Kalmia latifolia

An evergreen shrub of the heath family (Ericaceæ), native to North America, bearing glossy leaves and showy umbels. Like Rhododendron and Andromeda, it contains grayanotoxins (historically “andromedotoxin”) that act upon voltage-gated sodium channels in excitable tissues, provoking vagotonia, bradycardia, hypotension, nausea, salivation, visual disturbance, and weakness—“mad-honey” poisonings from Ericaceæ honeys furnish parallel toxicology [Hughes], [Clarke]. The leaves were used by early settlers as a topical rubefacient for rheumatism; crude ingestion produces gastric irritability, vertigo, limb weakness, marked slowing and irregularity of the pulse, with precordial anxiety and dyspnœa—features that map strikingly to the homœopathic sphere of neuralgia, wandering rheumatism, and rheumatic heart affections [Allen], [Hering], [Clarke]. Tincture from the fresh leaves and young shoots is prepared and potentised; the remedy’s keynote direction of pains—shooting downward from above to below—is repeatedly emphasised by provers and clinicians [Hering], [Boger], [Kent].

Provings and clinical collections (notably Hering, Hale, Allen) show violent neuralgias, especially of the right trigeminal and brachial distributions; wandering rheumatic pains that shoot downward (shoulder → elbow → wrist → fingers; hip → knee → ankle → foot); numbness and weakness following pain; slow, weak, irregular pulse with precordial anxiety and dyspnœa; aggravation from motion and cold, in storms; concomitant nausea with cardiac symptoms; and extension of pain from the heart into left scapula and down left arm [Hering], [Allen], [Clarke], [Farrington], [Boger], [Boericke], [Phatak]. Early clinical confirmations include neuralgic face-pains, cervico-brachial neuritis, rheumatic metastasis to the heart after suppressed joint pains, and albuminous urine in cardiac cases [Clarke], [Farrington], [Nash].

Kalmia latifolia embodies the Ericaceæ signature of meteorotropic neuralgia joined to a mineral-like law of direction. Its essence is a descending electricity: stabbing, shooting pains begin high—in the head, face, neck, shoulders, præcordium—and run downward along nerves and fibrous planes into the extremities. Where the pain has passed, it leaves numbness, coldness and weakness, a telltale hush after the thunder. The second pole of the remedy is the heart: the pulse is slow, weak, intermittent, out of proportion to anxiety; there is præcordial oppression with stitches that pass to the left scapula and down the left arm, and a vagal “sinking” at the epigastrium that rises and falls with the palpitation. Motion is dangerous—the patient scarcely dares to move lest a stab shoot and the heart fail—hence the striking ameliorations from absolute rest, head high, quiet, and the aversions to turning or raising the arms. In weather-labile constitutions, storms and cold winds awaken the pains (family likeness to Rhododendron), yet cool, open air can relieve the chest oppression, preserving the nuanced polarity frequent in deep remedies [Hering], [Clarke], [Boger], [Farrington].

Psychologically the patient is not theatrically fearful (contrast Aconite) but care-worn and cautious, conserving movement. Anxiety is concrete—about the heart stopping, about a stab shooting down the arm—not philosophical. After paroxysms he is dulled by numbness. The remedy’s miasmatic hue blends sycosis (wandering rheumatism, alternations, glandular lability) with a tubercular pace (quick changes, storm-reactivity), hardening toward syphilitic deterioration when rheumatism invades the heart and kidney function shows albumin [Kent], [Boger], [Clarke]. Pathophysiologically, grayanotoxin-like effects—vagal predominance, slowed sinoatrial conduction—explain the bradycardia and the odd disproportion between slow pulse and vivid pain; neuraxial irritability explains lightning neuralgia followed by conduction block (numbness). Homœopathically, the law of direction is precious: when a trigeminal, cervico-brachial, or intercostal pain can be mapped downward, when a rheumatic patient’s joint pains vanish and a slow pulse with left-arm numbness appears, when motion and weather-change stitch pain to numbness—Kalmia stands forward. Differentiate it from Spigelia (left heart, left orbit pains, quicker pulse), Cactus (constriction rather than shooting), Digitalis (slow pulse without the neuralgic descent), Ledum (pains ascend), and Rhododendron (storm pains without cardiac nexus). In management, honour its quiet: keep the patient still, head high, clothing loose at neck/chest; allow cool air for oppression; and do not rejoice if the joint pains fade suddenly—for in this remedy such suppression is a red flag pointing to the heart [Hering], [Farrington], [Clarke], [Kent].

