Paeonia officinalis

A hardy perennial of Paeoniaceae, long cultivated for showy flowers; in antiquity the root and seeds were used for spasms, epilepsy, and uterine disorders. In homeopathy the tincture is prepared from the fresh root (and sometimes fresh plant). Classical sources describe a strong action on the ano-rectal outlet with fissures, ulcers, and haemorrhoids of extreme sensitiveness, plus varicose/ulcerative skin conditions (especially legs, sacrum, perineum) and coccygeal pains; secretions are often fetid and corrosive [Hahnemann], [Hering], [Allen], [Clarke], [Boericke], [Boger]. Paeon. is therefore grouped with remedies for anal fissure, pain after stool, haemorrhoids that are raw, purple, exquisitely tender, bedsores over the sacrum, varicose ulcers of the legs, and ulcers of vulva and mouth with burning and smarting [Clarke], [Boericke]. The pathophysiologic colour is outlet inflammation/ulceration with venous stasis and hyperalgesia.

Early Hahnemannian proving fragments with abundant clinical confirmations: agonising pain during and especially after stool, fissures and ulcers of anus, purple, sore haemorrhoids, perineal cracks, coccyx pains, offensive discharges, varicose/indolent ulcers, bedsores, sacral soreness, and ulcers of vulva/mouth. Pains are burning, stinging, raw, with long persistence after rectal action; much worse at night and from sitting; warm bathing and soft applications often soothe [Hahnemann], [Hering], [Allen], [Clarke], [Boericke], [Boger]. Tags: [Proving] [Clinical].

Essence. Paeon. is the raw, ulcerated outlet remedy with exquisite tenderness and fetid secretions. The patient lives around the anus (and often vulva/mouth)—fissures, ulcers, haemorrhoids that are purple, sore, and bleeding; pains that begin with stool and, above all, long outlast it; a tail-bone that cannot bear a chair; bedsores over the sacrum that burn on the slightest touch. Wherever an orifice or dependent skin lies—there Paeon. may leave a ragged, burning, fetid ulcer. The modalities are almost diagnostic: worse after stool, sitting, at night, from touch/wiping, standing/walking long, cold damp; better warm bathing, soft cushions, gentle cleansing, elevation, soft stools. This profile separates it from Ratanhia (knife-cuts, boiling-hot applications indispensable), Nit-ac. (splinters, bleeding), Aesculus (dry congestion with back-ache), and Hamamelis (bleeding soreness without ulcer-rawness).

Clinical craft. The prescription is half regimen: secure soft stools (oils, stewed fruit, fluids), warm sitz post-evacuation, bland emollients, no harsh wiping, cushions, rest with limb elevation, and avoid alcohol/spices. With this “container,” Paeon. closes cracks, shortens after-pains, sweetens fetor, and allows sleep to return. For puerperal perineal tears with purple, sore piles—think Paeon. first; for varicose ulcers that are tender and fetid—again Paeon.; for sacral bedsores in the feeble—Paeon. with Calendula dressing and positioning. As the ulcer cleans and odour lifts, the mind brightens—a steady Paeon. barometer. When pain becomes knife-like, interpose Ratanhia; when bleeding dominates, add or follow with Hamamelis; for old, indolent ulcer beds, later Fluor-ac./Lachesis may finish. The essence remains: ulcer-raw, touch-intolerant, fetid, and worse after stool—made human by warm water and softness. [Hering], [Clarke], [Boericke], [Boger], [Allen].

• Anus / rectum (prime seat) — Fissures, ulcers, haemorrhoids with exquisite soreness, burning, stitching, purple swelling; pains long after stool; sphincter spasm with tearing [Hering], [Allen], [Clarke].
• Perineum / coccyx — Cracks of perineum; coccygodynia worse sitting and after stool; sacral bedsores in the weak or bedridden [Clarke], [Boericke].
• Skin / ulcers — Varicose and indolent ulcers (legs, sacrum, genital margin) with fetid ichor, ragged edges, burning sore; chilblain-like cracks between toes [Hering], [Clarke], [Boger].
• Veins — Haemorrhoidal venous stasis with purple congestion; local throbbing and pressure aggravate [Boger], [Clarke].
• Female genitals — Ulcers of vulva/labia with burning and smarting, acrid discharge; perineal tears and soreness after childbirth [Hering], [Clarke].
• Mouth — Aphthous or ulcerative patches with putrid taste/odour; gums and cheeks sore [Allen], [Clarke].
• Back (sacro-coccygeal) — Soreness and burning at sacrum/coccyx, bed pressure intolerable; requires soft cushion [Clarke], [Boericke].
• General outlets — Orifices (anus, vulva, mouth) raw, burning, cracked; secretions acrid and fetid—a recurring signature [Hering], [Clarke].

