The remedial measures in haemorrhoids may be grouped under four subheads; namely, the employment of (active) medicinal remedies, the application of an alkali (into the seat of the disease), actual cauterization (of the polypii) and surgical operation. A case of recent origin involving the action of the Doshas to a slight degree and uncomplicated with any grave or dangerous symptom and complication may prove amenable to medicine alone. Deep-seated polypii. which are soft to the touch and markedly elevated and extended (external - D R), should be treated with alkaline applications, while those which are rough, firm, thick and hard should be cauterized with fire. Polypii which are raised, exuding and slender at the roots should be surgically treated. Hoemorrhoids which are held amenable to medicine and are not visible (to the naked eye) should be treated with the help of medicines alone. Now, listen to the procedure to be adopted in the treatment of Arsas which would require alkaline applications, a cauterization, or a surgical operation. 2.

Application Of Kshára

The body of the patient suffering from haemorrhoids, in the event of possessing sufficient strength, should be anointed and duly fomented. He should be made to eat warm but demulcent food (Anna) in a fluid state (of a gruel-like consistency) to alleviate the excessive pain incidental to the action of the deranged Váyu. In a season neither too hot nor too cold, and when the sky is cloudless, he should be placed in a raised up position in a clean and well-equipped place on a plain slab or on a clean bed with his head resting on the lap of an attendant and the anal region exposed to the sun. In this position the waist should be made to elevate a little and to rest on a cushion of cloths or blankets. The neck and the thighs of the patient should be drawn out. and then secured with trappings and held fast by the attendants so as not to allow him to move. Then a straight and slender-mouthed instrument (somewhat like the modern rectal speculum) lubricated with clarified butter, should be gently inserted into the rectum and the patient should be asked to strain down gently at the time. After seeing the polypus (through the speculum), it should be scraped with an indicator and cleansed with a piece of cotton or linen after which an alkali should be applied to it. The exterior orifice of the instrument should be closed with the palm of the hand after this application and kept in that manner for a period that would be required to utter a hundred words.

Then after having cleansed the polypus, a fresh application should be made according to the strength of the alkali and the intensity of the aggravated Doshas involved in the case. Further application of the alkali should be stopped and the polypus washed with fermented rice-gruel (Dhányámla), curd-cream, Sukta, or the juice of acid fruits, in the event of its having been found to have become a little flabby, bent down, and to have assumed the colour of a ripe Jambu fruit. After that it should be cooled with clarified butter mixed with Yashti-Madhu, the trappings should be removed and the patient should be raised up and placed in a sitting posture in warm water and refreshed with sprays of cold water, or, according to some authorities, with warm water. Then the patient should be made to lie in a spacious chamber, not exposed to the blasts of cold winds (specially), and advised as regards his diet and regimen Each of the remaining polypii, if any, should be cauterized with the alkaline application at an interval of seven days. In case of a number of polypii, those on the right side should be first cauterized and then those on the left, and after that those on the posterior side; and lastly those that would be found to be in front. 3.

Polypii, having their origin in the deranged Váyu and Kapha, should be cauterized with fire or alkali; while those, which are the outcome of the deranged Pitta and vitiated blood should be treated with a mild alkali alone, A perfect and satisfactory cauterization (Samyag-dagdha) of a polypus should be understood from such symptoms as, restoration of the bodily Váyu to its normal condition, relish for food, keenness of the appetite, lightness of the body and improvement in strength, complexion and pleasure. An over-cauterized (Ati-dagdha) polypus gives rise to such symptoms as, cracking of the region of the anus, a burning sensation (in the affected locality), fainting, fever, thirst, and profuse haemorrhage (from the rectum), and consequent complications; while an insufficiently cauterized (Hina-dagdha) polypus is known by its tawny brown colour, smallness of the incidental ulcer, itching, derangement of the bodily Váyu, discomforts of the cognitive organs and a non-cure of the disease. 4.

