KSHARASUTRA PREPARATION PROJECT REPORT

INTRODUCTION :

Ksharasutra is an ayurvedic parasurgical treatment used to manage anorectal disorders such as pilonidal sinus (Nadivruna), Fistula-in-ano(Bagandara), and Haemorrhoids (Arsas). Ksharasutra therapy is the completely established ayurvedic procedure that is safe and cost effective in treating the painful anorectal conditions. It uses a thread that is coated with medicine that have anti inflammatory and antibacterial property, antislough agents and chemical curetting agents and with pH level  towards the alkaline side. These features help in simultaneous cutting, curetting, draining and healing  of the tissues in the anorectal canal. 

The mode of ksharasutra treatment slightly varies for each particular anorectal condition. A malleable probe is passed through the anal canal and gently taken out through external orifice of fistula to outside to form a groove of the probe and both ends of ksharasutra are tied together. The thread is replaced after an interval of 1 week with a new thread. Ayurvedic mechanism of action of ksharasutra also destroys and removes unhealthy tissue and promotes healing of anal tract. This method of treatment control infection by the microbicidal action of the thread and seperates the debris and clean the wound.

ADVANTAGES OF KSHARASUTRA THERAPY : 

1. Simple and safe ayurvedic parasurgical procedure

2. Out patient treatment

3. Cost effective and ambulatory

4. Reduces the risk of infection and recurrence

5. No surgical complications like incontinence and stenosis

6. Faster healing

                                                       (SU.CI.17/29)

INDICATIONS :

In persons who are emaciated,weak and frightful and if the ulcer is present in vital organs, the wise physician should cut open the sinus by using ksara sutra (threads soaked in caustic alkalies) and not by using sharp instruments.

METHOD OF APPLICATION :

This sinus should be probed with a probe, then introduce the needle(blunt) having alkali thread (through its hole in its distal end) till the end of the sinus is reached,the needle is then lifted up,the end(front tip) of the thread is pulled out and tight knot tied.After considering the strength of the alkali,another thread soaked/smeared with alkali may be inserted after removing the first one) by the physician till sinus get cut.

The same procedure should be adopted for bhagandara(fistula in ano),arbuda(malignant tumor) etc,by the intelligent physician.After lifting the arbuda from its base an alkali thread may be wound around its base and tied;the thread may be passed through the needle having a hole in front and inserted at the base of the tumour and tied.After it (tumor) has become cut,the resulting ulcer may be treated like any other wound.

AIM :

To prepare Ksharasutra as said in the text Chakradatta,Arsoadhikaram(145):

The thread coated with the latex of Euphorbia and turmeric powder repeatedly when tied firmly destroys arsas and bhagandara.

MATERIALS REQUIRED :
1.Snuhi Ksheera (Euphorbia nerifolia Linn.)
2.Haridra(Curcuma longa) churnam
3.Scalpel or  knife
4.Kidney tray
5.Glass jar
6.Surgical Linen thread
7.Kshara Sutra Cabinet with ultraviolet light*

*Kshara Sutra Cabinet with ultraviolet light:
This is a specially designed instrument for the preparation of kshara sutra in an effective way.
Available designs  Horizontal cabinet and Vertical cabinet
The cabinet has 2 chambers, the bigger one for the kshara sutra hangers and the smaller one for the hot air blower, fan etc. A thermometer is also fixed which will indicate the temperature inside the cabinet.
Kshara sutra hangers  They are the rectangular shaped structures. They are made up of thick aluminium or wooden strips of about 2cm width and 3-4 mm in thickness. Each hanger has small cuts (notches) on both sides which are placed at a distance of 2-2.5 cm from each other. These notches are for hooking the thread throughout the width and length of the hangers. Each hanger has 15-20 notches on either side. The size of the hanger varies with the size of the cabinet. The width of the hanger is about 30 cm. One hanger can thus accommodate as many as 30-40 threads at a time and one kshara sutra cabinet accommodates roughly 30-50 hangers. Thus, the total capacity of the cabinet to manufacture kshara sutra in one round is 900 - 1600 threads.

PROCEDURE :
A.COLLECTION OF SNUHI KSHEERA :

1.Selection of the Plant
2.Collection of Snuhi Ksheera
3.Storage of Collected Ksheera

1.Selection of the Plant :
* Botanical Name : Euphorbia nerifolia Linn.
* Family : Euphorbiaceae
* Size of the Plant : 2-3 yrs. Old

2.Collection of snuhi ksheera :
For best results, the snuhi ksheera should be collected early in the morning, before sunrise. If the latex is tried to extract after sunrise, we can get just a few drops of ksheera from Snuhi branch which might not be sufficient for preparing kshara sutra.

