J.R.A.S. Vol. XXXI, No.1, Jan.-March 10pp. 29-46

EVALUATION OF AYURVEDIC THERAPYFORARSHA (HAEMORROIDS)

MANAGEMENT - A THERAPEUTIC STUDYM.Mruthyumjaya Rao I, Anukul Chandra Kar 2, P.Bhattacharya J

and Jayram Hazra 4

(Received on 03-07-2007)

Abstract

In order to evaluate the efficacy of different drug combinations for themanagement of Arsha, a randomized single blind clinical study was carried out in threedifferent groups at Ano-Rectal Clinic, Central Research Institute (Ay.), Kolkata duringthe periodfrom May 1999 to March 2004. This trial was conducted on 659 patients ofArsha as per the proforma designed by CCRA S, New Delhi

III group -1, outo{247 cases, 42.91 percent patients got complete relief,"27.12percent patients got marked relief," 10.93 percent patients got moderate relief," 4.04percent patients got mild relief, 1.61 percent patients got No reliefwhile 13.36 percentpatients were dropped out.

III group - 2, out of230 cases, 37.39 percent cases got complete relief,"26J)8percent got marked relief,' 14.78 percent got moderate reliefand 6.52 percent got mildrelief,'while 15.21 percent of.cases were dropped out.

III group - 3, Out of 182 cases, 32.96 percent cases got complete relief,' 29.12percent got marked relief," 20.32 percent got moderate relief,' 1.09 percent got mildrelief,"0.54 percent go No reliefwhile 15.93 percent were dropped out. After analyzingthe results it was observed that the differences in the improvement among the threegroups were minimal and negligible and hence it is concluded that the drugcombination o{all the groups are similarly effective in the management ofArsha.

l.Asst.Director (Ay.) Central Research Institute(Ay.) Unit-I, Bhubaneswar, 2.Research Officer(Ay.) CCRAS, New Delhi,3.Research Officers (Ay.) & 4,AssistDirector I/C, Central Research Institute CAy.)Kolkata.

29

M. Mruthyumjaya Rao et al.

Introduction

Piles, or Haemorrhoids, are areas inthe anal canal where the tissue, whichcontains lots of blood vessels, hasbecome swollen. Piles are common inpregnant women, but are rare in children.

The exact cause of piles iscontroversial but it may be linked toexcess pressure in the anus and lowerrectum.

This pressure can have one or moreof several different causes:

• Straining to empty the bowels whenconstipated.

• Chronic diarrhoea.

• Pregnancy - the weight of the foetuson the abdomen and the increasedblood flow, as well as the effect ofhormones on the blood vessels.

• Childbirth - pushing duringchildbirth increases the pressure inthe veins.

• Straining to pass urine, especially inmen with prostate problems.

• Cancer or growths in the pelvis orbowel, which may exert pressure in asimilar way to a pregnancy. ¢ Fam iIYhistory - piles can run in families andare potentially hereditary, perhapsbecause of weak veins in the analarea.

• Obesity.

• Varicose veins-many people withthese also develop piles, althoughpiles are not varicose veins.

They can be internal, occurringinside the anus, or external, when theycan be seen and felt on the outside of theanus. When visible they look like roundpink swellings, the size of a pea or agrape. They are classified according totheir position. First-degree piles remaininside the rectum or anal canal. Second-degree piles protrude (or prolapse) fromthe anus when the bowels are opened, butreturn of their own accord afterwards.Third-degree piles are similar, but onlyreturn inside when pushed back. Fourth-degree piles hang permanently outsidethe anus.

Most people affected have internalpiles and may not have any symptoms atall. The earliest symptom is oftenbleeding offresh, red blood from the analpassage when the bowels are opened.There may be itching around the analarea. Third and fourth degree piles maybe more painful and tend to produce aslimy discharge of mucous that leaksfrom the exposed lining of the pile.

The patients who complain of pilesmay have one or more of a number ofindividual problems, that no singletreatment method can be advised for allpatients and that several differentmethods may achieve actually goodresult. Their size, shape and details ofanatomical configuration vary in thepopulation who do not complain of anylocal problems. But any classification ofclinical disease must be based onpatients' symptoms assigning from orcaused by ill defined derangement ofanal canal function.

30

EVALUATION OF AYURVEDIC .

Since the Haemorroids problem isnot a threat to life excepting fewconditions, the least invasiveprocedure/treatment is most desirable.Several cal/conventional therapies arenow in practice depending uponcondition of Haemorroids likesclerotherapy, rubber band ligation, analdilatation, photo coagulation,cryosurgery, Haemorroidectomy etc.This increasing number of therapiesthemselves proves that there is nouniversally acceptable technique in themanagement ofHaemorroids.

Sushruta (800 B.C.), the father ofancient surgery, has described 'Arsha'one among of the Mahagadas andmethodologically classified the disease,and recommended different drugregimens, which are widely acceptableand practicable even today.

