Veratrum viride

A tall, swamp-loving perennial (modern botany: Melanthiaceae; older authors filed it under Liliaceae) native to North America. Rhizome and root are rich in veratrum alkaloids (notably jervine-group bases), producing powerful cardio-vagal depression, arterial vaso-motor effects, and violent gastro-emesis in crude use. Nineteenth-century “physiological” medicine used tincture or alkaloidal preparations to lower a bounding pulse in sthenic fevers and pneumonias; overdosing yielded the classic triad: intense cerebral congestion (throbbing carotids, crimson face), uncontrollable nausea/retching, and sinking faintness with slow, weak pulse, sometimes passing into collapse. Homoeopathic pharmacy prepares a mother tincture (fresh root) and successive potencies; the remedy picture rests on provings and abundant toxicology/clinical confirmations from American and British writers of the period [Hale], [Hughes], [Allen], [Clarke], [Hering], [Boericke], [Farrington].

The pathogenesis is a composite of [Proving] (American provings under Hale and colleagues), [Toxicology] (therapeutic over-dosage, poisonings), and [Clinical] confirmations in congestive fevers, early pneumonias, apoplectic threatenings, puerperal convulsions with gastric aura, laryngo-tracheal spasm, and seasickness-like vomiting worse from the least motion [Hale], [Hering], [Allen], [Clarke], [Hughes], [Dunham], [Farrington].

Veratrum viride is the arterial tempest with a vagal undertow. The case opens in thunder: carotids hammer, face flushes crimson, the head threatens to burst in warm rooms; the patient is driven to the window, begging for cold to the head. Yet this is no mere Belladonna blaze. The medullary emetic centre is seized; the least motion kindles deadly nausea and projectile vomiting, and with the retching comes the turn of the tide—pulse slows, grows soft, intermittent; lips pale; cold, clammy sweat pearls on the brow; the sufferer dares not move for fear of faintness. This polarity—arterial storm → vagal sink—repeats across organ-systems: in pneumonia, a sthenic, throbbing outset falls into a soft-pulse adynamia; in laryngeal spasm, livid struggling yields to sweating collapse; in puerperal convulsions, a gastric aura ushers a congestive seizure, the heart faltering afterwards. The master-modality is unequivocal: worse from the least motion, especially of the head or body in bed; better absolutely still, better cold applications to the head, better cool air, and better after vomiting (for a time).

Constitutionally, Verat-v. suits robust or plethoric persons in acute vascular crises, and nervous patients with a stomach–heart axis so sensitive that the two organs “answer one another”: epigastric sinking mirrors præcordial sinking, retching loosens head pressure, and exertion blurs sight and breath as the pulse flags. Compared with neighbours, it differs as follows: Bell. roars without the emetic swing; Glon. pounds with sun/heat but scarcely vomits; Gels. dozes and trembles rather than storms; Verat.-alb. dies by the bowels (rice-water, icy cold) while Verat-v. dies of the vagus (slow pulse, cold sweat), and Tabac. collapses at once with motion without any prior carotid blaze. When you hear the story—violent head-congestion, nausea from the least motion, cold clammy sweat, pulse first full then slow/soft, and a marked relief from cold to the head and perfect quiet—Veratrum viride speaks with authority. [Hale], [Clarke], [Farrington], [Hughes], [Hering], [Allen].

• Vaso-motor centre & arterial tree — vehement cerebral congestion, throbbing carotids, flushed face, fulness in head; later arterial depression with slow, soft pulse (see Head, Heart, Fever) [Hughes], [Clarke], [Farrington].
• Heart & vagus — bradycardia, intermittence, faintness, precordial sinking, pallor after the storm; a keynote transition from bounding to failing (see Heart, Generalities) [Allen], [Hale].
• Stomach/medullary emetic centre — persistent nausea and vomiting, often projectile, with profuse salivation and cold sweat; worse the least motion (see Stomach, Perspiration) [Hale], [Allen].
• Lungs & serous surfaces — early pneumonia/pleuro-pneumonia with intense vascular excitement and dyspnoea; later adynamia (see Respiration, Chest, Fever) [Clarke], [Farrington], [Boger].
• Brain & meninges — threatened apoplexy, congestive headaches, blindness/blur during surges; spasms/convulsions in parturient or febrile storms (see Head, Mind) [Hering], [Clarke].
• Larynx/glottis — spasm of glottis, croup/laryngitis with livid face and arterial tumult (see Respiration) [Hering], [Allen].
• Female pelvis — puerperal eclampsia/convulsions with vomiting or epigastric aura, congestive head; albuminuria not infrequent (see Female) [Farrington], [Clarke].
• Retina/optic circulation — hyperaemic dimness, photophobia in vascular storms (see Eyes) [Hale], [Clarke].
• Skin & sweat glands — cold, clammy sweat with sinking; alternates with burning heat of head/face (see Perspiration, Chill/Heat) [Allen], [Boericke].

