A PRECLINICAL STUDY ON EVALUATION OF ANTICANCER ACTIVITY OF SNUHI KSHARA IN HUMAN COLON CANCER CELL LINE HCT-15

Snuhi (Euphorbia neriifolia Linn.) is a conventional herb used broadly in several disease conditions as indicated in classical texts of Ayurveda. As per literature review ascertained, no literature was accessible regarding anticancer activity of Snuhi Kshara. Thus, present work was designed to evaluate the anticancer activity of Snuhi Kshara in HCT-15 (Human Colon Cancer cell line). Anticancer activity was evaluated using MTT assay by % cell viability and IC50. Anticancer activity was compared with standard drug capecitabine. A positive correlation between Concentration and % cell viability was noticed. Lowest cell viability was noted at 5000 µg concentration. Results obtained through the study indicates towards anticancer activity of Snuhi Kshara.

Management of Recurrent Fistula-in-Ano (Bhagandara) Extending upto Thigh, by Partial Fistulectomy and Ksharasutra Application: A Case Report

In the present modern day's world, anorectal disorders are increasing in number due to sedentary lifestyle. They cause great discomfort and make one’s life miserable. Among these fistula in ano is most common. It is challenging to treat due to its recurrent nature. Fistula-in-ano is an inflammatory tract that is lined by unhealthy granulation tissue and has two openings, an external opening present in perianal skin and an internal opening in the anal canal or rectum. Fistula in ano is correlated with Bhagandara in Ayurveda. Acharya Sushruta has mentioned it among Ashta Mahagada and explained five types of Bhagandara. Many treatment modalities have been given for the treatment of fistula in ano, Ksharasutra application is one of them. It is a minimally invasive para-surgical procedure and induces both mechanical as well as chemical cutting and healing of the fistulous tract. This technique has a high success rate but it is time-consuming and causes minimal complication. A 73 years old male patient came to RGGPG Ayurvedic College and Hospital, with a complaint of pain and pus discharge from his left thigh for 7-8 years, he has been diagnosed with a case of recurrent fistula in ano. The patient was treated with partial fistulectomy along with Ksharsutra application and recovered well with complete excision of the tract.

Overview on Dravaka Kalpana w.s.r. to Shankha Dravaka

Rasashastra is the Iatrochemistry of Ayurveda which deals with formulations containing herbals, minerals and metals. Various Kalpanas are mentioned in Rasashastra such as Pottali Kalpana, Kharaliya Kalpana, Parpati Kalpana. Dravaka Kalpana is one among them which is made out of predominately “Lavana- Kshara” Dravyas. Dravaka Kalpana is a liquid dosage form that is prepared either by using Agni or without the use of Agni. Shankha Dravaka is one such Dravaka Kalpana that is mentioned in the different classical texts. It is indicated in various diseases such as Gulma (abdominal lump), Shoola (pain), Yakrit Dosha (disorders of the Liver), Pliha (splenic disorders), Ashmari (calculus) etc. It is used in less dosage by diluting with water. Different Acharyas have mentioned different methods of its preparation. This article compiles review of Ayurvedic literature on Shankha Dravaka. This literature review is carried out to create the base for undertaking future research work because without research efficacy, the utility cannot be established

The Comparative Analysis of Karanja Kshara Samples -Prepared According to Different Ayurvedic Textual References

Karanja Kshara is an alkali, extracted from water soluble ash of the plant – Karanja {Pongamia pinnata (L.)}. The Kshara preparation techniques differ according to various authors, with respect to the ratio of water added to ash, soaking time, folds of cloth and number of filtrations. In the current study, Karanja Kshara was prepared as per different classical methods and analysed for the differences. Three samples of Karanja Kshara were prepared, according to the textual references from Sushrutha Samhita (Sample A), Sharngadhara Samhita (Sample B) and Rasa Tarangini (Sample C). Analysis of the methods of preparation along with organoleptic and Physico-chemical tests were conducted. There was a 14% yield of Kshara in Sample A, 7.45% of yield in Sample B and 7.54% in Sample C. In physicochemical analysis, there was 6.8%, 6.1% and 5.4% of loss on drying in Samples A, B and C, respectively. Total ash value was 84.7%, 85.78% and 87.89% in Samples A, B and C respectively. Acid insoluble ash value was 11.34%, 11.04% and 9.15%. pH value was 10.36, 10.30 and 10.37. Traces of Sodium, Potassium, Magnesium, Calcium, Sulphur, oxides of silica, Carbonate & Bicarbonate were found in all the 3 samples. There are very few notable differences found in the results, however, they are quite similar. In terms of yield, economy and alkalinity, sample A (Sushrutha Samhita) can be considered as the better method while sample method C (Rasatarangini) is easier and faster.

