अथातोऽर्शसां निदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Arsha nidanam – diagnosis of haemorrhoids/piles; thus said Atreya and other great sages.
Arsha definition
अरिवत्प्राणिनो मांसकीलका विशसन्ति यत् । अर्शांसि तस्मादुच्यन्ते गुदमार्गनिरोधतः ॥ १॥ दोषास्त्वङ्मांसमेदांसि सन्दूष्य विविधाकृतीन् । मांसाङ्करानपानादौ कुर्वन्त्यशसि तान् जगुः ॥ २ ॥ Just as foes torment the person, similarly the sprouts of muscles (give troubles) by obstructing the passage of the rectum, hence it is called as Arsha. The dosas, vitiating the skin, muscles and fat produce sprouts of muscles, of different shapes in the rectum etc, which are called as Arsha (piles).
1-2.
Notes : The etymology of the term Arsha is ‘arivat’ like a foe ‘srnati’ gives trouble. The foe referred to here is not the one who resides far away but one who stays nearby and gives troubles frequently for a long time.. Sprouts of muscles, skin or fat tissue, growing in the nose, ears, skin etc., are also called Arsha, but these are refered to along with the name of the organ concerned; the term Arsha, without such a name of the organ refers only to piles/haemorrhoids occuring in the rectum. These are actually, engorged veins and not sprouts of muscles, as described above.
Bheda – Types
सहजन्मोत्तरोत्थानभेदाद् द्वेधा समासतः ।
शुष्कस्त्राविविभेदाच्च
Sahaja (congenital) and janmottaraja (arising after birth) are its two kinds, in brief; so also suska (dry, nonexudative and sravi ( exudative). 3a.
Guda-rectum
गुदः स्थूलान्त्रसंश्रयः ॥ ३ ॥
अर्धपञ्चाङ्गुलस्तस्मिस्तिस्त्रोऽध्यर्धाङ्गुलाः स्थिताः ।
प्रवाहिणी तासामन्तर्मध्ये विसर्जनी ॥ ४ ॥
बाह्या संवरणीय गुदौष्ठो बहिरङ्गुले । यवाध्यर्धः प्रमाणेन रोमाण्यत्र ततः परम् ॥ ५ ॥ वल्यः,
Guda (rectum) attached to the large intestine, is four and half angulas (fingers breadth) long, in which, three folds, each of one and half angula are located; of these, the pravahini is situated inside, visarjini in the middle and samvarani at the outside; in its outer portion ( of samvarani) of one angula ( in depth ) is the gudostha ( anal lip), of the length of one and a half yava (barley); and after that, there are the hair. 3b-5.
Notes In terms of modern measurement, the rectum or the terminal portion of the large intestine is 6/2-7″ in length. Pravahini is the fold which initiates the urge of defaecation, visarjini is that which expels the faeces and samvarani is the sphinctor which closes the orifice of the rectum. Pile masses develop in an area of about 3-4″ from the exterior.
Sahaja Arsha – congenital piles
तत्र हेतुः सहोत्थानां वलीबीजोपतप्तता । अर्शसां, बीजतप्तिस्तु मातापित्रपचारतः ॥ ६ ॥
दैवाच्च, ताभ्यां कोपो हि सन्निपातस्य तान्यतः । असाध्यान्येवमाख्याताः सर्वे रोगाः कुलोद्भवाः ॥ ७ ॥
The cause of sahaja Arsha (congenital piles ) is the abnormalities of valibija (seed/genes which are responsible for the formation of the rectal folds), abnormalities of the seed are improper activities of the parents and daiva (providence); their (of these two) aggravation is the cause for sannipata (increase of all the dosas together ). Hence this kind ( of Arsha) is described as incurable; similary are all the diseases which are kulodbhava (familial / hereditary). 6-7.
सहजानि विशेषेण रूक्षदुर्दर्शनानि च। अन्तर्मुखानि पाण्डूनि दारुणोपद्रवाणि च ॥ ८ ॥
Sahaja Arsha (congenital piles) are specially dry, ugly to look at, facing inward, yellowish-white and accompanied with grave complications ( secondary diseases). 8.
