Lyeopodium from provings ANTHONY CAMPBELL, MRCP, FFHOM

Introduction Lycopodium is one of the most widely used remedies in the homceopathic materia medica. It is of course a polychrest, and it has a detailed and elaborate "drug picture", which was painted by certain post-Hahnemannian authors such as Kent and Tyler. As was pointed out many years ago by Bodman, 1 however, this picture contains a large number of "clinical" symptoms and is therefore only partly derived from provings. Lycopodium is thus an important remedy to consider in any attempt to base the materia medica more firmly on provings.

Lycopodium is prepared from the spores of the club moss, L. clavatum. In former times these spores were used as an inert filling for making pills. Their inert- ness depends on the fact that the spores are waterproof; to release their pharma- cological effect the spores must be triturated (for at least two hours, according to Hughes 2) or be treated with a fat solvent'such asether.

Lycopodium was in limited use as a medicine (chiefly for urinary complaints) even before Hahnemann took it up, but the Credit for its more extensive applica- tion is certainly Hahnemann's. It does not appear in the Materia Medica Pura, however, but only in the Chronic Diseases, where it has 1608 symptoms, from Hahnemann and seven fellow-provers. As I have pointed out elsewhere, 3 the reliability of the Chronic Diseases as a record of provings is seriously open to question.

Materials and methods The present study is one of a series I am currently engaged in, to t r y t o reassess some of the materia medica from the standpoint of provings, using Hughes's Cyclopaedia. I had initially intended to present my findings for Lycopodium in much the same manner as I had earlier done for Thuja. ~ that is, by summarizing the more important and interesting of the individual proving narratives. I discovered, however, that this was not feasible, owing to the disappointing thinness and lack of form of the symptoms themselves. This has forced me to adopt a different approach and to summarize to a greater extent than I had originally intended.

In any attempt to digest proving material, there is a problem of selection. As Hughes remarked in his introduction to the Repertory to the Cyclopaedia, "we must not assume everything recorded in the pathogeneses as worthy of reference. The narratives of the provers have had to be given as they stand (with merely condensation of expression and omission of what is palpably dubious), lest anything should be lost. In reading them over, however, it is obvious that much is

94 The British Homoeopathic Journal

but incidental, transitory, personal.. . , ,5 This is, of course, the problem which faces a would-be abstracter such as

myself. He has to strike a balance between including too much and too little, and no doubt every reader would draw the line differently. I must therefore emphasize that these abstracts cannot be substitutes for the original reports, but are only pointers to the fiches they contain.

The principal guideline I have used in selecting material has been that of modern clinical relevance. My basic method has been to read through the provings as a whole, attempting to pick out those symptoms or classes of symptoms which seem most likely to be helpful in practical prescribing. In general, I have paid the greatest attention to symptoms which appear repeatedly in the provings of the drug in question and which seem to be reasonably characteristic of that particular drug. In other words, I have constantly asked myself two questions: (1) Does this symptom or group of symptoms have relevance to actual clinical situations that might be encountered at the bedside or in the consulting room? (2) Is the symptom or group of symptoms of a kind which would point reasonably exactly to the remedy under consideration, or is it so vague and general that it might well be a placebo effect or incidental?

The second point is, I think, particularly important, for unless a particular kind of symptom occurs with reasonable frequency in the provings of a given drug it can hardly be said to be characteristic of that drug. On the other hand, it ought not to be so widespread that it turns up in the provings of almost every drug. What we are looking for in homoeopathy is always the symptoms that are characteristic of the drug in question.

I have not, however, applied these principles too strictly. Occasionally one finds recorded a single instance of a striking or unuSual symptom, and when this happens I have drawn attention to the fact even if it has no obvious clinical relevance.

Res~dts Hughes lists contributions from twenty-five provers in addition to Hahnemann and his colleagues. He gives no reports of poisoning or animal experiments, a deficiency which probably reflects the low toxicity of Lycopodium. It has to be admired, I think, that the symptom picture which emerges from this material is on the whole thin and unconvincing, a fact which impressed at least one of the actual provers. Prover twenty-five, Dr Genzke, took large doses of tincture (up to 500 drops), and produced some rather unremarkable and disconnected symptoms. He then experimented on five children, aged from six to fifteen years, to whom he gave increasing doses of the I5th attenuation followed by a ten-day course of the 3rd trituration. No symptoms attributable to the drug resulted, and this was also the case with a 24-year-old subject on whom Dr Genzke carried out experiments. These negative resultsled Genzke to question whether his own symptoms were really due to the Lycopodium.

