Naja mossambica = Speikobra, Mosambique/Zulu: Mfezi, Afrikaans: Spoegslang

http://ir.dut.ac.za/bitstream/handle/10321/61/Taylor_2004.pdf;jsessionid=C124E57D6DF5E7BC8C9F0BF3789EC4E2?sequence=12

Vergleich: Comparison.: Naja. + Naja-mos.

Repertorium_naja_+_naja_mossambica_+_ophiophagus

Siehe: Schlangen allgemein + Cobras general. + Repertorium. (Naja haje. + Naja mossambica. + Ophiophagus Hannah).

An evaluation of the homoeopathic drug proving of Naja Mossambica in the light of a doctrine of signatures analysis and a comparison between the proving symptons and the venom toxicology

[Lorna Smal]

Poisening: Cytotoxic effects: The venom contains various proteases which cause cellular damage and hyaluronidase which encourages the spread of the venom through the tissues.

Complement activation by an alternate pathway triggers enzymes that cause cell damage, while C3 and C5 are thought to give rise to the formation of anaphylatoxins which cause the release

of histamine from mast cells and increase vascular permeability. Other complement reaction products induce polymorphonuclear infiltration. The release of lysosomal enzymes from dead

polymorphs also causes vascular damage and tissue injury (Tilbury, 1982).

The venom causes cytolysis where the tissue is destroyed and there is coagulation and thrombosis of the blood (this produces a barrier against the spread of the venom throughout the body). Bleeding occurs which adds to the internal pressure, increasing the possibility of ischaemia, causing swelling, induration, haemorrhage as well as ecchymosis, blisters and necrosis

(Chapman and Visser, 1978).

When only a small volume of venom is injected, instead of blood extravasation, the swelling is caused mainly by plasma exuding from injured vascular beds.

The local swelling at the site of the bite can be divided into two categories:

1. There may be little evidence of extravasation, with the limb appearing either soft or hard.

2. Haemorrhage may be evident as ecchymosis and bleeding from fang marks, with solid massive swelling.

Necrosis is usually seen in the second category. The necrosis is extensive and may be superficial or deep. Necrosis occurs from direct tissue destruction and occlusion of major vessels.

Severe pain and tenderness is experienced in both categories. In severe cases the limb may become solidly flexed which suggests serious muscle involvement caused by haemorrhages or tissue fluid

accumulation. Evidence has been found of recanalization (as though after a thrombosis) in the deep venous system. Thrombophlebitis (thrombosis with inflammation of a vein), of the Long Saphenous

vein was also observed (Chapman and Visser, 1978).

Naja mossambica venom has anticoagulant properties like most other snake venoms.

Cytotoxic symptoms are:

Local burning pain

Swelling

Redness

Superficial necrosis

Extensive blistering

Abscess formation

Extravasation of blood (ecchymosis)

Tissue destruction

Necrosis (can be extensive and have a curiously patchy appearance and occurs within 48 hours of the bite)

The area around the fang punctures darkens.

Blistering may follow.

Necrosis usually is confined to the skin and subcutaneous tissue but may be quite extensive.

A putrid smell is characteristic.

Oedema (in the effected limb if the lymph vessels and lymph glands are damaged or obstructed)

Shock (with „toxic’ appearance)

Infection (due to pathogens introduced during the bite or at a later stage)

Rare and unusual symptoms have been recorded by victims with greater sensitivity to the venom:

Vomiting

Abdominal colic

Dizziness

Headache

Sweating

Urticaria

Hyperpyrexia

Drowsiness

Haemorrhage at sites other than the bite

Subconjunctival haemorrhages

Haematuria

The neurotoxic symptoms are found to a lesser extent, compared to the cytotoxic symptoms.

Neurotoxic effects:

Cobra venom contains postsynaptic neurotoxins that competitively bind to nicotinic acetylcholine receptors to produce depolarising neuromuscular blockade. One group in this category has 60 - 62 amino acids and 4 disulfide bridges. Another has 71 - 74 amino acids and 5 disulfide bridges. It is suggested that a similar toxin to the curariform neurotoxin that is found in Naja

Nigricollis venom is found in the venom of Naja mossambica. This is responsible for the rapid death by respiratory paralysis in its prey and is evidenced in humans by the local effect of temporary paresis of the pupil constrictors in a patient having been spat in the eye (Tilbury, 1982).

Neurotoxic symptoms are:

Swelling

Pain spreading widely from the site of the bite

Low blood pressure

Profuse perspiration

Fever

Hyperpyrexia (from hypothalamic interferance)

Vertigo

Vomiting

Convulsions

Unconsciousness

Alteration of mental status e.g. Drowsiness and euphoria

Lethargy

Strabismus

Blurred vision

Restlessness

Frothing around the mouth

Chest pain/tightness

Tachycardia/bradycardia

Cyanosis (due to respiratory distress)

Progressive, spreading paralysis causes:

Ptosis (cranial nerve dysfunction)

Opthalmoplegia

Dysphagia (which results in too much saliva present in the mouth, leading

to the sensation of drowning in own saliva)

Dysphasia (speech incoordination)

Muscle weakness

Paralysis of the neck muscles, causing the head to fall

Paralysis of the sphincters results in incontinence

Paralysis of the diaphragm and accumulated secretions leads to severe respiratory distress and respiratory failure

Death is preceded by quiet unconsciousness with shallow respiration. (Marais, 1992)

According to Smith (2004), some people having received a bite from a neurotoxic snake have displayed signs of euphoria and unconcern for the fact that a deadly snake had bitten them. If the bite were left untreated the euphoria would progress to shallow, laboured breaths, unconsciousness and death.

