Iberis amara

Iberis amara is a small, bitter annual of the Cruciferæ with white cruciform flowers, native to dry, chalky places in Europe and long cultivated as an ornamental. The fresh plant abounds in glucosidic “mustard-oil” principles and bitter constituents; as with other crucifers, topical rubefaction and a reflex influence upon circulation are noted in crude use [Hughes], [Clarke]. The homœopathic mother tincture is prepared from the fresh herb in flower; triturations and centesimals are then made according to the pharmacopœia [Allen], [Clarke]. Proving and clinical experience converge upon the heart and circulation—palpitation, irregular action, valvular murmurs, dyspnœa on the least exertion, with attendant vertigo, head-congestion, and left-sided radiations to shoulder and arm—whence its reputation as a minor but pointed cardiac remedy [Hering], [Clarke], [Boericke].

Our knowledge rests on small provings (American school) and numerous [Clinical] confirmations in cardiac cases: palpitation with vertigo and frontal fulness; dyspnœa on ascending; precordial oppression with pains to left scapula/arm; irregular, intermittent pulse; cardiac murmurs (mitral, aortic) and failing compensation; cold extremities with faintness [Allen], [Hering], [Clarke], [Boericke]. The remedy’s picture has been repeatedly verified in out-patient dispensary work for “nervous heart” and early valvular disease [Clarke], [Boericke].

Iberis amara is the picture of the heart that “flies into tumult” at a touch—by the least ascent, a warm room, a fright, or a draught of coffee. The pulse bounds or stumbles; the chest grows tight; breath shortens until the patient must sit up and call for the window to be opened. In the same moment the head flushes—then goes black; the eyes blur, the ears roar; and an aching draws beneath the left breast to the scapula and down the arm. Relief is homely and precise: quiet, cool air, propping up, a steady hand on the præcordia, and abstinence from stimulant and tobacco. This mechanical, modal clarity is the clinical strength of Iberis. It lies between the purely functional “nervous heart” and the organ with early dilatation and valvular murmur: it does not replace Digitalis when the pulse has sunk slow and weak, nor Cactus when an iron band clamps the chest, nor Spigelia when stabbing neuralgic pains dominate; rather, it calms the tumultuous, irregular, effort-provoked palpitation with orthopnœa and left-sided radiation that is its seal [Clarke], [Boericke], [Hering].
Its miasmatic hue reflects this middle ground: sycotic overactivity—hypertrophic effort and congestion—slides toward a syphilitic failing compensation when murmurs and dilatation appear, while psoric reactivity colours the anxiety, startings, and cardio-neurotic urination. The generalities—worse exertion, warm rooms, emotion, tobacco/coffee; better cool air, rest, high pillows—recur in every subsection, and the organ affinities interlock cleanly: heart action ↔ head-congestion/vertigo ↔ visual/aural obscurations ↔ left shoulder/arm radiation ↔ dyspnœa of exertion. The remedy’s pace is rapid in onset but not overwhelming; it is the middle of the day stair and the warm theatre, more than the midnight angina. In the dispensary patient who says, “If I so much as hurry or sit in a warm room, my heart flutters—I must sit up by the open window till it goes off; the pain runs to my left shoulder,” Iberis deserves first thought. Practical prescribing couples the remedy with environment: ventilation, graduated exertion, and the avoidance of stimulants; under this regimen, one expects fewer startings from sleep, longer intervals without orthopnœa, and the return of steady pulse on moderate ascent [Clarke], [Boericke], [Allen].

• Heart muscle and valves—palpitation, irregularity, intermittency; dilatation and early hypertrophy; systolic murmurs (esp. mitral); oppression and pain radiating to left shoulder/arm (see Heart/Chest). [Clarke], [Boericke], [Hering].
• Arterial and venous circulation—flushes to head; vertigo, congestive headaches; cold extremities with weak peripheral pulse (see Head, Extremities). [Allen], [Clarke].
• Respiratory co-operation—dyspnœa on least exertion; orthopnœa; must sit up (see Respiration). [Boericke], [Hering].
• Cardio-neurotic sphere—anxiety about the heart, tremulousness, startings at night; palpitation from emotion or tobacco (see Mind, Sleep, Food & Drink). [Clarke], [Hughes].
• Left-sided chest wall and scapular region—aching/stitching under left scapula; pains shoot down left arm (see Chest, Extremities). [Clarke], [Allen].
• Hepatic/epigastric sympathy—weight at epigastrium with cardiac oppression; nausea during palpitations (see Stomach). [Allen], [Clarke].
• Visual/aural circulation—blurred sight, blackness before eyes, noises in ears synchronous with pulse during attacks (see Eyes, Ears). [Allen], [Hering].

