ARSHA or Haemarrhoids or Piles Ayurveda Management

 

 

 

Haemorrhoids, known as Arsha in Ayurveda are an ano-rectal disorder which affect people all over the world irrespective of age groups and economical groups. It is becoming very common now a days and is distressing too. Increased intake of processed food, growing mental tension, improper sleep, long working hours especially sedentary lifestyle and suppressing natural urges especially that of urination and defecation is increasing the incidence of Haemorrhoids now a days. There are many types of haemorrhoids and cause many complications. Haemorrhoids are enlarged veins in the wall of the anus commonly occurring in three main points equidistant around the circumference of anus. Haemorrhoids are often described as the varicose veins of the anus and rectum. Haemorrhoids are described in all Ayurveda classics. Acharya Susrutha has even mentioned it as one of the eight grave diseases.

 

 

Understanding Haemorrhoids in Ayurveda 

 

Improper functioning of digestive fire is the main cause of most of the digestive system disorders.

 

Irregularity in Digestive fire is the cause of most of the problems related to the digestive system. Disturbed digestive fire or low digestive fire known as Mandagni leads to constipation. Improper diet and irregular bowel habits disrupts the normal digestive process affecting proper digestion and absorption of nutrients in the body further leading to constipation.

 

A person suffering from constipation will develop habit of straining during defecation to evacuate the bowels which increases back pressure into the haemorrhoidal veins and produces haemorrhoids. The perianal skin is one of the most pain sensitive region in the body because of rich nerve endings. Hence even a small amount of pain causes great discomfort to the patient. The problem worsens with age and time.

 

Haemorrhoids, Sprue syndrome and Diarrhoea are causative factors for each other due to imbalance of digestive fire.

 

There is a simile in Ayurveda stating that just like an enemy trouble a person, inflamed and swollen veins in the anus obstructs the anal canal and troubles the person in haemorrhoids.

 

Different stages of Haemorrhoids

 

In first degree haemorrhoids, bleeding is the main symptom and there is no enlargement of veins at the anus. In second degree haemorrhoids, the pile mass protrudes beyond the anus but returns spontaneously after defecation and in third degree haemorrhoids, the pile mass remains outside the anus and needs to be pushed back by pressure.

 

Understanding Guda (Ano-Rectum)

 

Haemorrhoids occur in the Guda (Ano-Rectum) which is a Mamsa Marma that is vital points of the muscle tissue of the body where Prana (vital) energy flows. It is a Sadhya Pranahara Marma that is an important vital organ the damage to which will cause immediate death. It is one of the seats of life, known as Pranayatana in Ayurveda because proper action of it is necessary for functioning of the body. The main function of Guda is the elimination of faecal matter and flatus.

 

Ano-rectum is a soft part derived from the maternal factor and formed from the essence of blood tissue and Kapha Dosha. The hollow or tubular structure is because of the Pitta and Vata Dosha manifestation.

 

Guda is the distal part of the large intestine and is 4 and half angula (approx. 7.5 cm) in length, formed with 3 vali or folds, each one about 2.5 cm in length and namely Pravahini, Visarjini and Samvarani. They are like spiral grooves of a conch shell and like the palate of an elephant in colour.

 

Pravahini is the first and inner most fold of Guda which is attached to the rectum and it initiates the sensation of pulsation and pushes the faecal matter downwards. Visarjini is the second or middle part of the anal canal which helps in moving the faecal matter forward by its expansion and aids in its expulsion. Samvarini is the third and distal part just above the opening of the anus which opens when the faecal matter comes from above and closes after its expulsion.

 

Gudaoushta is the outer most part of the anus attached to the Samvarini. It is about 1 cm in length and width of the size of half barley.

 

Arshas occurs in any of these folds, the deeper the occurrence of Arshas, the more time it takes to treat.

 

Causative Factors of Arsha

 

Aharaja: Diet factors

 

• Heavy food items like black lentil, kidney beans – As they are difficult to digest.
• Cold foods and drinks – As they cause restriction of movement.
• Spicy food like pickles, sauce and food that causes burning sensation – These aggravates Pitta Dosha and causes irritation of body tissues.
• Incompatible food or mutually contradictory food (like cold drink while taking hot meal) – They do not nourish the tissues and reduces immunity.
• Over eating or eating good meal while having indigestion or no appetite – This will hamper the normal digestive process leading to impairment in digestion and elimination of stools.
• Excess intake of liquids of water – It dilutes the digestive fire, thereby affecting digestion
• Food which is not freshly prepared, having abnormal smell, dry.
• Grains and food those are putrefied or denatured.
• Taking food of single taste in diet regularly
• Diet taken after proper time
• Insufficient diet
• Food prepared by mixing various contradictory properties.
• Meat of cow, buffalo, goat, sheep, pig
• Sweet potato, mango, dates, milk, tubers, green leafy vegetables
• Fresh grains
• Raw vegetables especially carom seeds, ginger and garlic.
• Food substances prepared from rice, jaggery, milk, wheat
• Excess Sour and salty food items

