What is Arsha (Hemorrhoids/Piles) and it’s Ayurvedic Management
Abstract
ARSHA or PILES or HEMORRHOIDS are very common conditions which usually affect both the genders. The risks are increased after the age of 50 years and are rare under the age of 14 years. Piles derived from the word pila which means ball or mass like and the word haemorrhoid is derived from the greece word which means bleeding or flowing. There are many treatment options available from conservative management, para surgical to surgical treatment and ayurveda can give better Remedies for hemorrhoids. In this article we will discuss the haemorrhoidal management according to the modern as well as according to the Ayurveda.
Introduction
Hemorrhoids are the swollen, bulging veins that develop inside and outside the anus and rectum. They can be unpleasant and uncomfortable, and they might result in rectal bleeding. In ancient Ayurvedic texts, the illness that plagues a person like an enemy is referred to as Arsha. Dry hemorrhoids can be distinguished from external hemorrhoids by the presence of protrusion of mucosal folds without bleeding. Wet hemorrhoids have a kapha-vata predominance and are related to internal hemorrhoids, which bleeds frequently.
Classification
There are three types of Haemorrhoids
- Internal hemorrhoids
- External hemorrhoids
- Externo-internal hemorrhoids
1. Internal Haemorrhoids
- This involves the upper 2/3rd of the mucosal line, above the dentate line in the superior Haemorrhoidal plexuses.
2. External Hemorrhoids
- It is formed by inferior and middle hemorrhoidal plexuses. External hemorrhoids occur beneath the cutaneous lining of the lower 1/3rd part of the anal canal
3. Externo internal hemorrhoids
- After a long duration, sufficiently enlarged the internal and external haemorrhoidal plexus protrudes at the anal orifice.
Causes
There are many causes for the occurrence of the Hemorrhoids
- Heredity
- Morphological
- Anatomical
- Physiological
- Relaxation of Sphincter
- Improper Dietary habits
- Dietary habits
- As a secondary cause of other diseases.
Number and position of piles
Primary hemorrhoids: There are 3 main primary hemorrhoids. The 2 masses are on the right side and also one on the left side. The superior haemorrhoidal artery outside the rectal wall divides into left and right branches. The three branches form the haemorrhoidal plexus, two on the right side at 7 o’clock position and one on the left side at 3 o’clock position when examined in the lithotomy position. Some additional pile masses are also seen in the 1 and 5 o’clock positions also.
Degree of the hemorrhoids
- First Degree
- Second Degree
- Third Degree
- Fourth Degree
1. First Degree
- At the time of the defecation, the pile mass protrudes down in the lumen of the anal canal but does not at the outside of the anal canal.
2. Second Degree
- During defecation the pile mass gets larger in size and itdescends down outside the anal orifice and it is itself reduced in the anal canal after the act of straining is over.
3. Third Degree
- At the time of defecation,the pile mass protrudes at the anal orifice, in this it does not get reduced by itself and needs reduction by the digital manipulation. Even with the slightest straining or exertion it may prolapse again and needs digital reduction.
4. Fourth Degree
- This is the most advanced case, In this the internal haemorrhoids and External hemorrhoids get larger in size and get permanently prolapsed at the orifice and cannot return back to the anal canal
Sign and Symptoms
- Bleeding
- Discharge
- Pain
- Secondary anemia
- Pruritus
- Prolapse
- Hard lumps near anus
- Tenderness
Diagnosis
- History taking
- Inspection
- Palpation
- Proctoscopy
- Sigmoidoscopy
Complications
- Severe bleeding
- Strangulation
- Ulceration
- Gangrene
- Fibrosis
- Portal pyaemia
Modern Management
- Analgesics
- NSAIDS
- Sclerotherapy
- Manual anal dilation
- Elastic band ligation
- Cryosurgery
- Photocoagulation
- Hemorrhoidectomy: Surgery to remove big external hemorrhoids or internal hemorrhoids that have prolapsed.
- Internal hemorrhoid stapling: A stapling device is used to remove an internal hemorrhoid. Or it pulls and retains a prolapsed internal hemorrhoid back into your anus.
