ABSTRACT
In the present modern day's world, anorectal disorders are increasing in number due to sedentary lifestyle. They cause great discomfort and make one’s life miserable. Among these fistula in ano is most common. It is challenging to treat due to its recurrent nature. Fistula-in-ano is an inflammatory tract that is lined by unhealthy granulation tissue and has two openings, an external opening present in perianal skin and an internal opening in the anal canal or rectum. Fistula in ano is correlated with Bhagandara in Ayurveda. Acharya Sushruta has mentioned it among Ashta Mahagada and explained five types of Bhagandara. Many treatment modalities have been given for the treatment of fistula in ano, Ksharasutra application is one of them. It is a minimally invasive para-surgical procedure and induces both mechanical as well as chemical cutting and healing of the fistulous tract. This technique has a high success rate but it is time-consuming and causes minimal complication. A 73 years old male patient came to RGGPG Ayurvedic College and Hospital, with a complaint of pain and pus discharge from his left thigh for 7-8 years, he has been diagnosed with a case of recurrent fistula in ano. The patient was treated with partial fistulectomy along with Ksharsutra application and recovered well with complete excision of the tract.
ABSTRACT
Fistula-in-ano is a debilitating disease affecting anorectal region. It is an abnormal tract lined with fibrous tissue and unhealthy granulation tissue. It usually begins from a perianal abscess caused by cryptoglandular infection. The abscess burst spontaneously and forms fistula-in-ano. It may also seen in association with other diseases like Crohn’s disease, lymphogranuloma venereum, actinomycosis, malignancy and TB. It is distressing to the patient and the surgeon due to its recurrent nature and the complications like postoperative incontinence. The disease can be classified as low anal and high anal fistulae on the basis of its internal opening. Perianal subcutaneous fistula is included under low anal fistula. Generally, the modern treatment measures for fistula-in-ano include fistulectomy, fistulotomy, advancement flaps, fistula clip closure, LIFT technique, VAAFT procedure, anal fistula plug repair, fibrin glue and seton technique. The prime aim of the treatment is to eradicate the tract and drain the site of infection while preserving anal continence. In Ayurveda, Fistula-in-ano can be correlated with Bhagandara on the basis of signs and symptoms. Since it is difficult to treat, Acharya Susruta considered it as one among Ashtamahagada. He described the treatment as Shastra Karma, Kshara Karma, Agni Karma. In the present case study, a 35-year old male patient visited the OPD with perianal subcutaneous fistula was selected for Agnikarma after fistulotomy to reduce the treatment period and to improve the quality of living. Daily dressing was done with Jathyadi ghrta and the patient was cured within 21 days of intervention. The follow up was done for next 3 months and no complications were noted.
ABSTRACT
An internal opening (primary opening) in the anal canal or rectum and an exterior opening (secondary opening) in the perianal skin combine to form a ?stula-in-ano, an infiammatory track. Unhealthy fibrous tissue and granulation tissue line this tract. Intersphicteric fistulas are ones that cross the internal sphincter and then have a tract to the outside of the anus leading1. The prevalence of an anal abscess-induced fistula-in-ano ranged from 26% to 38%.In men,the prevalence is 12.3 cases per 100,000 population and in women, it is 5.6 cases per 100,000 population2. Fistula-in-ano is a complicated disease, its signs and symptoms which resembles bhagandara disease described in ?yurved?. ?c?rya su?ruta mentioned this disease under aa mah?gad?s which means difficult to cure. For the management of this painful disease many treatment modalities are enumerated in ?yurved? classics and k?ra s?tra therapy is one among them which is proved to be gold standard. Though k?ra s?tra therapy is a big revolution in the field of fistula in ano, but it has some disadvantages like it is time consuming process, severe post-procedural pain, and big scar marks. In the present case report,A 24yr old male p/t c/o pain and swelling in perianal region since three months and successfully managed with IFTAK (Interception of Fistulous tract and application of Ksharsutra) technique. which showed a greatpotential in management by minimizing the duration of treatment, mild post procedural pain and minimum scar mark
ABSTRACT
Ayurveda is an eternal branch considered as the science of life. Its prime motto is maintaining the health of healthy individual first and then curing the disease, which promotes a disease free, healthy life span. Ayurveda is an abundant ocean full of knowledge consisting of eight superior branches. Amongst them Shalya Tantra is the prime branch rich in surgical concept. History reveals that the period of Acharya Sushrut was the golden era of surgery where various surgical procedures were performed. More over in regards of anorectal and perineal surgery, Acharya has expounded much, with an approach of emphasise both surgical and Para surgical measures. Bhagandara can be screened in ancient Ayurvedic texts and varying systematic, scientific detailed descriptions are found. It is the common ano-rectal disease prevalent in the population worldwide. Because of its tedious nature of healing Bhagandara is considered difficult to be cured also it is found to be one amongst the Ashta Mahagada, where Acharya has explained the limitation of the treatment by considering it as Duschikitsya Vyadhi. Hence this article has emphasized on the available discretion on various types of Bhagandara and its management.
