Pareira brava

A twining vine of Menispermaceae; the root is used for the tincture. Classical sources equate “Pareira brava” with Pareira brava and describe long-standing ethnomedicinal use for urinary and pelvic disorders. In homeopathy it is a prime remedy for vesical tenesmus, renal colic, gravel, and prostatic obstruction, famous for the position in which the sufferer can void only by kneeling on all fours with the head pressed to the floor, with violent straining and urine passed in drops [Hering], [Clarke], [Allen], [Boericke], [Boger]. Toxicological colour from allied Menispermaceae (isoquinoline alkaloids; smooth-muscle effects) helps explain ureteric spasm, cystic hyperalgesia, and prostatic outlet resistance, with reflex pains into thighs, testes, and glans penis [Hughes], [Clarke].

A classical clinical–toxicologic pathogenesis with fragmentary provings: intolerable vesical tenesmus, strangury, urine only drop by drop, constant straining, pains radiating to thighs/testes/glans, renal colic, gravel (red sand), prostatic obstruction, catarrh of bladder, neuralgia of ureter, dribbling, and back/kidney pains; modalities include better on all fours/with head pressed down, better from pressure, worse at night, worse movement/jar, worse after cold [Hering], [Allen], [Clarke], [Boericke], [Boger]. Tags: [Proving] [Clinical].

Essence. Pareir. is the mechanical urinary spasm remedy: the bladder feels full but locked, the sufferer strains without relief, and only by kneeling on all fours with the head to the floor, or at least leaning forward with thighs flexed, does a few drops escape. This posture is not picturesque—it is pathognomonic. Pains track the ureter to the outlet, throwing shoots into the glans, testes, and anterior/inner thighs; movement/jar, night, cold, and the beginning and end of the act worsen, while heat, pressure, rest, and flexion ameliorate. The terrain is uric: mucus, red sand, occasionally blood; old men with prostatic resistance are frequent patients.

Differentiation. Use Cantharis when burning is intolerable and sex-erethism, fury, and continuous heat dominate; use Sarsaparilla when pain is purely at the close and the child must stand to pass; use Chimaphila when the posture is standing-bent-forward with feet apart and perineal ball is felt; use Berberis when pains “leap” and bubble in many directions; use Lycopodium when right-sided colic and 4–8 p.m. periodicity lead. Choose Pareir. when the all-fours posture, pains into thighs/glans, and drop-by-drop urine tell the story [Clarke], [Boger], [Boericke], [Allen], [Kent].

Practice. In renal colic and strangury, institute heat (fomentations, hot sitz), quiet, flexion position, and warm diluents, then dose Pareir. In BPH nights, Pareir. frequently cuts the tenesmus so Chimaphila or Sabal may consolidate. In gravel, follow with Lycopodium or Berberis to regulate the uric terrain. When blood predominates and smoky urine appears, think of Terebinthina. The position remains your compass: when, despite tinctures and baths, he must kneel to void—Pareir. is at hand.

• Bladder (neck, trigone) — prime seat. Extreme tenesmus, strangury, “must strain constantly,” urine drop by drop; sensation bladder is distended yet cannot empty; relief only in kneeling, head to floor posture [Hering], [Clarke], [Boericke].
• Ureter / renal pelvis. Renal colic with pains shooting down the ureter into testes, glans, and inner thighs; neuralgia of ureter with uric gravel [Allen], [Boger].
• Prostate / outlet. Prostatic hypertrophy with dribbling, interrupted stream, must strain; cystitis of old men [Clarke], [Boericke].
• Kidneys. Dull ache in loins; urine loaded with urates/mucus, red sand; lithic-acid diathesis (compare Lyc., Sars., Berb.) [Clarke], [Boger].
• Genital reflexes. Pains draw into testes and glans with urging; retraction or heaviness of testes during colic [Hering], [Allen].
• Thighs / anterior femoral nerves. Dragging, crampy pains shoot down inner/anterior thighs during urging—bedside keynote [Hering], [Clarke].
• Back / sacro-renal angle. Bruised, pressing pain in kidneys and sacrum; jar aggravates [Boger], [Clarke].
• Mucous membranes (urinary). Catarrh of bladder with ropy mucus, offensive urine; chronic sufferers cachectic and chilly [Clarke], [Boericke].

