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| Digitalis purpurea |
The only courage that matters is the kind that gets from one minute to the next.
[Mignon McLaughlin]
Signs
Digitalis purpurea. Foxglove. Fairy Bells. N.O. Scrophulariaceae.
CLASSIFICATION With about 220 genera and some 3,000 species the Scrophulariaceae is a large family of mainly north temperate shrubs. The family, commonly called the Foxglove or Figwort family, has wide distribution with a wide range of habitats – from grassy plains and very dry areas to swamps. There is only one tree genus in the family: Paulownia. Some of the herbaceous genera are semiparasitic, taking part of their nourishment from the roots of their host plants, most frequently members of the Graminae [Grasses].
SUBFAMILIES The family is usually divided into three subfamilies, based on the venation of the corolla lobes and on the arrangement of the leaves. The subfamily Verbascoideae consists of 2 tribes and about 10 genera. Best-known of these is Verbascum, which is also employed in homoeopathy. The subfamily Scrophularioideae comprises 7 tribes and over 100 genera, of which Linaria, Scrophularia, and Mimulus are used in homoeopathy. The Rhinanthoideae, containing 3 tribes and over 100 genera, includes the many semiparasitic genera of the family. Some species, particularly the semiparasites, are serious weeds, principally of cereal crops. Of the Rhinanthoideae, homoeopathy uses Digitalis, Veronica, Leptandra, Gratiola, and Euphrasia; the latter is semiparasitic.
POLLINATION The family reflects the evolution of specialized insect-pollination mechanisms, by which the chances of self-fertilization are reduced and cross-pollination is enhanced. “This is encouraged in many species by the stigma extending beyond the anthers, so that the visiting insect carrying pollen from another plant touches it first. In Scrophularia the female flowers have a relatively short style and are visited by wasps; an open flower with relatively short tube in Verbascum and Veronica is suited to flies and bees, while a long tube with anthers and stigma arranged so as to touch the back of the visiting bee is exemplified by Digitalis and Linaria. Pedicularis and Euphrasia have ‘loose pollen’ and spiny anthers which are protected by the upper lip of the corolla and shake the pollen on to the pollinator as it lands on the lower lip.”1
ECONOMIC USES Few members of the family are of economic importance, though many genera include ornamental varieties, e.g. Calceolaria [slipper flowers], Hebe, Veronica [speedwells], Mimulus [monkey flower], Antirrhinum [snapdragons], Penstemon [beard tongues], Digitalis. The foxglove is the source of the drugs digitalin and digoxin. It is estimated that, in the United States alone, over 3 million heart disease patients daily use digitoxin, digoxin, or one of the other cardiac glycosides found in Digitalis. In the past Antirrhinums were valued as a specific against witchcraft and were cultivated in Russia for the sake of the oil in their seeds, which is said to be almost as pure as olive oil.
GENUS The genus Digitalis is native to the Mediterranean region, Europe and Central Asia. Several species have been introduced into the United States. It comprises about 19 species of biennial and perennial herbs with simple leaves and racemes of showy, five-lobed, tubular flowers. Various species and numerous cultivars are grown ornamentally.
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| Digitalis purpurea |
DIGITALIS A favourite plant in the family is Digitalis purpurea, the Foxglove, a species native to W Europe [including Britain] but now naturalized in many parts of the world, even in the Andes and New Zealand [where it is classed as a noxious weed]. It is a biennial with greyish-green, oblong to lanceolate leaves and striking spikes of finger-shaped purple flowers 90-150 cm tall. These usually have dark purple spots inside. It is pollinated by bees and is commonly found in open spaces such as woods, and mountain rock. It has been found growing at heights up to 3,000 feet. The plant prefers light, dry, acid soil.
