Ayurvedic Dissolution Therapy for Gallstones

‘Gall Bladder Stone’ is termed as ‘Cholelithiasis’ or ‘Gallstone Disease’. Gall Bladder is a pear or globular shaped organ present in the abdominal cavity particularly in the right hypochondriac region and on the inferior surface of the liver. It is about 8-12 cm long in size. It consists of four parts, i.e. fundus, neck, infundibulum and neck. Gall Bladder is connected to common bile duct (C.B.D.) through cystic duct. It is drained by cystic artery and cystic vein.



Causes of gallstones:

• Disturbance of metabolism
• Infection
• Bile stasis e.g. obesity, pregnancy
• Haemolytic anaemia
• Saint’s triad (Gallstones with diverticulosis of colon and hitus hernia)
• Parasitic infection
• Due to abnormal mucus e.g. congenital cystic fibrosis

The risk factors for gallstones are-

• Female
• Forties (>40 years of age)
• Fertile (Having multiple pregnancies)
• Fatty body (Obese)
• Fatty diet (Consuming high animal fat)
• Flatulence

Types of gallstones:

• Cholesterol stones:
  a) These are 10% common.
  b) Occurs in patients with increased cholesterol levels.
  c) Fatty women are commonly affected.
  d) It is single, solitary, occurs in aseptic bile. Sometimes they can be multiple.
  e) Such stones can be silent for many years. They are radiolucent (translucent).
• Mixed stones:
  a) They constitute about 80% of gallstones.
  b) It contains cholesterol, calcium salts of phosphate carbonate, palmitate, proteins and are multiple faceted.
• Pigment stones:
  a) They are found in around 5 to 10% of patients of gallstones.
  b) They are calcium bilirubinate stones.
  c)  Commonly occur in haemolysis. Hence they are black, multiple, small, irregular concretions or sludge particles.

Symptoms of gallstones:

• In the gall bladder: a) Silent stones b) Flatulent dyspepsia c) Gallstone colic d) Acute cholecystitis e) Chronic cholecystitis f) Mucocele g) Carcinoma of gallbladder
• In the  bile duct: a) Obstructive jaundice b) Cholangitis c) White bile d) Acute pancreatitis
• In  the intestine: a) Acute intestinal obstruction (gallstone ileus)

Investigations for gallstones:

• Total WBC Count
• LFT (Liver Function Test)
• Plain X-ray abdomen
• USG (Ultrasonography) for abdomen

Treatment of gallstones:
Ayurvedic Dissolution Therapy for Gallstones:
Indications (Patient fit for Ayurvedic dissolution therapy):

• Functioning gallbladder with cholesterol stone
• Single stone which is less than 1.5 cm
• Radiolucent (Translucent) stone
• Old age
• Patient who are not fit for surgery

Contra-indications (Patient who are not fit for Ayurvedic dissolution therapy):

• Non functioning gallbladder
• Stone more than 1.5 cm in size
• Radio opaque stone
• Multiple stones

Ayurvedic medicines which can dissolve or eradicate the gallstones with regular use are given below-

• Kwath (Home-made decoctions): These are more famous and more preferable Ayurvedic medicines for gallstone disease.
  Guduchyadi Kwath; Faltrikadi Kwath; Bhunimbaadi Kwath; Abhayaadi Kwath; Triphala Kwath; Varunaadi Kwath; Pathyaadi Kwath; OPD CHEK Decoction etc.
  Method for preparing the Home-made decoction-
  Take around two tablespoonfuls of  Herbal decoction and mix it well with around two cups of water (Around 150 ml water) in the evening hours. Keep the mixture for whole night. The very next morning, boil this mixture on light to medium flame. Shake it well during boiling. Gradually the water will start to get evaporating. When around half cup of water remains in the mixture during boiling, take it down. Strain the liquid into a glass or ceramic container using a sieve or a cloth such as a jelly bag or muslin cloth. Drink the freshly prepared liquid decoction after 4-5 minutes.
• Kadha (Ready-made decoctions in Syrup base):
  Bhunimbaadi Kadha; Faltrikaadi Kadha; Pathyaadi Kadha etc.
• Churna (Ayurvedic herbal powders):
  Katuki Churna; Trivrut Churna; Triphala Churna; Haritaki Churna etc.
• Vati(Tabletes and Capsules):
  Pathyaadi ghanvati; Samsamani Vati; Livotrit tablet; Liver-Kidney Care Capsule; Immunity Capsule (Organic India Pharma); Beliver Capsule (Pink health Pharma), Reliz Capsule (Siddham Ayurveda’s) etc.
• Syrup:
  Livotrit Syrup, Hepnar Syrup, Liv-52 Syrup etc.

