Qualities of a surgeon according to Ayurveda

Qualities of a surgeon according to Ayurveda



According to the great Indian Surgeon, Acharya Sushruta, a surgeon must have the following six qualities;

• Shaurya: He should have enough‘Dare’ to perform surgical procedures.
• Aashukriya: He should be ‘fast acting’, both physically as well as mentally.
• Shastrataikshyanam: His instruments should be ‘sharp’enough to perform the surgical procedures.
• Swedavepathu: He ‘must not get frightened’ if there is any emergency and ‘his hands must not have tremors’due to fear.
• Asammohasha: He ‘must not become hopeless’ in case there is serious patient/emergency.

The teachings hold absolutely true in today’s era too. What a great Surgeon and scholar he was! Didn’t he?

Jai Ayurveda!!!

Thanks for patiently reading this article. I hope people will be more familiar to Ayurveda and our ancient India’s great scholars, after reading this article. If however, you still have any query/doubt, you can e-mail me at consult@ayurvedapilescure.com

Author: Dr. Naveen Chauhan

Consultant Surgeon cum Ayurveda Physician
 Specialist Kshar sutra surgery for Proctological diseases

SHRI DHANWANTARI CLINIC, GHAZIABAD

Kshara Sutra Therapy in the treatment of Pilonidal Sinus

‘Pilonidal Sinus’
‘Pilus’ = Hair and ‘nidus’ = nest; Pilonidal sinus means ‘sinus with nest of hair.’
This condition is commonly occurs in hairy men.
This is an acquired condition.

Pathogenesis: When a person sits, buttocks take maximum pressure. As they rub against clothing etc. hairs break off and get collected between cleft of the buttocks. These gradually penetrate the skin or enter the openings of sweat glands, forming a sinus. Gradually more hairs are sucked into the sinus forming a bunch of hairs, so it looks like a nest of hairs, thus it is called ‘Pilonidal Sinus’.
As this condition is common in jeep drivers, this condition is also called ‘jeep bottom’ disease.
In Ayurveda, ‘Pilonidal Sinus’ is a type of ‘Naadi Vrana’.

Symptoms of Pilonidal Sinus:
Chronic or recurring sinus in the midline, between buttocks.
A tuft of hair projects from its opening.
Discharge from the sinus is blood stained, foul smelling and contains hairs.
Secondary openings may be found in the midline or in the buttocks and there is an indurated track connecting the openings.
Generally the patient is a hairy, male and 20 to 40 yrs. of age.
There may be pain and swelling locally.
Generally, it does not penetrate the bone.
There may be history of repeated abscess in the region, which may have resolved spontaneously or may have been incised open.

Treatment of Pilonidal Sinus:

Conservative management of Pilonidal Sinus:

• Clean the track.
• Removing hairs from the track and a considerable area surrounding the track.
• Avoid occupations which involve long hours of sitting e.g. driving vehicles etc.

These measures have given encouraging results in those with mild symptoms.

When an abscess has been formed (acute stage):

Incision and drainage (I & D) needs to be done but this may be avoided by Kshara sutra threapy.
The abscess cavity has to be cleaned well to remove hairs and unhealthy granulation tissue to prevent recurrence.
Care should be taken as in a patient of abscess.

Excision (Surgical removal) of Pilonidal Sinus:

Operation has to be carried out after the signs of inflammation have subsided.
Patient is place in prone position.
Methylene blue dye can be injected into the opening to colour and thus identify the tracks.
The track once identified, has to be surgically laid open, hairs and debris removed and the edges sutured. But this is associated with risk of recurrence.
Hence, once all the tracks have been excised, and perfect haemostasis maintained, the area is packed with gauze dipped in Betadine/Povidone. Next day the dressing is removed, and patient is advised daily hip baths and a dressing till the wound has healed completely by secondary intention.

‘Kshara Sutra Therapy’ in the treatment of ‘Pilonidal Sinus’:Kshara Sutra, an alkaline herbal medicated thread which is one of the most successful among all the therapies available for the treatment of Naadi Vrana (Pilonidal Sinus) and Bhagandara (Fistula-in-ano) from ancient time to the present era.

How to apply Kshara Sutra in Pilonidal Sinus: Patient is placed in prone position.
Under aseptic measures and under proper anaesthesia, track should be identifying with the help of a probe.
After cleaning the track, Kshara Sutra (An alkaline herbal medicated thread) has to be passed in the track and make it fix over there.
As we discussed above that due to its proteolytic enzymes and hygroscopic action, the Kshara produced debridement of sluggish tissue.
The Kshara Sutra has power to cut and heal the sinus track simultaneously.
After every week, the Kshara Sutra has to be changed with the previous one.
After every week of Kshara-sutra change, the track cleans-up and simultaenous healing occurs, thus the length of track and the kshara sutra goes on decreasing on subsequent visits. Finally the whole track gets cut off (cut through) by the action of Kshara-sutra and the disease cures completely.

Principle behind ‘Kshara Sutra Therapy’:
Cutting and healing of the track (Sinus) simultaneously.
The idea has been to preserve the actions of all the three ingredients, i.e. the proteolytic action of the latex, the hygroscopic nature and caustic action of the Kshara and the antiseptic action of Haridra (Turmeric) powder. Due to its proteolytic enzymes and hygroscopic and penetrating action, the Kshara sutra produce debridement of sluggish tissue, which leads to cleaning and thus a good healing.

Thanks for patiently reading this article. I hope people will be more familiar to this disease, after reading this article. If however, you still have any query/doubt, you can e-mail me at consult@ayurvedapilescure.com

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and Proctologist

SHRI DHANWANTARI CLINIC, GHAZIABAD
Phone: +91-9818069989

Piles; causes, prevention and Ayurvedic Treatment

Piles; causes, prevention and Ayurvedic Treatment:

Piles is a disease in which there is prolapse of some mass through anal canal. It is also known as Hemorrhoids. In piles there occur stasis of blood inside the hemorrhoidal blood vessels. This leads to vericosities in these vessels.

Causes:
Irregular bowel habits
Prolonged standing and/or sitting
Constipation
Straining during defecation
Heredity factors
Due to other associated diseases like colitis, diarrhoea etc.

Symptoms:
Bleeding during defecation
Mass prolapse per anum
Sometimes pain when piles associated with fissure or external piles
Mucous secretions from piles masses

Prevention:
Avoid straining during defecation
Take plenty of fibres in diet like vegetables and fresh fruits to prevent constipation
Drink plenty of water (5-6 litres/day)
Consult an Ayurveda Physician or specialist if there is bleeding or pain
Drink buttermilk daily

Ayurvedic Treatment: In Ayurveda there is effective blood controlling and constipation medicines. These should be used by consulting a qualified physician. If prolapse is more (2nd or 3rd degree piles), kshara sutra ligation of piles masses is recommended. It’s a minimally invasive parasurgical procedure employed to cure anorectal diseases like; Piles, Fissure or Fistula in ano etc. in an effective way. Specialists’ consultation is advised before going for kshara sutra therapy.

AUTHOR

DR. NAVEEN CHAUHAN

CONSULTANT KSHARA SUTRA SPECIALIST FOR PROCTOLOGICAL DISEASES

SHRI DHANWANTARI CLINIC, GHAZIABAD

बवासीर (पाईल्स) कारण बचाव एवं आयुर्वेदिक चिकित्सा

बवासीर (पाईल्स); कारण, बचाव एवं आयुर्वेदिक चिकित्सा 
Piles; causes, prevention and Ayurvedic Treatment:

A case of 2nd degree Piles/ Hemorrhoids

बवासीर गुदा (मलद्वार) में होने वाली एक सामान्य बीमारी है, जिसमें मलत्याग के समय रक्तस्राव तथा मस्से फूलने की समस्या होती है. इसे पाईल्स या हेमोराइड्स भी कहते हैं। आयुर्वेद में इसे अर्श कहते हैं। यह बीमारी स्त्रियों की अपेक्षा पुरुषों में कुछ ज्यादा होती है।

प्रमुख कारणः बवासीर का प्रमुख कारण पेट की खराबी व पाचन तन्त्र का कमजोर होना है। इसके अतिरिक्त कारण निम्न हैं ;

• लम्बे समय तक कब्ज रहना
• मलत्याग के समय जोर लगाना
• टॉयलेट में काफी देर तक बैठना
• हेरिडिटि (वन्शानुगत कारण)
• अतिसार (दस्त)

