KsharaKarma: A Comprehensive Review of Its Preparations and Therapeutic Efficacy

Kshara Karma: A Comprehensive Review of its Preparations and Therapeutic Efficacy

Dr Bishnupriya Mohanty¹, Sakharam Ulhas Thakur², Travis Enrique Paulino Rodrigues³, Sangram Keshari Das⁴

¹Department of Sanskrit Samhita and Siddhanta

^2,3,4Professor & Head, Dept. of Dravya Guna vijnana, Gomantak Ayurveda Mahavidyalaya & Research Centre,

DOI: https://dx.doi.org/10.47772/IJRISS.2025.90400298

Received: 18 April 2025; Accepted: 21 April 2025; Published: 12 May 2025

ABSTRACT

Ksharakarma is a cornerstone procedure in Ayurvedicparasurgical techniques, utilized effectively for treating a variety of surgical and non-surgical conditions, particularly in proctology. Derived from herbal alkalis, Kshara and its formulations such as Ksharasutra, Ksharavarti, and Ksharapicchu offer a minimally invasive, cost-effective, and highly efficient alternative to conventional surgical interventions. This paper explores the theoretical basis, classifications, preparation techniques, indications, contraindications, and clinical significance of Ksharakarma.

Keywords: Ksharakarma, Anushastrkarma, Parasurgical procedures.

INTRODUCTION

Ayurveda describes Shastra (surgical), Anushastra (Parasurgical), and Aushadha (medicinal) modalities for disease management. Among these, Ksharakarma stands out as an essential parasurgical technique, particularly highlighted by Acharya Sushruta. Kshara, a caustic alkali derived from plant ashes, is capable of Chedana (excision), Bhedana (incision), and Lekhana (scraping) properties. This method is especially effective in treating anorectal disorders like Arsha (piles), Bhagandara (fistula-in-ano), and NadiVrana (sinus).

Definition

Kshara is which destroys and removes the unhealthy, vitiated tissues or it torments the healthy tissues.

Classification of Kshara

Based on Acharya Sushruta, Kshara is classified into:

PratisaraniyaKshara (external application)

• Used in : Skin diseases , KitibhaKushtha , DadruKushtha , Mandala Kushthta , leucoderma , Bhagandara, tumors , Haemorrhoids , infected ulcers , sinus , skin warts , black marks , hyper pigmentation , moles , external abscess , megot infestation , mukharoga .

PaneeyaKshara (internal administration)

• Used in : Artificial poison , abdominal swelling , Udara , Agni sanga , Ajirna , Arochaka , Anaha , Ashmari  , urinary gravels , Krimi , Arsha.

Ksharasutra (alkaline-coated surgical thread)

• Used in : NadiVrana , Bhagandara.

Method of Preparation of Kshara

• On an auspicious day , during sharadrutu from an auspicious place .
• A moderate, disease free plant is taken.
• It should be chopped into pieces.
• Then dry completely.
• Make into a heap, along with a small quantity of suddhasharkara , in a place free of breeze.
• Using few things of dried Tila plant above heap is burnt .
• After complete burning, the greyish ash is collected.
• To this ash , 6 parts of water / or cows urine is added and stirred well .
• Filtered 21 times through a cloth .
• Clear filtrate is taken in an iron vessel and stirred well and constantly heated over mild fire .
• As the water content reduces , the solution becomes reddish and slimy .
• Heating is continued to finally obtain a clear white powder .
• Kshara is Ready .

Indications of Ksharakarma:

• Arsha (piles).
• Bhagandara (fistula-in-ano).
• NadiVrana (sinus).
• CharmaGranthi (sebaceous cysts).
• DustaVrana (chronic wounds).
• MamsaArbuda (benign tumors).
• Visha.

Method of Preparation of Kshara Sutra:

Thread selection: Linen thread (Barbour surgical No. 20) is chosen for its strength and flexibility.

