Standard Operating Procedure for Preparing Kadali Ksharasutra with A 100% Alcohol-Based Guggulu Resin Solution and Lakadong Turmeric, Including Its Phyto-Pharmacological Review

Abstract

Alok Kumar*

Ksharasutra therapy is a recognised treatment method for managing Fistula in-ano (Bhagandara). Ksharasutra is a medicated thread made by coating it multiple times with herbal drugs described in ancient Ayurvedic texts. Fistula in ano is a challenging condition due to its tendency to recur. Various treatment options exist, including Fistulotomy, Fistulectomy, advanced anal flap, fibrin glue, LIFT, and VAAFT. Among these, Ayurvedic Ksharasutra therapy is regarded as the Gold standard for managing fistula in ano. It stands out because it reduces recurrence rates and minimises complications such as sphincter damage. However, the main challenge with Ksharasutra is the lack of a modern, scientific standard operating procedure (SOP) for its preparation. Although some studies have been published on standardizing the process of making Apamarga Ksharasutra using snuhi ksheer, this study aims to develop a comprehensive SOP for preparing Ksharasutra using Kadali Kshara instead of Apamarga Kshara, employing an alcoholic Guggulu resin solution in place of snuhi ksheer (latex), and coating with Lakadong turmeric. The field of Shalya Tantra, which focuses on surgical techniques in Ayurveda, has advanced significantly over time. Notably, the development of the Ksharasutra method for fistula-in-ano treatment is a groundbreaking innovation. This approach involves using a medicated seton crafted from herbal materials and has demonstrated exceptional success in managing this difficult condition. Traditional Ksharasutra preparation, as described by ancient Ayurvedic scholars, requires careful processes and specific ingredients to ensure its therapeutic potency. The modern version, developed at Banaras Hindu University, adheres to a strict SOP to ensure consistency and quality. I hope this SOP will gain international acceptance, establishing Ksharasutra therapy as a preferred option for treating anorectal diseases. The present includes a detailed step-by-step guide for preparing Ksharasutra with alternative herbal drugs, as well as a phytopharmacological evaluation of Kadali Ksharasutra and the safety measures necessary during preparation.

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