Administrators, Editors, Bots, Bureaucrats, Charaksamhita, Moderators (CommentStreams), Interface administrators, Administrators
10,113
edits
Changes
→Etiology of pittaja arsha
#Living in a place and season which are not cold, intake of alcohol and envy;
#Living in a place and season which are not cold, intake of alcohol and envy;
#Intake of drinks, food and drugs having vidahi (causing burning sensation), sharp and hot properties. [15-16]
#Intake of drinks, food and drugs having vidahi (causing burning sensation), sharp and hot properties. [15-16]
====Signs and symptoms of kaphaja arsha====
तत्र यानि प्रमाणवन्ति, उपचितानि, श्लक्ष्णानि, स्पर्शसहानि, स्निग्ध श्वेत पाण्डु पिच्छिलानि, स्तब्धानि, गुरूणि, स्तिमितानि, सुप्त सुप्तानि, स्थिर श्वयथूनि, कण्डू बहुलानि, बहुप्रतत पिञ्जर श्वेतरक्त पिच्छा स्रावीणि, गुरु पिच्छिल श्वेत मूत्र पुरीषाणि, रूक्षोष्णोपशयानि, प्रवाहिकातिमात्रोत्थानवङ्क्षणानाहवन्ति, परिकर्तिका हृल्लास निष्ठीविका कासारोचक प्रतिश्याय गौरव च्छर्दि मूत्रकृच्छ्र शोष शोथ- पाण्डु रोग शीतज्वराश्मरी शर्करा हृदयेन्द्रियोपलेपास्य माधुर्य प्रमेहकराणि, दीर्घकालानुबन्धीनि, अतिमात्रमग्निमार्दव क्लैब्यकराणि, आम विकार प्रबलानि, शुक्ल नख नयन वदन त्वङ्मूत्रपुरीषस्य श्लेष्मोल्बणान्यर्शांसीति विद्यात्||१७||
tatra yāni pramāṇavanti, upacitāni, ślakṣṇāni, sparśasahāni, snigdha śveta pāṇḍu picchilāni, stabdhāni, gurūṇi, stimitāni, supta suptāni, sthira śvayathūni, kaṇḍū bahulāni, bahupratata piñjara śvetarakta picchā srāvīṇi, guru picchila śveta mūtra purīṣāṇi, rūkṣoṣṇopaśayāni, pravāhikātimātrotthānavaṅkṣaṇānāhavanti, parikartikā hṛllāsa niṣṭhīvikā kāsārocaka pratiśyāya gaurava cchardi mūtrakṛcchra śoṣa śotha- pāṇḍu roga śītajvarāśmarī śarkarā hṛdayendriyopalepāsya mādhurya pramehakarāṇi, dīrghakālānubandhīni, atimātramagnimārdava klaibyakarāṇi, āma vikāra prabalāni, śukla nakha nayana vadana tvaṅmūtrapurīṣasya śleṣmolbaṇānyarśāṃsīti vidyāt||17||
tatra yAni pramANavanti, upacitAni, shlakShNAni, sparshasahAni [3] , snigdhashvetapANDupicchilAni,stabdhAni, gurUNi, stimitAni, suptasuptAni, sthirashvayathUni, kaNDUbahulAni,bahupratatapi~jjarashvetaraktapicchAsrAvINi, gurupicchilashvetamUtrapurIShANi,rUkShoShNopashayAni, pravAhikAtimAtrotthAnava~gkShaNAnAhavanti,parikartikAhRullAsaniShThIvikAkAsArocakapratishyAyagauravacchardimUtrakRucchrashoShashotha-pANDurogashItajvarAshmarIsharkarAhRudayendriyopalepAsyamAdhuryapramehakarANi,dIrghakAlAnubandhIni [4] , atimAtramagnimArdavaklaibyakarANi, AmavikAraprabalAni,shuklanakhanayanavadanatva~gmUtrapurIShasya shleShmolbaNAnyarshAMsIti vidyAt||17||
The following are the signs and symptoms of kaphaja arshas
#The hemorrhoids are large in size, swollen, smooth, painless to touch,
#The hemorrhoids are unctuous, white, pale white, slimy, having stiffness, heavy, rigid, benumbed, having consistent oedema and excessive of itching.
#The discharge from the hemorrhoids is excess and continuous having white or red in colour with slimyness.
