Rheum palmatum

A perennial of the Polygonaceae, native to China and Tibet. The root contains anthraquinone glycosides (rhein, emodin), tannins, and bitters that act as a purgative/aperient in crude doses, with a familiar sour, fermented odour to the stools and perspiration after its use—an odour that becomes a keynote in the homoeopathic picture [Hughes], [Clarke]. Mother tincture from the recently dried root; toxicologic observations give griping colic with tenesmus and fermenting, sour stools, especially in children, and a reflex salivation and sour taste in the mouth [Allen], [Hughes]. [Toxicology]

Primary provings and toxicology compiled by Hahnemann and Allen, with clinical confirmations in Hering, Clarke, and Boericke. Repeated constants: sourness of all excretions, pappy, fermenting, sour stools with tenesmus, griping umbilical colic, unrelieved by stool or relieved only briefly, sour saliva and sour taste, and the sour-smelling child—especially during dentition [Hahnemann], [Allen], [Hering], [Clarke], [Boericke]. [Proving] [Clinical]

Rheum is the portrait of sour fermentation—sour breath, sour saliva, sour sweat, sour stool—with umbilical griping and tenesmus that a stool eases only for a short time. The child is sour to smell and taste, fretful but not furiously angry; wants warmth and a warm hand on the belly, is worse if the abdomen is uncovered or if food (especially fruit, milk, sweets) is taken, and sleeps only in short snatches between calls to the stool. The chill during stool and the shudder afterward are small but telling physiological touches that, along with the white-coated tongue and water-brash, round out the gastric–enteric axis [Allen], [Hering], [Clarke]. Think Rheum when a dentitional infant smells sour though bathed, the pillow is wet with sour sweat, and the napkin shows pappy, sour stools that excoriate. Distinguish it from Cham. by the odour and the temperament (fretful rather than raging), from Mag.-c. by the generalised sourness and less specific milk-craving, and from Calc.-c. by diarrhoea rather than obstinate stool. In adults, the same logic prescribes it for fermentative dyspepsia with sour risings where every meal brings umbilical rumbling and tenesmus relieved only briefly by a stool, warmth being the one reliable comfort. Essence in one line: sourness everywhere + umbilical colic with short-lived relief + warmth/pressure > and cold air/uncovering <. [Clarke], [Boericke], [Boger], [Tyler]

• Small intestine/colon (enteric fermentation): Pappy, sour, fermenting stools with tenesmus and ineffectual urging; colic about the umbilicus; stool does not fully relieve (or only for a short time). Cross-ref. Abdomen, Rectum, Generalities. [Allen], [Clarke], [Boericke]
• Dentition & salivary glands: Teething with salivation, sour mouth, sour odour of the whole child, fretfulness before and after stool. Cross-ref. Teeth, Mouth, Mind. [Hering], [Clarke]
• Sweat glands/skin: Sour perspiration, especially scalp and nape; child smells sour despite washing. Cross-ref. Perspiration, Sleep. [Hering], [Boericke]
• Stomach (acid/fermentative dyspepsia): Sour eructations, nausea with water-brash, craving to eat yet worse after eating. Cross-ref. Stomach, Food and Drink. [Allen], [Clarke]
• Liver/portal tone (minor): Sense of biliousness with colic, but without the profound liver signs of Chel.; the keynote remains sour fermentation. Cross-ref. Abdomen. [Hughes], [Clarke]
• Rectal sphincter/tenesmus reflex: Straining with scant discharge, chilliness during stool, and shuddering after; children cry before, during, and after stool. Cross-ref. Rectum, Fever. [Allen], [Hering]

Irritable and fretful, especially before and after stool, with crying that the nurse cannot interpret—an unrest born of umbilical griping and the sensation that a stool is coming but will not fully relieve it [Hering]. Children are peevish, want to be carried warm and slowly, and then push away in discontent when the relief is only brief; this maps to the better warmth/pressure and transiently better after stool modalities already stated [Clarke], [Allen]. The sour odour of the child, the constantly sour saliva, and the chafing of the napkin area make them fastidious about being changed and covered; uncovering the belly annoys and worsens complaint, echoing cold air <. Mental picture lacks the angry violence of Chamomilla; it is a fretful, whining impatience linked tightly to intestinal fermentation, not the rage of over-sensitiveness [Tyler], [Boericke]. Anxiety about eating appears in older children who learn that a few bites bring immediate rumbling, sour risings, and urging; yet hunger returns in a cyclic way, making a dilemma the remedy resolves when given on its keynote. Mothers remark that the child “smells sour though bathed,” and that the fret lifts when the abdomen is warmed and the first stool passes—again underlining the peripheral gut–mood link. Sleep is broken by urging and by the shuddering that follows stool; once the bowels are quieted, the child smiles easily, supporting the notion that the mental state is secondary to fermentation and tenesmus [Clarke], [Hering]. [Clinical]

