Sanguinaria Canadensis — Homeopathic Remedy Profile

Sanguinaria canadensis, bloodroot, comes to the practitioner as a right-sided remedy of the head, liver, chest and deltoid. Its picture runs on burning heat and vaso-motor ebullition: circumscribed red cheeks, distended temporal veins, flushes rising into face and head. Classical prescribing sits at 30C and upward, with 200C on record in the vintage American cases where one dose was given and its action awaited. The tincture and the low decimals belong to a different register, one where the alkaloids of the fresh root do their pharmacological work.

At a Glance

Source and Preparation

The remedy is prepared from the tincture of the fresh root of Sanguinaria canadensis (N.O. Papaveraceae), a spring wildflower of the eastern woodlands of the United States and Canada. The rhizome bleeds a bright orange-red juice, from which the plant takes its common name; the same juice was used by Native peoples as a skin stain and as a dye. Boericke lists tincture and all potencies.

The tincture and low decimals (Ø through D6) carry pharmacological weight. The root contains sanguinarine and related isoquinoline alkaloids, and one older report describes the fatal poisoning of workmen who drank the tincture in mistake for brandy, all seized with racking burning pains in the stomach and bowels. From 30C upward there is no alkaloid present, and the same burning that killed the workmen becomes the diagnostic image the materia medica hands the prescriber, wherever burning is a leading feature of the case. What acts at 30C and above is the dynamic preparation, prescribed on the totality; the toxicological threshold belongs only to the herbal mode at Ø and low decimals.

The Essence of Sanguinaria

Burning is the leading note, and it is found in many different parts: the palms, the soles, the tongue, the pharynx, the sternum, the epigastrium, the palate that feels scalded, the tip of the tongue that feels as if it had been dipped in hot water. Alongside the burning runs a picture of ebullition — flushes of heat rising into the face and head, circumscribed red spots on the cheeks, temples distended, pulsations felt throughout. The right side dominates. Symptoms travel from right to left. Pain settles by preference over the right eye, in the right shoulder, in the right chest, in the right nostril, and where they cross the midline they do so from that side.

A marked periodicity binds the remedy. Symptoms worsen in the morning, increase to noon, diminish again with the sinking of the sun. Hemicrania that rises and falls with the sun is a keynote on which Hering, Clarke and Boericke agree. Add to this the vaso-motor storm of the menopause — flushes rising into the head, burning of palms and soles worse under the covers, painful enlargement of breasts, humming and roaring in the ear — and much of the remedy's clinical territory is already sketched.

The mental picture is thin. What is recorded is a state of torpor and lassitude, indisposition to move or make any mental effort, sensitivity to noise, and — with the physical suffering — irritability, grumbling, rage after insults. The patient recognizes everything but feels as if paralyzed, unable to move while lying on the back. Alongside this there is the "hopefulness" of the tubercular patient: confident of recovery even when the objective picture is grave. Where the source is three lines, three lines is what the case will yield.

Clinical Portrait

Head

The Sanguinaria headache is a specific image, precise enough to be recognised across a room. Hering called it the "American sick-headache." It begins at the back of the head, in the occiput, and spreads upward and forward, settling over the right eye. The pain has been described as a flash of lightning in the occiput, as if the forehead would burst, as if the eyes would be pressed out. Bursting, throbbing, sharp. The temples are distended. The face flushes dark red or livid.

Two features distinguish the paroxysm. Aggravation from light, from odour and from the least jar — the patient cannot bear anyone stepping across the floor, and the physical suffering can be so violent that she goes out of her mind or seeks relief by pressing the head against the pillow or against the floor. And the relief: the attack ends in sleep, in vomiting of food and bile, and in a copious flow of urine. An observation preserved in the older literature runs, "if he goes without food, gets bilious headaches" — a small clinical detail with real diagnostic weight, because it points at Sanguinaria rather than at other polychrests of the sick-headache group.

Headaches return at the menopause. Right-sided headaches with the flu. The periodicity is often weekly, sometimes daily with the rise and fall of the sun. Pain in a small spot over the upper left parietal bone appears among the outliers, but the great territory is right and occipital-to-frontal.

Nose and Sinuses

Chronic rhinitis with a membrane dry and congested, sinusitis more on the right, ozaena with profuse, offensive, yellowish discharges, pain at the root of the nose, sensitivity to the odour of flowers — all of these belong to Sanguinaria. In hay fever and allergic rhinitis, the picture is of an acrid coryza with hot lachrymation, followed characteristically by asthma; and, still more characteristically, of a coryza that gives way to diarrhoea. This keynote -- sudden stoppage of catarrh followed by diarrhoea -- is one Boericke italicised.

