Novel Use of Lajjalu Suppository as a part of Multi-Interventional Ayurveda Approach in the Managemnet of Abhyantara Arshas (2nd Degree Internal Hemorrhoids) – A case report

Abstract

Background: In India the incidence of anorectal disorders like Arshas (Haemorrhoids) is steadily increasing largely due to a change in dietary patterns and lifestyle habits. Inspite of availability of various conventional surgical and para surgical methods, a growing shift towards Ayurveda management is observed. In Ayurveda Arshas is regarded as one among Astamahagadas, with symptoms of mamsankura in guda pradesha, shoola, Raktarshrava obstructing gudamarga. Ayurveda explains this condition as  Deergakalanubandi, Duschikista, & is Tridoshaja. Haemorrhoids are observed commonly between 30-65years with increased prevalence over 50 years. Gudavarti described in Ayurveda for internal haemorrhoids management has prolonged tissue contact time of drug, improves the bioavailability compared to conventional local applications. However the therapeutic advantages, gudavarti exerts local discomfort limiting the patient compliance. So the main objective of this study is to formulate and evaluate an intervention i.e.,lajjalu suppository efficacy that might also minimize the local discomfort caused by varti application.Clinical findings: A 38years old male presented with complaints of pain and burning sensation during and after defecation since 18 months. Symptoms worsened since 2 weeks along with constipation. Proctoscopy findings revealed 2^nd degree internal haemorrhoids at 3 and 9 o’clock positions. Outcomes: Lajjalu suppository was prepared in a ratio of 1:1 with coco butter was sent for physico-chemical analysis (pH:5.9). It was used on a patient with a 2^nd degree internal haemorrhoid s for 15 days along with Panchavalkala Kashaya sitz bath, Triphala guggulu, Abhayarishtam. Symptomatic relief and complete regression of haemorrhoidal mass was noted within 15 days of treatment with no adverse effects or recurrence even during follow up. Conclusion: Lajjalu suppository used as a part of multi-interventional Ayurveda approach caused no local discomfort. Overall this multi-inetrventional approach was found safe, effective in managing 2^nd degree internal haemorrhoids, creating a scope for further evaluation with controlled trials.