Diagnosis and Management of Ano-Rectal Diseases (Critical Analysis of Ancient Concepts in the Light of Modern Medicine)

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Preface

Ano-rectal disorders are progressively increasing in the society. Few important causes out of a number of them are sedantary life style, irregular and inappropriate diet, prolonged sitting and psychological disturbances like anxiety and depression etc. Ano-rectal problems coupled with psychological manifestations, all are the causes inter-related to each other. These above mentioned causes result in derangement of Jatharagni (Power of digestion) which leads to constipation and other associated symptoms. It has been mentioned in ancient classics, that the derangement of Jatharagni leads to all kosthagata rogas hence, ano-rectal disorder also. A constipated bowel is the devil's workshop. The fecolith so formed due to constipation, while passing through anus produces trauma to anal valve and it results in the genesis of anal fissure. Crypto-glandular infection leads to ano-rectal abscess and fistula. Constipation increases the back pressure into haemorrhoidal veins to produce piles. By referring to the above examples, it could be said unanimously that constipation is the sole cause for most of these disorders. The fast-food culture has again worsen the condition as these foods are devoid of fibre. Once, these disorders get root in any person, the vicious circle of events is started because one condition may give rise to another one.

These disorders are utterly embarrassing to the patient. The peri-anal skin is one of the most pain sensitive region in the body due to rich nerve endings. By the above reasons, even a mild form of disorders can produce great discomfort to the patient. It has been observed that in the initial stage of the disease, most of the patients avoid consulting to the doctor and explaining their problem particularly because they feel ashamed. They try to prevaricate it. The tendency is still more in females. It will lead to manifold increment in the disorder. When they come to consult, they are too mentally disturbed to lose the interest in life. Few of them even try to attempt suicide. I have seen most of the patients suffering from ano-rectal problems, also gripped by one or other sort of mental disturbances in the form of anxiety or depression.

Among the list of ano-rectal disorders, following are commonly seen. They are fistula-in-ano, fissure-in-ano and haemorrhoids. Ancient and modern physicians equally consider these conditions difficult to cure. Moreover, fistula-in-ano among these three disorders is the most notorious one to tackle and cure. Results of surgery (fistulectomy) seem to be embarrassing as its recurrence is inevitable in most of the cases even after complete excision of the track and meticulous dressings. There is a proverb oftenly used by modern surgeons about this disease that “If you have enmity to a doctor, refer him a patient of fistula-in-ano and it will never heal”.

The challenges as described above were accepted by the Alumni of the Shalya-Shalakya department, BHU, and a scientific approach was made towards the management of these miserable disorders. The ano-rectal clinic was established three decades ago in the S.S. Hospital, B.H.U. The references on the management of ano-rectal diseases were collected and shaped into scientific framework. As a result of studies on these valuable references collected from the ancient texts, the ksarasutra came into existence. The treatment of fistula-in-ano was revolutionised after the availability of ksarasutra. The ksarasiitra was standardised. The revolutionary steps so-called had facilitated its spread not only all over the countary but also abroad alike. We would like to say in single sentence that the successful management of fistula-in-ano by application of ksarasutra method is the marvellous outcome of Ano-rectal clinic at S.S. Hospital BHU. Over six thousand of paticnts of fistula-in-ano have been treated successfully till dated at this centre. Not only this but the students trained here have spreaded this technique all over the country. At present, the fistula-in-ano is not a big challenge as recurrence rate is almost nil after ksarasutra treatment. Beside the ksarasutra treatment, the department of Shalya Tantra at B.H.V. and Tibbia College have also been engaged to search out different other treatment modalities for different types of ano-rectal disorders like Haemorrhoids, Fissure-in-ano, etc. Most of the disorders can be treated by the use of the Ayurvedic medicines only and surgery is rarely required. Patients with prolapse rectum are almost associated with gastrointestinal disturbances (disturbed agni). Ayurveda has provided several methods to correct agni. By treating these disturbances with the help of medicines, the patients get benefit to agreat extent.

Peoples have now turned their faith towards Ayurveda to resolve their problems. Due to this changed vision, the demand of Ayurvedic proctologist has suddenly been increased manifold. Proctology has emerged as a specialised branch of Ayurveda. In our opinion, this is the need of hour to give a viable cover of propagation to this science before the public. However, it is surprising that neither government nor Ayurvedic specialists are trying to expand this knowledge worldwide.

We have observed thoroughly, the utmost efficacy of Ayurvcdic treatment in ano-rectal disorders. Overall, we have seen the miraculous effects of Ayurvedic drugs particularly in the management of ano-rectal disorders.

Meanwhile We have decided that why should we not process some material in the shape of a book duly giving detailed informations on different topics of ano-rectal diseases including their diagnosis and management. It was our view from the very beginning that all ancient principles should be analysed critically in the light of modem advancement. This endeavour, in our opinion will bring-out phenomenal results not only in the field of therapy but equally in other fields also.

No any book containing comprehensive information on ano-rectal disorders so far is available in the market. Owing to this very reason, students and practitioners both feel discomfort. It further stands as a cardinal cause for limited expansion of this special knowledge.

The readers will find an Illustrative one as we have given several sketches, diagrams and photographs for understanding the contents in easy and orderly manner. This treatise is absolutely based upon practical aspects and students & practitioners both shall able to do whatever they are supposed to do. We are quite optimistic that this work will prove beneficent to the suffering humanity at large via medical students and practitioners. It is hoped further that the book will provide with adequate information to all those who have a direct or indirect nexus with therapy described herein. There may be some mistakes escaped in the book because of being it a manual work and to error is in human. Readers are therefore, requested to forget them and grasp positive as much as they can. It is further requested to communicate their viable suggestions so that the same could be incorporated in the revised edition of this work. May this treatise ease the practice of physicians and relieve the patients form Ano-rectal disorders.

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