This affection is probably as old as mankind and is often mentioned in the Bible.
The name is derived from the Greek aipoppoises, its chief symptom being a flow of blood. Other names are Haimorosis, Proctalgia haemorrhoidalis, Morbus Haemorrhoidalis, piles, Emerods.
Ancient peoples regarded affections of the genitals and anus as divine punishments, thus. “The Lord will smite thee with the emerods” (Deut. xxviii. 27). But it is clear that many different diseases are meant under the name emerods, or haemorrhoids, such as tumours, the morbus ficarius and the endless ills of the pathici (Hippocrates; Aristotle; Rosenbaum’s Geschichte der Lustseuche)
The piles do not usually get well of themselves.
Heart affections imperfect aeration of the blood; liver affections; congestions in the portal system of veins enlarged spleen; abdominal tumours; great accumulation of fat in the omentum, or of faeces in the intestines; in fact anything that disturbs the reflux of blood to the right heart vena cava inferior vena portae tends to hypostatic hyperaemia of th haemorrhoidal veins. The successful treatment of piles involves an accurate appreciation of the topography and of the anatomical relations from the midriff to the pelvic outlet as first ground work and then a consideration of the etiology of each case.
I cannot enter upon such an interminable path in this little tract as I merely put in a plea for the exclusively medicinal treatment of dilated veins by what name soever they may be nosologically baptized. The bulk of my own knowledge on the subject has already been given and I now being together from various sources the remedies most frequently called for together with, more less accepted indications for the same.
REMEDIES FOUND USEFUL IN THE TREATMENT OF DILATED VEINS PARTICULARLY OF Haemorrhoids.
Besides Gilchrist, Hughes, Hale, and Lilienthal, I have culled from a very able article on this subject in the Transactions of the Homoeopathic Medical Society of the State Pennsylvania, vol. II. The authors are the Alleghany Country Homoeopathic Medical Society, and the names of the special contributors are Drs Childs, Martin, Caruthers, and Edmundson, the last-named of whom says… “For the latest and most successful remedies used by the old school for the treatment of haemorrhoids, we refer you to Naphey’s `Therapeutics,’ where a very full and complete resume will be found; many of them you will recognise as well-known homoeopathic remedies.” Well, we had already previously gone to Naphey’s “Modern Medical Therapeutics,”sixth edition, 1879, but did not find anything of the kind, and on again hunting therein we do not find ever the words piles, haemorrhoids, varices, varicosis, or varicocele, anywhere. So, Probably, there must be another Naphey’s Therapeutics.
ACONITUM NAPELLUS.-When a febrile movement accompanies the piles, with dry skin and cephalic congestion. It is not often called for in practice in this affection, but in plethoric subjects in whom there is determination of blood to the head, a prompt use of this remedy may avert apoplexy. When this is done, see to your patient’s diet.
ACIDUM ACETICUM.- Profuse haemorrhoidal bleeding; haemorrhage from bowels after checked metrorrhagia; constipation malignant disease of rectum.
AESCULUS GLABRA.- The greater pathogenic power of this remedy should lead us to think of it especially when there is a paretic state of the legs and the cauda equina is disordered. Carrying the nut on the person is said to cure piles but I will not vouch for it.
AESCULUS HIPPOCASTANUM.- Dr Hale is of opinion that the central point of action of this drug lies in the liver and portal system. It is decidedly one of our most powerful remedies for piles and constipation. My own notion of its applicability points to those cases in which there are liver, portal, rectal, and spinal indications for its use. Hale says the absence of actual constipation differentiates between this and other pile remedies: to this I cannot assent my own pretty extensive experience with it leads me to say with Dr. Hughes that it is indicated in constipation, and that very strongly. That it is a great rectal remedy is undoubted. Dr. Hart’s special indication for it is throbbing in the abdominal and pelvic cavities. Lilienthal puts the following symptoms thus: DULL BACK-ACHE, PURPLE HAEMORRHOIDS. Sensation as if sticks splinters, gravel were in the rectum are said to be characteristic of it.
ALOES.- protruding piles, with constant bearing down sensation and prolapse of the bowel; paralysis of the sphincter ani.
