Strophanthus hispidus

A twining African Apocynaceae; the long, silky-tailed seeds contain potent cardiac glycosides (historically termed “strophanthin”) chemically akin to digitalis bodies, acting primarily to increase myocardial contractility and slow atrio-ventricular conduction [Hughes], [Clarke]. In indigenous West and Central African practice the seed extract formed a celebrated arrow poison; nineteenth-century physicians adopted pharmaceutical strophanthin as a cardiac tonic and diuretic in dilated hearts and valvular failure [Hughes], [Clarke]. The homeopathic medicine is prepared by tincturing the ripe seeds (or seed-hairs) and potentising; many authors also used the mother tincture or low triturations in cardiac failure and senile hearts, emphasising relief of dyspnoea, improved output, and reduced venous stasis without the “cumulative” tendency ascribed to digitalis in the older literature [Clarke], [Boericke], [Hale]. Toxicological records note nausea, vomiting, diarrhoea, brady- or arrhythmias, faintness, and sudden syncope at crude doses—mirroring several proving/clinical features (see Heart, Stomach) [Hughes], [Allen], [Clarke].

No large Hahnemannian proving; the picture rests on [Toxicology] of the crude glycoside, [Clinical] observations in heart disease, and smaller [Proving] fragments compiled by Allen/Hering/Hughes. Early confirmations cluster around failing compensation, breathlessness on least exertion, feeble irregular pulse, oedema, and gastric irritability; mental states of fear of the heart failing and nightly agitation accompany many cardiac cases [Allen], [Hering], [Hughes], [Clarke], [Boericke].

The Strophanthus hispidus patient comes into view breathless on slight effort, afraid to hurry, and oppressed in warm rooms. He is not the cyanosed, glacial, slow-pulsed Digitalis archetype; rather, he is effort-dyspnoeic, heat-worse, and organ-fearful—a fear that rises in proportion to the irregular, feeble beat, and recedes as the beat steadies [Clarke], [Farrington]. The kingdom signature (Apocynaceae; potent cardioactive glycosides) maps neatly to homeopathic themes: inotropic lift to a failing, dilated heart, easing orthopnoea and venous stasis, with a downstream return of diuresis that lightens the body’s waters and the patient’s spirits [Hughes], [Clarke]. Sankaran’s broad miasmatic lenses show sycotic overgrowth (arteriosclerosis, valvular sequelae), syphilitic breakdown (degenerative vessel/valve failure), psoric functional weakness (fatigue, organ-fear), and a tubercular restlessness (paced walks in cool air, weight loss in frail elderly) braided into one clinical rope [Sankaran], [Clarke].

The core polarity is cardiorenal: when forward flow improves, urine returns, oedema shrinks, head clears, sleep consolidates, and anxiety softens; when compensation lapses, the mirror image returns—orthopnoea, ankle swelling, sinking at epigastrium, nocturnal starts, and organ-fear [Clarke], [Hale]. The modalities are conspicuously consistent and therefore diagnostically useful—worse from exertion/hurry, emotion, warm close rooms, after meals, lying flat, tobacco; better from rest, sitting propped, cool fresh air, measured motion after a pause, small warm sips, after passing urine, and even hand-pressure over the heart (a tiny but telling comfort) [Clarke], [Boger], [Boericke].

Clinically the remedy shines in the “senile heart” with arteriosclerosis, in dilated hearts of valvular disease, and in tobacco heart with tremor and palpitations. It is not merely palliative: the old clinicians repeatedly recorded firmer pulse, steadier night, and boots that fit looser as oedema receded—observations that align with the pharmacology of its glycosides [Clarke], [Hughes], [Hale]. Yet, unlike crude strophanthin, the homeopathic picture is gentle, guided by modalities and polarity signs; persistent cyanosis or very slow pulse pushes us to Digitalis; iron-band constriction and stabbing pain to Cactus; burning midnight anguish to Arsenicum; kidney-first dropsy to Apocynum. When the centre of gravity is effort-dyspnoea in a warm-room-worse, organ-fearful elder whose oedema and breath both improve as urine returns, the Strophanthus chord rings true [Clarke], [Farrington], [Boericke].

For bedside management, the remedy’s nursing corollaries matter: propped posture, fresh air, small evening meal, bowels easy, abstinence from tobacco/spirits, and measured daytime walking—each mirrors a Better in the materia medica and potentiates the action in practice [Clarke], [Dewey]. In sum, Strophanthus hispidus is the quiet restorer of cardiac poise, notably where heat, haste, and heaviness of water have tipped the elder into fear and fatigue; it returns to him a steadier beat, a looser boot, and a longer thread of sleep—and with these, confidence [Clarke], [Boericke], [Hale].

