Aconite. Aconitum napellus.
- Aconitine, amorphous and crystalline; Pseudo-Aconitine, Aconine, Pseudo-Aconine, Picraconitine, Aconitic Acid, Sugar, Fat and Resin.
- Extractum Aconiti Radicis Fluidum, Fluid Extract of Aconite Root. Dose, one minim.
- Tinctura Aconiti Radicis, Tincture of Aconite Root. Dose, from one to ten minims.
- Specific Medicine Aconite. Dose, from one-twentieth to one-half minim.
- Aconitine Crystalline. Dose, one five hundredth of a grain.
- Aconitine Amorphous. Dose, one one-hundred and thirty-fourth of a grain.
Physiological Action—In a moderate dose of five minims of the tincture, a sense of numbness and tingling is felt in the tongue and lips, with muscular weakness and depression; by doubling the dose these symptoms are intensified and prolonged, the pulse falls and the breathing is slowed. A poisonous dose causes tingling in the skin, pain in the joints, vertigo, dimness of vision, extreme debility, pulse forty to fifty per minute and irregular, skin cool and moist, burning heat in the esophagus and stomach, nausea, vomiting and purging. There may be severe gastric and intestinal spasms, headache, complete loss of sight, hearing and speech, while consciousness remains; pupils dilated. muscles tremulous or convulsed, pulse imperceptible; death by syncope.
Aconite acts on the vaso-motor nervous system. It is a powerful depressant of the heart, and if given in sufficient quantity will paralyze that organ. Its apparent influence is upon the terminal filaments of the sensory nerves first, and afterwards, more slowly, upon the nerve trunks. It depresses the nerve centers of the cord, and destroys reflex activity and voluntary power.
A drop of a solution of aconite in the eye causes the pupil to contract. Larger amounts induce toxic symptoms, the principal of which are increase of tingling and numbness, excessive perspiration, rapidly lowering temperature, pupillary dilation, dimness of sight, loss of hearing and sense of touch, and diminished action of the sensory filaments supplying the skin.
Muscular weakness is marked; trembling and occasional convulsions may ensue. Excessive depression comes on, and the power of standing is early lost. The feet and legs become. cold, the face pale, and the patient has a tendency to faint. There may be violent burning in the stomach with great thirst and dyspagia, and vomiting and diarrhea may occur. The pulse is weak, rapid, and almost imperceptible; acute, lancinating pain may be felt, and more or less delirium may result, though as a rule the intellect remains unimpaired.
"The manner in which aconite affects the nervous system is not yet definitely known. That it is a heart paralyzer seems to be an accepted fact. Death may result from syncope, though usually it occurs from respiratory paralysis. The action of a lethal dose is rapid, toxic symptoms showing themselves within a few moments." (Lloyd and Felter.)
Administration—In my earlier teachings of the action of this agent, I taught that it was a remedy for sthenic fevers only. I have since been convinced that its influence in very small and frequently repeated doses, greatly broadens its application. Homeopathic physicians class it as one of the most important agents and their dosage is always minute. In such dosage, with small, feeble, frequent or corded pulse, in adynamic or asthenic fevers, it may be given with excellent advantage.
It restores normal conditions, so strengthening the action of the heart as to even bring a subnormal temperature, in some such cases as in cholera and malignant intermittents up to the normal point. It acts in harmony with belladonna in equalizing the circulation, lessening determination of blood, increasing arterial tension and greatly improving the capillary circulation.
In sthenic fevers it may be given in larger doses, with a view to producing results which are in line with its physiological action. It is contraindicated in that dosage, however, when the sthenic stage is passed. It should be given, if at all, in very small doses. One drop of the specific medicine in a four ounce mixture, a teaspoonful every half hour or hour, will sometimes produce the best results in patients under twelve years of age. In the sthenic stage five drops of the specific or fifteen drops of the U. S. P. Tincture in a four ounce mixture, to be given in dram doses hourly, is usually required.
So common is the use of aconite in fevers that all practitioners with experience recognize the indications. One physician suggests that in intestinal fevers the results are not so satisfactory, because of the fact that intestinal toxemia is so persistent. If the intestinal tract can be thoroughly cleansed and the toxemic influences removed, then the remedy acts as in other fevers. The same is true of septicemia from local causes.
Specific Symptomatology—When the pulse is small, hard, quick and sharp, the skin dry and hot, the secretions suddenly suppressed, the temperature rising, chilliness up and down the spinal column, a shivering when the bed coverings are moved, or from a slight draft, or on the least exposure, the agent is directly indicated.
