Rhus tox

Tom Whitmarsh profiles this commonly used remedy

Rhus tox is produced from the plant commonly known as poison ivy which grows as a shrub or a woody vine, spreading all over the countryside as a weed in the Eastern USA and Canada. The remedy was introduced into homeopathy by Hahnemann, who performed a proving which he published in the second volume of his Materia Medica Pura. The proper botanical name is now toxicodendron pubescens, but homeopaths will stick to the well known name and its abbreviation until all the anomalies in the naming of homeopathic remedies (and there are many) can be ironed out. It is a member of the anacardiaceae or sumach family of plants. Anacardium is really the only other commonly used member of this family in homeopathy, although there are quite a few others in the materia medica which are not so well known.

Poisoning
A cardinal feature of many of the sumachs is their production of sticky oils, which dry on contact with air to a black lacquer. In Anacardium, this gives the name “marking nut”, as it is produced from the ink-like substance just below the rind of the covering of the nut which has been used to mark clothes for laundry. In Rhus tox, the lacquering oil induces allergic skin reactions in previously sensitised individuals. Up to 50 per cent of the population of the USA, where poison ivy is endemic, is sensitive to the oil and much advice is available (for example on the internet) about avoiding rhus poisoning.

The oil, which binds to skin after even the slightest contact (even stroking a dog that has brushed past a poison ivy plant is enough) is called urushiol, after the Japanese word for lacquer. In Japan, another toxicodendron tree produces a lacquer used, for example, under applications of gold leaf to the Golden Temple in Kyoto. The oil is extremely potent, with only a nanogram needed to induce reaction in an individual, so just a quarter of an ounce would be enough to cause itching in every person on Earth! It is normal for the oil to stay fully active for five years even from dead plants. Samples of urushiol several centuries old have been found to cause at least an itch in some people.

Most people do not have a skin reaction to first exposure. In those who do, it can take seven to ten days to develop. Subsequent exposure, after this initial priming of the immune system to “recognise” the oil, induces a strong skin reaction within half a day to two days. There is inflammation, intense blistering and intolerable itching of the skin which continues for several days before healing and resolving.

Burning the plant releases urushiol into the air and can induce severe reactions in the lungs and eyes, so firefighters at bush fires can be at serious risk without protective equipment in regions where rhus is common. Notice that urushiol itself is not actually poisonous, except insofar as it induces an allergic response. The damage is done by the sufferer’s own immune system!

Rhus tox is a very “big” homeopathic remedy. By this I mean that it has many symptoms recorded in the homeopathic literature (repertories and materiae medicae). Out of 1600 remedies described in a large repertory – The Complete Millennium – Rhus tox is at number 11 when the remedies are listed by number of symptoms described, with 11,400 entries. The areas which stand out for the remedy in the repertory are concerned with the limbs, with disturbed sleep, with fevers and with the skin.

Restlessness
Describing the plant and its oil leads on to the ideas or themes in the illnesses that the remedy made from it might be homeopathically used to treat. The plant spreads rapidly across uncovered ground and up supports such as trees, via long stems and aerial rootlets. It takes many different forms, as a vine, a shrub or a bush and even produces different forms of stem and leaf from the same root-stock. Dr Gibson, in his Studies of Homeopathic Materia Medica describes Rhus tox as a “restless plant”. This shows a major characteristic theme of the remedy; it is one of the most restless of remedies.

People who might be helped by Rhus tox for example, have joint pains which have to be relieved by very regular movements. They cannot sit in the chair in the consulting room for more than a few minutes before getting up for a short walk and a stretch. They toss and turn all night, unable to find one position comfortable for long. When they are still for a while and do get some sleep, waking up is very painful as the relative immobility of the night has quickly rendered them extremely stiff. Thus the first few minutes of the day are spent “limbering up”. Once a little flexibility is restored to the joints, the pain lessens considerably and they can continue their restless search for comfort through the day – the right balance of action and rest.

There is a particular kind of restlessness caused by a stiffness of the neck which can only be relieved by stretching it and moving the head about. There may be accompanying headache relieved by the stretching. Pains in general are better for heat (eg a hot bath or shower) and worse for cold and damp. Similar modalities apply to the severe lower back pain experienced by some who are helped by Rhus tox. This also has the characteristic of being better from lying on a hard surface.

As a “general” symptom, this restlessness can feature in areas other than the purely physical. If a constant need for motion suggests an external restlessness, so we can talk of the restless mind that just can’t settle, there is an internal restlessness. Part of the picture in someone helped by Rhus tox might be restless dreams of great exertions like swimming or rowing, or of working hard in their occupation or of “roaming over fields”. Sleep is interrupted too by pains and by anxieties or illogical apprehensions that something bad is going to happen. Anxiety might drive someone out of bed and there may even be fear of going to sleep. In fact all symptoms are worse at night, another important general feature. This must in some part be responsible for the recorded moroseness at night, when bad things from the past come back to haunt the sufferer.

The restlessness can be seen in tossing and turning during fevers. Rhus tox is disproportionately highly represented in the sections of the repertory that deal with chills, fevers and perspiration (which mostly date from the pre-antibiotic days when the exact pattern of fever was an important observation to make in a sick person). It should be thought of when restless states with a high fever particularly worsen at night, for example in ’flu.

Stiffness
A few moments reflection on the nature of the poison ivy oil might help to explain the very well known joint and muscular stiffness associated with illnesses which are helped by Rhus tox. On contact with air and with the skin, a lacquer is produced. A lacquer is an inflexible, shiny, stiff film. One could image a joint coated in a lacquer being very difficult to get moving at first, but becoming freer with repeated movements. This is exactly the Rhus tox situation. Whenever initial movement is difficult, stiff and painful, but continued movement eases, Rhus tox is likely to be helpful.

In arthritis, this easing will often be followed (perhaps later in the day) by a worsening again as tiredness begins to take its toll. Rhus tox pain is classically worse in the cold and especially the damp and better for warmth. This sounds like an awful lot of sufferers’ arthritis and so Rhus tox is very widely successful in joint problems. It has often been said that it is too easy to give Rhus tox in arthritis. The detail is the important thing. Careful attention to the story might show most of these features, but actually the pain is better immediately on movement, rather than there being an initial aggravation before relief. The remedy Rhododendron might turn out to be more appropriate in this situation. Really extreme damp sensitivity in the joints (“I can predict the rain the day before it comes”) could well be best helped by Dulcamara.

If we go on to think about what the general characteristic of “stiffness” might mean on a mental plane, we can see that some people who do well with Rhus tox can be emotionally unbending, with a tendency to hold feelings back; they find it difficult to respond to others. In the end, when they are worn out by all the pains, this can turn into fixed ideas and superstition.

Skin
A very frequent use of Rhus tox is to help blistering skin diseases. The analogy is with the itchy, painful rash produced by contact of the plant sap with the skin of a sensitive individual. Thus, it is a major remedy to help the pain of shingles, which is caused by a herpes virus. Many homeopathically trained GPs use Rhus tox as their first line treatment for cold sores around the lips, also herpetic in origin, but any inflamed, intensely itchy rash, especially if there are fluid-filled blisters (like some forms of eczema) can benefit. The itch is often better from bathing with scalding hot water.

There are other features which are hard to fit into this analogical approach (looking at the characteristics of the way the remedy substance fits into the natural world and comparing it with the way a disease fits into a human life). A feature of Rhus tox is said to be that there may be a bright red tip to the tongue. On the food desires front, there can be a craving for cold drinks and especially cold milk.

Tom Whitmarsh MA MBBS FRCP FFHom is full-time Consultant Physician at the Glasgow Homoeopathic Hospital.