KALA SHARIRA

                            

          The Knowledge of bodily structure is invariably essential for its benefit i.e, for keeping the body healthy. A physician unless & until knows all the intricate secrets of this body, he cannot comprehend the factors that are beneficial for this body.

          Acharya Sushruta pioneer of Rachana Shareera presented the science of Kala Shareera in the chapter “Garbhavyakarana nama shareera” under which he tried to emphasize the concept of kala along with fundamental science.

       While composing the Anatomical and Physiological Sciences Ayurvedic acharya’s thought much for the basic constituents of the body (Dhatu) and their substratum (Ashaya). While considering upon the ashaya they had also thought of the linings making internal walls of the ashaya, designating them as Kala.They presented it in a very silent way.

Definition of Kala According to different Acharya’s,

 According to Sushruta Samhita:        

      Seven kalas are appearing as structure intervening between dhatu and their seat ashayas. Among the seven kalas, fourth is Shleshmadhara-kala is very important amongst all of them which is situated in all the sandhis (joints).Thus the Shlemadhara-kala present in all sandhis facilitates their proper functioning

 According to Ashtanga Samgraha and Ashtanga Hrudaya:

         Both Acharyas given similar description  i.e  The moisture that remains inside the spaces in the dhatus (tissues) gets cooked (processed) by the heat present in them (tissues),   forms into structure similar to those found in the wood (tree) and become covered with snayu (tendenous sheath), shlesma (kapha) and jarayu (chorionic membrane). It is called as kala, because it is formed from very little quantity of rasa, and essence of dhatus (tissues).

 According to Bhavaprakasha Samhita:

 The kleda (lubricating material, moist substances) present inside the dhatu (tissue), ashaya (organ/viscera), and dhatvantara (places in between organs/tissue) which gets cooked by the dehosma (heat of the body tissues) is known as kala.

  According to Sharangadhara Samhita:   

          The moisture present in the dhatus undergo transformation by the heat of the body and forms into structure known as kala. (Lining membranes, sheaths coverings and secreting membranes).

Details of kala According to Sushruta  Samhita:

The kalas too number seven in all and are situated at the extreme borders (forming encasement and support) of different fundamental princeples (DHATUS) OF The organism.

Memorable verses- as the duramen or core of a piece of wood or stem become exposed to view by cutting in to it so the root principles of the body may be removing the successive layers or tissues of its flesh. These kalas are extensively  supplied with snayus (fibrous tissues),bathed in mucous ,and encased in a membranous covering.

branch out.

The moisture present inside the dhatu and asayas cooked by their own heat (of each dhatu and asaya) become transformed in to structures called kala,just as essence gets formed in the trees .these  are covered with sleshman (kapha),snayu(tendenous waxy material) or apara (chorion); these are seven in number .

Identification of these structures known as kala has still remained a problem. These are generally assumed to be thin membrance , responsible for certain specific functions. Their names and details as furnished in susruta samhita chapter 4 of sarirsthana is as follows –

1) Mamsadhara kala- present inside the muscles and allow the formation of net work of veins, arteries, tendons and other tubular structures.

2) Raktadhara kala – present inside the muscls and more in the liver and spleen and holding the blood inside them

3) Medodhara kala – present in abdomen and interior of the bones holding the bone marrow (red marrow in small bones and yellow marrow in big bones)

4) Sleshmadhara kala- present inside the bony joints providing lubrication for easy movement.

5)-Purisadhara kala- present inside the pakvasaya and (intestine) attends to the function of separation the waste (faecal matter) at the unduka.

6) Pittadhara kala- present inside the amasaya (stomach and duodenum) with holds the ingested food for sometimes in the amasaya and attends the cooking of food.

7) Sukradhara kala- present in the right side of the urinary bladder spoken in terms of modern anatomical knowledge, they may be identified as-

Mamsadhara kala- seath or separating membranes of individual muscles

 Raktadhara kala- heamopoitic membranes of liver and spleen.

 Medodhara kala- membrane secreting synovial fluid

Sleshmadhara kala.-is present about all the joint and it is synovial membrane

purisadhara kala- mucus membrane of the intestine attending to absorption

Pittadhara kala –mucus membrane of the stomach ,duodenum and small intestine attending to digestion of food

Sukra dhara kala- membrane inside the testis and seminal ducts,producing and transporting semen

                  Reviw of Shleshmadhara Kalasharir :

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Sushruta has mentioned 7 kalas they are called as boundaries between the Dhatus and Aashaya, named as Dhatvashayantar-Maryada. Kleda which is present in between the dhatu and aashaya metabolized under the influence of dehoshma thus it forms the kala.  

