KSHARA SUTRA TREATMENT FOR FISTULA IN ANO AND PILES
Bhagandara (Fistula in ano) is a disease, which is described, in various ancient medical texts. Bhagandara was recorded as the most notorious disease for the treatment point of view. Fistula in ana is a disease, which takes place in the perineal part and ano-rectum. The fistulae are invariably preceded by ano -rectal abscess.

The treatment of fistula in ano has always been a great problem, both for the patient as well as for the surgeon. This is due to the high recurrence rate. A number of management techniques are described by a number of authors, but all these described techniques are not satisfactory therefore these techniques are discarded. The systemic use of anti- microbial agent is very limited to the earlier stage of peri anal abscess. It is well accepted that fistula in ano is a surgical disease, for that reason, a lot of preference has been given to surgical! operative approaches. Even despite the fact that it has high recurrence rate. Considering the problems in the management of fistula in ano, postoperative complications and recunence, the para-surgical procedure Kshara-Sutra (medicated thread) is re-practiced for the management of fistula in ano successfully by the Ayurvedic practitioners.

The Kshara sutra therapy is an age old known effective therapy, the efficacy of which has been reputable and acknowledged in the medical world for the treatment of fistula in ano. Every Ayurvedic scholar knows that this therapy is mentioned in Susruta Samhita in the chapter of Visarpa Nadi Stana roga chikitsa. Where it is mentioned as an alternative treatment of Nadi Vrana (sinuses) in emaciated and poor nourished weak persons where surgical procedure is not indicated. The process of Kshara sutra application in the cases of sinuses has also been elaborated which is also applicable in fistula-in ano. Repeated use of Kshara sutra is necessary in the management of sinus, because single application of Kshara sutra was not found sufficient for the complete cure of the disease. So the technique of successive changes of Kshara sutra as often as necessary has also been depicted. In Susruta samhita, a comprehensive procedure including primary application and successive changes of Kshara sutra has been clearly detlned.

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