Surgical treatment for gallstones:
Surgery must be the last sort of treatment for gallstones. ‘Laparoscopic cholecystectomy’ is ideal or ‘Open cholecystectomy’ is done through right subcostal Kocher’s incision.

Post Operative Care in Ayurveda

Post Operative Care in Ayurveda

Introduction of Post-operative Care:

Post-operative Care

Any surgery of a patient has been divided in three parts;

1) Pre-operative assessment
2) Main operative procedure/ Main surgical procedure
3) Post-operative care
After completion of the main operative procedure/surgery, initially patient is transferred in to the ward, where proper care should be taken by the hospital staff and his relatives.

Post-operative care mentioned in Ayurvedic Classics:

Usually patient is advised to take nothing by mouth prior and after 6-8 hours of the main operative procedure. After completion of the surgery, he is under effect of anaesthesia for some time, even he may loss some blood during operative procedure and certainly he may feel mental stress during the entire procedure, so ultimately he must be feeling weak from healthy one. Even his digestive power is being weak. He may be feeling of mild to moderate pain at the operative part. And sometimes due to the side effect of the anaesthesia, he may be complains of back pain, headache, continence of urine and abdominal discomfort.

For restores patient’s energy level and become free from all the infections and side effects, he must be care properly after the surgery. The authentic Ayurvedic classics i.e. Sushrut Samhita, have clearly given the rules for care of a patient after any operative procedure, which is known as ‘Vranitopasan’ (Post-operative Care). It is clearly mentioned in Ayurvedic classics that initial what type of accommodation required for the patient who has undergone Surgery, what type of food has to be given or not after surgery and the daily routine of a patient for restore complete health as soon as possible which is given below.

• He should be reside in such an auspicious house/ ward which is free from dirt, direct wind, direct sunlight, heavy breeze and insects such as flies, mosquitoes etc.
• He should be residing in such a place where he is being served with affectionate friends and caring nursing staff who talk pleasantly.
• The patient should sleep on a wide bed; convenient for easy movements of his body and head placed to the east (The head of the patient should be kept in that direction as a sign of worship).
• The patient should wear white dress which is symbol of purity.
• He should keep himself clean and pure.
• He should always remain devoid of undesirable nails and hairs.
• He should protect the operative part/wound during his activities such as raising, turning, walking, speaking loudly etc.
• He should avoid day sleep and sleep during late nights.
• The patient should not indulge in standing, sitting, walking for long time and over exercise initial after the surgery though he has strong body physique.
• He should keep away himself from sexual activities (copulation).
• He should avoid clashes such as jealousy, fear, anger, grief, worries etc.
• He should avoid excessive and untimely eating.
• Initially he should avoid to take freshly harvested grains, black gram, sesame, cow peas, things which  are sour, salty and pungent in taste, jiggery, eatables made from fine flour, dry meat, dry vegetables, meat and muscle fat of animals living in marshy places and water such as fish, beef, pork etc., cold water, milk pudding, milk, buttermilk etc. as these eatables are belongs to ‘Dosha Samjanana Varga’ (Group causing aggravation of Vata, Pitta and Kapha) and indulgence of these things will produce pus at the operative site.
•  The person who is habitual drunker should avoid alcohol which is sour in tast, dry, strong and having hot potency and quick acting such as wine, whisky, jinn, rum, vodka etc. as consumption of these things will damage the wound/operative site quickly.
• He should also avoid dislike foods.
• The patient should keep himself busy in worship the god and other spiritual activities so his mind and body will become full of positive energy.
• Bothe the priest and the physician should perform ‘Raksha Karma’ (Protective rites) daily during the union of the day and night (early morning and early evening) as stipulated in epic i.e. Rigveda, Saamveda, Yajurveda, Atharv-veda and other benedictory hymns.
• ‘Ayurvedic fumigation’ (Dhupan karma) should be done up to initial ten nights, twice a day after surgery using leaves of ‘Nimba’ (Azadirachta indica), Mustard seeds added with Ghee (Clarified butter) and Rock salt (Saindha Namak).
• Some special herbs i.e. Vacha (root of Acorus calamus), Ativisha (root of Aconitum heterophylum), Shatvirya (root of Asparagus racemosus), Brahmi (root of Centella asiatica), Jatamamsi (root of Nordostachys jatamansi) should keep under the cap wear on head by the patient. By resorting of the above activity initial after the surgery being performed, virus and bacteria is getting away from the patient just like other animals run away from the forest invaded by the lion.

