Piles is another term for hemorrhoids. Hemorrhoids are swollen veins in the lower anus and rectum. Piles are swellings that develop inside and around the back passage (anal canal).
There is a network of small veins (blood vessels) within the lining of the anal canal. These veins sometimes become wider and engorged with more blood than usual. The engorged veins and the overlying tissue may then form into one or more swellings (piles).
types of piles?
arsha roga
Haemorrhoids in Ayurveda is called as ARSHA. It is defined as”arivat pranan shrinoti hinasti iti arshah” A disease which tortures patient’s vital force (prana) as enemy is called as Arsha. Neglect of proper diet and lifestyle habits ends in reducing digestive fire (Agni) or making it abnormal called mandagni. This mandagni leads to development of GRAHANI ROGA which further developed to ARSHA ROGA.
CAUSATIVE FACTOR OF ARSHA:
Aharaja Nidana(Diet Factor)
- Heavy food items like black lentil, kidney beans – As they are difficult to digest. Cold foods and drinks – As they cause restriction of movement.
- Spicy food like pickles, sauce and food that causes burning sensation – These aggravates Pitta Dosha and causes irritation of body tissues.
Incompatible food or mutually contradictory food (like cold drink while taking hot meal) – They do not nourish the tissues and reduces immunity. - Over eating or eating good meal while having indigestion or no appetite – This will hamper the normal digestive process leading to impairment in digestion and elimination of stools.
- Excess intake of liquids of water – It dilutes the digestive fire, thereby affecting digestion
- Food which is not freshly prepared, having abnormal smell, dry.
- Grains and food those are putrefied or denatured.
- Taking food of single taste in diet regularly
- Diet taken after proper time
- Insufficient diet
- Food prepared by mixing various contradictory properties.
- Meat of cow, buffalo, goat, sheep, pig
- Sweet potato, mango, dates, milk, tubers, green leafy vegetables
- Fresh grains
- Raw vegetables especially carom seeds, ginger and garlic.
- Food substances prepared from rice, jaggery, milk, wheat
- Excess Sour and salty food item
Viharaja Nidana(Life style factor)
- Lack of physical activity or excessive physical activity or exercise in abnormal times of the day.
- Excessive indulgence in sexual intercourse or abnormal sex
- Straining at stools, urine or flatus Suppression of the urge to defecate or urinate
- Frequently washing rectum with cold water
- Frequent or excess use of laxatives or purgatives, enema
- Injury to the rectum while administering therapeutic enema
- Repeated abortion, preterm labour, pressure exerted by the growing foetus during pregnancy especially in the last trimester, straining to push the foetus during normal delivery, abnormal position of foetus, complications in delivery
- Riding on animals like horse, camel, etc. or travelling in two wheelers or bikes for long hours
- Sitting on uneven surfaces Prolonged sitting
- Excess intake of alcohol
- Sleeping immediately after meals,
- Day sleep
Literature also provides a vishesha nidana where in SAHAJA ARSHA(HEREDITARY PILES) is one such disorder hereditary transmitted to offspring. In ayurveda considered as beeja doshaja of matruja & pitruja bhavas. Sushruta in particular as given a separate nidana which is the sinful act called papa karma lead in the past life; for this we do not have any reference in modern science.
Pathogenesis of Arshas
The vitiated doshas (vata, pitta and kapha) contaminate the twak (skin), mamsa (muscle) and meda (fat) tissues and cause mamsa ankuras (fleshy masses) at the anal opening. These masses are called Arshas.
Types of Arsha
Arshas is of 6 types, they are:
- Vataja Arshas (caused by vitiated vata)
- Pittaja Arshas (caused by vitiated pitta)
- Kaphaja Arshas (caused by vitiated kapha)
- Sannipataja Arshas(caused by simultaneous vitiation of all the 3 doshas)
- Raktaja Arshas (caused by vitiated blood, bleeding piles)
- Sahaja Arshas (congenital haemorrhoids or hereditary)
Symptom of vataja arsha
Nature of arshas or pile mass:
- Shushka – dry
- Chimachimanvita – tingling sensation
- Mlaana – pale
- Shyava – blackish blue
- Aruna – yellowish red
- Stabdha – hard
- Parusha / khara – rough on touch
- Vakra – haphazard, crooked
- Mithovi sadrusha – split and broken
- Vishputita – cracks Resembling the fruits of bimbi (ivy gourd), karkandu (jujube), kharjura (dates), karpasa phala (fruit of cotton, cotton seeds), siddartha (mustard) etc
Symptoms of Pittaja Arsha
Appearance of arsha (pile mass):
- Neela mukha – blue tipped
- Rakta – red coloured
- Peeta – yellow coloured
- Asita – black coloured
- Mrudu – soft on touch
- Snigdha – unctuous
- Tanu, visra, asru visraavini – dilute, foul smelling discharges
- Shuka jihwa – shape resembling the tongue of parrot
- Yakrut khanda – shape resembling the piece of Liver
- Jalauka vaktra – resembling the mouth of leech
symptoms of raktaja arsha
Same as Pittaja Arsha.
