3. Dr. P. Hemantha Kumar M. S.(Ay) Dip.Yoga, (Phd) Prof. & HOD Dept. 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

4. Piles / Haemorrhoids can affect anyone, anytime, anyplace and anywhere. Commonest disease in Anorectal region. Recent statistics reveals that irrespective of age, sex, socio-economic status, people suffer from piles. Now a days every person suffered from any one of the complaint of piles during their life time.

5. Kshara is a caustic chemical, alkaline in nature obtained from the ashes of medicinal plants. It is a milder procedure compared to surgery and thermal cautery. It is the superior most among the sharp and subsidiary instruments because of performing excision, incision and scraping. Used safely on the patients who are afraid of surgery.

6. CLASSIFICATION 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

7. INGREDIENTS OF KSHARA APAMARGA – Achyranthes aspera

8. Sukti – Lime stone

9. Chitraka - Plumbago gelanica

11. Dried Apamarga plant (Achyranthes aspera) (5 kg) Burnt Burnt 500 gms of Achyranthes aspera Ash Add 6 times of water (3 liters) Add 6 times of water (3 liters) Filtered 21 times through cloth To get clean and clear solution – Cows urine colour To get clean and clear solution – Cows urine colour (slight reddish) (slight reddish) METHOD OF PREPARATION OF PRATISARANEEYA TEEKSHANA KSHARA (High concentration Kshara)

12. Filtrate Solution was boiled and evaporated Heating up to 2/3 remains Heating up to 2/3 remains Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga (Achyranthes aspera) filtrate solution Continuous mild heating Continuous mild heating Liquid evaporates to 1/3rd of its original quantity Add 1/10th (5gms) of Chitraka Kalka (Plumbago gelanica) PRATISARANIYA TEEKSHANA KSHARA (High concentration Kshara)

13. PREPARED KSHARA

14. PROPERTIES OF KSHARA It is having pungent, hot, sharp and digestive property. It does cauterizing, digesting and splitting actions. Externally it has Cleansing, Heating, Absorbent and Scraping properties. PH value of Teekshna Apamarga Kshara is 13.5.

15. INDICATIONS OF KSHARA IN PILES Soft, spread out, Soft, spread out, deep rooted & deep rooted & elevated type of Piles elevated type of Piles Internal Haemorrhoids – First degree, Second degree and Third degree. Internal Haemorrhoids – First degree, Second degree and Third degree.

16. 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 KSHARA

17. INSTRUMENTS

18. Patient is in lithotomy position L. A. / S. A. L. A. / S. A. Part cleaned with aseptic solutions Part cleaned with aseptic solutions Introduce lubricated slit Proctoscope into the anus and pile masses bulges in Pile mass should be scraped or rubbed with cloth or a cotton swab with warm water Operative

19. Kshara applied on internal piles Wait for 1- 2 min Pile mass turns to the colour of Pakva Jambhuphala (ripened black berry fruit) - Reddish black in colour Jambhuphala (ripened black berry fruit) - Reddish black in colour Pile mass washed with Lemon juice Pile mass washed with Lemon juice Apply Yashtimadhu Ghrita & Apply Yashtimadhu Ghrita & Proctoscope is removed Proctoscope is removed Rectal pack with Anu taila or Mahanarayana taila Rectal pack with Anu taila or Mahanarayana taila

20. 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

21. BEFORE DURING BEFORE AFTER

22. KSHARA KARMA – CAUSTIC CAUTERY

23. Before Application

24. During Application

25. After Application

26. MECHANISM OF ACTION OF KSHARA IN HAEMORRHOIDS

27. HISTOPATHOLOGICAL SLIDE OF SLOUGH COLLECTED AFTER KSHARA KARMA H.P.E of slough material in blackish brown discharge revealed the presence of necrosed haemorrhoidal tissue.

28. ADVANTAGES 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.

29. COMPLICATIONS Bleeding - Negligible Pain – Mild to moderate pain - relieved by hot sitz bath and oil enema. Discharge – Blackish brown discharge will be occur 5 to 7 days postoperatively. Anal stricture – Improper technique Recurrence – Improper technique

30. Dr P. Hemantha Kumar www.proctocure.com