Comparative Efficacy of Yashtimadhu Ghrita Anal Infiltration and Topical Diltiazem in Chronic Anal Fissure: a Randomised Controlled Trial

Background: Anal fissure is a very painful condition that mirrors Parikartika in classical Ayurvedic texts. Standard treatments are unsatisfactory due to recurrence or adverse effects. This signifies the integration of safe and effective traditional medical knowledge.Materials and Methods: This study included 100 individuals aged 18–60 years with chronic anal fissure lasting >6 weeks randomly assigned to two groups. Those with other anorectal conditions, systemic illnesses or trauma‐related fissures were excluded. Ayurvedic Group (AG) received 10 ml of Yashtimadhu Ghrita via anal infiltration twice daily after a sitz bath with Sphatika Bhasma (Potassium Alum), while the Control Group (CG) applied 2% diltiazem gel similarly. Both groups followed a high‐fibre diet and took 10 g of Triphala Churna at bedtime. The primary outcome was to assess the proportion of participants having complete healing of the chronic anal fissure by Day 30. Secondary outcomes were proportions of participants achieving complete healing by days 8 and 15, pain reduction (VAS), bleeding control, recurrence up to 180 days, and safety.Results: By day 30, AG showed significantly higher healing rates (81.6% vs. 45.8%; p = 0.001) and maintained results through day 60 (p = 0.009). No recurrences occurred in AG by Day 180, compared to 4.2% in CG. Pain decreased more rapidly in AG, and constipation was infrequent at follow‐up. No significant side effects were reported.Conclusion: Yashtimadhu Ghrita demonstrated faster healing, better symptom relief, and lower recurrence with good tolerability, and can safely be used in the treatment of chronic anal fissure.