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Introduction

The word Arsha is self-explanatory by itself, indicating that the disease troubles a person like an enemy.1 Arsha as a dreadful disease can affect anyone, anytime, anywhere. Arsha is being described by all the classics of Ayurveda. Acharya Sushruta even placed this disorder in the “Ashta Mahagada.”2 In the modern day, everyone has experienced one or more hemorrhoids-related problems at some point in their lives. Arsha is described as a fleshy outgrowth that blocks an enemy's anal entrance and kills them.3 The pathogenesis of Arshas has been described by Acharya Sushruta as the Nidanas resulting in the vitiation of Doshas in single, combination of two or more along with Rakta, Dosha moving downwards through the Mahadhamani reaching Guda and affecting the Gudavalitraya producing Arshas in individuals suffering from Mandagni and other local causes.4 Acharya Charaka has portrayed the causative elements in detail. The unwholesome way of behaving of guardians and the previous deeds are liable for Sahaja Arshas. Sushruta likewise determines the job of ill-advised Ahara and Vihara in the causation of Arshas. The primary and earliest symptom of haemorrhoids for which a patient seeks medical attention is bleeding. Bheshaja Chikitsa (medical therapy) is more effective in the early stages of Raktarsha (haemorrhoids) and has the greatest advantage of patient acceptance.

Objectives: To review the literature of Arsha in Ayurvedic texts and to review collect the information various methods for management and orevention of Arsha

Concept of Arsha: The causative factors have been thoroughly described by Acharya Charaka.5 The unwholesome behaviour of parents, as well as past deeds, are to blame for Sahaja Arshas.6 Sushruta also discusses the role of improper Ahara and Vihara in the development of Arshas. Vagbhata incorporated both Charaka's and Sushruta's perspectives.7 The following are broad categories of aetiology. Dietic factors- Incompatible diets such as Guru, Madhura, Sheeta, Abhishyandi, and so on. Excessive or insufficient intake. Habits-Suppression of natural urges or excessive straining, excessive sexual indulgence. Local irritation factors include defective sitting, uneven or hard seats, and excessive vehicle riding. According to Mandagni, Arshas, Grahani, and Atisara are all causative factors for each other.

Nidan of Sahaja Arsha:The cause of sahaja Arsha is dushti (vitiation) of beej-bhaga, which produces in the guda vali. 8 Beej-bhaga vitiation occurs due to 2 factors.

1) Mithya aahar vihar of parents

2) Poorvajanmakarma: According to Acharya Sushruta the vitiated shonita and shukra is the hetu of sahaj – Arsha. 9,10

The Nidana of Janmottaraj Arsha: a) Samanya Hetu: The samanya hetus which are responsible for all types of Arsha as described by Acharya Charaka are as given below.

1) Aaharaj hetu : 11,12

               Guru, madhur, sheeta, abhishyandi, vidahi, virudhdha-bhojan, pramit- bhojan, asatmya-bhojan; matsya, varaha, mahisha, aja-mansa; krusha-prani mansa; nava shami dhanya, atikranta madya, ati-snehapan, dadhi, guru jala, pinak, shaluka, shastika, shushka mansa; nava shuka dhanya, shrungataka, shushka teela, gud-vikruti, vasa, viruddha dhanya, aama moolaka, gurushaak, kasheruka, kilat, lashuna, mrunala, ikshu ras, ksheer, manda, mansa yoosha. Sushrut has mentioned only adhyashana, virudhdhashana.

2) Viharaj hetu: 13

Table.1. Viharaj hetu as per Acharya Charaka, Sushruta, Vagbhata

b) Vishesh hetu: The types of Arsha are according to the dosha involvement. Hence, the vishesh hetus of Arsha are as shown below: (Table no .2)

Sadhya Sadyata: (Prognosis): Acharya Sushruta has enumerated Arsha as one amongst eight mahagadas, hence by nature the disease is very much difficult to treat. 17 Assessment of sadhyasadhyata is based on the factors like doshik involvement, vyadhi sthana, vyadhi kala and association of upadravas. Opinions of different Acharyas regarding prognosis can be summarized as follows,

1. Those arise in the bahya vali, caused by single dosha and manifested recently are sukha sadhya. 18
2. Those which are caused by combination of two doshas, located in the madhyam vali and of more than one year, are kashta sadhya.
3. Those which are caused by combination of three doshas, located in the madhyam vali and of more than one year, are kashta sadhya.
4. Tridosa Arshas are yapya.
5. Arsha, which are sahaja, involving all the three doshas and located in the abhyantara vali should be discarded due to kashta sadhya nature. If rogi (patient) has developed shotha in hasta, pada, mukha, nabhi, guda, andakosha, severely debilitated and if hrudaya and parshva shoola is present should be discarded due to asadhya. However, if life span is remnant, the chikitsa chatushpada is provided and agnibala can be stimulated, then they can be treated otherwise should be rejected. 19

Pathya:20

Anna varga –                 godhuma, yava, raktashali, sastika, kulattha, priyangu, neem juice, yusha

Shaka varga –               surana, nimba, patola, punarnava, shringu, balamula, kusumbha, jeera, sohanjana, shali, rasana, chitraka, bathua

Ksheera varga –          aja ksheera, takra

Phala varga –                amalaki, kapittha

Ahara Upavarga –      palandu, maricha

Mamsa varga –             goha, mushaka, go, vanara, ashva, hirana, kukuta, aja, chataka mutra varga go mutra

Ahara- viruddha, vishtambhi, abhishyandi, guru ahara, anupa mamsa, dushta udaka, dosha prakopaka anna, anupa desha pashu and pakshi mamsa, matshya, tila khalli, dadhi, rooksha ahara, kareer, bilva patra, tumbi, jaliya kanda.

