E-ISSN:2456-3110

Case Report

Parikarthika

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan- Feb
Publisherwww.maharshicharaka.in

Management of Parikartika w.s.r. to Acute Fissur-In-Ano with Guduchi Taila Pichu - A Case Study

Renuka T.1*, Rao S.2
DOI:

1* T Renuka, Post Graduate Scholar, Dept of Shalya Tantra, Govt. Ayurvedic Medical College & Hospital, Bengaluru, Karnataka, India.

2 Shreedhar Rao, Professor, Dept of Shalya Tantra, Govt. Ayurvedic Medical College & Hospital, Bengaluru, Karnataka, India.

Fissure in ano is very common yet troublesome condition. Due to life style, intake of low fibre diet, junk food and constipation. Recurrence nature of this disease makes the treatment challenging. The symptoms can be correlated to Parikarthika according to Ayurveda. Many treatment modalities have been mentioned and practiced in management of Parikarthika such as Deepana, Pachana, Vaatanulomana, Avagaaha, Basti Karma and local application of Madhura, Sheetha, Snigdha Dravyas, Taila Poorana, Lepa and Pichu-Dharana. Pichudhaarana works on the basis of cellular absorption and is easier method for adoption. Conclusion: A case having features of Parikarthika was selected from OPD, SJIIM Hospital for case study and Guduchi Taila Pichudharana was done for 7 days. Assessment was done based on features like pain, burning sensation and sphincter tone. Significant improvement was observed after treatment.

Keywords: Parikartika, Guduchi Taila, Fissure-In-Ano

Corresponding Author How to Cite this Article To Browse
T Renuka, Post Graduate Scholar, Dept of Shalya Tantra, Govt. Ayurvedic Medical College & Hospital, Bengaluru, Karnataka, India.
Email: 		T Renuka, Shreedhar Rao, Management of Parikartika w.s.r. to Acute Fissur-In-Ano with Guduchi Taila Pichu - A Case Study. J Ayu Int Med Sci. 2022;7(1):339-342.
Available From
https://jaims.in/jaims/article/view/1616

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-26 2022-01-28 2022-02-04 2022-02-11 2022-02-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by T Renuka, Shreedhar Raoand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)339
Renuka T. et al: Management Parikartika w.s.r. to Acute Fissur-In-Ano Guduchi Taila Pichu

Introduction

Parikarthika is a complication of Basti Karma and Virechana Vyapath as mentioned in Brihatrayees.  Parikarthika is characterized by Kartanavat and Chedanavat Shoola in Guda.[1]Major etiological factors of Parikarthika are summarized as: improper administration of Virechana and Basti Karmas and it is a complication of Atisara, Grahani and Arsha Roga. Acharya Kashyapa classifies the condition into three type’s viz. Vataja, Pittaja and Kaphaja. Acharya Sushruta described the symptoms of the disease as cutting or burning pain in Guda, Basti Shiras and Naabhi[2] and Acharya Charaka describes the features as cutting pain with burning sensation in Guda, Naabhi, Medhra, Basti Shira and Aruchi. Acharya Charaka also mentioned slimy blood discharge as a Lakshana of Parikarthika in Siddhi Sthana.

Parikarthika can be correlated with Fissure-in-ano of the contemporary science. It is longitudinal split in anoderm of the distal anal canal which extends from the anal verge proximally towards but not beyond the dentate line.[3] Fissure in ano is characterized by excruciating pain during and after defecation, bleeding per anum along with spasm of anal sphincter. About 30-40% of population suffers from proctologic pathologies at least once in their lives. Anal fissures comprise of 10-15% of anorectal disorders. The line of management in contemporary science includes analgesics, stool softeners, smoothing ointments and anal dilatation. Surgical intervention includes Lords dilatation, Posterior fissurectomy and Anal sphincterotomy. All these treatments have their own limitations and side effects.[3]Acharya Sushrutha has mentioned Anuvasana Basti[4] with Ghrita Manda or oil processed with Yashtimadhu as line of treatment in Parikarthika. The condition demands innovative techniques for its management. Many techniques have been tried, each by no means better than other. There is always a need for the cost effective and patient friendly method of management for Parikarthika. Pichu[5] is safe, ideal, convenient and cost effective. Pichu is explained in Charaka Siddhi Sthana 5th chapter. Pichu is a thick swab or cotton pad which is soaked in medicated ghee or oil. And it can be placed in the desired position or according to site of treatment. As it remains in-situ for more duration better absorption and action of the drug can be achieved.  Guduchi Taila[6]

is Tridosa Shamaka having properties like Vranahara, Kushtagna, Vaata-Raktahara and Kandugna. Hence, Guduchi Taila Pichu is used here in the study for the treatment of Parikarthika.

Case Report

A 47 yrs old female, house wife presented with complaints of severe pain in the anal region during and after defecation associated with burning sensation, constipation, stools streaked with blood since a week at Shalya Tantra OPD, SJIIM Hospital, GAMC, Banglore, approached SJIIM Hospital for better management. The patient had history of constipation and is not a known case of Diabetes mellitus, Hypertension or underwent any surgery. Patient consent was taken. On physical examination pulse - 86/min, Blood pressure - 120/ 80 mmHg. All the laboratory investigations done were within normal limit. Systemic examination was done and clinically no abnormalities were detected.

