E-ISSN:2456-3110

Review Article

Agnikarma in Kamala

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 1 January
Publisherwww.maharshicharaka.in

A literary review article on Agnikarma in Kamala

Khandelwal A1*, V Rajneesh G2, Bhakta S3
DOI:10.21760/jaims.9.1.34

1* Khandelwal A, Post Graduate Scholar, Department of Pg Studies in Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

2 Giri V Rajneesh, HOD, Department of PG studies in Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

3 Bhakta S, Assistant Professor, Department of PG studies in Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

Jaundice is defined as a yellowish discoloration of skin, mucous membrane and sclera due to the deposition of bile pigment (bilirubin). It can be classified as pre-hepatic, hepatic and post hepatic jaundice. The causes of various forms of Jaundice are either acquired or congenital. The incidence of jaundice in India is 2.37-3.15 per 1000 population. Varied reasons result in jaundice. Some of them are medically managed whereas some require surgical interventions. The underlying causative factors and clinical manifestations in such conditions are similar to Kamala described in Ayurveda. Various treatment protocols have been mentioned by various Acharya in their respective Samhita. One among them is a handbook for an Ayurvedic physician from Andhra Pradesh, written by Basavaraju named as Basavarajiyam where he has mentioned Agnikarma in Kamala Vyadhi which is a unique practice that might help for early recovery of patients. Another famous book on Viddha and Agnikarma Chikitsa by Dr.R.B. Gogate from Maharashtra also mentions about similar kind of treatment. By considering all these, the present article is aimed at understanding the textual references of Agnikarma in Kamala.

Keywords: Agnikarma, Basavarajiyam, Jaundice, Kamala

Corresponding Author How to Cite this Article To Browse
Khandelwal A, Post Graduate Scholar, Department of Pg Studies in Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.
Email: 		Khandelwal A, V Rajneesh G, Bhakta S, A literary review article on Agnikarma in Kamala. J Ayu Int Med Sci. 2024;9(1):222-226.
Available From
https://jaims.in/jaims/article/view/2933

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-11-13 2023-11-23 2023-12-03 2023-12-13 2023-12-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.96

© 2024by Khandelwal A, V Rajneesh G, Bhakta Sand 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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Khandelwal A. et al. A literary review article on Agnikarma in Kamala

Introduction

Kamala Vyadhi, also known as Jaundice, is a common liver disorder that affects millions of people worldwide. Ayurvedic Standard Treatment Guidelines (ASTG) published by ministry of AYUSH government of India in 2007, has mentioned treatment of Kamala at 3 different levels - PHC, CHC, hospital at institutional level. Here they have given clinical features, investigations, various formulations, dose and mode of administration of oral medications, Pathya-Apathya (diet and lifestyle educations) that can be followed during Kamala. By this we can understand the importance of treating Kamala.[1] The disease Kamala is Nidanarthakara Roga of Pandu. It is a disease where the Rakta Dhatu gets vitiated along with Pitta Dosha. It is mentioned under Raktapradoshaja Vikara.[2] It is also a synonym of Pandu.[3] Some consider it as a type of Pandu whereas some consider it as a separate Vyadhi. The patient of Pandu (anemia), if excessively consumes the Pittakara Aahar Vihaar like Amla rasa (sour food), Madya, etc., then this aggravated Pitta burns Asrig (blood) and Mamsa (muscle) further producing the symptoms like Pandu (pale skin), Tandra (drowsiness) and Balakshaya (debility).[4] Some consider it as a separate Vyadhi.

Etiopathgenesis of Kamala

Koshthashakhashrita Kamala[5]

Pandurogi Pittakara Aahara Vihara Sevan

↓

Increased Ushna, Tikshna Guna, Dushta Aahara Rasa

↓

Pachak Pitta Dushti and Rasa Dushthi

↓

Agnimandya

↓

Rakta and Mamsa Vidaha

↓

Yakrutaagamana

↓

Kosthashrita Kamala

Shakhashrita Kamala[6]

Vata and Kapha Prakopa Hetu

↓

Rukshaguna Pradhan Vata Dosha gets Kapha Murchita

↓

Obstruction of Pitta Nalika

↓

Vimargagamana of Pitta all over

↓

Haridra Twacha, Netra, Mootra

↓

Shakhashrita Kamala

Samprapti Ghataka[7]

