• Liver and biliary tree—catarrhal hepatitis, portal congestion, right hypochondriac soreness, jaundiced tint; bilious diarrhœa (see Abdomen/Rectum) [Clarke], [Hughes], [Boericke].
• Duodenum and small intestine—watery, pitch-like stools; black, tarry, offensive evacuations with prostration (see Rectum) [Allen], [Hering].
• Portal circulation—venous fulness with sallow face, dull head, malaise; ague-type bilious fevers (see Fever/Generalities) [Hughes], [Boger].
• Stomach—bitter taste, nausea, empty sinking; intolerance of rich foods and fats (see Stomach) [Clarke], [Boericke].
• Head—dull frontal headache (over eyes), worse motion/after stool; bilious cephalalgia (see Head) [Allen], [Clarke].
• Gall-bladder colic facsimile—aching under right scapula, nausea, dark stools or, at times, clay-coloured stools in jaundice phases (see Abdomen/Rectum) [Clarke], [Farrington].
• Mucous membranes—bilious catarrh, foul mouth, slimy tongue (see Mouth/Throat) [Hering].
• • General nutrition—prostration after stool; faintness and chilliness with evacuations (see Generalities/Chill) [Allen], [Boericke].

• Rest, lying quiet after stool; siesta calms the head and liver ache [Clarke], [Boericke].
• Warm drinks and simple warm food; broths settle the stomach [Clarke].
• Warmth over the abdomen/right hypochondrium; hot flannel eases soreness [Hering].
• Open air, gentle walking after the acute purge subsides; clears the dull head [Boericke].
• Pressure with the hand or band about the waist in hepatic soreness [Clarke].
• Side-lying with knees up; some prefer the right side for gall discomfort [Farrington].
• Early light breakfast after a night of biliousness (micro-case); empties gently [Clarke].
• Quiet evening without study; dull headache lifts with disengagement [Allen].
• Time—stools moderate by midday after a morning storm (clinical) [Clarke].
• Small, frequent sips rather than large draughts (nausea) [Hering].

• Morning, especially after rising, 4–10 a.m.: bilious stools and head-dullness [Allen], [Clarke].
• After eating, particularly fat, rich foods; coffee may provoke a purge [Clarke], [Boericke].
• Motion; jar of walking increases hepatic soreness and head-ache [Allen].
• Hot weather, summer biliousness; damp heat before storms [Boger], [Clarke].
• Cold drinks during an attack; chill and nausea follow [Hering].
• Stooping or bending, pressure on liver region; also tight clothing about waist [Clarke].
• Mental work in the evening; the dull frontal ache returns [Allen].
• Sudden chill after overheating; “ague-bile” attacks [Boger].
• Neglect of stool; suppression increases nausea and headache [Clarke].
• During and after stool—prostration, faintness, sweat (echoed under Generalities) [Allen].

Irritable, languid, and indifferent during bilious attacks; work seems impossible until the intestinal storm passes, which tallies with the better-for rest already noted [Clarke]. A depressive gloom accompanies the early morning with nausea and the sense of a “bad liver”; he anticipates the purge with dread. Mental effort in the evening revives the frontal ache and nausea (Mind ↔ Head/Stomach), and the patient seeks quiet and warmth, in keeping with the ameliorations. Anxiety revolves round the bowels and the ability to leave home safely—fear of sudden stool. A child under Lept. is peevish before stool, listless after. Unlike Nux-vomica, anger is muted; the weakness is the stronger chord. As the stools moderate and bile flows more naturally, mood rises and the head clears.

A dull, heavy frontal headache, seated over the eyes and root of the nose, accompanies the hepatic disturbance; it worsens with motion and after stool, and lifts with rest, open air, and food taken with care [Allen], [Clarke]. The scalp feels tight; the brow must be knit to see clearly. A sick headache alternates with bilious stool; some attacks begin with the head, followed by nausea and purge, confirming the liver–head axis. Exposure to heat or a late night brings the headache back next morning. The contrast with Iris-v. is useful: Iris burns and vomits sour bile with periodical migraines; Lept. is heavier, more hepatic, with black stools.

Scleræ may show a subicteric tint in longer attacks; lids heavy during morning nausea [Clarke]. Vision is blurred during the frontal ache; eyes feel hot while feet are cool, a portal-congestion sign. Photophobia is slight; the keynote is weight, not neuralgia.

Ringing or singing in the morning with faintness; noises subside after stool. No inflammatory ear picture. The least motion at that time increases the head-swim (Ears ↔ Head/Generalities).

Nasal tip cool; sense of foul odour in own breath; occasional sneezing preceding the bilious stool. No defining coryza.

Sallow, bilious complexion; dark under the eyes; lips pale; sometimes a yellowish hue in prolonged catarrhal hepatitis [Clarke], [Hughes]. Expression is weary; perspiration beads on the upper lip during tenacious nausea. Heat of face with cold extremities before stool is common.

