अथातोऽर्शसां निदानं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥ १ ॥
We will now expound the chapter called Arsas Nidanam – diagnosis of piles; thus said by Atreya and other great sages. (1)
Arsas bheda – Piles types
अरिवद्विशसन्तीत्यशसि तानि पुनर्बहुप्रकाराणि सुबहूपद्रवाणि च पायुमेद्रादिसंश्रया मांसकीलाः ।
समासतस्तु द्विविधान्यशसि सहजानि जन्मोत्तरकालजानि च । पुनश्च द्विविधानि शुष्काण्यार्द्राणि च ।
सर्वेषां पुनरधिष्ठानं मेदो मांसं त्वक् च । स्थूलान्त्रप्रति – बद्धोऽर्धपञ्चाङ्गुलो हि गुदः ।
तस्मिन् पूर्वमुक्ता वलीसंज्ञास्तिस्त्रः पेश्योऽध्यर्धाङ्गुलाः । ता: प्रवाहिणी विसर्जनी संवरणी च ।
रोमान्तादध्यर्धयवं गुदौष्ठमाहुः । प्रथमा तु गुदौष्ठादङ्गुलमात्रे ॥२॥
Because they give troubles to the person like a foe, they are known as Arsas, they are pegs (sprouts, extrusions, projections) of mamsa ( muscle ) , situated in the anus (rectum), penis etc, of different kinds and with many complications (secondary diseases); in short, arsas are of two kinds viz, Sahaja (congenital/hereditary) and Janmottarakalaja (manifesting after birth, acquired). Again they are of two kinds Suska (dry, nonexudative, non-bleeding) and ardra (moist, exudative, bleeding ). For all these, the supporting tissues are fat, muscle and skin.
Notes: Pile mass in the rectum is actually a portion of dilated vein and not sprout of muscle as stated above. Sprout like growths on the skin, penis, nose, ear etc are excrescence on the skin and are called as warts, cyst, polyp, papilloma etc. in modern parlance.
Gudavali – folds ozf rectum
Guda (anus, rectum) is attached to the large intestine and is of five and half angula (fingers breadth), having three valis, (folds), by name pravahini, visarjini and samvarani described previously; one and half times the size of barley grain above the border line of hairs, is situated the gudosta (anal lip), the first fold is one and a half angula in length above the anal lip. (2)
Notes: The anal lip is of the thickness of one and a half times the size of a barley grain; above the anal lip lies the first layer known as Samvarini (that which closes the anal orifice) of one and half angula in length; above this is the second fold known as Visarjini (that which expels the faeces) of one and half angula; above that, is the third fold known as Pravahini (that which is the place of straining) also of the same length – making up five and half angula in total.
Sahaja arsas – congenital piles
तत्र सहजानां गुदवलीबीजोपतप्तिरायतनम् । तस्या द्विविधो हेतुः मातापित्रोरपचारो दैवं च ।
ताभ्यां सन्निपातप्रकोपः । तस्मात्तान्यसाध्यानि । एतेन कुलजाः सर्वे विकारा व्याख्याताः ॥३॥
विशेषतस्तु सहजानि दुर्दर्शनपरुषपाण्डूपचितदारुणान्यन्तर्मुखानि बहूपद्रवोपद्रुतानि भवति ॥४॥
The cause of Sahaja arsas (congenital piles) is the deformities/abuormalities of the parts of the seed responsible for genesis of the folds of the rectum; the causes for such derangement are two viz – misconduct of the mother and father, and providence; from these (two causes) occurs the increase of all the three doshas together, hence this kind of piles is incurable. This ( explanation) applies to all hereditary diseases. (3)
Congenital piles especially are ugly, hard (rough), yellowish-white, well grown (big), dreadful (causing severe pain etc) with internal opening (orifice inside the rectum only) and having many complications (secondary diseases). (4)
