Agnikarma Criticle Review

A CRITICAL ANALYSIS OF AGNIKARMA W.S.R.
TO
MANAGEMENT OF KADARA
BY
DR. MANOJ KUMAR SINGH
B.A.M.S
DISSERTATION SUBMITTED TO
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
In Partial fulfillment of the Regulations for the award of the Degree of
MASTER OF SURGERY (Ayurveda)

IN
SHALYA TANTRA
Under the Guidance of
Dr. SRINIVAS K. BANNIGOL.

M.D. (Ayu)
PROFESSOR AND HEAD

DEPARTMENT OF POST-GRADUATE STUDIES IN SHALYA TANTRA
AYURVEDA MAHAVIDYALAYA, HUBLI.
Co-Guide
Dr. C.THYAGARAJA.
M.S. (Ayu)
ASST.PROFESSOR
DEPARTMENT OF POST-GRADUATE STUDIES IN SHALYA TANTRA
AYURVEDA MAHAVIDYALAYA, HUBLI.
DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA

AYURVEDA MAHAVIDYALAYA, HUBLI
2011-2012
i
RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A CRITICAL
ANALYSIS OF AGNIKARMA W.S.R. TO
MANAGEMENT OF KADARA” is a bonafide and genuine
research work carried out by me under the guidance of. DR. S.
K.BANNIGOL in PROFESSOR AND H.O.D Department of Post Graduate
Studies Shalya Tantra, AYURVEDA MAHAVIDYALAYA, HUBLI.
Date:
Place: Hubli

P.G. SCHOLAR
DEPARTMENT OF POST-GRADUATE
Studies in Shalya Tantra
AYURVEDA MAHAVIDYALAYA,
HUBLI, KARNATAKA
DEPARTMENT OF POST GRADUATE STUDIES IN

SHALYA TANTRA
ii
SHALYA TANTRA
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A CRITICAL

MANAGEMENT OF KADARA” is a bonafide research work
done by DR. MANOJ KUMAR SINGH under the guidance of DR. S.
Studies Shalya Tantra, AYURVEDA MAHAVIDYALAYA, HUBLI.
Date:
Place: Hubli
H.O.D
Dr. S. K. BANNIGOL
M.D. (Ayu),
In PROFESSOR AND H. O.D
Department of Post Graduate Studies Shalya Tantra
Ayurveda Mahavidyalaya, Hubli, Karnataka -580024
iii
SHALYA TANTRA
CERTIFICATE BY THE CO-GUIDE
MANAGEMENT OF KADARA” is a bonafied research work
done by DR. MANOJ KUMAR SINGH in partial fulfillment of the
requirement for the degree of DOCTOR OF SURGERY
(AYURVEDA) in SHALYA TANTRA.
Date:
Place: Hubli
CO - Guide
Dr. C. THYAGARAJA
M.S. (Ayu),
ASST- PROFESSOR
Department of Post Graduate Studies Shalya Tantra
Ayurveda Mahavidyalaya, Hubli, Karnataka
iv
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE
INSTITUTION

Certificate
MANAGEMENT OF KADARA” is a bonafied research work
done by DR. MANOJ KUMAR SINGH under the guidance of DR. S.
Studies Shalya Tantra, Ayurveda Mahavidyalaya, Hubli.
H.O.D PRINCIPAL
DR. SRINIVAS K. BANNIGOL DR.S. J. DESHPANDE
M.D. (Ayu), Ayurveda Mahavidyalaya,
PROFESSOR AND HEAD HUBLI, KARNATAKA
Department of Post-Graduate studies
Shalya Tantra, Ayurveda
Mahavidyalaya, Hubli
DATE: DATE:
PLACE: HUBLI PLACE: HUBLI
v
SHALYA TANTRA
COPYRIGHT DECLARATION BY THE

CANDIDATE
DR. MANOJ KUMAR SINGH, hereby declare that the Rajiv Gandhi
University of Health Sciences, Karnataka shall have the rights to
preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.
Date:
Place: Hubli
P.G. SCHOLAR
DEPARTMENT OF POST-GRADUATE
Studies in Shalya Tantra
AYURVEDA MAHAVIDYALAYA,
HUBLI, KARNATAKA
© Rajiv Gandhi University of health sciences, Karnataka
vi
SHRI DHANVANTAREYE NAMAH

CONTENTS vii
CONTENTS
ACKNOWLEDGEMENT
ABBREVATIONS
ABSTRACTS
LIST OF TABLES
LIST OF GRAPHS
LIST OF FIGURES
PART 1
1. Introduction………………………………………………… 1–3
2. Objectives and Previous work done……………………… 4–5
3. Review of Literature……………………………………….. 6 - 38
HISTORICAL REVIEW……………………………………. 6–7

AYURVEDIC REVIEW……………………………………………. 8 - 27
Modern Review…………………………………………….... 28 - 38
PART 2
4. Methodology……………………………………………….. 39– 55
PART 3
5. Observations ………………………………………………. 56 - 82
6. Results…………………………………………………….. 83 - 92
7. Discussion………………………………………………….. 93 – 106
8. Conclusion…………………………………………………. 107 – 109
9. Summary…………………………………………………… 110– 112
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”

CONTENTS viii
10. Bibliographic References…………………………………... 113- 118
11. Annexure…………..……………………………………….. i – xi

ACKNOWLEDGEMENT IX
ACKNOWLEDGEMENT
First I pray to the almighty God, because God is omniscient and supreme
power. Who is all-pervading the opportunity to me. I offer my prayer to Lord
Dhanwantari, the God of Ayurveda and add this small endeavor of my dissertation to
the ever green knowledge of Ayurveda.
Parents Are The Representatives Of God On Earth. First And Foremost I
Express My Deep Sense Of Gratitude To My Parents Shri Lal Bahadur Singh And
My Mother Mrs.Savitri Singh And Also To My small Brother Dr.Manish Kumar
Singh,and her wife Dr. Nisha singh . I Express My Humble and Heartily Gratitude to
My Beloved Wife Amrita Singh And My Son Sakshi And Pranav Singh. Whose
Lovable and Inspiring Manner Were Key Factors of My Success and Progress. My
Potential Has Been Always Appreciated To Its Best By Them In Their Unique
Disciplined Way. Who Are The Best Advisors And Criticizers Of My Career If I
Could Earn A Drop Of Knowledge It Is Solely Because Of Their Meticulous
Background And Strapping Moral Support.
At this landmark of thesis completion. The unfathomable world of medicine with
as many possibilities and immeasurable boundaries poses an un-navigable path to a
novice. Since the day I set my foot into DR.S.K.BANNIGOL PROFESSOR &
H.O.D. SHALYA TANTRA DEPT and my beloved Guide has been my MENTOR.
The founder of this Dissertation, his relentless support and valuable inputs during
the entire period of the research work helped me and see the fruition of my dreams.
I am really grateful to my Co-Guide Dr C.Thyagaraja for his untiresome guidance
throughout the study.
I wish to propose my sincere thanks to Dr.S.J.Deshapande Principal,
Ayurveda Mahavidyalaya, Hubli, for the encouragement and support.

ACKNOWLEDGEMENT X
I thank to Dr S.A.Patil, Dr. Prabhu, Dr.Deepak, Dr.Srivatas,Dr.
Manjunath Naik for their friendly co-operation. My special thanks to Dr. Mahesh
Desai for his support in analysis of Statistical Data and also helping me in
interpretation of statistical data.
My Heartiest gratitude to my beloved and revered teachers
Dr.P.G.Subbanagouda, Head of K.C Dept, Dr.M.A. Hullur and Dr.A. S
Prashant for their guidance and timely help throughout my studies. My sincere
thanks to Dr. A.I.Sanakal HOD of Panchakarma Dept. for his constant support and
encouragement given to me and rectifying my mistakes. My sincere thanks to
Dr.J.R.Joshi HOD of Siddhanta Dept. for his constant support in the entire
research work. I am extremely grateful to Dr. B. B. Joshi, and Dr.Pradeep
Agnihotri, and Dr. Anita, for there valuable guidance.
I am much indebted to my senior friends Dr. Reshma, Dr. Ravi, Dr. Sunil
Roy, Dr. Dhanvantari, Dr. Sivakumar, Dr. Rahul, Dr. Gireesh Dr.
Madhusudhan, Dr. Piyush, Dr. Suhail, Dr. Praveen, Dr. Keshav, Dr. Anil, their
supportive guidance helped me a lot to overcome the device of hindrances in my
research work, let it be physical or intellectual.
I need to thank my esteemed colleagues, Dr. Alok, Dr. Ragavendran, Dr.
Hari Dr. Rohini, Dr. Yogesh and Dr.Markandeya and juniors Dr. Santosh, Dr.
Sanmmuka, Dr. Ritesh, Dr. Ranjeet and all my juniors for similar favors they had
rendered throughout my research study, which is worth to be enumerated or repaid.
I would like to thank my juniors of all the Post Graduate Departments for their
supportive nature, especially to Dr.Paritosh Bhatt for his valuable inputs in
dissertation.

ACKNOWLEDGEMENT XI
It is my pleasure to thank Mr.Rajashekar Librarian, PG Library Mr
Prashanth Librarians of UG Library, Mr.Kolyal, Lab technician and nonteaching
staff specially Mr Prabhakara Kulkarni.
I am thankful to Sunil Kumar Gupta and Students of second professional
BAMS, College and Hospital staff of our college.
To many I wish to express my thanks, especially to all my patients, whose
participation and attentive following of instructions regarding treatment accounts a lot
in success of my research work.
PLACE: HUBLI

ABBREVATIONS xii
ABBREVIATIONS
• A. H. - Ashtanga Hrudaya
• A. H. Sa. - Ashtanga Hrudaya Shareera Sthana
• A. H. U. - Ashtanga Hrudaya Uttara Sthana
• A. K. - Amara Kosha
• A. S. - Ashtanga Sangraha
• A. S. Sa. - Ashtanga Sangraha Shareera Sthana
• A. S. Su. - Ashtanga Sangraha Sutra Sthana
• A. T. - After Treatment
• A. V. - Atharvaveda
• B. L. - Balley and Love’s Short Practice of Srugery
• B. P. - Bhavaprakasha
• B. P. N. - Bhavaprakasha Nighantu
• B. P. Pu. - Bhavaprakasha Purvardha
• B. R. - Baishajyaratnavali
• B. S. - Bhela Samhita
• Bh. S. - Bhoja Samhita
• B. T. - Before Treatment
• B.Y.T. - Brihat Yoga Tarangini
• C. D. - Chakradatta
• Comm. - Commentary
• Cha. S. - Charaka Samhita
• Cha. S. Sa - Charaka Samhita Shareera Sthana
• Chi. - Chikitsa Sthana
• D. I. M. - Dorlands Illustrated Medical Dictionary

ABBREVATIONS xiii
• Dal. - Dalhana
• D.C.P. - Dravyaguna Vignan Continental Prakashana
• G.N. - Gada Nigraham
• J. M. - Jata Kamala
• Kal. - Kaipa Sthanam
• M. N. - Madhava Nidana
• M.M.W. - Minier & Moner Williams’s Dictionary
• Ni. - Nidana Sthana
• P. - Probability
• R. R. S. - Rasa Ratna Samoochaya
• R. T. - Rasa Tarangini
• R. V. - Rigveda
• S. D. - Standard Deviation
• S. E. - Standard Error
• S. H. - Sringarahata
• S. K. D - Shabdha Kalpa Druma
• S. M. D. - Stedman’s Medical Dictionary
• S. S. - Sushruta Samhita
• S. S. M. - Shabdha Stoma Mahanidhi
• S. S. N. - Sushruta Samhita Nidana Sthana
• S. S. Sa. - Sushruta Samhita Shareera Sthana
• S. Y. - Sahasra Yoga
• Sa. S. - Sharangadhara Samhita
• Sa. S. P. K. - Sharangadhara Samhita Pradhama Kanda
• Sha. - Shareera Sthana

ABBREVATIONS xiv
• Sh. M. - Sharngadhara Samhita Madhyama Khanda
• Sh. Pu. - Sharngadhara Samhita Purva Khanda
• Si. - Siddhi Sthana
• Su. - Sutra Sthana
• Vi. - Vimana Sthana
• Vi.Pu. - Vishnu Purana
• V. S. - Vangasena Samhita
• Y. M. - Yoga Mruta
• Y. R. - Yoga Ratnakara
• Y. S. - Yogaratna Samuchaya
• Y. V. - Yajurveda

ABSTRACT xv
ABSTRACT
Kadara is a Kshudra roga. It is characterized by hard granthi type swelling; it
gives pain and discomfort on pressure. The disease Kadara even though is not life
threatening, but makes the life of the sufferer more miserable, Patients are running from
Pillar to Post to get rid from this disease. Kadara can be correlated to corn of modern
medical science. The management of corn in modern medical science is application of
corn caps and surgical excision. But by these procedures the results are not satisfactory as
chance of reoccurrence is very common. So keeping these draw backs of Modern
Medicine treatment in view this comparative clinical study, Agni karma procedure and
surgical excision was selected to give new dimension in the management of Kadara roga.
In the present study total 30 subjects were selected, and randomly divided into
two Groups. In Group A 15 subjects were treated by Agni karma procedure and Jatyadi
gruta and Triphala Guggulu and 15 subjects in Group B were treated by Surgical excision
and Betadine and diclofenac. In Group A, excision of Kadara is done by Red-hot Pancha
Loha Shalaka and immediately Jatyadi Gruta was applied. And in Group B, Surgical
Excision of Kadara around was done by Brad parker surgical blade, and immediately
Betadine was applied. In Group A internally Triphala Guggulu 2 tab tid for 5 days with
Luke warm water after food was given. And In Group B for 5 days internally Diclofenac
50 mg bid for5 days with Luke warm water after food was given. Each patient was
followed up to 60th day of the procedure, to observe and note any recurrence

ABSTRACT xvi
After completion of clinical trial it was found that by Agni karma procedure there was
highly significant results were found in parameters like pain, bleeding, infections and
healing period. Whereas by surgical excision there was more pain, bleeding and infection
was observed. Healing period was also more in surgical excision and there was no
reoccurrence by Agnikarma procedure, but surgical excision reoccurrence was observed
in 7 patients. By these results it can be concluded that Agnikarma has shown better
results when compared to surgical excision in the present study.
KEY WORDS:
Kadara, Corn, Agni karma procedure, Pancha loha Shalaka, Surgical excision,
Jatyadi gruta, Triphala Guggulu, Betadine Solution, Tab Diclofenac 50 mg.

LIST OF TABLES xvii
LIST OF TABLES
TABLE
NO CONTENTS PAGE NO
Table Showing kshirpa marma 9
1.
Table Showing tala hridaya 10

2.
3. Table Showing kurcha marma 11

Table Showing kurcha sira 12
4.
Table Showing Paryayas (Synonyms) 13

5.
Table Showing different Dahanaupakarana as mentioned in 20

6.
various texts:
7. Table Showing indication of Agni Karma in various diseases 22
Table Showing Contra Indication for Agni karma 25
8.
Table showing differences between corn & callosity 36

9.
10. Table Showing the Properties of Ingredients of Triphala Guggulu 41

11. Table Showing Jatyadi Ghruta 43
12. Table Showing Composition of Jatyadi Ghruta 44
13. Table Showing Age wise distribution 56
14. Table Showing Sex wise distribution 57
15. Table Showing Religion wise distribution 57
16. Table Showing Marital Status wise Distribution 57
17. Table Showing Education wise distribution 58
18. Table Showing Occupation wise distribution 58
19. Table Showing Economic status wise distribution 59
20. Table Showing Dietary Habit wise Distribution 59
21. Table Showing Habitat wise distribution 59
22. Table Showing Agni wise distribution 60
23 Table Showing prakruti wise distribution 60

LIST OF TABLES xviii
24 Table Showing Koshta wise distribution 61

25 Table Showing Pradhana Rasa wise distribution 61
26 Table Showing Sara wise distribution 62
27 Table Showing Samhanana wise distribution 62
28 Table Showing Satwa wise distribution 63
29 Table Showing Satmya wise distribution 63
30 Table Showing Deha Bala wise distribution 64
31 Table Showing Chronicity wise distribution 64
32 Table Showing Showing Incidence of pain in 30 patients 65
33 Table Showing Incidence of Severity of pain in 30 patients 65
34 Table Showing McGill Pain Index Score Group A (Agni karma) 66
35 Table Showing Average McGill Pain Index Score 66
Table Showing McGill Pain Index Score Group B (Surgical 67
36
Excision)
37 Table Showing Average McGill Pain Index Score 67
Showing Incidence of Raktasrava during Agnikarma/ Surgical 68
38
Excision
39 Table Showing Incidence of Sankramana 68
40 Table Showing Incidence of Ropana Kala 69
41 Table Showing Incidence of Sparsana. 70
42 Table Showing Incidence of Recurrence. 70
Table Showing the comparative reduction in Pain at the end of 83
43
the treatment in the groups based on McGill’s Pain Index score.
Table Showing Overall Relief of Pain at the end of 15 days of 83
44 treatment in Group A & Group B after Agnikarma/ Surgical
Excision by McGill’s Pain Index score.
Table Showing the Comparison between Group A and Group B 84
45 in Relief of Pain end of 15 days of treatment according to
McGill’s Pain Index score.
Table Showing Incidence of Raktasrava in Agni karma(Group A) 84
46 and Surgical excision(Group B).
Table Showing the comparative Raktasrava at the end of the 15 85

47
days treatment in the groups.

LIST OF TABLES xix
Table Showing Overall Rakta srava at the end of 15 days of 85

Excision.
Table Showing Analysis of variance in Raktasrava in Group A & 86
49
Group B after Agnikarma/ Surgical Excision.
Table Showing Sankarmana (Infection) after Agni karma and 86
50
Surgical excision.
Table Showing the comparative Sankramana at the end of the 15 87
51
days treatment in the groups.
Table Showing Overall Sankramana at the end of 15 days of 88
Excision.
Table Showing Analysis of variance in Sankarmana in Group A 88
53
& Group B after Agnikarma/ Surgical Excision.
54 Table Showing Ropana Kala. 89
Table Showing Overall Ropana kala in Group A & Group B after 89
55
Agnikarma/ Surgical Excision.
Table Showing Analysis of variance in Ropana kala in Group A 90
56
& Group B after Agnikarma/ Surgical Excision.
57 Table Showing Incidence of Recurrence. 90
Table Showing Analysis of variance in Recurrence in Group A & 91
58
Group B after Agnikarma/Surgical Excision.
Table Showing overall effect of therapy in 15 patients who have 91
59
undergone Agni Karma in Group A.
Table Showing overall effect of therapy in 15 patients who have 92
60
undergone Surgical Excision procedure in Group B.
Table Showing Comparison between agnikarma and surgical 106
61
excision of kadara.

