In these slides application of Ksharkarma, Ksharsutra , raktamokshan and agnikarma in Anorectal dieases like piles, Fissure, Fistula in ano and pilonidal sinus

2. ROLE OF ANUSHASTRA IN
ANORECTAL DISEASES
WITH SPECIAL REFERNCE TO
KSHARSUTRA, AGNIKARMA
AND RAKTAMOKSHANA
Dr.Monica Shrestha, BAMS
M.S. (Shalyatantra)
PhD (G.A.U)
Email: shresthamonica33@gmail.com

3. ANORECTAL DISEASES
• FISSURE IN ANO
• PILES
• FISTULA IN ANO & PERIANALABSCESS
• PILONIDAL SINUS

4. ANUSHASTRA
अनुशस्त्राणि तु त्वक्सारस्त्फटिककाच
कु रुववन्दजलौकोग्ननक्षारनखगोजी
शेफाललकाशाकपरकरीरबालाङ्गुलय
इतत ||

6. MANAGEMENT OF FISSURE IN ANO
•Parikartikā (fissure-in-ano), is a
disease whose description is available
in Caraka Saṃhitā, as a
complications of Pañcakarma.*
•Fissure-in-ano is a tear in the pectin
(below the dentate line of the anal
canal) caused by trauma from the
passage of hard stool.
*Pandey G. Charaka Samhita, Part-II, Sidhi Sthana 6/61-62. In: Agnivesa, editor. 5th ed. Varanasi: Chowkhambha Sanskrit Sansthan; 1997. p. 948

7. MANAGEMENT
FISSURE IN ANO
ACUTE FISSURE
Avgaha Sweda
Matrabasti,
Trifala Gugglu,
Rasayana Churna
Laxative
CHRONIC FISSURE
Agnikarma
Ksharsutra
Leech application

8. •Arṣha and its treatment has been
available in classics like Suśruta
Saṃhitā*and Caraka Saṃhitā.**
• Hemorrhoid cushions are part of
normal anatomy but become
pathological when swollen or
inflamed.
PILES
*Acharya JT. Sushruta Samhita, Reprint. Nidana Sthana, 2. In: Sushruta, editor. Varanasi: Chowkhambha Surabharati Prakashan; 1994. pp.
223–6.
** Pandeya G. Charaka Samhita, Part-II, Chikitsa Sthana, 14. In: Agnivesa, editor. 5th ed. Varanasi: Chowkhambha Sanskrit Sansthan; 1997. pp.
342–76.

9. •Treatment of hemorrhoids includes variety of
methods such as medical therapy, sclerotherapy
(injection of sclerosant agent in sub-mucous spaces
of hemorrhoids), rubber band ligation, infra-red
coagulation, cryo-surgery (using nitrous oxide gas)
and excisional hemorrhoidectomy,etc., according to
the nature and degree of pile mass, but these
procedures have their own limitations.

10. MANAGEMENTOFPILES
चतुवविधोऽशिसाां साधनोपायः |
तद्यथा- भेषजां क्षारोऽग्ननः शस्त्रलितत |
तर, अचचरकालजातान्यल्पदोषललङ्गोपद्रवाणि भेषजसा
ध्यातन,
िृदुप्रसृतावगाढान्युग्रितातन क्षारेि,
ककि शग्स्त्थरपृथुकटिनान्यग्ननना,
तनुिूलान्युग्रितातन क्लेदवग्न्त च शस्त्रेि |

11. FISTULA IN ANO
•Suśruta has elaborately described Bhagandara (fistula-
in-ano), its pathogenesis two stages of disease formation
as Bhagandara pīḍaka *(peri-anal abscess)
and Bhagandara (fistula-in-ano), along with remedial
surgical procedures.
•Fistula-in-ano implies a chronic granulating track
connecting two epithelial lined surfaces. This may be
cutaneous or mucosal.
.

