Graphites

Source
This remedy is prepared from powdered graphite, black lead or plumbago, a
mineral carbon containing traces of iron. Rather surprisingly, considering its
medicinally inert source, the remedy in potency has a very wide range of
therapeutic usefulness. Hahnemann obtained his preparations from 'the purest
black-lead taken from a fine English pencil'.
Pharmacology
An affinity with skin and nails leads to malnutrition and a variety of skin
eruptions; an affinity with connective tissue tends to fibrosis and also the
deposition of adipose material. Other affinities are with mucous membranes and
By nph nodes, inducing inflammatory or hypertrophic lesions.
Proving
A pathogenesis of Graphites appeared in the first volume of Hahnemann's
Chronic Diseases.
Appearance
The usual picture is of a gross, obese, but at the same time poorly- nourished
individual with a pale puffy look reminiscent of Calcarea Carb. The face is
described as having a pale, waxy, sickly hue.
Children appear flabby and florid, often with seborrhoeic scalp and unhealthy
eyelids. Adults look anaemic with pale lips and a tendency to easy flushing.
The skin is thickened, dry and liable to show cracks or fissures, especially at the
fingertips and mucocutaneous junctions. Nails are likely to be thickened, dark in
colour and fissured.
 Psychology
The sphere of the emotions is profoundly affected under this remedy, especially
in the case of adults.
Children are 'not at all awed in the presence of the doctor; prowl around
manhandling charts, instruments, anything within reach, and ignoring parental
admonitions'.
The adult is anxious, restless, apprehensive, full of fearful forebodings which
cannot be stilled; regards himself as unlucky and ill-used.
Is weepy, sad, despondent, full of self-pity, at times preoccupied with thoughts of
death. Gets rattled with the children; dreads and avoids mental effort; is affected
by music, even to tears; weeps on least pretext or for no reason at all.
Moods vary; often quite cheerful in the morning but shows agitation, impatience,
irritability, especially over trifles, in the late afternoon and evening.
Is extremely irresolute and quite unable to make a decision.
Thought processes are sluggish and memory is poor, especially for recent events.
There is utter lack of zest for any form of activity, and this may almost take the
form of catalepsy.
There is a desire for solitude because is annoyed by everybody. May get really
mad and fly into a rage, but is also easily consoled.
Physiology
The Graphites subject is extremely chilly and sensitive to the least draught of cold
air, but also averse to great heat and feels oppressed in a hot stuffy atmosphere.
Craves air, like Carbo Veg. and Pulsatilla. Feels cold both indoors and in the open,
and desires to be warmly clad. The face may be flushed and hot, with at the same
time icy cold hands and feet.
The appetite is often ravenous with a constant urge to eat, for a feeling of ease
rather than from genuine hunger. There is desire for beer, acid drinks and cold
fluids - which may disagree. There is distaste for sweets, meat, salt, fish, cooked
foods. Fat cannot be taken with impunity; sweets may cause nausea.
There is a violent thirst in the morning with a dry mouth. This is in contrast to
Pulsatilla with its characteristic lack of thirst.
Drowsiness by day is followed by sleeplessness at night, often accompanied by
pulsations all over the body, especially in the first part of the night. Keeps
constantly waking and feels unrefreshed in the morning.
Sweats readily on least exertion; night sweats are very profuse; the sweat stains
linen yellow; foot sweats are offensive.
Symptomatology
General
There is a tendency to the sudden onset of weakness and exhaustion, with a
desire to lie down. Dropsical conditions may develop. Offensive odour of breath,
sweat and discharges is noticeable. There is a great liability to skin eruptions,
small pimples which come and go and are often worse during menstruation, or
moist eruptions with a viscid discharge. Pains may be burning in nature, or
complaint may be made of numb sensations. Symptoms tend to be left-sided.
Head
A sensation may be felt of cobwebs on the face or forehead, unaltered by
attempts to brush them off. This rather curious symptom is shared also by
Alumina, Baryta Carb. and Borax. Alopecia is common, in shiny bald patches. Scalp
is itchy and there is much scurf which disappears on washing the hair. Eczema
occurs on the scalp with massive dirty crusts which mat the hair; the scalp is sore
and tender to the touch. Sebaceous cysts may be present. Vertigo occurs readily
on looking upwards, or when rising from stooping. It causes a feeling as if would
fall forward and is accompanied by a desire to lie down for relief. A unilateral
headache is described with tearing pain extending to teeth and neck; it is present
on waking and is accompanied by nausea and a desire to vomit; the head feels
numb and torpid, as if the contents of the skull were made of pith. A constrictive
pain occurs in the occiput extending to the nape, and the neck feels 'broken'.
