Ashtanga Hridayam Chikitsa sthanam Chapter 8: Arshasam Chikitsitam Adhyaya (Treatments of haemorrhoids / piles)

The 8^th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Arsas Cikitsitam Adhyayah. This chapter deals with the explanation of ‘treatment of hemorrhoids / piles.

The topics covered in this chapter include –

–   Sadagdha laksana – signs of proper cauterization
–   Treatment of bladder pain in piles
–   Treatment of shakrt mutra pratighata (obstruction of feces and urine)
–   Bilwadi Taila
–   Kasisadi Taila
–   Arkadi Dhupa
–   Gudavarti
–   Lepa Yogah
–   Raktamokshana – bloodletting
–   Takra prayoga – use of buttermilk
–   Takrarista
–   Chitrakasiddha Takra
–   Medicated gruel, soup, ghee
–   Treatment for patients having loose and hard stools
–   Use of Varuni
–   Use of herbs
–   Use of Pathya (Terminalia chebula)
–   Use of Ajasrngi and Vartaka
–   Use of Trivrt and Pathya
–   Use of Takra, Sidhu, Gauda and Sura
–   Vardhamana Pippali
–   Dusparshakadi kashayam
–   Abhayarishta
–   Dantyarista
–   Duralabharista
–   Ghrta Yogas
–   Ahara – diet in piles
–   Anuvasana – oil for enema therapy
–   Niruha – decoction for enema therapy
–   Raktarsas Cikitsa – treatment of bleeding piles
–   Shodhana and Langhana
–   Tikta pachana and dipana
–   Snehana
–   Stambhana Cikitsa
–   Kashaya for Rajtaja Arsas associated with Kapha
–   Kutajadi Curna
–   Kutajadi Leham
–   Lodhradi Yoga
–   Yastyahvadi Yoga
–   Lodhradi Yoga
–   Yavanyadi Curna
–   Sarkaradi Yoga
–   Good foods and wine for bleeding piles
–   Ideal things for Vataja Raktarshas
–   Controlling Vata and bleeding in bleeding hemorrhoids
–   Indication of coolant measures
–   Tarpana and Avapeedaka
–   Pichcha Basti
–   Anuvasana Basti
–   Madhukadi Ghrta
–   Vyatyasa Chikitsa
–   Varti – suppository
–   Churna vinirdhamana
–   Kalyanaka Ksara
–   Treatment of gadavarca arshas
–   Putikaranjadi Yoga
–   Chukra Prayoga
–   Pilvadi Yoga
–   Dasamuladi Guda
–   Chitrakadi Leham
–   Vyoshadi Gutika
–   Use of Surana
–   Maricadi Guda
–   Suranadi Pindi   
–   Pathyadi Curna
–   Kalingadi Guda
–   Lavanottamadi Curna
–   Use of Bhallataka, Kutaja and Kalasheya
–   Principles for using ideal foods and drinks in piles
–   Importance of protecting the digestive fire in piles and other disorders

Pledge by the author (s)

अथातो रक्तपित्तचिकित्सितं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to God, henceforth we are going to explain the chapter pertaining to the explanation of ‘hemorrhoids / piles’. Thus say (pledge) atreya and other sages.

Kshara-Agnikarma: Cauterization with alkali and fire

काले साधारणे व्यभ्रे नातिदुर्बलमर्शसम् ।
विशुद्धकोष्ठं लघ्वल्पमनुलोमनमाशितम् ॥ १ ॥
शुचिं कृतस्वस्त्ययनं मुक्तविण्मूत्रमव्यथम् ।
शयने फलके वाऽन्यनरोत्सङ्गे व्यपाश्रितम् ॥ २ ॥
पूर्वेण कायेनोत्तानं प्रत्यादित्यगुदं समम् ।
समुन्नतकटीदेशमथ यन्त्रणवाससा ॥ ३ ॥
सक्थ्नोः शिरोधरायां च परिक्षिप्तमृजु स्थितम् ।
आलम्बितं परिचरैः सर्पिषाऽभ्यक्तपायवे ॥ ४ ॥
ततोऽस्मै सर्पिषाऽभ्यक्तं निदध्यादृजु यन्त्रकम् ।
शनैरनुसुखं पायौ ततो दृष्ट्वा प्रवाहणात् ॥ ५ ॥
यन्त्रे प्रविष्टं दुर्नाम प्लोतगुण्ठितयाऽनु च ।
शलाकयोत्पीड्य भिषग्यथोक्तविधिना दहेत् ॥ ६ ॥
क्षारेणैवार्द्रमितरत् क्षारेण ज्वलनेन वा ।
महद्वा बलिनश्छित्त्वा वीतयन्त्रमथातुरम् ॥ ७ ॥
स्वभ्यक्तपायुजघनमवगाहे निधापयेत् ।
निर्वातमन्दिरस्थस्य ततोऽस्याचारमादिशेत् ॥ ८ ॥
एकैकमिति सप्ताहात् सप्ताहात् समुपाचरेत् ।
प्राग्दक्षिणं ततो वाममर्शः पृष्ठाग्रजं ततः ॥ ९ ॥
During Sadharana Kala (moderate seasons such as autumn and spring), on a cloudless day, the patient of hemorrhoids, who is not very weak, whose alimentary tract has been purified, who has consumed easily-digestible and laxative foods in little quantity, who is clean, who has performed auspicious rites, who has eliminated the feces and urine, who is free from worries, who is sleeping either on a cot or plank, or other horizontal surfaces with the upper portion of the body placed a little high, the rectum facing the sun, the region of the waist raised up, the thighs and neck restrained, by tying them with cloth (made as rope), and placed straight and held tightly, suspended by attendants. The rectum is bathed with ghee, then, the Yantra (Arso Yantra – rectal speculum) which is smeared with ghee is introduced slowly straight into the rectum (following the passage of rectum) in a comfortable way; then observing the pile mass getting into the instrument (into the slit of the rectal speculum) after straining, it is raised with the help of a probe which is covered at its tip with cotton swab; then the physician should cauterize it with caustic Alkali according to the method explained only if it (piles) is of the moist kind (bleeding piles) and the other kind (non-bleeding) with either caustic Alkali or fire (touching a red hot metal probe etc.) or excising (with sharp instrument) if the pile mass is big, especially in strong patients. Afterwards, the instrument is removed, the rectum and pelvis smeared with fats (ghee or oil) and the patient asked to sit in a tub (containing lukewarm or cold water (processed with herbs) kept in a chamber devoid of breeze (for sometime) and then instructed to adhere to the procedures (vide verses 26 and 27 of chapter 16 of Sutrasthana). The pile masses, one by one; should be treated week after week in this manner, that situated on the right side treated first and next, that situated on the left, and then the top on, when there are multiple masses.

Sadagdha lakshana: Signs of proper cauterization

बह्वर्शसः सुदग्धस्य स्याद्वायोरनुलोमता ।
रुचिरन्नेऽग्निपटुता स्वास्थ्यं वर्णबलोदयः ॥ १० ॥
When the cauterization is proper, there is downward movement of Vata, desire for food, keenness of digestive fire, health and increase of strength and color /complexion.

Treatment of bladder pain in piles

बस्ति शूले त्वधो नाभेर्लेपयेच्छ्लक्ष्णकल्कितैः ।
वर्षाभूकुष्ठसुरभिमिशिलोहामराह्वयैः ॥ ११ ॥
If there is pain in the region of the bladder, thin paste of varṣābhū – Boerhavia diffusa, kuṣṭha – Saussurea lappa, surabhi – Ocimum sanctum / Pluchea lanceolata, miśi – Foeniculum vulgare, loha – Aquilaria agallocha, amarāhvayaiḥ tu – and Cedrus deodara should be applied, below the umbilicus.

Treatment of shakrt mutra pratighata (obstruction of feces and urine)

शकृन्मूत्रप्रतीघाते परिषेकावगाहयोः ।
वरणालम्बुषैरण्डगोकण्टकपुनर्नवैः ॥ १२ ॥
सुषवीसुरभीभ्यां च क्वाथमुष्णं प्रयोजयेत् ।
सस्नेहमथवा क्षीरं तैलं वा वातनाशनम् ॥ १३ ॥
युञ्जीतान्नं शकृद्भेदि स्नेहान् वातघ्नदीपनान् ।
If there is obstruction / difficulty for elimination of feces and urine, decoction of varaṇa – Crataeva nurvala, alambuṣa – Biophytum sensitivum / Sphaeranthus indicus, eraṇḍa – Ricinus communis, gokaṇṭaka – Tribulus terrestris, punarnava – Boerhavia diffusa, suṣavī – Carum carvi, surabhībhi – Ocimum sanctum should be made use of for pouring over the part (pelvis) and immersing in it, made warm and mixed with fat (ghee); or milk or oil which mitigates Vata should be used (for pouring and immersing). The food which is purgatory and fats (ghee) which mitigate Vata and are carminative should be administered.

Bilwadi Taila

अथाप्रयोज्यदाहस्य निर्गतान् कफवातजान् ॥ १४ ॥
सस्तम्भकण्डूरुक्शोफानभ्यज्य गुदकीलकान् ।
बिल्वमूलाग्निकक्षारकुष्ठैः सिद्धेन सेचयेत् ॥ १५ ॥
तैलेनाहिबिडालोष्ट्रवराहवसयाऽथवा।
Further, those pile masses, which are unsuitable for cauterization and are of kapha or vata in origin, which are stiff / protruding, itching, painful and swollen should be massaged with (below mentioned bilwadi oil) and should be bathed by pouring the oil boiled with bilvamūla – root of Aegle marmelos, agnika – Plumbago zeylanica, kṣāra – alkali, kuṣṭha – Saussurea lappa, or with the fat of snake, cat, camel or boar.

Bilwadi Taila

स्वेदयेदनु पिण्डेन द्रवस्वेदेन वा पुनः ॥ १६ ॥
सक्तूनां पिण्डिकाभिर्वा स्निग्धानां तैलसर्पिषा ।
रास्नाया हपुषाया वा पिण्डैर्वा कार्ष्ण्यगन्धिकैः ॥ १७ ॥
Next, the pile masses should be given fomentation either with the bolus (of herbs) or liquids or with balls of flour mixed with oil and ghee or with bolus of rāsnā – Pluchea lanceolata, hapuṣā – Juniperus communis, kārṣṇya gandhika – Moringa oleifera mixed with oil and ghee.

