The subject is a 35 year old male, looking pale, thin and prostrated. He complains of bleeding plies with severe pain and weakness. He was lying down on a bench in the reception room of my clinic for about half an hour before I called him in to take his case. On entering the consultation room, he asked for my permission to lie down on the examination table while giving the case. Throughout the case taking he was lying on the examination table.
His case as given on August 3, 2003:
“I have complaints of piles. There is a lot of swelling and pain. It’s impossible for me to sit because of pain and weakness. So can I lie down and give the case?”“ Four years back, my complaint started with constipation and eight months later I was diagnosed having piles. I get bleeding with stools every day. Bleeding may vary from a few drops of blood to a few spoonfuls. There is a lot of pain passing stools. Stools are always hard and with a lot of straining and then bleeding. There is a lot of soreness of the parts for about an hour after passing the stools. The pain is unbearable; I can’t bear the parts to be touched. I am not able to wear inner garments because of severe pain. There is lot of weakness after passing the stools. Due to severe pain and weakness, I have to lie down at least for an hour after passing stools, every morning. I can lie only on my back with my knees folded and legs drawn, up or I have to lie on one side. The piles prolapse with the stools every day. The swelling persists for the next hour. Oh! I have got tired of the daily pain, bleeding and weakness.”
“Three years back I consulted a surgeon who advised surgery as the only solution. I underwent surgery for piles. The problem was OK for 3-4 months after the surgery. Then the constipation started again and since then the cycle of constipation, bleeding, pain and weakness is continuous.”
“The bleeding is more if I eat spicy things. It also aggravates after taking beer or alcohol in any form. I feel better only after lying down on one side. The surgeon also prescribed some ointment to apply to the piles. But that gives only temporary relief. I was using ointment for about 6 months after the surgery. Then I stopped its application because I could not make out any difference with or without its use. Presently I am not taking any medicines.”
“My appetite is very poor and I don’t feel thirsty. I drink hardly a glass of water in a day. I like to eat spicy things but I avoid eating spicy food because of the piles. There is no complaint about urine and my sleep is also peaceful. I don’t get dreams usually. Apart from this surgery for piles, I have never received any long term treatment. In childhood, once I had convulsions due to high fever. Nobody in my family is suffering from any major illness. Both my parents are healthy and also my brother. I can tolerate summer and winters equally.”
“Please give me relief of this suffering. Day by day the pain and bleeding is getting more. It’s impossible for me to do anything. I left my job 15 days back because it was impossible for me to work with this suffering.”
At this time, the patient’s mother who was attending him interrupted and gave the further details as follows:
“It’s his old habit of leaving the job for one and the other reason. It’s true that now his suffering is unbearable. He has grown weak in last few days, but it is also true that he never had interest in working. He leaves the jobs due to one or the other worthless reason. He is a married man with a 2 year old son, but he still is not able to realize his responsibilities. He likes to spend time in watching TV or playing cricket with his friends. He sits at home for hours without doing anything. In last 5 years, he must have changed jobs for 15 times. He can’t work consistently for more than 2 months. I am sorry to say this but my son is an indolent, lazy man”
“He was a problem child always. Till age of 6 years, he used to fall sick often. He never had interest in studies. Often he used to run away from school and play with friends. He was not mischievous. He never troubled others but he never liked to study or going to school. He never liked reading books or doing some mental work. He could never concentrate while reading. He has poor memory. He used to fail in every exam. Finally he left the school when he was in 8th standard. His father asked him to join our family business but he never showed any interest in it. He is hardly earning anything. Still he expects that he should be treated with respect and gets angry if blamed for not doing anything.”
When I examined him at the end of case taking, I confirmed that he had prolapsed external hemorrhoids. His anus was swollen from all sides. The area was full of bloody mucus. His blood pressure was 100/70 mm Hg.
This man has come for relief from severe bleeding, soreness and weakness due to piles. He has external piles with tendency to recurrence. Pain is unbearable on touching and sitting, even the touch of his clothes on the examination table. As his mother described him, he is indolent with aversion to both mental and physical work.
Repertorization using complete repertory:
Rectum, hemorrhoids, external
Rectum, hemorrhage, anus from
Generalities, weakness, enervation, exhaustion, prostration, infirmity: hemorrhage in
Mind, indolence, aversion to work
Mind, work, aversion to, mental
The remedies seriously considered were: Hamamelis, Acid mur, Sulphur.
Hamamelis is a well known remedy for venous congestion, passive venous hemorrhage, varicose veins and hemorrhoids. It is the indicated remedy for piles when they are large, external, bleed intensely with stools and bleed with soreness. It is also indicated for prostration after hemorrhage from piles, when prostration is out of all proportion to the amount of blood lost. For me, it was more interesting to find Hamamelis graded in italics under the following rubrics of mind:
Indolence, aversion to work
Work, aversion to mental
So Hamamelis covered all the physical as well as mental symptoms. In his book, ‘Materia Medica of Homeopathic Medicines’, Dr. S. R. Phatak, mentions the mind symptoms of Hamamelis as: ‘Forgetful. No desire to study or work. Wants due respect to be’ shown. Irritable. Hemorrhage with tranquil mind.’
