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Arsha Chikitsa (view source)

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<big>'''Abstract </big>'''

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This chapter of [[Chikitsa Sthana]] exclusively deals with the treatment of ''guda arsha'' (piles/hemorrhoids). Congenital and acquired types, their causes, clinical features of ''dosha'' dominance and management are elaborated. The usual treatment of hemorrhoids is surgical, but if proper treatment is received it can be best managed with medicinal treatment. The disease ''arsha'' is mentioned in the ''Ashtomahagada'' (group of eight diseases that are difficult to cure).

+

This chapter of [[Chikitsa Sthana]] exclusively deals with the treatment of ''guda arsha'' (piles/hemorrhoids). Congenital and acquired types, their causes, clinical features of ''[[dosha]]'' dominance and management are elaborated. The usual treatment of hemorrhoids is surgical, but if proper treatment is received it can be best managed with medicinal treatment. The disease ''arsha'' is mentioned in the ''Ashtomahagada'' (group of eight diseases that are difficult to cure).

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Recurrence rate of hemorrhoids is high, even after surgical intervention. Sushruta has mentioned that any disease, if can be cured with the medicine is not required to be treated with ''shodhana'' and ''shastrakarma'' (surgical intervention). So, every attempt should be made to treat hemorrhoids with medicinal treatment, diet and lifestyle changes. Different medicinal formulations for conservative management and local applications, soothing therapy, sitz bath, fumigation, and sprinkling with the herbs are some of the modes of treatment prescribed to relieve the local inflammation, bleeding and maintain the peri-anal hygiene to control the disease. The principal of treatment is to avoid the ''nidana'' (causative factors), with diet being one of them. Digestive power of the person should be strong, which can be maintained with the consumption of different types of thin and thick gruels. ''Anuvasana basti'' is used for management of constipation, the root cause of ''arsha''. ''Raktamokshana'' (bloodletting), in cases of vitiation of ''rakta'', is advised. Finally, it is evident that treatment of hemorrhoids is multifocal and no single modality is effective including surgery.

+

Recurrence rate of hemorrhoids is high, even after surgical intervention. Sushruta has mentioned that any disease, if can be cured with the medicine is not required to be treated with ''[[shodhana]]'' and ''shastrakarma'' (surgical intervention). So, every attempt should be made to treat hemorrhoids with medicinal treatment, diet and lifestyle changes. Different medicinal formulations for conservative management and local applications, soothing therapy, sitz bath, fumigation, and sprinkling with the herbs are some of the modes of treatment prescribed to relieve the local inflammation, bleeding and maintain the peri-anal hygiene to control the disease. The principal of treatment is to avoid the ''nidana'' (causative factors), with diet being one of them. Digestive power of the person should be strong, which can be maintained with the consumption of different types of thin and thick gruels. ''Anuvasana [[basti]]'' is used for management of constipation, the root cause of ''arsha''. ''[[Raktamokshana]]'' (bloodletting), in cases of vitiation of ''[[rakta]]'', is advised. Finally, it is evident that treatment of hemorrhoids is multifocal and no single modality is effective including surgery.

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'''Keywords''': ''Arsha, anuvasana basti, raktamokshana,'' hemorrhoids, ''shodhana chikitsa'', soothing therapy, sitz bath, fumigation, ''asava, arishta, churna, vati, pichcha basti'' </div>

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'''Keywords''': ''Arsha, anuvasana basti, [[raktamokshana]],'' hemorrhoids, ''[[shodhana]] chikitsa'', soothing therapy, sitz bath, fumigation, ''asava, arishta, churna, vati, pichcha basti'' </div>

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The chapter describes types of ''arsha'' (such as congenital or acquired), sites of manifestation other than the ano-rectal region, ''doshic'' signs and symptoms, etio-pathogenosis, etiology of the ''doshaja arsha'', and prognosis along with the symptoms of curable and incurable hemorrhoids. Hemorrhoids can be ''shushka'' (dry or non-bleeding) and ''sravi'' (wet or bleeding) with different modes of treatment for each of these. In the bleeding type hemostatic management is essential while in non- bleeding type hemostatic treatment is not needed.

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The dry hemorrhoids can be correlated with the external hemorrhoids where protrusion of mucosal folds occur, without bleeding. Local treatment includes, fomentation, sitz bath, sprinkling, smearing and fumigation and topical medicament. The need of proper hygiene of the peri-anal area is important. ''Raktamokshana'' (bloodletting) was advised as one of the para-surgical procedure and in cases of vitiation of ''rakta'' and predominance of ''pitta dosha''. Oral intake of the herbal powders, ''takraarishta, abhayaarishta, dantyaarishta, phalaarishta'' are described along with their method of preparation. In ''pathya'' the recipes like thick gruel, curd, buttermilk, leafy vegetables for vegetarian and meat as well as meat soup for non-vegetarian was advised in cases of constipated bowel. It proves that along with the other causative factors constipation is an important cause. The role of ''haritaki'' with jaggery is one of the requirements for ''deepana'' and ''pachana'' because the cause of ''arsha'' is depressed digestive power. The other recipes like ''ghrita,'' preparations like ''pippalyadi ghrita, chavyadi ghrita, nagaradi ghrita'' in constipated patients. The ''anuvasana basti'' is advisable with medicated ''taila'' in the management of dry or external hemorrhoids.

