Uterine Tonics
The richness of uterine tonics in the North American materia medica is often squandered through a lax over use of the idea of toning. The differential indications of these valuable remedies is worth exploring in some depth. The best sources of information are the writings of the old eclectics and physiomedicals, based as they are on extensive experience and observation.

The material that follows consists of direct quotes. Please note the 19 th. century usage of terms and concepts. The sometimes overtly sexist language is not mine!

Amenorrhoea & Dysmenorrhoea
Caulophyllum thalictroides

King's a powerful emmenagogue it promotes delivery, menstruation.

Cook It is a moderate diffusive, stimulating and relaxing in about equal degrees, spending its main powers upon the nervous system. These qualities make it one of the very best of anti-spasmodics, to relieve nervous feebleness with irritability, as in crampings of the bowels, twitching of the muscles in typhoid and parturient cases, hysteria, painful menstruation, colic, etc. Its efficacy in these cases is remarkable; and it is also a valuable adjunct to other suitable agents in the treatment of puerperal convulsions, epilepsy, and chorea. It enjoys deserved reputation in neuralgic forms of rheumatism, especially that form which passes with some as chronic inflammation of the womb. It sustains the nervous system, but at the same time soothes it; and is of especial service in strengthening and relieving painful functional difficulties of the female generative organs.

King's In painful menstruation it has been found especially adapted to those cases in which there is pelvic fullness, a sensation as if the womb and rectum were distended with blood, and the aching, bearing-down organs feel as if they would fall out of the body. Its action here is very decided when the smaller doses are employed.

Kings Upon the reproductive organs it exerts a specific influence, promoting the menstrual discharge, and by its power of increasing contractility of the unstriated fibres of the uterus, it acts as an efficient parturient. The venereal propensity in man is said to be stimulated by Cimicifuga. By its special affinity for the female reproductive organs, it is an efficient agent for the restoration of suppressed menses. It is even a better remedy in that variety of amenorrhoea termed absentio mesium. Cimicifuga plays a very important part in the therapeutics of gynecology. It is a remedy for atony of the reproductive tract. In the painful conditions incident to imperfect menstruation, its remedial action is fully displayed. In dysmenorrhoea it is surpassed by no other drug, being of greatest utility in irritative and congestive conditions of the uterus and appendages, characterized by tensive, dragging pains, resembling the pains of rheumatism.

Cooks Its action on the uterus is well marked - relieving neuralgia and rheumatism of this organ, proving efficient in painful menstruation accompanied by tardiness...

Ellingwood In menstrual disorders, accompanied with aching or muscular soreness and cool skin. Relieves amenorrhoea with these symptoms; will control congestive dysmenorrhoea. Its influence here is enhanced by aconite or belladonna. Is beneficial in menorrhagia and metrorrhagia; is given in menstrual irregularities of young girls.

King's It is very efficient in promoting the menstrual flow, and may be given alone, in infusion, or in combination, in amenorrhoea, not connected with some structural lesion. It will also be found valuable in dysmenorrhoea, sterility, and chlorosis.

Ellingwood Relieves nervous irritation mildly, restores tonicity; promotes normal regular flow, in atonic cases, and prevents excesses; must be given during the intermission and during the period also, and continued past two or three epochs.

King's It allays uterine irritation with a tendency to terminate in hysteria, while in the neuralgic and spasmodic forms of dysmenorrhoea, it is a favorite remedy with many physicians. The action of this agent closely resembles that of the black haw, and there is reason to believe that they are often used interchangeably for similar purpose. The following forms an excellent preparation for the relief of spasmodic attacks, vis.:
Take:

cramp bark, 2 ounces;
skullcap,
skunk-cabbage, of each, 1 ounce;
cloves, 1/2 ounce;
capsicum 2 drachms.

Have all in powder, coarsely bruised, and add to them 2 quarts of good sherry or native wine. Dose, 1 or 2 fluid ounces, 2 or 3 times a day.

Cook it is chiefly employed in hysteria, painful menstruation, neuralgia and rheumatism of the womb, and the uterine crampings incident to pregnancy.

King's In amenorrhoea in pale, bloodless subjects, the menses are restored by it. In dysmenorrhoea, with deficient menses, uterine colic, and in those cases where there are severe lumbar and bearing-down pains, it will prove an efficient drug. It is specifically indicated in cramp-like menstrual pains, decidedly expulsive and intermittent in character and in the various painful contractions of the pelvic muscles, so common to disorders of women. Uterine congestion and chronic uterine inflammation are often greatly relieved by specific black haw. It acts promptly in spasmodic dysmenorrhoea. especially with excessive flow.

