Reviving Ancient Alchemy: Saptaparna Pratisarniya Kshara's Triumph Over 1st & 2nd Degree Haemorrhoids ( Arsha ) – A Clinical Odyssey in Ayurvedic Precision

Abstract

Background: Internal haemorrhoids (first–second degree) are common anorectal conditions that cause bleeding, pain, pruritus, mucous discharge and prolapse. Traditional Ayurvedic paraclinical therapies include topical alkaline Kshara preparations; however, contemporary clinical data are limited. Objective: To assess the safety and clinical effectiveness of Saptaparna (Alstonia scholaris) Pratisaraniya Kshara applied proctoscopically in patients with first- and second-degree internal haemorrhoids. Methods: This single-arm prospective clinical trial enrolled 32 patients aged 19–80 years presenting to the Shalya Tantra OPD/IPD with at least three cardinal symptoms of internal haemorrhoids. Under proctoscopic guidance, Saptaparna Pratisaraniya Kshara was applied to haemorrhoidal tissue for approximately 100 Matrakala and irrigated with Nimbu (lemon) Swarasa; treatment was repeated on day 7. Gandharva Haritaki was administered to support bowel regularity. Primary outcomes included changes in pain, bleeding, prolapse (pile size and grade), pruritus, constipation, mucous discharge, and pile count, assessed at baseline and day 15. Statistical analysis used Friedman's test for repeated measures where appropriate. Results: Thirty-two patients (62.5% male; majority aged 20–30 years) completed follow-up. By day 15, median pain scores decreased by 91% (Friedman's test, p < 0.001). Bleeding resolved in 30/32 (93.8%) patients. Pile size reduced in 94% of patients; pruritus and mucous discharge resolved in all affected patients. Constipation improved in 31/32 (96.9%). Pile count decreased by 71.9% with most patients achieving grade 0. Transient application-related burning was reported but was self-limited; no serious adverse events were observed. Conclusion: In this uncontrolled single-arm study, proctoscopic application of Saptaparna was associated with substantial symptomatic and objective Pratisaraniya Kshara improvement in first- and second-degree internal haemorrhoids over 15 days and was well tolerated. Limitations include small sample size, lack of a control group, short follow-up and concomitant use of Gandharva Haritaki. Randomized controlled multicentre trials with longer follow-up are needed to confirm efficacy, define safety profile, and compare this intervention with standard therapies.