Arsha Management Sushruta samhita sthana

Comprehensive Ayurvedic Management of Arsha (Piles): A Detailed Overview

Introduction

Arsha, commonly known as piles or hemorrhoids, is a prevalent anorectal disorder characterized by the swelling and inflammation of veins in the anal and rectal regions. In Ayurveda, Arsha is classified as one of the Ashta Mahagadas (eight great diseases), emphasizing its chronic nature and potential severity. The condition is primarily categorized into internal and external types based on the location of the hemorrhoidal mass.

Etiology (Nidana)

The development of Arsha is attributed to various etiological factors:

Dietary Factors: Consumption of dry, spicy, and irregular foods.

Lifestyle Factors: Prolonged sitting, excessive standing, and lack of physical activity.

Psychological Factors: Stress and anxiety leading to vitiation of doshas.

Underlying Conditions: Chronic constipation, obesity, and sedentary lifestyle.


These factors lead to the aggravation of doshas, particularly Vata and Pitta, resulting in the formation of hemorrhoidal masses.

Pathophysiology

The pathogenesis of Arsha involves the vitiation of doshas:

Vata Dosha: Leads to the formation of dry, non-bleeding hemorrhoids (Shushka Arsha).

Pitta Dosha: Results in inflamed, bleeding hemorrhoids (Rakta Arsha).

Kapha Dosha: Causes soft, non-bleeding hemorrhoids (Shita Arsha).

Sannipataja Arsha: A mixed type involving all three doshas.


Clinical Features

Symptoms of Arsha vary based on the dosha involved:

Vataja Arsha: Painful, dry, and non-bleeding masses.

Pittaja Arsha: Bleeding, inflamed, and tender masses.

Kaphaja Arsha: Soft, painless, and non-bleeding masses.

Raktaja Arsha: Bleeding with a reddish hue.

Sannipataja Arsha: Combination of symptoms from all doshas.


Diagnosis (Roga Pariksha)

Diagnosis is primarily clinical, based on:

Patient History: Assessment of symptoms and lifestyle factors.

Physical Examination: Inspection and palpation of the anal region.

Proctoscopy: Visual examination of the rectal canal.

Anorectal Manometry: Assessment of anal sphincter function.


Management (Chikitsa)

Ayurvedic management of Arsha is holistic and tailored to the dosha involved:

1. Bheshaja Karma (Pharmacological Therapy)

Internal Medications: Herbal formulations such as Triphala Guggulu, Abhayarishta, and Gandharvahastadi Kashayam are commonly used to alleviate symptoms and promote healing.

External Applications: Topical applications of medicated oils like Jatyadi Taila can provide relief from pain and inflammation.



2. Kshara Karma (Alkaline Therapy)

Apamarga Kshara: A caustic alkaline paste derived from the seeds of Achyranthes aspera is applied to the hemorrhoidal mass to reduce size and alleviate symptoms.



3. Shastra Karma (Surgical Intervention)

Ksharasutra Therapy: A specialized surgical thread medicated with Kshara is tied around the base of the hemorrhoidal mass, leading to its gradual sloughing off.



4. Agni Karma (Thermal Therapy)

1. Arśa (आर्शः) and its Management Based on Suśruta Saṃhitā Compiled by: Dr. ...

2. Definition Arśa = growth in guda (anal canal) caused by vitiated doṣa obstructing the pathway of mala. Mahat vyādhi due to chronic nature. Shloka (Suśruta Nidāna 2/4): “गुदे मारुतपित्तश्लेष्ममेदःशोणितसंभवः । तत्रार्शो नाम तद्दोषैः पीडितं मार्गमीरितम् ॥” Meaning: When vāta, pitta, kapha, meda and rakta afflict the anal canal, piles develop.