Sleep is broken by urging and by inquietude before stool; infants sleep fitfully and only in warmth or on the arm; after a stool they doze briefly until urging returns [Hering], [Clarke]. Night sweat on scalp and nape is sour, soaking the pillow; the child throws off the covers and immediately feels worse from cold air on the belly, demanding re-wrapping—this recapitulates the modality uncovering abdomen <; warmth >. Parents report repeated cycles through the night—urge, stool, shuddering, brief doze—until early morning. [Boericke]. [Clinical]

In older children, dreams of being late to the closet, or of eating forbidden fruit; in adults, dreams of food and sour tastes, reflecting daytime dyspepsia. These abate as fermentation settles. [Clinical]

Rheum is the sour fermentation remedy: sourness of stools, sweat, saliva; pappy, fermenting, sour diarrhoea with umbilical griping, tenesmus, chill during stool, and only short relief after [Allen], [Hering], [Boericke]. The child smells sour despite washing; the abdomen hates cold air and loves warmth and pressure; eating/drinking quickly worsens; dentition sets the whole machine in motion. Differentiate from Cham. (anger, one cheek red/one pale, hot sweat, green “chopped” stools), Mag.-c. (sour stools too, but marked milk intolerance, great chilliness, and craving for fat/milk), Calc.-c. (sour head-sweat, but constipation and fat, flabby habit), Podoph. (profuse, gushing, painless morning stools), Aethusa (milk-vomiting with collapse), and Ars. (burning watery stools with anguish and thirst in sips). The thread that never breaks is sourness plus umbilical colic with short-lived relief after stool and warmth > / cold air <. [Clarke], [Boger], [Boericke], [Tyler]. [Clinical]

Not a fever remedy per se; chilliness during stool and a slight heat of face after are common; the child may flush then shudder. The thermal curve follows the stool-cycle, not an independent pyrexia. [Allen], [Clarke]. [Clinical]

Chill during stool, with goose-flesh; sour sweat chiefly on scalp/neck, worse in sleep and during dentition; heat local to face after effort. These swings arise from enteric irritation and tenesmus and settle as stools moderate. [Hering], [Boericke]. [Clinical]

Head is heavy during attacks; infants perspire sour across scalp and nape, soaking the pillow, especially during and after the stool-crying [Hering], [Boericke]. Fontanelles are not a Rheum sign as in Calc.-c., but the sour head-sweat links them as comparisons in dentition. Headache in older children and adults is frontal, pressing, with nausea and sour eructations; it comes after errors of diet and lessens with warmth and a light stool, showing the same gastrointestinal driver as elsewhere [Clarke]. The child dislikes cold air on the head or abdomen; draughts bring renewed griping. [Clinical]

Eyes look dull, with blue circles from a restless night; occasional lachrymation during griping; no specific ophthalmic pathology. Sour sweat may irritate lashes in infants, and chafing appears at inner canthi when the napkin rash is bad, a small echo of the sour excoriation theme. [Clarke]. [Clinical]

No settled otic picture; ear-rubbing is from general fretfulness rather than otitis. In teething bouts, the child pulls at ears while simultaneously drawing up legs, the more characteristic umbilical colic sign. [Hering]. [Clinical]

Sweat and exhalations are sour; nose may be moist but not notably coryzal. Sneezing from draughts accompanies the abdominal chill that worsens colic, dovetailing with cold air <. [Clarke]. [Clinical]

Pale, with a tired look; sometimes a faint redness around mouth, excoriated by sour saliva during dentition. Unlike Cham., there is not the one cheek red, one pale signature; the face instead looks damp from sweat during colic, and the lips have a sour taste when kissed. The child’s features relax briefly after a stool then pucker again as urging returns—graphically expressing the short relief of evacuation in this remedy. [Hering], [Clarke]. [Clinical]

