Posted on

Chapter 5 — Arsha Nidanam

The fifth chapter of Madhava Nidana deals with Arshas i.e., Piles, Haemorrhoids.

Sangraha Grahani and Ghatiyantra Grahani –

पृथग्दोषैः समस्तैश्च शोणितात् सहजानि च |
अर्शांसि षट् प्रकाराणि विध्यादद्रुदवलित्रये || १ ||

prthagdoṣaiḥ samastaiśca śoṇitāt sahajāni ca |
arśāṃsi ṣaṭ prakārāṇi vidhyādadrudavalitraye || 1 ||

Arsha (Piles, haemorrhoids) which appear in the three folds of the rectum, are of six types: three from each of the three doshas, one due combination of them, one due to blood and one due to Sahaja (congenital) affliction. 1

Samprapti (Pathogenesis) of Arsha (Piles) –

दोषास्त्वङ्गमांसमेदांसि संदूष्य विविधाकृतीन |
मांसाङ्कुरान् पानादौ कुर्वन्त्यार्शांसि ताञ्जगुः || २ ||

doṣāstvaṅgamāṃsamedāṃsi saṃdūṣya vividhākrtīna |
māṃsāṅkurān pānādau kurvantyārśāṃsi tāñjaguḥ || 2 ||

Arsha is defined as a sprout of muscle of different shapes appearing in the rectum and other places generated by the doshas involving the skin, muscle, and adipose tissues. 2

The Etiology of Vata type of piles –

कषाय – कटु – तिक्तानि रुक्ष – शीत – लघूनि च |
प्रमिताल्पाशनं तीक्ष्णं मध्यं मैथुनसेवनम् || ३ ||
लङ्घनं देश – कालौ च शीतौ व्यव्यामकर्म च |
शोको वातातपस्पर्शो हेतुर्वातार्शसां मतः || ४ ||

kaṣāya – kaṭu – tiktāni rukṣa – śīta – laghūni ca |
pramitālpāśanaṃ tīkṣṇaṃ madhyaṃ maithunasevanam || 3 ||
laṅghanaṃ deśa – kālau ca śītau vyavyāmakarma ca |
śoko vātātapasparśo heturvātārśasāṃ mataḥ || 4 ||

The causes of piles generated by vaata dosha (vataja arsha) are:

  • Excessive intake of astringent, bitter, dry, cold and light food and drinks,
  • decrease in the quantity and/or frequency of meals,
  • having strong alcoholic drinks,
  • indulging in excessive sexual intercourse,
  • fasting/starvation,
  • the cold season,
  • living in cold places,
  • excessive physical activity,
  • grief,
  • exposure to heavy breeze and sunlight. 3-4

Etiology of pitta type of piles –

कत्वम्लम् – लवणोष्णानि व्याव्यामाग्नन्यातपप्रभाः |
देश – कालवाशिशिरौक्रोधो मध्यमसूयनम् || ५ ||
विदाहि तीक्ष्णमुष्णं च सर्वं पानान्न – भेषजं |
पित्तोल्ब्णानां विज्ञेयः प्रकोपे हेतुर्शसाम् || ६ ||

katvamlam – lavaṇoṣṇāni vyāvyāmāgnanyātapaprabhāḥ |
deśa – kālavāśiśiraukrodho madhyamasūyanam || 5 ||
vidāhi tīkṣṇamuṣṇaṃ ca sarvaṃ pānānna – bheṣajaṃ |
pittolbṇānāṃ vijñeyaḥ prakope heturśasām || 6 ||

The etiological factors of pittaja arshas are:

  • Over intake of foods that are pungent, sour and warm in nature,
  • strenuous exercise;
  • exposure to heat;
  • sunlight;
  • warm places;
  • warm season;
  • anger;
  • alcohol;
  • jealousy;
  • intake of herbs and eatables that generate heart burn, produce heat and penetrates into the tissues;
  • and others which lead to increase of the pitta. 5-6

