Issue : 01 DOI : 10.5281/zenodo.8147277

INTERNATIONAL

JOURNAL

DIAGNOSTICS

AND

RESEARCH

Volume : 01

Abstract

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

Corresponding author: Dr.Abhinav Dubey

Article Info: Published on : 15/07/2024

ISSN No. : 2584-2757

Volume : 01

Issue : 04

Publisher

ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION

FOR PATHOLOGY AND RADIODIGNOSIS

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: 1 0 . 5 2 8 1 / z e n o d o . 1 2 7 4 4 0 4 1

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Year of Establishment – 2016

INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Conservative Management Of Acute Prolapsed External Haemorroids By Leech

Therapy And Adjuvant Ayurvedic Medicines- A Single Case Study

Dr. Dwivedi Amarprakash

, Dr. Abhinav Dubey

Professor, Department of Shalyatantra, School of Ayurveda, D. Y. Patil Deemed to be University, Navi

Mumbai, India.

MS (Shalya- Scholar), Department of Shalyatantra, School of Ayurveda, D Y Patil Deemed to be University,

Navi Mumbai, India.

Cite this article as: - Dr.Abhinav Dubey (2024) ; Conservative Management Of Acute Prolapsed External Haemorroids By Leech

Therapy And Adjuvant Ayurvedic Medicines- A Single Case Study; Inter.J.Dignostics and Research 1(4) 1-7,

DOI: 10.5281/zenodo.12744041

Issue : 04

INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]

Volume : 01

Introduction:

Haemorrhoids or Piles are masses or clumps of

tissues which consist of muscle and elastic fibers

with enlarged, bulging blood vessels and

surrounding supporting tissues present in the anal

canal of an individual. It is a condition

characterized by the prolapsed of an anal cushion

that may result in bleeding and pain.

[1]

It is

classified into Internal (defect in internal

hemorrhoidal plexus, located above the dentate

line) and External Haemorrhoids (defect in external

hemorrhoidal plexus, located below the dentate

line). The available data reveals that prevalence

rate of this disease is 4.4% in 10 million people.

[2]

The conventional medical treatment includes diet-

lifestyle modification, sclerotherapy, banding,

LASER ablation etc. in early stage and various

surgical procedures such as Haemorrhoidectomy,

MIPH etc. in advanced stage with varied prognosis.

Further, Prolapsed Haemorrhoids is an emergency

condition which requires immediate surgical

intervention and the condition becomes worse after

thrombosis and strangulation of the pile mass with

severe pain and discomfort. The venous return of

such strangulated pile mass become very low and

severe oedema occurs along with painful

condition

[3]

. Hemorrhoids can be co -related with

Arsha or Gudarsh mentioned in Ayurvedic texts.

Further, Arsha is included in Ashta-mahagada

category (amongst 8 diseases which are difficult to

treat).

[4]

Arsha is defined as a disease which

produces extreme discomfort to the patient

resembling one’s enemy, leading to painful

defecation and pile mass formation. According to

Acharaya Sushruta it is a rakta and mamsa doshaja

vyadhi (disorder related to blood and muscle).

[5]

The Ayurvedic texts explains pathogenesis of Arsha

as vitiated Vata, along with blood and muscle tissue

(Rakta, Mamas dhatu) and local blood vessels

(pradhan dhamani), disturb sphincters and

surrounding tissues in the anal canal, leading to pile

mass formation i.e. hemorrhoids (Gud Arsha).

Further, fourfold treatment for Arsha is mentioned

such as Bheshaj (Medicinal treatment), Kshar

karma (Herbal caustic paste), Agnikarma (thermal

heat burn) and Shastra karma (Surgery).

[6]

Acharya

Vagbhata & Charak has mentioned use of Jalauka

(leeches) for eliminating the vitiated blood in

management of protruded large pile masses.

[7,8]

Similarly, Acharya Sushruta has also advocated

Jalukavacharana (leech therapy) as one of the lines

of treatment in all inflammatory conditions.

[9,10,11]

has been proven that Leech’s saliva has numerous

bioactive constituent which possesses anti-

inflammatory, analgesic, thrombolytic, anti-

coagulant and blood circulation enhancing

properties .

[12]

Hence, in present case study, an

Acute prolapsed external Haemorrhoids was

conservatively managed successfully with 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.

