KSHARKARMA THERAPY (CAUSTIC THERAPY)
Introduction
Kshara is an alkaline, caustic substance derived from the ashes of medicinal plants. It represents a gentler alternative to both surgery and thermal cautery. Standing out as the foremost among sharp and subsidiary instruments, Kshara excels in performing excisions, incisions, and scrapings. Its versatility shines through, as it can effectively address challenging locations that may be difficult to approach through conventional means. Kshara Karma serves as a valuable substitute for surgical instruments, offering a safe option for patients averse to surgery due to its ease of performance, cost-effectiveness, absence of complications, proven efficacy over time, and the convenience of not requiring hospital admission.
Classification
- On the basis of Administration –
- Pratisaaraneeya Kshara – External application
- Paneeya Kshara – Internal administration
- On the basis of Concentration – Mild, Moderate and High
Preparation
Gather 5 kilograms of the entire plants of Apamarga (Achyranthes aspera), Palash, Kutaj, Aragwadh, Arka, Snuhi, Patala, Chitrak, Karveer, Saptaparna, Agnimanth, Ashwakarna, Tilvak, Paribhadra, Kadali, Nimb (Azadirakta indica), etc., dry them, and then burn them. Collect 500 grams of the resulting ash and mix it with approximately 3 liters of water, filtering the mixture 21 times.
The resulting filtrate is clear, resembling the color of cow’s urine. It is then heated gently until the liquid reduces to one-third of its original quantity, creating what is known as Mridu or mild concentrate Kshara. Next, introduce 50 grams of red-hot Shukti (Limestone) to the filtrate, stirring continuously until it evaporates again to one-third of its original volume. This stage is termed Madhyama or moderate Kshara.
Further heating is done by adding 5 grams of Chitraka moola Kalka (Plumbago gelanica). This process yields a thick solution, referred to as Pratisaraneeya Teekshana or highly concentrated Kshara. Collect this solution and store it in an airtight container.
Microscopy features of prepared Kshara
Fibrous and sclereidal tissues, along with polygonal crystals of varying sizes, were uncovered through the examination. After decanting the supernatant liquid, the Kshara paste exhibited loss on drying. The Kshara powder, devoid of moisture, was analyzed for total ash and acid insoluble ash. Additionally, the pH of the supernatant liquid was measured and found to be 13.3.
Indications
Following are the possibilities behind the development of hemorrhoids.
Paneeya Kshara – Mild concentrate Kshara is used internally in worms, indigestion, urinary calculus, skin diseases, obesity etc.
Pratisaraneeya Kshara – Highly concentrate Kshara is used in internal haemorrhoids ( Piles) , after fistulectomy, rectal prolapse, after excision of pilonidal sinus, after incision and drainage of anorectal abscess, infected wounds , fissures etc
The patient undergoes local or spinal anesthesia before the introduction of a lubricated slit proctoscope into the anus. Kshara is then applied over the internal pile mass and left for 2 minutes or until the pile mass adopts a reddish-black color (Pakwa Jambu Phala Varna). Following this, the pile mass is cleansed with lemon juice to neutralize the Kshara after the effective burning of piles. This procedure is replicated for other piles as well. Subsequently, a rectal pack containing Yashtimadhu taila or ghrita is applied.
Histopathological examination of slough material in blackish brown discharge reveals the presence of necrosed haemorrhoidal tissue.
For small, low anal fistulas, the initial step involves excising the fistula tract, followed by the application of Kshara. This approach promotes swift healing and helps prevent the recurrence of the fistula tract. In cases of high-level fistulas, a partial excision of the fistulous tract is performed, followed by the application of Kshara. Subsequently, Kshara Sutra is employed in the remaining portion of the fistulous tract situated in the anal sphincter area.
The excised fistulous tract undergoes complete healing with the aid of Kshara, while the remaining portion is managed through Kshara Sutra ligation. This comprehensive technique aims to expedite the patient’s recovery with minimal discomfort. After excising the fistulous tract and applying Kshara, the fibrous tissue undergoes debridement, and the remaining wound benefits from the scraping and healing properties of Kshara. Simultaneously, Kshara Sutra ligation at the sphincteric area of the fistulous tract achieves cutting, debridement, and drainage, all while preserving the continence of the anal canal.
Kshara is administered to the entire healthy mucosa around the lowermost part of the anal canal until proper burning of the mucosa is achieved. Subsequently, a rectal pack containing medicated ghrita is applied. Following the application of Kshara in cases of rectal prolapse, the burnt area undergoes healing, resulting in the fibrosis and narrowing of the anal canal. This, in turn, leads to the complete cessation of rectal prolapse.
Following the excision of the Pilonidal sinus, the application of Kshara on the wound proves beneficial. This application aids in the healing process after the removal of the Pilonidal Sinus by scraping the pits in the surrounding tissue, preventing the development of unhealthy granulation tissue and promoting the healing of the wound from its base.
The patient undergoes local or spinal anesthesia before the introduction of a lubricated slit proctoscope into the anus. Kshara is then applied over the internal pile mass and left for 2 minutes or until the pile mass adopts a reddish-black color (Pakwa Jambu Phala Varna). Following this, the pile mass is cleansed with lemon juice to neutralize the Kshara after the effective burning of piles. This procedure is replicated for other piles as well. Subsequently, a rectal pack containing Yashtimadhu taila or ghrita is applied.
