A REVIEW ON SIDDHA POLYHERBAL FORMULATION NILAVAGAI CHOORANAM- A SPECIAL MEDICINE FOR ANORECTAL DISEASES

A REVIEW ON SIDDHA POLYHERBAL FORMULATION NILAVAGAI CHOORANAM- A SPECIAL MEDICINE FOR ANORECTAL DISEASES

S. Venkatesh *, H. Nalini Sofia and H. Vetha Merlin Kumari

Department of Maruthuvam, National Institute of Siddha, Tambaram Sanatorium, Chennai, Tamil Nadu, India.

ABSTRACT: Traditional Siddha Medicine (TSM) is one of the oldest forms of traditional medicine, having its roots in South India's ancient Tamil Nadu. One of the Internal Medicines available in Classical text Brammamuni Karukkidai Choothiram is Nilavagai Chooranam. It is used to treat Malakkattu (Constipation), Vaaivu (One of the three humours), Soodukollal (Intense heat in pelvic region), Sori & Sirangu (A kind of itch or scabies), Moolavaayu (Accumulation of bowel gas), Malam suththi (Stool/faeces will be purified), Moola noygal (Diseases of Anorectal region). Ingredients of the formulation and their pharmacological action in various research studies are discussed in this review. The details were collected from different Siddha texts, Medicinal botany books and electronic databases such as Pubmed. In conclusion the results of the review revealed that the pharmacological actions such as analgesic, anti-inflammatory, laxative and vasoactive actions were consistent with the medicinal uses of each ingredient of formulation with respect to anorectal ailments.

Keywords: Moolam, Brammamuni Karukkidai Choothiram, Nilavagai Chooranam, Siddha medicine, Thirithodam, Anorectal diseases

INTRODUCTION: Traditional Siddha Medicine (TSM) is one of the oldest forms of traditional medicine, having its roots in South India's ancient Tamil Nadu. It ensures everyone to lead a disease-free healthy life. Siddhars classified the human diseases as 4448 in number ¹. Anorectal diseases are one among them.  Under the spectrum of anorectal diseases sage Yugi mentioned the disease Moolam and its 21 types in Yugi Vaidhya Chinthamani ². In Siddha, Moolatharam is mentioned as one of the 6 pillars and six psychic centres in the human body.

It is said to be located near the coccygeal plexus beneath the sacrum which is the principal axis of the body.  According to Thiridhosha theory, derangement of both Vatham and Pitham Humour is attributed as etiological factor for moolam.

“Anila pithathondhamalathumoolamvaraathu” - Siddhar Theraiyar. (Anilam-Vaatham, Pitha-Pitham). In Moola noi, deranged Vatha humor triggers keezhvaikanal (abanavaayu) which in turn stimulates pithamhumor resulting in Moolam. With the symptoms of constipation, bleeding during defecation, pain in umbilical region, pallor of the body, headache, giddiness are developed. Haemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions ³. Usual treatments provided for Haemorrhoids are conservative management includes stool softeners, bulking agents for stage 1 and 2.

Conditions Refractory to conservative management or stage 3 and 4 Haemorrhoids will be treated surgically ⁴. The recurrence rate after stapled hemorrhoidopexy and conventional hemo-rrhoidectomy 0 to 26% and 0 to 10.8%, respectively; reoperation rate was 16.7% after stapled hemorrhoidopexy ⁵.

Though there are many formulations are available in siddha system of medicine for managing the Anorectal disorders, the medicine Nilavagai Chooranam ⁶ is a classical siddha herbo-mineral compound indicated in Brammamuni Karukkidai Choothiram for various anorectal diseases. Nilavagai Chooranam contains 20 ingredients. This review describes the phytochemicals, pharmacological action and medicinal uses of the part of each ingredient used in this formulation.

MATERIALS AND METHODS:

Research Design: Drug Review on Literature

Research Type: Literature Review

Research Period: 3 months

Literature Collected from: Brammamuni Karukkidai Choothiram – 380. Edited by S. B. Ramachandiran (February 1998), Page No: 68, 69; Publication: Thamarai Noolagam, 7, N.G.O Colony, Vadapalani, Chennai-26.

