Probable Mode of Action of Kshara Sutra

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, BAMS
Among all the shastras (sharp surgical instruments) and anushastras (minor or accessory instruments), Kshara (alkali) is said to be the best. It performs many functions including chedana (incising), bhedana (excision) etc.  

Kshara superiority

Its benefits are appreciable because they can also be applied on the most difficult and inaccessible places of the body. It is highly beneficial in curing the most difficult diseases. It can also be used in the form of drink.

The combination of the kshara (alkali) of apamarga etc, the ksheera (latex) of snuhi etc and churna of haridra will be lethal to the anorectal diseases. They cut curette and heal the fistula. They also destroy the sinus and pile mass from their roots and make them fall off.

The multiple coats of medicaments on the threads probably make the effect of the herbs gradual and continuous.

The contact period Since the kshara sutra will be left in place for few days (differs in different people, because the grade of pathology differs and the action and strength of medicines used also make an impact), the medicines in the thread are slowly released into the ano-rectal lesions. The lesions are dissolved and destroyed from their base. If the fistula, sinus, or pile mass is not totally destroyed in few days, the doctor can plan to insert and knot a new kshara sutra. The thread acts like a vehicle for the medicines to reach the site and the coating on the thread probably renders a sort of sustained release effect of the medicines in the disease tracts.

Pressure factor The cut through of fistula tract is affected by the pressure exerted on the ano-rectal tissue by the kshara sutra introduced in the fistula tract and tied tightly. This moderately tight ligation of kshara sutra in the tract allows close contact of the medicaments with the diseased tract ably supported by the pressure factor from the thread. This allows quick healing of fistula tract.

In kshara sutra, linen thread supports the strength of ligation and the weight of 21 coatings of medicaments. Snuhi latex acts as binding material for preserving all the properties of the kshara. Kshara sutra works basically by the pressure effect caused by the ligation of thread. This creates mechanical strangulation of blood vessels and tissues. This in turn causes the pressure necrosis of the body of any swelling, the piles and fistula in this context.

Effective wound healing and pus drainage Kshara sutra introduced into the fistulous tract doesn’t allow the cavity to close down at both ends. This allows continuous and easy drainage of pus along the kshara sutra. This in turn helps ward off all contaminants and debris from the tract and help in quick and effective healing of wound. The kshara sutra gradually cuts through the fistulous tract from apex to the periphery.  Simultaneously there is cutting and healing of the tract and no pus pocket is allowed to be left over.
Read related: Kshara Sutra application in Fistula in ano (Bhagandara)

Chemical curettage of the tract Kshara Sutra does chemical curettage of the sinus tracts. The kshara or caustics applied on the thread are anti-inflammatory, anti-slough agents and have property of causing chemical curettage. The kshara sutra remains in direct contact of the sinus tract. As a result it directly curettes out the tract and sloughs out the epithelial lining and thus allows the fistulous tract to collapse and heal in quick time.
Read related: Administration of Kshara Sutra in Arshas (piles, haemorrhoids)

– Kshara invades the cells of lesion till the engorged tissue destruction occurs by the ksharana guna or corrosive property of the kshara sutra.
– Snuhi latex is proteolytic in nature. It dissolves the tissues at the base of the lesion.
– Turmeric provides bactericidal action along with its unparalleled healing property

Incision and excision role Kshara sutra has the ability to perform incision and excision (simultaneously) slowly by the virtue of its controlled chemical cauterization.

Comprehensive action of herbs All the 3 herbs used in the preparation of ksharasutra does not contradict or antagonize each other’s properties. In fact they act as comprehensive package and support each other’s actions so as to provide desirable effect.

Antibacterial propertyOwing to its antibacterial property, the kshara sutra doesn’t allow bacteria to multiply while it is in contact with the sinus or fistula.

Protein coagulation property of kshara During the cutting effect, there may be oozing of blood which is ceased by the sclerosing effect of the kshara by its protein coagulation property. This prevents the chances of bleeding during the procedure (while cutting the mass).

Less chances of infection Due to the sustained action of anti-infective action of kshara, the chances of infection of lesion are less.

Seton action In case of fistula in ano (bhagandara), the kshara sutra also acts as a seton to allow the proper drainage of pus and debridement of unhealthy tissue, thus providing a cleaner base for wound healing with minimal scarring and without complications.

pH role The pH of kshara sutra is alkaline. Therefore it doesn’t allow the rectal pathogens to invade the cavity in its presence.
Click to consult Dr Raghuram MD (Ayu)

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