Paeon. patients are exasperated and anxious under constant outlet pain; the dread of stool—knowing the hours of torture that follow—breeds fear, moroseness, and irritability, yet relief brings a transient quiet that tallies with the after stool worse and warm bathing better modalities [Hering], [Clarke]. They are oversensitive to touch, shrinking from examination and wiping; sleepless nights amplify despondency and the sense of being poisoned by their own discharges (fetor cross-link). There may be a fastidious urge to cleanse the parts repeatedly, though cleansing itself excoriates if harsh; when done gently with bland washes the mind eases, echoing the better gentle cleansing modality. Patients complain that the least pressure—a chair edge, tight garment, or even bedclothes—makes them “wild with pain,” summoning the coccygeal and haemorrhoidal affinities. Shame about the odour and location of disease withdraws them from company; the mental picture thus mingles mortification, touch-dread, and a wish to “sit in warm water and be left alone.” Contrast Ratanhia (fierce knife-like pains with urgent straining and an almost desperate need for hot water) and Nit-ac. (splinter pains with bleeding and fissure), while Paeon. is softer, rawer, ulcerative, with marked fetor and purple congestion [Clarke], [Boericke], [Boger]. When ulcers improve and secretions lose their putridity, patients report an immediate lift of mood, cementing the local–mental axis so typical of the remedy.

Broken by rectal and perineal pains; the patient dreads lying down at night as the itch-burn and throbbing mount; brief dozes are followed by wakings with soreness and need to bathe (Mind/Modalities cross-link) [Allen], [Clarke]. Sleep is restless, with frequent position changes to spare the coccyx. Dreams of filth, soiled garments, or searching for a privy mirror the outlet preoccupation. Morning brings fatigue, heaviness of head, and renewed soreness on rising. If stool occurs late evening, the after-pains occupy the first half of the night; if in morning, the day is spent in torture and night in exhaustion. Warm sitz before bed improves sleep length. Gentle oils/ointments at bedtime reduce excoriation next waking.

Dreams of uncleanness, of being exposed while soiled, of endless corridors leading to a closet, and of being pricked or burned at the seat; on waking the anus stings and the patient fears to move (Rectum cross-link). Dreams may be fetid, with smell remembered on waking—a psychical echo of the ulcer odour [Clarke]. When ulcers heal, dreams turn to clear water or bathing, correlating with the better warm bathing keynote. There are also dreams of falling on the tail-bone with a start, after which the coccyx aches until adjusted on cushions. The dream-life thus faithfully tracks the outlet condition.

Paeon. is the ulcer-raw outlet remedy: anus, perineum, vulva, mouth and dependent skin are burning, cracked, ulcerated, with fetid, acrid secretions and exquisite tenderness. The master keynote is pains during and especially long after stool, with worse sitting, worse night, worse touch/wiping, worse standing/walking long, worse cold damp, and better warm bathing, better soft cushions/lying on side, better gentle cleansing/bland dressings, better elevation for venous legs, and better soft stools [Hering], [Allen], [Clarke], [Boericke], [Boger]. Venous stasis and ulceration explain its reach to varicose ulcers and bedsores; micro-comparisons: Ratanhia (knife-like pains; absolute hot water craving), Nit-ac. (splinter pains; bleeding fissures), Aesculus (dry, aching back, congestive piles), Hamamelis (bleeding, soreness), Muriatic acid (bluish piles, puerperal soreness), Graphites (moist fissures with sticky exudation), Lachesis/Fluor-ac. (ulcers more sloughing/chronic), Calendula/Hypericum (topical). When those after-stool pains and fetid ulcers dominate, Paeon. stands foremost.

