Comparative study of the Application of Apamarga Ksharasutra with Anal Dilatation in the Management of Guda-Parikartika

Parikartika resembles fissure-in-ano which is very common among all ano-rectal disorders. In Ayurvedic texts, Parikartika is described as a complication of Atisara and Virechana karma. Ksharasutra was proved successful in the management of fistula-in-ano, piles, and there is a need to try its efficacy in fissure-in-ano. This Study was conducted to evaluate the role of Apamarga Ksharasutra Stitching (AKSS) in fissure bed in chronic fissure-in-ano. 120 patients of chronic fissure-in-ano were selected and randomly divided into two groups (60 in each group). In group-A, patients were treated with AKSS; while the patients of Group-B with Anal dilatation followed by AKSS under pudendal block anesthesia. The AKSS was done once and after slough out of Ksharasutra, the wound was treated for 4 weeks and assessment of the result was done on the basis of gradation adopted. The pain relief on 14th day in Group-A was 86% while in Group-B 100% was observed. As on 7th day in Group-A, oozing was stopped in 68% patients, while in Group-B, oozing was stopped in 82% patients. On 21st day, Group-B showed more healing (85%) as compared to Group-A (69%). In this study 68% of patients were cured. In Group-B (AKSS with anal dilatation) patients were cured early as compared to patients of Group-A (AKSS alone). REFERANCES 1. Sushruta, Sushruta Samhita, Chikitsa Sthana, Vamana-Virechan Vyapada Adhyaya, 34/37, edited by Shastri A, 12th ed. Chowkhambha Surabharati Sanshtan, Varanasi, 2001; 147. 2. Bhuyan C, Dudhamal TS, Gupta SK. A new technique for the treatment of Jeerna Parikartika w.s.r. to chronic fissure-in-ano. Indian J Anc Med Yoga 2010;3:133-40. 3. Sharma KR, Sharma SK, Deshpande PJ. Conservative treatment of fissure-in-ano. Nagarjuna 1973;XVI: 56-8. 4. Bhuyan C, Dudhamal TS, Gupta SK, Jaiswara S. Effect of Ksharakarma in Parikartika (acute fissure-in-ano). Indian J Anc Med Yoga 2009;2:65-75 5. Goligher J. Fissure in ano. Surgery of the Anus Rectum and Colon. 5th ed. Delhi: A.I.T.B.S. Publishers and Distributors; 2002. pp. 150. 6. Vriddha Jivaka, Kashyapa Samhita, Khila Sthana, Antarvatni Adhaya, 10/102. edited by Tiwari PV, reprint ed. Chaukhambha Vishvabharati, Varanasi, 2008; 565. 7. Das S. Chronic fissure-in-ano. A Concise Textbook of Surgery. 6th ed. Kolkata: Dr. S. Das Publication; 2010. pp. 967. 8. Vagbhata, Astanga Hridayam, Nidansthana, Udaranidana Adhyaya, 12/1, edited by Shastri K, 1st ed. Krishnadas Academy, Varanasi, 1994; 133. 9. Williams NS, Bulstrode CJK, OConnell PR. Chronic fissure in ano. Baily and Love’s Short Practice of Surgery. 25th ed. Boca Raton: UK Hodder Arnold Part of Hachette; 2008. pp. 1252. 10. Goligher J. Fissure in ano. Surgery of the Anus Rectum and Colon. 5th ed. Delhi: A.I.T.B.S. Publishers and Distributors; 2002. pp. 158. 11. Jonas M, Scholefield JH. Anal fissure. Gastroenterol Clin North Am 2001;30:167-81. 12. Anonymous. Ksharasutra (Medicated thread). Ayurvedic Pharmacopia of India. 1st ed., Part-II. Vol. II., New Delhi: Dept. of AYUSH, Govt. of India; 2001. pp. 209-13. 13. Sushruta, Sushruta Samhita, Sutra Sthana, Ksharapakavidhi Adhyaya, 11/3, edited by Shastri A, 12th ed. Chowkhambha Surabharati Sanshtan, Varanasi, 2001; 34. 14. Ibidem, Sushruta Samhita, Sutra Sthana, Ksharapakavidhi Adhyaya, 11/5; 34. 15. Rasik AM, Shukla A, Patnaik GK, Dhawan BN, Kulshrestha BK, Srivastava S. Wound healing activity of the latex of Euphorbia nerifolia Linn. Indian J Pharmacol 1996;28:107-9. 16. Negi PS, Jayaprakasha GK, Jagan Mohan Rao L, Sakariah KK. Antibacterial activity of turmeric oil: A byproduct from curcumin manufacture. J Agric Food Chem 1999;47:4297-300. 17. Synopsis of turmeric’s healing properties.(n.d.). Available from: http:// www.turmeric.co.in/turmeric_ayurvedic_use.htm. [Last accessed on 2012 Jan 12]. 18. Bhuyan C. Malasaya Roga Chikitsa Vignyan (Anubhuta Yoga). 1st ed. Puri: Indian Proctology Society; 1998. p. 38. 19. Jensen SL. Treatment of first episodes of acute anal fissure: Prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran. Br Med J (Clin Res Ed). 1986 3;292:1167-9. 20. Shri Krishnarams Bhatta, Sidhabhaishaja Manimala, Chturtha guchha, Udavarta Chikitsa 7, edited by Kaladhar Bhatt R, 2nd ed. Chowkhamba Krishnadas Academy, Varanasi, 1999; 257. 21. Panda AK, Debnath SK. Overdose effect of aconite containing Ayurvedic Medicine (‘Mahashankha Vati’). Int J Ayurveda Res 2010;1:183-6. 22. Dorababu M, Prabha T, Priyambada S, Agrawal VK, Aryya NC, Goel RK. Effect of Bacopa monniera and Azadirachta indica on gastric ulceration and healing in experimental NIDDM rats. Indian J Exp Biol 2004;42:389-97. 23. Pai MR, Acharya LD, Udupa KN. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel - A 6-week clinical study. J Ethnopharmacol 2004;90:99-103. 24. Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U. Biological activities and medicinal properties of Neem (Azadirachta indica). Curr Sci 2002;82:1336-45.