 

Viharaja: Lifestyle factors

 

• Lack of physical activity or excessive physical activity or exercise in abnormal times of the day.
• Excessive indulgence in sexual intercourse or abnormal sex
• Straining at stools, urine or flatus
• Suppression of the urge to defecate or urinate
• Frequently washing rectum with cold water
• Frequent or excess use of laxatives or purgatives, enema
• Injury to the rectum while administering therapeutic enema
• Repeated abortion, preterm labour, pressure exerted by the growing foetus during pregnancy especially in the last trimester, straining to push the foetus during normal delivery, abnormal position of foetus, complications in delivery
• Riding on animals like horse, camel, etc. or travelling in two wheelers or bikes for long hours
• Sitting on uneven surfaces
• Prolonged sitting
• Excess intake of alcohol
• Sleeping immediately after meals, Day sleep

 

Other factors include hereditary or familial tendencies, congenital factors, local abnormalities like boils, tumour, abscess or cancer.

 

Pathogenesis of Arsha

 

Indulgence in the above-mentioned causative factors will lead to low digestive fire, imbalance in Apana Vata, one of the 5 types of Vata Dosha which is mainly present in the rectum and constipation. This in turn leads to vitiation of other Doshas along with the involvement of blood tissue. These vitiated Doshas and blood tissue then enters into the passage of Dhamani (veins) affecting the folds of the anal canal, and involving the muscle, fat and skin representing the anal cushions leading to haemorrhoids. (Reference 1)

 

The factors involved in pathogenesis of haemorrhoids are summarised in the below table.

 

DOSHAS	Vata Pitta Kapha
TISSUES	Skin Blood Muscle Fat tissue
CIRCULATORY CHANNELS	Raktavaha (Blood carrying channels) Mamsavaha (Muscle tissue carrying channels)
TYPE OF AFFLICTION IN CIRCULATORY CHANNELS	Siragranthi (Venous Swelling)
SITE OF MANIFESTATION	Three folds of the anal canal
PATHWAY OF DISEASE	Internal External
STATUS OF DIGESTIVE FIRE	Low

 

 

Types of Haemorrhoids

 

Haemorrhoids are classified into different types based on various factors.

 

Two types based on origin –

 

1. Sahaja – Congenital
2. Janmottaraja – Acquired, that which develops after birth.

 

Acquired type is again classified into the further subtypes which are as follows.

 

Two types based on nature –

 

1. Sushka – Dry or non-bleeding, due to the predominance of Vata / Kapha Dosha
2. Ardra – Moist or bleeding, due to the predominance of Pitta Dosha / Rakta Dhatu

 

Bleeding type is further classified into the below types –

1. Associated with Vata
2. Associated with Kapha

 

Two types based on site –

 

1. Bahya – External haemorrhoids
2. Abhyantara – Internal haemorrhoids

 

Six types based on Dosha Predominance –

 

1. Vataja
2. Pittaja
3. Kaphaja
4. Dwandaja – Two Dosha predominance
5. Sannipataja – Three Dosha predominance
6. Raktaja

 

Premonitory Signs of Arsha

 

1. Krichrat Pakti: Food gets digested with difficulty
2. Antra Kujana: Gurgling noise in the intestine
3. Udgara Bahulya: Increased belching
4. Amlika: Sour taste in the mouth
5. Aruchi: Disinterest in taking food
6. Atopa: Expulsion of flatus with great difficulty and sound
7. Guda Parikartanam: Pain in anus
8. Balahani: Weakness
9. Mandagni: Low digestive fire
10. Pipasa: Thirst
11. Anna Vishtambi: Delayed digestion of food
12. Alpa Mala Pravritti: Scanty stools

 

Symptoms of Piles

 

Main symptoms are

• Bleeding per rectum
• Pile mass
• Painful defaecation
• Anal itching
• Constipation

 

Other symptoms include indigestion, constipation, low digestive fire, anal fissure, prolapsed rectum.

 

Symptoms of different types of haemorrhoids are as follows.

