🔘 Kshara Karma

KSHARA KARMA:-

👉🏻 Introduction:-

- Among all the yantras, upayantras, shastras, anushastra and

medicines (oushadhas) the kshara is the supreme, because it is

most effective and acts immediately.

- There are many diseases which are not curable with medicine or

drugs or are not so much effectively treated such as,

• Skin diseases

• Some allergic condition

• Bhagandra (Fistula in ano)

• Nadi Vrana (Sinuses)

• Arbuda (Cancer)

• Arsha (Piles)

• Dusta Vrana (chronic or non healing ulcers)

• CharmaKila (wart)

• Tilkalaka (Melanomas)

• External abscess

• Disease of Mouth

• Some tumor of oral cavity

- These are notorious diseases where use of medicine as well performing surgery also are difficult and has a lot of complication like, infection, disfigurement, difficulty to approach etc.

- The diseased portion should hould be removed or killed but it is observed that many a time, drug fail to do its work.

- Surgery is always feared by even those who advocate it.

- Many a time, patients are not fit to undergo surgical operation.

- Under such condition the alternative measure for advancing the result of surgery is always welcome.

- The external application of Kshara are used in various diseases further it can bring about the same result as a surgical operation

without its pain agony, mortifying tissue by less degree may give rise to less effusion of blood and less agony than operation.

- Its use is not confined to surgical disease only or local applications but also advocated in medical disease.

- Such as urinary calculus, for oral administration another advantage of application of Kshara is that it can be applied to the people of delicate temperament and age Kshana can also be used even in the vishamavastha (dangerous condition) of disease.

- Ksharas are more effective than other methods of treatment because they can be administered both internally as paneeya

ksharas and externally as pratisaraneeya ksharas.

- Kshara is tridoshahara, hence a single drug, it acts all the three doshas.

👉🏻 Definition:-

- It is called kshara since it destroys (the vitiated tissues and

makes the fall off of since it torments (harms) the tissue.

- The word 'kshara' derived from the root char-- to remove or satan destruction or kshana violence.

- It literally means that which destroys fleshy mass either healthy or unhealthy.

- In charaka kshara is one which scrapes the abnormal tissue from its location and destroys it after dissolving it because of

its corrosive nature.

• तत्र क्षरणात् क्षणनाद्वा क्षारः ||

- क्षणन means himsana - twak mamsadi himsana.

- क्षरण means shodhana - kshara act as a shodana both internally and externally.

👉🏻 Importance of Kshara:-

• शस्त्रानुशस्त्रेभ्यः क्षारः प्रधानतमः,

छेद्यर्भेद्यलेख्यकरणात् त्रिदोषघ्नत्वाद्विशेषक्रियावचारणाच्च|| 

(Su.Su. 11/3)

1. Kshara is any caustic chemical, alkaline/acidic in nature

obtained from the ashes of medical plants

2. It is a milder procedure compared to sastra & Agni karma.

3. It is mentioned among anusastra & upayantra

4. It is most potent among the sharpd subsidiary instruments because of performing chedana (exicision), bhedana (incision), and lekhana (scraping).

5. It destroy all thridoshaja vyadhis

6. It is versatile because even such places which are difficult in approach by ordinary measures can be treated by kshara karma.

7. Ksharakarma is more effective than the other because they can be administered both internally & externally.

8. Ksharakarma is a substitute of surgical instruments because they can be used safely on the patients who are afraid of surgery.

9. Kshara can safely be used even in vishamavastha of a disease eg gulma, udaara etc.

10.The alkali used properly by an intelligent person cures even dreadful disease quickly.

- In the same way alkali administered by a person of poor intelligence will be like the effect of poison, fire, sharp weapon, thunder.

- So it should be used wisely.

👉🏻 Kshara Karma:-

• नानौषधिसमवायात्रिदोषघ्नः, शुक्लत्वात् सौम्यः; तस्य सौम्यस्यापि सतो दहनपचनदारणादिशक्तिरविरुद्धा, आग्नेयौषधिगुणभूयिष्ठत्वात् कटुकउष्णस्तीक्ष्णः पाचनो विलयनः शोधनो रोपणः शोषणः स्तम्भनो लेखनः कृम्यामकफकुष्ठविषमेदसामुपहन्ता पुंस्त्वस्य चातिसेवितः।

(Su.su. 11/4)

1. Thridoshagnata - Kshara is made up of several drugs in their most concentrated and subtle forms, and hence effective over all the doshas.

