The physiological action of China is probably identical with that of its main alkaloid, quinin, and in this discussion the two will be considered to be identical. The finer differences between the two agents are apparent, only when the symptomatology of the respective drugs is studied.

China is a protoplasmic poison, affecting such forms of life as the malarial parasite, the microbes of putrefaction, spermatozoa and ova. Amebae are destroyed and the movements of ciliated organisms become slow and finally stop. China has antiseptic powers. Lactic, butyric and alcoholic fermentations are retarded or prevented.

Upon the alimentary tract, China causes an increase in the salivary and gastric secretions, as the result of reflexes. For the time being, it increases the appetite and promotes digestion. Soon, however, the gastric and pancreatic ferments are less active. Pepsin, rennin and trypsin are retarded in their activity and the absorption of foods is not so rapid. This interference with these enzymes is probably the cause of the indications for China in certain dyspeptic conditions.

China affects the blood. In vitro, the normal changes in the form and the position of the leukocytes are stopped; they disintegrate. If the mesentery of a frog is slightly irritated, so as to produce an inflammatory reaction, and if quinin is then applied, the leukocytes do not accumulate in the tissues as they otherwise would. If quinin is applied after such irritation, diapedesis is at once arrested. The leukocytes, especially the polynuclears, assume a spheroid form and their number is diminished. Quinin is negatively chemo-tactic. The leukocytes cannot collect to form pus. Little effect upon the red cells is observed. They may be increased in number. That the oxidizing action of the blood is interfered with, is shown by the fact that blood to which the drug has been added, fails to decolorize indigo. The coagulation of the blood is retarded; but the hemoglobin is uninfluenced.

Quinin affects the heart and circulation. The first effect is to produce a contraction of the arterioles and a quicker heart action; later on, dilatation of the vessels occurs, with a slower and weaker heart action. The vasoconstriction leads to a higher blood pressure. It is noted that these are effects directly upon the muscle.

In the ear, 'the following changes are noticed: deafness of varying degrees; ringing in the ears and perhaps permanent impairment of hearing. These results are due to degenerative changes in the ganglia in the cochlea.

The possible effects upon the eye are as follows: diminished acuteness of vision; defective color vision; dilated pupil; contracted field of vision; temporary blindness; atrophy of the optic nerve; in the fundus, there may be observed contraction of the retinal arteries, anemia of the retina and thrombosis of the central vein. These various effects are attributed to an action of the drug upon the ganglionic structures.

China slightly stimulates and then depresses the respiration.

The cerebrum is stimulated by small doses. Certain people become mildly exhilarated. Large doses cause heaviness, depression, confusion, vertigo and difficulty in speaking.

The voluntary muscles are affected by quinin. The strength of the contractions may be increased six times, by moderate doses; but the muscle is more quickly fatigued than is the normal muscle and the total amount of work is less. This is a direct muscular effect. Smooth muscle is not so surely affected, with the exception of the arterioles of the spleen.

When labor has already commenced, quinin stimulates uterine contractions.

The tone is increased; that this is a direct muscular effect, is proven by the fact that even the excised organ is acted upon in this way. In such cases, quinin never causes tetanic contractions of the uterus, as does ergot or pituitrin. It simply strengthens the usual, intermittent, expulsive contractions which take place in labor. Upon the metabolism, the following changes are noted: the excretion of nitrogen is at first increased, but later is greatly decreased. This is a result of the profoundly depressing action of the quinin on the elimination of all the nitrogenous excretions, especially urea and uric acid. The same amount of nitrogenous food may be absorbed, but less is consumed, a procedure which causes a storing up of proteins. This effect is opposite to that of fever, which is associated with excessive protein destruction. The normal temperature is slightly lowered; occasionally a slight rise is the result. Small doses cause this slight rise and larger doses cause a fall. In febrile conditions, China is a decided antipyretic. This is not due to any change in the central nervous system, since it occurs after division of the spinal cord. China, therefore, does not exert this action through the heat regulating center. The fall in temperature is due to lessened production of heat, since less heat is generated because of the lessened destruction of proteid. The drug lowers the temperature of malarial fever, simply by killing the parasite which causes this disease.

In the liver, China causes a depression of the glycogenic function. Less sugar is supplied to the blood.

The function of the spleen is depressed and this organ undergoes contraction.

Therapeutics

The keynote, or great characteristic of this remedy, is found in its relation to the effects of vital depletion, especially loss of blood. Hemorrhage followed by fainting, prostration, ringing in the ears, will indicate this remedy. It suits intermittent complaints with an every-other-day periodicity, such as malarial fevers where the stages of chill, fever and sweat are well marked and distinct. In such conditions, there is great thirst after the chill and during the sweating period.

In general, drenching sweats will be relieved by China when they occur from the least exertion, or at night, and are the result of weakness or depletion. China patients are oversensitive to drafts, to cold air and to light touch or pressure, but firm hard pressure relieves many of the symptoms.

Indigestion, when flatulence is a prominent symptom, with eructations of gas which give no relief, will frequently require this remedy. The liver and spleen may be enlarged, particularly in malarial complaints, and the formation of gallstones is common. Bitter taste is present and desire for dainties and sweets. Diarrhea, which is entirely painless, is characteristic, the stools being dark, watery and of foul odor, and occurring after eating especially.

Bursting, throbbing headaches, especially in conditions of anemia due to the loss of vital fluids, when there is a sensation as though the brain were swashing to and fro, will be relieved by China.

The face of the China patient is usually sickly and pale, with dark circles about the eyes. The menses are dark, clotted and profuse.

Neuralgic affections having a malarial basis and in which the pain is decidedly aggravated by drafts or by light touch, are met by China. The weakness caused by excessive or prolonged lactation, as well as that brought about by seminal losses, will be benefited by this medicine.

Anemic states in general will often require china, when some of the above characteristic symptoms are present and when such anemia is due to loss of vital fluids, blood especially.

Characteristic Symptoms Of Cinchona

1. Intense throbbing headache after excessive hemorrhage.

2. Periodical prosopalgia, pains excessive, skin sensitive to touch, mostly infra-orbital and maxillary branches.

3. Uncomfortable distension of the abdomen with a desire to belch, or a sensation in the abdomen as if it were packed full, not in the least relieved by eructation.

4. After eating fruit, undigested stools pass involuntarily.

5. Diarrhea with undigested stools; immediately after eating.

6. Black stools, thin and watery; great prostration; no pain.

7. Cough with granular expectoration during the day or in the evening; not at night or in the morning.

8. Profuse, debilitating night sweats.

9. Debility or other complaints after loss of blood, and other fluids, particularly from nursing, salivation, hemorrhoids, etc., or leucorrhea, night sweats, seminal emission, onanism, etc. 10. Hemorrhage of dark clotted blood from nose and other parts, in anemic subject, with ringing in the ears, great weakness, etc.