While many remedies are useful in the treatment of painful uterine contractions, only two have been shown to produce contractions at regular intervals simulating labor. Both were introduced into homeopathy from American Indian medicine, and both are still used primarily for complaints of or in relation to the female reproductive cycles of pregnancy, childbirth, and menstruation. Because their symptom pictures closely resemble two major subtypes of dysfunctional labor, they are also useful standards against which other possible remedies can be measured, and can reasonably be tried when other more specific indications are lacking.
Tincture of the root, Caulophyllum thalictroides, N. O. Berberidaceae, blue cohosh or "squaw root."
1. UTERINE DYSFUNCTION
The muscle fibers of the mammalian uterus have the unique ability to relax isometrically at their contracted length, such that each contraction further reduces the volume of the organ. In labor, rhythmic contractions of this type, centered in the fundus or upper segment, accomplish the splendid athletic feats of effacing the lower segment, dilating the cervix, and pushing the baby into, through, and out of the vagina. After labor, similar contractions expel the placenta and any remaining clots and placental fragments, compress the decidual vessels, and thus minimize further blood loss.
The symptomatology of CAULOPHYLLUM is dominated by abnormal uterine contractions of an easily recognizable type. While often extremely painful and distressing to the patient, they are centered primarily in the lower segment, and tend to be sharp and spasmodic in character, brief in duration, and very unstable, often flitting about or into the bladder, groins, and thighs. Above all, they fail to dilate the cervix, which remains thick and spasmodically closed, and in emptying the uterus, which reverts after each contraction to its former length, like any other muscle.
Such contractions are commonly seen in prolonged or difficult labors that get "stuck" in the dilatation phase, when the vaginal exam reveals so little objective progress that it feels awkward to have to break this news. In such cases, both midwife and patient may have been misled by the intense pain and accompanying exhaustion to conclude that the labor was progressing normally.
2. MUSCULAR WEAKNESS AND NERVOUS EXCITEMENT.
Almost invariably, the contractions of CAULOPHYLLUM are associated with a sense of marked weakness or muscular exhaustion, sometimes to the point that the patient can hardly move or speak. At the same time, there is usually evidence of trembling, shivering, or some other form of nervous excitement, such as retching or vomiting. In both respects, its closest analogue is GELSEMIUM, which often succeeds where CAULOPHYLLUM seems indicated but does not help
3. NEURALGIC AND ARTHRITIC PAINS.
CAULOPHYLLUM can also relieve neuralgias in various locations, especially the bladder, vagina, and intestines. Like the uterine pains, these too are short, sharp, spasmodic, and tend to fly about from place to place. The remedy also has a rheumatic tendency, and can be helpful for pain, swelling, and stiffness in muscles and in the smaller joints (e.g., fingers, toes).
4. MISCELLANEOUS SYMPTOMS.
Weakness and excessive relaxation of muscles and supporting structures may affect the suspensory ligaments of the uterus to the point of actual prolapse. Occasionally the remedy has produced or relieved an irritating vaginitis with profuse discharge.