• Heart and conduction system — bradycardia, intermittence, precordial anxiety; pains radiate to left scapula and arm; dyspnœa on the least effort. (see Heart/Respiration) [Hering], [Clarke], [Farrington]

• Peripheral nerves — trigeminal (often right), cervico-brachial, intercostal; violent shooting pains followed by numbness and prostration. (see Face/Back/Extremities) [Allen], [Hering], [Boger]

• Fibrous and sero-fibrous tissues — wandering rheumatism with stitching, tearing pains descending tendons and nerves; pains shift and leave numbness. (see Extremities/Back) [Kent], [Boger], [Boericke]

• Cervical spine and scapulae — pains from nape into shoulders and down the arms; scapular cardiac reflex pains. (see Back/Heart) [Clarke], [Farrington]

• Eyes and ciliary body — ciliary neuralgia; shooting orbital pains in rheumatic diathesis; photophobia with heart symptoms. (see Eyes/Head) [Hering], [Allen]

• Kidneys/urine — albuminuria, scanty urine in cardiac cases; dark urine with prostration. (see Urinary) [Clarke], [Nash]

• Gastric–vagal axis — nausea and sinking at epigastrium with heart palpitation and slow pulse. (see Stomach/Heart) [Allen], [Farrington]

• Direction and alternation — pains move from above downwards; rheumatism alternates with heart symptoms; pains ↔ numbness; suppression aggravates the heart. (see Generalities) [Hering], [Kent]

• Weather/atmospherics — storms and weather changes excite pains (Ericaceæ signature; cf. Rhododendron). (see Generalities/Extremities) [Clarke], [Boger]

Apprehensive about the heart; a distinct fear that movement will stop it, so he lies very still and scarcely dares breathe deeply, which tallies with the amelioration from absolute rest already noted [Clarke], [Kent]. Anxiety rises in waves with palpitation and sinking at the epigastrium; the hand goes to the præcordium and left arm as if to steady a clutching pain (Mind ↔ Heart). Irritable under questioning during neuralgic paroxysms, yet dull and indifferent afterwards when numbness supervenes—a polarity of spasm and paresis repeating through the case [Hering]. Memory is not markedly affected, but concentration fails during storms when the head is tight and the eyes ache (Mind ↔ Head/Eyes). He is averse to company in pain but craves reassurance in cardiac attacks; fear centres on suffocation rather than death per se (contrast Acon.). Children with rheumatic diathesis are peevish in bad weather and cry when moved; they fear the coming wind (Ericaceæ signature) [Clarke]. Melancholy after exertion accompanies slow pulse and faintness, lifting as the pulse fills with rest. Quiet perseverance is a trait; the patient will bear any position that keeps the pain from shooting downward (Mind ↔ Modalities).

Cannot lie on the left side or flat; must lie on back with head high; any turn starts pains that descend the arm or leg (Sleep ↔ Heart/Extremities) [Farrington]. First sleep after midnight is broken by palpitation and sinking at the heart; short naps toward morning refresh when pulse steadies [Allen]. Dreams of falling or of being pursued down steps—downward imagery that curiously echoes the pain-direction. Wakes with numb hand that slowly “comes alive.”

Anxious, of suffocation or of stairs and descents; of storms advancing; wakes with palpitation and a need to sit up (Dreams ↔ Heart/Generalities) [Clarke]. In neuralgic subjects, dreams of knives or shooting arrows; after pain ceases, dreams cease.

