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Introduction

Arshas (Haemorrhoids) is a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent as one of the medico-surgical and socioeconomic problem.1

Management of this condition is through either conservative or surgical approach, patients are always apprehensive about surgical correction of this ailment, they constantly prefer conservative management. The management of Arshas is purely based on the degree of the condition as detailed in the literature2,3,4 The treatment modality is classified as Bheshaja [Medicinal], Shastra [Surgical], Kshara [Chemical cautery] and Agni [Thermal cautery]. Medicinal mode is the most preferred and economical among other modes of treatment. Numerous herbal and herbo-mineral preparations cited in Ayurvedic texts, many of them are used extensively in clinical practice.5,6,7,8 There may be many formulations mentioned and on initial evidence all may appear as same, but only on avid reading it is perceived that every classical combination is contrived with their own set of principles and objectives to combat a disease and its associated complications/symptoms. Among all formulations, the one containing mineral medicines are considered superior for the reason that, their particle size being in micro -nano meter and their abiding quality, bestow rapid and prolonged results. Henceforth, this paper is an attempt to screen and review the various Rasoushdhis mentioned in classical texts.

Objective

To screen and review the Rasaoushadhis cited in Ayurvedic texts for Haemorrhoids with special reference to pharmacological actions.

Materials & Method:

Screening and Review of six treatises of Ayurveda –Bhaishjya Ratnavali, Rasa ratna samucchaya, Rasamrita, Yoga ratnakara, Sushruta samhita and Siddha yoga sangraha.

Method – Hand Search

Observation and Discussion:

Ayurveda has been embodied with huge literary contributions from many Acharyas. Among them all, the reason to take only these books are; Bhaisajya Ratnavali, a literature of 19th C is relatively applicable to current period. The text discusses Rasaoushadhis in detail and gives it a pivotal position. Rasa ratna samuchchaya, is an authentic text of Rasa shastra and contains detailed descriptions of various complex metallurgical processes. Disease wise description of rasa formulations are written precisely. Yoga ratnakara compiled work and masterpiece of Indian medical system in terms of both disease and treatment. Sushruta samhita, the treatise is the first and authentic book of Ayurveda belonging to surgical domain. The Compendium of Sushruta is one of the foundational texts of for all medico surgery cases. Rasamrita -The text Rasamritam is full of practical therapeutic use of different Rasa Dravyas and their processing techniques. As time went on, there was increase of diseases and decrease of classical knowledge. Hence the Ayurveda Martanda Shri Y.T.Acharya has come up with this literature after adopting the scientific and practical knowledge   for alchemical methodologies, thereby placing the rasa dravyas at top in scrutiny. Siddha yoga sangraha, is the doctrine prepared for beginners.This book is an excellent compilation of yogas which are easy to prepare and have given proven effects in daily practice.

In total there are 38 number of rasa yogas of Arshoadhikara found in six classics. However, only few are available in market currently.

The market available few drugs are not completely enough to fulfil all the demandable conditions of the disease. This is the reason why texts have given multifold combinations of drugs. Pharmacies are to be encouraged to come out with these yogas for betterment of treatment. Henceforth it becomes essential to learn and scrutinise all the yogas w.r.t rasa dravyas.

Numbers of rasa yogas mentioned in Arshoadhikara of each text are enlisted below-

table 1,2

table 3

table 3

table 3

Discussion

Ayurvedic classics opine, Arshas Haemorrhoids is due to impairment of agni [Digestive fire] vikrutijanya vyadhi, wherein constipation is a frequent addition to vikruti. 23 Hence treatment always initiates with correction of agni with Deepaka, Pachaka and Vata-mala anulomaka dravyas. Research works reveals   that, the abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoidal disease. They also attribute involvement of ANS and Genetic factor for the condition. 24

Above said pathology is reiterated as Khavaigunya in classics which could be inherited (Genetic) or acquired (Disturbed metabolism) and manifest as Dilated Arterio venous plexus, Damaged anal cushion and weak anal sphincter.

Considering facts of pathology and manifestations, an axiom could be formed to treat arshas :

• Restore agni-deepana, Pachana – Restoring digestive fire to normalcy and improve the metabolic activity.
• Regulate bowel habit-Anulomana/Grahi (as condition demands) – Regular emptying of the bowel as per the biological cycle, constitution of an individual
• Due to inert properties of mineral compounds, the size of the pile mass gets shrunken, Sira balya (Venotonicity) improves the tonicity of vascular intima and due to scarifying activity the mucosal prolapsed of the dilated haemorrhoidal plexus of veins is rectified.
• Correct Khavaigunya25 [Weakness of any bodily channel or Srotas]-

Discussion on Pharmacological properties of Rasa dravyas which are part of classical formulations mentioned in above texts: 26,27,28,29,30

• Rasa sindhura31,32,33-Arshohara,Snayu balya, Kaphavatahara34

Hence Rasa Sindura is incorporated to scrape off deep rooted, chronic pile mass and to correct Khavigunya of anal cushions and sphincter

• Tamra35,36- Lekhana, Saraka, Mamsa dushanahara, Increases Arterial pressure. Hence Tamra yukta yogas [Copper containing preparations] should not be given for more than 21 days and contraindicated in bleeding and Hypertension conditions. 37,38,39,40
• Abhraka41 –Yogavahi-Enhances properties of fellow drugs without losing its own, Nadi balya (Regulates and strengthens Nadi)Facilitates in Strengthening of Snayu, Sira, Helps to check bleeding, Hastens post surgery healing but not a direct drug to treat Arshas. Hence Abhraka yukta yogas or as individual could be administered to correct ANS which is part of pathology in both Genetic And Acquired cause & repair anal sphincter
• Loha, Mandura42, 43 -Rakta prasadana-Improves circulation and nourishes all components of blood, Sira balya (Strengthens walls of blood vessels) Hence this is advised in correcting Dilated Arterio venous plexus, Repair damaged anal cushion
• Gandhaka44,45 -Udara shuddhi, Mrudu virechana, Daha shamaka, corrects intestinal flora, Increases cell permeability

Hence a drug to include for arshas which has its root cause as disturbed metabolism and improper life style

• Swarna makshika46 -Pacifies teekshnata, Amlata, ushnata & dravatva of pittha, Sowmya guna. Hence particularly used in habitual bleeding condition of arshas without hard stools being a cause for bleeding
• Shilajatu- Arshogna, Lekhana, Snayu balya, Improves cellular circulation and permeability. Shilajatu is a good choice of drug in both bleeding and non bleeding arshas with suitable co ingredients to get rid of piles.
• Rajata- Vata pittha shamaka,Vedana shamaka Drug to be a part of formulation t to regulate ANS and in painful condition of arshas.
• Naga –Antra balya,Snayu balyakara,Shothgna,corrects dhatu vikruti. Naga bhasma is advised for condition like constipation that has caused due to incompetent intestines and has raised a pile mass which is usually soft fragile mass.
• Kaseesa47 -Rakta mamsa gata vrana shodhaka,ropaka

The sulphate form of iron is potent enough to scrape out pile mass, increases blood circulation to GIT and thereby regulated all necessary secretions of GIT to keep digestion part clear.

Conclusion

Herbal and herbo mineral preparations are an essential part of Ayurvedic therapeutics. The pharmacological actions rely on the proper preparation as per textual guidelines and its judicial application in Arshas with due consideration to posology.