Abstract

APPLICATION OF ARAGWADHADI SUTRA IN THE MANAGEMENT OF BHAGANDARA (FISTULA-IN-ANO): A CLINICAL CASE STUDY

Dr. Satish Pal*, Prof. Dr. Chhayakanta Dash, Dr. Manisha

Abstract

Background: Bhagandara, closely mirroring fistula-in-ano in contemporary surgical science, is classified as one of the Ashta Mahagada (eight deeply deep-seated grave diseases) in Ayurvedic classical literature due to its chronic nature, painful presentation, and high recurrence rate.[3] Standard surgical options like fistulotomy or fistulectomy carry inherent risks of accidental anal sphincter injury, leading to incontinence and prolonged wound healing.[8] Conventional Ksharasutra (medicated alkaline thread) is highly effective but often causes intense burning pain and local irritation due to its high pH. Objective: This case study evaluates the clinical efficacy, tolerability, and healing rate of a modified, less-irritant parasurgical thread—Aragwadhadi Sutra—in the management of Bhagandara. Methods: A 49-year-old male patient presented with chronic perianal pain, inflammatory swelling, and persistent purulent discharge for one month. Clinical examination and MRI fistulogram confirmed a trans-sphincteric low anal fistula measuring 6.3 cm with an external opening at the 4 o’clock position. The patient was treated with the application of Aragwadhadi Sutra (prepared via 11 coatings of Aragwadha pulp, Madhu, and Ghrita, layered with Haridra and Tagara powders) utilizing the traditional railroad technique under local anaesthesia. Weekly thread replacements and tracking of the Unit Cutting Time (UCT) were conducted. Results: The fistulous tract successfully healed completely within 6 weeks (45 days) without any surgical complications. The Unit Cutting Time was recorded at 7.14 days/cm. Symptoms such as pain, discharge, and perianal itching were significantly relieved within the first two weeks. A subsequent 3-month follow-up confirmed zero recurrence and excellent scar tissue formation with intact sphincter tone. Conclusion: Aragwadhadi Sutra serves as a safe, highly economical, and minimally invasive alternative to conventional Ksharasutra. It exhibits significant Vrana Shodhana (wound debridement) and Vrana Ropana (healing) properties while substantially lowering the pain index during treatment.

Keywords: Bhagandara, Fistula-in-ano, Aragwadhadi Sutra, Ksharasutra, Shalya Tantra, Case Study, Unit Cutting Time.