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Abscess is an acquired condition seen all over the body. The clinical features of abscess are swelling, pain, redness, local temperature and tenderness. Salivary gland infection complications are uncommon. Submandibular abscess is caused when a salivary gland infection is left untreated, pus can collect and cause an abscess. Here, the commonly used treatment is incision and drainage followed by antibiotics which may have chance of re-occurrences. Hence, incision and drainage followed by the use of Pratisarana Kshara was used as the treatment modality to cure submandibular abscess.

Background: Mutrashmari is a stone like structure anywhere in the Mutravaha Srothas which can be compared with renal calculi and one among the Astamahagada, clinical features as renal angle pain, haematuria, pyuria and dysuria. Peak age is 3rd to 5th decade while majority of patients report regarding onset of disease in 2nd decade of life and male to female ratio is 3:1. Objectives: To compare the effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari with special reference to Renal calculi. Materials and Methods: 30 patients were selected on the basis of inclusion criteria and divided into 2 groups with 15 patients in each group by chit method. Group A was treated with standard drug Tilanalakshara Yoga and Group B was traeted with trial drug Gokshura Churna. Results: It was found that standard group reduced the abdominal pain by 85.1%, dysuria by 89.4%, renal angle tenderness 88.4%, haematuria 100%, pyuria 100%, size of renal calculus 41.9% by 21st day of treatment. In study group it was observed that abdominal pain reduced by 92%, dysuria 96.1%, renal angle tenderness 91.6%, haematuria 100%, pyuria 100% and size of renal calculus 48.5% by 21st day of treatment. Conclusion: This assessment showed Gokshura Churna had significant result over Tilanala Kshara Yoga in both subjective and objective parameters with P value less than 0.0001.

Background: Arsha is fleshy projection that pains like an enemy and creates obstruction in Guda Marga which can be compared with haemorrhoids and one among the Astamahagada. Arsha presents with clinical features as bleeding per rectum, prolapse, feeling of mass, pain, anaemia. Peak age is 4rd to 6th decade while majority of patients report regarding onset of disease in 5th decade of life and increased prevalence in women compared with men. Objectives of the Study: To compare the efficacy of Shireesha Beejadi Lepa over Apamarga Pratisaraniya Kshara in the management of Arsha with special refence to Internal Haemorrhoids. Methods: 30 patients were selected on the basis of inclusion criteria and divided into 2 groups with 15 patients in each group by computerized random technique. Group A was treated with Apamarga Pratisaraniya Kshara, while Group B was treated with Shireesha Beejadi Lepa. Results: It was found that the main clinical features like Pain were reduced 84.09% in Group A and 90.90% in Group B, Bleeding per Rectum were 68.18% in Group A and 86.36% in Group B. Colour of Pile mass changes of 75% in Group A and 81.81% in Group B. Size of Pilemass reduced 70.45% in Group A and 68.18% in group B after 7th day of treatment. Conclusion: Apamarga Pratisaraniya Kshara had significant result over Shireesha Beejadi Lepa Yoga in both subjective and objective parameters with P value less than 0.0001

Abdominal tuberculosis (TB) is an uncommon affliction in adolescence. It is usually associated with pulmonary tuberculosis. The disease is caused by lymphohaematogenous spread after primary infection in the lung or ingestion of infected sputum and has a typically nonspecific presentation. The occurrence of ileocaecal TB is probably from the contiguous spread of an abdominal focus or mesenteric lymph node. Ileocaecal TB is a rare entity, with very few reported cases in the literature. We report here a case of abdominal TB that manifested in the infection of an abdominal wall resulting in sinus at inguinal region and there by highlighting the Ayurvedic management of abdominal sinus by the use of Kshara Varti. Kshara Varti is the chief modality in the treatment in the Ayurvedic science and has been explained in Nadivrana.

Kshar kalpana is one of important dosage form developed as sub type of panchavidh kashayKalpana.Kshara is alkaline in nature.It is based on the principle that alkaline substances get dissolved in water and can be obtained by evapourating water content.It is derived from certain plants as well as minerals and animal products which contains more alkaline substances.It is first described in Sushrut samhita.There are various methods described in ayurvedic texts to prepare kshara.It has been proved to be effective medicine internally as well as externally.Ksharasutra described by Chakradatta is being used widely by surgeons and appreciated its effectiveness.Kshara also have pharmaceutical application like shodhan,satvaptana of shilajatu,kankshi,parada etc.There is wide range of description available about kshara in ayurvedic texts.Based on plant/mineral or animal product and mode of use,it has various types like pratisaraniya,paniya kshara,Yavakshara,tankan kshara,Apamarga Kshara etc.

Rasa Shastra and Bhaishajya Kalpana is branch of the ancient Indian medical science based on herbs and herbo-mineral preparation. Tankana has been described under Uparasa Tankana, which is one among the Kshara Trayas has been used since very long time in Ayurveda. It has a wide range of therapeutic applications, including diseases like Varna (ulcers), Shvasa (asthma), Kasa (cough), Hrudya (beneficial to heart disease), Streepushpajanana (menstrual disorders) etc. It is used in the form of compound formulations like Parpati, Kupipakwa, Khalvee Rasayana, Churna, Vati, Lepa etc. In this paper Tankana Shodhana procedure, different synonyms, dose, Anupana, indications and different formulations containing Tankana Bhasma has been discussed.

Bhagandara is a disease which is pertaining to anorectal region and it is the 2nd highest prevalent disease among the anorectal diseases. Acharya Sushruta considered it as one among the Ashtamahagadas. There is a wide description of its etiology, pathogenesis, its various types, various modality of treatment and its Sadyasadyata, Pathya and Apathya are available in various classical texts. The Ayurveda classics have explained different types of Bhagandara and its Chikitsa which includes medical, para-surgical and surgical management. The modern medical system treats the condition using seton technique or surgery. The Ksharasootra method explained in Ayurveda Samhitas believed to have more efficacy than the seton technique. The incidence of fistula in ano is increasing gradually irrespective of age and sex. It affects the day to day life of the patients with its severity in presentation. Here a case study is being discussed in which the patient suffered from multiple fistula in ano and was treated with Teekshna Apamarga Ksharasootra along with internal medications and the complaints got cured completely in 6 months of period without remaining a scar mark.