Kalmia integrates an Ericaceæ storm-sensitivity with a mineral-like precision of direction: pains begin high and shoot downward along nerves and fibrous planes, leaving numbness and weakness in their wake [Hering], [Boger]. The picture knits neuralgia + rheumatism + heart: suppression or sudden cessation of joint pains is followed by cardiac involvement—slow, intermittent pulse, precordial stitches, dyspnœa, left scapular and arm radiation—hence the grave modality “worse suppression,” cross-linked throughout (Mind/Heart/Back/Extremities) [Hering], [Kent], [Farrington]. Motion aggravates, even slight; rest, head high, quiet ameliorate; cold wind and storms awaken pains (Ericaceæ signature), yet cool open air may ease oppression in the chest (modal polarity) [Clarke], [Boger]. Gastric–vagal sinking accompanies heart distress—nausea with slow pulse (Stomach/Heart) [Allen]. The left arm becomes numb in cardiac storms; the right trigeminal and cervico-brachial tracks host violent neuralgias. Above all, the clinical law “from above downward” decides: head → neck → arm; chest → scapula → arm; hip → knee → ankle—when this descent is clean and pains leave numbness, Kalmia stands out among the neuralgics. Compare Rhododendron (storm pains but not the descending direction), Ledum (pains travel upward), Spigelia (left heart and left eye neuralgia with stabbing but more left-sided, less numb after-pain), Cactus (constriction “iron band,” not the shooting descent), Aconite (acute fear with swift pulse, not bradycardia), Digitalis (slow, weak pulse without Kalmia’s neuralgic descent), and Actæa spicata (small-joint rheumatism without heart radiation) [Clarke], [Farrington], [Kent], [Nash], [Phatak].

Little fever; heat slight with soft pulse; yet during paroxysms the face may flush though the pulse remains slow—discordant circulation [Clarke], [Boger]. Febrile chill on weather-change provokes neuralgic descent. Perspiration occurs with cardiac anxiety, not relieving until rest calms the pulse.

Chilliness with wind and storms; coldness of extremities in cardiac spells (Chill ↔ Heart/Extremities). Heat of bed at first aggravates neuralgic stabs, afterward may soothe as numbness sets in (Heat ↔ Face/Extremities) [Clarke]. Sweat clammy on forehead with sinking; the least motion renews it.

Neuralgic, stitching, stabbing pains that begin in the temples or occiput and shoot downward into the neck and shoulders, worse by turning the head or rising quickly, better lying quiet with head high [Hering], [Allen]. Occipito-cervical headache accompanies heart palpitation; a band feels tight round the head when the pulse is slow (Head ↔ Heart). Ciliary pains radiate to the temples; eyes feel strained; light excites a jerking stab above the orbit (Head ↔ Eyes). Weather-change aggravates dull pressure in frontal sinuses; before thunderstorms the scalp is sore to the roots (Head ↔ Generalities). Nausea may rise with head-pain during cardiac oppression, linking stomach–vagal disturbance to the circulation (Head ↔ Stomach/Heart). After a neuralgic bout, the scalp and face become numb and cold.

Ciliary neuralgia in rheumatic subjects: violent, shooting orbital pains, sometimes alternating with trigeminal stabs, worse by eye movement and light, better with darkness and rest [Hering], [Allen]. Vision dims in cardiac spells; sparks or a film before the eyes attend slow, intermittent pulsation (Eyes ↔ Heart). Photophobia accompanies supraorbital pain that runs down into cheek or teeth (Eyes ↔ Face/Teeth). Lids feel heavy; twitching of upper lid with stabbing pains is recorded. The conjunctivae are not acutely inflamed; it is neuralgic–ciliary rather than catarrhal disease. On weather-change the eye-pains reawaken (Ericaceæ signature).

Neuralgic radiations run into the ears from jaw or mastoid; sharp stabs followed by a peculiar cold numbness of the auricle (Ears ↔ Face). Noise aggravates during heart-sinking; sudden sounds startle and induce a flutter (Ears ↔ Mind/Heart) [Clarke]. Otalgia is often part of a cervico-brachial neuralgia; motion of neck excites it. No true catarrhal otitis belongs here unless from rheumatic metastasis.

Little coryza; sneezing may precipitate a downward shot of pain into the neck or arm—mechanical trigger of neuralgia (Nose ↔ Back/Extremities). Nostrils feel cold in collapse; smell not much altered. Weather-change causes a sense of frontal stuffiness more than discharge.

