Role of Chitraka Pratisaraneeya Kshara in Abhyantara Arshas w.s.r. to Internal Hemorrhoids - A Single Case Study

K Anushree; Prashanth K

doi:10.21760/jaims.9.12.35

Role of Chitraka Pratisaraneeya Kshara in Abhyantara Arshas w.s.r. to Internal Hemorrhoids - A Single Case Study

K Anushree^1*, Prashanth K²

DOI:10.21760/jaims.9.12.35

^1* K Anushree, Post Graduate Scholar, Dept of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

² Prashanth K, Associate Professor, Dept of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

Haemorrhoid is caused by increased pressure and abnormal dilatation of the hemorrhoidal vascular plexus. Today it remains the most common anorectal disorder and more than half of people will at some point develop symptomatic haemorrhoids. Various management strategies need to be considered to ensure the success of therapy and improve the quality of life of patients with internal haemorrhoids. Kshara Karma is a unique, minimally invasive procedure in Ayurveda mentioned by Acharya Sushruta. A 54-year-old female admitted with a complaint of bleeding per anus and was diagnosed as Internal haemorrhoid and underwent Kshara Karma with no complications.

Keywords: Arshas, Chitraka, Pratisaraneeya Kshara, Internal Hemorrhoids, Piles, Ano-rectal disorders, Ayurveda

Corresponding Author	How to Cite this Article	To Browse
K Anushree, Post Graduate Scholar, Dept of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India. Email:	K Anushree, Prashanth K, Role of Chitraka Pratisaraneeya Kshara in Abhyantara Arshas w.s.r. to Internal Hemorrhoids - A Single Case Study. J Ayu Int Med Sci. 2024;9(12):266-269. Available From https://jaims.in/jaims/article/view/3877/

Introduction

Hemorrhoidal disease is a pathological condition due to the abnormal engorgement of the vascular plexus beneath the anal mucosa. Today it remains the most common anorectal disorder and is frequently encountered in primary care clinics, emergency wards, gastroenterology units and surgical clinics. More than half of all people will at some point develop symptomatic haemorrhoids.^[1] The reported prevalence is about 4.4% to 36.4% of the general population, with peak prevalence occurring in individuals aged 45 to 65 years.^[2] Hospital based proctoscopy studies show 86% of patients with haemorrhoids experience symptom.^[3] Approximately one-third of patients with haemorrhoids seek medical advice and 5%-10% do not respond to conservative treatments, necessitating surgical intervention.^[2] Multiple community-based studies have reported the prevalence of rectal bleeding ranging from 13% to 34%. Patient frequently complains of painless bright red bleeding that occurs during defecation often associated with constipation, prolapse and mucous discharge.^[4] Although it is a non-threatening condition, it impacts one’s lifestyle, mental health and social well-being. Therefore, comprehensive management is essential to ensure the long-term quality of life for individuals affected by haemorrhoids.

Guda Vikara is increasing due to low fibre diet, straining on bowels, travelling or prolong sitting and suppression of urine, flatus or bowel. As per Ayurveda, anorectal disorders are caused by Mandagni, leading to Vibandha which is considered as the root cause of Arsha.^[5] Arshas which are Mridu (soft), Prasruta (spread), Avagada (deep), Uchritha (elevated) should be treated by Kshara Karma which can replace Shastra Karma, as it does the functions of Chedana, Bhedana and Lekhana Karma.^[6] In this study, Abhyantara Arshas was treated with Chitraka Pratisaaraneeya Kshara.

Case Report

The case study was undertaken in SDM Ayurveda Hospital, Udupi, Karnataka. A 54years old female who is a homemaker presented with complaints of recurrent episodes of bleeding per rectum since 1 year and increased bleeding with constipation since 2 months.

History was not significant for pain, protrusion, mucus discharge and any other medical illness or surgery. Anorectal examination and proctoscopy revealed a normotonic anal sphincter with a 1^st degree Internal haemorrhoid at 7 o’clock position.

