Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Parikartika – It’s a painful situation which has been talked about in additional than couple of cases in Ayurveda treatises. Nevertheless it has not been given an impartial standing as a illness and has not been defined in a separate context of its personal.
The that means of Parikartika shall be understood from its ‘root that means’. The place of the physique by which it happens may also be assumed by the contextual clarification / point out of this phrase within the texts.
Which means of Parikartika
The phrase Parikartika has two phrases in it:
- Pari – which suggests throughout
- Kartika – this time period comes from kartana which suggests ‘to chop’.
The phrase ‘Parikartika’ has the time period ‘kartana’ in it. Kartana means ‘to chop’. It defines ‘reducing ache within the anal area’. Right here Kartana or Kartika shall be learn as ‘Kartanavat Peeda’ i.e. ache as if the organ (anal area on this context) is being lower or sawed. Whereas not being restricted to throughout the guda (anal area), the excruciating reducing kind of ache appears to be skilled throughout the basti / basti shirah (head or fundus of urinary bladder) and nabhi (navel area) additionally.
This time period parikartika has additionally been talked about as a complication of ‘vamana – therapeutic emesis’ and ‘virechana – therapeutic purgation’ and in addition as a complication of wrongly launched enema nozzle. Parikartika has been talked about among the many signs of Vataja Atisara, Vataja Grahani and Purisha Udavarta.
It has additionally been talked about among the many issues of assorted ailments together with Vatika Jwara (fever of predominantly vata origin) and Vatika Pakvatisara (continual diarrhea of vata origin), Arsha Purvarupa (premonitory symptom of piles / hemorrhoids), Udavarta (illness marked by irregular upward motion of vata) and in addition as Garbhini Vyapad (problems of being pregnant).
The therapy ideas of those circumstances shall be thought-about in treating anal fissure.
A situation referred to as as Parikartika talked about in several contexts in Ayurveda treatises will be carefully in comparison with ‘anal fissures’.
Nidana – Causative Components
A lot of the ailments or the subtypes of ailments by which Parikartika has been talked about as a symptom are predominantly attributable to aggravated vata. So, vata rising and kapha reducing meals, actions and habits will play an essential function in causation and manifestation of parikartika. Right here we have to bear in mind the etiological components for trigger (vata enhance or vataja ailments) and impact would be the similar (signs of elevated vata or vataja ailments – parikartika on this context). Vata enhance and kapha lower may happen concurrently. Separate etiological components could also be accountable or every situation could cause the opposite situation i.e. vata enhance could cause kapha lower and vice versa. Since guda – rectum and anus are positioned within the zone belonging to Apana Vata i.e. the decrease portion of the physique, apana vata vitiation ought to be primarily thought-about as causal for parikartika.
Samprapti – Pathogenesis
Each these i.e. vata enhance and kapha lower are liable for many pathological modifications within the physique, together with the colon, rectum and anal area that are the territories (residence, abode) of vata and its functioning. Extra dryness within the physique triggered as a result of vata enhance (and or kapha lower) might trigger extreme dryness of feces resulting in constipation. When there’s extreme or continual constipation or onerous bowel motion the individual strains at defecation. Constipation and straining are the principle causes of fissures as nicely.
Involvement of pitta within the samprapti of parikartika
Other than vata, aggravated pitta too could be generally concerned within the causation of parikartika. Ashayapakarsha is a pathological situation whereby the aggravated vata displaces regular pitta or kapha from their regular seats. When aggravated vata pulls down regular pitta (displacing it from its seat) into the decrease zone of the physique (which belongs to vata), particularly colon (together with rectum and anus), it will trigger reducing ache (like parikartika – although the time period has not been talked about within the context of ashayapakarsha) within the anal area and in addition inflammatory situation within the anal area. This may trigger circumstances like arshas, bhagandara and parikartika.
Involvement of Ama and Mandagni
As a consequence of much less power of digestive fireplace (mandagni), lot of ama is shaped (intermediate merchandise of faulty digestion that are sticky in nature and tends to trigger blocks and clogs within the physique). Affiliation of ama with doshas (sama doshas) is a vicious mixture. These sama doshas would trigger blocks within the physique, within the passages and channels of the physique, together with the intestine. This might ultimately trigger circumstances like constipation. If there are indicators of low digestion energy or signs of ama, they need to be addressed earlier than another interventions.
