ANORECTALDISEASES

Group members• E.P.C.Priyadarshani• L.A.A.C.Subhashini• H.W.K.T.Karunarathna

Importance of Anorectal diseases• Guda is one of the main marma’s in the body.

In addition to that guda is Pranayathan, where the Prana is situated. Guda is sadyopranahara marma, mansa marma and dhamani marma. Guda is mulasthana of Purishavaha srotas.

• Nowadays, lot of patients suffer from Anorectal diseases.

• But most of western medicinal treatments are failure for this kind of diseases.

• But Ayurvedic treatments have successful treatment procedures for Anorectal diseases.

Guda (Anal canal and Rectum)

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Guda is a structure which is related to the Stula antra(large intestine), and the length of guda is 4

½ angula.

Origination and FormationGuda is originated from Matruja Bhava(Maternal Source) of Garbha. (A.H.S-3/4)Guda is formed by the best part(prasad baga) of blood and Kapha, after being digested by Pitta with the help of Vayu.Around the Guda, there are

Sira - 34Dhamani - 10Snayu - 80

Synonyms • Apana • Guda• Payu

Parts of Guda

• Uttara guda (Upper portion of rectum and sigmoid colon)is a part which faeces is stored or collected.

• Adhara guda (Lower portion of rectum and anal canal)is a part which helps in expulsion of faeces.

• Gudhoshta (Anal orifice) is the terminal portion of guda, 1 angula inside the hairy region in buttock.

Guda wali • Pravahini - placed 1 angula above Visarjani is

indicative of the Inferior Houston’s value or the rectal ampulla.

• Visarjini - placed 1 angula above samvarani is indicative of the anorectal ring.

• Samvarani - placed 1 anugla above the Gudoshta can be correlated to the zone of sphincter muscles especially the area of external sphincter.

Physiological functions of Guda • Main function is excretion of Vayu and Faecal

materials.• This is controlled by Apana vayu with the help of Guda

vali.• Pravahini forces the stool downwards.• Visarjini relaxes the anorectal muscles and performs

excretion of the faecess• Samvarani closes the anal orifice after faecal column

has been cut by the action of Visarjini.

REVIEW OF MODERN LITERATURE

Anatomy of the Anal canal The anal canal is the terminal part of the large intestine. It is situated between the rectum and anus, below the

level of the pelvic diaphragm. It lies in the anal triangle of perineum in between the

right and left ischiorectal fossa. In humans it is 4 cm long, extending from the anorectal

junction to the anus. It is directed downwards and backwards.

It’s anterior wall is slightly shorter than posterior wall.

Musculature of the Anal canal Internal anal sphincterInvoluntary in nature.(Autonomic nerve supply)Formed by the thicked circular muscles.

External anal sphincterUnder voluntary control.Made up of a striated muscle.Supplied by the inferior rectal nerve and perineal branch of 4th sacral nerve.It surround the whole length of the anal canal and has three parts subcutaneous, superficial and deep.

Anorectal ring This is a muscular ring present at the anorectal

junction. It is formed by the fusion of the puborectalis,

deep external sphincter and the internal sphincter.

It is easily felt by a finger in the anal canal. Surgical division of this ring, results in rectal

incontinence.

Surgical spaces related to the Anal canal• Ischiorectal fossa• Perianal fossa• Submucous fossa

Arterial supply• -Above the pectinate line, is supplied by the superior rectal artery.• -Below the pectinate line, is supplied by the inferior rectal artery. Venous drainage• Superior haemorrhoidal vein.• Middle and inferior haemorrhoidal veins

Lympatic drainage• Above the pectinate line, drain with internal illiac nodes.• Below the pectinate line, drain with superficial inguinal nodes.

Nerve supply o Above the pectinate line, is supplied by the

autonomic nerves both sympathetic (inferior hypogastric plexus, L1, L2) and parasympathetic (pelvic splanchnic, S2, S3, S4). Insensitive to pain.

o Below the pectinate line, is supplied by the somatic nerves.(inferior rectal, S2, S3, S4). There fore, sensitive to pain.

o Sphincters – the internal sphincter is caused to contract by sympathetic nerves and is relaxed by parasympathetic nerves. The external sphincter is supplied by the inferior rectal nerve and by the perineal branch of 4th sacral nerve.