The mental state is dominated by anguish from incessant urging and inability to finish; the sufferer grows irritable, despairing, and fearful of the next paroxysm, watching the clock towards midnight when symptoms worsen—this tallies with the night aggravation already noted [Allen], [Clarke]. There is a restless impatience, pacing until the pain compels the peculiar kneeling posture; with relief of a few drops he becomes briefly hopeful, only to sink into despondency as urging returns. He dreads examination and the pressure of clothes; he is fastidious about cleanliness because the urine is offensive with mucus, and this shame isolates him (Urinary cross-link) [Clarke]. Anxiety rises when obliged to stand to urinate in public places, knowing the stream will arrest unless he can lean forward or kneel—a behavioural echo of the remedy keynote [Hering]. Anger is not explosive (as in Nux-v.); it is a tired fretfulness of pain-worn men, especially the aged with prostatic obstruction. Consolation is unwelcome while the spasm lasts; after a warm sitz and rest he can speak calmly, which matches the better warmth/rest modality.

Broken by night urging; drops into brief dozes between attempts; dreams of searching for a privy and finding none (Mind/Urinary link) [Allen], [Clarke]. On waking he is chilly, irritable, heavy-headed; after a hot sitz and a few drops passed, he can sleep for a short interval. Sleep improves toward morning if the tenesmus has remitted, which echoes the temporal modality of the remedy. Position in bed—on side with thighs flexed—may give a little rest, aligning with flexion amelioration.

Dreams of impediment, locked doors, fountains that won’t flow, and stones obstructing a stream; dream-pains in thighs on attempted urination; relief dreams follow warm baths, matching the heat modality [Clarke]. After successful passage of gravel, dreams become clear water and open gates, a patient’s own phrasing that clinicians note.

Pareir. synthesises spastic–obstructive urinary suffering with a unique mechanical signature: urine in drops, unending tenesmus, and the necessity to kneel on all fours, head to floor, or at least lean forward with thighs flexed, to void at all [Hering], [Clarke], [Boericke], [Boger]. Pains radiate along ureter to glans/testes and anterior/inner thighs; movement/jar, night, cold, and beginning/end of urination worsen; heat, pressure, rest, flexion, and small discharges ameliorate. Urine shows mucus, red sand, sometimes blood; old men with prostate troubles are frequent subjects. Differentiate from Cantharis (intense burning, sexual erethism; pain through whole act but without the all-fours keynote), Sarsaparilla (pain at close, must stand), Chimaphila (must stand/bend forward, feet apart, ball in perineum), Berberis (wandering shoots and bubbling), Lycopodium (right renal colic, 4–8 p.m., red sand but less tenesmus), Ocimum canum (violent right colic with foul urine), and Terebinthina (smoky haematuria) [Clarke], [Boger], [Boericke], [Allen], [Kent].

In renal colic chilliness with sweat on effort; slight fever with mucus cystitis; heat is less than in Cantharis. Temperature tracks the mechanical pain more than inflammation [Clarke], [Boericke].

Chilly, especially at night and after attempts; heat local to hypogastrium with throbbing; sweat clammy during strain and warm after fomentations (which also ameliorate pain). Sweating brings little relief unless flow occurs.

Headache is secondary, from loss of sleep, straining, and toxic urine retention; it is dull, frontal or occipital, and throbs with each vesical effort [Allen], [Clarke]. The head feels heavy when the bladder is full and lightens as even drops pass—an instructive reflex to the pelvic state (Generalities link). Cold draughts across the head chill him and intensify the spasm (modal echo). Unlike Cantharis, in which head heat accompanies burning, Pareir. has a wearied, drawn face from suffering. The headache eases in warm rooms or after a hot fomentation over the hypogastrium, again demonstrating the benefit of heat.

Lids are heavy from broken nights; conjunctivae may appear suffused in paroxysms of pain. Vision blurs momentarily during straining and clears with quiet. No primary ophthalmic disease belongs; the eye picture mirrors autonomic stress rather than local pathology [Clarke]. Photophobia is not characteristic; the patient simply avoids glare which jars the head.

Ringing may accompany vesical throbbing during effort; hyperacusis to sudden noises appears at night as the sufferer starts with each call to void. Otherwise ears are not a sphere.

Odours of stale urine and mucus disgust him, aggravating nausea (Stomach cross-link). The nasal mucosa is quiet; coryza, if present, is incidental.

Expression anxious, pinched, often sweaty about the lips during violent straining; colour pales with colic and flashes when the stone or spasm bites [Clarke]. Beard area may be damp after the hot sitz, with relaxation of features aligning with amelioration by warmth.

