Lachesis

The venom of Lachesis muta (Bushmaster, family Viperidae, subfamily Crotalinae) yields a complex mixture of proteases, peptidases, haemorrhagins, and fibrinolysins producing haemorrhagic, septic, and vasomotor phenomena in toxicology—bluish discolorations, ecchymoses, oozing of dark, non-coagulable blood, and cardiac-depressive effects [Hughes], [Clarke], [Allen]. In homeopathic preparation the venom is triturated and subsequently potentised; despite infinitesimal dose the clinical picture retains the toxicologic signature: sepsis, purplish congestions, left-sided anginoid and throat affections, and a characteristic intolerance of constriction about neck or waist [Hering], [Kent], [Boericke]. The mental portrait centres on loquacity, jealousy, suspicion, and religious or prophetic exaltation—an impression of the “chosen speaker” whose words outrun disciplined thought [Kent], [Clarke], [Allen].

First systematically proved and introduced by Constantine Hering (c. 1828–1830s, Surinam/Philadelphia), using the dynamised venom; early confirmations by Hering, Lippe, Dunham, and Allen in septic, haemorrhagic, and climacteric states. [Proving] [Hering], [Allen], [Lippe], [Dunham].

Lachesis is the hot, congestive orator whose voice is both symptom and salve. The venom’s haemorrhagic–septic logic writes itself across the mind as jealous suspicion, rapid associative speech, and a need to discharge—through words, sweat, bleeding, or menses—what the system cannot bear to hold. The keynote polarity is constriction versus release: collars, bands, and narrow spaces are intolerable; the throat seems gripped by a hand, the chest by a cord, and even the mind feels throttled unless permitted to speak. Hence the famous loquacity—talk that leaps from theme to theme, sermonising, advisory, sometimes with a religiose tint that imagines inspiration, mission, or prophetic status. This is the false-guru posture: persuasive warmth, charisma, and claim to wisdom, but with corrosive jealousy and suspicion when rivals appear or loved ones dissent—a trait authoritatively sketched by Kent, Hering, Clarke, and Allen [Kent], [Hering], [Clarke], [Allen]. The physiology mirrors the psychology. Venous congestion darkens tissues (purple, livid), septic tendencies exude foulness, and discharges of dark, fluid blood relieve pressure. The left-sidedness (throat, ovary, face) gives Lachesis its geographic stamp, as does the timing: worse after sleep. The patient “sleeps into aggravation,” waking with a throttled throat and a mind swarming with suspicious thoughts that must spill out; relief appears as talk, as epistaxis, as free menses, as sweat—echoing the affinity and modalities already laid out. Thermal reactivity is hot; heat and sun expand the vascular storm; open air soothes. At the climacteric, this architecture is iconic: hot flushes, palpitations, choking on falling asleep, left ovarian ache, jealousy and fluency, intolerance of collars, better when menses flow. Distinguish Lachesis from Sulphur’s grandiose theorist (less jealous, more slovenly abstraction), from Veratrum’s missionary zealot (more rigid moral harangue, colder collapse), and from Stramonium’s terror-stricken prophet (hallucinatory, fright-driven). In septic typhoid-like states, compare Baptisia’s stuporous besotted hush with Lachesis’ dusky, loquacious fever. In haemorrhagic diathesis, separate Crotalus’ yellow-icteric bleeding from Lachesis’ dark, fluid, purple oozings. The totality—hot, jealous, loquacious, purple, left-sided, worse after sleep, better by discharges—writes the Lachesis name across mind and body in unmistakable letters [Kent], [Hering], [Clarke], [Allen], [Hughes], [Boericke].

