Research Articles List

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.

“A CLINICAL COMPARATIVE STUDY ON THE EFFICACY OF

GHONTAPHALADI VARTI AND SAINDHAV VARTI IN THE
MANAGEMENT OF NADIVRANA (SINUS)”
The dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, in partial
fulfillment of the requirements for the award of the degree of
MASTER OF SURGERY (Ayurveda)

in the specialty of
SHALYA TANTRA
By
Dr. S.VIKRAM
B.A.M.S.
Guide
Dr. JAYASHEELA. M. GONI
M.D.(Ayu)
Guide and Professor

Department of Post Graduate studies in Shalya Tantra
Ayurvedic Medical College,
Davanagere.
DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA

AYURVEDIC MEDICAL COLLEGE
DAVANAGERE – 577 566. KARNATAKA
2007 - 2010
KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “A CLINICAL
COMPARATIVE STUDY ON THE EFFICACY OF GHONTAPHALADI
VARTI AND SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA
(SINUS)”, is a bonafide and genuine research work carried out by me under the guidance of
Dr. JAYASHEELA. M. GONI. M.D. (Ayu), Professor and Guide, Dept. of P.G. Studies in
Shalya Tantra, Ayurvedic Medical College, Davangere.
Date :
Place :
Dr. S. Vikram
KARNATAKA
CERTIFICATE BY THE GUIDE
This to certify that this dissertation entitled “A CLINICAL COMPARATIVE
STUDY ON THE EFFICACY OF GHONTAPHALADI VARTI AND
SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA (SINUS)”, is a
bonafide and genuine research work done by Dr. S. VIKRAM in partial fulfillment of the
requirement for the degree of Master of Surgery (Ayurveda) in the speciality of Shalya
Tantra, under my direct guidance.
Dr. JAYASHEELA. M. GONI M.D. (AYU)
Guide & Professor,
Department of Shalya Tantra,
Date : Ayurvedic Medical College,
Place : Davangere.
CERTIFICATE BY THE CO-GUIDE-
This to certify that this dissertation entitled “A CLINICAL COMPARATIVE
STUDY ON THE EFFICACY OF GHONTAPHALADI VARTI AND
SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA (SINUS)”, is a
bonafide and genuine research work done by Dr. S. VIKRAM in partial fulfillment of the
requirement for the degree of Master of Surgery (Ayurveda) in the speciality of Shalya
Tantra, under my guidance.
Dr. SATISH.B.G. M.S. (AYU)
Reader,
Department of Shalya Tantra,
Date : Ayurvedic Medical College,
Place : Davangere.
KARNATAKA
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTE
This is to certify that the dissertation entitled “A CLINICAL
COMPARATIVE STUDY ON THE EFFICACY OF GHONTAPHALADI
VARTI AND SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA
(SINUS)”, is a bonafide and genuine research work done by Dr. S. VIKRAM under the
guidance of Dr. MANJUNATH S. M.D. (Ayu), H.O.D. & Professor, Dept. of P.G.Studies in
Shalya Tantra, Ayurvedic Medical College, Davangere.
Dr. MANJUNATH S. M.D. (Ayu.) Dr. UMA G GUBBI , M.D (Ayu).
Head of the Department Principal,
Dept. of P.G.Studies in Shalya Tantra, Ayurvedic Medical College &
Ayurvedic Medical College & P.G.Centre P.G Centre,
Davangere. Davangere.
Date: Date:
Place: Place:
KARNATAKA
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation / thesis in print or electronic
format for academic / research purpose.
Date :
Place : Dr. S. Vikram
CONTENTS
INTRODUCTION
OBJECTIVES
REVIEW OF LITERATURE
METHODOLOGY
OBSERVATIONS AND RESULTS
DISCUSSION
CONCLUSSION
SUMMARY
REFERENCES
BIBLIOGRAPHY
ANNEXURE
LIST OF TABLES
S.No Particular Page
No.
1 Table showing tract length assessment
2 Table showing distribution of patients based on sex
3 Table showing distribution of patients based on religion
4 Table showing distribution of patients based on age
5 Table showing distribution of patients based on marital status
6 Table showing distribution of patients based on occupation
7 Table showing distribution of patients based on diet pattern
8 Table showing distribution of patients based on chronicity of disease
9 Table showing distribution of patients based on site of sinuses
10 Table showing distribution of patients based on length of the tract. (Group A)
11 Table showing distribution of patients based on length of the tract. (Group B)
12 Table showing length of the tract rate of healing in every seven days upto 42nd day
in all 20 patients of Group A
13 Table showing length of the tract rate of healing in every seven days upto 42nd day
in all 20 patients of Group B
14 Table showing rate of healing per week in Group A
15 Table showing rate of healing per week in Group B
16 Table showing unit healing time in Group A
17 Table showing unit healing time in Group B
18 Table showing evaluation of pain between two groups
19 Table showing evaluation of induration between two groups
20 Table showing evaluation of discharge between two groups
21 Table showing evaluation of burning sensation between two groups
22 Table showing evaluation of itching between two groups
23 Table showing statistical analysis of group A by using paired t-test
24 Table showing statistical analysis of group B by using paired t-test
25 Table showing comparative statistical analysis of both the groups after treatment
using unpaired t-test
26 Table showing overall comparison of outcome (%)
LISTS OF GRAPHS AND FIGURES
S.No Particualar Page

No.
1 Graph showing distribution of patients based on sex
2 Graph showing distribution of patients based on religion
3 Graph showing distribution of patients based on age
4 Graph showing distribution of patients based on Marital status
5 Graph showing distribution of patients based on occupation
6 Graph showing distribution of patients based on diet pattern
7 Graph showing distribution of patients based on chronicity of disease
8 Graph showing distribution of patients based on site of sinuses
9 Graph showing distribution of patients based on length of the tract (Group A)
10 Graph showing distribution of patients based on length of the tract (Group B)
11 Graph showing distribution of patients based on evaluation of pain between two
groups
12 Graph showing distribution of patients based on evaluation of induration between
two groups
13 Graph showing distribution of patients based on evaluation of discharge between
two groups
14 Graph showing distribution of patients based on evaluation of burning sensation
between two groups
15 Graph showing distribution of patients based on evaluation of itching between two
groups
16 Graph showing overall comparison of outcome (%)
17 Showing different types of sinuses.
18 Showing contents and prepared vartis of both the groups
ACKNOWLEDGEMENT
First of all I wish to place my sincere gratitude and thanks to my Guide
DR. JAYASHEELA. M. GONI, Department of PG studies in Shalya Tantra, AAMC and
PG Centre, Davangere for her valuable help and guidance.
I am thankful to DR MANJUNATH. S. Professor and H.O.D, Department of PG Studies in
Shalya Tantra, AAMC and PG Centre, Davangere for his encouragement and help in success
of my endeavour.
I am thankful to DR SATISH B.G. Reader, Department of PG Studies in Shalya Tantra,
AAMC and PG Centre, Davangere for his help and guidance.
My sincere thanks to Principal DR UMA G. GUBBI AAMC and PG Centre, Davangere, for
her precious support given for my study.
My sincere gratitude and respect to DR K.G. CHANDRAPPA, Dean and CCIM Member,
AAMC and PG Centre, Davangere for his generous co-operation and advice.
I would like to thank other management members DR MRITYUNJAYA HIRAMATH, DR
SURESH AMBERKER, DR SHANKAR NARAYAN AND DR RAVINDERNATH for
supporting and providing me an opportunity to conduct my study.
I am also thankful to all my PG colleagues who have helped me in many ways.
My special thanks to Dr. Sanjay Bhardwaj, Dr. Tushar Patil, Dr. Amar Patil and Dr.
Venkanna for their timely support and help.

How can I forget to express my acknowledgement to all college staff, college office staff,
Hospital staff, Laboratory staff, Pharmacy staff for their help and support in one or the other
way.
Also my special thanks to Librarian Mr. Srinivas, Rajappa and S.B. Masanagi for providing
me the books and collection of literature which really served as a strong pillar for conceptual
study.
I would also like to thank Mr. Nandakumar, Statistician for his valuable guidelines for my
study.
I am thankful to Mr and Mrs Thomas owner of Thomas computers and Samarth Xerox centre
for their efficient and meticulous typing for this dissertation.
I express my thanks to all the patients who have co-operated and taken treatment in this
study. Also I am thankful to all the persons who have helped me directly and indirectly for
completion of my study.
Date: With Heartfelt gratitude
Place:
Dr. S.Vikram
ABSTRACT
OBJECTIVES:
To evaluate the efficacy of Ghontaphaladi varti in nadi vrana (sinus).
To evaluate the efficacy of Saindhav varti in nadi varana (sinus).
To compare the effects of Ghontaphaladi varti and Saindhav varti in the management
of Nadi vrana (Sinus).
METHODS:
Total 40 patients diagnosed to be suffering from nadi vrana (sinus) were selected
randomly. These were divided into two groups A and B containing 20 patients in
each. Group A patients were treated with Ghontaphaladi varti application and Group
B patients were treated with Saidhav varti application. The data was collected and
observations were made before treatment on 7th, 14th, 21st, 28th, 35th, 42nd day and
after the treatment. The data obtained from the results was subjected to statistical
analysis and conclusions were drawn.
RESULTS:
In both the groups the drugs showed highly significant results (P < 0.001) in
parameters such as Pain, Burning sensation, Itching, Discharge and Length of the
tract where as in parameter Induration both the drugs were significant (P < 0.05).
Among the groups A and B the results so obtained were non-significant (P > 0.05) in
all the parameters except Length of the tract where it showed significant result
(P < 0.05).
CONCLUSION:
The drugs of both the groups were quiet effective in all the parameters but Group A
medicine is more effective than Group B in reducing the Length of the tract.
KEY WORDS:
Nadi vrana, Sinus, Ghontaphaladi varti, Saindhav varti.

