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    Anal Fistula: Ayurvedic idea, Types, Treatment

    Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa B.A.M.S
    Anal fistula has ben compared to a condition caled ‘Bhagandara’ explained in Ayurveda due to resemblance in clinical picture.
    Painful blisters (boils, eruptions) ocuring al around the guda (anal region) encroaching an plot of 2 angulas, when crash open are caled as Bhagandara. They are of 5 types.
    Painful blisters (boils, eruptions) ocuring al around the guda (anal region) encroaching an space of 2 angulas, when break start are caled as Bhagandara. They are of 5 types.
    Thus Bhagandara means – painful blisters which initiate up, ocur around the anal opening and violate around an area of 2 angula dimension al around the guda.
    Table of Contents
    Sanskrit verse
    Types of Bhagandara

    Shataponaka Bhagandhara
    Ushtragreva Bhagandhara
    Prisravi Bhagandara
    Shambukavarta Bhagandara
    Agantuja Bhagandara
    Prognosis of Bhagandara
    Bhagandara Chikitsa

    Apakwa Pitika Chikitsa
    Pakwa Pidika Chikitsa
    Shataponaka Bhagandara Chikitsa
    Ushtragreva Bhagandara Chikitsa
    Parisravi Bhagandara Chikitsa
    Agantuka Bhagandara Chikitsa
    Panchakarma treatment
    Arsha Chikitsa
    Sanskrit verse
    The disease which causes painful and draining openings in and around guda (anal region), vasti (urinary blader) and bhaga (pubic position, perineum, vaginal region, genital area) is caled Bhagandara. When this blister remains unripe it is caled Pidaka, when the same gets ripened it wil be caled Bhagandara.
    Types of Bhagandara
    Bhagandara is of 5 types. They are as below mentioned –
    Shataponaka Bhagandhara
    Vataja or Shataponaka Bhagandara
    Causes – lavish consumption of Kashaya (fod predominant in astringent taste) and Rukhsa (dry) fods
    Pathogenesis – The Vata agravated due to the above said causative factors wil cause a pidaka or blister in the anal region. This pidaka when neglected gets ripened (supurated). This is caled Vataja Bhagandara
    Symptoms –
    Pakwa Pidaka ̵ ripened blister
    Daruna Ruja ̵ harsh pain
    Bhina aruna phena vahini – when the blister opens it presents aruna (redish yelow) and phena (froathy) discharges
    Aneka vrana – many openings
    Mutra-puresha-retasam agame – discharge of urine, stols and semen through multiple orifices of the fistula
    Ushtragreva Bhagandhara
    Paitika (Ushtragreva) BhagandaraCauses – abundant consumption of Pita agravating fods and lifestyle practices
    Pathogenesis – The Pita agravated due to the above said causes a red coloured blister near the anal situation. This is caled Pitaja or Paitika Bhagandara.
    Symptoms –
    Ashupaki – the lesions get ripened quickly
    Ushna srava – hot discharges
    Puti srava – foul smeling discharges
    Ushtra shiro gharam – shape of the blister resembles the neck of a camel
    Read related:Anal Fistula: 25 Diet And Lifestyle Tips To Avoid Repeated Infection
    Prisravi Bhagandara
    Kaphaja (Parisravina) Bhagandara
    Causes – abundant consumption of Kapha agravating fods and lifestyle practices
    Pathogenesis – The kapha agravated due to the above said causes a blister in the anal plan. This is caled Kaphaja Bhagandara.
    Symptoms –
    Kanduyana – itching
    Ghana srave – dense discharges (thick)
    Kathina – wearisome in consistency
    Manda vedana – mild pain
    Shweta avabhasa – white coloured
    This is caled Parisravi Bhagandara because the chunky discharges put flowing from the blisters.
    Shambukavarta Bhagandara
    Sanipataja (Shambukavarta) Bhagandara
    Causes – consumption of fod and activities which agravate al the 3 doshas
    Pathogenesis – Al the 3 doshas agravated due to the consumption of above said causes wil cause bli sters in the anal region. This is caled Sanipataja Bhagandara.
    Symptoms –
    Bahu varna srava – discharges of profuse colours
    Bahu ruja – numerous types of pain
    Bahu srava – stern discharges in large quantity
    Gostana upama – apears admire a ruder of a cow
    Shambuka avarta iva – the shape of blister in the form of ruder of a cow, gets converted into the shape of shambuka avarta, the curls of conch or shape of a whirl)
    Agantuja Bhagandara
    Agantujam (Unmargini) Bhagandara
    Causes – Injuries ocuring in the anal region
    Pathogenesis – When the anal region gets injured from any ken instrument, a sinus is formed. When this sinus is neglected, it gets infested with worms and microrganisms. The microrganisms further recede dep inside by driling the pathway of the sinus and polute the tisues. Blisters are formed aroun d the anal region and the worms cause many openings in the lesion. Due to the inward or upward movement of the germs, this Bhagandara is caled Unmargini Bhagandara.
