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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).

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''

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

{{Infobox

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== Introduction ==

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This chapter is followed by ''udara roga'' because the causative factors for both the diseases are similar like vitiation of ''tridosha''. Both the diseases are related to the same system i.e. gastrointestinal tract. Further, ''arsha'' is one of the causative factors of ''udara roga'' (''Boddhagudedara''- intestinal obstruction) Therefore the chapter dealing with ''arshas'' (hemorrhoids) follows the chapter on the treatment of ''udara'' (obstinate abdominal disorders).

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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.

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</div>

== Sanskrit text, Transliteration and English Translation ==

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sAdhyAsAdhyavibhAgaM ca tasmai tanmunirabravIt||4||

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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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</div>

=== Types of hemorrhoids ===

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tatra sahajAni saha jAtAni sharIreNa, arshAMsItyadhimAMsavikArAH||5||

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O Agnivesha!, The ''arsha'' is of two types:

#Congenital

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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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sarveShAM cArshasAmadhiShThAnaM- medo mAMsaM tvak ca||6||

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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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</div>

=== Forms of congenital hemorrhoids ===

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tatra sahajAnyarshAMsi kAnicidaNUni, kAnicinmahAnti, kAniciddIrghANi, kAniciddhrasvAni, kAnicidvRuttAni,kAnicidviShamavisRutAni, kAnicidantaHkuTilAni, kAnicidbahiHkuTilAni, kAnicijjaTilAni,kAnicidantarmukhAni, yathAsvaM doShAnubandhavarNAni||7||

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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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tairupahato janmaprabhRuti bhavatyatikRusho vivarNaH kShAmo dInaHpracuravibaddhavAtamUtrapurIShaH sharkarAshmarImAn,tathA~aniyatavibaddhamuktapakvAmashuShkabhinnavarcA antarA~antarAshvetapANDuharitapItaraktAruNatanusAndrapicchilakuNapagandhyAmapurIShopaveshI,nAbhibastiva~gkShaNoddeshe pracuraparikartikAnvitaH,sagudashUlapravAhikApariharShapramehaprasaktaviShTambhAntrakUjodAvartahRudayendriyopalepaHpracuravibaddhatiktAmlodgAraH, sudurbalaH, sudurbalAgniH, alpashukraH, krodhano,duHkhopacArashIlaH,kAsashvAsatamakatRuShNAhRullAsacchardyarocakAvipAkapInasakShavathuparItaH, taimirikaH,shiraHshUlI, kShAmabhinnasannasaktajarjarasvaraH, karNarogI, shUnapANipAdavadanAkShikUTaH,sajvaraH, sA~ggamardaH, sarvaparvAsthishUlI ca, antarA~antarApArshvakukShibastihRudayapRuShThatrikagrahopataptaH, pradhyAnaparaH, paramAlasashceti;janmaprabhRutyasya gudajairAvRuto mArgoparodhAdvAyurapAnaH [1] pratyArohansamAnavyAnaprANodAnAn pittashleShmANau ca prakopayati, ete sarva eva prakupitAH pa~jca vAyavaHpittashleShmANau cArshasamabhidravanta etAn vikArAnupajanayanti; ityuktAni sahajAnyarshAMsi||8||

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The person suffering with congenital hemorrhoids has the following signs and symptoms:

#Right from the birth he is lean and thin, pale, emaciated, weak, excessive or obstructed flatus, urine and stool. He has gravels and stone in the urinary system.

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#He has persistent giddiness and is extremely lazy.

