E-ISSN:2456-3110

Review Article

Chitraka Kshara

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

Role of Chitraka Kshara in Abhyantara Arshas - A Literary Review

Anushree K.1*
DOI: http://dx.doi.org/10.21760/jaims.8.3.14

1* K. Anushree, 1st Year Post Graduate Scholar, Department of Shalyatantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Kuthpady, Udupi, Karnataka, India.

The present sedentary lifestyle, irregular food intake, prolonged sitting or standing and psychological problems has affected quality of life. Hemorrhoids are one such disease which is co-related to Arshas. The change in lifestyle has caused increase in the prevalence of this disease. It may occur at any age but mostly seen in the age between 30-65 years. Incidence is equal in both the sexes. Prevention of this is done by healthy diet and lifestyle modifications. Arshas is an abnormal fleshy overgrowth in Guda which is caused due to Virudhaahara Sevana, Adhyashana, Uttkatukasana, Vegadharana, Sahajaani etc. leading to derangement of Tridosha. Treatment of Arshas is of 4 types and Kshara Karma is one among them. Kshara Karma is indicated where Arshas Ankura is Mridu, Prasruta, Avagada and Uchritha. Kshara is considered superior among Shastra and Anushastra due to its property of Chedana, Bhedana, Lekhana and Tridoshagna. Chitraka being mentioned in preparation of Kshara and has Arshohara, Lekhana, Krimighna property. Considering all these factors an effort is made to substantiate the role of Chitraka Kshara and its probable mode of action in Arshas.

Keywords: Chitraka Kshara, Kshara Karma, Abhyantara Arshas, Hemorrhoids

Corresponding Author How to Cite this Article To Browse
K. Anushree, 1st Year Post Graduate Scholar, Department of Shalyatantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Kuthpady, Udupi, Karnataka, India.
Email: 		K. Anushree, Role of Chitraka Kshara in Abhyantara Arshas - A Literary Review. J Ayu Int Med Sci. 2023;8(3):81-83.
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https://jaims.in/jaims/article/view/2254

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-24 2023-01-26 2023-02-02 2023-02-09 2023-02-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by K. Anushreeand 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].

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Anushree K: Role of Chitraka Kshara in Abhyantara Arshas A Literary Review

Introduction

Hemorrhoids are dilated veins within anal canal in the subepithelial region formed by radicles of the superior, middle and inferior rectal veins. The prevalence rate of piles is 4.4% in the world, in about 10 million people. It may occur at any age but mostly seen in the age between 30-65 years. Incidence is equal in both the sexes. Hemorrhoids are of 2 types based on location -external and internal hemorrhoids. External hemorrhoid is situated below the dentate line and is covered by skin. Internal hemorrhoid is situated above the dentate line and is covered by mucous membrane. The primary hemorrhoids occur at 3, 7, 11 ‘o’ clock position. Secondary hemorrhoids occur between the primary hemorrhoid. The main symptom is bleeding

Which is bright red, painless and occurs during defecation associated with constipation, prolapse, mucous discharge.[1] Based on prolapse, Hemorrhoids are divided into 4 degrees: 1st degree- bleed only, no prolapse. 2nd degree- prolapse but reduce spontaneously. 3rd degree- prolapsed and have to be manually reduced. 4th degree- permanently prolapsed.[2] Management of piles range from simple dietic regimen to surgical excision. Conservative management like bowel regulation, use of laxative, more fiber diet, sitz bath, local topical applications. Interventional management like injection sclerotherapy, Rubber band ligation, Cryosurgery, Lord’s Anal dilatation, Hemorrhoidectomy has been explained.[3]

Acharya Charaka explains that Arshas is an abnormal fleshy growth in Guda, whereas the word Arshas has also been used for fleshy growth in other sites like Nasa, Karna etc.[4] Arshas is considered as one among Ashtamahagada. Acharya Vagbhata defines Arshas as Mamsa Ankura which occurs at Gudamarga, obstructs the pathway and troubles like an enemy.[5] Acharya Charaka mentioned Meda, Mamsa and Twak as the Adhisthana of Arshas. Arshas is divided as Sahaja and Jatasya-Uttarakalaja Arshas. Sahaja Arshas occurs due to Gudavali-Bija Upaghata and Jatasya-Uttarakalaja Arshas occurs after birth due to unhealthy dietary habits and lifestyle.[6] While describing the Chikitsa of Arsha, Acharya Charaka has listed its two types as Ardra and Shushka. Acharya Sushruta has explained 6 varieties of Arshas - Vataja, Pittaja, Kaphaja,

