Haemorrhoids managment by Ayurveda and Modern

Ayurvedic managmnet of haemorrhoids

1. RANDOMIZED CONTROLLED CLINICAL TRIAL OF
MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R.
TO HAEMORRHOIDS
GUIDED BY:
DR.D.W.LILKE
PRESENTED BY:
DR.VIPIN KRISHNAN.C

2. INTRODUCTION
Haemorrhoids are defined as dilated veins within the
anal canal in the subepithelial region formed by
radicles of the superior, middle and inferior rectal
veins.
Arsha can be correlated with haemorrhoids
described in modern science.
One of the prime important diseases from
Ashtamahagad is Arsha, defined as a disease which
torture patients vital force as enemy.
The dhatuvaigunya (organic pathology due to local
deformity) of anal mucosa requires local treatment,
so local application of murivenna study carried out.
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

3. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

4. AIMS & OBJECTIVE
AIM:
1.To study the efficacy of murivenna oil local application in
the management of Arsha (Haemorrhoids).
0BJECTIVE:
1.To find cost effective therapy.
2.To establish alternative ayurvedic remedy in
management of Arsha (Haemorrhoids).
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

5. HYPOTHESIS:
Null Hypothesis (H
o):
Murivenna oil local application is not effective in
management of Arsha (Haemorrhoids).
Alternate Hypothesis (H
1):
Murivenna oil local application is effective in
management of Arsha (Haemorrhoids).
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

6. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS
Murivenna was first explained in Agastyamarma Sastra, a medicine
textbook of Siddha medicine.
The reference of Murivenna is available in the Pharmacopeia of
Government Ayurveda college, Trivandrum, Kerala and Ayurveda
Formulary of India (AFI) Part 33.
Arsha is mentioned as one of indications in Yoga of murivenna.
It contains 10 ingredients including
Karanja,Palandu,Paribhadra,Sathavari,Vasuka,Kerathaila,Tambula ,
Shigru,Tandula and Kumari.
MURIVENNA

7. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS
चोल्लिटाम्मुरिवेण्णकाचुमतिनायुलिोरुयोगम्।
निकेलिाम्िियोटुिोगमोळिचाल्ककटान्पुिट्टटटान्
िलिेल्लकलकिलिेटीवीणु
मुरिवेल्लकलषिमेल्लकिुम्
िीपोलिीटटल्लचिनीरिनुम्
गुदििं ववङगुन्नोिर्शळिनुम्
(अनुभूिम)

8. MATERIALS
STUDY DESIGN
Single Blind Randomized Prospective Clinical Study
Group-A- (Trial group)
Murivenna Oil local
application was done
once in a day after
defaecation for 7 days
GROUP B(Control group)
Kasisadi taila
application was done
once in a day after
defaecation for 7 days .
DURATION OF APPLICATION -7 DAYS
FOLLOW UP 7,15,21,30 DAYS
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

9. CRITERIA OF SELECTION OF PATIENTS :
•INCLUSION CRITERIA:
•1) Patients of age group between 18 to 60 years.
•2) Both male and female patients were selected
•3) 2
nd
and 3
rd
degree interno external haemorrhoids.
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

10. EXCLUSION CRITERIA :
•1) Patients of age group less than 18 and more than 60 years.
•2) 4th degree prolapsed Internal and external Haemorrhoids
•3) Patient suffering from haemorrhoids with ulcerative colitis,
Crohn’s disease, liver disorder and other chronic disease.
•4) Other anorectal conditions with haemorrhoids, CA.
•5)Pregnancy
•6) Uncontrolled Systemic Disorders like HTN, DM, Asthma, CVS
disorders
•7) HIV, HbsAg positive Patients.
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

11. ASSESEMENT CRITERIA
Per- rectal examination
1 SIGNS
GRADE
2 No pile mass 0
3 Pile mass into Anal Canal 1
4 Pile mass comes out from anal canal during
defecation then goes back by itself
2
5Pile mass go back by manual reduction3
Bleeding per rectum
SR.
N
O
BLEEDING SCALE GRADE
1No Bleeding 0
2Less than 2 ml 1
32 to 5 ml 2
4More than 5 ml 3
Per Rectal Pain
SR.NO SIGN GRADE
1 Absent 0
2 Present 1
Itching with mucous discharge
SR.NO SIGN GRADE
1 Absent 0
2 Present 1
Pile mass
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