Physiology of Defecation

Defecation is an act of emptying the distal colon from the splenic flexure through the anal orifice into the exterior which is a reflux process.

When faeces enters the rectum

Distention of the rectal wall(initiate the afferent signals that spread through the mesenteric plexus to

initiate the peristaltic wave in the descending colon, sigmoid and the rectum)

Forcing the faeces towards the anus

Clinical Features of Anorectal Diseases1. Bleeding2. Pain.3. Altered bowel habit.4. Discharge.5. Tenesmus.6. Prolapse.7. Pruritus.8. Loss of weight

Anorectal diseases

1. Haemorrhoids/piles (w¾Yia)2. Fissure in ano (mrsl¾;sld)3. Fistula in ano (N.kaor)4. Rectal prolapse ^.=o N%xY)5. Fistulous boils ( N.kaor msvld)6. Anal stricture (ikaksreoaO .=o)7. Anal boils/Perianal abscess ( .=o úøê)8. Napkin rashes ( wysmQ;kd)9. Proctitis ( .=o mdl)10. Pruritus in anus ( .=o lKavq)11. Anal warts ( p¾u l’,) 12. Rectal cancers ( w¾nqo)

ArshasEtymology Arsha Ru(root) + Asun get the life away

Definition • wrsj;a m%dKsfkda udxi l’,;d úIika;s h;a w¾Ydxis ;iaudÿpHkaf;a .=o ud¾. ksfrdaO;d#

w.yD.ks.7 Arshas is a muscular projection(mans keel), which troubles the patient like an enemy.• wrsjwi%ekHia;s b;s w¾Y#Arshas is like an enemy, that destroys the blood in the body.

SynonymsDurnama, Guda kila, Gudānkura, Payu roga,

Mula vyadi, Anamaka, Gudaja

Classifications of ArshasFirst ClassificationmD:la fodaffI iuiaff;Yap fYdaKs;dka iycdkspw¾Ydxis iïm%ldrdKs úoHd;a .=o j,s;%fh1. Vata2. Kapha3. Pitta4. Sannipatha5. Rakthaj6. Sahaj

Second Classification1. Bahira (External) Arshas2. Abyantara (Internal) Arshas

Third Classification3. Sahaja4. Janmoththaraj 7 (Vata, Kapha, Pitta,

Kaphavatha, Kaphapitta, Vatapitta, Sannipatha)

Fourth Classification1. Shushka Arshas (Vataj, Kaphaj)2. Sravi Arshas ( Pittaj, Rakthaj)

Fifth Classification3. Bheshaja sadya4. Kshara sadya5. Shashtra sadya6. Agni sadya

Nidana of ArshasAll reasons can be divided into 2 groups named as

Sahaja and Janmoththaraj.

Nidana of Sahaja Arshas• Mithya ahar and vihar of mother and father• Poorvajanma karma

Nidana of janmoththaraja Arshas

Samanya Hethu (Normal reasons)Which are responsible for all types of arshas. It can divided into 2 groups.• Aharaja hethuGuru, madhura, sheeta, abhishandi, vidhahi, virudda bojana, asatmya bojana, mansya, varaha, mahisha, aja mansa, krusha prani mansa and shushka mansa.• Viharaja hetuAthi vyayama, guda garshana, uthkatasana, vega vidarana, athipravahana, kathin asana, vishama asana, asamyak samshodana, basti vibrama, diwa swaap, garba pidana, sheetamaba sparsha, gulma, jeerna kaasa, jwara, pandu, kshavathu, vibanda, vyadijanya kushta, yaan sankshobha

VISHESHA HETHU1. Vataja arshas Kashaya

KatuTikthaRukshaSheetaLaghu rasa aharaPramitha/alpa bojanaTeekshana madyaAnaashana

Athi-maithunaAthi-vyayamaAthi-upavasaAthi-vata sparshaAthi-athapa sparshaShokaSheeta desha sevanaSheeta kala sevena

1. Pittaja arshas LavanaAmla Katu Ushna VidahiTikshna rasa aharaUshna jala

Athi-vyayamaAtapa sevanaAgni sevanaUshna desha,kalaKrodhaDwesha

1.Kaphaja arshas

MadhuraSnigdhaSheetaLavanaAmla rasa aharaGuru ahara

AvyayamaDiva swapnaAasan shookAchintamPraag vata sevanaSheeta desha,kalaRati sevana

