भगन्दर (फिस्टुला): कारण, निदान एवं आयुर्वेद चिकित्सा | Fistula Ayurveda treatments in Hindi

भगन्दर (फिस्टुला): कारण, निदान एवं आयुर्वेद चिकित्सा

डॉ. नवीन चौहान, बी.ए.एम.एस., सी.आर.ए.वी. (क्षार सूत्र)

भगन्दर (Fistula in ano)

भगन्दर से पीड़ित एक रोगी.

भगन्दर: भगन्दर गुदा क्षेत्र में होने वाली एक ऐसी बीमारी है जिसमें गुदा द्वार के आस पास एक फुंसी या फोड़ा जैसा बन जाता है जो एक पाइपनुमा रास्ता बनता हुआ गुदामार्ग या मलाशय में खुलता है.

शल्य चिकित्सा के प्राचीन भारत के आचार्य सुश्रुत ने भगन्दर रोग की गणना आठ ऐसे रोगों में की है जिन्हें कठिनाई से ठीक किया जा सकता है. इन आठ रोगों को उन्होंने अपने प्रसिद्ध ग्रन्थ सुश्रुत संहिता में 'अष्ठ महागद' कहा है.

भगन्दर कैसे बनता है?

गुदा-नलिका जो कि एक व्यस्क मानव में लगभग ४ से.मी. लम्बी होती है, के अन्दर कुछ ग्रंथियां होती हैं व इन्ही के पास कुछ सूक्ष्म गड्ढे जैसे होते है जिन्हें एनल क्रिप्ट कहते हैं; ऐसा माना जाता है कि इन क्रिप्ट में स्थानीय संक्रमण के कारण स्थानिक शोथ हो जाता है जो धीरे धीरे बढ़कर एक फुंसी या फोड़े के रूप में गुदा द्वार के आस पास किसी भी जगह दिखाई देता है. यह अपने आप फूट जाता है. गुदा के पास की त्वचा के जिस बिंदु पर यह फूटता है, उसे भगन्दर की बाहरी ओपनिंग कहते हैं.

भगन्दर के बारे में विशेष बात यह है कि अधिकाँश लोग इसे एक साधारण फोड़ा या बालतोड़ समझकर टालते रहते हैं, परन्तु वास्तविकता यह है कि जहाँ साधारण फुंसी या बालतोड़ पसीने की ग्रंथियों के इन्फेक्शन के कारण होता है, जो कि त्वचा में स्थित होती हैं; वहीँ भगन्दर की शुरुआत गुदा के अन्दर से होती है तथा इसका इन्फेक्शन एक पाइपनुमा रास्ता बनाता हुआ बाहर की ओर खुलता है.

भगन्दर के लक्षण:

• गुदा के आस पास एक फुंसी या फोड़े का निकलना जिससे रुक-रुक कर मवाद (पस) निकलता है.
• प्रभावित क्षेत्र में दर्द का होना 
• प्रभावित क्षेत्र में व आस पास खुजली होना
• पीड़ित रोगी के मवाद के कारण कपडे अक्सर गंदे हो जाते हैं.

भगन्दर प्रकार FISTULA IN ANO; TYPES 

आचार्य सुश्रुत ने भगन्दर पीडिका और रास्ते की आकृति व वात पित्त कफ़ दोषों के अनुसार भगन्दर के निम्न 5 भेद बताएं हैं;

1. शतपोनक
2. उष्ट्रग्रीव
3. परिस्रावी
4. शम्बुकावृत्त
5. उन्मार्गी  

आधुनिक चिकित्सा विज्ञान के अनुसार भी फिस्टुला का कई प्रकार से वर्गीकरण किया गया है परन्तु चिकित्सा की दृष्टि से दो प्रकार का वर्गीकरण उपयोगी है;

१. लो - एनल :- चिकित्सा की द्रष्टि से सरल माना जाता है.

२. हाई - एनल :- चिकित्सा की दृष्टि से कठिन माना जाता है.