LIST OF GRAPHS
LIST OF GRAPHS xx

GRAPH CONTENTS PAGE NO

NO
71
1 Graph showing Age wise distribution
2 Graph showing Sex wise distribution 71
Graph Showing Religion wise distribution 71

3
Graph Showing Marital status wise distribution 72

4
Graph Showing Educational status wise distribution 72

5
Graph Showing Occupation wise distribution 72

6
Graph Showing Socio Economic status wise distribution 73

7
Graph Showing Dietary Habit wise Distribution 73

8
Graph Showing Habitat wise distribution 73

9
Graph Showing Agni wise distribution 74

10
Graph showing Prakruti wise distribution 74

11
Graph Showing Koshta wise distribution 75

12
Graph Showing Pradhana rasa wise distribution 75

13
Graph showing Sara wise distribution 76

14
Graph showing Samhanana wise distribution 77

15
Graph showing Satwa wise distribution 77

16
Graph showing Satmya wise distribution 77

17
LIST OF GRAPHS xxi

Graph showing Deha Bala wise distribution 78
18
Graph Showing chronicity wise distribution 78

19
Graph Showing Incidence of pain in 30 patients 79

20
Graph showing Incidence of Severity of pain in 30 patients 79

21
Graph showing Group A Average McGill Pain Index Score 79

22
distribution
Graph Showing Group B Average McGill Pain Index Score 80

23
Graph Showing Incidence of Raktasrava 80

24
Graph Showing Incidence of Sankramana 80

25
Graph Showing Incidence of Ropana Kala 81

26
Graph Showing Incidence of Sparsana 81

27
Graph Showing Incidence of Recurrence 82

28
INTRODUCTION 1
INTRODUCTION
Shalya Tantra has been hailed as the most important branch of Ayurveda. The
uniqueness of Shalya Tantra is due to the availability of dual treatment procedures i.e.
shastra karma (surgical procedures) and Anushastra karma (Para surgical procedures).
Further shastra karma is of eight types and Anushastra karma includes Ksharakarma,
Agnikarma and Raktamokshana.
Amongst Anushastra karma, Agnikarma is unique because of its simple
technique and optimum result. By this technique various diseases are treated
successfully without recurrence. Kadara is a Twak Roga where Agnikarma is
indicated.
Kadara is a Kshudra Roga. But gives more trouble for the patient and
intervenes with routine work. The disease is characterized by formation of hard
swelling in soles and palms. The management Kadara is aimed at removal of swelling
by Agnikarma and/or by shastra karma. Kadara has been correlated to the disease corn
as described in modern medical science.
Skin is the largest organ of the body. It forms the protective layer over the
body. Apart from other functions, it shields internal parts of the body from injury. As
Skin is the outermost layer it is exposed to the hazards of environmental factors. Chief
hazards of the environment are friction, trauma, heat, cold and radiation. The skin can
well protect itself from these agents normally. But due to genetic causes and if the
environmental factors are too strong it may result in the development of certain
skin lesions. Sometimes the patient would develop lesions even if he is exposed to a
minimal intensity of the environmental agent. The protective function of skin is called
upon more effectively in region of feet and palms. As these parts are more prone to
trauma.

INTRODUCTION 2
In India where 80% of the population lives in the villages and engaged in
mainly manual labor either for farming, construction and such other means of
livelihood. Chances of trauma is common due to poor protective measures
practiced by these people, due either to ignorance, negligence or poor economic
status. Even in the urban population, wearing of defective footwear and negligence of
foot care leads to various foot lesions. The common lesion seen in the foot is Corn. A
corn is a localized hyperkeratosis with a hard centre caused by undue pressure. The
management of Corn consists destruction of abnormal tissue by chemicals like
salicylic acid or by total excision under local anesthesia. Both these procedures are
not giving good result and are not devoid of recurrences. Apart from recurrence,
bleeding, pain and post excision infections are observed frequently.
To prevent recurrences due to remnants of the corn tissue Agnikarma is
adopted after excision. In Ayurveda also excision is advised followed by Agnikarma
by hot oil. The pilot study in this condition has revealed that Agnikarma by Pancha
loha Shalaka in kadara has encouraging results. In this work an attempt is made to
find out the efficacy of Agni karma by Pancha loha Shalaka in the management of
Kadara (Corn).
Agni karma by Pancha loha Shalaka is selected for the present study as
logically it should help in better prevention from recurrence by destroying the tissue
due to its direct heat. Apart from this it also helps in controlling the bleeding. There
will be less pain as the nerve fibers destroyed by Agni karma. Chances of infection
are also less as Agni karma itself being a sterile procedure.
In the present study the Agnikarma procedure was critically analyzed to
suggest standard guidelines for this procedure. The efficacy of Agnikarma procedure
on kadara is compared with modern of conventional method of Corn Excision to
evolve a simple, safe and effective remedy for Kadara.

INTRODUCTION 3
In the present study the patients suffering from Kadara lesion over the sole are
selected. The patients were randomly categorized in to two groups. Patients of one
group were subjected for Agni Karma by specially designed Pancha Loha Shalaka and
patients of other group were subjected for surgical excision. Results were compared
after follow up of three months.
There are three parts in this dissertation,
¾ Part 1- It deals with the Introduction, Objectives, and Literary Review.
¾ Part 2- It deals with the Methodology.
¾ Part 3- It deals with Observation Results, Discussion, Conclusion,
Summary.
The observation and results obtained from the clinical study have been
analyzed statistically to evaluate the significance of the curative properties of
therapies. The section of discussion includes the appraisal of the results obtained from
the clinical studies. The study has been concluded with the summary and conclusion
of the entire work.

OBJECTIVES OF THE STUDY 4
OBJECTIVES OF THE STUDY
The present work has been undertaken with the objectives of ascertaining
therapeutic effect of Agni karma and surgical excision in the management of Kadara.
Agni karma procedure as described in Ayurvedic texts has been compiled and effort
has been made to evolve guidelines for standard Agni karma procedure in Kadara.
During the study, the available literature in Ayurvedic and modern medical books
with regards to Kadara and Corn has been compiled and critically analyzed. This can
be helpful for one to understand the physiopathology of the kadara and to evaluate the
efficacy of the procedures in a better way. Taking these factors into consideration,
various objectives of the study can be enumerated as following;
1. To review and analyze available literature of Agnikarma in Ayurvedic
Texts.
2. To review and analyze available literature of kadara and its treatment in
Ayurvedic Texts.
3. To review and analyze available literature of Corn in Modern Medical
science.
4. To evaluate the efficacy of Pancha loha Shalaka in the management of
kadara in comparison with Surgical Excision.

PREVIOUS WORKS DONE 5
PREVIOUS WORKS DONE ON KADARA
1. Dave D.S – Kadara Nidana Chikitsatmaka Adhyana Gujarat ayurved
University Jamnagar, 1979.
2. Chandra Kumar G- A Comparative Study of Agnikarma with Electrical
cautery in the Management of Kadara, GAMC, Bangalore, 1985.
3. Nimblkar sangitu R- Agnikarma chikitseche Upayogitva kadara ek Abhyas,
R.K Toshaniwal Ayurveda Mahavidyalaya, Amaravathi University,
Akola.1995.
4. Subha K.P- A study on efficacy of various Agnikarma in Kadara, Govt.
Ayurveda College, Karala University, thiruvananthapuram, 1995.
5. Sharma R,C- Kadara meni Agnikarma ki karmukata, National Institute of
Ayuveda, Rajasthan University, Jaipur, 1997.
6. Shankar S – A clinical study on the management of Kadara (corn) with
pratisaraneeya kshara, S.N.K Jabshetty Ayurveda Medical College,
R.G.U.H.S, Bidar, 2006.

HISTORICAL REVIEW 6

HISTORICAL REVIEW
History tells us about the past and shows path for future. History reveals the
development and evolution of the mankind. It helps to reveal hidden facts and ideas of
concerned subject. The above statement apparently defines the need for a thorough
historical review prior to dealing with the subject matter.
For convenience, the historical review is done under the following headings:
I PREVEDIC PERIOD (Before 8000 B.C):
No reference is traced regarding description of Agni karma and Kadara.
II VEDIC PERIOD (2500BC-1000BC):
The Vedas are the oldest recorded documents of knowledge and also
considered as literature of history of human kind. In all the Vedas Kadara
disease description is not available. Atharva Veda which has been termed as
precursor of Ayurveda, we find the description of application of torch (light)
to the bite of serpent. Perhaps this can be taken as a method of Agni karma.1
III SAMHITA PERIOD (1000BC-100AD):
Samhita Period was the golden era for Ayurveda. In Sushruta Samhita detail
description of Nidana, Samprapti, Lakshana and chikitsa of Kadara is available.
a) Sushrutha Samhita (1000-800 B.C): -
Acharya Sushrutha has explained about Kadara in 13th chapter i.e. Kshudra
roga in Chikitsa Sthana2. Acharya Sushrutha explained about agnikarma in 12th
chapter i.e. Agnikarmavidhya in Sutra Sthana, 3
b) Charaka Samhita (1000 B.C): -
Acharya Charaka has not devoted a separate chapter on Agnikarma. Acharya
Charaka has not explained about Kadara.

HISTORICAL REVIEW 7

IV SANGRAHA PERIOD (800AD-1700AD):
a) Astanga Sangraha- Agni karma is explained in Sutra Sthana 40th Chapter
Agni karma vidhiadyaha.4 Kadara is explained in Uttara Sthana 36th chapter
Ksudraroga Vijnaniya.5
b) Astanga Hridaya- In Uttara Sthana 31th Chapter of Kshudra roga
vigyaniydhyay explained about Kadara6 and 32th Chapter of Uttara Sthana
explained about chikitsakarma.7 Agni karma is explained in 30th chapter
Ksharagnikarma vidhi in shutra sthana.8
c) Sarangdhara Samhita- In 7th Chapter explanation of Kadara is available.9
d) Yogartnakara- In kshudra roga Yogartnakara explained about Kadara
Lakshana10 and its chikitsa.11
e) Bhavaprakash- In Uttarardha part II, 61st Chapter kshudra rogadhikada
lakshana12 and Chikitsa of Kadara is explained.13
f) Madhava Nidana- Kadara roga is explained in 55th Chapter i.e. Kshudra roga
Adhyaya.14
g) Bhoja Samhita- Kadara roga is explained. Kadara is denoted by sarkara and
kandakam.15
h) Sringarahata16 and Jatakamala have explained about kadara roga by denoting it
by Kina.17
V ADHUNIKA KALA (1700AD):
a) Bailey And Love’s – Short Practice of Surgery explained about Corn and it’s
Management.18
b) S Das- A Concise Text Book of Surgery explained sign and symptoms and
treatment of the Corns.19
c) Manipal Manual of Surgery –Corn signs, symptoms and treatment has been
explained.20

AYURVEDIC REVIEW 8
AYURVEDIC REVIEW
The condition Kadara has been considered as an abnormality which is
incidental and normal to routine life. Valid references in respect of Kadara are not
available when a survey is made on the Vedic literature. However a detailed
description of Kadara was first described in Sushruta samhitha and in the due course
of time descriptions came to light in Astanga Sangraha, Astanga Hridaya, Bhaishajya
Ratnvali, Yogaratnakara, Sharangadhara samhita, Gadanigraha etc. But information in
these texts regarding kadara remains the same as that of Sushrutha. Since the
Sushrutha is an authoritative in Shalya Tantra, his description is followed by others.
As Kadara occurs in Pada, before dealing with details of Kadara21, brief description of
Pada is given below.
Description of Pada:
Pada is the part of Adha shaka. Pada are two in number. It is a karmendiya.
The main function of Pada is to help for walking. It also bears weight of the body.
The various parts of Pada are angusta, anguli, parshni, padatala etc. In each Pada
about thirty asthi are present. Chief asthi’s are angulyasthi, angustasthi, kurhcakasthi
and parshnyasthi.22 Kurcha, dhamani and sira are also present in Pada. In Pada there
are four marmas. They are Kshipra, Tala hrudaya, Kurcha marma and Kurcha shira.23
Brief description of these marma is given in the following table.

AYURVEDIC REVIEW 9
Table No1: KSHIRPA MARMA
NAME KSHIRPA
NUMBER,STRUCTURE,MEASU 2, Snayu Marma
REMENT AND TYPE ½ Anguli, kalantara pranhara
SITE In between big toe and the first toe.Controls
rasavaha, pranvaha, avalambhaka kapha and
heart.
TISSUE INVOLVED AND Adductor hallicus bravis, lumbricals muscle,
ANATOMICAL STRUCTURES posterior tibial, nerve, dorsal metatarsal artery,
plantar arch, and maedial plantar artery,
metatarso phalangeal jont.
SIGNS IF INJURED Injury may cause impairment of the function of
the adduction and flexion of the great toe.
Damage to the artery may cause severe
bleeding, hematoma inside the plantar
aeroneurosis and septic toxemia. T he trauma of
the marma is commonly leads to death due to
convulsion. The death is reorted due to severe
pain.
TREATMENT Use mahanaryana taila, which is fortified
formula of naryana oil and aromatic oil orange
{cirus aurantum}, is good.

AYURVEDIC REVIEW 10
Table No. 2 : TALA HRIDAYA

NAME TALA HRIDAYA { HEART OF SIDE}
AYURVEDIC REVIEW 11
NUMBER,STRUCTURE, 2, Mamsa marma
MEASUREMENT AND TYPE ½ Anguli, kalantara pranhara
SITE Centre of the facing the root of the third toe,
where plantar moves round to form the
plantea arch.
Control Pranvaha Srotas
TISSUE INVOLVVD AND Flexor digitorum bravis and longus muscle ,
ANATOMICAL STRUCTURES adductor hallicus, flexor digitorum
accessories muscles. Mamsa dhatu of tunica
media of plantar arch. Plantar arch artery
and tributaries of cephanous vein.
SIGNS OF INJURY Injury may cause impairement of the great
toe. Severe bleeding may occur due to injury
to plantar arh. The frequent trauma result
into the extreme pain followed by death.
TREATMENT Massage with bala taila or aromatic oil of
cedar wood, {juniperus virginicna} or
Himalayan cedar wood.
Table No.3: KURCHA MARMA
NAME Kurcha { A knot-bundle of the muscles and
tendon} It is situated above the kshirpa marma on
both sides.

AYURVEDIC REVIEW 12
NUMBER, 2, snayu marma
STRUCTURE,MEASUREMENT ½ Anguli, vaikalyakara marma
AND TYPE
SITE 2 inch proximal and ½ inch medial to the centre
of the sole of the foot. Controls Alochaka pitta
and eye sight.
TISSUE INVOLVED AND Tendon of flexor hallicus longus, abductor
ANATOMICAL STRUCTURE hallicus muscle, medial plantar nerve, medial
plantar and doral matatrsal and arcutate artries.
SIGNS IF INJURED Injury may cause damage to the bones and
ligaments resulting in non-coordination of the
action of the muscles and the shape of the foot
may get disfigured. Injury to this marma leads to
tremors and rational deformity of foot.
TREATMENT For controlling Alochaka pitta, and Triphla ghee
or Castrol oil{Ricinus communis}
Table No.4: KURCHA SIRA
NAME Kurcha shira {head of the kurcha}. The
marma is situated below gulfa and
manibandha snadhi

AYURVEDIC REVIEW 13
NUMBER, 2, snayu marma
STRUCTURE,MEASUREMENT ½ Anguli, vaikalyakara marma
AND TYPE
TISSUE INVOLVED AND Peroneous bravios and longus muscles.
ANATOMICAL STRUCTURE Peroneal artery and tributaries of short
cephaneous vein. Peroneal nerve.
SIGNS IF INJURED Damaged to the ligaments and bone may
cause severe pain along with the impairment
of all the functions of the foot. The post
traumatic effect if this marma is Ruja,
Sopha along with vikalta {functional loss}.
TREATMENT Agnikarma-Vatakantaka {calcenial spur} it
should be done on the sensitive point with
iron probe.
Massage- use Doorvi oil, ushiradi oil
{vettiveria zizianoides}
KADARA DESCRIPTION
NIRUKTI / PARIBHASHA
Vyutpatti:
Kadara word is derived by the union of Ka+Dru+Ai.24

AYURVEDIC REVIEW 14
Nirukti:
Kena-Vayuna pada visishtabhagam drunathi darayathi nasayathi Ithi
kadara”.25 [Sabdakalpadruma]
Kadara means – that which destroys the particular part of the foot by the
influence of Vata.
Paribhasa:
Kadara is a hard painful growth with raised and deep seated hard muscular growth on
palms and soles casued by vitiated Kapha and vata which resembles to that of seed of
Kadara.26
Names in different languages-
Sanskrit - Kadara Tulugu - Ane
Malayalam - Ani Gujarathi - Kadar
Tamil - Ani English- Corn
Kannada - Ani
Table No. 5: Paryayas (Synonyms)
Synonyms S.S. A.H. B.P.N. Y.R. Sa.S G.N. B.S. M.N. S.H. J.M.
Kadara + + + + + + + + - -
Kina + +
Sarkara +
Kandakam +
NIDANA
Nidana plays an important role in the manifestation of a disease. In classics
Nidana is defined as the factors which lead to the disease by deranging the
equilibrium of the Doshas in the body. The knowledge of Nidana is essential for the

AYURVEDIC REVIEW 15
understanding of samprapti and to determine the sadhyasadhyata and chikitsa. In
Ayurveda, Nidana have been given it most importance because the first line of
treatment is Nidana parivarjana.
The most important etiological factors described in Sushruta Samhita in
respect of Kadara are injury to the pada because of thorn prick, stone, and any type of
cut injury or repeated pressure over the foot during barefoot walking. Doshas also
play an important role as Nidana. Vitiation of Vata and Kapha along with Rakta gives
rise to changes which are more confined to parts of the skin subjected to friction and
pressure effects.27
According to Astanga Hridaya Kadara develops due to placing the foot on a
rough stone or hurt by thorns.28
According to Madhava Nidana, aghata by rough stones or prick of thorns
causing a wound on the soles will result into Kadara.29
According to Bhavaprakash by placing the foot on rough stone pebbles or
injury by thorns will lead to kadara.30
According to Gada nigraha by placing the foot on rough stone pebbles or
injury by thorns forms kadara.31
After careful observation of Nidanas mentioned in the above texts
It is clear that Aghata to the pada by – Kantaka - Thorns
Sharkara – Stone pieces
Pashana - Stone
Undue pressure and friction.
SAMPRAPTI
The above mentioned Nidana causes aghata to the pada results in aggravation
of Vata and Kapha Doshas. Aggravated Doshas intern vitiate Medha and Rakta

AYURVEDIC REVIEW 16
dhatus. With the involvement of these Doshas and dhatus a hard swelling is
produced.32The swelling resembles to Kola33. This condition is known as Kadara.
NIDANA
AGHATA TO PADA
VATA, KAPHA PRAKOPA
RAKTA AND MEDA DUSTHI
GRATHANATA IN PADA
KOLASTHI SADURSHA GRANTHI
KADARA
SAMPRAPTI GHATAKA
Doshas : Vata & Kapha
Dooshya : Twak, Rakta, and Medhas

AYURVEDIC REVIEW 17
Agni :
Jatargni: Manda
Dhatwagni: Manda
Srotas : Rakta and Medhovaha
Srotodusti prakara : Sanga
Udbhava Sthana : Pada
Sanchara Sthana : Raktavahini sira
Roga-Marga : Bahya
Adhisthana : Pada
Vyaktasthana : Pada
ROOPA OF KADARA
The symptoms of Kadara mentioned in the texts can be enlisted as following:
Kathina Granthi – Hard swelling
Keela sadrusha – Cone shape
Nimna Madyonnata – Depressed at the centre.
Vedana – Painfull.
Sravi – Discharge (Occationally).
According toBhoja Kadara can occur both in hands and feet equally.34
SADYA SADYATA
In Sharangadhara Samhita, Kadara has been mentioned as one of the Krichra
sadya (Difficult to cure) Kshudra Roga.