Etiology of Kapha types of piles –

मधुर – स्निग्ध – शीतानि लवणाम्ल गुरूणि च |
अव्यव्यामो दिवास्वप्नः शय्यासनसुखे रतिः || ७ ||
प्राग्वद्सेवा शीतौ च देश – कालावचिन्तनम् |
श्लेष्मिकाणां समुद्दिष्टमेतात् कारणमर्शसाम् || ८ ||

madhura – snigdha – śītāni lavaṇāmla gurūṇi ca |
avyavyāmo divāsvapnaḥ śayyāsanasukhe ratiḥ || 7 ||
prāgvadsevā śītau ca deśa – kālāvacintanam |
śleṣmikāṇāṃ samuddiṣṭametāt kāraṇamarśasām || 8 ||

The etiological factors of kaphaja arshas are —

  • Over intake of the foods that are sweet, fatty, cold, salty, sour and hard to digest;
  • lack of physical activity;
  • sleeping at daytime;
  • using comfortable soft bed and seat;
  • exposure to the eastern breeze,cold season and places;
  • absence of worry and
  • such others factors that lead to morbid increase of kapha

Etiology of piles of dual dosha affliction –

हेतु – लक्षणसंसर्गाद्विध्याद् द्वन्द्वोल्बणानि च |

hetu – lakṣaṇasaṃsargādvidhyād dvandvolbaṇāni ca |

When etiological factors and the clinical features of two doshas are present the piles should be understood to be due to the dual combination of these doshas.

Etiology of piles of three dosha affliction —

सर्वो हेतुस्त्रिदोषाणां सहजैर्लक्षणं समम् || ९ ||

sarvo hetustridoṣāṇāṃ sahajairlakṣaṇaṃ samam || 9 ||

All types of etiological factors may be roughly identical in the types; features of hereditary piles are also similar. 9

Symptomatology of Vata type of piles –

गुदाङ्कुरा बह्वनिलाः शुस्कास्चिमचिमान्विताः |
म्लानाः श्यावारुणाः स्तब्धा विशदाः परुषाः खराः || १० ||
मिथो विसदृशा वक्रास्तीक्षणा विस्फुटिताननाः |
बिम्बी – खर्जूर – कर्कन्धू – कार्पासिफलसन्निभाः || ११ ||
केचित् कदम्बपुष्पाभाः केचित् सिद्धार्थ कोपमाः |
शिरः – पार्श्वांसि – कट्युरु – वंक्षणाध्यधिकव्यथाः || १२ ||
क्षवथूद्गार – विष्टम्भ – हृद् ग्रहारोचकप्रदाः |
कास – श्वासाग्निवैषम्य – कर्णनाद – भ्रमावहाः || १३ ||
तैरार्तो ग्रथितं स्तोकं सशब्दं सप्रवाहिकम् |
रुक्फेन – पिच्छानुगतं विबद्धमुपवेश्यते || १४ ||
कृष्णात्वङ्गनख – विण्मूत्र – नेत्र – वक्त्रश्च जायते |
गुल्म – प्लिहोदराष्टिलासंभवस्तत एव च || १५ ||

gudāṅkurā bahvanilāḥ śuskāscimacimānvitāḥ |
mlānāḥ śyāvāruṇāḥ stabdhā viśadāḥ paruṣāḥ kharāḥ || 10 ||
mitho visadrśā vakrāstīkṣaṇā visphuṭitānanāḥ |
bimbī – kharjūra – karkandhū – kārpāsiphalasannibhāḥ || 11 ||
kecit kadambapuṣpābhāḥ kecit siddhārtha kopamāḥ |
śiraḥ – pārśvāṃsi – kaṭyuru – vaṃkṣaṇādhyadhikavyathāḥ ||12||
kṣavathūdgāra – viṣṭambha – hrd grahārocakapradāḥ |
kāsa – śvāsāgnivaiṣamya – karṇanāda – bhramāvahāḥ || 13 ||
tairārto grathitaṃ stokaṃ saśabdaṃ sapravāhikam |
rukphena – picchānugataṃ vibaddhamupaveśyate || 14 ||
krṣṇātvaṅganakha – viṇmūtra – netra – vaktraśca jāyate |
gulma – plihodarāṣṭilāsaṃbhavastata eva ca || 15 ||