Janmottaraja arsas – acquired piles
अथेतराणि षड्विधानि पृथग्दोषैः संसृष्टैः सन्निपतितैः शोणितेन च । तत्र वातश्लेष्मोत्तराणि शुष्काणि रक्तपित्तोत्तराण्यार्द्राणि ॥५॥
The other kind (acquired) is of six kinds-from each dosha seperately, by combination of two and of the three, and from rakta; the dry (non-exudative, non-haemorrhagic), piles has the predominance of vata and kapha, while the moist (exudative, haemorrhagic) kind has the predominance of the rakta and pitta. (5)
Arsha Nidana- causes
दोषप्रकोपहेतुस्तु प्रागुक्तः । स यदा मलोपचयमादधाति पुनश्चोत्कटकविषमकठिनासनसेवनादुद्भ्रान्तयानोष्ट्रादिप्रयाणादतिव्यवायद्वास्तिनेत्रासम्यक्प्रणिधानादिना गुदक्षणनादभीक्ष्णं शीताम्बुसंस्पर्शाच्चैललोष्टतृणादिसङ्घर्षात्प्रततातिप्रवाहणाद्वातमूत्रपुरीषवेगोदीरणधारणात्स्त्रीणां चामगर्भभ्रंशाद्गर्भोत्पीडनाद्विषमप्रसूतेरेवंविधैश्चापरैः कुपितो वायुरपानस्तं मलमुपचितमधोगतमासाद्य गुदवलीष्वाधत्ते । ततस्तास्वभिष्यण्णास्वर्शांसि सम्भवन्ति ॥ ६ ॥
The causes for the increase of the doshas have been enumerated earlier (vide chapter 1). When these bring about increase of faeces, indulgence (habitually for long periods) in activities such as sitting on the heels, and on uneven and hard seats, riding on vehicles, which jump upwards, such as camel etc; excess of sexual intercourse, improper manner of inserting the enema nozzle etc, causing injury to the rectum; washing the rectum repeatedly with very cold water, injury caused by contact with cloth, stone, grass etc, constant straining (at stools) too much for long time; initiating the urges of flatus, faeces, and urine prematurely or suppressing them; abortion, miscarriage, injury to the foetus, abnormal delivery etc, in women and such other causes, bring about increase of apana vata, which in turn, withholds the accumilated faeces in the folds of the rectum – thus weakend. (6)
Purvarupa – premonitory symptoms
तेषां पूर्वरूपाणि कृच्छ्रात् पक्तिरन्त्रकूजनमुद्गारबाहुल्यमम्लकोऽन्नाश्रद्धाविष्टम्भोश्मगर्भाभनाभित्वमाटोपोऽधस्तात् कृच्छ्रेण सशब्दस्य चवायोः प्रवृत्तिर्बहुमूत्रत्वमल्पपुरीषता गुदपरिकर्तनं सक्थिसदनमक्ष्णोः श्वयथुरविमलेन्द्रियत्वमालस्यं तन्द्रा कार्यं दौर्बल्यमाशङ्का ग्रहणीदोषशोफोदरपाण्डुरोगगुल्मेषु । जातेषु चैतानि लिङ्गानि प्रव्यक्ततराणि भवन्ति ॥७॥
Their premonitory symptoms are – digestion of food with difficulty, gurgling in the intestines, excess of belching, sourness, lack of relish for food, long stasis of food inside, hardness underneath the region of the umbilicus like a stone being concealed, sound in the intestines, flatus moving downwards with difficulty and expelled with noise, frequent urination, less quantity of faeces, cutting pain in the rectum, weakness of the thighs, swellings around the eyes, accumulations of dirt in the sense organs, stupor, emaciation, debility, the condition creates doubt of diseases like grahani dosha (duodenal disorder) sopha (dropsy), udara (enlargement of the abdomen), panduroga (anaemia), and gulma (tumors of the abdomen). These very same symptoms become profound (well manifest) during the next stage. (7)
तैः खल्वधोमार्गोपरोधाद्वायुरपानो निवर्तमानः समानव्यानोदानप्राणान् पित्तश्लेष्माणौ च प्रकोपयन्ननलमुपमृद्गाति ॥ ८ ॥