Ellingwood Indicated in dysmenorrhoea, with cramp-like or spasmodic pains. Corrects nervous irritation and sympathetic disturbances, a tonic and corrective in persistent irregularity, either in time or quantity

King's As a gynecian remedy it has been employed to relieve irritation of the reproductive organs as if dependent on congestion. It controls chronic inflammatory states of these organs and gives tone in cases of debility. In the sexual disorders of the female it is indicated by tenderness and pain in the uterus, in debilitated patients. It has been very successfully used in cases of hysteria to overcome the attack, and to relieve ovarian, or mammary pain, or irritation when accompanying that disorder. Chronic corporeal, or cervical endometritis, metritis, ovaritis, ovaralgia, uterine leucorrhoea, amenorrhoea, and dysmenorrhoea, are conditions in which it has been most successfully employed. It has an established reputation as a remedy for rheumatism of the uterus, with nervous excitement, for uterine cramps attending menstruation, and for menorrhagia, depending on uterine subinvolution.

King's In diseases of the reproductive organs of females, and especially of the uterus, it is one of our most valuable agents, acting as a uterine tonic, and gradually removing abnormal conditions, while at the same time it imparts tone and vigor to the reproductive organs. Hence, it is much used in leucorrhoea, amenorrhoea, dysmenorrhoea, and to remove the tendency to repeated and successive miscarriages. A particular phase removed by it is the irritability and despondency that often attends uterine troubles.

Cook ...its most prominent and valuable action is upon the uterine organs; where it scarcely has an equal in atonic forms of prolapsus, leucorrhea, passive hemorrhage and menorrhagia, and similar enfeebled conditions. While its use in sensitive patients and irritable uterine conditions is to be avoided, it can be employed to the greatest advantage in flaccid and prostrated states for the maladies above named. Though in no sense an astringent, its tonic influence is peculiarly efficacious in arresting too excessive menstruation and lochia, when associated with laxity and depression.

Ellingwood Has a pronounced tonic influence, in general relaxation and feebleness of uterine structures. Specific in prolapsus, with a dragging or pulling down sensation in lower abdomen. When there is pelvic engorgement with prolapse.

Kings If the patient be despondent and chilly, combine Cimicifuga with Pulsatilla, especially in anemic subjects. It is a good remedy for the reflex side-aches of the unmarried woman; also for mastitis and mastodynia. It should be remembered in rheumatism of the uterus, and in uterine leucorrhoea, with a flabby condition of the viscus, its effects are decided. When there is a disordered action or lack of functional power in the uterus, giving rise to sterility, Cimicifuga often corrects the impaired condition and cures. Reflex mammary pains during gestation are met by it, and in rheumatic subjects it promptly relieves such ovarian troubles as ovarialgia and neuralgia, the pain being of an aching character. Orchialgia and aching sensations of the prostate are conditions calling for Cimicifuga , and as a tonic it is not without good effects in spermatorrhoea.

Ellingwood Exercises a wide influence on the nerve centers, and their blood supply. Is a mild motor depressant and nerve sedative. Positively relieves muscular soreness or aching, induced or idiopathic, from whatever cause. Relieves erratic nervous conditions; acts directly upon the reproductive functions.

King's It seems to have an especial affinity for the uterus, exerting a powerful tonic and alterative influence upon this organ, and has hence been found highly beneficial in many uterine derangements, as in amenorrhoea some forms of dysmenorrhoea, menorrhagia, chronic congestion of the uterus, enfeebled uterine nervous system, etc.

Cook The greater portion of its power is expended upon the uterus, where its action is tonic and moderately antispasmodic; but it also influences the kidneys, testes, and the entire nervous system as connected with the generative organs. The chief value set upon it by most physicians is for its soothing and strengthening influence upon the uterus in hysteria, leucorrhea, prolapsus, and rheumatic or neuralgic pains, and chronic painful menstruation.

King's ... exerts a peculiar influence upon the reproductive organs, and particularly of the female, which has given to it the name of Female regulator. This is one of our valuable remedies in the treatment of female diseases. It relieves irritation and strengthens functional activity. Ovarian or uterine atony, with impairment of function, increased mucous or mucopurulent secretions, or displacements of the womb and vaginal prolapse, are the chief guides to its use.