प्रमुख लक्षणः
मलत्याग के समय रक्तस्राव - सामान्यतः ताजा रक्त बूंदों या धार के रूप में निकलता है, जो दर्द रहित होता है। परन्तु जब बवासीर के साथ फिशर (गुद्चीर) भी होता है, तो रक्तस्राव के साथ दर्द भी हो सकता है।
मलत्याग के समय मस्सों का बाहर निकलना - रोगी जब टॉयलेट में बैठकर जोर लगाता है, तो मस्से बाहर आ जाते हैं व जब जोर हटाता है तो मस्से अन्दर चले जाते हैं। कभी कभी जब बवासीर पुरानी हो जाती है तो मस्सों को अन्दर करने के लिये उंगली का सहारा देना पड्ता है।
म्यूकस का निकलना - कभी कभी मस्सों के स्थान पर श्लैष्मिक द्रव का स्राव भी हो सकता है।

बचाव के उपायः

• भोजन सम्बन्धी आदतों में बदलाव – रेशेदार सब्जियों, सलाद व फलों का नित्य सेवन करें, तेज मिर्च, मसालों का प्रयोग ना करें। पानी ४-६ लीटर प्रतिदिन पियें। चाय, कॉफी का कम प्रयोग करें। इससे पेट ठीक रहेगा व कब्ज नहीं होगी।
• मलत्याग के समय ज्यादा जोर ना लगायें।
• यदि कब्ज हो तो रात में दूध के साथ मुनक्का व १-२ चम्मच इसबगोल की भूसी लें।

यदि कोई समस्या हो तो किसी क्वालीफाईड आयुर्वेद फिजीशियन या क्षारसूत्र विशेषज्ञ से मिलकर सलाह अवश्य लें।

आयुर्वेदिक चिकित्साः बवासीर की शुरुआती अवस्था में जब केवल रक्तस्राव होता है तो क्वालीफाईड आयुर्वेद फिजीशियन की सलाह से आयुर्वेदिक औषधियों के प्रयोग द्वारा काफी आराम मिल सकता है तथा बीमारी को आगे बढ्ने से रोका जा सकता है। जब बीमारी ज्यादा बढ जाती है तो क्षारसूत्र चिकित्सा से मस्सों को निकाल दिया जाता है। इससे बीमारी से स्थायी रूप से छुटकारा मिल जाता है। यह विधि सर्जरी की अन्य विधियों की अपेक्षा आसान व अधिक कारगर है।

लेखकः डॉ० नवीन चौहान

आयुर्वेद फिजीशियन व क्षारसूत्र विशेषज्ञ

श्री धन्वन्तरि क्लीनिक, गाजियाबाद (उ० प्र०)

मोबाइल : +91-9818069989 

PILES/ HEMORRHOIDS : Kshara-sutra treatment

PILES/ HEMORRHOIDS : Kshara-sutra treatment

The disease piles is as old as the history of mankind. A lot of people suffer from it and many of them hide the disease and reach to the doctor when the disease become chronic and only surgical option is left then usually.

Hemorrhoids are defined as varicose condition of haemorrhoidal plexus. In modern era, Hippocrates, The Father of Modern Medicine (450 B.C.) has also described the method of diagnosing ano-rectal disorders. Later on, in the present era Turell (1960) told that about 70% of human beings suffer from haemorrhoids and 40% of them need surgery. About 10% cases remain undiagnosed and do not visit doctor. Golligher (1967) expressed that the incidence of hemorrhoids increases with the age and at least 50% of the people over the age of 50 have some degree of hemorrhoids. Ferguson (1973) reported that 100% of the population has hemorrhoid but 50% may be symptomatic. Men seem to be affected more as compared to women. It is very common above the age of 30 years.





A case of 2nd degree Primary Hemorrhoids

Causes

Primary causes

1. Heriditary

2. Constipation

3. Diarrhea and dysentery

4. Faulty habits of defecation

5. Dietary habits

6. Anatomical factors
Secondary causes

1. Portal obstruction

2. Carcinoma of rectum

3. Abdominal tumors

4. Pregnancy

CLASSIFICATION:

A. In relation to site of origin

1. Internal hemorrhoids

2. External hemorrhoids

3. Interno-external hemorrhoids

B. In relation to pathological anatomy

1. Primary hemorrhoids

2. Secondary hemorrhoids

C. In relation to pathophysiologically

1. Mucosal

2. Vascular

D. In relation to facilitate the line of management

1. 1st degree hemorrhoids

2. 2nd degree hemorrhoids

3. 3rd degree hemorrhoids

4. 4th degree hemorrhoids


CLINICAL FEATURES:

1. Bleeding during defaecation

2. Prolapse of mass during defaecation

3. Discharge

4. Anal irritation

5. Pain

6. Anaemia (If bleeding is persistent and severe)

COMPLICATIONS:
Hemorrhage
Strangulation
Thrombosis
Ulceration
Gangrene
Suppuration
Fibrosis
Pylophlebities

DIFFERENTIONAL DIAGNOSIS:

It should be differentiated from;

1. Partial prolapse of rectum

2. Rectal polyp

3. Carcinoma of anal canal

4. Multiple small ulcers in the rectum

5. Condyloma lata and accuminatum

6. Sentinel tag

In Modern science the following types of treatments are available to treat the disease;

1. Medical treatment

2. Sclerotherapy

3. Barron Band Ligation

4. Lord’s manual dilation

5. Cryosurgery

6. Pedicle ligation
7. Haemorrhoidectomy

8. Infrared coagulation
ayurvedic treatment of haemorrhoids:

Application of Kshar sutra in Arshas (Haemorrhoids)

Pre Kshar sutra measures:

a. The patient should be admitted in the hospital a day before operation.

b. Soap water enema should be administerd after admission.

c. Shave and part preparation done.

d. Keep the patient fasting at least for 8 hours

e. Consent of the patient in written

f. Proctoclysis eneme 2 hours before the procedure

g. Inj. Xylocaine sensitivity test

h. Inj. Tetenus toxoid 1 Amp. IM stat.



EQUIPMENTS AND OTHER REQUIREMENTS
Proctoscope Pile holding foreceps
Artery foreceps both Staight & curved Sponge holding foreceps
Surgical gloves assorted size and pair Scissiors
Needle holder Round body curved needles
Towel clips Syringes
Swabs Linens
Kshar sutra

POSITION: Maximum number of patients has lithotomy position for this procedure.

Kshar sutra ligation procedure:
The patient is made to lie on the operation table in Lithotomy position.
The perianal area is cleaned with Savlon and spirit followed by Betadine painting.
The outer area is covered with sterile cloth, leaving the anal area open.
Proctoscopy is done and the positions of various pile masses are assessed.
The pile mass is protruded outside by asking the patient to strain out.
Hold the pile mass with pile holding foreceps.
Then Inj. 2% Xylocaine is infilterated around the root of pile masses.
The protrued pile mass is held with pile holding foreceps. Slight pull is exerted over the pile mass, so that the base of pile mass is clearly demarcated alongwith the blood vessel.
The pile mass is transfixed with curved cutting needle with the help of needle holder and it is followed by kshar sutra ligation.
The same procedure is performed to ligate other haemorrhoids if present.
The ligated haemorrhoids are replaced inside the anal canal and the kshar sutra is allowed to suspend out.
10 ml. of jatyadi oil is pushed inside the rectum and sterilized gauze is applied on the anus.
T-bandage is tied to keep the dressing in proper position.
Thereafter the patient is shifted to the ward.

Post Kshara-sutra ligation management:

1. Nil orally for 4 hours

2. Give liquid diet after that to avoid any type of inconvenience.

3. Note pulse, temp., B.P. 6 hourly

4. If operation is done under spinal anaesthesia, to avoid complication give head-low position to the position for 48 hours.

5. Jatyadi oil P/R BD

6. Hot sitz bath with panchvalkal kwath 8 hourly

7. To avoid hard stool, give mild laxative to the patient

8. If pain is excessive, urinary retention was occurred then go for the systemic treatment.

Mode of action of Kshara-sutra:

Kshar sutra by its chemical cauterization and mechanical strangulation of blood vessels, causes local gangrene of the pile mass and pile mass get removed within 5 to 7 days. No effort should me made to pull out the Kshar sutra or pile masses as it may cause pain and bleeding which is not desirable. The healing of the resulting wound takes a week’s time.

Post Kshara-sutra ligation complications:

1. Retention of urine – It has been observed that within 8 to 10 hours after ligation, some of the patients complain of retention of urine which can be tackled by frequent sitz bath in lukewarm panchvalkala kwatha or simple warm water. Catheterization is seldom required.

2. Local irritation – In some of the patients local i.e. perianal irritation is seen which needs frequent use of oil application and hot sitz bath etc.

3. Abscess formation – In some of the patients (especially who was suffered from interno-external piles), abscess formation takes place which was managed with local application of Dashang lepa with Goghrita.