 

Congenital Haemorrhoids

 

The pile mass is yellowish in colour, hard, strong, visible with difficulty and painful.

 

Acquired Haemorrhoids

 

Symptoms of acquired haemorrhoids are different based on Dosha predominance and is summarized below.

 

1. Vataja Arshas – In this type, Vata Dosha is predominant and the pile mass will be dry, hard, Rough, irregular surface or shape, various shapes, variegated colours, blackish appearance mostly and frequently associated with constipation or painful defecation.
2. Pittaja Arshas – Because of Pitta Dosha predominance, the pile mass will be small in size and may cause burning sensation while defecation, also leading to thirst, fainting and shock, etc. There could be passage of blood mixed with stools.
3. Kaphaja Arshas – As Kapha Dosha is predominant, the pile mass will be wide, smooth come on fleshy, fixtured or stable and generally there will be no bleeding or suppuration but severe itching and mucus discharge will be experienced.
4. Samsargaja (From the combination of two Doshas – Vata Pittaja, Pitta Kaphaja and Vata Kaphaja) - This type will have mixed features of the two Doshas according to the predominance.
5. Sannipataja (From the combination of all three Doshas – Vata Pitta Kaphaja) – Features of all three Dosha imbalance will be seen in this type.
6. Raktaja – Predominance of Rakta Dhatu causes fleshy nature of the pile mass. There will be immense blood loss during defecation.

 

Bleeding Haemorrhoids Natural Management

 

• Bleeding haemorrhoids with association of Vata will lead to dry stools, flatulence, pain in the thighs, lumbar region and perianal region, and extreme weakness. The haemorrhoids will be grey in colour and blood exudation from the haemorrhoids will be thin, reddish and frothy. Hence unctuous and cold comforts are beneficial for its treatment.

 

• Bleeding haemorrhoids associated with Kapha will lead to unctuous stools which are semi-solid, heavy and whitish in colour, numbness in the anus and exudation of slimy material or mucus. Blood exudation from the haemorrhoids will be dense and slimy. Dry and cold comforts are suggested for its treatment.

 

Ayurveda Management of Piles

 

Ayurveda treatment aims to help to fibrose the haemorrhoidal tissue onto the underlying anal sphincter, thus restoring support for these vascular cushions and thereby preventing complications.

 

Although haemorrhoids are a local disease, it starts from the gastrointestinal system. Improper functioning of Agni, that is low digestive fire leads to malformation of stools which become difficult to excrete, hence the person starts straining unconsciously to eliminate the stools from the body. Hence first line of treatment should be to correct the digestive fire using digestives and carminatives thereby restoring normal digestive process. The usage of Vata Anulomana herbs will help in downward movement of stools thereby expelling them easily.

 

The line of treatment of dry haemorrhoids and bleeding haemorrhoids are different. Bheshaja Aushadhi (Medicinal treatment) suggested in Ayurveda text books are conservative and the following steps are involved in the management of Haemorrhoids.

 

1. Use of Dipana (Carminatives) and Pachana (Digestives) to correct digestive fire.
2. Anulomana: Use of safe laxatives for relief from constipation
3. Vrana Ropana & Shothahara: Anti-inflammatory medicines to relieve pain and Haemostatic medicines in case of bleeding haemorrhoids to arrest bleeding. Herbs and medicines which are wound healing, soothing the inflamed mucous layer, relieving constipation, regulating bowel movements, anti-microbial, that repairs, heals and regenerates the functions if skin, promotes skin elasticity and epithelial formation.
4. Abhyanga: External application of medicated oils
5. Swedana: Fomentation using herbal bolus or fumigation
6. Avagahana: Sitz bath
7. Lepa: Application of herbal pastes
8. Sarpi Prayoga: Use of medicated ghee
9. Takra Prayoga: Use of buttermilk
10. Basti: Use of Medicated enema
11. Pathya Ahara-Vihara: Resorting to wholesome diet and lifestyle

 

Following table shows the suggested Ayurveda treatments when different Doshas are involved.

 

Dosha predominance / Type of Haemorrhoids	Suitable therapy / herbs
VATA	Snehana: Internal & External oleation Swedana: Fomentation Vamana: Therapeutic Vomiting Virechana: Therapeutic purgation Basti: Medicated enema
PITTA	Virechana: Purgation
RAKTA	Shamana: Pacification procedures Rakta Sthambhaka: Haemostatic treatments Tikta Aushadi Prayoga: Use of bitter herbs
KAPHA	Use of Dry ginger and Horse gram
RAKTA + VATA	Sneha Pana: Oral intake of ghee Sneha Abhyanga: Oil massage Sneha Basti: Oil enema Unctuous and Cold drugs
RAKTA + KAPHA	Dry and Cold drugs
KAPHA + PITTA	Shodhana: Detoxification
SRAVI / BLEEDING	Vatsaka
SUSHKA / NON-BLEEDING	Bhallataka
ALL TYPES	Takra: Buttermilk

 

Managing constipation Naturally

 

To relieve constipation, the following recipes are suggested.