Cook The chief use made of it is as a nervine tonic in female weaknesses, and a mild yet reliable promoter of menstruation. For neuralgia and rheumatism of the womb, the achings and crampings incident to gestation, and mild cases of leucorrhea and prolapsus, it is of much value; also in uterine hysteria, and the feeble appetite and aching of the back suffered by so many females; possibly also acting on the kidneys. While it promotes menstruation in languid and partially atonic amenorrhea, it does so mostly by virtue of its efficient tonic action; and it is in no sense a forcing emmenagogue, but rather aids passive menorrhagia by giving tone to the uterus.

Ellingwood Indicated in atonic disorders of uterine function with much loss of tone and general relaxation; in misplacement from this cause; in passive congestion with feebleness and flaccidity; increases ovarian activity, and overcomes sterility. Acts somewhat upon and through the central nervous system.

King's Its principal use at the present day is in disorders of the female organs of reproduction. As a uterine tonic it is unquestionably of great utility. It restores normal innervation, improves the circulation and corrects impaired nutrition of these organs. In the hyperasthetic, or irritable condition of the uterus incident to highly nervous women, or as the result of overwork, it will be found an admirable agent. It is called for in weakened conditions of the body, with feeble performance of the uterine functions.

Ellingwood Acts mildly as a nerve sedative and antispasmodic. Produces muscular relaxation, and reduction of reflux irritation. Corrects nervous irritation during pregnancy. Has atonic and soothing influence on the entire uterine structures. Regulates sympathetic disturbances, from uterine irritation. Overcomes sterility

King's As a partus preparator Caulophyllum has enjoyed a well merited reputation. When used by delicate women, or those who experience prolonged and painful labors, for several weeks previous to confinement, it gives tone and vigor to all the parts engaged in the accouchement, facilitating its progress, and relieving much suffering.

Cook ...previous to parturition to give tone and comfort to the uterus.

King's It is considered useful by some for the relief of the vomiting of pregnancy.

Ellingwood Is not used alone, but in combination with Mitchella and Cimicifuga produces a reliable compound. Does away with erratic pain, and liability to accidents or malpositions.

Kings It is an excellent partus preparator if given for several weeks before confinement. It is a diagnostic agent to differentiate between spurious and true labor pains, the latter being increased, while the former are dissipated under its use.

Ellingwood The most frequently used remedy for this purpose, less reliable than Mitchella; removes erratic pains, and irregular conditions; overcomes hysteria, soothes general muscular irritation; and conducive to a normal, easy, short labor.

King's It is said that the squaws drink a decoction of this plant for several weeks previous to their confinement, for the purpose of rendering parturition safe and easy. Similar virtues have been ascribed to it by competent physicians of our time.

Cook Used for several weeks before parturition, it allays the uterine crampings incident to the latter period of gestation, and so strengthens this organ as to make an easy labor much more probable.

Ellingwood Not active except to a limited extent; used in conjunction with the other remedies. Indicated by extreme loss of tone.

King's It is very effective in relaxing cramps and spasms of all kinds, as asthma, hysteria, cramps of the limbs or other parts in females, especially during pregnancy, and it is said to be highly beneficial to those who are subject to convulsions during pregnancy, or at the time of parturition, preventing the attacks entirely, if used daily for the last 2 months of gestation. Like Viburnum prunifolium, it is a remedy for the prevention of abortion, and to prepare the way for the process of parturition.

King's Cramps of limbs attending pregnancy yield to both black haw and cramp bark. It Is considered almost specific for cramp in the legs, not dependent on pregnancy, especially when occurring at night. False pains of pregnancy are readily controlled, and for after pains it is nearly as valuable as Cimicifuga. Black haw promptly allays ovarian irritation.

Ellingwood Abates nerve irritation, restlessness, and hysterical symptoms and erratic pains; contributes to a normal condition; prevents morning sickness; induces cheerfulness and hopefulness and prevents accidents

King's Its use as a parturient originated in the custom of the Indian squaws of employing a decoction of the root for 2 or 3 weeks previous to labor to facilitate child-birth. There is no doubt but that Caulophyllum has a decided action upon the gravid uterus. During labor it relieves false pains and coordinates muscular contractions, at the same time increasing their power. It stimulates normal contraction instead of inducing spasmodic uterine action. It is most valuable in those cases where delay is due to debility, fatigue, or lack of uterine nervous energy, and for deficient contractions where the tissues feel full, as if congested.

