Effect of Homoeopathic remedy Merc Cor

Dr Puneet Kumar Misra

Abstract- mere cor is the inattention medicine in the common clinical practice in the gastric disorder, but this medicine having a remarkable and quick effect on the acute as well chronic disorder of the rectal region associated with large intestine along with gastric and small intestine due to dietary habit or illness .

Introduction – the Diarrhea and Constipation is the disordered defecation. but many   patient  have  normal tendency of defecation, but  before ,during and  after  defecation the mild to moderate pain, burning and uneasiness  in the rectal region  with or without lower abdomen pain with feel of  incomplete defecation  and  which  associated with dietary change  in many person .

Key words – Diarrhea, Constipation,   Defecation,

Abbreviation- IBS- Irritable bowel syndrome . GI-gastrointestinal , UC- ULCERATIVE COLITIS,

DEFECATION – Tonic contraction of the puborectalis muscle, which forms a sling around the recto anal junction, is important to maintain continence; during defecation, sacral parasympathetic nerves relax this muscle, facilitating the straightening of the recto anal angle. Distention of the rectum results in transient relaxation of the internal anal sphincter via intrinsic and reflex sympathetic innervations. As sigmoid and rectal contractions, as well as straining (Valsalva maneuver), which increases intra abdominal pressure, increase the pressure within the rectum, the recto sigmoid angle opens by >15°. Voluntary relaxation of the external anal sphincter (striated muscle innervated by the pudendal nerve) in response to the sensation produced by distention permits the evacuation of feces. Defecation can also be delayed voluntarily by contraction of the external anal sphincter. 1

DIARRHOEA
Diarrhea is loosely defined as passage of abnormally liquid or unformed stools at an increased frequency. For adults on a typical Western diet, stool weight >200 g/d can generally be considered diarrheal. A careful history and physical examination  generally allow these conditions to be discriminated from true diarrhea. 1,2,3

CONSTIPATION
Constipation is a common complaint in clinical practice and usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation.  A person whose parents attached great importance to daily defecation will become greatly concerned when he or she misses a daily bowel movement; some children withhold stool to gain attention or because of fear of pain from anal irritation; and some adults habitually ignore or delay the call to have a bowel movement.1,2,3

ULCERATIVE COLITIS
Signs and Symptoms The major symptoms of UC are diarrhea, rectal bleeding, tenesmus, passage of mucus, and crampy abdominal pain.  Other symptoms in moderate to severe disease include anorexia, nausea, vomiting, fever, and weight loss. Physical signs of proctitis include a tender anal canal and blood on rectal examination. With more extensive disease, patients have tenderness to palpation directly over the colon. 1,2

CROHN’S DISEASE
Although CD usually presents as acute or chronic bowel inflammation, the inflammatory process evolves toward one of two patterns of disease: a fibrostenotic obstructing pattern or a penetrating fistulous pattern, each with different treatments and prognoses. The site of disease influences the clinical manifestations.

ILEOCOLITIS
Because the most common site of inflammation is the terminal ileum, the usual presentation of ileocolitis is a chronic history of recurrent episodes of right lower quadrant pain and diarrhea.  

JEJUNOILEITIS
Extensive inflammatory disease is associated with a loss of digestive and absorptive surface, resulting in malabsorption and steatorrhea. 

COLITIS AND PERIANAL DISEASE
Patients with colitis present with low grade fevers, malaise, diarrhea, crampy abdominal pain, and sometimes hemato chezia. Gross bleeding is not as common as in UC and appears in about one-half of patients with exclusively colonic disease.  . Perianal disease affects about one-third of patients with Crohn’s colitis and is manifested by incontinence, large hemorrhoidal tags, anal strictures, anorectal fistulae, and perirectal abscesses. Not all patients with perianal fistula will have endoscopic evidence of colonic inflammation 12

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities.   Furthermore, IBS symptoms are prevalent in non cardiac chest pain patients, suggesting overlap with other functional gut disorders.1,2