Right-sided trigeminal neuralgia is conspicuous: lightning-like stabs in malar and maxillary branches, shooting downward into teeth and jaw, followed by numbness of cheek and lip; worse by motion, stooping, touch and cold wind; better gentle heat and pressure [Hering], [Clarke]. Face pale or flushed with palpitation; a drawn expression during paroxysm. After pain passes off, face feels cold and wooden. Temples throb when pulse is slow and irregular (Face ↔ Heart). Exposure sets off pains that descend into neck and shoulder.

Toothache neuralgic, extending from upper molars to ear and down the neck; teeth and gums feel long and cold after paroxysm (Mouth ↔ Ears/Back). Taste flat in cardiac spells; saliva may lessen; thirst small though mouth is dry. Tongue feels heavy during vagal sinking.

Neuralgia rather than caries: shooting from malar bone to upper molars, worse cold air and motion, better steady pressure and warmth [Hering]. Teeth sensitive to change of temperature; clenching aggravates stabs but may steady the numb after-pain.

Tightness about the throat with palpitation; cannot bear a collar; swallowing may send a downward stab into sternum (Throat ↔ Heart). No exudative angina; rather a reflex constriction with cardiac distress. Voice low, hurried in attacks; speech excites flutter (Throat ↔ Mind/Heart) [Clarke].

Stitches about heart and under left breast extending to left scapula and down left arm; inspiration short; must sit still and high in bed (Chest ↔ Heart/Respiration) [Farrington], [Clarke]. Intercostal neuralgia shoots from axilla down the ribs; motion aggravates, pressure partly relieves. A cold, empty feeling accompanies chest pains. On change of weather the chest wall becomes sore along nerve-tracts.

Cardinal sphere. Palpitation with slow, weak, intermittent pulse; præcordial anxiety; pains shoot into left scapula and down the left arm to fingers; numbness and coldness of left hand; cannot lie on left side or flat; slightest motion increases oppression [Hering], [Farrington], [Clarke]. Dyspnœa on ascending; faintness at epigastrium; sensation as if the heart would stop if he moved (Mind ↔ Heart). Rheumatic metastasis: when joint pains are suppressed, heart symptoms arise—pericardial stitches, irregular pulse, albuminous urine—this tallies with the “worse suppression” modality already stated [Hering], [Kent]. Pulse may be slow despite anxiety (“pulse-picture” out of proportion to mental state).

Short, quick breaths from cardiac oppression; wants cool air and head high; exertion brings gasping and arm-numbness (Respiration ↔ Heart/Modalities) [Clarke], [Farrington]. A teasing tickle-cough occurs with scapular pains; coughing sends a stab down the intercostal nerve. Larynx itself is not inflamed. After rest in a propped posture, respiration eases as the pulse steadies.

Nausea with precordial anxiety and slow, intermittent pulse is a hallmark—gastric sinking goes hand in hand with heart oppression (Stomach ↔ Heart) [Allen], [Farrington]. Epigastrium feels empty and cold; a few mouthfuls may steady the faintness. Eructations give little help; warm food may aggravate nausea during palpitation, though local heat can soothe neuralgia elsewhere. Vomiting is rare; if present, it relieves the head.

A tight band across upper abdomen during anginous moments; flatus inhibited by fear of motion (Abdomen ↔ Heart). Liver and spleen not central. Bowels tend to inactivity when the pulse is slow. Neuralgic threads may run through the intercostals into the hypochondria, descending still further on rising.

Constipation from fear and immobility during cardiac anxiety; stool retarded; haemorrhoids not typical. After a quiet stool there is often a sense of relief in precordial pressure (Rectum ↔ Heart).

Urine scanty, dark, sometimes albuminous in cardiac states; urging small; flow increases as pulse steadies and dyspnœa lessens—useful barometer of improvement (Urinary ↔ Heart/Generalities) [Clarke], [Nash]. Cutting at close of micturition may shoot down urethra when sacral nerves are involved (direction downward).

