Bothrops lanceolatus

The New England Journal of Homeopathy
Fall/Winter 1999, Vol.8 No.2

By Paul Herscu ND, DHANP, MPH

When I think of Bothrops, I am reminded of a story that I read in college some years ago. It was of Damocles and his sword. As the story goes, Dionysius, the king, had a subject, Damocles, who lamented about how great it would be to be the rich and powerful, even for one day. Dionysius said great, come back and we will change places for a day.

The next day, Damocles arrived to a feast in his honor. He ate the best of foods, prepared by the finest chefs. He drank the finest wines, and enjoyed the greatest of jewels.

By chance, he looked up. He was shocked to find a very, very sharp sword hanging, point down, aimed straight at his head. It was held by a single horse’s hair.

Horrified, he asked Dionysius why it was there. The short version of the story has Dionysius share that all the rich and powerful had such a sword hanging over their heads. It was the difficult part, the responsibility, that came with the benefits of power. Needless to say, Damocles gave up his desire to be a king. Who can blame him?

The reason I am reminded of this myth has to do with a patient I consulted on several years ago. He was a man who, in the prime of his life, all of a sudden developed a pericarditis. With drugs it began to resolve only to return once more. This time, though, the cardiologist noted that he was beginning to have clots occlude his carotid arteries. With all the medical help he received, with all of the drug therapies he tried, the clots were simply becoming more numerous and larger. He had very little flow left going to his brain. They told him that there was nothing more they could do for him. They did not know why the drugs were not working. They had given up. It was only a matter of time until the blockage would get so large as to end this vibrant, young man’s life. And so he walked about, having this Sword of Damocles hanging over his head with the thinnest of hairs holding it in suspension, waiting for his time to run out. Luckily, Bothrops saved his life.

Bothrops is a remedy that is not well known to us. It has not had a proper proving and has not been used in a grand way, outside of a few types of situations. The reason we do not use it as often as we should has to do with the fact that it lacks known symptoms. In fact, in the repertory it is listed in only about eighty rubrics. That makes this remedy one of the smallest in our materia medica. It is thought of for specific clinical uses such as thrombi, strokes and heart attacks, during as well as after the attack.

It has such specific strong key symptoms in this sphere that the pathology actually leads to the remedy. And so it goes in our community. The remedy is given, it acts in some of these situations and we confirm its use, but we still do not have a good picture of the remedy.

By studying a number of my own patients that benefited greatly from using Bothrops, as well as from a handful of cases that I consulted with colleagues about, I was able to find common ideas, which lead to a Cycle of the remedy. In this article, I shall describe some of these key features and see if we can develop a fuller understanding of Bothrops.

The Cycle of this remedy as I see it is: Thrombi Formation, leading to Fullness which leads to Restlessness. The restlessness leads to Inflammation which is followed by Discharges like Bleeding. The bleeding leads to Weakness and finally to a kind of Paralysis which brings us back to the stuck sort of Segment of Thrombi Formation. Let’s go through Segment by Segment and see how this Cycle unfolds.

The first main idea or Segment is the tendency towards Thrombosis. As I mentioned, this is one of the main pathologies helped by this remedy. The physical pathology is only one example of a generalized thrombosis, a closing up. I have seen this tendency in many of my Bothrops patients. The easiest way to notice this, is to observe the paralytic effect on the face, mouth and eyes, where they are basically closed. This paralysis we will talk about further along in this article. The point is that the closing off nature is a very strong component of this remedy.

Interestingly, the emotions often show this closed, shut down tendency in Bothrops patients as well. One way to see it is in their obstinacy. Bothrops patients, may feel quite strongly about their opinions. This is not necessarily haughtiness or self-assuredness, it is more an issue of getting stuck in one way of being. Here, it could be confused with Calcarea carbonica, in obstinacy and even more so with Causticum, especially if there is also one-sided paralysis along with being strongly opinionated. It is this strong stubborn opinion that becomes problematic after a stroke. Bothrops should be added to the rubric, Mind, conscientious about trifles, in plain type.

After a stroke some people develop aphasia, as we will mention later. Here, the Bothrops patient wants to say something, but can not say it. They have the clear image of what they want to say but are unable to do so. They use a different word, but are troubled or tortured by the fact that they cannot say exactly what they want to say. Think about it. The main point of language is to communicate. For some of us, if we can put our point forth, if we can state our case, it may not matter what words we use. But that is not so with Bothrops. Even though they make their point, they will be dissatisfied because the exact word in their brain is not the word that comes out. It is a kind of obstinacy, not being satisfied with strictly making the point, in fact frustrated by not making it the way they want to. It is this dichotomy that disturbs them.

Sometimes, people that have surgeries and come out of anesthesia with these same symptoms. There is no clear diagnosis of a stroke and yet the symptoms persist. Think of Bothrops in this situation.

