Kshara Karma in diseases of Shalakya Tantra - Case Series

SN Raju

Kshara Karma is one of the Anushastra Karmas popularly understood as Para surgical procedures. It’s an outstanding contribution of Acharya Sushruta. The surgical disorders which are mentioned in the Shalakyatantra are also can be managed with the Kshara Karma with ease and comfort for both surgeon and patients. In the clinical practice of Shalakya Tantra, there is a need of adopting this procedure for effective management of disorders such as Jalarbuda, Upajihwa, Adhijihwa, Upakusha, Dantavaidharbha, Rohini, Nasarsha, Karnarsha, and Pakshmakopa. This procedure is simple, safe, effective with minimal or no complications, and easily acceptable to the patients. Long-term follow-up is essential to know its results. The patients get clinically meaningful improvement by Kshara Karma along with internal medicines and dietary restrictions. Adopting the Kshara Karma followed by internal medicines will prevent recurrence/relapse with a high cure rate with no adverse effects.

Corresponding Author

How to Cite this Article

To Browse

SN Raju, Assistant Professor, Department of PG and PhD Studies in Shalakya Tantra, Shree Jagadguru Gavisiddeshwara Ayurvedic Medical College, Koppal, Karnataka, India.
Email:

SN Raju, Kshara Karma in diseases of Shalakya Tantra - Case Series. J Ayu Int Med Sci. 2022;7(8):186-190.
Available From
https://www.jaims.in/jaims/article/view/1969

Manuscript Received

Review Round 1

Review Round 2

Review Round 3

Accepted

2022-07-30

2022-08-01

2022-08-08

2022-08-15

2022-08-22

Conflict of Interest

Funding

Ethical Approval

Plagiarism X-checker

Note

Nil

Yes

19%

Introduction

Kshara^[1]is a caustic, alkaline in nature obtained from the ashes of medicinal plants. It is a milder procedure compared to surgery and thermal cautery.^[2]

It is superior among the sharp and subsidiary instruments because of performing excision, incision, and scraping. It is versatile because even such places that are difficult to approach by ordinary measures can be treated by Kshara Karma. Kshara Karma is useful as a substitute for surgical instruments because it can be used safely on patients who are afraid of surgery. Many diseases are mentioned in Shalakyatantra where Kshara Karma is the first line of management such as Jalarbuda, Upajihwa, Adhijihwa, Upakusha, Dantavaidharbha, Rohini, Nasarsha, Karnarsha, and Pakshmakopa. Using Apamarga kshara the following cases like Jalarbuda (Mucocele) Nasarsha (nasal polyp) Aural keloid, and Gingival hyperplasia have been treated, and patients got a high rate of cure with no reoccurrence.

Methodology

Literary review method of preparation and clinical use of Pratisaraniya Kshara in clinical practice are described in the present article.

Classification^[3]

Based on administration;
- Pratisaaraneeyakshara - external application
- Paneeyakshara - internal administration
Based on concentration - mild, moderate, and highly

Preparation^[4]

The Panchanga (whole plant) of Apamarga (achyranthes aspera) 5 kgs should be collected, dried up, and burnt.
The whole ash of 500 gms was collected and mixed with 6 times (approx 3 liters) of water and supernatant water is filtered 21 times.
The filtrate is clean and clear like the color of cow’s urine and it is kept on mild fire and the liquid evaporates to 1/3rd of its original quantity.
This is known as Mridu or mild concentrate Kshara.

Then add 50 gms of red hot shukti (limestone) to the filtrate solution and continuously stirred well until it evaporates to 1/3rd of its original quantity.
This is known as Madhyama or moderate
This should be further heated up by adding 5 gms of Chitraka Kalka (plumbago zeylanica).
This thick solution is obtained which is known as Pratisaraneeya Teekshana or highly concentrated Kshara.
It will be collected and stored in an airtight container.

Indications

1. Paneeya Kshara - Mild concentrate Kshara is used internally in worms, indigestion, urinary calculus, skin diseases, obesity, etc.

2. Pratisaraneeya Kshara - Highly concentrated Kshara is used for external applications in Urdhwa Jatrugatha Vikaras.

Application of Pratisaraneeya Teekshana Kshara^[5]

First, explain the procedure to the patient and patient attendees.
Obtain consent to perform the procedure.
The area where Kshara has to be applied is anesthetized with local or topical spray.
Kshara is applied over the mass and waited for 2 minutes or until the mass turns to the color of Reddish black (Pakwa Jambu Phala Varna).
After this process, the mass must be washed with lemon juice to neutralize the
After attaining the Samyak Dagda Lakshana Jathyadi Tail or Ghrita is applied.

Advantages of Kshara Therapy

Postoperative pain is mild in intensity
No bleeding
Minimum hospitalization - can be done under daycare
No scope for recurrence
The patients who are suffering from Systemic diseases are also can undergo Kshara Karma.

Case-1

A 20-year-old female patient came to the Shalakya outpatient department with complaints of a progressive lesion located on the right pinna which is not painful and which is recurrent after the first excision.

The patient has been suffering for 2 years. She noticed slight elevation at the sight of ear piercing. The patient was diagnosed as having a “recurrent infected aural keloid” On examination, the lesion is expanding in nature. There was no vesiculation or oozing. There was no history of discharge from the mass. The patient was not having any addictions and she was nondiabetic. Her vital signs were stable, and on systemic examination, there was nothing abnormal.

