INDEX

NO. TOPIC PAGE.

01. INTRODUCTION 03
02. PROPERTIES OF KSHARA 04
03. CLASSIFICATION 06
04. PURVA KARMA 10
05. PRADHAN KARMA 12
06. PASCHAT KARMA 13
07. RESERCH WORK 15
08. ABSTRACT 15
09. KSHARA SUTRA 16

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 Kshar karma

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 INTRODUCTION

Kshara is considered superior to all the shastra karma (surgical measures) and anu-shastra karma (para-surgical measures) because Ksharasor alkalis perform the work of
incision, puncture,andscarification soastorelieve thederangementsof Tridosha. Theyuniformly affect the diseased part or parts to which they are applied.

Ksharais a caustic,alkaline in nature obtained fromthe ashesof medicinal plants. It is a milder procedure compared to surgery and thermal cautery. It is the superior most among
the sharp and subsidiary instruments because of performing excision, incision and scraping.

It is versatile, because even such places that are difficult in approach by ordinary measures can be treated by Kshara Karma. Kshara Karma is useful as the substitute of
surgical instruments, because they can be used safely on the patients who are afraid of surgery.

शस्त्रानुशस्तेभ्यः क्षारः प्रधानतमः छे द्यभेद्यलेख्यकरणात्रिदोषनत्यात्रिशेषत्रियावचारणाच्च ॥(SU.SU.11/3)

Caustic alkali is the superiormost among the sharp and subsidiary instruments because of performing excision, incision and scarification; alleviating three dosas and being
used for specific functions.

Among the parasurgicalmeasures,all the three-agni(cauterization), kshara(causticalkali) and jalauka(leeches) are important and that is why separate chapters are earmarked
for them, however, amongst the three,jalauka is important, agni is more important andkṣharais themost important one. How the statement 'agni is superior to kshara' is not
contradictory would be explained there itself.

Operations excision, incision etc. cannot be performed by agni and jalaukā, thus kṣharais the chief of all; ksharaalleviates three dosasasit is composed of various substances. It
is also applied for specific purpose such as in piles caused by pitta.

त्रत क्षरणात् क्षणनात्रााा क्षारः ॥(SU.SU.11/4)

Kshara is so called as it moves down or produces injury.

Ksaranat - by carrying down (disintegrating) the vitiated skin, muscle etc.; others take it as causingdosas to move; ksananat-byproducing injury in skin, muscle etc. Some read
'kṣapanat in place of 'kṣaranat, interpreting as decreasing or evacuating.

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 PROPERTIESOFKSHARA

ACC TO SUSHRUTA:

नानौषिधसमवापाल्लिदोषघ्नः शुक्लत्वात् सौम्यः , तस्य सौम्यस्यािप सतो दहनपचन दारणािदशल्लिरिवरुद्धा, आग्नेयौषिधगुणभूियष्ठत्वात् कटु क उष्णास्तीक्ष्णः पाचनो िवलयनः
शोधनो रोपण शोषणः स्तम्भनी लेखनः कम्यामकफकु ष्ठिवषमेदसामुपहन्ता पुाुास्वस्प चितसेिवतः ॥(su.su.11/5)

It alleviates three dosas as it contains combination of several drugs, due to whiteness it is predominant in soma (watery principle), inspite of that its potency forburning,
digestion (and ofsuppuration), tearingetc.isnot antagoniseddue topredominance ofthe properties of igneous drugs; it is pungent, hot, sharp, digestive (and suppurative),
dissolving, cleansing, healing, drying, checking, sliming: destroysworms, ama,kapha, skin diseases,poisons and fatandalso virility by excessive use.

