CASE STUDY: EFFICACY OF PRATISARNIYA KOUSATAKI KSHAR IN THE MANAGEMENT OF INTERNAL HEMORRHOIDS (ABHYANTARA ARSHA)

Arsha (haemorrhoids) is among the most common ano‑rectal disorders treated in Ayurveda. Internal (abhyantara) haemorrhoids are characterised by bleeding, prolapse, discomfort and size of pile mass. Among Ayurvedic therapies, Pratisarniya Kshara is a local application of caustic/alkaline agent on the pile mass. Kousataki (from Kusha‑taka or a plant‑based/alkaline preparation) Kshar is one of the variants. This case study aims to evaluate the efficacy of Pratisarniya Kousataki Kshar in a patient with internal haemorrhoids (II‑degree) in terms of symptom relief, reduction in size of the pile mass, and recurrence. Case Presentation: A 35‑year‑old male patient presented with complaints of intermittent per rectal bleeding, mild prolapse of mass during defecation (reducible), discomfort and mucous discharge. Bowel habits included constipation with straining. On proctoscopic examination, confirmed II‑degree internal haemorrhoids. Intervention: Application of Pratisarniya Kousataki Kshar locally on the pile mass up to the stage of “Pakwa Jambu Phala” (i.e. till colour or condition similar to fully ripened jambu fruit) under adequate anaesthesia or local measures. Repeat application after 7 days if necessary. Supportive measures: sitz baths, internal Ayurvedic medicines, dietary and lifestyle modifications. Outcome: After two applications over 14 days, there was marked reduction in bleeding, discomfort, and prolapse. Complaints resolved by day 21. Proctoscopic evaluation showed regression of pile mass size by ~80‑90%. Follow‑up up to one year showed no significant recurrence. Conclusion: Pratisarniya Kousataki Kshar appears to be a safe, effective, minimally invasive outpatient therapy for II‑degree internal haemorrhoids, with good patient acceptance, significant symptom relief, rapid regression of pile mass, minimal complications, and low recurrence when combined with lifestyle/dietary modifications. Further controlled trials are warranted.