Introduction

Ayurveda serving the mankind since long time with the aim to provide healthy status to healthy individual and to cure the diseases. It has immense potential to solve many challenging and unsolved problems of the medical world among them Arsha is one such grave disease.It is the science which deals human being for their physical,mental and spiritual health.Ayurveda is giving the ideal way of living being and it has skillful knowledge.it has eight major branches. these branches are collectively known as AshtangAyurveda.ShalyaTantra is the best amongst all branches of AshtangAyurveda.Arsha is mentioned in all classical texts of Ayurveda.According to AyurvedaAcharyaSushruta and AcharyaVaghbhata described ArshainAshtamahagada.in ayurvedic literature gives some various synonyms e.g.Durnamakam, Gudakila,Gudankur etc. 1 Many diseases cause due to our daily day to day changing lifestyle, our dietary habit, Vegavarodh2 and increase stress etc.3. which leads to ‘Agnimandya’. Agnimandya is the major causative factors for Arsha.4 AcharyaSushruta has described that the person who does not follow the Aaharvidhi gets his food in Vidahi in nature which leads to Agnidushtiand it is the root causes of all disease. AacharyaSushruta the father of surgery had described the six types of Arsha:Vataj, Pittaj, Kaphaj,Raktaj,Sannipataj and Sahaj in detail7.He described four types of treatment of Arsha– Bheshaj (medical management), Kshar (alkaline preparation of medicinal herbs), Agni (cauterization), and Shastra (surgery) 8.Arsha can be correlated with haemorrhoid in modern science.

NEED OF STUDY:

In today’s lifestyle, May patient refuses for surgical treatment because of its postoperative complications and expenditure. Ksharkarma is substitute of surgical instruments because they can be used safely on the patients who afraids of surgery. KsharPratisaran means application of Kshar locally. It produces local inflammation and induces fibrosis in haemorrhoid. So haemorrhoidal mass will shrink and reduces its size. It can be done especially Arsha which are Mrudu (soft), Prasruta (extensive), Avagadha(deeply situated), Uchrita (projected)14 his procedure is less invasive and can be performed under local anaesthesia also. It gives very less unwanted side effects like bleeding burning sensation. Many KsharDravayas were described by AacharyaSushruta15.ArkaKshar and ApamargaKshara are used for Pratisarana but there are many drugs which has to prove its efficacy in the treatment of Arsha. In previous trial ArkaKshara has proven its efficacy in comparison with Apamarga Kshara. So in trial sincere efforts will be made to compare with the efficacy of PalashKshar and ArkaKshar.

Methods & Results:

METHODOLOGY:

A)Inclusion Criteria:

i. Diagnosed patients of 2nd and 3rd degree haemorrhoids from Shalyatantra OPD and IPD within age groups 18 to 60 years.

ii. Selection will be irrespective of gender, religion, education and socio-economic status, were included in this study.

B)Exclusion Criteria:

i.          Patients suffering from CA rectum.

ii.         Patients with uncontrolled DM and HTN.

iii.       Patients with 1st and 4th degree haemorrhoids and interno-external haemorrhoids.

iv.        Known cases of portal hypertension will be excluded.

ASSESSMENT CRITERIA

1.P R Bleeding(Raktasrava)

2.Pain (Shula) : VAS SCALE.

3. Size of pile mass.

Overall assessment criteria:  Criteria of assessment will be based on improvement in subjective and objective parameters after the treatment.

The results will be categorized as,

Complete relief                        75% and above.

Moderate relief                     50% to 74% improvement

 Mild relief                              25 to 49% improvement

No relief                                 Below 24% improvement

METHOD OF PREPARATION:

Kshar  was prepared and standardized at Rasashastra department of our institute .Panchangas of Palash (10kg) was collected and dried plant was burnt to ashes. Then  allowed to cool by itself. The whole collected ash approximately (1 kg) was mixed with six parts (in volume) of water and stirred well.

Allowed to settle overnight. Then it was  filtered through double folded cloth for 21 times and the residue was thrown out.Gomutra Varna filtrate was obtained.  And  heated on slow fire.When the contents was reduce to half, about 1/3 of KsharaJala was  be taken out of the vessel. 100 gm. of Shukti was heated up to red hot and then mixed with 1/3 KsharaJala and dissolve  completely. Thus dissolved Shukti was added to boiling Ksharajala(Avapa stage) and continued to boil till the content attained consistency as described by Sushruta (not too liquid or too solid).10 gm. of  ChitrakamulaKalka was  finally added to this Kshara.Then it was  removed from fire and transferred into separate container with lid and stored for used.