Anxiety centres in the præcordia: a morbid watchfulness of the heart’s action, with fear of a stoppage or fatal attack whenever palpitation begins; this dread rises on lying down in a warm room and falls with cool air and quiet (cross-link Better cool air; Worse warm room) [Clarke], [Hering]. Irritability and fretfulness attend the periods of irregular pulse, especially when excited by tobacco or emotion (Food & Drink linkage) [Hughes], [Clarke]. The patient dreads exertion lest breath fail; yet, paradoxically, gentle open-air movement calms him when the tumult has passed (modal nuance) [Clarke]. Startings from sleep with alarm at the heart’s beating are frequent; after sitting up the fear subsides (Sleep). Concentration fails during attacks—head feels full, ears roar, eyes blur—and the sufferer becomes hypochondriacal about the chest (Head/Ears/Eyes cross-links) [Allen], [Clarke]. Spirits sink with chronic dyspnœa; yet there is no deep suicidal temper as in Aurum; the psychology is cardio-neurotic rather than melancholic [Kent], [Clarke]. Children with palpitation from fright cling and beg to be held upright by a cool window; the mental colouring is secondary to the circulatory storm [Hering], [Clarke].

Cannot lie on the left side or flat in bed; starts from sleep with a sense the heart will leap from the chest; must sit up to breathe (modal echo) [Boericke], [Clarke]. Warm bed aggravates palpitation; a cool, well-ventilated room and high pillows bring repose. Unrefreshing dozes after midnight with alarmed dreams of climbing or being pursued (Dreams). When the heart steadies, sleep returns quickly.

Dreams of exertion—running, ascending—with breath failing; or of fright and sudden wakings clutching at the chest [Clinical], [Clarke]. Cardiac content fades as the circulation steadies.

Iberis synthesises a cardio-neurotic and early valvular picture marked by palpitation, irregular/intermittent pulse, dyspnœa on least exertion, orthopnœa, and left-sided radiations to scapula and arm, with head-congestion and sensory obscurations. Modalities are constant: worse exertion (ascending, hurrying), warm, close rooms, emotion, tobacco/coffee, lying on the left; better rest, cool moving air, pressure of the hand to præcordia, high pillows, small cold sips. The remedy sits between the purely functional and the organic: it soothes tumult and eases breath where overaction and failing compensation predominate, and its confirmations appear across Heart, Respiration, Head, Eyes, Extremities. Compare Digitalis (slowness, fear to move lest the heart stop), Cactus (iron band constriction), Spigelia (sharp, neuralgic, left-sided cardiac pains), Kalmia (shooting to arm with slow pulse), Strophanthus/Crataegus (tonic action in dilatation), Naja (valvular disease with throat constriction), and Glonoinum (throbbing head-vascular storm). Choose Iberis when the keynote is tumultuous, effort-provoked palpitation with orthopnœa and left scapular/arm radiation, relieved promptly by cool air and quiet [Clarke], [Boericke], [Hering], [Allen].

No distinctive pyrexia. Anxious flushes with slight evening heat may accompany attacks; temperature otherwise normal or subnormal during faintness [Clarke].

Chilliness of extremities with præcordial heat and head-flushes during palpitation; sweat cold and clammy on forehead and chest at the height of dyspnœa [Clarke], [Boericke]. Warm rooms increase oppression; cool air ameliorates (master modality).

