• Liver and biliary passages — Hepatic congestion, dull ache in right hypochondrium, jaundice, clay-coloured stools, dark bile-stained urine; torpor after malaria, alcohol, or drug abuse (quinine/mercury) [Clarke], [Hughes], [Boericke].
• Portal system & veins — Haemorrhoids, varices, fullness about the anus and lower abdomen; relief as evacuations and bile become free [Boger], [Clarke].
• Spleen — Post-malarial splenomegaly with dragging in the left hypochondrium, sallow hue, and easy fatigue [Hughes], [Clarke].
• Mouth & throat mucosae — Aphthae, ulcers, salivation with foetid breath; sore, raw fauces; tongue indented and slimy [Allen], [Clarke].
• Stomach–bowel digestion — Aversion to fatty, rich food, bitter taste, pyrosis, flatulent distension, and constipation alternating with bilious looseness [Boericke], [Boger].
• Skin & sweat — Sallow, icteric tint, pruritus, night-sweats that weaken; moist eruptions about flexures in cachectic states [Clarke], [Boericke].
• Haemorrhages (passive) — Oozing, dark bleeding from piles and gums in portal stasis; anaemic faintness from small losses [Hughes], [Clarke].
• General nutrition — Lassitude, weight-loss, low fever in evenings, chilly heat in damp weather; “port-wine” complexion in drinkers [Clarke], [Nash].
• Gallbladder — Biliary insufficiency with pale stools and itching skin; dull right scapular referral less marked than Chelidonium but present [Clarke], [Boger].

• Warm applications over right hypochondrium — Soothe hepatic ache and promote flow of bile (echoed in Abdomen/Generalities) [Clarke], [Boericke].
• Gentle walking / out-of-doors — Relieves portal stasis, improves bowel action, clears head (Mind/Rectum cross-link) [Boger].
• After a good stool / free bile — Oppression, headache, and pruritus lessen as colour returns to stool [Clarke].
• Looser clothing at waist — Reduces waist-band aggravation, eases liver–spleen pressure [Clarke].
• Simple, non-fatty diet; warm drinks — Diminish bitterness, pyrosis, and flatulence; settle stool rhythm [Boericke].
• Dry, warm climate / dry heat locally — Damp chill worsens spleen–liver aches; dryness calms skin itch [Hughes], [Clarke].
• Propped rest after meals (short) — Reduces epigastric pressure and reflux in congested livers [Boger].
• Sweating moderately — Gentle perspiration lightens the sallow heaviness (not exhausting night-sweat) [Clarke].

• Fatty, rich, fried foods — Renew bitter taste, heartburn, and clay stools [Boericke].
• Alcohol (wine, spirits, beer) — Heightens hepatic ache, piles, and foetor; next-morning sallow stupor [Clarke], [Nash].
• Tight clothing / belts at the waist — Intolerable pressure over liver–spleen; patient loosens garments (cross-link Abdomen) [Clarke].
• Damp heat / muggy weather — Deepens splenic drag and skin itch; favours night-sweats [Hughes].
• After malaria / quinine; after mercury — Chronic portal–splenic torpor with sallow cachexy (aetiologic keynote) [Hughes], [Clarke], [Boger].
• Evening and night — Oppression, itching, and weakness mount; piles bleed after straining late [Clarke].
• Exertion immediately after meals — Stitch and heaviness in right side; giddiness [Boger].
• Sedentary habits / long sitting — Piles, flatulence, and hepatic fulness increase [Clarke].
• Cold, wet applications — Chill of belly and limbs aggravates ache and diarrhoea-proneness [Clarke].
• Anger or vexation — Bitter eructations and hepatic pains flare (mind–liver tie) [Kent].
• Jar and stepping — Tender liver resents jolting; prefers smooth motion [Clarke].
• Suppression of haemorrhoids or eruptions — Internal congestion and headache return (portal back-draught) [Boger].

The mental tone is dull, heavy, sallow, with lassitude and a disinclination for effort; accuracy falters towards evening as portal fulness and bitter taste mount [Clarke]. Irritability follows slight contradiction, and anger or vexation sends a wave of heat to the head, with bitter eructations and right hypochondrial stitch, a pattern that tallies with the aggravation from anger noted under Modalities [Kent]. Melancholy shades the outlook in long-standing jaundice or post-malarial cases; the patient is burdened by work yet too apathetic to rise early. Anxiety is corporeal and centred in the abdomen—fear of the next painful stool, of bleeding piles, of the “sinking” that comes in muggy weather. Relief in mind often coincides with a free stool or after a gentle walk, which is repeatedly observed in this remedy (cross-link Rectum/Generalities). Unlike Nux-v., the temper is not fiery with spasmodic effort; unlike Chelidonium, there is less sharp definition of scapular pain and more sallow depression. Company does little; kindness is tolerated, not relished. With mouth ulcers, conversation is avoided from soreness and foetor; self-consciousness exaggerates the gloom [Clarke], [Allen].

A dull, congestive headache accompanies biliary torpor: forehead and temples feel heavy, worse evening, warm, damp rooms, and after rich food or alcohol; better after a good stool or a warm compress to the liver [Clarke], [Boger]. Vertigo on rising quickly or after meals reflects venous stasis; the face is sallow, eyes slightly icteric, pupils somewhat sluggish in bad cases. A band sensation crosses the brow; turning suddenly brings a throb as if the liver pulled upon the head. The scalp may itch at night with sweat, connecting skin to hepatic state. Compare China (venous congestion with flatulence; wants open air), Chelidonium (clear right scapula pain), and Nux-v. (hangover headache with irritability): Nit-m-ac. has a more icteric, ulcerative-mouth and piles background [Clarke], [Boericke].