Post operative diet plan:

• ‘Ashtaguna Mand’ – A thin gruel made by eight drugs i.e. Moong beens and Rice fried in  Sesame seed oil with the toppings of Dry ginger powder, Black pepper powder, Long pepper powder, Coriander seeds powder, Asafoetida and Rock salt. This gruel is very much powerful for increasing the digestive power of the patient and helps to produce new blood in the body. This gruel will help to come out from the side effects of the anaesthesia such as continence of urine flow, abdominal discomfort. This gruel restores the patient’s energy level quickly. So after surgery, patient should start his diet with this ‘Ashtaguna Mand’.
• Vegetables: Pointed gourd (Parwal), Bitter gourd (Karela), Momordica dioica (Kankoda), Bottle gourd (Dudhi/loki), Snake gourd (Galaka), Ridge gourd (Turiya), Brinjal (Bengan), Cucumber (Kakadi), Drumstick (Sargava), Spinach leaves (Paalakh), Prickly Amaranth (Tandalaja), Coriander leaves (Dhaniya)
• Non-veg: Meat of animals dwells in arid climate or deserts, Meat of goat, Meat of deer.
• Grains/Cereals: Rice flakes, Popcorn, Popped Jowar and Puffed Rice
• Beans: Moong beans, Moong Dal (to be fried in Cow’s Ghee(clarified butter made from cow’s milk)
• Edible Oils, Ghee (clarified butter), Milk & other Dairy Products: Sesame seed oil, Cow’s Ghee (clarified butter made from cow’s milk) and Tea.
• Fruits: Pomegranate (Daadim), Grapes, Gooseberry (Aavlaa) and Coconut water
• Dry Fruits: Figs and Dry black grapes
• Salt/Honey: Rock Salt (Saindhav/Sindhalun) and Honey
• Drinking Water: Warm water for whole day

Few scientific appratus and their use (Hindi)

कुछ प्रमुख वैज्ञानिक उपकरण (Scientific Apparatus)

स्टेथिस्कोप – हृदय के स्पन्दन को सुन कर रोग के लक्षण ज्ञात करने का उपकरण

एमीटर – विद्युत धारा नापने का यंत्र

कैलीपर्स – गोल वस्तुओ के भीतरी तथा बाहरी व्यास तथा मोटाई नापने का यंत्र

एनिमोमीटर – वायु की शाक्ति तथा गति नापने का यंत्र

कम्पास नीडिल – किसी स्थान की दिशा ज्ञात करने का उपकरण

लैक्टोमीटर – दूध की शुद्धता ज्ञात का उपकरण

ग्रेवोमीटर – पानी की सतह पर तेल की उपस्थिति ज्ञात करने का यंत्र

हाइग्रोमीटर – वायुमण्डल में व्याप्त आर्द्रता नापने का यंत्र

फेदोमीटर – समुद्र की गहराई नापने हेतु उपकरण

ग्रामोफोन – रिकार्ड पर अंकित ध्वनि तरंगों को पुन: उत्पादित करके सुनने हेतु यंत्र

पेरिस्कोप – किसी स्थान से किसी अन्य अप्रगट स्थान में देखने का यंत्र

पोटेन्शियोमीटर – किसी सेल के विद्युत वाहक बल तथा तार के दो सिरों के विभवान्तर नापने का यंत्र

ऑल्टीमीटन – ऊँचाई नापने का उपकरण

रेडियेटर – वाहनों के इंजिनों को ठण्डा करने वाला उपकरण

ओडियोफोन – कमजोर श्रवणशक्ति वाले लोगों के लिए सुनने का यंत्र

फोनोग्राफ – ध्वनि की तंरगो को पुन: ध्वनि में परिवर्तित करने का उपकरण

सिस्मोग्राफ – भूकंप की तीव्रता मापने का उपकरण

कार्डियोग्राम – हृदय गति की जाँच करने का यंत्र

माइक्रोस्कोप – सूक्ष्म वस्तुओं को आवर्धन करके देखने का यंत्र

टेलिस्कोप – दूर स्थित वस्तुओं को देखने का यंत्र

Tips to have a stress free life (Hindi)

