Background: Parikartika is a clinical condition enrolled with the Lakshanas like Kartanavat and Chedanavat Shoola in anal region, and it can be correlated with Anal fissure associated with pain, burning sensation during defecation and tear in the distal anal canal. The incidence rate varied by sex and was significantly higher among females (12-24 years) and among males above (30 years), with the prevalence of 0.18% or 1.1 cases per thousand people per year. Aims and Objectives: To study the effect of Talisadi Taila Matrabasti in the management of Parikartika w.s.r Fissure-in-ano. Materials and Methods: For the present study, cases were obtained form Shalya Tantra OPD with complaint of Kartanavat and Chedanavat Shoola in anal region has been taken up for the study. Intervention: Talisadi Taila Matrabasti (48ml) administerd for 7 days along with Triphala Choorna (1tsp) HS. Results: Satisfactory relief was seen in signs and symptoms and improved quality of life after treatment. Conclusion: The study proved that Parikartika was effectively managed by Talisadi Taila Matrabasti

Dr. Shankranand

Dr. Shilpa P. N.

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

                                                      ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 45  A role of Talisadi Taila Matra Basti in the manaegement of Parikartika w.s.r Fissure-In-Ano Dr. Shankranand1, Dr. Shilpa P. N.2 1Post Graduate Scholar, 2Associate Professor, Department of Shalya Tantra, Government Ayurveda Medical College, Bangalore, Karnataka, INDIA.                     INTRODUCTION Ayurveda by definition implies the knowledge of life or the knowledge by which life may be prolonged. The health of an individual depends solely on his diet and life style. But in this present era, due to sedentary life style, increased stress, unhealthy diet regimen, prolong sitting, continuous travelling, sleep habits and various life style disorders are increasing continuously. Thus, this leads to Agnimandya and leading  to  increase  in  incidence  of  constipation  in Address for correspondence:  Dr. Shankranand Post Graduate Scholar, Department of Shalya Tantra, Government Ayurveda Medical College, Bangalore, Karnataka, INDIA. E-mail: shankranandmugnoor@gmail.com  Submission Date: 03/09/2019 Accepted Date: 13/10/2019 Access this article online Quick Response Code Website: www.jaims.in  DOI: 10.21760/jaims.4.5.9 population, which causes too many ano-rectal diseases, most commonly being Hemorrhoids, Fistula-in-ano and Fissure-in-ano. Parikartika means “Parikruntavat Vedana” i.e. cutting type of pain specially observed in Gudapradesha (anal region). We get description about Parikartika in Brihatrayees and later period authors of Ayurveda, but not as an independent disease but as a complication of Virecana,[1] Basti,[2] Garbhini[3] (Vyapath). In Parikartika due to Nidanas aggrevated Apanavata attains upward movement and repelled by Udanavata, reaches Guda and obstructs the passage of faeces producing severe Ruja, Gudadaha, Pichhaasrava, which is very much suggestive of clinical feature of fissure-in-ano as per modern science when it’s limited to anal region.    Fissure in ano was most common cause of pain in anal canal; it was first recognized as a disease in 1934. About 30-40% of population suffers from proctologic pathologies at least once in their life time. Anal fissure comprises 10-15% of ano-rectal disorders and it’s characterized by excruciating pain during and after A B S T R A C T  Background: Parikartika is a clinical condition enrolled with the Lakshanas like Kartanavat and Chedanavat Shoola  in anal region, and it can be correlated with Anal fissure associated with pain, burning sensation during defecation and tear in the distal anal canal. The incidence rate varied by sex and was significantly higher among females (12-24 years) and among males above (30 years), with the prevalence of 0.18% or 1.1 cases per thousand people per year. Aims and Objectives: To study the effect of Talisadi Taila Matrabasti in the management of Parikartika w.s.r Fissure-in-ano. Materials and Methods: For the present study, cases were obtained form Shalya Tantra OPD with complaint of Kartanavat and Chedanavat Shoola in anal region has been taken up for the study. Intervention: Talisadi Taila Matrabasti (48ml) administerd for 7 days along with Triphala Choorna (1tsp) HS. Results: Satisfactory relief was seen in signs and symptoms and improved quality of life after treatment. Conclusion: The study proved that Parikartika was effectively managed by Talisadi Taila Matrabasti. Key words: Parikartika, Fissure-in-ano, Talisadi Taila, Matrabasti. Dr. Shankranand et al. A role of Talisadi Taila Matra Basti in the manaegement of Parikartika ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 46  defecation, burning in nature, bleeding per rectum with spasm of anal sphincters.