An interesting proving, in which suggestion can be excluded, is No.4. The subject was a one-year old child who had suffered soon after birth from emaciation and fetid diarrhoea; he recovered after a few months of homoeopathic

Volume 70, Number 2, April 1981 95

treatment and was perfectly well when the proving began. (Incidentally, the willingness shown by some of these early experimenters to test drugs on small children is remarkable.) For five days he was given Lycopodium as a 5x trituration, 2 grains twice daily. On the second and third days his face looked puffy and yellow; he felt hot to the touch and he was exhausted. These symptoms grew worse on the following days and he had diarrhoea. By the fifth day he could no longer sit, he had lost weight, and his nose was running. His limbs moved rest- lessly. On the sixth day (no medicine given) he was unchanged except that his right leg was bent at the ankle. His abdomen was very distended, his stools were yellow and loose, he was irritable and he sweated a lot during sleep. These symptoms gradually abated, and disappeared by the 14th day.

It would be possible to attribute much of this symptomatology to an incidental infection, but it does correspond fairly well to what a number of the adult provers experienced. The majority of the provers took their Lycopodium in the triturated form, from lx to 6x, in quantities up to 90 grains daily. Most of the trials lasted two to four weeks. The principal symptoms were as follows.

1 Sensations of heat and flushing in the face and head. Many provers experienced this. In one particularly interesting case a 16-year-old girl took all kinds of preparation of the tincture from the 30th dilution to the 1st without any symptoms except a transient heat and redness of the face after each dose. She then tried triturations of 6x to 4x, in doses up to 60 grains, and had a number of symptoms, including a sensation of flushing as well as nausea and dysuria. She eventually developed an "ague" which in the opinion of the experimenter was certainly due to the drug. (It should be remembered that the clinical thermometer had not yet come into use.)

2 Gastrointestinal symptoms of various kinds, especially salivation, a slimy feeling in the mouth, nausea, abdominal distension, flatulence, and diarrhoea. Gastrointestinal symptoms are generally very common in provings, which is hardly surprising since the drugs were taken in large doses by mouth; this in my view reduces their clinical importance somewhat, but those of Lycopodium do seem to be fairly distinctive. The slimy mouth is a particularly frequent finding, and so is the abdominal distension and flatulence, which were often sufficiently severe to make any kind of abdominal pressure intolerable.

3 Urinary symptoms: several provers report symptoms suggestive of urethritis, and one (No. 7) had a frank urethral discharge. A number passed increased amounts of urine or noted the passage of brownish or reddish urine---"like brickdust" in one instance.

4 Exhaustion and depression were quite common, sometimes associated with an inability to concentrate. Other "mental" symptoms were sleep disturbance and unpleasant dreams.

5 A few provers had skin symptoms, especially A. Huber, a 31-year-old surgeon who took five grains of a 5x trituration twice daily for eight days. On the seventh day there appeared several brown spots on the inner aspects of both

96 The British Homoeopathic Journal

thighs; over the next few days these became inflamed and painful, and then gradually disappeared.

6 There are numerous reports of joint and muscle pains, mostly of brief duration.

Discussion The symptom classes mentioned above would certainly form part of the classic "Lycopodium picture" as it is represented in post-Kentian textbooks. On the other hand, a great deal that appears in such textbooks does not come out in the provings. For example, there is nothing to support the well-known four to eight p.m. aggravation. And what about the supposed association of Lycopodium with right-sided symptoms, or with symptoms moving from right to left? I have sifted through the provings in an attempt to verify this, and have found that left-sided symptoms are mentioned approximately twice as often as right-sided ones. There is no mention of a fight-to-left progression, though the converse occurs three times. So far as these provings are concerned, therefore, Lycopodium is if anything a left-sided medicine.

As for the idea that Lycopodium is a prominent skin remedy, this finds little support in the provings, and there is not much to suggest that it gives rise to many mental symptoms though it is true that a number of provers experienced fatigue, depression, and irratibility. (These, however, are commonly found for many substances, and may well be non-specific.)

As for such "typical" Lycopodium features as preference for hot food, a craving for sweets, dislike of physical exercise, preference for solitude or for the company of a single person, and so on, these would hardly be expected to emerge from provings, and they do not do so.

It is interesting to compare the Lycopodium provings with those of Thuja discussed in an earlier paper. The Thuja picture is much more definite and convincing than the Lycopodium One, and on the basis of its provings Thuja would seem to be a more toxic substance than Lycopodium. Indeed, it would not be difficult to attribute the majority of the alleged symptoms of Lycopodium to non-drug causes; it would be much more difficult to do this in the case of Thuja. It is fair to point out, however, that some of the Thuja provers went on taking large doses of the drug for long periods (several months at a time), which was not the case with Lycopodiurn.

In sum, I find I must agree with Bodman I that much of the "Lycopodiurn picture" derives from clinical observations and not from provings. This does not necessarily invalidate the picture, though it remains a most unfortunate fact that there is no way in which we can today evaluate the accuracy or reliability of the clinical contribution to the materia medica, since the sources of this clinical contribution are nowhere specified.

So far as particular clinical indications for Lycopodium are concerned, the following conditions suggest themselves on the basis of the provings.

~1 Any wasting or debilitating illness, especially if associated with weight loss, irritability, depression, and sleeplessness. Marasmus in infants.

