Fundamentals of Agnikarma/Heat Therapy in Ayurveda

The two words Agni and Karma unite to form a unique term or procedure i.e., Agnikarma which means “the act / Karma which take place by nature of Agni to spread in upward direction”. When it is done with the help of various Dravya to transfer heat to different parts of the body or organs to produce Samyaka Dagdha Vrana is called Agnikarma, superior to other para-surgical procedures like Siravedha (Bloodletting), Jalokaavcharna (leech therapy), and Ksharkarma (caustic).

Agnikarma and Sushruta Samhita

Acharya Sushruta has given a great contribution to Ayurveda regarding Agnikarma Chikitsa. Nowadays this Agnikarma procedure is modified scientifically as electric cauterization which is used for various therapeutic purposes starting from minor surgical procedures to major surgical procedures.

In the context of the Shonitavarnaniya chapter in Sutrasthana four types of procedures (Sandhana, Skandana, Pachana, and, Dahana) have been mentioned to control the bleeding. Dahana is the last procedure for stoppage of bleeding when the other three procedures failed, Bloodless surgery evolved from this principle.

Classification of Agnikarma: –

1.According to Dhatu involved: Twak Dagdha &Mamsa Dagdha

2. According to Dravya used for Dahana:

  • Snigdha Dagdha– by Madhu, Ghrita, used in disorders of Sira, Snayu, Asthi, and Sandhi
  • Ruksha Dagdha -Loha, PippaliSara, Shalaka, etc. to manage the disorders which are treatable by Twak Dagdha and Mamsa Dagda.

The material used for Dahankarma

1. Materials useful for Twak Dagdha are:

  • Pippali (Piper longum)
  • Ajashakrut (fecal pellets of a goat)
  • Godanta (Moonstone)
  • Shara (arrow-like device)
  • Shalaka (rod of metal)
  • Suryakanta and Varti (mentioned by Vagbhata)

2. Materials useful for Mamsa Dagdha are: –

  • Jambaustha (device resembling like Jambu) and other metallic instruments
  • Madhu (honey)
  • Guda (jaggary)
  • Sneha (oil/ghee) (Vagbhata)
  • Materials useful for Sira, Snayu, Asthi, and Sandhi are: –
  • Madhu (honey)
  • Guda (jaggary)
  • Sneha(oil/ghee)
  • Jambaustha mentioned by Vagbhata

Dahana Shalaka:

  • Due to the quick transfer of heat in Tamra and Rajat Shalaka Atidagdha Vrana develops. Samyaka Dagdha Vrana is done by using Loha Shalaka as it becomes red hot and cools down soon afterward. But it is suggested that solitary metal Shalaka is not used as an ideal Shalaka. Ideally 20-30 Samyakdagdha Vrana is made once Shalaka is heated. So single metal Shalaka is not much liable to use.
  • Prof. P.D. Gupta’s innovative Panchadhatu Shalaka is considered ideal as 20-30 Samyaka Dagdha Vrana could be made satisfactorily after once heating and sustaining heat.

Dahana Vishesa:

Dahana Vishesa implies the type of shape produced in the skin after Agnikarma.

Acharya Sushruta has mentioned four types:

  • Valaya– Figure of a Circle or Round shape.
  • Bindu– Figure of dot shape
  • Vilekha– Figure of parallel line
  • Pratisarana– Figure after rubbing or scrapping nature.

Acharya Vagbhata has mentioned 3 more types of varieties in addition to the above four:

  • Ardhachandrakara– Semilunar shape
  • Swastika – four tailed mark
  • Astapada -eight-tailed mark

Characteristics of Samyaka Dagdha Vrana

According to Dhatu:

Twak Dhatu Dagdha –

  • Shabda Pradurbhava (Production of sound)
  • Durgandhata (Bad odor)
  • Twak Sankocha (Contraction of skin)

Mamsa Dhatu Dagdha –

  • Kapota Varnata (Color like a pigeon)
  • Alpa Shwayathu (Mild inflammation)
  • Alpa Vedana (Mild pain)
  • Shushka Sankuchita Vranata (Dry, contracted wound)

Sira, Snayu Dagdha –

  • Krishna Varnata (Black discoloration)
  • Unnata Vranata (Elevated)
  • Srava Sannirodha (Stoppage of discharge)

Asthi, Sandhi Dagdha –

  • Rukshata (Dryness)
  • Arunta (Dark red coloration)
  • Karkashata (Roughness)
  • Sthirata (Stability)

Principles of Agnikarma:

  • Agnikarma Yogya Kala– Any season except Summer (Greeshma) and autumn (Sharad) as it favors chances of Pitta Prokopa and complications but in emergency Paratyanika Vidhi (by adopting proper countermeasures) is adapted. Dalhana has advised covering the body or the site of Agnikarma with a moist cloth, use of cold foods and drinks, applying pastes that have a cooling effect, etc. as counter methods to pacify the effect of burning.
  • Diet before Agnikarma Chikitsa: – Sushruta mentioned that patients should Pichhila Ahara (rice and curd) before the procedure in all diseases or seasons except Ashmari, Bhagandara, Arsha, and Mukha Roga. Acharya Dalhana has specified the reason that Pichhila Ahara suppresses the Pitta Dosha under its Sheeta, Mridu, and Pichhila Virya.

