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Arsha Chikitsa (view source)

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We shall ~~now~~ expound the ~~treatment~~ of hemorrhoids. Thus said Lord Atreya. [1-2]

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Now we shall expound the chapter "Arsha chikitsa" (Management of hemorrhoids). Thus said Lord Atreya. [1-2]

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To Punarvasu (Lord Atreya), who was in calm pose after having completed his religious rituals, Agnivesha inquired about the etiology, aggravating factors, shape, size, location, clinical features, treatment and prognosis of ''arsha'' (hemorrhoids). Then Lord Atreya responded. [3-4]

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==== Types of hemorrhoids ====

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=== Types of hemorrhoids ===

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These two categories of causative factors are also responsible for all the other congenital disorders in the human body. ''Sahaja'' means the disorder which is manifested along with the appearance of the body parts since birth. ''Arsha'' (hemorrhoids) is characterized by morbid growth in the muscle tissue. [5]

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==== Locations of hemorrhoids ====

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=== Locations of hemorrhoids ===

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The hemorrhoids are located in the space of four and half ''angulas'' (or approximately 8-10 cm) in the lower part of rectum and anal canal. This area has three sphincters dividing the space into three parts (''guda vali''). There are other locations of ''arshas'' (hemorrhoids) in the body in which excessive and unnatural growth of the muscle tissue also takes place, such as, pudendum, female genital tract, throat, palate, mouth, nose, ears, eyelids and skins. However, in this chapter the ''arsha'' occurring in the anal region are only considered as ''arsha'' (hemorrhoids). The ''adhishthana'' (involved morbid tissue elements) of all the types of ''arsha'' are ''medas'' (fatty tissue), ''mamsa'' (muscular tissue) and ''tvaka'' (skin and mucous membrane). [6]

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==== Forms of congenital hemorrhoids ====

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=== Forms of congenital hemorrhoids ===

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Among the congenital hemorrhoids, some are small, some are large, some are long, some are short, some are round, some are irregularly spread, some are curved internally, some are curved externally, some are matted together, and some are introverted. Their characteristics or forms are as per the ''doshas'' involved in their formation. [7]

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==== Signs and symptoms of congenital hemorrhoids ====

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=== Signs and symptoms of congenital hemorrhoids ===

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#Right from the birth, his apana vayu gets obstructed by the hemorrhoid-mass and moves upwards leading to aggravation of samana vayu, vyana vayu, prana vayu, udana vayu, pitta and kapha. When all these five types of vayu, pitta and kapha get aggravated the individual suffers from above mentioned morbidities of congenital hemorrhoids.[8]

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====Etiology and pathogenesis of acquired arsha (hemorrhoids)====

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===Etiology and pathogenesis of acquired arsha (hemorrhoids)===

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The apana vayu aggravated by the above mentioned factors, brings down the accumulated waste products and so afflicts the anal sphincters and leads to acquired type of hemorrhoids. [9]

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====Shapes of the arsha (hemorrhoids)====

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===Shapes of the arsha (hemorrhoids)===

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All above mentioned shapes are in general the characteristic shapes of hemorrhoids caused by excessive aggravation of vayu, pitta and kapha. [10]

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====Signs and symptoms of vataja arsha ====

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===Signs and symptoms of vataja arsha ===

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#Greyish, reddishness and roughness of nails, eyes, face, skin, urine and stool. [11]

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====Etiology of vataja arsha hemorrhoids====

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===Etiology of vataja arsha hemorrhoids===

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#Fasting, living in cold country and cold season, physical exercise, grief and exposure to sun and wind. [12-13]

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====Signs and symptoms of pittaja arsha====

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===Signs and symptoms of pittaja arsha===

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#The nails, eyes, skin, urine and stool become yellow in color. [14]

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====Etiology of pittaja arsha====

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===Etiology of pittaja arsha===

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#Intake of drinks, food and drugs having vidahi (causing burning sensation), sharp and hot properties. [15-16]

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====Signs and symptoms of kaphaja arsha====

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===Signs and symptoms of kaphaja arsha===

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#The nails, eyes, face, skin, urine and stool are become white in color. [17]

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====Etiology of kaphaja arsha====

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===Etiology of kaphaja arsha===

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#Living in cold place and exposure to cold season and mental inactivity. [18-19]

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====Etiology and symptoms of dwandaja and sannipataja type of arsha hemorrhoids====

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===Etiology and symptoms of dwandaja and sannipataja type of arsha hemorrhoids===

