The recently dried root and fruit of Phytolacca decandra, Linné (Nat. Ord. Phytolaccaceae). North America, along roadsides and fences, and in clearings and uncultivated fields; grows also in northern Africa, southern Europe, China, the Azores, and Sandwich Islands. Dose, 1 to 20 grains.
Common Names: Poke, Poke-root, Poke Weed, Garget, etc.
Principal Constituents.—Root: A remarkably large amount of potassium, a body closely resembling saponin, and the alkaloid phytolaccine. Berries: A purplish-red powder (the coloring body), indifferent phytolaccin, and phytolaccic acid.
Preparations.—1. Specific Medicine Phytolacca. (Prepared from the root.) Dose, 1 to 20 drops. (Usual form of administration: Rx Specific Medicine Phytolacca, 10-30 drops; Water, enough to make 4 fluidounce. Mix. Sig.: One teaspoonful every one, two or three hours.
2. Tinctura Phytolaccae Recentium, Green Tincture of Phytolacca. (Fresh, recently dried root, 8 ounces (This should read: Fresh root, 8 ounces [the customary definition of "Green Tincture"]...MM); Alcohol (76 per cent), 16 fluidounces.) Dose, 1 to 30 drops.
Specific Indications.—Pallid mucous tissues with ulceration; sore mouth, with small blisters on buccal mucous surfaces and tongue; sore lips, pallid and with separated epidermis; fauces full and mucous surfaces pallid, sometimes livid, with swollen tonsils and whitish or ashen-gray tenacious exudate; aphthae; imperfect glandular secretion; faucial, tonsillar or pharyngeal ulceration; secretions of mouth impart a white glaze over mucous membranes and tongue; white pultaceous sloughs at angles of mouth or lining the cheeks; hard painful glandular enlargements; pallid sore throat with cough and difficult respiration; mastitis; orchitis; parotitis; soreness and swelling of mammary glands; diphtheroidal sore throat; and fatty degeneration .
Action.—Physiologically, phytolacca acts upon the skin, the glandular structures, especially those of the mouth, throat, sexual system, and very markedly upon the mammary glands; also upon the fibrous and serous tissues, and mucous membranes of the digestive and urinary tracts. It is principally eliminated by the kidneys. Applied to the skin, either in the form of juice, strong decoction, or poultice of the root, it produces an erythematous, sometimes pustular, eruption. The powdered root when inhaled is very irritating to the respiratory passages, and often produces a severe coryza, with headache and prostration, pain in chest, back, and abdomen, conjunctival injection and ocular irritation, and occasionally causes violent emeto-catharsis. Upon the gastro-intestinal tract doses of from 10 to 30 grains of it act as an emetic and drastic cathartic, producing nausea which comes on slowly, amounting almost to anguish, finally after an hour or so resulting in emesis. It then continues to act upon the bowels, the purging being prolonged for a considerable length of time. It is seldom used for emeto-cathartic purposes, on account of its tardy action, which, when established, continues for some time. It rarely causes cramps or pain. Large doses produce powerful emeto-catharsis, with loss of muscular power -occasionally spasmodic action takes place, and frequently a tingling or prickling sensation over the whole surface. Dimness of vision, diplopia, vertigo, and drowsiness are occasioned by large doses not sufficient to produce death. Phytolacca slows the heart's action, reduces the force of the pulse, and lessens the respiratory movements. It is a paralyzer of the spinal cord, acting principally on the medulla. In poisoning by this agent tetanic convulsions may ensue. Death results from carbonic acid poisoning, the result of respiratory paralysis.
The treatment of poisoning by phytolacca is that of gastro-enteritis.
Therapy.—External. A poultice of poke root has given relief to felons and mammary inflammation. If used early resolution may take place; if suppuration occurs it will hasten that process. Locke advised the specific medicine with glycerin (2 fluidrachms to 1 fluidounce) for external use in mammitis. The same preparation occasionally heals sore nipples, and an ointment has been used successfully in scaly forms of eczema, in glandular engorgement, and may give relief in some cases of hemorrhoids, and in goitre. In most instances its local use should be accompanied by its internal exhibition.
Internal. Medicines which act directly upon the glandular structures are not numerous. Among those that do so act, none is more direct than phytolacca. Phytolacca belongs to that class of remedies which is denominated alteratives. Whether such terms as the latter are justifiable in the light of present-day progress may be open to question. The experience of many years with phytolacca with success in what has been understood to be alterative effects, is a matter of Eclectic record. That it powerfully impresses the glands of the skin, lymphatic system, buccal, faucial, nasal, and sexual systems, and particularly the tonsils, ovaries, testicles, and mammary glands, we are well satisfied. The periosteal and other fibrous tissues are also acted upon by it, and there is no doubt but that it has more or less influence over the deposition of fats, its favorable action in fatty degeneration of the heart entitling it to consideration.