Lakshana – Signs
Signs of Parikartika – The title of the illness itself signifies its primary symptom additionally i.e. ‘presence of excruciating reducing ache within the anal area and in addition within the area of urinary bladder and umbilicus’.
Parikartika as a Symptom / Premonitory symptom
Parikartika can also be talked about as a symptom of few ailments. They’re –
- Vataja Atisara / Vataja Pakvatisara (Cha.Chi.19/5)
- Vataja Grahani (Cha.Chi.15/62)
- Purishaja Udavarta (Su.Ut.55/8)
- Sahaja Arshas (Cha.Chi.14/8)
- Arsha Purvarupa (Su.Ni.2/9)
Parikartika as a complication of therapies
- Vamana-Virechana Vyapat – as a complication triggered as a result of extreme administration of emesis and purgation remedy or administration of fast performing emesis and purgation medicines / recipes (Cha.Si.6/61-63)
- Vasti Vyapat – as a complication triggered as a result of administration of enema ready with un-unctuous and sharp performing herbs / elements (Cha.Si.7/54-57)
- Vasti Netra Vyapat – as a complication of erroneously / shortly launched enema nozzle into the anus / rectum (although the phrase parikartika has not been talked about in these contexts, signs indicating damage to the anal canal have been talked about)
Etiology and indicators and signs of Parikartika triggered as complication of (emesis and) purgation remedy
स्निग्धेनगुरुकोष्ठेनसामेबलवदौषधम्|
क्षामेणमृदुकोष्ठेनश्रान्तेनाल्पबलेनवा||६१||
पीतंगत्वागुदंसाममाशुदोषंनिरस्यच|
तीव्रशूलांसपिच्छास्रांकरोतिपरिकर्तिकाम्||६२||
If an individual who’s oleated, who has costive bowel and who’s bothered with Ama or if an individual who’s weak, who has lax bowel, who’s fatigued and who has taken a fast performing drugs for purification, then the recipe reaches the rectum to trigger excruciating sawing sort of ache accompanied with slimy and bloody discharge. That is referred to as as Parikartika. (This parikartika ought to be thought-about as a complication of erroneously administered purgation remedy. In erroneously administered emesis remedy related reducing ache could also be skilled within the throat as an alternative of anus).
Etiology, indicators and signs of Parikartika attributable to administration of un-unctuous and sharp enemas
मृदुकोष्ठाल्पदोषस्यरूक्षस्तीक्ष्णोऽतिमात्रवान्|
बस्तिर्दोषान्निरस्याशुजनयेत्परिकर्तिकाम्||५४||
त्रिकवङ्क्षणबस्तीनांतोदंनाभेरधोरुजम्|
विबन्धोऽल्पाल्पमुत्थानंबस्तिनिर्लेखनाद्भवेत्||५५||
If enema with un-unctuous and sharp elements is given to a affected person who has laxed bowel and who has much less of aggravated Doshas, then it instantly eliminates Doshas to trigger partikartika (sawing ache), pricking ache within the lumbar area, groins and the area of urinary bladder and ache within the decrease stomach under the umbilical area. Due to the scraping impact of enema, the affected person suffers from constipation and frequent voiding of stool in small portions.
Administration of PARIKARTIKA
Parikartika shall be handled with the assistance of under talked about ideas.
Therapy of Vata –
Since aggravated vata is the principle explanation for parikartika and its signs, vata shall be dealt with with the assistance of vata balancing measures together with weight loss program, way of life modifications, medicines and therapies. Medicated oils and ghee shall be used for oral consumption and as enemas.
Vasti – Lubricating enemas i.e. anuvasana / matra vasti will act as vatanulomana i.e. regularize the motion of vata and management its actions and therefore addresses vata aggravation successfully. This might assist therapeutic the fissure / wound, lubricating the anal passage, relieving constipation, native spasm, ache and discomfort attributable to parikartika.
Pichcha Basti – Slimy medicinal enemas shall be administered if there’s discharge of mucus, slimy materials or blood from the anus within the presence of anal fissures.