During the arterial storm the patient is anxious, hurried, and distressed, with dread of the head “bursting”; he begs for air and cold to the head [Clarke]. As nausea mounts with the least motion, irritability alternates with apathy; speech slows as faintness approaches, and he answers reluctantly, “let me lie still” (cross-links Stomach, Generalities) [Allen], [Hale]. Delirium may be noisy in the congestive stage (face crimson, eyes injected), changing to low muttering as the pulse falls and sweat turns clammy [Hering], [Clarke]. Fear of death is less vivid than in Acon.; rather a sinking despair with indifference between retchings is recorded [Farrington]. In puerperal storms, fury or maniacal struggle may prelude spasms, often with a gastric aura (see Female) [Hering], [Clarke]. After vomiting there is brief lucidity and relief of head pressure, then recurrence with motion or warmth (echoes Modalities) [Allen]. Children in laryngeal attacks clutch the larynx, eyes staring, terrified by the want of air; afterwards they lie pale, sweating and apathetic (see Respiration, Perspiration) [Hering]. [Proving][Toxicology][Clinical]

Little sleep in the congestive stage: head heat, throbbing, and nausea on moving prevent repose; if sleep comes, it is broken by retching or by a sense of sinking [Clarke], [Allen]. After the crisis passes with a sweat, sleep is deeper and more refreshing; but any attempt to turn in bed may renew the sickness (modal cycle) [Hale]. [Clinical]

Anxious, of falling or suffocation; startings with a sense that the heart ceased for a moment; wakens in a clammy sweat [Allen]. [Clinical]

A polar remedy of the circulation: from arterial storm (head throbs, face crimson, carotids hammer) to vagal sink (slow, feeble pulse; cold sweat; deadly nausea). The least motion is the master-modality for nausea and vomiting; heat and closed rooms aggravate head and vessels; cold to head, open air, perfect quiet, and cold sips palliate. Think of early pneumonias/pleurisies, apoplectic threatenings, puerperal convulsions with gastric aura, seasickness, and cardio-vagal syncope states in which the stomach and heart answer to each other [Clarke], [Hale], [Farrington], [Boger]. [Proving][Toxicology][Clinical]

Sthenic onset: hot, dry skin, flushed face, throbbing carotids, full bounding pulse, intense headache; soon pulse lowers, skin becomes clammy, and adynamia appears—the Verat-v. arc [Hughes], [Clarke]. Delirium may give way to muttering; temperature not invariably extreme, the distress being vascular rather than purely thermic [Farrington]. [Clinical]

Chill with sinking and slow pulse after arterial excess; heat of head/face > body; sweat cold, clammy, relieving head pressure yet marking cardiac depression (cross-link Heart, Perspiration) [Allen], [Boericke]. [Clinical]

Cardinal field for vascular excess. Fulness and throbbing, vertex weight, carotids hammering, crimson or dusky face, eyes injected, head feels as if it would explode in a warm room [Clarke], [Farrington]. The least jar or stooping increases the throb; the patient seeks the coldest air and begs for the head to be kept cool (cross-link Better cold applications) [Clarke]. With the nausea the head swims; turning in bed produces instant giddiness with deathly sickness—a decisive modality [Hale], [Allen]. Vision blurs at the height of congestion; sparks or darkness threaten; a true apoplectic facies may show—thick speech, heavy face—yet often recedes as vomiting relieves pressure [Hering], [Clarke]. Later, in the depression phase, headache becomes a dull, empty ache with pallor and cold sweat of forehead (micro-comparison: Verat.-alb. has colder surface, rice-water stools, and collapse; Verat-v. centres on vascular storm → vagal sink) [Farrington], [Boericke]. [Proving][Toxicology][Clinical]

