Types are 2 types of piles: Congenital and acquired. The cause of congenital piles is seed(sperm and ovum combined) having genetic morbidity for the anal folds. This morbidity also is caused by the unwholesome behaviour of the parents and the past deeds. These are the causes of other congenital disorders as well. Congenital ones are those which manifest along with the body. Piles are the disorders characterised by growth like polypus.
Site of all the piles: The site of piles is the three ano-rectal folds situated in the space of five and half fingers each at the distance one-third(of the above measurement). Substratum of all the piles is fat, flesh and skin.
Some say more sites of piles such as penis, vagina, throat, palate, mouth, nose, ear, eyelid and skin.
Shape of Piles according to dosha:
|Vataj Arsh||Pittaj Arsh||Kaphaj Arsh|
|Sarshap, Masura, Masha, Mudga, Yava, Kalaay, Pindi||Tintikera, Kebuka, Tinduka, Karkandhu, Gunja, Bimbi, Badara, Karika, Udumbar, Kharjura, Jambu||Cow’s udder, Angushtha, Kasheru, Shringatak, Shrungi, Beak and tongue of cock, Peacock, Parrot, bud and seed receptacle of lotus respectively.|
Prodromal sign and symptoms:
Stasis of ingested food, weakness in bowels along with gurgling sound, emaciation, excessive eructation, weakness in legs, small quantity of stool, suspicion of Grahani-rog, anemia or abdominal disorders.
- Vataj Arsh specific features:
The growths are dry, faded, hard, course, rough and blackish with painted tips, curved, having open mouth and irregularly spread, attended by pain, convulsions, needling pain, twitching, pricking and expansion, suited to unctuous and hot applications, association of severe dysentery, tympanitis, constriction in penis-scrotum-urinary bladder, groin and heart, body-ache and palpitation of heart, constantly constipated flatus, urine and stool, causing pain in thighs, waist, back, sacral region, sides, belly and bladder, headache, sneezing, eructation, coryza, cough, upward movement of vayu, stretching, waisting, swelling, fainting, anorexia, tastelessness in mouth, blurred vision, itching, pain in nose, ear and temples and loss of voice, appearance of blackish or reddish tinge and coarseness in nails, eyes, face, skin, urine and stool.
- Pittaj Arsh specific features:
The growths as soft, lax, delicate and tender; red, yellow, blue or black, having profuse exudation and moisture with discharge as having fleshy smell, thin yellow or red, discharging blood, attended with burning, itching, discomfort, piercing pain and inflammation; suited to cold things; loose, yellow and green stools, excessive excretion of yellow and foetid stool and urine, causing thirst and fever, darkness before eyes, fainting and aversion to food; yellow tinge in anils, eyes, face, skin, urine and stool-these are the characters of the piles predominant in pitta.
- Kaphaj Arsh specific features:
The growths as massive, developed, smooth, devoid of tenderness; unctuousness; unctuous, white, pale and slimy; stiff, heavy, wet, benumbed; with stable swelling, profuse itching and excessive, constant brown, white, red and slimy discharge; attended with heavy, slimy and white urine and stool, suited to rough and hot, associated with tenesmus frequent urge for evacuation and excessive swelling in groins; causing cutting pain in anorectal region, nausea, excessive spitting, cough, anorexia, coryza, heaviness, vomiting, dysuria, emaciation, swelling, anemia, fever with shivering, calculus and gravels, plastering of heart and senses, sweetness of mouth and prameha, continuing for long, causing excessive sluggishness of digestion and impotency, having severe disorders due to ama; white tinge in nails, eyes, face, skin, urine and stool.
Intake of astringent, pungent, bitter, rough, cold and light food items, deficient and little food(under-nutrition), use of sharp wines, excessive sexual intercourse, lightening, cold place and time, over exercise, anxiety and exposure to wind and the sun.
Intake of pungent, sour and salty things and alkali, exposure to physical exercise, fire, sun and brilliance, hot place and time, anger, wine envy and all drinks, foods and drugs which are burning, irritant and hot.
Intake of sweet, unctuous, cold, salty, sour and heavy things, lack of exercise, day-sleep. Liking for the comfort in bed and seat, exposure to easternly wind, cold place and time, lack of mental work.
