Role of Kshoudra in Agnikarma

Anji Maria Joseph; Anand Katti

Role of Kshoudra in Agnikarma

Maria Joseph A.^1*, Katti A.²

DOI:

^1* Anji Maria Joseph, Post Graduate Scholar, Dept. of Shalya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

² Anand Katti, Associate Professor, Dept. of Samhita Sidhanta, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

Sushruta known as father of surgery has described various procedures along with some parasurgical measures. Agnikarma is one amongst these parasurgical procedures. Agnikarma has been given special place in surgery by Sushruta and it is believed that disease treated by Agnikarma never reoccurs. Based on the specific heat retention and transmission capacity Acharya prescribed different materials like Pippali (Piper longum), Ajasakruth (goat’s excreta), Godantha (cow’s teeth), Shara (arrow), Shalaka (metal rods), Kshoudra (honey) etc. For Agnikarma on specific body parts. Kshoudra is one among them used to treat diseases situated in Sira, Snayu, Sandhi, Asthi.[1] The mechanism of action of Agnikarma is still obscure. Agnikarma act on a multi-factorial level in the body. Mainly it is indicated in the diseases caused by Vata and Kapha because of its Tikshna (quick action), Ushna (hotness), Sookshma (subtle), Vyavayi (quick spreading), Vikashi (works without being metabolised) properties to remove Srotorodha (obstruction in channels of body). Agnikarma with Kshoudra was not widely practiced. This paper deals with details of Agnikarma with Kshoudra and its utility.

Keywords: Agnikarma, Kshoudra, Daha, Para-surgical measures

Corresponding Author	How to Cite this Article	To Browse
Anji Maria Joseph, Post Graduate Scholar, Dept. of Shalya Tantra, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India. Email:	Anji Maria Joseph, Anand Katti, Role of Kshoudra in Agnikarma. J Ayu Int Med Sci. 2022;7(1):142-145. Available From https://jaims.in/jaims/article/view/1545

Introduction

Shalya Chikitsa or surgery is among eight branches of Ayurveda. This branch comes under Dhanwantariya Sampradaya and one of the two main schools of Ayurveda, was founded by Divodasa Dhanwantari. It was later developed by his student the great Maharishi Sushruta. Sushruta mentioned different methods of management of diseases, such as Bheshaja Karma, Kshara Karma, Agnikarma, Shastra Karma and Raktamoshana. Agnikarma means application of Agni directly or indirectly with the help of different materials to relieve the patient from disease.

He has also explained that the diseases treated with Agnikarma modality don’t reoccur. The approach of Agnikarma has been mentioned in the context of disesaes like Arshas Arbuda, Bhangandara, Sira, Snayu, Asthi, Sandhigata Vata Vikaras and Gridhrasi.^[2] Based on the part where Agnikarma has to be done and the ability of a material to retain and transmit heat energy, different instruments (Dahanopakarana) are enumerated by the ancient physicians. Substances which can retain less heat energy and can transmit lesser amount of heat energy are indicated for skin (Twak Dagdha) like Pippali, Ajasakrut, Godantha, Sara, Shalaka. Substances which can retain more heat energy and can transmit it to further deep layers are used for burning the muscles, tendons and ligaments. For e.g. Jambavoshta and metals are used for transmitting the heat energy to the level of muscles and Kshoudra, Guda and other viscous materials like oil, fat etc. are used to transmit the heat energy to ligaments, tendons or blood vessels.

Review of Literature

In the classic texts, various forms of Dahanopakarana have been described with greater clarity. Dahanopakarana refers to accessories used for the Agnikarma process. Each of these accessories has its unique property and application in Dahanopakarana.

