E-ISSN:2456-3110

Case Report

Madhu Agnikarma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

Madhu Agnikarma in the pain management of Tennis Elbow - A Case Study

Parvathy M.1*, Padma.2, M Sweta K.3
DOI:

1* MG Parvathy, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

2 Padma, Associate Professor, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

3 K M Sweta, HOD and Professor, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

Lateral epicondylitis, also known as ‘tennis elbow’, is a very common condition that presents with pain and tenderness on the lateral side of the elbow due to the repetitive stress, results in inflammation of the common extensor tendon of the lateral epicondyle of the humerus. According to Ayurveda, Snayugata Vikara can be correlated with the condition of tennis elbow. Agnikarma being superior among all surgical and parasurgical procedure by its action seems to be more effective in providing instant pain relief. The therapeutic effects of Agnikarma with Kshoudra include relief of pain and muscle spasm, acceleration of healing, promotion of resolution of inflammation and increase in the range of movement of joint.

Keywords: Madhu Agnikarma, tennis elbow, Anusastra

Corresponding Author How to Cite this Article To Browse
MG Parvathy, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.
Email: 		MG Parvathy, Padma, K M Sweta, Madhu Agnikarma in the pain management of Tennis Elbow - A Case Study. J Ayu Int Med Sci. 2022;7(9):216-220.
Available From
https://www.jaims.in/jaims/article/view/2095

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-29 2022-08-31 2022-09-07 2022-09-14 2022-09-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by MG Parvathy, Padma, K M Swetaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Lateral epicondylitis, also known as ‘tennis elbow’, is a very common condition that presents with pain and tenderness on the lateral side of the elbow due to the repetitive stress, results in inflammation of the common extensor tendon of the lateral epicondyle of the humerus. This malady hampers a person’s ability to perform day to day activities, as forearm movements are restricted due to pain.[1,2]

The overall prevalence rate of the disease is 1-3% of population, generally affecting the middle aged without gender predisposition. A wide range of symptomatic treatments used in contemporary medicine are use of anti-inflammatory drugs, analgesics, physiotherapy, and local corticosteroid injections in the affected site. In less than 10% of cases, Surgery is indicated.[3]

Long term uses of anti-inflammatory drugs, analgesics and steroid injections have their own limitations and adverse effects. Hence treatment modality which is easier to administer with lesser complications and better rate of success should be the criteria in choosing the management of this disease.[3]

According to Ayurveda, Snayugata Vikara can be correlated with the condition of tennis elbow. Due to Balavadvigraha and Ativyayama etc the vitiated Vata, get localised in the Kurpara Sandhi leading to pain, stiffness and restricted movements.[4] The Chikitsa Sutra of Snayugata Vata comprises of Snehana, Upanaha, Agnikarma and Bandana.[5]

Agnikarma being superior among all surgical and parasurgical procedure by its action seems to be more effective in providing instant pain relief.

Acharya Susrutha in his treatise recommended Kshoudra, Guda or Sneha as Dahanopakarana in Snayuvikara. The therapeutic effects of Agnikarma with Kshoudra include relief of pain and muscle spasm, acceleration of healing, promotion of resolution of inflammation and increase in the range of movement of joint.[6]

This study is an attempt to revalidate the effectiveness of Kshoudra for Agnikarma in tennis elbow, considering its deeper heat penetration property, availability, and better cosmetic outcome, which would add up it to the domain of practically and easily accessible Dahanopakarana.

Aim and Objective

To evaluate the efficacy of Kshoudra as Dahanopakarana for the pain management in Snayuvikara with special reference to Tennis Elbow.

