Dr. P. Hemantha Kumar M. S .(Ay) Dip.Yoga, (Phd)

Prof. & HODDept. of Shalya Tantra in P.G. Studies

S.D.M.College of Ayurveda & Hospital, Hassan, Karnataka, INDIA

Mobile – 9448156362

Email –phk4uster@gmail.co

phk4u@redifmail.co

Piles / Haemorrhoids can affect anyone, Piles / Haemorrhoids can affect anyone,

anytime, anyplace and anywhere. anytime, anyplace and anywhere.

Commonest disease in Anorectal region.Commonest disease in Anorectal region.

Recent statistics reveals that irrespective Recent statistics reveals that irrespective

of age, sex, socio-economic status, of age, sex, socio-economic status,

people suffer from piles. people suffer from piles.

Now a days every person suffered from Now a days every person suffered from

any one of the complaint of piles during any one of the complaint of piles during

their life time. their life time.

Kshara is a caustic chemical, alkaline Kshara is a caustic chemical, alkaline

in nature obtained from the ashes of in nature obtained from the ashes of

medicinal plants. medicinal plants.

It is a milder procedure compared to surgery It is a milder procedure compared to surgery

and thermal cautery. and thermal cautery.

It is the superior most among the sharp and It is the superior most among the sharp and

subsidiary instruments because of subsidiary instruments because of

performing excision, incision and scraping. performing excision, incision and scraping.

Used safely on the patients who are afraid of Used safely on the patients who are afraid of

surgery.surgery.

CLASSIFICATION OF KSHARACLASSIFICATION OF KSHARA

On the basis of Concentration

1. Mridu - Mild

2. Madhyama - Moderate

3. Teekshana - High

On the basis of Administration

1. Pratisaaraneeya Kshara – External application

2. Paaneeya Kshara – Internal application

On the basis of Origin

1. Herbal 2. Mineral 3. Animal

According to

Preparation

1. Uttama - Best

2. Madhyama - Moderate

3. Adhama - Poor

INGREDIENTS OF KSHARAINGREDIENTS OF KSHARA

APAMARGA – Achyranthes aspera

Sukti – Lime stone

Chitraka - Plumbago gelanicaChitraka - Plumbago gelanica

Dried Apamarga plant (Achyranthes aspera) (5 kg)Dried Apamarga plant (Achyranthes aspera) (5 kg)

BurntBurnt

500 gms of Achyranthes aspera Ash500 gms of Achyranthes aspera Ash

Add 6 times of water (3 liters)Add 6 times of water (3 liters)

Filtered 21 times through clothFiltered 21 times through cloth

To get clean and clear solution – Cow’s urine colourTo get clean and clear solution – Cow’s urine colour

(slight reddish)(slight reddish)

METHOD OF PREPARATION OF PRATISARANEEYA TEEKSHANA KSHARA(High concentration Kshara)

Filtrate Solution was boiled and evaporatedFiltrate Solution was boiled and evaporated Heating up to 2/3 remainsHeating up to 2/3 remains

Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga (Achyranthes aspera) filtrate solution (Achyranthes aspera) filtrate solution

Continuous mild heatingContinuous mild heating

Liquid evaporates to 1/3rd of its original quantity Liquid evaporates to 1/3rd of its original quantity

Add 1/10th (5gms) of Chitraka Kalka Add 1/10th (5gms) of Chitraka Kalka (Plumbago gelanica) (Plumbago gelanica)

PRATISARANIYA TEEKSHANA KSHARAPRATISARANIYA TEEKSHANA KSHARA(High concentration Kshara)(High concentration Kshara)

PREPARED KSHARAPREPARED KSHARA

PROPERTIES OF KSHARAPROPERTIES OF KSHARA

It is having pungent, hot, sharp and It is having pungent, hot, sharp and digestive property.digestive property.

It does cauterizing, digesting and It does cauterizing, digesting and splitting actions.splitting actions.

Externally it has Cleansing, Heating, Externally it has Cleansing, Heating, Absorbent and Scraping properties.Absorbent and Scraping properties.

