JS: Either bacterial or non-bacterial; it is irrelevant. Cystitis is one of the easiest things to handle homoeopathically, because the remedies which apply to the majority of cases are few in number and the symptoms are usually (if you know which ones to look for) fairly prominent. Of course the best way to deal with it is still at the hospital, specially if you have a good health insurance. But if you follow the information on this page, there is no reason why you can't handle it well at home. We can divide the presentation of cystitis into four main groups and the vast majority of cases will fall into one or other of these groups.
Group A: intensity of the onset of the symptoms.
Group B: tenesmus and urging.
Group C: pain at the close of urination.
Group D: children and other remedies.
Sarsaparilla: is number one, it is the most common remedy in cystitis.
Nux vomica: is number two.
If you don't know anything and you just have these two remedies and give them out, you will deal with a definite number of cases, no question. Just throw the remedy at them. But of course, if you know what you are doing it is always a help.
Group a (intensity of onset)
This is when the symptoms come very quickly and are very severe. I am now really speaking about women, because these are the ones who get cystitis by the nature and structure of their anatomy. In a way, I am not differentiating here between a urethritis and a cystitis; we just lump them all together. In men, really it is extremely uncommon in my experience to have an acute urethritis or cystitis unless it is venereal, unless it is gonorrhoeal. For some reason we don't see that many of those cases, and I believe it is illegal in California to treat gonorrhoea with anything but antibiotics. And the truth is, in all my years I don't think I have really had to come up against that. So I have very little experience in that realm, but acute cystitis in women is a very common complaint and I am sure in general practice you must meet with it a lot. And those of you who do know: for some reason or another, it produces a lot of anxiety and discomfort in the women. It is not a complaint which is well-tolerated, actually. So when I say here that the symptoms must be intense, I mean they must be intense relative to what you know. This is an unusual case in which within an hour or two hours or three, it is as if it has come on and they cannot stand it and the pain is terrible.
The first remedy here is Cantharis. Of course you all know that Cantharis is Spanish fly. It has its reputation as an aphrodisiac, because of its local irritation of the urinary tract, which then leads people to believe that they are sexually excited; it acts at that level. Cantharis has the most intense symptoms; the pain is burning, severe burning pain. The symptoms come on very quickly; there is violent urging every two to three minutes. These are people who cannot leave the toilet. Because the whole organism is in such a state, the urine dribbles out like drops of scalding acid; it is terribly ... Cantharis is a big remedy as first aid for burns. So you get the idea that this is what is going on subjectively in the urethra. It has this sort of intensity, as if boiling hot water or lead were being poured down the urethra. And so here it is actually during urination that the pain is at its worst. As the urine passes, these are people who scream from the pain. You know, they sit on the toilet and scream: "Ahhh!!!" like this; it is so bad, they cannot contain it. It is like knives in the neck of the bladder.
The urine itself is very acrid and excoriating and will actually burn the skin over which it passes, not only the urethra, but if the urine dribbles onto the thigh, or onto the genitalia, it scalds and burns. And of course the urine may be frankly bloody, because of the intensity of the onset and the severity of the condition. You will get blood, early, and it is one of the remedies which has casts; you may have mucous casts in the urine. The amelioration comes from urinating into water, because the water washes the urine away very quickly. So these are people in whom, if they sit in the bath or stand in the shower, it decreases the pain. And of course, because of the intensity of the infection, this is the sort of case where if they are not treated early and are not treated correctly, within twenty-four to forty-eight hours you can have a full blown pyelonephritis. However, the pain here may be violent but does not have to be. Once it has gone up into the kidneys, you can have just this dull lumbar pain with or without sharp pains, which sort of extend down the ureters into the bladder or even into the genitalia. If it happens to be a man, for instance, who has pyelonephritis, you will get an extension through the spermatic cord into the testes and the penis. So you won't recognize this remedy after twenty-four or forty-eight hours, unless you get the history of the onset. But if you get this history of onset, you know. If for some reason or other they are out on some farm or this or that and they couldn't get the local doctor and they finally arrive at you, and they have pyelonephritis, but you see this story of how it started, you can give Cantharis, even at that point. There is one exception to this picture, which happens in little boys. In little boys all you may see is that they just pull at their penis. This is a sort of a keynote for Cantharis in little boys; it is not masturbation, but there is a kind of irritation there and they are always tugging and fiddling at their penis, because of the irritation of the urethra.
