1. KSHARA KARMA CAUSTIC THERAPY
Dr. P. Hemantha Kumar
Professor & HOD
PG Dept. of Shalya Tantra, NATIONAL INSTITUTE OF AYURVEDA
Rajasthan, INDIA

2. • Minimal Invasive Ayurvedic Parasurgical Procedure.
• Kshara - Caustic Chemical obtained from the ashes of medicinal plants.
• Excision, Incision & Curettage.
• Used safely on the patients who are afraid of surgery.
Kshara Karma/ Caustic Therapy
2

3. Preparation Of Kshara /Caustic Alkali
3

4. Prepared Kshara
PH value - 13.8
APAMARGA Achyranthes aspera
CHITRAKA –Plumbago zeylanica
SUKTI Oyster shell /Ostreaedulis

5. Dried Apamarga Plant (5 kg)
Burnt
500 gms of Apamarga Ash
Add 6 times of water (3 liters)
Filtered 21 times through cloth
To get clean and clear solution – Gomutra Varna (slight reddish)
Filtrate Solution was boiled and evaporated
Heating up to 2/3 remains
Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga filtrate solution
Continuous mild heating
Liquid evaporates to 1/3rd of its original quantity
Add 1/10th (5gms) of Chitraka Kalka
PRATISARANIYA TEEKSHANA KSHARA
5
Method Of Preparation Of Pratisaraneeya Teekshana Kshara

6.  Soft, spread out, deep rooted & elevated type of Arshas
 INTERNAL HAEMORRHOIDS
6
Indications Of Kshara In Arshas/ Haemorrhoids

7. Pre-operative
• Required instruments - Proctoscopes, Prepared Kshara, Lemon juice, Allis tissue
forceps, Artery forceps etc.
• Night prior to procedure, the patient is advised to have light diet afterwards nil
orally.
• Part preparation and enema 2 to 4 hours prior to procedure.
• Inj Tetanus Toxoid – I.M.
7
Application Of Kshara

8. Instruments
8

9. Patient is in lithotomy position
L. A. / S. A.
Part cleaned with aseptic solutions
Introduce the Arsho Yantra / Proctoscope
into the anus and assess pile masses
Pile mass should be scraped or rubbed
9
Operative

10. Kshara applied on internal piles
(1- 2 min)
Pile mass turns to the colour of Pakva
Jambhuphala (reddish black)
Pile mass washed with Lemon juice
Apply Yashtimadhu Ghrita
&
Arsho Yantra is removed
Rectal pack with Anu Taila or Mahanarayana Taila 10
Wait for hundred Matrakala

11. Post Operative
11
• Orally liquid diet after 4 to 6 hours
• Packing removed after 6 hours
• Sitz bath –Triphala Kwatha twice daily
• Triphala Guggulu – 2 TDS
• Gandaka Rasayana – 2 TDS
• Satsakara Churna – 5gms HS
• 10 ml Yastimadhu Taila per rectally twice daily

12. Figure No. 12 – Before application of KsharaFigure No. 12 – Before application of Kshara
Figure No. 13 – During application of KsharaFigure No. 13 – During application of Kshara
Figure No. 14 – After application of KsharaFigure No. 14 – After application of Kshara
BEFORE DURING
AFTER 12

13. PROBABLE MODE OF ACTION OF
KSHARA KARMA/CAUSTIC THERAPY IN ARSHAS
Coagulates protein in
Haemorrhoidal plexus
Cauterises pile mass
Disintegration of haemoglogin
Haem & globin
Blackish brown discharge
Decreases size of pile mass
Necrosis oftissue with obliteration of
Haemorrhoidal radicles
Necrosed tissue sloughed out
Fibrosis & scar formation
Obliteration of haemorrhoidal vein
Complete wound healing (21 days)
(5 -7 DAYS)

14. ADVANTAGES
• Simple procedure
• Mild postoperative pain
• No bleeding
• Minimum hospitalization
• No stricture formation (if correct procedure is
followed)
• Cost effective with encouraging results
• Kshara Karma - treating all the pile mass in one
sitting, reducing the total duration of treatment.

15. Complications
• Bleeding
• Pain
• Stricture formation
• Recurrence
Improper application of kshara in Piles leads to

16. 16
KSHARA KARMA
IN
FISTULA-IN-ANO

17. Parisravi Bhagandara - Intersphincteric Fistula
Fistulectomy + kshara karma

18. 18
Blind Internal Fistula-in-Ano - Kshara Karma

19. 19
Phk Technique
Low Anal Fistula - Kshara Karma

20. Bhagandara Pidika - I & D with Kshara Karma

21. Pilonidal Sinus – Excision with Kshara Karma

22. Gudabhramsha – Pratisaraneeya Kshara
108
rd
BEFORE DURING
AFTER ONE DAY AFTER 3 MONTHS

23. Hemantha Kumar Modified Sphincter meter

24. THANK YOU