Kasisadi Taila

कासीसं सैन्धवं रास्ना शुण्ठी कुष्ठं च लाङ्गली ।
शिलाभ्रकाश्वमारं च जन्तुहृद्दन्तिचित्रकौ ॥ १६-१+ (१) ॥
हरितालं तथा स्वर्णक्षीरी तैश्च पचेत्समैः ।
तैलं सुधार्कपयसी गवां मूत्रे चतुर्गुणे ॥ १६-१+ (२) ॥
एतदभ्यङ्गतोऽर्शांसि क्षारवत्पातयेद्द्रुतम् ।
क्षारकर्मकरं ह्येतन्न च दूषयते वलीम् ॥ १६-१+ (३) ॥
Medicated oil is prepared from decoction of equal quantities of kāsīsaṃ – green vitriol, saindhavaṃ – rock salt, rāsnā – Pluchea lanceolata, śuṇṭhī – Zingiber officinale, kuṣṭhaṃ – Saussurea lappa, lāṅgalī – Gloriosa superba, śilā – Bitumen, abhraka – mica, aśvamāraṃ – Nerium oleander, jantuhṛt – Embelia ribes, danti – Baliospermum montanum, citraka – plumbago zeylanica, haritālaṃ – Arsenic trisulphide, svarṇakṣīrī – Argemone mexicana; milky sap of sudhā arka – Euphorbia neriifolia, Calotropis gigantea and cow’s urine. These should be taken four parts each by anointing with this oil, the pile masses fall off as though touched by Alkali; it performs the actions of the Alkali and does not harm the folds of the rectum.

Arkadi Dhupa

अर्कमूलं शमीपत्रं नृकेशः सर्पकञ्चुकम् ।
मार्जारचर्म सर्पिश्च धूपनं हितमर्शसाम् ॥ १८ ॥
तथाऽश्वगन्धा सुरसा बृहती पिप्पली घृतम् ।
Fumigation with arkamūlaṃ – roots of Calotropis gigantea, śamīpatraṃ – Prosopis cineraria, nṛkeśaḥ – human hairs, sarpa kañcukam – snake peel, mārjāra carma – and skin of cat, mixed with ghee is good for piles. Similarly, aśvagandhā – Withania somnifera, surasā – Ocimum sanctum, bṛhatī – Solanum indicum, pippalī – and Piper longum mixed with ghee.

Gudavarti

धान्याम्लपिष्टैर्जीमूतबीजैस्तज्जालकं मृदु ॥ १९ ॥
लेपितं छायया शुष्कं वर्तिर्गुदजशातनी ।
सजालमूलजीमूतलेहे वा क्षारसंयुते ॥ २० ॥
गुञ्जासूरणकूष्माण्डबीजैर्वर्तिस्तथागुणा ।
Seeds of Luffa echinata and its Jalaka (web-like portion present inside Jimuta fruit) macerated with fermented gruel, made into a nice paste, is applied over a reed and dried in shade. This wick (rectal suppository) destroys the piles. Similarly the confection prepared from the web and roots of Luffa echinata mixed with Ksara (Yavakshara – alkali of whole plant of Hordeum vulgare) ; likewise the rectal suppository prepared from guñjā – Abrus precatorius, sūraṇa – Amorphophallus campanulatus kūṣmāṇḍa bījai: – and seeds of Benincasa hispida possess similar properties.

Lepa Yogah

स्नुक्क्षीरार्द्रनिशालेपस्तथा गोमूत्रकल्कितैः ॥ २१ ॥
कृकवाकुशकृत्कृष्णानिशागुञ्जाफलैस्तथा ।
स्नुक्क्षीरपिष्टैः षड्ग्रन्थाहलिनीवारणास्थिभिः ॥ २२ ॥
कुलीरशृङ्गीविजयाकुष्ठारुष्करतुत्थकैः ।
शिग्रुमूलकजैर्बीजैः पत्रैरश्वघ्ननिम्बजैः ॥ २३ ॥ १३७५
पीलुमूलेन बिल्वेन हिङ्गुना च समन्वितैः ।
कुष्ठं शिरीषबीजानि पिप्पल्यः सैन्धवं गुडः ॥ २४ ॥
अर्कक्षीरं सुधाक्षीरं त्रिफला च प्रलेपनम् ।
आर्कं पयः सुधाकाण्डं कटुकालाबुपल्लवाः ॥ २५ ॥
करञ्जो बस्तमूत्रं च लेपनं श्रेष्ठमर्शसाम् ।
Similarly the application of paste of snukkṣīra – milk of Euphorbia neriifolia, ārdra niśā – and moist Curcuma longa or of excreta of the cock, kṛṣṇā – Piper longum, niśā – Curcuma longa, guñjāphalai: – Abrus precatorius macerated with cow urine. Paste of roots of ṣaḍgranthā – Piper longum, halinī – Gloriosa superba, bones of the elephant, kulīra śṛṅgī – Pistacia chinensis, vijayā – Terminalia chebula, kuṣṭha – Saussurea lappa, aruṣkara – Semecarpus anacardium, tutthaka – blue vitriol), seeds and roots of śigru – Moringa oleifera, leaves of aśvaghna – Nerium indicum, and nimbaja – Azadirachta indica, root of pīlu – Salvadora persica, bilva – and Aegle marmelos, macerated with the milky sap of snuk – Euphorbia neriifolia, hiṅgunā ca samanvitaiḥ – mixed with Ferula narthex (applied on the piles act similarly). Application of paste of kuṣṭhaṃ – Saussurea lappa, śirīṣa bījāni – seeds of Albizia lebbeck, pippali – Piper longum, saindhavaṃ – rock salt, guḍaḥ – jaggery, Latex of arka – Calotropis gigantea, sudhākṣīraṃ – Latex of Euphorbia neriifolia, triphalā – and Triphala (is beneficial). Application of latex of ārka – Calotropis gigantea, sudhākāṇḍaṃ – stem of Euphorbia neriifolia, kaṭukālābu pallavāḥ – tender leaves of Lagenaria siceraria, and karañja – Pongamia pinnata and goat urine is best for piles.

Lepa Yogah

आनुवासनिकैर्लेपः पिप्पल्याद्यैश्च पूजितः ॥ २६ ॥
एभिरेवौषधैः कुर्यात्तैलान्यभ्यञ्जनाय च ।
Application of paste of herbs such as Piper longum etc. meant for Anuvasana (oil enema) (vide verses 89 to 92) is considered best; oil prepared from these herbs is good for anointing on the piles.

Raktamokshana: Bloodletting

धूपनालेपनाभ्यङ्गैः प्रस्रवन्ति गुदाङ्कुराः ॥ २७ ॥
सञ्चितं दुष्टरुधिरं ततः सम्पद्यते सुखी ।
The pile masses eliminate the vitiated blood accumulated inside them by the use of fumigation, topical application and anointing; after that the patient obtains comfort.

Raktamokshana: Bloodletting

अवर्तमानमुच्छूनकठिनेभ्यो हरेदसृक् ॥ २८ ॥
अर्शोभ्यो जलजाशस्त्रसूचीकूर्चैः पुनः पुनः ।
शीतोष्णस्निग्धरूक्षैर्हि न व्याधिरुपशाम्यति ॥ २९ ॥
रक्ते दुष्टे भिषक् तस्माद्रक्तमेवावसेचयेत् ।
For the hemorrhoid pile masses which are coiled, swollen and hard, blood should be removed again and again by the use of either leeches, knife or brush of needles. When the blood is vitiated, the disease (piles) does not get relieved by treatments such as cold and hot, unctuous and dry treatments. Hence the physician should remove the blood itself.

Takra prayoga: Use of buttermilk

यो जातो गोरसः क्षीराद्वह्निचूर्णावचूर्णितात् ॥ ३० ॥
पिबंस्तमेव तेनैव भुञ्जानो गुदजान् जयेत् ।
कोविदारस्य मूलानां मथितेन रजः पिबन् ॥ ३१ ॥
अश्नन् जीर्णे च पथ्यानि मुच्यते हतनामभिः ।
He who drinks milk boiled with the powder of Plumbago zeylanica and eats food along with it only, gets cured of piles. He who drinks buttermilk mixed with / macerated with the powder of roots of Bauhinia variegata and eats suitable foods only after its digestion gets cured of piles.

Takra prayoga: Use of buttermilk

गुदश्वयथुशूलार्तो मन्दाग्निर्गौल्मिकान् पिबेत् ॥ ३२ ॥
हिङ्ग्वादीननुतक्रं वा खादेद्गुडहरीतकीम् ।
तक्रेण वा पिबेत्पथ्यावेल्लाग्निकुटजत्वचः ॥ ३३ ॥
कलिङ्गमगधाज्योतिःसूरणान् वांऽशवर्धितान् ।
कोष्णाम्बुना वा त्रिपटुव्योषहिङ्ग्वम्लवेतसम् ॥ ३४ ॥
He who has swelling and pain in the rectum, poor digestion and abdominal tumor should consume Hingvadi Churna (chapter 14) with buttermilk as after-drink, consume jaggery and Terminalia chebula with buttermilk one should drink (powder of) pathyā – Terminalia chebula, vella – Embelia ribes, agni – Plumbago zeylanica, kuṭaja tvacaḥ – bark of Holarrhena antidysenterica; kaliṅga – or (powder of) Holarrhena antidysenterica, magadhā – Piper longum, jyotiḥ – Plumbago zeylanica, sūraṇān – Amorphophallus campanulatus each succeeding one increased by one part than its preceding should be consumed with warm water (or buttermilk) powder of the three salts, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, hiṅgu – Ferula narthex, amlavetasam – Garcinia pedunculata.

Takra prayoga: Use of buttermilk

युक्तं बिल्वकपित्थाभ्यां महौषधविडेन वा ।
अरुष्करैर्यवान्या वा प्रदद्यात्तक्रतर्पणम् ॥ ३५ ॥
दद्याद्वा हपुषाहिङ्गुचित्रकं तक्रसंयुतम् ।
मासं तक्रानुपानानि खादेत्पीलुफलानि वा ॥ ३६ ॥
पिबेदहरहस्तक्रं निरन्नो वा प्रकामतः ।
अत्यर्थं मन्दकायाग्नेस्तक्रमेवावचारयेत् ॥ ३७ ॥
Takra Tarpana (buttermilk mixed with flour of barley (Hordeum vulgare) mixed with bilva – Aegle marmelos, kapittha – Limonia acidissima, mahauṣadha – Zingiber officinale and Vida salt aruṣkara – Semecarpus anacardium, yavānyā vā – Trachyspermum ammi should be given to drink especially; or butter milk mixed with the hapuṣā – Juniperus communis, hiṅgu – Ferula narthex, citrakaṃ saṃyutam – and Plumbago zeylanica should be given (to drink); eat the fruits of Salvadora persica only for one month with buttermilk as an after-drink; or drink buttermilk only, without any food, regularly, as much as desired. For those who have very weak digestive power, buttermilk only should be given especially (without any other food).

Takra prayoga: Use of buttermilk

सप्ताहं वा दशाहं वा मासार्धं मासमेव च ।
बलकालविकारज्ञो भिषक् तक्रं प्रयोजयेत् ॥ ३८ ॥
सायं वा लाजसक्तूनां दद्यात्तक्रावलेहिकाम् ।
जीर्णे तक्रे प्रदद्याद्वा तक्रपेयां ससैन्धवाम् ॥ ३९ ॥
तक्रानुपानं सस्नेहं तक्रौदनमतः परम् ।
यूषै रसैर्वा तक्राढ्यैः शालीन् भुञ्जीत मात्रया ॥ ४० ॥
The physician who has understood the strength of the patient, time, season and the nature of the disease should administer buttermilk for seven or ten days, half a month or one month; or Lajasaktu (powder of fried paddy) made into a paste with buttermilk can be given in the evenings. After the buttermilk gets digested, gruel mixed with buttermilk added with rock salt should be given. Then, boiled rice mixed with buttermilk, then added with ghee should be consumed followed by buttermilk as an after drink; or boiled rice can be consumed in proper quantity either with soup, meat soup mixed with more of buttermilk.