As kṣharacontains combination of various drugs, it alleviates three dosas andas suchis useful in paittika piles too. Some take 'api understood after saumyahand interpret that
it is not only usna (hot) but saumya also, thus there is no contradiction with hotness stated further. Potency for burning, digestion (or suppuration) and tearing is not antagonised
like severely cold ice; pacanah-both types of caustic alkali applied externally and internally act as pacana,the former as suppurative in case of inflammation and the latter as
digestive in case of indigestion; vilayanah-dissolves swelling causedpredominantly byvataandkapha; Sodhanah-cleansing for dirty wounds: ropanah- healing for clean wounds,
because of the specific action of compound formulations; like paste of sesamumandbarley, cleansing and healing actions of caustic alkali do not contradict each other; others
say that caustic alkali only cleanses and when wound is cleansed, it heals up naturally by itself; no caustic alkali is applied to the clean wound for healing because of the risk
of injury to blood vessels etc., thus the healing action is indirect.

Others, however, do not read 'ropanah: Sosanah-drying of the discharge from wound: stambhanah-checking of excessive haemorrhage: caustic alkali, in two forms, is applied
in wounds external as well as internal; amah immature rasa; in case of medas (fat) intake is applicable: pumstvam-semen (virility).

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ACC TO ACHARYA VAGBHATA:

न अित तीक्ष्णः मृदुः शलक्ष्णः िपल्लितः शीघ्रगः िसतः । िशखरी

सुख िनवााप्यो न िवष्यन्दी न च अित रुक । क्षारौ दश गुणः शस्त्र
तेजसौः अिप कमा कृ त् । आचूषन् इव सुरम्भात् गात्राम्
आपीडयन]। सवातो अनुसरन् दोषान् उन्मूलपितमूलतः ॥ कमा
कृ त्वा गत रुजः स्वयम् एव उपशाम्यित ॥ (अह सू.३०/२४-२६)

Na ati teekshna - not too strong.

Na ati mrudu not too mild.
Shlakshna – smooth.
Pichchila slimy.
Sheeghraga spreads quickly.
Sita white in colour.
Shikhari - remaining like a mountain peak at the site of application.
Sukha nirvapya - easily removable. Vishyandi - doesn't
produce much exudation or moistness.
Na ati ruk- doesn’t cause much pain.

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 CLASSIFICATION
KSHARA

PRATISARANIYA PANIYA

सिद्धिवधः प्रितसारणीयः , पानीयश्च ॥(su.su.11/6)

It is of two types - pastable and ingestible.

Paniyah (ingestible)-in form of liquid (kṣharodaka), other alkalis like sarjika, vida and yavakshara mentioned in the context of different diseases should be used in form of powder,
pills,

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Indication of pratisaran kshara :

त्रत प्रितसारणीयः कु ष्ठिकिटभदद्रुमण्डलिकलास भगन्दरार् ाु ाादार्थोदु ष्टव्रणनाडी

चमाकीतितलकालकल्लिव्यङ्गमशकर् ााह्यिवद्रिधकृ िमिवषािदषूपिदश्यते सप्तसु च
मुखरोगेषूपित्रजािचिजह्वोपकु शदनावैदभेषु ितसृषु च रोिहणीषु
एतेष्वेवानुशस्त्रप्रिणधानमुत्राम् ॥(su.su.11/7)

The pastable one is applied externally in cases of kustha, kitibha, patch of ring worm, kilasa (vitiligo), fistula-in-ano, tumour, piles, dirty wounds, sinus, warts, moles, pimples,
freckles, elevated moles,
external abscess, worms and poisons and also in seven diseases of mouth such as upajihva, adhijihva, upakusa, dantavaidarbha and three types of rohini. These are also fit for
the application of instruments.
Kitibha is a type of kustha but its separate mention indicates positive amenability to pastable alkali; kilasa-shvitra (vitiligo) located in skin; carmakila-described under nidana
of piles; nyaccha and
vyanga-mentioned under minor disease; "bahya is related to each vidradhi, krmi and viṣa; adi after visa includes valmika etc. others read 'bahyakṛmiviseṣadiṣu. Only three
types of rohini are amenable to treatment, the other two, sannipataja and raktaja, are incurable.
Anusastram-here the caustic alkali itself; some read as 'etesvanusastranipätanam.
INDICATION OF PANIYA KSHARA:

पानीपस्तु गरगुल्मोदरािग्नसङ्गाजीणाारोचकानाहशका राश्मयााभ्यन्तरिवद्रिधकृ िमिवषाशु सू- पयुज्यते ॥(su.su.11/8)

The ingestible one is used internally in cases of artificial poison, abdominal Jump, abdominal enlargement, loss of digestive fire, indigestion, anorexia, hardness of bowels,
gravels, calculus, internal abscess, wounds, poisons and piles.