Aversion to coffee and stimulants which excite palpitation; desire for small, frequent sips to allay epigastric sinking (Food ↔ Stomach/Heart) [Allen], [Clarke]. Warm drinks may comfort neuralgia but can aggravate faintness in sensitive subjects. No specific cravings; appetite small during storms.

Sexual power depressed in cardiac sufferers; emissions rare; numbness of genitals after neuralgic bouts (Male ↔ Extremities). Prostate not a seat of action; motion aggravates groin shooting pains that descend to testis and thigh.

Palpitations with numb left arm and downward neuralgias about menses; suppressed flow may precede cardiac anxiety (Female ↔ Heart). After pains in groins shoot downward to knees on rising; weather-change sharpens pelvic neuralgia. Lactation diminishes palpitations in some, likely via vagal modulation (clinical note) [Clarke].

Cervico-dorsal region is a battlefield: pains from nape shoot downward into shoulders and arms; scapular neuralgia, especially left, accompanies heart symptoms (Back ↔ Heart/Extremities) [Clarke], [Hering]. Dorsal spine tender to motion; stooping sends downward shocks. Lumbar region feels weak after attacks; sacral nerves may carry pains into thighs. Local warmth and pressure soothe.

The keynote appears in the limbs: pains travel from above downward along nerves—shoulder to elbow to wrist to fingers; hip to knee to ankle to toes—leaving numbness and weakness behind; motion excites, rest relieves [Hering], [Boger], [Boericke]. Right arm often the seat of fierce neuralgia; left arm carries the heart-reflex numbness. Hands tremble after exertion; grasp weak. Knees lame as if they would give way, particularly going downstairs; a jerk or step starts a downward shooting to ankle. Coldness of fingers accompanies slow pulse; tingling follows the pains.

Cold, pale, sometimes with mottled patches during cardiac faintness; sweat clammy in attacks [Clarke]. Neuralgic areas may feel cold to touch and numb after pain. Herpetic eruptions occasionally appear along nerve-tracks; chill and storm aggravate them (Ericaceæ echo) [Hering]. No marked pruritus; the surface signs mirror vascular tone.

Aetiology / Metastatic rheumatism → heart

• Spigelia — Left-sided heart pains, stabbing, worse from motion; marked eye neuralgia; less “from above downward”; pulse not typically slow. Kalmia has bradycardia and left arm numbness. [Farrington], [Clarke]

• Cactus grand. — Constrictive “iron band” with cyanotic anxiety; less neuralgic descent; pulse may be quick. Kalmia shows shooting scapular-to-arm pains with slow pulse. [Kent], [Farrington]

• Digitalis — Slow, weak, irregular pulse with syncope; little neuralgia or downward pains; fear of motion from faintness rather than pain. [Clarke], [Nash]

• Rhus-t. — Rheumatism worse at first motion, better for continued motion; heart rarely central; pains not characteristically downward. [Kent], [Boger]

Direction of pains (keynote)

• Ledum — Gout/rheumatism ascend from feet upward; better from cold; heart not central. Kalmia pains descend. [Boger], [Boericke]

• Rhododendron — Storm-sensitive like Kalmia; wandering rheumatism, but no fixed “downward” direction and less cardiac nexus. [Clarke]

• Colocynthis — Neuralgia relieved by pressure and heat; direction indifferent; lacks cardiac features. [Farrington]

Trigeminal / cervico-brachial neuralgia

• Mezereum — Facial neuralgia with burning, extending to teeth; eruptions; less descent into arm; little heart connection. [Clarke]

• Mag-phos. — Cramping lightning-like neuralgia, better warmth/pressure; lacks post-pain numbness typical of Kalmia. [Boger], [Phatak]

• Cedron — Periodic supraorbital/right malar neuralgia, clock-like periodicity; less descending trajectory. [Clarke]

Heart radiation to left arm

• Naja — Moral depression, valvular lesions, stinging left-arm pains; pulse usually quick; less numbness, more suffocation at night. [Clarke], [Farrington]

• Arnica — Sore, bruised heart with arm pains after strain; no fixed downward neuralgic pattern. [Kent]

• Aconite — Panic, rapid pulse, acute onset; no residual numbness. [Kent]