The other remedy which you must think of with such a violence is one of the Mercuries and it is especially Mercurius corrosivus. Mercurius corrosivus is the Mercurius which has violence in the sense of very rapid onset of symptoms and great discomfort. One of the main ways that you differentiate it from Cantharis is that although the onset has great violence and intensity, it is not as strong as in Cantharis and Mercurius corrosivus has bloody urine, almost from the very beginning. Almost from the first symptoms there comes blood. And of course it is very helpful to have other characteristic Mercurius symptoms: worse at night, salivation, or a metallic taste in the mouth. For those who are miasmatically inclined, the remedies which are worse at night belong to which miasm?
JS: The syphilitic miasm. And mercury was the main treatment for syphilis and how did you know when you had given enough mercury?
JS: The patients would produce salivation. Very characteristic of Mercurius. And if you do not have salivation or metallic taste in the mouth, you can give Mercurius, but you like to see this in Mercurius. This is related in some way to the essence of this remedy. I mean, every single prover of mercury has salivation; this is how they knew that they were giving enough just to poison the body without killing it.
There is a third remedy which has very acute onset, which is not very usual, but which you need to know in a way, and that is Aconitum. Of course Aconitum is good for any condition in the early stages where there is very sudden onset, and so, of course, Aconitum is useful only in the early stages at the onset of the condition. And mostly you will be led to this remedy by the suddenness of onset and the accompanying anxiety and restlessness. So this is a cystitis which starts out suddenly, and the people have a fever, which is unusual in just a cystitis. At the same time they are very restless and have the characteristic sort of Aconitum anxiety, which is what?
AD: Fear of death.
JS: They are going to die, yes. They just feel somehow that they are going to die, because Aconitum is the remedy which does what about death?
AD: Predicts the time.
JS: It predicts the time of death. You see, it is so strong that they know when they are going to die.
I will just diverge for a moment, but it is useful to know. It has got nothing to do with cystitis. Aconitum is an extremely useful remedy in any form, in a way, of chronic illness, but mostly persistent anxieties and things which come from a time in which the person had a moment in which they thought they were going to die. So you have someone who has been in an automobile accident, for instance. And since that time, or within a week or so afterwards, they have developed nightmares, they have insomnia, they have some palpitations or they may have other complaints. They come to you a year later after having been to this physician and that one, and they have been given the usual B-blockers and various anti-depressants and nothing is helping. They are not sleeping and they are waking up with nightmares; you take their case, and you understand that just in the moment that the automobile had an accident (or whatever it was, it can be an air flight in which the plane hits a pocket and drops like that), they may hardly even remember it, comes the thought: "Oh my God, I am going to die." And at that moment it enters deeply into their unconscious and produces an Aconitum state. So this is a very useful remedy for the after effects of fright of specific sort, which involves the sudden realization of their mortality. So earthquakes, these sorts of things, produce chronic Aconitum states.
Group b (tenesmus and urging)
You have to have a little bit of experience in evaluating the relative weight of these symptoms in the case. So of course you can have someone who has a fairly intense onset of symptoms and then you have to see what the main thing is that bothers them. And you may find, even though there is a fairly rapid onset of symptoms and they are complaining a lot and the pain is quite intense, that really the main thing is this tremendous urging, straining and urging. They are sitting on the toilet; they cannot get off the toilet and the urine actually won't come, it is just: "It wants to come, it wants to come ..." and they strain and they urge and yet nothing comes. Then a little bit comes and there is very little relief, and the same picture starts over again. Or they get up from the toilet and they go and they sit down in the bedroom or in the office, and within a few minutes ... this is the same story. But mostly these are people who are spending a lot of time on the toilet as well. It is not that the pain is so severe, these are not people who are screaming when the urine passes. These are people in which the urine doesn't pass so well. There is a straining and an urging and a tenesmus.
Of course, the main remedy which characterises this sort of reverse peristalsis is Nux vomica. Because that is what this is - reverse peristalsis - which is very characteristic of the nature of Nux vomica: a sort of disharmonious, spasmodic action. So although the urine wants to come out, the muscular fibres of the urethra contract and stop it happening. Or the neck of the bladder goes into a spasm and there is an urging and a resistance, and you will see this really in any of the colics associated with Nux vomica. In fact, if you are prescribing acutely for maybe a biliary colic, or an intestinal problem, any acute colitis, something like this, you want to see that there is tremendous straining with no result. So here it is not the passage of urine which is painful, it is the urging which drives them crazy.