Pichu – Small pads of sterile cotton dipped in medicated ghee or oil, saved contained in the anal canal in shut contact with the wound (fissure wound) acts like a protecting layer and causes soothing of anal canal. It relieves ache, burning sensation and danger of bleeding. It additionally helps in wound cleaning and therefore is efficient in wound (fissure) therapeutic). It doesn’t enable formation of unhealthy granulation tissue. Jatyadi Taila / Ghrta or Jivantyadi Yamakam / Yashtimadhu Taila shall be used for the aim.
Gudavarti – natural suppositories talked about within the contexts of udavarta and adhmana shall be utilized in parikartika too.
Avagaha Sweda – Tub fomentation or sitz bathtub in a bathtub crammed with scorching / heat water ought to be utilized by the affected person after each bowel motion. As a substitute of plain heat water, natural decoctions like heat dashamula kashaya ought to be used within the tub. The affected person ought to sit waist deep within the tub for 10-20 minutes. Other than ‘after defecation’ the affected person can use this as and when wanted. This might soothe ache and loosen up spasm of anal sphincters and would additionally cleanse the wound (fissure).
Therapy of Pitta –
If signs of pitta aggravation are seen in parikartika pitta balancing measures ought to be included within the therapy of Parikartika.
Therapy on the idea of Ashayapakarsha –
Pitta signs within the anal area could also be as a result of hyperactivity of vata which might pull regular pitta into the anal area. Right here aggravated vata ought to be handled promptly which is able to in flip handle pitta and its signs.
Therapy of Mandagni and Ama / Sama doshas –
If signs of mandagni or ama or sama doshas are current they need to be promptly handled earlier than beginning another interventions. On this route langhana (lightness producing measures), pachana (ama digesting medicines and measures) and rukshana (dryness producing measures) shall be skillfully used as and when required, solely till these circumstances are resolved. If these procedures are achieved for longer time with out monitoring the affected person’s situation they might trigger extra dryness and worsen constipation and signs of parikartika.
Arsha Bhagandara Chikitsa –
Parikartika shall be handled on the traces of treating arsha – piles and bhagandara – fistula in anus. All these circumstances happen within the anal area. It ought to be primarily handled on the traces of treating shushkarsha – dry or non-bleeding piles or bahya arsha – sentinel piles.
Grasp Sushruta has described fourfold strategy (modalities) in treating arshas. They’re –
- Bheshaja prayoga – use of medicines / conservative therapy
- Ksharakarma – use of alkali cautery
- Agnikarma – use of fireplace cautery
- Shastrakarma – use of surgical strategies
Amongst these, leaving out agni karma, the opposite three shall be skillfully applied for successfully treating parikartika.
Kshara Sutra Remedy
Kshara Sutra means thread smeared or impregnated with natural alkalis. On this process, the alkali thread is inserted and knotted into the fistula, pile mass, sinus in anal area or fistula in anal area and left in place for few days. The alkali, by the advantage of its intense and deep penetrating motion and by the advantage of its scorching efficiency, burns the pathological space (cauterization impact) and eliminates them from the bottom. Ksharasutra is a minimal invasive Ayurvedic para-surgical process and time-tested Ayurveda approach within the administration of Anorectal problems. Sentinel pile plenty are generally related to fissures, vis-à-vis parikartika. Ligation of alkali risk to those plenty will be sure that they fall off inside few days.
Associated Studying – Ksharasutra
Kshara Lepa – Software of alkali paste (pratisaraniya kshara) over continual fissures have proven significantly good outcomes by way of fissure therapeutic. Alkali imparts scraping motion which reduces the fibrous tissue formation (and clears that which has been shaped) over and across the fissure mattress. However, anal sphincters would loosen up.
Agnikarma – Fireplace cautery / electro-thermal cautery can also be a para-surgical process. It has been efficiently used for treating many sophisticated circumstances particularly by the traditional surgical colleges of Ayurveda. In circumstances of parikartika, the arsha surrounding it (sentinel piles current within the neighborhood of fissures) will be handled in order to mark reduction and forestall recurrence.
Bheshaja and Pathya Apathya – Medicines and modulations in dietetic routine and way of life actions shall be the identical as for arshas and bhagandara.
Therapy of Koshtabaddhata
Koshtabaddhata or constipation is the principle trigger for parikartika. That is attributable to vata imbalance within the colon. Right here too laxatives and delicate purgatives which may cleanse bowel shall be given within the type of ‘laxative oils’. Gandharvahastadi Eranda Taila or Nimbamrutadi Eranda Taila can be utilized for this goal.
