Arshas (Piles), Ayurvedic Types, Causes And Symptoms

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa B.A.M.S
Definition of Arshas
The disease in which the mamsa ankuras (fleshy masses) which occur at the opening of guda marga (anus), obstructs the pathway and troubles the person like an enemy is called Arshas. 

Pathogenesis of Arshas

The vitiated doshas (vata, pitta and kapha) contaminate the twak (skin), mamsa (muscle) and meda (fat) tissues and cause mamsa ankuras (fleshy masses) at the anal opening. These masses are called Arshas.

Types of Arshas

Arshas is of 6 types, they are:

• Vataja Arshas (caused by vitiated vata)
• Pittaja Arshas (caused by vitiated pitta)
• Kaphaja Arshas (caused by vitiated kapha)
• Sannipataja Arshas (caused by simultaneous vitiation of all the 3 doshas)
• Raktaja Arshas (caused by vitiated blood, bleeding piles)
• Sahaja Arshas (congenital haemorrhoids or hereditary)
• Read related: Buttermilk Home Remedy For Hemorrhoids [Video]

Vataja Arshas

Causes of Vataja Arshas

• Kashaya – excessive consumption of astringent foods
• Katu – excessive consumption of pungent foods
• Tikta – excessive consumption of bitter foods
• Ruksha – excessive consumption of dry foods
• Sheeta – excessive consumption of cold foods
• Laghu – excessive consumption of light foods
• Pramita ahara – taking food in deficit quantities (against the quantity needed) or eating after the time for food has elapsed
• Alpa ahara – very less food
• Teekshna Madhya – excessive consumption of strong alcohol
• Maithuna – – excessive indulgence in sex
• Langhana – fasting in excess
• Sheeta desha – cold places
• Sheeta kala – cold season
• Vyaayama – excessive indulgence in physical exercises
• Shoka – grief
• Vata – excessive exposure to breeze
• Atapa – excessive exposure to heat of the Sun
• Read related: Easy Ayurvedic Home Remedy For Bleeding Hemorrhoids

Symptoms of Vataja Arshas –
Nature of arshas or pile mass:

• Shushka – dry
• Chimachimanvita – tingling sensation
• Mlaana – pale
• Shyava – blackish blue
• Aruna – yellowish red
• Stabdha – hard
• Parusha / khara – rough on touch
• Vakra – haphazard, crooked
• Mithovi sadrusha – split and broken
• Vishputita – cracks
• Resembling the fruits of bimbi (ivy gourd), karkandu (jujube), kharjura (dates), karpasa phala (fruit of cotton, cotton seeds), siddartha (mustard) etc

Associated symptoms –

• Shira shula – headache
• Parshwa shula – pain in flanks
• Amsa shula – pain in scapular region
• Kati shula – low back pain
• Uru shula – thigh pain
• Vankshana shula – pain in groin
• Kshavathu – sneeze
• Udgaara – belchings,
• Hrid graham – tightness in the chest
• Arochaka – anorexia
• Kasa – cough
• Shwasa – shortness of breath
• Agni vaishamya – metabolic errors
• Karna nada – tinnitus
• Bhrama – giddiness
• Grathita, stokam, sashabdam pravahikam – loose stools or dysentery with pellet like stools, coming in less quantity along with sound, blood, froath, mucus and with delayed evacuation
• Gulma – abdominal tumour
• Pleeha – spleen enlargement etc

Pittaja Arshas

Causes of Pittaja Arshas:

• Katu ahara – excessive consumption of pungent foods
• Amla ahara – excessive consumption of sour foods
• Lavana ahara – excessive consumption of salt or salty foods
• Ushna ahara – excessive consumption of hot foods
• Vyaayama – excessive exercise
• Agni – excessive exposure to fire
• Atapa – excessive exposure to heat of Sun
• Ushna desha – living in hot areas / places
• Krodha – anger
• Madhyam – excessive consumption of alcohol
• Asooyanam – jealousy
• Vidahia ahara, pana, bheshaja – excessive consumption of corrosive foods, drinks and medicines
• Teekshna ahara, pana, bheshaja – excessive consumption of irritating foods, drinks and medicines
• Ushna ahara, pana, bheshaja – excessive consumption of hot foods, drinks and medicines

