Sushruta Samhita Chapter 11 Ksharapaka Adhyaya

This article explains Sushruta Samhita Sutrasthana Chapter 11 “Ksharapaka Adhyaya”- Preparation of Caustic alkali.

We will now expand the chapter, by name Ksharapakavidhi – preparation of caustic alkali; as revealed by the venerable Dhanvantari.

Kshara Mahatva

Importance of Alkali
Among the shastra (sharp instruments) and anushastra (accessory instruments) – kshara (caustic alkali) is the most important one because –

• It serves the functions like chedana – excision (removing), bhedana – cutting (dividing) and lekhana – scraping,
• It is prepared by many herbs,
• It mitigates all the three doshas and
• It is suitable for being used in many special procedures
  Read – Kshara: Properties, Types, Preparation Method, Benefits

Nirukti

Definition
It is called Kshara, since it does ksharana (destroys the vitiated tissues and makes them fall off) or since it does kshanana (torments the tissues).

Ksharaguna

Properties of Alkali
The kshara is prepared by the combination of many herbs / drugs. Therefore, it mitigates tridoshas. (Alkali is prepared using many herbs which are useful in destroying the morbid tridoshas and hence useful in aggravation of all three doshas).

Since kshara is white in color, it is cool in nature. In spite of being cool it would preserve its actions including burning, ripening, and bursting.

Kshara is prepared using drugs / herbs which are predominant in Agneya guna (having fiery nature). Therefore, it is pungent in taste and hot in potency. (Due to the same qualities) it is deep penetrating and causes ripening (of swelling around wounds – vrana sotha etc), liquefaction (of gulma – tumors etc., purification / cleansing (of contaminated wounds and ulcers), healing (of clean wounds – shuddha vrana), absorption (of fluids – dampness or excessive moistness of wounds / ulcers), withholding (stops bleeding – checks excessive bleeding), and scarification (of hard and elevated tissues including muscles). It destroys worms (bacteria, virus etc.), ama (undigested materials), and kapha. It also cures kushta (skin diseases, leprosy), poisons and excessive accumulation of fats (obesity). If alkali is taken in excess, it destroys masculinity (sexual powers in male).
Read – Kshara Agnikarma Vidhi – Cauterization- Astanga Hridaya Sutrasthana 30

Vidha- Kinds

Kshara is of two kinds, viz,

1. Pratisaraniya Kshara – meant for external application and
2. Paniya Kshara – meant for internal administration i.e., to be drunk (internal potion)

Pratisaraniya Kshara

Pratisaraniya Kshara i.e., application of caustic alkali externally is indicated in the below mentioned conditions –

• Kustha – leprosy
• Kitibha, Dadrumandala – minor skin diseases  
• Kilasa – leucoderma
• Bhagandara – fistula-in-ano
• Arbuda – malignant tumors
• Arsha – piles / hemorrhoids
• Dusta vrana – vitiated (septic) ulcers
• Nadi – sinus ulcers
• Charmakila – skin warts
• Tilakalaka – pinheads
• Nyaccha – pigmented patches on the body and face
• Vyanga – pigmented patches on the face
• Mashaka – moles on the skin
• Bahya Vidradhi – external abscess
• Krumi – worms (bacteria etc.)
• Visha – diseases produced by poisons / poisoning
• Seven diseases of the mouth including – Upajihva, Adhijihva, Upakusha, Dantavaidarbha and three kinds of Rohini / Kantarohini (Vataja Rohini, Pittaja Rohini and Kaphaja Rohini)
• Eteshu anushastra pranidanam uktam – in all those diseases wherein use of accessory instruments has been indicated
  Read – Ksharasutra Preparation Method: Detailed Explanation

Paniya Kshara

Paniya Kshara i.e., drinking of the solution of alkalies is indicated in the below mentioned conditions –

