Aditya Nema, Dr. T. S. Dudhamal* and Sanjay Kumar Gupta


Ksharasootra is being practiced from ancient times to global era for management of anoectal disorders in general and fistula as well as piles in particular. In anorectal disorder some cases have both piles and fistula-in ano and at that time it is difficult to treat both diseases at same time which sometime leads to bad prognosis. In modern surgery it may escort to complications like stricture, post operative sepsis, recurrence, etc. But in Ayurveda the Ksharasootra have potential to treat the piles and fistula in single sitting without complication. In this case report a 33 years old male patient visited in outpatient department of Shalya Tantra, IPGT&RA Hospital, Jamnagar for treatment of Arsha (Piles/hemorrhoids) and Bhagandara (Fistula-in-ano). Patient had complained of pain bleeding per anum, protrusion of piles since last one year. The symptom like pain with pus discharge from anterior perianal region was severe since last one week. After local PR examination case was diagnosed as Arshobhagandara that is Arsha (intero-external piles) at 3, 7 and 9 O’clock position and Bhagandara (fistula-in-ano) at 1 o’clock position. He was treated with Apamarga Ksharasootra (medicated thread) ligation in piles and partial fistulotomy along with simultaneous Ksharasootra application in fistula in single sitting. The ligated piles were cut through on 5th postoperative day and leads to the fresh wound. The Ksharasootra in fistula was changed after every seventh day and simultaneous cutting and healing of tract taken place. The wound of piles and fistula track both healed within 2 months completely without complication. The adjuvant medications prescribed during post-operative period were sitz bath with Panchavalkal decoction, 10 ml Jatyadi Taila instillation per rectum, and dressing with Panchavalkal ointment. Triphala Guggulu 1 gm three times a day was given with warm water for 2 months. This case demonstrated the advantages of Ksharasootra in the management of piles and fistula at the same time.

Keywords: Arsha, Bhagandara, Fistula-in-ano, Jatyadi Taila, Ksharasootra, Matra Basti, Panchavalkal, piles, Triphala Guggulu.

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