Now, the interesting thing about Rhus Tox is the stiff personality as well as the stiff body, and that was what we always thought about Rhus Tox, but as it turns out, this is a later stage. You know, how we always thought they were stiff emotionally and they couldn’t give easily? That is a later stage of Rhus Tox. Actually at the beginning, Rhus Tox people are distinctly cheerful and outgoing. The mind is very active. They are joking, wisecracking and sort of a wry sense of humor, reactive. They can be irritable and they can be low patience with a low tolerance threshold, in other words they are cheerful and happy, everything is going along fine, but just some little thing overwhelms them, and then they can get irritable. They get irritable at the beginning; eventually they will be overwhelmed. Not like Calcarea, in a different way. The next stage is when we see the internal restlessness. It goes from reactive, cheerful, sort of lively and then the liveliness gets carried up an octave to a type of restlessness. Like the nerves are standing on edge. The whole system gets stirred up inside and they get hurried and then finally even to a state of an agitated sort of feeling. Remember we always used to make this differentiation — with restlessness, Rhus Tox is because of physical and Arsenicum is because of mental. Well, there is not a clear differentiation there. Rhus Tox gets extremely restless on a mental level. They are also very restless on a physical level earlier, but the mind can get very restless and they can skip around from one subject to the next. You can get it confused with Lachesis, but it doesn’t have the intensity behind it, it is different. If you look under "timidity" Rhus Tox is listed capitals. They are bashful people. You know how George always says if you are sitting with the Rhus Tox patient, you have to watch out of the corner of your eye. If I’m Rhus Tox, when you start lookinq down to write, I’ll look like this and then when you look up, I will be back like this. There is bashfulness. They don’t want to show. They hide the stress and so forth. Now, that same timidity gets carried along with this restless mind, and it produces something that you may confuse with Lachesis, but it looks quite different in the way that they speak. They will come in in a sort of agitated state and they want to tell you some symptoms and yet they are constantly looking at you because they have an active mind. They are looking at you to observe whether or not you are paying attention, how you are evaluating it, whether you are getting bored with this, so they sit there and they will say, "Ok, I just want to tell you this one thing. " "You know sometimes I get this stiffness in my wrist. " Then they see you are not interested in the wrist and they say, "Well, sometimes also my stomach isn’t good. Sometimes it gets a burning there and I, oh, but just let me tell you this, because I know you are busy, but I just want to go on with this one point. " Like that. Very sensitive, restless, bashful, this kind of thing mixed up all together. If you are not listening, they will change the subject and tell you another symptom. And they stop and they stop and they are rushed and they are timid. It’s all mixed up in this kind of. It gives you that kind of impression of skipping around in the mind and that the mind goes five different points at once. On the other hand, they can go in these deeper stages where they become withheld and they don’t express their feelings, or they are too stiff to respond even though they want attention and affection, they are too stiff to respond. That is when they become miserable and discouraged and that is, where you could sort of confuse it with the Calcarea overwhelmed. They will say something else that may remind you of Calcarea which is that life is a struggle and they may even contemplate suicide even though it is not a truly suicidal remedy. Finally, when the stiffness goes to a deeper plane, which is the mental plane is when we get the fixed ideas and the superstitions and the ritualistic behavior. They like affection and caring, but they can’t give it back. They become withheld. They can’t respond.

So the generalities. Of course arthritis and stiffness are the main complaints. Second is skin problem and third are heart problems. That is where the pathology usually will go. The generalities are worse cold, worse damp, worse drafts, worse before a storm. They are ameliorated by dry heat, dry hot climates and also ameliorated by hot bathing and hot showers. They are worse in the morning on rising and they are worse in the evening by the end of day. They are ameliorated by motion. Those are the generalities. Now there are some other generalities, which are important. First of all, there can be these sudden chills which come on periodically especially at night without any reason, so a sudden paroxysm of a chill especially at night. There is the restlessness and yet, there is the aggravation from overexertion. It is very common and it doesn’t have to be so much overexertion sometimes. They don’t tolerate moving very much. In general it is a left-sided remedy. Sometimes, there can be a general aggravation from the exposure of one hand or one foot to cold. Like they reach into the refrigerator and get a cold milk bottle out because they want the milk, and their hand gets cold and from that cold that got into their hand, they get a stiffness up in the neck or in the spine or wherever. Or even, you remember that case I presented with the woman with the rhinitis that she grabbed a cold bottle and her rhinitis got worse. Also, fever at 10:00 A.M.

