E-ISSN:2456-3110

Review Article

Tilwaka Ksharasutra

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

A conceptual study on effect of Arka Ksheera based Tilwaka Ksharasutra in the management of Bhagandara

Jain S.1*, Shilpa P.2
DOI:

1* Shrenik Jain, Post Graduate Scholar, Department of Shalya Tantra, Govt Ayurveda Medical College, Bengaluru, Karnataka, India.

2 PN Shilpa, Professor, Department of Shalya Tantra, Govt Ayurveda Medical College, Bengaluru, Karnataka, India.

Kshrasutra refers to corrosive or caustic thread. Kshara is considered superior to all surgical and para surgical procedures, because they perform the work of incision, puncture and scarification to relieve the derangements of Tridosha and uniformly affect the diseased part to which they are applied. Ayurveda advocates application of Ksharasutra in Bhagandara, Ksharasutra is being used and researched by various Ayurvedic scholars and is standardized over the years, materials used for preparation of Ksharasutra are Snuhi Ksheera, Apamarga Kshara, Haridra Churna and linen barbour thread no. 20, which is a recent advancement, although standard Apamarga Sutra is used successfully in the management of Bhagandara, problem in its preparation are worth noting, one of the essential component of the Kshara Sutra is Snuhi latex, this creates problems like, it is not available through the year, so these problems have put necessity of further advancement in Ksharasutra, hence in this study Arka Kshera based Tilwaka Ksharasutra is being tried to overcome ailment.

Keywords: Ayurveda, Bhagandara, Tilwaka Ksharasutra, Fistula in ano

Corresponding Author How to Cite this Article To Browse
Shrenik Jain, Post Graduate Scholar, Department of Shalya Tantra, Govt Ayurveda Medical College, Bengaluru, Karnataka, India.
Email: 		Shrenik Jain, PN Shilpa, A conceptual study on effect of Arka Ksheera based Tilwaka Ksharasutra in the management of Bhagandara. J Ayu Int Med Sci. 2023;8(1):78-80.
Available From
https://jaims.in/jaims/article/view/1669

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-22 2022-11-24 2022-12-01 2022-12-08 2022-12-15
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Shrenik Jain, PN Shilpaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)78
Jain S et al: Arka Ksheera based Tilwaka Ksharasutra in management of Bhagandara

Introduction

Bhagandara[2] is one among the Astamahagada[3] mentioned by Acharya Sushrutha due to its grave nature and it is one of the common disease related to the rectal region, treatment for the fistula in surgery has become major challenges to the modern sciences because of its high chance of recurrence and also the post operative complications like pain, wound management and incontinence. So, to combat the severe ano-rectal problems, a comprehensive approach through Ayurveda has been extend with clear and positive outcome.

Prevalence of fistula-in-ano is 8.6 cases per 100000 population, the incidence of fistula-in-ano developing from an anal abscess ranges from 26%-38% which was explained by Sushrutha Acharya, that untreated Vranashopha may lead to Nadivrana[4] or Bhagandara in 500 BC ago.

Acharya Sushruta has explained use of Ksharasutra in the management of Bhagandara. Ksharasutra preparation is first explained by Acharya Chakrapani Dutta, Sushruta mentioned application of Ksharasutra in the Nadivrana and used in the management of Bhagandara in patients of Avara Satva, Vriddha and Garbhini.

Preparation of Tilwaka Ksharasutra
Materials required

a. Arka Ksheera

b. Tilwaka Mridu Kshara

c. Haridra Churna

d. Linen Barbour thread No. 20

Method of preparation of Ksharasutra
Ksharasutra will be prepared by using Barbour surgical linen thread no. 20, initially thread will be coated with 11 coating of Arka Ksheera and dried after each coating. 7 coatings of Arka Ksheera and Tilwaka Kshara is applied consequently and dried after each coating, followed by 3 coatings of Arka Ksheera and Haridra is applied and dried, thus prepared Ksharasutra are exposed to UV rays and stored in air tight container.