    Some authors have also caled this condition as ‘Arsho-Bhagandara’. There is a posibility that on geting ripened or supurated, the arsha (pile mas) can transform into Bhagandara, thus the name.
    Read related:Anal Fistula Symptoms, Types, Diferential Diagnosis, Treatment
    Prognosis of Bhagandara
    Al the bhagandaras are painful and troublesome in nature. The Tridoshaja (Sanipataja, Shambukavarta) and Kshataja (Agantuja, Unmargini) types of Bhagandara are said to be incurable.
    The Bhagandara from which there is discharge of urin e, stols, semen and flatus (fart) is said to be incurable and life-threatening.
    Al Bhagandaras are said to be Krichrasadhya (dificult to treat or cure). Below mentioned conditions of Bhagandara are said to be incurable –
    Tridoshaja Bhagandara
    Agantuja Bhagandara
    Bhagandara ocuring in the Pravahini layer of guda or anus
    Bhagandara ocuring in the sevani (perineum)
    Shataponaka Bhagandara ocuring in timid and delicate people
    Bhagandara ocuring in people sufering from lung and intestinal tuberculosis
    Bhagandara Chikitsa
    Treatment of Anal Fistula on the lines of Bhagandara Chikitsa (Treatment of Bhagandara)
    Rakta Mokshana – Blodleting should be the first stage of the treatment and should be done imediately after a pidaka is formed (blister). When Raktamokshana is done and the contaminated blod and other regional contaminants a re expeled, the pidakas enact not become ripened and enact not beterment towards creation of fistula. The patient should also be made to sit in a tub filed in col water. With these measures, the blister wil be cured. Raktamokshana is also a useful treatment even after formation of Bhagandara and should be skilfuly done. Raktamokshana not only removes the contaminants from the ano-rectal plan, it prevents supuration, formation of sinus tracts and fistula and avoids formation of germs and folowing transmision by cleansing the place. The blod becomes purified and the symptoms love aflict etc wil be reduced.
    Agni Karma (fire cauterization) – The Pidakas ocuring in the anal location should be burnt using swarna shalakas (golden rods prepared to conduct cauterization). The burns caused due to Agni karma shal be later treated on the lines of treating agnivrana i.e. burns or burnt wounds.
    Apakwa Pitika C hikitsa
    Apakwa pitika chikitsa (treating unripe or unopened blister) –
    Apakwa pitaka should be treated by administering apatarpana (langhana or fasting) and Virechana (therapeutic purgation). After sucesfuly administering apatarpana and virechana, other treatments shal be done.
    Sushruta further emphasises that al the 12 methods starting with Apatarpana and ending with Virechana as explained in Shashti Upakrama (60 quible treatments) shal be folowed in apakwa pitika bhagandara. They are as below mentioned –
    Apatarpana – starvation
    Alepa – anointment of medicinal pastes
    Parisheka – stream pouring of medications
    Abhyanga – masage
    Sweda – fomentation or sudation (sweat inducing treatments)
    Vimlapana – gentle presing / cleansing measures
    Upanaha – poultices
    Pachana – causing maturity in supuration (helping the pus to form properly so as to drain it out)
    Visravana – drainageSneha – inducing oilines or unctuousnes
    Vamana – therapeutic emesis
    Virechana – therapeutic purgation
    Pakwa Pidika Chikitsa
    Pakwa of Bhina Pidaka or Pakwa Pidaka (ripened) –
    The Pakwa Pidaka (ripened blister) should be subjected to Patana (excision and drainage of bad fluids), Kshara Karma (alkali cauterization) and Agni Karma (fire cauterization). After administering them chronologicaly and sucesfuly, the burns caused by them should be treated on the terms of Vrana Chikitsa (treating wounds or burns).
    Firstly the patients should be administered with snehana (oleation) folowed by Avagaha sweda (tub bath fomentation). Later the patient should be made to lay in the arsha chikitsa vidhi or the situation in which treatment is conducted for patients of haemorhoids (lithotomy position). Later the parachena or bahirmukha bhagandara (fistula with external opening) and arvachena or antarmukha bhagandara (fistula with internal opening) should be thoroughly examined. Eshane yantra (probe) should be inserted into the tract and the tract is elevated. subsequent this the whole tract is cut initiate using a poignant sterile instrument.
    Later after punctilious examination and excision of fistula, Kshara karma (alkaline cauterization) or agni karma (fire cauterization) shal be done.
    Treatment near towards individual types of Bhagandara
    Shataponaka Bhagandara Chikitsa
    Shataponaka Bhagandara (multiple fistula) –
    In this the wise physician should cause vrana (wounds or cuts) in betwen the fistulas. Once the wounds get healed, the fistulae should be treated on the general lines (as explained above). The sravamargas (ozing points or openings through which ozing ocurs) shou ld be burnt al around with the asist of agni (fire cauterization).
