In Ayurveda, Arsha (piles/ hemorrhoids) is described as a result of Mandagni (low digestive fire), Apana Vata Dushti, and accumulation of Mala (waste), leading to engorged venous plexuses in the rectal region. Abhyantara Arsha refers to internal hemorrhoids, which are often painless but can cause bleeding and prolapse. Among the various treatment modalities described, Kshara Karma (alkaline cauterization) is a minimally invasive, effective, and non-recurrent procedure indicated for Arsha, especially when surgical intervention is to be avoided. For Apamarga Pratisaraneeya Teekshna Kshara the source plant is Achyranthes aspera (Apamarga). For its preparation ash obtained from burning the whole plant of Apamarga is filtered. The ash is mixed with water and allowed to settle. The supernatant is collected and evaporated to obtain concentrated Kshara. Additional ingredients like Chitraka, Snuhi, or Kanji may be added to enhance potency. The mechanism of Action includes Chedana (Excision); Breaks down the mass by liquefying proteins and dissolving tissues, Bhedana (Incision); Penetrates and separates abnormal tissue and Lekhana (Scraping); Scrapes out unwanted growth and debris from the mucosa. It also represents Shodhana & Ropana (Cleansing & Healing) characteristics antimicrobial, astringent, and wound-healing properties help in faster recovery.