detailed description of Agnikarma indication, method, contraindication etc.

2. Introduction of Agnikarma &
Ayurvedic management of Burn
Dr. ALOK KUMAR VERMA
Ph.D SHALYATANTRA.
LECTURER DEPARTMENT OF SHALYA TANATRA
NEIAH, SHILLONG

3. अग्निकर्म Agnikarma
The procedure performed by using
the Agni (HEAT) to cure the various
disorders is known as Agnikarma.
The therapeutic use of agni is
described as Agnikarma. In Sushrut
samhita sutra sthan chapter .12
Acharya Sushrut included this in the
Anushastra i.e. parasurgical
procedures.
Agnikarma could be correlated to
thermal cauterization.

4. Why Agnikarma ???
तद्दग्धानाां रोगाणामपुनर्ाावाद्र्ेषजशस्त्रक्षारैराा्याानाां
तत्ाा्यात्वाच्च
su.su. 12/3
The disease treated with proper agnikarma has no chance of recurrence. It
cures the disease which are not treatable with medicine, surgery and
kshar karma (chemical cauterization).

5. Types of agnikarma
Acharya sushrut described agnikarma of four types
 1. Tvacha (Skin)
 2. Mansa (Muscles)
 3. Sira , Snayu ( vessels and ligaments, tendons)
 4. Sandhi and Asthi ( joints and bones)
But some other says only tvacha and mansa

6. Types of Agnikarma
According to pattern of Agnikarma
1. Valaya (circular )
2. Bindu (pointed) .
3. Bilekha (straight )
4. Pratisaran (rubbing)
 Some Acharya added some more shape like swastika , astapad etc.
 The classification was done on the basis of shape of tip of shalaka as
well as method of performing Agnikarma.

7. Instruments/ upkaran used in
Agnikarma
 पपप्पल्याजाशकृ द्गोदन्तशरशलाकास्त्त्ग्गतानाां
i.e. for vat kaphaj skin disorders. (su.su. 12/4)

8.  जाम्बवौष्ठेतरलौहा, माांागतानाां i.e. for vat kaphaj muscular
disorders. (su.su. 12/4)

9.  क्षौद्रगुडस्त्नेहााः सारास्त्नायाुान््यास्स्त्िगतानाम ् (su.su. 12/4)
i.e. For vat kaphaj disorders of vessels, ligaments, joints and bones.

10. Panch dhatu shalaka
Components of Panchadhatu
Shalaka
Tamra (copper) → 40%
Loha (iron) → 30%
Yashada (zinc) → 10%
Rajata (silver) → 10%
Vanga (tin) → 10%
Acharya Sushrut described these various measures of
Agnikarma for the purpose of heat regulatios

11. Indication of Agnikarma
त्वङमाांासारास्त्नायाुान््यास्स्त्िस्स्त्ितेऽत्याुग्ररुस्ज वायाावुस्च्ितकठठनाुप्तमाांाव्रणे
ग्रन््याशोऽबुादर्गन्दरापचीश्लीपदचमाकीलततलकालकान्रवृद्धधास्न्धसाराच्छेदनाठदषु
नाडीशोणणताततप्रवृपिषु चास्ग्नकमा क
ु यााात् (su.su. 12/10)
The pain aggravated by vata in tvacha , mans, sira, snayu, sandhi and asthi .
Chronic wound having some hard elevated tissue. Cystic lesion, hemorrhoids,
tumor, fistula, sinus lymphadenopathy, filarial, skin tag, hernia, joints disorders,
to stop bleeding from cut vessels.

12. Contraindications
 तरास्ग्नकमा ावातुाषु क
ु यााादन्यार शरद्ग्रीष्माभयााां;
तराप्याात्यातयाक
े ऽस्ग्नकमााा्याे व्यााधौ तत्प्रत्यानीक
ां पवधधां कृ त्वा (su.su. 12/5)
 अिेमानस्ग्नना पररहरेत ्- पपिप्रकृ ततमन्ताःशोणणतां सर्न्नकोष्ठमनुद्धृतशल्याां
दुबालां बालां वृद्धां र्ीरुमनेकव्रणपीडडतमस्त्वेद्यााांश्चेतत (su.su. 12/14)
 All types of pittaj and raktaj disorders, patients with concealed bleeding,
intestinal perforation, retain foreign body, weak, children , old age person,
and patients with multiple wounds and who are not fit for swedana arma .

