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ANORECTAL

DISEASES

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 marmas 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.

Guda (Anal canal and Rectum)


;;% ia:Q,dka;% m%;snoaOx wO
mxpdx.=,x .=ox udyq -iq'ks'2$5Guda is a structure which is related to
the Stula antra(large intestine), and the
length of guda is 4 angula.

Origination and Formation


Guda 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
- 34
Dhamani - 10
Snayu
- 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
Houstons 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 4cm long, extending from the
anorectal junction to the anus. It is directed
downwards and backwards.
Its anterior wall is slightly shorter than posterior
wall.

Musculature of the Anal canal

Internal anal sphincter


Involuntary in nature.(Autonomic nerve supply)
Formed by the thicked circular muscles.
External anal sphincter
Under 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


Diseases
1. Bleeding
2. Pain.
3. Altered bowel habit.
4. Discharge.
5. Tenesmus.
6. Prolapse.
7. Pruritus.
8. Loss of weight

Anorectal diseases
1. Haemorrhoids/piles (wYia)
2. Fissure in ano (mrsl;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 )
8. Napkin rashes ( wysmQ;kd)
9. Proctitis ( .=o mdl)
10.Pruritus in anus ( .=o lKavq)
11.Anal warts ( pu l,)
12.Rectal cancers ( wnqo)

Arshas
Etymology
Arsha
Ru(root) + Asun

get the life away

Definition
wrsj;a m%dKsfkda udxi l,;d Iika;s h;a
wYdxis ;iaudpHkaf;a .=o ud. 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 wY#
Arshas is like an enemy, that destroys the blood
in the body.

Synonyms
Durnama, Guda kila, Gudnkura, Payu
roga,
Mula vyadi, Anamaka, Gudaja

Classifications of Arshas
First Classification
mD:la fodaffI iuiaff;Yap fYdaKs;dka
iycdksp
wYdxis im%ldrdKs oHd;a .=o j,s;%fh
1. Vata
2. Kapha
3. Pitta
4. Sannipatha
5. Rakthaj
6. Sahaj

Second Classification
1. Bahira (External) Arshas
2. Abyantara (Internal) Arshas
Third Classification
3. Sahaja
4. Janmoththaraj 7 (Vata, Kapha, Pitta,
Kaphavatha, Kaphapitta, Vatapitta,
Sannipatha)

Fourth Classification
1. Shushka Arshas (Vataj, Kaphaj)
2. Sravi Arshas ( Pittaj, Rakthaj)
Fifth Classification
3. Bheshaja sadya
4. Kshara sadya
5. Shashtra sadya
6. Agni sadya

Nidana of Arshas
All 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 hethu
Guru, madhura, sheeta, abhishandi, vidhahi, virudda bojana,
asatmya bojana, mansya, varaha, mahisha, aja mansa,
krusha prani mansa and shushka mansa.
Viharaja hetu
Athi 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 HETHU
1. Vataja arshas

1. Pittaja arshas

Kashaya
Katu
Tiktha
Ruksha
Sheeta
Laghu rasa ahara
Pramitha/alpa
bojana
Teekshana madya
Anaashana

Athi-maithuna
Athi-vyayama
Athi-upavasa
Athi-vata sparsha
Athi-athapa
sparsha
Shoka
Sheeta
desha
sevana
Sheeta
kala
sevena

Lavana
Amla
Katu
Ushna
Vidahi
Tikshna rasa ahara
Ushna jala

Athi-vyayama
Atapa sevana
Agni sevana
Ushna desha,kala
Krodha
Dwesha

1.Kaphaja
arshas

Madhura
Snigdha
Sheeta
Lavana
Amla rasa
ahara
Guru
ahara

Avyayam
a
Diva
swapna
Aasan
shook
Achintam
Praag
vata
sevana
Sheeta

Purva rupa of Arshas


IagfNdazkakiH fo!n,Hx l=lafIardIAfgdam tajp
ldIH uqoa.dr ndyq,Hx ila:sidfoda,am l;d
.%yKs fodaI mdKajf;rdYxld fpdaoriHp
mQj rEmdKs ksosYagd
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 symptoms


Acharya charak has described different sizes and
shapes of arshas.
Eg: sarshapa, masur, masha, yawa, tinduka,
kareera, udumbara etc.

Vishesha rupa of Arshas


Vataja arshas
;;% udre;dka mrsY=IaldreK jKdks Iu
uOHdks
lon mqIam ;=kaflars kd uqLq, iq
uqLdlD;sk p Njka;s
ff;rem;# iY=,x ixy; uqmfYHf; l mDIAG
mdYj
fV% .=o kdNs m%foafYaIq pdiH fokd Njka;s
.=,audIa,d
ma,fydaordKs
pdiH
;kaks;a;dkafhaj Njka;s
lDIAK ;ajla kL khk oYk jok uq;% mqrIYa p
mqrefIda 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

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 arshas
Piles produced by all the three doshas
together, will have symptoms of all the doshas
simultaneously. (Su.Ni. 2/24)
Sahaja arshas
Sahaja 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 Arshas
Baddagudodara, udawartha, vamana,
aruchi, vibanda, athisara, shawasa,
jwara, shosha, moha, pada shotha, guda,
nabhi and medra shotha
Examination of Arshas
General examination
Local examination
General-per rectal examination
Special instrumental-Proctoscope

Treatment of Arshas

Chikithsa sutra
iafkay
iafjod;ajfhd
jdf;
ms;af;aIq
frpkdoh!#
lfM jdka;HdofhdYia fY% Y% m%;sls
%hd#
ms;a;j;a rla;fc ldhh m%;sldfrdYxis O
%ej
- fhda. r;akdlrh-