• Gara visha – artificial poisons
• Gulma – abdominal tumors
• Udara – enlargement of abdomen
• Agnisanga – diminished digestive power (irregularities or impairment of digestive capacity and disorders resulting from the same)
• Ajirna – indigestion
• Arochaka – loss of taste / anorexia
• Anaha – flatulence / distension of abdomen
• Sharkara – urinary gravel
• Ashmari – urinary calculi
• Abhyantara vidradhi – internal abscess
• Krumi – worms
• Visha – poisons
• Arsha – hemorrhoids
  Read – Administration of Kshara Sutra in Arshas (piles, haemorrhoids)

Contraindications for administration of Paniya Kshara

Paniya Kshara is contraindicated in the below mentioned conditions and people (since it is harmful in these conditions) –

• Raktapitta – bleeding disorders
• Jwarita – fevers
• Pitta prakruti – those belonging to pitta constitution / body type
• Balaka – children
• Vrddha – old aged people
• Durbala – debilitated persons
• Bhrama – giddiness / those suffering from dizziness
• Mada – intoxication
• Murcha – fainting
• Timira – blindness
• and similar ailments

Method of preparation of Paniya Kshara
Paniya Kshara should be prepared by burning (incinerating) the drugs and making a solution of it. Its method of preparation is the same as that of other ksharas, the details of which will be described elsewhere.

Kshara nirmana

Preparation of Alkali
The other Kshara i.e., Pratisaraniya Kshara – meant for external application is of three kinds viz –

• Mrudu – alkali having mild power
• Madhyama – alkali having medium strength
• Tikshna – alkali which is powerful / of immense strength

The person (physician) who desires to prepare kshara should follow the below mentioned procedures –
He should choose an auspicious day during Sharad Rtu – autumn season. He should cleanse himself and observe fasting. Later he should reach the peaks (slopes) of the mountain on the chosen day. He shall search for a Kala Mushkaka tree grown in the auspicious regions of these peaks. This tree should be of middle age (enriched with taste and potency) and big in size. The power (effect) of its potency should not have been destroyed by the effect of cold, rains, fire, poisons and insects (worms etc.). On the first day the physician should offer worship and oblations to the tree (enchant hymns in favor of the tree and induce power in the same). On the second day (next day) the tree should be de-rooted. Its stem and branches should be cut into small pieces with the help of an axe and stored in the form of a heap in a place devoid of breeze. On this heap one should add some quantity of small pieces of sudha sharkara i.e., lime stones (some limestones shall be placed beneath the heap and some in the between). This heap should be put on fire (burnt) with the help of dried reeds of Tila (sesame) plant. Ashes of the tree shall be collected in a separate vessel and that of the limestone in a separate one, after the fire gets extinguished all by itself.

In the same manner, the below mentioned plants / trees along with their roots, stem, branches, leaves and fruits shall be burnt and their as collected –

• Kutaja
• Palasham
• Ashvakarna
• Paribhadraka
• Bibhitaka
• Aragvadha
• Tilvaka
• Arka
• Snuhi
• Apamarga
• Patala
• Naktamala
• Vrusa
• Kadali
• Chitraka
• Putika
• Indravruksha
• Asphota
• Ashvamaraka
• Saptachchada
• Agnimantha
• Gunja
• Four kinds of Koshataki

The ash of the above said shall be taken in the quantity of 1 drona (10.24 kg), put and mixed in six drona (61.44kg) of water. If strong alkali is needed, the ash is mixed in the urine of cows etc. (instead of water). This ash mixed water shall be filtered through cloth for twenty-one times.
This filtered water is now put in a large iron cauldron and boiled. While boiling, the liquid should be slowly and constantly stirred with a ladle.

