Ayurvedic Treatment of Cancer

Ayurvedic Treatment of Cancer - Cancer natural Remedies

Ancient Ayurvedic texts are full of chapters dedicated to this disease called Cancer. Cancer is not new and it was known as "arbud" (tumor) and Granthi, vridhi in Ayurvedic texts. Arbud means tumor and karkatarbud is known as malignant cancer. Modern medical science recommends use of Chemotherapy and radiotherapy for fighting cancer cells but there is not much emphasis on supportive nutritional therapy or improving the host cells defense mechanisms to fight the disease from with in. Immunity suppressing drugs are given to kill the cancer cells but they not only kill the cancer cells but also do a lot of harm to the body.

There is no harm if we do Ayurvedic treatment for cancer along with the Chemotherapy or immunosuppression therapy or radiation, rather there will be much more support to the body using ayurvedic medicines along with the ongoing modern treatment of cancer.  These are all natural remedies for cancer and can be used along with any ongoing homeopathic or allopathic treatment of cancer.

Now a days the no. of people suffering from this disease has increased manyfolds. The following ayurvedic treatment mentioned here contains herbo-mineral-metal based formulations which are developed only using ayurvedic principles. This gives excellent result in Cancers of all types like adenocarcinomas, sarcomas, brain tumors, hodgkin's lymphoma and many others. The diamonds( Hirak bhasma) , Gold ( swarn Bhasma) , Silver( Rajat Bhasma) and others make it very effective treatment of cancer of all types.

(1)   Hirak Bhasm300mg

(2)   Swarn Bhasm 500mg

(3)   Rajat Bhasm 2.5 gm

(4)   Swarnbhasantmalti Ras 2 gm

(5)   Abharak Bhasm Sahasar Putti 3 gm

(6)   Swarnmakshik Bhsam 5 gm

(7)   Shwaschintamani Ras 2 gm

(8)   Rasraj Ras 2 gm

(9)   Bhrami Vati with gold 2gm

(10) Yogender Ras 1 gm

(11) Cancervidhwansan Ras 2 gm

(12) Shilasandoor 2.5 gm

(13) Navratankalpamrit Ras2 gm

(14) Rajmrigank Ras 1 gm

(15) Sarweshar Parpati Ras 2 gm

(16) Hemgarbhpotli Ras 1gm

(17) Vaikrant Bhasm 2.5 gm

(18) Vrhitvangeshvar Ras 2 gm

(19) Basantkusmakar Ras 1 gm

(20) Vrhitsutshekh Ras 2 gm

(21)  Dhatri Loh 5gm

(22) Kalmeghnavayas Loh 5gm

(23) Punarvamandoor 5 gm

(24) Tamar Bhasm 1 gm

(25) Giloysatv 10 gm

(26) Mukta Pisti 2 gm

(26) Parval Panchmamrit Ras 5 gm

(27) Sidhmakardhwaj 2gm

(28) Vrhtvatchintamani Ras 2gm

Mix all the above medicines and make Sixty equal doses.Take 1 dosage, twice a day with one to two teaspoonful of honey and half teaspoonful of almond oil or with milk. This will last 1 month.

2) Agastya Haritaki Avaleha Jam - 1 tablespoonful twice daily, with milk or warm water.

3) Giloy  capsules- Take one capsule three time a day - These capsules are made from Tinospora cordifolia herb extract and improves overall immunity of cells and helps in fighting with cancer cells.

(4) Capules Cruel  20 .Take one cap once a day with water.

(5) Capsules Cancergaj kesari 20.. Take one caps once a day.

(6) Yakritpilhantk Churna - -  Take one teaspoonful twice a day with water

(7) Swamla Compound - 1 tablespoonful twice daily with milk or warm water.

(8) Cap. Curcumin - 2 capsules twice

(9) Tab. Kachnaar Guggul - 2 tablets twice daily

10. Arjun Saar - 20 ml twice daily

Age spot (vyanga ) Ayurvedic treatment

Age spots are the yellowish-brown flat spots that look like large freckles and are thought to be caused by aging, too much sun, impaired liver function, and a dietary or nutritional deficiency. Like freckles, it is important to be cautious and aware of any unusual changes. However, most likely, they are not bound to be a problem.

As we age, our metabolism changes and the liver may become so over-loaded with toxins that it cannot get rid of them. Result is age spots. They take years to form and eliminating them takes time too.

Guidelines

•                 Improve your diet to include fruits and vegetables, especially in raw form. Drink eight to 10 glasses of water daily.
•                 Avoid sweets, caffeine, alcohol, tobacco, and junk foods.
•                 Avoid rancid oils. Refrigerate all after opening; store nuts and seeds in the freezer or refrigerator; store grains in a cool place; avoid all fried foods as the hot cooking oils contain substances that damage the skin.
•                 Take beta-carotene rich foods such as carrots, spinach, sweet-potatoes, pumpkin, mango, cauliflower, etc.
•                 Take potassium-rich foods such as banana, potato, coconut-water, curd, soybeans, orange, pumpkin, sweet potato, almonds, spinach, ground nuts, etc.
•                 Wheat flour, chicken liver, oysters, sunflower seeds, etc. contain reasonable amounts of selenium, which will also help the condition.
•                 Consume Vitamin E rich foods such as almonds, cashew nuts, groundnuts, soybeans, sunflower oil, sesame oil, groundnut oil etc. Vitamin E is an antioxidant that slows aging and aids in tissue repair.
•                 Zinc is important for your skin’s health. Meat and poultry are generally high in zinc. Also, include guava, papaya, aamla, grapes, oranges, tomatoes, and such vitamin-C rich foodstuffs in your diet.

Ayurvedic Remedies

Try a remedy from the following for some months, and if the condition does not improve, try another.

•                 Rubbing fresh aloe-vera juice or gel on the spots will help fade them. Use the gel twice a day for a month or two.
•                 Dab buttermilk on the spots. The lactic acid and other ingredients in the milk are beneficial to the skin. Buttermilk has been used for generations as a skin cleaner and as a beauty aid.
•                 Apply castor oil on the spots in the morning and in the evening, and rub well into the skin. The spots should disappear within a month.
•                 Try using the Manjishta root. Add half-a-teaspoonful powder to plain hot water and drink. Used externally as a paste by itself or with honey, it heals inflammation and gives the skin an even tone and smoothness.
•                 Dab some fresh lemon juice on the spots twice daily. If you are going outdoors, wait for the juice to dry as it increases the skin’s sensitivity to sunlight. It may take a few months, but the acidity will make the spots fade.
•                 Grate an onion and squeeze it through cheese cloth so that you have one teaspoonful of juice. Mix with two teaspoonfuls of vinegar and rub into the spots. Do this two times a day until the spots disappear.

Note

As we all are genetically different with different constitutions and patterns, we respond to treatments in many different ways. Hence Standard Ayurvedic Treatments are always individually formulated. This article is intended only for information. It is not a substitute to the standard medical diagnosis, personalized Ayurvedic treatment or qualified Ayurvedic physician. For specific treatment, always consult with a qualified Ayurvedic physician.

Acne (Aja Khallaika) Ayurvedic treatment

Acne is not a physically painful or discomforting condition. Though the problem is common among teenagers, adults experience it too. For those adults who have acne, it can be even more embarrassing than for adolescents.

