• Cerebrospinal axis (coma, apoplexy). Stupefaction, stertorous breathing, dilated or pinpoint pupils, with retained reflexes—danger without complaint. See Mind, Sleep, Respiration. [Hahnemann], [Hering], [Kent]
• Respiratory centre. Slow, shallow, noisy (“stertorous”) breathing; breath holds; cyanosis with deceptively placid face. See Respiration, Chest. [Allen], [Clarke]
• Intestinal tract. Obstinate constipation by atony; no urging; large, dry, black balls when passed. See Rectum. [Hering], [Boericke]
• Vascular tone & brain circulation. Congestion to head; apoplectic states; hot face, cold extremities. See Head, Fever. [Kent], [Boger]
• Sensory threshold. Analgesia—painlessness of complaints normally agonising; insensibility after injuries or operations. See Generalities, Mind. [Hahnemann], [Nash]
• Urinary bladder. Retention from atony; dribbling overflow; no desire. See Urinary. [Clarke], [Boericke]
• Uterus & puerperal states. Lying-in somnolence, after-pains absent, suppressed lochia; neonatal asphyxia. See Female, Newborn notes under Respiration. [Hering], [Farrington]
• Peripheral circulation & skin. Coolness, mottling, sweat suppression; bedsores from stupor. See Skin. [Allen], [Hughes]
• Autonomic reactivity after fright. “Fright with stupefaction” (vs. Acon.’s panic); locked expressions. See Mind. [Kent], [Clarke]
• Spasm/convulsion paradox. From suppression or intoxication; twitchings with insensibility. See Generalities, Extremities. [Allen], [Hering]

• Being left undisturbed; aversion to attention, answers reluctantly when roused. [Hering]
• Warm room for chilliness in collapse (though head may be hot). [Clarke]
• Cold applications to forehead in congestive stupor (temporary). [Boger]
• Head high; semi-erect position eases stertorous breathing. [Kent]
• Gentle, rhythmic ventilation (newborn asphyxia, drowned; Op. as stimulus) with cautious handling. [Farrington], [Clarke]
• After stool when it finally passes; abdominal distension eases. [Boericke]
• Darkness and quiet; any sensory input disturbs the fragile stupor. [Hering]
• Sips of cool water moistening mouth during heat (thirst is generally low). [Allen]
• Fanning in hot, congestive head states. [Kent]
• Reassurance without stimulation (soft voice, light touch). [Nash]

• Fright leading to stupefaction (shock, bad news, near-accident): “fright, then sleep.” [Kent], [Clarke]
• Heat of head with cold body; room overheated; bed too warm. [Hering]
• Alcohol, narcotics, anaesthetics—deepens respiratory depression. [Hughes]
• Suppression of secretions/excretions (lochia, sweat, stool, urine). [Hering], [Clarke]
• Being roused suddenly, noise, light, handling; barbiturate-like arousal reactions. [Allen]
• Lying flat—breathing more obstructed, stertorous. [Kent]
• Overeating, opiates, constipation—worsen cerebral congestion. [Clarke]
• Pregnancy/puerperium (retention tendencies), neonatal asphyxia. [Farrington]
• Heat of sun on head (apoplexy risk). [Boger]
• After sudden cooling during perspiration (retrocession → coma). [Hering]

Opium’s mental state is one of stupefaction, torpor, and insensibility, often following fright: not panic but a blanking of consciousness—“fright with stupefaction.” The patient lies with eyes half open, face dark-red or mottled, mouth open, lower jaw dropped; when asked a question, answers slowly, drowsily, or not at all. There is absence of complaint disproportionate to danger: severe disease with no apprehension or even euphoric indifference—a deadly quiet. Pain that should torment is unfelt; injuries seem nothing; they say, “I am well,” while sinking. Alternately, a paradoxical excitability appears—visions, joyous delirium, loquacity—as a toxic counterpart. Startling may provoke jerks or convulsions but consciousness remains clouded. Compare Acon. (fright with heat and fear of death), Gels. (fright with weakness and tremor), and Stram. (terror with violent delirium); Op. is the silent abyss. Case: after a house-fire scare, a man falls into profound sleep, face flushed, pupils small, breathing slow; when roused, smiles vaguely—Op. 200C reversed the stupor. [Hahnemann], [Hering], [Kent], [Clarke], [Nash]