Sushruta Samhita: Acharya Sushruta has listed the materials according to the site of Agnikarma. For Twakgatha Vyadhi - Pippali, Ajasakrut, Godanta, Shara, Shalaka, for Mamsagatha Vyadhi - Jambhavsta Shalaka and other Metals and for Sira, Snayu, Sandhi and Asthigatha Vyadhi - Madhu, Guda and Sneha were mentioned. Dalhana

in his commentary on Sushruta Samhita mentioned Kshoudra in diseases caused by the vitiation of Vata and Kapha in Sira, Snayu, Sandhi and Asthi sites. There only he mentioned other’s opinion also. Acharya Kasyapa mentioned Kshoudra has to be use in cases of excessive bleeding occurred due to Chedana of Sira, Snayu etc., not in Vyadhi’s in these sites. He also mentioned with Mamsadaha only diseases of Sira, Snayu etc. get cured. Acharya Bhadrasounaka has the opinion that with Twakdaha only, diseases on Twak and Mamsa subsides. By Mamsadaha only diseases on Sira, Snayu, Sandhi and Asthi subsides.^[3]

Ashtanga Hridaya: Acharya Vagbhata has listed the materials according to the site of Agnikarma. For Twakdaha, Varti, Godantha, Suryakantha, Shara etc. and for Mamsadaha, Madhu, Sneha, Jambavoshta, Guda etc. are mentioned. Acharya mentioned that for the Dahana of Sira, Snayu, Sandhi, Asthi we can use the same materials used for Mamsadaha. Hence according to Acharya Vagbhata, Kshoudra can be used for both Mamsadaha and Siradi Daha. Mamsadaha is indicated in diseases such as Arshas, Bhagandhara, Granthi, Nadivrana, Dustavrana etc.^[4]

Charaka Samhita: Acharya Charaka given detail description of Agnikarma. It comes under 36 Upakarmas of Vrana in the chapter of “Dwivraniya Chikitsa”. He mentioned Agnikarma with Kshoudra in Vrana, which is Kapha Dosha Pradhana and is mild one. Advised to do in Asukmara patients.^[5]

Ashtanga Samgraha: In Samgraha Acharya mentioned materials for Agnikarma according to site and also, he mentioned diseases where we have to do Agnikarma.

For Twakdaha, Godantha, Suryakantha, Shara etc. and for Mamsadaha Jambavoshta, Suchi, Shalaka, Ghrita, Guda Madhu, Madhuchista, Taila, Vasa, Hema, Tamra, Rupya etc. are mentioned. For Siradi Daha - Jambavoshta, Suchi, Shalaka, Madhu, Madhuchista, Guda etc. are indicated.

Madhu mentioned in both Mamsadaha and Sira Snayu Sandhi Asthi Daha. Mamsadaha is mentioned in diseases such as Granthi, Arbuda, Arshas, Bhagandara, Gandamala, Slipada, Antravridhi, Dustavrana, Puyalasaka. Siradi Daha mentioned in Sira-Snayu-Sandhi-Asthi Cheda Sonita Atipravarthi, Dantanadi, Slishtavartma, Upapakshma, Lagana, Liganasa.^[6]

Properties of Kshoudra: Kshoudra comes under Madhuvarga. It is Madhuram Kashya Anurasam, Rooksha Seetam, Laghu. It causes Agnideepanam, Varnyam, Swaryam, Vajeekarana. It has Lekhana, Sandhana, Ropana, Chakusyaya, Prasadana Karma. It can enter Sookshmamarga. It has Prasammana effect on diseases such as Medo, Meha, Hikka Swasa, Kasa, Atisara, Chardi, Trishna, Krimi and Visha. By the Usna quality of Kshoudra it pacifies both Vata and Kapha. By the Laghu, Ruksha and Sukshma properties it alleviates Kapha.^[7]

Physical analysis of Kshoudra: Kshoudra was experimented for its boiling point by academicians for their research work.^[8] A direct method was resorted for the purpose, which involved temperature measurement using a laboratory thermometer. The boiling point of the sample was determined to be 140°C. Because on further heating Kshoudra gets charred. Therefore, it may be considered that Kshoudra heated upto its boiling point is to be used for Agnikarma, as further heating causes charring and renders its unusable. On removing the heat source, a gradual dissipation of temperature was noted at a rate of 2°C per minute for a period of 3-4 minutes under atmospheric conditions. After this short initial duration there was a gradual and almost constant dissipation of heat about 6° to 8°.

Procedure of Agnikarma: The procedure of Agnikarma consisted of 1. Purva Karma, 2. Pradhana Karma, 3. Pascat Karma.

