Reference:
C.Chi.12, S.Chi.8, A.H.U.28, N.R. Bhagandara
Introduction:
Bhagandara is anal fistula. Generally, while treating Bhagandara, principles to treat Vran`a should also be applied.
Chikitsaa
Prior to manifestation of Bhagandara, Bhagandari Pit`ikaa appears. It is necessary to avoid suppuration in the Pit`ikaa. For this purpose, Rakta Sraava and Seka could be done. Then also, if the Pit`ikaa gets suppurated, then Snehana, Svedana, Avagaaha Sveda should be done.
Bhagandara should be treated with following modalities:
- Virechana
- Eshan`a (to know the direction of the Bhagandara tract using probe)
- Paat`ana
When Bhagandara becomes clean (free from vitiated Dosha) with above four Chikitsaa Karma, it is to be burnt / cauterized by using oil i.e. Taila Daaha
Ks`haarasootra should be used in Bhagandara management.
When the tract of Bhagandara is split open with the Kshaara, it should be treated like a Vran`a.
If Bhaagandaree Pid`akaa is Apakva (not perforated and without suppuration),then it is to be treated with the procedures in following order
- Apatarpan`a
- Aalepa
- Parisheka
- Abhyanga
- Sveda
- Vimlaapana
- Upanaaha
- Paachana
- Visraavan`a
- Snehana
- Vamana
- Virechana
S`hataponaka Chikitsaa
If Bhaagandaree Pid`akaa is Pakva i. e. spontaneously perforated and with suppuration, it should be treated in the following manner
- Snehana
- Avagaaha Sveda
Bhagandara should be examined with the procedure same as that of Ars`ha
Bhagandara may be having opening internally or externally.
Using probe (Eshan`aa), its direction should be defined and in that direction, incision to be made.
This is to be done for both the types of Bhagandara having opening internally or externally.
After that, Agni Karma or Ks`haara Karma is to be done.
This is the general treatment for all the types of Bhagandara.
If the Bhagandara tract is incised more than once it may lead to widening the anus and even urine and stools may pass through it. Repeated incisions vitiate Vaayu which causes Guda S`hoola (pain in ano rectal region), Aat`opa (gurgling in the abdomen). Hence it is advisable to avoid repeated surgery.
If anal perforation or laceration occurs, it may lead to death. (Guda is a Praan`aayatana and Sadyah Praan`ahara Marma)
In S`hataponaka, the incision should be
- Ardhalaangalaka plough like
- Laangalaka
- Sarvatobhadra – military array
- Goteerthaka it suggests flexibility of the incision. Multiple and flowing incisions can be taken, It resembles the external genitalia of a cow / oblong or it could resemble the pug marks of a cow at their drinking place.
After that, Agnikarma / cauterization should be done.
S`hataponaka is difficult to cure in Sukumaara and Bheeru persons.
After the S`hastrakarma, following is the advised regime
- Svedana By using Kris`haraa, Paayasa, made from Graamya, Aanoopa, Audaka, Vishkira Maamsa; Kvaatha of Vrikshaadanee, Eran`d`a, Bilva should be used for Naad`ee Sveda.
- After the Svedana, Kusht`ha, Lavan`a, Vachaa, Hingu, Ajamodaa Choorn`a should be given internally with Ghee or Maardveeka or Amla Dravya; depending upon the Dosha and Avasthaa.
- Parisheka should be done with Madhuka Taila.
Usht`ragreeva Chikitsaa
Usht`ragreeva Bhagandara is to be incised first, after probing.
Kshaara is applied.
Agni Karma is contraindicated.
Paste of Tila and Ghee is to be applied on the wound.
Ghrita Parisheka also can be done.
Then it is to be bandaged Gophan`aa Bandha for three days.
After Vran`a S`hodhana, the wound is to be applied with healing agents.
Ropan`a Kriyaa – After removal of bandage and examination of the wound.
The Antarmukha type of Bhagandara should be incised with a S`hastra after probing.
The Bahirmukha Bhagandara, should be treated with Ks`haara Karma only.
Parisraavee Bhagandara Chikitsaa
Utkartana (incised) of the passage with secretions should be done.
Kshaara Karma or Agnikarma should be done.
Followed by An`utaila Parisheka|
Upanaaha, Pradeha with Mootra and Kshaara should be used.
Parisheka could also be done with Vaamaka Aushadha.
Probing should be done (Eshan`a), and Chhedana should be done of the Bhagandara in various ways
- Kharjoorapatraka
- Chandraardha
- Chandrachakra
- Soocheemukha
- Avaanmukha
After the incision, Kshaara / Chemical cauterization, Teekshn`a S`hodhana should be done.
Bhagandara in the children, which may be having opening towards inner or outer side (Antarmukhee or Bahirmukhee Bhagandara), is not to be treated with
- Virechana
- Agni Karma
- S`hastra Karma
- Kshaara Karma which should not be excessively mild or strong should be used in children.
Kshaara Sootra could be applied even in children according to Vaagbhat`a.
Aagantu Bhagandara Chikitsaa
Aagantu Bhagandara is to be incised.
Agni Karma should be done by using Jaambavausht`ha S`halaakaa.
If there is any incumbent S`halya (foreign body), it is to be removed.
Krimighna Chikitsaa should be done.
Kshataja Bhagandara Chikitsaa
This is Pratyaakhyaaya.
It should be treated with the knowledge that it is incurable.
Foreign body if present should be removed first.
Krimighna Chikitsaa is advised by Vaagbhat`a.
Pin`d`a and Naad`ee Sveda should administered after Snehana, especially when there is pain, to relieve local pain.
Aavasthika Chikitsaa
Ars`ho Bhagandara Chikitsaa
In the Ars`ho Bhagandara, Ars`ha should be treated first.
S`hastrakarma Chikitsaa (after incision of Bhagandara)
- After S`hastrakarma, to reduce pain, following Chikitsaa Karma should be performed.
An`utaila Parisheka – by
Sneha Parisheka
Baashpa Sveda
Avagaahana
- All the Bhagandara should be treated with Agnikarma, cauterization of the Bhagandara tract renders the wound clean and prevents its recurrence.
- Kosht`ha S`huddhi of the patient is always the first step of treatment.
Precautions
Following things should be avoided for one year after Bhagandara is treated successfully
- Vyaayaama
- Maithuna
- Kopa
- Prisht`hayaana traveling on back of fast moving vehicles
- Guru Bhojana
- Madya Paana
- Ajeern`a
- Asaatmya
- Saahasa
Pathya –
Rasa – AmlaTikta
Gun`a / Karma – Deepana
Dhaanya – S`haalee, Kulattha
S`haaka – Vetaagra, Pat`ola, S`higruphala, Jalapippalee, Moolaka
S`himbee – Kulattha, Mudga
Maamsa – Jaangala Maamsarasa
Dugdha – Ghrita
Drava – Tila Taila, Sarshapa Taila
Kritaanna – Vilepee, Madhu, Suraa, Sauveeraka, Jambooka Maamsajanita Padaartha
Other – Lepa, Langhana, S`hodhana, Raktamokshan`a (In Apakvaavasthaa)
Apathya –
Rasa – Amla, Madhura
Gun`a / karma – Guru
Maamsa – Aanoopa Maamsa
Dugdha – Dugdha, Dadhi
Kritaanna – S`higrujanya Padaartha
Other – Vyaayaama, Maithuna, Kopa, Prisht`hayaana, Madyapaana, Ajeern`a, Asaatmya, Atisaahasa
Search Anveshaka –
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Last updated on March 2nd, 2021 at 07:59 am