Coating process:

•    Initial 11 coatings of Snuhi latex
•    Next 7 coatings with Snuhi latex mixed with ApamargaKshara
•    Final 3 coatings with Snuhi latex and Haridra (Curcuma longa)

Drying:Each layer is dried before applying the next.

Sterilization:The prepared thread is sterilized and stored in sterile glass tubes.

Method of Preparation of KsharaVarti:

• Preparation of Kshara paste: Obtained from the evaporation process of the Kshara solution.
• Shaping:The paste is molded into a small cylindrical shape like a suppository.
• Drying: These are sun-dried and stored in airtight containers.

Method of Preparation of Kshara Picchu

• Preparation of Kshara solution: A diluted form of the Kshara is prepared.
• Soaking:  A sterile gauze or cotton swab is soaked in Ksharaand dried .
• Then other round with Kshara andHaridra is applied and soaked.
• Application: It is then applied locally to ulcers or wounds.

Contraindications

• Acute inflammatory conditions.
•  Bleeding disorders.
•  Immuno-compromised patients.
•  Pregnancy and lactation (internal use).
•  Systemic infections and critical illness.
•  Elderly.
•  Children.
•  Debilitated person.
•  Raktapitta.
•  Prameha patient.
•  Fearful patient.
•  In places such as Marma, sira, Sandhi , Snayu , Tarunasthi , Dhamani , Gala , Nabhi, Swalpa Mamsa Pradesh.

DISCUSSION

Kshar has very good result in Arsha , Bhagandara and even in NadiVrana. Having good action in Arsha it is used for Pratisarana or as a Sutra where in it corrodes the pile mass causing coagulation and necrosis of Eventually the mass sloughs off and heals the base. It reduces blood flow due to vasoconstriction helping control bleeding.

In Bhagandara Kshara Sutra is threaded through fistulous tract. It gradually cuts through the tract while simultaneously cauterizing and healing it. The alkali cleanses the infected area and destroys unhealthy tissues and prevents re-infection. It encourages granulation tissue formation and eventually closure of the tract.

In Nadi Vrana it dissolves the unhealthy granulation tissue and facilitates the drainage of pus or debris and it heals by regeneration of healthy tissues.

Kshara Karma presents a unique integration of herbal pharmacology and surgical precision. It avoids major operative procedures, reduces hospital stay, and has fewer complications. The caustic nature of Kshara allows targeted tissue debridement, promoting healing while minimizing damage to healthy tissues. Modern clinical studies support its effectiveness, especially in proctological disorders.

CONCLUSION

Ksharakarma, as an Ayurvedic para-surgical modality, provides a holistic and practical solution for many surgical conditions. Its natural origin, minimal invasiveness, and proven efficacy make it a viable option in integrative medicine.

REFERENCES

1. Aacharya Sushrutha. Sushrutha Samhitha with the Nibanda Sangraha commentary of Sri Dalhanaacharya edited by Vaidya Yadavji Trikamji Acharya and Narayan Ram Acharya Kavytirtha.Varanasi: Chaukhambha Sanskrit Sansthan.; 2010.p.668.
2. Charaka Samhitha with Ayurvedadipika commentary. Chikitsasthana. Reprint edition. Varanasi: Chaukhambha Prakashan; 2013.p.634.
3. Monisha CJ, Narmada MG. A Study on the Effectiveness of Guggulu-Based Karaveera Ksharasutra in Managing Pilonidal Sinus. Journal of Ayurveda and Integrated Medical Sciences. 2020;8(3):101-110.
4. Srivastava P, Sahu M. Efficacy of Ksharasutra therapy in the management of fistula-in-ano. World Journal of Colorectal Surgery. 2010;2(1):6.
5. Rath SK, Barman PK, Medhi C. Preparation of Ksharasutra: A Comprehensive Study. Journal of Ayurveda and Integrated Medical Sciences. 2023;8(8):151-154.