Of course, the point here is that these people are in a Nux vomica state, which means that they will be on the phone to you and they will be saying: "Do something now!! This minute!! I cannot stand it, it is driving me mad." And you will sense that there is an irritability and an urgency which may even be disproportionate to their symptoms. So they sit on the toilet and they strain and the more they strain, the harder it is, the less result. And when the urine comes, it is only a little urine, but it does give some relief. So here we have also some relief from urination. The pains in Nux vomica are generally worse before and shortly after urination; not at the end of urination. And very characteristically, there will be amelioration from warmth. These are people who need to sit in a hot bath, or need to put a hot water bottle or warm towels over the lower abdomen, and this will give relief. So if you spot a Nux vomica patient like this, usually these things are over the phone and it takes a little while to get the remedy to them, or even they have the remedy there, you tell them: "Use warmth, sit in the bath, put a hot water bottle there," because you know that it will relieve them. Or if you are not sure, you tell them: "You do this, run a warm bath, sit in it, see what happens, call me back; put a hot water bottle there." If they call you back and they say: "Well I am still pretty bad," and you say: "Did it help?" they say: "While I was sitting in the bath, it was fine, but I cannot sit in the bath the whole night." Then you definitely confirm your remedy like this.
The other remedy which has this urging, but of a somewhat different character, is Pulsatilla. The main remedy for intensity of onset is Cantharis. The main remedy for tenesmus and urging is Nux vomica. When the urging and the tenesmus is the centre of the case, seventy to eighty per cent will be Nux vomica. However seventy to eighty per cent is not really good enough, because what happens if the person happens to fall into the other twenty per cent; you still have to do something. So Pulsatilla is the next one to consider. In Pulsatilla it is not that there is so much tenesmus. Pulsatilla, of course, is quite a different remedy and it does not have this sort of disharmonious, spasmodic action. Here, there is sudden and intense urging. They feel they have to go and Kent describes it like this: when one drop comes into the bladder, they must go, or they will lose the urine.
So there is frequent urging to urination, and the more this urging is resisted or delayed, the worse it gets. But if they feel the urge and they go and they sit on the toilet, the urine flows freely; it comes out in large quantities, which is very paradoxical, because Pulsatilla is generally thirstless. Don't be mistaken here. Generally people who have bladder trouble know to drink large amounts of water and so on, and so you say: "Yes, they are drinking large amounts of water and that is why they pass large quantities of urine." Pulsatilla will manufacture large quantities of urine in the absence of fluid intake. It is characteristic of this remedy and is not what we may call a mechanical symptom. So there is this urging, they feel they have to go, otherwise the urine is going to come out. They sit on the toilet, pass a lot of urine quite freely and then after they have passed the urine, comes the pain. So here we have pain after urination. But more characteristic is the sudden urging, with the free passage of large quantities of urine, in someone (if you are lucky enough to get it) who in fact is relatively thirstless and has not taken very much fluid at all. And of course, generally speaking, because of the nature of the remedy, the episodes are much milder, both in intensity and in the rapidity of onset than the remedies discussed so far. Also there is a characteristic in Pulsatilla in which they will wake at night with this sudden urging to urinate, when they roll over onto their backs. Pulsatilla is a remedy which likes to sleep on their back, and so they fall asleep maybe on their side and then after a while they roll onto their back, and it wakes them up with this urging to urinate. I have not seen this symptom, but it is characteristic and if you get it, that is the remedy. With respect to males, I must say it is a very common prostatitis remedy. In prostatitis Pulsatilla is definitely a remedy which you must think of. The few cases of Pulsatilla that I can remember off-hand having prescribed for males, it was for prostatitis - either acute or chronic. And the sort of one-liner characteristic is that the prostatitis has this pressing pain after urination.
Another remedy which is much less common, but which you need to know, is Apis mellifica. In Apis it is almost the opposite of Pulsatilla, in that the pains come before and at the beginning of urination and the tenesmus and urging come after urination. The characteristic pains of Apis are stinging and burning. There is thirstlessness and scanty urination, and an increase in urine volume is one of the indicators of action of the remedy. So in an Apis case, when you are dealing with oedema or this sort of scanty urination and you give the remedy and they start to pass more urine, you know that your remedy is acting. I am giving you just the local characteristics here, but you would really like it to have something of Apis in them, so they should be warm and Apis can be really pretty irritable as well.