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Shleshmadhara-kala is very important amongst all of them which is situated in all the sandhis (joints).Thus the Shlemadhara-kala present in all sandhis facilitates their proper functioning.

Shleshmadhara kala:

The kala (lining) having importance in the present subject is Sleshmadhara. It is stated to be present in all joints. The shleshma contained in the sac lubricates the joint and enable them to function smoothly like a wheel which easily rotates upon a well greased axile.

Shleshaka kapha:

It is one of the components of Kapha dosha which located at Sandhies to help in their function, these components if the bony joints firmly united, protect their articulatation and oppose their separation. These functions are helped by the qualities of Kapha Dosha such as Snigdha, Shlakshna, Picchila and Mritsna.

                                Synovial membrane

                             

 synovial membrane of the knee joint lines the capsule. Except posterior where it is reflected forward by the cruciate ligaments, forming a common covering for both ligaments.

    In front, it is absent from the patella. Above the patella, it is prolonged upwords for 5 cm .or more as the suprapatellar bursa, belOw the patella, it covers the deep surface of the infrapatellar pad of fat, which separates it from the ligament patellae. A median fold, infrapatellar synovial fold, extends backwards from the pad of fat the intercondylar  fossa of the femur. an alar fold diverges on each side from the median fold to reach the lateral adages of the patella.

Unfolding suprapatellar recess.

Anteriorly, the reflection of the synovial membrane lies on the femur; located at some distance from the cartilage because of the presence of the suprapatellar bursa. Above, the reflection appears lifted from the bone by underlying periosteal connective tissue. In a standing posture, the suprapatellar bursa is seemingly redundant. It is however also referred to as the suprapatellar synovial recess as it gradually unfolds as the knee is flexed; to open up completely when the knee is flexed 130 degrees. The suprapatellar bursa is prevented from being pinched during extension by the articularis genus muscle. On the tibia, the anterior reflection and attachment of the synovial membrane is located near the cartilage.

Anteriorly, the infrapatellar fat pad is inserted below the patella and between the two membranes. It extends from the lower margin of the patella above, to the infrapatellar synovial fold below. With its free upper margin, this fold extends dorsally through the joint space to surround the two cruciate ligaments from the front, thus dividing the surrounding joint space into two chambers. Laterally of this are a pair of alar folds.

Posteriorly, the femoral attachment of the synovial membrane is located at the cartilaginous margin of the lateral and medial femoral condyles, why the joint space has two dorsal extensions. Between these, the synovial membrane passes in front of the anterior and posterior cruciate ligaments, why these ligaments are both intracapsular and extra-articular with their tibial attachment located exactly on the cartilage margin. Both the lateral and medial meniscus is, however, located within the synovial capsule

It is a thin, but strong, fibrous membrane which is strengthened in almost its entire extent by bands inseparably connected with it.

Above and in front, beneath the tendon of the Quadriceps femoris, it is represented only by the synovial membrane.

Its chief strengthening bands are derived from the fascia lata and from the tendons surrounding the joint

Synovial fluid:

        The synovial membrane secretes synovial fluid (ov = egg) which forms a thin film over the surfaces within the articular capsule. This viscous, clear or pale yellow fluid was named for its similarity in appearance and consistency to uncooked egg-white (albumin). Synovial fluid consists of hyaluronic acid, secreted by fibroblast-like cells in the synovial membrane and interstitial fluid filtered from blood plasma. Its several functions include reducing friction by

lubricating the joint and supplying nutrients to and removing metabolic wastes from the chondrocytes within articular cartilage. Synovial fluid also contains phagocytic cells that remove microbes and the debris that results from the normal wear and tear in the joint. When a synovial joint is immovable for a time, the fluid is quite viscous (gel-like) but as the joint movement increases the fluid becomes less viscous

Bursae

 Bursae of the knee joint

The numerous bursae surrounding the knee joint can be divided into the communicating and the non-cummunicating bursae:

     Communicating bursae:

   The suprapatellar bursa, the largest bursa, extends the joint space anteriorly and proximally.

  The subpopliteal recess and semimembranosus bursa are located posteriorly and are much smaller

 The lateral and medial subtendinous bursae of gastrocnemius are located at the origin of the two heads of the gastrocnemius muscle.

 Non-communicating bursae:

 The subcutaneous prepatellar bursa is located in front of the patella.