Bhagandara is a 2nd highest prevalent disease among the anorectal diseases. It can be correlated to Fistula-In-Ano. For the management of fistula in ano various surgical, parasurgical and minimally invasive surgical procedures have been mentioned. But all these procedures carry a disadvantage of high rates of recurrence and also have a great chance of creation of serious complications like anal incontinence and anal stenosis. Hence the search for a newer, safer and scientific treatment for the management of this disease continues. Objectives: A new Kshara Sutra with fewer coatings has been tried to see if results are the same with an advantage of early and easy preparation. Materials and Methods: Total 30 patients were randomly selected in the study and divided into 2 groups fulfilling the inclusion criteria which were designed for the study. Results: Study showed significant results in reducing the discharge, pain, itching and burning sensation and induration within the group and insignificant result obtained between the groups statistically. Conclusion: The study revealed that Kshara Sutra prepared with 7 coating is more economical, easy to prepare and equally efficient in the management of Bhagandara.

USE OF KSHAR VARTI IN DESLOUGHING OF WOUND Dr.Vilas Kedar1 Dr.Vidya Dharne2M.S. Scholar (Kshar Karma Avum Anu Shastra Karma)M.S. Professor Shalya Tantra Department, Dr. G D Pol foundations YMT Ayurvedic Medical College, KhargharCorresponding auther:Mob:9594968208;email id-kedarclinic@gmail.comABSTRACT:Application of Varti in management of Vrana is well known and Sushruta has mentioned it Shastiupkrama in Dwivaranachikitsaadhya1. Kshar Varti chikitsa2 in Vrana is used for the Shodhana and Ropana as Kshar is also one Varity of cauterization by using phytochemical substance. Kshar is used for Sashodhana of Dushata Vrana and Ropana of Shudha Vrana. It also used as the Shoshana of the Vrana kleda3 that is desloughing of wound. In this study done by using Kshara Varti for the desloughing of the wound as the slough delay wound healing and not allowing healthy granulation tissue to overcome. Use of Kshara Varti for three days shows removal of slough from wound and to grow healthy granulation tissue.

In the present study, we have identified ten compounds, namely dodecanol acid, myristic acid, neophytadiene, palmitic acid, heptadecanoic acid, linoleic acid, elaidic acid, 3-7-dimethyl acid, stearic acid and methyl eicos acid, of the methanolic extract of Apamarga Kshara by GC-MS analysis. Apamarga Kshara has been reported to be active against cervical erosion. Major causal organism for cervical erosion is Trichomonas vaginalis. However, there is a paucity of information about the mechanism of action and inhibitory effect of the biologically active natural compounds presented in A. Kshara against this organism (T. vaginalis). Therefore, present investigation was conducted to observe possible interactions of these compounds on T. vaginalis carbamate kinase using molecular docking software 'AutoDock 4.2.' Identification of the amino acid residues crucial for the interaction between T. vaginalis carbamate kinase and these natural compounds is of due scientific interest. The study will aid in efficacious and safe clinical use of the above-mentioned compounds.

Gall bladder stone (Cholelithiasis) is one of the commonest among the major gallbladder disease, affecting large popul ation of community. In untreated cases it may lead to numerous complications. The clinicians and scientists all over the world are trying hard to find out any safe and effective remedy. The effective method for the treatment of gallbladder stone available so far is surgical maneuver. In surgical management of diseases sometimes patients have to lose the organ associated with disease. In this context Cholelithiasis (Gall bladder stone) is a disease in which patient has to sacri fice with his gall bladder. Aft er the removal of gall bladder, patient becomes away from the normal physiological life and suffers from hyperacidity, nausea, dyspe psia etc. for whole life. Ayurveda being pioneer of the medical modalities of the world has a definite role in the managemen t of such diseases. Efficacy of indigenous herbs in reference to the management of gall bladder stone has not been well documented till date. The critical review of Ayurveda lit erature revealed that Ikshuraka Kshara might be the solution of problem as Iksh uraka is hepato - protective and Kshara preparation is effective in stone management.

Standardization of herbal drugs is essential to certify their quality and purity. Kshara (alkaline substance) of Apamarga (Achyranthes aspera Linn.) is an important constituent in many Ayurvedic formulations, but its standard manufacturing process (SMP) is not attempted till date. This study is aimed to establish SMP for Apamarga kshara. In pharmaceutical process; generally the sediments of ash obtained at the end of washes will be discarded. However, in the study, we attempted to wash the sediments repeatedly by adding water to extract more Kshara. Apamarga was collected from the local area and authenticated. Kshara was prepared by following standard methods and the preliminary physicochemical profile was developed. It is observed that the ash yields Kshara even in the consecutive washes. First wash yielded 21.23% w/w Kshara, while the second and third washes yielded 9.38% w/w and 4.76% w/w, respectively. Repeated washes yield more Kshara. Hence, it is advocated to wash the ashes repeatedly. As the findings are encouraging, similar experiments can be extended to all other Kshara preparations.

Hydradenitis suppurativa (HS), also known as Acne Inversa, is a chronic disease characterized by recurrent, painful, deep-seated, rounded nodules and abscesses. Subsequent hypertrophic scarring and suppuration of apocrine gland bearing skin: axilla, groin, peri-anal and perineal regions are main features. Onset is usually after puberty. The disease tends to become chronic with subcutaneous extension leading to indurations, sinus and fistula having a profound impact on the quality of life. The exact aetiology remains unknown. The clinical features of HS can be compared with Naadivrana mentioned in classics. Treatment modalities of Naadivrana includes mainly Ksharataila Poorana and Ksharasutra application are adopted in the present case. A case report of patient suffering from HS since 4.5 years (c/o multiple pus discharging abscesses and hardened area in both axillary region) was treated by number of allopathic surgeons and physicians but there was minimal relief and recurrence (6-7 times) even after Incision and Drianage (IandD) and wide excision. The patient was under Ayurveda treatment for approximately 5 months and pus discharge, hardness reduced completely and is on followup since 8 months there is no recurrence, patient was treated internally with Gandakarasayana, Triphala Guggulu and Varunadi Kashaya. Apamarga Kshara Taila infiltration followed by Apamarga Kshara Sutra application to the intercommunicating sinuses, adviced to maintain local hygiene.