4. Haemorrhage – Alarming type of haemorrhage is not a rule with Kshar sutra treatment. However in some of the cases slight oozing may be seen which need no special care except the usual routine line of management, viz. avoidance of hard stool and much straining during defecation.

Pathya-apathya:

From the very first day of Kshar sutra ligation light diet like Khichri is advised. Patient is also advised to take plenty of fluids, blend diet, green vegetables and seasonal fruits. Patient is further advised to avoid spicy and fried food and not to strain during defecation.

Finger dilation of anus/Ganesh kriya: From 3rd week of Kshar sutra application or after the falling of pile mass, lubricated index finger with jatyadi oil is gently introduced inside the anal orifice and is gradually rotated clockwise and anti-clockwise for 2 to 3 minutes.

Patient is advised to carry out this practice of this procedure by himself by using the finger stall on right index finger after defecation in the squatting position daily for a period of 1 to 3 months. Such a practice is advised just to avoid any chance of post ligation narrowing of anal opening.

Piles/hemorrhoids; Home remedies and Ayurvedic treatment

Piles/hemorrhoids; Home remedies and Ayurvedic treatment


Piles
Piles, also known as ‘Haemorrhoids’, are small, bluish swellings, comprising of enlarged blood vessels situated either just inside or just outside the anus commonly called internal piles and external piles. In case of bleeding, they are termed as bleeding piles.
Causes
Persistent constipation due to poor dietary habits.
Sitting on hard seats for prolonged periods.
Lack of exercise.

Because of all these factors, straining is needed to pass the small hard stools, which causes
congestion in the network of blood vessels located inside the anal cushions. Gradually, these vessels enlarge and form piles. If the constipation further continues, they become large enough to be called second or third degree piles.
Signs & Symptoms
Internal piles: These are found inside the anal canal and lined by mucous membrane. Depending on the chronicity of the disease and prolapse these can be;

First-degree Piles:
Many people have these without even being aware of them. These are located just inside the anus, ocassionally causing some discomfort when a motion is passed. Rarely, slight bleeding may also occur during evacuation.
Second-degree Piles:
They usually appear as pea-sized swellings outside the anus after a bowel motion has been passed. They are usually retained inside the anus and may bleed and cause
discomfort during passing stool with some degree of itching.
Third-degree Piles:
The swollen blood vessels are so enlarged that they remain outside the anus permanently. These are known as external piles, and are more troublesome. Soreness and persistent irritation are the common features.
External haemorrhoid (sometimes called a perianal haematoma)

This is less common than internal haemorrhoids. An external haemorrhoid is a small lump that develops on the outside edge of the anus. Many do not cause symptoms. However, if a blood clot forms in the haemorrhoid (a thrombosed external haemorrhoid) it can suddenly become very painful and need urgent treatment. The pain due to a thrombosed external haemorrhoid usually peaks after 48-72 hours, and then gradually goes away over 7-10 days. A thrombosed external haemorrhoid may bleed a little for a few days. It then gradually shrinks to become a small skin-tag.

Some people develop internal and external haemorrhoids at the same time.


Home remedies:
1. The poultice made of sesame (til) seeds can be applied over bleeding piles as an
external measure, and internally also ½ teaspoonful of sesame seeds can be taken
orally with some butter.
2. A mixture can be made of: Ripe bael fruit pulp = loz, Sugar = 180gms, Powder of black peppers = 7 in number, Cardamom powder = 7gms. This can be taken twice a day as a good remedy.
3. Radish (Muli) is a useful home remedy for piles.
* The hot poultice of dry radish (Muli) is a good application in non-bleeding
piles.
* The juice is also useful in piles. 60 to 100 ml of radish juice well mixed with little
bit of salt, should be taken twice a day, daily for 40 days.
4. Butter Milk: It is the home remedy of choice in piles. l00ml well mixed with a little bit of black pepper powder, and salt should be taken daily for a few months at least. Ayurveda stresses upon daily intake of butter milk by the piles patients.
5. Hareetaki, popularly known as harad is a good remedy for constipation. The decoction of the fruit peel of harad (Terminal a Chebula) is taken 1 cupful with jaggery at bed-time.
6. Rose petals, 11 in number crushed with 50 ml of water should be taken for 3 days on empty stomach. This is a very good remedy for bleeding piles. Banana fruit should not be taken for 1year along with this treatment.
7. The decoction of sonth (dried ginger) is very useful inpiles. It should be taken in
the quantity of 30 to 50ml daily.

Ayurvedic medicines:
1. Triphalachurna: This should be taken regularly to remove the constipation. 2 tsf of
powder well mixed in a glass of lukewarm water should be taken orally before retiring to bed. Externally also it is widely used in different methods. One popular method is to take a plastic tub, fill it with warm water to a level where one can sit comfortably. Add 10 teaspoonfuls of Triphalachurna to the water and mix well for some time.Then the patient should sit in the tub, duly immersing the anus in the lukewarm water for 30 minutes. This should be carried out daily. This practice brings in enormous benefits to the piles patient.
2. Abhayarista: As an oral liquid preparation, it is also useful in constipation. 30 ml of the
medicine dissolved in equal quantity of lukewarm water should be taken before going
to bed.
3. Arsha Harivati is a common herbo-mineral compound prescribed by Ayurveda. 2
pills twice a day with some butter milk or warm water should be taken for 40 days.
This gives great relief from piles.
4. Arshonyt tablet/ointment (Charak) 1-2 tablets thrice daily along with application of ointment before and after defecation.
5. Many Ayurvedic ointments are quite useful. Dosages are as above.
6. Arshoghnivati tablet 1 to 2 tablets with water or butter milk can be taken thrice or four times daily.
7. Kankayan Vati is quite beneficial in piles.
8. Pileen, Arshon and Rasanjan Vati tablets (Bhaat Ayurvedic Pharmacy) can be taken in the dose of 1 to 2 tablets daily for 2 to 3 months.
9. Kasisadi Tailam when applied externally is also helpful.

Ayurvedic surgical treatments:

When internal piles bleed profusely and is in 2nd or 3rd or 4th degree, medicines do not have much benefit. In such case the piles masses have to be removed surgically. In Ayurveda Kshara sutra ligation and Agnikarma excision are the procedures which can be used to remove the piles masses (Internal as well as external) thus leading to a permanent cure of the problem. One should not hesitate or have any kind of fear of surgical procedures and should consult a qualified expert Ayurveda doctor to get rid of the problem. Delay may sometimes lead to serious complications like severe anemia due to continual bleeding and shock and so on.

External piles if get thrombosed need immediate surgical intervention because of severe pain. Kshara sutra ligation and Agnikarma are equally beneficial in curing external piles permanently.



NOTE: Ayurvedic medicines and treatments including surgical procedures like kshara sutra and agnikarma etc. should be taken under Qualified Ayurvedic Doctor/Physician/Surgeon. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and Proctologist

SHRI DHANWANTARI CLINIC, GHAZIABAD

Kshar-sutra therapy in Fistula-in-ano

Ayurveda Kshar-sutra therapy in Fistula-in-ano

The history of medical literature available today very clearly speaks that the disease Fistula-in-Ano (Bhagandara) affects more reputations of surgeons who deals with it. There is a saying in medical world “the best way to take revenge of a surgeon is to refer him a patient of Fistula-in-Ano”. Thus, it is a well known fact that in spite of the tremendous developments of modern medical science especially of surgery, the disease Fistula-in-Ano still remains a challenging problem to the medical world.

The ano-rectal disorders and their management has established a separate surgico-dynamic speciality among the various surgical disorders. The ano-rectal disorders have been known form the very early period of evolution to the medical science. The disease Bhagandara (Fistula-in-Ano) is said to have existed about four thousand years according to Wilson (1963) as mentioned by Khurana et al (1972). Furstenbergh et al (1964) have mentioned the method of Apolinose by which Hippocratus, the Father of modern medicine (460 BC) treated Fistula-in-Ano.


The main limitation of treatment of Fistula-in-Ano by conventional surgery is that even after surgical excision of the tract the recurrence rate still remains between 20-30%. Hence this disease even today stands as a challenge in front of the medical world.


