Dr Thanka R
Haemorrhoids is one such disease which challenges the modern treatment namely local medication and surgical removal. Half the population suffers from this disease with bleeding, pain, itching, prolapse or altered bowel habits. This causes extreme inconvenience which hurdles and hinders the patient’s daily routine with great mental agony and anxiety.
Haemorrhoids caused Napoleon to sit side- saddle, sent President Jimmy Carter to the operating room, and benched baseball star George Brett during the 1980 World Series. Over two thirds of all healthy people reporting for physical examinations have haemorrhoids. Unfortunately a haemorrhoidal condition only tends to get worse over the years, never better.
The concept of Ayurveda regarding Haemorrhoids states that it is one among the eight “Maha vyadis” of medicine, obstinate for management because of recurrence and prolonged suffering. They consider their origin to the fault in the “Tridoshas”- the vatha, pitha and kabha. The terminology in use is “Arshas”. They can be of sushka (non-bleeding) and ardra (bleeding) varieties. Regarding the aetiology, the concept is intertwined with the habit of bowel movement (constipation- ‘udavartham’). To the question of treatment it is listed under “Yapyam”- only manageable and not curable.
In Homoeopathy, Haemorrhoids are treated as not local but as derangement in the dynamic vital force that are expressed out through signs and symptoms of bleeding, pain, itching and prolapse and are corrected only by means of dynamic medicines, which are capable of producing artificial similar diseases in healthy individuals, in a safe, gentle and effective manner.
As man is prior to his organs so is the derangement of vital force to the development of tissue changes. These tissue changes are the result of disease. These local tissue changes are not the disease but only the external manifestation of the disease on the material body which stem forth from the internal dynamic derangement of the vital force. Through this dynamic derangement, the man is affected in totum which rationally demands a constitutional management for the extirpation of the illness in its entirely leading to a permanent restoration of health which inevitably wards off its recurrence and transference to the progeny and this can be achieved only through the symptomatic individualistic antimiasmatic constitutional treatment administered by Homoeopathic system.
Under these circumstances it is decided to conduct a clinical study to evaluate the effectiveness of constitutional medicine in the management of bleeding Haemorrhoids. The detailed methodology and plan of action are discussed in the concerned section and the results are statistically analyzed to derive evident conclusions.
The present study has been ventured by me to verify the efficacy of constitutional management in bleeding Haemorrhoids emboldent by the statement made by Dr. Samuel Hahnemann in his Materia Medica Pura-
“This doctrine appeals solely to the verdict of experience. Repeat the experiments , it cries aloud , repeat them carefully and accurately , and you will find the doctrine confirmed at every step ; and it does what no medical doctrine , no system of physic ,no so- called therapeutics ever did or could do- it insists upon being judged by results.”
To study the effectiveness of Constitutional Medicines in the treatment of Bleeding Haemorrhoids.
To verify statistically the results of the study through the analysis of clinical symptoms before and after treatment.
REVIEW OF LITERATURE
- General concept of health
- Homoeopathic perspective of disease
- Constitution and constitutional medicine
- Anatomy of rectum and anal canal
- Physiology of defecation
Randomly selected 30 cases of Haemorrhoids from patients registered in the special OP for piles and fistula under the department of Homoeopathic Philosophy, Government Homoeopathic Medical College, Thiruvananthapuram.
The period of study was from July 2006 to January 2008. For analysis, I have taken the cases where follow-up was obtained for one year. Patients were reviewed on monthly basis for a period of 12 months. Each case was analyzed, evaluated and prescribed according to the principles of Homoeopathy. The repetition, change of potency and remedy were done according to the principle of Homoeopathy.The effect of remedy was studied on the symptomatic basis.
Sample of cases include bleeding types of first, second and third degree haemorrhoids and were judged by the seven international criteria for haemorrhoids which include haemorrhage, pain, constipation, prolapse of pile mass, mucus discharge, itching and anaemia.
The study was conducted in both men and women under the age group 20-60 years. Only bleeding type of first, second and third degree haemorrhoids with any of these clinical symptoms such as haemorrhage, pain, constipation, prolapse of pile mass, mucus discharge, itching and anaemia were selected.
Non bleeding piles, prolapse of rectum and other conditions with similar clinical symptoms like fissure, fistula, anorectal abscess, malignancy, Chron’s disease, ulcerative colitis, polyp of rectum, diverticulitis and other diseases having rectal complaints as secondary phenomena were excluded. Other causes of pruritis ani and anaemia were also excluded. Cases which needed surgical intervention were also excluded. Cases outside the prescribed age group were also excluded.
Clinical diagnosis was done by assessing the presenting signs and symptoms of seven international criteria for haemorrhoids such as bleeding, pain, difficulty in passing stool and protrusion etc. Confirmatory tests like digital rectal examination and proctoscopy were also done in each case.
