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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

 

 Chinese Traditional Medical Journal 

Case Study Non- Surgical Management of Low Anal Fistula in an 

Infant with Udumbara Ksheerasutra– A Case Study 

Yan Yongia, Che Xi,  Li Jianshen 
College of Basic courses, Guangdong Pharmaceutical University, Guangzhou 

Division of Education and Research, Shantou Central Hospital, Shantou 

, Institute of Geriatrics, Henan College of Traditional Chinese Medicine, Zhengzhou 

 

 

 

 

 

 

 

 

 

 

Introduction 
 anal canal and the perineonum is known 
as a'stula-in-ano. Perianal infections are 
the most common cause, and a congenital 
abnormality is very unusual [1]. 
Nevertheless, the pathophysiology of ano-
stula is yet unknown [2]. Adults are 

considered to be more likely than children 
to get the disease than the reverse. In 

babies, diminished immunity and changes 
in bowel habits during weaning are to 

blame. [3] Boys are more likely to be 
afflicted than girls, with 96 percent of 

cases occurring in newborns less than one 

year of age [4]. Fistula is likened to a 
disease in Ayurveda. 

Though often thought of as an incurable 

illness [5], some new research suggests 
that bhagandhara in babies is a temporary 
and self-limiting sickness [2]. 

There are a variety of ways to handle a 
problem. 

stula, However, despite instances of 

post-operative recurrence, surgery is 
universally approved and has shown to be 

effective. Using the techniques of the 
Ksharasutra in order to better manage 

Abstract 
Background: A long-standing condition, fistula in ano (Bhagandara) has been documented 
in infants as young as six months old. Surgery is the most common method of therapy for 
ano stula, however there are other options. The goal of this study was to find a non-surgical 
treatment for a child with a low anal stula who was ten months old. 
Materials & Methods: The Ksharasutra (Ayurvedic Seton) was employed in this case study 

as a modified version of the well-known Ksheerasutra (Ayurvedic Seton). After a first probe, 
Seton was injected into the stulous tract in an aseptic manner (Eshana Karma). At the end 

of the fifth week, the tract had been fully cut, with healthy tissues forming in its place, and 
the Seton had been replaced four times (one each week). The technique was safe, non-
irritating, and well-tolerated by the youngster throughout the length of treatment. 
Keywords: In ano, Infants, Non-surgical management, Ayurvedic Seton Udumbara 
Ksheerasutra  
 



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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

considered one of the most effective 

approaches to date. ' 

As a non-surgical method with minimal 

risk of recurrence, Ksharasutra application 
for stula has been more popular over the 
last decade or so. Alkaline characteristics 

may induce acute burning sensation, 
discomfort and inflammation around the 

stula despite its benefits. 

Ksharasutra application in newborns is a 
lengthy process since they are deemed 

Sukumara (fragile, unable to bear pain). 
Nonsurgical, non-invasive, and affordable 

to the poor people are some of the goals 
of this project. 

Corresponding address: 

Prof. Subhash Chandra Varshney 

Dept. of Shalya Tantra Mahatma Gandhi 
Ayurved, College, Hospital & Research 

Center, Salod (H), Wardha, Maharashtra, 
India. 

 Bhagandhara advocated by Acharya 

Sushruta [6] remains 

 Email: scvbhu@gmail.com 

 

A non-alkaline medication was used to 
make a less painful version of Seton for 
the youngster. Udumbara (Ficus 

glomerata Roxb.) milk was employed for 
this purpose. 

Ksharasutra's effectiveness in adults has 

been thoroughly shown in several 
research [7]. Kshara and Ksheerasutra, on 
the other hand, have not been tested on 
newborns. Udumbara Ksheerasutra has 
been shown to be an effective treatment 
for newborns with a stula, and this 
research is the first of its type to focus on 

this. 

Method of Preparing of Ksheerasutra: 

Cuts were made to the Udumbara tree 

using a sharp knife in the early morning, 
and the latex that oozes from the 

branches was collected in a sterile 
container. A 0.91mm-thick layer of 

Udumbara Ksheera was applied to a 
surgical linen thread size 11 with a no.20 

coating. It was kept in a Cabinet to 
prevent contamination and sterilisation of 

the Sutra. 

Case History: 

In the OPD of Mahatma Gandhi Ayurved 
College, Hospital & Hospital, Wardha, a 

ten-month-old newborn was brought in 
for treatment of pus discharge, itching, 

and bleeding around the anal area over 
the last three months. Also, the mother 

stated that her kid regularly touched the 
anal region and cried. 