INTRODUCTION
Nadi vrana is an ulcer having a tract extending into the deeper tissues. Nadi
vrana is associated with the presence of a large number of recesses or cavities in
a ulcer. When excessive infiltration of pus burrows deeply then it can be called as
nadi vrana. Nadi vrana or sinus comes under a non-healing ulcer so to
understand the nature and clinical presentation of nadi vrana, the knowledge of
an ulcer is needed ayurvedic classics state “vrana gathre vichoornana’’ that
means to break in the skin and flesh of the affected part.
A sinus is defined as a blind tract leading from surface down into the tissue
and lines either by granulation tissue or by epithelium. It persists due to the
presence of in depth foreign body (sequestrum, suturing material etc.) non
dependent drainage and infection.
Broadly vrana is classified into two groups.
1. Sudha vrana
2. Dusta vrana
Grossly, sudha vrana is comparable with healing ulcer and dusta vrana is
comparable with non-healing ulcer.
According to modern science, an ulcer can be defined as break down in the
continuity of the covering epithelium-skin or mucous membrane. It is molecular
death of the surface epithelium leading to ulcer formation.
A Clinical Comparative study on the efficacy of Ghontaphaladi varti & Saindhav varti in the Mgmt of Nadivrana (Sinus) 1
Clinically it is of 3 types:
1. Spreading ulcer
2. Healing ulcer
3. Callous ulcer
Pathologically it is again 3types.
1.Non specific ulcer
2.specific ulcer
3.malignant ulcer
A Nadi vrana if not timely treated may lead to the formation of a fistula by
burrowing deeper and deeper into the tissues . most of the sinuses are known to
occur in the perianal region.
Sushruta gives a broader view regarding bhagandara as “bhaga guda vasti
pradesa daarayanth iti
Bhagandara’’, here bhaga , guda, vasti, region that is nothing but a perianal
region along with anorectal canal. In a nut shell, both the diseases can be
considered as one due to similar pathology and presentation.
In spite of the great progress in the field of modern surgery, sinus still exists as a
disease with the presently available therapeutic measures. The patient
complaints of recurrence and reduced success rate. Hence they are non reliable.
The lacunas in the present day management can be grouped as:
1. Wide excision of the sinus tract during operative procedure becomes the
major surgery, as it cannot be performed without general/ spinal
anaesthesia.
2. Very wide excision of the part causes a lot of problem to the patient and
makes him recumbent for a long time.
3. Inability to maintain complete sterility is due to constant source of
infection from anus.
4. In multiple sinuses, total excision of various tracts is practically
impossible due to ineffective identification of minute sinus tracts.
So as the operative treatment has its own limitations and adverse effects, there is
a dearth of treatment which, should be convenient, effective and economic for a
sinus patient.
In our Ayurveda acharyas have explained in detail about the management of
nadi vrana with different treatment modalities.varti application is one among
them which does not require anaesthesia and having good curative properties
with worth full results.
The varti is considered to possess an anti inflammatory and good broad
spectrum activity. It must be remembered that nadi vrana is a chronic non-
healing ulcer (dusta vrana) and may occurs due to specific organisms also.
Here ghontaphaladi varti and saindhav varti are selected for the study, which
has got shodhana and ropana properties, thus helps in treating the nadi vrana
effectively.
OBJECTIVES
• To Review the literature on nadi vrana
• To evaluate the efficacy of Ghontaphaladi varti in Nadi vrana.
• To evaluate the efficacy of saindhav varti in Nadi vrana.
• To compare the Results of both the vartis.
LITERARY REVIEW OF AYURVEDA
Concept of Vrana :1
NIRUKTI (Definition): Vrana is so called by the wise, since it is loss of
continuity of skin or the area of the body and also the vrana vastu (scar / cicatrix
) does not get disappear even after healing. It remains till the body survives.
As the word ‘vrana’ is derived from "Vrana Sanchoorane" it is said that
vrana occurs in the body cavity and break in the flesh 2
BHEDA (Types):
The Vrana was broadly classified into 2 varieties in the Ayurvedic treatise3.
¾ Nija Vrana (due to vitiation of doshas).4
¾ Agantuja Vrana (trauma).5
Nija group includes all ulcers that are caused through the vitiated
condition of the doshas.
Agantuja vrana is a fresh wound caused by various external agents such
as trauma from blunt or sharp objects, agni or kshara karmas including animal
bites. Agantuja vranas will convert into Nija vranas due to involvement of
doshas after stipulated period of 7 days.
Suddha Vrana:
Vrana, which is of the same colour with the dorsum of the tongue soft,
glossy, smooth, painless, well shaped and marked by the absence of any kind of
secretion, is called suddha vrana.
Suddha vrana is also caused generally by a surgeon's knife and these
vranas do not require any specific treatment, except its protection from various
contaminations.
Sudha vrana is unaffected by any of the three doshas and assumes a dark
brown hue along its edges.lt is characterized by the absence of pain, postural
eruptions or secretions vrana having an equal elevation throughout its length,
should be regarded as sudha vrana. It is cleansed and deprived of all morbid
matter or principles.6
Dushta Vrana:
Dushta vrana is an excessively damaged wound with discoloration of its
adhistana(seat), whether it may be caused by vitiated doshas ( Nija vrana) or
caused by external injuries (Agantuja vrana).
Dushta vranas are either too narrow or too wide mouthed, they feel either
extremely hard or soft to touch and passes either a raised or depressed margins.
They are either of a black, red, yellow or white in colour and are characterized
by extremes of temperature. They are filled with putrid and sloughing flesh,
Indefinite and irregular in shape. They are found to exude a sort of dirty, fetid
pus, which runs into t cavities following an oblique and upward course.
They have a cadaverous look and smell and are characterized by extreme
pain burning sensation, redness, swelling, itching and suppuration. Pustules crop
up round these ulcers, which largely secrete vitiated blood, and linger; unhealed
for an inordinate length of time7.
VRANA LAKSHANAS: (Symptoms):
Symptoms of an ulcer may be divided into two kinds viz., general and
specific. General:
¾ Ruk or vedana (pain).
¾ Gathra Vichoornane (crushing of the body).
Specific : Exhibited in each case according to by virtue of the deranged doshas
involved. 8
VISHESHA LAKSHANAS (Characteristic features)
Both Nija and Agantuja vranas have the following characteristic features.
¾ Classified into twenty varieties.
¾ Examined in those different ways.
¾ Exhibit twelve characteristic features in their advanced stages.
¾ Located in eight places.
¾ Associated with eight types of foul odorous.
¾ Fourteen types of discharge.
¾ Sixteen types of complications.
¾ Twenty-four factors which cause impediments and twenty-six
effective therapeutic measures.9
VRANADHISTANA:
Base of the vrana is known as vranadhistana. All vranas are situated in
them. Those are twak(skin), mamsa(flesh), sira(veins) snayu(ligaments),
Asthi(bone), Sandhi(joints), Kosta(viscera) and marma(vital spots).10
A little variation is found in the concepts of Acharya Susrutha and Acharya
Charak has mentioned medas as one of the adhistana in the place of snayu.
MANAGEMENT:
Acharya Susrutha has also approach towards the management of vrana is
a comprehensive manner. He has described sixty measures i.e.
"Shashtiupakarma" towards the medical and surgical management of vrana.11
Acharya Susrutha has also mentioned seven measures i.e. Saptopakramas
which comprehensively includes all the above procedures.12
NADIVRANA
Derivation of Nadivrana –
1. Nalam vranantharam naali iti bhasha (shabdakalpdrum)13
• That which is having a tract inside the ulcer is called Nadi vrana.
• A vrana vishesa which discharges pus at all time is called “Nadi
Vrana”.
2. Nadou samlagnou vranaha sarvada galada vranam naali va ithi bhasha.
(Amarkosha)14
NADA : means a reed.
• That which is having a tract like a reed.
• A vrana vishesha, the nature of which remains unhealed with the
characteristic of oozing or discharge of pus is called as Nadi Vrana.
3. NADI: A tract, “VRANA” – an ulcer.
4. NADI: Nadi + kwadikara bhakthinaha – ithi nadishu (Amarakosha
Manushyavarga)15
The one, which is having GATHYATMAKA property letting or expelling
out material, is known as Nadi Vrana.
The word NADI refers to a deformity where the formation of tract
or a passage takes place.
5. Nadi Nali va ithi – i.e. reed or flute. This is described as pranali or a
condition causing nali or pranali or nadi and this occurs in the case of
nadivrana.
6. Nadi Nadayaithi Nadi
7. Nadikam Nadireva prathikruthi. – that which resembles tubular (hallow)
structure is called nadi.
SYNONYMS: As the word Nadi implies the direction of
pooya(Athimathragamana) embedded inside "Gathi" is also a synonym of
NADIVRANA, NAD1SHATAM, GATHI, AVARAM:
¾ As if flows like a drain, it is called as Nadi. 16
¾ Because of its copious flow; it is also known as Gati. 17
NOTE: According to some ancient authors if pooya (pus), raktha (blood) etc
passes through a single curved track it is called Nadivrana and that passing
through, more than one curved track attains the name Gathi.
HISTORICAL REVIEW
VEDIC PERIOD:
As there is no much details are available in the Pre Vedic period, the
recorded evidence from the beginning of Ayurveda is seen in Rugveda and then
in the Atharva Veda.
Atharva Veda :
1. Yaethe nadyou devkrutho yayosthistanthi vrishyam18.
Atharva veda.6/138.4
This verse describes the ducts above the testicles, through which semen
flows. This word Nadi is related etymologically with NADA (reed), means hollow
with in, which grows in rainy season.
2. The diminutive of Nada is Nadika
• It is used in Atharva Veda to denote speech organ vak (wind pipe).
• In Atharva veda different ailments are explained and its effects on
different organs were mentioned, along with them there are the
references about the disease Asrava (formation of pus) along with
other diseases.19
(Atharva veda 7/78.1)
These two references give an idea that the people of Vedic period also
suffered from collection of pus and formation of Nadi Vrana, but we don’t get
direct reference of the term Nadivrana as such.
SAMHITHA PERIOD:
The term Nadi vrana was coined during this period and described
extensively by Acharya Sushruta. In this treatise several methods are explained
for the treatment of Nadi Vrana one among them is application of varthis.
MEDIEVAL PERIOD :
Acharya Chakrapani, has explained in his book ‘chakradatta’ about Nadi
Vrana and its different treatment principles like Patana, application of varthi
and ksharasutra application in Nadivrana chikitsa 45th chapter.
In Bhaisajya Ratnavali also a separate chapter is dedicated for treatment
modalities of nadi Vrana.
Hence the Acharyas have added the improved versions of treatment
modalities for Nadi vrana in adition to the procedures which were mentioned in
Brihatrayees.
MODERN PERIOD:
Post independence period saw the revival of Ayurveda and the Shalya
Tantra in many aspects like in the preparation of Pratisarneeya Kshara, Kshara
sutra, varthi etc., which are considered as prime procedures in the management
of nadi vrana.
CLASSIFICATION: Nadivrana is classified here as per sushruta
1. Vatika.
2. Paithika.
3. Kaphaja.
4. Thridoshaja.
5. Shalyaja.
6. Dwandwaja
However Vagbhata does not considered dwandwaja type, while
classifying Nadivrana.
NIDANA: (Etiology of Nadivrana):
As Shopha is the primordial condion of NADIVRANA, the etiological
factors of sopha can be considered for Nadivrana too. Sopha means
inflammatory swelling, is defined as an elevation caused by doshas localized and
situated between skin and muscles, widespread, knotty, even or uneven.20
Some factors are:
1. Long time journey over horses.
2. Sitting on a hard surface for prolonged period.
3. Factors vitiating apana vayu e.g. indulgence in excessive sexual activity.
4. Acting contrary to contemporary ethics.
5. Sitting in unnatural postures (ukudu posture by goldsmith etc.)
SAMPRAPTHI (Pathogenesis):
If vranashopha is not timely treated in pakvavastha or inadequately
drained the pus, invades deeper and deeper into the tissues in the form of a tube
resulting in Nadivrana. The direction of invasion might be straight or depending
upon it is Gathi or Nadivrana.
The pus of an abscess or swelling burrows into the affected part if a
persons neglects it in its fully suppurated stage, and then the pus has been
entered into deeper tissues and penetrates inside and results into Nadi vrana.21
LAKSHANAS (Symptoms):
According to doshic involvement and to the presence of foreign bodies
inside the tissues Nadivrana is classified as follows.
VATIKA:
Vathika type of sinus is characterized by parusha sookshma mukha
(rough and short orifice) soola (pain) " Phenanuvidha adhikam sravathy
kshapayam" - frothy secretion enhanced at night.22
PAITHIKA:
Nadivrana caused by vitiated pitta dosa has thirst, burning sensation,
exudes yellow, warm, foul smelling pus, and occurs more during the day.23
KAPHAJA:
Nadi vrana caused by vitiated Kapha has very thick, slimy exudation,
severe itching, hardness, exudation occurs more at night24.
THRIDOSHAJA:
Any Nadivrana exhibiting above symptomatology in a mixed
fashion associated with jwara (fever), daha (burning sensation), swasa (breathing
difficulty), vakthra sosha, moorcha (syncope) can be considered as tridoshaja or
sannipata. This type of Nadivrana have grave prognosis.25
DWANDWAJA:
The conjugated action of any two of the deranged doshas present
dwandwaja type and vrana symptoms peculiar to the involved doshas.26
SHALYAJA:
Any foreign body material accidentally lodged inside the body though
externally invisible tends to burst open out side along its channel of insertion.
Nadivrana is characterized by nityaruja (constant pain), sahasaaphenilam
(Sudden exudation of frothy discharge), Acham (clear) and ushnam asrik (hot
and blood coloured). Vagabhata, however does not considered dwandwaja
type.27
COMPLICATION OF NADIVRANA:
As previously narrated Nadivrana of Bhagapradesh is termed
as Bhagandhara, which means the tubular ulcer piercing bhagapradesha
including bhaga, guda and vasthi.
PROGNOSIS:
Nadivrana caused by all the doshas (Tridoshaja) precence of all the
symptoms should be rejected, while the four remaining types amenable to careful
medical treatment28.
MANAGEMENT
Acharya Sushruta has classified the whole methodology of management
into 4 types.
1. Bhaisajya Chikitsa (Medical treatment)29.
2. Kshara karma.30
3. Agni karma (Cauterization)
4. Shastra karma (Surgical treatment). 31
VARTHI KALPANA
• Varthis Basically come under ‘vati’ Kalpana
• They differ only in shape and use
• Varthis are elongated with tapering ends while vatis are round.
• Varthis are used externally
• Varthis help in expelling the collected mala, mootra, pooya, Rakta, kapha,
etc. thus help in therapeutic field.
• Depending upon the organ & action varthis are classified and named as
a. Guda Varthi
b. Yoni varthi
c. Shishna varthi
d. Vrana varthi
e. Netra varthi
f. Dhooma varthi
g. Nasa Varthi
General method of preparation
A thick syrup of (3-4 thread consistency) Jaggery is taken in equal
proportion to the weight of all the ingredients. To this syrup, fine powder of the
