INTERNATIONAL

AYURVEDIC
MEDICAL JOURNAL

Research Article ISSN: 2320 5091 Impact Factor: 4.018

A CLINICAL STUDY TO ASSESS THE EFFICACY OF TILADI MODAK IN THE

MANAGEMENT OF ABHYANTAR ARSHA w.s.r. to 1st & 2nd DEGREE INTERNAL
HEMORRHOIDS
Pardeshi Neetu Narayan

P.G. Scholar, Department of Shalya Tantra, R. A. Podar Ayurved Medical College, Worli, Mumbai – 400018,
Maharashtra

Email: [email protected]

ABSTRACT
Arsha, that is one of the Prime Ano-rectal diseases, is a Mamsa Dushtigata Vikara. As per Aacharya Sushruta,
Arsha occurs when vitiated tridoshas combines with Rakta Dhatu & gets collected at Dhamnies (Veins) of Anal
canal & further create swelling (Mamsa Ankura). As per Ayurveda Science, Malavashtamba & Visheshat Mand
Agni are two root causes of Arsha. Aacharya Sushruta has mentioned four types of management in Arsha as
Bhaishjya, Kshara, Agni & Shastrakarma. In 1st & 2nd degrees of Arsha, first line of treatment is Bhaishjya
chikitsa. Here, Tiladi Modak, indicated for treatment of Arsha, is selected for study, because it acts on
Agnimandya which is a major cause of Haemorrhoids. Tiladi Modak with its properties like Deepan, Pachan,
Vatanuloman, Kaphanashan, Shotahar, Malshodhak, regulates Agni which then improves digestion that relieves
constipation resulting in cure of Arsha by lowering the pressure on anal varices.

Keywords: tiladi modak, pain at anal region, PR bleeding, constipation, pile mass

INTRODUCTION
Aacharya Sushruta, the Father of Surgery has given of Arsha, the first line of treatment is Bhaishjya
Shalyatantra the utmost importance and considered chikitsa.
it as a first anga amongst the eight angas of The para-surgical techniques have got one or the
Ayurveda. other types of limitations and are not free from post
Acharya Sushruta defines Vyadhi as the Samyoga operative complications. Hence, it leaves a scope to
with Dukha & this Dukha as per him is of three find out a remedial measure which would ideally
types: offer the cure of the disease that is free from
1) Aadibala Pravrita Roga complications and economically better. Also, there is
2) Doshbala Pravrita Roga a need & scope of medicinal treatment in those
3) Janambala Pravrita Roga where in Surgery is contraindicated or unwilling for
The diseases such as Arsha, Kustha, etc. comes Surgery. Therefore here it was preferred to choose
under Aadibala Pravrita Roga. In 1st and 2nd degrees Bhaishjya chikitsa under which the Ayurvedic
 Pardeshi Neetu Narayan: A Clinical Study To Assess The Efficacy Of Tiladi Modak In The Management Of Abhyantar Arsha W.S.R. To 1st &
2nd Degree Internal Hemorrhoids

