Last verified: April 2026

Arsha — Haemorrhoids

आर्श — Arsha — that which torments like an enemy

Arsha is the classical Ayurvedic documentation of haemorrhoids (piles) — the abnormal tissue growths in the anal region that obstruct the anal canal and produce pain, bleeding, and discomfort. Charaka Samhita and Sushruta Samhita both document Arsha extensively — Sushruta Samhita's documentation is particularly detailed as it encompasses both medical and surgical management of what it recognises as a disease requiring different treatments at different stages.

Important noticeThis page documents what classical Ayurvedic texts record. Not medical advice. Diagnosis and treatment require assessment by a qualified practitioner (BAMS or MD Ayurveda). Full disclaimer

Sushruta Samhita, Nidanasthana 2.4

Arshamsi yatha shatrum peedata — Arsha torments like an enemy — hence the name. The masses that form at the anal verge obstruct the passage of stool, produce burning, itching, pain, and bleeding, and reduce the patient's quality of life persistently. No other condition produces such constant interference with daily function from such a small anatomical location.

Six classical types

Vataja Arsha: Dry, rough, dark-coloured masses; severe pain; irregular; constipation-associated. Pittaja Arsha: Soft, inflamed, bleeding, burning; associated with Pitta-type digestion and liver conditions. Kaphaja Arsha: Large, smooth, white, cold; mucus discharge; mild pain; associated with Kapha constitution. Sannipataja (Tridoshic): Features of all three; most difficult to treat. Sahaja (Congenital): Present from birth; Beeja Dosha (hereditary). Raktaja (Bleeding): The specific haemorrhoidal type with primary bleeding as the dominant feature — corresponds to internal haemorrhoids with bright red rectal bleeding.

Medical management

Kshara application

Sushruta Samhita documents Kshara (alkaline caustic) application as the primary non-surgical medical procedure for Arsha — the Ksharakarma procedure. Apamarga Kshara (alkaline paste from Achyranthes aspera) is applied to the haemorrhoidal mass through a specifically designed Arsha Yantra (anal speculum instrument). The Kshara causes controlled chemical cauterisation of the mass, shrinking it. This is documented as the most effective medical procedure for medium-sized haemorrhoids that do not require surgical excision.

Surgical management

Excision — Shastra Karma

Sushruta Samhita documents surgical excision for large, prolapsed, or non-responsive haemorrhoids. The classical operation is performed after anaesthesia with specific herbal preparations, using the Vrihimukha Shastra (one of the 120 classical surgical instruments). Post-operative dietary restriction — Samsarjana Krama — is documented in detail.

Primary internal herbs

Haritaki — the primary Arsha herb in Charaka Samhita; specifically documented for constipation-associated Vataja Arsha. Nagakesara (Mesua ferrea) — primary Pittaja Arsha herb for bleeding haemorrhoids. Abhayarishta — the primary classical Arishta formulation for Arsha. Triphala — tridoshic, improves bowel regularity, reduces the constipation that exacerbates Arsha.