E-ISSN:2456-3110

Review Article

Pain Management

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

Role of Agnikarma in Pain Management

Kahi A1*
DOI:10.21760/jaims.9.4.37

1* Ashima Kahi, Undergraduate Student Scholar, Jammu Institute of Ayurveda and Research, Jammu, India.

Pain is a bad feeling that makes a person visit a doctor because it prevents them from doing their daily tasks. When Sandhigata Vata affects movable joints of the body, like the knee joint (Janusandhi), the condition becomes more excruciating. Due to its frequent involvement in daily routine work, its status as a weight-bearing joint, and its tendency to develop in overweight patients, the disease Sandhigata Vata is more likely to affect the knee joint. Vata Dosha is predominant in the pathophysiology of Sandhigata Vata, exhibiting symptoms like Vedana (pain during joint movement) and Shopha (swelling). The joint stiffness and crepitus (specific sound during joint movement) are symptoms that may be co-related in modern parlance with osteoarthritis (OA) of the knee joint in this article details description given about Agnikarma.

Keywords: Ayurved, Pain, Vata, Agnikarma

Corresponding Author How to Cite this Article To Browse
Ashima Kahi, Undergraduate Student Scholar, , Jammu Institute of Ayurveda and Research, , Jammu, India.
Email: 		Kahi A, Role of Agnikarma in Pain Management. J Ayu Int Med Sci. 2024;9(4):231-235.
Available From
https://jaims.in/jaims/article/view/3274

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-16 2024-02-26 2024-03-05 2024-03-15 2024-03-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 20.23

© 2024by Kahi Aand 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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Ashima Kahi. Role of Agnikarma in Pain Management

Introduction

According to the International Association for the Study of Pain, pain is defined as an unpleasant emotional and sensory experience that is linked to or implies actual or potential tissue damage. Pain can be interpreted as a sign of an underlying illness or as a side effect of another illness. Pain is described by Sushruta Samhita as a distinct entity known as Shool.[1] One of the eight branches of Ayurveda is Shalya Tantra or surgery.[2] Various approaches to managing a disease have been mentioned by Acharya Sushruta. Examples are Bheshaja Karma (drugs), Kshara Karma (caustic therapy), Agni Karma (thermal cautery), and Shastra Karma (operations).[3] Agnikarma, also known as thermal therapy, is the use of various materials to apply Agni both directly and indirectly to treat a patient's illness. Thermotherapy practitioner Sushruta Agnikarma is categorized as "Agni Krita Karma" because of the Karma or action.[4,5]

Classification of Agnikarma

1. According to Dravya

a) Snigdha Agnikarma: Madhu, Ghrita, Taila are used for Sira, Snayu, Sandhi, Asthi type of Agnikarma.

b) Ruksha Agnikarma: Pippali, Shalaka, Godanta are used for Twak and Mamsa Dagdha.

2. According to Site: a) Sthanika (local): Kadara, Arsha, Vicharchika b) Sthanantariya (systemic): Apachi, Gridhrasi

3. According to Disease a) In the disease like Arsha, Kadara it should be done after surgical excision (Chhedan). b) In the disease like fistula, sinus etc. it should be done after surgical incision (Bhedana). c) In the disease like Krimidanta, it should be done after filling by the Guda.

4. According to Akriti as described earlier in Dahana Vishesha. Itratha Dagdha according to Sushruta, all Dagdha are included under four types of Dagdha Vrana.

a. Plushtha Dagdha - Plushtha is that which has pigmented area on the skin has associated with severe burning sensation.

b. Durdagdha - Durdagdha is that in which Sphota (blebs, vesicles) appear, accompanied with severe

pain such as sucking, burning, redness, Paka (exudation or ulceration) and pain, these subsiding after a long time.

c. Samyaka Dagdha - There are Samanya Lakshana (common symptoms) produced in any type of Dhatu (tissue) and special symptoms are only related to the Dhatu

d. Ati Dagdha - (Deep burn) Mamsa-Avalambana (Hanging of burnt tissue), Gatra-Vishlesha (Parts become loose and useless), Destruction of Sira, Snayu, Sandhi (tendons in joints), Jwara (Fever), Daha (Burning), Pipasa (Thirst), Murchha (Unconsciousness), Wound heals after a long time and healed ulcers have discoloration.

