Hydrocotyle asiatica

Hydrocotyle asiatica is a creeping, marsh-loving umbellifer (Apiaceae/Umbelliferæ) native to South and East Asia. Traditional medical systems (Ayurveda, Unani) used the plant as a vulnerary for chronic skin ulcers and as a tonic; pharmacognosy identifies triterpenoid saponins (e.g., asiaticoside, madecassoside) with trophic effects on connective tissue—an observation that accords with the homœopathic sphere of action on skin and subcutaneous cellular tissue, especially thickening, induration, and dyskeratotic patches [Hughes], [Clarke]. The mother tincture is prepared from the fresh herb; triturations and centesimals follow standard methods [Allen], [Clarke]. Toxicologic notes are scant; the remedy-picture rests on provings and abundant clinical confirmations in dermatoses (psoriasis, lupus, leprosy-analogues), pruritus (notably vulvar), and hypertrophic states of mucosa and cervix [Hering], [Clarke], [Boericke].

Hydrocotyle’s pathogenesis derives from small American and European provings and extensive [Clinical] confirmations in skin disease (psoriasis—circinate and palmar, lupus, leprosy), pruritus vulvæ, and cervical hypertrophy/erosion with leucorrhœa [Allen], [Hering], [Clarke]. The remedy is therefore essentially a clinical-polished portrait anchored by strong, repeated observations rather than by a large Hahnemannian proving.

Hydrocotyle’s essence is the conjunction of hypertrophy and itch: connective-tissue overgrowth of skin and cervix produces circinate or mammillated, glazed patches and granular erosions; these burn and itch intolerably, especially with heat and in bed, and scratching—though momentarily blissful—inevitably begets smarting and further excoriation. Its signature polarity is simple and reliable: heat aggravates and summons the itch; coolness—air, water, loose clothing, bland unguents—brings quiet. The kingdom signature (Plant—Apiaceae) appears as surface reactivity and trophic modulation rather than deep organ spasm (cf. Conium, Cicuta). Miasmatically, a sycotic hypertrophic drive makes disks, warts, keloids and a beefy cervix; the syphilitic current contributes fissure, ulcer and lupus when unchecked; psora supplies the furnace of itch. The pace is chronic, indolent, and non-suppurative: lesions expand peripherally without storm, patients sleep poorly from heat and itch, and morale sinks under nightly torture.
Clinically this produces a recognisable patient: they dread warmth; the very act of going to bed heralds a siege of itching, especially of palms, soles, or the vulva. They will say, “Cold water is the only thing that helps.” Patches are thick, slow, and glazed more than oozy; if scaly, they are psoriatic rather than eczematous. At orifices the skin cracks and smarts; at the cervix it is hypertrophic and granular with little corrosive discharge but much itch. Mental disturbance is reactive—peevish, despondent from lost sleep and disfigurement—and lifts conspicuously when the surface cools. Differentials resolve along the heat axis: Arsenicum burns but wants heat; Rhus itches but is pacified by hot bathing; Sulphur’s itch with heat often paradoxically seeks warmth; Graphites oozes honey and is sluggishly moist; Kreosotum corrodes; Kali-ars. is a sterner, restlessly burning psoriasis. Hydrocotyle fits when the mind says “I must be cool,” the hands and vulva agree, and the tissues are thick yet quiet, itching to madness in the least heat [Clarke], [Boericke], [Boger], [Phatak]. Practically, success depends on aligning regimen with the remedy: cool sleeping conditions, loose cotton, avoidance of spices/alcohol, bland emollients, and minimal scratching. Under such conditions the medicine’s action often shows early as longer “cool intervals” at night, less post-scratch burn, softening of plaques, and steady regression of cervical granulations.