#Urine and stool of the patient are heavy, slimy and white
#Ruksha (un-unctuous) and hot therapies gives relief from symptoms
#The patient has an excessive desire to pass stool with tenesmus and distension in the lower pelvic region
#The patient suffers from burning pain in anus, nausea, excessive spitting, cough, anorexia, cold, heaviness, vomiting, dysuria; lethargy, edema, anemia.
#Patient suffer from fever associated with cold, stone and gravels in genito¬urinary tract, a feeling as if the heart and sense organs are covered with sticky material, sweet taste in the mouth and prameha (obstinate urinary disorders including diabetes),
#The disease becomes chronic condition. So, digestive power gets suppressed and causes impotency
#They are associated with acute diseases caused by ama (product of improper digestion and metabolism).
#The nails, eyes, face, skin, urine and stool are become white in color. [17]
====Etiology of kaphaja arsha====
भवतश्चात्र-
मधुर स्निग्ध शीतानि लवणाम्ल गुरूणि च|
अव्यायामो दिवास्वप्नः शय्यासनसुखे रतिः||१८||
प्राग्वातसेवा शीतौ च देशकालावचिन्तनम्|
श्लैष्मिकाणां समुद्दिष्टमेतत् कारणमर्शसाम्||१९||
bhavataścātra-
madhura snigdha śītāni lavaṇāmla gurūṇi ca|
avyāyāmo divāsvapnaḥ śayyāsanasukhe ratiḥ||18||
prāgvātasevā śītau ca deśakālāvacintanam|
ślaiṣmikāṇāṃ samuddiṣṭametat kāraṇamarśasām||19||
bhavatashcAtra-
madhurasnigdhashItAni lavaNAmlagurUNi ca|
avyAyAmo divAsvapnaH shayyAsanasukhe ratiH||18||
prAgvAtasevA shItau ca deshakAlAvacintanam|
shlaiShmikANAM samuddiShTametat kAraNamarshasAm||19||
The causes of kaphaja arsha (hemorrhoids) are as follow
#Sweet, unctuous, cold, salty, sour and heavy food
#Lack of exercise, sleeping during day time and indul¬gence in the pleasure of beds and seats (excess sleeping and sitting)
#Direct exposure to wind
#Living in cold place and exposure to cold season and mental inactivity. [18-19]
====Etiology and symptoms of dwandaja and sannipataja type of arsha hemorrhoids====
हेतु लक्षण संसर्गाद्विद्याद्द्वन्द्वोल्बणानि च|
सर्वो हेतुस्त्रिदोषाणां सहजैर्लक्षणैः समम्||२०||
hetu lakṣaṇa saṃsargādvidyāddvandvolbaṇāni ca|
sarvo hetustridoṣāṇāṃ sahajairlakṣaṇaiḥ samam||20||
hetulakShaNasaMsargAdvidyAddvandvolbaNAni ca|
sarvo hetustridoShANAM sahajairlakShaNaiH samam||20||
The dwandaja arsha (in which two doshas are predo¬minantly aggravated) is caused by the combination of two types of etiological factors and clinical features of two doshas. If the causative factors of all the doshas are combined together, then tridosaja type of hemorrhoids (in which all the three doshas are simultaneously aggravated) is manifested. The signs and symptoms of hemorrhoids are similar to those described for hereditary type of hemorrhoids- (vide verses 7 and 8 above). [20]
====Purvaroopa (premonitory) signs and symptoms of hemorrhoids====
विष्टम्भोऽन्नस्य दौर्बल्यं कुक्षेराटोप एव च|
कार्श्यमुद्गारबाहुल्यं सक्थिसादोऽल्पविट्कता||२१||