Susruta’s method of thread treatment is known as Kshara-sutra treatment as mentioned above and even today it is quite successful method in treating this difficult disease. Hippocrates named the procedure of passing the ligature along the fistulous tract as Appolinose. Chandsi and Madrasi treatments are known by their names only and much detail are not known about them. However it was Prof. P. J. Deshpandey at Banaras Hindu University, who took the lead after ancient Acharyas for exploring the technique, and modified and standardized it with the help of modern science and technology. The treatment was put to clinical trials in patient of Bhagandara and many scientific papers published. Apart from that, at the Department of Shalya Shalakya, Gujrat Ayurved University, Jamnagar many works done on Kshara-sutra treatment for the disease Bhagandara under the guidance of Prof. Kulwant Singh. Later on various other places in India and abroad started Kshara-sutra treatment in Bhagandara (Fistula-in-Ano) and piles patients. The Kshara-sutra treatment is now a well accepted Ayurvedic technique for treating the ano-rectal diseases viz. Fistula-in-Ano, Arshas (Piles), Parikartika (Fissures with tags) etc.


APPLICATION OF KSHARA-SUTRA IN A PATIENT OF BHAGANDARA (FISTULA-IN-ANO):

Pre Kshara sutra (Pre-operative):

a. The patient should be admitted in the hospital a day before operation.
b. Laxative like Panchsakara churana is given at previous night
c. Shave and part preparation done.
d. Patient is kept fasting for at least 8 hours
e. Consent of the patient in written
f. Proctoclysis enema 2-4 hours before the procedure
g. Inj. Xylocaine sensitivity test
h. Inj. Tetenus toxoid 1 Amp. I/M stat.

EQUIPMENTS AND OTHER REQUIREMENTS:
Proctoscope, Probes of different sizes, Artery foreceps both Staight & curved, Sponge holding foreceps, Surgical gloves assorted size and pair of scissors, Towel clips, Syringes, Swabs, Linens, Kshara sutra, Jatyadi oil etc.

POSITION: All the patients were given lithotomy position for the procedure.

Kshara sutra threading procedure (Operative procedure):
Spinal anesthesia is induced by the Anesthetist.
The patient is made to lie on the operation table in Lithotomy position.
The perianal area is cleaned with Savlon and spirit followed by Betadine painting.
The outer area is covered with sterile cloth, leaving the anal area open.
Digital examination done to locate any induration, internal opening and to exclude other lesions.
Probing is done through a malleable probe to locate the internal opening with the index finger of other hand inside the anus. If internal opening is located, the probe is pushed out through the anal verge and the track is threaded loosely by Kshara sutra. However if internal opening couldn’t be located it is made inside the anal canal at a point which offer least resistance to the tip of the probe. Again Kshara sutra threading of the track is done loosely.
10 ml. of Jatyadi oil is pushed inside the rectum and sterilized gauze is applied on the anus covering the external opening.
T-bandage is tied to keep the dressing in proper position.
Thereafter the patient is shifted to the ward.


Post Kshara sutra threading management (Post operative):


1. Nil orally for 4 hours
2. Give liquid diet after that to avoid any type of inconvenience.
3. Monitor the vitals
4. If operation is done under spinal anaesthesia, to avoid complication give head-low position for 12 hours.
5. Jatyadi oil P/R OD
6. Hot sitz bath with panchvalkal kwath 8 hourly
7. To avoid hard stool, give mild laxative to the patient
8. If pain is excessive, urinary retention occurred, it is managed accordingly.

Post Kshara sutra threading complications:


1. Retention of urine – it has been observed that within 8 to 10 hours after ligation, some of the patients complain of retention of urine which can be tackled by frequent sitz bath in lukewarm panchvalkala kwatha or simple warm water. Catheterization is seldom required.
2. Local irritation – In some of the patients local i.e. perianal irritation is seen which needs frequent use of oil application and hot sitz bath etc.
3. Abscess formation – In some of the patients (especially who was suffered from interno-external piles), abscess formation takes place which was managed with local application of Dashang lepa with Goghrita.
4. Haemorrhage – Alarming type of haemorrhage is not a rule with Kshara sutra treatment. However in some of the cases slight oozing may be seen which need no special care except the usual routine line of management, viz. avoidance of hard stool and much straining during defecation.

Weekly change of the sutra: - Kshara-sutra applied initially is kept for 7 days after which it is replaced by a fresh Kshara-sutra by Rail Road Technique. This procedure is repeated every week till the track completely cut through and if there is any unhealthy granulous tissue, it is scrapped-off during this weekly follow-up to promote a better healing.

Mode of action of Kshara sutra:

Kshara sutra works by pressure necrosis, chemical cauterization by kshar (alkali) and sloughing of the tissue of the walls of the fistulous track along with adequate drainage. It leads to an easy debridement of unhealthy tissue and pus etc. and thus providing a cleaner base for the wound healing of the fistulous track. The Kshara-sutra is changed weekly so that an average pace of cutting of about 0.5-0.8 cm/week is maintained along with healing from behind. Finally the whole track is cut through and the fistula gets healed up with minimal scarring and without any other major complication.

Pathya-apathya (Diet and routinely activities):
From the very first day of Kshara sutra threading procedure, light diet like Khichri is advised. Patient is also advised to take plenty of fluids, blend diet, green vegetables, salad and seasonal fruits. Patient is further advised to avoid spicy and fried food and not to strain during defecation.



Picture 1: A case of multiple Fistula-in-ano, with kshar-sutra threading done in all the 3 tracks separately.



Picture 2: A completely healed case of Fistula-in-ano after kshar sutra treatment. In this case there was done fistulectomy which was not successful and fistula recurred. Thereafter the threading of the track was done by kshar sutra and the fistula healed successfully in about 4 months without any recurrence.

NOTE: The procedure can also be performed under local anaesthesia or without anaesthesia at all if the patient is co-operative. However if the patient is sensitive (Vata dominant prakriti), spinal anaesthesia is the best choice.

AUTHOR: DR. NAVEEN CHAUHAN

CONSULTANT AYURVEDA PROCTOLOGIST
Contact: +91-9818069989

Fistula-in-ano; 10 important things you must know!

Fistula-in-ano is a disease in which there develops a track between perianal skin and/or rectum or anal canal. The main symptom that appears is mucopurulent discharge through the external opening present anywhere in the perianal area. This sometimes leads to itching and or burning sensation.

I am going to give 10 valuable tips for the patients of Fistula-in-ano which being an ano-rectal specialist doctor, I feel are necessary to be communicated to them.

1. Many patients wander here and there in search of any doctor or medicines to cure Fistula and often waste their time, money and energy by getting trapped in the misleading advertisements, quacks etc. without any result. Remember, Fistula-in-ano is a 100% surgically curable disease. Sometimes, if fistula is due to tuberculosis then Anti-tubercular therapy can work to heal it otherwise surgical intervention is necessary in it.

2. Beware of quacks and false claims’ advertisements like those of injection treatment, herbal treatment etc. seen commonly in media. Bengali, Chandsi, Madrasi are also not genuine and legal treatments. They can harm your health and can lead to complications like anal incontinence.

3. Antibiotics can only temporarily reduce the symptoms like pus discharge but will not help in long term use.

4. Conventional surgical operations for Fistula-in-ano have high recurrence rates, especially in high anal types. Fortunately, there have been excellent results obtained by Ayurveda Kshar Sutra therapy, which can be used extremely effectively to cure Fistulae of almost all the types completely, without any complication or recurrence. It has been well established and proven scientifically by various research centres in India like AIIMS, BHU, ICMR, PGI etc.

5. One should not wait in seeking an expert physician’s/surgeon’s consultation due to shyness or hesitation. As soon as symptoms like persistent or intermittent discharge of pus, soiling of clothes, feeling of some abscess, pain in perianal region etc. appear, expert’s consultation must not be delayed.

6. Since Ayurveda Kshar-sutra therapy is extremely effective in curing fistula-in-ano, one should prefer a qualified and experienced Ayurveda Kshar-sutra specialist doctor over other therapies physicians.

7. Fistula patients feel pain when there is collection of pus inside the track or inside the abscess cavity. So, there must be measures to drain out the collected pus. Though kshar-sutra does the drainage by itself, patient can increase the drainage effectively by keeping themselves ambulatory. So, regular walks will help in healing of your fistula even if you are continuing the Kshar-sutra therapy.

8. Have complete faith in your doctor. Afterall he has seen and helped many patients like you. Don’t be panic as kshar-sutra therapy sometimes takes longer times (3 months or more) to heal the fistula completely depending on the track length, type of fistula and many more factors.

9. During the kshar-sutra therapy sometimes patient feels pain, burning sensation etc. during and/or after the weekly changing of thread. Have patience. Remember it is only temporary and ultimately you are going to get rid from this disease completely. Follow the instructions of your physician strictly.

10. Sitz bath is a wonderful remedy in relieving the pain. It not only gives a soothing sensation and provides relief from pain but it also helps in keeping the perianal region clean. So, it should be employed correctly as per your doctor’s instructions.

