Aconitum napellus — monkshood — is the remedy of the storm that arrives out of a clear sky. Boger's phrase for it is exact: "a big storm that soon blows over."
Boericke opens with the essence in a single line: "A state of fear, anxiety; anguish of mind and body. Physical and mental restlessness, fright, is the most characteristic manifestation of Aconite." And immediately after: "Acute, sudden, and violent invasion, with fever, call for it."
Two causations produce the state, and both are worth asking about directly. The first is dry, cold wind — Boericke: "complaints and tension caused by exposure to dry, cold weather, draught of cold air, checked perspiration." The second is fright or shock; Boger heads his aggravations with "violent emotions: FRIGHT. SHOCK."
Aconite is also the remedy with the clearest limits in the whole materia medica, and Boericke states them so plainly that they belong at the front of any study of it — see the modalities section below.
This guide profiles it for clinical study from Boericke's Materia Medica, Clarke's Dictionary, Boger's Synoptic Key and Lippe's Keynotes. The originals can be read in full — Clarke's Aconite, Boericke's Aconite and Kent's Aconite — through Similia's free digital materia medica.
The Aconite State
Aconite is not a constitutional type. It is an acute state that can seize a healthy person within hours, and Boger's constitutional note is simply "robust habit" — this happens to strong people.
The state has three components. Suddenness: Boger capitalises "SUDDEN, violently acute, painful effects." Tension: Boericke writes of "tension of arteries; emotional and physical mental tension explain many symptoms." And fear, which colours everything else.
Physically the picture is one of intense arterial excitement without exudation. "First remedy in inflammations, inflammatory fevers." Boger: "excited nervous and vascular systems... congestion; often apoplectic," with a pulse "fast, bounding, shaking, forcible and tumultuous or wiry."
Alongside the heat run two sensations that recur everywhere in the remedy: numbness and tingling. Boericke lists "burning in internal parts; tingling, coldness and numbness"; Boger adds that parts "remain sore or numb after the pains."
Mental and Emotional Picture
Agonising fear. Boericke: "Great fear, anxiety, and worry accompany every ailment, however trivial." Boger capitalises "TERROR. ANXIETY. AGONIZING FEAR; of death, crowds." This is the single most important feature of the remedy and the one that separates it from every other acute fever medicine.
Predicts the day of death. One of the most specific symptoms in the materia medica. Boericke: "Fears death but believes that he will soon die; predicts the day." Boger: "forebodings; predicts time of death."
Fear of crowds and of crossing the street. Boericke lists both, and they persist as chronic rubrics well after any acute illness has passed — which is why Aconite is prescribed for panic states as well as fevers.
Restlessness. "Restlessness, tossing about. Tendency to start." Lippe: "the patient is full of fears and tosses about as if in agony."
Intolerable pain. "Pains are intolerable; they drive him crazy." Boger: "beside himself; frantic from intensity of the pain; with fear; screams, moans, gnaws the fist."
Music is unbearable. Boericke: "Music is unbearable; makes her sad." Boger: "music saddens." A small, easily-asked symptom shared with Natrum muriaticum.
Strange bodily ideas. "Thinks his thoughts come from the stomach — that parts of his body are abnormally thick. Feels as if what had just been done was a dream."
Physical Affinities
Fever. The classical picture: "cold stage most marked. Cold sweat and icy coldness of face. Coldness and heat alternate... Cold waves pass through him. Thirst and restlessness always present." Boger: "CHILL; in waves; alternates with heat. HIGH FEVER. Dry, burning heat... must uncover." Crucially, "sweat drenching, on parts lain on; relieving all symptoms" — the sweat breaks the state. Lippe calls Aconite "the most valuable febrifuge in the entire range of therapeutic agents."
Face. Two observations of high confirmatory value: "one cheek red, the other pale," and "on rising the red face becomes deathly pale, or he becomes dizzy." Boger repeats "face pales on rising" and adds the "ANXIOUS LOOK."
