Management of Abhyantar Arsha (Second-Degree Internal Haemorrhoids) via Targeted Vasa Pratisarniya Kshara Karma and Complementary Oral Remedies: A Care-Compliant Clinical Case Report

Background: Arsha (haemorrhoids) is a prevalent anorectal disorder classified under the Ashtamahagada (eight dreadful diseases) in Ayurveda due to its deep-seated pathogenesis and challenging prognosis. Modern lifestyle shifts, characterized by low-fibre dietary habits and prolonged sitting, have caused a surge in early-stage internal haemorrhoids (1st and 2nd degree). While conventional surgeries offer management, they often present substantial post-operative morbidity, bleeding, and long recovery times. This case report evaluates the clinical efficacy of Vasa Pratisarniya Kshara—an alkaline caustic preparation—combined with conservative oral medication in managing chronic Abhyantar Arsha. Case Presentation: A 29-year-old male patient presenting with a two-year history of recurrent, painless rectal bleeding during defecation and protruding masses that reduced spontaneously was examined in Shalya Tantra OPD No. 05. Proctoscopic evaluation confirmed second-degree internal haemorrhoids at the 3, 7, and 11 o'clock positions. The patient underwent a single-sitting proctoscopic application of Vasa Pratisarniya Kshara on the prominent pile masses, followed by a post-operative oral regimen consisting of Triphala Guggulu, Arshoghni Vati, and Abhayarishta. Results: Total cessation of rectal bleeding was achieved within 4 days post-procedure. Follow-up examinations at the 4th week showed significant sloughing, tissue fibrosis, and absolute involution of the pile masses. The patient reported minimal, transient post-procedural pain that resolved within 48 hours without conventional analgesics. A 12-month post-procedural audit recorded complete clinical resolution with no structural recurrence or anal stenosis. Conclusion: Vasa Pratisarniya Kshara Karma, combined with targeted oral Arshoghna remedies, provides a robust, safe, cost-effective, and minimally invasive day-care option for managing early-stage internal haemorrhoids.