Introduction

Introduction

We have created lifestyle diseases, which are now the leading cause of death and disability in the world. One illness that makes life terrible for people is arsha (piles), which is now the most prevalent and distressing sickness in the 21st century. At least 50% of people will experience symptoms of haemorrhoids at some point in their life, with 5% of people experiencing symptoms at any one moment. The root term Ru-gatau is used to create the word Arsha, which is then given the asuna suffix, which meaning to take life.[1] Its synonyms are Durnama, Gudamaya, Gudaja, Gudankura, etc. [2]According to Ayurveda, the disease comes under the heading of Maharogas as it is Dirghakalanubandhi, Dushchikitsya in nature, and Tridoshik and involves the Marma. Arsha is the condition associated with Mans and RaktaDhatuDushti and characterized by Mansakur (Protruding Mass), Rakta-Strava(per rectal Bleeding), and Panduta (Pallar). Arsha occurs in Gudabhaga, which is undoubtedly a Marma, and it is well known for its chronicity and difficulty intreating.[3,4]

Types of Arsha [5]

Arsha is classified into

1.Sahaja – Due to chromosomal problems in both her mother's and father's chromosomes, Arsha is classified as a congenital abnormality. Due to its irregular size and form, it is exceedingly difficult to diagnose.

2.Janmottarakalaja - Arsha is brought on by mistakes made in daily life, such as poor eating and exercise routines.

The classification on the basis of the predominance of Dosha is mainly sub division of the janmottarklaja type of Arsha. They are of five types:

• Vataja
• Pittaja
• Kaphaj
• Raktaja
• Sannipataja

Nidana of Arsha (Aetiology) [6,7]

• Dietetic factors - Excessive or less intake of food, irregular intake and lack of fibrous diet etc., which disturbes jatharagni (digestive power) leads to poor digestion and constipation.
• Habits -Suppression of natural urges, Excessive indulgence of sexual activity etc. these factor increases vata dosha.
• Local factors - Excessive vehicle riding, prolonged sitting or standing positions. [
• Genetic factors: Due to involvement of Beeja Dosha of parents, genetic factors are responsible for Sahaja Arsha. Due to congenital weakness of walls of the haemorrhoidal veins etc. piles get transferred to next generation.
• Other causes: Pleeha-vriddhi, Udararoga, pregnancy, abdominal tumours, Straining during micturition, Portal hypertension.
• Mandagni: Mandagni is responsible for causing Arsha, Grahani, and Atisara and each of them is also responsible for each other.

Specific causes according to Doshic Arsha

Table 1 – Depicting Nidana of Arsha according to specific Dosha predominance

Poorvaroop of Arsha according to Acharya Sushruta [10,11]

Anna Vishtambha / atopa , Grahani / pandu rog ashanka , Udgar bahulya , Shakti saad, Amlika / anna- ashradhdha, Antra koonjana / Guda parikartan, Akshi shoth, Indriya daurbalya ,Bhrama / tandra, Kaas / shwas, Kruchchata annapakti, Amashaye paridaha, Bala haani / shosha ashanka , Nidra / pipasa

Samanya Roopas [12,13]

According to Acharya Vagbhata the samanya roopas of Arsha are given below.

Agnimandya, Asya Vairasya, Arochak, Vankshana Shool, Hradaya-Nabhi Shool, Payu Shool, Angamarda, Klama, Swara Krishata, Asthiparva Shool, Hatotsah, Deenata, Asarata, Jwara, Swasa- Kaasa, Sarakta Stheevana, Timir, Baadhirya, Peenasa, Pipasa, Klaibya, Vaman, Vistambha, Pandu, etc.

Vishesh Roopas according to Doshas predominance in Arsha[13, 14,15,16]

• Vataja Arsha

These arshas are dry, hard, painful, having various shapes, are usually of external origin, these arsha having irregular surface and are of various colours, these are associated with constipation and painful defecation.

• Pitaja Arsha

These arshas are usually of small sized, bluish coloured, moist fleshy masses, these pile masses enlarges with straining during defecation with passage of blood.

• Kaphaja Arsha

These have wide based, smooth surface, oval shaped, fixed and fleshy masses. They generally do not bleed.

• Raktaja Arsha

They leads to secondary anaemic condition due to immense bleeding during defecation and other lakshanas.

Discussion

Arsha is one of the Asthamahagadas and is hard to heal. Everywhere in Ayurveda, the difficulty of treating Arshas is stressed. The extensive list of etiological elements, which includes dietary components, behaviours, activities, and indulgences, as well as the methodical explanation of the disease's development, are each evidence of our Acharyas' insightful comment, profound insight, and scientific understanding of the condition. Sushruta described the pathogenesis of arshas as the Nidanas leading to the vitiation of Doshas in single, combination of two or more, along with Rakta, Dosha move downward through the Mahadhamani reaching Guda and affecting the Gudavalitraya producing arshas to the people suffering from Mandagni and other local causes. [21]According to Charaka, Arshoroga is created when all the Doshas get vitiated, followed by Bahya and Abhyantararogamarga, and has an impact on Gudavalitraya. Vagbhata asserts that vitiation of the Doshas results in the formation of Mandagni, vitiation of the Apanavayu causes the stagnation of Mala in Gudavali, and prolonged contact with Mala results in the emergence of Arshas. According to the Ayurvedic definition of Samprapti of Arshas, this illness is a local expression of a systemic disturbance in the balance of Doshas. Acharya Sushruta outlined four therapy modalities for Arsha, which are all used based on Dosha participation and phases of Arsha, such as Bheshaja Karma, Shastra Karma, Kshara Karma, Agni Karma, similarly Snehana, Swedana, Vamana, Virechana, Asthapana and Anuvasana Basti for Vataja Arsha, Virechana for Pittaj Arsha, Aharadravya mixed with Sunthi and kulatha for Kaphaj Arsha and Shamana Chikitsa for Raktaj Arsha etc.[22]

Conclusion

People who adhere to the ideal way of life outlined in the classics of Ayurveda can enjoy long, disease-free lives. Consuming foods low in fibre, having poor eating habits, having abnormal body posture, having a difficult delivery, having multiple abortions, experiencing psychological imbalances, and having physical trauma to the anal region are some significant factors cited in the classics of Ayurveda for the manifestation of Arsha (piles). It is a common lifestyle problem that affects both men and women equally and makes life miserable. Because piles are tough to treat and reoccur frequently, it is always best to take extra precautions with our food and way of living to prevent them.