Hekla lava

Hekla lava is the finely comminuted ash and scoriæ ejected by Mount Hekla. Geologically it is a basaltic volcanic ash rich in siliceous, calcic, and aluminous constituents with admixtures of iron oxides and magnesia, a combination consistent with basaltic ejecta. The remedy entered homœopathy not through a Hahnemannian proving, but via toxicological and observational evidence: flocks pasturing on Hekla’s slopes developed remarkable bony enlargements, particularly of the jaws and facial bones, together with dental loss and alveolar inflammation—an occurrence carefully noted by observers and transmitted into the literature by British homœopaths; its pharmacodynamics were later summarised by Hughes and amplified by Clarke [Hughes], [Clarke]. Triturations of the ash are prepared in the usual manner (centesimals), the crude material being levigated to the desired potency [Clarke], [Boericke]. The material’s tendency to provoke periosteal irritation and osteitis in animals provides the rationale for its human application to exostoses, osteitis, caries, and glandular swellings contiguous to bony structures—especially of the maxilla and mandible [Clarke], [Boericke].

No classical Hahnemannian proving exists. The pathogenesis rests on toxicological/observational data from animals exposed to Hekla ash and on early clinical confirmations in humans with exostoses and osteitis of the jaws and long bones [Hughes], [Clarke]. Multiple clinical reports—jaw nodes, alveolar abscess, facial neuralgia with malar tenderness—formed the backbone of its introduction and have been repeatedly corroborated in practice [Clinical] [Clarke], [Boericke], [Phatak].

Hekla’s essence is the marriage of sycotic overgrowth and syphilitic erosion concentrated in bone, especially the maxillo-mandibular complex. The keynote is periosteal suffering of the face: nodes, exostoses, osteitis, and caries in a tight anatomic field where mechanical function (chewing) must provoke the part repeatedly. This mechanical provocation explains the entire modality schema: worse chewing, worse motion (local), worse touch and cold air, worse at night; better from warmth and firm pressure—steady counter-force calming the over-excitable periosteum [Clarke], [Boericke]. Kingdom signature (mineral) manifests as structure: too much bone (exostosis), bone in the wrong place (node), and bone inflamed (osteitis), with functional flow (lymph, sinus drainage) clogging over thickened foundations [Scholten-style reasoning], [Clarke]. The pace is sub-acute to chronic; outbreaks (gumboil) may punctuate a quietly relentless nodosity. When a fistula opens, or after surgical evacuation, pain reduction is swift—a clinical law across Hekla cases that parallels Silicea’s draining tendency, yet Hekla acts earlier on the bony driver of the suppuration [Clarke], [Boger], [Phatak].
Psychologically, there is no intrinsic constitutional drama; the mind is the voice of the bone. The sufferer is cautious and practical: protective of the jaw, anxious before meals, avoiding cold air, and irritable when pain is stirred (Mind reflects local pathology). Thermal state is chilly-local; the cheek craves wrapping and warmth. Miasmatically, the picture bears sycotic hypertrophy—nodal growth, polypoid mucosa—layered with syphilitic undermining where bone decays and fistulises, an interplay repeatedly attested in the jaw-sinus-gland axis [Sankaran], [Clarke]. Micro-comparisons help focus selection: Calc-fluor. shares exostoses but extends to elastic tissues and enamel; Silicea shares fistulæ and chill but is more systemic and slower; Mezereum shares nightly bone pains but adds cutaneous neuralgias; Fluoric acid shares destruction but is more corrosive; Phosphorus fits necrosis with haemorrhagic diathesis; Mercurius suits septic mouths with salivation; Hekla stands when the bony periosteum itself is sovereign and mechanically aggravated [Clarke], [Boericke], [Boger].
In practice, Hekla is a regional remedy of high value. It does not attempt to “rule the patient” constitutionally; rather, it rules the pathological centre where bone, sinus, tooth, and gland meet. Chosen on these grounds, it often unlocks stubborn maxillofacial conditions and tibial nodes alike, especially when pain exceeds the visible dental defect and palpation finds a tender bony prominence. The physician should expect improvement to track the mechanical story: less tenderness to pressure, mastication tolerated, fistula drying, swelling softening, and sleep returning as the nocturnal pains abate—precisely mirroring the modalities recorded in the materia medica [Clarke], [Boericke].

