The Ksharasutra is a specialized Ayurvedic surgical thread renowned for its efficacy in treating anorectal disorders, particularly fistula-in-ano. This paper aims to provide a comprehensive overview of the preparation process of Ksharasutra, focusing on the selection of thread, preparation of Kshara, collection of Snuhi Ksheera, the Ksharasutra cabinet, and the method of sealing. Through a detailed explanation of these essential steps, the purpose of this paper is to enhance the understanding of the complex and comprehensive method involved in developing the Ksharasutra.