Chelidonium Majus — Homeopathic Remedy Profile

The pain sits at the inferior angle of the right shoulder blade. Bruised, continuous, sharp. It may travel forward through the chest to the stomach. The tongue is wide and yellow and takes the imprint of the teeth. The complexion is dirty yellow. The patient prefers food and drink almost too hot to swallow. This is Chelidonium majus, greater celandine, a poppy of the Papaveraceae, and one of the enduring liver remedies of the materia medica.

At a Glance

Source and Preparation

Chelidonium is prepared from the whole fresh plant at the time of flowering. Its juice is bright yellow, resembling bile, and vesicates the skin. It is this signature that led classical authors to prescribe the plant for jaundice long before homeopathy existed; the empirical tradition of organ-therapy carried the same use forward into the herbal materia medica of the modern West.

Chelidonium is prescribed in two distinct registers, and confusion between them is the most common technical error made with this remedy.

• Herbal, drainage and organopathic register. Mother tincture (Ø) and low decimals — D1 to D8 — containing measurable alkaloids. Real dosimetry applies. The EMA/HMPC hepatotoxicity signal of 2011 concerns Chelidonium majus L., herba at "more than 2.5 mg alkaloids per day." It is a herbal-drug caution about a herbal-drug dose, and it belongs to this register.
• Classical homeopathic register. 6C, 30C, 200C and higher. No molecule of the plant is present. Dose-based data, pharmacology and toxicity do not apply, because there is nothing dose-based to describe. What acts is the dynamic preparation, prescribed on the totality of the case.

Rademacher assigned Chelidonium to the center of the liver. Teste, who proved it, placed it at the head of a group that includes Capsicum and Viola odorata. Both branches — organ-therapy at Ø, individualized prescribing at 30C and above — have coexisted since the nineteenth century, and both remain in use. They are not interchangeable.

The Essence of Chelidonium

Chelidonium is a right-sided remedy of the liver, spleen, kidneys, portal system, right lower lung and right ovary. Sanguinaria stands beside it as a right-sided companion, and Lycopodium shares the laterality more closely still. Chelidonium's own signature is the fixed bruised pain at the inferior angle of the right scapula, the yellowness of skin, tongue and urine, and a whole bilious temperament: sallow, cross, obstinate, skeptical of authority, lethargic, averse to motion, with a horror of exertion after meals and a marked amelioration from eating and from anything hot.

The symptoms gathered under this name belong to a patient whose bile is not moving and whose vitality has settled into the hepatic region. The head is heavy. The whites of the eyes are yellowed. The ears feel stopped up. The tongue is imprinted. The appetite swings between disgust and craving, and the whole body wants heat. The right-scapular pain is often the first landmark; the yellow tongue and dirty-yellow complexion confirm it.

Clinical Portrait

Mind and Temperament

The Chelidonium patient is despondent and restless. Restless because she is agile, moving from one place to another without settling. There is anxiety as if she had committed a crime, fear of going crazy, fear of an incurable disease, fear that health has been ruined. Yet the surface is not soft. The temperament is bilious: forceful, very obstinate, cross, irritable, easily upset by trifles. Violent outbursts of temper. Domineering and skeptical, not impressed by authority.

Alongside the sharpness runs a marked weariness of mind. Aversion to conversation and mental exertion. Great absence of mind: forgets what she meant to do, forgets whether she has done it. A stupid feeling on looking intently. Vivid dreams about business matters that leave sleep unrefreshing. Confusion at night on waking. On the sensitive edge of the picture, the patient talks incoherently during a fit of anxiety, feels she must die, weeps without reason, and imagines she cannot think and will lose her reason.

Head

The headache is right-sided and bilious. Pain over the right eye, in the right cheekbone, behind the right ear, extending down to the shoulder blade. It is preceded by pain in the liver. Nausea and bilious vomiting come with the sick headache. Pressing pain in the head. Pressure in the brain with burning over the eyebrows. Cranium feels too small. Occiput heavy as lead, with icy coldness spreading from the nape. The pain is worse in the very early morning, at 4 a.m. and again at 4 p.m., a rhythm Chelidonium shares with Lycopodium. Eating relieves it. This is the classic Chelidonium migraine picture.

Eyes

Whites of the eyes are dirty yellow. Aching in the eyeballs, worse moving the eyes. Orbital neuralgia of the right eye with profuse lachrymation, contracted pupils, relieved by pressure. Tears gush out. Soreness worse looking up. Thick yellow mucus discharge from the eyes; lids agglutinated in the morning. Fistula lachrymalis and hordeolum both appear in the record.