Dosha: Pitta Pradhana Tridosha

Dusya: Rasa, Rakta, Mamsa

Agni: Jatharagni, Dhatvagni

Agnidushti: Mandagni

Ama: Agnijanya

Srotas: Rasavaha, Raktavaha, Annavaha

Srotodusti: Sanga, Atipravrutti, Vimargagamana

Udbhavasthana: Amashayotha, Koshta, Mahasrotas

Sancharasthana: Koshta

Vyaktasthana: Tvak, Nakha, Netra, Shakha

Purva Roopa[8]

  • Twak Sphutanam (cracking of the skin)
  • Shthivanam (salivation)
  • Gatrasada (lassitude)
  • Mridbhakshana (desire for eating clay)
  • Kuta Shotha (swelling of the eyelids)
  • Vinmutra Peetatwa (yellow color of the stool and urine)
  • Avipaka (indigestion)

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Roopa[9]

  • Haridra Varna of Netra, Twak, Nakha, Aanana (Yellow color of Sclera, skin, underneath the tongue)
  • Rakta Peeta Varna of Shakrit and Mutra (changes in color of stool and urine)
  • Hatha indriya (hampered in functioning of sense organs)
  • Avipaka
  • Dourbalya (Fatigue)
  • Aruchi
  • Karshya (Changes in Weight)

Classification of Kamala

  • Charakh Samhita[10] - Koshtha shakhashrith,
  • Sushrut Samhita[11] - Kamala, Halimaka, Kumbhahvaya (Kumbha Sahva), Lagharaka (Laghrakaalasaka).
  • Astanga Hridaya[12] - Swatantra, Paratantra.

Kamala can be correlated to jaundice.[13] Jaundice is yellow skin pigmentation caused by elevation in serum bilirubin level (also termed as icterus); often more easily seen in sclera. Scleral icterus becomes clinically evident at a serum bilirubin level of greater than 51 µmol/L (3 mg/dL).[14] The incidence of jaundice in India is 2.37-3.15 per 1000 population.[15] The causes of various forms of Jaundice are either acquired or congenital. It can be classified as

1. Hepatocellular

  1. Acute: Viral hepatitis, Drug hepatitis, Alcoholic hepatitis, etc.
  2. Chronic: Congenital hyperbilirubinemia, Cirrhosis

2. Obstructive

  • Without mechanical obstruction
  1. Acute: Drugs, e.g. chlorpromazine, viral hepatitis with cholestasis etc.
  2. Chronic: Primary biliary cirrhosis
  • With mechanical obstruction
  1. Intra hepatic (medical)
  2. Extra hepatic (surgical)

3. Hemolytic [16]

Table 1: Clinical presentation of a case with jaundice varies according to the cause.

ConditionsSymptoms[17]
HepatitisFever, abdominal pain, jaundice, anorexia, tastelessness
Hemolytic jaundiceInsidious onset and long duration of jaundice, dark colored urine and stool
Obstructive jaundiceAbdominal pain, pruritus, and alcoholic stools (in case of bile duct stone)
Painless progressive jaundice with palpable gallbladder (in carcinoma of the pancreas)
Cirrhosis of liverPortal HTN, jaundice develops during decompensation of liver disease

Conventional treatments for Kamala primarily focus on managing symptoms and addressing the underlying cause, such as viral infections, alcohol abuse, or liver diseases. However, these treatments often have limitations and may not provide complete relief. Agnikarma (Thermal cauterization) is an important para surgical procedure and is still used extensively in surgical practice in modified form of electrical thermal cautery. A disease cauterized with Agni will not recur and diseases which are not curable by medicines, surgery and alkali therapy are curable by Agnikarma.[18]

Table 2: Upakaranas (instruments) are used to perform Agnikarma.