Guidelines

                Acne is aggravated due to the food that you eat. Some people, who have kapha constitution, react to milk products, nuts, fats, fried and oily foods, chocolate, hydrogenated oils and sugar. Iodine rich foods, such as liver, cheese, iodised salt, and crabs have been associated with acne, and should be avoided.

                Apply an ice cube (wrapped in a soft piece of cloth) where you spot redness. It not only reduces the redness, it lessens the inflammation and helps the skin heal.

                Expose your body to sun and air, but do not sunburn. Fresh air and daily exercise are very important. Get sufficient sleep. Keep your bowels regular.

                Keep your bed sheets clean, as dead skin, oil, cosmetics, hair and dirt on the sheets will clog your pores further.

                Do not pinch the pimple, as it can lead to inflammation. Worse still, squeezing can leave scars on your face. However, if you are desperate, then use a hot, clean cloth or tissue to soften the pimple. This will allow you to break the pimple open with gentle pressure.

                Wash your face twice or thrice a day. However, avoid using soaps that dry your skin. Avoid oil-based cosmetics, as they tend to clog the pores on your skin.

                Wash your hair every third or fourth day.

                Several prescription drugs, including many types of contraceptive pills and corticosteroids, can cause or aggravate acne.

                Emotional disorder can disturb digestive and endocrinal functions, leading to inefficient digestion of oils and to a potential increase in skin oil, which will, in turn, cause acne.

Ayurvedic Remedies

                Clean your skin thoroughly and apply egg white with a cotton swab. Let it sit for several hours or overnight. Egg white acts as an astringent.

                Make a poultice of sugar with a small amount of water; wash your face and apply on the affected area. Sugar has an anti-bacterial effect.

                To treat affected area, make an infusion of tulasi (basil) leaves. Put two to four tsp of dried basil leaves in a cup of boiling water, steep for 10 minutes, cool, and apply.

                Place turmeric powder or tulasi leaves in a bowl of water, which has just been boiled. Cover your hair with a towel. Create a mini-steam bath for your face. Make sure to wash your face immediately afterwards, as dirt and oil can be removed more easily from open pores.

                Kumkumaadi lepam applied on the face after washing it, can give good results.

                Saaribaadyaasav about 15-30 ml with equal quantity of water taken twice daily acts as a blood purifier and controls acne.

Note

As we all are genetically different with different constitutions and patterns, we respond to treatments in many different ways. Hence Standard Ayurvedic Treatments are always individually formulated. This article is intended only for information. It is not a substitute to the standard medical diagnosis, personalized Ayurvedic treatment or qualified Ayurvedic physician. For specific treatment, always consult with a qualified Ayurvedic physician.

Bronchial asthma-Thamaka Swasa -Ayurvedic management

Bronchial asthma is a common disease affecting 10-20 per cent of the population. In the vast majority of cases, the disease is mild and often unrecognised. There is evidence that the prevalence of asthma is increasing. In spite of better understanding of the pathophysiological processes involved in this disease, mortality from asthma has not been influenced, and in our country, it has been increased!

Asthma means twitchy airways! These narrowed airways may lead to coughing, wheezing, chest tightness and shortness of breath, symptoms often being worse at night.

Invasion of allergens into our daily life is the prime cause for it. Increasing industrialisation and spreading urbanisation are the provoking factors for it. Surprisingly, in a majority of the cases, allopathic drugs such as beta-antagonists, aspirin and non-steroidal anti-inflammatory drugs often cause acute attacks of asthma. It is often aggravated by non-specific factors such as cold air, tobacco smoke, dust and acrid fumes, respiratory viral infection and emotional stress.

Asthma is a clinical condition characterised by attacks of wheezing, breathlessness and cough due to the narrowing of the air passage within the lungs. There are two types of asthma—extrinsic and intrinsic.

Extrinsic asthma occurs in the younger age group. Patients are usually sensitive to pollen, house mice, feathers, food, fur, and drugs and have a family history of similar sensitivities. Exposure to the precipitating factor causes an inflammatory allergic reaction in the mucous membrane. This type of asthma tends to be sporadic. Intrinsic asthma tends to occur in older patients. It is a chronic condition. It has no apparent allergic cause or family history. This type of asthma is precipitated by bronchial infections, chronic bronchitis, strenuous exercise, stress or anxiety.

Throughout the world, bronchial asthma is on the rise. Out of sheer desperation, sufferers readily fall for any wonder cure. Consequently, hundreds of traditional healers make tall claims of having found a permanent cure for asthma. Most of these healers are quacks. Bronchial asthma is a complex disorder, which needs to be treated by a qualified medical doctor. Instead of searching for symptomatic relief or a magical cure, it is always better to concentrate on predisposing conditions and causative factors. If you identify them, then you can avoid frequent attacks.

Ayurvedic View

Bronchial asthma is known as tamaka svassa in Ayurveda. This medical science emphasises on gastro-intestinal factors apart from the respiratory afflictions to be the cause for bronchial asthma. That is why in the preliminary stage of the disease or just before its onset, the patient complains of indigestion, constipation or diarrhoea.

It is mainly a kapha syndrome, though differentiation of humoural types also exists. In other words, bronchial asthma can be from any of the three humours—vaata, pitta or kapha. Most often, the disease is kapha in nature.

Vaata type asthma, is characterised by dry cough and wheezing. Additional symptoms are thirst, dry mouth, dry skin, constipation, anxiety and craving for warm drinks. Attacks occur predominantly at vaata time—dawn and dusk.

Pitta type asthma is characterised by cough and wheezing with yellow phlegm. Other symptoms are fever, sweating, irritability and need for cool air. Attacks are at pitta time—noon and midnight.

Kapha type asthma is characterised by cough and wheezing with abundant clear or white phlegm. The lungs are often congested producing a whistling sound.

Attacks are at kapha time—morning and evening.

Guidelines & ayurvedic remedies

The treatment of asthma consists in the employment of remedies to allay the paroxysms, and in the adoption of measures likely to prevent the recurrence.

According to Ayurveda, the asthma of recent origin can be treated effectively but if it becomes chronic, it can only be managed. It is not the drug alone that can give relief from asthma but regulation of diet and the change of conceptual thinking can also play a great role. Along with proper medication and control over eating and living, asthmatics can get better and quick results.

                During an acute attack, a hot chest and shoulder pack, repeatedly given every half an hour, will have a sedative effect upon the nerves and a relaxing influence generally, giving the quickest and most satisfactory relief.

                Hot milk or hot water when sipped little by little, provides immediate relief from the attack. The inhalation of steam-laden air may be provided by using an ordinary teakettle, attaching a funnel to the spout, and inhaling from the upper wide end of the cone. This is very effective in relieving spasms. In many acute attacks, relief will be found in a simple hot hand-bath or hot foot-bath (immersing hands or feet up to the elbows or knees).

                Concussion to the cervical vertebrae from the fourth to the seventh for six to eight minutes with half minute interruptions every minute is excellent to relieve attacks.

                A creeping plant known as somalataa (Ephedra vulgaris) is found to be highly efficacious in relieving asthma. This grows in western Himalayas in abundance and is sent in hundreds of tonnes to western countries where ephedrine is prepared from it. The powder made from the whole plant, after drying in the shade and is given in the dosage of 100 to 250 milligrams, mixed with honey or water at the intervals of 8 to 4 hours.

