Arśa (piles) according to Caraka

Maharṣi Caraka discusses disease of Arśa and treatment of piles or Arśa-cikitsā. Piles occur when all the black, reddish veins in the lower intestinal tract, i.e., the anus, are blocked for some reason and the edges become swollen. Piles are all tiny little abscesses. Piles can occur on the outside of the anal lips and also on the inside. The first of the two types of piles are hereditary or congenital, i.e., the first type of piles originates from the seed defect in the parents and the second type of piles are originated from the Karma of pre-birth of the child. Haemorrhoids are a type of flesh growth. The origin of piles is said to be that all type of piles is located in the space of four and half aṅgulas. That part of the intestine is divided into three parts. These three parts are the location of piles. Valitraya are Prabāhaṇī, Visarjjanī, Saṃbaraṇī. The other places of piles are penis, vagina, throat, palate, mouth, nose, ear, eyelids, and skin. According to Ācārya Caraka, the first vali is the external vali or the lips of the anus. medas, māṃsa and tvak (skin) are the adhiṣṭhānas of all types of piles^[1].

Etiology and pathogenesis of acquired piles are: intake of heavy, sweet, cool, Abhiṣyandī, vidāhi and viruddha food; indigestion, intake of small quantity of food, and unwholesome food; Intake of the flesh of cattle, fish, pig, buffalo, goat and sheep; intake of dried meat and putrefied meat; intake of parasites, paramānnna, milk, whey, māṣa, sugarcane juice, oil cake; intake of heavy fruits, vegetable; wrong application of enema therapy; lack of exercise; sleep during day time etc., and suppression of manifested urges; miscarriage, pressure of the pregnant uterus and abnormal delivery in case of women etc. Due to the all these reasons, the Apāna vāyu gets aggravated, brings down the accumulated waste products and so afflict the anal sphincters. Because of this, piles are manifested in the sphincters.

Table: 3 Describes of Different types of Piles^[2]

Sl. No.	Type	Definition	Characteristics features	Shape	Cause
1	Vātaja-piles	Dry, pale, hard, wrinkled, rough, ununctuous and greyish colour, sharp tips, curved, cracks on the surface, and spread irregularly; pain, itches, numbness etc.; as well as pain in the penis cells, in the groin, and weakness in the heart, etc.; and when ailments like sneezing, headache, coryza, fainting, loss of appetite, sore throat, etc. are produced; these symptoms are called Vātaja piles.	Blackish growth pointed tip, irregular.	Like Sarṣapa	Eating astringent, pungent, bitter, ununctuous, cold and light foods; habitual intake of food in extremely small quantities, intake of alcoholic drinks sharp quality and excessive sexual intercourse, exercise, etc.
2	Pittaja-piles	The mass of piles is soft, flabby, delicate and tender to touch; red, yellow, blue, or black in colour; sweat, Kleda, raw flesh glands, easy bleeding, burning, kaṇḍū, pain and needle pain; these symptoms are called biliary piles.	Reddish, yellowish, bluish, blackish, growth, bleeding, yellow discharge	Like Tinduka, Guñja, Bimbi, Badara etc.	Intake of pungent, hot saline and alkaline food; exercise and exposure to the heat of fire and the sunray; intake of alcohol and envy etc.
3	Kaphaja-piles	The mass of piles is large in size, swollen, smooth, painless of touch, unctuous, white, pale white, slimy, having stiffness, heavy, rigid, benumbed, having constant oedema and excessive of itching; sweat, reddish and slippery discharge, excrement heavy, slippery and white; these symptoms are called Khapaja piles.	Pale or white growth, moist, with itching, continuous discharge of whitish colour or discharge is mixed with blood.	Like cows, udder (gostana), aṅguṣṭha, etc.	Excessive consumption of cold, salt, alum and guru products, lack of physical exertion, day-dreaming, happiness emanating from sleep, etc.

(Source: Synopsis on Caraka Saṃhitā)

All types of piles have involvement of all three doṣa, but depending on predominance of one doṣa, it is of eight types, namely, vāta, pitta, kapha, Sannipāta, vāta-pitta, pittakapha, vāta-kapha congenital.

Premonitory signs and symptoms in the development of piles are -Viṣkambha of the food, weakness, gurgling sound in the lower abdomen, emaciation, vomiting, exhaustion in thigh, stool deficiency, Grahaṇī disease, vitiligo and stomach ailments. Tridoṣas can get predominantly aggravated for the causation of this disease. It is the predominance of the aggravated doṣa or dosas which determines the various types of piles. Five kinds of vāyu, Pitta, and phlegm all these morbid factors in their aggravated from afflict the three anal-sphincters, as a result of which piles are manifested. For this, piles are painful and are associated with several complications. they afflict the entire body, and generally, these are difficult to cure.

Prognosis symptoms of piles are as follows: piles associated with pain in the cardiac region, oedema in hands, feet, face, navel, anus, and scrotum, and if the patient suffers from pain in the cardiac region and in the sides of the chest, then he is incurable. Piles which are hereditary involves three doṣa and is located in the internal fold of the anus are to be determined as incurable.

Piles are caused by the involving vitiation of two doṣa and situated in the second fold, and is one year old. Then such patients are difficult to cure. Piles in the external fold, caused by one aggravated doṣa, and if they are not very chronic, then such a patient is easily curable.

