Colocynthis.
The dried, peeled pulp of the fruit of Citrullus Colocynthis (Linné,) Schrader. (Nat. Ord. Cucurbitaceae.) Mediterranean basin of Europe, Asia, and Africa. Dose, 1 to 5 grains.
Common Names: Colocynth, Bitter Apple, Bitter Cucumber, Colocynth Pulp.
Principal Constituent.—The bitter active glucoside colocynthin (C56H34O23)
Preparation.—Specific Medicine Colocynth. Dose, 1/30 to 5 drops.
Specific Indications.—Pain of a cutting, twisting, boring, or tearing character, and if of the bowels, a desire to go to stool; visceral neuralgia, with cutting pain; dysentery, with tormina, and small passages of mucus, or diarrhoea with mucoid passages . and intense cutting pain; colicky pains anywhere in the abdomen (minute doses); distressing accumulations of gas; constipation with dry scybala and griping pain in the lower bowel (larger doses).
Action.—Colocynth is a decided local irritant. In small doses it is a stomachic bitter, exciting an increased flow of gastric juice. In even moderate doses it is a violent hydragogue cathartic, producing copious watery evacuations, and sometimes violent emesis, tormina, and bloody stools. It may cause death from gastro-enteritis. The powder or the tincture applied to a raw surface or to the abdomen will purge as if given by the mouth. Colocynth, in small doses, increases the renal function.
Therapy.—Colocynth is a powerful hydragogue cathartic, but is seldom employed as such in Eclectic practice. Except in minute doses it should not be given alone, at least never to the extent of causing purging. It is commonly administered with other cathartics in pill form, the compound extract of colocynth being preferred, and its violence controlled by hyoscyamus or belladonna. When so employed it is usually in melancholia and hypochondriasis with sluggish hepatic and intestinal action, with large fecal accumulations; and sometimes to produce local pelvic effects and thereby stimulate menstruation in atonic amenorrhoea. It has been largely employed in ascites from all causes, but while actively cathartic, it is less desirable than some other hydragogue cathartics. It should never be so used in the aged and where there is great debility or gastro-intestinal inflammation. It is very rarely employed in Eclectic therapy for dropsical effusions.
Specifically, colocynth is a remedy for visceral pain of a sharp, colicky character-cutting, darting, cramping, or tearing pain. The fractional dose only should be used. In sharp "belly ache" attending stomach and bowel disorders, colocynth is splendidly effective when the patient feels cold, weak and faint, and the pain is so great as to cause him to flex his body upon his thighs. Even when neuralgic or rheumatoid, such a condition is promptly relieved by colocynth.
In atonic dyspepsia, with bitter taste, bitter yellow eructations, bloating after eating, with sharp, griping or cutting pain in the umbilical region minute doses give excellent results. When gaseous accumulations cause disturbances of breathing, or cardiac palpitation, with loud belching and expulsion of flatus, and nausea and vomiting are present, colocynth should be given with prospects of prompt relief. ℞. Specific Medicine Colocynth (1 x dilution), 1-10 drops; Water, 4 fluidounces. Mix. Sig.: One teaspoonful every 3 or 4 hours. Where there is a lack of normal secretion 5 drops of tincture of capsicum may be added to the mixture.
With similar symptoms minute doses act well in cholera infantum; in chronic diarrhoea with slimy stools and tympanites; in diarrhoea from overeating or improper food; and in dysentery with great tormina, tenesmus and cutting pain, with ineffectual efforts at stool it is one of the most certain of agents to relieve. In intestinal and hepatic torpor, with bloating and dry scybalous stools it should be given in somewhat larger doses (1/4 to 1 drop of Specific Medicine Colocynth). When persistent headache depends upon the stomach and bowel perversions named above it is often corrected by colocynth. In that form of lumbago and sometimes pressure sciatica, due to gaseous accumulations in the bowels, colocynth, capsicum, and bryonia should be considered. The dose should not be large enough to purge.
Colocynth is useful in neuralgia of the viscera in the parts supplied by the splanchnic nerves, as neuralgic colic. Other nerve endings seem to respond to it, for it relieves ovarian neuralgia, orchialgia, and sometimes neuralgia of the fifth nerve, when the characteristic cutting pain prevails. It should be given also when colicky pain precedes or accompanies amenorrhoea.
