Guggulu-Coated Chitrak Kshara Sutra Ligation in the Management of 2nd Degree Internal Haemorrhoids: A Case Report

Abstract

Background: Arsha (haemorrhoids) is one of the most prevalent anorectal conditions encountered in clinical practice, significantly affecting quality of life. Despite multiple available treatment modalities, a universally satisfactory approach remains elusive. Case Presentation: A 40-year-old male presented with bleeding per rectum, prolapsed pile mass at 3 and 7 o\'clock positions (2nd degree), mild mucous discharge, and constipation of 2 years duration. Guggulu-coated Chitrak Kshara Sutra ligation was performed under local anaesthesia. Outcome: Complete sloughing and falling of the pile mass occurred by Day 7. Bleeding ceased by Day 1 post-procedure. Pain was well-managed and resolved by Day 28. The patient remained symptom-free at 60-day follow-up. Conclusion: Guggulu-coated Chitrak Kshara Sutra ligation is a safe, effective, minimally invasive, and cost-efficient treatment for 2nd degree internal Arsha with no major complications.

Introduction

The text describes the relevance of Ayurveda in managing modern lifestyle-related diseases, with a focus on anorectal disorders such as haemorrhoids (Arsha), anal fissure (Parikartika), and fistula-in-ano (Bhagandara). Among these, haemorrhoids are highlighted as a common condition caused by dilated rectal veins, often linked to age and lifestyle factors.

Classical Ayurvedic texts by Acharya Sushruta describe four treatment approaches for Arsha: medicinal therapy, chemical cauterization, thermal cauterization, and surgery. Among these, Kshara Sutra therapy is emphasized as a minimally invasive, cost-effective, and effective treatment method. It uses a medicated thread coated with herbal substances like Guggulu, Chitrak, and Haridra, which provides antibacterial effects, promotes healing, and reduces complications such as bleeding or incontinence.

A case study of a 40-year-old male patient with chronic haemorrhoids (bleeding, prolapse, mucus discharge, and constipation) is presented. Clinical examination confirmed 2nd-degree internal haemorrhoids at 3 and 7 o’clock positions. The patient had stable vital signs and no major comorbidities.

Kshara Sutra ligation using Guggulu-coated herbal thread was performed. The treatment was found to be safe, simple, cost-effective, and effective in managing symptoms without disrupting daily life. The study concludes that this Ayurvedic procedure is a viable and practical treatment option for haemorrhoids, especially in appropriate clinical cases.

Conclusion

Guggulu-coated Chitrak Kshara Sutra ligation is an effective, safe, and minimally invasive Ayurvedic surgical procedure for the management of 2nd degree internal haemorrhoids. The procedure was well tolerated, produced complete resolution of the prolapsed pile mass by Day 7, and achieved symptom-free status by Day 28, which was maintained at 60-day follow-up. The therapy is cost-efficient, requires no hospitalization, and does not impair the patient\'s daily routine. Since these findings are based on a single case study, larger controlled clinical trials are recommended to generate more robust and conclusive evidence.[7]

References

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Copyright

Copyright © 2026 Dr. Grishma Rakholiya, Dr. Vishnu Dutt Sharma, Dr. Arun Bhati, Dr. Rahul Mehra. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.