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The dwandaja arsha (in which two doshas are predo¬minantly aggravated) is caused by the combination of two types of etiological factors and clinical features of two doshas. If the causative factors of all the doshas are combined together, then tridosaja type of hemorrhoids (in which all the three doshas are simultaneously aggravated) is manifested. The signs and symptoms of hemorrhoids are similar to those described for hereditary type of hemorrhoids- (vide verses 7 and 8 above). [20]

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====Purvaroopa (premonitory) signs and symptoms of hemorrhoids====

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===Purvaroopa (premonitory) signs and symptoms of hemorrhoids===

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Delayed digestion of the food, weak¬ness, gurgling sound in the lower abdomen, emaciation, fre¬quent eructation; pain in thighs, voiding less stool, anemia, apprehension of the manifestation of udararoga (obstinate abdominal disorders including ascites)-these are the premonitory signs and symptoms in the development of hemorrhoids. [21-22]

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====Involvement of three doshas====

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===Involvement of three doshas===

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Hemorrhoids never manifest without the aggravation of all the three doshas. It is evident that the predominance of one or all the doshas determine the type of hemorrhoids. The nomenclature of doshaja arsha is given according to the predominance of dosha e.g. if vata dosha is predominat then that hemorrhoid is said to be vataja arsha. [23]

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====Aggravation of tridosha in arsha====

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===Aggravation of tridosha in arsha===

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Five types of vayu (prana, apana, vyana, udana and samana), pitta and kapha - all these morbid factors in their aggravated state afflict the three anal sphincters at ano-rectum and lead to hemorrhoids. These hemorrhoids are painful and are usually associated with several complications. These hemorrhoids affect the whole body and so they are difficult to cure with conservative measures. [24-25]

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====Symptoms of incurable arsha====

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===Symptoms of incurable arsha===

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If the hemorrhoids are located in the external anal sphincter with vitiation of one dosha, and are not chronic then patient is said to be curable.

A wise physician/surgeon should treat the patient early otherwise the enlarged hemorrhoids can obstruct the anal canal and lead to baddha-gudodara (obstruction in the passage of the ano-rectum). [30-32]

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====Treatment of hemorrhoids====

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===Treatment of hemorrhoids===

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Now the treatment which involve less of risk and which are not painful will be described for the eradication of hemorrhoids. [33-37]

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====Classification of arsha====

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===Classification of arsha===

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Hemorrhoids caused by aggrava¬tion of vayu and kapha are called dry hemorrhoids. Whereas those with excess discharge(bleeding) and wetness are caused by aggravation of rakta and pitta. [38]

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====Treatment of dry hemorrhoids====

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===Treatment of dry hemorrhoids===

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Dry, hard, inflamed and painful hemorrhoids should be first treated with fomentation. [39]

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====Recipes for fomentation====

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===Recipes for fomentation===

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The above mentioned recipes (no. 6 to 10) should be luke-warm and should be added with fat. The hemorrhoids mass should be smeared with oil prepared by boiling with rasna (Pluchea lanceolata). Thereafter, it should be fomented, with the help of a potalli containing brick powder, kharahva (Ajamoda/Apium leptophyllum (Pers.)) and the pulp of gunjanaka (Abrus precatorius Linn.). [39-43]

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====Recipe for Sprinkling====

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===Recipe for Sprinkling===

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====Recipes for sitz-bath====

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===Recipes for sitz-bath===

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Before sitz-bath, medicated oil should be applied on the hemorrhoids mass and the decoction should be warm. [45-47]

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====Recipes for smearing and fumigation====

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===Recipes for smearing and fumigation===

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#Saktu (roasted corn-flour) and ghee should be used for fumigation. Fumigation with sarjarasa mixed with ghee is also used for hemorrhoids. [51]

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====Ointment recipes====

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===Ointment recipes===

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The vitiated blood which is accumulated in the hemorrhoids mass, oozes out by local application of the above mentioned recipes and ointments which ultimately give relief to the patients of hemorrhoids. [59]

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====Raktamokshana (bloodletting)====

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===Raktamokshana (bloodletting)===

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Bloodletting with the help of application of leeches or sharp instruments or needles should be done in raktaja arsha, if blood doesn't come out on its own. [61]

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====Churna (powder formulations) ====

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===Churna (powder formulations) ===

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The recipes for pachana (which help in the digestion of undigested food), which are described for the treatment of atisara (diarrhea) should be given to the patients of hemorrhoids.[65]

