Ksharsutra Manual for BAMS Graduate, prepared by Health Directorate, Province 1

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 !