                At the time of a full attack, wrapping a hot brick in a rough cloth and then giving dry fomentation with it to the chest is found to be useful in asthma. Smearing chandanaadi oil and then giving heat fomentation is also good. Turmeric paste used as poultice on the chest or warming the chest with it is very soothing.

                Only the use of pippalee (Piper longum) powder along with pure honey, makes an attack of asthma subside.

                The rhizomes of turmeric are to be baked in hot sand slightly and made into fine powder. This is to be taken 3 grams twice a day with sugar. The dose can be increased up to 10 grams in due course.

                During an acute attack of asthma, drink some hot water with the juice of one clove of garlic.

                Take the juice of the whole plant of Solanum surattense (chote kateri)—7 to 14 ml as such, or with Trikatu (equal parts of dried ginger, long pepper and black pepper)—one gm twice a day. You can even take Terminalia bellirica powder (baheda)—3 to 6 grams with 4 to 6 grams honey twice a day.

                Mustard oil (sarason) is a good remedy. Take a spoonful with jaggery, twice a day.

                If you wish to use a compound formulation, then here is a medicine for you. Prepare a decoction by boiling equal parts of root of Adhatoda vasica (adoosaa), rhizome of turmeric, stem of Tinospora cordifolia (giloa), and the fruit of Solanum surattense (chote kateri). Take this decoction internally, 14 to 28 ml. with one gram of powdered black pepper twice a day.

                Smoke leaf of Datura stramonium (dhatura). This gives instant relief but needs medical supervision.

Specific Medicines

Kapha kartari: This cuts the kapha like scissors, hence the name. About 200 milligrams of this powder is to be wrapped in a betel leaf and chewed slowly. As soon as the saliva mixes with the powder and reaches the stomach, its effect will be clearly felt. Even when the attack subsides, four doses of it are to be taken for the next 24 hours.

Bhaarangee guda: It is a good remedy for asthma. It also relieves all types of coughs. A dose of 12 grams is taken together with one boiled fruit of hareetakee (harad/Termilalia chebula).

Kanakaasava: It is a proven medicine for asthma and allied-complaints like cough, tuberculosis, bronchiectasis, chronic fevers and haemoptysis. The principal ingredient in this preparation is kanaka (Datura stramonium), which has been a reliable drug for asthma. 10-30 ml of this medicine is to be taken twice a day after meals.

Chyavana praasa and Agastya rasaayana: The main ingredient of the former medicine is amla, the richest source of vitamin C in nature. A peculiarity of this fruit is that its vitamin content is not lost by exposure to heat, as is the case with other drugs and fruits. The latter preparation is indicated in cases of asthma where the patient is constipated. However, chyavana praasa is the better remedy. Both the medicines can be taken in one teaspoonful doses thrice a day, preferably before food intake. They are slow acting remedies but are surer in the efficacy. In chronic cases, their effect is evident from the increasing gap between successive attacks.

Sitopalaadi choorna: This should be taken three or four times a day in one teaspoonful dose with honey. Since the drug is likely to cause irritation of the throat, it is better when mixed with honey and taken as a linctus.

During Acute Attack

                In severe cases, any of the following medicines can be tried with the advice of the physician—Swaasakaasa chintaamanee rasa, Swaasa kuthaara rasa etc.

                In case a patient has a long history of asthma and other complications are present, the panchakarma therapy of Ayurveda gives satisfactory results.

Diet and other considerations

                Avoid foods that can aggravate asthma. Common foods, which trigger asthma, are animal foods, milk products, food items which take more than two hours to digest, mucous producing foods such as curd, bananas, sugar, sweets, black gram, etc.

                Drink plenty of liquids, 8 to 10 glasses a day, to keep secretions loose.

                Find out what triggers your asthma, and get rid of things that bother you at home and work. Upper respiratory infections, either viral or bacterial often trigger an asthmatic attack. Exposure to smoke, perfumes, paints or other strong chemical odours are common culprits.

                Change in weather, exposure to moulds, animal dander, grass or tree pollen triggers asthmatic attacks. Certain food colourings and preservatives may trigger asthma. Drugs, such as aspirin, non-steroidal anti-inflammatory drugs, beta-blockers, ACE inhibitors can precipitate an asthma attack.

                Make a special effort to keep your bedroom allergen-free. Sleep with a foam or cotton pillow, not a feather pillow.

                Use a plastic cover over the mattress. If possible, wash your mattress in hot water every week.

                Dust your room often, but not with a broomstick. Vacuum cleaning is the better option. Wear a dust filter mask when you do so.

                Avoid using perfumes.

                Wear a scarf round your mouth and nose in cold weather. Doing so will warm the air as you breathe in and will prevent cold air from reaching sensitive airways.

                Mild exercise, like swimming, is good for asthmatics. However, some asthmatics are allergic to chlorine, which rules out swimming in a public pool.

                During an asthma attack, sit up straight or bend forward. Do not lie down.

                If you have an air conditioner, change its filter regularly.

                Make a paste of rock-salt and old ghee or mustard oil. Rub it on the chest. Alternately, you can massage Saindhavaadi tailam on the chest.

                Place a hot towel over the chest. This helps to relax muscles and restore normal breathing.

                For an acute asthma attack, try steam inhalation. Add a few drops of eucalyptus oil in a bowl of hot water. Cover your head and the bowl with a towel. Be careful that the water is not so hot that the steam burns your face.

                You should not suppress natural urges like urination, thirst and cough. In addition, you must avoid smoking and moving in the sun.

                It may be useful to assess the alignment of your spine. Often the upper throacic vertebrae are not in alignment with the spine after an asthmatic attack. This ultimately puts greater pressure on the lungs and possibly precipitates another attack. Getting a professional massage, specifically between the shoulder blades with Chandana bala laakshaadi taila can reduce the frequency of attacks.

                Yoga benefits asthmatics. The integral yoga approach to asthma includes correction of distorted posture and faulty breathing habits, methods for the expectoration of mucous, teaching a system of general muscle relaxation, techniques for the release of suppressed emotion and for reducing anxiety.

                In yoga, the purpose of functional breathing exercise is to learn to engage both abdominal muscles and the diaphragm in breathing. The duration of exhalation should double the inhalation.

                During the process of breathing, you must learn to relax. Asanas such as suryanamaskaara, shashankaasana, pranamaasana, sarvangaasana, supta vajraasana, ushtraasana, hasta-uttanaasana, uttita-lolaasana, dwikonaasana, matsyaaasana are helpful. Pranaayaamas like naadi-shodhana, bhastrika, kapaala-bhaati are beneficial. If you want to try some higher range of yoga procedures, shat karmas such as vastradhauti, shankha-prakshaalana, jalaneti are considered therapeutic. Other yoga related aspects like yoga-nidra, antar-mouna, meditation and relaxation techniques are useful to remove the source of nervousness.

                The first and foremost thing is to keep the bowels regular. Constipation should not be allowed to supervene. Exposure to cold should be avoided. Edibles, which are hard to digest, should also be avoided. The supper should contain easily digestible and light food. It is better if the food is taken before sunset. Boiled water should invariably be taken. If milk increases coughing or phlegm, it may be boiled with, equal quantity of water and two or three numbers of pippalee (long pepper) crushed and ground.