The mass was superficial firm and hard in consistency, tender while pressing, mobile, and 5mm × 5 mm × 4 mm in size. Initially, the keloid was removed surgically and Apamarga Kshara was applied over the lesion it was repeated two times and Tab Nimbadi Guggulu 1 tid was given orally for seven days and there was no reoccurrence noted even after four months of follow-up.

Case- 2

A 45-year-old female patient came to the Shalakya outpatient department with complaints of swelling in the upper gingiva above the incisor tooth for three months and which is not painful The patient was diagnosed as having a “gingival hyperplasia” On examination, the lesion is expanding in nature. There was no vesiculation or oozing.

There was no history of discharge from the mass. The patient was not having any addictions and she was nondiabetic. Her vital signs were stable, and on systemic examination, there was nothing abnormal.

The mass was superficial firm and hard in consistency, elevated with regular borders, shiny, non-tender while pressing, non-mobile and there was no bleeding on touch the size of the lesion was 3mm × 3 mm × 2 mm in size. Three sittings of Apamarga Kshara were applied and Tab Nimbadi Guggulu 1 tid was given orally for seven days, after three sittings of application, there was complete regression of the lesion.

Case- 3

A 30-year-old male patient came to the Shalakya outpatient department with complaints of complete nasal block in the left nostril for three months and he was a known case of a nasal polyp where he had undergone polypectomy three years back the patient was diagnosed as having an “ethmoidal polyp”. The patient was not having any addictions and she was nondiabetic. Her vital signs were stable, and on systemic examination, there was nothing abnormal. On examination in anterior rhinoscopy, a large mass was shiny smooth, and greyish in color and soft in consistency, insensitive on probing and there was no bleeding on touch CT PNS shows a polypoidal mass in the left nostril. Four sittings of Apamarga Kshara were applied on the polypoidal mass with the interval of three

Case- 4

A 17-year-old female patient came to the Shalakya outpatient department with complaints of swelling in the lower lip for three weeks and it was non-tender, mobile, and pale in color. The patient was not having any addictions and she was nondiabetic. Her vital signs were stable, and on systemic examination, there was nothing abnormal. Here three sittings of Apamarga Kshara were applied on the mucocele with the interval of three days and Tab Nimbadi Guggulu 1 tid was given orally for seven days, after three sittings of Kshara application there was complete regression of the mucocele was noted.

Discussion

Pratisaraneeya Teekshna Kshara was applied to the masses on different cases of Urdhwajatrugatha Vikharas as mentioned in the above case reports. It was observed that the mass color changed to Pakwa Jambu Phala Varna as described in the Sushruta Samhita and later Lemon juice (citric acid) was used to neutralize the Kshara after proper burning of mass. Due to the properties^[6] of Kshara like Katu Rasa Ushnaveerya, Teekshna, and Agneyaguna and Tridoshahara properties will yields to actions like Dahana, Pachana, Darana, Vilayana, Shodhana, Ropana, and Shoshana so by these Karmas the mass/ growth undergoes Shoshana, in turn, it will lead to regression of the mass. Pratisaraneeya teekshna kshara causes coagulation of mass due to the effect of cauterization, necrosis of tissue followed by fibrosis, adhesion of mucosal, submucosal coat helps in prevention as well regression of size of the mass.

Conclusion

Pratisaraneeya Teekshna Kshara was found effective in all the above-treated cases. Even after three follow up there was no reoccurrence and in Nasarshas, there was a decrease in the nasal block due to a decrease in the size of the polyp these results themselves show the positive effect of the Kshara and the effect of Kshara depends on its Ph. These case studies show that a combination of Kshara Karma, conservative treatment (Shamana Aushadhis), diet restrictions, and lifestyle modifications administered over a period of time effectively in the treatment of different mass as well as preventing recurrence on a long-term basis due to its high rate of cure.

Consent of Patient: Informed written consents of the patients was taken for procedure and publication of the images without disclosing the identity of a patient.

Reference

1. Acharya Sushruta, Sushruta Samhita, by; Prof. K R Shrikanthamurthy, Choukambaorientalia, Reprint edition; 2012, chap 11, shloka 3; p.63.

2. Acharya Sushruta, Sushruta Samhita, by; Prof. K R Shrikanthamurthy, Choukambaorientalia, Reprint edition; 2012, chap 11, shloka 4; p.63.

3. Acharya Sushruta, Sushruta Samhita, by; Prof. K R Shrikanthamurthy, Choukambaorientalia, Reprint edition; 2012, chap 11, shloka 11; p.63.

4. Acharya Sushruta, Sushruta Samhita, by; Prof. K R Shrikanthamurthy, Choukambaorientalia, Reprint edition; 2012, chap 11, shloka 11; p.63.

5. Acharya Sushruta, Sushruta Samhita, by; Prof. K R Shrikanthamurthy, Choukambaorientalia, Reprint edition; 2012, chap 11, shloka 11; p.65.

6. Acharya Sushruta, Sushruta Samhita, by; Prof. K R Shrikanthamurthy, Choukambaorientalia, Reprint edition; 2012, chap 11, shloka 5; p.63.

Case Report

Kshara Karma

Journal of Ayurveda and Integrated Medical Sciences