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Table of Contents
CASE REPORTS
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 47-50

Proficiency of Khanduchakka Ghrit in the management of Parikartika: A case report


Department of Shalyatantra, MGACH and RC, Wardha, Maharashtra, India

Date of Web Publication27-Aug-2019

Correspondence Address:
Dr. Suraj V Tichkule
Shalyatantra Department, MGACH and RC, Wardha, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_11_19

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  Abstract 

Background: Fissure-in-ano is a common anorectal disease. It is mainly of two types: acute and chronic. Chronic fissure-in-ano is difficult to treat and most of the time, it is associated with sentinel tag, which guards the fissure from healing, resulting in nonhealing ulcer, which calls for surgical intervention. Khanduchakka (Ehretia laevis) is a folklore plant that is used popularly by the tribal people for the healing of the nonhealing ulcers. Using that reference in this research work, Khanduchakka Ghrit was used as a local application for managing chronic fissure-in-ano and its efficacy was evaluated. Materials and Methods: In this case report, a patient with chronic fissure-in-ano was treated by Khanduchakka Ghrit, which was used as a local application, after all the mandatory investigations, and its efficacy was evaluated on the basis of clinical parameters such as pain, bleeding, itching, and healing. Results: The patient showed significant results in the clinical parameters evaluated. She got relief in pain, itching, bleeding per rectum, and fissure within 20 days. Even on follow-up assessment, no signs of recurrence were reported. Conclusion: From the aforementioned case, it was concluded that simply applying Khanduchakka Ghrit over a chronic fissure-in-ano is able to heal it. This study revealed that it not only acts as a Ropana (healing agent) but also acts as a Lekhandravya (scrapping agent), which helps in removing slough present at fissure bed and simultaneously helps in the healing of chronic fissure-in-ano.

Keywords: Anorectal disease, fissure-in-ano, Ghrita, Khanduchakka, Lekhan, Ropan


How to cite this article:
Tichkule SV, Khandare KB, Shrivastav PP. Proficiency of Khanduchakka Ghrit in the management of Parikartika: A case report. J Indian Sys Medicine 2019;7:47-50

How to cite this URL:
Tichkule SV, Khandare KB, Shrivastav PP. Proficiency of Khanduchakka Ghrit in the management of Parikartika: A case report. J Indian Sys Medicine [serial online] 2019 [cited 2019 Nov 17];7:47-50. Available from: http://www.joinsysmed.com/text.asp?2019/7/1/47/265514


  Introduction Top


Parikartika (fissure-in-ano) is derived from the root word “Parikrt,” which denotes “to cut around” (pari = all around, kartanam = the act of cutting).[1] It is a symptom rather than a disease. Many different opinions are available regarding the concept of parikartika. According to Acharya Dalhan, it is a cutting and tearing pain anywhere in the body,[2] and Vijayaraksita[3] mentioned it as a cutting type of pain, specially localized in guda. It is correlated to anal fissure or fissure-in-ano in modern medical parlances. Anal fissure is defined as an acute superficial break in the continuity of the anal skin, usually in the anal margin. They are of two types: acute and chronic. Basically, it is a lifestyle disorder; in men, fissures usually occur in the midline posterior (90%) and much less commonly anterior (10%) and in women, fissures on the midline posteriorly are slightly more common than the ones present anteriorly (60:40).[4]

Various surgical and medicinal treatments are in vogue for treating anal fissures but all have certain limitations and recurrence rates. Management of chronic fissure-in-ano is still a challenge for a surgeon. In this case study also, the case was of chronic fissure, which was not healing in a right manner even after a long course of conservative treatment. Even though her pain and bowel habit improved, the fissure was not healing. Here, we found a need to explore new and better substitute for local application medicaments. For that, a folklore plant named “Khanduchakka” was used. It is used for treating fractures and ulcers by the tribal people. Using this perception, this case was managed as chronic fissure is nothing but an ulcer. For application purpose, Ghrit was prepared by using fresh leaves of Khanduchakka by Sneha Kalpana method and was given to the patient for local application. It showed significant results in healing a chronic fissure-in-ano of the patient owing to its properties.