• Bones—especially maxilla, mandible, malar bones; nodes, exostoses, osteitis, caries, and fistulæ, with tenderness of malar and maxillary surfaces (see Face, Teeth, Throat). The jaw affinity is keynote and historically derived from the toxicological observations in sheep. [Clarke], [Boericke], [Hughes].
• Periosteum—periosteal thickening and painful nodes; periostitis of long bones (tibia) and facial bones; pain often aching, boring, or tender to touch (see Extremities, Face). [Clarke], [Boericke].
• Dental alveoli and gums—alveolar abscesses, gumboils, fistulous tracts; dental neuralgia linked to bony irritation rather than mere pulpitis (see Teeth, Mouth). [Clarke], [Boericke], [Phatak].
• Maxillary antrum and adjacent sinuses—pressure, tenderness, post-dental sinusitis; polypoid overgrowth where mucosa sits on thickened bone (see Nose, Face). [Clarke].
• Submaxillary and parotid glands—reactive swellings connected to bony irritation of jaws (see Face, Throat). [Clarke], [Boericke].
• Mastoid/cervical periosteal areas—mastoid tenderness where periosteitis abuts Eustachian drainage; clinical analogies in mastoiditis states (see Ears, Face). [Clarke].
• Long bones—tibial exostoses, aching in shafts; nodes sensitive to touch and motion (see Extremities). [Clarke], [Boericke].
• Dental pulp secondarily—neuralgia when alveolar bone is inflamed; pains radiate along branches of V nerve (see Teeth, Face). [Clarke].
• Lymphatic drainage contiguous to bone—regional adenopathy from chronic periosteal irritation (see Generalities). [Clarke], [Phatak].

The recorded mental picture is scant in formal pathogenesy; Hekla’s portrait is dominated by local bony and periosteal states rather than psychic features [Hughes], [Clarke]. Clinically, patients with protracted jaw pains and disfiguring nodes may become withdrawn, preoccupied with the affected part, and irritable when questioned during paroxysms—an irritability second to pain rather than constitutional peevishness [Clinical], [Clarke]. Worry about mastication, appearance, and upcoming dental procedures is common; this anticipatory anxiety often heightens at night when bone pains are worse, echoing the nocturnal aggravation under Generalities (worse night) [Clarke]. There can be aversion to social eating because chewing aggravates; thus a functional sadness or discouragement about meals appears (cross-ref. Worse chewing under Modalities) [Clinical]. Some develop a meticulous, protective manner of speaking and moving the jaw, reflecting fear of provoking pain; when relieved by warmth or pressure, mood briefly brightens, matching “better warmth, better firm pressure” (Modalities) [Clinical]. Sleep disturbance from malar pressure or throbbing nodes yields daytime dullness and low spirits (cross-ref. Sleep) [Clinical]. No excitatory “over-joyous” or “fear-of-death” states are characteristic; rather, the disposition mirrors the osteitic suffering. On relief (e.g., drainage of alveolar abscess), a noticeable calm and renewed sociability appear, aligning the mental state with the local pathology [Clarke]. Taken together, the mind reflects a syco-syphilitic somatic burden: irritability, self-consciousness, and pain-driven anxiety instead of a distinct primary psychodynamic keynote [Sankaran], [Clarke].

Sleep is disturbed chiefly by nocturnal bone pains (worse night) [Clarke], [Boericke]. Patients lie with the affected cheek uppermost or propped to avoid hard pressure (worse hard pillow pressure), and warmth over the node assists onset (Better warmth) [Clinical]. Short naps refresh more than prolonged lying, which may increase awareness of throbbing (Better short repose) [Clinical]. Early night aggravation corresponds to the classic periosteal rhythm seen in many bone remedies (compare Mez., Merc., Aur.) [Clarke]. Dreams, when noted, revolve around dental operations or breaking teeth—a psychical echo of somatic fear [Clinical]. On improving drainage or after softening of an exostosis, sleep quality improves dramatically.

