The term hiatal hernia describes a condition where the upper part of the stomach that normally is located just below the diaphragm in the abdomen pushes or protrudes through the esophageal hiatus to rest within the chest cavity.

The esophagus connects the throat to the stomach. It passes through the chest and enters the abdomen through a hole in the diaphragm called the esophageal hiatus.

P.S: A strangulated hernia is a medical emergency.

Fundoplication Surgery for Hiatal Hernias and GERD

Surgery is never the first option for treating GERD. Changes in lifestyle, diet, and habits, nonprescription antacids, and prescription medications all must be tried before resorting having hiatal surgery. Only if all else fails, surgery is recommended because lifestyle changes and medications work well in most people, surgery is done on only a small number of people.

1. The most common surgery is used most often for GERD and is fundoplication.
2. Fundoplication works by increasing pressure in the lower esophagus to keep acid from backing up.
3. During the fundoplication surgery, the surgeon wraps part of your stomach around your esophagus like a collar and tacks it down to provide more of a one-way valve effect.
4. This procedure now can be done laparoscopically (a type of surgery that does not require abdominal sutures or staples).
5. During the surgery, the surgeon makes a couple of very small cuts in your belly and inserts long narrow instruments and a fiberoptic camera (laparoscope) through the slits.
6. This method leaves little scarring and can produce a much faster recovery.
7. A newer procedure, the LINX procedure, works by placing a ring around the lower esophageal sphincter and is less invasive than a fundoplication.

Like all surgical procedures, fundoplication does not always work and can have complications.

Symptoms and signs

Hiatal hernias do not cause symptoms, and most are found incidentally when a person has a chest X-ray or abdominal X-rays, including:

1. An upper GI series and CT scans in which the patient swallow barium or another contrast material.
2. It also is found incidentally during gastrointestinal endoscopy of the esophagus, stomach, and duodenum (EGD).
3. If symptoms do occur, they are due to gastroesophageal reflux disease (GERD) where the digestive juice containing acid from the stomach moves up into the esophagus.

Unfortunately, the esophagus does not have a similar protective lining. Instead, it relies on the lower esophageal sphincter (LES), a band of muscle located at the junction of the stomach and esophagus, and the muscle of the diaphragm surrounding the esophagus to act as a valve to prevent acid from refluxing from the stomach into the esophagus.

Moreover, to the esophageal sphincter (LES), the normal location of the stomach and esophageal junction within the abdominal cavity is important in keeping acid where it belongs. There is increased pressure within the abdominal cavity compared to the chest cavity, particularly during inspiration which would normally cause the acid and contents from the stomach to reflux back into the esophagus, but the combination of the pressure exerted within the lower mostly is from the esophageal sphincter (LES), and the muscle of the diaphragm create a zone of higher pressure that keeps stomach acid in the stomach.

In the situation of a sliding hiatal hernia, the gastroesophageal and esophagus junction move above the diaphragm and into the chest, and the portion of the higher-pressure zone due to the diaphragm is lost. Acid is allowed to reflux back into the esophagus causing inflammation of the lining of the esophagus.

The symptoms of gastroesophageal reflux disease (GERD) include:

1. Heartburn.
2. Chest pain.
3. Nausea, vomiting or retching (dry heaves).
4. Burping.
5. Waterbrash (the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid).

What makes symptoms of a hiatal hernia more painful and worse?

Symptoms of a hiatal hernia usually are worse after meals and may be made worse when lying flat, which may resolve with sitting up or walking.

In some people with a hiatal hernia, it refluxes into the lower esophagus which sets off nervous reflexes that can cause a cough or even spasm of the small airways within the lungs.

Rarely, some people with a hiatal hernia may feel reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing:

1. 1. coughing spasms,
   2. asthma, or
   3. repeated lung infections including pneumonia and bronchitis.

People of any age can get a hiatal hernia from infants to the elderly. Fortunately, it is very rare.

What is a paraesophageal hiatal hernia? What are its symptoms and signs?

Usually, people with a paraesophageal sphincter have no symptoms of reflux because the gastroesophageal esophagus junction remains below the diaphragm, but if the hernia is large, the way the stomach rotates into the chest, there is the possibility of volvulus of the stomach in which the stomach twists upon itself. Fortunately, paraesophageal hernias are relatively uncommon.