Symptoms of Pittaja Arshas –
Appearance of arsha (pile mass):

• Neela mukha – blue tipped
• Rakta – red coloured
• Peeta – yellow coloured
• Asita – black coloured
• Mrudu – soft on touch
• Snigdha – unctuous
• Tanu, visra, asru visraavini – dilute, foul smelling discharges
• Shuka jihwa – shape resembling the tongue of parrot
• Yakrut khanda – shape resembling the piece of Liver
• Jalauka vaktra – resembling the mouth of leech

Associated symptoms:

• Daha – burning sensation
• Paka – suppuration
• Jwara – fever
• Sweda – excessive sweating
• Trushna – thirst
• Murcha – fainting
• Arati – discomfort,
• Moha – loss of consciousness, confusion
• Ushna, drava neela ushna peeta rakta varcha – stools which are hot, watery, blue, yellow, or red coloured
• Harit peeta haaridra twak nakhadayaha – green, yellow or turmeric discolouration of skin, nails, eyes etc.

Kaphaja Arshas

Causes of Kaphaja Arshas:

• Madhura ahara – excessive consumption of sweet foods
• Snigdha ahara – excessive consumption of unctuous or oily foods
• Sheeta ahara – excessive consumption of cold foods
• Lavana ahara – excessive consumption of salt or salty foods
• Amla ahara – excessive consumption of sour foods
• Guru ahara – excessive consumption of heavy to digest foods
• Avyayama – lack of exercise, sedentary life habits
• Diva swapna – sleeping in day time
• Shayya sukha – comfortable bedding
• Asana sukha – comfortable seating
• Prag vata – excessive exposure to wind blowing from east direction
• Sheeta desha – living in cold areas / places
• Sheeta kala – excessive exposure to cold climate
• Achintanam – lack of worries

Symptoms of Kaphaja Arshas:
Appearance of Arshas (pile mass):

• Mahamula – deep rooted mass
• Ghana – thick, heavy
• Manda ruja – mild pain
• Sitaa – white in colour
• Utsanna – swollen
• Snigdha – unctuous
• Stabdha – hard
• Vrutta – rounded
• Guru – heavy
• Sthira – stable
• Pichchila – slimy
• Stimita – feeling as if covered with wet cloth
• Shlakshana – smooth
• Kandu – itching
• Sparshana priya – feels comfort on touching
• Kareera samana – shape of Capparis deciduas
• Panasasthi samana – shape of seed of jack fruit
• Gostana samana – shape of udder of cow

Associated symptoms:

• Vankshna anaha – heaviness in groin (hernia)
• Payu avakarshana – pulling pain in anus
• Vasti avakarshana – pulling pain in urinary bladder
• Nabhi avakarshana – pulling pain in navel region
• Kasa – cough
• Shwasa – dyspnoea
• Hrullasa – excessive salivation, nausea
• Praseka – excessive watering in the mouth
• Aruchi – tastelessness
• Peenasa – cold, running or stuffy nose
• Meha – urinary disorders
• Shiro jadya – heaviness of head
• Shishira jwara – fever with cold and chills
• Klaibya – impotence
• Agnimandya – sluggish digestion
• Chardi – vomiting
• Vasaabha sa kapha pureesha – stools appearing like muscle fat and mixed with phlegm
• Pravahika – dysentery
• Na sravanti – no discharges
• Na bhidyanti – will not open up easily
• Pandu snigdha twak adi – pallor of skin, nails, eye etc

Tridoshaja Arshas

Causes – all the causes which aggravate the doshas individually taken together
Symptoms – mixture of symptoms mentioned in arshas caused by vitiation of individual doshas

Treatment – Treatments said for arshas caused by vitiation of individual doshas shall be clubbed together skilfully to combat Tridoshaja Arshas. Tretment depends on the predominance of dosha in the combined vitiation.

Raktaja Arshas

Causes – vitiation of rakta or blood by morbid doshas or by itself
Charaka has included Raktaja Arshas in Pittaja Arshas and has not counted it separately.