• Blood and vasculature (haemorrhagic–septic states): dark, fluid, decomposed bleedings; tendency to ecchymoses and purple discoloration; septic throat and wound states reflect venom haemorrhagins [Hughes], [Allen]; echoed under Fever/Generalities (bluish, prostrated sepsis).
• Throat and larynx (left-sided choking, constriction): violent odynophagia, left→right spread, intolerance to collars; “as if strangled on falling asleep” [Hering], [Kent]; echoed under Throat/Respiration.
• Heart and circulation (flushes, tachyarrhythmia): climacteric hot flushes, palpitation, congestive headaches; purple cyanosis tendency [Clarke], [Boericke]; echoed under Chest/Heart/Generalities.
• Female pelvis (climacteric, ovaries—left): congestive, painful left ovary; menses relieve congestions (amelioration from discharges) [Hering], [Kent]; echoed under Female/Modalities.
• Mind and speech centre (loquacity, jealousy, religiose exaltation): rapid topic-switching, “prophet” delusion; seductive rhetoric with underlying suspicion [Kent], [Clarke]; echoed under Mind.
• Skin and ulcers (purple, indolent, phagedenic tendency): dusky margins, tendency to bleed; septic, malignant sore throats and carbuncles [Hering], [Allen]; echoed under Skin/Throat.
• Left side and left-to-right progression: left throat/ovary/face first; modalities reinforce lateral affinity [Kent], [Hering]; echoed under Head/Throat/Female.
• Neck/waist (cannot bear constriction): intolerance of tight clothing, especially at neck; choking sensation [Kent], [Boericke]; echoed under Generalities/Throat.
• Sleep centre (aggravation after sleep): “sleeps into aggravation”; wakes worse, confused, choking [Kent], [Hering]; echoed under Sleep/Generalities.
• Alcohol and heat sensitivity: worse heat and sun; alcohol provokes mental looseness and vascular flush [Clarke], [Boericke]; echoed under Modalities/Generalities.
• Septic mucosae (nose→throat→chest): purple, fetid, bleeding mucosae [Allen], [Hering]; echoed under Nose/Throat/Chest.
• Speech/breath coupling: talking excites cough, palpitation, and congestions [Kent], [Boericke]; echoed under Respiration/Chest.

The mental sphere is a drama of congestion and release: the head teems with words that must escape or else the chest and throat feel strangled. Speech is rapid, digressive, and dazzling, with loquacity and swift topic-changes; the patient often feels unusually wise, inspired or “chosen,” preaching or advising others with a tone of certainty that conceals an unstable inner core [Kent], [Allen], [Clarke]. Religious or prophetic colouring is frequent—“a divine mission,” “a special insight”—the false-guru posture of self-exaltation, jealousy of rivals, and suspicion of dissenters; here Lachesis can look like a charismatic leader whose warmth is edged with envy and possessiveness [Kent], [Hering], [Clarke]. Jealousy is intense, sometimes irrational; suspicion reads plots into casual words; this can be domestically destructive and clinically decisive [Hering], [Boericke]. The mind is worse on waking and after sleep; thoughts feel heavy, resentful, and choking, as if the act of sleeping congealed the inner venom—relieved when the tongue is set free to talk (echoing the modality “worse after sleep,” “better by discharges” but here as verbal discharge) [Kent], [Hering]. There is an intolerance of contradiction; criticism ignites a torrent of speech or silent smouldering jealousy, with micro-comparisons favouring Lachesis over Sulphur (the latter theorises grandly yet is less suspicious) and over Veratrum (more missionary zeal with moral harangue) [Kent], [Clarke]. Sexual and religious themes intermix in some states (snake archetype): seductive rhetoric, magnetism, and a proprietary, jealous love that regards others as spiritual property [Kent], [Tyler]. Fear of poison, of snakes, of being harmed is found, paradoxically alongside the identification with serpentine power [Hering], [Allen]. Periods of despair and self-reproach occur after jealous storms, yet typically without the clinging remorse of Staphysagria; instead there is a hard pride that seeks release in talk or tears, or (characteristically) finds relief when menses or other discharges flow [Hering], [Kent]. Case pearl: a woman at the climacteric, “preaching” to family with nightly torrents of speech, waking choking and hot, improved dramatically after Lachesis 200C—speech softened as hot flushes and throat constriction receded [Clinical] [Tyler], [Boericke].

A keynote: aggravation after sleep—“sleeps into aggravation.” The patient dreads the moment of drifting off because choking and strangling sensations arise; on waking, the mind is darker, more suspicious, and the throat tighter, until “discharges” occur (speech, bleeding, menses) [Kent], [Hering]. Sleep is unrefreshing; dreams are vivid, often jealous or religious in colouring; talking in sleep or waking with a gasp is common [Clarke]. Daytime naps are especially treacherous; even a short doze provokes a storm on waking [Kent]. Motion to sit up and loosening the collar are instinctive acts of relief [Hering]. Heat of bed aggravates; open window improves [Clarke]. Compare Sulphur (hot, restless but not choked) and Opium (sleep heavy, breathing stertorous yet mind stupefied rather than suspicious) [Kent], [Farrington]. Case pearl: recurrent nocturnal choking at the menopause with jealous tirades in the daytime resolved when sleep aggravation and left-sided throat were recognised and Lachesis selected [Clinical] [Tyler].

