Back ground: Haemorrhoid is defined as prolapse of an anal cushion that may result in bleeding and pain from rectum or anal canal. It is classified into Internal and External Haemorrhoids. Further, prolapsed haemorrhoid is an emergency condition which require immediate surgical intervention. If it is not treated properly, the condition becomes worse after thrombosis and strangulation of the pile mass. Haemorrhoid can be co-related with Gud-Arsha in Ayurveda. Sushruta has advocated fourfold therapy for Arsha such as – Palliative medicinal treatment, local application of Alkaline paste, Thermal cauterization and Surgery. Similarly, Acharya Vagbhata & Charaka has advocated use of Jalauka (leeches) for eliminating the vitiated blood in management of protruded large pile masses. Methodology: In this case report, a 63-year-old male patient came with complaints of severe pain and discomfort at anal region due to inflamed pile mass at anal region (not reducible), constipation and occasional per rectal bleeding since 7 days. The condition was diagnosed as Acute prolapsed external Haemorrhoids and was treated with specific regimen -3 sittings of Jalaukavacharana (leech therapy) locally along with Triphala guggulu (500mg), Arogyavardhini Vati (400mg) two tablets twice a day and Gandharva Haritaki (3gm) at night with lukewarm water for 28 days. Therapeutic evaluation and assessment of treatment was done based on prognosis in pain, size of pile mass, discoloration, bleeding per rectum and constipation. Result: It was observed that pain was relieved immediately after Leech therapy. However, swelling of prolapsed mass, per rectal bleeding and constipation reduced gradually. Also, color of prolapsed pile mass turned to normal texture at completion of treatment. Conclusion: In this case study, Acute prolapsed external Haemorrhoids (Grade IV) was conservatively managed by three sitting of Jalaukavacharana (leech therapy) locally along with adjuvant Ayurvedic medicines which clearly revealed significant improvement in the symptoms of Acute prolapsed Haemorrhoids. Keywords: Haemorrhoids, Arsha, Jalaukavacharana, Leech therapy