CHIKITSA VIVECHANA 17

CHIKITSA VIVECHANA
The Authors of Sushrutha Samhita, Astanga Hridaya, Yogartnakara,
Gadanigraha and Bhavaprakash agree on the line of treatment of kadara that it is to be
excised and should be followed by Sneha Dahana. The Sneha to be used is
particularly identified as thaila by Chakradatta and Gadanigraha.35
The other treatment modalities mentioned by recent Authors in their respective
books and few Anubhuta yogas are given below.
¾ Application of the paste prepared out Shigru swarasa and
Coppersulphate will give immediate cure to Kadara.36
¾ Licking of Madhusnuhi powder mixed with honey after consuming
dhathryadi ghrutha is a good recipe for Kadara.37
¾ One part Hareethaki, ½ part of Yavachincha together boiled with six
parts of water and reduced to ¼, this quatha can be used for massaging
the affected part of the foot.38
¾ External application of Calcium carbonate and washing soda mixed
together and the paste prepared with coconut oil followed in some part
of Kadara.
¾ Hot oil prepared from Cashew nut shell is also used externally for
Kadara.
¾ A paste prepared with washing soda and lime can also be used as an
external application for kadara.

AGNI-KARMA
Utpatti and Nirukti:
Agnikarma:
The Agnikarma consists of two words i.e. Agni and Karma.
The word Agni is a pulling shabdha.
That which has the course of action in the upward direction is Agni.39
Agni bears the meaning of movement also.40
Karma means procedure.
DIFINITION:
The procedure which is performed with the help of Agni or any procedure
related to Agni is called as Agnikarma.
The term Agni Karma comprises of two words ‐ Agni and Karma,
collectively gives the meaning, as the procedure done by Agni.
Any procedure that involves the Agni directly or indirectly i.e. by the help of
different materials to cure the disease, is considered under Agni karma.41
Since Vedic period, Agni Karma is in practice to treat various human ailments.
During the period of Sushruta, Agni Karma has gained importance as a
treatment for so many diseases. It was the Sushruta, who have earmarked the Agni as
supreme in all the Para surgical procedures. A separate chapter in SutraSthana with
details about every aspect of the procedure Agni Karma is available.

Superiority of Agni Karma:
Agni Karma is superior to Ksharakarma as the procedure is very easy to
perform. A disease treated with Agnikarma will not reoccur. Disease which cannot be
cured with oushadi, Kshara and Shastra, can be cured with Agni.42 Agnikarma is
always utilized as the ultimate measure.
Agnikarma is having the effect of nirjantukarna (sterilization). It destroys the
pathogens because of its heat effect. Thus, the post agnikarma wounds are rarely
infected.43
There will be vaso constriction due to heat and it will check the Heamorrhage.
Agnikarma is the ultimate measure for the haemostasis among the four
raktasthambhana measures i.e., sandhana, skandhana, pachana and dahana.
Dahanaupakaranas (Materials used for Agni karma):44
The materials used to perform Agni karma are called as Dahanaupakaranas.
The different Dahanaupakaranas mention in various texts are Shown in the Table

Table No.6: Showing different Dahanaupakarana as mentioned in various texts:
Name of Dahanaupakarana Su. Ch. A.S. A.H.
1 Pipali (Long Piper) + - + -
2 Aja Shakrida (Excreta of goat) + - + -
3 Godanta + - + +
4 Shara + + + +
5 Shalaka + - + -
6 Jambavastha + - + +
7 Kshaudra/madhu (Honey) + + + +
8 Madhuchhista (Wax) + + + -
9 Jaggery/guda + - + +
10 Sneha + - + +
11 Loha + + + -
12 Grutha - + + -
13 Taila - + + -
14 Vasa - + + -
15 Majja - + - -
16 YastiMadhu - - + -
17 Suchi (Needle) - - + -

18 Hema (Gold) - + + -
19 Tamra (Copper) - - + -
20 Rajata (Silver) - - + -
21 Kansya (Bronze) - - + -
22 Varti - - - +
23 Suryakanta - - + -
24 Ardhendu Vaktra Shalaka + - + +
25 Kalasthidal Tulya Shalaka + - + +
Acharya Sushruta has advised the use of dahanaupakarna according to the site
of diseases.45
1. For diseases situated in Twaka - Pippali, Ajasakrida, Godanta, Shara, Shalaka
are to be used.
2. For diseases situated in Mamsa - jambhavsta Shalakla and Other Metals are to
be used.
3. For diseases situated in Sira, Snayu, Sandhi and Asthi - Madhu, guda and
Sneha are to be used.
Agni karma is performed in the form of different shapes depending on the
swaroopa of the diseases. The different shapes produced as a result of the Agni Karma
are as follows46.
1. Valaya - It means Circular shape.
2. Bindu - Dot like shape. According to Dalhana Shalaka should
be of pointed tip.
3. Vilekha - Making of different shapes by heated shalaka
4. PratiSarana - Rubbing at indicated site by heated Shalaka.

5. Ardhchandra - Crescent shape.
6. Swastika - It is specific shape of Swastika Akruti.
7. Astapada - It is specific shape containing eight limbs in different
directions.
Indications of Agni Karma:
the diseases in which Agni karma indicated, as mentioned in various texts are
given in the table
Table No.7: Showing indication of Agni Karma in various diseases47
Sl.No. Name of Disease Ch. Su. A.S. A.H.
1 Shiroroga - + - +
2 Vataja Shiroroga - - + -
3 Kaphaja Shiroroga - - + -
4 Ardhav bhedaka + - - -
5 Bhru-lalata Vedana - - + -
6 Vartma Roga - + - -
7 Pakshama Kopa - + + -
8 ShlistaVartma - - + +
9 Bisa Vartma - - + -
10 Alaji - - + +
11 Arbuda - - - +
12 Puyalasa - - - +
13 Abhisyanda - - + -
14 Adhimantha - + + -

15 Lagana - + + +
16 Medaja Ostha Roga - + + +
17 Danta Nadi - + + +
18 Krimi Danta - + + +
19 Adhidanta - - + +
20 Sheeta Danta - - + +
21 Danta Vidhradhi - - + +
22 Jalarbuda - - + +
23 Arsha (Vataja-Kaphaja) - + + +
24 Nasa arsha - - + +
25 Karnarsha - - + +
26 Lingarsha - - - +
27 Yonya arsha - - - +
28 Bhagandar + + + +
29 Chippa - + - -
30 Kunakha - + - -
31 Kadara - + + +
32 Balmika - + + +
33 Jatumani - + + +
34 Mashaka - + + +
35 Tilakalaka - + + +
36 Charmakila - + + +
37 Prasupti - + - +
38 Visha Chikitsa + - - -
39 Sarpna Damsa + + + +
40 Alarka Visha - + - +
41 Luta Visha - - + +

42 Mushaka Visha - - + +
43 Gridhrasi + - - -
44 Vataja shoola in Twaka - + - -

45 Vishwachi - - + +
46 Galaganda - + + +
47 Ganda mala + - + +
48 Apachi - + + +
49 Granthi + + + +
50 Arbuda + + + +
51 Antra Vridhi - + + +
52 Shlipada - + + +
53 Nadivrana - + + -
54 Upadamsa - + - -
55 Gulma + - + +
56 Vishuchika - + + +
57 Alasaka - + - -
58 Vilambika - + - -
59 Sanyasa + - - -
60 Unmada - - - +
61 Yakrita Plihodara - - + +
62 Sonita Ati Pravriti + + + -

63 Sira Sandhichheda - + + -
64 Visarpa + - - -
65 Sotha + - - -

Table No.8: Contra Indication for Agni karma: 48
There are certain conditions and diseases where Agni Karma should not be
performed. Such conditions and diseases are given in the following table.
Unsuitable Prakruti Pittaja
Unsuitable season Sharada and greeshma
Unsuitable age Bala and vrudha
Unsuitable according to Durbala, abala, bheeru
strength
Unsuitable conditions Garbhini, vishadayukta
Unsuitable diseases Antahashonita; Rakta pitta; Anudhruta shalya; Bhinna
koshta; Aneka vrina peedita; Trishna; Jwara; Netra
vruna, Kushta vruna; Visha jushta; Aswedya like pandu;
Pramehi; Kshayartha; Kshama; Ajeerni; Udara rogi;
Chardi peedita; Madhya peetha and Atisari
Unsuitable Sthana Marma and snayugata vruna;
Unsuitable dushya Rakta and Pitta. As Agni, pitta and Rakta are having
samana Veerya i.e. Ushna. Hence if Agni karma is
performed it leads to excessive burning sensation,
sphota utpatti, jwara and trishna.)
Suitable Season for Agni Karma:49
Agni Karma can be done during all the seasons except Grishma and Sharada
rutu. In Sharada rutu there is Prakopa of Pitta and Agni Karma also aggravates Pitta,
so it may lead to Pitta Prakopa janya vyadhi, that’s why here Agni Karma is

contraindicated. While in Grishma rutu the environment is very hot hence Agni
Karma is contra indicated. In case the disease is amenable only to Agnikarma and in
the state of emergency, Agni karma can be performed after taking appropriate counter
measures to combat ill effects of the procedure.
Pre Agni Karma Diet:50
In all diseases and during all seasons, the Agni Karma can be done after
feeding the patient with pichhila ahara.But should be performed in empty stomach in
cases like Mudagarbha,Ashmari,Bhagandar,Udararoga,Arsha and Mutrakruchra.
Procedure of Agni Karma:51
Prior to the procedure of Agni Karma, Prayer by chanting Mantras and
collection of related materials and instruments should be done. The patient is made to
sit or lie down in suitable position by keeping head in the East direction. Patient is
held by expert assistants to avoid movement. After this the surgeon should select the
appropriate dahana upakrama as preferred for the disease, It is heated in a smoke free
fire of Khadira or Badara. when dahana upakarana becomes red hot then Agnikarma
is performed in the described shape. Agnikarma is done till the samyaka dagdha
lakshan are seen. During this period if patient feels discomfort then keep them
satisfied by courageful, consolating talks. Give cold water for drink and sprinkle cold
water. After Agni karma the patient has to be observed for Samyak dagdha, Hina
Dagdha and Atidagdha.
Samyak Agni dagdha lakshana:-52
The lakshana of Samyak Agni dagdha are stoppage of bleeding , cracking
sound accompanied with slight discharge, the vruna is having colour resembling a
ripe tala fruit or a pigeon(dark grey). The wound heals easily and there will be
minimum pain.

Hina Agni dagdha lakshana:-53
The Hina Agni dagdha lakshana are discolouration of the skin, severe burning
sensation and appearance of boils.
Ati Agni dagdha lakshana:-54
Atidgdha lakshana are drooping down of the mussels, constriction, burning
sensation feeling of hot fumes coming out, pain, destruction of veins, thirst,
fainting, and exacerbation of the wound.
Paschatkarma:55
After completion of Agni Karma the part where Agni Karma has done should
be anointed with Madhu and Ghruta for Ropana of Dagdha Varna
Precaution:56
Kshara karma, Agni karma, Shastra karma should be done very carefully
in rogas. Improper use of these causes vandhyata, shoth, daha, bhrama, atopa,
anaha, Vibhanda, Atisara or even death. Hence the procedure is to be performed
by an expert with maximum precaution.
MODERN REVIEW 28

CORN-MODERN ASPECT
Human foot:
Anatomy:
The human foot and ankle is a strong and complex mechanical structure containing
more than 26 bones, 33 joints (20 of which are actively articulated), and more than a
hundred muscles, tendons, and ligaments.--
The feet are flexible structures of bones, joints, muscles, and soft tissues that
let us stand upright and perform activities like walking, running, and jumping. -- The
feet are divided into three sections:
The hindfoot is composed of the talus or ankle bone and the calcaneus or heel
bone. The two long bones of the lower leg, the tibia and fibula, are connected to the
top of the talus to form the ankle. Connected to the talus at the subtalar joint, the
calcaneus, the largest bone of the foot, is cushioned inferiorly by a layer of fat.
MODERN REVIEW 29

The five irregular bones of the midfoot, the cuboid, navicular, and three
cuneiform bones, form the arches of the foot which serves as a shock absorber. The
midfoot is connected to the hind- and fore-foot by muscles and the plantar fascia---.
The forefoot is composed of five toes and the corresponding five proximal
long bones forming the metatarsus. Similar to the fingers of the hand, the bones of the
toes are called phalanges and the big toe has two phalanges while the other four toes
have three phalanges. The joints between the phalanges are called interphalangeal and
those between the metatarsus and phalanges are called metatarsophalangeal.--
Both the midfoot and forefoot constitute the dorsum (the area facing upwards
while standing) and the planum (the area facing downwards while standing).
The instep is the arched part of the top of the foot between the toes and the
ankle.
Muscles:
The muscles acting on the foot can be classified into extrinsic muscles, those
originating on the anterior or posterior aspect of the lower leg, and intrinsic muscles,
originating on the dorsal or plantar aspects of the foot.
All muscles originating on the lower leg except the popliteus muscle are
attached to the bones of the foot.
There are three groups of muscles in the sole of foot.62
1. Muscles of the first layer of the sole. These are as:
¾ Flexor digitorum brevis(this muscle lies deep to the planter
aponeurosis)---
¾ Abductor hallucis(this muscles lies along the medial border of foot,
and covers the origin of the plantar vessels and nerves)
¾ Abductor digiti minimi(this muscle lies along the lateral border of foot)
MODERN REVIEW 30

2. Muscles of the second layer of the sole. These are as:
¾ Flexor digitorum longus.
¾ Flexor digitorum accessories (It is so called because it is
accessory to the flexor digitorum longus)
¾ Lumbricals (there are four of them, numbered from medial to
lateral side)
¾ Flexor hallucis longus.
3. Muscles of the third layer of the sole:
¾ Flexor hallucis brevis (It covers the plantar surface of the first
metatarsal bone.)
¾ Adductor hallucis.
¾ Flexor digiti minimi brevis (It lies along the fifth metatarsal
bone.)
Plantar vessels and Nerves63
The chief Arteries of the sole are the medial and lateral planter artery. They are
terminal branches of the posterior tibial artery.
1. The chief nerves of the sole are the medial and lateral planter nerves. They are
terminal branches of the tibial nerves.
2. These arteries and nerves being deep to the flexor retinaculum. The posterior
tibial artery divides into the medial and lateral plantar arteries a little higher
than the division of tibial nerves. As a result the arteries are closer to the
margins of the sole than the corresponding nerves.
3. The medial plantar vessels and nerve lie between the abductor hallucis the
flexor digitorum brevis.
4. The lateral plantar vessels and nerve run obliquely towards the base of the 5th
metatarsal bone, between the first and second layers of the sole. Here the
artery turns medially and becomes continuous. The third and fourth layers of
the sole.
MODERN REVIEW 31

PHYSIOLOGY OF SKIN
The stratum corneum acts as a protective layer against the action of caustic substances
and this is aided by the presence of sebum excreted by the sebaceous glands. It also
protects the underlying epidermal cells from the sun rays. When skin is subjected to
excessive radiation, the stratum corneum in anticipation increases its thickness as a
protection against subsequent exposures. It also thickens when necessary to prevent
injury from trauma as it is particularly evident from the palms and soles.
LANGER LINES – Principles of incision and closure
Human skin is usually under tension. Whenever the skin or any part of the body is
incised, the wound gapes and the subcutaneous fat herniated. This internal tension of
skin is not same in all directions. These skin tension areas have been worked out in
details by Langer and they are known as ‘Langer’s lines of cleavage’ or ‘Cleavage
lines’. The main principle of incision all over the body is that the incision should be
parallel to Langer’s lines. But for accessibility of exposure to certain deep lying
structures incision often be made in contrary to the direction of the Langer’s line.
Particularly on hands and feet, incisions are to be made in such a way that the
resultant scars do not hamper mobility and function. In case of tip of the fingers, the
incisions are made on the sides but not on the tip or middle of the pulp as a later
produces the scars at the site of Contact when the figure touches other objects.
Subcutaneous tissue in weight bearing areas of the sole as a result of trauma, the
defect is best covered by a local flap. A distant flap containing fat is used as a local
flap but lacks of fibrous septa binding the skin to the Incisions on the sole heal well. If
there is loss of skin and underlying tissues in the local flap results in the excessive
movement of the skin on walking.
MODERN REVIEW 32

