Ksharodhaka, a solution made from Apamarga kshara, was injected intralesionally to treat various types of warts. Four cases are described where warts of different sizes and locations were treated with Ksharodhaka injections. In all cases, the warts hardened, darkened and shed off within 2-7 days, leaving only minor scars. The procedure is presented as an effective novel treatment for warts that requires only a single sitting.

2. JOURNALJOURNAL
PRESENTATIONPRESENTATION
DEPARTMENT OF SAMHITADEPARTMENT OF SAMHITA
PRESENTERPRESENTER
Dr. S. KAMALAKARDr. S. KAMALAKAR
22ndnd
YEAR PGYEAR PG

3. Journal of Ayurveda & Integrative
Medicine
| October-December 2014 | Vol 5 |
Issue 4
C A S E RE PORT
SUBCUTANEOUS INTRALESIONAL KSHARODAKA INJECTION:
A NOVEL TREATMENT FOR THE MANAGEMENT OF WARTS
MANOHAR S. GUNDETI, R.GOVIND REDDY, JANGLE VIDYA MURALIDHAR
Raja Ramdeo Anandilal Podar Ayurveda Cancer Research Institute
(CCRAS, Department of AYUSH, GoI),
Department of ShalyaTantra,
RA Podar Medical (Ayu) College, Mumbai, Maharashtra, India
Downloaded free from http://www.jaim.in

4. AIM OF THE ARTICLEAIM OF THE ARTICLE
• Different types of warts treated with intralesional
infiltration of Apamarga Ksharodaka (AK)

5. AUTHOR LANGUAGE STYLE AND EXPRESSIONAUTHOR LANGUAGE STYLE AND EXPRESSION
Very simple,
Easily understandable language
Grammatically correct, straight to point
Has systematically arranged the information under proper
headings

6. INTRODUCTIONINTRODUCTION

7.  Warts, also known as Verrucae, is a common dermatological
condition caused by the Human Papilloma Virus (HPV)
 Charmakila are the hard, rough, nail like projections over the‑
skin caused due to vitiation of Vyanavayu and Kapha
 Ayurveda recommends a holistic approach for treating the
Warts, such as oral medications, external application of
Kshara, Agnikarma or Surgical excision.

8. WHYWHY
KSHARODHAKAKSHARODHAKA

9.  Ksharasutra (thread smeared with Kshara) is tied around the
warts for removal. However, these methods require multiple
sittings with a longer duration for shedding off of the Wart
with limitations to use in smaller Warts.
 In Ksharodhaka observed that all these Warts took a minimum
of 2–6 days to shed off in one sitting and leaving minor scars.
There were no adverse reactions.

10.  Animal studies of AK injection have reported it to be safe at
different dose levels, to as high as 2000 mg/kg.
 The duration of follow up was until the 14th day of the study‑
and the Authors concluded that the formulations were safe.

11. PREPARATION OFPREPARATION OF
KSHARAKSHARA

12. • The dried pieces of medicinal plant are put in an earthen pot
and burnt to ash.
• After cooling the ash, water is added in a ratio of 1:6, i.e. one
part ash and six parts water, and mixed well.
• This is then strained through a piece of cloth for two or three
times till a clear liquid is obtained.
• This liquid is then put in an iron or earthen vessel and heated
over a moderate fire till the water evaporates, leaving a solid
salty white substance that is known as Kshara.

13. CASE REPORTSCASE REPORTS

14. •2.5 g of Apamarga Kshara was thoroughly mixed in 10 mL of
distilled water and kept for 15 min. The supernatant solution, i.e.
Apamarga Ksharodaka (AK), was used for the procedure.
•AK was drawn into a disposable syringe having a number 24
gauze needle
•slowly injected underneath the warts keeping the syringe
parallel to the skin surface with the bevel facing upward

15. CASE 1CASE 1

16. • Case 1
• A 73 year old male with a known case of diabetes mellitus‑ ‑
and hypertension (well controlled with allopathic medicines)
was having multiple warts of varying sizes on his face, neck,
axilla and groin regions.
• The warts on the face and neck were of varying size and
shape, painless and soft in consistency.

17. •AK was injected at the base of a flat wart on the right cheek,
three filliform warts on the right side of the neck and thigh with
a disposable syringe using a 24 number hypodermic needle in the
dose of 0.1 cc each.
•On the next day, mild inflammation was seen at the base of the
warts.
•The hardness and darkness in color of the wart got increased
every day but the patient was not having any complains.
On the seventh day, the warts shed off .
•.

18. BT AI AT

19. CASE 2CASE 2

20. • A 54 year old, apparently healthy female presented with‑ ‑
multiple painless warts on the right side of the neck region (as
filliform warts), left shoulder and in the right axillary region.
• She was subjected for an intralesional AK injection at a dose of
0.4cc. This patient complained of burning at the site of the
injection during the procedure.
• On the next day, all the warts turned harder, darker and
subsequently shed off, leaving a small wound
Case 2

22. CASE 3CASE 3

23. • Case 3
• A 30 year old female presented with a flat, skin colored‑ ‑ ‑
wart of approximately 0.5 cm diameter in size on the scalp
just behind the left ear at the hairline on the mastoid region.
• 0.2 cc of AK was injected at the base of the wart using
disposable syringe with a 24 number needle.
• She complained of pain and burning at the site of the
injection during and after the procedure for 1h.
• The wart shed off on the fourth day with a slight wound that
healed leaving a minimal scar at the site within 7 days

25. CASE 4CASE 4

26. • Case 4
• A 60 year old female presented with a dry, rough,‑ ‑
brown colored wart on the face above the right eye, near the‑
medial end of the eyebrow as a filliform wart measuring
• approximately 0.1 cm.
• 0.2 cc of AK was infiltrated at the base of the wart using a
disposable syringe with a 26 number needle.