And it is interesting -- Rhus Tox is a remedy that is so affected by bathing and by water. It seems to be the main remedy that gets this sensation as if water was dashed on them. In the fever, it is as if hot water was dashed on them, or sometimes they will say as if hot water was going through their veins, or just the reverse in their chills, as if they are getting cold water thrown on them or cold water coursing through their veins.

In the head, there is a characteristic keynote that they perspire everywhere except the head. In the acutes, they sometimes get this symptom of the tongue, a red triangle at the tip of the tongue. Headaches that are worse before a storm. Headaches that start because of cervical stiffness, so you may confuse it with Cimicifuga or Calcarea Phos.

They are generally better from motion, either motion of the head or motion in general. In the throat, it is a very good remedy for hoarseness, especially from hoarseness of over using the voice and sometimes they may be hoarse at the beginning, and then as they speak the voice becomes loosened up and they can speak, and then if they stop they are hoarse again. So, it is as if the vocal chords are ameliorated by motion.

Also, fever blisters and eruptions on the lips.

They crave milk and sweets, mostly milk and sweets and there can sometimes be an aggravation and aversion to meat.

It is a remedy that is useful in asthma, in pneumonias sometimes with rusty sputum. There is a keynote of cough just prior to the chill. They have a coughing attack and then the chill comes on. Also, in the chest is coronary disease, angina with pain radiating down the left arm. It is one of the main remedies for angina.

In the genital system, eruptions on the genitalia and especially on the thigh, thigh around the groin. Also, it is said to be a remedy for incontinence in boys or enuresis in boys. I have used it on that. I actually cured a bad rhinitis using that as a guiding indication but the enuresis didn’t get any better. It is the only remedy listed.

It is one of our most useful remedies in neck pain and backaches and sciatica with stiffness, need to stretch, have to get up and move around. If you have someone with a back pain who comes into your office and sits there for a while and finally says, "Oh, excuse me Dr. I have just got to get up," and then he stands up and does this business, that is stretching, that is a very key indication for Rhus Tox.

They are better by rubbing on a hard surface. Like on something hard, they will sort of get the handle of something and do that on it. Something hard. Then they are better from massage, especially Rhus Tox seems to affect this region, sort of the neck into the trapezium muscles here and into the middle of the back, all of this area it seems to affect very much. The upper shoulders. Any little stress or if they get angry, they get irritated, goes right there. They feel the tension there very much. There is a lot of cracking in the neck and so forth as they rotate it. Especially they will do that when nobody is looking. The back is aggravated from sitting for a long time, so if they have to take a long car drive, or if they have to sit in a movie theatre for a long time, the back will really get bothered.

Rhus Tox will be one of our most important remedies in rheumatoid arthritis, or really any type of arthritis, but especially rheumatoid. Almost any of the joints can be affected. Now, the modalities are the modalities of the generalities in the arthritis. Frequently, we will see cases of rheumatoid arthritis or arthritis in general which have exact Rhus Tox modalities, but Rhus Tox doesn’t work. So, just as a hint, if you see that, there are some other remedies that you can think of. Phosphorus, for example, has exact Rhus Tox modalities in arthritis. Ruta, Rhododendron, and Tuberculinum all have Rhus Tox modalities. So, if you see somebody with a family history of TB, that has a Rhus Tox arthritis, it is probably Tuberculinum. But inevitably we end up using Rhus Tox first, and sometimes it doesn’t work, that is why we have to think of some of these other remedies. Stellaria is more like Bryonia. It can seem like Rhus Tox. Stiff and painful in all the joints. Worse on awakening. Worse with first movement. And you know how they have to sort of crawl up out of a chair, you know how people use their hands, old people who sort of support themselves to get up out of a chair? They put their hands on their thighs as they are getting up and hunch up their shoulders and sort of push with their arms and with their thigh muscles at the same time to get up and then they have to sort of walk their way up their thighs like that. It is very characteristic of Rhus Tox. Especially left shoulder pain they can have. With these arthritises they get up in the morning just horrible. They struggle out of the bed and go straight for their shower, and then finally they get a little bit of relief. By the time they have moved around a little while, they get into the shower. A lot of times they won’t get into a hot tub because they are afraid that they won’t be able to get back out easily. So they get into the shower. They are sort of mobile but then all through the day they have to keep moving. They sit down in the chair and if they are there too long, if they rest too long, then they get stiff. Then they have to get up and then they have to move. They are in motion and they have to keep forcing to feel comfortable but then the catch 22 is that as they keep moving around, they wear out their muscles. They overexert themselves and then they end up worse off than if they had not done anything. But they can’t keep still because the only time they feel comfortable is when they are moving, but then if they move too much they get fatigued and this comes on so it is really a torturous existence. It is a trap.