[4] Pain may be so severe that patient may avoid defecation for days together until it becomes inevitable. Fissures occur most commonly in midline posterior and less common in anterior, thus protected part of anal canal. Incidence is commonly seen in youngsters and adults (19-40 yrs), pregnant women and puerperal period. It is commonly seen in both males and females. It’s very painful because of injury to somatic nerve supply to the anal region. Acute fissure-in-ano usually takes 2-3 weeks to heal even with the use of stool softners and topical applications. Yet, some fissures persist for more than 6 weeks  and considered as chronic ones which show reluctance to heal. For Parikartika, Acharyas have described treatments both local as well as systematic but no where given description of surgical management. It seems in this regard that they don’t consider it to be a disease complication of any significance which requires surgical intervention. It’s described well by Acharya Sushruta, which must have the property of Vranaropana, Vedanasthapana, Dahaprashamana and Vata-Pittahara. Among Shastiupakramas, Acharya Sushruta mentions treatment like Picchu Basti, Anuvasana Basti, Matrabasti with Taila or Ghruta or Manda along with Sheetambu Parisheka, as these does Ropana of Vrana.[5] The Basti Karma is the first line of treatment for Vatavikaras. As Parikartika being one of the Vatavikara the Basti with Taila or Ghrita is beneficial in Parikartika. Most of the drugs which are used in Bastikarma are Vata-Pitta Shamaka and Vranaropaka in nature. In Astanga Hrudaya, Talisadi Taila[6] (oil prepared with Talisa, Padmaka, Mamsi, Harenu, Chandana, Haridra, Daruharidra, seeds of Padma, Usira and Madhuka) have the Phalashruti like Vranaropaka, Dahaprashamaka, Vedanasthapaka, Raktasthambaka and Krimighna which helps to treat in Parikartika, hence taken up for this study. Source of Data 20 Diagnosed patients of Parikartika following inclusion criteria approaching the OPD of GAMC, Bangalore, were selected for the study. Inclusion criteria Patients having following features of Fissure-in-ano were included for the study;  Painful defecation  Burning sensation   Bleeding per anum  Constipation  Anal sphincter spasm  Presence of solitary Fissure-in-ano  Age group between 18-50 Exclusion criteria  Patient with any other ano rectal diseases  Uncontrolled Diabetes mellitus and serious illness  Pregnant and lactating woman Study design - Open label randomized continuous clinical study. Intervention Poorvakarma Procedure was explained to the patient in his/her own language and informed consent taken. Required materials were kept ready. The patient was asked to lie comfortably in left lateral position on examination table. The left leg of the patient should be straight and the right leg flexed at knee and hip joints and the head should be supported by left hand with the right hand resting on the right leg. The part was cleansed with swab dipped in warm water and then mopped with a dry sterile gauge. 1 pala (48ml) of warm Talisadi Taila was taken in a sterile kidney tray and then loaded into the disposable syringe. Dr. Shankranand et al. A role of Talisadi Taila Matra Basti in the manaegement of Parikartika ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 47  Pradhana Karma A sterile red rubber catheter was fixed to the nozzle of the loaded syringe and air bubbles were evacuated from it. Tip of the catheter was lubricated with the same Taila and gently inserted into the anal canal of the patient upto 3 Angula. 1 pala of Talisadi Taila was then pushed inside slowly. The catheter was gently withdrawn and a sterile gauge was kept in place. Paschat Karma After administration of the matrabasti, patient was made to lie in left lateral position. The buttocks of the patient were gently tapped with palms for 3 to 4 times. Then the soles and palms should be rubbed for 3 to 4 times.  