Cook It is one of the most valuable of all parturients, when the uterine action is becoming weary; in which case it may be combined with the Composition Powder; or with Cypripedium and a very little Capsicum (or Bayberry) added when depression is considerable.

Ellingwood Is not used in labor for any direct influence. The benefits obtained are secured by its previous use. After labor it preserves tone in the structures, preventing involution, prolapsus and malpositions.

Kings Cimicifuga has proved a better agent in obstetrical practice than ergot. It produces natural intermittent uterine contractions, whereas ergot produces constant contractions, thereby endangering the life of the child, or rupture of the uterus. Where the pains are inefficient, feeble, or irregular, Cimicifuga will stimulate to normal action. It is the best and safest agent known for the relief of after-pains, and is effectual in allaying the general excitement of the nervous system after labor. As a partus accelerator, it may be substituted for, and should be preferred to, ergot; 1/2 drachm of the powdered root may be given in warm water every 15 or 20 minutes, until the expulsive action of the uterus is induced, and which it seldom fails to bring on speedily and powerfully. In acute troubles, as acute muscular rheumatism, and in false pains, and as an oxytocic, Webster prefers the strong decoction of the recent root in tablespoonful doses. The fluid extract of black cohosh may be used in all cases where the article is indicated; its dose is from 1/2 fluid drachm to 2 fluid drachms. The ordinary dose for its specific effects is a teaspoonful of a mixture of from 10 drops to 1 drachm of Cimicifuga tincture in 4 ounces of water, the larger or smaller dose being determined by the condition of the patient.

Cooks ... decidedly and powerfully expediting delivery when the uterine action becomes weary and irritable.

Ellingwood A most reliable oxytocic; produces normal regular intermittent pain; does away with erratic and irregular pains, especially if of rheumatic or neuralgic origin. Prevents postpartum hemorrhage; relieves nervous irritation. Relieves severe aching and muscular soreness, controls postpartum hemorrhage, promotes normal involution; militates against the recurrence of uterine misplacement; cures persistent leucorrhea, especially if accompanied with relaxation and hypertrophy.

Cooks Used as a warm infusion, it expedites parturition with great certainty in cases of uterine and nervous fatigue.

Ellingwood Is not depended upon during labor. After labor it restores lochia, promotes normal uterine contractions, antagonizes a tendency to relaxation; promotes normal after pains, and tends to prevent excessive flow.

Ellingwood Promotes normal conditions, with regular normal contractions, soothes undue muscular irritations. Prevents hemorrhage. Restores normal tone following labor, as well as normal capillary circulation, prevents subinvolution, prolapse, and malposition.

King's It is a good remedy for after pains, especially when spasmodic in character. Caulophyllum acts as an anti-abortive by relieving the irritation upon which the trouble depends. King states that for this purpose it is fully equal to Viburnum.

Cook ...it rarely fails to arrest a threatened abortion arising from the conditions (mentioned above). In these connections, it is one of the most reliable tonics in the Materia Medica.

Ellingwood Not to be relied upon in emergency; of assistance to prevent abnormal conditions, which induce habitual abortion.

Ellingwood Is not depended upon. Acts more like ergot; is given only in small doses, for its specific indications.

King's Like Viburnum prunifolium, it is a remedy for the prevention of abortion, and to prepare the way for the process of parturition.

King's The condition for which black haw is most valued is that of threatened abortion. It is the most prompt drug in the materia medica to check abortion, provided the membranes have not ruptured. In all cases of habitual abortion it should be given in small doses for a considerable length of time. The abundant testimony as to its value in this condition alone gives it a high place among drugs. By its quieting effects upon the irritable womb, women who have previously been unable to go to full term have been aided by this drug to pass through the pregnancy without mishaps which would otherwise have proven disastrous to both child and mother. Small doses of the specific black haw should be administered throughout the dangerous period, and may be continued with good results until parturition.

Cook The best use to be made of it, is as a tonic for uterine weaknesses, as prolapsus with flaccidity of the structures, chronic leucorrhea, and passive menorrhagia. .... This is an excellent treatment for threatened abortion from feebleness.

Ellingwood The best of remedies for this purpose, reliable in emergencies if given in full doses, frequently repeated. Reliable in habitual abortion; will prevent induced abortion if membranes not ruptured. Should be given in advance in habitual cases, and continued past the time.