What is kshar sutra - www.ksharsutraallahabad.com

Ksharsutra is a medicated thread (chemical seton) prepared by using plant based ingredient. The active ingredients are coated repeatedly on surgical linen (barbour) thread no. 20 so that a required amount of drug gets adhered on the thread to achieve therapeutic value. The thread, when applied judicially, helps in cutting, curetting, draining and healing of fistulous track.  Kshar sutra is an old age minimal surgical procedure described in Ayurveda for the treatment of sinus and fistula in ano but it was not in practice until it was re-established by Dr P S Shankaran and Pro. P J Deshpande in the department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Science at Banaras Hindu University, Varanasi, India. Subsequently, this treatment modality were further developed and popularized by the work of Pro. K S Sharma, Dr. S N Pathak, Pro. G C Prasad and others in the same department.

Ksharsutra nowadays prepared from the caustic material obtained from the  ashes of plants along with other ingredients like latex of snuhi (Euphorbia Nerifolia), resin of guggulu (Commiphora mukul) and haridra (Curcuma longa) powder etc. The preparation of ksharsutra has gone through many phases of development. Sushuta described the use of ksharsutra in the management of sinus diseases but so far, no description was available regarding its method of preparation. The initial details of ksharsutra preparation were given by Chakrapani in his text Chakradutta where the latex of snuhi and the powder of haridrawere smeared over the thread repeatedly and no kshar (caustic material) was used in this preparation. As the name ksharsutra itself suggests, kshar should also be one of the ingredients which was missing in the description of Chakradatta. Therefore, kshar was added subsequently in the preparation of ksharsutra at the Department of Shalya Tantra, BHU. Among the various types of higher yield of kshar from the pant. Surgical linen thread (barbour thread no. 20) is preferred because of its high tensile strength, absorption and adhering capacity and better knot security.

For preparation of ksharsutra, kshar (caustic material) is commonly obtained from ash of apamarga ( Achyranthes aspera). However ashases of other plants like kadli (Musa paradisiaca),  palash (Butea monosperma), nimba (Azadirachta indica), yava (Hordeum vulgare) etc. can also be used either alone or in combination for this purpose.

Various type of ksharsutra have been prepared and evaluated clinically in the department from time to time.

Kshar Sutra Preparation Method

One end of selected thread is tied into the fissure of side arm of the frame. The thread is wrapped into the fissure of both side arms. Thus it is spread horizontally on entire frame between fissures. Now, it is ready for smearing the latex. The fresh latex is collected from Euphorbia nerifolia. With the help of gauze piece soaked into latex entire length of thread is smeared. Pulp of thumb and index finger alone may be used for smearing. The complete natural sunlight of 30-60 minutes  then replaced into kshar sutra cabinet. The frame may be replaced into cabinet immediately after smearing and heat is provided from the side bulb of cabinet for 30-40 minutes, after that switch is off, to maintain the room temperature into the cabinet for one night. During dusty, windly and cloudy atmosphere the frame is not placed in sunlight but directly into the cabinet. Such 11 coating are applied for 11 days each one per day. In summer season where smeared threat dries within 4-6 hours, second coating may be applied on the same day. After 11 coating next 7 coating of latex and kshar powder are applied simultaneously. Unbounded dry, crust like particle ok kshar on the thread is brushed with piece of dry gauge to obtain the uniform thickness of thread after each coating.

After kshar coating last 3 coating are done with howder of Haldi for 3 days after smearing the thread with the latex. Daily brushing of kshar sutra continued till last coating is completed to have a smooth and uniform thickness of thread.

The order of coating is as follows:

Kshar sutra evaluated clinically in the department of Shalya Tantra, Institute of Medical Science, BHU Varanasi  

Kshar-sutra is a thread coated with medicinal plants parasurgical procedure of Ayurveda indicated best in the treatment of Piles, Fistula, Fissure, Sentinel piles/Tag, Pilo-nidal sinus, Rectal polyp, Papilla etc.