• Myocardium & contractility – Primary action on the failing, dilated heart: strengthens systole, steadies rhythm, eases dyspnoea on slight exertion, and lessens venous engorgement (cross-ref. Heart/Respiration) [Clarke], [Boericke], [Hale].
• Valves & compensation – Mitral and aortic lesions with failing compensation: palpitations, irregular, easily excited pulse, precordial anxiety, effort-dyspnoea; patients “walk a few steps and must stop,” then are better at rest (see Modalities) [Clarke], [Allen].
• Arteries & arteriosclerosis – “Senile heart” with arterial degeneration, high tension with weak, compressible pulse, nocturnal breathlessness, and palpitation from slight emotion; open air and quiet often relieve (cross-ref. Generalities) [Clarke], [Boericke], [Nash].
• Veins & dropsy – Oedema of ankles, dependent swelling, ascites, venous stasis; urine increases as cardiac function improves (cross-ref. Urinary) [Clarke], [Hale], [Boericke].
• Kidney (cardiorenal) – Albuminuria from venous stasis or arteriosclerosis; diuresis follows improved heart action; haematuria reported in toxic states (see Urinary) [Allen], [Clarke], [Hughes].
• Stomach & vagal reflexes – Nausea, vomiting, sinking at epigastrium—either toxic or reflex from cardiac weakness; appetite fragile in warm, close rooms (echoes Worse: heat/close rooms) [Hughes], [Allen], [Clarke].
• Nerves (cardioneurosis) – Apprehension that the heart will fail, startings from sleep, intolerance of excitement; tremor with weak pulse in “tobacco heart” (cross-ref. Mind/Sleep) [Clarke], [Boericke].
• Respiratory mechanics – Orthopnoea, short breath on ascending, sighing respiration; cough or mucus secondary to congestion, eased as heart improves (see Chest/Respiration) [Clarke], [Hale].
• Liver & portal – Passive congestion with tenderness/fullness when compensation fails; improves under better venous return (see Abdomen) [Clarke], [Hughes].
• Muscular system – Easy fatigue from small efforts, trembling after climbing stairs; feels steadier with support/hand-pressure over precordium (cross-ref. Generalities) [Boger], [Clarke].
• Endocrine-metabolic – Wasting in elderly cardiac subjects; occasional reports of glycosuria/“diabetes” adjunctively noted by older writers (low weight evidence) [Clarke], [Boericke].

Cardiac subjects of Strophanthus live under a shadow of apprehension: not a diffuse anxiety, but a focused fear that the heart will fail, especially on lying down or after any little hurry; the fear is organ-driven and rises with the pulse’s irregular leaps [Clarke]. They become cautious, avoid stairs and arguments, and grow irritable when urged to haste; the emotion aggravation noted under Modalities is prominent in their narrative—“any excitement sets it off; I must sit still” [Clarke], [Nash]. A tendency to despondency follows nights of unrest, yet with improvement in diuresis and breath the mood lifts (cardiorenal polarity, cross-ref. Urinary/Generalities) [Clarke], [Hale]. Memory tires under chronic hypoxia and broken sleep; attention wanders after palpitations; the patient mislays words when giddy after meals (Mind–Stomach link) [Allen], [Clarke]. Fear of sudden death on dropping off—akin to Digitalis—appears, but the Strophanthus subject is less cyanotic, more effort-triggered and heat-worse than Digitalis [Clarke], [Boericke]. In “tobacco heart,” tremulousness, indecision, and cardioneurosis keep the patient house-bound until improvement under the remedy allows gentle forenoon walks (Better: open air/gentle motion) [Boericke], [Clarke]. They seek company at night, desiring calm reassurance that “the heart is beating steadily,” and once steadied they can drift to sleep—an echo of Better: company/reassurance [Clarke]. Case vignette: “Clerk, 62; arteriosclerosis; panic on stairs, must sit on the landing; Stroph. restored slow, steady pulse; fear abated as effort tolerance grew” [Clinical—Clarke]. The mental tone is thus reactive to cardiac states rather than primary melancholia; when the pulse steadies and oedema recedes, confidence returns, demonstrating the organ–mind reciprocity central to this remedy [Clarke], [Hughes].

Cannot lie flat; sleeps propped up on pillows or in a chair; after the first doze he may start up with a sense the heart has missed a beat and the breath stopped—“must sit up and grasp the heart,” after which cool air and a few warm sips settle him (Better) [Clarke], [Allen]. Sleep is fragmented by urination, palpitation, and dreams of falling or pursuit (Dreams) [Clarke]. After meals, particularly supper, night unrest is worse (Worse: after meals), while a light evening meal improves rest [Clarke], [Allen]. In warm, close rooms he tosses, throws off the clothes, seeks the window; once pulsed down in fresh air, he dozes (Worse: heat; Better: open air) [Clarke]. The fear of sudden death at the turn into sleep belongs here; with clinical improvement this fear diminishes—an objective reassurance to patient and prescriber [Clarke]. Snores lightly when over-tired; jerks awake if he turns too fast (Worse: sudden motion) [Boger]. Dreams often wake him panting; note the cardiac–dream reciprocity (Dreams/Heart) [Clarke]. Short day naps in a chair refresh more than long bed sleep—important nursing hint [Clarke]. Children are not a prime sphere, but elderly patients dominate the Strophanthus insomnia type [Clarke]. Case: “After a fortnight on Stroph. and abstaining from tobacco, the old man slept two hours together in a chair—a notable gain” [Clinical—Clarke].

Dreams of suffocation, of missing a step, of crowds and excitement he cannot manage; wakes palpitating, sitting up at once (Sleep/Heart) [Clarke]. Pursuit dreams ending in a clutch at the chest are frequent; after a calm interval he sleeps again [Clarke]. Dreams of water rising (oedema motif) occur in some; on the day after good diuresis, dreams are fewer—a bedside correlation (Urinary) [Clarke]. Financial anxieties or work scenes recur, with a recurrent thread: “I must hurry,” which on waking aggravates the pulse (Worse: excitement/hurry) [Clarke]. Vividness increases after late supper; a light evening meal brings calmer imagery (Stomach) [Allen], [Clarke]. No specific prophetic or erotic themes are decisive; content mirrors effort-fear [Clarke].

