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ORIGINAL ARTICLE
Year : 2017  |  Volume : 38  |  Issue : 1  |  Page : 52-56  

Role of Agni Karma with Pippali on Kadara- An open labeled clinical trial


Department of Rachana Sharira, Saraswati Ayurved Hospital and Medical College, Punjab, India

Date of Web Publication20-Apr-2018

Correspondence Address:
Dr. Nitika Ganjoo
#2147 B, Block Number 9, CHB Flats, Sector 63, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ayu.AYU_196_17

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   Abstract 


Introduction: Ayurveda has a rich and comprehensive concept of life and health. Callosity is a French word meaning a local thickened or hardened part of the skin. It is a plaque of hyperkeratosis caused by repeated friction or pressure. It is assumed that frictional forces induce hyperkeratosis leading to thickening of stratum corneum of the skin over certain areas prone to mechanical stresses. Kadara, as described by the Samhitas, can be closely related to lesions of the skin caused by hyperkeratosis. Kadara has been enumerated and described in the classical literature under the heading of Kshudra Roga. Agni Karma has been mentioned for the proper management of Kadara. Aims and Objective: The management of Kadara is aimed at removal of the hyperkeratosis lesion by Agni Karma along with or without Shastra Karma. Material and Methods: Pippali has been mentioned as a Dahana Upakarna in Sushruta Samhita and Ashtanga Samgraha. It was a randomized, prospective, single-blind and clinical trial. Fifteen patients suffering from hyperkeratosis lesions were selected according to the conditions mentioned under inclusion and exclusion criteria and Agni Karma procedure was carried out for them. Assessment of the lesion was done before treatment and after 7 days and 14 days of treatment. Results and Observation: Based on the study, it was observed that Pippali can be used to create superficial burns only. The extent of tissue destruction due to burning with Pippali is very minimal. Hence, it was observed to be effective for treating superficial Kadara lesions. It was observed that eventually in 7 days the area of the lesion turned soft with reddish black discoloration. Softening of the lesion and its discoloration might be due to penetration of the volatile oil and active principles of Pippali into the affected area while doing the Agni Karma procedure. It was further observed that the area of lesion eventually dried and peeled off along with the Kadara tissue within about 15 days. Conclusion: Hence, Pippali was able to provide satisfactory results in case of superficial hyperkeratosis lesions.

Keywords: Agni Karma, cosmetology, hyperkeratosis lesions, Pippali Agni Karma


How to cite this article:
Ganjoo N. Role of Agni Karma with Pippali on Kadara- An open labeled clinical trial. AYU 2017;38:52-6

How to cite this URL:
Ganjoo N. Role of Agni Karma with Pippali on Kadara- An open labeled clinical trial. AYU [serial online] 2017 [cited 2019 Dec 5];38:52-6. Available from: http://www.ayujournal.org/text.asp?2017/38/1/52/230778




   Introduction Top


Ayurveda has a rich and comprehensive concept of life and health; taking into account all parts of human existence from the abstract transcendental value to its most concrete expressions in human physiology.

Callosity is a French word meaning a local thickened or hardened part of the skin.[1] It is a plaque of hyperkeratosis caused by repeated friction or pressure.[2] It is assumed that frictional forces induce hyperkeratosis leading to thickening of stratum corneum of the skin over certain areas prone to mechanical stresses. If these frictional forces are distributed over a broader area, a callus occurs.[3] In a callus, there is epidermal hyperplasia. The stratum corneum is thickened and compacted, sometimes with parakeratosis over the dermal papillae leading to expansion of the granular layer. The underlying dermis may show an increase in dermal collagen and fibrosis around the neurovascular bundles.[1]

Kadara as described in classical Ayurvedic literature can be closely related to lesions of the skin caused by hyperkeratosis. Kadara has been enumerated and described in the classical literature under the heading of Kshudra Roga.[4],[5],[6] However, meager this disease may seem to be, it has a major impact on the physical fitness and mental tranquility of the patient.

Ayurvedic classics have advocated the use of various procedures to treat Kshudra Roga. Agni Karma has been mentioned for the proper management of Kadara.[7],[8],[9] The management of Kadara is aimed at removal of the hyperkeratosis lesion by Agni Karma along with or without Shastra Karma. Agni Karma can be done using different types of instruments depending on the nature of disease and the site of lesion. Some of the instruments include Pippali, Aja Shakrita, Godanta, Kshara, Shalaka, Jambvoushtha, Ghrita, and Majja.[10]

Agni has been considered superior among the Anushastras for possessing fast action and permanent cure. It has been attributed the quality of curing the diseases which cannot be cured by other therapeutic measures such as surgery treatment with Kshara and medicinal management.