Dreams of snakes, strangling, preaching, jealousy, or pursuit are frequent; the patient may awake hot, talking, or suspicious [Hering], [Clarke]. Dreams often presage fever flares or menses; discharge (sweat, bleeding) restores equilibrium [Allen]. Religious or leadership fantasies appear—a shadow of the day-time “prophet” stance [Kent]. Dreams aggravate after day-naps [Hering]. Compare Stramonium (terrifying, demonic) vs Lachesis (jealous/serpentine with speech) [Clarke]. Music or prayer in dreams may feel ecstatic yet leaves throat tight on waking [Kent].

Left-sidedness, intolerance of constriction (neck, waist), septic–haemorrhagic predisposition, hot reactive circulation with purple hue, “worse after sleep,” and better by discharges are the general architecture [Hering], [Kent], [Allen]. Speech operates as a quasi-physiologic discharge: talking eases oppression even as it can aggravate palpitation and throat (bidirectional mind–body link) [Kent]. Heat and sun worsen; open air and loosening garments relieve [Clarke], [Boericke]. Alcohol, jealousy-provoking stimuli, and contradiction precipitate storms; the patient is magnetically engaging yet corrosively suspicious [Kent], [Clarke]. Venous states (ulcers, haemorrhoids, carbuncles) carry the purple signature and bleed dark, fluid blood [Hughes], [Allen]. The remedy’s timing around menopause is classic, but the pattern appears in both sexes: congestive storms with a rhetoric-driven mind, left-sided throat/ovary, choking on sleep, and relief by outward flows [Hering], [Tyler]. Micro-map: compared with Sulphur (theorist, careless), Veratrum (missionary zeal), and Stramonium (psychotic religious terror), Lachesis is the jealous prophet-orator who loosens the collar to keep talking [Kent], [Clarke].

Septic, low typhoid forms with livid patches, dark haemorrhages, and loquacious delirium typify Lachesis fevers [Hering], [Allen]. Heat surges upward (head, face) with cool extremities; worse warmth and after sleep; better by epistaxis or other drains [Clarke]. Sweat may be offensive; alternations of chill and flush near the menopause are frequent [Boericke]. Pulse excitable with talk; speech fans the fever [Kent]. Tongue dusky, tremulous, and dry at tip [Hering]. Compare Baptisia (prostration with besotted stupor) vs Lachesis (loquacious, suspicious, dusky) [Farrington].

Chill creeps with venous stasis; heat mounts to head with choking; sweat foul and relieving when it breaks, consistent with the “better by discharge” law [Hering], [Allen]. Heat of sun or room aggravates; open air helps [Clarke]. Sweats on slight effort accompany palpitations and jealous excitement [Kent]. Cold extremities with hot face are notable [Boericke]. After short sleeps, an immediate recrudescence of heat appears [Hering]. Micro-comparison: Glonoinum’s sun-heat explodes the head, but lacks jealousy and choking [Farrington].

Congestive headaches surge with a purple, bursting quality, often left-sided or beginning left and travelling right; the scalp may feel tight, as if a band or collar encircled the head (mirroring the intolerance of constriction at neck) [Hering], [Kent]. Heat crowds the head with throbbing temples, worse from sun, warm rooms, wine, or after sleep, better open air, better if a nosebleed breaks the load (a “discharge” modality mirrored somatically) [Allen], [Clarke]. Vertigo on turning in bed, particularly on first moving after sleep, is frequent; patients may grip the neck or loosen scarves instinctively [Hering], [Boericke]. Hair and scalp become sensitised; the skin can feel sore with the congestive swelling, sometimes with small purple spots or livid hue in violent attacks [Allen]. Mental exertion aggravates cephalalgia when it inflames the speech-drive; conversely, gentle talking to “vent” the heat may relieve in a paradoxical way—reflected in Mind and Generalities cross-references [Kent]. Headaches at the climacteric with flushes, palpitation, and a desire to remove tight pins or bands, strongly point to Lachesis rather than Sanguinaria (which is right-sided and periodic with sun-headache) [Clarke], [Tyler].

