Arsha is a common anorectal disorder described in Ayurveda and is correlated with hemorrhoids or piles in modern medicine. It is characterized by swelling of veins in the anal canal associated with pain, bleeding, itching, and discomfort during defecation. Ayurveda considers Arsha as one of the “Ashta Mahagada” due to its chronic and difficult nature. Various treatment modalities such as Shamana Chikitsa, Shodhana Chikitsa, Kshara Karma, Agni Karma, and surgical procedures are described for its management. Among the external therapies, Lepa Chikitsa plays an important role in reducing local inflammation, pain, burning sensation, and swelling. Lepa refers to the external application of medicated herbal paste over the affected area for therapeutic purposes. This article highlights the Ayurvedic concept of Arsha and emphasizes the role of Lepa Chikitsa in its management.