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

[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

1. Avoid straining at stools
2. Intake of adequate water
3. High fiber diet
4. Counseling to reduce tension as far as possible.

Specific Management: 
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:

1. Burning⁺⁺⁺
2. pain throbbing⁺⁺
3. Bleeding
4. Constipation
5. urging for stool
6. weakness.

Case was analysed. Positive changes were expected in coming follow up when constitutional remedy would be given.

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,

To Confirm, case was repertorised and for PDF following remedies came up.

Criteria For Follow Up

1. Worries mental
2. Sleep
3. App
4. Thirst
5. Bowels
6. Urine
7. Burning.
8. hrobbing
9. Bleeding
10. Headache
11. Weakness

Case 2
Mr. MSK, 46 yrs; working as manager and married having 2 children.

Chief Complaints:

Life Space Investigation: Patient is the eldest and only son among 5 siblings. He got married late after all the sisters were married. He lost his father at a young age, which had affected him to some extent. But he could not tolerate his mother's nature, which he feels worsened after his marriage. He feels she is indifferent to him in spite of he taking good care of her. Patient's wife narrated that he gets angry very easily and shouts very rudely when angry; quarrels many times with mother for house matters. He feels he had always been a victim of criticisms of his mothers and sisters. Patient feels that his mother never agrees to his proposals and views, which makes him very angry. At present since 3 years his family stays in a newly constructed house just next to old one in the same campus. But his mother rejected and stays in same old house.

Wife told us that the patient is very lazy and does not attend to any household work. But he undergoes lots of mental strain being a bank manager. There he is very particular and careful in completing his work but at the same time looses patience very quickly. He doesn't like to be with people, nor talk. He likes to dedicate himself for working overtime or even on holidays. Because of this, has become addicted of tea and coffee. Too much of mental exertion makes him exhausted and his complaints too get aggravated.

Physical Generals:
Appetite: good
Cravings: Meat⁺⁺ fish⁺⁺ Tea⁺⁺ Coffee³
Thirst: increased⁺⁺
Perspiration: ⁺⁺on head
Stools: hard
Thermals: Chilly pt - C4 H

Mentals:
A/F : Mental stress, mental exertion
Irritable⁺⁺⁺ violent, abusive, shouts back
Quarrelsome⁺⁺
Responsible++, careful⁺⁺
< Contradictions⁺⁺⁺
Dreams: Fire, land slide.
O/E: Obese; Dark circle around eyes
BP: 130 / 90, P / A - NAD, P / R - Mass protrudes. While straining recedes back on its own.
Disease diagnosed as 20 hemorrhoids

General Management

1. High Fibre diet
2. Avoid stimulants
3. Exercises to reduce the obesity
4. Avoid oily, fat items.
5. Intake of adequate water

Specific Management: Depending on chronicity of complaints without much of A/c exacerbation, directly chronic Rx was thought to be given. Patient was told to wait for sometime and analysis was done mainly considering prominent generals and particulars like A/ F mental stress and exertion
Irritable⁺⁺⁺ - Abusive
Quarrelsome⁺⁺, Responsible⁺⁺, careful⁺⁺
< Contradiction³, Perfectionist, Dreams - fire
Chilly pt, Cr - Tea⁺⁺ Coffee³, Meat⁺⁺, fish⁺⁺,
Obese, Perspiration⁺⁺ , on head, thirst⁺⁺
Ch. Part - hemorrhoid bleeding bright red.
Ineffectual urging³ with dissatisfied feeling
< before and during stool
A/F < mental stress
< non veg⁺⁺, sitting³
< Tea and coffee³

Remedy of choice was Nux-vom
So 19/4/99 1 wk
1 Nux-vom 200 (IP) HS wkly
(2) 3 gr tab 1-1-1

Case was evaluated and interpreted, Nux-vom was selected as constitutional remedy also on repertorisation with Kent.

Criteria For Follow-Up

1. Irritability
2. App.
3. Sleep
4. Bowels
5. Piles
6. Bleeding
7. Addiction to Tea and coffee.
8. Any other symptoms were taken

Now also wife comes for treatment for herself and other family members and she reports her husband has no complaint.

Conclusion:
These cases demonstrate psychosomatic basis of illnesses, how a patient reacts and adopts to life situation and its repercussion at the physical level. The efficacy of Hom. Treatment in so-called surgical diseases is proving it to be a cost-effective alternative. By treating the individual as a whole with the appropriate constitutional remedy the external manifestation of the disease is removed with overall well-being of the patient.