Treatment of Trans-Sphincteric Fistula-In-Ano with Combined Therapy of Laser and Kshara Sutra

Fistula-in-ano is most infectious disease among all the ano-rectal disorders since ancient times. Over the past few decades, various techniques are being evaluated in terms to prevent its recurrence and complications; it is still a challenging surgical disease. The sign and symptoms of fistula in ano resembles with Bhagandar described in Ayurvedic classics. Kshara sutra therapy (medicated thread) practiced in Ayurveda Since ancient time for the management of Naadi Vrana and Bhagandar. Kshara sutra therapy has revolutionized the treatment of fistula-in-ano, as it treat the main culprit of fistula that is cryptoglandular origin but the drawback of Kshara sutra therapy are as it takes more number of hospital visit, long anxiety period and discomfort. In present time LASER therapy is used in various medical surgery and also in proctology like in fistula as FILAC, DLPL etc. Diode LASER 980nm (Radial Fibre) burns unhealthy granulation tissues in 360° manner with less or minimal pain, LASER act as photo evaporation effect and leads to the shrinkage of the fistula tract. But if we do LASER in internal opening of fistula it provides a bare area for microbes and creates a chance to re-infects the crypts and anal glands, which further leads recurrent fistula formation. Therefore a novel technique for sphincter preserving surgery proposed as combined therapy of Kshara sutra ligation for main culprit that is cryptoglandular infection as SMAK (Sub Mucosal Application of Kshara Sutra) and LASER, shrink the remaining fistula tract instantly

Clinical Evaluation Of Apamarga Prati-sharaniya (teekshna) Kshara (local Application) Haritaki Churna In The Management Of Arsha (hemorrhoids)

Arsha (Hemorrhoids) is one of the most common conditions affecting peoples since time immemorial. The prevalence is equal in both sexes, peaks between the ages of 45 and 65 and declining thereafter. The main cause of hemorrhoids is constipation over a prolonged period of time and has to strain to pass stools, it can damage the lining of anal canal. Sushruta the Father of Surgery advocated four method of treatment of Arsha, which are Bheshaja, Kshara, Agni and Shastra. Under Sushrutas operative procedure local application of Pratisharaniya Kshara in the prolapse piles mass helps to reduce pile mass effectively (Ref.Su.Chi.6). It is safe, cheap, effective, simple, easily approachable procedure and ambulatory treatment and the patients acceptability is good to overcome such problem. Aims & Objective is to evaluate the clinical efficacy of Apamarga Pratisharaniya teekshna kshara in the management of Arsha. & to evaluate the safety of Apamarga Pratisharaniya teekshna kshara in the management of Arsha. Material and Methods: 30 patients were enrolled for the study within a period of one year and Teekshna pratisharaniya kshara was applied on piles mass intra anally under operative procedure with the help of a instrument proctoscope. Observation and result: Reduction in the piles mass evident by Inspection/ proctoscopy /Visual perception was observed remarkably.Bleeding and pain were also reduced remarkably in all the piles patient. 100% relief in bleeding, reduction of pile mass and total reduction in size of pile mass was recorded. Conclusion: Recently these Oldest technique advocated by Sushruta have been proven to be most effective and free from post-operative complications.

