• Heart and pericardium (primary): Palpitation violent and visible, anginal stitches, pericardial pains radiating to left arm/shoulder, cannot lie on left side, must lie on right with head high, least motion aggravates; sense of heart stopping and then starting with a shock appears in some cases. Cross-ref. Heart, Chest, Respiration, Modalities. [Clarke], [Kent], [Boericke], [Farrington]
• Trigeminal nerve (V) — supraorbital/maxillary (left > right): Stitching, burning, thread-like neuralgia, from temple and eye to cheek and teeth, touch and motion aggravate, warmth and rest relieve. Cross-ref. Head, Face, Teeth, Modalities. [Hering], [Allen], [Clarke]
• Ciliary body/eyes (ocular neuralgia): Intense pain on moving the eyes, photophobia, as if the eye were too large, tearing from orbit to occiput; ciliary neuralgia after suppression of discharge. Cross-ref. Eyes, Head. [Allen], [Hering], [Clarke]
• Intercostal nerves & precordial region: Stitching intercostal pains, left chest wall tenderness, heart region sore to touch; cardiac neurosis pictures. Cross-ref. Chest, Back, Modalities. [Clarke], [Boger]
• Gastro-intestinal (vermifuge heritage): Borborygmi, colic about the navel, pinworms, sour taste, morning nausea; nervous children with worm signs and cardio-neurotic palpitations. Cross-ref. Abdomen, Rectum, Generalities. [Allen], [Clarke], [Hughes]
• Cervico-occipital & nuchal nerves: Occipital–nuchal drawing pains, neck stiffness accompanying eye/temple neuralgia; worse motion. Cross-ref. Head, Back. [Hering], [Allen]
• Autonomic/vaso-motor: Startings, faintness on rising, cold sweat during anginal waves; palpitations from emotion. Cross-ref. Mind, Generalities. [Kent], [Clarke]
• Left-sidedness: Many complaints especially left eye, left temple, left chest/arm, guiding selection when modalities agree. Cross-ref. throughout. [Hering], [Clarke]

• Absolute rest; avoidance of the least motion in heart or neuralgia states. [Kent], [Clarke]
• Lying on the right side with head high; cannot lie on left. [Hering], [Clarke], [Boericke]
• Warm applications and wrapping to face/eye for neuralgia; dry heat to precordia. [Allen], [Clarke]
• Closing the eyes; keeping them still (ciliary pain abates). [Allen], [Hering]
• Gentle pressure to the painful nerve-track or over the heart (hand supports). [Hering], [Boger]
• Silence and dark room for head/eye pains. [Clarke]
• After perspiration or after a quiet sleep, pains remit somewhat. [Nash]
• Warm drinks; small sips to ease faintness. [Clarke]
• Steady posture; sitting propped in cardiac dyspnoea. [Kent], [Clarke]
• Expiring slowly rather than taking deep breaths during anginal stitches. [Clinical]
• Firm bandaging of chest during intercostal neuralgia. [Boger]

• Least motion—walking, turning, stooping, stepping, raising the arms, deep inspiration—brings palpitation/angina or neuralgic stitches. [Kent], [Clarke], [Hering]
• Lying on the left side; lying flat; first turning in bed. [Clarke], [Boericke]
• Touch and pressure on nerve/heart region (except light, comforting pressure). [Hering], [Allen]
• Cold air, drafts, washing with cold water on face/eyes; wet weather in neuralgias. [Clarke], [Allen]
• Noise, bright light, moving the eyes, reading. [Allen], [Hering]
• Morning to noon for supraorbital neuralgia; forenoon exacerbations; also before a storm. [Clarke], [Hering]
• Emotion, fright, surprise—pulse becomes irregular, palpitation violent. [Kent], [Clarke]
• Tobacco/coffee in sensitive hearts; stimulants aggravate palpitations. [Hughes], [Clarke]
• Stooping (rush to head) and ascending (dyspnoea with palpitation). [Boger], [Clarke]
• Jar of the bed or floor during neuralgic attacks. [Hering]

Highly sensitive, apprehensive, and watchful regarding the heart; the patient fears to move because the least motion brings palpitations or a stabbing precordial pain [Kent], [Clarke]. There is a peculiar expectant dread as night approaches if the last attempt to lie down produced violent palpitation, echoing worse left side and lying flat already listed. The temper is nervous-irritable during neuralgic fits; noise and light are intolerable when the supraorbital/ciliary pains rage [Hering], [Allen]. Depression alternates with anxious vigilance; the face is pale with an inward listening to the heart. Compared with Aconite, fear here is not wild panic but a mechanical dread of motion and posture; compared with Arsenicum, the anxiety is less restless and more guarded, strategising to keep still and on the right side with head high. Thoughts of the heart stopping, or that one blow will end life, pass like shadows during pericardial pain; once seated upright and still, courage returns—thus rest is not only a modality but a mental antidote. Sleep loss increases emotional lability and aggravates ciliary excitability, which in turn rekindles headache and palpitations, forming the feedback loop Spig. is chosen to arrest.

