A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFECT OF ARKA KADALI AND APAMARGA PRATISARANIYA KSHARAKARMA IN THE MANAGENMENT OF ABHYANTARA ARSHA vis a vis INTERNAL HAEMORRHOIDS

Arsha is a protrusion of mamsa which obstructs gudamarga and torture the person like an enemy. Arsha is one among Ashta mahagadha as it is deergakalanubandi and dushchikitsya in nature and involves guda pradesha which is sadyo prana hara marma. Etiology being indulging in mithya ahara and vihara produces mandagni, and later aggravated doshas enters guda and vitiates gudavalis to form mamsapraroha called as Arsha".

Ksharakarma is one of the four treatment modalities mentioned in chikitsa of Arsha. It is indicated in the Arshas which are mridu, prasrita, avagada, uchchhrita Haemorrhoids are dilated veins within the anal canal in sub-epithelial region formed by radical of superior, middle, inferior rectal veins.Normally anal cushions helps in maintenance of the anal continence and sliding of anal cushion abnormally is called as Haemorroids". Globally incidence ranges from 50-80% and in India it affects around 75% of population" Internal pile is a natural consequences of adaptation of erect posture of mankind Clinical features are bleeding. mass per anus, prolapsed, discharge, pruritus-ani, pain Treatment includes more liquid intake and fiber diet. Medical measures are local applications, sitzbath, laxatives, analgesics. Parasurgical measures includes Sclerotherapy, Banding, Cryotherapy, IRC, Laser therapy, DGHAL. Surgical measures are Hemorrhoidectomy, Staple Haemorrhoidectomy

These interventions have complications like Hypochondric pain, pelvic abscess, severe pain, secondary hemorrhage, ulceration, incontinence, injury to sphincter, retention of urine, anal stricture, anal fissure and recurrence is also common.

Hence there is always a need for cost effective, simple treatment for Arshas. Pratisaraniya teekshna ksharakarma has very low rate of recurrence and it causes less pain, less bleeding, less chances infection with no anal incontinence. Arka and Kadali are mentioned as kshara dravys by sushruta in kshrapakavidiadyaya. Arka has gunas like vranaropana, vranashodana, kandugna, kaphashamana arshogna Kadali kanda has gunas like kaphapittahara, raktashamaka. Hence combination of these two Kshara Dravyas i.e., Kadali and Arka is selected in the present study in the management of Abhyantara Arshas by Pratisarana kshara karma.