Thanks for patiently reading this article. I hope Fistula patients will be benefitted by these tips. If however, you still have any query/doubt regarding your disease, you can e-mail me at consult@ayurvedapilescure.com

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and Kshar sutra specialist

SHRI DHANWANTARI CLINIC, GHAZIABAD

Sitz bath; a wonder remedy in anorectal problems

Sitz Bath:

The name is derived from the German verb ‘sitzen’ meaning ‘to sit.’

Definition:

A sitz bath (also called a hip bath) is a type of bath in which only the hips and buttocks are soaked in water or saline solution.

In Ayurveda it has been described as ‘Kati Snaana’

Equipment used for sitz baths:


Sitz bath apparatus

A sitz bath, in which only the hips and buttocks are soaked in water or saline solution, is used for patients who have had surgery in the rectal area or to ease discomfort from fissure, painful hemorrhoids, bladder, prostate, or vaginal infections etc.

Purpose:

A sitz bath is used for patients who either have had surgery in the area of the rectum, or to ease the pain of Anal fissure or an abscess in anal or perianal region or thrombosed/strangulated external hemorrhoids, uterine cramps, prostate infections, painful ovaries, and/or testicles. It is also used to ease discomfort from infections of the bladder, prostate, or vagina. Inflammatory bowel diseases are also treated with sitz baths.

Preparation

The bath should be filled with 3-4 in (8-10cm) of water. For most conditions, nothing else should be added (no bubble bath or oil).

Description

Warm sitz baths are one of the easiest and most effective ways to ease the pain of painful anorectal conditions like Fissure in ano, Thrombosed/strangulated haemorrhoids or an abscess in the anorectal region.

A brief, cool sitz bath helps ease inflammation, constipation, and vaginal discharge. It can be used to tone the muscles in cases of bladder or bowel incontinence.

How to take a sitz bath?
A sitz bath tub can be easily purchased at any general/plastic utensils’ store. Select the size that suits you. Sometimes you may also find them at hospital pharmacies or medical supply stores.
Prepare the items you will need so they are near at hand from where you will be using the sitz bath.
Place the sitz bath tub over the horizontal surface of bathroom, and fix it at its place.
Fill the sitz bath with warm water. Remember that the water temperature will feel cooler to your hands than it will to the rest of the body.
If your doctor has recommended it, add salt or alum powder to the water.
Sit in the sitz bath for 10-20 minutes, or as recommended by your doctor.
When finished, use a towel to gently pat the affected area dry.
Use your sitz bath as often as recommended by your doctor; generally several times a day as needed to ease discomfort.
Wash your sitz bath tub after each use and dry it thoroughly.

Precautions

Some patients may become dizzy when standing up after sitting in hot water; it is best to have someone else present when doing a sitz bath.

Aftercare

The area should be carefully patted dry and, if necessary, clean dressings should be applied.

Risks

Sitz baths pose almost no risk. On rare occasions, patients can feel dizzy or experience rapid heart beat because of blood vessel dilation.

Normal results

Swelling goes down; discomfort is eased; healing is promoted.



Thanks for patiently reading this article. I hope people will be more familiar to this simple but very effective remedy to relieve pain and discomfort in anorectal problems, after reading this article. If however, you still have any query/doubt, you can e-mail me at consult@ayurvedapilescure.com

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and Proctologist

SHRI DHANWANTARI CLINIC, GHAZIABAD

Kshara sutra therapy: Frequently asked questions

FREQUENTLY ASKED QUESTIONS ABOUT KSHARA SUTRA THERAPY IN ENGLISH

Q. 1: What is Kshara sutra therapy?

Ans.: Kshara sutra therapy is a modified and standardized version of an Ancient treatment procedure, originally described by Ancient Indian Ayurveda Sages like Sushruta, Vagbhatta etc. for the treatment of Naadivrana (Sinus) & Bhangadara (Fistula in ano).

Kshara sutra is an Ayurvedic medicated thread which is prepared by smearing a special Linen thread with Ayurvedic drugs. It takes about one month to prepare it.

It is used for the treatment of anorectal diseases like; Bhagandara (Fistula in ano), Arshas (Piles/Hemorrhoids), Parikartika (Chronic fissure in ano), Pilonidal sinus, etc.

Q. 2: What makes this therapy so special?

Ans.: When you will go through this questionnaire, you will know the answer of this question.

Q. 3: Is it a surgical operation? Does the patient need hospital admission?

Ans.: It is a minimum invasive procedure in which ligation of Piles, Sentinel tags and Threading of Fistulous track is done under local anesthesia (generally) or no anesthesia at all. So, it will not be suitable to compare it with surgical operation.

Normally the patient doesn’t need any hospitalization but in few cases where the procedure is carried out in spinal or general anesthesia, a hospital stay of about 24 hours may be required.

Q. 4: Is it a painful procedure? Does the patient need anesthesia? Is there any risk?

Ans.: The feeling of pain can’t be generalized for all individuals. Some people feel more pain even in minor injury while a few can tolerate much more pain. So, it is not possible to say that how much pain a particular patient will feel? However, some pain can be felt as in other procedures.

Generally the procedure is carried out under local anesthesia. But depending upon the case, spinal or general anesthesia may also be needed in a few patients.

As compared to other contemporary procedures for anorectal diseases, kshara sutra therapy has minimum risk and possibility of complications.

Q. 5: When does the patient resume his job and daily routinely activities after the procedure?

Ans.: Normally the patient can carry out his daily routinely activities from the same day.

Q. 6: How much time does it take to cure the disease completely?

Ans.: The complete cure of any disease depends upon the condition of patient, stage of disease, Prakriti (Body constitution) and many more factors. So, it can’t be generalized.

Generally it takes about 10-14 days to cure Piles and Fissure and the healing time of Fistula in ano can be estimated only after a thorough examination of the patient.

Q. 7: Is it true that in Fistula in ano, the kshara sutra needs to be changed every week? Is changing of kshara sutra a very painful procedure? Is there need of any anaesthesia during the kshara sutra changing?

Ans.: Yes, depending on the length of fistulous track, one has to undergo several sittings of weekly kshara sutra change. As far as pain is concerned during the kshara sutra change, I would like to tell you that if kshar sutra is done by skilled doctor, the pain during changing of thread can be minimized. As far as anaesthesia is concerned, it is practically very much difficult (almost impossible) to give anaesthesia every time while changing the thread because the number of sittings of thread change are quite much. However when threading of fistulous track is done first time, local or spinal anaesthesia can be given for patient’s convenience. It’s all depends on surgeon’s skill. If a surgeon is having a good experience, he can change the thread with minimum pain and inconvenience.

Q. 7: After the treatment can the disease reoccur?

Ans.: This is the main feature of kshara sutra therapy that chances of recurrence of disease after the treatment are only 2-4% which is practically nil as compared to other surgical procedures employed for fistula in ano, piles, fissure, pilonidal sinus, anorectal abscess etc.

Following the surgical procedures like Fistulectomy and fistulotomy, for the diseases like Fistula in ano the recurrence rates are very high and there are chances of complications like anal incontinence in High anal fistulae. In such cases kshara sutra therapy is an excellent treatment option.

Q. 9: What are the precautions to be followed during and after the therapy?

Ans.: The instructions of the doctor should be followed strictly. Patient should take adequate fluids, diet rich in fibers to avoid constipation. Sitz bath with Ayurvedic drugs warm decoction should be taken as per the physician’s instructions.

Q. 10: Does the patient need to swallow many medicines during the therapy?

Ans.: Only a few medicines a patient needs to take during the therapy.

Q. 11: Is it an expensive therapy?

Ans.: No, Kshara sutra therapy is very cost effective. As compared to other contemporary surgical procedures, kshara sutra treatment is very effective, safe and cost effective.

Q. 12: Can ano-rectal diseases be cured by medicines only without any surgical or parasurgical procedure?

Ans.: Practically it has been observed that only first degree piles/hemorrhoids and anal fissure in its initial stage can be controlled by Ayurvedic medication. But in 2nd, 3rd and 4thdegrees of piles/hemorrhoids, Chronic fissure in ano and fistula in ano, abscess, pilonidal sinus etc. need surgical intervention. However people tend to refrain from surgery due to fear and/or expensiveness and wander here and there in search of medicine. Quacks take the advantage from such patients and finally lead to aggravation of the disease. Among various surgical and parasurgical approaches, the Ayurvedic kshara sutra therapy has been proved to be extremely safe and effective. It has been well established by premier institutions like AIIMS New Delhi, ICMR New Delhi, PGI Chandigarh, CCRAS New Delhi etc. that kshara sutra therapy is an effective way to treat anorectal diseases like Fistula in ano, Piles, Fissure in ano, Pilonidal sinus, Anorectal abscess etc.

