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“Ksharasutra Application in Pilonidal Sinus: A Minimally Invasive
Para-Surgical Management”
Dr. Archana
1
, Dr. Vikash Kaushik
2
1
Associate Professor in Shalya Tantra Dept. at Gaur Brahmin Ayurvedic Medical College and Hospital,
Brahmanwas, Rohtak, Haryana, India
2
Assistant professor at Kaumarbhritya Dept. at Gaur Brahmin Ayurvedic Medical College and Hospital,
Brahmanwas, Rohtak, Haryana, India
DOI: https://doi.org/10.51584/IJRIAS.2025.100900010
Received: 09 Sep 2025; Accepted: 15 Sep 2025; Published: 10 October 2025
ABSTRACT
A 30 year old man presented with pilonidal sinus on MRI reporting along with pain, itching and purulent
discharge from sacral region.The objective of this study is to evaluate the efficacy and safety of Ksharasutra
therapy in the management of Pilonidal Sinus (Nadi Vrana)with respect to wound healing time . recurrence rate
, postoperative complication and patient compliance.
Case Report
A 30 year old man came with complaints of purulent discharge ,pain and itching at sacral region in the O.P.D.
of Shalya Tantra. After taking detailed history from the patient,he was evaluated for the same and in physical
examination I found that there is a long tract of app. 8cm present on the tail bone of patient with multiple
external opening .Management was explained to the patient in details and after ensuring him consent was taken
for operate and operation was done by ensuring all aseptic condition .After that ksharasutra thread was
changed after every seven days for 95 days ,total 13 thread was changed in post-op management with sitz bath
and medications .Now patient recovered completely from the diseases and yet there is no report of recurrence
of the diseases.
Discussion
Pilonidal Sinus ,a common condition in the sacrococcygeal region, is characterized by chronic inflammation
and recurrent discharging sinus tract, often associated with hair and debris accumulation. Modern surgical
treatment like excision with primary closure or flap surgeries are associated with longer hospital stays ,high
recurrence rates, and postoperative complications like infection,pain delayed healing.In this context,
Ksharasutra , an Ayurvedic para-surgical intervention, offers a promising alternative for managing pilonidal
sinus effectively.
Conclusion
The study concludes that Ksharasutra therapy is a safe , effective and minimally invasive modality for the
management of Pilonidal Sinus (Nadi Vrana).The procedure is associated with low recurrence ,minimal
complications,faster recovery and better patient compliance.
INTRODUCTION
“Pilonidal sinus” is a chronic inflammatory condition typically located in the sacrococcygeal region, often
affecting young adults, particularly males. It presents with a discharging sinus tract, pain, and occasional
abscess formation, which significantly affects the quality of life. The condition is thought to be acquired due to
the penetration of loose hairs into the skin, leading to a foreign body reaction and subsequent sinus formation.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue IX September 2025
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Page 112
In modern medicine, treatment involves surgical excision with primary or secondary closure or flap surgeries.
However, these procedures are often associated with a high recurrence rate, delayed wound healing, risk of
infection, and prolonged hospitalization. Hence, there is a growing need for a minimally invasive, effective,
and patient-friendly treatment alternative.
In Ayurveda, Pilonidal sinus can be correlated with “Nadivrana”, a type of chronic sinus described in classical
texts. The “Ksharasutra therapy”, a well-established para-surgical technique mentioned in “Sushruta Samhita”,
has shown proven efficacy in managing various sinus conditions including Bhagandara (fistula-in-ano), Nadi
Vrana (sinuses), and Arsha (piles).Ksharasutra is a medicated thread prepared using Apāmārga Kshāra, Snuhi
(Euphorbia neriifolia) latex, and Haridra (Curcuma longa). Its triple action—cutting, curettage, and healing—
makes it a powerful tool in managing sinus tracts. It promotes controlled chemical cauterization of unhealthy
tissue, maintains proper drainage, prevents secondary infection, and induces healthy granulation tissue
formation.
This study aims to evaluate the clinical effectiveness of Ksharasutra therapy* in the management of pilonidal
sinus, assessing parameters such as healing time, recurrence, and patient outcomes, and to establish it as a
viable alternative to surgical intervention in selected cases.
Case Report :
A 30 year old man ,non-diabetic,non-smoker,no any systemic diseases yet, presented with complaints of pus
discharge ,pain and mild swelling and itching in the sacrococcygeal region for the past 3months.their is no
history of trauma, surgery or systemic illness.
Gen. examination :
Name :xyz
Age :30yrs
Sex:Male
Occupation :software department
Marital status :married
Address: Delhi
Vital signs :
Blood pressure :118/76mm of Hg
Pulse rate :76 beats /min.
Respiratory rate :15/min.