• Skin and subcutaneous cellular tissue—thickening, induration, circinate or mammillated patches; psoriasis (especially palmar and circinate forms), lupus/lupoid granulomas; intolerable itching with burning after scratching; fissures and rhagades (see Skin). [Clarke], [Boericke], [Hering].
• Female pelvic organs—cervix uteri hypertrophied and granular (“erosion”), pruritus vulvæ of tormenting intensity, thick leucorrhœa; pelvic bearing-down from connective-tissue laxity/overgrowth (see Female). [Clarke], [Boericke], [Phatak].
• Mucocutaneous junctions—lips, anus, vulva: cracks and raw, glazed surfaces with scant pus but much thickening (see Mouth, Rectum, Skin). [Clarke], [Boger].
• Lymph and trophic beds—slow, non-suppurative ulceration with indurated base; old cicatrices and keloidal tendencies (see Skin). [Clarke], [Hering].
• Palms and soles—intense pruritus and hyperkeratosis; psoriatic disks; cracks that smart and burn (see Extremities, Skin). [Boericke], [Clarke].
• Nervous terminations of the skin—formication, “crawling,” numb zones about patches (leprosy-analogue) (see Skin). [Clarke], [Hering].
• Cervico-vaginal mucosa—granulation and hyperplasia with itching far out of proportion to visible discharge (see Female). [Clarke], [Phatak].

The mental state in Hydrocotyle is secondary and pruritus-driven. Irritability rises with the itching, and the patient becomes fretful, dissatisfied, and short with family, yet steadies once the burning subsides (cross-ref. “worse heat of bed,” “better cool applications”) [Clarke], [Boericke]. Anxiety centres on disfigurement when facial patches (lupus/psoriasis) are present, with social withdrawal and a tendency to brood over the lesions (Mind ↔ Skin). Sleep-loss from nocturnal itching induces daytime dullness and peevishness; attention is more easily maintained when the skin is cool and clothing loose (Sleep/Generalities). Some exhibit a compulsive scratching behaviour despite knowing it worsens the burn—a psychophysical loop characteristic of chronic pruritus [Clarke]. Work or conversation that occupies the mind transiently reduces the impulse to scratch (Better occupation), though returning heat restarts the cycle [Farrington]. Melancholy may shadow women with obstinate pruritus vulvæ; this is proportional to the torture and often abates when a cool regimen is instituted alongside remedy [Clarke], [Phatak]. No delirium, fears, or grand emotional themes are recorded; the mind mirrors the cutaneous torment and its relief in a simple, mechanical way [Hering], [Clarke].

Broken by nocturnal itching, worst after settling in a warm bed; the patient roams for cool parts of the sheet or sits by an open window to quiet the crawl (Worse heat, night; Better cool air) [Clarke], [Boericke]. Sleep onset is delayed by pruritus vulvæ or palmar/plantar itch; scratching cycles recur until cooling measures are applied. Dreams are of being on fire or of insects crawling, reflecting the sensory storm (Dreams). On nights when a cool regimen is used pre-emptively, sleep is much improved, confirming the modality. Daytime drowsiness and irritability follow bad nights; both lift when itch control is achieved (Mind). There is no characteristic feverish insomnia; it is purely cutaneous.

Dreams of flames, hot rooms, or swarms of insects on the skin are reported; waking to scratch is common [Clinical], [Clarke]. Dreams recede as heat is controlled and patches cool. No consistent mental-emotional themes beyond the itch appear.

Hydrocotyle centres on hypertrophy/induration of skin and adjacent mucosa with violent pruritus, little pus, fissures at orifices, and burning after scratching. The modalities are consistent: worse heat (bed, rooms, bathing), worse wool and friction, worse night and before menses/pregnancy; better cool air, cold applications, loose clothing, bland emollients, and—often—after the menstrual flow begins (explicit echoes across Skin, Female, Sleep) [Clarke], [Boericke], [Phatak]. The tissue tone is sycotic (overgrowth, keloid tendency) shading syphilitic when ulceration/lupus appears; psora supplies the itch drive. The remedy is regional—skin and cervix—rather than constitutional, yet its repetition of keynote across sites gives it decisive value. Compare Kali-ars. (psoriasis with violent burning; more constitutional anxiety), Graphites (oozy fissures, honey-like discharge, obesity), Ars. (burning better heat, opposite modality), Sepia/Kreos. (pruritus vulvæ—discharge and mental states distinguish), and Chrysarobinum (eczema/psoriasis with infiltration and honey crusts but different modalities) [Clarke], [Boericke], [Boger], [Farrington].

