Abstract

COMPARATIVE AYURVEDIC MANAGEMENT OF BHAGANDARA (FISTULA-IN-ANO) USING TILANALA KSHARASUTRA AND APAMARGA KSHARASUTRA – A CASE STUDY

Dr. Dharmendra G. Sanghani* and Dr. N. H. Kulkarni

ABSTRACT

Fistula-in-ano (Bhagandara) is a chronic anorectal condition characterized by persistent pus discharge, pain, and recurrence. The conventional surgical approaches such as fistulectomy and fistulotomy have high recurrence rates and complications, including fecal incontinence. Ksharasutra therapy, an Ayurvedic para-surgical technique, has gained recognition due to its superior outcomes with minimal recurrence. Among the different Ksharasutra formulations, Apamarga Ksharasutra (Achyranthes aspera) is the most widely used, while Tilanala Ksharasutra (Sesamum indicum) is emerging as a promising alternative with possibly reduced post-procedural discomfort. This case study presents a comparative assessment of these two Ksharasutra types in two patients with low anal fistula, focusing on healing time, pain, recurrence, and post-treatment comfort. The study found that both types of Ksharasutra were equally effective inhealing the fistula, but Tilanala Ksharasutra caused less burning sensation and discomfort post-procedure, suggesting its potential as a better-tolerated alternative.

Keywords: Bhagandara, Fistula-in-Ano, Ashtamahagada, Ano-rectal etc.