Ano-Rectal Treatments

Dhanwantari is referred to as ‘Adideva’ i.e. considered first among gods who freed all other gods and heaven from the chains of diseases, old age and death.

In Ramayana and Mahabharata, Dhanwantari is considered to be celestial being who appeared in white robes, with pot of nectar, during the churning of milky ocean (Kshirasagar manthana) which is churned by gods and demons.

It is said that Dhanwantari is said to have taken birth on earth in the dynasty of king Dhanva. He was son of Divodasa the ruler of Kasi and hence called Divodasa Dhanwantari. He took birth on the earth to teach the science of Shalya Tantra (surgery) and other branches of Ayurveda to address the suffering people. He is credited with specialising Ayurveda into 8 branches. He taught Shalya tantra to his disciples – Sushruta, Aupadhenava, Karavira, Vaitarana and others.

Among the 8 branches of Ayurveda, the science of Shalya tantra or Surgery is placed in a position of great respect as it ensures complete and early relief from diseases and encompasses not only surgical procedures but also minimally invasive surgical methods like Kshara Karma (Chemical Cautery), Agni Karma (Thermal Cautery), Rakta Mokshana (Blood-letting) therapy which are equally adopted in other branches of Ayurveda.

Like Agnivesa of Punarvasu Atreya, Sushruta of Dhanwantari is considered to be able and most learned disciple. Dhanwantari taught the skill of surgery to various disciples at Kasi. Among them Sushruta was the one who mastered the surgical skills and compiled his experiences and thoughts in the form of a text called Sushruta Samhitha. It not only signifies the surgical aspect but also provides information about other branches of Ayurveda.

The efforts and contributions of Sushruta towards Shalya Tantra stand out to be pioneering even in today’s world making him the ‘Father of Surgery’. References of Sushruta in various texts direct him as many personalities, but after extensive research and as per view of Ayurveda Vriddha Sushruta the direct disciple of Divodasa of 1500-1000 BC and Sushruta between 1-2 AD hold significance.

Susruta Samhitha

It is a classical treatise which not only focuses on surgery but also emphasises on other branches of Ayurveda. It comprises of 186 chapters divided into 6 sections (sthanas).

Following and using the rules and techniques of surgical procedures in the treatise a wide variety of chronic and long standing morbidities can be cured which are likely categorized under the indicated process

Sl. No	Procedure	Morbidity
1.	Kshara karma (Paneeya& Pratisaraneeya )	Worms, Indigestion, urinary Calculus , Skin diseases, obesity, etc. & Internal haemorrhoids, kusta, Fistula, Warts, etc.
2.	Agni karma(Thermal cautery)	Pain in muscles, joints, ligaments; hard outgrowths, cervical lymphadenitis (Apaci), Hernia, Haemorrhoids, Haemorrhage, e.t.c
3.	Rakta mokshana (Mainly Jalauka and sira vyadhana)	Raktaja vikaaras. (Blood related Problems).

KSHARA KARMA

Kshara Karma uses Alkali for the treatment purpose. It is one of the important Anu sastra (Para-Surgical Procedures), which can singly produce many surgical effects like Incision, Excision and scrapping etc., pacifies vitiated tri-dosas and is very convenient for usage. It is very much indicated in persons who are sensitive and afraid of surgery.

Kshara is of 2 types

1. Pratisaraniya ( External)
2. Paniya ( Internal)

KSHARA SUTRA

Kshara Sutra is a Medicated thread with coatings of Kshara and other mediacted drugs. Kshara sutra therapy is a minimal invasive Ayurvedic procedure technique which is safe, sure and cost effect therapy described by sushruta in his treatise effective in Fistula-in-ano, Haemorrhoids and other sinus diseases. pH of Kshara Sutra is 9.72.

Application of Kshara sutra in

Fistula-in –ano	Haemorrhoids		Pilonoidal sinus
The patient is anaesthetized with local or spinal or general anesthesia, then a malleable probe is passed through the external opening of the fistula to the internal opening in the anal canal and probe is gently taken out through anal opening to outside along with a Kshara Sutra in the groove of the probe. Later both ends of the Kshara Sutra is tied together. The Kshara Sutra is replaced by a new one after an interval of one week. The Kshara Sutra gradually cuts and heals the tract. Finally the whole fistulous tract heals after cutting.	The patient is anaesthetized with local anesthesia. First pile mass holding with pile holding forceps and bring them out of the anal orifice, then give incision at muco cutaneous junction. Later slight pull exerted over the pile mass and transfixed by Kshara Sutra at the base. Ligated pile mass replaced inside the rectum and rectal pack with Yastimadhu taila or ghrita.	The patient is anaesthetized with local anesthesia and then a malleable probe with Kshara Sutra is passed through the external opening of the pilonidal sinus to the skin. Later both ends of the Kshara Sutra is tied together. The Kshara Sutra is replaced by a new one after an interval of one week. The Kshara Sutra gradually cuts and heals the sinus tract.