Ayurvedic Overview
The person who is having poor digestive capacity and also gets indulged in consuming the Ahita Aahar and vihara in the long run, ends up with a disease called Arsha. Arsha has been placed under the Mahavyadhi. Arshas are the muscular enlarged masses in the three gudavalli (Pravahini, Visarjini and samvarini). The vitiated doshas (Vata, pitta, kapha, sanipaataja and rakta) circulate through the vascular channels, Twak (Skin), mamsa (Muscle), meda (Fat) and they reach to the gudavallis and produce the muscular enlarged masses, the arsha.
The Doshas which get vitiated with such activities will move in downward direction and vitiate the Guda (rectum and anal canal) there in producing a mass or growth. These Mamsa Ankura (growths) are called Arsha.
Classification of the Arshas
इह खल्वग्निवेश! द्विविधान्यर्शांसि- कानिचित् सहजानि, कानिचिज्जातस्योत्तरकालजानि|
तत्र बीजं गुदवलि बीजोप तप्तमायतनमर्शसां सहजानाम्|
तत्र द्विविधो बीजोपतप्तौ हेतुः- मातापित्रोरपचारः, पूर्वकृतं च कर्म; तथाऽन्येषामपि सहजानां विकाराणाम्|
तत्र सहजानि सह जातानि शरीरेण, अर्शांसीत्यधिमांसविकाराः||५||
- Doshaj- Vataja, Pittaja, Kaphaja, Sannipataj, raktaja (Acquired)
- Sahaj Arsha (Congenital)
Congenital hemorrhoids are produced by beeja dosha vitiation (deformity in sperm and ovum), specifically the section of the anal canal or anal sphincters. Two types of variables contribute to the vitiation of the beeja dosha:
Parents’ poor nutrition and regimen, Individuals’ sinful behaviors from their previous lives. All other congenital abnormalities in the human body are caused by these two groups of causal causes. Sahaja is a condition that manifests with the appearance of body parts since birth.
1. Vataja Arshas
तेषामयं विशेषः– शुष्कम्लान कठिन परुष रूक्ष श्यावानि, तीक्ष्णाग्राणि, वक्राणि, स्फुटित मुखानि, विषम विसृतानि, शूलाक्षेपतोदस्फुरण चिमिचिमासंहर्ष परीतानि, स्निग्धोष्णोपशयानि, प्रवाहिका ध्मान शिश्न वृषण बस्ति वङ्क्षण हृद्ग्रहाङ्गमर्द हृदय द्रव प्रबलानि, प्रतत विबद्ध वात मूत्र वर्चांसि, ऊरु कटी पृष्ठ त्रिक पार्श्व कुक्षि बस्ति शूल शिरोऽभिताप क्षवथूद्गार प्रतिश्याय कासोदावर्तायाम शोष शोथ- मूर्च्छारोचक मुखवैरस्य तैमिर्य कण्डू नासा कर्ण शङ्ख शूल स्वरोपघातकराणि, श्यावारुण परुष नख नयन वदन त्वङ्मूत्र पुरीषस्य वातोल्बणान्यर्शांसीति विद्यात्||११||
The Signs and Symptoms of Vataja Arshas Include
- Hemorrhoids are dry, wrinkled, hard, rough, unctuous, and grayish in color, they are sharp, pointed and are curved and have fissures on the surface, also scattered irregularly. Excessive hemorrhoids cause discomfort, cramping toda (piercing pain), itching, numbness, and tingling sensations. In this condition, unctuous and spicy foods provide relief. The patient has diarrhea, abdominal distension, and genital, testicular, urinary bladder, pelvic, and cardiac stiffness; he also has excessive malaise and palpitation.
