A Case discussion on Effect of Apamarga Pratsaraneeya Kshara
in the management of Ardra Arshas w.s.r to Histopathological
examination
Case report
Avnish
Pathak1*, Dr.P.Hemantha kumar2
1*.
Reader, Department of PG Studies in ShalyaTantra, S.D.M.College of Ayurveda & Hospital, Hassan,
Karnataka- 573201. E,mail - dravinishms@gmail.com
2.
Professor & HOD Department of PG Studies in ShalyaTantra, S.D.M.College of Ayurveda &
Hospital, Hassan, Karnataka -573201. Email – phk4uster@gmail.com
Abstract
Kshara Karma is a one of the
parasurgical procedure in Ayurveda. In this study Apamarga Pratisarneeya Kshara is used
in Ardra Arshas (Internal
Piles). After application of kshara size of Arshas and bleeding
reduced completely and later on the wound created by Kshara Karma get fibrosed and prevents
recurrence. A case report of 35 year old lady who presented with complaints of
bleeding per rectum associated with constipation since last three months has
been presented here.
Key
Words: Kshara, Apamarga, Arshas
Introduction:
Haemorrhoids are
one of the commonest diseases occurring in ano-rectal
region. Its incidence increases with advancing age, at least 50% of the people
over the age of 50 years have some degree of Haemorrhoidal
symptoms. The disease haemorrhoids
dealt under the concept of Arshas. Kshara Karma is one
of the superior modality of parasurgical measures
that has wide applicability in haemorrhoids.
Pratisaraneeya Kshara (caustic
cauterization) is useful in wide, deep rooted, spreaded
and elevated type of Arshas vis-a-vis II degree haemorrhoids. In
this Case Apamarga Pratisarneeya Kshara is used and later on biopsy was taken from the
site of application and Histopathological Examination
was done to rule out the cause of recurrence.
After
application of Apamarga Pratisarneeya
Kshara it is being observed that there is no
recurrence of hemorrhoids, to know the cause, that why there is no recurrence
biopsy was taken from the site of application of kshara,followed by histopathological
study and it is observed that The tissue
becomes fibrosed and scar formation seen. The haemorrhoidal vein obliterates permanently and there is no
recurrence of hemorrhoids.
The
present ambulatory surgical procedures like Sclerotherapy,
Rubber band ligation and infrared photo coagulation requires high cost
sophisticated instruments. One of the great advantages of Pratisarneeya Kshara is that it can be safely and
effectively used for patients of old age, late pregnancy and in persons unfit
for surgery.
Case report:
A
35yr old female presented with complaints of bleeding and mass per rectum
associated with constipation. Bleeding was just before defecation. Three months
ago patient was alright, gradually she developed the above complaint in the
beginning bleeding per rectum was mild but later on it was going on increasing.
There is no history of DM/HTN, the family history was
not suggestive of same complaint to other member. On Digital Rectal Examination-there
was normal sphincter tonicity. On Proctoscopy - Internal piles are visualized at 11’o clock
position.
The
classical Lakshanas of Ardra Arshas like Neela,
Tuni, Visarpani, shookaJivha Kledavat, Panasa phala (1) like etc. were
observed Routine hematology
investigations (TC, DC, Hb, ESR, RBS) and urine
investigations were within normal limits. As Susrutha describred the indication of Pratisarneeya Kshara are Mrudu, Prasrut, Avagada and slightly elevated piles. The patients were
laid down on table in lithotomy position and Slit proctoscope lubricated with Lox – 2% (Lignocaine Hydrochloride gel) a local anesthetics, was slowly introduced in anal canal fully.
The hemorrhoid site was identified
and cleaned with cotton swab. Packing was done to the surrounding area and kshara is applied
only to the pile mass for hundred matra kala (approx 2 mins) and in this time period the pile mass became in black color (like Jambu Phala). Soon after this Biopsy specimen
is taken and sent for histopathological examination.
Later on after one week the slough of the region sent for HPE. Same procedure
is repeated after 15 days. Later on in the third month biopsy was repeated and
it is suggestive of Fibrosis of that area.
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Photo 1: Application of Pratisarneeya Kshara |
Photo 2: After 2 minutes (like Jambuphala) |
Photo 3: Fibrosis at the site of application |
Discussion on the effect of treatment:
PratisaraneeyaKshara acts on haemorrhoids in two ways
(1) It cauterizes the pile mass directly because
of its corrosive nature.
(2) It
coagulates protein in haemorrhoidal plexus.
The
coagulation of protein leads to disintegration of haemoglobin
into haem and globin. Synergy of these actions results
in decreasing the size of the pile mass. Further, necrosis of the tissue in the
haemorrhoidal vein will occur. This necrosed tissue slough out as blackish brown discharge for
3 to 7 days. The haem present in the slough gives the
discharge its color. (3)
PRATISARANEEYA
KSHARA COAGULATES PROTEIN
IN HAEMORRHOIDAL PLEXUS CAUTERISES PILE MASS DISINTEGRATION OF
HAEMOGLOBIN HAEM & GLOBIN BLACKISH BROWN
DISCHARGE DECREASES SIZE OF
PILE MASS NECROSIS OFTISSUE WITH
OBLITERATION OF HAEMORRHOIDAL RADICLES NECROSED TISSUE
SLOUGHED OUT FIBROSIS & SCAR
FORMATION OBLITERATION OF
HAEMORRHOIDAL VEIN COMPLETE WOUND
HEALING (21 DAYS) (3-7 DAYS)
Conclusion:
The tissue becomes fibrosed and scar formation seen. The haemorrhoidal
vein obliterates permanently and there is no recurrence of hemorrhoids.
References:
1.
Vaidya Yadavji Trikamjiacharya:Sushruta samhitha with Dalhanacharya Nibhandhasangraha
and Gayadasacharya Nyaychandrika
Panjika commentary edited by Krishnadas
Academy, Varanasi, 7th Edition 2002,
Nidanasthana 2/14, Page – 273.
2.
Vaidya Yadavji Trikamjiacharya:Sushruta samhitha with Dalhanacharya Nibhandhasangraha
and Gayadasacharya Nyaychandrika
Panjika commentary edited by Krishnadas
Academy, Varanasi, 7th Edition 2002, Chikitsasthana
6/3-4, Page – 430.
3.
Dr.P.Hemantha Kumar, P.V.Ramesh Babu
and M.Sahu, Effect of Pratisaraniya
Kshara in the Management of Haemorrhoids
Journal of National Integrated Medical Association, June, 1998, Vol.XLno-6 Page no 9 to11,
ISSN-0377-0621