Revisiting the 'Acute' Remedies through differential world of MM
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Sep / Oct VOL VI NO 5.
Dr Ajit Kulkarni
'Acon / Bell / Ars

The study of remedies through comparison can not be underestimated. 'Similimum' has to be fished out through discrimination. Apparently many remedies appear similar and they need to be differentiated at large. This is true not only in acute cases but also in chronic cases. Acute cases demand a quick action of right order and the comparative study becomes imperative to unlock a case.

Three frequently indicated 'acute' remedies - Aconite, Belladonna and Arsenic-alb with their distinct energy patterns are discussed through a differential world of Materia Medica.

Aconite: The Storm
We begin with Aconite, a storm remedy indicated in the first stage, first few hours, first stage of inflammation. The episode occurs suddenly, becomes fierce and goes to the peak where certain characters are thrown on the screen. The mind: with fear - fright - anxiety state accompanied with restlessness and a high degree of panic comes into the play very strongly and quickly. The mind is almost paralyzed with fear. Bell and Ars need to be differentiated from Aco as they share the 'storm' but there are distinct differences.

Aconite and Bell: The Stormy Cognates
Acon is like Bell but without its raving, grizzling, grumpiness, violent temper and excitability. Retrospectively, Bell is like Aco but without its anxiety, restlessness and fear of death. Both represent the overwhelming state where the patient may become critically ill in a few hours but they differ at the level of presentation.

Both act on circulatory system. Aco acts here through two ways.

1. Congestive erethism manifested in flushing of face, hard and rapid pulse etc.
2. Febrile erethism preceding a general inflammatory stage without specific localization.

Few more characteristics of Aco are:

1. Sudden hyperthermia, which often starts off with bouts of shivering.
2. Red, dry skin without perspiration.
3. Intense thirst for large quantities of cold water.
4. One cheek red, the other pale.

In Bell too we get a congestive erethism. It is due to two alkaloids - hyoscyamine and atropine. In Aco it is due to a toxic alkaloid Aconitine. Both have redness and dryness, but Bell has them more intense than Aco. Hot perspiration accompanies the condition in Bell while absence of perspiration typifies Aco. Onset of perspiration relieves Aco but not Bell. Bell's redness is brighter than Aco in view of dilatation / hyperemia caused by Atropine. Aco has heat of the whole body while Bell may be hot centrally, but cold peripherally. Hyperpyrexic states are often accompanied by offensive foot sweat in Aco too but not a feature of Bell. Thirstlessness is a strong feature of Bell, though Bell desires lemon drinks while Aco desires bitter drinks. Aco is worse at 11pm, Bell at 3 pm.

Sensitivity Pattern
All senses are heightened and easily aggravated in Bell and Aco. Bell has acute senses; he is hyperesthesic, hypersensitive to sensory stimuli like light, noise, touch, jolts, sun, cold air etc and > rest, Aco not > with rest and is restless even while resting, all food, even drink tastes bitter except water while Bell has a bad taste and offensive breath.

Sensitivity pattern in Bell is more at CNS level, disrupted nervous system accompanied by mental disturbances, delirious state which is different from Aco. It is the tubercular miasmatic activity which develops heightened sensitivity and susceptibility bringing all sense organs into play. Hence ample stimuli and expressions!

Family Characteristics
Bell comes from the Solanaceae family which also includes Hyos, Stram, Dulc, Capsicum, Tabacum etc. Central theme of Solanaceae family is affinity for head / brain which becomes the target. Headache accompanies Bell symptoms most frequently. This can be functional or organic. Bell pathogenesis ranges from simple headache to migraine, from a mere congestion to violent inflammatory pathology viz meningitis, encephalitis etc. The erethistic action on brain induces commotion, spasms, tremors and convulsions.

Aco is a member of the Ranunculaceae family which also includes Hell, Ran-bulb, Puls, Cimicifuga, and Staph etc. Core features of this family are shock, excitement, distress, suddenness, panic and painfulness.

Qualitative difference between the two families will make the indications clear.