Congested, bloodshot, lids heavy; pupils variable—often dilated during the arterial surge, tending to contract with vagal depression [Hale], [Clarke]. Photophobia with the heat-head; sight grows dim on rising; objects turn with vertigo. Orbital neuralgic stitches may attend the throbbing and yield to cold sponging and rest (modalities concordant) [Farrington]. [Clinical]

Roaring in ears synchronous with the carotid beat; hearing dulled in the storm; noises vanish after free vomiting or when the pulse softens [Clarke]. [Clinical]

Hot, dry nose in the feverish surge; epistaxis may give relief in robust subjects, acting as an outlet to tension [Farrington], [Clarke]. [Clinical]

Early phase: flushed, dusky, shining with sweat, eyes injected; later: pale, anxious, cold sweat, lips bluish at edges in respiratory crises [Allen], [Hering]. Expression frightened during laryngeal spasm; afterwards the mask of collapse appears (see Respiration, Perspiration). [Toxicology][Clinical]

Profuse salivation with incessant nausea; tongue at first red-edged, later pale and moist; taste flat or bitter [Hale], [Allen]. Mouth is hot while extremities are cold; thirst for cold sips between bouts [Hale]. [Clinical]

Grinding in convulsive paroxysms (puerperal/childhood laryngismus); dental region otherwise non-keynote [Hering]. [Clinical]

Fauces dry and hot in vascular stage; swallowing renews nausea; constricted feeling mounting to glottic spasm (cross-link Respiration) [Hering], [Allen]. Warm drinks aggravate; cold sips palliatively ease [Hale]. [Clinical]

Precordial oppression with sinking and bradycardia after the arterial rush; chest feels bound; must loosen clothing (echo Better loosening) [Hale]. Stitching pleuritic pains in early pneumonias subside as pulse lowers; respiration shallow during faintness [Boger], [Clarke]. [Clinical]

A double-phase action: at first arterial excitement with bounding pulse and carotid hammering; soon the vagal dominance asserts—pulse slows, grows feeble or intermittent, with syncope, cold sweat, and anxiety (this polarity defines the remedy) [Hughes], [Allen], [Hale]. Palpitation when sitting up; faintness on the least exertion; sensation as if the heart would stop if he moved (micro-comparison: Digitalis has slow, weak pulse with dread of motion but less gastric violence; Gels. has drowsy paresis with soft pulse and less emesis) [Farrington], [Clarke]. [Toxicology][Clinical]

Spasm of glottis or rigid larynx with livid face; crowing efforts; intense fear; later, sighing, shallow breathing with cold sweat and slow pulse (cross-link Larynx) [Hering], [Allen]. Early pneumonia/pleuro-pneumonia: hot skin, red face, carotid throb, stitching, nausea from motion; later adynamia with soft pulse—Verat-v. often bridges the transition [Clarke], [Boger]. [Clinical]

The emetic core. Persistent nausea with projectile vomiting of mucus, bile, or food; the least motion renews it—turning head on pillow, sitting up, carriage travel, ship motion (seasickness picture) [Hale], [Allen]. Pharyngeal and gastric tenesmus of retching leaves the patient prostrate, cold, and faint; cold sweat beads on the forehead (echo Perspiration) [Allen], [Boericke]. Epigastrium feels empty and sinking, yet any pressure or warm drink aggravates; desires iced water in sips; vomiting may temporarily relieve the head (modality cross-reference) [Hale], [Clarke]. Compared: Ipec. has constant nausea not better by vomiting; Tabac. has deadly coldness and sinking with motion-sickness but less arterial storm; Verat.-alb. adds profuse diarrhoea and rice-water stools with more extreme algidity [Farrington], [Hering]. [Proving][Toxicology][Clinical]