During the process of boiling, when the liquid becomes clear, red colored, sharp and slimy, the vessel should be removed from the fire. This should again be filtered through a thick cloth into another (iron) vessel and the filtrate (liquid) should be cooked again. Before heating, one or one and half kudava (160 or 240 grams) of the solution of ash (alkaline water) should be removed and kept separately, stored in a different vessel.
After that, the ash of Katasarkara, Bhasmasarkara (ash of limestone), Kshirapaka (oyster shell) and Sankha Nabhi (conch shell) ate burnt on fire and made red hot and put into iron vessel containing the solution of ash (alkali) and stirred well. Then eight pala (320 grams) of ash of Sankhanabhi etc. are macerated in two drones (20-84 kg) of the same solution (taken out separately as explained earlier), made into paste is also added (as prativapa). Cooking is continued while stirring the contents all through till the mass becomes neither too solid nor too liquid (thin). When the cooking is almost complete, the liquid is then poured into the iron vessel, closed with a lid and preserved carefully. This is the method of preparing Madhyama Kshara (alkali of moderate strength and potency).

This Kshara (Alkali) itself if prepared without Prativapa (adding paste of other drugs) is called as Samvyuhima Kshara or Mrdu Kshara (Alkali of mild potency).

In the prativapa of Katasharkaradi herbs, the fine powder of equal quantity of each of Danti, Dravanti, Chitraka, Langali, Putikapravala, Tadapatri, Bida lavana, Suvarchika, Kanakakshiri, Vacha and Ativisha – all or as many as available are added in quantity of one shukti (20 grams). In this way if prativapa (adding extra drugs to enhance the properties) of Katasharkara etc. is added with prativapa of Danti etc. and cooked, it is called as (the resultant alkali) Tikshna Kshara (alkali of strong potency). It is also called as Pakya Kshara.

These (two kinds of Alkali – Mrdu and Tikshna) should be used according to the strength of the disease. If the Alkali is weak (mild potency) it should be soaked (for a short time) in the solution of Alkali to enhance its strength.

Kshara Guna Dosha

Good Properties and demerits of Caustic Alkali

Kshara Ashta Guna – The eight good properties of alkali are –

1. Naiva Atitikshna – Not very strong,
2. Na Mruduh – not very mild
3. Shuklah – white in color
4. Shlakshna – smooth
5. Pichchila – slimy
6. Avishyandi – not spreading
7. Shiva – good acting
8. Shighrah – quick acting

Kshara Ashta Dosha – The eight demerits of alkali are –

1. Ati mardava – very mild / weak,
2. Ati shvaitya – too much white in color
3. Ati ushna – very hot (heat producing)
4. Ati tikshna – highly penetrating
5. Ati pichchila – very slimy
6. Ati sarpitah – greatly spreading
7. Ati sandrata – very thick (liquid
8. Apakvata – not well cooked, and
9. Hina dravyata – lacking in drugs (mentioned in the classics) required to prepare the

Pratisaraniya Kshara prayoga

Procedure of Applying caustic Alkali externally
The patient, who is suffering from a disease which is curable with application of alkali, should be made to sit in a place devoid of breeze and sunlight. The place should be broad (not narrow). All the necessary equipments and things required for conducting kshara karma shall be collected beforehand and kept ready, as explained in agropaharaniya chapter (chapter 5).

 Next, the place (site) for the application of the Alkali, in the patient fit to undergo alkali therapy, should be observed (inspected well) properly. Later the site should be scrubbed, scrapped or cut (incised). Then the Alkali held in a salaka yantra – rod like instrument (specially meant for this purpose described in chapter 8) should be smeared on the place (site of the disease). After applying, a period of time required for pronouncing one hundred letters should be allowed to elapse (the physician should wait for a time period of hundred counts).
Read – Sushruta Samhita Chapter 8 Shastravacharaniya Adhyaya

Kshara Dagdha Lakshana

Signs of good burning by alkali (cauterization)

The signs of good burning by alkali (cauterization by alkali) are –

• disappearance of the disease following the application of kshara / falling off of the diseased part following the application of kshara and
• development of black color at the site 

Once this appears, the drugs of the ‘sour tasting group – amla varga’ are mixed (processed, boiled) with ghee and powder of licorice is applied. This relieves burning sensation, pain and discomfort.

