Anapile Ointment

2. Internal hemorrhoids-

Internal hemorrhoids are located inside the rectum or anal canal, and are usually not painful. This is because the anal canal does not have many nerve endings.  Indeed, most people are not aware that they have internal hemorrhoids until a hard stool rubbing against them cause these hemorrhoids to rupture and bleed.

Apart from this classification, Haemorrhoids are further classified according to degree of clinical symptoms

1. First-degree hemorrhoids: Hemorrhoids that bleed but do not prolapse.
2. Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own (with or without bleeding).
3. Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed back in by a finger.
4. Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in.

Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed (containing blood clots) or that pull much of the lining of the rectum through the anus.

Aetiologyof haemorrhoids

• Low-fiber diet– Following a low-fiber diet usually triggers hemorrhoids as it causes small-caliber stools which result in straining during defecation. Aside from this, pregnancy and extremely high tension of the internal sphincter muscle & rectal veins also cause hemorrhoidal problem.

• Constipation: Constipation is defined as infrequent bowel movements or the difficulty in passing stool. As long as the stool remains in the colon it will become dry & hard. While passing this dry & hard stool straining is required that exerts pressure on the veins of the anus & leads to hemorrhoids.

• Postponing bowel movement: Usually, by postponing bowel movement, the urge to defecate goes away. While occasionally postponing bowel movement does no harm, doing it regularly can contribute to constipation & thus hemorrhoids.

• Weak­ening of the connective tissue– Another cause of hemorrhoids is the weak­ening of the connective tissue in the rectum and anus that occurs with age.

• Genetics: Inherited characteristics such as weak vein walls can result in tendencies to develop hemorrhoids.

• Bouts of diarrhea- In the case of diarrhea, the expulsive force of the watery stool can damage rectal veins and lead to hemorrhoids.

• Extreme physical exertion- Laborers and weightlifters often hold their breath while lifting heavy objects. This forces air exerts pressure on the diaphragm, which in turn exerts pressure on the abdominal organs and rectal veins.

• Prolonged sitting or standing and lack of exercise- Sedentary lifestyle, lack of exercise, as well as jobs which require prolonged periods of sitting and standing can lead to, or exacerbate, existing hemorrhoids.

Haemorrhoids According to Ayurveda

Piles isknown as Arshain Sanskrit.Arsha pertains to a disease occurring in Guda(Anal Canal)and it is torturing to the patients. Neglect of proper diet and lifestyle habits results in mandagni (reduced digestive fire). It means inability to digest food material with proper pace and time leading to accumulation or stagnation of Ama (indigested food material) in the form of stool inside or expelling it before time in watery or semisolid form, which disturbs doshas at anorectal region.

Classification of arsha according to Ayurveda:There are different opinions of Acharya regarding the classification of Arsha.

On the basis of the character of bleeding:-

1. Ardra (Sravi)-Bleeding piles due to vitiation of Rakta and Pitta Dosha.
2. Shushka- Non bleeding piles due to vitiation of Vata and KaphaDosha.

On the basis of the origin:-

1. SahajaArsha(Hereditary)
2. JanmottarakalajaArsha(Acquired)

On the basis of the site of origin:-

1. Bahya(External)
2. Abhyantara(Internal)

On the basis of prognosis:-

1. Sadhya(Curable)
2. Yapya(Palliative)
3. Asadhya(Incurable)

On the basis of management:-

On the basis of the treatment, Arsha can be classified into four varieties as follows.

1. BhaishajaSadhyaArsha(Drug therapy)
2. KsharaSadhyaArsha(Chemical cauterization)
3. AgnikarmaSadhyaArsha(Cauterization)
4. ShastraSadhyaArsha(surgical therapy)

On the basis of the predominance of Dosha

1. Vataj
2. Pittaj
3. Kaphaj
4. Raktaj
5. Sannipataj
6. Sahaj

The symptoms like itching, inflammation, pain and bleeding will be present depending on the type of Piles. In piles the astringent herbs are used to stop the bleeding in case of bleeding piles. The Astringentproperty of herbs helps to constrict tissues and helps heal mucus membranes and prevents bleeding. Along with Astringent herbs anti-inflammatory, analgesic, and anti-microbial herbs are used in the treatment.

Composition

Each 30gm contains

Extract of: Kanchnar 2%, Shirisha 2%, Neem 2%, Haridra 3%, Kushtha 3%, Bhrigaraj 2%, Samanga 2%.

