Kshar sutra is an Ayurvedic parasurgical technique great Indian surgeon acharya Sushruta described kshar sutra application in the Fistula, Sinus, Tumor, and Piles-like mass in his treatise Sushruta Samhita.

The technique of kshar sutra application in the above disease is totally similar to the modern technique of plan thread ligation  in high anal fistula (baily) and plan thread ligation of hemorrhoids (mile 1918)

What is Kshar sutra?

Kshar sutra Alkaline medicated thread. this thread action like the surgical procedure the excision incision drainage and scraping of unhealthy tissue of body kshar sutra made of a combination of various ayurvedic drugs. Kshar sutra destroys the unhealthy tissue of wounds and promotes healing.

The main aim of this treatment is to remove the dead tissues and then promote new tissues growth that is healthy and strong. This treatment is done with the help of a special thread which is called Kshar Sutra.

This thread is first sterilized in the medicated decoction after which it is passed through the affected area. The time taken for this procedure depends on the condition of the patient. After certain period of time when the thread gets dissolved in the wound, a new layer of skin gets formed which helps in healing of the wound completely. In order to stop bleeding, a powder called Prakshepana bhasma is used. This powder also helps in stopping pain, swelling and itching in that area.

Anal fissure can occur in people of any age and usually is not a serious condition. Fistula-in-ano is a chronic condition where a tunnel forms connecting the epithelialized surface of the anal canal and the perianal skin. It mainly occurs in people with an anal abscesses history and forms when the abscesses or cyst has not healed completely. It can be very painful and irritating.

The Kshar Sutra therapy was developed in India by Charak, Sushruta and Vagbhata, and its efficacy was established again by BHU’s Shalya Tantra Department. The Kshar Sutra treatment is absolutely effective, very safe, and affordable. The technique basically uses a specially prepared thread to treat the diseases.

This technique has been medically practiced in India for over 3000 years. It is one of the oldest Ayurvedic techniques that deals with intestinal disorders such as chronic constipation or diarrhea.

Preparation of Kshar Sutra:


  1. The surgical thread linen barbour”s no- 20 or cotton thread 9/20 (modi or vardman)
  2. Latak=x of euphorbia nerifolia (snuhi)
  3. Apamarg kshar
  4. Haridra

The fresh latex is collected from euphorbia nerifolia (snuhi) with the help of a gauge piece soaked into latex entire length of thread is smeared 11 coatings are applied for 11 days each one par day after coating next 7 coating of latex and kshar powder are applied simultaneously. After kshar cutting, last 3 coatings are done with powder of Haridra for 3 days after smearing the thread with the latex

Method of Preparation:

For the preparation of thread, surgical linen thread gauge number 20 is manually coated eleven times with the latex of Euphorbia neriifolia, followed by seven coatings of the latex and the alkaline powder of Achyranthus aspera alternatively, and dried. In the final phase, three coatings of latex and powder of Curcuma longa is to be given alternatively.

The thread thus prepared is sterilized by ultraviolet radiation and placed in a polythene bag or glass tube.

Steps of Kshar Sutra Treatment

  1. The cut through of fistulous tract is affected by the pressure exerted on anorectal tissue by the moderately tight Kshar Sutra tied in the fistulous tract.
  2. The presence of Kshar Sutra in the fistulous tract does not allow the cavity to close down from either ends and there is a continuous drainage of pus along the Kshar Sutra itself.
  3. The Kshar Sutra slowly and gradually cuts through the fistulous tract from apex to the periphery. There is an ideal simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back.
  4. The Kshara (Caustics) applied on the thread are anti-inflammatory, anti-slough agents and in addition, have property of chemical curetting. The Kshar Sutra remains in direct contact of the tract and therefore, it chemically curettes out the tract and sloughs out the epithelial lining, thereby allowing the fistulous tract to collapse and heal.
  5. The Kshar Sutra, due to its antibacterial property, does not allow bacteria to multiply in its presence.
  6. The pH of Kshar Sutra was towards the alkaline side and therefore it did not allow rectal pathogens to invade the cavity.