Aloes stood of old in evil repute in haemorrhoidal affections; thus in Nathanael Sforzia’s NEUES ARTZNEYBUCH (Basel, 1684) we read, p.34 Alle purgierende Sachen, son-derlich von ALOE, alle gesalzenen and gewurtzten Sachen seynd schadlich (in piles). So that with our law to lead we know how to use Aloes.
How is it Sforzia was so enlightened? He was in his day heterodox! ALUMINA.- Haemorrhoids worse in the evening; better nights rest; clots of blood pass from anus; stools hard and knotty like sheep’s dung.
AMBRA GRISEA.- Itching smarting and stinging at the anus; increased secretion of urine, much more than the fluid drunk. Worse in the evening also when lying in a warm place, and on awakening Better from slow motion in the open air and when lying or pressing upon the painful part. Presence of cholesterine in the faeces.
AMMONIUM CARB.- HAEMORRHOIDS PROTRUDE INDEPENDENT OF STOOL.
AMMONIUM MUR.-Haemorrhoids sore and smarting after suppressed whites; hard, crumbling stools, requiring great effort to expel them; bleeding from the rectum, with lancinating pains in perinaeum, especially evenings; stinging and itching in rectum before and during a stool; the piles surrounded by inflamed pustules.
ANACARDIUM.-Lilienthal says; Internal piles, especially if fissured; painful haemorrhoidal tumours; frequent profuse haemorrhage when at stool; great and urgent desire for stool, great and urgent desire for stool, but the rectum seems powerless, with sensation as if plugged up; great hypochondriasis.
ANTIMONIUM CRUDUM.-Copious haemorrhoidal haemorrhage accompanying a stool of solid faecal matter; MUCOUS PILES; pricking burning; continuous mucous discharge, staining yellow; sometimes oozing away of an ichorous discharge; feeling of soreness in the rectum as if an ulcer had been torn open.
APIS.-When there is much burning and excessive oedema of the parts.
ARNICA MONTANA.-Blind haemorrhoids, with painful pressure in rectum, constipation and tenesmus; worse when standing and from cold things. In prolapse from over-straining at stool and from violent riding.
ARSENICUM ALBUM.-Haemorrhoids with stitching pain when walking or standing, not when at stool, with burning pain; burning and soreness in rectum and anus; rectum is pushed out spasmodically with great pain, and remains protruded after haemorrhage from rectum, BURNING IN ALL THE VEINS, restlessness and great debility, worse at night and from cold, better from warmth; HAEMORRHOIDS OF DRUNKARDS.
AURUM.-My own use of this polychrest in piles has been confined to syphilitic subjects aggravated by mercurial symptoms. I should consider it especially called for in the aged and in pining youthful subjects.
BADIAGA.-I have put down the river-sponge as an anti- haemorrhoidal remedy, because Hering says it is useful in the complaints of adults who had manifestations of scrofula in their youth, and because it has a reputation in Russia for the cure of piles. Now there is a class of persons who are strumous and haemorrhoidal, and hence it may be worth remembering, especially when the lung or heart symptoms of Badiaga are present.
BELLADONNA.-Bleeding piles; spasmodic constriction of sphincter ani; if it would break; piles so sensitive that the patient has to lie with the nates separated; scanty red urine; congestion of blood to head; red, hot face; thirst and restlessness.
BERBERIS VULGARIS.-Haemorrhoids with itching and burning, particularly after stool, which is often hard and covered with blood; soreness in the anus, with burning pain when touched, and great sensitiveness when sitting; hard stool like sheep’s dung, passed only after much straining; constant pulsating stitches in sacrum; fretful and weary of life.
BRYONIA ALBA.-Hard, tough stool, with protrusion of the rectum; long-lasting burning in the rectum after hard stool; sharp burning pain in the rectum with soft stool; white and turbid urine; sensation of constriction in the urethra when urinating. Worse in the morning, also from motion and from heat.
Better while lying down, or on getting warm in bed.
CACTUS GRAND.-Constipation as from haemorrhoidal congestion; swollen varices outside the anus, causing great pain; itching of anus, pricking in the anus, as from sharp pins, ceasing from slight friction; copious haemorrhage from anus, which soon ceases.
