A randomized open labelled controlled clinical study to evaluate the role of Krutamalakadya Sutra in the management of Bhagandara with special reference to Fistula-In-Ano

Abstract

Acharya Sushruta has included Bhagandara as one among the Ashtamahagadas. Fistula in ano is an ano-rectal condition with a worldwide prevalence of 8.6 cases per 100,000 population. Ksharasutra ligation is one of the popular modalities in treatment of Bhagandara. In present era, there are different types of Ksharasutra available. Most widely used Ksharasutra is Apamarga Ksharasutra which is having Chedana, Bhedana, Lekhana properties and anti-inflammatory effect on the fistula tract. But some of the problems are faced during preparation and also in the course of Ksharasutra therapy viz, collection and preservation of Snuhi (Euphorbia nerifolia) latex is very difficult and time taking process. The main complaints reported by the patients are pain and discomfort during the course of treatment with Ksharasutra for Bhagandara, which requires management with oral analgesics. Considering the above problems, a non irritant preparation such as Krutamalakadya Varti mentioned in Sushruta Samhita in the chapter of Bhagandara Chikitsa Adhyaya is modified in the form of Krutamalakadya Sutra which contains following ingredients such as Aragvadha, Haridra, Ahimsra, Madhu and Ghrita is taken for the study. Krutamalakadya Sutra is also having a good binding property, as well as Chedana, Bhedana, Lekhana, Vedanasthapana, Vrana Shodhana and Vrana Ropana properties. A total of 30 subjects were taken, Trial group treated with Krutamalakadya Sutra and control group treated with Apamarga Ksharasutra. The study shows that preparation of Krutamalakadya Sutra is much easier than Apamarga Ksharasutra and had high efficacy in subjective parameters like burning sensation compared to Apamarga Ksharasutra.