Anushastra Karma (Para Surgical Procedures)

Shalya Tantra is one of the important branches of Ayurveda in which surgical and parasurgical techniques has described for management of various diseases.Sushruta – The father of surgery has scientifically classified it in a systemic manner whose wealth of clinical material and the principles of management are valid even today.Anushastra Karma means surgical procedure performed by non surgical items or instruments in absence of surgical instruments. Acharya Sushruta described different Anushastra karma like Kshara karma,Kshara Sutra,Agnikarma,Siravyadaha,Jalukavacharana(leech Therapy) etc for different disease condition like fissure,fistula,pilespilinoidal sinus,non healing wounds etc.

AGNIKARMA

In agnikarma, agni is applied directly or indirectly with the help of different materials to cure the diseased.  So any procedure that involves the agni directly or indirectly is considered under agnikarma. Agnikarma does not allow the diseases to reccur, once they are treated by it..Agnikarma is having the effect of  sterilisation.  It destroys the pathogens because of its heat effect.  Thus, the post agnikarma wounds are rarely infected.

Agnikarma is one of the para-surgical procedure in which heat is applied to the points in body afflicted by pain using Shalaka i.e., an instrument made up of Panchadhatu. Agnikarma is indicated disorders of Asthi (bone), Sandhi (joint) and Snayu (ligament/tendon) also in Arsha (Piles), Arbuda (tumour), Bhagandar (Fistula in ano), Sira- Snayu-Asthi- Sandhigata Vata Vikaras (Ligament injury, Tendonitis, joint pains) and Gridhrasi (Sciatiuca). Agnikarma is effective in conditions of acute pain, as well as chronic pain in condition.

 Fissure in Ano:

It is longitudinal tear in the lower end of anus. It is the most painful condition affecting the anal region. Sometimes a little tag, swelling of the skin develops at the edge of the anus. This is called as sentinel tag or Sentinel Piles. This stays even after the fissure heals unless excised. It commonly seen in young & middle age people. Due to wrong food habits fissures are found in children also.

Symptoms :

• Severe burning – cutting pain during and after passing stool
• Severe constipation
• Drop of blood or streak of fresh blood during defecation.
• Sentinel piles (Tag of skin at the outer end of anus)
• Itching
• Hard stool

Causes :

• Extreme condition like severe constipation or dysentery
• Surgeries (Piles surgery)
• Sphincter hypertonia (spasm of anus)
• Repeated child birth
• Excessive use of ointments
• Excessive use of laxatives

How to cure fissure :

Self help –

Correcting Constipation :

This can be done by adopting a high fibre diet. Also eat as per your appetite. Avoid fast food. Drink sip by sip water during eating. Do exercise regularly.

Sits Bath :

The best way to reduce pain is a sits bath in simple warm water or warm medicated water

Agnikarma :

This is para surgical procedure. This is a sort of thermal cauterisation. In this procedure sentinel tags are removed by thermal cauterisation and sphincterotomy also will be performed by agnikarma to relduce spasm of anal ring.

Fistula In Ano (Bhagandara)

History of fistula :

This disease is said to have existed about more than 4000 years. In spite of the tremendous developments of modern medical science in surgery, to cure fistula-in-ano is a challenge for medical world.

 What is Fistula :

Anal Fistula is an abnormal tube like passage (communication) between the interior of the anal canal (or rectum) and the outer skin surface around the anus. One opening of the fistula (Internal opening) is inside the anus (or rectum) and another opening ( External opening) is on skin surface around the anus. A tube like structure ( Fistula track) connect them.

Symptoms of fistula :

• Persistant seropurulent ( sticky) discharge of pus and/or stool from the external opening near anus
• History of recurrent swelling & abscess on buttock
• Itching & moist feeling in the anal area
• Pain in the lump on buttock
• Flatus (gas) escape from external skin opening

Causes of fistula :

• Ignored fissure can get infected and get converted in to fistula
• Spicy & fast food habits , sitting job
• Can cause as a complication in Abscess, Tuberculosis.(T.B) , Cancer , IBS ( Inflammatory bowel Syndrome), Ulcerative colitis , Crohn’s disease
• Diagnosis Techniques for fistula :
• Fistula Probing
• Fistulogram
• MRI

How to cure fistula permanently :

Fistula treatment is a challenge for modern medical science. Antibiotics & advance surgeries can not assure the removal of fistula track & infection.  At AyurRemedy, we are proud to say that we have cured those patients who were not cured by advance repeated surgeries.

How Ksharsutra Treatment works for fistula :

Now a days the Kshara-sutra treatment is a well accepted Ayurvedic technique for treating  Fistula-in-Ano, Advantage of kshara sutra is

1)  Minimal recurrence

2)  Minimal hospital stay

3)  Non invasive technique

4)  Patient can resume day today activities soon

5)  Less complication. (chances of incontinence is rare in this procedure.

