Literary and Analytical Study of the Source Plants of Kshara (Alkali) for Ksharasutra Preparation in the Management of Fistula-in-ano

The different surgical techniques and importance in disease treatment were explored by Sushruta, the father of surgery. Furthermore, Anushastra or parasurgical substances and methods from Ayurveda are distinctive in surgical fields as discovered by Sushruta. According to Susruta Samhita, Kshara or alkali are useful for performing excision/removal, incision/cutting, scraping, alleviating three Doshas and several special procedures, and therefore superior to Shastra (sharp instruments) or Anu Shastra (accessory apparatuses). Also, Kshara is derived from diverse Ayurveda plants and applied in different ways to manage various diseases, including bhagandara (fistula-in-ano) and other numerous anorectal conditions. Ksharasutra, a novel drug delivery system, is now popular in Ayurvedic surgery for anorectal Diseases and involves a thread smeared with kshara (alkali) applied to induce both mechanical and chemical cutting and healing. There are 23 Kshara source plants provided by Sushruta. This study implemented a literary analysis of the three plant sources employed to prepare Kshara sutra used for managing Fistula-in-ano.