Herbal Treatment of Hemorrhoids: An Ayurvedic Method

International Journal of Indigenous Medicinal Plants, ISSN: 2051-4263, Vol., Issue. 1

© RECENT SCIENCE PUBLICATIONS ARCHIVES |April 2014|$25.00 | 27703352| *This article is authorized for use only by Recent Science Journal Authors, Subscribers and Partnering Institutions*

Herbal Treatment of Hemorrhoids: An Ayurvedic Method

Meenakshi Priyadarshni Plant Biotechnology Laboratory, University Department of Botany,

B.R.A.Bihar University, Muzaffarpur, 842001, Bihar, INDIA

Email: [email protected]

L.N. Shukla Plant Biotechnology Laboratory, University Department of Botany,

B.R.A.Bihar University, Muzaffarpur,842001, Bihar, INDIA Email: [email protected]

ABSTRACT

Hemorrhoid is a type of gastrointestinal disorder may be internal or externally prolapsed. These are classified into I-IV grades. High fibre food may reduce constipation and enhance the bowel movements. Over a period when the hemorrhoid get worst , the disease should be treated by several non-operative treatments like, sclerotherapy, cryotherapy, rubber band ligation, bipolar diathermy, direct current electrotherapy, infrared photocoagulation etc and surgical treatment. Ayurvedacharya, tribals and Hakeems have many formulas for the preparation of medicines which are implemented in the treatment of various severe diseases .The whole plant or its part either alone or in combination are used for treatment. The natural products in the form of alkaloids, saponin, tannin, particular acids etc helps in to reduce hemorrhoid.. Medicinal plants are extremely main for health and material goods part of the biodiversity. Kasharpa method , Pratisaraneeya teekshna kshara and Triphlaguggulu are some of the Ayurvedic methods applied from past upto present for curing bleeding piles.

Keywords-Alkaloid, Tribal, medicinally active plants, Herbs, Hemorrhoidectomy,Triphala, Ayurveda

1. Introduction

Hemorrhoids are masses or clumps "cushions" of tissue in the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease. There are two types of piles – internal and external. Internal piles occur inside the rectum. The set of veins inside the rectum when distended, results in internal piles and the set of veins under the skin around the anus when distended results in external piles( fig-1&2) .In case of bleeding, these are termed as bleeding piles. They are varicosities of veins draining the territory of branches of the superior rectal arteries. Since, this area lack pain receptors most people do not feel pain. One theory proposes that it is the shearing force of stool, particularly hard stool, passing through the anal canal that drags the hemorrhoidal cushions downward. Another theory suggests that with age, the supporting tissue that is responsible for anchoring the hemorrhoids to the underlying muscle of the anal canal

deteriorates. With time, the hemorrhoidal tissue loses its mooring and slides down into the anal canal. Internal hemorrhoid may lead to severe form of hemorrhoid i.e., prolapsed and strangulated hemorrhoids and the external lead to thrombosis and if the vein ruptured can become a thrombosed hemorrhoid. External hemorrhoids are more painful.

Depending upon the symptoms, internal hemorrhoids are classifies as (Church J.M.,1991) –

a.) Grade I: Hemorrhoid that do not prolapsed, rectum bleeds.(fig-3)

b.) Grade II: Hemorrhoid prolapsed upon defecation, but spontaneously reduce.(fig-4)

c.) Grade III: Hemorrhoid prolapsed upon defecation but reduce after manipulation.(fig-5)

d.) Grade IV: Hemorrhoid prolapsed upon defecation and remains prolapsed.(fig-6)

Hemorrhoids develop because of increasing pressure in the veins of the lower part of the rectum and anus. The pressure increases generally due to sitting or standing for long time, lifting heavy weights over a long period, chronic constipation accompanied by straining to evacuate the bowels, repeated diarrhoea & dysentery, obesity, straining during child birth, pregnancy etc.

On the basis of lithotomy position there are usually three major hemorrhoidal cushions originated to the right posterior, right anterior and left lateral position known as 3, 7 and 11 o’clock position of the anal (Chaurasia’s Human Anatonny and Charles et al. ,1991).

2. PREVENTION AND TREATMENT METHODS

The treatment of piles mainly includes oral medicines like stool softeners, laxatives etc and local anti- inflammatory creams and warm water sits bath cancer help to reduce the symptoms. A very new technique known as crayon surgery it sore also used to treat the piles. In this technique the affected part is freezed by nitrous oxide or carbon dioxide gas to cut off the circulation and destroys the piles mass. Some other techniques like infrared photocoagulation, laser therapy, convention surgery etc are also used for the treatment of hemorrhoids. According



to Shusrut Samhita, the Kasharpa method is used to treat piles. It is a non surgical procedure of Ayurveda prepared from different combination or herbs. This medicine is applied to the piles mass.