Bitter taste on waking; tongue yellow-coated, sometimes with a darker or blackish centre; edges redder, tip pointed; excess saliva in nausea [Allen], [Clarke], [Hering]. Mouth feels foul, with stringy mucus; water is distasteful unless warm. The bitter taste relents after stool but returns with meals, echoing Worse after eating.

No fixed toothache; teeth feel elongated and sensitive in the morning during bilious crises, a reflex of mucosal acidity; better after warm drinks.

Bitter, bilious mucus drains into throat; hawking brings slight relief but renews nausea (Throat ↔ Stomach). Swallowing cold water chills the epigastrium.

Nausea on waking, with empty sinking at epigastrium; eructations bitter; vomiting of bile in some attacks precedes the black stool [Allen], [Clarke]. Appetite capricious; fats and rich dishes disagree; desire for warm broth and toast. Pressure or tight clothing at epigastrium is intolerable. The stomach feels better after a moderate breakfast than if fasting too long—small, regular meals suit the assimilative weakness.

Right hypochondrium sore, dull aching, sometimes extending to the right scapula; umbilical griping before stool; abdomen sensitive to jar and pressure of the belt [Clarke], [Farrington]. A sense of fullness in portal region with chilliness and languor hints at ague-bile states (Abdomen ↔ Fever/Generalities) [Boger]. Distension is moderate; gas moves with rumbling before the watery stool. Warmth and gentle hand-pressure ease the ache (echoing Better for warmth/pressure).

Urine scanty and high-coloured during hepatic storms; later more copious and lighter as bile excretion normalises [Clarke]. Burning is absent; sediment may be bilious-looking. Nocturia rises when the day is free of stools.

The axis of Leptandra: profuse watery stools that soon become black, pitch-like, tarry, horribly offensive, with great prostration—often worse in the morning and after eating [Allen], [Hering], [Clarke], [Boericke]. Stools may be painless or attended by dull umbilical griping; tenesmus is slight compared with Merc. There are alternating phases where stool is clay-coloured or very pale in jaundiced subjects, preceding the black stage—an alternation useful diagnostically [Clarke]. After stool there is faintness, chilliness, cold sweat, and an aggravation of the frontal headache, which tallies with the modalities (worse during/after stool). In children: greenish, dark loose stools with weakness and sallow face.

Sexual sphere little marked; emissions weaken the lumbar region during bilious states; vesical dribbling after stool is an occasional reflex. Libido returns with appetite as the liver clears (Male ↔ Generalities).

Bilious diarrhœa around menses or during pregnancy; offensive dark stools with nausea and great languor; right-sided abdominal tenderness aggravated by motion. Milk disagrees if rich; warm, small feeds tolerated (Female ↔ Stomach/Rectum).

Short breath on ascending stairs during bilious days; sighing to relieve epigastric tension; dyspnœa eases with warmth and rest (Respiration ↔ Stomach/Generalities).

Palpitation from weakness after stool; pulse soft, compressible in portal congestion [Hughes], [Clarke]. No true angina; faintness and chill are the cardiovascular stamp of depletion.

Oppression from abdominal fulness; must loosen clothing; stitching under right ribs toward axilla in some attacks (hepatic pleurodynia). Breathing shallow during cramps; better after stool. No primary bronchial catarrh.

Aching in lumbar and right dorsal region (beneath right scapula), synchronous with liver soreness; jar aggravates; warmth relieves [Clarke], [Farrington]. Backache better lying on the side with knees up.

Lassitude; heavy limbs; knees tremble after stool; feet cold with hot head. Cramps in calves in summer heat with biliousness; better warmth and rest.

Sallow or icteric tint in prolonged cases; itching slight; eruptions not characteristic. Sweat cool during faintness; skin feels greasy in hot weather biliousness [Clarke], [Boericke].

Restless before dawn with urge to stool; sleep thereafter heavy but unrefreshing. Late-night study renews the morning headache and diarrhœa, echoing Worse (evening mental work). Drowsy after noon when stools subside; a short nap restores capacity [Allen], [Clarke].

Of business worries and delays; anxious dreams before an attack; dreams vanish with hepatic relief. Children dream of being late to school, waking to stool.

Bilious remittents: chilliness and languor with frontal heaviness; later slight heat with flushed face and bitterness in mouth; crisis by stool and sweat, leaving prostration [Boger], [Hughes]. Periodicity manifests in morning exacerbations.

Chill before and during stool; heat slight; sweat cool and weakening afterwards—this tallies with the general post-stool prostration already noted [Allen], [Clarke]. Summer damp heats provoke attacks; dry warmth soothes.

