Kshara Sutra therapy is a minimal invasive Ayurvedic Parasurgical procedure and time-tested Ayurvedic technique in the management of Anorectal disorders. Here, Dr Suresh Negalaguli, tells us how this safe, sure and cost-effective method is applied in the treatment of fistula-in-ano, haemorrhoids and other sinus diseases.
Piles or Haemorrhoids are one of the most common disorders of the anusthat are seen to affect people above 30 years of age and also those leading sedentary lifestyles. Mostly, the affectedpeople seek medical support only once the disease becomes acute and intolerable as they are often shy to consult a doctor regarding this disease. Thus, the affected ends up in self-medication which are often failures.
Other anorectal disorders include abscess, fissure & fistula. Haemorrhoids or piles are nothing but engorged rectal veins, just like the varicose veins of the legs. As the rectum is the end part of the alimentary canal and opens at the anus these engorged veins directly come out from the anal orifice.
Initially, this may not start like a protrusion but instead as a bleeding during defecation. Later, they may merge out and go inside spontaneously. Still later, fingers may be required to push them inside and lastly it will be seen hanging outside without responding to the finger attempts. These stages are called as the first, second, third, &fourth degrees.Moreover, the enlarged specific vein maybe in the third, seven& eleven ‘o’clock positions. This vein may appear to be one among them or all together called as position of piles.
As far as the management is concerned medicinal, caustic burn, cautery burn & excision are to be advocated accordingly with reference to the degree of the disease.Piles, thus appear as a physiological change with anatomical variations in the anal canal. Hence, it requires a prompt repair manually apart from oral therapy. The ultimate treatment includes the management of removing engorged masses, i.e. the rectal veins.
The good old procedure for managing this disorder is nothing but the surgical repair called Hemorrhoidectomy. This requires a prolonged post operative care and relapses can happen occasionally. Considering the above complications, the most adopted procedure now-a-days consists of burning the mass rather than cutting them.
Ayurveda too has surgical procedures to piles, with reference to the gradations and ‘thridosha’ dominance. When pitta and kapha are more significant like in internal haemorrhoids a special burning procedure by medicated caustics called as “Prathisaraneeya Kshara” is ideal, whereas if vata and kapha dominance like in external piles “Cautery Burn” called as “Agnikarma “is required. Hence ultimately Kshara and Agni Karmas are carried out in general under spinal anaesthesia. This procedure is just 15 minutes long only.
Kshara Therapy aspects:-
Kshara is prepared systematically from the ash of Apamarga (Achyranthes Aspera), a herb which is prepared after filtering it 21 times. This is then boiled to which a paste of lime is added along with some corrosive herbal powders like Chitraka ( Plumbago Zylanica) langali (Gloroisa Superba) pravala(Coral ) etc. The final paste obtained is kept in a bottle and applied to the infected area. Under anaesthetic position, the rectal dilatation is done and all masses are to be made visible through a special windowed rectal speculum.
Now, the surrounding pile mass is covered with cotton and the Kshara is applied over the mass. This is retained as such for a minute (100 eye blinks) where it becomes blueberry coloured. It is then washed using lemon juice for neutralization.The tag like external pile masses are then cauterized and Narayanataila (medicated oil) is inserted in the affected area in the form of wick. This puts an end to the main procedure.
After about three weeks of care at home the wound is cured. Now, the person may carryout his/her normal routine.
Kshara Sutra application:-
Here, the pile masses are tied with medicated Ksharasuthra (caustic threads) under anaesthetic conditions. This is kept intact until the pile masses fall by means of necrosis. This is another alternative procedure and the results here maynot be as efficient as the Kshara Karma procedure. In Kshara Suthra procedure, the medicated caustic threads give extraordinary results and avoids recurrence and treats relapsed fistulae through fistulectomy.
However, the application of Kshara (caustic paste) is an ideal procedure where ever the growths are present especially in smooth surface like Tonsil , Nasal Polipsetc too. These give excellent results.Thermal cautery helps to burn out hard tissues like Sentinal Piles, Warts, Cracked Foot etc. This is highly experienced and practised by Ayurvedic Surgeons.
Dr Suresh Negalaguli
Professor & Surgeon
Former Principal & Dean
Alvas Ayurveda Medical College Moodbidri
Consultant inMangala Hospital