Javed. European Journal of Biomedical and Pharmaceutical Sciences www.ejbps.com 436 A CLINICAL TRIAL OF “BEADED” KSHAR-SUTRA & “DOUBLE” KSHAR-SUTRA TECHNIQUE IN THE CASES OF FISTULA IN ANO. Dr. Danish Javed* Ayurveda Surgeon and Expert in Marma Therapy, Clinical Registrar (Shalya), Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi. Article Received on 13/03/2017 Article Revised on 03/04/2017 Article Accepted on 24/04/2017 INTRODUCTION Bhagandara is a common ano-rectal disease. It can be co-related with fistula in ano. The first description of kshar sutra and its role in bhagandar comes from Charka samhita in the chapter of shotha chikitsa. [1] ” Father of Surgery", Acharya Sushruta mentioned it for the treatment of Nadi Vrana (sinus), Bhagandara (fistula-in-ano), arbuda (excision of small benign tumor) etc. [2] It was Chakrapani Dutta who in late eleventh century emphasized in his book Chakradatta, the method of preparation with a clear-cut indication of its use in bhagandar (fistula-in-ano) and arsha (hemorrhoid). [3] But because of brevity of preparation and inadequate explanation of procedure of application, it lost its popularity among Ayurvedic surgeons. Later on effort of Dr. P.J. Deshpande, brought back the usefulness of Kshar sutra for treatment of nadi vrana and bhagandara [4] At present, treatment of fistula-in-ano with the help of Kshar sutra is very popular among ayurvedic as well as allopathic surgeons. [5] Many of the surgeons are now establishing their specialized ano-rectal centers all over the India and providing the services related to the diseases of anal canal. Government sector is also very much concerned regarding encouragement of kshar-sutra therapy. Now, it is well known, that kshar sutra treatment is recognized as non-recurrence therapy for fistula in ano. Lot of the researches has been done to improve the quality of kshar sutra. [6] All of them are concerned with the coating material of drug by various means of kshar and latex. This study is not based upon the different type of coating material over thread; but it is a trial of two techniques “BEADED” Kshar-sutra & “DOUBLE” Kshar-sutra technique. So many studies have already been carried out with variations in the Kshara and the latex. The most remarkable are Guggulu Kshara sutra, Udumbara Kshara sutra, Gomutra Kshara sutra, Papaya tankana Ksharasutra, yava Kshara sutra, gritakumari Kshara sutra, aragvadhadi Kshara sutra etc. The standard kshar sutra is prepared by repeated coatings of snuhi ksheera (latex of Euphorbia nerrifolia Linn), apamarga kshar (water extract of ashes of Achyranthus aspera Linn.) and haridra powder (Curcuma longa Linn.) over a surgical linen thread no. 20. This thread is spread lengthwise in hangers. Each thread on the hanger is then smeared with snuhi latex with the help of gauze piece soaked in the latex. This wet hanger is transferred in kshar sutra cabinet for drying and sterilization. Kshar sutra cabinet has a source of hot air with regulated temperature to dry SJIF Impact Factor 4.382 Research Article ejbps, 2017, Volume 4, Issue 05, 436-441. European Journal of Biomedical AND Pharmaceutical sciences http://www.ejbps.com ISSN 2349-8870 Volume: 4 Issue: 05 436-441 Year: 2017 *Corresponding Author: Dr. Danish Javed Ayurveda Surgeon and Expert in Marma Therapy, Clinical Registrar (Shalya), Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi. ABSTRACT Kshar sutra therapy in cases of fistula in ano, despite a long medical history of credentials and conduct, still poses a challenge to medical fraternity in terms of finding satisfactory cure of disease. In this study, standard kshar sutra technique (SKST), a well known ayurvedic modality of treatment, has been compared with double kshar sutra technique (DKST) and beaded kshar sutra technique (BKST) for anal fistula. Forty five patients were selected randomly from OPD and IPD of department of ano-rectal surgery of Institute. All patients were randomly divided into three groups. Group (A) control group: 15 patients were treated with SKST; Group (B) control group: 15 patients were treated with DKST and Group (C) control group: 15 patients were treated with BKST. Same type of kshar sutra was used in all patients but technique used was different according to their group. Student’s t -test was applied for statistical comparisons. Value were interpreted as mean ±SD, p value < 0.05 was considered significant. Pain and burning sensation were found higher in group B and C, while the other symptoms like itching, duration of pain, discharge of pus were higher in group A. Double kshar sutra technique and beaded kshar sutra technique provide better, effective, safe and faster recovery in management of fistula in ano. KEYWORDS: Fistula in ano, kshar sutra technique, bhagander.