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====Other Recipes====

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===Other Recipes===

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#Panchakola [(Sunthi (Zingiber officinale)pippali (piper longum), pippali moola, chavya (Piper retrofractum) and chitraka (Plumbago Zylanica)) should be given with butter-milk. [65-71]

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====Takraarishta====

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===Takraarishta===

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The powder of hapusha, kunchika, dhanyaka (Coriandrum sativum), jeera (Cuminum Cyminum), karavi (Foeniculum Vulgare), kachur, pippali (Piper longum), pippali mula ( root of Piper longum), chitraka (Plumbagoylanica) gajapippali (Scindapsus officinalis Schoott.), yavani (Trachyspermum ammi) and ajamoda (Carum roxburghianum) (in equal quantity) should be taken in a jar which is smeared with ghee, butter-milk. The paste of the ingredients to be kept in the jar will be slightly sour and pungent. When it is well fermented, the sour and pungent tastes become well manifested. This is called takraarishta, which is very delicious in taste. This drink should be taken in apropriate dose during the beginning, middle and end of meals, to overcome thirst. It also stimulates digestion, improves appetite, promotes complexion, helps in downward movement of kapha and vayu, cures swelling, itching and pain in anus and promotes strength. [72-75]

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====Benefits of curd and butter-milk====

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===Benefits of curd and butter-milk===

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Butter-milk cleanses the channels of circulation as a result of which rasa (end product of the food after digestion) reaches [the tissue elements] appropriately. This produces proper nourishment, strength, complexion and exhilaration, and cures one hundred diseases including those caused by vayu (80) and kapha (20). There is no medicine, better than butter-milk, for the treat¬ment of hemorrhoids caused by vitiation of vayu and kapha. [87-88]

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====Other Recipes====

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===Other Recipes===

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With the above mentioned ingredients, khada (a type of sour drink) should be prepared and given to the patient. Ghee boiled with the above ingredients is useful in. [91]

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====Thick gruel====

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===Thick gruel===

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Rakta shali, mahashali, kalama, langala, sita, sharad and jshasthik types of rice can be given as food to the patient suffe¬ring from hemorrhoids. Thus, the therapeutic measures for the patients of hemorrhoids having loose motions are described. [95-96]

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====Treatment of hemorrhoids with constipated bowels====

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===Treatment of hemorrhoids with constipated bowels===

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#Madira (a type of alcohol) along with salt should be taken before food; and along with sidhu (a type of alcohol) or sauvira ( a type of vinegar ) along with jaggery and nagara ( dry ginger). [102]

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====Pippalyadi ghrita====

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===Pippalyadi ghrita===

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Ghee cooked with pippali (Piper longum), pippalimoola, chitraka (Plumbego zylanicum), gajapippali, shringavera, yavakshara should be given in hemorrhoids. [104]

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====Recipes of medicated ghee====

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===Recipes of medicated ghee===

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Ghee cooked with the paste of chavya (Piper retrofractum) and chitraka (Plumbego zeylanicum) and added with jaggery, kshara and nagara (Zingiber officinalis) should be given in hemorrhoids. Ghee cooked with the paste of pippali moola and added with jaggery, kshara (alkali) and nagara (Zingiber officinalis) should be given in hemorrhoids. [105]

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====Pippalyadi ghrita====

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===Pippalyadi ghrita===

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Ghee cooked with the paste of pippali (Piper longum), pippalimoola and dhanyaka (Coriandrum sativum) and curd should be given to patient of hemorrhoids. It helps in the movement of flatus and stool. [106]

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====Chavyadi ghrita====

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===Chavyadi ghrita===

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Ghee should be cooked with the paste of chavya (Piper retrofractum), trikatu, patha (Cesalpinia pareira), kshara, kustumbaru (dhanyaka (Coriandrum sativum)), yavani, pippali moola, vida, saindhava (rock-salt). chitraka (Plumbego zeylanicum), bilva (Aegle marmelons) and abhaya (Terminalia chebula). To this, well fermented curd (four times the quantity of ghee) should be added while cooking. It helps in the downward movement of stool and flatus, and also cures pravahika (amoebic dysentery), prolapsed of rectum, dysuria, and pain in perianal and pelvic region. [107-109]

