Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa B.A.M.S
In Ayurveda Arsha (piles or haemorrhoids), bhagandara (fistula in ano) and Nadi vrana (sinus) are treated on same lines. In fact Ayurvedic management of all ano-rectal disorders is almost done on similar line.
Nadi Vrana is a name given to describe Sinus occuring in anal region. Fistula in ano can also be included under Nadi Vrana (though Bhagandara is a name given for Ayurvedic version of anal fistula).
Causes of Nadi vrana:
Shopha upeksha – Due to the miss-diagnosis from the part of physician, when a formed and ripe pus cavity or abscess or swelling is considered to be unripe one and neglected or when pus filled wounds or ulcers are neglected, the pus (infected and contaminated material) on not finding the exit traverses in a reverse direction and penetrates the deeper tissues and organs. The pus makes its own tract to travel deep into the body and the tract or pathway through which the pus travels deep into the tissues is called Nadi. The ulcers causing such nadi are called Nadi Vranas. These are compared to Sinus explained in modern science.
Types (According to Sushruta) –
Vataja Nadi – Sinus associated with vitiated Vata: rough on touch, narrow opening and associated with pain, foamy discharges at night
Pittaja Nadivran – Sinus associated with vitiated Pitta: associated with thirst, rise in body temperature, pricking pain, body fatigue, fever and splitting pain, hot and yellow discharges during day time
Kaphaja Nadivranam – Sinus associated with vitiated Kapha: hard, itchy, associated with mild pain, thick, viscous, white coloured unctous discharges during day time
Vata-Pittaja Nadi – Sinus associated with vitiated Vata and pitta: presents with mixed symptoms of Vataja and Pittaja Nadi
Pitta-Kaphaja Nadi – Sinus associated with vitiated Pitta and Kapha: presents with mixed symptoms of Pittaja and Kaphaja Nadi
Kapha-Vataja Nadi – Sinus associated with vitiated Kapha and Vata: presents with mixed symptoms of Kaphaja and Vataja Nadi
Tridoshaja Nadi – Sinus caused or associated with vitiation of all 3 doshas: presents with burning sensation, fever, dyspnoea, fainting, dryness of mouth and other mixed symptoms of vitiation of all 3 doshas. This is a dangerous and life threatening condition which had crossed the limitations of treatment.
Shalya janya Nadi – Sinus caused due to foreign substances is called shalya janya nadi. If a foreign body like thorn etc on entering the skin and muscles cause damage, leading to formation of pus cavity and disappear, the tract formed by such foreign substance is called Shalya janya nadi.
Treatment of Nadi Vrana
Vataja Nadi Vrana – Initially Upanaha or poultice of medicinal pastes should be applied over the nadi so as to enable the accumulation of pus at one place. Later the entire length of sinus should be cut open and make sure that the entire quantity of pus is drained to optimum, without any pus remaining in the tract. Later the paste of Tila (sesame), Apamarga (Achyranthes aspera) and Saindhava Lavana (rock salt) is applied over the area and bandaged. The decoction of Brihat Panchamula (greater 5 roots) should be used for cleansing the wound on daily basis.
Pittaja Nadi Vrana – Initially upanaha or poultice should be applied with utkarika (cake like preparation) prepared with ghee and milk. Later the afflicted part (sinus tract) should be cut open with sterile instrument. After draining the contaminants and morbidity of the sinus, the wound should be filled and dressed with paste of tila (sesame), nagadanti (Croton polyandrum) and yashtimadhu (liquorice). The decoction of Somalata (Ephedra gerardiana), Nimba (neem) and Haridra (turmeric) shall be used for cleansing the wound on daily basis.
Kaphaja Nadi Vrana – Initially the upanaha or poultice made up of Kulattha (horse gram), Sarshapa (mustard), Saktu (flour of parched rice) and Surabeeja (sediments containing yeast cells, accelerator of fermentation process) should be tied so as to soften the sinus. Later the tract is probed with a probe and cut open to its length using a sharp sterile instrument. The wound should be filled with paste of Nimba (neem), Tila (sesame), Sourashtra mruttika (special type of mud found in Saurashtra, Gujarat) and Saindhava lavana (rock salt) and bandaged. The decoction of Karanja (Pongamia pinnata), Nimba (neem), Jati (jasmine), Bibhitaka (Terminalia bellirica) and Peelu (Salvadora persica) should be used for cleansing the wound on daily basis.
Shalya janya Nadi Vrana – Initially the sinus should be cut open and the shalya or foreign body removed. The wound should be cleansed and filled with tila kalka (sesame paste) mixed in ghee and honey and bandaged. This cleanses and heals the sinus tract and the wound.
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