Investigation:Her preoperative blood and urine tests were unremarkable. Preoperative ECG showed no abnormality.

Diagnosis: Pittaja Abhyantara Arshas (1^st Degree Primary Internal Haemorrhoid)

Therapeutic Intervention: Surgical Intervention

Chitraka Pratisaraneeya Kshara applied in a single setting over Internal haemorrhoid at 7 o’clock position under IV analgesia (Inj. Tramadol).

Patient was detailed regarding operative procedure and an informed consent was taken. Preoperative procedures carried out like s/w enema, preparation of perianal part, 6hrs nil oral and administration of pre-medication. Patient made to lie in lithotomy position, prepping and draping done.

Lubricated slit proctoscope introduced, positioned against pile mass and measured using measuring stick designed to measure length of pile mass. Chitraka Kshara was applied to Internal haemorrhoids at 7 o’ clock position and kept for Vaak Shatamatrakala (62sec). The Pile mass turning into blackish colour (Pakwajambuphala Varna) confirmed adequacy of treatment.

Kshara was neutralised by cleaning pile mass with freshly prepared Lemon juice (Nimbu Swarasa). Proctoscope removed after application of Yashtimadhu Ghrita and dry dressing done. Patient was advised oral fluids after 3hrs followed by bland diet.

Internal medications like Tab. Kaishora Guggulu 450mg 1tid, Tab. Gandhaka Rasayana 250mg 1 tid and Swadishta Virechana Churna 50gm 1/2tsp HS with lukewarm water were prescribed.

Observations and outcome

The patient responded well to the treatment. Chitraka Kshara was found effective in obliterating the haemorrhoid mass within 8 days of application and no mass was seen thereafter till follow up period. There was mild pain and no per rectal bleeding. Anal tone was normal.

Consistency of stool was normal after 8^th post operative day. Oral medicines were continued and no complications were noted in 2months follow up period.

Observation	BT	1st day	8th day	15th day	21st day	Follow-up 45th day
PR bleeding	Severe->3drops	Mild-2drops	No	No	No	No
Mucous Discharge	Mild	No	No	No	No	No
Pain	Moderate	Moderate	Mild	No	No	No
Degree of haemorrhoid	1st degree	Thrombosed 1st degree	Nil	Nil	Nil	Nil
Consistency of stool (Bristol stool chart)	Type 2	Type 2	Type3	Type 3	Type 3	Type 3
Complication if any	No	No	No	No	No	No

Figure 1: State of pile mass

Figure 2: Application of Kshara

Figure 3: Cleaned with Nimbu Swarasa

Figure 4: Pakwajambuphala Varna

Figure 5: Healthy granulated wound

Discussion

Arshas is considered as one among the Ashtamahagada.^[7] This case was diagnosed as Pittaja Arshas which is small, purplish, moist mass with bleeding on defaecation. Acharya Sushruta has mentioned Chaturvidha Sadhanopaya in treatment of Arshas and Kshara Karma is one among them. It is indicated when Arshas Ankura is Mridu, Prasruta, Avagada and Uchritha.^[8] Chitraka is one of the drugs mentioned for the preparation of Kshara which has Katu Rasa, Ushna Veerya, Arshohara, Lekhana and Krimighna property.^[9]

Application of Kshara i.e. a caustic herbomineral compound, causes thrombosis of the hemorrhoidal tissue followed by necrosis and sloughing out. The inflammation that follows results in fibrosis and resolution. Oral medications such as Kaishora Guggulu have predominance of Tikta Rasa and hence pacifies Pitta, reduces Kleda Guna of Rakta and also has Lekhana, Shodhana, Vranahara properties. It has analgesic, anti-inflammatory properties.^[10]

Gandhaka Rasayana having Katu Rasa and Ushna Veerya is a Rasayana and has Tridosha Shamana, Vranahara, Jantughna and Shoolahara properties.