+

The dry hemorrhoids can be correlated with the external hemorrhoids where protrusion of mucosal folds occur, without bleeding. Local treatment includes, fomentation, sitz bath, sprinkling, smearing and fumigation and topical medicament. The need of proper hygiene of the peri-anal area is important. ''[[Raktamokshana]]'' (bloodletting) was advised as one of the para-surgical procedure and in cases of vitiation of ''[[rakta]]'' and predominance of ''[[pitta dosha]]''. Oral intake of the herbal powders, ''takraarishta, abhayaarishta, dantyaarishta, phalaarishta'' are described along with their method of preparation. In ''pathya'' the recipes like thick gruel, curd, buttermilk, leafy vegetables for vegetarian and meat as well as meat soup for non-vegetarian was advised in cases of constipated bowel. It proves that along with the other causative factors constipation is an important cause. The role of ''haritaki'' with jaggery is one of the requirements for ''[[deepana]]'' and ''[[pachana]]'' because the cause of ''arsha'' is depressed digestive power. The other recipes like ''ghrita,'' preparations like ''pippalyadi ghrita, chavyadi ghrita, nagaradi ghrita'' in constipated patients. The ''anuvasana [[basti]]'' is advisable with medicated ''taila'' in the management of dry or external hemorrhoids.

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The wet hemorrhoids have the predominance of ''kapha'' along with ''vata'' and can be correlated with internal hemorrhoids which are usually bleeding in nature. The line of treatment as per predominance of ''vata'' or ''kapha'' has been described. In initial stage the bleeding should not be stopped as the vitiated blood should be let out. Later on ''kutajadi rasakriya'' for hemostatis, thick and thin gruel remedies were explained. Cooling therapy, sprinkling therapy with different herbal preparations, warm and cold water sitz bath was advised in the cases of bleeding. Recipes of curds and rice in the diet are also recommended. For local treatment external application of cold leaves, soothing ointment, rubbing recipes and topical application in the bleeding hemorrhoids are described.

+

The wet hemorrhoids have the predominance of ''[[kapha]]'' along with ''[[vata]]'' and can be correlated with internal hemorrhoids which are usually bleeding in nature. The line of treatment as per predominance of ''[[vata]]'' or ''[[kapha]]'' has been described. In initial stage the bleeding should not be stopped as the vitiated blood should be let out. Later on ''kutajadi rasakriya'' for hemostatis, thick and thin gruel remedies were explained. Cooling therapy, sprinkling therapy with different herbal preparations, warm and cold water sitz bath was advised in the cases of bleeding. Recipes of curds and rice in the diet are also recommended. For local treatment external application of cold leaves, soothing ointment, rubbing recipes and topical application in the bleeding hemorrhoids are described.

</div>

== Sanskrit text, Transliteration and English Translation ==

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</div></div>

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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]

+

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 ''[[meda]]s'' (fatty tissue), ''[[mamsa]]'' (muscular tissue) and ''tvaka'' (skin and mucous membrane). [6]

</div>

=== Forms of congenital hemorrhoids ===

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</div></div>

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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]

+

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 ''[[dosha]]s'' involved in their formation. [7]

</div>

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

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#Patient gets stiffness in chest, abdomen, region of urinary bladder, cardiac region, back and lumber region.

#He has persistent giddiness and is extremely lazy.

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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]

+

#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 [[vata]], [[pitta]] and [[kapha]] get aggravated the individual suffers from above mentioned morbidities of congenital hemorrhoids.[8]

</div>

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

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The causes of acquired hemorrhoids :

In a person whose power of digestion is afflicted, mala (waste products) gets accumulated in excess due to the following reasons:

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#Intake of heavy, sweet, cold, abhishyandi (food that causes obstruction in the channels of circulation), vidahi (that causes burning sensation) and viruddha ( mutually contra¬dictory ) food; intake of food before the previous meal is digested; intake of a small quantity of food;and intake of unwholesome food;

+

#Intake of heavy, sweet, cold, abhishyandi (food that causes obstruction in the channels of circulation), vidahi (that causes burning sensation) and viruddha ( mutually contra¬dictory ) food; intake of food before the previous meal is digested; intake of a small quantity of food; and intake of unwholesome food;

#Excessive intake of the meats of cattle, fish, pig, buffalo, goat and sheep;

#Meat of emaciated animals, dried meat and putrefied meat.

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#Intake of heavy fruits, vegetables, pickles, hantaka (uncooked vegetables), mardaka, vasa (muscle fat), meat of head and legs of animals, stale, putrid and sankeerna anna (food prepared by the mixture of different items, like rice and meat).

#Intake of mandaka (immature curds) and wrongly (excess) fermented wines.

−

#Drinking of polluted and heavy water, excess intake of sneha (oleation therapy), non-use of panchakarma (elimination therapies), improper basti karma (enema therapy)

+

#Drinking of polluted and heavy water, excess intake of sneha (oleation therapy), non-use of [[panchakarma]] (elimination therapies), improper [[basti]] karma (enema therapy)

#Lack of exercise, avayaya (lack of sexual activity) or adhivayaya (excess sexual activity), sleep during day time; and habits to pleasant beds, seats and location.

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Hemorrhoids have different shapes and resemble mustard, masura, masha, mudga, kushtaka (Saussurea lappa CB. Clarke), yava (barley), kalaya (green pea), pindi, tundikeri (fruit of karira), kebuka, tinduka, karkandhu, kakanantika, bimbi badara, karira, udumbara (Ficus racemosa Linn), kharjura (Phoenix dactylifera) jambu (Syzygium cuminii (Linn.)), gostana (cow's breast), thumb, kasheruka, shringataka, shringi, beaks or tongues of a fowl, a peacock or a parrot, and buds of lotus or karyika.

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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]

+

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

</div>

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

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===Signs and symptoms of [[vata]]ja arsha ===

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</div></div>

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Hemorrhoids caused by the predominance of aggravated vata:

+

Hemorrhoids caused by the predominance of aggravated [[vata]]:

#The mass of hemorrhoids is dry, wrinkled, hard, rough, ununctuous and greyish in color; these masses have sharp tips; these are curved and with cracks on the surface; and these are spread irregularly.

−

#The mass of hemorrhoids is associated with pain, cramps toda (piercing pain), itching, numbness and tingling ~~sensa¬tion~~ in excess.

+

#The mass of hemorrhoids is associated with pain, cramps toda (piercing pain), itching, numbness and tingling sensation in excess.