symptoms of kaphaja arsha
Appearance of Arshas (pile mass):
- Mahamula – deep rooted mass
- Ghana – thick, heavy
- Manda ruja – mild pain
- Utsanna – swollen
- Snigdha – unctuous
- Stabdha – hard
- Vrutta – rounded
- Sthira – stable
- Pichchila – slimy
- Stimita – feeling as if covered with wet cloth
- Shlakshana – smooth
- Kandu – itching
- Sparshana priya – feels comfort on touching
- Kareera samana – shape of Capparis deciduas
- Panasasthi samana – shape of seed of jack fruit
- Gostana samana – shape of udder of cow
symptoms of sannipataja arsha
All the causes which aggravate the doshas individually taken together cause sannipataja arsha.
Symptoms – mixture of symptoms of all three doshaja arsha is appear here.
symptoms of sahaja arsha
The symptoms indicate not only that of the manifested piles but also those signs and symptoms seen from childhood or early adolescence which indicate the inherited tendency to develop piles.
- Krisha, Vivarna, Kshama, Deena – thin (emaciated), discoloured, weak, helpless right from the birth
- Prachura vibaddhaha – severe constipation with obstruction of stools, flatus and urine
- Sharkara, ashmari – develops gravel and stones in urinary tract
- Aniyata malabaddhata – unpredictable bowel changes
- Sama mala – unformed stools occasionally which comes in different colours, white,pale, green, yellow, red, reddish yellow, loose, sticky, smell of dead body, foul smell
- Shula – cutting pain in the navel region, butts, groin and urinary bladder
- Shotha – swelling in hands, legs, face and around eye sockets
- Tikta amla udgaara – sour and bitter belching
- Durbala – weak
- Durbala agni – weak digestion
- Alpa shukra – less semen
- Krodhana – anger
- Suffers from – pravahika (dysentery), romancha (horripulation), prameha (urinary disorders), vishtambha (constant constipation), antra kujana (constant presence of gurgling sounds in the abdomen), udavarta (upward movement of vayu), hrudaya upalepa (feeling of coating over the heart), indriya upalepa (feeling of coating over the sense organs), kasa (cough), shwasa (dyspnoea), tamaka shwasa (asthma), trushna (thirst), hrullasa (belching, nausea), vamana (vomiting), arochaka (tastlessness), peenasa (cold),kshawathu (excessive sneezing), timira (darkness before eyes), shira shula (headache), swara kshaya (loss of voice), karna roga (ear diseases), asthi shula (bone pains), sandhi shula (joint pains), jwara (fever), angamarda (body pains), parshwa shula (pain in flanks), udara shula (colic), prushta shula (back pain), trika shula (sacral pain), alasya (lazyness), Dukha upachaarasheela – will develop health upsets and diseases which are very difficult to manage.
ayurvedic management
Ayurveda treatment aims to help to fibrose the haemorrhoidal tissue onto the underlying anal sphincter, thus restoring support for these vascular cushions and thereby preventing complications. Although haemorrhoids are a local disease, it starts from the gastrointestinal system.
mproper functioning of Agni, that is low digestive fire leads to malformation of stools which become difficult to excrete, hence the person starts straining unconsciously to eliminate the stools from the body. Hence first line of treatment should be to correct the digestive fire using digestives and carminatives thereby restoring normal digestive process. The usage of Vata Anulomana herbs will help in downward movement of stools
thereby expelling them easily. The line of treatment of dry haemorrhoids and bleeding haemorrhoids are different. Bheshaja Aushadhi (Medicinal treatment) suggested in Ayurveda text books are conservative and the following steps are involved in the management of Haemorrhoids.
- Use of Dipana (Carminatives) and Pachana (Digestives) to correct digestive fire.
- Anulomana: Use of safe laxatives for relief from constipation
- Vrana Ropana & Shothahara: Anti-inflammatory medicines to relieve pain and Haemostatic medicines in case of bleeding haemorrhoids to arrest bleeding.
- Herbs and medicines which are wound healing, soothing the inflamed mucous layer, relieving constipation, regulating bowel movements, anti-microbial, that repairs, heals and regenerates the functions if skin, promotes skin elasticity and epithelial formation.
- Abhyanga: External application of medicated oil.
- Swedana: Fomentation using herbal bolus or fumigation
- Avagahana: Sitz bath
- Lepa: Application of herbal pastes.
- Sarpi Prayoga: Use of medicated ghee
- Takra Prayoga: Use of buttermilk
- Basti: Use of Medicated enema
- Pathya Ahara-Vihara: Resorting to wholesome diet and lifestyle