Nutritional Support in Fever
By.Dr.G.Satheesh MD(Hom)

1.  Introduction

In the management of diseases diet and nutrition plays an important role. Well thought out nutritional
support is a valuable aid to any practitioner. This is particularly true about febrile cases because fever is a
common symptom of many diseases.  In fact, it is one of the early responses of our body to many harmful
agents. Also many patients with high and/or prolonged fever develop nutritional depletion, which in turn lead
to other complications. Hence dietary care plays an important role in the management of many cases of high
and prolonged fevers.

2.  Causes of nutritional depletion

Fever is produced by metabolic processes and muscular activity.  This accelerated metabolism leads to
breakdown of tissues and results in loss of calories and nutritional depletion.

Again, when you are hot, your body perspires to cool you down.  Increased perspiration result in water
and electrolyte depletion as in the cases of high fever.

2.1 Functional consequences of nutritional depletion (fig. 1)

1.  Reduced cellular or humoral responses to infection

2.  Impaired wound healing

3.  Bed sores and Ulcers

4.  Reduced haemopoiesis

5.  Muscle weakness; reduced ability to cough; susceptibility to bronchopneumonia.

6.  Dehydration-Dryness of mouth, herpes, Parotitis, oral infection

    Constipation

    Oliguria; dysuria; retention of urine.

2.2. Objectives of nutritional care

1.  Nutritional support to compensate energy loss

2.  Correction of fluid and electrolyte deficit

3.  Prevention of complications developing from the causes mentioned above

4.  To pave way for speedy recovery

3.  Principles

1.  Assess calorie and protein needs

2.  Mark out clearly the route of administration

3.  (Oral Route, Tube feeding, parenteral nutrition)

4.  Specify the frequency and rate of feeding

5.  Designate special restrictions (if any)

     (Na, Ca, K, fluid, gastric irritants, fibre, residue, gluten, fat, carbohydrate, protein, galactose, oxalate, lactose)

6.  Designate special additions (if any)

     (Fibre, vitamins, prepared nutrient supplements. etc.)

7.  Restrictions and / or additions according to the indicated Homoeopathic Medicine.

3.1 Diet

Generally diet should be easily digestible, soft and palatable.  In order to maintain a positive calorie balance,
it should provide 2500-3000 k cal / day.

3.2 Fluid intake

Unless contraindicated the fluid intake should be about 3000 ml/day - to prevent dehydration.  Fresh fruits
and fruit juices (rich source of K+ and Na+) and vegetable juices (eg- carrot juice) can be given to prevent
constipation associated ith fever.

Frequent sips of fluids and proper oral hygiene also helps to prevent herpes and Parotitis.

3.3 Caloric requirements

In hospitalized patients with prolonged febrile illness, the daily caloric requirements can be estimated
by using the Harris-Benedict equation for basal energy expenditure (BEE)
Men, k cal / day
BEE = 66 + 13.8W + 5H - 6.8A
Women, k cal / day
BEE = 665 + 9.6W + 1.8H - 4.7A
Where W = Weight in Kg, H = height in cm, and A = age in years
Average energy expenditure is 1.37 BEE - 312.  To maintain a positive caloric balance when energy expenditure
is increased as in prolonged fevers, burns, infections etc. the energy intake should be 1.5 -2 times this value.

3.4 Administration

Can be oral intake, tube feeding or parenteral.

3.4.1 Tube feeding

This is indicated in patients who are very sick and unable to take oral feeds.  Total amount of feed varies from
2000 ml to 3000 ml / day.  Each feed should not exceed 150-300 ml because rapid feeding may cause rapid
distension of stomach, nausea and regurgitation. Feeds should be at 380C. Food must be nutritious, in liquid
form containing milk, egg, cream, glucose, vegetable soup, rice water etc.

3.4.2   Parenteral nutrition

It is indicated when the patient cannot eat or deteriorate on oral feeding.  Partial or total nourishment can be
given through the parenteral route.