CORN-MODERN ASPECT
A Corn (Old French – Corn = grain) is a horny indurations of the cuticle with
a hard Centre caused by undue pressure chiefly affecting toes and feet. A horny
indurations and thickening of the stratum corneum of the Skin, produced by friction
and pressure, forms a conical mass pointing down into the corneum producing pain
and irritation. It is also called as Clavus.64
AETIOLOGY
Injury, repeated irritation and undue pressure are the chief causes of corn.
These factors lead to cell irritation and the area will grow at faster rate leading to
overgrowth, thickening of skin, and finally a callus is formed.65
SIGN & SYMPTOMS
Corn: A small, tender, and painful raised bump on the side or over the joint of a
toe. Corns are usually 4mm to10mm in diameter and have a hard center.
Callosity: A rough, thickened area of skin that appears after repeated pressure or
irritation. The area most commonly involved is feet, hand and knees. Callosities
on the soles of the feet are the most troublesome.
A corn is the thickening of the stratum corneum. A chronicp repeated friction.
Which is not sufficient to produce a blister gradually leads to thickening of the
stratum. Smaller lesions produced by ill fitting shoes or projecting ends of shoe nail
are called Corn, while larger lesions usually caused by friction produced during the
per suit of professional activities are called callosities. Due to continued pressure on
the surface the deeper end of the corn may start pressing on the under lined epidermis
in thinning of stratum Malpighi. If it presses an underlying nerve twig it may cause
acute pain when ever this area comes under pressure.
MODERN REVIEW 33

The familiar Corns on the feet are circumscribed horny thickening, Cone like
in shape with their apex pointing in word, and their base on the surface. They occur at
the sites of localized friction or pressure and usually disappear spontaneously, when
the etiologic agent (pressure) is removed. Because they extend inward at sites of
pressure considerable pain may result.
Histologically Corns are composed of compressed certified masses. The
remainder of the epidermis may be somewhat an atrophic. The basal layer is intact
and a mild lymphocytic infiltrate can be seen in the underlying corium. The diagnosis
can be suspected from the microscopic section.
A callosity (French Collocate) is a localiesed thickened or hardened part of the
skin caused by friction. It is commonly occupational, e.g. on gardeners hand or the
finger of a violinist.66
Callosities and corns are caused by pressure and friction due to faulty weight
bearing orthopedic deformities or improperly fitting shoes. Some persons are
hereditarily predisposed to abnormal callus formation.
A soft corn often occurs laterally on the proximal portion of the fourth toe as a
result of pressure against the loamy structure of the inter phalengeal joint of the fifth
toe.
Infected adventitious bursa beneath a Corn is usually the result of improper
chiropody. There signs of inflammation around the Corn, the slightest pressure on
which evokes excruciating pain. Drainage is accomplished by paring the Corn with a
sterile Scalpel until pus exudes.
HORD CORN (Heloma durum)
Corn develops when intermittent pressure occurs over a very limited area.
Corn is more pathological than callosity. It occurs but rarely in a normal foot. Corn
MODERN REVIEW 34

consists of a conical wedge of highly compressed Keratotic epithelial cells. Corn is
cone shaped. The apex of the cone points towards the underlying bone, and impinges
on the Malpighi an layer of the dermis, with its nerve endings, which explains why
corn is painful. A corn is characterized by a central core of white appearance
composed of degenerate cells and cholesterol. This core becomes apparent or more
obvious when the superficial layer of the corn has been pared away. Because of the
paring, the corn is seen to have a concave surface. Formerly it was thought that these
was always a bursa beneath the apex of the corn, now it has been shown that in most
instances there is no bursal sac but liquefaction has occurred in the depths of the corn.
The corn is encircled by a narrow area of keratosis, which disappears gradually at the
periphery. Palpation especially after removing of the superficial layer, reveal a bony
projection beneath the cutaneous lesion. In contradistinction to callosities, corns occur
chiefly where the normal skin is thin. Corns are found particularly on the 4th toe and
over the dorsal projection of hammer toes.
SOFT CORN (Heloma mollies)
It is soft because it occurs where maceration takes place. The site of
appearance of a soft corn is at the bottom of the cleft between 4th and 5th toes where
opposing prominent projections of the bases of the proximal phalanges gives rise to
pressure and friction. The great pressure exerted on toes is shown by their prismatic
shape. The apex of the prism is directed towards the intervening cleft. Soft corns are
particularly painful due to its contour and consistency.
MODERN REVIEW 35

COMMON SITES
Corn commonly involves the skin on the hand, feet and knees. The area of
occurrence of corn in sole of the foot is mentioned here under as follows.
Site: Right /Left sole
¾ Antero lateral
¾ Antero medial
¾ Medial
¾ Lateral
¾ Postero lateral
¾ Postero medial
MODERN REVIEW 36

TABLE No. 9: DIFFRENCES BETWEEEN CORN & CALLOSITY
CORN CALLOSTY
¾ A thickening of the outermost skin ¾ Painless thickening of skin caused
layer, usually over bony areas such as by repeated pressure and irritation.
toe joints.
¾ Horny indurations of the cuticle with a ¾ Localized thickening of the skin
hard center on the feet and toes. seen on the feet and the hands.
¾ Result due to undue pressure as seen ¾ Seen at the sites of friction.
with ill fitting shoes.
¾ Cone shaped thickenings with the base ¾ Acquired, superficial, yellow-white
on the surface and the apex in the patches of hyperkeratotic material.
tissue. Lesions are painful. Lesion are usually painless.
¾ Histologically it is composed of keratin ¾ Histologically there is thickening of
masses with intact basal layer. the stratum corneum, and
granulosum.
¾ Treatment is by surgical excision. ¾ Treatment is usually not required.
MODERN REVIEW 37

TREATMENT
The main treatment for Corn and callosities lies in preventing further friction
on that area, because if further friction is not prevented the Corn and callosities are
always likely to reoccur. The lesion itself can be treated either by locally applied
keratolytic agents or by surgical excision. For local treatment an ointment containing
10 to 40% Salicylic Acid in Vaseline or any other keratolytic agent should be liberally
applied over the lesion which should be bandaged overnight. Next morning the soften
keratin should be rubbed off and during the day the lesion should be protected from
friction with a cotton pad. At night the same ointment can be applied again under
bandage and this should be continued till the keratin plug has been shed off
completely.
Salicylic Acid in collodin (20%) applied for a few nights followed by soaking
in hot water are often effective in removing a corn.
The surgical treatment is undertaken under local anesthesia and consists of
removing the thickened keratin plug from the underlying epidermis by dissecting at
the level of stratum granulose, which is visible as a dark brown layer. Following this,
the base of the lesion should be cauterized with concentrated phenol or tricolor acetic
acid and the wound should be dressed with an anti-biotic ointment. Cauterization of
the wound with phenol or tricolor acetic Acid should be repeated on the third or
fourth day. Once the lesion has healed a daily massage with 10% Salicylic Acid in
Vaseline for two or three weeks will be sufficient to keep the skin soft.
When the Corn becomes too painful on pressure, one can prepare a 5%
aqueous solution of tricolor acetic Acid and inject a drop of this solution at the base of
the Corn. It is convenient to take a large syringe preferably 10ml capacity and a wide
bore (20 or 19 gauge) long needle.
MODERN REVIEW 38

The needle should be inserted obliquely from the periphery of the corn to the
extent that the tip of the needle lies at the base of the corn. Success of the injection
can be judged from the fact that a pressure on the Corn after the injection would no
longer elicit any pain.
Apart from this if corn is due to orthopedic deformities it should be corrected
properly.
RISK FACTORS AND PREVENTIVE MEASURES
Besides all these conventional techniques the main treatment for corn lies in
prevention. Hence some preventive measures were mentioned as follows.
¾ Prevention of further friction on that particular area by keeping soft shoes or
soft pads at the pressure point of the sole.
¾ Don’t wear shoes that fit poorly.
¾ Avoid activities that create constant pressure on specific skin areas.
¾ Those with occupations that involve pressure on the hands and knees, such as
carpenters, writers, guitar players or tile layers etc. should wear protective gear
such as gloves or knee pads.
¾ Daily massage with 10% salicylic acid in Vaseline for two or three weeks to
keep the skin soft.
POSSIBLE COMPLICATIONS
Corn if not treated properly will lead to change of gait. This will result into pain in
Back, hip, knee or ankle.
MATERIALS AND METHODS 39

MATERIALS AND METHODS
The present study aims at comparative efficacy of Agnikarma procedure and
Surgical Excision in the management of Kadara. In this chapter the various materials
required for the study along with their descriptions and methods of Agnikarma and
principles of surgical excision are explained. The study plan along with assessment
criteria are also dealt in this chapter.
Following drugs and materials are required for this study.
1. Pancha loha shalakha.57
2. Tab. Triphala Guggulu58
3. Jatyadi Ghruta.59
4. Betadine Solution.60
5. Tab. Diclofenac Sodium.61
The brief description of the above said materials and drugs are described in the
following paragraphs.
Pancha loha Shalaka:
The Shalaka is made up of pancha loha. The individual loha are mixed in the
following composition.
Tamra (copper)-40%,
Loha (iron)-30%,
Yashada (zinc)-10%,
Rajatha (silver)-10%
Vanga (tin)-10%.

By using these pancha loha a specially designed Shalaka is prepared which is
useful in the procedure of Agni karma. The photograph of the specially designed
Shalaka is shown below.

Triphala Guggulu
The ingredients used in the preparation of Triphala Guggulu along with their
therapeutic properties and other details are given in the following Table.
Table No - 10: Showing the Properties of Ingredients of Triphala

Guggulu:
Upauk
Botanical Dosha Sanstanik
Drug ta Rasa Guna Veerya Vipaka
Name Karma Karma
anga
Shothahar
Terminalia Except Laghu, Tridosha Vedanasthapak
Haritaki Phala Ushna Madhura
Chebula Lavana Rooksha ghna vranashodhan,
vranaropan
Shothahar
Terminalia Ruksha, Tridosha
Vibhitaki Phala Kashaya Ushna Madhura Vedanasthapak,
bellirica Laghu ghna
raktasthabhan,
Lavana Guru
Emblica rahita, Tridosha Dahprashaman
Amalaki Phala Rooksha Sheeta Madhura
Officinalis Amla ghna
pradhana Sheeta
Piper Laghu, Anushna Shothahar

Pippali Phala Katu Katu Pittahara
Longum Snigdha Sheeta Vedanasthapak
Guggulu
Vedanasthapak,
Comniphora Tikta Ruksha Vatakap
Niryas Ushna Katu vranashodhan,
mukul Katu Laghu hashmak
vranaropan
Triphala Guggulu is prepared in the Dept. of Rasa shastra and Bhaishajya Kalpana,
Ayurveda Mahavidyalaya, Hubli.

Composition of Triphala Guggulu
Triphala Choorna - 3 parts / 3pala
Pippali - 1 part / 1 pala
Shuddha Guggulu - 5 parts / 5 pala
Method of Preparation of Triphala Guggulu:
Shodhana of Guggulu is done by the classical method. Five parts of Shudha Guggulu,
three parts of Triphala choorna and one part of Pippali are mixed and grinded well.
The tablets weights 500mg were prepared.
Dosage: - 500mg 2 Tablet tid.
Anupana: - Ushna Jala / Triphala Kwatha
Indications: - Vrana, Arsha, Bhagandara, Gulma, Shoth

JATYADI GHRUTA
The Ingredients of the Jatyadi Ghruta along with their details are tabulated in
the following table.
Table No.11: Jatyadi Ghruta
Serial Name Botanical name Parts used Rasa Guna Viry Vipaka Doshagataka
no. a
1. Jati patra. Jasminum (Lf.) Tikta, Laghu, Usna Katu Tridosahara

grandiflorum Linn. Kasaya. Snigdha,
Mrdu
2. Patola patra. Tricosanthes dioica (Lf.) Tikta, Katu Laghu,Ru Usna Katu Kapha-pittahara
Roxb. ksa
3. Nima patra Azadirachta indica (Lf.) Tikta Laghu Sita Katu Kapha-pittahara
,kasaya ,ruksa
4. Katuki Pichrorhiza kurroa (Rt/Rz.) Tikta Ruksa,La Sita Katu Kapha-pittahara

roylex benth ghu
5. Daru Haridra Berberis Aristata (St.) Tikta kasaya Laghu, Usna Katu Kapha Pittahara
Ruksha.
6. Haridra Cucuma longa linn. (Rz.) Tikta, Katu Ruksha, Usna Katu Kapha-vathara
Laghu.
7. Sariva Hemedisms indicus (Rt.) Madhura, Guru, Sita Madhura Tridosahara,

Tikta Snigdha. Grahi
8. Manjistha Rubia cardifolia (Rt.) Madhura,Ti Guru, Usna Katu. Kapha-pittahara

kta Ruksha.
9. Hritaki Terminalia chebula (Rt.) Kasaya Laghu, Usna Madhura Tridosahara,

Ruksa Rasayana
10. Mulethi Glycyrrhiza Glabra (Rt.) Madhura Guru, Sita Madhura Tridosahara,
Snigdha Rasayana
11. Karanja Pongamia pinnata (Sd.) Tikta, katu Laghu, Usna Katu Kapha-vathara ,
kasaya Tikshna Bhedana
12. Thotha Cuso4.7H2o Tikta, katu Laghu Usna sss Kapha-pittahara

kasaya Visada

13 Madhuchissti Madhura Snigdha Sita Madhura Kapha Pittahara
Medohar
14 Go Ghruta Cows ghee Guru vata Sita Medya, Madhura

Snigdha pittahara balya
Madhura
Table No.12: Composition of Jatyadi Ghruta:
Sl no. Drugs quantity
1. Jati patra 14.76 g
2. Nimba patra 14.76 g
3. Patola patra 14.76 g
4. Katuki 14.76 g
5. Darvi,(Daruharidra) 14.76 g
6. Haridra 14.76 g
7. Sariva 14.76 g
8. Manjistha 14.76 g
9. Haritaki 14.76 g
10. Sikthaka (mom) 14.76 g
11. Tuttha (Tutiya) 14.76 g
12. Madhuka(Mulethi) 14.76 g
13. Karanja 14.76 g
14. Sarpi (Goghruta) 768 g
15. Water 3.072 l

The Jatyadi ghruta was prepared as per the standard method of Ghruta preparation.
Prepared Ghruta is preserved in the plastic container.
Jatyadi Ghruta is hailed as one of the best Shodhana and Ropana dravya. It is
indicated in various types of vranas as external application.
Dose: As per requirement
BETADINE
Betadine is a brand name for a range Povidone-iodine (PVPI) topical antiseptics.
Betadine, like most PVPI products, is available in three formulations:
1. A solution, sold over-the-counter (OTC) for cleaning minor wounds and used
in hospitals to prepare a patient's skin prior to surgery. Solutions are 10%
Povidone-iodine in water.
2. A 'surgical scrub', which is a mixture of Povidone-iodine and detergent, sold
OTC as a skin cleaner and disinfectant hand wash and used for cleansing
hands prior to surgery and other aseptic procedures.
3. An ointment base used as external application in wounds.
Povidone-iodine (PVP-I) is a stable chemical complex of
polyvinylpyrrolidone (povidone, PVP) and elemental iodine. It contains from 9.0% to
12.0% available iodine, calculated on a dry basis.
This unique complex was discovered at the Industrial Toxicology Laboratories
in Philadelphia by H. A. Shelanski and M. V. Shelanski. They carried out tests in vitro
to demonstrate anti-bacterial activity, and found that the complex was less toxic than
tincture of iodine in mice. Human clinical trials showed the product to be superior to
other iodine formulations.
It was first sold in 1955, and has since become the universally preferred iodine
antiseptic.

Properties
PVP-I is completely soluble in cold water, ethyl alcohol, isopropyl alcohol,
polyethylene glycol, and glycerol. Its stability in solution is much greater than that of
tincture of iodine or Lugol's solution.
Free iodine, slowly liberated from the poviodine-iodine (PVP-I) complex in
solution, kills eukaryotic or prokaryotic cells through iodination of lipids and
oxidation of cytoplasmic and membrane compounds. This agent exhibits a broad
range of microbicidal activity against bacteria, fungi, protozoa, and viruses. Slow
release of iodine from the PVPI complex in solution minimizes iodine toxicity
towards mammalian cells.
Uses
Wound area covered in povidone-iodine. Gauze has also been applied.
Povidone-iodine applied to an abrasion using a cotton swab.
Following the discovery of iodine by Bernard Courtois in 1811, it has been
broadly used for the prevention and treatment of skin infections, and the treatment of
wounds. Iodine has been recognized as an effective broad-spectrum bactericide, and it
is also effective against yeasts, molds, fungi, viruses, and protozoans. Drawbacks to
its use in the form of aqueous solutions include irritation at the site of application,
toxicity and the staining of surrounding tissues. These deficiencies were overcome by
the discovery and use of PVP-I, in which the iodine is carried in a complexed form
and the concentration of free iodine is very low. The product thus serves as an
iodophor. In addition, it has been demonstrated that bacteria do not develop resistance
to PVP-I, and the sensitization rate to the product is only 0.7% ,Consequently, PVP-I
has found broad application in medicine as a surgical scrub; for pre- and post-
operative skin cleansing; for the treatment and prevention of infections in wounds,
ulcers, cuts and burns; for the treatment of infections in decubitus ulcers and stasis

ulcers; in gynecology for vaginitis associated with candidal, trichomonal or mixed
infections. For these purposes PVP-I has been formulated at concentrations of 7.5–
10.0% in solution, spray, surgical scrub, ointment, and swab dosage forms. It is
available without a prescription under the generic name povidone-iodine or the brand
name Betadine.
DICLOFENAC
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce
inflammation and as an analgesic reducing pain in certain conditions.
The name is derived from its chemical name: 2-(2,6-dichloranilino) phenylacetic
acid.
In the United Kingdom, India, Brazil and the United States, it may be supplied
as either the sodium or potassium salt, in China most often as the sodium salt, while in
some other countries only as the potassium salt. Diclofenac is available as a generic
drug in a number of formulations. Over-the-counter (OTC) use is approved in some
countries for minor aches and pains and fever associated with common infections.
History
Diclofenac originated from Ciba-Geigy (now Novartis) in 1973.Diclofenac
was first introduced in the UK in 1979. Recent research (2010) has linked use of
Diclofenac to an increased chance of strokes.
Mechanism of action
The exact mechanism of action is not entirely known, but it is thought that the
primary mechanism responsible for its anti-inflammatory, antipyretic, and analgesic
action is inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX).
It also appears to exhibit bacteriostatic activity by inhibiting bacterial DNA synthesis.
Inhibition of COX also decreases prostaglandins in the epithelium of the stomach,
making it more sensitive to corrosion by gastric acid. This is also the main side-effect

