Management of rare, low anal anterior fistula exception to Goodsall′s rule with Kṣārasūtra

Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn′s disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra

Development of mucinous adenocarcinoma in chronic fistula-in-ano: A case study

Chronic perianal fistulas are a common clinical condition. However, their evolution to carcinoma is rare. We report a case of recurrent chronic perineal fistula which turned into malignant tumor. The diagnosis was established by clinical examination, repeated biopsy, and colonoscopy. Clinical examination features suggested malignancy, but initial biopsy report showed cellular atypia and colonoscopy followed with biopsy revealed as large ulcerated rectal growth suggesting Carcinoma (CA) rectum and histopathological report showed infiltrating mucinous adenocarcinoma. It is suggested that this rare complication of chronic fistula-in-ano may be prevented by prompt expert management of complex primary fistula

Integrative management of diabetic foot ulcers – A case series

Diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus and a cause of significant morbidity, mortality and healthcare expenditure. Treatment of DFU includes multimodal approach like surgical debridement, infection control, vascular assessment, dressing etc. Multidisciplinary approach towards foot care is becoming a mainstay of therapy, and even with this comprehensive approach, there is still room for improvement in DFU outcomes. Integrative management includes the adoption of various systems of treatment with standard treatment for better outcomes. In the present case series, six cases of DFU were managed with the integration of Ayurveda and allopathic treatments. The cases were managed according to the standard diabetic foot ulcer management principles like surgical debridement, insulin therapy, along with incorporation of Ayurveda procedures like Vimlapana, Prakshalana, Bandhana etc. Standard assessment of ulcers at different time points was done using the Bates- Jensen Ulcer assessment tool. All the six DFU healed with minimal scar formation and in less time, lowering the risk of further amputation. Promising results were obtained in all six cases by adopting integrated Ayurveda and allopathic treatments, which indicates the potential benefits of alternative systems of medicine

Evaluation of effect of kalyanaka kshara in vibandha with special reference to constipation: An open clinical trial

INTRODUCTION: Constipation (vibandha) is a common clinical problem and symptoms of many diseases. It is not described as a separate disease in the classical text. Westerned life style, mental stress and diets are play major role in occurring in constipation (vibnadha). The diagnostic and evaluation of vibandha includes an proper history and investigation to exclude any other abnormalities and disease. OBJECTIVE: The objective of this study was to evaluate the effect of kalyanaka kshara in vibandha. MATERIALS AND METHODS: A clinical trial was conducted on a group of 30 patients diagnosed with the help of rome III criteria and Bristol stool scale with constipation (vibandha). Patients were selected openly irrespective of their religion, race, occupation, sex etc. They were internal administered kalyanaka kshara, a herbal formulation, at a dose of 500 mg Bid a day for ten days for internal administration with ghee and monitored at 3rd, 5th, 7th, 10th and 15th days for any adverse effect and effect of drug. Symptoms of constipation like straining, lumpy and hard stool, stisfction after daefecation, nature of stool etc. were observed over the treatment. RESULTS: Analysis of result showed improvement in vibandha (constipation). CONCLUSION: Finally study concluded that kalyanaka kshara is effective in the treatment of vibandha

Bone healing efficacy of Lakshagrishtiksheeradi churna over Calcium +Vit D3 in Avrana Kanda Bhagna (Closed fractures of long bones) - A Randomized controlled clinical trial