3.4.3 Parenteral feeding by a peripheral vein

Can be easily established for caloric and fluid support.  In order to prevent the development of phlebitis, the
concentration of glucose infusions should not exceed 10%.  Adequate total energy requirements cannot be
achieved from 10% glucose infusions alone.

3.4.4  Parenteral feeding by central nervous alimentation

Glucose infusions of higher concentration (25-35%) can be administered in this way.  It is best to give about
30% energy as intravenous fat emulsion, along with glucose, amino acids and micronutrients.

3.4.5 Total parenteral nutrition (TPN)

TPN is indicated in malnourished persons who cannot tolerate oral feedings.  In TPN all the essential nutrients
have to be given.  TPN should generally provide 2500 - 3000k cal / day.  Unless contra indicated, the total volume
administered per day should be around 3000 ml.

3.5   Restrictions and additions

Needs for special restrictions and / or additions to diet depends on diagnosis.  For eg. Protein and sodium
free diet in Hepatic coma and anemia.  High protein and high calorie diet in T.B., chronic fevers, infections and
in burns etc.

3.6   Diet and Homoeopathic Medicines

When patients are under constitutional remedies, they need caution about certain kinds of foods that are
known to disagree with their constitutional remedy.  For example a patient taking Bryonia is often made sick
from eating vegetable salads.  It is wise to caution persons under the influence of pulsatilla to avoid the use
of fatty foods, as it will upset the action of the remedy.  At the same time increase in the intake of coffee in
diet will enhance the curative action of medicines like aconite, arsenic alb and colocynth.

There is no general rule on the dietetic restrictions for all the patients.  In other words, the foods that
should be avoided tempo­rarily and that should be taken by a patient differ from one patient to another
depending up on individuality of each case as well as that of the patient.

(Dr.Kent says “In accordance with a principle and not by rule... do not have one list of foods for your
patients, do not have a list of things for everybody. There is no such thing in Homoeopathy”).

4. In acute fevers.

Apart from all this, in acute febrile conditions, plenty of fluids (as much as the patient normally can)
preferably isotonic will be the best advice. Juices of citrus fruits, tender coconut water, soups etc are all
very good and also readily available at home.

Also, in acute cases restriction of dietary items is not advisable unless some food items are strongly
contra indicated in the malady.  As the master himself said “In acute diseases, on the other hand-except
in cases of mental alienation - the subtle unerring internal essence of the awakened life preserving faculty |
determines so clearly and precisely, that the physician only requires to councel the friends and attendants

to put no obstacles in the way of the voice of nature by refusing any thing the patient urgently desires in
the way of food or by trying to persuade him to partake of anything injurious”.  ($262, Organon of Medicine).

5. Conclusion

Serious illnesses are associated with chance of severe nutritional depletion because patients may be
unable to take, digest or absorb their food and also due to the loss of large amount of Calories.

The major problem in the nutritional support is to provide water, calories and proteins to the patient.

The type of diet, its ingredients, quantity, concentration rate and route of feeding depends up on the
requirements of the pa­tient, nature of his illness and the ability of the GI tract to absorb sufficient nutrients.

The basis of dietary additions and restrictions is according to the precise diagnosis.

(A Homoeopath should impose dietary addition and restrictions not only according to the diagnosis
but according to the similimum also).

