Ashtanga sangraha Chapter 40 – Agnikarma vidhi Adhyaya -fire cautery therapy
9Agnikarma); thus said atreya and other great sages. (1)
अथातो ऽग्निकर्मविधिमध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
Agnikarma sresthata Fire cautery is best
अग्निः क्षारादपि गरीयानौषधशस्त्रक्षारैरसिद्धानां तद्दाहसिद्धेरपुनर्भवाच्च । तत्राग्निकर्म त्वचि मांसे सिरास्नायुसन्ध्यस्थिषु च प्रयुज्यते । तत्र मशतिलकालकचर्मकीलसरुक्स्तब्धप्रम्लानाङ्ग भिष्यन्दाधिमन्थशिरोभ्रूशङ्खललाटरुजार्दितेषु सूर्यकान्तपिप्पल्यजाशकृद्गोदंतशरशलाकाभिस्त्व ग्दाहो यथास्वमभिष्यन्दादिषु तु भ्रूशङ्खललाटदेशेषु । ग्रन्थ्यर्बुदार्शोभगन्दरगण्डमालाश्लीपदान्त्र वृद्धिदुष्टव्रणगतिनाड्यवगाढपूयालसकेषु जाम्बवौष्ठसूचीशलाकाघृतगुडमधुमधूच्छिष्टतैलवसा हेमताम्रायोरूप्यकांस्यैर्मांसदाहः । सिरास्त्रायुसन्ध्यस्थिच्छेदशोणितातिप्रवृत्तिदन्तनाडीश्लिष्टवर्मोपपक्ष्मलगणलिङ्गनाशासम्यग्व्यधेषु जाम्ववौष्ठसूचीशलाकामधुमधूच्छिष्टगुडस्त्रेहै: सिरादि दाहः ॥ २ ॥
Fire cautery (Agnikarma) is more powerful than caustic alkali, successfully usable in diseases which are not amenable to drugs, surgical treatment and caustic alkalies and gives no room for the diseases to reoccur. It can be done to the skin, muscles, veins, tendons, joints and bones.
In diseases like discoloured patches, moles and warts on the skin; painful, stiff and drooping body parts, ophthalmia, glaucoma, pain of the head, eyebrows, temples and forehead, Agnikarma should be done on the skin of the diseased part by using the suryakanta stone, pippali, (pellet of ) excreta of a goat, tooth of a cow, arrowhead, or metal rod; in ophthalmia, glaucoma etc., over the eye-brows, temples and forehead.
In diseases like tumors, malignant tumors, haemorrhoids, rectal fistula, scrofula, filariasis, intestinal hernia, bad ulcers, sinus ulcers, deep or concealed ulcers and puyalasaka (a disease of the eye) it should be done by using a Jambavosta (an appliance made from metal, having lips like fruits of jambu), needles, metal rod, ghee, mollasses, honey, bees-wax, oil, muscle-fat, rods of gold, copper, iron, silver or bronze; this Agnikarma should burn the muscle.
In diseases like tearing or cutting of the veins, tendons, joint and bones; profuse bleeding, sinus ulcer of the gums, in diseases of the eye such as slistavartma, upapaksma and lagana; linganasa; and in cases of improper venesection, Agnikarma should be done by using Jambavosta, needle, metal rod, honey, bees-wax, mollasses (jaggery) oil or ghee, it should be on the veins etc. (2)
न तु दहेद्भिन्नकोष्ठमन्तश्शोणितमनुद्धृतशल्यमनेकव्रणपीडितमुष्णे च काले तथा क्षारान च। आत्ययिके तु व्याधौ कृतोष्णप्रतीकारस्य पिच्छिलमन्नमशितवतोऽग्निकर्म कुर्यात् ॥३॥
Fire cautery (Agnikarma) should not be done in conditions such as perforations of alimentary tract, collection of blood inside the alimentary tract, wounds from which foreign bodies have not been removed, persons who are suffering from multiple wounds, during hot seasons and those who are ineligible for caustic alkali therapy.