The classical left supraorbital and left frontal hemicrania feels stitching, burning, thread-like, sometimes “as if a nail were driven above the eye,” spreading to temple, zygoma, teeth and occiput [Hering], [Allen], [Clarke]. Forenoon exacerbations are frequent; the least jar, touch, eye-movement, or cold air increases suffering; warmth, quiet, and resting the eyes give relief. The pain may march along the supraorbital branch of V and then involve maxillary teeth, with facial twitching and tearing. Dizziness occurs on stooping or turning, and is purely neuralgic/vaso-motor; the scalp becomes sore and hair roots tender. Differentially, Cedron gives clock-like periodic left supraorbital neuralgia, Mag-phos. eases with pressure/heat and is cramping rather than stabbing, Mez. is burning along the zygoma with eruption; Spig. is the thread-like, stitching type with eye-movement < and warmth > [Farrington], [Clarke]. Relief often follows gentle sweating or a short sleep, cross-linking to Better after perspiration/sleep.

The eye seems too large; ciliary neuralgia radiates from eye to occiput, intensifies on moving or turning the eyes, with photophobia and lachrymation [Allen], [Hering]. Retinal hyperaesthesia makes reading impossible; looking quickly from object to object stings like wires pulling at the globe. The lids feel stiff; pains shoot into the root of the nose and cheek, merging with the trigeminal picture. Warm applications and a dark room afford relief; cold air and washing with cold water rekindle pain—precise echoes of Modalities. After suppressed catarrh or dental work the ciliary track may fire up; Spig. compares with Ruta (asthenopia, strain), Paris (“ball too large” but with neck sensations), and Physostigma (spasm, ache on accommodation), but the left-sided ciliary stitch with cardiac concomitants points strongly to Spig. [Clarke], [Farrington].

Neuralgic shoots may include the ear; tinnitus with palpitation occurs in cardiac-sensitive subjects. Sudden noises aggravate head and eye pains; ear symptoms usually subside when the cardiac and trigeminal storms abate. No central otic pathology is implied in the remedy image.

Neuralgic shoots to the root of nose; sneezing jars the head and aggravates left frontal pain. Alternate dryness and fluent coryza may accompany weather-change neuralgias; the coryza itself does not select the remedy, the neuralgic thread does. Pressure at the root briefly relieves.

Left-sided tic douloureux: tearing, stitching along the infraorbital nerve, with face pale or pinched, perspiring with pain; slightest touch intolerable, yet the patient sometimes presses firmly or wraps hot cloths for relief [Hering], [Clarke]. Facial muscles twitch; pains extend to upper teeth (odontalgia neuralgica) worse cold air, better warmth. Compare Coloc. (cramping, pressure > but gastric/anger aetiology), Mez. (burning bone-pain with eruption), Verbascum (pressing pain in malar region with voice modification).

Teeth on the left upper arcade ache with face pains; cold drinks aggravate; warmth soothes. Tongue moist; taste sour or metallic in mornings; saliva increased during neuralgic distress. Clenching the teeth worsens head-shock from each heartbeat when the heart is stormy.

Odontalgia relates to the infraorbital track: touch, cold air, chewing, or stooping aggravate; warmth and firm pressure sometimes help. No caries signature is implied; it is a nerve-pain overlay.

Tightness about the throat and supra-sternal region during palpitations; swallowing jars the head; tickling cough rare and secondary. Warm drinks calm vagal irritability; cold air drafts provoke throat chill and neuralgia.

Sinking and faintness accompany cardiac fits; nausea in the morning with sour taste; worse from emotion. Appetite small during neuralgic days; warm fluids and small feedings best tolerated. Gastric symptoms subside as the heart steadies.

Peri-umbilical colic and rumbling with worm indications (children picking the nose, grinding teeth), but this is not the chief sphere unless accompanied by cardiac or neuralgic concomitants [Allen], [Clarke]. Left-sided abdominal stitches occur on motion and with palpitation. Flatulence aggravates the sense of precordial oppression; relief follows flatus.

