Parikartika: Revisiting the Classical Ayurvedic Concept in the Light of Contemporary Proctology

Parikartika is one of the commonly described painful disorders of the anorectal region in Ayurveda. Based on its characteristic clinical features, particularly severe cutting or tearing pain in the anal region, it can be correlated clinically with fissure-in-ano. The condition can significantly affect the patient’s daily activities and quality of life because of the intense pain associated with defecation. The term Parikartika is derived from the characteristic nature of pain, described as Parikartanavat Vedana, meaning pain resembling a cutting or incising sensation around the Guda Pradesh. References to Parikartika are found at various places in the Ayurvedic Samhitas. Sushruta Samhita provides one of the early and important descriptions of the condition, while it is also mentioned as a Vyapad or Upadrava associated with different diseases and therapeutic procedures. It has been described in relation to Vamana-Virechana Vyapad, Basti Karma Vyapad and Garbhaṇī Vyapad, as well as in association with conditions such as Arsha, Atisara and Grahani. The clinical presentation of Parikartika commonly includes severe pain in the anal region, burning sensation, bleeding per rectum and difficulty or discomfort during defecation. These features closely resemble those observed in fissure-in-ano, making the condition clinically relevant from both Ayurvedic and modern perspectives. An individual’s dietary habits, bowel pattern and lifestyle have an important influence on anorectal health. Irregular eating habits, inadequate dietary fibre, constipation and improper bowel habits may contribute to the development or aggravation of anorectal disorders. From the modern perspective, fissure-in-ano may also occur secondary to conditions such as Crohn’s disease, tuberculosis and other underlying pathological disorders. Thus, Parikartika represents an important anorectal condition described in Ayurveda, with considerable clinical similarity to fissure-in-ano. Understanding its Ayurvedic description alongside modern clinical concepts can provide a broader perspective for the diagnosis and management of this painful condition.