Medicated Alkaline Thread
Medicated Alkaline Thread (Sanskrit: Kshara Sutra) is an instrument used in kshara sutra and para-surgical instruments. A specially prepared surgical thread coated with three layers: latex of Snuhi (Euphorbia neriifolia), Apamarga Kshara (Achyranthes aspera alkali), and Haridra (turmeric) powder. Applied repeatedly (21 coatings) to create a medicated thread used for gradual cutting, drainage, and healing of fistulous tracts.
| Sanskrit name | Kshara Sutra |
|---|---|
| Ayurvedic category | Kshara Sutra and Para-Surgical Instruments |
A specially prepared surgical thread coated with three layers: latex of Snuhi (Euphorbia neriifolia), Apamarga Kshara (Achyranthes aspera alkali), and Haridra (turmeric) powder. Applied repeatedly (21 coatings) to create a medicated thread used for gradual cutting, drainage, and healing of fistulous tracts.
Where is it described in the classical texts?
Sushruta Samhita Chikitsasthana Chapter 17 (Bhagandarachikitsitam) describes Kshara Sutra for Bhagandara (fistula-in-ano). Further developed by Dhanwantari and described in Chakradatta, Rasaratna Samuchaya.
How is it used traditionally?
Fistula-in-ano (Bhagandara) - primary indication. Also used for hemorrhoids (Arsha), pilonidal sinus, and chronic non-healing sinuses. ICMR-validated technique. WHO recognized as a minimally invasive alternative to fistulotomy.
Traditional materials
- Barbour’s linen thread (No. 20)
- Snuhi Kshira (Euphorbia neriifolia latex)
- Apamarga Kshara (Achyranthes aspera alkali)
- Haridra Churna (Curcuma longa powder)
Modern variants
- Standardized Kshara Sutra prepared under GMP conditions
- Modified Kshara Sutra with different alkaline agents
- Kshara Sutra with antibacterial coatings
Regulatory status
- India Cdsco: Kshara Sutra is recognized as a validated Ayurvedic surgical procedure. ICMR-validated. Taught in BAMS curriculum. Regulated under AYUSH surgical practice guidelines.
- Us Fda: Not FDA-cleared. Would require regulatory pathway determination (likely Class II or III) if marketed as a medical device in the US.
- Eu Mdr: Not CE-marked. Would require classification under EU MDR (likely Class III due to implantable/invasive nature).
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