Background: Delayed bone healing or non-union of fractures owns high rate of complications, morbidity and mortality. It possesses enormous burden to both patients and healthcare system. Till now there is no proven molecule which could enhance the process of bone healing. Hence, time tested Lakshagrishtiksheeradi churna, an Ayurvedic formulation is explored for its efficacy in the management of Avrana Kanda Bhagna. Objective: To Evaluate Bone healing efficacy of Lakshagrishtiksheeradi churna in Avrana Kanda Bhagna. Methods: Total 30 patients meeting the inclusion criteria of Avrana Kanda Bhagna, with age group 14-50 years participated in the study. They were randomly divided into two groups. Group A received Lakshagrishtiksheeradi churna 6 grams and group B Tab Calcium 500 mg +VitD3 respectively twice a day for 30days. Assessments were done through various variables like Pain, Tenderness, Swelling and Bone callus index. Follow up visit was on 30th day and 45th day. Results: Study showed that both Lakshagrishtiksheeradi churna and Calcium + Vit D3 produced improvement in most of the variables and were comparable. However, marked improvements were seen in various variables like Pain, Tenderness, Swelling and Bone callus Index. Conclusion: Clinical efficacy showed that Lakshagrishtiksheeradi churna is safe, effective oral medication in the management of Avrana Kanda Bhagna (Closed Fractures of long bones)

An integrated management (Ayurveda and Modern medicine) of accidental burn injury: A case study

Burn injuries are frequent, horrifying, and life-threatening conditions that are still challenging to cure. Complications like scarring, keloid formation, and contractures are the main challenges for the treating surgeon. The Ayurvedic classics explain different treatment modalities for the management of burn wounds, like oral medicines, topical applications prepared with herbal medicines, ghee, oil, and typical wound dressing techniques like Patraadaana (wound covering with medicinal leaves), and fumigation therapy, etc. Here we report a case of accidental burn injury with a TBSA of 27% First degree (superficial) and 15% second degree (deep partial-thickness) burns with complaints of fever and burning sensation at the burn site. On the basis of the symptoms listed in the classical texts of Ayurveda, the case was diagnosed as Pramadadagdha (accidental burn). To properly manage the burn wound, an integrated therapy strategy was designed. Ropanaghrita (medicated ghee) was applied locally, followed by the application of Tinospora cordifolia leaves to cover the wound, fumigation therapy, and oral medications to hasten wound healing and reduce infection. In the first seven days, modern medicine was used as emergency care in addition to Ayurvedic management. Within 60 days of receiving treatment, the burn wound had entirely healed, and the patient was able to resume her regular work activities. In the current situation, the combined strategy produced encouraging burn management outcomes

Ayurveda management of Recurrent Ischiorectal Abscess with Horseshoe connection - A case report

Anorectal abscesses are one of the potentially debilitating diseases among them perianal abscess and ischiorectal abscess are common. Lateral spread of the ischiorectal abscess through the conjoint tendon leads to a horseshoe abscess. Surgical treatment is incision and drainage. Complications include sepsis, faecal incontinence, and fistula in ano. Kshara sutra is proved effective for fistula in ano, which helps in preventing recurrence. Here we report a case of ischiorectal abscess with horseshoe connection came with swelling and pain over the right perianal region. The condition was diagnosed as guda vidradi (perianal abscess) as per Ayurveda classics, and Bhedana karma is considered as primary treatment. Considering the recurrence and chronicity, kshara sutra ligation was planned after Bhedana karma. The case was completely cured with minimal follow-ups. Post-operative wounds healed with minimal scar formation. Adoption of the treatment has given successful results in the management of ischiorectal abscess with horseshoe connectio

An analytical study to evaluate the safety of reusing of the vomited leech in leech therapy: A pilot study

Background: Leech therapy is a point of attraction in the medical as well as in the scientific world due to its various outstanding properties, while studying the Ayurveda and scientific literature one can find difference, i.e., discarding after single use as per modern literature, but in Ayurveda, it can be reused after 7 days of leech therapy. Studies of such kind were not carried or published in any scientific journals, so ethical approval and developing scientific methods for validating the study were necessary, so a pilot study began with ethical clearance. Objective: The objective of the study was to evaluate the bacterial and fungal count of leech saliva and blood emesis before and after leech therapy using disc diffusion method. Materials and Methods: Leeches were collected from the normal habitat from Mangalore region possessing the same weight and morphological characteristics as that of the Nirvisha Jalouka as mentioned in classics (Shanku-mukhi). The selected leeches were stored in well water having nonchlorinated with minimum bacterial load. The well water was selected from three geographical regions of Belagavi city, and among them, one sample was selected having minimal bacterial load. Ten patients with infectious skin diseases who were indicated for Jalaukavacharana (Vidradhi, Dushta-vrana) were selected. The experimental leech saliva was tested for total bacterial count (TBC) and total fungal count (TFC) before and on 8th day of application, along with venous blood of the patient and blood vomitus of leech after application was tested for TBC and TFC. Statistical analysis was done based on TFC and TBC before and after application. Results: TBC and TFC of leech saliva at 8th day and before application were similar which indicates the leech gut has destroyed the bacteria or inhibited the growth of bacteria. Conclusion: TBC and TFC help to produce evidence that after application of leech and proper vomiting will not allow the growth of bacteria. Hence, safely, it can be reused after 7 days