No high fever; evening flush with burning in ulcers and throbbing piles; slight chill after exposure to cold damp; sweats at night with fetid odour when ulcers are active [Clarke], [Boericke]. Temperature follows the local inflammation.

Chilliness in cold damp; heat at the seat and in ulcer margins; sweat at night, notably about perineum and sacrum, with offensive odour that worsens excoriation [Clarke]. Heat of bed aggravates itching unless bathing precedes. Sweat does not relieve pains after stool.

Headache attends sleepless painful nights and prolonged straining; it is dull, heavy, and frontal, with heat of face when the rectum burns—an autonomic echo [Allen], [Clarke]. Odours from ulcers or haemorrhoids can turn the stomach and aggravate head discomfort (Mouth/Rectum cross-link). Wine and spices redden the face and provoke throbbing when outlets are inflamed; quiet and warm bathing ease the head by easing the cause (Modalities). Unlike Aesculus, whose head pains couple with back weakness, Paeon.’s head follows the raw outlet and fetid discharge. The head clears after a soft stool obtained with oils or a sitz, mirroring the stool-dependent aggravations. With varicose-ulcer cases, a heavy head comes and goes with venous weather and long standing.

Little primary action; eyes may smart and water in the night aggravations, partly from loss of sleep. In the bedridden with bedsores, eyelids are puffy on waking and clear by day; the eye picture reflects general toxicity/fetor rather than an ocular affinity [Clarke]. Vision blurs transiently during paroxysms of pain and returns once the rectal storm passes. Photophobia is not characteristic; the eyes simply look weary.

Fleeting roaring with facial flushing during straining; ears grow hot when the anus burns, and cool with baths—a minor sympathetic echo [Clarke]. Otherwise unremarkable.

Acrid odours of discharges and ulcers are perceived as nauseating; patients become fastidious about smells. The nasal mucosa itself is quiet; any coryza is incidental to season. Offensive breath with mouth ulcers ties the nose into the fetor theme (Mouth link) [Allen], [Clarke].

Face flushed in paroxysms, pale and drawn afterwards; lips dry from mouth-breathing during pain. Expression betrays touch-dread—the sufferer guards the seat and sits sideways to spare the coccyx. In chronic ulcer cases, a sallow look declares the venous and toxic burden.

Aphthae and ulcers on cheeks, tongue, or gums with smarting, burning, and offensive saliva; acid or spiced foods sting (better bland washes, oils) [Allen], [Clarke]. The mouth mirrors the outlet theme: raw margins, fetid odour, and soreness to touch. Eating becomes timid; soft, tepid foods are preferred. Small bleeding points appear if roughly brushed. Compare Merc. (salivation, flabby tongue, night sweat) and Kali-bi. (punched-out ulcers); Paeon. links mouth lesions to perineal and sacral ulceration.

No special odontalgia belongs; tooth-brushing may sting aphthae; jaw clenches during stool dread. Teeth feel coated after foul night sweats and improve with rinses.

Raw fauces in those with mouth ulcers; swallowing stings with sharp foods; warm bland drinks soothe [Clarke]. No membrane; the throat reflects the ulcer-raw signature seen at other outlets. Much hawking in fetid cases.

Breathing short while bearing-down or when pain shoots in rectum; a sigh may relieve. No bronchial signature; chest reflects the pain-guarding posture. Tenderness over sternum from propping forward to spare coccyx.

Palpitation from pain or loss of sleep; settles with relief of outlets. Venous fullness gives a sense of throbbing in haemorrhoids and legs; heart itself is structurally quiet [Boger], [Clarke].

Anxious breathing during stool dread; breath held at evacuation, then sighs. No asthma; rhythm resumes when pain eases.

Nausea from odours of ulcers or stool, from pain-loss of sleep, and after spices/wine; warm drinks and rest abate [Allen], [Clarke]. Appetite variable—poor when rectum is aflame; patients fear eating lest it bring stool. Craving for tepid, soft food that passes easily; cold food/drink can grip the bowel (Rectum link). Hiccough sometimes follows weeping or pain.

