Neoteric Management of Bhagandara: Arka Kshara Sutra Varti
Journal name: Ayushdhara
Original article title: Neoteric Technique towards the Management of Bhagandara w.s.r. to Blind External Fistula: Arka Kshara Sutra Varti
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Aarushi Prasher
P.G. Scholar, Department of Shalya Tantra, Jammu Institute of Ayurveda & Reasearch, Nardini (Raipur), Jammu
H.S.Bali
Professor & HOD, Department of Shalya Tantra, Jammu Institute of Ayurveda & Reasearch, Nardini (Raipur), Jammu
Ayushdhara:
(A peer-reviewed, bi-monthly open-access journal)
Full text available for: Neoteric Technique towards the Management of Bhagandara w.s.r. to Blind External Fistula: Arka Kshara Sutra Varti
Year: 2021 | Doi: 10.47070/ayushdhara.v8i6.849
Copyright (license): CC BY-NC-SA 4.0
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Summary of article contents:
Introduction
Fistula-in-ano, clinically referred to as Bhagandara in Ayurveda, is a chronic condition characterized by a tubular structure connecting the anal canal to the perianal skin, often leading to persistent infection and discharge. It typically features two openings, an internal and an external, but in the case of a 'Blind external fistula,' the internal opening closes, leaving only the external opening. Acharya Sushruta described Bhagandara as one of the eight grave diseases and emphasized the use of Kshara Sutra—a treatment involving medicated thread for surgical intervention. This study investigates the efficacy of Arka Kshara Sutra Varti, an alternative treatment engaging alkaline wicks for managing blind external fistulas.
Efficacy of Arka Kshara Sutra Varti
The study focused on the administration of Arka Kshara Sutra Varti on fifteen patients diagnosed with blind external fistula. The preparation involved placing a piece of Arka Kshara Sutra in Jatyadi oil and inserting it into the fistulous tract, which was changed every alternate day for six weeks. Outcomes were evaluated through objective (Unit Healing Time) and subjective measures (pain, discharge, itching, burning sensation). Results showed statistically significant improvements in all subjective parameters with an average UHT of 7.16 days/cm, indicating efficient healing. Notably, 66.67% of patients experienced complete healing without recurrence during a six-month follow-up.
Mechanism of Action
The therapeutic benefits stem from the properties of Arka, which is fortified with anti-bacterial, anti-fungal, and anti-inflammatory attributes. These properties contribute to pain alleviation, reduction of purulent discharge, and overall improvement of the fistulous tract's condition. The vedanasthapana (pain-relieving) nature of Arka assists in managing discomfort while its krimighana property cleanses the infected area, promoting the formation of healthy granulation tissue. Furthermore, the gradual chemical action of the Kshara Sutra facilitates the breakdown of tough fibrous tissue in the fistulous tract, providing a conducive environment for healing and minimizing the chances of recurrence.
Conclusion
The Arka Kshara Sutra Varti technique presents an effective and less invasive therapeutic option for managing blind external fistulas, emphasizing minimal surgical intervention with significant efficacy. The study demonstrates its potential as an alternative to conventional methods, showcasing reduced recovery time and negligible loss of sphincter muscle tone. Further comparative studies with larger sample sizes are recommended to establish the broader applicability and effectiveness of this innovative Ayurvedic approach in treating fistula-in-ano.
FAQ section (important questions/answers):
What is the condition described as 'Blind external fistula'?
Blind external fistula is a chronic inflammatory tubular structure with one external opening only. This condition occurs when the internal opening of a classical anal fistula may close, leading to discharge through the external opening.
How is 'Arka Kshara Sutra Varti' used in treatment?
'Arka Kshara Sutra Varti' involves inserting an alkaline wick into the fistula tract. It promotes healing by dissolving tough fibrous tissue and helps in drainage, with a reported average healing time of approximately 7.16 days per centimeter.
What were the results of the treatment with 'Arka Kshara Sutra Varti'?
The treatment produced statistically significant improvements in pain, discharge, itching, and burning sensations. Two-thirds of patients experienced complete healing, demonstrating its efficacy in managing blind external fistulas without recurrence.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Neoteric Management of Bhagandara: Arka Kshara Sutra Varti”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Arka:
Arka is a medicinal plant described in the study, known for its various properties including Vedanasthapana (pain alleviating), Vatahara (alleviates Vata Dosha), Shothahara (anti-inflammatory), Krimighana (anti-microbial), and Shodhana (cleansing). It is a key component in the preparation of Kshara Sutra Varti.
2) Bhagandara (Bhagamdara):
Bhagandara, correlated to anal fistula in contemporary medicine, is one of the Ashta Mahagadas (eight grave diseases) described in Ayurveda. It is a chronic disease characterized by an abnormal connection between the ano-rectal canal and perianal skin.
