Strychninum

A bitter indole alkaloid chiefly obtained from the seeds of Strychnos nux-vomica and Strychnos ignatii (Loganiaceae). Pharmacodynamically it is a potent spinal reflex excitant, producing exaggerated reflexes, clonic–tonic spasms, trismus, opisthotonos, and sensory hyperaesthesia; death in poisoning is due to asphyxia from sustained spasm of respiratory musculature [Hughes], [Clarke]. Toxicology details an exquisite startle from the slightest touch, noise, light, or draught, with mind clear between paroxysms; the jaws lock, the back arches, and the face assumes risus sardonicus [Allen], [Hering]. Homeopathically the pure substance is triturated or dissolved for potencies; its narrower curative sphere is spinal irritation and hyper-reflexia, tetanoid convulsions, insomnia from hyperaesthesia, and spasmodic states of hollow viscera (rectum, bladder, oesophagus) [Clarke], [Boericke], [Boger]. [Toxicology] [Clinical]

No extensive Hahnemannian proving; the pathogenesis is compiled from small provings, poisoning records, and copious clinical confirmations. Constants: convulsions from trivial stimuli, trismus, opisthotonos, exalted reflexes, starting on falling asleep, insomnia, spasmodic constipation with ineffectual urging, bladder spasm/retention, hyperacusis/photophobia, and fear of movement lest a spasm ensue [Allen], [Hering], [Clarke], [Hughes], [Boericke]. [Proving] [Toxicology] [Clinical]

Strych. is the portrait of a nervous system wound like a spring. Every sense is edged: the slightest touch, whisper, glint, or breath of air detonates a reflex storm; the jaw locks, the back arches, the chest cannot draw air, and yet—most cruelly—the mind is clear, counting each second until the spasm loosens. The same reflex surplus governs the sphincters: the rectum drives but cannot let go, the bladder urges yet shuts tight. At night, when others trust the dark, the Strych. patient fears sleep, for at the threshold comes the violent start that threatens to pull the whole frame into tetany. The remedy is chosen when the case obeys a single law: stimulus → spasm, stillness → reprieve. That law appears in every room decision—close the shutters, soft-shoe attendants, no sudden touch, no draught, no clatter of crockery—and in every bodily habit—minute sips, no gulps, slow breaths, do not turn suddenly. In the repertory of convulsives, Cicuta is more bestial and delirious, Hydrocy-ac. more apoplectic and brief, Cuprum more cramping of flexors; Nux-v. is temper–gut first; Gelsemium is its soft antagonist. Give Strych. when the clear, intelligent sufferer pleads for darkness and absolute quiet, when jars and draughts are fatal, and when trismus, throat spasm on liquids, rectal or vesical lock, and sleep-starts bind the whole into one tense bow [Hering], [Allen], [Clarke], [Hughes], [Boericke], [Boger], [Kent], [Farrington].

• Spinal cord (anterior horn/reflex arcs): Heightened reflexes, clonic–tonic spasms, startle from minimal stimuli; opisthotonos; jaw/masseter rigidity; mind clear between fits. Cross-ref. Back, Extremities, Generalities. [Hughes], [Allen], [Hering]
• Trigeminal/masticatory muscles: Trismus, risus sardonicus, face drawn, jaw-locking in paroxysms. Cross-ref. Face, Teeth, Throat. [Allen], [Clarke]
• Respiratory centre/chest wall: Spasm of thoracic muscles, dyspnoea during fits, fear of suffocation; breath easier if absolutely still in darkness. Cross-ref. Respiration, Chest, Sleep. [Hering], [Clarke]
• Rectum & sphincters: Intense urging with inability to expel, spasm of sphincter, cramp-like tenesmus; classical paradox with soft stool yet difficult also appears, though less characteristic than in Stann./Alum. Cross-ref. Rectum, Abdomen. [Allen], [Clarke]
• Bladder & urethra: Retention from neck-of-bladder spasm, tenesmus vesicae, dribbling after strain. Cross-ref. Urinary. [Hering], [Clarke]
• Special senses (hyperæsthesia): Hyperacusis, photophobia, cutaneous hyperalgesia—the world is “too loud, too bright, too sharp.” Cross-ref. Mind, Eyes, Skin, Sleep. [Allen], [Hughes]
• Mind/insomnia: Sleepless from sensory over-activity; starting as soon as drowsy; fear of the fit. Cross-ref. Mind, Sleep. [Boericke], [Clarke]
• Gastro-oesophageal: Spasm on swallowing, painful constriction, nausea with attempts to drink; bitter taste. Cross-ref. Throat, Stomach. [Allen]
• Male sexual sphere (spastic strand): Erections/spasm or impotence from spinal exhaustion; emissions bring increased startle. Cross-ref. Male, Generalities. [Clarke], [Hering]