Janmottaraja Arsha – piles occuring after birth – षोढाऽन्यानि पृथग्दोषसंसर्गनिचयात्रतः ।
The other kind is of six varieties; one from each dosa separately, one from the combination of all and one from asra (blood).
शुष्काणि वातश्लेष्मभ्यामार्द्राणि त्वत्रपित्ततः ॥ ९ ॥
Suska (dry, non-exudative) are caused by vata and slesma (kapha) and the ardra (moist, exudative) by asra (blood) and pitta. 9.
Nidana – causes of piles
दोषप्रकोपहेतुस्तु प्रागुक्तस्तेन सादिते । ॥ ११ ॥
अग्नौ, मलेऽतिनिचिते, पुनश्चातिव्यवायतः ॥ १० ॥
यानसङ्क्षोभविषमकठिनोत्कटकासनात् । बस्तिनेत्राश्मलोष्ठोर्वीतलचैलादिघट्टनात् भृशं शीताम्बुसंस्पर्शात्प्रततातिप्रवाहणात् । ॥१२॥ | ।
वातमूत्रशकृद्वेगधारणात्तदुदीरणात् ज्वरगुल्मातिसारामग्रहणीशोफपाण्डुभिः कर्शनाद्विषमाभ्यश्च चेष्टाभ्यो, योषितां पुनः ॥ १३ ॥
आमगर्भप्रपतनाद्गर्भवृद्धिप्रपीडनात् ईदृशैश्चापरैर्वायुरपानः कुपितो पायोर्वलीषु तं धत्ते तास्वभिष्यण्णमूर्तिषु ।
जायन्तेऽशसि मलम् ॥ १४॥
The causes of aggravation of the dosas have been enumerated previously (chapter. 1 of this section); they cause weakness of the fire (digestive activity) and accumulation of wastes, the faeces (which lead to the production of piles). Further, indulging too much in copulation, riding, strain, sitting for long periods on uneven, hard seats and on ones own heels; abrasion caused by enema nozzle, stones, bricks, rough surface of the ground, cloth etc; contact with very cold water (during ablution),
too much of straining at stools habitually, suppression of the urges of the flatus, urine, faeces or premature initiation (of these urges); emaciation caused by fever, abdominal tumors, diarrhoea, accumulation of ama (undigested material), disorders of the duodenum, dropsy, and anaemia; indulging in improper activities (such as exertion etc.); again, in women, due to abortion or miscarriage, and abnormalities of development of the foetus; by these and similar other causes apana vayu (a division of vata) getting aggravated withholds the accumilated faeces in the folds of the rectum. From such a contact ( hard and intimate, causing friction) arises the piles. 10-15a.
Purva rupa – premonitory symptoms of piles
तत्पूर्वलक्षणं मन्दवह्निता ॥ १५ ॥
विष्टम्भः सक्थिसदनं पिण्डिकोद्वेष्टनं भ्रमः । सादोऽङ्गे नेत्रयोः शोफः शकृद्धेदोऽथवा ग्रहः ॥ १६॥
मारुतः प्रचुरो मूढः प्रायो नाभेरघश्चरन् । सरुक् सपरिकर्तश्च कृच्छ्रान्निर्गच्छति स्वनन् ॥ १७ ॥
अन्त्रकूजनमाटोपः क्षामतोद्गारभूरिता । प्रभूतं मूत्रमल्पा विडश्रद्धा धूमकोऽम्लकः ॥ १८ ॥
शिरः पृष्ठोरसां शूलमालस्यं भिन्नवर्णता । तन्द्रेन्द्रियाणां दौर्बल्यं क्रोधो दुःखोपचारता ॥ १९ ।
आशङ्का ग्रहणीदोषपाण्डुगुल्मोदरेषु च । एतान्येव विवर्द्धन्ते जातेषु हतनामसु ॥ २० ॥
Its premonitory symptoms are weak fire (digestive activity), indigestion, weakness of the things, twisting pain in the calves, dizziness, debility of the body parts, swelling of the eyes, either diarrhoea or constipation, maruta ( vayu, here refers to flatus) accumulates in large quantity moving downwards below the umbilicus, accompanied with pain (in the lower abdomen) and cutting pain in the anus, comes out with difficulty and great noise, intestinal gurglings, distention of the abdomen, emaciation, too many belchings, large quantity of urine and little of faeces, absence of inclination to void faeces, feeling of hot fumes coming out, increased sourness (acidity), pain in the head, back and chest; lassitude, discolouration of the skin, stupor, weakness of the sense organs, anger, feeling of unhappiness,-all these creating doubt of (the presence of) disorders of duodenum, anaemia, abdominal tumors and enlargement of the abdomen; these (diseases) get increased when hatanama (Arsha-piles) manifests. 15b-20.