3) Pain:
Pain is a primary subjective parameter evaluated in the study. Arka Kshara Sutra Varti's effectiveness in relieving pain is attributed to the Vedanasthapana properties of Arka, leading to less inflammation and discomfort in patients suffering from Blind external fistula.
4) Kshara (Ksara):
Kshara refers to the alkaline substance used in Ayurvedic surgeries. Arka Kshara is specifically mentioned in the study for the preparation of Kshara Sutra Varti, which is used to treat the tough fibrous tissue of a fistulous tract by dissolving it and promoting healing.
5) Varti (Vartin):
[see source text or glossary: Varti]
6) Sutra:
Sutra means 'thread' in Ayurveda. In the context of this study, it refers to the Kshara Sutra, a specially prepared thread used in the treatment of Bhagandara (anal fistula) by applying it to the fistulous tract to promote healing and prevent recurrence.
7) Ksharasutra (Ksarasutra, Kshara-sutra):
Ksharasutra is an Ayurvedic treatment method that involves the use of a specialized thread covered in Kshara (alkali) to treat conditions like Bhagandara (anal fistula) and Nadi Vrana (sinus). It promotes healing by removing debris and encouraging fresh granulation tissue.
8) Burning sensation:
Burning sensation is one of the subjective parameters for assessment in the study. Arka Kshara Sutra Varti, with its Shothahara (anti-inflammatory) and Krimighana (anti-microbial) properties, effectively reduces burning sensations, thereby improving patient comfort.
9) Disease:
Disease in this context specifically refers to anal fistula or Bhagandara. The study evaluates Ayurvedic treatments for this chronic condition, which is characterized by an abnormal connection between the anal canal and the skin around the anus, causing pain, discharge, and discomfort.
10) Bali:
[see source text or glossary: Bali]
11) Ayurveda (Ayus-veda):
Ayurveda is the ancient Indian medical system that forms the foundation of the treatments discussed in the study. It involves using natural remedies, such as the Kshara Sutra Varti, for managing chronic conditions like Bhagandara (anal fistula).
12) Shalyatantra (Salyatantra, Shalya-tantra, Shalyatamtra):
[see source text or glossary: Shalya-tantra]
13) Inflammation:
Inflammation is commonly seen in patients with Bhagandara (anal fistula). The anti-inflammatory properties of Arka, used in the Kshara Sutra Varti, help in reducing inflammation, pain, and discomfort, thus aiding the healing process.
14) Swelling:
Swelling (Ashunam) is one of the characteristics of a wound that is assessed for the healing process. In the study, the application of Arka Kshara Sutra Varti helps reduce swelling, thereby contributing to the overall healing of the fistulous tract.
15) Tantra (Tamtra, Tantrism):
[see source text or glossary: Tantra]
16) Shalya (Salya):
[see source text or glossary: Shalya]
17) Pidika:
Pidika refers to the initial swelling or boil that precedes the development of Bhagandara (anal fistula) according to Ayurveda. Without proper treatment, this Pidika bursts and forms Bhagandara, characterized by multiple openings and discharge.
18) Sugar:
Sugar levels are part of the routine biochemical investigations conducted on patients. Monitoring sugar levels, including fasting and postprandial blood sugar, helps ensure that patients are fit for the Arka Kshara Sutra Varti treatment and excludes complications like diabetes.
19) Blood:
Blood investigations, such as hemograms and tests for HIV, VDRL, and Hepatitis B, are crucial for patient selection criteria. Ensuring normal blood parameters is necessary to rule out conditions that might affect the efficacy and safety of the treatment.
20) Guda:
Guda refers to the anal region in Ayurveda, where Bhagandara (anal fistula) typically develops. The term Bhagandara itself means a condition involving 'Darana' (tearing) around the Guda, and the study focuses on treating fistulas in this area.
21) Vedanasthapana (Vedana-sthapana):
Vedanasthapana refers to pain-alleviating properties, crucial for reducing pain in patients suffering from Bhagandara (anal fistula). Arka, used in Arka Kshara Sutra Varti, is noted for its Vedanasthapana properties, making it effective for this treatment.
22) Antibiotic (Antibacterial):
Anti-bacterial properties are essential for treating infections in Bhagandara (anal fistula). Arka Kshara Sutra Varti is noted for its anti-bacterial attributes, which help in cleaning the tract, reducing infections, and promoting healthy tissue formation without the need for antibiotics.
23) Nadivrana (Nadi-vrana):
Nadi-vrana (sinus) is another condition treated using Kshara Sutra. In the treatment of Bhagandara (anal fistula), Nadi-vrana is referenced in the context of applying Kshara Sutra to promote healing through the removal of unwanted tissue and infection.