Formulation Tiladi modak was used in the Arsha occurs when the vitiated tridoshas combines
management of Abhyantar Arsha. with Rakta Dhatu & gets collected at Dhamnies
The present work has been planned by taking the (Veins) of Anal canal and further create swelling
symptoms of 1st and 2nd degree internal hemorrhoids (Mamsa Ankura) It is one among the Ashta
(Arsha) into consideration i.e. Local pain, Per rectal Mahagad Vikaras.
bleeding, Constipation and Pile mass for the clinical As per Ayurveda Science, Malavashtamba &
study. Mandagni are two root causes of Arsha, while
Among several causes of Hemorrhoids, Agnimandya Modern Science speaks that increased abdominal
and Malavashtambh is found in about 80% to 90% pressure due to Obesity, Pregnancy, Standing or
of the patients. Tiladi Modak indicated for treatment Sitting for a long time, Straining or prolonged sitting
of Arsha is selected for present study because it acts during bowel movements, Coughing, Sneezing, poor
on Agnimandya which is a major cause of posture, all such situations causes the veins to swell
Hemorrhoids. In the present study, an effort has been and become susceptible to irritation. Also the low
made to derive a standard and easily accessible, cost fiber diet promotes straining on the toilet and also
effective treatment for Abhyantar Arsh i.e. 1st and 2nd aggravates the hemorrhoids by producing the hard
degree internal Hemorrhoids from ancient resources. stools that further irritate the swollen veins. Modern
Tiladi Modak with its properties like Deepan, Science has described 2 types of hemorrhoids -
Pachan, Vatanuloman, Kaphanashan, Shotahar, External and Internal.
Malashodhak, regulates the Agni which then Both Ayurvedic and Modern Science have described
improves the digestion that may relieves similar signs & symptoms like :
constipation resulting in cure of Arsha by lowering - Tod (pricking pain)
the pressure on anal varices. That is why Tiladi - Raktstrava (Per rectal bleeding)
Modak is selected for the clinical evaluation in this - Kandu (Pruritis)
study. - Malavastamb (Constipation)
Aacharya Sushruta has mentioned four types of
AIM management in Arsha as Bhaishjya, Kshara, Agni
To study the therapeutic effects of treatment by and Shastrakarma and in 1st and 2nd degrees of
Tiladi Modak in the management Abhyantar Arsha Arsha, the first line of treatment is Bhaishjya
W.S.R. to 1st & 2nd degree Internal Hemorrhoids. chikitsa. This Bhaishjya chikitsa is being indicated
in Achirkalaja and Alpa Dosh-Linga-Updrava
OBJECTIVE conditions.
To evaluate the improvements seen in the cases of As per Aacharya Charaka, Kshar, Agni and
management Abhyantar Arsha W.S.R. to 1st & 2nd Shastrakarma have Updravas such as
degree Internal Hemorrhoids after treatment with punsatavaupghata, gudashavyathu, mala avrodha,
Tiladi Modak in terms of symptoms like per-rectal aadhmana, darunashool, raktstrava, gudabhransha,
bleeding, constipation, pile mass. the recurrence of haemorrhoidal swelling, etc. , so he
preferred this Adarunachikitsa i.e. Bhaishjya
LITERARY REVIEW chikitsa for arsha. The parasurgical treatment
Arsha is a Mamsa Dushtigata Vikara. It is Avarya, ranging from Sclero therapy, Rubber band ligation,
Durnama, Dushchikitsaya and Chirkalina Roga. Manual dilatation, Cryosurgery, Infrared
Aacharya Vagbhata states that Arsha is a swelling in coagulation, DGHAL and the surgical one Stapler
anal canal which obstructs the canal & troubles the hemorrhoidectomy
patient like an enemy. As per Aacharya Sushruta,

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 Pardeshi Neetu Narayan: A Clinical Study To Assess The Efficacy Of Tiladi Modak In The Management Of Abhyantar Arsha W.S.R. To 1st &
2nd Degree Internal Hemorrhoids

MATERIAL AND METHOD No. of Patients - 15 patients

The clinical study was carried out at OPD and IPD Selection of patients - Diagnosed patients of
of Shalyatantra department of our institute. The Abhyantar Arsha i.e. (1st and 2nd degree internal
clinical parameters of diagnosis & follow up were hemorrhoid) in Shalyatantra Department of our
followed as per standard protocols. institute at O.P.D. and I.P.D.
Detail Plan and Protocol: Duration of treatment – 6 weeks and clinical
Centre of Study - OPD and IPD of Shalyatantra findings were recorded every weekly
department of our institute. Follow up – Every week till the treatment was given
Type of Study - Open, Clinical, Prospective,
Randomized study.

Method of preparation of Tiladi Modak:

Table 1: Composition
Table : 01
Jaggery ( Gud – Made up of Sachhrum Officinarum Stem Juice ) 3 Parts
Haritaki ( Terminalia Chebula fruit powder ) 1 Part
Bhallatak ( Semicarpous Anacardum fruit powder ) 1 Part
Krushana til ( Sesamum indicum ) 1 Part