Weather-change neuralgia

• Dulcamara — Damp-cold aggravation with catarrh; muscular rather than neuralgic focus; no cardiac picture. [Clarke]

• Bryonia — Stitching pains, worse from motion, better pressure or lying on painful side; direction not fixed; pulse not slow. [Kent]

Eye (ciliary) neuralgia

• Spigelia — Left orbital stabbing, worse from motion, marked photophobia; lacks numbness after pain. [Farrington]

• Gelsemium — Dull heaviness with diplopia and prostration; pulse slow but pains not shooting downward. [Clarke]

• Complementary: Spigelia — Both cardiac–neuralgic remedies. Kalmia when the pulse is slow and pains descend; Spig. when left eye/heart predominates without numbness. [Farrington], [Clarke]

• Complementary: Rhododendron — Storm-sensitive subjects. Rhod. when storm-sensitivity dominates without heart signs; Kalmia when downward pains and cardiac symptoms appear. [Clarke]

• Complementary: Digitalis — Follows Kalmia where bradycardia and weakness persist without neuralgia. [Nash], [Clarke]

• Complementary: Arnica — After cardiac overstrain or chest-wall soreness remains when Kalmia has quelled descending pains. [Kent]

• Follows well: Aconite — In acute rheumatic invasion. Kalmia follows when pains establish their downward course with cardiac anxiety. [Farrington]

• Follows well: Bryonia — When stitching rheumatism passes into neuralgic descent with heart-reflex symptoms. [Kent]

• Precedes well: Cactus grand. — If constriction becomes the dominant heart sensation after the neuralgic phase abates. [Farrington]

• Related (family): Ledum (upward pains), Rhododendron (storm pains), Kali-bi. (periosteal or spot pains without heart), Actæa spicata (small-joint rheumatism). [Clarke], [Boger]

• Antidotes: Camphor for over-action; rest, head-high posture, and cool air palliate cardiac spells (directional aids). [Clarke], [Hering]

• Inimicals: None fixed; avoid alternation with Digitalis without fresh indications, as both act strongly on the pulse. [Kent]

• Rheumatic heart sequelae — Precordial stitches to left scapula and down the left arm, slow intermittent pulse, worse from motion, better rest and head high. Kalmia often cuts the cardiac–neuralgic storm. [Farrington], [Clarke]

• Neuralgia — Trigeminal (right) or cervico-brachial with downward radiation and post-pain numbness. Select Kalmia over Mag-phos. (cramping, better warmth) and Mezereum (burning). [Hering], [Clarke], [Boger]

• Wandering rheumatism — Descending pains; knees give way when going downstairs. Suppression of sweat or joint pains precedes palpitation—this sequence guides the prescription. [Hering], [Kent]

• Potency guidance — Tincture not used internally. 6C–30C in acute neuralgia; 30C–200C where cardiac features predominate. Repeat cautiously—over-dosing may aggravate pulse irregularity (watch the wrist). [Dewey], [Nash], [Boericke]

• Regimen — Insist on rest, loose collar, head elevation, cool, still air during attacks; avoid stimulants and sudden movements. [Clarke]

Mind

• Anxiety — heart; fears to move lest it stop—guides rest posture. [Clarke], [Kent]

• Fear — suffocation with slow pulse; cardio-vagal picture. [Farrington]

• Irritability — during neuralgic stabs; apathy after—spasm ↔ numbness. [Hering]

• Aversion to motion — dreads downward pains; cautious bearing. [Boger]

• Consolation — desires gentle reassurance during heart spells. [Clarke]

• Weather — approaching storm makes him gloomy and expectant—meteorotropism. [Clarke]

Head

• Headache — occiput to nape, shooting downward; worse motion, stooping. [Hering]

• Neuralgia — supraorbital into cheek (right); downward radiation. [Allen], [Clarke]

• Constriction — band-like with slow pulse; cardiac link. [Clarke]

• Weather change — head pains before storm—Ericaceæ sign. [Clarke], [Boger]

• Turning head — sends pains into arm; cervico-brachial map. [Hering]

• Photophobia — with ciliary neuralgia; better dark and rest. [Allen]