ABSTRACT
Acharya Sushrut has involved Bhagandara among the Ashtamahagad (8 dreadful diseases). At first it is present as Pidika (boil/abscess) in Apakwa (non-suppurated) state, become Bhagandara when it becomes Pakwa (suppurated). As defined in modern science, it is associated with fistula in ano. An anal fistula is an abnormal track having an external opening in the perianal region and internal opening in the anal canal and/or rectum. Ayurveda has a special approach to fistula management. All anal fistulas counter well to different forms of Kshar and Ksheer Sutra therapy. They are nothing but the medicated seton. The Ksheer sutra mechanical and chemical action of drugs coated on the thread work jointly to cut, cure, drain and clean the fistulous tract, thereby promoting track/wound healing. Though Bhrihattrayi, (chief three texts of Ayurveda) stated the use of Kshar Sutra, there is no proper description of their method of preparation. In eleventh century, Chakrapani Datta mentioned the preparation method of Ksheer sutra in his book Chakradatta for the first time which is indicated in Arsha and Bhagandara. Apamarga Kshar Sutra is the standard Kshar Sutra, and but it has some disadvantages. A variety of other Kshar Sutra, as well as Ksheer Sutra, have been prepared to resolve these inconveniences of Apamarga Kshar Sutra. One of them is Udumbara Ksheer Sutra which was founded by Prof. P.J Deshpande and M.K Jalan in 1984. Udumbara is one among the Nyagradhadi Gana Dravya mentioned by Acharya Sushrut. He described in Bhagandara Chikitsa that the Nyagradhadi Gana Dravyas are Bhagandaranashak.
ABSTRACT
From the origin of civilization the people suffered from various diseases and among the many uncomfortable conditions, Guda Roga is one of the most important one. The disease is widely prevalent and numerous options are being practiced for its management. Fistula in ano is one condition for which the maximum types of surgical, parasurgical and medical applications have been described. This divergent approach to the treatment for a single disease is only suggestive of the fact that none of these methods is complete or satisfactory. Sushruta described a detailed surgical approach involving excision of the fistulous tract but also felt the necessity of a parasurgical approach since he was not quite satisfied with the surgical excision which often resulted into recurrence. However, they limited this alternative method called Ksharasutra in selected cases only in which found unfit for surgery. Due to Ksharsutra procedure Recurrence rate is almost nil but it takes very long duration to cut and heal the track. Khadiradi Kwaths helps to inhibit to break pathogenesis of Bhagandara in short time and also prevent the recurrence rate of Bhagandara and hence recurrence rate is nearly nill and it does not take very long duration to cut and heal the track of Bhagandara with minimum expenditure. In our present study we have taken 60 patients, in two groups, 30 patients in each group. The first group is experimental group i.e., Khadiradi Kwath along with standard Ksharsutra and second is control group i.e. only Ksharsutra. We have taken observations viz. age, sex, occupation, Agni, Koshtha etc. by which we can observe the characteristics of disease in these conditions. To assess the nature of disease we have taken assessment criteria like pain, discharge, in duration, foul smell, burning sensation, itching. From above criteria we made the result of effectiveness of treatment by using ‘t’ test on 0.001% level of significance.