A comparative clinical study on the efficacy of Apamarga Teekshna Kshara application and Sclerotherapy in Arsha w.s.r to 1 st and 2 nd degree Heammoroids - An open labeled, randomized, controlled clinical trial.

Methodology:

·         Study design: Randomized control clinical study.

·         Grouping: Patients shall be allotted into two groups by computer generated randomization chart.

Pre- operative procedures in Group A and Group B:

Ø  Enemawill be given in the before surgery.

Ø  Written informed consent will be taken before surgery.

Ø  Lignocaine 2 % sensitivity test will be done (0.1ml intradermal).

Ø  Inj. Tetanus Toxoid 0.5 ml intramuscular will be given to each patient.

Ø  Local part will be prepared (local shaving) before operation.

Operative procedure:

GROUP-A: (Apamarga Teekshna Kshara Application): Minimum 30 patients will be treated by Apamarga Teekshna Kshara application.

Methodology: In Lithotomy position, Under Local anesthesia with 2% xylocaine and adrenaline solution, the slit proctoscope will be inserted and confirm the position of Hemorrhoids. The hemorrhoidal mass will be cleaned with normal saline and the Apamarga Theesksna Kshara will be applied on Hemorrhoidal mass. After 100 matra kala when the hemorrhoidal mass turns into Pakwa Jambu Phala Varna. The Kshara will be washed out with Citrus juice.

GROUP-B :( Sclerotherapy): A minimum of 30 patients will be treated by sclerotherapy.

Methodology: In Lithotomy position, Under Local anesthesia the slit proctoscope will be inserted and confirm the position of Hemorrhoids. The Sclerosant solution (Inj 3 % Polidocanol) will be injected through a very fine needle directly into the submucosa of hemorrhoids. This procedure will be performed under the supervision of General Surgeon of  Mahagujarat Hospital, Nadiad, Gujarat.

Post operative: General Management in both the groups: (for 15 days)

·         Vital data like TPR, BP will be monitored and recorded.

·         Hot sitz bath was advised with 4 L of Panchavalkala Kwatha twice a day.

·         Triphala guggulu 500 mgwill be given twice a day after meal with luke warm water.

·         Eranda Bhrushta Haritaki Churna 5 g will be given at night with luke warm water.

·         10 ml Jatyadi Taila Matra Basti will be given in the morning.

·         Antibiotic (Tablet amoxicillin 500mg + potassium clavulanate 125mg 1 tablet after food twice a day) will be given in the initial 5 days.

· Dietary regimen

The patients will be directed to follow dietary restrictions according to the etiology of hemorrhoids. Apart from this, all the patients will be restrained from strong and spicy foods, coffee, tea, increased quantity of milk and milk products, condiments, and other food items. And advised to take a regular and proper fibrous diet with adequate quantity of water.

 Observation and Follow-up: Patient observation will be done on 1st, 7th, 14th, 21st and 28th day of treatment and follow up after 1 months of treatment.