Congestion to the head with heavy, hot, stupefying weight; head feels full as lead, as if brain were thickened. Face dark-red or livid; pupils contracted or sluggish. Apoplexy: stertor, snoring, insensibility, heat of head with cold limbs; pulse slow and full or intermittent; no complaint. Headache—if felt—is dull, stupefying, with vertigo on the least movement; cannot hold the head upright. Worse heat, sun, lying flat; better cool air to face, head raised. Compare Bell. (violent throbbing, brilliance, delirium), Arn. (says he is well after injury; but Arn. is sore and wants to be left alone, not profoundly narcotised), and Lach. (left-sided, loquacious, cannot bear pressure on throat). [Allen], [Hering], [Kent], [Clarke]

Eyelids heavy, half-closed; pupils contracted (toxic triad) or sluggishly dilated in some states; conjunctiva injected; eye looks glazed. Vision clouded; sees as through a mist; objects swim. Insensibility to bright light—no reaction—or paradoxical photophobia during delirium. Ocular congestion with brain symptoms; fundus may show venous engorgement (clinical observation). Compare Gels. (ptosis from paresis, dull and heavy but with anxiety when roused) and Nux-v. (spasm with photophobia but active irritability). [Hering], [Allen], [Clarke]

Hearing dull; insensible to noise or startled violently by sudden sounds causing jerks. Ears hot and red with head congestion; tinnitus like distant roaring noted in toxic states. Earaches are unusual because pains are not perceived; if present, they are blunt, pressive. [Hahnemann], [Hering]

Nostrils flapping with slow, laboured breath; snoring through nose and mouth; epistaxis with brain congestion in children (face hot, limbs cold). Smell dull; odours scarcely perceived. In collapse, nose pinched, cold, and bluish. Coryza is rare in the Opium picture; rather retained secretions, dryness, and obstruction. [Clarke], [Hering], [Allen]

Dark-red, dusky, livid, or deeply flushed face with expression of stupid happiness or vacant calm; jaw relaxed; lips bluish in asphyxial states. One cheek hot, the other cold may occur but less prominently than Acon. Sweat is suppressed; skin feels hot and dry on the face; or cold clammy in collapse. Trismus or twitching around mouth may accompany convulsive variant. [Hering], [Clarke], [Allen]

Mouth open; tongue dry, brown or black, trembling when protruded (if rousable). Insensibility of mouth and throat—swallows badly; saliva scant; breath warm, sweetish. Taste dull; food may be retained in mouth without chewing. Speech slow, drawling, muttered; words forgotten mid-sentence. [Hahnemann], [Allen], [Hering]

Gnashing of teeth in narcotic sleep (children) or during convulsions; grinding without awareness. Toothache absent though teeth are decayed—painlessness of normally painful states. Jaws hang; difficult to close the mouth. [Hering], [Allen]

Swallowing reflex sluggish; liquids may be swallowed noiselessly or pool in mouth; choking if roused suddenly. Throat dry, insensible; no desire for drink, or only occasional sips. In apoplectic stupor, uvula relaxed; soft palate trembles with stertor. Compare Gels. (pharyngeal paresis but conscious) and Lach. (exquisite sensitivity to touch, choking sensation). [Clarke], [Hering]

No hunger, little thirst; stomach atony; slow gastric emptying. Nausea uncommon unless from drugging; vomiting may be absent despite poisoning (retention). Belching rare; abdomen becomes distended from retained gas and feces. If pain occurs it is dull and unfelt until pressure applied. Worse after overeating or alcohol; better absolute quiet. Compare Nux-v. (spasm and irritability) and Ars. (burning, anxiety, extreme restlessness—opposite temperament). [Allen], [Hering], [Clarke]

Tympanitic distension from retained stool and flatus; abdomen feels heavy, inert, and insensitive to pain; yet colic may provoke groans in the half-sleep state. Peristalsis torpid; secretions and excretions are retained. Liver region congested and hot in fevers; splenic congestion possible. Palpation often tolerated without complaint. [Hering], [Allen], [Clarke]