Ingredients of the Drug: The formulation comprises a harmonious blend of potent herbal and mineral ingredients: Nilavagai (Cassia senna, Linn.), Milagu (Piper nigrum, Linn.), Kadukkai (Terminalia chebula, Retz), Thaanrikkai (Terminalia bellerica, Roxb), Seeragam (Cuminum cyminum, Linn.), Vaaluluvai (Celastrus paniculatus, Willd), Sirunaagapoo (Mesua nagassarium, Kosternm), Elam (Elettaria cardamomum, Maton), Ilavanga pattai (Cinnamomum verum, Presl), Kadugurogini (Picrorhiza scrophulariiflora, Pennell), Sivadhai (Operculina turpethum, Linn.), Thalis apathiri (Abies spectabilis, Mirb), Jaadhikkai (Myristica fragrans, Houtt), Kiraambu (Syzygium aromaticum, Linn.), Thippili (Piper longum, Linn.), Seviyam (Piper nigrum, Linn.), Indhuppu (Sodii chloridumimpura), Koogaineeru (Maranta arundinacea, Linn.), Sukku (Zingiber officinale, Rosc), and Seeni Sarkkari (Saccharum officinarum, Linn.). Each component has been carefully selected for its therapeutic potential, working synergistically to support the intended pharmacological action.

Drug Administration: The prescribed dosage of the formulation is Verukadialavu (approximately 1.375 grams) ⁷, to be administered twice daily. It is to be taken along with an appropriate adjuvant such as ghee or honey, based on the individual's condition and practitioner’s guidance. The duration of therapy is one Mandalam, equivalent to 48 days, allowing sufficient time for the drug to exert its intended therapeutic effect within the body.

Purification Process of Raw Drugs ⁸: The purification process of the raw drugs involves various traditional methods tailored to enhance the therapeutic efficacy and safety of each ingredient. Nilavagai leaves are powdered and subjected to steam boiling in milk for 3 hours. Milagu is soaked in buttermilk and then dried, while Kadukkai has its seeds removed and is dried. Thaanrikkai is soaked in Thazhaivizhuthu (Pandanus odoratissimus) juice for 3 hours before sun drying. Seeragam, Sirunaagapoo, Elam, Ilavangapattai, Thalisapathiri, Kiraambu, and Seviyam are simply cleaned and dried under sunlight. Vaaluluvai is washed in Katraalai (Aloe barbadensis) juice and dried. Kadugurogini is soaked in either neem or nochi (Vitex negundo) leaf juice for 3 hours before sun drying. Sivadhai's central root veins are removed, boiled in milk, and then dried. Jaadhikkai is peeled, cut into small pieces, and sun-dried. Thippili is soaked in Kodiveli (Plumbago zeylanica) leaf juice for 24 minutes before drying. Indhuppu is soaked in fermented rice water for three days, followed by drying. Koogaineeru is mixed with water, washed seven times, filtered, and then sun-dried. Sukku is soaked in limestone water for 3 hours, after which the outer layer is removed. Lastly, Seeni Sarkkari is crushed into a fine powder. This meticulous purification ensures the removal of impurities and enhances the bioavailability of the medicinal constituents.

Indications:

• Megam (A sexually transmitted disease classified into 21 types) ⁹
• Pitham (One of the three humours) ⁹
• Arosagam (Anorexia)
• Vaai neerooral (Excessive salivation) ¹⁰
• Malakkattu (Constipation) ⁹
• Vaaivu (One of the three humours) ¹⁰
• Soodukollal (Intense heat in pelvic region) ¹⁰
• Sori & Sirangu (A kind of itch or scabies) ⁹
• Moolavaayu (Accumulation of bowel gas) ¹⁰
• Malam suththiaagum (Stool/faeces will be purified) ¹⁰
• Moolathil noyellam murindhu pogum (Diseases of Anorectal region)

RESULT:

TABLE 1: SCIENTIFIC & SELECTED VERNACULAR NAMES, FAMILIES OF THE MEDICINAL INGREDIENTS

TABLE 2: MORPHOLOGY, PARTS USED & ORGANOLEPTIC CHARACTERS OF THE HERBAL INGREDIENTS IN NILAVAGAI CHOORANAM

TABLE 3: PHYTOCONSTITUENTS AND MEDICINAL USES OF THE INGREDIENTS IN NILAVAGAI CHOORANAM

Pharmacological Importance of Parts of the Herbs: The analysis of Nilavagai Chooranam reveals that roots (ver), fruits (kani), and seeds (vithai) form the core of its herbal composition Fig. 1. In Siddha medicine, these parts are revered for their potent therapeutic energy, acting effectively on the gastrointestinal and circulatory systems. Roots like Sivadhai and Thippiliver possess purgative and analgesic properties, promoting virechana and easing anorectal inflammation and pain. Fruits such as Kadukkai and Thaanrikkai regulate vata and pitta doshas, soften stools, and heal mucosal irritation, while Jaadhikkai and Ilavangapattai enhance agni and reduce flatulence. Seeds, rich in oils and active compounds, offer carminative, anti-inflammatory, and styptic effects. Vaaluluvai and Milagu stimulate digestion, addressing constipation, whereas Seeragam and Elam improve intestinal motility and balance vata-kapha. Collectively, these parts act synergistically to relieve symptoms and correctthe underlying doshic imbalances in anorectal disorders such as haemorrhoids.

FIG. 1: USED PARTS OF HERBS PRESENT IN NILAVAGAI CHOORANAM

Pharmacological Importance of Families of the Herbs: The analysis of Nilavagai Chooranam with respect to families of herbs they belong to Fig. 2, highlights the therapeutic significance of herbs from the Piperaceae, Combretaceae, and Zingiberaceae families in treating anorectal disorders. Piperaceae members like Piper nigrum and Piper longum are rich in piperine and essential oils that stimulate agni, relieve vata-induced bloating, and reduce inflammation and pain in hemorrhoidal tissues ^{39, 40}. Combretaceae fruits such as Terminalia chebula and T. bellerica, known for their thuvarpusuvai (astringent taste), promote venous constriction, reduce bleeding, and act as mild laxatives, facilitating smooth evacuation. Zingiberaceae spices like Zingiber officinale and Elettaria cardamomum exhibit ushnaviriyam (warming) and deepana (Stimulates digestive fire) actions, improving digestion, relieving flatulence, and reducing rectal spasms. Together, these families support dosha balance, soften stools, reduce inflammation, and tone anorectal tissues, thereby forming a pharmacological cornerstone in Siddha management of haemorrhoids and related conditions.

FIG. 2: FAMILIES OF HERBS PRESENT IN NILAVAGAI CHOORANAM

Potential Therapeutic Benefits of Nilavagai Chooranam through Pharmacological Actions: Nilavagai Chooranam demonstrates a broad spectrum of pharmacological actions Fig. 3 beneficial in the management of haemorrhoids. One of its primary effects is anti-inflammatory activity, crucial for reducing pain, swelling, and bleeding associated with inflamed hemorrhoidal veins. Inflammation, often exacerbated by straining and chronic constipation, is significantly modulated by 33.3% of the herbs in the formulation, including Piper nigrum, Elettaria cardamomum, Zingiber officinale, Piper longum, Mesua nagassarium, and Abies spectabilis, all known for their anti-inflammatory properties. Analgesic activity is another critical therapeutic property. Pain in haemorrhoids, especially external types, arises from swollen veins, mucosal irritation, and sphincter spasms. While NSAIDs are contraindicated in bleeding piles, 22.2% of herbs such as Cuminum cyminum, Piper nigrum, Myristica fragrans, and Zingiber officinale exhibit analgesic effects. These effects are likely due to a synergistic interplay with their anti-inflammatory and mucosal healing properties.

FIG. 3: PHARMACOLOGICAL ACTIONS OF HERBS PRESENT IN NILAVAGAI CHOORANAM

Oxidative stress plays a pivotal role in weakening anal vasculature and promoting inflammation. The antioxidant activity of 11.1% of herbs, including Saccharum officinarum, Cinnamomum verum, and Elettaria cardamomum, offers protection against free radicals by supplying phytochemicals like flavonoids, quercetin, and polyphenols that prevent cellular damage and vascular degradation ^{41, 42}.

Constipation is a key etiological factor in haemorrhoids, addressed by the laxative activity of 5.5% of herbs, prominently Cassia senna. This helps in softening stools, easing defecation, and reducing the mechanical strain on rectal veins ⁴². Furthermore, vasoactive, wound healing, and astringent activities are attributed to around 10% of the herbs, including Cassia senna, Piper nigrum, Abies spectabilis, and Terminalia chebula. These properties contribute to vasomodulation, reduce bleeding, enhance mucosal repair, and promote the shrinkage of the hemorrhoidal mass without causing excessive purgation or constipation. Astringents like Terminalia chebula and T. bellerica also help tone the tissues and support healing ⁴³. Collectively, these actions form a synergistic pharmacological foundation, positioning Nilavagai Chooranam as a holistic therapeutic agent in the Siddha management of hemorrhoidal disorders.