Vertigo on rising or moving quickly, with blackness before the eyes and a sense the head will burst; relief on sitting still and taking cool air (Better rest/cool air) [Allen], [Clarke]. Dull, heavy frontal or occipital headaches accompany palpitations; the carotids throb and the face flushes, then turns pale as the heart flags—an alternating congestion and faintness characteristic of the remedy (General circulatory swing) [Clarke], [Boericke]. A band-like pressure across the forehead is described during tachycardia; noise and light aggravate (Mind). Headache follows ascent of stairs, hurry, or warm rooms (Worse exertion/warmth), and subsides after a few minutes’ quiet [Clarke]. Ears ring with the pulse; attention to the sound increases the confusion and anxiety (Ears/Mind). When the heart steadies, the head clears quickly; the cranial symptoms closely mirror the cardiac rhythm [Clarke], [Allen].

Sight dims suddenly with palpitation; sparks or black spots float; letters swim; sometimes transient diplopia during violent cardiac action [Allen], [Hering]. On rising or hurrying a mist comes over the eyes and is blown off, as it were, by cool air (Better cool air) [Clarke]. Pupils may dilate slightly during attacks; convergence feels effortful; there is no primary inflammatory picture. A direct relation between ocular obscurations and the heart’s tumult is a valuable bedside confirmation [Clarke].

Ringing, rushing, or humming synchronous with the pulse during palpitations; a sense as if the ears were stuffed when the head is hot (Head linkage) [Allen], [Clarke]. Sudden noises aggravate cardiac start and dyspnœa (Mind). There is no true otitis; the ear-signs are circulatory and reflex. Relief follows quiet and fresh air [Clarke].

Nasal tip cool and pale during faint turns; occasional epistaxis from head-congestion at the beginning of attacks (Head concordance) [Clarke]. No coryza; the nasal note is vascular.

Face alternately flushed and pale; lips may bluen slightly in severe dyspnœa; expression anxious [Hering], [Clarke]. Left cheek heat during præcordial oppression has been noted (left bias). Sweat beads on forehead with faintness, especially in warm rooms (Chill/Heat/Sweat). Colour returns with cooler air and rest.

Dry mouth with anxious palpitation; tongue moist, slightly tremulous; bad taste after tobacco in sensitive subjects (Food & Drink). Speech breaks on exertion from breath-failure (Respiration). No aphthous state belongs here; the oral signs are sympathetic.

No decisive tooth-symptoms; jaw feels weak during faintness; clenching from anxiety may occur. Dental exertion (prolonged mouth open) may provoke palpitation in nervous subjects, but this is incidental.

Tightness in the throat as if a hand compressed it when the heart flutters; difficult deglutition during paroxysm from want of breath (Respiration) [Clarke]. Hoarseness and choking when speaking during palpitation; better after sitting quietly. No primary inflammation.

Oppression across the upper chest, worse in warm, close room, with desire to loosen clothing (Worse heat/pressure of clothes) [Clarke]. Sharp stitches under the left breast and beneath the left scapula; dull aching towards left axilla and down the arm (left radiation) [Allen], [Clarke]. Must sit up and breathe quietly; slightest movement renews the struggle (Better rest; Worse motion). Chest-walls feel tired after paroxysm; a sense of emptiness follows tumult. Pressure of hand affords comfort (Better pressure) [Clinical].

The heart is the centre: tumultuous palpitation; pulse full, bounding, or irregular and intermittent; every effort seems to upset the rhythm [Clarke], [Boericke]. Systolic murmurs (especially mitral) with dyspnœa on ascending a few steps; tendency to dilatation with early hypertrophy; præcordial anxiety as if the heart were too large for its place [Clarke], [Hering]. Fluttering with sinking at the epigastrium; faintness and cold sweat on slightest exertion or emotion (modal ties). Pain extends to left shoulder and along left arm; numbness/tingling may accompany (Extremities) [Allen]. Cannot lie on left side without sense of stoppage or suffocation; sleep is half-sitting (Sleep) [Boericke]. Tobacco and strong coffee invariably aggravate (Food & Drink) [Hughes]. In failing compensation Iberis is palliative—quieting tumult and easing breath while more fundamental measures proceed [Clarke].