The piles predominant in two doshas should be known by the combination of the respective etiology and characters. These caused by tridoshas has all the etiological factors and symptoms similar to those of congenital piles.
- The patient of piles having oedema on hands, feet, face, navel, anus and scrotum as well as pain in cardiac region and sides is incurable.
- Pain in cardiac region and sides, fainting, vomiting, bodyache, fever, thirst and inflammation in ano-rectal part kill the patient of piles.
- The piles which are hereditary, caused by three doshas and located in the internal fold should be declared as incurable.
- The piles caused by two doshas, situated in the second fold and with the duration of more than a year are difficult to be cured.
- Those arisen in the external fold, caused by single dosha and manifested recently are curable easily.
Some prescribe treatment of piles by surgical excision others by application of alkali and some by cauterization-all are right if these three operations are performed by a learned, wise and experienced surgeon but still there are grave risks. Loss of sexual potency, swelling in anorectal region, retention of urges, tympanitis, severe colic pain, profuse haemorrhage, relapse of healed wounds, wetting and prolapse of anus or immediate death. Hence sage Acharya describes medicinal treatment for eradication of piles.
The piles predominant in Vata and Kapha are known as dry piles and those predominant in Rakta-pitta are wet and discharging(bleeding) piles.
- Dry piles treatment-
- Piles should first be inuncted with the oil followed by fomentation. This will reduce stiffness and its associated swelling/ pain.
- Thereafter one should sprinkle them with decoction of leaves of bilva, errand, vasa etc.
- If there is pain, the patient should be massaged well and then given tub bath in the decoction of mulaka, triphala, agnimantha, sigru, cow’s urine etc.
- Paste- latex of snuhi mixed with haridra powder should be applied as paste over the piles.
The measures beginning with inunction and ending with paste as said above relieve the piles of stiffness, swelling, itching and pain.
The piles treated with the measures ending with the paste discharge the accumulated defective blood and thus the patient is relieved.
- In case of vitiated blood, the disease doesn’t subside with the pacificatory measures alone! One should drain the unmanifesting blood from the bleeding piles frequently with the help of leeches, instruments or needles.
In case the patient is suffering from swelling and pain in ano-rectum and poor digestion he should be given the powder of herbs like trikatu, bilwa, patha, hingu, yavani etc. or he should take haritaki with jiggery before meals or one should administer buttermilk or takrarishta. By these the morbidity located in anorectal region is removed and thus the piles are alleviated. Takrarishta is appetiser, improves relish, promotes complexion, carminates kapha and vata, alleviates swelling, itching and pain of the anorectum and promotes strength.
- One should administer gruel processed with sati and karchura or pippali or shunthi. Rakt shali(red Sali),mahashali, kalama, lagli etc. are wholesome for the patient of piles.
- Arisht useful in this case:
- Wet/bleeding piles treatment:
In case of association of vata the remedial measures should be unctuous and cold whereas in that of kapha they should be rough and cold. If there is predominance of pitta and kapha one should administer evacuative therapy.If the discharged blood is checked at the very outset, that impure blood causes many diseases such as raktpitta, fever, thirst, sluggishness if digestion, anorexia, pain in anorectum and groins. Hence checking of blood is desirable only after the impure blood is let out. The physician acquainted with etiology, symptoms, time, strength and blood colours should ignore it till there is emergency. Exception- the blood which is predominant in pitta and comes out in summer should be checked immediately provided there is no association of vata and kapha.
Thereafter one should manage the case with bitters in order to stimulate digestive fire, to check blood and to help digestion of doshas.
- Medicines to check blood:
- Kutajaadi rasakriya
- Nilotpala+lajjalu+mochrasa+chandan+til+lodhra to be taken with goat’s milk. The diet should be Sali rice with goat’s milk.
- Pulse of masura soured with buttermilk
- Even only onion used with meat soup, khada, vegetable soup or gruel over comes profuse bleeding and vata.
In predominance of vata the patient should be given the unctuous enema quickly with warm ghee or following medicated ghees, like-
- Hriberaadi ghrut
- Sunishannakchangeri ghrut
The patient of piles should always use diet and drugs which are carminative for the wind and promotive of digestive power. They should never use the substances contrary to the above and those mentioned under the etiological factors.