कुछ बातें हैं जिन्हें अपनाकर आप तनावमुक्त जीवन जीने की कोशिस कर सकते है....|

1- बेहतर हैं कि चुप रहकर लोगों को सोचने दो कि तुम मूर्ख हो, बनिस्बत के कि मुँह खोल कर लोगों को जान लेने दो कि तुम वास्तव में मूर्ख हो।

2- यदि किसी व्यक्ति के चरित्र को परखना चाहते हो तो उसे अधिकार दे दो।

3- सफलता प्राप्ति के मामले में आपकी अपनी राय दूसरों की राय की अपेक्षा अधिक महत्वपूर्ण होती है।

4- आप सभी लोगों को कुछ समय के लिए बेवकूफ बना सकते हैं या कुछ लोगों को हमेशा के लिए बेवकूफ बना सकते हैं, किन्तु आप सभी लोगों को हमेशा के लिए बेवकूफ नहीं बना सकते।

5- यह बात मायने नहीं रखती कि आपने जीवन को कितने साल जिया है, मायने तो यह बात रखती है कि उन वर्षों में आपने कैसा जीवन जिया है।

6- चरित्र एक वृक्ष के समान है और प्रतिष्ठा उसकी छाया के समान, छाया कभी रहती तो कभी नहीं रहती किन्तु वृक्ष सदैव रहता है।

7- मैं इस बात से सरोकार नहीं रखता कि भगवान हमारे साथ हैं या नहीं, मैं तो इस बात से सरोकार रखता हूँ कि हम भगवान के साथ हैं या नहीं, क्योंकि भगवान हमेशा सही होते हैं, हम नहीं।

8- किसी पेड़ को आरी से चीरने के लिए आप मुझे छः घण्टे का समय दें, और मैं पहले चार घण्टे आरी धार तेज करने में लगाउँगा।

9- दृढ़तापूर्वक खड़े होने के पहले सुनिश्चित कर लीजिए कि आपके कदम सही स्थान पर हैं।

Piles/hemorrhoids; Home remedies and Ayurvedic treatment

Piles
Piles, also known as ‘Haemorrhoids’, are small, bluish swellings, comprising of enlarged blood vessels situated either just inside or just outside the anus commonly called internal piles and external piles. In case of bleeding, they are termed as bleeding piles.
Causes

• Persistent constipation due to poor dietary habits.

• Sitting on hard seats for prolonged periods.

• Lack of exercise.

Because of all these factors, straining is needed to pass the small hard stools, which causes
congestion in the network of blood vessels located inside the anal cushions. Gradually, these vessels enlarge and form piles. If the constipation further continues, they become large enough to be called second or third degree piles.
Signs & Symptoms
Internal piles: These are found inside the anal canal and lined by mucous membrane. Depending on the chronicity of the disease and prolapse these can be;
First-degree Piles:
Many people have these without even being aware of them. These are located just inside the anus, ocassionally causing some discomfort when a motion is passed. Rarely, slight bleeding may also occur during evacuation.
Second-degree Piles:
They usually appear as pea-sized swellings outside the anus after a bowel motion has been passed. They are usually retained inside the anus and may bleed and cause
discomfort during passing stool with some degree of itching.
Third-degree Piles:
The swollen blood vessels are so enlarged that they remain outside the anus permanently. These are known as external piles, and are more troublesome. Soreness and persistent irritation are the common features.

External haemorrhoid (sometimes called a perianal haematoma)

This is less common than internal haemorrhoids. An external haemorrhoid is a small lump that develops on the outside edge of the anus. Many do not cause symptoms. However, if a blood clot forms in the haemorrhoid (a thrombosed external haemorrhoid) it can suddenly become very painful and need urgent treatment. The pain due to a thrombosed external haemorrhoid usually peaks after 48-72 hours, and then gradually goes away over 7-10 days. A thrombosed external haemorrhoid may bleed a little for a few days. It then gradually shrinks to become a small skin-tag.
Some people develop internal and external haemorrhoids at the same time.