ingredients is added, mixed well and varthi are prepared.
Other wise Bhavana with specific liquid is given to the fine powder of the
ingredients and varthis are made.
The size of varthis should be 2” – 6” long and ¼ “ – ½ “ thick.
Vrana Varthi actions
• Vrana Shodana & Ropaka
• Pooya Nissaraka
Vrana Vrthi Indications
• Nadivrana
• Dusta vrana
Method of administration
The site of application as well as the end of the varthis to be applied
should be lubricated with Taila or Grita before introducing it.
Different types of varthis are described in “Dwivraneeya adhyaya” varthi
is also one among shashti upakramas explained by sushrutha in the management
of vranas. Further among shasthi upakramas it comes under “sapta shodhana –
Ropaneeyas”
Varthi is mainly indicated in vranas with embedded foreign body, which
has small external opening which involved deeper Tissues. Varthi prepared
using shodhana dravyas destroys unhealthy Tissues.
Varthi prayoga is given much importance in the management of Naadi
vrana in texts like chakradatta and yogarathnakar.
Sushrutha32 and vagbhata33 both have explained regarding varthi
properties action and also explained about its adverse effects. If not prepared
properly or if it is not properly placed. Varthi should not be very snigdha
(Unctous) Ruksha nor it should be very thick or thin and it should not cause any
problem to the patient. If it is very unctous it causes excess exudation; if it is dry
it causes abrasion, bleeding and pain, if thick or thin or not inserted properly
causes friction to the edges of the sinus. If correctly prepared and placed it
drains the pus and removes the unhealthy Tissues and purifies the tract.
Generally the treatment advocated for all Nadivranas is as opening up of
the course of the pus channels with a surgical knife and followed by the shodana
and ropana measures.
Prior to this sastrakarma poorvakrma in the form of sneha, sweda and
after the sastralkarma i.e. samsarjanakarma must be done.
Pathya and Apathya in Nadivrana :
Pathya:
Yava, shashtika shali, godhuma Purana shali, sita, masura, dhanya,
Tuvari, mudga, yusha, madhu, sharkara vilepi, laajamanda, Jaangala mamsa
rasa Grita, Taila, Pathola, Vetragra, balamoola vaartaka, Kaaravella, karkotha,
Tandulodaka
Apathya:
Ruksha, Sheeta, amla, lavana ahara sevana.
Vyayama, vyavaya, paribhashana, Nidra prajagaram, chankraman,
shoka, Virudhashana, ambupana, Tambula, Patrashaka, ajangala mamsa,
asatmya anna.34
These should be avoided for a period of one year.
MODERN LITERARY REVIEW
Prologue: A clear understanding of sinus, its classification, anatomical
specificity, aetiopathogenesis, and management styles according to current
understanding of the subject is inevitable for the successful management of
Nadivrana.
Historical aspects: Much data is not available in the management of sinuses in
general, because of versatility of anatomical locations, specific infections etc.
However the nature of the disease (e.g. congenital nature in bronchial sinuses
and fistulae) infectious pathology (e.g. Tuberculoses sinuses following
tuberculosis, lymphadenitis), affinity of certain areas of the body (e.g. pre-
auricular sinus at the root of helix in pinna), obstructive pathology (e.g. pilonidal
sinus) etc, reveals that majority of the sinuses occurs in anorectal region possible
because of the extensive chances of infection from this unhygenic locality.
John Ardene described the steps of operation for anal sinus in 1339 and
following that Charles Felix performed the operation for adequate drainage was
emphasized by fercival pott (18th century). But later studies with ligaturing the
tract with strong silk or India rubber ligatures, injections of modification of the
classical incision by Fredrick salman followed by Nargan. Miligan and syabrid
etc.
DEFINITION OF SINUS:
A sinus is a blind track leading from the surface down to the tissues.
There may be a cavity in the tissue, which is connected to the surface through a
sinus. The sinus is lined by unhealthy granulation tissue, which may be
epithelialised.
In Latin "sinus' means - ;A hollow', a bay' or 'gulf
AETIOLOGICAL FACTORS:
1. Infection,
2. Foreign body.
3. Trauma.
4. Carcinoma.
5. Congenital anomalies.
6. Inadequate drainage of an abscess.
7. Occupational factors.
CLASSIFICATION:
1) Congenital e.g. Pre auricular sinus.
2) Traumatic e.g. following trauma a foreign body may be implanted into
deep tissue and following infection a sinus may persist.
3) Inflammatory e.g. tuberculosis sinus, osteomyelitic sinus or sinus of a
chronic abscess which discharge pus due to inadequate treatment of acute
abscess.
4) Neoplastic e.g. Sinus due to degenerative change have a malignant growth
or due to secondary infection of a malignant growth, which was incised
for drainage.
5) Miscellaneous e.g. Pilonidal sinus.
ANATOMICAL LOCATION OF SINUSES:
A majority of sinuses occur in the anal region and reason might be.
1) Increased chances of infection of the anal glands due to constant contact
with faecal matter.
2) Constant exposure of the region to trauma as from horse riding, cycle
riding etc.
3) The anatomical peculiarities of anorectal region.
4) Sinuses are known to occur at the end of long bones following
osteomyelitis.
5) Root of the helix or tragus on the pinna in the case of preauricular sinus
(congenital origin).
6) Sinuses present at the umbilical region are met with the following aspects,
a. The entry of hairs,
b. Foreign body after operation,
c. Gall stones,
d. Diverticulitis.
e. Carcinoma of the colon.
7) In the neck it is presented at the anterior lower third of the sternomastoid
muscle in the case of bronchial sinus (congenital origin).
8) In the thyroid region due to bursting of inflamed thyroglossal cyst.
PATHOLOGY:
Sinus pathology has many factors. Almost in all instances (with the
exception of congenital cases), sinus is the result of an internal pathology and
draining the resultant material of the pathology to the extension.
The sinus will internally be lined with granulation tissue or epithelial
tissue and might be associated with dense fibrosis along the wall of its tract to
prevent its collapse. The presents of granulation tissue or epithelial tissue suggest
the frequent closure of the sinus. The infective pathology is relevant in case of
1. Actniomycosis.
2. Bilharziasis.
3. Tuberculosis.
4. Dracontiasis.
5. Ulcerattve proctocolitis
6. Lymphogranuloma inguinale with fibrous rectal stricture.
7. chrons disease of colon orileum.
8. Osteomyelitis
SYMPTOMATOLOGY:
The clinical presentation in most instances will be done one or more
external openings with a history of discharge and presenting sprouting
granulation tissue around the orifice.
a. Orifice: Slightly elevated with granulation tissue.
b. Pain: Pain might not be a constant features and it will not be there
when the track is open. If the track is closed either by foreign body
or by the growth of granulation tissue, pressure shoots up in the
area of suppuration and pain results. However, in the cases of
neoplastic origin, pain is a constant feature in later stages.
c. Irritation: This complaint is caused by the purulent discharge.
d. Discharge: It should be examined macroscopically, physically,
chemically; and microscopically.
Staphylococcal pus is yellow and of creamy consistency
whereas Streptococcal pus is watery slightly opalescent and some
times it will be stained with blood. Pseudomonas aeruginosa
discharges the typical or bluish green pus. Sometimes the sinus might
discharge pus containing sulphur granules as in actinomycosis or
sequestrum in osteomyelitis or faecal matter, and bile in fistula etc.
Association with pus can be understood according to the site of the
sinus.
e. Odour: Coli pus is absolutely colourless with objectionable odour.
The odour is thought to be due to the proteoltic properties of the
causative organism.
f. Surrounding stain: There may be a scar in surrounding tissue,
which may indicate chronic osteomyelitis or previously healed
tuberculosis sinus.
g. Wall of the sinus: Chronic sinuses will have thick surrounding wall
due to presence of fibrosis.
h. Tenderness: It can be elicited in the sinus track closed due to
obstruction.
CAUSES FOR PERSISTANCE OF SINUS:
1. Presence of foreign body e.g. necrotic tissue, suturing material, hair
sequestrum etc.
2. Non-dependent drainage or inadequate drainage of an abscess.
3. Inadequate rest during healing time.
4. Presence of infection.
5. When the tract becomes epithelialized.
6. Fibrosis around the wall of the tract preventing it collapse.
7. Irritant discharges with obstruction distal to the tract.
8. Presence of malignant disease.
9. Ischaemia.
10. Malnutrition.
11. Crohn's disease.
12. Drugs e.g. steroids, cytotoxics.
COMPLICATION OF SINUS:
The main complication of sinuses is fistula. This is true especially when
the sinus is in contact with a hollow viscous internally. Fistula in ano is a striking
example, result in the formation of fistula in ano as majority of the sinuses
occurs in the peri-anal region. In case of osteomyelitis damaging of the tissue
results in the formation of a big cavity.
Sinuses and Fistulae of Peri-Anal Region
As it is known fact that clinical examples of sinuses are more in the peri-
anal region.
MANAGEMENT
As sinuses are tubular ulcers penetrating deeper into the tissues the
problem confronted by the surgeons in the management aspect are many.
The principles of management:
1. Removal of obstructive factors.
2. Laying open the sinus tracts.
3. Enabling healing to start from the bottom.
4. Prevention of excess formation of scar tissue to avoid contracture
of the part.
5. Treatment of specific infection.
6. Prevention of formation of granulation and epithelial tissue as well
as removal.
MANAGEMENT TECHNIQUES:
1. Excision with primary closure.
2. Laying open the sinus tract to allow healing by secondary
intention.
3. Excision of excessive fibrous tissue.
4. Curetting the wound by removing the hair, granulation tissue and
skin debris to promote adequate wound healing.
5. Creation of an INTERNAL OPENING to form a fistula by
PROBING. For example, the surgical options for management of a
uncomplicated chronic pilonidal sinus include excision with
primary closure, excision and laying open the tract, wide and deep
excision to the sacrum, incision and marsupialization, and phenol
injection.
NON-OPERATIVE AND PARA SURGICAL PROCEDURE:
The Para surgical procedure available at present in indigenous system is
Varti, Ksharasutra, oil infiltration therapy etc.
LACUNA IN THE PRESENT DAY MANAGEMENT (ALLOPATHIC):
1. Higher incidence of recurrence rate.
2. Excess of scar tissue formation causing severe contracture of the
part.
3. Excessive excision leads to prolapse of supportive tissue and in the
case of anorectal sinuses; faecal incontinence is a draw back.
4. Prolonged hospital stay.
5. In case of multiple sinuses, total excisions of various tracks are
practically impossible due to ineffective identification of minute
sinus tracks.
PICTURES OF DIFFERENT TYPES OF SINUSES
DRUG REVIEW
In the management of Nadivrana we find references of different
preparations of varthis mentioned in classical texts. As Nadivranas are
manifested with different actiology and are treated with difficulty. Drug to
cure all such Nadivranas should have a wide range of activity in it. In this
present modern surgical practice there is no such applicant which will have wide
range of activity and effective in healing all types of non healing Nadivranas and
they are having their own limitations and drawbacks. But there are many drugs
in Ayurveda, which are said to be effective in healing of nadivrana. So, in the
present clinical study Ghontaphaladi Varthi and saindhav varthi have been
taken for the management of Nadivrana. To study the healing effects on
different types of Nadivranas.
GROUP ‘A’ MEDICINE
Ghontaphaladi Varthi : Ghontaphaladi varthi was said to be effective in
Nadivrana. It is described in Bhaishajya rathnavali, Nadi vrana chikitsa
prakarana.
Ingredients of Ghontaphaladi varthi
1. Ghontaphala twak
2. Madan Phala
3. Pooga phala twak
4. Saindhav Lavan
5. Snuhi ksheera
6. Arka ksheera
GHONTAPHALA
Botanical Name : Zizyphus Zylopyra (WLLD)
Zizy Phus Sativas (Cultivated)
Family : Rhamnaceae
Kula : Badarakula
Classical Categorization : Shramahara, Virechanopaga,
Swedopaga, Hrudya, Hikkanigrahan
Udardaprashaman (charak)
Aragvadadi
Vatashamanadi (Sushrut)
Synonyms : Karkandu, Kola , Badari, Ajapriya,
Koli, Sauveer, Abhay Kantak,
Rajabadara
Vernacular Names : Kannada : Bare, Borehannu,
Hindi : Baer ,
Tamil : Koli,Elandai
Telugu : Badaram , Regu,
Malayalam : Lanta
English : Jujaba Fruit, Indian Cher ry
Botanical Description : It is a medium sized tree with spikes,
bark – grey and torn , drupe 1.5 to 2.5
cm diameter globose first yellow then
orange and finally reddish brown
,containing a single seed surrounded by
fleshy pulp, Rajabadar variety is used in
medicine.
Distribution : Punjab, Himachal Pradesh, West
Bengal, Afghanistan, Iran, Kashmir,
China & all over India
Chemical Composition : Alkaloides, Jejubosides a & b
Properties : Rasa – Amla, Madhura, Kashayam ,
Vipaka – madhur, Veerya – Seetha
: Guru, Snigdha, picchila.
Karma : Vrana Ropaka, Vrana Shodhaka,
Sonitasthapana, Hrudya, Grahi, vata
pittahara, Sukrala
Indications : Vranashodhaka, Vrana Ropaka Kasa,
Swarabheda, Udara, Chardi Krimi,
Pradara
Parts Used : Fruit Seed
Dosage : Power of dried fruit 20 gms , Juice ½ Oz
to 1 Oz
MADANAPHALA
Botanical Name : Randia Dumetorum
Family : Rubiaceae (Rubus = Red)
Kula : Manjisthta Kula
Classical categorization : Vamaka, Phalini (charak)
Urdhvabhagahara, Aragwadhadi,
Muskakadi (sushrut)
Synonyms : Madana, Pindi, Shalyak ,
Vishapushpaka, Ratha, Pinditaka,
Harnya, Ghantakhya, Bastishohana,
Granthiphala, Golaphala,
Vishamushkaka
Vernacular Names Kannada - maggarekai, Hindi- Arara,
main, mainphal, Tamil- Kadudum,
Pungarai, Telugu- Madanamu, Mangu,
Marathi- Galay, Monigeli, Gujarathi-
Medhola, mindhula, Bengali- Maiphal,
Eng- Common Emetic nut.
Botanical Description : It is reticulated, thorny medium sized
tree, leaves like Achyranthes aspera,
Slightly round and long sharp thorns are
situated on either side of leaf axis.
Flowers yellowish, White, Fruit – Like
Naspati fruits are round, yellow or dusky
coloured fruit pulp – sweet and bitter
resembles walnut pulp.
The tree bears flowers in summer and
fruits in winter
Distribution : Foot fills of Himalaya from Jammu and
Sikkim Sindh, Kuchabihar, Southern
India & Maharashtra.
Major Chemical Composition : Fruits contains 33.3% Saponin also
contains valerenic acid, Resin, Wax.
Seeds Contains : Volatile oil.
Properties :
Guna : Laghu, Ruksha
Rasa : Madhura, tikta, Kashaya, Katu
Vipaka : Katu
Veerya : Ushna
Karma : Kaphavata shodaka and Shamaka pitta
nissaraka
Indications : Shopha, Sula, Vrana, Vidradi Amavata,
Kusta, Anaha, Gulma
Parts Used : Fruits, Seed rind, Bark
Dosage : Powder 1-3 gm, Decoction of fruits rind
15-30 Tala.
Preparations : Madanadi Lepa, Charaka Kalpa stana
contains 133 Kalpas derived through this
drug.
POOGA
Botanical Name : Areca catechu Linn
Family : Palmae
Kula : Narikela Kula
Vernacular Names : Kan-Adike, Adaki, Hindi-Supari, Tamil-
Kamugu, Pakku, Telugu-Oppulu, Poka,
Malayalam-Atekka, Pakka, Marathi-
Supari, Gujarathi-Sopari, Bengali-Gua,
English, Arecanut, Beetle Nutpalm
Synonyms : Akota, Chikkana, Guvaka, Kramuka
puga, Deerghapadapa, Valkataru,
Dridavalka, Poogi, Tamboola,
Suranjana.
Botanical Description : A tree 10-15 mts, high having no
branches, usually 50 cm in
circumference, uniformly thick. Leaves-
1.5 to 2mts, leaflets-30 to 50cms long &
