Introduction:

In Ayurveda, Parikartika is mentioned as a Vaman, Virechan and Basti vyapat. (1)

Parikartika is defined as localized cutting pain within the region of guda (2). Chakrapani mentioned synonyms of Parikatika as a Kshatgud and Vikartika (3). According to modern science fissure is defined as longitudinal ulcer in the lower anal canal.

Acharya Vagbhata also explained parikartika in the Chapter of ‘Atisar Grahni Dosha Nidan’ . According to Vagbhata the patient suffering from Vatik atisar has complaints of scanty motion and Hard stoo.while passing through anal canal it tears the anal margin causing parikartika. This disease also most commonly seen during pregnancy period in the females. Kashyapa has stated 3 types of parikartika i.e. vataj pittaj, & kaphaj & treatment accordingly in pregnant lady (4). hetu of parikatika are tikshna, lavan yukta, ruksha aushadhi in patient suffering from Shram , Mandagni & Mrudu koshtha (5).Acharya Sushruta has mentioned treatment of Parikartika as Deepan.,Pachan, Anuloman ,Sthanik Snehan- Swedan and Dusta Vranavat Chikitsa,Application of Yasthimadukadi varti having properties of vrana shodan & ropan which comes under heading of dustha vrana chikitsa.

Aims & Objectives:

1. To evaluate the efficacy Yashatimadhukadivarti for local application.

2. To compare the effect of Yashatimadhukadivarti & Diclofenac Sodium Suppositories in the management of Parikatika w.s.r to fissure in ano.

3. To derive a standard an easily accessible and Cost effective treatment for fissure in ano.

Materials & Methods:

Clinical study –

A) Study design – A randomized single bind comparative study in 60 patients.

B) Selection of Patient – Patient with Sign & Symptom of fissure.

Method:

Examination

i) History of Patients

ii) Systemic examination

iii) Local examination

a) Inspection

b) Palpation

c) Digital rectal examination

iv) Investigation: Routine blood investigation e.g. CBC, BSL, BT, CT, Blood Urea, urine routine & microscopc examination, stool examination for Ova & Cyst.

v) Specific investigation like VDRL, Culture & Sensitivity of wound if discharged presents & histopathological examination when required.

Selection of the patients:

Inclusion criteria

1. Age – all age groups

2. Sex – both male & female

3. Acute fissure (within 21 days)

4. Primary fissure

Exclusion criteria

1. Chronic fissure with tag

2. Secondary fissure

3. Internal piles

4. Ext. Thrombosed piles

5. Rectal polyp

6. Proctitis

7. CA of Anus & Rectum

8. HIV anal syndrome.

Total number of the patients taken for the study was divided in two groups

· Group A (Experimental Group): 30 patients were treated with yashatimadhukadivarti 10 gm.

· Group B (Control Group): 30 patients were treated with Diclofenac Sodium 100 mg Suppositories.

Drug study

Drug Material:

Yashatimadhukadivarti was prepared with Yashatimadhu kalka, Krushna Tila Kalka, Ghruta and Madhu (6)

Yashatimadhukadivarti was prepared at S.V.N.H.Ayurved College Rahuri, in the Department of shalya tantra & Diclofenac sodium suppositories were used from college medical stores of Neon Pharma (Brand name-Justtin) .

Route of administration – Anal Route

Dose –

Yashtimadhukadi varti 10 gm & Diclofenac Sodium Suppositories 100 mg once in a day

Time –morning after defecation

Duration of treatment - 21 days

Follow up – Every 5 days

Criteria of Assessment:

Sr. No.	Symptoms	Absent	Mild	Moderate	Severe	Makedly Severe
1	*Gudashula*	0	1	2	3	4
2	*Gudadadha*	0	1	2	3	4
3	*GudaRaktasrava*	0	1	2	3	4
4	*Kandu*	0	1	2	3	4
5	*Gudasrava*	0	1	2	3	4
6	*Malavashtmba*	0	1	2	3	4
7	*Mutrasang*	0	1	2	3	4
8	*Aruchi*	0	1	2	3	4

Result obtained from the study was assessed in the terms of percentage of relief as follows:-

Incurable - Below 25%

Improved - 25% to 50%

Markedly improved - 51% to 75 %

Cured - More than 75%

Observation & Result

Table No 1: Observation according to Nature of Diet

.Diet	Group A	Group B
Veg	6 (20%)	5 (16.67%)
Non- Veg	24 (80%)	25 (83.33%)
Total	30 (100%)	30 (100%)

Table No 2 Observation According to Kostha.

