Medicated Alkaline Thread
Medicated Alkaline Thread (Sanskrit: Kshara Sutra) is an instrument in the Kshara Sutra and Para-Surgical Instruments category. 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 (Visarpa-Nadi-Stanaroga Chikitsitam) describes Kshara Sutra for Nadi Vrana (sinus). It is also described in later texts such as Chakradatta and Rasaratna Samuchaya.
How is it used traditionally?
Bhagandara (fistula-in-ano): used in classical practice as the primary indication. Also traditionally used for Arsha (hemorrhoids), pilonidal sinus and chronic non-healing sinuses. It is described 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 an Ayurvedic surgical procedure. It is taught in the BAMS curriculum. It is 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).
Reviewed by Dr. Awadesh Pratap Singh, BAMS, on 11 October 2026. What that review covered.
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