Comparative clinical study on the effect of madhu based tankana ksharasutra and standard apamarga ksharasutra in bhagandara( fistula in ano)

Bhagandara is second common disease occurring in ano-rectal region after haemorrhoids. The word Fistula is derived from a Latin word reed, pipe or flute. It implies a chronic granulation track connecting two epithelial lined surfaces. The prevalence rate of fistula-in-ano is 8.6 cases per 1 lakh population. The prevalence in men is 12.3 and in women is 5.6 cases per 1 lakh population. The male-to-female ratio is 1.8:1. The mean age of patients is 38.3 years. It is considered as one among the Mahagada in Sushruta Samhita. In Ayurveda Ksharasutra application is well known for management of Bhagandara.

Though in this disease many Ksharasutras tried, Apamarga Ksharasutra is widely being practiced.  When go through the classics we get reference regarding  Tankana grouped into Kshara Dravyas. This Tankana is not widely practiced. Apamarga is very effective but preparation of this Apamarga  Kshara is not at all easy process. It needs burning of lots of Apamarga plants,then processing including boiling etc, and the end we get a little quantity of final product. In other hand Tankana, as per reference, is also a Kshara, cost effective and abundantly available. It minimizing the problems like burning sensation, local irritation during the course of therapy.

Madhu has Vranaropaka properties as per the principles of the sixty Upakramas of Vrana management described in Susrutha Samhitha . The authors like Chakrapani, Susruta, Bhavaprakasha, Vangasena and Yogaratnakara have described the qualities of Madhu as Vranashodhana, Vranaropana, Lekhana, Sandhana, Varnya, Srotovishodana, Yogavahi..

Advantages of Kshara Sutra Therapy: Simple and safe parasurgical procedure, cost-effective and ambulatory, minimal recurrence rate, no surgical complications like incontinence, stenosis and stricture. Snuhi Ksheera based Apamarga ksharasutra is the standard one and is proved effective treatment in the management of Fistula-in-ano. But, burning sensation, local irritation during the course of therapy and difficulty of manufacturing process has limited its use.

To overcome these problems, I have taken the study of Madhu based Tankana Kshara sutra for better action, availability and acceptability. Madhu based Tankana Kshara sutra will be prepared by the same method as that of Snuhi Apamarga Kshara Sutra. So, the present study has been taken up to know the efficacy of Madhu based Tankana Kshara Sutra in the management of Bhagandhara.