Hydrocotyle has no febrile cycle. Slight evening heat of surface may accompany itch; internal temperature is unimpressive. If fever exists, look elsewhere. The “heat” is a cutaneous phenomenon—worse hot rooms, better cool air [Clarke], [Boericke].

Subjective heat of skin in bed; desire to uncover. Sweating is not characteristic, though effort perspiration under wool magnifies itch (worse wool/friction). Cool draughts are gratefully received (Better cool air). No chill or sweating modalities define the remedy [Clarke].

Head symptoms are adjunctive, arising from skin or cervical conditions. A dull frontal pressure occurs on warm evenings when the face is flushed and itchy; cool air relieves (Better cool air) [Clarke]. The scalp may itch violently with small, thickened plaques or fine branny scales; scratching causes burning and oozing (worse heat of bed, worse scratching), and the patient prefers cool rinses [Clarke], [Boericke]. In lupus-like facial lesions there is soreness of borders and indurated base—non-suppurative, slow, with a glazed surface (Skin cross-reference) [Clarke]. Vertigo is rare; heaviness of head follows bad nights of itching. The head reflects the general trophic theme: thickened, indolent, pruritic skin with burning after scratch [Clarke], [Hering].

Not a primary ocular remedy; yet peri-orbital patches (lupoid/psoriatic) may encroach the lids, causing itching and burning worse warmth, better cool sponging [Clarke]. Margins of lids can be thickened and fissured at the outer canthi. Photophobia is not characteristic. The main ocular note is cosmetic anxiety when lesions threaten appearance, which amplifies the Mind picture. Improvement of adjacent skin calms the ocular discomfort.

Ears may host circinate plaques on the lobule and behind the auricle, itching intolerably in warm rooms and becoming tender and fissured with scratching [Clarke]. Otalgia is not typical; hearing unaffected. A few cases show thickened, glazed meatus skin with smarting after scratching. Relief follows cool applications and avoidance of woollen headwear (Modalities).

No acute coryza picture. At the alæ nasi, fissures and glazed rawness appear in warm, windy weather; crusts form without much pus, a small analogue of the broader trophic sphere [Clarke]. Nasal vestibule itching provokes rubbing until burning sets in (worse scratching). Lupus vulgaris of nose—slow, indurated, non-suppurative—belongs to the clinical range of Hydrocotyle (compare Ars., Kali-ars., Tub.) [Clarke], [Boericke]. Smell is normal. Pruritic distress abates in cool air.

The face may show lupoid or psoriatic patches—circular, slightly elevated, desquamating or glazed—with advancing edges and indurated bases, slowly enlarging without acute inflammation [Clarke]. Heat reddens them; scratching tears the thin surface and leaves burning. Cosmetic distress is high; patients avoid society during flares (Mind linkage). Lips may crack at the angles; the surrounding skin is glazed and pruritic, better cool water and bland ointment (Mouth/Skin). The facial picture, though not universal, is classical in Hydrocotyle’s cutaneous sphere—chronic, thickened, pruritic, little pus, much induration [Clarke], [Hering].

Corners of the mouth fissure; lips feel tight and smarting after scratching or warm drinks (worse heat; burning after irritation) [Clarke]. Aphthous patches are not characteristic, but small, shallow ulcers with indurated rims may occur in cachectic subjects (Skin congruence). Tongue and taste are generally normal. Cold rinses soothe chaps and burning; spices may sting (Food & Drink). The oral mucosa thus echoes the cutaneous trophic tendency.