Allen’ s keynotes and characteristics with comparisons.
Dysentery  and  summer  complaints  of  intestinal canal, occurring from  May  to  November. Tenesmus: of  rectum,  not  >.  by  stool  [  <.  by  stool,  Nux];  incessant,  persistent;   stool   hot,   scanty,  bloody,  slimy,  offensive;  shreds of mucous  membrane  and  terrible cutting, colicky pains. 6

Boerickes new manual of homoeopathic materia medica with repertory. #General
This  salt leads all other remedies in tenesmus of  the  rectum,  which  is  incessant,  and is not relieved  by  the  stool.7

A Dictionary of Practical materia medica vol 2^nd

#Abdomen
Pains  in liver and right shoulder. Stitches as if in middle  of  liver.  Bloated  abdomen, painful, very painful to  least  touch.  Cutting  below  navel.  Bruised pain in  abdomen,  especially  in  caecal  region  and  over  transverse  colon.  Pressive  pain  in  inguinal glands. Lancinating drawing in left inguinal region.

#Stool and Anus
Diarrhoea,  yellow,  green,  bilious,  bloody,  with  membranous  shreds,  of faeces with mucus and dark clotted blood. Burning  in  rectum  and  anus, during stool. Faeces loose, with  bilious  and  fetid  evacuations,  green  or brown, or  composed  of  thin  and  sanguineous  mucus, accompanied by almost incessant  cuttings  in  abdomen and discharge of small quantities of bloody mucus, almost  unsuccessful  pressing, straining and tenesmus. Ineffectual  want  to  evacuate.  Tenesmus with dysenteric discharges,  vomiting  of  bile,  cramps in calves, and stitches in side. (Spasm  of  rectum  after  coitus.)  _  Painful  bloody  discharge,  with   vomiting.

Dysentery.  Corrosive  ichol  oozes from  anus,  excoriating  the  parts.  Itching  about  anus  (while  walking). Very  persistent  distressing  tenesmus  and  cutting colicky  pains,  after  stool  burning and tenesmus of rectum and bladder, stools hot, frequent,  scanty,  nothing but mucus tinged with blood. Stool  pasty,  dark  green,  bilious,  blackish,  offensive.  Constipation,  tenacious  faeces.8

The guiding symptoms of our materia medica Volume VII
Abdomen Abdomen swollen, hard and sensitive to pressure, especially about  umbilicus.  Cutting below navel.  Bloated abdomen, very painful to least touch.  Peculiar bruised sensation in abdomen, especially in cecal region  and  following  course of transverse colon; painful  to  moderate  pressure, as though bruised.   Intolerable  cutting  pains  in abdomen and  constant  urging  to  stool,   followed  by  slight  discharge  of  blood  and   mucus;  despondent, walks up and down.9

Lectures on homeopathic materia medica
In <dysentery> there is more violence; copious bleeding; great  anxiety, can scarcely leave the stool a second, great tenesmus of  rectum  and bladder; urging to urination and stool  is  constant;  great burning in the rectum. It is a violent case of dysentery. I  would  prefer  <Merc.>  in ordinary <Merc.> cases,  but  if  this  patient  is  not  relieved he will not live, and  Merc.  cor.  is  needed here.10

Leaders in homoeopathic therapeutics
Most persistent and  terrible tenesmus before,during and   after   stool; stool scanty, mucus tinged with blood. Of MERCURIUS CORROSIVUS we have to say that it   leads  all  other  remedies for TENESMUS  OF  THE  RECTUM.   This tenesmus  is incessant. Stool  does not relieve it,11

A manual of  pharmacodynamics
But when the large intestine are affected , whether with simple inflammation , with chronic ulceration, or with dysentery ,its effects are amongst the most brilliant thing in medicine .hahnemann was the first to recommend in the dysentery ,say (1822) that he had  found it almost specific  in the common autumnal invasion of the complaint .he gave the 15^th dilution in the single dose ; but dr ringer reports correspondingly good result with hourly repeated dose of a hundredth of a grain .12 

Concordant Reference Complete Classic Materia Medica
Generals . this salt lead all other remedies in tenesmus of the rectum ,which is incessant and not >by the stool .13

The Continues observation of drug action on the complaint of defecation in  normal  or deformed state  of stool  with mild to moderate pain, burning and uneasiness  in the rectal region  before ,during and  after  defecation. during the course of three year in all weather condition on the 64 case mention below in table.

