KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA STURA IN ANORECTAL DISORDERS-----SD - M56BOOKSTORE

1. IMP.OF KSHARA STURA
IN ANORECTAL DISORDERS
⮚presented by – saransh D.
⮚Guided by- Dr.Nirupama mam
M.S ( AYU )

2. Introduction
⮚Kshara Sutra therapy is a minimal
invasive Ayurvedic
Parasurgicalprocedure and time-
tested Ayurvedic technique in the
management ofAnorectal disorders.
⮚It is a safe, sure and cost effective
method oftreatment for fistula-in-ano,
haemorrhoids and other sinus
diseases.

3. ⮚Though the therapy has been described in Ayurveda by -----
⮚Sushruta
⮚Charak
⮚Vagbhata
⮚But the efficacy of this therapy was re-established by the
Dept. of Shalya Tantra, Banaras Hindu University………
⮚Later period revalidated by scientific organizations like CCRASand ICMR.
⮚This technique is being practiced widely in our country and in some other
countries.

4. PREPARATION OF
KSHARA SUTARA
⮚The Standard Kshara Sutra is prepared
by-----
⮚11 coatings of Snuhi latex(Euphorbia
nerifolia).
⮚7 coatings of Snuhi latex.
⮚Apamarga Kshara(Achyranthes aspera).
⮚last 3 coatings of Snuhi latex.
⮚HaridraChurna (Curcuma longum).
⮚The pH of Apamarga Kshara Sutra is9.72.

9. INDIACATIONS
⮚Fistula-in-ano.
⮚Haemorrhoids sentinel piles.
⮚Pilonidal sinus.
⮚rectal or anal polyps.
⮚warts etc.

10. SYMPTOMS
•ANAL PAIN. ...
•LUMP/ PALPABLE MASS.
...
•RECTAL BLEEDING.
•DIFFICULTY PASSING
STOOL. ...
•FECAL IMPACTION. ...
•FECAL INCONTINENCE.

11. APPLICATION OF KSHARA SUTRA IN
FISTULA-IN-ANO -
⮚The patient is anaesthetized with local or spinal or general
anesthesia,
⮚Then a malleable probe is passed through the external
opening of the fistula to the internal opening in the anal
canal .
⮚Probe is gently taken out through anal opening to outside
along with a Kshara Sutra in the groove of the probe.

12. ⮚Later both ends of the Kshara Sutra is tied together.
⮚The Kshara Sutra is replaced by a new one after an
interval of one week.
⮚The Kshara Sutra gradually cuts and heals the tract.
⮚Finally the whole fistulous tract heals after cutting.

13. MECHANISM OF ACTION OF KSHARA SUTRA IN
FISTULA-IN-ANO -
• It helps is cutting, curetting, draining and healing of the fistulous track.
• It destroys and removes unhealthy tissue and promotes healing of the
fistulous track due to caustic action.
• Controls infection by the microbicidal action.
• Separation of debris and cleaning the wound.
• Facilitate in drainage of pus in fistulous tract and help in healing.
• Cutting through the tissues and laying the track open.

14. Application of Kshara Sutra in Haemorrhoids –
⮚The patient is anaesthetized with local anesthesia.
⮚First pile massholding with pile holding forceps and bring them out
of the anal orifice,
then give incision at mucocutaneous junction.
⮚Later slight pull exertedover the pile mass and transfixed by Kshara
Sutra at the base.
⮚Ligatedpile mass replaced inside the rectum and rectal pack with
Yastimadhutaila or ghrita.

15. Mechanism of action of Kshara Sutra in Haemorrhoids –
⮚ Chemical cauterization and mechanical strangulation of theblood vessel.
⮚ Local gangrene of the pile mass tissue.
⮚ Ischemic necrosis and debridement of unhealthy tissue.
⮚ Sloughing of the mass within 5-7 days.
⮚ Healing of the resulting wound takes 10-15 days.

16. Application of Kshara Sutra in Pilonidal Sinus -
⮚The patient is anaesthetized with local anesthesia .
⮚Then amalleable probe with Kshara Sutra is passed through the
externalopening of the pilonidal sinus to the skin.
⮚Later both ends of theKshara Sutra is tied together.
⮚The Kshara Sutra is replaced by a newone after an interval of one
week.
⮚ The Kshara Sutra gradually cutsand heals the sinus tract.

17. ADVANTAGES OF KSHARA SUTRA THERAPY –
• Simple and safe parasurgical procedure.
• Cost-effective and ambulatory.
• Minimal recurrence rate.
• Systemic diseases are also undergoing this procedure.
• No surgical complications like incontinence, stenosis
andstricture.