They areAushadha Chikitsa (Employment ofmedicinal remedies)

Kshara Chikitsa (Application of Kshara(alkali) i.e. chemical cauterization).

Agnikarma (Thermal cauterization)

Sashtrakarma (Surgical management).

Out of four therapeutic regimens, theKshara & Agni Karmas are regarded aspara-surgical procedures, which can becarried out without much preparation. InSushrut Samhita, we can also see someexternal applications apart from someoral remedies.

Based on the treatment descriptionsgiven by Sushruta, the present drugregimen is kept on trial on 724 patientsselected as per the selection / exclusioncriteria laid down by the Council and theresults were analyzed and assessed onvarious parameters.

Material and MethodsThe study was conducted at Ano-

rectal clinic ofC.R.I.(Ay.), Kolkata usingspecially devised protocol & proforma,designed as per both Ayurvedic andmodem parameters. Essentially, the trialaimed to evaluate an effective Ayurvedicdrug combination in terms of the daystaken to check the bleeding as well asalleviation of associated symptoms andto see the recurrence of bleeding & othersymptoms even after complete healing.

A) Selection of cases: A total no. of659 patients with complains of bleedingper rectum during andlor after thedefecation with or without othersymptoms like, itching, discharge,constipation, with lor without pain wereexamined per-rectally and confirmed byproctoscopic examination were admittedfor the study. The cases of strangulatedpile masses, and Haemorroids associatedwith malignancy were excluded from thestudy. The cases were randomly selectedirrespective of age, sex, chronicity,Prakriti and type of Haemorroids andfollow-up was made at interval of7 daysduring the study period of 21 days and atinterval of 15 days up to 6 weeksthereafter.

31

M Mruthyumjaya Rao et al.

B. Drug

Group- I

Ka s e e sa d i Taila-IO ml to beadministered per rectally half an hour

before defaeeation daily once in the

morning with the help of syringe andplain rubber catheter no. 7.

Kankayana Vati - 500 mg. daily three

times with warm water after food.

Triphala Churna - 5 gm. at bed time withwarm water.

Group- II

Kas e e sa d i Taila-IO ml to beadministered per rectally half an hour

before defaecation daily once in themorning with the help of syringe and

plain rubber catheter no. 7.

Kravyadi Rasa - 500 mg. daily three

times with warm water after food.

Triphala Churna -5 gm. at bed time withwarm water.

Group-III

Kaseesadi Tail a - 10 ml to be

administered per rectally half an hourbefore defaecation daily once in themorningwiththehelpofsyringe and

plain rubber catheter no. 7.

Kankayana Vati - daily three times with

warm water after food.

Kravyadi Rasa - daily three times with

warm water after food.

Abhayarishtam - 25 ml twice daily withluke warm water

Triphala Churna -5 gm. at bed time with

warm water.

C. Diet To be taken: Ghee, milk, riceand plenty ofliquids.

To avoid: Non-veg. and spicy foods.

D. Criteria adopted for assessment ofthe response oftherapy

Since the bleeding is the mamsymptom in the bleeding haemorrhoids,

the days taken to arrest the bleeding is

noted along with alleviation of otherassociated symptoms and the result wasassessed in the following manner.

Complete relief - when the bleeding is

checked completely within 7 days oftherapy and complete disappearance of

associated symptoms if any and norecurrence up to 6 weeks of the follow-

up.

Marked relief - When the bleeding is

checked after 7 days but Before 14 daysof therapy and complete disappearanceof associated symptoms if any and no

recurrence up to 6 weeks of the follow

up.

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EVALUATION OF AYURVEDIC .

Moderate relief -Arrest of bleeding after14days but before 21 days of the therapyand complete disappearance ofassociated symptoms if any and norecurrence up to 6 weeks of follow-up.

Mild relief - Arrest of bleeding after 21days but before 30 days and completedisappearance of associated symptoms ifany and no recurrence up to 6 weeks offollow-up.

No relief - No checking of blood before30 days or checked after 30 days and/orrecurrence even after completerecovery from the symptoms.

Drop out/LAMA

1. Discontinuation of the treatmentduring the trial

2. Development of any seriouscomplications.

3. Aggravation of the disease.

Results / Conclusions

a) Condition of patients on admission:(Summarized in table -I)

A. Out of 659 patients admitted forclinical trial, 490 (74.35%) weremales and 169 (25.64%) werefemales. Maximum number of (169)patients belong to the age group of31 - 40 yrs while minimum of 75cases belong to below 20 yrs.

B. Out of 659 cases about 54.32 percentof patients reported to be of PittaPrakriti, about 36.87 percent of Vata

Prakriti while minimum of about 8.8percent of Kapha Prakriti.

