By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Arshas is the name given to piles developing usually in anal region. A similar mass when develops in nose, is called as nasarsha and when developed in vagina / uterus is called yonyarsha. Read – Arshas (Hemorrhoids), Ayurvedic Types, Causes And Symptoms
Masters of Ayurveda, mainly Sushruta, Harita and Vagbhata have described yoni Arsha along with description of general arshas i.e. piles. Charaka also mentioned that the piles like mass would develop even in genital region. Read – Charaka Samhita Chikitsa Sthana 14 – Arsha Chikitsa
Sushruta, though has emphasised that pile like mass develops in the anal region, has also mentioned other locations wherein such masses would develop and has included the genital area too. He has also given aetiology and pathogenesis of these sub-types of piles situated in other parts of the body. Harita too has mentioned genital arshas.
Vagbhata too has mentioned that pile like mass would be developed in the penis. Commentator Arunadatta further adds that just like in penis, the pile like mass would also manifest in vaginal canal / uterus / genital tract. Read – Ayurvedic Treatment For Non Bleeding Piles: Shushka Arsha Chikitsa
What to understand?
Due to resemblance in the shape and structure of muscular protuberances as seen in piles occurring in anal region, the protuberances of vaginal / uterine area also have been named as arshas i.e. pile-like-muscular-protuberances. This is the reason that both these conditions have been explained at the same place.
Vagbhata clarifies that detailed description of other forms of arshas occurring in other parts of the body, i.e. other than those occurring in the anal region, would be detailed along with other diseases of that body part, though they too have been mentioned alongside anal piles, including vaginal / uterine / genital arshas.
Read – Line Of Treatment For Ardra (Raktaja, Pittaja, Rakta-Pittaja) Arsha
After pledging so, Vagbhata has explained the arshas of genital passages with other diseases of the genital system of women in the context of guhya rogas. This demands a separate explanation of different types of arshas occurring in different parts of the body in respective contexts i.e. within the bracket of description of diseases related to that particular body part, including the vaginal / uterine piles.
This is also because the etiology, pathogenesis, clinical features, complications and features of yonyarsha are different from the description of general anal piles. Therefore a separate discussion of yonyarsham is needed. Read – Heavy Periods, Menstrual Bleeding: Ayurvedic Treatment
Etiological factors of yonyarsh –
Though specific etiological factors have not been enumerated for yoni Arsh, it should be assumed that the doshas get aggravated due to consumption of etiological factors specific for their vitiation. In this context since doshah i.e. plural of dosha has been mentioned, we should infer and consider the foods and life activities which are capable of aggravating all three doshas simultaneously. Read – Gynecological Disorders Causes, Types As Per Ayurveda
Pathogenesis – Aggravated doshas on reaching the reproductive organs of a woman gets localised in blood and muscle tissue of those organs. After getting localised in the reproductive organs, vagina / uterus to be precise in this context, produce muscular sprouts / protuberances which have shape of umbrella. Read – Understanding Blood Functions, Vitiation And Treatment As Per Ayurveda
Signs and Symptoms – These protuberances occurring in vaginal / uterine region are associated with foul smelling, unctuous, sticky and blood mixed discharges.
Complications – If these vaginal sprouts are not treated promptly at right time, they tend to destroy vagina, vulva, uterus and menstrual blood. Read – Vatala Yoni Vyapad – Causes, Symptoms, Treatment
Sanskrit verse, correlation
Yoni arsham has been correlated with
- polyps of reproductive organs – uterine or cervical polyps to be precise (uterus is also included under the term yoni)
- fibroid polyps of uterus and adenomatous polyps of cervix
- cervical or vaginal papillomas
- warts or condylomata acuminate developing in cervix, vagina or vulva
Treatment of Yonyarsha
Since the treatment for yonyarsha has not been mentioned separately, line of treatment and principles of treatment of general piles occurring in the anal region should be implemented in vaginal / uterine sprouts too.
The fourfold treatment approach for curing piles are as below mentioned –
- Bheshaja – oral medicines – used to treat piles of recent origin, associated with less vitiation of doshas, having less signs and symptoms and fewer complications
- Kshara karma – administration of alkalis – used to cure piles which are soft, spreading, wide, deep rooted and protuberant
- Agni karma – administration of fire cauterization – are used to treat rough, fixed, big and hard pile masses
- Shastra karma – surgical interventions – used to cure pile masses which have thin root or stem, protuberant and moist
On the basis of description of above said options of treatment of piles, yonyarsha are considered to be curable by surgical methods. This is because these have thin stem, spreads upwards, protuberant and are moist.
Master Vagbhata opines that first the person suffering from piles should be subjected to purifying measures. After purifying treatments including emesis and purgation, he or she should be treated with surgery, alkalis and fire cauterisation after having considered the condition of the patient and after analysing the quantum of dosha vitiation. Read – Abnormal Vitiation Of Doshas – Vaikruta Dosha Dushti Later the wound which has been left over after these procedures, shall be treated with ointments prescribed for treatment of upadamsha i.e. syphilis, gonorrhoea etc sexually transmitted diseases.
Vagbhata II advocates treating piles with excision and cauterization, followed by the treatment prescribed for upadamsha.
To sum up –
Yoniarsha i.e. protuberances of the vagina / uterus should be treated effectively with –
- Administration of cleansing / purifying treatments inclusive of emesis and purgation, as per need followed by
- Removal of the mass by means of surgical intervention, fire cauterization or alkali cauterization as and when required as per condition of the disease followed by
- Administration of treatment prescribed for upadamsha for cleansing and healing the wounds left out after the above mentioned procedures Read – KsharaSutra Treatment: Introduction, Indication, Contra Indications
Post surgical wound treatment
Treatment of wounds produced after removal of yonyarsha, as described in treatment of upadamsha
1. Jambvadi Kwatha Kshalana – Washing / irrigation of wound with decoction prepared with tender leaves of Jamun fruit (Syzygium cumini), mango, jasmine, Anthocephalus indicus and Breynia patens, stem bark of Boswellia serrata, jujube, , Butea monosperma, Ogeinia dalbergioides, and latex yielding trees and triphala should be done. Following this, for healing, the oil medicated with these herbs mentioned above should be applied.
2. Tuttadi Lepa – Anointment with finely powdered copper sulphate, red ochre, Symplocos racemosa, cardamom, purified realgar, purified arsenic tri-sulfide, and aqueous extract of Berberis aristata, Vitex agnus, parched green vitriole, alum and rock salt mixed with honey heals the ulcer quickly when applied.
3. Triphala – Kept between broken earthen pots, heated till it is not burnt or else properly burnt should be taken and mixed with ghee and used.