6.   References
1.       Rudman.D- Diet Therapy Chapt.74
2.       Jeejeebhoy K.N., Baker J.P- Parenteral Nutrition Chapt.75
3.       Braunwald.E, Isselbacher K.J ET al- Harrison’s Principles of Internal Medicine 11th Ed.       
          Companion Handbook.
4.       Park .K- Park’s Textbook of Preventive and Social Medicine 15th Ed.
5.       Santwani M.T- Practical Diet Guide in Homoeopathy. B.Jain Publishers New Delhi
6.       Teachers of M.C. Calicut- Doctors Pocket Companion
7.       Debora Tkae-The Doctors Book of Home Remedies Rajendra Publishing house Pvt.Ltd., P 258-264.
8.       Edwards C.R.W, Bouchier IADET al- Principles and Practice of Medicine 15th edition.  Churchill Livingstone
9.       Krishna Das K.V- Textbook of Medicine 3rd edition Jaypee Brothers Medical Publishers
10.       Kent, James Tyler- Lectures on Materia Medica. B.Jain Publishers New Delhi.
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Abrus precatorius; An Image yet to be formulated
By.Dr.P Sunilraj BHMS.

When we think about valuable therapeutic agents of various ho­moeopathic materia medica available at present and comparing it with the possible advanced types of materia medica in the future, we would be astonished to see that our present treasure of medi­cines is much less than what is really required for dealing with the ever increasing human ailments.  The number of new homoeo­pathic medicines which will be added in our pharmacology are beyond limits because, anything which can make a change in the healthy state is something which is surely to be considered as an agent which is therapeutically effective.  Nature creates diseas­es and as a compensation it also creates materials which can conquer these disturbing, debilitating and destructive forces effectively.

Each and every nation has abundant treasure of indigenous thera­peutic agents.  The question regarding the origin, nature and market value of these drug substances are not the primary matter of concern, because even a member from a precious stone family may not provide much help as pure flint do.  Here let me quote P.B. Bell’s emphatic statement, “whether derived from purest gold or purest filth, our gratitude for its excellent service forbids us to inquire or care.”  The only thing one has to do is to explore the therapeutic possibilities of these agents effective­ly.  Here comes the need of observations, pharmacological experi­mentations and clinical trials of the suspected and apparently useful medicinal agents.

Dr. Samuel Hahnemann elaborately described various sources of information regarding the pathogenetic powers (and thereby the curative powers) of medicinal substances in the aphorisms 105-145.  Among this we know that drug proving on healthy human beings is the most important, reliable and recommendable source.  He wrote that every medicine exhibits peculiar actions on the human frame, which are not produced in exactly of a different kind (apho.118).  He also told that anyone who has a thorough knowledge of, and can appreciate the remarkable difference of, effects on the health of man of every single substance from those of every other, will readily perceive that among them there can be, in a medical point of view, no equivalent remedies whatever, no surrogates (foot note of apho.119)-ie, no medicine can be used as a substitute for another one.

He said that morbid lesions which resulted from medicinal sub­stances when taken into the stomach of healthy persons, either in large doses given by mistake or inorder to produce death in themselves or others, or under other circumstances, accorded very much with his own observations when he was experimenting with the same substances on himself and other healthy  individuals.  In addition to these accidental, homicidal and suicidal poisoning cases, Dr. Hahnemann also described about Idiosyncrasy as a source of information regarding the disease producing properties of substances (apho.117). Eventhough the hypersensitiveness is a constitutional peculiarity, the basis of such manifestations cannot be attributed to the peculiar constitution alone, because the power of producing such manifestations lies with the particu­lar substance itself.

The therapeutic use of more and more agents from vegetable, animal and mineral origin and also from various energies should be discoverd and systematically arranged so that these can be used as valuable medicines.  Among these sources vegetable group play an important role especially when we think about the pos­sibility of the additon of new medicines because of the avail­ability of a large number of plants both cryptogams and phaner­ogams around us.

Now let us think something about the plant ‘Abrus precatorius’, which is commonly seen in India, but the medicinal properties of which is not well known, especially in the Homoeopathic point of view.  Our traditional system of medicine namely Ayurveda ex­plained about the plant regarding the parts used and also the individual therapeutic properties of these parts in the angle of ayurvedic approach.  In Homoeopathy we know that it is not a well proved drug substance and is using ayurvedic instructions of medication. Well, it will be far away from classical Homoeopathy.  So it is high time to prove this drug on healthy human beings in non-toxic doses and obtain a portrait of the pathogenetic ef­fects.