It is also indicated when the pulse is full and hard and sharp, with suppressed secretions in the initial stages of acute inflammation of any organ, and at the onset of protracted fevers and especially of exanthematous diseases.
In asthenic fevers, which are usually protracted, the pulse small, feeble, frequent, sometimes wiry and corded, with or without evidences of impairment of the capillary circulation, the agent is specifically demanded, but in small dosage. With these phenomena, its use may often be continued for a few days, then discontinued to be resumed later as before, if needed.
In the early stages of local inflammatory disorders, which involve the mucous membranes, where the secretions of these membranes are perverted or suppressed, the agent in small doses is indicated. This condition is found in laryngitis, tonsillitis and bronchitis, also in gastritis, colitis, or enteritis, and especially in cholera infantum.
Therapy—Aconite has become the greatest of the agents used by the profession in the control of fever; but its indication must be complied with.
At the onset of fever Aconite is the remedy. At that stage of the disease when the evidences of some disorder are apparent, and yet its localization can not be determined, the indications for treatment pronounced, why should the physician wait until a group of symptoms appears that has a name—that is known as disease—when the indications for one remedy are so conspicuous? We have known of many cases where all the evidences of approaching inflammation were plainly apparent, where the initial fever has been promptly met with Aconite and no inflammatory condition has ever developed. It is the experience of all physicians.
Aconite is specifically the fever remedy in childhood. Infants are susceptible to minute doses often repeated, and it is kind and soothing in its action. Five drops of the tincture to four ounces of water given in teaspoonful doses every hour is the usual maximum dose for a child one year of age. Because of its prompt action and ready elimination the doses must be given frequently.
In severe fevers, it is better to give one half teaspoonful every half hour. As soon as the sedative influence is apparent, the skin becomes moistened, the restlessness abates and the temperature falls, the doses must be reduced in size or in frequency until no longer indicated. Simple fevers will abate in from four to twelve hours under this administration of Aconite.
Aconite promotes tone and power in the arterial capillaries, and is opposed to blood stasis. In this influence it has a powerful auxiliary in belladonna. The two agents, in small doses, work harmoniously in incipient inflammation. Their combined influence in capillary engorgement is most salutary.
At the onset of inflammation, the synthetic heart depressants will perhaps stay the fever, but their influence is not so benefically exercised upon the inflammatory processes. If inflammation is in progress they will not dissipate its results. Aconite retards pathologic exudation, suppuration, adhesion, induration and hypertrophy. This can by no means be as truly said of any other agent. Aconite certainly antagonizes inflammation or inflammatory processes and their results. It hastens resolution and promotes rapid absorption of inflammatory products.
Under the influence of this agent there is an entire change in the heart's action. The heart beats more slowly and quietly, the pulse becomes fuller and more natural, there is a general soothing effect upon the nervous centers, and the natural secretions from all the emunctories are re-established. It promotes free diaphoresis, and thus, a more rapid dissipation of heat. It is thus especially indicated when the skin is dry and hot. The mouth is no longer dry, the eyes assume a more natural appearance, and there is a large increase of the urinary secretion and the arterial tension is materially lessened. Aconite has a direct effect on the heat centers, inducing marked reduction in temperature. It is due to this influence that it is so reliable whenever there is an excess of body heat.
In acute congestion or in inflammation of the brain and spinal cord or their meninges, this agent exercises a double influence in the initial stages, but as soon as prostration or lack of power is evidenced it must be discontinued. In cerebro-spinal meningitis of infancy, with gelsemium and other antispasmodic sedatives, its influence is of prime importance. Acute discrimination must be exercised as to the limits in which it will be useful.
With the statements made, concerning the action of this remedy, it will be seen that in the diseases of children, and especially during the summer, aconite is more frequently called for perhaps, than any other one fever remedy. The fevers resulting from heat, from gastric disturbances and intestinal faults, as well also as those of nerve irritation from any cause occurring during warm weather, nearly all show the aconite indications, and consequently respond very quickly to this remedy.
Aconite has a direct influence on respiration and upon the respiratory organs. In pneumonitis its influence upon the capillary circulation is so pronounced that it is impossible to overlook its benefits. Usually for the first five days of the fever its indications are conspicuous and no remedy will take its place. If given with veratrum at this time the violence of the circulation and temperature is restrained more promptly. In bronchitis it allays irritation, restores secretion, and by its paralyzing effect on the end nerve filaments quickly soothes the irritable or inflamed condition of the mucous membrane.