Aversion to rich, fatty foods; desire for warm, simple fare (broths, toast); coffee and cold drinks aggravate [Clarke], [Boericke]. Thirst moderate, prefers small warm sips; fasting too long worsens the head.

Leptandra centres on liver–duodenum–portal dysfunction with bilious diarrhœa of a distinctive black, pitch-like, horribly offensive character, morning aggravation, right hypochondriac soreness, dull frontal headache, bitter taste, and prostration during and after stool [Allen], [Hering], [Clarke], [Boericke]. The modalities crystallise: worse morning, after eating (especially fats/coffee), motion, heat of summer, tight clothing, and during/after stool; better rest, warmth, pressure over liver, open air, and warm drinks. It spans phases from pale/clay stools in obstructed bile-flow to the characteristic black tarry evacuations as bile pours through—an alternation that, with right-sided soreness and head-dullness, separates it from Podophyllum (painless, gushing, often 4–5 a.m., no hepatic soreness) and Mercurius (marked tenesmus and slime) [Clarke], [Farrington]. Direction of cure runs from morning crises to even day, from black offensive stools to formed brown stools, from frontal heaviness to clear head, and from prostration to steadier strength.

• Aetiology—Bilious diarrhœa / hepatic catarrh
  • Podophyllum: profuse, painless, gushing stools at 4–5 a.m., with much gurgling; less right hypochondriac soreness. Lept. has black, pitch-like stools and post-stool prostration, with hepatic ache. [Clarke], [Farrington].
  • Mercurius: dysentery with tenesmus, slime, blood, offensive sweat and salivation. Lept. has little tenesmus; stools trend black; tongue yellow with bitter taste. [Hering], [Allen].
  • Iris versicolor: periodic bilious vomiting and migraine, burning; stools not typically tarry. Lept. heavier, hepatic, with black stools and right soreness. [Farrington].
• Keynotes—Stool characters
  • Baptisia: dark, putrid, offensive stools in typhoid states; general septic tone. Lept. lacks the septic stupor and exhibits hepatic soreness. [Hughes], [Clarke].
  • Aloes: mushy stools with urgency and insecurity; much flatus; rectal fullness. Lept. more hepatic, with black pitch-like stools. [Boger].
  • Sulphur: early morning diarrhœa driving out of bed; heat, burning anus; not the tarry blackness of Lept. [Kent], [Clarke].
• Organ affinity—Liver/gall
  • Chelidonium: constant pain to right scapula, jaundice, yellow tongue with one-sided symptoms; stools clay from obstruction. Lept. alternates clay and black tarry stages with watery purging. [Clarke], [Farrington].
  • Chionanthus: gall-stone colic, jaundice, clay stools, intense right hypochondriac pain. Lept. adds bilious purge and black stools. [Clarke].
  • Myrica: jaundice with thick, sticky bile, muddy tongue; less diarrhœa. Lept. more purgative picture. [Hughes].
• Modalities—Morning, after eating, heat
  • Nux-v.: morning nausea, irritability, dyspepsia from stimulants; stools small, frequent with tenesmus. Lept. has offensive tarry stools, prostration, softer temperament. [Kent].
  • Nat-sulph.: bilious states worse damp weather, green watery stools; headache in occiput. Lept. black stool hallmark and right soreness. [Boger].
• Collapse / weakness after stool
  • China: exhaustion after losses, pale face, flatus; diarrhœa after fruit. Lept. hepatic sign-set and black stools decide. [Farrington].
  • Arsenicum: burning, restlessness, anxiety; stools offensive but not characteristically pitch-black. Lept. wants warmth and rest without Arsenic’s anguish. [Clarke].

• Complementary: Chelidonium—right scapula pains and jaundice; Lept. for the bilious purge/black stools phase; Chel. to complete bile regulation. [Farrington], [Clarke].
•  Complementary: Chionanthus—gall-colic/clay stools; follows Lept. when pain persists without purging. [Clarke].
•  Complementary: China—to restore from post-stool weakness after Lept. has checked the torrent. [Dewey].
•  Follows well: Nux-v.—after dietary excess and stimulants, when the picture passes from gastric to hepatic–intestinal with black stools. [Kent].
•  Follows well: Iris-v.—when bilious vomiting/migraine abate and a hepatic diarrhœa remains. [Farrington].
•  Precedes well: Myrica—for sticky bile and persistent sallow in convalescence. [Hughes].
•  Related: Podophyllum, Merc., Baptisia, Aloes, Nat-s., Chel., Chionanthus, Myrica—see differentials.
•  Antidotes (states): Rest, warmth, bland diet; medicinally Nux-v. or Puls. according to gastric excess. [Clarke], [Kent].
•  Inimicals: None recorded; avoid alternation except on new totality. [Kent].

