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Haemorrhoids are among the most prevalent anorectal disorders, characterized by symptomatic enlargement and distal
displacement of anal vascular cushions. Conventional management includes conservative therapy and minimally invasive
procedures such as rubber band ligation (RBL), which is widely regarded as the standard treatment for grade I–III internal
haemorrhoids. In Ayurveda, Arsha is described as a disease caused by vitiation of Doshas, and Kshara Karma—a parasurgical procedure involving the application of alkaline substances—is advocated as an effective treatment modality. This
review aims to critically compare Kshara Karma and RBL in terms of efficacy, safety, recurrence, procedural aspects, and
patient outcomes. A structured literature review was conducted using classical Ayurvedic texts (Charaka Samhita, Sushruta
Samhita, Ashtanga Hridaya) and modern databases including PubMed, Scopus, and Web of Science. Evidence suggests
that both modalities are effective for internal haemorrhoids; RBL offers simplicity and rapid symptom relief, whereas
Kshara Karma provides a more comprehensive approach with potential for lower recurrence due to its tissue-destructive
and healing-promoting properties. However, Kshara Karma may be associated with increased procedural discomfort and
requires technical expertise. While RBL is supported by robust clinical evidence, studies on Kshara Karma are limited and heterogeneous. Integrative evaluation indicates that both modalities have distinct advantages, and selection should be
individualized based on disease severity, patient preference, and available expertise.

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