- His flatus, urine, and feces are always obstructed. He has sneezing, udavarta (mis-peristalsis), itching, pain in the nose, ears, and temporal region, lethargy, eructation, coryza, cough, edema, fainting, anorexia, distaste in mouth, timira (vision impairment) and voice impairment. Greyish, reddish, and harsh nails, eyes, face, skin, urine and stool
2. Pittaja Arshas
मृदु शिथिल सुकुमाराण्य स्पर्शसहानि, रक्त पीत नील कृष्णानि, स्वेदोपक्लेद बहुलानि, विस्र गन्धि तनु पीत रक्त स्रावीणि, रुधिरवहानि, दाह कण्डू शूल निस्तोद पाकवन्ति, शीतोपशयानि, सम्भिन्नपीत हरित वर्चांसि, पीत विस्रगन्धि प्रचुर विण्मूत्राणि, पिपासा ज्वर तमक सम्मोह भोजन द्वेषकराणि पीत नख नयन त्वङ्मूत्र पुरीषस्य पित्तोल्बणान्यर्शांसीति विद्यात्||१४||
On palpation, the pile mass will be soft, flabby, fragile, and gentle. Hemorrhoids can be red, yellow, blue, or black in color.They are characterized by profuse perspiration and sticky discharge. Visra (raw-meat-smelling) discharge from the hemorrhoids mass is thin, yellow or red. Hemorrhoids are causing bleeding. It is characterized by burning, itching, soreness, pricking pain, and suppuration. The symptoms are relieved by cold objects. The patient passes stool which is loose, yellow or green. Urine and feces are excreted in enormous volumes by the patient and are yellow in color, smelling like raw meat. The patient presents features like severe thirst, fever, asthma, fainting, and a dislike for certain meals.
3. Kaphaja Arshas
तत्र यानि प्रमाणवन्ति, उपचितानि, श्लक्ष्णानि, स्पर्शसहानि, स्निग्ध श्वेत पाण्डु पिच्छिलानि, स्तब्धानि, गुरूणि, स्तिमितानि, सुप्त सुप्तानि, स्थिर श्वयथूनि, कण्डू बहुलानि, बहुप्रतत पिञ्जर श्वेतरक्त पिच्छा स्रावीणि, गुरु पिच्छिल श्वेत मूत्र पुरीषाणि, रूक्षोष्णोपशयानि, प्रवाहिकातिमात्रोत्थानवङ्क्षणानाहवन्ति, परिकर्तिका हृल्लास निष्ठीविका कासारोचक प्रतिश्याय गौरव च्छर्दि मूत्रकृच्छ्र शोष शोथ- पाण्डु रोग शीतज्वराश्मरी शर्करा हृदयेन्द्रियोपलेपास्य माधुर्य प्रमेहकराणि, दीर्घकालानुबन्धीनि, अतिमात्रमग्निमार्दव क्लैब्यकराणि, आम विकार प्रबलानि, शुक्ल नख नयन वदन त्वङ्मूत्रपुरीषस्य श्लेष्मोल्बणान्यर्शांसीति विद्यात्||१७||
The hemorrhoids are huge, bloated, smooth and painless to the touch. They are unctuous, whitish, pale white, slimy, stiff, heavy, inflexible, have constant oedema, and itches excessively. The flow from hemorrhoids is excessive and continuous, white or red in color, and slimy. The patient’s urine and stool are thick, slimy and white. Ruksha (unctuous) and heat therapy may relieve symptoms. Distening in the lower pelvic region, the patient has a primal urge to pass stool. The patient complains of pain in anus, cough, anorexia, cold, nausea, excessive spitting, heaviness, vomiting, edema, dysuria, lethargy and anemia. Fever with cold, stone and gravels in the genitourinary tract, a sensation that the heart and sense organs are covered with sticky material, a sweet taste in the mouth, and prameha (obstinate urinary diseases including diabetes). As a result, digestive power is suppressed. They’re linked to acute disorders produced by ama (a byproduct of poor digestion and metabolism).
The nails, eyes, face, skin, urine and stools all turn into white colour.
4. Sannipataj Arshas
Due to the vitiation of the three doshas. Mixed symptoms of the doshas (vata, pitta, kapha) are present.
5. Raktaja Arshas
The symptoms of the raktaja arshas mimic the symptoms of the pittaja arshas but in a serious form.
Location of the Arshas
- सर्वेषां चार्शसां क्षेत्रं- गुदस्यार्ध पञ्चमाङ्गुलावकाशे त्रिभागान्तरास्तिस्रो गुदवलयः क्षेत्रमिति; केचित्तु भूयांसमेव देशमुपदिशन्त्यर्शसां- शिश्नमपत्यपथं गल तालु मुख नासिका कर्णाक्षि वर्त्मानि त्वक् चेति|
- तदस्त्यधि मांस देशतया, गुदवलिजानां त्वर्शांसीति सञ्ज्ञा तन्त्रेऽस्मिन्|
- सर्वेषां चार्शसामधिष्ठानं- मेदो मांसं त्वक् च||६||
The hemorrhoids are placed four and a half angulas (or around 8-10 cm) below the rectum and anal canal. This area is divided into three sections by three sphincters (guda vali). Other places of arshas (hemorrhoids) in the body where excessive and unnatural muscle tissue growth occurs include the pudendum, female genital system, throat, palate, mouth, nose, ears, eyelids, and skins. However, arsha occurring in the anal region are only termed arsha (hemorrhoids) in this chapter. Medas (fatty tissue), mamsa (muscular tissue), and tvaka (skin and mucous membrane) are the adhishthana (involved pathological tissue elements) of all arshas.
