CYPRIPEDIUM PUBESCENS

LADY’S SLIPPER, NERVE ROOT, UMBEL, AMERICAN VALERIAN, MOCCASIN FLOWER

Description:  Natural Order, Orchidaceae. Genus CYPRIPEDIUM : Perennial herbs, growing in moist woods and meadows in the Northern States and Canada. Flowers large and very showy; the lower lip greatly inflated, so as to bear a rude resemblance to an ancient buskin– whence the generic name, which is from the Greek, signifying Venus’ Slipper. Sepals three, spreading; petals three, the lower one forming a large, inflated, saccate lip. Column of consolidated stamens short, three-lobed, with a two-celled anther under each lateral lobe, and the central lobe consisting of a barren stamen developed into a thickish and in curved petaloid form. Stigma terminal, obscurely three-lobed. Root of many tufted fibers. C. PUBESCENS:  Stem a foot or more high, usually several from the same root-stalk. Leaves broad-oval, acute, many- veined, clasping at base, three to six inches long by two to three inches broad. Flowers mostly solitary, rarely two to three on a plant; sepals long-lanceolate, two, the lower composed of two united either their entire length or at their tips; petals long, linear, twisted-wavy, spreading, and greenish like the sepals, marked with peculiar purple spots; lip gamboge-yellow, shorter than the greenish petals, one and a half to two inches long, with a narrow aperture, spotted inside, scentless. Whole plant covered with a soft pubescence. May and June.

This brilliant species of cypripedium is quite common in shady marshes and bogs north of Pennsylvania. Its four long and purple-dotted segments of the perianth, with the large saccate lip hanging horizontally with its opening upward, at once attract attention. There is a smaller species, with a smaller and less brilliant lip–the C. parviflorum–which is said to possess the same medicinal properties. The species candidum and spectabile with white saccate lips, and the acaule with no leaves along the stem and a pale purplish lip, are said also to be the same as the pubescens medically; but this I think is an error.

The roots are about a line in diameter, tufted, brownish yellow, forming a gray powder. They have a peculiar and somewhat unpleasant relaxing odor; and a slightly bitter and rather nauseous taste. Age and heat greatly. impair their qualities, which are distinctly volatile. They contain an oleo-resinous substance, and a very small quantity of oil is obtainable by treatment with ether; but neither of these fairly represents the plant. Water acts on them imperfectly; alcohol, and diluted alcohol, extract their virtues fully.

Properties and Uses:  The roots of these plants are the medicinal part, and were introduced to practice by Dr. S. Thomson–with whom they formed a leading remedy. They are nearly pure relaxants, with not enough stimulation to be available. Their influence is manifested slowly, and is expended wholly upon the nervous system; and it is only through the nervous tissues that they impress other parts. Thus they belong to the pure nervines or parodynes, (§235;) and are antispasmodic, and mildly tonic to these structures.

They are used in all the multiplied forms of nervous irritability and excitement, except when arising from advancing putrescence. They. soothe and calm the entire system, easing all forms of pain growing out of local or general irritation, (§237;) and inducing quiet and usually securing sleep. They have been accused of possessing narcotic properties, but I could never detect any such impression from them; as the sleep is not accompanied by stupor, is no more profound than would naturally follow the most sanative relief from protracted pain or nervous agitation, is associated with a warm and gentle perspiration, and is not followed by ,any suppression of the secretions or feelings of languor. Such facts are not indicative of narcotism, (§90;) or else all forms of relief from suffering and excitement must be of narcotism. Further, the cypripedium can not be given in quantities to stupefy acute suffering in the presence of offending substances, as opium will do; but the relief obtained from it must always be connected with such a relaxation and opening of the emunctories as will make a way of escape for injurious materials; and it is always peculiar of it that ease will not be obtained by its use, unless at the same or a previous time the system has been depurated of morbific accumulations. Hence it is a nervine only when the frame has been, or is being, rid of such offending elements as would provoke the restlessness; and that fact alone shows how wide is the difference between this agent and any narcotic. The cypripedium itself aids somewhat in this depurative work, as is made known by a mild increase of perspiration, diuresis, and even alvine action, in connection with its use; but its influence on the secernents is too indirect and feeble to accomplish much elimination, and hence this remedy is then combined, or used coetaneous with such agents as influence those secreting organs that need assistance in each particular case.

From this nature of the article, its use can at once be seen to be very wide and peculiar. In hysteria through all its varied forms, it is second to no remedy; in headache, sleeplessness, and restlessness, when proceeding from feebleness and irritability of either the nerve centers or peripheries, it is an admirable agent; and in chorea, neuralgia, neuralgic rheumatism, and the restlessness of the later stages of typhus, typhoid, bilious, and intermittent fever, (after the secretions have been well influenced,) it is a valuable adjunct to other treatment. It is not relied upon alone in these cases, but is used as the nervine associate of such remedies as may be indicated. Thus, in hysteria of a sub-acute and chronic character, it is combined with liriodendron, aralia racemosa, etc.; in hysterical convulsions or other acute forms of this malady, with asafoetida, zingiber, or lobelia; in rheumatism, with xanthoxylum or phytolacca berries; in painful menstruation, with anthemis, caulophyllum, and zingiber; in febrile cases, with asclepias, zingiber, and other diaphoretics; in colic and painful flatulence, with dioscorea and anise; in delirium tremens and subsultus tendinum, with capsicum and ginger; and in like manner a moderate portion of it may be used in company with a large variety of remedies–the cypripedium being employed for the nervous irritability. It is an excellent antispasmodic, but nearly always needs to be combined with some stimulant, (§245 ;) and when combined with the leaves of rubus and a very small quantity of capsicum, forms one of the most reliable compounds in parturition where the nervous system becomes weary and the uterine efforts lag. Directed to the uterus by such an agent as trillium, (§265,) it affords great relief in after pains.