No distinctive toothache. Gums may crack or become tender at the margins in dry, heated rooms, improving with cool water and unspiced diet (minor echo of mucocutaneous sensitivity) [Clarke]. Dentistry is not guided by this remedy; selection lies in the skin and cervico-vaginal fields.

Throat symptoms are slight: sensation of heat and rawness posteriorly in heated rooms, with relief from cool air and sips of cold water [Clarke]. There is no marked catarrh or hawking; Hydrastis or Kali-bi. better fit such pictures. The throat merely shares the heat-sensitivity seen on surfaces.

No primary lung action. Heat of rooms may provoke a sense of surface burning of the chest skin; cool air relieves. Mammary areolæ may crack in heated seasons, smarting after scratching, again better with cool compresses (Skin satellite). Cardiorespiratory features do not guide prescription.

No characteristic cardiac symptoms. Palpitation from excitement or heat is incidental; select by skin and pelvic signs, not by heart. Pulse otherwise unremarkable in the literature [Clarke], [Boericke].

Comfortable; respiration only indirectly affected when heat provokes restlessness from itch. Open, cool air soothes both mind and skin (Generalities). No cough or laryngeal keynote.

Appetite fair; rich, spicy foods aggravate flushing and itching (modal linkage). Some patients crave cool, simple fare during flares, reporting that hot meals increase the skin heat [Clarke]. Nausea is uncommon. Epigastric comfort correlates little with the skin, save via dietary triggers. The remedy is not chosen for gastric features.

Generally soft; obstinate constipation is not a keynote (contrast Graph., Sulph.). However, at the anal margin fissures and itching occur (Rectum), matched to the global cutaneous theme. Warmth of bedding worsens perianal pruritus at night; cool bathing helps [Clarke]. No hepatic specialism is recorded.

Itching and fissuring at the anus, with glazed, thickened skin; scratching causes smarting with little bleeding (worse heat, worse scratching; better cool bathing and bland applications) [Clarke], [Boger]. Haemorrhoids are not central. Stools may sting cracked margins on passage. The rectal sphere is a satellite of the skin affinity rather than a bowel-action remedy.

Urinary tract largely quiet. External urethral meatus may itch in heated rooms; smarting follows scratching, eased by cold applications (Skin-at-orifice motif). No cystitis or tenesmus keynotes are recorded in the classical texts [Clarke], [Boericke].

Spices, alcohol, and hot drinks aggravate flush and itch; cool, simple food mitigates (modal link) [Clarke]. No strong cravings; aversion to “heating” fare during flares. Hydrocotyle is not chosen for gastronomy, but diet helps confirm and manage the case.

Pruritus of scrotal and perineal skin in warmth; scratching leads to burning and glazed rawness, better cool washing and air (Skin). No seminal, prostatic, or erectile keynotes. The male sphere is cutaneous-pruritic rather than genito-urinary.

A capital sphere. Pruritus vulvæ is extreme, often intolerable at night and in heated rooms; scratching gives instant relief but is followed by violent burning and excoriation (modalities echoed) [Clarke], [Boericke], [Phatak]. Cervix uteri hypertrophied, granular (“erosion”) with thickening of pericervical tissues; pelvic weight or bearing-down is reported in association with pruritus and leucorrhœa [Clarke]. Leucorrhœa may be scant and sticky or moderate without great acridity; the itching is out of proportion to discharge (contrast Kreos.) [Phatak]. Symptoms are worse before menses or in pregnancy; cool bathing, loose clothing, and bland local applications palliate (Better cool, Better loose garments) [Clarke]. Mini case: “Middle-aged woman with granular cervix and intolerable itching at night; Hydrocotyle 6C with cool regimen quieted pruritus and reduced cervical hyperplasia” [Clinical], [Clarke].

