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Background: Anal fissure is a painful tear in the anoderm that affects people of all ages and is one of the most common anorectal conditions seen in surgical practice; a population-based study estimated a lifetime incidence of about 8%^[1]. Ayurveda describes a similar condition, Parikartika, characterised by cutting pain in the anal region, both as a disease in its own right and as a complication of improper purgation or enema. Objective: To review the Ayurvedic concept and management of Parikartika and compare it with the modern understanding and evidence-based management of anal fissure. Methods: Narrative review of classical Ayurvedic texts, clinical practice guidelines, Cochrane reviews and clinical trials, including an Ayurvedic randomised trial protocol. Results: Classical texts describe Parikartika as cutting or sawing pain in the anus, associated with Vata aggravation, hard stools and improper Panchakarma procedures, and treat it with oleation, soothing enemas, ghee-based applications, sitz baths and diet. Modern pathophysiology attributes chronic fissure to internal sphincter hypertonia and local ischaemia. Guidelines recommend fibre, sitz baths and topical analgesics first, then topical nitrates or calcium channel blockers, botulinum toxin and, for refractory fissures, lateral internal sphincterotomy. Ayurvedic measures such as sitz baths, stool softening and Jatyadi Taila application overlap with first-line conservative care, and a randomised trial comparing an Ayurvedic protocol with diltiazem gel is under way. Conclusion: Ayurvedic management of Parikartika aligns closely with conservative fissure care. Its specific formulations need evaluation in controlled trials against standard first-line treatments.

KEYWORDS: Parikartika; anal fissure; fissure-in-ano; Jatyadi Taila; Matra Basti; sitz bath; lateral internal sphincterotomy