Background Herbal seton (Kṣārasūtra) is a cost effective para-surgical technique employed in the management of anorectal conditions like fistula and hemorrhoids without causing much complications. Perennial non-availability raw materials, severe pain and allergic reactions are the major demerits of standard Kṣārasūtra demanding for its better options. Guggulu ( Commiphora wightii ) and Tankana (Borax) coated Kṣārasūtra ( GTK ) a modified variant of the standard is being used in the Anorectal Clinic under the Department of Shalyatantra (Surgery), Amrita School of Ayurveda since last 6 years. It has been observed for good patient tolerance, cutting and healing properties. Methods The physico-chemical evaluation of GTK was conducted in the Quality Control (QC) lab of Amrita School of Ayurveda. The parameters assessed were length, weight, thickness, tensile strength, loss on drying, water soluble extractive, sulphated ash, pH and macroscopic appearance following the methodology elaborated in Ayurvedic Pharmacopoeia of India (API). Those were compared with the corresponding values of standard Kṣārasūtra prescribed by Indian Council for Medical Research (ICMR). Results The final results on each parameters were length – 39.44 cm, weight – 0.19934 g, thickness – 0.7147 mm, tensile strength – not less than 6.25 kg, loss on drying – 18.73%, water soluble extractive – 39.79%, sulphated ash – 12.89%, pH – 7.94 and macroscopic appearance – blackish brown. Conclusion GTK was found less alkaline, higher in tensile strength, more in moisture content and less brittle in nature suggesting it as a safe choice in anorectal practice compared to the ICMR standard.
An internal opening (primary opening) in the anal canal or rectum and an exterior opening (secondary opening) in the perianal skin combine to form a stula-in-ano, an inammatory track. Unhealthy brous tissue and granulation tissue line this tract. Intersphicteric stulas are ones that cross the internal sphincter and then have a tract to the outside of the anus leading1. The prevalence of an anal abscess-induced stula-in-ano ranged from 26% to 38%.In men,the prevalence is 12.3 cases per 100,000 population and in women, it is 5.6 cases per 100,000 population2. Fistula-in-ano is a complicated disease, its signs and symptoms which resembles bhagandara disease described in āyurvedā. ācārya suśruta mentioned this disease under aa mahāgadās which means difcult to cure. For the management of this painful disease many treatment modalities are enumerated in āyurvedā classics and kāra sūtra therapy is one among them which is proved to be gold standard. Though kāra sūtra therapy is a big revolution in the eld of stula in ano, but it has some disadvantages like it is time consuming process, severe post-procedural pain, and big scar marks. In the present case report,A 24yr old male p/t c/o pain and swelling in perianal region since three months and successfully managed with IFTAK (Interception of Fistulous tract and application of Ksharsutra) technique. which showed a greatpotential in management by minimizing the duration of treatment, mild post procedural pain and minimum scar mark.
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