CLINICAL OUTCOMES OF ANULOMANA THERAPY IN GRADE I INTERNAL HEMORRHOIDS: A CASE SERIES

Background: Grade I internal hemorrhoids present with bleeding per rectum without prolapse, and constipation (Vibandha) is a key aggravating factor. In Arsha, Anulomana is the first step of Bheshaja Chikitsa. This case series aimed to document bowel regularity and symptom outcomes after Anulomana therapy in Grade I internal Hemorrhoids. Materials and Methods: Three patients (38-year-old male, 32-year-old female, 45-year-old male) with proctoscopically confirmed Grade I internal Hemorrhoids and constipation were treated at the Shalya Tantra OPD and reported as per CARE guidelines. They received Avipattikara Churna, Swadishta Virechana Churna and Triphala Churna respectively, 5 g at bedtime with lukewarm water for 30 days, with Pathyahara. The primary outcome was bowel regularity (Bristol Stool Form Scale, frequency, straining, complete evacuation). Secondary outcomes were Hemorrhoid Severity Score (HSS) and bleeding, assessed at Day 0, 15 and 30. Results: All three patients achieved regular bowel habit by Day 30, shifting from hard stools (Bristol Type 1-2) with straining. Bleeding was controlled in all. HSS fell from 7, 6 and 5 at baseline to 1, 1 and 0 respectively. No adverse events occurred. Conclusion: Anulomana therapy with Pathyahara for 30 days was associated with regular bowel habit, cessation of bleeding and reduced symptom scores in Grade I internal hemorrhoids, supporting correction of Vibandha and Apana Vata as first-line care. Larger controlled studies with recurrence follow-up are warranted.