Multimodal Ayurveda Intervention in the Management of Recurrent Pilonidal Sinus: A Case Report

Pilonidal sinus (PNS) is a chronic inflammatory condition that primarily originates from hair follicles in the natal cleft at the base of the spine and may also occur in other areas such as the axilla and umbilicus. A 25-year-old male patient presented to the outpatient department (OPD) of the surgery unit at the National Ayurveda Teaching Hospital, Borella, in November 2022 with complaints of pain and purulent discharge from the sacral region near the anus, accompanied by intermittent fever for 5 days. Clinical examination revealed a tender swelling in the sacral area with a discharging sinus opening and multiple scar marks from previous surgeries. The patient had previously undergone two surgical procedures (wide excision and primary closure) for the same condition. Based on the clinical findings, the case was diagnosed as a recurrent PNS with abscess formation. Management was initiated with incision and drainage of the abscess, followed by application of a semisolid paste of Apamarga Theekshna Kshara, a herbomineral alkaline preparation from the whole plant of Achyranthes aspera L., burnt conch shells (a source of calcium carbonate) and a paste of the roots of Plumbago indica L. (added to improve and to achieve the maximum potency of Kshara). Microbiological culture of the pus revealed the presence of beta hemolytic Streptococcus (group G) and coliform. Internal medications, including Pancha tikta decoction, Sudarshana Choorna (powder), Triphala Guggulu (tablets), Amurta Guggulu (tablets), and Kaishora Guggulu (tablets), were administered to manage the infection and fever. During the postoperative period, the wound was cleansed with a polyherbal decoction (Pancha valkala) prepared from the aqueous extracts of the barks of Ficus religiosa, Ficus benghalensis, and Ficus racemosa. Wound dressings were performed using the same decoction mixed with Apamarga Kshara powder (herbomineral alkaline paste prepared from the whole plant of Achyranthes aspera L.and burnt conch shells) (without adding P. indica L roots. Hence, it's in medium potency). Once a healthy wound bed was achieved, dressing was continued with Seethodaka Taila, a medicated oil known for its wound-healing properties, for 3 months until complete wound healing was achieved. The patient was followed up for 3 years, during which no recurrence was reported. This case suggests that the multimodel ayurveda management approach may be a potential clinical experience that may encourage further study.