If the diseased part (vitiated muscle etc tissues) does not fall off in spite of being burnt by the alkali, the area should be smeared with paste of all the drugs which are mentioned henceforth.
Equal quantities of amla kanjika bija (the solid part settled at the bottom of amla kanjika – sour gruel), sesame and madhuka – licorice should be ground together and the resultant paste be applied on the part burnt by alkali.
For further healing of the ulcer left out after application of the above said formulation, paste of tila – sesame and madhuka added with ghee is applied at the site.

Amlarasa Karma

Action of the sour taste
Lord (Master) Dhanwantari said to Sushruta ‘Dear son, if you opine – how does amla rasa (sour taste) which possesses penetrating property, hot potency and fire like activities, having fire like action, mitigate the effect of kshara – alkali, which also has similar properties as those of fire, then listen to what I am going to say now (my reply)’.

In Kshara (alkali), all tastes (sweet, salt, pungent, bitter and astringent) are present, except sour taste.
Among these five tastes, pungent is the predominant taste and salt is the secondary taste. When these pungent and salt tastes combine with the sour taste, they become predominantly sweet.

When salt having penetrating quality gets mixed with sour taste it would acquire excessive sweetness and cast off its penetrating quality and also gets subsided by (mitigated) the sweetness, just like the fire subsides when water is poured on it (effects of burning by alkali gets mitigated).
Read – Amla Benefits, Dose, How To Use, Side Effects, Home Remedies

Dagdha Lakshana

Signs of burning (cauterization)
Samyak Dagdha Lakshanas (signs of proper cauterization) –

• Mitigation of the diseases (subsiding of symptoms like pain, swelling, bleeding etc.),
• Feeling of lightness (of the diseased part) and
• Stoppage of exudations

Hina Dagdha Lakshanas (signs of inadequate cauterization) –

• pricking pain,
• itching,
• loss of movement and
• increase of the disease (aggravation of symptoms)

 Ati Dagdha Lakshanas (signs of excessive / over burning) –

• burning sensation,
• suppuration (ulceration),
• redness,
• discharges / exudation,
• pain in the body parts,
• exhaustion,
• severe thirst,
• fainting and
• even death

The ulcer produced by burning (cauterization)by Alkali should be treated suitably according to the aggravated Dosa and the disease.
Read – How To Make Herbal Oil To Remove Burn Scars

Kshara Anarha

Contraindications for Alkali Cautery: –
Cauterization by Alkali should not be done for persons such as

• the debilitated,
• children,
• old aged,
• fearful,
• those suffering from swelling all over the body, enlargement of the abdomen, bleeding diseases,
• pregnant lady,
• woman during menstruation,
• those in whom the intensity of the fever has abnormally increased (advanced stage of fever),
• those suffering from diabetes, those who are emaciated due to injury to the chest (lungs), thirst, fainting
• those impotent,
• women whose uterus has been displaced downwards or upwards

So also, alkali shall not be administered in places such as vital spots, veins, ligaments, joints, cartilages, sinews (raphae, sutures), arteries, throat, umbilicus, nail-bed, penis, channels, places of the body with less muscles and eyes, except diseases of the eyelids

Even in those diseases which are curable with the use of alkali, administration of kshara (alkali) will not benefit (yield good results) in patients having swelling all over the body, pain in the bones, aversion towards food, pain in the heart and joints.

Limitations of administration of kshara – alkali
Alkali (cauterization) administered by a person of poor intelligence will be like (the effect of) poison, fire, sharp weapon, thunderbolt and death. On the contrary, if alkali is administered properly by an intelligent person (physician, surgeon) it can cure even dreadful diseases in quick time.
Thus end the 11th chapter by name Ksharapakavidhi in Sutra Sthana of Sushruta Samhita.