Vascular congestion imparts a bloodshot, glistening look in febrile or jealous storms; lids may be puffy, with livid or bluish tints in septic states [Hering], [Allen]. Photophobia attends hot flushes; visual disturbance with vertigo on rising after sleep reflects the general “worse after sleep” pattern [Kent], [Clarke]. Lachrymation may be acrid, and in malignant sore throat or measly states the conjunctiva partake of the purplish congestion [Hering]. Ocular symptoms often ease in cool air and worsen in heated rooms, mirroring general modalities [Clarke]. The patient may dislike pressure about the brows and orbits, paralleling the intolerance of bands elsewhere [Kent]. Comparison with Crotalus and Phosphorus: the former more haemorrhagic with yellow icteric tinge; the latter more photophobic and anxious with bright haemorrhage—Lachesis has the purple, septic hue and jealous talkative mental colour [Allen], [Farrington].

Congestive tinnitus, pulsing with the circulation, is frequent during flushes or jealous excitement, worse after sleep and heat, better in cool air [Hering], [Clarke]. Otalgia may be left-sided, with sore meatus and purple engorgement in septic colds [Allen]. Sounds can be intolerable when the mind is excited; yet the patient often wants to talk more than to listen, a behavioural keynote reflected in Mind [Kent]. External ears can appear dusky in low fevers; the patient loosens scarves or jewellery due to a sensation of strangling [Hering]. Hearing may feel obstructed from venous congestion and improves when an epistaxis or menses unloads the system [Allen]. Unlike Nux-v. (irritable but contained), Lachesis spills noise outward—loquacity with vascular din [Kent].

Epistaxis of dark, fluid blood relieves head and chest congestion; bleeding often comes in hot rooms or after sleep and mitigates headache (classic “better by discharge”) [Allen], [Hering]. Coryza tends to be purplish, with raw, sore septum, and a tendency to sore throat extension (left-sided) [Hering]. Smell may be perverted in septic states; odours seem oppressive in warm rooms, better open air [Clarke]. Sneezing triggers throat irritation and choking tendency; touch at the bridge may be painful [Allen]. Nasal obstruction alternates sides but tends to begin left; pressure from spectacles can be intolerable (constriction theme) [Kent]. Differential: Crotalus more yellow haemorrhage; Lachesis darker, fluid, septic [Farrington].

Flushes and a purplish tinge with livid lips or mottled cheeks mark vascular storms; the face is hot while extremities may be cool—unequal circulation [Hering], [Clarke]. A dusky, congested look in malignant sore throat or low fevers is a red flag; lips may bleed easily [Allen]. Tight collars, scarves, or jewellery provoke discomfort and irritability; patients often tear them off (echoes Generalities/Throat) [Kent]. Left-sided facial neuralgia with throbbing heat, worse touch and heat, better open air and discharges, is characteristic [Hering]. Expression alternates between seductively animated and suspiciously contracted; the eyes glitter during speech torrents [Kent]. Compare Belladonna (red, brilliant, acute, right-sided); Lachesis is duskier, left-onset, septic [Clarke].

Tongue is swollen, trembles, and may be protruded with difficulty—sometimes catches between the teeth; the tip can be red or the whole tongue purplish, with imprint of teeth [Hering], [Allen]. Saliva can be stringy, offensive in septic states; talking aggravates dryness and heat, yet the impulse to talk persists (mind–mouth axis) [Kent]. Aphthae bleed readily; gums spongy and dark [Allen]. Taste altered; fluids may choke in sensitive throats [Hering]. The mouth is worse after sleep and heat; better as discharges establish (e.g., menses) [Kent], [Clarke]. Micro-comparison: Mercurius also has flabby, indented tongue and fetor, but is more sweat-ridden and chilly; Lachesis is hotter, more congestive, more loquacious and jealous [Hering], [Clarke].

Toothache throbbing, congestive, worse warmth and wine, better cool air; gums bleed easily and look dusky [Allen], [Clarke]. Pain can be left-sided with facial extension; pressure is poorly tolerated [Hering]. Nocturnal aggravation, especially after a nap, aligns with global sleep modality [Kent]. Teeth feel elongated in septic states; clinching may occur in jealous rages [Hering]. Lachesis differs from Nux-v. (contractile, spasmodic) by its venous, dusky character and heavy heat [Clarke]. Relief follows nasal or menstrual discharges that reduce head congestion [Allen].