slender, Flower stalk-hard & branched,
Fruits-appear in bunches 3-6 cm round,
smooth & hard orange or scarlet colour.
Distribution : East & western ghats of India & indo-
malaya.
Chemical composition : Catechu -15%, Gallic acid-14%, it
contains arecoline 0.07%, arecaine-1%,
arecaidine, Guvacine, & chloride
Guvacoline in traces.
Properties :
Rasa : Kashaya, Madhura
Virya : Sheetha
Guna : Guru, Ruksha
Vipaka : Katu
Karma : Kapha, pittanashak, Tridoshagna if
Roasted with sand Mohaka, Deepaka,
Ruchya, Aasyavairasya Nashaka.
Indications : Haemostatic, Wound-Healing
(Raktastambaka) (Vrana Ropaka),
Katishoola, Krimi, Swetapradhara,
Aruchi, Mukharogas, Nadidourbalya
Parts Used : Seed, fruit
Dosage : Nut 1 to 3 gms, it is intoxicant because of
its vikasi guna, in such conditions water,
milk and milk products should be used.
Preparations : Poogakhanda
SAINDHAV LAVAN
Latin Name : Sodium Chloride
Names in other languages
Hindi : Sendha namak, Sendhanana Lahuri
namak
Bengali Saindhava Lovana, Saindhava nun
Marathi : Sende lona
Gujarathi : Sindha Luna
English : Rock Salt
Description : Saindhava lavana is mineral which is
obtained from Punjab, mines. Two
varieties of saindhava are available i.e.
white and Red. According to charaka
saindhava is considered best amongst all
the salts for internal use.
Properties
Rasa : Lavan
Guna : Laghu
Virya : Seeta
Karma : Dipana, Hridya, Vrishya, Avidahi &
Sukhada Tridoshagna
Indication : Aruchi, Netraroga, Vrana & vibandha
SNUHI
Botanical Name : Euphorbia nerifolia Linn,
Classical Categorization : Virechana (charak), Adhobhaghara
(Sushrut)
Family : Euphorbiaceae
Kula : Erand Kula
Synonyms : Snuk, Snuhi, Mahavruksha, Guda
Nistrinshapatrak, Samantdugdha
Gandir, Vajrakantak, Sudha, English
Name-Common milk hage.
Botanical description : Shrub is small with trunk and branches
bearing thorns leaves 30-60 cm thick and
fleshy. Flowers-Yellowish, seeds-flat
leaves shred during winter. Flowering
and fruiting occurs in summer
charakacharya has devided it into
a) alpakantaka b) Bahukantak
The latter variety is considered to be
superior. Latex is usually collected at
the end of winter from a plant which is 2
to 3 years old.
Distribution : All over India, Sikkim, and Bhutan
Chemical Composition : Euphorban, resin, gum rubber, calcium
maleate etc.
Properties : Guna-Laghu, snigda, Tikshna, Rasa-
Katu, Vipaka-Katu, Veerya-Ushna,
Karma-Kaphavata hara, Pittashodana
shodhana of Rasa, Rakta, mamsa, meda
majja.
Parts used : Latex, Leaves, Root powder
Dosage : Root powder - 250 to 500 mg
Juice of stem - 12 to 24 ml
Leaf Juice - 2 to 5 drops
Latex - 20 to 125 mg
Indications : Inflammatory conditions, skin diseases,
toothache, piles, as a strong purgative,
Anaemia Ascitis, Leucoderma, Dm, RA,
Gout, Swasa, In preparation of
ksharasutra, Root is used as antidote to
poisons of plant origin.
Preparations : Vajrakshar, Snuhyadi Taila
ARKA
Botanical Name : Calatropis Procera
Family : Asclepiadacea
Kula : Arka kula,
Classical categorization : Bhedaneeya, Swedopaga, Vamanopaga
(charak), Arkadi, Adhobhagahara
(Sushrut)
Synonyms : Toolaphala, Ksheeraparna, Arka,
Arkanama, Arka parna, Vasuka
Supushpa, Shuklarka, Viksheer.
Vernacular Name : Kannada-Ekke, Hindi-Aak, Tamil-
Aerakham, Telugu-Jilledu, Malayalam-
Erukku, Marathi-Rooee, Gujarathi-
Aakado, Bengali-Aakanda, Panjab-Aak,
English-Madar.
Botanical Description : This is a much Branched Large, Erect,
Pale, Greyish, Profusely milky shrub
grows about 2-3mts. High, leaves are 10
to 15 cm long and 2.5 to 7.5 cm wide big
and ovoid in shape, Flowers are white
externally, Internally reddish, Fruits are
long, curved and break open on drying,
Seeds are small 4-6 mm and black in
colour flowering occurs in spring and
fruiting in summer.
Distribution : All over India in dry and pungent soil,
Srilanka, Afghanistan, Iran & Africa.
Chemical Composition : Its root bark has a Bitter Principle. It
has yeast in small amount because of
which hot milk curdles immediately (gets
solidified). Besides that, it contains
madar alban, madar Fluabil black acid
resin. Yellow bitter resin, calatropin.
Properties :
Guna : Laghu, Rooksha, Teekshna
Rasa : Tikta, Katu
Vipaka : Katu
Veerya : Ushna
Karma : Kapha, Vata, Shamaka, Sara,
Krimighna, Vamaka, Deepaka,
Vishaghna.
Parts used : Root bark, Latex, Flowers
Dosage : Root powder 2-3 grains, Arka ksheera ¼
- ½ gms. Flowe Kalka-5 gms.
Indications : Kusta, Kandhu, Gulma, Arsha,
Pleehavriddi, Shleshmodara.
Preparations : Arka Lavana, Arkataila, Sootika
bharana, Ekangaveer
Varieties : i) White & ii) Blue acc to colour of
flowers 4 types-Acc Raja Nighantu.
ii) Arka, Alarka ii) Rajarka,, iii)
Shuklarka, iv) Shwetamandara.
Method of preparation of Ghontaphaladi varthi
The powder of Ghontaphala skin, Madanphala, Poogaphala skin and
saindhav Lavan are taken in equal quantity. This powder is mixed with quantity
sufficient snuhi ksheera and Arka Ksheera and made in to paste. This paste was
applied on plain thread and preserved after dryness is attained and kept inside
the sterilized test tube and closed by tight air cork.
Group ‘B’ medicine
Saindhav Varthi : The saindhav varthi described in chakradutta is having two
ingredients, which are effective in Nadivrana.
Ingredients of saindhav varthi.
i) Saindhav Lavanam (Rock salt)
ii) Honey
MADHU (HONEY)
Botanical Name : Mel
Hindi : Madhu, Shahad
English : Honey
Kannada : Jenutuppa
Synonyms : Madhu, Kshoudra, Makshika,
Kusumasavam, Pushpasavam,
Pavithram & Pushparasavahyam.
Types : 1. Makshika 2. Bhramara
3. Kshaudra 4. Pautika
5. Chhatra 6. Audalaka
7. Argha 8. Dala
Properties (Guna) :
Rasa : Madhura
Anurasa : Kashaya
Guna : Sheeta, Laghu, Rooksha
Karma : Grahi, Lekhana, Chakshusya, Deepana,
Vranashodhana, Roopana Kapha pitta
rakta shamaka.
Indications : Kusta, Prameha, Krimi, Kaasa Shwasa,
Hikka, Atisara, Malasanga Trishna,
Daha, Kshata etc.
Chemical constituents : a) Moisture – 14 to 20%
b) Ash – 0.05 to 0.18%
c) Sucrose – 2 to 5%
d) Reducing sugar – 65 to 79%
e) Formic acid in very small quantity
0.0825%
f) Certain Enzymes i.e, Diastase &
Invartase
g) Various other compounds of calcium
sodium, potassium, sulphar, Iron, Silica,
Phosphorus, Copper, Manganese,
chlorides, magnesium & Aluminium in
the proportion in which they are
available in fruits.
h) Some experts say that in honey some
non-detectable amounts of vitamin
A,B,C & D are present.
Method of preparation
The wick made of Rock salt mixed with honey was applied on plain thread and
preserved after dryness is attained and kept inside the sterilized test tube with
tight air cork.
MATERIALS AND METHODS
The clinical trial will be carried out on the patients attending the OPD &
IPD of AMCH & ATMH which is undertaken by the Department of Shalya
Tantra Ayurvedic Medical College and Post Graduate Centre, Davangere.
Source of the data:
1) Patients attending the OPD and IPD of AMCH and ATMH with classical
symptoms of sinus (Nadivrana) are selected for the study.
2) Pharmacy attached to the college for the preparation of drug.
3) OPD, IPD, Laboratory and other provisions of the hospital are availed to
do this intended work.
Selection of Patients:
40 Patients were selected in two groups excluding dropouts with 20
patients in each group on the basis of inclusion and exclusion criteria.
Inclusion Criteria:
¾ Patients presenting with classical signs and Symptoms of Nadivrana with
External opening on the body surfaces will be selected.
¾ The age group between 15 to 60 years.
¾ Both sexes.
¾ Patients ready to take treatment.
¾ Patients who are reluctant for surgery.
Exclusion Criteria:
¾ Patient reluctant to take treatment.
¾ The age group below 15 years and above 60 years.
¾ Congenital sinuses.
¾ Nadivrana with systemic diseases like DM, Bleeding disorders, AIDS,
Tuberculosis and Actinomycosis.
¾ Osteomyelitis followed by sinus.
¾ Patients having complicated sinus.
¾ Patients having Neoplastic Sinus.
¾ If the Sinus tract is more than 10 cm.
Study Design :
A comparative clinical Trial and was designed in the following manner.
a) The patients were selected by simple randomized sampling procedures.
b) 20 patients were selected in group ‘A’ and 20 patients were in group ‘B’.
c) Group ‘A’ patients were treated with ‘Ghontaphaladi Varti’ and group
‘B’ patients were treated with Saindhav Varti.
d) Finally the results were assessed.
Method of Collection of Data :
¾ Drugs were collected from the market under the guidance of Dravya guna
specialist from our college.
¾ The patients were selected based on the clinical examination. 40 patients
were divided into two groups of 20 patients each.
¾ The total duration of the treatment taken is maximum of 6 weeks.
¾ The length of the tract taken is maximum of 10 cm.
¾ Progress was assessed on Regular follow up.
1. Group ‘A’ – Ghantaphaladi Varti
2. Group ‘B’ – Saindav Varti.
1. Required Equipment for Varti application :
i) Lithotomy table.
ii) Shadowless light
iii) Instruments
¾ Various sizes of probes
¾ Artery forceps
¾ Scissors
¾ Surgical blade
¾ Scalpel
¾ Plain forceps
iv) Surgical Gloves 7’’
v) Kidney tray
2. Examination of the patient
¾ History taking
¾ The religion, sex, age, occupation and residence are noted.
¾ Complaints and their duration (clinical status) are noted.
3. The signs and symptoms of Nadivrana are Estimated as follows
¾ Presence of opening and number
¾ Site of openings
¾ Discharge
¾ Duration
¾ Pigmentation
¾ Pain
¾ Burning sensation
¾ Itching
¾ Local temperature
¾ Induration
4. Chief complaints
Discharge through an opening with or without pain and induration are
considered as chief complaints.
5. Past History
The following points should be noted.
¾ History of abscess formation
¾ History of disease causing formation of sinus like asteomyelitis, Tuber
culosis, Ulcerative Colitis, Crohn’s disease.
¾ History of previous medical and surgical treatment.
6. Present History :
The present history of illness and duration are elicited.
Eg : History of abscess before on set of sinus.
7. Personal history :
The following are noted under this
1. Nature of work
2. Diet regime
3. Addiction/s
8. Family History
Congenital or acquired Nature of sinus and the time of on set in both
cases are noted.
9. a) Physical Examination
¾ Built
¾ Tempt.
¾ Pulse
¾ BP
¾ Respiratory Rate
¾ Odema
¾ Cyanosis
¾ Icterus
¾ Lymphadenopathy
b) Systemic examination
¾ CVS
¾ RS
¾ P/A
¾ GUS
¾ CNS
c) Local examination
1) Inspection : The following points should be observed.
Number : Nadivrana having single opening are selected for the study.
Position : It is to make the diagnosis only by looking at the position of these
sinuses. Congenital and acquired can be known by its position.
Opening of the Sinus :
Sprouting Granulation Tissue at the opening of the sinus suggests
presence of foreign body at the depth. Eg. Sequestrum, Draining tube etc and to
diagnose the presence of systemic diseases like TB.
Discharge : Look for the characteristic features of the discharge. Pus in
asteomyelitis, serosanguineous in tuberculosis Ulcer and presence of sulphar
granules in actinomycosis.
Surrounding Skin : Scar indicates chronic asteomyelitis (or) previously healed
Tubercular sinus. Dermatitis and Pigmentation are characteristic features of
Crohn’s disease and actinomycosis.
d) Palpation : It is done to elicit tenderness indurations, and direction of the tract
mobility of the sinus over deep structures and for the presence of Lump.
10. Method :
This present study is planned to assess the efficacy of the Ayurvedic
preparation ‘Ghontaphaladi Varti in Group ‘A’ and Saindhav Varti in Group
‘B’. Varti applied into the Nadivrana tract, Routine dressing with sterile pads is
used in required cases. The patients were weekly assessed as per the parameters.
11. Probing :
It was done cautiously without using force, to note the following points.
1. The direction and depth of the sinus.
2. The presence of any foreign body or movable sequestrum.
3. Whether the end of the probe enters a bony cavity or a hollow viscus.
4. Whether fresh discharge comes on withdrawal of the probe.
12. Examination of the lymph nodes is draining the area. This is done according
to the site and causes of the sinus.
13. Provisional diagnosis
Sinus (Nadivrana) is provisionally diagnosed on the basis of the chief
complaints and clinical examination.
14. Specific Investigations :
a) Examination of the discharge (whenever necessary)
b) X-ray examination (Sinogram)
Injection of canray 420 into the sinus tract is done to determine the tract
of the sinus and to exclude the fistula-in-Ano in case of perianal region of
doubtful cases.
c) Examination of Blood :
Various examination of the blood such as total count, differential court
ESR, Hb % and RBS are done to know about the Haemopoetic and pathogenic
conditions of the patients.
15. Other Investigation :
a) Per Rectal examination :
This is done to know the condition of mucous membrane and Rectal wall.
b) Bimanual Examination :
This is done to elicit the presence or absence of abscesses, indurations and
condition of the associated structure etc.
c) Proctoscopy :
This is done to elicit other pathogenesis which is done after giving a lower
bowel wash.
Diagnosis : The cases are diagnosed and selected based on the above mentioned
symptomatology and investigation.
Management :
Preparation of the patient for Varti application :
The site of the application of the varti is shaved and made aseptic.
Systemic and general examination of the patient is thoroughly performed and
details were noted.
Method of application of Varti : (Ghontaphaladi Varti & Saindhav Varti)
After detecting the tract with probe Varti is introduced in the Sinus with
the help of a probe. Which goes up to the end. Varti is changed on 4th day, 7th
day, 10th day etc., upto 6th week of duration giving two days gap between two
applications changing of Varti was continued.
After taking all aseptic precautions the patient is made to lie down on the
table according to the site of the sinus. A simple probe is introduced into the
sinus tract from skin surface slowly & depth of the tract is estimated. If the
depth of the tract is more, local anesthesia may be necessary. The Varti is
introduced into the sinus by probe and then the probe is pulled out from the
sinus tract.
PARAMETERS FOR ASSESSMENT
Efficacy of treatment in both the groups were assessed based on changes
in signs and symptoms. To assess the efficacy following parameters were
considered and patients were assessed every week and improvement was
recorded using the following parameters.
Subjective Parameters
1. Pain
Grade – 0 : No Pain
Grade – 1 : Mild pain (Not interfering day to day activities)
Grade – 2 : Moderate Pain ( Disturbing day to day activities;
tolerated with difficulty)
Grade – 3 : Severe Pain ( Disturbing day to day activities and
Difficult to tolerate)
2. Burning Sensation
Grade – 0 : Absent
Grade – 1 : Present
3. Itching
Objective Parameters
4. Discharge
5. Induration
Grade – 0 : No Induration
Grade – 1 : Induration upto 1.5 cm radius
Grade – 2 : Induration extending from 1.6 cm to 3 cm radius
Grade – 3 : Induration extending beyond 3 cm radius.
6. Length of the Tract
1. The initial length of the tract was noted with the help of a probe in
the specially prepared performa progress was recorded at weekly interval
upto 6th week healing is ensured. The assessment is done as mentioned here
under.
A) Average time taken in weeks to heal per unit length (in cm.)
Formula :
Time taken per week = No. of weeks taken for healing of the tract
Initial length of the tract
B) Average unit length (cms) healed per week.
Formula :
Rate of healing = Initial length of the Tract 0