Purva rupa of Arshas

úIagïfNdazkakiH fo!¾n,Hx l=lafIardIAfgdam tajpld¾IH uqoa.dr ndyq,Hx ila:sidfoda,am úÜl;d.%yKs fodaI mdKaâj¾f;rdYxld fpdaoriHpmQ¾j rEmdKs ks¾osYagd• Anna vishtambha• Daurbalya• Atopa• Ksrusha• Udgara bahulya• Pada apranikatha• Alpa mala/constipation• Grahani• Pandu• Udara

Samprapthi of Arshas

Nidana

Agni mandaya

Mala samchaya (SAMCHAYA)

Apana vata kopa(PRAKOPA)

Pradana damani (PRASARA)

Guda valitraya (STANA SAMSRAYA)

Arshas(VYAKTHI)

Vataja pittaja kaphaja rakthaja sannipataja (BHEDHA)

Roopa of Arshas Subjective General symptoms Agni mandya, Asya vairasya, arochak, asthiparva shoola, vankshana shoola, hridaya shoola, nabhi shoola, payu shoola, angamarda, klama, jwara, swasa, kasa etc. Objective General symptomsAcharya charak has described different sizes and shapes of arshas.Eg: sarshapa, masur, masha, yawa, tinduka, kareera, udumbara etc.

Vishesha rupa of ArshasVataja arshas;;% udre;dka mrsY=IaldreK új¾Kdks úIu uOHdksloïn mqIam ;=kaäflars kdä uqLq, iqÑ uqLdlD;sk’ p Njka;sff;remø;# iY=,x ixy; uqmfõYHf; lá mDIAG md¾YjfïV% .=o kdNs m%foafYaIq pdiH fõokd Njka;s.=,audIaá,d ma,’fydaordKs pdiH ;kaksñ;a;dkafhaj Njka;slDIAK ;ajla kL khk oYk jok uq;% mqr’IYa pmqrefIda Njka;s iq'ks'2/10

• Pile masses are dry, slight red or many colours, Irregular in their middle, Resembles flower of kadamba and tundikeri, Nadi, mukula/flower bed or suchi mukha in shape

• Person suffering by these, expels hard faecess with pain, Feels pain in the waist, back, flanks, penis, anus and area of umbilicus

• He becomes a patient of abdominal tumour, prostate enlargement and splenomegaly

• His skin, nails, teeth, mouth, urine and faeces all become black.

Pittaja Arshas• Pile masses are blue at their tip, thin, spreding,

yellowish or similar to liver, resembles the tongue of the parrot in their shape, bulged in the middle like barley or the mouth of leech and exudating fluid

• The patient suffering; expel liquid faecess mixed with blood, fever, burning sensation, severe thirst and fainting

• His skin, nails, teeth, mouth, urine and faeces all become yellow.

Kaphaja Arshas• Pile masses are white in colour, deep, rooted,

stable, round, unctuous, pale, resembles karira, panasaasthi or gosthana, do not exudate fluids and have severe itching.

• The person has diarrhoea, with faecess mixed with kapha, large in quantity, resembling mutton wash, swelling, cold fever, loss of taste, indigestion and heavyness of head

• His skin, nails, teeth, mouth, urine and faeces all become white.

Rakthaja Arshas• Pile masses are same like pittaja arshas• Colur is same as vata praroha, gunja and

vidruma• The patient expels hard stool with lots of blood• Due to loss of bala, varna/ojoshaya and blood,

he suffering from anaemic diseases.

