ABSTRACT Haemorrhoids also known as piles are inflamed or swollen anal cushions. They are classified in four categories. A fourth-degree piles mass refers to severely prolapsed internal hemorrhoids that are permanently outside the anus and cannot be pushed back in. Ksharasutra ligation treatment is in practise for Arsha(piles), Bhagandara(Fistula), Nadivrana(sinus) etc. Due to its potential healing, sclerosing and antibacterial property it is found very effective in the treatment of piles. In this study, a 56-year-old patient with the complains of protrusion of mass per ano having pile mass at 7 & 11 o’ clock position. Ksharasutra (medicated thread) ligation on all pile mass was done under local anaesthesia. Complete sloughing of pile mass was noted in 6th day and healing of ulcer was achieved by 30 days along with resolution of all symptoms. The patient was relieved from all symptoms within two weeks. No complications were reported after the procedure.