Takra prayoga: Use of buttermilk

रूक्षमर्धोद्धृतस्नेहं यतश्चानुद्धृतं घृतम् ।
तक्रं दोषाग्निबलवित्त्रिविधं तत्प्रयोज्येत् ॥ ४१ ॥
Buttermilk can be administered in three forms: dry (fatless), removed of half of fat, and not removed of fat at all, depending on the condition of the Doshas and strength of the digestive fire.

Takra prayoga: Use of buttermilk

न विरोहन्ति गुदजाः पुनस्तक्रसमाहताः ।
निषिक्तं तद्धि दहति भूमावपि तृणोलुपम् ॥ ४२ ॥
Pile masses do not grow again, which have been rooted out by the use of buttermilk, because it (buttermilk) burns away (destroys) even the grass when poured on the ground.

Takra prayoga: Use of buttermilk

स्रोतःसु तक्रशुद्धेषु रसो धातूनुपैति यः ।
तेन पुष्टिर्बलं वर्णः परं तुष्टिश्च जायते ॥ ४३ ॥
वातश्लेष्मविकाराणां शतं च विनिवर्तते ।
मथितं भाजने क्षुद्रबृहतीफललेपिते ॥ ४४ ॥
निशां पर्युषितं पेयमिच्छद्भिर्गुदजक्षयम् ।
Rasa Dhatu moving through the channels purified by buttermilk easily reaches all the tissues; by this nourishment, strength, complexion, and best of satiation are produced, and hundreds of diseases caused by Vata and Sleshman (Kapha) get cured. Buttermilk kept overnight in a pot smeared inside with the paste of fruits of Solanum indicum and well churned the next morning should be consumed by those who wish to get cured of hemorrhoids.

Takrarista

धान्योपकुञ्चिकाजाजीहपुषापिप्पलीद्वयैः ॥ ४५ ॥
कारवीग्रन्थिकशठीयवान्यग्नियवानकैः ।
चूर्णितैर्घृतपात्रस्थं नात्यम्लं तक्रमासुतम् ॥ ४६ ॥
तक्रारिष्टं पिबेज्जातं व्यक्ताम्लकटु कामतः ।
दीपनं रोचनं वर्ण्यं कफवातानुलोमनम् ॥ ४७ ॥
गुदश्वयथुकण्ड्वर्तिनाशनं बलवर्धनम् ।
Buttermilk fermented in a pot smeared inside with the ghee, is mixed with (powder of) dhānya – Coriandrum sativum, upakuñcika – Nigella sativa, ajājī – Cuminum cyminum, hapuṣā – Juniperus communis, pippalīdvayaiḥ – Piper longum and Scindapsus officinalis, kāravī – Carum carvi, granthika – Piper longum, śaṭhī – Curcuma zedoaria, yavāni – Trachyspermum ammi, agni – Plumbago zeylanica, yavānaka – Apium graveolens – is allowed to ferment. When it becomes not very sourbut of perceptible sour and gets pungent tastes, it should be consumed as much as desired. This recipe known as Takrarista is carminative, appetizer, bestows color / complexion, leads to downward movement of Kapha and Vata, cures the swelling, itching and cures pain of the rectum and increases strength.

Chitrakasiddha Takra

त्वचं चित्रकमूलस्य पिष्ट्वा कुम्भं प्रलेपयेत् ॥ ४८ ॥
तक्रं वा दधि वा तत्र जातमर्शोहरं पिबेत् ।
भार्ग्यास्फोतामृतापञ्चकोलेष्वप्येष संविधिः ॥ ४९ ॥
A pot should be smeared inside with the paste of bark of citraka – Plumbago zeylanica buttermilk or dadhi vā – curds put into it and kept overnight; it should be consumed for the cure of piles. Similarly, those prepared with (paste of) bhārgī – Clerodendrum serratum, asphota – Vallaris solanacea, amṛtā – Tinospora cordifolia and Panchakola.

Medicated gruel, soup, ghee

पिष्टैर्गजकणापाठाकारवीपञ्चकोलकैः ।
तुम्बुर्वजाजीधनिकाबिल्वमध्यैश्च कल्पयेत् ॥ ५० ॥
फलाम्लान् यमकस्नेहान् पेयायूषरसादिकान् ।
एभिरेवौषधैः साध्यं वारि सर्पिश्च दीपनम् ॥ ५१ ॥
Paste of gajakaṇā – Scindapsus officinalis, pāṭhā – Cissampelos pariera, kāravī – Carum carvi, Panchakola, tumbu: – Zanthoxylum alatum, ajājī – Cuminum cyminum, dhanikā – Coriandrum sativum, and marrow of bilva – Aegle marmelos is to be made use of to prepare sour syrup of fruits, mixture of two fats, thin gruel, soup or meat-soup, drinking water and medicated ghee prepared by these herbs are carminatives.

Treatment for patients having loose and hard stools

क्रमोऽयं भिन्नशकृतां वक्ष्यते गाढवर्चसाम् ।
These treatments are meant for persons who have loose feces; further on, will be described to those of hard feces.

Use of Varuni

स्नेहाढ्यैः सक्तुभिर्युक्तां लवणां वारुणीं पिबेत् ॥ ५२ ॥
लवणा एव वा तक्रसीधुधान्याम्लवारुणीः ।
Varuni (a kind of wine) should be consumed by mixing it with more fats, corn-flour and salt; or buttermilk, Sidhu, Dhanyamla; or Varuni added with salt only.

Anulomana Saktu

प्राग्भक्तान् यमके भृष्टान् सक्तुभिश्चावचूर्णितान् ॥ ५३ ॥
करञ्जपल्लवान् खादेद्वातवर्चोऽनुलोमनान् ।
karañja pallavān – Tender leaves of Pongamia pinnata fried in a mixture of two fats (oil and ghee) added with powdered flour should be consumed before the first meal; it moves the flatus and faeces downward.

Use of herbs

सगुडं नागरं पाठां गुडक्षारघृतानि वा ॥ ५४ ॥
गोमूत्राध्युषितामद्यात् सगुडां वा हरीतकीम् ।
nāgaraṃ – Zingiber officinale, pāṭhāṃ – Cissampelos pareira added with jaggery or jaggery with alkali and Ghrta (ghee), harītakīm – or Terminalia chebula soaked in cow urine should be consumed first with jaggery.

Use of Pathya (Terminalia chebula)

पथ्याशतद्वयान् मूत्रद्रोणेनामूत्रसङ्क्षयात् ॥ ५५ ॥
पक्वात् खादेत्समधुनी द्वे द्वे हन्ति कफोद्भवान् ।
दुर्नामकुष्ठश्वयथुगुल्ममेहोदरकृमीन् ॥ ५६ ॥
ग्रन्थ्यर्बुदापचीस्थौल्यपाण्डुरोगाढ्यमारुतान् ।
pathyā – Terminalia chebula – two hundred in number, is cooked in 12.288 liters of cow urine till the urine gets evaporated. Two such cooked Pathya mixed with honey consumed at each time cures piles caused by kapha, kuṣṭha – skin diseases, śvayathu – dropsy, gulma – abdominal tumor, meha – diabetes, udara – enlargement of the abdomen, kṛmi – intestinal worms, granthi – tumors, arbuda – malignant tumors, apacī – goiter, sthaulya – obesity, pāṇḍuroga – anaemia, āḍhyamārutān – and rigidity of the thighs arising fom Kapha. 

Use of Ajashringi and Vartaka

अजशृङ्गीजटाकल्कमजामूत्रेण यः पिबेत् ॥ ५७ ॥
गुडवार्ताकभुक् तस्य नश्यन्त्याशु गुदाङ्कुराः ।
Piles of the person who drinks goat urine mixed with the paste of root of Gymnema sylvestre and consuming jaggery and Solanum indicum as food, gets cured quickly.

Use of Trivrit and Pathya

श्रेष्ठारसेन त्रिवृतां पथ्यां तक्रेण वा सह ॥ ५८ ॥
पथ्यां वा पिप्पलीयुक्तां घृतभृष्टां गुडान्विताम् ।
अथवा सत्रिवृद्दन्तीं भक्षयेदनुलोमनीम् ॥ ५९ ॥
हते गुदाश्रये दोषे गुदजा यान्ति सङ्क्षयम् ।
trivṛtāṃ – Operculina turpethum consumed with decoction of Triphala, Terminalia chebula with buttermilk; or Pathya (Terminalia chebula) fried in ghee along with Pippali (Piper longum) and mixed with Guda (jaggery) or Terminalia chebula mixed with – trivṛt – Operculina turpethum, dantīṃ – Baliospermum montanum should be consumed acts as an laxative; when the doshas localized in the rectum are mitigated, the rectal sprouts also get subsided.

Use of Takra, Sidhu, Gauda and Sura

दाडिमस्वरसाजाजीयवानीगुडनागरैः ॥ ६० ॥|
पाठया वा युतं तक्रं वातवर्चोऽनुलोमनम् ।
सीधुं वा गौडमथवा सचित्रकमहौषधम् ॥ ६१ ॥
पिबेत् सुरां वा हपुषापाठासौवर्चलान्विताम् ।
Buttermilk, mixed with juice of dāḍima – Punica granatum, ajājī – Cuminum cyminum, yavānī – Trachyspermum ammi, guḍa – jaggery, nāgara – and Zingiber officinale, or pāṭhaā – Cissampelos pareira, vāta varco anulomanam – moves the flatus and faeces downwards. Similarly, Sidhu or Gauda (kinds of liquor) mixed with citraka – Plumbago zeylanica, mahauṣadham – Zingiber officinale; or Sura (beer) should be consumed mixed with hapuṣā – Juniperus communis, pāṭhā – Cissampelos pareira and black salt.

Vardhamana Pippali

दशादिदशकैर्वृद्धाः पिप्पलीर्द्विपिचुं तिलान् ॥ ६२ ॥
पीत्वा क्षीरेण लभते बलं देहहुताशयोः ।
Commencing with ten, increased by ten daily, pippalī: – Piper longum mixed with two Pichu (2 Karsha – 24 grams) of Sesamum indicum boiled in milk and consumed; by this the person attains strength of the body and of the digestive fire.

Dusparshakadi Kashayam

दुःस्पर्शकेन बिल्वेन यवान्या नागरेण वा ॥ ६३ ॥
एकैकेनापि संयुक्ता पाठा हन्त्यर्शसां रुजम् ।
pāṭhā – Cissampelos pareira consumed along with duḥsparśaka – Alhagi camelorum, bilva – Aegle marmelos, yavāni – Trachyspermum ammi, nāgara – or Zingiber officinale each one separately (or all together) cures the pain of the piles.