Sannipataja arshasPiles produced by all the three doshas together, will have symptoms of all the doshas simultaneously. (Su.Ni. 2/24)

Sahaja arshasSahaja is due to vitiation of blood and semen. Pile masses are difficult to see, dark brown in colour, troublesome and bent inward. Afflicted by this the person is emaciated, eats very little food, network of veins visible prominently all over the body, has less children and semen, has feeble voice and is always angry, has poor digestion. (Su.Ni. 2/25)

Complications of ArshasBaddagudodara, udawartha, vamana, aruchi,

vibanda, athisara, shawasa, jwara, shosha, moha, pada shotha, guda, nabhi and medra shotha

Examination of ArshasGeneral examinationLocal examination • General-per rectal examination• Special instrumental-Proctoscope

Treatment of Arshas Chikithsa sutraiafkay iafjod;ajfhd jdf; ms;af;aIq frpkdoh!#lfM jdka;Hdofhd¾Yia ñfY% ñY% m%;sls%hd#ms;a;j;a rla;fc ld¾hhï m%;sldfrd¾Yxis O%ejï

- fhda. r;akdlrh-

Y=Iald¾Yx m%f,amdos ls%hd ;’laIK úëhf;i%dùkï rla; udf,dalH ls%hd ld¾hdY= ffm;a;sfl

-prl ixys;dj- ÿ¾kdïkdidOfkda;amdh# p;=¾úO# mrsl’¾;s;#fNaIc laIdr Yia;%d.aks idOH;sx hdmH uqpHf;hoajdfhdrkqf,daukdh ho.aks n, j¾Ofhawkakmdfk!IOx øjHx ;;a fiajHx ks;H u¾Yffi#

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1. Beshaja/medicinesArshas-Which are newly occurred-Having less dosha-dushya-Symptoms are not fully developed-Without complications 2. Kshara applicationsArshas-Of soft consistency-Which are widely spread-Deeply situated-Protruded out

3. Shashtra/surgeryArshasWhich are thin rootedWhich mucous dischargeProjected out4. Agni/thermal cauterization ArshasHaving rough surfaceHaving fixed baseWhich are thickenedWhich are harder in consistency

Medicinal treatments for ArshasVataja - sneha, sweda, vamana, virechana, asthapana and anuwasana vasthiPittaja - virechanaRakthaja - sanshamanaKaphaja - ardrak, kulathyaThridoshaja - all doshaja cikithsa

Kashaya/decoction• Yafõ; uQ, úYAj mQ;kd rfidak idê;ï¡¡¡ - lIdh ix.

%yh- idrK uq,a" úh<s b.=re" wr¿" iqÿÆKq• rla;dmdud¾. c,o lajdf:d rla;d¾Y ixys;ï• mqgmdlx m,dfvdIag yúIHd¾Yidx yf¾;a• Y;djr’ f.damlkHd¡¡¡• fldys, w," r;= ÆKq" uqx weg" Wïn,lv" f.dgq

ovq lIdh• Ñr ì,aj mqk¾kjd lIdh• uqia;d lrxc uQ, ;ajla• OdkH mxplh 

PeyaOdkH mxpl fmahdjmxpflda, fmahdjIvx. mdkhArishta wNhdrsIaghmsmam,HdoHdijh;l%drsIagÞdlaIdrsIagYdrsndoHdijhWYsrdijhPkaokdijhChurna/powders Od;’% pQ¾KhudksNø pQ¾KhNdIalr,jK pQ¾Khwúm;a;slr pQ¾Kh

Alepa/pastes• fnfy;a wfkdaod fld< we,a osfhka wUrd .Eu• oe;a;" ;sriaijd¨" m,audkslalï m%f,amh• frdayfka ldIa yd i¾j úIdos f;,a ñY% lr .Eu• l=lals,a tkafka m%f,amh• cd;Hdos ff;,h fyda uQIsldos ff;,h• ;sla; jegfld¿ yd ly wUrd .Eu Sweda/sitz bath• mxp j,al, lIdh• wdvf;davd" jrd" fn,s" trvq fld< ;ïnd wj>dykh• .xiQrsh fld< yd fmd;= iu. fldfydU fld< yd

fmd;= wj>dykh

Kshara karma for ArshasPurva karmaSneha, sweda and one day prior mrdu virechana was given. Pradana karmaThis is indicated for II Grade internal piles. The patient is in lithotomy position and kshar is applied to the dilated pile pedicles with the help of “Jambaushatha shalaka” under the guidence of proctoscope (Arsho darshan yantra) having slit on its side. When the colour of arshas aree appeared like a colour of ‘pakwa-jambu’, kshara is washed out by amla dravya. Kshara application is repeated till the pakwa-jambu colour is not appear.Each pile pedicle is treated differently at the interval of one week. This may cause fibrosis of the tissues which prevents the pile pedicle from protrusion. Paschat karmaThe paste of yashtimadhu and ghruta is applied to the arshas.