Face

The face is red and swollen, or sallow and sunken. Yellowness is worst on nose and cheeks. Right cheekbone feels swollen with tearing pain. Nodular eruptions. Red pimples on different parts of the face. Inflamed pimples on chin and cheeks. Itching herpes chiefly on chin. Facial erysipelas. The lower jaw drops. In the fanlike movement of the alae nasi during chest disorders, Chelidonium meets Lycopodium.

Digestion

The digestive picture is the center of the remedy. The patient generally feels better after eating, better from very hot food and hot drinks. Only water almost boiling stays on the stomach. Cold drinks disagree. Nausea is better for milk and better for very hot water. There is aversion to cheese in many gastric conditions, and aversion to meat and coffee. Bitter, pasty, metallic taste. Bitter water collects in the mouth.

The stomach itself carries anxiety and oppression. Pain shoots from the stomach through to the back and the right shoulder blade. Eructations taste like juniper berries. Gnawing, scraping gastric pains, better eating. A sensation of a plug in the stomach. Nausea and vomiting in pregnancy, better drinking milk, with desire for food.

The abdomen is full and distended. Constriction across it, as if a string were tied around. Rumbling and gurgling with pinching and cutting pains, then diarrhea. Severe pain around the umbilicus; navel drawn in during colic. Pot-belly with worms. Fatty liver with icterus, with pressive and dull throbbing pain in the region of the liver. Jaundice from hepatic and gallbladder obstruction. Gallbladder colic. Gallstones rank alongside Berberis on Murphy's short list. Liver enlarged and tender, with spasmodic pain in the right kidney and liver together.

Stools alternate between the two extremes. Hard round balls like sheep's dung on one side; bright yellow pasty, clay-colored, floating stools, or rice-water stools tinged yellow, on the other. Chronic diarrhoea with liver affection is a clear indication. Burning and itching of the anus.

Chest and Lungs

Chelidonium has a long chapter in respiratory illness, always with the liver in the background. Bilious pneumonia, pneumonia of the right lung, particularly when the upper half is hepatized, with distressing pain under the right scapula. Bronchial pneumonia. Nightly attacks of asthma with a sense of constriction in the chest. Deep-seated pain or a nail sensation in the right chest. Stitches under the left clavicle and in the region of the right breast. Blood-streaked phlegm, or brownish-bloody sputum. Intercostal neuralgia.

The cough carries its own signature. Short and exhausting, worse at night, worse the cough itself. It is excited by a sensation as if the larynx were full of dust — the "dust" cough. Small lumps of mucus fly from the mouth on coughing. Whooping cough, spasmodic, loose and rattling with difficult expectoration. Frequently useful in bronchitis of children with a dusky red face and oppressed breathing.

Bryonia is a close analog in pneumonia, but the pains in Chelidonium go continually to the back and especially to the right scapula, where Bryonia's do not.

Back and Limbs

The keynote is the fixed, bruised, sharp aching pain at the inferior angle of the right scapula, worse inspiration, worse motion of the right arm. It may extend into the chest and stomach, causing nausea or vomiting. Aching soreness in all vertebrae, worse motion and pressure on the spinous processes. Stiffness between the shoulders. Stiff neck, head drawn to the left. A sensation of a string around the neck. Pain from neck to right temple.

The limbs feel paralyzed and heavy. Rheumatic pain in hips and thighs. Burning and stiffness in the right knee, worse motion. Intolerable pain in the heels, as if pinched by too narrow a shoe, worse right. One foot cold, the other hot — a curious hemilateral symptom in Chelidonium's temperature picture. Icy fingertips. Wandering pains in joints. Edema around ankles and feet.

Kidneys and Bladder

Kidneys sensitive to pressure, even of clothing. Spasmodic pain in the right kidney and liver together. Violent paroxysms of pain in the kidneys with headache, vertigo and syncope. Urine copious, foaming, yellow, yellow as gold, dark and turbid like beer, staining the diaper dark yellow. Urine smells acid or ammoniacal, or has a resinous odor. Diabetes mellitus appears on the clinical list. Hypoglycemia in both the herbal and the homeopathic chapters: the weak liver with low blood sugar, morning fatigue, craving for sweets, which Murphy pairs with Carduus marianus in the tincture register.

Skin

Yellow-grey color of the skin. Sallow, cold, clammy. Skin cool and dry, or cool and rough. Dry heat with itching. Jaundice, including neonatal jaundice, for which Chelidonium ranks alongside Phosphorus, Chamomilla and China. Burning pain like nettles precedes an eruption resembling measles. Painful red pimples and pustules. Old, spreading, offensive ulcers. Red, ring-shaped, confluent spots — the skin seems mottled. Itching, better eating. Warts and scald-head are on the clinical list; the plant's fresh juice has been used externally for warts and chronic ulcers since antiquity, but that is the herbal, not the homeopathic, application.