NAME The generic name was given by the German herbalist Fuchs in 1542 and is derived from L. digitus, finger, in reference to the flowers being likened to the fingers of a glove. It is a translation into Latin of the German name Fingerhut [thimble]. The specific purpurea means ‘purple’, the usual colour of the flowers. The common name was applied in very early times. It could be taken from the Anglo-Saxon foxes-glew, ‘fox-music’, because of the bell-shaped flowers. It may also be derived from ‘folksglove’, the glove of the ‘good folk’ or fairies. Fairies, or pixies, were believed to have a particular liking for the plant. It gave rise to such popular names as ‘fairy bells’, ‘fairy cap’, ‘fairy glove’, ‘fairies petticoat’,and ‘fairy thimbles.’ Their favourite haunts were deep hollows and woody dells, places where the Foxglove delights to grow. Bad fairies gave the plant to the fox so that he could put flowers on his toes and prowl the chicken roosts in silence. “The mottlings of the blossoms of the Foxglove and the Cowslip, like the spots on butterfly wings and on the tails of peacocks and pheasants, were said to mark where the elves had placed their fingers, and one legend ran that the marks on the Foxglove were a warning sign of the baneful juices secreted by the plant, which in Ireland gain it the popular name of ‘Dead Man’s Thimbles.’ In Scotland, it forms the badge of the Farquharsons, as the Thistle does of the Stuarts.”2 ‘Popdock’ is a local name used in Cornwall, England; it comes from the habit of children to inflate and burst the flower.
CONSTITUENTS There are many natural, secondary, and other derived compounds from Digitalis species. The important cardenolides or cardiac glycosides include digitoxin, digoxin, gitoxin, from the lanatosides A, B, and C, and from purpurea glycoside A and B. The important saponins include digitonin, tigonin and gitonin. Additional medicinally useful steroids and cortical hormones can be made from the plant steroids. The glycoside content of tissue varies with the individual plant, the stage of development, the growth environment, and the time and method of harvest. Comfrey leaves have been reported to be used as an adulterant. 3 Plants with cardioactive glycosides were widely used by hunter-gatherer communities around the world as arrow poisons. “The cardiac glycosides are built up from a steroidal aglycone having very similar properties and origins to the steroidal saponins [they are sometimes found together] and thus to the steroid hormones, vitamin D, the bile acids and cholesterol. They are divided into two groups on the basis of whether the aglycone possesses a five- or six-membered ring: The bufadenolides [so called from their structural similarity to constituents in toad venom], are restricted to the Liliaceae [such as squills] and the buttercup family or Ranunculaceae [such as the hellebores]. The cardenolides are by far the most common variety.”4 The cardenolides have a wide distribution, being recorded in over 200 species representing 55 genera and 12 families, with Digitalis perhaps as the best known one. Another common source of cardenolides are the milkweeds Asclepias and Calotropis.
HISTORY The potency of Digitalis had been known since ancient times; yet there is not much evidence of its use. The ancient Druids are known to have used the plant and valued its medicinal properties. In medieval times it had served as a poison for “trials by ordeal”, and was also used as an external application to promote wound healing. The old herbalists employed the plant for various purposes. Gerard recommends it for bruises of those “who have fallen from high places.” Kuklin says that Mahatma Ghandi used to sip tea brewed from foxglove leaves, and that holy men have been known to chew it while meditating. 5
FOLKLORE A decoction of Digitalis, added to the water in vases, helps to preserve the life of cut flowers. Grown in the garden it protects it, as well as the home. Housewives in Wales used foxgloves-leaves to make a black dye, which they used to paint crossed lines on their cottage’s stone floors to keep evil from entering the house. In Staffordshire, England, the reverse was believed: bringing foxgloves into the house gave witches or the devil access to it. In the same area the plant was regarded as an omen of war. An English legend tells how foxglove came into existence. On his way from Wales to Devon, a Saint was attacked by robbers and decapitated by them. Undaunted by the inconvenience, the Saint picked up his head and continued his journey. Wherever a drop of blood fell from his wound a foxglove sprang up. Noisy children were compared with bees buzzing with anger from being trapped in a foxglove bell. Fairies were said to employ the plant to punish overconfident mortals. Rather than being fairy plants, foxgloves were sometimes thought to be dangerous to fairies. “If you have a cross or peevish child, or one than from being in good health becomes sickly, and you have reason to believe it is a fairy child, the following plan may be tried in order to ascertain whether this is the case. Take foxglove and squeeze the juice out. Give the child three drops on the tongue, and three in each ear. Then place it at the door of the house on a shovel [on which it should be held for some time], and swing it out of the door on the shovel three times, saying: ‘If you’re a fairy away with you!’ If it is a fairy child, it will die; but if not, it will surely begin to mend.”6
