A clinical study to evaluate the efficacy of classical ksharsutra and ksharsutra coated with shodhan dravya in the management of bhagandar w.s.r. to fistula in ano: an open-label randomized trial

Bhagandara, known as fistula-in-ano in modern medicine, is a chronic anal condition marked by a pus-discharging tract between the anal canal and perianal skin.

Ayurveda classifies it among the Ashta Mahagada, highlighting its complex and recurrent nature.

Modern treatments for fistula like fistulectomy and fistulotomy have limitations, Ayurveda offers Ksharsutra therapy—a para-surgical method using a medicated thread prepared with herbal alkaline drugs. This thread, traditionally coated with Snuhi latex, Apamarga Kshara, and Haridra, is effective in excising, cleaning, and healing the tract. However, it may cause discomfort and delayed healing in some patients.

Recent innovations suggest modifying the Ksharsutra with Vranashodhana Dravyas to enhance healing, reduce pain, and improve outcomes.

A comparative clinical study is proposed to evaluate the benefits of this modified approach in managing Bhagandara more effectively.

Ksharsutra therapy, an Ayurvedic para-surgical method, offers benefits like minimal recurrence, sphincter preservation, and simultaneous cutting and healing.

However, the classical Apamarga Ksharsutra may cause local irritation, prolonged healing, and discomfort in some patients.

Enhancing the Ksharsutra with wound-cleansing (Vranashodhana) herbs may address these issues. A clinical study is essential to evaluate whether the modified Ksharsutra improves healing time, reduces discomfort, and lowers recurrence ultimately aiming to refine treatment protocols and enhance patient outcomes in Ayurvedic management of Bhagandara.