Kshara Agnikarma Vidhi – cauterization- Astang Hriday Sutrasthan 30

Kshara is an effective Ayurvedic medicine for healing wound. Agnikarma is also used as a surgical instrument in Ayurveda. This is the 30th chapter of Ashtanga Hridaya Sutrasthana, called Kshara Agnikarma Vidhi Adhyaya. 

Kshara Sresthata – advantages of alkaline cautery:-
Of all the sharp instruments and accessory instruments, Kshara (caustic alkali) is the best.
It performs many functions such as incising, excising etc;
It can be used even in inaccessible places.
Success can be obtained by its use even in diseases which are very difficult to cure and also because it can be used even in the form of a drink. 1 – 2.

Paneeya Kshara indication – In a drinkable form it is used in
Arsha – haemorrhoids,
Agnisada – dyspepsia,
Ashma – renal calculus,
Gulma – Tumors of the abdomen
Udara – ascites, enlargement of the abdomen
Garavisha – chronic poisoning etc.

Pratisarana Kshara Yogya –
In the form direct application, Kshara can be used in
Mashaka – moles – warts,
Shvitra – leucoderma,
Bahya Arsha – external piles,
Kushta – skin diseases
Supti – anesthetic patches,
Bhagandara – rectal fistula,
Arbuda – cancerous growth,
Granthi – tumour, fibroid
Dushta Nadi vrana – foul and sinus ulcers etc.

Kshara Nisedha – contra indication:-
Neither externally, nor internally, Kshara should be used in
Aggravation of Pitta and Rakta
and diminished Vata;
Jvara – fever
Atisara – diarrhoea, dysentery
Hrut Murdha Roga – diseases of the heart and head,
Pandu – anemia
Aruchi – anorexia,
Timira – blindness;
Kruta samshuddha – in those who have been administered Panchakarma therapies (recently),
Sarvagatra shvayathu – who have swelling of the entire body,
Bheeru – who are fearful, coward,
the pregnant, the menstruating woman, woman who has difficult menstrual flow, or woman who has displacement of either vagina or uterus;
Ajirne Anne – when the food remains undigested,
for infants and old persons,
on places of the body such as the arteries, joints, vulnerable spots, cartilages, veins, tendons/nerves, sutures, throat, umbilicus and places which are poor of muscles, the testes, penis, orifices, passages, interior of the nails;
In diseases of the eyes except those of the eyelids; during cold, rainy and hot seasons and on days when the sun in not seen. 4 – 7.

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Kshara Nirmana – preparation of caustic alkali:-
Moist roots, branches and other parts of trees such as Kalamushkaka, Shamyaka, Kadali (Banana), Paribhadraka, Ashvakarna, Mahavriksha, Palasha, Asphota, Vrikshaka, Indravriksha, Arka, Putika, Naktamala, Ashvamaraka, Kakajangha, Apamarga, Agnimantha, Agni or Tilvaka – are cut into small pieces and placed on clean stone slabs, separately, in heaps;
Pieces of the four kinds of Koshataki plants, the spikes and reeds of Yava (barley) plants are also similarly heaped.
Into the heap of Kalamushkaka, pieces of lime stone are put in.
All the heaps are set on fire by making use of dried chaff of Tila plant (Sesame plant).
After the heaps have been well burnt and fire has disappeared, one Drona (12,288 g) of ash of lime stone together with ash of Kalamushkaka and one and a quarter Drona (3072 g) of ash of others are taken, mixed together, dissolved well in half Bhara (48000 g) of water and cows urine separately, and filtered through a thick cloth till a slimy, reddish, clear and penetrating alkaline material is obtained.
It is then transferred into an iron cauldron and cooked, stirring it constantly with a ladle;
To this is added one Kudava (192 g) of ash of limestone, shells of mother of pearls, Kshirapaka (Khatika or clay), spiral of conch shell – each made red hot over a pan, fine powder of excreta of cock, peacock, falcon, heron and pigeon, bile of quadrupeds and birds, Ala ( haritala-Orpiment), Manohva (Realgar) and salts, all these are ground into a paste and mixed with the boiling solution, stirring it all the while from all sides.
When it begins to emit fumes, bubbles come up and attains a solid consistence like a confection (Avaleha), the cauldron should be taken out of fire.
When it gets cool, it is transferred into an iron vessel which is kept concealed inside a heap of Yava (barley) for some days.
This is the mode of preparing Madhyama Kshara – alkali of medium potency. 8 – 19½.

For preparing Mrudu Kshara – alkali of mild potency, the admixture – ash of shells, powder of excreta, biles etc. should not be made into a paste and added but put in powder form and taken out – filtered and thrown away.

