Presented by -

Dr. Vikas Saroch PG scholar

Dr.Shrinivas.M.Patil M.D.lecturer

Shri. B.M.K. Ayurved College,Shahapur, BELGAUM.

State Karnataka.

Introduction

Kshar sutra in ano rectal disorders has shown miraculous effects and now it’s a Precious gem in the crown of Shalya Tantra. We have very less references regarding utility of Rasaaushadhis in shalya tantra infact we can say both these disciplines never mingled in each other. The Preparation of Khsar sutra using Rasa Aushadhis like Gandhaka etc. may open a new path in the treatment of ano rectal disorders, keeping this in mind some experiments were tried and some positive hopes were observed.

Aims and Objectives

• Preparation Of Rasashastriya Kshara Sutra

• Physicochemical analysis of prepared Kshara Sutra

• Clinical studies on Prepared Kshara Sutra

Materials and Methods

• Compilation of literature available.

• Preparation of Kshara Sutra using Rasaushadhis

• Physical and Chemical analysis of Prepared Kshara Sutra

• Clinical Studies on Patients of Bhgandhara

( Fistula in Ano)

Review of literature

• Compilation of literature on ingredients of Kshara sutra available in various texts of Rasashstra.

• Selection of Ingredients by observing their qualities and rationality with respect to healing of Ano Rectal fistula

Ingredients

• Shudha Gandhaka

• ShudhaTankana

• Shudha Kankshi

• Madhu chisti

. Shudha Gandhaka- (Sulphur)

According to Bhavaprakasha

Nighantu Purvardha Shloka no . 111

- Jantukandu hara

According to Rasa Ratnasamuchhaya

- Kanduhara

- Vishahara

- Krimihara

. Shudha Tankana –(Borax)

–According to Rasa Tarangini

Taranga no. 23-

- Ushna, Teekshna, Sarak - Vividha vrananashana

Shudha Kankshi –(Alum)

According to Rasa Tarangini

Taranga no. 11 –

- Ushna, Vishadoshahanti

- Kandutihara

- Vranaropana

- Vranaharini

Madhu chisti –(Bees wax)

According to Bhavaprakash Nighantu

Purvardha – madhuvarga- shloka no.30

- Bhutaghna

- Vranaropana

Preparation of Kshara sutra

Ingredients Qnty.

1 Shudha Gandhaka- 30 g

2 Madhu Chisti- 30 g

3 ShudhaTankana- 20 g

4 Shudha Kankshi- 10 g

5 20 no. Surgical

cotton Thread-

q.s.

• About 6 inches long pieces of Surgical cotton thread (No. 20) were used.

• Shudha Kankshi and Shudha Tankana were mixed well and to it sufficient qnty. of 95% ethyl alcohol is added to

make a homogenous thin paste.

• This mixture is taken in a stainless steel bowl and all pieces of thread are put in bowl. The threads are moved well in bowl till they soak in it.

• This bowl is either kept in sun light or heated on mild temperature at about 70 Degree Celsius ,By this all alcohol get evaporated.

• The threads are then separated from each other. Due to the coating of kankshi and tankana, the threads appear stiff.

• In another stainless steel bowl, madhu chisti and shuddha Gandhaka are melted together with constant stirring.

As soon as the mixture is melted, the threads coated with kankshi and tankana are dipped in the molten mixture for about 5 to 10 seconds and then taken out. They are held in a straight position till they are cooled and the mixture of madhu chisti and gandhaka becomes solid again. All the thread are coated in this manner and they are stored in a cool and dry place.

Physicochemical Analysis• Organoleptic characters-

colour- yellowish brown coloured threadtouch - smoothsmell – Pungent foul smell

• pH of the thread coated with Sulphur,Bee wax,Alum and Borax - 8.89

• Total waxy material with Sulphur (Petroleum ether extractives) - 66.4554%

• Weight of single thread coated with alum + borax + Sulphur + Bees' wax = 0.2609 g

• Weight of single thread without any coating = 0.0558 g

Clinical Studies

• Clinical studies of the prepared kshar sutra are conducted at K.L.E.S. Ayurvedic Hospital ,Belgaum.

• The trials are conducted only on 15 patients of Bhagandara as a pilot studies and results are as follow

Inclusive criteria

– Fistula in ano

with single opening

Exclusive criteria

- Fistula in ano with multiple openings

- Patients with HIV Positive

- Patients of Tuberculosis

All the pre operative, operative and post operative measures are conducted similar as in standard Kshar sutra ligation.

Patients are called for follow up after every 7 days for change of thread.

Out of 15 patients for first follow up

• 9 patients showed decreased purulent discharge and inflammation.

• 4 patients showed decreased purulent discharge but inflammation was still there.

• 2 patients showed no significant change in the complaints.

- When same patients were followed

up for 3rd thread change, they showed

significant cutting and healing action in

fistula with less granulated tissue

9 patients got healed in 4 thread changes.

4 patients got healed in 5 thread changes.

2 patients got healed in 6 thread changes.

Assessment of healing of fistula in ano was done on following points.

• Reduction in purulent discharge and inflammation.

• Reduction in length between anterior opening of fistula and anal orifice.

• Cutting (anterior wall of fistula) and Healing (posterior wall of fistula) action.

• Number of threads required for healing.

Conclusion • As we know in practice we are using Kshar sutra

containing Aushadhis like Snuhi Ksheera, Apamarga Kshar and Haridra. Though this Standard Kshar sutra gives good results in the ano rectal disorders like fistula in ano i.e. Bhagandara, It is quite tedious job to prepare it. Its most complicated part is the availability of Snuhi in surrounding vicinity. And collection of Snuhi Ksheera. Also Above mentioned Kshar sutra using Madhu Chisti, Gandhaka, Kankshi and Tankana are easy to prepare and their properties as mentioned in literature are quite acceptable for the cutting and healing action in Bhagandara.

• Another advantage of this Kshar sutra is the shelf life period, When it is preserved in cool place it will not loose any of its ingredient’s efficacy as all ingredients can last for long time.