This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
Active Ingredient. - The properties of cocculus seem to be fully represented by its alkaloid cocculine, or picrotoxine, C12H1405. This substance crystallizes out of a clear solution in stellate bundles of colorless shining needles, free from water of crystallization. It is odorless, neutral in reaction, and bitter in taste; very highly soluble in alcohol; soluble in ether, amylic alcohol, and chloroform; also soluble in aqueous solutions of alkalies and of ammonia, and in concentrated acetic acid; but not very soluble in water.
Physiological Action. - The shell of the Anamirta seed is bitter and acrid; the seed itself is also very bitter. The substance of the seeds introduced into the stomachs of quadrupeds operates upon the spino-cerebral system in such a way as to cause trembling, tetanic convulsions, and insensibility, and in large doses becomes fatal. Deadly effects of a similar kind are induced by cocculus indicus in fish, whence it is employed as a fish-poison.
When cocculus is swallowed by man, its action appears to be exerted chiefly upon the muscles of volition. If used in the brewing of beer, as a substitute for hops (which is done by dishonest brewers, though prohibited by statute), it gives the drink more "bottom," and renders it more intoxicating. The intellectual faculties appear to be less influenced by it than the muscular powers. No chemical antidote is known, but, if taken in excessive quantity, relief appears to be given by acetic acid.
The poisonous action of picrotoxine is remarkable and important; leading to the belief that the abandonment of cocculus as a remedy by many physicians has been a singularly unwise step. There is a general resemblance to the phenomena of strychnine, but this is not so accurate as has been represented. Falck observed that fish made twisting and boring movements, with intervals of quiet swimming. Roeber found that frogs had violent tetanic convulsions, with intervals of stupor, and a notable protrusion of the belly from overfilling of the lung with air. Small doses, 1/30 to 1/15 of a grain, produced restlessness, weakness of movements, sinking in of the eyes, somnolence, occasionally a temporary loss of reflex irritability, which afterwards became active again, and, in fifteen minutes, attacks of opisthotonos (with distention of the belly), at intervals of half a minute, semicircular swimming movements, winding up with violent tonic spasms, and violent noisy expulsion of air from the mouth. Then came an interval of exhaustion, followed by emprosthotonos, and most singular movements of the hinder limbs. The attacks increased in number and severity, but death was not induced for several hours, sometimes not till after several days. The heart's action is slowed, or even stopped; during the tetanic spasms the capillaries are gorged. In experiments on mammalia there has been the same alternation of tonic and clonic convulsion, the latter frequently of the most singular but definite kind, as swimming, thrusting backwards and forwards, rolling over on the axis of the body, accompanied by great slowness of respiration and of heart-action. The pupils seem to be at first contracted, and afterwards dilated. After death, in mammalia, the meninges are always found engorged with blood, while the nervous centres themselves are either normal or anaemic; the vena3 cavae and the flaccid heart (especially the right side) are very full of dark blood; the lungs are also engorged, and present apoplectic spots, and there is a profusion of mucus in the mouth, throat, trachea, and bronchi. The main action of picrotoxine seems to be that of an excitant to the centres, especially the medulla oblongata. It is obvious that the motor centres, the vagus centres, and the centres for restraint of reflex movements, are powerfully affected. It has been experimentally proved that the convulsions can be excited in an animal from which the brain has been removed.
Therapeutic Action. - In medicine cocculus indicus has long been considered useful for the destruction of pediculi; also in certain skin diseases, such as porrigo, scabies, and ring-worm of the scalp; for all of which purposes it is best employed in the form of ointment. The last-named disease (tinea tonsurans) and ringworm of the body (or tinea cir-cinata) are both advantageously treated also with decoction of cocculus, the skin being well washed with common brown soap and hot water every night and morning, before the employment of it. If the ointment be preferred it should be prepared from the kernels alone.
In Vomiting, etc. - Cocculus indicus likewise possesses considerable value as a medicine for internal exhibition, - in certain forms of vomiting, for example, such as those which are accompanied by dull and heavy pain in the head, giddiness, and intolerance of light and sound. Vomitings of this class are sometimes very severe and persistent. In other patients there are alternations of constant nausea, with violent but ineffectual efforts to evacuate the stomach, the latter becoming so exceedingly irritable that no description of food can be endured. In either case cocculus is an efficient agent in allaying the symptoms, and seldom fails to give the relief so much desired. It is when the part primarily affected is the head (as indicated in the pains there felt, and in the giddiness), and stomach affections of the character spoken of ensue, that cocculus, by relieving the cephalic symptoms, removes the stomach affections which follow them.