Dry mouth follows the long night; tongue coated; thirst is for warm sips that seem to assist flow (Modalities) [Clarke]. Metallic taste can occur in haematuric episodes. The mouth otherwise plays little role.

Grinding from pain and sleeplessness may be noticed; dental neuralgia is not a keynote. Teeth feel coated after nights of urging and improve with warm drinks.

A globus sensation rises at the peak of tenesmus, reflecting vagal strain; warm drinks relieve. No primary throat pathology.

Anxiety of breathing during violent urging; sighing after small relief; no primary chest disease. Palpitation reflects autonomic strain and settles with warmth and rest.

Pulse irritable in paroxysms; soft and slow after relief. No structural cardiac sphere belongs; any arrhythmia is reflex.

Breath short, held involuntarily during the effort; deep sigh marks release. Cold air across hypogastrium may provoke fresh spasm (modal cross-link).

Nausea accompanies colic and offensive mucus in urine; he shuns cold drinks which increase spasm, preferring warm fluids (modal echo) [Clarke]. Appetite is poor during pain and returns after short relief. Vomiting is rare, unlike Coloc. colics. Hiccough may appear after prolonged straining.

Hypogastrium feels heavy, full, and tender; the patient bends forward instinctively for relief (Better leaning) [Clarke]. Cutting pains run from kidneys along ureters to groin and thighs; abdomen is sensitive to jar and tight waistbands. Flatulence increases pelvic pressure; passing flatus brings a moment’s ease (Modalities). Unlike Berberis, which sprays pains in many directions with bubbling sensations, Pareir. is linear—kidney → ureter → outlet, with thigh reflex.

Tenesmus recti often accompanies vesical tenesmus—constant sense of must press, yet little passes; a small cord-like stool may temporarily ease vesical pressure [Allen], [Boger]. Haemorrhoids may congest during straining but are not central (contrast with Aesculus). Stool hard when urine is scanty; as urine flows, stool softens—another reflex pairing.

This is the centre. There is constant urging, straining with urine in drops, pain at beginning and end of micturition, spasm in the neck of bladder, and the unforgettable need to kneel on all fours with the head pressed down to void at all [Hering], [Clarke], [Boericke]. Pains run to glans, testes, and along inner/anterior thighs; urine is scanty, cloudy, often thick with mucus or red sand, sometimes streaked with blood when gravel moves [Allen], [Clarke]. Old men with enlarged prostate pass driblets at night with unrelieved tenesmus, and the pressure of clothes across the hypogastrium is intolerable (Affinities/Modalities cross-link) [Boericke]. Attempts to pass urine standing fail; leaning forward or kneeling enables a few drops (compare Chimaphila, which must stand, bend forward, feet apart) [Clarke], [Boger]. Cantharis shares the burning and tenesmus but is more scalding, with sexual erethism; Sarsaparilla has severe pain at the close of urination and a need to stand, while Pareir. has pain both at beginning and end and the all-fours posture.

Desires warm drinks which aid flow; cold drinks aggravate spasm; beer/wine increase uric load and night urging (clinical) [Clarke]. Avoid spices and acids that smart in inflamed mucosa. Appetite returns when pains remit.

Retraction and aching of testes during urging; pains jerk into glans; coitus followed by vesical irritation in sensitive subjects [Hering], [Allen]. Prostatic hypertrophy with nightly sufferings is a clinical field for Pareir., especially when the position and mucus-laden urine point the choice [Clarke], [Boericke]. Compare Sabal (general prostatic trophic action) and Chimaphila (must press perineum and bend forward).

Less frequently required, yet vesical catarrh in women with urging, mucus, red sand, and pains radiating to thighs calls for Pareir. when the kneeling/leaning amelioration is present [Clarke]. Gravid women with stone show classic tenesmus but must be differentiated from Cantharis (burning dominating) and Ocimum (right-sided colic with offensive urine) [Boericke]. Reflex pains may shoot to labia or inner thighs during attempts to void. Postpartum cystitis with mucus is occasionally met.

Sacro-renal and lumbar aching, bruised feeling, “must support” the loins when attempting to walk; jar aggravates, heat and pressure relieve [Boger], [Clarke]. Pain follows the ureteric track round to groin.