Management of rectal prolapse (Guda Bhramsa) through Kshara Karma (chemical cauterisation): a case study / Manejo do prolapso retal (Guda Bhramsa) usando Kshara Karma(cauterização química): um estudo de caso

Abstract Rectal Prolapse is a condition where the rectum protrudes beyond the anus. The explanation of this condition can be traced back to ancient Ayurveda text like Susruta Samhita, Ebers Pappyrus of 1500 B.C., etc. The exact cause of rectal prolapse is unclear but it is predominant on female gender and on people having constipation, previous anorectal surgeries etc. Both partial and complete varieties of rectal prolapse are extremely debilitating because of the discomfort of the prolapsing mass and variety of symptoms like rectal bleed, intermittent constipation or fecal incontinence. Although, diverse modalities of surgical management of rectal prolapse are present, no single optimal procedure is proved and the choice of operation is determined by the patient's age, sex, degree of incontinence, operative risk, as well as by the surgeon's experience. In Ayurveda, Guda Bhramsa (Rectal prolapse) is explained by Acharya Susruta under Kshudra Rogas (chapter of minor diseases) and has elaborated it's conservative management very beautifully. In this case, a female with partial rectal prolapse was treated with Kshara application and managed without complications. So, Kshara application can be a safe and effective alternative for the management of rectal prolapse.

Resumo O prolapso retal é uma condição em que o reto se projeta para além do ânus. A explicação desta condição foi relatada em antigos textos Ayurveda como Susruta Samhita e Ebers Pappyrus, datados de 1500 aC. A causa exata do prolapso retal não é clara, mas essa condição é predominante no sexo feminino e nas pessoas com constipação e histórico de cirurgias anorretais anteriores. Tanto o prolapso retal parcial quanto total são extremamente debilitantes devido ao desconforto da massa prolapsante e da variedade de sintomas como sangramento retal, constipação intermitente ou incontinência fecal. Embora diversas modalidades de tratamento cirúrgico para corrigir o prolapso retal tenham sido relatadas na literatura, nenhum procedimento é consensual; a escolha da operação é determinada pela idade, sexo, grau de incontinência, risco operatório e experiência do cirurgião. Na Ayurveda, Guda Bhramsa (prolapso retal) é explicado por Acharya Susruta no Kshudra Rogas (capítulo de doenças menores) e seu manejo conservador é descrito de forma bastante completa. No presente caso, uma paciente do sexo feminino com prolapso retal parcial foi tratada com aplicação de Kshara e administrada sem complicações. Assim, a aplicação de Kshara pode ser uma alternativa segura e eficaz para o manejo do prolapso retal.

The Pharmaceutical And Analytical Study Of Palash Kshara

Background: Kshara is an important dosage form mentioned in Ayurveda which is derived from plant ash. The Kshara have some similar properties like alkaline nature, water solubility, whitish color etc. Kshara are given advantage over all surgical and parasurgical measures as it can be used in thin, weak and patients who fears for surgery. Different herbs like Apamarga, Snuhi, Kadalipalasha are used to prepare Kshara either single or collectively in classical texts. Therapeutic use of Kshara of different herbs differs from each other hence analytical study of each Kshara is necessary. Aims & Objectives: In the present study preparation of Palash (Butea monosperma) kshara and analytical study is done to understand the characteristics of Palashkshara. Material & methods: The preparation of Kshara is a multistep procedure. In the present study preparation of Palasha Kshara is done according general method of preparation of Kshara mentioned in Sharangadhara Sanhita. Prepared Kshara is subjected to various Physico chemical analyses and results are concluded. Results: The Palash Kshara shows physical properties like whitish in color, pungent odor and soft in touch. Chemically it shows combination of Potassium, Phosphate and Sulphate along with other elements in traces. The present study gives the details of methodology and results of the pharmaceutical and analytical study of Palash Kshara.

