Introduction
Bhagandara is primarily attributed to the vitiation of Tridosha, particularly Vata and Pitta, leading to the formation of a suppurative lesion in the anorectal region. If inadequately treated, the lesion progresses into a sinus tract with persistent discharge. Classical Ayurvedic texts, particularly the Sushruta Samhita, provide detailed descriptions of its etiology, classification, and treatment principles. The primary objectives of treatment are elimination of unhealthy tissue, drainage of infection, healing of the tract, and restoration of normal anorectal function.
Therapeutic approaches
Ksharasutra therapy:
Ksharasutra therapy is considered the gold standard Ayurvedic treatment for Bhagandara. The medicated thread is prepared using coatings of Snuhi (Euphorbia neriifolia) latex, Apamarga Kshara (Achyranthes aspera), and Haridra (Curcuma longa). The thread is placed within the fistulous tract, where it exerts simultaneous cutting, debridement, antimicrobial, and healing actions.1 Weekly replacement of the thread facilitates gradual excision of the tract while promoting healthy granulation tissue formation.2 Clinical studies have reported low recurrence rates and minimal risk of anal sphincter injury compared with conventional surgery.
Shastra karma (Surgical management):
In selected cases, particularly superficial and uncomplicated fistulas, surgical procedures such as fistulotomy and fistulectomy may be employed. Ayurveda advocates precise excision of diseased tissue while preserving surrounding healthy structures. Surgical intervention is often combined with postoperative wound care and herbal therapies to enhance healing and prevent recurrence.2
Kshara karma:
Kshara Karma involves the application of herbal alkaline preparations to destroy unhealthy tissue and promote wound cleansing. Apamarga Kshara is commonly used because of its cauterizing, antimicrobial, and debridement properties. This technique is particularly useful in small sinus tracts and residual unhealthy tissue following surgery.
Herbal and supportive therapy:
Several Ayurvedic herbs support healing and infection control in Bhagandara. Haridra (Curcuma longa) provides anti-inflammatory and antimicrobial effects, while Nimba (Azadirachta indica) and Triphala possess wound-cleansing and antioxidant properties. Jatyadi Taila and Panchavalkala preparations are frequently used for local wound management and tissue regeneration.
Postoperative care
Successful management of Bhagandara requires meticulous postoperative care. Warm sitz baths, maintenance of local hygiene, adequate hydration, and a high-fiber diet help prevent constipation and facilitate wound healing. Regular follow-up is essential to monitor healing progress and detect recurrence at an early stage.
Conclusion
Ayurvedic management of Bhagandara combines surgical precision with biological wound-healing principles. Ksharasutra therapy, supported by Kshara Karma, surgical intervention, and herbal wound-care measures, provides a comprehensive treatment strategy. Its ability to achieve tract eradication, infection control, and simultaneous healing has established Ayurveda as a valuable contributor to the contemporary management of fistula-in-ano.3
Reference:
- Kurapati VK, Nishteswar K. Management of Ano-Rectal disorders by Kṣārasūtra: A clinical report. Anc Sci Life. 2014;34(2):89-95. doi:10.4103/0257-7941.153467 https://pmc.ncbi.nlm.nih.gov/articles/PMC4389399/
- Dutta G, Bain J, Ray AK, Dey S, Das N, Das B. Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano. J Nat Sci Biol Med. 2015;6(2):406-410. doi:10.4103/0976-9668.160022 https://pmc.ncbi.nlm.nih.gov/articles/PMC4518420/
- Nema A, Gupta SK, Dudhamal T, Mahanta V. Efficacy of Guggulu and Shallaki based Ksharasutra with Triphala Guggulu orally in the management of Bhagandara w.s.r. to fistula-in-ano: A open labelled randomized comparative clinical study. Ayu. 2020;41(4):211-217. doi:10.4103/ayu.AYU_156_16 https://pmc.ncbi.nlm.nih.gov/articles/PMC9261991/