Samprapti – pathogenesis of hemorrhoids
निवर्तमानोऽपानो हि हि तैरधोमार्गरोधतः । क्षोभयन्ननिलानन्यान् सर्वेन्द्रियशरीरगान् ॥ २१ ॥
तथा मूत्रशकृत्पित्तकफान् धातूंश्च साशयान् । मृनात्यग्निं ततः सर्वो भवति प्रायशोऽर्शसः ॥ २२ ॥
Apana vayu, moving in the upward direction, due to obstruction of the lower passage (rectum), aggravates all the other divisions of vata; present in the entire body, and also the urine, faeces, pitta, kapha and the dhatus (tissues) along with their places of dwelling, causes weakness of the fire (digestive activity). Then all these together lead to production of piles. 21-22.
Clinical features of Arsha / Piles – Rupa
कृशो भृशं हतोत्साहो दीनः क्षामोऽतिनिष्प्रभः । असारो विगतच्छायो जन्तुजुष्ट इव द्रुमः ॥ २३ ॥
कृत्स्नैरुपद्रवैर्ग्रस्तो यथोक्तैर्मर्मपीडनैः । ॥ २४ ॥
कासपिपासास्थवैरस्यश्वासपीनसैः तथा क्लमाङ्गभङ्गवमथुक्षवथुश्वयथुज्वरैः क्लैब्यबाधिर्यतैमिर्यशर्कराश्मरिपीडितः ।। २५ ।।
क्षामाभिन्नस्वरो ध्यायन्मुहुः ष्ठीवन्नरोचकी । सर्वपर्वास्थिहन्नाभिपायुवङ्क्षणशूलवान् गुदेन स्रवता पिच्छां पुलाकोदकसन्निभाम् । विबद्धमुक्तं शुष्का पक्कामं चान्तराऽन्तरा ॥ २७ ॥ पाण्डु पीतं हरिद्रक्तं पिच्छिलं चोपवेश्यते। २६॥
Profound emaciation, loss of enthusiasm, feeling of helplessness, feeble voice, profound loss of complexion, absence of excellence (health) of the tissue ), loss of ability of giving shelter like a worm-eaten tree (unable to help or support others), seized with many complications as enumerated earlier, pain in the vital points (or organs) and also with cough, thirst, bad taste in the mouth, dyspnoea, nasal cattarrh, exhaustion, vague pains in the body, vomitting, more of sneezes, oedema, fever, impotence, deafness, blind – ness, urinary gravel and calculii;
voice feeble and broken, worry, frequent spitting, loss of appetite, pain in all the joints, bones, heart, umblicus, anus and groins; slimy fluid resembling rice gruel coming out of the rectum, sometimes hundered and sometimes free; pile masses ( appearing ) either dry or moist, ripe or unripe in between, white, yellow, green or red in colour, and slimy (slippery). 23-28a.
