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Introduction: Kshara Karma and Agnikarma are classical surgical techniques described in Ayurvedic Samhitas, particularly in Sushruta Samhita, for management of various chronic and acute conditions. Kshara Karma involves application of alkaline substances for chemical cauterization, whereas Agnikarma employs thermal cauterization for tissue excision or modification. Both are widely used in management of fistula, hemorrhoids, warts, chronic ulcers, and musculoskeletal disorders. Methods: A comprehensive literature review was conducted using classical Ayurvedic texts (Sushruta Samhita, Charaka Samhita, Ashtanga Hridaya), as well as modern research indexed in PubMed, Scopus, Web of Science, and Google Scholar. Inclusion criteria were textual descriptions of Kshara and Agnikarma, clinical studies, and experimental research evaluating efficacy and safety. Exclusion criteria included anecdotal reports and non-peer-reviewed sources. Results: Samhitas describe detailed procedures, indications, contraindications, complications, and post-operative care for Kshara and Agnikarma. Modern research supports their efficacy in anorectal disorders, chronic ulcers, warts, and musculoskeletal pain. Mechanisms include localized tissue necrosis, anti-inflammatory effects, and improved healing. Both therapies are minimally invasive alternatives to conventional surgical interventions. Discussion: Kshara and Agnikarma exemplify precise, rational surgical techniques rooted in classical principles. Integration with modern surgical practice can enhance outcomes, especially in chronic, refractory conditions. Evidence supports their safety and therapeutic relevance, but standardized protocols and randomized trials remain limited. Conclusion: Kshara Karma and Agnikarma provide scientifically grounded, effective interventions with potential for integration into contemporary clinical practice. Future translational research and clinical trials may further validate their efficacy and expand their application in integrative healthcare.

KEYWORDS: Agnikarma, Ayurveda, Kshara Karma, Samhita, Surgical Techniques