ABSTRACT
Background: Bhagandara is a disease of ano-rectal region and can be correlated with fistula-in-ano. Ksharasutra (application of medicated thread) is being practiced for ano-rectal disorders, particularly in Bhagandara. Guggulu-based Ksharasutra has shown good results in previous studies. Literatures and experiments of Shallaki showed anti-inflammatory, antifungal, analgesic, wound healing properties and Shallaki Niryasa (resin of Boswellia serrate Roxb.) is also having binding effect. Here, Shallaki-based Ksharasutra is used in comparison of Guggulu-based Ksharasutra with Triphala Guggulu orally for better outcome in the management of Bhagandara. Aim: The aim of this study was to evaluate and compare the efficacy of Guggulu and Shallaki based Ksharasutra with Triphala Guggulu orally in the management of Bhagandara. Materials and methods: Total 46 patients were registered and randomly allocated by computer generated chart by into three groups. In group A (n = 15), Guggulu-based Ksharasutra was applied in fistula-in-ano without any oral medication; in group B (n = 16), Guggulu-based Ksharasutra was applied with Triphala Guggulu orally; and in group C (n = 15), Shallaki-based Ksharasutra was applied with Triphala Guggulu orally. Patients were assessed for pain, discharge, itching and swelling in the affected region and unit cutting time (UCT) of fistulous tract. Ksharasutra was changed by railroad technique on weekly based follow-up till complete healing of the tract occurred. Results: In group A, relief in pain, discharge, and swelling was found and was statistically highly significant while insignificant result was found in itching after cut through of the fistulous tract and the same results were found in group B (n = 14) and group C (n = 15). The mean UCT was higher in group A (8.94 days/cm) than in group C (8.43 days/cm) and in group B (8.59 days/cm). Conclusion: Shallaki based Ksharasutra is more effective in cutting of fistula track while Guggulu based Ksharasutra is more effective in pain relief in the treatment of Bhagandara, along with oral Triphala Guggulu as compared to Guggulu based Ksharasutra with and without Triphala Guggulu orally.
ABSTRACT
Ksharasutra (parasurgical procedure using a thread treated by alkalies) is being practiced in Indian system of medicine since ancient time for management of ano-rectal disorders; particularly for Bhagandara, (fistula in ano), and generally difficult to treat. In this case series, standard Ksharasutra was prepared as per the Ayurvedic Pharmacopeia of India and used to treat the different cases of Bhagandara. In this case series total 6 patients of Bhagandara were treated with Ksharasutra and partial fistulectomy. The average Unit Cutting Time and healing (UCTH) was observed 7.86 days/cm. During treatment Panchawalkala Kwatha (decoction of five medicinal plant's bark), Shatdhautaghrita, Jatyaditaila and Erandabhrishtaharitaki Churna were used as adjuvant drugs. To generate quality evidence Transrectal Ultra Sonography (TRUS) was used in pre as well as post-treatment and showed remarkable tool to assess effect of treatment. Substantial clinical result was observed at the end of treatment and all the patients were free of fistula. No recurrence was observed in any case during the 12 follow up of 12 months. The treatment was reported safe and well tolerated in all the patients.
ABSTRACT
Amavata is a disease in which vitiation of Vata Dosha and accumulation of Ama take place in joint(s), and it simulates rheumatoid arthritis (RA) at modern parlance. Shamana (conservative) and Shodhana (biological purification of the body) treatments are advised in Ayurveda whereas anti-inflammatory, analgesics, steroids, and disease-modifying antirheumatic drugs are required for its management as per modern medicine, which are not free from side effects. A female was suffering from multiple joints pain with swelling, severe morning stiffness, restricted movements, malaise, and Mandagni (poor appetite) for the past 1½ year, which was classified as Amavata/RA (having 7/10 score as per the RA classification criteria, 2010). After Deepana-Pachana and Snehapana, Virechanakarma was done by the administration of Trivrita Avaleha and castor oil. The assessment was made on the basis of relief in signs and symptoms and serological findings of RA factor, C-reactive protein (CRP), immunoglobulin E (IgE), and erythrocyte sedimentation rate. After Virechanakarma, RA factor reduced from 94.0 IU/ml to 50.0 IU/ml, CRP reduced from 22.7 mg/L to 1.8 mg/L, and IgE was reduced from 680 kU/L to 53.7 kU/L, with remarkable reduction in joints pain and swelling. Further, by avoiding specific Nidanas, i.e., known allergens for food, drugs, and inhalants, the patient has relief in almost all signs and symptoms for the past 1 year of follow-up with least medications. This single case report highlights that Amavata/RA can be managed with appropriate diet regimen, Virechanakarma and can be managed effectively with minimum requirement of medicines.
