The treatment of painful condition, fistula-in-ano is being done by surgery. It is not surprising that many people would like to avoid the surgery, if possible. It has become possible now. And this is due to the pioneering work of the Late Professor Deshpande of the college of Medical Sciences, Varanasi, and the painstasking work of a team of research workers and scientists at New Delhi, Chandigarh, Wardha and Bombay. All the information was compiled with dedication by Dr G.V. Satyavati and her team at the Indian Council of Medical Research, Who have come up with an alternative nonsourgical treatment for this condition. This could be considered as one of the contributions of Ayurveda and Indian research on using international therapeutics.
‘Kashaarsootra’, the Ayurvedic medicated thread was described as a method of treatment for fistula-in-ano by the Indian surgeon Sushruta in his famous treatise Susbruta Sambita written in 600 BC in Shlokas 29-33 in Chapter 17. The treatment consists of passing a thread treated with three plant materials through the fistula track at regular intervals.
The three plants which are used for coating the thread are Euphorbia nerifolia commonly known as Snuhi, Archyranthes aspera known as Apaamarga and Curcuma longa known as haldi. The medicated thread has been used by ayurvedic physicians of this country, particularly after Professor Deshpande published the results of his work in the American Journal of Proctology 1976. The Central Council of Research in Ayurveda has brought out special monograph on this treatment in 1989.
What was needed however was a well controlled comparative trial where similar type of patients with fistula would be divided into two groups. One group would be treated by the standard surgical treatment whereas the other group would be treated by the medicated thread. The results of both these treatments would then be compared. It was this type of trial which was organized and coordinated by the Indian Council of Medical Research and carried out at different centres out at Chandigarh and Lucknow, the threads were manufactured at Varanasi, the trial was carried out at New Delhi, Chandigarh Wardha and Bombay and the results were analyzed at Madras. It was indeed a tremendous team effort.
The results published in the Indian Journal of Medical Research in 1991 showed clearly “that the long term outcome with Ksharsootra is better than surgery, although the intital healing time is longer”. The medicated thread has been used for the treatment of fistula-in-ano in least two countries outside India. It is expected that other centres around the world will also offer to their patients this form of treatment. The threads need to be manufactured on a large scale under carefully controlled conditions.
It is hoped that Indian industry would become more interested in taking over the manufacture of medicated threads. What appears remarkable and causes much satisfaction to Indian scientists and Ayurvedic physicians is that a specific treatment mentioned 2,594 years ago has been found, by modern clinical pharmacological methods, to do exactly what is was supposed to do. One can get to know of easy and inexpensive ways to treat complicated ailments by referring to ancient texts, as has been evident in India and in other countries like China.
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