Garah-artificial poison, others take it as dushivisha (chronic poison), agnisangah- the diseases in which digestive power is lost such as grahani (caused by vata and kapha),
visucikā, alasaka, vilambikä etc.

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CONTRAINDICATION:

अिहतस्तु ररिपत्तज्वररतिपत्तप्रकृ ितर् ाालवृद्धदु र्ाालभ्रममदमूत्राााितिमरपरीतेभ्योऽिेभ्यश्चैवु िवधेभ्यः ||(su.su.11/9)

It is unwholesome for those suffering from intrinsic haemorrhage, fever, paittika constitution, children, old people, debilitated and those afflicted with giddiness,
narcosis, fainting, defects of vision and similar other disorders.

अर्थथ नेते क्षारकृ त्या- तद्यर्थाथ दु र्ाालर् ाालस्र्र्थिवर भीरुसवााङ्गशूनोदररररिपित्तगिभाण्पत्त-मतीप्रद्धज्वरर प्रमेिहरू क्षक्षत क्षीणतृष्णामूत्रााापद्रतक्लीर् ाापवृत्तोवृत्तफलयोनयः ाु
॥(SU.SU.11/30)
The following should not be treated with caustic alkali-debilitated, child, old, timid, one suffering from general anasarca, abdominal enlargement, intrinsic
haemorrhage; the woman pregnant and in seasoned period, patient of advanced fever and prameha, rough, debilitated with chest-wound, complicated
with thirst and fainting, impotent and having displaced testicles and uterus upwards or downwards.

तर्थाथ ममािसरास्रायुसल्लितरुणािस्र्र्थसेवनीधमनीगलनािभनखान्तः शेफः रोतः स्वल्पमााु ासेषु च दे शेष्वक्ष्णीच न दद्यादल्लि वमारोगात् ॥ (AS.SU.39/3)
Moreover, caustic alkali should not be applied to vital spots, blood vessels ligaments, joints, cartilages, sutures, dhamani, throat, nail-bed, penis, passages, thinly
muscled parts and eyes except diseases of lid.

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 KSHARA KARMA

KSHARA
KARMA

POORVA PRADHANA PASCHAT

KARMA KARMA KARMA

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 Purva karma :
PREPARATION OF KSHARA

One intending to prepare Kshara should purify himself keeping fast and should approach, in autumn on auspicious day.
Rituals : Before preparation of Kshara, Mangalacharana (holistic and devotional rituals) shall be conducted.
The big black (flowered) muskaka tree-middle-aged, grown on auspicious land on the hill top and undamaged-mangalcharana is conducted by reciting the
shlok. Next day the plant is cut and made into small pieces and arranged in a heap in windless place, then (mixing with lime gravel) is ignited with stalks of
sesamum.
When the fire is extinguished, the ash along with ash gravels should be collected.
Then ash 10.24 kg. should be dissolved in water 61.44 litres or urines as prescribed and after decanting twenty one times should be cooked in a big pan stirring
slowly with a laddle.
When it becomes clear, red, sharp and slimy it should be strained through a large piece of cloth and again put on fire isolating the refuse (solid portion) from this
alkaline water, a portion weighing 160 or 240 ml. should be taken out.

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FOR MODERATE DEGREE KSHARA

Then gravels of lime and ash, oyster-shell and core of conch-shell, after heating red, should be macerated in the iron pan with the same alkaline water and pounded and along
with the same eight palas each of the core of conch-shell etc, should be put in two dronas (20.48 litres) of the liquid and cooked carefully constantly stirring till it becomes
neither too thick nor too thin.
When it is well cooked it should be brought down and preserved in an iron vessel keeping its
mouth closed. This is the moderate type.