Sour saliva, sour taste, and water-brash belong here; during dentition, salivation is profuse and sour, excoriating the lip-angles and chin [Hering], [Allen]. The tongue is usually white-coated, with imprint of teeth after restless nights; the taste of all foods seems sour or causes sour risings. The mouth-waters on merely thinking of food, but eating quickly rekindles colic and diarrhoea—perfectly mirroring after eating < in Modalities. [Clarke]. [Clinical]

Dentition is a main clinical plane: cutting teeth brings salivation, sour stools, napkin rash, and umbilical griping with fretfulness [Hering], [Tyler]. The child gnaws the ring but cries on being jostled; warm carry and abdominal pressure soothe briefly. Contrast Chamomilla, where pain is violent and child is angrily inconsolable, and Magnesia carbonica, where sour stools occur too but the child is often thinner, chilly, and craves milk which disagrees notably [Clarke], [Phatak]. [Clinical]

Much swallowing of sour saliva; a scraping sensation with constant water-brash may appear in older sufferers with fermentative dyspepsia. No marked tonsillar picture. Relief comes as abdominal turmoil abates. [Allen], [Clarke]. [Clinical]

Oppression when colic is intense, from reflex inhibition of deep breathing; sighing after a stool; no primary bronchial involvement. [Clinical]

Palpitation in nervous dyspeptics during griping, subsiding as the bowel quiets—secondary, not organic. [Clarke]. [Clinical]

Short and superficial during urging; a deep breath comes only when the warm compress is applied and the first stool passes—an explicit cross-link to Better warmth and after stool (briefly) >. [Clinical]

Sour eructations, nausea with accumulation of watery fluid in mouth (water-brash), and immediate rumbling after eating mark the gastric field [Allen]. Appetite is capricious; small quantities of food suffice to start fermentation and the umbilical griping that heralds a stool; warm drinks in small sips sit best, while fruit, milk, and sweets are a near-certain aggravation, explicitly cross-linked to Modalities and Food and Drink [Clarke]. Vomiting is not a keynote as in Aethusa or Ant-c.; here the trouble passes quickly to the bowels. [Clinical]

The centre of the picture: griping about the umbilicus, with borborygmi and a sense as if fermentation were going on; the abdomen is sensitive to cold air and uncovering, and likes the warm hand pressed upon it [Allen], [Clarke]. Children draw up the legs and then push them down in impatience; adults bend a little forward and loosen the belt. The colic is often not relieved by stool or only for a short time; urging soon returns, matching the observing authors’ emphasis on short-lived relief [Hering], [Allen]. Compare Colocynthis, where bending double gives long relief and pains are cutting-violent; in Rheum the pains are less neuralgic, more fermentative, and sourness pervades all excretions. [Clinical]

Stool pappy, pasty, fermenting, sour; sometimes frothy; often mucous; accompanied by tenesmus, chilliness during stool, and a shuddering or goose-flesh after stool [Allen], [Hering], [Clarke]. The odour is a guide: sour—not the cadaveric fetor of Merc. nor the rotten-egg smell of Psor. The child cries before, during, and after stool, and the napkin excoriates from sourness. Urging recurs soon; stool is not final. Distinguish from Podophyllum (gushing, profuse, painless mornings), Cham. (greenish, chopped-egg stools with anger and heat), and Mag.-c. (sour diarrhoea with milk-aggravation and marked chilliness), and Sulph. (early-morning urgency with burning and general heat). [Boericke], [Clarke]. [Clinical]

Urine may have a sour odour or scald slightly at the meatus after frequent stools, a local excoriation phenomenon; otherwise unremarkable. Polyuria is not implied; frequency may accompany restlessness. [Clarke]. [Clinical]

Worse from fruit, milk, sweets, and cold drinks; better for warm, bland, starchy foods in small amounts (thin gruels, lightly toasted bread) until fermentation abates [Allen], [Clarke]. Appetite returns in cycles but overeating renews complaints; teach parents to feed little and often, warm. [Clinical]

No constant sexual sphere. Occasional perineal excoriation from sour stools in nurslings. [Clinical]

