The twenty eighth chapter of Uttara Sthanam of Ashtanga Hridayam is known as as Bhagandara Pratishedha. This chapter offers with the reason of ‘Treatment of ano-rectal fistula’.
The subjects coated on this chapter embrace –
- Nidana, Nirukti – causes and definition
- Sorts
- Pitika Lakshana – options of the eruptions
- Vataja Pitika – Shataponaka
- Ustragriva and Parisravai
- Parikshepi
- Ruju
- Arsho Bhagandara
- Shambukavarta
- Unmargi or Kshataja
- Prognosis of various sorts of Bhagandara
- Cikitsa – remedy
- Therapy of ripening ulcer
- Therapy of fistula opening to the outside
- Therapy of Shataponaka
- Therapy of Parikshepi
- Therapy of Arshobhagandara
- Therapy in presence of a number of sinuses
- Kinds of incision
- Therapy of orifices exuding fluids
- Koshta Shodhana – purification
- Lepa
- Jyotishmatyadi Taila
- Madhukadi Taila
- Vidangasaradi Churna
- Amritadi Guggulu
- Magadhikadi Churna
- Guggulu pancha palam
- Uttamadi Churna Yoga
- Vrana Cikitsa in Bhagandara
- Avoidable issues in Bhagandara
Pledge by the writer(s)
अथातो भङ्गदरप्रतिषेधं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having supplied prayers to the God, henceforth we’re going to clarify the chapter pertaining to the reason of ‘Treatment of rectal fistula’. Thus, say (pledge) Atreya and different sages.
Nidana, Nirukti: Causes and definition
हस्त्यश्वपृष्ठगमनकठिनोत्कटकासनैः ।
अर्शोनिदानाभिहितैरपरैश्च निषेवितैः ॥ १ ॥
अनिष्टादृष्टपाकेन सद्यो वा साधुगर्हणैः ।
प्रायेण पिटिकापूर्वो योऽङ्गुले द्व्यङ्गुलेऽपि वा ॥२॥
पायोर्व्रणोऽन्तर्बाह्यो वा दुष्टासृङ्मांसगो भवेत् ।
बस्तिमूत्राशयाभ्यासगतत्वात्स्यन्दनात्मकः ॥ ३ ॥
भगन्दरः स सर्वांश्च दारयत्यक्रियावतः ।
भगबस्तिगुदांस्तेषु दीर्यमाणेषु भूरिभिः ॥ ४ ॥
वातमूत्रशकृच्छुक्रं खैः सूक्ष्मैर्वमति क्रमात् ।
Using on elephant, horse and so forth. for lengthy durations, sitting on arduous seats, one’s personal heels (and such different troublesome postures) and indulging in unsuitable actions enumerated because the causes of Arshas (piles / haemorrhoids), maturing of sinful acts of earlier lives or present life, of abusing ascetics; by these causes the blood and muscle tissue within the rectum turn into vitiated, give rise to the formation of a vrana (ulcer), most likely preceded by a pitaka (eruption); one angula or two angula (deep), opening both to the inside or to the outside; due to proximity to the urinary bladder, it’s exudative (discharges urine, fecal matter and so forth.), this illness is named Bhagandara. As a result of it causes tearing of all components (talked about beneath), in an individual who doesn’t comply with correct weight-reduction plan (or has achieved sins) because of extreme tearing within the pelvis, urinary bladder, rectum and so forth. there’s gradual elimination of air, urine, faecal matter and semen although its small orifices.
Sorts
दोषैः पृथग्युतैः सर्वैरागन्तुः सोऽष्टमः स्मृतः ॥ ५ ॥
It’s of eight sorts, from every dosha individually, of their mixtures of two and all of the three and from agantu (exterior agent) the eighth.
