The 4th chapter of Nidanasthana of Sushruta Samhita is known as as Bhagandara Nidanam Adhyaya. This chapter offers with Fistula-in-Ano.
अथातो भगन्दराणां निदानं व्याख्यास्यामः ।।१ ।।
यथोवाच भगवान् धन्वन्तरिः ।।२ ।।
We are going to now expound Bhagandara nidanam – analysis of Fistula-in-ano; as revealed by the venerable Dhañvañtari .
Nirukti – Bheda: Definition and varieties
वातपित्तश्लेष्मसन्निपातागन्तुनिमित्ताः शतपोनकोष्ट्रग्रीवपरिस्राविशम्बूकावर्तोन्मार्गिणो यथासङ्ख्यं पञ्च भगन्दरा भवन्ति |
ते तु भगगुदबस्तिप्रदेशदारणाच्च ‘भगन्दरा’ इत्युच्यन्ते |
अभिन्नाः पिडकाः, भिन्नास्तु भगन्दराः ||३||
There are 5 sorts of Bhagandara. They’re –
Bhagandara Kind Different title
Vataja Sataponaka
Pittaja Ustragriva
Kaphaja Parisravi
Sannipataja – brought on resulting from simultaneous aggravation of all of the three doshas Sambukavarta
Agantuja – attributable to exterior causes Unmargi
Why is it referred to as Bhagandara?
This illness known as as Bhagandara as a result of it causes a tear within the area of pelvis, rectum and urinary bladder.
They’re referred to as Pidaka – eruption – when they don’t seem to be open. Alternatively, when they’re opened, they’re referred to as Bhagandara – fistula.
(Mainly, this illness progresses by way of completely different levels. It begins with an eruption. Later this eruption bursts and later a sinus kinds – fistula.)
Purvarupa: Premonitory signs
तेषां तु पूर्वरूपाणि – कटीकपालवेदना कण्डूर्दाहः शोफश्च गुदस्य भवति ।।४ ।।
Under talked about are the premonitory signs of Bhagandara –
- Ache within the alae of the pelvic bones
- Itching
- Burning sensation
- Swelling / edema of the anus
Samprāpti – Rupa: Pathogenesis and scientific options
Sataponaka Bhagandara
तत्रापथ्यसेविनां वायुः प्रकुपितः सन्निवृत्त : स्थिरीभूतो गुदमभितोऽङ्गले व्यङ्गुले वा मांसशोणिते प्रदूष्यारुणवर्णं पिडकां जनयति , साऽस्य तोदादीन् वेदनाविशेषाञ्जनयति , अप्रति क्रियमाणा च पाकमुपैति , मूत्राशयाभ्यासगतत्वाच्च व्रण : प्रक्लिन्नः शतपोनकवदणुमुखैश्छि दैरापूर्यते , तानि च छिद्राण्यजस्रमच्छं फेनानुविद्धमधिकमास्राव स्रवन्ति , व्रणश ताडयते भिद्यते छिद्यते सूचीभिरिव निस्तुद्यते , गुदं चावदीर्यते , उपेक्षिते च वातमूत्रपुरीषरेतसामप्यागमश्च तैरेव छिट्टैर्भवति ; तं भगन्दरं शतपोनकमित्याचक्षते ।।५ ।।
Vata will get aggravated in individuals who repeatedly indulged in unhealthy meals and actions.
This aggravated vata will get localized at a distance of about one or two angula (2-4 cm roughly) across the guda – anus.
The localized aggravated vata vitiates the muscle groups and blood across the anal area.
Later it offers rise to an eruption. The eruption is of sunshine purple in colour and is related to pricking ache and likewise different kinds of ache.
This eruption undergoes suppuration if not handled in correct time.
The eruption / ulcer turns into enormously moist by way of the minute pores in it which resemble a Shataponaka (sieve) as a result of it’s located close to the urinary bladder.
Discharges (exudes) happen repeatedly from these holes in nice amount. The fluid discharge is obvious and frothy.
The individual feels as if the ulcer therein is being hit, cut up, torn and pricked by needles. The rectum additionally will get torn.
Fart, urine, feces and semen are additionally eradicated from these pores / holes if this situation is uncared for.