DISCOVERY The discovery of Digitalis as a heart medicine is accredited to the British physician William Withering [1741-1799]. The story is that a patient with a very bad heart condition came to see him, in 1775. Withering could offer no effective treatment and thought the man was going to die. The patient, however, went to an ‘old woman’ for alternative treatment, which consisted of a secret herbal remedy. The herbal remedy promptly helped the man. When Withering heard about this, he became curious and searched for the old woman to learn what was in the secret remedy. This proved to be a concoction of twenty or so herbs, but Withering concluded quickly that the important active ingredient was the purple foxglove. Withering tried out various formulations of digitalis plant extracts on 163 patients, and found that if he used the dried, powdered leaf, he got amazingly successful results. He introduced its use officially in 1785. In 1799, Withering became very ill and it looked as though he was going to die. One of his friends, who was noted for his black sense of humour, commented “The flower of Physic is withering…” When he finally died, his friends carved a bunch of foxgloves on his memorial. 7 Several of Withering’s contemporaries also considered foxglove leaves to be useful in the treatment of tuberculosis. Such claims were never substantiated -then or later – and Withering didn’t pay much attention to them. The irony of it all is that Withering died of tuberculosis. [Withering’s observations on patients treated with Digitalis can be found in Allen’s Encyclopedia of Pure Mat. Med., as source 51. Also, he is one of Hahnemann’s ‘old-school authorities’ for this drug picture.]
HEART Digitalis preparations – for which Digitalis lanatum today is the main source – are available under various brand and generic names, such as cedilanid, crystodigin, digitoxin, digoxin, lanoxicaps, lanoxin, novodigoxin. They are used for strengthening weak heart-muscle contractions and to correct irregular heartbeat. Digitalis does not prolong survival of heart failure patients, according to a clinical trial involving 302 clinics in the United States and Canada. However, the trial found that the drug eases symptoms for those with heart failure, helping to keep them out of the hospital.
TOXICOLOGY “In single large doses, digitalis is an irritant-narcotic poison, producing gastrointestinal irritation, nausea, vomiting, and very abundant alvine evacuations. Its action is afterward spent upon the nervous system, causing vertigo, dimness of sight, delirium, convulsions, or a general debility, and finally death. A slow, feeble, irregular pulse and suppression of urine are generally present. When given in medicinal doses, too long continued, or in quantities to exert an immediate action on the system, it causes an increased discharge of urine, reduces the pulse from 70 beats in a minute to 30, with languor, nausea, occasionally anxiety and salivation, a sense of weight, or constriction, obtuse pain in the head, giddiness, disordered vision, mental disturbance, and rarely spectral illusions; not infrequently a huskiness of the voice is present, the result of irritation of the fauces, trachea, etc. The nausea produced by digitalis, and more quickly by digitalin and digitoxin, is preceded by malaise, faintness, and depression, and is exceedingly distressing. Vomiting temporarily relieves it, the vomited material being first dark-green, afterward yellow. Prostration becomes so great that the individual can not stand without help, and an intense disgust for food is experienced. Familiar objects are unrecognizable – a disturbed vision with yellowness or blueness supervening. Persons are recognized only by their voices. These effects, if not fatal, may last several days, the sleep being disturbed by nightmare and general unrest. Finally sound sleep and a voracious appetite quickly restore the individual to normal health. If the use of the remedy be persisted in, these effects will continue to increase until the poisonous symptoms, first referred to, become developed.”8
SIDE EFFECTS Digitoxin is found in high concentrations in the liver, gallbladder, and small and large intestine. The right and left heart ventricles contain nearly twice the concentrations as that of the atria. Digitoxin passes easily through the placenta, and filters into mother’s milk. Symptoms of overdose of Digitalis preparations include nausea, vomiting, diarrhoea, vision disturbances, [yellow] halos around lights, fatigue, irregular heartbeat, confusion, hallucinations, convulsions. Loss of appetite and diarrhoea are considered common side effects of Digitalis use. More infrequent side effects are extreme drowsiness, lethargy, disorientation, headache, and fainting. Rare adverse reactions include rash, hives; diplopia; enlarged, sensitive male breasts; tiredness and weakness; depressed; decreased sex drive; hallucinations, psychosis.