Materials and Methods

  • Kshoudra
  • Borosil glass pipette
  • Stove
  • Sterile Laddle
  • Mixture of Madhu-Sarpi (Equal quantity)
  • Sterile cotton balls
  • Measuring scale

jaims_2095_01.JPGFigure 1: Materials required

Properties of Kshoudra

Table 1: Properties of Kshoudra[8]

Properties Caraka Samhita Susrutha Samhita Ashtanga Sangraha Ashtanga Hridaya Madanpal Nighantu Kaiyadeva Nighantu Bhava Prakasha Nighantu
Rasa Madhura, Kashaya Madhura Madhura, Kashaya Madhura, Kashaya - Madhura Madhura
Anurasa - Kashaya - - - Kashaya Kashaya
Guna Guru, Ruksha Laghu, Ruksha, Picchila Guru, Ruksha Ruksha Laghu, Ruksha, Vishada Laghu, Ruksha, Vishada, Sukshma Laghu, Ruksha, Vishada, Sukshma
Virya Sheeta Sheeta Sheeta - Sheeta Sheeta Sheeta
Vipaka - - Katu - - - -
Doshagna Kaphapitta Hara Tridosha Hara Kaphapitta Hara Kaphapitta Hara Kaphapitta Hara Kaphapitta Hara Kaphapitta Hara

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Parvathy M et al: Madhu Agnikarma in the pain management of Tennis Elbow
  • Boiling point of Honey: 130– 150 degree Celsius.
  • On removing from the heat source, immediate heat dissipation is zero degree Celsius and gradual heat dissipation at a rate of 2 to 3 degree Celsius per minute, under normal atmospheric conditions.
  • Specific heat for Taptha Kshoudra is in the 0.54- 0.60cal/g/degree Celsius range.[7]

Intervention

Preparation of Kshoudra for Agnikarma [7]

  • Kshoudra was boiled in a Sterile Laddle

Agnikarma Procedure(7)

  • Patient was allowed to sit comfortably and instructed to bend the elbow at 90 degree with pronated forearm.
  • Most tender points was marked using a pen or marker.
  • Kshoudra was heated in sterile laddle and using a Borosil Pipette Kshoudra was sucked and dropped over the marked points from a height of 1 cm.
  • It was wiped off immediately using sterile cotton balls anointed with Madhu-Sarpi

Figure 2: The method of Heating Kshoudra and procedure of Agnikarma

jaims_2095_02.JPGHeating Kshoudra

jaims_2095_03.JPGTender points marked

jaims_2095_04.JPG

Kshoudra dropped over points

jaims_2095_05.JPG

Wipped off using Madhu- Sarpi mixture

Table 2: Subjective symptoms assessed before and after the Madhu Agnikarma was as mentioned in the table.

Pain Assessment VAS Scale[9] 0 - No Pain 1-3 - Mild pain 4-6 - Moderate pain 7-10 - Severe pain
(Before treatment)  -  -  +  -
After 4th sitting of Agnikarma  +  - -             -

Table 3: Objective symptoms assessed before and after the Madhu Agnikarma.

Tenderness[10]   Grade 0 No Tenderness Grade 1 Tenderness to palpation without grimace or flinch Grade 2 Tenderness with grimace and or flinch to palpation Grade 3 Tenderness with withdrawal     Grade 4 Withdrawal to non-noxious stimuli
Before treatment  -  -  +  - -
After treatment  -  + -             - -
Swelling[11] Grade 0 - No swelling Grade 1 - Swelling present
Before treatment  -  +
After treatment  +  -


 Cozen’s test[12]  0 - Negative 1 - Positive
Before treatment  -  +
After treatment  +  -



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Mill’s Manoeuvre[12]  0 - Negative 1 - Positive
Before treatment  -  +
After treatment  +  -

Results

Complete reduction of Symptoms was achieved within 4 sittings of Madhu Agnikarma.

Discussion

Lateral epicondylitis or tennis elbow is a common condition that presents with pain and tenderness around the common extensor origin of the elbow. The Chikitsa Sutra of Snayugata Vata comprises of Snehana, Upanaha, Agnikarma and Bandana.[5] Among all these Agnikarma seems to be more effective in providing instant pain relief. In this study, four sittings of Madhu Agnikarma were done and by the end of fourth sitting complete remission of pain were observed. During the process of Madhu Agnikarma, due to Ushna, Tikshna, Sukshma and Aasukari Guna of Agni and Ruksha, Vishada, Sukshma properties of Madhu helps in the deeper penetration of heat so that it reaches Snayu and causes Vata Samana, reduces chronic inflammation and thus reducing pain and tenderness. The therapeutic heat helps to remove Srotavarodha and increases the Dhatvagni, which causes local Ama Pachana. From the above explanations, Heat energy (Ushna Guna) thus might have increased the tissue temperature, blood flow, metabolism and the extensibility of the connective tissue.[12] The therapeutic effects of Agnikarma with Kshoudra include relief of pain and muscle spasm, acceleration of healing, promotion of resolution of inflammation and increase in the range of movement of joint.[6]