Pitika Lakshana: Options of the eruptions
अपक्वं पिटिकां आहुः पाकप्राप्तं भगन्दरम् ।
गूढमूलां ससंरम्भां रुगाढ्यां रूढकोपिनीम् ॥ ६ ॥
भगन्दरकरीं विद्यात्पिटिकां न त्वतोऽन्यथा ।
The unripe stage is named as Pitika (Bhagandara Pitika) and the ripe stage as Bhagandara; the Pitika (eruptions) which is deep seated, having nice swelling, extreme ache and elevated (recurring) even after therapeutic, must be recognised as inflicting Bhagandara (rectal fistula) whereas with out this function as a tough illness.
तत्र श्यावारुणा तोदभेदस्फुरणरुक्करी ॥ ७ ॥
पिटिका मारुतात्पित्तादुष्ट्रग्रीवावदुच्छ्रिता ।
रागिणी तनुरूष्माढ्या ज्वरधूमायनान्विता ॥ ८ ॥
स्थिरा स्निग्धा महामूला पाण्डुः कण्डूमती कफात् ।
श्यावा ताम्रा सदाहोषा घोररुग्वातपित्तजा ॥ ९ ॥
पाण्डुरा किञ्चिदाश्यावा कृच्छ्रपाका कफानिलात् ।
पादाङ्गुष्ठसमा सर्वैर्दोषैर्नानाविधव्यथा ॥ १० ॥
शूलारोचकतृड्दाहज्वरच्छर्दिरुपद्रुता ।
व्रणतां यान्ति ताः पक्वाः प्रमादात्
The Pitika (Bhagandra Pitika) brought on by Vata, is blackish purple, with pricking, puncturing and throbbing sorts of ache; that brought on by Pitta is raised up just like the neck of the camel, purple, skinny (small) with nice heat accompanied with fever and feeling of scorching fumes popping out; that brought on by Kapha is static, unctuous, deep rooted, pale yellow and has itching; that brought on by Vata and Pitta is black, coppery with burning sensation, has nice heat and extreme ache; these brought on by Kapha and Vata is pale, barely bluish and ripens with issue; that brought on by all of the doshas collectively resembles the massive toe, has totally different sorts of ache, with secondary ailments resembling ache within the stomach, lack of style, thirst, burning sensation, fever and vomiting. These (Pitika/ eruption) if uncared for, get suppurated and result in the formation of Vrana (ulcer).
Vataja Pitika: Shataponaka
त्तत्र वातजा ॥ ११ ॥
चीयतेऽणुमुखैश्छिद्रैः शतपोनकवत्क्रमात् ।
अच्छं स्रवद्भिरास्रावमजस्रं फेनसंयुतम् ॥ १२ ॥
शतपोनकसञ्ज्ञोऽयम्
The Vrana (Bhagandara-rectal fistula) brought on by Vata, slowly develops with small a number of orifices resembling a Shataponaka (sieve); exudes clear, skinny, frothy fluid continually. This is called Shataponaka.
Ustragriva and Parisravai
उष्ट्रग्रीवस्तु पित्तजः ।
बहुपिच्छापरिस्रावी परिस्रावी कफोद्भवः ॥ १३ ॥
Ustragriva is brought on by Pitta, Parisravi is by Kapha and exudes massive quantities of slimy fluid.
Parikshepi
वातपित्तात्परिक्षेपी परिक्षिप्य गुदं गतिः ।
जायते परितस्तत्र प्राकारं परिखेव च ॥ १४ ॥
Parikshepi is of Vata-Pitta origin, types a round fistula across the anus just like the moat (pit) across the fort.
Ruju
ऋजुर्वातकफादृज्व्या गुदो गत्यात्र दीर्यते ।
Ruju is of Vata-Kapha origin, types a straight fistula, inflicting a tear within the rectum.
