• Anurag Kaushik
• Dr. Yogesh Yadav
• Dr. Pushpendra Kumar Pandey
• Dr. Ashish Choyal

Kshara Karma represents one of the most distinctive Anushastra (para-surgical) procedures in Ayurveda, utilizing alkaline herbal or herbomineral preparations for chemical cauterization. Derived primarily from the ashes of selected medicinal plants, Kshara possesses the dual capacity to destroy vitiated tissues while promoting healing. Classical texts, especially the Sushruta Samhita, describe Kshara as superior among sharp and subsidiary instruments because it simultaneously performs Chedana (excision), Bhedana (incision) and Lekhana (scraping). Two principal forms exist: Pratisaraniya Kshara for external application and Paniya Kshara for internal use. Modern practice has refined these into specialized formulations such as Ksharasutra, Ksharavarti and Ksharapicchu, which are widely employed in proctology for Arsha (hemorrhoids), Bhagandara (fistula-in-ano) and Nadi Vrana (sinus tracts). Preparation involves controlled incineration of plant material, aqueous extraction of the alkaline fraction, repeated filtration and concentration, often with potentiating agents to achieve Mridu (mild), Madhyama (moderate) or Tikshna (strong) potency. Clinical studies and meta-analyses demonstrate high success rates, particularly for Ksharasutra in fistula-in-ano, with low recurrence and minimal sphincter damage compared with conventional surgery. Advantages include minimal invasiveness, cost-effectiveness, outpatient feasibility and suitability for patients reluctant to undergo open surgery. Contraindications include extreme age, debility, bleeding disorders, pregnancy and application over Marma (vital points). Complications such as excessive burning or incomplete action are largely avoidable with proper technique and post-procedure care. This review synthesizes classical descriptions from Sushruta Samhita, Charaka Samhita and Ashtanga Hridaya with contemporary clinical evidence, preparation protocols, indications, mechanisms and limitations. Kshara Karma continues to offer a rational, evidence-supported alternative within integrative surgical practice, warranting further standardized research and wider clinical adoption.

Anushastra; Arsha; Ayurvedic para-surgery; Bhagandara; chemical cauterization; Kshara Karma; Ksharasutra; Pratisaraniya Kshara

"KSHARA KARMA IN AYURVEDA: A COMPREHENSIVE REVIEW OF CLASSICAL PRINCIPLES, PREPARATIONS, CLINICAL APPLICATIONS AND MODERN EVIDENCE", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.13, Issue 10, page no.c248-c255, October-2026, Available :http://www.jetir.org/papers/JETIR2610229.pdf

"KSHARA KARMA IN AYURVEDA: A COMPREHENSIVE REVIEW OF CLASSICAL PRINCIPLES, PREPARATIONS, CLINICAL APPLICATIONS AND MODERN EVIDENCE", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.13, Issue 10, page no. ppc248-c255, October-2026, Available at : http://www.jetir.org/papers/JETIR2610229.pdf