भगन्दर चिकित्सा

Reference:
C.Chi.12, S.Chi.8, A.H.U.28, N.R. भगन्दर

Introduction:
भगन्दर is anal fistula. Generally, while treating भगन्दर, principles to treat व्रण should also be applied.

चिकित्सा
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.

भगन्दर should be treated with following modalities:

Virechana
Eshan`a (to know the direction of the भगन्दर tract using probe)
Paat`ana

When भगन्दर 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 भगन्दर management.
When the tract of भगन्दर 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
अभ्यंग
Sveda
Vimlaapana
Upanaaha
Paachana
Visraavan`a
Snehana
वमन
Virechana

S`hataponaka चिकित्सा

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 भगन्दर 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 भगन्दर.
If the भगन्दर 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 व्रण सौषधं, 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 भगन्दर 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 भगन्दर in various ways

Kharjoorapatraka
Chandraardha
Chandrachakra
Soocheemukha
Avaanmukha

After the incision, Kshaara / Chemical cauterization, Teekshn`a S`hodhana should be done.

भगन्दर 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 नाड़ी स्वेद 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 भगन्दर)

After S`hastrakarma, to reduce pain, following Chikitsaa Karma should be performed.
An`utaila Parisheka – by
Sneha Parisheka
Baashpa Sveda
Avagaahana

All the भगन्दर should be treated with अग्निकर्म, cauterization of the भगन्दर 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 भगन्दर is treated successfully

Vyaayaama
Maithuna
Kopa
Prisht`hayaana traveling on back of fast moving vehicles
Guru Bhojana
Madya Paana
अजीर्ण
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 –

खोज करें Kalpa, Dravya, Aahaara, Vihaara, Chikitsaa Karma
Vyaadhi Bhagandara, Naad`ee Vran`a, Vran`a
Adhikaara Bhagandara, Vran`a
Karma Vran`as`hodhana, Vran`aropan`a

Last updated on March 2nd, 2021 at 07:59 am