ग्रहणीदोषपाण्ड्वर्तेराशङ्का चोदरस्य च|
पूर्वरूपाणि निर्दिष्टान्यर्शसामभिवृद्धये||२२||
viṣṭambho’nnasya daurbalyaṃ kukṣerāṭopa eva ca|
kārśyamudgārabāhulyaṃ sakthisādo’lpaviṭkatā||21||
grahaṇīdoṣapāṇḍvarterāśaṅkā codarasya ca|
pūrvarūpāṇi nirdiṣṭānyarśasāmabhivṛddhaye||22||
viShTambho~annasya daurbalyaM kukSherATopa eva ca|
kArshyamudgArabAhulyaM sakthisAdo~alpaviTkatA||21||
grahaNIdoShapANDvarterAsha~gkA codarasya ca|
pUrvarUpANi nirdiShTAnyarshasAmabhivRuddhaye||22||
Delayed digestion of the food, weak¬ness, gurgling sound in the lower abdomen, emaciation, fre¬quent eructation; pain in thighs, voiding less stool, anemia, apprehension of the manifestation of udararoga (obstinate abdominal disorders including ascites)-these are the premonitory signs and symptoms in the development of hemorrhoids. [21-22]
====Involvement of three doshas====
अर्शांसि खलु जायन्ते नासन्निपतितैस्त्रिभिः|
दोषैर्दोषविशेषात्तु विशेषः कल्प्यतेऽर्शसाम्||२३||
arśāṃsi khalu jāyante nāsannipatitaistribhiḥ|
doṣairdoṣaviśeṣāttu viśeṣaḥ kalpyate’rśasām||23||
arshAMsi khalu jAyante nAsannipatitaistribhiH|
doShairdoShavisheShAttu visheShaH kalpyate~arshasAm||23||
Hemorrhoids never manifest without the aggravation of all the three doshas. It is evident that the predominance of one or all the doshas determine the type of hemorrhoids. The nomenclature of doshaja arsha is given according to the predominance of dosha e.g. if vata dosha is predominat then that hemorrhoid is said to be vataja arsha. [23]
====Aggravation of tridosha in arsha====
पञ्चात्मा मारुतः पित्तं कफो गुदवलित्रयम्|
सर्व एव प्रकुप्यन्ति गुदजानां समुद्भवे||२४||
तस्मादर्शांसि दुःखानि बहुव्याधिकराणि च|
सर्वदेहोपतापीनि प्रायः कृच्छ्रतमानि च||२५||
pañcātmā mārutaḥ pittaṃ kapho gudavalitrayam|
sarva eva prakupyanti gudajānāṃ samudbhave||24||
tasmādarśāṃsi duḥkhāni bahuvyādhikarāṇi ca|
sarvadehopatāpīni prāyaḥ kṛcchratamāni ca||25||
pa~jcAtmA mArutaH pittaM kapho gudavalitrayam|
sarva eva prakupyanti gudajAnAM samudbhave||24||
tasmAdarshAMsi duHkhAni bahuvyAdhikarANi ca|
sarvadehopatApIni prAyaH kRucchratamAni ca||25||
Five types of vayu (prana, apana, vyana, udana and samana), pitta and kapha - all these morbid factors in their aggravated state afflict the three anal sphincters at ano-rectum and lead to hemorrhoids. These hemorrhoids are painful and are usually associated with several complications. These hemorrhoids affect the whole body and so they are difficult to cure with conservative measures. [24-25]
====Symptoms of incurable arsha====
हस्ते पादे मुखे नाभ्यां गुदे वृषणयोस्तथा|
शोथो हृत्पार्श्वशूलं च यस्यासाध्योऽर्शसो हि सः||२६||
हृत्पार्श्वशूलं सम्मोहश्छर्दिरङ्गस्य रुग् ज्वरः|
तृष्णा गुदस्य पाकश्च निहन्यर्गुदजातुरम्||२७||
सहजानि त्रिदोषाणि यानि चाभ्यन्तरां वलिम्|
जायन्तेऽर्शांसि संश्रित्य तान्यसाध्यानि निर्दिशेत्||२८||
शेषत्वादायुषस्तानि चतुष्पादसमन्विते|
याप्यन्ते दीप्तकायाग्नेः प्रत्याख्येयान्यतोऽन्यथा||२९||
द्वन्द्वजानि द्वितीयायां वलौ यान्याश्रितानि च|
