Chapter 30: Kshar-AgniKarma Vidhi

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:सवश ा अनुश ाणां ारः े ठो बहू न यत ् छे यभे या दकमा ण कु ते वषमे व प बुःखावचायश अ त कृ

ेषु तेन स

मया सु च

े षु रोगेषु य च पाने अ प यु यते

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 – स पेयो अश ि नसादा मगु मोदरगरा दषु 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 यो यः सा ा मषि व बाहयाशः कु ठसिु तषु भग दराबुद ि थद ु टनाडी णा दषु

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:न तूभयो अ प यो त यः प ते र ते चले अबले वरे अ तसारे

त मरे कृतसंशु ौ

मूध रोगे पा

वामये अ चौ

वयथौ सवगा गे

भी ग भ यतुमती ोदव ृ तफलयो नषु

अजीणअ ने शशौ व ृ े धमनीसि धममसु त णाि थ सरा नायुसेवनीगलना भषु

दे शे अ पमांसे व ृषणमे

ोतोनखा तरे

व मरोगा ते अ णो च शीतवष णद ु दने 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.

Kshara Nirmana – preparation of caustic alkali:कालमु ककश याककदल पा रभ कान ्

अ वकणमहाव ृ पलाशा फोतव ृ ाकान ् इ

व ृ ाकपू तकन तमाला वमारकान ्

काकज घाममपामागमि नम थाि न त वकान ् सा ा समूलशाखाद न ् ख डशः प रकि पतान ् कोशातक चत

च शूकं नालं यव य च

नवाते नचयीकृ य प ृथ क् ता न शलातले

य मु ककचये सुधा मा न च द पये त ्

तति तलानां कृतलै द

वाअ नौ वगते पथ ृ क्

मु कको तरमादाय

ये कं जलमू योः

कृ वा सुधा मनां भ म

ोणं

वतरभ मनः

गालयेदधभारे ण महता वाससा च तत ्

यावि पि छलर ता छ ती णोजात तदा च तम ् ग ृह वा

ार न य दं पचे लो यां वघ यन ्

शिु तः

ीरपकं श खनामी चायसभाजने

प यमाने तत ति म ताः सुधाम यशकराः कृ वा अि नवणा बहुशः नवा य प

शल णं श ु चत ु पा प

ारो थे कुडवोि मते

वा तेनैव

तीवापं व न

पे त ्

श खग ृ क ककपोतजम ्

प तालमनोहवालवणा न च

प रतः सुतरां चातो दा या तमवघ ये त ् सबा पै च यदोि त ठे बु बुदैलहव नः

अवताय तदा शीतो यवराशावयोमये था यो अयं म यमः

ारो

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 (Kshar of Mild Potency) – न तु प

वा

पे मद ृ ौ

नवा यापनये ती णे पूववत ्

तवापनम ्

तथा ला ग लकादि त च का त वषावचाः विजकाकनक ी र ह गुपूतीकप लवाः

तालप ी वडम ् चे त, स तरा ा परं तु सः

यो यः

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:ती णो अ नल ले ममेदोजे वबुदा दषु

म ये वे वेव म योअ यः प ता गुदज मसु बलाथ

ीनपानीये

ारा बु पुन रावपे त ्

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:ना तती ण म ृद ुः ल णः पि छलः शी गः सतः

शखर सुख नवा यो न व य द न च अ त क् २४ ारो दशगुणः श

तेजसोरा प कमकृत ् आचूषि नव संर भो गा मापीडयि नव २५

सवतो अनुस रन ् दोषानु मूलय त मूलतः कम कृ वा गत जः

वयमेवोपशा य त २६

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 Alkaline cauterization :ारसा ये गदे छ ने ल खते

ा वते अथवा

ारं शलाकया द वा लोत ाव ृतदे हयो

मा ाशतमप ु े ेत

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. त ाशः

वावत ृ ाननम ्

ह तेन य नं कुव त व मरोगेषु व मनी

नभु य पचन ु ा आ छा य कृ णभागं व न

प प तनुः

ारलेपो, ाणाबुदे षु च

पे त ्

या द यं नष ण य समु न या ना सकाम ्

मा ा वधायः प चाशत ् त व श स कणजे 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. ारं

