Abstract

THERAPEUTIC ASSESSMENT OF PANCHAVALKAL KWATHA ADMINISTERED VIA AVAGAHA SWEDANA IN PARIKARTIKA (FISSURE-IN-ANO): A PROSPECTIVE OPEN-LABEL TRIAL

Chandan Parashar*, Deepali Sundari Verma

Abstract

Background and Rationale: Among anorectal ailments presenting to surgical units, fissure-in-ano occupies a clinically demanding position, constituting roughly one-tenth to one-sixth of all such referrals.[1] The condition is defined by a longitudinal mucosal breach in the distal anal canal, typically situated at the posterior commissure, and produces intense perineal distress that undermines daily functioning. In classical Ayurvedic scholarship, an almost identical symptom constellation—parikartana-vat vedana (lancinating anal pain), Daha (scorching sensation), and Rakta-srava (anorectal haemorrhage)—is codified under the designation Parikartika, a Guda Roga documented across the Brihatrayee.[2,3,4] Panchavalkal Kwatha, a decoction derived from the cortex of five botanically allied trees, enjoys explicit textual endorsement in Bhavaprakasha as a Parikartika-specific therapeutic, underpinned by Vrana Ropana and Shothahara pharmacodynamic activities.[5] Aim: To determine the clinical benefit and safety profile of Panchavalkal Kwatha delivered as Avagaha Swedana in patients with Parikartika (acute fissure-in-ano). Methodology: An open-label, single-arm, prospective trial was conducted at GACH, Patna. Thirty patients (20– 60 years) were treated with Panchavalkal Kwatha Avagaha Swedana twice daily for 60 days. Five outcome domains were tracked at weekly intervals using ordinal grading scales. The Student paired t-test was applied for statistical inference. Key Findings: All five parameters showed highly significant improvement (p < 0.001): pain 92.98%, bleeding 90.00%, pruritus 90.32%, burning sensation 90.38%, and wound healing 78.18%. Complete cure was achieved in 33.33% of participants; 30.00% showed marked improvement. No adverse events were recorded. Conclusion: Avagaha Swedana with Panchavalkal Kwatha is a well-tolerated, cost-effective, and clinically meaningful non-invasive remedy for acute Parikartika warranting wider adoption in Ayurvedic anorectal practice.

Keywords: Parikartika, anal fissure, Panchavalkal Kwatha, Avagaha Swedana, Shalya Tantra, Vrana Ropana, herbal decoction, anorectal disease.