Thus a labor pain might begin with all the proper focus and intensity, only to disappear before reaching its peak, or pass off into a disabling obturator neuralgia or sciatica, or be replaced by negativistic or psychotic behavior. Like IGNATIA, LILIUM TIGRINUM, and PLATINA, CIMICIFUGA is one of the principal remedies for physical symptoms that alternate back and forth or with mental states.

4. NERVOUS EXCITATION AND CHOREA.
The nervous system is likewise as hyperexcitable as with CAULOPHYLLUM, and just as prone to trembling, convulsions, and so on; but again the movements tend to be coarser and jerkier, and often involve the basal ganglia and extrapyramidal system, (chorea, athetosis, grimacing, etc.).

On the physical no less than the mental level, the replacement or alternation of large, discontinuous chunks of experience without pattern or warning makes the CIMICIFUGA picture not merely changeable or unstable, but disjointed and freaky, both to the patient herself and to everybody near her. The fundamental impression is one of disintegration, of experience coming "unglued" or disarticulated in Humpty-Dumpty fashion, without any corresponding assurance of restitution in the future.

5. PAIN: HEADACHE, NEURALGIA, RHEUMATISM, ARTHRITIS.
Among the numerous and frequently disabling pains of CIMICIFUGA, the headaches tend to be located in the occiput, extending down the neck, or ln the vertex, "as lf the top of the head would fly off." No less intense are the neuralgias, typically described as "darting," or "like needles pricking,~ or Hllke electtlc shocks here and there " These too may occur anywhere, and change abruptly from one place to another without continuity or warning. Between pains or independently, patients also mention a rheumatic sensation of bruised soreness, whether generalized or in certain bones, muscles, or joints.

6. MISCELLANEOUS SYMPTOMS.
In general, CIMICIFUGA patients tend to be chilly, and most symptoms are aggravated in cold, damp weather, except the headaches, which are often better from cold. Miscellaneous nervous phenomena, such as nausea, insomnia, and palpitations, are quite common, as might be expected. As with CAULOPHYLLUM, the symptoms of uterine dysfunction may be accompanied by bearing-down sensations or even frank prolapse, and by abnormal or dysfunctional bleeding.

Differential Disqnosis.
Because of its unique combination of uterine dysfunction with evidence of physical and mental fragmentation, the fully-developed picture of CIMICIFUGA will seldom be mistaken for that of any other remedy. As much as its uterine symptoms resemble those of CAULOPHYLLUM, their freaky and disjointed arrangement, often in alternation with other symptoms, will usually set them apart. Though as restless and fearful as ACONITE, as arthritic as BRYONIA, as volatile as PULSATILLA, and as morose as SEPIA or NATRUM MUR., its "essence~ or flavor remains equally distinct from all of these.

Probably its closest analogue is IGNATIA, which is also motivated by dejection and fear, and displays a similar alternating tendency, with a comparable inventory of headaches, neuralgias, and elusive female symptoms that never quite add up or stay put. But IGNATIA symptoms are derived from grief and disappointment, and therefore appear contradictory or anatomically impossible, whereas those of CIMICIFUGA culminate in insanity or the fear of it, and therefore give the impression of fragmenting or dissociation. Both stylistically and down to its minutes" details, there is no other remedy even remotely like it. On the other hand, it is relatively unknown, seldom thought of, and in less advanced cases may easily be overlooked.