DISCUSSION: The conventionally used Nilavagai Chooranam formulation from Siddha vaidhyathirattu ⁴⁴ book has 5 ingredients. It is indicated for conditions like Ushna vaayu, bloating of abdomen, Hiccups, Vomiting and Bronchial asthma. The drug Nilavagai Chooranam taken for this study has 20 ingredients. It has various indications like Megam (A sexually transmitted disease classified into 21 types), Pitham (One of the three humours), Malakkattu (Constipation) ⁹, Vaaivu (One of the three humours), Soodukollal (Intense heat in pelvic region), Sori & Sirangu (A kind of itch or scabies), Moolavaayu (Accumulation of bowel gas) and proposed to cleanse the bowel and to cure all the diseases arising from the seat of moolam ^{10, 9}.

According to the review of literature of Nilavagai Chooranam, the following topics were analysed such as part used, family, morphology, pharmacological actions and indications of each ingredient. Herbs from the following familes, Piperaceae (15.8%), Zingiberacea (10.5%), Combretaceae (10.5%) were mostly used. Upon analysis of parts used Fruit (20%), Root (15%), Seed (15%), Flower bud (10%), Leaf (10%) were majorly used. In Potency of herbs, hot potency were 70% Cold potency were 25%. According to Siddha, in anorectal disorders there will be vitiation of Vadham & Pitham humours. Mandāgni (sluggish digestion) and Ama (undigested toxins) is said to be the causative factors for many illnesses especially the anorectal ailments. Hot potency (Ushna Veeriyam) herbs play a pivotal role in rectifying these imbalances. Their inherent qualities help stimulate Agni (digestive fire), thereby enhancing digestion and preventing the accumulation of Ama a known etiological factor in hemorrhoidal conditions. These herbs also have the anti-inflammatory effect in system. Cold potency herbs have the tendency to heal and reduce the soreness. They have demulcent activity.

In division Sweet (30%), Pungent (65%). Pungent taste herbs stimulate metabolism and disperse the stagnation thereby relieving the vascular congestion and promotes blood flow. They also have antimicrobial and anti-inflammatory effects which helps in healing and pain relief. According to Siddha, the sweet taste is said to have nourishing and tissue regenerative properties. They also have Haemostatic and anti-ulcer property. Thus, they regulate bowel habit and pacify Vaatham. When considering the pharmacological actions, majority of the ingredients has laxative, anti-inflammatory. analgesic, carminative, stomachic and astringent properties. Some of drugs like Zingiber officinale, has vasoactive property.

CONCLUSION: Nilavagai Chooranam, formulated based on Siddha tridosha principles Suvai, Gunam, Veeriyam, and Pirivu has shown therapeutic relevance, now further supported by modern scientific validation. This alignment strengthens confidence among Siddha physicians in managing ailments like haemorrhoids.

Future directions include conducting preclinical and clinical trials to establish safety and efficacy, exploring pharmacological mechanisms, and setting quality control standards for consistency. Thus, this study not only reaffirms traditional knowledge but also opens avenues for scientific exploration and global integration of Siddha medicine.

ACKNOWLEDGEMENTS: I express my thanks to Dr. C. B. S. Bharath Christian MD (S), Assistant Professor, Department of Maruthuvam for his valuable guidance & support in publication of the study. I express my thanks to Dr. B. Anbarasan, MD (S), Assistant Professor, Department of Maruthuvam for his valuable guidance in publication of the study.