Abscess in Ano-rectal region

Anorectal abscess
Anal abscess; Rectal abscess; Perirectal abscess; Perianal abscess; anal gland abscess; Abscess – anorectal


An anorectal abscess is a collection of pus in the area of the anus and rectum.

Causes, incidence, and risk factors

Common causes of anorectal abscess include:
Blocked glands in the anal area
Infection of an anal fissure
Sexually transmitted infection

Deep rectal abscesses may be caused by intestinal disorders such as Crohn’s disease or diverticulitis.

The following factors increase your risk for an anorectal abscess:
Anal sex
Chemotherapy drugs used to treat cancer
Diabetes
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
Use of medications such as prednisone
Weakened immune system (such as from HIV/AIDS)

The condition may occur in infants and toddlers who are still in diapers and who have a history of anal fissures.

Symptoms

Swelling around the anus and a constant, throbbing pain are the most common symptoms. Pain with bowel movements may be severe.

Other symptoms may include:
Constipation
Discharge of pus from the rectum
Fatigue and general malaise
Fever, night sweats, and chills
Lump or nodule, swelling, redness, tenderness at edge of anus
Painful, hardened tissue

In infants, the abscess often appears as a swollen, red, tender lump at the edge of the anus. The infant may be fussy and irritable from discomfort, but there are usually no other symptoms.

Signs and tests

A rectal examination may confirm that you have an anorectal abscess. A proctosigmoidoscopy may be done to rule out other diseases.

Rarely, you may need a CT scan, MRI, or ultrasound to determine where the pus collection is located.

Treatment

The problem rarely goes away on its own. Antibiotics alone usually cannot treat the problem.

Treatment involves surgery to open and drain the abscess.
Surgery is done using local numbing medicine, along with medicine to make you sleepy or spinal anesthesia.
Surgery is most often an outpatient procedure. The surgeon will cut open the abscess and drain the pus. You will go home the same day.
If the pus collection is deep, you may need to stay in the hospital until the abscess has completely drained.
After surgery, you will need warm sitz baths (sitting in a tub of warm water). This may help relieve pain, reduce swelling, and make the abscess easier to drain.

Drained abscesses are usually left open and there are no stitches.

Your doctor may prescribe pain medication and antibiotics.

You may need stool softeners. Practice good hygiene and eat a soft or liquid diet until the abscess has healed.

Expectations (prognosis)

With prompt treatment, people with this condition usually do well. Infants and toddlers usually recover very quickly.

Complications tend to occur when treatment is delayed.

Complications
Anal fistula
Body-wide infection (sepsis)
Continuing pain
Problem keeps coming back (recurrence)
Scars

Calling your health care provider

Call your health care provider if:
You notice a rectal discharge, pain, or other symptoms of anorectal abscess
You have fever, chills, or other new symptoms after being treated for this condition

Prevention

Prevention or prompt treatment of sexually transmitted diseases may prevent this cause of anorectal abscesses. Use condoms during intercourse, including anal sex, to prevent such infections.

Frequent diaper changes and proper cleaning during diaper changes will help prevent both anal fissures and perianal abscesses in infants and toddlers.

Ayurvedic Treatment:

Acharya Sushrut has described in detailed procedure to drain and incise an abscess. He also mentioned many drugs for local application to dress the abscess. Panchavalkal kwath, Trifala kwath, Nimba patra kwath etc. are a few preparation which are used to wash the abscess wound. These readily help in healing abscess.

If an anorectal abscess has been turned into a Fistula, Kshara sutra therapy is the treatment of choice in Ayurveda.

Ayurvedic treatment for Fissure in ano

ANAL FISSURE/FISSURE-IN-ANO – Causes, prevention and treatment



Anal fissure or Fissure-in-ano is a kind of longitudinal cut (linear ulcer) at the anal canal outer anterior and posterior margins (skin-lined part) which is formed when a person suffering from constipation passes hard stool with strain. It is extremely painful ano-rectal condition which lead sufferer into stress and anxiety. The person is so much distressed that he/she develops fear for passing stool. This tendency however adds to his problem as it further aggravates the problem of constipation.
Anal fissure commonly occur at midline posteriorly but sometimes seen at midline anteriorly and rarely seen at anywhere in the anal circumference.


The ulcer of anal fissure doesn’t heal up easily because;
The anal canal always full of microorganisms i.e. it is always lodged with infection.
The passage of hard stool during the act of defaecation prevents it from healing easily.

In acute stage the fissure is extremely painful and may bleed frequently but if ignored for a long time for more than 7-8 months, it gets partially healed up and a skin growth known as sentinel tag or sentinel pile surrounds it. This sentinel tag further hinder the complete healing of the underlying fissure.
Who suffer more from Anal fissure the causative factors?
People who have a habit of eating junk food and fast food with less dietery fibres.
People who drink less fluids and water.
People who do not exercise or walk and have sedentary lifestyle.
Women during pregnency generally develop constipation and thus anal fissure is seen more in women than men.
How fissure can be prevented?
The primary cause of anal fissures is constipation. So, one has to develop habits by which constipation can be prevented. A few measures can be;

Taking adequate dietary fibers. Eat more vegetables, fruits and salad.
Drink plenty of water and fluids but avoid much coffee and tea.
Avoid straining during defaecation.
Avoid excessive chillies and spices in food items.
Avoid much of non-veg. food. Try to be vegetarian.
Use of buttermilk (Lassi without butter) with a pinch of cumin powder and black salt keeps the digestion correct.

What is the treatment?
In acute condition, medicines to relieve constipation along with Ayurvedic healing oils for local application, are prescribed. Dilation using anal dilators of appropriate diameters or using index finger is done along with ayurvedic healing oils. However if the condition becomes chronic and sentinel tag has been formed, surgical intervention is necessary.
In Ayurveda the sentinal tag is cut by using a specialized medicated alkaline thread ligation technique, known as Kshara-sutra ligation which offers a better way to treat chronic fissure-in-ano than conventional surgery. Kshara sutra method is least invasive para surgical procedure for cutting benign tissues like sentinel tag, piles masses, warts, condyloma etc. In this technique a highly specialized medicated thread is ligated tightly around the sentinel tag, which strangulate the tissue and cause necrosis thus the tag fall off in 3 to 5 days. The underlying fissure heals up in next 5-15 days. Ayurvedic medicines for constipation and Ayurvedic healing promotion oils like Jatyadi oil or panchguna oil etc.along with Finger dilation of anal canal (Ganesh Kriya) are used till the fissure gets healed completely.
Sitz bath :- In acute as well as chronic cases of fissure in ano, Sitz bath with lukewarm triphala or panchwalkal kwath is quite helpful in relieving the pain. Patient should use a plastic tub of appropriate diameter and fill it with lukewarm panchwalkal/triphala kwath or simply tap water with some some antiseptic solution and should sit in such a way that his anus and buttocks get submerged inside the warm medicated water. It greatly help in reliving the pain in ano-rectal diseases and gives a soothing effect.Sitz bath is advised in all patients suffering from fissures, piles or fistula in ano and also it is an important part of post operative treatment in ano-rectal cases.


Thanks for patiently reading this article. I hope Fistula patients will be benefitted by these tips. If however, you still have any query/doubt regarding your disease, you can e-mail me at consult@ayurvedapilescure.com

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and Kshar sutra specialist

SHRI DHANWANTARI CLINIC, GHAZIABAD

Precautions during Kshara sutra treatment

Avoid straining during defecation: It has been observed that people suffering from anorectal diseases (Piles, Fissure in ano, Fistula in ano etc.) generally do excessive straining during the act of defecation. According to Ayurveda, the root cause of these diseases is ‘mandaagni’ (sluggish digestive fire) which ultimately leads to ‘kosthabaddhta’(constipation). An individual with constipated bowels try to strain while passing stools to expel the faeces but ultimately it aggravates the symptoms like bleeding or pain etc.

Thus an individual (even the healthy one) should not strain much during defecation. A better way can be to drink 1 or 2 glasses of lukewarm water and go to toilet only when there is feeling of adequate pressure for defecation.

Follow the dietary precautions: Take food items rich in fibres and easily digestible to avoid ‘mandaagni’ (sluggish digestive fire) and constipation. For more details kindly read the author’s article on diet management for anorectal patients. CLICK HERE

Avoid prolonged sitting and/or standing. Be ambulatory. Do regular morning and/or evening walks. It promotes healing and leads to adequate drainage in fistula patients.