Arsho Bhagandara
कफपित्ते तु पूर्वोत्थं दुर्नामाश्रित्य कुप्यतः ॥ १५ ॥
अर्शोमूले ततः शोफः कण्डूदाहादिमान् भवेत् ।
स शीघ्रं पक्वभिन्नोऽस्य क्लेदयन् मूलमर्शसः ॥१६॥
स्रवत्यजस्रं गतिभिरयमर्शोभगन्दरः ।
Kapha and Pitta invading the beforehand present hemorrhoids and getting vitiated, give rise to swelling, itching and burning sensation on the roots of the pile plenty, very quickly ripens, types a fistula by softening, the roots of the pile mass begins to get rid of continually by means of its sinuses. This situation is Arshobhagandara.
Shambukavarta
सर्वजः शम्बुकावर्तः शम्बूकावर्तसन्निभः ॥ १७ ॥
गतयो दारयन्त्यस्मिन् रुग्वेगैर्दारुणैर्गुदम् ।
Shambukavarta is brought on by all of the doshas and resembles the shell of a snail in its sinuses, inflicting extreme ache and laceration of the rectum by its a number of sinuses.
Unmargi or Kshataja
अस्थिलेशोऽभ्यवहृतो मांसगृद्ध्या यदा गुदम् ॥ १८ ॥
क्षिणोति तिर्यङ्निर्गच्छन्नुन्मार्गं क्षततो गतिः ।
स्यात्ततः पूयदीर्णायां मांसकोथेन तत्र च ॥ १९ ॥
जायन्ते कृमयस्तस्य खादन्तः परितो गुदम् ।
विदारयन्ति न चिरादुन्मार्गी क्षतजश्च सः ॥ २० ॥
In an individual who eats meat with nice relish, small items of bone swallowed together with it, whereas passing out of the rectum in an obliquely irregular course, causes tear and this harm offers rise to sinuses in its passage. Later there’s discharge of pus and decaying of muscle tissue within the passage of the rectum. This results in progress of worms (micro organism and so forth.) in it and so they eat away the rectum and trigger tears therein quickly, this is called Unmargi or Kshataja (Bhagandara).
Prognosis of various sorts of Bhagandara
तेषु रुग्दाहकण्ड्वादीन् विद्याद्व्रणनिषेधतः ।
षट् कृच्छ्रसाधनास्तेषां निचयक्षतजौ त्यजेत् ॥ २१ ॥
प्रवाहिणीं वलीं प्राप्तं सेवनीं वा समाश्रितम् ।
In these (every kind of Bhagandara), the character of ache, burning sensation, itching and so forth. must be learnt from Vrana Pratishedha (chapter 25). Out of those, six (there from particular person dosha and three from their mixture in twos) are tough to treatment, that brought on by all of the doshas and that by harm must be refused; so additionally, if the fistula is within the pravahini layer of the rectum or whether it is within the sevani (vesico-rectal raphae).
Chikitsa: Therapy
अथास्य पिटिकामेव तथा यत्नादुपाचरेत् ॥ २२ ॥
शुद्ध्यसृक्स्रुतिसेकाद्यैर्यथा पाकं न गच्छति ।
Through the Pitika (eruption) stage solely, efficient remedy must be achieved with effort by administering purificatory therapies, bloodletting, bathing the lesion with decoction and such others, in order that it doesn’t endure ripening (suppuration, ulceration).
Therapy of ripening ulcer
पाके पुनरुपस्निग्धं स्वेदितं चावगाहतः ॥ २३ ॥
यन्त्रयित्वाऽर्शसमिव पश्येत्सम्यग्भगन्दरम् ।
अर्वाचीनं पराचीनमन्तर्मुखबहिर्मुखम् ॥ २४ ॥
If the pitaka ripens, the ulcer must be barely anointed with oil and fomentation given by immersing the half (buttocks) in medicated heat water, the doctor ought to then examine the rectum through the use of the rectal speculum identical to visualizing the piles, correctly and be aware whether or not the fistula is nearer or farther, opening inside or opening outdoors.
