KSHARA SUTRA THERAPY (MEDICATED CAUSTIC THREAD)

Introduction

Kshara Sutra therapy is a minimal invasive Ayurvedic Parasurgical procedure and time-tested Ayurvedic technique in the management of Anorectal disorders. It is a safe, sure and cost effective method of treatment for fistula-in-ano, haemorrhoids and other sinus diseases.

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

Preparation of Kshara Sutra

The Standard Kshara Sutra is prepared by 11 coatings of Snuhi latex (Euphorbia nerifolia), 7 coatings of Snuhi latex and Apamarga Kshara (Achyranthes aspera) and last 3 coatings of Snuhi latex and Haridra Churna (Curcuma longum). The pH of Apamarga Kshara Sutra is 9.72.

Indications – Fistula-in-ano, haemorrhoids, sentinel piles, pilonidal sinus, rectal or anal polyps, warts etc.

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 and probe is gently taken out through anal opening to outside along with a Kshara Sutra in the groove of the probe. 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.

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.

Application of Kshara Sutra in Haemorrhoids –

The patient is anaesthetized with local anesthesia. First pile mass holding with pile holding forceps and bring them out of the anal orifice, then give incision at mucocutaneous junction. Later slight pull exerted over the pile mass and transfixed by Kshara Sutra at the base. Ligated pile mass replaced inside the rectum and rectal pack with Yastimadhu taila or ghrita.

Mechanism of action of Kshara Sutra 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 Kshara Sutra in Pilonidal Sinus -

The patient is anaesthetized with local anesthesia and then a malleable probe with Kshara Sutra is passed through the external opening of the pilonidal sinus to the skin. 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 sinus tract.

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 and stricture.

References :

1. P. Hemantha Kumar and M. Sahu, Role of Aragvadhadi Sutra in the Management of Fistula-in-ano, Ancient Science of Life, 2000, Vol. XIX (3&4): 110-112. (ISSN 0257-7941).
2. Gopikrishna and P. Hemantha Kumar, Effect of Madhu Kshara Sutra in the management of Bhagandara (Fistula-in-ano), International Journal of Ayurvedic Medicine, 2013, Vol. 4(3), 237-241. (ISSN 0976-5921).
3. Mahesh Kumar ES, Hemantha Kumar P, A case discussion on effect of Palasha Kshara Sutra in the management of Bhagandara (Fistula-in-ano) with special reference to its Antimicrobial effect, International Journal of Ayurvedic Medicine, 2013, Vol. 4(3), 242-244. (ISSN 0976-5921) .
4. Yadav Vikas S, Rao Prasanna N, P Hemantha Kumar, Effect of Kadali Kshara Sutra in the management of Bhagandara (Fistula-in-ano), International Ayurvedic Medical Journal, Sep-Oct 2013, Vol. 1(5), 1-5. (ISSN 2320-5091)

The content of this module has been authored by Dr. P. Hemantha Kumar, Professor & Head PG Department of Shalya Tantra National Institute of Ayurveda, Jaipur, Rajasthan