Retention from atony; bladder full yet no desire; dribbling overflow; insensibility to passage; urine scant, dark. After labour or surgery, no urging though bladder distended. Children may pass urine unconsciously during narcotic sleep; neonates asphyxiated have suppressed urine initially. Compare Caust. (retention from paralysis but with burning sensation), Ars. (scant from collapse but anxious), and Gels. (paresis with dullness, yet conscious). [Clarke], [Boericke], [Hering]

Classic Opium constipation: no urging whatsoever; rectum as if paralysed; when stool appears it is large, hard, black, round balls (“sheep dung”) or very large, dry, knotty masses; stool may have to be manually removed. Paradox: diarrhoea in infants from narcotic action (toxicology), but the homeopathic picture is predominantly retentive. Piles may be insensible; no pain even when prolapsed. Compare Alum. (no desire, great straining; stool dry like sheep dung but with ineffectual effort), Bry. (dry large stool with great dryness but with urging), and Plumb. (spasm-stenosis, string-like stools, colic). [Hering], [Allen], [Boericke], [Kent]

Sexual functions torpid; erections fail; spermatorrhoea during heavy narcotic sleep may occur. Testicular pain is rare owing to analgesia; hydrocele or oedema in comatose states has been observed (clinical). After fright, impotence with indifference. [Hering], [Clarke]

Puerperal states with somnolence, absence of after-pains, suppressed lochia, and retained urine point to Opium. During pregnancy, foetal movements quiet; maternal drowsiness marked. Labour pains cease (inertia uteri) with warm, flushed head and cold limbs. Neonatal asphyxia: infant dusky, limp, feeble or absent cry, pupils contracted, breath slow—Op. has classical standing. Compare Sec. (uterine atony with haemorrhage), Gels. (paresis with tremors), and Puls. (mild, changeable, not narcotised). [Hering], [Farrington], [Clarke]

Respiration is the crux: slow (bradypnoea), shallow, noisy, often Cheyne–Stokes-like in deep states; apnoeic pauses; laryngeal and cough reflexes depressed. In asphyxia of newborns or drowned persons, Op. has classical indication along with physical resuscitation; in bronchitis/pneumonia the lack of expectoration and painlessness amid cyanosis guides. Worse lying flat, after sleep; better head high, air fanned on face. [Allen], [Clarke], [Hering], [Farrington]

Pulse slow, full, and laboured or weak and irregular in collapse; palpitations seldom noticed by patient. Precordial anxiety is conspicuously absent even in danger; face may be flushed, neck veins distended. Sudden syncope on sitting up in comatose state. Compare Carbo-v. (air hunger, wants to be fanned) and Ars. (anginous anxiety with restlessness). [Allen], [Clarke], [Kent]

Oppressed, slow, stertorous breathing; thorax hardly moves; sighing respirations; breath retained long, then expelled with snore. Cough reflex inhibited; chest full but no cough—retained secretions. Pneumonia with no complaint, cyanotic lips, hot head, cold limbs; expectoration scant or absent. If cough occurs, it is weak, slow, and ineffective. Compare Ant-t. (rattling with inability to raise; but child is restless and suffocative), Phos. (burning chest, anxiety, thirst), and Lach. (aggravation after sleep). [Allen], [Clarke], [Hering], [Kent]

Back and neck limp, powerless; cannot support head; opisthotonos in convulsive variant with insensibility. Coccygeal bed-soreness from long stupor. Stitching pains, if present, are reported vaguely or not at all. [Hering], [Allen]

Limb torpor: heavy, numb; no complaint though circulation poor; hands and feet cold, bluish. Twitchings, subsultus tendinum, or convulsions may alternate with coma—paradox typical of Opium. Reflexes slow or absent. Dropsies from recumbency. Compare Cupr. (violent cramps with shrieks), Stram. (terrified, active delirium), and Cicuta (terrible spasms with opisthotonos but rigid hypersensitivity). [Hering], [Allen], [Kent]