#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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kShaNanAdabhIkShNaMshItAmbusaMsparshAccelaloShTatRuNAdigharShaNAt pratatAtinirvAhaNAdvAtamUtrapurIShavegodIraNAt samudIrNavegavinigrahAt strINAMcAmagarbhabhraMshAdgarbhotpIDanAdviShamaprasUtibhishca prakupito vAyurapAnastaM malamupacitamadhogamAsAdya gudavaliShvAdhatte,tatastAsvarshAMsi prAdurbhavanti||9||

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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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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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sarShapamasUramAShamudgamakuShThakayavakalAyapiNDiTiNTikerakebukatindukakarkandhukAkaNantikAbimbIbadarakarIrodumbara-kharjUrajAmbavagostanA~gguShThakasherushRu~ggATakashRu~ggIdakShashikhishukatuNDajihvApadmamukulakarNikAsaMsthAnAnisAmAnyAdvAtapittakaphaprabalAni||10||

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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.

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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teShAmayaM visheShaH- shuShkamlAnakaThinaparuSharUkShashyAvAni, tIkShNAgrANi, vakrANi, sphuTitamukhAni,viShamavisRutAni, shUlAkShepatodasphuraNacimicimAsaMharShaparItAni, snigdhoShNopashayAni,pravAhikAdhmAnashishnavRuShaNabastiva~gkShaNahRudgrahA~ggamardahRudayadravaprabalAni,pratatavibaddhavAtamUtravarcAMsi,UrukaTIpRuShThatrikapArshvakukShibastishUlashiro~abhitApakShavathUdgArapratishyAyakAsodAvartAyAmashoShashotha-mUrcchArocakamukhavairasyataimiryakaNDUnAsAkarNasha~gkhashUlasvaropaghAtakarANi,shyAvAruNaparuShanakhanayanavadanatva~gmUtrapurIShasya vAtolbaNAnyarshAMsIti vidyAt||11||

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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.

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#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.

#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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shoko vAtAtapasparsho heturvAtArshasAM mataH||13||<br />

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The causes of vataja 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.

#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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mRudushithilasukumArANyasparshasahAni, raktapItanIlakRuShNAni, svedopakledabahulAni,visragandhitanupItaraktasrAvINi [1] , rudhiravahAni, dAhakaNDUshUlanistodapAkavanti, shItopashayAni,sambhinnapItaharitavarcAMsi, pItavisragandhipracuraviNmUtrANi,pipAsAjvaratamakasammohabhojanadveShakarANi pItanakhanayanatva~gmUtrapurIShasyapittolbaNAnyarshAMsIti vidyAt||14||

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The following are the signs and symptoms of Pittaja Arshas:

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

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#The patient suffers from morbid thirst, fever, asthma, fainting and disliking for foods

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

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===Etiology of pittaja arsha===

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pittolbaNAnAM vij~jeyaH prakope heturarshasAm||16||<br />

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The causes of pittaja arsha are as follow:

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

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#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. [15-16]

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

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tatra yAni pramANavanti, upacitAni, shlakShNAni, sparshasahAni [3] , snigdhashvetapANDupicchilAni,stabdhAni, gurUNi, stimitAni, suptasuptAni, sthirashvayathUni, kaNDUbahulAni,bahupratatapi~jjarashvetaraktapicchAsrAvINi, gurupicchilashvetamUtrapurIShANi,rUkShoShNopashayAni, pravAhikAtimAtrotthAnava~gkShaNAnAhavanti,parikartikAhRullAsaniShThIvikAkAsArocakapratishyAyagauravacchardimUtrakRucchrashoShashotha-pANDurogashItajvarAshmarIsharkarAhRudayendriyopalepAsyamAdhuryapramehakarANi,dIrghakAlAnubandhIni [4] , atimAtramagnimArdavaklaibyakarANi, AmavikAraprabalAni,shuklanakhanayanavadanatva~gmUtrapurIShasya shleShmolbaNAnyarshAMsIti vidyAt||17||

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The following are the signs and symptoms of kaphaja arshas

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

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#They are associated with acute diseases caused by ama (product of improper digestion and metabolism).

