Effect of topical application of triphala kumari kalka in third and fourth degree haemorrhoids

This study evaluates the effect of a classical Ayurvedic formulation Triphala Kumari Kalka in managing advanced stages of Arsha like third and fourth degree hemorrhoids through topical application. Both ingredients are well documented in classical texts Charaka Samhita and Bhaishajya Ratnavali in the context of Arsha Chikitsa for their Shothahara or anti inflammatory and Ropana or wound healing properties. The study follows a non randomized, single arm, open label, pre post design in a well defined group of patients. The intervention is classical, safe and does not require surgical intervention, which makes it a promising conservative alternative. Proper ethical clearance has been obtained and patient consent will be taken in written form. Equal quantity of Haritaki, Vibheetaki and Amalaki are made in to fine powder. Mix it with equal quantity of freshly collected pulp of Aloe Vera, till it attain a paste form. Patient in lithotomy position. Clean the haemorrhoid mass and perianal region with Triphala kashaya.Prepared Lepa apply on the surface of the haemorrhoid mass in 6.5mm or ¼ angula thickness. Cover the same with sterile cotton pad. Lepa will be kept in Situ till next defecation or for 1 hour. Internally 1 tsp Triphala choornam with warm water provided as BID. Outcome measures include pain, bleeding per rectum, prolapse size, burning sensation and pruritus ani. Continue the treatment twice daily for 21 days. Assess the parameters on 0th day, 5 th day, 10th day, 15th day and 22nd day. Follow up on 45th day. During visit patient will be assessed on clinical features listed in the assessment criteria and also will be clinically examined and the same will be documented.