Even though Naja mossambica has a neurological component to its venom, the neurological symptoms are usually slight and overshadowed by the cytotoxic symptoms. Fatalities are rare (Marais, 1992).

Direct effects of the venom on the eyes

Snake venom in the eye results in immediate, intense burning pain (venom is rapidly absorbed by small blood vessels close to the surface) and blepharospasm. It is difficult to open the eye, tears flow copiously, membranes around the eye become swollen and severely inflamed and the eyeball appears very red with severe conjunctivitis. Extreme photophobia is seen. There is a temporary impairment/blurring of vision. Without treatment the lids swell, the membranes of the eye develop haemorrhages, uveitis, keratitis and ulcerations of the cornea within 24 hours, which is followed by blindness. The eyes should be washed with water or milk as soon as possible and for a bite immobilization and pressure bandages should be employed (Marais, 1992) (Patterson, 1987). Systemic toxicity does not occur with eye exposure. The eyes < rubbing and extremely sensitive to light. The nasal membranes also become irritated.

[Tilbury (1982:308)] typical untreated case of envenomation would progress as follows:

0 - 3 hours: moderate to severe pain at the site of the bite associated with a progressively enlarging area of swelling and warmth of the affected area.

3 - 5 hours: first signs of tissue necrosis may appear at the site of the bite, either as a dark discolouration or asa raised blister. Serosanguineous fluid may begin to ooze from the bite.

5 - 9 hours: the discolouration begins to spread from the bite site, often caudad (towards the end of the spine) and occasionally in a „skipping’ fashion, leaving areas of normal skin in between.

9 - 48 hours: plumcoloured discolouration reaches its maximum extent between 36 and 48 hours and becomes sharply demarcated.

48 - 72 hours: swelling reaches its maximum. The plumcoloured discolouration darkens to black. Blisters may now appear in the discoloured area, but usually first appear at the periphery of the necrotic area.

Day 3 onwards: the swelling gradually subsides. Blisters coalesce to form a blistered rim around the edge of the lesion.

Day 6 - 8 onwards: the necrotic area may be debrided. The subcutaneous tissues under viable skin could be destroyed; forming subcutaneous burrows which may extend quite far from the demarcated area of necrosis. After debridement the resulting ulcer invariably has peripheral undermining.

Necrosis was observed to involve mainly the subcutaneous tissue, sparing the muscles and deeper structures. This is presumably due to the Mozambican spitting cobra’s relatively short fangs depositing the venom in the subcutaneous space where it spreads through the superficial lymph drainage system.

Five of the patients vomited, one after drinking a homemade potion and one after receiving anti-venom.

Two patients reported diarrhoea. Drowsiness was noted in four patients; three were children with severe swelling and required resuscitation for hypovolaemic shock. Patient sixteen was noted to be very

drowsy on admission three hours after the bite, but there was no severe swelling or other neurological symptoms.

The only neurological sign seen in these patients was drowsiness.

The dominant feature of the bite is a characteristic cytotoxic lesion, the venom having a far more destructive cellular toxicity than that experienced in Puff adder (Bitis arietans arietans) bites.

Tilbury (1982) believes than many bites attributed to puff adders are actually from the Mozambican spitting cobra. According to Smith (2004), the snake may inject venom in variable quantities, resulting

in cases that range from being very serious with widespread tissue destruction, to cases where the amount of venom injected was insufficient to cause any serious symptoms.

An example of a potentially life-threatening bite:

A one-year old girl was bitten by a Mozambican spitting cobra at Leeukop Game Ranch near Pongola. The maid sleeping in the room with the girl and her sister got sprayed in the eyes by the cobra. She ran from the room with the two girls. Only after treating the maid’s eyes, it was noticed that the little girl had been bitten on her left upper wrist. The girl’s family first rushed her to Pongola hospital, then to Vryheid hospital and then to Entabeni hospital in Durban. Due to incorrect treatment and misdiagnosis the little girl appeared in danger of loosing her limb. She was being treated for the neurotoxic venom,

which is commonly associated with cobras, when in fact the venom of the Mozambican spitting cobra is predominantly cytotoxic.