Therapy of fistula opening to the outside
अथान्तर्मुखमेषित्वा सम्यक् शस्त्रेण पाटयेत् ।
बहिर्मुखं च निःशेषं ततः क्षारेण साधयेत् ॥ २५ ॥
अग्निना वा भिषक् साधु क्षारेणैवोष्ट्रकन्धरम् ।
That fistula which opens to the inside must be explored by the probe after which lower with the knife correctly; that which opens to the outside also needs to be probed, lower with out leaving any remnant after which handled both with kshara (caustic alkali) or agni (fireplace); Ustragriva Bhagandara must be handled with utility of kshara (alkali) solely by the doctor.
Therapy of Shataponaka
नाडीरेकान्तराः कृत्वा पाटयेच्छतपोनकम् ॥ २६ ॥
तासु रूढासु शेषाश्च मृत्युर्दीर्णे गुदेऽन्यथा ।
Shataponka must be lower with the knife, one sinus after the opposite, after therapeutic of the sooner one, in any other case loss of life could happen if the rectum is vastly injured.
Therapy of Parikshepi
परिक्षेपिणि चाप्येवं नाड्युक्तैः क्षारसूत्रकैः ॥ २७ ॥
In Parikshepi additionally, the identical remedy defined for nadi, as well as, ksharasutra (thread soaked in alkaline juice could also be used).
Therapy of Arshobhagandara
अर्शोभगन्दरे पूर्वमर्शांसि प्रतिसाधयेत् ।
त्यक्त्वोपचर्यः क्षतजः शल्यं शल्यवतस्ततः ॥ २८ ॥
आहरेच्च तथा दद्यात्कृमिघ्नं लेपभोजनम् ।
पिण्डनाड्यादयः स्वेदाः सुस्निग्धा रुजि पूजिताः॥२९॥
In case of Arshobhagandara, Arshas (piles) must be handled first; after having refused remedy, if the wound incorporates overseas physique, that overseas physique must be eliminated, then utility of paste of herbs and meals which kill the worms must be adopted. Fomentation by pinda (scorching balls of herbs), nadi (tubes emitting steam) and so forth. after lubrication are useful when there’s ache.
Therapy in presence of a number of sinuses
सर्वत्र च बहुच्छिद्रे छेदान् आलोच्य योजयेत् ।
गोतीर्थसर्वतोभद्रदललाङ्गललाङ्गलान् ॥ ३० ॥
In case of a number of sinuses and openings, the suitable sort of incision must be chosen after cautious consideration of each facet, resembling Gotirtha, Sarvatobhadra, Dala, Ardhalangala and Langalaka.
Kinds of incision
पार्श्वं गतेन शस्त्रेण छेदो गोतीर्थको मतः ।
सर्वतः सर्वतोभद्रः पार्श्वच्छेदोऽर्धलाङ्गलः ॥ ३१ ॥
पार्श्वद्वये लाङ्गलकः
Gotirtha is incision made out of the perimeters through the use of the knife, Sarvatobhadra is that made out of all the perimeters, Ardhalangalaka is incision from one aspect and incision made out of each side is named Langalaka.
Therapy of orifices exuding fluids
समस्तांश्चाग्निना दहेत् ।
आस्रावमार्गान्निःशेषं नैवं विकुरुते पुनः ॥ ३२ ॥
All of the orifices exuding fluids must be lower open fully and burnt by fireplace (thermal cautery), solely then the wound doesn’t recur once more.
Koshta Shodhana: Purification
यतेत कोष्ठशुद्धौ च भिषक् तस्यान्तरान्तरा ।
The doctor also needs to attempt to purify the alimentary tract, repeatedly with time gaps.
Lepa
लेपो व्रणे बिडालास्थि त्रिफलारसकल्कितम् ॥ ३३ ॥
For utility to the wound, paste product of bones of a cat, macerated with the decoction of triphala is greatest suited.