   The [deep] infrapatellar bursa is located under the patella, between the patellar ligament and the fibrous membrane of the joint capsule. It is communicating with the joint space in particular cases.

  Other less regularly present bursae include the subfascial prepatellar, the subtendinous prepatellar, and the subcutaneous prepatellar bursae.

Adding to the complex structure of the knee space, there are remnants of three embryonic septal divisions of the knee space called synovial plicae:

  The suprapatellar plica dividing the suprapatellar recess

 The infrapatellar plica, in front of the anterior cruciate ligament, reaches from the intercondylar notch to the infrapateller fat pad

 The medial patellar plica, located adjacent to the patella's medial facet, runs vertically along the medial joint capsule 

ROLE OF PANCHTIKT GHRITA KSHEER BASTI ALONG WITH OTHER AYURVEDIC TREATMENT IN THE MANAGEMENT OF KHALITYA (ALOPACIA).

 Basti is one of the most powerful of all the main five procedures    of Panchakarma. Charaka as well as many other Ayurvedic scholars have     unanimously praised the features of Basti. Basti is said to be equal to half of all the Ayurvedic treatments.

Basti is the introduction of herbal decoctions and medicated oils into the colon through the rectum. While it directly affects the colon, it is not a localized or symptomatic treatment. It is a highly specialized procedure aimed to achieve a therapeutic goal and must be carried out in hospital settings by an expert.

In today’s developing world there are lots changes in the eating habits and the lifestyle. Due to which its ill effects are seen on the body and out of which hair is affected the most. And hair fall has erupted as a major problem.

        Acharya Shusruta had said in his Shushruta Samhita that the Drusthi and the lomkupa never grow throughout lifetime but hairs and nail do. Acharya Charaka has also mentioned in his text that hairs are the mala of Asthi Dahtu. Acharya Sharanagdhara has mentioned that kesha, loma are the updhatu of Majja Dhatu.

Acharya vagbhata said that Asthidhara kala reside on Pakwashaya and pakwashaya is the main Stahana of vata and Basti is the main treatment of Vata Dusti. Panchtiktaksheer Basti provides nourishment to Asthidhatu after that mala of Asthi (hair) also get nourishment and improved hair fall.

Presently available modern medication for alopecia   is causing many side and toxic effect and when we stop the medication hair fall increases and it is requires long term medication or life time which suppresses immunity and produces other diseases like libido.

Hence there is a need to find such a therapy which gives better relief without any side or toxic effect and also natural, cost effective and easily available. hence the Ayurvedic Basti and other supportive treatment required for this Asthi Vikara like that alopecia.

Key words –khalitya, panchtikt kscheer Grita Basti

Introduction

It is said that face is the mirror of our personality and it should be maintained from the hairstyle we keep.

The most who are affected with this problem is the young population not only men but also women’s. And people are spending lots of money to get rid of this problem but all in vain. In our ancient ayurvedic Granthas it is said that hair and nail are the Malas of the Asthi Dhatu ie they develop from the Asthi Dhatu.

Acharya Charak said that main treatment of Asthivikaras is Panchtikta Sidhha Basti. So this  study a small effort to find out role of Panchtikta ksheer Basti along with other supportive treatment in the management of hair loss.

CAUSES OF HAIR FALL:-

Ayurveda

1)   Virudh aahara vihara

2)   Pitta vardhaka aahara vihara

3)   Hina, mithya, and aatiyoga of aahara, nidra and bhramachaya.

4)   Consuming polluted water

5)   Living in polluted environment

6)   Non application of oil on the scalp

7)   Consumption of dushi visha

Modern

1)   Fungal infection (tinia capitis)

2)   Ulcerative colitis

3)   Vit B12, iron, zinc, biotin and also vit e deficiency

4)   Over dosage of vit A

5)   Lack of vit B6 and folic acid in food

6)   Rheumatoid arthritis

7)   Thyroid dysfunction

8)   Vitiligo

9)   Radiotherapy and chemotherapy

10)               Systemic lupus erthrematus

11)               Psychological stress

12)               Nutrition

13)               Seborhhic dermatitis

14)               Hormonal imbalance

15)               Folliculitis

16)               Secondary syphilis  and usage of drugs like warfarin and heparin

17)               Usage of contraceptive pills antihypertensive drugs and anti diabetic drugs.

18)               Anemia

19)               Long term usage of steroids

20)               Over usage of shampoo containing Selenium.