PROVINGS •• [1] Hahnemann – 11 provers; method: unknown.
•• [2] Jörg – 7 provers [6 males, 1 female], 1823-24; method: 1/4 to 2 grain doses of powdered digitalis [leaves] for three days, or infusion of leaves, or tincture.
•• [3] Hutchinson – self-experimentation, 1826; method: repeated doses of tincture, and increasing doses of tincture.
•• [4] Black – 4 provers, 1845; method: increasing doses of tincture.
•• [5] Lembke – self-experimentation; method: powdered leaves, in doses increasing from 1/4 to 1 grain, symptoms recorded for 80 days.
[1] Heywood, Flowering Plants of the World. [2] Grieve, A Modern Herbal. [3] Simon [ed.], Herbs: An Indexed Biography. [4] Mills, The Essential Book of Herbal Medicine. [5] Kuklin, How Do Witches Fly? [6] cited in Vickery, Dictionary of Plant-lore. [7] Local Heroes, BBC2 TV Programme, 1996. [8] King’s American Dispensatory.
Affinity
HEART; muscle. CIRCULATION [liver; lungs; stomach]. Occiput. Genito-urinary organs. * Right side. Left side.
Modalities
Worse: Raising up. Exertion. Heat. Lying on left side. Motion. Smell of food. Cold drinks. Excesses; sexual. During sleep. Talking. Emissions. Excitement. After eating. Music.
Better: Rest. Cool air. Lying flat on back. When stomach is empty; fasting. Pressure. Frequent micturition.
Main symptoms
M Fear of DEATH during HEART symptoms.
Fear of death while WALKING.
Anxiety from motion.
Sensation as if the heart would STOP beating if he MOVED.
M SADNESS from MUSIC.
Sadness > sighing.
M Ailments from GRIEF / DISAPPOINTMENT.
Palpitation after grief.
• “Anxious and concentrated sadness, with sleeplessness at night, owing to pains in the region of the heart: for instance, from disappointed love, especially in women of brown complexions, firm and obstinate dispositions. In such cases far preferable to Ign.” [Teste]
Wants to be alone; tries to escape if others force themselves on her.
M DREAMS of FALLING [Cact.].
M Failure.
• “Lachrymose sadness about many things in which he has been unsuccessful [after half an hour].” [Hahnemann]
• “Digitalis subjects are too vulnerable to failed plans. They are full of anxiety about the future. … Digitalis is an introvert who does not do things wholeheartedly.” [Grandgeorge]
M Secret mania and disobedience and obstinacy; he tries to run away. [Hahnemann]
G High living [alcohol, sexual excesses] with stomach and liver disorders.
And Circulatory disturbances [e.g. slow pulse, palpitation, angina pectoris].
G Old men with enlarged prostate, constant urging to urinate at night, scanty flow alternating with copious flow, impotence and lascivious thoughts.
G Ailments after coition.
[unconsciousness; ringing noises in ear; putrid taste in mouth; disordered stomach; seminal emissions; difficult respiration; pain in heart; palpitation; faintness; flushes of heat]
G DESIRE for BITTER food, drinks.
Dutch saying: • “Bitter in de mond maakt het hart gezond.”
[literally: Bitter in the mouth – expressing bitterness, too – keeps the heart healthy.]
G < MOTION, but must walk about. And Precordial anxiety. And Urging to urinate. • “… he had considerable disturbance of the circulatory organs, so much so that on night of the 3rd and 4th days he had, on account of palpitation and anxiety, to get out of bed, to walk about, and open window.” [Hughes] G < Becoming heated. G > Vomiting.