Prodromal symptoms of piles are as follows: Indigestion, general weakness, gurgling sounds in abdomen, emaciation, excessive eructation, weakness in legs, anaemia, abdominal disorders.

Piles doctors have divided piles into two parts. For example, piles which are caused by the predominance of aggravated Vayu and Kapha, are called dry piles or non-bleeding piles. Piles which are caused by the predominance of aggravated rakta, are called wet piles or wet piles or bleeding piles.

The following general treatment of non-bleeding piles has been said to be: oleation, fomentation and sitz-bath, fumigation with human hairs, serpent's slough, arka roots and Sami leaves should be used for piles. Tumburu, Viḍaṅga, Devadāru, Ātava Taṇḍula, Ghṛta, Bṛhatī, Aśvagandhā, Pipula, Surasatulsī etc., are used for Fumigation.

Also, Śirīṣa seeds, Jujube, Pipula, Saindhava, Molasses, Ākanda latex, Manasā latex, Triphalā are crushed together and should be used as ointments in the treatment of piles. Fifteenth addition is applied to destroy piles. For example, soaking Harītakī with cow’s urine overnight, it should be given along with molasses the next day; Harītakī along with butter-milk, Triphalā along with butter-milk etc.

Takrāriṣṭra which is very delicious, stimulates digestion, improves appetite for food, promotes complexion, helps in the downward movement of Kapha and Vayu, cures swelling, itching and pain in anus and promotes strength.

Curd and Butter-milk are the best medicine in dry piles. Butter-milk is of three types, as follows: one from which fat is completely removed; one from which half of the fat is removed; one from which fat is not at all removed. The first variety of Butter-milk is useful if piles are caused by the predominance of Kapha, if the power of digestion is extremely weak, and if there is the strength is low. The second type of butter-milk is useful if piles are caused by the predominance of Pitta, if the power of digestion is moderate and if the patients have moderate strength. The third type of butter-milk is useful if the piles are caused by the predominance of Vayu, if the power of digestion is strong and the patient has enough strength. As last resort, bloodletting is adopted.

The physician should overcome piles by the use of different types of fried vegetables, Yavāgū, vegetable-soup, meat-soup, Khaḍa, milk and butter-milk.

Piles treatment is done with Pippalyādi Ghṛta, Cavyādi Ghṛta various vegetables such as Trivid, Dantī, Palāśa, Āmrul and Citā which is fried in vegetable oil and ghee along with curd.

Piles treatment is done with leafy vegetables i.e., Vīrā, Jīvantī, Śaṭī etc. And also applied meat-soup. This should be prepared by Godha, Lopaka, Mārjāra, Śvavit, Uṣṭro, Cow, Kūrma and Śallaka. Along with meat-soup, red variety of Śāli rice should be given for the Alleviation of Vayu. Piles are also cured by application of Anuvāsana type enema, Niruha type of enema. Used to cure non-bleeding piles to applied Abhayāriṣṭa, Dantyāriṣṭa, Phalāriṣṭa and Kanakāriṣṭa.

Line of treatment of bleeding piles are: Not to arrest bleeding initially; then advice bitter drugs, to cheek bleeding and improve digestion. Purgation intake of powder of Pāṭhā, Indrayava, Śuṇṭhi, Bilva. Used formulations to cure for piles are, namely, Kuṭajādirasakriyā, Hrīverādi-ghṛta, Picchā basti onion with butter milk; Masūra with butter milk; rice, green-gram, Hrīverādi-ghṛta or Suniṣaṇṇaka-ghṛta.

The patient is first covered with cold oil and then bathed with honey, Mrinal, Padmakāṣṭha, Raktacandana, Kusa and cough decoction to control the Piles. Then the patient is covered with fancy plantain leaves or cool water-soaked lotus leaves or blue leaves. If the bleeding does not stop due to all these cold actions, the haemorrhoid patient has to apply tarpan with soft meat. In addition, bleeding-piles are added to the massage, Picchābasti and Siddhabasti.

Intake of following drugs to cure piles are, namely, Bhallātaka for non-bleeding piles and Kuṭaja for bleeding piles. Butter-milk helps digestion, when used singly, or mixed with other drugs should be taken for a week, ten days, fortnight, or a month.

The following symptoms are due to complication of improper kṣāra and agni karma: loss of sexual potency, swelling in anorectal region, retention of various urges, distension of abdomen, severe pain in the abdomen, haemorrhage, prolapse of anus and immediate death^[3].

Footnotes and references:

[1]:

sarveṣāṃ cārśasāṃ kṣetraṃ-gudasyārdhapañcamāṅgulāvakāśe tribhāgāntarāstisro gudavalayaḥ kṣetramiti; kecittu bhūyāṃsameva deśamupadiśantyarśasāṃ-śiśnamapatyapathaṃ galatālumukhanāsikākarṇākṣivartmāni tvak ceti | tadastyadhimāṃsadeśatayā, gudabalijānāṃ tvarśāsīti saṃjñā tantre'smin | sarveṣāṃ cārśasāmadhiṣṭhānaṃ-medo māsaṃ tvak ca ||(C. Cikitsāsthāna–XIV.6); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 417.

[2]:

C. Cikitsāsthāna–XIV.5-248; Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, pp. 416-449.

[3]:

C. Cikitsāsthāna–XIV.5-248; Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, pp. 416-449.