Toxicology

A wealth of information is obtained from the study of the toxicology of homoeopathic remedies. Precise records kept of the effects of a poisoning (or in this case a poisonous snakebite) give a clear picture of the possible action of the remedy. A poisoning may be viewed as a crude 'proving' and may be regarded as invaluable according to the homoeopathic principle that what a substance can cause it can cure (the law of similars). Hahnemann believed that the noxious and poisonous character of these substances were sure revelations of the power of these drugs to extinguish curatively similar symptoms occurring in natural diseases, that their pathogenetic phenomena were intimations of their homoeopathic curative action (Hahnemann, 1998:191). The toxicology provides us with a clear picture if the organs and body systems that the remedy will effect. In the proving of Bitis arietans arietans (Wright, 1999), the toxicology was taken into account to provide a more complete picture of the action of the remedy on healthy human beings, thereby widening the possible therapeutic spectrum of the homoeopathic proving of Bitis arietans arietans. Another remedy, which has its toxicology comprising a large proportion of its symptomology, is Naja tripudiens (Demarque, et al. 1997:262).

Indigenous snakes are particularly intriguing because other snakes (Lachesis muta, Naja tripudians, Crotalus horridus) have been extensively and successfully used in homoeopathy.

Bitis arietans arietans (Puff adder) and Bitis gabonica (gaboon adder), both South African species have recently been proven and have produced interesting symptomatology pictures.

It was hypothesized that the proving of Naja-mos. would produce vivid and remarkable symptoms and become an indispensable remedy in the materia medica. The researcher chose Naja-mos.

due to its similarity in family and genus as Naja. Naja., is known generally as the common, Asiatic, Indian or spectacled cobra. Naja. has been invaluable in cardiac cases both in orthodox and

homoeopathic medicine.

The Mozambican Spitting cobra or Naja-mos. although related and from the same family as the Indian cobra, has some very different components to its venom.

The significant differences in the properties of the venom should impact on the symptoms experienced in the proving. The researcher will be comparing the differences between Naja. and Naja-mos.

in the mind and dream aspects of the proving.

It is one of the most dangerous snakes, inflicting fatal bites but more commonly spitting its venom. The commonest victims are young African women who get bitten while they are busy around

their home at sunset. The snake is very quick and alert, when threatened or confronted, it raises almost 2/3 of its body, spreads its long narrow hood and hisses loudly in readiness to spit

venom at its enemy when the latter comes into range. The fangs are specially modified with the discharge orifice on the anterior face rather than at the tip. The snake has to lean well back to

ensure that the venom is directed both upwards and forwards. It can eject venom with its mouth only slightly open by lifting its upper lips in the form of a snarl. The snake can also eject venom

from almost any position making it dangerous to the unwary that may expect it to eject venom only from the reared-up position. Venom is effectively ejected from 1,5 - 2 metres but in large

snakes has been recorded up to 3 metres. Venom directed at the eyes and causes instant blindness, which can become permanent unless immediate remedial measures are taken.

The snake seldom attempts an actual bite. It is also one of the snakes that feign death when threatened.

The venom of Naja-mos. has few neurotoxic and primarily local cytotoxic effects and is produced in copious amounts. Bites result in local and extensive cytotoxic effects.

1. local PAIN and swelling/may spread quickly up the affected limb. Painful, tender, enlargement of the regional lymph glands is typical.

Blisters may develop as soon as a few hours to 24 hours after the bite. Most marked at the site of the fang marks and may form a ring around a defined area of darkened or pale numb skin.

2. Blisters may also extend up the bitten limb, discontinuously in the form of "skip" lesions.

3. Earliest signs of tissue death or necrosis are changes in colour and sensation, the appearance of blisters and a smell of rotting flesh. Areas of necrotic tissue and deeper tissues may slough off spontaneously. Tissue loss may be massive, ext. up the bitten limb, along the path of the lymphatics in the form of discrete "skip" lesions separated by areas of apparently normal skin.

4. Complications can include secondary infection of dead tissue, sometimes with bacteria (Clostridia) causing tetanus or gas gangrene (first vomiting); this may require extensive surgical removal/amputation.

Other complications include keloid formation; chronic ulceration with or without infection of the underlying bone and in worst cases can lead to cancerous changes later.

There is absence of neurological symptoms and few fatalities. Anti-venoms are not effective (in delay of treatment). Most fatalities occur particularly in infants and children due to shock.

Hypoglycemia caused by leakage of plasma out of blood vessels in the bitten limb resulting in swelling, shock and a severe depletion in blood volume. Venom may also affect the heart directly.

When venom is spit into the eyes an additional, unique form of toxicity is found: acute ophthalmia,. Naja-mos. can spit venom into a person's eyes from up to 3 metres away. Immediate and intense pain results, with blepharospasm, tearing, and blurring of vision. It is difficult to open the eye, tears flow copiously, membranes around the eye become swollen and inflamed and the eyeball appears very red. Without treatment the lids swell, the membranes of the eye develop haemorrhages and keratitis and ulcerations of the cornea within 24 hours, which is followed by blindness. Systemic toxicity does not occur with eye exposure, but corneal ulcerations, ireitis, and permanent visual impairment or blindness has been reported in untreated cases.