CALCAREA CARBONICA.-Haemorrhoids protruding, painful when walking, better which sitting, causing pain during stool; great irritability of the anus, even a loose stool is painful; frequent and copious bleeding of the piles, or for suppression of habitual bleeding (after sulphur). Perspires a good deal in the head, especially at night. The Calcarea subject is light haired.
CAPSICUM.-Piles having swollen; itching, throbbing, with sore feeling in anus; the tumours are very large, with discharge of blood or bloody mucus from the rectum; blind piles with mucous discharge; suppressed haemorrhoidal flow, causing melancholy; lack of reactive force, especially with fat people who are easily exhausted.
CARBO VEG.-Discharge of an acrid, corrosive, viscid humor from the anus, causing much itching and some smarting; oozing of moisture from the perinaeum, with soreness and much itching; protruding large bluish varices, suppurating and offensive, with burning pains in the anus, stitching pains in the small of the back, burning and tearing in the limbs; constipation, with burning stools and discharge of blood; frequent determination of blood to the head, flatulence, slow action of the bowels; epistaxis; dysuria; especially called for in debauched, used-up subjects and in profound adynamia.
CHAMOMILLA.-Bleeding piles, with compressive pain in the abdomen, frequent urging to stool; occasional burning and corrosive diarrhoeic stools; tearing pain in the small of the back, especially at night; painful and ulcerated rhagades of the anus.
COLLINSONIA CANADENSIS.-Dr Hale believes that this remedy has the power of contracting the branches of the portal vein- indeed, he inclines to believe that it has this action on all the blood vessels and even on the heart. It is common use in America as a vulnerary. It claims a careful study and comes into very frequent use in general varicosis, and any of its varieties, such as haemorrhoids, varices, or varicocele. And if Hale’s view of its action is right those cases of dilated right heart, passive portal congestion with haemorrhoids, would be its triune sphere, and here by there is always constipation and the cases are chronic and obstinate.
DIOSCOREA VILLOSA.- Dr Burt got haemorrhoids and yellow thin, bilious stools with prolapse of the rectum when he was proving the colic root. In another a haemorrhoidal tumour of nearly four years standing disappeared while proving it. Its reputation in enteralgia is now well established. Acute painful varicocele from excess in venery, or long-lasting unsatisfied desire will make us think of Dioscorea or Dioscorein. Dioscorea is a powerful cardiac, and has cured a case of angina pectoris in the hands of Dr Skinner.
FERRUM.- Piles copious bleeding or ichorous oozing tearing pains with itching and gnawing costiveness, stool hard and difficult, followed by backache. We heartily, endorse Schussler’s recommendation of the phosphate, and that in the sixth centesimal trituration, but very irritable subjects must not take it at night, as it is very apt to keep such awake. It comes in specially after their work to consolidate the cure by reason of its profound action on the whole systemic circulatory apparatus.
GRAPHITES.- Piles with pain on sitting down or on taking a wide step, as if split with knife also violent itching and very sore to the touch burning rhagades at the anus; large haemorrhoidal tumour, protrusion of the rectum, without urging to stool as if the anus was lame; fissure of the anus, sharp cutting pain during, followed by constriction and aching aching for several hours, worse at night chronic constipation with hardness in hepatic region moist humid eruption on scalp and behind ears; watery leucorrhoea at the times of menstruation piles, accompanied by dizziness.
HAMAMELIS VIRGINICA.- The use of this remedy is somewhat empirical, but its power over haemorrhoids and other venous sticlis such that it stands facile princeps at the head of them all. The stasis its introduction into our practice is thus given: Mr. Pond brought out his Extract of Hamamelis as a remedy for piles. Dr Constantine Hering was Mr. Pond’s family physician and was induced by the latter to try its efficacy in some diseases, particularly in painful bleeding piles. But its virtues as a pile medicine were well known to the aborigines of North America and the earlier settlers got their knowledge of it from them. Speaking of it in a letter to Hering in 1853, Dr Okie says: “I next made use of Hamamelis in a number of cases of painful and bleeding piles. Those cases in which it has proved most beneficial in my hands are characterized by running soreness, fullness, and at times rawness of th anus; in the back a weakness or weariness, or or as the patients graphically express it “Doctor, my back feels as if it would break off.'”