Local Examination

Inspection: Active bleeding was seen at the anal verge. On separation of anal verge, a longitudinal tear extending from the anal verge was seen at 1 o’ clock position 1cm inside the anus.

Palpation: Tenderness present over the fissure area

Nidana

Ahara - Ruksha Aahaara, Katu Pradhaana Aahaara Sevana

Vihara - Prolong standing

Samprapti: The Nidanas (Aetiological factors) results in Agnimandya and there by leads to Vata Pradhana Pitta Dosha Dushti. Then localisation of Dushita Doshas occurs particularly in Guda Pradesha, producing Twak Mamsa Dushti and results in Rukshata of Twacha which later attains tendency to crack. Thus, cracked skin in the perianal region is Parikartika.

Diagnosis: Parikartika (Acute Fissure in Ano)

Materials and Methods

Guduchi Taila preparation

Moorchita Tila Taila cooked with Guduchi Kashaya and Kalka with equal quantity of milk on mild fire till Paaka Lakshana was observed.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)340
Renuka T. et al: Management Parikartika w.s.r. to Acute Fissur-In-Ano Guduchi Taila Pichu

Treatment was planned as:

Sthanika Chikitsa and Pathya

Sthanika Chikitsa :  Guduchi Taila Pichhu for 3 hours and duration of 7 days

Pathya: Sukoshna Jala Paana (Deepana, Paachana, Vaataanulomana) Rice, wheat, Buttermilk, milk, Bottle guard (Patola), elephant foot yam (Soorana), green leafy vegetables and rich fibre diet.

Assessment Criteria

Burning sensation at anal verge

  • Severe - 3
  • Moderate - 2
  • Mild - 1
  • Absent - 0

Pain - Visual analogue scale

  • 7-10 : severe
  • 4-6 : moderate
  • 1-3 : mild
  • 0 : absent

Bleeding per anum

  • Grade 0 : Absent
  • Grade 1 : Present

Sphincter tone

  • Grade 1 : spasm present
  • Grade 0 : Normal sphincter tone
Treatment Day Observation
Burning sensation Pain Bleeding per anum Sphincter tone
Guduchi Taila Pichu 1st 3 Severe 1 1
2nd 3 Moderate 1 1
3rd 2 Mild 1 0
4th 1 Mild 1 0
5th 0 0 1 0
6th 0 0 0 0
7th 0 0 0 0

Observations and Results

Clinical examination of the patient revealed regression of symptoms with treatment day by day. On third day there was mild pain and scanty bleeding streaked to stools. On 4th day

minimal burning sensation was seen and sphincter tone was normal and on last day of treatment patient had no symptoms.

Discussion

Patient got relieved from the symptoms of fissure-in-ano with Guduchi Taila Pichu.

Probable mode of action

Properties Guduchi Taila
Rasa Tikta, Kashaya Katu
Guna Guru, Snigdha Guru
Veerya Ushna Ushna
Vipaaka Madhura Madhura
Doshagnata Tridoshashaamaka Vaataghna

Guduchi Taila mentioned by Chakradatta in Vaatarakta does Shamana of Vaata and Rakta and is indicated in Kushta, Twak Dosha, Vrana, Visarpa, Kandu and Dadru.

Local action of Pichu is based on cellular absorption of medicines, by which Vaata is regulated and Vedana and Rookshata is reduced.

Thus, Guduchi Taila Pichu helps in healing of acute fissure with symptomatic relief.

jaims_1616_01.JPGBefore treatment

jaims_1616_02.JPGAfter treatment


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)341
Renuka T. et al: Management Parikartika w.s.r. to Acute Fissur-In-Ano Guduchi Taila Pichu

Conclusion

In this single case study, Guduchi Taila Pichu along with proper Pathya has showed good results. Relief from Acute Fissure-in-ano was seen. And on examination Fissure was also healed completely.

Reference

  1. Kashinath Shastri, Gorakanath Chaturvedi Charaka Samhita 23rd edition, Uttarardha, Siddisthana Ch.No.06 Sl No. 61-62, Chowkamba Varanasi pp.1027
  2. Kaviraja Ambika Datta Shashtri. Sushruta Samhita. 11th edition, Chikitsa sthana, Ch. No.34, Sl.No16 Chowkambha Varanasi pp.151
  3. Baileys and love short practice of surgery 24th ed.pp.1253-1254
  4. Kaviraja Ambika Datta Shashtri. Sushruta Samhita. 11th edition, Chikitsa sthana, Ch. No.34, Sl.No16 Chowkambha Varanasi pp.151
  5. Kashinath Shastri, Gorakanath Chaturvedi. Charaka Samhita. 23rd edition, Uttarardha, Siddisthana Ch.No.06 Sl No. 61-62, Chowkambha Varanasi. Pg.no. 620
  6. Chakradatta, Priyavat Sharma, Chaukambha Publishers, Chikitsastaana. Vatarakta Chikitsa. Ch No.23. Sl no.21,22.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)342