Raktaja, Sannipataja and Sahaja. It is caused due to Sahajaani, Virudhaahara Sevana, Adhyashana, Uttkatukasana, Vegadharana etc. which lead to the derangement of Tridosha. These aggravated Doshas vitiates Shonita and spreads through Pradhana Dhamani reaches down and lodges in Guda Pradesha and vitiates Gudavali, giving rise to Arshas.[7]

Sushruta has mentioned Chaturvidha Sadhanopaya in treatment of Arshas. They are Bheshaja, Kshara, Agni and Shastrakarma. Kshara Karma is one among them and indicated when Arshas Ankura is Mridu, Prasruta, Avagada and Uchritha [8] and it has property of Chedana, Bhedana, Lekhana and Tridoshagna.[9] Chitraka Kshara is mentioned by Sushruta in preparation of Kshara and has Arshohara, Lekhana, Krimighna property.[10] An effort is made to substantiate the role of Chitraka Kshara and its probable mode of action in Abhyantara Arshas by critical review of literature.

Aims and Objective

To evaluate the role of Chitraka Kshara in Abhyantara Arshas.

Materials and Methods

All the available references regarding Chitraka Kshara and Arshas are studied comprehensively.

Review of Literature

Review on Kshara: Kshara is an alkaline herbomineral extract that is applied on the pile mass to induce thrombosis. Kshara is considered superior among Shastra and Anushastra, due to its property of Chedana, Bhedana, Lekhana and Tridoshagna. Kshara is classified on the basis of their mode of application as Pratisaraneeya (external use) and Paneeya (internal use) Kshara.[11] The Pratisaraneeya Kshara is further divided into three types, Mridu (mild in action), Madhyama (moderate in action) and Teekshna (strong in action). Various medicinal drugs for preparation of Kshara are mentioned like Apamarga, Snuhi, Chitraka, Palasha, Vibhitaka, Arka, Kadali, Aragwada etc.[12]

  • Properties - Katu Rasa; Usna Veerya;
  • Guna - Teekshna, Agneya.
  • Doshagna - Tridoshagna.

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  • Karma - Dahana, Pachana, Darana, Vilayana, Shodhana, Ropana, Shoshana, Lekhana.[13]

Review of Chitraka: Chitraka has Katu Rasa; Ruksha, Ushna Guna; Katu Vipaka; Vata Sleshmahara, Kapha Pittahara property.

  • Botanical name - Plumbago zeylanica
  • Family - Plumbaginaceae.
  • Chemical Composition - Plumbagin.
  • Synonyms - Analanama, Paati, Vyalah, Ooshana, Daaruna, Agnika, Deepaka, Paatinah.
  • Therapeutic uses - Arshohara, Lekhana, Krimighna, Graahi, Pachaka, Agnidipana, Kushtagna, Shothagna, Rasayana.[10]

Method of preparation of Kshara

The Panchanga (whole plant) of Chitraka (Plumbago zeylanica) should be collected, dried up and burnt. The whole ash should be added with 6parts of water/ Gomutra and filtered 21 times. The filtrate should be clean and clear like Gomutra Varna and it is kept on mild fire and liquid evaporates to 1/3rd of its original quantity. This is known as Mridu Kshara. Then add 1/10th 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 Kshara. This should be further heated up by adding 1/10th of Chitraka Kalka (Plumbago zeylanica). It attains consistency of not too liquid or too solid. This is known as Teekshana Kshara.[14] It is collected and stored in air tight container