It has analgesic, anti-nociceptive and anti-inflammatory properties helping in post-operative pain management.^[11]

Swadishta Virechana Churna has laxative property which helps in making stool passage smooth with decrease in straining during defecation.^[12]

Conclusion

A single case study of Chitraka Pratisaraneeya Kshara was found effective in treating 1^st degree Internal Haemorrhoid within 8days of application and no complications were seen in 2 months follow up period. Application of this Kshara can be an effective alternative to conventional surgical procedures. Combination of Kshara Karma, oral medicines, diet restrictions and life style modifications suggested are effective in curing the haemorrhoid in the initial phase itself and preventing its recurrence.

References

1. Villalba H, Abbas MA. Hemorrhoids: Modern Remedies for an Ancient Disease. Perm J. 2007;11(2):74–6.

2. Sakr M, Saed K. Recent advances in the management of hemorrhoids. World J Surg Proced. 2014;4(3):55-65. Available from: http://www.wjgnet.com/2219-2832/full/v4/i3/55.htm.doi: 10.5412/wjsp.v4.i3.55.

3. Madoff RD, Fleshman JW. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. 2004;126:1463–1473.

4. Das S. The Rectum and Anal Canal. A Concise Textbook of Surgery. 11th ed. Kolkata: S Das; 2020. p. 1074-1077.

5. Mudgal H, Kumar PH. A Clinical Study on The Efficacy of Vasa Pratisaraneeya Teekshna Kshara in The Management of Abhayantara Arsha/ Haemorrhoid. Int J Ayurveda Pharma Res. 2020;8(Suppl 1):57-61.

6. Acharya YT, editor. Sushrutha Samhita of Sushruta, Sutrasthana: Ksharapakavidhi Adhyaya, Chapter 11, Verse 6. Varanasi: Chaukambha Orientalia; 2019. p. 46.

7. Shastri HS, editor. Ashtanga Hridaya of Vagbhata. Nidanasthana; Arshonidana, Chapter 7, Verse 1. Varanasi: Chaukhamba Surbharati Prakashan; 2014. p. 490.

8. Acharya YT, editor. Sushrutha Samhita of Sushruta. Chikitsasthana; Arsha Chikitsitopakrama, Chapter 6, Verse 3. Varanasi: Chaukambha Orientalia; 2019. p. 430.

9. Pandey GS, editor. Bhavaprakasha Nighantu of Bhavamishra. Purvakanda; Haritakyadi Varga, Chapter 1, Verse 70-1. Varanasi: Chaukambha Orientalia; 2010. p. 21.

10. Gupta V, Mata VS, Bansal P, Lather A, Gupta V, Sahu M, et al. An Ayurvedic Polyherbal Formulation Kaishore Guggulu: A Review. Int J Pharm Biol Arch [Internet]. 2011;2(1):497–503. Available from: https://www.researchgate.net/publication/285511210

11. Deshpande R, Prakash NS, Swaroop M, Muralimohan M, Shetty A. A randomized controlled trial to evaluate the effect of Gandhaka Rasayana rectal suppository in postoperative pain management in ano-rectal disorders. J Ayurveda Integr Med [Internet]. 2022;13(1):100485. Available from: https://doi.org/10.1016/j.jaim.2021.07.001.

12. Navthale HA, Bhaltadak MB, Thenge RR, Shinde SA, Adhao VS. Formulation and Comparative Standardization of Polyherbal Swadisht Virechan Churna. Am J Pharm Health Res. 2018;6(10):30–42.

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Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-11-08	2024-11-18	2024-11-28	2024-12-09	2024-12-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	13.36

Case Report

Internal Hemorrhoids

Journal of Ayurveda and Integrated Medical Sciences

Role of Chitraka Pratisaraneeya Kshara in Abhyantara Arshas w.s.r. to Internal Hemorrhoids - A Single Case Study

K Anushree1*, Prashanth K2

Introduction

Case Report

Observations and outcome

Discussion

Conclusion

References

K Anushree^1*, Prashanth K²