Respiratory. A leading croup remedy. "Hoarse, dry, croupy cough; loud, labored breathing. Child grasps at throat every time he coughs." The cough is "dry, short, hacking; worse at night and after midnight." Boger: "croup with fever," worse "from every inspiration."
Stomach. "Intense thirst" for cold water, with "bitter taste of everything except water." And a symptom that captures the whole remedy in one line: "Drinks, vomits, and declares he will die."
Heart. "Tachycardia. Affections of the heart with pain in left shoulder... Palpitation, with anxiety, fainting, and tingling in fingers." Boger notes complaints of the heart are worse from sitting erect.
Eyes and ears. Eyes "feel dry and hot, as if sand in them," with profuse watering after exposure to dry cold wind, reflection from snow, or after the extraction of a foreign body — a genuinely useful acute indication. Ears "very sensitive to noises."
Urine. "Scanty, red, hot, painful... Anxiety always on beginning to urinate. Retention, with screaming and restlessness" — a classical paediatric indication.
Extremities. "Numbness and tingling; shooting pains; icy coldness and insensibility of hands and feet... hot hands and cold feet." Boericke adds "weak and lax ligaments of all joints" and "painless cracking of all joints," together with an oddly specific observation — "bright red hypothenar eminences on both hands" — and the sensation "as if drops of water trickled down the thigh."
Back. "Numb, stiff, painful. Crawling and tingling, as if bruised. Stiffness in nape of neck. Bruised pain between scapulæ." Boger: "back and sacrum feel bruised." The bruised quality belongs to the same numbness-and-tingling family that runs through the whole remedy.
Skin. "Red, hot, swollen, dry, burning. Purpura miliaris. Rash like measles. Gooseflesh. Formication and numbness. Chilliness and formication down back." Lippe records "dry, burning skin" and "heat, with inclination to uncover oneself," alongside a "miliaria-like eruption of measles." Boericke notes one curiosity: "pruritus relieved by stimulants."
Female. Two indications with the characteristic emotional causation. "Menses... suppressed from fright, cold, in plethoric subjects," and "after-pains, with fear and restlessness." Boericke also gives "frenzy on appearance of menses" and congested, painful ovaries — the same arterial excitement expressed pelvically.
Key Modalities
Worse from:
- Dry, cold winds; draught of cold air; becoming chilled while sweating
- Fright, shock, vexation
- Warm room
- Evening and night; in bed
- Lying on the affected side
- Music; noise; light; tobacco smoke
- Touch and pressure; dentition; during menses
Better from:
- Open air
- Repose; sitting quietly
- Warm sweat — the drenching perspiration that ends the attack
Lippe adds a rhythm worth knowing: "most symptoms disappear while sitting quietly, but at night and in bed it is unsupportable."
And the limits. This is the part of Aconite that matters most in practice, and Boericke states it without hedging:
When prescribing Aconite remember Aconite causes only functional disturbance, no evidence that it can produce tissue change — its action is brief and shows no periodicity. Its sphere is in the beginning of an acute disease and not to be continued after pathological change comes.
He excludes it further: "not indicated in malarial and low fevers or hectic and pyaemic conditions, and in inflammations when they localize themselves." An Aconite prescription that has not acted within hours is the wrong prescription, and a case that has moved on to exudation or localisation has moved past the remedy.
Keynote Symptoms
- Sudden, violent onset — a storm that soon blows over
- Ailments from dry cold wind or from fright and shock
- Agonising fear and anguish with every symptom, however trivial
- Fears death and predicts the day
- Restlessness with tossing about
- Intense thirst for cold water
- Numbness and tingling of affected parts; soreness or numbness remaining after the pain
- One cheek red, the other pale
- Red face turns deathly pale on rising
- Music is unbearable and makes the patient sad
- Croupy cough after midnight; child grasps the throat with every cough
- Anxiety on beginning to urinate
- Drenching sweat relieves all symptoms
- No periodicity — a distinguishing negative
Clinical Applications
Onset of acute fever. The first hours: dry burning heat, high pulse, restlessness, thirst, fear. We compare it directly with its two nearest rivals in the acute fever differential guide.