Another remedy which we have discussed, but which falls into the tenesmus and urging group, is Mercurius corrosivus. You have to consider this both under intensity of onset and under tenesmus and urging.
Group c (pain at the close of urination)
The remedy here is Sarsaparilla and this is, by far and away, the most common remedy in acute cystitis. Maybe fifty per cent of cases will respond to this remedy. In other words, pain at the close of urination is one of the most common symptoms of cystitis.
Maybe you don't know this, but if you start to ask ... You have to push the people. They call up and they say: "I have bladder trouble." You say: "Well, tell me about it." They say: "Oh so painful!" It is not enough; you say: "When is the pain?" They say: "Oh, when I pee." You say: "At the beginning, in the middle, at the end?" And in about half the cases, people will say: "It is at its worst, towards the end." In ninety-five per cent of cases with this symptom, Sarsaparilla will deal with the condition. Of course these are cases who are very uncomfortable, who have lots of urging, who maybe have to sit on the toilet the whole time, who feel they cannot stand to have this condition for another minute. But it doesn't matter; when you take the case and you are questioning, you see that this picture of pain at the end of urination is when the pain is the most severe, and really the pain and the discomfort is the worst thing, then Sarsaparilla: ninety-five per cent. See further below (*).
If you have this picture and you give them Sarsaparilla and it doesn't work, the other 4.95 per cent will be Natrum carbonicum (4.95 instead of 5 per cent to leave room for the one other remedy). Natrum carbonicum is what you give when Sarsaparilla has not worked, unless you know something about your homoeopathy and you know the person and you know that they are a Natrum carbonicum type of person. Then why not go ahead and give it. But just on acute cystitis you first give Sarsaparilla.
One of the reasons why cystitis was always such a mystery to me (before I happened to get this particular lecture from Vithoulkas some years ago) was that I didn't know where to find it in the repertory. It is a mess, but the place to look is: bladder, pain, neck, close of urination, you will see there is a useful rubric. So really the cystitis remedies in women are covered in the repertory under complaints of the neck of the bladder. That is how this is represented in the repertory. Pain, neck, close of urination: Cannabis sativa, ; Pulsatilla, ; Sarsaparilla, . But Sarsaparilla is the main remedy urethra, pain, urination, at close of (Natrum carbonicum, ; Sarsaparilla, ).
JS: Yes, it is there too, it is sort of all over, but actually this neck of the bladder represents ... In other words, there are one or two other remedies which will cover it. It is true: bladder, pain, cutting, urination, close of, at the (Natrum carbonicum, ; Petroleum, ; Sarsaparilla, ; Thuja, ).
(*) There are some peculiarities of Sarsaparilla, which do not have to be present, but if you are undecided about whether this is pain at the close of urination, or whether the urging is the main thing and you see these other characteristics, it can be very helpful. And this is that when they sit down, the sphincter closes off and the urine doesn't come, but on standing up it flows freely. Also there is a condition in which there is gas, it comes out of the urethra with urination; so urination proceeds with a sort of gurgling sound (I myself have never seen this symptom). The urination during the day is scanty, but is copious at night. Natrum carbonicum is what you give when Sarsaparilla has not worked. Unless you know something about your homoeopathy and you know that they are a Natrum carbonicum type of person, then why not go ahead and give Natrum carbonicum. But, just on acute cystitis you first give Sarsaparilla.
There is a characteristic in infants with Sarsaparilla that they scream before urination. You are misled to think that it is painful before urination, but mostly in infants and little children, once they have urinated once or twice and it has been painful and they feel the urge, they know it is going to be painful no matter, where the pain comes at the end of urination. They fear the pain and they try and hold it back as they know that at some point it is going to be painful, and so they cry and they start to scream and fuss, when they feel the urge. Here you can use Sarsaparilla
Cannabis sativa is a more common remedy in men. Cannabis sativa is a remedy for gonorrhoeal urethritis, maybe even gleet; I am not sure with that. I think gleet is post-gonorrhoeal discharge from the male urethra, or it means gonorrhoeal discharge which has persisted for some time.
I don't know the medical dictionaries in Britain, but I use Dorland's medical dictionary; it is indispensable for interpreting the repertory. It is good - it gives the old terms as well - for understanding the meaning of things like catarrh and gleet.
