IPECAC

I’m extraordinarily patient provided I get my own way in the end. [Margaret Thatcher]
Cephaelis ipecacuanha – Ipecacuanha, Ipec Root.
Family Rubiaceae – other members include Cinchona (Quinine Bark), Coffea (Coffee), Galium-
Aparine (Cleavers), Uncaria (Cat’s Claw), Yohimbe.

BODY SYSTEM AFFINITY:

MUCOUS MEMBRANES
[DIGESTIVE TRACT; stomach; RESPIRATORY; lungs].
Nerves [pneumogastric; spinal; cutaneous].
Umbilicus.
*Right side. Left side.

Constitutions – It is specially suited to: stout persons of lax

tissue to fair people to women and children to emphysematous
persons to persons who have a history of nosebleed or other
blood-loss. Indicated in fat children and adults who are feeble
and catch cold in warm wet weather.

Causations – Ill effects of vexation, reserved displeasure. Injuries, loss of blood, suppressed
eruptions. Morphine, opium and heroin addictions. Quinine. Indigestible food, rich food, pork,
pastry, fruits, candy, ice cream.

MODALITIES:
Worse: Better:
WARMTH; damp warmth; warm room; warm Open air
moist, south winds.
Generally warm-blooded.
Overeating [ice cream; pork; veal; mixed or
rich foods; fruits; salad; fats]. Fasting.
Periodically. Quinine. Heat and cold.
Recession of eruptions. Slightest motion.
Winter and dry weather. Autumn. Cold nights
after hot days.
Stooping [vomiting].

OVERVIEW:
Morrison: Whenever nausea and vomiting are a prominent element of a case we must think of
Ipecac. Virtually any organ system may be affected in this remedy and yet there is nearly always a
concomitant action on the stomach. Despite this almost universal tendency for vomiting, there is
no amelioration and often a general aggravation from emesis. There are two special areas of

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usefulness of Ipecac: asthma (or asthmatic bronchitis) and haemorrhage. It palliates nausea
following chemotherapy.
Murphy: The principal feature of Ipecacuanha is its PERSISTENT NAUSEA AND VOMITING,
which form the chief guiding symptoms. Morphine or heroin addiction (Aven.).
Ipecacuanha acts chiefly on the pneumo-gastric nerve, producing a gastro-intestinal
disturbances and respiratory disorders with continuous nausea. Especially indicated in fat
children and adults, who are feeble and catch cold in relaxing atmosphere, warm, moist weather.
Spasmodic disorders. Haemorrhages bright-red and profuse. Discharges are foamy and
profuse. Bright red, gushing haemorrhages with nausea. Indicated after indigestible food,
raisins, cakes, etc. Nausea and shortness of breath usually accompany most of the complaints. …
The special form of nausea is a constant desire to vomit or immediately after vomiting there is
instead of relief, a desire to vomit again. With this there is a clean or not very dirty tongue.
There is profuse salivation with the nausea. The nausea of Ipecac is often met with in disorders of
the stomach and bowels of the respiratory organs and in fevers. In the stomach itself, there is
a symptom which is very characteristic of the remedy, a feeling “as if the stomach were hanging
down relaxed.” There is disgust at the stomach for food, empty vomiting, vomiting of bile of blood.
No better by vomiting.

MAIN SYMPTOMS:
Murphy: “The stomachic disgust of the remedy is depicted on the countenance, which expresses
nausea. The corners of the mouth are drawn down. Blue rings round the eyes. Sometimes the
mental state corresponds: "Moroseness and contempt for everything,” “Disdainful humour”. The
irritability of the elders becomes in children crying and screaming.”
Ailments, PAINS and CONSTANT NAUSEA and vomiting. Nausea
not amel. by vomiting. “Adapted to cases where the gastric symptoms
predominate” [Allen]
Constant nausea which is incapacitating; stomach seems to
hang loose inside; nausea unrelieved by vomiting. Stomach
feels relaxed, as if hanging down.
VOMITING worse STOOPING
Diarrhoea of a dysenteric nature. Autumnal dysentery; cold nights,
after hot days. Nausea and vomiting of pregnancy.