Urine scant during palpitations; becomes freer as circulation steadies; dark or high-coloured during neuralgic storms, lightening after rest. No constant albuminuria picture; urinary signs are reactive.

Itching and crawling suggestive of pinworms; stool otherwise normal or costive. Straining aggravates cardiac throbbing; haemorrhoids occasionally sensitive to touch during neuralgic days.

Sexual excitement or coitus may precipitate palpitations; neuralgic headaches worsen with sexual excess. Not a primary genital remedy.

Palpitations around menses; left mastalgia with stitching extending to axilla on exertion; ciliary/trigeminal neuralgia at menses in sensitive women. Pregnancy with cardiac irritability may show the right-side posture need—cannot lie left without palpitation.

Short, anxious breathing on exertion or turning in bed; must sit propped; deep inspiration brings a stitch through the heart; patient fears to breathe deeply. Breathlessness is cardiac rather than bronchial and eases as he lies quietly on the right side. Talking and ascending stairs provoke dyspnoea plus palpitation.

The centre of Spig.: violent palpitation from the least motion, visible apex-beat, cannot lie on the left side, must lie on the right with head high; angina pectoris with stitches, oppression, and left arm radiation; pericarditis with soreness to touch, friction-feel, and posture-strategy [Kent], [Clarke], [Boericke], [Farrington]. Deep inspiration or raising the arms aggravates; slow expiration eases. Compare Cactus (iron-band constriction, less left-sided nerve radiation), Digitalis (slow, weak pulse, icy prostration), Kalmia (cardiac pains shooting down left arm with numbness; rheumatic base), Naja (constrictive left carotid throb with moral depression), Acon. (first-hour panic and heat), Latrodectus (extreme angor with tearing left-arm pains). Spig. is recognised by the motion-worse, left-side-worse, right-side-and-head-high-better axis, with neuralgic stitch quality predominating [Farrington], [Nash].

Left chest stitches, soreness of the intercostals, precordial tenderness to touch, palpitation visible and audible, dyspnoea on the least motion; the patient supports the chest with the hand, sits propped, and refuses to turn left [Clarke], [Kent]. Sensation that the heart will cease, then a sudden shock as if it started again, belongs to the neurosis/pericarditis edge. Radiations to neck and down the left arm occur; cold sweat may attend a bad wave; pulse irregular during motion, steadier at rest. Intercostal neuralgia (often left) is sharp, thread-like; touch and motion <, firm bandaging and heat >—completely consonant with the remedy’s neuralgic theme [Boger].

Nape stiff; cervico-occipital pulling with eye/temple pains; between-scapulae ache during cardiac anxiety; left dorsal intercostals sensitive. Warmth and rest help; rotation of the neck aggravates.

Left arm numbness or shooting pains accompany precordial anguish; hands tremble during palpitation; legs weak on ascending, knees knock with fear of starting the heart. Slight oedema may appear during cardiac failure but is not a keynote.

Pale or sallow in neuralgic/cardiac subjects; cold sweat on forehead in anginal waves. Itching at anus in children with worms is occasional. No characteristic eruption.

Sleep is broken: on lying down palpitation starts, especially lying left; the patient seeks the right side, head high, and perfect stillness [Clarke], [Hering]. Starting on first sleep is common; dreams of death or of a blow to the heart; early morning dozes occur once a position is found that does not excite the heart. Neuralgic patients dread turning the head/eyes on the pillow for fear of a stab of pain. After slight perspiration in the early morning, sleep deepens—a practical observation tying back to Better after perspiration.

Of heart stopping; of being stabbed in the left chest; of climbing and panting; of glaring light and knives near the eye—imagery drawn straight from the remedy’s neuralgic and cardiac poles.

No specific eruptive fever; heat of face and cold extremities during cardiac anxiety; slight rises with neuralgic storms; temperature falls with rest. Alternations of flush and pallor during angor are common.

Chill on the least motion during cardiac weakness; flushes with palpitations; cold sweat on forehead with angor; warm wrapping is preferred in neuralgias, again echoing warmth >.

Aversion to stimulants—coffee and tobacco aggravate palpitations; warm drinks in small sips soothe faintness. Appetite low during neuralgic days; cold drinks and cold air to the face provoke pain.