G BLUENESS.
[skin, eyelids, lips, tongue, finger nails]
G SLOW PULSE. [• “an excellent indication” – Lippe]
G Liver disorders and heart problems.
G Jaundice and weakness of heart, slow pulse and white or ashy stool.
G Vertigo and slow pulse.
P Migraine.
In an article on ‘Migraine and Digitalis’ Imhäuser says that “there is not known a characteristic megrim corresponding to Digitalis.” Treatment of 54 cases of migraine, with Digitalis D3 three times daily for some months, resulted in 34 complete cures; there was an improvement in 8 patients, and little or no result in 12 patients. The patients included 10 girls, 8 boys, 34 women, 2 men. The study was intended “to find out the characteristics of Digitalis migraine. There are found a number of symptoms, cured by Digitalis, which also are rather frequently found in migraine.”
Summary of cured symptoms:
c Location: Temples [23 patients]; one-sided pain slightly more often in right temple [9] than in left one [7]. Forehead [17], sometimes extending to occiput, or vice versa. Above the eyes [10].
c Pain: Pressing / bursting [23]. Stitching [16]. Pulsating, hammering [16].
c Concomitants: Nausea/vomiting [32]. Vertigo [11]. Urging to urinate / copious urine [11]. Chilliness [9]. Flickering/black-white colours [14]. Coloured vision [2]. Sensation as if eyes were pressed out [3]. 1
P VISUAL DISTURBANCES.
Vision disturbances, particularly diplopia and yellow vision, are a common side effect of the orthodox treatment with digitalis medication. There is also a high incidence of visual disturbances among the participants in the Digitalis provings [which were undertaken with material doses].
c COLOURS
• Bright sparks.
• Sudden dazzling of eyes, followed by sparks as if around eyes.
• White spots and black rings hover before eyes [for more than one hour].
• Many spots, stripes, white specks hovering before eyes.
• Bright stripes hovering before eyes.
• The flame of a coal-fire appears to be blue.
• External objects appear of a yellow or green colour.
• His own hands or another’s face seem blue.
• All objects, esp. all bright ones, seemed in a slightly yellow light.
• Luminous objects seem to jump before his eyes, on covering them.
• All objects seemed covered with snow, in the morning, on waking.
• Faces of people seem as pale as corpses.
• Colours before eyes, red, green, yellow, like a shimmering light in the twilight.
• Clouds of phosphorescence, on closing eye and rubbing it slowly.
• Flickering roses.
c INTENSE YELLOW HUES
• “Not only art historians but doctors have wondered why Van Gogh’s paintings were characterized by intense yellow hues and halo effects. Chronic solar injury, glaucoma, and even cataracts have been suggested, while some physicians believed that Van Gogh had acute mania with generalized delirium. Others diagnosed epilepsy, and in 1981, Dr. Thomas Courtney Lee concluded that Van Gogh may have suffered from digitalis intoxication. Digitalis was a common remedy in the 19th century for epilepsy. In large doses it can produce disorientation, yellow vision, and even coronas of swirling light. That would fit Van Gogh’s late paintings which are dominated by yellow, a chromatic obsession he described at length in his letters. But there is no record that Van Gogh was ever treated with digitalis. The only fact rising above conjecture is that Van Gogh drank enormous amounts of absinthe.”2
Artemisia absinthium and Artemisia cina both cause yellow vision!
c CHANGE FROM LIGHT TO DARK
• Sight suddenly confused as when one passes from darkness into a bright light.
• Cannot look steadily at a bright object.