भगन्दर की चिकित्सा :

चिकित्सा की दृष्टि से देखा जाए तो भगन्दर औषधि साध्य रोग नहीं  है, अर्थात यह पूर्णतया शस्त्र-साध्य (सर्जरी से ठीक होने वाला) रोग है. 

आधुनिक सर्जरी में एक चीरे से भगन्दर के संक्रमित ट्रैक को काटकर निकाल दिया जाता है. इस ऑपरेशन को फिस्लेटूक्टोमी कहा जाता है. यदि इस ऑपरेशन की सफलता के बारे में बात करें तो लो-टाइप फिस्टुला में तो यह कुछ हद तक सफल है परन्तु हाई-टाइप फिस्टुला में सफलता की दर बहुत कम है. ज्यादातर केसों में यह दोबारा हो जाता है. 

आधुनिक सर्जरी में गुदा के इंटरनल स्फिन्क्टर के कटने का ख़तरा रहता है, जिससे रोगी की मल को रोकने की शक्ति समाप्त हो जाती है और मल अपने आप ही निकल जाता है. यह एक काफी विकट स्थिति होती है.

आचार्य सुश्रुत ने भगन्दर और नाड़ीव्रण (sinus) में छेदन कर्म और क्षार सूत्र का प्रयोग बताया है. 

आयुर्वेद क्षार सूत्र चिकित्सा :-

आयुर्वेद में एक विशेष शल्य प्रक्रिया जिसे क्षार सूत्र चिकित्सा कहते हैं, के द्वारा भगन्दर पूर्ण रूप से ठीक हो जाता है. इस विधि में एक औषधियुक्त सूत्र (धागे) को भगन्दर के ट्रैक में चिकित्सक द्वारा एक विशेष तकनीक से स्थापित कर दिया जाता है. क्षार सूत्र पर लगी औषधियां भगन्दर के ट्रैक को साफ़ करती हैं व एक नियंत्रित गति से इसे धीरे धीरे काटती हैं. इस विधि में चिकित्सक को प्रति सप्ताह पुराने सूत्र के स्थान पर नया सूत्र बदलना पड़ता है. 

क्षार सूत्र बंधन के उपरान्त भगन्दर का एक रोगी

इस विधि में रोगी को अपने दैनिक कार्यों में कोई परेशानी नहीं होती है, उसका इलाज़ चलता रहता है और वह अपने सामान्य काम पहले की भांति कर सकता है. इलाज़ के दौरान एक भी दिन अस्पताल में भर्ती होने की जरुरत नहीं होती है.  क्षार सूत्र चिकित्सा सभी प्रकार के भगन्दर में पूर्ण रूप से सफल एवं सुरक्षित  है. यह बात अखिल भारतीय आयुर्विज्ञान संस्थान, ICMR, पी.जी.आई. चंडीगढ़ जैसे संस्थानों द्वारा किये गए अनेक शोधों और क्लिनिकल ट्रायल द्वारा सिद्ध हो चुकी है. क्षार सूत्र चिकित्सा में इंटरनल स्फिन्क्टर के कटने और रोग के दोबारा होने की संभावना लगभग नगण्य होती है. 

कोई भी क्वालिफाइड आयुर्वेद चिकित्सक जिसने क्षार सूत्र में विशेषज्ञता प्राप्त की हो, इस चिकित्सा को कर सकता है. तथाकथित बंगाली डॉक्टर जो की वास्तव में अन क्वालिफाइड होते है, बवासीर, भगन्दर आदि रोगों  की धागे से चिकित्सा करते  हैं, परन्तु वह वास्तव में क्षार सूत्र न होकर कुछ और ही होता है. अतः ऐसे फर्जी चिकित्सकों से बचना चाहिए और क्वालिफाइड डॉक्टर से ही इलाज़ करवाना चाहिए; विशेषकर जब रोग भगन्दर जैसा कठिन हो. 