of diclofenac. Diclofenac has a low to moderate preference to block the COX2-
isoenzyme (approximately 10-fold) and is said to have, therefore, a somewhat lower
incidence of gastrointestinal complaints than noted with indomethacin and aspirin.
The action of one single dose is much longer (6 to 8 hours) than the very short half-
life that the drug indicates . This could be partly because it persists for over 11 hours
in synovial fluids.
Diclofenac may also be a unique member of the NSAIDs. There is some
evidence that diclofenac inhibits the lipoxygenase pathways, thus reducing formation
of the leukotrienes (also pro-inflammatory autacoids). There is also speculation that
diclofenac may inhibit phospholipase A2 as part of its mechanism of action. These
additional actions may explain the high potency of diclofenac – it is the most potent
NSAID on a broad basis.{Scholer. Pharmacology of Diclofenac Sodium. Am J of
Medicine Volume 80 April 28, 1986}
Besides the well-known and often-cited COX-inhibition, a number of other
molecular targets of diclofenac that could contribute to its pain-relieving actions have
recently been identified. These include:
• Blockage of voltage-dependent sodium channels (after activation of the
channel, diclofenac inhibits its reactivation also known as phase inhibition.
• Blockage of acid-sensing ion channels (ASICs)
Positive allosteric modulation of KCNQ- and BK-potassium channels
(diclofenac opens these channels, leading to hyperpolarization of the cell membrane)
Medical uses
Inflammatory disorder may include musculoskeletal complaints, especially
arthritis, rheumatoid arthritis, polymyositis, dermatomyositis, osteoarthritis, dental
pain, TMJ, spondylarthritis, ankylosing spondylitis, gout attacks,and pain
management in cases of kidney stones and gallstones. An additional indication is the

treatment of acute migraines. Diclofenac is used commonly to treat mild to moderate
post-operative or post-traumatic pain, in particular when inflammation is also present,
and is effective against menstrual pain and endometriosis.
Contraindications
• Hypersensitivity against diclofenac
• History of allergic reactions (bronchospasm, shock, rhinitis, urticaria)
following the use of aspirin or another NSAID
• Third-trimester pregnancy
• Active stomach and/or duodenal ulceration or gastrointestinal bleeding
• Inflammatory intestinal disorders such as Crohn's disease or ulcerative colitis
• Severe insufficiency of the heart (NYHA III/IV)
• Recently, a warning has been issued by the FDA not to use for the treatment of
patients recovering from heart surgery
• Severe liver insufficiency (Child-Pugh Class C)
• Severe renal insufficiency (creatinine clearance <30 ml/min)
• Caution in patients with preexisting hepatic porphyria, as diclofenac may
trigger attacks
• Caution in patients with severe, active bleeding such as cerebral hemorrhage
• NSAIDs in general should be avoided during dengue fever, as it induces (often
severe) capillary leakage and subsequent heart failure.
Induces warm antibody hemolytic anemia by inducing antibodies to Rh antigens,
ibuprofen also does this.
• Diclofenac may disrupt the normal menstrual cycle.
Dose: 50 mg tablet bid after food.
Maximum dose 50 mg tablet Qid.

METHODOLOGY
Source of Data:
Patients attending OPD and IPD of postgraduate Department of Shalya Tantra
of Ayurveda Mahavidyalaya Hospital Hubli were selected for trial.
Method of collection of data:
1. Patients attending OPD and IPD of postgraduate Department of Shalya Tantra
of Ayurveda Mahavidyalaya Hospital Hubli, who were fit for the study as per
inclusion criteria, were selected randomly.
2. Patients were registered and details were recorded in specially designed Case
Sheet Proforma.
3. Pain was graded based on McGill Pain Index Score.
4. Review of intensity of pain, bleeding, infection, healing time and recurrence
was done periodically.
Inclusion Criteria:
1. Patient with clinical features of Kadara.
2. Kadara present in Pada tala.
3. Patient of both the sexes of age group between 10-60years.
Exclusion Criteria:
1. Patient who are contraindicated for Agnikarma.
2. Patients having more than two Kadara.
3. Patients with Uncontrolled Systemic disorders like diabetes.
4. Patients with infective conditions like HIV and HbsAg were excluded.

Parameters of study:
Following Subjective and Objective parameters were considered for the study.
Subjective Parameters:
Vedana (Pain)
All the patients were examined once in two days during the treatment for assessment
of pain.
Gradation of Parameters:
Vedana (Pain):
Pain was recorded before and after treatment based on McGill Pain Index Score.
¾ No pain - 0
¾ Mild pain - 1
¾ Discomforting pain - 2
¾ Distressing pain - 3
¾ Horrible pain - 4
¾ Excruciating pain - 5
Objective Parameter-
1. Raktasrava (Bleeding)
2. Sankarmana (Infection)
3. Ropana kala (Healing time)
4. Mruduta or Kthinata ( Soft or Hard)
5. Recurrence.

Raktasrava (Bleeding):
Raktasrava was recorded during procedures on Self Scoring Index.
2gm cotton Swabs used to measure Raktasrava.
¾ No Swab - 0
¾ 0-2 Swab - 1
¾ 2-4 Swab - 2
¾ 4-6 Swab - 3
¾ 6-8 Swab - 4
Sankarmana (Infection):
Infection was recorded until the Vrana healed completely on Self Scoring
Index.
¾ No infection - 0
¾ Mild - 1
¾ Moderate - 2
¾ Severe - 3
Gradation Parameters:
Ropana kala (Healing time):
Healing time was based on number days required for complete healing of
Vrana.
¾ 6 days - 1
¾ 8 days - 2
¾ 10 days - 3

¾ 12 days - 4
¾ 14 days - 5
Sparsana: After healing the site was examined for the presence of Mruduta and
Kathinata. The same was recorded as
¾ Mruduta ( Soft) - Present
¾ Kathinata- ( Hard) – Present
Recurrence: The patients were followed for a period of 2 months. After 2 months the
site was again examined for recurrence. The findings were recorded as reccurence
present or absent.
INVESTIGATIONS:
Blood: Hb % RBS
BT HIV 1& 2
CT HbsAg
Study Design: Present study was a comparative clinical study.
Sample size: Minimum of 30 patients were selected randomly and categorized into
Two groups as Group A , Group B.
Group A:
Sample Size: Minimum of 15 patients
Procedure: Agnikarma with Pancha loha Shalaka.
Locally: Sterile Dressing once in a day with Jatyadi Ghruta for 15 days.
Internally: Tab -Triphala Guggulu (500mg) 2 tid for 5 days with hot water.

Group B:
Sample Size: Minimum of 15 patients
Procedure: Surgical excision.
Locally: Sterile dressing once in a day with Betadine solution for 15 days.
Internally: Tab –Diclofenac Sodium 50 mg bid for 5 days.
INTERVENTIONS:
Agnikarma: Agnikarma was performed by specially designed Pancha loha shalaka.
Pancha loha shalaka was made red hot over Agni and was applied over the Kadara till
samyak dagdha lakshanas are obtained.
Surgical excision: A circumscribed incision is taken around the Corn and is
extended up to the base and excised.
Duration: Medication 5day and dressing for 15 days.
Follow up: follow up for 60 days.
ASSESSMENT CRITERIA:
A. Criteria of assessment were based on improvement in subjective and objective
parameters. The results were categorized as,
Complete relief -- 100%
Marked relief -- Above 75% improvement
Moderate relief -- 50 to 74% improvement
Mild relief -- 25 to 49% improvement
No relief -- Below 24% improvement.

B. Overall assessment was done on the comparison of subjective and objective
symptom score index between the groups, which were subjected for statistical
analysis.
The analyses of the effects of therapy were based on “student t test”
application. The significance is discussed on the basis of the mean score, percentage,
SD, SE, t and p values.
Level of significance:
p = > 0.05 is statistically insignificant.
p = < 0.05 is statistically significant.
p = < 0.01 and < 0.001 is statistically highly significant.
OBSERVATIONS 56
OBSERVATIONS
30 Subjects who were fulfilling the Inclusion criteria were randomly selected
and were taken for the present study. Subjects were divided into two groups as Group
A and Group B with each group having 15 subjects. Data was collected as:
1) Demographic Data
2) Data related to disease
i) Subjective parameters.
ii) Objective Parameters.
Details of the data have been presented in the following tables.
1) Demographic Data:
Age incidence
Table No.13: Showing Age wise distribution:
Age (in yrs.) Group A Group B Total %
10-20 3 2 5 16.67%
21-30 8 4 12 40%
31-40 1 4 5 16.67%
41-50 2 2 4 13.33%
51-60 1 3 4 13.33%
Total 15 15 30 100%
Out of 30 subjects taken for clinical trial, 05 (16.67%) subjects were in the age
group 10-20 yrs, 12 (40%) subjects were in age group 21-30yrs, 05(6.67%) subjects
were in 31-40 yrs, 04 (13.33%) subjects were in age group 41-50 yrs of age and 04
(6.67%) subjects were in age group 51-60 yrs of age.

OBSERVATIONS 57
Sex incidence
Table No.14: Showing Sex wise distribution:
Sex Group A Group B Total %
Male 6 7 13 43.33%
Female 9 8 17 56.67%
Total 15 15 30 100%
Out of 30 subjects taken for clinical trial, 13 (43.33%) subjects in the study were
males and 17 (56.67%) subjects were females.
Religion
Table No.15: Showing Religion wise distribution:
Religion Group A Group B Total %
Hindu 12 13 25 83.33%
Muslim 3 2 5 16.67%
Out of 30 subjects taken for clinical trial, 25 (83.33%) subjects were Hindu and 05
(16.67%) subjects were Muslim.
Marital status
Table No.16: Showing Marital Status wise Distribution:
Status Group A Group B Total %
Married 8 11 19 63.33%
Unmarried 7 4 11 36.67%
Out of 30 subjects taken for clinical trial, 19 (63.33%) subjects were married and 11
(36.67%) subjects were unmarried.

OBSERVATIONS 58
Education
Table No.17: Showing Education wise distribution:
Education Group A Group B Total %

Primary 4 8 12 40%
P.U.C. 4 0 4 13.33%
Graduate 6 6 12 40%
Post Graduate 1 1 2 6.67%
Out of 30 subjects taken for clinical trial, 12 (40%) subjects were up to
Primary education, 04 (13.33%) subjects were educated up to P.U.C, and 12 (40%)
subjects were graduates and 02 (6.67%) subjects were Post Graduate.
Occupation
Table No.18: Showing Occupation wise distribution:
Occupation Group A Group B Total %

Labour 4 0 4 13.33%
Agriculture 1 3 4 13.33%
Service 1 4 5 16.67%
House Wife 2 4 6 20%
Student 7 4 11 36.67%
Total 15 15 30 100%
Out of 30 subjects taken for clinical trial, 04 (13.33%) subjects belonged to
Labour class, 04 (13.33%) subjects belonged to Agriculture, 05 (16.67%) subjects
Service classes, and 06 (20%) subjects were House wife’s, and 11 (36.67%) subjects
were students.

OBSERVATIONS 59
Socioeconomic status
Table No.19: Showing Economic status wise distribution:
Socio-economic
status Group A Group B Total %
Poor 9 6 15 50%
Middle 6 9 15 50%
Rich 00 00 00 00
Out of 30 subjects taken for clinical trial, 15(50%) subjects were of Poor class
and 15 (50%) subjects belonged to Middle class.
Dietary habits
Table No.20: Showing Dietary Habit wise Distribution:
%
Diet Group A Group B Total
Vegetarian 4 7 11 36.67%
Mixed 11 8 19 63.33%
Out of 30 subjects taken for clinical trial, 11 (36.67%) subjects were

vegetarians and 19 (63.33%) subjects were consuming mixed diet.
Table No.21: Showing Habitat wise distribution
Habitat Group A Group B Total %

Rural 6 4 10 33.33%
Urban 9 11 20 66.67%
Out of 30 subjects taken for clinical trial, 10 (33.33%) subjects were Rural
area, and 20 (66.67%) subjects were Urban area related.

OBSERVATIONS 60
Table No.22: Showing Agni wise distribution
AGNI WISE DISTRIBUTION OF 30 SUBJECTS
Pachakagni Status Group A Group B Overall

Wise No of % No of % No of Pts %
Pts Pts
Mandagni 08 53.33% 09 60% 17 56.67%
Samagni 00 00% 00 00% 00 00%
Vishamagni 07 46.67% 06 40% 13 43.33%
Teekshnagni 00 00% 00 00 00 00%
Agni wise: Out of 30 subjects studied, Maximum no. of subjects’ i.e.13
(43.33%) were having Vishamagni while 17 (56.67%) were having Mandagni.
Table No.23: showing prakruti wise distribution
PRAKRUTI WISE DISTRIBUTION OF 30 SUBJECTS
Prakruti Wise Group A Group B Overall

No of % No of % No of %
Pts Pts Pts
Pitta Kapha 01 6.67% 07 46.67% 08 26.67%
Vata kapha 02 13.33% 03 20% 05 16.66%
Vata pitta 12 80% 05 33.33% 17 56.67%
Prakriti wise: Out of 30 subjects studied, Maximum no. of subject’s i.e.17
(56.67%) were of Vata pitta prakruti and 08 (26.67%) were of Pitta- Kapha prakruti
while 05(16.66%) were of Vata Kapha prakruti.

OBSERVATIONS 61
Table No.24: showing Koshta wise distribution
KOSHTA WISE DISTRIBUTION OF 30 SUBJECTS
KOSHTA WISE Group A Group B Overall

No of Pts % No of Pts % No of Pts %
Mrudu 06 40% 07 46.67% 13 43.34%
Madhyam 08 53.33% 08 53.33% 16 53.33%
Kroora 01 6.67% 00 00% 01 3.33%
Koshtha Wise: Out of 30 subjects studied, maximum number of subjects i.e.
16 (53.33%) subjects were reported with Madhyam Koshtha, 13(43.34%) subjects
were having Mrudu Koshtha and 01(3.33%) subject was having Kroora Koshtha.
Table No.25: showing Pradhana Rasa wise distribution
PRADHANA RASA WISE DISTRIBUTION OF 30 SUBJECTS
Rasa Wise Group A Group B Overall

No of % No of Pts % No of Pts %
Pts
Madhura 02 13.33% 05 33.33% 07 23.33%
Amla 00 00% 00 00% 00 00%
Lavana 00 00% 00 00% 00 00%
Katu 08 53.33% 07 46.67% 15 50%
Tikta 04 26.67% 03 20% 07 23.34%
Kashaya 01 6.67% 00 00% 01 3.33%
Rasa Wise: Out of 30 subjects studied, maximum number of subjects i.e.
15(50%) were taking Katu rasa, 07(23.34%) subjects each were taking Madhura and
Tikta rasa, while 01 (3.33%) subject was taking Kashaya rasa Pradhana Aahara .

OBSERVATIONS 62
Table No.26: showing Sara wise distribution
SARA WISE DISTRIBUTION OF 30 SUBJECTS
SARA WISE Group A Group B Overall

No of Pts % No of Pts % No of Pts %
Pravara 05 33.33% 02 13.33% 07 23.33%
Madhyam 10 66.67% 12 80% 22 73.34%
Avara 00 00% 01 6.67% 01 3.33%
Sara wise: Out of 30 subjects studied, maximum number of subjects i.e.
22(73.34%) were having Madhyam Sara, 07(23.33%) were having Pravara Sara and
01(3.33%) was having Avara Sara.
Table No.27: showing Samhanana wise distribution
SAMHANANA WISE DISTRIBUTION OF 30 SUBJECTS
SAMHANANA Group A Group B Overall

WISE
No of % No of % No of Pts %
Pts Pts
Pravara 04 26.67% 00 00% 04 13.33%
Madhyam 11 73.33% 13 86.67% 24 80%
Avara 00 00% 02 13.33% 02 6.67%
Samhanana Wise: Out of 30 subjects studied, maximum number of subjects
i.e.24 (80%) were of Madhyam Samhanana, while, 04 (13.33%) were of Pravara
Samhanana and 02(6.67%) were of Avara Samhanana.

OBSERVATIONS 63
Table No.28: Showing Satwa wise distribution
SATWA WISE DISTRIBUTION OF 30 SUBJECTS
SATWA WISE Group A Group B Overall

Pts Pts Pts
Pravara 04 26.67% 04 26.67% 08 26.67%
Madhyam 11 73.33.% 06 40% 17 56.66%
Avara 00 00% 05 33.33% 05 16.67%
Satwa Wise: Out of 30 subjects studied, maximum number of subjects i.e.
17(56.66%) were having Madhyam Satwa, 08 (26.67%) were having Pravara Satwa
and 05 (16.67%) were having avara satwa.
Table No.29: showing Satmya wise distribution
SATMYA WISE DISTRIBUTION OF 30 SUBJECTS
SATMYA WISE Group A Group B Overall

Pts Pts Pts
Pravara 10 66.67% 10 66.67% 20 66.67%
Madhyam 02 13.33% 01 6.66% 03 10%
Avara 03 20% 04 26.67% 07 23.33%
Satmya Wise: Out of 30 subjects studied, maximum number of subjects i.e.
20(66.67%) were of Pravara Satmya, while 07 (23.33%) were of avara Satmya and
03(10%) were of Madhyam Satmya.

OBSERVATIONS 64
Table No.30: showing Deha Bala wise distribution:
DEHA BALA WISE DISTRIBUTION OF 30 SUBJECTS
DEHA BALA Group A Group B Overall

No of % No of % No of Pts %
Pts Pts
Pravara 06 40% 09 60% 15 50%
Madhyam 09 60% 04 26.67% 13 43.33%
Avara 00 00% 02 13.33% 02 6.67%
Deha Bala: Out of 30 subjects studied, maximum number of subjects i.e. 15(50%)
were of Pravara Deha Bala, 13(43.33%) were of Madhyama Deha Bala and
02(6.67%) subjects were of Avara Deha Bala.
Table No.31: showing Chronicity wise distribution
CHRONICITY WISE DISTRIBUTION OF 30 SUBJECTS
CHRONICITY Group A Group B Overall

WISE No of % No of % No of Pts %
Pts Pts
Less than 6 month 03 20% 05 33.33% 8 26.67%
6 month to 1 years 07 46.67% 05 33.33% 12 40%
1years to 2 years 05 33.33% 05 33.33% 10 33.33%
Chronicity Wise: Out of 30 subjects studied, 08(26.67%) subjects were having
chronicity Less than 6 month, while 12(40%) subjects were having chronicity 6
month to 1 years and 10(33.33%) subjects were having chronicity 1 year to2 years.

