Podophyllum.
The dried rhizome and roots of Podophyllum peltatum, Linné (Nat. Ord. Berberidaceae). Rich woods and thickets of North America. Dose, 5 to 30 grains.
Common Names: May Apple, Mandrake, Lemon Apple, Wild Lemon, Raccoon Berry.
Principal Constituents.—Resin of podophyllum (see below) and podophyllic acid, a coloring substance; podophyllotoxin, the purgative principle of the resin exists free in the rhizome.
Preparations.—1. Specific Medicine Podophyllum. Dose, 1/10 to 30 drops; fractional doses preferred.
2. Elixir Podophylli, Elixir of Podophyllum. Dose, ½ to 1 fluidrachm.
Derivative.—Resina Podophylli, Resin of Podophyllum (Podophyllin). A light brown to greenish-yellow, amorphous powder turning darker when heated above 77û F, or when exposed to light. It has a faint peculiar odor and feebly bitter taste. It is very irritating to the conjunctivae and to other mucous membranes. Soluble in alcohol, chloroform and ether. It consists chiefly of the purgative principle podophyllotoxin mixed with podophyllic acid (80 per cent), other minor resins, and a yellow, coloring body, podophylloquercitin. Resin of podophyllum was first isolated and used by Dr. John King. Dose, 1/30 to ½ grain.
Preparation.—Trituratio Podophylli, Trituration of Podophyllin (1 to 100). Dose, 5 to 10 grains.
Specific Indications.—I. Podophyllum. Podophyllum is specifically indicated by fullness of tissues, and particularly by fullness of superficial veins; oppressed full pulse; dirty yellowish coating of tongue and dizziness. It is contraindicated by pinched features and tissues, contracted skin and tongue.
II. Resin of Podophyllum (Podophyllin). Podophyllin is specifically indicated by fullness of tissues, fullness of veins, sodden, expression-less countenance, dizziness, tongue coated dirty yellowish-white, heavy headaches, indisposition to bodily exertion, intestinal atony, with sense of weight and fullness, full open pulse; "pain deep in ischiatic notches;" and as an ideal cholagogue; clay-colored stools, floating upon water; stools, hard, dry, and accompanied by distended abdomen and colicky pain. It is contraindicated by pinched features, and small, wiry pulse, or when the pulse has a sharp stroke.
Action and Toxicology.—Applied continuously podophyllum and its resin cause irritation and suppuration of the skin and subcutaneous tissues; inhaled they provoke sneezing and violent coryza, and drug workers handling either are sometimes affected with conjunctival inflammation. The green rhizome or large doses of the dried drug (30 to 60 grains), or its resin, produces violent emeto-catharsis and gastro-enteritis. Smaller doses are cathartic; and doses short of catharsis induce ptyalism. Hence the names once applied—"vegetable mercury" and "vegetable calomel". Both undoubtedly increase the secretion of bile, notwithstanding the many statements to the contrary. This is most apt to occur from the small dose which stimulates, and less likely from a drastic dose which hurries the drug through the intestinal canal. Even the latter is said to cause a flow of biliary secretion, probably by emptying the duodenum and producing a derivative effect. All the intestinal glands are stimulated by podophyllum; and the catharsis, like that from jalap, is slow, sometimes from ten to twelve hours (podophyllin, four to ten), and even a day elapsing before purgation takes place. Then it is likely to persist several days and if the dose be large to occasion debilitating hydro-catharsis. Very little tormina is caused by them compared with the thoroughness of their action. This may be prevented, in a measure, by administration with leptandra, hyoscyamus or belladonna and aromatic carminatives, such as ginger, cloves, etc. When the resin is precipitated by alum in its preparation, it is more apt to gripe; common salt intensifies its action and cream of tartar increases the hydragogue effect; alkalies favorably modify or check its activity. Podophyllin (resin of podophyllum) is correspondingly more energetic than the parent drug. The evacuations of podophyllum purgation are copious, prolonged, and dark or bile-stained in color.
Overdoses of podophyllum, or its resin, produce hyper-emesis, drastic hyper-catharsis, with griping and tormina, and large doses have caused death by gastro-enteritis. Even moderate doses, when contraindicated, occasion painful and griping irritation and inflammation.
