Background - The diseases Arsha is considered to be a Mahagada according to the Ayurveda. Among the different types of Arshas explained by the Acharya Sushruta the Lakshanas of Bahya Arshas is looks similar to the structural presentation of the Sentinel pile. This condition, even though rarely fatal, gives more trouble to the sufferer and pose great difficulty for treatment. As we know the Sentinel pile is guarding to the fissure not to heal so keeping in view this clinical study Agnikarma with Panchaloha Shalaka and Electric Cautery was selected to give new dimension in the management of sentinel pile. Methodology - A comparative clinical study was done on forty subjects of both sexes, between the age group of 20-60 years who were randomly assigned into two groups, namely group A where Agnikarma by Panchalaoha Shalaka was used to the subjects and group B where Agnikarma by Electric Cautery was used to the subjects. After completion of the study, results were assessed using ‘Wilcoxon signed rank test’ for Single group and ‘Mann-whitney u-test’ for comparative Analysis for collected during the study. Result - Statistically Both group proved to be equally Significant. But according to the relief got by the patients Group-A proved to be more effective than group-B. Group-A overall result is 95.71% and Group-B overall result is 91.79%.