 

The features of vataja arsha are the following:

The muscular sprouts in the anus affected by piles caused by provoked Vaata are dry, with pricking sensation, thin in consistency, blackish red, rigid, with no exudation, harsh, coarse, irregular in shape and size, bent, poignant, and cracked at the ends. They look like the fruits of bimbi (the plant of Cephelendra indica), kharjura (date palm), Karkandhu (the plant Zizyphus ceroplia), Karpasa (cotton), Kadamba flower (having several sprouts) and some like mustard seeds (very small in size).

The patient complains of –

  • Pain in the head, flanks, shoulders, waist, thighs,groins
  • Suffers from stoppage of sneezing, belching, bowel movements.
  • Pain near the heart
  • Anorexia
  • Cough
  • Difficult respiration
  • Irregular digestion
  • Ringing in the ears and
  • Giddiness.

The patient eliminates faeces which is

  • Scrabulous
  • Scanty
  • Associated with noise
  • Straining and painful;
  • Frothy and semi solid consistence
  • And has skin, nails, faeces, urine, eyes and face becomes black in colour.

These diseases may appear as its implication –

  • Gulma (Abdominal tumour)
  • Pliha (splenic enlargement)
  • Udara (enlargement of abdomen)
  • Asthila (enlargement of prostate)

Symptomatology of pitta type of piles –

पित्तोतरा नीलमुखा रक्त पीतासितप्रभाः |
तन्वस्रस्राविणो विस्रास्तनवो मृदवः श्लथाः || १६ ||
शुकजिह्वा – यकृत्खण्ड – जलौकोवक्त्रसन्निभाः |
दाह – पाक – ज्वर – स्वेद – तृणमूर्च्छारुचि – मोहदाः || १७ ||
सोष्माणो द्रव निलोष्ण – पीत – रक्तामवर्चसः |
यवमध्या हरित्पीत – हरिद्रत्वङ्ग्नखादयः || १८ ||

pittotarā nīlamukhā rakta pītāsitaprabhāḥ |
tanvasrasrāviṇo visrāstanavo mrdavaḥ ślathāḥ || 16 ||
śukajihvā – yakrtkhaṇḍa – jalaukovaktrasannibhāḥ |
dāha – pāka – jvara – sveda – trṇamūrcchāruci – mohadāḥ ||17||
soṣmāṇo drava niloṣṇa – pīta – raktāmavarcasaḥ |
yavamadhyā haritpīta – haridratvaṅgnakhādayaḥ || 18 ||

Pittaja Arsha would have the following features:

The pile caused by vitiated pitta has

  • Bluish tips and is reddish, yellowish, or blackish
  • It gives rise to a thin sanguineous discharge and emits a foul odour.
  • The pile masses are a few in numbers and are soft and elongated.
  • They appear like the tongue of a parrot, a piece of liver or the mouth of a leech.
  • They are associated with a burning sensation, suppuration, fever, sweating, thirst, fainting, anorexia, and confusion.
  • They produce a burning sensation.
  • The patient passes aama type of liquid, blue, yellow or red faeces.
  • The pile mass is swollen in the middle as a grain of barley.
  • The skin as well the nails, etc., of the patient turn to a green, yellow or turmeric colour. 16-18