In pleuritis it is the first remedy to be thought of in the initial stage. Its influence is enhanced here by the use of asclepias tuberosa, and by alternation with bryonia. The chilliness, cutting pain on respiration, sharp cough and dry skin and mucous membranes, all point directly to it; but as soon as effusion to any great extent occurs, the agent may be dropped and the other agents continued.
It is of essential value in the treatment of mucous and serous inflammations. Its influence is evidenced in a marked manner in the treatment of acute enteritis or peritonitis, local or diffused, idiopathic, traumatic or septic. In gastritis, appendicitis and hepatitis; in acute nephritis, cystitis or urethritis, specific or non-specific, it is the first indicated remedy and may be continued until asthenia appears. In acute catarrh and other similar inflammations it may be persisted in as long as the inflammation lasts.
Its influence in stomach and intestinal troubles is in part due, although to no great extent, to its local as well as its general influence. In the inflammatory stage of dysentery and cholera infantum minute doses of ipecac and aconite exercise a specific effect when the causes of the disease are removed and intestinal asepsis secured.
In the onset of diphtheria it is an essential auxiliary. In acute tonsilitis, pharyngitis or laryngitis its specific influence is conspicuous because of its local as well as its constitutional effects. Minute doses will often abort a case of croup or terminate it abruptly. Its internal administration in acute inflammation of the throat or post-nasal mucous membrane is greatly enhanced by a warm spray which contains aconite in an appreciable quantity.
In the treatment of continued or septic fevers aconite is usually indicated at the onset, but as soon as impairment of the blood, by the influence of high temperature and rapid destructive metabolism, with defective excretion of the waste products, is apparent, the agent must be discarded. The nerve force is deficient by this time and depressing agents are contra-indicated. This is especially true in typhoid conditions. The changes take place early, and the period of aconite indications is very short. Cactus grand, organic antiseptics and bryonia will produce a sedative influence, and we will find their indications conspicuous when the time for aconite has passed.
Aconite is of value in the treatment of rheumatism and rheumatic fever. In addition to its general influence upon inflammatory conditions it is a great promoter of excretion. It is combined to an advantage with cimicifuga, sodium salicylate, bryonia, or rhus tox.
In exanthematous disease aconite is doubly indicated because of its direct action upon the capillary circulation of the skin. It assists in determining the eruption to the surface and promoting exfoliation. It curbs the temperature and prevents complications and conduces, to a normal condition of the mucous surfaces, which is important where those surfaces are in danger of being involved also.
In acute mastitis, if treatment be inaugurated at once, an actual specific effect is accomplished by administering a full dose of aconite with ten drops of the tincture of phytolacca, one hour, and alternating it the next hour with aconite and ten grains of acetate of potassium. But few doses will be given until abatement of the active symptoms will be observed. The same course may be advised in prostatitis or acute orchitis with similar results. In metritis it has a prompt influence and gives excellent satisfaction.
Aconite is a remedy of prime importance in the treatment of amenorrhea when the suppression results from acute cold. It is conjoined with other measures indicated, and is prompt and satisfactory. Cimicifuga enhances its influence here, as well as Polygonum punctatum. When the secretion of the skin and mucous membrane is restored by aconite, a full dose of quinine will sometimes accomplish the desired result, when it would accomplish nothing without this agent.
Aconite is so assuredly a specific in febrile conditions that its influence in chronic diseases is almost entirely overlooked. It is in certain chronic and non-febrile conditions a very reliable remedy because of its certain action upon the nervous system. John King advised its use in treatment of non-febrile spinal irritation in young women, and the writer has followed his suggestions in this condition for years with superior results in many cases.
Its direct influence upon the cerebro-spinal system is recognized by homeopathists, Deschere says: "Aconite is useful in mental diseases and hysteria when there is particular aversion to excitement; the patients show an intolerance of music; they can bear no sounds."
Aconite is an important remedy in the treatment of affections of the heart. The symptoms indicating it in these cases are numerous and important, and necessarily so, since aconite restrains the blood flow and also exerts a special action on the heart and its nerves. There are congestions of both heart and lungs, palpitation with anxiety, cardiac oppression and even syncope. The palpitation is worse when walking, lancinating stitches occur and prevent the patient from assuming an erect posture or taking a deep inspiration. Attacks of intense pain at times extend down the left arm from the heart and are associated with numbness and tingling in the fingers.
