Kshara is a caustic, alkaline in nature obtained from the ashes of 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.
The Panchanga (whole plant) of Apamarga (Achyranthes aspera) 5 kgs should be collected, dried up and burnt. The whole ash 500 gms were collected and mixed with 6 times (approx 3 liters) of water and filtered 21 times. The filtrate is clean and clear like color of cow’s urine and it is kept on mild fire and liquid evaporates to 1/3rd of its original quantity. This is known as Mridu or mild concentrate Kshara. Then add 50 gms of red hot Shukti (Limestone) to the filtrate solution and continuously stirred well until it evaporates to 1/3rd of its original quantity. This is known as Madhyama or moderate Kshara. This should be further heated up by adding 5 gms of Chitraka Kalka (Plumbago gelanica). With this thick solution is obtained which is known as Pratisaraneeya Teekshana or highly concentrate Kshara. It will be collected and stored in air tight container.
Microscopy features of prepared Apamarga Pratisaraneeya Teekshana Kshara –
It has revealed fibrous / sclereidal tissues and polygonal crystals of different sizes. Loss on drying of Kshara paste after decanting the supernatant liquid, total ash and acid insoluble ash of Kshara powder free from moisture and pH of the supernatant liquid is 13.3
Application of Pratisaraneeya Teekshana Kshara in Internal haemorrhoids -
The patient is anaesthetized with local or spinal anesthesia, lubricated slit proctoscope is to be introduced into the anus and Kshara applied over the internal pile mass and wait for 2 minutes or until the pile mass turns to the color of Reddish black (Pakwa Jambu Phala Varna). After this process, the pile mass must be washed with lemon juice to neutralize the Kshara after proper burning of piles. The same procedure should be followed in other piles also. Later the rectal pack with Yashtimadhu taila or ghrita is applied.
Mode of Action of Pratisaraneeya Kshara in Internal piles
Histopathological examination of slough material in blackish brown discharge reveals the presence of necrosed haemorrhoidal tissue.
Application of Pratisaraneeya Teekshana Kshara in after fistulectomy in Fistula-in-ano -
In small low anal fistulas, first excise the fistula tract followed by application of Pratisaraneeya Teekshana Kshara and wait for 2 minutes, later neutralize with lemon juice and pack with Yastimadhu taila or ghrita. It is helpful for quick healing and avoids recurrence of fistula tract. In high level fistulas, excision of fistulous tract was done partially followed by application of Kshara. Later Kshara Sutra is applied in remaining fistulous tract at anal sphincteric area. The excised fistulous tract heals completely with help of Kshara and remaining fistulous tract was cut by Kshara Sutra ligation. So that patient can be cured at less time and pain.
In this technique, after excision of fistulous tract and applying Kshara, leads to debridement of the fibrous tissue and at the same time remaining wound will be healed by its scraping and healing property of Kshara. In the mean time, the Kshara sutra ligation at sphincteric area of fistulous tract leads to cutting and debridement and drainage of fistulous tract at the same time preserving continence of anal canal.
Application of Pratisaraneeya Kshara in Rectal Prolapse
The patient is anaes- thetized with local or spinal anesthesia, lubricated slit proctoscope is to be introduced and Kshara applied at lower most all around healthy mucosa of 3 cm area of anal canal and wait for 2 minutes or until it turns to the color of reddish black. After this process, the mucosa must be washed with lemon juice to neutralize the Kshara after proper burning of mucosa. Later the rectal pack with Yashtimadhu taila or ghrita is applied.
After Kshara application in rectal prolapse, the burned part heals and anal canal become fibrosed and narrowed. Then prolapse of rectum is stopped completely.
Application of Pratisaraneeya Teekshana Kshara in Pilonidal Sinus
After excision of Pilonidal sinus, the Kshara applied over the wound and wait for 2 minutes. Later neutralize with lemon juice and pack with Jatyadi / Yastimadhu taila or ghrita. The application of Pratisaraneeya Kshara helped after excision of Pilonidal Sinus by scraping of pits in the surrounding tissue of the sinus, avoids the formation of unhealthy granulation tissue and helps in healing of the wound from the base.
Advantages of Kshara Therapy
The content of this module has been authored by Dr. P. Hemantha Kumar, Professor & Head PG Department of Shalya Tantra National Institute of Ayurveda, Jaipur, Rajasthan