1. Jaggery with dry ginger
2. Ajwain, Patha, Dry ginger, Pomegranate juice, jaggery and buttermilk.
3. Leaves of Karanja fried in ghee and oil and sprinkled with roasted corn flour suggested before food.
4. Ghritabhrista Haritaki with Pippali and jaggery
5. Ghritabhrista Haritaki with Danti and Trivrit

 

Ayurveda Treatment of Dry Haemorrhoids

 

1. Stanika Abhyanga: Local application of lukewarm medicated oil such as Jatyadi oil
2. Sthanika Swedana: Local Fomentation using any of the following methods.

 

1. Pinda / Potali Swedana - Use a Potali (cloth bolus filled with any of the below herbal mix) which is made comfortably warm by heating it on a pain.

 

• Powders of Vacha and Satahva
• Paste of sesame seeds
• Husk of paddy
• Powder of Rasna and oil
• Roasted corn flour mixed with ghee

 

1. Sitz bath – Immerse the hips in any one of the below formulas.

 

• Triphala decoction
• Warm water
• Decoction of Bilwa
• Warm buttermilk

 

1. Dhupana: Fumigation using one of the following recipes

 

• Brihati, Ashwagandha, Pippali and Tulsi mixed with ghee
• Vidanga, Devadaru, Rice and Tumbi mixed with ghee
• Roasted cornflour and ghee
• Sarjarasa mixed with ghee

 

1. Lepa: Application of paste of herbs on the haemorrhoids using any of the below recipe

 

• Turmeric powder with latex of Snuhi
• Turmeric with Pippali powder
• Seeds of Shirisha, Kushta, Pippali, Triphala, latex of Snuhi and Arka along with jaggery and rock salt.
• Danti powder and jaggery
• Pippali, Chitraka, Madana, Tumeric and jaggery.
• Nimbadi malhar

 

1. Anuvasana Basti with lukewarm medicated oil like Jatyadi oil or Pippalyadi oil will help in healing, reducing the haemorrhoids and prevent constipation.
2. To keep the perianal region clean, one should wash it with lukewarm decoction of Triphala once a day, and then pat it dry.
3. Single herbs – Trikatu, Pippalimool, Patha, Hingu, Chitraka, Sauvarchala, Pushkaramoola, Jeerak, Ajwain, Bilwa, Saindhava, Vacha, Vidanga
4. Ayurveda Medicines - Triphala guggulu, Kankayana Vati, Abhayarishta, Haritaki churna, Triphala churna, Panchasakar churna, Avipathikar churna, Takrarishta, Dantyarishta, Guggulvasava, Karanja Sukta, Pippalyadi ghrita
5. Herbal remedies

 

• Haritaki churna with jaggery
• Trivrit powder with Triphala decoction
• Triphala churna with buttermilk
• Haritaki churna with buttermilk
• Churna of Chitraka, Hapushpa, Hingu with buttermilk
• Panchakola churna with buttermilk
• Bilwa, Chitraka, Ajwain and Dry ginger
• Bhallataka mixed with Tarpana
• Ghee or milk mixed with gruel
• Paste or Powder of Shatavari with milk
• Rice cooked with roots of Apamarga
• Suran pak
• Anantamool powder with milk
• Amalaki juice or Garcinia drink
• Water boiled with roots of Ushira

 

1. Tips to prevent and manage haemorrhoids

 

• One should prevent and treat constipation in order to reduce haemorrhoids.
• Eat plenty of fresh fruits, cooked vegetables, whole grains. Drink 8 glasses of water daily, preferably lukewarm.
• Reduce excess intake of salads as they increase dryness and may lead to constipation.
• Sitting for long duration will increase heat in the anal region and put pressure on the veins which might aggravate haemorrhoids.
• Avoid straining at stools as it puts pressure on the veins.
• Tight clothing and underwear or frequent wiping of anus using toilet paper also contributes to irritation in anal region leading to haemorrhoids.
• Maintain healthy weight as obesity increases the risk of haemorrhoids.
• Practice the following Yogasana daily –