Dreams of dentists, loose teeth, or being unable to bite are typical when anxiety about chewing dominates (Mind/Teeth cross-reference) [Clinical]. Nightmares are rare; dreams are more anxious-pragmatic than terrifying. Dreams diminish as local pain subsides (Better after relief of local condition).

The general image is of sycotic overgrowth (exostoses, periosteal thickenings) set against syphilitic tendencies to caries and fistulisation in the same territory [Sankaran], [Clarke]. Pains are boring, pressing, steady; worse at night; worse touch, motion of the implicated part (chewing, jolting), and cold air; better warmth and firm pressure—modalities that repeat across face, teeth, and long bones (explicit echo of Modalities) [Clarke], [Boericke]. The remedy centres anatomically on bone-gland-sinus complexes of the maxillofacial region—with extensions to tibia and other long bones. Lymphatic enlargement is regional and reactive, not a systemic glandular diathesis [Clarke]. Constitutional temperature is neutral-chilly; patients wrap the jaw. Prostration is minimal; suffering is local and intrusive, disturbing rest and alimentation. The clinical “unlock” is often the combination of malar tenderness, alveolar fistula/abscess, and palpable bony nodosity—especially when tooth pathology is disproportional to the pain (bone > pulp) [Clarke], [Boericke]. Where fistulæ drain, pains remit—an axiom frequently met in Hekla cases (Better after evacuation) [Phatak], [Clarke].

No febrile signature. Low-grade evening heat may accompany acute alveolar abscess; fever falls with drainage (Teeth; Better after evacuation) [Clarke], [Phatak]. Hectic patterns belong more to septic complications than to Hekla per se.

Slight chilliness with night pains is reported; patients draw warmth to the cheek (Better warmth) [Clarke]. Sweats are not characteristic; when present they are effort-related from guarded chewing. No drenching night sweats belong to the picture by itself.

Cephalgia is secondary, arising from referral along branches of the trigeminal nerve when periosteitis of maxilla/mandible is active [Clarke]. Frontal and malar-rooted aching, worse stooping and exposure to cold drafts, suggests sinus-bone interface irritation (cross-ref. Worse cold air, worse stooping) [Clarke]. Pain may radiate to temple and ear, with sense of “heavy cheek” as if an internal weight sat upon the maxillary antrum; warmth externally eases (Better warmth) [Clarke], [Boericke]. When an alveolar abscess is encapsulated, pounding can echo in the ipsilateral temple at night (worse night), subsiding after evacuation (Better after drainage) [Clarke], [Phatak]. Occipital symptoms are rare; the head sphere remains a satellite of the face and jaw pathology. Mini case: “Woman with chronic alveolar fistula left upper molars: nightly hemicrania and malar weight; Hekla 3X relieved fistula discharge and cephalalgia together” [Clinical], [Clarke].

Direct ocular action is not a keynote; however, lacrimation may accompany malar/peri-antral pain by reflex, and patients shield the eye on the affected side when cold air touches the cheek (worse cold air) [Clarke]. Photophobia is not typical; yet light avoidance may occur from neuralgic tenderness of infra-orbital region (V2) [Clarke]. Circumorbital ache can appear with maxillary sinus involvement, easing with warmth and steady pressure against the cheek (Better warmth, better pressure) [Clarke]. No specific corneal or retinal symptoms are recorded in the classical texts for Hekla; ocular signs are therefore reactive and referred [Clarke], [Boericke]. Eye movements seldom aggravate; rather, jaw and cheek motion are the primary mechanical provocations. Recovery of facial pains often normalises ocular comfort promptly (cross-ref. Face) [Clarke].

