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Introduction
‘Fistula–in-ano’ is an inflammatory track which has an external
opening (secondary opening) in the perianal skin and an internal
opening in the anal canal or rectum, which is lined by unhealthy
granulation tissue and fibrous tissue. It is classified as low
level or high level fistula depending on whether the internal
opening is below or above the anorectal ring respectively.
It usually
originates from a perianal abscess in the inter-sphincteric
space of the anal canal from infection of the anal gland; other
causes include Ulcerative colitis, Colloid carcinoma of the
rectum, Crohn’s disease, Tuberculosis etc. (the last 2 are
associated with multiple fistulous openings, TB being more
common in India)
Patients
usually present with pain in the perianal region, fever, and/or
discharge of pus which maybe bloodstained.
For
recovery maintenance of proper hygiene is a must. Bowel habits
can be improved to ease pain with intake of a high fiber diet
and plenty of fluids. Sitz Bath for 10-15 minutes especially
after defecation is soothing and promotes relaxation of anal
muscles.
Surgical
treatment(?) of the fistula is the only mode of treatment for
the dominant school. John Henry Clarke has mentioned in his
works that not infrequently it has been observed that surgical
correction (or in-correction!) of the disease is often followed
by chest ailments (Calc phos, Silica etc.) For the homoeopathic
physician, it is a deep seated miasmatic disturbance which
demands a homoeopathic similimum.
Our
literature is rich in medicines for this condition like Calc
phos, Silica, Nitric acid, Kali carb, Graphites, Mercurius,
Fluoric acid, Sulphur, Syphilinum etc. each having its specific
indication to be prescribed according to symptom totality.
We must go
through the small but beautiful monograph ‘Fistula & Its Radical
Cure’ by James Compton Burnett, in which he describes it as a
disease fully amenable to internal medications.
I am
forever indebted to Prof. L. M. Khan who as my Guru has taught
me whatever little I know of homoeopathy and humbly submit that
this disease is indeed completely curable with the indicated
homoeopathic medicines chosen and prescribed as per the
directions that Hahnemann laid down in Organon.
I share
below 2 of my clinical successes:
Case no
1
Mr. A.M. 26
years old consulted us in April ’06. He was short with dark hair
and eyes, a sharp nose with a prominent angle below the glabella,
numerous black moles all over the body and trembling hands.
Presenting Complaints
History
He was
diagnosed as a case of right sided fistula-in-ano which was
operated upon. Few months later he developed a left sided peri-anal
abscess which too was surgically drained. For last 1 year again
there is diffuse pain in the perianal region with discharge
which is purulent, sticky and bloodstained. Associated itching
and burning is present in the entire area.
Past
Illnesses
- Twice had
convulsions with high fever and diarrhea when 6-8 months old
- Typhoid
during school time with relapse
- Chicken
pox (severe) - 7 yrs back
- Tinea cruris 2-3 times in the
last 3-4 years (more often on right side) treated with topical
antifungals
Family
Illnesses
Father:
Piles
Mother:
Asthma
Sisters:
Carcinoma; Epileptic convulsions
Personal
History
Born in U.P.;
in Delhi for the last 12 years; single, working and a vegetarian
Generals
Appetite:
normal, can tolerate hunger
Thirst:
good; likes cold water++
Desires:
sweets++; ice cream ++; alcoholic drinks (vodka, beer) ++
Aversion:
milk products++; brinjal & gourd
Bowels:
normal, cleared once or twice
Urine:
normal
Sleep:
refreshing; on abdomen; salivation during sleep; thumb sucking
during sleep as a child which still occurs occasionally
Dreams:
numerous
Perspiration:
profuse ++; on face; while awake
Thermal
reaction:
loves rains and cloudy weather+++; loves strong winds
Life and
Circumstances
He grew up
watching fights and arguments between his parents all through;
developed hatred for father because of his behavior towards his
mother as he grew up- Never been able to come up with his
feelings, his anger is pent up all inside him. Came to Delhi
about 12 years back to pursue studies. He could not clear the
MBA entrance exam after engineering and had to struggle to get a
job. During the last 3-4 years he has got habituated to alcohol
which he attributes to stress.
Mentals
His anger
against his father was as palpable as soft corner for his
mother. While talking about the situation at home he casually
mentioned that he could not bear to see anyone in trouble and
tried to do much as he could to help.
On
examination
Abdomen: NAD
Respiratory
system: normal breath sounds on auscultation
Peri-anal: fistula at 7’o’clock
Prescription
14/4/06
Rx
Causticum L.M 1 B.D
Analysis
& Discussion
His
sympathetic nature, love for rainy weather, right-sidedness of
affections (both in fistula and tinea) and thirst for cold water
formed the basis of prescription.
Follow
up
Under
Causticum (LM 1 to LM 5) he improved and his discharge decreased
and was no more blood-stained. He now complained only
occasionally of pain in buttocks and perianal region. Backache
too became infrequent. But the tendency for pain in the right
side of the abdomen with loose stools after eating out
persisted.
