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A young boy was brought to me by his parents complaining of throat pain since two days. The pain was getting worse by swallowing and talking, hence he refused food and drinks. The only history is they had attended a marriage ceremony and the pain started after the feast. They had consulted their family doctor on phone and taken some medicines as per his suggestion. But the pain was getting worse. When he was brought to me, he was just moaning, and his mouth was open with dribbling of saliva. When I examined the throat, I could notice a dark tumor like object on his left tonsil. The moment I took the forceps and tongue depressor, he got frightened and started trembling. I gave him one dose of aconite 200 and made him to relax. After a few minutes, I gently removed the object using a forceps, and with a great shock noticed that it was a clove, that got lodged into the tonsillar crypt while hurriedly having the wedding-day special Biriyani!

I made a mistake that I forgot to take the photographs before and after removing the “tumor”.

Dr Muhammed Rafeeque

Views: 395

Comment by DR. ARINDAM DUTTA on February 3, 2010 at 9:21am
Good work Dr Rafeeque.

Another thing I want to contribute in this regard.
In any type of rectal complaints (be it haemorrhoids, fissure, fistula or simply pain or bleeding as complained by the patients), we MUST examine the part carefully, what I think is the most neglected area as far as the clinical examination is concerned. Patient tells us his symptoms & they are precious for our prescriptions but we should not rely upon their self “diagnosis”. Moreover, the anus is anatomically so placed that it is not so easy for self visualization. If we treat the patients as per their own “diagnosis” without examining the case, we may suppress his symptoms, but never cure. Instead, the case may go much deeper & becomes more fatal.
Comment by Dr. Wequar Ali Khan on February 3, 2010 at 10:46am

I agree with both Dr Rafeeque and Dr Dutta, but i have one question. Even when examining the anus we can visually only see up to a certain limit, then comes the need of end oscopy for more realistic diagnosis, and in such condition quite a lot of homeopath, I being one of them, feel helpless and resort to report from hospital or clinic where it can be performed. In case of throat one can see the tonsils and other part of the fauces with help of light and tongue depressor. How ever totality of symptoms under even acute condition will help in diagnosis. Aconite helped the child to relax before he could be examined.

Comment by Suhas Kotbagi on February 3, 2010 at 11:36am
The true art of practicing any medical science lies in knowing what exactly is to be cured, Organon App 3.

What a physicians 5 senses can see and confirm, no gadgets can compete on that level, but having said that we can very well use these machines to compliment our own judgments and diagnosis.

I am reminded of my friend (Dr.Ahmed) who always tells his students, "Eyes do not see what Mind do not know", and he is so right. The physician (his mind) has to know what to look for, or s/he may miss a big tumor right in front of her/his eyes.
Comment by Dr Muhammed Rafeeque on February 3, 2010 at 11:17pm
Thanks to Dr Arindam, Dr Wequar and Dr Suhas for your valuable comments.
Per rectal examination may not help to diagnose deep pathological conditions. But it can surely help to diagnose the following: Piles (internal/external), fissures, sentinel pile, rectal polyp, rectal cancer/anal cancer, rectal prolapse, anal fistula, peri anal abscess, swelling of prostate (can also differentiate benign and malignant swelling), Intussusception (Red currant jelly like blood in gloved finger after rectal examination in a patient with absolute constipation).

Let me add my article on piles:

All that bleeds is not piles!

In the recent years, there is a rise in the number of people suffering from piles, a condition medically termed as hemorrhoids. Proportionately, there is a hike in the advertisements in different media on various patent products that are supposed to cure piles. But the fact is, majority of the piles patients we come across are self diagnosed cases. Most of them suffer from occasional burning pains or soreness in the anal region and diagnose themselves as piles without a medical consultation. Thereafter, they go on taking patent preparations over the counter without a doctor’s prescription.

Piles is actually a dilated & tortuous hemorrhoidal plexus, i.e. veins in the anal region that drain impure blood to rectal veins. Piles can be either external piles or internal piles. External piles is painful and seen outside the anal orifice, whereas internal one is painless and not visible outside initially. But when the condition progresses, the internal piles comes out while defecating and goes back automatically after; later on it is protruded permanently. Depending upon bleeding, piles can be either bleeding piles or non-bleeding piles. Non-bleeding piles is also called as blind piles. In case of bleeding piles the blood comes in splashes just before defecation.

