Comparative efficacy of Apamarga Kshara in Haemorrhoids with respect to size of Pile Mass and Bleeding: A Systematic Review

Haemorrhoids are among the most common anorectal condition frequently encountered in clinical practice, often presenting with symptoms such as prolapse, bleeding, etc. Despite the availability of numerous treatment options, including conservative, minimally invasive, and surgical interventions, no single modality offers a complete and sustained outcome. In Ayurveda, Apamarga Kshara is considered the standard and well-documented para-surgical treatment for internal haemorrhoids. Although various studies have evaluated its efficacy, a comprehensive comparative analysis with other haemorrhoid treatments remains limited. Therefore, present study aims to evaluate the best available treatment for haemorrhoids by comparing Apamarga Kshara with other existing treatment modalities. Eight clinical studies conducted between 2018 and 2025 involving 330 participants were included in the review. The findings suggest that Apamarga Kshara provides significant improvement in key clinical outcomes such as bleeding and reduction in pile mass size and may offer a superior efficacy compared with other Ksharas like Arka Kshara, Bilwa Kshara, Snuhi Kshara etc. as well as modern therapies like rubber band ligation and sclerotherapy. Most studies reported significant symptomatic improvement within 2 to 12 weeks of treatment. Further high-quality trials are needed to confirm these results and establish broader clinical application.