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Pilonidal disease is a common anorectal problem that typically affects young people. Pilonidal  sinus describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region known as the natal cleft. the pilonidal sinus, presented with boil with slight seropurulent foul discharge from post anal region in the natal cleft.  The most commonly used surgical techniques for pilonidal sinus includes excision with  primary closure and excision with reconstructive flap with their own limitation(PNS).In Ayurveda acharya Sushruta has considered it under shalyaj nadi vrana ( sinus or fistula due to foreign body). Sushruta mentioned the chedana as well as ksharkarma in the management of Nadivrana. Hence the study concluded that excision & ksharkarma in pilonidal sinus is one of the potential treatment option to avoid recurrence. Nowadays Pilonidal Sinus (PNS) is becoming common disease in between 20-50 years of age, in men and mostly dense hairy persons. Commonly it occurs midline over the coccyx. It results in purulent discharge, pain and discomfort. In Ayurvedic practice, there are many surgeons who are practicing classical Ksharasutra management to treat PNS, which is very effective but there are some problems using classical Kshara in the management of PNS, such as discomfort, burning sensation, itching and irritation due to Snuhi-ksheera. So patients can do their daily routine work without any pain or discomfort. In Ayurveda, Shastra and Anushstra Karma are described in detail. Kshara is best among Shastra and  Anushastras. Two types of Kshara are there - Paneeya and Pratisarneeya. Pratisarneeya Kshara is of  three  types-  Mridu,  Madhyama  and  Teekshana.  Kshara  Karma  include -  Pratisarneeya  Kshara  application, Kshara Sutra therapy and Kshara Varti. Pratisaraniya Kshara is mainly used in wound management, various anorectal disorders such as Arsha (Haemorrhoids), kushtha, Arbuda, Dushta Nadivrana, Guda Bhramsha (Rectal prolapse). Kshara is a caustic material. It causes chemical burn on the area where it is applied. It helps in sloughing of necrosed and infected tissues. Kshara Sutra therapy is used specially in Bhagandara (Fistula in Ano), Nadivrana (Pilonidal sinus) and various benign growth of skin such as papilloma, warts etc. Kshara Varti  is used in chronic non healing wounds for debridement and in sinuses or fistula in ano. Ksahra Karma has been very much effective non surgical means in the management of various disorders especially in anorectal disorders.

Conceptual & clinical application of kshara in anorectal disease.