The lumbosacral region may itch beneath clothing in warm rooms, worse woollens; scratching causes burning and a glazed patch (Skin congruence) [Clarke]. Cervico-dorsal restlessness from heat in bed (turning to find cool areas) mirrors the Sleep picture. No specific spinal pains are noted.

Palms and soles are frequent sites of torment: intolerable itching with hyperkeratotic, circinate, or psoriatic patches; cracking at flexures or heel fissures; after scratching, burning that compels cold bathing (Better cold applications; Worse heat) [Boericke], [Clarke]. Edges of plaques are indurated; centres may be glazed or minimally scaly. Formication and numb borders round patches suggest peripheral-trophic involvement (leprosy-analogue) [Clarke], [Hering]. Hands in heated workrooms become almost unendurable; relief by cool water immersion is a keynote. Nails may show pitting over psoriatic plaques but are not a prime target.

This is Hydrocotyle’s genius. The skin thickens and indurates in circinate disks or mammillated fields; patches may be glazed, slightly desquamative or warty, with slow peripheral extension and scant suppuration [Clarke], [Hering]. Itching is violent, especially in warmth and at night; scratching gives brief relief but is followed by burning, smarting, and further excoriation (modal triad: worse heat, worse scratching → burning; better cool) [Boericke], [Clarke]. Palmar and plantar psoriasis, fissures at mucocutaneous junctions, and lupoid granulomas of face and nose fall within the clinical range; anaesthetic rings and keloidal tendencies are described in older literature (leprosy, scars) [Clarke], [Hering]. The surface often looks glazed and coppery rather than fiery; pain is moderate compared with itch. Bland emollients and cool bathing act synergistically with the remedy (Practical). Mini case: “Palmar psoriasis with night torment; Hydrocotyle 3X + cold compresses stopped scratching and softened plaques in three weeks” [Clinical], [Boericke], [Clarke].

• Pruritus (especially vulvar)
– Sepia: bearing-down, indifference; pruritus with yellow-green discharge; Sep. better vigorous exercise; Hydrocotyle’s itch is out of proportion to discharge, worse heat, better cool, with cervical hyperplasia. [Kent], [Clarke].
– Kreosotum: excoriating, offensive leucorrhœa corroding parts; Hydrocotyle discharge scant/moderate, itching primary; less corrosion. [Hering], [Clarke].
– Rhus toxicodendron: itching better hot water; opposite modality to Hydrocotyle. [Boericke].
• Psoriasis / Palmar–Plantar
– Kali arsenicosum: inveterate psoriasis with violent burning and restlessness; Hydrocotyle more hypertrophic/glazed, less restlessness, better cool. [Clarke], [Boger].
– Graphites: fissures with sticky honey oozing; obese, chilly; Hydrocotyle has burning after scratch, glazed plaques, less oozing. [Farrington], [Clarke].
– Chrysarobinum: thick infiltrated eczema/psoriasis with honey crusts; Hydrocotyle more indurated/glazed with intolerable itch. [Clarke], [Boericke].
• Lupus / Lupoid
– Arsenicum album: ulcerative, burning pains better heat; Hydrocotyle prefers cool; less constitutional anxiety. [Kent], [Clarke].
– Kali bichromicum: punched-out ulcers with viscid plugs; Hydrocotyle shows indurated, glazed, slowly extending lesions. [Boger], [Clarke].
• Leprosy analogues / Anaesthetic rings
– Psorinum: filthy skin, offensive discharge, chilliness; Hydrocotyle less offensive, more hypertrophic, heat-worse itch. [Hering], [Clarke].
– Sulphur: universal itch, heat of vertex, offensive sweat; Sulph. craves warmth despite itch; Hydrocotyle craves cool. [Kent], [Boericke].
• Cervical hypertrophy / Erosion
– Murex: uterine congestion with increased desire; Hydrocotyle has pruritus and structural hyperplasia without erotic keynote. [Clarke].
– Alumina: dryness with itching and fissures at orifices; Hydrocotyle more hypertrophic/granular cervix with heat-worse pruritus. [Boger], [Clarke].