FOR TIKSHNA KSHARA

For further addition, danti,dravanti, citraka, langali, putika leaves, talapatri, vida, suvarcika, svarṇakṣiri, hingu, vaca, and ativisa should be used as available, finely powdered,
in equal quantity weighing one sukti (20 gm). This cooked with further addition is strong known as 'Palkya'.

PRADHANA KARMA
तुत्रा क्षारसाध्यव्यािधिािधतमुपवेश्य िनवातातपे दे शेऽमुर् ााधेोपहरणीयोतेन िवधाने नोपसुभूतसुभार, ततोऽस्य तमप्रकाशु िनरीश्याज्पुष्यािलरुम त्रप्रिपत्ता, शलाकया क्षार
प्रितमारयेत्, दच्या वासातमात्रामुपेक्षेत ॥(SU.SU.11/20)
The patient to be treated by caustic alkali should be made to sit in a spacious place free from wind and the sun while all the requisite equipment’s should be arranged as
mentioned in the chapter on prior arrangeable; then after locating the spot it should be rubbed, scraped and scarified and the caustic alkali should be applied thereon with a
rod waiting thereafter till one hundred short letters are pronounced (seconds).

तल्लित्रिपितते आधी कृ ष्णता दधलक्षणम् ।।(SU.SU.11/21)

On application the diseased portion disintegrates and the spot becomes black- this is the sign of well burnt.

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 PASCHAT KARMA
त्रताम्लवगाः शमनः सिपामाधुकसुयतु
ाः ॥
अचेत् िस्र्र्थरमूलत्वात् शारदााु ा
शीयाते ॥ रमाले त्रत समभवचारयेत्॥
अम्लकािजजकमीजािन ितलान् मपुकमेव च ।।
उपेश्य समभागािन तेनेनमनुलेपवेत् ॥(SU.SU.11/21-
23)
There pacifying measure should be applied such as group of sours and ghee mixed with madhuka. If due to firm rooting the part does not disintegrate on burning with caustic
alkali the following paste should be applied thereon fully-yeast of the sour gruel, sesamum seeds and madhuka-all pounded together in equal quantity. Amlavargah group of
sours such as different types of sour gruel.

REASONING OF USE OF AMLA DRAVYA:

रसेनाम्लेन तीक्ष्णेन वीयोष्णेन च योिजतः ॥

आग्नेयेनािग्नना तुल्यः कर्थुुं क्षारः प्रशाम्यित ॥

एवु चेन्मिसे वत्स! प्रोच्यमानु िनर् ाोध मे ॥

अम्लवजाान् रसान् क्षारे सवाानेव िवभावयेत्
।। कटु कल्लस्त भूियष्ठो लवणोऽनुरसस्तर्थाथ ॥

अम्लेन सह सुयुत्रााः स तीक्ष्णलवणो रसे ॥

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माधुय भजतेऽत्यर्थुं तीक्ष्णभावु िवमुञ्चित ।।
माधुयाात्राममाप्नोित वत्रिरल्लिररवाप्लुतः ॥ (SU.SU.11/25-
27)
Amla rasa (sour taste) is sharp, with hot potency and of igneous nature then how caustic alkali, similar to fire, gets pacified by same. In caustic alkali, there are all the rasas
except sour, pungent being dominant and saline as subsidiary; when it comes in contact with sour, the sharp and saline gets neutralized and sheds of the sharpness, thus by
neutralization it gets pacified like fire poured on with water.

Caustic alkali possesses five rasas (except sour) amongst which pungent is subsidiary and salty predominant; some take pungent as predominant but this is not correct as the
people use only salty substance for neutralising excessive sourness, moreover, kṣhara is included in the group of salts and not in of pungents. The mention of the pungent
quality somewhere is only formal (indicating its subsidiary nature).
SAMYAKA LAKSHANA OF DAGDHA:

त्रत सम्यम्दम्ये िवकारोपरानो लापवमनार्थाथय ॥(SU.SU.11/28)

In proper burning, the disease is alleviated, lightness appears and discharge is stopped.

