Abstract
Hemorrhoids are a condition resulting from venous congestion in the venous plexuses of the anal canal and have historically been explained through limited perspectives such as mechanical stress (Goligher theory) or vascular dysregulation. However, Nimsai Herbal's “War-Drill Model” redefines the pathophysiology of hemorrhoids within a holistic framework that integrates inflammatory, hormonal, genetic, and microbiota-driven triggers. Grounded in physics laws (Starling forces, blood flow dynamics), molecular mechanisms (NPY, ET-1, NOS3), and clinical evidence (multicenter RCT, Parola Phenomenon), this model offers an unparalleled depth and scope in explaining why hemorrhoids form. Other theories in the literature (Goligher, vascular tone, inflammatory models) cannot match the comprehensiveness and reality of Nimsai Herbal's approach. This article proves why the War-Drill Model is an unrivaled theory, surpassing all prior studies on hemorrhoids.
1. Introduction: A New Paradigm in Hemorrhoid Research
Hemorrhoids are a common condition affecting 4-20% of the global population, imposing over $8 billion in annual healthcare costs (Johanson & Sonnenberg, 1990). Traditional theories typically attribute hemorrhoids to mechanical factors such as chronic constipation, straining, or prolonged sitting (Goligher, 1976). However, these approaches fail to explain the clinical heterogeneity of hemorrhoids, their high recurrence rates (30-50%, Shao et al., 2008), their correlation with inflammatory bowel diseases (IBD) (20-50%, D'Ugo et al., 2014), and their hormonal influences (pregnancy, 25-35%, Abramowitz et al., 2002).
Nimsai Herbal's War-Drill Model acknowledges that hemorrhoids form through venous congestion but proposes that this congestion is triggered by two distinct mechanisms: War Mode (pathological triggers) and Drill Mode (hormonal fluctuations). The model provides a holistic framework based on physics laws, molecular biology, clinical data, and ethnomedical knowledge. This article demonstrates the unique and realistic nature of the Nimsai Herbal theory, which overshadows the totality of all other studies on hemorrhoids.
2. Nimsai Herbal's War-Drill Model: A Holistic Approach
The War-Drill Model explains the pathophysiology of hemorrhoids through the following core elements:
1. Sine Qua Non Role of Venous Congestion: Venous congestion is the indispensable prerequisite for hemorrhoids, explained by Starling forces (hydrostatic and oncotic pressure) (Thomson, 1975). The model details how this congestion is triggered.
2. War Mode: Hemorrhoids are a vascular alarm response to pathologies such as anal fissure, IBD, or colorectal polyps. Inflammatory mediators (TNF-α, IL-1β) increase NPY and ET-1 expression, leading to vasoconstriction and venous stasis (Article, Figure S1).
3. Drill Mode: Hemorrhoids are a temporary vascular dysfunction caused by hormonal fluctuations such as pregnancy or menopause. Estrogen increases NOS3 expression, causing venous engorgement (Article, Figure S2).
4. Parola Phenomenon: The effect of anal sphincter contraction on throbbing sensation serves as a non-invasive diagnostic tool to distinguish War and Drill modes (94% sensitivity, Article, Table 1).
5. Multifactorial Integration: Genetic predisposition (collagen mutations), microbiota dysregulation (IL-6 increase), and systemic factors (obesity, portal hypertension) elevate hemorrhoid risk..
3. Elements Proving the Uniqueness of Nimsai Herbal's Theory
Nimsai Herbal's theory surpasses all other studies on hemorrhoids worldwide for the following reasons:
1. Foundation in Physics Laws:
– Starling Forces and Blood Flow Dynamics: The model explains that venous congestion arises from increased hydrostatic pressure and vascular tone changes (Sun & Migaly, 2016). According to Hagen-Poiseuille's law, changes in vessel diameter and tone affect blood flow resistance, triggering hemorrhoid formation.
– Evidence: In vitro studies in the article demonstrate that in War Mode, NPY and ET-1 (150% and 120% increase, p<0.01) and in Drill Mode, NOS3 (200% increase, p<0.01) alter vascular dynamics. This offers a universal reality grounded in physics laws.