Histopathological examination of slough material in blackish brown discharge reveals the presence of necrosed haemorrhoidal tissue.
For small, low anal fistulas, the initial step involves excising the fistula tract, followed by the application of Kshara. This approach promotes swift healing and helps prevent the recurrence of the fistula tract. In cases of high-level fistulas, a partial excision of the fistulous tract is performed, followed by the application of Kshara. Subsequently, Kshara Sutra is employed in the remaining portion of the fistulous tract situated in the anal sphincter area.
The excised fistulous tract undergoes complete healing with the aid of Kshara, while the remaining portion is managed through Kshara Sutra ligation. This comprehensive technique aims to expedite the patient’s recovery with minimal discomfort. After excising the fistulous tract and applying Kshara, the fibrous tissue undergoes debridement, and the remaining wound benefits from the scraping and healing properties of Kshara. Simultaneously, Kshara Sutra ligation at the sphincteric area of the fistulous tract achieves cutting, debridement, and drainage, all while preserving the continence of the anal canal.
Kshara is administered to the entire healthy mucosa around the lowermost part of the anal canal until proper burning of the mucosa is achieved. Subsequently, a rectal pack containing medicated ghrita is applied. Following the application of Kshara in cases of rectal prolapse, the burnt area undergoes healing, resulting in the fibrosis and narrowing of the anal canal. This, in turn, leads to the complete cessation of rectal prolapse.
Following the excision of the Pilonidal sinus, the application of Kshara on the wound proves beneficial. This application aids in the healing process after the removal of the Pilonidal Sinus by scraping the pits in the surrounding tissue, preventing the development of unhealthy granulation tissue and promoting the healing of the wound from its base.
Advantages of Kshara Therapy
- Postoperative pain is mild in intensity
- Fast recovery
- No bleeding/ minimal bleeding
- Minimum hospitalization – one day care
- Routine activity can start earlier
- No wound
- Less follow up
- No scope for recurrencey
- Systemic diseases are also undergoing this procedure.
- No scope for recurrencey
- No surgical complications like incontinence, stenosis and stricture.
KSHARASUTRA THERAPY (MEDICATED CAUSTIC THREAD)
Introduction
Ksharasutra therapy, a minimally invasive and well-established Ayurvedic approach, is a proven method for managing Anorectal disorders. This safe, reliable, and cost-effective treatment is particularly effective for conditions such as fistula-in-ano, hemorrhoids, and other sinus diseases.
While the ancient Ayurvedic texts of Sushruta, Charak, and Vagbhata originally described this therapy, its effectiveness was reaffirmed by the Department of Shalya Tantra at Banaras Hindu University. Subsequently, scientific organizations like WHO, AAYUSH Ministry Govt. of India, CCRAS and ICMR further validated its efficacy. This technique is now widely practiced not only in our country but also in various other nations.
Preparation of Ksharasutra
The Standard Ksharasutra undergoes a preparation process involving 11 coatings of Snuhi latex (Euphorbia nerifolia), followed by 7 coatings of Snuhi latex and Apamarga Kshara (Achyranthes aspera), and finally, the last 3 coatings consist of Snuhi latex and Haridra Churna (Curcuma longum). The pH level of Apamarga Ksharasutra is recorded at 9.72.
Indications
Fistula-in-ano, hemorrhoids, pilonidal sinus, rectal or anal polyps etc.
Application of Ksharasutra in Fistula-in-ano
Following the administration of local, spinal, or general anesthesia, the patient undergoes a procedure wherein a flexible probe is inserted through the external opening of the fistula, traversing to the internal opening in the anal canal. Subsequently, the probe is gently guided out through the anal opening, carrying with it a Ksharasutra positioned within the probe’s groove. The two ends of the Ksharasutra are then securely tied together. After a week, the Ksharasutra is replaced with a new one. Over time, the Ksharasutra gradually cuts and promotes healing of the fistulous tract. Ultimately, the entire fistulous tract heals following the cutting process.
Mechanism of action of Ksharasutra 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.
Application of Ksharasutra in Haemorrhoids
The patient is administered local anesthesia for numbing. Initially, the pile mass is gripped using pile-holding forceps and gently brought out of the anal orifice. Subsequently, an incision is made at the mucocutaneous junction. A gentle pull is applied to the pile mass, followed by transfixing it at the base using Ksharasutra. The ligated pile mass is then carefully repositioned inside the rectum, and a rectal pack is applied using Yastimadhu taila or ghrita.
Mechanism of action of Ksharasutra in Haemorrhoids
- Chemical cauterization and mechanical strangulation of the blood 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.
Application of Ksharasutra in Pilonidal Sinus
Local anesthesia is administered to anesthetize the patient, following which a flexible probe containing Ksharasutra is inserted through the external opening of the pilonidal sinus to the skin. Subsequently, both ends of the Ksharasutra are securely tied together. After a week, the Ksharasutra is replaced with a new one. Over time, the Ksharasutra delicately cuts through the sinus tract, facilitating healing.
Advantages of Ksharasutra Therapy
- Simple and safe parasurgical procedure.
- Cost-effective and ambulatory.
- Minimal recurrence rate.
- No any complications
- Systemic diseases are also undergoing this procedure.
- No surgical complications like incontinence, stenosis and stricture.