Home remedies:
1. The poultice made of sesame (til) seeds can be applied over bleeding piles as an
external measure, and internally also ½ teaspoonful of sesame seeds can be taken
orally with some butter.
2. A mixture can be made of: Ripe bael fruit pulp = loz, Sugar = 180gms, Powder of black peppers = 7 in number, Cardamom powder = 7gms. This can be taken twice a day as a good remedy.
3. Radish (Muli) is a useful home remedy for piles.
* The hot poultice of dry radish (Muli) is a good application in non-bleeding
piles.
* The juice is also useful in piles. 60 to 100 ml of radish juice well mixed with little
bit of salt, should be taken twice a day, daily for 40 days.
4. Butter Milk: It is the home remedy of choice in piles. l00ml well mixed with a little bit of black pepper powder, and salt should be taken daily for a few months at least. Ayurveda stresses upon daily intake of butter milk by the piles patients.
5. Hareetaki, popularly known as harad is a good remedy for constipation. The decoction of the fruit peel of harad (Terminal a Chebula) is taken 1 cupful with jaggery at bed-time.
6. Rose petals, 11 in number crushed with 50 ml of water should be taken for 3 days on empty stomach. This is a very good remedy for bleeding piles. Banana fruit should not be taken for 1year along with this treatment.
7. The decoction of sonth (dried ginger) is very useful inpiles. It should be taken in
the quantity of 30 to 50ml daily.
Ayurvedic medicines:
1. Triphalachurna: This should be taken regularly to remove the constipation. 2 tsf of
powder well mixed in a glass of lukewarm water should be taken orally before retiring to bed. Externally also it is widely used in different methods. One popular method is to take a plastic tub, fill it with warm water to a level where one can sit comfortably. Add 10 teaspoonfuls of Triphalachurna to the water and mix well for some time.Then the patient should sit in the tub, duly immersing the anus in the lukewarm water for 30 minutes. This should be carried out daily. This practice brings in enormous benefits to the piles patient.
2. Abhayarista: As an oral liquid preparation, it is also useful in constipation. 30 ml of the
medicine dissolved in equal quantity of lukewarm water should be taken before going
to bed.
3. Arsha Harivati is a common herbo-mineral compound prescribed by Ayurveda. 2
pills twice a day with some butter milk or warm water should be taken for 40 days.
This gives great relief from piles.
4. Arshonyt tablet/ointment (Charak) 1-2 tablets thrice daily along with application of ointment before and after defecation.
5. Many Ayurvedic ointments are quite useful. Dosages are as above.
6. Arshoghnivati tablet 1 to 2 tablets with water or butter milk can be taken thrice or four times daily.
7. Kankayan Vati  is quite beneficial in piles.
8. Pileen, Arshon and Rasanjan Vati tablets (Bhaat Ayurvedic Pharmacy) can be taken in the dose of 1 to 2 tablets daily for 2 to 3 months.
9. Kasisadi Tailam when applied externally is also helpful.
Ayurvedic surgical treatments:
When internal piles bleed profusely and is in 2nd or 3rd or 4th degree, medicines do not have much benefit. In such case the piles masses have to be removed surgically. In Ayurveda Kshara sutra ligation and Agnikarma excision are the procedures which can be used to remove the piles masses (Internal as well as external) thus leading to a permanent cure of the problem. One should not hesitate or have any kind of fear of surgical procedures and should consult a qualified expert Ayurveda doctor  to get rid of the problem. Delay may sometimes lead to serious complications like severe anemia due to continual bleeding and shock and so on.
External piles if get thrombosed need immediate surgical intervention because of severe pain. Kshara sutra ligation and Agnikarma are equally beneficial in curing external piles permanently.

NOTE: Ayurvedic medicines and treatments including surgical procedures like kshara sutra and agnikarma etc. should be taken under Qualified Ayurvedic Doctor/Physician/Surgeon. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and  Proctologist

SHRI DHANWANTARI CLINIC, GHAZIABAD

Keep your eyes Healthy in rains

आंखें हमारे शरीर का सबसे नाजुक और संवेदनशील अंग है। इसलिए इनकी देखभाल में सबसे ज्यादा सावधानी बरतनी चाहिए, और बरसात के मौसम में तो आंखों को खास देखभाल की जरूरत होती ही है। मानसून के आते ही आंखों में कई तरह की परेशानियों का खतरा बढ़ जाता है। कंजक्टिवाइटिस, स्टाई और खुश्क आंखों जैसी समस्याएं इस मौसम में ही अधिक होती हैं। बरसात के दौरान आंखें वायरल संक्रमण का शिकार बन सकती हैं।

मानसून में आंखों की विशेष देखभाल के लिए कुछ आसान से टिप्स अपनाएं और अपनी आंखों को स्वस्थ्य रखें-

• आंखें साफ रखें, आंखों को हमेशा साफ और ठंडे पानी से धोएं। दिन में दो-तीन बार आंखों को जरूर धोएं।