Purva Karma: The patient should be on Snigdha and Pichila diet before Agnikarma. Agropaharaniya should be done along with well-prepared minor OT. Sterile Sponge holding forceps, Cotton pieces, Drape, Kshoudra, Steel dish, Borosil pipette and Madhu Ghruta mixture should make kept ready. The patient should lie over the procedure table. The area of Agnikarma should be cleaned and the area of maximum tenderness should be palpated, then marked with skin marker.

Pradhana Karma: The heated Kshoudra should be taken in a container which can bear the high temperature, which has minimum heat absorption and can provide a steady and interrupted (as drops) flow of Kshoudra. We can use a Borosil glass pipette for the same. The Tapta Kshoudra should be sucked using Borosil glass pipette, poured on the pre - determined site and wiped off after a 1 minute. At least 1/2 inch gaping should be maintained between the Dagdha Stana.

Pascat Karma: A mixture of Madhu and Ghrita has to be applied immediately after Agnikarma. Pathya - Apathya according to Susrutacharya for Vruna has to be advised.^[9]

Importance of Agnikarma: Acharya Sushruta and Acharya Vagbhata have both given superior place to Agnikarma as compared to Kshara karma among Dahana Kriyas that are used for the treatment of various diseases. Because cases treated with Agnikarma, chances of recurrence are not present.^[10] It is supposed to have effect of sterilization. It causes coagulation and closure of bleeding vessels and thus helps haemostasis. Agnikarma eradicates disease from its root and so considered to be superior. It shows Shamaka effects on both Vata and Kapha Doshas.

Effects of Agnikarma: It increases metabolism, blood circulation, decreases pain, stimulates nerves, relax muscles, decreases infection, joint stiffness and inflammation.

Discussion

Mode of Action: Agnikarma is considered as the most preferred therapy to pacify vitiated Vata Dosha with or without Anubandha of Kapha, by virtue of the properties that Agni possess viz, Usna, Tiksna, Suksma, Asukari Guna. These Guna are opposite to the properties of Vata and Kapha. Kshoudra when employed for Agnikarma, Kshoudra owing to its higher Latent heat (heat retention capacity of sticky liquids are high) can effect a greater variation in the temperature of the tissue surface in contact with the molten honey and also that of the subsequent layers. Eventually the heat penetration will be always be higher when such liquids are used for Agnikarma.

Due to Usna, Tiksna, Suksma, Asukari Guna it removes the Srotorodha and pacify the vitiated Vata and Kapha Dosha and maintain equilibrium. It increases the blood circulation to the affected site. More blood circulation flushes away the pain producing substances and patient gets relief from symptoms. The therapeutic heat also increases the Dhatvagni, which cause Amapacana. Further it can be endorsed that the heat pacifies the Sheeta Guna of Vata and Kapha Dosha.

Agnikarma using Kshoudra like substances is considered to aid the penetration of heat through Sukshma Sira. By the Usna quality of Kshoudra

it pacifies both Vata and Kapha. By the Laghu, Ruksha and Sukshma properties it alleviates Kapha.

Conclusion

Agnikarma is a para surgical modality indicated in the management of diseases having Vata and Kapha predominance and also in conditions of Atyugra Ruja. Agnikarma with Kshoudra, Guda, Sneha are indicated in diseases of Sira, Snayu, Sandhi and Asthi.

Agnikarma can be conducted at the O.P level with the patient requiring no hospital stay. It is a simple procedure, has very less and easily manageable complications and cost effective. Kshoudra heated upto its boiling point is to be used for Agnikarma, as further heating causes charring and renders its unusable. Kshoudra being a sticky liquid has a high latent heat and hence will induce better heat penetration. Agnikarma using Kshoudra like substances is considered to aid the penetration of heat through Sukshma Sira. By the Ushna quality of Kshoudra it pacifies both Vata and Kapha. By the Laghu, Ruksha and Sukshma properties it alleviates Kapha.

Reference

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Sushrutha Samhita with Nibandha Sangraha commentary of Sri Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya edited by Vaidya Yadavji Trikamji Acharya, Chaukamba Krishnadas Academy Prakshana, Varanasi. reprint 2008, Sutra sthana 12^thchapter.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-01-24	2022-01-26	2022-02-02	2022-02-09	2022-02-16
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

Review Article

Agnikarma

Journal of Ayurveda and Integrated Medical Sciences