Patient’s Information:

In this case study, a 63-year-old male patient with

chief complaints of severe pain and discomfort at

anal region, mass at anal region (not reduceable),

occasional per rectal bleeding, constipation,

difficulty in sitting due to inflamed pile mass since

7 days, visited Shalyatantra (~Surgery) OPD for

Ayurvedic treatment. Patient has no history of

similar episode in past, no history of drug allergy,

any previous surgery and no relevant disease family

history was noticed. Patient was K/C/O

hypertension and on regular treatment since 2005.

The personal history of patient revealed non-

vegetarian diet, normal appetite, good frequency of

intake, normal sleep pattern, addiction of Tobacco

and Alcohol since 30-40 years. The patient was

vitally stable having pulse-78/min, Temperature-

98-degree Fahrenheit, blood pressure-

120/70mmHg, respiratory rate was found 20/min.

General examinations of the patient were found

normal.

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Local examination:

 Inspection- Bluish prolapsed thrombosed

circumferential Haemorrhoidal mass with active

per rectal bleeding seen (size -3”x3”cm inflamed

x bleeding)

 Palpation- Severe tenderness was noted. Due to

severe sphincter spasm, tenderness at anal region

and active bleeding, proctoscopy was not done.

 The final clinical diagnosis - Acute prolapsed

external Haemorrhoids.

Laboratory examination:

CBC

Hb – 9.9gm/dl,

TLC – 9,200/cumm,

RBC count -5.31millions/cumm,

Platelet Count – 3.22Lakh/cumm,

ESR-50mm/hr.

Blood Suger

Fasting - 98 mg/dl

PP -110.0 mg/dl

Bleeding And

Clotting Time

BT-1min 40 seconds

CT-4 min 50 seconds

RFT

Serum Uric acid-6.7mg/dl, Serum

creatinine-1.2mg/dl

BUN-8.8mg/dl

LFT

Serum Bilirubin-0.4mg/dl, ALP -

66.6mg/dl, AST-24.7 mg/dl

Urine Routine

And

Microscopic

NAD

Triple H

Antigen

HBsAg – Non reactive, HIV

(Antibodies) – Non reactive,

HCV- Non-reactive

Table 1: Blood investigations on visit day

Material And Method:

This is a single case study. A 63-year-old male

patient (OPD/2024/364451) diagnosed as Acute

prolapsed external Haemorrhoids was treated with

Jalaukavacharana (Leech therapy) locally along

with internal administration of Ayurveda drugs

conservatively. Proper counselling, written

informed consent was taken after explanation of

proposed line of treatment. For the therapeutic

evaluation, Parameters such as pain, size of

prolapsed mass (swelling), per rectal bleeding,

discoloration of prolapsed pile mass and

constipation were assessed before, during and after

completion of treatment. Assessment of pain was

done by using ‘Visual Analogue Scale ’whereas

evaluation of other parameters assessed using 0-3

gradation score. Similarly, constipation was

assessed by ‘Victoria Bowel Performance Scale”

Drug Profile:

1. Jalaukavacharana (~Leech therapy): Three

consecutive sittings of leech therapy done (at the

interval of seven days) locally at protruded pile

mass.

2. Internal medicines- Triphala Guggulu(500mg),

Arogyavardhini vati (400mg) twice a day with

Luke warm water and Gandharva Haritaki

(3gm) at night for 28 days.

Adjuvant to above regimen-

Tab. Orofer-XT 1 OD for 1 month after observing

low hemoglobin level (9.9 gm/dl). Similarly, light

easy digest salutory diet and sitz bath with Luke

warm water was advocated.

Leech therapy application procedure was

divided in three steps:

Purva karma (pre-operative procedure)-

The Leeches were purified and activated by putting

it in bowl containing Haridra powder (Curcuma

longa) and water. Thereafter, leeches were

transferred to another bowl of clean water.

Similarly, part preparation i.e. cleansing and

draping (perianal) of the patient was done.

Pradhan karma (main procedure)-

Patient was placed in right lateral position and the

anal verge was cleaned with tap water.

Subsequently, 3 leeches were applied at perianal

region (over prolapsed external Haemorrhoids at 3,

11 and 7’O clock positions) for 20 minutes.

Leeches were covered by wet cotton gauze to moist

its skin. After 20 minutes of blood sucking, the

leeches fallen off from the site spontaneously.

Paschat karma (post-operative procedure):

After Pradhan karma the site was cleaned and

Haridra powder was applied on bleeding site

followed by applying of tight dressing with sterile

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gauze and adhesive sticking tape. The bandage was

removed coming morning before act of defecation.