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====Nagaradi ghirta====

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===Nagaradi ghirta===

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Ghee should be cooked with the paste of nagara (Zingiber officinalis), pippali moola, chitraka (Plumbego zeylanicum), gaja pippali, shvadanshtra, pippali (Piper longum), dhanyak (Coriandrum sativum), bilva (Aegle marmelons), patha (Cissampelos Pareira) and yavani (Trechyspermum ammi), juice of changeri (Oxalis corniculata) (four times the quantity of ghee) and curd (four times the quantity of ghee). This medicated ghee alleviates kapha and vayu and cures hemorrhoids, grahani, dysuria, pravahika (amoebaisis), prolapse of rectum, pain in the anal region and flatulence. [110-112]

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====Pippalyadi ghrita====

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===Pippalyadi ghrita===

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Decoction should be prepared with pippali (Piper longum), nagara (Zingiber officinalis), patha (Cissampelos Pareira), gokshur (Tribulus terrestris) and taken three palas of each add 160 palas of water and reduced to one fourth, i.e. 40 palas. In this decoction, the paste of gandira, pippalimoola; vyosha [sunthi (Zingiber officinalis), pippali (Piper longum) and maricha (Piper nigrum)], chavya (Piper retrofractum) and chitraka (Plumbego zylanicum), taken two palas of each, should be added. To this, 40 palas of ghee, 40 palas of the juice of changeri (Oxalis corniculata) and 240 palas of curd should be added and cooked over mild fire. This medicated ghee should be kept in a clean jar and used in food and as a drink regu-larly. It cures grahani (digestive system disorders), hemorrhoids, gulma (tumour), heart diseases, oedema, splenic disorders, flatulence, dysuria, febrile condition, cough, hiccup, anorexia, breathlessness and pain in the sides of the chest. It is an excellent promoter of strength, plumpness of the body, complexion and digestive and metabolic power. [113-118]

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====Administration of haritaki====

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===Administration of haritaki===

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Haritaki (Terminalia chebula) fried in ghee along with either jaggery and pippali (Piper longum), or trivrita (Operculina terpenthum) and danti (Beliospermum montenum) should be given for the downward movement of vaju. Due to downward movement of stool, flatus, kapha and pitta and by their elimination, hemorrhoids are cured and improve the digestive power. [119-120]

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====Meat soup====

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===Meat soup===

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The meat-soup of peacock, partridge, grey quail, cock and bustard quail which is sour and well sizzled relieves obstruction of stool and flatus. [121]

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====Leafy vegetables====

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===Leafy vegetables===

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The leaves of upodika, tanduliya, vira, vastuka, suvarchala (one kind of salt) yava, avalguja, kakamachi (Solanum nigrum), ruhupatra, mahapatra, amlika, jivanti (Leptadenia reticulata), shati (Hedychium spicatium) and gunjanaka (Abrus pricatorius) should be cooked with curd and fried with ghee as well as oil. This should be given to the patient suffering from hemorrhoids mixed with dhaniya (Coriandrum sativum) and nagara (Zingiber officinalis). [122-125]

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====Use of meat====

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===Use of meat===

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The meat-soup of godha, lopaka, mnrjara, svavidu, ushtra, cow, kurma and sallaka should be prepared on the line suggested above for leafy vegetables. Along with this meat soup, red variety of sali rice should be given in patients of mandagni and vata predominant hemorrhoids. [126-127]

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====Anupana====

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===Anupana===

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Whey, boiled, and cooled water, decoction of kantakari (Solanum xanthocarpum) or decoction of nagara (Zingiber officinalis) and dhanyaka (Coriandrum sativum) as anupana (post-prandial drink) for the downward movement of flatus and stool. [127-129]

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====Anuvasana basti====

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===Anuvasana basti===

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Anuvasana type of enema should be administered to the patient suffering from udavarta (upward movement of wind in the abdomen), who is extremely devoid of unctuousness, whose wind moves in the opposite direction and having colic pain. [130]

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====Anuvasana basti with pippayadi taila====

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===Anuvasana basti with pippayadi taila===

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The ingredients like pippali (Piper longum), madan (Randia spinosa), bilva (Aegle marmelons), shatavha, madhuka, kushtha (Saussurea lappa) shati (Hadychium spicatium), pushkarmoola (Inula racemosa), chitrak (Plumbego zylanicum), devadaru (Cedrus deodara) made in paste, added sesame oil 4 times to kalka then added milk 2 times more the oil and prepare the medicated oil as per standard procedures. This oil should be used in patients having obstruction of flatus for anuvasan basti. Rectal prolapse, pain in ano, dysurea, amoebaisis, weakness in back, thigh, flatulence, mucous discharge through rectum, peri-anal inflammation, obstruction in flatus, and feces and increased frequency of defecation or unsatisfactory defecation in all above disorders or symptoms should be treated with anuvasan basti with above ingredients should be given. [131-134]

