COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF KUTAJA PRATISARANIYA KSARA AND KASISADI TAILA IN THE MANAGEMENT OF ARSAS HEMORROHOIDS

Arshas has become one of the commonest health problems of the modern society. It is the foremost common disease among Anorectal disorders and the area of concern even since the Vedic periods. This disease causes discomfort and severe pain to the patient which creates problems in his daily routine. Because of its severity it is considered as one among Ashta Mahagada. As it is difficult to treat completely and because of its Svabhava which create problems to the patients as an enemy the name Arshas has been given. The food habits and life styles of modern man also added to the increase in the rate of incidence of Arshas.

Present time is the era of changing food, sedentary life style and mental stress, all these factors disturbs the digestive system resulting into many diseases. Among them one important group is  Ano-rectal diseases and Arshas is one among them. Arshas have been known to mankind since long time and one of the commonest disease to effect the human being. One of its prime etiological factor is Mityaahara-Vihara. When we observe the today’s patients, we understand that they want quick relief but at the same time not interested to undergo surgery that may give severe post-operative pain. In such conditions the alternative is Kshara Karma procedure that gives relief and the pain is insignificant.

The great Indian Surgeon Susrutha known as father of surgery has described Arshas in Susrutha samhita Nidana stana[5] 2nd chapter and its chikitsa in Chikitsa sthana 6th chapter . He considered Arshas as one of the Astha Mahagadas means diseases which are very difficult to treat. Arshas causes troublesome pain for patient like enemy, which afflicting mankind for thousands of years[7]. According to Madhavakara, the disease which kills a man like an enemy is called Arshas. The present lifestyle is adding to the prevalent rate of this disease.

This condition can be correlated with Haemorrhoids in modern medical science, in which dilated veins within the anal canal in the sub epithelial region formed by radicals of superior, middle and inferior rectal veins. Haemorrhoids are engorgement of the Haemorrhoidal venous plexus, characterized by bleeding per rectum, constipation, pain, prolapse and discharge.

Depending on grade of prolapse , Haemorrhoids can be divided into 4 degrees :

1.                First degree     : Haemorrhoids within that may bleed but does not come out of anus.

2.                Second degree : Haemorrhoids come out only during defecation and gets reduced

Spontaneously.

3.                Third degree    : Haemorrhoids come out only during defecation and do not return by themselves, but need to replaced manually and then they stay reduced.

4.                Fourth degree  : Haemorrhoids are permanently prolapsed with great discomfort and feeling of heaviness in the rectum[1].

It is manifested due to improper diet, prolonged standing and faulty habits of defecation causing derangement of tridoshas, mainly vata dosha. Vitiated doshas localizes in gudhavali pradhana dhamani and mamsadhara kala and vitiates twak, mamsa and raktha, resulting in annavaha srotho dushti. These vitiated doshas moves in downward direction, reaches guda and produces sprouts of muscle in gudavali. These sprouts are called Arshas.

In Charaka samhitha, Charakaacharya has given more emphasis on the conservative treatment and prescribed suitable diet regimen with drugs, further he also advised kshara karma treatment for different types of arshas.

In Sushruta Samhita, Acharya Susrutha has mainly narrated the four types of treatment modalities in sushruta samhitha chikitsa sthana in Arshachikitsa for successful management of Arshas viz., Bhesaja [Internal and external medications], Shastra [Surgical methods], Kshara [Caustic cauterization], and Agnikarma [Thermal cauterization].[6]

Susrutha, while describing the preparation of kshara, emphasized on the procedure of kshara karma and mentioned that arshas which are Mridu,Prasrutha,Avagadha,Uchrita should be treated only by kshara karma. The effect of kshara is praised so much that it can replace sastrakarma as it does the functions of Chedana, Bhedana, Lekhana karmas without using the sastras[surgical instruments]. Among the four treatment modalities in Arshas mentioned by susrutha, kshara karma and Agnikarma are considered as para-surgical procedures.

Despite of many more modern treatments like Rubber band ligation, Sclerotherapy, Photocoagulation, Cryosurgery, Haemorrhoidectomy, etc., Ayurveda is well known for the treatment of Arshas for its negligible rate of recurrence, cost effective, less chances of pain, Haemorrhage, infection and anal incontinence.

In Sushruta Samhita, Sutrastana  “Ksharapakavidi  adyaya” mentioned 23 kshara dravyas, Kutaja is the  first one among them[4]. Here I would like to prepare kshara with KUTAJA (bark), In  this clinical study kutaja kshara will be take into consideration for local application directly on the arshas.