Ksharsutra is very special Ayurvedic Treatment for Fistula in Ano .This can be called as Surgery without Knife .PPT will explain you about some important aspects of Ksharsutra Treatment .This PPT presentation is outcome of discussions with Ayurvedic well known surgeon Prof.Dr.B.N.Deshpande

1. Kshar sutra ppt
• Presented for welfare of Ayurvedic
students ,By ---
• Prof.Dr.R.R.Deshpande
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• Mail ID –
mailme.drrrdeshpande@rediffmail.com
• professordeshpande@gmail.com
3/18/2015 1Prof.Dr.R.R.Deshpande

2. Special Thanks for
His Knowledge & Guidance & References
• Dr.B.N.Deshpande,Professor & HOD
,Dept of Surgery ,CARC,Nigdi ,Pune 44
• BAMS & AVP (Surgery)
• Dr.B.N.Deshpande had performed N
number of Ksharsutra Procedures in
Ayurved Hospital ,Nigdi,Pune
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3. God of Health = God Dhanvantari
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4. Anatomy of Ano rectal region
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5. Fistula in Ano ( Bhagandar)
• Bhagandara = Bhag + Daran
• Bhaga = Yoni ( Bhavamishra)
• Bhaga = Peri anal region
• Daran = Tare of surface
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6. 3 Stages of Fistula in Ano
• 1) Formation of Papule
• 2) Suppuration ( Abscess formation)
• 3) Burst open of suppuration
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7. What is Fistula ?
• Abnormal communication between 2
epithelium is called as fistula.
• Latin – Fistula = Hollow pipe
• This hollow tract connect 2 body cavaties
or 1 cavity & the body surface
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8. Causes of Fistula in Ano
• 1) Sequel of Ano rectal abscess
• 2) Tuberculosis
• 3) Ulcerative colitis – develop regional
proctitis
• 4) Cancer of Rectum or Anal canal
• 5) Lymphogranuloma venerum
• 6) H/O – Ano rectal or Gynaec Surgery
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9. Types of Fistula in Ano
• 1) Low Level ( anal) – Normal
Fistulectomy may be compatible with
Ayurvedic Ksharutra
• 2) High Level ( anal ) – Modern
Fistulectomy has always a danger of
complication like Incontinence of
Faeces.So Ayurvedic Ksharsutra is better
option
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10. Ksharsutra
• This is the Treatment of choice in fistula in
ano
• A surgery without Knife
• This is the only Ayurvedic surgery ,which
remains time tested & now even
recommended by Modern Ano rectal
Surgeon ( Dr.Raghunath Godbole –
recommends for High level fistula – to
avoid Incontinance of Urine)
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11. Examination of patient
• 1) P/R Examination in left lateral position &
with handgloves
• 2) Inspection for number of openings
,position & character of them
• 3) Discharge nature
• 4) Scar of previous surgery
• 5) Palpation of tract
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12. P/R Examination
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13. Perianal Abscess &
Fistula in Ano
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14. Piles
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15. Ano rectal problems
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16. Formation of Haemorroids
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17. Anal Fissure & Fistula
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18. Can you imagine pain
of Anal fissure ?
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19. Tracts of Fistulae
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20. External & Internal piles
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21. Kshar ( Chemical cautery)
• 1) Kshar = Substance ,which cuts the
devitalized tissue & having property of
cleansing ( Shodhan).
• 2) Kshar --- Alkali in nature
• A) Mrudu Kshar ( mild) = PH 8.4
• B) Madhya Kshar( moderate) = PH 9.2
• C) Tikshna Kshar (strong) = PH 9.4
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22. Kshar
• 1) Mainly prepared by Herbs ,which
contain Sodium carbonate ,potassium
carbonate ,calcium oxide ,magnesium
oxide ,silica
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23. Material for preparing
Ksharsutra
• 1) Cotton thread number 10
• 2) Binding agent – Udumber Ksheer or
Gum ekesia
• 3) Kshar
• 4) Turmeric ( Haridra)
• 5) Water
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24. Apamarga for Kshar
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25. PH Values of Kshar
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26. Ksharsutra Preparation
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27. Making of Ksharsutra
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28. Drying of Ksharsutra –
Dryer or oven
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29. Ksharsutra – Ready to use
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30. Preparation of Ksharsutra
• 1) Prepare solution of – Kshar(Apamarga or Arka) 1
part + Turmeric 3 parts + Udumbar ksheer or powder of
Gum ekesia
• 2) Add sufficient quantity of water .This solution should
not be too thick or too watery
• 3) Dip cotton thread in this solution .Dry it in cool place
• 4) Repeat this procedure for 11 times
• 5) After preparation,Kshar sutra is kept in Formalin
Chamber
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31. Patient Examination
• Pain of the patient can be graded as 0 to 3
( No pain, Pain during defaecation
only,Pain releived by Sitz’s bath,Pain
releived by Analgesics)
• Burning sensation also can be graded as 0
to 3 (No Burning Sensation, Burning only
after defecation, Intermittent Burning &
Continuous burning)
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32. Patient Examination
• Pus Dischage graded as 0 to 3 ( No
pus,Dischrge only during
defaecation,Intermittent discharge,Pus
dischage with soiling of cloth)
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33. Patient Examination
• Perianal region is examined for –No of
openings, Location of openings,
Discharge,Colour of Peri anal skin,
Condition of sphincter on staining, Scar of
previous surgery
• By Palpation – Check Increased Local
Temperature, Tenderness, Feel of Tract
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34. Patient Examination
• PR Examination or Digital Examination is
done in Left Lateral Position for Palpation
of Internal opening,Spincter tone & to
palpate any other Pathology like Tumour
or ulcer
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35. Examination
• Proctoscopy
• Fistulogram
• Other base line Investigation like
Haemogram,
Urine,Stool,BSL,Urea,Creatinine,Cholester
ol,BT & CT,ECG etc
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36. Drugs
• Haridra( Curcuma longa),
• Arka ( Calotropis procera),
• Udumber (Ficus racemosa),
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37. Action of Ksharsutra
• Kshar has a action of Vrana
Shodhan,Lekhan & Ropan (
Cleansing,Scrapping & Healing)
• Kshara sutra does not allow to track close
abruptly & allow pus to drain
• Fistulous Track is cut by Chemical cautery
• UCT of Arka is 1 cm in 8 days & UCT of
Apamarga is 1 cm in 7 days
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38. Comparison of Arka & Apamarga
• Although Arka is supposed to be stronger
by it’s Hot & cutting property ,in Practice
Apamaga Kshar can show better results
due to –
• Apamarga has good healing property &
less burning
• With Arka Ksharsutra,some times
unhealthy Hypergranulation is noted
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39. Surgical Instruments
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40. Procedure -- 1
• 1) Routine Lab
• 2) If H/O recurrence – Colonoscopy &
Fistulogram
• 3) Appropriate Local Anaesthesia( Spinal
at L4 & L 5)
• 4) Lithotomy position
• 5) Painting with spirit & povidone Iodine &
draping
3/18/2015 40Prof.Dr.R.R.Deshpande