Source of Funding: None

CONFLICT OF INTEREST: None

REFERNCES:

1. Shanmugavelu M: Noinaadal Noi Muthal Naadal Thirattu – Paagam 1. 3rd ed. Chennai: Directorate of Indian Medicine and Homeopathy 2003; 363.
2. Anbarasu K: Yugi Vaidhya Chindhamani 800 (Moolamum Uraiyum). 2nd ed. Chennai: Directorate of Indian Medicine and Homeopathy 2013; 253.
3. Lohsiriwat V: Haemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009–17.
4. O’Connell PR, McCaskie AW and Sayers RD: Editors. Bailey & Love's short practice of surgery. 28th ed. Boca Raton: CRC Press 2023.
5. Picchio M, Greco E, Di Filippo A, Marino G, Stipa F and Spaziani E: Clinical outcome following hemorrhoid surgery: A narrative review. Indian J Surg 2015; 77(3): 1301–7.
6. Ramachandiran SB: editor. Brammamuni Karukkidai Choothiram – 380. Chennai: Thamarai Noolagam 1998; 68–9.
7. Sornamariyammal I: Siddha Marundhaakkaviyal Vidhigalum seimuraigalum. Chennai: Directorate of Indian Medicine and Homeopathy 2010; 174.
8. Kannusamy Pillai C: Kannusami Parambarai Vaidhyam. 2nd ed. Thirumagal Publications: B. Rathina Nayagar and Sons 1922; 28–32.
9. National Institute of Siddha. Development of standard Siddha terminologies. 1st ed. Chennai: National Institute of Siddha; 2014.
10. World Health Organization. WHO international standard terminologies on Siddha medicine. Geneva: WHO Press; 2022. (CC BY-NC-SA 3.0 IGO).
11. Gulec M, Ogur R, Gul H, Korkmaz A and Bakir B: Investigation of vasoactive ion content of herbs used in hemorrhoid treatment in Turkey. Pak J Pharm Sci 2009; 22(2): 187–91.
12. Tasleem F, Azhar I, Ali SN, Perveen S and Mahmood ZA: Analgesic and anti-inflammatory activities of Piper nigrum L. Asian Pac J Trop Med 2014; 7(1): 461–8.
13. Taqvi SI, Shah AJ and Gilani AH: Blood pressure lowering and vasomodulator effects of piperine. J Cardiovasc Pharmacol 2008; 52(5): 452–8.
14. Bulbul MRH, Chowdhury MNU and Naima TA: A comprehensive review on the diverse pharmacological perspectives of Terminalia chebula Retz. Heliyon 2022; 8(8): 10220.
15. Gupta A: Terminalia bellirica (Gaertn.) Roxb. (Bahera) in health and disease: A systematic and comprehensive review. Phytomedicine 2020; 153202.
16. Kalaivani P, Saranya RB and Ramakrishnan G: Cuminum cyminum, a dietary spice, attenuates hypertension via endothelial nitric oxide synthase and NO pathway in renovascular hypertensive rats. Clin Exp Hypertens 2013; 35(7): 534–42.
17. Sayyah M, Peirovi A and Kamalinejad M: Anti-nociceptive effect of the fruit essential oil of Cuminum cyminum L. Iran Biomed J 2002; 6(4): 141–5.
18. Aleem M: Phytochemistry and pharmacology of Celastrus paniculatus Wild.: A nootropic drug. J Complement Integr Med 2021; 20(1): 24–46.
19. Asif M, Jafari F, Iqbal Z, Revadigar V, Oon CE and Farsi E: Ethnobotanical and phytopharmacological attributes of Mesua ferrea: A mini review. JAPS 2017; 7: 242–51.
20. Rabb UN: Pharmacological actions of Eladwaya (Elettaria cardamomum Maton and Amomum subulatum Roxb): A review. Int Res J Ayurveda Yoga 2022; 5(4): 92–7.
21. Lartey STJ, Josiah WTM and Stephen A: Nutritional composition of cinnamon and clove powder and the evaluation of the antimicrobial properties of their extracts: A comparison between Ghana and other countries. Afr J Plant Sci 2023; 17(2): 11–7.
22. Wu P, Chang C and Zhu G: Network pharmacology study of bioactive components and molecular mechanisms of the glycoside fraction from Picrorhiza scrophulariiflora against experimental colitis. Drug Des Devel Ther 2023; 17: 1531–46.
23. Gupta S and Ved A: Operculina turpethum (Linn.) Silva Manso as a medicinal plant species: A review on bioactive components and pharmacological properties. Pharmacogn Rev 2017; 11(22): 158–66.
24. Khare CP: In: Khare CP, editor. Indian herbal remedies. Berlin: Springer 2004; 1.
