Haemorrhoids is also called as Piles which makes our lifestyle measurable due to its unwanted location, pain, itching and foul discharges. PR-examination by surgeons in cases of haemorrhoids is very common which creates big harassment for both males and females. Also, surgical option has its bad impact on mind. Even after best surgical treatment, haemorrhoids may relapse where patients felt abusing physically mentally and economically. So, to overcome these factors treatment of haemorrhoids by homoeopathy with special emphasis on Nux vomica is put forwarded for the benefit of society. As far as Posology is concerned it is nothing but the doctrine of doses of medicine [1]. When we consider posology, the main focus automatically comes on DOSE or POTENCY. This terminology of ‘dose’ derived from the word ‘dosis’ which means the quantity of a drug or other therapeutic agent to be taken or applied all at a time or in fractional amounts within a stated period. In allopathy ‘dose’ means so many drops by measure or so many grains by weight enough to produce the direct, positive, or physiological effect and not enough to endanger the patient. Allopath relates the word ‘dose’ to the material quantity of the medicine used. As far as Homoeopathic doses are concerned the homoeopathic ‘dose’ of anything means an infinitesimal dose where at first the ‘dose’ is related to the particular preparation of medicine used. Secondly the ‘dose’ is related to the quantity of that preparation and the form of that preparation. Finally, the ‘dose’ is related to the number of administrations of the medicine e.g. repetition of dose or potency [2].

Today’s life has become very fast. People are working and living under stressful conditions. Eating habits and bowel habits are considerably disturbed now a day. No proper attention is given on diet. Recent trend of having or consuming fatty and junk food, frequent hoteling with consumption of liquor, spicy and oily food, late night Parties/Get together with alcohol consumption and improper eating hobbits leads to adverse effect on health of person. Whatever man eats in his day-to-day life, at first G.I.T. gets affected in most of the people [3]. In recent days, there is huge population who gets affected by Ano-rectal disorders such as Haemorrhoids, fissure, fistula etc. Among this Haemorrhoids is very common in both males and females. As per the data available in National and worldwide databank, such as the Databases searched MEDLINE, pre-MEDLINE, the Cochrane Database of Systematic   Reviews,  meta-analysis and the Cochrane Database of Registry of Controlled Trials along with literature available on WHO / CCRH web sites and ICMR literature in relation to haemorrhoids and its treatment it has been found that about half of population will have haemorrhoids by the age of 50 [4]. Haemorrhoid affects about 4.4 to 5 % people amongst world population. Approximately 1 in 20 people will get haemorrhoids at some point of life. The prevalence of Haemorrhoids is extremely high in western countries and other industrialized societies with millions affected worldwide. However, the burden of disease is difficult to capture as many patients are reluctant to seek medical suggestions for various personal, cultural and socio-economic reasons [5]. The prevalence of Haemorrhoid in India according to recent survey is around 40 million. The Risk factors commonly associated with haemorrhoidal disease include low fibre diet, chronic constipation and diarrhoea, straining during defecation, pregnancy, sedentary lifestyle, obesity, aging, stress, disturbed daily routine, wrong food habits such as spicy-junk-fatty food with alcohol intake etc. In Ano-rectal disorders, piles/ haemorrhoids is very common which most of the time makes life miserable due to bleeding, pain, soreness and discharges etc [6]. Now a day so many established modes of treatments are available for haemorrhoids which includes Banding and sclerotherapy for First-, Second- and Third-degree haemorrhoids. Fourth degree haemorrhoid with bleeding may need surgical intervention as per modern method of treatment but no perfect cure has been achieved yet [7]. So many cases have been reported relapsing of disease worldwide as per the systematic review and meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids published in 30 september2015 in British journal of surgery and hence fail to achieve an ideal cure. And lastly one cannot omit to mention the psychological aspect of the anorectal disorders along with haemorrhoids such as constant worries which generates mental tension. So many references (www.preparationh.com) suggest that as far as the physical aspect of haemorrhoids is concerned, the emotional aspect can even prove more distressing for almost every person suffering from haemorrhoids where the feeling of embarrassment, isolation and shame will demoralise them as a result of their condition [8].

Haemorrhoids mostly occur at 3 points around circumference of anus@ 3, 7 and 11 O’clock with patients in lithotomy position. This distribution has been ascribed to the arterial supply of the anus whereby there are two sub divisions of the right branch of the superior rectal artery, but the left branch remains single. In between these 3 primary haemorrhoids there may be a smaller secondary haemorrhoids [9]. 

Mostly, 3 types of Haemorrhoids are seen according to its intensity

• 1st Degree Haemorrhoids: - Never appear at the anus. Bleeding at the end of defecation is only symptom.

• 2nd Degree Haemorrhoids: - Protruding swelling at anal region but returns spontaneously. 

• 3rd Degree Haemorrhoids: - Protruding swelling out of anal region and need to be returned by pressure. 3rd degree haemorrhoids with fissure and bleeding may need surgical treatment.

• 4th degree Haemorrhoids are permanently prolapsed with great discomfort, bleeding and heaviness in rectum. Such haemorrhoids offen needs surgical intervention.

Clinical Features: Pain, Prolapse, Pruritus, Discharges, Discomfort, Bleeding related to anal region and alternate bowel habit [10].