The study was a clinical trial. Each case was taken properly in an elaborate manner, as per the directions given by Dr. Hahnemann in aphorisms 83-104 of 5th edition of Organon of Medicine. All the symptoms including subjective and objective were considered. Separate case records were kept with detailed format for each patient and routine investigations were done according to the cases. Each case was analyzed, evaluated and repertorised according to the principles of Homoeopathy. If repertorisation was needed, it was done with the software RADAR. Remedies were selected based on individualizing constitutional totality of symptoms of each patient and not on pathological findings.
Diet and regimen – The patients were directed to follow dietary restrictions according to the aetiology of haemorrhoids. Apart from this, all the patients were restrained from taking other medications, internally or externally, strong and spicy foods, coffee, tea, increased quantity of milk and milk products, condiments and other food items supposed to be of possessing medicinal value during the study period. Advised to take regular proper fibrous diet and increased adequate quantity of water. Also the use of strong smelling perfumes and deodorants were advised to avoid. Regular proper exercise is also advised. However, 100 percent restriction of diet and regimen cannot be guaranteed.
Review and follow up
All the cases were reviewed every monthly and assessed using the following disease criteria.
Disease criteria used for assessment
- Haemorrhage per rectum
- Pain with relation to defaecation
- Protrusion of pile mass
- Mucus discharge
- Itching of anus
The discussion that follows is exclusively based on the observation and results presented in the former section. Firstly, to discuss about the various attributes involved in this study.
1. Age incidence: Haemorrhoids are found to occur more among the age group from 31 to 40 i.e., 43.33%.
2. Sex incidence: 53.33% were males and 46.67% were females.
3. Educational status: prevalence is more in college level education. This can be considered as a reflection of the higher rate of literacy in our state
4. Occupational status: higher incidence was found to be in house wives (23.33%) and next in labourers.
5. Economic status : 56.67% in middle class group which can be attributed to higher concentration of aetiology in middle class population
6. Distribution of clinical features: 100% had bleeding, 83.33% had pain and constipation, 50% had prolapse and itching and 33.33% had anaemia at the first consultation. After treatment it was found out that there was marked reduction in symptoms which showed the efficacy of management.
7. Hereditary tendency: 80% of patients showed a history of piles in family.
8. Miasmatic predominance: 36.67% showed Psoric predominance though bleeding haemorrhoids come under tubercular miasm which was 33.33% in this study.
9. Order of effective medicines: A single medicine cannot be said as much effective for haemorrhoids when compared to others, which emphasizes the significance of individualization in Homoeopathy.
10. Evaluation of change in disease criteria :
a) Bleeding – Out of 30 cases ,26 cases (86.67%) were cured and 4 cases (13.33%) showed improvement
b) Pain - Out of 29 cases, 22 cases (75.86%) were cured and 7 cases (24.13%) showed improvement
c) Constipation – Out of 29 cases, 21cases (72.41%) were cured, 7cases (24.13%) improved and 1case (3.45%) remained unchanged.
d) Prolapse – Out of 25 cases, 18 cases (72%) were cured, 6 cases (24%) improved and1case (4%) remained unchanged.
e) Mucus discharge – Out of 11 patients, 8cases (72.73%) were cured and 3 patients (27.23%) showed improvement
f) Itching – Out of 25cases, 21cases (84%) were cured and 4cases (16%) showed improvement.
g) Anaemia – Out of 9 patients, 6 cases (66.67%) were cured, 2 cases (22.22%) improved and 1 case (11.11%) remained unchanged.
From the evaluation of results obtained after the statistical analysis of the pre-treatment and post-treatment disease intensity scores, it is obvious that constitutional medicines selected on the basis of the conceptual totality of symptoms are highly effective in the management of Haemorrhoids.
The mental generals and physical generals should be given prime importance. The tendency to the recurrence of piles can be controlled/ eradicated by the exact simillimum. Thus it is proved that any disease, even if it is a surgical one (provided they are within the reversible limit) can be cured by the intuitive and diligent adherence to the Homoeopathic principles.
Other factors observed in this study are high prevalence of Haemorrhoids is seen in age group 31-40, coming from middle class with an adequate educational status. Even though bleeding Haemorrhoids are coming under pseudopsora, my study verified its Psoric predominance of in these 30 cases.
Antimiasmatic deep acting constitutional medicines like Sepia, Natrum mur, Ignatia, Phosphorus, Calc.carb, Lycopodium, Nux vomica, Sulphur, Pulsatilla, Silicea, Stapysagria etc were found to be effective for controlling both the acute attacks and also for preventing recurrence, when given after strict individualization.
Many cases, which are recommended to do surgery, can be effectively treated with Homoeopathic constitutional medicine. It can also be claimed that Homoeopathy is far more cost effective when compared with expensive drugs and other procedures like cryosurgery, banding etc used in other systems of medicines.
To conclude, limited reliability can only be guaranteed with such a study involving a chronic disease, with 30 cases, for period of one year follow up. A long term follow-up study will be more reliable as the disease is exhibiting recurrence. Comparative studies involving other systems of medicine can also be accomplished with better results.
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