Under stomach symptoms, Dr. Phatak mentions, ‘averse to water, makes him sick to think of it.’ This matches with the patient’s symptom of having no thirst.
Hamamelis is also present under the following mind rubrics in the complete repertory:
Indifference, business affairs, to
Memory, weakness of, read, for what he has
Prostration of mind, mental exhaustion, brain fag
Thoughts, wandering, studying, while
Desires, respect, due to him, shown. (Hamamelis is the only remedy mentioned in the repertory.)
Opinions, expects others to pay respect to her (only remedy)
These additional confirmations from materia medica and repertory, make Hamamelis the strongest choice.
Muriatic acid was the remedy I thought of while listening to the case. All remedies from the acid group are known to cause weakness and debility. In Allen’s keynotes, the debility of muriatic acid is described as: ‘great debility: as soon as he sits down his eyes close; lower jaw hangs down: slides down in bed.’ It is the indicated remedy for violent hemorrhages and piles. It is indicated for hemorrhoids when they are swollen, blue, sensitive and painful to touch. They are too sore to bear least touch, even the sheet is uncomfortable. Soreness > heat. But mentally, the Muriatic acid patient is irritable, peevish, disposed to anger and chagrin. He suffers in silence. This remedy is a good match for the physical symptoms (bleeding, protruding piles, piles < touch, prostration) but there is not a close enough match on the mental/emotional plane. However it is my second choice remedy. I suspect that if Muriatic acid were given it would be only palliative.
Sulphur was the remedy coming up in the repertorization. However it was missing under the important rubric: Generalities, weakness, enervation, exhaustion, prostration, infirmity: hemorrhage in. Sulphur, the king of antipsorics is often indicated for internal or external piles when they are protruding, sore, tender, raw with burning and bleeding. It is also the indicated remedy for habitual constipation and for suppressed hemorrhoids especially when suppressed by applying ointment. Sulphur covers all the complaints of the patient. Generally Sulphur is indicated for persons who are dirty, filthy, stoop shouldered and prone to skin eruptions or with a history of suppressed skin affections. This description of Sulphur, does not match with the case. Redness, burning sensation, < standing position are other characteristics of this remedy, missing in the case. Though Sulphur is listed as a high rank remedy under indolence, usually Sulphur patients are intellectual, philosophical, theorizing which contradicts with the given case. So Sulphur was similar only for particular or disease symptoms (piles) but there is not a close enough match on the physical general and mental/emotional plane. I suspect if Sulphur were given it would be only palliative.
Based on my evaluation, Hamamelis was selected. It was given in 200c potency. This is the potency I generally start a case with, unless there is a reason to go higher or lower. The remedy covered both mental and physical symptoms. He took a single dose of Hamamelis 200c on August 3, 2003.
Follow up August 23, 2003.
He reports: All the complaints were the same for the first 2-3 days after the remedy. From the fourth day onwards there was a dramatic change. Bleeding reduced to a great degree and also the pain. The piles use to prolapse with the stools and there used to be swelling, severe pain and weakness for the next hour. But now piles do not prolapse with the stools. Swelling has reduced by almost 90% since I started the remedy. Bleeding has stopped completely in the last week. “Pain is still there, but it is bearable. I can sit now. If I sit continuously for one hour or so then I can feel some soreness at the anal region. Stools are a little hard, but I don’t have to strain much as before. I don’t feel weak. Now I don’t need to lie down off and on. Since 4-5 days I am going out daily. My appetite has also increased and I feel thirsty. I am drinking around 5-6 glasses of water a day.”
In response to questioning, he indicated that still he has no desire to do a job though he feels like doing something. He took his son out in the garden the day before after a long time. He also helped his mother in cleaning the house.
I checked his blood pressure and it was 110/70 mm Hg.
My assessment based on this information was that Hamamelis was acting. The patient was showing improvement both in his general and particular symptoms. His energy level, appetite and thirst had increased. Simultaneously, prolapsed piles, pain and bleeding had reduced to a remarkable degree. Stools were still hard, but he did not have to strain. Improvement on the mental plane was slow compared to the physical level. That was not surprising because the mental symptoms were quite deep. It was a good sign that he developed some desire to work. He started coming out of total indifference to work.
Because of physical improvement in prolapse, pain and bleeding of piles with simultaneous improvement in energy level, appetite, thirst and development of interest in work, I felt that the action of the remedy was in progress and it should be left to do its work. No action was taken and follow up was scheduled.
Follow up: September 25, 2003:
He reports: “I am feeling much better now. I got a job and I started working. Now its three weeks since I started working. The work is interesting. I am enjoying my work. Now complaints are much less since I started Homeopathic medicines. I am able to concentrate on my work properly.