Phytolacca is pre-eminently a remedy for swollen or engorged glands and adenitis. It is of undeniable value in conditions which might be conveniently classed as the dyscrasias-scrofulous, syphilitic, and rheumatic. It is not a direct antisyphilitic in the sense that it will destroy treponema, but for the train of ills due to the ravages of that disease as shown in the glandular and skin involvement it is among the most useful of drugs. When ulcerations result from the same cause it is particularly effective. It has long been used in various mixtures designed as antisyphilitics, which are, of course, but general alteratives. In those vague conditions, with pain and swellings at the joints, probably arthritic, and associated with swellings of the lymph glands, passing current under the elastic name of chronic rheumatism, phytolacca has acted most satisfactorily. It is, however, of little or no value in acute articular rheumatism.
Without phytolacca we should be at a loss to know how to treat glandular affections undergoing swelling or inflammation. Its most direct indication is hard, painful enlargement of the glands with associated pallid mucous membranes. It is not so direct a remedy for suppurating glands. It is of signal value in mumps, and inflammation of cervical, axillary, and inguinal glands, when not due to tuberculosis. Even then its influence is often shown by its power to reduce the glands more or less, but exceedingly slowly; while in those enlargements due to syphilis its effects are more prompt and decided. Its beneficial control over tonsillitis and swelling of the submaxillary glands is well known. In acute mastitis phytolacca is by far our best remedy, and its action is hastened by its conjoint administration with aconite and bryonia. This treatment, with mechanical support, gentle withdrawal of the milk, if possible, or sometimes strapping of the gland with adhesive plaster may avert suppuration. After surgical measures for the liberation of pus the use of phytolacca should be continued to reduce any remaining engorgement of the organ. Sore nipples and mammary tenderness, and morbid sensitiveness of the breasts during menstruation are relieved by phytolacca, and it is decidedly useful in the mammary swelling which sometimes occurs in infants.
Though its action upon the reproductive glands is less decided than upon other specialized glands and upon the lymphatic nodes, it is not without value sometimes in orchitis and ovaritis. It is most effectual in the former when the inflammation is occasioned by the metastasis of mumps. Phytolacca has aided in the reduction of goitre, but ordinarily it is little to be relied upon for that purpose; iris is more effective, and that fails far oftener than it succeeds, except in the soft varieties.
Phytolacca is important in dermatological practice. It destroys the "itch" insect, consequently it is of value in scabies, though it is by no means as effectual as sulphur. The condition which calls for it internally in skin diseases is one of indolent action of the skin, usually associated with vitiated blood and hard glandular enlargements. There may be scaly, vesicular, pustular, or tuberculous eruptions, and lymphatic enlargements with pain. The skin may be inflamed, but does not itch because there is not activity enough in the part. It is often indicated in chronic eczema, syphilitic eruptions, psoriasis, tinea capitis, favus, and varicose and other ulcers of the leg. Associated with iris, it is a valuable agent in fissures, boils, carbuncles, dermal abscesses, and ulcerations of the outlets of the body. For skin diseases it should be employed internally and locally. Rx Specific Medicine Phytolacca, 1/2 fluidrachm; Water, 4 fluidounces. Sig.: Teaspoonful every three hours. Locally: Rx Specific Medicine Phytolacca, 2 fluidrachms; Glycerin, 1 fluidounce. Mix. Apply.
Phytolacca is useful in acute and chronic mucous affections, as in tracheitis, laryngitis, chronic catarrh, and especially in those affections where there is a tendency to the formation of false membrane. There is a pallid, somewhat leaden-colored tongue, with but little coating, being a slick, glutinous coat, if covered at all. The mucous membranes present whitish erosions, or vesicular patches. With these conditions it may be employed in follicular tonsillitis, follicular pharyngitis, stomatitis, aphthae, nursing sore mouth, or ordinary sore mouth, and syphilitic faucial ulcerations. It should be taken internally and used locally as a wash. It is one of our most valuable agents in sore throats resembling diphtheria, but is not curative in genuine diphtheria showing the presence of the Klebs-Leoffler bacillus. It may be and should be used conjointly with antidiphtheritic measures, however, to stimulate the mucous membranes, promote glandular activity and assist in loosening the membrane. Phytolacca acquired a reputation at one time as a positive remedy for diphtheria. That was before the presence of the bacillus was determinable by laboratory methods. It is largely possible that many border-line cases were then called diphtheria, as some streptococcic inflammations are now until bacteriological investigations prove otherwise. Even in true malignant types its use was an improvement over old-time treatment and the claims of those who advocated it for diphtheria were reasonably just. But time has clarified the situation, and now we use it as a valuable auxiliary remedy for sore throat with exudation.
Phytolacca has been suggested to prevent and to cure gastric ulcer, and the suggestion seems fairly reasonable provided the general specific indications are observed, and the case is one long preceded by debility and catarrhal hypersecretion. It has relieved headache due to gastric acidity. Its usefulness in nephritis with the voiding of albuminous urine is open to question, if not exceedingly doubtful, and the reputation of an extract of the juice of the berries for the reduction of obesity has not been sustained. Single results from the use of any remedy in any of the difficultly curable diseases do not justify the too common practice of asserting its wholesale utility for such disorders. We prefer a tincture prepared from the freshly dried root for internal administration.
The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.