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.