AN EXPLORATORY STUDY TO EVALUATE THE EFFICACY OF KADALI (MUSA PARADISIACA) PRATISARNEEYA KSHAR APPLICATION IN THE MANAGEMENT OF 2nd INTERNAL HAEMORRHOIDS

Background: Haemorrhoids (Arsha) are counted among the Ashtamahagada by Acharya Sushruta and remain one of the most common anorectal disorders seen in surgical practice. Conventional haemorrhoidectomy is effective but carries the burden of hospitalisation, anaesthesia and post-operative pain, prompting continued interest in gentler, para-surgical alternatives. Kshara Karma — the application of a caustic alkali to the pile mass — was regarded by Sushruta as the foremost of these alternatives, and Kadali (Musa paradisiaca, the banana plant) is one of the classical Kshara-yielding drugs described for this purpose. Objective: To evaluate the efficacy and safety of topically applied Kadali Tikshna Pratisarneeya Kshara in the management of second-degree internal haemorrhoids. Methods: Thirty patients of second-degree internal haemorrhoids, aged 16–70 years, were enrolled in this single-arm, open-label, prospective exploratory study at the Post Graduate Institute of Ayurveda, Jodhpur. Kadali Kshara, prepared by the classical Sushrutokta method and confirmed to have a pH greater than 12, was applied to each pile mass at the 3, 7 and 11 o'clock positions, one quadrant per sitting, seven days apart. Bleeding, itching, colour of the pile mass and prolapse were scored on a 0–3 grading scale at baseline, Day 7, Day 14, Day 21 and a follow-up assessment, and analysed with the Wilcoxon signed-rank test and paired t-test (significance at p < 0.05). Results: All four parameters improved significantly from baseline to the end of treatment (p < 0.001 for each). Bleeding fell by 87.5%, itching by 96.3% and prolapse by 93.3%, while the colour score followed the expected biphasic pattern of chemical cauterisation followed by healing. Twenty-six of the thirty patients (86.7%) achieved complete resolution, and an equal proportion reported satisfaction with the outcome. No major systemic adverse effects occurred; one patient (3.3%) withdrew because of persistent local pain. Conclusion: Kadali Pratisarneeya Kshara produced a statistically significant and clinically meaningful improvement in second-degree internal haemorrhoids with a favourable safety profile, supporting its classical standing as a simple, cost-effective, outpatient-based alternative to surgery. As a single-arm exploratory study, these findings are hypothesis-generating and warrant confirmation in a randomised controlled trial with a longer follow-up.