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====Topical application of paste====

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===Topical application of paste===

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The 11 ingredients ending with devadaru (in verse 131) should be mixed with oil and ghee and applied in the dry and painful type of hemorrhoids after application of medicament the hemorrhoids discharge the mucous and blood and relieve pain, itching and swelling of dry hemorrhoids. [135-36]

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====Niruha basti in dry hemorrhoids====

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===Niruha basti in dry hemorrhoids===

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The ingredients used in niruha enema are milk, decoction of dashamoola, , cow's urine, sneha, salt and the paste of madanaphala (Randia spinosa), etc.[137]

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====Abhayarishta====

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===Abhayarishta===

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Thereafter, it becomes suitable for adminis¬tration as a drink. It should be given in an apropriate dose depending upon the strength of the patient. By the regular intake of this arista, hemorrhoids get cured. This effective recipe is called abhayarishta. It cures grahani, pandu (anemia), heart diseases, spleen disorders, gulma (abdominal lumps ), udara (obstinate abdominal diseases including ascites), kushtha (obstinate skin diseases including leprosy), edema, anorexia, jaundice, leucoderma, krimi (worm infestation with intestinal parasites), granthi (benign swellings), arbuda (tumours), vyanga (freckles), tuberculosis and fever. It promotes strength, complexion and digestive power. [138-143]

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====Dantyarishta====

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===Dantyarishta===

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This is called dantyarishta and it cures hemorrhoids, grahani and pandu (anemia). It helps in the downward movement of flatus and feces and also stimulates the digestive power and cures anorexia. [144-147|

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====Phalarishta====

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===Phalarishta===

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To this, one tula of jaggery should be added and kept in a ghee-smeared jar for fifteen days. Intake of this recipe cures grahani, hemorrhoids, heart diseases, spleen dis¬orders, jaundice, visamajwara (malarial fever), obstruction to the passage of stool, urine and flatus, low power of digestion, cough, gulma and udvarta (upward movement of wind in the abdomen ). It stimulates the power of digestion. It is called phaldrista, and is propoun¬ded by the sage Krishnaatreya. [148-152]

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====Phalarishta (Second recipe) ====

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===Phalarishta (Second recipe) ===

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Duralabha (Fagonia criteca) (one prastha) and chitraka (Plumbego zylenicum), vasa (Adhatoda vasika), haritaki (Terminalia chebula), amalaki (Embelica officnalis), patha (Cesalpinia pareira), nagara (Zingiber officinalis) and danti (each two pala) should be added with two dronas of water and boiled till one fourth remains. The decoction should be strained out through a cloth and cooled then added 100 palas of sugar. It should be kept in a jar for fifteen days. The inside wall of the jar should be smeared with the paste containing pippali (Piper longum), chavya (Piper retrofractum), priyangu (Callicarpa macrophylla), honey and ghee. This preparation should be taken in apropriate dose depending upon the strength of the patient. It cures hemorrhoids, grahani, udavarta, anorexia, obstruction to the movement of stool, urine, flatus and eructation, low power of digestion, heart diseases and pandu (anemia). [153-157]

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====Kanakarishta====

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===Kanakarishta===

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Freshly collected amalaki (one tula) should be coarsely pounded added pippali (Piper longum), vidanga (Embelia ribes) and maricha (Piper nigrum) (4 pala each), one pala of each patha(Cissampelos Pareira ), pippalimoola, kramuka chavya (Piper retrofractum), chitraka (Plumbego zylanicum), manjishta (Rubia cordifolia), elvaluka and half pala of each of kushta (Sassurea lappa), daruharidra (Berberis aristata), suraha, sariva (Hemidesmus indicus), indrahva (Holarrhina antidysenterica) and bhadramusta and four pala of freshly collected nagapushpa should be added. To this two drona of water should be added and boiled till one fourth remains. The decoction should be strained out through a cloth and cooled. To this, two adhakas of the cooled decoction of madhuka, two tulas of pounded sugar, half prastha of freshly collected honey and the powder of tvak, ela, plava, patra, ambu, sevya, kramuka and kehra taken in the quantity of one karsha each, should be added. The inside wall of the clean jar should be smeared with ghee and fumigated with sugar and Aguru. This should be kept for fifteen days. After fifteen days, the recipe should be filtered out. This is called kanakarishta which is sweet in taste and is cardiac tonic. It produces relish in the food and cures hemorrhoids, grahani, flatulence, udara, fever, heart diseases, pandu (anemia), edema, gulma (tumour), obstruction to the passage of stool, cough and other diseases caused by kapha. It also cures vali (appearance of wrinkles in the body), palita (appearance of premature grey hair) and khalitya (alopecia) caused by the vitiation of doshas. [158-168]