APPLICATION OF KSHARA-SUTRA THERAPY.In this process hemorrhoids are tied off at its base (pedicle) by Kshara-sutra or specially processed thread with medicines. By the principle of pressure necrosis, it prevents blood supply to the respective pile mass immediately. Eventually hemorrhoids shrink, shrivel up, die and ultimately fall off within 10 days, leaving some scar tissue which supports the corresponding veins in that area, preventing them to distend or bulge further.

Agni karma for ArshasAgnikarma in the form of thermal cautery is a suitable procedure in the excision of sentinel piles and anal warts falling in Vatha Kaphaja type of Arsha.The hot shalaka is applied at arshas. Procedure is same as kshara application. Even after the excision of arshas, agni karma is recommended.

Shashtra karma for ArshasAfter preparing the patient, the arshas is excised in lithotomy position. All the bleeding points are cauterized. Raktha mokshana for ArshasIt is done with the help of jalauka, suchi, shashtra etc.

Pathyapathya Do’sDrink Plenty of fluidsDo take adequate fibers in the dietExercise regularly. Walking is the one of the best thingsTrain yourself for regular food intake of lunch and dinnerLose weight, if you are overweightChew your food properly which enable digestionTake buttermilk, onion, leafy vegetables and green gram You should not eat any food which is hard to digest

Don’tsDon’t sit too much on a hard surface because it can restrict blood flow around the anal areaDon’t sit in the toilet for long periods. This position causes extra pressure on the anal areaDon’t drink coffee or alcoholHurry, worry and curry is absolutely not advisable for a piles patientDon’t lift heavy objects. Even if you lift anything heavy exhale and don’t hold your breathDon’t use laxatives regularly as it may become a habit and cause the bowels to lose its ability to function normallyDon’t consume any medication directly; this can be harmful for your stomach as well as diseases

HAEMORROIDS/PILESLatin word - PILE – pila(a ball)Greek word - HAEMA - blood

RHOOS - flowing - HAEMORRHOID Definition Dilated plexus of superior haemorroidal veins, in relation to anal canal.

Classification 1. Primary/Idiopathic HemorrhoidsCauses Standing position of human beingAnatomical factorsFamilial or geneticConstipation causes excessive straining2. Secondary HaemorrhoidsCauses Carcinoma of rectumPortal hypertensionPregnancy

3. Depending upon the location of HaemorrhoidsInternal haemorrhoids – above the dentate line, covered with mucous membrane.External haemorrhoids – at anal verge, covered with skinInterno-external – both varieties togetherLocation Classically situated in the 3, 7, 11 0’ clock positions.

Degrees of Internal Piles1st-degreeProjects into anal lumen internally2nd-degree IProtrusion outside anal canal at defecation with spontaneous reduction2nd -degree IIProtrusion outside anal canal at defecation straining and needs digital repositioning3rd -degree Permanently prolapsed irreducible piles

Clinical features• Painless bleeding – fresh bleeding occurs after

defecation. (Flash in the pan). • Constipation • Discharge of mucous • Irritation of peril anal skin• Pruritus• Permanently prolapsed pile outside – patient

complains of pain and discomfort

Investigations Per rectal examinationProctoscopySigmoidoscopy Complications • Chronic anaemia• Strangulation – if the treatments are not given

in right time, may cause suppuration, ulceration, thrombosis, fibrosis, gangrene or pyaemia.

• Ulceration and secondary infection• Thrombosis and fibrosis

Treatments of pilesLord’s dilatation- Under general anesthesia, the internal sphincter it widely stretched which is supposed to relieve the venous congestion and improve the piles. This is indicated in grade 1 piles. Injection of sclerosant- 5% of phenol in almond oil is injected into sub mucosa above the dentate line. Hence it is painless. It produces aseptic thrombosis of pile mass and is indicated in grade 1.

Barron’s band application- It is indicated in grade 1 and 2 haemorrhoids, where in bands are applied at the neck of the haemorrhoids.Haemorrhoidectomy- Excision of the pile masses up to base is indicated in grade 2 and 3 haemorrhoids.Cryosurgery- Liquid nitrogen at -1960C is applied to pile masses which coagulate tissues.