No. of weeks taken for healing
C) Average rate of healing of
Total average rate of healing

20
Selected cases in each group =
D) Average healing time
taken in selected cases = Total average time of 20 cases

20
TABLE FOR TRACT LENGTH ASSESSMENT
Case No. of Initial Length Day
No. Opening (cm) 7th 14th 21st 28th 35th 42nd
10
11
12
13
14
15
16
17
18
19
20
Clinical Status : I.e., symtomatology is recorded on the commencement of
therapy and subsequent weekly follow up session improvement is gauged.
Follow up and Termination :
15 days once follow-up is done using the above said parameters for
assessing the result of the treatment and to cheek the reccurrance of the disease.
Management is terminated after 6 weeks of the commencement of the therapy.
Materials required for diagnosis, management and assessment.
1. Copper probe blunt and sharp.
2. Torch
3. Proctoscope
4. X-ray films, Radio opaque dye and other requirement (If
necessary).
5. Pads and Bandages for local management.
ASSESSMENT OF RESULTS
This was done to assess the improvement of the patients in both the
groups after treatment. So the cases which had responded to the treatment were
grouped in to four categories.
1. Very good response :
Tract length if reduced by >3 cm associated with absence of discharge.
2. Good Response :
Tract length if reduced by >2 cm associated with absence of discharge.
3. Fair Response :
Tract length if reduced by >1 cm associated with control of discharge.
4. Poor Response :
Tract length if reduced by < 1 cm associated with moderate discharge.
OBSERVATIONS AND RESULTS
The following observations were made during the course of the present
clinical research study.
1) Incidence of Sex :
Group ‘A’ Group ‘B’ Total

Sex
No. % No. % No. %
Male 18 90.00 19 95.00 37 92.50
Female 02 10.00 01 5.00 03 7.50
Total 20 100.00 20 100.00 40 100.00
Group 'A'
Male
Female
18
Group 'B'
Male
Female
19
Out of 40 patients 37 (92.5%) patients were males and 3 patients (7.5%)
were females.
2) Incidence of Religion :
Group ‘A’ Group ‘B’

Sex
No. % No. %
Hindu 17 85.00 15 75.00
Muslim 03 15.00 05 25.00
Total 20 100.00 20 100.00
Group 'A'
Hindu
Muslim
17
Group 'B'
Hindu
Muslim
15
Out of 40 patients 32 patients (80%) were Hindus 8 patients (20%) were
Muslims.
3) Incidence of Age :
Age in Group ‘A’ Group ‘B’ Total
Years No. % No. % No. %
15 – 25 5 25.00 7 35.00 12 30.00
26 – 35 6 30.00 6 30.00 12 30.00
36 – 45 3 15.00 4 20.00 07 17.50
46 – 55 5 25.00 1 05.00 06 15.00
56 – 60 1 5.00 2 10.00 03 7.50
Total 20 100.00 20 100.00 40 100.00
10
8 Group ‘A’
Group ‘B’
7
No. of Patients
0
15 – 25 26 – 35 36 – 45 46 – 55 56 – 60
Age in Years
Out of 40 patients 12 patients (30%) in the age group of 15-25 years and
12 patients (30%) were there in the age group of 26-35 Years and 07 patients
(17.5%) in the age group of 36-45 years, 6 patients (15%) were in the age group
of 46-55 years and 3 patients (7.5%) in the age group of 56—60 years.
4) Incidence of Marital Status :

Marital Status
No. % No. %
Married 13 65.00 14 70.00
Unmarried 07 35.00 06 30.00
Total 20 100.00 20 100.00
Group 'A'
Married
Unmarried
13
Group 'B'
Married
Unmarried
14
Out of 40 patients 27 patients (67.5%) were found to be mar ried and 13
patients (32.5%) were unmar ried.
5) Incidence of Occupation :

Occupation
No. % No. %
Driver 8 40.00 9 45.00
Manual Labour 3 15.00 5 25.00
Sedentary work 9 45.00 6 30.00
Total 20 100.00 20 100.00
Group 'A'
8
9
Driver
Manual Labour
Sedentary work
Group 'B'
6
9
Driver
Manual Labour
Sedentary work
Out of 40 patients 17 patients were drivers, 15 patients were doing
sedentary work and 8 doing manual works.
6) Incidence of Diet Pattern

Diet Pattern
No. % No. %
Veg 11 55.00 12 60.00
Mixed 09 45.00 08 40.00
Total 20 100.00 20 100.00
Group A
9
Veg
Mixed
11
Group 'B'
Veg
Mixed
12
Out of 40 Patients 23 patients (57.5%) were vegetations and 17 patients
(42.5%) were on mixed diet.
7) Incidence of Chronicity of Disease :

Chronicity
No. % No. %
< 6 months 04 20.00 03 15.00
6 months – 1 year 10 50.00 10 50.00
> year 06 30.00 07 35.00
Total 20 100.00 20 100.00
15
14 Group ‘A’
13
12 Group ‘B’
11
10
No. of patients
9
8
7
6
5
4
3
2
1
0
< 6 months 6 months – 1 year > year
Chronicity
It was observed that among 40 patients these were 20 patients (50%) in
the category of 6 months to 1 year duration and 13 patients (32.5%) were of
more than 1 year category and 7 patients (17.5%) were in the category of less
than 6 months.
8) Incidence of site of the sinuses :
Sl. No. Sites No. Percentage
01 Perianal Sinus 18 45%
02 Pilonidal Sinus 14 35%
03 Inguinal Sinus 02 05%
04 Sinus following post Tubectomy scar

03 7.5%
at pelvic region
05 Sinus of a chronic abscess Thigh

03 7.5%
Region.
Total 40 100.00
30
Perianal Sinus
25
Pilonidal Sinus
Inguinal Sinus
20 Sinus following post Tubectomy scar at pelvic

region
Total number of patients
Sinus of a chronic abscess thigh region
15
10
0
Perianal Sinus Pilonidal Sinus Inguinal Sinus Sinus following post Sinus of a chronic
Tubectomy scar at abscess thigh region
pelvic region
Site s of Sinuse s
It was observed that among 40 patients 18 patients (45%) were perianal
sinus (perianal region) , 14 patients (35%) were pilonidal sinus. (post anal
region), 2 patients (5%) were inguinal sinus (Inguinal region) , 3 patients (7.5%)
were sinus following post tubectomy scar at pelvic region and 3 patients (7.5%)
were sinus of chronic abscess thigh region.
9) Incidence of length of Tract of Group ‘A’
Length (cm Male Female Total Percentage
01 0 0 0 0%
02 0 0 0 0%
03 3 2 5 25%
04 2 0 2 10%
05 3 0 3 15%
06 8 0 8 40%
07 1 0 1 5%
08 1 0 1 5%
09 0 0 0 0%
10 0 0 0 0%
Total 18 2 20 100%
6
Length in Cm
4
Male
Female
3
0
1 2 3 4 5 6 7 8 9 10
No. of Patie nts
Maximum length of the tract found was 8 cms where as minimum length
of the tract found was 3 cm. Maximum patients of 8 men were found in 6 cm
length and minimum no. of patients i.e. 1 in each 7 & 8 cm respectively.
10) Incidence of Length of Tract of Group ‘B’
Length (cm Male Female Total Percentage
01 0 0 0 0%
02 0 0 0 0%
03 0 1 1 5%
04 4 0 4 20%
05 6 0 6 30%
06 6 0 6 30%
07 2 0 2 10%
08 1 0 1 5%
09 0 0 0 0%
10 0 0 0 0%
Total 19 1 20 100%
6
Length in Cm
4 Male
Female
3
0
1 2 3 4 5 6 7 8 9 10
No. of Patie nts
Maximum length of the tract found was 8 cm where as minimum length
of the tract found was 3 cm. maximum No. of patients of 6 men were found in 5&
6 cm and minimum of one patient found in each 3 cm and 8 cm.
11) This table shows the length of the tract rate of healing in every 7 days upto
42nd in all 20 of Group ‘A’.
Initial
Case No. of 7th 14th 21st 28th 35th 42nd
Length
No. Opening day day day day day day
in (cm)
1 1 3 2 2 1 0
2 1 3 2.5 2 1.5 1 0
3 1 5 4 3 2 1 0.5 0
4 1 3 2.5 2 1.5 1 0
5 1 3 2.5 2 1.5 1 0
6 1 5 4.5 4 4 3.5 3 2
7 1 6 5 4.5 4 3.5 3 2
8 1 6 5 4 3.5 3 2 1.5
9 1 5 4.5 4 3 2 1 .5
10 1 4 3.5 3 2 0.5 0 0
11 1 6 5.5 4.5 4 3 2 1
12 1 6 5 4 3.5 3 2 1
13 1 4 3 2 1 0
14 1 8 7 6 5 4.5 4 4
15 1 6 5 4 3 2 1.5
16 1 3 2 1 0.5 0
17 1 6 5 4 3.5 3 2 0.5
18 1 7 6 5 4.5 4 3 3
19 1 6 5 4.5 4 3.5 3 2.5
20 1 6 5 4.5 3.5 3 2 1.5
12) This table shows the length of the tract rate of healing in every 7days upto
42nd day in all 20 cases of Group ‘B’.
Initial
Case No. of 7th 14th 21st 28th 35th 42nd
Length
No. Opening day day day day day day
in (cm)
1 1 8 8 8 8 8 7.5 7
2 1 5 5.5 5 5 4.5 4 3
3 1 5 5 5 4.5 3.5 3 2.5
4 1 6 6 6 6 6 5 5
5 1 5 5 5 4.5 4 3.5 3
6 1 6 6 6 6 5.5 5 5
7 1 6 6 6 6 5.5 5 4.5
8 1 5 5 5 5 4.5 4 3
9 1 7 7 7 7 6 6
10 1 5 5 5 4.5 4 3.5 2.5
11 1 3 2 2 1 1 0 0
12 1 6 6 6 5.5 5 4 3
13 1 4 4 3.5 3 2 1 0.5
14 1 5 5 5 4 3 2 2
15 1 4 3.5 3 3 2 2 1
16 1 6 6 6 5.5 5 4 3
17 1 4 3 2.5 2 1.5 1 0.5
18 1 7 6.5 6 6 5 4 4
19 1 6 5.5 5 5 4 3 2
20 1 4 3 2.5 2 1 0.5 0
13 a) This table shows the rate of healing per week (in group ‘A’)
Initial Length of
Sl. No. of Case Weeks taken Healing per
the tract
No. Opening No. for healing week (in cms).
(in cms)
1 1 1 3 4 0.75
2 1 2 3 5 0.60
3 1 3 5 6 0.83
4 1 4 3 5 0.60
5 1 5 3 5 0.60
6 1 6 5 6 0.83
7 1 7 6 6 1
8 1 8 6 6 1
9 1 9 5 6 0.83
10 1 10 4 6 0.6
11 1 11 6 6 1
12 1 12 6 6 1
13 1 13 4 4 1
14 1 14 8 6 1.30
15 1 15 6 6 1
16 1 16 3 4 0.75
17 1 17 6 6 1
18 1 18 7 6 1.16
19 1 19 6 6 1
20 1 20 6 6 1
13 b) This table shows the rate of healing per week in Group ‘B’
Sl. No. of Case Initial Length of Weeks taken Healing per

