E-ISSN:2456-3110

Review Article

Preparation of Ksharasutra

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

Preparation of Ksharasutra: A Comprehensive Study on Selection, Preparation and Processing

Ahmed J1*, Barman P2, Medhi C3
DOI: DOI:10.21760/jaims.8.8.22

1* Jakaria Ahmed, Post Graduate Scholar, Shalya Tantra, Govt Ayurvedic College, Guwahati, Assam, India.

2 Pankaj Kumar Barman, Professor and Head, Shalya Tantra, Govt Ayurvedic College, Guwahati, Assam, India.

3 Champak Medhi, Associate Professor, Shalya Tantra, Govt Ayurvedic College, Guwahati, Assam, India.

The Ksharasutra is a specialized Ayurvedic surgical thread renowned for its efficacy in treating anorectal disorders, particularly fistula-in-ano. This paper aims to provide a comprehensive overview of the preparation process of Ksharasutra, focusing on the selection of thread, preparation of Kshara, collection of Snuhi Ksheera, the Ksharasutra cabinet, and the method of sealing. Through a detailed explanation of these essential steps, the purpose of this paper is to enhance the understanding of the complex and comprehensive method involved in developing the Ksharasutra.

Keywords: Kshar, Ksharasutra cabinet, Snuhi Ksheera, Surgical thread

Corresponding Author How to Cite this Article To Browse
Jakaria Ahmed, Post Graduate Scholar, Shalya Tantra, Govt Ayurvedic College, Guwahati, Assam, India.
Email: 		Ahmed J, Barman P, Medhi C, Preparation of Ksharasutra: A Comprehensive Study on Selection, Preparation and Processing. J Ayu Int Med Sci. 2023;8(8):151-154.
Available From
https://jaims.in/jaims/article/view/2699

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-11 2023-06-18 2023-06-25 2023-07-02 2023-07-15
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.65

© 2023by Ahmed J, Barman P, Medhi Cand 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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Introduction

The Ksharasutra, an integral component of Ayurvedic surgical interventions, is renowned for its therapeutic efficacy in anorectal disorders. This study explores the meticulous preparation process, emphasizing the significance of key aspects like selection of thread, Kshara preparation, collection of Snuhi Ksheera, the Ksharasutra cabinet, and effective sealing methods.

Material and methods

1. Selection of thread

The choice of surgical thread (Sutra) plays a pivotal role in the preparation of Ksharasutra. A sterile, excellent quality  thread  with  appropriate  tensile  strength and thickness is chosen to withstand the processing and ensure safe application. The surgical linen thread of size 20 is having the maximum tensile strength of 5.0 kg and it retains its strength throughout the processing of 20 Bhavanas. So, the surgical linen thread no. 20 is the standard thread for the preparation of Ksharasutra.

2. Preparation of Kshara

The Kshara, a specialised alkaline formulation, is a key ingredient in Ksharasutra. The preparation involves following steps:


a. Collection and Drying of Apamarga Plant Material: There are 24 numbers of Ksharadravya described in Ksharapakavidhi Adhyaya of Sushruta Samhita out of which Apamarga is used extensively for preparation of Ksharasutra to treat Fistula-in-ano. In this study Apamarga is taken as standard Kshara Dravya. The entire Apamarga plant, including root, stems, leaves, and seeds/fruits, is collected during early summer and allowed to air dry in a shaded area. The dried plant material is then placed on a clean platform in a semi-closed environment to prevent direct exposure to wind while combustion takes place.


b. Controlled Combustion: The dried Apamarga plant material is ignited on the platform, ensuring complete combustion of all parts. No other plant or material is burned alongside the Apamarga plant to prevent adulteration. The resulting ashes are collected and dissolved in six times of clean

tap water and thoroughly mixed, kept for a while to settled down and collected the supernatant fluid in a stainless still vessel. The residual ashes are again mixed with four times of water and the same procedure is repeated for twice in order to take away all the alkaline material from the ashes.