Type of DagdhaUpakarana [19]
Twak DagdhaPippali,
Ajashakrit (Excreta of goat),
Godanta (Cows teeth),
Shara (Arrow head),
Shalaka (Metal rod)
Mamsa DagdhaJambavoushta (a piece of black stone made like a Jambuphala),
Itara Loha (Rods of other metals like Tamra, Rajata etc.)
Sira and Snayu (vessels, ligaments)Kshaudra or Madhu (Honey),
Guda (Jaggery),
Sneha- Ghrita, Taila, Vasa and Majja
Sandhi and Asthi Dhatus (joints and Bones)Kshaudra or Madhu (Honey),
Guda (Jaggery),
Sneha - Ghrita, Taila, Vasa and Majja

Based on Akruti (shape) Agnikarma can be done in 4 kind[20]

1) Bindu (shape of dot)

2) Valaya (circular ring)

3) Vilekha (vertical line)

4) Pratisaran (scrapping)

Benefits and advantages of Agnikarma

One of the key advantages of Agnikarma in treating Kamala is its non-invasive nature. Unlike invasive procedures, Agnikarma does not involve surgical incisions or the use of strong medications, making


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it a safer and more accessible option for patients. Additionally, Agnikarma is known for its minimal side effects and relatively quick recovery time. It is a technique that involves the controlled application of heat to specific points on the body. It aims to alleviate various diseases by balancing the body's energies and promoting healing.

Aim and Objectives

To review the available literature regarding Agnikarma in Kamala.

Methodology

Various textbooks are reviewed critically and scientifically to understand Kamala, jaundice, Agnikarma, and Agnikarma in Kamala.

Discussion

Treatment of Kamala mainly includes Nidana Parivarjana, Shodhana Chikitsa, Shamana Chikitsa (e.g. Pachana, Deepana, Snehana, Pitta shamak Chikitsa), Rasayana etc. Basavarajiyam describes Agnikarma as an effective treatment for Kamala. It involves the precise application of heat to specific points on the body, indirectly targeting the liver and associated organs. The controlled thermal stimulation is believed to restore the balance of bodily energies, promoting liver function and aiding in the elimination of toxins. In the text, Valaya type of Agnikarma in Ghutika (elbow) and Manibandha (wrist joints) is mentioned, which can be performed with Swarna (gold), Tamra (copper), or Rajata (silver) Shalaka. There is no direct reference that connects Manibandha region of right hand to Yakrut, but just like Agnikarma on Manibandha sandhi of Vama Hasta (left hand) is mentioned to treat Pleeha Roga (spleen disorder) similarly Agnikarma on Dakshina Hasta (right hand) may have some role in treating Yakrut Vikara (liver disorders). Here, Twak Dagdha has been followed with the help of Swarna, Tamra and Rajata Shalaka, as Kamala shows its Lakshana over Twacha (skin). Haridra rhizome can also be considered as modified Shalaka as well.[21] While Agnikarma shows promise in the treatment of Kamala, it is essential to approach its integration with conventional medicine cautiously. Collaborative efforts between Ayurvedic practitioners and modern healthcare professionals can help bridge the gap,

ensuring a holistic approach to patient care. Further studies and collaborations are needed to explore the full potential of Agnikarma in the treatment of Kamala and other ailments, ultimately benefiting individuals seeking holistic and personalized healthcare solutions.

Conclusion

Traditional treatments for Kamala often involve medication, dietary modifications, and rest. However, Dr. R.B. Gogate's research suggests that Agnikarma can offer a unique and effective alternative. According to his research, Agnikarma helps stimulate the liver, enhance bile secretion, and improve overall liver function. By targeting specific points on the body associated with liver health, Agnikarma aims to restore balance and alleviate the symptoms of Kamala. The controlled application of heat through Agnikarma is believed to enhance blood circulation, reduce inflammation, and promote the elimination of toxins from the body. Dr. R.B. Gogate's research on Agnikarma in the treatment of Kamala opens up new possibilities for integrating this ancient technique into modern medical practices. While further research and clinical trials are necessary to validate its efficacy, holds promise as a complementary therapy for various liver-related conditions. Its non-invasive nature, minimal side effects, and potential to enhance liver function make it an attractive option for patients seeking alternative treatments.

References

1. Nesari M, Baghel MS, Thakar A, Khandel SK, Godatwar P, Mangalasseri P. Ayurvedic Standard Treatment Guidelines (ASTG). New Delhi: Ministry of AYUSH Government of India, Institute for Postgraduate Teaching & Research in Ayurveda, Jamnagar and National Institute of Ayurveda, Jaipur; 2017. p.69.