Rarely, gastric volvulus of the stomach in which an abnormal rotation of the stomach more than 180 degrees is a surgical emergency and causes difficulty with

1. painful swallowing.
2. chest pain.
3. vomiting.

Signs and symptoms of a hiatal hernia that needs to be treated right away, include:

• Vomiting blood
• Dark, tarry stools
• Palpitations (feel the heart beating in your chest) or feeling faint
• Cough and fever
• Shortness of breath
• Inability to swallow solid food or liquids easily
• Chest pressure or pain, especially if you know that you have heart disease or these risk factors
  • diabetes,
  • smoking,
  • high cholesterol,
  • high blood pressure,
  • older than 55 years,
  • male gender, or
  • family history of early heart attacks or angina (before age 55 years).

Causes of hiatal hernia

Normally, the space where the esophagus passes through the diaphragm is sealed by the phrenoesophageal membrane, (a thin membrane of tissue connecting the esophagus with the diaphragm) where the esophagus passes through the diaphragm.  Thus, the chest cavity and abdominal cavity are separated from each other. Because the muscles of the esophagus tighten and the esophagus shortens with each swallow, essentially squeezing food into the stomach, this membrane needs to be elastic to allow the esophagus to move up and down.

Normal physiology allows the gastroesophageal junction, where the esophagus and stomach meet, to move back and forth within the hiatus. However, at rest, the gastroesophageal junction should be located below the diaphragm and in the abdominal cavity. It is important to remember that these distances are very short.

Over time, the phrenoesophageal membrane may weaken, and a part of the stomach may herniate through the membrane.  It may remain above the diaphragm permanently or move back and forth across the diaphragm.

Hiatal hernias are common, and in the majority of cases, the cause is unknown. They may be present at birth or develop later in life.

• Pregnancy: Theoretically, decreased abdominal muscle tone and increased pressure within the abdominal cavity could lead to the development of a hiatal hernia. Thus, people who are obese and women who are pregnant may be at an increased risk for developing a hiatal hernia although this has not been demonstrated.
• Constipation and vomiting: People who have repetitive vomiting or those who have constipation and strain to have a bowel movement, increase the intra-abdominal pressure when they strain, and this may weaken the phrenoesophageal membrane.
• The membrane also may weaken and lose its elasticity as a part of aging.
• Ascites: Ascites is an abnormal collection of fluid in the abdominal cavity, which is often seen in people with liver failure, also may be associated with the development of a hiatal hernia.

Types of hiatal hernias

There are three types of hiatal hernias.

1. Sling hiatal hernia: A sliding hiatal hernia is the most common type of hiatal hernia (around 95% of all hiatal hernias). In a sliding hernia, a portion of the stomach slides upward through the diaphragm and into the chest such that the junction of the esophagus and stomach (gastroesophageal junction) lies in the chest. A sliding hernia is present during inspiration when the diaphragm contracts and descends toward the abdominal cavity and when the esophagus shortens during swallowing, but at rest, it is not present.
2. Paraoesophageal hernia: A paraesophageal hernia accounts for only 5% of hiatal hernias, the gap in the diaphragm through which the hernia occurs, phrenoesophageal membrane is larger, and a portion of the stomach herniates into the chest alongside the esophagus and stays there, but the junction between the stomach and the esophagus remains below the diaphragm.
3. Paraoesophageal and sliding: In a combination of events, should the defect in the diaphragm become larger, the junction between the stomach and the esophagus can herniate through the diaphragm into the chest causing a hernia that is both paraesophageal and sliding.

Diagnose

• X-rays, EDG, and CT scan: Most often, a hiatal hernia is found incidentally with gastrointestinal X-rays, EGD, and sometimes CT scan, since by itself, it causes no symptoms. Only when there are associated symptoms of GERD will that usually need treatment. With symptoms of GERD, a hiatal hernia is likely to present since most people with GERD have hiatal hernias.
• Barium swallow or upper GI series: Often, the diagnosis of a hiatal hernia is confirmed by a barium swallow or upper GI series, where a radiologist uses fluoroscopy to observe in real-time as the swallowed barium outlines the esophagus, stomach, and upper part of the small intestine. In addition to seeing the anatomy, the radiologist also can comment upon the movement of the muscles that work to propel the barium (and presumably) food through the esophagus into the stomach and beyond.
• Endoscopy: Endoscopy is a procedure performed under sedation by a gastroenterologist to look at the lining of the esophagus, stomach, and duodenum. A hiatal hernia may be diagnosed easily in this manner and more importantly, the physician may be able to see complications of GERD from the reflux of acid. Endoscopy is used to diagnose scarring with strictures (narrowing of the esophagus) and precancerous conditions like Barrett’s esophagus. Biopsies or small tissue samples may be taken and examined under a microscope.