Total Case	Age Group	Male	Female
064	03y to 74y	44	20

Discussion

1. The discomfort in the rectal region   before ,during and  after  defecation is not an specific disorder  it associated with meal ingredients and eating habits along with whole GI system .
2. Most of the patients come with this complain  having the highly spices and fried food habits and remedy with normal meal gives the fast relief.
3. The nature of stool in the most of the case is unexplained .
4. The many patient having the upper or lower  abdominal pain complaints with this disorder .
5. The 30c  given  better improvement in the children group and 200c having remarkable improvement in both  children as well as adults in the BID frequency.
6. When  this disorder associated with the cramp in the lower abdomen then its association with Nux Vomica 30/200 give rapid improvement
7.   When  this disorder associated with the distension of  abdomen then its association with Mag Phos 30/200 give rapid improvement
8. When  this disorder associated with the upper  abdomen  discomfort  then its association with  Phosphorus  30/200 empty stomach  give rapid improvement
9. In the most of acute case BID dose is sufficient for the 4-7 days ,
10. When  patient having the recurrent tendency of discomfort then night dose of the mere cor after meal and empty stomach phosphorus on the onset of disorder shows good response for inhibit the tendency .
11. When the patient having an external cause(skin eruption or ulcer around anal region  ) of discomfort then no improvement after internal use of  medicine.
12. The future study provide the more evidence if  treatment done with ultra sound whole abdomen and colonoscopy along with CBC AND LFT. 

Conclusion
The mere cor is the predominated a rectal tenesmus medicine, at acute state the rectal Discomfort is only clinical main manifestation but with chronic tendency of disorder head and abdomen manifestation are seen and control by this medicine,this shows that medicine predominantly act on the rectal and its associated part of the large intestine along with whole gastrointestinal tract .   

Reference

1. Harrison T. R. Harrison’s Principles of Internal Medicine. 20 Editions.  By McGraw-Hill Education; 2018. page 259-70,2258-82,
2. Davidson Sir Stanley. Davidson Principal & Practice of medicine. 23^nd Edition. Elsevier Ltd; 2018. Page 783,786,787,813-25,
3. Dr Robert Hutchison .Hutchison’s Clinical Methods. 24^th editions. Elsevier Ltd; 2018.Page 242,243
4. E Noble Chamberlain. Chamberlain’s Symptoms and Signs in Clinical Medicine. 13th edition.  Edward Arnold (Publishers) Ltd; 2010. Page 112-14
5. Alan G Japp Colin Robertson. Maclode’s clinical diagnosis.  1^st Edition. Elsevier Ltd; 2013.page 88-93
6. H C allen.  Allen’s keynotes and characteristics with comparisons.  49^th impression. New Delhi: B Jain publishers (p) Ltd; 2018. Page no 207
7. Dr W Boericke. Boerickes new manual of homoeopathic materia medica with repertory.  41^st   impression. Delhi: B Jain publishers (p) Ltd; 2018. Page no 387-88
8. Dr John Henry Clarke. A Dictionary of Practical materia medica vol 2^nd. Reprint edition1999. New Delhi. B Jain publishers Pvt.Ltd; 1999. Page 464
9. Dr C.hering.  The guiding symptoms of our materia medica Volume VII. 12^th impression.      New Delhi: B Jain publishers (p) Ltd; 2018. Page no414
10. DR James Tyler Kent.  Lectures on homeopathic materia medica .  Reprint edition2006.  Delhi: B Jain publishers (p) Ltd;  2006.page 742-43
11. E B Nash .leaders in homoeopathic therapeutics. reprint edition 1995. Delhi: B Jain publishers (p) Ltd;  1995.page 43
12. Richard hughes. A manual of  pharmacodynamics. edition 6^th . Delhi: B Jain publishers (p) Ltd;  2016.page 658
13. Frans Vermeulen. Concordant Reference Complete Classic Materia Medica.1^st edition:2011.B Jain Archibel S.P.R.L Belgium Europe.Page 1328

Dr Puneet Kumar Misra B.Sc, BHMS
Lecturer(Practice of Medicine
Govt Pt J LN H M C  Kanpur