• मानसून में हरी सब्जी, सीजन का फल एवं दूध का सेवन जरूर करें।

• अगर इस मौसम में कोई संक्रमित हो जाए तो अपनी आंखों को अच्छे से धोए, और उन्हें ठंडक प्रदान करें। चिकित्सक को जरूर दिखाएं। किसी दूसरे व्यक्ति का रूमाल या तोलिया इस्तेमाल ना करें, बल्कि अपने ही तौलिए एवं रूमाल का ही इस्तमाल करें।

• बार-बार अपनी आंखों को हाथ से न छुएं।

• आंख में कुछ गिर जाने पर उसे मले नहीं, बल्कि उसे साफ पानी से धुले। आराम न मिले तो तुरंत चिकित्सक की सलाह लें।

• अपने आई-मेकअप का सामान किसी के साथ शेयर न करें।

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Abscess in Ano-rectal region: An Ayurvedic view

Anorectal abscess

Anal abscess; Rectal abscess; Perirectal abscess; Perianal abscess; anal gland abscess; Abscess - anorectal

An anorectal abscess is a collection of pus in the area of the anus and rectum.

Causes, incidence, and risk factors

Common causes of anorectal abscess include:

• Blocked glands in the anal area
• Infection of an anal fissure
• Sexually transmitted infection

Deep rectal abscesses may be caused by intestinal disorders such as Crohn's disease or diverticulitis.
The following factors increase your risk for an anorectal abscess:

• Anal sex
• Chemotherapy drugs used to treat cancer
• Diabetes
• Inflammatory bowel disease (Crohn's disease and ulcerative colitis)
• Use of medications such as prednisone
• Weakened immune system (such as from HIV/AIDS)

The condition may occur in infants and toddlers who are still in diapers and who have a history of anal fissures.

Symptoms

Swelling around the anus and a constant, throbbing pain are the most common symptoms. Pain with bowel movements may be severe.
Other symptoms may include:

• Constipation
• Discharge of pus from the rectum
• Fatigue and general malaise
• Fever, night sweats, and chills
• Lump or nodule, swelling, redness, tenderness at edge of anus
• Painful, hardened tissue

In infants, the abscess often appears as a swollen, red, tender lump at the edge of the anus. The infant may be fussy and irritable from discomfort, but there are usually no other symptoms.

Signs and tests

A rectal examination may confirm that you have an anorectal abscess. A proctosigmoidoscopy may be done to rule out other diseases.
Rarely, you may need a CT scan, MRI, or ultrasound to determine where the pus collection is located.

Treatment

The problem rarely goes away on its own. Antibiotics alone usually cannot treat the problem.
Treatment involves surgery to open and drain the abscess.

• Surgery is done using local numbing medicine, along with medicine to make you sleepy or spinal anesthesia.
• Surgery is most often an outpatient procedure. The surgeon will cut open the abscess and drain the pus. You will go home the same day.
• If the pus collection is deep, you may need to stay in the hospital until the abscess has completely drained.
• After surgery, you will need warm sitz baths (sitting in a tub of warm water). This may help relieve pain, reduce swelling, and make the abscess easier to drain.

Drained abscesses are usually left open and there are no stitches.
Your doctor may prescribe pain medication and antibiotics.
You may need stool softeners. Practice good hygiene and eat a soft or liquid diet until the abscess has healed.

Expectations (prognosis)

With prompt treatment, people with this condition usually do well. Infants and toddlers usually recover very quickly.
Complications tend to occur when treatment is delayed.

Complications

• Anal fistula
• Body-wide infection (sepsis)
• Continuing pain
• Problem keeps coming back (recurrence)
• Scars

Calling your health care provider

Call your health care provider if:

• You notice a rectal discharge, pain, or other symptoms of anorectal abscess
• You have fever, chills, or other new symptoms after being treated for this condition

Prevention

Prevention or prompt treatment of sexually transmitted diseases may prevent this cause of anorectal abscesses. Use condoms during intercourse, including anal sex, to prevent such infections.
Frequent diaper changes and proper cleaning during diaper changes will help prevent both anal fissures and perianal abscesses in infants and toddlers.
Ayurvedic Treatment:
Acharya Sushrut has described in detailed procedure to drain and incise an abscess. He also mentioned many drugs for local application to dress the abscess. Panchavalkal kwath, Trifala kwath, Nimba patra kwath etc. are a few preparation which are used to wash the abscess wound. These readily help in healing abscess.
If an anorectal abscess has been turned into a Fistula, Kshara sutra therapy is the treatment of choice in Ayurveda.

