Management of Parikartika (fissure in ano) in Ayurveda

It is the condition in which patient’s experience sensation of pain as if the Guda(anal region) is being cut around with the scissors pain is most accepted and important symptoms in this disease.

“Parikartika” is not being described in Vedas even tough Vedas have a rich description of various diseases and their management. sushruta samhita in nidana sthana, chikitsa sthana, and uttaratantra.

Symptoms:

• The most presenting symptoms of this disease is severe pain in anus, which has been described by all ancient author.
• It also cause a cutting or burning pain in the region of guda, nabhi, medhra and vastisira, appetite vanishes and vatavaigunya occurs.
• If  we take the above view in the light of modern medicine, it has been seen that the pain in the region of umbilical and urinary bladder and suppressions of flatus are the common reflex symptoms of anal fissures. Patient afraid to take food and this again increase the intensity of constipation which results in further aggravation of the diseases.

Management

It can be categorized under

1. Local measures
2. General measures

Local measures

• Pichha vasti with Krishna tila kalka and madhuyashthi  containing ghrita and madhu. Anuvasana vasti fortified with yasthimadhu or ghritamanda.
• Vasti and pariseka with oil.
• Sneha vasti, piccha vasti, sitala vasti, fortified by kashaya and madhura dravyas.

General measures

• Dipana, pachana
• Cold water bath
• Food with plenty of water
• Pittashamak treatment
• Single drugs depends upon dosha predominance

Treatment at glance:

1. Oil vasti: 5 ml vasti should be given before the urge of defaecation. It may be given by the help of  a disposable syringe (5ml) and rubber catheterization   . Oils like Pilu taila, Anu taila, Narayana taila. Yashtimadhu taila, jatyadi taila

1. Sitz bath: Patients should be advised to take sitz bath with luke warm water or warm water mixed with alum.
2. Shigru guggul: Two tablet twice a day
3. Abhayarishta and guggulu asava : each of asava is taken at a dose of four tablespoon with equal amount of water after meal.
4. Jati ghrita is to be applied locally inside the anus after sitz bath.
5. Local application of ghrita kumara pulps which having both anaesthetic and healing properties.
6. Panchasakar/shatsakar should be taken at bedtime with luke warm water in a dose of one or two tablespoon ful according to used and degree of constipation.