Sleep and Temperature

Drowsy and chilly. Sleepiness without being able to sleep. Falls asleep while speaking. Unrefreshing sleep. Yawning by day; wakes wretched. Dreams of bodies, corpses and funerals. Dreams of pursuit, of falling, of unfinished tasks.

General lack of vital heat. Chill and coldness of the whole body. Chilliness with cold feet in the morning on waking. Yawning and shivering before a neuralgic attack. Sweats from slight exertion. Watery, sour-smelling sweat.

Modalities

Worse:

• Motion; touch; pressure on the spinous processes
• Cough; deep inspiration
• Right side
• Change of weather; north-east wind
• 4 a.m. and 4 p.m.
• Very early in the morning
• Looking up
• Cold drinks

Better:

• Eating; after dinner
• Very hot food and hot drinks; hot water
• Milk
• Hot bath
• Pressure
• Lying on the abdomen
• Bending backward

The rhythm around meals is the clinical landmark. A patient who says the gastric pain, the headache and the general fog all improve as soon as she eats, and who then wants to lie flat afterwards, is describing Chelidonium.

Relationships

Complementary. Bryonia is the closest analog in many symptoms: yellow tongue, swelling of the liver, right-sided respiratory involvement. Where Bryonia and Chelidonium diverge is that Chelidonium's pains go continually to the back and especially to the right scapula. Arsenicum album, Ipecacuanha, Lycopodium and Sulphur often complete Chelidonium's work.

Antidoted by. Aconitum, Chamomilla, acids, wine, coffee, and Camphor. Chelidonium is itself an antidote to Bryonia.

Comparisons for the right infrascapular keynote. Juglans cinerea; Chenopodium (nearer the spine); Ranunculus bulbosus (edge of the left scapula, through to chest); Lobelia cardinalis (inside edge of the right scapula); Angustura (cutting from just beneath the right scapula to the breast near the nipple). For the wider liver-and-gastric picture: Nux vomica, Sulphur, Bryonia, Lycopodium, Opium, Podophyllum, Sanguinaria, Arsenicum. Colchicum for nausea with desire for food. Kali carbonicum for pneumonia in later stages, copious exudation, rattling worse at 2–3 a.m.

Closely allied to Lycopodium. When Lycopodium seems indicated but fails to act, Chelidonium should be considered. It shares with Lycopodium the 4 p.m. aggravation, the right-sidedness, the fanlike movement of the alae nasi in respiratory disease, and much of the digestive picture; Chelidonium's center of gravity, however, is the liver itself.

Clinical Uses

Right-sided bilious headache

Right-sided headache with pain over the eye, in the cheekbone, and behind the ear, preceded by pain in the liver and accompanied by bilious vomiting. Yellow tongue with tooth imprints, dirty-yellow complexion, worse in the very early morning, better eating. 30C is the customary starting potency for this presentation. Higher potencies fit where the mind picture is clear and the constitutional pattern of the obstinate, skeptical, bilious temperament runs through the case.

Jaundice and hepatobiliary disorders

Jaundice from hepatic or gallbladder obstruction. Yellowness of skin, tongue and whites of the eyes. Clay-colored or bright yellow stools. Dark, foaming urine staining the diaper yellow. Enlarged, tender liver. Fixed right-scapular pain. Chelidonium is a first-thought remedy in these presentations and a leading remedy in neonatal jaundice, alongside Phosphorus, Chamomilla and China. Attention to the potency register is essential here: the herbal alkaloid caution belongs to Ø and low decimals; classical prescribing is at 30C and higher, where no molecule is present and the caution does not apply.

Gallbladder colic and gallstones

Gallbladder colic with severe pain in the right hypochondrium, radiating through to the right scapula, with nausea and bilious vomiting. Chelidonium and Berberis are the two principal remedies of the acute gallstone attack. The differential runs on laterality and on the character and radiation of the pain: Chelidonium's pain is fixed to the right, and to the back and up.

Right-sided pneumonia and bronchitis

Pneumonia of the right lung, especially where the upper half is hepatized and where the pains go to the right scapula. Bronchial pneumonia in children with a dusky red face, oppressed breathing, rattling, fanlike movement of the alae nasi. Bilious pneumonia — pneumonia with a yellow tongue, sallow face and hepatic derangement. The "dust" cough is a specific indication: the patient describes the throat and larynx as full of dust.