• “Without any general disturbance, there occurred on 2nd day a very slight flickering before l. eye, but therewith he was unable to recognise a distinct conformation in the distribution of light and shade. It was as if at each glance the crystalline lens trembled, and thereby altered refraction, producing transient breaking up of lights and shadows on objects. Next day flickering was more noticeable, and not only on winking, but as often as he looked from a light to a dark portion of the field of vision; this led him to suppose it not a mechanical movement, as he was at first disposed to think, but one more due to the sudden change from light to shade. He now directed his eye to the bright sky, and suddenly covered it, without closing eye or moving it in the least, with the flat hand, when flickering was noticed quite as distinctly as before. On succeeding day this condition also occurred in r. eye; repeated observation sharpened the vision, and he was able to discern a definite conformation; there seemed to be in the middle of visual field an alternately disappearing and reappearing roundish spot of dim light, and about this concentrically several waves of light and shade in similar motion. This flickering continued for 7 days after taking drug; but at last intermitted, appearing [for short time only] when going into room from open air, after moderate exercise, or after going upstairs.” [Hughes]
P Nausea [faint sinking sensation at pit of stomach].
And Sensitiveness to smell of food.
Nausea not > vomiting.
Pain at root of nose after vomiting.
[Illustrative case of severe nausea and vomiting of pregnancy in Hom. Links 4/98.]
P Heart problems and epistaxis.
Heaviness head > epistaxis.
[1] Imhäuser, Migräne und Digitalis; Zeitschrift für Klass. Hom., 5/1984. [2] Barnaby Conrad III, Absinthe: History in a Bottle.
Rubrics
Mind
Desires activity [1]. Anxiety, evening, in the twilight [1], from music [1], from pressure on chest [2], > weeping [1]. Delusions, he is light [1], conversing with absent people [1], he has done wrong [1]. Excitement, stammers when talking to strangers [1]. Fear, of lightning [1], of reproaches [1], > weeping [1]. Desire for mental exertion, at night [1]. Talking, with absent persons, at night [1/1]. Weeping, > [2].
Vertigo
Accompanied by headache [1I]. Looking steadily > [2]; looking upward < [1]. Head Pain, accompanied by nausea [1I], by vomiting [1I]; from cold drinks [1], > epistaxis [1]; forehead, > lying on back [1].
Eye
Pain, pressing, as from a finger [1H]; outward, during headache [1I].
Vision
Objects seem brighter [1]. Colours, black, during headache [1I]; white, during headache [1I]. Diplopia, on turning eyes to right [1; Caust.]. Flickering, on entering a house [1/1], during headache [1I], with vertigo [1]. Hemiopia, upper half lost [2], while walking [1/1]. Lost, by light, after entering from dark [1/1]. Objects seem covered with snow, in morning on waking [1/1].
Ear
Noises, crashing, at night, on falling asleep [2; Zinc.]. Stopped sensation, < excitement [1/1]. Nose Smell, acute, sensitive to odour of cooking food [2]. Stomach Sensation of fulness, at sight or smell of food [1/1]. Nausea, at night, after lying down [1], after copious urination [1/1]. Sinking sensation, after bad news [2/1]. Vomiting, sudden, while eating [1; Ferr.]. Bladder Sensation of fulness, after urination [3]. Urging to urinate, during headache [1I], > lying on back [1/1]. Urination, frequent, during headache [1I].
Respiration
Difficult, from coffee [1], > lying on back [1; Cact.], wants doors and windows open [2], during pain in heart [1], when talking [1/1].
Chest
Sensation as if heart had ceased to beat [3], would cease [1].
Limbs
Sensation of vibration, upper limbs [1].
Sleep
Feeling of suffocation on falling asleep [2]. Position, on back with left arm over head [1/1], can lie only on back [1]. Waking, from sneezing [1].
Dreams
Falling, from a height [2], into water [2]. Unsuccessful efforts [1].
Chill
Chilliness, during headache [1I].
Perspiration
Profuse, with relief of heart symptoms [1/1].
Skin
Itching, of suffering parts [1/1]. Swollen sensation [1].
Generals
Flushes of heat, after coition [2], followed by weakness [1]. Sensation as if blood stagnated [1].
* Repertory additions: H = Hughes; I = Imhäuser.
Food
Aversion: [1]: Food, sight of; food, smell of.
Desire: [3]: Bitter food. [2]: Bitter drinks. [1]: Beer; cold drinks; sour.
Worse: [2]: Cold drinks; cold food; food, smell of; sausages, smell of. [1]: Coffee; ice cream [= headache].
Better: [1]: Tea.