Keep yourself mentally strong and tolerable:Though kshara sutra procedure is a minimally invasive procedure, a few patients may feel some pain after kshara sutra treatment like felt in other surgical procedures. Such patients should;

• Maintain their manobala because just in a few days you are about to get rid of this disease permanently.
• Take painkillers after consulting their physician.
• Increase the frequency of sitz bath.
• Maintain proper hygiene of the anorectal region.
• Do the sitz bath with lukewarm decoction of ‘panchavalkal drugs’ regularly or as directed by your physician.

Avoid alcohol, smoking, tobacco chewing, excess tea or coffee and excessive spicy or junk food items.
Avoid sitting on two-wheelers like cycle/motor cycle etc.
Avoid sexual intercourse during the kshara sutra therapy.
Take the medicines prescribed by your physician regularly and follow the instructions given by him strictly.

AUTHOR: DR. NAVEEN CHAUHAN,

Consultant Ayurveda Physician & Proctologist,

SHRI DHANWANTARI CLINIC, Ghaziabad, India.

If you have any query, you may post your comment or e-mail the author at:consult@ayurvedapilescure.com

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Diet instructions for Ano-rectal patients

Diet for Constipation, Piles/Hemorrhoids, Anal fissure and Fistula in ano (ano-rectal) patients as per Ayurveda


Breakfast:
Dalia (sweet or salty depending on individual’s choice), Milk without fat, Tea, Toast, Chapati, Mix veg., Brown bread, Sprouts, Fruits like apple etc.
Lunch:
Chapatis, Cooked mixed vegetables, Daal (cooked pulses), Boiled rice, Takra (Buttermilk), Salad prepared from onion, tomato, radish, turnip, carrots, papaya etc.
Evening Tea/snacks:
Tea or coffee, Toasts, Dry fruits, Biscuits, roasted popcorns or any other light food item can be taken.
Dinner:
Chapatais, cooked vegetables, Daal (cooked pulse), salad
Note:
Please don’t take dahi (curd) or buttermilk in dinner.
At bedtime lukewarm milk can be taken.
Food items:

Flour: Mixed grains flour like wheat, barley, gram, soybeans etc. However wheat flour with husk (without refining) can also be used.
Pulses: Moong, Masoor, Gram, Soybean etc.
Vegetables: Bottle gourd, radish, turnip, cabbage, cauliflower, raw green papaya, carrot, fenugreek leaves, chenopodium leaves, spinach leaves, tomato, potato and other green leafy vegetables.
Fruits: Papaya, Coconut, Apple, Litchi, Figs, Watermelon, Orange, Guava etc.
Juices: Coconut water, Bottle gourd juice, Apple juice, Mixed fruit juice, Aloe vera juice, Trifala ras, Wheat grass juice etc.
Dry fruits: Almonds, Pistachio, Dried grapes etc.
Spices: Turmeric, Coriander powder, Fenugreek, Cummins seeds, Ajwain, Saunf etc.
Ghee-cooking oils: Cow’s ghee, mustard oil, olive oil, groundnuts’ oil, soybean’s oil etc.
Note:
Drink plenty of fluids including water.
Tea/Coffee should not be taken in excess.
Avoid non-veg. and junk/spicy food items.
Avoid smoking, alcohol, chewing of tobacco products.
Follow the instructions of your physician strictly.
The above diet instructions are in general for the patients suffering from anorectal diseases. Depending on individual’s need, food articles may be added or restricted. Physician’s advice and instructions are to be strictly followed.
ARTICLE AUTHOR: DR NAVEEN CHAUHAN, CONSULTANT AYURVEDA PHYSICIAN AND PROCTOLOGIST.
Thanks for reading this article. You may post your queries/suggestions as comment or can mail the author directly at: consult@ayurvedapilescure.com

How kshara sutra treatment is better than conventional surgery in Fistula in ano

ADVANTAGES AND BENEFITS OF KSHARA SUTRA THERAPY OVER CONVENTIONAL SURGERY IN ANORECTAL PATIENTS









It is a simple, safe and sure treatment for fistula –in-ano (95-98% success rate)

Ksharsutra is – chemical fistulectomy rather than surgical fistulectomy.

It is a simple minimum invasive surgical technique.

Recurrence is negligible (3-5%).

Performed in Minor O.T. conditions.

No damage to anal sphincter and chances of incontinence is practically nil.

It is an Ambulatory procedure, no hospitalization required.

Only local/topical anesthesia required (generally). However sometimes no anesthesia at all is required.

Usually no antibiotic coverage required.

How Kshara sutra works?

Kshara sutra works by pressure necrosis, chemical cauterization by kshar (alkali) and sloughing of the tissue of the walls of the fistulous track along with adequate drainage. It leads to an easy debridement of unhealthy tissue and pus etc. and thus providing a cleaner base for the wound healing of the fistulous track. The Kshara-sutra is changed weekly so that an average pace of cutting of about 0.5-0.8 cm/week is maintained along with healing from behind. Finally the whole track is cut through and the fistula gets healed up with minimal scarring and without any other major complication.

Ano-rectal diseases; an introduction and treatment approach as per Ayurveda

Ano-rectal diseases; an introduction and treatment approach as per Ayurveda



Ano-rectal disorders are progressively increasing in the society. Few important causes out of a number of them are; sedentary life style, irregular and inappropriate diet, prolonged sitting and/or standing and psychological disturbances like anxiety, depression etc. Ano-rectal problems coupled with psychological manifestations are the causes, inter-related to each other. As per Ayurveda, these above mentioned causes result in derangement of‘Jatharagni’ (the digestive power) which leads to constipation and other associated symptoms. Constipation leads to generation of hard stool (fecolith) which when expelled leads to trauma in anal canal and ultimately generates Anal fissure. Constipation increases the back pressure onto haemorrhoidal vessels to produce Piles/Haemorrhoids. Crypto-glandular infection leads to ano-rectal abscess and Fistula-in-ano. Thus constipation seems to be the very important cause for most of these disorders. The fast food culture has again worsen the condition as these foods are devoid of dietary fibres.

These disorders are utterly embarrassing to the patient. The peri-anal skin is one of the most pain sensitive region in the body due to rich nerve endings. So, even a mild form of disorder can produce great discomfort to the patient. It has been observed that in the initial stages of the disease, most of the patients avoid consulting to the physician and explaining their problem particularly because they feel ashamed. They try to prevaricate it. This tendency is still more in females. This ultimately leads to manifold increment in their problem and the disease. When they visit to doctor for consultation, they are too mentally disturbed to lose the interest in life. They become very much anxious, many go in depression and few of them even try to attempt suicide.

Among the list of ano-rectal disorders, following are commonly seen;
Piles (Haemorrhoids)
Fissure-in-ano (Anal fissure)
Fistula-in-ano (Anal fistula)
Ano-rectal abscess

Ancient and modern physicians equally consider these conditions as difficult to cure. Moreover, among these three disorders, Fistula-in-ano is the most notorious one to tackle and cure. Results of surgery (fistulectomy) seem to be embarrassing as there is high recurrence in most of the cases even after complete excision of the track and meticulous post-operative dressings. There is a proverb often used by modern surgeons about this disease that “If you have enmity to a doctor, refer him a patient of Fistula-in-ano and it will never heal”.

The treatment of these disorders especially Fistula has been revolutionized after the availability of kshara sutra. Kshara sutra therapy has been scientifically standardized at BHU, Varanasi by Prof. P. J. Deshpandey and his team of co-workers.

Besides Kshara sutra, Ayurveda has a rich source of herbs based formulations mentioned in Classics, which can be effectively used to correct the gastrointestinal disturbances(disturbed agni) and provide relief to such patient to a great extent. Moreover, the prevention from these diseases can be achieved if a person follows ayurvedic life-style and dietary regime.

Thus, proctology has been emerging as a highly specialized branch of Ayurveda since about last three decades and people are turning their faith towards Ayurveda to resolve their problems. Thus, in the interest of public, this science of healing should be propagated more and more so people can have a better health through Ayurveda.

AUTHOR: DR. NAVEEN CHAUHAN,

Consultant Ayurveda Physician & Proctologist,

SHRI DHANWANTARI CLINIC, Ghaziabad, India.

If you have any query, you may post your comment or e-mail the author at:consult@ayurvedapilescure.com

Kshara sutra: its ingredients and preparation

Preparation of Ksharsutra and the Drugs Required

Preparation of Ksharsutra
Preparation of Kshar-Sutra is no doubt, a lengthy and difficult task and the collection and preparation of required drugs is still more cumbersome.

