Describes how the Ksharsutra Manual was developed in Province 1, Nepal. This Manual is the first ever Manual developed in Nepal in the field of Ayurveda.

1. All about the Ksharsutra Training
Manual for BAMS Graduate
Dr Suresh Maharjan
Consultant Ayurveda Vigya
Health Directorate,
Bagmati Province, Hetauda

2. Name of the training
• Ksharsutra Training Manual for the BAMS
graduate

3. Why Ksharsutra Training Manual
• To produce medium level human resources in
the field of anorectal surgery of Ayurveda
(Ksharsutra), equipped with the necessary
knowledge, skills and attitudes.

4. What will Trainee do after the
Training
• Practice Ksharsutra service in the district
level health facility that can be manage there
and refer other cases to higher center

5. Duration
• 42 days (35 working days)

6. Training Course Structure
S No Subjects Nature Teaching hours
Theory Practical Total
1. Anatomy and Physiology of Anorectal Canal T 4 4
2. Pathophysiology, Presentation and Diagnosis
of Anorectal Disease
T/P 10 10 20
3. Ksharsutra in Bhagandar (Fistula in ano) T/P 12 56 68
4. Ksharsutra in Arsha (Hemorrhoids) T/P 10 56 66
5. Ksharsutra in Pilonidal sinus T/P 4 18 22
6. Sthanika (Local anesthesia) in Ksahrsutra
Sangyaharan
T/P 4 8 12
7. Sterilization and disinfection 2 2 4
Total 46 150 196

7. Selection of Training sites
• Nardevi Hospital and NARTC
• Later to develop own training site at
Province.

8. Methodology to be used during
Training
• Lecture, group discussion, assignment, group
work, demonstration, observation, guided
practice, practical experiences, laboratory
observation, opd and ipd duty, case study,
tutoring and self-practice etc

9. Monitoring and evaluation
• Pre-test and post test
• Appear in final examination at the end of
training, both theory and practical
• Should prepare at least 10 case sheetss.

10. Administration & Management
• Concept of Ksharsuta Center (but removed
later in the final copy of the Manual)

11. Recording and Reporting
• Case sheets given in the Index
• Case recording and reporting included in
AMIS

12. Presentation of the syllabus
• Specific Objectives
• Teaching materials
• Clinical diagnosis
• Investigations
• Treatment
– Nidanaparivarjana: (Life Style Modification)
– Bheshaja Chikitsa (Medical / conservative management)
– Ksharsutra Treatment
• Indication of Ksharsutra
• Advantages of Ksharsutra
• Procedure of Kshara Sutra Ligation
– Purvakarma:
– Pradhana Karma
– Pashchat Karma
– Pathya Apathya
• Follow-up of treated case:
• Referral criteria: refer to higher centre

13. Acknowledgement
• Honourable Minister MOSD
• Secretary MOSD
• Director, Health Directorate
• Concerned Ayurveda staff of MOSD and Health
Directorate
• All the family of MOSD and Health Directorate
• All the participants of Manual Preparation
Conference

14. Thanks !