Purvaroopa (premonitory) Signs and Symptoms of Hemorrhoids
- विष्टम्भोऽन्नस्य दौर्बल्यं कुक्षेराटोप एव च|
- कार्श्यमुद्गारबाहुल्यं सक्थिसादोऽल्पविट्कता||२१||
- ग्रहणीदोषपाण्ड्वर्तेराशङ्का चोदरस्य च|
- पूर्वरूपाणि निर्दिष्टान्यर्शसामभिवृद्धये||२२||
Gurgling sound in lower abdomen, Delayed digestion, weakness, emaciation, frequent eructation, anemia, pain in thighs, voiding less stool, fear of the manifestation of udararoga (obstinate abdominal disorders including ascites)-these are the warning signs and symptoms of hemorrhoids.
Shapes of the Arsha (Hemorrhoids)
- सर्षप मसूर माष मुद्गमकुष्ठ कयव कलाय पिण्डिटिण्टिकेर केबुक तिन्दुक कर्कन्धु काकणन्तिका बिम्बी बदर करीरोदुम्बर- खर्जूर जाम्बव गोस्तनाङ्गुष्ठ कशेरु शृङ्गाटक शृङ्गीदक्ष शिखि शुकतुण्ड जिह्वा पद्ममुकुलकर्णिका संस्थानानि सामान्याद्वात पित्त कफ प्रबलानि||१०||
Hemorrhoids resemble mustard, masura, masha, mudga, kushtaka (Saussurea lappa CB. Clarke), yava (barley), kalaya (green pea), pindi, tundikeri (karira fruit), kebuka, tinduka, karkandhu, kakanantika, bimbi badara, karira, udumbara (Ficus race All of the above shapes are the typical shapes of hemorrhoids induced by excessive vata, pitta, and kapha aggravation.
Ayurvedic management
General treatment
- भृष्टैः शाकै र्यवागूभिर्यूषैर्मांसरसैः खडैः|
- क्षीर तक्र प्रयोगैश्च विविधैर्गुदजाञ्जयेत्||२४६||
Hemorrhoids should be treated by using various varieties of fried vegetables, thick gruel, vegetable soup, meat soup, khada (a sour preparation), milk, and curd.
- Aushadi (Medicines)
- Kshar karma (Chemical cauterization)
- Agni karma (Thermal cauterization)
- Shastra karma (Haemorrhoidectomy)
- Kshara Sutra (Excision of the piles mass by the medicated thread)
Aushadhi: The Arshas that are recent, have minimal symptoms, and pose no consequences can be effectively controlled by medical therapy.
1. Ksara karma
- The hemorrhoids with smooth surfaces, deep locations that are nevertheless easily visible, and larger bases respond well to Kshara Karma treatment.
2. Agni Karma
- Agni Karma can be used to treat Arsha that have a broader surface, are more fixed and less smooth.
3. Shastra Karma
It works well for hemorrhoids with a narrow base, a tendency to bleed, and a noticeable appearance.
4. Kshar sutra
Acharya sushruta has described the ligation of the kshar sutra for excision of the hemorrhoids. The thread used to treat various anorectal ailments is known as Kshar Sutra or Alkaline Medicated Thread. This thread is made with high strength ayurvedic herbs and can be utilized in a variety of ways. In this the patient is placed in a lithotomy position. The thread is delicately wrapped around the mass of heaps. The thread separates the excess mass in about a week, and pus is also evacuated.