Antisocial

There was a strong desire to be alone, not wanting to be around people, unsociable. A strong feeling of irritability and a need for own space and quiet was noted (36F 00:). People who usually love people, felt averse to company. They felt quiet and withdrawn and didn’t want to make the effort to socialise, these feelings were noted to be very unusual and out of character (35F :XX).

Provers felt distant and not as friendly as usual, being unable to get into a „party mood’ (35F 02:). Feeling reserved and serious, quite low. Worse for crowds and authorative people.

Anxiety

There was stress and worry and anxiousness about work and things that had to be done, or for no particular reason. Anxious feeling in the pit of the stomach. Anxiety, frustration and agitation

(38F 02:08:50) was experienced.

Worry and tension. Anxiety throughout the day. There was difficulty coping (29F 01:) and being overwhelmed with everything. Restlessness.

Carefree

This ranged from not caring “everything just seemed to glide off my back” to being light hearted and carefree. Not worried about work or the things that normally irritate, just want to go have fun

(38F 05:). Not worried about responsibilities or what is expected of a person. Unmotivated and indifferent, not being able to take things seriously (exams).

Delusions of separation

There was a strong feeling of separation. The feeling of floating, of getting a lift with their body rather than being in it. The soul being separated from the body (03F 01:15:55), the head being separated from the body. A sensation of lightness in the limbs. The feeling of something strange happening to the top half of the body. Didn’t feel themselves. Light headed and airy.

Depression

Feeling down, tired and heavy. Dull and withdrawn. Not themselves, distant and not as friendly as usual. Just want to sleep and not wake up (suicidal thoughts). Feeling low and averse to company.

Not happy.

Depression and mania

An interesting fluctuation between extremes of emotion. This theme overlaps with the theme of heightened emotions. Provers were experiencing serious depression followed by loudness, laughter and silliness.

“I felt very depressed tonight.. withdrawn and quiet, then I just got loud again (29F 00:20:00). “Acting loud and silly, laughing and doing stupid things” (29F 00:). Feeling miserable (29F 4:20:30). “Feeling like I can’t handle life and I just want to curl into a little ball and give up”.

Feeling jovial, confident, giggly. “Feeling good, happy, quite excitable” (38F 03:10:15). “Am feeling absolutely horrible..want to cry..feeling extremely low..alone and miserable” (38F 03:19:30).

“Very happy again!!! Feel a bubble of happiness coming up in my chest, then need to laugh uncontrollably. Dancing around, laughing and hugging everyone” (38F 04:).

“Feel dull, have no energy. Want to give up on everything.” (36F 00:).

“Optimistic, happy, have energy. Alert, awake, in a good mood.” (36F 01:). “Sad and depressed, tired, unfocused and antisocial” (36F 03:)

Desire Company

When prover 29 was sad and troubled she had the desire to be with someone (29F 13:). Provers also recorded feeling sociable and confident.

Feeling relaxed and talkative and happy to see friends.

Difficult Concentration

There was huge difficulty concentrating on work in many of the provers. There was the sensation of being on a cloud (38F 01:13:20) and being light headed and airy (35F 01:). Frustration that it took a long time to do something short. There was lethargy, feeling distracted and a considerable lack of focus.

Relaxed and lazy,

fighting to study. Feeling floaty, drifting along can’t concentrate. Mentally slow. Indecisive and getting words wrong in sentences (29F 00:). Thoughts in a jumble. Slurring of words (31F 01:).

There was a lack of concentration accompanied by slow movements (05M 00:04:40). Feeling dull and demotivated. A thick feeling in the head, feeling dumb. It was noted that huge focus and attention was needed and that short term memory seemed deficient.

Heightened Emotions

There is an overlap of themes between „Heightened emotions’, „Depression and mania’ and „Irritability’. In „Heightened emotions’ the rapid movement between polar moods is observed. An extremely elevated mood is followed by the plummet to an incredible low mood and visa versa. “Emotions oscillated greatly today, quite sensitive and emotional.” (28M 07:).

“Mood swings” (42F 04:). “Had mood swings at work today. I would be upset and swearing, then angry and swearing, then happy again.” (31F 02:).

“Unsettled emotions” (28M 07:). “Heightened emotions - joyous and happy, then low” (38F 00:21:07). Emotions were felt to be messed up and “emphasized to the extremes” (38F 04:). There seemed to be an increased sensitivity to what people said.

“Overreacting to things that normally would not phase me” (31F 03:).

Feeling emotional and depressed because of a dream (29F 12:).

Getting nervous and sick because of dissection, couldn’t touch the body part, started crying.” (29F 12:). “..feeling absolutely horrible, constant feeling that I want to cry.” (38F 03:19:30).

Provers noted that the emotions that they were feeling were often for no reason. “Felt like crying for no reason.” (03F 02:15:50). “Very good mood, no reason to be in one though” (38F 04:).

“Felt sad about nothing when I woke up” (03F 03:08:00). Provers also noted the strange symptom of being irritable and frustrated on waking (38F 11:). Then feeling quite happy later (03F 03:10:57).

