Post on 30-Mar-2015
transcript
Dr. P. Hemantha Kumar M. S .(Ay) Dip.Yoga, (Phd)
Prof. & HODDept. of Shalya Tantra in P.G. Studies
S.D.M.College of Ayurveda & Hospital, Hassan, Karnataka, INDIA
Mobile – 9448156362
Email –phk4uster@gmail.co
phk4u@redifmail.co
Piles / Haemorrhoids can affect anyone, Piles / Haemorrhoids can affect anyone,
anytime, anyplace and anywhere. anytime, anyplace and anywhere.
Commonest disease in Anorectal region.Commonest disease in Anorectal region.
Recent statistics reveals that irrespective Recent statistics reveals that irrespective
of age, sex, socio-economic status, of age, sex, socio-economic status,
people suffer from piles. people suffer from piles.
Now a days every person suffered from Now a days every person suffered from
any one of the complaint of piles during any one of the complaint of piles during
their life time. their life time.
Kshara is a caustic chemical, alkaline Kshara is a caustic chemical, alkaline
in nature obtained from the ashes of in nature obtained from the ashes of
medicinal plants. medicinal plants.
It is a milder procedure compared to surgery It is a milder procedure compared to surgery
and thermal cautery. and thermal cautery.
It is the superior most among the sharp and It is the superior most among the sharp and
subsidiary instruments because of subsidiary instruments because of
performing excision, incision and scraping. performing excision, incision and scraping.
Used safely on the patients who are afraid of Used safely on the patients who are afraid of
surgery.surgery.
CLASSIFICATION OF KSHARACLASSIFICATION OF KSHARA
On the basis of Concentration
1. Mridu - Mild
2. Madhyama - Moderate
3. Teekshana - High
On the basis of Administration
1. Pratisaaraneeya Kshara – External application
2. Paaneeya Kshara – Internal application
On the basis of Origin
1. Herbal 2. Mineral 3. Animal
According to
Preparation
1. Uttama - Best
2. Madhyama - Moderate
3. Adhama - Poor
INGREDIENTS OF KSHARAINGREDIENTS OF KSHARA
APAMARGA – Achyranthes aspera
Sukti – Lime stone
Chitraka - Plumbago gelanicaChitraka - Plumbago gelanica
Dried Apamarga plant (Achyranthes aspera) (5 kg)Dried Apamarga plant (Achyranthes aspera) (5 kg)
BurntBurnt
500 gms of Achyranthes aspera Ash500 gms of Achyranthes aspera Ash
Add 6 times of water (3 liters)Add 6 times of water (3 liters)
Filtered 21 times through clothFiltered 21 times through cloth
To get clean and clear solution – Cow’s urine colourTo get clean and clear solution – Cow’s urine colour
(slight reddish)(slight reddish)
METHOD OF PREPARATION OF PRATISARANEEYA TEEKSHANA KSHARA(High concentration Kshara)
Filtrate Solution was boiled and evaporatedFiltrate Solution was boiled and evaporated Heating up to 2/3 remainsHeating up to 2/3 remains
Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga (Achyranthes aspera) filtrate solution (Achyranthes aspera) filtrate solution
Continuous mild heatingContinuous mild heating
Liquid evaporates to 1/3rd of its original quantity Liquid evaporates to 1/3rd of its original quantity
Add 1/10th (5gms) of Chitraka Kalka Add 1/10th (5gms) of Chitraka Kalka (Plumbago gelanica) (Plumbago gelanica)
PRATISARANIYA TEEKSHANA KSHARAPRATISARANIYA TEEKSHANA KSHARA(High concentration Kshara)(High concentration Kshara)
PREPARED KSHARAPREPARED KSHARA
PROPERTIES OF KSHARAPROPERTIES OF KSHARA
It is having pungent, hot, sharp and It is having pungent, hot, sharp and digestive property.digestive property.
It does cauterizing, digesting and It does cauterizing, digesting and splitting actions.splitting actions.
Externally it has Cleansing, Heating, Externally it has Cleansing, Heating, Absorbent and Scraping properties.Absorbent and Scraping properties.