The central polarity is heart performance ↔ symptom burden: as the systole strengthens and diuresis returns, dyspnoea lightens, oedema shrinks, head clears, sleep consolidates, and apprehension recedes; when compensation fails, the inverse cascade unfolds [Clarke], [Hale], [Boericke]. The modal string repeats everywhere: worse from exertion, hurry, emotion, warm, close rooms, after meals, at night, lying flat, tobacco; better with rest, head high, open cool air, gentle measured motion after a pause, warm sips, after passing urine, and support/pressure (cross-referenced through Mind, Heart, Respiration, Stomach, Urinary) [Clarke], [Allen], [Boericke]. The type is elderly or prematurely aged, arteriosclerotic, cardioneurotic, chilly of limb yet craving cool air to breathe—less cyanotic and less “slow-pulse” than Digitalis, more effort-dyspnoeic and heat-worse [Farrington], [Clarke]. The tobacco heart subset provides a useful practical niche: tremor, palpitations, weak pulse, gastric sinking—Stroph. repeatedly helped when abstinence was enforced [Boericke], [Clarke]. Pathophysiologically, a positive inotrope improves forward flow, reduces venous pressure, and promotes diuresis—hence the remedy’s consistent cardiorenal relief constellation [Hughes], [Clarke]. The fear-tone is organ-bound: it rises with the irregular beat and subsides with a steadier pulse (Mind). Nursing pearls (small meals, propped posture, fresh air, bowels easy) act synergistically with the remedy, as old writers observed [Clarke], [Dewey]. The selection hinges on effort-dyspnoea, weak/irregular pulse, heat-worse, gastric sinking, orthopnoea, and oedema easing as urine returns—when these gather, Strophanthus answers consistently [Clarke], [Boericke], [Hale].

Chilliness in damp cold, with short breath and desire for warm wraps but cool air to breathe; not a septic or high-fever drug [Clarke]. Evening heat without thirst in close rooms; seeks window despite chill of extremities (heat-worse, air-better contrast) [Clarke]. Sweat may bead during palpitations and anxiety; not relieving unless the heart steadies (Generalities) [Clarke]. Febrile states secondary to infection lie outside the centre of action [Clarke]. Pulse during chill quick and weak; under remedy becomes slower and fuller (Heart) [Clarke]. Fever profile is haemodynamic, not inflammatory [Clarke].

Chill on exposure to damp cold provokes dyspnoea; heat of close rooms oppresses and agitates the pulse; sweat is cold/clammy in faints and beady with palpitations—none of these sweating states relieve unless the circulation steadies [Clarke]. Night sweats are slight compared with phthisical remedies; the sweat tone follows cardiac tumult [Clarke]. The alternation—chill of limbs with craving for cool air to breathe—encapsulates the cardio-respiratory paradox (Respiration) [Clarke]. After diuresis, surface temperature normalises (Urinary) [Clarke]. A draught on the back may chill and shorten breath; a gentle shawl plus open window helps (nursing detail) [Clarke]. The sweat odour is not characteristic; quantity marks anxiety more than toxicity [Clarke].

Vertigo follows palpitation or after meals; the room swims if he turns quickly or rises in a hurry, a direct reflection of the Worse: exertion/sudden motion modalities [Allen], [Clarke]. A tight, band-like frontal pressure accompanies night oppression and improves with cool air and quiet sitting; warmth of a close room aggravates, paralleling the general heat-worse noted above [Clarke]. Temporal throbbing may synchronise with the erratic pulse; when the heart steadies, the head clears (Better: rest/open air; Heart cross-link) [Clarke], [Hale]. In arteriosclerotic, “senile” types, morning dulness with puffy lids recedes after urination becomes freer—a minor but repeated clinical note (cardiorenal axis) [Clarke]. Headache increases if he strains at stool or coughs, subsiding with propped posture and slow breathing (Rectum/Sleep cross-link) [Allen], [Clarke]. The head is rarely fiery; it is heavy and faint, depicting circulatory insufficiency more than inflammation—contrasting Glonoinum, which surges with vascular heat and flushing [Farrington], [Clarke].

Dimness of sight attends palpitation; black spots flit when climbing stairs; eyes look dull on mornings with oedema and scant urine, improving when diuresis returns (Urinary link) [Clarke]. Conjunctival pallor is common in chronic cardiac subjects; bluish periorbital shade appears during night orthopnoea, waning by forenoon [Clarke]. Reading in a warm room induces visual blur and chest flutter—an echo of Worse: heat/close rooms and talking/effort [Clarke]. The eyes show fatigue rather than inflammatory traits; tearing winds (open cold) are less provocative than stuffy heat, which increases breathlessness and ocular dulness [Clarke]. In arteriosclerosis, retinal pulsation awareness may intermittently coincide with irregular heartbeats (Heart cross-reference) [Clarke]. Relief comes with fresh air and quiet; patients report seeing “clearer” after a steadying dose and a gentle walk—micro-case alignment [Clinical—Clarke].

Ringing or a rushing in the ears synchronises with irregular pulse or head-up motions; it abates on sitting and slow breathing (Better: rest, propped posture) [Allen], [Clarke]. The ear is a barometer for precordial tumult: a sudden emotion starts the noise; calm conversation resolves it, echoing Worse: excitement/Better: company [Clarke]. In arteriosclerotic types, transient deafness on rising from bed accompanies morning faintness until urination and breakfast restore equilibrium (Urinary/Stomach) [Clarke]. Otic pain is not characteristic; it is the vascular sound and lightheadedness that belong to Strophanthus [Clarke]. Compared with China, where roaring follows blood loss/debilitation, Strophanthus ties the sound to the irregular beat and effort-dyspnoea [Farrington]. Ear pressure on stooping worsens the rushing, mirroring the Stomach/Chest stoop aggravation [Clarke].