A number of different drugs are used in various combinations for the preparation of the Kshar-Sutra. The ksheer (latex) generally used are of Snuhi, Ark, Arendakarkataki, Udumbar etc. The Ksharas used are Apamarg Kshar, Ark Kshar, Kadali Kshar etc. We have here used the following drugs.

Drugs Required
•    Snuhi Ksheer

Snuhi Ksheer (Milk of stem of Euphorbia nerllifolia)

•    Apamarg Kshar

Apamarg kshara (Extract of Acyranthus aspera)

•    Haridra powder
•    Thread,-Linen Barbour No.-20.

Surgical linen Barbour brand size 20

Aluminium or steel frames are drilled with small hooks for holding threads in place at an interval of about 1 1/2″. The size of the frame may vary to suit specific needs.

Any cotton / linen thread of good strength can be used for Kshar-Sutra. In our practice, we generally use Barbour Linen No. 30 and 20. No. 30 is finer compared to No. 20. The tensile strength of No. 20 is reduced to the least extent in comparison to other threads after the complete procedure and hence it is this thread which is usually preferred in the manufacture of Kshar-sutras. The thread is tightly wound around opposite hooks to form rows.

The thread is given 21 coatings out of which the first 10 coating are given only the fresh Snuhi Ksheer. The next 7 with Snuhi Ksheer and Apamarg Kshar and the last 4 with Snuhi Ksheer and Haridra.

A piece of gauze is taken and folded into a small square. It is then dipped in the fresh Snuhi Ksheer (latex of Euphorbia neriifolia) and the thread is coated (i.e. a Bhavna is given) with the ksheer from down upwards. When all the threads are coated in this manner, the frame is kept to dry in a specially made chamber. The second coating (Bhavna) is given only when the first one dries. The thread is coated 10 times in this way; one after the other after the previous coating of the ksheer dries completely. The frames are placed in a special chamber for drying. The temperature inside the chamber may be increased by passing hot dry air with the help of a fan. The air inside the chamber should be kept circulating to facilitate quicker drying of the threads. The process of drying is best performed when the level of Humidity is lower.

Coating of thread with Snuhi ksheer and kshara

After completing the first 10 coatings of Snuhi ksheer, we now proceed to coat the thread with both Snuhi ksheer and Apamarg Kshar. The thread is coated with fresh Snuhi ksheer in the way described above. Apamarg Kshar is coated on it immediately (i. e. when the thread is still wet) so that it sticks to the thread properly. Different practitioners have developed different ways in which to do this. With experience we have found that the best way to do it is to coat only 3 or 4 threads at a time with Snuhi ksheer and then pass them through a pile of Apamarg Kshar on a flat plate. This is done by sliding the frame over the pile of Kshar in such a way that the threads pass through the pile of Kshar and the Kshar sticks on the wet thread. When all threads of a frame are coated in this way, the frame is again kept for drying in the chamber. The thread is coated in this way 7 times. The thread is coated only when the previous coat is completely dry. Hence 10+7= 17 coats are completed.

The last four coats are to be given with Snuhi ksheer and Haridra. This is done in the same way as the previous 7 coats substituting Haridra powder in place of Apamarg Kshar. While applying every coat, care should be taken that the drug spreads evenly on all the sides of the thread and does not aggregate at one spot to make a knot like appearance. The thread should be smooth and even, having the same thickness through out the length. Care should be taken to carry out the procedure in a dry atmosphere. A specially prepared chamber is used for drying the threads so that it can be dried in a dust free atmosphere. In the absence of a chamber the threads may be dried in the open under direct sun rays in a dry and dust free atmosphere. After we finish coating the threads 21 times and they are totally dry the threads are cut to size and then packed in capillary like glass test tubes. These tubes are cut to size, cleaned, dried, and sterilized. One or two threads are packed in each tube. The tube is packed/ sealed over a burner so that the Kshar-Sutra in it remains dry and sterile. These tubes are sent for Gama radiation after being packed & sealed. The tube is broken and the Kshar-Sutra removed for use when required.

Before going into the details of the collection and preparation the drugs required, I would like to mention here that though the most widely used Kshar-Sutra are prepared from Snuhi ksheer and Apamarg Kshar and Haridra, we can make a variety of different Kshar-sutra from a combination of ksheer from different ksheeri vrikshas i.e. latex of different trees like Udumber ksheer, Arka ksheer, Aerandkarkati ksheer and Ksharas like Ark Kshar, Kadli Kshar, Nimb Kshar etc.

Collection and preparation of the drugs required in the preparation of Kshar sutra

Collection of Snuhi Ksheer (Latex of Euphorbia neriifolia)

The ksheer from Snuhi is collected best, early in the morning, before sunrise. If collection of ksheer is tried after sunrise, we can get just a few drops of ksheer from a Snuhi branch. With the help of a scalpel, we slit the Snuhi branch vertically from down upwards (5mm deep) keeping a collection jar under the slit. As soon as the cut is made, a milky substance (ksheer) starts dripping down. This ksheer is collected in the jar. The amount to be collected depends upon the threads to be coated. After collection the ksheer, jar is to be packed so that no air enters it because ksheer if kept in contact with air, starts to coagulate and turns into a chewing-gum like sticky semisolid substance. Before coating the threads, the ksheer is to be strained from a wire strainer or with the help of a double folded gauze piece. The ksheer is now ready for use. Snuhiksheer should be always used fresh.

Method of preparing Apamarg Kshar (Water soluble extract of the ash of Achyranthus aspera)

Acyranthus aspera (Apamarga) plant

Burning of Apamarga whole plant into ashes

Well grown shrubs are collected in the month of November. These shrubs are dried. When dry, they are burned down to ash in a clean open space or in a big container. The ashes of the Panchang (whole plant) of the shrubs are collected on cooling. The ash itself can be preserved in airtight containers and may be used to prepare the Kshar at convenience.

Ash dissolved in water and water filtered

The ash is stirred in pure soft water 4 times the ash (Rastarangini). Here the ratio of ash to water is in reference to its volume and not weight. The water soluble constituents of the ash are dissolved in the water. The mixture is stirred for a few minutes and then allowed to stand for a few hours. This process is repeated 4 to 5 times. The mixture is then allowed to stand for a period of a few hours again. The ash settles down and we get a clear yellowish liquid solution on top which now contains all the water soluble constituents of the Apamarg ash. The solution is carefully decanted into another container and strained. The clear yellowish solution may still contain minute insoluble parts of the ash. To get pure Kshar it is advisable to further purify this solution by filtering so that the remaining minute insoluble particles are removed.

Filtered liquid boiled

The solution is now kept to boil in a thick preferably stainless steel container. As the water evaporates, we start getting crystals of Apamarg Kshar. They adhere to the sides of the container. Theses should be constantly removed by stirring the boiling solution. When almost all the water is evaporated we get a white substance which settles at the bottom. Minimizing the heat, the process should be continued till all the water evaporates and we get a thick layer of the Kshar at the bottom of the container. This thick layer can be removed on cooling. The substance which we now get is the pure extract of the ash of Apamarg Panchang. This is powdered and packed in air tight container for further use.

Kshara finely grinded and ready to use

The method of preparing the Kshar may be modified when mass production is desired.

Preparation of Haridra Powder
Curcuma longa

Dried rhizomes of Haridra plant

The third drug required for the last three coatings is Haridra powder. Haridra is known to most of us as turmeric. The well developed dry rhizomes of Curcuma longa are used to prepare the powder. The combination of the three above mentioned drugs does the work of cutting, curetting and healing the fistula. The multiple coats on the threads probably make the effect of the drugs gradual and continuous. The drugs keep on dissolving and being released gradually for a couple of days, after which the Ksharsootra is changed if and when required. The thread itself acts as a vehicle for the drugs to reach the sight and the coating on the thread probably renders a sort of a sustained release effect of the drugs in the track.

With the picking up of the Kshar-sutra mode of treatment in Ano-rectal diseases, the requirement and demand for good quality standardized Kshar-sutra is inevitably going to increase and hence Kshar-sutra manufacturing and marketing on both large scale as well as small scale though quite difficult and cumbersome may be a rewarding project.

Ready to use Kshara sutra packed and sealed in a tube

Advantages of Kshar Sutra
•    The procedure does not require hospitalization for more than 3 to 4 hours.
•    The patient requires no bed rest & can resume his/her daily routine within 6 to 12 hours.
•    The procedure leaves just a pencil scar at the site.
•    Freedom from painful dressings.
•    There are no chances of incontinence and the recurrence rate which is usually found to be quite high after Fistulectomy is less than 2% with Kshar – Sutra treatment. This is because the medicines on the thread gradually and continuously curate the pyogenic membrane and fibrous tissue and thus leave no pus pockets undrained