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Efficacy of kasisadi ghrita in parikartika
In the era of fast food, there is change or irregularity in diet and diet timings and also sedentary life style. In addition to change in diet and life style, one is always under tremendous mental stress. All these causes disturb in digestive system which results into many diseases amongst them ano-rectal disorder constitute an important group.
Parikartika (fissure in Ano) is very common and painful condition. The factors responsible for causation of Parikartika are found in various texts as Vamana–VirecanaVyapada, BastiKarmaVyapada and Upadrava of Atisara, Grahaņi, Arsa, Udavarta etc.
The other contributory factors which are primary like constipation, spasm of internal sphincter, surgical catastrophe during operation for hemorrhoids followed by anal stenosis which may ultimately result into fissure in ano. Similarly secondary causes like
ulcerative colitis, Crohn’s disease, syphilis and tuberculosis have also been held responsible for the formation of the disease fissure-in-ano.
In the modern science, fissure-in-ano has been classified into two viz. acute and chronic. In both condition pain and bleeding are two main symptoms.
On the basis of symptoms, the disease fissure-in ano can be these procedures like recurrence; incontinence and pruritus are even more agonizing than the actual pathology.
According to Ayurvedic literature, there are several methods of treatment i.e. Bhaişaja – Ksara – Śhastra Karma etc. Among them Bhaişaja Karma – medicinal treatment is the first line of treatment.
Nowadays, various topical remedies are available for local application for wound healing in the market including for fissure-in ano.In the present study, an effort is made to derive a standard and easily accessible treatment for fissure-in-ano from classical resources.KasisadiGhŗita is having ingredients with VraņaŚodhana and Ropaņa
Properties which can help the Vraņa (wound) to heal rapidly (Su. Su.36/16). Its base is Ghŗita which itself is having SamskaraAnuvarti and healing properties.KasisadiGhŗita is economic by virtue of less number of easily available ingredients and a time tested classical formulation. Hence, it was selected for the clinical evaluation in the compared to the disease Parikartika described in Ayurveda. AcharyaSusruta has described the term ‘Parikartika’ as a condition of Guda (anus) where cutting and burning pain is there.
The treatment of fissure in Ano depends on type of disease. In acute fissure-in-ano treatment is painkiller, stool softner and soothing ointment. In chronic fissure treatment is anal dilatation, sphincterotomy, fissurectomy are in vague but the complication of present study.
AIMS AND OBJECTIVE
To assess the efficacy of KasisadiGhŗita in the management of Fissure-in-ano.
MATERIAL AND METHOD
- Patients : Source of the data : study is carried out in “IPD of Shalyatantra , Y.M.T. Ayurvedic Medical College and Hospital , Kharghar , Navi Mumbai
- Drugs : The drugs were prepared by the pharmacy of Y.M.T. Ayurvedic Medical College And Hospital , Kharghar , Navi Mumbai
- Type of study: single case study
- Research Proforma : A detailed proforma was prepared for the study incorporating all the relevant point from both the Ayurvedic as well as modern point of view.
Patient name: Mrs. GH
Age:35 ,Sex: female
Complaints: BurningPain at anal region during and after defaecation
Per rectal bleeding during defaecation since 3-4 days. Mild itching at anal region
No H/O – DM / HTN/ KOCH’S / Bronchical Asthama
No H/O – Any drug allergy.
P/M/H – NIL
O/E – G.C- fair
Wt - 56 Kg
P- 80/ MIN
B.P.- 120/ 80 mm of hg.
S/E- RS- AEBE Clear
CVS- S1 ,S2- normal
CNS- conscious and oriented.
P/A- Soft and non tender.
P/H- Bowel – irregular bowel habit
Bladder –normal habit
Sleep – normal
Appetite - normal.
Addiction :- no any specific addiction
P/R- fissure at 6 0`clock.
No fresh bleeding
INVESTIGATIONS:HIV and HbsAg
Treatment planned as follows:
The patient was given KasisadiGhŗita in the dose of 10 ml
intrarectally once a day for 28 days.
CRITERIA FOR ASSESSMENT
Local Symptoms :
1. Gudadaha (burning pain) :
0 - No Gudadaha.
1 -Patients complains of Daha only during interrogation.
2 -Patients complains of Daha during and after defaecation which is relieved after some time without medicine.
3- Patient complains of daha during and after defeacation for some hours and relieved only with some medicine.
4 -Patient complains of daha that is sour all through the day hampering his normal routine work.
2. Guda Pida (cutting pain) :
0 - No pain.
1 -Patients complain only when interrogated and pain is relieved after defecation immediately on its own.
2- Patients complain of pain during after defecation for few hours but pain is relieved without medicine and not hampers normal routine.