                Curd, buttermilk, bananas, guavas and fried foods are to be avoided. All sour substances should be banned. Smoking—both active and passive, should be strictly prohibited.

                Allergens and other substances liable to provoke attacks of asthma are to be avoided. For example, pollen may be avoided by not being exposed to flowering vegetation and closing the bedroom windows. Mites in house dust may be prevented by cleaning mattresses and blankets with vacuum cleaners. Animal dander is best avoided if contact with dogs, cats, horses or other animals is avoided. It will be good if feather pillows are substituted with cotton pillows. Often, allergens are produced from certain foods such as fish, eggs, milk, yeast and wheat. These should be carefully identified and eliminated from diet. Exposure to chemicals is to be avoided. If it is not possible, it is better to change the profession. In addition, indiscriminate usage of chemical pain relieving drugs should be avoided. Physical and mental stress should be avoided.

Hemorrhoids / Piles. -Arsha

Know more about Hemorrhoids / Piles.

Hemorrhoids or Piles as is generally known is a very common disease. About 70% of the population have at some time in their lives suffered from piles or have had experienced some symptoms related to it.

We will first try to understand what Piles / Hemorrhoids are. Piles or Hemorrhoids are actually, distended veins in the anal canal. Veins tend to stretch under pressure. When veins in the lower part of the rectum or anus stretch, swell or descend in to the anal canal, i.e. when they prolapse or protrude in to the canal they are considered as Piles/Hemorrhoids.

The set of veins inside the rectum when distended result in internal hemorrhoids and the set of veins under the skin around the anus when distended result in External Piles.

Some other factors also contribute to the prolepses of the veins. They are long standing constipation, leading to straining while passing stool, pregnancy, weakening of the muscles supporting the veins due to ageing etc. One may also have a hereditary tendency to develop piles.

If you have any of the following symptoms you are probably suffering from Hemorrhoids- Piles.

1. Bleeding from the anus :

after defecation (passing stool)

during defecation

during and after defecation

usually without pain but in some conditions with pain.

2. Constipation

3. Itching

4. Protrusion of a mass from the anal canal (can be felt digitally).

Causes

As described earlier, hemorrhoids develop because of increasing pressure in the veins of the lower part of the rectum and anus. This increasing pressure can be due to various reasons like -

Pregnancy

Straining during chilled birth

Obesity

Lifting heavy weights over a long period

Sitting or standing for a long time

Chronic constipation accompanied with straining to evacuate the bowels

Repeated diarrhea and dysentery

A habit of suppressing the urge to defecate

There may also be an inherited tendency to develop Hemorrhoids / Piles.

               

Hemmorrhoids ( Piles )

Free piles diagnostic camp on world piles day (20th November 2013).

Know more about Hemorrhoids / Piles.

Hemorrhoids or Piles as is generally known is a very common disease. About 70% of the population have at some time in their lives suffered from piles or have had experienced some symptoms related to it.

We will first try to understand what Piles / Hemorrhoids are. Piles or Hemorrhoids are actually, distended veins in the anal canal. Veins tend to stretch under pressure. When veins in the lower part of the rectum or anus stretch, swell or descend in to the anal canal, i.e. when they prolapse or protrude in to the canal they are considered as Piles/Hemorrhoids.

The set of veins inside the rectum when distended result in internal hemorrhoids and the set of veins under the skin around the anus when distended result in External Piles.

Some other factors also contribute to the prolepses of the veins. They are long standing constipation, leading to straining while passing stool, pregnancy, weakening of the muscles supporting the veins due to ageing etc. One may also have a hereditary tendency to develop piles.

If you have any of the following symptoms you are probably suffering from Hemorrhoids- Piles.

1. Bleeding from the anus :

after defecation (passing stool)

during defecation

during and after defecation

usually without pain but in some conditions with pain.

2. Constipation

3. Itching

4. Protrusion of a mass from the anal canal (can be felt digitally).

                                 

Causes

As described earlier, hemorrhoids develop because of increasing pressure in the veins of the lower part of the rectum and anus. This increasing pressure can be due to various reasons like -

Pregnancy

Straining during chilled birth

Obesity

Lifting heavy weights over a long period

Sitting or standing for a long time

Chronic constipation accompanied with straining to evacuate the bowels

Repeated diarrhea and dysentery

A habit of suppressing the urge to defecate

There may also be an inherited tendency to develop Hemorrhoids / Piles.

Types of Hemorrhoids / Piles

Hemorrhoids / Piles can be classified in two ways

I. As per their site of development

1. Internal hemorrhoids / piles

2. External hemorrhoids / piles

II. As per the stages of the diseases

1. First degree hemorrhoids

2. Second degree hemorrhoids

3. Third degree hemorrhoids

4. Fourth degree hemorrhoids

First degree Hemorrhoids: Is the condition when the mass (The structure with the veins) projects slightly into the anal canal, but only when the veins are congested i.e. during defecation / passing stool.

In this stage the patient will have no mass protruding from the anus.

Second degree Hemorrhoids: The mass protrudes out of the anus, but only during defecation. The hemorrhoidal mass returns into the anal canal spontaneously after passing stool as soon as the accompanied straining stops.

Third degree hemorrhoids: The hemorrhoidal mass protrudes from the anus during defecation or on exerting force and remains protruded until forced back into the anus digitally ( with fingers) .

Fourth degree hemorrhoids: The hemorrhoidal mass (Piles) remains protruded (out of the anus) at all times and can not be forced into the anal canal with the help of the fingers.

Treatments

1. Oral medicines, like laxatives, stool softeners etc and local anti inflammatory creams and warm water sits bath can help to reduce the symptoms. However second, third and fourth degree piles can not be cured with just oral treatment.

2. Barran band ligation: One or two special kind of rubber bands are tied around the base (slipped to the base with the help of a special instrument,) of the internal hemorrhoids. The pressure exerted by the rubber band stops the circulation in the tied off pile mass. Gradually, within seven to ten days, the pile mass falls off. This is comparatively a simple procedure and is usually painless. It is performed under anesthesia or even without anesthesia. This treatment is indicated in most cases of second and third degree hemorrhoids.

3. Sclero therapy: A chemical solution is injected around the veins of the hemorrhoids. This treatment is indicated in first to second degree piles. Sclero therapy is not preferred by most surgeons now.

4. Crayo surgery: The affected part is freezed by nitrous oxide or carbandioxide gas. This cuts off the circulation and destroys the pile mass. This is indicated in first to third degree hemorrhoids. This method is now not preferred by most surgeons.

5. Cauterization: The pile mass is shrunk with the help of bursts of electric current. Indicated in second to third degree piles. This method is not now practice by most surgeons

6. Infrared photo coagulation: Infra red rays are given to an internal hemorrhoid which cuts off the circulation in it. Some heat may be experienced during the procedure. The pile mass falls off within a few days. There may be some bleeding. Indicated in second to third degree piles.

7. Laser therapy: The hemorrhoid mass is vaporized by a laser beam. Using laser beams for surgery is beneficial since it minimizes pain and bleeding. Indicated in second to fourth degree piles.