Discussion

Action of Pratisaraneeya Kshara in Arshas

Pratisaraneeya Kshara acts on Hemorrhoids in two ways – It coagulates the pile mass directly because of its Ksharana Guna. It coagulates protein in Hemorrhoidal plexus. The coagulation of protein leads to disintegration of Hemoglobin into heme and globin. Synergy of these actions results in decreasing the size of the pile mass. Further, necrosis of the tissue with obliteration of Hemorrhoidal radicles and vein will occur. This necrosed tissue slough out as blackish brown discharge for 3 to 7 days. The heme present in the slough gives the discharge its color. The tissue becomes fibrosed and scar formation is seen. Complete wound healing with no recurrence of hemorrhoids is seen.[15]

Conclusion

Kshara Karma is a minimally invasive procedure. It destroys the unhealthy tissues and promotes healing process. The Kshara preparations have therapeutic and pharmaceutical uses and even proved to be effective in treating many disorders. Application of these preparations has replaced surgical procedure. Many researches also reveal that Kshara therapy not only minimizes complication but also reduces recurrence of diseases with minimal side effects. Healthy diet and lifestyle modifications can prevent the recurrence of disease.

Reference

1. Das S, The Rectum and Anal Canal. A Concise Textbook of Surgery. 11th ed. Kolkata: S Das; 2020:1074- 7.

2. Bailey HH, Love RJ, editors. The Anus and the Anal Canal. Baileys and Love’s Short Practice of Surgery, 27th ed. vol2. Boca Raton, FL: CRC Press;2017:1355.

3. Bhat SM, Rao P, Joshua TV, Editors. Rectum and Anal Canal. SRB’S Manual of Surgery, 5th ed. New Delhi: Jaypee publications;2017:972.

4. Acharya YT, editor, (3rd Ed). Charaka Samhita by Agnivesha. Chikitsasthana; Arshachikitsa Adhyaya; chapter 14, verse 6. Bombay: Satybhamabai Pandurang, 1941;501.

5. Shastri HS, editor (1st ed.). Ashtanga Hridaya of Vagbhata. Nidanasthana; Arshonidana; Chapter 7, verse 1. Varanasi: Chaukhamba Surbharati Prakashan, 2014; 490.

6. Acharya YT, editor, (3rd Ed). Charaka Samhita by Agnivesha. Chikitsasthana; Arshachikitsa Adhyaya; chapter 14, verse 5. Bombay: Satybhamabai Pandurang, 1941;501

7. Acharya YT, editor, (1st Ed). Sushruta Samhita of Sushruta. Nidanasthana; Arshonidanopakrama: chapter 2, verse 3, 4. Varanasi: Chaukhambha Orientalia, 2019;271.

8. Acharya YT, editor, (1st Ed). Sushrutha Samhita of Sushruta. Chikitsasthana; Arsha chikitsitopakrama: chapter 6, verse 3. Varanasi: Chaukambha Orientalia, 2019;430.


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9. Acharya YT, editor, (1st Ed), Sushrutha Samhita of Sushruta, Sutrasthana: Ksharapakavidhi Adyaya: chapter11, verse3. Varanasi: Chaukambha Orientalia, 2019;45.

10. Pandey G.S, editor, Bhavaprakasha Nighantu of Bhavamishra. Purvakanda; Haritakyadi varga: chapter 1, verse70-1. Varanasi: Chaukambha Orientalia, 2010;21.

11. Acharya YT, editor, (1st Ed), Sushrutha Samhita of Sushruta, Sutrasthana: Ksharapakavidhi Adyaya: chapter 11, verse6. Varanasi: Chaukambha Orientalia, 2019;46.

12. Acharya YT, editor, (1st Ed), Sushrutha Samhita of Sushruta, Sutrasthana: Ksharapakavidhi Adyaya: chapter 11, verse11. Varanasi: Chaukambha Orientalia, 2019;46.

13. Acharya YT, editor, (1st Ed), Sushrutha Samhita of Sushruta, Sutrasthana: Ksharapakavidhi Adyaya: chapter 11, verse5. Varanasi: Chaukambha Orientalia, 2019;45.

14. Kumar PH, Recent trends in the management of Arshas/Haemorrhoids; Kshara Karma: Section1.Delhi: Chaukamba Sanskrit Pratishthan; 2015:33.

15. Kumar PH, Recent trends in the management of Arshas/Haemorrhoids; Kshara Karma: Section 1. Delhi: Chaukamba Sanskrit Pratishthan;2015:39.


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