Nimsai Herbal for Grade 2-3 Hemorrhoids: A Quadruple-Blind Placebo-Controlled Mechanistic Trial

Inclusion Criteria: * Endoscopically confirmed Grade 2 or 3 internal hemorrhoids History of hemorrhoidal symptoms persisting for more than 6 weeks prior to screening Age 18 to 70 years inclusive at time of informed consent Willingness and ability to provide written informed consent Willingness and ability to comply with all study procedures, schedules, and follow-up requirements Exclusion Criteria: * Diagnosis of Grade 1 or Grade 4 hemorrhoids Any known anorectal malignancy or suspicion of malignancy Active bleeding from sources other than hemorrhoids Currently pregnant or lactating women, or women of childbearing potential not using effective contraception Known hypersensitivity or allergy to any component of Nimsai Herbal or placebo Significant systemic diseases including severe cardiovascular disease, severe renal impairment, severe hepatic dysfunction, or uncontrolled diabetes mellitus (HbA1c \> 9%) Any medical or psychiatric condition that might compromise participant safety or data integrity Participation in another interventional clinical trial within 30 days prior to screening Use of concurrent treatments for hemorrhoids within 7 days prior to screening History of hemorrhoidectomy or other invasive hemorrhoid procedures within the last 6 months