- The procedure by which Vilayana or Dravikaran`a (liquefaction) of Dusht`a Tvak and Maamsa and also removal of the same is achieved with the help of Kshaara is called as Kshaarakarma.
- It becomes imperative in certain conditions to physically remove the sloughs, Dusht`a Tvak (contaminated) skin or hypertrophic muscles from a wound or a lump, at such places Kshaarakarma should be done.
- Prtisaaran`eeya Kshaara is again divided into three types viz.
o Madhyama and
- Madhu, Kaanjee, Dadhi, Dadhi Mastu, Lepa of S`heetaveerya Dravya, Tila Kalka, Yasht`i, Ghrita, Amla Varga, Sauveeraka, Tushodaka, Dhaanyaamla
- The procedure should be conducted inside a room free from excessive wind flow and sunlight.
- The person should be given a position according to the disease.
- The area around the site of Kshaarakarma should be covered by a cloth.
- For Pittaja diseases Gharshan`a (rubbing), for Vaataja diseases, Kathin`a and Supta Tvak Lekhana (scrapping) for Kaphaja diseases and when excessive Kan`d`ooand S`hotha is present then Prachchhaana Karma should be done before application of Kshaara.
- Then Kshaara should be applied with the help of S`halaakaa.
- Kshaara should be washed off after a time required calculating 100 numbers. (For Kshaara karma at Mridu organs the time should be that equal to calculate 50 numbers.)
- The site should be covered by a Plota / palm.
- The site of Kshaarakarma should be flushed with drugs from Amlavarga.
- Then Lepa of solid part from Sauveeraka, Tushodaka etc. or Tila, Yasht`i should be applied at the site of Kshaarakarma.
- The patient should be given Abhishyandi Aahaara e.g. Dadhi, Maasha. Due to this there is formation of Kleda at the site of Kshaarakarma and Vilayana ofMaamsaadi Dhaatu resulting in Ksharan`a (destruction) of Dhaatu.
- Pratisaaran`eeya Kshaara should not be used at the region of Marma, Siraa, Snaayu, Sandhi, Tarun`aasthi, Sevanee, Dhamanee, Gala, Naabhee, Nakhaanta,Med`hra, Srotasaagra, Netra, Kan`t`ha and the region where small amount of Maamsa is present.
- This procedure has effect on Kleda.
- This procedure should not be done when the patient is having multiple wounds.
- After S`hastrakarma, Kshaarakarma should be done over Vartmaars`ha, S`hushkaars`ha (Netra Roga) and Arbuda Netra Roga.
Following is the procedure performed particularly in the treatment of Ars`ha:
- S`halaakaa Yantra
- The patient should eat light diet having Anulomana effect in small amount on the previous night.
- The patient is not allowed to eat anything on the day of procedure till the end of the procedure.
- He should be asked to evacuate bowel and pass urine prior to the procedure.
- The patient should have bath. (The area should be cleaned thoroughly before Kshaarakarma.)
- Svastivaachana to stabilize the patient psychologically.
- Pratisaaran`eeya Kshaara Mridu Kshaara should be used for Kshaarakarma of Raktapittaja Ars`ha.
- Yantranaa positioning The position should lie down in a supine position on a bed or a table with legs spread to expose the anus for better view and to facilitateKshaarakarma.
- In case of a child or a serious patient, the patient should lie on the lap of the assistant (in such a manner that the patients body above waist, lies on the lap of assistant.)
- The patients anus should face east.
- His waist should be elevated by keeping a pillow below his waist.
- The patient should be asked to raise his legs and should be given lithotomic position.
- Then the assistant should apply lubrication to anus and insert lubricated Ars`ha Veekshan`a Yantra, slowly and steadily through the anal opening.
- Then the patient is asked to do Pravaahan`a (straining).
- Due to this the Ars`ha will be visible in the Ars`ha Veekshan`a Yantra.
- The Kshaara should be taken over a Jambvosht`ha S`halaakaa Yantra which is covered by the cloth at one end.
- The physician should pull the Ars`ha slightly upwards or press the upper part of Ars`ha so that the root of the Ars`ha is visible and apply the Kshaara at the root ofArs`ha.
- After application of Kshaara the Ars`ha Veekshan`a Yantra should be closed with hand for a time required to count 100 numbers.
- Then the Kshaara is applied again till the symptoms of proper Kshaarakarma are achieved.
- When the Ars`ha looks like ripe Jambu or Avasanna (shrinked) or slightly Nata (bent), Kshaara should be washed off with Kaanji, Dadhimastu, S`hukta or Phalaamla Rasa. Then ghee and Yasht`imadhu should be applied.
- Then the Ars`ho Yantra should be removed gently.
- Kshaara karma should be done for one Ars`ha at one time. After 7 days Kshaara should be applied to another Ars`ha and so.
- The Kshaara should be applied to Ars`ha on right side initially then to that on left side, then back and then front.
- In case of prolapsed piles the Kshaara should be applied without using any instrument.
- Abhyanga should be done over anus and the area around anus.
- Avagaaha should be done with hot water and Parisheka with cold water. (According to some Parisheka with hot water should be done.)
- Then the patient should be asked to rest for a while.