24) Shodhana (Sodhana):
Shodhana refers to the cleansing properties crucial in treating Bhagandara (anal fistula). Arka, used in the Arka Kshara Sutra Varti, possesses Shodhana properties that help in cleaning the fistulous tract by removing infected and necrosed tissue.
25) Pradesha (Pradesa):
[see source text or glossary: Pradesha]
26) Vatahara (Vata-ahara):
Vatahara means alleviating Vata Dosha, the primary cause of pain and inflammation in Ayurveda. Arka, used in Arka Kshara Sutra Varti, has Vatahara properties, making it effective in reducing pain and inflammation in the treatment of Bhagandara (anal fistula).
27) Samhita:
[see source text or glossary: Samhita]
28) Jatyadi:
Jatyadi oil is used for soaking the Arka Kshara Sutra Varti before its insertion into the fistulous tract. This oil has properties that further aid in the healing process and enhance the effectiveness of the Varti when treating Bhagandara (anal fistula).
29) Vrana:
Vrana means wound or ulcer in Ayurveda. Bhagandara (anal fistula) is treated as a type of Vrana. Arka Kshara Sutra Varti's application helps to clean and heal the Vrana by removing infected tissue and promoting healthy granulation.
30) India:
India is the origin of Ayurveda, the ancient medical system used to treat Bhagandara (anal fistula) with traditional methods like Kshara Sutra Varti. The country's diverse flora, including medicinal plants like Arka, plays a significant role in Ayurvedic treatments.
31) Katu:
Katu refers to a pungent taste, a characteristic of Arka, one of the plants used in the Kshara Sutra preparation. Its Katu Rasa contributes to its therapeutic properties, including anti-inflammatory and antimicrobial effects, essential for treating Bhagandara (anal fistula).
32) Nadi (Nadin):
[see source text or glossary: Nadi]
33) Shri (Sri, Sr):
[see source text or glossary: Shri]
34) Viru:
[see source text or glossary: Viru]
35) Curcuma longa:
Curcuma longa (turmeric) is used in the study's preparation of Kshara Sutra as Haridra Churna (turmeric powder). It is known for its anti-inflammatory, antimicrobial, and wound-healing properties, contributing to the effectiveness of the treatment for Bhagandara (anal fistula).
36) Sushruta-samhita (Susruta-samhita):
Sushruta Samhita is an ancient Ayurvedic text by Acharya Sushruta, which describes surgical techniques and treatments like Kshara Sutra for conditions such as Bhagandara (anal fistula). It provides the foundational knowledge for the procedures used in this study.
37) Krurakoshtha (Krurakostha, Krura-koshtha):
Krura Koshtha is one of the patient characteristics observed in the study, referring to individuals with a hard bowel. Understanding Koshtha types helps in tailoring Ayurvedic treatments effectively, as bowel conditions can affect the healing process of Bhagandara (anal fistula).
38) Tuberculosis:
Tuberculosis is one of the exclusion criteria for the study. Patients with tuberculosis were excluded from the trial to ensure that the condition did not complicate the treatment or skew the results of the efficacy of Arka Kshara Sutra Varti for Bhagandara (anal fistula).
39) Sutrasthana (Sutra-sthana):
[see source text or glossary: Sutrasthana]
40) Shothahara (Sothahara, Shotha-hara):
Shothahara means anti-inflammatory, a property of Arka used in the Kshara Sutra Varti. This attribute is crucial in reducing the inflammation associated with Bhagandara (anal fistula), facilitating pain relief and promoting healing.
41) Vatadosha (Vatadosa, Vata-dosha):
Vata Dosha is one of the three doshas in Ayurveda, primarily responsible for biological functions related to movement and pain. The Arka Kshara Sutra Varti targets Vata Dosha, alleviating pain and inflammation in the treatment of Bhagandara (anal fistula).
42) Discussion:
The discussion section of the study elaborates on the findings and efficacy of Arka Kshara Sutra Varti in managing Bhagandara (anal fistula). It highlights the significant pain relief, reduced discharge, and effective healing observed in the trial.
43) Education:
Education refers to the academic environment where the study was conducted. The Department of Shalya Tantra at Jammu Institute of Ayurveda and Research provided the educational and research basis for investigating the Arka Kshara Sutra Varti treatment.
44) Apamarga:
Apamarga is another plant traditionally used in Kshara Sutra preparation. The study on Arka Kshara Sutra Varti mentions the need for alternate plants like Arka due to the limited availability of Apamarga globally, ensuring a broader applicability of the treatment.
45) Prakriti (Prakrti):
Prakriti refers to a person's constitution in Ayurveda. The study observed that most patients had Vatakaphaja Prakriti, which influenced the treatment approach. Understanding Prakriti helps in tailoring Ayurvedic treatments to individual patient needs.
46) Guggulu:
Guggulu (Commiphora mukul) is administered orally to patients in the study as Navkarshik Guggulu. It is used for its anti-inflammatory and healing properties, complementing the Arka Kshara Sutra Varti therapy for Bhagandara (anal fistula).
