Presented by -

Dr. Vikas Saroch

PG scholar

Dr.Shrinivas.M.Patil M.D. lecturer

Shri. B.M.K. Ayurved College,

Shahapur, BELGAUM.
State Karnataka.
 Introduction
Kshar sutra in ano rectal disorders has shown
miraculous effects and now it’s a Precious gem in the
crown of Shalya Tantra. We have very less references
regarding utility of Rasaaushadhis in shalya tantra infact
we can say both these disciplines never mingled in each
other. The Preparation of Khsar sutra using Rasa
Aushadhis like Gandhaka etc. may open a new path in
the treatment of ano rectal disorders, keeping this in
mind some experiments were tried and some positive
hopes were observed.
 Aims and Objectives
• Preparation Of Rasashastriya Kshara Sutra

• Physicochemical analysis of prepared

Kshara Sutra

• Clinical studies on Prepared Kshara Sutra

 Materials and Methods
• Compilation of literature available.
• Preparation of Kshara Sutra using
Rasaushadhis
• Physical and Chemical analysis of Prepared
Kshara Sutra
• Clinical Studies on Patients of Bhgandhara
( Fistula in Ano)
 Review of literature
• Compilation of literature on ingredients of
Kshara sutra available in various texts of
Rasashstra.
• Selection of Ingredients by observing their
qualities and rationality with respect to
healing of Ano Rectal fistula
 Ingredients
• Shudha Gandhaka
• ShudhaTankana
• Shudha Kankshi
• Madhu chisti
. Shudha Gandhaka- (Sulphur)
According to Bhavaprakasha
Nighantu Purvardha Shloka no . 111

- Jantukandu hara

According to Rasa Ratnasamuchhaya

- Kanduhara
- Vishahara
- Krimihara
. Shudha Tankana –(Borax)
–According to Rasa Tarangini
Taranga no. 23-

- Ushna, Teekshna, Sarak

- Vividha vrananashana
Shudha Kankshi –(Alum)
According to Rasa Tarangini
Taranga no. 11 –
- Ushna, Vishadoshahanti
- Kandutihara
- Vranaropana
- Vranaharini
 Madhu chisti –(Bees wax)
According to Bhavaprakash Nighantu
Purvardha – madhuvarga- shloka no.30
- Bhutaghna
- Vranaropana
Preparation of Kshara sutra
Ingredients Qnty.

1 Shudha Gandhaka- 30 g

2 Madhu Chisti- 30 g

3 ShudhaTankana- 20 g

4 Shudha Kankshi- 10 g

5 20 no. Surgical q.s.

cotton Thread-
• About 6 inches long pieces of Surgical cotton thread (No.
20) were used.

• Shudha Kankshi and Shudha Tankana were mixed well

and to it sufficient qnty. of 95% ethyl alcohol is added to
make a homogenous thin paste.
• This mixture is taken in a stainless steel bowl and all
pieces of thread are put in bowl. The threads are
moved well in bowl till they soak in it.

• This bowl is either kept in sun light or heated on mild

temperature at about 70 Degree Celsius ,By this all
alcohol get evaporated.
• The threads are then separated from each other. Due
to the coating of kankshi and tankana, the threads
appear stiff.

• In another stainless steel bowl, madhu chisti and

shuddha Gandhaka are melted together with
constant stirring.
• As soon as the mixture is melted, the threads coated
with kankshi and tankana are dipped in the molten
mixture for about 5 to 10 seconds and then taken
out. They are held in a straight position till they are
cooled and the mixture of madhu chisti and
gandhaka becomes solid again. All the thread are
coated in this manner and they are stored in a cool
and dry place.
 Physicochemical Analysis
• Organoleptic characters-
colour- yellowish brown coloured thread
touch - smooth
smell – Pungent foul smell

• pH of the thread coated with Sulphur,Bee wax,Alum and Borax -

8.89

• Total waxy material with Sulphur (Petroleum ether extractives) -

66.4554%

• Weight of single thread coated with alum + borax + Sulphur + Bees'

wax = 0.2609 g

• Weight of single thread without any coating = 0.0558 g

 Clinical Studies
• Clinical studies of the prepared kshar sutra are conducted
at K.L.E.S. Ayurvedic Hospital ,Belgaum.

• The trials are conducted only on 15 patients of

Bhagandara as a pilot studies and results are as follow
 Inclusive criteria Exclusive criteria

- Fistula in ano with multiple

– openings
Fistula in ano
- Patients with HIV Positive
with single opening

- Patients of Tuberculosis
 All the pre operative, operative and post operative
measures are conducted similar as in standard Kshar
sutra ligation.

Patients are called for follow up after every 7 days for change
of thread.
Out of 15 patients for first follow up

• 9 patients showed decreased purulent discharge and

inflammation.

• 4 patients showed decreased purulent discharge but

inflammation was still there.

• 2 patients showed no significant change in the complaints.

 - When same patients were followed
up for 3rd thread change, they showed
significant cutting and healing action in
fistula with less granulated tissue

9 patients got healed in 4 thread changes.

4 patients got healed in 5 thread changes.
2 patients got healed in 6 thread changes.
Assessment of healing of fistula in ano was done on
following points.

• Reduction in purulent discharge and inflammation.

• Reduction in length between anterior opening of fistula

and anal orifice.

• Cutting (anterior wall of fistula) and Healing (posterior wall

of fistula) action.

• Number of threads required for healing.

 Conclusion
• As we know in practice we are using Kshar sutra
containing Aushadhis like Snuhi Ksheera, Apamarga
Kshar and Haridra. Though this Standard Kshar sutra
gives good results in the ano rectal disorders like fistula in
ano i.e. Bhagandara, It is quite tedious job to prepare it. Its
most complicated part is the availability of Snuhi in
surrounding vicinity. And collection of Snuhi Ksheera. Also
Above mentioned Kshar sutra using Madhu Chisti,
Gandhaka, Kankshi and Tankana are easy to prepare and
their properties as mentioned in literature are quite
acceptable for the cutting and healing action in
Bhagandara.
• Another advantage of this Kshar sutra is the shelf life
period, When it is preserved in cool place it will not loose
any of its ingredient’s efficacy as all ingredients can last
for long time.