Many of the cases that are self diagnosed as piles are actually anal fissure or erosion in anal orifice due to various causes. In case of anal fissure, the patient get bleeding while defecation and the blood comes in strings along with the stool. Here, the pain will be more if the stools are very dry due to constipation and fewer intakes of water and fibrous diet.

Rectal bleeding should not be ignored as few cases of bleeding associated with altered bowel habit may be due to some life threatening conditions such as rectal cancer. Hence it is mandatory to go for a consultation before self-diagnosing all bleeding cases as piles.

Food items like prawns, crabs, lobsters, oysters, chicken, hens egg etc should be refrained in all rectal diseases. Avoid sitting in toilet for a long time as it can predispose weakness of muscles and stagnation of blood in rectal vessels. Drink plenty of water and take vegetables, fruits and fibrous diet in adequate quantity to make bowel movement easy and regular. Finally, whenever you suffer from any sort of symptoms such as pain, soreness, bleeding or swelling in the anal region, consult your doctor for correct diagnosis and suitable management.

Dr Muhammed Rafeeque
Comment by dr.sadathsait on February 9, 2010 at 9:09am

Why we homoeopaths are looked down upon always? How many homoeopaths can stand up to any allopathic specialist and say this is what we are treating? Its because we don't look anything beyond sighns and symptoms. Homoeopathy has grown and evolved. The world has changed. We have got to get modernised with the approach yet sticking to basical individualisation. In many cases diagnosis helps us to prescribe. Prescription can be done with characteristic symptoms may be just one. I will site 2 examples. We get lots of cases on laryngitis and pharyngitis. The patient complaints of diagnostic symptoms. I first differentiate medicines this way. After the patient explains things I ask them, "Do you always clear throat or has to make clearing sound." There is no other medicne other than WYETHIA. 2. Patients come to us with cough and say the moment he falls asleep he gets cough. I don't look beyond those symptoms after carefully physical examinations. I give DROSERA. 99% of the times it has given me amazing results. Point is diagnosis is very important in homoeopathy, as equal as individualisation. Please go through Rr. Dhawles principle and practise of homoeopathy. Homoeopathy is so simplified in that book yet modern in approach.

Comment by Dr Muhammed Rafeeque on February 9, 2010 at 11:04pm
thanks for sharing ur knowledge.
Comment by Ali Haider on October 7, 2010 at 3:16pm
I agreed with dr.sadathsait.
Comment by Ignacio de Jesús Cabrera Larios on October 8, 2010 at 3:52pm

I agree with Dr. Sadathsait. Homeopathy is evolving and now we have many resources that were not available at the beginning. Signs and symptoms are a reflection of the pathopysiological state of the patient. When I doubt of certain signs I ask for laboratory tests or radiogarphy. Ultrasound and endoscopy are useful too. Last weekend I received a German Shepherd dog with an apparent pneumonia, and It clearly sounded like one to auscultaion and percussion.They had made radiographs already but when I asked to see them they told me that they were not available. I asked them to get the radiographs so I could see them. I was not called back, until the dog was dying after a morning of respirtory distress a week later. He had Improved very much during the week, so they thought it was doing well, until the last day when he began getting ill in the morning. The cause? Three lung tumours, at least one of them bleeding! I was called late in the morning, when I finally crossed Mexico City, the patient was at a necropsy room already. I console on the idea that he died with dignity after a short agony.


Clinical tests clarify the situations, and they can also mark the path we are going either well or wrong. Nevertheless, individualzation of the sindrome to the carachteristics of the patient and of the moment he is living shall never be omited. Tests are diagnose adjutants, no more, but that is true also to allopathy.


On the other hand, we all have the headache of the self prescribing patients who make things more complicated than they should be. Applies to owners in veterinary medicine. They have given salicilic acid and naproxene to dogs and even cats, not to say kaolin based suspensions that can be very irritant to dogs and cats. One day a trainer took of a cast from a tendinitis sufering horse because he couldn't understand its mechanical fucntion. I had to deal with a very sensitive situation here and replace the cast. This happened in my allopathy days. Homeopathy or not, biomechanics is biomechanics, and lesions are lesions. ~ Greetings from Mexico

Comment by Dr Muhammed Rafeeque on October 9, 2010 at 12:04am
Thanks to Dr Ali and Dr Ignacio de Jesús Cabrera Larios for the valuable comments. Nosological diagnosis is a must. The impact of patient dying without diagnosis is different from patient dying with diagnosis, because, the response from the family members may be violent in the former.

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