13. Samyak dagdha lakshana
(Features of perfect Agnikarma )
 शब्दप्रादुर्ाावो दुगान्धता त्वक्ाङकोचश्च : त्वग्दग्धे
 कपोतवणाताऽल्पश्वयािुवेदना शुष्काङक
ु धचतव्रणता च :
:माांादग्धे
 कृ ष्णोन्नतव्रणता स्रावास्न्नरोधश्च : सारास्त्नायाुदग्धे
 रूक्षारुणता कक
ा शस्स्त्िरव्रणता च : ान््यास्स्त्िदग्धे
(su.su. 12/8)

14. Pre / post procedure care
रोगस्त्या ाांस्त्िानमवेक्ष्या ाम्याङनरस्त्या ममााणण बलाबलां च
व्यााधधां तितुुं च ामीक्ष्या ाम्याक् ततोऽव्यावस्त्याेद्सर्षगस्ग्नकमा
(su.su. 12/12)
 The careful examination of patients as well as disease is must prior to the
Agnikarma procedure.
 तर ाम्याग्दग्धे मधुापपाभयााामभयाङगाः| (su.su. 12/13)
 The madhu (honey) and ghrita (Ghee) should be applied after the agnikarma
procedure.

15. Procedure of Agnikarma
 After complete examination of patient and taken written consent ,
first identify the site of agnikarma.
 Injection T.T. 0.5 ml IM should be given as prophylaxis.
 Patients should be taken in proper position, must be in ease.
 After marking site, Clean the area with triphla kwath .
 Take the red hot shalaka and touch the shalaka on identified marks
for few seconds and withdraw it followed by immediate application
of ghritkumari swaras ( aloe vera pulp).
 Apply bandage after application of madhu + grita or pouring of
haridra powder with triphla churna.
 Patient should be advised to avoid wet that area up-to 24 hrr.

16. इतरथा / प्रमाद दग्ध
Etartha / pramad dagdha
 इतरिा दग्धसमतत प्रकारान्तरेण वैद्याादृते (su.su. 12/15)
 प्रमादाद्दग्धम्| तरेत्यााठद द्रव्याां स्स्त्नग्धां ापपाराठद, रूक्षां द्रव्याां
काष्ठपाषाणलोष्टाठद ( Dalhan comm.)
 When person got burn accidently that is different from the
Agnikarma described earlier is called etartha or pramad dagdha i.e.
burn injury.
 It is of two types
 Wet and dry.
 Acharya stated that wet burn is more painful than dry because in
wet burn latent heat penetrates deeper & damages the tissues of
body.

17. Types of Agnidagdha (burn injury)
 तर प्लुष्टां दुदाग्धां ाम्याग्द ग्धमततदग्धां चेतत चतुपवाधमस्ग्नदग्धम ् |
(su.su.12/16)
प्लुष्ट
दुदाग्ध
अततदग्ध

18. प्लुष्ट दग्ध
 तर याद्पववणुं प्लुष्यातेऽततमारां
तत् प्लुष्टां (su.su.12/16)
 The affected part become
different in color from skin
along with very severe
burning sensation.
 Condition almost similar to
first degree burn.

19. दुददग्ध
 यारोपिष्ठस्न्त स्त्फोटास्त्तीव्राश्चोषदाहरागपाकवेदनास्श्चराच्चोपशाम्यास्न्त
तद्दुदाग्धां; (su.su.12/16)
 The burn injury having blisters, severe burning sensation, redness,
suppuration and pain remains for very long time, condition almost similar
to advance II and III degree burn.

20. सम्यक दग्ध
ाम्याग्दग्धमनवगाढां तालवणुं ाुाांस्स्त्ितां
पूवालक्षणयाुक्तां च
(su.su.12/16)
The burn injury which is not too deep neither
very superficial , having color like Asian palm
fruit (taal phal varna), tissues remains on their
own site and having other sign symptoms
described earlier.
This is not considered as injury when performed
for the therapeutic purpose. If the above sign
and symptoms occurs that indicate the perfect
Agnikarma.