Pains Aco has acute, sudden, unbearable pains that alternate with feelings of either numbness or 'pins and needles.' Bell has throbbing, pulsating, burning and bursting type of pains. Both have abruptly beginning and abruptly ending pains. A strong feel of heat and redness accompany pains in both, but Bell is more intense.

Overlapping And Recognition
Aco and Bell are similar to a great extent, making the choice difficult. Study of body language will help to differentiate. Aco patient will approach a physician with anxious and panicky face; agitated and restless; impatient and tossing. Bell will approach with anger and irritability; the eyes will be fierce and dilated. Language used by Bell may be abusive, because all senses are heightened, they cannot tolerate sensory inputs and are intolerable to others.

Bell follows Aco when the shift has occurred from anxiety  fear  panic  restlessness to anger  irritability  violence. Physically once the sweating has begun after Aco, it is better to switch over to Bell. Aco goes for more general / systemic reaction while Bell accentuates on early localization.

Look for different remedy If
Aconite

·         The symptoms are not sudden

·         The symptoms are not intense

·         There is a lingering state

·         The patient is quiet and relaxed

·         Not averse to touch

Belladonna

·         Slow onset

·         The symptoms are not intense

·         Ongoing, chronic condition

·         Fear of death

·         Calm with quiet mental state

Aconite And Arsenic-alb: The Tossing Cognates
Ars shares suddenness, fear-fright-anxiety-restlessness and acuity with Aco. Both have a strong fear of death but Ars does not predict the time of death. Aco predicts the time of death as he views the situation as that of shock. The overwhelming state produces a severe panicky reaction - convinced that he is going to die at a certain time, This may be due to panic. It is a short but intense reaction of the mind. Ars does have fear of death but it comprehends the seriousness of the disease. Once the 'storm' is over, Aco may assume the 'peace' baseline. Ars anxiety is much deeper coupled with restlessness and prostration. Restlessness of Ars comes in later stages when the patient loses strength out of prostration while restlessness of Aco comes in early stages. Ars is insecure which he tries to seek outside. In comparison to Aco, Ars is dictatorial, has controlling nature, is more critical and fretful, drives everyone crazy making them dance to his orders.

Physical Differentiation
Prostration
Physically Ars has much more prostration than Aco and this is definitely out of proportion to the morbid condition. This is due to the fact that Ars is prepared from Arsenious-acid. Acid element is reflected through more damage, deeper layers affection, more destruction, more acidity, more burning, more fetidness, hemorrhagic diathesis and the system in the grip of overwhelming state. Obviously Ars pathology is deeper due to strong miasmatic activity. With prostration there is desire to move or be moved constantly. Exhausted from slightest exertion which is not felt while lying still.

Thirst
Aco has intense thirst for large quantities of cold water while Ars for frequently repeated small amounts of water. Ars is also listed three marks in the Rep for ‘thirst for large quantities of water. However it longs for hot water that gives relief.

Typology
Ars is lean, weak and cachectic due to acid element. Aco is robust, plethoric and of sedentary habits. Ars is listed under plethoric subjects too. Ars appears pale and as if suffering horribly.

Look for different remedy If
Arsenic-alb

·         Calm, quiet and relaxed patient

·         Suffering without complaints

·         Thirstlessness

·         Passive picture of illness

·         Desire and tolerance for cold drinks

Exclusiveness
It is only Ars which is fastidious, which has dreams of sadness, of dead people and of embarrassment. It is only Aco, which has clairvoyant dreams and sustains shock due to fright as a cause. Biting in children is exclusive to Bell while avarice is exclusive to Ars and worse from music is exclusive to Aco.

Conclusion
An attempt has been made to differentiate between frequently indicated acute remedies like Aco, Bell and Ars from Clinico-pathological, miasmatic, non-verbal communication and conceptual angles than merely symptom based.

Chart demonstrating characters of Aconite, Belladonna and Arsenic. #

# This is a general chart from differentiating point of view. Individual remedy response may vary.