It is our best topic in all forms of dilated veins. Almost all Americans en voyage seem to carry Extract of Hamamelis with them.
HYDRASTIS.- This plants has a reputation for many things. Undoubtedly it is a great polychrest. I should think of it for haemorrhoids with jaundice and constipation some other Hydrastis symptoms being present. I have known it cause balanitis and yellow balanorrhoea, with such a strong-smelling discharge that the unintentional prover had to keep away from society for several days, and so profuse that he fastened a piece of linen of his shirt to help to absorb the discharge and nevertheless his trousers were spoiled by the flux. The discharge was very yellow and after it has lasted three days there was phimosis, and on my forcing the prepuce back it cracked in three places and bled. There had previously been nothing whatever wrong with the parts, and from my knowledge of the gentleman and a very careful ocular examination of the parts, I can say that there was no urethritis or urethral flux, and no chance or chancroid, and there had been no coition of any kind at this time. At the eight of the affection one of the inguinal glands became painful and swelled; it all passed off in a week with no treatment but cleanliness. He had taken it about a week, some six or eight very yellow pilules a day, evidently or 1, and ” for a stitch in the liver and dirty tongue” To the best of my know ledge and belief the whole series of phenomena were pathogenetic
IGNATIA AMARA.- SUDDEN SHARP STITCHES IN RECTUM SHOOTING UPWARD INTO THE BODY; evacuation of faeces difficult because of seeming inactivity of rectum every violent effort to expel them may produce prolapsus ani; after stool frequent spasmodic constriction of the anus; recurring pains in the anus, compounded of soreness, spasmodic constriction, and pressure moderate effort at stool causes prolapsus ani; bleeding during and after stool; fissures of anus; haemorrhage and pain are worse when the stools are loose.
KALI CARBONICUM.- Passage of faeces difficult owing to their bulk; sensation as if the anus would be fissured; stinging, burning tearing, itching stinging, burning tearing, itching screwing pain, followed even a natural stool, setting the patient nearly crazy and depriving him of sleep; the tumours swell and bleed much; riding on horseback ameliorates the pain for the time being haemorrhoids complicating fistula in ano, especially in the poitrinaires.
KALI SULPHURICUM.- Haemorrhoids with catarrh of stomach, and tongue coated with yellow mucus; sensation of faintness in the stomach, and dull feeling in the head fearing to lose her senses.
LACHESIS.- Piles PROTRUDING AND STRANGULATED, or with stitches upward at each cough or sneeze; sensation as of a plug in the anus; rectum prolapsed or tumefied hammering, beating in the rectum; worse at the climaxis, or with drunkards.
LYCOPODIUM CLAVATUM.- Varices protrude, painful when sitting; discharge of blood even with soft stool itching eruption at the anus painful to touch; itching and tension at the anus in bed continued or stitching pain in the rectum; constipation; ineffectual urging from the contraction of the sphincter ani; flatulence haematuria; pain in the sacral region, extending to the thighs worse rising from a seat. Lycopodium has undoubtedly cured aneurisms of small calibre; it lessened one in my hands while I was House-Surgeon at the Hardman St. Homoeopathic Dispensary, in Liverpool. Hence its power over blood vessels must be admitted.
MERCURIUS.- LARGE BLEEDING VARICES WHICH SUPPURATE; haemorrhage after micturition; haematuria; with violent frequent urging to urinate; prolapsus recti after stool; rectum black and bleeding; pain in sacrum as after lying on a hard cough great weakness, with ebullition and trembling from the least exertion.
CYANURET OF MERCURY.- I have used this remedy in diphtheria with very satisfactory results, and hence it constitutes a part of my usual drug choice. The enormous activity of all the combinations of the metals with hydrocyanic acid leads us naturally to expect great things from the Cyanide of Mercury. It causes phlebitis and varicosis it has a grand future. The sixth centesimal dilution is the lowest I ever use of this deadly drug in this strength it may be given to the tenderest babies.
German homoeopathic practitioners speak highly of Acidum hydrocyanicum in varicose ulcers.