12. CRITERIA FOR ASSESSING THE RESULT:
• Cured symptoms -70-100% relief in signs & symptoms
• Markedly improved -50-70% relief in signs & symptoms
• Improved -30-50% relief in signs & symptoms
• Unchanged -< 30% relief in signs & symptoms.
PROCTOSCOPY
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

13. PREPARATION OF MURIVENNA
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

14. PROCEDURE
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

15. OBSERVATION AND RESULTS
Group Day N Mean SD W P
Group A BT 32 2.2180.553 0 < .00001
AT 32 0.3130.592
Group B BT 32 2.2810.523 0 < .00001
AT 32 0.5940.559
Group Day N Mean SD W P
Group A BT 32 1.6560.545 52 .00008
AT 32 0.8440.677
Group B BT 32 1.6560.545137 < .00001
AT 32 0.2180.420
1) Bleeding per rectum[Wilcoxon signed rank
test]
2)Pile mass [Wilcoxon signed rank test]
0
5
10
15
20
25
D0 D7 D15D21D30D0 D7 D15D21D30
Group A Group B
No of patients
0
6
8
16
24
0 0
2
5
14
2
16
17
13
6
1
21
24
23
17
21
9
7
3
2
21
11
6
4
1
9
1
0 0 0
10
0 0 0 0
No. of patients
Bleeding per rectum
Grade 0Grade 1Grade 2Grade 3
0
5
10
15
20
25
D0D7D15D21D30D0D7D15D21D30
Group A Group B
No of patients
0 0 1
5
10
0 0
2
9
25
12
1920
1817
12
202120
7
19
13
11
9
5
19
12
9
3
01 0 0 0 0 1 0 0 0 0
No. of patients
Size of Pile Mass
Grade 0Grade 1Grade 2Grade 3
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

16. Group Day N Mean SD W P
Group A BT 32 0.5620.504 40 .0002
AT 32 0 0
Group B BT 32 0.4680.507 8 .00512
AT 32 0.1560.369
Group Day N Mean SD W P
Group A BT 32 0.3120.471 8 .00512
AT 32 0 0
Group B BT 32 0.4060.498 17 .00148
AT 32 0 0
4) Itching and mucous discharge[Wilcoxon signed rank test]
3) Per Rectal Pain[Wilcoxon signed rank test]
0
5
10
15
20
25
30
35
D0D7D15D21D30D0D7D15D21D30
Group A Group B
No of patients
14
30
323232
17
22
26
2827
18
2
000
15
10
6
45
No. of patients
Per Rectal Pain
Grade 0Grade 1
0
5
10
15
20
25
30
35
D0D7D15D21D30D0D7D15D21D30
Group A Group B
No of patients
22
31323232
19
28
30
3232
10
1000
13
4
2
00
No. of patients
Itching and Mucous Discharge
Grade 0Grade 1
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

17. DISCUSSION
0
2
4
6
8
10
12
14
16
18
Cured Markedly Improved Improved Unchanged
13
15
4
0
18
10
4
0
No. of Patients
Overall Effect of Therapy
No. of patients Gr. ANo. of patients Gr. B
AVERAGE PERCENTAGE OF RELIEF GROUP A 76.24%
GROUP B 80.06%
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

18. PROPOSED MODE OF ACTION
Most of the ingredients of murivenna are Tikta, Katu and Madhura Rasa
predominant and are Kapha Pitta Shamana also.This will alleviate the kapha
pitha dosha associated with arsha.
Previous researches shows the ingredients are anti inflammatory, anti
microbial and anti oxidants and promotes wound healing
These properties together contribute to reduce PR bleeding and
Inflammation associated with Haemorrhoids
Taila preparation applied locally to the anal canal may correct the apana
vayu vaigunya which is the major nidana of arsha and correct mamsa,meda
dhathu vaigunya locally.
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

19. 1)Since P value is less than 0.05 ,Local
application of Murivenna oil treatment for
Haemorrhoids is result oriented, cost effective,
decreases chances of surgical procedure.
2) There is no adverse reactions/complications
seen after applying Murivenna oil.
CONCLUSION
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