#Unctuous and hot things give relief in this condition.

−

#The patient suffers from dysentery, abdominal ~~disten¬sion~~ and stiffness of genitals, testicles, urinary bladder, pelvis and cardiac region; he also suffers from malaise and palpitation in excess.

+

#The patient suffers from dysentery, abdominal distension and stiffness of genitals, testicles, urinary bladder, pelvis and cardiac region; he also suffers from malaise and palpitation in excess.

#His flatus, urine and stool are constantly obstructed.

#He suffers from pain in thighs, lumber region, back, trika (sacral region), parshva (sides of the chest), kukshi (sides of the abdomen ) and in basti (urinary bladder)

−

#He gets heat sensation in the head and suffers from, sneezing, eructation, coryza, cough, udavarta (mis-peristalsis), lethargy, edema, fainting, anorexia, distaste in mouth, timira (impairment of vision) ~~it¬ching~~, pain in the nose, ears and temporal region, and impairment of the voice.

+

#He gets heat sensation in the head and suffers from, sneezing, eructation, coryza, cough, udavarta (mis-peristalsis), lethargy, edema, fainting, anorexia, distaste in mouth, timira (impairment of vision) itching, pain in the nose, ears and temporal region, and impairment of the voice.

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

</div>

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

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===Etiology of [[vata]]ja arsha hemorrhoids===

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</div></div>

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The causes of ~~vataja~~ arsha are as follow.

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The causes of [[vata]]ja arsha are as follow.

#Habitual intake of astringent, pungent, bitter, ununctuous, cold and light food;

−

#Habitual intake of pramitashana ( food measured in extremely small quantities), intake of less quantity of food, intake of excess ~~alcoho¬lic~~ drinks and indulgence in sexual acts.

+

#Habitual intake of pramitashana ( food measured in extremely small quantities), intake of less quantity of food, intake of excess alcoholic drinks and indulgence in sexual acts.

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

</div>

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

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===Signs and symptoms of [[pitta]]ja arsha===

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</div></div>

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The following are the signs and symptoms of ~~Pittaja~~ Arshas:

+

The following are the signs and symptoms of [[Pitta]]ja Arshas:

#The pile mass is soft, flabby, delicate and tender to touch

#The color of hemorrhoids is red, yellow, blue or black

−

#The hemorrhoids is associated with excessive ~~swea¬ting~~ and sticky discharge

+

#The hemorrhoids is associated with excessive sweating and sticky discharge

#The discharge from the hemorrhoids mass is visra (smelling like raw-meat), thin, yellow or red

#There is bleeding from the hemorrhoids

−

#The hemorrhoids are associated with burning ~~sensa¬tion~~, itching, pain, pricking pain and ~~suppura¬tion~~.

+

#The hemorrhoids are associated with burning sensation, itching, pain, pricking pain and suppuration.

#Cold things relief the symptoms

#The stool of the patient is loose, yellow or green

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

</div>

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

+

===Etiology of [[pitta]]ja arsha===

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</div></div>

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The causes of ~~pittaja~~ arsha are as follow:

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The causes of [[pitta]]ja arsha are as follow:

#Intake of pungent, hot, salty and alkaline food,

#excess exercise and exposure to the heat of fire and Sun

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

</div>

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

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===Signs and symptoms of [[kapha]]ja arsha===

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</div></div>

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The following are the signs and symptoms of ~~kaphaja~~ arshas

+

The following are the signs and symptoms of [[kapha]]ja arshas

#The hemorrhoids are large in size, swollen, smooth, painless to touch,

#The hemorrhoids are unctuous, white, pale white, slimy, having stiffness, heavy, rigid, benumbed, having consistent oedema and excessive of itching.

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

</div>

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

+

===Etiology of [[kapha]]ja arsha===

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</div></div>

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The causes of ~~kaphaja~~ arsha (hemorrhoids) are as follow

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The causes of [[kapha]]ja arsha (hemorrhoids) are as follow

#Sweet, unctuous, cold, salty, sour and heavy food

−

#Lack of exercise, sleeping during day time and ~~indul¬gence~~ in the pleasure of beds and seats (excess sleeping and sitting)

+

#Lack of exercise, sleeping during day time and indulgence in the pleasure of beds and seats (excess sleeping and sitting)

#Direct exposure to wind

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

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</div></div>

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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]

+

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 [[dosha]]s. If the causative factors of all the [[dosha]]s are combined together, then tridosaja type of hemorrhoids (in which all the three [[dosha]]s 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]

</div>

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

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</div></div>

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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]

+

Delayed digestion of the food, weakness, gurgling sound in the lower abdomen, emaciation, frequent 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]

</div>

−

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

+

===Involvement of three [[dosha]]s===

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</div></div>

−

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]

+

Hemorrhoids never manifest without the aggravation of all the three [[dosha]]s. It is evident that the predominance of one or all the [[dosha]]s 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 [[vata]]ja arsha. [23]

</div>

===Aggravation of tridosha in arsha===

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</div></div>

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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]

+

Five types of [[vata]] (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]

</div>

===Symptoms of incurable arsha===

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Pain in the cardiac region and lateral parts of the chest, fainting, vomiting, pain in the limbs, fever, thirst and perianal swelling - these complications lead to the death of the patient suffering from hemorrhoids. [27]

−

Congenital/hereditary hemorrhoids caused by aggravation of three ~~doshas~~ and hemorrhoids located in the internal sphincter of the anus are also considered as incurable. [28]

+

Congenital/hereditary hemorrhoids caused by aggravation of three [[dosha]]s and hemorrhoids located in the internal sphincter of the anus are also considered as incurable. [28]

In the presence of above incurable symptoms, if all four aspects of treatments like physician, drugs, attendant and patient are in the state of their excellence and if the patient has strong kayagni (power of digestion and metabolism) the disease may become yapya (palliative). Otherwise the disease became incurable. [29]

−

If the hemorrhoids are caused by vitiation of two ~~doshas~~, and are located in the second anal- sphincter and if these are more than one year old, then these are difficult of cure.