No. Opening No. the tract for healing week (in cms)
1 1 1 8 6 1.30
2 1 2 5 6 0.83
3 1 3 5 6 0.83
4 1 4 6 6 1
5 1 5 5 6 0.83
6 1 6 6 6 1
7 1 7 6 6 1
8 1 8 5 6 0.83
9 1 9 7 6 1.16
10 1 10 5 6 0.83
11 1 11 3 5 0.60
12 1 12 6 6 1
13 1 13 4 6 0.60
14 1 14 5 6 0.83
15 1 15 4 6 0.60
16 1 16 6 6 1
17 1 17 4 6 0.6
18 1 18 7 6 1.16
19 1 19 6 6 1
20 1 20 4 6 0.60
¾ From table No. (13a & b) it can be understood that the average tract
healing per week was seen 0.89 cm in Group ‘A’ and 0.88 cm was seen in
group ‘B’.
Table 14 a Group ‘A’ showing the unit healing time (Group –A).
Average Time
Sl. No. of Case Initial Length of Weeks taken
taken to heal
No. Opening No. the tract for healing
1cm length.
1 1 1 3 4 1.30
2 1 2 3 5 1.60
3 1 3 5 6 1.20
4 1 4 3 5 1.60
5 1 5 3 5 1.60
6 1 6 5 6 1.20
7 1 7 6 6 1
8 1 8 6 6 1
9 1 9 5 6 1.20
10 1 10 4 6 1.50
11 1 11 6 6 1
12 1 12 6 6 1
13 1 13 4 4 1
14 1 14 8 6 0.75
15 1 15 6 6 1
16 1 16 3 4 1.30
17 1 17 6 6 1
18 1 18 7 6 0.85
19 1 19 6 6 1
20 1 20 6 6 1
Table 14 b Group ‘B’ showing the unit healing time (Group –B).
Average Time
Sl. No. of Case Initial Length of Weeks taken
taken to heal
No. Opening No. the tract for healing
1cm Length
1 1 1 8 6 0.75
2 1 2 5 6 1.20
3 1 3 5 6 1.20
4 1 4 6 6 1
5 1 5 5 6 1.20
6 1 6 6 6 1
7 1 7 6 6 1
8 1 8 5 6 1.20
9 1 9 7 6 0.85
10 1 10 5 6 1.20
11 1 11 3 5 1.60
12 1 12 6 6 1
13 1 13 4 6 1.50
14 1 14 5 6 1.20
15 1 15 4 6 1.50
16 1 16 6 6 1
17 1 17 4 6 1.50
18 1 18 7 6 0.85
19 1 19 6 6 1
20 1 20 4 6 1.50
¾ From table No. (14 a & b) it can be understood that total average unit
healing for 20 cases in group ‘A’ is 1.15 weeks and in Group ‘B’ is 1.16
weeks.
Evaluation of pain between two Groups
Table 15 Evaluation of Pain
Group Pain BT 7th day 14th 21st 28th 35th 42nd %

day day day day day Recovery
Grade- 4 4 3 3 3 2 2
3 (20%) (20%) (15%) (15%) (15%) (10%) (10%)
Grade- 6 6 5 5 4 4 3
2 (30%) (30%) (25%) (25%) (20%) (20%) (15%)
A 65%
Grade- 10 8 7 6 4 3 2
1 (50%) (40%) (35%) (30%) (20%) (15%) (10%)
Grade- 2 5 6 9 11 13
0
0 (10%) (25%) (30%) (45%) (55%) (65%)
Grade- 3 3 3 3 2 2 2
3 (15%) (15%) (15%) (15%) (10%) (10%) (10%)
Grade- 7 7 6 6 5 5 4
2 (35%) (35%) (30%) (30%) (25%) (25%) (20%)
B 45%
Grade- 10 9 9 8 8 7 5
1 (50%) (45%) (45%) (40%) (40%) (35%) (25%)
Grade- 3 5 6 9
0 1 (5%) 2 (1%)
0 (15%) (25%) (30%) (45%)
20
18
16
14 Grade-0
No. of Patients 12 Grade-1
10 Grade-2
8 Grade-3
6
4
2
0
BT 7th 14th 21st 28th 35th 42nd
day day day day day day
Group A
20
18
16
14
No. of P atients
12
Grade-0
10 Grade-1
8 Grade-2
Grade-3
6
0
BT 7th day 14th day 21st day 28th day 35th day 42nd day
Group B
¾ Among 20 patients before treatment in Group-A 10 patients (50%) were
in Grade, 6(30%) in Grade-2, 4(20%) in Grade-3 and in Grade-3 and
Group B, 10 patients (50%) were in Grade-1 7(35%) patients in Grade-2,
3(15%) in Grade-3.
¾ On 7th day in Group A, 2 patients (10%) in Grade-0 8(40%) in Grade-1,
6(30%) in Grade-2, 4(20%) in Grade-3 and Group B, 1 patient (5%) in
Grade-0 9(45%) in Grade-1, 7 (35%) in Grade-2, 3(15%) in Grade-3.
¾ On 14th day in Group A 5 patients (25%) in Grade-0 7 (35%) in Grade-1,
5(25%) in Grade-2, 3(15%) in Grade-3 and Group-B, 2 Patients (10%) in
Grade-0 9(45%) in Grade-1, 6 (30%) in Grade-2, 3(15%) in Grade-3.
¾ On 21st day in Group-A 6 patients (30%) in Grade-0 6(30%) in Grade-1,
5(25%) in Grade-2, 3(15%) in Grade-3 and in Group-B 3 patients (15%)
in Grade-0, 8(40%) in Grade-1, 6(30%) in Grade-2, 3(15%) in Grade-3.
¾ On 28th day in Group-A 9 patients (45%) in Grade-0 4(20%) in Grade-1,
4(20%) in Grade-2, 3(15%) in Grade-3 and in Group-B 5 patients (25%)
in Grade-0, 8(40%) in Grade-1, 5(25%) in Grade-2, 2(10%) in Grade-3.
¾ On 35th day in Group A 11(55%) patients were in Grade-0, 3(15%) in
Grade-1, 4(20%) in Grade-2, 2(10%) in Grade-3, and in Group B 6(30%)
patients were in Grade-0 7(35%) in Grade-1, 5(25%) in grade-2, 2(10%)
in Grade-3.
¾ On 42nd day in Group A 13(65%) patients in Grade-0, 2(10%) in Grade-1,
3(15%) in Grade-2, 2(10%) in Grade-3 and in Group B 9(45%) patientsin
Grade-0 5(25%) in Grade-1, 4(20%) in Grade-2, 2(10%) in Grade-3.
Evaluation of Induration between 2 groups
Table 16 Evaluation of Induration
Group Induration BT 7th 14th 21st 28th 35th 42nd %
day day day day day day Recovery
Grade-3 1 (5%) 1 1 1 1 1 1
(5%) (5%) (5%) (5%) (5%) (5%)
Grade-2 5 4 4 3 3 2 2
(25%) (20%) (20%) (15%) (15%) (10%) (1%)

A 55%
Grade-1 11 10 10 8 8 7 6
(55%) (50%) (50%) (40%) (40%) (35%) (30%)
Grade-0 3 5 5 8 8 10 11
(15%) (25%) (25%) (40%) (40%) (50%) (55%)
Grade-3 2 2 2 2 2 2 2
(10%) (10%) (10%) (10%) (10%) (10%) (10%)
Grade-2 3 3 3 3 3 2 2
(15%) (15%) (15%) (15%) (15%) (10%) (10%)

B 40%
Grade-1 12 11 11 10 10 9 8
(60%) (55%) (55%) (50%) (50%) (45%) (40%)
Grade-0 3 4 4 5 5 7 8
(15%) (20%) (20%) (25%) (25%) (35%) (40%)
20
18
16
14 Grade-0
No. of Patients
12 Grade-1
10 Grade-2
8 Grade-3
6
4
2
0
BT 7th 14th 21st 28th 35th 42nd
day day day day day day
Group A
20
18
16
14
No. of Patients
12 Grade-0
10 Grade-1
Grade-2
8
Grade-3
6
0
Group B
¾ Among 20 patients before treatment in Group-A 3(15%) patients were in
Grade-0, 11 (55%) in Grade-1, 5(25%) in Grade-2, 1(15%) in Grade-3,
and in Group-B, 3(15%) in Grade-0, 12(60%) in Grade-1, 3(15%) in
Grade-2, 2(10%) in Grade-3.
¾ On 7th day in Group A 5(25%) in Group-0 10(50%) in Grade-1, 4(20%) in
Grade-2, 1(5%) in Grade-3 and in Group-B, 4(20%) in Grade-0 11(55%)
in Grade-1, 3(15%) in Grade-2 and 2(10%) in Grade-3.
¾ On 14th day in Group A 5(25%) in Grade-0 10(50%) in Grade-1, 4(20%)
in Grade-2, 1(5%) in Grade-3 and in group B 4(20%) in Grade-0,
11(55%) in Grade-1 (3(15%) in Grade-2, (2(10%) in Grade-3.
¾ On 21st day in Group A 8(40%) in Grade-0 8(40%) in Grade-1, 3(15%) in
Grade-2, 1(5%) in Grade-3, and in Group B 5(25%) in Grade-0 10(50%)
in Grade-1, 3(15%) in Grade-2, and 2(10%) in Grade-3.
¾ On 28th day in Group-A 8(40%) in Grade-0, 8(40%) in Grade-1, 3(15%)
in Grade-2 and 1(5%) patients in Grade-3 and in Group B 5 patients
(25%) in Grade-0, 10(50%) in Grade-1, 3(15%) in Grade-2, 2(10%)
patients in Grade-3.
¾ On 35th day in Group-A 10(50%) patients in Grade-0 7(35%) in Grade-1
2(10%) in Grade-2 1(5%) in Grade-3 and in Group B 7 patients (35%) in
¾ On 42nd day in Group A 11(55%) patients in Grade-0, 6(30%) in Grade-1,
2(10%) in Grade-2, 1(5%) in Grade-3 and in Group B 8(40%) patients in
Evaluation of Discharge between two Groups
Table 17. Evaluation of Discharge
14th 21st 28th 35th 42nd %

th
Group Discharge BT 7 day
20 18 15 12 11 9 8
Present
(100%) (90%) (75%) (60%) (55%) (45%) (40%)
A 60%
2 5 8 9 11 12
Absent 0
(10%) (25%) (40%) (45%) (55%) (60%)
20 19 17 17 15 13 11
Present
(100%) (95%) (85%) (85%) (75%) (65%) (55%)
B 45%
0 1 3 3 5 7 9
Absent
(5%) (15%) (15%) (25%) (35%) (45%)
20
18
16
14
No. of patients
12
10
Absent
Present
8
0
Group A
20
18
16
14
No. of patients
12
Absent
10 Present
8
0
Group B
Among 20 patients before treatment in Group A 20 patients (100%) were in
present category and in Group B also all patients were of present category
only.
¾ On 7th day in Group A 18 (90%) patients were had discharge and 2 were
not had. And in Group-B, 19 (95%) patients were had discharge and only
one patient was not had discharge.
¾ On 14th day in Group A, 15(75%) patients were had discharge 5 (25%)
were not had discharge, and in Group B 17 (85%) patients were had
discharge and 3 (15%) were not had discharge.
¾ On 21st day in Group A 12 (60%) patients were had discharge and 8
(40%) were not had discharge and in Group B 17(85%) patients were had
discharge and 3(5%) patients were not had discharge.
¾ On 28th day in Group A 11(55%) patients were had discharge and 9(45%)
were not had discharge in Group B 15(75%) patients were had discharge
5(25%) patients were not had discharge.
¾ On 35th day in Group A 9(45%) patients were had discharge and 11(55%)
patients were not had discharge and in Group B 13(65%) patients were
had discharge and 7 (35%) patients were not had discharge.
¾ On 42nd day in Group A 8(40%) were had discharge and 12 (60%)
patients were not had discharge and in Group B 11(55%) were had
discharge and 9(45%) patients were not had discharge.
Table 18. Evaluation of burning sensation between two groups.
Burning 14th 21st 28th 35th 42nd %