8. Conventional surgery: (Open and closed hemorrhoidectomy) An operation is performed under suitable anesthesia, the vein in the pile mass is tied / legated and the mass is cut off with a surgical knife or scissors. The wound caused is closed or kept open. The surgery requires 24 to 48 hours hospitalization. Indicated in 3rd to 4th degree piles

9. Kshar Patan (Ksharkarma): Ksharpatan is a non surgical procedure of Ayurveda used to effectively treat hemorrhoids. A medicine (chemical) derived from a combination of various herbs is applied to the pile mass with the help of a special slit proctoscope. It is a type of chemical cauterization. This method is highly effective, cost effective and can be performed on OPD level.

The patient may require more that one sitting. The Ksharpatan method of treating piles has been described in detail in the ancient Shusrut Samhita. The details of preparation of the herbal combination used can also be got from the Shusrut Samhita. This method of treating piles- hemorrhoids was forgotten for years, but thanks to the research in the field of Ayurveda Surgery, it has made a comeback.

This simple procedure is so effective and safe that it is now slowly becoming popular in India like the Kshar-sutra legation method of treating Ano-rectal fistulae.

This method is indicated in 2ndo 3rd degree Piles- Hemorrhoids

Prevention

To prevent hemorrhoids or Hemorrhoidal flare-ups:

Eat high-fiber foods.

Why is fibre important?

Stools (sometimes called faeces or motions) are usually soft and easy to pass if you eat enough fibre, and drink enough fluid. A diet with plenty of fibre will help to:

Prevent constipation.

Prevent diverticulosis (a common bowel condition).

Prevent hemorrhoids (piles) and anal fissure (a painful condition of the anus).

Reduce weight. Fiber is filling but not fattening as it has no calories and is not digested.

Possibly reduce the risk of developing bowel cancer.

30 grams of fiber per day is recommended. However, the average person in the UK eats only about 20 grams of fiber each day

High fiber foods include the following

Whole meal or whole-wheat bread and biscuits.

Whole meal flour used for baking and cooking.

Fruit, vegetables, and nuts.

Whole-grain breakfast cereals such as All Bran, Bran Flakes, Weetabix, Shredded Wheat, muesli, etc.

Brown rice, and whole meal spaghetti and other whole meal pasta.

A simple thing like changing your regular breakfast cereal can make a big difference

Fiber supplements

You may need to take extra fibre supplements if you have constipation or other bowel problems. Several are available. You can buy them at pharmacies or health food shops.

Unprocessed bran is the most common (and cheapest) fibre supplement. If you take bran, it is best to build up the amount gradually. Start with 2 teaspoons a day, and double the amount every 5 days until you reach about about 1-3 tablespoons per day. You can sprinkle bran on breakfast cereals, or mix it with fruit juices, milk, stews, soups, crumbles, pastries, scones, etc.

Some people find bran unpalatable, and you may want to try other fibre supplements such as ispaghula husk or methylcellulose. Ispaghula husk is also gluten-free.

Have lots to drink when you eat a high fibre diet or fibre supplements. Drink at least 2 litres (about 8-10 cups) per day. You may find that if you eat more fibre, you may have some bloating and wind at first. This is often temporary. As your bowel becomes used to extra fibre, the bloating or wind tends to settle over a few weeks.

Eat more fruits, vegetables and grains. Doing so softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids.

Drink plenty of liquids.

How much water and other fluids should you drink daily ? The National Research Council (NRC) uses a sliding scale of 1 milliliter (ml) of water for every calorie burned. This scale is not for women who are pregnant or breast-feeding, infants, children and older adults who are unhealthy. The NRC says the average man — who burns about 2,900 calories daily — needs 2,900 ml, or about 12 cups, of water each day. The average woman — who burns 2,200 calories daily — needs about 2,200 ml, or about 9 cups, of water each day. For your own calculations: One measuring cup (8 fluid ounces) of water equals 236 ml. But these cups don't have to be filled with water. Solid food contains water. In an average diet, food provides about 3 to 4 cups of water each day. Men, because they generally are bigger and have more lean muscle tissue, on average need more water each day than women do.

Try fiber supplements

Over-the-counter products such as Metamucil and Citrucel can help keep stools soft and regular. Check with your doctor about using stool softeners. If you use fiber supplements, be sure to drink at least 8 to 10 glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse. Add fiber to your diet slowly to avoid problems with gas.

Exercise

• Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise can also help you lose excess weight.

• Avoid long periods of standing or sitting. If you must sit for long periods, don't use an inflatable doughnut cushion to pad your chair. It can increase the pressure on the veins in the anus.

Don't Strain

• Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

• Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

Self - Care

You can temporarily relieve the mild pain, swelling and inflammation of most Hemorrhoidal flare-ups with the following self-care measures :

Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a topical numbing agent.

Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn't necessary and may aggravate the problem. Gently drying the area with a hair dryer after bathing can minimize moisture, which can cause irritation.

Soak in a warm bath several times daily.

Apply ice packs or cold compresses on the anus for 10 minutes up to four times a day.

If a hemorrhoid has prolapsed, gently push the hemorrhoid back into the anal canal.

Use a sitz bath with warm water. A sitz bath fits over the toilet. You can get one at a medical supply store or some pharmacies.

Use moist towelettes or wet toilet paper after a bowel movement instead of dry toilet paper.

These self-care measures may relieve the symptoms, but they won't make the hemorrhoid disappear. See your doctor if you don't get relief in a few days.

Anal Fissure

What is an anal fissure?

This is a very common Ano rectal disease causing a lot of suffering to the patient. It consist of a tear or a crack in the skin lined part of the anal canal. It usually found in young and middle age people but some times even in children. Though a small crack, the pain and suffering inflicted by it is of great magnitude. Beside, more often than note, it dose not heal permanently and keeps on showing its effects continually or intermittently.

Site

The crack is usually in the midline posterior i.e. in line with the cleft of the buttocks. Occasionally it may be in the front or sides. Some times a little tag, swelling of the skin develops at the edge of the anus. This is could the sentinel tag or Sentinel Piles. This stays even after the fissure heals unless excised.

Very long standing fissure develops hard fibroid tissue. Later on perennial abscess or a anal fistula may form as a complication. Fissure in Ano is also a common cause of anal stenosis / spasmodic anus

Causes

The causes of fissure are not very clear. Rarely fissure are cause due to some bigger under line problem like chrons, Ulcerative colitis, Tuberculosis, Growths etc. The other main possible region could be trauma to the area due to passage of unusually hard stool. Patients often tend to take laxatives for getting soft watery stool, thinking that this will not cause them pain and will solve the problem. It is true that such patients will note face the problems (Pain, temporarily) avoiding the necessity to expand or starch anal canal / anal orifice, but ultimately this leads to more contractions of the canal. Hence, after some times this patients face difficulty in passing even normally formed stool.

Spasm in the anal sphincter (Valve of the anal canal) and ischemia (insufficient blood supply to the area may be the helping factors in the development of fissure and also in preventing the healing process.

The internal sphincter plays an important role in the development of a fissure. These mussels, controlling the opening of the anus, can not be control voluntarily. Pain due to the fissure will cause spasm of the internal sphincter and not allowed it to relax.