21. अततदग्ध
 अततदग्धे माांाावलम्बनां गारपवश्लेषाः
सारास्त्नायाुान््यास्स्त्िव्याापादनमततमारां
ज्वरदाहपपपााामूच्छााश्चोपद्रवा र्वस्न्त,व्रणश्चास्त्या
धचरेण रोहतत, रूढश्च पववणो र्वतत |
(su.su.12/16)
 The injury affecting the whole tissue as skin
subcutaneous tissue, muscles , vessels , tendons,
ligaments and exposing to other deeper structure.
 The patients having high grade fever, burning
pain, increase thirst, syncope and other features of
dehydration.
 The wound healing delayed with discoloration of
particular part.
 The condition is almost similar to advanced 3rd
degree burn .

22. Management of Agnidagdha
(BURN)
 प्लुष्ट दग्ध तितकत्सा
“प्लुष्टस्त्याास्ग्नप्रतपनां कायाामुष्णां तिौषधम ् | (su.su.12/19)
शरीरे स्स्त्वन्नर्ूतयाष्ठे स्स्त्वन्नां र्वतत शोणणतम्
प्रकृ त्याा ह्याुदक
ां शीतां स्त्कन्दयात्याततशोणणतम ् | (su.su.12/20)
तस्त्मात ् ाुखयातत ह्याुष्णां न तु शीतां किञ्चन” (su.su.12/21)
Acharya Sushrut mentioned warm medicine for the local application as well as
internal medication.

23. Why warm ???...

24. Superficial burn
Injury causes water loss from that area
Blood concentration increases
Application of Cold
Coagulation of blood in vessels
Reduced blood supply of that area
Delayed healing
May leading to Necrosis

25. दुददग्ध तितकत्सा
 शीतामुष्णाां च दुदाग्धे क्रियााां क
ु याााद्सर्षक् पुनाः |
घृतालेपनाेकाांस्त्तु शीतानेवास्त्या कारयाेत्||
(su.su.12/22)
Acharya Sushrut mentioned both warm and cold medication for this
type of burn injury.
Acharya Dalhan commented on this explaining that for the deep burn
internal medicine with cold active principle should be used and if burn
injury is superficial then medicine with the warm active principle
should be used.
But for the external application only cold application should be used.

26. Burn injury ( Durdagdha )
Internal medication external medication
Deep - cold cold application
Superficial - warm cold application

27. सम्यक दग्ध तितकत्सा
 ाम्याग्दग्धे तुगाक्षीरीप्लक्षचन्दनगैररक
ै ाः |
ाामृतैाः ापपाषा स्स्त्नग्धैरालेपां कारयाेद्सर्षक्
 ग्राम्याानूपौदक
ै श्चैनां पपष्टैमाुंाैाः प्रलेपयाेत् |
पपिपवद्रधधवच्चैनां ान्ततोष्माणमाचरेत्| (Su.Su. 12/23-24)
As per Acharya Sushrut above said medicines should be used in
post agnikarma procedure for local as well as internal
medication.
Acharya Sushruta added that if person dosen’t get relief from
above medicine that surgeon should follow the line of
treatment like abscess.
Acharya Sushrut stated lot of medicine for the treatment of
abscess , in which most of them are having pittashamak
property.

28.  Paste of तुगाक्षीरी ( Tugakshiri ), प्लक्ष Plaksha, Chandan, amrita
& Gairik with Gritha can be used as ointment for local application.
 Paste of flesh of some animals like horse, pig etc may also be used
as lepa /ointment for local application.
 If there is continuous burning sensation then line of treatment
should be same as Pittaj Vridhadhi .
 In treatment of pittaj vidradhi Acharya sushrut mention piitashamak
medicine for internal as well as local application , incision and
drainage on suppuration, leave it for healing with secondary
intension.
 Karanjadi ghrita for enhanching wound healing.
 Madhuchisth ghrita prepared by processing of wax (र्ोर्,) in ghrit
with mulethi(र्ुलेठी), lodhra (लोध्र), raal (राल ), sarjras (सर्मरस) manjistha
(र्ंग्र्ष्ठा), rakta chandana (रक्त चन्दि ) and murva (र्ुर्ाम).