Vataja Arsha
गुदाङ्कुरा वह्वनिलाः शुष्काश्चिमिचिमान्विताः ॥ २८ ॥
म्लाना: श्यावारुणा: स्तब्धा विषमाः परुषाः खराः । मिथो विसदृशा वक्रास्तीक्ष्णा विस्फुटिताननाः ॥ २९ ॥
बिम्बीकर्कन्धुखर्जूरकार्पासीफलसन्निभाः केचित्कदम्बपुष्पाभा: । केचित्सिद्धार्थकोपमाः ॥ ३० ॥
पार्श्वासकट्यूरुवड्ङ्क्षणाभ्यधिकव्यथाः । ॥३१॥
शिरः क्षवथूगारविष्टम्भहृद्ग्रहारोचकप्रदाः कासश्वासाग्निवैषम्यकर्णनादभ्रमावहाः तैरात ग्रथितं स्तोकं सशब्दं सप्रवाहिकम् ॥ ३२ ॥
रुक्फेनपिच्छानुगतं विबद्धमुपवेश्यते । कृष्णत्वड्नखविण्मूत्रनेत्रवक्त्रश्च गुल्मप्लीहोदराष्ठीलासम्भवस्तत जायते ॥ ३३ ॥ एव च ।
Rectal sprouts caused by predominence of anila (vata) are dry (non-exudative), having tingling sensation, dull or shrivelled, bluish-red, static, irregular (uneven), coarse and hard, each one different from the other ( in shape), curved, sharp, their face cracked, resemble the fruits of bimbi, karkandhu, kharjura, and karpasa, some like the flower of kadamba, some others like siddharthaka; severe pain in the head, flanks shoulders, waist, thighs and groins; producing more of sneezing, belching, stasis of food without digestion, catching pain in the region of the heart, loss of taste or appetite, cough, dyspnoea, irregularities of digestion, ringing in the ears and dizziness; suffering by all these the person voids faeces which is scabellous, less in quantity, accompanied with noise and straining; followed by painful expulsion of forthy and slimy fluid hundered in its passage; the skin, nails, faeces, urine, eyes and face become black. Then there is the possibility of manifestation of abdominal tumors, enlargement of spleen, the abdomen and the prostate. 28b-34a.
Pittaja Arsha
पित्तोत्तरा नीलमुखा रक्तपीतासितप्रभाः ॥ ३४ ॥
तन्वस्त्रस्त्राविणो विस्त्रास्तनवो मृदवः श्लथाः । शुक्रजिह्वायकृत्खण्डजलौकोवक्त्रसन्निभाः दाहपाकज्वरस्वेदतृणमूर्च्छारुचिमोहदाः ॥ ३५ ॥
सोष्माणो द्रवनीलोष्णपीतरक्तामवर्चसः ॥ ३६ ॥
यवमध्या हरित्पीतहारिद्रत्वङ्नखादयः ।
That caused by predominance of pitta, the sprouts have blue, red, yellow or black complexion; exude thin blood of foul odour; are thin, soft, supple; resemble the tongue of the parrot, piece of liver, mouth of a leech; produce burning sensation in the body, ulceration, fever, perspiration, thirst, fainting, loss of taste and appetite and delusion; faeces is warm, watery, blue, yellow or red in colour, and unripe (not well processed hence heavy), the skin, nails etc. are of the colour of middle portion of barley ( brownish), green, yellow, or termuric (deep yellow). 34b-37a.