The churnas (powders) of all dravyas in above said Fissure in ano, Fistula in ano, Rectal Polyps, Rectal
composition are mixed together in Gudpaka ( Ulcer and Rectal Prolapse.
liquefied Guda) and after homogenous mixture 3) HIV Positive Patients.
modak of 1.5 gm are formed and kept in air tight 4) Pregnancy & Lactation.
container. 5) Patients with Hepatic Disorders, Uncontrolled
Dosage: Diabetes, Pulmonary & Intestinal Tuberculosis,
Tiladi Modak – 1.5 gm twice a day by orally (total 3 Carcinomatous conditions of Ano-rectal region,
gm per a day) Syphilis and bleeding disorders.
Withdrawal Criteria
Criteria of selection of patients:
1) Severe drug reaction.
The patients having classical signs and symptoms of
2) Occurrence of any other serious illness.
Abhyantar Arsha i.e. P/R bleeding, constipation,
3) Patient not coming for follow ups or has become
internal piles mass of 1st& 2nd degree will be
uncooperative.
selected.
Criteria for Assessment:
Inclusion criteria:
The following pattern was adopted for scoring:
1) 1st & 2nd degree internal Hemorrhoids.
1. PR bleeding:
2) Both male and female patients.
Grade 0 - absent
3) Patients of age group 18 to 65 years old.
Grade 1 - present
4) Hb more than 8 gm%
2. Constipation:
Exclusion criteria:
Grade 0 - No constipation
1) 3rd & 4th degree Hemorrhoids.
Grade 1 – Mild constipation (evacuation of bowel
2) Thrombosed Hemorrhoids, External
after 1 day gap)
Hemorrhoids, Hemorrhoids with ulcerative colitis &
Grade 2 – Moderate constipation (evacuation of
along with other Ano-rectal disorders such as
bowel after 2 day gap)

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 Pardeshi Neetu Narayan: A Clinical Study To Assess The Efficacy Of Tiladi Modak In The Management Of Abhyantar Arsha W.S.R. To 1st &
2nd Degree Internal Hemorrhoids

Grade 3 - Severe constipation (evacuation of Blood Sugar Levels: Fasting & Post-Prandial
bowel after 3 or more than 3 days gap) Liver Function Tests
3. Pile Mass (assessment by proctoscopy): Renal Function Tests
Grade 0 - absent pile mass HBsAg
Grade 1 - Pile mass into anal canal (elevation with HIV I & II
erosion on anal mucosa) Urine: Routine & Microscopic examination
Grade 2 - Pile mass into the anal canal of larger size Stool: Routine & Microscopic examination
(bulge with erosions on mucosa) Clinical Local Examination:
Investigations: Digital Rectal Examination
Routine investigations done before & after the Proctoscopy
treatment: Sigmoidoscopy, if necessary
Blood: CBC, ESR, Bleeding Time, Clotting Time

OBSERVATION & RESULT:

The observed Percentage of Relief & the effect seen in total number of patients for each parameter is followed as
below (Table – 02):
Table : 02
If Percentage of Relief Then effect
> 76% Cured
51 – 75 % Markedly improved
26 – 50 % Improved
< 25% Not improved

Therefore accordingly after undertaking the above said treatment measures, following results were observed
(Table – 03):
Table : 03
Parameter Observation after treatment % of Relief Effect
Constipation Decreased in 11 out of 15 patients 73.34% Markedly Improved
Pile Mass Decreased in 8 out of 15 patients 53.34% Markedly Improved
Per – Rectal Bleeding Decreased in 13 out of 15 patients 86.67% Cured

DISCUSSION doing Deepana, Pachana, Vatanullomana, Srotas

Since agnimandata & malavashtamba are two root shodhana. Hence, this lets to state here that Tiladi
causes of Arsha, therefore hereby used Ayurvedic Modak really offers a good result in diseases like
formulation of ‘Tiladi modak’ owing to its Deepana, Arsha Vikaras.
Pachana properties leads to Aam-pachana. Haritaki
gives a laxative action in Arsha patient. The CONCLUSION
reference is given in Yogratnakar Arsha wherein it is Use of Tiladi Modak is effective and economical
given that the combination of Gud & Haritaki brings mode of Ayurvedic treatment in cases with
the anulomana of Vata & Mala, thereby leading to Abhyantar Arsha (1st and 2nd degree Internal
reduction in pain, itching & Size of Haemorrhoids. Hemorrhoids).
Haritaki, Bhallatak shares the common property of

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 Pardeshi Neetu Narayan: A Clinical Study To Assess The Efficacy Of Tiladi Modak In The Management Of Abhyantar Arsha W.S.R. To 1st &
2nd Degree Internal Hemorrhoids

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