भगन्दर

Reference:
S.Ni.4, A H.U.28, M.N.46

Introduction:
Bhagandara is laceration of anal region (fistula). According to Sus`hruta it is one of the Mahaavyaadhi.

Nirukti:

• Te Tu Bhaga Guda Basti Prades`ha Daaran`aat Cha Bhagandaraa Iti Uchyante |
• Bhagam Parisamantaat Cha Gudam Bastim Tathaa Eva Cha |
• Bhagam Daarayati Tasmaat Tat Dnyeyo Bhagandarah || M. N. 46/1 Madhukos`ha

Whenever an Pid`akaa (abscess) formed at the sites like perineal region(Bhaga), anal region(Guda) and bladder region(Basti) bursts out after suppuration, it causes tearing of the skin making an opening on the surface of skin, this is called as भगन्दर.

Manifestation of Bhagandara:
Due to Krimi, Asthi, Kshan`ana, Vyavaaya, Pravaahan`a, Utkat`akaasana, there is manifestation of abscess (Pid`akaa) with excessive pain (Bhris`ha Arti) at the anal region. This Pid`akaa gets suppurated and bursts out, which leads to भगन्दर. After suppuration, the Pid`akaa is called as Bhaagandaree Pid`akaa.

Types:T
here are 5 types of भगन्दर according to Sus`hrita.

1. S`hataponaka
2. Usht`ragreeva
3. Parisraavee
4. S`hambookaavarta
5. Unmaargee

Doshabhedena:

1. Vaataja
2. Pittaja
3. Kaphaja
4. Vaatapittaja
5. Vaatakaphaja
6. Kaphapittaja
7. Saannipaatika
8. Aagantu

If the Pid`akaa is not treated at proper time, this leads to formation of Bhagandara. Bhaga, Basti and Guda, these areas get lacerated. There is secretion of Vaata, Mootra, S`hukra in succession.

Sampraapti:

S`hataponaka:
S`hataponaka Chaalanikaa, Sahasra Dhaaraa Iti Anye |
S`hataponakavad Anekamukhaakaara Bhagandarah | M. N. 46/2 Madhukos`ha

1. In a person who is consuming unwholesome diet, aggravated Vaayu residing at the periphery of anal region 2 to 3 Angula in length, vitiates Rakta and Maamsa. It causes Arun`a Varn`ee Pid`akaa of (reddish colour).
2. Due to this Pid`akaa, a person suffers from pain. If this is not treated then it gets suppurated.
3. As it is near the urinary bladder, it gets vitiated (Praklinna).
4. This Pid`akaa may have hundreds of (many) small openings.
5. These openings discharge with continuous frothy secretions.
6. At the site of व्रण, there are different types of pain like Taad`ana, Bhedana, Chhedana, Todana.
7. Ultimately, the anal region gets lacerated. At this stage also if at all it remains untreated, then Vaata, Pureesha, Retas may get secreted through these openings.
8. This type of भगन्दर is called as S`hataponaka.

Usht`ragreeva:
Atra Pid`akaavasthaagatagalavaktratvena Usht`ragreevaakaaratvam, Tena Usht`ragreeva Samdnyaa | M. N. 46/3, 4 Madhukos`ha

1. Aggravated Pitta is carried towards the anal region by Vaayu.
2. It gets resided around the anal region in the periphery.
3. It manifests with a Pid`akaa which is red colored, thin, elevated and resembles to Usht`ragreevaa. (neck of the camel)
4. It causes different types of pains. It remains untreated, it gets suppurated.
5. There is a burning sensation as if the wound is being burnt by fire or alkali (Agni and Kshaara)
6. There is discharge having the foul smell and hot property.
7. Then also, if remains untreated, it may secrete Vaata, Mootra, Pureesha and Retas.
8. This type of भगन्दर is called as Usht`ragreevaa.

Parisraavee:
Ghanasraava Yogaat Parisraavee | M. N. 46/5 Madhukos`ha

1. Aggravated Kapha is carried by the Vaayu towards anal region.
2. It gets resided around the anal region in the periphery.
3. It manifests with a Pid`akaa which is white (S`hukla), Sthira, Kan`d`oomatee (with itching).
4. It remains untreated, it gets suppurated.
5. The wound becomes hard (Kat`hina) and Samrambhee, more with itching.
6. It discharges with the sticky secretions (Pichchhila).
7. Then also, if remains untreated, it may secrete Vaata, Mootra, Pureesha and Retas.
8. This type of भगन्दर is called as Parisraavee.

S`hambookaavarta:|
Poorn`a Nadyaavarta S`hambookaavartaakaaren`a Avagatvaad Avagaad`ha Vedanaa Bhavanti | S. Ni. 4/8 D`alhan`a
S`hambookaavartavad Aavartam Vedanaa Doshagati Vis`heshaad Bhavanti Iti S`hambookaavartah | M. N. 46/6

1. Aggravated Pitta and Kapha are carried towards the anal region by Vaayu.
2. They cause a Pid`akaa similar in size of thumb of foot.
3. This Pid`akaa gets manifested with the symptoms by all the three Dosha.
4. It causes different types of pain like Toda, Daaha, Kan`d`oo etc.
5. The wound secretes different types of secretions in color.
6. The pains in this type of भगन्दर are as severe as the whirlpool of the fully flooded river.
7. Therefore, it is called as S`hambookaavarta.