• Complementary: Sepia—pelvic support and bearing-down; Sep. covers constitutional stasis; Hydrocotyle addresses pruritus vulvæ with cervical hyperplasia and cool-amelioration. [Clarke], [Kent].
• Complementary: Graphites—fissures at orifices with thickened skin; Graph. for oozing/honey crusts; Hydrocotyle for glazed thickening and burning after scratch. [Farrington], [Clarke].
• Complementary: Kali arsenicosum—in obstinate psoriasis; use Hydrocotyle when cool amel., burning after scratch, hypertrophic plaques dominate. [Boger], [Clarke].
• Follows well: Sulphur—after Sulph. rouses the reactive plane, Hydrocotyle reduces hypertrophy/pruritus in heat-worse cases. [Kent], [Clarke].
• Follows well: Arnica/Calendula (locally)—once surface trauma is calmed, Hydrocotyle consolidates trophic repair (clinical). [Clarke].
• Precedes well: Thuja—if warty sycotic overgrowth remains after itch abates. [Clarke], [Boericke].
• Related: Chrysarobinum (psoriasis/eczema), Kreosotum (corroding leucorrhœa), Rhus tox. (hot-water amel.), Arsenicum (heat-amel. opposite), Petroleum (winter cracks, but oiliness). [Clarke], [Boericke], [Boger].
• Inimicals not recorded; individualise by modalities (heat-worse, cool-better) and hypertrophic skin/cervical signs. [Clarke], [Boericke].

Indications: Psoriasis (palmar/plantar, circinate); lupus/lupoid granulomas with indurated bases; leprosy-analogous anaesthetic rings; fissures and glazed rawness at orifices; intolerable pruritus vulvæ (especially heat- and night-worse) with granular/hypertrophic cervix; keloidal scarring tendencies [Clarke], [Hering], [Boericke], [Phatak]. Posology: Low to medium potencies (3X–6X, 6C) repeated once–twice daily in chronic hypertrophic skin states; 30C when the keynote modalities are striking across sites (pruritus vulvæ + palmar psoriasis) [Clarke], [Boericke]. Repetition: taper as burning-after-scratch subsides and sleep improves; resume during warm-weather relapses. Adjuncts: cool bathing; loose cotton; bland, unscented emollients; avoidance of hot rooms, alcohol, spices (explicitly matching modalities) [Clarke], [Phatak].
Case pearls:
• “Palmar psoriasis, heat-worse, burning after scratch; Hydrocotyle 3X + cold soaks—night torment ceased, plaques softened.” [Clinical], [Boericke], [Clarke].
• “Pruritus vulvæ with granular cervix; worse before menses and in bed; Hydrocotyle 6C cleared itch and reduced cervical hyperplasia.” [Clarke], [Phatak].
• “Lupoid facial patch—glazed, indurated, little pus; cool regimen + Hydrocotyle narrowed the ring steadily.” [Clinical], [Clarke].