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====Cleanliness of peri-anal region====

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===Cleanliness of peri-anal region===

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The patient of hemorrhoids should use the decoction of leaves which are curative of hemorrhoids) or warm water for cleansing of per anal region. Thus, the effective treatment for dry type of hemorrhoids is described. [169]

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====Treatment of bleeding hemorrhoids====

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===Treatment of bleeding hemorrhoids===

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Now after treatment of dry hemorrhoids the treatment of bleeding hemorrhoids is mentioned further which are associated with vitiated vayu and kapha. [170]

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====Signs and symptoms of bleeding hemorrhoids associated with vayu====

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===Signs and symptoms of bleeding hemorrhoids associated with vayu===

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The color of hemorrhoids is gray, hard to feel and ununctuousness of the stool, flatulent, blood which exudes from the hemorrhoids is thin, reddish and foamy, pain in the lumber region, thighs and peri-anal region with excessive weakness. [171-172]

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====Signs and symptoms of bleeding hemorrhoids associated with kapha====

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===Signs and symptoms of bleeding hemorrhoids associated with kapha===

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The following signs and symptoms are manifested in bleeding hemorrhoids secondarily associated with kapha. Stool is loose, white, yellow, unctuous, heavy and cold, the blood which exudes from the hemorrhoids is dense, pale yellow and slimy, the anus is smeared with slimy material and there is numbness in that region. [173-174]

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====Line of treatment as per dosha====

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===Line of treatment as per dosha===

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If there is predominance of pitta and kapha dosha, the patient should be administered shodhan (elimination) therapies. However, bleeding should not be stopped immediately anyone should wait for appropriate time. The patient can be given fasting therapy. [175-176]

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====Complications of immediate hemostasis therapy====

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===Complications of immediate hemostasis therapy===

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The physician should be well known with the etiology, signs and symptoms, nature of the time, strength and color of the blood and should wait for appropriate time before administering hemostatic therapies unless there is an emergency. [177-181]

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====Use of bitter drugs====

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===Use of bitter drugs===

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For stimu¬lation of the digestive power, hemostasis and pachana (meta¬bolic transformation) bitter drugs should be given. [182]

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====Use of sneha====

+

===Use of sneha===

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In hemorrhoids having predominance of vayu, bleeding continues even after the aggravated doshas are eliminated then the patient should be given unctuous therapies in the form of drinks, massage and anuvasana basti. [183]

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====Indications for hemostatic therapy====

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===Indications for hemostatic therapy===

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In summer season pitta predominant hemorrhoids without secondary predominance of vayu and kapha hemostatic therapies should be administered immediately to stop bleeding. [184]

−

====Hemostatic recipes====

+

===Hemostatic recipes===

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Bark and fruits of kutaja (Holarrhina antidysenterica) along with ativisha (Aconitum heterophylum) and rasanjana should be mixed with honey and used as a hemostatic in hemorrhoids. If the patient is suffering from morbid thirst tandulodaka (thin rice gruel), should be given. [187]

−

====Kutajadi rasakriya====

+

===Kutajadi rasakriya===

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Kutaja (Holarrhina antidysenterica) bark (100 palas) should be boiled with rain water (one drona) till the entire essence of the bark comes to water (i.e. till 1/8th remains). This decoction should then be strained out through a cloth. To this, the powders of mocharasa, (one pala), samanga (one pala) Phalini (one pala) and seeds of kutaja (Holarrhina antidysenterica) (three palas) should be added and boiled again till it becomes semi-solid and till it sticks to the stirring spoon. This rasakriya (semi- solid extract) stops bleeding in hemorrhoids if administered in appropriate dose and time. This rasakriya should be administered along with goat-milk depending upon the strength of the patient. [188-190]

−

====Peyamanda (thin gruel) ====

+

===Peyamanda (thin gruel) ===

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After the digestion of above rasakriya, the patient should be given shashtika shali (one type of rice) along with goat-milk to eat. It instantaneously cures bleeding hemorrhoids, diarrhea with bleeding, blood-diseases and serious types of urdhvaga as well as adhoga Rraktapitta [191-192]