A leading sphere: violent left-sided soreness and choking with exquisite tenderness to touch or pressure—cannot bear even a light collar; slightest contact provokes a strangled gasp [Hering], [Kent]. Pain and inflammation often begin on the left and travel right; fauces look dark, purple, oedematous; swallowing liquids may be more difficult than solids (“liquids go the wrong way”) [Allen], [Clarke]. The sensation of a plug or constriction intensifies on falling asleep—patient starts up, choking—mirroring the “worse after sleep” keynote [Kent]. Talking aggravates, yet there is an urge to talk; the paradox reflects the mental motor of discharge and the physical intolerance of laryngeal contact [Kent]. Malignant sore throat, diphtheritic or septic states with fetor, lividity, and dark haemorrhagic oozing are classic Lachesis fields [Hering], [Allen]. Distinguish from Mercurius (salivation, bone-aching chilliness) and Belladonna (scarlet heat, right-sided onset); Lachesis is dusky, left-onset, touch-intolerant, and talks as if inspired [Clarke], [Farrington].

Palpitation with flushes; sensation of suffocation, especially on first falling asleep; must loosen clothing and sit up [Hering], [Kent]. Talking excites palpitation; jealousy provokes vascular storms (mind–chest axis) [Kent]. Cyanotic lips or dusky nails in low fevers betray venous stasis [Allen]. Stitching left chest pains may extend from left breast/ovary upward [Clarke]. Heat aggravates; cool air relieves [Clarke]. Compare Naja (moral sadness, cardiac oppression more constant) vs Lachesis (jealous heat, choking) [Farrington].

Intermittent, tumultuous action with congestive surges; hot flushes with faintness; worse after sleep and heat, better open air and after free bleeding (epistaxis/haemorrhoids) [Allen], [Hering]. Endocardial murmurs may accompany septic states; pulse easily excited by speech and emotion [Clarke], [Kent]. Constriction sensation around precordia parallels neck intolerance [Hering]. Alcohol exaggerates palpitations and mental heat [Clarke]. Distinguish from Digitalis (slow, weak, fear to move) and Glonoinum (explosive sun-head with surges) [Farrington].

Choking on falling asleep, laryngeal touch-intolerance, left laryngeal soreness, and hoarseness from talking are classic [Hering], [Kent]. Cough worsens with speech and pressure at the neck; warm rooms aggravate; open air relieves [Clarke], [Boericke]. Dyspnoea feels like a noose tightening, compelling loosening of clothes [Kent]. Paroxysms worse after naps (day sleep) [Hering]. Sputa dark or streaked in septic broncho-laryngeal states [Allen]. Compare Hepar (extreme touch sensitivity but chilly, suppurative) vs Lachesis (hot, jealous, purple) [Clarke].

Aversion to tight waistbands; fullness from small quantities; nausea with faint, hot flushes, worse after sleep and in warm rooms [Hering], [Clarke]. Craving for alcohol may trigger mental disinhibition and flushes (aggravation) [Clarke]. Burning or sinking at epigastrium feels better for loosening clothing and sometimes after a nasal or uterine discharge lessens venous load [Allen], [Hering]. Sensation of cork or obstruction aligns with global constriction theme [Kent]. Hiccough or gulping with choking tendency appears when laughing/talking [Hering]. Compare Nux-v. (spastic, chilly, irritable) vs Lachesis (congestive, hot, jealous, worse after sleep) [Kent].

Venous congestions—purple haemorrhoidal tendency, tympanitic discomfort worse heat and after naps—improve transiently after stool or bleeding (again “better by discharge”) [Allen], [Hering]. Left ovarian irradiation is common in women; in men, left inguinal sensitivity may echo pelvic congestion [Clarke]. Clothing pressure is intolerable; patients unbutton or wear loose garments [Kent]. Abdominal sepsis (typhoïde tendency) shows lividity, prostration, and a loquacious delirium out of proportion to strength [Hering], [Allen]. Gas and pulsation in epigastrium worsen when lying left; better in cool air [Clarke]. Distinguish from Crotalus (more severe haemorrhagic jaundice) [Farrington].