Symptomatology of Shleshma type of Piles –

श्लेष्मोल्बणा महामूला घना मन्दरुजः सिताः |
उत्सन्नोपचित – स्निग्ध – स्तब्ध – वृत्त – गुरु – स्थिराः || १९ ||
पिच्छिलाः स्तिमिताः श्लक्ष्णाः कण्डवाद्यः स्पर्शनप्रियाः |
करीर – पन साथ्याभास्तथा गोस्तनसन्निभाः || २० ||
वङ्क्षणानाहिनः पायु – बस्ति – नाभिविकर्षिणः |
सश्वास – कास — हृल्लास – प्रसेकारुचि — पीनसाः || २१ ||
मेह – कृच्छ्र – शिरोजाड्य – शिशिरज्वरकारिणः |
क्लैब्याग्निमार्दव – च्छर्दिरामप्रायविकारदाः || २२ ||
वसाभ – सकफप्रायपुरिषाः सप्रवाहिकाः |
न स्रवन्ति न भिद्यन्ते पाण्डु स्निग्धत्वगादयः || २३ ||

śleṣmolbaṇā mahāmūlā ghanā mandarujaḥ sitāḥ |
utsannopacita – snigdha – stabdha – vrtta – guru – sthirāḥ ||19||
picchilāḥ stimitāḥ ślakṣṇāḥ kaṇḍavādyaḥ sparśanapriyāḥ |
karīra – pana sāthyābhāstathā gostanasannibhāḥ ||20||
vaṅkṣaṇānāhinaḥ pāyu – basti – nābhivikarṣiṇaḥ |
saśvāsa – kāsa — hrllāsa – prasekāruci — pīnasāḥ || 21 ||
meha – krcchra – śirojāḍya – śiśirajvarakāriṇaḥ |
klaibyāgnimārdava – cchardirāmaprāyavikāradāḥ || 22 ||
vasābha – sakaphaprāyapuriṣāḥ sapravāhikāḥ |
na sravanti na bhidyante pāṇḍu snigdhatvagādayaḥ || 23 ||

In the case of kaphaja arsha sprouts are:

  • Deep rooted, hard, with mild pain
  • White in colour
  • Elongated, big in size, smooth,
  • Not flabby
  • Roundly shaped, straight, heavy, tight, slippery, immovable and shining;
  • With severe itching, comfortable on scratching/ touching
  • Resembling the Karira (bamboo shoot) or the seed of panasa or the teat of the cow’s udder.

The patient of kaphaja arsha may have symptoms such as

  • the swelling or distension in the groins,
  • dragging sensation of the rectum, bladder and umbilicus

He might feel –

  • difficulty in respiration
  • could have cough, nausea, salivation,
  • Anorexia
  • Running of the nose
  • Dysuria
  • Heaviness of the head
  • And fever with cold.

Moreover, impotence, indigestion, vomiting and other diseases are also generated. The patient is also troubled by the aama or undigested material and he passes faeces that resemble fat and are mixed with mucus and accompanied with straining. The pile mass of kaphaja arsha does not exude mucus or blood. It gets split or cracked even by the friction of hard faeces. 19 -23

Symptomatology of Sannipata (tridoshaja) and Sahaja (congenital) Piles –

सर्वैः सर्वात्म कान्याहुर्लक्षणैः सहजानि च |

sarvaiḥ sarvātma kānyāhurlakṣaṇaiḥ sahajāni ca |

The features of all the three doshas could be found together in the case of sahaja arshas.

रक्तोल्बणा गुदेकीलाः पित्ताकृतिसमन्विताः || २४ ||
वटप्ररोहसदृशा गुञ्जा – विद्रुम सन्निभाः |
ते अत्यर्थं दुष्टमुष्णं च गाढविट्कप्रपीडिताः || २५ ||
स्रवन्ति सहसा रक्तं तस्य चाति प्रवृत्तितः |
भेकाभः पीड्यते दुःखैः शोणितक्षयसंभवैः || २६ ||
हीनवर्ण – बलोत्साहो हतौजाः कलुषेन्द्रियः |

raktolbaṇā gudekīlāḥ pittākrtisamanvitāḥ || 24 ||
vaṭaprarohasadrśā guñjā – vidruma sannibhāḥ |
te atyarthaṃ duṣṭamuṣṇaṃ ca gāḍhaviṭkaprapīḍitāḥ || 25 ||
sravanti sahasā raktaṃ tasya cāti pravrttitaḥ |
bhekābhaḥ pīḍyate duḥkhaiḥ śoṇitakṣayasaṃbhavaiḥ || 26 ||
hīnavarṇa – balotsāho hataujāḥ kaluṣendriyaḥ |