Apana vata, thus being obstructed in its downward movement by the piles, turns upwards, brings about the increase of samana, vyana, udana and prana vatas and also pitta and kapha, and destroys the fire (digestive activity in the alimentary canal). (8)
Samanya Lakshana – clinical features
अथ सर्व एवार्शसो भवत्यतिकृशो विवर्णः क्षामो दीनः प्रचुरविबद्धवातमूत्रपुरीषोऽश्मरीशर्करावाननियतविबद्धमुक्तामपक्वभिन्नशुष्कवर्चास्तथान्तराश्वेतपाण्डुहरितपीतरक्तारुणतनुसान्द्रपिच्छिलोपवेशी नाभिवङ्क्षणोद्देशप्रचुरपरिकर्तिकान्वितः सगुदशूलप्रवाहिकाप्रहर्षप्रमोहोऽल्पशुक्रप्रजोऽल्पभुक् सिरासन्ततगात्रः क्रोधनो दुरुपचारः कासश्वासपीनसतृष्णारोचकपाणिपादवदनाक्षिकूटश्वयथुक्षवथुवेपथुवमथुपरीतस्तैमिरिक: शिरःशूली क्षामभिन्नस्वरः कर्णरोगी सज्वरः साङ्गमर्दः सर्वपर्वास्थिशूलोऽन्तरान्तरा हृदयकुक्षिपार्श्वपृष्ठबस्तित्रिकग्रहोपतप्तः प्रध्यानपरः परमलसश्च ॥ ९ ॥
Then in all kinds of piles, the patients become very emaciated discoloured, wasted, timid, develop great difficulty in elimination of flatus, urine and faeces, urine contains gravel or stones, feaces flatus, eliminated either irregularly with difficulty or feebly, either not processed or well processed, broken and dry, in different colours, such as white, yellowish-white, green yellow, red or crimson, intermittantly with severe cutting pain in the umbilicus, groins and round about, along with (pricking), pain in the rectum (anus), straining and tingling sensation, severe delusion, has little of semen and offspring, eating every little, body full of network of veins, he is always angry, so difficult for others to serve him, accompanied with cough, dyspnoea, running in the nose, thirst, loss of appetite (or of taste), oedemaof the hands, feets, face and eye sockets, sneezing, vomiting, blindness, headache, feeble, and broken voice, pain in the ears (other diseases), fever, body aches, pain in the joints and heart, abdomen, flanks, back, region of the bladder and sacro – rectal area, very much worried and thoroguhly inactive. (9)
Vataja arsas
तत्र वातोल्बणानि शुष्कम्लानकठिनपरुषरूक्षश्यावारुणानि तीक्ष्णस्फुटितमुखानि विषममध्यानि कदम्ब पुष्पतुण्डिकेरीकर्कन्धुसिद्धार्थबिम्बीखर्जूरफलप्रमाणानि वक्राणि मिथो विसदृशानि कटीपार्श्वादिष्वधिकवेदनानि सशूलोदावर्तकराणिगुल्माष्ठीलाप्लीहोदराणि चास्य तन्निमित्तान्येव । कृष्णत्वड्नखनयनवदनमलाश्च भवन्ति ॥१०॥
Those (piles) with the pedominance of vata are dry (non-exudative) faded in colour, hard, rough, dry ( course ), bluish-red in colour, their mouth ( tip) deep and open (cracked, fissured), uneven in the middle, of the size of flower of kadamba, fruits of tundikeri, karkandhu, siddhartha, bimbi, and kharjura, curved, each one (pile mass) appearing different from the other, associated with severe pain in the waist, flanks etc, causing pain in the abdomen and upward movement (reverse peristalisis) they become the cause of diseases such as gulma (abdominal tumor), asthila (enlargement of prostate ), pliha ( enlargement of spleen) and udara (enlargement of the abdomen), the skin, nails, eyes, face and faeces are all blackish. (10)
Pittaja arsas
पित्तोल्बणानि नीलाग्राणि रक्तपीतकृष्णानि मृदुशिथिलानि स्पर्शासहानि विस्रगन्धीनि तनूनि तनुरक्तस्रावीणि दाहपाकवन्ति ज्वरमोहारुचिकराणि यकृत्प्रकाशानि शुकजिह्वाजलौकावक्त्रसदृशानि यवमध्यानि प्रक्लिन्नानि भिन्नपीतवर्चांसि हारिद्रत्वङ्नखादिकराणि च ॥११॥