Tamaka Shvasa is described as a most difficult to cure (Yapya) among all diseases in Ayurveda. In present study Tamaka Shvasa is correlated with Bronchial Asthma because of its symptomatology is much similar with Tamaka Shvasa. In modern medical science, steroids and bronchodilators are mainly used for its management, but they cause certain side effects. Present study was undertaken to provide safe and effective remedy for Tamaka Shvasa through Ayurvedic medicaments. Shirishadi tablet was given as internal medicine for 30 days. Upto 60% relief was found in signs and symptoms of Tamaka Shvasa. Ayurveda describes various dosage forms for the administration of the medicament in human body. These dosage forms are denoted by the term Kalpana. Many Kalpana have been described in the classical texts along with five basic Kalpana. One such Kalpana is Kshara Kalpana. The utility of Kshara is mainly seen in the field of Shalya Tantra where it is used in the management of the cases of Arsha, Bhagandara, Nadi Vrana etc. but at the same instance it also provides fruitful results in the cases of Shwasa, Mootrakrichha etc. Kshara proves its utility in the processing of Parada whereby it acts as a Vida and makes the processing of Parada easy. Due importance has been given to Kshara preparation in most of the classics but at the same moment, we find differences in the various methods mentioned for the preparation. Hence an attempt has been made to compile the various references available in the classical texts and to justify their probable use in the present paper.

Rasa oushadies are the potent Ayurvedic preparations mainly containing metals and minerals. These oushadies possess a wide range of therapeutic efficacy and are considered superior because of their qualities like small dose, quick action, palatability and longer shelf life. Tamra Yoga is an important Rasa oushadi described in Rasa Tantra Sara Va Siddha Prayoga Sangraha indicated for the management of the disease Vataja Shula, Gulma and Ajirna. The ingredients present in the “Tamra Yoga” are Tamra Bhasma, Yashtimadhu, Trikatu, Souvarchala Lavana, Chincha Kshara and Bharjitha Hingu. The main pharmaceutical procedures involved in the preparation of Tamra Yoga are Shodhana, Bhavana, Marana, Amrutikarana, Chincha Kshara nirmana, Hingu bharjana, Churna nirmana and preparation of capsules of Tamra Yoga. The specific pharmaceutical blend of these contents can result in a more effective formulation. Till date, no research work has been carried out to standardize this formulation. Therefore the present study has been planned to standardize the method of preparation of Tamra Yoga according to the method explained in the classical literature. Keywords: Tamra Yoga, Shodhana, Bhavana, Marana, Amrutikarana, Chincha Kshara nirmana, Standardization.Â

Bhagandara (Fistula in ano) is a common anorectal condition prevalent world wide, and its prevalence is second highest after Arshas (Haemorrhoids). Kshara Karma is a one of the parasurgical procedure in Ayurveda. In this study Palasha Kshara Sutra is used in Bhagandara (Fistula-in-ano). Though, Apamarga Kshara Sutra is highly effective in the management of Fistula-in-ano. But pain, irritation, difficulty in preparation has limited its use. Thus, various type of Kshara Sutra tried with their efficacy in different angle. In this present study effort will be made to define the probable mode of action of Palasha Kshara Sutra prepared in Arka Ksheera in Fistula-in-Ano. This is equally effective with less pain and easy to prepare because a single plant is enough and not a seasonal plant. A 56 yr old male presented with complaints of painful swelling with pus discharge in the anal region since 1 week has been presented here.

Pionidal Sinus is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Different surgical methods have been described for this disorder. The most commonly used are excision and primary closure and excision with reconstructive flap. However the risk of recurrence or developing an infection of the wound after the operation is high. The patient requires longer hospitalization and the procedure is expensive. There is a similarity between pilonidal sinus and Shalyaja Nadi Vrana described in Susruta Samhita. Susruta has advocated a minimally invasive parasurgical treatment, viz., Kshara Sutra procedure, for Naadivrana. Hence this procedure was tried in Pilonidal Sinus. This treatment not only minimizes complication and recurrence, but also enables the patient to resume work quicker and with less discomfort.

Kshara Karma, Agni Karma is known as Anushastra Karmas. Popularly understood as Para surgical procedures. They are outstanding contributions of Acharya Shushruta. The surgical disorders are managed with these procedures with ease and comfort for both surgeon and patients. In Shalakya Tantra there is a need of adopting these procedures for effective management of disorders such as Upajihwa, Adhijihwa, Upakusha, Dantavaidharbha, three types of Rohini, Nasarsha, Karnarsha and Pakshmakopa. Kshara Karma said to be one among the Anushastra Karma explained by Acharya Shushruta which is not widely practised and popularised in Shalakya diseases. There is need of research work in this area to utilize Kshara Karma and give optimum result.

Introduction: Kshara is described in Anuyantras and Anushastras according to Acharya Sushruta. It is considered to be Pradhana among Shashtra and Anushashtra because of its Chedana, Bhedana, Lekhana property, as well as it is said to be Tridoshaghna and used for the special procedures. Pratisaraneya Kshara is been indicated externally for various disorders such as Arsha, Bhagandara, Kilasa. Materials and Methods: Pratisaraneeya Kshara with the drug Apamarga is prepared as per Acharya Sushruta’s description with 12 kg of Apamarga Panchanga. Results: Physicochemical analysis: iron as Fe - 0.043%, sodium- 0.63%, potassium - 9.19%, ph value - 13.88, acid insoluble ash - 9.69%, loss on drying at 110 degree c - 64.24%, total ash - 47.03%, colour - white. Discussion: Physicochemical analysis shows ph value as alkaline, amount of insoluble ash, iron, sodium and potassium. Conclusion: The method of preparation of Pratisaraneeya Kshara holds good even for today’s era and can be considerd as standard protocol for Teekshana Pratisaraneeya Apamarga Kshara.

Bhagandara (Fistula in ano) is a common ano-rectal condition prevalent worldwide. Ksharasutra being a chief modality in management of Bhagandara in Ayurveda. Exploration of new plants for the preparation of Ksharasutra as a better substitute of Apamarga Kshara is need of the hour. Hence present research work was planned to evaluate the effect of Palasha Ksharasutra prepared with Arka Ksheera and to compare the effect of Palasha Ksharasutra prepared with Arkaksheera and Apamarga Ksharasutra in the management of Bhagandara. In this study sample size was 30, patients were selected by simple random sampling, 15 in Trial Group and 15 in Control Group. Trial group treated with Palasha Ksharasutra prepared with Arkaksheera and Control group treated with Apamarga Ksharasutra in Bhagandara. In both group patients were symptoms free after treating, but when compared to the cutting rate Apamarga Ksharasutra has average of 0.8cm and Palasha Ksharasutra prepared in Arkaksheera with an average of 0.68cm. Thus, Palasha Ksharasutra had equipotent effect as Apamarga Ksharasutra.