Rose-cold with subsequent asthma is one of the classical prescribing situations for this remedy in the American materia medica. Loss or perverted sense of smell — smell in the nose like roasted onion — is another. Nasal polyps stand under its rubric; so do uterine polyps, and the reputation Clarke summarised as tending to reduce tumours and new growths.

Chest and Cough

Sanguinaria acts powerfully on the outer chest, sternum and breasts. In pneumonia, one accepted indication is a circumscribed burning in the chest, commonly followed by heat through the abdomen and diarrhoea; the picture is right-sided, the patient lies on the back with head elevated, sputum tough, rust-coloured, purulent, offensive, almost impossible to raise. Clarke recorded several cases of thick plugs of suffocating mucus which the patients were too weak to dislodge.

The cough has a well-defined tickling behind the sternum that causes a constant hacking. It is worse at night on lying down, worse on the right side, with burning pain in the chest as of hot steam extending down into the abdomen. Cough of gastric origin, relieved by eructation, distinguishes it from remedies whose cough is purely bronchial. And there is the post-influenza sequela: spasmodic cough after influenza, spasmodic cough after whooping cough (particularly in children), cough that returns with every fresh cold. Tracheal and bronchial coughs in epidemic influenza. Membranous croup and laryngitis, sometimes with aphonia; larynx dry and full in singers.

Hemoptysis from suppressed menses. Valvular disease with lung development, phosphates in the urine, loss of flesh. The tubercular affinity is real: circumscribed hectic flush, hopefulness, wasting.

Shoulder and Rheumatic Affinity

The right shoulder is the classical Sanguinaria joint. Rheumatism of the right shoulder, worse at night; cutting pain or stiffness in the right deltoid, worse raising or turning the arm; pain in the arm better swinging it to and fro — the patient cannot lift the arm to comb the hair, but can let it swing. Aching and swelling of the ball of the right thumb. Pain at the inner border of the right shoulder blade. This is one of the most reliable indications in the whole materia medica for a right-sided arthritis of the shoulder joint, and it appears in the older repertories under the rubric of frozen shoulder.

Metastasis of rheumatism or gout to the heart from outward applications is a warning Boericke records, worth remembering when a patient reports that suppression of a joint eruption preceded palpitations. Rheumatism of the left hip joint and nape of neck sits at the other end of the picture — the right-sidedness is a strong tendency, not an absolute rule.

Digestion

The stomach is a burning organ under Sanguinaria. Sinking, faint, all-gone feeling; burning in the stomach with headache and vomiting; nausea with salivation, not relieved by vomiting; vomiting of bitter water, of sour and acrid fluids, of worms, of ingesta. Sweet things aggravate and taste bitter. Craving for spicy things is a positive keynote. Aversion to butter, which leaves a sweetish taste.

Bilious headaches if the patient goes without food. Colic with torpor of the liver. Bilious, liquid, gushing diarrhea. Hiccough while smoking — one of those small, idiosyncratic modalities that occasionally decide a case. The gastric picture is often the hinge on which the whole case turns: cough that eructation relieves, headache that vomiting relieves, sick-headache that ends with a flush of urine and sleep. Pain over the region of the liver, jaundice, and the peculiar "liver-cough" all point at the hepatic affinity Boericke flagged in his opening remark — pulmonary disorders with liver involvement.

Female and Menopausal Sphere

At the menopause Sanguinaria comes into its own: flushes of heat rising into face and head, burning of the palms and soles worse under the covers, sore and enlarged breasts, humming and roaring in the ear painfully sensitive to sounds, headaches returning after years of quiet. Menses too early and offensive, bright red flow at first, later blood darker and less offensive; itching of the axillae before menses; leucorrhoea fetid and corrosive. Uterine polyps are among the growths this remedy has a reputation for reducing. Acne of young women with scanty menses.

Pain in the right breast to the shoulder, severe soreness under the right nipple, a hot streaming from the breast towards the liver — the right-sidedness is preserved even in the mammary sphere.