PH value of Teekshna Apamarga Kshara PH value of Teekshna Apamarga Kshara is 13.5.is 13.5.

INDICATIONS OF KSHARA IN PILESINDICATIONS OF KSHARA IN PILES

Soft, spread out, Soft, spread out,

deep rooted & deep rooted &

elevated type of Pileselevated type of Piles

Internal Haemorrhoids – First degree, Second Internal Haemorrhoids – First degree, Second degree and Third degree.degree and Third degree.

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 soap water enema.

APPLICATION OF KSHARAAPPLICATION OF KSHARA

INSTRUMENTS

Patient is in lithotomy positionPatient is in lithotomy position

L. A. / S. A.L. A. / S. A.

Part cleaned with aseptic solutionsPart cleaned with aseptic solutions

Introduce lubricated slit ProctoscopeIntroduce lubricated slit Proctoscope

into the anus and pile masses bulges in into the anus and pile masses bulges in

Pile mass should be scraped or rubbed with cloth or a Pile mass should be scraped or rubbed with cloth or a cotton swab with warm watercotton swab with warm water

OperativeOperative

Kshara applied on internal pilesKshara applied on internal piles

Wait for 1- 2 minWait for 1- 2 min

Pile mass turns to the colour of Pakva Pile mass turns to the colour of Pakva Jambhuphala (ripened black berry fruit) - Jambhuphala (ripened black berry fruit) -

Reddish black in colourReddish black in colour

Pile mass washed with Lemon juicePile mass washed with Lemon juice

Apply Yashtimadhu Ghrita & Apply Yashtimadhu Ghrita & Proctoscope is removedProctoscope is removed Rectal pack with Anu taila or Mahanarayana taila Rectal pack with Anu taila or Mahanarayana taila

Post operative

Orally liquid diet after 4 to 6 hours

Packing removed after 6 hours

Sitz bath -Triphala decoction

10 ml Anu taila / Mahanarayana taila per

rectally twice daily

BEFORE DURINGBEFORE

AFTER

KSHARA KARMA – CAUSTIC CAUTERY

Before Application

During Application

After Application

PRATISARANIYA KSHARA

COAGULATES PROTEIN INHAEMORRHOIDAL PLEXUS

CAUTERISES PILE MASS

DISINTEGRATION OF HAEMOGLOGIN

HAEM & GLOBIN

BLACKISH BROWN DISCHARGE

DECREASES SIZE OF PILE MASS

NECROSIS OFTISSUE WITH OBLITERATION OFHAEMORRHOIDAL RADICLES

NECROSED TISSUE SLOUGHED OUT

FIBROSIS & SCAR FORMATION

OBLITERATION OF HAEMORRHOIDAL VEIN

COMPLETE WOUND HEALING (21 DAYS)

(3-7 DAYS)

MECHANISM OF ACTION OF KSHARA IN HAEMORRHOIDS

HISTOPATHOLOGICAL SLIDE OF SLOUGH COLLECTED AFTER KSHARA KARMA

H.P.E of slough material in blackish brown discharge revealed thepresence of necrosed haemorrhoidal tissue.

ADVANTAGESADVANTAGES

Mild postoperative pain

No bleeding

Minimum hospitalization

No scope for recurrence

No stricture formation (if correct procedure is followed)

Kshara Karma - treating all the pile mass in one sitting.

COMPLICATIONSCOMPLICATIONS

Bleeding Bleeding - Negligible- Negligible

Pain Pain – Mild to moderate pain - relieved by hot – Mild to moderate pain - relieved by hot sitz bath and oil enema.sitz bath and oil enema.

Discharge Discharge – Blackish brown discharge will be – Blackish brown discharge will be occur 5 to 7 days postoperatively.occur 5 to 7 days postoperatively.

Anal strictureAnal stricture – Improper technique– Improper technique

RecurrenceRecurrence – Improper technique– Improper technique

Dr P. Hemantha Kumarwww.proctocure.com