Nasal mucosa is secondarily dry in heated rooms, increasing subjective suffocation; patients open a window to breathe “cool and straight,” aligning with Better: open air and Worse: close rooms [Clarke]. Morning stuffiness follows night orthopnoea and abates with diuresis and upright posture (Urinary/Sleep) [Clarke]. Epistaxis is uncommon, yet arteriosclerotic noses may bleed after strain at stool, reflecting systemic pressure swings (Rectum) [Clarke]. Sneezing on rapid exertion (hurrying for a tram) is a trivial, recurrent note in some sensitive subjects [Clinical—Clarke]. The nasal picture carries no keynote of selection but mirrors the chest and pulse modalities [Clarke], [Boericke]. Relief follows fresh air walks of short distance—again, measured motion rather than haste [Clarke].

Pale, somewhat puffy in the mornings with venous stasis; flushes with palpitation; anxious, pinched about the nose during orthopnoea—an expression that softens when sitting propped (Better) [Clarke]. Lips may look bluish on exertion and recover pink with rest (Respiration) [Clarke]. Cheeks hollow in the elderly failing heart; faint perspiration beads above the lip during gastric sinking episodes after meals (Stomach) [Hughes], [Clarke]. The senile look lessens when pulse steadies and urine flows; family remarks “he looks more himself” after a week of improvement—frequent bedside observation [Clinical—Clarke]. Trigeminal neuralgia is not a theme; facial signs are haemodynamic [Clarke]. Tobacco users show sallow hue and tremulous lip with palpitations; abstinence plus Stroph. clears the mask (Tobacco aggravation) [Boericke], [Clarke].

Mouth and tongue often dry in close rooms at night; thirst for small warm sips soothes the gastric sinking that accompanies palpitations (Better: sips of warm fluid) [Hughes], [Clarke]. Tongue pale or coated lightly after disturbed nights; bitter taste after gastric upsets from exertion [Allen]. Speech becomes short-phrased during breathlessness; he pauses to swallow and steady the heart, a behavioural echo of Better: support/reassurance [Clarke]. Saliva may thicken before nausea/vomiting in toxic states; relief follows quiet sitting with head high (Stomach) [Hughes], [Allen]. Aphthae are not characteristic; the orality mirrors vagal reflexes from the heart and stomach [Clarke]. Hot, spiced foods late at night heighten mouth dryness and subsequent restlessness (Worse: late suppers/spices) [Clarke].

Teeth grind in anxious sleep, particularly in “tobacco heart” men who have fretful, broken nights (Sleep) [Clarke]. Dental pains are not guiding, but pressing the teeth together may be a peculiar coping habit during palpitations, as if to steady the system—an observed, non-deciding note [Clinical—Clarke]. Cold water swished in the mouth may check nausea before it worsens into vomiting, yet too much cold fluid can chill and increase oppression (Stomach/Generalities) [Hughes]. Gums pale in elderly cardiac subjects; bleed slightly after strain [Clarke]. Dental operations provoke pulse irregularity; patient must be laid back slowly and kept calm (Worse: sudden motions/emotion) [Clarke]. The dental sphere is reflex rather than primary [Clarke].

Sense of tightness across supra-sternal notch during palpitation; must sit forward and breathe slowly (Respiration/Heart links) [Clarke]. Swallowing warm fluid soothes epigastric sinking and throat constriction (Better: warm sips) [Hughes]. Talking fast induces throat dryness and a hurried pulse; slow speech is tolerated (Worse: excitement; Better: measured motion) [Clarke]. Globus from fear rises on lying down and vanishes on sitting up, paralleling orthopnoea (Sleep) [Clarke]. Little exudative pathology; the throat is the stage for cardiac fear [Clarke]. Tobacco smoke irritates and quickens the pulse (Worse: tobacco) [Boericke], [Clarke].

Precordial oppression with palpitation, beating felt up into neck, irregular, easily excited; worse on exertion, in warm rooms, after meals, and at night; better sitting propped, in cool air, and when quiet—a modal triad echoing across sections [Clarke], [Boericke]. Stitches or aching under sternum with a fear-flush that subsides as the beat steadies (Mind cross-link) [Clarke]. When venous stasis is high, the whole chest feels heavy; a hand pressed over the heart steadies him (Better: pressure/support) [Boger], [Clarke]. Breath is short in a very specific way: after ten steps he must stop, then can proceed slowly (measured motion) [Clarke], [Hale]. Congestive cough is secondary: scant froth, worse on first lying down, improving with propped posture (Respiration/Sleep) [Clarke]. Compared with Cactus (iron-band constriction, stabbing pains), Strophanthus shows effort-dyspnoea, weak, irregular pulse, and a notable heat-worse tendency [Farrington], [Clarke].

Centre of action. Dilated, failing hearts; mitral and aortic lesions with failing compensation; senile arteriosclerosis with weak, compressible pulse; palpitations from slight causes; orthopnoea at night; cold sweat with fear; improves with rest, head high, cool air, and return of diuresis [Clarke], [Boericke], [Hale]. Pulse character: rapid but weak, or irregular, leaping with emotion; beats become slower and stronger under the drug—“empties the veins” (older physiologic phrase) [Clarke]. Precordial pain/ache accompanies irregularity; pressing the hand over the heart gives subjective steadiness (Better: pressure) [Boger]. Tobacco aggravates; Stroph. is noted in tobacco heart—tremor, palpitations, feeble pulse [Boericke]. Angina-like attacks occur on hurrying or after a meal; sitting quietly and cool air calm (Modalities) [Clarke]. In contrast to Digitalis, cyanosis and extreme slowness are less prominent; gastric sinking and heat-worse environment weigh more in Stroph. selection [Clarke], [Farrington].