Post-operative complicationsRetention of urineSecondary haemorrhageAnal stenosisWound infection

The Speciality of Ayurvedic treatments than Modern treatments, in the management of Haemorrhoids• Guda is one of the main marma’s in the body. In

addition to that guda is Pranayathan, where the Prana is situated.

• So guda must have protected from diseases.• Haemorrhoids are one of the Ano-rectal disease

which can cause discomfort to the patients.• Hemorrhoids is begins with less discomfort but, it

get worse over time and its treatment must begin as soon as possible. It requires several non-surgical and surgical treatments for curing hemorrhoids.

• According to Ayurveda,Haemorrhoids originated due to apathya ahara and vihara.

• There fore, the first step of the treatment is nidana parivarjana.

• According to acharya Sushruta, there are 4 kinds of treatment methods in the management of Haemorrhoids.

1. Bheshaja2. Kshara3. Shashtra4. Agni

• Bheshaja can be used as internally and externally.• Kshara and Agni karma are para surgical methods

and also those are minimally invasive procedures.• if we failed these methods, then only we can go

to the surgical methods to control the disease.• So surgery is not the first, but the last step of the

Ayurvedic treatment protocol.• Before that, we have various kinds of treatment

methods which can cause non invasive or minimally invasive to the patient.

• In Bheshaja cikithsa, the treatment of piles mainly includes oral medicines like stool softeners, laxatives and local anti- inflammatory creams, oils and warm water or decoction sits bath can help to reduce the symptoms.

• Drugs prepared from the plants alone and in combination cures I –IV degree of piles.

• Mainly 1st degree haemorrhoids can cure by medicines.

• Kshara karma can used to the Arshas which are soft consistency, widely spread, deeply situated and protruded out. It can used internal Haemorrhoids as kshara drava and external Haemorrhoids which are protruded and fixed to anal sphincter.

• Pratisaraneeya teekshna kshara was found effective in obliterating the hemorrhoid mass within 21 days of application. It is also the combination of powdered form of Plumbago zeylanica, Gloriosa superba, Acorus calamus, Achyranthus aspera and Coral. This medicine was applied on the internal hemorrhoids. It was observed that the pile mass became black in 35 seconds( Shushruta Samhita). Lemon juice was applied to neutralize it after proper burning of pile mass.

• Agni karma used in Having rough surface,Having fixed base, Which are thickened and Which are harder in consistency. It cause less pain and chance of recurrence is very rare.

• Surgery is indicated when Arshas Which are thin rooted, Which mucous discharge and Projected out. Mainly used in grade iii and iv type haemorrhoids.

Discussion• Ayurveda, the born of life is the basis of long and healthy life in India

from the ancient period. • The medicines are prepared from the herbal plants and their extracts for

piles treatment. • Several modern therapy like Sclerotherapy, Cryotherapy, Rubber band

ligation, Bipolar diathermy, Direct current electrotherapy, Infrared photocoagulation, Surgical treatments etc. are used for the curing of hemorrhoids.

• The modern treatment of and surgery gives many other side – effects like burning sensation , pain, bleeding, itching etc. Post-operative complications are Retention of urine, Secondary haemorrhage, Anal stenosis, Wound infection which cause life time disability to the patient.

• but the herbal / natural therapy and Para surgical methods only takes slightly long time in comparison but do not shows any type of side effect.

• Drugs prepared from the plants alone and in combination cures I –IV degree of piles.

• Pratisaraneeya kshara is used to reduce bleeding piles.

• A combination of kshara karma, conservative treatment (Shamana aushadha), diet restrictions, and lifestyle modifications administered over a period of one year is effective in obliterating the pile mass as well as preventing recurrence on a long-term basis.

• Agni karma also helps to complete eradication of disease and it gives minimally invasive to the patient.

• There fore, we can decided that Ayurvedic treatments are more specific and effective than modern therapies, gives minimally discomfort to the patient, can reduce the symptoms, have less side effects, chances of recurrence are rare and used successfully to the any age group of patients.