Short breath on exertion; orthopnœa—must sit up; warm rooms oppressive; cool air relieves [Clarke], [Boericke]. Cheyne-like inequality during severe palpitation: a few deep sighs then a catch. Talking or swallowing increases dyspnœa; the voice becomes husky in an attack. After the storm, breathing is easy but shallow from fatigue. No bronchitic rattling; the dyspnœa is cardiac.

Nausea with præcordial anguish; sinking at epigastrium when the pulse intermits, relieved by small cold sips (Better cold water) [Allen], [Clarke]. Fullness or weight at the pit of stomach accompanies cardiac oppression, worse after meals and on stooping (Worse after meals/stooping) [Allen]. Eructations may relieve a congestive head-feeling (Head-Stomach reflex). Appetite is capricious; fear of an attack diminishes desire to eat. No gastritis.

General abdominal flaccidity; a sense of emptiness with palpitations. Liver may feel full or tender during congestive headaches (hepatic sympathy) [Clarke]. Bowels inactive during heart-failures, but not a keynote. Flatulence aggravates epigastric oppression, better after passing wind (Stomach).

No characteristic rectal picture; urging may bring on palpitation from strain in weak hearts (Worse exertion). Faint feeling after stool in nervous subjects is possible, relieved by lying quietly (Generalities).

Frequent urination during palpitations and after fright—nervous diuresis—light-coloured urine [Clarke]. Suppression is not recorded. Burning and tenesmus are absent.

Tobacco, strong coffee, and alcohol bring on or aggravate palpitation and irregular pulse; abstinence a practical part of the prescription [Hughes], [Clarke]. Heavy meals or late suppers aggravate epigastric weight with heart oppression (Stomach). Desires cool drinks in small sips during nausea.

Sexual excitement or coitus may precipitate palpitation and dyspnœa in sensitive hearts; a useful caution rather than a guiding symptom [Clarke]. No specific urethral or prostatic sphere.

Palpitations at the climacteric or around menses, with flushes and head-congestion; left breast and axilla achy during attacks (left-sided radiation) [Clarke]. Pregnancy dyspnœa on ascending suits Iberis when the cardiac picture is clear; otherwise, look to Actæa, Cactus, or Gels. No uterine pathology peculiar to the drug.

Aching beneath and between scapulæ, chiefly left, during palpitation; pains creep from præcordia to left interscapular space (cardiac-reflex track) [Clarke]. The dorsal region is tired after slight efforts; stooping or straightening suddenly brings back the flutter (Worse motion). Warmth to upper back comforts.

Left arm and shoulder ache, with numbness or tingling during præcordial oppression; hand may feel weak and cold (cardiac radiation) [Allen], [Clarke]. Legs easily tired on ascending; trembling and weakness after short walks; ankles cool. Fingers may become bluish in severe dyspnœa (Skin). Cramps in calves on exertion occasionally noted. Relief comes with rest and cool air.

Pallor with cold, clammy sweat during attacks; in severe cases circummoral cyanosis and bluish nails appear [Hering], [Clarke]. Flushes to face alternate with pallor of extremities. No characteristic eruption.

• Aetiology / Triggers
– Aconitum: palpitation from fright with acute fear of death; Acon. is stormy, feverish; Iberis is cooler, effort- and heat-worse with orthopnœa. [Kent], [Clarke].
– Gelsemium: cardiac weakness with tremulousness and slow action; Iberis shows tumultuous, irregular action and head-congestion. [Farrington], [Clarke].
• Cardiac—Pace and Pulse
– Digitalis: failing compensation with slow, weak pulse; fear to move; Iberis has bounding/irregular pulse, effort-worse tachy-palpitations. [Clarke], [Boericke].
– Strophanthus: dilated heart with breathlessness on exertion; Stroph. more tonic, less head-congestion; Iberis adds vertigo, visual obscurations. [Boericke], [Clarke].
– Crataegus: myocardic tonic without a proving picture; Iberis has specific modalities (left scapula pain, warm-room agg.). [Clarke], [Boericke].
• Sensation / Constriction
– Cactus grandiflorus: “iron band” around heart; Iberis lacks the vise-like clamp, has more flutter and radiation to left arm. [Clarke], [Boger].
– Spigelia: sharp, stabbing left chest pains, sensitive to least motion; Spig. more neuralgic; Iberis more circulatory tumult with orthopnœa. [Farrington], [Clarke].
• Radiation / Arm
– Kalmia: pains shoot to left arm with slow pulse; Iberis with irregular, often quick pulse and head symptoms. [Boger], [Clarke].
– Naja: valvular disease with throat constriction and nocturnal aggravation; Iberis has warm-room and exertion aggravation with vertigo and visual blur. [Clarke], [Boericke].
• Vascular Head
– Glonoinum: violent throbbing, head feels enormous, heat-sun agg.; Iberis head-congestion is secondary to cardiac tumult and relieved by cool air. [Clarke], [Kent].
– Aurum: hypertrophy with profound melancholy; Iberis has anxiety about heart but not Aurum’s suicidal gloom. [Kent], [Clarke].