17/6/06
The pain
had decreased considerably but there was a milky white discharge
almost every alternate day with accompanying itching off and on.
Backache again became more prominent.
We had also
observed that during all he visits he would call and confirm his
appointment and yet reach much before the scheduled time. He
also said that he would go to the washroom a number of times
just to check himself even when he did not feel any discharge or
discomfort. He also had a constant apprehension of something
going wrong and would repeatedly ask ‘I will be alright doctor?
I hope I don’t have to undergo knife again.’
He further
disclosed that he was always nervous and restless before the
exams.
Rx
Argentum nitricum L.M 1 B.D
30/6/06
No pain at
all; discharges absent; Backache-absent.
He received
Argentum nitricum LM 2 – LM 4 B.D. and LM 5 -LM 9 O.D. and
recovered completely. The fistulous opening closed and he could
work more comfortably; his backache also vanished. Now he could
tolerate food from restaurant more comfortably though too
frequent eating out still caused indigestion.
He has been
off medicines for last 1 year and reports doing well. For any
trivial complaint he still receives placebo on telephone!
Case no
2
Mr. V.J.,
24 years old first visited us in March ’07. He was obese and had
dark hair and eyes, a dry pouting lower lip and was perspiring
on nose and forehead. He was noticed sitting with his arms
folded across his chest and he had eaten most of his nails.
Presenting Complaints
History
It all
started as a painful solitary eruption on the left buttock
somewhere in summer ’06. Later it began to discharge pus and
blood during defaecation or even anytime through the day with
occasional itching. A surgeon diagnosed it to be fistula-in-ano
at 3’0’ clock and 5’o’clock for which he took homoeopathic
treatment (Silica, Flouric acid, Nitric acid etc.) without any
relief.
Past
Illnesses
-Chicken
pox in early childhood
-Fracture
(hairline) of Rt ankle twice in childhood
-Monkeybite
when 4-5 yrs of age
-Left
facial herpes zoster in august ‘06
-Eosinophilia
in November ’06.
Family
Illnesses
-Father: lichen simplex chronicus
-Paternal
grandmother: cancer
-Paternal
uncle: HT & obesity
-Paternal
aunt: Brain tumor
-Mother:
asthma and piles
-Maternal
uncle: diabetes mellitus
-Maternal
grandfather: cancer and piles
-Maternal
grandmother: piles and allergic cough
Personal
history
Belongs to
Delhi; is unmarried and working (in a BPO) with shift duties.
Generals
Appetite:
normal
Thirst:
normal
Desires:
sweets++; warm food++; yellow butter+
Bowels:
regular; occasionally hard stool
Urine:
normal
Perspiration:
profuse and easy; more when awake
Sleep:
Disturbed; irregular sleeping pattern due to changing timings of
office duties; on abdomen; occasional salivation
Thermal
reaction: doesn’t tolerate extremes of temp well
Life and
Circumstances
Youngest of
three (2 elder sisters), he was born and brought up in a joint
family background and grew up seeing his mother being
ill-treated by his paternal aunts and overworking too. His
father didn’t ever pay any heed to this and never supported or
consoled her. Instead, he would discriminate between his own and
his brother’s children, and was more inclined towards them.
Consequently he grew up with numerous insecurities which is
reflected in his habit of nail biting, defensive sitting posture
and tendency to sleep on abdomen. He couldn’t mix well with
people and surroundings or make friends with ease all through
his life.
Mentals
He is
extremely touchy, defensive, insecure, nervous and short
tempered. He is extremely particular about things; he also
disclosed that his colleagues and associates often said that he
was too high-headed and argumentative by nature.
On
Examination
Abdominal
examination: could not be done properly as he was extremely
ticklish
Local
examination: 2 openings at 3’o’clock and 5’o’clock positions
Prescription
On 29 /3/07
Kali
Carbonicum LM 1 BD
Analysis
& Discussion
The most
striking feature was his insecurity which was evident in his
inability to blend with people and make friends and his habit of
nail biting. As he grew up in an unhealthy family atmosphere
without his father’s affection, he became extremely sensitive
and short tempered (touchiness).
His
high-headedness and argumentative nature was just a mask to
cover his indwelling insecurities.
Kali carb
was the drug of choice as it covered his entire persona- his
sensitiveness; his insecurities; his desire for sweets; being
ticklish and tendency to sweat freely.
Follow
up
Pricking
pain felt along with burning during later part of defecation but
much better than before.
Discharge
occasional and watery now. Very slight itching now.
Bleeding
very occasional.
App: good;
Bowels: normal
Over a
period of 5 months he received Kali carb LM 1 – LM 8 B.D. and
Kali carb LM 9- LM 11 O.D. and recovered completely. He has
been without any medication for last 18 months and has also
referred to us 3 more cases fistula-in-ano.
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