During pregnancy or nursing, errors of diet may provoke sour diarrhoea with umbilical griping and water-brash; infants at breast develop sour napkin rash; diet correction plus Rheum resolve the cycle—extending the dentition logic to the nursing dyad. [Clarke]. [Clinical]

Lumbosacral ache after repeated stools in adults; children arch from fretfulness rather than true back pain. The back is not a leading region here. [Clinical]

Restless kicking in children with colic; feet cool in the chill of stool; warmth of socks and bedclothes comforts. [Hering], [Boericke]. [Clinical]

Sour perspiration excoriates folds; napkin rash is common, red and smarting from sour stools and saliva. The odour (cleaned, yet soon sour again) is a striking domestic keynote. [Hering], [Clarke]. [Clinical]

• Dentition diarrhoea / sour child
  • Chamomilla — Green, chopped stools; anger, inconsolable except carried fast; sweat hot; odour not characteristically sour. Rheum: sour everything, wants warmth/slow carry, relief after stool brief only. [Clarke], [Tyler].
  • Magnesia carbonica — Sour stools and milk-aggravation marked; child chilly and thin, desires milk which disagrees; less sweat on scalp. Rheum: broader sour odour (sweat, saliva, stool) and umbilical griping. [Phatak], [Clarke].
  • Calcarea carbonica — Sour head-sweat and dentition troubles, but constipation predominates with flabby habit; Rheum has diarrhoea with fermenting stools. [Tyler], [Boericke].
  • Aethusa — Milk vomited in curds with collapse; less tenesmus; stool not so sour; Rheum primarily bowel-ferment with sourness. [Clarke].
• Enteric fermentation / dyspepsia
  • Antimonium crudum — Gastric disorder from overeating; white-coated tongue, aversion to heat of bath; stools not typically sour; more nausea/vomiting. Rheum: sour risings and diarrhoea with umbilical griping. [Allen], [Clarke].
  • China (Cinchona) — Bloating and offensive flatus after fruit; stools yellow, painless; exhaustion after loss of fluids; not the sour signature of Rheum. [Clarke].
  • Podophyllum — Profuse, gushing, morning stools, often painless, with prolapse; odour not distinctively sour. Rheum has tenesmus, chill during stool, sour odour. [Boericke].
  • Arsenicum — Burning stools with anguish, thirst in sips, restlessness; odour acrid rather than sour; colic relieved by heat but anguish is disproportionate; Rheum is fretful without the Arsenical despair. [Clarke], [Nash].
• Colic modalities
  • Colocynthis — Bending double gives marked relief; pains cutting-violent. Rheum: warmth/pressure help, but relief short, and sour keynote rules. [Boger].
  • Dioscorea — Colic > bending backward; flatulence more upper. Rheum: umbilical and tenesmus with sour stools. [Farrington].

• Complementary: Calc.-c.—for the dentitional constitution with sour head-sweat, when Rheum covers the acute sour diarrhoea episode. [Tyler], [Clarke].
• Complementary: Mag.-c.—often follows when milk-intolerance dominates after Rheum has checked the sour ferment. [Phatak].
• Follows well: Nux-v.—in dyspeptic parents after purgative abuse or coffee excess; Rheum then clears the fermenting diarrhoea stage. [Clarke], [Hughes].
• Precedes well: Sulph.—for recurrent morning looseness and heat after the acute sour phase ends. [Kent].
• Compare: Cham., Calc.-c., Mag.-c., Podoph., Aeth., Ars., China, Coloc., Ant-c.—see Differentials for discriminants.
• Antidotes (drugging): Nux-v., Ipec., Camph. to large-dose rhubarb effects (old-school note). [Clarke], [Hughes].

• Dentition diarrhoea with sour odour of child, napkin rash, umbilical griping: Rheum 6x–30C every 2–6 hours, spacing as stools settle; keep abdomen warm, feed little and often (warm, bland), avoid fruit/milk/sweets temporarily. [Hering], [Clarke], [Boericke].
• Fermentative dyspepsia in adults (sour risings, water-brash, urging after meals): Rheum 30C once or twice daily for a short course; add warmth to abdomen, moderate portions, and avoid cool drinks with meals. [Allen], [Clarke].
• Sour scalp-sweat of children soaking the pillow with fretfulness: Rheum 6x at bedtime for a few nights; compare Calc.-c. if constipation/constitutional signs predominate. [Boericke], [Tyler].
• If milk intolerance is conspicuous after Rheum has checked diarrhoea: step to Mag.-c. or dietary adjustment; return to Rheum if the sour odour and umbilical griping recur. [Phatak].