Sinking at epigastrium; cutting colic may attend the retching; abdomen often cool to touch while head burns (thermal inversion) [Allen], [Clarke]. Hepatic region feels heavy in pneumonic fevers; portal fulness with engorgement signs in robust subjects (vascular remedy signature) [Hughes]. [Clinical]

Stools usually scant or suppressed in acute vascular storms; diarrhoea is not a keynote (contrast Verat.-alb.). With collapse there may be sudden relaxed stool coincident with faintness and sweat [Allen], [Boericke]. [Clinical]

Scanty and high-coloured during fever; increased flow as the pulse softens; albuminuria noted in puerperal convulsions contexts [Farrington], [Clarke]. [Clinical]

Thirst for cold water in sips; warm drinks aggravate; the very thought of food excites nausea in crises; least motion after drink renews retching [Hale], [Allen]. [Clinical]

Sexual symptoms seldom leading; in collapse, impotence of desire and chilliness [Allen]. [Clinical]

Puerperal convulsions with gastric aura (nausea/retching), congested head (crimson face, throbbing carotids), and slow, laboured pulse—an important sphere; urine may be albuminous [Farrington], [Clarke], [Hering]. Menstrual suppression from chill with violent head-congestion and vomiting occasionally recorded [Clarke]. [Clinical]

Cervico-occipital ache with throbbing; coldness between shoulders during sinkings; sacral weakness after vomiting [Clarke], [Allen]. [Clinical]

Trembling, weakness; cold, clammy hands and feet with hot head; cramps in calves during faintness; knees fail on attempting to rise (motion → nausea) [Allen], [Boericke]. [Clinical]

Cold sweat, especially on forehead and face, with pallor; alternates with burning heat of head/face in the storm [Allen], [Boericke]. Lividity of lips/ears in laryngeal crises; rash not characteristic. [Clinical]

Arterial/Cerebral Congestion

• Bell. — Throbbing, hot, furious; less nausea, more delirious heat; Verat-v. couples congestion to nausea and subsequent bradycardia [Clarke], [Farrington].
• Glon. — Sun/heat bursting headaches; throbs without gastric storm; Verat-v. has strong emetic–vagal axis [Farrington].
• Gels. — Dull, drowsy congestion, tremulous weakness; pulse soft; little vomiting; Verat-v. more stormy with motion-aggravated nausea [Kent], [Farrington].
• Acon. — Fearful anxiety, dry heat, full pulse; less emesis; Acon. often precedes Verat-v. at outset of sthenic fevers [Clarke].

Nausea/Vomiting (motion–vagal)

• Ipec. — Constant nausea not relieved by vomiting; clean tongue; Verat-v. has cold clammy sweat and pulse changes [Allen], [Farrington].
• Tabac. — Deadly coldness, collapse with < least motion; less arterial surge; Verat-v. starts with head-storm then sinks [Clarke].
• Verat.-alb. — Copious diarrhoea, rice-water stools, profound algidity; Verat-v.: less bowel flux, stronger cerebro-vascular picture [Farrington], [Boericke].
• Ant-t. — Nausea with rattling chest, drowsiness; respiratory secretion keynote, not vascular storm [Hering].

Heart/Slow Pulse/Collapse

• Dig. — Slow, weak, fearful to move lest the heart cease; less vomiting, more visual illusions and cardiac focus [Farrington].
• Camph. — Collapse icy-cold, gasping; gastric symptoms secondary; Verat-v. preceded by arterial heat and carotid throb [Boericke].
• Carbo-v. — Air hunger, venous stasis, flatulence; lacks violent emesis and carotid hammering [Clarke].

Laryngeal/Respiratory Crises

• Spong. — Dry, barking croup; anxiety, but no vascular roller-coaster; Verat-v. shows lividity + carotid storm with glottic spasm [Hering].
• Acon. — Croupy onset with fear; emesis not central; may precede Verat-v. when head-congestion and vomiting predominate [Clarke].
• Phos. — Pneumonia with burning chest, thirst for cold; less nausea; blood-affinity differs [Boger], [Farrington].
• Bry. — Pleuritic stitch < motion with dryness; no emetic centre hallmark; Verat-v. for sthenic onset with nausea [Boger].