+

If the hemorrhoids are caused by vitiation of two [[dosha]]s, and are located in the second anal- sphincter and if these are more than one year old, then these are difficult of cure.

−

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.

+

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]

</div>

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In the management of arsha,some physicians/surgeons advise excision of the hemorrhoids by sharp instruments, while others recommend cauterization with ksharakarma (alkalies) and agnikarma (thermal cauterization). These procedures should be administered only by a physician/surgeon who is well trained in the field.

−

Any mistake during these (surgical or para-surgical) procedures could result in serious ~~consequencwes~~ and complications, such as impotency, ano-rectal swelling, obstruction in defecation, abdominal distension, excruciating pain, excessive bleeding and recurrence of hemorrhoids. On healing stricture may form and chronic sticky /pus discharge, prolapse of the rectum can occur. Above complications may develop due to improper surgery, ksharakarma and agnikarma.

+

Any mistake during these (surgical or para-surgical) procedures could result in serious consequences and complications, such as impotency, ano-rectal swelling, obstruction in defecation, abdominal distension, excruciating pain, excessive bleeding and recurrence of hemorrhoids. On healing stricture may form and chronic sticky /pus discharge, prolapse of the rectum can occur. Above complications may develop due to improper surgery, ksharakarma and agnikarma.

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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</div></div>

−

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]

+

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

</div>

===Treatment of dry hemorrhoids===

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</div></div>

−

If there is pain in hemorrhoidal mass, then it should be well ~~smea¬red~~ with medicated oil and sitz-bath should be given with the help of decoction prepared by leaves of radish, triphala [Haritaki (Terminalia Chebula Roxb.), bibhitaka (Terminalia belerica Roxb.) and amalaka (Emblica officinalis Gaertn.)], arka (Calotropis procera Ait.), venu varuna (crataeva nurvala Buch-Ham), agnimantha (Clerodendrum phlomidis Linn.), shigru (Moringa oleifera Lam.) and ashmantaka.

+

If there is pain in hemorrhoidal mass, then it should be well smeared with medicated oil and sitz-bath should be given with the help of decoction prepared by leaves of radish, triphala [Haritaki (Terminalia Chebula Roxb.), bibhitaka (Terminalia belerica Roxb.) and amalaka (Emblica officinalis Gaertn.)], arka (Calotropis procera Ait.), venu varuna (crataeva nurvala Buch-Ham), agnimantha (Clerodendrum phlomidis Linn.), shigru (Moringa oleifera Lam.) and ashmantaka.

The patient can also be given sitz-bath with the decoction akola (Alangium salviifolium Linn.) or sauviraka or tushodaka or decoction of bilva (Aegle marmelos Carr.) or butter¬milk or dadhi manda (whey) or sour kanjika or cow's urine.

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

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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]

</div>

−

===Raktamokshana (bloodletting)===

+

===[[Raktamokshana]] (bloodletting)===

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</div></div>

−

If the disease is not relieved by the application of cold, hot, unctuous and ununctuous types of treatment then such disease is likely to be caused by vitiation of rakta (blood). In such condition raktamokshana (bloodletting) procedure should be administered. [60]

+

If the disease is not relieved by the application of cold, hot, unctuous and ununctuous types of treatment then such disease is likely to be caused by vitiation of [[rakta]] (blood). In such condition [[raktamokshana]] (bloodletting) procedure should be administered. [60]

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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If the patient suffers from edema and pain in the peri-anal region, and if there is suppression of the digestive power, then he should be treated with the combination of powder of trikatu [(Sunthi (Zingiber officinale), pippali (Piper longum)and maricha (Piper nigrum)], pippalimool (Piper longum), patha (Cissampelos parrira), hingu (Ferula narthex), chitraka (Plumbago Zylanica), sauvarchala (one kind of salt), pushkarmool(Inula racemosa), jeera (Cuminum cyminum), Pulp af bilva (Aegle marmelos), bidlavan, ajwyan (Trachyspermum ammi), hauber, vavding (Embalia ribes), saindhava (one kind of salt), vacha (Acorus calamus) and tintidika along with whey, alcoholic drink or hot water. This recipe also cures hemorrhoids, grahani (sprue syndrome), colic pain and flatulence.[62-64]

−

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]

+

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]

</div>

===Other Recipes===

Line 947: Line 947:

#Haritaki churna along with jaggery should be given before meal.

−

#Trivrita (operculina terpenthum) powder along with triphala decoction should be given which eliminates accumulated ~~doshas~~ through anal region and get relief from symptoms.

+

#Trivrita (operculina terpenthum) powder along with triphala decoction should be given which eliminates accumulated [[dosha]]s through anal region and get relief from symptoms.

#Haritaki (Terminalia Chebula) soaked overnight should be given along with jaggery

#Haritaki (Terminalia Chebula) along with butter-milk

Line 994: Line 994:

</div></div>

−

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]

+

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 [[vata]], cures swelling, itching and pain in anus and promotes strength. [72-75]

</div>

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

Line 1,083: Line 1,083:

The paste of the root-bark of Chitraka (Plumbago Zeylanica) should be smeared inside earthen jar and in this jar, curd or butter-milk should be prepared which relieves hemorrhoids. [76]

−

There is no medicine better than butter-milk for the treatment of hemorrhoids caused by aggravation of ~~vayu~~ and kapha. Butter-milk should be taken along with fat (for ~~vayu~~) or in an ununctuous form (for kapha).[77]

+

There is no medicine better than butter-milk for the treatment of hemorrhoids caused by aggravation of [[vata]] and [[kapha]]. Butter-milk should be taken along with fat (for [[vata]]) or in an ununctuous form (for [[kapha]]).[77]

The butter-milk should be given for either one week or for ten days or for fifteen days or for a month according to strength of the patient and season. [78]

Line 1,093: Line 1,093:

The physician acquainted with the time (kala) and procedure of administration (karma) should not discontinue butter-milk all of a sudden. Butter-milk should be administered up to one month, and thereafter, it should be gradually withdrawn. [82]

−

Takra should be withdrawn gradually in the same quantity in which it was increased. While reducing butter-milk, the patients total food intake should not be reduced. ~~Adop¬tion~~ of this procedure will promote and maintain his energy, maintain the strength, digestive power and promote the strength, plumpness as well as complexion.

