Madhava Nidana Chapter 46 Bhagandara Nidanam

This article explains Madava nidana 46th chapter “Bhagandara Nidanam”. Causes, pathology and symptoms of Bhagandara are explained in this chapter. Bhagandhara means fistula in ano.

Bhagandara rupa, Sankhya

Meaning and types of bhagandara
A papule (boil, blister) developing on either side of the anus, within a radius of two angulas accompanied with pain and exudation is known as Bhagandara (fistula-in-ano). It is of five kinds. (1)
Read – Anal Fistula: Ayurvedic Concept, Types, Treatment

Vatika Bhagandara

Vatika Bhagandara (Shataponaka Bhagandara)
Due to excessive indulgence in foods predominant in astringent taste and dry in nature leads to aggravation of vata.
This aggravated vata causes a papule in the anal region. When it is neglected, it undergoes suppuration and produces severe pain. Many ulcers are formed around the papule. Through these orifices of multiple ulcers, urine, faeces and semen are discharged. Due to multiple ulcers / openings (orifices) vataja bhagandara is also called as sataponaka. (2-3)
Read – Fistula In Ano Ayurvedic Understanding And Effective Treatment

Pittaja Bhagandar

Pittaja Bhagandara /Ushtragriva
Pitta undergoing severe increase in a person who has indulged in pitta aggravating etiological factors produces a red coloured pustule in the anal region. This pustule quickly undergoes suppuration. The discharges coming from it are hot and foul smelling. This type of bhagandara is called Ustraśirodhara (ustragrīvā). (4)
Note – Since its shape resembles the neck of the camel, it is called as Ustragriva.
Read – Pitta Increase Symptoms – Pitta Vriddhi Lakshana

Kaphaja Bagandara

Kaphaja Bhagandara /Parisravi
The bhagandara which is produced by aggravated kapha has itching, thick discharges (exudates), is hard, slightly painful and whitish in colour. This is also called as Parisravi Bhagandara. (5)
Note – Since there are continuous thick discharges taking place from this type of bhagandara it is called parisravi bhagandara.

Sannipataja Bagandar

Sannipataja Bhagandara / Sambukavarta
These pustules have different kinds of colours and discharges which resemble the teeth of the cow, creating spiral sinuses inside resembling that of seashell or whirls in a river. This is known as Śambūkavārtā (this is produced by increase of all the three doshas together and is associated with many types of pain). (6)

Agantuja Bhagandara

Agantuja Bhagandara /Unmargini
Injury caused by any foreign object like thorns, etc. at the anus, causes formation of sinus which goes on increasing in size (depth). When this condition is neglected worms (germs) are formed in these sinuses (sinuses get infected with  worms / germs). These worms later form many small ulcers with many openings inside the sinuses. This condition is called as unmargi bhagandara. (7)
Read – Kshara Sutra application in Fistula in ano (Bhagandara)

Symptoms of incurability of Bhagandara

All kinds of bhagandara – fistula are dreadful and difficult to cure. Those caused by all the three doshas and injury (by external agents / foreign objects) are mainly incurable. (8)

Other symptoms of incurability of Bhagandara
When gas (fart), urine, faeces, worms and semen begin to come out of the fistula, it is going to kill the patient (such fistula is incurable). (9)
Thus ends the chapter on Bhagandara Nidanam in Madhava Nidana text written by Acharya Madhavakara.