Fistula-in-ano is a chronic and troublesome disease encountered in general practice. It consists of 1.6% of all surgical admissions and leads to physical, psychological and social problems. The management includes various treatment modalities with variable outcomes. Ksharasutra is a medicated thread used in ano-rectal disorders particularly for the management of fistula-in-ano in Ayurveda. In this study Ksharasutra was prepared by Apamarga Kshara (Ash of Achyranthus aspera Linn.), Snuhi Ksheera (Euphorbia neriifolia Linn.) and turmeric powder (Curcuma longa Linn.). A patient with multiple fistula-in-ano was treated by application of Ksharasutra. This case study demonstrates the utility of Ksharasutra in Multiple Fistula-in ano.

Ayurveda, the science of life is being practiced by Aryans from Vedic period. Kalpana is the process through which a substance can be transformed in to the form of medicine according to the need. Samskaras are to be done for potentiating the drug or the formulation. Among all these pharmaceutical processes Shodhana is one of them. For a single drug many process of Shodhana have been mentioned. Arsenic compounds are being popularly used in Ayurveda therapeutics since centuries, Haratala being important among them. It is commonly used in treating the diseases like Sleshmaroga, Raktapitta, Vatarakta, Kustha etc.Haratala is called orpiment of yellow arsenic with two molecules of Arsenic and three molecules of Sulphur (AS2S3). Patra Haratala is Srestha and used for the present study. Haratala consumed without proper Shodhana shortens the life span, causes diseases of Kapha and Vata, Prameha, Santapa, Spotha, Snayu Sankocha. Hence Shodhana of Haratala is essential. Shodhana is the process of removal of physical, chemical impurities and potentiating of the drugs. Generally Shuddha Haratala is not given alone. It is administered along with herbal drugs or in the form of Rasamanikya or also as a main ingredient in most of the popular formulations like Samirapannaga Rasa, Vatagajankusha Rasa etc. There are different Medias explained in literature for Shodhana of Haratala. According to the media of purification the quality and pharmacological properties of Haratala will vary. Depending on the change in properties the therapeutic effect may also vary. The present study includes Shodhana of Patra Haratala as per Classical reference of Rasa Ratna Samucchaya where Shodana of Patra Haratala is done by Kushmanda Swarasa, Tila Kshara Jala and Churnodaka. Standard Operative Procedure of the process is done in the pharmaceutical study. The analytical study reveals the standards which can be given for Ashuddha Haratala and Shuddha Haratala of various Samples. The differences in the parameters reveal that there are some changes which give us the idea regarding role of a particular media in purification of a substance, where it adds some properties of the media used.

Diabetic patients are vulnerable to develop non healing ulcers. Treatment modalities like conservative, good diabetic control, wound toileting seem to be incomplete by looking at prevalence rate of amputation in diabetic patients. This case report refers to wound healing effect of local application of Apamarga Kshara Taila and oral Ayurvedic medications in the management of diabetic foot ulcer in a 42 years female. Complete wound healing was achieved in 76 days with Unit healing time (UHT) of 5.88 days/cm3. Local cleaning by Triphala Kwatha has showed antimicrobial effect which augmented the healing process while Apamarga Kshara Taila application enhanced tissue debridement. Internal Ayurveda medications like Pippali (Piper longum Linn.) Haritaki (Terminalia chebula Linn.) and Sanjivani Vati (polyherbo-mineral medication) with Pathya-Apathya (prescribed diet and regimen) pacified vitiated Kapha-Vata Pradhana Tridosha and enhanced tissue rejuvenation and repair by their pharmacological properties.

Ksharakarma is a type of chemical cauterization which is performed by Kshara (caustic alkali substance) and said to be one of the important para surgical procedure s in Ayurveda . Th is Kshara is classified in to various types a mong tho se Teekshanakshara is used for Arshas (h a emorrhoids) and in other ano - rectal disorders and also its practice is well described by A charya Sushruta . However in present surgical practice due to lack of und erstanding and practical exposure in the preparation of Teekshana Kshara and its application in the h a emorrhoids is not being practiced commonly. In view of that a standard method is developed on the basis of principles explained by Acharya Sushruta . It s p reparation requ ires ash of Apamarga ( Achyranthes aspera ), Shukti ( Ostrea edulis ) and paste of Chitraka ( Plumbago zylanica ). These are taken in fixed proportions. After specific steps semisolid Teekshanakshara is prepared and preserved in tight lid bottle . This Kshara is to be applied over the haemorrhoids in lithotomic position under suitable anesthesia to the patient . Later the Kshara applied site is washed with lemon juice and post operative maintenance is followed in a standard method. After some time th e h a emorrhoid site will get s l oughed out and leads to fibrosis of mucous membrane which further avoids the recurrence of disease. This is minimal invasive procedure and better than presently available conventional methods and successfully practiced in many of the h a emorrhoids patients. Key word: Arsha, Pratisaraniyakshara , Ksharakarma, haemorrhoids

The dis ease Ashmari is one among the eight major diseases or Astamahagadas. Detail information regarding the various aspect of the disease is available in the texts of Ayurveda. This infers the prevalence of ashmari since the inception of medicine in India. Even in the current era also, urinary calculi is an important health problem. In India 5 - 7 milllion people are estimated to be suffering from the disease. So only the study was conducted to evaluate the efficacy of narikela kusuma yoga in the management of mutr ashmari. An observational study was conducted on 20 patients who were sampled in to one group. All the patients were administered the formulation in the form of kalka consisting of 10 g of narikela kusuma and 500 mg of yava kshara, twice daily for 21 days two hours before the intake of food. A pre test and a post test observation was made in terms of relief of symptoms such as bastipeeda, mutrakrichra etc, and in terms of reduction in the size of the stone. The reduction of size of the stones and relief of predominant symptoms like basti peeda, mutrakrichra were highly significant statistically with P < 0.001.