Spig. is a left-sided neuralgic–cardiac remedy: stitching, thread-like pains, ciliary/trigeminal neuralgia, left supraorbital hemicrania, and cardiac neuralgia/pericardial tenderness with violent palpitation from the least motion, cannot lie left, must lie right with head high [Hering], [Allen], [Clarke], [Kent], [Farrington], [Boericke]. Modalities are precise: motion, touch, jar, eye-movement, cold air, noise worse; rest, warmth, dark/quiet, gentle pressure, right-side posture better. The signature neuralgic stitch links eye–face–teeth to precordium; the worm background may appear in children with palpitations and colic but is secondary. Differentially, Kalmia is nearer in left-arm radiation (with numbness and shooting), Cactus constricts in a band, Naja constricts with moral depression, Digitalis fails from weakness and coldness, Latrodectus screams with unbearable radiation; in trigeminal/ciliary fields compare Mag-phos., Mez., Cedron, Paris, Ruta, but choose Spig. when eye-movement <, thread-like stitches, and cardiac concomitants are decisive.

• Cardiac neuralgia/angina; pericarditis with motion-worse palpitation
  • Cactus — Constrictive “iron band” about heart; less left-sided neuralgic stitch; Spig. guided by motion-worse stitches and right-side posture need. [Farrington], [Clarke]
  • Kalmia — Sharp pains shoot down left arm with numbness; rheumatic base; Spig. has more precordial soreness to touch and eye/face neuralgia concomitants. [Farrington], [Kent]
  • Naja — Constrictive throat/heart, left carotid throb, moral depression; less thread-like neuralgia. [Clarke]
  • Digitalis — Slow, weak pulse, icy surface, faintness; motion feared from weakness, not from stitch; lying left not so decisive. [Kent], [Clarke]
  • Latrodectus — Extreme tearing pains to left arm, impending death, collapse; storms more violent, continuous; Spig. less overwhelming, posture-sensitive. [Clarke]
  • Aconite — First hours, feverish panic; Spig. later, mechanical motion-worse neuralgia with posture rules. [Kent]
• Trigeminal/ciliary neuralgia (left >)
  • Magnesia phosphorica — Cramping neuralgia better firm pressure and heat; less stitching thread-like quality and less eye-movement <. [Clarke]
  • Mezereum — Burning, bone-deep pains, eruption; not so strictly left supraorbital nor eye-movement <. [Hering]
  • Cedron — Clock-like periodicity; often left supraorbital with eye-watering; Spig. lacks fixed clock but has eye-movement < and cardiac links. [Farrington]
  • Paris — Sensation “eye on a string” with neck sensations; less cardiac accompaniment. [Clarke]
  • Ruta — Asthenopia/strain pains; lacks neuralgic stitch and cardiac axis. [Farrington]
• Intercostal neuralgia (left chest)
  • Ranunculus bulbosus — Sharp intercostal stitches, weather-change <, motion <; Spig. when precordial and cardiac signs co-exist. [Boger], [Clarke]
  • Bryonia — Stitching chest pain worse every motion, better pressure; more pleurodynia than cardiac. [Farrington]
• Worm colic with nervous palpitations
  • Cina — Grinding teeth, boring nose, cross; less cardiac neuralgia. [Allen]
  • Teucrium — Crawling in rectum, thread-worms; no heart picture. [Clarke]

• Complementary: Kalmia—rheumatic heart cases with left-arm shooting; often follows Spig. or alternates when numbness predominates. [Farrington], [Kent]
• Complementary: Cactus—when constriction remains after Spig. has calmed motion-worse stitches. [Clarke]
• Follows well: Aconite—after first fright and vascular storm, the mechanical motion-worse neuralgic phase calls for Spig. [Kent]
• Precedes well: Digitalis in failing hearts with weakness/collapse after Spig. has quelled neuralgic storms. [Clarke]
• Related (family): Gelsemium (Loganiaceae) has drowsy paresis, not neuralgic stitch; Ignatia has paradoxes and globus, not cardiac stitch. [Farrington]
• Antidotes/Avoid: Coffee, tobacco, sudden exertion, cold drafts aggravate; counsel strict posture-rest during treatment. [Hughes], [Clarke]