To prevent hemorrhoids, high fiber foods are eaten because it prevents constipation, diureticulosis, anal fissures etc. Prolonged sitting or straining, often association with constipation or diarrhea may lead to hemorrhoids. The food implemented with 20- 30 grams of fibre per day in the diet may be beneficial (Dr. Wolf, July; 2013).

3. TREATMENT OF HEMORRHOIDS

Hemorrhoids is begins but, it get worse over time and its treatment must begin as soon as possible. It requires several non-surgical and surgical treatments for curing hemorrhoids.

3.1 Sclerotherapy

In 1869, Morgan started the treatment of hemorrhoids for 1st and 2nd degree. According to Walker et.al., 1990, a submucosal injection of 5ml of 5% phenol in oil, 5% quinine and urea, or hyper tonic(23.4%) salt solution at the base of the hemorrhoidal complex causes thrombosis of vessels, sclerosis of connective tissues, and shrinkage and fixation of overlying mucosa . It takes very little time. Sclerotherapy is minimally invasive it causes only a little pain as complication reported in 12%- 70% of patients (Walker et.al.,1990 and Sim AJ et.al., 1981 and 1983). Sclerotherapy may also cause side effects as impotency which is a major problem in young people (Bullock N; 1997). According to Bleday, 1992, this therapy may also cause urinary retention and abscess.

3.2 Cryotherapy

According to the research articles of O’Callaghan JD et.al., 1982, cryotherapy is mainly used as best therapy for internal hemorrhoids. This therapy shows many side effects like prolonged pain and foul smelling discharge (Smith L.E. et. al., 1979).

3.3 Rubber Band Ligation

It is one of the best techniques used for all types of hemorrhoids. According to Budding J; et al; 1997, RBL relies on tight encirclement of redundant mucosa connective tissue and blood vessels in the hemorrhoidal complex. Internal hemorrhoid is also ligated by several new techniques. About 80% success is achieved by continuous five-year experiment of different workers (Wrobleski et. al., 1980 and Kanellos et.al., 2000).

3.4 Bipolar Diathermy

According to the survey experiments of some workers this technique become successful among 88 to 100% patients of second and third degree of hemorrhoids(Jensen DM et al., 1997, Randall et.al, 1994; Dennison et. al., 1990 and Hinton CP. et.al., 1990). This therapy is applied one second pulse of 20W until the underlying tissue

coagulates. Many problems arise like pain, and bleeding (Jensen et.al; 1997).

3.5 Direct Current Electrotherapy

In this technique, direct current of 110V is applied to the base of hemorrhoids above the transition zone for 14 minutes (Norman DA et.al; 1989, Zinberg et.al.,1989 and Varma JS et.al.,1991). This therapy is not accepted because it may cause severe complications of pain (33%), bleeding (10%) and ulcer formation (4%) (Yang R et.al; 1993 and Zinberg et. al;1989).

3.6 Infrared Photocoagulations (IRC)

According to Dennison AR et.al; 1989, in this technique coagulation of tissue is done by focuses of infrared radiations by a tungsten- halogen lamp. During, treatment both mechanical pressure and radiation energy are applied simultaneously. It can eliminate some disadvantage in electro coagulation like grounding the patients and charring of the tissue (Pravin J Gupta, 2004). By random studies done by Walker AJ et.al; 1990, 67%- 96% of success rate have been reported. At one tissue 2- 6 hemorrhoids can be treated by this methods.

3.7 Surgical Treatment

For long term relief in greater degree prolepses surgical method is used. Hemorrhoidal surgery is called Hemorrhoidectomy. It can be performed by either Open Hemorrhoidectomy also known as Milligan- Morgan Hemorrhoidectomy or by Closed Hemorrhoidectomy also called Ferguson Hemorrhoidectomy. According to survey, complications may occur as urinary retention (2%- 36%) (Reis Neto et.al; 1992) and sphincter defect is 12% patients (Felt- Bersma RJ et.al; 1995). Prevention is the best treatment for hemorrhoids but botanical treatment may also leads to cure.