Samanya Lakshana

Samyaka Dagdha Vrana - Ana-Awagadha Vranata (Wound which is not deep), Talphala Varnata (Fruit of Tala tree-blue-black in color), Susamshita Vrana (Without elevation or depression).

Samyaka Dagdha Vrana of Twak - Shabdapradurbhao (Production of sound), Durgandhata (Bed odor), Twak Sankocha (Contraction of the skin).

Samyaka Dagdha Vrana of Mamsa Dhatu - Kapotvarnata (Color like that of pigeon i.e., ashy, dark grey), Alpa Swayathu (Mild swelling), Alpa Vedana (Less pain), Shuska Sankuchit Vranata (Dry, contracted wound).

Samyaka Dagdha Vrana of Sira, Snayu - Krishna Vranata (Black coloration), Unnata Vranata (Elevated), Srava - Sannirodha (Stoppage of discharge).

Samyaka Dagdha Vrana of Sandhi - Asthi Rukshata (Dryness), Arunata (Dark red coloration), Karkashata (Roughness), Sthirata (Stability).

Suitable time for Agnikarma

Agnikarma can be done in all seasons, except Sharad (autumn) and Grishma (Summer); because, in Sharad there is a Prakopa of Pitta and Agnikarma also aggravates.

Indication of Agnikarma

Vatakanṭaka, Shiroroga, Ardhavabhedaka, Vratma Roga, Pakshmakopa, Shlista Vratma, Vishavratma, Alaji, Arbuda, Puyalasa, Abhiṣyanda, Adhimantha, Lagana Medoj Oshtha Roga, Danta Nadi,


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Krimidanta, Adhidanta, Shitadanta, Dantavruddhi, Jalarbuda, Arsha, Nasa Arsha Karnarsha, Lingarsha, Yoniarsha, Bhagandara, Nadivrana, Upadvansha, Gulma, Vilambika, Sanyasa, Unmada, Yakruta & Plihodara, Shonita Atipravrutti, Shira Sandhi Cheda, Visarpa.

Contraindications of Agnikarma

Pitta Prakruti, Bhinna Kostha, Daurbalya, Vruddha, Antah Shonita, Anuddhrata Shalya, Bala, Bhiru, suffering from - Pandu, Atisara, Kshaya, Guda Bhrumsha, Udararoga, Nasa Sanga, Chhardi, Shoshita, who has taken alcohol, Oja Kshaya, Vigagdha, Rakta Pitta, Sthula, Ajirna, Kroddha, Trushna, Adhya Rogi, Garbhini Prameha, Ruksha, Daurbalya, Visha, Kshudha, Timira, Kshata, According to Charaka, Agnikarma should not be done in the Vrana of Snayu, Marma, Netra, Kushtha and Vrana with Visha and Shalya.

Agnikarma Vidhi (Procedure)

Purvakarma - The Agnikarma room should be well prepared with all required Agropaharaniyani described by Acharya Sushruta. Prepare Triphala Kashaya for Prakshalana of the local part of patient. Yashtimadhu Churna, small pieces of Kumari Patra, swab holding forceps, Plota (gauze piece), Pichu (cotton), and gas stove, Shalakas etc. are kept ready for use. The Shalaka is heated upto becomes red hot on fire.

Pradhana Karma - Aasana for Agnikarma: In Sandhigata Vata, it is easy to do Agnikarma in prone position as it is good and comfortable to the patient. After carefully considering the symptoms of the disease, vitals and the strength of the patient as well as disease and seasons, physician should undertake the patient for Agnikarma. On the diseased skin of the patient, the Samyak Dagdha Vrana should be produced by red hot Shalaka. The number of the Samyak Dagdha Vrana should be 15 - 30 or according to the extent of the diseased area. Apply immediate cooling agents: After making Samyak Dagdha Vrana apply cooling agent immediately to subside burning pain.