41. Procedure -- 2
• 6) Inject Betadine + Hydrogen peroxide from
external opening & observe internal opening ,by
putting Seem’s speculum
• 7) Probing is done with Malleable probe of silver
,costing Rs.200 /- ,which is washed thoroughly
after procedure & kept in formalin Tablets
chamber ( Take precaution that not to create
false passage )
3/18/2015 41Prof.Dr.R.R.Deshpande

42. Procedure -- 3
• 8) Probe is expected to come out from
internal opening in the rectum ( confirmed
by injecting Betadine + Hydrogen peroxide
solution
• 9) Insert Ksharsutra & tight knot is applied
• 10) Go for Lord’s dilatation for painless
defecation
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43. Ksharsutra application
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44. Procedure -- 4
• 11) R/O any other pathology by doing P/R
& Proctoscopy
• 12) Insert Voveran( Diclofenac)
suppositories to avoid post operative pain
,with Jatyadi Taila varti as a lubricating
agent
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45. Post operative Management
• 1) NBM for 3 to 4 hours
• 2) Soft & bland diet for a week
• 3) Anti biotics ( Inj Taxim 1 Gm I / V – BD ) &
Analgesics for a week
• 4) Then Saptavinshati Guggulu 2 BD +
• 5) Gandhak Rasayan 2 BD
• 6) Daily Sit’z bath
• 7) Change of Ksharsutra after 7 or 10 to 15
days
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46. Ksharsutra Indication
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47. Healing complete with
Kshar sutra
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48. Warts on neck – another
indication for Ksharsutra
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49. Planter Warts
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50. Wart around anus
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51. Wart on fingers
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52. Advantage of Ksharsutra
• 1) Can perform under LA ( If it is low level &
patient is cooperative )
• 2) Huge wound can be avoided
• 3) No dressing ,No Pain
• 4) Short stay in hospital ( 1 or 2 days)
• 5) Much economical
• 6) Can attend normal duties from 3rd or 4th day &
on any vehicle
• 7) Negligible recurrence
3/18/2015 52Prof.Dr.R.R.Deshpande

53. IMP Advantage of Ksharsutra
• There is no fecal Incontinence in High
level fistula because
• 1) cutting & healing of fistulous Tract is
simultaneous procedure .This is chemical
cautery
• 2) This is surgery without knife ,so less
chances of getting fibers cut of sphincters
3/18/2015 53Prof.Dr.R.R.Deshpande

54. Dr.Bhalchandra N Deshpande
• Professor & HOD ,Dept of Surgery
,CARC,Nigdi ,Pune 44
• BAMS & AVP (Surgery)
• Article published in Ayurvidya magazine
,Jan 2012
• Got 1st prize of Best Article ,by Dr.Ranade
Foundation
3/18/2015 54Prof.Dr.R.R.Deshpande

55. Kshar sutra Learning
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56. Book to purchase
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57. CME on Ksharsutra
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58. Start Ksharsutra Clinic
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59. 3/18/2015 Prof.Dr.R.R.Deshpande 59
Ayurved for General Practioner
• Very very popular
Book in Medical
Practioners
• 100 common
symptoms of General
Practice with
causes,Investigations
& Ayurvedic
Treatments
3/18/2015 59Prof.Dr.R.R.Deshpande

60. 3/18/2015 Prof.Dr.R.R.Deshpande 60
Clinical Examination
• Systemic Examination
of 8 systems
• Ayurvedic Srotas
Examination
• Clinical significance of
Lab Tests &
Radiology,USG,2D
Echo

61. 3/18/2015 Prof.Dr.R.R.Deshpande 61
Notes on Medicine Part 1
• Very very useful Book
for all Medical
Practioners
• Guidelines with
causes,symptoms,Ay
urvedic & Modern
Treatments to treat
Fever,Pain in
Abdomen & Arthritis

62. Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://www.youtube.com/user/deshpande1
959
• http://www.slideshare.net/rajendra9a/
• http://www.mixcloud.com/jamdadey/
3/18/2015 Prof.Dr.R.R.Deshpande 6262

63. Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://professordeshpande.blogspot.in
• http://professordrdeshpande.blogspot.in/
• http://www.mixcloud.com/rajendra-
deshpande
• https://soundcloud.com/professor-
deshpande
3/18/2015 Prof.Dr.R.R.Deshpande 63