Anyway we are lucky to have so many toxicological effects of this plant and its various parts which will help us to know about its Homoeopathic therapeutic aspect upto cerain extent.  It also gives an idea about the part or parts which is to be used for the preparation of our medicine, about the nature and strength (dilu­tion) of the extracts to be used and also about the precautions to be taken during drug proving.  So let us now consider about this plant in a systematic way.
Botanical name  :        Abrus precatorius
Synonyms         : Abrus aaculatus, Abrus minor; Abrus pauciflorus; Abrus squamulosus; Indian liquorice; Jequirity.
Names in different languages
English              : Crab’s eye vine
Malayalam        : Kunni
Sanskrit             : Gunga, Kakachinji; Kakanandi; Kakadanee; Kakavallari; Kakacheelu; Rakthika;
Hindi                 : Rati, Ghungchi
Tamil                : Kunti
Telugu               : Guriginja
Kannada           : Galaganji
Bengali              : Kunch
Marathi             : Gunj
Family              : Leguminosae
Distribution      : All over India, in land up to 1000 metres high; also cultivated in gardens.

Description

Macroscopic:-

Abrus precatorius is a beautiful deciduous, creeping or climbing plant.  Stem is about 1.2 cm. in diameter; branches slender, flexible and tough.

Leaves 5-10 cm. long compound, paripinnate; Leaflets narrow, 10-20 pairs, opposite, increasing slightly in size from the base, 7.5 to 23mm by 3.6 to 6 mm, linear or linear oblong, thinly depressed, silky beneath.  Rachis produced beyond the last pair of leaflets as a soft bristle.  Leaves may taste sweety when chewed.  Inflorescence one sided, usually leaf bearing, axillary, pedunculate raceme, 5-10 cm long.  Flowers may be red, purple, yellowish, pink or white and are like the flowers of pea,1.0 to 1.25 cm long, clustered on tubercles arranged along the rachis of raceme.  Seed pot (fruit) have more or less the shape of beans (pod), borne in clusters, 2.5-4.5 by 1.0-1.25c.m, turgid, thinly pubescent, having a sharp deflexed beak, green when immature, becoming brown and dry later, splitting open and remaining on the branch with 3-6 seeds exposed.  Seeds egg shaped (ovoid), hard, smooth and polished.  The colour of the seed may be either of these-bright scarlet red with a black spot at the hilum; white with black spot; all white; all black; all yellowish or all blue.  Seeds are odourless and tasteless.  Each seed is about 8 mm long and 6 mm broad and average weight of each seed is about 105mg.  They were used by Indian goldsmiths for weighing silver and gold.

Microscopic:-(Seed)

Seed coat:-  Testa and tegmen fused.  From outer to inner there are 5 types of cells.
(a)   Epidermis; single layer of tangentially elongated thick walled cells.
(b)   7-10 layers of red colour bearing (towards proximal portion) and black colour bearing (towards distal portion) thin walled tangentially flattened cells.
(c)   A zone of 1-2 layers of rectangular cells.
(d)   8-10 layers of highly sinous thick walled sclerotic cells
(e)   Single layer of hyaline sclerotic palisade cells.

Cotyledon:-  There are two types of cells.
(a)   Epidermis of 1-2 layers of thin walled angular cells.
(b)   Cells of ground tissue having conspicuous beaded cell walls and full of starch granules.

Toxicological aspects

Abrus precatorius is mainly an organic irritant poison.  All parts of the plant are poisonous.  Seeds contain a variety of poisonous proteins, among which the most important one is abrin, a thermolabile toxalbumin, which is very similar to viperine snake venom in their physiological and toxic properties.  In addition to abrin the seeds contain a fat-splitting enzyme; Abrine, an aminoacid, haemagglutinine in the cotyledons; Abralin, a glycoside; Abrussic acid and urease. The root and stem also contain an active principle, glycyrrhizin.  The shell of the seed contain a red colouring matter.