Ayurvedic Concept and Samprapti of khalitya-

          Acharya Sushruta have mentioned about hair fall in sushruta samhita nidan sthan there are three stages

1)   Khalitya (alopecia totalis)

2)   Palitya (whitening of hairs)

3)   Indralupta (hair fall in patches ie alopecia areata)

“Romakupanugam pittam vaaten saha murchitam |

Prachyavayati romani tata: shleshma sahshonitam||

Runadhi romkupanstu taato anyesham sambhav|

Tad indraluptam khalitya rujyeti ch vibhajyate||”. Su. Ni. 11

The meaning of the above phrase is that when the vaata Dosha get vitiated along with Pitta Dosha it goes into the Romkupam ie the hair follicles and which results in hair fall. The next pathology that occurs is that the Rakta Dosha along with the kapha Dosha goes in the romkupas whish cause the romkupas to close

Which ultimately results in non growth of hair from that respective follicle. This disease is known as indralupta, khalitya, or rujya.

Strotasa that get involved in the following pathology.

1)   Swedawaha strotasa

2)   Asthivaha strotasa

3)   Majjavaha strotasa

4)   Rasavaha strotasa

5)   Purishvaha strotasa

Modern concept:- 

  Alopecia is a condition in which there is a loss of hair from head and body. Alopecia can refer to general hair loss or male pattern baldness. In a normal individual there are 1 to 1.5 lakh of hairs.

Mainly there are two types of alopecia

1)   Scarring

2)   Non scarring 

1)           Scarring: - The type of baldness the hair fall in which the hairs fall with the follicle and is known as scarring alopecia . In this type of baldness there is no chance of hairs growing back after falling.

2)           Non scarring:- The type of baldness in which only the hairs falls and not the follicles so there is a chance that the hairs grow again. The main cause of non scarring baldness is Telogen effluvium.                

In women the ovarian and adrenal gland dysfunction causes the hairs to fall.

WAY TO GROW:-                

                   Hair grow in three different cycles

1)   Anagen

2)   Catagen

3)   Telogen

About 90% of the hair of the head is in the anagen or the growing phase, which last for anywhere from 2 to 8 years. The catagen or the transition phase typically last for 2 to 3 weeks during which the follicles shrink. During the telogen cycle which last for around 2 to 4 months the hair rests.

Hairs grow about 6 inches a year for most people. In a normal individual hair falling of 100 to 150 hairs per day is a normal thing but more than 150 per day hair e fall would indicate there is a problem.

Drug review –

Panchatikta Grita ksheer Basti-

Panchatikta Gritaksheera Basti was described by Chakra and vagbhhata, as very safe and effective in Asthi vikara like osteoporosis etc.

Indication –

ASTHIKSHAYA

Content and dose of panchtiktagritakscheera basti-

1-Makchika -20ml

2-Saindhava lawan -2gm

3-Panchtikta Grita -20ml

4-Panchtikta ksheera paka -50ml

Total -120ml

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Material and methods:

The present clinical study is a case study. The aim of the clinical study is to evaluate the effect of panchatikta Grita ksheera Basti and oral use of other ayurvedic supportive treatment in the patients suffering from alopecia.

Material:      1-panchatikta Grita ksheera Basti

                   2- kukkutand twak bhashama

                   2) Rubber catheter

                   4) Glycerine syringe ect.

Method

 Study was carried out over a period of 1yr in M.A. Podar Ayurved hospital, Worli Mumba. Total 15 selected Patients of the male sex between the ages 20 to 40 year with condition of alopecia (khalitya) were selected on the basis of selection criteria.

In  Group-A panchatikta ksheera Basti  and in Group-B Panchatikta Grita kshheera Basti  along with oral administration of kukkutand twaka Bhasma 500 mg. BD was given after meal.

At the time of baseline assessment, a profile of heamogram, biochemical investigations

 Serum calcium

 Serum alkaline phosphatise was obtained  

Duration of treatment in 3 cycle-14 days and 15 days gap was given after each cycle.

Follow-up:  monthly once for 3 months

Preparation of Basti Dravya-

10 gm of panchatikta bharad was taken and 200ml water was added to it and boiled up to only 100ml left.50milk was added to it and again boiled up to the only kwatha left. After that 20 ml Panchatikta Grita , 2gm Saindhav lavana and 20ml Madhu was added. This mixture will be used as Basti Dravya.

Time of administration- After lunch.

Mode of action of Basti-

As per modern medical science in Basti or enema, drug is administered by transrectal route. The rectum has rich blood and lymph supply.