• Bilious diarrhœa with black, tarry, offensive stools, right hypochondriac soreness, dull frontal headache, and post-stool prostration—Lept. 6C–30C every 2–4 hours, taper as stools form [Allen], [Clarke], [Boericke].
• Catarrhal jaundice with alternating clay and black stools, bitter mouth, and right scapular ache—alternate regimen (warmth, bland diet) with Lept.; follow by Chel./Chionanthus if pain persists [Clarke], [Farrington].
• Summer biliousness after fat-rich meals/coffee—anticipate with Lept. in the evening; insist on warm drinks and early rest [Boericke], [Boger].
• Bilious cephalalgia: frontal weight worse motion, better rest; Lept. acts when head and liver move together and stool tells the tale [Clarke].

Mind
• Indifference and languor during liver attacks—work seems impossible till after stool. Clinical guide in hepatic diarrhœa. [Clarke].
• Irritability before stool; peevish children with bilious stools—small confirmatory sign. [Allen].
• Anxiety about sudden stool when from home—practical prescribing cue. [Clarke].
• Aversion to evening study—revives head and nausea. [Allen].
• Better for rest and quiet—aligns with hepatic catarrh remedies. [Boericke].
• Dullness of mind with bitter taste—portal stagnation picture. [Hughes].

Head
• Headache, frontal, over eyes, with bilious diarrhœa—cardinal concurrence. [Allen], [Clarke].
• Headache worse motion, worse after stool—hepatic reflex. [Allen].
• Heaviness of head in morning with bitter mouth—choose over Nervines. [Clarke].
• Headache with hot face, cold feet—portal congestion sign. [Clarke].
• Better—rest, open air, warm drinks—modal trio. [Boericke].
• Pain to right occiput with right hypochondriac soreness—hepatic link. [Farrington].

Mouth / Stomach
• Tongue yellow-coated with blackish centre—Lept. colour-keynote. [Allen], [Clarke].
• Bitter taste on waking—hepatic catarrh. [Clarke].
• Nausea on rising; vomiting of bile—before black stool. [Allen].
• Aversion to fats; coffee aggravates diarrhœa—dietary selectors. [Clarke], [Boericke].
• Empty sinking at epigastrium, better warm drinks—comforting sign. [Hering].
• Tight clothing at epigastrium aggravates—pressure intolerance. [Clarke].

Abdomen / Liver
• Soreness—right hypochondrium; worse motion, belts; better warmth/pressure—hepatic keynote. [Clarke].
• Pain to right scapula—gall-link. [Farrington].
• Umbilical griping before stool—prelude sign. [Allen].
• Portal congestion with sallow face and dull head—terrain rubric. [Hughes], [Boger].
• Distension with rumbling preceding watery stool—sequence rubric. [Allen].
• Summer heat/damp aggravates hepatic symptoms—seasonal cue. [Boger].

Rectum / Stool
• Stools black, pitch-like, tarry, offensive—signature rubric. [Allen], [Hering], [Clarke].
• Diarrhœa morning; after eating—timing/food modalities. [Allen], [Clarke].
• Prostration during/after stool; faintness, chill—state rubric. [Allen].
• Stools painless or with dull griping; slight tenesmus only—differentiates from Merc. [Hering].
• Alternation—clay-coloured stools with jaundice phases—pathway rubric. [Clarke].
• Children—dark, loose, offensive stools with weakness—paediatric pointer. [Hering].

Skin / Generalities
• Sallow or icteric tint—hepatic involvement. [Clarke].
• Chill before stool; sweat cool after—characteristic sequence. [Allen].
• Weakness after evacuations; knees tremble—post-stool collapse. [Allen].
• Worse morning, summer heat, tight waist; better rest, warmth—modal cluster. [Boericke], [Boger].
• Desire for warm simple food; aversion fats—dietary concordance. [Clarke].
• Head clear as stools normalise—direction of cure marker. [Clarke].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): proving/clinical—bilious diarrhœa, black tarry stools, frontal headache, modalities.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): confirmations—hepatic soreness, morning aggravation, bitterness, prostration after stool.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): remedy portrait—preparation from root; bilious catarrh; alternation of clay and black stools; relationships.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—black stools, liver soreness, summer biliousness; diet/modalities.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): cholagogue/cathartic actions; portal congestion terrain; clinical analogies.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): generalities—weather/season aggravations; ague-bile states; comparisons.
Farrington, E. A. — Clinical Materia Medica (1890): liver and gall differentials—Chelidonium, Chionanthus, Iris-v.; scapular radiation.
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): convalescence and collapse after diarrhœa; sequencing with China.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): gastric–hepatic remedy distinctions; Nux-v. relations in dietary excess.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): bilious states; remedy ordering by stool qualities.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (20th c.): condensed keynotes—liver–bowel axis, modalities, exhaustion.
Dunham, C. — Homœopathy, the Science of Therapeutics (1877): philosophy of selecting by evacuations and concomitants in gastro-hepatic disease.