Cannabis sativa; the pain is cutting like a knife and there may be pain throughout urination, but the pain is especially violent at the close of urination. The entrance to the urethra is dark and swollen. It takes quite a while for the flow to begin and the characteristic in the urethritis in males (and maybe in women as well) is the pain extends backwards from the urethral meatus along the urethra into the bladder. In women there may be a pressing-out feeling in the urethra after urination.
These remedies are all you have to know to treat cystitis, for practical purposes. To manage cystitis, of course (never mind all this that I have told you), the very best is to take the case, looking for symptoms which are peculiar to that condition and to decide on your remedy based upon the whole case. But you will find, even if you do it this way and you keep this lecture in mind, that mostly you should decide upon the remedies which I have given you, because they come up the most commonly.
Group d (children and other remedies)
There are remedies which are peculiar to children; they are fairly unusual, but if you don't know them, you will never think of them. The first one is Petroselinum.
What I myself have found extremely helpful, is to take a book like Boericke (or Phatak's materia medica is excellent, maybe even a little better than Boericke), and to keep notes in this book. So either you go back after a lecture like this, or during the lecture when it is being said, you look under Petroselinum and you write somewhere in the book ...
Just have a look in Boericke and you will see that Petroselinum has the symptoms: sudden urging to urinate (with great pain). So you put a circle around that or you underline it. Then it says: sudden, irresistible desire to urinate; intense biting, itching, deep in urethra, and you underline that. Then you know that these are reliable symptoms of Petroselinum. And especially in children you have to write it in. There is a sudden, intense urging to urinate and the child jumps up and down in an attempt to contain the urge . They have to go immediately, but it is not so painful; it is the urging. They may complain of an itching in the urethra and sometimes they even have an urge to scratch it or, in little boys or girls, to insert objects into the urethra in an attempt to relieve the itching. So this is what it means, intense biting, itching deep in the urethra. And of course Petroselinum is a big remedy for gonorrhoea.
But anyway, I have found myself that to use Boericke in this way is tremendously helpful. I have all the keynotes and things written in and underlined. I keep it on my desk, and if I am taking a case and I think, what am I going to ask to differentiate between X remedy and Y remedy, then I can open my Boericke, which is beautifully alphabetized for me already, and I look under the particular remedy which I want and I see, I have written in this keynote and that keynote, or this or that, and then I have something to ask. Where if I am thinking of a smaller remedy, then I can turn to it and I can see, yes, these are the main characteristics of this remedy and then I know how to proceed in order to confirm it. It is very useful to use it in that way.
You must not be afraid to use your books. In fact, I would say, if I were to give a sort of snapshot criterion of a homoeopath never to see, is one who never opens their book during the interview. A homoeopath who does not open their book during the interview is not a good homoeopath, because no one can remember all this information. And if you don't have to refer to your books (to your repertory, to some materia medica or something like that), you are not practising good homoeopathy. You are missing a lot of the cases. No one can remember all this. Even the greatest homoeopaths; Vithoulkas looks all the time in the repertory. I mean, no one can remember everything. Maybe this treads on some toes, but it is exactly the opposite from allopathic medicine. If an allopath takes out a book and starts to look, it means he knows nothing. If a homoeopath takes out a book and starts to look, it means he is a good homoeopath.
You must not be afraid. I will sit there in the office and I will take Clarke, I will study my materia medica in front of the patient, in the office, in an attempt to see where to proceed. If I get an idea that this is a smaller remedy, and I don't know much about the remedy, the first thing I do is to pull the book off a shelf and I start to study it. It is a sign of a competent. Of course, just because you read the book doesn't mean you are competent, but the converse is true. If you don't read the book, either you are a great egotist, or you are not doing good prescribing.
Doryphora is also a small remedy. This is urethritis in small children, brought on by a local irritation such as bubble bath, tight clothes, masturbation. This sort of local, mechanical irritation of the urethra in small children: Doryphora.
Rhus aromatica is another one which is also pretty obscure. Rhus aromatica has severe pains before or at the beginning of urination, with large quantities of pale urine. You use Rhus aromatica where there is the kid, the kid has a bladder infection, you are searching for symptoms, you cannot find anything really and the only reliable stuff you can come up with, is you notice that the kid is passing large quantities of urine and the pains are really bad just before the urine starts, or right at the beginning. And if you have tried very hard, and you can find nothing else characteristic of any remedy and you have these symptoms, you give Rhus aromatica.
