Ksharapaka Vidhi Adhyaya - 11th Chapter of Sushruta Samhita
Sushruta Samhita is the oldest Ayurvedic text written by Acharya Sushruta who is commonly known as "The Father of Surgery". Various diseases, medicines and surgeries written in Sanskrit have been described in Sushruta Samhita. Acharya Sushruta has described 120 surgical instruments, 300 surgical procedures in Sushruta Samhita. The oldest evidence of cosmetic surgery is also found in Sushruta Samhita. In this article, we will discuss the 11th chapter of Sushruta Samhita (Sutra sthana) which is Ksharapaka Adhyaya.
In Ksharapaka Adhyaya, Acharya Sushruta has discussed Kshara in detail. Kshara is a substance made up of herbs that helps in removing abnormal tissues from the body. There are two types of Kshara that are Pratisarniya and Paniya Kshara. Depending upon the potency of the Kshara. It is divided into mridu, madhyam and theekshana kshara. Acharya Sushruta has also described the contraindications of Kshara Karma. Kshara dagdha lakshan and its management are also mentioned in this chapter.
Kshara Mahatva (Importance of Alkali)
Among Shastra and Anushastra Kshara is considered the most important. Kshara is tridosha shamak as it is made up of various herbs, performs various functions like chedana (excision), bhedana (cutting) and lekhana (scraping).
Kshara Nirukti (Etymology of Alkali)
It is called Kshara since it does ksharan karam or removes vitiated tissues from the body.
Kshara Guna (Qualities of Alkali)
Kshara is made by the combination of various herbs and it balances all three doshas. Although Kshara is white in color and gentle (saumya). It has dahan (burning), pachan (ripening), and daran (bursting) tendencies. Kshara is made up of herbs that are Agneya in guna (hot potency) therefore it is pungent in taste, hot in potency, aggressive, dissolves swelling around wounds, dissolves gulma, purifies wounds, heals wounds, stops the blood, causes scarification of elevated, hard tissues, removes toxins, mucus, poisons and excess fat. If the alkali is taken in excess, it destroys sexual power in males.
Types of Kshara (Alkali)
Kshara are two in number Pratisarniya Kshara and Paniya Kshara.
1. Pratisaraniya Kshara
Pratisarniya Kshara is used in the diseases mentioned below:
- Kustha (leprosy)
- Kitibha, Dadrumandala (minor skin diseases)
- Kilasa (leucoderma)
- Bagandara (fistula in ano)
- Arsha (hemorrhoids)
- Vyanga (facial melanosis)
- Mashaka (moles on skin)
- Dusta Vrana (septic ulcers)
- Nadi (sinus ulcers)
- Charamkila (warts)
- Tilakalaka (pinheads)
- Arbuda (cancerous tumors)
- Nyaccha (pigmentation on the body and face)
- Bahya Vidradhi (external abscess)
- Krimi (worms and parasites)
- Visha (poisoning)
- Seven diseases of the mouth - Upajihva, Adhijihva, Upakusha, Dantavaidarbha
- Three kinds of Rohini - Vataj Rohini, Pittaj Rohini, Kaphaj Rohini.
- Pratisarniya Kshara can also be used in diseases where accessory instruments are indicated.
2. Paniya Kshara
Paniya Kshara is used in diseases mentioned below:
- Gara visha (pseudo poisons)
- Gulma (abdominal tumors)
- Udar (abdominal enlargement)
- Agnisanga (reduced digestive power)
- Ajirna (indigestion)
- Arochak (anorexia)
- Anaha (flatulence)
- Sharkara (gravel in the urinary system)
- Ashmari (renal stone )
- Abhyantravidradhi (internal abscess)
- Krimi (worms infestation)
- Visha (poisons)
- Arsha (hemorrhoids)
Contraindications For The Administration Of Paniya Kshara
Given below are the conditions in which Paniya Kshara is contraindicated:
- Raktapitta (bleeding disorders)
- Jwarita (all types of fevers)
- Pitta Prakriti (person having pitta constitution)
- Balaka (children)
- Vridha (old people)
- Durbala (general debility)
- Brahma (dizziness)
- Mada (intoxication)
- Murcha (fainting)
- Timira (blindness)
Paniya Kshara Nirmana (Preparation of Paniya Kshara)
Paniya Kshara is prepared by burning the herbs and making its solution. Its method of preparation is the same as that of kshara which is mentioned further in this article.