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

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</div>

===Etiology of kaphaja arsha===

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shlaiShmikANAM samuddiShTametat kAraNamarshasAm||19||<br />

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The causes of kaphaja arsha (hemorrhoids) are as follow

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

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#Direct exposure to wind

#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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sarvo hetustridoShANAM sahajairlakShaNaiH samam||20||<br />

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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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pUrvarUpANi nirdiShTAnyarshasAmabhivRuddhaye||22||<br />

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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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doShairdoShavisheShAttu visheShaH kalpyate~arshasAm||23||<br />

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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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sarvadehopatApIni prAyaH kRucchratamAni ca||25||<br />

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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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tAnyAshu hi gudaM baddhvA kuryurbaddhagudodaram||32||<br />

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If the patient of hemorrhoids develops edema in upper and lower extremities, face, umbilicus, anus and scrotum, and if he suffers from pain in the cardiac region and lateral parts of chest, then such types of patients became incurable. [26]

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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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tadarshasAM pravakShyAmi samUlAnAM vivRuttaye||37||<br />

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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.

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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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prasrAvINi tathA~a~ardrANi raktapittolbaNAni ca||38|| <br />

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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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abhyajya kuShThatailena svedayet poTTalIkRutaiH| <br />

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The pile mass should be smeared with the help of the oil prepared by boiling chitraka (Plumbago zeylanica Linn.), alkalies and bilva (Aegle marmelos Carr.).

Fomentation should be done with the help of the following formulations:

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#Pinda containing hapusha

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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vRuShArkairaNDabilvAnAM patrotkvAthaishca secayet||44||

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The hemorrhoids mass should be sprinkled with decoction of the leaves vasa (Adhatoda zeylanica Medic.), arka (Calotropis procera Ait.), eranda (Ricinus communis Linn.) and bilva (Aegle marmelos Carr.) [44]

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</div>

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===Recipes for sitz-bath===

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gomUtre vA sukhoShNe taM svabhyaktamavagAhayet||47|| <br />

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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.

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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===Recipes for smearing and fumigation===

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ku~jjarasya purIShaM tu ghRutaM sarjarasastathA||51|| <br />

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#The fat black variety of cobra, pig, camel, jatuka and cat should be applied on the piles mass and also used for fumigation of piles.[48]

#Fumigation should be done with the help of human hair, serpent's slough, cat's skin, root of Arka (Calotropis procera Ait.) and leaf of shami. [49]

#Fumigation should be given with tumbi, vidang (Embelia ribes), devadaru (Cedrus deodaru) and akshat (rice) mixed with ghee. Brahati (Solanum indicum), ashvagandha (Withania somnifera), pippali (Piper longum) and surasa/tulasi (Ocimum sanctum) mixed with ghee can be used for fumigation.[50]

#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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kara~jjo bastamUtraM ca lepanaM shreShThamarshasAm||57|| <br />

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The following recipes should be used in the form of ointments in the management of hemorrhoids:

#Turmeric powder (Curcuma longa) mixed with latex of snuhi (Euphorbia nerifolia) paste should be applied on hemorrhoids.

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#The luke¬warm paste prepared of hartala mixed with the fat of camel should be applied. It cures pain and edema in the hemorrhoids mass. [56]

#The paste of the latex of arka (Calotropis procera Ait.), stem of snuhi (Euphorbia nerifolia), leaf of bitter variety of alabu (bottle guard), karanja (Pongamia pinnata) and urine of goat is excellent in treatment of hemorrhoids. [57]

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stambhashvayathukaNDvartishamanAste~arshasAM matAH||58|| <br />

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All above mentioned recipes started with abhyanga (recipes for smearing) and ending with pradeha (local application of ointment) are useful in management of hemorrhoids associated with stiffness, edema, itching and pain. [58]

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sa~jcitaM duShTarudhiraM tataH sampadyate sukhI||59|| <br />

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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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avartamAnaM rudhiraM raktArshobhyaH pravAhayet||61||<br />

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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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===Churna (powder formulations) ===

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pAcanaM pAyayedvA tadyaduktaM [7] hyAtisArike| <br />

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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]

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===Other Recipes===

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pa~jcakolayutaM vA~api takramasmai pradApayet||71||<br />

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#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.