Of course Aconitum is most useful in paediatrics, in urinary retention in the neonates and also in the mother post-partum: in either of them. Of course the reason why it is very common in urinary retention in neonates is what? Well, who wants to come into the world these days ... I mean, the shock of birth, it is terrible. The methods that we use to bring children into the world, that is another thing.
I will give you a little story, it was very interesting to me. I had a patient who I had seen for many years actually, in quite close psychotherapeutic relationship. My one experiment: I decided I would take one patient and I saw her twice a week for a few years. The only non-homoeopathic patient. And while I was seeing her she became pregnant with her second child and of course she was in a pretty fragile state. But while we were talking about delivery and this and that, I said to her: "You know, I believe that a child remembers everything, absolutely everything." Her first child was actually a pretty precocious little guy. At the age of two, when I first started to treat him, I called the family one day and he picked up the phone and I said: "This is doctor Shore," and he said: "Oh doctor Shore, yes, you are going to treat me with homoeopathy." So one day while she was playing with him, she said to him: "M. do you remember when you were born?" and he just said: "Oh yes, the scale was so cold, I couldn't stand it. And you know, the worst thing was that I couldn't see my feet," and it is true, when he came out he was in such a position that he was sort of stuck for a while, with his head out and his feet in. And he just made these statements and then he carried on playing. I mean, it was nothing, it was no big thing, but it was very clear that he remembered everything. And he was verbal enough and young enough that he had not lost the memory and he could express that. So these little kids that come into the world; they are not dumb. They just have not learned to drive the machine, but the driver is there.
AD: What about Staphisagria as an acute cystitis remedy, particularly after ...
JS: Yes, it falls into the category of other remedies. We have the category of other remedies which I have of course cut very short, because the category of other remedies is about two hundred of them, which occupy about .001 per cent of the cases. But these are remedies which are good to know and which you do need to consider under their particular circumstances.
Borax is of course another quite big remedy in childhood and infancy, and here there is the same as in Sarsaparilla, they shriek before urinating. It is in the repertory, shrieking, urinating, before, . Of that rubric the main ones are Borax and Sarsaparilla; although Lycopodium is a three, Borax and Sarsaparilla will be more common. In Borax the urine has a pungent odour and may leave a red sand in the diaper. Then, of course, if you happen to have some aphthae or something with it, your diagnosis is made. Borax is one of the Natrums, a sodium compound. Borax is an interesting remedy to study, but it doesn't seem to be that common, at least in my experience. It is the sort of remedy which when you read it, you feel that it is the thing which you are going to prescribe ten times a day, but it doesn't come up that commonly in my experience.
Benzoicum acidum is definitely a remedy which has its main action upon the joints and upon the urinary tract. This is the main remedy when the pain comes only between urination. That is, the pain is ameliorated as soon as the person begins to urinate. However, the outstanding characteristic of Benzoicum acidum is the intensity of the odour and the colour of the urine. The urine is very dark and smells intensely urinous; it is the sort of thing where the whole house is sort of permeated with the odour of the urine. Or it smells like that of a horse. The other remedy with that is Nitricum acidum. It is rare these days, for us city dwellers, to get the symptom that the urine smells like that of a horse, but it is definitely very, very strong. The thing about the odours of Nitricum acidum, which differ from that of Benzoicum acidum, is in Nitricum acidum it tends to be a general, in that Nitricum acidum has bad odours, no matter from where. Benzoicum acidum is a much smaller remedy than Nitricum acidum. And if you happen to be so lucky as to find that the person has gouty symptoms, or joint symptoms, which go away and then the urine gets this very heavy, turbid and dark appearance with a strong odour, there is only one remedy: Benzoicum acidum. In children you may get the story that the whole house has this urine odour, because a little kid has a diaper, and goes from one room to another; they don't only pee in the toilet and so it is as if this odour of urine is permeating the house.