Kshara is a commonly used alkaline herbal p reparation in Ayurveda. D iff erent methods are mentioned in A yurvedic texts for Kshara preparation . T he aim of this study wa s to carry out standard operating procedure fixation and standardization of Yava kshara and to find out the best method for Kshara preparation. Y ava kshara has been prepa red by the method mentioned in Rastarangini 13 Tarang and 14 T a rang by specific and gen eral method. The specific method comes out to be the best in terms of yield . K sh ara has also been obtained by filtering the mud resi d ue and heating it again and there was no much difference in the kshara obtained fro m initial ash an d mud residue . But t he kshara prep ared from general method wa s more ac idic. S o we can conclude that the quality of ksha ra depends on the number of filt ration , more filtration better the kshara .

Amlapitta or Acid peptic disease i s a common crisis in this present era which impinges on more than 40 % of the population . It can be considered as Prajnaparadha janya vyadhi , as it occurs beca use of undisciplined and imbalanced food habits , where the concept of Hitabhuk , Mitabhuk and Rhutabhuk is totally ignored . S imilarly , with immense degree , hectic routine and psychological stress is also responsible for this condition. In this condition, Vi dagdhata of Pitta with dominancy of Amla bhava is seen . Amlapitta presents with the cardinal features like Avipaka, Klama, Utklesha, Tikta - Amla Udgara, Gaurava, Hrit - Kanta Daha and Aruchi. Depending upon Doshotklesha Gati , Amlapitta is of two types viz Urd hvaga Amlapitta and Adhoga Amlapitta. The line of treatment f or this condition includes Shodhana and Shamana. A clinical study was conducted with Sad y o Vamana followed by the internal administration of Yavakshara. Sady o Vamana helps to evacuate the Utklist a Dosha from Amashaya. Kshara converts the Amlabhava in to Madhura bhava, as it contains Amlavarjita pancharasa with dominancy of Katu or Lavana rasa. This co m bined approach gives significant result (P < 0.001) in relieving the symptoms of Amlapitta . K ey wo rds : Amlapitta, Acid peptic disease , Sadyo Vamana, Yavakshara.

Nasapratinaha (nasal obstruction) is a commonly encountered disease in clinical practice. It is one of the nasal disorders, explained in Ayurveda, having nasal obstruction leading to difficulty in breathing as the main cardinal feature. In contemporary science, this condition can be correlated with various diseases such as turbinate hypertrophy, deviated nasal septum, nasal mass, mucosal congestion, allergic rhinitis, and others; among which turbinate hypertrophy is a common cause. Turbinate hypertrophy can be treated with surgical and medical methods. The medical treatment has limitation for prolonged use because of health purpose, surgical approaches too have failed to achieve desired results in turbinate hypertrophy due to complications and high recurrence rate. The medical and surgical managements have their own limitations, merits, and demerits like synechiae formation, rhinitis sicca, severe bleeding, or osteonecrosis of the turbinate bone A parasurgical treatment explained in Ayurveda, known as kshara pratisarana, which is a minimal invasive and precise procedure for this ailment, tried to overcome this problem. ′Kshara Karma′ is a popular treatment modality in Ayurveda, which has been advocated in disorders of nose like arbuda (tumor) and adhimamsa (muscular growth). Clinical observation has shown its effectiveness in the management of turbinate hypertrophy. A case report of 45-year-old male who presented with complaints of frequent nasal obstruction, nasal discharge, discomfort in nose, and headache; and diagnosed as turbinate hypertrophy has been presented here. The patient was treated with one application of Kshara over the turbinates. The treatment was effective and no recurrence was noticed in the follow up.

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as "Raktarsha" - 11 & 7 'o' clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids.

Tamarindus indica Linn. fruits (Chincha) are extensively used in culinary preparations in Indian civilization. Its vast medicinal uses are documented in Ayurvedic classics and it can be used singly or as a component of various formulations. Besides fruit, the Kasta (wood) of T. indica L. is also important and used to prepare Kshara (alkaline extract) an Ayurvedic dosage form. Pharmacognostical and physicochemical details of Chincha Kasta are not available in authentic literature including API (Ayurvedic Pharmacopoeia of India). The study is an attempt in this direction. T. indica L. stem with heartwood was selected and morphological, microscopic and physicochemical standardization characters along with TLC finger print, and fluorescence analysis were documented. Transverse section of stem showed important characters such as phelloderm, stone cells layer, fiber groups, calcium oxalate, crystal fibers, and tylosis in heartwood region. Four characteristic spots were observed under UV long wave, in thin layer chromatography with the solvent combination of toluene: ethyl acetate (8:2). The study can help correct identification and standardization of this plant material.

Bhagandara (Fistula in Ano) at modern parlance is a common anorectal condition prevalent in the populations worldwide and its prevalence is second highest after Arsha (hemorrhoids). Kshara Sutra (K.S.) is one of the chief modality in the treatment of Bhagandara in Ayurvedic science. Exploration of the new plants for the preparation of Kshara as a better substitute to Apamarga Kshara is the need of the hour. To find out an effective alternative to Apamarga K.S. in view of easy processing, a Snuhi Ksheera Sutra without any Kshara and the Tilanala K.S. were opted for their clinical evaluation. Total 33 cases of Bhagandara were divided randomly into 3 groups, having 11 patients in each group. In Group A, Snuhi Ksheera Sutra; in Group B, Tilanala K.S. and in Group C, Apamarga K.S. were used. Assessment was done on objective (Unit Cutting Time - UCT) and subjective parameters. Statistically insignificant difference was observed in the efficacy of treatment by subjective parameters like pain, discharge, etc. between the three groups. It was found that Tilanala K.S. showed higher UCT (9.76 days) while lower in Snuhi Ksheera Sutra (7.42 days) as compared to Apamarga K.S. (8.82 days). Thus Tilanala K.S. can be used as a substitute for Apamarga K.S. and Snuhi Ksheera Sutra can be employed in the recurrent fibrosed cases of Bhagandara.