OBSERVATIONS 65
Data Related to Disease:

A) Subjective Parameter:
Table No.32 : Showing Incidence of pain in 30 patients:

Sl. No Incidence of pain Total No. of patient Percentage
1 Present 30 100%
2 Absent 00 00
Out of 30 subjects taken for clinical trial, all patients were suffering from pain
(100%).
Table No.33 : Showing Incidence of Severity of pain in 30 patients:
Vedana (Pain) Group A % Group B %
0 0
No pain 00 0
Mild pain 2 1
13.34% 6.67%
8 9
Discomforting pain 53.33% 60%
Distressing pain 4 4
26.66% 26.66%
Horrible pain 0 1
00 6.67%
Excruciating pain 1 0
6.67% 00
Total 15 15
100% 100%
Out of 30 subjects taken for clinical trial, in Group A 02 (13.34%) subjects
were having Mild pain, and 08 (53.33%) subjects were having Discomforting pain, and
04 (26.66%)subjects were having Distressing pain, and 01(6.67%). subject had
Excruciating pain. And in Group B 01 (6.67%) subjects were having Mild pain, and
09 (60%) subjects were having Discomforting pain, and 04 (26.66%) subjects were
having Distressing pain, and 01(6.67%) subject had Horrible pain.

OBSERVATIONS 66
PAIN SCORE: Group A (Agni karma)

Table No.34 : Showing McGill Pain Index Score:

Patient No Pain score on 1st Day Pain score on 15th Day

1. 1 0
2. 3 0
3. 2 0
4. 2 0
5. 2 0
6. 1 0
7. 2 0
8. 2 0
9. 3 0
10. 2 0
11. 5 0
12. 3 0
13. 2 0
14. 2 0
15. 3 0
Table No.35: Showing Average McGill Pain Index Score:
1st Day 15 Day
2.34 00
The average McGill pain index score on day 1 in Group A was 2.33 and at the
end of 15 days patients experienced no pain.

OBSERVATIONS 67
PAIN SCORE: Group B (Surgical Excision)
Table No.36 : Showing McGill Pain Index Score:
Patient No Pain score on 1st Day Pain score on 15thDay
1. 2 2
2. 2 0
3. 3 2
4. 2 0
5. 3 0
6. 2 1
7. 4 2
8. 2 0
9. 3 2
10. 2 0
11. 2 0
12. 2 0
13. 3 2
14. 1 0
15. 2 1
Table No.37 : Showing Average McGill Pain Index Score:
1st Day 15th Day
2.34 0.8
The average McGill pain index score on day 1 in Group B was 2.34 and at the
end of 15 days patients experienced average of 0.8 on McGill’s Pain Index
Score.

OBSERVATIONS 68
B) Objective Parameter
a) Raktasrava during Agnikarma/ Surgical Excision:
Table No.38 : Showing Incidence of Raktasrava
Raktasrava Group A % Group B %
No Swab – 0 15 100% 00 00
0-2 Swab - 1 00 00 1 6.64%
2-4 Swab - 2 00 00 2 13.33%
4-6 Swab - 3 00 00 5 33.33%
6 -8 Swab - 4 00 00 7 46.64%
Total 15 100% 15 100%
Out of 30 subjects taken for clinical trial, In Group A 15 (100%) subjects had no
bleeding, and in Group B 1 (6.64 %) subjects had bleeding Grading 1, and 2 (13.33
%) subjects had bleeding Grading 2, and 5(33.33%) subjects had bleeding Grading 3,
and 7 (46.64%) subjects had bleeding Grading 4.
b) Post Agnikarma /Surgical Excision Sankarmana (Infection)
Table No.39: Showing Incidence of Sankramana:
Sankramana Group A % Group B %
No Infection 14 93.34 8 53.34
Mild 1 6.66 4 26.66
Moderate 00 00 3 20
Severe 00 00 00 00
Total 15 100% 15 100%

OBSERVATIONS 69
Out of 30 subjects taken for clinical trial, In Group A 14 (93.34%) subjects had no
infection, and 01 (6.66%) subjects had Mild infection, and in Group B 08 (53.34%)
subjects had no infection and 04 (26.66%) subjects had Mild infection, 03 (20%)
subjects had Moderate infection.
b) Post Ropana Kala (Healing time):

Table No.40: Showing Incidence of Ropana Kala:
Ropana Kala Group A % Group B %
6 days 1 6.66% 00 00
8 days 4 26.67% 2 13.33%
10days 6 40% 4 26.66%

12 days 3 20% 5 33.33%
14 days 1 6.66% 4 26.66%
Total 15 100% 15 100%
Out of 30 subjects taken for clinical trial, Ropana Kala (Healing time) seen in all the
subjects in all the two groups. In Group A 01 (6.66%) subject had healing time within
6 days and 04(26.67%) subjects had healing time within 8 days, and 06 (40%)
subjects had healing time within 10 days, and 03 (20%) subjects had healing time
within 12 days. and 01 (6.66%) subjects had healing time within 14 days. .in Group B
no had healing time within 6 days and 02(13.33%) subjects had healing time within 8
days, and 04 (26.66%) subjects had healing time within 10 days, and 05 (33.33%)
subjects had healing time within 12 days. and 04 (26.66%) subjects had healing time
within 14 days.

OBSERVATIONS 70
c) Sparsana after treatment

Table No.41: Showing Incidence of Sparsana:
Sparsana Group A % Group B %
Mruduta(Soft) 15 100% 8 53.34%
Kathinata(Hard) 00 00 7 46.66%
Total 15 100% 15 100%
Out of 30 subjects taken for clinical trial, in Group A 100 (100%) subjects had
Mruduta (Soft), and in Group B 07 (46.67%) subjects had Kathinata (Hard) and
08(53.33) subject had Mruduta.
d) Recurrence after treatment

Table No.42: Showing Incidence of Recurrence:
Recurrence Group A % Group B %
Absent 15 100% 8 53.33%
Prasent 00 00 7 46.67%
Total 15 100% 15 100%
Out of 30 subjects taken for clinical trial, in Group A 15(100%) subjects had no
Recurrence, and in Group B 07 (46.67%) subjects had Recurrence. and 08 (53.33%)
subjects had no Recurrence,

OBSERVATIONS 71
Showing Age wise distribution Graph:1.
Incidence of Age in Years
15
14
13
12
11
10
9
No. of Patients
8
7 Group A
6 Group B
5
4
3
2
1
0
10‐20 21‐30 31‐40 41‐50 51‐60 Total
Age Groups in years
Showing Sex wise distribution Graph:2.
Showing Religion wise distribution Graph:3.

OBSERVATIONS 72
Showing Marital Status wise Distribution Graph:4.
Showing Education wise distribution Graph:5.
Showing Occupation wise distribution Graph:6.

OBSERVATIONS 73
Showing Socio Economic status wise distribution Graph:7.
Showing Dietary Habit wise Distribution Graph:8.
Showing Habitat wise distribution Graph:9.

OBSERVATIONS 74
Showing Agni wise distributionGraph:10.
Showing prakruti wise distribution Graph:11.

OBSERVATIONS 75
Showing Koshta wise distribution Graph:12.
Showing Pradhana Rasa wise distribution Graph:13.

OBSERVATIONS 76
Showing Sara wise distribution Graph:14.
Showing Samhanana wise distribution Graph:15.

OBSERVATIONS 77
Showing Satwa wise distribution Graph:16.
Showing Satmya wise distribution Graph: 17.

OBSERVATIONS 78
Showing Deha Bala wise distribution Graph: 18.
Showing Chronicity wise distribution Graph:19.

OBSERVATIONS 79
Showing Incidence of pain in 30 patients Graph:20.
Showing Incidence of Severity of pain in 30 patients Graph:21.
Showing Group A Average McGill Pain Index Score Graph:22.

OBSERVATIONS 80
Showing Group B Average McGill Pain Index Score Graph:23.
Showing Incidence of Raktasrava Graph:24.
Showing Incidence of Sankramana Graph:25.

OBSERVATIONS 81
Showing Incidence of Ropana Kala Graph:26.
Showing Incidence of Sparsana Graph:27.

OBSERVATIONS 82
Showing Incidence of Recurrence Graph:28.

RESULTS 83
RESULTS
Effects of Agni karma and Surgical Excision on different parameters such as
Vedana (Pain), Raktasrava (bleeding), Sankarmana (Infection), Ropana Kala (Healing
Time) were recorded during and after the treatment. The results obtained were
subjected to statistical analysis. The results are tabulated in the following tables
Table No.43: Showing the comparative reduction in Pain at the end of the
treatment in the groups based on McGill’s Pain Index score.
Mean %
Groups S.D. S.E. ‘t’ ‘p’ Remarks
B.T. A.T. Relief
Group A
2.33 00 100% 0.97 0.25 9.26 <0.001 H.S.
(n=15)
Group B
2.33 0.8 65.81% 0.74 0.19 7.9 <0.001 H.S.
(n=15)
Group A showed 100% relief of pain in the post operative period which was
statistically Highly significant at the level of p <0.001 (t = 9.26) where as Group B
showed relief of pain of 65.81% which was statistically highly significant at the level
of p < 0.001 (t = 7.9) at the end of treatment of 15 days.
Table No.44: Showing overall Relief of Pain at the end of 15 days of treatment in
Group A & Group B after Agnikarma/ Surgical Excision by McGill’s Pain Index
score.
Groups Mean B.T. Mean A.T. % Relief of pain

Group A 2.33 00 100%
Group B 2.33 0.8 65.81%
At the end of 15 days, Group A showed relief in the intensity of pain 100%
over B.T. Mean of 2.33 where as Group B in the same duration had relief of pain of
65.81% over B.T. Mean of 2.33 in patients who had undergone surgical excision.

RESULTS 84
Table No.45: Showing the Comparison between Group A and Group B in Relief
of Pain end of 15 days of treatment according to McGill’s Pain Index score.

Group A
0.86 0.31 2.52 P<0.01 S
Group B
(n1= 15) (n2 = 15)
The intensity of pain experienced by patients of Group A was lesser than Group B
which was statistically significant at the level of p < 0.01 (t = 2.52).
Raktasrava during Agnikarma/ Surgical Excision:
Table No.46: Showing Incidence of Raktasrava in Agni karma(Group A) and

Surgical excision(Group B):
Group A Group B
No of Subject Raktasrava No of subject Raktasrava

Grading Grading
1 00 1 3
2 00 2 4
3 00 3 2
4 00 4 1
5 00 5 3
6 00 6 4
7 00 7 2
8 00 8 3
9 00 9 4
10 00 10 3
11 00 11 4
12 00 12 3
13 00 13 4
14 00 14 4
15 00 15 4
Total 00 Total 48
Average 00 Average 3.2
There was no bleeding in Group A and in Group B there was Raktasrava (bleeding)
with Average of 3.2 cotton swabs of 2 gms each.

RESULTS 85
Table No.47: Showing the comparative Raktasrava at the end of the 15 days
treatment in the groups.
Mean
D.T. A.T.
Group B
3.2 00 0.99 0.25 11.20 <0.001 H.S.
(n=15)
Group A had no Raktasrava (bleeding) during and in the post operative period
where as Group B had Raktasrava (bleeding) of DT mean of 3.2 swabs of cotton
which was statistically highly significant at the level of p < 0.001 (t = 11.20) and the
end of treatment of 15 days in Group B.
Table No.48: Showing overall Rakta srava at the end of 15 days of treatment in
Group A & Group B after Agnikarma/ Surgical Excision.
Groups Mean D.T. Mean A.T.

Group A 00 00
Group B 3.2 00
At the end of 15 days, Group A had no Raktasrava at all treated with Agni
karma where as Group B in the same duration had Raktasrava of 3.2 swabs of 2gms
each in patient who had undergone surgical excision of Kadara.

RESULTS 86
Table No.49: Showing Analysis of variance in Raktasrava in Group A & Group
B after Agnikarma/ Surgical Excision.
Anova test for comparision of Raktasrava(bleeding) in two Groups

Groups Count Sum Average Variance
Agnikarma Group 15 0 0 0
Sugical Excision Group 15 48 3.2 0.8
ANOVA
Sum of Mean of P-
Source of Variation square Df Square F value F crit
Between Groups 76.8 1 76.8 173.41 1.6 4.19597
Within Groups 12.4 28 0.4
Total 89.2 29
Comparing the two Groups, i.e. Agnikarma Group and Surgical Excision Group, there
is a significant difference between the two Groups as the calculated F value is 173.41
which is greater than the critical F which is 4.19 at 5% level of significance. The
means of the two Groups which is 0 and 3.2 swabs shows a significant difference
between the two Groups.
Sankramana (Infection) after Agni karma and Surgical excision
Table No.50: Showing Sankarmana (Infection) after Agni karma and Surgical
excision:
Group A Group B
No of Sankramana No of Sankramana
Patients Patients
1 0 1 1
2 0 2 0
3 0 3 2
4 1 4 0
5 0 5 0
6 0 6 1
7 0 7 1
8 0 8 0
9 0 9 2

RESULTS 87
10 0 10 0
11 0 11 0
12 0 12 0
13 0 13 2
14 0 14 0
15 0 15 1
Total 1 Total 7
6.66% of subjects in group A presented with mild infection where as in group B
46.66% of subjects presented with mild to moderate infection at the end of 15 days of
treatment.
Table No.51: Showing the comparative Sankramana at the end of the 15 days
treatment in the groups.
Mean %
D.T. A.T. Relief
Group A
0.06 00 93.34 0.25 0.06 1 >0.10 N.S.
(n=15)
Group B
0.66 0.26 53.33 0.50 0.13 3.05 <0.01 S
(n=15)
At the end of treatment of 15 days in Group A had on Sankarmana (infection)
during treatment (DT) 0.06, which was statistically non significant at the level of
p>0.10 (t=1) and in the post operative period where as Group B had Sankarmana
(infection) of DT 0.66 mean. Which was statistically significant at the level of p <
0.01 (t = 3.05) Group A and Group B.

RESULTS 88
Table No.52: Showing overall Sankramana at the end of 15 days of treatment in

Group A & Group B after Agnikarma/ Surgical Excision.
Groups Mean D.T. Mean A.T. % Relief

Group A 0.06 00 93.34
Group B 0.66 00 53.33
At the end of 15 days, Group A had mild infection over D.T. Mean of 0.06
where as Group B in the same duration had mild to moderate infection over D.T.
Mean of 0.66 in patients who had undergone Agnikarma and Surgical excision of
Kadara respectively.
Table No.53: Showing Analysis of variance in Sankarmana in Group A & Group
Anova test for comparision of Sankramana in two Groups

Agnikarma Group 15 1 0.07 0.07
Surgical Excision Group 15 10 0.67 0.67
ANOVA
Sam of Mean of P- F
Source of Variation Square df Square F value crit
Between Groups 2.7 1 2.7 7.36 0.01 4.20
Total 12.97 29
means of the two Groups which is 0.07 and 0.67 grade of infection shows a
significant difference between the two Groups.

RESULTS 89
Ropana Kala (Healing Time):

Table No.54: Showing Ropana Kala:
Number of Days
Group A Group B
No of Ropana No of Ropana
Patients Kala Patients Kala
1 8 1 14
2 10 2 8
3 10 3 14
4 14 4 12
5 8 5 10
6 6 6 12
7 10 7 14
8 12 8 10
9 10 9 12
10 8 10 10
11 12 11 12
12 10 12 10
13 8 13 12
14 10 14 8
15 12 15 15
Total 148 Total 172
Average 9.86 11.46
Average healing time in group A was 9.86 days and group B 11.46 was days.
Table No.55: Showing Overall Ropana kala in Group A & Group B after
Agnikarma/ Surgical Excision.
Groups Mean Healing Time
Group A 9.86 days

Group B 11.46 days

RESULTS 90
Table No.56: Showing Analysis of variance in Ropana kala in Group A & Group
Anova test between two Groups in Ropana Kala

Agnikarma Group 15 148 9.87 4.27
Excision Group 15 172 11.47 4.27
ANOVA
Sum of Mean P- F
Source of Variation Square Df Square F value critical
Between Groups 19.2 1 19.2 4.5 0.04 4.20
Total 138.67 29
Comparing the two Groups, i.e. Agnikarma Group and Surgical Excision
Group, there is a significant difference between the two Groups as the calculated F
value is 4.5 which is greater than the critical F which is 4.20 at 5% level of
significance. The means of the two Groups which is 9.47 and 11.47 days shows a
significant difference between the two Groups.
Recurrence after treatment

Table No.57: Showing Incidence of Recurrence:
Recurrence Group A Group B
Recurrence 00 7
% 00 46.66
Group A subjects had no Recurrence, and in Group B 07 (46.66%) subjects had
Recurrence.

RESULTS 91
Table No.58: Showing Analysis of variance in Recurrence in Group A & Group
B after Agnikarma/Surgical Excision.
Anova test for comparision of Recurrence in two Groups

Agnikarma Group 15 0 0 0
Surgical Excision
Group 15 7 0.47 0.27
ANOVA
Sam of Mean of P-
Source of Variation Square Df Square F value F crit
Between Groups 1.63333 1 1.63 12.25 0.002 4.196
Total 5.36667 29
means of the two Groups which is 0 and 4.7 shows a significant difference between
the two Groups.
Table No.59: Showing overall effect of therapy in 15 patients who have

undergone Agni Karma in Group A.
Sr. No. Relief No. of Patients Percentage

1 Complete relief 15 100%
2 Marked Relief -
-
3 Moderate relief -
-
4 Mild relief -
-
5 No relief -
-
Total No. of Patients. 15 100%
The overall effect of Agnikarma therapy in Group A treated with Jatyadi
Ghruta and Triphala Guggulu had complete relief in 15 patients (100%).