Otalgia may be experienced via referred pain to Eustachian or mastoid regions contiguous to inflamed periosteum of the upper jaw (zygoma-mastoid connections), especially when chewing or at night (worse night, worse chewing) [Clarke]. There is mastoid tenderness in some cases where chronic periosteitis encroaches; warmth and avoidance of drafts relieve (Better warmth, worse cold air) [Clarke]. Noises are not typical, but a sense of stuffiness or pressure appears when maxillary sinus swelling abuts the Eustachian outlet [Clarke]. After dental extraction with osteitic sequelae, ear pain may be intermittent, receding as alveolar inflammation subsides (Better after evacuation/drainage) [Phatak], [Clarke]. Otorrhœa, perforation, or specific middle ear pathology is not part of the remedy core; the ear chiefly reflects neighbouring bony inflammation [Clarke].

Antral pressure is frequent: dull, heavy ache under the orbit, worse stooping, worse damp/fog, and worse sudden weather changes, suggesting mucosal swelling on thickened bone (sycotic overgrowth with syphilitic irritation) [Clarke]. Post-dental sinusitis with facial tenderness belongs here, often relieved by local heat (Better warmth) [Clarke]. Epistaxis is not characteristic; catarrh tends toward thick, scant discharge where polypoid mucosa overlies sclerosed bone [Clarke]. Smell may be blunted transiently from congestion; when periosteal activity abates, nasal comfort returns (cross-ref. Affinity to maxillary antrum) [Clarke]. Mini case: “Man with chronic right antral pressure following molar extraction: cheek tenderness, worse drafts; Hekla in low trituration removed the weight and ache in a fortnight” [Clinical], [Clarke].

This is the sphere par excellence. Swelling and tenderness over malar bone and along the maxilla; nodes and exostoses palpable, painfully sensitive to touch (worse touch), especially at the angle of the mandible and zygomatic prominence [Clarke], [Boericke]. Patients describe a boring or pressing pain, worse at night, worse chewing, and better from warmth and steady pressure (cross-ref. Modalities) [Clarke]. The cheek on the affected side may appear fuller; prolonged pathology can distort contour (sycotic overgrowth). Facial neuralgia tracks infra-orbital branches, with pain running to temple and ear on mastication [Clarke]. In sinus-linked cases, stooping increases malar heaviness (worse stooping), warmth relieves. The submaxillary gland may be enlarged and tender as part of the regional reaction (Affinity: glands contiguous to bone) [Clarke]. Mini case: “Girl with malar node, exquisite to touch; pain nightly; Hekla 3X softened and reduced node, with pain ceasing in ten days” [Clinical], [Clarke].

Salivation is not prominent beyond local gum inflammation; halitosis can arise when a fistulous alveolar tract exists [Clarke]. Mouth opening may be guarded due to pain (trismus-like caution), especially on the side of exostosis; speech becomes measured to avoid jolting the jaw (worse jaw motion) [Clarke]. The mucosa is generally normal except where contiguous to diseased bone; there, it is boggy, tender, or fistulous. Warm rinses give comfort (Better warmth), while cold liquids shoot pain into the malar region (worse cold drinks) [Clarke], [Boericke]. Taste is unchanged unless septic discharge flows into the mouth from an alveolar fistula, when patients complain of foul or metallic taste that clears as drainage improves (Better after evacuation) [Clarke], [Phatak].

Alveolar abscess and fistula are cardinal: gumboils recurring over a particular molar; fistulous tracts that intermittently discharge; pain throbs at night and with chewing (worse night, worse chewing) [Clarke], [Boericke]. The pains are more bony than pulpal—steady, pressing, boring; the tooth may be sound while the socket and surrounding bone are diseased (keynote distinction from purely dentinal remedies) [Clarke]. Sensitivity to cold drinks is marked; warmth soothes (cross-ref. Modalities) [Clarke]. After extraction, a “dry socket” osteitis may linger, with ache to temple and ear until local reaction subsides; Hekla has aided resolution where periosteal irritation dominated [Phatak], [Clarke]. Teeth may loosen from alveolar involvement; foul discharge subsides as periosteitis resolves [Clarke]. Mini case: “Recurrent gumboil over left upper molar; outlet closed, nocturnal throbbing; Hekla trit. opened drainage and closed fistula within a week” [Clinical], [Clarke].