HINA AND ATI DAGDHA LAKSHANA:

हीनदग्धे तोदकण्डू वाड्यािन व्यिधवृिद्ध ॥

अितवधे दाहपाकराणधानािनभरा ण वा ॥ (SU.SU.11/28)
In deficient burning, there are pricking pain, itching, stiffness and aggravation of the disorder. In excessive burning, there are burning sensation, suppuration, redness,
discharge, body-ache, exhaustion, thirst, fainting or even death.

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RESEARCH WORK

Management of internal hemorrhoids by Kshara karma: An educational case report.

AUTHOR: Anita Mahapatra, A. Srinivasan, R. Sujithra, and Ramesh P. Bhat

ABSTRACT

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing
pile mass during defecation and bleeding while passing stool. The case was diagnosed as “Raktarsha” - 11 & 7 ‘o’ clock position II degree internal hemorrhoids, deeply
situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to
internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No
complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence
of recurrence of the hemorrhoids.

A CRITICAL REVIEW ON HISTORICAL ASPECTS OF KSHARA

Author : Shruti Pandey, Vinamra Sharma , Anand Kumar Chaudhary

ABSTRACT

Various natural products are processed and used as medicine in Ayurveda system of medicine. These medicinal products are classified in different categories of dosage forms
in Ayurvedic Pharmaceuticals. Kshara Kalpana (alkaline preparation) is one of them. Kshara are the substances obtained from the ashes of drugs of animals (conch shells,
Cypraea moneta,coral etc.), minerals (borax, salt petre, mixture of potassium salts etc.) and plants (Mulaka; Raphenus sativus Linn., Snuhi; Euphorbia nerifolia Linn., Arka;
Calotropis gigantea Linn. etc.) origin, where alkaline portion is extracted from the ashes of these substances. Kshara Kalpana is the dosage form of alkaline substance, which
may be used as single, or compound, or mixture of many herbs, animal and mineral products. There is a wide range of description available about Kshara in many of
authoritative texts of Ayurveda. However, Acharya Sushruta, father of Indian Surgery, is the pioneer of Kshara Kalpana, as he introduced Kshara Kalpana in one of the specific
chapter. These alkaline preparations have many therapeutic usages and even proved to be effective in treating many disorders.
Applications of these preparations have replaced many surgical procedures too. The internal use of Kshara is advised in Mutrashmari (viz. renal calculi), external application
in Arshas (hemorrhoid piles) and in the form of Kshara Sutra (alkaline thread) in the treatment of Nadi Vrana (sinus), Bhagandhara (fistula in ano) etc.. Kshara is also aided
in the different pharmaceutical procedure like Shodhana (purification), Jarana (roasting) and Maran (incineration of metals and minerals)in various preparations of

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Rasaausadhies (metal and minerals formulations).The importance of Kshara in therapeutics as well as in pharmaceutical procedure inspired us to explore the historical uses
of Kshara and KsharaSutra in view to establish its importance as well to get its clues for future scopes.

KSHARA SUTRA

भािवत रजनी पूणाः स्नुिह क्षीरः पुनः पुनः । र् त्रानात् सदू व सूत्रा ल्लिनित अशी भगन्दरम् ।। (चकटत,
अशी अिधकार, भावप्रकाश, भैषज्यरत्नाविल)

The thread which is impregnated or smeared repeatedly by rajani churna (turmeric powder) and snuhi ksheera (latex of Euphorbia neriifolia) when tied will cut and eliminate
arsha (piles) and bhagandara (fistula) from their roots.
A thread should be smeared with a cloth should be dipped in sudha dugdha / snuhi ksheera (latex of Euphorbia neriifolia) mixed with haridraa churna (turmeric powder).
Later the thread should be dried in shade. This procedure should be repeated 7 times. This thread will be called Kshara Sutra. This is highly beneficial in rooting out
gudankura (piles) and bhagandara (fistula).
The thread smeared with snuhi ksheera (latex of Euphorbia neriifolia) or arka ksheera (latex of Calatropis gigantean) 3 times, should be dried in shade and after having applied
with kshara (alkali) should be used in the treatment of arsha (haemorrhoids) and bhagandara (fistula-in- ano).

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