Abhayarishta

सलिलस्य वहे पक्त्वा प्रस्थार्धमभयात्वचाम् ॥ ६४ ॥
प्रस्थं धात्र्या दशपलं कपित्थानां ततोऽर्धतः ।
विशालां लोध्रमरिचकृष्णावेल्लैलवालुकम् ॥ ६५ ॥
द्विपलांशं पृथक् पादशेषे पूते गुडात्तुले ।
दत्त्वा प्रस्थं च धातक्याः स्थापयेद्घृतभाजने ॥ ६६ ॥
पक्षात् स शीलितोऽरिष्टः करोत्यग्निं निहन्ति च ।
गुदजग्रहणीपाण्डुकुष्ठोदरगरज्वरान् ॥ ६७ ॥
श्वयथुप्लीहहृद्रोगगुल्मयक्ष्मवमिकृमीन् ।
Half Prastha (384 grams) of fruit skin of Terminalia chebula, one Prastha (768 grams) of Emblica officinalis ten Pala (480 grams) of Limonia acidissima, half of it of Citrullus colocynthis, lodhra – Symplocos racemosa, marica – Piper nigrum, kṛṣṇā – Piper longum, vella – Embelia ribes, elavālukam – Prunus cerasus each two Pala (96 grams) are boiled in two Vaha (four Drona – 48.9 Litres) of water, decoction reduced to a quarter, filtered and mixed with one Tula (4.8 Kg) of jaggery and one Prastha (768 grams) of Woodfordia fruticose. It is then filled into a pot smeared inside with ghee and kept undisturbed for a fortnight. This Arista consumed daily, increases digestive power and cures gudaja – piles, grahaṇī – duodenal diseases, pāṇḍu – anaemia, kuṣṭha – skin diseases, udara – ascites, gara – artificial poison, jvara – fever, śvayathu – dropsy, plīha – splenic disorders, hṛdroga – heart diseases, gulma – abdominal tumour, yakṣma – tuberculosis, vami – vomiting, kṛmi – and worms.

Dantyarista

जलद्रोणे पचेद्दन्तीदशमूलवराग्निकान् ॥ ६८ ॥
पालिकान् पादशेषे तु क्षिपेद्गुडतुलां परम् ।
पूर्ववत्सर्वमस्य स्यादानुलोमितरस्त्वयम् ॥ ६९ ॥
dantī – Baliospermum montanum, daśamūla – Dashamula, varā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, agnika – Plumbago zeylanica each one Pala (48 g) are boiled in one Drona (12 Litres 228 ml) of water and decoction reduced to a quarter; after filtering, one Tula (4.8 Kg) of jaggery and all the herbs enumerated earlier (in Abhayarista) are added, and kept undisturbed for a fortnight and then used acts as laxative.

Duralabharista

पचेद्दुरालभाप्रस्थं द्रोणेऽपां प्रासृतैः सह ।
दन्तीपाठाग्निविजयावासामलकनागरैः ॥ ७० ॥
तस्मिन् सिताशतं दद्यात् पादस्थेऽन्यच्च पूर्ववत् ।
लिम्पेत्कुम्भं तु फलिनीकृष्णाचव्याज्यमाक्षिकैः ॥ ७१ ॥
One Prastha (768 grams) of Fagonia cretica, along with one Prasrta (768 grams), each of – dantī – Baliospermum montanum, pāṭhā – Cissampelos pareira, agni – Plumbago zeylanica, Vijayā – Terminalia chebula, vāsā – Adhatoda vasica, āmalaka – Emblica officinalis, Nāgara – Zingiber officinale are boiled in one Drona (120 Litres 228 ml) of water and decoction reduced to a quarter; to this is added one hundred Pala (4.8 Kg) of sugar and other herbs as enumerated previously and poured into a pot smeared inside with a paste phalinī – Lagenaria sicerania / Callicarpa macrophylla, kṛṣṇā – Piper longum, cavya – Piper retrofractum, ājya – ghee, mākṣika – and honey; this recipe acts similarly.      

Ghrita Yogas

प्राग्भक्तमानुलोम्याय फलाम्लं वा पिबेद्घृतम् ।
चव्यचित्रकसिद्धं वा यवक्षारगुडान्वितम् ॥ ७२ ॥
पिप्पलीमूलसिद्धं वा सगुडक्षारनागरम् || ७७ ॥
Medicated ghee should be consumed processed with sour fruits before meals in order to cause downward movement; or that (ghee) prepared with: cavya – Piper retrofractum, and citraka – Plumbago zeylanica, yavakṣāra – alkali of whole plant of Hordeum vulgare, guḍa – and jaggery; pippalīmūla – or that (ghee) prepared with roots of Piper longum, added with jaggery, alkali of whole plant of Hordeum vulgare, nāgaram – Zingiber officinale.

Ghrita Yogas

पिप्पलीपिप्पलीमूलधानकादाडिमैर्घृतम् ॥ ७३ ॥
दध्ना च साधितं वातशकृन्मूत्रविबन्धनुत् ।
Medicated ghee prepared with (decoction of): pippalī – Piper longum, pippalīmūla – Piper longum roots, dhānakā – Coriandrum sativum, dāḍima – Punica granatum, dadhnā ca – and mixed with curds; flatus, faeces, urine.and if consumed, relieves the obstruction of above three (flatus, faeceas and urine)

Ghrita Yogas

पलाशक्षारतोयेन त्रिगुणेन पचेद्घृतम् ॥ ७४ ॥
वत्सकादिप्रतीवापमर्शोघ्नं दीपनं परम् ।
Medicated ghee prepared from three parts of solution of ash of Butea monosperma and powder of herbs of Vastakadi Gana (chapter 15 of Sutrasthana) destroys piles and is a best carminative.

Ghrita Yogas

पञ्चकोलाभयाक्षारयवानीविडसैन्धवैः ॥ ७५ ॥
सपाठाधान्यमरिचैः सबिल्वैर्दधिमत् घृतम् ।
साधयेत्तज्जयत्याशु गुदवङ्क्षणवेदनाम् ॥ ७६ ॥
प्रवाहिकां गुदभ्रंशं मूत्रकृच्छ्रं परिस्रवम् ।
Medicated ghee should be prepared with (decoction of): pañcakola – herbs of Panchakola, abhayā – Terminalia chebula, kṣāra – alkali, yavānī – Trachyspermum ammi, viḍa – Vida salt, saindhava – rock salt, pāṭhā – Cissampelos pareira, dhānya – Coriandrum sativum, maricaiḥ – Piper nigrum, bilva – and Aegle marmelos added with curds / yoghurt; this quickly cures the pain of the rectum and groins, pravāhikāṃ – dysentery, gudabhraṃśaṃ – prolapse of the rectum, mūtrakṛcchraṃ – dysuria, parisravam – and slimy discharge from the rectum.  

Ghrita Yogas

पाठाजमोदधनिकाश्वदंष्ट्रापञ्चकोलकैः ॥ ७७ ॥
सबिल्वैर्दध्नि चाङ्गेरीस्वरसे च चतुर्गुणे ।
हन्त्याज्यं सिद्धमानाहं मूत्रकृच्छ्रं प्रवाहिकाम् ॥ ७८ ॥
गुदभ्रंशार्तिगुदजग्रहणीगदमारुतान् ।
Medicated ghee prepared with (decoction of): pāṭhā – Cissampelos pareira, ajamoda – Apium graveolens, dhanikā – Coriandrum sativum, śvadaṃṣṭrā – Tribulus terrestris, pañcakolakaiḥ – herbs of Panchakola, bilva – and Aegle marmelos added with four parts of dadhni – curd, svarase and juice of cāṅgerī – Oxalis corniculate – hanti ānāhaṃ – cures flatulence, mūtrakṛcchraṃ – dysuria, pravāhikām – dysentery; gudabhraṃśa arti – prolapse of the rectum and pain, gudaja – haemorrhoids, grahaṇī gada – duodenal disease, mārutān – and increase of Vata.

Ahara: Diet in piles

शिखितित्तिरिलावानां रसानम्लान् सुसंस्कृतान् ॥ ७९ ॥
दक्षाणां वर्तकानां वा दद्याद्विड्वातसङ्ग्रहे ।
When there is obstruction of faeces and flatus juice (soup) of meat of Śikhi – peacock, tittiri – black partridge, lāva – common quail, dakṣāṇāṃ – cock, vartakānāṃ vā – or button quail processed with sours should be administered.

Ahara: Diet in piles

वास्तुकाग्नित्रिवृद्दन्तीपाठाम्लीकादिपल्लवान् ॥ ८० ॥
अन्यच्च कफवातघ्नं शाकं च लघु भेदि च ।
सहिङ्गु यमके भृष्टं सिद्धं दधिसरैः सह ॥ ८१ ॥
धनिकापञ्चकोलाभ्यां पिष्टाभ्यां दाडिमाम्बुना ।
आर्द्रिकायाः किसलयैः शकलैरार्द्रकस्य च ॥ ८२ ॥
युक्तमङ्गारधूपेन हृद्येन सुरभीकृतम् ।
सजीरकं समरिचं विडसौवर्चलोत्कटम् ॥ ८३ ॥
वातोत्तरस्य रूक्षस्य मन्दाग्नेर्बद्धवर्चसः ।
कल्पयेद्रक्तशाल्यन्नव्यञ्जनं शाकवद्रसान् ॥ ८४ ॥
गोगोधाछगलोष्ट्राणां विशेषात् क्रव्यभोजिनाम् ।
Tender leaves of vāstuka – Chenopodium album, agni – Plumbago zeylanica, trivṛt – Operculina turpethum, dantī – Baliospermum montanum, pāṭhā – Cissampelos pareira, and amlīka – Tamarindus indica / Emblica officinalis and other greens which mitigate Kapha and Vata, which are easily digestable and purgative in action, should be given, fried in two fats, mixed with Ferula narthex, cheese from curds mixed with paste of Coriandrum sativum herbs of Panchakola macerated with juice of Punica granatum, tender leaves of (Dhanyaka) Coriandrum sativum pieces of Zingiber officinale made fragrant by the fumes of fire which is pleasing, added with jīrakaṃ – Cuminum cyminum, maricaṃ – Pepper nigrum, and little more of Bida and black salt should be given as adjuvants to staple food, to persons of Vata predominance, who are dry, have weak digestive power and constipation, to be consumed along with mess of red rice, similarly soup processed with greens (mentioned above) prepared from the meat, of the go – cow, godhā – lizard, chagala – iguana, uṣṭra – camel or especially of carnivorous animals.