Haemorrhoids dark, bleeding easily, and relieving head/chest congestion when they flow; when suppressed, symptom-rebound ensues [Allen], [Hering]. Tenesmus may be spasmodic with choking sensation on straining (neck–rectum constriction mirror) [Hering]. Left-sided anal pain or burning fits the lateral tendency [Kent]. Stool may be offensive, dysenteric, with purple prolapse in malignant states [Allen]. Pain worse after sleep; better cool applications (select) [Clarke]. Compare Sulphur (burning, red, dirty) vs Lachesis (dusky, congestive, jealous talker) [Kent].

Urine dark, offensive in low fevers; haematuria with dark fluid blood in septic states [Allen], [Hughes]. Strangury from pelvic congestion; pressure at waistband aggravates [Hering]. Urging worsens after nap; better as general circulation steadies [Kent]. Nocturnal aggravation with heat aligns with global modalities [Clarke]. Compare Crotalus (bleeding with jaundice); Lachesis tends to purple congestion [Farrington]. Relief of mental oppression may follow free urination in congestive storms (minor discharge-relief echo) [Clinical].

Desire for alcohol or stimulants may aggravate mental and vascular picture; intolerance is shown by flush and loquacity [Clarke]. Aversion to tight waist after eating; small quantities cause fullness [Hering]. Thirst is variable; cold drinks may choke in throat states [Allen]. Craving for oysters or highly seasoned food appears in some provers [Hering]. Worse warm food/rooms during meals [Clarke]. Compare Nux-v. (coffee, spice, chill) vs Lachesis (heat, jealousy, constriction) [Kent].

Sexual desire may be heightened with jealousy and suspicion; impulses coloured by possessiveness and rhetoric [Kent], [Clarke]. Prostatic congestion worsens sitting and heat; clothing pressure is intolerable [Hering]. Left testicular or inguinal tenderness appears in venous stasis [Allen]. Emissions after jealous quarrels reflect psychosexual coupling of mind and pelvis [Kent]. After sleep aggravation of sexual excitement is noted [Hering]. Compare Hyoscyamus (lewd foolishness) vs Lachesis (jealous magnetism) [Kent].

A cardinal sphere: climacteric storms—hot flushes, palpitations, choking on falling asleep, jealousy and loquacity—defined Lachesis usage for generations [Hering], [Tyler], [Boericke]. Left ovarian pain, swelling, and sensitivity to tight clothing point strongly; symptoms often improve once menses or a leucorrhoeal discharge begins (discharge-relief) [Hering], [Kent]. Menses may be dark and offensive; pelvic congestions colour mood: suspicious, talkative, seductive, then repentant [Allen]. Menstruation or epistaxis often unloads congestive headaches and throat tightness [Hering]. Worse after sleep and in heat; better open air [Clarke]. Differentiate from Sepia (indifferent, bearing-down, chilly) and Sanguinaria (right-sided flush/headache) [Tyler], [Farrington].

Cervical hyperaesthesia; pressure at collars triggers discomfort and mood flare [Kent]. Left scapular or interscapular throbbing during flushes [Clarke]. Lumbar aching worse heat and after naps [Hering]. A sense of venous fullness around dorsal spine reflects general congestion [Allen]. Loosening garments relieves [Kent]. Compare Sepia (sinking backache with indifference) vs Lachesis (venous heat with jealousy) [Tyler].

Dusky, mottled hands and feet in low fevers; veins turgid; purplish spots appear easily [Allen], [Hughes]. Numbness and tingling worse heat, better motion; worse after sleep [Hering]. Cannot bear tight sleeves or garters [Kent]. Left-sided neuralgias are common [Clarke]. Varicosities bleed darkly and relieve head pressure when they do [Allen]. Compare Pulsatilla (venous, yielding, weepy) vs Lachesis (venous, hot, jealous, talkative) [Kent].

Purplish, ecchymotic tendency; ulcers with dusky margins and offensive oozing; carbuncles malignant in type [Hering], [Allen]. Erysipelatous inflammation with livid hue and sepsis marks the terrain [Hughes]. Scratches bleed freely; skin feels tight, band-like [Clarke]. Heat aggravates pruritus; cool air soothes [Clarke]. Septic rash in low fevers corresponds to internal state; bleeding dark, fluid [Allen]. Distinguish from Anthracinum (malignant sepsis) and Crotalus (more yellow-icteric haemorrhage) [Farrington].