+

Takra should be withdrawn gradually in the same quantity in which it was increased. While reducing butter-milk, the patients total food intake should not be reduced. Adoption of this procedure will promote and maintain his energy, maintain the strength, digestive power and promote the strength, plumpness as well as complexion.

Butter-milk is of three types:

#From which fat is completely removed

Line 1,099: Line 1,099:

#From which fat is not at all removed. [83-84]

−

The physician acquainted with the nature of the dosha involved in the causation of the disease, agni (power of diges¬tion and metabolism) of the patient and his strength should administer any of the above mentioned three types of butter¬milk appropriately.[85]

+

The physician acquainted with the nature of the [[dosha]] involved in the causation of the disease, agni (power of diges¬tion and metabolism) of the patient and his strength should administer any of the above mentioned three types of butter¬milk appropriately.[85]

−

Hemorrhoids once cured by the administration of butter-milk, do not recur. The butter milk burns all the grass sprinkled over the ground, let alone the dry type of hemorrhoids in a patient whose agni (digestive power and ~~meta¬bolism~~) has been kindled through this therapy.[86]

+

Hemorrhoids once cured by the administration of butter-milk, do not recur. The butter milk burns all the grass sprinkled over the ground, let alone the dry type of hemorrhoids in a patient whose agni (digestive power and metabolism) has been kindled through this therapy.[86]

−

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]

+

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 [[vata]] (80) and [[kapha]] (20). There is no medicine, better than butter-milk, for the treatment of hemorrhoids caused by vitiation of [[vata]] and [[kapha]]. [87-88]

</div>

===Other Recipes===

Line 1,178: Line 1,178:

Vegetable soup prepared from dried radish or kulattha (Dolichous biflorus) or combination of kapittha (Limonia acidissima), bilva (Aegle marmelons), Kulattha (Dolichous biflorus) and makushtka (Vigna aconitifolia) is useful for hemorrhoids. These soups can be added with the soup of goat-meat. The soup of the meat of lava, etc. added with the juice of sour fruit, butter-milk should be given to such a patient. [93-94]

−

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]

+

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

</div>

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

Line 1,352: Line 1,352:

</div></div>

−

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]

+

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 [[vata]] and cures hemorrhoids, grahani, dysuria, pravahika (amoebaisis), prolapse of rectum, pain in the anal region and flatulence. [110-112]

</div>

===Pippalyadi ghrita===

Line 1,420: Line 1,420:

</div></div>

−

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]

+

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 [[vayu]]. Due to downward movement of stool, flatus, [[kapha]] and [[pitta]] and by their elimination, hemorrhoids are cured and improve the digestive power. [119-120]

===Meat soup===

Line 1,515: Line 1,515:

</div></div>

−

Madira (wine), butter-milk, tushodaka (a type of vinegar prepared of barley ), arishta ( recipes to be described in verses 138-168 ) should be given to the patient having hemorrhoids caused by the predominance of aggravated ~~vayu~~, having ununctuousness and having less digestive power.

+

Madira (wine), butter-milk, tushodaka (a type of vinegar prepared of barley ), arishta ( recipes to be described in verses 138-168 ) should be given to the patient having hemorrhoids caused by the predominance of aggravated [[vata]], having ununctuousness and having less digestive power.

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]

Line 1,534: Line 1,534:

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]

−

===Anuvasana basti with pippayadi taila===

+

===Anuvasana [[basti]] with pippayadi taila===

Line 1,566: Line 1,566:

</div></div>

−

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]

+

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]

===Topical application of paste===

Line 1,590: Line 1,590:

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]

−

===Niruha basti in dry hemorrhoids===

+

===Niruha [[basti]] in dry hemorrhoids===

Line 1,737: Line 1,737:

Fruit pulp of haritaki (Terminalia chebula) (one prastha), amalaki (Embelica officinalis) (one prastha), visala (Cirullus colocunthis) (two palas), kapittha (Limonia acidissima) two palas), patha (Cesalpinia pareira) (two palas) and root of chitraka (Plumbego zylenicum) (two palas) should be added with four dronas of water and boiled till one fourth remains. The decoction should then be strained out through a cloth.

−

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]

+

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 disorders, 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 phalarista, and is propounded by the sage Krishnaatreya. [148-152]

===Phalarishta (Second recipe) ===

Line 1,780: Line 1,780:

</div></div>

−

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]

+

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 appropriate 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]

===Kanakarishta===

Line 1,859: Line 1,859:

</div></div>

−

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]

+

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 [[dosha]]s. [158-168]

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

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</div></div>

−

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

+

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

−

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

+

===Signs and symptoms of bleeding hemorrhoids associated with [[vata]]===

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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]

−

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

+

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

Line 1,935: Line 1,935:

</div></div>

−

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]

+

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]

−

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

+

===Line of treatment as per [[dosha]]===

Line 1,957: Line 1,957:

</div></div>

−

Unctuous and cold things should be used if vitiation of ~~vayu~~ in bleeding hemorrhoids. In case of vitiation of kapha in bleeding hemorrhoids ununctuous and cold-things are useful. Therefore, therapies should be administered after considering these points .

+

Unctuous and cold things should be used if vitiation of [[vata]] in bleeding hemorrhoids. In case of vitiation of [[kapha]] in bleeding hemorrhoids ununctuous and cold-things are useful. Therefore, therapies should be administered after considering these points .