Colic as stool approaches; tenesmus with a sense of ulcerated rectum. Flatulence aggravates haemorrhoids and sacral pressure; warmth and lying relieve. The hypogastrium feels sore after straining; tight garments are intolerable (Generalities).

The centre of Paeon.: Fissures, ulcers, haemorrhoids—purple, sore, bleeding—with tearing, burning, stitching pains during stool and, characteristically, agonising pains long after stool, often for hours [Hering], [Allen], [Clarke], [Boericke]. The anus is raw, cracked, moist with fetid, acrid oozing that excoriates; wiping is unbearable; patients sit in warm water for relief (Modalities cross-link). Stool may be hard and dry, followed by spasm of sphincter, or soft yet still lacerating the fissure; in either case, after-pains are the keynote. Protruding haemorrhoids are exquisitely tender and purple; walking and sitting aggravate; soft cushions and elevation help. Compare Ratanhia (knife-like, compelling hot applications), Nit-ac. (splinter pains with bleeding fissures), Aesculus (dry piles with backache, less ulceration), Hamamelis (sore, bleeding piles with venous fullness), and Muriatic acid (bluish haemorrhoids, excessive soreness, especially in the puerperium) [Clarke], [Boger], [Boericke].

Urination smarting if perineal cracks extend forward; pressure of haemorrhoids makes passing urine awkward and painful posture-wise. Frequent calls at night from restlessness; urine otherwise unremarkable [Clarke]. No specific cystitis.

Spices, alcohol, coffee aggravate burning and smarting at outlets; tepid fluids, oiled foods, stewed fruit make stools softer and pains less (Rectum cross-link) [Clarke], [Boericke]. Craves warm food; cold drinks can grip. Little appetite on days of dread.

Perineal soreness between scrotum and anus; sitting aggravates; coitus may excori­ate if cracks present. Haemorrhoids troublesome after straining or alcohol; the sexual sphere is secondary to outlet disease [Clarke]. Compare Aesculus if backache dominates.

Vulvar and perineal ulcers/cracks with burning and smarting, acrid leucorrhoea excoriating; puerperal perineal tears exquisitely tender, worse sitting, better warm bathing [Hering], [Clarke]. Haemorrhoids of pregnancy and after labour are purple, sore, and bleed easily. Coitus painful when fissures present; patients dread stool during menses. Compare Muriatic acid (blue, intensely sore piles in puerperium) and Graphites (moist fissures, sticky exudation without the after-stool agony).

Sacral and coccygeal soreness; sitting on hard surfaces intolerable; needs soft cushion; bedsores readily form over sacrum in the weakened [Clarke], [Boericke]. After stool the coccyx throbs with the anus; lying on side helps.

Varicose legs with ulcers—edges ragged, purple, fetid; burning sore margins; standing aggravates; elevation and gentle cleansing soothe [Clarke], [Boger]. Cracks between toes, chilblain-like, sting in cold damp; warmth eases once heat is gentle (Skin link). Ankles heavy by evening from venous stasis.

Ulcerative tendency at orifices and dependent parts: anus, vulva, mouth, legs, sacrum. Ulcers are painful, burning, fetid, often purple or bluish with ragged borders; touch intolerable; warm bathing and bland dressings best (Modalities) [Hering], [Clarke]. Bedsores on sacrum are a Paeon. indication, especially with foul odour and exquisite tenderness. Compare Lachesis (dark, sloughing), Fluor-ac. (old varicose ulcers), Calendula (topical healing), Carbo-veg. (low vitality with foulness).

Anal fissure / post-stool agony

• Ratanhia — Knife-like rectal pains with uncontrollable urge for very hot water to the anus; Paeon. has raw, ulcerative, fetid, purple outlet and broader ulcer field [Clarke], [Boger].
• Nitric acid — Splinter pains, streaky bleeding, fissures; less fetor, more sharp pain; Paeon. softer, burning-raw with ulcer borders [Boericke], [Clarke].
• Aesculus — Dry, blind piles with aching sacrum/back; post-stool pain less enduring; Paeon. marked after-pains and ulceration [Boger].
• Hamamelis — Bleeding piles with soreness and venous engorgement; Paeon. adds ulcerative rawness and fetid oozing [Clarke].
• Muriatic acid — Bluish, intensely sore haemorrhoids in puerperium; Paeon. covers perineal tears and ulcers with warm-bath amelioration [Boericke].