माजनेनानु प रम ृ यावग य च

सुद धं घ ृतम व तं त पयोम तुकाि जकै ः नवापये ततः सा यैः

वादश ु ीतैः

अ भ य द न भो या न भो या न य द च ि थरमूल वा

धा या लबीजय

दे येत ् लेदनाय च

ार द धं न शीयते

याःव तलै रालेपये ततः

तलक कः समधुको घ ृता तो

णरोपणः

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; तलक क: समधुको घ ृता ता

णरोपण: ।

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

व सतं स नं स य द धम ् वपयये ३४

ता तातोदक

वा यैद ुद धम ् तं पुन दहे त ्

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 अ तद धे

वे

तं मू छादाह वरादयः

गद ु े वषेशा व मू संरोधो अ त वतनम ्

पुं तोपघातो म ृ युवा गुद य शातना

नासायां ना सकावंशधरणाकु चनो वः भवे च वषया ानम ् त व च

ुवम ्

ो ा दकेषु अ प

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 वशेषाद

से को अ लैलपो मधु घ ृत तलाः

वात प तहरा चे टा सवव श शरा अ लो ह शीतः या याशु

पशन

या

ार तेनोपसं हतः

वादत ु ां त माद लै नवा ये तराम ्

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. वषाि नश

ाश नम ृ युतु यः

ारो भवेद पम त यु तः

स धीमता स यगनु यु तो रोगाि नह याद चरे ण घोरान ् 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:अि नः

ारद प

भेषज ारश

े ठ त

धानामस भवात ्

ै च न स ानां

साधनात ् ४०

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 :व च मांसे सरा नायुस

यि थषु स यु यते

मषा ग ला नमध ू ा तम थक ल तला दषु

व दाहो व तगोद तसूय का तशरा द भः

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 अश भग दर ि थनाडीद ु ट णा दषु

मांसदाहो मधु नेहजा बवौ ठगुडा द भः 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 ि ल टव मा यस ृ सरा ददाह तैरेव

ावनी यस य या धषु

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 – न दहे

ारवा रतान ्

अ तःश यास ृजो भ नको ठान ् भू र णातुरान ् 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 सद ु धं घत ृ म व तं ि न धशीतैः

दे हये त ्

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:त य ल गं ि थते र ते श दव ल सकाि वतम ् ॥४५॥ पकतालकपोताभं सरु ोहं ना तवेदनम ् । 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 सादद धव सव दद ु धा यथद धयोः

चत ुधा त त ु तु छे न

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. तु छ द ध ल ण – The signs of tuccha dagdha सह तु छ य ल णं । वक् ववण उ यते अ यथ न च स फोटदाहती ोषं द ुद धं अ तदाहतः

फोटसमु व: ॥४७॥

मांसलंबनस कोचदाहधूपनवे दनाः

सरा दनाश त ृ मू छा णगा भीयम ृ यवः

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

तु छ याि न पतनं कायमु णं च भेषजम ्

याने अ े वेदना अ यथ वल ने म दता

जः

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 द ुद धे शीतमु णं च यु

यादादौ ततो हमम ्

In case of Durdagdha- improper burning clod and hot treatment should be used, the hot one first and the cold one next. 50 स य द धे व ी र ल च दनगै रकैः ल पे सा याम ृतै

व प त व धवि

या

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 अ तद घे

ुतं कुया सव प त वसपवत ् ।

नेहद घे भ ृशतरं

ं त

त ु योजयेत ् ॥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 श

ारा नेयो य मा म ृ योः परममायुधम ्

अ म तो भषक् त मा तान ् स यगवचारये त ् 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.

Some Points to Note About Ayurveda: 

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Ayurveda is the most ancient healing science, most ancient human effort for health and well-being ever recorded. It is sister science of Yoga. It is still a living and influencing science of prevention, treatment, and health promotion. Ayurveda has its own peculiarity. It has its own philosophy. All of which may not always exactly fit with other medical sciences. Ayurveda believes in cause-effect phenomenon. The therapies are broadly classified into – Yukti vyapasraya (use of rational therapies), Sattvavajaya (use of psychological therapies), and Daivyavyapasraya (use of Divine methods like faith healing). Today medical science has extensively studied many things, but still these ideas of Ayurveda help to a large extent. Both ancient and modern ideas should be encouraged to be studied and practiced in medical field for overall welfare of all. Practitioners and Institutions or organizations who deal with Ayurveda can have specific guidelines based on such classical texts and/or new studies or experiences.