−

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]

+

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

===Complications of immediate hemostasis therapy===

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</div></div>

−

If the blood vitiated by ~~doshas~~, which comes out from the hemorrhoids is arrested in the beginning then it may lead to several complications like raktapitta (a disease characterized by bleeding from various parts of the body ), fever, morbid thirst, ~~suppre¬ssion~~ of digestive power, anorexia, jaundice, edema, pain in the anus and pelvic region, urticaria and pimples in the lumber region and thighs, kushtha, pandu (anemia), obstruction in flatus, urine and stool, headache, staimitya (a feeling as if the body is covered with a wet cloth ), heaviness of the body and other diseases caused by vitiated blood.

+

If the blood vitiated by [[dosha]]s, which comes out from the hemorrhoids is arrested in the beginning then it may lead to several complications like raktapitta (a disease characterized by bleeding from various parts of the body ), fever, morbid thirst, suppression of digestive power, anorexia, jaundice, edema, pain in the anus and pelvic region, urticaria and pimples in the lumber region and thighs, kushtha, pandu (anemia), obstruction in flatus, urine and stool, headache, staimitya (a feeling as if the body is covered with a wet cloth ), heaviness of the body and other diseases caused by vitiated blood.

Therefore, only after elimination of vitiated blood hemostatic measures are useful.

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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</div></div>

−

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

+

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

===Use of sneha===

Line 2,032: Line 2,032:

</div></div>

−

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]

+

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

===Indications for hemostatic therapy===

Line 2,048: Line 2,048:

</div></div>

−

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

+

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

===Hemostatic recipes===

Line 2,161: Line 2,161:

</div></div>

−

Intake of the juice of vastuka along with goat-milk, the soup of the meat of birds and animals ~~inhabi¬ting~~ arid zone should be taken without any sour ingredient or with small quantity of sour drug, which is useful for bleeding hemorrhoids. [194]

+

Intake of the juice of vastuka along with goat-milk, the soup of the meat of birds and animals inhabiting arid zone should be taken without any sour ingredient or with small quantity of sour drug, which is useful for bleeding hemorrhoids. [194]

Line 2,175: Line 2,175:

</div></div>

−

If there is pain in bleeding hemorrhoids then the powder of patha (Cissampelos pareria), seed of vastak (Holerrhina antidysentrica), ~~rashanjana~~, nagara (Zingiber officinalis), yavini (Trachyspermum ammi) and bilva (Aegle marmelos) should be taken in the form of a drink. [195]

+

If there is pain in bleeding hemorrhoids then the powder of patha (Cissampelos pareria), seed of vastak (Holerrhina antidysentrica), rasanjana, nagara (Zingiber officinalis), yavini (Trachyspermum ammi) and bilva (Aegle marmelos) should be taken in the form of a drink. [195]

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</div></div>

−

Onion taken alone or along with meat soup, khada (pungent drink), yusha (vegetable soup) and yavngu (thick gruel) cures excessive bleeding and aggravated ~~vayu~~. [208]

+

Onion taken alone or along with meat soup, khada (pungent drink), yusha (vegetable soup) and yavngu (thick gruel) cures excessive bleeding and aggravated [[vata]]. [208]

Line 2,385: Line 2,385:

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 [[vata]]===

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</div></div>

−

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]

+

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===

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</div></div>

−

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]

+

If there is predominance of [[rakta]] and [[pitta]] and there is less of the signs and symptoms of aggravated [[kapha]] and [[vata]], 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===

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</div></div>

−

If there is prolapse of rectum, burning sensation or ~~sticki¬ness~~ in the anus, then the following recipes should be gently rubbed over the anus. [220-221]

+

If there is prolapse of rectum, burning sensation or stickiness in the anus, then the following recipes should be gently rubbed over the anus. [220-221]

#Samanga and madhuka

#Tila and madhuka

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Patient should be given medicated ghee which is administered, prior to taking food. His anus should be massaged with luke warm ghee or oil, or the hemorrhoid mass should be fomented with luke-warm milk, ghee or oil. These remedies should be administered quickly.

−

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]

+

If bleeding doesn't stop and there is aggravation of [[vata]] 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===

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</div></div>

−

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]

+

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 administered along with ghee, honey and sugar. It cures dysentery, prolapsed of rectum, bleeding and fever. [225-228]

===Anuvasana basti in bleeding hemorrhoids===

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</div></div>

−

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]

+

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 excellent 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 [[dosha]]s. [230-233]

===Sunnishannak changeri ghrita===

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Avakpushpi, balamoola, daruharidra, pithavana, gokshuru and adventitious roots of nyagrodha, udumbara and ashvattha (2 pala each drug) these drugs should be added and boiled till one prastha of water remains. This decoction should be strained through a cloth. In this decoction jivanti, kutaki, pippali, pippalimoola, nagara, devadaru, indrajava, Flower of shalmali, shatavari, rakta chandana, utpala, katphala, chitraka, musta, priyangu, ativisha, sarivan, pollens of padma, utpala, majitha bhatakataiya, bilva, mocharasa and patha. All these drugs should be taken in the quantity of one karsha each and made to a paste.

−

The juice of changari in the above recipe should be added four times the ~~quan¬tity~~ of ghee because this portion does not contain any other liquid sunishanyaka changeri ghrita.

+

The juice of changari in the above recipe should be added four times the quantity of ghee because this portion does not contain any other liquid sunishanyaka changeri ghrita.

−

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]

+

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 [[dosha]]s, 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===

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</div></div>

−

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]

+

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

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

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</div></div>

−

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]

+

The foods that lead to downward movement of [[vata]] 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===

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#Different recipes for massage, fomentation, fumigation, sitz bath, external or topical application, blood-letting and digestive stimulation and laxatives.

#The most useful modes of taking different herbal herbo-mineral drinks and prepared food for patients of arsha;

−

#Many recipes for the downward movement of flatus and stool to control the vitiation of vata dosha.