Coccygodynia / sacral bedsores

• Hypericum — Nerve-crush pains, shooting up spine; Paeon. is ulcer-raw, pressure-sore type with fetor [Clarke].
• Ruta — Periosteal coccyx pain from strain; Paeon. from ulcer/pressure and piles [Boger].
• Aesculus — Coccyx ache tied to piles but less ulceration and fetor [Boger].

Varicose/indolent ulcers

• Fluoric acid — Long-standing varicose ulcers in warm-blooded patients; Paeon. when tender, fetid, ragged and orifice-linked [Clarke], [Boericke].
• Lachesis — Dark, sloughing, septic tendency; Paeon. less septic, more raw-burning with exquisite tenderness [Clarke].
• Carbo-veg. — Low vitality, cold, foul ulcers; Paeon. has stronger pain and touch-dread [Boger].

Ulcers of vulva / mouth

• Graphites — Fissures with sticky discharge; skin thick; Paeon. more burning-raw with fetid ichor [Clarke].
• Mercurius — Salivation, night sweats, spongy gums; Paeon. lacks Merc. systemic picture [Allen].
• Kali-bichromicum — Punched-out mouth ulcers; Paeon. has ragged, burning sores [Clarke].

• Complementary: Ratanhia — Shares post-stool agonies; alternate when knife-like vs raw-ulcer phases predominate [Clarke], [Boger].
• Complementary: Hamamelis — Venous bleeding and soreness when ulcer edge is quieted by Paeon. [Clarke].
• Complementary: Calendula (topical) — Cleansing/epithelialising adjunct for ulcers/tears while Paeon. acts constitutionally [Boericke].
• Follows well: Nux-vomica — In constipated, irritable patients once evacuation improves yet ulcer-raw pains persist [Boger].
• Follows well: Aesculus — When back-ache and venous stasis have been reduced but post-stool pains remain [Boger].
• Precedes well: Graphites — If fissure becomes chronic with sticky exudate after Paeon. eases acute rawness [Clarke].
• Precedes well: Fluor-ac./Lachesis — For stubborn varicose ulcers once pain has been quieted [Clarke].
• Related (cluster): Ratanhia, Nit-ac., Aesculus, Hamamelis, Muriatic acid, Graphites, Fluor-ac., Lachesis, Carbo-veg., Hypericum, Calendula—select by pain quality, bleeding, ulcer character, and fetor.
• Antidotes (functional): Warm sitz, bland emollients, soft pads, rest with elevation, diet to secure soft stool—they potentiate the remedy’s action [Clarke], [Boericke].

• Anal fissure with hours of pain after stool: Warm sitz immediately, Paeon. 30C every 2–4 hours day one, then space; interleave Ratanhia only if pains turn knife-like [Clarke], [Boger].
• Puerperal perineal tears + purple piles: Paeon. 200C single on day of presentation; Calendula dressings topically; repeat Paeon. on clear relapse of raw-burning [Hering], [Boericke].
• Sacral bedsores (fetid, exquisitely tender): Paeon. 30C bid with positioning, air-mattress, bland cleansing; escalate potency once pain and fetor diminish [Clarke].
• Varicose ulcer, tender, ragged, fetid: Elevate, cleanse, Paeon. internally; if chronic bed persists after pain quiets, follow with Fluor-ac. [Clarke], [Boericke].

Mind

• Irritability and dread before stool; fear of the pain after — behaviour hallmark in fissure/haemorrhoid cases [Clarke], [Hering].
• Aversion to touch/examination of affected parts — extreme hyperaesthesia [Hering].
• Fastidious about cleanliness yet cleansing aggravates if harsh — needs gentle care [Clarke].
• Despondency from offensive secretions — fetor–mind link [Clarke].
• Better from warm bathing and quiet — regimen rubric [Boericke].
• Anxiety at night from burning at outlet — night aggravation [Allen].

Head

• Headache from loss of sleep and straining — frontal heaviness [Allen].
• Face flushes with rectal burning — autonomic echo [Clarke].
• Worse from wine/spices — vascular irritants [Clarke].
• Better when outlet is soothed (sitz, soft stool) — causal relief [Clarke].
• Heaviness in venous subjects — varicose tie [Boger].
• Nausea from fetor — odour link [Clarke].