Primarily a sympathetic sphere via submaxillary/parotid swelling; occasional sore-throat sensation from extension along mylohyoid spaces when the jaw angle is involved [Clarke]. Swallowing solid food aggravates jaw pain more than throat per se (worse chewing); warm fluids give relief (Better warmth) [Clarke]. No specific tonsillar picture belongs to Hekla; when glands subside with jaw improvement, throat comfort returns (Affinity: glands contiguous to bone). Voice and phonation are normal unless guarded by the patient to avoid jaw movement.

Beyond referred pain patterns (face to ear/temple) there is no primary chest action. Breathing cold air may aggravate facial pains by chilling the cheek and maxilla (worse cold air), making patients wrap the lower face in scarves [Clarke]. No cardiac or pulmonary hallmark is recorded.

No remedy keynotes for the heart. Palpitations, if present, reflect pain-related anxiety rather than myocardial action. Not used on cardiac indications in the classical literature [Clarke], [Boericke].

Respiration is comfortable unless cold air irritates the face/jaw leading to guarded breathing to protect the cheek (worse cold air) [Clarke]. No cough or laryngeal picture belongs to Hekla.

Appetite may be diminished during painful exacerbations (particularly in the evening/night), reflecting dread of mastication pain rather than primary gastric disorder [Clarke]. Soft, warm foods are preferred (Better warm, soft diet), while cold items provoke dental-facial pains (worse cold drinks) [Clarke]. Nausea may follow swallowing fetid drainage from alveolar fistula; this abates with improved drainage (Better after evacuation) [Clarke], [Phatak]. No specific cravings or aversions characterise Hekla beyond pragmatic choices to minimise jaw strain. Weight loss can occur if chronic chewing pain leads to prolonged soft-diet restriction.

No primary action recorded; any disturbance is secondary to disgust from oral sepsis or reduced intake during painful phases [Clarke]. Bloating and discomfort are not typical keynotes. When oral pathology resolves, any mild dyspeptic reflex symptoms tend to abate, arguing for a secondary relationship.

No characteristic symptomatology in the classical sources. The analogy of relief after drainage (alveolar fistula) is noted under Teeth, illustrating the general principle that Hekla’s pains are relieved when enclosed periosteal collections evacuate ([Clinical] echoing “Better after evacuation”). True rectal symptoms are not part of its core [Clarke], [Boericke].

No proving symptoms recorded in standard authorities for this sphere; urinary findings are incidental and not integral to remedy choice [Clarke], [Boericke].

Preference for warm, soft foods; aversion to cold drinks because of pain (worse cold drinks) [Clarke], [Boericke]. No entrenched cravings/aversions beyond these mechanical considerations. Hard crusts, nuts, and cold sweets are avoided during flares (worse chewing, worse cold). Nutritional downtick is possible in chronic cases.

No distinctive sexual or genital symptoms appear in classical sources. Selection is not based on this sphere [Clarke], [Boericke].

Not a uterine or ovarian remedy. Some nursing mothers with jaw pains report reduced desire to chew tough foods; lactation itself is not influenced in Hekla’s picture [Clinical]. No specific menses or leucorrhœa pattern belongs here [Clarke].

No distinctive spinal or dorsal symptoms. If cervical nodes are involved secondarily (lymphatic drainage from jaw), neck stiffness may be protective rather than primary (see Generalities) [Clarke].

Periosteal nodes and exostoses may occur on long bones—especially the tibia—with tenderness to touch and aching worse at night, better from firm bandaging or steady pressure (echoing the jaw) [Clarke], [Boericke]. Walking fast or jolting aggravates (worse motion/jarring), whereas gentle, sustained movement after morning stiffness may ease (Better gentle motion) [Clinical], [Clarke]. The symmetry is not fixed; single-bone focus is common. The bone ache is steady, boring, periosteal in quality, and the overlying skin is not acutely inflamed unless fistulous.