c. Filtration: The collected ashes' water is meticulously filtered drop by drop through a double Watman filter paper or alternative pressure filters, yielding a clean, light brown liquid devoid of impurities.


d. Evaporation and Drying: The filtered liquid than transferred to a wide-mouth stainless steel vessel and gently evaporated over a moderate flame. Constant stirring prevents overcooking and ensures uniform consistency. Cooling during the drying process is managed, and the flame is extinguished when the liquid becomes a thick paste. This paste is allowed to dry while maintaining continuous stirring to prevent burning or clumping.


e. Grinding and Storage: The resulting coarse powder is processed in a grinder to achieve a uniform fine Kshara powder. This powder is stored in a clean glass bottle with an airtight cork, suitably labelled with manufacturing date and batch number.

3. Collection of Snuhi Ksheera

Snuhi Ksheera, the latex of Euphorbia nerifolia is an essential component of conventional Ksharasutra. Its collection and preparation involve the following steps:


a. Collection Procedure: To obtain high-quality Snuhi latex, must collected on the day of preparation, 1-2 hours prior to usage. Latex cannot be stored for prolonged periods due to its tendency to separate into watery and solid gelatinous components. The latter can be stored temporarily in a sealed container within a refrigerator for future use after dissolution in chloroform. However, for regular coatings, fresh latex is essential. Hence, maintaining a nearby Snuhi plantation is recommended for a steady supply.


b. Optimal Collection Season: The most suitable time for latex collection spans from October to April,


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aligning with the period of Kshara Sutra preparation. This temporal correspondence ensures the availability of latex throughout the year.


c. Collection Technique: The latex should be collected preferably in the morning hours. Latex collection involves carefully incising the Snuhi plant's stem with a stainless-steel knife. Due to the plant's thorny projections, protective gloves preferably rubber or leather are indispensable. Sequential stabs at separate sites are performed and drop by drop Snuhi is collected in a glass container, the collection conducted until the desired latex quantity is acquired.


d. Laboratory Setup: Latex collection transpires within a clean laboratory environment using specialized glassware (flasks, tubes, or dishes). Prompt corking of containers upon collection prevents contamination.


4. Ksharasutra Cabinet

The Kshara Sutra Cabinet plays a pivotal role in facilitating systematic and uniform coating of threads with specialized substances.


a. Kshara Sutra Cabinet Design: The Kshara Sutra Cabinet is tailored to the practitioner's needs and resources. Two main designs, horizontal and vertical, are available. The choice between them depends on laboratory space availability. Each cabinet consists of two chambers: a larger one for Kshara Sutra hangers and a smaller one for a hot air blower. A thermometer is integrated to monitor internal temperature.


b. Thread Coating Process: Threads are smeared systematically using U-shaped aluminium hangers, each accommodating multiple threads. The threads are uniformly coated with surgical linen thread (Barbour brand) size 20. Coating is performed in a controlled environment, with the thread smeared using a clean gauze-piece soaked in latex. Eleven coatings with Snuhi Ksheera (latex) alone are followed by seven coatings of Snuhi Ksheera and Kshara (finely powdered alkaline substance). Three subsequent coatings involve Snuhi Ksheera and Haridra (turmeric). A total of 21 coatings are achieved in this manner.


c. Sterilization: To ensure thread sterilization, an integrated ultraviolet lamp is activated for 20-30 minutes daily. Once the 21 coatings are complete, threads, measuring approximately 10-11 inches, are meticulously detached from the hanger and sealed. This standardized process ensures the consistent and reliable preparation of Kshara Sutra threads, integral to the success of Ayurvedic surgical interventions.


