Vol. 2, Issue 1, Part A (2025)

Introduction: Bhagandara, identified with fistula-in-ano in modern medicine, is a chronic and recurrent ano-rectal disorder mentioned as one of the Ashta Mahagada (eight major diseases) in Ayurveda. Conventional surgical methods often lead to complications such as recurrence and sphincter injury. Ksharasutra therapy, a unique Ayurvedic parasurgical technique described by Acharya Sushruta, offers a minimally invasive alternative for effective management of this condition.

Objective: To evaluate the clinical efficacy of Ksharasutra therapy in terms of symptom relief, healing duration, and recurrence prevention in patients with Bhagandara.

Methodology: A prospective interventional clinical study was conducted on 20 patients diagnosed with low anal fistula. Patients underwent Ksharasutra therapy using a thread medicated with Apamarga Kshara, Snuhi latex, and Haridra. Weekly thread changes were performed, and parameters like pain (VAS score), pus discharge, tract cutting time, and healing duration were recorded. Data were analyzed using paired t-tests and Wilcoxon Signed-Rank Test.

Results: There was a statistically significant reduction in pain scores (mean from 8.1 to 1.3, p<0.001) and pus discharge severity. The average tract cutting time was 32.1±3.5 days, and healing was achieved in 39.5±4.2 days. No recurrence or complications such as incontinence were observed over a six-month follow-up.

Discussion: The results demonstrate that Ksharasutra therapy is not only effective in symptom management but also safe and minimally invasive, with better outcomes than conventional surgical interventions. The findings are consistent with earlier studies and reinforce the efficacy of this Ayurvedic approach.

Conclusion: Ksharasutra therapy proves to be a clinically and statistically effective treatment for Bhagandara, ensuring gradual tract excision, symptom relief, and low recurrence with preserved sphincter function. It should be considered a frontline intervention in uncomplicated fistula-in-ano cases, particularly in outpatient and resource-limited settings.