Psychosomatic concept of ano-rectal disease
NATIONAL JOURNAL OF HOMOEOPATHY 2000 July / Aug VOL II NO 4.
Dr Amitha Baliga
'Puls / Nux-v / Sulp
The classification of psychosomatic strata of disease according to modern medicine does not include the considered ano rectal disorders. But it obviously falls under psychosomatic disease for nothing takes place without a cause; nothing remains unless there is disposition to it. Every person with constipation may not develop piles / fissures / fistula. Not all women suffer this after bearing down during delivery. Characteristic features of a disease differ from patient to patient, as every individual is unique.
For a Homeopath, however, mind is the master of the body. As Dr H A Robert said "diseased condition develops as an expression of the inward turmoil and distress under which the whole individual suffers." So the sole duty of physician is to heal the sick individual and not the results of sickness. Successful case taking supplies to the physician all the evidence that is necessary to arrive at both disease diagnosis and person diagnosis and there on to prognosis and treatment. Especially in these cases, general management is essential in the form of confrontation, making him understand his situation in life as to where he has fallen / failed to adapt himself. At same time he also needs deep acting constitutional remedy for complete cure, taking into consideration miasms too.
The following cases will illustrate the above concepts.
Case 1
Mr SB, 35 yrs, Occupation - Accountant
Status - married since 4 yrs, Religion - Hindu
Fa - 80 yrs, Mo - 58 yrs died 3 yrs ago, Siblings - (M) - 8, (F) - 2
Children - 3 Daughters.
Chief Complaints
| Anus Since 2 yrs. increased since 2 days > Allopathic RX > Hom. RX |
Cracks++ like erosion Pain+++ Burning+++ & Throbbing++ Bleeding++ in drops dark blood, scanty++ Constipation++ > Stool... blackish hard++ Increased Urge for stool Can not finish sensation |
A/F silent grief < Meat++ < Sitting++ < during2 & after stool2 > Cool breeze Washing with cold H2O+++ < Worry++ < Thinking++ |
weakness++ |
| Head Frontal Since 2 yrs |
Pain++ Throbbing |
A/F Suppressed Anger++ Grief++ < Tensions+++.... < Evening++ < Summer |
[Presently no Headache]
Even though patient was in severe pain, he gave full history, showing that mental stress was the chief causative factor.
P/H - Nil
Life Space Investigation: Patient hails from Chennai now since 2 years, he is transferred to Mangalore on promotion. He lives in a, closely-knit, joint family of 25. Patient is 5th among 8 brothers and 2 sisters - all married. He likes the joint family set up. 3 yrs ago he lost his mother and one brother within a short period, grieving him a lot. Thinking about them still upsets him. To top it, he got transferred and separated from the joint family. More tension. He broods3 and feels bad for his family members. But he is also worried about the future of his 3 Daughters. Added to it is the job tension after being promoted to a superior position. Basically indecisive with poor confidence, he finds it difficult to take decisions, worries much before traveling- fears whether he or luggage will reach destination safely, on time. His anger is never expressed and his complaints worsen by suppression. He likes company, feels better if consoled.
Physicals Generals:
Chilly patient
Perspiration: reduced. Head ++, Legs
Appetite: good THIRST: reduced ++
Micturition: scanty flow
Stools: hard, constipated
O/E: BP 126/80 mm Hg
Pulse: 74/ mm; Systemic: NAD
Anal region: fissures+ at anterior part of orifice.
On Palpation: tender 3
Diagnosis: Fissure In Ano.
Management: General
- Avoid straining at stools
- Intake of adequate water
- High fiber diet
- Counseling to reduce tension as far as possible.
Began with Sulphur considering following totality:
Severe pain with burning+++ and hard stool.
Burning+++ pain with Throbbing++
Dark red bleeding++, constipation with hard stool having urging ++
< During and after stool, < worry, meat++, sitting
> cool breeze, washing with cold water
Criteria For Follow Up:
- Burning+++
- pain throbbing++
- Bleeding
- Constipation
- urging for stool
- weakness.
The Totality:
Mind: Irritable++
A/F suppressed
A/F Grief+++ silent death of Mother and Br separation from joint family
Attachment+++ to family members
Anxiety++ Anticipatory future about ++
Indecisive - lack of confidence, Poor judgement
Likes company >consolation3,
Dreams - pleasant, about happy happenings in family.
Reserved - timid
Fear of snakes++
Physical: Chilly pt.
Perspiration: scanty, Head ++, Legs ++
CR - Sweets2, cold food2 AV- sour2 meat2
Thirst less, scanty urine but no burning
Particulars
Fissures with burning throbbing
Scanty dark red bleeding
Hard blackish stool
Urging with cannot finish sensation
A/F silent, Grief
Stool < meat, sitting, > cool breeze, > washing with cold water3, < mental stress2, weakness
Headache throbbing AF: suppressed anger, grief
< evening3 summer
Pulsatilla was thought to be the remedy.
Finally Pulsatilla was selected as chronic constitutional remedy
Pt came after 1 wk,
| Calc 20/8 | Lyc 20/11 | NM 17/10 | NV 15/9 | Kalc 18/8 | Puls 26/8 | Phos 15/9 | |
| 1. Mind > consolation | 0 | 0 | 0 | 0 | 0 | 3 | 0 |
| 2. Anger Suppressed from | 0 | 0 | 0 | 0 | 0 | 3 | 0 |
| 3. Stomach Desires Cold food | 0 | 2 | 1 | 0 | 0 | 3 | 3 |
| 4. Chilly pt. | 3 | 0 | 0 | 3 | 3 | 0 | 3 |
| 3/1 | 2/1 | 1/1 | 3/1 | 3/1 | 6/2 | 6/2 | |
| 23/9 | 22/12 | 18/11 | 18/10 | 21/9 | 32/13 | 21/11 |
Criteria For Follow Up
- Worries mental
- Sleep
- App
- Thirst
- Bowels
- Urine
- Burning.
- hrobbing
- Bleeding
- Headache
- Weakness
| Date | Follow-up | Interpretation | Action | ||||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | |||
| 10/6/98 | >++ | >++ | Occ | Same | > | > | Pt. Was > as expected So constitutional Rx to be given | Puls 200 (IP) Hs on every 3rd day Placebo | |||||
| 19/6/98 | > | G | G | R | >++ | O | Occ | >++ | + | >++ | Generally >++ | Rpt 1 wk | |
| 24/6//98 | >++ | G | G | ve>++ | R | O | O | O | O | > | >++ | Rx Puls 200 (IP) Hs 3 days |
|
| 1/7/98 | >+ | G | G | veR | R | O | O | O | O | >++ | >++ | Repeat for 15 days | |
| O/E fissures healing + | |||||||||||||
| 15/7/98 | >+ | G | G | veR | R | O | O | O | O | >++ | >++ | Repeat for 15 days | |
| Once with Meat had mild burning. | |||||||||||||
| 29/7/98 |
No complaints O/E Fissures almost healed, Bleeding 0 Mentally also feels happy, feels satisfied with present situation. |
1.Puls 200 (IP) HS weekly 2. Placebo |
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