Attar Sajida1, Paradkar Hemant2, Pal Subodh3, Prabhu Pooja3,
1Assistant Professor, Dept. of Kayachikitsa, APM’s Ayurved Mahavidyalaya, Sion, Mumbai.
2Associate Professor, Dept. of Kayachikitsa, APM’s Ayurved Mahavidyalaya, Sion, Mumbai.
3PG Scholar, Dept. of Kayachikitsa, APM’s Ayurved Mahavidyalaya, Sion, Mumbai.
*Corresponding Author: dr.sajidaattar@yahoo.com
Agnikarma has demonstrated remarkable efficacy in managing pain, a hallmark of its application within Apunarbhavachikitsa. Pain, often the catalyst for seeking medical intervention, can manifest and intensify across different regions of the body. Gridhrasi, a condition delineated in Vatavyadhi, manifests symptoms such as radiating pain from the lower back or hip area to the ankle or posterolateral portion of the foot. This aligns with sciatica, where discomfort originates in the lumbar region and progresses along the pathway of the sciatic nerve, increasing in severity. While painkillers offer transient relief, they do not address the underlying cause of sciatica, typically stemming from substantial nerve compression. Prolonged usage of pain medication is also discouraged due to potential adverse effects on the body. Ayurveda prescribes treatment for Gridhrasi encompassing Siravedha (Venesection), Basti (Enema therapy), and Agnikarma (Thermal cauterization). Agnikarma, synonymous with thermal cauterization, constitutes a traditional Ayurvedic therapeutic modality involving the application of heat for diverse health benefits, including pain alleviation, inflammation reduction, and facilitation of tissue healing. It is imperative to acknowledge that the efficacy of Agnikarma may vary, necessitating its administration under the supervision of qualified Ayurvedic practitioners. In the context of sciatica (Gridhrasi), Agnikarma is recommended along the trajectory of the sciatic nerve and at its originating points. This paper explores the multifaceted dimensions of Agnikarma as applied in everyday clinical practice.
Agnikarma, Gridhrasi, Sciatica, Pain management, Vatavyadhi
Pain serves as a primary symptom prompting individuals to seek medical attention,[1] with its associated discomfort significantly hindering daily functioning. The spectrum of pain encompasses various types, including acute, chronic, neuropathic, and nociceptive. Each type of pain has distinct characteristics and requires different treatment approaches. Gridhrasi, delineated in Vatavyadhi,[2] presents with symptoms such as radiating pain from Sphik (Hip), Kati (Waist), Uru (Thigh), Janu (Knee), and jangha (Calf), respectively.[3] This condition manifests in two forms: Vataja and Vatakaphaj.[4] According to AcharyaCharaka, VatajaGridhrasi is characterized by signs such as Stambha (stiffness), Ruka (pain), Toda (pricking sensation), and Spandana (twitching), while additional symptoms of VatakaphajaGridhrasi include Aruchi (anorexia), Tandra (drowsiness), and Gaurava (heaviness).[5] The term "Gridhrasi" draws parallels to the gait resembling that of Gridhra (Vulture).[6] Modern medical understanding finds similarities between the signs and symptoms of "Sciatica" and those described in Ayurveda as Gridhrasi.[7] Ayurvedic literature provides insights into a broad spectrum of etiological factors contributing to Vatavyadhi,[8] which are now observed to manifest in conditions like sciatica. Contemporary treatments for sciatica typically involve conservative approaches such as physiotherapy, analgesics, lumbar belts, and in severe cases, surgery. Whereas Ayurvedic treatment modalities for Gridhrasi include Siravedh, Basti, and Agnikarma.[9]Agnikarma is a para-surgical procedure primarily employed for immediate pain relief. The indication for Agnikarma is the site of intense pain, so Agnikarma can be done along the path of the sciatic nerve and at the root of the sciatic nerve. Its efficacy in alleviating sciatic pain and discomfort has been well-documented.