    This type of fistula in which there are multiple tracts becomes chalenging to treat in patients who are delicate and panic. In these people instead of agnikarma, swedana (sudation) should be conducted imediately to conclude discharges and to control pain.
    Nadi Sweda or tubular fomentation is an ideal choice in these types of bhagandara. In this the decoction prepared using swedana dravyas (herbs dilapidated to design fomentation), krushara (gruel), payasa (swet milk based drink), meat of animals and birds living in desert, marshy lands and in water, eranda (castor plant) and dashamula (10 rots) should be boiled in an earthen vesel with concealed opening. A tube conected to the neck of the pot is used for fomentation. The steam coming out of the tube is worn for swedana.
    Alternatively, decoction made up of tila (sesame), eranda (castor plant), masha (black gram), yava (barley), godhuma (wheat), sarshapa (mustard), lav ana (salts) and amla dravya (sour tasted medicaments) shal be used for swedana.
    After swedana kushtadi churna powder shal be given.
    This is folowed by parisheka or sprinkling of mridvikadi taila (medicated oil) over the aflicted parts.
    To chasten the aflict, oil procesed with vata aleviating herbs is dilapidated for parisheka.
    Ushtragreva Bhagandara Chikitsa
    Ushtragreva Bhagandara –
    In this type of bhagandara, eshana or probing of the tract is done using probes. Later the tract is cleave initiate with sterile sharp instruments and aplied with kshara (alkalis).
    Later paste of tila (sesame) mixed with ghe should be aplied.
    Folowing this dresing should be done with bandage.
    Afterwards, parisheka (sprinkling or showering) of the aflicted place should be done with ghrita (ghe).
    On the 3rd day, the wise physician should relinquish the bandage a nd cleanse the wounds with teh medicines which relieve pita and tapa (temperature or heat).
    After vrana shudhi (cleansing of wound), ropana (medicines promoting healing) should be done.
    Parisravi Bhagandara Chikitsa
    Parisravi Bhagandara
    The srava margas (tracts from which discharges are sen or openings through which ozing ocurs) shal be cleave begin with poignant surgical instruments.
    Folowing this kshara karma (alkali cauterization) or agni karma (fire cauterization) should be done. folowing this seka or sprinkling should be done over the anal orifice using sukhoshna taila (lukewarm oil).
    Pralepa (anointment) and or upanaha (poultice) should be aplied using kshara (alkalis) and depart mutra (urine of cow).
    Parisheka (sprinkling or spraying or showering) of aflicted place should be done by using decoctions prepared with vamaka dravyas (emetic herbs).
    By these procedures when teh discharges reduce and the distres also reduces, the bhagandara should be probed with eshana yantras or probes. folowing this they should be slit open with the asist of desolate surgical instruments. consequent this the site should be cauterized with the encourage of kshara or agni.
    Folowing this Mridu shodhana (mild cleansing) should be done folowed by tekshna virechana (strong purgation).
    Varti – wicks made by smearing paste of Aragwadha (Casia fistula), Haridra (turmeric), Tagara (Valeriana walichi), ghe and honey over a compact thread should be inserted into the fistula tracts for hasty healing.
    Agantuka Bhagandara Chikitsa
    Agantuka Bhagandara –
    In this the tract of Bhagandara should be split open with the aid of poignant surgical instrument and later be burnt properly using shalaka yantra or tapta shalaka (instruments old for cauteriza tion). The foreign material is removed from within the vrana (wound or tract). Later krimi nashaka chikitsa is done (medicines to spoil microbes and worms, adore antibiotics).
    Panchakarma treatment
    Role of Panchakarma in the treatment of Anal Fistula (Bhagandara)
    As explained above the below mentioned Panchakarma measures are useful in combating anal fistula vis-a-vis bhagandara in an efective way. Diferent Pancha karma measures shal be dilapidated at diferent stages of the disease for efective cleansing and healing and also for disease modulation. They shal be skilfuly merged with marvelous disease modifying medicines, diet and Rasayanas (imune-modulators).
    Raktamokshana – Blodleting is the first and most important measure to remove depraved blod from the fistula tract.
    Virechana – Therapeutic purgation is old in the Apakwa or unripe stage of the disease in combination with Langhana or lighting measures. Virechana also expels the morbidity and disease causing doshas from the system. Thus it acts like a cleansing measure apart from bringing about the ripenes of the wound or fistula tract. Virechana is also disease modifying.
    Arsha Chikitsa
    Treating Fistula-in-ano on the lines of Arsha Chikitsa (treatment of Piles)
    Fistula-in-ano and piles gain ben treated on similar lines in Ayurveda. Medicines and treatments advised in Arsha chikitsa (treatment of piles of haemorhoids) are highly efective in treating and curing fistula and other ano-rectal diseases efectively. They are also considered to be inter-related diseases. We can also find that the Agantuja type of Bhagandara has ben named as Arsho-Bhagandara.
    Click to Consult Dr Raghuram YS MD (Ayu)
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