The mental state is marked by exquisite vigilance and fear of the next spasm. He implores attendants not to touch him, to close the blinds, and to keep silence, knowing that the least stimulus precipitates a convulsion [Clarke], explicitly echoing worse touch/noise/light. Anxiety is not diffuse like Acon.; it is mechanical—a learned dread of triggers. During paroxysms the countenance is distorted into risus sardonicus with eyes staring, yet consciousness is often preserved and terror is heightened by the clarity with which he registers each pull of the muscles [Allen], [Hering]. Between attacks, the mood may be melancholy and suspicious; the world is too sharp, and even gentle kindness is perceived as a possible disturbance. Startings on the verge of sleep strengthen the conviction that rest is dangerous, and so insomnia feeds irritability and hypersensitivity—a vicious circle cross-linked to Sleep. Comparatively, Nux-v. is irritable and spasmodic but still capable of sleep and relief by warmth and pressure over organs; Strych. is a diffuse spinal hyper-reflexia with universal startle from trifles, and the patient fears any intervention.

Sleep is the enemy: as soon as drowsy, the body starts violently, often with a sense that the heart stopped and then jerked, or that one is falling [Hering], [Boericke]. The patient learns to resist sleep unless the room is dark, silent, and still, precisely mirroring Better absolute rest/darkness. Night is worse; after midnight the threshold-starts multiply. Dreams, when obtained, replay suffocation and falling, and loud noises or touches from attendants immediately jerk the body. Cat-naps lengthen only when stimuli are perfectly excluded.

Of being struck by a sudden shock; of falling; of being seized by something from behind (opisthotonos iconography); of choking on water. Dreams cease as stimuli are rigorously controlled.

Strych. embodies spinal hyper-reflexia with universal startle: the least touch, noise, light, draught, or motion provokes clonic–tonic spasm, yet the mind remains clear between fits [Hering], [Allen], [Clarke], [Hughes]. It extends this reflex excess to the sphincters (rectal/vesical), the masticatory muscles (trismus), and the respiratory apparatus (chest-wall spasm), and imprints the whole case with insomnia from starts at the threshold of sleep. The modalities are decisive: worse the least stimulus, night, swallowing liquids, cold air; better absolute rest, darkness, silence, warm wrapping, skilled, minute sips, firm support. Differentially, Nux-v. shares irritability and ineffectual urging but lacks the explosive generalised startle; Cicuta has more opisthotonos with delirium and injuries to head, Hyos./Stram. are delirious with grotesque movements rather than clear consciousness; Gelsemium is the physiologic opposite—diminished reflexes, heaviness, drowsy paresis; Physostigma antagonises strychnine physiologically and clinically shades to flaccidity rather than spasm [Hughes], [Clarke]. The case is chosen when management by stimulus control changes everything, and when sphincter spasm and sleep-starts echo the spinal theme.

No characteristic pyrexial curve; chill with startle, cold sweat during spasm; heat local to face/head; temperature otherwise normal. Fear of draughts is protective rather than thermal.

Chill from slightest air-movement; heat flush during terror; clammy sweat at the summit of spasm, especially forehead and neck. Sweating does not relieve unless quiet is absolute.

Head feels drawn backwards during paroxysms; the occipito-cervical region is cramping and sore after a fit. There is a bursting, congestive ache after minimal noise or light exposure; the scalp is tender, and the jar of footfall shoots through the spine to the head [Allen]. Vertigo is positional and stimulus-driven, appearing when the patient attempts to rise or to turn quickly. A characteristic threat of spasm on trying to yawn or open wide the mouth appears with trismus. Headache subsides if the patient lies perfectly still in the dark, illustrating Better absolute rest, darkness.

Photophobia is extreme; glittering or sudden light sends a shock through the system and may precipitate a spasm [Allen], [Clarke]. Muscles around the globe tremble with attempts to fix gaze; lids twitch; vision blurs momentarily during startle. The patient keeps the eyes closed by preference. Unlike Bell., which blazes with heat and delirium, Strych. shows cold sweat, pallor, and a poised spring of the reflexes without flush.

