Worldwide International Inter Disciplinary Research Journal (A Peer Reviewed Referred) ISSN – 2454 - 7905 "REVIEW ARTICLE ON PARIKARTIKA" Nilima zarikar 1 kanchan Borkar 2, Anantkumar shekokar 3 1 P.G.Scholar , 2 Associate professor , 3Professor and HOD, Dept of shalya tantra, S.V.N.H.T’S Ayurved college, Rahuri, Dist- Ahmednagar, Maharashtra, India. ABSTRACT Nowadays due to faulty lifestyle, patient suffering from constipation with a rectal disease are quite high in number Parikartika is characterized by kartanwat and chhedandvat shool in Guda. Parikartika is a word which has been referred to in Bruhat-trayi (earlier three Samhitas of Ayurveda) not as separate entity, but as a complication of other diseases pertaining to ano-rectal region. The description of Parikartika resembles the signs and symptoms described for anal fissure. The symptoms include cutting or burning pain in anus, pain in umbilical region and radiating pain in the genitals and thighs. In Parikartika Vata is the dominant dosha. This is because of the site, Guda, which is actual site of Vata especially Apanavayu. According to Acharya Sushruta, there is vitiation of Vayu and Rakta. Pitta is the main dosha in Rakta so Pitta is also vitiated simultaneously.Thus when the ruksha mala passes through unlubricated Guda there is formation of crack with severe pain & burning or difficulty in passing flatus or stool, as per the doshik predominance. Both Charaka and Sushruta have advocated for treatment of Parikartika Pichha Basti with Madhuyashti, Madhu and til. KEYWORDS: Parikartika, constipation ,guda ,kartanvat ,chhedanvat shool, fissure in ano. INTRODUCTION Ayurveda is an ancient medical science. It is a boundless ocean of knowledge. Probably is the only medical science which has such elaborate knowledge about the life of living beings. In brief Ayurveda deals with physical. Mental and spiritual healthy life of persons. Today in the fast running life human being is inviting many diseases because of junk food, Viruddha Ahar-Vihar, Contaminated food etc. These disturb digestive system and cause constipation, hyperacidity, loss of appetite etc resulting into anorectal diseases. Parikartika disease is one of them. In this concern Ayurveda gives requisite guideline for health than other medical sciences. Acharya Sushrut has described Parikartika in “Vaman virechanvyapad chikitsa” (treatment of side effects of therapeutic vomiting & medicated purgation) in chikitsa sthan Acharya Charak has also motioned Parikartika under heading “Vaman Virechan Vyapad”. Acharya Vagbhat has stated Parikartikain “Arishta Lakshan”(Unauspecious prognostic features). The major reference stated by Acharya Kashyapa is found in ‘Garbhini chikitsa’ (ANC & PNC treatment) Vol. I - ISSUE – XXXIII SJIF Impact Factor : 6.91 Page - 1 Worldwide International Inter Disciplinary Research Journal (A Peer Reviewed Referred) ISSN – 2454 - 7905 MODERN VIEW : Anal fissures are longitudinal or elliptical tears in the distal anal canal, extending below the dentate line to the anal verge. The condition is the commonest cause of severe anal pain. fissure in ano is characterized by excruciating pain during and after defecation and drop by drop bleeding per anus with spasm of anal spinctuer. NIRUKTI: It refers to a condition in which patient experiences a sensation of pain as if the Guda is being cut around with scissor. The disease is characterized by excessive cutting pain around the anus. Kashyapa says that parikartika is the one having cutting and tearing pain in Guda pradesha VYUTPTTI: The term Parikartika comprises of two words Pari and Kartika.The suffix Pari when used it means “all over” or “whole” or “every entity” or “every aspect”Kartika is derived from “Krita” verb, which means to cut. It is a noun form.Thus the word Parikartika as a whole means “to cut circumferentially” or to cut all around. Jejjata has anticipated this condition and explained pin pointedly. According to him in Parikartika a specific pain i.e. A cutting and tearing pain around the anal region. Dalhana also gives the similar opinion Guda vidara, Guda kshata, Kasta guda, Kasta payu Vyakta malahe are terms used in different context, which denotes similar conditionlike parikartika NIDAN: In Parikartika, Vata is the dominant Dosha. The etiological factors of Parikartika can be divided in three types as per Aacharya Sushruta. 1. Nija Hetu (Endogenous factors): Vedana (pain) is the main symptom of Parikartika, so Vata Dosha vitiation must be there. Hence, all factors responsible for vitiation of Vata Dosha can beconsidered under Nidana of Parikartika. In the classics, factors responsible for vitiation of Vata 2. Aagantuja Hetu (Exogenous factors): The trauma at Guda leading to Parikartika. During the procedure of Basti or Virechana, iatrogenic complications may develop in the form of Parikartika. It may happen due to rough and thick Basti Netra. 