See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/276453196

UTILITY OF APAMARGAKSHARA IN NON-HEALING CHRONIC ULCER: A

REVIEW

Article in International Journal of Research in Ayurveda and Pharmacy · May 2015

DOI: 10.7897/2277-4343.06237

CITATIONS READS
0 181

4 authors, including:

Pradnya Bhagat Savita Sharma

Datta Meghe Institute of Medical Sciences (Deemed University) Central Council for Research in Ayurvedic Sciences
3 PUBLICATIONS 12 CITATIONS 10 PUBLICATIONS 7 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

"A COMPARATIVE STUDY ON EFFECT OF KSHARA APPLICATION AGAINST FISSURECTOMY IN PARIKARTIKA (FISSURE IN ANO) View project

IMR Project : Menopausal Syndrome View project

All content following this page was uploaded by Savita Sharma on 19 August 2019.

The user has requested enhancement of the downloaded file.

 Pradnya J. Bhagat et al / Int. J. Res. Ayurveda Pharm. 6(2), Mar - Apr 2015

Review Article
www.ijrap.net

UTILITY OF APAMARGAKSHARA IN NON-HEALING CHRONIC ULCER: A REVIEW

Pradnya J. Bhagat1*, Savita Sharma2, Subhash Y. Raut3, Sunita Khatri4
1
Senior Research Fellow (SRF), Ayurveda Mental Health Research Institute, NIT Complex, Near Gharkulparisar,
Nandanvan, Nagpur, Maharashtra, India
2
Research Officer (R.O. Ayu), Ayurveda Mental Health Research Institute, NIT Complex, Near Gharkul Parisar,
Nandanvan, Nagpur, Maharashtra, India
3
Professor and Head of Department, Department of Shalyatantra, Government Ayurved College and Hospital, Nagpur,
Maharashtra, India
4
Private Practionar, Prishram Niwas, Hazare Lay Out, Ratan Nagar, Nagpur, Maharashtra, India

Received on: 29/12/14 Revised on: 05/02/15 Accepted on: 12/03/15

*Corresponding author
Dr. Pradnya J. Bhagat, Senior Research Fellow (SRF), Ayurveda Mental Health Research Institute, NIT Complex, Near Gharkulparisar, Nandanvan,
Nagpur, Maharashtra, India E-mail: [email protected]

DOI: 10.7897/2277-4343.06237

ABSTRACT

The disease that cannot be cured by any other medicine or in subjects where surgery is not possible this para-surgical procedure of Kshara-karma is
effective. Acharya Sushruta and Vagbhata have dedicated one complete chapter in Sutrasthana for Kshara preparation and Kshara-karma. Apamarga
kshara is the drug of choice in many diseases and the previous researchers have proved antimicrobial activity of Apamarga kshara in various studies.
In ‘Shashti Upakrama’ (sixty measures of wound treatment) advocated by Sushruta for comprehensive management of ‘Vrana’(wound), one of the
‘Upakrama’(procedure) is Ksharakarma mentioned for Shodhana (purification). The present article is devoted to establish the concept and principle of
action of Apamarga Kshara, when used externally, especially in non healing chronic ulcer. This article reviews the concept of Kshara as per
Ayurveda, preparation of Apamarga Kshara and its source plant and discussion on its mode of action about utility of Apamarga Kshara in non healing
chronic ulcer.

Keywords: Apamargakshara, non-healing ulcers, chronic ulcers, Vrana, Achyranthes aspera Linn.