कृच्छ्रसाध्यानि तान्याहुः परिसंवत्सराणि च||३०||
बाह्यायां तु वलौ जातान्येकदोषोल्बणानि च|
अर्शांसि सुखसाध्यानि न चिरोत्पाततानि च||३१||
तेषां प्रशमने यत्नमाशु कुर्याद्विचक्षणः|
तान्याशु हि गुदं बद्ध्वा कुर्युर्बद्धगुदोदरम्||३२||
haste pāde mukhe nābhyāṃ gude vṛṣaṇayostathā|
śotho hṛtpārśvaśūlaṃ ca yasyāsādhyo’rśaso hi saḥ||26||
hṛtpārśvaśūlaṃ sammohaśchardiraṅgasya rug jvaraḥ|
tṛṣṇā gudasya pākaśca nihanyargudajāturam||27||
sahajāni tridoṣāṇi yāni cābhyantarāṃ valim|
jāyante’rśāṃsi saṃśritya tānyasādhyāni nirdiśet||28||
śoṣatvādāyuṣastāni catuṣpādasamanvite|
yāpyante dīptakāyāgneḥ pratyākhyeyānyato’nyathā||29||
dvandvajāni dvitīyāyāṃ valau yānyāśritāni ca|
kṛcchrasādhyāni tānyāhuḥ parisaṃvatsarāṇi ca||30||
bāhyāyāṃ tu valau jātānyekadoṣolbaṇāni ca|
arśāṃsi sukhasādhyāni na cirotpātatāni ca||31||
teṣāṃ praśamane yatnamāśu kuryādvicakṣaṇaḥ|
tānyāśu hi gudaṃ baddhvā kuryurbaddhagudodaram||32||
haste pAde mukhe nAbhyAM gude vRuShaNayostathA|
shotho hRutpArshvashUlaM ca yasyAsAdhyo~arshaso hi saH||26||
hRutpArshvashUlaM sammohashchardira~ggasya rug jvaraH|
tRuShNA gudasya pAkashca nihanyargudajAturam||27||
sahajAni tridoShANi yAni cAbhyantarAM valim|
jAyante~arshAMsi saMshritya tAnyasAdhyAni nirdishet||28||
shoShatvAdAyuShastAni catuShpAdasamanvite|
yApyante dIptakAyAgneH pratyAkhyeyAnyato~anyathA||29||
dvandvajAni dvitIyAyAM valau yAnyAshritAni ca|
kRucchrasAdhyAni tAnyAhuH parisaMvatsarANi ca||30||
bAhyAyAM tu valau jAtAnyekadoSholbaNAni ca|
arshAMsi sukhasAdhyAni na cirotpAtatAni ca||31||
teShAM prashamane yatnamAshu kuryAdvicakShaNaH|
tAnyAshu hi gudaM baddhvA kuryurbaddhagudodaram||32||
If the patient of hemorrhoids develops edema in upper and lower extremities, face, umbilicus, anus and scrotum, and if he suffers from pain in the cardiac region and lateral parts of chest, then such types of patients became incurable. [26]
Pain in the cardiac region and lateral parts of the chest, fainting, vomiting, pain in the limbs, fever, thirst and perianal swelling - these complications lead to the death of the patient suffering from hemorrhoids. [27]
Congenital/hereditary hemorrhoids caused by aggravation of three doshas and hemorrhoids located in the internal sphincter of the anus are also considered as incurable. [28]
In the presence of above incurable symptoms, if all four aspects of treatments like physician, drugs, attendant and patient are in the state of their excellence and if the patient has strong kayagni (power of digestion and metabolism) the disease may become yapya (palliative). Otherwise the disease became incurable. [29]
If the hemorrhoids are caused by vitiation of two doshas, and are located in the second anal- sphincter and if these are more than one year old, then these are difficult of cure.
If the hemorrhoids are located in the external anal sphincter with vitiation of one dosha, and are not chronic then patient is said to be curable.