Allopathic treatment for hiatal hernias

The treatment for hiatal hernia is actually the treatment for GERD and minimizing acid reflux. This includes:

• decreasing acid secretion in the stomach,
• avoiding substances that are irritating to the stomach lining, and
• mechanical means to keep the remaining acid in the stomach where it belongs.

When is surgery for a hiatal hernia necessary?

Most often, the surgery is done as a minimally invasive procedure using a laparoscope. While there are different techniques, the results are similar, and the best option is usually the one the surgeon feels most comfortable performing in a specific situation.

Proton pump inhibitor medications: With the development of proton pump inhibitor medications, medical therapy has decreased the necessity of surgery for sliding hiatal hernias, and it is often only recommended for people who have failed aggressive drug treatment or who have developed complications of GERD include:

• strictures,
• ulcers, and
• bleeding or those with repeated pneumonia form aspiration.

Paraoesophageal hernias: Patients with paraesophageal hernias often have no symptoms, and surgery is required only if the hernias become trapped in the chest and become stuck in the diaphragmatic hiatus or rotate to cause a volvulus. While this is more commonly seen in older people, paraesophageal hernias also may occur from birth as a congenital condition in neonates and infants.

Diet changes

Foods, drinks, and home changes that treat hiatal hernia symptoms include:

• Elevating the head of the bed when sleeping to allow gravity to prevent acid from refluxing into the esophagus.
• Eating small frequent meals may help instead of eating two or three larger meals a day.
• Some foods and habits that that trigger hiatal symptoms should be avoided, and include:
  • chilly,
  • oily foods,
  • raw/fresh onions,
  • processed/packed food,
  • fast food,
  • coffee, tea, chocolates etc
  • tobacco and alcohol,
  • carbonated drink, and
  • citrus fruits,
  • white sugar etc.

Homeopathic treatment for hiatal hernia

Hernia is a surgical condition, but it can be corrected by well selected Homoeopathic medicines. In Homeopathy, there is not any concept of surgery for almost 99% diseases. This constitutional approach framing mind and body works at the root-level and will help strengthen the lower muscular sphincters. For hernias there are dozens of well proven medicines, very few of them are as under:

Natrum Muriaticum

Heartburn, with palpitation. Throbbing in pit. Sticking sensation in cardiac orifice. Cutting pain in abdomen. Distended. Pain in hiatus on coughing. Hiatal hernia. Cough from a tickling in the pit of stomach, accompanied by stitches in liver and spurting of urine. Stitches all over chest. Cough, with bursting pain in head. Shortness of breath. Heart and chest feel constricted.

Nux Vomica

Throat rough, scraped feeling. Tickling after waking in morning. Sensation of roughness, tightness, and tension. Pharynx constricted. Uvula swollen. Stitches into ear. Bloody saliva. Sour taste, and nausea in the morning, after eating. Weight and pain in stomach; worse, eating, sometime after. Sour, bitter eructation. Nausea and vomiting, with much retching. Region of stomach very sensitive to pressure. Epigastrium bloated, with pressure s of a stone, several hours after eating. Dyspepsia from drinking strong coffee. Difficult belching of gas. Wants to vomit but cannot.

Bruised soreness of abdominal walls. Spasmodic colic. Liver engorged, with stitches and soreness. Colic, with upward pressure, causing short breath, and desire for stool. Weakness of abdominal ring region (hiatal sphincter). Strangulated hernia. Hiatal hernia. Umbilical hernia of infants.

Phosphorus

Throws up ingesta by the mouthfuls. Vomiting: water is thrown up as soon as it gets warm in the stomach. Hiatal hernia. Cardiac opening seems contracted, too narrow; the food scarcely swallowed, comes up again. Pain in stomach. Region of stomach painful to touch, or on walking. Inflammation of stomach, with burning extending to throat and bowels. Liver congested. Acute hepatitis. Fatty degeneration.