Irritability

Irritability was very marked in all of the provers. There were instances of being abrupt and rude, grumpy and irritable and snapping at others (29F 01:).

There was irritability over small things aggravated by tiredness, heat and humidity (02M :XX). Unusual shortness of temper was noted (01M 05:21:00). Waking up and feeling irritable for no reason (38F 11:).

Irritable with self and family for no reason (34F 11:16:00). Feeling frustrated, restless but at the same time like doing nothing (03F 13:11:30). There was the desire to relieve extreme irritation through physical violence. Depressed and annoyed, “Irritated, frustrated - want to hit something/ someone.” (36F 04:). Feeling “..very irritable, get angry easily, want to let frustration out physically.”

(35F :XX). Little things causing irritation, hostility and impatience whilst driving (provers 02 and 05). Irritated by being pushed around, with an intense aversion to authorative people

(36F 10:). Easily irritated, overreacting, wanting to be alone (provers 26 and 25). Jumping to conclusions. “Moody and better for nothing!” (42F 05:).

Laziness

There were feelings of being depressed, unsociable and lazy. Being relaxed and unmotivated and feeling as if they were on holiday. Finding it difficult to study and would rather go and have fun.

Mania

Hysterical laughter and the sensation of going mad. Uncharacteristic giggling fits in the evening. “Feel like I am going mad, this is unusual. I feel as though I am not able to keep all the bits of my mind together. The feeling doesn’t worry me, it is usually accompanied by much laughter.” (03F 05:21:30). “..not all there!! Can’t take much seriously - feel lightly drunk.” (05M 00:06:10).

Feeling in high spirits but semi dazed. Acting loud and silly, giggling, saying things without thinking. Feeling excitable. The sensation of a bubble of happiness coming up in the chest, then needing to laugh uncontrollably. Dancing around, laughing and hugging everyone.

Motivation and Enthusiasm

Provers felt energetic and motivated to work and study and get things done.

They were enthusiastic and could focus well on work. Trying to do too many things at once. Feeling positive. “Feeling on top of the world, in a very good mood, can overcome all obstacles with a smile on my face. Am great, very happy. More confidence, more energy. Jumping around instead of moping around.” (39F 01:09:55). Able to concentrate, well rested and energised. “At peace with the world, can motivate myself better than usual” (03F 14:10:25).

Optimistic and feeling better about the future.

Paradoxical thoughts

There was the feeling of being in two minds, of own desires being in conflict with the needs of others. Wanting to have fun but feeling guilty. “Want to do what is right, trying to restrain myself from what I want. Feeling spiritual” (36F 05:). Needing to do work but wanting to relax, “..not want to do work - prefer to go have fun.” (35F :XX).

It was observed that there seemed to be two trains of thought in some provers that was often reconciled by quiet time and introspection. Overreacting to things but after contemplation being able to put things into perspective again.

Restlessness

Feeling hot, bothered and rushed. Busy and hyperactive. Feeling that something that should be quick is taking a long time (38F 12:). Feeling that there is lots to do but there’s not enough time. Tired, restless, want time to hurry up - frustrated.” (03F 02:10:10).

Spaced Out

This was a common symptom in many of the provers. They felt spacey, drowsy and slow. Light headed and dreamy. Not focussed on the conversation or the surroundings (29F 01:).

“Feeling floaty, just drifting along, can’t focus.” (03F 03:11:30). Felt surreal on waking (03F 11:).

Mellow, dreamy, slow, wasting time. Feeling dreamy, disorientated, “Not completely on earth.” (36F 05:). Light headed, difficulty focussing, feeling distant (35F 01:).

Feeling stoned (31F 01:). Light headed, stupid, almost stoned feeling (05M 00:00:25). Dazed. Head feels cloudy (02M 02:).

[Liesel Taylor]

https://ir.dut.ac.za/bitstream/10321/61/12/Taylor_2004.pdf

Mind:

POSITIVE NEGATIVE

Alertness Laziness

Tranquillity Irritability

Desire company Antisocial

Mania Depression

Motivation and enthusiasm Difficult concentration

Carefree Anxiety

Heightened emotions Tiredness

Abrupt - rough - harsh

Absentminded - dreamy

> Activity/inactiv

Ailments from suppressed anger

Alert

Angers easily

Antisocial

Anxious - about business/causeless/about own family/about his money matters/about others/for paroxysms felt in stomach/from thoughts

Busy at night

Carefree

Cheerful

Company - < mental symptoms/aversed to (> when alone/desires solitude)/desires it

Concentration - active/difficult (cannot fix attention/on attempting to concentrate/vacant feeling/with headache/reading/studying/talking/working)

Confusion - talking/”As if intoxicated”

Actions contradictory to intentions

Dancing

Delusions: body is divided/body lighter than air/body divided in two parts/floating in air/head separated from body/becomes insane/is intoxicated/is excited and light/

body and mind separated/separated from the world/separated from the world/thoughts are separated

Disoriented with everything

Dissociation from environment

“As if in a dream”