INTRODUCTION Ksharana (localized cleansing properties) and Kshanan

(debridement) properties.3 Explanation of these two
In Ayurvedic ancient literature, Sushruta and other words by Dalhana is as under, ‘Ksharan’ means the one
authors discussed the wound in a clear and systematic which mobilizes and removes the morbid skin, flesh etc.
manner under the heading of Vrana. There is a detailed or which removes the vitiated Doshas. Dalhana mentioned
description of concept of wound is available with their that a few authorities considered the reference as Ksharan
classification, sign and symptoms, complications and the means purification.4 ‘Kshanan’ means which destruct the
management. Ancient scholars have classified the Vrana deformed skin flesh etc. Kshara is alkaline substance
as Nija and Agantuja. In Nija variety they have included obtained from the water soluble ash of the medicinal
all those causes where the systemic involvement of the plants. Every Kshara is made by treating with a definite
body found, where as in Agantuja variety, they have alkali known as Kshar Kalpana Dravyas like limestone,
explained about Vrana caused by the external factors silica, marble, chalk powder, Shankh Shukti (conch
mainly by trauma. Acharyas also explained that in due shell)5. In comprehensive management plan of ‘Vrana’
course of time Agantuja Vrana turn to Nija variety. (wound) known as ‘Shashti Upakrama’ (the sixty
Beside these two gross divisions of Vrana, there is measures of treatment of wounds), Sushruta has
another variety of Vrana which takes special attention advocated the ‘Ksharakarma Upakrama’ for purification
which is Dusta Vrana (chronic non healing wound)1. Out (Shodhana) of long standing ulcer which have raised
of all the Yantras, Upayantras, Shastras, Anushastras granulation tissue, are hard, itching, chronic and difficult
(ancient surgical instruments) and Oushadhas (medicines) in cleansing should be cleansed by applying caustic
the Kshara is the supreme, because it is most effective and alkali.6 The main aim of Vrana Shodhana is to remove the
acts immediately. Generally all the Ksharas act as dead tissue, keeping the wound bed free from unwanted
Chedana (cutting), Bhedana (penetrating) and Lekhana and harmful material, thus minimising the reactionary
(scrapping) Dravyas (substances). Ksharas are best useful inflammation. Apamarga Kshara is the drug of choice
as the substitute of surgical instruments, because they can having various therapeutic uses in Ayurvedic practices. It
be used freely on the patients who are Shastrabheerus is prescribed mainly for the treatment of Gulma
(those who are afraid of operative procedures). Lastly (Abdominal lump), Udara-shula (Pain in the abdomen),
Kshara is Tridosha Hara (corrects the vitiation of the three Grahani (Mal absorption syndrome) and Visuchika
basic bodily humours), hence, as a single drug, it acts on (Gastro-enteritis with piercing pain) etc7. Recent study by
all the three Doshas, i.e. Vata, Pitta, Kapha.2 Acharya Ghosh PK et al shows that, Achyranthes aspera Linn. leaf
Sushruta defined the Kshara as the substance possessing extract (aqueous and ethanolic) on topical application

185
 Pradnya J. Bhagat et al / Int. J. Res. Ayurveda Pharm. 6(2), Mar - Apr 2015

enhanced wound contraction and healing and was as hygroscopic), Sukha Nirvapya (easily neutralise) and
effective as soframycin (standard cream for comparison). Naati ruk (should not be too painful on application).17
The treatment group exhibit significantly smaller wounds
when compared with control (P < 0.001 each group) 8. Properties of Kshara
The aqueous extract of leaf of Achyranthes aspera Linn
was found to be more effective for its wound healing Rasa: Katu (pungent)
activity as compared to ethanolic extract. 9 Almost all the Veerya: Ushna (hot)
plants can produce Kshara which are pharmacologically Guna: Tikshna (sharp), Ushna (hot), Shlakshna (smooth)
similar to Apamarga Kshara.10 A case study by Pratik Varna: Krishna (blackish colour)
Wani et al also supports the wound healing properties of Doshaghnata: Tridoshaghna
locally applied kshara in excised secondary sinus.11 The
Sanskrit word Apamarga (Achyranthes aspera) literally Bahya Karma (Topical action)
means that which keeps away the Doshas.
Tridoshaghna (equilibrium of three vitiated doshas),
Latin name: Achyranthes aspera Linn. Saumyata (Mild-Slow acting), Dahana (Burning),
Pachana (Suppuration), Darana (Tearing), Vilayana
Family: Amaranthaceae. (liquefaction and dissolving), Shodhana (Cleansing),
Ropana (Healing), Shoshana (Drying and absorption),
Parts used: Panchanga (The leaves, roots, seeds, stem, Stambhana (Astringent/ contraction action) and Lekhana
fruits i.e. the whole plant). (Scaling)19.