Skin changes are secondary over nodes—shiny, stretched, tender; fistulous openings discharge if alveolar tracts reach the surface (dental). No eczematous or pruritic keynotes are part of the drug picture [Clarke]. When bony activity recedes, the overlying skin regains normal colour and sensibility.

• Aetiology/Pathology – Bony overgrowth & periosteitis
– Calcarea fluorica: bony spurs, exostoses, dental enamel issues; more elastic ligament/varix themes; Hekla is more local, jaw-centric with malar tenderness and alveolar fistulae [Clarke], [Boericke].
– Silicea: chronic suppuration and fistula with chilliness; Sil. is slower, deeper, with sweat disorders; Hekla has prominent malar-maxillary tenderness and pressure amel. [Boger], [Clarke].
– Mezereum: periosteal nightly pains, especially cranial; Mez. has cutaneous eruptions and neuralgia with burning; Hekla more mechanical jaw-chewing aggravation [Clarke], [Boericke].
– Fluoric acid: bony caries with destructive, syphilitic pace; Fl.-ac. has venous and tooth decay trends; Hekla shows nodosity with local tenderness, often less corrosive discharges [Clarke].
– Phosphorus: necrosis of jaw (phossy jaw), bleeding gums; systemic haemorrhagic tendency stronger in Phos.; Hekla more regional periosteitis without marked bleeding diathesis [Hughes], [Clarke].
• Organ Affinity – Jaw/Teeth/Face
– Mercurius solubilis: suppurative, salivary, offensive mouth; Merc. has general mercurial features (sweat, salivation, tremor); Hekla lacks those, and pains are “bone-pressure” type [Clarke], [Boericke].
– Hepar sulphuris: acute abscess, exquisite sensitivity, chilliness; Hepar is oversensitive all over with splinter sensations; Hekla less general hypersensibility, more bony node tenderness [Clarke], [Boger].
– Phytolacca: jaw and gland pains, mastication soreness; Phyt. has mastitis/tonsil tropism; Hekla strongly periosteal with exostoses [Clarke].
– Ruta: periosteum remedy for strain; Ruta better for trauma-strain tendinoperiosteal complaints; Hekla for osteitis and nodosities [Boger], [Clarke].
• Modalities – Night, cold, pressure
– Aurum metallicum: bone pains of facial bones, sadness; Aur. has profound melancholia and nasal bone caries; Hekla’s mind is pain-reactive rather than primary melancholic [Clarke], [Hering].
– Kali iodatum: syphilitic periostitis with night bone pains; Kali-i. has more general catarrhal acridity and wasting; Hekla more local jaw/tibia nodes [Clarke].
– Bryonia (contrast): worse motion but neuralgia > bone; Bry. lacks exostoses; Hekla’s periosteal nodes and dental fistulae decide [Kent], [Clarke].
• Sinus/Antrum
– Kali bichromicum: thick stringy catarrh with pressure in sinuses; K-bi. mucous keynote strong; Hekla emphasises bone thickening underlying antral pressure [Clarke], [Boericke].
– Staphisagria: dental neuralgia after procedures; Staph. is incisional/nerve irritation with indignation; Hekla for post-extraction osteitis and socket pains [Clarke].
• Long bones
– Asafoetida: bone pains with outward pressing; often hysterical overlay; Hekla steadier boring ache with palpable node [Boger], [Clarke].
– Symphytum: fracture repair pain; Symph. for bone healing; Hekla when exostotic periosteitis complicates or persists [Boericke].