NO THIRST.
RESPIRATORY AILMENTS and NAUSEA and CLEAN TONGUE – “Constant nausea with a
clean tongue is the watchword” [Dewey]
Gastric ailments [NAUSEA] and constant SALIVATION.
Troubles arising from fat food, pork, pastry, candy, etc
HAEMORRHAGES [epistaxis, haemorrhoids, menstruation, hematemesis] of bright red colour and
sudden [haemorrhage and vomiting both represent loss of body fluids]
Uterine haemorrhage which starts suddenly with bright red uncoagulated blood, coming
in gushes, often with nausea and faintness.
Metrorrhagia, < motion, < during labour or postpartum. Severe dysmenorrhea with nausea
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 Weakness AFTER MENSES.
Asthmatic bronchitis and coughs especially of children.
COLDS in children; starting with stoppage of the nose at night, followed by hoarseness and
suffocative, spasmodic cough; and retching and vomiting. DRY, SPASMODIC COUGH,
ENDING IN CHOKING AND GAGGING
RATTLING, great accumulation of mucus in chest, but NO EXPECTORATION. Child
stiffens and becomes pale or blue; gasps for breath [Ant-Tart.]. Comes on in warm humid
weather. Respiration arrested from severity of cough. Hemoptysis.
Pertussis or other severe coughs with retching, vomiting, stiffness, and cyanosis.
Bronchiolitis. Croup. Bronchiolitis, bronchitis or asthma with spasmodic, suffocative cough
and retching and VOMITING.

COMBINED SYMPTOMS: Nausea and haemorrhage tendency.

CLINICAL:
Asthma. Bronchitis. Epistaxis. Haemorrhage. Hematuria. Hemoptysis. Metrorrhagia. Migraine.
Miscarriage. Pertussis. Recurring fevers.

NUCLEUS:
1. Ailments or pains attended with constant nausea and clean tongue.
2. No thirst.
3. Worse Heat.
4. Profuse salivation during nausea.
5. Spasmodic respiratory ailments.

DIFFERENTIAL:
Complementary: Cuprum. Arnica. Ant-Tart.
Compare: Tabac. Kali-C. Kali-S. Sang. Ant-Tart. Puls. Lobelia. Squilla. Ars-Alb.

NOTES:
In whooping cough a characteristic is the spasmodic rigidity of the patient. “Child loses breath, turns pale,
stiff and blue, strangling with gagging and vomiting of mucus, bleeding from nose or mouth.”
Guernsey thus describes the effect of Ip. in the female sexual sphere in which the hemorrhagic power of the
remedy is of the highest importance: “Threatened miscarriage often with a sharp pain around the umbilicus,
which runs downward to the uterus with constant nausea and discharge of blood before the proper period,
metrorrhagia often after confinement, which is heralded by a low pulse, nausea, etc., there is a steady flow of
bright red blood, which may soak through the bed to the floor or may run over the foot of the bed.” Where
there is this steady flow of bright red blood give Ipecac, run from above down, some from left to right
(cutting pain in abdomen).

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Cooper cured an immense uterine fibroid where persistent painful irritation of the skin with constant retching
and vomiting, made worse irritation of the skin with constant retching and vomiting, made worse by eating,
constituted the prominent symptom. Frightful irritation inside and out, especially vaginal with thick
leucorrhoea and a feeling of desperation, yields to Ipecac.

From Ellingwood (1919), American Materia Medica (a classic Eclectic herbal materia medica):

IPECAC. Cephaelis ipecacuanha.

Synonym—Ipecacuanha.
CONSTITUENTS—
Emetine., the emetic principle existing in the stem, leaves and root,
cholin and cephaeline in the root, ipecacuanhic acid, and a nauseating ethereal oil.

PREPARATIONS—
Extractum Ipecac Fluidum, Fluid Extract of Ipecac; dose, from one
to forty minims.

Syrupus Ipecac, Syrup of Ipecac; dose, from ten to sixty minims. Pulv. Ipecac et Opii, Powder of
Ipecac and Opium, composed of Ipecac and opium of each ten parts, Sugar of Milk, eighty parts;
dose, from three to ten grains.

Specific Medicine Ipecac; dose, for gastric, intestinal or bronchial irritation, five drops in four
ounces of water; a tablespoonful every hour. As an emetic, from five to twenty minims in hot water.
Alcresta Ipecac is prepared by the action of Lloyd's reagent on the solution of the alkaloids of
ipecac. It represents the medicinal properties of the ipecac, but will not produce nausea or emesis.
It is superior to emetine in its general use because it is not hypodermic. One tablet represents ten
grains of the powdered ipecac. It may be given in doses of one, two or three tablets three times per
day, before meals,