Skin

Heat and dryness. Prickling heat spreading over the body. Circumscribed red spots. Red, blotchy eruptions worse in spring. Acne with scanty menses. Scaly eruptions, carbuncles. Old indolent ulcers with callous borders and ichorous discharge. Sanguinaria antidotes poison ivy and Rhus poisoning, a small but reliable indication that keeps the remedy on the shelf of every practitioner working with rural or gardening patients.

A Case from the Record

One case from the older American literature, preserved in the compilations, illustrates the burning-in-the-stomach indication in its purest form. Mr. F., 48, of sanguino-bilious temperament, energetic and refined, had been ill with pains in the stomach for several months. A clairvoyant had recommended "a decoction of blood-root and bone-set in tablespoonful doses" — a piece of herbal prescribing in the drainage mode. Each dose produced intense burning pains in the stomach lasting for hours, and had to be discontinued. Weeks later, on consultation with a homeopath, the burning was still there: epigastric burning with pressure, worse at night, coming on soon after lying down and compelling the patient to rise. Belching gave no relief. Great appetite, torpid bowels, an unsatisfactory stool each morning leaving a sense of discomfort. A peculiar drawing pain in the shoulders and arms during sleep, so that when he woke his fists were tightly clenched and flexed on the sternal end of his clavicle, with lameness and weariness of the muscles.

Sang. 200C was chosen after careful comparison with Nux vomica and Graphites. One dose at bedtime. After the first dose the symptoms disappeared "like magic," and the patient was soon well.

The crude decoction produced the symptom; the dynamic preparation cured it. Tincture and 200C are two different medicines under one Latin name, and the case turns on that distinction. A second case, of a young woman of 19 with tinnitus, vertigo, sudden daytime flushings, frequent menses, leucorrhoea and jaw-angle pains dating back to a scarlatina three years earlier, ran on the same principle: a single dose of Sang. 200C cleared the whole picture, though the leucorrhoea briefly worsened first.

Modalities

Worse:

• motion; raising the arms; looking up
• touch; the right side generally
• light; sun; strong odours
• sweet things
• 3 a.m.; weekly, nightly, periodically
• menopause
• suppression of a catarrh

Better:

• acids and sour things
• vomiting; passing flatus
• cool air
• darkness; sleep
• lying on the back or on the left side
• hard pressure (for the headache)
• swinging the arm to and fro (for the shoulder pain)

Relationships

Complementary: Antimonium tartaricum, particularly where a rattling, mucous chest with sputum the patient is too weak to raise sits alongside the Sanguinaria stomach and shoulder.

Antidotes: Opium. Sanguinaria itself antidotes poison ivy.

Compatible: Belladonna in the scarlatina rashes.

Compare in the sick-headache group: Iris versicolor for periodic sick headache; Silica for the migraine that extends forward from the occiput and settles over the right eye; Spigelia for the same trajectory of pain; Sepia for menstrual headache with scanty flow (Sanguinaria's flow is profuse); Ignatia and Gelsemium for paroxysms of headache ending in profuse urination; China for headache better by hard pressure; Belladonna for right-sided, throbbing, congestive headache worse light and noise.

Compare in other spheres: Phosphorus for the sinking, all-gone stomach; Lycopodium for bilious, gushing diarrhoea; Lachesis and Ferrum metallicum among the flush-of-heat remedies; Chelidonium majus for the right-sided liver-lung remedy with pain under the right scapula and its own reputation for reducing tumors and polyps; Justicia adhatoda for bronchial catarrh, hoarseness and oversensitivity; Magnesia carbonica in rheumatism of the right deltoid.

Clinical Uses

Migraine

Right-sided periodic migraine beginning in the occiput and settling over the right eye is the Sanguinaria migraine, and it is one of the most recognisable pictures in the whole repertory. Weekly attacks. Rising with the sun, worst at noon, easing as evening comes. The paroxysm terminates in vomiting of food and bile, in sleep, in a copious flow of urine. Light and odours are intolerable; the sound of a footfall crossing the floor is enough to intensify the pain. Bilious headaches if the meal is missed. Menstrual headaches with profuse flow. The vintage American record favors 200C as a single dose at bedtime, awaited without repetition; 30C is common where the picture is only partial and the case is being investigated.

Frozen Shoulder and Right-Sided Rheumatism of the Deltoid

For the patient who cannot raise the arm to comb the hair or reach an overhead shelf but can let the arm swing, and whose pain is worse at night and worse on any attempt at active motion, Sanguinaria is one of the two or three first-line remedies to consider. The right shoulder is the classical seat. Cutting pain in the deltoid, aching and swelling of the ball of the thumb, pain at the inner border of the right shoulder blade, sometimes soreness of the nape on being touched. 30C two or three times a day for a subacute case; 200C less often, for a fixed chronic frozen shoulder in a patient whose totality otherwise fits.