47) Lekhana:
Lekhana refers to scraping properties. In the context of the study, Arka used in Kshara Sutra Varti has Lekhana properties, which help in scraping off dead or necrosed tissue from the fistulous tract, aiding in the cleansing and healing process.
48) Koshtha (Kostha):
[see source text or glossary: Koshtha]
49) Sharada (Sarada, Sara-da):
[see source text or glossary: Sharada]
50) Haridra:
Haridra, or Curcuma longa (turmeric), is used as Haridra Churna in the preparation of Kshara Sutra. It has significant antimicrobial, anti-inflammatory, and wound-healing properties, enhancing the effectiveness of the Varti in treating Bhagandara (anal fistula).
51) Ropana:
Ropana means healing in Ayurveda. The Arka used in Kshara Sutra Varti possesses Ropana properties, which promote the healing of the fistulous tract by encouraging healthy granulation tissue and reducing inflammation and infection.
52) Shotha (Sotha):
Shotha means swelling, a common symptom of Bhagandara (anal fistula). The study shows that Arka possesses Shothahara (anti-inflammatory) properties, which help in reducing swelling and enhancing the healing process when used in Kshara Sutra Varti.
53) Ruksha (Ruksa):
Ruksha means dryness, one of the qualities (Guna) of Arka used in the Kshara Sutra Varti. This dryness helps in absorbing moisture and reducing infection in the fistulous tract, contributing to a cleaner and healthier healing environment.
54) Angula (Amgula):
Angula, a measurement unit, is used to describe the depth and circumference of the initial swelling (Pidika) in Bhagandara (anal fistula). Proper measurement helps in accurately gauging the extent of the condition and deciding the treatment approach.
55) Vipaka:
[see source text or glossary: Vipaka]
56) Darana:
Darana means tearing or perforation. Bhagandara, as discussed in the study, involves Darana around the Guda (anal region), Yoni (genital area), and Basti (bladder area), leading to the formation of fistulous tracts.
57) Sharman (Sarma, Sharma, Sarman):
[see source text or glossary: Sharma]
58) Nature:
[see source text or glossary: Nature]
59) Labour (Labor):
[see source text or glossary: Labour]
60) Powder:
[see source text or glossary: Powder]
61) Dosha (Dosa):
Dosha refers to the three biological energies (Vata, Pitta, and Kapha) in Ayurveda that govern physical and mental processes. An imbalance in Vata Dosha is typically attributed to the pain and inflammation seen in Bhagandara (anal fistula).
62) Vidhi:
[see source text or glossary: Vidhi]
63) Laghu:
[see source text or glossary: Laghu]
64) Tikta:
[see source text or glossary: Tikta]
65) Ushna (Usna):
[see source text or glossary: Ushna]
66) Basti:
Basti refers to the bladder region in Ayurveda. Bhagandara can involve Darana (tearing) around the Guda (anal region), Yoni (genitals), and Basti (bladder), leading to serious complications if not properly managed with treatments like Kshara Sutra Varti.
67) Krura:
[see source text or glossary: Krura]
68) Virya:
[see source text or glossary: Virya]
69) Snuhi:
Snuhi Ksheera (latex of Euphorbia nerifolia) is a crucial ingredient in the preparation of Kshara Sutra. Its properties complement those of Arka, making it effective in dissolving fibrous tissue in the fistulous tract and aiding in the healing process.
70) Ayus (Ayush):
[see source text or glossary: Ayush]
71) Arshas (Arsa, Arsha, Arsas):
Arsha refers to hemorrhoids in Ayurveda. The Kshara Sutra technique, initially mentioned for treating Bhagandara (anal fistula), is also applicable for managing Arsha, reducing symptoms and promoting healing effectively.
72) Ashta (Asta, Astan, Ashtan):
Ashta indicates 'eight', referenced in the term Ashta Mahagadas, which includes Bhagandara among eight grave diseases in Ayurveda. The study focuses on treating Bhagandara, illustrating its severity and the necessity for effective interventions like Kshara Sutra Varti.
73) Fever:
Fever is often associated with Bhagandara Pidika, the initial stage of Bhagandara (anal fistula). Proper treatment at this stage can prevent the progression to fully developed Bhagandara, characterized by more severe symptoms and complications.
74) Yoni (Yonin):
Yoni refers to the genital region. Bhagandara involves Darana (tearing) around the Guda (anal), Yoni (genital), and Basti (bladder) areas, resulting in fistulous tracts that require effective treatments such as Kshara Sutra Varti for healing.
75) Rasa (Rasha):
[see source text or glossary: Rasa]
[Note: The above list is limited to 75. Total glossary definitions available: 77]
Other Science Concepts:
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