A wise physician/surgeon should treat the patient early otherwise the enlarged hemorrhoids can obstruct the anal canal and lead to baddha-gudodara (obstruction in the passage of the ano-rectum). [30-32]
====Treatment of hemorrhoids====
तत्राहुरेके शस्त्रेण कर्तनं हितमर्शसाम्|
दाहं क्षारेण चाप्येके, दाहमेके तथाऽग्निना||३३||
अस्त्येतद्भूरितन्त्रेण धीमता दृष्टकर्मणा|
क्रियते त्रिविधं कर्म भ्रंशस्तत्र सुदारुणः||३४||
पुंस्त्वोपघातः श्वयथुर्गुदे वेगविनिग्रहः|
आध्मानं दारुणं शूलं व्यथा रक्तातिवर्तनम्||३५||
पुनर्विरोहो रूढानां क्लेदो भ्रंशो गुदस्य च|
मरणं वा भवेच्छीघ्रं शस्त्रक्षाराग्निविभ्रमात्||३६||
यत्तु कर्म सुखोपायमल्पभ्रंशमदारुणम्|
तदर्शसां प्रवक्ष्यामि समूलानां विवृत्तये||३७||
tatrāhureke śastreṇa kartanaṃ hitamarśasām|
dāhaṃ kṣāreṇa cāpyeke, dāhameke tathā’gninā||33||
astyetadbhūritantreṇa dhīmatā dṛṣṭakarmaṇā|
kriyate trividhaṃ karma bhraṃśastatra sudāruṇaḥ||34||
puṃstvopaghātaḥ śvayathurgude vegavinigrahaḥ|
ādhmānaṃ dāruṇaṃ śūlaṃ vyathā raktātivartanam||35||
punarviroho rūḍhānāṃ kledo bhraṃśo gudasya ca|
maraṇaṃ vā bhavecchīghraṃ śastrakṣārāgnivibhramāt||36||
yattu karma sukhopāyamalpabhraṃśamadāruṇam|
tadarśasāṃ pravakṣyāmi samūlānāṃ vivṛttaye||37||
tatrAhureke shastreNa kartanaM hitamarshasAm|
dAhaM kShAreNa cApyeke, dAhameke tathA~agninA||33||
astyetadbhUritantreNa [5] dhImatA dRuShTakarmaNA|
kriyate trividhaM karma bhraMshastatra sudAruNaH||34||
puMstvopaghAtaH shvayathurgude vegavinigrahaH|
AdhmAnaM dAruNaM shUlaM vyathA raktAtivartanam||35||
punarviroho rUDhAnAM kledo bhraMsho gudasya ca|
maraNaM vA bhavecchIghraM shastrakShArAgnivibhramAt||36||
yattu karma sukhopAyamalpabhraMshamadAruNam|
tadarshasAM pravakShyAmi samUlAnAM vivRuttaye||37||
In the management of arsha,some physicians/surgeons advise excision of the hemorrhoids by sharp instruments, while others recommend cauterization with ksharakarma (alkalies) and agnikarma (thermal cauterization). These procedures should be administered only by a physician/surgeon who is well trained in the field.
Any mistake during these (surgical or para-surgical) procedures could result in serious consequencwes and complications, such as impotency, ano-rectal swelling, obstruction in defecation, abdominal distension, excruciating pain, excessive bleeding and recurrence of hemorrhoids. On healing stricture may form and chronic sticky /pus discharge, prolapse of the rectum can occur. Above complications may develop due to improper surgery, ksharakarma and agnikarma.
Now the treatment which involve less of risk and which are not painful will be described for the eradication of hemorrhoids. [33-37]
====Classification of arsha====
वातश्लेष्मोल्बणान्याहुः शुष्काण्यर्शांसि तद्विदः|
प्रस्रावीणि तथाऽऽर्द्राणि रक्तपित्तोल्बणानि च||३८||
vātaśleṣmolbaṇānyāhuḥ śuṣkāṇyarśāṃsi tadvidaḥ|
prasrāvīṇi tathā”rdrāṇi raktapittolbaṇāni ca||38||
vAtashleShmolbaNAnyAhuH shuShkANyarshAMsi tadvidaH|
prasrAvINi tathA~a~ardrANi raktapittolbaNAni ca||38||
Hemorrhoids caused by aggrava¬tion of vayu and kapha are called dry hemorrhoids. Whereas those with excess discharge(bleeding) and wetness are caused by aggravation of rakta and pitta. [38]
====Treatment of dry hemorrhoids====
तत्र शुष्कार्शसां पूर्वं प्रवक्ष्यामि चिकित्सितम्|
स्तब्धानि स्वेदयेत् पूर्वं शोफशूलान्वितानि च||३९||
tatra śuṣkārśasāṃ pūrvaṃ pravakṣyāmi cikitsitam|
stabdhāni svedayet pūrvaṃ śophaśūlānvitāni ca||39||
