A REVIEW ON ARSHOGHNA MAHAKASHAYA GUGGULU-BASED KSHARASUTRA IN THE MANAGEMENT OF ARSHA (HAEMORRHOIDS): A CLASSICAL AND PHARMACOLOGICAL PERSPECTIVE

Abstract

Background Arsha is a common anorectal disorder described extensively in Ayurvedic classical literature and is included among the Ashta Mahagada because of its chronicity and therapeutic difficulty. Its clinical manifestations include bleeding per rectum, pain, constipation, prolapse, itching and abnormal fleshy growth. Although Arsha is commonly correlated with haemorrhoids, the Ayurvedic concept encompasses a broader pathological spectrum. Ayurveda describes Bheshaja, Kshara, Agni and Shastra as principal approaches for the management of Arsha. Among parasurgical procedures, Ksharasutra combines the therapeutic action of Kshara with sustained local contact and mechanical ligation. Aim To review the classical, pharmacological and therapeutic rationale of Arshoghna Mahakashaya Guggulu-based Ksharasutra in the management of Arsha with special reference to Samprapti Vighatana. Methodology Classical Ayurvedic texts including Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya and relevant Nighantus were reviewed for the concepts of Arsha, Arshoghna Mahakashaya, Kshara and Guggulu. Published scientific and clinical literature related to haemorrhoids, Ksharasutra and Guggulu-based Ksharasutra was also reviewed. Review Arshoghna Mahakashaya comprises ten drugs having predominantly Katu, Tikta and Kashaya Rasa and properties relevant to Deepana, Pachana, Grahi, Anulomana, Krimighna and Shothahara actions. Kshara contributes Ksharana, Lekhana and Shodhana activity, whereas Ksharasutra provides sustained local action and mechanical ligation. Guggulu possesses classical Lekhana and Shothahara properties and has also been investigated experimentally and clinically. A previous clinical study has evaluated Guggul-based Apamarga Kshar Sutra in grade II and III haemorrhoids, demonstrating the feasibility of this modification. However, specific evaluation of an Arshoghna Mahakashaya-oriented Guggulu-based Ksharasutra remains limited. Conclusion Arshoghna Mahakashaya Guggulu-based Ksharasutra has a rational multidimensional basis involving systemic digestive and bowel-regulating actions, local Shodhana-Lekhana, mechanical ligation and tissue healing. Its specific therapeutic efficacy and possible advantages over standard Ksharasutra require systematic comparative clinical evaluation.