Jyotishmatyadi Taila
ज्योतिष्मतीमलयुलाङ्गलिशेलुपाठाकुम्भाग्निसर्जकरवीरवचासुधार्कैः ।
अभ्यञ्जनाय विपचेत भगन्दराणां तैलं वदन्ति परमं हितमेतदेषाम् ॥ ३४ ॥
Medicated oil ready with jyotiṣmatī – Celastrus paniculatus, malayu – Psoralea corylifolia, lāṅgali – Gloriosa superba, śelu – Cordia dichotoma, pāṭhā – Cissampelos pareira, kumbha – Operculina turpethum, agni – Plumbago zeylanica, sarja – Veteria indica, karavīra – Nerium indicum, vacā – Acorus calamus, sudhā – Euphorbia neriifolia, arkaiḥ – Calotropis gigantea and used for anointing the rectal fistula is claimed to be extremely useful for it.
Madhukadi Taila
मधुकलोध्रकणात्रुटिरेणुकाद्विरजनीफलिनीपटुसारिवाः ।
कमलकेसरपद्मकधातकीमदनसर्जरसामयरोदिकाः ॥३५॥ सबीजपूरच्छदनैरेभिस्तैलं विपाचितम् ।
भगन्दरापचीकुष्ठमधुमेहव्रणापहम् ॥ ३६ ॥
Medicated oil must be cooked with madhuka – Glycyrrhiza glabra, lodhra – Symplocos racemosa, kaṇā – Piper longum, truṭi – Elettaria cardamomum, reṇukā – Vitex agnus-castus, dvirajanī – the 2 Rajani- Haridra – Curcuma longa and Daruharidra – Berberis aristata, phalinī – Callicarpa macrophylla, salt, sārivāḥ – Hemidesmus indicus, kamala kesara – Nelumbo nucifera, padmaka – Prunus cerasoides, dhātakī – Woodfordia fruticosa, bee wax, sarjarasa – resin of Vateria indica, āmaya – Saussurea lappa, rodikāḥ – Mimosa pudicaand bark of Citrus medica. This cures rectal fistula, goitre, ulcers of pores and skin illness and diabetes mellitus.
Vidangasaradi Churna
मधुतैलयुता विडङ्गसारत्रिफलामागधिकाकणाश्च लीढाः ।
कृमिकुष्ठभगन्दरप्रमेहक्षतनाडीव्रणरोपणा भवन्ति॥३७॥
iḍaṅgasāra – Powder of sara of Embelia ribes, triphalā – Triphala-
Haritaki – Terminalia chebula
Vibhitaki – Terminalia bellerica
Amalaki – Emblica officinalis,
māgadhikā – Piper longum, and kaṇāśca – Piper longum licked with honey and oil heals the ulcers brought on by worms, pores and skin illness, rectal fistula, diabetes, harm and sinus ulcers.
Amritadi Guggulu
अमृतात्रुटिवेल्लवत्सकं कलिपथ्यामलकानि गुग्गुलुः ।
क्रमवृद्धमिदं मधुद्रुतं पिटिकास्थौल्यभगन्दराञ्जयेत् ॥३८॥
amṛtā – Tinospora cordifolia, truṭi – Elettaria cardamomum, vella – Embelia ribes, vatsakaṃ – Holarrhena antidysentirica, kali – Terminalia bellirica, pathyā – Terminalia chebula, āmalakāni – Emblica officinalis, and gugguluḥ – Commiphora mukul, elevated by one half of their succeeding order (powdered properly), soaked in honey (and consumed) cures eruptions, weight problems and rectal fistula.
Magadhikadi Churna
मागधिकाग्निकलिङ्गविडङ्गैर्बिल्वघृतैः सवरापलषट्कैः ।
गुग्गुलुना सदृशेन समेतैः क्षौद्रयुतैः सकलामयनाशः ॥ ३९ ॥
māgadhikā – Piper longum, agni – Plumbago zeylanica, kaliṅga – Holarrhena antidysenterica, viḍaṅgai: – Embelia ribes, bilva – Aegle marmelosand ghee every one pala (48 grams) added with six pala (288 grams) of varā – Vara and equal amount (six pala – 288 grams) of guggulunā – Commiphora mukul, powdered and consumed together with honey cures all ailments.