3. Importance of Management • If untreated → anemia, severe pain, infection. • Recurrence is common → needs comprehensive management. • Suśruta gave Caturvidha Upakrama (fourfold treatment). Shloka (Suśruta Cikitsā 6/1): “भेषजक्षाराग्निशस्त्रैः चतुर्भिरुपक्रमैः । साध्यान्यर्शांसि विज्ञेया भवन्ति चिकित्सया ॥”

4. Bheshaja Cikitsā (Medicinal Therapy) Indicated in Sādhya Arśa (early stages). Methods: - Virecana: Triphala, Aragvadha, Haritaki, Eranda Taila - Takra Prayoga: improves digestion, reduces kapha & meda - Ghṛta & Taila: Haridrādi ghṛta, Yashtimadhu ghṛta - Oral drugs: Abhayādi modaka, Arśoghni vati Shloka (Suśruta Cikitsā 6/5): “तक्रं शृतं पिबेत् तैलं हिङ्गुयष्ट्यादिसंयुतम् । स्नेहं त्रिफलया युक्तं पिबेन्मारुतजेषु च ॥” Meaning: Takra with hing & yashtimadhu, ghṛta with triphalā – beneficial in vāta piles.

5. Kṣāra Karma (Alkaline Therapy) Indicated in Yāpya Arśa & when bheshaja fails. Procedure: - Application of Pratisārṇīya Kṣāra on pile mass - Causes chemical cauterization → sloughing - Leaves clean wound → heals without recurrence Shloka (Suśruta Cikitsā 6/11): “क्षारः शस्त्रं च नित्यं स्यात् पित्तशोणितसंभवे । दोषजं तु व्रणं कुर्यात् क्षारः शस्त्रं तथैव च ॥” Meaning: In pitta-rakta dominant piles, kṣāra is choice.

6. Agni Karma (Thermal Cauterization) Indicated in bleeding piles (Raktārśa). Procedure: - Heated metallic probes (Śalākā) applied - Controls bleeding, shrinks pile mass Shloka (Suśruta Cikitsā 6/15): “दग्ध्वा चाग्निसमायुक्तैः शलाकाभिर्निवारयेत् । रक्तपित्तसमुत्थानि यथोक्तानि विनाशयेत् ॥” Modern correlation: Electrocautery, laser coagulation.

7. Śastrakarma (Surgical Management) Indicated in large, prolapsed, recurrent piles. Steps: 1. Patient in lithotomy position 2. Excision of pile at root 3. Hemostasis by kṣāra/agni karma 4. Wound care with ghṛta & taila Shloka (Suśruta Cikitsā 6/17): “च्छित्त्वा शस्त्रैः समं मूले शुष्येत् क्षारदग्धवत् । शस्त्रकर्म विधानेन सर्वेषामप्यरोः क्रमः ॥” Modern correlation: Hemorrhoidectomy, stapler surgery.

8. Post-operative Care • Sitz bath with Triphala kwath • Local application: Jatyādi Taila, Yashtimadhu Ghṛta • Shamana drugs: Guggulu preparations, Triphala • Diet: Laghu, fiber-rich food • Lifestyle: Avoid straining, avoid prolonged sitting

9. Pathya & Apathya Pathya: - Takra, Kulattha, Yavagu, Mudga, leafy vegetables - Regular exercise, bowel regulation Apathya: - Dadhi, Masha, heavy/fried food, alcohol - Sedentary lifestyle

10. Ayurveda vs Modern Management | Ayurveda (Suśruta) | Modern Medicine | |---------------------|----------------| | Bheshaja Cikitsā | Conservative (diet, stool softeners) | | Kṣāra Karma | Kṣāra Sutra / Injection therapy | | Agni Karma | Electrocautery / Laser | | Śastrakarma | Hemorrhoidectomy / Stapler |

11. Conclusion • Suśruta provided a systematic fourfold approach. • Mild cases → Bheshaja • Moderate → Kṣāra / Agni Karma • Severe → Surgery • Still relevant in modern proctology.