In Dyspepsia. - Cocculus is likewise a valuable medicine in various forms of dyspepsia, and specially for employment in particular stages of that disorder. In cases where there is severe epigastric pain, aggravated by pressure, or by taking food, - and which are accompanied by flatulent distention of the stomach, and perhaps of the intestines generally, with nausea, giddiness, headache, dryness of the mouth, and a feeling of hunger, yet a repugnance towards food, - the same good results attend the exhibition. If not invariably successful, there is at all events great probability of relief being experienced.
Again, when the colon is distended with flatus; when the bowels are constipated, and the motions are more or less hard and lumpy, cocculus proves, in many cases, of singular service.
The same result ensues in those milder cases of tympanitis so often met with in the later stages of peritonitis, and frequently encountered also in enteric fever; here, as in the preceding, a few doses of the tincture of cocculus will often remove the pain, and relieve the distention. Colic is similarly amenable to the influence of cocculus, as are most other spasmodic affections of the stomach and bowels depending on flatulent distention of any of the abdominal viscera.
The good effects of cocculus are likewise seen during pregnancy. At this period the intestines are often much distended with flatus, and the patient suffers from frequent desire to urinate, referable in part to flatulent pressure on the bladder.
In Menstruation, etc. - Other affections to which women are subject, and which cocculus is able to mitigate, if not to subdue, are found among those which occur during the menstrual period. In females of nervous temperament, and of thin and delicate fabric of body, the menses are often preceded by certain paroxysmal pains of a colicky nature, felt in the hypogastric region, and accompanied by more or less pain in the back and hips. These pains not only precede the arrival of the catamenia, but accompany them for the first day or two. They are of a twisting, griping, or colicky character, and are attended by a scanty discharge, or by a profuse one, in either case somewhat paler perhaps than customary, and attended not uncommonly by clots or shreds. The administration of cocculus in these cases, commencing a few days prior to the expected flow, and continued during the first two or three days of its progress, will frequently ward off the pains, and render the discharge more natural.
Leucorrhcea is also treated advantageously with cocculus, especially when the discharge is of a sero-purulent character, and accompanied by pain in the lumbar region.
Chlorosis too, where the menses disappear for months together; or where the discharge takes place only at irregular and long-separated intervals, and is pale and scanty. Patients so conditioned often suffer from profuse and exhausting leucorrhoea between the periods; but by the employment of cocculus they may receive great benefit, and have the menses re-established and regulated.
Nervous Affections. - Cocculus is a very valuable medicine in various nervous affections, such as certain forms of hemiplegia, paraplegia, and paralytic stiffness, accompanied by a sense of heaviness, and by a loss of motor power in the lower limbs, with giddiness, and a feeling of lightness in the head. I have recently witnessed its good effects upon a patient who had suffered for several months from loss of power in the lower limbs, moving them only with considerable difficulty, and who, when standing erect, became giddy, disposed to be sick, and light-headed. This patient quite recovered through a few weeks' perseverance with the tincture.
Nervous affections, such as hysterical hemiplegia, choreic hemiplegia, and epileptic hemiplegia may likewise be usefully treated with cocculus. I have seen well-marked cases of hysterical paralysis - where the sensibility and the muscular power were both impaired - yield quickly to this drug; and cases, in particular, which have been accompanied by menstru-ous irregularities, and by spasms attacking different organs. Some of those epileptic cases which are attributable to onanism likewise derive benefit from cocculus.
Reil employed tincture of cocculus seeds in chorea; in hemiplegia arising from cold; and in paralysis of the sphincter vesicae; and in every instance with advantage to the patient.
Gubler recommends picrotoxine in chorea.
Tschudi recommends cocculus also in paralysis of the extremities, and of the sphincters; resorting, however, to picrotoxine.
Preparations And Dose. - None officinal. A tincture may be made of the usual strength (1 - 8), of which the dose would be from mij. - x. (.12 - .60). The dose of picrotoxine is from gr. 1/65 1/12 (.001 - .005).