28. •Here, the base of the wart was small; hence, a 26 number needle
was used.
•She complained of pain at the site of the injection during the
procedure.
•Mild inflammation was seen at the base of the wart on the next
day with no obvious pain and burning sensation.
•On Day 5, the wart shed off

29. CONCLUSIONCONCLUSION

30. • Kshara possess caustic properties resulting in excision of
unwanted tissues.
• It works like a sclerosant agent locally and creates sterile
inflammation at the base of the wart.
• Subsequently, the process of sclerosis takes place and the wart
falls off.
• Kshara has dual properties of cutting and healing locally.
Apamarga has been a drug of choice for preparation of Kshara,
and it has been used in the management of hemorrhoids, warts,
etc.

32. FURTHER
UNDERSTANDING

33. Introduction:
Charmkeela is a most commonly encountered problem in the
routine practice, which deserves special attention on account of its
cosmetic importance.
Samprapti (Pathogenesis):
The vitiated Vyanavata in association with Kapha produces
firm and nail shaped projections externally which are known as
Charmakila (Warts).
 In those Warts pain is produced due to Vayu,
while color and nodularity are due to Slesma.
 Pitta and Shonita produces dryness, blackness, glossiness and
excessive roughness over the entire surface of the Charmakila.

34. DERIVATION OF KSHARA
• ‘Kshara’ - The root “Char” (to remove) or
“Kshana”(violence).
• Kshara - Destroys fleshy mass either healthy or unhealthy .
• Kshara - one which scrapes the abnormal tissue from its
location & destroys it after dissolving it, because of its corrosive
nature.

35. KSHARA KARMA
Kshara Pradhana tama
• Chedya Bhedya Lekhya karanatwat
• Tridoshaghnatwat
• Vishesha kriya avacvharanaat

36. • Superior most among the sharp and subsidiary instruments -
performing Chedana (Excision), Lekhana (Scraping) and destroys
the Tridoshaja disorders.
• More effective than the other modalities of treatment - can be
administered both internally and externally.
• Useful as the substitute of surgical instruments - can be used
safely on the patients who are afraid of surgery.

37. • Warts are common Benign epithelial hyperplasia due to
infection with Human Papilloma Virus
• Papilloma viruses or double standed DNA viruses
• They infect squamous epithelia of the skin and mucous
membrane causing cell proliferation
• The virus infects the basal layer of the epethelium
• But viral replication takes place in fully differentiated cells of
upper Stratum Spinosum and Granulosum

38. • COMMON WARTS:
• These present as dome shaped papules with verrucous
surface commonly on the hands and feet
• They are rough keratotic papules that may appear single or
grouped on cutaneous surface.
• They are commonly located on the dorsal surface of the
hands, fingers and knees. Size are less than a millimeter to
over a centimeter.
• FILIFORM WARTS-
• They appear as long slender filiform projections.
•

40. • FLAT WARTS (PLANE WARTS)-
• They are slightly elevated, smooth papules, that are less than
5mm.
• They may be flesh coloured gray or brown and are usually
located over the face, hands and legs.
• Koebners phenomenon is seen frequently…new warts
forming over sites of trauma
•

41. • PLANTAR WARTS-
• These are small shiny horney papules and located beneath the
pressure point i.e. soles of the feet.
• It produce pain on walking.
• Multiple plantar warts called as mosaic wart

42. • Genital warts(Sexually transmitted):
• They may be either hyperplastic, sessile (papular), Verruca
vulgaris like or flat warts. Occurs at the mucocutaneous
junction of external genital in male & female.
• Sometimes the transmission may be non veneral
• High infectivity
• They effect the penis in males,
• perianal area in homosexuals
• Vulva, perinium and vagina in females
• The wart may be small or may be large cauliflower like
condylomata accuminata

44. CLASSIFICATION OF KSHARA
On the basis of Administration
1. Pratisaaraneeya Kshara
2. Paaneeya Kshara

45. METHOD OF PREPARATION OF PANEEYA KSHARA
Dried Apamarga Plant
Burnt
Apamarga Ash
Add 6 times of water
Filtered 21 times through cloth
To get clean and clear solution – Gomutra Varna (slight reddish)
Filtrate Solution was boiled and evaporated
Heating up to water evaporates completely
leaving a solid salty white substance
PANEEYA KSHARA

46. PROPERTIES OF KSHARA
 RASA - Katu
 VEERYA - Ushna
 VARNA - Shukla
 GUNA - Thiksna, Agneya
 DOSHAGNA - Tridoshagna
 KARMA - Dahana, Pachana,
Shodana, Ropana,
PH value - 13.5

47. METHOD OF PREPARATION OF PRATISARANEEYA KSHARA
Dried Apamarga Plant (5 kg)
Burnt
500 gms of Apamarga Ash
Add 6 times of water (3 liters)
Filtered 21 times through cloth
To get clean and clear solution – Gomutra Varna (slight reddish)
Filtrate Solution was boiled and evaporated
Heating up to 2/3 remains
Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga filtrate solution
Continuous mild heating
Liquid evaporates to 1/3rd of its original quantity
Add 1/10th (5gms) of Chitraka Kalka
PRATISARANIYA KSHARA

48. CONCLUSION
Ksharodhaka procedure very effective in Charmakila
Simple technique
Less time
Sometimes it will shows adverse reactions because of
necrotising property
So utmost care while injecting the ksharodhaka in unwanted
tissue growths like charmakila