PH value of Teekshna Apamarga Kshara PH value of Teekshna Apamarga Kshara is 13.5.is 13.5.
INDICATIONS OF KSHARA IN PILESINDICATIONS OF KSHARA IN PILES
Soft, spread out, Soft, spread out,
deep rooted & deep rooted &
elevated type of Pileselevated type of Piles
Internal Haemorrhoids – First degree, Second Internal Haemorrhoids – First degree, Second degree and Third degree.degree and Third degree.
Pre-operative
Required instruments - Proctoscopes, Prepared Kshara, Lemon juice, Allis tissue forceps, Artery forceps etc.
Night prior to procedure, the patient is advised to have light diet afterwards nil orally.
Part preparation and soap water enema.
APPLICATION OF KSHARAAPPLICATION OF KSHARA
INSTRUMENTS
Patient is in lithotomy positionPatient is in lithotomy position
L. A. / S. A.L. A. / S. A.
Part cleaned with aseptic solutionsPart cleaned with aseptic solutions
Introduce lubricated slit ProctoscopeIntroduce lubricated slit Proctoscope
into the anus and pile masses bulges in into the anus and pile masses bulges in
Pile mass should be scraped or rubbed with cloth or a Pile mass should be scraped or rubbed with cloth or a cotton swab with warm watercotton swab with warm water
OperativeOperative
Kshara applied on internal pilesKshara applied on internal piles
Wait for 1- 2 minWait for 1- 2 min
Pile mass turns to the colour of Pakva Pile mass turns to the colour of Pakva Jambhuphala (ripened black berry fruit) - Jambhuphala (ripened black berry fruit) -
Reddish black in colourReddish black in colour
Pile mass washed with Lemon juicePile mass washed with Lemon juice
Apply Yashtimadhu Ghrita & Apply Yashtimadhu Ghrita & Proctoscope is removedProctoscope is removed Rectal pack with Anu taila or Mahanarayana taila Rectal pack with Anu taila or Mahanarayana taila
Post operative
Orally liquid diet after 4 to 6 hours
Packing removed after 6 hours
Sitz bath -Triphala decoction
10 ml Anu taila / Mahanarayana taila per
rectally twice daily
BEFORE DURINGBEFORE
AFTER
KSHARA KARMA – CAUSTIC CAUTERY
Before Application
During Application
After Application
PRATISARANIYA KSHARA
COAGULATES PROTEIN INHAEMORRHOIDAL PLEXUS
CAUTERISES PILE MASS
DISINTEGRATION OF HAEMOGLOGIN
HAEM & GLOBIN
BLACKISH BROWN DISCHARGE
DECREASES SIZE OF PILE MASS
NECROSIS OFTISSUE WITH OBLITERATION OFHAEMORRHOIDAL RADICLES
NECROSED TISSUE SLOUGHED OUT
FIBROSIS & SCAR FORMATION
OBLITERATION OF HAEMORRHOIDAL VEIN
COMPLETE WOUND HEALING (21 DAYS)
(3-7 DAYS)
MECHANISM OF ACTION OF KSHARA IN HAEMORRHOIDS
HISTOPATHOLOGICAL SLIDE OF SLOUGH COLLECTED AFTER KSHARA KARMA
H.P.E of slough material in blackish brown discharge revealed thepresence of necrosed haemorrhoidal tissue.
ADVANTAGESADVANTAGES
Mild postoperative pain
No bleeding
Minimum hospitalization
No scope for recurrence
No stricture formation (if correct procedure is followed)
Kshara Karma - treating all the pile mass in one sitting.
COMPLICATIONSCOMPLICATIONS
Bleeding Bleeding - Negligible- Negligible
Pain Pain – Mild to moderate pain - relieved by hot – Mild to moderate pain - relieved by hot sitz bath and oil enema.sitz bath and oil enema.
Discharge Discharge – Blackish brown discharge will be – Blackish brown discharge will be occur 5 to 7 days postoperatively.occur 5 to 7 days postoperatively.
Anal strictureAnal stricture – Improper technique– Improper technique
RecurrenceRecurrence – Improper technique– Improper technique
Dr P. Hemantha Kumarwww.proctocure.com