−

====Recipes for hemorrhoids====

+

===Recipes for hemorrhoids===

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Bleeding and pain in the hemorrhoids relieved with medicated ghee cooked with the juice of dadima (Pongamia granatum) and yavakshara as well as ghee cooked with nidigdhika (Solanum surratense) and dugdhika (Euphrbia thymifolia).[198]

−

====Recipes of peya (thin gruel) ====

+

===Recipes of peya (thin gruel) ===

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Peya prepared by adding gunjanaka and sura (a type of alcohol), sizzled with ghee and oil cures of raktatisara, colic pain, pravahika (dysentery) and edema. [199-201]

−

====Recipes of curds====

+

===Recipes of curds===

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#Roots of nyagrodha (ficus bengalensis) and flowers of kovidara (Borrhavia diffusa)

−

====Diet in bleeding hemorrhoids====

+

===Diet in bleeding hemorrhoids===

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Bleeding stops if the patient takes freshly prepared ghee from butter, goat-meat, shashtika types of rice, freshly fermented sura (a type of alcoholic drink). [211]

−

====Predominance of vayu====

+

===Predominance of vayu===

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In case of excessive bleeding, the arsha becomes vata dominant. Even if pitta and kapha are predominantly vitiated, then also predominance of vata shall be considered in excessive bleeding. [212]

−

====Cooling Therapy====

+

===Cooling Therapy===

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If there is predominance of rakta and pitta and there is less of the signs and symptoms of aggravated kapha and vayu, then the patient should be given cooling remedies which are already described and some of which are to be described later. [213]

−

====Sprinkling in bleeding hemorrhoids====

+

===Sprinkling in bleeding hemorrhoids===

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To stop bleeding, hemorrhoids should be sprinkled with the decoctions of madhuka, panchavalka [barks of nyagrodha (ficus bengalensis), udumbara (ficus glomeruta), ashwatha (ficus religiosa), parisha (thespesia populnea) and plaksha (ficus lacor)], bark of badar, udumbara (ficus glomeruta), dhava (Anogeissus latifolia) and patola (Tricosanthes dioica) or vasa (Adhatoda vasika), kakubha,Yavasaka (Alhagi camelorum) and nimba (Azadiracta indica). [214]

−

====Warm water sitz-bath in bleeding hemorrhoids====

+

===Warm water sitz-bath in bleeding hemorrhoids===

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The patient should be given warm water sitz bath with the decoction of madhuka, nifnala, padmaka, chandana (Santalum album), kusha (Desmospachya bipinnata) and kasha (Saccharum spontaneum) in cases suffering from bleeding, burning sensation and stickiness. [215]

−

====Cold water sitz-bath in bleeding hemorrhoids====

+

===Cold water sitz-bath in bleeding hemorrhoids===

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The peri-anal area of the patient should be first anointed with cold oil and then sitz bath should be given with sugar-cane juice and the decoctions of madhuka and vetasa mixed with cold water in excessive bleeding. [216]

−

====Hemostatic douche====

+

===Hemostatic douche===

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To stop bleeding in hemorrhoids the genitals, anus and lumber region should be smeared with ghee and sugar then douche of cold water should be applied to stop bleeding. [217]

−

====External application of cold leaves====

+

===External application of cold leaves===

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Hemorrhoid mass should be covered with the leaves of banana, and puskara sprinkled with cold water. Similarly, covering these masses with the leaves of padma (Nelumbo nucifera) and utpala is useful. [218]

−

====Soothing Ointment====

+

===Soothing Ointment===

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External application of durvaghrita, shatadhauta ghrita and sahasradhauta ghrita, and fanning of cold air stops bleeding. [219]

−

====Topical application or rubbing====

+

===Topical application or rubbing===

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#Utpala (Nelumbo nucifera) and ghee

−

====Topical application in continuous bleeding====

+

===Topical application in continuous bleeding===

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If bleeding doesn't stop and there is aggravation of vayu then the patient should be given anuvsana type of enema with the help of luke-warm ghritamanda (upper portion of the ghee). He should be given the effective piccha basti (recipe of which is described below) at the appropriate time. [222-224]