Ahara: Diet in piles

मदिरां शार्करं गौडं सीधुं तक्रं तुषोदकम् ॥ ८५ ॥
अरिष्टं मस्तु पानीयं पानीयं वाऽल्पकं शृतम् ।
धान्येन धान्यशुण्ठीभ्यां कण्टकारिकयाऽथवा ॥ ८६ ॥
अन्ते भक्तस्य मध्ये वा वातवर्चोऽनुलोमनम् ।
Madira (wine) prepared with Sharkara or Guda, Sidhu (wine prepared from sugarcane juice), Takra (buttermilk), Tusodaka (fermented water soaked with husk of grains), fermented decoction or whey should be used for drinking or drinking water boiled slightly with dhānya – Coriandrum sativum or Coriandrum sativum along with and śuṇṭhī – Zingiber officinale, kaṇṭakāri – Solanum xanthocarpum should be drunk either at the end or middle of the meals; this helps downward movement of flatus and faeces.

Ahara: Diet in piles

विड्वातकफपित्तानामानुलोम्ये हि निर्मले ॥ ८७ ॥
गुदे शाम्यन्ति गुदजाः पावकश्चाभिवर्धते ।
When the rectum becomes free of faeces, Vata, Kapha and Pitta by the downward movement, piles subside and digestive power becomes increased.

Anuvasana: Oil for enema therapy

उदावर्तपरीता ये ये चात्यर्थं विरूक्षिताः ॥ ८८ ॥
विलोमवाताः शूलार्तास्तेष्विष्टमनुवासनम् ।
For those who are having Udavarta (upward movement), who are greatly dried, who have upward movement of Vata accompanied with pain, Anuvasana (oil enema) is desirable.

Anuvasana: Oil for enema therapy

पिप्पलीं मदनं बिल्वं शताह्वां मधुकं वचाम् ॥ ८९ ॥|
कुष्ठं शठीं पुष्कराख्यं चित्रकं देवदारु च ।
पिष्ट्वा तैलं विपक्तव्यं द्विगुणक्षीरसंयुतम् ॥ ९० ॥
अर्शसां मूढवातानां तच्छ्रेष्ठमनुवासनम् ।
गुदनिःसरणं शूलं मूत्रकृच्छ्रं प्रवाहिकाम् ॥ ९१ ॥
कट्यूरुपृष्ठदौर्बल्यमानाहं वङ्क्षणाश्रयम् ।
पिच्छास्रावं गुदे शोफं वातवर्चोविनिग्रहम् ॥ ९२ ॥
उत्थानं बहुशो यच्च जयेत् तच्चानुवासनात् ।
Medicated oil should be prepared with the paste of pippalīṃ – Piper longum, madanaṃ – Randia dumetorum, bilvaṃ – Aegle marmelos, śatāhvāṃ – Anethum graveolens, madhukaṃ – Glycyrrhiza glabra, vacām – Acorus calamus, kuṣṭhaṃ – Saussurea lappa, śaṭhīṃ – Curcuma zedoaria, puṣkarākhyaṃ – Inula racemosa, citrakaṃ – Plumbago zeylanica, and devadāru – Cedrus deodara are added and made paste with two parts of milk. This oil is best for oil enema therapy arśasāṃ – in piles, mūḍhavātānāṃ – inactivity of Vata, guda niḥsaraṇaṃ – prolapsed of the rectum, śūlaṃ – pain of the abdomen, mūtrakṛcchraṃ – dysuria, pravāhikām – dysentery, kaṭi ūru pṛṣṭha daurbalyaṃ – weakness of the waist, thighs, and back; ānāhaṃ – abdominal distention, vaṅkṣaṇa āśrayam – localized in the groins, picchāsrāvaṃ – slimy discharge from the rectum, gude śophaṃ – swelling of the rectum, vātavarco vinigraham – obstruction of flatus and feaces and frequent elimination of faeces get cured by this oil used for oil enema therapy.

Niruha: Decoction for enema therapy

 निरूहं वा प्रयुञ्जीत सक्षीरं पाञ्चमूलिकम् ॥ ९३ ॥
समूत्रस्नेहलवणं कल्कैर्युक्तं फलादिभिः ।
Even a decoction enema may be administered, prepared with milk decoction of Panchamula, with cow urine, fat (oil), salt and paste of Randia dumetorum etc.

Raktarshas Chikitsa: Treatment of bleeding piles

अथ रक्तार्शसां वीक्ष्य मारुतस्य कफस्य वा ॥ ९४ ॥
अनुबन्धं ततः स्निग्धं रूक्षं वा योजयेद्धिमम् ।
Finding the presence of Raktarsas (piles arising from vitiation of blood) having Vata or Kapha as the secondary Doshas, therapies (herbs, diet etc.) which are unctuous or dry (for Vata and Kapha respectively) but cold (in potency/ nature/ effect) should be administered.

Raktarshas Chikitsa: Treatment of bleeding piles

शकृच्छ्यावं खरं रूक्षमधो निर्याति नानिलः ॥ ९५ ॥
कट्यूरुगुदशूलं च हेतुर्यदि च रूक्षणम् ।
तत्रानुबन्धो वातस्य श्लेष्मणो यदि विट् श्लथा ॥ ९६ ॥
श्वेता पीता गुरुः स्निग्धा सपिच्छः स्तिमितो गुदः ।
हेतुः स्निग्धगुरुर्विद्याद्यथास्वं चास्रलक्षणात् ॥ ९७ ॥
If the feces are black, hard and dry, flatus does not come down, there is pain in the waist, thighs and rectum when there is cause for dryness (by using dry things as foods) then Vata is the secondary Dosha; if the faeces is loose, white or yellow, heavy unctuous, mixed with slimy material, the rectum is static (without movement), when there is cause for unctuousness and heaviness (by using foods of these properties) then Kapha is the secondary Dosha, associated with the symptoms of vitiated blood.

Shodhana and Langhana

दुष्टेऽस्रे शोधनं कार्यं लङ्घनं च यथाबलम् ।
यावच्च दोषैः कालुष्यं स्रुतेस्तावदुपेक्षणम् ॥ ९८ ॥
When the blood is vitiated, purifactory therapy and also fasting and other thinning therapies should be done depending on the strength of the person. Discharge of blood (from the piles) should be neglected (not stopped) till it has signs of vitiation by the Doshas.

Tikta pachana and dipana

दोषाणां पाचनार्थं च वह्निसन्धुक्षणाय च ।
सङ्ग्रहाय च रक्तस्य परं तिक्तैरुपाचरेत् ॥ ९९ ॥
Afterwards the person should be treated with herbs which are bitter, in order to cook / ripen the Dosas, augment the digestive fire and control bleeding.

Snehana

यत्तु प्रक्षीणदोषस्य रक्तं वातोल्बणस्य वा ।
स्नेहैस्तत् साधयेत् युक्तैः पानाभ्यञ्जनबस्ति षु ॥ १०० ॥
Discharge of blood in a person who has great decrease/depletion of the Doshas, or who has great aggravation of Vata, should be treated with fats, (medicated ghee or oil) used in the form of drinking, anointing and enema.

Stambhana Chikitsa

यत्तु पित्तोल्बणं रक्तं घर्मकाले प्रवर्तते ।
स्तम्भनीयं तदेकान्तान्न चेद्वातकफानुगम् ॥ १०१ ॥
When Pitta is aggravated along with Rakta flows in Greeshma Ritu (summer season), then Stambhana treatment (blocking therapy) should be adopted. However, this rule is not applicable if there is association of Vata and Kapha.

Kashaya for Raktaja Arshas associated with Kapha

सकफेऽस्रे पिबेत् पाक्यं शुण्ठीकुटजवल्कलम् ।
किराततिक्तकं शुण्ठीं धन्वयासं कुचन्दनम् ॥ १०२ ॥
दार्वीत्वङ्निम्बसेव्यानि त्वचं वा दाडिमोद्भवाम् ।
When Raktaja Arshas is associated with Kapha Dosha, then decoction prepared with Zingiber officinale, bark of Holarrhena antidysenterica should be consumed kirātatiktakaṃ – Swertia chirata, śuṇṭhīṃ – Zingiber officinale, dhanvayāsaṃ – Alhagi camelorum, kucandanam – variety of Santalum album – sappan, log-wood, dārvī tvak – or decoction prepared with bark of Berberis aristata, nimba – Azadirachta indica, sevya – Vetiveria zizanioides or decoction prepared from tvacaṃ vā dāḍima – fruit skin of Punica granatum

Kutajadi Churna

कुटजत्वक्फलं तार्क्ष्यं माक्षिकं घुणवल्लभाम् ॥ १०३ ॥
पिबेत्तण्डुलतोयेन कल्कितं वा मयूरकम् ।
Powder of bark of Holarrhena antidysenterica, fruit, tārkṣyaṃ – Daru Haridra – Berberis aristata, mākṣikaṃ – honey, ghuṇavallabhām – Aconitum heterophyllum is consumed along with rice washed water or powder of Achyranthes aspera is consumed along with rice washed water.

Kutajadi Leham

तुलां दिव्याम्भसि पचेदार्द्रायाः कुटजत्वचः ॥ १०४ ॥
नीरसायां त्वचि क्वाथे दद्यात् सूक्ष्मरजीकृतान् ।
समङ्गाफलिनीमोचरसान् मुष्ट्यंशकान् समान् ॥ १०५ ॥
तैश्च शक्रयवान् पूते ततो दर्वीप्रलेपनम् ।
पक्त्वाऽवलेहं लीढ्वा च तं यथाग्निबलं पिबेत् ॥ १०६ ॥
पेयां मण्डं पयश्छागं गव्यं वा छागदुग्धभुक् ।
लेहोऽयं शमयत्याशु रक्तातीसारपायुजान् ॥ १०७ ॥
बलवद्रक्तपित्तं च स्रवदूर्ध्वमधोऽपि वा ।
1 tula – 100 pala = 4.8 kg of ārdrāyāḥ kuṭajatvacaḥ – wet bark of Holarrhena antidysenterica is cooked with rain water, till the bark of Holarrhena antidysenterica loses its taste and is filtered. Till the Kutaja loses its taste – It is added with 1 Mushti (1 Pala – 48 grams) of fine powders of samaṅgā – Manjishta – Rubia cordifolia, phalinī – Lagenaria siceraria / Callicarpa macrophylla, mocarasān – and Salmalia malabarica. Indrayava (Seeds of Kutaja – holarrhena antidysenterica) is added equal to the powders of the above three, heating is continued till the content becomes semi solid and sticks to the ladle (Darvi Pralepa). Once confection is prepared, it is consumed, as per digestion strength after its consumption, Peya, Manda, goat milk or cow milk, or the person should have food along with goat milk. This Avaleha pacifies quickly bleeding diarrhea bleeding piles. It is useful in strong bleeding associated with Urdhvaga and Adhoga Raktapitta.