Drug can cross rectal mucosa like other lipid membranes, thus by entering in general circulation, Basti drugs can act on whole body. Action of Basti in body follows ‘laws of osmosis’ Niruha Basti is hyper osmotic – It facilitates absorption of morbid substances from blood into gut. And helps there expulsion. Whereas Anuvaasan Basti is hypo-osmotic and hence gets absorbed in the blood. And helps in nourishment of body. Electrolyte help in ionic exchange Basti acts through collaboration between enteric nervous system and central nervous system. Internal viscera are highly supplied with nerve fiber of Autonomic Nervous System which in turn has connection with CNS

 Basti causes visceral afferent stimulation .hence activates hypothalamus, pituitary, adrenal and ANS, Thus it increases secretion of hormones and neurotransmitters.

Sneha Basti flourishes normal bacterial flora, thus it increases endogenous synthesis of vitamin B12 and Vitamin- K.

Sneha Basti causes increments in fatty acids and proteins hence give nourishment to body. Bruhan Basti like ksheer Basti increases phospholipids levels. Phospholipids form cell membranes and hence give stability to cells

Criteria for selection of patient-

A) Inclusion criteria:-

1)   Sex –  Male

2)   Age group -20 to 40 years

3)   Patients having sign and symptoms of alopecia.

4)   Patient fit for Basti.

B) Exclusion criteria:-

.

1)   Above 40yr age and below 20yr.

2)   Patient not fit for Basti.

3)   Alopecia totalis

4)   Drug induced alopecia,

5)   patient with hormone therapy

6)   chemotherapy

AYURVEDIC LINE OF TREATMENT

1.pachana and deepan

2.snehan and swedan

3.panchakarma (virechana)

4.nasya (yastimadhu tail).

5.basti (panch tikta kshir)

6.dhumpan

7.shirodhara

8.Rasayana chikitasa   9.Abha Guggul

MODERN  LINE OF TREATMENT

The management of baldness is a multidisciplinary effort that spans the medical, pharmaceutical, food supplement, and exercise and fashion industries.

1. finesteride and minixidol are usually first line therapy for its treatment. Other options include tropical or systemic spironolactone or flutamide, at through they have a high incidence of feminizing side effects and better threated in female androgenic hair loss.

A number of other medication used commonly off label are dutasteride and ketokanazole and in female androgenic alopecia spironolactone and flutamide.

Combination of finesteride, minoxidol and ketokanazole are more effective than individual use, suigesting synergistne effects of the medication

2 More advanced cases may be resistant or unresponsiveness to medical therapy, however and require hair transplantation.

Discussion

1.   As per Ayurveda Basti is mainly indicated in Vata predominant diseases. The two types of abnormalities of Vatanamely; Avaran and Dhatukshayjanya can be treated by Basti karma. Direct application of this type of treatment to colon helps not only in regulating and co-coordinating and Vatadosha in its site, but also controls the other doshas involved in the pathogenesis of the disease (S.S.Chi.35/6). Basti is used in Sakhagat, Tiyarkgamidosha, kosthagatrogas. Among them panchtikta ksheera basti is anubasan Basti used in Asthi kaschaya.

As per ayurveda main sthana of vata is pakwashaya and according to vagbhata asthidhara kala situated in the pakwashay so this Basti provide nourishment to asthi and as we know hair is mala of asthi.

Charak also said that treatment of asthivikara is panchtikta sidhha Basti .so this Basti prevent Asthi kschaya and prevent hair fall.

2-Ayurveda explains health as equilibrium of the Dhatus "Dhatu Samyam Arogata". Among the Dhatus, Asthi is blessed with the function of Shareera Dharana. Any derangement in Asthi results in disease. Asthi Kshaya is a condition in which there is Kshaya of the Asthi Dhatu. Asthi Kshaya may be compared to Osteoporosis, in which there is a decrease in bone mass leading to bone fragility and fractures. kesha and nkakha are malas of Asthi. so Asthi kashya also promote hair fall . According to the principle of Ashrayaashrayee Bhava, when Vata increases Asthi decreases because, both are inversely proportional to each other. Classics mention the use of Basti prepared with Tikta Dravya, Ksheera and Ghrita for the treatment of Asthi Kshaya. To assess the efficacy of Tikta Ksheera Basti and kukkutand twaka Bhasma in the management of alopecia, present study was undertaken on 30 patients of hair fall.

Conclusion-

2.   In Group - A significant result were obtained in hair fall

3.   In Group-B highly significant results were obtained in hair fall

4.   It was observed that relief in sign and symptom of hair fall was found in the both group correlatively Group-B group showed better result.