Further, induction of emesis to the Leech was done

by dusting Haridra powder on its mouth, followed

by putting it into Haridra jala, then in pure water.

The used leeches were kept in a separate jar

labelled with details of the patient. The same

procedure was repeated after a week.

Assessment parameters and gradations:

To evaluate the effect of therapeutic intervention,

parameters such as Pain, size of prolapsed pile

mass, per rectal bleeding, discoloration of skin and

Constipation were assessed before and after

treatment. Pain was assessed by Visual Analogue

Scale whereas other symptoms were taken into

consideration under grading system according to

their severity No symptom = 0, Mild = 1, Moderate

=2, Severe =3. Similarly, constipation was

assessed by ‘Victoria Bowel Performance Scale”

tabulated as below in table (2).

Pain

Category

Grade

Severe pain

7-8

Moderate pain

4-7

Mild pain

1-3

No pain

Gradation

for size of

prolapsed

mass (On

the basis of

day-1 size)

Less than 1cm (25%)

Between 1.5cm to 2cm (50%)

Between 2cm to 2.5cm (75%)

About 3cm (100%)

Per rectal

bleeding

No bleeding

Mild bleeding

Moderate bleeding

Severe bleeding

Gradation

for

discoloration

of skin

Skin color (Normal color)

Pinkish color

Reddish color

Bluish color

Constipation

Minimal or no effort to

defecate

Mild effort or straining

required to defecate

Moderate effort or straining

required to defecate

Unable to defecate despite

maximum effort or straining

Table 2 :Gradations of different parameters

Observations:

After, the first sitting of Jalaukavacharana (~Leech

therapy) locally along with adjuvant Ayurvedic

medicines, pain and per rectal bleeding reduced

from severe to mild, about 25% reduction in size of

prolapsed mass was noted i.e. from 3”x3”cm to

2.5”x2.5”cm, changes in color of prolapsed pile

mass from bluish to reddish color was observed and

constipation relieved moderately from grade 3 to

grade 2. The patient came for follow up after first

sitting of leech application on day 3 and during

assessment it was found significant improvement in

symptoms and the treatment regimen continued.

After, second sitting of leech therapy locally mild pain

and per rectal bleeding was observed. Further, about

50% reduction in size of prolapsed pile mass was noted

i.e. from 3”x3”cm to 1.5”x1.5”cm, the color of pile mass

changed from reddish to pinkish, and constipation was

completely relieved.

After, third sitting of Jalaukavacharana (~Leech

therapy) locally, there was no pain, no per rectal

bleeding, about 75% reduction size of prolapsed

mass i.e. from 3”x3”cm to0.5”x0.5”cm, prolapsed

plie mass color changed from pinkish to skin colour

and no constipation.

The patient got significant relief in all symptoms

after third sitting of Leech therapy (locally). Hence,

thereafter only palliative medicine was prescribed

for smooth act of defecation for 15 days

(Image 1: Day 1 Clinical

presentation of Acute

prolapsed Ext.

Haemorrhoids)

(Image 2: First sitting of

Leech therapy)

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Table 3: Therapeutic efficacy of treatment

Results:

After, the first sitting of Jalaukavacharana (~Leech

therapy) pain and per rectal bleeding reduced

significantly to mild, about 25% reduction in size of

prolapsed mass was noted, color of prolapsed mass

changed to reddish color and constipation was

moderately relieved. After, second sitting of leech

therapy mild pain and per rectal bleeding was

observed, 50% reduction in size of prolapsed pile

mass was noted, color of pile mass changed to

pinkish, and constipation was completely relieved.

After, third sitting of Jalaukavacharana (~Leech

therapy) there was no pain, no per rectal bleeding,

about 75% reduction size of prolapsed mass was

noted, plie mass color turned to skin colour and

there was no constipation. The patient got

significant relief in all symptoms after third sitting

of Leech therapy (locally). Thereafter only

palliative medicine was prescribed for smooth act

of defecation for 15 days. Moreover, there was

asymptomatic, shrunken external pile mass

(0.5”x0.5”cm) remained which may require

surgical excision after proper evaluation.

Discussion:

The Acute prolapsed haemorrhoid is an emergency

condition ,the condition becomes worse after

thrombosis and strangulation of the pile mass with

severe pain and discomfort. It require immediate

surgical intervention. Acharya Sushrutha has

mentioned Jalukavacharana (leech therapy) as

instant and effective treatment in all inflammatory

conditions.