C. About 82.09 percent of patients hadconstipated bowel habits which isthe main reason for the bleeding perrectum in those cases whileminimum of about 8.34 percent hadregular bowel habits.

D. Among 659 cases about 95.29percent were non - vegetarians whileremaining were vegetarians.

b) The characteristic of Arsha /Haemorroids on admission:(Summarized in Table- II).a) About 56.29 percent of patients had

the disease for at least one year whileminimum number of patients(5.46%) had the duration of illnessabove three yrs. and 48 percentpatients had acute onset.

b) About 9.3 percent of patients hadprevious history of anal surgery;about 57.96 percent of patients hadtaken medicines for this purposewhile 32.77 percent of cases werereported as afresh.

c) The type of Haemorroids wasrecorded maximum as internal inabout 57.05 percent of patients whileminimum number of cases (8.64%)was found with external type ofHaemorroids A maximum no. of32.16 percent of Arsha was found tobe of Pittaja type followed byRaktajaa with the incidence of about20.78 percent while minimum

33

M. Mruthyumjaya Rao et at.

number (4.4%) found to be of Sahajaa type ofArshas.

e) About 56.60 percent ofhaemorroidswas positioned at 3° clock followedby 11°, 5° & 7° clock positions withthe incidences of 46.73 %,44.15% &35.96 % respectively.

c) Clinical findings noticed onadmission (Summarized in Table - III)

All patients had bleeding per rectumand Prolapse in 37.32 percent, 37.32percent had pruritis, 63.27 percent haddiscomfort at peri-anal region, 23.52percent had pain during/after defecation,and 34.59 percent had mucous discharge.

d) Haemoglobin levels recorded onadmission (Summarized in Table - IV)

In Group-lAbout 29.14 percent had the mean

hemoglobin of 6.5 gm%., about 63.15percent had the mean Hb% of 9.8 gm%percent while remaining patients(7.69%) had either mild anemia ornormal level of hemoglobin with mean of11.5 gm%. About 41.7 percent hadmoderate bleeding, about 34.81 percentand 23.48 percent had mild and profusebleeding per rectum respectively.

InGroup-2About 12.14 percent had the mean

hemoglobin of 6.8 gm%, about 49.56percent had the mean Hb% of 8.5 gm%percent while remaining patients(38.69%) had either mild anemia ornormal level of hemoglobin with mean of10.8 gm%. About 60.43 percent had

moderate bleeding; about 9.13 percentand 30.43 percent had mild and profusebleeding per rectum respectively.

InGroup-3

About 10 percent had the meanhemoglobin of 4.5 gm.%, about 53.29percent had the mean Hb% of 7.2 gm%percent while remaining patients of36.81 percent had either mild anaemia ornormal level of haemoglobin with meanof 10.3 gm%. About 44.5 percent hadmoderate bleeding; about 12.08 percentand 43.4 percent had mild and profusebleeding per rectum respectively.

d) The speed of recovery frombleeding and other associatedsymptoms (Summarized in TablesfromVtoX)

(Table- V)InGroup-l

Healing took place in 211 patientswith varying degree of duration startingfrom one week to four weeks. Out of247cases 33 patients were dropped out fromthe study. About 42.41 percent patientshad healing (complete relief) by Ist week,27.12 percent had (marked relief) by twoweeks, 10.93 percent had (moderaterelief) by three weeks and about 4.04percent had (mild relief) by four weeks.But after four weeks 0.61 percent had therecovery but all of them (04 patients) hadthe recurrence within 30 days.

InGroup-2

Healing took place in 195 patients

34

EVALUATION OFAYURVEDIC .

with varying degree of duration startingfrom one week to four weeks. Out of230cases 35 patients were dropped out fromthe study. About 37.39 percent patientshad healing (complete relief) by 1stweek,26.08 percent had (marked relief) by twoweeks, 14.78 percent had (moderaterelict) by three weeks and about 6.52percent had (mild relief) by four weeks.In Croup - 3

Healing took place in 149 patientswith varying degree of duration startingfrom one week to four weeks. Out of 182cases 29 patients were dropped out fromthe study. About 3 I percent patients hadhealing (complete relief) by 1st week,29.12 percent had (marked rei iet) by twoweeks, 20.32 percent had (moderatereliet) by three weeks and about 1.09percent had (mild relief) by four weeks.

(Table- VI)In Croup-l

Out of 106 cases who had completerelief, 37 patients fall under the age group21-30 yrs, 31 cases under 31-40 yrs whileminimum of 07 cases up to the age of 20yrs .. Out of 67 cases who had markedrelief, maximum cases (20) were in the41-50 yrs. age group, while minimum(07) up to the age of 20 yrs. Out of 27cases who had moderate relief, thenumber was almost equally distributedin all the age groups. Out of 4 patientswho were under No response category,two were in the group up to 20 yrs andone each under 3 1-40 & 41-50 yrs. Reliefwas found in all of them but recurrencehad observed in four cases.