Kutajadi Leham

कुटजत्वक्तुलां द्रोणे पचेदष्टांशशेषितम् ॥ १०८ ॥
कल्कीकृत्य क्षिपेत्तत्र तार्क्ष्यशैलं कटुत्रयम् ।
लोध्रद्वयं मोचरसं बलां दाडिमजं त्वचम् ॥ १०९ ॥
बिल्वकर्कटिकां मुस्तं समङ्गां धातकीफलम् ।
पलोन्मितं दशपलं कुटजस्यैव च त्वचः ॥ ११० ॥
त्रिंशत्पलानि गुडतो घृतात् पूते च विंशतिः ।
तत् पक्वं लेहतां यातं धान्ये पक्षस्थितं लिहन् ॥ १११ ॥
सर्वार्शोग्रहणीदोषश्वासकासान्नियच्छति ।
1 Tula – 4.8 kg of Bark of Kutaja (Holarrhena antidysenterica) is cooked with 1 Drona (12.288 ml) of water, reduced to 1/8^th quantity of water and filtered. It is added with 1 pala – 48 grams of each of paste of tārkṣya – Berberis aristata, kaṭutrayam – Piper longum, Piper nigrum and Zingiber officinale lodhra dvayaṃ – two types of Symplocos racemosa, mocarasaṃ – Salmalia malabarica, balā – Sida cordifolia, dāḍimajaṃ tvacam – fruit bark of Punica granatum, bilva – Aegle marmelos, karkaṭikāṃ – Cucumis sativus / Pistacia chinensis, mustaṃ – Cyperus rotundus, samaṅgāṃ – Rubia cordifolia, dhātakīphalam – fruits of Woodfordia fruticosa, kuṭajasyaiva ca tvacaḥ – bark of Holarrhena antidysenterica is added in quantity of 10 pala (480 grams) 30 pala (1.44 Kg) of jaggery is added and ghee is added 20 pala (960 grams) quantity once confection is prepared, it is kept in the heap of grains for 1 paksha (15 days). It is consumed for sarva arśo – the treatment of all types of hemorrhoids, grahaṇīdoṣa – disorders of duodenum, śvāsa – dyspnea, kāsa – and cough.

Lodhradi Yoga

लोध्रं तिलान् मोचरसं समङ्गां चन्दनोत्पलम् ॥ ११२ ॥
पाययित्वाऽजदुग्धेन शालींस्तेनैव भोजयेत् ।
lodhrā – Symplocos racemoasa, tila – Sesamum indicum, mocarasaṃ – Salmalia malabarica, samaṅga – Rubia cordifolia, candana- Santalum album, utpalam – Nymphaea stellata are administered along with goat milk and for meals, the patient is given cooked rice along goat milk.

Yastyahvadi Yoga

यष्ट्याह्वपद्मकानन्तापयस्याक्षीरमोरटम् ॥ ११३ ॥
ससितामधु पातव्यं शीततोयेन तेन वा ।
yaṣṭyāhva – Glycyrrhiza glabra, padmaka – Prunus cerasoides, anantā – Hemidesmus indicus, payasyā – Impomoea paniculata, kṣīramoraṭam – Marsdenia tenacissima goat’s milk along with sugar candy, honey is administered with cold water.

Lodhradi Yoga

लोध्रकट्वङ्गकुटजसमङ्गाशाल्मलीत्वचम् ॥ ११४ ॥
हिमकेसरयष्ट्याह्वसेव्यं वा तण्डुलाम्बुना ।
lodhra – Symplocos racemosa, kaṭvaṅga – Oroxylum indicum / Ailanthus excela, kuṭaja – Holarrhena antidysenterica, samaṅgā – Mimosa pudica / Rubia cordifolia, śālmalītvacam – bark of Butea monosperma, hima – Santalum album, kesara – Messua ferrea, yaṣṭyāhva – Glycyrrhiza glabra, sevyaṃ vā – Vetiveria zizanioides are administered along with rice washed water.

Yavanyadi Churna

यवानीन्द्रयवाः पाठा बिल्वं शुण्ठी रसाञ्जनम् ॥ ११५ ॥
चूर्णश्चले हितः शूले प्रवृत्ते चाति शोणिते ।
दुग्धिकाकण्टकारीभ्यां सिद्धं सर्पिः प्रशस्यते ॥ ११६ ॥
अथवा धातकीलोध्रकुटजत्वक्फलोत्पलैः ।
सकेसरैर्यवक्षारदाडिमस्वरसेन वा ॥ ११७ ॥
Powder of: yavānī – Trachyspermum ammi, indrayavāḥ – Holarrhena antidysenterica, pāṭhā – Cissampelos pareira, bilvaṃ – Aegle marmelos, śuṇṭhī – Zingiber officinale, rasāñjanam – extract of Berberis aristata is good to take with water to treat pain and excess bleeding, or ghee prepared with dugdhikā – Euphorbia prostrate, kaṇṭakārībhyāṃ – Solanum xanthocarpum is useful for the same purpose or ghee prepared with dhātakī – Woodfordia fruticosa, lodhra – Symplocos racemosa, kuṭajatvak phala – bark and fruits of Holarrhena antidysenterica, utpalaiḥ – Nymphaea stellata sakesarai: – or ghee prepared with Mesua ferrea, alkali of Hordeum vulgare, juice of dāḍima –  Punica granatum.

Sharkaradi Yoga

शर्कराम्भोजकिञ्जल्कसहितं सह वा तिलैः ।
अभ्यस्तं रक्तगुदजान् नवनीतं नियच्छति ॥ ११८ ॥
śarkara – sugar, ambhoja kiñjalka – stamen of lotus taken with butter in meals, as a practice relieves bleeding hemorrhoids, also Sesamum indicum along with butter in meals.  

Good foods and wine for bleeding piles

छागानि नवनीताज्यक्षीरमांसानि जाङ्गलः ।
अनम्लो वा कदम्ल वा सवास्तुकरसो रसः ॥ ११९ ॥
रक्तशालिः सरो दध्नः षष्टिकस्तरुणी सुरा ।
तरुणश्च सुरामण्डः शोणितस्यौषधं परम् ॥ १२० ॥

Butter, ghee, milk of Goat meat from animals of dry land are best for bleeding hemorrhoids not sour or slightly sour, meat soup of animals of dry land along with juice extract of Chenopodium album raktaśāliḥ – red variety of Oryza sativa, supernatant layer of curd, rice harvested in 60 days, sweet wine upper layer of fresh wine is good for bleeding hemorrhoids.

Ideal things for Vataja Raktarshas

पेयायूषरसाद्येषु पलाण्डुः केवलोऽपि वा ।
स जयत्युल्बणं रक्तं मारुतं च प्रयोजितः ॥ १२१ ॥
Drink, thin gruel, soup, meat soup etc. Allium cepa (onion) or the above ones prepared just with onion when administered. It cures aggravated hemorrhoids associated with vitiated blood afflicted by vata dosha.

Controlling Vata and bleeding in bleeding hemorrhoids

वातोल्बणानि प्रायेण भवन्त्यस्रेऽतिनिःसृते ।
अर्शांसि तस्मादधिकं तज्जये यत्नमाचरेत् ॥ १२२ ॥
When there is severe bleeding in haemorrhoids, it may lead to Vata aggravation. Hence, in case of bleeding hemorrhoids, special efforts should be put to control bleeding and Vata Dosha.

Indication of coolant measures

दृष्ट्वाऽस्रपित्तं प्रबलमबलौ च कफानिलौ ।
शीतोपचारः कर्तव्यः सर्वथा तत्प्रशान्तये ॥ १२३ ॥
After observing severe bleeding disorders and weak Kapha and Vata, one should resort to coolant measures always to pacify that condition.

Tarpana and Avapeedaka

न चेदेवं शमस्तस्य स्निग्धोष्णैस्तर्पयेत्ततः ।
रसैः कोष्णैश्च सर्पिर्भिरवपीडकयोजितैः ॥ १२४ ॥
सेचयेत्तं कवोष्णैश्च कामं तैलपयोघृतैः ।
When the bleeding hemorrhoids do not heal, nourishing therapy should be done using unctuous and hot meat soups luke-warm ghee should be used in avapeedaka manner (in maximum dose at the end of digestion of meal of both the mid-day and night) sechana (pouring / showering) should be done according to the requirement with lukewarm oil, milk or ghee.

Pichcha Basti

यवासकुशकाशानां मूलं पुष्पं च शाल्मलेः ॥ १२५ ॥
न्यग्रोधोदुम्बराश्वत्थशुङ्गाश्च द्विपलोन्मिताः ।
त्रिप्रस्थे सलिलस्यैतत्क्षीरप्रस्थे च साधयेत् ॥ १२६ ॥
क्षीरशेषे कषाये च तस्मिन् पूते विमिश्रयेत् ।
कल्कीकृतं मोचरसं समङ्गां चन्दनोत्पलम् ॥ १२७ ॥
प्रियङ्गुं कौटजं बीजं कमलस्य च केसरम् ।
पिच्छाबस्ति रयं सिद्धः सघृतक्षौद्रशर्करः ॥ १२८ ॥
प्रवाहिकागुदभ्रंशरक्तस्रावज्वरापहः ।
kuśa – Desmostachya bipinnata, kāśa – Saccharum spontaneum, root and flower of śālmaleḥ Bombax ceiba śuṅgāśca – and tender shoots of nyagrodha – Ficus benghalensis, udumbara – Ficus racemosa, aśvattha – Ficus religiosa, are cooked with 3 prastha (2.304 liters) of water and 1 prastha (768 ml) of milk, when only the milk remains while heating, it is filtered, and mixed with paste of 3-12 grams of mocarasaṃ – Salmalia malabarica, samaṅgāṃ – Rubia cordifolia, candana – Santalum album, utpalam – Nymphaea stellata, priyaṅguṃ – Callicarpa macrophylla, seeds of Holarrhena antidysenterica and stamen of lotus, mixed with ghee, honey and sugar, this preparation Picchabasti (slimy enema) pravāhikā – cures dysentery, gudabhraṃśa – rectal prolapse, raktasrāva – rectal bleeding and jvarā – fever.

Anuvasana Basti

यष्ट्याह्वपुण्डरीकेण तथा मोचरसादिभिः ॥ १२९ ॥
क्षीरद्विगुणितः पक्वो देयः स्नेहोऽनुवासनम् ।
yaṣṭyāhva – Glycyrrhiza glabra, puṇḍarīkeṇa – Nelumbo nucifera Salmalia malabarica and other herbs (mentioned in verse 127) made into paste, cooked with double the quantity of cow’s milk is used for oil enema.