The agent is advised by many in angina pectoris when there are strong contractions or pure hypertrophy, but not in enfeebled heart or where there is much valvular insufficiency.
In reflex vomiting without prostration or exhaustion aconite is useful. This is especially true in some cases of the vomiting of pregnancy.
In neuralgia it is of use externally as well as internally. The aconitine, in granules, is the best form for its internal administration in neuralgia. Externally the tincture may be applied.
Webster has used aconite externally for pruritus, with excellent results. Occasionally the condition returns but in most cases the cure has remained permanent. Harrington confirms Webster's observations as does Robinson, who believes that the influence is induced by a direct anesthetic effect at first, with an influence upon the nerve endings, which prevents a return of the condition. The remedy is diluted and applied according to the discretion and knowledge of the physician.
Aconite is of common use in local pain, to relieve congestion, irritation and distress. Perhaps the most immediate influence obtainable in acute pain is to pour ten drops each of chloroform and aconite into the palm of the hand and hold it over the seat of the pain for two or three minutes. The effect is instantaneous and marvelous. It may be used in this manner in acute stomach or bowel pains until the cause of the pain is removed by other measures, or in acute pleurisy, and especially in angina pectoris. The pain ends with the application, and measures can be adopted to prevent its recurrence. Any local pain or neuralgia will yield, for a time at least, and in some cases it will not return. Sciatica treated two or three times per week with this simple formula will sometimes cease to return.
We have observed that aconite intensifies, modifies and otherwise improves the action of several other agents with which it may be combined or alternated. The characteristic effects of Cimicifuga racemosa will occur in much less time with this remedy than when given alone. The influence of belladonna upon all local congestions and in equalizing general circulation is intensified in a characteristic manner when the remedy is given with, or alternated with aconite. Given in proper doses with veratrum the influence of both remedies is active. Their influence on serous inflammation is most marked. In many cases either alone will not produce the same results.
Given with gelsemium in nervous excitement, cerebral fullness, nervous twitchings and fevers which result from irritation of the nerves and nerve centers, the effects of both are heightened.
Given with asclepias tuberosa, with proper external means, hardly any other agent will be needed in acute pleuritis.
Veterinarians find aconite immensely beneficial in the treatment of the inflammatory diseases of animals; but objections arise in the treatment of disease in horses, from the fact that horses are much more susceptible to its action than man. A correspondingly smaller dose must be given, and repeated quite often.
Toxicity—Poisoning by aconite is not common. An overdose produces in the mouth and throat a tingling sensation, followed by symptoms of strangulation from paralysis of the nerve endings. The tingling becomes quickly general. This is followed by a sensation of numbness. The skin, relaxing, becomes covered with cold sweat, and finally becomes cold. The patient becomes too weak to stand, the respiration is greatly depressed and insufficient, the heart beats more feebly and the pulse may vary every few minutes in its character, but it is always weak. The temperature falls rapidly. Aconite depresses the heat centers, and, by dilating the capillaries of the skin, permits rapid heat radiation, thus at the same time, acting in a two-fold manner upon the temperature. Consequently the temperature of the surface of the body is a fairly correct criterion by which to judge of the internal temperature.
There may be vomiting, failure of the special senses from the general paralyzing effect of the agent, syncope or mild delirium and convulsions. These symptoms are not usual.
Antidotes—If a full toxic dose be taken, the above symptoms advance most rapidly, and no time whatever should be lost in combating the influence of the agent. It has no known physiological antidote. The conditions must be met according to their indications. If there is any reason for believing that the stomach contains any of the agent, large quantities of warm water should be swallowed and immediately evacuated. It may be vomited or siphoned out with a long stomach tube, or pumped out, but extreme nauseating emetics are contra-indicated. A mild infusion of oak bark, drunk freely, serves the double purpose of diluting the aconite and antidoting it by the tannin it contains. Tannic acid is believed to be a chemical antidote to a limited extent, and given in suspension in water is efficient.
The most immediately diffusible stimulants must then be given freely. Alcoholic stimulants, ammonia, capsicum in a hot infusion, and digitalis, strophanthus or atropine by hypodermic injection, or nitro- glycerine are most serviceable remedies. External heat continually and electricity are demanded. Lobelia should prove valuable. A pint of vinegar, diluted, saved one life.
The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.