InGroup-2Out of 86 cases who had complete

relief, 13 patients fall under the age up tothe age of 20, 32 cases under 31-40 yrswhile minimum of 10 cases under the ageof 50 & above. Out of 60 cases that hadmarked relief, maximum cases (25) werein the 31-40 yrs. age group, whileminimum (07) up to the age of 50 &

above. Out of27 cases who had moderaterelief, the number was maximum (17) inthe age group 41-50, while minimum (2)in the group 51 & above. Out of 15patients who were under mild responsecategory, 09 were in the group 51 &above and three each under 21-30 & 41-50yrs.

InGroup-3Out of 60 cases who had complete

relief, 09 patients fall under the age up tothe age of 20, 20 cases under 31-40 yrswhile minimum of 07 cases under the ageof 21-30 yrs. Out of 53 cases who hadmarked relief, maximum cases (21) werein the 31-40 yrs. age group, whileminimum (03) up to the age of20. Out of37 cases who had moderate relief, thenumber was maximum of 11 each in theage groups of 21.30 & 51 and abovewhile minimum (2) in the group upto to20 yrs. Out of 2 patients who were undermild response category, 0 I each in thegroup of 5 I and above and 21-30.

Table-VIIInGroup-l

Data shows maximum of the Pittajatype of Arsha (47) had complete relieffollowed by Raktajaa (16) and Kaphajaa

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M. Mruthyumjaya Rao et al.

type. Under marked relief categorymaximum of 25 patients of pittaja typewhile minimum of 2 cases of Sahaja atype of Arsha. Under No responsecategory 2 cases were found to be ofSanipataja and one each to be ofKaphajaa and Vatajaa type of Arsha.

In Group-2Data shows maximum ofthe Pittaja

type of Arsha (37) had complete relieffollowed by Sannipataja (19) andRaktajaa (16) type. Under marked reliefcategory maximum of 20 patients ofpittaja type while minimum of2 cases ofSahaja a type of Arsha. Under moderateresponse category 10 cases were found tobe Vatajaa, 06 in Raktajaa while 04 eachto be of Kaphajaa and pittaja type ofArsha.

InGroup-3Data shows maximum of 24 cases

of the Pittaja type of Arsha had completerelief followed by Raktajaa(l8) andSannipataja (08) type. Under markedrelief category maximum of 13 patientseach of Sannipataja and Raktajaa typewhile minimum of 3 cases of Sahaja atype of Arsha. Under moderate responsecategory 12 cases were found to beSannipataja, 07 in Raktajaa while 06each to be of Vatajaa, Kaphajaa andPittaja type ofArsha.

(iv) Table-VIIIIn Group-l

Analysis was made about theresponse in reference to the duration ofthe disease and it shows the maximum

number (81) who had complete relief(106) had the duration of illness less thanone year. Out of 67 who had markedrelief, 39 had illness less than one yearfollowed by 22 cases up to 2 years. Out of27 cases who had moderate relief,maximum number (17) had the illnessless than one year.

InGroup-2The maximum number (61) who had

complete relief (86) had the duration ofillness less than one year. Out of 60 whohad marked relief, 34 had illness less thanone year followed by 17 cases up to 2years. Out of34 cases who had moderaterelief, maximum number 17 had theillness less than one year.

In Group-3The maximum number of 46 cases

who had complete reliefhad the durationof illness less than one year. Out of 53cases who had marked relief, 25 hadillness less than one year followed by 21cases up to 2 years. Out of 37 cases whohad moderate relief, maximum numberof 19 had the illness less than one year.

Table-IXInGroup-t

A maximum no. of 71 & 37 internalhemorrhoid cases had complete andmarked relief respectively and a total of80 of cases of intero-externalhemorrhoids, 33 cases had complete, 23had marked while minimum of 2 caseshad no relief.

InGroup-2A maximum no. of 56 & 47 internal

36

EVALUATION OF AYURVEDIC .

hemorrhoids cases had complete andmarked relief respectively and a total of63 of cases of intero-externalhemorrhoids, 24 cases had complete, 09had marked, 14 had moderate reliefwhileminimum of 04 cases had mild relief.

InGroup- 3 A maximum no. of27, 31& 20 of internal haemorrhoid cases hadcomplete, marked and moderate reliefrespectively and a total of 83 of cases of

intero-external hacmorrhoids, 30 caseshad complete, 20 had marked, 17 hadmoderate relief while minimum of 02cases had mild relief.

Table-XIt has also been observed from the studythat there is a significant improvement inhemoglobin levels after 45 days of thetherapy in all the three groups.

