Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa B.A.M.S
Treatment principles of Arshas
Arshas can be treated with 4 fold approach –
– Shastra Karma – surgical methods
– Kshara Karma – Cauterization with alkalis or caustic cauterization
– Agni Karma – Fire cauterization
– Aushadha – internal and external medicines.
Kshara Sutra – In Kshara karma, a method called Kshara Sutra is effectively practised in the comprehensive treatment of arshas (piles) and bhagandara (fistula in ano). Kshara sutra is a procedure in which the thread smeared with kshara or alkalis obtained from medicinal herbs is ligated and left in place. The thread smeared with alkali (kshara sutra) completely destroys the pile mass and also fistula. Kshara Sutra is also an effective choice in many other ano-rectal disorders.
Types of Arsha for convenience of treatment –
For the convenience of treatment, Arsha is divided into 2 main types. They are:
Shushka Arsha – Arsha or piles which are dry in nature and which manifest due to pathological vitiation of Vata, Kapha or Vata-Kapha are called Shushka Arsha. Therefore, Vataj, Kaphaja and Vata-Kaphaja types of Arsha are called Shushka Arsha or Dry form of Arsha.
Ardra Arsha – Arsha or piles which are wet in nature and which manifest due to pathological vitiation of Pitta, Rakta or Rakta-Pitta are called Ardra Arsha. Therefore, Pittaja, Raktaja and Rakta-Pittaja type of Arsha are called Ardra Arsha or wet type of Arsha.
Treatment line-up of Shushka (Vata, Kapha and Vata-Kaphaja) Arshas:
Fomentation or sudation should be given for the piles mass which is stiff, swollen and painful.
Pinda Sweda and Seka Sweda – Pinda Sweda means Bolus fomentation. In this the medicaments are made hot and tied in a cloth so as to form a bolus. This hot bolus is used to foment the afflicted part. Seka Sweda is a process in which the hot liquids are poured on the afflicted part.
- Mashadi Pinda sweda – Chitrakadi taila oil should be applied to the piles mass and anus followed by swedana with Mashadi pinda (black gram, horse gram etc tied in a bolus and made hot).
- Tila kalka sweda – Fomentation alternatively can be given using tila kalka (paste of sesame).
- Gomayadi sweda – bolus made up by tying the dungs of cow, donkey, horse etc in a cloth
- Tusha sweda – bolus of tusha or husk
- Vachadi pinda – bolus of Vacha (Acorus calamus), Shatahva (dill seeds), mixed with ghee and oil
- Yava sattu pinda – bolus of flour of barley made hot and tied in a cloth bolus should be used to foment the piles mass after having applied ghee and oil to the afflicted part
- Shushka mulaka pinda sweda – bolus of dried radish
- Shigru pinda sweda – bolus of bark of Shigru or drumstick
- Rasnadi Pinda Sweda – bolus of Rasna (Alpinia galangal) and Hapusha (Juniperus communis) mixed with oil and ghee
- Ishtika sweda – After applying Kushta taila oil to the afflicted part, fomentation should be given by hot bricks or dill seeds made hot and tied in a bolus or leaves of carrot made hot and tied in a bolus
- Vasadi seka sweda – decoction of Vasa (Adhatoda vasica), Arka (Calotropis gigantean), Eranda (castor leaves) and Bilwa patra (leaves of Aegle marmelos) should be sprinkled over the afflicted part
Avagaha Sweda (tub bath sudation) – This can be given in presence of pain. Firstly the afflicted part should be smeared with pain relieving oil and the patient is made to sit in the tub filled with one of the below said liquids, the liquids being tolerably hot.
- Mulakadi kwatha – Decoction prepared using Mulaka (radish), Arka patra (leaves of Calotropis gigantea), Triphala (3 fruits, those of Terminalia chebula, Terminalia bellirica and Emblica officinalis), Vamsha patra (leaves of bamboo) etc
- Badara patra kwatha – Decoction of leaves of Jujube
- Ushna Souveera – Hot fermented herbal liquid
- Kanji – Hot fermented liquid prepared from fermentation of herbs, grains etc
- Bilwa kwatha – Hot decoction of Aelge marmelos
- Takra – hot buttermilk
- Dadhimanda – hot supernatant water of curds or curd water
- Gomutra – hot cow urine
Dhuma – Fumigation
After applying any one among teh fat of black snake, pig, camel, fumigation should be given to the dried piles mass.