Unmaargee:
Unmaargen`a Vikrita Gati Maargen`a Pureeshaadigamanaat Unmaargee Samdnyaa | M. N. 46/7 Madhukos`ha

1. When a stupefied person consumes meat with bones, then this Asthi (bone) passes with the stools which causes tear in the anal region and causes putrefaction in the wound.
2. In this vitiated wound where Maamsa is putrefied with Rakta and pus, maggots (कृमि) are formed. They eat the region causing tears.
3. Through this wound created by Krimi, Vaata, Mootra and Pureesha, Retas are secreted.
4. This type of भगन्दर is called as Unmaargee.

Parikshepee:
This भगन्दर is manifested around the anus like a trench round a town or fort.
This is caused due to Vaata and Pitta.

Riju:
This type of भगन्दर is caused due to Vaata and Kapha.
This भगन्दर tears anus in a straight direction towards anus.

Ars`hobhagandara:

There is शोथ at the root of the अर्श. There is Kan`d`oo and Daaha. Here, Kapha and Pitta gets aggravated. This शोथ bursts out causing wetness at the root of the Ars`ha. This is called Ars`hobhagandara.

Difference between Pid`akaa and Bhaagandaree Pid`akaa:

Pid`akaa	Bhaagandaree Pid`akaa
Alpa Vedanaa Pid`akaa	With severe Vedanaa (Rug Aad`hya)
शोथ pacifies earlier	शोथ does not pacifies easily
Not so close to the anal region	They are near to anal region around anus of 2 to 3 Angula in diameter
Not so deeply rooted	Deeply rooted (Good`hamoolaa) with inflammation. Itvitiates after healing also.

Vaataja Pit`ikaa:
It is S`hyaava, Arun`a in color.
There is Toda, Bheda, Sphuran`a and Rujaa.

Pittaja Pit`ikaa:
This is thin Pit`ikaa elevated like Usht`ragreeva.
There is redness at the site (Raaga). Temperature is elevated at the site (Ushmaad`hyaa).
Other signs are ज्वर and Dhoomaayana.

Kaphaja Pit`ikaa:
Sthira (stable not increasing or decreasing in size)
Snigdha
Deeply rooted (Mahaamoola)
Whitish in color(पाण्डु)

Vaata Pittaja Pit`ikaa:
Paan`d`ura
Dark brownin color(Kinchid S`hyaava)
It does not suppurate easily (Krichchhrapaaki).

Sarva Doshajaa Pit`ikaa:
It resembles to the shape and size of thumb of foot.
It manifests with different pains.
There is S`hoola, अरोचक, तृष्णा, दाह, ज्वर, Chhardi.
All these types of Pit`ikaa get suppurated if remain untreated.

Correlation of types of Pit`ikaa and भगन्दर:

Type of Pit`ikaa	Type of भगन्दर
Vaataja Pit`ikaa	S`hataponaka
Pittaja Pit`ikaa	Usht`ragreeva
Kaphaja Pit`ikaa	Parisraavee
Vaatapittaja Pit`ikaa	Parikshepee
Vaatakaphaja Pit`ikaa	Riju
Kaphapittaja Pit`ikaa	Ars`hobhagandara
Sarva Doshaja	S`hambookaavarta
Aagantu (Kshataja Unmaargee)	Kshataja

Asaadhya Criteria:

1. Vaata Sraavee Bhagandara
2. Mootra Sraavee Bhagandara
3. Pureesha Sraavee Bhagandara
   

Comparative study of भगन्दर

	भगन्दर	S`hataponaka	Usht`ragreeva	Parisraavee	S`hambookaavarta	Kshataja(S`halya nimittaja)
रोगमार्ग	Madhyama
Svabhaava	MahaavyaadhiGhora
Avayava	GudaBhagaBasti
Krichchhra	Kasht`asaadhya	SukumaaraBheeru
Asaadhya***	Sevanee Praapta BhagandaraValee Praapta Bhagandara			Asaadhya		Asaadhya
Dosha		Vaata Prakopa	Pitta Prakopa	Kapha Prakopa	Vaata PrakopaPitta PrakopaKapha Prakopa
Dhaatu		Maamsa Dusht`iRakta Dusht`i	Maamsa Dusht`iRakta Dusht`i	Maamsa Dusht`iRakta Dusht`i	Maamsa Dusht`iRakta Dusht`i
Srotas		MaamsavahaRaktavahaPureeshavaha	MaamsavahaRaktavaha	MaamsavahaRaktavaha	MaamsavahaRaktavaha
Avayava	GudaBhagaBasti

*** As per Vaagbhat`a, Saannipaatika and Aagantu (Kshataja)are Asaadhya.

Last updated on March 2nd, 2021 at 08:16 am