In European countries and America herbalists typically use witch hazel both as internal and topical remedy for hemorrhoids, and thus both the European Scientific Cooperative on phytotherapy and France have approved the herb’s combined used for treatments of hemorrhoids 104 In vitro study of witch hazel extract show plant extract inhibit αglucosidase and human leukocyte elastase enzyme which contribute to the degradation of connective tissue, extract also exhibited a strong antiphlogistic effect in the croton oil ear edema test in the mouse . 122 Apart form these plants several other plants are use in various form for the treatment of hemorrhoids, and they are component of polyherbal formulation. In table -1 plant are described with their scientific name, useful part, family, and reference, which are reported antihemorrhoidal properties alone or in combined with other herbs. . Topical treatments In tropical treatment of hemorrhoids to assist locally in claming inflammation and for stopping bleeding and swelling are highly useful. The late Rudolf Fritz Weiss a German physiotherapist, favored the best treatment of acute hemorrhoids with wet compress, he also recommended arnica compresses using 1-2 teaspoons of arnica tincture per half-liter of water for compress. Alternatively he suggested the use of an oak decoction or a chamomile infusion for acute hemorrhoids137 Hamamelis Virginiana alone will often suffice to sooth minor symptoms of acute inflammation; effect of these plants is attribute to presence of tannin in the plant . 137. Several cream based ointments, essential oils are available in markets over the counter drugs for the topical treatment of hemorrhoids, like Neo Healer s Piles Treatment Cream® 138, Hemorrhoids No More® 137, and Pilex ointment ® 141 Flavonoids and Tocotrienols for hemorrhoids treatment . A number of flavonoids have been reported to have antiinflammatory effects and to strengthen blood vessels, so many preparations made for treatment of hemorrhoids, from purified or crude extracts of flavonoids. Several scientific studies favored treatment of hemorrhoids with flavonoids142. But scientific study showed that all flavonoids couldn’t provide the effective treatment for acute hemorrhoids143. Recent study regarding the flavonoids and symptomatic hemorrhoids was carried out by Alonso et al and they reported, reduction in the risk of bleeding, persistent pain, itching, and reoccurrence, but yet more in-depth study with effective methodological quality needed for the apparent beneficial effects of flavonoids for the treatments of hemorrhoids144 Flavonoids particularly diosmin, oligomeric proantho cyaniding complexes (OPCs) and hesperidin, have demonstrated efficacy in the treatment of hemorrhoids and varicose veins. These flavonoids exhibit phlebotonic activity, vasculoprotective effects and antagonism of the biochemical mediators of inflammation . 145 Animal studies have shown flavonoids reduce neutrophil activation, mediate inflammation, and decrease soluble endothelial adhesion molecules . 146. Human trials have shown the ability of flavonoids to 
improve venous tone and vein elasticity assessed by plethysmography, and significant improvement in CVI, venous leg ulcers, and hemorrhoids147. Hemorrhoids treatment during the pregnancy is bit difficult by injection, RBL, and surgery and these techniques are contradicted, and flavonoid treatment is the best option, clinical trials shows treatment did not affect pregnancy, fetal development, birth weight, infant growth and feeding148 Prof. Jacques Nasquelir, France have first received patent for the method of isolation of OPSc from pine bark, in 1951, and form grape seeds in 1970 . 149. In vitro studies shows OPSc to inhibit the enzymes hyaluronidase, elastase, and collagenase, also reported for their antioxidant and free radical scavenging properties150, and OPSc have demonstrated preferential binding to areas characterized by a high content of glycosaminoglycans such as the capillary walls, these properties make them effective in decreasing vascular function, and peripheral circulation, which is the beneficial for the treatment of hemorrhoids151 Tocotrienols are collectively known as vitamin E, and are identical in structure to tocopherols except for the degree of saturation in their side chain, having properties of antioxidant . 152. Tocotrienols are found in high concentration in palm oil and rice bran oil, and are well investigated for their nutrient ional, antioxidant activity, cholesterol lowering, anti-cancer effects and protection against atherosclerosis153. In double-blind placebo-controlled clinical trials tocotrienols found to be improvement in overall symptoms of hemorrhoids 8 Hydrotherapy and Dietary approaches to Hemorrhoids . Dietary habit is the key link for the number of diseases, and diet therapy for hemorrhoids is a widely accepted modality. High fiber diet with commercial fiber supplements and bhenough oral fluids to produce soft, well-formed and regular bowel movements, high fiber diet is an important component to the prevention and treatment of both hemorrhoids and varicose veins. One old myth regarding the diet and hemorrhoids is that “spicy food, including red hot chili powder, produces hemorrhoid symptoms”. Recently one randomized controlled double-blinded trial reported no evidence to support this myth154 The warm sitz bath is the hydrotherapy recommended for the conditions associated with increased pelvic congestion