Ayurvedic Management of Arvachina Bhagandara: A Case Study

Abstract

Bhagandara, classified among the Ashta Mahagada in Ayurveda, analogous to fistula-in-ano in contemporary surgical practice. It is characterized by chronic purulent discharge, perineal pain, and a high recurrence rate. Ksharasutra, a medicated alkaline thread, exerts combined actions of cutting, curetting, wound healing, and infection control invasive Ayurvedic surgical intervention. A 46-year-old male presented with a 4-month history of perianal pain and burning sensation following defecation, and a 3-month history of persistent purulent anal discharge. Symptoms followed a febrile episode and subsequent incision and drainage of a submucosal abscess. Despite allopathic management, complete resolution was not achieved. On admission to the Pallekele Ayurveda Hospital, the patient was diagnosed with Bhagandara. Surgical management involved Chedana Karma was performed at the 6 o'clock position, followed by Ksharasutra application. The thread was changed periodically, with internal medications and external Panchawalkala Avagaha. Post-operative care included Sudarshana Choorna, Amrutha Guggulu, Triphala Guggulu, and Kaishora Guggulu. The patient demonstrated progressive reduction in purulent discharge, perineal pain, and burning sensation, with ongoing healing at the time of follow-up. This case highlights Ksharasutra therapy as an effective, minimally invasive, and recurrence-preventive approach for fistula in ano, though longer follow-up is required to confirm complete recovery.