Kaphaja Arsha
श्लेष्मोल्बणा महामूला घना मन्दरुजः सिताः ॥ ३७॥
उच्छूनोपचिता: स्निग्धाः स्तब्धवृत्तगुरुस्थिराः ।
पिच्छिलाः स्तिमिताः श्लक्ष्णाः कण्ड्वाढ्याः स्पर्शनप्रियाः ॥ ३८ ॥
करीरपनसास्थ्याभास्तथा गोस्तनसन्निभाः । वक्षणानाहिनः पायुबस्तिनाभिविकर्तिनः ॥ ३९ ॥ ।
सकासश्वासहृल्लासप्रसेकारुचिपीनसाः मेहकृच्छ्रशिरोजाड्यशिशिरज्वरकारिणः ॥ ४०॥
क्लैब्याग्निमार्दवच्छर्दिरामप्रायविकारदाः । सप्रवाहिकाः ॥ ४१ ॥ वसाभसकफप्राज्यपुरीषा: न स्त्रवन्ति न भिद्यन्ते पाण्डुस्निग्धत्वगादयः ।
That produced by predominance of slesma (kapha) the sprouts, are deep rooted, thick/hard; with dull pain, round white, bulging, well grown, greasy, static (immovable), heavy stable, slimy, steady, smooth, with severe itching, likes touching (scratching); resemble the sprouts of karira, stone of panasa fruit, or nipple of the cow; produce swelling of the groins, cutting pain in the anus, urinary bladder, and umbilicus; accompanied with cough, dyspnoea, nausea, salivation, anorexia with nasal catarrh; gives rise to dysuria, dull pain in the head, fever with rigors, impotence, dyspepsia, vomitting and diseases caused by ama; the faeces resembles muscle-fat, mixed with kapha (mucus), more in quantity, associated with straining; sprouts neither exude (blood) nor break (get split); the skin etc. are yellowish-white in colour and greasy. 37b-42a.
Tridosaja
संसृष्टलिङ्गाः संसर्गात् निचयात्सर्वलक्षणाः ॥ ४२ ॥
That produced by all the dosas will have all the symptoms simultaneously. 42b.
Raktaja
रक्तोल्बणा गुदेकीलाः पित्ताकृतिसमन्विताः । वटप्ररोहसदृशा गुञ्जाविद्रुमसन्निभाः ॥ ४३ ॥
तेऽत्यर्थं दुष्टमुष्णं च गाढविट्प्रतिपीडिताः । स्त्रवन्ति सहसा रक्तं तस्य चातिप्रवृत्तितः ॥ ४४ ॥
भेकाभ: पीड्यते दुःखैः शोणितक्षयसम्भवैः । हीनवर्णबलोत्साहो हतौजाः कलुषेन्द्रियः ॥ ४५ ॥
Rectal sprouts produced by aggravation of rakta (blood) are similar with those caused by pitta (in symptoms), resemble the sprouts of vata, the seeds of gunja and bead of coral; troubled by the hard faeces, the pile masses exude impure and warm blood suddenly; from such heavy bleeding the person develops the colour of the frog and suffers from diseases caused by loss of blood, becomes poor in colour, strength and enthusiasm; destroyed of vigour and impaired 43-45. sensory activities.
Udavarta nidanam diagnosis of udavarta
मुद्द्रकोद्रवजूर्णाह्नकरीरचणकादिभिः रूक्षैः सङ्ग्राहिभिर्वायुः स्वेस्थाने कुपितो बली ॥ ४६ ॥
अधोवहानि स्रोतांसि संरुध्याधः प्रशोषयन् । पुरीषं वातविण्मूत्रसङ्गं कुर्वीत दारुणम् ॥ ४७ ॥
तेन तीव्रा रुजा कोष्ठपृष्ठहृत्पार्श्वगा भवेत् । आध्मानमुदरावेष्टो हल्लासः परिकर्तनम् ॥ ४८ ॥
बस्तौ च सुतरां शूलं गण्डश्वयथुसम्भवः । पवनस्योर्ध्वगामित्वं ततश्चछर्द्यरुचिज्वराः ॥ ४९ ॥
हृद्रोगग्रहणीदोषमूत्रसङ्गप्रवाहिकाः बाधिर्यतिमिरश्वासशिरोरुक्कासपीनसाः । मनोविकारस्तृष्णास्त्रपित्तगुल्मोदरादयः ॥५०॥
ते ते च वातजा रोगा जायन्ते भृशदारुणाः ॥ ५१ ॥ दुर्नास्नामित्युदावर्तः परमोऽयमुपद्रवः ।
वाताभिभूतकोष्ठानां तैर्विनाऽपि स जायते ॥ ५२ ॥
By partaking of mudga, kodrava, jurnahva, karira, canaka etc, foods which are water absorbent ( and so constipating), vata getting aggravated in its own seat (pakvasaya or large intestine) and becoming powerful, blocks the downward channels, dries them up ( of their moisture ) and produces severe obstruction to the movement of faeces, flatus and urine. By that, severe pain develops in the abdomen, back, region of the heart and flanks; flatulence, griping pain in the abdomen, nausea, cutting pain in the rectum, severe constant pain in the urinary bladder; the possibility of swelling of the cheeks, upward movement of pavana (vata); then vomitting, anorexia and fever; other diseases of vata origin such as diseases of the heart and duodenum, suppression of urine, dysentery, deafness, blindness, dyspnoea, headache, cough, nasal catarrh, disorders of the mind, thirst, bleeding diseases, abdomina tumor; enlargement of the abdomen, etc. which are difficult to manage also develop as secondary affection of the durnama (piles); thus (the disease) udavarta is the cheif complication/secondary disease. This Udavarta may arise in persons who have predominance of vata in the alimentary tract, even without piles. 46-52.
