Kshara Sutra therapy:  a  new dimension

Dr. Abhiram Thakur

Dr. Aneesh S.

MS(Ay) Scholars, GAC, Tripunithura

                         Kshara sutra the unique  Ayurvedic para surgical intervention using medicated thread now getting huge popularity all over. Susruta described KsharaSutra in the context of Sinus (Nadi Vrana) of breast. In the contest of Fistula in ano he asked to refer  the same therapy from the previous therapy.  The interesting point here is that in the breast tissue, there is more of adipose tissue providing little scope for the structural interplay of fibrous tissue. Same is the case of Fistula-in ano where there is more of adipose tissue in Ischio-rectal fossa. Apart from it Kshara sutra is also effective  in conditions which demand gradual excision and overgrown soft tissues like polyps, wants, non healing chronic ulcers and sinuses
and papillae.  The vrihattrayees doesn’t got the exclusive description of Kshara Sutra . Ayurvedic texts are thought to be written in  Sutra-form, i.e. elaboration to be extended by the scholars. Later texts  Bhavaprakash  gives few information regarding this . How ever Chakradutta is thought be the main reference for present scholars.

 This was later  in 1964 demonstrated  into an applicable technique by Dr. P. J. Deshpandey, Dr. I. Sanjeeva Rao and Dr. S. N. Pathak at Banaras Hindu University.He is now considered to be the father of present form Kshara Sutra therapy by many authors. This work has been extended by Central Council for Research in Ayurveda and Siddha (CCRAS) and the Indian Council for Medical Research (ICMR) in a  scientifically validated researches made it popular. Trials were held in renowned medical institutes in various cities of India. The method is fully standardized and is extensively used. As it does not require hospitalization, antibiotics or anaesthesia, it has taken a grand popularity. The success rate of ksharsutra  treatment has been very high although it is an ambulatory procedure.

 Research conducted by CCRAS reports that Ksharasutra offers effective ambulatory and safe alternative to surgery in fistula in ano. Recurrence rate was 4% in Ksharsutra group when compared 11  %with surgery. The study revealed 98.7% cure rate.  The  procedure done in OPD basis.  Cutting and Healing took place simultaneously so that no raw area was left besides Minimal tissue damage and less pain.  It was reported at that time by the Mayo Clinic of USA that even in the hands of a best surgeon and best surgical facility available, when fistulectomy was done, there was 47.6% recurrence.• Hence the success rate of Ksharasutra therapy is of highly significant. Considering  the over whelming success India govt. is planning to institute one  Kshara sutra unit along with a Panchakarma unit in all district level hospital.

In Indian subcontinent excluding  India Kshara sutra is in practiced in many countries like Nepal, Srilanka  from many years. Other than this  , physicians of Korea and Japan also adopting  this techniques from last few decades. Many researches conducted in these states had  revealed some new facts that we are presenting here.

 In traditional use Kshara of Apamarga (Achyrenthus aspera), latex of Snuhi(Euphorbia norifolia) and powder of turmeric(Curcuma lunga) used for the preparation of Kshara sutra. In last few years many researchers have tried with some different kshara like Arka, Kadali, Plasha, Nimba Kshara and latex of Udumbara , Arka, Erandakarkati etc.  Below is a chemical analysis of variant Kshara used for Kshara Sutra therapy.

                                                    With reference of some  Indian and Srilankan researches,  a group of scholars from  Kanazawa University, Kanazawa, Japan modified the drugs according to availability of drugs in Japan. They used another species of Apamarga i. e. achyranthus bidentata Bl. For Kshara purpose, Fig tree latex(Ficus carica L.) ,  tincture of red pepper(Capsicum 10% diluted) and also turmeric powder. According to their assumption Snuhi aids in the stimulation of  granulation of the affected part and it can be attained by red piper too. Adhesion by snuhi latex can be added by fig latex  with out any poisonous effect. There found some traditional use of fog latex in Japan and it is plentily available there. Another fact is that more production of latex occurs in fig plant than Snuhi. Observing these merits they preferred these changes. In result they obtain a good success negligibly less than previous. The ph of the thread in saline solution was 9 comparing to 10 of conventional. Hence there was a slight increase in the time to incise the wound. The thread used in  Srilanka was 0.5 mm thick where as this was 1.1mm. The hospital stay was 22.59 days , comparative to 19.18 by previous. Hece there was no bad effect , accept a slow cut. They named it as Kanzawa sutra.

Snuhi contains the active principle ‘ingol ester’ that  induces  inflammation . Red pipper contains capsaicin which is too one of  ingol ester and thought to do the same. During the coating of Turmeric powder the acidic constituent of turmeric -   ‘curcumin’ decreases the alkalinity . So, according to its percentage the alkaline strength may differ  . Some research shows that the cutting is independent of alkalinity of Kshara Sutra. The standardization of Kshara sutra had added a scientific acceptance in the modern society . However more research on the topic is required with difference drugs utilization and thorough scientific explanation of the physiology.

* The article was published in souvenir of Anusastra2008 National Seminar