RESULTS 92
Table No.60: Showing overall effect of therapy in 15 patients who have

undergone Surgical Excision procedure in Group B.
Sr. No. Relief No. of Patients Percentage

1 Complete relief 8 53.34%
2 Marked Relief -
-
3 Moderate relief -
-
4 Mild relief 2
13.33%
5 No relief 5
33.33%
Total No. of patients. 15 100%
The overall effect of Surgical Excision therapy in Group B treated with
Betadine and Diclofenac Sodium had complete relief in 8 patients (53.34%) mild
relief in 2 subjects (13.33%) and no relief in 5 subjects (33.33%).

DISCUSSION 93
DISCUSSION
The present clinical trial was conducted to establish efficacy of Agnikarma in
the management of Kadara (Corn). In this work literary review of Kadara, corn,
Agni Karma and surgical excision, as described in Ayurvedic and Modern Medical
Sciences are also dealt. So the discussion of the present study, apart from the clinical
study, includes discussion on conceptual study too. Hence the discussion of the
present work is made on the following headings as,
1. Discussion on literary review.
2. Discussion on materials and methods.
3. Discussion on observations and results.
4. Discussion on overall effect of therapy.
1. DISCUSSION ON LITERARY REVIEW:
Kadara has been described as one of the Kshudra roga in Sushruta Samhita.
The similar description is available in Astanga Hridaya, Astanga Sangraha,
Bhavaprakash and Sharangadhara. Even though the description of Kadara in all these
texts is brief, but it is very precise and devoid of any controversy.
Kadara occur due to injury because of thorn prick, stone and any type of cut
injury or repeated pressure over the foot while walking barefoot may give rise to local
changes like hardening, thickness, dryness, and discolouration. Pressure causes cells
in the irritated area to grow at faster rate leading to overgrowth and thickening of skin.
So there is usually horny induration of the cuticle with a hard centre. Hence, skin
exhibits sthirata and katinatha as described in Ayurvedic classics.
Doshas also play an important role in Nidana. Vitiation of Vata and Kapha
along with Rakta gives rise to changes which are more confined to parts of the skin
subjected to friction and pressure.

DISCUSSION 94
The present clinical study involves the Kadara seen on Planter aspect of pada
only being it is the area of common occurrence due to ill fitted shoes or bare foot
walking.
Corn is localized hyperkeratosis of the skin, cone shaped and its apex pointing
inwards and the base at the surface, this leads to inward extension of disease to deeper
areas.
The pain and tenderness at the sight of the corn in plantar aspect of foot gives
rise to lot of discomfort while working and affects gait of the person. Due to the
change of gait, patient may subsequently get the extension of pain in other areas such
as hip, back etc, which influence the posture.
The management described in the modern science is corn cap and excision of
the part, but results are not always satisfactory. In the corn cap the salicylic acid is
impregnated on the Cap and applied locally. This may cause local caustic reaction by
delineating the local cornfield or hyperkeratosed tissue. But still there are chances of
recurrence.
The management described in Samhitas for Kadara is promising, as it has been
tried by several scholars (Surgical excision of Kadara with Agni karma procedure).
Agnikarma has been indicated in Kadara, etc. Agni is possessed with important
qualities like dahana, chedana, bedhana, pachana, sandhana, skandhana.
Moreover, it has been indicated in subjects where shastra karma is
contraindicated. Thus the clinical study ensured the role of Agni karma in Kadara.
After thorough review of literature Kadar the following observation are made.
1. Historical study reveals that Kadara and its medical management do not exists
in Vedic period.

DISCUSSION 95
2. Kadara was first described in Sushruta Samhitha. Same description is
available in other texts like Astanga Hrudaya,Astanga Sangraha,
Bhavaprakash and Sharngdhara Samhita.
3. Aetio-pathology, clinical symptomatology, prognosis and management of
Kadara has been reviewed which has elucidated that Kadara is Vata, Kapha
dosha pradhana and rakta medha dushya pradhana disease.
4. Aetiological factors of Kadara are injury to pada because of thorn prick,
trauma by stone, cut injury or repeated pressure over the foot during barefoot
walking. In Kadara the local skin attains thickness, dryness, hardness and
discolouration along with sthiratha and katinatha.
5. Lakshanas of Kadara are pain (shoola), Tenderness (sparshasahanatawa),
discoloration (vivarnata) and central depression (vinamana) or raised surface
(utsanna).
6. Kadara can be correlated to Corn as described in Modern medical science.
7. Corn is often caused by frictional pressure or ill fitting and tight shoes.
8. The cells in the irritated area grows at faster rate leading to overgrowth,
thickening of skin, and finally horny indurations of the cuticle with a hard
centre is formed. Histologically it is composed of Keratin masses with intact
basal layers.
Discussion on materials and methods:
Pancha loha Shalaka: Pancha loha Shalaka is made by classical method told
in Ayurveda and used in many types of diseases. Pancha loha includes: tamra, loha,

DISCUSSION 96
Yashada, Rajatha,Vanga in 4:3:1:1:1 ratio. The shalaka prepared by combination of
these pancha loha retains agni for longer period. This facilitates proper Agni karma
and desired effects are obtained.
In the present study specially designed Pancha Loha Shalaka was used to
perform Agnikarma. It takes 5minute to become red hot, Temperature attained at red
hot was 200oc and temperature falls 10oc in every 5 seconds. Time taken to attain
room temperature was 1minute 40seconds. Pancha Loha Shalaka retains heat for a
longer period, thus felicitating proper heat decapitation at the affected site, and proper
administration of Agnikarma
Probable mode of Action of Pancha loha Shalaka
Agni is the factor responsible for the complete destruction of a matter. None
other than Agni can provide a stage of non occurrence. Hence, keeping this property
of Agni in mind Agnikarma has been designed by our Aacharyas. By virtue of its
nature Agnikarma pacifies Vata and kapha Doshas. When we see the Nidana of
Kadara, Vata and Kapha are the chief Doshas responsible for its manifestation. Thus,
potentially, the use of Agnikarma can be rationalized in the treatment of kadara
without paka and its non occurrence in future.
Agnikarma increases local dhatwagni and thus helps curing disease as well as
reducing the chance of recurrence. By agni tapta shalaka when Agnikarma is
performed there will be no fear of paka.
Triphala Guggulu:
Triphala and Guggulu are chief ingredients of Triphala guggulu. Triphala guggulu
when taken internally cures vibandha and it acts as vrana shodhaka & vrana ropaka.

DISCUSSION 97
Tab Triphala guggulu taken internally also relieves pain & swelling. It reduces
moisture, prevents paka and minimizes discharge & smell (Chakradatta vrana shotha
chikitsa).
Probable action of Triphala Guggulu:

Triphala by its Kashaya rasa acts as Vrana Ropana, by Tikta rasa acts as krimigna, by
Madhura rasa acts as Rasayana and helps in tissue repair, by amlarasa which is rich in
Vitamin C improves blood circulation. Haritaki having Tridoshaghna property helps
in Tridosha Shamana & pippali by its katu rasa & tikshana guna acts as deepana &
pachana. Guggulu is a major component of this yoga it acts as vedana shamaka.
Jatyadi gruta:
Ghrutas are preparations in which ghee is processed with prescribed Kasayas
(decoctions) and kalkas of drugs according to the procedure mentioned in the classics.
This process ensures proper absorption of the active therapeutic principles of the
ingredients into the ghruta.
Probable action of Jatayadi Ghruta:

Jatyadi Ghruta is hailed as one of the best Shodhana and Ropana dravya. It is
indicated in various types of vranas as external application i.e. Marmritavrana (Ulcers
in vital points), Kledi Vrana (Oozing/weeping ulcer), Gambhira Vrana (Deep ulcer),
Saruja Vrana (Painful ulcer).
Jatayadi ghurta is having majorty of Tikta rasa (40%), kasaya (25%), madhur (20%)
and katu (15%) and the presence of tuttha in the ghruta imbibes the Vishada guna.
Tuttha is also known for its vrana Ropana property, presence of which makes the
Jatyadi ghruta extremely good wound healing agent.

DISCUSSION 98
Haridra, Daruharidra,katuki,and sariva present in the jatayadi ghruta are known
antiseptic , anti-inflammatory and anti carcinogenic agents. Nimba and patola with its
laghu and ruksha guna are proven krimighna and shothaghna drugs.
With these properties, Jaatyadi ghruta is used as Shodhana and Ropana dravya in
agnidagdha caused due to administration of Agnikarma with pancha loha shalaka
The present study was carried out in total 30 Subject as prospective study by
simple randomized sampling. It was made into 2 Groups. Group A is the trial group
(Agni karma) where 15 patient were selected and Group B (Surgical Excision) is
Control group where 15 patient were selected are shown in Table .—Patient were
selected considering the inclusion and exclusion criteria from OPD and IPD of
Ayurvedic Mahavidyalaya and Hospital, Hubli.
2. DISCUSSION ON OBSERVATIONS AND RESULTS:

Discussion related to demographic data:
Age:
The age wise distribution in 30 subjects of Kadara shows that 12 (40%)
subjects were in age group 21-30yrs. In this period people are doing more physical
work so there are chances of injury to foot by thorn or stone. Hence incidence is more
common in this age group.
Sex:
The sex wise distribution shows that female subjects were more in number i.e.
17(56.67%) than males which were 13 (43.33%). Incidence of Kadara has no sex
predisposition. In present study females are more but by this data it cannot be
concluded that females are more prone to this disease.
Religion:

DISCUSSION 99
Religion wise incidence of the disease states that, the prevalence was more
seen in Hindu religion i.e. 25 (83.33%) subjects and 05 (16.67%) subjects were
Muslim. But, it can’t be concluded on this basis, that the Hindus are more affected by
this disorder. The people of all religion are susceptible to this disease. This finding
may be due to the geographical distribution of communities in and around Hubli.
Marital status:
19 (63.33%) subjects were married while 11 (36.67%) subjects were
unmarried. Marital status doesn’t have any relation with incidence of the disease.
Education:
In the present study maximum 12 (40%) subjects were educated up to P.U.C.
Education dose not play any role in this disease.
Occupation:
Occupation wise students were more in number i.e. 11 (36.67%).
More incidences may be due to playing and other activities where in chances of
trauma in more hence they are more prone for Kadara.
Socio-economic status:
There were 15 (50%) subjects in middle class followed by 15 (50%) subjects
in poor class. Equal distribution of socio-economic status shows that disease has equal
predisposition in the middle and poor class.
Dietary habits:
11(36.67%) subjects were vegetarians while 19(63.33) subjects were
consuming mixed diet. Diet has no influence in this disease.
Habitat wise:

DISCUSSION 100
10 (33.33%) subjects were from rural area, and 20 (66.67%) subjects were
from urban area. Subjects of urban area have shown more incidences in the present
study.
Agni Wise:
Maximum number of subjects i.e. 17 (56.67%) were having Mandagni and 13
(43.33%) has Vishamagni. Further, Mandagni leads to the Dhatwagni maandyata,
which is the basic cause for the manifestation of kadara.
Prakriti wise:
In the present study, all the patients were belonging to Dwandaja Deha
Prakruti with dominance of Vata-Pitta prakruti(56.67%), followed by Pitta-Kapha
prakruti(26.67%) and 05 (16.66%) patients were of Vata- Kapha Prakruti. The
present study shows that vata pitta prakruti subjects are more prone to this disease.
Pradhana Rasa:
Maximum numbers of patients in this study, 15(50%) were taking Katu rasa
pradhana Aahara, 07(23.34%) patients were taking Madhura and Tikta rasa pradhana
Aahara each, while 01(3.33%) patient was taking Kashaya rasa pradhana aahara.
However from the present study role of ahara rasa in the manifestation of kadara
could not be established.
Sara:
Maximum numbers of patients in this study, 22(73.34%) were having
Madhyama Sara, followed by 07(23.33%) patients having Pravara Sara and
01(3.33%) patients having Avara Sara. These findings are inconclusive in the present
study.
Samhanana:
Maximum numbers of patients in this study, 24(80%) were having

Madhyama Samhanana, followed by 04(13.33%) patients having Pravara Samhanana

DISCUSSION 101
and 02(6.67%) patients having Avara Samhanana. These findings are inconclusive in
the present study.
Satwa:
Maximum numbers of patients in this study, 17(56.66%) were having

Madhyama Satwa, followed by 08(26.67%) patients having Pravara Satwa and
05(16.67%) patients having Avara Satw. These findings are inconclusive in the
present study.
Satmya:
Maximum numbers of patients in this study, 20(66.67%) patients

having Pravara Satmya, followed by 03(10%) patients were having Madhyama
Satmya, and 07(23.33%) patients having Avara Satmya. These findings are
inconclusive in the present study.
Deha bala:
Maximum numbers of patients in this study, 15(50%) patients having Pravara
Deha Bala, followed by 13(43.33%) patients were having Madhyama Deha Bala, and
02(6.67%) patients having Avara Deha Bala. These findings are inconclusive in the
present study.
Chronicity:
In this study, 08(26.67%) subjects were suffering from the disease since
Less than 6 month, while 12(40%) subjects were suffering from the disease since 6
month to 1 year and 10(33.33%) subjects were suffering from the disease since 1 year
to 2years. This shows that subjects neglect the disease and comes for the treatment
very late.
Discussion related to Disease:
Effect of Vedana (Pain) in Kadara:
Out of 30 subjects, all subjects were suffering from pain (100%).

DISCUSSION 102
Vedana (Pain):-
Group A:
In Group A subjects showed 100% relief of pain in the post operative period
which was statistically highly significant at the level of p <0.001 (t = 9.26) at the end
of 15 days of treatment.
Group B:
Group B subjects showed relief of pain of 65.81% which was statistically
highly significant at the level of p < 0.001 (t = 7.9) at the end of 15 days of treatment.
Both the two groups had shown highly significant relief in pain. The intensity
of pain experienced by patients of Group A was lesser than Group B which was
statistically significant at the level of p < 0.01 (t = 2.52) because it is one of the
property of Samyak agni karma dagdha lakshana that if agni karma is done properly
with dahana upakarana,then there will be less pain and burning sensation .
Effect of Raktasrava during Agnikarma/ Excision:
Out of 30subjects, there was no bleeding in Group A, and in Group B there
was Raktasrava (bleeding) with Average of 3.2 cotton swabs of 2 grams each.
Group A had no bleeding during and in the post operative period where as
Group B had bleeding of D.T. mean of 3.2 (0.66) swabs of cotton which was
statistically highly significant at the level of p < 0.001 (t = 11.0). Because Agnikarma
is one of the chaturvidha uapaya of raktstambhana. The pancha loha shalaka is heated
till it becomes red hot on fire and there is a foul smell of burning of the skin. This in
turn contracts the localized blood vessels and arrests bleeding.
The Analysis of Variance shows that when compared between two groups
there was no bleeding in group A. This was not by chance but because of the property
of Agnikarma by Pancha loha Shalaka.

DISCUSSION 103
Effect of Agni Karma on Sankramana (Infection):
6.66% of subjects in group A presented with mild infection where as in group
B 46.66% of subjects presented with mild to moderate infection at the end of 15 days
of treatment.
Group A had Sankarmana (infection) during treatment (DT) 0.06 , which was
statistically non significant at the level of p>0.10 (t=1) and in the post operative
period where as Group B had Sankarmana (infection) of DT 0.66 mean which was
statistically significant at the level of p < 0. 01 (t = 3.05) at the end of treatment of 15
days in Group A and Group B.
Comparing the two Groups, i.e. Agnikarma Group and Excision Group, there is a
significant difference between the two Groups as the calculated F value is 7.36 which
is greater than the critical F which is 4.20 at 5% level of significance. The means of
the two Groups which is 0.07 and 0.67 grade of infection shows a significant
difference between the two Groups. This is because the Panchaloha Shalaka is heated
directly on Agni till it becomes red hot. There are no chances that any
microorganisms survive on direct fire. Sushruta also says that “paka bhayam nasti”
when agnikarma is done. Triphala Guggulu and Jatyadi grita have also contributed in
the control of the infection.
Effect of on Ropana Kala (Healing Time):
Average healing time in group A was 9.86 days and group B was 11.46 days.
the two Groups which is 9.47 and 11.47 days shows a significant difference between
the two Groups.

DISCUSSION 104
There is no bleeding and infection in the Group treated with Pancha loha Shalaka
which enhances the healing time. So the Group treated with Agnikarma along with
Triphala Guggulu internally and Jatyadi Gruta externally may have played a crucial
role in the faster healing of the wound.
Recurrence after treatment
Group A subjects had no Recurrence, and Group B 07 (46.66%) subjects had
Recurrence.
the two Groups which is 0 and 4.7 shows a significant difference between the two
Groups. This difference is because the shape of the Shalaka is such that when
agnikarma is done the red hot Shalaka pierces the keratin upto the base of the kadara
where as in excision there is always a chance of some keratin hitch is left behind
which once again causes the same problem. Sushruta in agnikarma chikitsa adhyaya
says that diseases once treated with agnikarma will never reoccur because it is
apunarbhava chikitsa. Internally Triphala Guggulu and Jatyadi Gruta when compared
with diclofenac tab and Betadine might have played a role in non recurrence.
Overall effect of the therapy
The overall effect of Agnikarma therapy in Group A treated with Jatyadi
Ghruta and Triphala Guggulu had complete relief in all 15 subjects (100%).
The overall effect of Excision therapy in Group B treated with Betadine and
Diclofenac Sodium had complete relief in 8 subjects (53.34%), and mild relief in 2
subjects (13.33%) and no relief in 5 subjects (33.33%).

DISCUSSION 105
STATISTICAL ANALYSIS:
In both the groups, it was found that the improvement of Mean Score of pain relief at
the end of 15 days in group A shows 100 % relief, where as in group B shows 53.34%
relief. This shows that conventional Agnikarma therapy is less painful compared to
Surgical Excision therapy.
The Mean healing period after Agnikarma of Kadara in Group A patients who
were treated by Pancha Loha Shalaka was 9.2 days where as in Group B patients who
were treated by Excision therapy it was 11.69 days. This finding shows that the
healing of wound took 2.49 days less in Agnikarma compared to Surgical Excision
therapy.
The reoccurrence was nil in the Group A treated with Agnikarma with pancha
loha Shalaka whereas 46.66% reoccurrence was observed in Group B which was
treated with Surgical Excision therapy.
In Group A the Rakta Srava in the post operative period was absent, as
Agnikarma is also a Raktastambhaka. In Group B average 3.2 swabs Rakta srava was
observed in post operative period.