Sadhyasadhyata – prognosis of piles
सहजानि त्रिदोषाणि यानि चाभ्यन्तरे बलौ । स्थितानि तान्यसाध्यानि, याप्यन्तेऽग्निबलादिभिः ॥ ५३ ॥
Piles which are congenital, born from all the three dosas, which are situated in the inner-most fold (of the rectum) are incurable; or persist for a long time depending on the strength of the digestive fire etc. 53.
द्वन्द्वजानि द्वितीयायां बलौ यान्याश्रितानि च । कृच्छ्रसाध्यानि तान्याहुः परिसंवत्सराणि च ॥ ५४॥
Those which are born from two dosas, which are located in the second fold (of the rectum) are difficult to cure; so also those which are more than one year old. 54.
बाह्यायां तु बलौ जातान्येकदोषोल्बणानि च । अर्शांसि सुखसाध्यानि न चिरोत्पतितानि च ॥ ५५ ॥
Those which are situated in the outer fold, which are caused by the increase of any one dosa are easily curable; so also those which are not chronic. 55.
Anya sthana Arsha – piles of other places
मेद्रादिष्वपि वक्ष्यन्ते यथास्वं नाभिजानि तु । गण्डूपदास्यरूपाणि पिच्छिलानि मृदूनि च ॥ ५६ ॥
Arsha (piles) arising in the penis etc. will be described at relevent contexts; that arising at the umbilicus resembles the mouth of the Carthworm in shape, slimy ( slippery) and soft.
व्यानो गृहीत्वा श्लेष्माणं करोत्यर्शस्त्वचो बहिः । कीलोपमं स्थिरखरं चर्मकीलं तु तं विदुः ॥ ५७॥ वातेन तोदः पारुष्यं, पित्तादसितरक्तता ।
श्लेष्मणा स्निग्धता तस्य ग्रथितत्वं सवर्णता ॥ ५८ ॥ Vyana (division of vata) combining with slesma (kapha) produces piles on the exterior of the skin, resembling a nail, which is static (immovable) and rough ( hard ) is called as Carmakila (warts); with predominance of vata, it is painful and rough, with pitta, it is blackish-red, with slesma (kapha), it is greasy, knotty and of the same colour ( of the skin ).
अर्शसां प्रशमे यत्नमाशु कुर्वीत बुद्धिमान् । तान्याशु हि गुदं बद्धवा कुर्युर्बद्धगुदोदरम् ॥ ५९॥
The wise physician should try to cure piles (of the rectum) quickly since it may lead to the disease-Baddhagudodara (intestinal obstruction) by blocking the rectum. 59.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थानेऽर्शसां निदानं नाम सप्तमोऽध्यायः ॥ 7 ॥
Thus ends the chapter-Arsha nidana-the seventh in of Astanga hrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
