Haemorrhoids (Arsha) are one of the most common ano rectal diseases in which varicosity of haemorrhoidal vein occurs, may be internal or external. In simple understanding, it is defined that piles are dilated or engorged veins within anal canal in the sub epithelial region formed by radicles of superior, middle and inferior rectal veins. Ksharasuta (medicated thread) is an alkaline coated thread with different plant alkaline, was prepared with Apamarga Kshara (Ash of Achyranthus aspera Linn.), latex of Snuhi (Euphorbia nerifolia) and Haridra (Curcuma longa Linn.). Ksharasutra therapy has revolutionized the treatment of various anorectal disorders. A case of 35 year male was diagnosed as Multiples Fourth Grade Interno–External Haemorrhoids. Induration of whole perianal structure felt, big size protrusion of mass at 1, 3, 5, 7 & 11 o’clock position. During PR examination Interno–External pile mass felt at 1, 3, 5, 7, 11 o’clock position. Ksharasutra (medicated thread) ligation on all pile mass was done under spinal anaesthesia. The dressing was done daily with Panchawalkal Kawath (decoction of five herbs) and Jatyadhi Tail (Medicated oil). The ligated pile masses were sloughed out on fifth to seventh postoperative day and the patient was relieved from all symptoms within two weeks. No complications were reported after the procedure. The patient was followed up regularly onward till date after 1 year and did not reveal any postoperative complication and evidence of recurrence of piles. Thus, ksharsutra shows tremendous role with minimum invasive surgical modality for management of Treatment of Multiples Fourth Grade Interno–External Haemorrhoids.