18. BENEFITS -

19. The Kshara Sutra gradually cuts and heals the tract.
Finally the whole fistulous tract heals after cutting.
It helps is cutting, curetting, draining and healing of the
fistulous track.
It destroys and removes unhealthy tissue and
promotes healing of the fistulous track due to caustic
action.
IMPORTANCE OF KSHARA SUTRA -

20. • P. Hemantha Kumar and M. Sahu, Role of Aragvadhadi Sutra inthe
Management of Fistula-in-ano, Ancient Science of Life.
• Gopikrishna and P. Hemantha Kumar, Effect of Madhu KsharaSutra in the
management of Bhagandara (Fistula-in-ano),International Journal of
Ayurvedic Medicine, 2013, Vol. 4(3).
• Mahesh Kumar ES, Hemantha Kumar P, A case discussion oneffect of
Palasha Kshara Sutra in the management ofBhagandara (Fistula-in-ano)
with special reference to itsAntimicrobial effect, International Journal of
Ayurvedic Medicine.
• Yadav Vikas S, Rao Prasanna N, P Hemantha Kumar, Effect ofKadali
Kshara Sutra in the management of Bhagandara(Fistula-in-ano),
International Ayurvedic Medical Journal .
References :

21. KSHARA KARMA THERAPY
(CAUSTIC THERAPY)
PRESENTED BY – SARANSH D
DEPARTMENT OF SHALYA TANTRA GUIDED BY – DR. NIRUPAMA MAM
M.S ( AYU )

22. INTRODUCTION
► Kshara is a caustic, alkaline in nature obtained from the ashes of
medicinal plants.
► It is a milder procedure compared to surgery and thermal cautery.
► It is the superior most among the sharp and subsidiary instruments
► because of performing excision, incision and scraping.
► It is versatile, because even such places that are difficult in approach
by ordinary measures can be treated by Kshara Karma.
► Kshara Karma is useful as the substitute of surgical instruments,
► because they can be used safely on the patients who are afraid of
Surgery.

23. CLASSIFICATION
► On the basis of Administration –
► Pratisaaraneeya Kshara – External application
► Paneeya Kshara - Internal administration
► On the basis of Concentration –
- Mild
- Moderat
- Highly

26. PREPARATION
► The Panchanga (whole plant) of Apamarga (Achyranthes aspera) 5 kgs should be
collected, dried up and burnt.
► The whole ash 500 gms were collected and mixed with 6 times (approx 3 liters) of
water and filtered 21 times.
► The filtrate is clean and clear like color of cow’s urine and it is kept on mild fire
and liquid evaporates to 1/3rd of its original quantity.
► This is known as Mridu or mild concentrate Kshara.
► Then add 50 gms of red hot Shukti (Limestone) to the filtrate solution and
continuously stirred well until it evaporates to 1/3rd of its original quantity.
► This is known as Madhyama or moderate Kshara.
► This should be further heated up by adding 5 gms of Chitraka Kalka (Plumbago
gelanica).
► With this thick solution is obtained which is known as Pratisaraneeya Teekshana
or highly concentrate Kshara.
► It will be collected and stored in air tight container.

27. Microscopy features of prepared Apamarga
Pratisaraneeya Teekshana Kshara –
⮚ It has revealed fibrous / sclereidal tissues and
polygonal crystals of different sizes.
⮚ Loss on drying of Kshara paste after decanting the
supernatant liquid, total ash and acid insoluble ash
of Kshara powder free from moisture and pH of the
supernatant liquid is 13.3.

28. INDICATIONS
1. Paneeya Kshara –
►Mild concentrate Kshara is used internally in
worms, indigestion, urinary calculus, skin
diseases, obesity etc.
2. Pratisaraneeya Kshara –
⮚ Highly concentrate Kshara is used in – internal
haemorrhoids, after fistulectomy, rectal prolapse, after
excision of pilonidal sinus, after incision and drainage of
anorectal abscess, infected wounds etc.

29. PARTISARANEEYA KSHARA
FLOW CHART

30. APPLICATION OF PRATISARANEEYA TEEKSHANA
KSHARA IN
INTERNAL HAEMORRHOIDS
⮚ The patient is anaesthetized with local or spinal anesthesia, lubricated
⮚ slit proctoscope is to be introduced into the anus and Kshara applied
⮚ over the internal pile mass and wait for 2 minutes or until the pile mass
⮚ turns to the color of Reddish black (Pakwa Jambu Phala Varna).
⮚ After this process, the pile mass must be washed with lemon juice to
⮚ neutralize the Kshara after proper burning of piles.
⮚ The same procedure should be followed in other piles also. Later the rectal
pack with Yashtimadhu taila or ghrita is applied.

31. Mode of Action of Pratisaraneeya Kshara
in Internal piles
⮚Histopathological examination of slough
material in blackish brown discharge reveals
the presence of necrosed haemorrhoidal
tissue.