2.Soumya - kshara is considered to be soumya in nature, mainly due to the white colour of the substance, which is indicative of satwa guna and soumyatwa.

- The major reason for attributing kshara, its soumya guna is that it is completely harmless, as it acts only over the deranged and unnecessarily grown and hypertrophied structures.

- As a whole its better to say kshara is soumya in nature but theekshina in action.

3. Daahana-In contrary to the soumya guna kshara also possess agneya property, which helps it to induce paaka, puyothpathy (suppuration) in cases of external application like vidhradhi, arbuda etc, and agnideepana when used internally.

4. Aparutihata shakti (uncompromising action in pachana, darana etc.):-

- Any new growth or inflammatory swelling requires pachana followed by darana subsequently.

- Pachana is a process which encourages the body forces(antibodies) to fight against the (antigens pathogens) if the body forces gain access over pathogenic forces, the inflammation subsides

- In case the pathogens over power then a pocket of pus will be formed then darana helps in opening or rupture of abscess without operation.

- Ksharas were used in inflammations and new growths through their dual action, the pachana and darana

- When taken internally they do aama pachana and break down clogged elements (granthi bhutha doshas) obstructing sources sama pachana and Sroto shodhana bring about dosha samantha or swasthana annayana of doshas.

5. Sodhana - Kshara has got ushna and tikshna guna which help in desquamation sloughs (debridement) and draining of pus when

used externally.

6. Ropana - Kshara helps in ropana or healing process because of their cleansing antiseptic properties.

- Healing requires new vascularisation, granulation tissue formation.

7. Sthambana (hemostasis)

8. Lekhana (chemical debridement)

9. Shoshana (exudates)

10. Vilayana (swellings)

👉🏻 Ideal qualities of kshara (Uttama kshara lakshanas):-

1. Natitikshna-should not be too corrosive

2. Natimrudu-should not be too mild

3. Shukhla-white ash

4. Natislakshna-should not be too smooth

5. Natipichila-should not be too sticky

6. Avishyandi-should not be too slippery

7. shiva- saumya guna.

8. shighra – effective 

👉🏻 Kshara dosha:-

1. Too mild

2. Too white

3. Too hot

4. Too sharp

5. Too slimy

6. Too spreading

7. Too thick

8. Un cooked (not well prepared)

9. Less potencey

👉🏻 Types of Kshara:-

- Kshara is made by burning whole of the plants or parts of it.

- These kshara type according to use / on the basis of administration are:-

1. Paneeya Kshara - for internal use

2. Pratisarniya kshara - for external application

- According to preparation:-

1. Uttama

2  Madhyama

3. Adhama

- According to Ashtanga Samgraha:-

1. Bahya parimarjana (extternal application)

2. Antah parimarjana (oral intake)

👉🏻 Indications:-

1) Paneeya kshara acts:-

- By neutralizing the gastric acidity

- By stimulating the production of digestive enzymes

- By alkalizing the blood.

- Arshas-hemorrhoids

- Agnisadhyam-indigestion

- Ashmari-calculus.

- Gulma-internal tumor/abscess

- Udara- ascites

- Gara-food poison

- Ajeerna-indigestion

- Arochaka-anorexia

- Anaha-flatulence

- Sarkara-gravel in urine/type of urinary calculus

- Anthar vidhradi-internal abscess

- Krimi-intestinal worms

2) Pratisaraniya Kshara:-

- Masaka-elevated mole

- Bahyarsa-external piles

- Supthi-loss of sensation

- Arbuda-tumour

- Dushta vrunna non healing ulcer.

- Kitibha-skin disease

- Mandala kushta-skin disease/patchy dermatitis

- Charma keela-keloid

- Swithram-leukoderma

- Bhagandharam-fistula in ano

- Graanthi-benign tumor

- Nadi vruna-sinus

- Thilakalaka-phyrynoderma

👉🏻 Mode of action of pratisaraniya kshara:-

- Since it has chedana, bhedana and lekhana gunas kshara can be used as substitute for sastra and it serves three of the eight sastra karma purposes.

- It is made of several herbs, it is tridosha hara and thus shows miraculous effect in diseases like arbuda, granthi etc. which are otherwise incurable.

- It is both soumya and theekshna due to its

visheshakriyavacharana and prabhava.