3.7.1 Treatment and cure of hemorrhoid by Natural Products/ Botany

The difficulty experienced in passing small hard stools, due to congestion in the network of blood vessels located inside the anal cushions. Gradually, these vessels enlarge and form piles. If the constipation further continues, it becomes large enough to be called second or third grade piles.Tribal use different plants and plant product for the treatment of hemorrhoids. They prepare several decoctions by plant parts or mixing of different plants. They used the ingredient either externally over the prolaps or internally by oral decoction. Ethnobotanical lore of the Saurashtra is very rich, which are used by them in their domestic and social life.

4. DISCUSSION

Ayurveda, the boon of life is the basis of long and healthy life in India from the ancient period.The traditional medicines are prepared from the herbal plants and their extracts for piles treatment (Lewington,A.,1993). Several modern therapy like sclerotherapy, cryotherapy, rubber band ligation, bipolar diathermy, direct current



electrotherapy,infrared photocoagulation, surgical treatment etc and tradional drugs (Shusrut Samhita, (1980) 4th edition & Charak Samhita, (1995)) are used for the curing of hemorrhoids. Kasharpa method to treat piles in tribals (Shusrut Samhita).The modern treatment of and surgery gives many other side – effects like burning sensation , pain,bleeding,itching etc but the herbal / natural therapy only takes slightly long time in comparition but do not shows any type of side effect. Triphlaguggulu is an Ayurvedic medicine and it is the combination of Emblica officinalis, Terminalia chebula,T. bellarica , Piper longum and Comiphora mukul is one of the best remedies for hemorrhoid( Murti,S.K.R.,1984). Guggulu is one of the best known anti-inflammatory herb of Ayurveda. Triphala helps in easy bowel movements and relieves the constipation,a problem often troubling the people suffering from hemorrhoids. Drugs prepared from the plants alone and in combination cures I –IV degree of piles. One more

Indian Ayurvedic medicine prepared by the combination of different plants is Pratisaraneeya teekshna kshara is used to reduce bleeding piles.It is also the combination of powdered form of Plumbago zeylanica,Gloriosa superb,Acorus calamus,Achyranthus aspera and Coral. This medicine was applied on the internal hemorrhoids. It was observed that the pile mass became black in 35 seconds( Shusruta Samhita) . Lemon juice was applied to neutralize it after proper burning of pile mass. Pratisaraneeya teekshna kshara was found effective in obliterating the hemorrhoid mass within 21 days of application. A combination of kshara karma, conservative treatment (samana aushadhis), diet restrictions, and life style modifications administered over a period of one year is effective in obliterating the pile mass as well as preventing recurrence on a long-term basis.

Figure-1 & 2 shows heavy prolaps in hemorrhoid. Fig-3,4,5&6 shows different grades in hemorrhoid.



Conclusion

The Ayurvedic medicines from different medicinal plants and there parts is the real basis for the preparation of several drugs for severe diseases. These medicines can cure severe diseases.The knowledge of Vaidya, Ayurvedacharya , older people, and tribals are the treasures by which pharmaceuticals and different drugs can be manufactured. One more important thing is that these plants are not effective only in isolation but many of them are more effective in combination, not only for one disease but also for many (Sushruta Samhita;1980 & Charaka Samhita;1995). Pharmaceutical companies and drug industries may prepare medicines by these natural herbs. It is illustrated that the valuable plants that have a variety of uses by different folks in treating various diseases, like piles. The treatment of piles through medicinal plants has been more successful without any side-effect. Everyone can try the natural treatment and herbal medicines. Most of the times, it can become much less expansive then buying normal drugs. Conservation of Ayurveda and these medicine can be done only by conserving all medicinal plants .

ACKNOWLEDGEMENT

The authors are thankful to Department of Science and Technology (INSPIRE DIVISION) for their support. We are grateful to the Head, University Department of Botany B.R.A.Bihar University,Muzaffarpur for the permission & help to do this research work.

Miss Meenakshi Priyadarshni is also very thankful to the Ayurvedacharya Dr.Gyan Shankar Prasad Singh and his library Yadunath Granthagar, Kuboli Ram, for the collection of Ayurvedic books like Charak Samhita,Shushurta Samhita,BhavPrakash etc.

Special thanks to Dr. Shri Raman (S.K.Medical College,Muzaffarpur) for providing me permission to treat the hemorrhoid patients by Ayurveda.

ACKNOWLEDGEMENT FOR LEGAL ADVICES

The first author is paying special thanks to the Advocate Prabhat Kumar Sharma for his legal advises.