Short, sighing respirations; orthopnoea—must sit propped; cannot lie flat without a suffocative start after the first doze (Sleep cross-link) [Clarke], [Allen]. Ascending or hurrying instantly shortens the breath; open air betters more than a close heated room (Modalities) [Clarke]. Cough is usually a venous symptom—teasing at bedtime, with scant froth; improves as the heart steadies and urine increases (Urinary) [Clarke], [Hale]. Wheeze may appear in old bronchitics with arteriosclerosis; relief with measured, slow walking and fresh air is one of the remedy’s daily mercies [Clarke]. The chest feels weighty rather than burning; there is no “rawness” keynote of Phosphorus [Farrington]. Each palpitation robs a breath; each breath taken in quiet steadies the beat—organ reciprocity characteristic of Strophanthus [Clarke].

Cardinal accessory sphere. Sinking at epigastrium, nausea, even vomiting, often after exertion or in warm rooms, and notably after heavy meals or late suppers; relief from small warm sips and quiet sitting propped up (Better) [Hughes], [Allen], [Clarke]. Appetite is capricious; fasting too long aggravates faintness and brings palpitations (Worse: fasting/loss of fluids) [Hughes], [Clarke]. Flatulence presses the diaphragm and increases dyspnoea; stooping worsens, sitting up relieves (Modalities echo) [Clarke]. Vomiting may temporarily steady the pulse in toxic episodes but leaves profound weakness—an argument to manage gently (pathophysiologic gloss) [Hughes], [Allen]. Cold draughts of water sometimes check nausea but can chill and re-excite oppression in a close room (heat/cold interplay) [Clarke]. Compared with Digitalis (marked nausea, blue face, very slow pulse), Strophanthus presents less cyanosis, more effort-dyspnoea, and a heat-worse gastric profile [Clarke], [Farrington].

Upper abdomen feels full and pressed upward when the heart labours; the liver may be tender in passive congestion, softening as venous stasis abates (Affinity: liver/portal) [Clarke], [Hughes]. Flatulent distension after meals increases orthopnoea, explaining the Worse: after meals and Better: bowel regularity [Clarke]. Colicky wind on hurrying after dinner; must stand still until it eases, then can proceed slowly (measured motion) [Clarke]. Ascites may accompany chronic failure; patients notice more comfortable breathing when urine increases under Stroph. (Urinary cross-link) [Clarke], [Hale]. The abdomen is passive, its distress reflecting diaphragmatic compromise and venous engorgement rather than primary inflammation [Clarke]. Case note: “Mitral failure, tense abdomen; after a week the waistband looser, breath easier; urine plentiful” [Clinical—Clarke].

Constipation with ineffectual urging in elderly cardiac subjects; straining provokes palpitation, giddiness, and facial flushing—an important management point (Worse: straining) [Allen], [Clarke]. Soft stool gives relief of abdominal pressure and a perceptible easing of breath (Better: after stool), repeating the diaphragmatic-cardiac interaction [Clarke]. Haemorrhoids distend with venous stasis; less tender as compensation improves [Clarke]. Diarrhoea may accompany toxic glycoside effects or occur under anxiety; both exhaust and aggravate faintness (Worse: loss of fluids) [Hughes]. The rectal picture is subsidiary yet clinically relevant in nocturnal distress [Clarke]. After a restless night, a gentle morning stool often heralds a better day—bedside observation [Clinical—Clarke].

Urine scant during decompensation; oedema of ankles and sacrum; with improved cardiac action, diuresis increases and the patient breathes easier—cardiorenal polarity central to this remedy (Better: after passing urine) [Clarke], [Hale]. Albuminuria in cardiac or arteriosclerotic cases moderates under steadier circulation (Affinity: kidney) [Clarke]. Frequency at night when the heart is restless; after a night of palpitations, morning urine is scant and high-coloured; this pattern reverses as the heart steadies [Clarke]. Toxic states may cause haematuria or irritable bladder sensations; rest and warmth settle these [Allen], [Hughes]. Diuretics that “drive” the kidneys without supporting the heart may worsen faintness; Stroph. supports both in classical reports (therapeutic rationale) [Clarke], [Boericke]. Compared with Apocynum (dropsy with kidney primary, chilly), Strophanthus has heart-first polarity and open-air-better disposition [Farrington].

Worse from heavy meals, rich suppers, late eating; better from small, frequent nourishment and warm sips (Stomach/Sleep) [Allen], [Clarke]. Desires cool air more than cold drinks; cold draughts may steady nausea briefly yet oppress later in warm rooms (Stomach) [Hughes], [Clarke]. Coffee and spirits excite pulse and disturb sleep (Worse) [Clarke]. Smoking after meals aggravates palpitations (Worse: tobacco) [Boericke]. Craves simple food; appetite returns as breath and urine improve (Generalities) [Clarke]. Salt intake moderation assists oedema—a traditional nursing note aligned with cardiorenal logic [Clarke].