Mind / “False-guru” axis

• Sulph. — Grand theories, vanity, neglect of details; less jealousy/suspicion than Lach., more indolent disarray [Kent], [Clarke].
• Verat. — Fanatic missionary pride, moral harangue; colder, often collapsing; lacks Lach. left throat and “after sleep” keynote [Clarke], [Farrington].
• Lach. vs Lach-like snakes (Crot-h., Naja): Crot-h. more jaundice–haemorrhage; Naja more cardiac oppression with moral sadness; Lach. has jealousy, loquacity, left-throat [Farrington].

Religious/psychotic colouring

• Stram. — Holy terror, visions, violence; less jealousy, more fear-driven; right-sided head; photophobia [Kent], [Clarke].
• Hyos. — Lewd foolishness, boastful divinity without dignity; lacks Lach. suspicion and choking [Kent].

Climacteric / Pelvic

• Sep. — Bearing-down, indifference, chilly; not jealous–loquacious; clothing pressure less decisive [Tyler].
• Sang. — Flushes, right-sided head/ovary; less “after sleep,” less jealousy [Tyler].

Throat

• Bell. — Scarlet, right-sided, throbbing; fears, delirium; lacks dusky sepsis and collar intolerance of Lach. [Clarke].
• Merc. — Salivation, bone-deep chilliness, foulness; talkativeness absent; Lach. hotter, left-onset [Hering], [Clarke].
• Hepar. — Needle-like pains, extreme touch-sensitivity but chilly and suppurative; Lach. is hot, dusky, septic, and jealous [Clarke].

Haemorrhagic–Septic

• Crot-h. — Yellow-icteric haemorrhage; profound prostration; less loquacity [Farrington].
• Phos. — Bright red haemorrhage, anxious openness; lacks jealousy and “after sleep” [Kent].
• Bapt. — Prostration with besotted stupor; no talk torrents [Farrington].
• Anthracinum — Malignant sepsis without Lach. mental picture [Clarke].

Modalities

• Glon. — Sun-heat explodes head; no jealousy/suspicion; no collar-intolerance [Farrington].
• Nux-v. — Worse morning, irritable, spasmodic; not jealous–loquacious; chilly rather than hot [Kent].

• Complementary: Sulph. — often opens or follows Lach. in congestive, venous constitutions; both antipsoric; Sulph. clears residual skin/venous reactivity [Kent], [Boericke].
• Complementary: Lyc. — in chronic venous states with pride–cowardice; may follow Lach. when jealousy softens [Kent], [Clarke].
• Follows well: Nux-v. — after drugging or gastric irritability, Nux-v. may precede Lach. when heat/jealousy emerge [Kent].
• Follows well: Phos. — when bright haemorrhage replaces dark, consider Phos. after Lach. phase [Farrington].
• Precedes well: Sep. or Sang. in climacteric sequences when the polarity changes to indifference or right-sidedness [Tyler].
• Antidotes: Ars., Nux-v., Op. for medicinal overaction—watch for over-talkative heat with choking [Boericke].
• Is antidoted by: Nux-v., Coff. in mental over-excitement (select cases) [Boericke], [Clarke].
• Compare: Crot-h., Naja, Bothrops—close venous–haemorrhagic family; Lach. most jealous–loquacious [Farrington].
• Inimical/Non-compatible: reported difficulties alternating with Merc. (clinical caution rather than absolute) [Clarke].
• Tissue relationships: Carb-v. in terminal venous collapse; Bapt. in typhoid states with mute stupor [Farrington].

• Climacteric storms: hot flushes with choking on falling asleep, left ovary, jealousy and talk torrents—Lachesis often first choice; many authors favour 200C or higher, single dose, and long observation [Tyler], [Boericke], [Kent].
• Septic throat/ulcer states: purple, dusky, touch-intolerant, dark bleeding; consider high potencies when mental picture concurs; watch “after sleep” aggravation [Hering], [Allen].
• “False-guru” mental set: loquacious, jealous, prophetic posture with worse after sleep; striking results when the collar intolerance and discharge-relief modalities concur [Kent], [Clarke].
• Dosing & repetition: in chronic Lachesis pictures, single dose and wait (weeks) is classical; repeat only on clear relapse of the whole state. In septic acutes, repetition may be closer but avoid mechanical dosing—follow vital reaction [Kent], [Dunham].
• Intercurrents/sequences: where bright haemorrhage supersedes dark, consider Phosphorus; where indifference replaces jealousy in the menopause, Sepia; where jaundice–haemorrhage deepens, Crotalus [Farrington], [Tyler].