Mind

• MIND — FRETful — children — before and after stool. — Fretfulness tracks the stool cycle. [Hering], [Clarke]
• MIND — WANTS to be carried — slowly — ameliorates. — Warm, gentle carrying soothes briefly. [Hering]
• MIND — IRRITABILITY — eating — after — aggravates. — Food restarts fermentation. [Clarke]

Stomach / Abdomen / Rectum (core)

• STOMACH — ERUCTATIONS — sour. — Gastric sourness keynote. [Allen]
• STOMACH — WATERBRASH — with salivation — sour. — “Water in mouth” and sour taste. [Allen]
• ABDOMEN — PAIN — umbilicus — around — griping. — Central colic site. [Clarke]
• ABDOMEN — COLD — uncovering abdomen — aggravates. — Hates draught on belly. [Clarke]
• RECTUM — TENESMUS — stool — with — not relieved by. — Short relief only. [Allen]
• STOOL — ODOUR — sour. — Distinctive smell. [Clarke], [Boericke]
• STOOL — CONSISTENCE — pappy; pasty — fermenting; frothy. — Textural keynote. [Allen]
• STOOL — DENTITION — during — diarrhoea. — Classic sphere. [Hering]

Skin / Perspiration

• PERSPIRATION — SOUR — children — head; scalp — during sleep. — Sour head-sweat soaking pillow. [Hering], [Boericke]
• SKIN — EXCORIATION — from stools — sour — children. — Napkin rash from sour discharges. [Clarke]

Modalities

• GENERALITIES — WARMTH — abdomen — ameliorates. — Warm hand/flannel soothes. [Clarke]
• GENERALITIES — COLD air — aggravates — uncovering abdomen. — Draughts renew griping. [Clarke]
• GENERALITIES — EATING — after — aggravates. — Even small amounts. [Allen]
• GENERALITIES — PRESSURE — abdomen — slight — ameliorates. — Doubling up/hand pressure. [Hering]

Teeth / Mouth

• TEETH — DENTITION — salivation — sour; with diarrhoea. — Twin keynote. [Hering]
• MOUTH — SALIVA — profuse — sour — excoriating. — Lip angles sore. [Allen], [Clarke]
• TONGUE — COATING — white — morning. — Fits ferment type. [Allen]

Sleep / Fever

• SLEEP — DISTURBED — stool — urging before. — Broken nights in infants. [Clarke]
• CHILL — DURING — stool. — Shuddering with tenesmus. [Allen], [Hering]

Hahnemann — Materia Medica Pura (1821–34): proving fragments; sour taste/salivation; abdominal griping and stool notes.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): toxicology and proving—pappy sour stools, tenesmus, water-brash, chill during stool.
Hering — The Guiding Symptoms of Our Materia Medica (1879): dentition sphere—sour child, napkin rash, warmth/pressure >, uncovering <.
Clarke — A Dictionary of Practical Materia Medica (1900): substance background; clinical keynotes—sour odour, umbilical colic, short relief after stool.
Boericke — Pocket Manual of Homoeopathic Materia Medica (1901): modalities (night, after eating; warmth >; cold air <), sour perspiration, dentition diarrhoea.
Hughes — A Manual of Pharmacodynamics (1870s): pharmacology of rhubarb (anthraquinones); purgative → enteric fermentation rationale.
Boger — Synoptic Key of the Materia Medica (1915): modalities grid—warmth >, uncovering <; comparisons with Cham., Mag.-c., Calc.-c.
Tyler — Homoeopathic Drug Pictures (1942): clinical portraits in dentition; contrasts with Cham. and Calc.-c.
Phatak — Concise Materia Medica (1977): sour stools and milk-aggravation differentials; relationship to Mag.-c.
Nash — Leaders in Homoeopathic Therapeutics (1907): comparisons for infantile diarrhoeas (Ars., Pod., Cham.).
Dewey — Practical Homoeopathic Therapeutics (1901): dentition diarrhoea management; dietary counsel.
Farrington — Clinical Materia Medica (late 19th c.): colic differentials (Coloc., Diosc.) and ferment patterns.