Ayurvedic Properties Probable mode of action of Kshara in non-healing

ulcer
Rasa: Katu (pungent) and Tikta (bitter)
Guna: Laghu (light), Ruksha (dry) and Tikshna (sharp) Kshara is Tridoshaghna as it helps in equilibrium of
attributes. localized vitiated Tridoshas hence facilitates quick
Vipaka: Katu (pungent) in the post digestive. healing. Saumyata is one of the characteristic of Kshara
Virya: Ushna (hot) potency12-16 which actually looks like contradicting as the basic nature
Kshara is Teekshna but here Saumyata attributes that
Effect on Doshas: It is Kaphavatshamak and Kshara acts only on the deranged, unhealthy growth and
Kaphapittasanshodhak. hypertrophied tissues. Dahana again is the apparently
antagonist properties, Saumyata and Dahana of Ksharas
are complimentary to each other. The Kshara in particular
Aabhyantara Karma (systemic actions): It is diuretic, is moulded during its preparation to have both these
astringent and blood purifier. It is useful in the diseases, qualities in a therapeutically useful chemical structure.
like obesity, haemorrhoids, vomiting, abdominal pain, Ksharas acts externally through their dual action i.e.
pruritus (kandughna) and diseases due to Ama. Pachana and Darana properties. Pachana in an
inflammation implies hastening of inflammatory process
Bahya Karma (local actions): Shothahara (anti which is nothing but encouraging the body forces
inflammatory), Vedanasthapana (analgesics), Lekhana (Antibodies) to fight against pathogens (antigens) later
(scrapping), Twagdoshahara (reduces skin pathology), Darana helps in opening or rupture of the abscess. These
Vranashodhana (cleansing of wound). properties help in resolving the swelling or convert them
into abscesses for further (Shodhana) debridement.
Method of preparation of Apamarga Kshara Kshara by its Shodhana property helps in elimination or
expulsion of unwanted and harmful substances from the
The whole plant including its root, steams, leaves, seeds wound. Ksharas because of their Ushna and Tikshna
and fruits are collected in the beginning of summer and gunas helps in desquamation of sloughs (debridement)
allowed to dry in shade. After drying the whole plant is and draining of pus. After attaining this debridement of
burnt in a semi-closed space and ashes are collected. unhealthy tissues Kshara helps in Ropana or healing of
Ashes are allowed to cool down and dissolved in six Vrana (wound) due to its antiseptic property which has
times of clean tap water and thoroughly mixed and been reported by the researches in various studies.
allowed to settle down. It is filtered without the settled Healing requires new vascularisation, granulation tissue
down material and then heated. Kshara is stuck at the formation and lastly in pouring of proteins and fibrocytes
bottom of vessel. It is kept in glass bottle with airtight for formation of healthy tissue which is taken care by
cork for future use. The Kshara prepared by the above Ropana property of Kshara. Healing in ulcer is delayed
procedure must fulfil the qualities mentioned by the because of moisture, as moisture facilitates breeding and
Acharya Sushruta and Vagbhata18 as, Naati Tikshna growth of micro organism. Shoshana property of Kshara
(should not be too corrosive), Naati Mridu (should not be helps in drying up and absorption of mucous discharge
too mild), Naati Shlakshna (should not be too smooth), that gets collected in ulcer bed promoting the granulation.
Naati Pichhila (should not be too sticky), Sheeghra grahi Kshara being in the form of ash acts as an absorbent
(easily applicable), Naati sthira (should not be too stable), (hygroscopic), so that ulcer becomes relatively aseptic
Shikhari (effervescent), Avishyanda (should not be and healing is hastened. Stambhan property helps in