Drawing pains down anterior/inner thighs with each vesical attempt, a highly confirmatory sign [Hering], [Clarke]. Legs tremble after a paroxysm; walking reawakens pain (worse movement). Warmth to thighs often soothes reflex neuralgia.

In chronic, dry, harsh skin with uric diathesis; cold, clammy sweat during pains. No characteristic eruption; the skin texture reflects metabolic terrain (urates) [Clarke].

Acute tenesmus / strangury

• Cantharis — Scalding burning before/during/after; sexual erethism; no need to kneel; Pareir. has mechanical posture keynote and pains to thighs [Clarke], [Boericke].
• Equisetum — Tenesmus with little pain; bladder full sensation; Pareir. has violent pains and position compulsion [Boger], [Clarke].
• Nux-v. — Spasmodic urging with rectal irritability; less uric gravel, no kneeling keynote [Boger].

Renal colic / gravel

• Berberis — Radiating “stitching all ways,” bubbling in kidney; Pareir. is strictly ureter→outlet with thigh/glans radiation [Boger], [Clarke].
• Lycopodium — Right renal colic, red sand, flatulence, worse 4–8 p.m.; Pareir. more tenesmus and posture [Clarke], [Kent].
• Sarsaparilla — Pain at end of urination; must stand; child screams at close; Pareir. pain beginning & end, kneeling [Clarke], [Boericke].
• Ocimum canum — Right-sided colic with offensive urine, uric diathesis in children; Pareir. older men with prostate or marked tenesmus [Boericke].
• Terebinthina — Haematuria, smoky urine, nephritis; less postural element [Clarke].

Prostatic obstruction / old men

• Chimaphila — Must stand, bend forward, sometimes press perineum; sensation of ball; Pareir. must kneel on all fours, pain to thighs/glans [Clarke], [Boger].
• Sabal — Trophic action in BPH with dribbling; Pareir. for spasm–tenesmus crises [Boericke].
• Clematis — Urine intermittent from urethral stricture; less bladder tenesmus [Boger].

Cystitis with mucus

• Uva-ursi — Catarrh with burning and purulent urine; Pareir. more spasm and posture [Clarke].
• Merc-c. — Tenesmus with pus/blood and systemic sweat; Pareir. lacks Mercury’s salivation and bone signs [Allen].

Neuralgia referred to thighs/genitals

• Colocynthis — Cramp colic better hard pressure, but GI focus; Pareir. is urinary with kneeling [Boger].
• Staphisagria — Cystitis after catheter, cutting pains; less postural necessity [Clarke].

• Complementary: Chimaphila — Shares prostate–bladder sphere; follow when posture and tenesmus have eased but atony persists [Clarke], [Boericke].
• Complementary: Berberis — For residual kidney pains and radiations after Pareir. breaks the spasm [Boger].
• Complementary: Lycopodium — To regulate uric terrain after acute attacks (red sand) [Clarke], [Kent].
• Follows well: Cantharis — When burning phase subsides yet tenesmus with posture remains [Clarke].
• Follows well: Nux-v. — In irritable, chilly subjects once recto-vesical spasm turns purely urinary [Boger].
• Precedes well: Sarsaparilla — If end-of-urination pain persists in children after gravel cleared [Clarke].
• Precedes well: Sabal — For chronic BPH after acute tenesmus crises relieved [Boericke].
• Antidotes (functional): Heat, rest, diluent warm drinks; avoid cold, alcohol, spices which increase spasm [Clarke].
• Related cluster: Canth., Sars., Berb., Lyc., Chim., Sabal, Tereb., Uva-ursi, Equis., Ocim-c., Nux-v., Staph.—select by posture, phase of pain, burning vs spasm, and terrain [Clarke], [Boger], [Boericke], [Allen], [Kent].

• Renal/ureteric colic with drop-by-drop urine; must kneel head to floor: Pareir. 200C single then 30C every 1–3 hours with hot sitz; space on clear relief [Hering], [Clarke].
• BPH night crises (tenesmus, mucus, dribbling): Pareir. 30C t.i.d. for 2–3 days; add Chimaphila to maintain flow; avoid cold and tight belts [Boericke], [Clarke].
• Child with gravel (red sand) and thigh pains on urinating: Pareir. when pains at beginning and end; if end-only, pivot to Sarsaparilla [Allen], [Clarke].
• Uric diathesis, recurrent “red sand”: Between attacks, diet/light alkalinisation and Lycopodium or Berberis constitutionally after Pareir. has quelled spasm [Boger], [Kent].