Types Of Pratisarniya Kshara
Pratisarniya Kshara is of 3 types which are written below:
- Mridu Kshara (mild alkali strength)
- Madhyama Kshara (good alkali strength)
- Theekshana Kshara (great alkali strength)
Kshara Nirmana (Preparation of Kshara)
The person who wants to prepare alkali should select an auspicious day in Sharad Ritu (autumn season). He should clean himself and fast. Later he should trek in the mountains on a chosen day and search for the Mushka tree having big, black flowers. The tree should be present on the ideal land and should be of middle age. It should have good potency and should not be destroyed by weather conditions, fire, poisons, or worms. On the first day, the tree should be found and is then offered holy hymns. On the second day, the tree is de-rooted and its stems and branches are collected. Then it is cut into small pieces and kept in a place where the breeze is not present. The limestone is spread over the pieces of branches and is burnt with the help of dried stalks of sesame plant. After the fire is extinguished on its own ashes of limestone and ashes of branches should be separated.
In the same manner which is mentioned above. The roots, branches, leaves, and fruits of Kutaja (kurchi), Palasha (flame of the forest tree), Ashvakarna (Indian gurjan), Paribhadraka (Indian coral tree), Bibhitaki (beach almond), Aragvadha (purging cassia), Tilvaka (symplocos bark), Arka (madar), Snuhi (common milk hedge), Apamarga (prickly chaff flower), Patala (rose flower fragrant), Karanja (Indian beech), Adusa (malabar nut), Kadali (banana), Chitraka (leadwort), Putika (peridot), Indira Vriksha (conessi tree), Sariva (Indian sarsaparilla), Kanera (Indian oleander), Saptaparna (Indian devil tree), Gunja (abrus) and four types of Koshataki (ribbed gourd) can be burnt and alkali can be made. After, burning the herbs and making ashes out of them. 1 drona of Kshara and 6 drona of water is mixed. If you want to prepare a tikshana kshara (strong alkali) then cow urine is used instead of water. After mixing water and Kshara it is filtered 21 times with the help of a cloth. The Kshara water is kept inside a wok and mixed slowly with the help of a ladle. It is cooked till it gets transparent, reddish, sharp and slimy. After it, it is sieved with the help of thick cloth. The filtrate is again kept in the wok and cooked. But before cooking it, one kudava or one and a half kudava Kshara water is removed and poured into another vessel.
Other substances like Kata-Sharkara, Bhasamasharkara, Kshirapaka and Shankha nabhi should be burnt till they get red hot and should be poured into Kshara water and churned well. Then, the left two drona kshara water is mixed with eight pala shankha nabhi and mixed well with a ladle. The prepared Kshara should not be thicker or thinner. After looking at the sign of the ideal kshara it is removed from the heat. This is how madhayam kshara is made. If shankha nabhi and other substances mentioned above are not fed in the Kshara water then it is called Mridu Kshara. It is also called Svayuhima.
Then Kshara can also be prepared by adding danti (red physic nut), dravanti (purging nut), chitraka (Ceylon leadwort), langli (climbing lily), putika (peridot), tadapatri, vidalavan (artificially prepared salt), suvarchika (sodium carbonate), kanak kshiri (golden thistle), hinga (asafoetida), vacha (sweet flag), atisa (Indian atis) taken in equal quantity and powdered finely and mixed with Kshara water mixed with Katasharkar and other substances in Shuktipramana. In this way, tikshana kshara is made. It is also called Pakya.
Depending upon Rogi and Roga, mridu kshara (mild alkali), madhyama kshara (moderate alkali), and tikshana kshara (alkali with great strength) can be used.
Kshara Guna Dosha (Properties And Demerits Of Kshara)
- Naiva atitikshana - Kshara should not be very strong/ aggressive.
- Na mridu - It should not be very mild.
- Shukla - It should be white in color.
- Shalakshana - It should be smooth.
- Pichchila - It must be slimy.
- Abhishyandi - It should not cause any obstruction.
- Shiva - It should be good acting.
- Shighrah - It should work fast.
