A case study on Sophayuktha Charmakeela Arshas

V S Jisi; E S Maheshkumar

Charmakeela Arshas (sentinel pile) is a skin tag, also associated with chronic fissure in ano, at the lower part of the chronic fissure in ano skin enlarges and appears like guarding the fissure. It causes discomfort, itching and low grade infection.[1] Here the Sophayukta Charmakeela Arshas (inflamed sentinel piles) are treated with Jalouka and after the pain reduction Kshara Sutra is applied for Chedana of Charmakeela. Inflammation occurs due to Pitta-Raktadoshavardhana, for reducing inflammation Jaloukavacharana is the best. Jaloukas have Sheetha and Madhuraguna[2] because of that it helps to remove excess Dosas from inflamed sentinel pile and helps to reduce pain and swelling. Kshara Sutra is the medicated thread, prepared from Snuhi, Apamarga Kshara and Haridra.[3] In this case Jaloukavachara helps to reduce inflammation and Kshara Sutra ligation helps to remove the Charmakeela from it base and relieves the symptoms. Jalouka kept over inflamed pile mass for 5 days and Kshara Sutra was administered on the base of sentinel tag for three consecutive sittings with an interval of one week along with other oral medications, Avagaha Sweda (sitzbath) and local application. Signs, symptoms and size of sentinel tag are assessed after each week till the sentinel tag cut through takes place. This paper elaborates upon the effect of Jaloukavacharana and Kshara Sutra application in the management of inflamed sentinel pile. Ksharasutra and Jaloukavacharanas are good Anusastras to surgery as it is less risky and can be performed easily and is devoid of major complications. Jaloukavacharana done in IPD basis and Ksharasutra on an OPD basis as there is no chance of bleeding during procedure and on follow up.

Corresponding Author

How to Cite this Article

To Browse

V S Jisi, Post Graduate Scholar, Department of Shalyatantra, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email:

V S Jisi, E S Maheshkumar, A case study on Sophayuktha Charmakeela Arshas. J Ayu Int Med Sci. 2022;7(1):375-378.
Available From
https://jaims.in/jaims/article/view/1724

Manuscript Received

Review Round 1

Review Round 2

Review Round 3

Accepted

2022-01-29

2022-01-31

2022-02-07

2022-02-14

2022-02-20

Conflict of Interest

Funding

Ethical Approval

Plagiarism X-checker

Note

Nil

Yes

19%

Introduction

Chronic fissure in ano is an ulcer present in the longitudinal axis of the lower anal canal commonly at midline anteriorly and posteriorly. Chronic fissure is having inflamed and indurated margin with sentinel tag at its inferior margin which is oedematous and act like a guard. It causes repeated infections, discomfort, and burning sensation and is less painful. Charmakeela Arshas (sentinel pile) is a skin tag causes discomfort, itching and low-grade infection.^[1]

In Charmakeela Arshas, Doshas will vitiates and produce symptoms like pricking pain due to vitiation of Vata, growth increase due to Kaphadosha and due to Pitta Rakta vitiation Keela become hard and blackish red colour.^[4]

Blood vitiated by Doshas are removed with help of Raktavasechana method.^[5]

Inflammation occurs due to Pitta Rakta Doshavardhana, for reducing inflammation Jaloukavacharana is the best. Jaloukas have Sheetha and Madhuraguna^[2] because of that it helps to remove excess Pitta from inflamed sentinel pile and helps to reduce pain. Kshara Sutra is the medicated thread, prepared from 21 coating of Snuhi, Apamarga Kshara and Haridra.^[3]

Kshara Sutra ligation helps to remove the Charmakeela from it base as it is explained in Nadivrana treatment Ksharasutra applied at the Moola of Arshas^[6] and also relieves the symptoms.

In the present study the application of Jaloukavachurna and Ksharasutra on a case of Sophayukta Charmakeela Arshas is elaborated upon.

Materials and Methods

The method used for this study is clinical case study method. As a preliminary method of treatment Jaloukavacharana was done.

The materials used for the study included mainly Jaloukavacharana, Kshara Sutra (a medicated thread, prepared from 21 coating of Snuhi, Apamarga Kshara and Haridra). Matrabasthi with Mahanarayanataila, sitzbath with Triphala Churna and Tab Bolabaddharasa, Syp Asanadikashaya and Tab Nimbadiguggulu were used.