- Eventhough corrosive it can be used orally with safety in some extra ordinary conditions

- The kshara cause coagulation of the vessels (cauterization of hypergranulation ), necrosis of tissues followed by fibrosis of

plexus, adhesion of mucosal, sub mucosal coat helps in prevention of further dilation of veins. which is ceased by the sclerosing effect of the kshara by it coagulating property of protein.

- Hence there was no chance of bleeding during kshara application.

- The chance of infection is least due to the sustained action of the anti-microbial property of kshara.

- Application of kshara is found to be safe, efficacious and cost effective method for management of internal 1st, 2nd and 3rd

degree haemorrhoids.

👉🏻 Contraindication of Kshara Karma:-

- Disease like:- Raktapitta, Jwara,

- Pittaprakruti patients

- According to physical & mental status-

children, aged debilitated etc.

- According to site- arteries, joints vital parts, cartilages, testis, penis, eye except eyelid etc.

- According to season in summer, autumn and claudy seasons.

- Neither of two forms should be made use of during aggravation of pitta and rakta and dimished vata in fevers, diarrhoea, diseases of heart and head anaemia, blindness, in those who have been administered purifactory therapies.

- Who have swelling all over the body,

who are pregnant, the menstruating woman,

woman who has difficult menstrual flow. when food remains undigested, for infants and old persons.

- On places of the body such as arteries, joints,vulnerable spots, cartilages,veins tendons, nerves, sutures, throat umbilicus,

places,which are poor of musles, testis, penis, orifices, passages, interior of the nails, in diseases of the eye, during cold, rainy and hot seasons and on days when sun is not seen.

👉🏻 Ksara anarha:-

- Cauteisation by alkali should not be done for persons such as,

• debilitated

• children

• old aged

• fearful

• suffering from swelling all over body

• enlargement of abdomen

• bleeding diseases

• pregnant lady

• woman during menstruation

• advanced stage of fever

• injury to chest(lungs),

• emaciation injury

• thirst,

• fainting

should be deemed unfit for cauterized with alkalies.

- More over their application not to be sanctioned over vital spots

veins, ligaments, joints, cartilagers, sutures, arteries, throat,

umbilicus, genitals, nailbed, places, with less muscles and in

diseases of eyes, except those which affect the eyelids.

- Kshara may produce in excess proportion causing harmful

effect on the hair, eyes, heart as well as virility.

- Therefore kshara should not be taken in excess.

It is agreed upon all that kshara should not be used in pitta and

rakta by people of weak mind and constitute.

- It should also not be used on organ of the body which is delicate

in nature such as in arterial disease, marasmus, joints, ear lobule,

and vein, and ligament, umbilicus, in part of body relatively with

less muscle and in texture.

👉🏻 Pakya kshara/tikshna kshara:-

- Danti dravanthi chitraka laangali putika, bida,suravacika, kanakakshiri, hingu, vacha and ativisaall or as many as available, each equal in quantity of one sukti (20g) are made into fine powder and added;this is prativapa (addition of extra drug to enhance the properties).

- When kshara (alkali) is prepared with prativapa it is called pakya kshara or the teekshna kshara of strong potency.

- According to vagbhata it should be used after a lapse of seven days.

👉🏻 Indication of tikshna kshara and madhyama kshara:- 

• क्षारतीक्ष्णोऽनिललेष्मेदाजोवर्बुदादिषु । (A.H.Su. 30/12)

- Vata kapha medhodushti rogas 

- Yapya and asadhya rogas like arbudas etc

👉🏻 Indication of mrudu kshara:-

• अन्यः पित्तासगुदजन्मसु II     (A.H..Su. 30/13)

- Disease due to increasd pitha rakta, heamorroids are indicated

👉🏻 Drugs for making kshara:-

- Apamarga

- Snuhi

- Palasha

- Putheeka 

- kutaja

- Aragvadha

- Agnimantha 

- Nimba 

- Paribadra 

- Tilvaka 

- Patala 

- Kadali

- Asvamaraka 

- Kosathaki 

- Arka

- Naktamala 

- Chitrak

- Gunja

• For madhyama kshara

- Bhasma 

- Sharkara 

- Shukthi

- Sudhasma bhamsa

- Sankha nabhi

• For teekshna kshara:-

- Danti 

- Sajakshara 

- Ativisha

- Langali 

- Drawlvanti

- Karanja 

- Hingu 

- Swarnaksheeri

- Bida lavana

- vacha

👉🏻 Definitions of Samvyuhana / mrudu and Pakya/tikshna Kshara:-

1) Samvyuhima kshara/ Mrudu kshara:-

- The kshara itself if prepared without prativapa (adding paste of other drugs/with only kshara- ash) is called as samhvyuhima or mrudukshara.(alkali of mild potency).