After study it is observed that the drug is highly effective in both groups the percentage relief was more in group -B. than in Group.

Pathyapthya-

Sr. No.	Pathya	Apathya
1	Milk ,Egg , protein diet Vit-c, Shigru, Laghu Aahaar , Ghrita, fruits ,almond , vitamin –E, black til tail and seed, mustard oil, sleep.	Pitta and rakta parkopak aahaar. Nidra veg vidharana, purisha veg vidharana.

FISSURE IN ANO

Pain is a most terrible lord of mankind than even death himself

-          Albert schweitzer

      Anal fissure is one of most painful condition among the anorectal disorder. In classical Āyurveda literature, Anal fissure is termed as Parikartika. It is a common anorectal condition in terms of prevalence it ranks third after chronic constipation and hemorrhoids, but exact data of its prevalence is rare. The true prevalence of anal fissure though is not known but it is estimated that they account for 6% to 15% proctology diseases.

          On the basis of symptoms, the disease fissure-in-ano can be compared to the disease Parikartika according to Āyurveda. Ācārya Dalhana has described the term Parikartika as a condition of Gudā in which there is cutting and tearing pain. Similarly, Jejjāta and Todara have clearly described Parikartika as a condition which causes cutting pain in anorectum. The factors responsible for causation of Parikartika as found in various texts are Vamana-Virecana-Vyāpada , Bastikarma Vyāpada , Atisāra, Grahani, Arśa, Udāvarta etc. In the similar manner, it has been described of three types viz. Vātaja, Pittaja and Kaphaja. Suśruta while describing the symptoms of the disease speaks of the features like, cutting or burning pain in anus, penis, umbilical region and neck of urinary bladder with cessation of flatus. Whereas Caraka has described the features like, pricking pain in groins and sacral area, scanty constipated stools and frothy bleed per anus.

          An alarming rise in the incidence of the disease fissure-in-ano and no known satisfactory remedies evolved so far has given an impetus to find out a suitable solution, with altogether better effects from among the treatments advocated by the ancient Āyurvedacāryas.

An anal fissure is a painful linear tear or crack in the distal anal canal. In Ayurveda anal fissure termed as Parikartika.

Fissure-in-ano is very common and painful condition fissure occur most commonly in the midline posterior. In males fissures usually occur in the midline posterior- 90%, and much less commonly anterior 10%. In females fissures on the midline posterior are slightly commoner than anterior (60:40).

On the basis of the clinical symptoms the disease fissure-in-ano has been classified into two varieties, viz. acute fissure-in-ano and chronic fissure-in ano. Either acute or chronic, pain or bleeding are the two main symptoms of this condition, pain is sometimes intolerable. In long standing cases it may be associated with hemorrhoids or a sentinel tag. Pruritis ani may be another symptom of this condition. So, to restrict the progress of the disease and emergence of complications, so this disease should be treated early.

           The present trend in the treatment of fissure-in-ano depends on the type of the disease, e.g. in cases of acute variety with short history of the problem can be treated on the conservative lines, which include oral pain killing medication to be taken before anticipated bowel movement. Stool softener may be used to make the stool soft enough, weak bulk laxative or cathartics are the use. Soothing ointment, self dilatation etc. are considered to be effective. Sometime fissure does not heal by conservative treatment, this could be happens due to scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain or bleeding.

       Whereas in chronic ulcer Anal dilatation, posterior sphincterotomy and fissurectomy and excision of the anal ulcer are the gold standard treatment modalities but still recurrence have been recorded in the long due course.

             Keeping the above disadvantages of various treatment modalities, A comparative study of ksārasūtra application to fissure in ano with standard sphincterotomy procedure is selected in management of Parikartika. The well accepted sphincterotomy procedure not only relieve the spasm of anal canal instantly but also minimize the pain during defecation. But in long due course recurrence have been recorded, even with the sphincterotomy procedure. 
BY.Dr.Manoj Dubey

AYURVEDCHINTAN: Basti karma an important procedure of Panchkarma

AYURVEDCHINTAN: Basti karma an important procedure of Panchkarma: oÉÎxiÉ ÌlÉÂÌ£ü : v   uÉxÉÑ - ÌlÉuÉÉxÉå – zÉUÏUqÉåÇ erÉÉSÉ SåU UWûMüU MüÉrÉï  MüUlÉåuÉÉsÉå v   uÉxÉç - AÉcNûÉSlÉå  urÉÉZrÉÉ : •...