Those (piles) with the predominance of pitta, have blue tips, red, yellow or black bodies, are soft, flaccid, tender (not allowing touch), of foul smell, thin, exuding thin red blood, having burning sensation and ulceration, causing fever, delusion and loss of appetite (or taste), resemble the liver, tongue of the parrot or the mouth of the leech (in colour), of the size of a barley in their middle, very moist, the faeces is broken and yellow in colour, these cause turmeric – colour (deep yellow) in the skin nails etc. (11)
Kaphaja arsas
श्रेष्मोल्बणानिमहामूलानि स्थिरस्निग्धपाण्डुवृत्तोपचितानिगुरुस्तब्धशुक्ष्णपिच्छिलानि सुप्तसुप्तानि स्पर्शक्षमाणि करीरपनसास्थिगोस्तनाकाराण्यतिमात्रोत्थानप्रवाहिकावङ्क्षणानाहनाभिपरिकर्तिकाहल्लासप्रसके कासश्वासपीनसारुचिच्छर्दिकृ छ्रमूत्रप्रमहेशतज्वरशोफशिरोगौरवेन्द्रियोपलेपाग्निमार्दवक्लैब्यामविकारप्रबलानि न भिद्यन्ते न स्रवन्ति कण्डूबहुलानि सश्लेष्मवसाप्रकाशातिमलोपवेशीनि शुक्लत्वड्नखादि कराणिच । लक्षणसङ्करात् संसर्गसन्निपातजानि विभजेत् ॥ १२ ॥
Those with the predominance of slesma ( kapha) are deep rooted, immoveable, unctous, (greasy ) , yellowish white, round, big in size, heavy, stiff smooth, slimy, sleeping with lack of sensation, tolerating touch, resembling karira, seed of panasa, gostana (nipple of the cow) in shape, arising in wide areas, associated with straining at stools, bulging at the groins, cuting pain in the umbilicus, nausea, salivation, cough, dyspnoea, running in the nsoe, loss of appetite (or taste ), vomiting, dysurea, polyurea (increase of frequency), fever with rigors, oedema, heaviness of the head, sense organs covered with dirt, weakness of digestion, sexual debility and other disease caused by ama, they (pile mass) do not burst nor exude anything, have severe itching, the patient eliminates faeces mixed with slesma (mucus) and vasa (muscle-fat) and of large quantity cause white discolouration of the skin, nails etc.
Those arising from combination of two doshas and of all the three, should be distinguished by the presence of mixed symptoms. ( 12 )
Raktaja arsas
रक्तोल्बणानि तु वटप्ररोहविद्रुमकाकनन्दिकाफलाभानि पित्तलक्षणानि च तथा गाढपुरीषप्रतिपीडितान्यत्यर्थं दुष्टमुष्णमसृक् सहसा विसृजन्ति । तस्यातिप्रवृत्तौ रक्तक्षयोपद्रवा भवन्तीति । भवति चात्र श्लोकः ॥ १३ ॥
मुद्गकोद्रवजूर्णाह्वकरीरचणकादिभिः। रूक्षैः सङ्ग्राहिभिर्वायुः स्वे स्थाने कुपितो बली ॥१४॥
अधोवहानि स्त्रोतांसि संरुध्याधः प्रशोषयन् । पुरीषं वातविण्मूत्रसङ्गं कुर्वीत दारुणम् ॥१५॥
तेन तीव्ररुजा कोष्ठपृष्ठहत्पार्श्वगा भवेत् । आध्मानमुदरावेष्टो हल्लासः परिकर्तनम् ॥१६॥
बस्तौ च सुतरां शूलं गण्डे श्वयथुसम्भवः । पवनस्योर्ध्वगामित्वं ततश्छर्द्यरुचिज्वराः ॥१७॥
हृद्रोगग्रहणीदोषमूत्रसङ्गप्रवाहिकाः। बाधिर्यतिमिरश्वासशिरोरुक्कासपीनसाः॥१८॥
मनोविकारस्तृणास्त्रपित्तगुल्मोदरादयः । ते ते च वातजा रोगा जायन्ते भृशदारुणाः ॥१९॥
दुर्नाम्नामित्युदावर्तः परमोऽयमुपद्रवः । वाताभिभूतकोष्ठानां तैर्विनापि स जायते ॥२०॥
Those (piles) having the predominance of rakta (blood) resembles the sprout of vata, vidruma or kakanandika phala, have all the symptoms of pitta, exude large quantities of spoilt, occult, warm blood suddenly by the friction of hard faeces, with such excessive bleeding, the complications arising from deficiency of blood manifest.