Y=IaldYx m%f,amdos ls%hd ;laIK hf;


i%dk rla; udf,dalH ls%hd ldhdY= ffm;a;sfl
-prl ixys;dj
kdkdidOfkda;amdh#
p;=O#
mrsl;s;#
fNaIc laIdr Yia;%d.aks idOH;sx hdmH uqpHf;
hoajdfhdrkqf,daukdh ho.aks n, jOfha
wkakmdfk!IOx jHx ;;a fiajHx ks;H uYffi#
-iq6$3

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

3. Shashtra/surgery
Arshas
Which are thin rooted
Which mucous discharge
Projected out
4. Agni/thermal cauterization
Arshas
Having rough surface
Having fixed base
Which are thickened
Which are harder in consistency

Medicinal treatments for Arshas


Vataja - sneha, sweda, vamana,
virechana, asthapana and anuwasana
vasthi
Pittaja - virechana
Rakthaja - sanshamana
Kaphaja - ardrak, kulathya
Thridoshaja - all doshaja cikithsa

Kashaya/decoction
Yaf; uQ, YAj mQ;kd rfidak id; - lIdh ix.
%yhidrK uq,a" h<s b.=re" wr" iqKq
rla;dmdud. c,o lajdf:d rla;dY ixys;
mqgmdlx m,dfvdIag yIHdYidx yf;a
Y;djr f.damlkHd
fldys, w," r;= Kq" uqx weg" Wn,lv" f.dgq ovq
lIdh
r ,aj mqkkjd lIdh
uqia;d lrxc uQ, ;ajla
OdkH mxplh

Peya
OdkH mxpl fmahdj
mxpflda, fmahdj
Ivx. mdkh
Arishta
wNhdrsIagh
msmam,HdoHdijh
;l%drsIag
dlaIdrsIag
YdrsndoHdijh
WYsrdijh
Pkaokdijh
Churna/powders
Od;% pQKh
udksN pQKh
NdIalr,jK pQKh
wm;a;slr pQKh

Alepa/pastes
fnfy;a wfkdaod fld< we,a osfhka wUrd .Eu
oe;a;" ;sriaijd" m,audkslal m%f,amh
frdayfka ldIa yd ij Idos f;,a Y% 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< ;nd wj>dykh
.xiQrsh fld< yd fmd;= iu. fldfydU fld< yd fmd;=
wj>dykh

Kshara karma for Arshas


Purva karma
Sneha, sweda and one day prior mrdu virechana was given.

Pradana karma
This 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 karma
The 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

Agni karma for Arshas


Agnikarma 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 Arshas


After preparing the patient, the arshas
is excised in lithotomy position. All the
bleeding points are cauterized.

Raktha mokshana for Arshas


It is done with the help of jalauka, suchi,
shashtra etc.

Pathyapathya
Dos
Drink Plenty of fluids
Do take adequate fibers in the diet
Exercise regularly. Walking is the one of the best
things
Train yourself for regular food intake of lunch and
dinner
Lose weight, if you are overweight
Chew your food properly which enable digestion
Take buttermilk, onion, leafy vegetables and green
gram
You should not eat any food which is hard to digest

Donts
Dont sit too much on a hard surface because it can
restrict blood flow around the anal area
Dont sit in the toilet for long periods. This position
causes extra pressure on the anal area
Dont drink coffee or alcohol
Hurry, worry and curry is absolutely not advisable for
a piles patient
Dont lift heavy objects. Even if you lift anything
heavy exhale and dont hold your breath
Dont use laxatives regularly as it may become a
habit and cause the bowels to lose its ability to
function normally
Dont consume any medication directly; this can be
harmful for your stomach as well as diseases

HAEMORROIDS/PILES
Latin 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 Hemorrhoids
Causes
Standing position of human being
Anatomical factors
Familial or genetic
Constipation causes excessive straining
2. Secondary Haemorrhoids
Causes
Carcinoma of rectum
Portal hypertension
Pregnancy

3. Depending upon the location of


Haemorrhoids
Internal haemorrhoids above the
dentate line, covered with mucous
membrane.
External haemorrhoids at anal verge,
covered with skin
Interno-external

both
varieties
together
Location
Classically situated in the 3, 7, 11 0
clock positions.

Degrees of Internal Piles


1st-degree
Projects into anal lumen internally
2nd-degree I
Protrusion outside anal canal at defecation
with spontaneous reduction
2nd -degree II
Protrusion outside anal canal at defecation
straining and needs digital repositioning
3rd -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 examination
Proctoscopy
Sigmoidoscopy
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 piles
Lords 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.

Barrons 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 complications
Retention of urine
Secondary haemorrhage
Anal stenosis
Wound infection

The Speciality of Ayurvedic treatments than


Modern treatments, in the management of
Haemorrhoids
Guda is one of the main marmas 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. Bheshaja
2. Kshara
3. Shashtra
4. 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

In Bheshaja cikithsa, the treatment of


piles mainly includes oral medicines like
stool softeners, laxatives and local antiinflammatory 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. areused for the curing of hemorrhoids.
The modern treatment of and surgery gives many other side
effects like burning sensation , pain, bleeding, itching etc. Postoperative 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(simbi).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 antiinflammatory 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

Chemotherapy
Chemotherapy (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. Theseside 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 calledhand-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 ,MahaPanchamula 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 RESECTION
Minimally 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)

THANK
YOU.

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