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Medicinal plants used in ksharasutra therapy: a review of their pharmacological roles in ano-rectal diseases
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Medicinal plants used in ksharasutra therapy: a review of their pharmacological roles in ano-rectal diseases

Introduction

Ksharasutra therapy is a specialized Ayurvedic para-surgical technique widely employed in the management of ano-rectal disorders such as fistula-in-ano (Bhagandara), hemorrhoids (Arsha), pilonidal sinus, and chronic sinus tracts. The therapeutic efficacy of Ksharasutra is largely dependent on the medicinal plants used in its preparation. Among these, Apamarga (Achyranthes aspera), Snuhi (Euphorbia neriifolia), Haridra (Curcuma longa), and Koshataki (Luffa acutangula) possess significant pharmacological properties that contribute to tissue debridement, antimicrobial action, inflammation control, and wound healing. These medicinal plants act synergistically to facilitate the unique mechanism of simultaneous cutting and healing that characterizes Ksharasutra therapy.1

Pharmacological roles of medicinal plants in ksharasutra therapy

Apamarga (Achyranthes aspera)

Apamarga is the primary source of Kshara (alkaline extract) used in Ksharasutra preparation. The plant contains alkaloids, flavonoids, saponins, and phenolic compounds that contribute to its therapeutic effects. Apamarga Kshara possesses potent chemical debridement activity, enabling controlled cauterization and removal of necrotic tissue, unhealthy granulation tissue, and epithelial lining of fistulous tracts. It also exhibits antimicrobial properties that help reduce local infection and promote healthy wound healing. The combined cutting and healing action of Apamarga Kshara makes it highly effective in fistula-in-ano management.2

Snuhi (Euphorbia neriifolia)

Snuhi latex serves as a natural drug-delivery medium in Ksharasutra therapy. Its adhesive nature facilitates uniform coating of Apamarga Kshara and Haridra powder onto the surgical thread. The latex ensures sustained release of medicinal agents within the diseased tract, thereby enhancing therapeutic efficacy. In addition, Snuhi possesses antimicrobial, anti-inflammatory, and wound-healing properties that support tissue repair and reduce inflammation. These actions contribute significantly to successful treatment outcomes in ano-rectal disorders.3

Haridra (Curcuma longa)

Haridra, commonly known as turmeric, is rich in curcumin, a bioactive compound with proven antimicrobial, anti-inflammatory, antioxidant, and wound-healing activities.4 In Ksharasutra therapy, Haridra is applied as the final coating over the medicated thread. It helps prevent secondary infections, reduces inflammation, and accelerates tissue regeneration. Curcumin promotes fibroblast proliferation, collagen synthesis, and epithelialization, thereby facilitating faster wound healing and minimizing postoperative complications.

Koshataki (Luffa acutangula)

Koshataki is traditionally recognized for its anti-inflammatory and wound-healing properties. The plant contains flavonoids, triterpenoids, and saponins that exhibit antimicrobial and analgesic activities. Although less commonly used in standard Ksharasutra preparation, Koshataki has demonstrated potential in reducing inflammation, controlling microbial growth, and promoting tissue repair in chronic wounds and ano-rectal disorders. Its therapeutic properties may complement the actions of other medicinal plants used in Ksharasutra therapy.

Conclusion

Medicinal plants play a crucial role in the effectiveness of Ksharasutra therapy for ano-rectal diseases. Apamarga provides chemical debridement and tract excision, Snuhi acts as a sustained drug-delivery medium, Haridra offers potent antimicrobial and wound-healing effects, and Koshataki contributes anti-inflammatory and tissue-repair activities. The synergistic action of these plants promotes infection control, tissue regeneration, and complete healing while preserving anorectal function. Contemporary pharmacological and clinical studies support the continued use of these herbal agents as valuable components of Ayurvedic para-surgical management of ano-rectal disorders.

References:

  1. Hariprasad CP, Kumar A, Kumar M, et al. The efficacy of Ksharsutra, Fistulectomy and Ligation of Intersphincteric Fistula Tract (LIFT) procedure in management of Fistula in ano a prospective observational study. BMC Surg. 2023;23(1):70. Published 2023 Mar 29. doi:10.1186/s12893-023-01969-w https://pmc.ncbi.nlm.nih.gov/articles/PMC10061687/
  2. Nakrani HL, Dudhamal TS. ApamargaKsharasutra application and open lateral internal sphincterotomy in the management of Parikartika (chronic fissure‑in‑ano): A randomized controlled clinical trial. Ayu. 2019;40(3):164-170. doi:10.4103/ayu.AYU_144_18 https://pmc.ncbi.nlm.nih.gov/articles/PMC7685256/
  3. Mali PY, Panchal SS. Euphorbia neriifolia L.: Review on botany, ethnomedicinal uses, phytochemistry and biological activities. Asian Pac J Trop Med. 2017 May;10(5):430-438. doi: 10.1016/j.apjtm.2017.05.003. Epub 2017 May 18. PMID: 28647179. https://pubmed.ncbi.nlm.nih.gov/28647179/
  4. Kurapati VK, Nishteswar K. Management of Ano-Rectal disorders by Kṣārasūtra: A clinical report. Anc Sci Life. 2014;34(2):89-95. doi:10.4103/0257-7941.153467 https://pmc.ncbi.nlm.nih.gov/articles/PMC4389399/