The thrombosis can be a clot in the leg, leading to a thrombophlebitis, with attendant symptoms. It can involve the heart and may lead to a pericarditis or a heart attack. But most often, for this remedy, we will see a thrombus in the brain leading to a stroke with major damage resulting. Interestingly enough, this tendency may become so strong, so intense that the patient may develop clots throughout his great vessels. I treated one man whose carotids were nearly occluded.

Of course, the most closed that this patient is, is when he or she is in a coma or unconscious during and after the stroke. If the symptoms match, Bothrops may be given at this time. Bothrops comas are serious comas; it is possible that without aggressive intensive care unit therapies, as well as giving this remedy, the patient may die.

Another place to see this tendency of thrombosis or closing off is in the feeling like the throat is closing off. This is a typical symptom of other remedies in the snake group and Bothrops has it as well.

Lastly, one may need this remedy for a patient who develops tremendous swelling and clotting in a wound which is purple and may remind one of Belladonna or Lachesis.

The pains may also be cramping off anywhere in the body.

The next Segment is Fullness, which accompanies the thrombi. For example, the patient may tell you that during the pericarditis, he felt like a great weight was sitting on his chest, stopping his heart. Fullness in the stomach aggravates him, fullness in the head, eyes, ears or the throat all are common symptoms of the remedy. Feeling full in the abdomen and not wearing tight things, just as seen with the clothing aggravation of Lycopodium or Lachesis are also common.

We then can see a Restlessness in this remedy. I think it is in part a discontentment with their state. This can happen before, during, and after the actual stroke. He may feel that there is something wrong with him. Who knows, maybe he can feel on a subconscious level that something bad is going to befall him. Surely after his first attack, he fears what will happen to him. He is dissatisfied with his situation. He feels all the little symptoms greatly and thinks he will die from his condition. This is not so much an anxiety panicky feeling, but rather an internalized knowledge that this is the truth about his current condition. He is doubtful of his recovery because he knows the seriousness of his condition.

The restlessness is seen at night, when he dreams of his condition, and of his fate. He tosses and turns and may wake up frequently from his sleep.

The restlessness is aggravating to this patient. One of the oldest key symptoms of this remedy is the aggravation by eating. His stroke may come on after a meal. Similarly, his pericarditis may be aggravated by a full meal. He may develop some shortness of breath after eating.

When the restlessness leads to excessive motion, as in getting up and exerting herself, it may eventually lead to fainting. So all in all we find the person, for one reason or another, not doing things yet being extremely dissatisfied internally with their health prospects and he becomes restless from that.

There is an Inflammatory element in this remedy, though it is much less than for other snake remedies. This remedy spends most of its time in the clotted stage. The inflammations may be seen in the localized area where the clots first developed. For example, the blood vessels may become inflamed, or the patient may develop pericarditis, or the leg may become inflamed from the phlebitis.

The easiest place to see the inflammatory aspect is in the pains. The pains are more severe and sharper than other remedies such as Lachesis. In fact, there is a keynote that the pains are so severe that they lead the patient to shiver. In truth, this shivering from pain is a rare symptom for the remedy, I mention it here to illustrate just how severe the sharp pains can be. More common is the fact that the pains are worse from motion, whether it be chest pain or a headache.

The most dangerous place to see this inflammatory portion of the remedy relates to blood pressure. Bothrops has a keynote of developing strokes from hypertension. But the bigger keynote is to develop high blood pressure after the stroke. It is as if the blood vessels changed in some way. As if due to some clogging, or due to some blockages, the blood pressure changed to accommodate the need for the blood. Now we find hypertension where there used to be none. Before understanding the inner workings of this remedy, this keynote alone had led me to prescribe this remedy early on in my practice, much to the benefit of my patients.

The face may be mottled, or dark red or purplish.

The inflammations may lead to Discharges. Bleeding is found in this remedy, though not as commonly as it is found in other snake remedies like Lachesis. Here, the bleeding is related to the clotting and is secondary to the coagulation which is the main problem. So even though there is bleeding mentioned in many locations, it rarely shows up in practice. Do not deny someone this remedy because they did not bleed enough, according to your readings. The thrombi is much more to the point!

Bleeding into the eye is a major symptom of the remedy. However, there are other remedies that have this symptom. And in fact, looking at all patients that have this symptom occurring, it is the minority that will benefit from Bothrops. However, Bothrops is one of the remedies. It can be used in diabetic retinopathy, with bleeding. It is a main remedy for people who bleed in the eye during a stroke. We also think of Bothrops in acute hypertensive crisis, leading to stroke.

Another form of discharge is the tendency towards loose stools and vomiting. I would like to talk about this tendency for a bit and compare it to Lachesis, which has the extreme, explosive, component more commonly, yet is balanced off by a strong tendency towards constipation. In Bothrops, we find the exact opposite; we see its strong tendency to clump or coagulate, which is balanced off by occasional loose stools and vomiting. While both remedies share these two poles, they spend most of their energy on opposite sides. In Bothrops patients, the vomiting is followed by intense weakness and lassitude.