Hypothyroidism is emerging as a common health concern in India as well as worldwide. An autoimmune cause accounts for approximately 90% of adult hypothyroidism mostly due to Hashimoto’s disease. This autoimmunity goes parallel with the theory of Ama (intermediatory product) in Ayurveda. A case of a 27-year-old female patient, presenting with pain in multiple joints, deformity in the right little finger, morning stiffness lasting for more than 3 h, reduced appetite, constipation, and lethargy, diagnosed with Amavata (rheumatoid arthritis), was subclinically diagnosed with hypothyroidism and treated with Deepana (stimulates digestion), Pachana (promots digestion) and Koshtha Shuddhi (mild purgation) for 5 days followed by Kshara Basti (therapeutic enema) for 5 days. Reduction in serum- thyroid-stimulating hormone (S. TSH) (31.1 mIU/ml to 16.6 mIU/ml) along with relief in clinical manifestations of the disease was the outcome. Koshtha Shuddhi followed by Kshara Basti has its efficacy in hypothyroidism, as it not only improved signs and symptoms but S.TSH level was reduced significantly. This case report proposes an innovative treatment modality for the management of hypothyroidism, which needs to be validated through a well-planned study on a large sample size.

Generally, Tailas and Ghritas have been prepared by using Kalka (paste) and Drava dravya (liquid media usually SwaRasa or Kwatha). However, Apamarga Kshara taila is prepared by using Apamarga Kshara drava (the alkali is obtained after dissolving it in water, after obtaining it by burning, dissolving, and filtration of the same plant). Therefore, to evaluate the role of the media during the preparation, the Taila was prepared in different samples by using the fresh and dry paste of Apamarga along with SwaRasa and Kwatha of Apamarga. All the samples were tested through various analytical parameters, that is, pH, acid value, iodine value, saponification value, and soon. Finally, it was found that Apamarga Kshara taila prepared by using fresh Kalka and Ksharajala was better and it was also an easy pharmaceutical procedure.

Vatastheela is a disease of Mutravahasrotasa, one among the 12 types of Mutraghata disorders elaborated by Sushruta in his seminal work, the Sushruta Samhita. Vatastheela, as described in Ayurveda, closely resembles benign prostatic hyperplasia (BPH) of modern medicine in its signs and symptoms. It is a senile disorder and chiefly affects individuals above the age of 40 years. The symptoms are those of bladder outflow obstruction, with increased frequency of micturition, dribbling, hesitancy, and the features of chronic urinary retention. Surgical management has been accepted as the standard management but is associated with many disadvantages as well as complications, which may not be acceptable at this age. Conservative management with modern medicines is also not free from side effects. So, in this age-group, there is a need for much safer alternative method of management. In this regard, many works have been carried out and shown that the Ayurvedic approach, using natural medicines, is a far better approach. We carried out a comparative study of Mahayavanala Roma Kshara (MRK) and Dhanyaka Gokshura Ghrita (DGG), which are the compounds prescribed for Mutraghata in Ayurvedic literature. The patients were randomly selected from the OPD and IPD of IPGT and RA hospital, Jamnagar, Gujarat, and divided into two groups. In first group, one (500 mg) capsule of MRK was given twice a day with lukewarm water for 45 days; in second group, 10 gm of DGG was given orally twice a day with lukewarm water for 45 days. DGG showed significantly greater relief in the subjective parameters as per International Prostate Symptoms Score (IPSS) than MRK. However, reduction in the size of the prostate and in the volume of the post-void residual urine was found much better in the MRK group.

There are so many basic concepts in Ayurveda; Dhatvagni mandya is one of them. The whole phenomenon of disease cannot be completed without Dosha-Dushya Siddhant. They play important role in the pathology of disease. Obesity is one of them, which affect the health as well as life span. Sthaul ya is one of the disease which is known to mankind since Vedic era, has been dealt in great details in Ayurvedic texts. The sign, symptoms and etiological factor of Sthaulya show very much resemblance with obesity. Worldwide Obesity is emerging health problem. It is a metabolic disorder which has affected every corner of world. In present study 30 patients of Sthaulya were selected from OPD and IPD of M.A. Podar hospital, Mumbai. These patients were undergone throw laboratory investigations. They were treated with Eranda Kshara with Ghrita bharjit Hingu given orally, duration of treatment was two months and follow up was done with parameters like Height, weight, BMI, Mid arm circumference, Waist circumference, Waist Hip ratio and symptoms of Sthaulya . It was observed that Atikshuda and Atitrushna reduce significantly. It shows relief in weight, BMI, Waist Circumference, Mid Arm Circumference and Waist Hip ratio. There was no significant change in hematological as well as Urine investigations. Average percentage of relief was 60.72%.Â

Objective: Apamarga Kshara Yoga (APK), a classical Ayurvedic formulation containing Apamarga Kshara (alkaline substance of Achyranthes aspera Linn . ), Manahshila (Arsenic Disulphide) and Gomutra (cow’s urine) is effective in cases of Shvitra (vitiligo). As the formulations has short shelf life, inconvenient to patients and involve longer duration of pharmaceutical preparation; it is planned to convert into more convenient form. Design: Raw materials were authenticated and APK was prepared. Further, organoleptic and physico-chemical properties were evaluated. Results: An average 909.8 gm (90.98 %) yield after Taila Paka and 1379.6 gm ointment was observed in the process. Conclusions: As observed in present study, addition of wax to attain ointment consistency is mandate. Residue as Apamarga Kshara and Manahshila incorporated in preparation of ointment yielded more without losing its consistency.

Infertility is the most sensitive and cumbersome problem which haunts every couple. The major cause in infertility is female factor which is 30.20%. Among female factor the sub factors are ovarian, tubal, endometrial and uterine. Female Infertility due to tubal blockage is the 2nd most contributing factor, in 30% of the cases. So for this study, we considered only tubal infertility and to make a pin-pointed assessment criteria. The criteria for selection of patients and assessment of results were unilateral or bilateral tubal blockage diagnosed in hysterosalpingography (HSG). Thus 18 patients in the age group of 20-40 years were registered for the study, with 75% primary infertility and 25% secondary infertility. Of these patients 16 completed the course of treatment. Patients having acute pelvic infection, hypersensitivity to chemical dye, congenital anomalies of vulva & vagina, CA cervix, STD or any debilitating diseases like T.B. were excluded. Apamagra Kshara Taila was selected for its Vata-Kapha Shamaka and Lekhana properties. The dose of Uttar Basti was 5 ml with duration of two consecutive cycles at the interval of three days. The tubal blockage was removed in 75% of the patients and 25% of the patients had conceived within the follow-up period of two months. The results suggest that Uttar Basti is a safer, cost effective and highly significant Ayurvedic treatment modality for tubal-blockage, with no apparent complications.