Treatment of Arbuda

According to Acharya Sushrutha: Treatment for Vataja Arbuda. Herbal poultice (composed of Karkaruka,Erudruka,coconut,Piydla, and Castor seeds ,boiled with milk,water and clarified butter, and mixed with oil,should be applied lukewarm (to the tumuor).As an alternative ,a poultice applied made up of boiled meat or Vesa –vara ,should be applied to It.)

Formentation of the part in the manner of a Nadi-Sweda.

The Vitiated blood (of the locality) should be repeatedly cuffed off with a horn.

Vayu-subduing drugs (Satakuva or trivut boiled with decoction of the and with milk and kanjika , should be given to patient.)

Treatment for Pittaja arbuda

Application of mild formentation and poultice. purgatives are effcacious in Pittaja Arvuda.

The tumour should be well rubbed with (the rough surface of) the leaves of the Goji and it should be plastered over with the powders,

(composed with Sarja-rasa,priyangu,pattanga (Red sandal wood),Rodhra,Anjana and Yasti-madhu, mixed with honey.)

Pith shamaka drugs (Draksha and saptalika) should be prescribed for internal application in a case of a pittaja arvuda.

Treatment for Kapaja arbuda

Blood should be let out from the affected part ( after the systems of patients has been cleaned (by emetics and purgatives) .

Medicinal plaster composed of the drugs which are efficacious in correcting the doshas.

Herbal drugs pasted together with urine ,or with alkaline water should be applied to it.

The kalkas (pastes)of nishpdva(s’imbi).Pinyaka (oil-cakes of sesamum)and Kulattha pulse,pasted with curd-dream and an abundant quantity of flesh , should be used in plastering the affected part so that worms and parasites may be produced in the ulcer and flies attracted to it (and so consume the ulcer ).

A small portion of the ulcer ,left unconsumed( un –eaten) by worms and parasites ,etc, should be sacrificed and the ulcer should then be cauterized with fire.

A comparatively superficial tumour (Arvuda; should be covered with thin leavesof zinc,copper,lead or of iron and cauterization with fire or with an alkali as well an surgical operation should be carefully and repeatedly resorted to, so as not to hurt ,nor in any way injure the body.The incidental ulcer should be washed with the decoction of the leaves of the Asphota,Jati and Karvira for the purpose of purification. A medicated oil ,cooked with Bhargi,Vidanga,Patha and Tripala should then be used as a healing remedy.An experienced physician should treat a tumour ,spontaneously suppurating, in the manner of a suppurated ulcer.

Treatment for Medoja Arbuda (Fat origined tumour)

Should be first fomented and then incised.

The blood in its inside having been cleansed it should be quickly sutured and then plastered over with a compound composed of Haridra,Grika-dhuma (soot of a room),Rodhra,Pattanga,Manasil and Haridra pounded together and mixed with a proper quantity of honey.After its purification, thus produced, it should be treated with the application of Karanja-Taila.

Even the least particle of doshas (pus ,etc)in a tumour , left unremoved ,would lead to a fresh growth of the excrescence and bring on death just like the least particle of an unextinguished fire.

Hence it should be destroyed in its entirety.

Western Management

The treatment of colorectal cancer can be aimed at cure or palliation.The decision on which aim to adopt depends on various factors, including the person's health and preferences, as well as the stage of the tumor. When colorectal cancer is caught early, surgery can be curative. When it is detected at later stages (for which metastases are present), this is less likely and treatment is often directed at palliation, to relieve symptoms caused by the tumuor and keep the person as comfortable as possible..

Treatments•May include some combination of surgery.•Radiation therapy.•Chemotherapy.•Targeted therapy.•Oral drugs (Aspirin and other non-steroidal anti-inflammatory drugs decrease the risk). Their general use is not recommended for this purpose, however, due to side effects.

Surgery

Surgery is the main treatment for early colorectal cancer. Often, the piece of the colon or rectum with the tumor is removed and the ends are sewn back together.

This can either be done by an open laparotomy or sometimes laparoscopically. Side effects of surgery

If there are only a few metastases in the liver or lungs they may also be removed.

Pain and nausea.

Sometimes ended up with colostomy , In that case, one end is attached to the wall of the belly so that stool can empty into a bag outside the body.

