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Parikartika (Fissure-in-ano): Cure by Ayurveda

Parikartika (Fissure-in-ano): Cure by Ayurveda
By Nagaland Post | Publish Date: 10/20/2019 4:58:48 AM IST

 PARIKARTIKA; Parikartika itself denotes the cutting pain .Though now a day’s Parikartika is separate disease but in the history it was mentioned a complication of some other disease or some Ayurvedic procedures like Basti. Kashyap has described Parikartika as complication in pregnancy. Sushruta mentioned Parikartika as a complication of one of the Panchakarma treatment –Basti . Considering treatment of Parikartika the main objective of treatment is to relieve pain, which provides relaxation of Sphincter. Sushruta has advised to treat this condition same as wound management mentioned in Sadyakshta vidi (Treatment of traumatic injury). Kashyapa has given detailed medicinal treatment of this diseases. He says oral medicines should be prepared by Madhuka (Glycyrrhiza Glabra), Kantakari (Solanum Surattense), Shwadaunshtra (Tribulus Terrestirs) etc. according to Dasha Pradhanya 

FISSURE-IN-ANO: An anal fissure is an elongated ulcer in the long axis of anal canal. It is usually encountered in young or middle aged adults, but is sometimes seen at other ages, including infancy and early childhood. An anal fissure is either acute or chronic. 
• Acute Anal Fissure is a deep tear through the skin of the anal margin extending into the anal canal. There is little inflammatory indurations or oedema of its edges. There is accompanying spasm of the anal sphincter muscle. 
• Chronic Anal Fissure is those which present for more than 6 weeks, often have a sentinel tag at the distal aspect caused by inflammation.
NIDĀNA (AETIOLOGY) OF PARIKARTIKA: The factors responsible for the cause of Parikartia may be classified 
• Diet plays very important role in Parikartika.
• Intake of Mudga, Kodrava, Chanaka and such other pulses and Rooksha aharas which are water absorbent in nature (Sangrahi) leading to constipation. 
• Apanavata gets aggravated in its own seat (Pakwashaya) which blocks the adhovaha srotas, dries them up (of their moisture) and produces obstruction to the movement of feces, flatus and urine by which Parikartika occurs.
• As per modern science intake of non fibrous food will leads to hardening of stools and cause Fissure-in-ano.
• When Vata is covered with feces, the stool is constipated, patient suffers from severe pain and passes hard stools with difficulty and evacuation is delayed. This causes Parikartana leading to Parikartika .
• If a person debilitated with Mridukoshta or Mandagni, the ingestion of Atirooksha, Atiteekshna, Atiushna, Atilavana ahara causes Dushana Of Pitta and Vata and produces parikartika.
AETIOLOGY OF FISSURE-IN-ANO: Fissure-In-Ano is divided into
• Constipation has been the most common aetiological factor.
• Spasm of internal Sphincter has also been incriminated to cause Fissure-In-Ano.
• When too much skin has been removed during operation for haemorrhoids, anal canal stenosis may result in which anal fissure may develop when hard motion passes through stricture.
• Secondary causes of anal fissure must be remembered. These are
1) Ulcerative colitis
2) Crohn’s disease
3) Syphilis
4) Tuberculosis
CLINICAL FEATURES: 
• Anal pain, bright red bleeding, perianal swelling and occasionally mucous discharge.
• The pain is sharp, agonising pain starting during defecation, often overwhelming in intensity and lasting for an hour or more. 
• A dull ache is usually experienced for 3-4 hours after defecation.
• Sometimes it may ceases suddenly, and the sufferer is comfortable until the next action of the bowel. 
• Periods of remission occur for days or weeks.
• The patient tends to become constipated rather than go through the agony of defecation.
• Bleeding is only small in amount, is bright red in color. 
• Profuse blood loss is rare.
• Swelling and discharge are characteristic of chronic fissure, which maybe complicated by pruritis ani and perianal excoriation.
• Chronic Fissures often have a sentinel tag at the distal aspect caused by inflammation.
MANAGEMENT OF PARIKARTIKA: Up to 70% of acute fissure resolve with conservative medicine, if not they progress to form a chronic fissure. However, Ayurvedic preparations are used in primary stage of disease the chance to progression in chronic one can be minimized. The main aim of treatment is to relive sphincter spasm and healing of fissure wound, soothing of anal canal and to relieve the agonizing pain and associated burning sensation and bleeding. In general the aim of treatment is sampraptivighatan or reduces the strength of vyadhighatkasie
• Treatment of vibandha has lot of importance. Due to purisa vega avaroadha there is vitiation of vāyu (apānavayu) leads to vivandha as well as Parikartika. So the cycle should be broken.
• The mandaagni is most important factor of Parikartika as well as in arsa, atisara, grahani. So Increasing and maintain the agni in equilibrium state is necessary. 
• In the treatment of Parikartikathe ĀcāryaCarak gave special importance to āma.
1) samadosha-a) langhan b) pachan c) rooksh ausnalaghubhogan
2) amajirna-anubandheshu (nirama state by vrddha vāgbhata)-use of kshār, amla, madhu Ācārya Carak also mention to take brimhana and madhuradrava in emaciated patient.
3) In vāta predominant condition-the following medicine should taken by patient
• Sarpi prepare with dadima rasa added with puşpa-kāsis or kşhara or lavan.
• Food and drink containing sour curd mixed with the skin of dadima (pomegranate)
• Paste of devadaru and tila along with warm water
• Milk boiled by adding aśvattha, udumbara, plaksa, and kadmba
4) In the Jwara -CikitsāĀcāryaCaraka has also mentionedthat in Jwarita person, there are chances of having Parikartikā. He should consume Peya of red rice made from decoction of Brakshamala, Bera, Pithivana, Kantakāri with powder of unriped fruit of Bela’s cortex.
• In relation with garbhani chikitsa Ācārya Kasyapa, classified the disease in three category and give specific treatment according to the doshas.
• Though among the various preparations Piccha Basti and anuvasan Basti has given special importance. Picchā Basti is specially advice when there is piccha Srava or asrasrava, especially for stambhan purpose. Anuvāsana Basti has ability to treat the vitited Apāna Vāyu.
• Picchā Basti should be given in cold state prepapre by kaŝāya and madhurdrava. Anuvāsana Basti should be given with Yastimadhu Siddha Taila.
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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