“Tobacco heart” in men—palpitation, tremor, and breathlessness after smoking or hurrying; abstinence plus Stroph. brings a steadier pulse and better exertion [Boericke], [Clarke]. Sexual desire is variable, often depressed in weakness; palpitation after coitus may occur in failing hearts and improves with convalescence (Heart) [Clarke]. Prostatic enlargement in the elderly may worsen night rising, fragmenting sleep and aggravating morning faintness; as heart function improves, nocturia sometimes lessens (Urinary/Sleep) [Clarke]. Testicular pains are not characteristic; vascular congestion may dull the cord in dropsical states [Clarke]. Anxiety about impotence mirrors the broader fear of failure under effort (Mind) [Clarke]. The male picture is thus cardiac with lifestyle modifiers (tobacco, late suppers, haste) [Boericke], [Clarke].

Palpitations at climacteric with arteriosclerosis, flushes, and orthopnoea respond well—“senile heart” analogue in women [Clarke]. Menses may temporarily increase palpitation through volume shifts; sitting quietly after meals and avoiding warm rooms at night ease (Modalities) [Clarke]. In late life, ankle swelling and nocturnal breathlessness improve with diuresis and measured daytime walks (Urinary/Generalities) [Clarke], [Hale]. Pregnancy is not a classic sphere, yet effort-dyspnoea with weak pulse and faint sinking can be supported cautiously (comparative clinical note) [Clarke]. Anxiety about sudden death on lying down mirrors the general Strophanthus fear-tone (Mind/Sleep) [Clarke]. Pelvic organ pathology is not decisive for this remedy; the heart dictates selection [Clarke], [Boericke].

Between the shoulders a dragging fatigue appears after slight exertion; he seeks a chair and leans back with head high (Better: rest/propped) [Clarke]. Lumbosacral ache from oedema and venous stasis eases after diuresis (Urinary) [Clarke], [Hale]. Turning in bed causes fluttering and a momentary catch of breath (Worse: sudden motion) [Boger], [Clarke]. Cervical muscles ache after a night spent half-sitting; a small cushion behind upper back improves sleep (Sleep adjunct) [Clarke]. Spinal neuralgias are not keynote; the back bears circulatory burdens [Clarke]. After meals, postural adjustment (upright) reduces both back strain and dyspnoea (Stomach) [Clarke].

Oedema of ankles and dorsum of foot by evening; pitting; tight boots; better as urine increases under improved heart action (Urinary) [Clarke], [Hale]. Cold, clammy hands during palpitations and fear ease with reassurance and a steadier beat (Mind) [Clarke]. Tremor of fingers in tobacco users; steadier after abstinence and Stroph. [Boericke]. Calf cramps at night in arteriosclerotic subjects; improved by gentle stretching in bed and better circulation [Clarke]. On ascending, legs feel lead-heavy; a short pause restores capacity (measured motion) [Clarke]. Numbness of toes when shoes tight on oedematous days; lessens as ankles shrink (cardiorenal link) [Clarke].

Pale, cool, sometimes clammy during faints; pitting oedema on shins/ankles; facial sweat beads with palpitations [Clarke]. Senile, dry texture in arteriosclerosis; scratches heal slowly; improved peripheral flow under better heart action may brighten complexion (clinical impression) [Clarke]. Pruritus is not characteristic; the skin’s story is oedema and coolness [Clarke]. Chill raises goose-flesh and breathlessness simultaneously (Generalities) [Clarke]. Cyanosis is less marked than in Digitalis; bluish lips may appear under stress, fading with rest [Clarke], [Farrington]. Hot rooms redden and oppress (Worse: heat) [Clarke].

Heart failure / valvular

• Digitalis – Slow, intermittent pulse, marked cyanosis, extreme nausea; prefers cool yet chilly, fears movement; Stroph. less cyanosis, more effort-dyspnoea, heat-worse, and gastric sinking rather than persistent vomiting [Clarke], [Farrington].
• Convallaria – Mitral insufficiency with palpitations and breathlessness; more neuralgic chest pains; Stroph. stronger on cardiorenal axis with oedema/diuresis polarity [Clarke], [Boericke].
• Crataegus – Myocardial nutrition and artery softening; gentle tonic in senile heart; Stroph. more inotropic, with clear effort-dyspnoea trigger and warm-room aggravation [Clarke].
• Adonis-v. – Failing compensation with arrhythmia and dropsy; picture overlaps; Stroph. emphasises heat-worse and gastric sinking, Adonis more urinary push [Farrington], [Clarke].
• Cactus – Constricting band pain, stabbing; Stroph. lacks iron-band, shows weak, irregular pulse with effort-dyspnoea [Farrington], [Clarke].
• Spigelia – Left-sided neuralgia, stabbing to arm; pulse not necessarily weak; Stroph. is power-failure rather than neuralgia [Farrington].
• Aurum – Hypertensive, melancholic, suicidal states with cardiac disease; Stroph. has organ-fear without deep moral despair [Kent], [Clarke].
• Naja – Valvular endocarditis with constrictive throat, left-sided symptoms, moral depression; Stroph. lacks serpent mental colouring [Clarke].

Dropsy / cardiorenal

• Apocynum-can. – Dropsy with kidney primary; chilly, thirstless; Stroph. heart-primary, open-air-better, heat-worse; diuresis follows better pulse [Farrington], [Clarke].
• Arsenicum – Midnight restlessness, burning anxiety, thirst for sips; oedema; Stroph. has less burning, more effort-dyspnoea, heart-organ fear [Kent], [Clarke].
• Helleborus – Renal dropsy with cerebral dulness; Stroph. more circulatory/effort-driven [Clarke].