Therapy.—I. Podophyllum. Podophyllum is a certain but slow cathartic; it is also. alterative. Unlike most strong cathartics the effects are quite permanent and the tone of the intestines improved. It may be used in nearly all cases in which podophyllin is useful, though there are some conditions where the former gives better results than the latter. (Compare to Resina Podophylli). These conditions we will briefly notice. It is conceded that as an alterative it is infinitely more decided in its action than the resin. It exerts a strong influence upon the glandular system. Associated with proper hygienic measures and the indicated tonics and other alterative drugs, it will give good results as an aid to elimination of broken-down products in the secondary phase of syphilis, in so-called chronic rheumatism and in scrofula. The dose should be small, not sufficient to produce any marked intestinal activity. In stomach troubles, podophyllum is often superior to podophyllin. It acts as a gentle stimulant tonic, improves the appetite, and is particularly valuable in atonic dyspepsia, gastric and intestinal catarrh, and atonic forms of indigestion, when the patient complains of dizziness, loss of appetite, and heavy headache. There is indisposition to exertion, the movements being heavy and sluggish, the tongue is dirty and flabby, and the superficial veins, abdomen, and tissues in general are characterized by fullness. Its action on the liver renders it particularly serviceable where gastric disturbances are due to hepatic torpor. In stomach disorders, hydrastis, nux vomica and other tonics and peptics may also be indicated and associated with this drug. Podophyllum, iris, chionanthus and chelidonium are excellent agents for that rarely occurring affection, chronic hepatitis. By its slow and thorough action, yet permanent in its effects in restoring and maintaining the normal hepatic and intestinal secretions, podophyllum is one of the very best agents to overcome habitual constipation, and more especially if it be due to portal engorgement. The small dose should be given and continued until the evacuations become regular and normal. Formerly this drug was much employed in bilious, remittent and intermittent fevers. Cathartic and sometimes emeto-cathartic doses were employed with the result of producing so profound an impression on the hepatic function and on the portal circle and general glandular system that, it is asserted, the disease was often aborted, or at least rendered milder and of short duration. It is never so employed at the present day. When at the inception of fevers a cathartic is needed, which, however, is not often, specific medicine podophyllum may be combined with compound syrup of rhubarb and potassa (neutralizing cordial), or to render it milder, lobelia, ipecac, leptandra, hyoscyamus or belladonna may be administered with it. Though rarely now used as a cathartic in dropsy, if selected at all, it should be given with cream of tartar. Further uses of this drug are identical with those of podophyllin, some preferring to employ interchangeably one for the other for the purposes named here and under Podophyllin. The usual medicinal dose of specific medicine podophyllum ranges from one to ten drops. Dose of the powdered root (almost never used), as a cathartic, from ten to thirty grains; of the tincture, from ten to sixty drops; as a sialagogue and alterative, from one to five grains of the powder, or from one to ten drops of the tincture.
II. Resin of Podophyllum (Podophyllin). Podophyllin possesses the cathartic properties of the crude drug in an exalted degree. While it is slow in action, it is certain in its results. Some persons are so susceptible to the action of the drug, that a dose of one-half grain will actively purge them. The ordinary cathartic dose of this resin generally requires from four to ten hours to act, but this action is quite persistent, often producing copious alvine discharges for one to two days, and when over leaves the intestines in a normal condition, seldom being followed by the after constipation so common from the use of ordinary purgatives. As with the crude drug the cathartic action of podophyllin is increased by common salt. From four to eight grains operate as an active emeto-cathartic, with griping, nausea, prostration, and watery stools; from two to four grains, as a drastic cathartic, with nausea and griping; from one-half to two grains generally operate as an active cathartic, leaving the bowels in a soluble condition; in very small doses, it is gently aperient and alterative. In doses of one-half or one grain, it is one of our most valuable cholagogue cathartics, operating mildly, yet effectually and very persistently arousing the biliary and digestive apparatus to a normal action. It also exerts a favorable influence on the cutaneous functions, producing and maintaining a constant moisture on the skin. In doses of from one-eighth to one-half grain, or rather in doses insufficient to purge, it is strongly but quietly alterative, and will induce ptyalism in some persons. This drug should not be given in bulk, but should be combined with ginger, hyoscyamus, leptandra, or some form of alkali, which renders it less liable to nauseate or gripe. Should catharsis be too severe, an alkaline solution, with aromatics, by mouth, will check it. A popular and good method of preparation is that of triturating it with milk sugar (lactin). This not only obviates, to a certain extent, its irritant action, but singularly increases its purgative qualities. During its administration, all articles of food difficult of digestion should be avoided. According to Locke podophyllin prepared by alum water is apt to gripe. Eclectics long made use of this resin in cases where mercurials were used by other practitioners, and found the result vastly in favor of resin of podophyllum. It appeared to fulfill all the purgative indications, at least, for which mercurials were recommended and used.
It is not, however, for its cathartic use that podophyllin is most valued by the Eclectic profession, but rather for its specific effect when given in small doses. Properly administered it is a stimulant to the sympathetic nervous system, acting principally upon the parts supplied by the solar plexus. It improves digestion and blood-making and stimulates normal excretion. For its action upon the liver, repeated small doses of the trituration (1 to 100), or a daily pill of podophyllin (1/20 grain) and hydrastin (¼ grain) is much to be preferred to its cathartic dose. It should be given in the same manner when its action on the pancreas and spleen is desired.