Agnikarma:
Agnikarma, elucidated by AcharyaSushruta in chapter 12 of Sutrasthana, stands as a para-surgical procedure with significant therapeutic implications.[10]Sushruta highlights its efficacy in cases where diseases persist despite treatment with Bheshaja (medications), Shastrakarma (surgical procedures), and Kshaarkarma (alkaline cauterization). Notably, diseases addressed through Agnikarma exhibit a reduced tendency for recurrence, suggesting its enduring benefits.[11] This procedure serves to rebalance local Vatadosha, crucial for restoring health. Agnikarma employs specialized instruments, known as Dahanopkarana, tailored to the specific organ or site involved. The choice of instrument is contingent upon its capacity for heat retention and transmission. These instruments fall into three categories:[12]
The selection of the appropriate instrument is crucial, ensuring optimal outcomes in Agnikarma procedures.
The Agnikarma procedure unfolds in three distinct phases: Purvakarma (Pre-procedure), Pradhankarma (Main procedure), and Paschchatkarma (Post-procedure).
During Purvakarma, the patient is thoroughly briefed about the Agnikarma process, and they are advised to consume Picchilaahaar (unctuous diet) beforehand. Additionally, the site exhibiting maximum tenderness is carefully marked for precise treatment.
In Pradhankarma, the patient assumes a prone position, optimizing exposure of the lower back region and the affected sciatic nerve along the lower limbs. A suitable Dahanopkarana (instrument) is selected, heated until red hot, and then applied to the designated site. To prevent the intersection of two Dagdhavranas (burned wounds), minimal distance (1-10mm) is maintained between Agnikarma points.
The final phase, Paschchatkarma, involves the application of SiddhaGhruta (medicated ghee) at the site of the Dagdha (burned) area.[14] Subsequently, the patient is closely monitored for the ensuing 30 minutes to ensure proper healing and comfort. AcharyaSushruta has outlined specific Pathyapathya (regimens) post-Agnikarma, crucial for the optimal recovery of SamyakDagdhaVrana (properly burned wounds).
Classification of Agnikarma:
Vaghbhatta added 3 more 1) Ashtapada (Octagon) 2) Ardha Chandrika (Crescent) 3) Swastika.[16]
The qualities indicative of a well-executed Agnikarma vary according to the specific site targeted:[19]
These qualities serve as crucial benchmarks for assessing the effectiveness of Agnikarma interventions tailored to specific anatomical structures and conditions.
Indications of Agnikarma:[20]
Agnikarma finds its indications primarily at sites of intense pain, with several specific examples listed, including:
Shiroroga (headaches), Adhimantha (eye disorders), Vartmaroga (vascular diseases), Vrana (wounds), Granthi (cysts or tumours), Arsha (haemorrhoids), Arbuda (cancer), Bhagandar (fistula-in-ano), Apachi (carbuncles), Shlipada (filariasis), Charmakila (chronic ulcers), Tilakalaka (wart-like growths), Antravruddhi (internal growths), and others.
These conditions represent a diverse range of ailments where Agnikarma is deemed beneficial for symptom relief and therapeutic management.
Contraindications of Agnikarma:[21]
The contraindications for Agnikarma include individuals with Pittaprakruti (constitution dominated by Pitta dosha), Durbal (weak), Baal (children), and Vruddha (elderly). Additionally, individuals contraindicated for Svedanakarma (sudation therapy) should avoid Agnikarma.
Moreover, Agnikarma is not recommended during the Sharad (autumn) and Grishma (summer) seasons. These seasons are characterized by the predominance of Pittadosha, and Agnikarma, being a Ushnachikitsa (hot therapy), may exacerbate Pitta and lead to Pittaja disorders. However, Agnikarma is considered highly beneficial for patients suffering from Vataja and Vata-kaphaj disorders, especially during other seasons.
Complications of Agnikarma:[22]
Complications associated with Agnikarma, as classified by AcharyaSushruta, are as follows:
The precise mechanism of action of Agnikarma remains a subject of ongoing discussion. However, several principles are proposed to elucidate its therapeutic effects:[23]
The prevalence of Gridhrasi is on the rise, significantly impacting individuals' daily lives with its debilitating pain and interference with routine activities. The prolonged use of painkillers poses risks, making them an unsustainable solution. However, Agnikarma emerges as a promising alternative, offering notable relief from Gridhrasi's symptoms without adverse effects on other bodily systems. Its swiftness, cost-effectiveness, and efficacy position Agnikarma as a superior therapeutic intervention for Gridhrasi, addressing the need for faster and more efficient pain management solutions.