• Pericarditis/angina with “cannot lie on left; least motion brings stitches & palpitation”: Spig. 30C–200C acutely (single or spaced doses); strict right-side, head-high posture; no exertion; compare Kalmia if left arm numbness predominates. [Clarke], [Kent], [Farrington]
• Left supraorbital/trigeminal neuralgia with eye-movement <, warmth >: Spig. 6C–30C every few hours during flares; insist on dark, warm compress, eyes at rest; review dental/ocular triggers. [Hering], [Allen]
• Ciliary neuralgia after suppression of discharge/dental work: Spig. with warmth, mydriatic rest avoided; alternate with Ruta/Paris only if strain dominates rather than stitch. [Clarke], [Farrington]
• Children with worms + palpitations/colic: Spig. 3x–6x, hygienic worm measures; if rectal crawling is foremost, consider Teucrium or Cina. [Allen], [Clarke]
• Intercostal neuralgia (left): Spig. plus firm bandaging and dry heat; avoid twisting and deep inspirations until pain track is quiet. [Boger], [Clarke]

Mind

• MIND — ANXIETY — heart; about — motion from — aggravates. — Motion dread tied to palpitation.
• MIND — FEAR — to move — lest heart fail. — Mechanical vigilance.

Head

• HEAD — PAIN — SUPRAORBITAL — left — stitching; thread-like — forenoon — aggravates. — Spig. keynote.
• HEAD — JAR — slightest — aggravates — touch — aggravates. — Hyperaesthesia of scalp/nerve.
• HEAD — EYE MOVEMENTS — aggravate — pains extend to occiput/teeth. — Ciliary trigger.

Eyes

• EYES — PAIN — ciliary — motion of eyes — aggravates — warmth — ameliorates — dark room — ameliorates. — Core ciliary rubric.
• EYES — SENSATION — eyeball — too large — as if. — Spig./Paris motif; Spig. with cardiac axis.

Face / Teeth

• FACE — NEURALGIA — left — infraorbital — touch — aggravates — warmth — ameliorates. — Tic douloureux strand.
• TEETH — PAIN — upper left — cold air — aggravates — warmth — ameliorates. — Neuralgic odontalgia.

Heart / Chest

• HEART — PALPITATION — least motion — aggravates — visible — with. — Hallmark Spig.
• HEART — PAIN — stitching — precordial — left — motion — aggravates — touch — aggravates. — Cardiac stitch quality.
• HEART — LYING — left side — aggravates; LYING — right side — ameliorates; HEAD — high — ameliorates. — Posture law.
• CHEST — INTERCOSTAL NEURALGIA — left — motion — aggravates — pressure (firm) — ameliorates. — Chest wall thread-pain.

Respiration / General

• RESPIRATION — DIFFICULT — exertion — on — must sit up — head high. — Orthopnoea of cardiac type.
• GENERALITIES — MOTION — aggravates — slightest. — Global Spig. modality.
• GENERALITIES — COLD AIR — aggravates; WARMTH — dry — ameliorates. — Thermal polarity.

Sleep

• SLEEP — POSITION — right side — on — ameliorates; left side — on — aggravates — palpitation. — Night management rubric.
• SLEEP — STARTING — first sleep — palpitation — with. — Onset fragility.

Hahnemann — Materia Medica Pura / Chronic Diseases (early 19th c.): primary proving threads—neuralgic stitches, left hemicrania, cardiac posture rules.
Hering — The Guiding Symptoms of Our Materia Medica (1879): left-sided supraorbital/trigeminal pains; ciliary neuralgia; cardiac motion-intolerance; modalities.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): eye-movement <; thread-like neuralgia; worm/abdominal notes; cardiac palpitation.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): angina/pericarditis picture; posture (right side, head high); neuralgia differentials.
Kent, J. T. — Lectures on Homoeopathic Materia Medica (1905): Spig. cardiac mechanics; motion-worse law; comparisons with Cactus, Digitalis, Kalmia, Naja.
Farrington, E. A. — Clinical Materia Medica (late 19th c.): heart and neuralgia comparisons (Cedron, Kalmia, Cactus); left-sidedness.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1907): practical keynotes—thread-like pains; better after perspiration; cardiac posture.
Boericke, W. — Pocket Manual of Homoeopathic Materia Medica (1901): cannot lie left; visible palpitation; supraorbital neuralgia.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): intercostal neuralgia; firm bandaging; modality grid.
Hughes, R. — A Manual of Pharmacodynamics (1870s): drug background, toxicity; stimulants aggravate.
Tyler, M. L. — Homoeopathic Drug Pictures (1942): ciliary/trigeminal portraits; bedside posture-management.
Dunham, C. — Lectures on Materia Medica (1870s): neuralgia teaching points; posture and rest.
Phatak, S. R. — Concise Materia Medica (1977): compact keynotes—left-sidedness; motion-worse; cardiac stitch.