Efficacy of Kshara Karma (Caustic therapy) in Primary and Secondary Third Degree Arshas (Haemorrhoids) - A Case Report

Background: Haemorrhoids are dilated veins within anal canal in the sub epithelial region formed by radicles of superior, middle and inferior rectal veins. Recent statistics reveals that irrespective of age, sex, socioeconomic status, people suffer from haemorrhoids. In 3rd and 4th degree haemorrhoids available treatments are surgical treatments like open haemorrhoidectomy, closed haemorrhoidectomy, submucosal haemorrhoidectomy, Doppler-Guided Hemorrhoid Artery Ligation (DGHAL), trans anal suture rectopexy, etc. whereas Acharya Susrutha explains para surgical procedures like Kshara Karma (Caustic therapy) which practically seems to be more convenient for the patients as it is cost effective and needs minimum hospital stay and has relatively is very less complication. Aim: To evaluate the effect of Prathisaraneeyakshara (External caustic therapy) with Apamargakshara in 3rd degree haemorrhoids. Materials & Methods: Single case with pre and post treatment study of Apamargakshara application in 3rd degree haemorrhoids, which is assessed based on inspection, per digital examination and proctoscopic examination. Single sitting of Apamargakshara application then followed by daily assessment till 21 days and follow up on 30th and 60th day. Observations: There was severe burning sensation, inflammation and blackish discolouration immediately after the procedure, which started to reduce from the next day of procedure. From 2nd day of procedure there was moderate brownish black discharge. Discharge completely subsided on 14th day. Burning sensation got subsided by 20 days. Pile mass got completely reduced by 21 days on inspection. On proctoscopy examination after 30 days the size of pile mass was reduced considerably and it was in 1st degree. Haemorrhoids got completely resolved by 60 days. Conclusion: As the present case study revealed appreciable results in reducing the size of pile mass, it can be indicated in all internal haemorrhoids irrespective of their degree. Further, studies with larger sample size may yield more concrete results to justify the claim.