2) Pakya kshara/ Teekshna kshara:-

- Danti dravanti etc are the prativapa, when kshara is prepared with this prativapa it is called pakya kshara/teekshana kshara.

- These mrudu and teekshana are to be used according to the strength of the disease.

• Element:-

- sodium, potassium, calcium, magnesium. iron,aluminum, carbon, sulphur, silica, phosphorus etc.

• pH Value:-

1. Mridu 8.4

2. Madya 9.2

3. Tikshna 9.4

• Properties of kshara:-

- Rasa: Katu

- Veerya: Ushna

- Varna:Sukla

- Guna: Soumaya, teekshana, Agneya

- Doshagna: Tridoshagna

- Karma: Dahana, pachana, darana, vilayana, shodhana, ropana,

shoshana, lekhana, bedana, chedana

- Colour of ash: greyish white

- pH is the negative logarithm of hydrogen ion concentration in an

aqueous solution.

- A neutral solution has a ph of 7,

where is any acidic solution has ph of less than 7 and

 for alkaline solution the ph is more than 7.

- Ph meter used to analyse and measure pH.

👉🏻 Procedure of Kshaara Karma (pratisarana):-

(1) Poorva karma (Preoperative Preparation)

(2) Pradhana karma (Operative Procedure)

(3) Paschat karma (Post Operative Procedure)

1. Purva Karma:-

- During the poorva karma the physian chooses the place (the place should be devoid of breeze and sunlight), where Kshara Karma can be applied.

- The place should be closed, it should have much space.

- He makes sure that all the appliances necessary for Kshara Karma are there in proper condition or not.

2. Pradhana karma:-

- The physician first examines the case thoroughly & decide the dosha and dushya of disease.

- Later on

• lekhana for vata

• gharsana for pitta and

• prachhana for khapha dosa is given and with the help of rod ,darvi or brush, Kshara is applied.

- After the application, one must count the hundred numbers (approximately one minute).

- Kshara is applied with shalaka which has been cemented with gauze or cotton.

3. Paschat karma:-

- If physician is satisfied after the application that proper dagdha (burning) has been made; he should wash out the kshara by amla (acid) dravya.

- Falling of the diseased part and development of black colour at the site are the signs of good cauterization.

- Later on honey and ghee should be applied after that it should be washed out with amlavarga like milk. dahi and kanji in the

last wound healers drugs should be given with ghee.

- Teekshna (Strong) kshara should be applied in disease as Arbuda and in disease originating from vata kapha and medo roga.

👉🏻 Kshara Dagdha lakshana/signs of burning (cauterization):-

1. Samyak dagda (proper cauterisation):- 

• तत्र सम्यग्दग्धे विकारोपशमो लाघवमनास्त्रावश्च ।

- Mitigation of the disease (subsiding of symptoms like pain, swelling etc.),

- feeling of lightness of the diseased part) and

stoppage of exudations are the symptoms of samyak dagdha (proper cauterisation).

2. Heena dagda lakshana (inadequate cauterization):-

• हीनदग्धे तोदकण्डुजाड्यानि व्याधिवृद्धिश्च  ।

- Pricking pain.

- Itching,

- loss of movement and increase of the disease (aggravation of symptoms) are the symptoms of heena dagdha lakshana.

3. Atidagdha (faulty/complicated cauterization):-

• अतिदग्ये दाहपाकारागस्रावाङ्गमर्दक्लमपिपासामूच्च्छाः स्यूमरणं वा ।

- In case of athidagda there will be burning sensation,ulceration, and redness, exudation, twisting pain in the body part, exhaustion,

severe thirst, fainting and even death

👉🏻 Kshara karma in piles:-

- Those which are soft, broad deep seated and bulged up are to be treated with kshara.

- Piles with vata kapha are treated with agni karma &/ teekshna kshara and piles with pitta rakta treates with mrudu kshara.

✓ Kshara dagda lakshana in piles:-

1. Samyak dagdha:-

- Downward movements of flatus

- desire for food,

- increase of hunger

- feeling of lightness,

- restoration of strength and blissful in mind are symptoms of

samyakdagda.

2. Atidagdha:-

- Tear in the anus

- burning sensation

- fainting

- fever

- thirst

- heavy bleeding and

complications consequent to it are the symptoms.