186
 Pradnya J. Bhagat et al / Int. J. Res. Ayurveda Pharm. 6(2), Mar - Apr 2015

contraction or coming together of the opposing edges of 6. Sushruta, Sushruta Samhita, edited by Sharma PV, Varanasi:
an ulcer to promote active healing. Vilayana property Chaukhambha Surbharti Prakashan. Vol II, Chikitsa sthana,
chapter 1, Shloka 88; 2005. p. 265.
helps in liquificaton and dissolving of localised unhealthy 7. Anonymous, Ayurvedic Pharmacopoeia of India, Govt. of India,
tissues. Lekhana The fibrosed tissue in the edges of Ministry of Health and Family Welfare, Dept. of AYUSH, New
chronic ulcer hampers the healing process. The Tikshna Delhi, Part II, Vol. 1, 101; 2007.
Guna of Kshara scraps the site of fibrosis. Thus when 8. Ghosh PK et al, Wound healing potential of aquas ethanolic
extract of Achyranthe aspera leaves. Int. J. Green pharmacy. 2011;
fibrosis is sloughed out the process of healing becomes 5(1): 12-15.
faster. 9. Edwin S et al, Wound healing and antioxidant activity of
Achyranthe aspera. Informa healthcare 2008; 1(46-12): 824-28.
CONCLUSION 10. Rath Sudipt Kumar et al, Review of source plant of Kshara for
Kshrasutra preparation for the management of fistula in ano. Int. J.
Res. Ayurveda Pharm 2012; 3(3): 333-340.
Kshara is basically Shodhana (purification) in nature 11. Pratik Wani et al, Effect of Apamarga Pratisaraneeya Kshara in the
which helps in elimination or expulsion of unwanted and Management of Nadivrana (Pilonidal Sinus) – A Case Report.
harmful substances from the chronic non-healing wound International Ayurvedic Medical Journal 2013; 14(2).
12. PV Sharma. Dravyaguna vijnana Vol-2, Chaukhambha Bharathi
by desquamation of sloughs (debridement) and draining Academy, Varanasi. Reprint; 2009. p. 543-544.
of pus. Debridement removes devitalized tissue, which 13. Rajanighantu of Pandit Narahari by Dr Indradev Tripathi,
can be a source of endotoxins that inhibit fibroblast and Chowkhambha Krishnadas Academy, Varanasi; 2006. p. 78-79.
keratinocyte migration into the wound and promotes the 14. PV Sharma and guru prasada Sharma. Kayyadevanighantu.
Chaukhamba orientalia, Varanasi; 1979. p. 191.
process of healing. 15. Danvantari Noghantu with Hindi Translation and Commentary
Edited and Commentated by Jharkhandey Ojha, Dept of
REFERENCES Dravyaguna Institute of Medical Sciences, BHU, Varanasi; 1985.
p. 91-92.
1. Sushruta, Sushruta Samhita, edited by Sharma PV, Varanasi: 16. Prasad PVV and Subhaktha PKJP. Apamarga (Achyranthes aspera
Chaukhambha Surbharti Prakashan. Vol. 1 Sutrasthana, chapter 22, Linn) Medico-Historical review 2001; 31(1): 15.
Shloka 07; 2004. p. 241. 17. Sushruta, Sushruta Samhita, edited by Sharma PV, Varanasi:
2. Sushruta, Sushruta Samhita, edited by Sharma PV, Varanasi: Chaukhambha Surbharti Prakashan. Vol. 1 Sutra sthana, chapter
Chaukhambha Surbharti Prakashan. Vol. 1 Sutrasthana, chapter 11, 11, Shloka 13-15; 2004.
Shloka 03; 2004. p. 113. 18. Sushruta, Sushruta Samhita, edited by Sharma PV, Varanasi:
3. Sushruta, Sushruta Samhita, edited by Sharma PV, Varanasi: Chaukhambha Surbharti Prakashan. Vol. 1 Sutra sthana, chapter
Chaukhambha Surbharti Prakashan. Vol. 1 Sutrasthana, chapter 11, 11, Shloka 5; 2004.
Shloka 4; 2004. p. 113. 19. Vagbhata, Ashtang Hriday Edited By Vaidya Yadavaji Trikamji
4. Dalhanacharya Virachita, Sushruta Samhita, Acharya, Chaukhambha Sanskrit Sansthan, Varanasi, India, Ed,
Nibandhsangrahvyakhya Sanvalita, Edited By Vaidya Yadavaji Sutra Sthana, Chapter 11, Shloka 4; 2009. p. 352-353.
Trikamji Acharya, Chaukhambha Sanskrit Sansthan, Varanasi,
India, Ed, Sutra Sthana, Chapter 11, Shloka 4; 2009. p. 45. Cite this article as:
5. Ayurvedic Formulary of India. Govt. of India, Ministry of Health
and Family Welfare, Dept. of Indian System of Medicine and Pradnya J. Bhagat, Savita Sharma, Subhash Y. Raut, Sunita Khatri.
Homeopathy, New Delhi; 2003. p. 164. Utility of apamargakshara in non-healing chronic ulcer: A review. Int. J.
Res. Ayurveda Pharm. 2015;6(2):185-187 http://dx.doi.org/10.7897/
2277-4343.06237

Source of support: Nil, Conflict of interest: None Declared

187

View publication stats