Puerperal Convulsions

• Bell. — Congestive, hot, furious; little vomiting; Verat-v. has gastric aura + pulse slowing [Farrington].
• Hyos. — Wild, silly spasms; gastric element not leading; Verat-v. has vascular–vagal swings [Clarke].
• Cupr. — Cramps/blue face; stomach less involved; compare case-by-case [Hering].

• Complementary: Gels. — Both relieve cerebro-vascular tension; Gels. for drowsy paresis; Verat-v. for storm + nausea; often follows Acon. [Farrington], [Clarke].
• Complementary: Acon. — Outset of sthenic fevers; Acon. quiets fear/skin-heat; Verat-v. meets carotid storm + emesis [Clarke].
• Follows well: Bell., Glon. — When congestion persists with vomiting and failing pulse [Farrington].
• Precedes well: Bry., Phos. — After arterial crisis in pneumonia passes into a settled exudative/pleuritic stage [Boger], [Clarke].
• Related: Verat.-alb. (collapse diarrhoea), Tabac. (motion-nausea), Dig. (slow weak pulse with motion dread) — compare axes.
• Antidotes (drug state): Camph., Coff., Nux-v. for medicinal aggravations (clinical tradition) [Boericke], [Clarke].
• Inimical/Use with care: Avoid routine alternation with Bell. unless clear stage-change—risk of confusing the picture (prescribing caution per lecturers) [Farrington], [Kent].

• Early pneumonia/pleuro-pneumonia in plethoric subjects: throbbing carotids, flushed face, dyspnoea, incessant nausea on motion; Verat-v. steadies the storm and spares cardiac depression; later Bry. or Phos. may carry the exudative stage [Clarke], [Boger], [Farrington].
• Apoplectic threatenings: crimson face, injected eyes, bursting head better cold, worse warm room, nausea with motion—Verat-v. may avert the blow when Bell./Glon. fail if vomiting is prominent [Clarke], [Farrington].
• Puerperal eclampsia with gastric aura (retching), congested head, and slow, laboured pulse afterwards—repeated small doses while watching urine and pressure (classical practice) [Farrington], [Hering].
• Seasickness/kinetosis: nausea from least motion, cold sweat, better lying still and cold sips; compare Tabac./Coccul. if arterial storm absent [Hale], [Allen].
• Cardio-vagal syncope: sinking at epigastrium with bradycardia; small doses may cut the cycle of retching→faintness [Hughes], [Allen].
• Dosing (classical): 3x–6x for vascular states and respiratory onsets; 12C–30C for nausea-vagal syndromes; in high fevers some used frequent low-potency repetition then lengthened as pulse softened [Hale], [Clarke], [Dunham].
• Pearls: Keep the head cool and the body still; give cold sips; do not urge movement immediately after relief, lest relapse ensue (bedside caution) [Farrington], [Allen].

Mini-pearls

• Case: Sthenic pneumonia, face crimson, carotids like hammers, nausea on turning—Verat-v. 3x every hour → pulse steadied; next day Bry. took the stitch and cough [Clarke], [Boger].
• Case: Threatened apoplexy after sun-heat; bursting head, vomiting with motion; Verat-v. 30C relieved congestion when Bell. had failed [Farrington].
• Case: Puerperal convulsions preceded by violent retching; after fit, pulse slow and soft—Verat-v. 6x shortened the storm and sleep ensued with cool head-sponging [Hering].

Mind

• Mind; anxiety; during nausea and faintness — vascular–vagal crises [Allen].
• Mind; delirium; congestive; alternating with muttering — storm then sink [Clarke].
• Mind; indifference; during nausea — “let me lie still” [Allen].
• Mind; fear; of motion; lest he vomit — master-modality [Hale].
• Mind; despair; during vomiting — sinking phase [Farrington].
• Mind; mania; puerperal; with gastric aura — convulsive storms [Hering].

Head

• Head; congestion; carotids; throbbing violently — crimson face, hot head [Clarke], [Farrington].
• Head; pain; bursting; warm room; agg.; cold applications; amel. — seeks cold air [Clarke].
• Head; vertigo; on turning in bed; with nausea/vomiting — least motion agg. [Hale], [Allen].
• Head; apoplexy; threatened; with vomiting — preventive sphere [Clarke].
• Eyes; injected; with heat of head — arterial storm [Farrington].