Table-ICondition of patients on admission

S1.No Condition No. of patients

A Age group(in yrs.) Male I Female I TotalUpto 20 47 28 7521-30 108 39 14731-40 119 50 16941-50 104 32 136

51 & above 112 20 132Total 490(74.35) 169(25.64) 659(100.00)

B Prakriti of patient No. of patientsVata 243(36.87)Pitta 358(54.32)

Kapha 58(8.80)

C Bowel habits No. of patientsRegular 55(8.34)

Constipated 541(82.09)Alternate bowel habits 63(9.55)

D Dietary habit No. of patientsVegetarian 31(4.7)

Non-vegetarian 628(95.29)

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M. Mruthyumjaya Rao et al.

Table-IICharacteristics of Arsha / Haemorroids on admission

SI.No Incidence I Characteristics No. of patients

a) Duration of disease (yr) No. of patients<1 371( 56.29)1-2 184(27.92)2-3 68(10.31)>3 36(5.46)

b) H/O previous treatment

Medical 382(57.96)Surgical 61(9.25)

FreshINone 216(32.77)

c) Type of Haemorrhoids

External 57(8.64)Internal 376(57.05)

lntero external 226(34.29)

d) Type of Arsha

Vatajaa 85(12.89)Pittaja 212(32.16)

Kaphajaa 67(10.1 6)Sannipataja 129(19.57)

Raktajaa 137(20.78)Sahajaa 29(4.4)

e) Position of Haemorrhoids (0' clock)

30 clock 373(56.60)50 clock 291(44.15)70 clock 237(35.96)11 0 clock 308(46.73)

38

EVALUATION OF AYURVEDIC ..................

Table-IIIClinical features (signs & symptoms) noticed on Admission

SI. Symptom Percentage

A. Bleeding (659=100%)

Profuse/ severe 207(31.41)Moderate 323(49.01)

Mild 129(19.57)B. Prolapse of pile masses 246(37.32)C. Itching/ Pruritis 246(37.32)

D Discomfort 417(63.27)

E. Pain 155(23.52)

F. Discharge (mucous) 228(34.59)

Table-IVHaemoglobin levels recorded on Admission

S1.No AnaemiafHb levels

No. of Patients (%) with mean hemoglobin levelGroup - 1 I Group - 2 I Group - 3

Severe(Hb%<7 gm.%)

GModerate

(Hb% 7-10gm)

Mild / normalcy(Hb%>10gm%)

72(29.14) 27(12.14) 18(9.89)(mean Hb (mean Hb (mean Hb

gm %=6.5) gm %=6.8) gm %=4.5)

156(63.15) 114(49.56) 97(53.29)(meanHb (mean Hb (meanHbgm %=9.8) gm% =8.5) gm %=7.2)

19(7.69) 89(38.69) 67(36.81)(meanHb (meanHb (meanHb

gm %=11.5) gm %=10.8) gm %=10.3)

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M. Mruthyumjaya Rao et al.

Table-VSpeed of Recovery from bleeding and other associated symptoms

51. Result/ No. of patientsNo Recovery Group - 1 I Group - 2 I Group - 3 Total

1 Complete relief 106 (42.91) 86(37.39) 60(32.96) 252(38.23)by 1 week

2 Marked relief 67(27.12) 60(26.08) 53(29.12) 180(27.31)by 2 weeks

3 Moderate relief 27(10.93) 34(14.78) 37(20.32) 98(14.87)by 3 weeks

4 Mild relief 10(4.04) 15(6.52) 02(1.09) 27(4.09)by 4 weeks

5 No relief 04(0.61) 00(00.00) 01(0.54) 05(0.75)after 4 weeks

6 Drop out / 33(13.36) 35(15.21) 29(15.93) 97(14.71 )Recurrence

7 Total 247(100.00) 230(100.00) 182(100.£'" ,100.00)

CR - Complete Relief, MR - Marked Relief, MDR - Moderate Relief, l'vNR - No Relief, D.O. - Drop out.

:v1ild Relief,

Table-VISpeed of recovery according to Age

Age Results of the treatment (Percentage)J group

(in yrs.) CR MR MDR MLR NR DO Total-

.i Up to 20 7(2.83) 7(2.83) 3(1.21) 0(00) 2(0.80) 6(2.42) 25(10.12)2130 37(14.97) 10(4.04) 6(2.42) 2(0.800 0(0.00) 3(1.21) 58(23.48)31-40 31(12.55) 13(5.26) 8(3.23) 1(0.04) 1(0.04) 10(4.04) 64(25.91)

18(7.28) 20(8.09) 7(2.83) 3(1.21) 1(0.04) 7(2.85) 56(22.67)13(5.26) 17(6.88) 3(1.21) 4(1.61) 0(0.00) 7(2.85) 44(17.81)

106(42.91) 67(27.12) 27(10.93) 10(4.04) 4(0.61) 33(13.36) 247(100.00)

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EVALUATION OF AYURVEDIC ..................