Powders of: YashadBhasma 1%,Shuddha Tankan 1%

Features of Herbs

Kanchnar (Bauhinia variegate) –

In Ayurvedic texts,Kanchnar has been reported to have anti-microbial property.In a study, Excision and incision wound models the wound healing activity of extracts of root of Bauhinia variegate has been evaluated. Both aqueous and ethanolic extracts of root of Bauhinia variegata produced significant wound healing by excision and incision wound models, which was comparable to that of standard (framycetin) in excision wound model. ^{Asian Journal of Research in Pharmaceutical Science Year : 2015, Volume : 5, Issue : 3}

 

Shirisha (Albizialebbeck) –

The anti-inflammatory activity of the extracts of A. lebbeck was studied using carrageenan-induced paw edema and cotton pellet-induced granuloma models. The extract of the leaves of A. lebbeck showed a significant inhibition of carrageenan-induced hind paw edema and granuloma. The extract of the leaves of A. lebbeck showed significant (p < 0.05) anti-inflammatory activity.^{J Tradit Complement Med. 2016 Apr; 6(2): 172–175.}

The paste of bark is applied locally for healing wound, acne vulgaris, non-healing ulcers, boils, and abscess. It is also used to treat itiching.

Neem (Azadirachtaindica) –

A study revealed promising wound healing activity of extract ofA. indicaand provides a scientific rationale for the traditional use of the plant in the management of wounds. The healing effect produced by the plant extract, was assessed by rate of wound contraction, skin breaking strength and histopathology of healing tissue.The extract of leaves of A. indica significantly promoted the wound healing activity in both excision and incision wound models. ^{Pharmacologyonline 1: 70-77 (2010)}

Haridra (Curcuma longa) –

In classical ayurvedic texts turmeric is used as kanduhara(anti-itching) and kusthaghna (curing skin diseases).In a study, Curcuma longawas investigated for its anti-inflammatory effects.The extract of Curcuma longa inhibited the development of oedema at the end of 3 hours. The anti-inflammatory activity exhibited by the extract was dose dependent and statistically significant at dose levels of 1000-mg/kg and comparable to that of standard drug used Aspirin.^{Savaringal JP et al. Int J Basic ClinPharmacol. 2018 Feb;7(2):229-233}

 Kushtha (Saussurealappa) –

The different bioactive compounds isolated from Saussurealappa haveinhibitory effect on inflammation in human and animals.The extracts from S.Lappa were experimented for a given dose of 50 to 200mg/kg and found that the extract have inhibitory effect on inflammation. The anti-inflammatory effect was proved through carrageenan induces paw edema.

Bhringraj (Ecliptaalba) –

Bhringraj extract was investigated for anti-inflammatory activity in which methanolic extract was administered orally. The extract showed significant anti-inflammatory activity in carrageenin and egg white induced hind paw edemawhich was compared with indomethacin (10 mg/kg) and cyproheptadine (8 mg/kg).

Analgesic effect was studied on albino mice using ethanolic and alkaloidal extract of Eclipta alba. Standard experimental models such as the tail clip method, the tail flick method and the acetic acid induced writhing response were used which showed that extract produced good analgesic activity in all the different models of analgesia used.

The crude extract has been found to have wound healing properties.Externally it is used for inflammation, minor cuts and burns and the fresh leaf-juice is considered very effective in stopping bleeding.

 

Samanga (Mimosa pudica)-

It has Sheet virya (coolant), Raktasravhara (arrest bleeding) and Vranaropana(Healing of wound) properties. In a study, the roots of M. pudica were studied for wound healing activity by incorporating the extracts in simple ointment base B.P. in concentration of 0.5% (w/w), 1% (w/w), and 2% (w/w). Wound healing activity was studied in three types of model in rats viz. excision, incision, and estimation of biochemical parameters. Treatment of wound with ointment containing 2% (w/w) the methanolic and 2% (w/w) the total aqueous extract exhibited significant wound healing activity.

 YashadBhasma-

YashadBhasma used as antibacterial agent locally in the form of ointment since ancient times in Ayurveda. Due to its kashaya(Pungent)rasa it has a Sandhaniyakarma(as it promotes Epithelisation of cells)hence used as Vranaropana(Healing of wound).

In a study on topical use of YashadaBhasma along with other herbs shows that it has better wound healing properties as it contains essential nutrient for collagen formation and cell division.

It also improves the binding power of the cells of skin soft tissues, improves cellmigration and cell regeneration and hastens wound healing.

Shuddha Tankan-

Tankan or borax is used traditionally for local application on wounds as a disinfectant.

Justification and Rationale of the Combination

Hemorrhoids or piles are swollen veins in anus and lower rectum. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). The symptoms like itching, inflammation, pain and bleeding will be present depending on the type of Piles.

Anapileointmentis specifically designed for the treatment of Hemorrhoids.It is prepared by the combination of Ayurvedicherbo-metallic ingredients that are having anti-inflammatory action to combat the inflamed skin and tissues.

• Yashadbhasma accelerates the epithelial regeneration therefore it helps in healing of wound. The analgesic properties provide relief from pain and helps pain free evacuation.
• The anti-itching properties of Haridra provide relief from itching.
• Astringent properties of herbs like Samanga and Bhringraj are effective in treating bleeding piles.
• Tankan bhasma act as a disinfectant on the pile mass.
• Kanchnar, Neem, Haridra and Yashsadbhasma possesses antimicrobial properties, which prevents secondary microbial infections.