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"Kshar Sutra" (क्षारसूत्र) is a sanskrit phrase in which Kshar (क्षार) refers to anything that is corrosive or caustic; while Sutr(सूत्र) means a yarn or thread. (The origin of the English word "Sew".) It is described in one of the most ancient medicine known to mankind that is - Ayurved, which originated and flourished in India. Ayurveda is still at its peak in India and gaining a great popularity worldwide.
The Ksharsutra was first mentioned by the "Father of Surgery" Sushruta in his text named SUSHRUT - SAMHITA for the treatment of Nadi Vrana(sinus), Bhagandara (fistula- in - ano), arbuda(excision of small benign tumour) etc..Although Brihattrayi- the chief three texts of Ayurveda mention the use of kshara sutra,there is no description of their preparation properly. It was Chakrapani Dutta in late eleventh century in his book Chakradatta ,first mentioned the method of preparation with a clear-cut indication of its use in bhagandara and arsha(haemorrhoid). In his book Chakradutta explains the method that by smearing a sutra (thread) repeatedly in the latex of snuhi() and haridra(turmeric) powder makes the kshara sutra. Later authors like Bhavamishra, Bhaisajyaratnavali etc. also mention the same method. But because of brevity of preparation and inadequate explanation of procedure of application, it lost its popularity among Ayurvedic surgeons. Later in Rasatarangini a better preparation procedure was introduced still the credit of making it practically in use goes to Late Prof. P.J.Deshpandey and his team headed by Dr. S R Gupta. They rediscovered and standardized this ksharasutra in the present era . The Dept. of Shalya- Shalakya, Faculty of Ayurveda, IMS, BHU should be credited for the abundant use and popularization of this technique.
Method of Preparation
The standared kshar sutra is prepared by repeated coatings of snuhi ksheera(latex of Euphorbia Nerrifolia), apamarg kshar(ash of Achyranthus aspera) and haridra powder over a surgical linen thread no. 20. This thread is spread throughout lengthwise in hangers. Each thread on the hanger is then smeared with snuhi latex with the help of gauze piece soaked in the latex. This wet hanger is transferred in kshar sutra cabinet. Same process is repeated next day. Eleven such coatings with snuhi ksheera alone should be accomplished. Twelfth coating is done by first smearing the thread with ksheera and in wet condition thread is passed through the apamarg kshar. It is again transfer into the cabinet for drying. This process is repeated till seven coatings of snuhi ksheer and apamarg kshar is achieved. Final three coating are completed with snuhi ksheera' and fine powder of turmeric in the same fashion. Thus twenty-one coatings over the thread are completed.,
Mode of Action
Kshar Sutra is now a popular treatment modality in India for the management of fistula in ano. Many Clinical trials have done all over in different institutes to evaluate the action. In countries like Srilanka and Japan also many clinical trial has already done and established its action. Precisely the action of Kshar sutra is thought to be due to its healing and cleansing effect according to Ayurveda. It can be suggested that due to the anti microbial action, and as a saton it allows the proper drainage of pus from the fistula, that leads to a proper healing. On the other hand the cutting effect of thread incises the skin gradually with out a surgical incision. Many studies cofirms that it is more effective in the way of reducing hospital stay and less infection than the conventional seton therapy.Researches suggests that it is having the cation of Excision, Scrapping, Draining Penetrating, Debridement , Sclerosing, Healing, it is Bactericidal and Bacteriostatic. It is a wonderful treatment procedure.
Types of Kshar Sutra
In the textual reference of Chakradatta and Rasatarangini we get only indication of the thread made up of Snuhi, apamarga and Turmeric. Susruta describes about many kind of Kshars like Karaveera, Palasa, Kadali etc. in Susruta Samhita. So many studies have already carried out with variations in the Kshara and the latex. The most remarkable are Guggulu Ksharasutra, Udumbara KS, Gomutra KS, Papaya KS, KS with Ficus carica latex etc.
References
- A hand book of Anorectal Disorders and their Ayurvedic Management, Dept. of Salyatantra, GAC, Tripunithura, Kerala
- A hand book of Anorectal Disoreders and their Ayurvedic Management, Dept. of Salyatantra , GAC, Tripunithura, Kerala
- Anal Fistula and KST, Pathak S.N., Chawkhamba Krishnadash Academy, Varanasi
- Shukla, N.K. Narang, R. Nair, N.G.K., Radhakrishna, S., Satyavati, G.V.: Multicentric randomized controlled clinical studies of Kshara-sootra in management of fistula-in-ano. Indi J. Med. Res. (B), 177-185, 1994
- Thakur abhiram at al , Kshara sutra therapy a new dimension, souvenir-Anusastra 2008, Dept. of Salyatantra, GAC, Tripunitura, Kerala
- Ghanekar BG , Susruta Samhita, Sutra sthana 11, ML Publication, New Delhi,1998
External links
- Kshar Sutra Preparation
- Anal Fistula Kshar Sutra Cure]