Fissure-in-ano
1. PRELIMINARY DATA
- No.: 229/2026
- Patient's Name: GHI
- Address: Row House 27, Lotus Grove, Pune.
- Occupation: Homemaker (prolonged sitting during household work, constipation history)
- Religion: Hindu
- Date: 20/07/2026
- Age: 45 Years
- Sex: Female
- Education: B.A.
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|
| Anus & Rectum | Acute burning/stinging pain during & after stool, bright red blood on tissue/paper, fissure tear at posterior midline | < Straining/hard stool, < Spicy food, < After stool (pain lasts 1-2 hours), > Warm sitz bath, > Cold applications, since 6 years (recurrent, worse last 2 years with chronic constipation) | Spasm of sphincter, itching, irritability, anxiety about bowel movement |
| General | Abdominal discomfort | < Constipation | Low mood, fear of recurrence |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Chronic constipation since childbirth; recurrent fissures treated with ointments & sitz baths; suppressed piles with suppositories; frequent laxative use; suppressed skin dryness with creams.
- Family History: Mother has chronic constipation & fissure. Sister has haemorrhoids. Father has diabetes.
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Normal
- Desires: Warm drinks (+++), Spicy food (+)
- Aversions: Cold food
- Thirst: Moderate
- Elimination:
- Urine: Normal
- Stool: Hard, dry, with blood
- Perspiration: Scanty
- Sleep: Disturbed by pain; wakes anxious
- Thermal State: Chilly patient (prefers warm clothing)
B. Reactions - Physical Factors
- Weather: Aggravation in cold weather
- Position: Better lying on side
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Irritable, anxious, perfectionist
- Anxiety: About pain during defecation, family duties
- Fear: Fear of chronic illness, fear surgery
- Dreams: Pain, bleeding, being stuck
- Other: Suppressed worry, feels helpless
6. PHYSICAL GENERAL EXAMINATION
- Wt: 70 kg | Ht: 155 cm | Temp: 98.6°F
- RR: 18/min | Pulse: 80 bpm | B.P.: 130/82 mmHg
- Face: Tense
- Tongue: Clean
- Nails: Normal
- Skin: Dry
7. SYSTEMIC EXAMINATION
- Rectum/Anus: Posterior midline fissure, sentinel pile, sphincter spasm, bright red bleeding on examination
- GIT: Abdomen soft, hard stool palpable
- CVS: S1, S2 Normal
- Respiratory: Clear
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Irritability, anxiety about pain/health, fear surgery (Grade 3)
- Physical General: Chilly, desire warm drinks, hard dry stool with bleeding (Grade 3)
- Particular: Chronic anal fissure with burning pain during/after stool, bright red blood, < straining/spicy, > warm bath/cold (Grade 2)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: Chronic anal fissure with strong Mental Generals (irritability, anxiety) and Physical Generals (thermal, stool character) dominating; Kent suits rectum rubrics for fissure/piles.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- Irritability and anxiety
- Fear surgery/illness
- Desire warm drinks
- Chilly patient
- Stool hard dry with blood
- Anal burning/stinging pain
- Bright red bleeding
- < Straining, after stool
-
Warm sitz bath, cold applications
- Chronic constipation history
- Family fissure history
11. CONVERSION INTO REPERTORIAL RUBRICS
| SR. NO. | SYMPTOMS | RUBRICS WITH SUB-RUBRICS | PAGE NO. (Kent) |
|---|
| 1 | Irritability | Mind; IRRITABILITY | 57 |
| 2 | Anxiety health | Mind; ANXIETY; health, about | 6 |
| 3 | Desire warm drinks | Stomach; DESIRES; warm drinks | 486 |
| 4 | Rectum fissure | Rectum; FISSURE | 618 |
| 5 | Rectum pain burning | Rectum; PAIN; burning | 625 |
| 6 | Rectum bleeding bright red | Rectum; HAEMORRHOIDS; bleeding; bright red | 619 |
| 7 | Chilly | Generalities; COLD; agg. | 1348 |
12. SELECTION OF REPERTORIZATION (NUMERICAL ORDER)
| SR. NO. | REMEDIES | RUBRICS COVERED | TOTAL MARKS |
|---|
| 1 | Nitric Acid | 7/7 | 22 |
| 2 | Graphites | 6/7 | 18 |
| 3 | Ratanhia | 5/7 | 15 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|
| Burning pain, irritability, chilly | Fissure, chronic constipation | Family rectal issues | Destructive fear surgery |
Dominant Miasm: Psora-Syphilitic
14. FINAL STEPS
- Provisional Diagnosis: Chronic Fissure-in-ano
- Differentiation of Remedies: Compared Nitric Acid with Graphites. Graphites has more honey-like discharge, chilly; Nitric Acid matches chronic fissure with burning/stinging pain, bright red bleeding, splinter-like sensation, < after stool, chilly, anxiety/fear illness. Ratanhia more for burning > cold water.
- Selection of Remedy (Materia Medica): Nitric Acid matches chronic fissure-in-ano with burning/stinging pain during/after stool, bright red bleeding, splinter sensation, chilly patient, anxiety about health (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 200C (Chronic rectal miasmatic case, sensitive constitution)
- Actual Prescription:
- Nitric Acid 200 — single dose (one dose only, wait & watch)
- Placebo — 4 pills twice a day for 8 weeks
15. FOLLOW-UP'S TABLE
| DATE | COMPLAINTS | REMEDY | ADVICE |
|---|
| 20/08/2026 | Pain reduced 70%, bleeding minimal, stool softer | Placebo | High fiber diet, sitz bath twice daily, avoid straining |
| 20/12/2026 | Fissure healed, no bleeding/pain, regular bowel | Placebo | Maintain hydration/fiber, report recurrence |