Haemorrhoids (arsha)

Piles give rise to nodules, gulma, liver enlargement, ashthila, abdominal disease, loss of strength and colic; being the root cause of many diseases, they are called mularoga (mulavyadhi).

Piles are of six kinds: vataja, pittaja, kaphaja, raktaja, sannipataja and sahaja (congenital).

Piles also arise in the penis, vagina, eyes, ears, mouth and nose, bringing other diseases of those sites with them; on the skin they are called charmakila.

Suppressing the urges of stool and urine, sitting for long, constipation, injury and irregular eating are said to cause piles through vata, pitta, kapha and blood, separately or all together.

Sour belching and a sour taste in the mouth, loss of taste, burning, abdominal disease, indigestion, emaciation, trembling of the abdomen and many other signs are said to appear before piles develop.

Vataja piles are hard and cause pain, distension and retention of flatus and stool.

Pittaja and raktaja piles are soft and repeatedly discharge very hot blood; kaphaja piles are very hard, larger than the others and very itchy.

In sannipataja piles the signs of all three doshas appear together; sahaja (congenital) piles are very minute and show all the signs of sannipataja piles.

Piles are to be treated with instruments, bandaging, excellent medicines and surgery, and with the caustic alkali (kshara) method.

The commentary explains that piles which are recent, with few doshas, signs and complications, and internal so that they are not seen outside, are to be cured with medicines taken internally.

Piles whose masses are soft, spread, thick and raised are to be overcome by applying caustic alkali.

Piles that are rough, firm, raised and hard are to be treated with cautery.

Piles with a thin base that are raised, hanging and moist are to be cut off with the knife.

Piles from vata and kapha are treated with caustic alkali and cautery, piles from blood and pitta with caustic alkali, and piles thick at the base, hard and very large with excision and cautery; soft piles in a strong patient are pacified with various pastes and drug combinations.

The chitraka rasayana taken always by rule is said to destroy dreadful piles.

All these kinds of piles are said to be hard to cure.

Those afflicted by piles that show the signs of all the doshas together, with complications, are said soon to enter the mouth of death.

A patient of piles with profuse bleeding and complications such as diarrhoea, breathlessness, pain, wasting and great thirst is to be given up by the physician who cares for his reputation.

Patients with piles of the inner (third) fold or with piles from all three doshas, who constantly pass stool mixed with slimy blood and kapha with severe pricking pain, are to be regarded as incurable.

When the anal folds are very foul or rotten with piles and the patient is afflicted by a host of other diseases, he is to be regarded as incurable and given up.