Procedure of application of Ksharasutra
In the procedure of Ksharasutra application patient is made to lie in lithotomy position under aseptic measures probing and primary

threading will be done. After 2 days primary thread is replaced by Ksharasutra in rail road method and ligated adequately tight. On every 7th day Ksharasutra change is done, length is measured in every sitting and observation should be made till complete healing and cutting of the tract.

jaims_1669_01.JPGjaims_1669_02.JPGjaims_1669_03.JPGjaims_1669_04.JPG

Discussion

Properties of Arka Ksheera based Tilwaka Ksharasutra

Arka which is Laghu, Rooksha, Teekshna and having the Prabhava like Krimihara, Arshohara and its acts as good binding agent and can be stored for long time compared to Snuhi latex.



Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)79
Jain S et al: Arka Ksheera based Tilwaka Ksharasutra in management of Bhagandara

Tilwaka which is mentioned as Kshariya Dravya by both Sushrutha[5] and Vagbhata.[6] It is Kaphapitta Shamaka, Vrana Ropaka and Rakta Sthambaka. As per research conducted in various institutes glycosides from Tilwaka showed spasmolytic activity and Spinastrol isolated from stem bark of Tilwaka showed significant anti-inflammatory effect.

Haridra is having Krimihara properties, the antibacterial effect of turmeric helps in avoiding secondary infection of the wound.

The drugs used in the preparation of this Ksharasutra are easily available. One can prepare it easily and can be used in clinical practice. The combined effect of all the 3 medications on Ksharasutra helps in lysis of the tissue. Recurrence is the most common complications of fistula-in-ano. So, we can use cost effective, safe, simple procedure of Ksharasutra which is gaining importance day by day.

Conclusion

Since Ksharasutra is considered as simple, safe, and minimally invasive para surgical procedure, it can be used in Bhagandara and also in Shalyaja Nadivrana. Tilwaka which is Kshariya Dravya having properties mentioned above the combined effect of the both drugs will cut the tract and heal and then by closing the tract. By considering all these factors, Tilwaka Ksharasutra can be taken up in Bhagandara for purpose of study and results can be evaluated.

Reference

1. Acharya Sushruta. Sushruta Samhita with Nibandhasangraha commentary of Sri Dalhanacharya, Edited by Vaidya Yadavji Trikamji Achraya. Chaukhamba Surbharati Prakashan, Varanasi. reprint 2008, Sutra Sthana, Chap.11, Verse 11, Pp-824, Pg-46.

2. Sri Chakrapanidatta. Chakradatta with Vaidyaprabha Hindi Vyakhya by Indradeva Tripati. Chaukhamba Samskrth Samsthan, Varanasi. reprint 2005, Chapter 5, Verse 148, Pp-542,Pg-66.

3. Acharya Sushruta. Sushruta Samhita with Nibandhasangraha commentary of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya. Chaukamba Surbharati Prakashan, Varanasi. reprint 2008, Sutra Sthana, Chap.33, verse 4,Pp-824, Pg-144.

4. Acharya Sushruta. Sushruta Samhita with Nibandhasangraha commentary of Sri Dalhanacharya, Edited by Vaidya Yadavji Trikamji Achraya. Chaukhamba Surbharati Prakashan, Varanasi. reprint 2008, Chikitsa Sthana, Chap.17, Verse 30-33,Pp-824, Pg-468.

5. Acharya Sushruta. Sushruta Samhita with Nibandhasangraha commentary of Sri Dalhanacharya, Edited by Vaidya Yadavji Trikamji Achraya. Chaukhamba Surbharati Prakashan, Varanasi. reprint 2008, Sutrasthana, chapter 11, Verse 11, page no -47.

6. R. Vaidyanath. Astanga Hridaya of Maharshi Vagbhata with English commentary, Sutra Sthana Chapt 30 Verese 8-19. Chaukamba Surbharati Prakashan, Varanasi. page no 413.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)80