• Complementary: Crataegus—tonic support in dilatation while Iberis quiets tumult and orthopnœa. [Clarke], [Boericke].
• Complementary: Strophanthus—failing compensation and exertional dyspnœa; Iberis for irregular, effort-provoked palpitations; Stroph. for myocardial tone. [Boericke].
• Complementary: Kalmia—left arm radiation; Kalm. when slow pulse and neural shooting dominate. [Boger], [Clarke].
• Follows well: Aconite—after acute fright/panic settles, Iberis controls persisting palpitation. [Kent], [Clarke].
• Follows well: Naja—in valvular disease with throat constriction once distressing tightness abates, Iberis for effort-dyspnœa. [Clarke].
• Precedes well: Digitalis—when action sinks slow after Iberis has controlled tumult; change as pace changes. [Clarke], [Boericke].
• Related: Cactus, Spigelia, Glonoinum, Convallaria, Adonis vernalis—distinguish by quality of pain, pulse, and modalities. [Clarke], [Boericke], [Boger].
• Antidotes/Aggravants: Tobacco and strong coffee aggravate Iberis states; abstinence assists action. [Hughes], [Clarke].
• Inimicals not recorded; individualise by cardiac modalities and left radiation. [Clarke].

Indications: Palpitation and dyspnœa on the least exertion; orthopnœa—must sit up; pulse irregular/intermittent; præcordial oppression with pains to left scapula/arm; effort- or heat-provoked attacks with head-congestion and visual obscurations; early mitral murmur or cardiac dilatation; tobacco/coffee heart [Clarke], [Hering], [Boericke], [Allen]. Potency/posology: Low to medium potencies (Ø, 3X–6X) traditionally in failing compensation or valvular states (drops in water t.d.s.–q.i.d.); 6C–30C where the modal and sensory corroborations are strong and the case is more functional; repeat according to attack frequency, then lengthen intervals as exertional tolerance returns [Clarke], [Dewey], [Boericke]. Repetition: In acute paroxysms dose more frequently for several hours, then reduce; in chronic exertional dyspnœa, steady doses with lifestyle measures. Adjuncts: Cool, well-ventilated rooms; head and shoulders raised for sleep; graded exercise; strict avoidance of tobacco and strong coffee; moderation in meals (explicit modality alignment) [Hughes], [Clarke].
Case pearls:
• “Mitral systolic murmur with dyspnœa on ascending one flight; left scapular ache—Iberis 3X t.i.d. with window ventilation: stair tolerance advanced steadily” [Clinical], [Clarke], [Boericke].
• “Palpitation in warm room, head swam, could not lie on left—30C at bedtime; slept propped, no night startings for a week” [Clinical], [Clarke].
• “Tobacco-heart in clerk—irregular pulse, dyspnœa on hurry—abstinence + Iberis 6X regularised action” [Hughes], [Clarke].