Inspection of defective Agnikarma and management

1) Plushtha Dagdha - If the Shalaka is not properly heated then it will produce this type of Dagdha. Management for Plushtha Dagdha (burns of the first degree), warming of the body (increasing

the body temperature) and administration of drugs / medicines of hot properties should be given; when the temperature of the body becomes increased, the blood becomes liquefied; water by nature is cold in potency and hence makes the blood thick to coagulate, so that, only heat gives comfort.

2) Durdagdha - When the physicians are unskilled hand or patient is shaking his body parts due to fear of burn then Durdagdha can occur. Management In Durgagdha (burns of the second degree) the physician should resort to both warm and cold therapies, application of Ghee, poultices and bathing the body should be done in cold state only.

3) Ati-Dagdha (burn of the fourth degree) - This complication is produced due to more heat which is transferred from the red hot Shalaka to the diseased part. In Ati Dagdha the torn (hanging loose) muscles should be removed followed by cold therapies, then the physician should apply the paste of rice, bark of Tinduki mixed with ghee or cover the wound with leaves of Guduchi or aquatic plant (like lotus etc.). All the treatments which are similar to that of Visarpa of Pitta origin should be done. Madhuchhisthadi Ghrita contains Madhuchhistha, Madhuka, Lodhra, Sarjarasa, Manjishtha, Chandana and Murva, should be macerated together and then cooked with Ghee, is best for healing of wound in all kinds of burns.

4) Daha (Burning pain) - More or less burning pain is experienced by each and every patient who uses to take Agnikarma Chikitsa. This may be treated by Ghrutakumari Patra Swarasa.

5) Dushtha Vranata (Sepsis of wound) - After Agnikarma, it should be observed for any complications. If there is any sign of sepsis, treat the patient accordingly.

Pashchat Karma

Pathya Apathya in Agnikarma procedure, it is necessary that it should be healed without any complications. So, all the Pathya-Apathyas which have been described by Acharya Sushruta are advised here. It is utmost advisable to the patient that “Do not allow water to touch the Samyak Dagdha Vrana site for one Ahoratra (24 hours)”. The complete Ropana (healing) of the Vrana should be observed. Agnikarma Chikitsa can be repeated after 7 days.


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Agnikarma in Moden Era - In modern medicine era, there is no use of therapeutical burn i.e., Samyak Dagdha Vrana. But on the other hand, use of Agnikarma for other way around is used now days. There are procedures as mimic to Agnikarma are practiced in modern era. Electrocautery - It is a most useful instrument in surgical procedure which consists of platinum wire can be heated to red hot by using an electric current. Use of this electric cautery to cut the tissue or to coagulate the bleeding points, so this application of electro cautery is ideal for removing small skin tags, papilloma and also to control the bleeding during surgical procedures.

Discussion

Probable mode of action of Agnikarma

Agnikarma act on a multi-factorial level in the body and its importance lies in its action. Exact mechanism action of Agnikarma still remains unsolved. Some theories can be adopted to explain these mechanisms but their action varies according to the condition. According to Ayurveda it acts against Vata and Kapha Dosha by its Ushna (hot), Tikshna (penetrating), Sukshma (minute), Laghu (small), Vyavayi (quick acting), and Vikasi (quickly spreading) Guna and it breaks Srotoavarodha, produced due to Vata and Kapha, results in relieving pain and inflammation at that site.[6] The heat therapy, which is given at the local or affected area, increases the local blood circulation by vasodilatation, local metabolic process speedup, waste products get excreted, reduce edema, accelerate repair, and the which resulting in decreased intensity of pain.

Agnikarma may stimulates the sensory receptor lying in the muscle, by sending a message to the brain which stimulates the pituitary gland to release endorphin which in turn binds with opiate receptors in the pain cells to block the pain stimuli. Endorphin is a naturally occurring neuro peptide and like morphine and other opiates it has a marked propensity for binding on to the “opiate receptors” of the pain cell in the brain.[7] The pain receptors in the skin and other tissues are all having free nerve endings, due to hot Shalaka there is destruction of the free nerve endings and it causes, closing the “gate” and prevent the sensory transmission of pain.[8] By applying Ushna (hot), Sukshma (penetrating), Ashukari (rapid acting) properties of

