Abstract

CLINICAL EFFECT OF APAMARGA KSHAR PRATISARAN ALONG WITH PILUPHAL SHUKTAPAN IN THE MANAGEMENT OF ABHYANTAR ARSHA (INTERNAL HAEMORRHOID): A CASE REPORT

Dr. Sahili H. Gharde*, Dr. Dinesh I. Rathi, Dr. Chandrakant A. Dhanokar, Dr. Priyanka P. Sawai

Abstract

Haemorrhoids are one of the most prevalent anorectal disorder commonly seen in clinical practice characterized by bleeding per rectum, constipation, mass per anum, a mucoid discharge, pruritus and pain may be due to prolapsed haemorrhoid. In Ayurveda, the symptoms of haemorrhoids can be correlated with Arsha vyadhi. The management of haemorrhoids include medical, office based method and surgical approaches. As per the available treatment modalities of Arsha, the Ksharkarma modality is the best one. Apamarga Kshara is considered as theconvenient, easy adoptable and cost effective parasurgical treatment for internal haemorrhoids. It is a type of chemical cauterization. The ksharkarma method of treating piles had described in detail in ancient text Sushruta Samhita. Similarly, Piluphalshukta which is mentioned in Ashtang Hridaya is also used in the treatment of Arsha. A 42 year old male patient presented with a complaint of mass per anum, bleeding during defecation, constipation and mild discomfort. Patient was diagnosed with second degree internal haemorrhoids. He was managed by conservative treatment but did not get rid of the treatment. So, Ksharkarma was adviced to the patient. Patient was treated with Apamarga kshar pratisaran locally at 3, 7 and 11 o’clock position and Piluphal shuktapan (20 ml) internally for 15 days. Follow up taken after 7 days. Assessment of patient done before and after treatment based on subjective and objective parameters including Gudagata Raktastrava, Vedana, Gudakandu, Malavashtambha and Gradations of haemorrhoids based on prolapsed. During the follow up period, he noticed marked reduction in bleeding and constipation both in the first and second week. During the 3rd week of follow up, on proctoscopic examination there was a regression of haemorrohidal mass. This present case was treated successfully with therapeutic approach of Pratisarneeya Apamarga kshara along with Piluphal shuktapan in the management of Abhyantar Arsha w.s.r.to internal haemorrhoid.

Keywords: Apamarga kshara pratisaran, Piluphal shuktapan, Abhyantar Arsha, Internal haemorrhoid, Ksharkarma.