The article fully merits all the praise here given it. It is not so powerful as the foreign valerian, nor so active upon the brain centers in procuring sleep; but it is less unpleasant in taste, (though still quite slowly nauseous to some stomachs,) and more tonic in action. Yet cypripedium will disappoint the practitioner who relies upon it alone as a tonic for chronic cases of nervousness; for it is too relaxing to serve such a case. So also it is not to be relied on alone in the restlessness of putrescence, of low typhus, of congestive chills, and similar states of great depression, unless associated with an excess of the positive and permanent stimulants–as capsicum with hydrastis, and quinia when the case needs this with capsicum. Physicians too many times overlook the slow and nearly pure relaxing qualities of cypripedium, and so fail to apply it properly, (§55, 261, 262.) The cases where it alone is needed are really few; but its combination in moderate quantities with tonics and stimulants of such grades as the case in hand requires, enables it to fill a very great number of important requirements. Its nauseating-relaxing action is well covered, and its diffusion aided, by the addition of such articles as orange peel, fennel seed, or ginger.

Dose of the powder, ten to thirty grains every four hours. It is sometimes given in much larger quantities at longer intervals, and in smaller quantities at shorter intervals; but when given as a powder, it retains its influence about four hours, and the above range will be found to include the most serviceable dose. It may be administered in mucilage by injection, along with lobelia, ginger, or capsicum, as needed, to very great advantage.     

Pharmaceutical Preparations:  I. Infusion. Cypripedium in powder, half an ounce; warm water, a pint. Infuse in a covered vessel at a moderate heat for half an hour. Dose from half a fluid ounce to two fluid ounces every two hours in ordinary cases; or a fluid ounce every hour or half hour when urgency requires its full action. Water does not take up all the properties of this root. II. Cypripedin. For a number of years this preparation was looked upon as a resinoid, and was made after the manner of such resinoids as leptandrin and podophyllin. But it is not a substance of this class; and when thus made, is nearly an inert article. As now manufactured, it is virtually an alcoholic extract, purified and powdered. Dr. T. L. A. Greve, druggist, Cincinnati, has kindly furnished me with the following process: Macerate the crushed roots with absolute alcohol; transfer to a percolator, and treat with absolute alcohol till exhausted; distill off four-fifths of the alcohol at a low temperature, and evaporate the remainder on a. low water bath till of the consistence of thick molasses; wash this product in 70 percent alcohol, and filter through muslin; by which step the extractive matter is washed away, and the cypripedin retained upon the filter. Now evaporate carefully; and when thoroughly dry, reduce to a powder in a mortar moderately warm. If the first product be not washed so as to remove the extractive matter, the cypripedin will be a brownish powder that will slowly settle into a gummy mass. The washed product is a dull-yellowish powder, and represents the plant quite well. As the roots of cypripedium vary greatly in strength, according to season, soil, and method of drying, so this alcoholic extract cypripedin is not always of the same strength, though nearly so. Dose, one to three grains, at such intervals as necessity requires. III. Extract. This is a hydro-alcoholic preparation, made after the general method for others of the same class. If manufactured with due care, it is a good preparation; but the temptations to save alcohol by using more water, and to save time by applying a high heat in evaporation, are so strong, that very little of the extract in the market is ever of much value. IV. Fluid Extract. Macerate a pound of crushed roots in 70 percent alcohol; transfer to a percolator, and treat with alcohol of the same strength till eight fluid ounces have passed. Set this aside, continue the process with water till exhausted, evaporate the last product on a water bath to eight fluid ounces, and mix the two liquors. This is a good preparation, of which the dose may range from five to twenty drops. V. Tincture. Three ounces of the crushed roots macerated in diluted alcohol, and then treated by percolation and pressure till a pint is obtained, form the usual tincture. Dose, half a fluid drachm to two fluid drachms, in water. It is seldom used.                                         

Cypripedium enters into officinal compounds under: the heads of myrrh and lobelia. It is often associated with valerian, cimicifuga, scutellaria, and other nervines; and with such tonics as frasera, anthemis, and leonurus. J. Overholt, M. D., of Columbus City, Iowa, furnishes the following formula as one that he has long used to much advantage in neuralgia, wakefulness, the restlessness of children, hysteria, etc.: Neuralgic Mixture. Two ounces fluid extract of cypripedium; one ounce each fluid extract scutellaria, xanthoxylum, and asclepias tuberosa; one ounce each of lobelia tincture and essence of anise. Dose, from one-fourth to a whole teaspoonful, in sweetened water or catnip tea. He says it will do for children all that is claimed for any “soothing sirup,” but with no fear of any shade of narcotism.