Line of Treatment as per dosha
- स्निग्धशीतं हितं वाते रूक्षशीतं कफानुगे|
- चिकित्सितमिदं तस्मात् सम्प्रधार्य प्रयोजयेत्||१७५||
- पित्तश्लेष्माधिकं मत्वा शोधनेनोपपादयेत्|
- स्रवणं चाप्युपेक्षेत लङ्घनैर्वा समाचरेत्||१७६||
If there is vata vitiation in bleeding hemorrhoids, employ unctuous and chilly foods. Unctuous and cold-things are beneficial in cases of kapha vitiation in bleeding hemorrhoids. As a result, therapies should be delivered after taking these factors into account. If pitta and kapha doshas predominate, the patient should be given shodhana (elimination) therapy. However, bleeding should not be stopped instantly and instead, a suitable interval should be allowed. Fasting therapy might be administered to the patient
Herbal Remedies To Manage Arsha(Piles) By Planet Ayurveda
Planet Ayurveda a holistic ayurveda center. Ailments are handled at Planet Ayurveda, Using dietary changes and herbal treatments, Planet Ayurveda produces both traditional and patent herbal preparations. All herbal formulations are produced there under the supervision of MD Ayurveda specialists, and the facility is GMP and ISO certified. These prepared compositions are completely risk-free, all-natural, and safe for consumption. The formulations are created in a variety of forms, including tablets, capsules, syrups, oils, and powder. They also produce cosmetic and veterinary products, and they do it with the aid of ancient herbs.
Products
- Pile off Capsules
- Vara churna
- Triphala guggul
- Arshkuthar ras
- Suran vatak
- Nirgundi oil
Product Description
1. Pile off Capsules
These are the patent ayurvedic formulation which is manufactured by planet ayurveda in capsule form. It consists of Ayurvedic herbs such as Haridra (Curcuma longa), Haritaki (Terminalia chebula), Nagkehsar (Mesua ferrea), Sajjikhar (Sodium bicarbonate) etc. It helps in diminishing pile lumps, reducing inflammation, reducing discomfort and also stops bleeding.
Dosage : 1-2 Capsules twice daily, with plain water, after meals.
2. Vara churna
These are the patent ayurvedic formulations which are manufactured by planet ayurveda in powder form. This powder consists of the herbs like haritaki (Terminalia chebula), amalaki (Emblica officinalis) and bibhitaki (Terminalia bellerica). This powder aids with colon cleansing. The herbs are useful for treating a variety of diseases such as excessive cholesterol, visual issues, acidity, migraine, general weakness, and obesity.
Dosage : Two to three grams of this powder should be mixed with warm water and consumed in the evening time.
3. Arshkuthar ras
Arshkuthar ras is a traditional ayurvedic medicine that has been utilized for piles and is available in tablet form by Planet Ayurveda. It stimulates digestion and promotes bowel movements. Improves liver function as well as vascular strength. It aids in the reduction of pile bulk as well as the reduction of local swelling and inflammation. It has laxative qualities and helps in managing constipation.
Dosage – 1 tablet twice a day after meals.
4.Suran vatak
Suran vatak is a classical ayurvedic medicine which is manufactured by planet ayurveda in tablet form. It consists of chitrak (Plumbago zeylanica), Vibhitaki (Terminallia bellerica), Surana (Amorphophallus campanulatus), Vidanga (Emblica ribes), Bhallataka (Semecarpus anacardium) etc. It also acts as aphrodisiac, rejuvenative. It has a pungent and astringent taste that is light to digest and has a drying, harsh, or piercing quality. It is high in potency, which helps decrease the kapha and vata dosha in the body. It has a unique effect on the body which is helpful in the treatment of piles. It purifies the body and can be used to treat constipation, worm infestation, and abdominal colic pain.
Dosage: 2 tablets twice daily with warm water after a meal.
5. Nirgundi oil
Nirgundi oil is a traditional ayurvedic preparation based on the classic samhitas. Nirgundi oil is primarily composed of nirgundi kwath (Vitex negundo) which consists of herbs like manjishtha (Rubia cordifolia), Haridra (Curcuma longa), Kalihari (Gloriosa superba) etc. The characteristics of nirgundi oil will provide relief from itching and burning sensations. This oil is an excellent analgesic and anti-inflammatory, making it useful in the treatment of piles.
Dosage: It is to be applied on the affected area twice a day.
Conclusion
Ayurveda has a significant role to play in the management of this illness. Arsho roga, as defined in Ayurveda, comprises all ano rectal pathologies as well as haemorrhoidal pathology. Among the causes of this illness is primarily the inadequate digestive fire and compromised dietetics. These signs are still significant today when determining whether to treat hemorrhoids medically, paraoperatively, or surgically.