Chronic diarrhea and constipation with hepatic involvement

Alternation of diarrhea and constipation, both with the yellow-clay signature. Sheep's-dung stools; or bright yellow, pasty, floating stools; or rice-water stools tinged yellow. Chronic diarrhoea with liver affection is a clear indication. Constipation with clay-colored stools points the same way, and the whole picture usually carries a yellow tongue and a headache better for eating.

Right-sided sciatica and rheumatism

Right-sided sciatica with afternoon and evening aggravation lasting into the middle of the night, cyanotic discoloration of the outer ankle and lower leg during paroxysms, swelling around the ankle, constriction above, great sensitiveness to touch and motion. Rheumatism of the ankles with heat, swelling, tenderness and stiffness, relief only from bathing with hot water, has been a picture on which Chelidonium has succeeded where Rhus tox and Bryonia failed. Edema, heat, tenderness and stiffness are the leading indications in Chelidonium's rheumatic field.

A note from the clinic

One of the cases collected by Murphy concerns a young woman who had coughed for several weeks. Dry, racking, fatiguing, day and night, worse at night, no expectoration, no pain, only the sensation as if throat and larynx were full of dust. She looked completely worn out. She was given Chelidonium 3C, a powder every two hours. She took three of them; the dust left the throat, and the cough with it, and it did not return. The specific character of that cough, the sensation of dust without pain and without productive expectoration, exhausting the patient far beyond what its physical presentation would suggest, is one of the small keynotes on which Chelidonium is chosen, and one of the tests of whether a case belongs to the remedy at all.

A comparable case in the same compilation concerns a man of 45 who had been told he had stomach cancer. Catarrh of the nose and of the stomach at the same time; tenderness over the stomach with a sinking, gone feeling that at times reached painful anguish; sickness at the stomach; all symptoms better by eating. Chelidonium 6X cured at once. The dirty-yellow complexion of Chelidonium, with its cachexia, its sinking pain, its emaciation, does at times suggest cancer, and the remedy has been used within that context. The prescription still rests on the totality: the right-sided liver picture, the pain to the back, the amelioration from eating and from hot drinks.

Frequently Asked Questions

What is the keynote pain of Chelidonium?

A continued, bruised, sharp aching pain at the inferior angle of the right shoulder blade, worse inspiration and worse movement of the right arm. It may extend forward into the chest and stomach, causing nausea or vomiting. It is one of the most specific single indications in the materia medica, and where it appears with a yellow tongue and yellowness of the whites of the eyes, Chelidonium should stand at the top of the differential.

What potency of Chelidonium is used, and what about the hepatotoxicity concern reported for greater celandine?

The concern reported by the European regulators in 2011 is dosimetric — "more than 2.5 mg alkaloids per day" — and it concerns the herbal drug (Chelidonium majus L., herba) used in the drainage or organopathic register at mother tincture and low decimals. Classical homeopathic prescribing sits at 30C and higher, where no molecule of the plant is present and the alkaloid threshold cannot be approached. The two registers ask different questions and take different cautions. In practice, 6C and 30C are the most commonly used potencies for the digestive and hepatic indications, 200C for the deeper mind and constitutional picture.

How is Chelidonium differentiated from Bryonia in liver disease and right-sided pneumonia?

Both remedies have a yellow tongue, right-sided pneumonia, hepatic swelling, and are worse from motion. The differential runs on the direction of the pain. Chelidonium's pain goes continually to the back and especially to the inferior angle of the right scapula; Bryonia's pain is anchored where the stitch is, and the patient wants to lie still on the painful side. Chelidonium is markedly better from eating and from very hot drinks; Bryonia is better from lying still and from rest. Chelidonium is an antidote to Bryonia, and Bryonia is a close analog and complement, so the two remedies often follow each other in a case where liver and lung are both involved.

When does Chelidonium follow Lycopodium?

When Lycopodium seems indicated on the mind picture and the 4 p.m. aggravation but fails to act, especially where the liver is the seat of the disease and where the right-scapular pain is present. Chelidonium's center of gravity is the liver itself; Lycopodium's is broader: digestion, urinary tract, self-doubt with domineering exterior. A failed Lycopodium prescription with a persisting yellow tongue, right-scapular pain and bilious vomiting is a signal to consider Chelidonium.

References

• Boericke, W. Pocket Manual of Homoeopathic Materia Medica with Repertory.
• Clarke, J. H. A Dictionary of Practical Materia Medica.
• Murphy, R. Nature's Materia Medica — Chelidonium majus entry.
• Phatak, S. R. A Concise Repertory of Homoeopathic Medicines.
• Rademacher, J. G. Rechtfertigung der von den Gelehrten misskannten Heilart.
• Teste, A. Systematisation pratique de la matière médicale homéopathique — proving and grouping of Chelidonium with Capsicum and Viola odorata.