Important rubrics in Guernsey’s Repertory of Haemorrhoids

Dr Shivani Singh
Dr Rita Chakraborty

Introduction
Haemorrhoids affect millions of people around the world, and represent a major medical and socioeconomic problem. Multiple factors have been claimed to be the aetiology of haemorrhoidal development, including constipation and prolonged straining. Lifestyle plays a major role in such diseases. Factors like hurry, worry, fast foods, sedentary work, irregular dietary habits, reduced intake of water & fibrous food and mental stress add to the problem⁶. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of haemorrhoidal disease².

The most common manifestation of haemorrhoids is painless rectal bleeding associated with bowel movement, described by patients as blood drips into toilet bowl. The blood is typically bright red as hemorrhoidal tissue has direct arteriovenous communication².

Classification of haemorrhoids

Haemorrhoids are generally classified on the basis of their location and degree of prolapse.

Internal haemorrhoids originate from the inferior hemorrhoidal venous plexus above the dentate line and are covered by mucosa, while external haemorrhoids are dilated venules of this plexus located below the dentate line and are covered with squamous epithelium. Mixed (interno-external) haemorrhoids arise both above and below the dentate line².

Diagnostic criteria

Diagnosis of haemorrhoids is based on patient history (bleeding per rectum, pain, burning, itching), digital examination and proctoscopy which reveals external haemorrhoids and internal haemorrhoids which are further graded based on their appearance and degree of prolapse, known as Goligher’s classification²:

First-degree haemorrhoids (grade I): The anal cushions bleed but do not prolapse;

Second-degree haemorrhoids (grade II): The anal cushions prolapse through the anus on straining but reduce spontaneously;

Third-degree haemorrhoids (grade III): The anal cushions prolapse through the anus on straining or exertion and require manual replacement into the anal canal; and

Fourth-degree haemorrhoids (grade IV): The prolapse stays out at all times and is irreducible. Acutely thrombosed, incarcerated internal haemorrhoids and incarcerated, thrombosed haemorrhoids involving circumferential rectal mucosal prolapse are also fourth-degree haemorrhoids.

The Homoeopathic Therapeutics of Haemorrhoids
In the preface of his repertory, “The Homoeopathic Therapeutics of Haemorrhoids⁷”, Dr. Guernsey says, “There are enough proven remedies to easily, surely and safely restore to health all patients suffering with uncomplicated piles”. The ” totality of symptoms” does not refer to the drug, but to the patient; and that it must not be expected that a case will present all the symptoms of any medicine; on the other hand, the remedy should contain all the prominent indications of the patient.”

The repertory part has three sections –

1. Subjective symptoms – includes the sensations experienced by the patient
2. Objective symptoms – physical signs evident to the observer/physician
3. Aggravation and amelioration – conditions which worsen or improve the patient’s complaints

The remedies are represented in three different gradations and typography –

1^st grade – Bold – 3 marks

2^nd grade – Italic – 2 marks

3^rd grade – Roman – 1 mark

Important points from the author’s preface:

1. The subjective symptoms, and the conditions of aggravation and amelioration are of more importance than the objective indications.
2. Aggravation and amelioration in general, as found in other repertories, should be consulted if needed, to confirm the selection of the remedy.
3. Concomitant symptoms are of importance in choosing the medicine, especially if they contain a peculiar or important symptom; and the search for these must not be confined to the meagre collection given in this book.

Some rubrics related to Haemorrhoids from Guernsey’s repertory:

 SUBJECTIVE SYMPTOMS

• Lump, sensation as of a – Aloe, Anac, Apocy., Bry., Crot. tig., Kali bi., Lach., Lil. tig., Medor., Nat. mur., Rumex, Sacch., Sang., Sep., Sul., Therid.
• Soreness – Aescul., Agnus., Aloe, Alum., Ambr., Am. bro., Am. mur., Ant. c. Apis, Arn., Ars., Berb., Bry., Calc. ph., Caps., Carb. an., Carb. vg., Caust., Crot. tig., Diosc, Gal. ac, Graph., Ham., Hep., Ign., Kali bi., Kali cb., Lach., Lactuc, Lil. tig., Lyc, Merc, Mur. ac, Nat. mur., Nit. ac, Nux, Phos., Phos. ac, Physos., Psorn., Puls. Rhus, Sacch., Sil., Sul, Sul. ac, Syph., Thuj., Zinc., Zing.

