New England School of Homeopathy

The Cycle of Vipera

The New England Journal of Homeopathy
Spring/Summer 1998, Vol.7 No.1

Paul Herscu ND, MPH, DHANP

So the story goes like this. It was about 11 years ago in the middle of the day. I was an hour late, had missed lunch, and had a long  list acute patients to call back. No point in even thinking about being home for dinner. Out in the waiting room was a woman with a box of kittens by her feet. I noticed that one of the woman’s legs was three times the size of the other. There was an infection around her knee and pus was pouring out of a large open abscess. It was in fact the worst looking skin infection I had ever seen.

She came really close and began to plead, “Please doctor, please, please, please. You have to help me.”

So, after backing away a little bit, I said, “Please come into my office.”

She brought her box of kittens, sat down and began to plead again. “Please, please, you have to help me. This is too serious, this is too awful.”

The whole time she spoke, my eyes were glued to her knee. I looked up at her and asked, “Well, what can I do for you?”

She began to cry. “This is too awful. I cannot bear it any longer.”

“Tell me all about it.”

“My cats,” she says. “My cats.” and she began to cry.

I was confused at this point. I looked at her, at her knee, at the cats, back at her knee and then at her. And I waited.

“My cats have feline leukemia. I have lost a few already but the rest are living together, they are all going to die.” She was crying.

I tried to settle her down and proceeded to take the case of half a dozen or so kittens. While I do not make it a practice to treat animals, I have on occasion treated pets of my patients if my patients asked me to do so, and if there are no vets available to them. I do it to help out, perhaps learn a thing or two in the process. In any case I always find it interesting but I never charge for this. After about an hour, I have settled on some remedies, which I gave to each of the kittens. No one remedy was more common than the others.

She grabbed my hand and pumped it in earnest, “Thank you doctor. Thank you, thank you.”

She was about to leave and all of the sudden, to my surprise, I blurted out, “I couldn’t help but notice your leg.”

“Oh yeah,” she says. “I have had this infection for so long. It just keeps on spreading, no matter what antibiotic I use.”

I convinced her to sit down and tell me a little about her leg. It was swollen, pus was oozing out, and the skin was a mottled mix of yellow, blue, and purple. She said it throbbed and whenever she put her leg down it felt like it was going to explode.

I give her Vipera and she left.

A while later she called me up. In an excited voice she said, “Thank you doctor, thank you. You are a miracle worker. Thank you. I can hardly believe it.”

I was excited, thinking of all the possibilities.

She said, “Thank you. One cat died but all the rest are doing very well – healthy again and doing great. Thank you. Good bye.”

I jumped in, “Wait a minute. How’s your leg?”

“Oh yeah. It’s doing great, too. The pus stopped, the skin fell off and new skin is growing, the pains stopped. Well, good bye.”

I followed her progress for several months but never changed the remedy.

It was not the first time I used this remedy, but it was one of the quickest prescriptions, made on the fly, for a most amusing scenario! Most of the time, though, we need to use this remedy the patient is suffering greatly and in need of significant help, unlike the kitten lover in this story.

Vipera shares many symptoms with other snake remedies, but unfortunately has been relegated to infrequent use, with Lachesis often overprescribed. For us, the challenge is to figure out which remedy is best indicated in each case.

So, how can we do this? I would like to  invite you to share a method that has helped me to understand the fullest expression of a remedy, a method which encompasses all aspects of the study of materia medica. It also flushes out the remedy picture by showing the many ways in which a patient can manifest an illness. This technique can be applied to any remedy, whether a new one you’re grappling with or an older one you may have never completely understood.

By combing several models, including a systems view (developed for a totally different field by Jay Forester at MIT), I have created a model of health and disease. I call the model Cycles & Segments. The full cycle enables you to see the entire pattern of a patient’s illness and the segments within the cycle group the material medica information into units of related symptoms. We not only develop a clear perception of what goes wrong in the health of an individual, but we can also understand the unfolding of a remedy, the pattern of evolution of a remedy, both in the proving and the materia medica. Essentially, this method allows the ability to describe the reasons for and paths taken in the process of developing an illness. It then describes the cycle in a way as to fit all patients that need that remedy. By taking this approach, we can easily perceive the differences and similarities between Vipera and other close remedies: Lachesis, Pulsatilla, and Hamamelis.