−

====Piccha basti====

+

===Piccha basti===

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Two palas each of yavasa, kusha, kasha, flowers of semul and adventitious roots of nyagrodha, udumbara and ashwattha should be added in six prasthas of water, two prasthas of milk and boiled till two prasthas remain. This should be strained through a cloth, and to this, the paste of the resin from shalmali (Mocharas), majishtha, chandana, utpala, seeds of kutaja, priyangu and padmakarira should be added. This effective recipe is called piccha basti and it should be admini¬stered along with ghee, honey and sugar. It cures dysentery, prolapsed of rectum, bleeding and fever. [225-228]

−

====Anuvasana basti in bleeding hemorrhoids====

+

===Anuvasana basti in bleeding hemorrhoids===

Prapaundarika and madhuka along with the drugs described in piccha basti should be made to a paste. This paste should be added to oil and double the quantity of milk, and cooked. [This medicated oil should be used for anuvasana type of medicated enema for the patients suffering from hemorrhoids. [229]

−

====Hriveradi Ghrita====

+

===Hriveradi Ghrita===

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The paste of ingredients like hribera, utpala, lodhra, majitha, chavya chandana, patha, atisa, bilva, dhataki, devadaru, bark of daruharidra, nagaramotha, jatamamsi, musta, yavakshara and chitraka should be made then added 4 times juice of changeri and cooked with ghee as per ghrita siddha. It is an excel¬lent remedy for hemorrhoids, diarrhea grahani, pandu (anemia), fever, anorexia, dysuria, prolapsed rectum, distension in the region of urinary bladder, dysentery, voiding of slimy material and pain in the hemorrhoids. It alleviates all the three aggravated doshas. [230-233]

−

====Sunnishannak changeri ghrita====

+

===Sunnishannak changeri ghrita===

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The above mentioned decoction and paste should be added with the juice of sunijannaka and changeri, two prasthas of each and one prastha of ghee, and cooked. This medicated ghee cures hemorrhoids, diarrhea, bleeding caused by the aggravation of all the three doshas, dysentery, voiding of different types of slimy material, prolapsed rectum, urge for motion, edema and pain in anal region, suppression and anorexia. This medicated ghee helps in the promotion of strength, complexion and digestive power. This medicated ghee is harmless, and it can be administered alone or along with different types of food for digestion and strength. [235-242]

−

====Different foods in arsha====

+

===Different foods in arsha===

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Thus it is said, depending upon the power of digestion, the patients of hemorrhoids should be given some time cold article and sometimes hot articles sometimes sweet or sour taste drugs or food should be given having opposite characters to keep digestive power normal. [243]

−

====Interdependence of diseases and protection of agni in hemorrhoids====

+

===Interdependence of diseases and protection of agni in hemorrhoids===

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Hemorrhoids, diarrhea and grahani these three diseases are interdependent. In all patients of above three diseases if the digestive power is low then disease gets aggravated and if digestive power is strong then relief occurs. So, the digestion power should be maintained in these three diseases to overcome them. [244-245]

−

====Treatment in General====

+

===Treatment in General===

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The physician should overcome hemorrhoids by the use of diffe¬rent types of fried vegetables, thick gruel, vegetable soup, meat soup, khada (a sour preparation), milk and curd. [246]

−

====Pathya (diet regimen) in hemorrhoids====

+

===Pathya (diet regimen) in hemorrhoids===

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The foods that lead to downward movement of vayu and promote digestive power should be daily consumed by patients of hemorrhoids. Those foods having opposite properties and those described in the etiology of hemorrhoids should never be used by the patient suffering from this disease. [247-248]

−

====Summary of the chapter====

+

===Summary of the chapter===

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#The remedies in cases of excessive bleeding in hemorrhoids. [249-255]

−

====Colophon====

+

===Colophon===

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In recent studies the sitz bath is advised with warm water in all kind of hemorrhoids or ano-rectal disorders. Charaka mentioned sitz bath with warm and cold water. The warm water should be used in cases of ''vataja'' and ''kaphaja'' type of hemorrhoids while cold water sitz bath should be given in cases of ''pittaja'' or ''rakataja'' predominant hemorrhoids.

−

==== Color atlas of various conditions of ''arsha'' ====

+

=== Color atlas of various conditions of ''arsha'' ===

Arsha1.jpg|thumb|Fig 1: Rectal polyp (''sahaja arsha'')

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</gallery>

−

==== Current Clinical Management ====

+

=== Current Clinical Management ===

{| class="wikitable"

|-

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|}

−

==== Surgical Management ====

+

=== Surgical Management ===

''Ksharasutra'' is the widely accepted effective method.

Agnivesha

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