Symptoms:

•  Pain : This is the most predominant symptom of fissure in Ano. It is often describe by the patient as of sharp, cutting searing and tearing nature & is of great severity. The pain is usually during defecation and may last up to three to four hours after defecation. The Pain is so agonizing that the patient dreads his visits to the toilet and tends to avoid passing stool, as a result in some cases remains constipated for several days. This further aggravates the symptoms when he eventually has to pass stool.

Some patient s discover that by passing soft watery stool, the pain can be avoided and develop a habit of tacking laxative / purgatives regularly instead of getting proper medical advise. These patents unknowingly are actually aggravating the problem by worsening the condition of the sphincter.

•  Bleeding : There may be fissures without bleeding but usually the pain is accompanied by bleeding during defecation it is bright red appears as a speak along with the passage of stool. Occasionally it may be profuse-heavy.

•  Swelling : Most patients develop a skin tag ( a lump) due to the swelling of the skin at the site of the fissure

•  Discharge & Purities- Anal itch : Occur usually in chronic cases and leaves the patient very uncomfortable.

•  Urinary problems : Some long standing cases of painful fissure develop disturbances in passage of urine, some times the frequency to urinate is increased whereas in some cases there is retention.

Condition of the Anal Fissure

Fissure can be categories as acute and chronic.

Acute anal fissures are those which have develop recently ( Less than about 5 weeks) these may heal spontaneously .

Chronic anal fissure are comparatively long standing fissure more than 5 to 6 weeks these fissures will usually not heal without professional care.

When to see a Doctor?

When the symptoms persist for more than five weeks or if the pain is sever or the bleeding profuse one should seek medical advice.

Treatment

Self help

Correcting Constipation : Correcting constipation is very essential. It is necessary to setup a regular pattern of passing stools. This can be done by adopting a high fiber diet, not only till the fissure heals bur permanently to avoid recurrence. A high fiber diet may be supplemented by taking bulk forming agent when & where required. (Proctobulk)

Local Anesthetics are effective to reduce patient should not be used over prolong periods.

Sitzs Bath : The best way to reduce pain is a sites bath in simple warm water or warm medicated water (Proctobath)

Conservative treatment of Anal Fissure:

Ayurveda offer conservative treatment for acute anal fissure, for some not so chronic fissures where operative procedure has to be temporarily avoided or prolonged due to various region, for infants and aged patient or where there is risk of surgery / anesthesia.

Classical texts of Ayurveda like Sushruta & Charak etc advocate the use of many herbal combinations both oral & topical for the treatment of Fissure in Ano. In our experience of over 20 years we have taken clinical trials of a number of these combinations and have developed a few very effective combinations to treat this condition.

•  Proctobulk powder - A unique combination of bulk forming herbal agents & other precious herbs that help to establish regular bowel movement. These herbs are also store houses of natural anti oxidants and have Rasayana (rejuvenation & longevity promoting) property

•  Solution Proctorelax (Topical) : This unique Ayurveda formula ( Medicated ghritam) is introduce in to the anal canal ( 15 to 20 ml) daily for 7 to 10 days before going to bed. It helps to heal the anal fissure and significantly reduces the pain & spasm.

•  Proctobath powder / tab (Topical) : This is a time tested Ayurveda - herbal combination slightly modified to suite our specific needs. Added to the warm water for the sits bath it provides quick and significant relief from Pain, burning & swelling in the anal - perennial region. It also helps to check infections, controls discharge and Anal itch -pruritus.

•  Anal dilators : use of anal dilators of varying size is helpful. The dilator is lubricated and gently inserted in to the anal canal ones a day after defalcation & sits bath for 7 to 15 days.

Surgical and Para Surgical Procedures

Anal Dilation : Dilation of the anal canal under anesthesia. This is a short procedure where by anal canal is manually dilated after giving a short acting deep general anesthesia. This is also called Lord's anal dilatation.

Spginchterotomy: This involves cutting the anal sphincter. In some cases the patient may develop partial incontinence (Inability to control wind or stool after surgery. However, in most cases this is a temporary condition and improves with time. Methods of spginchterotomy may vary (internal spginchterotomy, Posterior internal spginchterotomy, Lateral spginchterotomy).

Anal fistula -Bhagandara

What is an anal fistula?

A fistula in ano is a tunnel like- pipe like track, developed in the perennial region, usually having one or more external openings around the anus leading to an internal opening in the mucosa of the anal canal or the rectum.

Anal fistula is termed "Bhagandara" in Ayurveda. In Ayurveda fistulas, like other diseases have been classified according to the vitiation of one per more of the three doshas i.e. the vata, the Pitta & the kapha. They have been classified also according to the shape & site of the track of the fistula. Special treatment for such different kinds of fistulas is mention in detail. It is worth noting that the complex & most challenging horse shoe fistula ( complex Ischio-rectal fistula) has been dealt with in detail in Sushruta a classical Ayurveda text) even as early as 300 ad.

The Ksharsutra treatment was probably first advised per this type of fistula named Parikshepi Bhagandara by Sushurta. This Ksharsootra treatment, with a little modification has proved its worth even in modern times.

Anal fistula, a rare condition, is a chronically inflamed, abnormal tunnel between the anal canal and the outer skin of the anus. It often drains watery pus, which can irritate the outer tissues and cause itching and discomfort.

How does it occur?

An anal fistula usually results from an infection that forms in the tissue lining the anal canal. The infection may be caused by spread of bacteria that normally exist in the rectum. Occasionally, it may occur as a result of :

A healed sore in the rectal area

Ulcerative colitis, a disease associated with ongoing breakdown of tissues that causes a sore in the lining of the colon

Diverticulitis, inflammation of harmless growths in the wall of the intestines

Crohn's disease, a chronic inflammation of the intestines

Tuberculosis

Gonorrhea

Cancer of the large intestine.

What are the symptoms?

 Symptoms of anal fistula may include :

A patient of fistula in ano often suffers from a recurrent, small or large boil/boils/abscess surrounding the anus, accompanied with pain, discomfort & pus/blood discharge.

The symptoms subside when the boil / abscess burst spontaneously causing some more discharge for a couple of days.

The boil / abscess "heals up" temporarily but almost always reappears after some times.

Itching, discharge of watery pus, irritation of tissue around the anus, discomfort & pain these are the main symptoms of the fistula in ano

How is it diagnosed?

To diagnose an anal fistula, the doctor will review your symptoms, give you a physical exam, and may use the following procedures:

Anoscopy / Proctoscopy , a procedure in which the doctor inserts an instrument called an anoscope into the rectum to inspect the anus and lower part of the rectum

Probing examination: a procedure in which the surgeon insert an instrument called anal probe it to the external fistulous opening to internal fistulous opening.

Sigmoidoscopy , a procedure in which a doctor uses a flexible or rigid scope to inspect the lower part of the intestine for inflammation and/or disease

A biopsy to evaluate for inflammation or cancer

Lower gastrointestinal (gi) series, a procedure that uses a special fluid to show the intestines better on x-ray

A lower gi series requires a clean, clear gi tract. The doctor will prescribe a special diet, including plenty of water, for the day before the procedure. In addition, you may be given an enema the morning of the procedure.

Causes

In a few cases there is a previous history of ano-rectal abscess.

Some times a fissure in ano/ anal fissure gets infects & the infection travels down to form a track or a fistula.

However in most cases there are no definite causes found.

Possible contributing factors

Tearing of the lining of the anal canal.