Dull - when studying/unable to think long/thinking slowly

Excited easily/emotions heightened/excitement (at night)/# sadness/over trifles

Frivolous

Frustrated

Giggling

Hurry, haste (eating/in movements)

Impatience (driving)

Indifference (for business affairs/to the dictates of conscience/to duties/to everything)

Industrious - mania for work

Introspection

Irresolution, indecision (at night)

Irritable (morning/evening/at night/wishes to be alone/# cheerfulness/causeless?/from conversation/crying and weeping/with discouragement/to won family/about little things/loved ones/

from mental exertion/when spoken to/with sleepiness/from trifles/on waking/when working)

Laughing (desires to laugh/foolish/hysterical/loudly/everything seems ludicrous/silly/uncontrollably)

Laziness with sleepiness

Mania (# depression)

Meditating

Memora - weak (of memory/for facts/for recent facts)

Mistakes in speaking - using wrong words

Mood #

Motivated

Optimistic

Overwhelmed

Passionate

Positiveness

Prostration

Reserved

Restless (evening: 20 h./busy/when attempting to study)

Rude

Sadness (> company/with heaviness of body/would like to sleep and never to wake/with sleepiness)

Sensitive - to all external impressions/to mental impressions/to opinion of others

Serious, earnest

>/< Social meeting

Solitude desires it

Spaced out feeling

Speech - inarticulate/incoherent/”As if intoxicated”

Studying

Stupefaction (during vertigo)

Thoughts - disconnected/two trains of thought

Tranquility, serenity, calmness (# active concentration)

Weeping - anxious/desire to weep all the time/easily/after slight emotion

Will - contradiction of

Vertigo: Morning/+ staggering/”As if elevated”/tends to fall to the left (sitting)/”As if floating”/”As if intoxicated”/like swinging/in temples/”As if head turning around”

Head: Forehead - dull above eyes/cold/heaviness internal/pain (ext. ears/above eyes/behind eyes/between eyes/pulsating)

Constriction

Fullness

Heat

Heaviness

Itching when head becomes warm

Pain [l./r./morning on waking/+ pain in eye/from too eager attention/bending forward/constant, continued/exertion (body/of eyes)/increasing gradually - decreasing gradually/from light in general/

Lying/< motion (of eyes)/> external pressure/> rubbing/after sleep/in small spots ext. all directions/biting teeth together/in occiput/dull (> rising/l. side/from temple to temple/pressing behind

Eyes/pulsating/sharp/shooting (l./from temple to temple)/in temples (l./r./chewing/ext. neck/ext. parietal bone/ext. vertex)/pulsating]

Eyes: Agglutinated in morning

Bleeding - subconjunctival haemorrhage

Discharge yellow

Red (l.)

Dry

Heavy

Inflamed [conjunctiva (granular/> cold applications/sclerae red like raw meat]

Irritation

Itching

Pain [> bathing cold water/< bending forwards/during heat/from light/lying/< Wind/< sunlight/burning “As from sand”/”As from foreign body”/pressing outward/sore]

Photophobia

Staring

Swelling (l./lids)

“As if tired”

Twitching in lids

Vision: Accomodation defective/blutted/dim/foggy

Ear: “As if full”

Itching in meatus

Pain l.

Swollen l.

Nose: Catarrh

Coryza (without discharge/> lying/< motion)

Discharge constant

Itching (inside)

Obstruction (morning on waking)

Pain l.

Sensitive

Sneezing - constant/caused by dust/paroxysmal

Face: Discolored (dark circles under eyes)

Eruptions - l. cheek/acne/pimples (itching/on forehead painful/on lower jaw)

Greasy

Swollen l.

Mouth: Discoloration - white (yellowish)/yellow: white

Dry (with thirst)/”As if dry”

Tongue - enlarged/swollen/”As if thick”

Eruptions - on tongue/vesicles

Numb gums

Pain sore: palate

Salivation profuse

Speech difficult from swelling of tongue

Throat: Constricted

Red

Irritated

“As if a lump”

Mucus - morning on waking/tastes metallic

Pain - > cold drinks/> eating: ameliorates/burning (with dryness/drinking water/oesophagus/sore (sore > eating)

Scratching

Swallowing difficult

“As if thick”

Tickling causing coughing

External Throat: Eruptions - itching/pimples

Pain - l./r./pulsating sideways

Tension (r.)