Stomach

• Stomach; nausea; least motion; aggravates — keynote [Hale], [Allen].
• Stomach; vomiting; projectile; with cold sweat — emetic centre dominance [Allen].
• Stomach; thirst; for cold drinks; small quantities; amel. — sips only [Hale].
• Stomach; sinking; epigastrium; with bradycardia — stomach–heart axis [Allen].
• Stomach; warm drinks; aggravate — thermal modality [Hale].

Heart

• Heart; pulse; slow; weak; intermittent; with faintness — vagal sink [Allen].
• Heart; palpitation; on sitting up or slight motion — motion aggravates [Allen].
• Heart; fear; motion; lest heart stop — Digitalis-like but with vomiting [Farrington].
• Heart; oppression; precordial; with cold sweat — collapse sign [Boericke].
• Heart; inflammation; pericardial/pleuro-pneumonic onsets; with vascular excitement — early stage pointer [Boger].

Respiration/Larynx

• Larynx; spasm of glottis; with lividity — croupy crises [Hering].
• Respiration; shortness of breath; with carotid throbbing — sthenic onset [Clarke].
• Respiration; sighing; with faintness and slow pulse — sinking phase [Allen].
• Chest; pneumonia; first stage; with violent congestion and nausea — pivotal use [Boger].

Female

• Convulsions; puerperal; with vomiting; albuminous urine — gastric aura hallmark [Farrington], [Hering].
• Labour; vomiting; violent; with head congestion — obstetric storm [Clarke].

Fever/Generalities

• Fever; heat; head and face hot; body cooler — thermal inversion [Clarke].
• Sweat; cold; clammy; forehead — collapse marker [Allen], [Boericke].
• Generalities; motion; least; aggravates — master-modality [Hale].
• Generalities; room; warm; aggravates; open air; ameliorates — head/vascular [Clarke].
• Generalities; after vomiting; amelioration — temporary relief [Allen].

Extremities

• Weakness; on attempting to rise; with nausea and faintness — motion–vagal link [Allen].
• Cramps; calves; during collapse — peripheral sign [Boericke].
• Coldness; hands and feet; with hot head — inversion [Allen].

Hale — New Remedies, Clinical and Pathogenetic (1875–1891): primary proving/toxicology; emetic–vagal axis; vascular indications; dosing notes.
Hughes — A Manual of Pharmacodynamics (1870s–1890s): physiological action on heart/vessels; pneumonia/fever rationale; drug comparisons.
T. F. Allen — Encyclopaedia of Pure Materia Medica & Handbook (1874–92): symptoms (nausea < least motion, bradycardia, cold sweat); clinical annotations.
Hering — The Guiding Symptoms of Our Materia Medica (1879–91): laryngeal spasm, puerperal convulsions, congestive crises; polarity notes.
Clarke — Dictionary of Practical Materia Medica (c. 1900): congestive head, carotid throbbing, pneumonia onset, modalities; relationships.
Farrington — Clinical Materia Medica (1890s): differential emphasis (Bell., Glon., Gels., Dig., Verat.-alb., Tabac.); obstetric insights.
Dunham — Lectures on Materia Medica (1870s): vascular fevers; stage management (Acon. → Verat-v. → Bry./Phos.).
Boger — Synoptic Key & Studies of Materia Medica (early 20th c.): pneumonia/pleurisy staging; rubric style used in generals.
Boericke — Pocket Manual of Homoeopathic Materia Medica (1901): condensed picture—nausea with cold sweat; heart slow; respiratory uses.
Tyler — Homoeopathic Drug Pictures (early 20th c.): practical portrait; comparisons with Verat.-alb., Tabac., Dig., Bell., Gels.
Nash — Leaders in Homoeopathic Therapeutics (1899): collapse vs vascular remedies; clinical hints on cardiac depression.
Dudgeon/Hughes & Dake — Cyclopaedia of Drug Pathogenesy (1885–92): collated toxicology/over-dosage confirming medullary emesis and cardio-vagal depression.