Development of Triphala-Arishtaka Kwatha as an ayurvedic antiseptic and cleansing agent

Introduction: Antiseptics are vital in surgery. Triphala kwatha is being used as a wound-cleaning solution since years and is a known antimicrobial agent against some microbes. Arishtaka is easily available and has lekhana, kusthaghna, and vishanasana properties. Saponin is the main chemical constituent of arishtaka which produces froth. The aim of the study was to formulate an innovative preparation by combining triphala and arishtaka to evaluate its antiseptic and cleansing activity against selected human pathogens and establish it as an antiseptic and cleansing agent. Methods: Three different ratios of Triphala-Arishtaka kwatha (TAK) samples were prepared with different ratios of arishtaka (1:1:1:2[T1], 1:1:1:1[T2], and 1:1:1:0.5[T3]) and were subjected to physicochemical, phytochemical, antimicrobial, and antiseptic studies. Results: Out of the three samples of TAK, T3 showed better results with respect to antiseptic and cleansing properties. Antimicrobial study results showed that the antimicrobial activity of T3 was comparable to that of 5% povidone-iodine (PI) solution and the overall antiseptic activity of T3 is better than that of 5% PI solution. The cleansing activity was assessed by calculating the foaming indexes of the samples and all the samples of the TAK showed a value for more than 10,000, whereas the value for Savlon solution was 1000. Conclusion: Triphala-Arishtaka combination of 1:1:1:0.5(T3) has shown better antimicrobial activity against Streptococcus pyogenes, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, comparable to that of 5% PI solution. Overall it has also shown better antiseptic activity against S. aureus and E. coli and it has better cleansing activity than Savlon solution

Efficacy of Jatyadi, Madhughrita and honey tulle in wound management: a three-arm randomized controlled clinical trial

Background: Ayurveda underlines the significance of wounds and wound healing. Acharya Susruta has highlighted the need for shastiupakramas in the management of the wound. Even with a multitude of therapeutic concepts and formulations in Ayurveda, wound management has yet to gain acceptance. Objective: To evaluate the effect of Jatyadi tulle, Madhughrita tulle, and honey tulle in the management of Shuddhavrana (clean wound). Materials and methods: A three-arm randomized, parallel group, active-controlled, open-label clinical trial. Randomization was done through online random number generator software to allocate 45 patients treatment into three groups. Trial groups were treated with Jatyadi tulle (JT), Madhughrita tulle (MG), and control group was treated with Honey tulle (HT) for 10 days, and assessment was done on the 5th and 10th day. The wound was assessed using the Bates Jensen wound assessment tool, and the efficacy of the dressing material was assessed using the Worcestershire tissue viability team dressing assessment form. The study outcomes were early wound healing and clinical cure. Results: Within-group results were assessed using the Wilcoxon matched pairs test, and between-group results were assessed by Kruskal–Wallis ANOVA and Mann–Whitney U test. Significant results were obtained within-group (p value < 0.05) from day 0 and at various time points. The results between groups were found to be comparable; JT and MG were found to be significant in ease of application, removal, and patient comfort. No adverse drug events were identified throughout the study. Conclusion: JT and MG tulle have shown significant results in the management of shuddhavrana