Agnikarma Shreshthatav: (Superiority of Thermal Cautery)

  • Shreshthatav –Agni (fire) assumed as superior strata then Kshara (alkali) for burning Agnikarma eliminate reoccurance. And also untreatable diseases from application of medicines, sharp instruments and alkalis are also curable by Agnikarma.

क्षारादग्निर्गरीयान्क्रियासुव्याख्यातः, तद्दग्धानांरोगाणामपुनर्भावाद्भेषजशस्त्रक्षारैरसाध्यानांतत्साध्यत्वाच्च| (सु.सू– १२/१)

  • Nirjevanu Karan –Acharya Sushruta had mentioned that Agnitapta Shastras used for Chhedana to prevent sepsis in surgical procedure.

अग्नितप्तेनशस्त्रेणछिन्द्यान्मधुसमायुतम्|| (सु.चि.– २/४२)

  • Agnikarma is also useful after Shastra karma to avoid recurrence i.e., Kadara
  • Pradhanatwat – Considered superior than other Para surgical modalities
  • Vishishtopakram vat – Agni regarded Vishishta in Upkaram’s.
  • Sonitastnapantvat– Used to check bleeding as in Modern Surgery as Cautery.
  • Curative Property – Agnikarma eradicates diseases from its root.
  • Ashu Kriya Karanatvat – It has immediate action and emergency.
  • Sarva Tantra Samanyatvat -It brings the organ system to a state of homeostasis.

Best Para-Surgical Practices In Ayurveda

Para-Surgical Practices

Para-Surgical, however, is a broad term to describe the procedure or treatment modality that works as a surgical procedure but doesn’t use sharp or equipped instruments or medicine. In Ayurveda, there are multiple para-surgical procedures among which a major contribution is by  Sushruta Samhita is the basic source of origin, also to modern surgery. Sushruta described the para-surgical procedures and assigned a detailed separate chapter for them. The para-surgical process has gained a major boost in recent times due to its ease of practice and efficacy. These modalities are practicing for thousands of years and have a separate base in routine clinical practice. In Samhitas of Ayurveda, there is abundant literature available regarding the management of diseases with Para surgical modalities, this article shortly introduces some of them i.e. Agni karma, kshara karma, jalokaavacharan.

Superiority over surgical procedures

These procedures are somehow superior to surgical procedures as follows.

  • These are less invasive than an actual surgical procedure.
  • Doesn’t need hospitalization.
  •  Not as hectic as a surgical procedure
  •  Doesn’t interfere with the life process of an individual.
  •  day-care procedure.
  •  safe
  • cost-effective
  • doesn’t need specialized experts, equipment, and space.
  • usable in children, old age people, pregnant women, and co-morbid patients.

Agni karma/ Heat Therapy :

Agni karma is the most superior para-surgical modality in the context of action. It is a conventional method, in the Himalayan region as Tau Dam to treat diseases like the Liver, stomach, and the low back disc in regular practice. Agni karma is a superficial therapeutic burn, that used-hot hot metallic rods to treat mainly pain-related complaints. Sushruta stated numerous methods, the material according to the body parts and complaints. It is useful to eradicate the outgrowth on the body like warts, and hardened tissues like in corn. Also used to check to bleed. Cautery in modern surgical practice is another form of Agni karma that changed with time and technology.

Here are some of the materials listed from Sushruta according to the site

  • At skin – Goat Dung, Cows horn, long pepper, metallic rode
  • For muscle–metallic instruments
  • For Bone, joints, and vessels-honey, jaggery, and oil/ghee

Ksharakarama: Caustic application

The use of caustic chemicals prepared from the incarceration of selected herbal drugs and using that material in treating various diseases is called kshara karma. It is usable in various forms like powder kshara Jala( diluted with water), suppository, and medicated thread. It is widely gaining importance as it is superior to other para-surgical modalities in the context of properties. Kshar can act as a cauterizing agent, digestive element, scraping agent, and dressing material in selective wounds. Medicated thread i.e. Kshar sutra is broadly used in managing fistula-in-Ano because it reduces the chances of re-occurrence, it is enriched with the property of cutting and healing both. This provided new hope in treating fistula in Ano, the thread cut the tract, and it also possesses healing power.

Leech Therapy: Jalaukavcharan

Leech therapy is a type of bloodletting widely used to treat skin and blood-related disorders. It is very effective in managing varicose veins, non-healing ulcers, alopecia( loss of hair from the scalp), abnormal pigmentation, or local pathology of the skin, and can be in healthy individuals as regimental therapy. According to the concept of Ayurveda Leech sucks the impure blood which then after the body compensates itself with pure blood reverses the pathology of related disorders. Multiple types and their morphological characteristics to identify usable and non-usable leeches are available in Sushruta Samhita.

The process of leech needs the supervision of an expert sometimes their bite may cause an allergic reaction in the patients and may have local and systematic complications. A separate leech, for every patient to avoid transmission of disease from one individual to another. These can be reusable on the same individual with an interval of one week. The count of leeches applied depends on the severity of the disease and the condition of the patient.

Need for an hour

There is a need for an hour to raise the popularity and practice of these procedures. These are beneficial to both, practitioners as well as patients. Cost-effective, efficacy, and safety make these, more reliable, and convenient rather than an intake of chemically derived medicines and a hectic surgical procedure.