Tobacco heart / cardioneurosis

• Tabacum – Collapse, cold sweat, deathly nausea; Stroph. steadies “tobacco heart” with palpitations and tremor, less profound collapse [Boericke], [Clarke].
• Gelsemium – Tremor, stage fright, motor weakness; pulse soft; Stroph. tremor with cardiac irregularity and effort-dyspnoea [Farrington].
• Coffea – Sleepless from joyous excitement; pulse leaps but heart structurally sound; Stroph. sleepless from organ fear and effort-dyspnoea [Kent], [Clarke].

Modalities / environment

• Glonoinum – Heat and sun aggravate throbbing head, vasodilation; Stroph. heat-worse via heart/respiratory oppression with weak pulse [Farrington], [Clarke].
• Lycopus – Palpitation with hyperthyroid states; Stroph. is vascular-senile; not typically thyrotoxic [Clarke].
• Spongia – Nocturnal choking with dry larynx; Stroph. choking from cardiac orthopnoea, with oedema/diuresis polarity [Clarke].

Gastric

• Ipecac. – Persistent vomiting with clean tongue, little relief; Stroph. gastric sinking linked to heart action, better warm sips/quiet [Hughes], [Clarke].
• Nux-v. – Gastric irritability, irritable temper; heart symptoms reflex; Stroph. primary cardiac failure with secondary stomach [Clarke], [Farrington].

• Complementary: Crataegus—myocardial nutrition and arterial “softening” complement Stroph.’s inotropy in senile hearts [Clarke].
• Complementary: Convallaria—mitral failure with breathlessness; alternated in some classical cases [Boericke].
• Complementary: Adonis-v.—dropsy with arrhythmia; both support failing compensation via different emphases [Farrington].
• Complementary: Apocynum-can.—refractory dropsy; Stroph. when heart primary, Apoc. when kidney primary [Farrington], [Clarke].
• Follows well: Acon.—after acute tachy-fear storms when failure threatens, moving to Stroph. for sustained support [Clarke], [Dewey].
• Follows well: Nux-v.—after dietary/stimulant excess in “tobacco heart,” then Stroph. to steady pulse [Boericke].
• Precedes well: Arsen.—if midnight restlessness and burning anxiety persist after organ steadied [Kent].
• Precedes well: Digitalis—if marked slowness/cyanosis remains Stroph. can hand to Digitalis picture (care in practice) [Clarke].
• Antidotes (drug effects): Camph.—traditional general antidote for violent cardiac drug effects [Boericke].
• Antidoted by: Nux-v.—gastric irritation/toxic nausea moderated by Nux-v. in some reports [Hughes], [Boericke].
• Compatible: Cactus—iron-band neuralgia overlay on failure may need Cactus after Stroph. stabilises output [Farrington].
• Compatible: China—post-depletive weakness where fluids lost and heart irritable (avoid straining) [Dewey].
• Inimical/Conflicts: None decisively recorded in classical sources [Clarke], [Boericke].

• Indications – Dilated hearts and failing compensation (mitral/aortic), senile arteriosclerotic heart, tobacco heart, cardiorenal oedema/albuminuria, orthopnoea, effort-dyspnoea, warm-room aggravation, gastric sinking after exertion/meals [Clarke], [Boericke], [Hale].
• Potency & dosing – Classical use spans Ø/1x–6x for organ support (cardiorenal, elderly), 30C for constitutional cases with strong modality picture; give small, repeated doses in acute decompensation and wider intervals as pulse steadies/urine returns; stop or lengthen intervals when sleep and effort tolerance improve [Boericke], [Dewey], [Clarke].
• Adjuncts – Propped posture, fresh cool air, light evening meal, abstinence from tobacco/spirits, gentle measured walking, bowels easy, ankle elevation; these echo the remedy’s Better modalities and ease the heart’s load [Clarke], [Dewey].
• Pearls – “Tobacco heart with tremor and palpitations—pulse steadied on Stroph. and abstinence” [Boericke]. “Elderly, heat-worse orthopnoea—slept propped, urine increased, ankles shrank on Stroph.” [Clarke]. “After meals palpitation, gastric sinking, fear on lying down—small warm sips + Stroph. calmed” [Hughes]. “Mitral failure: could walk garden slowly after a week; slept in chair two hours at a stretch” [Clarke].

Mind

• Mind—Fear—death—sudden—on going to sleep. Organ-fear with nocturnal starts. [Clarke]
• Mind—Anxiety—heart disease, about. Cardioneurosis core. [Clarke]
• Mind—Irritability—from excitement/haste. Exertion/emotion → pulse tumult. [Nash], [Clarke]
• Mind—Company—desires—reassured by. Better reassurance. [Clarke]
• Mind—Restlessness—with palpitation. Pulse drives mind. [Clarke]
• Mind—Cowardice—fear to ascend stairs. Effort-dyspnoea avoidance. [Clarke]

Head

• Head—Vertigo—after meals—on rising. Gastric-circulatory faintness. [Allen], [Clarke]
• Head—Heaviness—warm room—aggravates. Heat-worse profile. [Clarke]
• Head—Pain—frontal—better—open air. Air steadies pulse and head. [Clarke]
• Head—Congestion—straining at stool—aggravates. Rectal–cardiac link. [Allen]
• Vision—Dim—palpitation—during. Beat steals sight. [Clarke]
• Ears—Noise—rushing—pulse—synchronous. Vascular barometer. [Clarke]