Conclusion

Significant relief on symptoms of tennis elbow including pain, swelling etc was being observed in the course of treatment. Agnikarma using Madhu was patient-friendly because the instrument used for the procedure was welcoming to the patient.[12] Agnikarma with Madhu has deeper heat penetration property, better cosmetic outcome and easy availability. Agnikarma being superior among all surgical and parasurgical procedure by its action seems to be more effective in providing instant pain relief.

Reference

1. Louis Solomon, David Warwick, Selvadurai Nayagam. Apley’s System of orthopaedics and fracture. 9th edition. London: Hodder Arnold; 2010. p.378.

2. Maheswari J, Mhaskar. Essential Orthopedics. 5thedition. New Delhi: Jaypee The Health sciences publisher; 2015. p.302.

3. Mahanta V, Dudhamal T S, Gupta S K. Management of Tennis Elbow by Agnikarma. Journal of Ayurveda and Integrative Medicine. 2013; 4(1):45-7. https://doi:10.4103/0975-9476.109552. s[accessed on 2021-7-03]

4. Acharya Trikamji Jadavji, editor. Susrutha, Susrutha samhitha, Nidanasthana, Ch-1, verse.25. Varanasi: Choukhamba Sanskrit Sansthan.2014. p.326.

5. Acharya Trikamji Jadavji, editor. Susrutha, Susrutha samhitha, Chikitsasthana, Ch-5, verse.52. Varanasi: Choukhamba Sanskrit Sansthan. 2014. p.428.

6. Acharya Trikamji Jadavji, editor. Susrutha, Susrutha samhitha, Suthrasthana, Ch-12, verse.4. Varanasi: Choukhamba Sanskrit Sansthan.2014. p.58.

7. Prasanth K S. A comparative study of agnikarma with Taptha Kshoudra and Panchaloha Shalaka in carpal tunnel syndrome: International Journal of Applied Ayurved Research. 2017Jul-Aug;3(3):677-83. http://ijaar.in/posts/images/upload/IJAAR_VOLUME_III__ISSUE_III_JUL_AUG_2017___677_683.pdf. [accessed on 2021-7-6]

8. Sharma Khemchand, Goyal Chinky, Prajapati Deepchand. Critical review on Madhu w.s.r. to honey. International Journal of Ayurveda and Pharma Research.2017;3(9):75-82. http://ijaar.in/posts/images/upload/IJAAR_VOLUME_III__ISSUE_III_JUL_AUG_2017___677_683.pdf. [accessed on 2021-7-6]

9. Haefeli M, Elfering A. Pain assessment. European Spine Journal. 2006;15(1): S17-24.

10. https://doi.org/10.1007/s00586-005-1044-x. [accessed on 2021-7-4]



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11. Ronald LeFebvre. Tenderness Grading, Soft Tissue. University of Western States. 2014;1-2. https://www.academia.edu/35960258/TENDERNESS_GRADING_SOFT_TISSUE_Tenderness_Grading_Soft_Tissue. [accessed on 2021-7-6]

12. Niketh Narayanan T K. A Clinical study on the role of Agnikarma in the management of Tennis Elbow. 2011; 5(3): 23-9.

13. http://www.rguhs.ac.in/cdc/onlinecdc/uploads/03_A014_23570.doc. [accessed on 2021-7-3]

14. Das S. A manual on Clinical surgery. 12th Edition. Kolkata: S.Das; 2016. p.230.

15. Sreelatha K. Agnikarma Using Honey In Tennis Elbow. International Ayurvedic Medical Journal.2021.p.4-5.

16. http://www.iamj.in/posts/images/upload/2659_2664.pdf


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