Hyperacusis is decisive; even a whisper at the keyhole can set the whole frame trembling. Ringing may attend the start; after a convulsion, hearing is painfully acute before exhaustion dulls it. Stuffing the ears with cotton is a wise, practical cross-link to Better reduction of stimuli.

Nasal tickle can launch a sneeze that detonates a spasm; therefore the patient resists sneezing and begs for still air. Epistaxis is uncommon; odours (ammonia, tobacco) provoke grimaces, jaw-clench, or coughing fits.

The face is set in risus sardonicus during attacks: masseters rigid, lips retracted, alæ nasi dilated; afterwards the muscles ache as after violent laughter. Touching the cheek evokes a visible quiver. There may be transient cyanosis of lips from respiratory spasm, which clears if all remains quiet.

Trismus is the centre; the jaw is hard to open; tongue feels stiff; biting the spoon is attempted but painful. Taste bitter; saliva thick under terror. Speaking movements precipitate facial and cervical twitchings; the patient communicates in a whisper or by signs—behaviour justified by worse speaking.

Grinding and chattering at the crest of a paroxysm; toothache neuralgia is a secondary reflection of masseter spasm. The act of clenching intensifies headache and neck-pain.

Swallowing is spasmodic; liquids especially provoke choking or a throat-cramp that radiates to chest [Allen]. There is a band-like constriction across supra-sternal notch. Attempting to drink in gulps risks a generalised start; minute sips are tolerated—echo of Better slow, skilled sips.

A constricting band crosses the sternum; intercostal muscles seize on attempting a deep breath; any draught or touch to thorax may provoke spasm of chest wall with cyanosis and terror [Hering], [Clarke]. The patient keeps breath shallow and regular by sheer will, an intelligent behavioural cross-link to Better slow regulated breathing. After an attack there is aching as after violent exercise.

Palpitation with startle rather than with weakness; pulse quick during fear and paroxysm, then soft. The least emotion shoots through the precordium and may synchronise with a whole-frame twitch. Not a nutritive myocardium remedy (contrast Cactus, Crataegus); cardiac phenomena are reflex and stimulus-driven.

Breath is quick, shallow, then suddenly checked by spasm; laryngeal/diaphragmatic cramp on swallowing or draught exposure. Air-hunger is mental as well as mechanical; windows are closed to avoid air-currents while the room is kept fresh quietly. Loud inspiration by the nurse can trigger the patient—a vivid lesson in the stimulus-law of this remedy.

Nausea and sinking accompany the aftermath of a fit; eructations are spasmodic and may start a fresh storm. Eating little and often is borne; large meals or very cold drinks provoke gastric and diaphragmatic spasm. Bitter taste; epigastrium twitching with attempts to speak or move. The fear of swallowing itself is learned behaviour after two or three painful efforts.

Crampy colic with abdominal wall tightening on the least jar; the patient holds the belly to reduce movement. Flatulence aggravates spasm; relief is by complete stillness or gentle, sustained pressure between attacks. Sudden laughter, cough, or sneeze shoots pain through the recti and may light a reflex storm.

Tremendous urging with spasm of the sphincter; stool may be soft yet the act is agonising and ineffectual until a transient relaxation permits expulsion [Allen], [Clarke]. Tenesmus persists after stool; the patient dreads the attempt because the bear down often precipitates a generalised spasm. This paradox distinguishes Strych. from Nux-v., which has frequent ineffectual urging with irritability but less universal hyper-reflexia. Haemorrhoids become exquisitely sensitive from spasm.

Retention from neck-of-bladder spasm; urging with drop-by-drop emission; after strain a sudden gush occurs and spasm ceases for a while [Hering]. Movement to the vessel may set off a fit; attendants learn to remove obstacles and keep the route silent and dark.

Swallowing liquids triggers throat and oesophageal spasm; warm sips are safer than cold draughts [Allen]. Appetite small from vigilance; stimulants (alcohol, coffee) aggravate startle. Cravings are insignificant amid the reflex storm.

Sexual reflexes are exaggerated; erections painful or spasmodic; emissions leave spine more startle-prone with shuddering at trifles [Clarke]. In exhausted states there is impotence from fear of spasm and spinal fatigue. Perineal touch aggravates.

Spasmodic dysmenorrhoea with cramp shooting to back and thighs; the least motion of bed renews it; uterine tenesmus with sphincter ani participation. Labour after-pains are exaggerated by noise or touch. Nursing mothers dread let-down reflex if the room is not quiet/dark.