• Complementary: Calcarea fluorica—jointly cover bony spurs/exostoses; CF for elastic tissues and enamel; Hekla for jaw-periosteal nodosity [Clarke], [Boericke].
• Complementary: Silicea—supports suppurative resolution of fistulæ after Hekla reduces bony irritation [Boger], [Clarke].
• Complementary: Phytolacca—glandular peri-maxillary pains alongside Hekla’s bone action [Clarke].
• Follows well: Hepar sulphuris—after acute alveolar abscess settles, Hekla addresses residual periosteitis/exostosis [Clarke], [Boericke].
• Follows well: Mercurius solubilis—post-septic mouth states; Hekla finishes the bony sequelæ [Clarke].
• Precedes well: Symphytum—when bone healing to be promoted after Hekla has quieted the periosteal storm [Boericke].
• Antidotes/adjusts: Silicea may antidote over-stimulation if suppuration becomes excessive; clinical prudence [Boger].
• Related: Fluoric acid—shared affinity to destructive bone states; FA deeper in syphilitic corrosion; Hekla more nodular [Clarke].
• Related: Mezereum—night periosteal pains; Mez. more skin-neuralgia; selection by skin vs bone node [Clarke].
• Related: Kali iodatum—periosteal, nocturnal; Kali-i. broader catarrhal cachexia [Clarke].
• Related: Aurum metallicum—facial/nasal bones with melancholia; Aur. when mental weight predominates [Hering], [Clarke].
• Inimical: None clearly recorded in classical sources; avoid routinism and assess local pathology [Clarke], [Boericke].
• Compare: Ruta (periosteum after strain), Staph. (post-dental nerve irritation), Kali-bi. (viscid antral catarrh), Phos. (jaw necrosis) [Clarke], [Boger], [Boericke].

Hekla excels in jaw exostoses with malar tenderness, recurrent gumboils with fistulae, post-extraction osteitis (dry socket pains), chronic maxillary periostitis, and tibial nodes. Low triturations (e.g., 3X–6X, once or twice daily) are widely recorded for bony conditions where structural change is sought; higher potencies (30C and above) have been used when pain is prominent but tissue change is less advanced [Clarke], [Boericke], [Phatak]. In acute alveolar abscess with exquisite hypersensitivity, Hepar may precede; once septic storm quiets, Hekla addresses the underlying periosteitis. Where fistulous tracts persist after repeated incision, Silicea may follow Hekla to complete drainage and closure [Boger], [Phatak]. Repetition: in chronic nodes, steady low trituration over weeks is classical; in painful neuralgia with jaw tenderness, a daily or alternate-day 30C may be sufficient—always watching for clinical endpoints (less night pain, improved chewing). Adjuncts: warm compresses, avoidance of cold air, and a soft, warm diet support the modalities (Better warmth, worse cold drinks).
Case pearls (one-liners):
• “Malar node with nocturnal boring; Hekla 3X t.i.d.—node softened and pain ceased in 10 days.” [Clinical], [Clarke].
• “Post-extraction dry socket, pain to ear/temple; Hekla 6X—ache abated, granulation advanced.” [Phatak], [Clarke].
• “Recurrent alveolar fistula over molar; Hekla 3X—discharge regulated, tract closed.” [Clinical], [Clarke].
• “Tibial exostosis tender to touch; Hekla 3X—steady reduction in soreness and girth.” [Clinical], [Boericke].