Staphisagria is, of course, honeymoon cystitis - a condition which has virtually disappeared from our culture. Of course, in the old days, it used to apply to newly married women who were virgins at the time of their marriage. This is why it is not so common these days, really. Staphisagria are very sensitive people and when you grow up to an age of eighteen or twenty, you have grown up fairly isolated and you never really had sexual contact and then suddenly it is the big night and it happens, it is as if there is a sort of psychic shock. So it is not only a mechanical event. It is not only honeymoon cystitis, because it was a virgin and they had sexual intercourse ten times in the first night or something and therefore there is this mechanical thing that happens. It is true, that is part of it, but it is the psychic component as well. So I think for that reason it is definitely less common. So these days, it applies more to the mechanical aspect of things and you can think of it in anyone in whom overvigorous sexual activity brings on a cystitis. But I would say that to give Staphisagria, it has to be very clear that this is the cause and you don't see a clear picture for the other remedies which I mentioned. Otherwise for myself, I don't care if someone meets a new man and develops cystitis; if they have burning pain at the end of urination, if that is their story, I will give Sarsaparilla. But if there is not a good story and this is the clear, definite aetiology, then you can go and give Staphisagria. Of course you will find this remedy more useful in chronic cases who have had a lot of trauma to their bladder. It is not so fashionable these days, but I know it used to be, this sort of urethral dilatation. (I suppose it is a little bit easier in women, but every time I hear that, I just shudder inside. What people do to each other. Urethral dilatation for chronic cystitis - a common treatment, I am sure done exclusively by men; I cannot imagine that women gynaecologists use urethral dilatation as a technique.) So women who have had this sort of treatment, and the cystitis gets almost worse after the treatment, or a bladder surgery. Surgery in that region, because of course Staphisagria is one of the main remedies for wounds from knives, from surgical incisions. So you will not get a very clear and distinct picture in these cases, but mostly it will be frequent, painful urging with burning pains during and after urination and then there is the story of the mechanical trauma and event.
Belladonna would fall into the category sudden onset. Sudden onset with constant urging and burning of both the bladder and the urethra. Tormenting tenesmus after urination. There are spasms at the neck of the bladder and the urine may be bloody with little clots. It is quite interesting that Belladonna is the main remedy for a certain sort of menstrual problem: bright red blood with large dark clots. It is not the only remedy, but it is not a very big rubric and Belladonna is there . So it is just interesting for me to see that in the urinary symptoms too, there is blood with clots; of course the clots are much smaller then. A very big characteristic of Belladonna which comes through here as well: the bladder is very irritable and very sensitive and it is aggravated by jarring (if they make a wrong step). So these are people who will have cystitis with a fairly sudden onset and it is painful and all this, but all the time there is a feeling of a sensitivity and discomfort in the bladder and then if they are walking from one room to the other, or they bump into something and there is a sudden jar, the pain in the bladder is much worse, it is a tip-off.
Berberis is one of the major remedies for pyelonephritis. If you don't know anything and the person has pyelonephritis, you give them Berberis. The main characteristic of Berberis is wandering, radiating pains. So Berberis has pain in one area and then from that spot the pains go all over the place, up, down, through, around. If you get this sort of story in pyelonephritis, it is Berberis. The pains shoot from the kidneys into the ureters, into the bladder, into the urethra. The whole pelvic area sort of aches and the pains go out in all directions and that is the sort of thing where maybe you have this pyelonephritis, there is severe pain and it shoots down into the bladder and at the same time then they have a pain in the calf of the leg or in the shoulder or the upper arm. Then the pain goes away from there and it comes over here. This is also the idea of Berberis. And here as well in the bladder itself, the discomfort is quite severe and there is burning in the bladder before and after urination, and during urination the urethra burns. So Berberis has this burning pain in the bladder and the urethra.
Terebinthina also has a very strong effect on the kidneys. The great characteristic of this remedy is burning. Burning pains with bleeding from mucous membranes. So thus we see there is inflammation of the renal parenchyme with haemorrhage. Burning pains with haemorrhage. The urine is scanty and is loaded with mucous and blood to the extent that it is almost black. And of course a peculiarity which is very helpful (only if it is present), is that the urine has an odour like violets. This remedy is similar to Cantharis in the intensity of the burning. So you will think of Terebinthina where the picture is not so clear, and you cannot say it is this remedy, or that one; you will see that one of the main characteristics is these tremendous burning pains and then you may notice that the urine is dark, and then you give Terebinthina. These are remedies (the smaller remedies, in this way), which you come to when there is not a clear picture of a bigger remedy and all that you are left with (which is really reliable in your case), are one or two characteristics and then if you know the remedy, you will see that these are the main characteristic of this remedy and then you are justified to give it.
AD: In the sheet there is an analysis of the commonest symptoms used in urinary problems in the U.K. , from Dr. Jeremy Swayne. One thing that stands out is that Dulcamara was the commonest used drug in acute cystitis in this sample. The rest fits with what you are saying, but that seems quite out of place; have you got any comment on that?
