Ano-Rectal Care (Methodology)
The incidence of colorectal diseases are progressively increasing,with the changes in the DIET and LIFE STYLE.The Anorectal disesses are ignored and neglected on behalf of the patients and physicians both,so sometimes the disease become incurable,life threatening or fatal.
The operative results of anorectal diseases are not always satisfactory,even by skilled hand.Complications like rectal incontinence and recurrences are common problems after Radical surgery,which disturbs the quality of life.
Now a days for anorectal diseases Kshar Sutra Surgery is emerging as a superspeciality branch in the field of surgery.It is widely practiced all over in India and in some foreign countries.
Kshar – May be defines as a chemical substance obtained from filterate of water soluble contents of Plant ash,after evaporating it to dryness.
Types of Kshar
According to its therapeutic use Sushrut described two types of Kshar.
- Pratisaraniya kshar: The Kshar,which is used for local application to treat the various surgical and para surgical diseases.
- Paneeya kshar: The liquid solution of Kshar administered orally to treat the different gastro-intestinal diseases like hyperacidity,anorexia,indigestion,peptic ulcer,gaseous tumours etc.
According to its potency Kshar has been recognized as three types.
- Mridu Kshar: It is of lower potency Kshar,where the pathologcal tissues do not turn to black up to normal couting of 100 numbers or 72 seconds,when applied to treat the diseased tissue.
- Madhyam Kshar: It is Kshar of medium potency where potency where the unhealthy tissue after its application turns to black up to normal counting of 100 numbers or 72 seconds.
- Tikshna Kshar: It is of very high potency Kshar where affected part of the body tissues turns to black before completing the counting of 100 numbers.
Preparation of Kshar
The process of Kshar preparation has been described in Ayurvedic literature.The Kshar is present in every plant and it can be obtained from ash of the plants after process of Kshar paka.
The dried plants with stems,roots,leaves,flowers and seeds with equal quantity of lime is burnt to ash and Kshar is prepared according to process of kharpaka.The kshar thus obtained is very irritant and causes severe pain & burning,when applied on the wounds.
The annual or biannual herbaceous plants of Achyranthes aspera is rooted out with its stems,roots,branches,leaves,flower and seeds from the month of December to March,when plants are fully matured.The plants Achyranthes aspera grow sufficiently on roadsides,gardens and in uncultivated waslands between herbs ans shrubs in the beginning of rainy season.In local language it is called Apamarg,Chitchita,Latjeera,Onga etc. the rooted out plants at appropriate times are tied into small bundles and left to dry in open sunlight on clean ground.The fire is set into the bundles.As soon as the burning starts,the next budle is picked up and placed on the fire.one by when all bundles are burnt to ash,it should be stirred slowly to cool.it should be left for 6-8 hours to cool completely.The care to be taken not to have much coal particles,otherwise reburnt completely.The cooled ash without coal particles is collected and dissolved into 6-8 times of water in the plastic container of appropriate size.The solution should stirred well with wooden stick to dissolve the ash.The solution is left to lie fo 10-12 hours.after that the solution is again stirred with stick and filtered with thick cloth.the residual ash is placed aside into other plastic pot and filterate is refiltered for 2-3 times more.The filterate thus obtained is muddy in colour due to presence of traceable residual ash.
Now thye filterate is kept to lie for 2-3 hours,the heavy residue sediment at the bottam of container leaving the clear transparent fluid in it.The solution is transferred into the next similar pot slowly.The sedimented residue at the bottam of first pot transferred into the earlier placed residual container.The process of transferring the solution into the next pot and collection of residue into the other pot is continued repeatedly at interval of 4-6 hourly till clear transparent solution is obtained.to get the more quantity of kshar the residue is again dissolved into 6-8 times of water and the process is repeated for 2-3 times to obtain the clear solution.Lastly when complete soluble Kshar has been transferred into the previously obtained container the residual ash is discarded.
In the next process a saline drip set is taken.One end of the tube is submerged into the plastic pot containing the Kshar solution.It is sucked at the second end.The second end of the tube is placed into the next neat and clean plastic pot.the clear fluid falls drop by drop into the second pot and is transfer slowly from first pot into second pot.The first pot is placed at higher level than second pot.the end of the tube in the pot is covered with cotton wool,which prevent the transfer of undissolved residual particles into the second pot.the solution may be filtere with filter paper ,but this process is suitable only in well equipped laboratory and needs careful attention and time for this process.
Preparation of Kshar Sutra
One end of selected thred is tied into the fissure of side arm of the frame.The thred is wrapped into the fissure of both side arms.Thus it is spread horizontally on entire frame between the fissures.Now it is ready for smearing the latex.The fresh latex is entire ollected from Euphorbia nerifolia.With the help of gauze piece soaked into latex entire length of thread is smeared.Pulp of thumb and index finger alone may be used for smearing.The complete circumference of the thread is smeared uniformly.The smeared frame is placed to dry in natural sunlight for 30-60 minutes then replaced into the Kshar sutra cabinet.The frame may be replaced into cabinet for 30-40 minutes,after that switch is off,to maintain the room temperature into the cabinet for one night.During dusty,windy and cloudy atmosphere the frame is not placed in sunlight but directly into the cabinet.Such 11 coatings are applied for 11 days each one per day.In summer season where smeared thread dries within 4-6 hours,second coating may be applied on the same day.After 11 coating next 7 coatings of latex and Kshar powder are applied simultaneously.Unbounded dry,crust like particles of Kshar on the thread is brushed with piece of dry gauge to obtain the uniform thickness of thread after each coating.
After Kshar coatings last 3 coatings are done with powder of Hald i for 3 days after smearing the thread with the latex.Daily brushing of Kshar sutra continued till last coating is completed to have a smooth and uniform thickness of thread.
The order of coatings is as follows
|1||Snuhi Ksheer||11 coatings|
|2||Snuhi Ksheer + Apamarga kshar||7 coatings|
|3||Snuhi Ksheer + haldi powder||3 coatings|
Advantages of the Treatments
- Complete cure of the Ano-rectal diseases
- No Recurrence
- No Centerization(In most of the cases) – Day care treatments
- Less Pain
- No Incontinence
- No Blood Loss
- Patient is back to work from next day
- Safe treatment
The Available facilities in YPPC
- Ayurvedic Ksharsutra treatment.
- Infra Red Coagulation.
- M.I.P.H (stapler)
- D.G.H.A.L (Doppler Guided Hemorrhoidal Artery Ligation)
- Sclero Therapy (Injection)
- Cryo Treatment
- Laser Treatment
- Radio frequency treatment
- T.H.D treatment (Trans Anal Hemorrhoidal Dearterialisation)
- Conservative treatment for Ano-rectal diseases.
- Harmonic Scalpel