Case pearls

• Choking at sleep + left throat + jealous talk: 200C single dose → relief of nocturnal strangling; speech softened over 2–3 weeks [Clinical] [Tyler].
• Dusky carbuncle with talkative delirium: high potency improved oozing and odour within 24–48 h when “after sleep” and collar-intolerance were present [Clinical] [Hering].
• Climacteric palpitations, collar intolerance, relief by epistaxis: Lachesis followed by Sulphur settled residual venous irritability [Clinical] [Kent], [Boericke].

Mind

• Loquacity; jumps from subject to subject — decisive keynote; matches “speech as discharge” [Kent].
• Jealousy; suspiciousness — corrosive domestic element; confirms mental colour [Hering].
• Religious mania; thinks she is a prophet; delusion of mission — the “false-guru” signature [Kent], [Clarke].
• Worse after sleep; mental — darkens on waking; fuels choking and suspicion [Kent].
• Intolerance of contradiction — triggers torrents or smouldering envy [Kent].
• Amelioration by expression (talking/weeping) — mental discharge relieves [Hering].

Throat

• Soreness left-sided; extends right — classic lateral key [Hering].
• Liquids more difficult than solids — neuromuscular choke pattern [Allen].
• Cannot bear touch at neck/collar — constriction hallmark [Kent].
• Diphtheritic/malignant; dusky, purple — septic sphere [Hering], [Allen].
• Choking on falling asleep — sleep-throttle keynote [Kent].

Generalities

• Worse after sleep — global law of aggravation [Kent].
• Better by discharges (menses, epistaxis, sweat) — venous unload relief [Hering].
• Left-sided; left→right — remedy geography [Hering].
• Heat aggravates; open air ameliorates — thermal pattern [Clarke].
• Intolerance of constriction (neck, waist) — identity keynote [Kent].

Female

• Climacteric flushes with choking/palpitations — menopausal signature [Tyler], [Boericke].
• Ovary; left; congested, tender — pelvic focus [Hering].
• Menses dark, offensive; relief with flow — discharge law [Allen].

Chest/Heart

• Palpitation from talking/emotion — speech–heart coupling [Kent].
• Suffocation on falling asleep; must sit up, loosen clothing — constriction [Hering].
• Flushes to head with cool extremities — circulation inequality [Clarke].

Skin

• Ecchymoses; purple, livid — haemorrhagic signature [Hughes].
• Ulcers, carbuncles; dark oozing — septic tendency [Hering], [Allen].
• Erysipelas; dusky — septic hue [Hughes].

Sleep

• Aggravation after sleep; day-naps aggravate — central keynote [Kent], [Hering].
• Talking in sleep; wakes choking — mind–throat axis [Clarke].

Hering — Guiding Symptoms (1879): clinical confirmations; left-sided, septic, throat; jealousy and loquacity.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): proving data; haemorrhagic/septic notes; tongue, throat.
Kent, J. T. — Lectures on Materia Medica (1897): mental portrait (loquacity, jealousy, prophetic delusion); sleep aggravation; modalities.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): clinical character; climacteric, thermal pattern, comparisons.
Boericke, W. — Pocket Manual of Homeopathic Materia Medica (1901): keynotes; climacteric; relationships.
Hughes, R. — A Cyclopaedia of Drug Pathogenesy / Manual (late 19th c.): toxicology; haemorrhagic physiology.
Farrington, E. A. — Clinical Materia Medica (1887): snake comparisons (Crotalus, Naja); haemorrhage differentials.
Dunham, C. — Homoeopathy, the Science of Therapeutics (1877): case orientation; dosing philosophy.
Lippe, A. — Keynotes and Characteristics (19th c.): early confirmations and pointers.
Boger, C. M. — Synoptic Key (1915): condensed keynotes; sepsis and modalities.
Tyler, M. L. — Homoeopathic Drug Pictures (1942): climacteric portraits; practical case notes.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1907): keynote emphasis and practical distinctions.
Phatak, S. R. — Materia Medica of Homeopathic Medicines (20th c.): condensed confirmatory notes (modalities).
Boenninghausen, C. von — Therapeutic Pocketbook (1846): repertory relationships (historical context).