My bowel motions are regular. Stools are not hard and I don’t have to strain anymore. There is no bleeding from piles and piles don’t prolapse after stools. I get mild burning occasionally but that’s only after eating something spicy. My energy level and stamina to work has increased a lot. Also I am eating well. I feel thirsty now and I am drinking around 6-7 glasses of water in a day. I think I have started putting on weight now. My friends were saying that I look healthy now.”
In response to questioning he indicated that now he had started taking interest in his family. Daily he was spending some time with his wife and son. He no more was feeling the burden of their responsibility. In fact he was feeling guilty for not paying proper attention to them for so long and neglecting his duties. He wanted to work hard and earn for his family.
I checked his blood pressure and it was 120/74 mm Hg.
My assessment was that he was continuing to improve. The mental state is improving with development of interest in work and recognizing his responsibilities towards his family. On the physical plane the further improvement is seen through improvement in constipation, increase in thirst and appetite and increase in stamina to work. Complaints due to hemorrhoids have reduced further. The case still has forward momentum and is still progressing. No action was taken and a follow up was scheduled.
Follow up October 15, 2003.
He reports: “Sorry for coming before the actual date of appointment, but I am having loose motions since yesterday. I was completely alright but don’t know how these loose motions started suddenly. I don’t remember eating any outside food which can cause diarrhea. Yesterday I passed 4-5 loose stools in a day. There was pain in abdomen yesterday morning and it reduced gradually by yesterday evening. Initially I thought it might be due to stomach upset and will get better in a day. But even today in the morning I passed loose stools twice. Though I don’t have to rush as frequently as yesterday, I am concerned because it should not increase.”
In response to questioning he indicated that in spite of loose motions his stamina to work was normal and he was working as usual. His appetite was a little less but he was drinking water normally. In fact he was drinking more to avoid dehydration.
I checked his blood pressure and it was 120/76mm hg. His pulse rate was 74/minute and he had no fever.
My assessment was that diarrhea was a state of indisposition. Since the frequency of stools had already reduced without any medication, his body mechanism was strong enough to overcome the problem. Therefore, no medicine was given to him. He was instructed to take a healthy diet and plenty of fluids. He was also instructed to report immediately if frequency of stools increase or persist for more than 2-3 days or if he gets fever.
Follow-up: November 29, 2003.
He reports: “By the next day loose motions got better. I am feeling normal. I have no complaints about piles since I came to see you in last month. In fact I have put on 5 lbs. weight. My friends keep on asking me which health tonic I am receiving to put on weight. My family members are now happy because I am working regularly. Life is becoming busy but I am enjoying it. I like to help my parents in their work. Also I feel emotionally attached with my wife and son. I am taking them on a vacation this weekend.”
My assessment was that he was improving in health further. Coming out of acute health complaints like diarrhea without help of any medication indicates that his resistance power has grown stronger. Further improvement in health is seen through weight gain. Improvement on the mental level is persistent. No action was taken and follow up was scheduled.
Follow-up January 5, 2004.
He reports: “I think I have recovered from problem due to piles. I have no complaints about it since four months. But I have another problem now. My whole body is itching since 8-10 days. There are small red eruptions all over my body. For initial 3-4 days itching was limited only to my back, chest and belly. But now it has spread to hands and legs also. There are no eruptions on legs yet. There is no discharge. But itching is constant. I feel irritated because of itching. Also I get distracted from work and have to scratch.”
In response to questioning he said, “I am not feeling weak. My stamina to work is perfectly normal. My work is interesting and for the first time in my life I am working continuously for so long. Only this itching is disturbing me. Otherwise everything is normal. I am eating normally. My bowel motions are regular. Thirst, sleep everything is normal.”
My assessment of the case at this point was that itching of the body was not a new health problem but was exteriorization of the disease force on the level of skin. Good stamina to work, normal appetite, thirst and sleep, regular stools, and no complaints about piles indicate that his health is nowhere deranged. He was improving as per Hering’s law of Cure (from within outward). As George Vitholkas says in his book, ‘The science of Homeopathy’, the disease force was moving from more important organs to less important organs to a least important organ (skin). No action was taken. He was assured that he will be recovering soon. Follow up was scheduled. He was instructed to call in the mean time if itching increases further or if piles return, or if his stamina and desire to work goes down.
Follow-up February 20, 2004:
He reports: “As you said, itching reduced gradually in a week. It was there on legs for a couple of weeks but that also reduced gradually. Eruptions also reduced simultaneously. Now there is no more itching or eruptions. Everything is normal again.”
My assessment was that he has continually improved over the past few months and shown consistent improvement in the last few months. His chief complaint of bleeding piles got better and it never recurred again in more than 5 months. Further improvement on physical plane was consistently seen through increase in energy level, increase in appetite, thirst and weight gain. His bowel habits became regular and normal. Drastic change was seen through improvement in mental symptoms. He was working consistently for more than 5 months. He was enjoying his work. He was paying attention to his family, doing his duties to them. This indicates that the remedy has acted well showing consistent improvement on all three levels: physical, emotional and mental level. Furthermore, cure followed Hering’s law of Cure. No action was taken and he was asked to call if he had problems in the future.