25. Ashokkumar K, Simal-Gandara J, Murugan M, Dhanya MK and Pandian A: Nutmeg (Myristica fragrans Houtt.) essential oil: A review on its composition, biological, and pharmacological activities. Phytother Res 2022; 36(7): 2839–51.
26. Tanko Y, Mohammed A, Okasha MA, Umar AH and Magaji RA: Anti-nociceptive and anti-inflammatory activities of ethanol extract of Syzygium aromaticum flower bud in Wistar rats and mice. Afr J Tradit Complement Altern Med 2008; 5(2): 209–12.
27. Salehi B, Zakaria ZA and Gyawali R: Piper species: A comprehensive review on their phytochemistry, biological activities and applications. Molecules 2019; 24(7): 1364.
28. Thiyagarajan R: Gunapadam Thathu Seerthirku Aagaram. 2nd ed. Chennai: Indian Medicine and Hom 2009; 369.
29. Firoskhan N and Ragunathan M: Review on Maranta arundinacea L. (Marantaceae). JHMR 2021; 3: 1–4.
30. Ojewole JA: Analgesic, anti-inflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res 2006; 20(9): 764–72.
31. Miraj S: Pharmacological effects of Saccharum officinarum L. Der Pharm Lett 2016; 8(13): 223–5.
32. Allaq AA, Sidik NJ, Abdul-Aziz A and Ahmed IA: Cumin (Cuminum cyminum L.): A review of its ethnopharmacology, phytochemistry. Biomed Res Ther 2020; 7(9): 4016–21.
33. Aleem M: Phytochemistry and pharmacology of Celastrus paniculatus Wild.: A nootropic drug. J Complement Integr Med 2021; 20(1): 24–46.
34. Kshirsagar PR and Patil SM: Phytochemistry and pharmacology of Mesua ferrea L. In: Reference Series in Phytochemistry 2020; 223–56.
35. Narayanankutty A, Kunnath K, Alfarhan A, Rajagopal R and Ramesh V: Chemical composition of Cinnamomum verum leaf and flower essential oils and analysis of their antibacterial, insecticidal, and larvicidal properties. Molecules 2021; 26(20): 6303.
36. Nema NK, Chaudhary SK, Kar A, Bahadur S, Harwansh RK and Haldar PK: Bioactive leads for skin aging Current scenario and future perspectives. Elsevier eBooks 2022; 185–222.
37. Nishaa S, Vishnupriya M, Sasikumar J and Gopalakrishnan VK: Phytochemical screening and GC-MS analysis of ethanolic extract of rhizomes of Maranta arundinacea L. Res J Pharm Biol Chem Sci 2013; 4: 52–9.
38. Ali SE, Gedaily RAE, Mocan A, Farag MA and El-Seedi HR: Profiling metabolites and biological activities of sugarcane (Saccharum officinarum Linn.) juice and its product molasses via a multiplex metabolomics approach. Molecules 2019; 24(5): 934.
39. GV K, MA K, M K, KC M, RM R and SH S: Review of plants used as Kshar of family Piperaceae. Int J Ayurvedic Med 2010; 1(2).
40. Tiwari BR, Inamdar MN, Orfali R, Alshehri A, Alghamdi A and Almadani ME: Comparative evaluation of the potential anti-spasmodic activity of Piper longum, Piper nigrum, Terminalia bellerica, Terminalia chebula, and Zingiber officinale in experimental animals. Saudi Pharm J 2023; 31(9): 101705.
41. National Cancer Institute. Antioxidant [NCI Dictionary of Cancer Terms]. n.d. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/antioxidant
42. Lohsiriwat V: Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009–17.
43. Andarkhor P, Sadeghi A, Khodadoost M, Kamalinejad M, Gachkar L and Abdi S: Effects of Terminalia chebula Retz. in treatment of hemorrhoids: A double-blind randomized placebo-controlled clinical trial. Eur J Integr Med 2019; 30: 100935.
44. Kuppusamy Mudhaliyar KN and Uthamarayan KS: Siddha Vaidhya Thirattu. 1st ed. Chennai: Directorate of Indian Medicine and Homeopathy 2016; 427.
    

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    How to cite this article:

    Venkatesh S, Sofia HN and Kumari HVM: A review on siddha polyherbal formulation Nilavagai chooranam- a special medicine for anorectal diseases. Int J Pharm Sci & Res 2026; 17(2): 427-36. doi: 10.13040/IJPSR.0975-8232.17(2).427-36.

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