Efficacy of Guggulu and Shallaki based Ksharasutra with Triphala Guggulu orally in the management of Bhagandara w.s.r. to fistula-in-ano: A open labelled randomized comparative clinical study.

Background: Bhagandara is a disease of ano-rectal region and can be correlated with fistula-in-ano. Ksharasutra (application of medicated thread) is being practiced for ano-rectal disorders, particularly in Bhagandara. Guggulu-based Ksharasutra has shown good results in previous studies. Literatures and experiments of Shallaki showed anti-inflammatory, antifungal, analgesic, wound healing properties and Shallaki Niryasa (resin of Boswellia serrate Roxb.) is also having binding effect. Here, Shallaki-based Ksharasutra is used in comparison of Guggulu-based Ksharasutra with Triphala Guggulu orally for better outcome in the management of Bhagandara.

Aim: The aim of this study was to evaluate and compare the efficacy of Guggulu and Shallaki based Ksharasutra with Triphala Guggulu orally in the management of Bhagandara.

Materials and methods: Total 46 patients were registered and randomly allocated by computer generated chart by into three groups. In group A (n = 15), Guggulu-based Ksharasutra was applied in fistula-in-ano without any oral medication; in group B (n = 16), Guggulu-based Ksharasutra was applied with Triphala Guggulu orally; and in group C (n = 15), Shallaki-based Ksharasutra was applied with Triphala Guggulu orally. Patients were assessed for pain, discharge, itching and swelling in the affected region and unit cutting time (UCT) of fistulous tract. Ksharasutra was changed by railroad technique on weekly based follow-up till complete healing of the tract occurred.

Results: In group A, relief in pain, discharge, and swelling was found and was statistically highly significant while insignificant result was found in itching after cut through of the fistulous tract and the same results were found in group B (n = 14) and group C (n = 15). The mean UCT was higher in group A (8.94 days/cm) than in group C (8.43 days/cm) and in group B (8.59 days/cm).

Conclusion: Shallaki based Ksharasutra is more effective in cutting of fistula track while Guggulu based Ksharasutra is more effective in pain relief in the treatment of Bhagandara, along with oral Triphala Guggulu as compared to Guggulu based Ksharasutra with and without Triphala Guggulu orally.