Abrin, the most important active principle of Abrus precatorius seed is a tasteless, amorphous, pale grey solid substance.  It dissolves readily in cold water, and the solution which is of slight yellowish in colour froths on agitation. Abrin is also soluble in glycerin.  When taken internally by mouth, the gas­tric juice has some inactivating action on it.  Abrin loses its activity on boiling, and therefore the seeds when cooked can be taken without any harmful effects.  It is said that the powdered seeds in 60-200mg doses boiled with milk are used as a nervine tonic.

Method of extracting abrin from the seeds

First remove the seed envelope and the inner portion is taken and rubbed in a mortar with 4% sodium chloride solution in which abrin is soluble.  It is allowed to settle when the sodium chlo­ride solution of abrin is separated out.  This process is repeat­ed twice or thrice.  The combined extracts are filtered and concentrated in vacuo.  They are then acidified with acetic acid and saturated with sodium chloride to precipitate the abrin.  The precipitate is separated and purified by dialysis in a parchment dialyzer for several days.  Lastly the residual abrin is dried in vacuo over sulphuric acid when an amorphous powder is obtained.

Identification tests of Abrin

(a) Physiological:-

A watery infusion of abrin or a decoction of the seeds, if dropped into the eye causes purulent ophthalmia.

(b) Agglutination test:-

If one or two drops of abrin solution made by dissolving 0.1gm of the substance in 10ml of 4% sodium chloride solution are added to 2ml of defibrinated blood in a small test-tube, the red blood corpuscles agglutinate into a mass resembling sealing wax.

Fatal dose of abrin:- 
90-120mg.
If injected subcutaneously abrin is 100 times as toxic as by oral route.
A dose of about 0.0001mg-0.0002mg of abrin per kilogram of body weight, injected subcutaneously said to be poisonous.

Fatal period:- 24 hours to 5 days.

Symptoms and signs of Abrus precatorius poisoning

[Pathological Drug Proving,
Partial Proving]

Symptoms may be delayed from a few hours to 2-3 days. If uncooked seeds are taken, the following signs and symptoms develop.  They include abdominal pain, nausea, vomiting, diarrhoea, weakness, sunken eyes, cold perspiration, trembling of the hands, dyspnoea, weak, rapid and irregular pulse, vertigo, faintness, rectal bleeding, oliguria and features of uraemia.

If injected subcutaneously in man, at the site of injection painful swelling and ecchymosis develop with inflammation and necrosis; generalised septicemia and haemolysis can occur.  There may develop convulsions and death may occur from cardiac failure (cardiac paralysis) within 3-5 days.

A decoction of the decorticated seeds or a watery infusion of abrin if instilled into the eyes will produce purulent ophthalmia and may cause fatal poisoning due to its absorption through the conjuctiva and here also certain features of generalised poison­ing can occur.

An extract of the seeds if injected subcutaneously in an animal causes inflammation, oedema, oozing of haemorrhagic fluid from the site of puncture and necrosis surrounding the site of injec­tion within few hours.  There is disinclination to take food and three or four days later it drops down and is unable to move.  Then it becomes cold, drowsy and comatose or may develop tetanic convulsions and dies within the next 24 to 48hours.  The symptoms resemble those of viperine snake bite, so one may think that the animal died from the effects of snake bite.

Autopsy studies in man shows ecchymotic patches under the skin, pleura, pericardium and peritoneum.  The mucous membrane of sto­mach and intestine is highly congested with numerous haemorrha­gic patches on its surface as well as in the interio r of the organs, such as lungs, liver and spleen.

History and authority as regards to Homoeopathic use.

First mentioning and few symptomatology of Abrus precatorius as a homoeopathic medicine is done by Dr.William Boericke in his Homoeopathic Materia Medica under the heading Jequirity.

