Arsha [Hemorrhoids]

Word "Arsha" defines; "Arshamsi tasmat ucchante guda marga nirodata" - Something which obstruct Anal canal called 'Arsha'. However modern Ayurvedic scholars co-relate 'Arsha' with 'Hemorrhoids'. According to Ayurvedic medicine, "Arsha" is a Major disease [Maha Roga] which is difficult to treat.
"Arivat pranan shrunati hinasti iti arsha: " - Which Destroys the body like an enemy to life.
Causes of Arsha :

• Chronic constipation
• Common in Pregnancy
• Prolonged sitting and standing
• Obesity
• Heriditary factors
• Anal cancer
• Ovarian cyst

These causative factors cause low digestive fire & then vitiation of  all doshas- especially that of Apana vayu results accumulation of waste products and varicosity of veins in the rectum.
Types of Arsha:

Image via Wikipedia
• External- Occur outside the anal verge, covered by squamous epithelium. Sometimes painful, [innervated by cutaneous nerves that supply the perianal area, include the pudendal nerve and the sacral plexus] and often accompanied by swelling and irritation. External hemorrhoids are prone to thrombosis.
• Internal - Occur inside the rectum, lined with columnar epithelium. Internal hemorrhoids are not supplied by somatic sensory nerves and therefore cannot cause pain, however, may bleed when irritated.

Internal hemorrhoids can be further graded by the degree of prolapse.
Grade I: No prolapse.
Grade II: Prolapse upon defecation but spontaneously reduce.
Grade III: Prolapse upon defecation, but must be manually reduced.
Grade IV: Prolapsed and cannot be manually reduced.

• Vataja -  Caused mainly by vitiated Vata dosha, & shows features of Vata, i.e. 

1. Dry
2. Darker in color, almost blackish
3. Rough, Hard
4. Constipation is present - Hard, exiguous stool
5. Acute pain is present in back, flanks, umbilical & anal region

• Pittaja -

1. Reddish and yellowish in color
2. Smooth, Wet
3. Usually gets inflammed 
4. Bleeding can be present
5. Burning sensation
6. Diarrhoea

• Kaphaja -

1. Large and whitish in colour
2. Itching occurs frequently
3. Smooth
4. Dyspepsia
5. Heavy, bulky stool

• Raktaja -

1. Similar to Pittaj arsha
2. Profuse bleeding
3. Reddish
4. Small

• Sannipataja -Features of all doshas

• Sahaja - [Congenital]

1. Dark brown in colour
2. Mostly internal
3. Bleeding
4. Dyspepsia, Emaciated

Complcations of Hemorroids:

• Ruptured hemorrhoid
• Gastrointestinal bleeding
• Anemia - if bleeding is severe
• Thrombosis - clotting in the veins
• Strangulation - blockage of the vein

Prevention of Arsha:

• Do not control your natural urge to defecate. As soon as you feel the motion, you must pass it out; or else you will have to exert the rectal area more. This could lead to complications.
• Obese people must work at losing their weight. This can be achieved with regular exercise.
• Horseback riding must be avoided by people with piles. This can adversely affect the anal area.
• Excessive sex must be avoided, especially that which involves the anus.
• Anal hygiene is of the utmost importance. Water must be ideally used to keep the anal area clean as toilet paper may not clean the area completely.
• It is not advisable to sit on hard surfaces for long periods of time. This could unduly exert the anal area. 

Diet for People with Arsha:

• Have lots of water. This facilitates easy expulsion of the wastes from the rectal canal, without subjecting the anus to much pressure.
• Green vegetables must be a major component of the diet. These vegetables can provide roughage, which facilitates faster movement of bowels.
• Vegetables with astringent and bitter tastes are of much benefit which prevent constipations.
• Hemorrhoids relief can be obtained from the itching pain if ghee with warm milk is taken every night.
• Barley, wheat and old rice are the carbohydrates that are beneficial for people with piles problems.
• The papaya fruit is also very beneficial as it helps in easy digestion of foods.
• Pungent, spicy, oily and salty foods must be avoided as they could make the digestion more difficult.

Treatment in Ayurveda:

1. Bheshaja - Medical
2. Shastra -  Surgical
3. Kshar- Chemical cauterization
4. Agni - Thermal cauterization

The Surgery unit of Ayurvedic Teaching Hospital, Borella, SriLanka has a special clinic for piles.
[every weekday 9.00- 12.00 noon at Room no 16]
 

Dr. Indunil Weerarathne