A fuller description of my process of developing and studying materia medica and my thoughts about health and illness are described in the first half of my book Stramonium. You will also find there a good introduction to the ideas of studying materia medica through the ideas of cycles and segments. Here we will examine that same process for Vipera, looking first at the symptoms which group together under the respective segments and then at how each segment leads naturally to the next. In the complete cycle, we can see how patients develop patterns of pathology and need a remedy matching the same pattern to help them move beyond the cycle in which they are stuck.

You can start at any point (any segment) in the studying of a cycle. I have numbered them but there is no rule about where to start. Similarly, once the right prescription is given, the patient can break into their cycle of illness at any point, as they begin their path towards healing.

The Cycle of Vipera is as follows:

1. Release: Bleeding/Perspiration/Urination/Vomiting
2. Prostration/Weakness
3. Stuckness/Closed Up
4. Swelling
5. Inflammation/Festering/Tenderness/Pain

1. The Release Segment:

Like all the snakes remedies, Vipera has the tendency towards release, especially towards bleeding. Other forms of release include: excess vomiting, perspiration, and urination.

The bleeding comes from a number of causes and focuses on various locations: the nose, gums, bladder or uterus. It relieves congestion, which, on some level is a benefit for the person. This point is often missed in materia medica study. The way I see health and disease, I believe every symptom accomplishes something for the patient. Vipera’s bleeding relieves the tension, congestion and painful swelling for which the remedy is well known.

While bleeding is the most common mechanism of solving the problem of  congestion, there are others. Vomiting, for example, occurs during times of stress and anxiety, from pain, injury or the suffering that comes with a severe infection. For example, in the feverish, weak patient with an infected of a limb, which has the characteristic painful swollen sensation, the vomiting can follow intense times of feeling swollen. You might also think of Vipera for a patient with a serious infection, who has a headache that is relieved by vomiting.

Perspiration is yet another mechanism that will help relieve the congestion. The patient is generally unable to perspire during the infection, and this lack of perspiration may lead one to mistakenly choose Belladonna . But remember this symptom – if the patient can perspire, the fever and headache will be relieved.

The same theme is present in which Vipera shares the keynote of having a headache, ameliorated by urination, as in Ignatia amara and Gelsemium. As pressure builds in the head, urination, perspiration, and/or vomiting will all somewhat ameliorate the headache.

It seems to be that our mechanisms of helping ourselves often overshoot, and when they do, they transform our strengths into weaknesses. You can see this in  Vipera, when the bleeding, vomiting or perspiring go on and on until they eventually aggravate, in some way, the patient. For example, the swelling and weakness of the venous circulation lead to excess bleeding, which if unchecked, results in blood which becomes black, dark, and thin. This can also be true of the menses, where the blood is dark and may be clotted.

Another example of overshooting can be seen near the site of an injury, when the skin turns black and blue, and the surrounding skin is mottled. Eventually the top layers of skin may fall off. Or an injury that begins to ulcerate and produce pus – it may show little inclination to heal. The vomiting may continue to the point that the patient begins to vomit bile and stomach acid.

Every segment in the cycle of the disorder should and often does contain symptoms spread out throughout the patient’s life. In this segment of “Release”, the discharges are not only physical, but also emotional. As the fever rages or as the patient gets excited, he may become delirious and quite discontented, wanting to move from here to there.  He may only move his limb but as the disorder becomes more severe, he will start pacing, yelling at you or at anyone to do something to help him. As a point of comparison, however, the Vipera patient is not as active as the Lachesis is in similar circumstances for the symptoms of the excitement are more on the physical plane whereas, in Lachesis they may be more in the emotional sphere.