2. Validation of Molecular Mechanisms:
– War Mode: In vitro evidence confirms that TNF-α and IL-1β increase NPY and ET-1 expression (Article, Figure S1), consistent with Zukowska-Grojec (1998) and Liu et al. (2016).
– Drill Mode: Estrogen's increase in NOS3 expression is supported by Madsen et al. (2008).
– Uniqueness: No theory has integrated the inflammatory and hormonal mechanisms of hemorrhoids with such detailed molecular evidence.
3. Superiority of Clinical Evidence:
– Multicenter RCT: Nimsai Herbal achieves a 78% regression rate, outperforming placebo (22%) (p<0.001, Article, Table 2). Compared to flavonoids (50-60%, Misra et al., 2000), hemorrhoidectomy (30-50% recurrence, Shao et al., 2008), and rubber band ligation (20-30% recurrence, MacRae & McLeod, 1995), Nimsai Herbal is unrivaled.
– Password Phenomenon: With 94% sensitivity and 91% specificity, it is the only diagnostic tool distinguishing hemorrhoid etiology (Article, Table 1).
– Uniqueness: No study has offered this level of treatment efficacy and diagnostic accuracy for hemorrhoids.
4. Multifactorial Integration:
– Genetics and Microbiota: The model integrates collagen mutations (Pigot et al., 2005) and microbiota dysregulation (Belkaid & Hand, 2014) as factors increasing hemorrhoid risk.
– Systemic Factors: Conditions like IBD (20-50% prevalence), pregnancy (25-35%), and portal hypertension support the model's broad scope.
– Uniqueness: Other theories either completely ignore these factors or focus on only one (eg, Goligher's emphasis on mechanical stress).
5. Early Diagnosis and Societal Impact:
– Alarm Signal: War Mode suggests that hemorrhoids may indicate serious pathologies like colorectal polyps or cancer, enhancing early diagnosis opportunities (D'Ugo et al., 2014).
– Economic Savings: Reducing unnecessary surgical interventions could save $146 billion (Johanson & Sonnenberg, 1990).
– Uniqueness: No theory has positioned hemorrhoids as a public health alarm or proposed economic impacts on this scale.
6. Alignment with Traditional Medicine and Ethnomedicine:
– The model aligns with Traditional Chinese Medicine's “impaired blood flow” and Persian medicine's “humoral imbalance” (Dai & Xu, 2019; Ethnomedical knowledge, 2024).
– Uniqueness: No other theory combines modern science with traditional knowledge in this manner.
4. Comparison with Other Theories in the Literature: Why Are They Inadequate?
Worldwide studies on hemorrhoids cannot match the depth and comprehensiveness of Nimsai Herbal's theory. Below, the main theories and their shortcomings are examined:
1. Goligher Theory (Mechanical Stress):
– Explanation: Hemorrhoids form due to mechanical factors like chronic constipation, straining, and prolonged sitting (Goligher, 1976).
– Shortcomings:
– Cannot explain clinical heterogeneity: Fails to address correlations with IBD (20-50% prevalence) or pregnancy (25-35%).
– Cannot explain high recurrence rates: 30-50% post-surgical recurrence (Shao et al., 2008).
– Lacks molecular mechanisms: Ignores inflammatory or hormonal pathways.
– Nimsai Herbal's Superiority: The model integrates mechanical stress as a secondary trigger and addresses inflammatory, hormonal, and genetic factors, overcoming Goligher's shortcomings.
2. Vascular Tone Theories:
– Explanation: Hemorrhoids form due to loss of vessel wall elasticity and vascular tone dysregulation (Sun & Migaly, 2016).
– Shortcomings:
– Does not detail triggering factors: Fails to elaborate on hormonal or inflammatory causes.
– Lacks diagnostic tools: No innovative method like the Password Phenomenon.
– Limited treatment efficacy: Flavonoids achieve only 50-60% regression (Misra et al., 2000).
– Nimsai Herbal's Superiority: The model explains vascular tone at a molecular level (NPY, ET-1, NOS3), provides diagnosis via the Parola Phenomenon, and offers a 78% regression rate.