In the case of haemorrhoids or bleeding piles (raktaarsha), most of the symptoms are identical to those of the pittaja arshas. The sprouts of this pile look like the tender twigs of banyan tree, gunja (abrus seed) and vidruma (coral bead). They exudate vitiated and warm blood on being pressurised by hard stool. Due to excessive loss of blood, the individual looks like a frog and suffers from the diseases that are caused due to diminished blood. The lustre of his body, his strength and aptitude and his ojas, that are the essential immunity factor in the body, are lost and his organs become feeble. 24 -26

Association of Vata and Kapha in Bleeding piles –

(तत्रानुबन्धो द्विविधः श्लेष्मणो मारुतस्य च |)
विट् श्यावं कठिनं रुक्षमधोवायुर्न वर्तते || २७ ||
तनु चारुणवर्णं च फेनिलं चासृगर्शसाम् |
कट्युरु – गुदशूलं – च दौर्बल्यं यदि चाधिकम् || २८ ||
तत्रानुबन्धो वातस्य हेतुर्यदि च रुक्षणम् |
शिथिलं श्वेतपीतं च विट् स्निग्धं गुरु शीतलम् || २९ ||
यद्यर्शसां घनं चासृक् तन्तुमत् पाण्डु पिच्छिलं |
गुदं सपिच्छं स्तिमितं गुरु स्निग्धं च कारणम् |
स्लेष्मानुबन्धो विज्ञेयस्तत्र रक्तार्शसां बुधैः || ३० ||

(tatrānubandho dvividhaḥ śleṣmaṇo mārutasya ca |)
viṭ śyāvaṃ kaṭhinaṃ rukṣamadhovāyurna vartate || 27 ||
tanu cāruṇavarṇaṃ ca phenilaṃ cāsrgarśasām |
kaṭyuru – gudaśūlaṃ – ca daurbalyaṃ yadi cādhikam || 28 ||
tatrānubandho vātasya heturyadi ca rukṣaṇam |
śithilaṃ śvetapītaṃ ca viṭ snigdhaṃ guru śītalam || 29 ||
yadyarśasāṃ ghanaṃ cāsrk tantumat pāṇḍu picchilaṃ |
gudaṃ sapicchaṃ stimitaṃ guru snigdhaṃ ca kāraṇam |
sleṣmānubandho vijñeyastatra raktārśasāṃ budhaiḥ || 30 ||

Raktarsha may have associations of two doshas as well, the vata and kapha. If the faeces are blackish, hard and dry, flatus is passed (easily) and thin, red coloured frothy blood is passed associated with colicky pain in the waist, thighs and perianal regions along with extreme weakness and if these are due to the substances which produce dryness in the body the secondary involvement should be considered to be that of vayu.

In the case of kapha association, faeces could be broken (semi solid), whitish yellow in colour, frothy, heavy, and cold. The pile mass exudes thick, sticky and whitish yellow blood that resembles piece of thread in shape. It could be smooth, immovable, heavy, and slippery to touch. 27 – 30

Premonitary symptoms of Arsha (Piles) –

विष्टम्बो अन्नस्य दौर्बल्यं कुक्षेराटोप एव च |
कार्श्यमुद्गारबाहुल्यं सक्थिसादो अल्पविट्कता || ३१ ||
ग्रहणीदोष – पाण्ड्वर्तेराशङ्खा चोदरस्य च |
पुर्वरुपाणि निर्दिष्टान्यर्शसामभिवृद्धये || ३२ ||

viṣṭambo annasya daurbalyaṃ kukṣerāṭopa eva ca |
kārśyamudgārabāhulyaṃ sakthisādo alpaviṭkatā || 31 ||
grahaṇīdoṣa – pāṇḍvarterāśaṅkhā codarasya ca |
purvarupāṇi nirdiṣṭānyarśasāmabhivrddhaye || 32 ||