Larynx very painful. Violent tickling in larynx while speaking. Aphonia. Cough from tickling in throat. Congestion of lungs. Burning pains, heat and oppression of chest. Tightness across chest; great weight on chest. Sharp stitches in chest; respiration quickened, oppressed. Much heat in chest. Pneumonia, with oppression. Pain in throat on coughing. Hiatal hernia. Violent palpitation with anxiety, while lying on left side. Heart dilated, especially right.

Opium

Vomiting with colic and convulsions. Fecal vomiting. Incarcerated hernia. Hiatal hernia. Abdomen: Hard, bloated, tympanitic. Lead colic during colic. Breathing stops on going to sleep; must be shaken to start it again. Deep snoring; rattling, stertorous breathing. Difficult, intermittent, deep, unequal respiration. Heat in chest; burning about heart. Cough, with dyspnea and blue face; with bloody expectoration.

Apis melifica

Sensation of fishbone in throat. Sore feeling in stomach. Vomiting of food. Abdomen: Sore, bruised on pressure, when sneezing. Extremely tender. Dropsy of abdomen. Peritonitis. Swelling in right groin. Hoarseness; dyspnea, breathing hurried and difficult. Edema of larynx. Feels as if he could not draw another breath. Suffocation; short, dry cough, suprasternal. Hydrothorax. Hiatal hernia.

Alumina

Dry, sore; food cannot pass, esophagus contracted. Feels as if splinter or plug were in throat. Irritable, and relaxed throat. Hiatal hernia. Heartburn; feels constricted. Can swallow but small morsels at a time. Constriction of esophagus. Colic, like painter’s colic. Pressing in both groins.

Cough soon after waking in the morning. Hoarse, aphonia, tickling in larynx; wheezing, rattling respiration. Cough on talking or singing, in the morning. Chest feels constricted. Condiments produce cough. Talking aggravates soreness of chest. Back – Stitches, gnawing burning pain. Pain along cord, with paralytic weakness.

Argentum Nitricum

Thick mucus in throat and mouth causes hawking. Raw, rough and sore. Sensation of a splinter in throat on swallowing. Dark redness of throat. Catarrh of smokers, with tickling as of hair in throat. Strangulated feeling. Hiatal hernia.

Belching. Nausea, retching, vomiting of glairy mucus. Flatulence; painful swelling of pit. Painful spot over stomach that radiates to all parts of the abdomen. Gnawing ulcerating pain; burning and constriction. Ineffectual effort at eructation. Ulcerative pain in left side under ribs. Trembling and throbbing in stomach. Enormous distention. Ulceration of stomach, with radiating pain. Colic, with much flatulent distention. Dyspnoea. Chest feels as if a bar were around it. Palpitation, pulse irregular and intermittent

Sulphur

Pressure in throat as from a lump, as from splinter, as of a hair. Burning, redness and dryness. Ball seems to rise and close pharynx. Hiatal hernia. Putrid eructation. Sever acidity, sour eructation. Burning, painful, weight-like pressure. Very weak and faint. Nausea during gestation. Water fills the patient up.

Abdomen very sensitive to pressure; internal feeling of rawness and soreness. Pain and soreness over liver. Colic after drinking. Oppression and burning sensation in chest. Difficult respiration. Aphonia. Heat, throughout chest. Chest feels heavy; stitches, with heart feeling too large and palpitating pleuritic exudations. Flushes of heat in chest. Oppression, as of a load on chest. Dyspnea, relieved by sitting up.

Sepia Officinalis

Nausea at smell or sight of food, worse lying on side. Tobacco dyspepsia. Band of pain about four inches wide encircling hypochondria. Hiatal hernia. Burning in pit of stomach. Acidic dyspepsia with bloated abdomen, sour eructation. Liver sore and painful. Feeling of relaxation and bearing down in abdomen.

Dry, fatiguing cough, apparently coming from stomach. Rotten-egg taste with coughing. Oppression of chest morning and evening. Dyspnea; worse, after sleep; better, rapid motion. Violent, intermittent cardiac palpitation. Beating in all arteries. Tremulous feeling with flushes. Coldness between shoulders.

