Indian Medicine (Medicin), translated by C. G. Kashikar c13.54

c13.54

§ 77. Fistula :- *Bhagandara*, *bhagadāraṇa*, fistula-in-ano, "crevice in the vagina or the genitals" is caused by riding, squatting, chiefly from causes similar to *arśas* (AS, AHr), and is known by pain on the hips, itching, burning and tumour on the anus (Su). First there appears an abscess, then it expands and forms a fistula (MN). 1. *śataponaka*. By vāta. A reddish, painful abscess occurs on the anus. If it is not cured, it leads to bad suppuration and forms many openings with narrow mouth, from which plenty of frothy discharge comes with needle-pricking and other violent pains. Wind, urine, pus and sperm also come out from these openings. 2. *Uṣṭragrīva*, *Uṣṭrasirodhara*. By pitta. The abscess is red, long and thin like the neck of camel (*Uṣṭragrīva*); it burns the wound caused by it as if fire or cautery were applied to it, the discharge is bad smelling and hot; by neglect of the wound urine, pus etc. come from it. 3. *parisrāvin*. By kapha. The tumour is whitish, hard, itching, the discharge is tough and phlegmatic; by neglecting it urine etc. come out. 4. *Śambūkāvarta*. By three doṣas. The tumour is of the size of a big toe, the above signs are combined, the discharge is of different colours. 5. *Unmārgin* or *kṣataja*. If a bone is swallowed while eating and wounds the anus while coming out of it in an oblique position, a faecal boil is formed by vāta in which maggots are created that gnaw and perforate the anus, so that faeces, urine etc. come out of these openings. All *bhagandaras* are dangerous; the fourth and fifth kinds are incurable (Su 2.4; AS 6.32; AHr 6.28; MN 284-87; Vang 635 ff.; Bhāv 2.4). The abscesses are to be treated carefully with fasts, purgatives, blood-letting, dressing etc., so that they may not suppurate. If there is suppuration a probe should first be inserted in order to ascertain the nature of the fistula, whether it is open by outside etc. Then an incision should be taken according to the condition, or a cautery or fire-brand should be applied. If there are many openings, an expert surgeon should take a plough cut (*lāngalaka*) in the middle, or a half plough cut (*ardhalāngalaka*) on one side or the quartering (*sarvatobhadraka*) or the side cut (*gotīrthaka*), then the canals on all sides should be branded (Su 4.8; AS 6.34; AHr 6.29; Vang; Bhāv 1. c.; Vṛnda 48).