2. Acharya YT. Commentary Ayurveda Deepika of Chakrapani datta on Charakh Samhita by Agnivesa, revised by Charaka and Dridhabala. 1st ed. New Delhi: Chaukhambha Publications; 2020. Sutra sthana, Vidhishonita Adhyaya: chapter 28, verse 12. p.528.

3. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha orientalia; 2021. Uttar Tantra: Pandu Roga Pratishedh Adhyaya, Chapter 44, verse 6. p.729.


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4. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha orientalia; 2021. Uttar Tantra: Pandu Roga Pratishedh Adhyaya, Chapter 44, verse 10. p.729.

5. Acharya YT. Commentary Ayurveda Deepika of Chakrapani datta on Charakh Samhita by Agnivesa, revised by Charaka and Dridhabala. 1st ed. New Delhi: Chaukhambha Publications; 2020. Chikitsa sthana, Pandu Roga Chikitsitam: chapter 16, verse 34. p.528.

6. Acharya YT. Commentary Ayurveda Deepika of Chakrapani datta on Charakh Samhita by Agnivesa, revised by Charaka and Dridhabala. 1st ed. New Delhi: Chaukhambha Publications; 2020. Chikitsa sthana, Pandu Roga Chikitsitam: chapter 16, verse 36-38. p.528.

7. Pandey KA. Kayachikitsa vol. 2 (Hindi). 1st ed. New Delhi: Chaukhambha publication; 2023. p.305.

8. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha orientalia; 2021. Uttar Tantra: Pandu Roga Pratishedh Adhyaya, Chapter 44, verse 5. p.729.

9. Acharya YT. Commentary Ayurveda Deepika of Chakrapani datta on Charakh Samhita by Agnivesa, revised by Charaka and Dridhabala. 1st ed. New Delhi: Chaukhambha Publications; 2020. Chikitsa sthana, Pandu Roga Chikitsitam: chapter 16, verse 34-38. p.528.

10. Acharya YT. Commentary Ayurveda Deepika of Chakrapani datta on Charakh Samhita by Agnivesa, revised by Charaka and Dridhabala. 1st ed. New Delhi: Chaukhambha Publications; 2020. Chikitsa sthana, Pandu roga chikitsitam: chapter 16, verse 36. p.528.

11. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha Orientalia; 2021. Uttar Tantra: Pandu Roga Pratishedh Adhyaya, Chapter 44, verse 6. p.729.

12. Pandey KA. Kayachikitsa vol. 2 (Hindi). 1st ed. New Delhi: Chaukhambha publication; 2023. p.305.

13. Kumar M. A Literary Review of Kamala with Special reference to Jaundice. International Research Journal of Ayurveda & Yoga. 2022;5(9):185–189. doi:10.47223/IRJAY.2022.5932.

14. Fauci SA, Braunwald

E, Kasper LD, et al. Harrison's Principles of International Medicine. 17th ed. Vol 1. New York: McGraw Hill Medical; 2008. p.261.

15. Available from: https://pubmed.ncbi.nlm.nih.gov/9447780/#:~:text=A%20total%20of%20192%20cases,feco%2Doral%20mode%20of%20transmission.

16. Golwalla FA, Golwalla AS, Naskar YM. Golwalla's Medicine for Students. 25th ed. New Delhi: JAYPEE The Health Sciences Publishers; 2017. p.72.

17. Fauci SA, Braunwald E, Kasper LD, et al. Harrison's Principles of International Medicine. 17th ed. Vol 1. New York: McGraw Hill Medical; 2008. p.261.

18. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha orientalia; 2021. Sutra Sthana: Agnikarmavidhi adhyayam, Chapter 12, verse 3. p.51.

19. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha orientalia; 2021. Sutra Sthana: Agnikarmavidhi adhyayam, Chapter 12, verse 4. p.51.

20. Acharya YT. Sushruta Samhita of Sushruta. 1st ed. Varanasi: Chaukhambha orientalia; 2021. Sutra Sthana: Agnikarmavidhi adhyayam, Chapter 12, verse 11. p.51.

21. Gogate RB. Viddha and Agnikarma chikitsa (Hindi). 1st ed. Mumbai: Atharva Prakashan; 2015. p.44.


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