The eight demerits of alkali are given below:
- Kshara which is very mild.
- Kshara which is too white in color.
- Kshara which is very hot.
- A highly penetrating Kshara.
- Kshara which is very slimy.
- Kshara which spreads greatly.
- A thick Kshara.
- Kshara which is not cooked properly and does not contain proper herbs.
Tikshana, Atitikshana and Atimridu Kshara
- Tikshana Kshara - The Kshara that burns the Eranda nal by counting till 100 is called Tikshana Kshara.
- Atitikshana Kshara - The Kshara that burns the Eranda nal before the completion of 100 counts is considered as Atitikshana Kshara.
- Atimridu Kshara - The Kshara that burns the Eranda nal after the completion of 100 counts is called Atimridu Kshara.
Pratisarniya Kshara Prayoga (Uses of Pratisarniya Kshara)
The patient who is given the application of Kshara is made to sit in a breeze and sunlight-free room. The physician should collect all the required material for Kshara Karma as explained in Agropharaniya Adhyaya. Then the site on which the alkali is to be applied is inspected well. Depending upon the doshas alkali are used differently in different conditions. In Vata dushti lekhan karma (scraping) is done whereas in Pitta dushti gharshan (rubbing) is done. Pracchana (multiple incisions) is done in Kapha dushti and then alkali is applied to the affected region with the help of Shalaka Yantra (rod-like instrument). After applying Kshara the physician should observe the site where Kshara is applied for 100 counts.
Kshara Dagdha Lakshan (Signs Of Good Cauterization)
After applying Kshara if the cauterized part becomes black is considered as the sign of Kshara Dagdha. After that sauvirak (fermented barley water), tushodak and kanji (fermented gruels) mixed with ghee and licorice powder should be applied in that region. It helps in reducing the burning sensation in the affected area.
If the diseased part is not burnt properly even after proper application of Alkali. Then a paste of an equal amount of amla kanjika bija (the concentrated part settled at the bottom of the container containing amla kanjika), sesame and licorice paste should be applied to that region. After applying this paste the affected region becomes worn out and a wound is formed. A paste of sesame seeds and licorice mixed with ghee is applied in that region.
The Action Of Amlarasa (Sour)
Kshara contains all tastes but is devoid of sour taste. It is mostly pungent and salt is its secondary taste. When a strong salt and sour taste combines then the kshara loses its strength and becomes sweet. Kshara loses its properties just like a fire is extinguished when water and fire meet.
Samyak Dagdha Lakshan
The Samyak Dagdha Lakshana is given below:
- Elimination of disease/ signs and symptoms associated with the disease.
- Lightness in the diseased part.
- Cessation of exudates from the affected parts.
Hina Dagdha Lakshan
The Hina Dagha Lakshan is given below:
- Pricking pain
- Stiffness in the affected region.
Ati Dagdha Lakshan
The Ati Dagdha Lakshan is given below:
- Burning sensation
- Exudation from the affected part
- Pain in the affected part of the body
- Severe thirst
Management Of Alkali Cauterised Area
The wound produced after alkali cauterization should be treated according to dosha and disease.
Contraindications Of Kshara Karma
Given below are the people and diseases in which Kshara Karma should not be done:
- A person with general debility
- Old aged people
- A person who is having swelling all over the body
- A woman during menstruation
- A person having with high fever
- A person who is emaciated after a chest injury
- A woman having displaced uterus
Body Parts Where Kshara Karma Is Contraindicated
- Vital parts
- Inside the scrotum
- Body channels
- Body parts having less muscle
People Unaffected By Kshara Karma
Given below is the list of people who don't get benefits after Kshara Karma:
- A person has swelling in the body after Kshara Karma.
- A person having pain in bones after Kshara Karma.
- A person having loss of appetite.
- A person having pain in the heart and joints after Kshara Karma.
Kshara is a substance that has the tendency of Ksharan Karam. It is considered important among Shastra and Anushastra. It is used in the treatment of various disease conditions. Elimination of signs and symptoms associated with the disease, lightness, and cessation of exudates from the affected parts are the signs of Samyak Dagdha. Veins, Ligaments, Joints, Cartilage, Suture, Arteries, Neck, Navel and Nails are some of the body parts where Kshara Karam is not done.