Madhukadi Ghrita

मधुकोत्पललोध्राम्बु समङ्गा बिल्वचन्दनम् ॥ १३० ॥
चविकातिविषा मुस्तं पाठा क्षारो यवाग्रजः ।
दार्वीत्वङ्नागरं मांसी चित्रको देवदारु च ॥ १३१ ॥
चाङ्गेरीस्वरसे सर्पिः साधितं तैस्त्रिदोषजित् ।
अर्शोऽतीसारग्रहणीपाण्डुरोगज्वरारुचौ ॥ १३२ ॥
मूत्रकृच्छ्रे गुदभ्रंशे वस्त्यानाहे प्रवाहणे ।
पिच्छास्रावेऽर्शसां शूले देयं तत्परमौषधम् ॥ १३३ ॥
madhuka – Glycyrrhiza glabra, utpala – Nymphaea stellata, lodhra – Symplocos racemosa, ambu – Pavonia odorata, Acorus calamus, samaṅgā – Rubia cordifolia, Mimosa pudica, bilva – Aegle marmelos, candanam – Santalum album, cavikā – Piper retrofractum, ativiṣā – Aconitum heterophyllum, mustaṃ – Cyperus rotundus, pāṭhā – Cissampelos pareira, kṣāro yavāgrajaḥ – alkali of whole plant of Hordeum vulgare, dārvītvak – bark of Berberis aristata, Zingiber officinale, māṃsī – Nardostachys jatamansi, citraka – Plumbago zeylanica, devadāru – Cedrus deodara, juice of cāṅgerī – Oxalis corniculata, ghee prepared with the above ingredients destroys all three doshas, it is the best medicine for arśa – haemorrhoids, atīsāra – diarrhea / dysentery, grahaṇī – duodenal disorders, pāṇḍuroga – anemia, jvara – fever, arucau – anorexia, mūtrakṛccha – dysuria, gudabhraṃśa – rectal prolapse, asti – urinary bladder disorder, ānāhe – bloating, pravāhaṇe – dysentery, picchāsrāve – slimy discharges, arśasāṃ – hemorrhoids, śūla – pain (colic) in these conditions it should be given, it is the best medicine.

Vyatyasa Chikitsa

व्यत्यासान्मधुराम्लानि शीतोष्णानि च योजयेत् ।
नित्यमग्निबलापेक्षी जयत्यर्शःकृतान् गदान् ॥ १३४ ॥
In patients seeking improvement of digestion strength, should be administered daily with sweet and sour herbs, cold and hot herbs alternatively this helps to win against haemorrhoids and (haemorrhoids) related diseases.

Varti: Suppository

उदावर्तार्तमभ्यज्य तैलैः शीतज्वरापहैः ।
सुस्निग्धैः स्वेदयेत्पिण्डैर्वर्तिमस्मै गुदे ततः ॥ १३५ ॥
अभ्यक्तां तत्कराङ्गुष्ठसन्निभामनुलोमनीम् ।
दद्याच्छ्यामात्रिवृद्दन्तीपिप्पलीनीलिनीफलैः ॥ १३६ ॥
विचूर्णितैर्द्विलवणैर्गुडगोमूत्रसंयुतैः ।
तद्वन्मागधिकाराठगृहधूमैः ससर्षपैः ॥ १३७ ॥
For the person suffering with Udavarta, massage should be done with oil which is used to treat Sheetajvara. To the person given with proper oleation (unctuousness therapy, massage) Pinda Sweda (bolus fomentation / sudation) is given. After this, the anal region is given massage and Varti (suppository) is prepared similar to the finger (size of the thumb), and is administered. The varti should be prepared with laxative herbs such as: śyāmā – Ipomoea turpethum, trivṛt – Operculina turpethum, dantī – Baliospermum montanum, pippalī – Piper longum, nīlinī phalaiḥ – Indigofera tinctoria, powdered rock salt and black salt guḍa – jaggery and urine of cow, similarly varti (suppository) prepared with māgadhikā – Piper longum, rāṭha – Randia dumetorum, gṛhadhūma – Gruhadhuma (soot), sasarṣa – Brassica alba

Churna vinirdhamana

एतेषामेव वा चूर्णं गुदे नाड्या विनिर्धमेत् ।
Or, the same herbs are made into powder and blown through a pipe into anal region.

Churna vinirdhamana

तद्विघाते सुतीक्ष्णं तु वस्तिं स्निग्धं प्रपीडयेत् ॥ १३८ ॥
ऋजूकुर्याद्गुदसिराविण्मूत्रमरुतोऽस्य सः ।
भूयोऽनुबन्धे वातघ्नैर्विरेच्यः स्नेहरेचनैः ॥ १३९ ॥
अनुवास्यश्च रौक्ष्याद्धि सङ्गो मारुतवर्चसोः ।
If administration of powder fails, then Teekshna basti (strong enema) with Sneha (fats) should be administered. This releases Vata Dosha obstructed in veins of anal region, feces and urine. Sneha virechana or virechana with Vata balancing herbs, once again followed by Anuvasana Basti is administered. Due to dryness, there will be obstruction of flatus and feces.

Kalyanaka Kshara

त्रिपटुत्रिकटुश्रेष्ठादन्त्यरुष्करचित्रकम् ॥ १४० ॥
जर्जरं स्नेहमूत्राक्तमन्तर्धूमं विपाचयेत् ।
शरावसन्धौ मृल्लिप्ते क्षारः कल्याणकाह्वयः ॥ १४१ ॥
स पीतः सर्पिषा युक्तो भक्ते वा स्निग्धभोजिना ।
उदावर्तविबन्धार्शोगुल्मपाण्डूदरकृमीन् ॥ १४२ ॥
मूत्रसङ्गाश्मरीशोफहृद्रोगग्रहणीगदान् ।
मेहप्लीहरुजानाहश्वासकासांश्च नाशयेत् ॥ १४३ ॥
Three kinds of salt i.e. rock salt, black salt and bida salt, trikaṭu – Piper longum, Piper nigrum and Zingiber officinale, śreṣṭhā – Aquilaria agallocha, dantī – Baliospermum montanum, aruṣkara – Semecarpus anacardium, citrakam – Plumbago zeylanica, are ground together, mixed with equal quantities of: fat (ghee or oil) and urine of cow, taken in a pan (mud crucible) and covered with other pan and the junction of pans sealed with mud, is subjected to heat by concealed heating (method), thus obtained alkali is called Kalyanaka Ksara, when it is consumed along with ghee or when it is consumed along with unctuous meal, udāvarta – bloating, vibandha – constipation, arśo – haemorrhoids, gulma – abdominal tumor, pāṇḍu – anemia, udara – ascites, kṛmi – intestinal worm infestation, mūtrasaṅga – difficulty in urination, aśmarī – urinary calculi,  śopha – inflammation, hṛdroga – cardiac disorders, grahaṇīgada – duodenal disorders (irritable bowel syndrome, sprue), meha – diabetes, plīha – splenic disorders, ruja – colic, ānāha – gaseous distension of abdomen, śvāsa – difficulty in breathing (dyspnea), kāsa – and cough destroys (cures) all these diseases

Treatment of gadha varcha arshas

सर्वं च कुर्याद् यत् प्रोक्तमर्शसां गाढवर्चसाम् ॥ १४४अब् ॥
All the measures told to treat Hemorrhoids associated with hard feces, all those measures should be followed here.

Putikaranjadi Yoga

द्रोणेऽपां पूतिवल्कद्वितुलमथ पचेत्पादशेषे च तस्मिन् ॥ १४४च् ॥
देयाऽशीतिर्गुडस्य प्रतनुकरजसो व्योषतोऽष्टौ पलानि ॥ १४४द् ॥
एतन्मासेन जातं जनयति परमामूष्मणः पक्तिशक्तिं ॥ १४४ए ॥
शुक्तं कृत्वाऽऽनुलोम्यं प्रजयति गुदजप्लीहगुल्मोदराणि ॥ १४४f ॥
In one drona (12.288 liters) of water atha pacet – is cooked with 2 tula (9.6kg) of Caesalpinia bonduc, once the quantity of water is reduced to a quarter (one fourth), 80 pala (3.840 kg) of jaggery is added to it 8 pala (384 grams) of Piper longum, Piper nigrum and Zingiber officinale is added to it, in fine powder form. This undergoes a kind of acidic fermentation in one month and generates very good heat and digestion strength restores downward movement of Vata in the gut, gudaja – wins over hemorrhoids, plīha – splenomegaly, gulma – abdominal tumour and udara – ascites.

Chukra Prayoga

पचेत्तुलां पूतिकरञ्जवल्काद्द्वे मूलतश्चित्रककण्टकार्योः ।
द्रोणत्रयेऽपि चरणावशेषे पूते शतं तत्र गुडस्य दद्यात् ॥ १४५ ॥
पलिकं च सुचूर्णितं त्रिजातत्रिकटुग्रन्थिकदाडिमाश्मभेदम् ।
पुरपुष्करमूलधान्यचव्यं हपुषामार्द्रकमम्लवेतसं च ॥ १४६ ॥
शीतीभूतं क्षौद्रविंशत्युपेतमार्द्रद्राक्षाबीजपूरार्द्रकैश्च ।
युक्तं कामं गण्डिकाभिस्तथेक्षोः सर्पिःपात्रे मासमात्रेण जातम् ॥ १४७ ॥
चुक्रं क्रकचमिवेदं दुर्नाम्नां वह्निदीपनं परमम् ।
पाण्डुगरोदरगुल्मप्लीहानाहाश्मकृच्छ्रघ्नम् ॥ १४८ ॥
1 Tula (4.8 Kg) of Caesalpinia bonduc 2 tula (9.6 Kg) of roots of citraka – Plumbago zeylanica, kaṇṭakāri – Solanum xanthocarpum are cooked 3 Drona (36.864 liters) of water, is cooked till the water quantity reduces to a quarter, it filtered and added with 100 pala (4.8 kg) of Jaggery. It is further added with fine powders of 1 pala (48 grams) of each of: trijāta – Cinnamomum zeylanicum, Cinnamomum tamala and Elettaria cardamomum, trikaṭu – Piper longum, Piper nigrum and Zingiber officinale, granthika – root of Piper longum, dāḍima – Punica granatum, aśmabhedam – Bergenia ligulata, pura – Commiphora mukul, puṣkaramūla – Inula racemosa, dhānya – Coriandrum sativum, cavyaṃ – Piper retrofractum, hapuṣāṃ – Juniperus communis, ārdrakaṃ – Zingiber officinale, amlavetasaṃ ca – and Garcinia pedunculata, Once it cools down, honey is added in 20 pala (960 grams) quantity. It is further added with fresh Vitis vinifera, bījapūra – Citrus medica, ārdraka – and Zingiber officinale, gaṇḍikābhi: tathekṣoḥ – Ikshu Gandika (knots on Saccharum officinarum), this is taken in a vessel coated with ghee, it is kept sealed for a month to prepare a fermented product called Chukra, which is just like a saw for haemorrhoids. It greatly improves digestive fire, cures pāṇḍu – cures anemia, gara – chronic poisoning, udara – ascites, gulma – abdominal tumor, plīha – splenomegaly, ānāha – distension of abdomen, aśma – urinary calculi and कृच्छ्रघ्नम् – kṛcchraghnam – dysuria.