20. 1. Nair VV, Mohanan A and Mishra AK: An experimental study to evaluate anti-
inflammatory activity of Murivenna in Wistar albino rats. Int J Pharm Sci & Res 2020;
11(10): 5091-03. doi: 10.13040/IJPSR.0975-8232.11(10).5091-03.
2..Sareena C, Suchithra T V.Screening Of Anti-Mrsa Activity Of Some Selected Traditional
Drug Formulations Against Diabetic Foot Ulcer Isolates. Int J Pharm Bio Sci.2014;5(3):254-
5211.
3. Jijith U.S, Evaluation of Anti-Inflammatory Activity Of Ayurvedic Formulation
Murivenna By Jijith-Jayakumari Method. WJPPS, 2021;10(9):2495 -2502.
4. Dwivedi, D., Dwivedi, M., Malviya, S., & Singh, V. (2016). Evaluation of wound healing,
anti-microbial and antioxidant potential of Pongamia pinnata in wistar rats. Journal of
traditional and complementary medicine, 7(1),79-85.
https://doi.org/10.1016/j.jtcme.2015.12.002.
5. Koriya, H et al. Management of Post Fracture Stiffness by Murivenna Taila Parisheka
with Rehabilitation exercise- A Case Report. International Journal of AYUSH Case
Reports, 2020; 6(3), 285-288.
6. Sreerag, M. V. and Dhule, M. (2021) “Effect of Murivenna Ointment in the Management
of Parikarthika (Acute Fissure in Ano) – A Pilot Study”, Journal of Pharmaceutical Research
International, 33(39A), pp. 156-161. doi: 10.9734/jpri/2021/v33i39A3215
REFERENCES
RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

21. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDSSR NOOPD NOAGE SEX RELIGIONOCCUPATIONDIET ADDICTIONSITE OF HAEMORROIDS
D0D7D15D21D30D0D7D15D21D30D0D7D15D21D30D0D7D15D21D30
1 4108 40M H FARM MIX NIL 3,7 322221111 1 1 00000 00 0 0
2 3927 33M H CLERK VEG ALCOHOL 7211001111 0 0 00001 00 0 0
3 1362 40F H HOUSEWIFEVEG NIL 3,7,11 332212222 1 1 10001 00 0 0
4 1821 34M H SHOP VEG TOBACCO7,11 211101111 1 1 00000 00 0 0
5 2833 38M H FARM MIX NIL 3,11 221002222 1 0 00000 00 0 0
6 3900 49M M SHOP MIX TOBACCO3,7 321002222 2 1 00001 00 0 0
7 1130 55M H FARM VEG NIL 3,7 210001111 1 0 00000 00 0 0
8 855 37F M HOUSEWIFEMIX NIL 7,11 300102211 1 1 00000 00 0 0
9 1262 45M H FARM MIX ALCOHOL 3211112111 1 1 00001 00 0 0
10 1116 33M H LAB VEG NIL 3200001100 0 1 00000 00 0 0
11 681 18M H STUDENT MIX NIL 7211001111 1 1 00000 00 0 0
12 239 27F H HOUSEWIFEMIX NIL 3,7 322212222 2 1 00000 00 0 0
13 718 29M M SHOP MIX TOBACCO3,7,11 322112211 1 0 00001 00 0 0
14 900 29M M TAILOR MIX ALC,TBCO7,11 211101111 1 0 00000 00 0 0
15 1767 49M H FARMER MIX NIL 3,7,11 211102222 2 1 00000 00 0 0
1618062 45M H SHOP MIX ALCOHOL3,11 100001110 0 1 00000 00 0 0
1717334 51M H CLERK MIX TOBACCO 7211001111 1 0 00000 00 0 0
1815873 28M H ENGINEER MIX NIL 3221101111 0 1 00001 00 0 0
1913906 26M H STUDENT MIX NIL 11211002221 1 1 10000 00 0 0
2022239 56M H FARMER VEG TOBACCO3,7 322112222 2 0 00000 00 0 0
2121687 43M M SHOP MIX TOBACCO3,7 211102222 1 0 00000 00 0 0
2220084 34M H FARMER MIX TOBACCO7,11 200101111 1 1 00001 00 0 0
2318572 45F M HOUSEWIFEMIX NIL 3,11 211002222 2 0 00000 00 0 0
24 689 55M H FARMER VEG TOBACCO3,7 311002222 1 0 00000 00 0 0
25 690 58M M BUSINESS MIX NIL 7210002111 0 0 00001 10 0 0
26 693 35F H NURSE VEG NIL 7,11 211001110 0 1 00000 00 0 0
27 5710 55M M SHOP MIX TOBACCO3,7 211002110 0 1 00000 00 0 0
28 8078 60M H FARMER VEG NIL 3200002111 1 1 00001 00 0 0
2920988 55M H CLERK VEG NIL 3,11 211112111 0 0 00000 00 0 0
3021459 60M H BUSINESS MIX TOBACCO3,7.11 322123220 0 0 00000 00 0 0
3121494 59F H HOUSEWIFEVEG NIL 3,7 222102111 0 0 00001 00 0 0
32 692 34M H TAILOR MIX NIL 3100002111 1 1 00000 00 0 0
GROUP A
PR BLEED PILE MASS PER RECTAL PAIN ITCHING AND MUCOUS DISCHARGE
ASSESSMENT CRITERIA

22. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDSSR NOOPD NOAGE SEX RELIGIONOCCUPATIONDIET ADDICTIONSITE OF HAEMORROIDS
D0D7D15D21D30D0D7D15D21D30D0D7D15D21D30D0D7D15D21D30
121849 55M H SHOP MIX NIL 3,7,11 322221111 1 1 00000 00 0 0
221687 43M M BUSINESS MIX TOBACCO3,7 211101110 0 0 00001 00 0 0
321349 50F H HOUSEWIFEVEG NIL 3,11 221212221 0 0 00000 00 0 0
4 8939 58M H SERVICE MIX NIL 3,7 311102111 0 1 11000 00 0 0
521113 35F H HOUSEWIFEMIX NIL 3221002221 0 0 00001 10 0 0
621023 60M H FARMER VEG NIL 3,7 211112211 0 0 00001 00 0 0
7 6732 33M H CLERK VEG TOBACCO3,7,11 321101111 0 1 10000 00 0 0
8 8558 35F M HOUSEWIFEMIX NIL 7,11 211102211 0 1 11111 11 0 0
9 8900 32M H SHOP MIX NIL 3,7 211112111 1 0 00001 00 0 0
10 9827 35M H FARMER VEG NIL 3,7 211111100 0 1 00000 00 0 0
1110162 47M H FARMER MIX NIL 7211111111 0 1 11110 00 0 0
1210486 49M H BUSINESS MIX NIL 3,7,11 322212221 1 1 00010 00 0 0
1310911 45F H HOUSEWIFEVEG NIL 3,7 322113211 0 0 00000 00 0 0
14 8173 42M H SHOP MIX ALCOHOL7,11 211101111 0 0 00001 00 0 0
1514873 59F H HOUSEWIFEVEG NIL 3,7,11 311102222 1 0 00000 00 0 0
1616942 32F H HOUSEWIFEVEG NIL 3,7 211111110 0 1 00000 00 0 0
1718125 35M H SHOP MIX TOBACCO7,11 211111111 0 0 00001 11 0 0
1818042 16M H STUDENT VEG NIL 11221101111 0 1 11001 00 0 0
1917786 50M H POLICE MIX NIL 3211002220 0 1 10000 00 0 0
2017334 56M M FARMER VEG TOBACCO3,7 322112221 0 0 00000 00 0 0
2120382 56M H FARMER MIX ALCOHOL3,7 211102222 0 0 00000 00 0 0
2223584 50F H HOUSEWIFEVEG NIL 7,11 200101111 1 1 00001 00 0 0
2323244 46M H BUSINESS MIX NIL 3,7 211112222 1 0 00000 00 0 0
2422736 18M H STUDENT VEG NIL 3,7,11 311002221 0 0 00001 00 0 0
2521954 42M H BUSINESS MIX NIL 3,7 210002111 0 0 00001 10 0 0
26 696 53F H HOUSEWIFEVEG NIL 7211112110 0 1 10000 00 0 0
2720148 56M M SALESMAN MIX TOBACCO3,7 322212111 1 1 11111 00 0 0
28 697 38M H FARMER VEG NIL 7,11 211112110 0 0 00000 00 0 0
2915598 65F H HOUSEWIFEVEG NIL 3,7,11 322112110 0 1 11111 00 0 0
3018095 66M H FARMER MIX TOBACCO3,7,11 211112100 0 0 00000 00 0 0
31 694 25F H NURSE VEG NIL 3,7 111001110 0 1 10000 00 0 0
32 2524 60M H SHOP MIX TOBACCO 11211111111 0 0 00000 00 0 0
GROUP B
PR BLEED PILE MASS PER RECTAL PAIN ITCHING AND MUCOUS DISCHARGE
ASSESSMENT CRITERIA

23. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS

24. RANDOMIZED CONTROLLED CLINICAL TRIAL OF MURIVENNA OIL LOCAL APPLICATION IN ARSHA W.S.R. TO
HAEMORRHOIDS