Management Of Asthi-majjagata Vata W.s.r. To Avascular Necrosis (avn) Of Femoral Head Stage 3 By Panchakarma - A Case Study

Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that occurs when there is loss of blood supply to the bone, an interruption to the blood supply causes bone to die. If not stopped this process eventually cause the bone to collapse. It is the most challenging condition of the present era in orthopedics. In Ayurveda it can be co-related with the Asthi Majja Gata Vata due to similar sign and symptoms of Avascular necrosis of neck of femur. Aim and objectives: To assess the efficacy of Manjisthadi Kshara Basti, Rooksha Choorna Pinda Swedana, Pizhichil and Shastikashali Pinda Swedana in the management of AVN. Objective was to stop the further deterioration of the hip joint and to reduce the chances of surgical intervention in managing AVN. Materials and methods: A diagnosed and non operated case of Avascular necrosis of stage 3 with complaints of pain of bilateral hip joint, restricted movements and limping gait approached the out-patient division of the hospital and was managed by Rooksha Choorna Pinda Swedana, Manjisthadi Kshara Basti, Pizhichil and Shastikashali Pinda Swedana. Observation and Result: Significant improvement was noticed after the treatment. Pain was reduced significantly with improvement in range of movement. Patient was able to walk and climb stairs after the treatment without pain and stiffness. There was reduction in VAS scale, marked improvement was noticed in Harris Hip Score.

Preparation And Physicochemical Evaluation Of Mridu Apamarga Kshara

Ksharakalpana is one of the unique pharmaceutical preparation forms described in Ayurveda. Kshara is ashes of herbal drugs and is alkaline in nature. A detailed description of Kshara Kalpana preparation methods, types, properties and applications of different Kshara are available in Ayurvedic classics. Kshara is the substance having Ksharana and Kshanan properties. Various plants are mentioned as suitable for the preparation of Kshara viz., Apamarga, Arka (Calotropis gigantea Linn.), Mulaka (Raphanus sativus Linn.), Snuhi (Euphorbia nerifolia Linn.) etc. Among these Apamarga, Arka are the most common drugs used for the preparation of Kshara. In the present study whole plant of Apamarga (Achyranthes aspera Linn.) was used for the preparation of Kshara. Different opinions are there about the amount of water to be used, number of filtrations etc., while preparing the Kshara. Generally Apamarga kshara is prepared by decantation process in a single wash. In order to obtain increased yield and to reduce the loss during straining, in the present study it was prepared by the capillary action and three times washing. This method gave 49% more yield of Apamarga kshara and is far more when compared to traditional methods. Physicochemical evaluation of the prepared Kshara complied with the pharmacoepial standards.

Management Of Genital Warts Through Ayurveda-a Case Report

External genital warts or Condyloma Acuminata is caused by the Human Papilloma Virus subtypes 6 and 11. According to Ayurveda it can be diagnosed as Yoni Arsa. This case report presents a 51 yr old female with the complaints of per vaginal discharge, itching and appearance of progressively increasing number of lesions in the vulva for 6 months. The pathological diagnosis of the vulvar lesion specimen was Condyloma Acuminata. Patient was treated with internal administration and external application of Ayurvedic medicines. Considerable relief for the condition was noted and the follow up visits confirmed the non recurrence of the disease. Ayurvedic interventions can be considered as minimal invasive and cost effective in the management of genital warts.

Pharmaceutical standardization of Apamarga kshara.

Standardization of herbal drugs is essential to certify their quality and purity. Kshara (alkaline substance) of Apamarga (Achyranthes aspera Linn.) is an important constituent in many Ayurvedic formulations, but its standard manufacturing process (SMP) is not attempted till date. This study is aimed to establish SMP for Apamarga kshara. In pharmaceutical process; generally the sediments of ash obtained at the end of washes will be discarded. However, in the study, we attempted to wash the sediments repeatedly by adding water to extract more Kshara. Apamarga was collected from the local area and authenticated. Kshara was prepared by following standard methods and the preliminary physicochemical profile was developed. It is observed that the ash yields Kshara even in the consecutive washes. First wash yielded 21.23% w/w Kshara, while the second and third washes yielded 9.38% w/w and 4.76% w/w, respectively. Repeated washes yield more Kshara. Hence, it is advocated to wash the ashes repeatedly. As the findings are encouraging, similar experiments can be extended to all other Kshara preparations.

Clinical evaluation of the efficacy of kshara karma with Apamarga kshara and Jatyadi taila pichu in the Management of Cervical Erosion (Karnini Yonivyapada).