REFERENCES



[1] Anita Mahapatra, Srinivasan A., Sujithra R., Ramesh P. Bhat; Management of internal hemorrhoids by Kshara karma: An educational case report; Journal of Ayurveda & Integrative Medicine, 2012,July-September,Vol 3,Issue 3

[2] Balasubramanian T, Chatterjee TK, Sarkar M, Meena SL. Anti-inflammatory effect of Stereospermum suaveolens ethanol extract in rats. Pharm Biol. 48:318–2

[3] Begum F, ZA Begum, MR Uddin, AHMZ Haider, RC BarmanEffects of Methanol Extract of Piper chaba Stem Bark on Acute Inflammation in Rats, Med. Coll. J.; (2012), 7(1): 26-28.

[4] Berkow R (ed) The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: Merck; (1992). 855-856.

[5] Bharat B. Aggarwal, Sahdeo Prasad and Bokyung Sung Identification of Novel Anti-inflammatory Agents from Ayurvedic Medicine for Prevention of Chronic Diseases, Curr Drug Targets. ; (2011 October 1), 12(11): 1595–1653.

[6] Bhattacharya G Medico-ethnobotanical values of Saurashtra weeds, J Econ Taxon Bot, (1996), 12 166.

[7] Budding J .Solo operated hemorrhoid ligator rectoscope. A report on 200 consecutive bandings. Int J Colorectal Dis.; (1997), 12: 42–44.

[8] Bullock N,Impotence after sclerotherapy of hemorrhoids: case reports. Br Med J.; (1997): 314:419.

[9] Charles VM, Russell RCG ,Revised ed. Bailey & Love’s short practice of surgery 21 edition, chapman and hall, London,(1991)

[10] Chaurasia’s Human Anatomy 3rd edition, Vol. 2, CBS –New Delhi, 338.

[11] Dennison A, Whiston RJ, Rooney S, Chadderton RD, Wherry DC, Morris DL ,A randomized comparison of infrared photocoagulation with bipolar diathermy for the outpatient treatment of hemorrhoids. Dis Colon Rectum. ; (1990): 33:32–34.

[12] Dennison AR, Whiston RJ, Rooney S, Morris DL ,The management of hemorrhoids. Am J Gastroenterol; (1989): 84:475- 481.

[13] Dev S.,A selection of Prime Ayurvedic Plant Drugs: Ancient - Modern concordance. Anamaya Publishers, (2006) New Delhi, , 377-381

[14] Gami Bharat, Hemorrhoids – a common ailment among adults, causes & treatment: A review; International Journal of Pharmacy and Pharmaceutical Sciences; (2011),Vol 3, Suppl 5.

[15] Gan, T., Y.D. Liu, Y. Wang and J. Yang, Traditional chinese medicine herbs for stopping

bleeding from hemorrhoids. Cochrane. Database Syst. Rev., (2010). Vol. 10.

[16] Heaton ND, Davenport M, Howard ER ,Symptomatic hemorrhoids and anorectal varices in children with portal hypertension. J Pediatr Surg.; (1992): 27(7): 833-835.

[17] Hep, A., O. Robek and T. Skricka, Treatment of hemorrhoids from the viewpoint of the gastroenterologist. Personal experience with the Ginkor Fort preparation. Vnitr. Lek., (2000). 46: 282-285.

[18] Hinton CP, Morris DL ,A randomized trial comparing direct current therapy and bipolar diathermy in the outpatient treatment of third-degree hemorrhoids. Dis Colon Rectum; (1990): 33: 931–932.

[19] Kanellos I., Goulimaris I., Vakalis I., Dadoukis I ,Long-term results of rubber-band ligation for second degree hemorrhoids, a prospective study. Techniques in Coloproctology.; (2000), 4(2): 99-101

[20] Kanyasara, The Ayurvedic Pharmacopeia of India, Part 1, Vol 1, pp 81.

[21] Khare CP:Indian Herbal Remedies, 1st edn. Springer-Verlag Berlin Heidelberg, Germany, (2004) pp 42–43.

[22] Lef f E: Hemorrhoids. Postgrad Med.; (1987), 82:95-101.

[23] MacKay, D.: Hemorrhoids and varicose veins: A review of treatment options. Altern. Med. Rev., (2001). 6:126-140.

[24] Mehra Raakhi, Renu Makhija, and Neera Vyas Ayu. (2011 Apr-Jun); 32(2): 192–195.

[25] Mishra MN, Bihari RJ:Sci. Tech, 7B , (1964), (3), 195.

[26] Mukherjee Tapan:Herbal drugs for piles (Haemorrhoids), a literature appraisal, Indian Drugs, (1989), 26(12) 670-671.

[27] Murti, Shrikant K.R., Prof. Sarangadhara Samhita : 1st ed. Chaukhamba Orientalia, Varanasi. (1984).

