• Rectum and Pelvic Veins – chronic venous stasis, haemorrhoids, rectal pain, congestion
• Liver and Portal Circulation – passive congestion, fullness, dull pressure
• Back and Sacroiliac Region – deep aching pain, especially lumbosacral and sacrum
• Mucous membranes – dryness, burning, rawness, especially in rectum and throat
• Venous system – dilated veins, varicosities, haemorrhoidal fullness
• Male pelvic organs – prostate, seminal vesicles, and spermatic cord congestions

• Gentle movement
• Cool air
• Lying down (in some back symptoms)
• Application of cold to haemorrhoids
• After stool (rectal pain relieved in some cases)

• Standing or walking for long
• Cold, damp weather
• After stool (especially rectal and sacral pain)
• During pregnancy (pelvic congestion)
• Afternoon and evening
• Motion (especially back and sacral pains)

Dull, despondent, gloomy. The Aesculus patient feels mentally burdened, with a sense of melancholy, forgetfulness, and slowness of thought. Depression is often associated with physical ailments, especially rectal or back pain, suggesting a strong psychosomatic link. [Clarke] notes irritability with inability to fix attention. Anxiety often arises from physical discomfort. There is a tendency toward self-absorption, with disinterest in surroundings or conversation.

Fullness, heaviness, and dull aching as if the brain were congested or too large for the skull. Headaches centred in the occiput, often extending down the spine. Scalp feels tight or tender. Vertigo on rising or moving suddenly. [Allen] noted pain that worsens in open air and from stooping. Headaches frequently accompany rectal issues or liver congestion.

Dryness and burning sensation as if sand were in the eyes. Dimness of vision with aching behind the eyeballs. Bloodshot appearance, with conjunctival congestion in venous states. Heaviness and fatigue of the lids. [Hering] mentions difficulty focusing due to ocular fullness and dullness.

Buzzing or ringing. Congestive fullness, as if ears were blocked. Pain in the ears associated with congestive headaches or general venous stasis. Sensitivity to pressure changes.

Dryness and congestion of the nasal mucosa. Post-nasal drip with rawness in the throat. Nose feels stuffed yet no discharge. Pain at the root of the nose or between the eyes. Often coincides with throat dryness or haemorrhoidal flare-ups.

Flushed, red, or earthy pallor. Dark circles under eyes. Expression dull and heavy. Facial heat corresponds with rectal or hepatic congestion. [Clarke] notes a swollen appearance with puffy eyelids.

Mouth dry, with a bitter or metallic taste. Tongue coated yellowish-white, especially in hepatic cases. Burning of the tongue and inner cheeks. Speech slow or thick. May bite cheek from internal swelling.

Not a major sphere, but dull aching in molars may occur during venous headaches. Gums occasionally bleed. Toothache associated with facial venous stasis.

Raw, dry, and burning—particularly in the posterior pharynx. Pain when swallowing dry food. Mucus thick and sticky. Sensation of a splinter or plug lodged in throat. Aggravated in dry weather or during constipation.

Sensation of heaviness and fullness, especially after eating small amounts. Nausea with bitter taste. Belching and reflux in portal congestion. Averse to fatty or rich foods. Appetite poor, often alternating with ravenous hunger. Better from eating small, frequent meals.

Congestion of portal and pelvic circulation, with a dull dragging pain and bloating. Liver feels enlarged, sore, or aching. Pressure in right hypochondrium with flatulence. Gurgling and fullness in the lower abdomen. Constipation with hepatic congestion is common.

Urging to urinate with scanty flow. Burning in urethra. Dull aching in bladder or urethra after micturition. Urine dark, thick, with offensive odour. Ineffectual urging, especially in haemorrhoidal states.

The chief sphere of Aesculus. Marked congestion, dryness, burning, and fullness in the rectum, even without stool. Pain is described as “dry sticks” or “fullness as if a foreign body were present.” [Clarke] called it a “haemorrhoidal remedy par excellence.”

Haemorrhoids are large, purple, blind or bleeding, often protruding. Worse after stool. Rectal pain often persists for hours after evacuation. Sensation of sharp needles or knife-like pain with or without defecation. Constipation with dry, knotty stools. Pruritus ani and fissures also noted.

Prostatic congestion, with heaviness or aching in perineum. Emissions with weakness. Dragging pain in spermatic cords. Dull aching or swelling of testicles. Varicocele. Sexual desire diminished or increased with pelvic congestion.