2 Up to 20 13(5.65) 08(3.47) 0(0.00) 0(0.00) 0(0.00) 06(2.60) 27(11.73)2130 32(13.91) 9(3.91) 5(2.17) 3(1.30) 0(0.00) 4(1.73) 53(23.04)31-40 15(6.52) 25(10.86) 10(4.34) 0(0.00) 0(0.00) 5(2.17) 55(23.91)41-50 16(6.95) 11(4.78) 17(7.39) 3(1.30) 0(0.00) 1(0.43) 48(20.43)51 & 10(4.34) 7(3.04) 2(0.86) 9(3.91) 0(0.00) 19(826) 47(20.43)

aboveTotal 86(37.39) 60(26.08) 34(14.78) 15(6.52) 0(0.00) 35(15.21) 230(100.00)

3 Up to 20 9(4.94) 3(1.64) 2(1.09) 0(0.00) 0(0.00) 9(4.94) 27(14.83)21-30 7(3.84) 14(7.69) 11(6.04) 1(0.54) 0(0.00) 3(1.64) 53(29.12)31-40 20(10.98) 21(11.53) 5(2.74) 0(0.00) 1(0.54) 4(2.19) 45(24.72)41-50 14(7.69) 7(3.84) 8(4.39) 0(0.00) 0(0.00) 2(1.09) 48(26.37)51 & 10(5.49) 8(4.39) 11(6.04) 1(0.54) 0(0.00) 11(6.04) 35(19.23)

aboveTotal 60(32.96) 53(29.12) 37(20.32) 2(1.09) 1(0.54) 29(15.93) 182(100.00)

Table-VIISpeed of recovery according to type of Arsha

Group Type of Results of the treatment (Percentage)Arsha

CR I ~R I MDR I MLR I NR I DHO I TotalA B C E F G I

Vatajaa 9(3.64) 5(2.02) 8(3.23) 3(1.21) 1(0.04) 4(1.61) 30(12.14)1 Pittaja 47(19.02) 25(10.12) 6 (2.42) 1(0.04) 0(00) 12(4.85) 91(36.84)

Kaphaiaa 14(5.66) 9(3.64) 2 (0.80) 0(0.00) 1(0.04) 0(0.00) 26(10.52)Sannipataja 10(4.04) 11(4.45) 4 (1.61) 5(2.020) 2(0.80) 9(3.64) 41(16.59)Raktaiaa 16(6.47) 15(6.07) 7 (2.83) 1(0.04) 0(00) 6(2.42) 45(18.21)Sahaja a 10(4.04) 2(0.80) 0(0.00) 0(0.00) 0(0.00) 2(0.08) 14(5.66)

Total 106(42.91) 67(27.12) 27(10.93) 10(4.04) 4(0.61) 33(13.36) 247(100.00)A I B C D E F G H I

Vataja 5(2.17) 5(2.17) 10(4.34) 4(1.73) 0(0.00) 4(1.73) 28(12.17)2 Pittaja 37(16.07) 20(8.69) 4(1.73) 6(2.60) 0(0.00) 6(2.60) 73(31.73)

Kaphaia 7(3.04) 12(5.21) 4(1.73) 01(0.43) 0(0.00) 0(0.00) 24(10.43)Sannipataja 19(8.26) 5(2.17) 8(3.47) 01(0.43) 0.(0.00) 14(6.08) 47(20.43)

Raktaja 16(6.95) 16(6.95) 6(2.60) 01(0.43) 0(0.00) 9(3.91) 48(20.86)

Sahaja 2(0.86) 2(0.86) 2(0.86) 2(0.86) 0(0.00) 2(0.86) 10(4.":'4). -

Total 86(37.39) 60(26.08) 34(14.78) 15(6.52) 0(0.00) 35(15.21) 230(100.lJe3 Vataja 5(2.74) 6(3.29) 6(3.29) 1(0.54) 1(0.54) 8(4.39) 27(14.83)

Pittaja 24(13.18) 8(4.39) 6(3.29) 0(0.00) 0(0.00) 8(4.39) 48(26.37)Kaphaja 3(1.64) 10(5.49) 6(3.29) 0(0.00) 0(0.00) 0(0.00) 17(9.34)

Sannipataja 8(4.39) 13(7.14) 12(6.59) 1(0.54) 0(0.00) 7(3.84) ·n(22.52)Raktaja 18(9.89) 13(7.14) 7(3.84) 0(0.00) 0(0.00) 6(3.29) 44(24.17)Sallaja 2(1.09) 3(1.64) 0(0.00) 0(0.00) 0(0.00) 0(0.00) 5(2.74)Total 60(32.96) 53(29.12) 37(20.32) 2(1.09) 1(0.54) 29(15.93) 182(100.00)

41

M. Mruthyumjaya Rao et al.

Group Duration Results of the treatment ( Percentage)of CR MR MDR MLR NR DO Total

illness(in yrs.)