Infection from an anal gland

Chron's, ulcerative colitis, tuberculosis

Guide lines to approach an expert for investigating a possibility of anal fistula.

Recurrent boils developing at the same site. (around the anus)

Burning sensation or pain in perennial region

Pus discharge /blood discharge in perianal or from the anus.

Modes of treatments

Anal fistulas are almost never found to heal spontaneously. The inner wall of the fistula develops fibers tissue & payogenic membrane not allowing spontaneous healings.

The most commonly followed mode of treatment is laying open the entire track of the fistula and removing the fibrous tissue & payogenic membrane. This sometimes, in complex fistulas is done in two or more sittings. In certain cases a silk setone is passed through parts of the track.

The Ksharsutra / Ksharsootra ( Medicated Setone ) Ligation.

Laser Surgery ( Fistulectomy / fistulectomy by laser beam )

Laying open the fistula and applying a skin graft.

Laying open, excision of the fistulous track and suturing the wounds.

Coring out the fistulous track. ( link with core technique for fistula )

Sealing with fibrin glue.

Fistula Plug Management.

VAFT Technique for anal fistula.

Reconstruction with flap surgery for anal fistula.

Ayurveda has a unique way of treating fistula in ano. Simple as well as complex fistulas, high anal fistulas, fistulas with multiple track, recurrent fistulas, chron's fistula, tubercular fistula, all respond well to the Ksharsutra ligation procedure.

What is Ksharsutra / Ksharsootra? 

The Ksharsootra /Ksharsutra is a type of thread / medicated setone prepared by coating and recoating the thread 15 to 21 times with different drugs of plant origin. The mechanical action of the treads and the chemical action of the drugs coated on the thread, to gather do the work of cutting, curetting, draining, and cleaning the fistulous track, thus promoting healing of the track/ wound.

A number of drugs like,

Apamarg kshar

Kadali kshar

Arka kshar

Nimb kshar

Snuhi ksheer

Udumber ksheer

Papaiya ksheer

And natural antibiotic like haridra powder, guggulu, etc are used in the preparation of different kind of Ksharsutra. It takes a number of days to prepare this Ksharsutra since the previous coat has to dry before the next is applied.

Different kinds of Ksharsootra are prepared using different drugs. These Ksharsutra are passed through the track (usually under short anesthesia) and the two ends of the thread are tied forming a loop.

The drugs coated on the thread are continually released through out the length of the track there by cutting, curetting, draining cleansing and healing the track simultaneously in the track after about eight days the thread loosens because it has cut through some of the tissues and also is now almost bare ( with no drugs on it). A new thread is now replaced in the track by a special method.

The changing of the thread is a simple opd procedure taking about 1 to 2 minutes and requires no anesthesia.

the thread gradually cuts through the tissue. The tissues above the thread heal up. Hence when at last the loop of thread comes out, the track is healed.

Benefits of the ksharsutra ligation procedure over other methods

The Ksharsootra ligation method is an age old, time tested procedure originally performed by Sushruta (the father of surgery) around 300 ad. The fact that it is still in practice to day is a proof in it self of its efficacy.

• The Ksharsutra procedure is performed under short acting anesthesia / local anesthesia and some times even without anesthesia.
• The procedure usually dose not require hospitalization for more than 4 to 5 hours.
• The patient requires minimal bed rest & can resume his / her daily routine within 12 to 24 hours.
• It gives freedom from pain full dressings.
• There is no loss of glutial mussels and hence the anatomy of the peri anal region is not distorted.
• The procedure lives just a pencil scar at the site.
• The recurrence rate which is usually found to be quite high after other methods is less than 2% after Ksharsutra ligation procedure. This is because the medicines on the thread gradually and continually curate the payogenic membrane and fibrous tissue in the track and thus leave no pus pockets un drained.
• Chances of partial or complete incontinence of flatus or / and faces (loss of control of passing stool / flatus) are always present in many types of fistula, (especially in fistulae involving the sphincter muscles after the conventional procedure. ( Fistulectomy Fistulotomy ). There are no chances of developing incontinence in Ksharsutra ligation method.

 take care

• Using stool softeners
• Adding fiber to your diet
• Drinking plenty of water, up to 8 eight-ounce glasses a day
• Taking warm baths
• Using clean, moist pads to wipe the area around the anus, to remove irritating particles and fluid from the fistula
• Using special skin creams to soothe irritated tissue.
• Follow these guidelines to help prevent an anal fistula. They help to keep the lower gastrointestinal tract healthy.
• Eat food high in fiber.
• Drink plenty of water each day (up to eight 8-ounce glasses).
• Have regular physical exams to look for underlying diseases of the rectum.
• Be aware of the signs and symptoms of bowel disease, and seek medical attention if any appear.

Kshara Sutra treatment

The fact that so many of us, from far & wide have gathered here is in itself evidence of the coming back of the age old science of life. "Ayurveda" is picking up momentum not only in India but also in other countries.

Globalization of Ayurveda brings with it increased requirement of all types of Ayurvedic preparations and even standardization of these preparations. Availability of standard Ayurvedic drugs, even those which are widely used, is a problem at many places even in India. Where rare, expensive or sparingly used drugs are considered, this problem rises still higher. Kshar-Sutra is one such preparation.

Treatment of anorectal diseases through Ayurveda is slowly becoming popular in India. People have started realizing that Ayurveda has a lot to offer in this field like in many others. Kshar Sutra is undoubtedly the preparation of prime importance in this field. However manufacturing and marketing of Kshar-sutra has not been given due importance till date and almost all Ayurvedic proctologist have to prepare their own Kshar-Sutra which makes it more difficult to work in this field.

We shall have to accept that there is not a single reference in the Brihattrayee or even in the Laghutrayee, of the method of preparation of Kshar Sutra as it is used today. Though there are some references indicating the use of medicated thread in the treatment of Arshas and Bhagandara in Sushruta and Bhavprakasha.

The tensile strength of the thread, the PH of the drugs used and the PH of the Ksharsutra itself, the dispersal pattern of different Ksharas, its chromatographic studies, the alkalinity, the method of sterilization and the packing and preserving methods of the prepared Ksharsutras were studied before the Ksharsutras could be standardized.

Preparation of Kshar-Sutra

Preparation of Kshar-Sutra is no doubt, a lengthy and difficult task and the collection and preparation of required drugs is still more cumbersome.

A number of different drugs are used in various combinations for the preparation of the Kshar-Sutra. The ksheer (latex) generally used are of Snuhi, Ark, Arendakarkataki, Udumbar etc. The Ksharas used are Apamarg Kshar, Ark Kshar, Kadali Kshar etc. We have here used the following drugs.

Drugs Required

Snuhi Ksheer

Apamarg Kshar

Haridra powder

Thread,-Linen Barbour No.-20.

Aluminium or steel frames are drilled with small hooks for holding threads in place at an interval of about 1 1/2". The size of the frame may vary to suit specific needs.

Any cotton / linen thread of good strength can be used for Kshar-Sutra. In our practice, we generally use Barbour Linen No. 30 and 20. No. 30 is finer compared to No. 20. The tensile strength of No. 20 is reduced to the least extent in comparison to other threads after the complete procedure and hence it is this thread which is usually preferred in the manufacture of Kshar-sutras. The thread is tightly wound around opposite hooks to form rows.