Graphite

Rotten odor from mouth. Breath smells like urine. Salivation. Sour eructation. Nausea and vomiting after each meal. Pressure in stomach. Burning in stomach. Eructation difficult. Constrictive pain in stomach. Recurrent gastralgia. Hiatal hernia. Stomach pain is temporarily relieved by eating, hot drinks especially milk and lying down.

Fullness and hardness in abdomen. Croaking in abdomen. Inguinal region sensitive, swollen, hernia. Constriction of chest; spasmodic asthma, suffocative attacks. Pain in middle of chest, with cough, scraping and soreness.

Calcarea Carbonica

Swelling of tonsils and submaxillary glands; stitches on swallowing. Parotid fistula. Frequent sour eructation; sour vomiting. Heartburn and loud belching. Cramps in stomach. Swelling over pit of stomach. Pain in epigastric region to touch. Hiatal hernia. Liver region painful when stooping. Cutting in abdomen; swollen abdomen. Inguinal and mesenteric glands swollen and painful. Increase of fat in abdomen. Umbilical hernia.

Tickling cough. Extreme dyspnea. Painless hoarseness; worse in the morning. Bloody expectoration. Suffocating spells; tightness, burning and soreness in chest. Chest very sensitive to touch, percussion, or pressure. Tachycardia at night and after eating, with feeling of coldness. Pain between shoulder-blades, impeding breathing.

Silicia Tera

Stinging pain on swallowing. On swallowing food, it easily gets into posterior nares. Sour eructation after eating. Pit of stomach painful to pressure. Pain or painful cold feeling in abdomen, better external heat. Hiatal hernia. Inguinal glands swollen and painful. Inguinal hernia. Hepatic abscess. Slow recovery after pneumonia. Cough and sore throat, with expectoration of little granules like shot, which, when broken, smell very offensive. Stitches in chest through to back.

Rhus Toxicodendron

Sticking pain on swallowing. Nausea, vertigo, and bloated abdomen after eating. Pressure as from a stone. Violent pains, relieved by lying on abdomen. Swelling of inguinal glands. Pain in region of ascending colon. Colic, compelling to walk bent. Excessive distention after eating.

Tickling behind upper sternum. Dry, teasing cough. Hemoptysis from overexertion; blood bright red. Hiatal hernia. Hoarseness from overtraining voice. Oppression of the chest – cannot get breath with sticking pains. Bronchial coughs in old people, worse on awaking and with expectoration of small plugs of mucus. Pain between shoulders on swallowing. Pain and stiffness in small of back.

Belladona

Throat feels constricted; difficult deglutition; worse, liquids. Sensation of a lump. Esophagus dry; feels contracted. Spasms in throat. Continual inclination to swallow. Scraping sensation. Muscles of deglutition very sensitive. Hypertrophy of mucous membrane. Loss of appetite. Spasmodic pain in epigastrium. Constriction: pain runs to spine. Nausea and vomiting. Hiatal hernia. Spasms of stomach. Empty retching. Spasmodic hiccough. Uncontrollable vomiting.

Abdomen distended, hot, extreme sensitiveness to touch, bedclothes etc.

Tickling, short, dry cough. Larynx feels sore. Respiration oppressed, quick, unequal. Cheyne-Stokes respiration. Pain in stomach expectoration of blood. Stitches in chest when coughing. Larynx very painful; feels as if a foreign body were in it, with cough. Violent palpitation, reverberating in head, with labored breathing. Palpitation from least exertion. Throbbing all through body. Dichrotism. Heart seemed too large. Rapid but weakened pulse.

Bryonia Alba

Dryness, sticking on swallowing, scraped and constricted. Nausea and faintness. Vomiting of bile and water immediately after eating. Hiatal hernia. Stomach sensitive to touch. Pressure in stomach after eating, as of a stone. Soreness in stomach when coughing. Liver region swollen, sore, tensive. Burning pain, stitches; worse, pressure, coughing, breathing. Tenderness of abdominal walls. Soreness in larynx and trachea. Dry, hacking cough from irritation in upper trachea. Frequent desire to take a long breath; must expand lungs. Difficult, quick respiration. Cough, with feeling as if chest would fly to pieces; presses his head on sternum; must support chest. Croupous and pleuro-pneumonia. Heaviness beneath the sternum extending towards the shoulder. Stitches in cardiac region. Angina pectoris.

