Comparative clinical study to evaluate the efficacy of Jalaukavcharan and Standard Conservative Treatment in the pain management of Perianal Abscess - A Case Study

Abstract

Background: A perianal abscess, also known as an anal or rectal abscess, is a common acute surgical condition characterized by a pus-filled cavity near the anal canal. Approximately 90% of cases are cryptoglandular in origin, caused by obstruction and infection of anal glands located within the intersphincteric space. Other etiologies include inflammatory bowel diseases. In Ayurvedic literature, Acharya Sushruta - revered as the Father of Indian Surgery - has described such abscesses under the broad category of Vidradhi. Jalaukavacharana (leech therapy), a form of Raktamokshana (bloodletting), is a unique Ayurvedic approach with potent anti-inflammatory, analgesic, thrombolytic, anticoagulant, vasodilatory, and circulation-enhancing properties, attributed to bioactive molecules in leech saliva. Acharya Vagbhata has advocated its use in inflammatory conditions like Vranashopha, a Raktapradoshaja Vyadhi characterized by localized swelling, discoloration, burning sensation, and pain. Materials and Methods: This is a comparative case study involving two patients: Standard Case: A 42-year-old male presented with severe throbbing pain in the perianal region, aggravated post-defecation, burning during defecation, inability to sit or sleep due to pain, and fever for two days. He was managed with conventional modern medical treatment. Experimental case: A 50-year-old male with similar complaints persisting for 5-6 days and fever for 3 days was treated using Ayurvedic principles, including Jalaukavacharana and internal medications. Results: Significant symptomatic relief was observed in the Ayurvedic case, including complete resolution of pain and associated symptoms. The outcome was superior in comparison to conservative modern treatment, which provided only partial relief over a period. Discussion: The successful outcome with Jalaukavacharana can be attributed to the synergistic effects of leech saliva, which contains bioactive compounds with anti-inflammatory, analgesic, and thrombolytic properties. Its role in improving local blood circulation and reducing localized inflammation likely contributed to rapid symptom resolution. Conclusion: Jalaukavacharana, when combined with internal Ayurvedic medications, provides a safe and effective alternative in the management of pain in perianal abscess. This case study demonstrates the potential of integrative Ayurvedic approaches in addressing inflammatory anorectal disorders.