Snuhi Ksheera and Haridra Ksharasutra: A Literature Review of Preparation, Pharmacology, and Clinical Efficacy in Anorectal Disorders-A Narrative Review

Background: Ksharasutra is an Ayurvedic para-surgical thread used mainly for Bhagandara (fistula-in-ano), Arsha (haemorrhoids), and pilonidal sinus. This review focuses specifically on two of its constituent drugs — Snuhi Ksheera (latex of Euphorbia neriifolia Linn.) and Haridra (Curcuma longa Linn.) — examining their preparation, pharmacological rationale, proposed mechanism of action, and the clinical evidence base. Methods: A narrative (non-systematic) review of peer-reviewed literature published between 1991 and 2026 was conducted across PubMed/MEDLINE, PMC, ScienceDirect, and Google Scholar. Twenty-three sources meeting relevance and reporting-quality criteria were included; methodological quality of the clinical studies was appraised narratively. Results: Snuhi latex acts chiefly as a binding medium with proteolytic and haemostatic properties, while Haridra contributes antiseptic, anti-inflammatory, and pro-granulation activity at the tissue interface. Comparative clinical studies suggest recurrence and continence outcomes at least comparable to, and in several small trials better than, conventional fistulotomy/fistulectomy, though the evidence is drawn largely from small, single-centre, unblinded studies with heterogeneous methodology. Conclusion: Snuhi Ksheera and Haridra provide a biologically plausible and clinically supported basis for Ksharasutra therapy, but stronger, standardised, multicentric trials are needed before firm efficacy claims can be made.

Ksharasutra; Snuhi Ksheera; Euphorbia neriifolia; Haridra; Curcuma longa; Bhagandara; fistula-in-ano

1. Indian Council of Medical Research. Multicentric randomized controlled clinical trial of Kshaarasootra (Ayurvedic medicated thread) in the management of fistula-in-ano. Indian J Med Res. 1991;94:177-185. PMID: 1937599. [Google Scholar] [Crossref]

2. Dutta G, Bain J, Ray AK, Dey S, Das N, Das B. Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano. J Nat Sci Biol Med. 2015;6(2):406-410. doi:10.4103/0976-9668.160022. PMID: 26283840. [Google Scholar] [Crossref]

3. Narasimha Rao KL, Lavanya KM, Nayak SR, Ashrith P. Ksharasutra vs. fistulectomy for fistula in ano - a randomized controlled trial in East Godavari district, Andhra Pradesh, India. MRIMS J Health Sci. 2018;6(2):79-82. doi:10.4103/2321-7006.303079. [Google Scholar] [Crossref]

4. Panigrahi HK, Rani R, Padhi MM, Lavekar GS. Clinical evaluation of Kshara sutra therapy in the management of Bhagandara (fistula-in-ano) - a prospective study. Anc Sci Life. 2009;28(3):29-35. PMID: 22557318. [Google Scholar] [Crossref]

5. Lobo SJ, Bhuyan C, Gupta SK, Dudhamal TS. A comparative clinical study of Snuhi Ksheera Sutra, Tilanala Kshara Sutra and Apamarga Kshara Sutra in Bhagandara (fistula in ano). Ayu. 2012;33(1):85-91. doi:10.4103/0974-8520.100319. PMID: 23049190. [Google Scholar] [Crossref]

6. Meena RK, Dudhamal T, Gupta SK, Mahanta V. Comparative clinical study of Guggulu-based Ksharasutra in Bhagandara (fistula-in-ano) with or without partial fistulectomy. Ayu. 2018;39(1):2-8. doi:10.4103/ayu.AYU_19_15. PMID: 30595627. [Google Scholar] [Crossref]

7. Nema A, Gupta SK, Dudhamal TS, Mahanta V. Transrectal ultrasonography based evidence of Ksharasutra therapy for fistula-in-ano - a case series. J Ayurveda Integr Med. 2017;8(2):113-121. doi:10.1016/j.jaim.2017.01.013. PMID: 28600166. [Google Scholar] [Crossref]

8. Radhakrishna S. Minimal invasive Kshara Sutra technique (MIKST) for the treatment of trans-sphincteric anal fistula - a single-centre retrospective study in India. [Retrospective observational study, n = 215]. 2024. [Google Scholar] [Crossref]