Preparation of Ksharsutra and the Drugs Required

Preparation of Ksharsutra
Preparation of Kshar-Sutra is no doubt, a lengthy and difficult task and the collection and preparation of required drugs is still more cumbersome.
A number of different drugs are used in various combinations for the preparation of the Kshar-Sutra. The ksheer (latex) generally used are of Snuhi, Ark, Arendakarkataki, Udumbar etc. The Ksharas used are Apamarg Kshar, Ark Kshar, Kadali Kshar etc. We have here used the following drugs.
Drugs Required
•    Snuhi Ksheer

Snuhi Ksheer (Milk of stem of Euphorbia nerllifolia)

•    Apamarg Kshar

Apamarg kshara (Extract of Acyranthus aspera)

•    Haridra powder
•    Thread,-Linen Barbour No.-20.

Surgical linen Barbour brand size 20

Aluminium or steel frames are drilled with small hooks for holding threads in place at an interval of about 1 1/2". The size of the frame may vary to suit specific needs.
Any cotton / linen thread of good strength can be used for Kshar-Sutra. In our practice, we generally use Barbour Linen No. 30 and 20. No. 30 is finer compared to No. 20. The tensile strength of No. 20 is reduced to the least extent in comparison to other threads after the complete procedure and hence it is this thread which is usually preferred in the manufacture of Kshar-sutras. The thread is tightly wound around opposite hooks to form rows.
The thread is given 21 coatings out of which the first 10 coating are given only the fresh Snuhi Ksheer. The next 7 with Snuhi Ksheer and Apamarg Kshar and the last 4 with Snuhi Ksheer and Haridra.
A piece of gauze is taken and folded into a small square. It is then dipped in the fresh Snuhi Ksheer (latex of Euphorbia neriifolia) and the thread is coated (i.e. a Bhavna is given) with the ksheer from down upwards. When all the threads are coated in this manner, the frame is kept to dry in a specially made chamber. The second coating (Bhavna) is given only when the first one dries. The thread is coated 10 times in this way; one after the other after the previous coating of the ksheer dries completely. The frames are placed in a special chamber for drying. The temperature inside the chamber may be increased by passing hot dry air with the help of a fan. The air inside the chamber should be kept circulating to facilitate quicker drying of the threads. The process of drying is best performed when the level of Humidity is lower.

Coating of thread with Snuhi ksheer and kshara

After completing the first 10 coatings of Snuhi ksheer, we now proceed to coat the thread with both Snuhi ksheer and Apamarg Kshar. The thread is coated with fresh Snuhi ksheer in the way described above. Apamarg Kshar is coated on it immediately (i. e. when the thread is still wet) so that it sticks to the thread properly. Different practitioners have developed different ways in which to do this. With experience we have found that the best way to do it is to coat only 3 or 4 threads at a time with Snuhi ksheer and then pass them through a pile of Apamarg Kshar on a flat plate. This is done by sliding the frame over the pile of Kshar in such a way that the threads pass through the pile of Kshar and the Kshar sticks on the wet thread. When all threads of a frame are coated in this way, the frame is again kept for drying in the chamber. The thread is coated in this way 7 times. The thread is coated only when the previous coat is completely dry. Hence 10+7= 17 coats are completed.
The last four coats are to be given with Snuhi ksheer and Haridra. This is done in the same way as the previous 7 coats substituting Haridra powder in place of Apamarg Kshar. While applying every coat, care should be taken that the drug spreads evenly on all the sides of the thread and does not aggregate at one spot to make a knot like appearance. The thread should be smooth and even, having the same thickness through out the length. Care should be taken to carry out the procedure in a dry atmosphere. A specially prepared chamber is used for drying the threads so that it can be dried in a dust free atmosphere. In the absence of a chamber the threads may be dried in the open under direct sun rays in a dry and dust free atmosphere. After we finish coating the threads 21 times and they are totally dry the threads are cut to size and then packed in capillary like glass test tubes. These tubes are cut to size, cleaned, dried, and sterilized. One or two threads are packed in each tube. The tube is packed/ sealed over a burner so that the Kshar-Sutra in it remains dry and sterile. These tubes are sent for Gama radiation after being packed & sealed. The tube is broken and the Kshar-Sutra removed for use when required.
Before going into the details of the collection and preparation the drugs required, I would like to mention here that though the most widely used Kshar-Sutra are prepared from Snuhi ksheer and Apamarg Kshar and Haridra, we can make a variety of different Kshar-sutra from a combination of ksheer from different ksheeri vrikshas i.e. latex of different trees like Udumber ksheer, Arka ksheer, Aerandkarkati ksheer and Ksharas like Ark Kshar, Kadli Kshar, Nimb Kshar etc.
Collection and preparation of the drugs required in the preparation of Kshar sutra
Collection of Snuhi Ksheer (Latex of Euphorbia neriifolia)

