Acute Fissure-in-ano
1. PRELIMINARY DATA
- No.: 115/2026
- Patient's Name: JKL
- Address: No. 34, Shree Nagar, Hadapsar, Pune-411028
- Occupation: Software Engineer (Long working hours, stress and limited physical activity)
- Religion: Hindu
- Date: 27/02/2026
- Age: 35 Years
- Sex: Male
- Education: B.E. (Computer Science)
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|
| Ano | Sharp pain, tearing sensation, burning, redness and swelling | Agg. by sitting, increased pain on passing stool, relieved by warm sitting bath | Constipation, occasional diarrhea, anal itching |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Hypertension
- Family History: Diabetes
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Normal
- Desires: Sweet
- Aversions: Spicy
- Thirst: Normal
- Elimination:
- Urine: Normal
- Stool: Constipation
- Perspiration: Normal
- Sleep: Normal
- Thermal State: Ambithermal
B. Reactions - Physical Factors
- Weather: No specific reaction
- Position: Pain worsens in sitting position
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Anxiety
- Anxiety: Fear of pain and discomfort
- Fear: Fear of medical treatment
6. PHYSICAL GENERAL EXAMINATION
- Wt: 70 kg | Ht: 170 cm | Temp: 98.2°F
- RR: 16/min | Pulse: 80 bpm | B.P.: 130/80 mmHg
- Face: Pale
- Tongue: Furred
- Nails: Normal
- Skin: Dry
7. SYSTEMIC EXAMINATION
- GIT: Constipated stools, occasional diarrhea
- CVS: S1, S2 Normal. No murmurs.
- Respiratory: Clear
- Anal Exam: Fissure on posterior midline, bleeding and redness
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Anxiety and fear (Grade 2)
- Physical General: Constipation, anal itching, pain (Grade 3)
- Particular: Sharp pain, tearing sensation, burning, redness and swelling (Grade 4)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: The patient presents with a chronic condition (fissure-in-ano), which is a manifestation of a deeper imbalance in his body. The symptoms of sharp pain, tearing sensation, burning, redness and swelling point towards a condition that is not only physical but also emotional and mental. The patient's fear of pain and discomfort, and fear of medical treatment also point towards a deeper psychological issue. Therefore, a remedy that can address the physical symptoms as well as the emotional and mental aspects is required.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- [bullet list of 7–9 key symptoms]
• Sharp pain in the anus
• Tearing sensation in the anus
• Burning sensation in the anus
• Redness and swelling in the anus
• Constipation
• Occasional diarrhea
• Anal itching
11. CONVERSION INTO REPERTORIAL RUBRICS
| SR. NO. | SYMPTOMS | RUBRICS WITH SUB-RUBRICS | PAGE NO. (Kent) |
|---|
| 1 | Sharp pain in the anus | Pain, sharp, in anus; Anus, pain, sharp in | 235 |
| 2 | Tearing sensation in the anus | Tearing, sensation of, in anus; Anus, tearing sensation in | 246 |
| 3 | Burning sensation in the anus | Burning, sensation of, in anus; Anus, burning sensation in | 251 |
| 4 | Redness and swelling in the anus | Redness, in anus; Swelling, in anus; Anus, redness and swelling in | 256, 258, 259 |
12. SELECTION OF REPERTORIZATION (NUMERICAL ORDER)
| SR. NO. | REMEDIES | RUBRICS COVERED | TOTAL MARKS |
|---|
| 1 | Anacardium orientale | Pain, sharp, in anus; Tearing, sensation of, in anus | 18 |
| 2 | Chamomilla | Burning, sensation of, in anus | 10 |
| 3 | Lycopodium | Redness, in anus; Swelling, in anus | 12 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|
| [...] | [...] | [...] | [...] |
Dominant Miasm: Psora
14. FINAL STEPS
- Provisional Diagnosis: Acute Fissure-in-ano
- Differentiation of Remedies: Anacardium orientale is chosen over Chamomilla and Lycopodium because it covers more rubrics related to the patient's symptoms, and the patient's overall picture is more aligned with the Anacardium orientale remedy.
- Selection of Remedy (Materia Medica): Anacardium orientale matches the patient's symptoms of sharp pain, tearing sensation, burning sensation, redness and swelling in the anus, and the patient's overall picture of anxiety and fear. (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 30C (Acute condition, sensitive patient)
- Actual Prescription:
- Anacardium orientale 30 — 4 pills, thrice a day until relief
- Placebo — 4 pills thrice a day for 3 days
15. FOLLOW-UP'S TABLE
| DATE | COMPLAINTS | REMEDY | ADVICE |
|---|
| 28/02/2026 | Improvement in pain and discomfort | Placebo | Continue treatment for 3 days |