Kostha	Group A	Group B
Krura	19(63.33%)	20 (66.67%)
Madhyam	11(36.67%)	10 (33.33%)
Mruda	00	00

Table No 3 Observation according to Sphincter Spasm

Spasm	Group A	Group B
Present	28 (93.33%)	29 (96.67%)
Absent	02 (6.67%)	1 (3.33%)

Table No 4 Statistical analysis for Improvement in Gudshula in two groups

Variable	Mean Difference	S.E	Applied test	Calculated ‘t’ Value
1 day	1.43	0.21	Unpaired test	6.97
6 day	0.87	0.18	Unpaired test	4.89
11 day	0.83	0.17	Unpaired test	4.84
16 day	0.17	0.14	Unpaired test	1.15
21 day	0.03	0.07	Unpaired test	0.46

The table shows the statistical analysis for relief in gudshula in two different group where the ‘t’ value shows the significant value at 1^st day & there after till 11 day after 11 day of treatment both group shows equal results in gudshula. It means that said formulation can be used to relieve gudshula.

Table No 5 Statistical analysis for Improvement in Guddaha in two groups

Variable	Mean Difference	S.E	Applied test	Calculated ‘t’Value
1 day	0.3	0.15	Unpaired test	2.0
6 day	0.43	0.15	Unpaired test	2.85
11 day	0.7	0.13	Unpaired test	5.52
16 day	0.73	0.14	Unpaired test	5.27
21 day	0.73	0.09	Unpaired test	8.38

The table shows the statistical analysis for relief in Guddaha in two different group where the ‘t’ value shows the significant value at 1 day & there after till 21 day of treatment both group shows equal results in Guddaha. It means that said formulation can be used to relieve Guddaha.

Table No 6 Cardinal Symptoms Wise % of Relief at 21 Day

Symptoms	Group A	Group B
Gudashula	95.92	96.81
Gudadaha	97.70	75.00
Gudasrava	100	56.00
Malavashtmbha	89.66	65.63
Kandu	100	53.66
Mutrasang	80.00	00
Aruchi	100	18.18

Table No 7 Total Effect of Therapy on 60 Patient of Parikartika in Both Group.

Criteria	Group A		Group B		Total
Criteria	Patients	%	Patients	%	%
Cured	30	100	11	36.66	68.33
Markedly improved	0	0	19	63.33	31.66
Improved	0	0	0	0	0
Unchanged	0	0	0	0	0

Mode of Action:

Yashatimadhukadivarti contain drugs which are having Vrana Shodhana & Ropana Properties. These drugs posses Vata – Pitta, Shaman Properties. The disease is aVata Pitta predominant (7). Ghrita & madhu in Combination possesses Vrana Shodhan & Ropana Properties & they reduce Vata Pitta. Therefore the action of the drug is enhanced by Ghrit. It also reduces the Rukshata of Vayu & Maintains the normal tone of muscles. According to morden pharmacological action this combination has a potent Anti inflamataory and steroidal activity.( 8 ) The relief of severe pain within 24 hours is remarkable about this drug.

DISCUSSION & CONCLUSION

Majority of the cases show a complete healing of the ulcer or fissure within 3 weeks time under the influence of Yashtimadhukadi varti & by the end of 4 weeks almost all the cases have a complete healing while with Diclofenac sodium this period is extended to 4 weeks in most of the cases.

The use of Yashtimadhukadi varti has a definite advantage in the treatment of fissure in ano in terms of relief of cardinal symptoms, spasm & quick healing of the ulcer. Lastly the experimental management was found to be very effective in this disease.

REFERENCES

1. Pt. kashinatha shastri charaksamhita, reprint 2001, Varanasi Chaukhambha Bharati Academy, page no 1041.

2. Kaviraj Ambikadutta Shastri Susrut Samhita ,13 edition, reprint 2002, Varanasi, Chaukhambha Sanskrit Sansthan. page No 151.

3. Dr. Anantkumar Shekokar & Dr. Kanchan Shekokar, Shalya part 2, second edition, Ahmednagar, Shantanu Prakashan 2010, page No 306.

4. Srisatyapala Bhisagacharya, Kashyapa Samhita, 1^st edition, reprint 2009, Varanasi, Chaukhambha Sanskrit Sansthan page no 299.

5. Kaviraj Ambikadutta Shastri, Susrut Samhita, 13 edition, reprint 2002, Varanasi, Chaukhambha Sanskrit Sansthan. page No 151.

6. Dr.Pashmina Joshi,TO study the effect of Yashtimadhukadi yog in management of parikartika W.S.R. to fissure in ano, 2004, I.P.G.T. & R.A., G.A.U.,Jamnagar.

7. Kaviraj Ambikadutta Shastri, Susrut Samhita, 13 edition, reprint 2002, Varanasi, Chaukhambha Sanskrit Sansthan. page No 158.

8. Kirtikar and Basu ,2’nd edition , reprint 1997 ,international book distributor deharadun (Uttaranchal ),vol.1’st,p-728.