Group BT 7th day
sensation day day day day day Recovery
12 10 9 7 5 3 2
Present
(60%) (50%) (45%) (35%) (25%) (15%) (10%)
A 83.3%
10 11 13 15 17 18
Absent 8 (40%)
(50%) (55%) (65%) (75%) (85%) (90%)
15 14 12 10 7 5 4
Present
(75%) (70%) (60%) (50%) (35%) (25%) (20%)
B 73.3%
6 8 10 13 15 16
Absent 5 (25%)
(30%) (40%) (50%) (65%) (75%) (80%)
20
18
16
No. of patients 14
12 Absent
10 Present
8
0
Group A
20
18
16
14
No. of patients
12 Absent
10
Present
8
0
Group B
Among 20 patients before treatment in Group-A, 12(60%) patients were had
burning sensation and 8(40%) patients were not had burning sensation and
in Group-B 15 (75%) patients were had burning sensation and 5(25%)
patients were not had burning sensation.
¾ On 7th day in Group A 10 (50%) patients were had burning sensation and
10 (50%) patients were not had burning sensation. In Group- B 14(70%)
patients were had burning sensation and 6 (30%) patients were not had
burning sensation.
¾ On 14th day in group - A 9(45%) patients were had burning sensation and
11(55%) patients were not had burning sensation and in group–B
12(60%) patients were had burning sensation and 8(40%) patients were
not had burning sensation.
¾ On 21st day in Group - A 7(35%) patients were had burning sensation and
13(65%) were not had burning sensation and in Group –B 10(50%)
patients were had burning sensation and 10(50%) patients were not had
burning sensation.
¾ On 28th day in Group -A 5(25%) patients were had burning sensation and
15 (75%) patients were not had burning sensation and in Group-B
7(35%) patients were had burning sensation and 13(65%) patients were
not had burning sensation.
¾ On 35th day in Group -A 3(15%) patients were had burning sensation and
17(85%) patients were not had burning sensation and in Group –B
5(25%) patients had burning sensation and 15 (75%) patients were not
had burning sensation.
¾ On 42nd day in Group-A 2(10%) patients were had burning sensation and
18(90%) patients were not had burning sensation and in Group –B 4(
20%) were had burning sensation and 16(80%) patients were not had
burning sensation.
Table 19. Evaluation of Itching between two groups.
14th 21st 28th 35th 42nd %

th
Group Itching BT 7 day
12 10 8 7 5 3
Present 1 (5%)
(60%) (50%) (40%) (35%) (25%) (15%)
A 91.6%
10 12 13 15 17 19
Absent 8 (40%)
(50%) (60%) (65%) (75%) (85%) (95%)
13 12 10 10 8 5 3
Present
(65%) (61%) (50%) (50%) (40%) (25%) (15%)
B 76.9%
8 10 10 12 15 17
Absent 7 (35%)
(40%) (50%) (50%) (60%) (75%) (85%)
¾
20
18
16
14
No. of patients
12
Absent
10
Present
8
0
Group A
20
18
16
14
No. of patients
12
10
Absent
Present
8
0
Group B
Among 20 patients before treatment in Group A 12(60%) patients were
had itching and 8(40%) patients were not had itching and in Group B
13(65%) patients were had itching and 7(35%) patients were not had
itching.
¾ On 7th day in Group A 10 (50%) patients were had itching and 10 (50%)
patients were not had itching and in Group B 12(60%) patients were had
itching and 8 (40%) patients were not had itching.
¾ On 14th day in group - A 8(40%) patients were had itching and 12(60%)
patients were not had itching and in group – B 10(50%) patients were
had itching and 10(50%) patients were not had itching.
¾ On 21st day in Group - A 7(35%) patients were had itching and 13(65%)
were not had itching and in Group –B 10(50%) patients were had itching
and 10(50%) patients were not had itching.
¾ On 28th day in Group -A 5(25%) patients were had itching and 15 (75%)
patients were not had itching and in Group-B 8(40%) patients were had
itching and 12(60%) patients were not had itching.
¾ On 35th day in Group -A 3(15%) patients were had itching and 17(85%)
patients were not had itching and in Group –B 5(25%) patients were had
itching and 15 (75%) patients were not had itching.
¾ On 42nd day in Group-A 1(5%) patients were had itching and 19(95%)
patients were not had itching and in Group –B 3( 15%) were had itching
and 17(85%) patients were not had itching.
Table 20. statistical analysis of (Group ‘A’) by using paired ‘t’ test
Sl. Parameters Difference P Value Remarks

SD SE t value d.f.
No. (Symptoms) of Mean
1 Pain P<0.00 Highly

1 0.9733 0.2176 4.5955 19
1 Significant
2 Burning P<0.00 Highly

0.5 0.5129 0.1146 4.363 19
sensation 1 Significant
3 Itching P<0.00 Highly

0.55 0.5104 0.11471 4.820 19
1 Significant
4 Discharge P<0.00 Highly

0.6 0.5026 0.1123 5.342 19
1 Significant
5 Induration 0.45 0.8255 0.1845 2.4390 19 P<0.05 Significant
6 Length of the P<0.00 Highly

3.95 0.7762 0.1735 22.7665 19
tract 1 Significant
Table 21. Statistical Analysis of (group ‘B’) using paired ‘t’ test:
Sl. Parameters Difference P Value Remarks

SD SE t value d.f.
No. (Symptoms) of Mean
1 Pain Highly
0.7 0.9233 0.2064 3.391 19 P<0.01
Significant
2 Burning P<0.00 Highly

0.55 0.5104 0.1141 4..820 19
sensation 1 Significant
3 Itching P<0.00 Highly

0.5 0.5129 0.1146 4.363 19
1 Significant
4 Discharge P<0.00 Highly

0.45 0.5104 0.1141 3.9439 19
1 Significant
5 Induration 0.3 0.5712 0.1277 2.362 19 P<0.05 Significant
6 Length of the P<0.00 Highly

2.47 0.9931 0.2220 11.126 19
tract 1 Significant
Table 22. Comparative statistical analysis of both the groups after treatment
(using unpaired t-test)
Sl. t P Remarks
Parameters Group Mean SD SE PSE
No. value Value
A 1 0.9733 0.2176 0.3 Non

P>0.0
1 Pain 1.0 Significan
5
B 0.7 0.9233 0.2064 t
A 0.50 0.5129 0.1146 0.4782 Non

Burning P>0.0
2 0.1046 Significan
sensation 5
B 0.55 0.5104 0.1141 t
A 0.55 0.5104 0.1141 0.4782 Non

P>0.0
3 Itching 0.1046 Significan
5
B 0.50 0.5129 0.1146 t
A 0.6 0.5026 0.1123 Non

P>0.0
4 Discharge 0.4758 0.3153 Significan
5
B 0.45 0.5104 0.1141 t
A 0.45 0.8255 0.1845 Non

P>0.0
5 Induration 0.5588 0.269 Significan
5
B 0.30 0.5712 0.1277 t
A 3.95 0.7762 0.1735 Significan