The premonitory features of Arsha include the following:

  • stasis of food particles in the stomach without digestion,
  • debility,
  • gurgling noise in the abdomen,
  • emaciation,
  • frequent belching,
  • weakness.

The patient passes feaces in only scanty amounts. Moreover, there could be presence of features of grahani dosha (sprue), pandu (anemia) and udara (distension of abdomen) diseases in this ailment causing confusion in the diagnosis of the arshas. 31-32

The role of piles in troubling the whole body –

पञ्चात्मा मारुतः पित्तं कफो गुदवलित्रयम् |
सर्व एव प्रकुप्यन्ति गुदजानां समुद्भवे || ३३ ||
तस्मादर्शांसि दुःखानि बहुव्याधिकराणि च |
सर्वदेहोपतापीनि प्रायः कृच्छ्रतमानि च || ३४ ||

pañcātmā mārutaḥ pittaṃ kapho gudavalitrayam |
sarva eva prakupyanti gudajānāṃ samudbhave || 33 ||
tasmādarśāṃsi duḥkhāni bahuvyādhikarāṇi ca |
sarvadehopatāpīni prāyaḥ krcchratamāni ca || 34 ||

All the five divisions of each of the vata, pitta and kapha doshas invade all the three folds of the rectum to generate arshas. Thus arsha is a very painful disease. It affects the whole body, is difficult for treatment, and gives rise to several other diseases also. 33 -34

Prognosis of the disease of piles –

बाह्यायां तु वलौ जातान्येक दोषोल्बणानि च |
अर्शांसि सुखसाध्यानि न चिरोत्पतितानि च || ३५ ||

bāhyāyāṃ tu valau jātānyeka doṣolbaṇāni ca |
arśāṃsi sukhasādhyāni na cirotpatitāni ca || 35 ||

The pile mass located in the external fold of the rectum, that has emerged out of the provocation of only one dosha and which has only recently appeared is easy to cure. 35

द्वन्द्वजानि द्वितीयायां वलौ यान्याश्रितानि च |
कृच्छ्रसाध्यानि तन्याहुः परिसंवत्सराणि च || ३६ ||

dvandvajāni dvitīyāyāṃ valau yānyāśritāni ca |
krcchrasādhyāni tanyāhuḥ parisaṃvatsarāṇi ca || 36 ||

The pile mass generated by vitiation of two doshas together, located in the middle fold of the rectum and existing for more than one year is difficult to cure. 36

सहजानि त्रिदोषाणि यानि चाभ्यान्तरां वलिम् |
जायन्ते अर्शांसि संश्रित्य तान्यसाध्यानि निर्दिशेत् || ३७ ||

sahajāni tridoṣāṇi yāni cābhyāntarāṃ valim |
jāyante arśāṃsi saṃśritya tānyasādhyāni nirdiśet || 37||

The Pile mass that is hereditary, born out of all the three doshas provoked together, that has been located in the innermost fold of the rectum is impossible to cure. 37

शेषत्वादायुषस्तानि चतुष्पादसमन्विते |
याप्यन्ते दीप्तकायाग्नेः प्रत्याख्येयान्यतो अन्यथा || ३८ ||

śeṣatvādāyuṣastāni catuṣpādasamanvite |
yāpyante dīptakāyāgneḥ pratyākhyeyānyato anyathā || 38 ||

Patients who have fortune of having a long life, who have access to suitable services of all four limbs of treatment (namely, the physician, medicine, nurse and patient) and who possess suitable digestive capacity can hope to live on with arshas, while those possessing none of these features are to be refused treatment by the wise physician. 38

