ROLE OF GUGGULU-APAMARGA KSHARASUTRA IN THE MANAGEMENT OF BHAGANDARA (FISTULA IN ANO)

ABSTRACT

Bhagandara?(Fistula-in-ano) is explained as one among Ashta Mahagada ( eight major diseases) in Sushruta Samhita1. This disease is recurrent in nature which makes it more difficult to treatment. So, it produces inconven- ience in routine life. The concept of?Kshara sutra?has been explained in the context of?Nadivrana?(sinus) by Acharya Sushruta2.?Ksharasutra?being a medicated thread prepared as per the standard protocol has been proved as a big revolution in the treatment of fistula-in-ano.?Ksharasutra?plays an important role, and the efficacy has been explained in various studies. Treatment of fistula-in-ano with?Ksharasutra?is a simple parasurgical procedure with low complications and minimal cost. Thus,?Ksharsutra?is very effective with a minimum invasive surgical modality for the management of?Bhagandara?(fistula-in-ano). One diagnosed case of?bhagandara?was taken from the OPD of Vaidyaratnam Ayurveda foundation and was applied with?Guggulu-Apamarga Ksharasutra.

Keywords:?Bhagandara, Ksharasutra, Guggulu- Apamarga Ksharasutra

INTRODUCTION

In the present era of the 21st?century, anorectal dis- eases like?Arshas?(piles) and?Bhagandara?(fistula in ano) have become the most common and among them,?Bhagandara is considered under the Ashta Mahagada (Eight major diseases). It is a chronic illness which is thought not fatal but quite discomforting and troublesome to the patient. It often puts a deep impact on the quality of life of the patient. The word?Bhagandara?is composed of two words:?bhaga?and?dara- na.?Bhaga?means a region around the anus which ex- tends between the anus to the genitalia.?Darana?means to tear or destroy. Therefore, the?Pidika?(ab- scess) which develops in this region and leads to the?Bhagandara?(fistula), is known as?“Bhagandara Pi-?dika”3. A disease/sinus that tears or damage the area around the genitalia, urinary bladder, and anus is known as?Bhagandara.?Often, it results after the bursting of?Bhagandara Pidika?or an abscess in this region. The sinus may discharge flatus, faeces, urine, seminal fluid, menstrual fluid, or even worms some- times. The disease is named?Bhagandara?since it oc- curs in the rectum, perineum, bladder, and adjoining space (the entire area is called?Bhaga). The pustules which appear in this region are called?Pidika?in their non suppurative stage while they are called?bhagan- dara?in their suppurative stage4. Acharya Sushruta?described?Bhesaja Chikitsa, Kshara Karma,?Agni Karma, and?Shastra Karma Chikitsa?for ano-rectal diseases4. Bhagandara?is a?Chedya(excision)?vyadhi. Kshara karma?has become a very useful and recently modified method of treatment for selected anorectal diseases mainly in?Bhagandara.?The?Ksharasutra?is a para-surgical measure capable to perform excision slowly by virtue of its mechanical pressure and chem- ical action in?bhagandara. Complete and detail de- scriptions about?kshara sutra?preparation are not available in?Sushruta samhita. The present form of?kshara sutra?therapy was initiated department of Shalya Tantra at Banaras Hindu University. It con- sists of 11 coatings of?Snuhi Ksheera, 7 coatings ofApamarga Kshara, and the last 3 coatings of?Haridra Churna.

CASE REPORT

In the present case study, a 48-year-old male patient came to our OPD of Shalya Tantra, Vaidyaratnam ayurveda foundation hospital, Thaikkattussery with the chief complaints of pain and pus discharge from the perianal region since last 1 month. The patient had a history of constipation for the past 1 month. He was an auto driver by occupation, who use to have prolonged sitting for nearly 6 hrs, a daily intake of spicy food, especially a non-vegetarian diet. He also had the habit of smoking and intake of alcohol for 10 yrs. No history of any major illness was found. On examination external opening was present at 12 o' clock at the perianal region approximately 4 cm away from the anal verge. The internal opening was also at 12 o' clock position into the anal canal at the dentate line on digital per rectal examination. Probing also was done to confirm the site of the internal opening of?Bhagandara.?The patient was diagnosed with a case of?Bhagandara?(fistula-in-ano) on the basis of clinical presentation.

Laboratory investigations?–?HIV, HCV, VDRL- non- reactive RBS, LFT, RFT, CT, BT -normal.

Treatment is given - After the due consent of the pa- tient, he was planned for?Apamarga Ksharasutra?management. After the application of xylocaine jelly 2%probing was done and then?Apamarga Ksharasu- tra?was ligated into the fistulous track. The patient was advised to maintain local hygiene by sitz bath in lukewarm?Triphala Kashaya?and also take care of proper bowel habits. Following internal medicines were given.

Guggulutiktakam kashayam?twice daily before food

Guggulupancapala choornam?1 tsp with honey twice daily after food

Kaishora guggulu gulika?1 -0-1 with Kashaya

Bruhath triphala choornam?1 tsp with hot waterbed time.

Daily cleaning and dressing with?Jathyadi varti?were done.?Ksharasutra?was changed weekly by the Rail- Road technique till the complete cutting of the fistu- lous track.

The initial length of the track was 8cm which got cut through in 28 days.?Kshara sutra?was changed week- ly once and at that time it causes burning pain in ano only for one day and got subsided after taking a sitz bath. The unit cutting length of the track was 2 cm per week. No signs and symptoms of recurrence were observed.

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