{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T19:40:07Z","timestamp":1792352407293,"version":"4.4.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":290,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n 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\u2010year\u2010old 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\n Apamarga Theekshna Kshara<\/jats:italic>\n , a herbomineral alkaline preparation from the whole plant of\n Achyranthes aspera<\/jats:italic>\n L., burnt conch shells (a source of calcium carbonate) and a paste of the roots of\n Plumbago indica<\/jats:italic>\n L. (added to improve and to achieve the maximum potency of\n Kshara<\/jats:italic>\n ). Microbiological culture of the pus revealed the presence of beta hemolytic\n Streptococcus<\/jats:italic>\n (group G) and coliform. Internal medications, including\n Pancha tikta<\/jats:italic>\n decoction,\n Sudarshana Choorna<\/jats:italic>\n (powder),\n Triphala Guggulu<\/jats:italic>\n (tablets),\n Amurta Guggulu<\/jats:italic>\n (tablets), and\n Kaishora Guggulu<\/jats:italic>\n (tablets), were administered to manage the infection and fever. During the postoperative period, the wound was cleansed with a polyherbal decoction (\n Pancha valkala<\/jats:italic>\n ) prepared from the aqueous extracts of the barks of\n Ficus religiosa<\/jats:italic>\n ,\n Ficus benghalensis<\/jats:italic>\n , and\n Ficus racemosa<\/jats:italic>\n . Wound dressings were performed using the same decoction mixed with\n Apamarga Kshara<\/jats:italic>\n powder (herbomineral alkaline paste prepared from the whole plant of\n Achyranthes aspera<\/jats:italic>\n L.and burnt conch shells) (without adding\n P. indica<\/jats:italic>\n L roots. Hence, it\u2019s in medium potency). Once a healthy wound bed was achieved, dressing was continued with Seethodaka Taila, a medicated oil known for its wound\u2010healing 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.\n <\/jats:p>","DOI":"10.1155\/cris\/1959796","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T19:07:46Z","timestamp":1792350466000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal Ayurveda Intervention in the Management of Recurrent Pilonidal Sinus: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8858-4279","authenticated-orcid":false,"given":"Wicramanayake","family":"W.A.A.P","sequence":"first","affiliation":[{"name":"Provincial Ayurveda Hospital Pallekele Kundasale Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3127-6168","authenticated-orcid":false,"given":"Peshala","family":"K.K.V.S","sequence":"additional","affiliation":[{"name":"Faculty of Indigenous Medicine University of Colombo Rajagiriya Sri Lanka cmb.ac.lk"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_12_1_2","first-page":"8","article-title":"Pilonidal Sinus of Atypical Areas: Presentation and Management","volume":"3","author":"Salih A.","year":"2017","journal-title":"Pilonidal Sinus Journal"},{"key":"e_1_2_12_2_2","first-page":"316","article-title":"Axillary Pilonidal Sinus: Fig. 1: Histological Appearance of Pilonidal Sinus (H&E Stain), a Case Report","volume":"1","author":"Sengul I.","year":"2009","journal-title":"North American Journal of Medical Sciences"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00337585"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v3.i10.876"},{"key":"e_1_2_12_5_2","first-page":"1","article-title":"Pilonidal Sinus of the Umbilicus: Presentation and Management","volume":"4","author":"Salih A. M.","year":"2017","journal-title":"Edorium Journal of Gastrointestinal Surgery"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/surgeries6030060"},{"key":"e_1_2_12_7_2","first-page":"82","article-title":"Results of Primary Closure and Excision of Pilonidal Sinus Disease","volume":"8","author":"Asghar S. T.","year":"2019","journal-title":"International Journal of Medical Research & Health Sciences"},{"key":"e_1_2_12_8_2","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.amsu.2020.07.050","article-title":"Pilonidal Sinus Disease: Review of Current Practice and Prospects for Endoscopic Treatment","volume":"57","author":"Mahmood F.","year":"2020","journal-title":"Annals of Medicne and Surgery"},{"key":"e_1_2_12_9_2","first-page":"572","volume-title":"Susruta Samhita of Susruta, Nidana Sthana; Chapter 10","author":"Singhal G. D.","year":"2007"},{"key":"e_1_2_12_10_2","volume-title":"Susruta Samhita of Susruta, Sutra Sthana; Chapter 25","author":"Singhal G. D.","year":"2007"},{"key":"e_1_2_12_11_2","volume-title":"Susruta Samhita of Susruta, Chikitsa Sthana; Chapter 17","author":"Singhal G. D.","year":"2007"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.4103\/0974-7788.64408"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.18203\/2349-2902.isj20170247"},{"key":"e_1_2_12_14_2","volume-title":"Pilonidal Cyst and Sinus","author":"Nixon A. T.","year":"2023"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.15584\/ejcem.2025.1.23"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.4103\/2231-4040.191426"},{"key":"e_1_2_12_17_2","doi-asserted-by":"crossref","unstructured":"PathiranaR. N. D. Antibacterial Efficacy of Apamarga and Karanja Kshara Against Staphylococcus and Escherichia coli Proceeding of 14th Annual Conference and Scientific Sessions 2025 Sri Lankan Society for Microbiology.","DOI":"10.4038\/sljid.v15i5.8936"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.7897\/2277-4343.03518"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.7897\/2277-4343.1106175"},{"key":"e_1_2_12_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaim.2024.101082"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.4103\/jpbs.jpbs_873_24"},{"key":"e_1_2_12_22_2","first-page":"86","volume-title":"Susruta Samhita of Susruta, Sutra Sthana; Chapter 11","author":"Singhal G. 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