Ksharsutra is a medicated thread or medicated set on which is prepared by applying the coating of apamarga kshar, haridra churna and snuhi ksheer. Snuhi ksheer acts as binding agent.
Ksharsutra Therapy method is used in the Anal-fistula, Piles, Rectal Polyps, Vaginal polyps, fissure-in-ano, warts etc. Ksharsutra Therapy is an effective Shalya chikitsa for anal-fistula and piles in the Ayurvedic Shaly chikitsa system according to the great father of surgery, Shusruta. In this method a medicated thread is prepared as following procedure.
The preparation of Ksharsutra has undergone many changes and has passed through various stages before it reached the present standard of manufacturing. It is a technique derived from the ancient Ayurvedic text books and modified on the basis of a number of experimentations and experiences. It is surprising to note that while the application of Ksharsutra has been referred to by almost all the authors of Ayurvedic Samhitas including the big three (Charak Sushruta & Vagbhatta) its preparation has hardly been mentioned by any one.
At first, a white kosher (alkaline) powder of the plant Achyranthes aspera L. (Amarantheceae) is prepared by cutting the whole plant in to small pieces and dry in the sun then burning them clay or iron pot in the open air or gas furnace to get white ash. The ash is allowed to dissolve in water and filtrate is dried over the sun to afford an alkaline powder (Kshara powder). Second, a Barbour Flax 100% Linen Suture Thread No-20 or a cotton thread is dipped in latex of Euphorbia nerifolia Lin. (Euphorbiaceae) -11 coating and in alkaline powder, ash of Achyrantes aspera alternately for 7 times coated and finally coated with the yellow powder of Curcuma longa (Zingiberaceae) for 3 times. The thread is then dried in the Ksharsutra cabinet fitted with ultra-violet radiation lamp, fan, etc. or in shade. The above-mentioned three drugs exert a powerful debridement effect on the fistula tract and induce healing by the fresh and healthy granulation tissues. The sutra (thread) is the mechanism of drug delivery precisely at the tissue involved.
Even today when the modern surgery is at its peek, fistula-in-ano is still a challenge to the surgeons for its incidence of recurrence and post operative complications.
The method devised by ancient acharyas to treat this disease is the only foolproof method available to cure fistula-in-ano.
Standard Apamarga Ksharsutra
It is kept in air container polythene bag after sterilization by ultra violet radiation, which is transferred to a glass tube containing silica gel, before sealing the tube to avoid contact with humidity which can destroy the Kshar-sutra as it is hygroscopic in nature, Any how if Kshar-Sutra be destroyed with the contact of humidity then three coating with the latex of Euphorbia nerifolia Lin. & yellow powder of Curcuma longa to be done.
Before preparation of Kshar-Sutra, thread is boiled in distilled water for 30 minutes. After preparation and before use it is sterilized by ultra-violet radiation.
A proper clinical and pathological examination of the patient of anal fistula & piles is generally sufficient to investigate with special reference to any other associate disorder like Diabetes mellitus, Tuberculosis, Hypertension, Chronic ulcerative colitis, Diverticulitis of the colon, Prostatic infection, Osteomyelitis of pelvic bones and Pott's disease of the spine etc.
All these condition which are suspected to be present of clinical examination have to be investigated by proper laboratory tests and radiological examinations. Thus the examinations should be ordered according to requirements of a particular case. The common examination which are required to be performed on blood and by radiology are;-
A. Blood Examination :
TC, DC, ESR & Hb% BT, CT, FBS, PPBS, Blood Urea, Serum Creatinine, Serum Cholesterol, VDRL& HIV were carried out as and when required.
B. Radiological Examination :
1. X-ray of chest in PA view ,
2. Plain X-ray of abdomen for K. U. B. region ,
3. X-ray of the spine in A.P. and lateral views,
4. X-ray of pelvis including both hip-joints,
5. Barium-Enema studies,
6. Fistulogram, sinogram.
=> Colonoscopy up to cecum,
=> Endoscopic studies,
C. Other Miscellaneous Examination :
1. Electro-Cardio-Gram (E. C. G.),
2. Montoux test
3. Biopsy for H/P from the floor of the fistulous tract & ano-rectal growth.
4. Pus culture and sensitivity.
The application of Ksharsutra in a patient of fistula-in-ano and piles is a simple process. It may be difficult if the surgeon has no experience of the procedure. While it is true that Ksharsutra can be applied in all type of fistula-in-ano, it is also important to know the condition where Ksharsutra should not be applied.
The sinuses which are connected with the following lesions away form the anor-ectal canal constitute definite contra-indication for Ksharsutra Therapy.
a. Osteomyelitis of pelvic bones
b. Osteomyelitis of femur
c. Tuberculosis of hip joint
d. Tuberculosis of spine
e. Intra-abdominal cold abscesses
f. Chronic/acute ulcerative colitis
h. Intestinal and pelvic malignancies
i. Venereal Diseases
j. Strictures of urethra causing urethral sinuses
k. Cases of RVF and WF
l. Cron's diseases
These are the fistulae and piles where Ksharsutra can be applied but the treatment for the systemic conditions should also be instituted. These are -
=> Diabetes Mellitus
=> Ischemic Heart Disease
=> Neuropathic condition e.g. paraplegia etc.
=> Chronic Amoebiasis
=> Benign Prostatic Hypertrophy
=> Uraemia and C.RF.
=> Urinary Tract Infections
1. Ksharsutra remains in direct contact of the tract and chemically curettes out of the tract and sloughs out of the epithelial lining, keep the passage patent and drainage of pus, allowing the fistulous tract to gradually collapse and heal under the delivery system.
2. pH value of Ksharsutra towards alkaline side ; not allow rectal pathogens to invade the cavity.
3. Ksharsutra ligation exerts mechanical pressure along with chemical cauterization, in the initial three days there is cutting of the tract.
4. After the cutting the fistulous tract by Ksharsutra in initial days the follow up of 3-4 days is the wound healing time; cutting and healing of ICM tract per week is achieved.
5. As cutting and healing go simultaneously, there is no recess for accumulation of pus in the cavity.
1. The "Ksharsutra Therapy" technique is safe.
2. It is safe and simpler procedure in the application.
3. The therapy dose not requires long time hospitalization for more than 3 to 4 hours, some cases require 1 to 2 days.
4. In the major cases the patient requires 2 days bed rest and can resume his/her daily routine within 6 to 7 days.
5. Local Anesthesia or Spinal Anesthesia is needed.
6. The Cost of this Therapy is comparatively cheaper.
7. The rate of success of Ksharsutra Therapy is 99.05%.
Some photo copies about anal-fistula & piles which is treated by Ksharsutra Therapy with its case history.
It has been found in the past that all cases fistula-in-ano are the subjects for Ksharsutra therapy; however, there are some cases that apparently look like fistula-in-ano but on investigation they are found to be something else. Without proper investigation any amount of Ksharsutra application is not going to cure the cases. On the other hand, it will only bring the bad name to this therapy. Therefore the practitioners are warned not to make injudicious use of Ksharsutra Therapy. All doubtful cases should be properly investigated before subjecting them to ksharsutra treatment
1) Treatment by Ksharsutra Therapy.
2) Training of Ksharsutra Therapy and preparation of Ksharsutra.
3) Available guest house for patient's party.