Skin hot and dry in congestive stupor, or cold and clammy in collapse; perspiration suppressed; mottled, livid patches; tendency to bedsores. Eruptions may be suppressed, with inward metastasis of symptoms. Itching is rare; patient too drowsy to scratch. [Clarke], [Allen], [Hering]

Overpowering drowsiness, profound sleep with loud snoring, mouth open, insensible to ordinary stimuli; starts when roused then drops back into stupor. Sleep aggravates: on falling asleep, breathing stops; on waking, slow to orient. Dreams (if recalled) are lascivious, vivid, or of pleasant scenes; in children, nightly grinding of teeth. Compare Nux-m. (stupor with muttering from heat/sunstroke), Lach. (worse after sleep, but talkative, jealous), and Acon. (cannot sleep from anxiety; Op. cannot stay awake). [Hahnemann], [Hering], [Kent], [Clarke]

Pleasant, voluptuous, or fantastical; of flying, feasting, theatres; or terrifying nightmare with suffocation, yet on waking they sink again into stupor. Dreams often lack emotional colour on recall—befitting the emotional blunting. [Hering], [Allen]

Congestive fevers with hot, flushed face, cold limbs, stupor, and slow, laboured respiration. No thirst, no complaint; pulse slow and full or irregular. Sweat suppressed; if sweat breaks, it may be cold and clammy in collapse. Typhoid states with insensibility, picking at bedclothes, muttering, open mouth, heavy snoring—no perception of illness. Compare Bell. (high delirium, throbbing), Bapt. (besotted stupor but foul discharges and sordes with offensive odour), and Arn. (says he is well but is sore and wants to be left alone). [Hering], [Clarke], [Kent], [Nash]

Chill: internal with external heat of head; shivering may be absent because the organism is too torpid to react.
Heat: hot head and face, dusky congestion, little thirst; sensation of heat without complaint.
Sweat: suppressed; if present, cold, clammy, odourless; breaking of sweat may herald improvement in torpor. Worse during sleep and lying flat; better propped, air fanned. [Hering], [Allen], [Clarke]

Little thirst; desire absent. Aversion to food from torpor, not nausea. Liquids may be sipped mechanically. Alcohol aggravates stupor. Coffee may transiently arouse but can provoke trembling or paradoxical excitement. [Allen], [Clarke]

Suppression and retention define Opium: of sensation (analgesia), reaction (torpor), and excretions (constipation, urinary retention, sweat suppression). The patient is uncomplaining in grave conditions—deceptive calm. States follow fright with stupefaction (vs. Acon.’s panic), injury with denial (vs. Arn.’s sore aversion), apoplexy with stertor, and puerperal torpor with retained lochia/urine. Worse after sleep, heat of head with cold body, suppression of discharges; better undisturbed, head high, fanning. The hallmark paradox: convulsions may erupt out of narcotism; yet between paroxysms, blankness. [Hahnemann], [Hering], [Kent], [Clarke], [Nash]

Aetiology — Fright:

• Acon. Fright with fear of death, heat, restlessness; Op. has fright with stupefaction and torpor. [Kent], [Clarke]
• Gels. Fright → trembling weakness and dullness, but patient answers; Op. sinks into unresponsive stupor. [Nash]
• Ign. Fright/grief with sobbing, globus; reactive, not narcotised. [Kent]

Shock/Head Injury:

• Arn. Says “I am well” (denial) with sore, bruised feeling; wants to be left alone but conscious; Op. is profoundly narcotised. [Clarke]
• Hyo. Head injury → loquacious mania with lasciviousness; Op. placid stupor or pleasant dreams. [Hering]

Apoplexy/Coma:

• Bell. Red, congested, delirious, throbbing carotids; Op. quiet, stertorous, no complaint. [Kent]
• Lach. Dark, asphyxial, worse after sleep, loquacious when awake; Op. silent, indifferent. [Clarke]
• Nux-m. Stupefaction from sun/heat; more sopor with muttering, less retention picture. [Boger]

Respiratory Centre Depression:

