Parikartika (Fissure-in-ANO): A Review of Ayurvedic Concepts and Therapeutic Potential of Durvadi Ghrita, Jatyadi Ghrita and Manual Anal Dilatation

Abstract

Parikartika is a painful ano-rectal disorder described in Ayurvedic literature and is clinically comparable to Fissure-in-Ano. It is characterized by Kartanavat Vedana (cutting pain), Daha (burning sensation), Raktasrava (bleeding per rectum), Vibandha (constipation), Kandu (itching), and painful defecation. The disease is predominantly a Vata-Pitta Pradhana Guda Vyadhi in which aggravated Vata causes pain, dryness, constipation, and sphincter spasm, while vitiated Pitta contributes to inflammation, ulceration, burning sensation, and bleeding. Modern management includes dietary modification, stool softeners, topical medications, and surgical procedures; however, recurrence and procedure-related complications remain concerns. Ayurveda advocates a comprehensive therapeutic approach through Vata-Pitta Shamana, Vranaropana, Shothahara, Vedanasthapana, and bowel regulation. Durvadi Ghrita and Jatyadi Ghrita are classical formulations possessing wound-healing, anti-inflammatory, haemostatic, and tissue-regenerative properties. Manual Anal Dilatation helps reduce sphincter hypertonicity, improve local circulation, and facilitate fissure healing. This review highlights the Ayurvedic and modern perspectives of Parikartika and explores the therapeutic role of Durvadi Ghrita, Jatyadi Ghrita, and Manual Anal Dilatation in its management.

Introduction

Parikartika is an important anorectal disorder described in Ayurveda, particularly under Shalya Tantra. It is characterized mainly by severe cutting or tearing pain (Kartanavat Vedana) around the anal region, often accompanied by burning, bleeding, constipation, itching, and painful defecation. The condition is described in classical Ayurvedic texts both as an independent disorder and as a complication of conditions such as Arsha, Atisara, Grahani, and certain Panchakarma procedures.

From a modern clinical perspective, Parikartika is closely correlated with fissure-in-ano (anal fissure), in which a longitudinal tear or ulcer develops in the distal anal canal. Severe pain causes sphincter spasm and increased sphincter tone, which may reduce local blood supply, delay healing, and contribute to recurrence.

The term Parikartika is derived from the Sanskrit root “K?t” (to cut), with “Pari” indicating around or surrounding. Thus, it signifies intense cutting pain around the anus, which is considered its cardinal symptom.

Etiology (Nidana)

The causative factors mainly aggravate Vata and Pitta Dosha and include:

• Spicy, dry, and rough foods

• Irregular dietary habits and inadequate water intake

• Suppression of natural urges

• Excessive straining during defecation

• Sedentary lifestyle and prolonged sitting

• Chronic constipation, Atisara, Arsha, and Grahani

• Trauma to the anal mucosa

Pathogenesis (Samprapti)

Parikartika develops primarily through the involvement of Vata and Pitta Dosha, particularly affecting Apana Vata and the anal region. The major Samprapti Ghatakas include:

• Dosha: Vata and Pitta

• Dushya: Rasa, Rakta, and Mamsa

• Agni: Vishama/Tikshna

• Srotas: Purishavaha Srotas

• Adhisthana: Guda Pradesh

• Udbhava Sthana: Pakvashaya

Classical References

Parikartika is mentioned in major Ayurvedic texts, including:

• Charaka Samhita – particularly in relation to Virechana Vyapad

• Sushruta Samhita – Guda Vikara and treatment principles

• Ashtanga Hridaya – complications of Panchakarma

• Bhaishajya Ratnavali – therapeutic management

Conclusion

Parikartika is a Vata-Pitta predominant Guda Vyadhi that closely resembles Fissure-in-Ano in terms of symptomatology and pathogenesis. The disease significantly affects quality of life due to severe pain, burning sensation, bleeding, constipation, and sphincter spasm. Ayurveda offers a comprehensive treatment approach through Dosha Shamana, wound healing, and restoration of normal bowel function. Durvadi Ghrita and Jatyadi Ghrita possess significant Vranaropana, Shothahara, and tissue regenerative properties that support healing of fissure pathology. Durvadi Ghrita appears particularly beneficial because of its additional Raktastambhaka and Pittashamaka actions. Manual Anal Dilatation serves as an effective adjunctive procedure by relieving sphincter hypertonicity, improving local circulation, and facilitating ulcer healing. The combined use of medicated Ghrita and Manual Anal Dilatation provides a safe, economical, minimally invasive, and rational therapeutic approach for the management of Parikartika. Further clinical and experimental studies are required to strengthen the evidence base and establish long-term therapeutic outcomes.

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Copyright

Copyright © 2026 Sarika Gupta, Anita Patel. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.