लेखक एक क्वालिफाइड आयुर्वेद क्षार सूत्र विशेषज्ञ  चिकित्सक हैं , और   पिछले 14 वर्षों से क्षार सूत्र चिकित्सा में सफलतापूर्वक प्रैक्टिस कर रहे हैं .
कोई भी शंका होने पर इनसे nchauhan.dr@gmail.com पर संपर्क किया जा सकता है. Please call at 7861888100 for an appointment.

Excellent results of Kshara sutra treatment in Chronic Fissure in ano

See the Excellent results of Kshara sutra treatment in Fissure in ano (Anal fissure). www.ayurvedapilescure.com

 — at Ayurvedic treatment for Piles, Anal fissure, fistula in ano in India.

Case details: Patient is 36 years old female had been suffering from severe pain during passing of stools. She also has some mass permanently hanging out outside the anus. She came to Dr. Naveen Chauhan, Ayurveda Proctologist, at Shri Dhanwantari Clinic, Ghaziabad for an examination and on advice of Dr. Chauhan she undergone Kshara Sutra Ligation procedure under local anesthesia. She had cured completely and permanently within 15 days.

Most people usually fear from surgery and try to neglect these disease even if they suffer from lot of discomfort and have symptoms like; Anal pain during defecation, Bleeding, Itching, anal burning etc. My purpose to present this case is to motivate people towards Kshara sutra treatments because results have been evaluated, researched and proved to be very effective and permanent.  

See the pictures: A. BEFORE, B. IMMEDIATELY AFTER AND C. AFTER 10 DAYS OF KSHARA SUTRA TREATMENT

Thus if you ever have any pain or bleeding or Buring or any boil or pus discharge in your anus or nearby area, I highly recommend that you should not hesitate and immediately consult an Ayurveda Proctologist.

Thanks for reading this article. Kindly give your valuable comments. Share it on various social media. 

क्षार सूत्र चिकित्सा: प्रश्न आपके उत्तर हमारे

क्षार सूत्र चिकित्सा: प्रश्न आपके उत्तर हमारे 

1. प्रश्न - क्षार-सूत्र चिकित्सा क्या है?
उत्तर - क्षार-सूत्र चिकित्सा प्राचीन आयुर्वेदिक चिकित्सा प्रक्रिया है, जिसमें बवासीर (Piles), भगन्दर (Fistula in ano), Fissure तथा अन्य गुदागत रोगों का स्थाई उपचार किया जाता है। क्षार-सूत्र को विशेष आयुर्वेदिक औषधियों के कई लेप करके लगभग एक माह में तैयार किया जाता है।


2.प्रश्न - ऐसा क्या है जो इस चिकित्सा पद्धति को इतना खास बनाता है?
उत्तर - जब इस पद्धति के बारे में आप आगे पूरा विवरण पढ़ेगें तो स्वयं जान जायेगें कि यह इतनी खास क्यों है।


3.प्रश्न - क्या यह एक ऑपरेशन है? क्या इसमें भर्ती होना पड़ता है तथा मैं अपने नियमित कार्यों को सुचारू रूप से पुनः कब प्रारम्भ कर सकता/सकती हूँ? उत्तर - यह एक minimum invasive procedure है, जिसमे Ksharsutra Ligation किया जाता है, अतः इसे ऑपरेशन कहना उचित नहीं होगा। यह एक थोड़ी देर की खास चिकित्सा प्रक्रिया है, जिसमें रोगी को भर्ती नहीं होना पड़ता है तथा रोगी उसी दिन अपने नियमित कार्यों क सुचारू रूप से कर सकता है। बस इलाज के दौरान कुछ सावधानियों व निर्देशों का पालन करना होता है।


4.प्रश्न - क्या इस प्रक्रिया में कोई खतरा होता है व दर्द अधिक होता है? उत्तर - अपने समकक्ष प्रचलित अन्य चिकित्सा प्रक्रियाओं की तुलना में यह सर्वाधिक सुरक्षित, सफल व सटीक चिकित्सा होने की वजह से इसमें खतरा एवं उपद्रव complications होने की सम्भावना नगण्य होती है। चूंकि दर्द की अनुभूति हर व्यक्ति में अलग-अलग होती है अतः यह कह पाना कि कितना दर्द होगा, सम्भव नहीं है। अन्य प्रक्रियाओं की तरह ही इसमें थोड़ा बहुत दर्द हो सकता है।