All of the child's vital signs were confirmed 

to be normal after a general assessment. 
With regular bowel movements, the 

child's appetite was judged to be 
adequate. A referral to Shalya Tantra's 

OPD was made when the child's condition 
worsened. 

 

A 7 o'clock external hole with averted 

margins and pus discharge was discovered 
during a rectal examination. A digital 

inspection was used to feel it out. An 
internal hole one inch  

 

Treatment: 

above the anal margin was found in a 
short tract of about 3.2 centimetres in 
length. 

The youngster was given a mild laxative 
(Avipattikara Choorna – 2 g with honey) 

the night before the treatment. The 
youngster was softly probed (Eshana 

mailto:scvbhu@gmail.com


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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

Karma) with a typical pliable probe from 

the exterior entrance that was pulled out 
via the internal opening the next day 

under aseptic precaution. Ksheerasutra 
has already been linked to the probe's 

eye. Patients are instructed to take 
internal drugs once the Seton (about 

7.5cms long) is wrapped gently around the 
patient's neck. There was no use of a local 

anaesthetic. 

Ÿ The youngster would scream as 
the anaesthetic substance was injected 

and become uncooperative during the 
surgery if this method was utilised. 

Ÿ  

Ÿ The following drugs were given to 

the child's internal organs. 

• 7-day supply of tablet Triphala Guggulu 
– 12 BD (250mg) with honey 12 BD 
(125mg) of Balachathurbhadra tablets, 
powdered and taken orally for 15 days 

 

Avipattikara Choorna–1g Hs with Honey–
7days for 1g Hs 

Adjuvant treatments included: 

Once a day for seven days, Jatyadi Taila is 
utilised for Matra Basti (a Medicated 
enema). 

Ten-minute sitz baths in hot water for 
seven days a week 

On the first day, the parents were taught 

how to administer Basti (enema) and Sitzs 
bath and requested  

Observation & Results: 

to do it every day for seven days at home. 

It took four weeks to go through the 
child's file and replace the Seton with a 

new one. During the fifth visit, the tract 

was entirely cut and healed, with good 

brous tissue development (Fig. 1). They all 
took place outside of the hospital. For the 

purpose of gauging the effectiveness of 
the cutting, thread length was measured 

and documented weekly. 

The following are the results of calculating 
the cutting rate per week (CRW):The 

length of the stula divided by the number 
of treatment days is the CRW.In the 

current investigation, the CRW was 
0.8cms per week. By the end of one week, 

there were no evidence of inflamation or 
irritation in the baby after the Seton was 

placed.According to this formula, the 
tract's unit cutting time (UCT) was 

determined. 

d/cm = number of days required to cut 
through = total number of days Track 

length at the start in centimetres 

In this investigation, the UCT was 8.75 
days/cm. 

 

Discussion: 

Although the cause of astula-in-ano is 
unknown, its hallmarks include male 
predominance, the onset of symptoms at 
less than 12 months of age, and the very 
low incidence of complicated avulsions.  

distinguishes this condition from that of 
adults [1,8]. The cause for stula in ano in 
present case may be secondary to a 
perianal abscess. 

Conventional surgery and Ayurvedic Seton 

have been found no different in treatment 
of stula in ano[9]. However treatment of 

stula with Ayurvedic Seton is said to have 
lesser recurrences and incontinence rates, 
though healing time is longer [10]. 

Ksharasutra is a scienti cally validated and 
standardized treatment in the 



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management of Bhagandara [11]. The 

mode of action of it is attributed to its 
Chedana (Cutting), Bhedana (Splitting), 

Lekhana (Scraping), Shodhana (Purifying), 
Ropana (Healing) and Tridoshaghna 

(Pacifying all three bodily humors) 
property. The cutting and healing of the 

stulous tract is not only a mechanical 
effect of Ksharasutra but it is also due to 

anti-in ammatory and other chemical 
properties of the drugs used in it [12]. 

In the present context Udumbara Ksheera 

was used to prepare Sutra which is said to 
be having properties like Shothahara 

(anti-in ammatory), Vedana Sthapana 
(analgesic) and Vrana Ropana (wound 

healing)[13]. Even though Ksheerasutra is 
a non-alkaline Seton the cutting & healing 

of stulous tract which occurred 
simultaneously can be attributed to the 

medicinal property possessed by the 
Udumbara Ksheera and mechanical 
pressure exerted by the Sutra. Anti- 

in ammtory action of Triphala Guggulu 
might have helped resolving the pus 

discharge. Jatyadi Taila Matra Basti and 
Avipattikara Choorna regularized the 

bowel habits of the child. 
Balachathurbhadra Vati was used to bring 

about immunomodulatory effects and 
prevent fever. Follow up was conducted 

at an interval of 1 month for 2 successive 
months, no history of recurrences was 

noted. 

