A randomized controlled clinical Study to evaluate the efficacy of Gunja Ksharasutra with Apamarga Ksharasutra in the patients of Bhagandhara(Fistula-in-Ano)

Bhagandhara can be compared with Fistula-in-ano in terms of clinical features and treatment. The word fistula is derived from the Latin word a Reed, pipe, or flute. It implies a chronic granulating Track connecting two epithelial-lined surfaces. These Surfaces may be cutaneous or mucosal. The main Cause known for fistula-in-ano is a crypto glandular Infection of anal crypts. The anal fistula is a single Track with an external opening in the skin of the peri- Anal region and an internal opening in the modified Skin or mucosa of the anal canal or rectum. Various operative procedures often lead to complications like recurrence, Anal incontinence, infections, etc. The prevalence rate is 8.6 cases per 1000 population. The male-to-female ratio is about 1.8:1. It is categorized as a surgical domain which still to date is where surgeons have been struggling for centuries with its incurable with recurrence rate of 30%-40%.

Acharya Sushruta described Bhaishajya chikitsa, Kshara karma, Agni Karma, and Shastra Karma chikitsa for anorectal Diseases. Kshara karma comes under anusastra which is defined as hina sastra (sub-surgical condition) or shaly sadrusya(similar to a surgical instrument), used like a surgical instruments but with lesser invasion and stress on the patients. Bhagandara is a Chedya (excision) vyadhi. The Ksharasutra is a Para-surgical measure capable to perform excision slowly by virtue of its mechanical pressure and chemical action in Bhagandara because the kshara possesses the qualities of chedana, bhedana, lekana, and tridoshahara.

kshara sutra is mentioned in the textual references of Chakradatta and Rasatarangini where we get only indication of a thread made up of snuhi, apamarga and haridra. Acharya Susrutha mentioned 23 types of plants useful for kshara karma (sus. su 11/11) like gunja, palasha, kutaja, and Gunja14.

Need for the study:

Kshara sutra is a successful novel drug delivery system in managing the cases of fistula-in ano but it has certain clinical problems like Pain, Burning sensation, Inflammation, duration for the complete cutting of the track anf finally complete healing time.

Scope of the study:

Gunja has tridoshahara properties which will works on all the doshas and helps to minimize adverse effects like inflammation, itching, burning sensation, pain and thereby decreases uct (unit cutting time) followed by fast healing of the wound. Gunja plant available in all seasons, it can be cultivated easily and economically. This study helps to develop a alternate standard Gunja kshara sutra along with Apamarga kshara sutra.