  Case Report Top


A 25-year-old woman presented in the outpatient department (OPD) of Shalyatantra of Mahatma Gandhi Ayurved College, Hospital and Research Centre (MGACHRC), Salod (Hirapur), Wardha, Maharashtra, India, complaining of pain at the anal region during and after defecation, itching at the anal region, and hard stool. History revealed that the patient was having the aforementioned complaints since 1 year; in the initial months, she was having severe pain and intermittent bleeding associated with stool. She took treatment for the same but did not get complete relief. With all the aforementioned complaints, the patient came to MGACHRC, Shalyatantra OPD for treatment.

Personal history: The patient was a staff nurse by profession, used to take mixed diet, and was having the habit of eating spicy and junk food with improper sleeping routine. Because of her improper lifestyle, she was having complaints of irregular bowel habit since a long time.


  Systemic Examination Top


General condition of the patient was moderate, well oriented, the air entry was equal on both sides, and her blood pressure was normal. Her weight was 70kg and height was 158cm.


  Ashtavidh Pariksha (Eightfold Examination) Top


Nadi (pulse): Vatapittapradhan (predominance of Vata and Pitta)

Mala (stool): Niraam (normal)

Mutra (urine): Samyak (normal)

Jivha (tongue): Sama (coated)

Shabda (voice): Spashta (clear)

Sparsh (touch): Anushnasheet (normal temperature)

Druk (eye): Pandu (pallor)

Akruti (built): Sthool (obese)


  Local Examination Top


Chronic fissure-in-ano was present at 12 o’clock and 6 o’clock position, fissure bed was appearing pinkish white in color. Anal spasm was of grade I, no active bleeding was present.


  Investigations Top


The patent’s investigations showed hemoglobin to be 11.2 g%; random blood sugar, 96 mg%; human immunodeficiency, nonreactive; and Hepatitis B surface antigen, nonreactive.


  Materials Used Top


  1. Khanduchakka leaves


  2. Go-ghrit


  3. Water


  4. Gauze piece



  Method Top


Khanduchakka Ghrit prepared as per Sneha Kalpana under all sterile precautions and was provided to the patient in a bottle with applicator. She was asked to take hot sitz bath in morning and evening followed by the application of Khanduchakka Ghrit[5] with the help of applicator at the anal region, followed by covering with a sterilized gauze piece. This procedure was to be performed by the patient twice a day up to 1 month, and the assessment was carried out on 0, 7th, 14th, and 21st day. Follow-up was conducted on 30th and 45th day to assess any recurrence.

Conservative treatment: Triphala guggul (500mg twice a day) and Triphala Churna (10g) with lukewarm water before bed time for 1 month was the conservative treatment that was followed by the patient.


  Assessment Criteria Top


1. Pain

[Table 1]


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2. Bleeding per rectum

[Table 2]


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3. Itching

[Table 3]


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4. Parikartika healing

[Table 4]


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  Observations and Results Top


In this work, assessment was carried out weekly up to 21 days to find out the symptoms of the patient, such as pain, itching, bleeding, and healing. She started getting relief from pain within 7–8 days and from itching within 15 days. She got completely cured within 20 days, follow-up assessment was carried out on 30th and 45th day where no recurrence of anal fissure or any complaints associated to it was found, resulting in complete cure [Figure 1],[Figure 2],[Figure 3],[Figure 4].
Figure 1: Image of fissure-in-ano on day 1

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,
Figure 2: Image of fissure-in-ano on day 7

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,
Figure 3: Image of fissure-in-ano on day 14

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,
Figure 4: Image of fissure-in-ano on day 21

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  Discussion Top


In this case report, the patient was young, staff nurse by profession, and was following a faulty lifestyle such as indulgence in spicy, junk food, and improper sleeping habits because of her day–night duty schedule. All these factors resulted in irregular bowel habits and hard stool, leading to anal fissure, which was associated with pain and bleeding during defecation. Even after taking a long course of conservative treatment, her complaints did not end. The important factors that were keeping her anal fissure away from normal healing were constant contamination of the wound by feces and frequent friction with the mucosa and her continued faulty lifestyle. By oral medications, she got relief in pain and irregular bowel habits but still her fissure was not healing with continued itching. She had tried almost all kinds of Ayurvedic and modern local applications but did not get any results even after correcting her lifestyle.

