Introduction
Bhagandara is a disease which defines itself as Darana of Bhaga, Guda and Basti Pradesha.[1] Bhagandara is one of graves disease for which Acharya Sushruta and Acharya Vagbhatta in their treatise has considered as one among Ashtamahagada,[2,3] which includes Vatavyadhi, Ashmari, Arsha, Bhagandara, Kushta, Prameha, Muda Garbha and Udara Roga. The word Mahagada indicates disease nature and also prognosis of disease. The disease Bhagandara can be considered as one of Nidanartakara Roga (secondary to other disease), Vyadhisankara (Having other Vyadhi associated with it) and also as a Upadrava.
Bhagandara can be correlated to Fistula-in-ano of conventional system of medicine, where various causative factors have been mentioned which includes non-specific causes like cryptoglandular infection and specific causes like Tuberculosis, ulcerative colitis etc.
One of presentations of extrapulmonary tuberculosis is said to be features of fistula-in-ano. While explaining management of fistula-in-ano which is caused due to tuberculosis, standard protocol says that cause should be treated first followed by treatment of disease to draw betterment of treatment and to avoid recurrence of disease.[4]
With above view Bhagandara can be one of Ubhayartakari type of Nidanartakara Roga as there will be an existence of primary disease even after manifestation of secondary disease[5] Chikitsa for such cases requires Shuddha Chikitsa[6] here management of disease & causative factors are important to suppress chances of reoccurrence of disease. As per all Bhrihatrayees[7,8,9] and other acharyas treatment of Bhagandara is Eshana followed by Bheshaja Prayoga, Agni or Kshara Prayoga and Shastra Prayoga. Kshara Sutra[10] is one of promising treatment modality in disease. Hence in present case study nature of disease and effectiveness of Ksharasutra has been dealt.
Case Study
A 27 years old female patient visited Shalya Tantra OPD, with complaints of Soiling of undergarments, Pain and discomfort while sitting since 1 month, occasionally constipation. Patient has similar complaints since 3 years but occasional in nature.
History of present illness
Patient was apparently normal 3 years back then she gradually developed with abscess at perianal region along with fever, generalized weakness, which used to subside after burst open followed by pus drainage either on its own or on taking conservative medications. The perianal abscess was recurrent in nature. The condition worsened since 1 month hence visited our hospital for further management.
Past medical history
Patient is non diabetic, non-hypertensive and not on any treatment for Thyroid dysfunction. Patient had completed 6 months regimen of anti-tuberculosis treatment for pulmonary Koch’s, which was diagnosed 7 months ago.
Surgical History: Undergone MTP 8 months ago.
Family history: Nothing contributory
Menstrual history: regular, 4-5 days/28 days cycle
Obstetric history: G1 P0 L0 A1
Personal history
- Appetite - Decreased and mixed type of diet with intake of food at irregular time
- Bowel - Constipated, regular
- Micturition - Normal in stream, no urgency/hesitancy/strangury
- Sleep - Sound
- Habits - No any habits
General Physical examination
- Moderately nourished, poorly built with Ectomorph body type
- Pallor - Absent
- Icterus - Absent
- Clubbing - Absent
- Cyanosis - Absent
- Lymphadenopathy - Left supraclavicular lymph node and right inguinal lymph node enlargement
- Oedema - Absent
Systemic examination
- Central nervous system: Patient was conscious, oriented to time, place and person,
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