[28] Nadkarni KM, Indian Materia medica, Vol -I, Bombay popular prakashan, (2005) :21-22.

[29] Navarra L, Pietroletti R, Maggi G, Leardi S, Simi M: Diagnosis and treatment of hemorrhoids in the eldery: results from 291 patients. Techniques in Coloproctology.; (2000): 3(3): 127-130.

[30] Norman DA, Newton R, Nicholas GV: Direct current electrotherapy of internal hemorrhoids: an effective, safe, and painless outpatient approach. Am J Gastroenterol.; (1989): 84:482–487.

[31] O’Callaghan JD, Matheson TS, Hall R: Inpatient treatment of prolapsing piles: cryosurgery versus



Milligan-Morgan Hemorrhoidectomy. Br J Surg.; (1982):69:157–159.

[32] Pravin J Gupta:Infrared coagulation: A preferred option in treating early hemorrhoids. Acta Cirurgica Brasileria. (2004): 19(1):74-78.

[33] Randall GM, Jensen DM, Machicado GA, Hirabayashi K, Jensen ME, You S, Pelayo E (1994): Prospective randomized comparative study of bipolar versus direct current electrocoagulation for treatment of bleeding internal hemorrhoids. Gastrointest Endosc.; 40: 403– 405

[34] Reis Neto JA, Quilici FA, Cordeiro F, Reis JA J :Open versus semiopen hemorrhoidectomy: a random trial. Int Surg.; (1992): 77:84–90.

[35] Samhita Carak of Agnivesa, elaborated by Charak and Dridhabala, Chaukhamba Surabharati Prakashan, Varanasi; (1995): p.97,782.

[36] Samhita Sushruta – Sushruta: 4th edition, Chaukhamba Orientalia, (1980) Varanasi.

[37] Sheetal A, Bagul MS, Prabia M, Rajani M :Evaluation of free radicals scavenging activity of an Ayurvedic formulation, Panchvankala. Ind J Pharm Sci.; (2008). 70(1): 31-35.

[38] Sim AJ, Murie JA, Mackenzie I: Comparison of rubber band ligation and sclerasant injection for first and second degree Hemorrhoids—a prospective clinical trial. Acta Chir Scand.; (1981): 147: 717–720.

[39] Sim AJ, Murie JA, Mackenzie I: Three year follow-up study on the treatment of first and second-degree hemorrhoids by sclerosant injection or rubber band ligation. Surg Gynecol Obstet. (1983):; 157:534–536.

[40] Smith LE, Goodreau JJ, Fouty WJ: Operative hemorrhoidectomy versus cryodestruction. Dis Colon Rectum.; (1979): 22:10–16.

[41] Thomson WH:The nature of hemorrhoids. Br J Surg (1975); 62:542-552.

[42] Varma JS, Chung SC, Li AK: Prospective randomised comparison of current coagulation and injection sclerotherapy for the outpatient treatment of haemorrhoids. Int J Colorectal Dis.; (1991): 6:42–45.

[43] Vaya, J., and Mahmood, S. Flavonoid content in leaf extracts of the fig (Ficus carica L.), carob (Ceratonia siliquaL.) and pistachio (Pistacia lentiscus L.). Biofactors; (2006). 28:169-75.

[44] Walker AJ, Leicester RJ, Nicholls RJ, Mann CV:A prospective study of infrared coagulation, injection and rubber band ligation in the treatment of hemorrhoids. I J Colorectal Dis; (1990): 5:113–116.

[45] Webster, D.J., D.C. Gough and J.L. Craven: The use of bulk evacuant in patients with hemorrhoids. Br. J. Surg., (1978). 65: 291-292.

[46] Wrobleski DE, Corman ML, Veidenheimer MC, Coller JA: Longterm evaluation of rubber ring ligation in hemorrhoidal disease. Dis Colon Rectum.; (1980): 23:478–482.

[47] Yang R, Migikovsky B, Peicher J: Laine Randomized, prospective trial of direct current versus bipolar electrocoagulation for bleeding internal hemorrhoids. Gastrointest Endosc. (1993):; 39:766-769.

[48] Zinberg SS, Stern DH, Furman DS, Wittles JM:A personal experience in comparing three nonoperative techniques for treating internal hemorrhoids. Am J Gastroenterol.; (1989): 84:488–492.

Herbal Treatment of Hemorrhoids: An Ayurvedic Method

Documents

Transcript of Herbal Treatment of Hemorrhoids: An Ayurvedic Method