Pippali has been mentioned as a Dahana Upakarana in Sushruta Samhita[10] and Ashtanga Hridayam.[11]Pippali had been chosen for this study as it is one of the Dahana Upakarana mentioned for skin lesions and also because it contains oleaginous, antibacterial and antifungal chemical constituents besides being available in abundance at cheap rates. Pippali contains coumaperine, N-5-(4-hydroxy-3-methoxyphenyl)-2E-pentenoyl piperidine, piperolactam A, 1-[1-oxo-5 (3,4-methylenedioxyphenyl)-2E,4E-pentadienyl]-pirrolidine, 1-[1-oxo-5 (3,4-methylenedioxyphenyl)-2E-pentenyl]-pirrolidine, 1-[1-oxo-9 (3,4-methylene dioxyphenyl)-2E, 8E-nonadienyl]-pyrrolidine, (R) -turmerone, octahydro-4-hydroy-3alpha-methyl-7-methylene-alpha-(1-methylethyl)-1H-indene-1-methanol, (+)-aphanamol I, bisdemethoxycurcumin and demethoxycurcumin.[12] Apart from this, Agni Karma also helps in controlling the bleeding. There would be less pain as the nerve fibers are destroyed by Agni Karma. Chances of infection are also less as Agni Karma itself is a sterile procedure.

Acharya Sushruta described Agni Karma as a parasurgical procedure and mentioned it as superior among all parasurgical procedures.[13]Agni Karma Vidhi Adhyaya has been mentioned in Sutra Sthana.[14]Agni Karma has also been elaborated under the context of Agropaharaniya[15] as Upayantra[16], Anu Shastra[17], for Kanthagata Shalya Nirharana[18], one of 60 Upakarma of Vrana[19], for the treatment of Vata Vyadhi[20], Ashmari[21], Bhagandara[22], Pleehodara[23] etc. Many references are available in Sushruta Samhita regarding Agni Karma.


   Materials and Methods Top


Source of data

Subjects

Patients who were found to be suffering from hyperkeratosis lesions of the skin were screened. Among them, 15 patients fulfilling the inclusion criteria of the study were taken irrespective of sex, religion, marital status, socioeconomic status and occupation. Detailed history taking and physical examination were carried out for these patients. Relevant data along with an elaborate assessment of the lesion, pain and tenderness were taken note of in the case proforma specially designed for the study.

Inclusion criteria

  1. Patients of age 16–60 years
  2. Patients irrespective of sex, religion and occupation
  3. Patients having hyperkeratosis lesions/Kadara.


Exclusion criteria

  1. Patients contraindicated for Agni Karma.[24] For example, pregnant women, children, old aged, individuals suffering from Antahashonita, Raktapitta, Anudhruta Shalya, Bhinna Koshta, Aneka Vrana Peedita, Trishna, Jwara, Netra-Vrana, Kushtha Vrana, Vishajushta, Aswedya- like Pandu, Pramehi, Kshayarta, Kshama, Ajeerni, Udara Rogi, Chardi Peedita, Madya Peeta and Atisari
  2. Patients having any serious systemic disease
  3. Pregnant women, children and patient aged below 16 years and above 60 years.


Research design

It was a randomized, prospective, single blind, clinical trial. Fifteen patients suffering from hyperkeratosis lesions were selected according to the conditions mentioned under inclusion and exclusion criteria and Agni Karma procedure was carried out for them.

Assessment criteria

The subjective and objective parameters before the procedure and post procedure were analyzed, recorded, and compared for assessment of the results. Following this, the outcome was analyzed statistically.

Subjective criteria:

Table 1: Mc. Gill's Questionnaire Rating Scale for pain

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Objective criteria

Table 2: Dr. Frank Painter's grading for soft-tissue tenderness

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The assessment was made on the basis of improvement in signs and symptoms for which suitable scores were assigned.

Therapeutic intervention

Agni Karma with Pippali Treatment was done in a single sitting.

Follow up

Assessment of the lesion was done before treatment, after treatment, 7 days and 14 days after treatment.

Duration

The total duration of the study was 15 days. Results were statistically analyzed and assessed after treatment and on 14th day after treatment.