Parts used:-  Seeds

Boericke mentioned certain conditions where Abrus precatorius can be used. They are epithelioma; lupus; ulcers; eye complaints like purulent conjunctivitis-inflammation spreads to face and neck; granular ophthalmia and keratitis.  Here we find that there is no rare, striking, singular, uncommmon or characteristic features which can help us to individualise this particular medicine and select it as a remedy, when a patient is brought to us with the above mentioned pathological conditions. This is because of the fact that the drug is not well proved.  So here comes the need of thorough drug proving of Abrus precatorius seeds.  We can also conduct drug proving using the active principle Abrin alone.  [The drug picture of the entire seed and abrin alone may not be the same.  So here we can have even two different medicines.] While conducting drug proving we should not forget that the seed as such is poisonous and we should not select potencies below 3x.

Preparation of the mother tincture
To prepare one litre of the mother tincture, take
Fine powder of Abrus precatorius seed-
100gm
Purified water-320ml
Strong alcohol-700ml
Drug strength of the mother tincture is 1/10 or 1x

Preparation of potencies
2x and higher potencies can be prepared using dispensing alcohol as the vehicle.
Caution:- Mother tincture should not be taken internally as it is highly toxic and abortive.

Potencies to be used:-

In classical homoeopathic prescriptions one can freely use 30th potency and above.

More clinical conditions where Abrus precatorius can be used:-

Based on the toxicological effects (Pathological drug proving) let me mention some of the clinical conditions where this drug can be used in addition to those mentioned by Boericke.  They are cholera, gastritis, dysentery, typhoid, cellulitis, gangrene, purpura, hypertension, nephritis, angina pectoris, myocardial infarction, valvular insufficiency, cardiomyopathies, epilepsy, brain tumour, septicemia and septicemic shock, tetanus and late sequelae of viperine snake bite.

In additon to drug proving we can also conduct clinical trials using the drug in 30th potency and above and try to have an idea about the therapeutic use of it.  Anyway thorough drug proving is essential so that this medicine can have a better position both in our materia medica and in our mind

References:-
(1)  Text book of Homoeopathic Pharmacy:Mandal and Mandal
(2)  ‘Oushadha Sasyangal’:Dr:S.Nesamony
(3)  The Essentials of Forensic Medicine and Toxicology:Dr:K.S. Narayan Reddy
(4)  Hand book of Forensic Medicine & Toxicology (Medical Jurisprudence) : Dr:P.V. Chadha
(5)  Modi’s Medical Jurisprudence and Toxicology:N.J.Modi
(6)  Encyclopaedia of Homoeopathic Pharmacopoeia; Vol II:P.N. Varma & Indu Vaid
(7)  Materia Medica with Repertory : Boericke
(8)   Organon of Medicine:Dr:Samuel Hahnemann.
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Two Rare Drugs Beneficial In Angina.
By.Dr.Kavitha Sunilkumar MD. (Hom)

Diseases of heart and circulation attributes to 50% of deaths.  Angina pectoris, the name itself depicts a picture of intense agony and the mere mentioning of such a case often steals a beat out of even the most experienced physician’s heart.  It is in such tricky situations that rare drugs come of help.

Here we are going to discuss about two rare drugs those come from two different kingdom viz.animal and vegetable.