Temperature :98.4F
SpO2:98.9%
Dashvidha Pariksha :
Pariksha Observation
Prakriti Vata-Kapha dominant
Vikriti Kapha-vata vitiation at local site
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Sara Madhyama (medium quality tissues)
Samhanana Madhyama (moderate physique)
Pramana Madhyama (moderate body measurements)
Satmya Shakahari, accustomed to regular meals
Satva Madhyama (moderate mental strength)
Aahara Shakti Samyak (good appetite & digestion)
Vyayama Shakti Madhyama (moderate exercise capacity)
Vaya (Age) Yuva (Young adult)
Clinical findings :
On examination , it was found that multiple external opening with purulent discharge and surrounding
induration present in the natal cleft. Local tenderness and hair tuft were present. On probing, a single tract of
approximately 8cm was detected.
MRI findings:
A linear, hypointense sinus tract is noted in the midline sacrococcygeal region, extending from the skin surface
of the natal cleft to a depth of approximately 8.0 cm, with minimal lateral branching.
Diagnosis :
Based on clinical examination and MRI reports, the case was diagnosed as Pilonidal Sinus.In Ayurvedic terma
, it was correlated with “Nadivrana”.
Therapeutic Intervention :
Pre-operative :
Patient was admitted in the ward in the early morning by maintaining N.P.O.4HRS before operate, written
consent was taken ,xylocaine sensitivity test was done , as bowel of the patient is satisfactorily clear so enema
not given,part preparation was done .All vitals were checked and stable and now patient is shifted to O.T. for
procedure.
Operative :
By maintain all aseptic measures, cleaning and draping of the patient was done 2ml.xylocaine 2%with
adrenaline solution diluted with 3ml of N.S.was given at the operative site of patient.Wait for 1min for
anaesthetic effect of the drug and after 1min. the tract was explored using a malleable probe.After conforming
the complete tract Apamarg Ksharasutra was inserted through the sinus and tied at both ends.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
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On the day of procedure
On 92th day of post-op
Post-operative :
The patient was advised to follow proper local hygiene, sitz bath, with syringing of 2ml jatyadi tail every night
after taking sitz bath at night .oral medication includes tan. Triphala guggulu 2BD for 1mnth. The Ksharasutra
was changed weekly .
Assessment criteria :
Objective Criteria :
Parameter
Method of Assessment
Scoring/Observation
Pain
Visual Analog Scale (VAS) 0–10
0 = No pain, 10 = Severe pain
Discharge
Observation of quantity and type
None / Serous / Purulent / Blood-stained
Swelling/Induration
Palpation and measurement
Present / Absent (Size in cm if present)
Tenderness
Graded response on palpation
Absent / Mild / Moderate / Severe
Tract Length
Measured using probe at each visit
In cm (Measured weekly)
Wound Healing
Time
Days from Ksharasutra application to
complete healing
Recorded in days
Recurrence
Clinical follow-up after 3–6 months
Present / Absent
Ayurvedic Parameters
Ayurvedic Parameter
Assessment Basis
Observation
Vrana Shuddhi (Wound
cleansing)
Absence of slough, discharge, foul smell
Achieved / Not achieved
Ropana (Healing progress)
Healthy granulation tissue, epithelialization
Satisfactory / Delayed
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Vedana (Pain)
Based on Ayurvedic observation (e.g., Daha,
Toda)
Nirvedana / Alpavedana /
Tivra Vedana
Srava (Discharge)
Quantity and quality per classical description
Visra / Picchila / Raktasrava
Functional Parameters
Parameter
Assessment Method
Observation
Return to Routine Activities
Days post-procedure
Number of days taken
Hospital Stay
Recorded duration (usually nil)
OPD-based / Admitted (days)
Need for Analgesics/Antibiotics
Duration used
Days or total doses used
Patient-Reported Outcomes
Parameter
Tool
Observation
Patient Satisfaction
Feedback scale (1–5 or
Excellent/Good/Fair/Poor)
Subjective
Ease of Procedure Tolerance
Interview / questionnaire
Easy / Moderate / Difficult
Cosmetic Outcome
Patient feedback and photo
comparison
Acceptable / Scar present /
Hypertrophic scar
Duration of treatment :
The tract healed completely in 95 days /13 weeks . No sign of infection , pain or discomfort were noted during
treatment.
Outcomes and followup:
Wound Healing :complete healing observed in 95 days.
Complications:None reported.
Recurrence : No recurrence observed during last 6month followup.
Patient feed back :minimal pain, can continue his routine on the 3
rd
day of operate and patient have more than
5hours sitting work at their work place ,fully satisfied.
RESULT
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DISCUSSION
The results of this study demonstrate that Ksharasutra effectively promotes simultaneous cutting, drainage,
debridement, and healing of the sinus tract. The alkali content (Kshara) causes controlled cauterization of
unhealthy tissue, while the latex of Snuhi and Haridra provide anti-inflammatory and antibacterial actions,
enhancing wound healing. Weekly thread changes maintained steady progression of tract cutting and healing.
