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A 23-year-old female patient presented with an abscess in the perianal region associated with pain for 1 week. At the onset of symptoms, she tried Ayurveda treatment at another facility for 1 week. But she did not get complete relief. The patient now consulted Dr Sreelekshmi for better ayurvedic management. Based on inspection, and probing, the biomedical diagnosis was made as Pilonidal sinus. Based on the clinical evaluation, the Ayurvedic diagnosis was made as Shalyaja Nadi vrana. The line of treatment followed was Vrana ropana and shodhana, and shopha hara. With 2 weeks of ayurvedic treatment, the tract was healed completely without any cosmetic deformations or clearly visible scars. After 1 month of treatment, there was normal skin and in and around that area. The case report demonstrates the remarkable clinical efficacy of Ayurveda in treating pilonidal sinus, resulting in complete healing within just one month. This success underscores the potential of Ayurvedic therapies as a viable and efficient option for managing this condition.