This brings us to the next Segment: extreme Weakness which is manifested by both physical weakness and the mental confusion.

In the physical weakness, we find a tendency to faint from exertion. One person reported, “Since the stroke, I want to sleep all the time.” Another said, “I can’t function anymore… I have to sit all the time…I used to lift weights, I used to play professional sports. Now I cannot do anything with my body…I am so weak, I cannot eat.” Another person said, “I pass out if I get up to vacuum or clean the house. Faintness after a stroke, or with thrombi occluding major vessels are common characteristics. “Since the stroke, my blood pressure drops quickly and I faint,” is how one patient put it. During this time the heart beats feebly; the patient is also chilly, and has a pale, blue discoloration of the extremities. It feels like the heart is going to stop beating. “All you want to do is sit or lie down, and think on how your life is ending right here and now.” So here we have the opposite of the main keynote of the remedy, the hypertension.

The weakness is also seen in vertigo. They may be dizzy, especially when they exert themselves, as in rising from a chair, standing too long, or lifting. They feel faint with the dizziness and want to lie down.

The mental weakness has to do with being able to keep focus, especially soon after a stroke. The patient may be really disoriented and may take months to feel reoriented. The mind wanders, as does the speech. This is easy to see when you talk to some of these patients. Many tend to be quiet. But if you do get a patient that is answering you fully, you will notice that their speech wanders. This is also seen in Lachesis, but in Lachesis it is due to an intensity that cannot be contained, whereas in Bothrops it is seen when the mind is so weak that the thoughts lazily trail from one to the other. This is not the aphasia I am describing here, I will do that in the Paralysis section below. Here I am focusing on the weakening of the mind and body.

The patient may become more sleepy as well. Here it is not so much a narcolepsy, as much as the sleepiness found in post head trauma patients. It is a mixture of weakness, tiredness, and sleeping from weariness due to the trial of focusing and working the mind.

Paralysis is the segment that follows weakness and as such is another main idea for the remedy. The most prominent symptoms that fit here are the paralysis of the body seen in three different places. Keynote number one is the stroke that leads to true aphasia. Where some people have a difficulty moving their mouth, that is less the case with Bothrops. Here, the patient is able to move the mouth but they have lost the words they want to say. This is not so much the difficulty articulating, as is found in Crotalus cascavella, this is a paralysis of the brain, not of the tongue.

The way they deal with the paralysis of the brain, is to use the wrong words. They may get their idea across by using some words and by gesturing, but they use the wrong words. For example, instead of saying window, they say “that hole,” or instead of saying door they may say “that wood” and point in the direction of the object. They make their point, but not with the words that they wish. This leads to a paradox or a state of agitation, as they are stuck on the word they want to say. They may be as surprised at the word that comes out as the listener, but still they stick to the point. They may also try several words out to find the one they want, and even though they may try very hard, they may still not get it.

The second big keynote is the blindness. Bothrops is one of the main remedies that have blindness after stroke. There may or may not be a reason in the eye that accounts for this. There may, for example, be a hemorrhage in the eye, but the bigger keynote is that there is nothing that can be seen pathologically in the eye, yet the patient does not see. The symptom in the materia medica says that they are blind in daylight mostly. I have not seen this so much. Mostly, if they are blind, they are blind. Do not be misled by that symptom.

Lastly, the paralysis may be of a limb, the face or one side. The keynote from the old literature is that the paralysis is right-sided; while this is mostly true, I have clearly seen the paralysis on either side. There may be some paralysis of the throat as well, where the patient has difficulty and may even choke on swallowing.

I would like to make some final differentiating points between Bothrops, Lachesis, and Arnica. Towards Lachesis, let me say that many of the common symptoms of Lachesis may also be found in Bothrops. However, Bothrops tends to be more inward, more towards the closing, thrombi, chilly, whereas Lachesis is more excessive, intense and hot. One interesting tidbit is the fact that Lachesis craves oysters, while I have found several of my Bothrops patients crave all kinds of fish.

The differential with Arnica is an important one for several reasons, including the fact that because we know Arnica better, we give it more frequently. Arnica is also mentioned much more frequently in the materia medica and therapeutic books. I think the easiest way to differentiate the two has to do with the etiology. When the etiology is from the outside, the remedy is more likely to be Arnica. When the etiology is an internal process the remedy is more likely to be Bothrops. Sometimes, the etiology is an injury and the remedy is Bothrops; where the injury is the final push of a process that has been going on previously. The injury then creates or dislodges a thrombus and the rest of the symptoms ensue. Even though the etiology looked like an injury, really the person was developing this state before. So injuries that lead to a vascular accident of some sort and finally lead to blindness or paralysis should make one think of Bothrops.

Hopefully, this description of Bothrops will help to clarify and place into context the few but important symptoms of this remedy to make it easier to prescribe effectively. I would love to read about other practitioner’s experience with this remedy and with treating stroke patients, in general.