Physiological Action of Ipecac, (J. U. Lloyd, Ph.D., LL.D., Ph. M., Western Druggist).—
Ipecacuanha root, from its first appearance in our materia medica, has been prized as an emetic
and anti-dysenteric remedy.
The peculiar effect that the dust of ipecacuanha powder exerts upon the respiratory organs of
some persons has been noted by early observers. Lewis, in 1761, makes the following statement:
“Geoffroy observed that in pulverizing considerable quantities, the finer powder that flies off, unless
great care be taken to avoid it, is apt to afflict the operator with difficulty of breathing, spitting of
blood and bleeding at the nose, or swelling and inflammation of the eyes and face, and sometimes
of the throat, adding that these symptoms disappear in a few days, usually spontaneously.
Poisoning in this manner may be treated by blood-letting and the taking of a decoction of uva ursi
and extract of rhatany; in another more recent instance, relief was afforded by a dose of extract of
quebracho.” Powdered ipecac applied to the skin produces irritation and redness, followed finally
by small isolated pustules, which increase in size to small ulcers. The powdered ipecac in one-sixth
of a grain doses is a stomachic tonic, stimulating the salivary and gastric secretions. In doses of

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ten grains it will act as a nauseating, emetic, but the emesis occurs slowly and is not extreme,
persistent nor prostrating like that of lobelia or tartar emetic.
In some cases continued repetition of the emetic dose produces a toleration, when the emetic
effect ceases, but there is diarrhea—an active cathartic influence, with stools characteristic of this
agent. In some children the persistent use of the syrup of ipecac will invariably produce diarrhea
often persistent and difficult to cure.
The agent is also diaphoretic and actively expectorant.
Emetine was first isolated as the emetic principle of ipecac in 1867. In1894 the other alkaloid
cephaeline was discovered. In 1912 it was determined that emetine destroyed the ameba which
has been known to be the cause of epidemic amebic dysentery, of a form of hepatitis, and also
as the cause of pyorrhea, commonly called Rigg's disease, and other conditions of less
importance. This important discovery has placed this alkaloid (like the hypodermic use of lobelia
has placed that important remedy) in a most conspicuous position, making it at once a specific for
the conditions named. Alcresta ipecac is exercising the same specific influence.
Dr. H. Barlow, Chief Surgeon to the Hospital at Cuyamel, Honduras, now using these preparations,
says: “My impressions are that while Alcresta ipecac cannot replace emetine in cases which can
be seen daily, or in severe cases, it has certain uses in which it is superior to emetine. These are:
1. Cases in which there is an insuperable objection to hypodermic injections;
2. Cases living at such a distance or too poor to make daily visits to a physician;
3. In the after treatment of cases which have been relieved by the treatment of emetine;
4. In the treatment of carriers; and
5. In the treatment of cases of Craigiasis, which indeed cannot be treated so well with emetine
alone as with emetine combined with some preparation of ipecac which can be administered
orally.”
The endameba which is the specific cause of Pyorrhea Alveolaris is almost invariably destroyed
by Alcresta Ipecac. Bass and Johns found that the germ would disappear from all lesions in from
one to three days in ninety per cent of the cases, and in six days from ninety-nine per cent of the
cases. They found it as efficient in most cases as emetine. The peculiar combination involved in
this substance prevents the alkaloids from being dissolved in acid or neutral solutions. Thus it
passes unchanged through the stomach without inducing nausea in any form.
The alkaloids are permitted full activity in the intestinal tract. The local influence of this agent upon
the endameba in the mouth is very prompt and satisfactory. In extreme inactive conditions of the
stomach and bowels, with or without pain—the inactivity shown by a broad, pallid tongue, covered
very thickly with a dirty white coat, which finally becomes sleek on the top, increasing from tip to
base in dirtiness, to a brown color-full emetic doses of the common forms of ipecac persisted in for
a short time will quickly correct almost the entire train of symptoms.

Specific Symptomatology—Persistent irritation in mucous membranes, with deficient secretion,

demand ipecac in small closes.
Persistent nausea and vomiting, with pale, relaxed membranes, white-coated, broad tongue, will
often yield most readily to minute doses (1/10 of a drop) frequently repeated.
Bronchial gastric or intestinal irritations are benefited by its use. It is indicated also in croup, with
sudden dypsnea and threatening suffocation, extreme secretion, without ability to dislodge. Half
teaspoonful may be given.