Volume 70, Number 2, April 1981 97

2 Dysuria, especially if associated with the passage of gravel.

3 Peptic ulceration, hiatus hernia, chronic or acute gastritis, irritable colon.

Although it does not arise from provings, an interesting clinical observation contributed by Hughes is that he has known two cases of aneurysm which responded favourably to Lycopodium.

Hughes regards the 12c dilution as the most useful in practice. Most of these provings, however, were made with low (under 6x) triturations, and there is a suggestion that triturations were more effective than dilutions. Perhaps, therefore, we ought to try the effect of triturations.

In conclusion, I should like to put forward for discussion an idea which has been suggested to me by my work with the raw data of homoeopathy. According to the prevailing view, in trying to select the "right" remedy, the physician should practise a method of exclusion. This is the underlying assumption of repertoriza- tion, whether by Kent's method or by Boenninghausen's. In both cases, one eliminates those remedies which do not "have" the exact symptoms of the case. Thus, in treating, say, peptic ulceration, one tries to obtain a precise estimate of the time at which pain comes on after eating, so as to eliminate all those medicines which produce earlier or later onsets of pain.

Now, a moment's reflection on the provings will show, I suggest, that this procedure is indefensible. Even supposing--what is by no means the case-- that all the symptoms recorded in the repertories are reliable, the number of subjects who have contributed to our knowledge of any one of even the best proved remedies is only about fifty. How, then, can we know what would have been found if a hundred, or a thousand, or ten thousand people had been tested? We are basing our ideas of the remedies on a minute sample of the population--a population, moreover, which lived 150 years ago. In other words, our "drug pictures", even if not greatly distorted by the inclusion of a great deal of dubious clinical material, are undoubtedly painted with an extremely broad and imprecise brush.

It follows from this, I believe, that we are only entitled to draw positive con- clusions from the provings, not negative ones. The fact that a particular symptom has appeared during the testing of a drug is relevant, but the fact that another sympton has not appeared is not very useful, since we cannot be sure that it would not have done so had more subjects been tested. One day, perhaps, sufficient numbers of provings will have been carried out to make the drawing of negative conclusions legitimate, but that day is a long way off at present.

Pending further provings on the lines of those reported by Hughes, we would do well to examine this old, but not outdated, material with the care it undoubtedly deserves, for it is in this way that we can best advance our understandings of hom~eopathy.

ACKNOWLEDGEMENT I should like to thank the Homceopathic Trust for its generous support of the research on which this study is based.

98 The British Homaeopathic Journal

REFERENCES 1 BodmanFH. TbeevolutionoftheLycopodiumdrugpicture. BrHomJ1936;26:416. 2 Hughes R. A Manual ofPharmacodynamics. 1880, Fourth edition, 617. 3 Campbell, ACH. Should we resurrect Richard Hughes? BrHom J 1980; 69;66. 4 Campbell ACH. Thuja--a drug picture based on provings. Br Horn J 1980; 69:182. 5 Hughes R. A Repertory to the Cyclopaedia of DrugPathogenesy. London and New York, 1900, 4.

Correspondence To the Editor, THE BRITISH HOMGEOPATHIC JOURNAL

Dear Sir, The January 1981 issue of the BRITISH HOM(EOPATHIC JOURNAL contained two very interesting articles. Dr Fisher, I think, should be congratulated on his paper on Lead Toxicology. This, in a much more detailed fashion, continues the earlier publications on the comparative studies with mercury, digitalis, X-rays and radium. It is surely by such articles that interest in the homc~opathic principle can be extended to the academic pharmacologists and clinicians. I look forward to seeing further work on these lines.

The other article which is of considerable interest, by Georg von Keller on Lilium tigrinum, demonstrates the problem which some of our continental colleagues have with the interpretation of the English language and the interpreta- tion of Kent's repertorizing methods.

From his condensed notes it would appear that impatience is not one of the characteristics of Mrs C., while "hurry" is. If one therefore excludes impatience from the repertorization, Sepia does not appear, but Lilium tigrinum does, although only on three occasions, including the lump sensation and the desire to take a deep breath.

In order of descending frequency, Pulsatilla, Lachesis, Nux and Sulphur occur. As I understand it, the principle laid down by Kent was to study these in the materia medica and confirm the symptomatology. As Georg von Keller says, none of these fit the picture as accurately as Lilium tigrinum, and so I suggest according to Kent one would have prescribed Lilium tigrinum.

This, as occurred in this case, does not deny the value of the repertorizing principle. I would suggest that it is more usual for repertorizing to indicate the correct remedy, though not necessarily in the highest numerical value. For the beginner this is surely the only way in which he can approach hom0eopathic prescribing, affording him the opportunity of studying a limited number of remedies for a particular case.

Having said this, however, I would congratulate Georg yon Keller on the quality of his paper and I look forward to seeing further articles.

Yours faithfully, 14 Wellington Place c. OLIVER KENNEDY London N2 0PN 10 February 1981

Volume 70, Number 2, April 1981 99