The thread is given 21 coatings out of which the first 10 coating are given only the fresh Snuhi Ksheer. The next 7 with Snuhi Ksheer and Apamarg Kshar and the last 4 with Snuhi Ksheer and Haridra.

A piece of gauze is taken and folded into a small square. It is then dipped in the fresh Snuhi Ksheer (latex of Euphorbia neriifolia) and the thread is coated (i.e. a Bhavna is given) with the ksheer from down upwards. When all the threads are coated in this manner, the frame is kept to dry in a specially made chamber. The second coating (Bhavna) is given only when the first one dries. The thread is coated 10 times in this way; one after the other after the previous coating of the ksheer dries completely. The frames are placed in a special chamber for drying. The temperature inside the chamber may be increased by passing hot dry air with the help of a fan. The air inside the chamber should be kept circulating to facilitate quicker drying of the threads. The process of drying is best performed when the level of Humidity is lower.

After completing the first 10 coatings of Snuhi ksheer, we now proceed to coat the thread with both Snuhi ksheer and Apamarg Kshar. The thread is coated with fresh Snuhi ksheer in the way described above. Apamarg Kshar is coated on it immediately (i. e. when the thread is still wet) so that it sticks to the thread properly. Different practitioners have developed different ways in which to do this. With experience we have found that the best way to do it is to coat only 3 or 4 threads at a time with Snuhi ksheer and then pass them through a pile of Apamarg Kshar on a flat plate. This is done by sliding the frame over the pile of Kshar in such a way that the threads pass through the pile of Kshar and the Kshar sticks on the wet thread. When all threads of a frame are coated in this way, the frame is again kept for drying in the chamber. The thread is coated in this way 7 times. The thread is coated only when the previous coat is completely dry. Hence 10+7= 17 coats are completed.

The last four coats are to be given with Snuhi ksheer and Haridra. This is done in the same way as the previous 7 coats substituting Haridra powder in place of Apamarg Kshar. While applying every coat, care should be taken that the drug spreads evenly on all the sides of the thread and does not aggregate at one spot to make a knot like appearance. The thread should be smooth and even, having the same thickness through out the length. Care should be taken to carry out the procedure in a dry atmosphere. A specially prepared chamber is used for drying the threads so that it can be dried in a dust free atmosphere. In the absence of a chamber the threads may be dried in the open under direct sun rays in a dry and dust free atmosphere. After we finish coating the threads 21 times and they are totally dry the threads are cut to size and then packed in capillary like glass test tubes. These tubes are cut to size, cleaned, dried, and sterilized. One or two threads are packed in each tube. The tube is packed/ sealed over a burner so that the Kshar-Sutra in it remains dry and sterile. These tubes are sent for Gama radiation after being packed & sealed. The tube is broken and the Kshar-Sutra removed for use when required.

Before going into the details of the collection and preparation the drugs required, I would like to mention here that though the most widely used Kshar-Sutra are prepared from Snuhi ksheer and Apamarg Kshar and Haridra, we can make a variety of different Kshar-sutra from a combination of ksheer from different ksheeri vrikshas i.e. latex of different trees like Udumber ksheer, Arka ksheer, Aerandkarkati ksheer and Ksharas like Ark Kshar, Kadli Kshar, Nimb Kshar etc.

Collection and preparation of the drugs required in the preparation of Kshar sutra

Collection of Snuhi Ksheer : - Latex of Euphorbia neriifolia

The ksheer from Snuhi is collected best, early in the morning, before sunrise. If collection of ksheer is tried after sunrise, we can get just a few drops of ksheer from a Snuhi branch. With the help of a scalpel, we slit the Snuhi branch vertically from down upwards (5mm deep) keeping a collection jar under the slit. As soon as the cut is made, a milky substance (ksheer) starts dripping down. This ksheer is collected in the jar. The amount to be collected depends upon the threads to be coated. After collection the ksheer, jar is to be packed so that no air enters it because ksheer if kept in contact with air, starts to coagulate and turns into a chewing-gum like sticky semisolid substance. Before coating the threads, the ksheer is to be strained from a wire strainer or with the help of a double folded gauze piece. The ksheer is now ready for use. Snuhiksheer should be always used fresh.

Method of preparing Apamarg Kshar :

Water soluble extract of the ash of Achyranthus aspera.

Well grown shrubs are collected in the month of November. These shrubs are dried. When dry, they are burned down to ash in a clean open space or in a big container. The ashes of the Panchang (whole plant) of the shrubs are collected on cooling. The ash itself can be preserved in airtight containers and may be used to prepare the Kshar at convenience.

The ash is stirred in pure soft water 4 times the ash (Rastarangini). Here the ratio of ash to water is in reference to its volume and not weight. The water soluble constituents of the ash are dissolved in the water. The mixture is stirred for a few minutes and then allowed to stand for a few hours. This process is repeated 4 to 5 times. The mixture is then allowed to stand for a period of a few hours again. The ash settles down and we get a clear yellowish liquid solution on top which now contains all the water soluble constituents of the Apamarg ash. The solution is carefully decanted into another container and strained. The clear yellowish solution may still contain minute insoluble parts of the ash. To get pure Kshar it is advisable to further purify this solution by filtering so that the remaining minute insoluble particles are removed.

The solution is now kept to boil in a thick preferably stainless steel container. As the water evaporates, we start getting crystals of Apamarg Kshar. They adhere to the sides of the container. Theses should be constantly removed by stirring the boiling solution. When almost all the water is evaporated we get a white substance which settles at the bottom. Minimizing the heat, the process should be continued till all the water evaporates and we get a thick layer of the Kshar at the bottom of the container. This thick layer can be removed on cooling. The substance which we now get is the pure extract of the ash of Apamarg Panchang. This is powdered and packed in air tight container for further use.

The method of preparing the Kshar may be modified when mass production is desired.

Preparation of Haridra Powder - Curcuma Lonnga

The third drug required for the last three coatings is Haridra powder. Haridra is known to most of us as turmeric. The well developed dry rhizomes of Curcuma longa are used to prepare the powder. The combination of the three above mentioned drugs does the work of cutting, curetting and healing the fistula. The multiple coats on the threads probably make the effect of the drugs gradual and continuous. The drugs keep on dissolving and being released gradually for a couple of days, after which the Ksharsootra is changed if and when required. The thread itself acts as a vehicle for the drugs to reach the sight and the coating on the thread probably renders a sort of a sustained release effect of the drugs in the track.

With the picking up of the Kshar-sutra mode of treatment in Ano-rectal diseases, the requirement and demand for good quality standardized Kshar-sutra is inevitably going to increase and hence Kshar-sutra manufacturing and marketing on both large scale as well as small scale though quite difficult and cumbersome may be a rewarding project.

Advantages of Kshar Sutra

The procedure does not require hospitalization for more than 3 to 4 hours.

The patient requires no bed rest & can resume his/her daily routine within 6 to 12 hours.

The procedure leaves just a pencil scar at the site.

Freedom from painful dressings.

There are on chances of incontinence and the recurrence rate which is usually found to be quite high after Fistulectomy is less than 2% with Kshar - Sutra treatment. This is because the medicines on the thread gradually and continuously curate the pyogenic membrane and fibrous tissue and thus leave no pus pockets undrained.