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My experience in a case of haemorrhoids: Prescribing on

alternating symptoms
Dr Shelly Arora BHMS
Medical Officer (H) Delhi !o"t# Homoeopathic Dispensary !arhi
$ect%rer Dept# Of &orensic Medicine ' (oxicology )ehr% Homoeopathic
Medical *ollege ' Hospital !o"t# Of )*( of Delhi
+mail: drshellyarora,
Haemorrhoids, also known as Piles, are a common and widespread condition. A
lady presented with first degree haemorrhoids at Delhi Govt Homoeopathic
Dispensary, Garhi. A careful case-perceiving revealed the presence of an
alternating disease state, Rheumatism alternating with haemorrhoids.
Abrotanum, selected on the basis of this alternating symptom gave a rapid and
gentle relief to the patient.
Haemorrhoids, Homoeopathy, Alternating diseases symptoms, Abrotanum
Haemorrhoids, commonly termed as !Piles", refer to the Varicosities of veins of
anal canal i.e. they arise from the congestion of venous ple#uses around the
anal canal. Depending on their location, they may be either Internal $covered
with mucus membrane% or Eternal $covered with skin%.
&he e#act aetiology is unknown although they are most commonly associated
with chronic constipation with straining, carcinoma of rectum and pregnancy.
Haemorrhoids may be asymptomatic or may present with some features, the
principal and earliest symptom being bleeding. At first the bleeding is slight,
bright red, and occurs during defecation $a s!lash in the !an% and it may
continue intermittently. 'ther symptoms include mucoid discharge, pruritis ani,
pain and anaemia.
Haemorrhoids that bleed and bulge into anal canal during bowel movements but
do not prolapse outside the anal canal are called first degree haemorrhoids.
Haemorrhoids that prolapse outside anus on defecation but return spontaneously
after defecation are called second degree haemorrhoids. Haemorrhoids that
prolapse outside anus on defecation and need to be replaced manually and then
stay reduced are called third degree haemorrhoids. Haemorrhoids that are
permanently prolapsed are called fo%rth degree haemorrhoids.$(-)%
&he complications associated with haemorrhoids include profuse haemorrhage,
strangulation $accompanied with considerable pain%, thrombosis, ulceration,
gangrene etc.
"reatment re*uires definitive measures to prevent constipation and straining,
hence dietary changes or la#atives may be re*uired. +urgical intervention is the
treatment of choice by dominant system of medicine, if la#atives do not help.
&he following surgical procedures are available, in-ection sclerotherapy, infrared
$photo-coagulation%, cryosurgery, band ligation or haemorrhoidectomy.$(-)%
&ime and again, homoeo!ath# has proven effective for haemorrhoids.
'ne of the earliest therapeutic guidance on this disease was published in the
form of a book by .illiam /organ as early as (012.$2% &hereafter numerous
books have been written by 3ohn Henry 4larke, 3ames 4ompton 5urnett, 6obert
7opf, 8+ Dodamani etc.
A number of medicines mentioned in our materia medica$1-9%, therapeutics$(:%
and repertory$((% have proved efficacious for this condition vi;. Aesculus, Aloes,
$elladona, %ra!hites, &ali carb, 'u vomica, Pulsatilla, (ul!hur, Arsenic, )alc.
carb, )arbo veg, )austicum, )ollinsonia, *amamelis etc.
< share with you a case of haemorrhoids, successfully treated with
Homoeopathy, where the similimum was discovered on the basis of alternating
Case study
A 2( years old female, suffering from first degree haemorrhoids since ( year,
consulted at Delhi Govt Homeopathic Dispensary at Garhi $'>D 8o. 2?::% on
(@th December A:().
+he primarily complained of hard stools with much straining and pain during
defecation. &here was bleeding off and on , the blood was thin, bright red,
dropping -ust after stool.
>atient also complained of heaviness and bloated feeling in the abdomenB after
eating even a little.
+he also complained of pain in right wrist -oint since ? months, which
aggravated by touch, rainy weather, night and morning on waking. &he initial
movements after rest were very painful and the later movements were
>atient also had a ganglion on left wrist since ? months with pain off and on.
>ast historyC
6ight sided 5ell=s palsy , ? months back - took allopathic treatment
>neumonia , ) months back , recovered with allopathic treatment
4holecystectomy - ) months back
Appetite- decreasedD didn=t feel like eating muchD heaviness abdomen soon after
eating, even a little.