Kshar pratisaran vidhi (method of Kshara application): Kshara pratisaran was done locally on the piles mass as per the classical technique which was very well explained by sushruta called “kshara pratisaran vidhi. [11] ” It was conducted under  principles of trividha karma. [12

Pre-operative procedure:

1.Routine investigations was takes place.

2.Written and informed consent of the patient was taken.

3.Fitness of Physician’s was  taken for anaesthesia.

4.Evacuation of bowel was  done by soap water enema in morning prior to procedure.

5. Part Preparation.

Operative procedure:

1.Underall aseptic precautions, under anaesthesia, the patient was lie down in lithotomy position.

2.Painting and draping of perianal area was  done.

3.Then, a slit proctoscope lubricated with the help of LOX jelly and it was introduced in the anal canal.

4.The pile mass fixed at the suitable place into the aperture.

5.Pile mass was identified firstly and then cleaned with dry gauze and remaining mucosa was covered with gauze to avoid Kshar application on normal tissue.

6.TikshnaKshar was  applied over it, in 1-2 gm. quantity.

7.AppliedKshara was  kept for 2 minutes approximately or Shatamatrai.e. Till the time taken to count no. from 1 to 100.

8.TheKshara was  then washed with the help of fresh lime juice.

9.After application of the Kshara, the pile mass will be changed into Bluish black (pakwaJambuphalavat) in appearance.

10.The procedure was repeated for each pile mass separately in the same sitting.

Postoperative procedure:

1.         NBM for 6 hrs.

2.         Light diet was allowed by the evening

3.         Trifalachoorna at night was given with koshnajala i.e. Luke warm water.

4.         Seitz bath with warm water was advised from next day.

OBSERVATION AND RESULT

In this study it was observed that palash kshar pratisaran was found more effective in reduction of pile mass, In the present study observations on comparison of Palash Kshar and Arka Kshar in two groups i.e. Group A and Group B shows that there was 90% reduction in size of pile mass in patients of Group A which contains patients with Palash Kshar prarisaran and 80%  reduction in size was noted in Group B which contains patients with ArkaKshar Pratisaran. Statistical data shows that there is more significant reduction in size of pile mass in patients of Group A than Group B reason behind more reduction in size in Palash Kshar may be due to more corrosive nature of Palash than Arka. As its PH is found more than Arka Kshara so the action is enhanced, as more the pH more is the corrosive property of kshara and faster is thea ctions of kshara like shodhan, lekhan,chedan of haemorrhoidal mass and resulting more significant effect than Arka Kshara

Table No. 3 : Comparison of Parameter between 2  Group

Discussion

In this present study PR bleeding is the cardinal symptom of haemorrhoid so for this study PR bleeding is important criteria for assessment. In group A i.e. Palash Kshar Pratisaran which is an experimental group showed total effect after kshar pratisara i.e., 93.51% relief. Since observations are on ordinal scale (gradations), we have used Wilcoxon Signed Rank Test to test efficacy in Group A and Group B. From above table we can observe that, P-Value for Group A is less than 0.05. Hence, we can conclude that, effect observed in Group is significant. pain is mild symptom and not found much significant in all the patient but we have taken pain was assesed because light increase in pain sensation just after the Kshar Pratisaran was foundas it is corrosive in nature. It was observed that Pain was increased just after the application of Palash Kshar Pratisaran in the first follow-up and then gradually reduced.Observations shows that mean Before treatment was 2.17 which was increased and decreased to 0.10, So the pain was increased after Palash Kshar Pratisaran and then it decreased. Hence 92.41 % relief in the pain was observed by the end to study in the patient swith group A so P value is less than 0.05.Since observations are on ordinal scale (gradations), we have used Wilcoxon Signed Rank Test to test efficacy in Group A. So, we can observe that, P-Value for Group A is less than 0.05. Hence, we can conclude that, effect observed in Group A is significant. reduction in size of pile mass was noted. In the patients with group A mean was 3.00 before treatment and after treatment it was 0.00. So the P value is 0.000 which is significant.

Conclusion

In this study, result found better  in palash kshar pratisaran than arka kshar pratisaran on reduction of pile mass so it can be concluded that palash kshar is more effective then Arks kshar in the treatment of arsha (haemorrhoids). As this study was more emphasised on reduction of size of pile mass we found better results of Arka kshar than Apamarga kshar so it can be conclude that Arka kshar Pratisarana is more useful in the management of Arsha (haemorrhoids).