Introduction: Ksharasutra therapy is long known for effectively treating Pilonidal sinus (Nadi Vrana). This study aims to compare the efficacy of two Ksharasutra insertion techniques: the 8-Shaped Ksharasutra and the standard single loop pattern Ksharasutra in patients with Pilonidal Sinus (Nadi Vrana). Methodology: Ten patients diagnosed with Pilonidal sinus at the outpatient department of Shalya Tantra, TMAES Ayurvedic Medical College, Hospete, Karnataka, India, were selected for this study. These patients were equally divided into two groups: Group A (n=5, 8-Shaped Ksharasutra) and Group B (n=5, Single loop Ksharasutra). Both groups received a standard Ksharasutra (21 Bhawana) made with Apamarga, Snuhi, and Haridra. The study evaluated three parameters: VAS score, time taken for cutting through the track and time span for complete healing. The Ksharasutra was changed weekly using the rail-road technique on an outpatient basis. Efficacy was assessed from insertion to complete wound healing. Results: A significant difference was observed between Group A and Group B concerning the time taken for cutting through the track, disinfection and complete healing of the Pilonidal Sinus track. However, there was no significant difference in VAS score between the two groups during the treatment course. Conclusion: 8-Shaped Ksharasutra offers the advantage of faster tract cutting, more efficient disinfection and quicker wound healing compared to the single loop pattern Ksharasutra.