Mind

• Anxiety and despair from constant urging to urinate — pain-worn fretfulness; night ≥ [Allen], [Clarke].
• Restlessness, cannot keep still during tenesmus — paces then kneels [Hering].
• Aversion to being stood over in public urinals — stream arrests unless leaning [Clarke].
• Irritable from loss of sleep — pain behaviour [Allen].
• Fastidious about cleanliness (offensive mucus urine) — disgust at odour [Clarke].
• Better warmth and quiet — mental relief tracks somatic easing [Boericke].

Head

• Headache from vesical tenesmus and loss of sleep — frontal/occipital heaviness [Allen].
• Throbbing synchronous with urging — reflex vascularity [Clarke].
• Cold air aggravates spasm and head — weather–spasm link [Clarke].
• Better hot applications — relief via pelvic easing [Boericke].
• Heaviness when bladder full; lighter after a few drops — pathognomonic reflex [Clarke].
• Face pinched and sweaty during efforts — paroxysm sign [Allen].

Abdomen/Back

• Hypogastric pressure; must bend forward — mechanical keynote [Clarke].
• Sacro-renal aching; jar aggravates — movement < [Boger].
• Pains following ureter to groin — linear track [Clarke].
• Tight clothing aggravates hypogastrium — pressure sensitivity [Clarke].
• Warmth ameliorates pelvic pains — heat > [Boericke].
• Passing flatus relieves vesical pressure — reflex easing [Allen].

Urinary

• Must kneel on all fours with head to floor to urinate — signature rubric [Hering], [Clarke].
• Urine passed in drops; constant tenesmus — centre of remedy [Allen], [Boericke].
• Pain at beginning and end of urination — phase pattern [Clarke], [Boger].
• Pains to glans/testes and inner thighs during urging — reflex mapping [Hering], [Clarke].
• Urine thick with mucus; red sand; occasional blood — terrain [Clarke], [Boger].
• Night aggravation of urging and pain — sleep-broken [Allen].

Male

• Prostate enlarged; dribbling; tenesmus at night — old men’s crises [Boericke], [Clarke].
• Retraction/aching of testes during colic — genital reflex [Hering].
• Urging with pain to glans — urethral echo [Allen].
• Standing to urinate aggravates — posture key [Hering].
• Better perineal/abdominal pressure — mechanical aid [Boger].
• Cold exposure aggravates — spasm trigger [Clarke].

Generalities

• Better heat, pressure, flexion, rest; worse night, cold, movement/jar — master modalities [Clarke], [Boericke], [Boger].
• Uric-acid diathesis (red sand) — constitutional hint [Clarke].
• Older men; BPH terrain — patient type [Boericke].
• Reflex pains to thighs — diagnostic aid [Hering].
• Post-paroxysm prostration — fatigue rubric [Allen].
• Diluent warm drinks ameliorate — regimen [Clarke].

Hering — The Guiding Symptoms of our Materia Medica (1879): signature posture (kneeling, head to floor); tenesmus; pains to thighs/glans; clinical confirmations.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): urinary pathogenesis; gravel; mucus; night aggravation; recto-vesical reflex notes.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): identity (Pareira brava); bladder/ureter/prostate affinities; modalities; comparisons.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—strangury, uric diathesis, BPH nights; heat and posture ameliorations; relationships.
Boger, C. M. — Synoptic Key (1915): generals—jar <, pressure/heat >; linear ureteric pains; repertory scaffolding.
Hughes, R. — Cyclopaedia of Drug Pathogenesy (1870): botanical background; toxicologic reasoning for smooth-muscle spasm/neuralgia.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): comparisons—Lyc., Berb., Sars., Canth.; uric terrain management.
Farrington, E. A. — Clinical Materia Medica (1887): urinary group differentiation (Canth., Sars., Chim., Berb.); posture cues.
Nash, E. B. — Leaders in Homeopathic Therapeutics (1899): clinical pearls in renal colic and strangury; remedy sequencing.
Dewey, W. A. — Practical Homœopathic Therapeutics (1901): cystitis/prostate therapeutics; regimen—heat, diluents, rest.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1941): concise keynotes—urine in drops; thigh radiation; mechanical modalities.
Tyler, M. L. — Homœopathic Drug Pictures (1942): bedside colour—old men, night crises; posture and warmth as selecting signs.