Headaches are aggravated in a warm room and better in the open air. There may
be a surge of blood to the head region accompanied by faintness and possibly
epistaxis. A burning spot is felt on the vertex.
Eyes
Excessive lachrymation is accompanied by extreme photophobia in bright
sunlight or intense artificial light. Inflammation of the lids is associated with
fissures at the lateral canthi. Fissures at the medial canthi point to Zinc. Edges of
the lids are pale and thickened, in contrast to Sulphur blepharitis with red rims.
The lids often show cracks covered with scales; they tend to adhere with dried
discharge on the eyelashes. Styes may be present. Cysts occur on the lid border.
The lids feel heavy. Conjunctivitis is associated with a thin acrid discharge from
eyes and nose. Dacryocystitis may occur with intense itching. Vision may be
disturbed at the menstrual period. Zigzags may be seen before the eyes. Acute
eye conditions often call for Pulsatilla; in chronic conditions Graphites is indicated.
Ears
Deafness occurs, associated with tinnitus. Often hears better in a noise, e.g. of
traffic. May notice his own voice, or the sound of his own footsteps, reverberating
in his ears. (Causticum shares this last symptom). Ears 'crackle' on moving the
jaws or on swallowing. Chronic otitis media is associated with a thin offensive
discharge. Eczema may be present on and behind the external ear with a very
sticky type of discharge.
Respiratory system
Nose is often sore inside, and blowing the nose is painful. Nose is often red, and
nostrils are fissured with formation of crusts. Nose becomes obstructed with
badly-smelling mucus. Eczema occurs on alae nasi and upper lip. The sense of
smell is affected variously; it may be very acute so that the scent of flowers is
unbearable; it may be lost altogether; or odours may be imagined. Acute sneezing
with fluent coryza may occur, or chronic rhinitis with dryness of mucosa and
formation of crusts, clinkers and cracks. A chronic sore throat is described with a
choking feeling as from a lump in the throat which causes a constant desire to
swallow, but attempts to do so only increase the distress. Spasmodic asthma
attacks wake from sleep, and the chest feels narrow and constricted; taking some
food affords relief. Paroxysms of coughing occur, ending in copious expectoration
of white viscid mucus.
Alimentary system
Burning blisters occur on the edges and tip of the tongue. There is a bad taste in
the mouth as if eggs had been eaten. The gums burn, sting and recede. Cracks
form at the corners of the mouth, possibly with ulceration. The tongue is whitish,
sore, often ulcerated. Salivation may be inopportune; dribbles during sleep, but in
spite of this the mouth is very dry on waking. Stomach pain occurs some hours
after taking food; it is gnawing or colicky and accompanied by heartburn and
eructations, which are sour or rancid and taste of food previously ingested. The
pain is relieved by taking food or drink, especially warm milk. It is also better by
lying down. Food is sometimes vomited soon after being taken. There may be a
feeling of nausea, worse in the morning and also worse at the menstrual period.
With an acute attack of pain the patient may experience a very horrible, sudden
sensation of extreme weakness - as if about to pass out. This may, of course, be
due to haemorrhage with accompanying haematemesis or subsequent melaena.
When treated with this remedy, duodenal ulcers revealed by X-rays are often
shown in subsequent X-rays to be well healed. Acute attacks of heartburn are at
times accompanied by a feeling of intense heat in stomach and throat, causing a
desire for cold drinks. As a rule, however, cold food and cold fluids aggravate the
symptoms.
Great distension of the abdomen may be present and associated with much
belching, which does not relieve the bloating. Vomiting gives relief. A good deal of
flatus is passed and is offensive in odour. By comparison the flatus passed in a
Lycopodium case is odourless. Constipation occurs, the stools being large, hard,
knotty and covered with mucus, or in hard lumps connected by threads of viscid
mucus. There may also be attacks of diarrhoea with fluid, brown, ill-digested and
very offensive stools. Piles burn and sting. Anal Assure may be present, causing
sharp pains after stool or on sitting. The anus may be sore and sensitive to touch.