Mind
• Mind—Anxiety—heart, about—palpitation with. Useful in cardio-neurosis. [Clarke].
• Mind—Fear—on lying down—suffocation from. Orthopnœa anxiety. [Boericke], [Clarke].
• Mind—Irritability—palpitation during. Neuro-cardiac excitability. [Clarke].
• Mind—Starting—sleep on—palpitation with. Night attacks. [Clarke].
• Mind—Company—desire for—during attacks (needs support and air). Practical bedside cue. [Clinical].
Head
• Vertigo—on rising—blackness before eyes—palpitation with. Key circulatory sign. [Allen], [Clarke].
• Head—Congestion—warm room—agg.—cool air—amel. Tracks modalities. [Clarke].
• Head—Pain—frontal—exertion agg.—rest amel. Effort link. [Clarke].
• Pulsation—carotids—palpitation during. Objective sign. [Clarke].
• Head—Pressure—band-like—tachycardia with. Common accompaniment. [Boericke].
Eyes
• Vision—blurred—palpitation during. Cardio-ocular link. [Allen].
• Photopsia—sparks—effort agg. Early warning of a turn. [Allen].
• Diplopia—transient—cardiac tumult during. Severe attacks. [Allen], [Hering].
• Blackness before eyes—ascending stairs—agg. Exertion test. [Clarke].
• Eyes—Pupils—dilated—palpitation with. Reflex sign. [Hering].
Ears
• Noise—humming—roaring—pulse synchronous. Circulatory hum. [Allen], [Clarke].
• Hearing—diminished—congestion with. Head-vascular pointer. [Clarke].
• Ears—Fullness—palpitation with—warm room agg. Simple confirmation. [Clarke].
• Sensitive to noise—startles, palpitation provoked. Reflex excitability. [Hering].
Heart/Chest/Respiration
• Heart—Palpitation—least exertion—agg. Cardinal rubric. [Clarke], [Boericke].
• Heart—Irregular—intermittent—attacks during. Rhythm pointer. [Clarke].
• Heart—Murmurs—systolic—mitral—with dyspnœa. Structural cue. [Clarke], [Boericke].
• Chest—Pain—left—scapula under—arm to—extends. Radiation key. [Allen], [Clarke].
• Respiration—Orthopnœa—must sit up—warm room agg., cool air amel. Master modality. [Clarke].
• Respiration—Ascending—stairs—agg. Exertional index. [Clarke].
• Clothes—intolerance—about chest—oppression. Practical marker. [Clarke].
• Pulse—bounding—then weak—alternating. Turbulent pattern. [Boericke].
Extremities
• Upper limb—Left—numbness/tingling—heart symptoms with. Radiation sign. [Allen].
• Weakness—legs—after slight exertion—palpitation with. Tolerance gauge. [Clarke].
• Coldness—hands—palpitation with—sweat. Autonomic tone. [Hering].
• Cyanosis—fingers—dyspnœa during. Severity marker. [Clarke].
• Cramps—calves—exertion agg. Peripheral circulation. [Clinical].
Generalities
• Exertion—least—agg.—palpitation/dyspnœa. Central generality. [Clarke].
• Warm room—agg.; Open air—amel. Environmental key. [Clarke].
• Position—lying on left—agg.—must sit up. Positional rubric. [Boericke].
• Tobacco—agg.; Coffee—agg.—palpitation. Etiologic rubrics. [Hughes], [Clarke].
• Rising—quickly—agg.—vertigo, faintness. Handling cue. [Allen].
• After meals—agg.—epigastric weight with oppression. Diet link. [Allen], [Clarke].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): proving fragments for Iberis; head/ocular/epigastric symptoms; cardiac notes.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): clinical confirmations—palpitation, orthopnœa, left-arm radiation, irregular pulse.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): cardiac sphere, modalities (exertion-, heat-worse; cool air better), valvular notes; relationships.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—palpitation on least exertion, orthopnœa, cannot lie on left, left scapular pains.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): substance background (Cruciferæ, bitter/mustard principles); tobacco/coffee aggravation; clinical remarks.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): repertorial entries—left arm radiation, exertion aggravations, environmental modalities.
Farrington, E. A. — Clinical Materia Medica (1890): comparative cardiac therapeutics—Spigelia, Cactus, Digitalis vs Iberis.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): miasmatic framing and comparisons (Acon., Aurum, Digitalis, Glon., Naja).
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): therapeutic grouping for cardiac dyspnœa/valvular disease; posology hints.
Tyler, M. L. — Homœopathic Drug Pictures (20th c.): clinical sketches of “nervous heart” states corroborating Iberis modalities.