Dual Modality for Arshas (Haemorrhoids)-a Case Study

Arshas are among the most common anorectal disorders described in both Ayurvedic and modern medical literature. Classified as Mahagada (difficult to cure), they are chronic, recurrent, and often painful. The condition arises due to derangement of Agni and vitiation of the Tridoshas, leading to venous engorgement in the Guda Pradesha. Based on the site of origin, hemorrhoids are classified as internal and external. Internal hemorrhoids develop above the dentate line, whereas external hemorrhoids occur below the dentate line. Kshara Karma, a para-surgical procedure described in Ayurveda, is highly effective for internal hemorrhoids but when an external component is present, it may cause excessive burning, ulceration, or delayed healing because of somatic innervation. Hemorrhoidectomy, though effective for extensive lesions, carries limitations such as postoperative pain, bleeding, and risk of anal stenosis and sphincter damage. To address these limitations, a dual-modality approach combining Kshara Karma for the internal component and hemorrhoidectomy for the external mass was employed in this case.