29. Name of the drugs
Name of drugs Botanical name
 तुगाक्षीरी tugakshiri (Curcuma angustifolia).
 प्लक्ष Plaksha (Ficus religiosa)
 चन्दि, chandan (santalum album)
 गैररक Gairik Fe2O3, (ferric oxide)
 अर्ृता Amrita (tenospora cardiofolia)
 र्ुलेठी mulethi (glycyrrhiza glabra)
 लोध्र lodhra (symplocos racemosa)
 राल raal (shorea robusta )
 सर्मरस sarjras
 र्ंग्र्ष्ठा manjistha (Rubia cordifolia)
 रक्त चन्दि rakta chandana (sntalum album)
 र्ुर्ाम murva (Chonemorpha macrophylla)

30. अततदग्ध तितकत्सा
अततदग्धे पवशीणाातन माांाान्याुद्धृत्या शीतलाम ् | क्रियााां क
ु याााद्सर्षक्पश्चाच्छासलतण्डुलकण्डनैाः|
ततन्दुकीत्वक्कपालैवाा घृतसमश्ैाः प्रलेपयाेत ् | व्रणां गुडूचीपरैवाा छादयाेदिवौदक
ै ाः |
क्रियााां च तनणखलाां क
ु याााद्सर्षक् पपिपवापावत ्
(Su.Su. 12/25)
As per acharya Sushrut atidadagdha is similar to advanced third / fourth degree
burn , management included surgical removal of dead tissue followed by
medical treatment by above mentioned drugs as local application. Acharya
sushrat indicated to avoid bandages on affected part , the area should be
covered with wet guduchi, kamal patra etc. the rest of treatment should be
same as pittaj visarp ( erysipelas) .
 Gauryadi ghrita for local application.

31. Line of treatment
Remove the dead/ burn tissue surgically
Local application of drugs mentioned in text
Covering the area with wet leaves of guduchi & lotus
Treatment
of Visarp (erysipelas )
Medical treatment to improve healing and prevent
complication

32.  Beside these dagdha condition acharya sushrut aslo
mentioned some other heat injuries as dhomoghat (
person traped in fire/ asphyxia due to smoke) and ushna
vat (heat stroke) .
 Treatment of dhomaghat includes vaman, kaval-grah,
siro-virechana followed by laghu and snigdha diet.

33. Current Practice of Agnikarma
 Now days the
agnikarma
shalaka got the
modification as
the heat source
is electricity.
 This shalaka
have different
shape of probes
for the specific
use.

34. shalaka
Shalaka with probe probes

35. Current Practice of Agnikarma
Now days there is list of common ailments where Agnikarma is very much
effective
 Sciatica pain
 Mechanical back pain
 Peri-arthritis shoulder joint
 Frozen shoulder
 Osteoarthritis knee joint in early stage
 Cervical pain
 Tennis elbow
 Plantar fasciitis
 Planter Corn
 Viral warts

36. Sciatica pain

37. Peri-arthritis
shoulder joint

38. Mech. Back pain

39. Early OA of knee joint

40. Plantar fasciitis /
painful heal

41. Cervical pain

42. Tennis elbow

43. viral wart

44. plantar corn

47. Common problems with therapy
1. Patient’s consent.
2. Scar formation.
3. Recurrence
4. Needs skill to perform
5. Burn injury

48. Mode of Action of Agnikarma
वातादृते नास्स्त्त रुजा न पाकाःपपिादृते नास्स्त्त कफाच्च पूयााः | (su.su. 17/12)
 The diseases in which Agnikarma is indicated are due to vitiation of
vata and kapha, so Agnikarma is considered as better therapy to
pacify these dohas. Due to Ushan, Sukshma, thekshna and Ashukari
guna of Agni , it pacifies vitiated vata and kapha dosha.
 As per Acharya Sushrut basically anginkarm is used in two manner
i.e. one for रोग उन्मूलन (diseases cure) and other for pain
management.
 First for the diseases cure we used is it in the assistance with surgery
and for pain control we use it independently.