Opisthotonos: strong extensor spasm bows the back; slightest jar or touch restarts it [Allen], [Hering]. After-fits show sore spinous processes, especially dorsal/lumbar; supports and warmth help. Turning in bed is feared.

Clonic–tonic spasms of limbs with thumbs clenched, heels drumming, toes flexed; slightest movement renews. Afterward, trembling and soreness remain. Hands start when the sheet grazes the skin; feet cramp in cold.

Hyperæsthetic; the patient shudders at the lightest touch or draught. Gooseflesh attends fear; cold sweat breaks out on the forehead at the crest of a spasm; between fits the skin is cool and sensitive.

Tetanoid/convulsive states (stimulus-triggered; mind clear between fits)

• Cicuta virosa — Terrific opisthotonos with chewing motions, injuries to head as aetiology; consciousness often clouded; eruptions; Strych. has triggered startle and clear intervals. [Hering], [Clarke]
• Hydrocyanic acid (Hydrocy-ac.) — Sudden asphyxial collapse, brief spasms, cyanosis, rapid death; less reflex build-up. [Allen], [Clarke]
• Nux vomica — Spasmodic, irritable; gastric/rectal focus; sleeps, though unrestful; reflexes not so explosively universal. [Clarke], [Kent]
• Gelsemium — Opposite: dullness, muscular relaxation, ptosis, tremulous weakness; used as physiologic counterpoint. [Hughes]
• Hyoscyamus / Stramonium — Delirium, grimaces, wild movements; stimuli excite, but sensorium is perverted rather than lucid between fits. [Hering]
• Cuprum — Tonic spasms, blue face, clenched thumbs; much cramping of flexors; less sensory hyperaesthesia. [Clarke]

Rectal/vesical spasm with urging but retention

• Nux-v. — Frequent ineffectual urging with irritability; less sphincter lock from trivial stimuli. [Clarke]
• Alumina — Atony; no desire to stool; different mechanism. [Allen]
• Stannum — Soft stool yet must strain; motor weakness rather than spastic lock. [Hering]

Insomnia with threshold-starts

• Coffea — Wide-awake from joy/thoughts; starts less spinal-reflex; senses acute without convulsion. [Hering]
• Zincum — Restless feet, twitchings, cannot keep still; sleep disturbed but reflex excess milder. [Boger]

Trismus / dysphagia spasmodica

• Belladonna — Hot, flushed, throbbing; delirium; less clear-mind tetany. [Clarke]
• Cuprum — Throat–chest cramps with nausea and collapse; flexor predominance. [Hering]

• Complementary: Nux vomica—gastro-intestinal and rectal irritability layers; Nux often constitutional, Strych. the excess reflex acute layer. [Clarke], [Kent]
• Complementary / Physiologic counterpoint: Gelsemium—when reflex storm yields to flaccid exhaustion or tremulous paresis. [Hughes], [Farrington]
• Compare: Physostigma (antagonist at spinal cord; flaccidity), Ignatia (spasm–sob paradoxes; grief) within Loganiaceae. [Hughes], [Farrington]
• Follows well: Aconite at the very outset of fright; Strych. when the stimulus–spasm law declares itself. [Kent], [Clarke]
• Precedes well: Zincum where restless twitchings persist after the tetanoid edge is blunted. [Boger]
• Antidotal (classical/physiologic notes): Chloral, bromides, chloroform, physostigma in strychnine states (recorded historically). [Hughes]
• Avoid: Noise, light, touch, cold draughts, and stimulants during treatment—management is part of the prescription. [Clarke], [Boericke]

• Tetanoid reflex storms (stimulus-triggered; mind clear): Strych. 6C–30C repeated at short intervals during crises while enforcing absolute stimulus control (dark, silence, still air). Compare Cicuta if head-injury or delirium dominates. [Hering], [Clarke], [Boericke]
• Insomnia with violent starts on dropping off: Strych. 6C–30C at bedtime; strict sleep-hygiene of darkness/silence; avoid coffee, tobacco, alcohol. If drowsy paresis sets in, review Gels. [Boericke], [Hughes]
• Rectal/vesical spasm: Strych. 6x–6C t.i.d.; coach unhurried attempts, warmth, and steady pressure; if atony predominates, switch to Alum./Stann. [Allen], [Clarke]
• Trismus/dysphagia spasmodica: Small sips only; warm fluids; dose Strych. 6C; compare Bell. if heat/delirium present, Cupr. if flexor cramps rule. [Allen], [Clarke]
• Post-fright reflex hyperaesthesia: When the whole frame remains startle-prone after fright, Strych. stabilises the reflex arc; if collapse replaces startle, follow with Gels. [Kent], [Farrington]

Mind / Sensorium

• MIND — FEAR — of being touched — from fear of convulsion. — Mechanical dread of triggers.
• MIND — STARTING — on falling asleep. — Signature insomnia threshold.
• MIND — HYPERSENSITIVITY — noise; light; touch — to. — Global sensory edge.
• MIND — ANXIETY — paroxysms — between — consciousness clear. — Lucid terror.

