Background: Bhagandara, described extensively in Sushruta Samhita, corresponds clinically to fistula-in-ano in modern medicine. It is considered a chronic and recurrent condition with significant impact on patient quality of life. Classical Ayurvedic texts outline multiple management strategies, notably different types of Ksharasutra therapy, which has gained contemporary attention. Objective: This systematic review aims to critically evaluate published literature on Bhagandara, focusing on its etiology, classification, clinical features, and comparative effectiveness of Ayurvedic and modern treatment modalities. Methods: A comprehensive search of electronic databases (e.g., AYUSH Research Portal) and classical Ayurvedic texts including Charaka Samhita and Sushruta Samhita was conducted. Studies published up to 2025 were screened. Inclusion criteria encompassed clinical trials, observational studies, and review articles focusing on Bhagandara or fistula-in-ano. Data extraction and qualitative synthesis were performed. Results: The review included studies highlighting both Ayurvedic and conventional approaches. Ksharasutra therapy demonstrated high success rates with low recurrence compared to conventional surgical procedures. Ayurvedic descriptions classify Bhagandara into various types based on doshic involvement, which aligns partially with modern classifications of fistula complexity. Integrated approaches combining surgical intervention with Ayurvedic post-operative care showed i healing outcomes. Conclusion: Ayurvedic management, particularly Ksharasutra therapy, is a safe and effective option for Bhagandara, with advantages in recurrence prevention. However, variability in study design and limited large-scale randomized trials highlight the need for standardized research methodologies and integrative clinical protocols.
Dr. Sucheta Ray1*, Dr. Shrikant Patel2, Dr. Deepak Kulshretha3, Dr. O. P. Dwivedi4 (Wed,) studied this question.