Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

ARSHA (HAEMORRHOIDS / PILES)

 

INTRODUCTION

Arsha is defined that the mass which is formed in Guda by pathological involvement of Twak, Mamsa and Meda. Moreover it is also opined by Charaka that a projection which is produced in Guda is called Arsha, while in other places of body is known as Adhimansa.

Arsha (Haemorrhoids) has been primarily classified into two types like Shushka and Ardra, Sahaja (congenital) and Jatottara (origi­nated later on due to its own causes). Consid­ering Doshic dominance, it is again classified into four varieties i.e. Vataja, Pittaja, Kaphaja & Shonitaja. Two or three Doshas together can produce mixed types of Arsha. Four kinds of treatments have been mentioned for Arsha i.e. Shastrakarma (surgical treatment), Agnikarma (cauterization), Ksharkarma (cauterization with alkali) and Shaman Chikitsa (medicines).

Case Definition:

Feeling of external mass in anal region associated with or without bleeding and pain. It usually occur at the level of Ano-rectal ring and prolapsed through anus at 3, 7 and 11 o’clock positions.

Various Presentations:

According to the predominance of particular Dosha, following presentations of the disease may be found.

 

Table 13.1: Types of Arsha with their characteristics

 

Features

Vatika

Paittika

Kaphaja

Raktaja

Morphology of Pile mass

Wrinkled, hard, rough, dry, dusky red coloured pile mass, Shape like Karpasa Phala or Kadamba Puspa

Soft, flabby and delicate, red yellow black or blue coloured pile mass, Shape like Jalauka or Yava

Large sized, protuberant, smooth, rigid and benumbed, pale or white coloured pile mass shape like Karira, Panasa Ashti, Gaustana

Shape like Vata, Gunja seed, Vidruma

Discharge

Absent

Foul smelling thin yellowish red discharge

continuous and profound discharge of tawny, whitish or reddish and slimy fluid

-

Bleeding

-

Present

-

Severe

Vega

Retention of flatus, urine and feces

-

-

-

 

Colour of Twak, Nakha, Mukha, Netra, Mala and Mutra

Blackish

Yellowish or greenish

Whitish

-

On palpation

-

Tender

Painless

Hot

Associated Features

Colicky, pricking pain, twitching, tingling

Burning sensation, itching, pricking pain and tendency to suppuration

Thick & long standing swelling, excessive itching

Loss of strength & valour, senses become weaker, Immunity decreases

 

 

 

 

Differential Diagnosis:

  • Rectal prolapse (Gudabhramsa)

  • Fissure-in-ano (Parikartika)

  • Ulcerative colitis and Crohn’s disease

  • Condyloma Acuminata

  • Proctitis

  • Ano-rectal warts

  • Ano-rectal abscess

  • Rectal polyp

  • Malignant tumours (Arbuda

 

LEVEL 1: AT SOLO AYURVEDA PHYSICIAN’S CLINIC/PHC

Clinical Diagnosis: On the basis of history and clinical presentations, patient can be diagnosed provisionally as case of Arsha.

Investigations: At this level, no specific test is needed to be performed.

Treatment: In the initial stage, when the patient is having mild features of Arsha, along with diet restriction, two or more of following drugs may be given:

 

 

Table 13.2: Medicines at level 1 for Arsha

 

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Haritaki Churna1

Churna

2-4 gm

Empty stomach / bed time or early morning

2-3 weeks

Luke warm water

Triphala Churna2

Churna

2-4 gm

Empty stomach / bed time or early morning

1-2 weeks

Luke warm water

Draksha3

Dried fruit

10-20 gm

Empty stomach / bed time or early morning

1-2 weeks

Luke warm water

 

 

Aragvadha4

Churna

2-4 gm

Empty stomach / bed time or early morning

1-2 weeks

Luke warm water

Castor oil5

Oil

10-20 ml

Empty stomach / bed time or early morning

1-2 weeks

Luke

warm water

Avipattikara

Churna6

Churna

5-10 gm

Empty stomach / bed time or early morning

2-5 days

Water

Piplayadi Ghrita7

Ghrita

5 gm

Twice daily before meals

1-2 weeks

Luke warm water

Takrarishta8

Arishta

10 -20 ml

Twice daily after meals

1-2 weeks

Equal quantity of water

Abhayarishta9

Arishta

10 -20 ml

Twice daily after meals

1-2 weeks

Equal quantity of water

Surana Vataka10

Vataka

500 mg

Twice daily after meals

1-2 weeks

Luke warm water

Eranda Bhristha Haritaki

Churna

3-5 gm

Empty stomach / bed time or early morning

2-5 days

Luke warm water

 

