References:
C.Chi.14, S. Ni 2, A.H.Ni.7, M.Ni.5,
Synonyms:
Durnaama, Maamsa Praroha, Maamsa Ankura, Maamsa Keelaka, Maamsa Kareera, Gudakeela, Gudaankura, Guda Rooha, Gudaja, Hatanaama
Svaroopa:
अर्श are hemorrhoids or piles. It is excessive and unnatural growth of the Maamsa Dhaatu. These are caused in Guda (anal canal) in folds or sphincters(Valee).
Nirukti:
- Arivat Praan`ino Maamsa Keelakaa Vis`hasanti Yat |
Ars`haamsi Tasmaad Uchyante || A. H. Ni. 7.1 - Arivat Praan`aan S`hrin`aati Hinasti iti Ars`hah | M. Ni. 5.1
(Patient having Maamsa Keelaka (अर्श) suffers severely as if one is suffering from an enemy (Arivat). Hence the disease is called अर्श.)
Anatomical aspect of Guda (anal canal)
This area has three Valee (folds) those divide the canal into three parts. Each Valee measures one and half Angula. These folds are constituted by Maamsa. This part of the colon, which is four and half Angula in length includes anal opening, which is half Angula (figure) in length. अर्श is manifested in this area.
Types of Ars`ha:
Types of Ars`ha according to various texts:
| Charaka | Sus`ruta | Asht`aanga Hridaya | Maadhava Nidaana |
| Sahaja | Sahaja | – | Sahaja |
| Vaataja | Vaataja | Vaataja | Vaataja |
| Pittaja | Pittaja | Pittaja | Pittaja |
| Kaphaja | Kaphaja | Kaphaja | Kaphaja |
| Dvandvaja | – | Dvandvaja | – |
| Saannipaatika | Saannipaataja | Saannipaatika | Saannipaatika |
| – | S`hon`itaja | Raktaja | Raktaja |
Sahaja Ars`ha
According to Charaka and Sus`ruta Ars`ha could be congenital in nature. They are termed as Sahaja Ars`ha. (Saha Jaataani S`hareeren`a).
Sahaja Ars`ha: Sampraapti:
1. Unwholesome dietary and behavioral regimes (also sinful acts of past life) of mother and father leads to impaired part of Beeja (S`hukra and S`hon`ita), which is responsible for Gudavalee formation.
2. This leads to deformity in anal region to manifest congenital piles (Sahaja Ars`ha)
These reasons are applicable not only to the Ars`ha but to all the other diseases also, which are caused by the Beeja Dusht`i.
Other types are based on Dosha dominance and are important for treatment decisions.
1. S`hushka Ars`ha = Vaata and Kapha Dominance
2. Sraavee Ars`ha = Rakta and Pitta Dominance
Related Sampraapti factors
Generally, this disease is caused by vitiation of Maamsa Dhaatu (Adhi Maamsa Vikaara) with vitiation of three Dosha. (i.e. it is Tridoshaja Vikaara). Meda and Tvak are other involved factors in the all types of Ars`ha.
This growth (Ars`ha) appears in various sizes and shapes as long, short, round, irregularly spread, matted together etc. Their characteristic colours are according the involved Dosha.
अर्श Sampraapti:
1. Apaana Vaayu gets aggravated due to causative factors. (Person having Mandaagni is prone to Ars`ha.)
2. The aggravated Apaana Vaayu brings down the accumulated waste products (Upachita Mala).
3. This aggravation of Dosha and Rakta takes place.
4. These aggravated Dosha (all three Dosha) move along with the course of Pradhaana Dhamanee (Pureeshavaahee) in the downward direction.
5. These Dosha get located in Guda and vitiate Guda valee producing the muscular growth or piles (Maamsapraroha).
6. Apaana Vaayu gets obstructed by the growth of Maamsa Dhaatu in the anal canal. Due to this obstruction Apaana Vaayu moves upwards and aggravates Samaana, Vyaana, Praan`a and Udaana Vaayu.
7. All the aggravated five types of Vaayu, Pitta and Kapha are responsible for the disease like Ars`ha.
8. A person with अर्श gets all the diseases caused by Vaayu (Vaata Vikaara) Pitta and Kapha Vikaara are also manifested as there is aggravation of Pitta and Kapha also.
Clinical presentation (Lakshan`a) of अर्श:
Presence of piles or hemorrhoids is cardinal sign of Ars`ha.
The prodromal symptoms of अर्श may mislead a physician with the diseases like उदर, Grahan`ee, पाण्डु.
The signs and symptoms of अर्श get manifested in accordance with the dominance of the Dosha.
Other signs include:Patient is becomes lean, thin, pale and emaciated.
Patient gets irregular bowel habits with changing stool consistency (i.e. hard, loose), sometimes it is normal and sometimes it is Saama or Niraama.
Patient passes stool, flatus, and urine in excessive quantity and sometimes having constipation. Also patient passes various coloured stained stools. viz. white, pale yellow, green, yellowish, red, reddish, having different consistencies i.e. slimy, thin, dense with offensive smell like dead body.
Patient get other diseases as complications as:
उदावर्त is the main complication.
Gravels and stone in the urinary tract.
Sharp shooting /cutting pain at umbilicus and around urinary bladder and pelvis, anal pain.
Pravaahikaa, Pariharsha, Prameha, Visht`ambha (constipation), Antrakoojana (hyper peristaltic sound), Hridaya Upalepa, Indriya Upalepa.
At times he gets excessive belching associated with bitter and sour taste.
Excessive generalized weakness with depleted digestive power.
Depleted state of S`hukra Dhaatu (semen)
These patients are agitated and are difficult to treat.