This sort of Bhagandara known as Sataponaka Bhagandara.
Uşțragriva Bhagañdara
पित्तं तु प्रकुपितमनिलेनाधः प्रेरितं पूर्ववदवस्थितं रक्तां तन्वीमुच्छ्रितामुष्टग्रीवाकारां पिडकां जनयति ; साऽस्य चोषादीन् वेदनाविशेषाञ्जनयति ; अप्रतिक्रियमाणा च पाकमुपैति ; व्रणश्चाग्निक्षाराभ्यामिव दह्यते , दुर्गन्धमुष्णमास्त्रावं स्रवति , उपेक्षितश्च वातमूत्रपुरीषरेतांसि विसृजति ; तं भगन्दरमुष्टग्रीवमित्याचक्षते ।।६ ।।
Pitta will get aggravated by its etiological components.
This pitta is pushed down by vata.
This pitta will get localized in the identical areas talked about earlier.
Now, pitta offers rise to an eruption. This eruption is purple in colour, small, elevated and is of the form of the neck of the camel. That’s the reason it’s referred to as Ustragriva (Ushtra = camel, Griva = neck).
The signs manifest within the type of sucking and different kinds of pains of pitta origin, like burning sensation, elevated warmth and many others.
This eruption would endure suppuration and kind ulcers if it isn’t handled at correct time. Burning sensation is manifested within the ulcer whereby the individual experiences as if that area is burnt by fireplace or alkali. There’s additionally exudation which is heat and smells unhealthy.
Flatus, urine, feces and semen come out by way of the ulcers if this situation is uncared for.
This Bhagandara of Pitta origin known as Ustragriva Bhagandara.
Parisrāvī Bhagañdara
श्लेष्मा तु प्रकुपितः समीरणेनाधः प्रेरितः पूर्ववदवस्थितः शुक्लावभासां स्थिरां कण्डूमती पिडकां जनयति , साऽस्य कण्ड्वादीन् वेदनाविशेषाञ्जनयति , अप्रतिक्रियमाणा च पाकमुपैति , व्रणश्च कठिनः संरम्भी कण्डूप्रायः पिच्छिलमजस्रमास्त्रावं स्रवति , उपेक्षितश्च वात मूत्रपुरीषरेतांसि विसृजति ; तं भगन्दरं परिस्राविणमित्याचक्षते ।।७ ।।
Sleshma / kapha will get aggravated by its components.
This kapha is pushed down by Vata.
The aggravated kapha will get lodged, as already described earlier.
This results in the manifestation of an eruption.
The eruption is white in colour, is fastened and related to itching.
Consequently, itching and different kinds of pains of kapha origin are manifested.
The eruption undergoes suppuration if it isn’t correctly handled.
When suppuration happens, an ulcer which is tough, swollen and related to itching is fashioned.
Exudations that are slimy fluids could be seen discharging repeatedly.
Flatus, feces, urine and semen come out of the ulcer when it’s uncared for and never handled promptly.
This Bhagandara brought on resulting from predominant aggravation of kapha known as Parisravi Bhagandara.
Sambükāvarta bhagañdaram
वायुः प्रकुपितः प्रकुपितौ पित्तश्लेष्माणौ परिगृह्याधो गत्वा पूर्ववदवस्थितः पादा पृष्ठाग्रप्रमाणाः सर्वलिङ्गा पिडकां जनयति , साऽस्य तोददाहकण्ड्वादीन् वेदनाविशेषाञ्जनयति , अप्रतिक्रियमाणा च पाकमुपैति , व्रणश्च नानाविधवर्णमास्रावं स्रवति , पूर्णनदीशम्बूकावर्तवच्चात्र समुत्तिष्ठन्ति वेदनाविशेषाः ; तं भगन्दरं शम्बूकावर्तमित्याचक्षते ।।८ ।।
Sambukavarta Bhagandara is brought on as a result of mixture of aggravated vata with aggravated pitta and kapha.
These doshas transfer downward and get localized within the areas described earlier.
These doshas now give rise to an eruption.
The eruption is the scale of the massive toe. It presents options (signs) of all of the three doshas. Pricking ache, burning sensation, itching and different signs are additionally current.