• Padha Hastasana (Standing forward bend), Paschimottanasana (Sitting forward bend), Pavanamuktasana (Wind relieving pose), Halasana (Plough pose), Ushtrasana (Camel pose), Mayurasana (Peacock pose) – Helps improve digestion, prevents flatulence and reduces the risk if haemorrhoids.
• Ashwini Mudra (Horse gesture) – Prevents and cures haemorrhoids.
• Vajrasana (Thunderbolt or Diamond pose) and Padmasana (Lotus pose) – Improves blood flow to the lumbar and abdominal region which helps in healing haemorrhoids. Also, the stretching movement in this Yoga posture helps to relieve pain in the thighs caused due to haemorrhoids by improving flexibility.

 

1. Recipes of buttermilk – Buttermilk is very effective in dry haemorrhoids and it is a digestive, corrects digestive fire and helps in downward movement of Vata Dosha thereby regulating bowel movements. Buttermilk balances Vata and Kapha Dosha. Following recipes of buttermilk in dry haemorrhoids are suggested.

 

• Thin gruel prepared with buttermilk and added with rock salt.
• Rice mixed with buttermilk and added with oil.
• Vegetable soup prepared with buttermilk

 

Wholesome Diet	Wholesome Lifestyle
Kshira: Milk Takra: Buttermilk Godhuma: Wheat Go Ghrita: Cow’s ghee Shaaka Varga: Vegetables	Vyayama: Regular Physical activity Nidra: Timely sleep

 

 

Unwholesome Diet	Unwholesome Lifestyle
Guru: Heavy to digest food Vishtambhi Ahara: Food that cause flatulence like nightshades Vidahi Ahara: Spicy food and food that cause burning sensation Katu Rasa: Pungent taste Ati Mamsa: Excess intake of meat Ati Dadhi Sevana: Excess intake or curd Ati Taila Prayoga: Excess use of oils Fried food	Avyayama: Lack of sufficient physical activity Diva Swapna: Day sleep Straining while defaecating Constant sitting on hard surfaces or uneven surfaces Excess riding on animals or vehicles

 

The above treatments will help in reducing haemorrhoids, pain, itching and swelling by bringing equilibrium of Doshas, reducing venous congestion. 

 

Ayurveda Management of Bleeding Haemorrhoids

 

• Sthanika Abhyanga: Local oil application and oil enema using lukewarm ghee or oil or Jatyadi oil.
• Sthanika Swedana: Local fomentation using any of the below methods.

 

1. Sitz bath with decoction of Panchavalkala or decoction of Madhuka and Vetasa and sugarcane juice.
2. Fomentation with lukewarm milk or ghee

 

• Recipes for external use

 

1. 1. Neem and ghee
   2. Sesame and liquorice
   3. Honey and ghee
   4. Utpala and ghee
   5. Ghee and sugar on anus followed by cold water douche.
   6. Shatadauta ghrita, Sahasradauta ghrita or Durva dhrita

 

• Bitter drugs are suggested as they have haemostatic property. They also stimulate digestive fire.
• Piccha Basti, a special type of Basti using milk decoction which has cooling, healing and haemostatic properties.
• Anuvasana Basti: Oil enema using lukewarm Ghritamanda or Jatyadi oil
• Suggested Wholesome Diet – Shali rice, Kodrava rice, boiled milk, ghee, coconut oil, fresh butter, vegetable soup, thick gruel and soup of green lentil, orange lentil, pigeon pea.
• Ayurveda medicines – Praval Pishti, Kamadudha, Kutajarishtam, Ashokarishta, Nagakesar Churna, Lodhra Churna, Mukta Bhasma, Lohasava, Kutajavaleha, Changeri Ghrita, Patha Ghrita
• Herbal Remedies having haemostatic and healing action.

 

1. Dry ginger powder mixed with decoction of Kutaja or Dadima or Chandana
2. Decoction of Darvi, Tvak, Agaru, Ushira, Nimba
3. Decoction of Chandana, Kiratatikta, Dhanvyavasa, Dry ginger
4. Thin rice gruel
5. Shali rice with goat’s milk
6. Juice of Vastuka with goat’s milk
7. Powder of Darvu, Musta, Duspharshika, Kiratatikta
8. Curd boiled with Dugdhhika or roots of Nyagrodha and flowers of Kovidara
9. Onion cooled with buttermilk
10. Soup of orange lentil added with sour buttermilk
11. Butter and sesame seeds
12. Saffron, butter and sugar
13. Cream of churned curd

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