Mouth

• Aphthae/ulcers with burning and fetor — Paeon. mouth signature [Allen], [Clarke].
• Acid/spiced foods aggravate — stinging [Clarke].
• Warm bland rinses ameliorate — nursing measure [Clarke].
• Small bleed on brushing — raw margins [Allen].
• Putrid taste — fetor theme [Clarke].
• Soreness to touch — outlet echo [Hering].

Rectum / Anus

• Fissure of anus; pains long after stool — keynote [Hering], [Clarke].
• Haemorrhoids, purple, exquisitely sore — venous ulcer-raw piles [Boericke].
• Ulcers of anus; fetid oozing; wiping intolerable — core pathology [Clarke].
• Sphincter spasm after stool — post-stool torture [Allen].
• Warm sitz ameliorates; sitting aggravates — master modalities [Hering], [Boger].
• Bleeding with smarting and burning — outlet burning [Clarke].

Female

• Ulcers/cracks of vulva and perineum, burning — orifice theme [Hering], [Clarke].
• Puerperal haemorrhoids intensely sore — Muri-ac. compare [Boericke].
• Leucorrhoea acrid, excoriating — outlet rawness [Clarke].
• Coitus painful from fissures — touch-dread [Clarke].
• Warm bathing ameliorates perineal soreness — regimen [Hering].
• Sitting aggravates coccyx/perineum — pressure law [Clarke].

Skin / Ulcers

• Ulcers, varicose, fetid, tender, ragged edges — Paeon. leg ulcer stamp [Clarke].
• Bedsores over sacrum, exquisitely tender — key indication [Boericke].
• Cracks between toes; chilblain-like — fissure tendency [Clarke].
• Warm gentle cleansing and bland coverings ameliorate — care rubric [Clarke].
• Cold damp aggravates fissures — weather modality [Clarke].
• Touch aggravates ulcer margins — hyperalgesia [Hering].

Back / Generalities

• Coccyx sore; sitting on hard surfaces intolerable — cushion > [Clarke], [Boericke].
• Night aggravates pains and fetor — timing [Allen].
• Better warm bathing; better soft stool — global ameliorations [Hering], [Clarke].
• Standing/walking long aggravate venous pains — varicose tie [Boger].
• Cold damp aggravates; elevation ameliorates — venous/weather laws [Clarke], [Boger].
• Fetor of secretions prominent — selection pointer [Clarke].

Hahnemann — Chronic Diseases / Materia Medica notes (1828–30): proving fragments; rectal fissure pains; outlet rawness.
Hering — The Guiding Symptoms (1879): fissures/ulcers of anus and vulva; coccyx pains; night aggravation; warm bathing amelioration.
Allen, T. F. — Encyclopaedia of Pure Materia Medica (1874–79): rectal after-pains; sphincter spasm; mouth ulcers; fetor.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): clinical confirmations—purple, sore piles; perineal tears; varicose/indolent ulcers; modalities; diet/regimen notes.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—ulcer-raw outlets; bedsores; warm bath better; relationships.
Boger, C. M. — Synoptic Key (1915): generals—post-stool pains; venous stasis; standing/walking aggravate; comparisons (Ratanhia, Aesculus, Hamamelis).
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1941): concise rectal/fissure pointers; ulcer/venous affinities; modalities.
Nash, E. B. — Leaders in Homeopathic Therapeutics (1899): clinical pearls in rectal therapeutics; differentiations with Ratanhia and Nit-ac.
Dewey, W. A. — Practical Homœopathic Therapeutics (1901): fissures/haemorrhoids therapeutics; puerperal care; sitz regimen.
Farrington, E. A. — Clinical Materia Medica (1887): outlet remedies contrasted (Paeon., Ratanhia, Nit-ac., Aesculus).
Tyler, M. L. — Homœopathic Drug Pictures (1942): bedside colour—touch-dread, cushions, warm baths; care counsel.
Hughes, R. — Cyclopaedia of Drug Pathogenesy (1870): historical herbal use; toxic/ulcerative tendencies collated.