Head / Face / Mouth

• HEAD — JAR — slightest — aggravates — convulsions from. — Vibration-trigger rule.
• FACE — RISUS SARDONICUS. — Tetanoid set of features.
• JAW — TRISMUS — touch — aggravates — opening mouth — impossible. — Masseter spasm.
• MOUTH — SWALLOWING — liquids — aggravates — spasm of throat. — Dysphagia spasmodica.

Eyes / Ears

• EYES — PHOTOPHOBIA — slightest light — aggravates — convulsions. — Light-trigger law.
• EARS — HYPERACUSIS — whisper — aggravates — convulsions from noise. — Sound-trigger law.

Throat / Chest / Respiration

• THROAT — SPASM — swallowing — on — liquids. — Oesophageal/laryngeal lock.
• CHEST — CONSTRICTION — spasm of intercostals — motion — aggravates. — Thoracic wall seize.
• RESPIRATION — SPASMODIC — convulsive — slightest draught — aggravates. — Draught law.

Abdomen / Rectum / Urinary

• ABDOMEN — CRAMPS — touch — aggravates — pressure (between attacks) — ameliorates. — Reflex belly.
• RECTUM — TENESMUS — stool soft yet difficult — sphincter spasm. — Lock-and-urge paradox.
• BLADDER — RETENTION — spasm of neck — urging with dribbling; then sudden gush. — Vesical lock.

Back / Extremities

• BACK — OPISTHOTONOS — touch — aggravates; noise — aggravates. — Extensor arc excess.
• EXTREMITIES — SPASMS — slightest motion — aggravates — clonic–tonic. — Universal startle.
• EXTREMITIES — CRAMPS — feet — cold — from. — Cold-trigger cramps.

Sleep / Generalities

• SLEEP — STARTING — on falling asleep; NIGHT — after midnight — aggravates. — Night threshold.
• GENERALITIES — TOUCH — aggravates; NOISE — aggravates; LIGHT — aggravates; DRAUGHT — aggravates. — Stimulus grid.
• GENERALITIES — REST — absolute — ameliorates; DARKNESS — ameliorates; WARMTH — ameliorates. — Management grid.

Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): toxicology and clinical—trismus, opisthotonos, reflex storms, rectal/vesical spasm.
Hering — The Guiding Symptoms of Our Materia Medica (1879): stimulus-triggered convulsions; sleep starts; dysphagia; management in darkness/quiet.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): spinal irritability portrait; comparisons with Nux-v., Gels., Cicuta; urinary/rectal spasms.
Hughes, R. — A Manual of Pharmacodynamics (1870s): physiologic action on spinal cord; antagonisms (physostigma, chloral, bromides); therapeutic inferences.
Boericke, W. — Pocket Manual of Homoeopathic Materia Medica (1901): keynotes—convulsions from least stimulus; starting on sleep; dysphagia; insomnia.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): modality grid—touch/noise/light/draught <; absolute rest >; relations.
Farrington, E. A. — Clinical Materia Medica (late 19th c.): Loganiaceae comparisons; Spasm vs. paresis (Strych. vs. Gels.); cardiac/respiratory notes.
Kent, J. T. — Lectures on Homoeopathic Materia Medica (1905): mechanical anxiety; management by removal of stimuli; sequence with Acon., Nux-v., Gels.
Nash, E. B. — Leaders in Homoeopathic Therapeutics (1907): concise reminders—sleep-starts; nervous tension; select comparisons.
Tyler, M. L. — Homoeopathic Drug Pictures (1942): bedside portrait—quiet and darkness as “half the remedy”; stimulus control.
Dewey, W. A. — Practical Homoeopathic Therapeutics (1901): convulsions and dysphagia outlines; regimen pearls.
Phatak, S. R. — Concise Materia Medica (1977): hyperaesthesia; trismus; rectal/vesical spasm; insomnia threshold.