Cervical erosion is one of the commonest gynecological diseases which includes large section of women among her reproductive age group and needs medical attention and non surgical treatment In modern system its treatment done with diathermy and cryosurgery which has various side effect like cervical stenosis, accidental burns, etc. In Ayurveda science treatment of karnini yonivyapada by kaphahara chikitsa with Apamarga kshara which have property of lekhana, sodhana, ropana, stambhana, kaphghna and so many properties and Jatyadi taila which have property of vatashamak ,sheshmhara, mansapkarshana, shodhana and ropana . All these properties facilitate destruction of columnar epithelium and facilitate the re-epithelization of new healthy stratified squamous epithelium on ectocervix with this entire basis, this research work was done. karnini yonivyapada described in ayurvedic text books can be correlated with cervical erosion. Apamarga kshara ( Sushruta Samhita Sutrasthana-11/5) and Jatyadi taila ( Bhava Prakash Madhyama Khand.- 47/90-95) . Group I- this group 15 registered patients were administered with application of 'Apamarga kshara' on cervix and 'Jatyadi Taila' Pichu in the vagina for 7 sitting alternate day in a month Group II- In this group 15 registered patients of Cervical erosion were administered with 'Jatyadi Taila ' Pichu in the vagina daily for 14 days in a month. Treatment was done after bleeding phase of menstrual cycles over. Overall percentage relief was higher in group I 72.17% followed by group II i.e. 68.44% . Statistically the results were highly significant (p<0.001) in both groups. Combined use of kshara karma and Jatyadi taila pichu (Group I) is more effectively helps in managing the disease cervical erosion.

Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series.

Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis‑a‑vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2–6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases.

Carmakila: An effective management by kshara karma.

Epidermal nevi are hamartomas that are characterized by hyperplasia of epidermis and adnexal structures. These nevi may be classifi ed into a number of distinct variants, which are based on clinical morphology, extent of involvement, and the predominant epidermal structure in the lesion. Variants include verrucous epidermal nevus, nevus sebaceous, nevus comedonicus, eccrine nevus, apocrine nevus, Becker’s nevus, and white sponge nevus. A 22-year-old girl approached us with complaints of blackish-colored hard growth, increasing in size over the right post-auricular region since 5 years. Ksharakarma is a procedure that involves the most important surgical, para-surgical, and critical-care procedures like incision, excision, scraping, and hemostatic locally (pratisaraneeya) and generally (panneya). Pratisaraneeya kshara is prepared with herbo-mineral medicines having an average pH of 13, possessing penetrating, corrosive, scraping, and healing properties, and are evidently indicated for external application in charmakīla. For the present case, kshara karma was preferred for application as the lesion was bigger in size and the results were appreciable clinically.

Management of internal hemorrhoids by Kshara karma: An educational case report.

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as “Raktarsha” - 11 & 7 ‘o’ clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids.

Treatment of Fistula in ano by Kshara Sutra

PURPOSE: Sushrutra (BC 5th century) advocated a conservative management by applying Kshara Sutra (phyto-chemically processed thread) for the treatment of anal fistulas in India. In 1965, this technique was introduced by Deshpande and 40 cases were treated on an "outpatient" ambulatory basis. The purpose of this study is to determine the result of Kshara Sutra (KS) in treatment of fistula in ano. METHODS: One hundred and five patients with anal fistula were treated with KS. Excision of the primary lesion and fistula tract was done externally and KS was passed around the tract. Tissue gripped within the thread was the anoderm, mucosa, and sphincter. Finally, the thread encircled the part of the anal wall that needed excision and an additional clamp for loose tying. RESULTS: The range of age was from 21 to 59 years while the sex ratio was 6.5:1 (M:F). In 94 patients, the average cutting time was about two weeks, and the other were three to four weeks. KS thread was applied only once for primary operation in 98 cases, and a successive change was required in 7 cases. The mean hospital stay after operation was 4.2 days. In 76 cases, the mean period of follow up was 23 (range 7~32) months. There were no recurrences, but there were 4 mild deformities of the anus, 2 mild soilings, 1 delayed cutting, and 5 delayed healings. CONCLUSIONS: Kshara Sutra is a technically easy, safe, and simple method and does not require a long hospitalization.