BACKGROUND:

Siddha system is one of the ancient systems of medicine, which originated from south India. According to Siddha medicine, diseases were classified into 4448 types based on Mukkutram (Vadham, Pitham, Kabam). Siddha system has a vast Internal and External medicines which cure the diseases. Most of the medicines are aimed at maintaining and balancing three humours (Vadham, Pitham, Kabam). In Yugi Vaithiya chinthamani, yugi classified the Powthiram disease into 8 types. Powthiram is characterized as a sinus present inside or outside anus or urethra. .The risk factors of powthiram in siddha literatures are, prolonged sitting, consuming spicy foods, horse mount, elephant climb, foods which cause piles. The common symptoms are redness, itching, and pain around the anus region, bloody or pus discharge from the fistula tract. According to Park’s classification it is classified into 4 types (Inter-sphincteric, Trans-sphincteric, Supra-sphincteric, Extra-sphincteric). The prevalence is greater in men than women, with a rate of 12.3 cases per 1,00,000 and 5.6 cases per 1,00,000 respectively. The average age at diagnosis is 38 years, with most occurring between 20 to 40 years of age.The goals in the treatment of an anal fistula are to eliminate the primary fistula opening, any associated tracts, or any secondary openings without change in incontinence. The simplest anal fistula are treated using fistulotomy with a recurrences and the other morbidities.Complex fistula management poses increased risk of a change in incontinence and the higher chances of recurrences which forced surgeons to search for a better option.Various modalities like cutting seton, Endorectal advancement flap, fibrin glue injection, fistula plug, Ligation of intersphincteric Fistula Tract (LIFT) are being tried to overcome the hardship faced by the patients. Siddha system of medicine treats the disease in more cost effective and palatable way, when compared with modern medicine. The formulation selected for this dissertation study is Gowri chinthamani chendooram (internal), which is described in Agasthiyar vaithiya kaviyam- 1500 and Pachai ennai (external) which is described in The pharmacopoeia of Siddha research medicines for Powthiram (fistula- in- ano).So, I have chosen this medicine for management of Powthiram. Kaarathiri is the best procedure for treatment of chronic ulcers, abscess and fistula-in-ano.Thiri will be prepared by applying Pachai ennai to sterilised gauze.

OBJECTIVES:

Primary objective:To determine the effectiveness of Gowri chinthamani chendooram (Internal) and Pachai ennai (External) in the management of Powthiram through Perianal Disease Activity Index (PDAI) score.

Secondary objective: To measure the unit cutting time assessed by, Unit cutting time = total number of days taken for cut through / Initial length of track in cms = ------days / cm.

STUDY DESIGN:

This is an interventional study  of Non Randomized sampling which will be carried out for 18 months in participants with Fistula-in-Ano reporting to OPD of Ayothidoss Pandithar Hospital, National Institute of Siddha,Chennai-47 with 20 Participants as Sample size.Participants with age from 18 to 60  years of both age  and with Fistula-in-ano  will be included.

OUTCOME OF THE STUDY:

Primary outcome will be assessed by Peri-anal Disease Activity Index (PDAI) and good outcome of PDAI score becoming zero, [Time points: baseline and post-treatment (Day 48)]

Outcome will be assessed by unit cutting time, Unit cutting time = total no of days taken for cut through / initial length of the tract in cms = -----days / cm [Time points: baseline and post-treatment (Day 48)].

RESULTS AND DISCUSSION:

The results will be statistically analysed and reported.

KEYWORDS:

Powthiram, Gowri Chinthamani Chendooram, Pachai ennai, Fistula-in-Ano.