Therapy of Udavarta (Anaha, Adhmana)
Udavarta too ought to be taken care of, primarily the irregular upward motion of vata attributable to forcible withholding of urges of fart and feces. Individuals ought to be educated to not withhold any of the physique urges and to handle them as and after they get manifested. Purishaja Udavarta i.e. vata aggravation and irregular upward motion as a result of forcible withholding of defecation reflex has been talked about as one of many chief causes for parikartika (parikartika is a symptom of this situation). Likewise Anaha – flatulence and Adhmana – distension of stomach whereby vata (and ama) are the principle causes too ought to be addressed. They might coexist with udavarta or manifest independently.
Right here, in parikartika, the therapy ideas of all these three circumstances defined within the classics shall be adopted.
Therapy of Atisara and Grahani
Atisara i.e. diarrhea and Grahani i.e. small bowel problems together with inflammatory bowel problems ought to be promptly handled and so additionally dysentery. In diarrhea there might be fluid loss resulting in dryness and vata vitiation. In grahani there might be alternating episodes of diarrhea and constipation. In dysentery there might be lot of straining. All these will continually irritate the rectum and anus and would trigger parikartika.
Vrana Chikitsa
Parikartika shall be handled on the traces of treating vrana i.e. ulcers or wounds as defined in Ayurveda treatises.
Therapy of Parikartika triggered as complication of emesis and purgation remedy
लङ्घनंपाचनंसामेरूक्षोष्णंलघुभोजनम्|
बृंहणीयोविधिःसर्वःक्षामस्यमधुरस्तथा||६३||
आमेजीर्णेऽनुबन्धश्चेत्क्षाराम्लंलघुशस्यते|
पुष्पकासीसमिश्रंवाक्षारेणलवणेनवा||६४||
सदाडिमरसंसर्पिःपिबेद्वातेऽधिकेसति|
दध्यम्लंभोजनेपानेसंयुक्तंदाडिमत्वचा||६५||
देवदारुतिलानांवाकल्कमुष्णाम्बुनापिबेत्|
अश्वत्थोदुम्बरप्लक्षकदम्बैर्वाशृतंपयः||६६||
कषायमधुरंशीतंपिच्छाबस्तिमथापिवा|
यष्टीमधुकसिद्धंवास्नेहबस्तिंप्रदापयेत्||६७||
On this situation related to Ama, the affected person ought to hold fasting; take Pachana (digestive stimulants) and meals which is un-unctuous, scorching and lightweight for digestion.
If the affected person is weak, then all of the nourishing therapies and recipes containing medication having candy style are taken.
Recipes for Parikartika
If Parikartika (sawing ache) proceed even after the Ama (product of improper digestion and metabolism) will get cooked consumption of alkaline, mild to digest and bitter meals are helpful.
If there’s predominance of vayu (aggravated), the under talked about recipes are helpful:
- Ghee together with pomegranate-juice added with Puspa-kasisa or alkalies or salt
- Meals and drinks containing bitter curd combined with the pores and skin of the pomegranate;
- Paste of Devadaru and Tila ought to be given for ingesting combined in scorching water.
- Milk boiled and processed with Ashwattha, Udumbara, Plaksha and Kadamba ought to be given for ingesting.
- Chilly enemas ready with astringent and candy tasting herbs or Pichcha Basti kind of enema shall be administered.
- Anuvasana Basti with oil / ghee ready with paste and decoction of Yashtimadhu.
Therapy of Parikartika attributable to administration of un-unctuous and sharp enemas
स्वादुशीतौषधैस्तत्रपयइक्ष्वादिभिःशृतम्|
यष्ट्याह्वतिलकल्काभ्यांबस्तिःस्यात्क्षीरभोजिनः||५६||
ससर्जरसयष्ट्याह्वजिङ्गिनीकर्दमाञ्जनम्|
विनीयदुग्धेबस्तिःस्यात्व्यक्ताम्लमृदुभोजिनः||५७||
Milk is boiled by including candy and cooling elements like sugarcane, and so on. To this medicated milk, the paste of Yastimadhu and Tila is added. Enema is given with this recipe holding the affected person on milk weight loss program.