It has been observed that emotionally unstable neurotic people have extremely high incidences of trouble in this region-( as per the study conducted on Type–D Personality on 106 OPD patients along with 96 healthy controls by Mustafa sit MD, Dept. of General surgery, Turkey in Przeglad Gastrornterologiczny) [11]. In view of the prevalence and the discomfort at mind and body level, Homoeopathy can provide a smooth and convenient mode of treatment in cases of Haemorrhoids without using any kind of external application as Dr. Samuel Hahnemann in his sixth edition of Organon of Medicine had guided against the use of external application for diseases caused due to dynamic cause [12]. Treatment on haemorrhoids is based on Individualization which is done by detailed case taking by noting Characteristic symptoms along with general, mental and concomitant symptoms. Homoeopathy not only treats the presenting complaints but also treats the person as a whole as well as to address the underlying cause and Individual susceptibility of the patient [13].

So, in view of above literature and the effects different potencies of Nux Vomica in haemorrhoids, it has been noted that Posological variations of remedy (Single drug in different potencies) proved exceptionally beneficial in certain potency which can be dispense easily to the people with an expert opinion of homoeopathic physician to the benefit of society. Nux vomica have a great role in this disease to reduce pain and discomfort associated with haemorrhoids. Complimentary medication may require to manage the disease without side effects. Nux vomica is a polychrest remedy having its action on almost every part of body with special affinity for GIT disturbances [14]. It has been observed that most of the symptoms of haemorrhoids are present in Nux vomica which indicate its importance in the treatment of haemorrhoids. Again, it is interestingly proved that all symptoms of haemorrhoids portrait a picture of PSORA and Nux vomica also have psora in the background, so it will be the most powerful and effective remedy for haemorrhoidal cases [15].

Homoeopathic management is also beneficial with other rare medication such as Sedum Acre, Neguindum Americanum, Paeonia Officinalis, Blumea Odorata, Kalium Carbonicum, Luffa Bindal, Chromicum acidum, Gratiola officinalis, Leptandra virginica, Lemium Album, Paraffinum, Polygonum Punctatum, Pinus Sylvestris, Scrophularia Nodosa, Wyethia helenoides, Yohimbinum, Muriaticum Acidum, Ammonium muriaticum, etc [16].

1. Loder P.B. Forn et al. “Haemorrhoids: pathology, pathophysiology and aetiology.” British Journal of Surgery, vol. 81, 1994, pp. 946–954.

2. Morgado P.J. Forn et al. “Histoclinical Basis for a new classification of hemorrhoidal disease.” Diseases of the Colon and Rectum, vol. 31, 1988, pp. 474–480.

3. Aigner F. Forn et al. “Revised morphology and hemodynamic of the anorectal vascular plexus: impact on the course of hemorrhoidal disease.” International Journal of Colorectal Disease, vol. 24, 2009, pp. 105–113.

4. Chung Y.C., Hou Y.C. and Pan A.C. “Endoglin (CD105) expression in the development of haemorrhoids.” European Journal of Clinical Investigation, vol. 34, 2004, pp. 107–112.

5. Goenka M.K. Forn et al. “Rectosigmoid Varices and Other Mucosal Changes in Patients with Portal Hypertension.” American Journal of Gastroenterology, vol. 86, 1991, pp. 1185–1189.

6. Thomson W.H. “The Nature of Haemorrhoids.” British Journal of Surgery, vol. 62, 1975, pp. 542–552.

7. Thomson W.H. “The Nature and cause of Haemorrhoids.” Proceedings of the Royal Society of Medicine, vol. 68, 1975, pp. 574–575.

8. Han W. Forn et al. “Pathologic change of elastic fibres with difference of micro vessel density and expression of angiogenesis-related proteins in internal haemorrhoid tissues.” Zhonghua Weichang Waike Zazhi, vol. 8, 2005, pp. 56–59.

9. Yoon S.O. Forn et al. “Roles of matrix metalloproteinases in tumour metastasis and angiogenesis.” Journal of Biochemistry and Molecular Biology, vol. 36, 2003, pp. 128–137.

10. Aigner F. Forn et al. “The vascular nature of Haemorrhoids.” Journal of Gastrointestinal Surgery, vol. 10, 2006, pp. 1044–1050.

11. Stankevicius E. Forn et al. “Role of nitric oxide and other endothelium-derived factors.” Medicina (Kaunas), vol. 39, 2003, pp. 333–341.

12. Sun W.M. Forn et al. “Haemorrhoids are associated not with hypertrophy of the internal anal sphincter, but with hypertension of the anal cushions.” British Journal of Surgery, vol. 79, 1992, pp. 592–594.

13. Ho Y.H., Seow-Choen F. and Goh H.S. “Haemorrhoidectomy and disordered rectal and anal physiology in patients with prolapsed Haemorrhoids”.

14. Murphy, Robin. Lotus Materia Medica. 2nd rev. ed., New Delhi, B. Jain Publishers (P) Ltd, 2006.

15. Clarke, J.H. “A Dictionary of Homoeopathic Medicines”. 3rd ed., vol. 3, New Delhi, B. Jain (P) Ltd, 2005.

16. Lohsiriwat, V. “Haemorrhoids: From Basic Pathophysiology to Clinical Management.” World Journal of Gastroenterology, vol. 18, no. 17, 2012, p. 2009.