Anushastra karmas such as Kshara karma, Agnikarma and Raktamoksha na are said to have immediate and long lasting results. Agnikarma is mainly indicated in Ruja pradhana, Vata and Kaphaja vyadhis. Pancha dh a tu shalaka has been used on a regular basis for the purpose of Agnikarma irrespective of the structure involved or l evel of the pathology. But more than 80 % of painful conditions are related to locomotory system which comprises Sandhi, Ast h i, Sira and Sn a yus . These are considered as Gambheera dhatus and Dah a nopakaranas mentioned for th e diseases of these locations are Snigdha dravyas such as K sh audra, Guda, Taila, Vasa, Madhuchista etc . When the thermal behavior of the Snigdha dravyas and Pancha dhatu shalaka were studied by direct methods employed in temperature measurement, Pancha dhatu shalaka requires considerably h igher temperature (235 o C - 240 o C) to become red hot, than that of the Snigdha dravyas to get boil (140 o C - 160 o C) . But Snigdha dravyas has got higher Latent heat than Pancha dhatu shalaka. The heat dissipation rate is about 2 o C in Snigdha dravyas and is 4 o C - 6 o C in Pancha dhatu shalaka. So in conditions like

Vidhrdhi or Pyogenic abscess i s a common entity comes across in day to day life. It presents as a localized swelling with pain, reddish discoloration , local rise of temperature, tenderness and restricted function of the affected part . There will be an invasion of pathogenic micro - organisms and it got the tendency of s uppuration. When the pus has been collected, t he n the mandatory surgical intervention has been mentioned both in Ayurveda as well as contemporary science in order to drain the pus. But sharp instrumentation is the dread factor for the patients and is diffi cult to handle in vital locations su c h as axilla groin, neck etc. Darana karma is one among Shasti upakrama described by Sushruta and is meant for this kind of situations only. It is the application of Teekshna dravyas over the suppurated abscess in order to open the pus cavity to facilitate the drainage of pus. Pratisaraneeya Ksharas are considered as best Darana dravya s. A clinical study was conducted in 20 patients of Pakva Vidhrdhi which are subjected to Darana karma by selecting Kshara as a choice of d rug . Application of Kshara to a great extent helps to break the pus cavity and drainage of pus due its Bhedana, Darana, Shoshana, Shodhana etc properties. It showed the high significant difference from baseline in all variables (p < 0.001) both statistical ly and clinically. It is a simple, cost effective , OPD procedure which gives considerable result in draining the pus from the suppurated pyogenic abscess and to sustain the non infective state of the wo und.

Epidermal nevi are hamartomas that are characterized by hyperplasia of epidermis and adnexal structures. These nevi may be classified into a number of distinct variants, which are based on clinical morphology, extent of involvement, and the predominant epidermal structure in the lesion. Variants include verrucous epidermal nevus, nevus sebaceous, nevus comedonicus, eccrine nevus, apocrine nevus, Becker's nevus, and white sponge nevus. A 22-year-old girl approached us with complaints of blackish-colored hard growth, increasing in size over the right post-auricular region since 5 years. Ksharakarma is a procedure that involves the most important surgical, para-surgical, and critical-care procedures like incision, excision, scraping, and hemostatic locally (pratisaraneeya) and generally ( panneya ). Pratisaraneeya kshara is prepared with herbo-mineral medicines having an average pH of 13, possessing penetrating, corrosive, scraping, and healing properties, and are evidently indicated for external application in charmakξla. For the present case, kshara karma was preferred for application as the lesion was bigger in size and the results were appreciable clinically.

Background: Anal fistula is an abnormal track with an external opening in the perianal skin region and internal opening in the modified skin or mucosa of anal canal or rectum. The description of Bhagandara described in Ayurveda can be correlated to anal fistula. Managing of high anal fistula is a very tedious job and fecal incontinence may be developed after surgery due to damage of anorectal ring. Kshara (alkali) work effectively on various stages of a wound and is helpful in treating fistula-in ano. Ksharasutra (alkaline seton) is a type of para surgical procedure described in Ayurveda classics. Aim: The present review aims at analysing the current trends in the usage of Ksharakarma (alkaline therapy) and Ksharasutra in the management of fistula–in-ano. Materials & Methods: The present study is a procedural review on techniques of application of Ksharakarma and Ksharasutra employed upon the patients with various types of fistula-in ano. Observations: Four techniques employed in various types of fistula-in any were analysed. These include Apamarga Theekhsna Pratisarniya Kshara applied on nonspecific low anal subcutaneous fistula-in ano, Ksharasutra Varti (alkaline wick) applied on non-specific inter-sphincteric grade Grade II fistula-in ano where there was no internal opening, Multistage Ksharasutra technique employed in an inter-sphincteric grade Grade II fistula in ano with gradual extension of track and technique of Interception of fistula track by application of Ksharasutra (IFTAK) was employed in Grade IV fistula. Conclusion: All the above four techniques employed were effective in managing fistula–in ano. The techniques described here are the modifications of classical procedures, which acts at different level and produce intended effect of healing the fistulous track without any complication or reoccurrence. However, larger comparative clinical studies may be required to further substantiate the effectiveness of these techniques.

BACKGROUND: The exact identification of the internal opening in the surgical treatment of anorectal fistulae is of basic importance for effective management, and the same concept was existed long back which was described by Acharya Sushruta in the context of Bhagandar (Arvachina and Parachina).In the current practice, the rule of Goodsall enables identification of the internal opening whether anterior or posterior with relation to its external opening. OBJECTIVES: The objective of this study is to substantiate the accuracy of Goodsall's rule and to establish rationality of the rule with anatomical consideration MATERIALS AND METHODS: A total of 53 operated (kshara sutra ligation) cases of fistula-in-ano during 2014–2015 were retrospectively assessed for locations of the primary (Arvachina) and secondary (Parachina) openings from the case sheets. The normal distribution test was used for the data analysis. RESULTS: Totally 46 anal fistula patients followed the Goodsall's rule while 7 patients were not as per rule, and all of them were falling in anterior external opening group. CONCLUSION: Posterior external opening fistulas were as per Goodsall's rule and anterior opening >3.25 cm or far had a straight or radial fistulous tract, which are against the Goodsall's rule.