tatra shuShkArshasAM pUrvaM pravakShyAmi cikitsitam|
stabdhAni svedayet pUrvaM shophashUlAnvitAni ca||39||
Dry, hard, inflamed and painful hemorrhoids should be first treated with fomentation. [39]
====Recipes for fomentation====
चित्रक क्षार बिल्वानां तैलेनाभ्यज्य बुद्धिमान्|
यव माष कुलत्थानां पुलाकानां च पोट्टलैः||४०||
गोखराश्वशकृत्पिण्डैस्तिलकल्कैस्तुषैस्तथा|
वचाशताह्वापिण्डैर्वा सुखोष्णैः स्नेहसंयुतैः||४१||
शक्तूनां पिण्डिकाभिर्वा स्निग्धानां तैलसर्पिषा|
शुष्कमूलकपिण्डैर्वा पिण्डैर्वा कार्ष्णगन्धिकैः||४२||
रास्नापिण्डैः सुखोष्णैर्वा सस्नेहैर्हापुषैरपि|
इष्टकस्य खराह्वायाः शाकैर्गृञ्जनकस्य वा||४३||
अभ्यज्य कुष्ठतैलेन स्वेदयेत् पोट्टलीकृतैः|
citraka kṣāra bilvānāṃ tailenābhyajya buddhimān|
yava māṣa kulatthānāṃ pulākānāṃ ca poṭṭalaiḥ||40||
gokharāśvaśakṛtpiṇḍaistilakalkaistuṣaistathā|
vacāśatāhvāpiṇḍairvā sukhoṣṇaiḥ snehasaṃyutaiḥ||41||
śaktūnāṃ piṇḍikābhirvā snigdhānāṃ tailasarpiṣā|
śuṣkamūlakapiṇḍairvā piṇḍairvā kārṣṇagandhikaiḥ||42||
rāsnāpiṇḍaiḥ sukhoṣṇairvā sasnehairhāpuṣairapi|
iṣṭakasya kharāhvāyāḥ śākairgṛñjanakasya vā||43||
abhyajya kuṣṭhatailena svedayet poṭṭalīkṛtaiḥ|
citrakakShArabilvAnAM tailenAbhyajya buddhimAn|
yavamAShakulatthAnAM pulAkAnAM ca poTTalaiH||40||
gokharAshvashakRutpiNDaistilakalkaistuShaistathA|
vacAshatAhvApiNDairvA sukhoShNaiH snehasaMyutaiH||41||
shaktUnAM piNDikAbhirvA snigdhAnAM tailasarpiShA|
shuShkamUlakapiNDairvA piNDairvA kArShNagandhikaiH||42||
rAsnApiNDaiH sukhoShNairvA sasnehairhApuShairapi|
iShTakasya kharAhvAyAH shAkairgRu~jjanakasya vA||43||
abhyajya kuShThatailena svedayet poTTalIkRutaiH|
The pile mass should be smeared with the help of the oil prepared by boiling chitraka (Plumbago zeylanica Linn.), alkalies and bilva (Aegle marmelos Carr.).
Fomen¬tation should be done with the help of the following formulations:
# Pottali (medicines tied in a piece of cloth in the form of a bolus) containing yava (Hordeum vulgare Linn.), masha, kulattha (Vigna unquiculata (Linn.) walp and pulaka (tucchadhnnya )
# Pottali prepared of the cake of the sesame seed
#Pottali containing husk of paddy.
#Pottali of vacha (Acarus calamus Linn.) and satahva (Anethum sowa Roxb.)
The above mentioned recipes of pottali and pindas should be tolerably warm and should be added with fat. [40-41]
#Pinda containing sattu (roasted corn flour) and added with unctuous substances, like oil and ghee
# Pinda containing the pulp of dry radish
# Pinda containing karshnagandhika
#Pinda containing rasna (Pluchea lanceolata)
# Pinda containing hapusha
The above mentioned recipes (no. 6 to 10) should be luke-warm and should be added with fat. The hemorrhoids mass should be smeared with oil prepared by boiling with rasna (Pluchea lanceolata). Thereafter, it should be fomented, with the help of a potalli containing brick powder, kharahva (Ajamoda/Apium leptophyllum (Pers.)) and the pulp of gunjanaka (Abrus precatorius Linn.). [39-43]
====Recipe for Sprinkling====
वृषार्कैरण्डबिल्वानां पत्रोत्क्वाथैश्च सेचयेत्||४४||
vṛṣārkairaṇḍabilvānāṃ patrotkvāthaiśca secayet||44||
vRuShArkairaNDabilvAnAM patrotkvAthaishca secayet||44||
The hemorrhoids mass should be sprinkled with decoction of the leaves vasa (Adhatoda zeylanica Medic.), arka (Calotropis procera Ait.), eranda (Ricinus communis Linn.) and bilva (Aegle marmelos Carr.) [44]
=== ''Tattva Vimarsha'' ===
=== ''Tattva Vimarsha'' ===