Apocynum Cannabinum.

Botanical name: 

The root of Apocynum cannabinum, Linné (Nat. Ord. Apocynaceae) gathered in autumn after the leaves and fruit have matured. Grows throughout the United States. Dose, 1 to 20 grains.
Common Names: Bitter Root, Canadian Hemp, and improperly, Indian Hemp.

Principal Constituents.—A resinous principle—apocynin, and a yellow glucoside, apocynein; and apocynamarin, or cynotoxin, or cymarin, all of which resemble digitalis glucosides in action.
Preparations.—1. Specific Medicine Apocynum. Dose, 1/4 to 20 drops. Usual form of administration: Rx Specific Medicine Apocynum, 10 drops to 1 fluidrachm; Water, four ounces; Mix. Sig. One teaspoonful every 1 to 3 hours.
2. Decoctum Apocyni, Decoction of Apocynum (root 1 ounce to Water, 16 ounces). Dose, 1 to 2 fluidrachms.

Specific Indications.—Watery infiltration of cellular tissue—edema—with weak circulation and general debility; skin blanched, full, smooth, and easily indented; puffiness under the eyes; eyelids wrinkled, as if parts had been recently swollen; feet full and edematous, pitting upon pressure; constipation, with edema; urine scanty and circulation sluggish; boggy, watery uterus; full relaxed uterus with watery discharge; profuse menorrhagia, too often and too long continued; passive hemorrhages, small in amount and associated with pedal edema; mitral and tricuspid regurgitation, with rapid and weak heart action, low arterial tension, difficult breathing, cough, and tendency to cyanosis.

Action.—Apocynum acts powerfully upon the heart, slowing its action and raising arterial tension. The cardiac muscle appears to be directly stimulated by it as are probably the arterial coats. Contraction of the renal arteries also takes place, so that while less blood passes at a time through the kidneys, the act of filtration is more perfect and marked diuresis results. Though long known that diuresis was one of its most prominent results, the knowledge that this is due to the better cardiac pressure and arterial tonus, rather than to the increased intrinsic secreting power of the renal glomeruli, is the result of pharmacologic investigation in recent years, particularly the work of Horatio C. Wood, Jr. The general effects upon man of full doses of apocynum are nausea, and sometimes vomiting and purging, succeeded by copious sweating. The pulse is then depressed, and in some a disposition to drowsiness is observed until relieved by vomiting. The powdered drug causes sneezing. The small doses employed in Eclectic therapeutics seldom occasion any of the above-named symptoms save that of severe watery purging, which may occur suddenly, when the drug has been administered persistently for several weeks.

Therapy.—No remedy in the Eclectic materia medica acts with greater certainty than does apocynum. In former times it was employed in heroic doses chiefly for its hydragogue cathartic and diuretic effects. Early in the last century it was employed by the botanic practitioners for the relief of dropsy. Later the Eclectic school developed its specific uses in dropsy and affections of the heart and circulation. Like many similar drugs, the powder was employed as a sternutatory in the days when it was believed that such effects as the increasing of the nasal discharges was the best way to relieve headaches and certain catarrhal affections. Again, it was recommended in diaphoretic doses, for the relief of intermittent and remittent fevers, and in pneumonic involvements, conditions in which it is now seldom or never thought of. It is rarely employed nowadays as a cathartic, and then only in dropsical conditions, as other hydragogues have been similarly used. Such is the use of it advocated by the authors of the regular school of medicine, by those who use it at all; and from such a use arises the criticisms frequently indulged in condemnation of the drug. Eclectics do not use it in this manner. Specific medication has established that this action is not necessary, for when specifically indicated it promptly removes effusions without resorting to cathartic doses. Consequently it finds little use as a cathartic, except very rarely as recommended by Goss, for the removal of ascarides.