Procedure

Purva Karma (pre-operative procedure)

Initially, all the materials required for the procedures were collected [Figure 1] and written consent of the patient was taken after duly explaining the details of the treatment procedure. The patient was made to assume a comfortable position over the minor OT table, as per the site of the lesion. Then the site of lesion was cleaned properly with distilled water.
Figure 1: Materials required (Purav Karma)

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Pradhana Karma (main-operative procedure)

Then, the area was moped, dried and draped in a sterile towel. The nursing assistant was told to firmly hold the body part as per need of the individual case. Then the site of the lesion was gently scraped with the help of a sterile surgical blade; until the area was made raw. Then the Pippali was heated to red hot and directly placed over the lesion [Figure 2]. The Pippali was reheated and reapplied to the lesion. The Dahana procedure was stopped when the Samyaka Dagdha Lakshanas were observed and there was complete hemostasis.
Figure 2: Pippali Agni Karma (Pradhan Karma)

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Pashchat Karma (post-operative procedure)

Following this, a mixture of Ghrita and Madhu was applied over the site of Agni Karma. The patient was advised to rest in the supine position for half an hour and was advised to go home and to keep the area clean and dry.

After treatment regarding the changes in the symptoms lesion were recorded in the case proforma, especially designed for the study.


   Results Top


An assessment of pain in patients of hyperkeratosis lesions/Kadara showed a reduction in the mean score from 2.467 to 1.667 after the treatment and further to 0.333 after follow-up with an improvement of 32.43% and 86.50%, respectively. It was found to be statistically highly significant (P< 0.001) [Table 3].
Table 3: Effect on pain

Click here to view


An assessment of Tenderness in patients of hyperkeratosis lesions/Kadara showed reduction in the mean score from 2 to 1.333 after the treatment and further to 0.133 after follow-up with an improvement of 33.35% and 93.35%, respectively. It was found to be statistically highly significant (P< 0.001) [Table 4].
Table 4: Effect on tenderness

Click here to view



   Discussion Top


Ayurveda being a medical science is formulated on the scientific parameters available. This study was aimed at re-establishing old facts while contemplating newer ideas and comparing their relative efficacy in Kadara.

Pippali has been mentioned as one of the Dahana Upakarna in the classical literature. It has been mentioned to be effective in conditions where the lesion is situated in the superficial layers of skin. For the purpose of Agni Karma, dried fruit of Pippali (Piper longum L.) is used.

When heated properly, this Pippali attains an average temperature ranging from 55°C–60°C. As soon as it is removed from fire, it immediately dissipates 10°C–12°C heat; followed by heat dissipation at the rate of 20°C/min.[25]

Pippali was selected for Agni Karma due to the following reasons:

  1. Kadara has been considered as a Vatadosha Pradhana Vyadhi. Pippali contains Snigdha and Tikshana Guna. Due to the Snigdha Guna, it shows Vatahara properties and Tikshana Guna promotes better penetration of the active principles into the skin
  2. When Pippali is used for Agni Karma; essential oil present in it evaporates from the burning surface in the form of fumes. When this red-hot fuming Pippali is touched to raw skin surface, the fumes condense over the tissue and the essential oil containing various active principles of the plant penetrates deeper into the skin. These eventually cause discoloration, drying and peeling off of the diseased tissue; hence healing the surface lesion
  3. Pippali contains essential oils that have been proven to exhibit antibacterial and fungicidal activity [26]
  4. The Adhisthana of the disease Kadara is the skin tissue; hence, Pippali proved effective to treat superficial hyperkeratosis/Kadara lesions.


Based on the study, it was observed that Pippali can be used to create superficial burns only. The extent of tissue destruction due to burning with Pippali is very minimal.

It was observed that Pippali as a Dahana Upakarana was able to produce a superficial physical burn due to its property of being able to attain and maintain only a lower range of temperature. However, it was observed that eventually within 7 days the area of the lesion turned soft with reddish-black discoloration. This might be due to penetration of the volatile oil and active principles of Pippali into the affected area while doing the Agni Karma procedure. It was further observed that the area of lesion eventually dried and peeled off along with the Kadara tissue within about 15 days.

Hence, Pippali Agni Karma was observed to be effective in treating superficial hyperkeratosis over the elbows, knuckles, lateral aspect of ankle, foot and hands. Besides this, the therapy did not left scar or disfigured the skin and produced cosmetically good results.


   Conclusion Top


The study concludes that Pippali Agni Karma can be used as an effective cosmetology procedure for the treatment of superficial hyperkeratosis lesions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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