12. Current surgical treatment methodologies for this
disease include: Fistulectomy, fistulotomy with
secondary healing, fistulectomy, followed by
immediate skin grafting, fistulectomy and primary
suturing, daestruction of fistula track by carbon
dioxide laser beam. Techniques like LIFT,VAAFT etc

13. Shataponaka Ushtragriva
Shambookaavarta
Parisravi
Unmargi Parikshepi
TYPES OF BHAGANDARA

14. Riju
Arsho- Bhaganadar

15. MANAGEMENT
BHAGANDARA TREATMENT
Shataponaka Chedana ( Excision) and Agnikarma
Ushtragreeva Chedana and Kshara Karma.
(Agnikarma is contra-indicated)
Parisravee Chedana, Kshara Karma and
Agnikarma.
Sannipataja Asadhya ( incurable)
Aagantuja Chedana, Shalyapanayaneeya Vidhi,
Agnikarma and Krimighna Chikitsa.

16. • So, from this description, it can be concluded that
Sushruta has recommended Chedana ( / Fistulectomy)
with cauterization for all the types of Bhagandara.
• Ksharsutra is not mentioned in the chapter of
Bhagandara Chikitsa.
• Ksharsutra application is mentioned in the Visarpa-
Naadee- Stanaroga Chikitsaadhyaya
• Kṣhārasūtra* first described in Suśruta Saṃhitā, later
by Cakrapāṇidatta (11CE).**

17. •In 1964, the conceptual basis for revival
of Kṣhārasūtra preparation was laid down by Dr. Shankaran and
Dr. Pathak under the guidance of Prof. Deshpande at Department
of Shalya-Shalakya, PGIIM, BHU, Varanasi.
•Kṣhārasūtra prepared with Barbour thread no. 20 thread coated
with latex of Snuhi (Euphorbia neriifolia), Haridrā (Curcuma
longa) powder and kṣāra made from the whole plant of Apāmārga
(Achyranthes aspera Linn., Amaranthaceae)
Acharya JT. Sushruta Samhita, Reprint. Chikitsa Sthana, 17/29-32. In: Sushruta, editor. Varanasi: Chowkhambha Surabharati Prakashan;
1994. p. 378.
17. Dwivedy R. Chakradatta, Reprint. Arsha Chikitsa 5/148. In: Chakrapanidatta, editor. Varanasi: Chowkhambha Sanskrit Bhavan; 2011.
p. 66.

18. PILONIDAL SINUS
•Pilonidal means a 'nest of hairs'.
•A sinus tract is a small abnormal channel (like a
narrow tunnel) in the body. The tract may discharge pus
from time to time onto the skin.
•It occurs under the skin between the buttocks (the natal
cleft) a short distance above the anus. The sinus track
goes in a vertical direction between the buttocks.
•Rarely, a pilonidal sinus occurs in other sites of the
body.

19. नाडीां तु शल्यप्रभवाां ववदायि
तनर्हित्य शल्यां प्रववशोध्य िागिि् |
सांशोधयेत् क्षौद्रघृतप्रगाढैग्स्त्तलैस्त्ततो रोपििाशु कु याित्
||२६||
कु म्भीकखजूिरकवपत्थबबल्ववनस्त्पतीनाां च शलािुवगगः |
कृ त्वा कषायां ववपचेत्तु तैलिावाप्य िुस्त्तासरलावप्रय
ङ्गूः ||२७||
सुगग्न्धकािोचरसाटिपुष्पां
रोध्रां ववदध्यादवप धातक ां च |
एतेन शल्यप्रभवा तु नाडी
रोिेद्रिो वा सुखिाशु चैव ||२८|| Su.Chi.17
MANAGEMENT