The ksheer from Snuhi is collected best, early in the morning, before sunrise. If collection of ksheer is tried after sunrise, we can get just a few drops of ksheer from a Snuhi branch. With the help of a scalpel, we slit the Snuhi branch vertically from down upwards (5mm deep) keeping a collection jar under the slit. As soon as the cut is made, a milky substance (ksheer) starts dripping down. This ksheer is collected in the jar. The amount to be collected depends upon the threads to be coated. After collection the ksheer, jar is to be packed so that no air enters it because ksheer if kept in contact with air, starts to coagulate and turns into a chewing-gum like sticky semisolid substance. Before coating the threads, the ksheer is to be strained from a wire strainer or with the help of a double folded gauze piece. The ksheer is now ready for use. Snuhiksheer should be always used fresh.
Method of preparing Apamarg Kshar (Water soluble extract of the ash of Achyranthus aspera)

Acyranthus aspera (Apamarga) plant

Burning of Apamarga whole plant into ashes

Well grown shrubs are collected in the month of November. These shrubs are dried. When dry, they are burned down to ash in a clean open space or in a big container. The ashes of the Panchang (whole plant) of the shrubs are collected on cooling. The ash itself can be preserved in airtight containers and may be used to prepare the Kshar at convenience.

Ash dissolved in water and water filtered

The ash is stirred in pure soft water 4 times the ash (Rastarangini). Here the ratio of ash to water is in reference to its volume and not weight. The water soluble constituents of the ash are dissolved in the water. The mixture is stirred for a few minutes and then allowed to stand for a few hours. This process is repeated 4 to 5 times. The mixture is then allowed to stand for a period of a few hours again. The ash settles down and we get a clear yellowish liquid solution on top which now contains all the water soluble constituents of the Apamarg ash. The solution is carefully decanted into another container and strained. The clear yellowish solution may still contain minute insoluble parts of the ash. To get pure Kshar it is advisable to further purify this solution by filtering so that the remaining minute insoluble particles are removed.

Filtered liquid boiled

The solution is now kept to boil in a thick preferably stainless steel container. As the water evaporates, we start getting crystals of Apamarg Kshar. They adhere to the sides of the container. Theses should be constantly removed by stirring the boiling solution. When almost all the water is evaporated we get a white substance which settles at the bottom. Minimizing the heat, the process should be continued till all the water evaporates and we get a thick layer of the Kshar at the bottom of the container. This thick layer can be removed on cooling. The substance which we now get is the pure extract of the ash of Apamarg Panchang. This is powdered and packed in air tight container for further use.

Kshara finely grinded and ready to use

The method of preparing the Kshar may be modified when mass production is desired.
Preparation of Haridra Powder
Curcuma longa

Dried rhizomes of Haridra plant

The third drug required for the last three coatings is Haridra powder. Haridra is known to most of us as turmeric. The well developed dry rhizomes of Curcuma longa are used to prepare the powder. The combination of the three above mentioned drugs does the work of cutting, curetting and healing the fistula. The multiple coats on the threads probably make the effect of the drugs gradual and continuous. The drugs keep on dissolving and being released gradually for a couple of days, after which the Ksharsootra is changed if and when required. The thread itself acts as a vehicle for the drugs to reach the sight and the coating on the thread probably renders a sort of a sustained release effect of the drugs in the track.
With the picking up of the Kshar-sutra mode of treatment in Ano-rectal diseases, the requirement and demand for good quality standardized Kshar-sutra is inevitably going to increase and hence Kshar-sutra manufacturing and marketing on both large scale as well as small scale though quite difficult and cumbersome may be a rewarding project.

Ready to use Kshara sutra packed and sealed in a tube

Advantages of Kshar Sutra
•    The procedure does not require hospitalization for more than 3 to 4 hours.
•    The patient requires no bed rest & can resume his/her daily routine within 6 to 12 hours.
•    The procedure leaves just a pencil scar at the site.
•    Freedom from painful dressings.
•    There are no chances of incontinence and the recurrence rate which is usually found to be quite high after Fistulectomy is less than 2% with Kshar - Sutra treatment. This is because the medicines on the thread gradually and continuously curate the pyogenic membrane and fibrous tissue and thus leave no pus pockets undrained