Take a sharp scalpel or knife.
Slit the branch of snuhi vertically from below upwards.
Before cutting the branch, make sure you place a collection jar below the branch right under the slit.
As soon as the cut is made,  latex starts dripping down from the branch of snuhi.
The ksheera is collected in the jar.
The amount to be collected depends upon the number of threads that need to be coated.
Storage of collected ksheera

After collecting the ksheera, care should be taken to close and seal the jar to prevent the entry of air into it.
If the ksheera is kept exposed to the air, the ksheera coagulates immediately on contact with air and turns into a gum like semi-solid substance.

B.MEDICATING THE THREAD : 

The thread used for kshara sutra is given several coatings (smearing) with snuhi ksheera. Over all 21 coatings were given. They are as follows:

Coating the thread with Snuhi ksheera
First Round of Bhavana  18 bhavanas (coats) with snuhi ksheera (latex of Euphorbia nerifolia)

The fresh Snuhi Ksheera (latex of Euphorbia nerifolia) is taken in  a bowl or crucible.
After wearing gloves a piece of gauze is taken and folded into a small square.
The square gauze is dipped in the latex.
The gauze dipped in the latex of snuhi is rubbed against the thread and the thread is coated (bhavana is given) with the snuhi ksheera from below upwards.
When all the threads are given bhavana in this manner, the frame is kept to dry in ksharasutra chamber.
The first coat is allowed to dry.
After the first coat is dried, the second bhavana or coating of snuhi ksheera is given.
In this way, the thread is coated with the latex of snuhi for 18 times, one after the other(after every old coat gets dried).
The frames of threads are placed in a special chamber for drying for around 3 hours each time.
Application of haridra(Curcuma longa L.) powder

The fine powder of haridra is sprinkled over the thread after the coating of the thread with snuhi ksheera.  Second round of bhavana  3 bhavanas (coats) with Snuhi Ksheera (latex of Euphorbia nerifolia) and Haridra Churna (Turmeric Powder).

The threads given bhavana with snuhi ksheera and haridra churna should be kept in drying chamber and dried.
On these dried threads again bhavana of snuhi ksheera and haridra churna is given.
This procedure is done for 3 times.
With the completion of 3 bhavanas with snuhi ksheera and haridra churna, we should have successfully given 21 bhavanas in total (18 with snuhi ksheera and final 3 by snuhi ksheera and haridra churna). Coating of the thread with kshara (like apamarga kshara) could be done alongwith the smearing of haridra churna and snuhi ksheera.
The kshara sutra is now ready for use.

PRECAUTIONS:

Every new bhavana (coat) of ksheera shall be applied only after the first coat has been thoroughly dried.

While applying each coat, care should be taken that the medicament is applied thoroughly and that the medicine spreads evenly on all the sides of the thread and does not aggregate at one spot to make a clump or knot of medicines.

The thread should be smooth and even, having the same thickness throughout the length.

Care should be taken to see that the whole procedure of preparing the kshara sutra is carried out in dry atmosphere.

A specially prepared drying chamber shall be used for drying the threads so that it can be dried in a dust free atmosphere.

In the absence of drying chamber, the threads may be dried in the open under direct sun rays in a dry and dust free atmosphere.

PRESERVATION OF KSHARASUTRA:

The dried threads are cut to uniform size and packed in sterile glass jar and labeled with manufacturing date.

RESULT :

Started procedure on 22 october 2020 and completed on 4 november 2020.

      35 cm X 23 pieces of Kshara sutra were obtained.

SCHEDULE :

The quality of the thread is checked by Dr.Alex Sebastian Chirayath ( Associate Professor, Department of Salyatanthra) on 5/11/2020.

BIBLIOGRAPHY :

1. Illustrated Susrutha samhitha by Prof. K.R. Srikantha Murthy (Chaukambha Orientalia) , Chikitsa Sthanam chapter 17

2.Chakradatta, Arsodikaram

   

PREPARED BY :

Dr.Alli.R, Dr. Aswin.M.G, Dr. Midhila.K.J, Dr.Nithina.K.R,Dr. Revathy Lal.S.A,Dr.Yadhu.S.K

THANKS TO :

 Dr K N Muhammed Ikbal, Professor and HOD, Department of Salyatanthra, Vaidyaratnam Ayurveda College, Ollur 

Dr Alex Sebastian Chirayath,   AssociateProfessor, Department of Salyatanthra,  Vaidyaratnam Ayurveda College, Ollur

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