Croup. Sudden onset, usually before midnight after exposure to cold dry wind, with the barking cough, loud breathing and terror.
Ailments from fright. Panic states, palpitation and insomnia dating precisely from a shock, accident or frightening event — including long after the event, where the fear pattern persists.
Acute eye injury and inflammation. After a foreign body, exposure to snow glare, or cold dry wind, with hot dry gritty eyes.
Acute otitis and earache. With extreme sensitivity to noise and the characteristic anguish.
Acute urinary retention in children. With screaming, restlessness and anxiety on beginning to urinate.
Early inflammatory joint conditions. "Rheumatic inflammation of joints; worse at night; red shining swelling, very sensitive" — again, only at the outset.
Differential Diagnosis
Aconite vs. Belladonna. Both sudden and violent. Aconite is dominated by fear and has intense thirst for cold water; Belladonna, in Boericke's phrase, has "no thirst, anxiety or fear," and is dominated by congestion — dilated pupils, throbbing carotids, burning red face and furious delirium. Aconite follows cold dry wind; Belladonna often follows a draught on the head or a haircut.
Aconite vs. Ferrum phosphoricum. Ferrum phos occupies the same early febrile ground but far more gently — a gradual, less violent onset, without the terror, the thirst or the sudden collapse.
Aconite vs. Chamomilla and Coffea. Boericke groups these three for "intense pain and sleeplessness." Chamomilla's intolerance of pain comes with anger and capriciousness (one cheek red, the other pale is shared); Coffea's comes with over-excitement and mental hyperactivity; Aconite's comes with fear.
Aconite vs. Sulphur. Not a differential but a sequence. "Sulphur may be considered a chronic Aconite. Often completes a cure begun with Aconite."
Aconite vs. Arsenicum album. Both have fear of death with restlessness. Arsenicum's restlessness is anxious but exhausted, worse after midnight, with burning pains better for warmth and thirst for small sips; Aconite is robust, acutely terrified, thirsty for large cold drinks, and its whole course is measured in hours rather than days.
Repertorisation Tips
These rubrics carry Aconite in high grade:
- Mind; FEAR; death, of and Mind; FEAR; death, of; predicts the time
- Mind; AILMENTS FROM; fright and Mind; ANXIETY; fear, with
- Generalities; SUDDEN manifestations
- Generalities; AIR; cold, dry; agg. and Generalities; WIND; cold; agg.
- Mind; RESTLESSNESS; anxious
- Mind; FEAR; crowd, of a and Mind; FEAR; crossing the street
- Face; DISCOLORATION; one cheek red, the other pale
- Vertigo; RISING; agg. with Face; DISCOLORATION; pale; rising, on
- Stomach; THIRST; large quantities, for; cold water
- Cough; CROUPY; midnight, after
- Mind; MUSIC; agg.
- Bladder; URINATION; anxiety before or during
Anchor on the causation (dry cold wind, or fright) plus the mental state (fear with restlessness), then confirm with thirst and the face signs. If the case has periodicity, or has already localised into an exudative or suppurative stage, Boericke's exclusion applies and the remedy is wrong. Our beginner's guide to repertorisation sets out the method in more detail.
Deepening Your Study
- Boericke gives the causations, the mental picture and — most valuably — the explicit limits on when the remedy does not apply
- Boger's Synoptic Key supplies "a big storm that soon blows over" and the fullest account of the arterial excitement
- Clarke's Dictionary holds the fullest proving and clinical compilation
- Lippe's Keynotes records the day/night rhythm and calls Aconite the most valuable febrifuge in the materia medica
- Kent's Lectures develop the quality of the anguish and its relation to the physical tension
You can read all of these side by side for any remedy through Similia's free digital materia medica. To place Aconite among its peers, see the guide to the essential polycrest remedies, or read how materia medica and repertory work together in case analysis.