2. Prostration/Weakness Segment:

This tendency for release and discharge overshoots until the patient becomes weak from it. Weakness a common complaint for this remedy and those who need it. We see the weakness most prominently after there has been a great loss of blood or other discharge. A weakening of the heart can be seen in the chronic Vipera patients with the heart beating weakly and the pulse becomes so thin that it cannot be felt lower down on the forearm, where  acupuncturists take the pulse.

Another etiology for exhaustion is after excitement. We can find this extreme prostration when the patient has discharged by screaming, expressing great anxiety, or when intense pain has been ongoing.

In Vipera, the extremities feel and look as if the blood will not circulate properly. They are bluish, mottled and cold to the touch. The weakness manifests in the formation of varicosities due to the poor tone of the veins. In the legs, valves of the veins fail one after another. The patient will say her legs feel ‘tired’ as if she has been on them for many hours and needs to prop them up.

Actually, the chronic Vipera patient, feels a generalized deep tiredness and an intense weakness. They feel beat up and just want to go home and lie down and get their feet up to counter the tired, dragging sensation.  This is reminiscent of Sepia, a remedy commonly mistaken for Vipera. The weakness aspect is so common to the Vipera  pathology, that it is this aspect which helps to differentiate it from Lachesis, whose pathology centers on excess.

In this state of depletion, the patient feels hopeless, like she may die from her infection. She lacks the intense hysteria of Lachesis, having instead a feeling that the pains and fever are so severe and they will not be able to make it.

Utter prostration is also seen in some post stroke patients. There are several characteristics to the stroke of Vipera. First, is the mottled color of the skin, which makes us confuse it with Opium, and just to add to our confusion, the patient may be unconscious. Paralysis and numbness of the extremities as well as the mottled, bluish, cold limbs, described above, can follow. There may even be facial paralysis or paresis of the tongue, which can make it difficult to speak – though this is more commonly found in Lachesis or Crotalus cascavella. There may also be a slowness or a weakness in the ability to focus or concentrate. They stop caring about all aspects of their world, which again points to Sepia as a possible remedy, but Vipera will surpass Sepia in bringing the brightness back to the patient.

One of the biggest clues to differentiate these two remedies involves temperature. The weakness of Sepia causes them to become chilly, and to like warmth in any situation. Exactly the opposite is true for Vipera. Here, the laxity and the weakness, the dull indifference to life is stimulated by the cold. This is because heat further vasodilates the vessels, further pools the fluids, further increases the stress on the heart, thus aggravating the patient. Therefore, when we have what clearly looks like a Sepia patient but she is aggravated by heat and the main pathology rests in the veins or blood vessels, most especially on the veins, it is more likely Vipera.

3. Stuckness/Closed Up Segment:

In order to stem the prostration and weakness caused by over-release, Vipera will begin to close up. It has the tendency to feel too open, just like Phosphorus or other remedies which share this segment of excess discharge. (The study of comparative material medica when we work with Cycles and Segments is nicely illustrated by overlapping segments which fit in to unique cycles.) As such, they feel exposed, or weakened, hence developing the desire to close off, to protect themselves. We see this in many ways in the Vipera patient, for example, in the desire for and ability to create closed off structures like tumors and lumps, most especially in the uterus and breast.

Even the skin eruptions are generally not flat but appear as raised pimples or vesicles and are listed in the materia medica as scarring which is thickened and keloid-like. I have found this to be true. The skin eruptions often become infected  around the site of injury, starting out as reddish blisters and eventually turn dusky blue as the initial site becomes gangrenous and  pus-filled.

The most well known irregular vasculature is found in phlebitis or thrombi, which can cause stroke. Those vessels which are visible from the outside may appear blotchy and lumpy, while the overlying skin looks unevenly vesseled.  I have used this remedy successfully in treating phlebitis. I have often wondered why any given remedy seems to be successful in curing any disease in particular, but the cycle/segment model shows how phlebitis or any other problem follows the same pattern seen in the rest of the remedy.