Lycopodium Clavatum

Food and drink regurgitate through nose. Inflammation of throat, with stitches on swallowing. Swelling and suppuration of tonsils. Diphtheria. Tubercular laryngitis, especially when ulceration commences. Dyspepsia. Sour eructation. Incomplete burning eructation rise only to pharynx there burn for hours. Weakness of digestion. Bulimia, with much bloating. After eating, pressure in stomach, with bitter taste in mouth. Eating ever so little creates fullness. Hiccough. Immediately after a light meal, abdomen is bloated, full. Constant sense of fermentation in abdomen. Hernia, right side. Hiatal hernia. Liver sensitive. Brown spots on abdomen. Dropsy (hepatic disease). Hepatitis, atrophic from of nutmeg liver.

Arsenicum Album

Throat swollen, edematous, constricted, burning, unable to swallow. Diphtheritic membrane dry and wrinkled. Nausea, retching, vomiting, after eating or drinking. Anxiety in pit of stomach. Burning pain. Heartburn. Long-lasting eructation. Vomiting of blood, bile, green mucus, or brown-black mixed with blood. Stomach extremely irritable. Gastralgia from slightest food or drink. Malignant symptoms. Everything swallowed seems to lodge in the esophagus, which seems as if closed and nothing would pass. Gnawing, burning pains in abdomen – relieved by heat. Liver and spleen enlarged and painful. Ascites and anasarca. Abdomen swollen and painful.

Unable to lie down; fears suffocation. Air-passages constricted. Asthma worse midnight. Burning in chest. Suffocative catarrh. Cough worse after midnight; worse lying on back. Darting pain through upper third of right lung. Wheezing respiration. Hemoptysis with pain between shoulders; burning heat all over.

Abrotanum

Undigested stool. Cutting gnawing pain in stomach. Stomach feels as if swimming in water; feels cold. Gnawing hunger and whining. Indigestion, with vomiting of large quantities of offensive fluid. Hard lumps in abdomen. Hiatal hernia. Distended. Alternate diarrhea and constipation. Ascarides. Oozing from umbilicus. Hiatal hernia.

Impeded respiration. Dry cough following. Pain across chest. Back lame, weak, and painful. Pain in lumbar region extending along spermatic cord. Pain in sacrum, with hemorrhoids.

Abis Nigra

Pain in stomach always comes on after eating. Sensation of a lump that hurts, as if a hard-boiled egg had lodged in cardiac end of stomach; continual distressing constriction just above the pit of the stomach, as if everything were knotted up. Hiatal hernia. Offensive breath. Eructation.

Chest painful sensation, as if something were lodged in the chest and had to be coughed up; lungs feel compressed. Cannot be fully expanded. Worse coughing: waterbrash succeeds cough. Choking sensation in throat. Dyspnea; worse lying down; sharp, cutting pain in heart; heart’s action heavy and slow; tachycardia, bradycardia.

Antimonium Tartaricum

Difficult deglutition of liquids. Vomiting in any position, excepting lying on right side. Nausea, retching, and vomiting, especially after food, with deathly faintness and prostration. Hiatal hernia. Nausea produces fear; with pressure in precordial region, followed by headache with yawning and lachrymation and vomiting.

Spasmodic colic, much flatus. Pressure in abdomen. Cholera morbus. Diarrhea in eruptive diseases. Hoarseness. Great rattling of mucus, but very little is expectorated. Velvety feeling in chest. Burning sensation in chest, which ascends to throat. Rapid, short, difficult breathing; seems as if he would suffocate; must sit up. Emphysema of the aged. Coughing and gaping consecutively. Bronchial tubes overloaded with mucus. Cough excited by eating, with pain in chest and larynx. Edema and impending paralysis of lungs. Much palpitation, with uncomfortable hot feeling. Pulse rapid, weak, trembling. Dizziness, with cough. Dyspnea relieved by eructation.