32. Application of Pratisaraneeya Teekshana Kshara in
after
fistulectomy in Fistula-in-ano -
In small low anal fistulas, first excise the fistula tract followed by –
⮚ Application of Pratisaraneeya Teekshana Kshara and wait for 2 Minutes
later neutralize with lemon juice and pack with Yastimadhu taila or ghrita.
⮚ It is helpful for quick healing and avoids recurrence of fistula tract.
⮚ In high level fistulas, excision of fistulous tract was done partially followed
by application of Kshara.
⮚ Later Kshara Sutra is applied in remaining fistulous tract at anal
sphincteric area.
⮚ The excised fistulous tract heals completely with help of Kshara and
remaining fistulous tract was cut by Kshara Sutra ligation.
⮚ So that patient can be cured at less time and pain.

33. ⮚ In this technique, after excision of fistulous tract
and applying Kshara,
⮚ Leads to debridement of the fibrous tissue and at
the same time
⮚ Remaining wound will be healed by its scraping
and healing property of Kshara.
⮚ In the mean time, the Kshara sutra ligation at
sphincteric area
⮚ Of fistulous tract leads to cutting and debridement
and drainage of
⮚ Fistulous tract at the same time preserving
continence of anal canal.

34. Application of Pratisaraneeya Kshara
in Rectal Prolapse
⮚ The patient is anaesthetized with local or spinal anesthesia,
lubricated slit proctoscope is to be introduced and Kshara applied at
lower most all around healthy mucosa of 3 cm area of anal canal
and wait for 2 minutes or until it turns to the color of reddish black.
⮚ After this process, the mucosa must be washed with lemon juice to
neutralize the Kshara after proper burning of mucosa.
⮚ Later the rectal pack with Yashtimadhu taila or ghrita is applied.
⮚ After Kshara application in rectal prolapse, the burned part heals
and anal canal become fibrosed and narrowed. Then prolapse of
rectum is stopped completely

35. Application of Pratisaraneeya Teekshana Kshara in
Pilonidal Sinus
⮚ After excision of Pilonidal sinus, the Kshara applied over the wound
and wait for 2 minutes.
⮚ Later neutralize with lemon juice and pack with Jatyadi / Yastimadhu
taila or ghrita.
⮚ The application of Pratisaraneeya Kshara helped after excision of
Pilonidal Sinus by scraping of pits in the surrounding tissue of the
sinus,
⮚ avoids the formation of unhealthy granulation tissue and helps in
healing of the wound from the base.

36. During application -

37. BEFORE KSHAR KARMA-

38. DURING KSHAR KARMA-

39. AFTER KSHAR KARMA -

40. Advantages of Kshara Therapy
►Postoperative pain is mild in intensity
►No bleeding
►Minimum hospitalization – one day care
►No scope for recurrence
►Systemic diseases are also undergoing this
procedure.
►No surgical complications like incontinence,
stenosis and stricture.

41. CONCLUSION
► Pratisaraneeya teekshna kshara was found effective in
obliterating the hemorrhoid mass .
► The patient was followed up regularly from 2004 onward
till date by doing proctoscopic examination in each visit
and proctoscopic examination did not reveal any evidence
of recurrence of the hemorrhoids.
► This case is being reported after a follow up of eight years
non-recurrence of hemorrhoids. The patient was on active
treatment for only a period of three months.

42. WHY KSHAR KARMA?
► These are notorious diseases where medicine as well as performing
surgery is also difficult and has a lot of complications like – infection,
disfigurement, difficulty to approach discomfort etc.
► Kshar karma is safe and furthermore an effective Ayurveda procedure as a
substitute for surgical procedure.
► We offer safe and effective ayurvedic treatments to patients who are
suffering with anorectal disorders.
► We treat anorectal disease like Piles, fissure, fistula through complete
natural and Ayurvedic procedures which not only help to recover fast but
also there are very less chances of reoccurrence

43. REFERENCES
► P. Hemantha kumar - Recent trends in the management
ofArshas/Haemorrhoids, Published by Chaukhamba SanskritPratishthan,
Delhi, 2011.
► P. Hemantha Kumar, Kshara Karma Therapy in Anorectaldiseases,
RGUHS Journal of AYUSH Sciences, 2011,
► Avnish Patak and P. Hemantha Kumar, A Case discussion ofeffect of
Apamarga Pratisaraneeya Kshara in the managementof Ardra Arshas
with special reference to Histopathologicalexamination, International
Journal of Ayurvedic Medicine, Oct-Dec 2012. Vol. 3(4)
► Yashawanth B.N, Pathak Avnish, Hemantha Kumar P, A CriticalAnalysis
of Pratisaraneeya Kshara, International AyurvedicMedical Journal, July-
Aug 2013, Vol. 1(4).