Table-VIIISpeed of recovery according to the duration of the illness

Upto1 81(32.79) 39(15.78) 17(6.88) 4(1.01) 1(0.40) 8(3.23) 150(60.72)1 1-2 18(7.28) 22(8.9) 7(2.83) 4(1.61) 2(0.80) 9(3.67) 62(25.10)

2-3 3(1.21) 3(1.21) 2(0.80) 2(0.80) 0(0.00) 15(6.07) 25(10.12)3& 4(1.61) 3(1.21) 1(0.40) 0(0.00) 1(0.40) 1(0.40) 10(4.04)

aboveTotal 106(42.91) 67(27.12) 27(10.93) 10(4.04) 4(0.61) 33(13.36) 247(100.00)

2 Upto1 62(26.95) 34(14.76) 17(7.39) 4(7.39) 0(0.00) 4(1.73) 121(52.60)1-2 16(6.95) 17(7.39) 9(3.91) 7(3.04) 0(0.00) 16(6.95) 65(28.26)2-3 4(1.73) 5(2.17) 6(2.60) 3(1.30) 0(0.00) 8(3.47) 25(10.86)3& 4(1.73) 4(1.73) 2(0.86) 1(0.43) 0(0.00) 7(3.04) 19(8.26)

aboveTotal 86(37.39) 60(26.08) 34(14.78) 15(6.52) 0(0.00) 35(15.21) 130(100.00)

Upto1 46(25.27) 25(13.73) 19(10.43) 0(0.00) 0(0.00) 10(5.49) 100(54.94)3 1-2 11(6.04) 21(11.53) 16(8.79) 0(0.00) 1(0.54) 8(4.39) 57(31.31)

2-3 2(1.09) 5(2.74) 2(1.09) 1(0.54) 0(0.00) 4((2.19) 18(9.89)3& 1(0.54) 2(1.09) 0(0.00) 1(0.54) 0(0.00) 4(2.19) 7(3.84)

aboveTotal 60(32.96) 53(29.12) 37(20.32) 2(1.09) 1(0.54) 29(15.93) 182(100.00)

Table-IXSpeed of recovery according to the type of Haemorroids

Group Type of Results of the treatment (Percentage)haemorroid

CR 1 MR -, MDRl MLR' NR , DO , Total

External 2(0.80) 7(2.83) 6(2.42) 1(0.40) 1(0.40) 10(4.04) 27(10.93)1 Internal 71(28.79) 37(14.97) 15(6.07) 4(1.61) 1(0.40) 12(4.85) 140(56.68)

Intero-ext. 33(13.36) 23(9.31) 6(2.42) 5(2.02) 2(0.80) 11(4.45) 80(32.88)Total 106(42.91) 67(27.12) 27(10.93) 10(4.04) 4(0.61) 33(13.36) 247(100.00)

External 6(2.60) 4(1.73) 2(0.86) 2(0.86) 0(0.00) 6(2.60) 20(8.69)2 Internal 56(24.34) 47(20.43) 18(7.83) 9(3.91) 0.40 17(7.39) 147(63.91)

Intero-ext. 24(10.43) 9(3.91) 14(6.08) 4(1.73) 0.80 12(5.21) 63(27.39)Total 86(37.39) 60(26.08) 34(14.78) 15(6.52) 0(0.00) 35(15.21) 130(100.00)

42

EVALUA TlON OF A YURVEDIC ..................

External 3(1.04) 2(1.09) 0(0.00) 0(0.00) 0(0.00) 5(2.74) 10(5.49)3 Internal 27(14.83) 31(17.03) 20(10.98) 0(0.00) 1(0.54) 9(4.94) 89(48.90)

Intero-ext. 30(16.48) 20(10.98) 17(9.34) 2(1.09) 0(0.00) 15(8.24) 83(45.60)Total 60(32.96) 53(29.12) 37(20.32) 2(1.09) 1(0.54) 29(15.93) 182(100.00)

Table-XImprovement in the Hemoglobin level

Group Level of Hemoglobin gm % on After 30 days After 45 days.Hbgm% admission Hbgm % Hbgm%

<7gm.% 72(29.14) IS( 6.07) 4(1.61)(mean=6.S) (mean=6.8) (mean=6.2)

7-10gm.% IS6(63.1S) 193 (78.13) 138(SS.87)(mean=9.8) (mean=9.6) (mean=9.4)

>10gm.% 19 (12.S) 39 (IS.78) IOS(42.S1)(mean=II.S) (mean=11.01) (mean=I1.3)

<7gm.% 27(12.14)) 20(8.69) 14(6.08)(mean=6.8) (mean=6.9) (mean=6.2)