Chemotherapy

ChemotherapyChemotherapy (chemo) is the use of drugs to fight cancer. The drugs may be put into a vein or given by mouth. These drugs enter the bloodstream and travel throughout the body, making this treatment useful for cancers that have spread to distant organs.

Side effects of chemo While chemo kills cancer cells, it also damages some normal cells and this can cause side

effects. These side effects will depend on the type of drugs given, the amount given, and how long treatment lasts. Common side effects could include:

• Diarrhea• Hair loss• Mouth sores• Loss of appetite• Nausea and vomiting• Increased chance of infection (from low white blood cell counts)• Easy bleeding or bruising after minor cuts or injuries (from low levels of platelets,

which help the blood clot)• Severe tiredness (fatigue) (from low levels of red blood cells)• Some drugs can cause something called hand-foot syndrome, where the palms of

the hands and the soles of the feet get red and irritated and may even blister or develop open, painful sores.

• Some drugs can cause nerve damage which can be painful.

Radiation treatment Radiation treatment is the use of high-energy rays (such as x-rays) to kill cancer cells or shrink tumors.Side effects of radiation therapy• Skin changes in the area where the radiation passes• Nausea and vomiting• Diarrhea• Rectal irritation, which can lead to trouble controlling your bowels Bladder irritation which can make you feel like you have to pass urine often. • Tiredness.• Sexual problems may also occur.• Side effects often go away or lessen over time after treatment is finished but problems such as rectal and bladder irritation may remain.

Guda Bramsha(Rectal prolapse)

Definition According to Acharya Sushrutha,

A prolapse or falling out of the anus (due to the Vayu) in a weak and lean patient through straining, urging or flow of stool as in dysentery is called Guda-Bhransa or prolapses ani.( su/ni/13/21)

Treatment of Guda-Bhramsa In a case of Guda-Bhramsa ,the protruded part should be fomented and lubricated with Sneha.It should then be gently re-introduced.the region of the anus should then be bandaged with a

piece of hide in the manner of a Gophana Bandha. with an opening in it (lying immediately below the anus),so that it may not in any way interfere with the emission of Vayu.

The affected part then should be constantly fomented .A quantity of milk ,Maha-Panchamula and the body (flesh) of a mouse bereft of its entrails should be first boiled together (with water ).An oil and Vayu-subduing drugs should be administered as unguents. By these measures the most difficult cases of Prolapsus ani would be cured.(su/chi/20/19)

• In traditional medicine, paste of Brahmi which fried with tila oil fumigation with the fumes of tortoise’ shell.Are indicated in Guda bramsha.

Western management of rectal prolapse. In adult patients, treatment of rectal prolapse is

essentially surgical; no specific medical treatment is available.

(Children, however, can usually be treated nonsurgically and by managing the underlying condition.) Which repair constitutes the best treatment is the main controversy in surgery for rectal prolapse

• If the prolapse is very small or the patient is too sick to undergo an operation. In these cases, supportive garments can help with keeping the prolapse from coming out all the time.

SURGERY FOR RECTAL PROLAPSE

• There are two general approaches to surgery for rectal prolapse –abdominal operations (through the belly) and perineal operations(through “the bottom”). Both approaches aim to stop the prolapse from occurring again and usually result in a significant improvement in quality of life.

ABDOMINAL APPROACHES•ABDOMINAL RECTOPEXY WITH POSSIBLE BOWEL RESECTION

• MINIMALLY INVASIVE RECTOPEXY WITH POSSIBLE BOWEL RESECTIONMinimally invasive techniques such as laparoscopy or robotically, are used in

some centers with equivalent success to traditional abdominal procedures. Laparoscopy refers to the use of small incisions through which the surgeon may place a camera and surgical instruments, allowing them to perform the

same procedures described above for abdominalapproaches.

Laparoscopic trocars placed for colon surgery

PERINEAL APPROACHES• It is generally believed that the perineal approach results in fewer

complications and pain, with a reduced length of hospital stay. These advantages have, until recently, been considered to be offset by a higher recurrence rate. Recent data is unclear on this point, however, and a properly executed perineal operation may yield good long-term results.

PERINEAL RECTOSIGMOIDECTOMY

MUCOSAL SLEEVE RESECTION (DELORME PROCEDURE)

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