3. Nidaanarthakaaree Roga (Complications of other diseases): Due to faulty procedure If Vamana and Virechana with Teekshna, Ushna and Pittaprakopaka medicine is given to the patients having Mridu Koshtha and Mandaagni then Pitta and Vata Prakopa Vol. I - ISSUE – XXXIII SJIF Impact Factor : 6.91 Page - 2 Worldwide International Inter Disciplinary Research Journal (A Peer Reviewed Referred) ISSN – 2454 - 7905 leads to Parikartika, Atiyoga of Virechana. If basti of Tikshna, Ushna & Lavan Dravya is given to the patient. Multiple or lateral fissures should arouse suspicion of another underlying pathology including Crohn’s disease, ulcerative colitis, tuberculosis, human immunodeficiency virus infection or syphilis The majority of fissures seen in patients with inflammatory bowel disease occur in the posterior midline and are painful in at least half of cases. Anal fissures are less likely to develop in those individuals who eat plenty of raw fruit and vegetables, and wholegrain breads, and more likely to affect those who eat highly processed foodstuff SAMPRAPTI: Due to nidana sevana Vata and Pitta prakopa. Prakupita doshas will travel down wards along with Adhogami Dhamanis and reaches Guda avayava. Due to excessive pressure and dusti in Rakta and Mamsa a kshata is produced. This condition is called as Parikartika. Samprapti Ghataka : Dosha- Vata & Pitta Dushya - Twak, Rakta And Mamsa Srotas - Purisha Vaha,Rakta& Mamsa Vaha Srotasha Udbhava Sthana - Pakwashaya Sanchar Sthana - Gudagata Sira Vyaktasthana - Gudanalika Rogamarga - Bahya Sadhyasadyata - Kasta Sadya Swabhava - Chirakaleena According to Kashyapa Samhita,the classification of Parikartika into 3 types is mainly based upon the character of pain i.e. 1. Vatika Parikartika - pain is shooting cutting or pricking in nature. 2. Paitika Parikartika - the character of pain is burning nature. 3. Shaleshmika Parikartika - dull ache pain represents the kapha preeminent Parikartika. Modern view: Hard stools and excessive straining causes pressure over anal canal. This results in tear of mucous membrane resulting into ulcer formation which is termed as fissure in ano. The prominent symptom is severe anal pain, usually on defecation, which may last betweena few minutes to a few hours afterwards with a tight, throbbing quality. It can be described as knifelike, cutting or tearing in character.Rectal bleeding is seen in 75–100% of cases and is Vol. I - ISSUE – XXXIII SJIF Impact Factor : 6.91 Page - 3 Worldwide International Inter Disciplinary Research Journal (A Peer Reviewed Referred) ISSN – 2454 - 7905 characteristically small in quantity, bright red and only occurs during straining or defecation. A minority of patients may also complain of mucous anal discharge and pruritus ani Sadhyasadhyata: The disease is characterized by formation of vruna in Guda nalika. Guda is a Marma sthana and adequate rest to this part is not possible. These factors make this condition very difficult for the treatment. Hence it is categorized as kruchra sadhya vyadhi. However if the vruna is restricted only to Twak and the patient is having good agnibala and Malabaddhata is not severe then it becomes sukha sadhya Treatment: The samprapti of parikartika involves Vata and Pitta prakopa, Rakta and Mamsa dusti, Malabdhata and kshata in Guda pradesha. Hence the treatment has to be aimed at Vata and Pitta shamana, Rakta and Mamsa prasadana, and Vatanulomana and vruna ropana.The disease clinically presents with Vedana, Malabaddhata and Rakta srava. So Vedana shamana, Malanissaraka and Rakta sthambana drugs are to be used. 1.general treatment 2. local treatment. 1.General treatment: The oral medication has multiple objectives. They include: Deepana and Pachana drugs for improving agni like, - Trikatu churna - Hingwastaka churna - Lavana bhaskar churna - Chitrakadi vati Malanissaraka and vatanulomana drugs for malabadhata like, - Avippatikara churna - Gandharva haritaki churna - Pancha shakar churna - Abhayarista Vedana shamaka drugs like, -Triphala guggulu vati - Yogaraja guggulu Sushruta has advised sheet ljala snana and dugdha sevana. Charaka has also advised dugdha sevana medicated with the bark of panchasksheeri vrikshas. Further charaka has advised to take aml dravya because it has the property of vata shamaka and increases the agni. Vol. I - ISSUE – XXXIII SJIF Impact Factor : 6.91 Page - 4 Worldwide International Inter Disciplinary Research Journal (A Peer Reviewed Referred) ISSN – 2454 - 7905 2.Local treatment This includes Basti karma. Most of the drugs which are used in basti karma are vata pitta shamaka, vranashodhana and vrana ropaka. Basties are prepared in Ghrita, Tail