7-10gm.% 114(49.S6) 112 (48.69) 87(37.82))(mean=8.S) (mean=8.9) (mean=8.7)

>10 gm.% 89 (38.69) 98 (42.60) 129(S6.08)(mean= 1O.S) (mean=1O.3 ) (mean=10.8)

<7gm.% 18(9.89) 12(6.S9) 7(3.84)(mean=4.S) (mean=S.8 ) (mean=6.9)

7-10gm.% 97(S3.29) 138(7S.82)) 161(88.46)(mean=7.2) (mean=8.S) (mean=9.8)

>10 gm.% 67(36.81 ) 32(17.S8) 14(7.69)(mean=10.3) (mean= 11.00) (mean=13.S)

1

2

3

Discussion

The diagnosis of Arsha is simple but thechoice of treatment is difficult, becauseone therapy can not be said to beapplicable to all the type ofArshalHaemorroids, which is capable tocure the disease. The disease itself hasdiverse manifestations and accordinglythe treatment has got to be based onindividual merits.

'Burkitt' (1977) conducted anepidemiological study and reported that"when traditional diet in a communitygives way to more refined foods; theincidence of haemorrhoids always risesbefore that of varicose veins". In thepresent study also it was found about95.29% patients were non-vegetariansand were very fond of spicy, fast foodsetc. Secondly, the Hemorrhoids are

43

M. Mruthyumjaya Rao et aJ.

regarded as a surgical disease. The factthat so many operative and para-surgicaltechniques now-a- days are in vaguethemselves prove that there is nostandard treatment procedure availablein the treatment of Arsha. KaseesadiTaila for per rectal application will helpin producing a soothing effect and willhelp easy descent of the faecal column.This process should be carried out half anhour before defecation daily irrespectiveof whether the patient moves his bowelsonce or twice. The main ingredient isKaseesa (Cu SOJ and due to its VranaRopana & Sodhana properties, it healsthe eroded portion of the haemorroidvessels and facilitates & promotes quickhealing.

Both Kankayan Vati and KravyadiRas improves the digestive fire, reducesthe Ama formation. Since the root causeof the disease mentioned in Ayurveda isAma or metabolic disturbances,Kanakayana Vatiwas selected in order toeliminate or treat the basic cause i.e.amadosha to achieve the ultimate/betterresults of the treatment.

Some drug is needed to take care ofpatients evacuatory process especiallywho have chronic or habitualconstipation which is regarded as one ofthe major causes for the disease,hemorrhoid bleeding. So TriphalaChurna was selected for its laxativeaction on the bowel.

Since the earlier studies revealed the

refined foods, fast foods and non veg.

diet rises the incidence of haemorroid

bleeding, the patients were kept on Milk,

rice diet and plenty of liquids which also

helps in the prevention of the recurrence.

On the basis of the results of this

single blind clinical trial in all the groups,

the results were shown in Group - I & 2

appears better than that of Group - 3,

which clearly indicates that adding more

medicines keeping the symptomatology

or the aetiopathogenesis in mind makes

no difference but expensive and difficult

to take all the medicines. The study gives

an impression that even using either

Kankayana Vati or Kravyadi Rasa orally

apart from local application of KaseesadiTaila and a laxative may not be having

additional benefit. The difference in

results among the both groups i.e group -

1 & 2 were very minimum and negligible

and hence it is concluded that the drug

combination tried in both the groups

were similarly effective in the

management of Arsha.

AcknowledgementThe authors are highly indebted to the

Director, CCRAS, New Delhi for his

financial and technical support. We are

also thankful to the patients who gave

their consent to can)' out the study.

44

EVALUATION OF AYURVEDIC .

Anderson H.G. 1909

Burkitt 1972

Fielding L.P.

Sharma S.K. et al: 1994-95

Sharma B.N 1999

Stanely.M.Goldburg 1980

Susruta, Susruta Samhita

Watts,J.M. 1965

References

The after results of the operativetreatment of Hemorrhoidspre.med.J.2: 1276.

Varicose vein, Deep Vein thrombosis andHemorrhoids (Epidemiology andSuggested Etiology,) Br.MJ.2,556

Management of patients withsymptomatic Hemorrhoids anintroduction - (page 462-63)

"Kshara sutra.therapy in Fistula-in-Aneand other Ano rectal diseases" RastreeyaAyurveda Vidyapeeth publication, NewDelhi

Ayurvedic management of Arsha(Hemorrhoids) - CCRAS publication Rob& Smith- Operative surgery Lippin cottcompany-4th edition.

Annals ofAno - Rectal Surgery, J.P.publication

(commentary by Ambika dutta Sastri),Chawkamba Sanskrit Series Office,Varanasi.

A controlled study of pain after differentforms of Haemorrhoidectomy,Surg,gynoec, obstet.120: 1037.

45

M. Mruthyumjaya Rao et al.

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46