Conclusion: 

The present reports highlights the bene ts 
of Ksheerasutra application in a 10 month 

old infant. The response of child was 
closely monitored as infants are unable to 

express their discomfort or pain. 
Complete cutting & healing of stulous 

tract occurred by 5th week 

without any complications. There was also 
simultaneous healing of the tract. The 

procedure throughout its course was safe 

without causing any signi cant discomfort 
to the child. The subsequent follow up for 

2 months period revealed no recurrence 
of 

stula. Hence it can be concluded that the 

application of Ksheerasutra in Bhagndhara 
of children is bene cial and may be 

recommended in clinical practice. 

Although a bigger sample size and 
randomised controlled research study 

would be useful in supporting the 
Ksheerasutra application in the treatment 

of stula in-ano of youngsters. 

References: 

1. In children, a congenital aetiology 

for fistulas-in-ano: Fitzgerald RJ, Harding 
B, Ryan W. Children's Hospital of 
Philadelphia 

2. Fistula-in-Ano in Infants: 
Nonoperative Management Is Effective? 

3. Ano in Pediatric Surgery – Case 

Report: Ksharasutra-Role of Ksharasutra in 
High Fistula in Ano in Pediatric Surgery 

Published in J Indian Assoc Pediatr Surg 
2004; Vol 9: 80-82 

4.  

5. This information is provided by 

Jayant Deodhar in Medscape, [Internet] 
2014. It was cited on December 6, 2015, 

and can be found at the following URL: 
https://www.emedicine.medscape.com/a

rticle/9353-12overview#a0199 

Susrutha, Dalhana, Susrutha Samhitha 
with Nibhadasangrahi Acharya, 

Avaraniyadhyayah, Sutrasthana, chapter 
4, verse 33, edited by Vaidya Jadavji 

Trikamji Acharya, 9th ed. Varanasi; 
Chaukambha Orientalia; 2008, p.144. 7. 



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Seventh-century Susrutha Samhita with 

Dalhana, Susrutha Samhitha with N I B H A 
N D A S A N G R A H A C O M M E N T A Y, 

Visarpanadisthananarogachikitsidhodiya, 
Chikita Sthana, chapter 17, verses 29-33. 

It's been eight years since Deshpande and 

his colleagues published their findings in 
the Journal of the American Medical 

Association. In 400 instances, ambulatory 

treatment of a stula in ano was effective. 
India's Journal of Surgery, 1975; 37:85-9 

8 Ano infected newborns should be 
treated conservatively, according to the 

authors of this study. Pediatr Surg 
International, 1998;Vol 13:274-276. 

This paper describes the non-operative 

therapy for the treatment of anorectal 
fistulas (stula-in-ano). Journal of Pediatric 

Surgery, Volume 35: 938-939 

The study was conducted by Ho KS, Tsang 
C, Seow Choen F, and others to compare 

Ayurvedic cutting seton and stulotomy for 
patients with low stula. In a word, yes. 

2001;Vol 5(3): 137-41 Tech Coloproctol 

One-center randomised controlled clinical 
study of the Ayurvedic medicine 

Ksharasotra (Ayurvedic medicinal thread) 

in children and adolescents 

9. Stula-in-ano treatment, Indian 

Journal of Medical Research, 1991;Vol. 
94:p. 177–185. 

Treatment of Fistula in Ano using Kshar 

Sutra (medicated seton) therapy: efficacy 
studies by Pankaj Srivastava and 

Manoranjan Sahu. Volume 2, Issue 1: p.1-

10 in the World Journal of Colorectal 
Surgery 

11. Reprint edition of PV Sharma's 
Dravyaguna Vijnyana, Part II. According to 

Chaukhambha Bharati Academy; Varansai, 
p. 666-667 

Figure 1: Week wise images showing 

application of Ksheerasutra and healing of 
fistulous tract by 5th week 

Figure 1: Week wise images showing 

application of Ksheerasutra and healing 
of fistulous tract    by 5th week 

  

 

How to cite the article: Varshney et al, 

Non- Surgical Management of Low Anal 



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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

Fistula in an Infant with Udumbara 

Ksheerasutra– A Case Study. J. Res. Trad. 
Medicine 2015;1(1): 29-32 

Source of Support: Nil, Con ict of 
Interest: Nil