Introduction:

   Dr. Krishnendu Maity is an associate professor and Head of the Department of Practice of Medicine, Lal Bahadur Shastri Homoeopathic Medical College, Bhopal. He is a leading academician and clinician. He is interested in scientific studies and dedicated for research in Haemorrhoids with his more clinical out comes.

   A 63 years old male presented the following complaints
1. Bleeding from anus with protrusion of soft mass during stool and recedes after evacuation – for about 6 months < walking
2. Insufficient stool – for about 8 months
3. Dimness of vision, different colours around the light, with a sense of burning in both the eyes and watering – for about 7 days

Past History
Small pox at the age of 7 or 8 years – treated allopathically
Hepatitis A – 3 years back – treated homoeopathically
Immunization scheduled – completed
Sensitivity (Drug & Allergen) – Brinjal [causes Prickly-heat like eruptions over face, with itching].
Mile-stone – Not delayed.
Family History
Father – Died of Carcinoma Prostate

Mother – Rheumatism

Brother – Sensitive to cold (? cold allergy)

Sister – Bronchial asthma

Paternal Grand father – Died; was alcoholic

Maternal Grand mother – Died (?) CVA

Maternal Grand father – Rheumatism

Maternal Uncle – Once attempted suicide by consuming poison

Personal History
Built – Thin and tall

Complexion – Fair

Habits:
Addiction – Tobacco smoking

Physical General
Appetite – Increased

Thirst – Diminished

Sleep – Sound

Bowels – Irregular has to go twice in a day, ‘not finish’ sensation

Character of stool – hard, knotty, difficulty while passing, rectum protrudes during and recedes after stool. Burning pain and bleeding after stool

Urine – Nothing significant

Sweat – Less

Thermal reaction – Hot3; a sense of flushes in the face and ears

Desire – Sweet3, salty things3 (no extra salt)

Intolerance – Hunger, especially at the forenoon after bathing

Tongue – Clean, slightly moist, red

General Aggravation – Light

General Amelioration – Lying down

Mind General
Anxious3, restless3, forgetful3, wants to be alert, sensitive; easily becomes frightened, wants to be alone.

Physical Examination
Temperature – 100oF

Pulse – 90 / min

BP – 136 / 88 mm of Hg

Pallor – Moderately present

Systemic Examination
CVS – No abnormality

Respiratory system – No abnormality

Nervous system – No abnormality

Eye – Normal light and accommodation reflexes

Erecting totality
1. Anxious and restless

2. Wants to be alone

3. Easily becomes frightened

4. Forgetful

5. Hungry after bathing, especially forenoon

6. Desires sweet

7. Desires salty things

8. Hot patient; sense of flushes of heat in face and ears

9. Constipation

10. Burning of anus after stool

11. Bleeding from anus after stool

12. Dimness of vision

13. Watering from eyes, with burning

14. A sense of different colours around light

15. Haemorrhoid protrudes during stool

16. Haemorrhoid < walking

17. < Light.

18. > Lying down

Repertorial Result
1. SULPHUR – 47/20 [Sulph. doesnot cover the symptom ‘Hæmorrhoid protrudes during stool’]
2. PHOSPHORUS – 35/17
3. PHOSPHORIC ACID – 19/11

Analysis of reportorial result
From the study of the whole case and reference to the Materia Medica – SULPHUR covers the most of the features. According to the Potential Differentiating Field (PDF), SULPHUR ranks highest.

Cross-repertorization from roberts’ ‘sensations as if’ :
1. The rubric ‘Halo about light’ in Roberts’ Sensations as if ——’ is covered by SULPHUR [chapter Eyes & Vision]
2. The rubric ‘Sensation as if – Burning’ in Roberts’ ‘Sensations as if ——’ is advised to see the GENERAL

REPERTORIES [chapter Generals].
3. The rubric ‘Heat were streaming out of ears’ in Roberts’ ‘Sensations as if ——’ is covered by SULPHUR [chapter Ears & Hearing].

First prescription                     05.02.2009
R/x
Sulphur 200 / 1 dose in Sac lac in the early morning in empty stomach
Followed by Placebo for 15 days
Advised Ophthalmoscopic examination for refractory errors

Follow Up -1                              22.02.2009
· Stool softer, but irregular ’ 25% improvement
· Lachrymation > ’ 50% improvement
· Burning of eyes > ’ 50% improvement
· Burning of anus & bleeding slightly > ’ 25% improvement
· Refractory error (Report): Rt. eye + 2.5D and Lt. eye + 2.75D
R/x
Placebo for 30 days

Follow Up -2                              27.03.2009
Overall 60% improvement
R/x
Placebo for 30 days

Follow Up -3                             12.04.2009
Bleeding P/R started after stool for last 2 days slight burning
R/x
Sulphur 200 / 1 dose repeated
Followed by Placebo for 7 days.

Follow Up -4                              20.04.2009
Bleeding and burning
R/x
Placebo for 15 days.

Follow Up -5                              7.05.2009
No such complaints. Placebo for 15 days.

Conclusion
After taking the case, as there were prominent mental, physical and particular symptoms, I had chosen the Kent’s Repertory for the repertorization. In the case there were some ‘sensations’ and I had decided to cross-repertorize the rubrics of sensations by Dr. Herbert Alfred Roberts’ ‘Sensations as if ——’.
The result from Kent’s Repertory was SULPHUR and the result of cross-repertorization did not differ. This also signifies that the regional / clinical repertories are as useful as the general repertories.