A number of Ghrit and Taila preparations such as Yashtimadhu Ghrit,[6]Jatyadi Ghrit,[7] and Jatyadi Tail[8] are in trend today for treating anal fissures. However, all these preparations have some untoward difficulties related to the availability of ingredients and cost-effectiveness. In this case, Khanduchakka, a folklore medicine in the form of Ghrit was used as a local medicament. Reason behind preferring Khanduchakka over other preparations is its easy availability throughout the year, providing the benefit of cost-effectiveness. It is said to be having Vrana (ulcer), Lekhan (scrapping), Shodhan (purification), and Ropan (healing) property.[9] Owing to all these properties, it gave significant results by healing a chronic fissure completely. This case opens the door to a new modality for further research work.


  Conclusion Top


It is quite difficult to treat chronic anal fissure. It takes a long time to heal. Many a times, it appears as a challenge before a surgeon because of its chances of recurrence. Various local application medicaments are available in day-to-day practice but all fail somewhere to heal a chronic fissure; therefore, search of a new substitute, which is more superior, is the need of time. In this case report, Khanduchakka, a folklore medicine, is used to treat chronic anal fissure, which has cured it successfully. As no research work is available on the efficacy of Khanduchakka (Ehretia laevis) on anal fissures, there is a lot of scope for further research works.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Williams MM Sanskrit–English Dictionary. 1st ed. Motilal Banarsidas publishers; New Delhi:1956. p. 591.  Back to cited text no. 1
    
2.
Yadavaji TA Dalhana nibandha saṃgraha commentary on Sushrut Samhita. In: Chikitsasthan. 9th ed, vol. 34. Varanasi, India: Chaukhamba Orientalia; 2002. p. 207-8.  Back to cited text no. 2
    
3.
Shastri B Vijayaraksita Madhukosa Commentary on Madhavakar: Madhavanidan: Grahaniroganidan. 23rd ed, vol. 65. Varanasi, India: Chaukhamba Orientalia; 1994. p. 567.  Back to cited text no. 3
    
4.
Das S A Concise Text book of Surgery. 9th ed. Kolkata, India: Somen Das Publisher; 2016. p. 1084-5.  Back to cited text no. 4
    
5.
Dhenge S, Khandare K Efficacy of local application of Khanduchakka (Ehretia laevis) ghrita in Dushtavrana: a case report. IAMJ 2016;4:3726-31.  Back to cited text no. 5
    
6.
Patel JR, Dudhamal TS A comparative clinical study of yashtimadhu ghrita and lignocaine-nifedipine ointment in the management of parikartika (acute fissure-in-ano). Ayu 2017;38:46-51.  Back to cited text no. 6
    
7.
Rao M, Kumar P, Das B Comparative study of efficacy of Jatyadi Ghrita Pichu and Yasthimadhu Ghrita Pichu in the management of parikartika (fissure-in-ano). IJAPR 2016;4:1-9.  Back to cited text no. 7
    
8.
Samantaray S, Bishwal R, Singhai S Clinical efficacy of jatyadi taila in parikartika (fissure-in-ano). WJPMR 2017;3:250-4.  Back to cited text no. 8
    
9.
Thakre R, Bhutada S, Chouragade B, Khobragade P, Harne K Unexplored wound healing property of Ehretia laevis Roxb (Khanduchakka) plant. IJRA 2016;7:54-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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  In this article
Abstract
Introduction
Case Report
Systemic Examination
Ashtavidh Par...
Local Examination
Investigations
Materials Used
Method
Assessment Criteria
Observations and...
Discussion
Conclusion
References
Article Figures
Article Tables

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