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Astanga = 8 organs (eight branches of classical Ayurveda) Hridaya = Heart (gist) Astanga Hridayam was written by Vagbhat in about 7th century in Indian subcontinent. It is about health care. In Ayurveda there are eight (Astanga) classical specialties. The predominant two schools in Ayurveda are Charak (Medicine) and Sushruta / Dhanwantari (Surgery). This book is the summary of all the branches including Charak and Sushruta. And the Sutra-sthan, the first section, is the summary of the whole book. Hence, it can be said that this collection is the summary of whole of the classical Ayurveda. Ashtanga Hridayam is one of the important ancient Ayurvedic text books. It is one of the basic text books that are included in BAMS curriculum. This is one of the books that can make you feel you've got the book that you were looking for, if you are interested in Ayurveda, Yoga, or traditional and ancient medicine. This can be also an ample help to anyone who wishes to know ideas of people of the past, for appreciation, for critical reviews, research etc. (You may belong to general people, or doctor, or nurse, or anyone directly or indirectly involved in health care.) It was written in the time of influence of Buddhism, the author has shown respect to Hindu and Buddhist ideals. These ideas are similar to the ideas in different parts of the world in ancient times; these ideas represent a kind of summary of ancient human knowledge from all over the world. Most of these ideas are very much useful even today. Some of the ideas may sound uncomfortable or harmful to present day ideas. Some ideas are not found in practice these days, while some ideas are found practiced same as mentioned in the text, some are practiced with some modifications. In some cases it is seen that one idea of an Ayurveda scholar may vary from that of another. Such issues used to be resolved by sambhasa or logical discussions.

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The number/s in the front or last of each paragraph indicates verse number. Reading this collection may be easier to those who already have got basic ideas of Ayurveda, or to those who want to know something of Ayurveda or ancient healing ideas. Some of the plants or animals explained in this ancient book may not be exactly translated in this translation, may be due to lack of exactly same species. Some of the terms explained in the ancient book may not have exact substitute in English. Some sorts of faults in translation can be traced, such as the translator may translate 'dravy' to be 'herb', but it can sometimes denote other substances to which either may be herb or metal or liquid or grain, that either may be used as medicine or as supplement or as food or as other sort of substance in the view of therapy. The word Vasti may also be written as Basti, Svedana as Swedana etc, Standard way of transliterating Sanskrit verses has not been strictly followed.(We shall try to do so in coming days) Almost all the translation has been included, excepts if any mistakenly unlisted lines exist; but not all the original slokas in 'devnagari' are listed. Most of the botanical/Latin/scientific names of species have not been italicized. (May be tried in next correction) A usual mistake during translation can be like use of general male tone like using 'he' to denote a person. It can be boring to a feminist. If s/he wants to make the reading comfortable s/he can replace those terms by proper feminist or neutral pronoun, in most of the times as long as the meaning does not get distorted. Some of the ideas may just be focused from the point of view of males, it should not be bothered, but there are some separate sections in Ayurveda which focuses on Female and child health called Kaumarbhrittya. (In ancient Ayurveda the word Purusha denotes anyone (male or female) who is the subject under consideration. However, Purusha in Nepali or Hindi general term denotes to male.) While using ideas in the book, it is good to take help from the Ayurveda scholar who has good level of knowledge and experience- so that we can prevent ourselves from wrong doing. While compiling this book, immense help from following webs and blogs were taken. We are thankful to them. o JV Hebber's Website http://www.learningayurveda.com/category/ashtangahrudaya/ o Tania Anvar's Blog http://ahsutrasthana.blogspot.com Better authentic books are available in book stores or in internet. This is just to share ideas, not to replace anything including professional advises or therapies. If there is anything you could do to help us first would be sending your feedback/comment. It needs some correction, which will be possible by your guidance. This is just an attempt to share knowledge. There can be some flaws which will be corrected in days to come, but there are a lot of interesting ideas in a simple English in this collection.

Live happily. Keep smiling. Be positive. Try your best. Keep loving yourself and others.