Abstract

A COMPREHENSIVE REVIEW ON THE MANAGEMENT OF ABHYANTARA ARSHA W.S.R. TO INTERNAL HEMORRHOIDS

Dr. Avinash Kumar Singh*, Dr. Ashutosh Upadhyay, Dr. Elizabeth P. John

.

Abstract

Background: Arsha (piles / hemorrhoids) is a common ano-rectal disorder described in classical Ayurveda as a Mahagada (major disease). Abhyantara Arsha refers to internal hemorrhoids, i.e. dilated veins in the anal canal that do not prolapse externally or are internal in location. Current incidence is rising, likely due to sedentary lifestyles, poor diets, habitual straining etc. Objective: To review classical Ayurvedic theory and modern clinical studies of Abhyantara Arsha, including etiopathogenesis, classification, signs-&-symptoms, diagnostic methods, Ayurvedic treatment modalities (Bhaishajya, Kṣāra karma, Agni karma, Śastra karma etc.), the evidence base for various treatments, comparative efficacy, safety, and gaps in knowledge. Methods: Survey of Ayurvedic classical texts (e.g. Sushruta Saṃhitā, Charaka Saṃhitā) for theoretical foundations; review of recent clinical studies, case reports, comparative trials and review articles; searches of modern Ayurveda journals for studies specifically on internal hemorrhoids / Abhyantara Arsha; evaluation of treatments used and outcomes reported. Results: Classical sources describe Arsha with etiological factors (diet, habit, Vāta-Pitta vitiation, Dūṣya involvement, Dhātu weakness etc.), classification (internal/external/mixed; bheda like Ardra, Raktarsha etc.), and multiple treatment options. Recent clinical studies show that Kṣāra Karma (various plant-based ksharas like Kutaja, Apamarga, Palasha, Chitraka etc.) are effective in reducing bleeding, size of hemorrhoidal mass, pain; some case reports of conservative internal medicine, local ointments, herbal formulations. Comparative studies (e.g. Apamarga vs Palasha kṣāra) show significant differences in certain efficacy parameters. While many patients show early symptomatic relief, long-term follow up data are limited. Safety is generally acceptable, though improper application or strength may cause discomfort. Gaps include standardization of doses, rigorous RCTs vs surgical procedures, histopathological assessments, recurrence rates, and consensus treatment protocols. Conclusions: Abhyantara Arsha is treatable effectively using Ayurvedic modalities, especially Kṣāra Karma and internal medicines, given appropriate case selection, preparation, and technique. To integrate more fully with evidence-based healthcare, further well-designed clinical trials, standardization, long-term follow-ups and comparative studies are needed.

Keywords: Internal Hemorrhoids, Kshara karma, Mahagada Abhyantara Arsha, Ayurveda.