Further some verses more –
By the use of mudga, kodrava, jurnahva, karira, canaka and such others which are dry and causing constipation, vayu (vata) undergoing increase causes obstruction of the downward channels, dries up the faeces and produces great obstruction to flatus, faeces and urine. The severe pain develops in the alimentary canal, back, heart and flanks, flatulance, twisting, pain in the abdomen, nausea cutting pain in the rectum, great pain in the region of the urinary bladder, swelling of the cheeks, upward movement of ana (air, gas) vomiting, loss of appetite, fever, heart diseases, duodenal disease obstruction to imxturition, dysentry, deafness, blindness, dyspnoea headache, cough running in the nose, enlargement of the abdomen, and such other grave disease of vata origin also. This disease Udavarta is the most dreadful complication (secondary diseases) of piles, it (udavarta) might also occur even without piles in persons who have predominance of vata in their alimentary tract. (14-20)
Sadhyasadhyata- prognosis
सहजानि त्रिदोषाणि यानि चाभ्यन्तरे वलौ । स्थितानि तान्यसाध्यनि याप्यन्तेग्निबलादिभिः ॥२१॥
द्वन्द्वजानि द्वितीयायां वलौ यान्याश्रितानि च । कृच्छ्रसाध्यानि तान्याहुः परिसंवत्सराणि च ॥ २२ ॥
बाह्यायां तु वलौ जातान्येकदोषोल्बणानि च । अर्शांसि सुखसाध्यानि नचिरोत्पतितानि च ॥ २३ ॥
Those (piles) which are congenital, caused by all the three doshas, those located in the two inner folds are uncurable, or persist for rest of the life if the digestive capacity and strength (of the patient are good).
Those which are caused by combination of two doshas, those located in the second fold, and of more than one year, are curable with difficulty; those located in the outer fold, caused by any single dosha and of recent onset are easily curable. (21-23)
मेढ्रादिष्वपि वक्ष्यन्ते यथास्वं नाभिजानि तु । गण्डूपदास्यरूपाणि पिच्छिलानि मृदूनि च ॥ २४ ॥
व्यानो गृहीत्वा लेष्माणं करोत्यर्शस्त्वचो बहिः । कीलोपमं स्थिरखरं चर्मकीलंतु तं विदुः ॥ २५ ॥
वातेन तोदपारुष्यं पित्तादसितरक्तता । श्रेष्मणा स्निग्धता तस्य ग्रथितत्वं सवर्णता ॥ २६ ॥
They (piles) also develop on the penis and other places (like nose, ears etc); of these, those developing in the umbilicus will be like the mouth of the earthworm, slimy and soft.
Vyana (vata) associating with slesma (kapha) produces piles externally on the skin, resembling a peg, immoveable and rough, these are known as Carmakila (warts) with the (predominance of) vata, there will be pain and roughness, with pitta, it will be of black or red colour, with slesma (kapha), greasiness, hardness and non- discolouration will be found in them. (24-26)
अर्शसां प्रशमे यत्नमाशु कुर्वीत बुद्धिमान् । तान्याशु हि गुदं बध्वा कुर्युर्बद्धगुदोदरम् ॥ २७ ॥
The wise physician should attempt to cure the piles of the rectum quickly. Otherwise, they will produce enlargement of the abdomen causing obstruction of the rectum. (27)
॥ इति सप्तमोऽध्यायः ॥
Thus ends the Seventh chapter.
