BHAGANDARA PIDAKA --Peri-anal abscess

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  You all know the great achaarya susruta described beautifully about various types of abscesses and their management...being the greatest surgeon himself he always advocated medicinal preparations whenever he felt the need of it.

He gave equal importance to the medicines as well as surgery..Which is a rare quality of any surgeon (they are always restless...they can’t wait)his beauty of treatment lies in his observation of the disease and its management accordingly...
The most surgical advanced books of our era still follows his parameters...
Here I would like to share my practical experiences regarding peri-anal abscess (I always skip theory part thinking you all know better than me...It’s true also) and treatment modalities.. Some of them you may not find in text books..
Bhagandar pidaka you can compare it as peri anal abscess....There are so many internal reasons for abscess in that reason known to you but sometimes(external) infection of the hair root (furunculosis) can also create a deep abscess there (remember arvaacheen and paracheen type of bhagandar mentioned by susrut)
1. Dont put knife on apakwa state
2. Never give antibiotics in apakwa state...sometimes it will be hardened and may create bigger problem when the bad time comes.
.3. In vaataj type of abscess shigru patra lapam is very useful for making it pakwa..
2. In pittaj type you can apply mulethi +saariba +milk...lep is very useful
3. Jalouka prayog is very useful and safest method in pittaj vidhradhi (all types vidhradhi)4. Althoguh sira vyadhan is indicated in vidhradhi but I didn’t find any benefit...it can be very well managed with medicinal and surgical therapies
5. kaphaj vidhradhi-lep it with simple clay (you can use multani mitti) mixed with gomutra
Coming to surgical aspect
1. Once it is in pakwa state...
2. Always make a kakapada(cruciate +) incision without any hesitation care should be taken and avoid sphincter injury...
3. Always drain out entire pus
4. Try to destruct pus locules inside(pus compartments) by putting your finger or artery forceps
5. Never use spirit or betadine and strong other chemicals ...sometimes you may need hydrogen peroxide...(you can use it if there is any excessive slough and if couldn’t be managed with surgical debridement.
6. After cleaning(syringing technique) the wound with vrana sodhanand ropan kashayas(you can prepare it ...nimba ..karanja..panvha valkaa..triphala...shigru...there so many options and all are better than our so called betadine ..)
7. Always remember to put fresh gauze piece (roll) should stuffed inside the wound without any medication for 2 to 3 days (because dry gauze piece has more squeezing capacity (hydrophilic property) of the secretions and pus of the abscess than the medicated one...because with medicine it ...It cannot squeeze the pus effectively)
8. Never seal the pus outlet with microspore and leucoplast...Air ventilation is best maintained by putting a thin gauze piece over the wound and use a micro pore ribbon close it is in plus mark fashion
9. Dressing twice daily is must for this type of abscesses otherwise risk of becoming fistula is not uncommon...I think I should end here..It’s an endless topic
(Twist of the tale...one young girl (known to me) came to my OPD and said innocently...doc!doc! I have pimple at my bottom..Then I immediately said..Don’t apply Clearasil to it..Leave it to us..It’s our headache now)THIS ARTICLE IS DEDICATED TO THE INNOCENT PATIENT OF MINE...OFCOURSE! SHE IS FINE NOW...



Courtesy:
Dr. T. Divakar Rao