But in emergency conditions, it can be done after the administration of antiheat (cold) therapies and slimy substances as food. (3)
Agnikarma vidhi – procedure of fire cautery
अथ दाहार्हमातुरं कृतस्वस्त्ययनमुपहृतसर्वोपकरणं प्राक्शिरः संविष्टमाप्तावलम्बितं कृत्वा वैद्योनिर्धूमबृहत्स्थिरदीप्तखदिरबदराद्यङ्गारैरयोघटनप्रकारेण भस्त्रानिलाध्मातैर्व्यजनेन चोर्ध्वा निर्गच्छज्ज्वालतयापादितापाद्यमानभासुराग्निवर्णैर्जाम्बवौष्ठादिभिर्व्याधिप्रदेशवशाद्वलयार्धचन्द्र स्वस्तिकाष्टापदबिन्दु रेखाप्रतिसारणविकल्पेन मुहुर्मुहुर्हितोपहिताभिर्वाग्भिरद्भिश्चातुरमाश्वास यन्दहेदासम्यदाहलिङ्गोत्पत्तेः । उश्च्छूनसुषिरप्रलूनदन्तनाडीसजन्तुदुष्टव्रणेषुतुस्नेहमधूच्छिष्टम धुगुडे: पूरयित्वा दहेत् । सम्यग्दग्धे च मधुसर्पिषी दद्याच्छीतस्त्रिग्धांश्च प्रदेहान् ॥४॥
The patient who is eligible for Agnikarma should be instructed to perform all auspicious ceremonies; (the physician should) keep ready at hand all the equipment needed, (make the patient) sit or lie down with his head held tight by attendants. A small open hearth is to be constructed, fixed with bellows similar to that of an ironsmith; into the hearth, wood of khadira or badari are put in and set fire. When the smoke has ceased and red burning coal is ready, the physician should put Jambavosta and other instruments into the hearth, make their points (tips) red-hot. take them out and place them on the body of the patient, creating marks such as circular, semicircular, swastika, number eight, point, straight line, dotted patch and such others; the patient being kept assured by encouraging words all the time. Agnikarma should be as much deep as required for the disease and till the symptoms of proper cauterisation manifest.
In condition such as wounds which are swollen, which have cavities, which are cut off and hanging; in cavity of the tooth; wounds having worms (bacteria) and bad ulcers, Agnikarma should be done by filling them with hot fats, (oil, ghee etc) bees-wax, honey and mollasses (jaggery).
After satisfactory Agnikarma, the area should be smeared with honey, ghee and paste of drugs which are cold and unctuous. (4)
सम्यग्दग्धलिङ्गं पुनस्सशब्दं दहनं दुर्गन्धित्वं त्वक्सङ्कोचश्चत्वग्दग्धे। कपोतवर्णत्वमल्पशोफ रुजता शुष्कसङ्कचितव्रणता च मांसदग्धे । कृष्णोन्नतव्रणत्वं स्थिते च रक्ते लसीकास्त्रुतिः सिरादग्धे। कृष्णारुणकर्कशस्थिरव्रणता स्नाय्वादिदग्दे च। दुर्दग्धातिदग्धयोस्तु प्रमाददग्धवल्ल क्षणम् चिकित्सितं च ॥५॥
Characteristic features of properly done Agnikarma are burning associated with sound, bad smell and contraction of the skin in case of burning of the skin; manifestation of the colour of a peigon (light grey), slight swelling and pain, the wound becoming dry (without exudations) and constricted in case of burning of the muscles; the wound becoming black and swollen, stoppage of bleeding but the discharge of lymph. in case of burning of the veins; the wound becoming blackish-red, rough and hard in case of burning of the tendons etc.
In case of inadequate and excess Agnikarma the symptoms will be similar to that an accidental burning and their treatment is also similar to that condition. (5)
Pramada dagdha – improper burns
प्रमाददग्ध पुनश्चतुर्विधं भवति । तुत्थं दुर्दग्धं सम्यग्दग्धमतिदग्धं च । तत्र यद्विवर्णमूष्यतेऽति मात्रं तत्तुत्थम् । यत्रोत्तिष्ठन्ति स्फोटास्तीव्रोषादाहरुजश्चिराच्चोपशाम्यन्ति तदुर्दग्धम् । पक्वतालफलवर्णं समस्थितं पूर्वलक्षणयुक्तं च सम्यग्द्ग्धम्। अतिदग्धे तूग्ररुजता धूमायानं मांसावलम्बनं सिरादिव्यापदोगम्भीरव्रणता ज्वरदाहतृणमूर्छाच्छर्दयः शोणितातिप्रवृत्तिस्तनिमित्ताश्चोपद्रवाः कृच्छ्रेण रोहणं रूढे च विवर्णतेति । स्नेहदाहस्तु कष्टतरो भवति । स हि स्नेहस्य सूक्ष्ममार्गानुसारित्वाद् दूरमनुप्रविशतीति । भवति चात्र ॥ ६ ॥
Improper burning is of four kinds; Tuttha, Durdagdha, Samyakdagdha and Atidagdha; Tuttha is that which causes discolouration and severe burning sensation locally; Durdagdha is that in which boils with severe local burning sensation develop (on the part) and burning sensation and pain are found in other parts of the body, and the boils requiring a long time to heal; Samyakdagdha is that in which the burnt parts assume the colour of ripe fruit of tala (dark bluish-black) and other symptoms of properly done Agnikarma are seen; Atidgdha is that which has severe pain, feeling as though hot smoke is coming out, muscles drooping (falling) out, disorders of the veins etc., wound becoming deeper, fever, burning sensation all over the body, thirst, fainting, profuse bleeding and its complications; the wound healing with difficulty and discolouration even after healing.