Hay Fever, Allergic Rhinitis and Sinusitis

Rose-cold with subsequent asthma; coryza with hot lachrymation; membrane of the nose dry and congested; offensive yellow discharge in ozaena; sensitivity to the odour of flowers; sinusitis on the right side; pain at the root of the nose; loss or perversion of smell — these are the indications for Sanguinaria in the seasonal rhinitis picture. The clinching keynote is the sudden stoppage of catarrh followed by diarrhoea. 30C daily or twice daily through the season, adjusted to the response, is the usual working range; a single 200C where the picture is very clear and stable.

Menopausal Flushes

Flushes of heat rising into face and head, burning of palms and soles worse under the covers, painful enlarged breasts, humming and roaring in the ear, headaches returning after years of quiet, menses profuse and offensive — the vaso-motor storm of the menopause runs through Sanguinaria's whole clinical portrait. 30C or 200C intermittently, guided by the totality of the case, covers most working use.

Cough after Influenza or Whooping Cough

A spasmodic cough that will not clear after influenza or whooping cough, particularly in children, and that returns with every fresh cold, is a standing indication. Tickling behind the sternum, worse at night on lying down, worse on the right side, rust-coloured tenacious sputum almost impossible to raise. Compare in this territory with Antimonium tartaricum for the rattle and weakness, and Drosera for the barking whooping-cough remnant.

Frequently Asked Questions

What is Sanguinaria canadensis in homeopathy used for?

Sanguinaria is used for right-sided sick headache beginning at the occiput and settling over the right eye, for right-sided frozen shoulder and rheumatism of the deltoid, for menopausal flushes of heat, for hay fever with hot lachrymation and coryza that suddenly gives way to diarrhoea, for pneumonia on the right side with rust-coloured tenacious sputum, and for spasmodic cough after influenza or whooping cough. Burning heat in many parts, marked periodicity and right-sidedness run through the picture.

Is Sanguinaria the same as bloodroot supplements or bloodroot salve?

Only the Latin name is shared. Bloodroot in the crude form contains sanguinarine and other isoquinoline alkaloids, and has been implicated in serious toxicity, both as an oral tincture and, in the modern era, as a caustic escharotic salve applied to the skin. The homeopathic remedy at 30C and above contains none of these alkaloids and works on the totality of the case as a dynamic preparation. Herbal Ø and low decimals belong to real dosimetry, with pharmacology and toxicity that apply; classical potencies from 30C upward do not. The two prescribing registers should never be conflated in reading, in prescribing or in safety discussion.

What potency of Sanguinaria is used for migraine?

The older American record favours 200C as a single dose at bedtime, awaited without repetition unless the picture returns. 30C is common where the case is being investigated or the picture is only partial. The essential requirement is the totality — right-sided, occipital-to-right-eye, periodic, worse light and jar, better vomiting and sleep. The dose is subordinate to the simillimum.

How does Sanguinaria differ from Belladonna in right-sided headache?

Both are right-sided, throbbing, congestive, aggravated by light and noise. Belladonna's onset is sudden and violent, the face is bright red and hot, pupils often dilated, the mental state excited or delirious. Sanguinaria's headache is periodical, begins in the occiput and travels forward, is bound to the rhythm of the sun, ends with vomiting, sleep and copious urine, and carries the specific bilious modality — bilious headaches if the patient goes without food. Menopausal return of headaches, right-sided post-influenzal migraine, and rose-cold coincidence all favour Sanguinaria.

References

• Boericke W. Pocket Manual of Homoeopathic Materia Medica with Repertory. Reprint, B. Jain Publishers, New Delhi.
• Clarke JH. A Dictionary of Practical Materia Medica, Vol. III. Reprint, B. Jain Publishers, New Delhi.
• Hering C. The Guiding Symptoms of Our Materia Medica, Vol. IX. Philadelphia: Estate of Constantine Hering, 1891.
• Murphy R. Nature's Materia Medica, 3rd ed. Lotus Health Institute, 2007. Entry: Sanguinaria canadensis.
• Phatak SR. Materia Medica of Homoeopathic Medicines. B. Jain Publishers, New Delhi.