JS: The weather, of course, is a real possibility that maybe women have taken to wearing shorter skirts or something. I am not sure, but that is the only thing I can think of. It must be. Because Dulcamara is essentially a remedy which is aggravated by cold and especially cold damp. So it wouldn't be surprising that Dulcamara would be a common remedy.
AD: The characteristic local symptoms of it, that would suggest it, apart from the aetiology of cold and wet ...
JS: I know nothing, or at least I know no more than any of you could find in the book, but I would say that cold and wet would have to be the story. In Boericke it says: must urinate when getting chilled. Who has used Dulcamara?
AD: Why do I find Mercurius a wonderful remedy for chronic cystitis?
JS: For chronic cystitis.
AD: Well, I don't think ... acute ...
JS: What is the difference between acute and chronic cystitis, how do you say?
AD: Well, you may get a person who never had cystitis ... acute case.
JS: You mean a current cystitis.
AD: ... or just chronic. And it clears so many cases.
JS: Well that is interesting. I cannot actually think of a case which I have used it for. I mean, Mercurius is a big remedy in this, no reason why it wouldn't work. And those cases that you have seen, they have the Mercurius characteristics?
AD: Yes, they do. But they may not have salivation, they may have sweating or some other ...
JS: Right, worse at night or something like that.
AD: Do you ever use placebo?
JS: Yes, I tried, but not with great success.
AD: You have not mentioned Causticum.
JS: Yes. Of course what I have just dealt with here was really the acute cystitis. I didn't deal with any other form because more or less, as far as I am concerned, those relate to, for want of a better word, constitutional prescribing. I think I must have given Causticum at one time or other in a cystitis like that, but I would especially want, of course, that they would lose their urine, that would be the characteristic. That with the cough or something like that, out it would come. But at least in my limited experience, Causticum in acute ailments comes much more often in the chest, as bronchitis, tracheobronchitis, stuff like that. And the bladder symptoms tend to be more of the chronic variety in which there is muscular paralysis that is already progressing. Causticum in the mucous membranes tends to be more acute, in the muscular system and the nervous system it tends to be more chronic.
AD: Are there any big remedies for people with urinary catheters in? You know, we have a number of patients with urinary catheters.
JS: Urinary catheters? Take them out. It is a mechanical event. You know, what is the remedy for headache when someone is hitting on the head with a hammer? I am not being facetious. There is very little that we can do. Homoeopathy is not the medicine for mechanical events and that is why it is so helpful to know pathology. I mean, if you have someone who has a large uterine fibroid and they have a sensation of something dragging down, you don't go to your repertory and look at dragging down, because you know this is a mechanical symptom. And you have to find what is peculiar to that patient, rather than what is just mechanical. So in that way I would say that a catheter is a mechanical sort of event, which predisposes to something like ... The best way to approach that would be to try and treat the person constitutionally, to take the whole case in order to raise the level of their resistance, and then maybe they will have less trouble.
AD: Where do I find renal calculi?
JS: Sometimes it is hard to find these things, but you have to look under urine, sediment, renal calculi .
AD: Staphisagria seems to be very helpful in trauma itself after chronic cases of traumas to the bladder ...
JS: Especially if it is incised. That is the characteristic of Staphisagria, clean wounds of some nature. I would say, for instance, if someone was in an automobile accident and they had this crushed pelvis or something like that and then there was bladder trouble, what remedy would you think of? Maybe Bellis perennis. You have to think like that. Or if someone was in a fight and they were kicked over that area and they had bladder trouble, maybe Arnica would be the remedy. So as best one can, even in these sort of situations, one tries to individualize as best one can and it is almost always possible to draw some sort of individualizing characteristics out of the case. So please, don't get me wrong; I am not saying that Staphisagria will not work for any sort of trauma to the bladder, because maybe the person needs Staphisagria, but the best is to try and find the closest thing to the nature of the remedy, as it meets the nature of the person.
JS: I have some additional information about catheters, which is absolutely fascinating to me. This is the experience of a homoeopath here, that with the men who come into the nursing home with the catheters in and are pulling at the catheters to get them out, the remedy is?
JS: Petroselinum, right, it works beautifully. Because this is what I would say real homoeopathy. The main symptom of Petroselinum is that they have this feeling in the urethra that it is irritated and itchy and they want to put something in to scratch it. So of course when something is in there and it creates this state, it is a Petroselinum state and Petroselinum will help this condition. You see, when you get this sort of information you know that it is true. You don't have to question: "How many cases have you seen, what do you think?"