Similarly, Acharya Vagbhata &

Charaka has advocated use of Jalauka (leeches) for

eliminating the vitiated blood in management of

protruded large pile masses.

Hence, in this single case study a patient with acute

prolapsed external heamorrhoids was treated with

Leech Therapy (locally) with adjuvant Ayurvedic

medicines such as - Triphala guggulu,

Arogyavardhini Vati and Gandharva Haritaki in the

prescribed dose provided significant relief in the

symptoms of prolapsed Haemorrhoids.

(Image 3: Second sitting of

Leech therapy)

(Image 4 : Third sitting of

Leech therapy)

Before

treatme

(11/4/20

24)

sitting

(12/4/20

24)

sitting

(19/4/20

24)

sitting

(20/4/2

024)

(23/4/20

24)

No of

leeches

applied

Not

applicab

No leech

applied

Pain

Severe

(3)

Mild (1)

pain(0)

No Pain

(0)

Swelling

Size of

prolapse

d mass

3”x3”c

(100%

swelling

size)

2.5”x2.5

”cm

(25%

reductio

swelling

size)

1.5”x1.5

”cm

(50%

reductio

n in

swelling

size)

0.5”x0.

5”cm

(more

than

75%

reductio

n in

swellin

g size)

Markedl

reduced

prolapse

d mass

Per-

rectal

bleeding

Moderat

e (2)

Mild (1)

No P/R

bleedin

g (0)

No P/R

bleeding

(0)

Discolor

ation of

prolapse

d pile

mass

Bluish

color

(3)

Reddish

color

(2)

Pinkish

color

(1)

Skin

color

(0)

Skin

color

(0)

Constipa

tion

Unable

defecate

despite

maximu

m effort

straining

(3)

Moderat

e effort

straining

required

defecate

(2)

Mild

effort or

straining

required

defecate

(1)

Minima

l or no

effort to

defecat

e (0)

Minimal

or no

effort to

defecate

(0)

(Clinical presentation

Before treatment)

(Clinical presentation

After treatment)

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Probable mode of action of action of Leech- The

major constituents Leech saliva- Hirudin inhibits

blood coagulation by binding to thrombin, Calin

inhibits collagen mediated platelet aggregation,

Destabilase dissolves fibrin, Bdelin acts as anti-

inflammatory and inhibits trypsin, Eglin acts as

anti-inflammatory and inhibit activity of cathepsin

G, Carboxypeptidase A inhibitors increases the

inflow of blood at the bite site, Histamine like

substance, acetylcholine acts as vasodilator and

Anaesthetic substance which causes anaesthesia at

the bite site. Thus, the Leech saliva increase the

microcirculation, decrease the inflammation as well

as pain and swelling

[13,14]

Triphala Guggulu has wound healing, anti-

inflammatory and antimicrobial activities. Hence,

pain, tenderness and discomfort were reduced due

to the anti-inflammatory and anti-infective

properties of Triphala Guggulu.

[15,16]

Arogyavardhini Vati having the properties like-

Pachani (digestive), Deepani (appetizer), Pathya

(wholesome for channel), increase Kshudha

(appetite) and Sarvaroga prashamani (can alleviate

all types of disorders from body).

[17]

It has proven

hepatoprotective action as well.

Gandharv Haritaki- Gandharva Haritaki is

polyherbal Ayurvedic medicine. The Contains of

this medicine are Erand Tail, Balharitaki, Sunthi,

Sandhav and Savarchal Lavana. It has purgative

and laxative action. Gandharva Haritaki helps in

smooth evacuation and removes toxins from

body.

[18]

Conclusion:

The observation showed that, this specific treatment

which was combination of Leech Therapy (locally)

with adjuvant medicines provided significant relief

in the symptoms such as pain, tenderness, size of

prolapsed Haemorrhoids and per rectal bleeding.

Similarly, the discoloration (bluish) of prolapsed

Haemorrhoids turned to normal skin colour

gradually. Hirudin and Hyaluronidase present in

saliva improves microcirculation and absorption of

extracellular fluids. Thus, Leech application proved

effective in reducing pain and swelling of prolapsed

pile mass.

Hence, it can be concluded that Leech Therapy

(locally) proved an effective alternative treatment in

the management of Acute prolapsed external

Haemorrhoids and immediate surgical intervention

can be avoided. Moreover, a large number of cases

need to be treated and evaluated with this specific

regimen to establish this alternative treatment

modality in the management of acute prolapsed

external Haemorrhoids.