• Ant-t. Rattling chest, cannot raise; restless and suffocative; Op. retains secretions quietly, slow snore. [Allen]
• Carb-v. Air hunger, wants to be fanned, icy; Op. less reactive, more narcotic. [Clarke]
• Phos. Anxiety, thirst, burning; Op. indifferent, thirstless. [Kent]

Constipation (Atonic):

• Alum. No desire, hard dry stool, ineffectual effort; Op. no urging at all, stool black balls, gigantic masses. [Hering]
• Bry. Dry, large stools with dryness of mucosa; Bry. still urges and is irritable. [Boericke]
• Plumb. Spastic constipation, string-like stools, colic; Op. atony without colic. [Allen]

Puerperal/Neonatal:

• Sec. Atony with haemorrhage, cold yet not asking to be covered; Op. suppressed pains, somnolence, retentions. [Farrington]
• Puls. Mild, changeable, weepy; not narcotised; pains too weak but conscious. [Clarke]

Convulsions with Stupor:

• Cicuta. Terrible opisthotonos with biting, violent; Op. less violent between fits, more blank. [Hering]
• Cupr. Cramps begin in fingers/toes, awful cries; Op. quieter, stuporous. [Allen]

• Complementary: Sulph.—restores reaction after suppression (sweat, stool) in chronic Op. states. [Kent]
• Complementary: Nux-v.—antagonistic to drug-sleep; re-excites peristalsis and reflexes after narcotic suppression. [Clarke]
• Follows well: Arn. (injury with denial) if stupor deepens; Lach. if asphyxial congestion with “worse after sleep” emerges. [Kent]
• Precedes well: Ant-t. in chest when secretions loosen and rattling begins; Carb-v. in collapse with air hunger. [Boericke], [Clarke]
• Antidotes (toxic/proving): Coffee, Camphor, Nux-v., Lach. (asphyxial states). [Hering], [Allen]
• Related: Alum. (constipation atony), Plumb. (spastic constipation), Gels. (paresis with dullness). [Boger]
• Inimical: Overuse with Morphinum/narcotics; careful sequencing required. [Hughes]

• After fright with stupefaction: If the patient grows sleepy and indifferent (not panicky), especially with snoring breath, Op. is near. [Kent], [Clarke]
• Apoplexy/coma: Op. when stertor, hot head, cold limbs, dark face, no complaint; head high, quiet, and Op. can bridge to reaction. [Hering], [Boger]
• Atonic constipation: Hallmark no urging; black, hard balls; rectum inert—Op. acts when Alum. fails from lack of effort. [Hering], [Boericke]
• Puerperal/neonatal: Suppressed lochia, somnolence; asphyxia neonatorum—Op. often with artificial respiration (clinical adjunct). [Farrington], [Clarke]
• Potency & repetition: In acute danger with clear keynotes, many favour 30C–200C repeated judiciously (short intervals initially, then stop as reaction appears). In profound coma some report success with high potencies; always reassess as reactivity returns. [Kent], [Nash], [Boericke]
• Case pearls:

• • Stroke patient, deep snoring, pupils pin-point, hot head, cold extremities, no complaint → Op. 200C; breathing regularised, colour improved; later Lach. as “worse after sleep” remained. [Kent]
  • Child after fright, sleeps too deeply, grinds teeth, face dusky, unrousable → Op. 30C at short intervals; normal sleep restored. [Clarke]
  • Post-op ileus: abdomen tympanitic, no urging, no pain, dry balls when passed → Op. resolved atony. [Boericke]

Mind

• Fright, effects of, with stupefaction. Key to aetiology; differentiates from Acon. (panic). [Kent]
• Unconsciousness, coma, answers slowly if at all. Defines narcotic torpor. [Hering]
• Delusion he is well, when dangerously ill. Diagnostic keynote. [Clarke]
• Indifference, apathy in grave disease. Masked seriousness. [Allen]
• Insensibility to pain. Analgesia theme. [Hahnemann]
• Startled by noise, then relapses into stupor. Frail arousal. [Boger]