To use apocynum intelligently and successfully, the prescriber must recognize, first, that debility is the condition in which it exerts its specific and beneficial effects—debility of the heart and circulatory apparatus, of the kidneys, of the capillaries of the skin particularly. In such a state it will prove a remedy; under opposite conditions it is likely to prove an aggravation. The patient with a strong, rope-like, hard, and quick pulse is not the patient for apocynum. On the other hand, the feeble pulse, soft and of little force, indicates its selection as the remedial agent. The atonic state which readily permits of exudation from the blood vessels is the ideal condition which we seek to remedy with apocynum. It is a vascular stimulant. Such results one would not expect to obtain if there were circulatory obstruction or active fever. The only apparent exception, in which it is adapted to active conditions, is that reported by Webster of its efficacy in active inflammation of the upper pharyngeal and post-nasal tract, where, he declares, it rivals phytolacca in its results. One can not expect apocynum to reconstruct worn-out tissues or to restore damaged vascular valves. We must not hope to work miracles with it where there are such structural lesions as incurable or malignant organic diseases of the heart, liver, or kidneys. Yet in these conditions, when debility and subcutaneous, watery exudation are strong factors, it alone is a powerful remedy to relieve urgent symptoms and to put into action that portion of sound tissue that remains. The most we can hope for is an amelioration of the symptoms, and a notable decrease of the watery accumulation may be looked for. Under these circumstances we have removed enormous dropsical swellings with it, giving quick relief from dyspnea and thereby allowing the patient to obtain rest in the recumbent position. Still it did not cure, and in many such instances death mercifully removes the victim before extensive infiltration can again take place. Digitalis, cactus, strophanthus, and convallaria often aid its action. It is a singular circumstance, mentioned by Krausi, and which we have also observed, that apocynum seldom has any effect upon patients who have been subjected to paracentesis. In our opinion this is due to the advanced stage of the disease, usually reached by the time it is necessary to tap; for tapping is seldom regarded a curative measure, and is resorted to in the later stages of ascites to give temporary relief. It is then too late for any drug to gain a satisfactory foothold. Moreover, apocynum is less effective in ascites than in edema or anasarca, for the latter is most likely to depend upon circulatory failure, whereas the former may depend most largely upon malignant or obstructing tumors.

The chief indication for apocynum is watery fullness of tissues as if infiltrated and accompanied by debility. This may be shown in the puffy eyelids, the swollen feet and ankles or other parts, which pit upon pressure. The skin is usually blanched, sometimes streaked with pinkish lines, full, smooth, and glistening. If the case be chronic or subacute, the more active the drug appears. With these conditions it may confidently be relied upon to cure curable cases or to give relief in incurable maladies, whether they are revealed in simple edema or anasarca, ascites, or dropsy of any of the serous cavities, or dropsy following scarlatina or malarial poisoning. In both of the latter conditions it is unusually effective. When such accumulations, functional in origin and due chiefly to vascular weakness, accompany atonic stomach and bowel disorders, as gastric and intestinal dyspepsia, and in syphilis, it is a signally useful drug. In rheumatism, arthritis, and sciatica, with edema, or even if but slight puffiness of the part be present, it renders valuable aid to antirheumatics or other appropriate remedies. Acute and chronic hydrocephalus, with spreading sutures, protruding fontanelles, and puffy eyelids, have yielded to the curative action of apocynum. It has been recommended in cerebro-spinal meningitis during the stage of effusion. In watery leucorrhoea, passive menorrhagia, irritable and congested uterus, prolapsus uteri, uterine subinvolution, and in some cases of amenorrhoea, in all of which debility is marked and the pelvic tissues are heavy, lax, and sodden, and there is slight infiltration about the ankles, apocynum has cured when remedies ordinarily directed in gynecological practice have failed to relieve. For the renal congestion of the second stage of tubular nephritis Gere found it to be the best remedy. Others assert its usefulness in the nephritis of pregnancy with albumen in the urine. Our experience with apocynum leads us to believe it less valuable in dropsies with albumen waste than in those without it but dependent most largely upon circulatory embarrassment.

Apocynum is of very great value in diseases of the heart and circulation—a fact recognized and acted upon in Eclectic therapy years ago. Its action in giving tone to the heart muscle and vessels, and its use in cardiac disorders, was the subject of comment by Scudder, Locke, Ellingwood, Freeman, Waterhouse, Webster, and others. Angina pectoris, attended with edema, and praecordial oppression of smokers, are relieved by it. Krausi calls attention to its utility in mitral regurgitation, and speaks of it as the king of remedies in tricuspid regurgitation, with rapid and feeble cardiac action, low arterial tension, cough, dyspnea, pulsating jugulars, general cyanosis, scanty and high-colored urine, and general dropsy. He also refers to it as giving no special aid in aortic diseases.

The observation made by Krausi that apocynum increases secretion and excretion by way of the kidneys, whereas digitalis, after twenty-four hours, causes a retention of urea, is an important one, and should not be lost sight of. This ought to make it a valuable agent in uraemia and conditions depending upon faulty elimination of that body. Within a few years the internal and the hypodermatic use of apocynum directly upon the nerve is said to have promptly relieved sciatic neuritis.

The observations of a single reporter on the use of the first dilution of apocynum in not over one-drop doses every two hours as a remedy for obesity, is worthy of consideration and seems rational as the classic indications are noted. However, one must not be too optimistic concerning the power of a medicine to reduce fat, nor must anasarca be mistaken for obesity. In these cases the pulse lacks strength, though it is rapid; the temperature is inclined to subnormal in the morning and slightly above normal in the evening; the tongue has a dirty-white coating; the appetite is poor, the abdomen full and doughy to the touch; and there are gaseous eructations from the stomach and expulsion of flatus from the bowels. Occasionally there are night-sweats, and the ever-present indication for apocynum, edema of the extremities, is constant.

The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.