3- Patient complains of executing pain during and after defecation for few hours, but pain is relieved only with some medicine and not hampers normal routine.
4- Patient struggles due to pain all the daylong and his normal routine is hampered and he had drastic medicine for same.
3. Raktasrava (bleeding) :
0 -No bleeding
1 -Bleeding along with defecation streak wise only over the stool /noticed on fissure rarely
2 -Drop wise bleeding during after defecation 0-10 drops occasionally.
3 -Drop wise bleeding during and after defecation 10-20 drops stopped.
4- Profuse bleeding drop wise or stream wise amounting more than 20 drops in each defecation
4. Kandu (itching) :
0- No Kandu.
1- Patients complains only when asked.
2 -Once or twice in a day relieved with seitzbath.
3 -Patients complains of itching sensation many often in a day and discomfort.
4 -Severe and constant itching sensation all the day long.
]5. Tenderness :
0 -No tenderness
1 -Pain on deep palpation
2 -Pain tenderness on light pressure.
3 -Pain on touch
4 -Patient does not allow palpation due to pain even on touching of under clothes and difficulty in sitting.
FOLLOW UP STUDY
After the completion of therapy the patients were asked to come weekly for one month for checkup. It was to be noted whether the relief provided by therapy was permanent or there was any recurrence.
PROBABLE MODE OF ACTION OF KASISADI GHŖITA
The important factors which keep a fissure-in-ano away from normal healing are constant contamination of the wound by faeces and frequent friction with the mucosa while there is continuous spasm of the sphincteric muscles. In such situation, a drug which
produces a soothing effect; Vraņa Sodhana, Vraņa Ropaņa, Vedana Shapana and Vata-pittahara action, is more suitable. Here Kasisadi Ghŗita has been selected for the present study due to having the same properties and good soothing effect. Vata-pittahara property may be due to its Ghŗita base and it probably removes the accumulated secretions in the fissure bed, promotes healing and reduces secondary infection too. It may be due to its Vraņa Sodhana, Vraņa Ropaņa,Sothahara and Vedanasthapanaproperties.
EFFECT OF THERAPY:
Effect of therapy on cardinal symptoms in the
patient of Parikartika (Fissure in ano) :
- Effect on Guda Daha : Before starting the treatment, mean gradation of GudaDaha 3 was reduced to 1.
- Effect on Guda Pida : It was reported that initial mean of Guda Pida was 4 and after treatment it reduced to 0.
- Effect on Rakta Srava :score was 2, which reduced to 0 after the treatment.
- Effect on Kandu : It was found that the mean score of Knandu before the treatment was 3 and after the completion of the course, it decreased to 0.
- Effect on Tenderness : In present study, it was found that the mean
gradation of swelling before treatment was 3 which decreased to 0 after the treatment .
Ano-rectal disorders are progressively increasing in society. Few important causes are sedentary life style, irregular and inappropriate diet, prolonged sitting and psychological disturbances like anxiety and depression etc. Ano-rectal problems are coupled with psychological manifestations, as all the causes are interrelated to each other.
There is a proverb used by modern surgeons about this disease that
Nowadays, fissure-in-ano is a big challenge as recurrence rate is almost high. ‘Parikartika’ is such a condition that has come up as an alarming problem in recent times. As described earlier, it is not described as any separate disease, but its existence is found as a complication of Virecana, Basti and also Vamana Karma. But the fact is that the occurrence of Parikartika is a sequel of Atisara, Jwara,
Pravahika etc. AchArya Kasyapa has mentioned this disease as a complication of pregnancy in women which is very keen observation from the modern point of view and also as is seen in everyday practice even today. In the present clinical research work there were significant relief from the symotoms of parikartika with the kasisadi ghrita.
On the basis of Āyurvedic texts, views of ancient scholars, facts and observations done in the present clinical research work some points can be concluded like –
- The site of Parikartika is Guda, which is similar to the site of fissure-in-ano.
- Vāta and Pitta Doşa have dominancy in the development of the disease Parikartika, but Vata is predominant.
- The most evident symptom present i.e. pain and spasm of anal sphincters in fissure-in-ano can be relieved much earlier by the application of Kasisadi Ghŗita.
- In the cases of Rakta Srava, the application of Kasisadi Ghŗita showed effective results and good control after 3 – 4 days.
- In the follow up study, it was observed that the results achieved in are effective and stable during follow up period too.
- The use of Kasisadi Ghŗita has a definite role in the treatment of fissure-in-ano in terms of earlier relief in cardinal and general symptoms and quick healing of ulcer too.
- In the present study it can be concluded that application of Kasisadi Ghŗita is effective in the management of fissure-in-ano (Parikartika).
*PG Scholar,(Shalya-Tantra Kshar Karma Avum Anushastra Karma