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#Chitraka(Plumbago Zylanica), hapushpa and hingu mixed with Butter-milk

#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===

Line 980: Line 982:

iti takrAriShTaH <br />

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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===

Line 1,068: Line 1,070:

nAsti takrAt paraM ki~jcidauShadhaM kaphavAtaje||88||<br />

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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]

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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]

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===

Line 1,115: Line 1,117:

etaishcaiva ghRutaM sAdhyamarshasAM vinivRuttaye||91||<br />

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Peya (thin gruel) should be prepared by cooking with pippali (piper longum), pippalimoola (root of piper longum), chitraka (Plumbago Zylanica), gaja pippali(Scindapsus officinalis Schoott.), shringvera (Zingiber officinale), ajqji (Cuminum Cyminum), karavi (Foeniculum vulgare), dhanyak (Coriandrum sativum), tumburu (Coriandrum sativum), bilva (Aegle marmelos), karkataka and patha (Cissampelos parrira). Intake of this peya (thin gruel) by adding sour fruits and sizzled with ghee and oil cures hemorrhoids. [89-90]

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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dadyAdyavAgUM takrAmlAM maricairavacUrNitAm||92|| <br />

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Thick gruel prepared by pippali (Piper longum) and nagara (Zingiber officinale) made sour by adding buttur-milk and sprinkled with the powder of maricha (Piper nigrum) is useful. [92]

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ityukto bhinnashakRutAmarshasAM ca kriyAkramaH|96|<br />

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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]

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

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guDanAgarasaMyuktaM [13] pibedvA paurvabhaktikam||102||<br />

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Now, recipes for the treatment of patients suffering from hemorrhoids and having excessive constipation are as follows:

#The patient should be given matsyandika (a preparation of sugar-cane juice) along with sunthi (Zingiber officinlis) and then prasanna (a type of alcoholic drink) mixed with saktu (roasted corn-flour) and salt.[97]

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#Leaves of karanja (Pongamia pinata) fried with ghee and oil, and sprinkled with the powder of saktu (roasted corn¬ flour) should be given before food which helps in the downward movement of flatus and stool.[101]

#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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phANitena ca saMyojya phalAmlaM dApayedghRutam||103|| <br />

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Phanita (penidium) prepared with and juice of sour fruits and ghee added with pippali (Piper longum), nagara (Zingiber officinalis), kshara, karavi, dhanya (Coriandrum sativum), jiraka (Cuminum cyminum) should be given in cases of hemorrhoids. [103]

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Line 1,248: Line 1,252:

shRu~ggaverayavakShArau taiH siddhaM vA pibedghRutam||104|| <br />

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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===

Line 1,264: Line 1,268:

pippalImUlasiddhaM vA saguDakShAranAgaram [14] ||105|| <br />

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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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</div>

===Pippalyadi ghrita===

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siddhaM sarpirvidhAtavyaM vAtavarcovibandhanut||106||<br />

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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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</div>

===Chavyadi ghrita===

Line 1,308: Line 1,312:

gudava~gkShaNashUlaM ca ghRutametadvyapohati||109|| <br />

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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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gudabhraMshArtimAnAhaM ghRutametadvyapohati||112|| <br />

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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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balapuShTikaraM varNyamagnisandIpanaM param||118||<br />

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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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gude~arshAMsi prashAmyanti pAvakashcAbhivardhate||120|| <br />

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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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#Rao MM, Kar AC, Bhattacharya P. Therapeutic evaluation of compound Ayurvedic formulations in the management of Arsha (haemorrhoids) - a clinical study. Journal of Research in [[Ayurveda]] and Siddha. 2006; 27(3-4):81-91.

#Chopade KM, Khatri SR, Raut SY, Lakhapati AM. To evaluate the efficacy of Kshiri - Vruksh Patra (Vata, Udumbara & Peepal) in management of Arsha. e-Journal Rasamruta. 2013; 5(14):1-5.

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