9. Sultana A, Hossain MJ, Kuddus MR, Rashid MA, Zahan MS, Mitra S, Roy A, Alam S, Sarker MMR, Naina Mohamed I. Ethnobotanical uses, phytochemistry, toxicology, and pharmacological properties of Euphorbia neriifolia Linn. against infectious diseases: a comprehensive review. Molecules. 2022;27(14):4374. doi:10.3390/molecules27144374. [Google Scholar] [Crossref]

10. Evaluation of haemostatic activity of latex from Euphorbiaceae species. J Ethnopharmacol / Fitoterapia. 2013 (in-vitro pharmacological study). [Google Scholar] [Crossref]

11. Characterization of a thermo- and detergent-stable antigenic glycosylated cysteine protease of Euphorbia nivulia Buch.-Ham. and evaluation of its ecofriendly applications. Enzyme Res. 2013. [Google Scholar] [Crossref]

12. Euphorbia neriifolia L.: review on botany, ethnomedicinal uses, phytochemistry and biological activities. J Tradit Complement Med. 2017. [Google Scholar] [Crossref]

13. Akbik D, Ghadiri M, Chrzanowski W, Rohanizadeh R. Curcumin as a wound healing agent. Life Sci. 2014;116(1):1-7. [Google Scholar] [Crossref]

14. Wound-healing effects of curcumin and its nanoformulations: a comprehensive review. Pharmaceutics. 2022;14(11):2288. [Google Scholar] [Crossref]

15. Curcumin-loaded drug delivery systems for acute and chronic wound management: a review. Pharmaceutics. 2025;17(8):860. [Google Scholar] [Crossref]

16. Negi PS, Jayaprakasha GK, Jagan Mohan Rao L, Sakariah KK. Antibacterial activity of turmeric oil: a byproduct from curcumin manufacture. J Agric Food Chem. 1999;47(10):4297-4300. [Google Scholar] [Crossref]

17. Sabale P, Bhimani B, Prajapati C, Sabale V. An overview of medicinal plants as wound healers. J Appl Pharm Sci. 2012;2(11):143-150. [Google Scholar] [Crossref]

18. Efficacy of Ksharasutra prepared through automated machine and manual process in fistula-in-ano: a study protocol for a double-blind, randomized controlled trial. 2022. [Google Scholar] [Crossref]

19. Effective Ayurvedic treatment of pilonidal sinus using latex-based medicated thread: a case study. J Pharm Bioallied Sci. 2024;16(Suppl 4):S3625-S3627. [Google Scholar] [Crossref]

20. Efficacy of Kshara sutra made from papaya and Snuhi latex in the treatment of fistula-in-ano. PMID: 22556882. [Google Scholar] [Crossref]

21. Gupta ML, Gupta SK, Bhuyan C. Comparative clinical evaluation of Kshara Sutra ligation and haemorrhoidectomy in Arsha (haemorrhoids). Ayu. 2011;32(2):225-229. doi:10.4103/0974-8520.92591. [Google Scholar] [Crossref]

22. Sushruta Samhita, Sutrasthana, Chapter 33 (K.R. Srikantha Murthy, trans.), Vol. II. Varanasi: Chaukhamba Orientalia; 2001. [Google Scholar] [Crossref]

23. Chakradatta (Chakrapanidatta), Bhagandara Chikitsa Adhyaya (P.V. Sharma, trans.). Varanasi: Chaukhambha Orientalia; 1994. [Google Scholar] [Crossref]

• Assessment of the Role of Artificial Intelligence in Repositioning TVET for Economic Development in Nigeria
• Teachers’ Use of Assure Model Instructional Design on Learners’ Problem Solving Efficacy in Secondary Schools in Bungoma County, Kenya
• “E-Booksan Ang Kaalaman”: Development, Validation, and Utilization of Electronic Book in Academic Performance of Grade 9 Students in Social Studies
• Analyzing EFL University Students’ Academic Speaking Skills Through Self-Recorded Video Presentation
• Major Findings of The Study on Total Quality Management in Teachers’ Education Institutions (TEIs) In Assam – An Evaluative Study