Vihara- vegadharana, atistreesanga, uttkatukasana, prushtayana, atapasevana, atijalapana, vamana, basti, poorva desha vayu sevana, viruddha dravya in rasa, veerya, vipaka.

Prevention and management of Arsha: 22

1. Bheshaja Karma (Drug Therapy)
2. Shastra Karma (Surgical Management)
3. Kshara Karma (Cauterization with Chemical)
4. Agni Karma (Cauterization)

On the basis on Dosha involvement in the pathogenesis of the disease, following treatment is given.

1. Vataja Arsha- Snehana, Swedana, Vamana, Virechana, Asthapana and Anuvasana Vasti
2. Pittaja Arsha - Virechana
3. Kaphja Arsha - Ahara dravya mixed with sunthi and kulatha.
4. Raktaja arsha - Shamana
5. Sannipataja Arsha- Mixed treatment of all dosha.

Bheshaj Chikitsa:23,24

Prevention of constipation- Laxative Triphalachurna, Panchsakarchurna, Haritakichurna etc. depending upon the Koshtha of the patient.

Deepan Pachan- Chitrakadivati, Lavanbhaskar churna, Agni tundivati, etc.

Arshoghna- Arshoghnivati, Soornapak, Arshkutharras, Shigru guggulu, etc.

Hot sitz bath- Tankan bhasma, Sphaticbhasma, Triphalakwath, Panchawalkalkwath, etc.

Rakta Stambhak- Bolbaddhras, Bolparpati, Kukkutandtwak bhasma, Pravalpisthi etc.

Vranropak- Jatyadi tail, Nirgundi tail, etc.

Vednahara- Madhuyastyadi tail, Triphala guggulu, etc

There are many preparations which are to be applied locally. Most of these preparations are helpful in eliminating the painful manifestations of Arsha as mentioned. Abhyanga - Medicated oil processed with Chitraka, Yavakshara Bilwa etc.

Swedna - Swedna with Vijyapinda, Rasoonpinda etc Avagahan- Avagahan with Triphla, Arka, Agnimanth, Kanji etc.

Virechana - in Pittaj Arsha, Virechana Karma has been mentioned as one of the main treatment modalities.

Basti - Chitrakadi Tailabasti, Kasissadi Tailabasti, Yastimadhu Taila. Dhoopana- Dhoopana with Vidanga, Devdaru, Pippali, Ghee etc.

Lepa - Haridrachurnapra Lepa, Pippalyadipra lepa, hartaladi Pralepa, Snuhiksheer mixed Haridra Choorna Lepa.

Discussion

Many aspects of modern surgical thinking can be found in an important branch of the Shalya Tantra. Acharya Sushruta, the father of surgery, detailed the Arsharoga, which was considered one of the Mahagada and was perpetually curable, in his treatise. Arsha is a terrible disease that can strike anyone, at any time, and in any location. Haemorrhoids are a common problem in today's world, and nearly everyone has had them at some point in their lives. Arsha is described as a fleshy growth that obstructs the anal channel and eliminates the enemy's existence. Arshas is caused primarily by binge eating and a sedentary lifestyle, which reduces the activity of digestive enzymes and results in constipation, itchiness, burning, and pain near the guda, which eventually results in bleeding. In Ayurveda, Arsha refers to the condition of hemorrhoids. Hemorrhoids are swollen blood vessels located in the rectum or anus, which can cause discomfort, pain, itching, and bleeding. Arsha is considered a common condition that can be caused by various factors such as chronic constipation, straining during bowel movements, a sedentary lifestyle, poor diet, and obesity. According to Ayurveda, Arsha is primarily caused by an imbalance in the Vata dosha, which governs the movement and elimination functions of the body. When Vata is aggravated, it can lead to dryness and hardening of the stools, making it difficult to pass them during bowel movements. This, in turn, puts pressure on the blood vessels in the rectum and anus, leading to the development of hemorrhoids.

Ayurveda recommends various natural remedies and lifestyle modifications to manage and prevent Arsha. These may include:

1. Dietary changes: Consuming a high-fiber diet with plenty of fruits, vegetables, whole grains, and legumes can help soften the stools and ease bowel movements. Drinking plenty of water and avoiding spicy, oily, and processed foods is also recommended.

2. Regular exercise: Engaging in regular physical activity, such as yoga or walking, can improve digestion, regulate bowel movements, and prevent constipation.

3. Herbal remedies: Ayurvedic herbs like Triphala, Haritaki, and Arsha Hita Kwath can be used to improve digestion, relieve constipation, and reduce inflammation in the rectal area.

4. Sitz baths: Soaking the rectal area in warm water for 10-15 minutes, two to three times a day, can help soothe the pain and inflammation associated with hemorrhoids.

5. Lifestyle modifications: Avoiding prolonged sitting, straining during bowel movements, and maintaining a healthy weight can help prevent the development or recurrence of hemorrhoids. It is important to note that Ayurvedic treatments for Arsha may vary depending on an individual's specific constitution and the severity of the condition. Consulting with a qualified Ayurvedic practitioner is recommended for a personalized treatment plan.

Conclusion

Arsha is a condition caused by lifestyle, age, occupation, and dietary factors. It is a terrible condition in which the patient is afraid to defecate due to pain and bleeding in the rectum. Furthermore, the patient becomes very anxious after seeing the pan full of blood. As a result, Ayurveda has enormous potential to successfully manage all stages of Arsha without complications.

There are four principal components of the treatment of Arsha in Ayurveda viz.Bheshaja Karma (Drug Therapy), Shastra Karma (Surgery), Kshara Karma and Agni Karma. As a result, Ayurveda has ultimate management modalities to get rid of such crippling conditions, which are described in various classical texts.