Chapter CLXXX - The Nidanam of Fistual in Anas, etc.

Now hear me, O Sushruta, discourse on the Nidanam of Bhagandara (fistula in ano). Within a space of two fingers’ width about the anus an extremely painful pustule, which bursts and is transformed into a kind of sinus, is called Bhagandara. This disease admits of being divided into five different types such as the Vataja, Pittaja, Kaphaja, Sannipatika, and Shalyaja (traumatic).

In the Vataja type of Bhagandara, which is also called Shataponaka (sive-like), ingestion of astringent and parchifying articles of fare serves to enrage and aggravate the bodily Vayu. The deranged Vayu, thus aggravated, gives rise to a pustule in the region above described, which, if not properly attended to at the outset, becomes suppurated and exudes a vermil-tinted, frothy discharge on bursting. A large number of sinuses is formed into the incidental sore through which semen, urine and feces are found to be discharged. In the Pittaja type of Bhagandara, which is also designated as Ushtragriva, a red pustule is produced in the region of the anus through factors, which are calculated to enrage the deranged Pittam. It is rapid in suppuration and discharges a warm, fetid pus. The disease is so named from the fact of. the pustule assuming an arched shape like the neck of a camel in its immature stage. In the Kaphaja type of Bhagandara, which is also called Parisravi, the pustule becomes hard, white, and slightly painful, attended with an itching sensation and marked by a thick, cold discharge. The Shalyaja (traumatic) type of Bhagandara is also designated as Unmargi. A sore about the anus owing to the pricking of any thorny substance into that region, if not properly cared for from the outset, is converted into a type of Bhagandara which is called Unmargi. All types of Bhagandara are extremely painful and obstinate, A case of Bhagandara in which flatus, stool, urine, semen and parasites are found to be ejected through the incidental sinuses should be regarded as incurable.

Incidentally I shall deal with the Nidanam of Nadi Viana (Vrana?) (sinus), O Sushruta. The pus in a fully suppurated abscess or swelling, if not evacuated at the proper time, begins to infiltrate and burrow into the underlying tissues, producing sinuses, which constantly discharge pus. In the Vataja type of Nadi-Vrana the sinuses become narrow, provided with extremely narrow orifices, and are attended with an aching pain in their inside, A frothy pus is discharged more in the night than in the day from these sinuses. In the Pittaja type of Nadi Vrana, fever, thirst and an intolerable burning sensation in the sinuses are found to supervene. A hot, yellow pus is discharged from these sinuses more in the day than in the night. In the Kaphaja type of Nadi Vrana the sinuses become hard and are marked by an iching sensation and an extreme pain, exuding a large quantity of thick, white, slimy pus in the night. In the Sannipatika form of Nadi-Vrana, the characteristic symptoms of all the three preceding types, together with fever, dyspnœa, epileptic fits and a burning sensation manifest themselves in unison. In the traumatic type, any foreign matter lying concealed in the incidental sore may give rise to sinuses, which are marked by a constant pain, and are found to excude(exclude?) a frothy, blood-streaked, churned-like pus. Sinuses of the Sannipatika type scarcely yield to medicinal treatment.