5.प्रश्न - मेरा रोग कितने दिनों में ठीक हो जायेगा?
उत्तर - किसी भी रोग के सही होने का समय रोग व रोगी की स्थिति पर निर्भर करता है। सामान्यतः बवासीर (Piles) व फिशर 7 से 10 दिनों में ठीक हो जाते हैं तथा भगन्दर (Fistula in ano) के ठीक होने का समय रोग की जाँच के बाद ही बताया जा सकता है।


6.प्रश्न - एक बार सही होने के बाद क्या यह रोग दुबारा (Recurrence) तो नहीं हो जायेगा? उत्तर - यही तो इस प्रक्रिया की सबसे बड़ी विशेषता है कि इस विधि से सही हुए रोगों के दोबारा (Recurrence) होने की सम्भावना मात्र 3-5 प्रतिशत ही होती है जो कि चिकित्सा की दृष्टि से नगण्य है जबकि अन्य पद्धतियों में यही संभावना कहीं अधिक (कई बार तो 50 प्रतिशत तक)होती है।
साथ ही व्यवहार में देखा गया है कि कई रोगी उचित जानकारी के अभाव में Invalid, Unregistered, Unskilled quack लोगों से इलाज कराकर अपने रोग को वीभत्स स्थिति में ले आते है, ऐसी स्थिति में क्षार सूत्र चिकित्सा ही एक मात्र विकल्प है। इस प्रक्रिया की एक अहम विशेषता यह भी है High Anal Fistula की चिकित्सा करने पर Damage of anal sphincter & chances of incontinence की संभावना व्यवहारिक तौर नही होती जबकि Surgery या अन्य तरीकों से चिकित्सा कराने पर ये समस्यायें अक्सर हो जाती है।


7.प्रश्न - इलाज के दौरान क्या व कितने दिनों तक परहेज रखना होता है? उत्तर - ठीक होने तक हल्खा व सुपाच्य भोजन करना होता है, तलाभुना व मसालेदार भोजन न करें। कब्ज न होने दें तथा मल त्याग के समय जोर न लगायें। सलाद व पानी का सेवन खूब करें।


8.प्रश्न - क्या इलाज के दौरान दवायें अधिक खानी होंगी? उत्तर - नहीं, बस कुछ आवश्यक औषधियाँ ही लेनी होंगी।


9.प्रश्न - क्या इलाज में खर्च अधिक आता है? उत्तर - बिल्कुल नहीं। अन्य सभी प्रचलित चिकित्सा प्रक्रियाओं की तुलना में इतनी सुरक्षित, असरकारक, लाभप्रद व सटीक होने के बावजूद क्षारसूत्र चिकित्सा का खर्च व समयावधि दोनों ही काफी कम होते है।


10.प्रश्न - क्या यह रोग दवाओं से ही ठीक नही हो सकता है ? उत्तर - व्यवहारिक तौर पर देखा गया है कि केवल Piles व Fissure की प्रारम्भिक अवस्था वाले Cases के अलावा अन्य स्थितियों में ये रोग दवाओं से ठीक नही होते हैं। लोग वर्षो तक ठीक होने की आशा में तरह - तरह की दवाओं का प्रयोग करते रहते हैं, परन्तु इससे उन्हे मात्र कुछ समय तक ही आराम मिल पाता है जबकि उनका रोग अन्दर ही अन्दर ब़ता जाता है।
कई बार लोग सब कुछ जानते हुए surgery के भय या ज्यादा खर्च की वजह से भी समय रहते चिकित्सा नही कराते जिस वजह से उन्हे स्थाई समाधान नहीं मिल पाता।

Author: 
Dr. Naveen Chauhan

Director and Consultant Ayurveda Proctologist

Shri Dhanwantari Clinic, Ghaziabad

Phone: +91-9818069989

www.ayurvedapilescure.com 

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