5. Method of Sealing

The preservation and sealing of Kshara Sutra threads are crucial to maintaining their therapeutic properties and prevent contamination.


a. Sealing Methodology: Each coated thread is carefully folded in the centre to facilitate sealing without compromising the coatings. Multiple folds are avoided to prevent damage to the coatings. A single fold suffices. The folded Kshara Sutra thread is then placed within a properly sized polythene bag, which is gently sealed. Subsequently, the sealed thread is enclosed within a high-quality glass tube. The tube's seal is accomplished over a patromax blower flame, a delicate procedure requiring utmost caution to prevent glass breakage or incomplete sealing.


b. Moisture Prevention and Labelling: To mitigate residual moisture within the sealed tube, a small silica bag is recommended before final sealing. This desiccant aids in absorbing any remaining moisture, ensuring the longevity of the thread's integrity. Each sealed tube is meticulously labelled, providing essential details such as the date of manufacture, sealing date, and batch number.


c. Documentation and Record Keeping: During the coating process, a dedicated register is maintained. This register logs the batch number, coating dates, the nature of coatings applied, and the technician responsible. This systematic documentation ensures traceability and quality control throughout the preparation process.


d. Storage and UV Exposure: The sealed tubes of Kshara Sutra threads are stored


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within a secure almirah, safeguarding them from external elements. To further enhance preservation, the sealed tubes are exposed to ultraviolet radiation within the cabinet. This step ensures additional sterilization and helps maintain thread integrity.

Result and discussion

The preparation of Ksharasutra is a meticulous and comprehensive process, involving several critical steps to ensure its therapeutic efficacy and safety for Ayurvedic surgical interventions. The selection of an appropriate surgical thread is paramount, with surgical linen thread size 20 identified as the ideal choice due to its optimal tensile strength and stability throughout the processing stages.

The methodical preparation of Kshara, a specialized alkaline formulation, underscores the importance of using the Ksharadravya (Apamarga) plant material. This ensures the purity and potency of the Kshara, which is vital for its successful application. The process of controlled combustion, meticulous filtration, and careful evaporation and drying results in a finely powdered Kshara with consistent quality, further enhancing its therapeutic potential.

The collection and handling of Snuhi Ksheera, the latex of Euphorbia nerifolia, play a crucial role in the Ksharasutra preparation. By emphasizing the importance of timely collection, appropriate storage, and meticulous handling, the study underscores the need to maintain the integrity of this essential ingredient. The availability of specialized Ksharasutra cabinets, whether horizontal or vertical, contributes to systematic thread coating and ensures uniform application of coatings, in turn enhancing the therapeutic properties of the final product.

The sealing process represents a critical step in preserving the quality of the Ksharasutra threads. The careful folding, sealing, and labelling procedures described in the study emphasize the importance of maintaining thread integrity and preventing moisture ingress. Documentation and record-keeping protocols are essential for quality control, allowing traceability and accountability at every stage of the preparation process.

Conclusion

In conclusion, the preparation of Ksharasutra is a comprehensive and intricate process that

requires meticulous attention to detail and adherence to established protocols. The selection of appropriate materials, including surgical threads, Apamarga plant material, and Snuhi Ksheera, lays the foundation for the therapeutic efficacy of the final product. The methodical steps involved in Kshara preparation, thread coating, and sealing contribute to the consistency and quality of the Ksharasutra.

The systematic approach outlined in this paper serves as a valuable guide for practitioners and researchers engaged in Ayurvedic surgical practices. By following these standardized procedures, practitioners can ensure the reliability and efficacy of Ksharasutra in the treatment of anorectal disorders. Further research and advancements in the preparation techniques, cabinet design, and sterilization methods will continue to refine and optimize the Ksharasutra preparation process, contributing to the advancement of Ayurvedic surgical interventions.

References

1. K. Thakral. Susruta Samhita of Maharshi susruta Vol – 1 (Sutra Sthana). Varanasi; Chaukhambha        Orientalia; 2019

2. K. Sharma, K. R. Sharma, Kulwant Singh. Kshara Sutra Therapy In Fistula-in-Ano And Other Ano-        Rectal Disorders; New Delhi; Rashtriya Ayurved Vidyapeeth; R.A.V. Publication 1994-95


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