The eruption undergoes suppuration if not handled at correct time and kinds an ulcer.
The ulcer exudes fluids of various colours and likewise produces ache.
The ulcer resembles Sambukavarta i.e. spirals of the conch shell. (Sambukavarta additionally explains the character of ache i.e. ache seated deep and strikes circularly, as spirals discovered within the conch shell).
This Bhagandara manifested resulting from aggravation of all of the three doshas known as Sambukavarta Bhagandara.
Unmārgi Bhagañdara
मूढेन मांसलुब्धेन यदस्थिशल्यमन्नेन सहाभ्यवहृतं यदाऽवगाढपुरीषोन्मिश्रमपाने नाध : प्रेरितमसम्यगागतं गुदमपक्षिणोति तदा क्षतनिमित्तः कोथ उपजायते , तस्मिंश्च क्षते पूय रुधिरावकीर्णमांसकोथे भूमाविव जलप्रक्लिन्नायं क्रिमय : संजायन्ते , ते भक्षयन्तो गुदमनेकधा पार्श्वतो दारयन्ति , तस्य तैर्मार्गः कृमिकृतैर्वातमूत्रपुरीषरेतांस्यभिनिःसरन्तिः ; तं भगन्दर मुन्मार्गिणमित्याचक्षते ।।९ ।।
Causes –
- Consumption of meat together with bone items and different international our bodies by a silly one who is grasping of consuming meat.
- Feces turning into laborious
Pathogenesis – the meat with bones and laborious feces, because the case could also be, is pushed down by Apana Vata and strikes in an improper method. They attain the rectum / anus, get lodged therein and produce a wound.
Additional occasions – Sloughing (putrefaction) of the muscle groups takes place as a result of wound. Pus and blood flows out. Later, there may be manifestation of worms / micro organism in that place, similar to the worms develop within the land whereby there may be waterlogging.
Signs – These worms eat away the anus / rectum at many locations. In addition they produce tears within the partitions of anus. Air (flatus), urine, feces and semen get discharged from the tears created by worms.
This Bhagandara known as Unmargagami Bhagandara.
Anya vidha pidaka: Other forms of eruptions
भवन्ति चात्र-
उत्पद्यतेऽल्परुक् शोफात् [१] क्षिप्रं चाप्युपशाम्यति |
पाय्वन्तदेशे पिडका सा ज्ञेयाऽन्या भगन्दरात् ||१०||
पायोः स्याद् द्व्यङ्गुले देशे गूढमूला सरुग्ज्वरा |
भागन्दरीति विज्ञेया पिडकाऽतो विपर्ययात् ||११||
Some verses right here –
There could also be another eruptions which develop within the anal area that are related to much less ache and swelling which additionally disappear rapidly. These eruptions is probably not Bhagandara and shall be understood as completely different from them.
Alternatively, these eruptions which develop at a tough distance of about 2 angulas i.e. 4 cm roughly across the anal area ought to be thought of as pidaka or bhagandara, particularly so when they’re deep seated and accompanied with ache and fever.
Bhagandara Purvarupa: Premonitory signs of bhagandara
यानयानान्मलोत्सर्गात् कण्डूरुग्दाहशोफवान् ।।
पायुवेगुजः कटयां पूर्वरूपं भगन्दरे ।।१२ ।।
Under talked about are the premonitory signs of Bhagandara –
- Itching
- Ache
- Burning sensation
- Swelling in anal area and waist
These signs are manifested whereas the individual having Bhagandara rides automobiles or animals or throughout defecation.
घोरा : साधयितुं दुःखा : सर्व एव भगन्दराः ।।
तेष्वसाध्यस्त्रिदोषोत्थः क्षतजश भगन्दरः ।।१३ ।।
All kinds of Bhagandara are dreadful and are tough to treatment. Bhagandara attributable to all three doshas is taken into account to be incurable and so is that which is attributable to harm.
इति श्रीसुश्रुतसंहितायां निदानस्थाने भगन्दरनिदानं नाम चतुर्थोऽध्यायः ।।४ ।।
Thus ends the fourth chapter by title Bhagandara nidāna – in Nidäna Sthana of Sushruta samhita.