Mind
• Mind—Irritability—from pain (jaw/teeth). Useful when mental state is purely pain-reactive; not a primary keynote but corroborative. [Clarke].
• Mind—Anxiety—about health—chewing/worsening pain. Aligns with anticipatory dread before meals. [Clinical].
• Mind—Aversion to company during pain. Pain-provoked withdrawal; resolves as local pain eases. [Clinical].
• Mind—Sleep disturbed—by pain. Maps to nocturnal periosteal aggravation. [Clarke].
• Mind—Concentration difficult—during facial pains. Reflects intrusive, steady ache. [Clinical].
Head/Face
• Head—Pain—temples—chewing agg. Referred from malar/maxillary periosteitis. [Clarke].
• Face—Pain—malar bones—touch agg., warmth amel. Core keynote for Hekla. [Clarke], [Boericke].
• Face—Swelling—malar—nodes/exostoses. Structural hallmark; guides prescription. [Clarke].
• Face—Neuralgia—infra-orbital—chewing agg., night agg. Trigeminal referral from bone. [Clarke].
• Face—Glands—submaxillary—swollen, tender. Regional gland response to bone irritation. [Clarke].
• Face—Pain—cold air agg. Distinct cold sensitivity of jaw/cheek. [Boericke].
Teeth/Mouth
• Teeth—Abscess—alveolar—fistula. Signature rubric; drainage improves pains. [Clarke], [Phatak].
• Teeth—Pain—chewing agg.—warm applications amel. Mechanical aggravation with warmth relief. [Clarke].
• Teeth—Pain—night—boring/pressing. Periosteal rhythm of nocturnal aggravation. [Clarke], [Boericke].
• Teeth—Socket—pain—post-extraction (dry socket). Osteitic sequelæ after extraction. [Phatak].
• Mouth—Fistula—dentalis. Chronic tract associated with periosteitis. [Clarke].
• Mouth—Offensive odour—from dental fistula. Septic drainage adjunct. [Clarke].
Nose/Sinuses
• Nose—Pain—maxillary antrum—stooping agg. Pressure over thickened bone/mucosa. [Clarke].
• Nose—Catarrh—thick—antrum pressure—cold air agg. Barometric/cold triggers on bone-mucosa interface. [Clarke].
• Nose—Polypi—maxillary origin (adjacent to thickened bone). Polypoid overgrowth over sclerosed foundations. [Clarke].
• Face—Pain—sinus region—warmth amel. Classical warmth relief. [Clarke].
Ears
• Ear—Pain—referred—from teeth/jaw. Jaw-ear referral common with chewing. [Clarke].
• Mastoid—Tenderness—contiguous periosteitis. Periosteal continuity explains tenderness. [Clarke].
Extremities/Bones
• Bones—Exostoses—general—tender to touch. Hekla’s general exostosis utility. [Boericke], [Clarke].
• Legs—Tibia—nodes—touch agg., night agg. Long-bone analogue of jaw picture. [Clarke].
• Bones—Periostitis—boring pains—pressure amel. Periosteal pain modality. [Clarke].
• Bones—Pain—jarring agg. Mechanical aggravation mirrors chewing/jaw. [Clarke].
Generalities/Modalities
• Generalities—Night—agg.—bone pains. Central rhythm of periosteal suffering. [Clarke], [Boericke].
• Generalities—Cold air—agg.—face/teeth. Cold sensitivity of jaw region. [Boericke].
• Generalities—Warmth—amel.—local applications. Reliable palliative sign. [Clarke].
• Generalities—Pressure—amel.—steady. Firm counter-pressure calms periosteum. [Clarke].
• Generalities—After evacuation—amel.—(drainage of abscess/fistula). Pain recedes with drainage. [Phatak], [Clarke].
• Generalities—Motion—local—chewing agg.; gentle motion of limbs amel. Distinguishes local vs systemic motion effects. [Clarke], [Clinical].

Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): substance background, veterinary/toxicological observations forming pathogenesis; periosteal/bony affinities discussed.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): primary clinical picture (jaw exostoses, alveolar abscess/fistula, malar tenderness, tibial nodes), modalities, relationships.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): concise keynotes—jaw affinity, exostoses, gumboils, facial neuralgia, modalities.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): general bone/periosteal correlations and relationships (Sil., Mez., Hepar), modality emphasis.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (20th c.): clinical keynotes—alveolar fistula, post-extraction osteitis, drainage amelioration.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–91): general confirmations on bone pains by night and facial periosteal tendencies (comparative notes).
Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): comparative discussion of bone remedies; toxicology context for skeletal action.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): comparative insights on bone/periosteal remedies (Mez., Aur., Merc.) utilised for differential framing.
Farrington, E. A. — Clinical Materia Medica (1890): organ-affinity method used comparatively to situate Hekla among jaw/sinus and bone remedies.
Dunham, C. — Homœopathy, the Science of Therapeutics (1877): methodological guidance on deriving remedies from toxicology/observation supporting Hekla’s admission.
H. C. Allen — Keynotes and Characteristics with Comparisons (1898): comparative pointers for bone pains and nocturnal aggravations referenced in differentials.
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): dental and maxillofacial therapeutic groupings where Hekla is placed by indication.