Head

• Apoplexy, stertorous breathing, hot head, cold limbs. Opium classic. [Kent]
• Congestion, face dark-red, livid. Asphyxial stasis. [Clarke]
• Vertigo with stupor, worse motion. Narcotic heaviness. [Hering]
• Jaw, lower, hanging (open mouth). Coma sign. [Allen]
• Pupils contracted, insensible. Toxic triad. [Allen]

Eyes

• Eyelids half-closed, heavy. Stupor sign. [Hering]
• Pupils, contracted (miosis). Central depression. [Allen]
• Vision dim, misty, swimming. Clouding perception. [Clarke]
• Insensible to light. Depressed reflexes. [Hering]

Respiration/Chest

• Respiration, slow, shallow, stertorous (snoring). Centre depression. [Allen]
• Asphyxia of newborn (with resuscitation). Classical indication. [Farrington]
• Cough, reflex absent or diminished; expectoration retained. Suppression. [Clarke]
• Cheyne–Stokes respiration. Periodic breathing. [Hering]

Rectum

• Constipation, no urging at all. Pathognomonic. [Hering]
• Stool, black, hard, large balls; requires manual removal. Atony. [Allen]
• Rectum inert, paralysis of. Mechanism rubric. [Boericke]
• Ileus, obstruction, atony. Clinical rubric. [Boger]

Urinary

• Retention of urine, no desire. Atonic bladder. [Clarke]
• Involuntary urination during sleep (children). Narcotic sleep. [Hering]
• Paralysis of bladder. Mechanistic. [Allen]
• Dribbling, overflow. Decompensation. [Boericke]

Sleep

• Sleep, profound, stertorous, with open mouth. Core sign. [Hering]
• Sleep aggravates; worse after sleep. Dangerous silence. [Clarke]
• Grinding of teeth during sleep (children). Night sign. [Allen]
• Nightmare with suffocation. Respiratory link. [Kent]

Generalities

• Suppression of secretions and excretions. Essential theme. [Hering]
• Painlessness of complaints ordinarily painful. Diagnostic paradox. [Hahnemann]
• Collapse with warm head, cold extremities. Maldistribution. [Clarke]
• Convulsions with insensibility. Paradox variant. [Allen]

Skin

• Lividity, mottled skin, cold sweat. Asphyxial state. [Allen]
• Bedsores from prolonged stupor. Nursing risk. [Clarke]
• Perspiration, suppressed. Retentive theme. [Hering]

Hahnemann — Materia Medica Pura (1821–1834): proving; stupefaction, analgesia, retention; early clinical notes.
Hering — The Guiding Symptoms of our Materia Medica (1879–1891): coma, apoplexy, neonatal asphyxia, constipation.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–1879): comprehensive proving/toxicology—respiratory centre, pupils, rectum.
Hughes, R. — A Manual of Pharmacodynamics (1867) & Pharmacography (1868): opioid toxicology, physiologic correlations (CNS, gut).
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): differentials (Acon., Arn.), puerperal/neonatal notes, relationships.
Kent, J. T. — Lectures on Homoeopathic Materia Medica (1905): essence—fright with stupefaction, apoplexy, deceptive quiet.
Boericke, W. — Pocket Manual of Homoeopathic Materia Medica (1901): constipation, atony, chest suppression; relationships.
Boger, C. M. — Boenninghausen’s Characteristics & Repertory (1905) and Synoptic Key (1915): modalities (worse after sleep), ileus, apoplexy rubrics.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1899): clinical strategy—when Opium is life-saving; potency notes.
Farrington, E. A. — Clinical Materia Medica (1887): obstetrics/paediatrics—lochia suppression, neonatal asphyxia.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): crisp keynotes—retentive states, insensibility.
Tyler, M. L. — Homoeopathic Drug Pictures (1932): vivid portrait of Opium’s deceptive calm and danger.
Dewey, W. A. — Practical Homoeopathic Therapeutics (1905): typhoid/coma states; constipation group comparisons.
Vithoulkas, G. — Materia Medica Viva (1990s): modern essence—masking, lack of complaint, suppression and collapse.
Morrison, R. — Desktop Guide to Keynotes & Confirmatory Symptoms (1993): quick clinical keynotes; paediatric pointers.