For preparing Teekshna Kshara – alkali of strong potency the admixture should be similar to that of previous – alkali of medium potency and also the paste of Langalika, Danti, Chitraka, Ativisha, Vacha, Svarjika, Kanakaksiri, Hingu, sprouts of Putika, Talapatri and Bida salt and alkali prepared as usual and used after a lapse of seven days. 20 – 21½.

Trividha Kshara Yojana – indications of three kinds of alkali:-

Teekshna Kshara – Alkali of strong potency should be used in diseases arising from Vata, Kapha, Medas – fat,
Arbuda – cancerous growth and such others which are very difficult to cure,
Madhyama Kshara – alkali of medium potency is useful in those diseases when they are of moderate strength, not very difficult to cure. Mrudu Kshara – Mild alkali is used In diseases arising from Pitta and Asra – Rakta and heamorrhoids,
When the alkali loses its water content some quantity of alkali solution should be added to strengthen it. 22 – 23.

Ksharaguna – properties and actions of alkali:-

Na ati teekshna – Neither too strong
na ati mrudu – nor too mild,
Shlakshna – smooth,
Picchila – slimy,
Sheeghraga – quick in spreading
Sita – white in colour,
Shikhari – remaining like a mountain peak at the site of application, Sukha nirvapya – easily removable,
Na vishyandi – producing neither too much of exudation / moistness
Na ati ruk –does not cause much pain
These are the ten ideal qualities of the caustic alkali.
It does all the functions of the sharp surgical instrument and also the fire.
By actions such as sucking quickly, healing effect over the body, spreading everywhere, it pulls out all the Doshas (vitiating materials) by their root;
After such actions when the diseases disappears, Kshara also subsides on its own accord. 24 – 26.

Kshara Prayoga – procedure of cauterization :-

The disease treatable by alkali should either be cut, scraped / made to exude fluid first.
Then the alkali taken in an iron rod, is placed on the spot, the other parts surrounding of the body kept covered and protected by cotton swabs and a time period of one hundred Matra awaited. 27.

In haemorrhoids, if the tip of the pile mass is found concealed, it should be manipulated by the hand in such way as to place the alkali on them, inside the anal canal.
In diseases of the eyelids, the lids are to be everted, the black area – cornea kept covered with cotton swab as protection and then alkali applied as thin as of a lotus petal to the interior of the lids.

In cancer of the nose, the patient is made to sit facing the sun, the tip of the nose is raised up and alkali applied into the nostril and a time of fifty Matra Kala awaited;
In case of piles, polyp of the ears also it shall be similar. 28 – 30.
Afterwards the prescribed time the alkali is wiped off with a cotton swab etc. and perceiving that the site has been properly burnt by the alkali, a mixture of ghee and honey should be applied, made cool by pouring milk, whey or sour gruel, and then applying a paste of drugs of sweet taste and cold potency.
The patient should consume foods which produce more secretions in the tissue cells in order to moisten the site of burn. If the site of the burn does not get torn from an ulcer because of being deep rooted, then a paste of seed of Dhanyamala-(sour gruel), Yashti (licorice) and tila (sesame) should be applied;
तिलकल्क: समधुको घृताक्ता व्रणरोपण: ।

Paste of tila (sesame), and Madhuka mixed with ghee heals the ulcer. 31-33 ½

Symptoms of good burning due to Kshara – Attaining black color, similar to the ripe fruit of Jambu (Jamun fruit),
depression of the site- are the feature of a samyag dagdha.
The opposite of it, that is appearance of
Tamravarna – coppery red color,
pricking pain, itching etc. are the features of Durdagdha improper- inadequate burning, such an area should be burnt again. 34

Atidagdha– over-burning produces bleeding, fainting, burning sensation, fever etc.
Over-burning of the Anus- rectum produces obstruction for passing of feces and urine or their excess elimination, loss of muscular and sexual power (impotency) and death.
In case of the nose, there will be severe burning sensation, contraction of the nasal bridge and loss of sense of smell; similarly so in case of ears etc other sense organs.  35-37

In such conditions, burning the part with sour fluids, applications of paste of honey, ghee and Tila (sesame),
activities- foods other comforts which mitigate Vata and Pitta and all others which produce cold, should be adopted.
As sour is cold to touch, combining with the Alkali it quickly attains the properties of sweet taste, hence the burn caused by Alkali should be washed with sour substances quickly. 38-39.

Kshara administered by the physician of poor intellect is like death caused by poison, fire, sharp weapon, or thunderbolt;
Whereas done properly by an intelligent physician it cures even dreaded diseases quickly.

