THE MANAGEMENT OF FISTULA-IN- ANO WITH TILADI KSHARA SUTRA AND AMRITA GUGGULU

Abstract

Most of the kshara sutra researches are carried on ksheera (like snuhi, karkati etc) based kshara sutra. The present study is carried on a kalka (Tiladi) based Apamarga kshara sutra along with oral administration of Amrita guggulu (Bhava prakasha, Vatarakta adhikarana).

Kshara sutra is prepared with tiladi kalka (Tilakalka sa madhukoghritaka vranaropana su.sU.11/29) as base, Apamarga kshara is applied over it as a 3 to 6 layers and lastly 5 coatings of Haridra powder is given.

Study of thirty cases done according to age, sex, occupation, type of fistula-in-ano, type of bhagandhara, chronicity, food habits, and unit cutting time in relation to diet, gender, diabetic, operative and non operative case, out of which 26 (83.34 %) are males and 4 (16.66%) are females. Vegetarians are 5(15%), non- Vegetarians are 25(85%). Most of patients i.e. 36.67% have chronicity of more than four years. Out of thirty patients, 4 (20%) are Shataponaka, 6 (26.7%) are Ushtragreeva, 19 (50%) are Parisravi, 1 (3.3%) is Shambukavarta and no patient is observed as Unmargi.

         High anal fistulas are observed in 6 (20%) patients and low anal fistulas in 24 (80%) patients. Recurrent fistula in ano after fistulotomy cases are 5 (15%).

          In present clinical study, the efficacy of Tiladi kshara sutra and Amrita guggulu was observed in 35 fistula tracks of 30 patients. The assessment of the results is mainly based on unit cutting time (U.C.T.) and unit cutting length (U.C.L).

          After calculating the unit cutting time separately for all the 30 cases the average unit cutting time was evaluated. The average unit cutting time in present study of 35 tracks of 30 cases was 7.55 days/cm and average unit cutting length was 9.26 mm per week.

             There was lot of relief in the symptomatic para meters- like dramatic relief in pain, inflammation and burning sensation and also there was lot of difference in pus discharge and bad smell before and after treatment with Tiladi kshara sutra.

No recurrence was found after 6 months of follow up in all thirty cases.

         This clinical study proves beyond doubt that the appreciable result obtained from this combination is an effective, economical and uncomplicated management for bhagandara.

        In comparison to previous works of efficacy of different kshara sutras in Fistula in Ano, the results observed in the present study with Tiladi kshara sutra are quite encouraging.


Dr.R.KrishnaKumar M.D(ayu), SRF(NIIMH)
mailto:kitsdr@gmail.com,