Mechanism of Kshara sutra in

FISTULA-IN-ANO

HAEMORRHOIDS

It helps is cutting, curetting, draining and healing of the fistulous track. It destroys and removes unhealthy tissue and promotes healing of the fistulous track due to caustic action. Controls infection by the microbicidal action. Separation of debris and cleaning the wound. Facilitate in drainage of pus in fistulous tract and help in healing. Cutting through the tissues and laying the track open.

Chemical cauterization and mechanical strangulation of the blood vessel. Local gangrene of the pile mass tissue. Ischemic necrosis and debridement of unhealthy tissue. Sloughing of the mass within 5-7 days. Healing of the resulting wound takes 10-15 days.

Haemorrhoidectomy is an operation to remove severe haemorrhoids in contemporary science. It is usually a day procedure and is usually carried out under a general anesthesia. The procedure is common and generally safe, but recovery after the surgery can take a few weeks and can be painful.

Types of haemorrhoidectomy procedure-

1. Haemorrhoids can be cut away
2. Haemorrhoids can be pulled back inside the rectum and stapled in place
3. Arteries supplying blood to the haemorrhoids can be closed to help them shrink.

Complications:

1. Excessive bleeding.
2. Difficulty Urinating.
3. Infection, which might cause a high temperature.
4. Loss of control of the rectal sphincter.
5. Narrowing or damage to the anal canal.

Advantages of kshara Therapy over Haemorrhoidectomy:-

Observations revealed that maximum advantages like

1. Minimum Hospital stay.
2. No bleeding during or after operation.
3. No Post-Operative Anal Stenosis.
4. A low cost-effective method.
5. Recoccurence of the condition is very less.

Anal Fissure

It is condition in which a tear occurs in the anal canal. It is presented with symptoms like pain and burning sensation. During defecation blood mixed stools may occur. In chronic cases there may be excruciating pain along with sentinel pile mass development. There will be severe constriction and muscle spasm in the anal region which causes severe difficulty while passing stools.

In ayurveda anal fissure is effectively treated with the kshara karma in 3-4 sittings depending on the chronicity of the condition. This helps in quick healing of the fissure and prevents recurrence. Along with this sitz bath with medicated drugs is advised. In conditions of anal fissure with sentinel pile mass kshara sutra treatment is advised.

AGNIKARMA/ THERMAL CAUTERY

Agnikarma is a superior Anusastra (Para surgical) karma which aims at management of various afflictions by inflicting burns on the tissue surface directly by using different materials known as ‘Dahanopakaranas’ (Tools of cauterization). It is now a days been popularized as Thermal Cautery.

Agni karma is ideal for curing ailments such as sprains, heel pain, headaches, sciatica, and arthritis etc. There are different materials subjected to heat and used for therapy in different conditions and specificity of tools depends on the status of disease. For superficial conditions, materials used are of minimum latent heat, where as in deeper tissues materials of maximum latent heat are selected.

Sl. No	Area to perform Agni karma	Dahanopakaranas
1	Skin surfaces	Pippali, Aja shakrit (feces of goat), Godanta (teeth of cow), Shara (arrow), Shalaka(probes), Varti(wicks), Suryakanta(type of stone) etc
2	Diseases of muscle	Loha(Iron), Swarna(Gold), Tamra(Copper), Kamsya(Bronze).
3	Deeper and stronger tissues like Bones, Ligaments, Tendons etc	Madhu(Honey), Guda(Jaggery), Vasa(Fat), Ghrita(Ghee), Taila(oil), Madhucchishta(Beewax).

‘PANCHADHATU SHALAKA’ is made up of five Metals namely Copper, Brass, Bronze, Lead and Tin (in equal quantity) will be used on regular basis for Agnikarma procedure irrespective of structure involved..

Agnikarma indicated in conditions like

1. Pain in bones and joints.
2. Joint stiffness.
3. Muscle spasm.
4. Tennis Elbow.
5. Calcaneal spur.
6. Sciatica.
7. Early stage of Hernia.
8. Removal of wart.
9. Excise corn from heel.
10. Disc Prolapse.
11. Removal of mucocele of lip, tongue etc.
12. Excise extra growths of skin and muscle.
13. Excision of Fistula tracks.

Agnikarma (Cauterization) in Pain relief- Rate of any metabolic activity increases by rise in temperature. Afferent nerves stimulated by heat gives analgesic effect by acting on gate control mechanism. Action of Agnikarma in pain relief is schematically represented.