Pruritus ani is worse at night. The liver may be congested, swollen, hard and sore,
accompanied by a sense of weight in the right hypochondrium. A burning
sensation is felt in the left hypochondrium if attempting to lie on that side.
Lymphatic and Glandular Systems Cervical and other lymph nodes become
enlarged and painful. Breasts become large and hard, especially during the
menstrual period. Indurations are felt in the breast, often resulting from previous
sepsis. Pain may be felt in the left breast at the menstrual period. Nipples become
cracked and sore. Secretion of milk may occur before or during the menstrual
period.
Cardiovascular system
Sudden 'shocks' are felt in the heart, associated with a feeling of constriction,
palpitation and strong pulsations all over the body. Oedema of feet and legs may
be present.
Urinary system
Urine is turbid with a sediment either white or red in colour; on standing an
iridescent film forms on the surface. An urgent desire to urinate may occur soon
after emptying the bladder. The urine may be passed drop by drop. Nocturia is
frequent, or enuresis may occur at night.
Genital system
Disturbances of sexual function may occur in the male. Menstrual periods may be
accompanied by hoarseness of voice, with or without nasal coryza and cough. The
period may be delayed and the flow scanty and pale. It is liable to be associated
with belching and gastric distress relieved by taking food. Severe pruritus vulvae
may precede the period. Leucorrhoea occurs both before and after the period;
the flow is profuse, milky, white, excoriating and comes in gushes both during the
day and at night. Pain may be felt in the uterus when reaching up to grasp
something at a height. Pain may be felt in the left ovary when taking a deep
breath, when coughing or on pressure over the left iliac fossa.
Nervous system
Limbs easily 'go to sleep' with complaint of numbness, dead feeling and coldness
of fingers and forearms. Muscular weakness may progress to virtual paralysis with
a cataleptic condition - is conscious but unable to move or speak.
 Locomotor system
Pain may be felt in the nape, extending to the shoulders. Lumbo-sacral region is
subject to pulling, shooting, burning pains which are worse before midnight and
also tend to be worse during or after the menstrual period. Pain in the lumbar
region may be described as a sensation as if the spine were broken. Pain may be
felt in sacrum and coccyx while urinating. Shooting pains may occur in the limbs,
accompanied by a paralysed feeling, especially affecting the left upper limb.
Skin
The skin is unhealthy; wounds and scratches tend to become septic and take a
long time to heal. Oozy, moist eruptions exude a thick, glutinous, viscid, honey-
coloured fluid; the areas most likely to be affected are flexures, the dorsal aspect
of hands and forearms, the external auditory canal, and behind the external ear,
face and chin. Similar eruptions may occur at the orifices and on the external
genitals. Cracks and fissures itch and bleed and are painful; these are liable to
occur at the tips of the fingers, the nipples, the angles of the mouth, the vulva,
the anus and between the toes. Itching is severe, worse at night, from heat and
contact with water; it is relieved by cold. This is in contrast to the pruritus of
Petroleum and Psorinum, which is aggravated in cold weather. Unaffected areas
of skin are dry and rough. Old scars tend to burn; palms likewise. Skin of hands is
tense and hard and liable to form cracks in winter. Psoriasis may be present on
the palms. Nails become brittle, cracked, distorted, thickened and may blacken
and fall off. Indolent ulcers have an indurated base and a very offensive discharge.
Smarting soreness may be felt in the groins and perineum. Feet perspire and the
skin between the toes exfoliates. Recurrent herpes affects especially the anal
region and the external genitalia.
 Modalities
There is aggravation from cold, cold drinks, damp in all forms; also from the heat
of the bed and if over-heated by exertion. Is worse also when lying on the left
side; before and during the menstrual period; at night, especially before midnight.
Feels better when warmly wrapped up, but must have plenty of air; is better also
when resting and in the dark.
Clinical notes
This remedy acts deeply and is especially suited to chronic conditions. Its `acute'
remedy is Pulsatilla. Complementary remedies are Causticum, Hepar Sulph.,
Lycopodium, Sulphur.
It is of special value in peptic ulcer, and various skin affections. May be helpful in
the resorption of scar tissue. It follows well after Calc. Carb in the obesity of
adolescence.