+

#Many recipes for the downward movement of flatus and stool to control the vitiation of [[vata dosha]].

#Dosha alleviating recipes as per doshic involvement.

#Different types of medicated ghee.

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#The wholesome regimens for dry type of hemorrhoids.

#The signs and symptoms of bleeding hemorrhoids.

−

#Two different types of anubandhas (secondary aggravation of ~~doshas~~) and their appropriate remedies;

+

#Two different types of anubandhas (secondary aggravation of [[dosha]]s) and their appropriate remedies;

#Hemostatic decoctions to stop bleeding in hemorrhoids.

#Preparation and uses of different types of pastes for local application in hemorrhoids.

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</div></div>

−

Thus ends of the 14th chapter which deals with the ~~treat¬ment~~ of hemorrhoids (arshas) in the section on therapeutics of Agnivesha's work as redacted by Charaka.

+

Thus ends of the 14th chapter which deals with the treatment of hemorrhoids (arshas) in the section on therapeutics of Agnivesha's work as redacted by Charaka.

== Tattva Vimarsha (Fundamental Principles) ==

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*The ''arsha'' is of two types viz. congenital and acquired (manifested after the birth).

*The congenital hemorrhoids are caused by the vitiation of the ''beeja dosha'' (deformity in sperm and ovum), specially the part of the anal canal or anal sphincters. This vitiation of the ''beeja dosha'' is caused by either wrong diet, lifestyle regimen of parents (father/mother) or by sinful acts of the past life of patient. These are also causes for all other congenital disorders.

−

*''Arsha'' (hemorrhoids) is characterized by morbid growth in the muscle tissue. 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).

+

*''Arsha'' (hemorrhoids) is characterized by morbid growth in the muscle tissue. 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).

−

*Characteristics or forms of all hemorrhoids are as per the ''~~doshas~~'' involved in their formation.

+

*Characteristics or forms of all hemorrhoids are as per the ''[[dosha]]s'' involved in their formation.

−

*In pathophysiology of ''arsha'', ''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 dosha''. When all these five types of ''~~vayu~~, pitta'' and ''kapha'' get aggravated the individual suffers from morbidities of hemorrhoids.

+

*In pathophysiology of ''arsha'', ''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 dosha]]''. When all these five types of ''[[vata]], [[pitta]]'' and ''[[kapha]]'' get aggravated the individual suffers from morbidities of hemorrhoids.

−

*The causes of ''~~vataja~~ arsha'' include habitual intake of astringent, pungent, bitter, ununctuous, cold and light food; habitual intake of ''pramitashana'' (food measured in extremely small quantities), intake of less quantity of food, intake of excess alcoholic drinks and indulgence in sexual acts; fasting, living in cold country and cold season, excess physical exercise, grief and exposure to sun and wind.

+

*The causes of ''[[vata]]ja arsha'' include habitual intake of astringent, pungent, bitter, ununctuous, cold and light food; habitual intake of ''pramitashana'' (food measured in extremely small quantities), intake of less quantity of food, intake of excess alcoholic drinks and indulgence in sexual acts; fasting, living in cold country and cold season, excess physical exercise, grief and exposure to sun and wind.

−

*The causes of ''~~pittaja~~ arsha'' include intake of pungent, hot, salty and alkaline food; excess exercise and exposure to the heat of fire and Sun; living in a place and season which are not cold, intake of alcohol and envy; Intake of drinks, food and drugs having ''vidahi'' (causing burning sensation), sharp and hot properties.

+

*The causes of ''[[[pitta]]ja arsha'' include intake of pungent, hot, salty and alkaline food; excess exercise and exposure to the heat of fire and Sun; living in a place and season which are not cold, intake of alcohol and envy; Intake of drinks, food and drugs having ''vidahi'' (causing burning sensation), sharp and hot properties.

−

*The causes of ''~~kaphaja~~ arsha'' (hemorrhoids) include sweet, unctuous, cold, salty, sour and heavy food; lack of exercise, sleeping during day time, excess sleeping and sitting; direct exposure to wind, living in cold place and exposure to cold season and mental inactivity.

+

*The causes of ''[[kapha]]ja arsha'' (hemorrhoids) include sweet, unctuous, cold, salty, sour and heavy food; lack of exercise, sleeping during day time, excess sleeping and sitting; direct exposure to wind, living in cold place and exposure to cold season and mental inactivity.

−

*Hemorrhoids always include aggravation of all the three ''~~doshas~~''. Predominance of one or all the ''~~doshas~~'' determine the type of hemorrhoids.

+

*Hemorrhoids always include aggravation of all the three ''[[dosha]]s''. Predominance of one or all the ''[[dosha]]s'' determine the type of hemorrhoids.

−

*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.

+

*Five types of ''[[vata]]'' (''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.

*Excision of the hemorrhoids by sharp instruments, cauterization with ''ksharakarma'' (alkalies) and ''agnikarma'' (thermal cauterization) are three modalities in the management of ''arsha''.

−

*Hemorrhoids caused by aggravation of ''~~vayu~~'' and ''kapha'' are ‘dry hemorrhoids’. Whereas those with excess discharge (bleeding) and wetness are caused by aggravation of ''rakta'' and ''pitta''.

+

*Hemorrhoids caused by aggravation of ''[[vata]]'' and ''[[kapha]]'' are ‘dry hemorrhoids’. Whereas those with excess discharge (bleeding) and wetness are caused by aggravation of ''[[rakta]]'' and ''[[pitta]]''.

−

*Dry, hard, inflamed and painful hemorrhoids should be first treated with fomentation in the form of ''avagaha'' (sitz bath in medicated decoction), ''abhyanga'' (local massage with medicated oils), sprinkling of medicated water, fumigation, ointment and external application. Then the vitiated blood shall be removed out by blood letting therapy. 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. Simultaneously with this localized treatment, generalized treatment to correct the ''agni'' is advised to patients.