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Therapy—For its emetic influence ipecac is one of the most satisfactory of the emetics. When
there is undigested food in the stomach, causing irritation, when mild poisons are taken, when
emesis is demanded to relieve sick headache, this agent is used in preference to others. If
promptness of action be demanded the full dose should be given in a bowl of warm water—not hot
—or a single full dose of lobelia may be given with it. This produces immediate emesis without
prostration. If powerful poisons are taken, and active emesis is demanded, the sulphate of zinc or
lobelia in persistent doses, or some other emetic more immediate in its influence, is usually used,
although the writer has always been able to adjust ipecac with such adjuvants as warm water,
mustard, or tickling of the throat, to every case. In cases where foreign bodies are lodged in the
esophagus, and in the threatened suffocation of mucous croup, or in membranous croup, ipecac
is the remedy, especially in childhood. No emetic more harsh should be used with children. In the
developing stage of malarial fevers it was once the practice to produce active diaphoresis by a hot
pediluvium and hot drinks, the patient being wrapped in warm blankets, and to produce profound
emesis with ipecac. Often the most desirable results were obtained, and in some cases where an
acute cold had been contracted or where there was a severe chill, in strong, previously healthy
patients, the disease, was suddenly terminated by this course. The author has had this experience.
In the bronchitis of childhood occurring often suddenly, with a dry, hoarse, stridulous or croupal
cough, without secretion, ten drops of the syrup of ipecac given every half hour, hour, or two hours
until nausea in induced, will sometimes abort the condition in a few hours, the influence of the
agent dissipating the conditions essential to the progress of the disease. This form of bronchitis is
common in furnace-heated houses, and in close, hot, unventilated apartments, in the beginning of
the winter when the furnace fire is first started, and in the spring.
Ipecac in small doses given in conjunction or in alternation with aconite or bryonia or belladonna, is
of great service in pneumonia, especially that of childhood. Five drops in a half glass of water, a
teaspoonful every hour, may be given with the best of results. In acute bronchitis it may be
prescribed in the same manner.
Ipecac is of value also in the after stages of pneumonia. In the stage of active inflammation it is
useful as stated, but is not given in the same. form as in the later stages. It is an excellent remedy
to assist in clearing up hepatization and in restoring normal conditions in the lung cells.
The author, when the temperature has subsided, gives one-fourth to onehalf a grain of powdered
ipecac to an adult, every two or three hours in a capsule, with two grains of the bisulphate of
quinine. The tonic influence of the quinine assists the influence of the ipecac.
Ipecac is of value in coughs when there is a deficient secretion, whatever the cause. Emetic doses
are not desirable if the agent is to be continued for a length of time.
It has been beneficial in spasmodic asthma, whooping cough and in laryngismus stridulus.
This agent is advised in irritation of the bowels resulting in acute inflammation. In small doses it is
given with good results in cholera infantum and in diarrheas, but is of no benefit beyond the acute
stage.
While ipecac has been known as a cure for certain forms of dysentery for more than a century, the
use of its active principle emetine as a cure for amebic dysentery is just now coming into
prominence. Our writers have always advised ipecac for this disease, but not all have given it in
sufficiently large doses. Administered now in the form of alcresta ipecac or emetine
hypodermically, the cures are prompt and highly satisfactory. In fact, the remedy is already being
classed with quinine for malaria, and antitoxin for diphtheria, as one of the great specifies. If the
dysenteric tenesmus is relieved with prompt doses of gelsemium— and we have a no more

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efficient remedy in the materia medica for this condition than that agent—the beneficial effects of
the ipecac upon the local inflammatory processes will be more plainly marked.
Recent observers in the general hospital in Calcutta, India, have found
that large doses of ipecac have most beneficial effects in amebic hepatitis and hepatic abscess.
If the diagnosis be made before the formation of pus, this is prevented by the agent. It should be
given when the patient suffers with a general feeling of lassitude, foul tongue, pain in the right
shoulder and in the right hypochondrium. The liver is enlarged and tender on pressure. There is
marked leukocytosis but the polynuclear increase is not great. Ipecac is given in these cases in
single large doses, usually from twenty to thirty grains, given at least two hours after eating and
best taken at bedtime. Occasionally this dose is given twice daily in capsules.
Frazier claims that ipecac in large doses is an excellent addition to the treatment of typhoid fever.
In five cases where he used it, the temperature dropped suddenly so that within four days it was
normal. In the earlier stages he gave thirty grains on the first day; twenty-five the next; twenty the
next and so on down until ten. He gave small doses of opium to keep the patient from vomiting.
The results were pronounced. This course is worth trying.
The successful use of this common remedy, in the treatment of epilepsy has been reported, since
our first edition. Persistent cases have been treated, with ten minim doses of a strong fluid extract,
increased to forty minims. This has been persisted in according to the susceptibility of the patient.
The action of emetine or alcresta ipecac should be at once determined for the above conditions.
In hemorrhages Ipecac has exercised a satisfactory influence. Its action upon the circulation is
quite prompt. It is given by some physicians in small doses for this purpose, and by others in full
doses to prompt emesis. It has controlled postpartum hemorrhage, menorrhagia, metrorrhagia,
epistaxis and hmmoptysis, and will exercise a beneficial influence in hematuria.

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