Length of P<0.0
6 0.6289 2.3533 t
the tract 5
B 2.47 0.9931 0.2220
Comparative statistical analysis of both groups denotes non significant
difference with respect to parameters such as pain, burning sensation, itching,
discharge and Induration. And significant difference in case of length of the
tract.
TABLE .23.OVERALL COMPARISON OF OUTCOME (%)
Out Come Variables Group ‘A’ Group ‘B’
Pain 65% 45%
Burning sensation 83.3% 73.3%
Itching 91.6% 76.9%
Discharge 60% 45%
Induration 55% 40%
Length of the tract 35% 15%
100%
90%
80%
70%
60%
Percentages
50%
Group ‘A’
40% Group ‘B’
30%
20%
10%
0%
Pain Burning Itching Discharge Induration Length of the
sensation tract
Outcome variables
Effect of Ghontaphaladi Varthi application in group A shown more
efficacy with respect to pain at (42nd day) with an improvement of 65%, whereas
the saindhav varthi application in Group ‘B’ shown low efficacy with 45%
improvement.
Effect of Ghontaphaladi Varthi application in Group ‘A’ shown more
efficacy with respect to burning sensation at 42nd day with an improvement of
83.3% where as the Saindhav Varthi application in group ‘B’ shown low efficacy
with 73.3% improvement.
Effect of Ghontaphaladi Varti application in Group ‘A’ shown more
efficacy with respect to Itching at 42nd day with an improvement of 916% where
as the saindhav varthi application in group ‘B’ shown low efficacy with 76.9%
improvement.
Effect of Ghontaphaladi Varthi application in group ‘A’ shown more
efficacy with Respect to Discharge at 42nd day with an improvement of 60%
whereas the saindhav varthi application in group ‘B’ shown low efficacy with
45% improvement.
Effict of Ghontaphaladi Varthi application in group ‘A’ shown more
efficacy with respect to Indusration at 42nd day with an improvement of 55%
where as the Saindhav Varthi application in Group ‘B’ shown low efficacy with
40% improvement.
Effect of Ghontaphaladi Varthi application in group ‘A’ shown more
efficacy with respect to length of the tract at 42nd day with an improvement of
35% where as the saindhav varthi application in group ‘B’ shown low efficacy
with 15% improvement.
DISCUSSION
Preface
Nadivrana is a common problem according to sushruta Nidana stana 10th
chapter. Nadivrana is one of the trouble some disease which can occur
anywhere in the body and is encountered in surgical practice which do not
respond to the medical treatment. The management of sinus still remains a
riddle to the attending surgeons. Even surgical management is also not
completely effective if the rate of recurrence is considered. Patients with sinuses
of varied pathology often seek sophistication of medico-surgical practice and a
desperate tendency is seen among them till today.
The methodology of the management are statistically frowned upon and
the surgeon finds it difficult to lay open the entire sinus tract because of
inaccessibility to deeper structures.
In the present clinical study, Ayurvedic preparations such as
Ghontaphaladi Varti and saindhav varti were selected. Both the vartis are well
known for its Vrana Shodhana and Vrana Ropara (wound healing) properties.
The basic principles of Vrana management include aetiopathogenesis of
Vrana as well as dustavrana in which involvement of tridoshas are there.
Nadivrana also considered as dustavrana due to its non healing in nature (it is
difficult to manage by the modern system of medicine and the rate of recurrence
is very high).
This trial is planned for the evaluation of Varthis (Ghontaphaladi Varthi
and Saindhav Varthi) on random cases of Nadivrana in the line of the
understanding of aetiopathogenesis and pharmacotherapeutics of Nadivrana,
explained by our Acharyas in Ayurveda with concurrent use of the parameters
available for the present day.
b) Understanding of the disease :
Nadivrana is identified as a Tubular Vrana and qualifies in every sense
with dusta vrana. Just a deep into the modern parlance will enable us to directly
correlate this condition as sinus because it is also a blind tubular tract leading
from surface down into the tissues. Innate foreign bodies according to the
classics also cause sinus. One of the main causes of non healing nature of
Nadivrana (shalyaja) is the presence of hair.
The occurance of sinus in anal region is also well understood to be
proceeded by local abscesses as per the modern and Ayurvedic concepts. These
abscesses also may be followers of infected anal crypts. More than 90% of the
sinuses occurring in the anoretal region are of infection to the anal glands. It is
well known fact that these sinuses are given rise to problem to the patients.
The obstructive pathology playing behind the screen in the genesis of
sinuses are well studied as in the case of pilonidal sinuses of the anal canal as
explained by modern authors.
Thus it can be understood that a decent amount of correlation exists
between the modern and ancient in understanding of Nadivrana with relevance
to its Nidana and Samprapthy.
c) The Management
The Management comprised of application of Ghontaphaladi varti and
saindhav varti into Nadivrana (sinus). Varti is mainly indicated in vrana with
minute external opening and in antaha shalyaja vrana. These vartis prepared
with shodhana and Ropana dravyas does debridement of the slough (or)
unhealthy tissue, alleviates all the vitiated doshas and facilitates for the healing
process. Weekly probing sessions are conducted for removing any obstructive
pathology in the sinus tract by which adequate drainage could be done and the
tract become more suitable for healing in proper way.
Ghontaphaladi Varti consists of Ghontaphala Twak, madanaphala, poogaphala
twak, saindhav Lavana, Snuhi Ksheera and Arkaksheera. These are all known
to possess tridosha shamaka and anti-inflammatory activities irrespective of the
organisms due to its Teekshna, sookshma, sara, krimighna and vishagna
properties. It acts as local debriding agent and keeps the tract clean and devoid
of purulent substances. Its laghu Rooksha and sara properties enable it to
penetrate deeper into the tissues and acts against the tendency of body towards
formation of fibrous tissues there by resulting in non-healing nature of
nadivrana besides, after healing scar tissue formation is less.
Saindhav varti consists of Madhu and Saindhav lavan Madhu is effective
promoter in enhancing tissue repair and wound healing. And also plays a role in
the initial debridement of non-healing Ulcers. It has antimicrobial activity
against gram positive and gram negative organisms.
Saindhav lavan is Tridoshagna and acts as a shodhana, lekhana and
Ropana.
On Observations :
Both the groups were observed thoroughly in respect of sex, age, religion,
occupation, marital status, diet and chronicity of illness and site of sinuses.
Age : Maximum number of patients that is 24 (60%) out of 40 patients were
found in the age groups between 15-25 and 26-35 years in both groups it was
observed that patients between the age groups 15-25 and 26-35 years are more
prone to sinus disease.
Sex : In the present study 37 patients (92.5%) out of 40 patients were males and
only 3 patients (25%) were females this shows that the disease is predominant in
males.
Religion : Distribution of the patients based on their religion shows that 32
(80%) out of 40 patients were Hindus, followed by 8 patients (20%) were
Muslims, the ratio tells us well with the ratio of Hindus and Muslims in the
general population. Hence therefore cannot be assumed that Hindus are
susceptible to Sinus.
Marital Status : On observation about this out of 40 patients 27 patients (67.5%)
were found to be marr ied and 13 patients (32.5%) were unmar ried. This can be
assured that the disease is affecting the age group of 25-35 and this is the age
group which a person will be married.
Occupation : In this study out of 40 patients 17 patients were drivers, 15 patients
were doing sedentary work and 8 were doing manual labour works.
Thus it was seen that (pilonidal) sinus is more common in patients who
were drivers due to friction and long time sitting and also sinus is common in
who were doing sedentary work.
Diet : Among the patients in the present study, 17 patients (42.5% reported to
be having mixed diet and rest 23 patients (57.5%) were vegetarians. But it seems
that dietary habits play no role in causing sinus.
Chronicity of illness : Most of the patients in the study groups presented with
chronicity of disease in the group of 6 months to 1 year i.e., 20 patients (50%)
out of 40 and 13 patients (32.5%) were of more than 1 year category and 7
patients (17.5%) were in the category of less than 6 months. It shows that if
chronicity of illness is less then possibilities of curing the disease will be more.
Economic status : In the present study the classification of patients based on
their economic status shows that people belonging to lower middle class were
more i.e., out of 40 patients, 25 patients (62.5%) were of lower middle socio-
economic status..
Addiction : Distribution of patients based on habits indicates that 40% of the
patients i.e, 16 out of 40 addicted to both alchohol and smoking 30% of the
patients i.e., 12 out of 40 addicted only to smoking and 3(7.5%) were addicted to
tobacco chewing.
Site of Sinuses : Distribution of patients based on site of sinus in the body
indicates that 45% of the patients i.e., 18 out of 40 were perianal sinus, and 35%
of patients i.e., 14 out of 40 were pilonidal sinus, 2 (5%) patients were inguinal
sinus, 3 patients (7.5%) were sinus following post Tubectomy scar (pelvic region)
and 3 patients (7.5%) were sinus of a chronic abscess (thigh region).
Thus the manifestation of sinus is more common at perianal region
(perianal sinus) and post anal region (pilonidal sinus).
Every 7 days a detailed subjective and objective examination helped to
know the progress in clinical status and details recorded. The initial length of
the tract and subsequent weekly tract length is recorded. The Gravity of clinical
status is also noted.
¾ Ghontaphala helps in reducing the inflammation and promotes wound
healing by its vrana shodaka, vrana ropaka, Krimigna and Vatapitta hara
properties.
¾ Madanphala reduces discharge and pain by its Kaphavata Shodhaka,
Shamaka and Pitta nissaraka, vranagna, Shoolagna and sophagna
properties inturn, helps in healing of ulcers.
¾ Poogaphala from its kaphapitta nashaka, Krimigna and Vrana ropaka
actions it is useful in treatment of Nadivrana.
¾ Snuhi Ksheera from its kaphavata hara, pitta shodhana and unique
properties like shodhana of rasa, rakta, mamsa, medha, majja is very
useful in inflammatory conditions like Nadivrana.
¾ Arkaksheera is kaphavata shamaka, having sara, krimigna and vishagna
properties useful in treating non healing ulcers like Nadivrana.
Discusssion on Treatment results obtained:
In both the groups the results obtained (within the group) using paired ‘t’ test
for the parameters viz. Pain, Burning sensation, Itching, Discharge and Length
of the tract showed Highly significance where as Induration parameter showed
significant result.
On comparing for the observed differences in values obtained for the respective
parameters between both the groups A and B (using unpaired ‘t’ test) the result
showed non-significance for all the parameters except for the parameter Length
of the tract for which the difference was significant.
From the above results it is proved that both the drugs are quiet effective in
relieving all the parameters. With regards to Length of the tract parameter
Group A medicine i.e. Ghonta phaladi varti is more effective than Group B
medicine i.e. Saindhav varti.
CONCLUSION
From this present clinical comparative study for evaluation of efficacy of
Ghontaphaladi Varti and Saindhav Varti in the management of Nadivrana. The
following conclusions were drawn after thorough review of the literature,
observation and scientific discussion.
¾ The description of Nadivrana available in ancient Ayurvedic Literature is
implies to sinus described in modern literature.
¾ The Healing of Nadivrana still remains a major problem to the surgeon as
well as patient.
¾ The present study proved that varti application procedure is very easy
and effective than any surgical procedure.
¾ The results of average tract unit healing time per week were seen as 0.89
cm in group ‘A’ and 0.88 cm in group ‘B’.
¾ The total average unit healing time for 1 cm in group ‘A’ is 1.15 weeks
and in group ‘B’ is 1.17 weeks.
¾ As per the unit healing time, Ghontaphaladi Varti was found more
effective compared to Saindhav Varti.
¾ After the statistical analysis of Group ‘A’ Ghontaphaladi Varti shown
highly significant effect on pain, burning sensation, Itching, Discharge
and length of the tract. But it was only significant on induration.
¾ After the statistical analysis of group ‘B’ saindhav varti shown highly
significant effect on pain, burning sensation, itching discharge and length
of the tract but it was only significant on induration.
¾ Between the Group A and Group B the difference observed in all
parameters except Length of the tract parameter is statistically non
significant. In Length of the tract parameter the difference observed is
significant; Group A being more significant than group B.
¾ This clinical study came out with the following interesting features.
¾ No need for Hospitalization
¾ It is an alternative to surgery
¾ Post operative hypertrophic tarnish looking scar is avoided.
¾ The clinical status of patients was significantly improved.
¾ Maintenance of general hygiene control in diet, avoidance of obesity and
driving for long hours, weekly shaving to the post anal region avoids
recurrence of pilonidal sinus in future.
Scope for further study
¾ The present study was carried out on 20 patients each for both the groups
which is a small sample. So further study may be done to conduct on a
large sample after which a pin point conclusion can be drawn.
SUMMARY
¾ The study entitled ‘A clinical comparative study an efficacy of
Ghontaphaladi Varti and Saindhav Varti in the management of
Nadivrana (Sinus)’ is mainly based on clinical observation.
¾ Review of both Ayurvedic and modern literature has been done and the
clinical symptoms of Nadivrana as described in classical Ayurvedic text
seems to cor relate with sinus.
¾ The concept of Vrana and formation of Nadivrana and its complications
have been described.
¾ Management of Nadivrana and Pathyapathya has also been delt.
¾ Varthi Kalpana, Ghontaphaladi Varthi and Saindhav varthi prayoga in
Nadivrana have been discussed.
¾ Thorough review of drugs used in Ghontaphaladi Varti and Saindhav
Varti preparation has also been delt.
¾ 40 patients of nadivrana were selected randomly irrespective of age, sex,
religion, chronicity, socio economic status and were divided into two
groups ‘A’ and ‘B’ of 20 patients each.
¾ Patients in group A were treated with Ghontaphaladi Varti and Patients
in Group B were treated with saindhav varti for the duration of 6 weeks.
¾ 37 out of 40 patients were males and 3 were females with maximum age
group of 15-25 and 26-35 years.
¾ In occupation drivers and sedentary working people were found to be
maximum suffers, most of patients had chronicity of less than one year
duration.
¾ When two groups were compared more improvement was seen in patients
treated with Ghontaphaladi Varti.
REFERENCES
1. Su.Su. 21/40
2. Su.Chi. 1/6
3. Su.Chi. 1/3
4. Su.Chi. 1/3
5. Su. Chi. 1/3
6. Su. Su. 23/18
7. Su. Su. 22/7
8. Su. Chi. 1/6
9. Cha. Chi. 25/17 – 19
10. Su. Su. 22/3
11. Su. Chi. 1/8
12. Su. Su. 17/ 22 – 23
13. Shabdakalpdrum
14. Amarkosha
15. Amarkosha manushyavarga
16. Su. Ni. 10/10
17. Su. Ni. 10/10
18. Atharva veda 6/138.4.
19. Atharva veda 7/ 78.1
20. Su. Su. 17/15
21. Su. Ni. 10/9
22. Su. Ni. 10/ 11.
23. Su. Ni. 10/11
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25. Su. Ni. 10/13
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32. Su.Su. 18/37 – 39.
33. As. Hr. Su. 29/ 45,47
34. YogRatnakar Sarvavarana roganam pathya apthya.
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PG DEPARTMENT OF SHALYA TANTRA
AYURVEDIC MEDICAL COLLEGE AND PG CENTRE,
DAVANGERE-577566
CASE PROFORMA
TITLE : A clinical comparative study on efficacy of ghontaphaladi varti and
saindhav varti in the management of nadivrana (Sinus)
Research Scholar: Dr. Vikram S.
Guide : Dr. Jayasheela M. Goni
PRELIMINARY DATA
PATIENTS PARTICULARS
Name of the patient:
Age: IPD No:
Sex: M F OPD No:
Religion : H M C Others Date of Commencement:
Occupation: Date of Completion:
Marital Status : Married
unmarried
Socio-economic status :
Poor Middle class High class
Address :
General Examination
1. Built :
2. Pulse :
3. BP :
4. Temperature :
5. Respiratory rate :
6. Pallor :
7. Items :
8. Cyanosis
9. Oedema
10. Lymphadenopathy
Systemic examination:
¾ CVS
¾ RS
¾ PA
¾ GUS
¾ CNS
Local Examination: (Especially of the sinus)
Inspection:
1. Number :
2. Position :
3. Sprouting Granulation tissue : Present / Absent
4. Discharge : Present / Absent
5. Blood : Present / Absent
6. Pus : Present / Absent
7. Surrounding skin : healthy/Unhealthy/Induration/Others …….. . .
8. Scar : Present /Absent
9. Pigmentation: Present / Absent
10. Dermatitis : Present /Absent
Palpation :
1. Tenderness : Present / Absent
2. Temperature : Normal / Raised
3. Induration : Present / Absent
4. Mobility :
5. Fixidity :
6. Lump :
Examination : With a probe
1. Direction of the sinus– upward, downward, forward, lateral, Medial
2. Depth.
3. Foreign bodies
4. Bone Chips : Present (+) / Absent (-)
5. Suturing Material:
6. Other Material:
7. End of the probe enters the bone cavity
8. End of the probe enters a hollow visucs
9. Discharge comes out on withdrawal of the probe : Present/Absent
Special Investigation:
1. Lab Examination of the discharge : (Whenever required)
2. X-ray Examination: (Whenever Required)
3. Other examination :
• Hb %
• TCL, DLC
• ESR
• BT, CT
• Urine: Routine
• RBS
DIAGNOSIS
TREATMENT
Group Treatment Duration Follow up
A Ghontaphaladi Taking aseptic precautions varti is Once in 15 days
varti inserted into Nadivrana giving two for 6 weeks.
days gap between two applications
for 6 weeks.
B Saindhav varti Taking aseptic precautions varti is Once in 15 days
inserted into Nadivrana giving two for 6 weeks.
days gap between two applications
for 6 weeks.
PATHYA
APATHYA
ASSESSMENT OF THE PARAMETERS:
A) Subjective parameters
During Treatment
Sl Before
Observation 7th 14th 21st 28th 35th 42nd
No Treatment
Day Day Day Day Day Day
1 Pain
2 Burning Sensation
3 Itching
B) Objective Parameters
During Treatment
Sl Before
Observation 7th 14th 21st 28th 35th 42nd
No Treatment
Day Day Day Day Day Day
1 Discharge
2 Induration
3 Length of the tract
FOLLOW UP TABLE
Subjective and objective criteria for follow up
Sl No. Criteria 57th day 72nd day 87th day
1 Pain
2 Burning sensation
3 Itching
4 Discharge
5 Induration
6 Length of the tract
RESULT: Very good Response
Good Response
Fair Response
Poor Response
Signature of the Scholar Signature of the Guide

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

“A CLINICAL COMPARATIVE STUDY ON THE EFFICACY OF

The dissertation submitted to the

MASTER OF SURGERY (Ayurveda)

Guide and Professor

DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A CLINICAL

COMPARATIVE STUDY ON THE EFFICACY OF GHONTAPHALADI

VARTI AND SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA

Shalya Tantra, Ayurvedic Medical College, Davangere.

CERTIFICATE BY THE GUIDE

This to certify that this dissertation entitled “A CLINICAL COMPARATIVE

STUDY ON THE EFFICACY OF GHONTAPHALADI VARTI AND

SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA (SINUS)”, is a

Tantra, under my direct guidance.

Dr. JAYASHEELA. M. GONI M.D. (AYU)

Guide & Professor,

Department of Shalya Tantra,

Date : Ayurvedic Medical College,

This to certify that this dissertation entitled “A CLINICAL COMPARATIVE

STUDY ON THE EFFICACY OF GHONTAPHALADI VARTI AND

SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA (SINUS)”, is a

Tantra, under my guidance.

Dr. SATISH.B.G. M.S. (AYU)

Department of Shalya Tantra,

Date : Ayurvedic Medical College,

ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTE

This is to certify that the dissertation entitled “A CLINICAL

COMPARATIVE STUDY ON THE EFFICACY OF GHONTAPHALADI

VARTI AND SAINDHAV VARTI IN THE MANAGEMENT OF NADIVRANA

Shalya Tantra, Ayurvedic Medical College, Davangere.

Dr. MANJUNATH S. M.D. (Ayu.) Dr. UMA G GUBBI , M.D (Ayu).

Head of the Department Principal,

Dept. of P.G.Studies in Shalya Tantra, Ayurvedic Medical College &

Ayurvedic Medical College & P.G.Centre P.G Centre,

DECLARATION BY THE CANDIDATE

format for academic / research purpose.

OBSERVATIONS AND RESULTS

S.No Particualar Page

First of all I wish to place my sincere gratitude and thanks to my Guide

DR. JAYASHEELA. M. GONI, Department of PG studies in Shalya Tantra, AAMC and

PG Centre, Davangere for her valuable help and guidance.

I am thankful to DR MANJUNATH. S. Professor and H.O.D, Department of PG Studies in

I am thankful to DR SATISH B.G. Reader, Department of PG Studies in Shalya Tantra,

AAMC and PG Centre, Davangere for his help and guidance.

her precious support given for my study.

I would like to thank other management members DR MRITYUNJAYA HIRAMATH, DR

SURESH AMBERKER, DR SHANKAR NARAYAN AND DR RAVINDERNATH for

supporting and providing me an opportunity to conduct my study.

I am also thankful to all my PG colleagues who have helped me in many ways.

Venkanna for their timely support and help.

for their efficient and meticulous typing for this dissertation.

Date: With Heartfelt gratitude

To evaluate the efficacy of Ghontaphaladi varti in nadi vrana (sinus).

To evaluate the efficacy of Saindhav varti in nadi varana (sinus).

of Nadi vrana (Sinus).

analysis and conclusions were drawn.

Nadi vrana, Sinus, Ghontaphaladi varti, Saindhav varti.

vrana is associated with the presence of a large number of recesses or cavities in