Mind
• Mind—Irritability—itching from—heat in bed agg. Cutaneous-driven temper. [Clarke].
• Mind—Anxiety—appearance about—facial patches. Social withdrawal sign. [Clarke].
• Mind—Aversion to company—skin disease from. Practical case-guidance. [Clarke].
• Mind—Dwelling on complaints—itch increases. Attention fuels itch loop. [Farrington].
• Mind—Sleep lost—pruritus from—peevishness. Confirms nocturnal torture. [Boericke], [Clarke].
Head/Face
• Face—Lupus—indurated base—non-suppurative—heat agg., cold amel. Hydrocotyle type. [Clarke].
• Scalp—Itching—scratching → burning. Modality hallmark. [Clarke].
• Lips—Cracks—angles—heat agg.—cool water amel. Orifice fissure theme. [Clarke].
• Head—Heaviness—evening—warm room agg. Heat-sensitivity marker. [Clarke].
• Face—Eruptions—circinate—glazed. Psoriatic/lupoid edge. [Clarke].
Female
• Vulva—Pruritus—intolerable—night—heat of bed agg.—cold applications amel. Cardinal rubric. [Boericke], [Clarke], [Phatak].
• Cervix—Hypertrophy—granular (erosion). Structural keynote. [Clarke].
• Leucorrhœa—moderate—itching out of proportion. Distinguishes from corrosives. [Phatak].
• Menses—Before—pruritus worse; during—relief. Cyclic cue. [Clarke].
• Bearing down—pelvic—connective-tissue changes. Supportive sign. [Clarke].
Skin
• Skin—Itching—violent—heat agg.—scratching amel. then burning. Core modality. [Clarke], [Boericke].
• Skin—Psoriasis—palmar/plantar—circinate—heat agg., cold amel. Target indication. [Clarke].
• Skin—Lupus—indolent—indurated edges—little suppuration. “Glazed” Hydrocotyle ulcer. [Clarke], [Hering].
• Skin—Fissures—at orifices—smarting—cool water amel. Orifice theme. [Clarke], [Boger].
• Skin—Keloid—tendency—old scars. Hypertrophic trope. [Clarke].
• Skin—Formication—crawling—warmth agg. Sensory pointer. [Clarke].
Extremities
• Hands—Palms—itching—intolerable—warmth agg.—cold water amel. Workroom cue. [Boericke], [Clarke].
• Feet—Soles—cracks—smarting after scratching. Plantar fissures. [Clarke].
• Extremities—Eruptions—circinate—glazed—psoriatic. Distribution clue. [Clarke].
• Nails—Pitting—psoriatic patches near. Ancillary sign. [Clinical].
• Clothing—Friction—agg.—woollens agg. Practical modality. [Phatak].
Rectum
• Anus—Fissures—glazed—itching—burning after scratch—cool bathing amel. Management rubric. [Clarke], [Boger].
• Anus—Pruritus—night—heat of bed agg. Sleep-breaking sign. [Clarke].
• Skin around anus—thickened—indurated. Trophic echo. [Clarke].
• Stool—Passage—cracks smarting. Orifice sensitivity. [Clarke].
Generalities
• Heat—aggravates—bed; warm room. Master modality. [Boericke], [Clarke].
• Cold—applications—amel.; cool air—amel. Master amelioration. [Clarke].
• Hypertrophy—connective tissue—skin/cervix. Structural keynote. [Clarke].
• Night—agg.—itching. Circadian pattern. [Boericke].
• Friction—wool—agg. Everyday trigger. [Phatak].
• Scratching—amel. then burning—worse. Behavioural-cue rubric. [Clarke], [Hering].

Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): skin/cervical hypertrophy, pruritus vulvæ, modalities (heat-worse, cool-better), lupus/leprosy range; clinical notes.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—intolerable itching (palms, vulva), psoriasis/lupus sphere, burning after scratching, modalities.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): confirmations in trophic skin disease, leprosy analogues, fissures; sensory polarity itch→burn.
Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): proving fragments and clinical collations; preparation notes.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): botanical/pharmacognostic background; connective-tissue rationale for skin/cervical indications.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): repertorial cues—fissures at orifices, heat-worse itch, circinate plaques; relationships.
Farrington, E. A. — Clinical Materia Medica (1890): organ-affinity method; comparisons for pruritus vulvæ and psoriasis set; mental overlay secondary to skin.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): miasmatic colouring and differentials (Sep., Ars., Graph., Sulph.) used herein.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (20th c.): clinical keynotes—pruritus vulvæ, wool/friction aggravation, cyclic aggravations.
Tyler, M. L. — Homœopathic Drug Pictures (20th c.): practical picture sketches for skin remedies, heat/cold modalities, and patient management hints.
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): brief therapeutic groupings (psoriasis, pruritus vulvæ) informing clinical tips.