 

 

Local Application:

  • Parishek: Arka11, Eranda12, Bilvapatra Kwatha13

  • Avagaha: Triphala Kvatha14, Panchavalkala Kwatha

  • Dhoopana: Arkamoola15 and Shamipatra16

  • Abhyanga: Jatyadi Taila17, Murivenna

Matra Basti: Jatyadi Taila Pippalyadi Taila

Patha-Apathya (Diet and life style):

Do’s -

  • Ahara: Green gram, fruits like Draksha, orange juice, sweet lemon juice, musk melon, salads prepared from cabbage, cucumber, carrot,

 

spinach and vegetables prepared from green leafy vegetables, Surana, Patola, gourd, intake of sufficient quantity of warm water.

  • Vihara: Regular exercises like walking, jogging, outdoor games, following daily & seasonal regimen properly.

Don’ts -

  • Ahara: Heavy food articles and preparation, green peas, black eyed beans, yellow gram, raw vegetables and salads, refined foods such as white flour, cabbage, cauliflower, brinjal, peas, potato.

  • Vihara: Jobs involving sedentary activities, continuous standing,

sitting for long durations on hard seats, continuous cycling or bike riding etc.

Referral criteria:

  1. Cases not responding to the therapy

  2. All case of moderate to severe bleeding per rectum

  3. Cases with complications

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

Clinical diagnosis: The diagnosis is made on the basis of criteria mentioned in level-1 for fresh cases. The case referred from level-1 or

fresh case must be evaluated thoroughly for any complication.

Examination:

  • Per rectal examination

  • Proctoscopic examination

Investigations:

  • CBC

  • Special investigations like ECG, Chest X-Ray may also be required for surgical fitness of patients who requires operation.

Treatment: Treatment given in level-1 may be continued. Following medicines may be added; patient may be kept under observation while prescribing these kinds of medicines.

 

Table 13.3: Medicines at level 2 for Arsha

 

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Arogyvardhini Vati18

Vati

1-2 Vati

At bed time or early morning empty stomach

1-2 weeks

Luke warm water

Arshakuthara Rasa19

Vati

1-2 Vati

At bed time or early morning empty stomach

1-2 weeks

Luke warm water

Kankayana Vati20

Vati

1-2 Vati

At bed time or early morning empty stomach

1-2 weeks

Luke warm water

Phalatrikadi Kwatha21

Kwatha

20-40 ml

Empty stomach / twice a day

1-2 weeks

-

Erandamula Kwatha22

Kwatha

20-40 ml

Empty stomach / twice a day

1-2 weeks

-

 

 

 

 

Pathya - Apathya (Diet and life style education): Same as level 1

Referral criteria:

  • Patients with severe bleeding per rectum.

  • Patients having severe anaemia, who needs blood transfusion.

  • Piles cases associated with other disorders like heart disease, uncontrolled BP, DM, HIV positive, HbsAg positive, VDRL positive, malignancy etc.

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT

HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS

Clinical Diagnosis: Same as level 1: For a fresh case reporting directly

Investigations: Same as level 2

Treatment: At this level, in addition to treatment options of level 1 and 2, the following treatment options should also be tried.

Kshara Karma (potential cauterization)

  1. Kshara Pratisarana

  2. Kshara Sutra ligation

  3. Agni Karma (direct cauterization)

  4. Shastra Karma (surgical management)

  5. Classical Virechana Karma

Pathya - Apathya (Diet and life style education): Same as level 1

 

REFERENCES

 

 

  1. Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.1, pg. 31.

  2. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.7, pg. 15.

  3. Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 3, pg. 21.

  4. Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.1, pg. 5.

  5. Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 3, pg. 23.

  6. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.7, pg. 2.

  7. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.6, pg. 29.

  8. Agnivesha, Charaka Samhita, Chakrapani commentary, Yadavji Trikamaji Acharya, editor, Varanasi: Chaukhambha Surbharti

 

Prakashana, Reprint 2011. Chikitsasthana, Arsha Chikitsa Adhyaya (14/72-75), pg. 505.

  1. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.1, pg. 1.

  2. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.12, pg. 34).

  3. Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1, pg. 6.

  4. Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 3, pg. 23.

  5. Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Fam­ily Welfare, Govt. of India, Part 1 Volume 3 (15).

  6. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.7, pg. 15.

  7. Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1, pg. 6.

  8. Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 6, pg. 62.

  9. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.8, pg. 17.

  10. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.20, pg. 4.

  11. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 2 Vol.16, pg. 2.

  12. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.12, pg. 5.

  13. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 2 Vol.4, pg. 16.

  14. Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3, pg. 23.