Agni karma- thermal cautery- branding:-
Fire- thermal cautery is better than even the Kshara, for the diseases that are treated by Agnikarma do not recur and it can be used even in diseases which have not been successful treated by Drugs, Kshara or Shastrakarma (surgery). 40

Agnikarma Yojana- indications and contraindications for thermal cautery :-

It is used on the skin, muscle, vein, tendon, joints and bones.
In diseases like black moles, weakness of body parts, headache, Adhimantha- a disease of the eye, warts, cysts etc. burning of the skin should be done either with a lighted wick, tooth of a cow, rock crystal, arrow head or others – such as Pippali, excreta of goat, iron- rod, piece  of bangles. 41

Haemorrhoids, rectal fistula, tumors, sinus ulcers and bad- septic, longstanding, foul ulcers etc. should be treated by burning of the muscles with- hot honey, fats, Jambavostha- an iron instrument with a spoon shaped tip, jaggery- treacle etc. 42

Slishtavartma- exudative disease of the eyelids, bleeding, blue mole, improper cutting- surgical wound etc. burning of the veins should be done by – using the same materials enumerated in the previous verse. 43

Contra indication for Agni karma – Burning should not be done for those who are not suitable for Kshara karma,
wounds which have foreign body or accumulation of blood inside,
persons who have perforation of abdominal viscera and
those who are suffering from severe wounds. 44

The site which has been burnt properly – by fire should be given a coating of ghee and honey and an application of paste of drugs which are unctuous and cold in potency. (snigdha, sheeta)

Daha laksana- features of proper and improper burning:-

तस्य लिङ्गं स्थिते रक्ते शब्दवल्लसिकान्वितम् ॥४५॥

पकतालकपोताभं सुरोहं नातिवेदनम् ।

The signs of samyak dagdha- proper burning are stoppage of bleeding, emergence of crackling sound accompanied with lymph, the area having color resembling a ripe Tala fruit or pigeon dark grey. The wound healing easily and not much of pain .45

The signs of inadequate burning and excess burning are similar to those of improper burning.
Burning is of four kinds, together with
Tuccha Dagdha- bad/ mean/ undesirable/ inadequate burning.

तुच्छ दग्ध लक्षण –

सह तुच्छस्य लक्षणं । त्वक् विवर्ण उष्यते अत्यर्थं न च स्फोटसमुद्भव: ॥४७॥

The signs of tuccha dagdha are discoloration of the skin, severe burning sensation,

Signs of atidagdha– over burning are
Mamsalambana – dropping down of the muscles,
sankocha – constriction,
Daha – burning sensation
Dhupana – feeling  of hot fumes coming out,
vedana –  pain
Siradi nasha – destruction of veins etc,
Trut – excessive thirst
Murcha – fainting, loss of consciousness
Gambhira Vrana –worsening of the wound and
Mrutyu – death. 46-48 ½

A Tuccha Dagdha- bad/ inadequate burning- should be burnt once again and paste of drugs which are hot in potency, should be used; when the blood is coagulated there is severe pain and when it is dissolved pain is mild. 49

In case of Durdagdha- improper burning clod and hot treatment should be used, the hot one first and the cold one next. 50

In case of Samyagdadha- proper burning, a paste of Tavaksiri, Plaksha, Chandana (Sandalwood), Gairika (Red ochre) and Amrita (Tinospora) mixed with ghee should be applied on the area of burn and then therapies indicated for an abscess of Pitta origin should be adopted. 51

अतिदग्घे द्रुतं कुर्यात्सर्वं पित्तविसर्पवत् ।
स्नेहदग्घे भृशतरं रुक्षं तत्र तु योजयेत् ॥५२॥

In case of Atidagdha- over burning all the therapeutic measures prescribed for Visarpa of Pitta origin should be done quickly.

In case of burning by fats- hot oil, ghee etc, measures which are very dry- cause severe dryness should be adopted. 52

The knife, Alkali and fire are chief weapons of the lord of death; hence the physician should administer them with great care.

Thus will be concluded, this section of Astanga Hrudaya which  is full of secrets, for in it are codified all the  chief doctrines which  are described in detail everywhere – in the entire treatment. 53

Thus ends the chapter named Ksharagni Karma Vidhi- the thirtieth in Suthrasthana of Astangahrdaya Samhita.


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Comments

  1. Agnikarma with panch loh shalaka is very effective treatment to combat all types of pain.
    What is your experience Dr hebbar with agnikarma.isIt relieved pain in pts.?for long &also improvement in physical activity.
    Thanks sir..

    • Dr J V Hebbar MD(Ayu) says:

      Hi, I have not used Agnikarma in my practice. Other doctors who might have used may comment and share their valuable experience.

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