Guggulu Panchapalam
गुग्गुलुपञ्चपलं पलिकांशा मागधिका त्रिफला च पृथक् स्यात् ।
त्वक्त्रुटिकर्षयुतं मधुलीढं कुष्ठभगन्दरगुल्मगतिघ्नम् ॥४०॥
5 pala (240 grams) of guggulu – Commiphora mukul, one pala (48 grams) every of māgadhikā – Piper longum and triphalā ca – triphala-
- Haritaki – Terminalia chebula
- Vibhitaki – Terminalia bellerica
- Amalaki – Emblica officinalis, individually one karsha (12 grams) every of tvak – Cinnamomum zeylanica and truṭi – Elettaria cardamomum powdered and licked with honey cures pores and skin illness, rectal fistula, belly tumorand sinus ulcers.
शृङ्गवेररजोयुक्तं तदेव च सुभावितम् ।
क्वाथेन दशमूलस्य विशेषाद्वातरोगजित् ॥ ४१ ॥
The identical herbs (Guggulu – Commiphora mukul and so forth. talked about above) added with powder of śṛṅgavera – Zingiber officinale and properly soaked within the decoction of daśamūlasya – Dashamula-
- Bilva – Aegle marmelos
- Agnimantha – Premna mucronata
- Shyonaka – Oroxylum indicum
- Patala – Stereospermum suaveolens
- Gambhari – Gmelina arborea
- Shalaparni – Desmodium gangeticum
- Prishniparni – Uraria picta
- Brihati – Solanum indicum
- Kantakari – Solanum xanthocarpum
- Gokshura – Tribulus terrestris cures ailments brought on by Vata particularly.
Uttamadi Churna Yoga
उत्तमाखदिरसारजं रजः शीलयन्नसनवारिभावितम् ।
हन्ति तुल्यमहिषाक्षमाक्षिकं कुष्ठमेहपिटिकाभगन्दरान् ॥ ४२ ॥
Powder of uttamā – Uttama (triphala)-
- Haritaki – Terminalia chebula
- Vibhitaki – Terminalia bellerica
- Amalaki – Emblica officinalis) and khadira sārajaṃ – sara of Acacia catechu repeatedly soaked asana vāri – within the decoction of Pterocarpus marsupium, consumed combined with addition of equal amount of mahiṣākṣa – (Guggulu) Commiphora mukul and honey cures pores and skin illness, diabetes, eruptions and fistula of the rectum.
Vrana Chikitsa in Bhagandara
भगन्दरेष्वेष विशेष उक्तः शेषाणि तु व्यञ्जनसाधनानि ।
व्रणाधिकारात्परिशीलनाच्च सम्यग्विदित्वौपयिकं विदध्यात् ॥ ४३ ॥
The process (therapies, recipes and so forth.) described right here particularly in Bhagandara; different strategies of remedy whichever wanted must be chosen by correctly going by means of the chapter on remedy of ulcers (chapter 25) and administered correctly and appropriately.
Avoidable issues in Bhagandara
अश्वपृष्ठगमनं चलरोधं मद्यमैथुनमजीर्णमसात्म्यम् ।
साहसानि विविधानि च रूढे वत्सरं परिहरेदधिकं वा ॥४४॥
Using on horse, suppression of urge of (Vata) flatus, faeces, urine and so forth., indulgence in wine, copulation, raw issues / indigestion, unaccustomed meals and totally different sorts of exertions must be averted for one 12 months or nonetheless extra after therapeutic (of the rectal fistula).
इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने भगन्दरप्रतिषेधो नामाष्टाविंशोऽध्याय: ॥ २८ ॥
Thus, ends the chapter- Bhagandara pratishedha- the twenty-eight in Uttarasthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