The restlessness could be from just minor sort of shifting around all the way to chorea in Rhus Tox. Especially restless legs in bed is a very strong keynote for Rhus Tox. Other remedies have that for different reasons but it is one of the most invariable signs of Rhus Tox is the restless legs in bed at night. I expect to see that in Rhus Tox cases. Causticum also has that very prominently. Of course all the joints are cracking.

It is a remedy for any type of vesicular eruption, poison oak or ivy. Rhus Tox has more of vesicular eruptions. Rhus Venenata has more cracks. But, both very prominently have an unusual feature, which is itching which is better from scalding water. Rhus Tox, of course, because of the vesicular nature is more indicated in things like shingles, eczema, in herpes. They have burning or itching. Better scalding water. Also in erythema it is an important remedy. I have had a lot of success with Bryonia in poison oak, Anacardium, Rhus Tox. I have used it. I keep trying to get Croton Tiglium to work and I haven’t had too many cases that responded to it. Graphites I have seen work. Yeah, sometimes it will go. One remedy will seem to work and then they need another remedy to clear it out.

The sleep in Rhus Tox is usually restless. Somebody once described that the bed looks like a war zone. They toss and turn so much. Frequently they dream of long walks, long journeys, or hard physical work. Things that tire them out.

It is also a remedy we use in first aid instances and in acutes. In first aid, of course, we use it in sprains, in strains of the muscle, especially when they have Rhus Tox symptoms. Some shin splints are sort of a constant thing that if once they have done a little bit of work they feel better. I have seen some cases that seem that way. Once they have sort of warmed up a little bit. But then afterwards they were much worse after the exercise, which goes along with Rhus Tox. Bryonia a lot of times in the acute phase of shin splints, I have seen that.

Q. So, in first aid, how would you tell it between Ruta and Rhododendron?

A. I have never used Rhododendron in first aid. Ruta, seems to affect more the tendons. Specifically I think of Rhus Tox more if it is the muscle. But, if there is stiffness that seems to get better from motion, I would first try Rhus Tox even if it was the tendon that was involved. But, if I had an injury that didn’t respond to Rhus Tox, I will frequently go to Ruta then, or if there was tendon strain, I might use it right at the beginning;

It is a big remedy in influenza. Influenza and other acutes where there is a lot of stiffness and restlessness. It can be very hard to differentiate from Arsenicum. If you gave Arsenicum and it didn’t work and you don’t know why. Arsenicum has the thirst for sips and so does Rhus Tox. They are both chilly. They can both crave milk and both restless. One of the main differentials is that while Rhus Tox is relieved by motion, Arsenicum is exhausted by it.

1. Adapted to the rheumatic diathesis.

2. Great sadness and apprehension with inclination to weep; < at night, in the house > out of doors.

3. Sub-acute and chronic rheumatism and rheumatoid affections with the characteristic modalities; pains as if the bones were scraped with a knife; also paralytic weakness with numbness and heaviness especially lower limbs.

4. Pains < rest, < on beginning to move, > continued motion; temp. > change of position; pains return if movement continues to point of fatigue.

5. Muscle or tendon strains, stiffness or soreness especially from over lifting or overreaching; < on grasping.

6. Adynamic fevers with mild delirium and stupefaction yet regular and persistent restlessness (from physical causes); red, dry, cracked, coated tongue, triangular red tip; sordes; stools loose, yellowish-brown, offensive, or bloody, frothy, sometimes involuntary during sleep, with great exhaustion.

7. All secretions and excretions acrid and fetid.

8. Complaints chiefly right-sided.

9. Acute skin diseases; eczematous eruptions, surface raw, excoriated; thick-crusts oozing and offensive; much burning and itching; rubbing increases the eruption. Erysipelas, vesicular, phlegmonous; parts dark red; especially of scalp, face and genitals.

10. Modalities; < cold especially cold, wet weather, cold winds; getting wet especially after overheating; before storms; after midnight; during and after rest.

Note: Apis inimical.