Health

Bhagandara (Fistula-in-ano): Cure by Ayurveda

Bhagandara (Fistula-in-ano): Cure by Ayurveda
By Nagaland Post | Publish Date: 10/15/2019 7:36:05 AM IST

 BHAGANDARA: The disease in which Bhaga, Guda and Basti Pradeśa becomes Vidaarita (get torn) is known as Bhagandara. In Apakvaavasthā, known as Piḍakā, which in Pakvaavasthā causes Bhagandara.    

FISTULA-IN-ANO: Fistula-In-Ano is an inflammatory track, which has an external opening (secondary opening) in the Peri-Anal skin and an internal opening (primary opening) in the anal canal or rectum. This track is lined by unhealthy granulation tissue and fibrous tissue

NIDĀNA (AETIOLOGY) OF BHAGANDARA: The factors responsible for the cause of Bhagandara may be classified 

• Aharaja factors: 

1) Kashaya-Rasa sevana

2) Ruksha sevana

3) Mithyaahara (Apathya sevana)

4) Asthi yukta ahara sevanaa

• Viharaja factors:

1) Excessive sexual activity

2) Sitting in awkward position

3) Forceful defecation

4) Horse & elephant riding

• Agantuja factors:

1) Trauma by krimi

2) Trauma by asthi

3) Improper use of vasti-netra

• Manasika factors (Mental Disorders)

AETIOLOGY OF FISTULA-IN-ANO: Fistula in ano is divided into

• Non specific: Caused by Crypto-Glandular infection and previous Ano-Rectal abscess.

• Specific: Caused by different diseases and conditions e.g.- Tuberculosis, Crohns disease, Ulcerative colitis, Lymphogranuloma venerum, Actinomycosis, Carcinoma of rectum and anal canal, Previous rectal or Gynological operations, Other abdominal condition producing a pelvic abscess

RUPA (SIGNS & SYMPTOMS) OF BHAGANDARA: The most typical sign and symptoms of Bhagandar are 

• A discharging Vrana within two-finger periphery of  Peri-Anal region with a history of  Bhagandar Pidika, which bursts many times, heals and recurs repeatedly and is painful.

• Specific type of discharge, pain and characters shows in different type of Bhagandar ,according to Doshaja involvement

CLINICAL FEATURES: 

• Swelling, Pain and discharge are the most frequent presenting complaints. 

• Swelling and pain are usually associated with abscess when the external opening is closed.

• The discharge from the external opening is mucous or pus mixed with stool. 

• In majority of cases of Fistula-In-Ano there will be an antecedent history of previous abscess.

CLASSIFICATION OF BHAGANDARA: Acharyas have classified the Bhagandar on the basis of doshik involvement and clinical consideration of its pathogenesis.According to Charak Samhita,There is no description about the types of Bhagandar According to Sushrut there are five types of Bhagandar- 

• Shatponaka- originating from vata dosha.

• Ushtragreeva- originating from pitta dosha.

• Parishravi- originating from kapha dosha

• Shambukavarta- originating from Tridosha

• Unmargi- caused by agantuja factors.

According Aashtanga Sangraha and Hridyam , eight types of Bhagandra are described. Among these five types are same that of Sushrut and other three types are

• Parikshepi- originating from vata and pitta dosha

• Riju- originates from vata & kapha dosha

• Arsho Bhadandra-originates from pitta and kapha dosha.

Acharyas again classified each type of Bhagandar according to its opening whether presents externally or internally

• Parachina (Bahirmukham): Having external opening.

• Arvachina (Antarmukham): Having internal opening

CLASSIFICATION OF FISTULA IN ANO : 

Milligan and Morgan classified the fistulas into 

• High Fistula

• Low Fistula 

Park classified the fistulas into 

• Sub-Mucosal

• Inter-Sphincteric

• Supra-Sphincteric

• Extra-Sphincteric. 

MANAGEMENT OF BHAGANDARA: The management of Bhagandara can be divided in 4 major types: 

A) PREVENTIVE MEASURES: 

1) Diet: 

• Guru (Heavy food)

• Madya (Excess of alcohol)

• Asatmya Ahara (Unwholesome food)

• Virudha Ahara (Antagonist to each other)

• Vishama Ahara (Incompatible foods). 

2) Life style: 

• Strenuous Exercise

• Excessive Coitus

• Anger

• Uncomfortable riding

• Suppression of Natural Urge.

 B) CURATIVE MEASURES: 

1) MEDICAL MANAGEMENT: 

• Chedana is choice of treatment in Bhagandara, but medical manage have also its own importance. As it helps in localizing inflammatory and suppuration, facilitates spontaneous drainage of pus in fistulous abscess, post operative care of the patient, wound management. Some of classical preparations being used orally are- Narayan rasa, Navakarshika guggulu, Saptavinshako guggulu, Saptanga guggulu, Vidangadi leha etc. which acts as both systemic and local. 

• Application Of Vartee (Medicated Wick): Vartee made up of kshara dravya are used. By virtue of ksharana(liquefying) property of kshara, it removes the slough & cleans the fistulous track , thus facilitates drainage. It is commonly used in blind tracks. Eg: vartee made up of latex of snuhi (Euphorbia nerifolia), arka (Calotropis procera) along with daruharidra (Berberis aristata). 

• Application of  Kalka (Medicated Paste): Kalka made up of drugs like Tila (Sesamum indicum), Haritaki (Terminalia chebula), Lodhra (Symplocus racemosa), Reeta (Sapindus trifoliatus), Haridra (Curcuma longa), Vacha (Acorus calamus) etc are used. 

• Application of Kashaya (Decoction): Kashaya are use for washing purpose & also it reduces inflammation, pain. Eg:Triphala kashaya, kashaya made up of Khadira, Triphala, Guggulu, Vidanga.` 

• Application of Taila (Medicated Oil): These are useful in controlling wound infection & promotes healing. Eg: Vishyanadana Taila, Karaviradi Taila, Nishadi Taila, Saindavadi Taila. 

2) SURGICAL MANAGEMENT: General principle of management of Bhagandara is: 

• Virechana (enema for bowel expultion)

• Eshana (probing)

• Chedana (excition) / Patana (laying open of the track)

• Marga vishodana (clensing of fistulous track)

• Dahana (cauterization)

• Vranachikitsa (post op wound management)

• Ksharasutra therapy (laying open of track using ksharasutra, for those persons who are not willing for surgery).

C) PARASURGICAL MEASURE: 

• Rakatamokshana: Jaloukavachrana is one of common method of raktamokshana. It prevents suppuration of Bhagandara pidaka. Minimizes inflammation & infection in post op period. 

• Agnikarma: It is adopted in all kind of Bhagandara except Ushtragreeva. It prevents recurrence & during procedure act as haemostatic.

• Ksharakarma: It can be done by using sutra, vartee, pichu, local application in the form of paste is done. Helps in management of wound by removing

D) ADJUVANT MEASURES: 

• Swedan, Parishek, Avgahan

• Vranashodhan & Vranaropan Lepa

• Varti, Taila, Guggulu, Shothahar Drugs

• Ghrita, Taila, Arishta

• Dipan, Pachan , Mridu Rechak drugs used as adjuvent measures for Bhagandar in different classics.

NOTE: Ayurvedic medicines and treatments should be taken under Qualified Ayurvedic Doctor/Physician. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician. The dose and duration of the treatment may be decided by the physician according to the condition of the patient.

Dr. Imlikumba, Medical Officer (Ayurveda), North Eastern Institute of Folk Medicine (NEIFM), Ministry Of AYUSH, Govt. of India, Pasighat: Arunachal Pradesh

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