Pelvic congestion with dragging in the sacrum and hypogastrium, often during pregnancy or after delivery. Menses may be irregular, painful, or suppressed. Haemorrhoidal flare-ups before menses. [Hering] notes pruritus vulvae with congestion. Leucorrhoea thick, yellow, and irritating.

Shortness of breath on exertion. Oppression of breathing when lying down. Respiratory fatigue. Sense of fullness in the lungs as if overloaded with blood.

Palpitations with fullness in chest and head. Pulse slow or full. Pressure in cardiac region as if the heart were enlarged. Congestive tendencies in venous constitution.

Aching or fullness across the chest. Stitching pains in the sides. Heart feels oppressed or heavy. Cough dry, irritating, with tickling in the larynx. Worse from cold air or lying down.

Another key region. Aching, stiffness, and lameness in the lumbosacral area, worse from standing or walking. Pain in sacrum as if bruised, often extending to thighs. Worse in the afternoon and evening. Pain in spine with haemorrhoids. Cannot walk or sit for long without discomfort. [Allen] notes a “give out” feeling in the spine.

Aching and weakness in legs, especially after walking. Heavy, weary sensation. Lower limbs may feel engorged or cold. Varicose veins, especially in calves. Stiffness of knees and hips. Neuralgic pains shifting from joint to joint.

Dryness and itching, especially about the anus or vulva. Blue, engorged veins. Haemorrhoidal swellings hot and painful. Skin may crack or ulcerate near rectum. [Hering] notes eruptions in venous constitutions.

Sleep disturbed by back pain or rectal pressure. Restless tossing. Wakes feeling unrefreshed. Vivid dreams of falling, drowning, or painful defecation. Drowsy in afternoon but sleepless at night.

Dreams full of anxiety and strain—often about falling, being lost, or pressing work. Dreams may be grotesque or involve pain and physical distress.

Congestive low-grade fevers. Face flushed. Heat worse in afternoon. No strong periodicity. Associated with sluggish portal circulation or haemorrhoidal irritation.

Chilliness alternating with flushes. Sweating is moderate but may occur at night. Cold limbs with hot face. Sweat may be offensive or sour.

Aversion to fatty food, pork, and milk. Bitter taste in mouth. Heartburn and indigestion from overeating. Craving for cold water. Worse from sweets or rich foods.

Fullness, congestion, and aching dominate the general state. Venous stasis, especially of the pelvic, portal, and spinal vessels, underlies many symptoms. Weakness and heaviness in the limbs, and aching in the sacrum and rectum. Worse from prolonged standing, better lying down. Prone to haemorrhoidal and back complaints without marked systemic fever or inflammation.

• Nux vomica – Also has rectal issues and portal congestion, but more spasmodic and irritable
• Aloe socotrina – Haemorrhoids with urgency and mucus, more rectal fullness and involuntary stools
• Collinsonia – Haemorrhoids with constipation during pregnancy, more cardiac symptoms
• Hamamelis – Haemorrhoids and varicosities, more bleeding and bruised sensation
• Sulphur – Burning anus, morning diarrhoea, constitutional psora with heat

• Complementary: Nux vomica, Collinsonia
• Antidotes: Nux vomica, Chamomilla
• Follows well: Sulphur, Pulsatilla
• Precedes well: Sepia, Lycopodium

• Chief remedy for dry, congested haemorrhoids with rectal pain post-stool
• Valuable in sacroiliac pain that coexists with portal or pelvic congestion
• Helpful in venous insufficiency of the lower limbs and varicosities
• Consider in pregnancy-related haemorrhoids or rectal discomfort
• A key remedy for prostatic congestion with backache and rectal pressure

Rectum

• Fullness, sensation of
• Haemorrhoids, blind, painful
• Pain, after stool, long-lasting
• Dryness, without stool
• Itching, burning

Back

• Pain, sacrum, as if bruised
• Pain, lumbar, worse walking
• Weakness, spinal

Mind

• Gloomy, depressed
• Difficulty thinking
• Irritability from pain

Generalities

• Venous stasis
• Worse standing, walking
• Better lying down

Skin

• Itching, anus
• Varicose veins
• Dryness, eruptions

Dr. W. E. Payne – Original prover and observer of rectal sphere

Hale – New Remedies: Described venous and spinal indications in detail

C. Hering – Guiding Symptoms: Gave the most detailed rectal and back symptomatology

T.F. Allen – Encyclopaedia: Confirmed hepatic and general venous action

John Henry Clarke – Dictionary of Practical Materia Medica: Emphasised dullness, back pain, and portal symptoms

William Boericke – Pocket Manual: Provided clinical pearls for rectal, liver, and spinal cases