Stomach: Appetite - diminished (daytime/evening/easy satiety/even after eating)/increased (daytime/even after eating/# loss of appetite/on waking/with weakness/ravenous)/without relish/wanting (evening)/wanting with thirst/wanting without thirst)/

Bubbling/gurgling

Disordered

Emptiness > eating

“As if full” - after eating ever so little

Nausea - after anxiety/after excitement/during fever/looking at food/after sleep

Pain (cramping)

Thirst (daytime/unquenchable/drinking cold water)/THIRST/thirstless

Uneasiness

Abdomen: “As if diarrhoea would come on” (with pain)

Distension

Flatulent on waking

Pain - “As if menses would appear”/cramping (with diarrhoea/during stool/before passing flatus/below umbilicus)

Rectum: Diarrhoea

Flatus (morning on waking)

Stool: Copious/dark/frequent/small

Bladder: Pain (on urination: urging to urinate)

Urine: dark/colourless in morning

Male organs: Pain in penis

Female organs: Leukorrhea - # bloody discharge/black/instead of menses

Menses - brown/too late/with leucorrhea/scanty (late)/painless

Pain sharp: ovaries

Respiration: accelerated/difficult - breathing: deep (want of breathe)/difficult in crowded room/inspiration/felt in throat

Chest: Constricted during fever

Rash

Pain under - r./l. mamma/sides/cramping in heart (cutting)

Back: Pain - in cervical region/in dorsal region: scapulae/in lumbar region (aching/sore)

Stiff

Tension (in cervical region: evening/on waking)

Extremities: Cold feet

Cramps in l. foot

Eruptions on upper limbs: rash/shoulder: rash/desquamation (of palm of hand/fingers/about nails)/pimples (legs itching/ankle)

Itching on lower limbs

Pain - l. knee/l. ankle/l. 5^th toe/

Twitching - upper arm/thumb/thigh

Sleep: Comatose

(Deep and) disturbed

Falling asleep - difficult/easy

Heavy/interrupted

Restless - at night/from bodily restlessness

Short afternoon

Sleepy - morning on waking/difficult opening eyes

Unrefreshing - morning

Waking “As from fright”

Dreams: some

Generals: r. side/l. then r.

> bending double

Heat and cold

Tends to take cold

Food and drinks: Desires: Choc./coffee/cold drink (water); <: smell of food/thought of food; Aversion: to food after eating a little/to food when seen/when smelling food/thinking of eating; Desires: fruit/sweets/water (carbonated);

Heat - flushes of heat with perspiration/lack of vital heat/sensation of heat (on exertion)Becoming heated/with nausea

“As if influenza coming on”

Lassitude

“As if strength”

> stretching

Weakness (morning/night/> exertion/in joints)

The researcher suggests that Naja-mos. be abbreviated Naja -mos, in accordance with the binary system described in Synthesis, 7th Edition (Schroyens, 1997). 5.3 The Symptoms The proving had to be repeated since the lack of compliance in the first trial amongst the lay volunteers resulted in a scanty collection of symptoms. The second trial was conducted with homoeopathic students from first to fourth year and ensured a better and more complete remedy picture. Prover symptoms from both the first and second trial were included in the final write up. The researcher however still feels that to claim that the proving produced a complete essence picture of Naja-mos. would be premature (Mortelmans, 1997:201). The proving at best gives one an indication of the potential of Naja-mos. as a remedy.

More research over an extended period of time into Naja-mos.’s characteristics is required to attain the quality of completeness required for a true understanding of this remedy. The concepts resulting

from the proving are discussed in a simple and comprehensive manner under the various sections of the repertory.

MIND A significant number of contradictions emerged from this proving and were particularly evident in the mind section. This was to be expected when one studies other snake remedies regarding the mind symptomatology - for example: Naja. with regard to the positive, energised emotions versus the depressive, apathetic emotions and Lachesis muta with regard to its loquacity versus its moroseness and lack of communication.

THE PARADOXES

The researcher attempted to extract and categorise the paradoxes in order to discuss them in a clear logical fashion.

Alertness versus lack of concentration

Most provers experienced clarity of mind and alertness following an initial period of total lack of concentration and focus. Since most of the provers were students in varying levels of study, this lack

of concentration pertained mainly to studying either for examinations or when attempting to understand lecture material. At first this lack of concentration was met with frustration and reluctant acceptance, then with indifference and a care less attitude that led many to neglect their studies in pursuit of other interests and pleasures. This lack of concentration was described as being “distracted”

or “dull, dazed” and a “stoned feeling”.

It suggests that the provers felt as if they had been under the influence of some kind of narcotic, which may account for the carefree attitude many adopted subsequently. Mistakes in speaking also occurred, some experienced it as a slurring of words (31F 00:) or “kept getting words wrong in my sentences” (29F 00: ). This lack of concentration and distraction appeared shortly after taking the remedy and was evident throughout the proving.

The alertness felt following this “dazed”, apathetic period resulted in the provers feeling more energised, positive and focussed on the task at hand. There was a feeling of motivation coupled with a sense of confidence in oneself to accomplish whatever task presented.

Anxiety versus Tranquillity

Anxiety was experienced by many provers but was mainly paired with frustration, agitation or a sense of being overwhelmed by a particular problem or by life in general. This anxiety was experienced as something that one could not control which exacerbated the frustration and agitation even more. Although the anxiety was caused mainly by events occurring around them, many provers experienced anxiety for no reason. It appears that the various individuals allowed outside impressions to affect them deeply, to such an extent that they experienced it as an influence that they had no control over.

