Pathya and Apathya in Bhagandara: Holistic Approaches to Fistula-in-Ano

Bhagandara, commonly known as fistula in ano, is a prevalent anorectal condition extensively described in classical Ayurvedic texts. Classified under Ashtamahagada by Acharya Sushruta, it initially appears as a pidika near the anus and transforms into Bhagandara upon rupture. The clinical features of this condition align closely with modern interpretations of fistula in ano, and its recurrent nature presents significant treatment challenges. While contemporary surgical methods offer various options, the management of this ailment remains complex for proctologists. Among Ayurvedic treatments, Ksharasutra has emerged as a particularly effective parasurgical intervention. In addition to surgical approaches, adherence to Pathya (beneficial) and Apathya (harmful) dietary rules plays a crucial role in the management and prevention of recurrence, enhancing overall treatment outcomes. This article explores the holistic understanding of Bhagandara, its clinical manifestations and the importance of diet in achieving optimal health.