Desire , sweets
&hermal reaction , chilly
&he following features of the case stood out in the entire historyC
6ight , sided complaints $>ain right wrist, H' 6ight-sided 5ell=s >alsy%
Desire for +weets
H' 4holecystectomy
Heaviness E bloated feeling B after eating a little
5leeding piles, constipation
&hey pointed out towards the homoeopathic remedy $ycopodi%m
Prescri!tion + follow u!
Dec. A:()
Fycopodium ): , ) doses $to be taken (A hourly%
+ac. Fac. ): , &D+ for @ days
Dec. A:()
8o remarkable change
Appetite , Decreased
>ain and bleeding >6 during defecation off and on continued
>ain wrists remained same
+ac Fac ): , &D+ for @ days
3an. A:(2
+tool , 5etter , normal consistency,
8o pain
8o bleeding >6
>ain 5F wrists , +ame
Appetite , +ame
+ac Fac ): , &D+ for @ days
3an. A:(2
+tool ,>ain during defecation started again
8o 5leeding >6
Appetite , Decreased
>ain 5F wrists , slightly 5etter
Fycopodium A:: , ) doses $to be taken (A hourly%
+ac Fac ): , &D+ for @ days
Geb. A:(2
>ain 6ight wrist , very severe since A-) days
B rainy weather
B morning on waking
>ain left wrist , same
+tool , Hnfinished sensation
8o pain or bleeding >6
6hus &o# A:: , &D+ for ) days
+ac Fac ): , &D+ for @ days
Geb. A:(2
>ain wrists II
8ow pain wrists only slightly in morning
Appetite , Decreased
+tool , Hard, much straining, ineffectual urge
5leeding >6 again started since yesterday
J#treme burning pain anal region
Re,anal#sis of the case
+ince the patient was not improving consistently and only transient relief of
some of the symptoms off and on was observed, a thorough re-interrogation of
the patient was done. During re-interrogation, the patient mentioned that when
the symptoms of pain in right wrist were relieved, symptoms of
haemorrhoids were aggravated & vice versa.
&his alternation of symptoms reminded me of the homoeopathic medicine,
Geb. A:(2
Abrotanum 30 3 doses, (A hourly
+ac Fac ): , &D+ for @ days
Geb. A:(2
Appetite , 5etter
+tool , 5etter
8ormal consistency, 8o 5leeding >6
5urning >ain much better
8o Gas formation
>ain wrists , only slightly in the morning
+ac Fac ): , &D+ for @ days
&he patient started feeling better and showed a gradual improvement in all the
symptoms since then. &he patient is still under observation and has not shown
any recurrence in the symptoms of haemorrhoids or pain in right wrist till date.
+he is on placebo since then.
Alternating disease states symptoms, when present in a case, form an
important constituent of the characteristic totality, as emphasised by
Hahnemann in his 'rganon of Healing Art, KA)( and KA)A.$(A% However, their
elicitation re*uires thorough case perceiving as per the guidelines of
homoeopathic philosophy in order to perceive the diseased phenomenon $of the
person% in its entirety.
6eferring to the case in hand, careful re-case perceiving revealed the presence
of alternating diseased states- 6heumatism alternating with haemorrhoids=,
which indicated the similimum.
&his is one of the keynote features of the remedy, Abrotanum, as mention by
Henry 4lay Allen $0% and also found in the 6epertory by 3ames &yler 7ent $((%.
Abrotanum is known for its efficacy in producing $and curing% various alternating
diseased states symptoms vi;.
Rheumatism alternating with haemorrhoids
Rheumatism alternating with d#senter#
Rheumatism after diarrhoea
<n order to ascertain the most appropriate remedy in homoeopathy, the
diagnosis of diseased state alone is not enough. <t is more important to perceive
the individual presenting with the diagnostic condition. &his fundamental
principle of homoeopathy was also e#tolled by the Gather of modern medicine,
+ir .illiam 'sler, "he good !h#sician treats the disease- the great !h#sician
treats the !atient who has the disease.
And, it is only when the entire history of the diseased person is perceived that
we can identify the phenomenon of alternating diseased states symptoms. <
share with my professional colleagues, the pleasure of prescribing on the basis
of this indication of Hahnemann.
( www.webmd.comdigestive-disordersinternal-haemorrhoids-first-to-
fourth-degree $as accessed on ()
/ay A:(2%
A $as accessed on ()
) www.en.wikipedia.orgwikihaemorrhoid $as accessed on ()
/ay A:(2%
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