MURIATIC ACID.- piles suddenly, IN CHILDREN; the haemorrhoidal tumours are inflamed, swollen bluish with swelling of anal region sore pains violent stitches and great sensitiveness to contact even of the sheets; prolapsus recti while urinating.
NITRIC ACID.- Long lasting cutting pain in rectum after loose stool, with haemorrhoidal troubles old pendulous haemorrhoids, that cease to bleed but become painful to the touch, especially i warm weather; HAEMORRHAGE BRIGHT RED NOT CLOTTED, faint from least motion, bleed after every stool spasmodic tearing during stool from fissures in rectum HAEMATURIA, shuddering along the spine during micturition, and urging afterwards.
NUX VOMICA.- Blind or bleeding piles, irregular piles; stitching, burning or itching of the anus; stitches and shocks in the small of the back, with bruised pains so that the patient is unable to raise himself; constipation with frequent ineffectual as if the anus were closed and constricted; frequent rush of blood to the head or abdomen, with distension of the epigastrium and hypochondria; haematuria from suppressed haemorrhoidal flow or menses; ischuria, suppression of urine backache, must sit up in bed.
PETROLEUM.- piles and fissures at the anus great itching; scurf on border of anus; stool insufficient difficult hard, in lumps.
PHOSPHORUS.- Constipation small-shaped hard stool, and expelled with great difficulty; discharges of blood from the rectum also during stool; spasm in the rectum; paralysis of the lower intestines and of the sphincter ani; discharge of mucus out of the gaping anus; stinging or itching at the anus the piles bleed easily increased secretion of pale watery urine; involuntary discharge of urine. Worse in the evening and at night, also when lying on the back or left side. Better when lying on the right side from rubbing and after sleeping.
PODOPHYLLUM.- This is a remedy that I myself, have used but very little, for the very good reason that of late years a veritable podophyllomania has raged in this country and almost all patient with anything wrong between liver and rectum have taken it on their own account. This regrettable abuse of a potent remedy must not deter us from bearing it is mind in suitable cases. Hale says: “Haemorrhoidal affections are admirably under the control of podophyllum. The specific affinity which this drug has for the liver, portal system and rectum as shown in the pathogenesis enables it to cause haemorrhoids from portal congestion, chronic hepatic affections, and primary irritation, congestion and even inflammation of the veins and mucous membrane of the rectum. It will be found useful in external piles, for those which bleed and those which do not. The sensations it causes in the rectum, anus and haemorrhoidal tumours and similar to the effects of Aloes of which it is a congener.”
Morning aggravation is characteristic of podophyllum PULSATILLA NIGRICANS.- Painful protruding piles, with itching and sticking pains and soreness.
RHUS TOX.- Fissures of the anus, with periodical profuse bleeding from the anus; sore piles protruding after stool drawing above drawing in the back from above downwards pains in the small of the back as if bruised when keeping quiet frequent urging to urinate day and night increased secretion sore blind haemorrhoids, protruding after stool with pressing in the rectum, as if everything would come out. Worse at night, from cold pressure or rest.
SILICEA.- HAEMORRHOIDS IN TENSELY PAINFUL, boring cramping sensation from the anus up the rectum and towards the testicles protrude during stool; become incarcerated. and suppurate; piles protrude with the stool and discharge bloody mucus can only be returned with difficulty; fistula at anus, with chest symptoms, aching, beating throbbing in lumbo-sacral region: anus is constantly damp.
SULPHUR.- Haemorrhoids blind or bleeding, blood dark with violent bearing down from small of back towards the anus; lancinating pain from anus upwards, especially after stool; suppressed haemorrhoids, with colic palpitation congestion of lungs; back feels stiff as if bruised; anal region swollen with sore, stitching pains; considerable quantity of blood passed with soft easy stool; PAINLESS PILES bleeding burning, and frequent protrusion of the haemorrhoidal tumours; weak digestion dysuria.
VALERIANATE OF ZINC.- Dr Dradwick noticed the fact that in a considerable number of patients troubled with piles and who were taking Valerianate of Zinc for other troubles, the haemorrhoids have, with few exceptions been relieved. In case of neuralgia prosopalgia, spinal neuralgia and proctalgia, together with haemorrhoids, we may be glad to remember this happy union of valerian and zinc.