This article is by Dr MS Krishnamurthy MD (Ayu), Ph.D (Ayu).
Fistula in ano is an unnatural tract formed in the body, which connects the skin around the buttock region with the anal canal. Ayurveda offers many effective treatments for this painful condition.
Fistula -in -ano is a condition usually resulted in the patrients who have the complaint of abscess in the anus for quite long period of time.Often the condition is resulted due to poor management of the illness or due to the negligence of the diseases because of lack of seriousness in the initial conditions of the illness.
In Ayurveda this condition is known as Bhagandara or arsho bhagandara.It is a kind of Sannipataja nadivrana(complicatory fistula).
Definition of Bhagandara:
Indian scholars had in detail knowledge about this disease about 3500 years back itself.We get several incidences and history of cure of Bhagandara in various Indian literatures and Philosoplhical books.
Acharya Sushruta defined bhagandara as below:
“Guda bhaga basti pradesha daaranaat bhagandaraha”
It means the condition resulted due to the laceration or tear in the lesions of guda (anus)-bhaga (pubic area)-basti (area of bladder) is termed as Bhagandara.
Acharya Bhoja further clarifies this as-
“Bhagam pari samantaat cha gudam bastim tathaiva cha|
Bhagavat daarayet tasmaat jneyo bhagandaraha||”
This summarizes the in detail concept behind the patho-physiology involved in the disease i.e The tear or break open caused in the area of pubis or around the perinum is called Bhagandara.
Origin of Bhagandara (Fistula in ano):
If the physician or a patient neglects a pus filled wound or abscess by thinking that the condition may be healed by its own,the pathology continues inside.Meanwhile if the patient continues the unwholesome food and habits, due to sepsis(abhishyandata), the wound/laceration begins to invade deep into the skin,muscles,vessels,ligaments,bones,joints,vital organs and hence a hollow –tubular tract is originated.This condition is called Nadivrana.If the pathology manifeasts in the area of anus and perineal region it is termed as Arsho bhagandara.
Acharya Madhavakara further clarifies the pathology that the boils that arise about 2 angula (1.5 inches) around the anus if bursts open and forms a track it is called-Bhagandara.
Types of Fistula in ano(Bhagandara):
Based upon the type of the tract formed and dosha involved, Bhagandara is classified into 5 types as below:
(1) Shataponaka – dominance of Vata dosha
(2) Ushtragreeva – dominance of Pitta dosha
(3) Parisraavi – dominance of Kapha dosha
(4) Shambookavarta – dominance of all the three doshas
(5) Unmargi – Due to injury/external causes
Nature and Features of different kind of Bhagandara:
Features of Shataponaka Bhagandara:
Excess intake of astringent,dry,spicy and pungent substances cause the vitiation of Vata dosha and inturn they cause boils in the anal region.When they are neglected or suppurated these boils burst open and the red –froathy discharge is found.Often this discharge is associated with urine, stool and semen.Due to the afliction of severly aggravated Vata, numerous ulcers are produced and hence this condition is called Shataponaka.
Features of Ushtragreeva Bhagandara:
Respective reasons provoke Pitta dosha and inturn this causes blood filled/oozing blisters/boils around the anus.These blisters are suppurated quickly and produce discharge of offensive smell.
As these tracks appear like the neck of ushtra(camel) they are termed Ushtragreeva bhagandara.
Features of Parisraavi Bhagandara:
Due to unctous food and beverages and relative habits Kapha dosha is severly agravated and in turn cause bigger boils in the anus.These are hard,stable and mature gradually.When these boils are burst open the tracks appear with itching , dense white discharge and associated with mild pain.As oozing is the typical characteristic feature,the condition is called Parisravi bhagandara.
Features of Shambookavarta Bhagandara:
Due to various dosha provocating factors all the three doshas are aggravated and multiple colored painful blisters are manifested over the anus and perineal region.When they suppurate, they produce multiple colored dischardge.The track is much wavy and curved like the shell of the snails. Hence the condition is called Shambookavarta bhagandara.
Features of Unmargi Bhagandara:
This kind of fistula are caused due to the injury or trauma.Due to the prick of the needles,nails ,stick or torns over the perineal region small abrasion is caused initially and gradually they are extended and worsened due to unwholesome food amd habits. Further, the germs are also manifested over these lesions and most painful condition –Unmargi kind of Bhagandara is resulted.
Prognosis of Bhagandara:
Acharya Sushruta included Fistula in ano under most miserable and critical illness due to bad prognosis and maximum chances of recurrence.Among these varieties,Shambookavarta and Unmargi are very difficult to treat.
The fistula which is associated with severe discharge,associated with worms and stool in its discharge are incurable.
These can be co-related to Vesico-seminal fistulae,ano-rectal fistulae and vesico- rectal fistulae.
Treatment of Bhagandara:
All these kinds of Fistula are treated by clearing their tracts.
In this regard Acharya Sushruta has appreciated the potent therapeutic effect of Kshara sutra (Further it is explained well by Acharya Chakrapani in his Text Chakradutta).
On tracking the path/tract of the fistula,the Ksharasutra is inserted.It helps in clearing the path(disinfection) and in earlly healing of the tract.Thus it serves both the purposes like shodhana(purification) and ropana(healing).
In recent days Snuhi-Arka-Apamnarga-Guggulu-Haridra and Papaya Ksharasutras are in practice.
Formulations used in Fistula in ano:
While treatnig the patients of Bhagandara following formulations are taken help:
1) Triphala guggulu
2) Gandhaka rasayana
4) Kaishora guggulu
5) Chandraprabha vati
6) Gokshuradi guggulu
8) Madhusnuhi rasayana
9) Chirabilvadi kashaya
10) Mahatiktaka kashaya etc
Wholesome and unwholesome diet and habits: The diet and habits specified for hemorrhoids
Dear readers and followers of Easy ayurveda.com,Fistula is a most dreadful and irritating illness which often disturbs the pleasure of the mind.Both sitting and travelling become difficult due to this illness.So the sufferers should take enough care and caustion while they are taking treatment for their illness. Ksharasutra is found to be a time tested answer for this illness.Both East and West is watching the improvised application of Kshara(alkaline application) and Kshara sutra(alkaline thread) in its management.