- Nrukeshadi Dhuma – with Nru kesha (hairs of man), sarpa nirmoka (skin of snake), arka mula (roots of Calatropis gigantea) or Shami Patra (Prosopis cineraria)
- Dhanyakadi Dhuma – with Dhanyaka (coriander), Vidanga (Embelia ribes), Devadaru (Cedrus deodara), Akshata (rice), Ghrita (ghee)
- Brihatyadi Dhuma – with Brihati (Solanum indica), Ashwagandha (Withania somnifera), Pippali (Long pepper), Surasa patra (leaves of holy basil) and Ghrita (ghee)
- Varaha vitkadi Dhuma – with varaha vit (excreta of pig), yava sattu (flour of barley), ghrita (ghee)
- Kunjara pureeshadi dhuma – with kunjara pureesha (excreta of elephant), ghrita (ghee) and Rala (sal tree)
Lepa – ointments, anointments, external application
- Haridra churnadi pralepa – with powder of Haridra (turmeric), Snuhi ksheera (latex of Euphorbia nerifolia)
- Pippalyadi Pralepa – with Pippali churna (powder of Long pepper), Haridra churna (Turmeric powder) mixed in Go pitta (bile of cow)
- Shireeshabeejadi Pralepa – with Shireesha beeja (seeds of Albizia lebbeck), Kushta (Saussurea lappa), Saindhava lavana (rock salt), Guda (jiggery), Arka ksheera (latex of Calotropis gigantea), Snuhi ksheera (latex of Euphorbia nerifolia), Triphala churna (powder of 3 fruits, those of Terminalia chebula, Terminalia bellirica and Emblica officinalis)
- Harataladi Pralepa – Haratala (orpiment) mixed in Ushtra vasaa (muscle fat of camel)
- Arka ksheeradi Pralepa – with Arka ksheera (latex of Calotropis gigantea), Snuhi ksheera (latex of Euphorbia nerifolia), katuka alabu (bitter bottle gourd), Karanja patra (Pongamia pinnata leaves) mixed in basta mutra (goat urine)
Classic formulations for Shushka Arsha –
Below said formulations help in rectifying the metabolism and also expel the morbidity present in the anal region (in ano-rectal diseases) and hence cleanses the system.
- Guda abhaya – Mixture of Guda (jiggery) and Abhaya (Terminalia chebula) should be given before food. Similarly powder of Abhaya or Haritaki and Guda should be kept mixed in gomutra (cow urine) over night and be given in the morning.
- Triphala Yoga – Decoction of Triphala (3 fruits, those of Terminalia chebula, Terminalia bellirica and Emblica officinalis) mixed with powder of Trivrit (Operculina turpethum)
- Triphala churna – Powder of Triphala (powder of 3 fruits, those of Terminalia chebula, Terminalia bellirica and Emblica officinalis) mixed in buttermilk
- Bilwadi Yoga – Pulp of the fruit of Bilwa (Bael fruit) and Shunti churna (powder of ginger) should be given with decoction of Yavani (Carom seeds) and Chitrakamula (roots of Plumbago zeylanica)
- Dadhi-Takra – Buttermilk processed with Chitrakamula or root of Plumbago zeylanica is highly effective in arshas and bhagandara. The root bark of Chitraka is ground and its paste is applied in the interior of an earthen pot. In this pot, curds are prepared from the milk. Buttermilk is extracted and used for internal consumption.
- Shuntyadi Churna – Powder of Shunti (ginger), Patha (Cyclea peltata) and Guda (jiggery) mixed in juice of amla dadima (sour pomegranate)
- Yavaksharadi yoga – Yavakshara (alkali prepared by burning the whole plant of barley) mixed with ghee and jaggery
Peyadi Krama (liquids and drinkables in Arsha) –
- Pippalyadi Peya – Drink prepared with Pippali (Long Pepper), Pippalimula (root of Long pepper), Chitrakamula (root of Plumbago zeylanica), Shunti (ginger), Jeeraka (cumin seeds), Dhanyaka (coriander) Gajapippali (Scindapsis officinalis), Tumburu (Zanthoxylum alatum), Bilwa (Aegle marmelos), Karkataka (Pistacia integerrima), Pata (Cyclea peltata) mixed with ghee and oil and seasoned with juice of sour fruits like pomegranate etc
- Pippalyadi Yusha – Soup prepared with the above mentioned herbs (in Pippalyadi peya)
- Pippalyadi jala – Water processed with the above mentioned herbs (in Pippalyadi peya)
- Pippalyadi Ghrita – Ghee processed with the above mentioned herbs (in Pippalyadi peya)
- Pippalyadi Yavagu – Gruel prepared with Pippali (long pepper), Shunti (ginger) mixed with sour buttermilk and sprinkled with Maricha churna (pepper powder)
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