Kshara Agnikarma Vidhi – Cauterization- Astanga Hridaya Sutrasthana 30

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

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Alkaline cautery advantages

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.

Drinkable alkali indications

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.

Alkali application indications

Pratisarana Kshara Yogya –
In the form of 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.

Alkali usage contraindications

Kshara Nisedha – contra indications:-
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.

Preparation of caustic alkali

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 added.
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 consistency 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.

Mrudu kshara

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.

Teekshna kshara

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.

Indications of three kinds of alkali

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.

Properties and actions of alkali

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.

Cauterization procedure

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 surrounding parts 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 in 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.
After 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;

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 samyak 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 to the passage 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, washing 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 if done properly by an intelligent physician it cures even dreaded diseases quickly.

Thermal cautery

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 successfully treated by Drugs, Kshara or Shastrakarma (surgery). 40

Indications

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

Contraindications

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 lakshana- features of proper and improper burning:-

Signs of proper thermal cautery

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

Signs of inadequate thermal cautery

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.

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

Signs of excessive thermal cautery

Signs of atidagdha– over burning are
Mamsalambana – drooping 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

Measures after thermal cautery

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 cold 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

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.