Become A Member

Introduction: Kshara Karma, an Ayurvedic para-surgical procedure employing alkaline preparations, has been a cornerstone in the management of anorectal disorders such as Arsha (hemorrhoids), Bhagandara (fistula-in-ano), and Nadivrana (sinus). Acharya Sushruta described Kshara as the most superior among surgical and para-surgical tools, owing to its ability to excise, incise, and drain without significant complications. Over centuries, Kshara Karma has evolved from crude herbal alkali applications to standardized therapeutic interventions validated through clinical research. Methods: A literature review was conducted using classical Ayurvedic texts (Sushruta Samhita, Ashtanga Hridaya, Chakradatta), commentaries, and modern surgical treatises. Databases including PubMed, Scopus, AYUSH Research Portal, and Google Scholar were searched with keywords: “Kshara Karma,” “Ayurveda anorectal surgery,” “Ksharasutra therapy,” and “alkaline cauterization.” Inclusion criteria comprised experimental studies, randomized controlled trials (RCTs), review articles, and clinical reports on anorectal disorders. Non-scientific articles and anecdotal evidence were excluded. Results: Classical texts detail two primary applications of Kshara: Pratisaraniya Kshara (topical application) and Apamarga Ksharasutra (alkali-coated thread). Historically, Kshara Karma was applied in hemorrhoids, fistula-in-ano, and sinus diseases with significant efficacy. Modern validations highlight Ksharasutra therapy as a minimally invasive, cost-effective alternative to conventional fistulectomy, reducing recurrence rates and improving wound healing. Comparative studies show Kshara Karma to be superior or complementary to modern surgical techniques in select cases. Discussion: Kshara Karma demonstrates remarkable continuity from ancient to modern surgical practice. Its mechanisms align with cauterization, chemical debridement, and seton therapy in contemporary medicine. However, large-scale RCTs, long-term outcome data, and standardization of formulations are needed for wider global acceptance. Conclusion: The evolution of Kshara Karma highlights Ayurveda’s scientific foresight in anorectal surgery. With further validation and integration into modern surgical frameworks, it holds promise as a globally accepted minimally invasive therapy.

KEYWORDS: Anorectal disorders, Ayurveda, Fistula-in-ano, Hemorrhoids, Kshara Karma