In this case, complete healing was achieved within 13 weeks with no postoperative complications or
recurrence during the 6-month follow-up. The procedure required no hospitalization or anesthesia, and the
patient was able to continue daily activities with minimal discomfort. These outcomes are consistent with other
clinical studies that affirm the high success rate and low recurrence of Ksharasutra therapy in similar cases.The
Ayurvedic principle of Shodhana (cleansing) and Ropana (healing) was successfully applied, and the treatment
reflected a balance of traditional knowledge and modern clinical application. Ksharasutra therapy addresses the
root pathology of pilonidal sinus without extensive tissue damage or surgical burden on the patient.
Like other operative management here in this case patient come back to their routine work on the very 3
rd
of
post-op period.in first 2 weeks discharge on sitz bath is thick and patient have slight pain on sitting because
patient continue{ sitting}their work of more than 5 hrs in their office but after that patient feels slight pain on
the time of thread change after 5min . he got relief after applying lignocaine jelly 2%over that site .This
healing time may become short if patient have not so much sitting work but patient fully satisfied because
according to patient pain was minimum and his work was not suffered due to this procedure..Now wound is
completely healed and yet no recurrence was noted since last 6mnth.of follow-up.
Role of Triphala guggule and Jatyadi taila :
Triphala Guggulu is a classical Ayurvedic formulation known for its anti-inflammatory, antimicrobial, wound-
healing, and detoxifying properties. It plays a supportive and adjunctive role in the management of pilonidal
sinus (Nadivrana), especially when used alongside Ksharasutra therapy or in the post-procedure healing phase.
Pharmacological Actions Relevant to Pilonidal Sinus:
Ingredient
Key Properties
Relevance to Pilonidal Sinus
Triphala (Haritaki,
Bibhitaki, Amalaki)
Tridosha balancing, anti-inflammatory,
antioxidant, wound-healing
Helps reduce local inflammation and
promotes tissue regeneration
Guggulu
(Commiphora mukul)
Lekhana (scraping), Shothahara (anti-
inflammatory), Ropana (wound healing),
antimicrobial
Aids in draining pus, reducing
fibrosis, and accelerating healing of
the sinus tract
Pippali (Piper
longum)
Deepana-Pachana (digestive stimulant),
bioenhancer
Improves bioavailability and supports
gut detox during infection
Shuddha Guggulu
Rasayana (rejuvenative), analgesic
Reduces chronic inflammation and
pain
Dose: 1–2 tablets (500 mg each), twice daily after meals with lukewarm water or as directed by an Ayurvedic
physician.In this study ,I have advisied 2tab. BD for 1month with lukewarm water.
Duration: Usually continued for 4–6 weeks, especially during or after Ksharasutra therapy.
Adjuvants: Can be combined with local application of Jatyadi Taila, Triphala Kashaya dhavana, or Sitz bath
with Panchavalkala decoction.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
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Jatyadi Taila, a classical Ayurvedic medicated oil, is widely used for Vrana Ropana (wound healing). In the
management of Pilonidal Sinus (Nadivrana), syringing with Jatyadi Taila plays an important local therapeutic
role, particularly in promoting cleansing, disinfection, granulation tissue formation, and faster healing.
Composition and Actions of Jatyadi Taila:
Ingredient
Key Properties
Action in Pilonidal Sinus
Jati (Jasminum officinale)
Vrana ropaka, anti-
inflammatory
Promotes wound healing and reduces local
inflammation
Neem (Azadirachta indica)
Antibacterial, anti-purulent
Prevents infection and supports tract
disinfection
Haridra (Curcuma longa)
Antiseptic, antioxidant
Aids in granulation and prevents oxidative
damage
Tila Taila (Sesame oil)
Snehana, deep tissue
penetration
Acts as the base oil to carry the herbs deep
into tissues
Manjistha, Daruharidra,
Patoladi dravyas
Anti-inflammatory, blood
purifier
Support faster tissue regeneration and
Shodhana (cleansing)
CONCLUSION
This case report demonstrates that Ksharasutra therapy, a classical Ayurvedic para-surgical procedure, is a safe,
effective, and minimally invasive modality for the management of Pilonidal Sinus (Nadivrana). The treatment
led to complete healing within 13 weeks, with no complications or recurrence during the 6-month follow-up
period.
The use of supportive therapies like Triphala Guggulu and syringing with Jatyadi Taila further enhanced
wound healing, reduced inflammation, and promoted early recovery. The procedure was performed entirely on
an OPD basis, ensuring patient convenience, minimal disruption to daily life, and cost-effectiveness.
This case supports the integration of Ayurvedic approaches like Ksharasutra in the management of chronic
sinus conditions and highlights their potential as viable alternatives to conventional surgical methods,
especially in recurrent or uncomplicated cases of pilonidal sinus.
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