Eyes

• Ciliary neuralgia — stabbing, worse movement, better dark. [Hering]

• Vision — dim during palpitation; sparks with slow pulse. [Allen], [Clarke]

• Pain — above right eye → cheek/teeth; downward. [Clarke]

• Eyelid — twitching with shooting pains. [Allen]

• Light — aggravates stabbing orbit pains; quiet room helps. [Hering]

• Weather — storm revives eye-pains; family trait. [Clarke]

Face / Teeth

• Neuralgia — right malar/maxillary, shooting downward, numbness after. [Hering], [Clarke]

• Pain — teeth → ear and neck; motion/air aggravate; warmth/pressure help. [Hering]

• Coldness/numbness — face after paroxysm; objective sign. [Clarke]

• Toothache — neuralgic, downward radiation; gusts aggravate. [Hering]

• Jaw motion — excites descent of pain; avoid chewing in attacks. [Clarke]

• Touch — tender along infraorbital nerve; firm pressure relieves. [Hering]

Throat / Chest / Heart

• Palpitation — slow, intermittent pulse; left arm numbness; cannot lie on left side. [Hering], [Farrington], [Clarke]

• Pain — heart → left scapula → left arm; descending heart-map. [Farrington]

• Dyspnœa — on least effort; better head high, quiet. [Clarke]

• Tight collar — intolerable; reflex throat–heart sign. [Clarke]

• Stitches — præcordial, worse motion; rest imperative. [Hering]

• Nausea — with cardiac oppression; vagal link. [Allen]

Back / Extremities

• Cervico-brachial neuralgia — from nape down arm; worse turning/motion. [Hering], [Clarke]

• Rheumatism — pains descend shoulder → elbow → wrist → fingers. [Boger], [Boericke]

• Knees — give way, especially descending stairs. [Boger]

• Hip → knee → ankle — downward shooting with weakness after. [Hering]

• Numbness — follows pains; cold hands with slow pulse. [Clarke]

• Motion — aggravates; rest ameliorates—key rubric. [Kent]

Stomach / Urinary / Generalities

• Sinking — epigastrium with palpitation; vagal link. [Allen], [Farrington]

• Urine — scanty, albuminous in cardiac states. [Clarke], [Nash]

• Modalities — worse storms/cold wind; better quiet, head high—master polarity. [Clarke], [Boger]

• Suppression — of rheumatism → heart symptoms (direction of disease). [Hering], [Kent]

• Direction of pains — from above downward; general keynote rubric. [Hering], [Boger]

• Pulse — slow with anxiety; discordant circulation. [Clarke]

Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): provings and clinical confirmations—downward pains; neuralgia; cardiac radiation; modalities.
Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): proving data—neuralgia; vagal sinking; slow, intermittent pulse; weather aggravations.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): full remedy portrait—cardiac left-arm numbness; Ericaceæ storm-sensitivity; relationships.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—pains descending; rheumatism with heart signs; modalities.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): direction (above → below); storm aggravation; motion worse; numbness after pains.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): miasmatic tone; suppression → heart; comparisons with Spig., Cact., Led., Rhod.
Farrington, E. A. — Clinical Materia Medica (1890): cardiac–neuralgic differentiations; scapular radiation; management (rest, head high).
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): cardiac indications; albuminous urine in heart cases; comparisons with Digitalis.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (20th c.): condensed keynotes—downward pains; slow pulse; modalities; cervico-brachial neuralgia.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): toxicology of Ericaceæ (grayanotoxin) and cardiovascular/neurologic correlates.
Dunham, C. — Homœopathy, the Science of Therapeutics (1877): neuralgia–rheumatism inter-relations; direction-of-symptoms in selection.
Tyler, M. L. — Homœopathic Drug Pictures (20th c.): vivid clinical image—“from above downward,” left arm numbness, weather-reactivity.
Lippe, A. von — Keynotes and Characteristics with Comparisons (late 19th c.): selecting keynotes—pains descend; numbness after pains; motion agg.
Boenninghausen, C. von — Therapeutic Pocket-Book (1846 & later eds.): rubric relationships—direction of pains; weather modalities among Ericaceæ.