Symptoms of Raktaja Arshas:

Appearance of Arshas (pile mass) –
Similar to the appearance of pile mass in Pittaja Arshas
Vata praroha sannibha – Similar to the colour and structure of shoots of Vata tree (Banyan tree)
Gunja sannibha – colour and appearance as that of Gunja seed or Abrus precatorius
Vidruma / Pravala sannibha – colour and appearance as that of Pravala (coral)

Associated symptoms:

• Dushtam ushnam raktam – bleeding of contaminated and hot (to touch) blood, due to the pile masses continuously subjected to errosion by hard stools
• Rakta ati pravrutti – excess bleeding
• Bhekabhaha – The person appears like a frog in rainy season due to excessive bleeding
• Peedaa – pain and discomfort
• Shonita sankshaya sambhava dukha vyadhi – painful and annoying diseases caused due to excessive blood loss
• Heena varna – loss of body colour
• Heena bala – loss of strength and vigour
• Heena utsaha – loss of enthusiasm
• Hata oja – lack lustre
• Kalusha indriyaha – disturbed sensorium

Sahaja Arshas

Causes – This type of arshas or haemorrhoids is hereditary, acquired from one of the parents. These people will have a tendency to get piles right from their birth.

Symptoms of Sahaja Arshas:
The symptoms indicate not only that of the manifested piles but also those signs and symptoms seen from childhood or early adolescence which indicate the inherited tendency to develop piles.

• Krisha, Vivarna, Kshama, Deena – thin (emaciated), discoloured, weak, helpless right from the birth
• Prachura vibaddhaha – severe constipation with obstruction of stools, flatus and urine
• Sharkara, ashmari – develops gravel and stones in urinary tract
• Aniyata malabaddhata – unpredictable bowel changes
• Sama mala – unformed stools occasionally which comes in different colours, white, pale, green, yellow, red, reddish yellow, loose, sticky, smell of dead body, foul smell
• Shula – cutting pain in the navel region, butts, groin and urinary bladder
• Shotha – swelling in hands, legs, face and around eye sockets
• Tikta amla udgaara – sour and bitter belching
• Durbala – weak
• Durbala agni – weak digestion
• Alpa shukra – less semen
• Krodhana – anger
• Suffers from – pravahika (dysentery), romancha (horripulation), prameha (urinary disorders), vishtambha (constant constipation), antra kujana (constant presence of gurgling sounds in the abdomen), udavarta (upward movement of vayu), hrudaya upalepa (feeling of coating over the heart), indriya upalepa (feeling of coating over the sense organs), kasa (cough), shwasa (dyspnoea), tamaka shwasa (asthma), trushna (thirst), hrullasa (belching, nausea), vamana (vomiting), arochaka (tastlessness), peenasa (cold),kshawathu (excessive sneezing), timira (darkness before eyes), shira shula (headache), swara kshaya (loss of voice), karna roga (ear diseases), asthi shula (bone pains), sandhi shula (joint pains), jwara (fever), angamarda (body pains), parshwa shula (pain in flanks), udara shula (colic), prushta shula (back pain), trika shula (sacral pain), alasya (lazyness),
• Dukha upachaarasheela – will develop health upsets and diseases which are very difficult to manage.

Treatment for Piles

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 – medicines

But apart from Aushadha, none of the principles can be followed in the treatment of varicocele.

Kshara Application on Arshas
By Dr Ashwin Shetty – Easy Ayurveda Hospital
Click to Consult Dr Ashwin

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 caused by vitiation of Vata, Kapha or Vata-Kapha are called Shushka Arsha. Therefore, Vataja, 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 occur due to 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.

Classic formulations for Shushka Arsha –

The formulations mentioned below help in relieving pain and swelling, controls Vayu and other morbid doshas, removes congestion, and helps in recovering from varicocele.

• Guda abhaya – Mixture of Guda (jiggery) and Abhaya (Terminalia chebula) should be given before food.
• Powder of 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.
• 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 is useful. Similarly yusha (soup), jala (water and ghrita (ghee) prepared with the above said herbs is also useful.

Note – The treatmen line-up of Aardra Arshas (Raktaja, Pittaja, Rakta-Pittaja) shall not be applicable in treating varicocele because this type of arshas is associated with bleeding whereas we don’t find any bleeding in varicocele. Therefore Shushka Arsha treatment is adapted in varicocele treatment.

