"Kshar Sutra" (क्षारसूत्र) is a sanskrit phrase in which Kshar (क्षार) refers to anything that is corrosive or caustic; while Sutra(सूत्र) means a thread.It is described by many Ayurvedic texts which originated and flourished in India. It is one among popular Ayurvedic treatment modality in the branch of Salyatantra followed by Susruta.
The Ksharsutra was first mentioned by the "Father of Surgery" Sushruta in his text named SUSHRUT - SAMHITA for the treatment of Nadi Vrana(sinus), Bhagandara(fistula- in - ano), arbuda(excision of small benign tumour) etc..Although Brihattrayi- the chief three texts of Ayurveda mention the use of kshara sutra,there is no description of their preparation properly. It was Chakrapani Dutta in late eleventh century in his book Chakradatta, first mentioned the method of preparation with a clear-cut indication of its use in bhagandara and arsha(haemorrhoid). In his book Chakradutta explains the method that by smearing a sutra (thread) repeatedly in the latex of snuhi (Euphorbia) and haridra(turmeric) powder makes the kshara sutra. Later authors like Bhavamishra, Bhaisajyaratnavali etc. also mention the same method. But because of brevity of preparation and inadequate explanation of procedure of application, it lost its popularity among Ayurvedic surgeons. Later in Rasatarangini a better preparation procedure was introduced still the credit of making it practically in use goes to Prof. P.J.Deshpande, his research officer Dr. S.R. Gupta and his coworkers. They rediscovered and standardized the ksharasutra in the present era . The Dept. of Shalya- Shalakya, Faculty of Ayurveda, IMS, BHU should be credited for the abundant use and popularization of this technique.
Method of preparation of Kshara sutra
The standard kshar sutra is prepared by repeated coatings of snuhi ksheera (latex of Euphorbia Nerrifolia), apamarg kshara (ash of Achyranthus aspera) and haridra powder over a surgical linen thread no. 20. This thread is spread throughout lengthwise in hangers. Each thread on the hanger is then smeared with snuhi latex with the help of gauze piece soaked in the latex. This wet hanger is transferred in kshara sutra cabinet. The same process is repeated next day. Eleven such coatings with snuhi ksheera alone should be accomplished. The twelfth coating is done by first smearing the thread with ksheera and in wet condition thread is passed through the apamarg kshar. It is again transfer into the cabinet for drying. This process is repeated till seven coatings of snuhi ksheer and apamarg ksharaare achieved. The final three coatings are completed with snuhi ksheera and fine powder of turmeric in the same fashion. Thus twenty-one coatings over the thread are completed.
Mode of Action of Kshara sutra
Kshar Sutra is now a popular treatment modality in India for the management of fistula in ano, piles, fissure tag, pilo-nodal sinus. Many Clinical trials have done all over in different institutes to evaluate the action. In countries like Sri Lanka and Japan also many clinical trial has already done and established it. Precisely the action of Kshara sutra is thought to be due to its healing and cleansing effect according to Ayurveda. It can be suggested that due to the anti microbial action, and as a Seton it allows the proper drainage of pus from the fistula, that leads to a proper healing. On the other hand the cutting effect of thread incises the skin gradually without a surgical incision. Many studies confirms that it is more effective in the way of reducing hospital stay and less infection than the conventional seton therapy. Researches suggests that it is having the action of Excision, Scrapping, Draining, Penetrating, Debridement, Sclerosing and Healing. It is Bactericidal and Bacteriostatic., paniya kshara act through changing internal environment of body (prakit vighata concept of ayurveda).
Types of Kshar Sutra
In the textual reference of Chakradatta and Rasatarangini we get only indication of the thread made up of Snuhi, apamarga and Turmeric. Susruta describes about many kind of Kshars like Karaveera, Palasa, Kadali etc. in Susruta Samhita. So many studies have already carried out with variations in the Kshara and the latex. The most remarkable are Guggulu Ksharasutra, Udumbara KS, Gomutra KS, Papaya KS, KS with Ficus carica latex etc