How is the Kshar Sutra treatment done?

In the Kshara Sutra, first prepared by coating a surgical linen thread gauge number 20 with Snuhi latex (Euphorbia neriifolia) for 11 times, Snuhi latex and Apamarga Kshara (Achyranthes Aspera) for 7 times and Snuhi latex and Haridra churna (turmeric powder) for 3 times.

For Fistula-in-ano

Kshara Sutra in Fistula-in-ano patients is applied by anesthetizing the person and passing a malleable probe with the Kshara Sutra in its groove through the external opening of the fistula to the internal one and carefully taking the probe out with the Kshara Sutra intact. Then both ends of the Khara Sutra are tied together and replaced by the new one a week later. This way the track is eventually cut and healed removing unhealthy tissue, controlling microbial infection, and facilitating drainage of pus in the tract to aid in healing.

For Haemorrhoids

In Haemorrhoids’ therapy the blood vessels are chemically cauterized and mechanically strangulated, then pile mass tissue’s local gangrene is done causing necrosis and detriment of unhealthy tissue that slough of the mass in 5-7 days and finally completely healing the wound in 10-15 days.

For Pilonidal Sinus

The Kshar Sutra therapy in Pilonidal Sinus is done by applying the same method as the previous one where the Kshara Sutra is passed through the sinus’ external opening to the skin and then tying its ends together and replacing it a week later. Kshara Sutra in Haemorrhoids is done by first sedating the patient, thereafter pile mass is brought out of the anal orifice using forceps, then given an incision at the mucocutaneous joint, slightly pulling the pile mass and transfixing it with Kshara Sutra treatment at its base, finally replacing the ligated pile mass into the rectum with Yastimadhu taila or ghrita.

Who is eligible for the Kshar Sutra treatment?

Anal Fissures, haemorrhoids, Fistula-in-ano and other ano rectal diseases occur mostly in people who do mainly sitting jobs, in young adults as well as in infants and children because constipation is a common problem in all age groups

Who is not eligible for Kshar Sutra treatment?

Pregnant women, people with carcinoma in the rectum, hepatitis and leprosy are not eligible for Kshar Sutra treatment.

Are there any side effects of Kshar Sutra therapy?

There is no side effect due to the Kshar Sutra treatment except a very mild post-procedural pain. The Kshar Sutra therapy comes as a very safe and a sure one to remove the pile mass, or the anal fissure or the sinus problem. The patients who opt for this Kshar Sutra ayurvedic treatment feel much happier and satisfied getting that extra mass out and healing that painful fissure.

Surgical complications that occur in non-ayurvedic treatments involve stenosis, stricture, and incontinence which do not happen in case of this therapy. Even the anaesthesia does not have any side effect as it is usually a local one.

What are the post-treatment guidelines after Kshar Sutra therapy?

Patients must take only liquid diet before six hours of the surgery and semi-solid diet after 3-4 hours. From the following day patients are advised to take warm Pancha Valkal Kwath sitz bath at least thrice for at least 3 weeks. Triphala Guggulu of 500 mg and Haritaki Churna of 5-10 mg at bed time with luke-warm water, for another two weeks, Jatyadi Tail Matrabasti of 10 ml is prescribed to the patient for twice a day and some analgesics are also given in case of any pain.

Patients are strictly advised to stay active by walking and doing other movements while the Kshar Sutra treatment is on-going, take normal fibre enriched food and mild laxatives daily to avoid constipation and have a clear bowel on a regular basis, avoid long-distance driving and traveling and also too long sitting or standing when the treatment is on.

How long does it take to recover after Kshar Sutra treatment?

One of the many benefits of Kahar Sutra therapy is that patients recover in just 3-5 days after the complete treatment is over, requiring very little bed rest, just 5-6 hours of stay at hospital taking only 30-45 mins for the procedure to get done.