References:

1. Amarprakash et. al., Vol.7 (Iss.7): July

2019] ISSN- 2350-0530(O), ISSN- 2394-

3629(P): A comprehensive review on

management of hemorrhoids (gudarsha) -

an integrated approach.

2. Amar Dwivedi, ISSN 2456-3110, Vol 5,

issue May- June 2020: To evaluate efficacy

of Suranpindi (internally) along with

Kasisadi Malahar (locally) in the

management of Gudarsha w.s.r. to Grade 1

and 2 internal Haemorrhoid.

3. S Das, A textbook of Surgery, 4th edition,

Published by Dr S. Das ,13, Old Mayors

Court, Calcutta, 1079p-1080p.

4. Kaviraja Ambika Datta Shastri, Sushruta

Samhita Sutra Sthana 33/4, Part I, By

Sushrutha with Ayurveda Tantvasandipika

commentary, Varanasi, Choukhamba

Sanskrit Sansthan, 2003, P-126.

5. Kaviraja Ambika Datta Shastri, Sushruta

Samhita Sutra Sthana 24/9, Part I, By

Sushrutha with Ayurveda Tantvasandipika

commentary, Varanasi, Choukhamba

Sanskrit Sansthan, 2003, P-101

6. Priya Vrat Sharma, Sushruta Samhita of

Acharya Sushruta: Nidana sthana, Vol 2.

Reprint: 2005; Varanasi; Chowkhambha

Visvabharati, 20p.

7. Srikantha Murthy KR, Astanga Hrdayam of

Vagbhatta : nidana sthana, Vol 2: Edition:

Reprint 2018, Varanasi, Chowkhamba

Krishnadas Academy, 310p.

Issue : 04

INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]

Volume : 01

8. Dr. Ram Karan Sharma & Vaidya Bhagwan

Dash, Agnivesa’s Charaka Samhita

Chikitsha Sthana Vol 3. Reprint 2005;

choukhambha Press, Varansi-1, 594p.

9. Dr. Ambika Datta Shastri, Hindi

commentary, Chaukhamba Sanskrit

sansthana Varanasi. Sushruta Nidanasthana

2. page no 306.

10. Tripathi R. Vagbhatta, Ashtanga Hridya,

Chaukhamba Sanskit Pratishthana.

11. Dr. Ambika Data Shastri, Sushrutha

Chikitsa sthana 6-page no. 46.

12. Dwivedi Amarprakash and Pathrikar Anaya.

Effect of Leech therapy along with adjuvant

Ayurveda drugs in the management of

Janusandhi Gata Vata with special

reference to Knee -osteoarthritis: A Case

Report. Int. J. Res. Ayurveda Pharm.

2019;10(6):100-103.

13. Archana Kumari, Dwivedi Amarprakash

Management of Acute Perianal Hematoma

with Leech Therapy Br J Pharm Med Res,

Vol.05, Issue 05, Pg. 2630 2636,

September – October 2020. ISSN:2456-

9836 Cross Ref DOI

https://doi.org/10.24942/bjpmr.2020.721.

14. Amarprakash, Dwivedi. (2012). Case study

of leech application in diabetic foot ulcer.

International Journal of Research in

Ayurveda and Pharmacy. 3. 748-751.

10.7897/2277-4343.03536

15. Anonymous. The Ayurvedic Pharmacopiea

of India, Part-2 (Formulations). Vol. 2. 1st

ed. New Delhi: Govt. of India; 2008. p.189-

91.

16. Jose AM, Adiga S, Ciraj AM, Shettigar KS,

Velladath SU Ramachandra L. Management

of grade IV diabetic foot ulcer by

vranaropanachikitsa. J Med Sci 2021;

41:247-52.

17. Santosh Pal, A Ramamurthy, Bidhan

Mahajon, Arogyavardhini Vati: A

theoretical analysis JSIR 2016; 5(6): 225-

227.

18. Sachinkumar Sahebrao Patil, Anuja

Surendra Bhojane et. al., An Ayurvedic

Management of Aamvata with special

reference to Rheumatoid Arthritis: A Case

Study World Journal of Advanced Research

and Reviews, 2023, 18(01), p.658

https://doi.org/10.30574/wjarr.2023.18.1.06

ISSN : 2584-2757

DOI : 10.5281/zenodo.12744041

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