A large polypus, appearing in a strong person, should be clipped off (with a knife) and cauterized with fire. As regards an external polypus full of extremely aggravated Doshas (Váyu, Pitta, Kapha and blood) no Yantra should be used, but the treatment should consist of fomentation, anointing, poulticing, immersion, plastering, evacuating measures (Visráva), cauterization with fire and alkali and a surgical operation. Measures laid down under the head of Rakta-pitta should be resorted to in cases of haemorrhage (from the seat of affection). Remedies mentioned in connection with dysentery (Atisára) should be employed in cases of a looseness of the bowels; whereas in cases of constipation of the bowels oily purgatives should be administered, or the remedies for Udávartta should be adopted. These rules shall hold good in the cases of treating (cauterization, etc.) a polypus occurring in any part of the body whatsoever. 5.

A polypus should be caught hold of and an alkali should be applied thereto with a Darvi, or a brush (Kurcha), or an indicator (Saláká). In a case of a prolapsus of the anus, cauterization should be made without the help of any Yantra (speculum).

Diet: - In all types of haemorrhoids, the diet should consist of wheat barley, Shashtika rice or Sáli rice, (boiled) and mixed with clarified butter, to be taken with milk, Nimba-soup, or Patola-soup. The patient should be advised to take (his meal) with Vástuka, Tanduliyaka, Jivanti, Upodiká, As'va-valá tender Mulaka, Pálanka, Asana, Chilli, Chuchchu, Kalája, Valli, or any other S'ákas (pot-herbs}, according to the nature of rhe Doshas involved in the case Any other oleaginous, diuretic, laxative and appetising (Dipana) diet possessing the virtue of curing piles should also be prescribed. 6.

After the cauterization of the polypus, as well as in a case where no cauterization would be necessary, the body of the patient should be anointed with clarified butter and oil, etc., and measures both general and specific (mentioned below and in accordance with the Dosha or Doshas involved: should be employed for the purpose of improving the digestive powers and to alleviate any aggravation of the Váyu. He should be made to drink a potion consisting of clarified butter cooked with the Váyu-subduing and appetising (Dipana) drugs * (Kalka and Kvátha) mixed with the powders of Hingu, etc., described in the treatment of Mahá-Váta-vyádhi, chapter. V). In a case of Pittaja-Ars'as, clarified butter prepared by cooking it with the drugs of the Pippallyádi and Bhadra-dárvádi † groups, should again be cooked with the decoction of Prithakparnyádi group and the Kalka of the Dipaniya (Pippallyádi) group, and given as a potion to the patient. In a case of haemorr-hoid due to the action of the deranged blood ‡ (Raktárs'ash the clarified butter should be cooked with a decoction of Manjishthá, Murungi, (D. R. Surangi), etc. while in a case of one due to the action of the deranged Kapha, the clarified butter should be cooked with a decoction of the drugs constituting the Surasádi group. The supervening distresses should be alleviated by the remedial measures peculiar to each of them 7.

Cauterization with fire or with an alkali or any surgical operation in the present disease should be effected by introducing the Yantra (speculum) into the rectum (with the utmost care, inasmuch as an error happening in any of these cases may bring on impotency, swelling (Sopha), a burning sensation, epilepsy, rumbling in the intestines, retention of stool and urine, dysentery, diarrhoea, or may ultimately end in death. 8.

* Such as the decoction of the drugs of the Bhadra-darvádi (Váyu-subluing) and Pippalyádi (Dipaniya) group?. This Ghrita should be prescribed in a Vátaja Ars'as.

† The epithet "Bhadra-dárvádi-pippallyádi" in the phrase "Bhadra-dárvádi-pippallyádi-sarpih" seems to be included into the body of the text through an accident. In our opinion, it is only an annotation of the phrase "Dipaniya-Váta-hara-siddha" occurring in the last sentence. - Ed.

‡ The Kalkas of the Pippallyádi group should also be taken in the preparation of the two kinds of medicated clarified butter to be used in Raktárs'as, and Pittárs'as. - Dallana.