20. कृ शदुबिलभीरूिाां नाडी ििािचिता च या |
क्षारसूरेि ताां ग्रिन्द्यान्न तु शस्त्रेि बुद्चधिान ् ||२९||
एषण्या गततिग्न्वष्य क्षारसूरानुसाररिीि् |
सूचीां तनदध्याद्गत्यन्ते तथोन्नम्याशु तनििरेत ् ||३०||
सूरस्त्यान्तां सिानीय गाढां बन्धां सिाचरेत ् |
ततः क्षारबलां वीक्ष्य सूरिन्यत ् प्रवेशयेत ् ||३१||
क्षाराक्तां िततिान ् वैद्यो यावन्न तिद्यतेगततः |
भगन्दरेऽप्येष ववचधः कायो वैद्येन जानता ||३२||
अबुिदाटदषु चोग्त्क्षप्य िूले सूरां तनधापयेत ् |
सूचीलभयिववक्रालभराचचतान ् वा सिन्ततः |
िूले सूरेि बध्नीयाग्रिन्ने चोपचरेद्रिि् ||३३||
Su.chi.17
KSHARASUTRA

21. ROLE OF KSHARKARMA IN
ANORECTAL DISEASE
Ksharakarma also known as Caustic therapy: It is
basically application of Pratisarniya type of Kshara.
It is a minimal invasive procedure
It is obtained from plant ash
It has properties of excision , incision , cauterization
It also promotes healing

22. PREPARATION OF PRATISARNIYA
KSHARA

24. KSHARKARMA IN FISTULA IN ANO

25. KSHARKARMA IN PILONIDAL SINUS

26. KHARAKARMA IN PILES

27. MODE OF ACTION OF KSHARA

28. KSHARSUTRA IN PILES

29. KSHARSUTRA PREPARATION

30. KSHARSUTRA IN PILONIDAL
SINUS

31. KSHARSUTRA IN FISTULA IN ANO
31

32. KSHASUTRA IN CHRONIIC FISSURE
After Ksharsutra ligation After 15 days

33. Irritation
(Due to the Snuhi / Apamarga Kshara
↓
Inflammation
↓
Softness of tissues along with Necrosis
↓
Separation of tissue (Cutting)
↓
Healing simultaneously ( Due to Haridra )
MODE OF ACTION OF KSHARSUTRA

34. LEECH APPLICATION IN
THROMBOSED PILES

39. MY PhD THESIS
TITLE
“A Comparative Clinical Study of Fistulotomy
Along with Ksharkarma and Ksharsutra
Application in the Management of Bhagandara
(Fistula-in-Ano)”

40. In this clinical study, 106 patients were diagnosed with
Bhagandara (fistula-in-ano) were selected and randomly
allocated using computerised randomisation table into two
groups.
In Group-A (n=53) patients were treated by Fistulotomy
with Kshara application, while in Group-B (n=53) patients
were treated with Ksharsutra application under local
anesthesia or spinal anesthesia.
In both groups Varuna Shigru Guggulu vati, Panchvalkal
kwath for sitz bath and Jatayadi tail matrabasti were given. In
Group A, dressing was done with Kshar plota (gauze dipped
in Ksharjala) till the post operative wound had slough on it
(Dustavrana).
In Group B, the tract was flushed with Ksharjala every
day and Ksharsutra was changed by rail road method every
week till the Ksharsutra got cut through.

41. The effect of the therapies was assessed on the basis of relief
in subjective parameters (pain, discharge and itching) and
assessment of objective parameters i.e. Unit cutting time (length
of Ksharsutra) in Group B and Length of post operative wound
in Group A.
Follow-up was taken after 1 month of healing of post
operative wound. The observed results in the study were
calculated statistically to derive final conclusion.
102 out of 106 patients (53 patients in each group) of two
groups had completed the treatment and 4 patients dropped
out from study (One patient dropped out from Group A while
3 patients dropped out from Group B).

42. On the basis of observed results and vivid discussion
finally study concluded that both the intervention were
effective in the management of Bhagandara (fistula-in-ano)
clinically as well as statistically. On comparison of two
interventions Fistulotomy and Ksharkarma was better in
terms of less duration of wound healing and early
symptomatic relief as compared to Ksharsutra in the
management of low anal fistula.