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The wet hemorrhoids have the predominance of kapha along with vata and can be correlated with internal hemorrhoids which are usually bleeding in nature. The line of treatment as per predominance of vata or kapha has been described. In initial stage the bleeding should not be stopped as the vitiated blood should be let out. Later on kutajadi rasakriya for hemostatis, thick and thin gruel remedies were explained. Cooling therapy, sprinkling therapy with different herbal preparations, warm and cold water sitz bath was advised in the cases of bleeding. Recipes of curds and rice in the diet are also recommended. For local treatment external application of cold leaves, soothing ointment, rubbing recipes and topical application in the bleeding hemorrhoids are described.     
 
The wet hemorrhoids have the predominance of kapha along with vata and can be correlated with internal hemorrhoids which are usually bleeding in nature. The line of treatment as per predominance of vata or kapha has been described. In initial stage the bleeding should not be stopped as the vitiated blood should be let out. Later on kutajadi rasakriya for hemostatis, thick and thin gruel remedies were explained. Cooling therapy, sprinkling therapy with different herbal preparations, warm and cold water sitz bath was advised in the cases of bleeding. Recipes of curds and rice in the diet are also recommended. For local treatment external application of cold leaves, soothing ointment, rubbing recipes and topical application in the bleeding hemorrhoids are described.     
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The chapter:
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===Sanskrit text, Transliteration and English Translation===
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अथातोऽर्शश्चिकित्सितं व्याख्यास्यामः||१||
 
अथातोऽर्शश्चिकित्सितं व्याख्यास्यामः||१||
 
इति ह स्माह भगवानात्रेयः||२||
 
इति ह स्माह भगवानात्रेयः||२||
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Thus ends of the 14th chapter which deals with the treat¬ment of hemorrhoids (arshas) in the section on therapeutics of Agnivesha's work as redacted by Charaka.
 
Thus ends of the 14th chapter which deals with the treat¬ment of hemorrhoids (arshas) in the section on therapeutics of Agnivesha's work as redacted by Charaka.
Tattva vimarsha:
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=== Tattva Vimarsha ===
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• The arsha is of two types viz. congenital and acquired (manifested after the birth).   
 
• The arsha is of two types viz. congenital and acquired (manifested after the birth).   
 
• The congenital haemorrhoids are caused by the vitiation of the beeja dosha (deformity in sperm and ovum), specially the part of the anal canal or anal sphincters. This vitiation of the beeja dosha is caused by either wrong diet, lifestyle regimen of parents (father/mother) or by sinful acts of the past life of patient. These are also causes for all other congenital disorders.  
 
• The congenital haemorrhoids are caused by the vitiation of the beeja dosha (deformity in sperm and ovum), specially the part of the anal canal or anal sphincters. This vitiation of the beeja dosha is caused by either wrong diet, lifestyle regimen of parents (father/mother) or by sinful acts of the past life of patient. These are also causes for all other congenital disorders.  
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• The foods that lead to downward movement of vayu and promote digestive power should be daily consumed by patients of hemorrhoids.  Those foods having opposite properties and those described in the etiology of hemorrhoids should never be used by the patients.  
 
• The foods that lead to downward movement of vayu and promote digestive power should be daily consumed by patients of hemorrhoids.  Those foods having opposite properties and those described in the etiology of hemorrhoids should never be used by the patients.  
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Vidhi Vimarsha:
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=== Vidhi Vimarsha ===
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In modern surgery, the primary hemorrhoids are located at 3, 7, and 11 0 clock position while secondary hemorrhoids are located in other positions as well. The sizes of the hemorrhoids differ from patient to patient as well as duration of disease.
 
In modern surgery, the primary hemorrhoids are located at 3, 7, and 11 0 clock position while secondary hemorrhoids are located in other positions as well. The sizes of the hemorrhoids differ from patient to patient as well as duration of disease.
 
The symptoms described for the incurable hemorrhoids develop due to severe bleeding in third and fourth grade of hemorrhoids and secondary complications may develop due to severe anemia and became incurable. But in the present era this type of condition rarely develops and can be managed with the help of blood transfusion. So, any kind of hemorrhoid is curable in present era except one associated with ano-rectal carcinoma.
 
The symptoms described for the incurable hemorrhoids develop due to severe bleeding in third and fourth grade of hemorrhoids and secondary complications may develop due to severe anemia and became incurable. But in the present era this type of condition rarely develops and can be managed with the help of blood transfusion. So, any kind of hemorrhoid is curable in present era except one associated with ano-rectal carcinoma.
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Surgical management:
 
Surgical management:
 
Ksharasutra is the widely accepted effective method.
 
Ksharasutra is the widely accepted effective method.
Further reading:
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=== Further reading ===
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1. Dudhamal TS, Gupta SK, Bhuyan C, Singh K. Clinical study of kutaja and palasha Kshara in the management of Arsha.  Indian Journal of Ancient Medicine and Yoga (IJAMY) 2009; 2(2):117-22.  
 
1. Dudhamal TS, Gupta SK, Bhuyan C, Singh K. Clinical study of kutaja and palasha Kshara in the management of Arsha.  Indian Journal of Ancient Medicine and Yoga (IJAMY) 2009; 2(2):117-22.  
 
2. Bhuyan C, Gupta SK, Dudhamal TS. Importance of Ksharasutra in the management of Arsha (A study of 3586 cases). AYU International Research Journal of Ayurved. 2009;30(2):232-35.  
 
2. Bhuyan C, Gupta SK, Dudhamal TS. Importance of Ksharasutra in the management of Arsha (A study of 3586 cases). AYU International Research Journal of Ayurved. 2009;30(2):232-35.