Agni through Agnikarma to Asthi Sandhi (bony joints) by approaching Twak Dhatu (skin), it produces direct impact on localized Dhatvagni (secondary level metabolism) and Bhutagni (tertiary level metabolism).[9]

By hot nature, Agni is supposed to remove obstruction in Dosha pathways which may have occurred due to Avarana of Vikrita Kapha over Vyana Vayu and improves the circulation of Rasa and Rakta (blood circulation) to the localized pathology. By establishing proper nourishment to lumbar joints, it resumes proper lumbar joint function. In Dhatukshaya (tissue degeneration), it removes degenerated and necrosis tissues aggregated in lumbar joints. Osteophytes of lumbar joint are pseudo projections of bones due to irregular osteoclastic and osteoblastic activity. Agnikarma is supposed to weaken these structures (osteophytes) and provide relief in pain by reducing nerve compression. By elimination of accumulated tissue wastes, it may be removing extra calcium depositions of osteophytes, fibrous tissue in Asthi Sandhi (bony joints) through venous and lymphatic drainage. Establishment of Agni in particular Sandhi (joint) improves normal joint function and reduces further Dhatukshaya (degenerative changes). Thus, it provides permanent relief from painful joints and reduces recurrence of pain episodes.

Conclusion

This review concludes that the Agnikarma procedure can be performed tonally, utilizing different materials and temperatures depending on the type of painful condition, with the goal of primarily relieving pain right away. It is a powerful and less invasive para-surgical technique. The majority of research is done on musculoskeletal conditions, such as cervical spondylosis, osteoarthritis of the knee joint, plantar fasciitis, calcaneal spur, sciatica, tennis elbow, frozen shoulder, etc. This review concludes that almost all studies have found Agnikarma, along with various types of Shalakas, to be significantly effective in pain management for musculoskeletal disorders. It can be used in conjunction with additional oral supportive medications. For the patient experiencing no or few complications, it is easy to use, economical, efficient, and convenient.


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1. Kaviraj Dr. Ambika-Dutt-Shastri Sushruta Samhita Hindi Commentary ‘Ayurveda- Tattva- Sandipika’ part-2 Chaukhambha Sankrit Sansthan 2017.P 346,42;813

2. Kaviraj Dr. Ambika-Dutt-Shastri Sushruta Samhita Hindi Commentary ‘Ayurveda-Tattva-Sandipika’ Part-1 Chaukhambha Sankrit Sansthan 2017.P 5,1;74.

3. Kaviraj Dr. Ambika-Dutt-Shastri SushrutaSamhita Hindi Commentary ‘Ayurveda-Tattva-Sandipika’ Part-1 Chaukhambha Sankrit Sansthan 2017. Chikitsa Sthan. P 46,6;3.5.

4. Kaviraj Dr. Ambika-Dutt-Shastri SushrutaSamhita Hindi Commentary ‘Ayurveda-Tattva-Sandipika’ Part-1 Chaukhambha Sankrit Sansthan 2017. Sutra Sthan. P 51

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6. Shekokar AV, Borkar KM. Role of Agnikarma in the management of chronic plantar fasciitis. IJAM, 2013; 4:421-5.

7. Vinodkumar K. Bhorale, & Dr. M. R. Hungundi. (2019). A Clinical Evaluation of Agnikarma in the management of Greeva Sandhigata Vata w.s.r. to Cervical Spondylosis.Journal of Ayurveda and Integrated Medical Sciences,4(04), 65-70. https://doi.org/10.21760/jaims.v4i04.646

8. Vinodkumar K. Bhorale, & Dr. M. R. Hungundi. (2019). A Clinical Evaluation of Agnikarma in the management of Greeva Sandhigata Vata w.s.r. to Cervical Spondylosis.Journal of Ayurveda and Integrated Medical Sciences,4(04), 65-70. https://doi.org/10.21760/jaims.v4i04.646

9. Vinodkumar K. Bhorale, & Dr. M. R. Hungundi. (2019). A Clinical Evaluation of Agnikarma in the management of Greeva Sandhigata Vata w.s.r. to Cervical Spondylosis.Journal of Ayurveda and Integrated Medical Sciences,4(04), 65-70. https://doi.org/10.21760/jaims.v4i04.646


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