Triphala Choorna 1 Karsha HS with warm water was given as stool softener. The same procedure was carried out daily for 7 days. Parameters Subjective parameters 1. Pain - Pain was graded according to visual analogue scale  VAS Grade 0 0 1-2 I 3-6 II 7-10 III 2. Burning Sensation  Grade 0 - Absent  Grade 1 - Present 3. Bleeding Per anum Bleeding was seen as streaks over the stools or few drops on toilet pan in some cases.  Grade 0 - Absent   Grade 1 - Present  4. Hard stools  Grade 0 - Absent   Grade 1 - Present Objective parameters 1. Length of Ulcer:  Grade 0 - Healed ulcer  Grade 1 - 1 to 5 mm   Grade 2 -  5 to 10 mm  Grade 3 - > 10 mm  2. Anal Sphincter tone scale Resting Score  0 - No discernable tone at rest, an open or patulous anal canal  1 - Very low tone  2 - Mildly decreased tone  3 - Normal  4 - Elevated tone, snug  5 - Very high tone, a tight anal canal, difficult to insert finger Squeeze Score  0 - No discernable increase in tone with squeeze effort.  1 - Slight increase   2 - Fair increase but below normal  3 - Normal  4 - Strong squeeze  5 - Very strong squeeze, to the point of being painful to the examiner Dr. Shankranand et al. A role ofISSN: 2456-3110                          Journal of Ayurveda and Integr Overall assessment and result The results were evaluated by subobjective parameters mainly based observation by grading method. Assessment response were done in foupoor response, moderate response, goand excellent response. Assessment of total effect  Poor response - <24% reductionparameters.  Moderate response - 25-49% reductiparameters.  Good response - 50-74% reductioparameters.  Excellent response - 75-100% reductiparameters. OBSERVATION The effect of Talisadi Taila was studied insuffering from Parikartika, fulfilling tcriteria. The observations were as followsMaximum number of patients was between 30-39 years that is 55%, follopatients in the age group of 20-29 andand 5% patients in the age group of 50-59patients were 90% and female patients w90% patients were middle class. 30% pbusinessman, 15% patients were teachersMost of the patients 72.5% were non37.5% patients were addicted to alcohol a85% patients were having Mandagni. 4were moderate built and 40% patients chronicity between 1-3 week. RESULTS The Talisadi Taila provided a highly signon Pain, Burning sensation, Bleeding, Lenand Sphincter tone (Resting and SqueeChoorna H.S with warm water relieves Co Talisadi Taila Matra Basti in the manaegem                          ORIGINAL ARTIated Medical Sciences | Sept - Oct  2019 | Vol. 4jective and on clinical r groups as od response  in overall on in overall n in overall on in overall  20 patients he inclusion : in age group wed by 20%  40-49 years  years. Male ere 10%. atients were  and drivers. -vegeterian. nd smoking. 0% patients were having ificant effect gth of ulcer ze). Triphala nstipation. Table 1: Showing effect ofparameters. Symptom Mean score BT AT BT-AT Pain 2.85 0.05 2.80 Burning Sensation 0.90 0.05   0.85 Bleeding 0.90 0.00 0.90 Constipation 0.90 0.00 0.90 Length of Ulcer 1.60 0.25 1.35 Sphincter Tone Resting Score 4.75 3.15 1.60 Sphincter Tone Squeezing Score 4.95 3.20 1.70 Figure 1 & 2 : Before and Basti Before treatment ent of Parikartika CLE Sept-Oct 2019  | Issue 5 48  therapy on the subjective % S.D (±) S.E  (±) t p 96 0.41 0.09 31.11 <0.001 94 0.36 0.08 10.62 <0.001 100 00 00   00 <0.001 100 00 00   00 <0.001 85 0.59 0.13 10.15 <0.001 94 0.44 0.09 19.44 <0.001 89 0.44 0.09 19.44 <0.001 After Talisaadi Taila Matra  Dr. Shankranand et al. A role ofISSN: 2456-3110                          Journal of Ayurveda and Integr After treatment DISCUSSION Pain Shoola in Parikartika is mainly due toaggrevation and as per modern science; ptear of the skin of the lower half of the ansphincter spasm always presenVedanasthspaka and vatanulomana Talisadi Taila helps in reducing the pain bthe anal canal pressure and hyper tonicitymuscles when it is administered in tMatrabasti. Burning sensation Daha in Parikartika is mainly due to incDosha, the drugs having PittaDahaprashamana properties of Ta(Candana, Usira Madhuka) helps in redusensation. Bleeding Raktasrava in Parikartika is mainly due Pitta Dosha and presence of Vrana in Guand as per Modern science in Fissure-straining for constipated hard stools aulcer or tear in lower anal canal formspassing streaks of blood seen in stPittahara and Raktastambaka (Haridra, properties of Talisadi Taila help in controlper anum.  