, M. L. — Homœopathic Drug Pictures (1942): vivid sketches of “water-gurgle” bowel types; bedside diet rules; comparisons (Podophyllum, Croton).