Ayurvedic medicines

Classic Ayurvedic medicines for piles treatment: 

• Dusparshakadi Kashayam
• Chiruvilwadi Kashayam
• LashunaErandadi Kashayam
• Sukumaram Kashayam
• Gandharvahastadi Kashayam
• Punarnavadi Kashayam
• Varanadi Kashayam
• Abhayarishta
• Mridwikarishta
• Dantyarishta
• Vidangarishta
• Bahushala guda
• Kalyanaka guda
• Manibhadra guda
• Suranavaleha
• Hingutriguna Leham
• Vyaghryadi leham
• Saptavimshati Guggulu
• Triphala Guggulu
• Kanchanara Guggulu
• Changeri Ghrita
• Avipattikara Churna
• Triphala Churna
• Arshoghna vati
• Kankayana Gutika Arsha
• Arshakutara Rasa etc

Proprietary products:

• Cap Arsol (BAN)
• Tab Arshonyt (Charak)
• Cap Balvac (BAL Vedics)
• Tab Kultab (Vasu)
• Tab Pilex (Himalaya)
• Tab Pilocure (Alopa)
• Tab Pilorid (Nagarjuna)
• Tab Pirrhoids (Baidyanath)
• Cap Pylapy (Capro)
• Tab Rectocare (Bacfo)
• Cap Sukhada (Ayulabs)
• Cap Sunarin (Phyto pharma) etc

Click to Consult Dr Raghuram YS MD (Ayu)

Yogas Mentioned in Sahasra yoga Text book
Arsohara Kashaya
Tiktaka Ghrita
Mahatikataka Ghrita
Sukumara Ghrita
Dasanga Ghrita
Sasa Vasadi Ghrita
Darvi Baladi Ghrita
Dhanvantari Ghrita
Chandanadi Choorna
Trikatwadi Choorna
Pushyanuga Choorna
Naracha Choorna
Hapushadi Choorna
Yavanyadi Choorna
Hutabhungadi Choorna
Suranadi Choorna
Nagaradi Choorna
Hingu Vachadi Choorna
Vyoshadi Choorna
Ayaskantadi Choorna
Yogaraja Choorna
Hutasana Choorna
Gandhaka Choorna
Narasimha Choorna
Kalyana Kshara
Suda Kandadi Kshara
Abhayarishta
Dasamoolarishta
Dantyarishta
Durlalabharishta
Devadarvyarishta
Pippalyasava
Usirasava
Lohasava
Kushmanda Rasayana
Manibhadra Guda
Ellum Tippalyadi Lehyam
Agasthya Rasayana
Danti Haritakyavaleha
Kutajavaleha
Kutaja Phanita
Kautajadi Guda
Bahusala Guda
Gandhaka Rasayana
Madanakameshwari Lehya (Chaturjadakad Rasayana)
Vyaghryadi Lehya
Dasamooladi Lehya
Chitrakadi Guda
Brihat Madhusnuhi Rasayana
Kutajadyavaleha
Kameshwari Lehya
Abhaya modaka
Yogaraja guggulu
Mandoora Vataka
Kankayana Gutika
Gulmakulantaka Rasa
Sankhapani Rasa
Anthrakuthara Rasa
Ashtakshari Gutika
Padma Kinjalkadi Kashaya
Muviladi Kanni Kashaya
Hriberadi ghrita
Punkin Toladi Kashaya
Agni Kandadi Ghrita
Kattuchen Ghrita (Vana soorana Ghrita)

Pathya apathya – Yogaratnakara

Wholesome diet and habits :

• Horsegram
• Barley
• Wheat
• Red rice
• Spreading Hogweed
• Elephant foot yam|
• Buttermilk
• Indian gooseberry
• Wood apple
• Butter
• Mexican tea
• Pointed gourd
• Black pepper
• Meat of deer
• Goat milk
• Brinjal
• Sour gruel

Wholesome diet and habits :

• Suppression of natural urges
• Sexual intercourse
• Riding horse etc. animals
• Utkatasana – practising “chair pose” or squatting posture
  Foods that aggravate doshas