3. Heena dagdha:-

- Pile mass becoming black

- developing a small wound

- itching

- irregularity of vata (pratiloma vayu)

- absence of calmness of the sense organs and (indriya aprassanata)

- non mitigation of the disease (vikara ashanti) are the symptoms of heena dagdha

- For grahani- paneya kshara

👉🏻 Action of kshara karma:-

- Coagulation of protein disintegration of haemoglobin-haem &

globin-blackish brown discharge-sloughing-re epithelialization.

- In cauterization-necrosis-slough out-fibrosis-scar formation-

obliteration haemorroidal vein complete healing.

👉🏻 Complication of kshara karma /atidagdha:-

- Bleeding, fainting, burning sensation, fever etc are the

symptoms of atidagdha.

- In anus athidagdha especially produces obstruction or passing

of faeces and urine or their excess elimination, loss of muscular

and sexual power and death surely by the destruction of the

rectum.

- In case of nose, there will be severe burning sensation, loss of

sense of smell, similar is the case of ear.

👉🏻 Treatment for atidagda / complication with kshara:-

- In the atidagda dhara with amla (sour fluids) rasa dravya and

lepana with honey, ghee and tila as well as vata pitha shamana

procedures are applicable

- As amla which is sheeta (cold) to touch when combines with

alkali attain the pr operties of madura taste

👉🏻 Kshara modern view:-

- In modern medicine kshara alkali can be used

1. To reduce the gastric secretion before food intake

2. To act as antacid in peptic ulcer etc.

3. To protect the gastric mucosa

4. To increase ph of blood in ketosis, acidosis

5. As diuretic

6. As mucolytic expectorant in bronchial asthma

7. Antiflatulant and carminative

👉🏻 Ksharasutra application:-

- Probing, incision, caustic alkali, and thermo cautery are mentioned as the general line of treatment in chakradhatta.

- Caustic ligature (Ksharsutra) is mentioned in a major text books on ayurveda like Sushruta Samhita, ashtanga samgraha etc.

- Today it has proved to be equally effective or perhaps even more effective than available modern methods of management in sinus & fistula in ano.

✓ Indication:-

• कृशदुर्बल भीरुणां नाड़ी मर्माश्रिता च या ।

क्षारसूत्रेण तां च्छिन्द्यान्न तु शस्त्रेण ।

(Su.chi. 17/29)

- In persons who are emaciated, weak and frightful and if the ulcer is present in vital organs, the wise physician should cut open the sinus by using kshrasutra and not using sharp instruments.

✓ Method of preparation:-

- Thread that coated with latex of Euphorbia, haridra & Kshara (Apamarga) 7 times respectively for total of 21 times in 21 days.

- The thread which is non dissolvable acts as drainage, thus the wound kept clean.

- Cutting also take place with tightening of the thread due to the help of kshara & snuhi ksheera, antimicrobial & anti inflammatory action by haridra gives cutting and healing simultaneously.

- In reference text of cutting seton chemical cautery using an ayurvedic method known in india as kshara sutra, in which a specially prepared seton thread burns through the enclosed circle.

✓ Method of application:-

- The sinus is probed with help of a probe (malleable or copper), then introduce the needle (blunt part) having the alkali thread (at another end/ distal end) till the end of the sinus is reached the needle is then lifted up, the end (front tip) of the thread is pulled out and tight knot tied.

- After considering the strength of the alkali, another thread soaked/smeared with alkali may inserted (after removing the first one by rail. rode method) by the physician till the sinus gets cut.

👉🏻Collection of kshara herb:-

- In sharada ritu

- Madhyam aayu aushadha

- 1st day abhimantrita mantra

- 2nd day collection in small pieces in dry storage

- Burnt whole panchanga with lime stones and tila nala

- After burn separate all ash (kshara)

👉🏻 Making of kshara:-

- Kshara (1 drone) dilute with 6 drona water / cow urine (tikshna kshara)

- 21 times cloath filtration

- Kshara paka till a slimy (Nirmala),reddish, clear and penetrating alkline material obtained

- In case of making madhyam kshara, kata sharkara, bhasma sharkara, jala shukti, shankh naabhi added in kshara jala (after

red hot powder process)

• In the case of tikshna kshara prativapa should be add i.e. danti, drawanti, chitraka, langali, pootika, bid lavana, suvarchika,

kanaka kshiri, hingu, vacha , ativisha.