Introduction: Kshara is derived from the word “Ksharana” that means as something that mobilizes and removes the deformed flesh, skin, tissue, etc., due to its corrosive nature (Ksharanata). Pratisarniya Kshara has been further classified into three types on the basis of its potency – Mridu (mild), Madhyama (moderate) and Tikshna (strong). This study aims at comparison between (Mridu and Tikshna) Apamarga Kshara on the basis of pharmacognostical and pharmaceutical evaluation. Materials and Methods: Apamarga Panchanga (whole plant of Achyranthes aspera Linn.) was collected, and authentication was done by the expert. Mridu Apamarga Kshara (MAK) and Tikshna Apamarga Kshara (TAK) were prepared as proposed by Sushruta Samhita. Pharmacognostical and pharmaceutical analyses were carried out according to standard protocol. Observation and Results: Both the Kshara showed their own peculiar crystal system and analytical findings showed higher pH value (10.65) and calcium content (6.1%) in TAK as compared to MAK. Discussion: Quantitative micrometric microscopy showed more amount of crystals in TAK (13/mm2) than MAK (6/mm2), which may be due to Kapardika and Chitrakamoola (roots of Plumbago zeylenica Linn.). pH of MAK and TAK was 10.2 and 10.65, respectively. This result showed that TAK is more alkaline, which may be also due to Kapardika and Chitrakamoola. Conclusion: Sodium and potassium ion concentration was higher in MAK (Na+ = 26%, K+ = 45%) as compared to TAK (Na+ = 12.6%, K+ = 32.5%). Calcium ion estimation was lower (2.31%) in MAK and higher (6.1%) in TAK. These findings can be further used for the standardization purpose of Tikshna Kshara which may enrich the Ayurvedic Pharmacopoeia of India.

Background: Cholelithiasis is one of the most expensive medical condition. It is either symptomatic or asymptomatic, if not treated properly it may lead to carcinoma of gall bladder which is 5th commonest GI malignancy world-wide. In Ayurveda, Pittashaya Ashmari (Gall bladder Calculi) may be considered as Cholelithiasis. However, there is no classical reference of this condition in any of the treatises of Ayurveda. Acharya Sushruta, has explained that the corrosive nature of Kshara (alkaline materials) have a significant role in managing Ashmari. Aim:The present study is aimed at evaluating the clinical efficacy of Paneeyakshara i.e. silk hair of corn (Makkaya - Maize) in the management of Pittashaya Ashmari. Materials & Methods: Single group clinical study with 30 patients fulfilling the inclusion criteria were selected from Shalya Tantra OPD, Parul Ayurved Hospital, Vadodara. Makkaya Paneeyakshara was administered in a dose of 250 mg twice a day on empty stomach with honey for 60 days. Results: Makkaya Paneeyakshara showed statistically significant relief in the subjective and objective parameters. Conclusion:Overall effect of therapy suggests that Makkaya Paneeyakshara provided significant improvement by dissolving the gallbladder stones which was less than 10mm within a period of 8 weeks.

Background: In Ayurveda, Bhagandara is considered as one of the grave disease by Sushruta due to more recurrence rate. Ksharasutra is para-surgical procedure which is found more effective in the management of fistula-in-ano. Ksharasutra is routinely prepared with Snuhi Ksheera (latex), Haridra powder and Apamarga Kshara. In conventional method collection of Snuhi latex is time consuming and laborious. Guggulu was selected as an alternative for preparation of Ksharasutra having similar binding property as Snuhi latex, and has antiseptic, anti-inflammatory and wound-healing properties. That is why, here, in this trial, the Snuhi latex was replaced by Guggulu. Aim: To evaluate the efficacy of Guggulu based Ksharasutra with and without partial fistulectomy in the management of Bhagandara. Materials and Methods: In this research study, 42 patients of Bhagandara (fistula-in-ano) were selected and randomly divided into two groups. In group-A (n = 22), patients were treated only with application of Guggulu-based Ksharasutra and in group-B (n = 20), partial fistulectomy was done and then Guggulu-based Ksharasutra was applied in remaining fistulous tract. After Ksharasutra application, patients were assessed for relief in symptoms such as pain, discharge, itching and swelling as subjective parameters and unit cutting time (UCT) as an objective parameter, on weekly follow-up basis and Ksharasutra was changed by railroad technique up to complete cut through of the tract. Results: In patients of group-A (plain Guggulu-based Ksharasutra), highly significant relief was seen in pain and discharge. The significant result was seen in itching while insignificant relief in swelling. In patients of group-B (partial fistulectomy with Guggulu-based Ksharasutra), relief in symptoms such as pain, discharge, and itching was statistically highly significant. The relief in swelling in this group was found statistically significant. The mean UCT was 8.85 days/cm in group-A, whereas the mean UCT was 8.19 days/cm in group-B. Conclusion: Partial fistulectomy with Guggulu-based Ksharasutra is better as compared to plain Guggulu-based Ksharasutra application in cases of Bhagandara (fistula-in-ano).

Amongst all the ailments that afflict the mankind Hemorrhoids are definitely the commonest of them. Further many of the persons have piles without any symptom and are diagnosed as per chance on routine rectal examination.Kshara sutra has been described in all the ancient books of ayurveda in treatment of anorectal diseases and in a number of surgical diseases. The auther review of role of The ksharsutra in treatment of haemorrhoids. Auther found after joint workshop with AIIMS Bhopal (M.P.) and PT Khusilal govt. Ayurved College Bhopal (M.P.) that kshara sutra therapy is more beneficial in treatment in Heamorroids

Anorectal fistulas have been the subject of medical and lay literature for over 2,500 years. The term fistula is ascribed to John Arderne (1307–1392) whose classic work on anal fistula is still in print. However, it is important to note that in Ayurvedic medicine, Suhruta (b ~800 bc) described both fistulotomy and fistulectomy as well as the chemical seton using Kshara Sutra. Hippocrates (b ~460 bc) described the use of horsehair (seta) in the treatment of anal fistulas. Fistulas have been written about in many languages and geographical locations throughout the years. The true incidence of anal fistulas is unknown.