Most of us are very familiar with Pulsatilla as a remedy with wandering symptoms, when the patient says that the pains keep moving from place to place. But Pulsatilla is also a remedy with alternating symptoms. Even though it did not appear as one of the specific examples presented in Aphorism 251 of the Organon, the proving of Pulsatilla in the Materia Medica Pura is full of examples presenting the alternating nature of the remedy.
So what are alternating symptoms? Here’s Hahnemann, explaining in the Organon:
Among these symptoms, there occur in the case of some medicines not a few which are partially, or under certain conditions, directly opposite to other symptoms that have previously or subsequently appeared, but which are not therefore to be regarded as actual secondary action or the mere reaction of the vital force, but which only represent the alternating state of the various paroxysms of the primary action; they are termed alternating actions.
Within the context of provings, it is particularly important to understand whether the prover is exhibiting symptoms that are the first or secondary actions, or whether they are alternating symptoms that can be produced by the remedy.
If, however, in order to ascertain anything at all, the same medicine must be given to the same person to test for several successive days in ever increasing doses, we thereby learn, no doubt, the various morbid states this medicine is capable of producing in a general manner, but we do not ascertain their order of succession; and the subsequent dose often removes, curatively, some one or other of the symptoms caused by the previous dose, or develops in its stead an opposite state; such symptoms should be enclosed in brackets, to mark their ambiguity, until subsequent purer experiments show whether they are the reaction of the organism and secondary action or an alternating action of this medicine
Just to round things off – here is Aphorism 251, quoted above:
There are some medicines (e.g., ignatia, also bryonia and rhus, and sometimes belladonna) whose power of altering man’s health consists chiefly in alternating actions – a kind of primary-action symptoms that are in part opposed to each other.
So does that mean we have to see an alternation of symptoms in order to prescribe Pulsatilla? It seems to me that although alternating symptoms would be a good reason to look carefully at the remedy for prescribing, what may more frequently happen is that in the process of a Pulsatilla case, we will observe symptoms switching from one modality to the opposite, from one state to the other. In other cases we may see this as curative action – but where the patient has been given Pulsatilla (and other remedies including Bryonia, Rhus-T, Belladonna, Ignatia etc. as mentioned by Hahnemann) we may be seeing case progression – but not necessarily directly curative action.
From the material it appears that while we may see the symptoms alternating, we also may see one or the other state prevalent in the patient. Each practitioner has to observe carefully in every individual case.
What are some of the alternating symptoms in the proving of Pulsatilla? Some may be surprising:
Pulsatilla is always better for open air, correct? Not exactly.
895. The symptoms are ameliorated IN THE OPEN AIR (895, 897, 898. Three alternating symptoms of Pulsatilla, the first of which is the most important, i.e. the most frequent and most severe.) (aft. 1/2 h.).
And these are perhaps less frequent, less severe, but they were observed in the proving.
897. He longs for the open air, and yet the abdominal pain and inclination to vomit in particular, are aggravated in the open air (aft. 10 h.).
898. Sufferings from open air; he dreads it (aft. 6 to 8 h.).
We’re usually familiar with the “wet” Pulsatilla cough, and when the patient “dries up” we may think Pulsatilla’s work is done.
618. Dry cough, with difficult expectoration (618. 620. 621. These and the preceding symptoms of dry cough seem to be in alternation with the symptoms of copious expectoration with the cough (625-627. 629-632), but the latter seem to be the principal symptoms, so that diseases, which in other respects are suitable for pulsatilla are removed more readily and permanently when the cough is attended by copious expectoration than those with dry cough. In 624 the chief alternating action with copious expectoration occurred only after dry cough, which is rarer.) (aft. several h.).
And here’s symptom 624:
624. First, for half a day dry cough, and then for several days mucus constantly in the anterior part of the trachea which can be expectorated in quantity by voluntary coughing.
What about the mental state?
The following alternating example that Hahnemann notes in the proving does not sound exactly like the “mild and yielding” temperament he mentions in his introduction to this proving::
1142. Everything disgusts him; everything is repugnant to him. (1142, 1144, 1154, alternating states.)
1144. He is not indifferent to external things, but he has no respect for them (aft. 1 h.).
1154. Extraordinarily whimsical and cross with everything, even with himself.
Alternating symptoms raise questions in treatment. We don’t always see the full alternation, but even if what is considered the “rarer” side of the symptom is all we see, and all other symptoms point to Pulsatilla, this remedy should be in focus for prescription..