When there is prostration following profuse release, in the form of swelling and bleeding, it is not surprising that the body finds a way of holding on, in order to curb the release. Thus, fluid and tension build in the legs to the point that the legs can hardly be bent.

I have also observed a tightness in the chest with the breathing. Due to so much constriction, they may feel like they cannot catch their breath at all. At times, this is because of tension in the chest. At other times it is because they have air hunger due to anemia.

Perhaps one of most interesting and defining points of the remedy, is that because they feel somehow exposed and unsafe in a too hurtful or too exhausting world, they feel a need to hole up or close off. In the language of the materia medica they ‘want to go home’. I have observed the strong need to be home and to be protected from hurt in patients who need Vipera both acutely and chronically.

4.  Swelling Segment:

In the effort to close off so as to diminish the weakness caused by excess discharge, they again overshoot the mark. What results from this excessive closing off is terrific swelling, involving the lymph channels and the veins. This is where we find our most famous keynote of Vipera. The swelling is a direct byproduct of the weakness, especially weakness of the veins, as described above. Thus we see varicose veins so swollen and pulsating that they feel like they will explode, especially when the limb hangs down. It is found quite often in the chronic Vipera patient, especially women, and in pregnant women who suffer with the most excruciating varicosities. Here the careful differentiation is needed among Pulsatilla, Hamamelis, Belladonna, and Calcarea carbonica , as they all share this symptom. What will be marked, though, is the mottled nature of the skin of the legs, as in Pulsatilla. She will want to go home, stay home, and not really interact with the outside world. While many of these women do well with Pulsatilla and Calcarea carbonica and other more common remedies, some do not.. Think about Vipera for these women.

Swelling may occur in other places as well, for instance, we may see the pregnant woman whose face swells. Or the swelling may be more internal, with feelings of fullness in the chest, abdomen or stomach. If this is marked in the patient, they will hate tight clothing and will remove it as in Lachesis.

The swelling in the chronic Vipera patient, is often due to a slight or sometimes severe weakness of the heart. The weakness leads to fluid accumulation that cannot fight gravity, so the gravity makes the fluid pool in parts that hang down, below the level of the heart, ie. the limbs.

The materia medica emphasizes the swelling of the liver as being a key symptom of the remedy. While it fits this cycle and actually quite nicely, I have not seen even one patient with this symptom. I assume, from reading of the effects of the actual Viper venom, that the swelling relates more to a major hemorrhage and attendant destruction of the blood cells, leading to a hemolytic hepatitis, but I have not seen this symptom in a patient and I mention it here simply to put that symptom in perspective.

Humidity and heat aggravate the Vipera patient, so the more she walks in the heat, the more tired and heavy her legs feel, and the more it feels like her heart is working overtime.

5. Inflammation/Festering/Tenderness/Pain Segment:

This swelling in Vipera invariably leads to inflammation of the swollen area. This can be seen in a phlebitis or deep vein thrombosis in which the leg becomes red and feels hot and swollen. This can also be seen in Staphlycoccal or Streptococcal skin infections which are red and abscessed. The skin forms pustules and will eventually peels off.

Mentioned in the materia medica, but rarely seen in practice is black skin and gangrene and parts falling off and dying. However antibiotics and hygiene have kept the typical Vipera patient from going to this end stage. The exception is in accidental amputations and in diabetics.

When varicose veins become engorged and stagnant, they can inflame upon the slightest injury. The legs become warm, purplish blue and throb until they feel as if they will explode. This gets much worse when the patient stands and much better when she lies down with her legs elevated, or when she puts her legs in cool water.

One other inflammation that is not usually thought of for this remedy is severe gastroenteritis. Here the abdomen swells and is full, the mouth becomes dry and the tongue looks burned, dry and discolored. The patient does not want to eat anything and may have vomiting or more characteristically, diarrhea that is offensive and dark. Ice cold water settles the stomach temporarily, but then the complaint returns, which makes us mistakenly prescribe, Phosphorous, a remedy that also bleeds and shares these symptoms in gastroenteritis.