+

*Dry, hard, inflamed and painful hemorrhoids should be first treated with fomentation in the form of ''avagaha'' (sitz bath in medicated decoction), ''abhyanga'' (local massage with medicated oils), sprinkling of medicated water, fumigation, ointment and external application. Then the vitiated blood shall be removed out by blood letting therapy. Bloodletting with the help of application of leeches or sharp instruments or needles should be done in ''[[rakta]]ja arsha'', if blood doesn't come out on its own. Simultaneously with this localized treatment, generalized treatment to correct the ''agni'' is advised to patients.

−

*Butter-milk is the best medicine for the treatment of hemorrhoids caused by aggravation of ''~~vayu~~'' and ''kapha''. Butter-milk should be taken along with fat (for ''~~vayu~~'') or in an ununctuous form (for ''kapha''). It can be given in various forms, at different times depending upon the state of disease.

+

*Butter-milk is the best medicine for the treatment of hemorrhoids caused by aggravation of ''[[vata]]'' and ''[[kapha]]''. Butter-milk should be taken along with fat (for ''[[vata]]'') or in an ununctuous form (for ''[[kapha]]''). It can be given in various forms, at different times depending upon the state of disease.

−

*''Anuvasana basti'' (unctuous enema) is best treatment for ''arsha'' associated with dysfunction of ''vata''.

+

*''Anuvasana [[basti]]'' (unctuous enema) is best treatment for ''arsha'' associated with dysfunction of ''[[vata]]''.

−

*The bleeding hemorrhoids shall be treated after assessment of association with ''vata'' dominance and ''kapha'' dominance in its patho-physiology. Unctuous and cold things should be used in cases of vitiation of ''~~vayu~~'' in bleeding hemorrhoids. In case of vitiation of ''kapha'' in bleeding hemorrhoids, ununctuous and cold-things are useful.

+

*The bleeding hemorrhoids shall be treated after assessment of association with ''[[vata]]'' dominance and ''[[kapha]]'' dominance in its patho-physiology. Unctuous and cold things should be used in cases of vitiation of ''[[vata]]'' in bleeding hemorrhoids. In case of vitiation of ''[[kapha]]'' in bleeding hemorrhoids, ununctuous and cold-things are useful.

−

*If there is predominance of ''pitta'' and ''kapha dosha, shodhana'' (elimination) therapies are indicated.

+

*If there is predominance of ''[[pitta]]'' and ''[[kapha dosha]], [[shodhana]]'' (elimination) therapies are indicated.

*Bleeding should not be stopped immediately by giving hemostatic therapies. One should wait for appropriate time till the vitiated blood goes out and the patient can be given fasting therapy.

−

*If the blood vitiated by ''~~doshas~~'', which comes out from the hemorrhoids is arrested in the beginning then it may lead to several other complications. Therefore, only after elimination of vitiated blood hemostatic measures are useful. The physician should be well aware of 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.

+

*If the blood vitiated by ''[[dosha]]s'', which comes out from the hemorrhoids is arrested in the beginning then it may lead to several other complications. Therefore, only after elimination of vitiated blood hemostatic measures are useful. The physician should be well aware of 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.

−

*Bitter drugs should be given for stimulation of the digestive power, hemostasis and ''pachana'' (metabolic transformation).

+

*Bitter drugs should be given for stimulation of the digestive power, hemostasis and ''[[pachana]]'' (metabolic transformation).

−

*In hemorrhoids with predominance of ''vayu'', if 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''.

+

*In hemorrhoids with predominance of ''[[vayu]]'', if bleeding continues even after the aggravated ''[[dosha]]s'' are eliminated, then the patient should be given unctuous therapies in the form of drinks, massage and ''anuvasana [[basti]]''.

−

*In summer season, ''pitta'' predominant hemorrhoids without secondary predominance of ''~~vayu~~'' and ''kapha'', should be treated with hemostatic therapies immediately to stop bleeding.

+

*In summer season, ''[[pitta]]'' predominant hemorrhoids without secondary predominance of ''[[vata]]'' and ''[[kapha]]'', should be treated with hemostatic therapies immediately to stop bleeding.

−

*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.

+

*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.

−

*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.

+

*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.

*If bleeding continues in spite of the above mentioned remedies and cooling therapies, then a wise physician should administer at the appropriate time, meat-soup which is unctuous and hot. Patient should be given medicated ghee which is administered, prior to taking food. His anus should be massaged with lukewarm ghee or oil, or the hemorrhoid mass should be fomented with lukewarm milk, ghee or oil. These remedies should be administered quickly.

−

*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 lukewarm ''ghritamanda'' (upper portion of the ghee). He should be given the effective ''piccha basti'' (recipe of which is described below) at the appropriate time.

+

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

*The power of digestion should always be preserved in the patients of hemorrhoids by giving sometimes cold articles and sometimes hot articles, sometimes sweet or sour taste drugs or food having opposite characters.

*''Arsha'' (hemorrhoids), ''atisara'' (diarrhea) and ''grahani'' these three diseases are interdependent. In all patients of these three diseases, if the digestive power is low then disease gets aggravated and if digestive power is strong then relief occurs.

−

*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 patients.

+

*The foods that lead to downward movement of ''[[vata]]'' 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 patients.

== Vidhi Vimarsha (Applied Inferences ) ==

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Charaka mentioned in most of the verses the effect of the formulation like ''dantyarishta'' helps in the downward movement of flatus and feces and stimulates the digestive power. It shows that the main cause of the disease is ''agnimandya'' and constipation.

−

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.

+

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 ''[[vata]]ja'' and ''[[kapha]]ja'' type of hemorrhoids while cold water sitz bath should be given in cases of ''[[pitta]]ja'' or ''[[rakta]]ja'' predominant hemorrhoids.

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

Eganeesh

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