Kshara Sutra Procedure:

Probing is done through a malleable probe to locate the internal opening . If internal opening is located, the probe is pushed out through the anal verge and the track is threaded loosely by Kshara sutra.

• 10 ml. of Jatyadi oil is pushed inside the rectum and sterilized gauze is applied on the anus covering the external opening.
• Thereafter the patient is shifted to the ward.

Weekly change of the sutra: – Kshara-sutra applied initially is kept for 7 days after which it is replaced by a fresh Kshara-sutra by Rail Road Technique. This procedure is repeated every week till the track completely cut through and if there is any unhealthy granulous tissue, it is scrapped-off during this weekly follow-up to promote a better healing.

Pilinoidal Sinus (Nadivrana)

What are pilonidal sinus ?

‘ Pilonidal ‘ means nest of hairs. A pilonidal sinus is a tube like random shape structure which contains a tuft of hairs. This cyst / abscess with infected tissues, pus, blood is found under the skin covering the last part of back bone – tail bone between the buttocks. It is also called as “Jeep- Bottom ” or Barber’s disease because this is very common in Jeep drivers.

Who gets pilonidal sinus?

This is more in India. It is rare in children and in people over the age of 40. It is four times more common in men (as they are hairier than women).

Certain factors increase the risk of developing the condition and include:

• A job involving a lot of sitting (a sedentary occupation)
• Being overweight (obesity)
• A previous persistent irritation or injury to the affected area
• Having a hairy, deep natal cleft
• A family history of the condition

Symptoms of pilonidal cyst :

• External sinus opening seen at the base of spine between the buttocks
• Pus discharge from the lump on lower back
• History of recurrent swelling & abscess on lower back
• Fever, pain

How Ksharsutra Treatment works for Pilonidal sinus

Pilonidal sinus treatment is a challenge for modern medical science. Antibiotics & advance surgeries cannot assure the removal of pilonidal sinus & infection.  At AyurRemedy we treat pilonidal sinus  by Ksharsutra treatment. This treatment is the best alternative for modern surgery techniques. Ksharsutra treatment is now replacing all complex surgeries for pilonidal sinus with great success rate.

Using appropriate technique kshar sutra is inserted correctly in the pilonidal sinus. This herbal thread is changed after every 7 days. The duration of the treatment depend on the length & stage of pilonidal cyst. No recurrence , no daily dressing required , no hospitalization required , no bed rest and patient can resume his / her routine work within few hours.

Thus pilonidal sinus / cyst can be cured permanently without surgery.

Importance of Kshar sutra treatment : But the ksharsutra treatment in Ayurveda has much more thoughts beyond that. This herbal therapy is not only removes the infection but helps human body to create new healthy tissue naturally. The quality of this tissue is so miraculous that it will not get infected easily. You can avoid surgery by this natural way. It has low recovery time & high success rate.

Haemorrhoids (piles}

The Sushrut Sanhita has explained the haemorrhoids as Arsha more than 4000 years ago .  The conservative treatment & kshar karma treatment described by him is used in AyurRemedy.

What are piles ?

Haemorrhoids also called piles, are swollen and inflamed veins in the anus and lower rectum. Haemorrhoids may result from straining during bowel movements or from the increased pressure on these veins during pregnancy.

Symptoms of piles :

• Bleeding (Splash in the pan)
• No pain
• Prolapsed mass through anus
• Discharge of mucous (Sticky fluid)
• Itching

Causes of piles :

• Chronic Constipation
• Straining during passing stool
• Genetic or Hereditary
• Straining during child birth
• Repeated diarrhea – dysentery
• Continues sitting or standing work position
• Continues Lifting heavy weights
• Habit to suppress the urge of defecation

Types of Piles :

As per the site :

• External – when thrombosed , cause severe pain
• Internal – may have painless bleeding
• Interno-external

According to length :

• First degree piles : No mass protruding from the anus(Only bleeding)
• Second degree piles : Piles mass protrudes out from the anus but returns spontaneously after passing stood
• Third degree piles: Piles mass protrudes out from the anus but some force (with finger) require to push back
• Fourth degree piles : Piles mass remains protruded out of anus permanent

Prevention of haemorrhoids :

• Eat high fiber food
• Drink adequate of liquids
• Exercise daily
• Don’t strain during defecation (Passing stool)
• Do not sit or stand at same place for more time
• Don’t lift heavy weights continuously
• Keep anal part clean

Ayurvedic treatments for Piles :

Ksharkarma :

It is non surgical procedure. A medicine derived from various herbs ( called ‘KSHAR’ ) is applied on pile mass. Kshar reduceses & shrinks piles. It is a type of chemical cauterization. Patient need to take rest at home for a period of 7 to 14days