Abstract

CLINICAL EVALUATION OF TOPICAL ASHWATHA (FICUS RELIGIOSA LINN.) OINTMENT IN THE MANAGEMENT OF PARIKARTIKA (ACUTE FISSURE-IN-ANO): A SINGLE CLINICAL CASE REPORT

Dr. Anuja Nana Pagar*, Dr. Ramesh Vanaji Ahire, Dr. Aparna Abhay Raut

Abstract

Background: Parikartika (Acute Fissure-in-Ano) is a distressing anorectal disorder characterized by severe cutting pain (Parikartanavat Vedana), intense burning sensation (Daha), fresh rectal bleeding (Rakta Srava), and persistent internal anal sphincter spasm. Modern conservative treatments such as topical nitrates often induce dose-limiting headaches, while surgical internal sphincterotomy carries a long-term risk of fecal or flatus incontinence. In classical Ayurvedic literature, Vrinda Madhava (Aagantu Vranadhikar 21/21) explicitly endorses dried bark preparations of Ashwatha (Ficus religiosa Linn.) for wound cleansing (Vranashodhaka) and wound healing (Vranaropaka). Case Presentation: A 54-year-old female patient presented to the Shalyatantra Outpatient Department with complaints of severe cutting pain and burning sensation during and after defecation, fresh blood streaks on stool, perianal itching, and constipation lasting for 15 to 20 days. Clinical examination in the left lateral position revealed a distinct, hyper-tender acute linear mucosal tear (Kshata/Vrana) in the anoderm at the 6 o'clock position accompanied by severe reflex sphincter spasm. Intervention: The patient was treated with local external application of Ashwatha Ointment (emulsion base containing Ashwatha Kwatha and Ashwatha Churna) applied over the fissure bed twice daily (BD) post-defecation for a duration of 15 consecutive days, along with dietary fiber modification. Outcome: Clinical evaluations at Day 0, Day 5, Day 10, and Day 15 demonstrated rapid, step-wise recovery. Defecatory pain (VAS score) dropped from 6 to 1, burning pain dropped from Grade 2 to 0 (complete resolution), bleeding ceased completely by Day 5, and sphincter spasm resolved from Grade 2 to Grade 0. Objective anal dilator tolerance expanded from Size 0 (non-tolerated) to Medium Size 4. Overall symptom relief was calculated at 84.62%, achieving complete clinical cure without any adverse drug reactions or systemic side effects. Conclusion: Topical application of Ashwatha Ointment provides a safe, non-invasive, highly effective, and continence-preserving Ayurvedic treatment for acute fissure-in-ano, breaking the neuro-ischemic pain-spasm cycle effectively.

Keywords: Parikartika, Acute Fissure-in-Ano, Ashwatha Ointment, Ficus religiosa Linn., Internal Anal Sphincter Spasm, Vrinda Madhava, Shalyatantra.