A 48 yrs old male pt suffering some ulcerative type prolapse hemorrhoids since 20 yrs.... pt complains when he try to slight tight pressing during stool piles mass comes out side automatically... then after toielet he press in anal region through d help of fingers. symptom ...in past history massive bleeding and pain but still ocassionaly bleeding and pain during only hard stool... some time blood stain arrives on inner wears or outer wears when piles mass comes out automatically.......sometime hard motion sometime loose motion. habits...past history..smoking,ocassinaly alcohal intake,hot desire of food..,but still stopped all habits excepts smoking. reports..all normal but HB level 6.5gm....ESR..88........respected drs..plz dx..and share ur valuable opinion in dis case.

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Sir, Again a top case from your side, and as from your case history it is Grade 3 internal bleeding piles. But the Haemoglobin level is 6.5gm , so it is better to avoid any surgical procedures ( including KS - ligation ) at this low Hb level. So Plan of Management must be - 1. To increase Hb level ( By BT and Iron Supplements ) 2. Shaman Chikitsha ( Give importance to Raktasthambhana, avoid constipation, Agni deepana and pachana ) A. BolaBaddha Rasa B. Kankayan Vati C. Chiruvilwadi Kashayam D. Mustakadyarishtam Lohasavam E. Dashamoola Hareetaki F. Pathya-Apathya sevanam G. Nidan Parivarjanam H. Sitz bath 3. Once you achieve the goal of Haemoglobin up to 10 GM , then you can opt for KS- ligation.

Many 2 thanks for ur valuable opinion @@Dr. Niranjan Ram sir
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As haemoglobin is very low first we need to improve Hb levels. Blood transfusion may be required.along with that iron salt ,folic acid vitamin b complex and vitamin c also required Loha bhasma , kantloh Punarnava mandur Bolbaddha ras sos Kanchanar guggulu Kankayan vati Arshakuthar ras Abhayarishta Gandharvharitaki KS ligation

Thank u so much for ur valuable opinion sir
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Once again a good case from u r side mostly it seems like a 3 'o'clock 4th degree haemorrid. first plan for to increase HB and plan to shrink a Mass by using jathyadhi thaila & kasisadhi thaila orally cap Arshacare 2 BD tab raktastambaka 2 BD cap laxsen 2 hs & advice sitz bath compalsary 3times per day. advise to take all med up to 10 days review after 10 days than u plan for kst.

Thank u so much sir..but what is ur opinion sir? What should I do for such kind of case sir?what will be first line of tt for such cases sir?
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Thrombotic 4 th degree prolapse Haemorrhoid , a superb case , A old anaemic case due to bleeding prolapse Haemorrhoid , Firstly full plage manage health condition , blood transfusion must 2 point , with haemataenic , folic acid ,iron polymaltose compound , with ferrum phos Kali phosphoricum , Arum metallicum, , Asculus Hippo Q daily night and Aloes socorot Q daily bid , Loha bhasma , lodrah tab TDs. Triphala gugulus TDs , Ets properly manager pt If medically fit then operative decision

Piles Best option crayo surgery 1 cap p 9 two bd 2 p 9 oil use for anus 3 sheikh Pachan churan one tea spon ate night with milk 4 aap week m ek bar one glass milk m 10 ml castor oil milakar pilaya Karo 5 aap guda k ander baruf ka pes din m do bar rakho

कटकर्नज के पाउडर को गुदा में बांधने से लाभ होगा। इस तरह के रोगी को पेचिश की शिकयत रहती है जो कि कांच को निकालने का प्रयास करती है। इसलिए पेचिश की चिकित्सा करनी चाहिए निश्चित रूप से लाभ होगा

Thank you doctor
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4 th degree internal piles. Prolaped. HB is low .due to prolonged bleeding. Will be recovered after ks ligation. Biopsy of pile mass is suggestive.

Thank u
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Go with Biopsy.... I agree with @Dr. A M Vishwa Aradhya sir....

Thank u sir
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1) punarnava mandur 2 bd 2) trifala guggulu 2 bd 3) erand bhrust haritaki at night 4) kutaj ghanvati if more bleeding 1 bd 5) last some recovery ksharsutra ligation

@Dr. A M Vishwa Aradhya sir@Dr. M V Subramanyam sir@Dr. Hemant Adhikari sir@Dr. Shukla Vikram sir@Dr. Aniruddha Lele sir@Dr. Iranna Shiragumpi sir..plz DX and share ur valuable opinion on dis case.

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