Milk is added with Sarjarasa, Yastimadhu, Jingini, Kardama (mud) and Anjana (stable extract of Daruharidra). This recipe is added with bitter juice and used as enema for the affected person who’s on smooth weight loss program.
Essential formulations for treating Parikartika
- Gandharvahastadi Kashayam
- Gandharvahastadi Tailam
- Nimbamritadi Eranda Tailam
- Sukumara Ghrtam
- Dusparshakadi Kashayam
- Jatyadi Ghrta
- Jatyadi Taila
- Triphala Churna
- Triphala Guggulu
- Kaishora Guggulu,
- Shigru Guggulu
- Lakshadi Guggulu,
- Sonamukhi Churna
- Haritaki Churna
- Kalyanaka Gulam
- Nirgundi Taila
- Arshakuthar Ras
- Panchasakar Churna
- Bolabaddha Rasa
- Abhayarishta
Essential herbs and issues in Parikartika
- Bilwa – Aegle marmelos
- Guggulu – Commiphora mukul
- Kutaja – Holarrhena antidysenterica
- Sonamukhi
- Haritaki – Terminalia chebula
- Nagakesara – Messua ferrea
- Haridra – Curcuma longa
- Takra – buttermilk
Pathya – helpful meals and practices
- Previous crimson rice and paddy grown in sixty days ought to be taken
- Barley and horse gram are good
- Mild, simply digestible meals
- Meals predominant in candy style
- Vata assuaging meals, drinks and actions
- Fasting, ama digesting herbs, dry and scorching, mild meals if ama is current
- Attend to urges of defecation and fats as and after they seem
- Keep away from constipation, meals and actions which trigger constipation and handle bowel well being
- Keep away from straining an excessive amount of throughout defecation
- Devour leafy greens
- Drink water and sustain the hydration
- Sitz Bathtub usually
Apathya – unwholesome meals and actions
- Withholding urges for defecation, fart and urination
- Extreme sexual activity
- Extreme train / strenuous bodily actions
- Consumption in extra of meals that are heavy to digest
- Anger
- Consumption of an excessive amount of spicy meals, corrosive meals and meals having sharp and penetrating properties
- Consumption of an excessive amount of salt or salty meals
- Consumption of too dry and rancid meals
- Any vata aggravating meals and actions
- Any pitta aggravating meals and actions
Works on Parikartika
1. A comparative scientific examine of Yastimadhu Ghrita and lignocaine-nifedipine ointment within the administration of Parikartika (acute fissure in ano)
2. Administration of Parikartika w.s.r to Acute Fissure-in-Ano with Guduchi Taila Pichu – A case examine
3. Administration of Submit-operative Wound of Parikartika (Power Fissure in Ano) by Seethodaka Thaila Pichu Adopted by Dorsal Sphincterotomy – A Single Case Report
4. Comparative Examine of Palashgudavarti and Diclofenac Sodium Suppository within the Administration of Acute Fissure in Ano (Parikartika) – An Ayurvedic Administration Protocol
5. Examine of The Impact Of Chandanabalalakshadi Taila Pichu in Parikartika With Particular Reference To Fissure-In-Ano: A Pilot Examine
6. Acute Administration of Parikartika (fissure in ano) by Tila Taila Matra Basti: Case Examine
7. A Examine on the Efficacy of Darvi Taila Matra Basti In The Administration Of Parikartika w.s.r to Fissure-in-ano
8. Scientific Examine on the impact of Dwiharidra Rasakriya Pichu in Parikartika
9. Randomized managed scientific trial to review the efficacy of Priyangvaadi Gana Siddha Taila within the administration of Parikartika w.s.r. to fissure-in-ano – An Ayurvedic Administration Protocol
10. Impact of Patoli Taila in Administration of Parikartika (Fissure-in-Ano) in Comparability with Jatyadi Taila: Randomized Scientific Trial
11. Comparative Examine of Ksharasutra suturing and Lord’s anal dilatation within the administration of Parikartika (continual fissure-in-ano)
Fashionable correlation
Parikartika will be carefully correlated to fissure / anal fissures defined within the trendy texts. All interventions mentioned on this context (of parikartika) will be skillfully and conditionally (as per state of affairs) administered in successfully treating anal fissure instances.
Associated Studying – Anal Fissures