OBJECTIVE SYMPTOMS

• Bluish – Aescul, Aethus., Carb. vg., Diosc, Ham., Lach., Manc, Mur. ac, Physos, Verat. vir.
• Inflamed – Acon., Agar., Apocy., Arg. nit., Ars., Cham., Hepar, Kali cb., Podo., Merc, Mur. ac, Sacch., Sil, Sul, Verat. vir., Zing.

AGGRAVATION AND AMELIORATION

• Exertion < Podo.
• Heat > Arsen.
• Sedentary habits < Nux

SINGLE REMEDY RUBRICS

Chapter – Subjective

• Drops, sensation as from cold (dripping) – Cannabis sativa
• Fullness alternating with emptiness – Thuja
• Moist sensation (Damp sensation; wet sensation) – Sulphuric acid
• Splitting, sensation as if – Staphysagria
• Twisting (Screwing, wringing, writhing) – Crocus

Chapter – Objective

• Dryness – Graphites
• Pendulous (Hanging, long) – Nitric acid
• Replaced easily (Reduce, easy to) – Ignatia

Chapter – Aggravation and Amelioration

• Bleeding, before < Hamamelis
• Bleeding, copiously > Aloes
• Climacteric period < Lachesis
• Drinking, after < Capsicum
• Forenoon < Thuja
• Kneeling > Aesculus
• Micturition, after < Merc
• Pregnancy, during < Collinsonia
• Sneezing < Lachesis
• Stool, evening, after < Nux vomica

Conclusion
Homoeopathy has a great scope in treating haemorrhoids. As Homoeopathy is a holistic medicine, it gives importance to the patient as a whole and treats the disease from the root itself. Homoeopathy works by rectifying constipation, checking the bleeding in the haemorrhoids, improving the elasticity of the veins as well as the surrounding tissues of anal cushion and curing the side effects of conventional therapy. By this work I have given a brief introduction on haemorrhoids, its aetiology, clinical depiction, diagnostic features and the utility of “The Homoeopathic Therapeutics of Haemorrhoids” repertory by exploring and highlighting the single remedy rubrics.

References

1. Kumar Malviya V, Diwan S, Kumar Sainia T, Apte A. Demographic study of hemorrhoid with analysis of risk factors. Surgical Review: Int J Surg Trauma Orthoped [Internet]. 2019Mar.31 [cited 2022Aug.23];5(1):7-13. Available from: https://surgical.medresearch.in/index.php/ijoso/article/view/82

2. Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-2017 [PMID: 22563187 DOI: 10.3748/wjg.v18.i17.2009] Available from: https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

3. Shinde, Prashant & Chawada, Meghraj & Deshmukh, Sudhir. (2019). A study of surgical profile of patients with hemorrhoids at a tertiary care hospital. International Surgery Journal. 6. 916. 10.18203/2349-2902.isj20190824. Available from: https://www.researchgate.net/publication/331338113_A_study_of_surgical_pr ofile_of_patients_with_haemorrhoids_at_a_tertiary_care_hospital

4. Das KD, Ghosh S, Das AK, Ghosh A, Mondal R, Banerjee T, Ali SS, Ali SS, Koley M, Saha S. Treatment of hemorrhoids with individualized homeopathy: An open observational pilot study. J Intercult Ethnopharmacol. 2016 Jun 15 25;5(4):335-342. DOI: 10.5455/jice.20160608030224. PMID: 27757262; PMCID: PMC5061475. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061475/

5. Hollingshead, J R F and Phillips, R K S. Haemorrhoids: modern diagnosis and treatmen. Postgraduate Medical Journal. 2016. DOI: 10.1136/postgradmedj2015-133328. Available from: https://pmj.bmj.com/content/92/1083/4.short

6. Najar FA, Faisal M, Khesal A, and Ansari TA. Prevalence of Haemorrhoids among the Patient visiting Surgery OPD at NIUM Hospital. European Journal of Biomedical and Pharmaceutical Sciences.2018;5(1):435-437. Available from: https://www.researchgate.net/publication/322276317_Prevalence_of_Hemorrh oid_Among_the_Patients_visiting_Surgery_OPD_At_NIUM_Hospital

7. Guernsey, WM. Jefferson. The Homeopathic Therapeutics of Haemorrhoids. Philadelphia: Boericke & Tafel. 1892. 2010-11-04 14:49:39. Available from: https://archive.org/stream/homoeopathicther00guer/homoeopathicther00guer_d jvu.txt

Dr. Shivani Singh
PG scholar, MD-I, Dept of Repertory
Father Muller Homoeopathic Medical College & Hospital, Mangalore, India

Dr. Rita Chakraborty
Prof & HOD
Dept of Repertory
Father Muller Homoeopathic Medical College & Hospital, Mangalore, India