Talisadi Taila Matra Basti in the manaegem                          ORIGINAL ARTIated Medical Sciences | Sept - Oct  2019 | Vol. 4  Vatadosha ain is due to al canal and t. Hence properties of y decreasing  of sphincter he form of reased Pitta hara and lisadi Taila cing burning to increased da Pradesha in-ano due to  longitudinal , from their ools. Hence daruharidra) ling bleeding Constipation Vibandha in Parikartika is mApanavata, where VatPureesha/Varcha, the stopatient passes Shushkashdifficulty. And as per modthe prime causative factFissure-in-ano. Hence Talisthe form of retention enemVatanulomana and softenconstipation got relieved. Length Ulcer  Presence of Vrana in GudParikartika. As per moderdue to straining for colongitudinal ulcer or tear inrupturing the one of Vranaropaka (Madhuka) helps in healing of ulcer. Sphincter spasm This Sphincter spasm can baggravation. As per Modmainly leads to ulcer followup in sphincter spasm assupplied with the same sothe sphincter muscles. So, part of anal canal will cauinto spasm. Hence Talisadi in the form of Matrabastdays. By this daily lubricatiocanal pressure reduced. Hspasm to be relieved by thiCONCLUSION Matrabasti carried out inclassical references whictreating Parikartika.  Timeand sufficient fluids wiregularize the bowel and prstools thus helps in healinMatrabasti was found eburning sensation, bleedinano. Matrabasti which is sient of Parikartika CLE Sept-Oct 2019  | Issue 5 49 ainly due to Varchasavrita a gets Aavruta with ol gets constipated and akrit (hard stools) with ern science constipation is or in the occurrence of adi Taila is administered in a daily for 7 days by this ing of stool occurs and apradesha is a feature of n science in Fissure-in-ano nstipated hard stools a  lower anal canal forms by the anal valve. Hence property of Talisadi Taila  e attributed to Vatadosha ern science, Constipation ing pain which finally ends  the lower anal canal is matic nerves which supply any irritation to the lower se these sphincters to go Taila, administered warmly i (retention enema) for 7 n of ano-rectal route, anal ence we can expect anal s treatment.  this study was based on h is highly effective in ly intake of fiber rich food th regular exercise will omotes easy evacuation of g of fissure. Talisadi Taila ffective in relieving pain, g and healing of Fissure-in-mple, economical, and free Dr. Shankranand et al. A role of Talisadi Taila Matra Basti in the manaegement of Parikartika ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 50  from side effects and did not require hospitalization and it could be carried out at OPD level itself.  REFERENCES 1. Agnivesha, Charaka, Drudhabala, Chakrapanidatta. Siddisthana Chapter 6 Verse 61-62. In: Acharya YT (Edi.). Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition, 2018: Varanasi: Chaukhamba Publications, Pp-1027. 2. Susruta; Susruta Samhita with Nibandha Sangraha commentary of Sri dalhanacharya and Nyaya Chandrika Panjika of Sri Gayadasacharya on Chikitsasthana edited  by Vaidya Jadavji Trikamji Acharya and the Rest by Narayanaram Acharya, Chaukambha Orientalia, Varanasi, Reprint 2014; Chikitsa Sthana 34/16. 3. Kashyapa: Kashyapa Samhita preached by Maharshi Maricha Kahyapa; Summarized then written by his disciple Acharya Vruddhajivaka; redacted by latter’s descendant Vatsya; Text with English Translation and Commentary, edited by P.V.Tewari, Chaukhambha Visvabharati; Reprint – 2014; Chikitsa Sthana; chapter 2. 4. Bailys and love short practice of surgery 24th ed.pp.1253-1254. 5. 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J Ayurveda Integr Med Sci 2019;5:45-50. http://dx.doi.org/10.21760/jaims.4.5.9  Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2019 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 

A role of Talisadi Taila Matra Basti in the manaegement of Parikartika w.s.r Fissure-In-Ano

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A role of Talisadi Taila Matra Basti in the manaegement of Parikartika w.s.r Fissure-In-Ano

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