Bleeding Haemorrhoids :: A Case Study

PRESENT COMPLAINTS:

• Bleeding from anus with protrusion of soft mass during stool and recedes after evacuation - for about 6 months; < walking.
• Insufficient stool - for about 8 months.
• Dimness of vision; different colours around the light, with a sense of burning in both the eyes; and watering - for about 7 days.

PAST HISTORY:

• Small Pox at the age of 7 or 8 years' - treated Allopathically.
• Hepatitis A - 3 years back - treated Homœopathically.
• Immunization Scheduled - Completed.
• Sensitivity (Drug & Allergen) - Brinzal [causes Prickly-heat like eruptions over face, with itching].
• Mile-stone - Not delayed.

PERSONAL HISTORY:

• Built - Thin & tall.
• Complexion - Fair.
• Thermal reaction - Hot 3; a sense of flushes in the face & ears.
• Sweat - Less.
• Desire - Sweet 3, salty things 3 (no extra salt).
• Aversion - Nothing particular.
• Intolerance - Hunger, especially at the forenoon after bathing.
• Appetite - Increased.
• Addiction - Tobacco smoking.
• Tongue - Clean; slightly moist; red.
• Thirst - Diminished.
• Bowels - Irregular; has to go twice in a day; 'not finish' sensation.
• Character of stool - hard, knotty, difficulty while passing. Rectum protrudes during and recedes after stool. Burning pain & bleeding after stool.
• Urine - Nothing significant.
• Sleep - Sound.
• General Aggravation - Light.
• General Amelioration - Lying down.
• Mind - Anxious 3; restless 3; forgetful 3; wants to be alert; sensitive; easily becomes frightened; wants to be alone.

FAMILY HISTORY:

• Father - Died of Carcinoma Prostate.
• Mother - Rheumatism.
• Brother - Sensitive to cold (? cold allergy).
• Sister - Bronchial asthma.
• Paternal Grand Pa - Died; was alcoholic.
• Paternal Grand Ma - Died, because not known.
• Maternal Grand Pa - Died (?) CVA.
• Maternal Grand Ma - Rheumatism.
• Maternal Uncle - Once attempted suicide by consuming poison.

PHYSICAL EXAMINATION:

• General Condition - Satisfied.
• Temperature - 100 0F.
• Pulse - 90 / min.
• BP - 136 / 88 mm of Hg.
• Neck vein - Not palpable.
• Lymph nodes - Not palpable.
• Conjunctiva - No yellow tinge.
• Pallor - Moderately present.
• Œdema - Nil.
• Cyanosis - Nil.
• Clubbing - Nil.

Systemic Examination:

• CVS - No abnormality.
• Respiratory System - No abnormality.
• Nervous System - No abnormality.
• Eye - Normal light and accommodation reflexes.

Erecting Totality:

• Anxious and restless.
• Wants to be alone.
• Easily becomes frightened.
• Forgetful.
• Hungry after bathing, especially forenoon.
• Desires sweet.
• Desires salty things.
• Hot patient; sense of flushes of heat in face & ears.
• Constipation.
• Burning of anus after stool.
• Bleeding from anus after stool.
• Dimness of vision.
• Watering from eyes, with burning.
• A sense of different colours around light.
• Haemorrhoid protrudes during stool.
• Haemorrhoid < walking.
• < Light.
• > Lying down.

Analysis & Evaluation:

Conversion into rubrics [kentian method]:

Reportorial result:

• SULPHUR - 47/20 [ Sulph. doesnot cover the symptom 'Haemorrhoid protrudes during stool'].
• PHOSPHORUS - 35/17.
• PHOSPHORIC ACID - 19/11.

Analysis of reportorial result:

From the study of the whole case and reference to the Materia Medica - SULPHUR covers the most of the features. According to the Potential Differentiating Field (PDF), SULPHUR ranks highest.

Cross-repertorization from roberts' 'sensations as if ----':

• The rubric 'Halo about light' in Roberts' 'Sensations as if ----' is covered by SULPHUR [chapter Eyes & Vision].
• The rubric 'Sensation as if - Burning' in Roberts' 'Sensations as if ----' is advised to see the GENERAL REPERTORIES [chapter Generals].
• The rubric 'Heat were streaming out of ears' in Roberts' 'Sensations as if ----' is covered by SULPHUR [chapter Ears & Hearing].

Prescription:

On 05.02.2009
Sulphur 200 / 1 dose in Sac lac in the early morning in empty stomach, followed by Placebo for 15 days; and advised Ophthalmoscopic examination for refractory errors.

On 22.02.2009

• Stool softer, but irregular ---> 25% improvement.
• Lacrymation > ---> 50% improvement.
• Burning of eyes > ---> 50% improvement.
• Burning of anus & bleeding slightly > ---> 25% improvement.
• Refractory error (Report): Rt. eye + 2.5D and Lt. eye + 2.75D.

Placebo for 30 days.

On 27.03.2009
Overall 60% improvement. Placebo for 30 days.

On 12.04.2009

• Bleeding P/R started after stool for last 2 days; slight burning.
• Sulphur 200 / 1 dose repeated followed by Placebo for 7 days.

On 20.04.2009
Bleeding & burning >. Placebo for 15 days.

On 10.05.2009
No such complaints. Placebo for 15 days.

Case summary:

Mr. XY, 55 years, Hindu, Male, Retired, Married, on 05.02.2009 came with complaints of bleeding P/R after stool, insufficient evacuation & burning in anus afterwards. He also complained of dimness of vision; with burning & watering from the eyes. He had a sensation of different colours around the light; < light; > lying down.

He wants to be alone; anxious & restless patient; forgetful and get frightened easily. Hot patient, with a sense of flushes of heat in the face & ears. He desires sweets & salty things; and gey hungry after bathing, especially forenoon.

After repertorization with Kent's repertory and cross-repertorized by Roberts' 'Sensations as if ---' SULPHUR was choose. And a dose of Sulphur 200 was administered. He was advised for checking the refractory errors; and was reported Rt. eye +2.5D, Lt. eye +2.75D.

He was on Placebo for about 55 days and was better. On April 12, 2009 he complained of reappearance of bleeding P/R & burning; and a dose of Sulphur 200 was repeated. Up to May 10, 2009 he had no complaints as such. He was CURED of that complaint.

Remarks:

This is a case of Chronic Bleeding Piles of my own clinic. Patient's name has been confined for Professional Secrecy. After taking the case, as there were prominent mental, physical & particular symptoms, I had chosen the Kent's Repertory for the repertorization. In the case there were some 'sensations' and I had decided to cross-repertorize the rubrics of sensations by Dr. Herbert Alfred Roberts' 'Sensations As If ----'.

The result of PDF from Kent's Repertory was SULPHUR; and the result of cross-repertorization did not differ. This also signifies that the regional / clinical repertories are as useful as the general repertories.

References:

• Kent, J. T. - Repertory of the Homœopathic Materia Medica (B. Jain).
• Roberts, H. A. - "Sensations As If ----" (B. Jain).
• Tiwari, S. K. - Essential of Repertorization (B. Jain).