The tranquillity evident in the proving emerges as a reprieve interspersed amongst the periods of tension and restlessness. Tranquillity is experienced as relaxation, peace and a time to replenish the energies. Anti-social versus Desire for company

This aversion to company appeared to be related to the depression and irritability felt by many in the proving. A number of provers felt irritated by company or by a social gathering and became angry

at being “imposed” upon. Although few provers enjoyed company and were reputed to be “party animals”, they became withdrawn in company and seeked solitude. Some provers experienced these contradictory feelings as alternating symptoms on the same day or on alternating days. All the provers experiencing this anti-social feeling did not experience the desire for company. One prover as an underlying need for security experienced the desire for company as a “wanting to be around my mom all the time, she stayed with me till I fell asleep” (29F 13:). This prover also felt sad and troubled within whilst enjoying the company of friends. Others however experienced this need for social interaction as a positive, confidence building experience. Carefree versus Heightened emotions

This carefree feeling paired with the lack of concentration and spacey feeling was a common thread and with it the contrast of heightened emotions whether positive or negative were experienced by

most of the provers throughout the proving. Carefree was interpreted in different ways as indifference, laziness, apathy, uncaring and an aversion to perform one’s duty. The heightened emotions experienced were interpreted by many as a sensitivity to outside impressions which resulted in emotions such as weeping, anger and irritation to name a few. Many experienced a vacillation in emotions

and caused many to overreact to trivial occurrences and lash out at those around them. This particular paradox relates to most of the other contradictory symptomatology in the proving. Depression versus Mania

The researcher felt that this was the main theme that emerged from the proving. The depression encompassed sadness, weeping, and suicidal thoughts to being serious and reserved. Provers felt unsure, indecisive and withdrawn from society whilst in this depressive state. One prover had suicidal thoughts, that didn’t last too long and were dramatically contrasted by the manic state of laughing, acting silly and being generally loud thereafter. (29 F 00:20: 00) The depression was vividly contrasted by the manic state in the provers. This state manifested in provers as laughing uncontrollably, acting silly and loud. The behaviour was described as uncharacteristic, unusual and being uncontrollable, a sense of going mad and an inability to take anything seriously (05 M 179 00:06:10) (03 F 04: 13: 42). The manic state is reminiscent of the effects of recreational drugs that provide one with a feeling of elation and energy. A prover mentioned her desire to dance, hug everyone and generally feeling loved.

38 F 04 and 05:) This is much like the effects of MDMA (ecstasy). Laziness versus Restlessness

This dramatic contrast between the apathetic versus the energetic hyped state is again clearly outlined under these contradictions of symptoms. Laziness is described as an aversion to anything that may

be regarded as work or duty and the subsequent desire for undertaking nothing. This laziness can be related to other feelings such as being carefree, unfocussed, antisocial and indifferent and a desire

to participate in other interesting distractions. Restlessness, associated with anxiety, irritability and frustration was felt by most of the provers. This restlessness was expressed as being rushed, wanting time to pass quickly and generally performing daily tasks in a hurried manner. The general restlessness was described as busy and hyperactive. Paradoxical thoughts - two trains of thought Provers 35, 36 and 38 expressed a moral dilemma in thoughts where their desire to do something conflicted strongly with the awareness of doing the “right” thing.

This detached feeling was particularly marked in prover 03 where her head felt detached from her body whilst driving a car. She experienced a sensation of floating and detachment from her surroundings and body when she was running. Her sense of detachment was associated with dizziness. Her head felt like it was swinging around when she stood still. Prover 29 had a similar experience where her upper body felt detached from the lower part of her body and her hands and arms “were irritated with writing”. Irritability, short temperedness and impatience Most if not all the provers experienced a general sense of irritability, short temperedness and impatience.

This irritability was associated with tiredness and an over reaction to trivial issues. Impatience was obvious when driving and instilled hostility in the driver due to short temperedness. Heat and humidity appeared to exacerbate these feelings of irritation. Irritability and hostility was mainly vented on family and friends. There was no clear cause for the irritation and general bad temperedness but was more

a state induced by overreaction. Motivation and Enthusiasm This theme is associated with much energy and optimism. The provers expressed a keenness to accomplish tasks and a motivation to study.

This is in sharp contrast to the aversion to work found in the laziness theme above. It should therefore also be contrasted with the laziness state. A general positive well-being underlies this energetic state.

Spaced out, tiredness

All the provers experienced tiredness in some form or other. Most experienced this overwhelming tiredness in the afternoon or evening, others felt unrefreshed in the morning. The tiredness in many cases was associated with a feeling of being spaced out and dreamy. Some expressed an irritability associated with the tiredness and being short tempered. Although associated with the tiredness, being spaced out was also experienced on its own.

Provers felt distant from their surroundings either not hearing conversations or in one case the morning alarm and as one prover described as feeling “surreal” on waking. This spaced out feeling was also described as being stoned and can be related to the unfocused feeling discussed under the lack of concentration theme. Modalities Ameliorating factors for mental emotional symptomatology were the outdoors and open air, activity, eating, solitude and company. Aggravating factors included heat and humidity, eating, company, morning on waking and mental exertion.

Vorwort/Suchen Zeichen/Abkürzungen Impressum