Ayurvedic Perspective on Parikartika (Fissure-in-Ano): A Comprehensive Review of Aetiopathogenesis, Clinical Features and Ayurvedic Therapeutic Strategies

Parikartika is a classical ano-rectal disease described in ancient Ayurvedic texts and closely corresponds to fissure-in-ano in contemporary surgical practice. 1Fissure-in-ano is defined as a longitudinal tear or crack in the mucosa lining the lower segment of the anal canal, representing one of the most prevalent and acutely painful conditions encountered in anorectal surgery and proctological medicine.4 The condition is characterised by intense cutting and burning pain during and after defecation (kartanvat vedana), constipation (malavashtambha), redness, pruritis, and occasionally a streak of fresh blood in the stool. In Ayurveda, Parikartika is primarily attributed to vitiation of Vata dosha and Pitta dosha, compounded by ruksha guna (dryness), Kapha involvement, and pre-existing strotovaigunya (structural weakness of the concerned channels).1,2,3 Classical texts including Charaka Samhita, Sushruta Samhita, and Kashyapa Samhita provide detailed descriptions of its aetiology, pathogenesis, and therapeutic management.1,2,3 The primary causative factors encompass inappropriate dietary habits — particularly excessive consumption of constipating foods, inadequate liquid intake, and disregard for natural dietetic principles — combined with adverse lifestyle practices such as irregular sleep schedules and sedentary routines. Ayurvedic management targets nidanaparivarjana (elimination of causative factors), Vatanulomana (normalisation of Vata), correction of constipation, local wound healing, and tissue rejuvenation through a combination of internal medications and external applications.1,2,3 This review consolidates the classical Ayurvedic conceptual framework of Parikartika, its pathophysiological correlation with modern surgical understanding of fissure-in-ano, the role of dietary and lifestyle factors in its aetiopathogenesis, and the evidence base for Ayurvedic therapeutic interventions, with the objective of providing a structured academic reference for clinicians and researchers in integrative proctology.