Purgatives with Mercurial Alteratives. In habitual costiveness, where there appears to be a deficiency of bile, a combination of Pilula Hydrargyri, with certain Aloetic compounds, may prove serviceable; for while the latter remedy will, in the absence of bile, supply to the intestines a congenial stimulus, the former will tend to restore the bilious secretion by its influence upon the hepatic system. See Form. 79, 81.
Purgatives with Diaphoretics. This combination of effects is often useful in practice, but it is desirable that the latter should not be established until the operation of the purgative upon the bowels has subsided. This is accomplished by certain doses of Tartarized Antimony in conjunction with some purgative. The Pulvis Aloes Compositus of our Pharmacopœia produces a somewhat similar effect.
Diaphoretics with Tonics. How frequently is the practitioner desirous of determining to the skin, and at the same time of supporting the strength of the general system? in the progress of a continued fever we are repeatedly called upon to fulfil such indications. Dr. Bree[[260]] also observes that “in the exhibition of Diaphoretics the addition of a bitter infusion, or tincture, is frequently proper; for the stomach should be gently excited and strengthened during the use of a diaphoretic draught.” On the other hand, Tonics not unfrequently require the aid of a diaphoretic; for instance, in the cure of Cynanche maligna, the use of bark is indicated; but if the skin be hot and dry, it should be accompanied with a diaphoretic. See Form. 126.
Antispasmodics with Tonics, or Narcotics. Under the history of Antispasmodics, (page 78) it is stated that there are certain bodies which seem to exert an absolute control over inordinate muscular action, from whatever general cause it may have arisen; in administering such remedies, however, the intelligent practitioner will not overlook the peculiar condition of the system in its relations to the disease; where debility is present, the Antispasmodic will be usefully combined with a Tonic; and, in certain morbid states of the nervous system, with a Narcotic.
Astringents with Diaphoretics. Dr. Fordyce has observed, that combinations of this kind are often indicated in cases of Diarrhœa, where it is necessary to astringe the vessels of the intestines, and at the same time to relax those of the skin; such an indication, he says, may be fulfilled by exhibiting Tormentil root, or any other vegetable astringent, with Ipecacuan.
Astringents with Narcotics, and Absorbents. It has been already observed, that in a Diarrhœa, depending upon the influx of acrid fluids into the intestines, there are three modes of treatment by which the malady may be obviated, viz. by a narcotic, diminishing the irritability of the intestines; by an astringent, restraining the serous excretion; and by an absorbent, neutralizing the acrid matter. As the modes of action are not incompatible with each other, they maybe simultaneously established with the greatest advantage. See Form. 52.
Astringents with Tonics. A combination of certain medicines belonging to these two classes is frequently indicated; in the treatment of passive hemorrhage, we have to astringe the bleeding vessels, and, at the same time, to cure the hemorrhagic diathesis by remedies which are capable of restoring the general tone of the system. In the treatment of the chronic and humid coughs of old persons, I have very frequently witnessed the beneficial union of the warm and stimulating influence of Myrrh with the astringent effects of Sulphate of Zinc. Form. 69 presents the combination which I have usually adopted with success on such occasions.
Diuretics with Tonics. As Dropsy is frequently associated with great debility, the practitioner should combine his diuretics with some tonic medicine; but in forming a judgment upon the case he must be guided by those precepts which have been laid down under the consideration of Diuretics at page 97. See Form. 114.
Diuretics with Aromatic Stimulants. Such a combination will be found advantageous in those cases where the powers of the system require to be excited by more prompt measures than those afforded by the agency of tonics. Ethereal preparations, with Squill and other stimulating diuretics, are well calculated upon such occasions to afford valuable assistance. Form. 101–116.
Tonics with Diffusible Stimulants. In the cure of dyspepsia, we frequently require a remedy, for the purpose of obviating debility, that is more sudden in its action, and prompt in its effects, than that of a bitter tonic, whose operation is almost imperceptible; while the case may at the same time stand in need of that permanent increase of tone, which the latter remedy can alone supply; such an indication therefore must be fulfilled by combination. Form. 40, 42.