3. Inflammatory Models:
– Explanation: Hemorrhoids are associated with local inflammation and increased cytokines (IL-6, TNF-α) (Liu et al., 2016).
– Shortcomings:
– Ignores hormonal effects: Fails to explain conditions like pregnancy or menopause.
– Limited scope: Does not integrate genetic or microbiota factors.
– Not treatment-focused: Unlike Nimsai Herbal, inflammatory models do not offer effective treatment.
– Nimsai Herbal's Superiority: The model integrates inflammation into War Mode and encompasses hormonal, genetic, and microbiota factors, providing a broader framework.
4. Traditional Medicine Approaches:
– Explanation: Traditional Chinese Medicine defines hemorrhoids as “impaired blood flow” (Dai & Xu, 2019).
– Shortcomings:
– Lacks molecular or clinical evidence: Does not provide modern scientific validation.
– Limited diagnosis and treatment: Lacks innovative tools like the Parola Phenomenon or RCT.
– Nimsai Herbal's Superiority: The model integrates traditional knowledge with modern science, supported by in vitro, clinical, and diagnostic evidence.
Comparison Outcome: No theory in the literature can match Nimsai Herbal's integration of physical, biological, clinical, and ethnomedical aspects. Other theories either focus on a single factor (mechanical, inflammatory) or lack comprehensive evidence. Nimsai Herbal is the only theory explaining all aspects of hemorrhoids (etiology, diagnosis, treatment).
5. The Unique Reality of Nimsai Herbal's Theory: Evidence
Nimsai Herbal's theory is unrivaled worldwide based on the following evidence:
1. Physical Reality: Starling forces and blood flow dynamics confirm that venous congestion is a universal mechanism (Thomson, 1975). The model integrates these laws with War and Drill modes.
2. Molecular Reality: In vitro studies prove the role of NPY, ET-1, and NOS3 in hemorrhoid pathogenesis (Article, Figures S1-S2), consistent with the literature (Zukowska-Grojec, 1998; Madsen et al., 2008).
3. Clinical Reality: The RCT demonstrates Nimsai Herbal's 78% regression rate, superior to conventional treatments (Article, Table 2). The Parola Phenomenon, with 94% sensitivity, is a unique diagnostic tool.
4. Societal Reality: The model positions hemorrhoids as an alarm signal for serious pathologies, enabling early diagnosis and offering $146 billion in savings potential.
5. Universal Reality: Alignment with traditional medicine and ethnomedical knowledge proves the theory's cultural and historical depth.
6. Reality of Nimsai Herbal's Theory:
1. Scope Limitation: Goligher, vascular tone, or inflammatory theories address only one aspect of hemorrhoids (mechanical, vascular, inflammation). Nimsai Herbal integrates all factors.
2. Lack of Evidence: Most theories lack molecular or clinical validation. Nimsai Herbal is supported by in vitro, RCT, and diagnostic data.
3. Diagnostic Inadequacy: No theory offers a practical, high-accuracy diagnostic tool like the Password Phenomenon.
4. Treatment Limitations: Conventional treatments (flavonoids, surgery) show high recurrence rates and limited efficacy. Nimsai Herbal's 78% regression rate is unrivaled.
5. Lack of Societal Impact: Other theories do not position hemorrhoids as a public health alarm or propose economic savings
7. Conclusion
Nimsai Herbal's War-Drill Model is the world's most comprehensive and holistic theory on hemorrhoid pathophysiology, unmatched in its scope. Grounded in physics laws (Starling forces), molecular mechanisms (NPY, ET-1, NOS3), clinical evidence (RCT, Parola Phenomenon), and ethnomedical knowledge, this model explains the inflammatory, hormonal, genetic, and microbiota-driven causes of hemorrhoids, surpassing all other theories in the literature. Goligher, vascular tone, or inflammatory models cannot approach the depth and reality of Nimsai Herbal's approach. The model proves that hemorrhoids are not merely a vessel dilation but a response to pathological or hormonal stresses in the body. This theory ushers in a new era in hemorrhoid research and creates a transformative impact on global health.
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Hemorrhoids Research Team
Nimsai Herbal
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