1.   Latrodectus mactans
It is a spider of genus Retitelariae under the family Theridide.  It is a native of America.  The females, after copulation eat up the male; hence they are also known as ‘Black widow’.
The venom is often lethal and a bite can produce tetanic effects that lasts for several days.  Its pathogenesis and effects were published in 1933 by Hering proving committee.
It causes cramps of muscles, haemorrhage of black blood, vascular spasms of extremities and the precordial region seem to be the centre of attack.  Coagulability of blood is lowered considerably.  Angina pectoris, Vasomotor ataxia, constriction of chest muscles with radiation of pain down the axilla, left arm and forearm to the fingers are the main indications.
Mother tincture is prepared from the live insect.  Trituration from 6x and higher dilutions are highly advisable in Angina pectoris.
Symptoms which often indicate the drug includes:
Anxiety with intense fear of death
Violent constrictive pain of precordial region radiating towards armpit along the left arm to fingers with numbness of the extremity (1, 2, 3, 4, 5, 6, 7, 10). Later most violent precordial pain & pain in  left arm which seems about to be paralysed (1, 2, 3, 4, 8, 10).
Sinking sensation at abdomen and cramping pain from chest to abdomen (10)
Coldness of body with rapid soft thready pulse (4,6,8) Pulse so frequent that it can’t be counted and so feeble that it can’t be felt (1,2,3,4,5) Pulse 130/mt. (1,2,3).
With intense distress patient cries out, screams with pain.  Pain in precordium with apnoea.  Screaming fearfully (4) exclaiming that she would loose her breath and die (1, 6 ,7) with sensation of severe thoracic constriction (4)
Hesitating speech with weeping
Coldness of whole surface.  Skin cold as marble (3, 7, 10)
Blood, when cupped flows like water; will not coagulate (1,3,4,5,8).  Haemorrhage of black blood; black vomit, stool copious & black.  Vomiting of black blood which ameliorates
Vascular spasm of the extremities.  Shivers, Vascular hypotonia (4)
Complaints of thermal regulation.  Shivers with temperature and profuse perspiration
Trembling tongue with great thirst, vomits what he drinks.
Itching  and redness of the part bitten, at first without pain
Cold sweat and above all pains like those of angina pectoris(4,5,6,7)
Loss of vital heat
Puffiness of face

Blood: Leucocytosis (4,8) Bleeding increases, clotting time increased blood pressure decreased (8)
General aggravation- by least movements, in the afternoon
General amelioration- by sitting still, cold bath. Over all, its action is comparable to that of Nitroglycerine.

2. Haematoxylon Campechianum

Common name:Logwood. 
Order Leguminosae Habitat-West Indian Is­lands.

It is useful in Angina pectoris where the sensation of constric­tion is characteristic (10)

The main indications of the remedy are as follows
Sensation as if a bar lay across the chest, (9,10) across the region of heart with acute pain in left upper portion of chest (1,6) (The bar sensation has been frequently removed by haema­toxylon and in a case of zona with agonising pain as if a bar lay across the chest, arresting breathing, Haematoxylon served bet­ter)
Angina pectoris with soreness in cardiac region with anguish redoubled by throbbing.  Small pulse, burning in hands and shiver­ing of the body (1).
Sensation of weakness and palpitation
Palpitation with diminished sensitivity of feet. (1)
Palpitation with diminished sensitivity of feet. (1)
Painful sensibility of limbs with lassitude (1)
Convulsive pain in heart region with oppression (10)
Painful dysentery with colic & tympanitic distention
Bellyache with inclination to vomit (1)
General uneasiness with anxiety and anguishes
Painful digging from abdomen to throat causing sore bruised pain in the region of heart with oppression aggravated by touch (10)
Better open air (6)

Mother tincture is prepared from the heart of the wood.  Use of Q, 1-10 drops or 3rd potency is often beneficial.

References
1.     Dictionary of Practical Materia Medica-JH Clarke
2.     Gibson D.M. Studyof Homeopathic remedy
3.     GrimmerA.H. Collected works
4.     Materia Medica of New Homoeopathic Remedies - Julian O.A.
5.     Concise Materia Medica of Homoeopathic Medicine - Pathak S.R.
6.     Homoeopathic Materia Medica of Graphic Drug Pictures- Pulford. A.
7.     Samual . Key Notes
8.     Materia Medica and Repertory- Stephenson.J.A.
9.     Encyclopaedia of Pure Materia Medica - Allen T.F.
10.  Pocket Manual of Materia Medica with Repertory - W. Boerike

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