Pilvadi Yoga

द्रोणं पीलुरसस्य वस्त्रगलितं न्यस्तं हविर्भाजने ॥ १४९अ ॥
युञ्जीत द्विपलैर्मदामधुफलाखर्जूरधात्रीफलैः ॥ १४९ब् ॥
पाठामाद्रिदुरालभाम्लविदुलव्योषत्वगेलोल्लकैः ॥ १४९च् ॥
स्पृक्काकोललवङ्गवेल्लचपलामूलाग्निकैः पालिकैः ॥ १४९द् ॥
गुडपलशतयोजितं निवाते निहितमिदं प्रपिबंश्च पक्षमात्रात् ।
निशमयति गुदाङ्कुरान् सगुल्मान् अनलबलं प्रबलं करोति चाशु ॥ १५० ॥
The fruit juice of Salvadora persica filtered through cloth, is taken in 1 Drona (12.288 liters) quantity put in a vessel smeared with ghee. It is added with 2 pala (96 grams) of each of madā – Woodfordia fruticosa, madhuphalā – Vitis vinifera, kharjūra – Phoenix dactylifera, dhātrīphala – Emblica officinalis, pāṭhā – 1 pala (48 grams) each of Cissampelos pareira, mādri – Vitex agnus-castus, durālabhā – Fagonia cretica, amlavidula – Garcinia pedunculata, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, tvak – Cinnamomum zeylanica, ela – Elettaria cardamomum, ullaka – Picrorhiza kurroa, spṛkkā – Anisomeles malabarica, kola – Ziziphus jujube, lavaṅga – Syzygium aromaticum, vella – Embelia ribes, capalāmūla – roots of Piper longum, agnika – Plumbago zeylanica, pālika – Linum usitatissimum, jaggery is taken in 100 pala quantity (4.8 Kg). This mix is kept in a place devoid of movement of air and this should be consumed after 15 days. It is useful in treating gudāṅkurān – haemorrhoids, gulma – abdominal tumors, strengthens digestion strength very quickly.

Dashamuladi Guda

एकैकशो दशपले दशमूलकुम्भपाठाद्वयार्कघुणवल्लभकट्फलानाम् ।
दग्धे स्रुतेऽनु कलशेन जलेन पक्वे पादस्थिते गुडतुलां पलपञ्चकं च ॥ १५१ ॥
दद्यात् प्रत्येकं व्योषचव्याभयानां वह्नेर्मुष्टी द्वे यवक्षारतश्च ।
दर्वीमालिम्पन् हन्ति लीढो गुडोऽयं गुल्मप्लीहार्शःकुष्ठमेहाग्निसादान् ॥ १५२ ॥
10 pala (480 grams) each of, daśamūla – group of 10 roots, kumbha – Baliospermum montanum, pāṭhā dvaya – Patha and Raja Patha (Cissampelos pareira and Cyclea peltata), arka – Calotropis gigantea, ghuṇavallabha – Operculina turpethum, kaṭphalānām – Myrica nagi, the above are burnt in open air and filtered. It is boiled in 1 Drona (12.288 liters) of water, reduced to a quarter and added with 1 tula (4.8 Kg) of jaggery, 5 pala (240 grams) each of: should be given separately vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, cavya – Piper retrofractum, abhaya – Terminalia chebula, 2 pala (96 grams) of Plumbago zeylanica and 2 pala (96 grams) of alkali of Hordeum vulgare, a semisolid preparation which adheres to the ladle, this jaggery preparation when licked, destroys gulma – abdominal tumor, plīha – splenomegaly, arśaḥ – haemorrhoids, kuṣṭha – skin diseases, meha – urinary tract diseases / diabetes, agnisāda – and weak digestion strength,

Chitrakadi Leham

तोयद्रोणे चित्रकमूलतुलार्धं साध्यं यावत्पाददलस्थमथेदम् ।
अष्टौ दत्त्वा जीर्णगुडस्य पलानि क्वाथ्यं भूयः सान्द्रतया सममेतत् ॥ १५३ ॥
त्रिकटुकमिशिपथ्याकुष्ठमुस्तावराङ्गकृमिरिपुदहनैलाचूर्णकीर्णोऽवलेहः ।
जयति गुदजकुष्ठप्लीहगुल्मोदराणि प्रबलयति हुताशं शश्वदभ्यस्यमानः ॥ १५४ ॥
1 drona (12.288 liters) of water is heated along with half tula (2.4 Kg) of citraka – Plumbago zeylanica, till the water quantity reduces to a quarter. It is added with 8 pala (384 grams) of old jaggery. It is heated till it gains a semisolid consistency. It is added with a total of 192 grams of trikaṭuka – Piper longum, Piper nigrum and Zingiber officinale, miśi – Foeniculum vulgare, pathyā – Terminalia chebula, kuṣṭha – Saussurea lappa, mustā – Cyperus rotundus, varāṅga – Cinnamomum zeylanicum, kṛmiripu – Embelia ribes, dahana – Plumbago zeylanica, powder of elā – Elettaria cardamom and the resultant confection cures gudaja – hemorrhoids, kuṣṭha – skin diseases, plīha – splenomegaly, gulma – abdominal tumor, udara – ascites and improves digestion, when consumed by practice regularly

Vyoshadi Gutika

गुडव्योषवरावेल्लतिलारुष्करचित्रकैः ।
अर्शांसि हन्ति गुटिका त्वग्विकारं च शीलिता ॥ १५५ ॥
A tablet prepared with: jaggery, vyoṣa – Piper longum, Piper nigrum and Zingiber officinale, varā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, vella – Embelia ribes, tila – Sesamum indicum, aruṣkara – Semecarpus anacardium, citrakaiḥ – Plumbago zeylanica, if used regularly, it cures: arśāṃsi – haemorrhoids tvak vikāraṃ ca – and skin diseases.

Use of Surana

मृल्लिप्तं सौरणं कन्दं पक्त्वाऽग्नौ पुटपाकवत् ।
अद्यात् सतैललवणं दुर्नामविनिवृत्तये ॥ १५६ ॥
Tuber of Amorphophallus campanulatus is coated with mud, and is heated on fire similar to putapaka (concealed heating in crucible), mixed with sesame oil and rock salt, and used in the treatment of chronic haemorrhoids.

Marichadi Guda       

मरिचपिप्पलिनागरचित्रकान् क्रमविवर्धितभागसमाहृतान् ।
शिखिचतुर्गुणसूरणयोजितान् कुरु गुडेन गुडान् गुदजच्छिदः ॥ १५७ ॥
marica – Piper nigrum, pippali – Piper longum, nāgara – Zingiber officinale, citrakān – and Plumbago zeylanica are taken in increasing parts, four times of śikhi – Plumbago zeylanica i.e. 16 parts is Amorphophallus campanulatus, is added with 16 times jaggery and tablets prepared, this is useful in haemorrhoids.

Suranadi Pindi          

चूर्णीकृताः षोडश सूरणस्य भागास्ततोऽर्धेन च चित्रकस्य ।
महौषधाद्द्वौ मरिचस्य चैको गुडेन दुर्नामजयाय पिण्डी ॥ १५८ ॥
16 parts of fine powder of sūraṇa – Amorphophallus campanulatus, 8 parts of citrakas – Plumbago zeylanica, 2 parts of mahauṣadhāt – Zingiber officinale, 1 part of marica – Piper nigrum are added with jaggery and large tablets are prepared, it is useful in curing chronic durnām – haemorrhoids

Pathyadi Churna

पथ्यानागरकृष्णाकरञ्जवेल्लाग्निभिः सितातुल्यैः ।
वडवामुख इव जरयति बहुगुर्वपि भोजनं चूर्णः ॥ १५९ ॥
pathyā – Terminalia chebula, nāgara – Zingiber officinale, kṛṣṇā – Piper longum, karañja – Pongamia pinnata, vella – Embelia ribes, agni – Plumbago zeylanica are taken in 1 part each, sugar is taken equal to the powders (and mixed), this powder (formulation) just like the forest fire (consumes the entire forest), digests even very heavy-to-digest foods.

Kalingadi Guda

कलिङ्गलाङ्गलीकृष्णावह्न्यपामार्गतण्डुलैः ।
भूनिम्बसैन्धवगुडैर्गुडा गुदजनाशनाः ॥ १६० ॥
kaliṅga – Holarrhena antidysenterica, lāṅgalī – Gloriosa superba, kṛṣṇā – Piper longum, vahni – Plumbago zeylanica, apāmārga taṇḍula – seeds of Achyranthes aspera, bhūnimba – Andrographis paniculata, saindhava – rock salt, fine powder of the above is mixed with jaggery and tablets are prepared, this formulation cures gudaja – hemorrhoids.

Lavanottamadi Churna

लवणोत्तमवह्निकलिङ्गयवांश्चिरिबिल्वमहापिचुमन्दयुतान् ।
पिब सप्तदिनं मथितालुडितान् यदि मर्दितुमिच्छसि पायुरुहान् ॥ १६१ ॥
lavaṇa uttama – rock salt, vahni – Plumbago zeylanica, kaliṅga – Holarrhena antidysenterica, yava – Hordeum vulgare, ciribilva – Holoptelea integrifolia, mahāpicumanda – Melia Azadirachta. It is consumed for seven days, mixed with luḍitān – buttermilk who desire to get rid of pāyuruha – hemorrhoids.

Use of Bhallataka, Kutaja and Kalasheya

शुष्केषु भल्लातकमग्र्यमुक्तं भैषज्यमार्द्रेषु तु वत्सकत्वक् ।
सर्वेषु सर्वर्तुषु कालशेयमर्शःसु बल्यं च मलापहं च ॥ १६२ ॥
In case of Shushka Arsha (dry haemorrhoids), bhallātakaṃ – Semecarpus anacardium is considered best herb. In the case of Ardra Arsha (wet haemorrhoids), the best herb is vatsaka tvak – bark of Holarrhena antidysenterica. In all types of haemorrhoids, in all seasons, a variety of buttermilk, prepared without adding water, and devoid of cream – is best which improves strength and eases bowel movement.

Principles for using ideal foods and drinks in piles

भित्त्वा विबन्धाननुलोमनाय यन्मारुतस्याग्निबलाय यच्च ।
तदन्नपानौषधमर्शसेन सेव्यं विवर्ज्यं विपरीतमस्मात् ॥ १६३ ॥
The food and drinks that help to break down the fecal matter and Maruta Anulomana – normalizes Vata movement, which strengthens digestive fire, such foods, drinks and medicines should be consumed in case of haemorrhoids. The foods, drinks and medicines opposite to the above functions should be avoided.

Importance of protecting the digestive fire in piles and other disorders

अर्शोऽतिसारग्रहणीविकाराः प्रायेण चान्योऽन्यनिदानभूताः ।
सन्नेऽनले सन्ति न सन्ति दीप्ते रक्षेदतस्तेषु विशेषतोऽग्निम् ॥ १६४ ॥
arśa – In case of hemorrhoids, atisāra – diarrhea, grahaṇī vikārāḥ ca – duodenal disorders and such other diseases are probably caused due to depleted digestive fire, diseases will not manifest when the digestive fire is strong. Hence, agni should be protected in such conditions with special effort

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थानेऽर्शचिकित्सितं नामाष्टमोऽध्याय: ॥ ८॥
Thus, ends the chapter, arshacikitsita – the eighth in cikitsita sthana in astanga hrdaya samhita, composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.