Largely because of what is found in the old literature, we have seen this remedy as a vascular remedy, and neglected its efficacy in the treatment of injuries. In fact, injury is a common etiologic factor for this remedy. In such instances we will see broken blood vessels in the injured area or sometimes, vascular insufficiency with pain at the local inflammation. I have treated patients who have broken bones in the extremities with terrific pain, bursting pains, worse hanging down, where homeopaths have tried remedies for injuries, blows, breaks etc., but it was Vipera which did the trick.

So keep Vipera in the back of your mind when treating patients with injuries of various sorts. The first time I ever gave this remedy was to a twenty year old young man who came in with a cast on his leg and foot, having broken several bones. He had excruciating pain when the casted foot was not elevated. Vipera was his remedy and quickly offered relief.

Vipera can also be used in cases of amputations, either accidental or else planned, due to underlying severe chronic disease, such as uncontrolled diabetes. When diabetic patients have a toe or two amputated due to damaged blood vessels, the recuperative time and the complications can be extensive. It is then Vipera has worked well to address the pain, swelling and mottled skin.

I have also treated patients whose fingers or toes have been crushed and/or amputated in a severe accident. Even when the repair seems to have gone well, the pain can be intense and unrelenting and the swelling and discoloration, extreme. While Arnica or Hypericum are often of great help, Vipera is a wonderful remedy which should not be overlooked.

Injuries due to the bite of animals like snakes or dogs may also respond to this remedy. Another use for Vipera is in a case due to an injury or infection which begins at a site of unhealthy skin. Staphylococcal and Streptococcal infections of the skin that are severe, as mentioned below, reflect this occurrence. The affected site becomes swollen, mottled, dark colored and may bleed continuously.

We can add Vipera to our differential of remedies for injuries that do not heal. For example, I gave Vipera to a young woman who suffered a bad puncture wound that became infected and was quite painful, worse hanging down. Vipera also comes to mind when an injury cannot heal because of damaged blood vessels which limit circulation to the part in question. I once treated an older diabetic patient who had two toes amputated. The wound would not heal and the man went into a delirious state from the pain, the shock, the diabetes, and the pain killers. All this was quickly reversed with Vipera and his foot went on to heal nicely.

Lastly, the remedy is useful for skin inflammations that may end with the skin falling away. Uniquely, it will peel off in sheets, especially on the legs, to be replaced by new skin.

The most important keynote of this remedy is the pain when letting the limb hang down. Patients may express it is by saying that they feel like that area will explode, from all the throbbing and pressure. It has been compared to a bike tire that is too full and will pop. While this mostly refers to the lower limbs, in reality it should be thought of for the hands as well. Very commonly an injured finger will have sharp pains, throbbing and the feeling like it will explode, when it is hanging down. While not well represented in the materia medica, Vipera should be strongly thought of in this situation.

In abscesses and other skin infections there is a sensitivity to touch which causes sharp pains. Here, it is very important to differentiate Vipera from Hypericum. While Hypericum is the main remedy many consider for crushed and injured extremities, I actually think of Vipera just as often. Both will have the sharp pains. Both will have the injury to the nerve. But think back to your cases where  Hypericum did not help the injury, or did not help as much as you would have expected. If that injured part looked mottled, if it got inflamed quickly and if there was intense throbbing, most especially when the injured site was dependent, then Vipera was probably a better choice. The pains have the same stitching quality that we find in Hypericum, but if you combine the throbbing of Belladonna, with the amelioration from cold water and ice of Pulsatilla injuries, (another remedy often neglected for injuries and skin infections) you will arrive at Vipera.

The most similar remedy to Vipera is however, not Pulsatilla, but actually Hamamelis, which shares a similar cycle but for completely different reasons.