Case Presentation

A female patient named XX aged 63yrs c/o mass per rectum associated with difficulty in sitting and severe Pain since 1 yr. C/o bleeding associated with burning sensation during defecation since 1 week. The patient is a case of type II DM and HTN under oral medication since 1 yr.

The symptoms increased since 1 week and patient was feeling difficulty in sitting position with severe pain for that patient came to our hospital for further management. The patient underwent per rectal examination, after per rectal examination was diagnosed as chronic fissure with inflamed sentinel tag at 6 and 10 o’ clock.

At first the patient was treated with Jalouka for pain management for 5 days. The Matrabasthi, sitzbath with Tripahala Churna was initiated for fissure management.

After 1 week of in-patient department treatment the patient was discharged and on next visit in outpatient department the patient after examination is found to have pain reduced and fissure healed. Then on OPD basis Ksharasutra was applied for 4 weeks.

Management

The management for chronic fissure with inflamed sentinel tag at 6 and 10 o’ clock were done by following the medical regime mentioned below which included:

Jaloukavacharana for inflamed sentinel tag for 5 days
Matrabasthi with Mahanarayana Taila BD
Sitzbath with Triphala Churna BD
Kshara Sutra (4 times in intervals of each week for two months)
Tab Bolabaddha Rasa 2 BD A/F (for two months)
Tab Nimbadi Guggulu 2 BD A/F (for two months)
Asanadi Kashaya 15 ml with lukewarm water BD B/F

After reducing inflammation to sentinel tag by following ‘ Jaloukavacharana’ method in the initial five days when the patient was admitted.

For 4 weeks, Kshara Sutra was administered on the

Discussion

Charmakeela Arshas is a immovable sprout in exterior skin, correlated with sentinel pile is a skin tag seen at the lower part of chronic fissure in ano appears like guarding the fissure, chronic fissure is an ulcer in the longitudinal axis of the lower anal canal occurs midline anteriorly and posteriorly. Charmakeela Arshas mainly due to the vitiation of Vyanavayu associated with Sleshma. It is a firm and nail like growth seen externally. It is classified into 3 types, Todha is due to Vata, Granthi and Savarnathwam due to Sleshma, and Rukshata, Krishnata and Sleshnata due to Pitha and Raktha. This pile mass should be treated with Kshara, Agni, Swedana and Shastra. Here the investigators applied first Jalouka for reducing inflammation and hardness of sentinel pile by its Sheeta and Madhura property, and after application of Kshara because of it Ksharana, Kshanana, Chedana and Tridoshagna property. Here, Ksharasutra applied has been prepared from 21 coatings of Snuhiksheera, Apamargakshara and Haridra as it is mentioned specially for Arshas and Bhagandara. The Ksharasutra mentioned by Acharya has to be applied at the base of the Arbuda, the same principle is adopted and applied over here.

Reference

Bhatt S. SRB Manual of Surgery. 5th ed. New Delhi: Jaypee the health science publisher; 2017.p 977-978
Ambikadatta Sastri. Susrutha Samhitha Sutrasthana Nibandha Sangrahakya Vyakya. 1^st Varanasi: Chaukhamba Publication; 2019.
Sastri, Chakradhatha, (Arshoadhikara Sloka No 145) Goodartha Deepika Vyakyana, S.T Reddiyar Kollam, 2014
Ambikadatta Sastri. Susrutha Samhitha Nidanasthana (2^nd chapter Arshas Nidanam, Sloka No. 18), Nibandha Sangrahakyavyakya, Chaukhamba Publication, 2014
Ambikadatta Sastri. Susrutha Samhitha ChikitsaSthana (6^th chapter, sloka no 7) nibandhasangrahakyavyakya, Chaukhamba Publication,2014
Ambikadatta Sastri. Susrutha Chikitsasthana, (17^th chapter Visarpa, Nadistanaroga Chikitsa. Sloka no.33) Nibandha Sangrahakya Vyakya, Chaukhamba publication, 2018

Case Report

Chronic fissure

Journal of Ayurveda and Integrated Medical Sciences