11and 30clock piles with external mass... pt.has complaint wd mild pain and bleeding during defecation of stool.. Constipation Alcohalic Chain smoker DM Hypertension... What is d managent? Respected doctors plz share ur valuable opinions.

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First constipation be relieved Abhayarista 3tsf bid Arshakutahara rasa250mg bid Bolabaddasrasa250mg bid Abhayarista lepa External application twice daily Sitz bath everyday once.. The course of treatment to be followed for about a week or 10 days once bleeding stops and constipation relieved , dosage may be varied. Also kasisadi taila can be used for ext. application locally. Strict bland diet is to be adviced for the patient. Abundant fluids,vegetables adviced to be intaken.

Try this Pranda vati Kankayan vati Arshakuthar ras Triphala guggul mix all and divide in 30 pkt. 1bid with Gulkand Abhyarishta 30ml 2 Kashisadi tail locally Panchsakar churna 5 gm HS

As per dr subhash poonia sir
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KSHAR SUTRA T/T IS best for that type of conditions

Tab. Pilocid 1 tab bd Tab. Kankayan vati 2 tab bd Syp. Abhyaristam 4tsf bd with equal water Oint. Pilocid la
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As per the case history and picture pt is suffering from bleeding piles Treatmemt suggested as per ayurveda is Arogyabardhini vati 500 mg bid in empty water Arsa kuthara rasa bid Suranakhanda modak 5gm bid after food with warm water Cap posex bid after food for bleeding Abayarista 15ml bid with equal amount of water after food Jatyadi tail for exernal application Than hot sizbath before defication

Kshara sutra Nd internally Manibhadra gulam 2tsp bd Chirabilwadi kashaya bd Kasisadi thaila ext application Swasthavritha acharana Pathya : use thakra+ onion + haridra+curry leaf + soorana Sits bath in madhu yashti thaila Apathy's: vatha vardhaka aahara n vihara. Proper sleep Avoid Vega udeerana n dharana

Thank u sir
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Post some clear pic,as much seen in picture its not piles,it seems like skin bulging/thrombosis because of fissure in ano(most probably if patient is40+ male), Go for kshar karma or RAKTAMOKSHAN And relive constipation... Alternate hot and cold compress..

Thank you doctor
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रोगी अर्श से पीड़ित है। चिकित्सा शुरू करें,पाइलेक्स किरीम गुदा द्वार मे लगवाएं।पाइलेक्स टेबलेट 2 सुबह शाम सेवन कराएं। त्रिफला चूर्ण 10 ग्राम रात को सोते समय दूध के साथ दे निश्चित रूप से लाभ होगा पिछ्ले 40 वर्ष से प्रयोग कर रहा हूं

Thank you doctor
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1 kharsutra is the best treatment. 1 Medicinal treatment is as follows. 1 sronitargal 2 tab BDPC 2 Arsakuther Luther ras 1 Tab BDPC 3l Lippu ointment TDPC 4 powder panchasakar 2 tsf atHß

Thank you doctor
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according to this snap. Patient is suffering from sub mucous fistula. I think he also feel itching and some irritation in it. Only kshar sutra ligation give permanent result.

Thank you so much for your valuable opinion @Dr. Abhishek Sharma sir
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It's a interoexternal piles ,ligate with kshar sutra and give panchskar churn 5gm xhs,arshkuthar vati ,jatyadi tail insert in anus,for bleeding calcium dobesilate 500mg bd

Thank you doctor
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