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Introduction: Arsha (hemorrhoids) is one of the most prevalent anorectal disorders described in Ayurveda, often compared to modern hemorrhoidal disease. Classical texts highlight three principal therapeutic approaches—Kshara (alkaline cauterization), Agni (thermal cauterization), and Shastra Karma (surgery). These methods remain highly relevant, even in the light of modern surgical advancements. Methods: A comprehensive literature review was conducted using classical Ayurvedic texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya), contemporary commentaries, and modern medical databases (PubMed, Scopus, Web of Science, AYUSH Research Portal). Studies were included if they addressed therapeutic principles, clinical efficacy, or comparative outcomes of Kshara, Agni, or Shastra Karma in Arsha management. Both experimental and clinical trials from the last 20 years were reviewed. Results: Kshara Karma, particularly the use of Apamarga Kshara, demonstrates high efficacy in reducing recurrence rates with minimal complications. Agni Karma offers effective hemostasis and is especially useful in early-stage hemorrhoids. Shastra Karma, such as excision and ligation, provides definitive treatment in advanced cases but carries risks of pain, bleeding, and recurrence. Recent studies suggest that integration of Ayurvedic parasurgical methods with modern surgical techniques enhances patient outcomes. Discussion: Classical Ayurvedic approaches to Arsha are not only scientifically rational but also resonate with principles of minimally invasive techniques in modern surgery. However, standardized protocols, robust clinical trials, and global acceptance remain challenges. Conclusion: Ayurvedic interventions—Kshara, Agni, and Shastra Karma—offer safe, effective, and sustainable management of hemorrhoids. Their integration with modern surgical advancements can pave the way for evidence-based complementary anorectal care.

KEYWORDS

Agni Karma, Arsha, Ayurveda, Hemorrhoids, Kshara Karma, Shastra Karma