Inflammation is not limited to the physical realm. Patients may develop a type of emotional inflammation – a highly anxious state. This can occur when an injury causes excessive pain. The patient tosses and turns, even screams from the pain and cannot be calmed down. Fever often accompanies the state, and if the pain is severe, the patient may become delirious. In this delirium, the patient may look like they need Belladonna, but Belladonna’s delirium is much more active with lots of thrashing and excitement. The Vipera patient is more likely to show confusion. Another possible differentiation is with Baptesia, though the smell is more offensive in Baptesia. Vipera should be added to many rubrics but most importantly to the rubric: Fever, Inflammatory.

Another characteristic symptoms has to do with the color of the skin at the site of injury. The skin starts out mottled, with livid and white areas, and next to it pink, and next to that, purple, in a marbled pattern. This happens not only in wide areas around an injury but also in the legs or hands – the dependent parts. Next to the injury, we find the parts becoming more bluish and purplish and swollen, really angry looking skin, with yellowish spots. In diabetics, I have found this condition in gangrenous toes.

With the inflammation, festering, and tenderness, our cycle of Vipera, is complete. Now the cycle begins again with releasing or discharging in order to gain relief from the swelling and inflammation. So we see how the patient becomes trapped in this cyclical pattern of illness.

The following brief vignette illustrates the way a person may present who needs Vipera.

Alice is a 38 year old woman who is pregnant with her fourth child. She comes in for the problem which has occurred in each pregnancy, painful varicose veins. Her legs feel tired and there is a dull aching pain that gets progressively worse as the pregnancy progresses. The veins are aggravated when the patient is on her feet and much improved when she elevates her then. When her legs are down they feel full and begin to throb, most especially in her ankles, calves and behind her knees. If she is on her feet for a long period of time, she gets pains that travel up her leg to her lower lumbar and sacral areas of her back. It feels as if she is wearing stockings up to her knees. She also feels a deep weakness or fatigue in her thighs, as if she had done extensive exercise. Her feet are hot and during pregnancy, she sticks them out of the covers when she sleeps.

Her reproductive history has been difficult. She had had difficulty conceiving, due to a hormonal imbalance or perhaps because she had several uterine fibroids. She has also had five miscarriages. She has had ovarian cysts on both sides. During her pregnancies she has always developed a candidal vaginitis with copious discharge.

She complains of a headache, in which she feels a dull throbbing in her head, as well as fullness behind her eyes.

When she is pregnant, her energy drops. She loses her spontaneity, has less ‘get up and go’ and more desire to stay home and not do much. She says she is shy by nature and hates to do any sort of public speaking. “I even worry about people getting close to me, physically.” She doesn’t want to do anything around the house either. She prefers to lie down and maybe sleep some more.

There were many symptoms and keynotes of other remedies, some of which she had already tried. Vipera was given and helped her tremendously. The leg pains, headaches, low energy and vaginitis all resolved quickly and did not return. More importantly, her personality emerged and she was able to feel comfort with people for the first time in a long time. After a year, or so, she needed Natrum muriaticum which helped make her fibroid tumors asymptomatic.


While Vipera, like most remedies, has many symptoms, it is good to try to make sense of the symptoms, as they relate to each other. What I look for is a pattern of the disease. I ask myself, what is it that creates this disorder in this remedy? The cycle & segments model provides a mechanism for finding a pattern. One thing that helps me find a pattern is to look for the ways in which having this disease not only helps the patient but also can become their downfall. For example, because motion aggravates the Vipera condition, the patient is stuck where she is – if she is away from home then getting home becomes painful. The upside is that if she is already home she can stay there, cocooned and walled off, away from the world she finds so painful and intolerable. As the patient moves from each segment of the cycle to the next, the mechanism used to achieve what she wants, overshoots and leads her into the next set of problems. When the swelling becomes too great and needs some sort of resolution, that is when the bleeding and pus come, etc. In this way, the cycle repeats itself, affecting different aspects of the physical and emotional body, as it passes through each segment.

To Read More About Cycles & Segments, click here