Complications of the piles disease –

हस्ते पादे मुखे नाभ्यां गुदे वृषणयोस्तथा |
शोथो हृत्पार्श्वशूलं च यस्यासाध्यो अर्शसो हि सः ||३९||

haste pāde mukhe nābhyāṃ gude vrṣaṇayostathā |
śotho hrtpārśvaśūlaṃ ca yasyāsādhyo arśaso hi saḥ ||39||

The patients of piles who have oedema in the hands, feet, face and the umbilical, anal and scrotal regions, as well as who have colicky pain in the pericardium and sides are incurable. The following symptoms are also indicative of a fatal variety of arshas: Pain in the region of the heart and flanks. 39

हृत्पार्श्वशूलं सम्मोहश्छर्दिरङ्गस्य रुग्ज्वरः |
तृष्णा गुदस्य पाकश्च निहन्युर्गुदजातुरम् || ४० ||

hrtpārśvaśūlaṃ sammohaśchardiraṅgasya rugjvaraḥ |
trṣṇā gudasya pākaśca nihanyurgudajāturam || 40 ||

If a patient of piles is having such symptoms as pain in heart, flanks, delusion, vomiting, pain all over the body, fever, thirst, anal suppuration, heavy bleeding from the pile mass, he might soon head to death. 40

तृष्णारोचक – शूलार्तमतिप्रसृता शोणितं |
शोथातिसार संयुक्तमर्शांसि क्षपयन्ति हि || ४१ ||

trṣṇārocaka – śūlārtamatiprasrtā śoṇitaṃ |
śothātisāra saṃyuktamarśāṃsi kṣapayanti hi || 41 ||

The patient of piles having such additional symptoms as thirst, anorexia, colic pain, profuse bleeding, oedema as well as diarrhoea id to be understood to have reached a fatal stage. 41

मेढ्रदिष्वपि वक्ष्यन्ते यथास्वं, नाभिजानि च |
गण्डुपदास्यरूपाणिपिच्छिलानि मृदूनि च || ४२ ||

meḍhradiṣvapi vakṣyante yathāsvaṃ, nābhijāni ca |
gaṇḍupadāsyarūpāṇipicchilāni mrdūni ca || 42 ||

The muscular sprouts occurring in places other than the anus:

The arsha (muscular sprouts) occurring on penis, nose, eye and the ear will be explained along with the other diseases of these organs. The ones originating in the navel look like the face of Gandupada Krimi and are sticky and soft. These have been described elsewhere. 42

Charmakila (wart) –

व्यानो गृहीत्वा श्लेष्माणं करोत्यर्शस्त्वचो बहिः |
कीलोपमं स्थिरखरं चर्मकीलं तु तद्विदुः || ४३ ||

vyāno grhītvā śleṣmāṇaṃ karotyarśastvaco bahiḥ |
kīlopamaṃ sthirakharaṃ carmakīlaṃ tu tadviduḥ || 43 ||

The vyana variety of vata if associated with sleshma will invade the skin and cause arsha on the skin. In shape, it resembles a nail, which is firm and hard. This is also known as charmakila or warts. 43

वातेन तोद पारुष्यं पित्तादसित वक्त्रता |
श्लेष्मणा स्निग्धता चास्य ग्रथितत्वं सवर्णता || ४४ ||

vātena toda pāruṣyaṃ pittādasita vaktratā |
śleṣmaṇā snigdhatā cāsya grathitatvaṃ savarṇatā || 44 ||

इति माधवकरविरचिते माधवनिदाने अर्शोनिदानं समाप्तं |

iti mādhavakaraviracite mādhavanidāne arśonidānaṃ samāptaṃ |

Due to vata there is pricking pain and roughness; due to pitta the tips of charmakila turn black and due to kapha the tips remain smooth, knotty and have the same colour as that of the skin. 44

Thus concludes the chapter on Arshas.