In this study, a case with internal piles at 3 o'clock, 7 o'clock, and 11 o'clock was treated with Palash Ksharasutra. Postoperative assessment was done daily by recording the relief and observing the signs and symptoms. Good results were attained after postoperative and no adverse effects. Kshara sutra remedy is a minimally invasive ayurvedic Parasurgical procedure and time-tested ayurvedic fashion in the operation of anorectal diseases