Other symptoms include: Kaasa, S`hvaasa, Tamaka S`hvaasa, Trishn`aa, Hrillaasa, Chhardee, Arochaka, Avipaaka, Peenasa, Kshavathu, malaise, Jvara (fever),oedema on hands, feet, face and Akshikoot`a, Paars`hva, Kukshi, Hridaya, Prisht`ha, Trika
Taimirika: patient feels as if he is entering into darkness and suffers from headache.
Voice becomes Kshaama (weak), Bhinna (broken), Sanna (low pitched voice), Sakta (impeded) and Jarjara (hoarse)
Patient develops frequent Karn`a Roga. (ear complainants)
Specific complications (Upadrava) of अर्श:
| Ars`ha type | Vaataja | Pittaja | Kaphaja | Raktaja |
| Upadrava | गुल्म | ज्वर | S`hopha | Aakshepaka |
| Pleehaa | दाह | S`heeta Jvara | ||
| Asht`heelaa | Pipaasaa | अरोचक | ||
| Moorchchhaa | Avipaaka | |||
| S`hirogaurava |
अर्श is to be treated immediately. Otherwise they produce Baddha Gudodara (obstruction to anal canal.)
Other sites of Ars`ha
Though the term Ars`hameans piles or hemorrhoids, various muscular growths like polyps are also described as Ars`ha due to similarity in pathogenesis. Ars`ha might occur at several other locations like S`hisna (penis), Apatya Patha (female genital tract), Gala (throat), Taalu (palate), Mukha (mouth), Naasaa (nose), Karn`a (ears), Akshi Vartma (eyelids), Tvak (skin) etc. Each type is described as follows:
Med`hra Ars`ha
Aggravated Dosha vitiate Maamsa and S`hon`ita of penis. It causes itching. The wound is formed due to scratching. In this wound, the vitiated Maamsa grow out on the glans penis, which lead to the deformity in the penis and causes Pumstva Upaghaata (impotency).
Yoni Ars`ha
Aggravated Dosha produce muscular growths in the vagina which destruct Aartava and normal functioning of vagina and anal related structures.
Naabhi Ars`ha
Aggravated Dosha produce muscular growths in the umbilical region.
Karn`a Ars`ha
Aggravated Dosha tend to develop अर्श in the ear causing deafness, pain and suppuration in ear. (For details, please refer कर्ण रोग)
Netra Ars`ha
अर्श formed on the eyelid cause difficulty in movements of eyelid, manifests symptoms like pain, lacrimation . It may hamper vision also.
Naasaa Ars`ha
It develops internal cavity of nose, causes Pratis`hyaaya, sneezing, difficulty in exhalation, Pootinasya, nasal voice (Anunaasika Vaakya), headache. (For details, please refer Naasaa Roga)
Mukha Ars`ha
It causes Gadgad Vaak (obstructed and deep voice ), Rasa Adnyaana (tastelessness) and diseases of mouth.
Charmakeela
The aggravated Vyaana Vaayu with Kapha produces stable muscular growth like Keela (nail) on the surface of the skin. In Charmakeela there is pricking pain and dryness due to Vaayu. It looks blackish red due to Pitta. It is oily and glandular due to Kapha. (For details, please refer क्षुद्र रोग)
Saadhya – Asaadhyatva:
अर्श is difficult to cure. Patient suffers a lot from this disease. In complications, other organs are also involved.
अर्श: Comparative study of subtypes and Sampraapti factors
| Sampra apti factors | अर्श | Sahaja | Jaatottaraja | Vaataja | Pittaja | Kaphaja | Tridoshaja | Raktaja |
| Dosha | Vaata PrakopaPitta PrakopaKapha Prakopa Praan`a, Udaana, Apaana, Samaana, Vyaana PrakopaApaana Prakopa | Apaana RodhaSamaana PrakopaVyaana PrakopaPraan`a PrakopaUdaana PrakopaPitta PrakopaKapha Prakopa | Apaana Prakopa | Vaata Prakopa | Pitta Prakopa | Kapha Prakopa | Tridosha Prakopa | Pitta Prakopa |
| DoshaGun`a(Rasa) | RookshaS`heetaLaghuKharaSookshma | Teekshn`aUshn`a (Kat`uLavan`a) | Snigdha, S`heetaGuruMandaS`hlakshan`aSthira | |||||
| Dhaatu | Medas, Maamsa | Alpa S`hukra, Ksheen`a Retas,Dhaatu Kshobha | S`hukra Naas`ha,क्लैब्य | |||||
| Upadhaatu | Tvak | |||||||
| Mala | Ati Nichita Mala | Prachura Vibaddha, Vaata Mootra, Pureesha Saama, Pureesha Mootra Kshobha,Pureesha Rodha | Upachita Mala | Pratata Vibaddha Vaata Mootra Varchas,Samhata Pureesha | Bhinna Varchas Prachura Vit`, MootraSarakta Pureesha | Sas`hleshma Pureesha | Avagaad`ha Pureesha, Gaad`ha Vit`,Sarakta Pureesha |
अर्श: Comparative study of subtypes and Sampraapti factors
| अर्श | Sahaja | Jaatottaraja | Vaataja | Pittaja | Kaphaja | Tridoshaja | Raktaja | |
| Srotas | Medovaha,Maamsavaha | |||||||
| Indriya | Indriya Daurbalya | Indriya Upalepa | Kalusha Indriya | |||||
| Agni | Agni Saada | Durbala Agni, Alpa Agni,Agni Manda | Agni Maardava | |||||
| Ojas | Hata Ojus |
Last updated on May 26th, 2021 at 11:29 am