Returning to internal usage, the focus in later authors is clearly on astringency in diarrhoea. Cullen (1772) states that tormentil is the most powerful of the vegetable astringents. He argues that the qualities are not sufficiently extracted into water or alcohol and that it should be used as a material substance in the form of a powder. Hill recommends tormentil in bleeding piles but Cullen makes the point that haemorrhoids are often caused by ‘costiveness’ or constipation, and that this may be worsened by the use of astringent herbs. Coffin gives tormentil as a powerful astringent in diarrhoea, long-standing bowel complaints and the powder for external use to sprinkle on an old sore, or to stop bleeding.
Astringent herbs were important to the 19th century authors as they were used to cleanse the digestive tract of ‘canker’. Robinson (1868) describes canker as ‘a morbific state, tendency to disease in any locality, internal or external’ which occurs in the throat, stomach or bowels and is caused by cold as ‘when cold obtains power over the inward heat, the stomach and bowels become coated with canker’. Thomson emphasizes the cleansing of canker from the bowel walls by use of astringents and this formed the third stage, No. 3 of the Thomsonian course of treatment (Comfort 1859). The sequence in the course of treatment was to use lobelia Lobelia inflata as an emetic, followed by cayenne Capsicum annuum to heat and then astringents to heal the tissues. He writes that ‘the canker is fixed on the inside and will ripen and come off in a short time, if the fever is kept up so as to overpower the cold’ (Thomson 1832). Stevens (1847) lists Thomson’s astringents then gives, as the eleventh astringent Potentilla erecta, and says that it was introduced to the list of tonic astringents and could be used equally as their substitute.
When discussing astringency Fox refers to canker as ‘anything which corrupts, corrodes, destroys’ and also recommends bayberry Myrica cerifera to ‘detach morbid and vitiated matter’. Bayberry is the original herb given as No. 3 and it maybe better than any substitute. It is certainly different in that it is a very peppery herb, which causes sneezing. Fox advises tormentil in all classes of bowel complaints, cholera, dysentery and diarrhoea associated with consumption. This last recommendation is also given by Robinson (1868), who ascribes the advice to Dr Graham. Fox calls tormentil ‘the very best remedy for bloody flux’. He recommends half a cup every 30 minutes, as warm as convenient, of a tea made by pouring 1 pint of boiling water on 1 oz of herb. He notes that it often ’causes free perspiration’.
Robinson also recommends tormentil for all fluxes of blood at the dose of 1 drachm (3.5 mL) four times a day in an infusion of hops Humulus lupulus, which is also given by Grieve. He adds a recommendation from Dr George Fordyce for use in relaxed bowels, and recommends juice or decoction of herb and root to expel fever if the person is also laid to sweat. This appears to be the recommendation originally given by Culpeper. Robinson adds the recommendation of Dr Thornton for use in ‘agues which had resisted the bark’, leg ulcers turned away as incurable, scorbutic ulcers and long standing diarrhoea, and also recalls earlier authors in recommending it to open obstructions of the liver such as in jaundice.
Grieve rates tormentil highly as very astringent and gives a compound powder that is ‘very reliable’ in diarrhoea and other discharges. Infuse powders of tormentil, marshmallow root Althaea officinalis and galangal Alpinia galanga each at 1 oz with ginger Zingiber officinale 4 drachms (16 g) in 1 pint of water. Cool, strain and take 1-2 fluid drachms (3.5-7 mL) every 15 minutes and then reduce the dose to three times a day. The National Botanic Pharmacopoeia notes extensive use of the herb and root in diarrhoea and other abnormal discharges to nourish and support bowels and tone the uterus and whole uterine area.