49. Mode of Action of Agnikarma
Application of Agni ( heat)
Raised Local temperature
Dilatation of local blood vessels
Increased tissue perfusion
Clearance of accumulated metabolic waste
Resolve inflammation
Reduces pain

50. Mode of Action of Agnikarma
Application of Agni ( heat)
Raised Local temperature
Dilatation of local blood vessels
Efficient tissue perfusion
Prompt Clearance of local inflammatory mediators
Resolve inflammation
Reduces pain

51. Application of Agni ( heat)
Increased local temperature
Raised local BMR
Enhances perfusion
Efficient delivery of oxygen
Ischemia and degeneration related Tissue injury healed due
to better blood perfusion
Mode of Action of Agnikarma

52. Application of heat
Stimulation of DPI (Descending pain inhibiting
mechanism)
Stimulation of CNS
Release of endogenous opioids in Pro-
opiomelanocortin (POMC) cells in the arcuate nucleus & in
the brainstem( eg. Endomorphins, dynorphins etc)
Reduces pain
Mode of Action of Agnikarma

53. Gate control theory of pain
The gate control theory of pain asserts that non-painful input closes the
"gates" to painful input, which prevents pain sensation from traveling to
the central nervous system. Therefore, stimulation by non-noxious input is
able to suppress pain.

54. Some Classical references of Agnikarma in
Ayurveda
1. त्वऽ.माांासारास्त्नायाुाां्यास्स्त्िस्स्त्ितेऽत्याुग्ररुजे वायाु |
(Sushruta samhita – sutrasthana – chapter 12, verse 10)
2. तद्दग्धानाां रोगानामपुनर्ावात ् र्ेषजशस्त्रक्षारैराा्याानाां तत्ाा्यात्वात च |
(Sushruta samhita – sutrasthana – chapter 12, verse 3)
3. स्त्नेहोपनाहास्ग्नकमाबन्धनोन्मदानातन च |
स्त्नायाुान््यास्स्त्िप्राप्ते क
ु यााात ् वायाावतस्न्द्रताः ||
(Sushruta samhita – chikitsasthana – chapter 4, verse 8)
4. अस्ग्नाः क्षारादपप श्ेष्ठस्त्तदग्धानामाांर्वात ् |
र्ेषजशस्त्रक्षारैश्च न साद्धानाां प्रााधनात ् ||
(Ashtanga hridaya – sutrashana – chapter 30, verse 40)
5. त्वधच माांा सारास्त्नायाुाां्यास्स्त्िषु ा याुज्याते |
(Ashtanga hridaya – sutrasthana – chapter 30, verse 41)

55. 6. स्त्नायाुास्न्धसाराप्राप्ते स्त्नेहदाहोपनाहनम ् |
(Ashtanga hridaya – chikitsasthana – chapter 21, verse 22)
7. स्त्नेहोपनाहास्ग्नकमाबन्धनोन्मदानातन च |
ि
ु द्धे स्त्नायाुगते वाते कारयाेत् क
ु शलो सर्षक् ||
(Bhavaprakasha – vatavyadhi chikitsa – verse 257)
8. क
ु यााात् ास्न्धगते वाते दाहोपनाहनम् |
(Bhavaprakasha – vatavyadhi chikitsa – verse 259)
9. स्त्नेहोपनाहस्ग्नकमाबन्धनोन्मदानातन च |
स्त्नायाुास्न्धसाराप्राप्ते क
ु यााात् वाते पवचक्षणाः ||
(Chakradatta – vatavyadhi chikitsa – verse 9)

56. References of Agnikarma in
Sushrut samhita
 Sutra sthan. Chapter 12
 Chikitsa sthan 1 in 60 upakrama of vrana chiktsaa.
 Chikitsa sthan 6 arsha chikista
 Chikitsa sthan 8 bhagandar Chikitsa
 Chikitsa sthan 14 plihodar Chikitsa
 Chikitsa sthan 18 grinthi Chikitsa
 Chikitsa sthan 18 apchi (Lymphadenopathy Chikitsa ( at 12 angul proximal to ankle joint
on posterior side)
 Chikitsa sthan 18 arbud (tumour) Chikitsa
 Chikitsa sthan 18 galgand (neck swelling) Chikitsa
 Chikitsa sthan 19 antra vridhi rog (Inguinal hernia) at great toe of opposite side.
 Chikitsa sthan 19 slipad ( filariasis)
 Chikitsa sthan 20 kadar ( corn), mashak,tilkalak ( mole),

57. धन्यर्ाद
Thank you
Khublei shibun