The value of podophyllin in small doses, in gastric and intestinal disorders, has not been as well appreciated as it deserves to be. It has a specific action on forms of stomach and bowel trouble with atony, characterized by full and relaxed tissues, with mucous discharge. The case is never one of loss of function from irritability, but from atony. In the summer disorders of children, especially cholera infantum, it often will be indicated, and is quick to restore normal action when the bowels are loose, with passages of mucoid, slimy material. The movements of the child are sluggish, the tongue is coated a dirty yellowish-white, the superficial veins are full, and the countenance is dull and expressionless. In chronic types of disease, associated with feeble digestive power, which is but little improved by the ordinary stomach tonic, this drug renders excellent service. The trouble is usually atony of the upper part of the small intestines, and the stimulant dose of triturated podophyllin corrects the difficulty. Podophyllin is a favorite anti-constipation remedy. It is equally valuable in costiveness of the young child and in the aged. In very young babies this trouble will yield to: Rx Podophyllin (2 x trit.), 30 grains; Brown Sugar, 2 drachms; Water, 4 fluidounces. Mix. Sig.: Teaspoonful four times a day. For adults the daily use of from one to two of the podophyllin and hydrastin pills (1/20 and ¼ grain) will generally be sufficient to gradually overcome the trouble. The cathartic dose should never be employed for the relief of constipation, or when a cholagogue action is required. When the stools are hard and grayish-white or clay-colored, and float upon water, the remedy is especially effective, as it is also in dry stools, with tympanitic abdomen and wandering, colicky pains. Flatulent colic of children, when associated with constipation, will readily yield to small doses of this drug, while as a remedy for dysentery and both acute and chronic diarrhea, all of the recurring type and accompanied by portal sluggishness and hepatic torpor, few remedies will excel it. Dyspepsia, with atony and thickened mucous membranes secreting abundantly, calls for stimulant doses of podophyllin. The head feels full, the tissues and veins appear full and doughy, the skin is sodden, and a dirty coating covers the tongue from tip to base. Rx Podophyllin, 1/20 grain, three times a day. Cardialgia, accompanied by constipation, sometimes yields to the trituration (1 to 100).
This drug has been justly valued in hepatic disorders. In that state ordinarily known as "biliousness," this drug or specific medicine iris can usually be depended upon. Indeed, they act well in combination. There is dizziness, a bitter taste, the stools show an absence of bile, and greenish, bitter material is vomited. Podophyllin is often indicated in both acute and chronic hepatitis, though usually contraindicated in inflammations of the gastro-intestinal tract. Fullness—in the region of the liver, with aching under the scapulae and in the back of the neck, with dizziness, usually calls for this drug. In catarrhal jaundice with clay-colored stools it may be alternated with chionanthus. In the unpleasantness attendant upon the retention or passage of biliary calculi, and in mild forms of cholecystitis a purge of podophyllin may assist in relieving distressing symptoms or in aiding the passage of the concretions. It is not, however, a drug to be relied upon unaided, either for a cure or to remove the calculi, but rather to improve the secretion and elimination of bile. When indicated there is great pain in the region of the gall bladder coursing to the left and downward. Sometimes there is constipation, as often diarrhea. There is a bad taste, and the patient is jaundiced. Rx Podophyllin, 2 grains, at night, followed in the morning with a large quantity of olive oil. In hemorrhoids, dependent on biliary insufficiency with portal inactivity, it may be given in alternation with sulphur, the podophyllin being particularly desired when there is constipation with tenesmus. The small dose alone is required, from 1/20 to 1/10 grain, three or four times a day.
Podophyllin may give good service in cough accompanied by bronchorrhea, especially if it be associated with gastric catarrh. Here minute doses of sulphur are also valuable. In heart disease, when aggravated by hepatic inactivity and portal torpor, the cardiac remedy may be rendered more efficient if associated with minute doses of this drug. It has long been recognized as serviceable in the rheumatic diathesis, when the patient is sallow and inactive, presents fullness of tissue, and complains of dull pain and heaviness in the right hypochondrium. In renal disorders, when the general specific indications for its use are present, it will usually restore the secretory power of the kidneys.
Podophyllin has long enjoyed the reputation of exerting a powerful action upon the lymphatic glandular system. It acts quietly but effectively as an alterative, one of the best in the whole domain of medicine, at the same time aiding and improving the digestive process. It was formerly, and is still with many, a favorite remedy in secondary and tertiary syphilis as an eliminant of broken-down material. Ellingwood declares it a good remedy for persistent pustular conditions, eczema, and cracked or fissured skin.
Podophyllin is a remedy for pain, according to Scudder--deep-seated pain in the ischiatic notches. It has served a good purpose in inflammations (when not of the digestive tract), accompanied by great constipation. Here the cathartic action is required, as it is also in the forming stage of febrile diseases, with the exception of typhoid fever, in which it is not to be commended, notwithstanding it was a prominent medicine in the so-called Woodbridge and other supposed abortive forms of treatment for enteric fever. In malarial cachexia, small doses of podophyllin may be alternated, or given with cinchona or quinine. For all of the preceding uses medicine podophyllum may also be used, but the dose must be correspondingly larger. For the gastric disorders many prefer it to the resin. Younkin advises cathartic doses (⅙ grain, every two hours, ten grains of potassium bitartrate) for the relief of gonorrheal epididymitis. The dose of podophyllin, as a cathartic, is from ½ to 2 grains; as an alterative and stimulant, 1 /100 to 1/10 grain; as a cholagogue, 1/20 to 1/10 grain. A good form in most disorders requiring the small dose, is the following: Rx Podophyllin Trituration (1 to 100), 5-30 grains; Water, 4 fluidounces. Dose, one teaspoonful every one to three hours.