Burning caused by boiling fatty materials (oil, ghee etc.) (scalds) will also be difficult, because of the capacity of fats to get deep into minute channels of the tissues and so the wounds caused by them will be very deep. (6)
Further;
Dagdha chikitsa- treatment of burns
तुत्थस्याग्निप्रतपनं कार्यमुष्णं च भेषजम् । स्त्याने रक्ते हिमैर्नोष्मा निष्क्रामति यतो बहिः ॥७॥ वेदना वर्धते तेन रुधितं च विदह्यते । उष्णं निष्क्रामयत् कुर्यादूष्माणं मन्दतां रुजः ॥८॥
The treatment of Tuthadagdha is exposure to heat and other hot therapies only, because the solidified (clotted) blood, does not come out by resorting to cold therapies, and when it is inside there will be increase of pain; hence only after expelling out the heat, treatment should be done to reduce the pain. (7-8)
शीतामुष्णां च दुर्दग्धे क्रियां कृत्वा ततः पुनः । घृतालेपनसेकांस्तु शीतानेवावचारयेत् ॥९॥
In conditions of Durdagdha, the treatment should be both hot and cold together and then the application of ghee and washing with cold decoctions (of drugs which possess cold potency). (9)
सम्यग्दग्धे तवक्षीरीप्लक्षचन्दनगैरिकैः। सामृतैः सघृतैर्लेपः कल्कैर्वानूपमांसजैः ॥१०॥ शान्तोष्मणि परं कुर्यात् पित्तविद्रधिसाधनम् । अतिदग्धे विशीर्णानिमांसान्युवृत्य शीतलाम् ॥११॥ क्रियां कुर्यात्ततः पश्चाच्छालितण्डुलकण्डनैः । तिन्दुकीत्वक्कषायैर्वा पिष्टैः साज्यैः प्रलेपयेत् ॥१२॥ गुडूच्याश्छादयेत् पत्रैरथवौपोदकैर्व्रणम् । भेषजं चास्य कुर्वीत सर्वं पित्तविसर्पवत् ॥१३॥ स्नेहदग्धे भृशतरं रूक्षं तंत्र तु योजयेत् ।
In Samyakdagdha, the wound should be smeared with ghee processed with tavaksiri, plaksa, candana gairika and amrta or with a paste of meat of animals living in marshy regions. After the heat subsides, the treatment prescribed for abscess due to increase of pitta should be undertaken.
In case of Atidagdha, the muscles which have been drooping should be cut off, given cold treatment and then the wound should be smeared with ghee macerated with broken rice or the decoction of the bark of tinduka; it is next covered with leaves of guduci or that of upodika. Next, the treatment as prescribed for visarpa (herpes) of pitta origin should be done.
In case of burning by fatty materials, (scalds) the treatment should be to produce profound dryness inside. (10-13)
शस्त्रक्षाराग्नयो यस्मान्मृत्योः परममायुधम् । अप्रमत्तो भिषक् तस्मात्तान् सम्यगवचारयेत् ॥१४॥
Sharp instruments, caustic (alkalies) and fire (cautery) are the chief weapons of death. Hence, the physician should be very careful and use them properly. (14)
इति तन्त्रस्य हृदयं सूत्रस्थानं समाप्यते । अत्रार्थाः सूत्रिताः सूक्ष्माः प्रतन्यन्ते हि सर्वतः ॥१५॥
Thus ends Sutrasthana (section on principles of Ayurveda), the heart of the treatise; the principles that are mentioned here in brief will be described in detail, throughout the text. (15)
॥ इति चत्वारिंशोध्यायः ॥
Thus ends the Ashtanga Sangraha Sutrasthana 40th Chapter.
॥ सुत्रस्थानम् समाप्तम् ॥
Thus ends Sutrasthana – the first section. of (Astanga Sangraha).