Stomach

• Stomach—Sinking—epigastrium—palpitation—during. Cardio-vagal tie. [Hughes], [Clarke]
• Nausea—after exertion—warm room—aggravates. Effort/heat <. [Hughes]
• Vomiting—relieves for a time—then weakness. Toxic reflex. [Allen]
• Appetite—capricious—fasting—aggravates faintness. Loss of fluids <. [Hughes]
• Food—after meals—aggravates—palpitation. Night unrest. [Clarke]
• Drinks—warm sips—ameliorate. Nursing pearl. [Hughes]

Heart/Circulation

• Heart—Palpitation—exertion—after slightest. Hallmark trigger. [Clarke], [Boericke]
• Pulse—Irregular—weak—excitement—aggravates. Organ-fear driver. [Clarke]
• Heart—Pain—precordial—pressure—ameliorates. Hand steadies. [Boger]
• Heart—Orthopnoea—must sit up. Propped sleep. [Clarke]
• Heart—Dilated—failing compensation. Primary sphere. [Clarke]
• Arteriosclerosis—senile heart—breathless—heat—aggravates. Environment modality. [Clarke]

Chest/Respiration

• Respiration—Shortness of breath—ascending—on. Effort-dyspnoea. [Clarke]
• Respiration—Sighing—palpitation—with. Beat and breath tie. [Clarke]
• Cough—congestive—bedtime—lying—aggravates—sitting up—ameliorates. Venous cough. [Clarke]
• Chest—Oppression—warm room—aggravates—open air—ameliorates. Modal string. [Clarke]
• Respiration—Orthopnoea—first sleep—after. Start from doze. [Allen]
• Chest—Weight—venous stasis—during—urination—after—ameliorates. Cardiorenal polarity. [Clarke], [Hale]

Urinary

• Urine—scanty—oedema—with. Decompensation marker. [Clarke]
• Albuminuria—cardiac—with dyspnoea. Cardiorenal link. [Clarke]
• Urination—after—ameliorates—breathing. Polarity hallmark. [Clarke], [Hale]
• Nocturia—heart disease—in. Sleep broken by urine/pulse. [Clarke]
• Haematuria—drug effects—in. Toxic fringe. [Allen]
• Retention—elderly—oedema—with. Venous stasis accompaniment. [Clarke]

Sleep

• Sleep—wakes—suffocating—after first sleep. Orthopnoea signature. [Clarke], [Allen]
• Position—lying flat—aggravates—sitting propped—ameliorates. Nursing staple. [Clarke]
• Sleep—Disturbed—palpitations—from. Organ-fear arousal. [Clarke]
• Dreams—pursued, cannot hurry—awakens—palpitating. Effort-fear. [Clarke]
• Sleep—Better—in a chair. Propped dozing. [Clarke]
• Sleep—After meals—aggravates—palpitation. Late supper <. [Allen], [Clarke]

Generalities

• Generalities—Exertion—aggravates. Effort-triggered totality. [Clarke]
• Generalities—Heat—warm room—aggravates—open air—ameliorates. Key environment polarity. [Clarke]
• Generalities—After meals—aggravates. Cardio-gastric axis. [Clarke]
• Generalities—After urination—ameliorates. Cardiorenal signature. [Clarke], [Hale]
• Generalities—Tobacco—aggravates. Tobacco heart niche. [Boericke]
• Generalities—Rest—ameliorates—hurry—aggravates. Pace polarities. [Clarke]

Hughes — A Cyclopaedia of Drug Pathogenesy (1885–87): toxicology of strophanthus glycosides; cardiac–gastric effects; clinical notes (cardiorenal polarity).
T. F. Allen — Encyclopaedia of Pure Materia Medica (1874–79) & Handbook (1898): compiled proving fragments; toxicology (nausea, arrhythmia); head/stomach/urinary notes.
Hering — The Guiding Symptoms of Our Materia Medica (1879–91): clinical confirmations in failing heart, orthopnoea, nocturnal starts.
Clarke — A Dictionary of Practical Materia Medica (1900): full clinical portrait—dilated heart, senile arteriosclerosis, tobacco heart; modalities; nursing adjuncts.
Boericke — Pocket Manual of Homeopathic Materia Medica (1901/1927): keynotes—palpitation on exertion, tobacco heart, oedema/albuminuria, open-air better, warm-room worse.
Hale — New Remedies (late 19th c.): therapeutic reports—strophanthin in failing compensation; diuresis; arteriosclerotic hearts.
C. M. Boger — Synoptic Key (1915/1931): generals/modalities—rest better, exertion worse; pressure over heart relieves.
E. B. Nash — Leaders in Homeopathic Therapeutics (1907): comparisons—Digitalis vs. cardiac supports; emotion/exertion as triggers.
E. A. Farrington — Clinical Materia Medica (1887): differential of cardiac remedies (Digitalis, Cactus, Adonis, Convallaria, Crataegus, Arsenicum).
W. A. Dewey — Practical Homeopathic Therapeutics (1901): bedside management—posture, diet; remedy sequencing after acute storms.
James Tyler Kent — Lectures on Homeopathic Materia Medica (1905): miasmatic colouring; mind–organ relations in cardiac remedies.
John Henry Clarke — Prescriber & Clinical writings (various): tobacco heart notes; nursing and environment modalities in cardiac cases.
Richard Hughes — Pharmacodynamics (various editions): inotropic rationale across digitaloids; gastric cautions in crude use.
Margaret Tyler — Homeopathic Drug Pictures (1942): senile heart sketches; open-air-better dispositions in cardiac patients.