Pulsatilla Pratensis

Eructation. Bitter taste, diminished taste of all food. Pain as from subcutaneous ulceration. Heartburn. Dyspepsia, with great tightness after a meal; must loosen clothing. Hiatal hernia. Vomiting of food eaten long before. Pain in stomach an hour after eating. Weight as from a stone. Perceptible pulsation in pit of stomach. All-gone sensation, especially in tea drinkers. Waterbrash, with foul taste in the morning.

Abdomen painful, distended, loud rumbling. Colic, with chilliness in evening. Great soreness of epigastrium. Pain as from ulcer in middle of chest. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation. Smothering sensation on lying down.

Thuja Occidentalis

Complete loss of appetite. Rancid eructation after fat food. Cutting pain in epigastrium. Hiatal hernia. Flatulence; pain after food; sinking sensation in epigastrium before food; thirst. Tea-drinking dyspepsia.

Abdomen distended, indurations in abdomen. Chronic diarrhea, worse after breakfast. Discharges forcibly expelled, gurgling sound. Brown spots. Flatulence and distension; protruding here and there. Rumbling and colic. Movements as of something living, without pain. Dry, hacking cough, with pain in pit of stomach. Stitches in chest; worse, cold drinks. Papilloma of larynx. Chronic laryngitis.

Carbo vegitablis

Disintegration and imperfect blood circulation. Eructation, heaviness, fullness, and sleepiness; tense from flatulence, with pain; worse lying down. Eructation after eating and drinking. Temporary relief from belching. Rancid, sour, or putrid eructation. Waterbrash, asthmatic breathing from flatulence. Nausea in the morning. Burning in stomach, extending to back and along spine. Contractive pain extending to chest, with distention of abdomen. Faint gone feeling in stomach, not relieved by eating. Crampy pains forcing patient to bend double. Hiatal hernia. Sensitiveness of epigastric region. Digestion slow; food putrefies before it digests. The simplest food distresses. Epigastric region very sensitive.

Pain in liver. Cough with itching in larynx; spasmodic with gagging and vomiting of mucus. Occasional spells of long coughing attacks, with burning in chest; worse in evening, in open air, after eating and talking. Spasmodic cough, bluish face, offensive expectoration, neglected pneumonia.

Robinia

Voice reduced to a whisper and efforts to cry exceedingly feeble, suddenly ceasing with a slight sigh, as if from exhaustion. Feeble respiration. Constant eructation of a very sour fluid. Heartburn and acidity of stomach at night. Regurgitation of acid and bitter substances, everything turns to acid. Nausea for three hours, followed by vomiting of an intensely sour fluid. Nausea and attempts to vomit when placed in sitting posture. Vomiting of ropy mucus; tinged with blood; retching and epigastric pains. Hiatal hernia. Constant dullness in epigastric region, with cutting pains in stomach and bowels and a good deal of rumbling.

Chamomilla

Eructation, foul. Nausea after coffee. Sweats after eating or drinking. Tongue yellow; taste bitter. Bilious vomiting. Acid rising; regurgitation of food. Bitter, bilious vomiting. Pressive gastralgia. Abdomen distended. Griping in region of navel, and pain in small of back. Flatulent colic, after anger, with red cheeks and hot perspiration. Hepatic colic. Hiatal hernia. Acute duodenitis.

Kali Bichromicum

Voice hoarse. Metallic, hacking cough. Profuse, yellow expectoration, very glutinous and sticky, coming out in long, stringy, and very tenacious mass. Tickling in larynx. Catarrhal laryngitis cough has a brassy sound. True membranous croup, extending to larynx and nares. Cough, with pain in sternum, extending to shoulders. Pain at bifurcation of trachea on coughing; from mid-sternum to back. Hiatal hernia.

Nausea and vomiting immediately after eating. Feels as if digestion had stopped. Dilatation of stomach. Gastritis. Round ulcer of stomach. Stitches in region of liver and spleen and through to spine. Cutting pain in abdomen, soon after eating. Chronic intestinal ulceration. Soreness in right hypochondrium, fatty infiltration of liver and increase in soft fibrous tissue. Painful retraction, soreness and burning.

PS: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

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None of above-mentioned medicine(s) is/are not the full/complete treatment, but just hints for treatment; every patient has his own constitutional medicine along with these mentioned above.

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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS) ; senior research officer Dnepropetrovsk state medical academy Ukraine; is a leading Homeopathic physician practicing in Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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