DISCUSSION 106
Table no: 61. Comparison between agnikarma and surgical excision of kadara
Parameters Agnikarma Surgical excision

Post-operative Minimum pain More pain
pain
Rakta srava No Raktasrava Average 3.2 swabs
Infection Mild Mild to moderate
Healing time 9.2 days 11.69 days
Instruments No sterilization required Needs sterilization
Recurrence No recurrence 46.66% recurrence
Sparshana Mriduta Kathinata
Procedure Easy to do Difficult to do
Cutting of mass Fast Slow
Procedure Time Within 1min 5 to 10 min

CONCLUSION 107
CONCLUSION
After thorough discussion on various observations in the present Comparative
clinical study following conclusions were drawn.
1. The disease Kadara is mentioned in Ayruveda classics under kshudra
rogas.
2. Kadara can be compared with Corn in Modern Medical Science.
3. Aetiopathogenesis, Symptomology, Classification and management of
this disease in both Ayurvedic and Modern Medical Science are all most
the same.
4. Agnikarma is a simple procedure and results oriented with nill
reoccurrence. Hence, could be potentially employed in different diseases
as well with further research.
5. In the present study one group was treated with Agnikarma, Triphala
Guggulu and Jatyadi ghruta and Second group with Excision Therapy
with Dicnofelic and Betadine.
6. In the present study total 30 patients were selected, which is a
satisfactory sample size in a short term Research work. All the patients
Co-operated during the procedure well.
7. Triphala Guggulu and Jatyadi ghruta are used in the present study.
Triphala Guggulu has helped in relieving the pain whereas Jatyadi
Ghruta was effective in wound healing.

CONCLUSION 108
8. In the present study Group A patients which were treated with
Agnikarma got 100% relief in the 15 days of duration. Whereas Group B
got 53.34 % relief with 46.66% reoccurrence.
The following are the advantages of the Agni Karma with Pancha Lauha
Shalaka over Surgical Excision therapy
Less painful
No Raktasrava
Mild or no infection
Shorter healing time
No need for instrument sterilization
Skin will be mrudu in sparsha
Procedure is easy to do
Quick to perform.
9. Thus from the present study it can be concluded that CONVENTIONAL
AGNIKARMA BY PANCHA LOHA SHALAKA IS SUPERIOR TO
SURGICAL EXCISION THERAPY.

CONCLUSION 109
RECOMMENDATION FOR FURTHER STUDY
1. Agnikarma therapy has lot of potential, hence extensive study based on
scientific parameters in the management of Kadara as well as in other
diseases by Agnikarma is need of the hour.
2. Designing of different Agnikarma Shalakas, suitable for performing
Agnikarma in different diseases is absolute necessity.
3. Department proposes to, improve upon newly designed Pancha Loha
Shalaka ideally suitable for performing conventional Agnikarma
procedure.

SUMMARY 110
SUMMARY
The present clinical study entitled as “A CRITICAL ANALYSIS OF
AGNIKARMA W.S.R. TO MANAGEMENT OF KADARA” was completed with
a clinical trial. The introductory part gives the brief picture of the contents and the
approach towards the study of this dissertation.
During the study, the available literature in the Ancient and Modern medical
books with regard to Kadara, Corn, Agni Karma procedure, Pancha loha Shalaka, and
Surgical excision were compiled and critically analyzed.
The literary review reveals that Kadara has been first described by Sushruta.
He has considered it as a Kshudra roga. The similar description of Sushruta is
available in other texts like Astanga Hrudaya, Astanga Sangraha, Bhavaprakasha and
Sharngdhara. Kadara is caused by aghata by thorns, stones or any cut wounds. The
disease is having clinical features like pain and hardness. The management of this is
by chedana karma followed by Agni karma. This disease can be compared to Corn.
There are striking similarities in etiology, clinical features and management of both
these conditions.
The present study aims at comparative efficacy of Agni karma by Pancha loha
Shalaka and Surgical excision in Kadara roga. In this study the various materials
required for the study along with their descriptions and method of Agni karma are
explained. The study plans along with assessment criteria are also dealt.
Patient with clinical features of Kadara roga and fulfilling the criteria of
selection of the present study were selected. The patients were subjected for detail
clinical examination and investigations as per the specially designed proforma.

SUMMARY 111
The study design that was prepared with the consideration of inclusion /
exclusion criteria, materials, methods, follow ups and assessment criteria is recorded
in the second part of the dissertation, along with observations, results and discussion,
which includes the reasoning for the observations and results, that are obtained.
The present clinical study comprises of 30 patients. They were divided into
two groups as Group-A, Group-B and each having 15 patients.
The Group-A patients were subjected to Agni karma procedure with Jatyadhi gruta
local application and Tab Triphala Guggulu internally, Group-B patients were
subjected to Surgical Excision with Betadine Solution local application and Tab
Diclofenac Sodium internally.
Among the selected 30 patients, the following observations were made like
majority 12 (40%) patients were in age group 21-30yrs, 17 (56.67%) were females, 19
(63.33%) patients were married, 11 (36.67%) patients were students. It was also
observed 15 (50%) patients were middle class and 15(50%) patients were poor class
had socio-economic status.
The post-operative pain was relieved almost completely by 15 day (100%).
whereas treatment in Group B by Surgical excision, the post-operative pain was
relieved 65.81%.
In group A subjects had no Raktasrava and in group B had average Raktasrava
3.2 swabs subjects.
In Group A had nil to mild Sankarmana i.e. 93.34% subjects and in Group B had
mild to moderate Sankarmana i.e.53.33% subjects.
In Group A subjects healing period was 9.86 days, whereas in Group B subjects
healing period was 11.46 days.

SUMMARY 112
Each patient was followed up to 60th day of the procedure, to observe and note
any recurrence. But, none of the patient experienced recurrence of any of the
complaints in Group A i.e. Agnikarma by Pancha Loha Shalaka, whereas 7 subjects
recurrence in Group B who were treated by Surgical excision.
Comparative analysis of both types of Agnikarma and Surgical excision reveals
that conventional Agnikarma by Pancha Loha Shalaka is superior to Surgical
procedure.

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41. Su. S. Su. S. - 12/4
42. Su. S. Su. S. - 12/3
43. Su. S. Su. S. - 12/3
44. Su. S. Su. S. - 12/4
45. Su. S. Su. S. - 12/4
46. Su. S. Su. S. - 12/11
47. Su. S. Su. S. - 12/10
A. H. Su. S. - 30/42/43
48. Su. S. Su. S. - 12/14
49. Su. S. Su. S. - 12/5
50. Su. S. Su. S. - 12/6
51. Su. S. Su. S. - 12/8
52. Su. S. Su. S. - 12/8
53. A. H. Su. S. - 30/47
54. A. H. Su. S. - 30/48
55. Su. S. Su. S. - 12/13
56. Su. S. Su. S. - 12/12
Materials And Methods

57. Su. S. Su. S. - 12/4
58. Y. R. - 89
59. Y. R. - 46to50
S.Y. -
60. www.wikipediabetadine.com
61. www.cambiarx.com
Modern Review
62. Human Anatomy III, B. D. Chaurasia
63. Human Anatomy III, B. D. Chaurasia
64. D. I. M.
65. S. Das.
66. B.L.
BIBLIOGRAPHY 115
BIBLIOGRAPHY
1. Sushruta (1980), Sushruta Samhita with Nibandha Sangraha commentary edited by
Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya, Varanasi, Chaukhambha
Orientalia, 4th Edition.
2. Sushruta(1987),Sushruta Samhita with Ayurveda-Tattva-Sandipika Hindi
commentary edited by Kaviraja Ambikadutta Shastri,Foreword by Dr. Pranajivana
Manekchanda Mehta, Varanasi, Chaukhambha Orientalia, 6th Edition.
3. Sushruta (2001), Sushruta Samhita with Sushrutavimarsini commentary edited by Dr.
Anant Ram Sharma Acharya & Priya Vrat Sharma Acharya, Varanasi, Chaukhambha
Orientalia, 1st Edition.
4. Madhava Nidana, V. Kesavanasan – 1970, Sarachandrika Malayalam Commentary.
5. Arunadatta & Hemadri (1998), Ashtanga Hridaya of Vagbhata, with Sarvanga
Sundara & Ayurveda Rasayana Commentaries, Edited by Harishastri Paradakara
Vaidya, Varanasi, Chaukhambha Orientalia, 8th Edition.
6. Bhacamishra (1995), Bhavaprakasha Edited by Brahmashankar Mishra, Varanasi,
Chaukhambha Sanskrit Series, 6th Edition.
7. Bhavamishra (1995), Bhavaprakasha Nighantu, Edition by G.S. Pandey, Varanasi,
Chaukhambha Bharati Academy, 10th Edition.
8. Kanta Deva (1967), Shabda Kalpa Druma, Varanasi, Chaukhambha Sanskrit Series,
3rd Edition.
9. Sharangdhara Samhitha, Sri Sharangdhar, edition by Sharma P. V., Choukambha
Orientalia, Varanasi, U.P. 2003.
10. Shri Rajesh Waradhatta Shastri Govinda Dasa (1999) Bhaishajya Ratnavali:
vidhyotini Hindi commentary, Varanasi, Chaukhambha Sanskrit, Sansthan, 13th
Edition.

BIBLIOGRAPHY 116
11. Sharma P.V., Davya Guna Vignana, Choukhambha Bharti Academy, Varanasi,
Reprint 2001.
12. Madhavakara (1996), Madhava Nidana, Madhukosha Sanskrit Commentary, edited
by Yadunandan Upadhyaya, Varanasi, Chaukhambha Sanskrit, Sansthan, 26nd
Edition.
13. Shastri Ambika Dutt, Sushruta Samhitha, Choukhamba Sanskrit Sansthan, Varanasi.
14. Shastri J. L. N., Illustrated Dravya Guna Vijnana, Chaukhamba Orientalia, Varanasi,
U. P., 1st edition, 2004.
15. Pandit Ramgopal Shastry, Vedome Ayuveda, Edt. by Madanmohan Lal.
16. Priyavrita Sharma (1992), Dravya Guna Vijnana, Vol II, Varanasi, Chaukhambha
Sanskrit, Sansthan, 13th Edition.
17. Srikanth Murthy, K.R., Sharangadhara Samhitha by Sharangadhara, Chaukhamba
Orientalia, Varanasi, U. P., 1st edition, 1984.
18. Sushrutha, Sushrutha Samhitha, Commentary ‘Nibanda Sangrah’ of Dalhana, and
‘Nyayachandrika Panjika’ pf Gayadasa, Ed. Acharya, Y. T., Chaukhamba Orientalia,
Varanasi, U. P., 5th edition, 1992.
19. Vaghbhata’s Astanga Hrudayam, Murthy Srikanta Prof. K. R. Krishnadas Academy,
Varanasi 4th edition 2000, editor Priya Vorat Sharma,
20. Vaghbhata’s Astanga Sangraha, Translation K. R. Srikanta Murthy, Chaukhamba
Orientalia, Varanasi, Vishwabharati, U. P., 1st edition, 1997.
21. Yoga Ratnakar, Vidyotini Hindi Teeka by Yadunanandan Upadhyaya Shastri L. P.,
Chaukhamba Sanskrit Sansthana, Varanasi, 21st edition, 1973.
22. Sharangdhara Acharya (1983), Sharangdhara Samhita, edited by Pandit Parashurama
Shastri, Varanasi, Chaukhambha Orientalia, 3rd Edition.
23. Shodala, Gadanagriha (1969), edited by Ganga Sahaya Pandeya, Varanasi,
Chaukhambha Sanskrit, Sansthan.

BIBLIOGRAPHY 117
24. Vachaspati Bhatt Acharya (1970), Vachaspatyam, Vol II, Varanasi, Chaukhambha
Sanskrit Series, 3rd Edition.
25. Vagbhata (1978), Rasaratna Samuchchaya, Edited by Kaviraj Ambiladatta Shastri,
Varanasi, Chaukhambha Sanskrit Series, 6th Edition.
26. Vagbhata (1988), Ashtanga Sangraha, Edited by D.V. Pandita Rao, New Delhi:
C.C.R.A.S.1st Edition.
27. Vangasena (1893), Chikitsa Sara Sangraha, Calcutta, Jivanand Vidyasagar Bhatt
Acharya, 2nd Edition.
28. Priyavrat Sharma- (1998). Cakradatta Chaukambha Publishers Varanasi. 2nd edition
29. Concise Medical Dictionary, Oxford University press, reprinted- 1992-94.
30. Anonymous (1993) Yoga Ratnakara, Vidyoiti Hindi Teeka, edited by Brahmashankar
Shastri, Varanasi, Chaukhambha Sanskrit, Sansthan, 5th Edition.
31. Das Somen, A concise text book of Surgery, Dr. Das, Calcutta, 3rd edition.
32. Das Somen, A Manual of Clinical Surgery, Dr. Das, Calcutta, 4th edition.
33. Dorland’s Medical Dictionary, W. B. Saunders Publication 24th edition.
34. Gray’s Anatomy, Edited by Peter’s. Williams And Roger Warwick, 37th edition,
Churchill Livingstone, Edinburgh, London, Melbourne And New York, 1989.
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Ltd., New Delhi, 6th edition, 2004.
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39. Dr.Ramnivas Sharma & Dr.Surendra Sharma, (2000) Sahasta Yogam. Caukambha
Sanskrit Sansthan, Varanasi. 3rd Edition.

BIBLIOGRAPHY 118
40. Bailey And Love’s Short Practice of Surgery, A. J. Hardingrains, H. David Ritchie –
17th edition.
41. K.L.Joshi Atharva Veda Samhita Delhi; Parimala publications 2004.
42. Sri M. Monier williams A Sanskrita English Dictionary 1899 New Dheli.

CASE SHEET i
A CRITICAL STUDY OF INDIGENOUS SUTURE MATERIALS

W.S.R TO MANAGEMENT OF KSHATAJA VRANA
Guide: Dr. S. K. BANNIGOL Co-Guide: DR. C.THYAGARAJA

M.D (Ayu.) M.S. (Ayu.)
Candidate: Dr. MANOJ KUMAR SINGH

M.S. Scholar
PATIENT CONSENT FORM
I ____________________________________________________
Exercising my free of choice, hereby give you my complete consent to be include
as a subject in the Clinical trail on “A CRITICAL ANALYSIS OF
AGNIKARMA w.s.r. TO MANAGEMENT OF KADARA”. I have
been inform to my satisfaction by attending Doctor, the purpose of clinical trail and
nature of drug treatment, therapeutic procedures, follow-up and probable
complications. I m also ready to undergo necessary Laboratory Investigations to
monitor and safeguard my body functions.
I am also aware of my right to opt out of the trial at any time during the
course of the trial without having to give the reasons for doing so.
Signature of the Candidate Signature of the Patient / Guardian

(Dr MANOJ KUMAR SINGH)
M.S. Scholar
Signature of the guide Signature of the co-guide

(DR. S. K. BANNIGOL) (DR. C.THYAGARAJA)
M.D. (Ayu) M.S. (Ayu)

CASE SHEET ii
A CRITICAL STUDY OF INDIGENIOUS SUTURE MATERIALS W.S.R TO

MANAGEMENT OF KSHATAJA VRANA
Guide: Dr. S. K. BANNIGOL Co-Guide: DR C.THYAGARAJA

M.D. (Ayu) M.S. (Ayu)
Candidate: Dr. MANOJ KUMAR SINGH
M.S. Scholar
CASE SHEET
Name: _________________________________ Clinical Trial No.: - ________

Age: ___________________________________ O.P.D. No: - ________
Sex: ___________________________________ I.P.D.No: - ________
Occupation______________________________ Date: - ________
Religion________________________________ D.O.A.: - ________
Marital Status: ___________________________ D.O.D.: - ________
Habitat__________________________________ Diagnosis: - ________
Socio Economical Status____________________
Educational status_________________________
Address: ________________________________
________________________________________
________________________________________
Ph.No ____________________
E-Mail ____________________
CLINICAL TRIAL INFORMATION
Group A Group B Group C

Ashwa Bala Guduchi Snayu Cotton Thread no
10
Date of Procedure
Done
Date of Complete
Recovery

CASE SHEET iii
PRADHANA VEDANA: Kala Prakarsha:
Vedana:
Raktasrava:
ANUBANDHI VEDANA: Kala Prakarsha:
DETAILS OF LAKSHANA:
Vedana - Present / Absent
Duration -
Mode of Onset -
Aggravating factor -
Relieving factor -
Raktasrava - Present / Absent

Mode of Onset -
Severity - Mild / Moderate / Severe
ADYATAN VYADHI VRUTANTA:
POORVA VYADHI VRUTTANTA:
KULA VRITTANTA:

CASE SHEET iv
VAIYAKTIKA VRUTTANTA:
1. Aharaja - Vegetarian / Mixed

Pradhana Rasa -
Guna -
2. Vihara -
3. Nidra -
4. Vyasana - Tobacco chewing /Smoking/Alcohol/Gutka
/Others/Nil
5. Mala pravrutti -
6. Mootra pravrutti - Frequency-Day -------- / Night ------ --
VYAVASAYA VRUTTANTA:
Nature of Work - Sedentary /Moderate /Laborious /Traveling /Sitting /H/W
Working hours -
RAJA PRAVRUTI VRUTANTA:

Raja pravrutti - Regular / Irregular
Menarche -
Menopause -
Others -
SAMANYA PAREEKSHA:
Nadi Jihva Drik Dehoshma
Mala Shabdha Akruti Raktachapa
Mootra Sparsha Bhara Shwasavega

CASE SHEET v
SYSTEMIC EXAMINATIN:-
*R.S. - *Urinary -
*C.V.S. - *Genital -
*C.N.S. - *G.I System-
DASHAVIDHA PAREEKSHA:-
1. Prakruti -V / P / K / VP / VK / PK / Tridoshaja
2. Vikruti -Dosha - V / P / K / VP / VK / PK / Tridoshaja
-Dushya-Rasa/Rakta/Mamsa/Meda/Asthi/Majja/Sukra
3. Sara -
4. Samhanana -Pravara / Madhyama / Avara
5. Pramana -Pravara / Madhyama / Avara
6. Satwa -Pravara / Madhyama / Avara
7. Satmya -
8. Ahara Shakti -Abhyvaharana – P / M / A
-Jarana – P / M / A
9. Vyayama Shakti - Pravara / Madhyama / Avara.
10. Vayataha -Bala / Madhyama / Vradha

CASE SHEET vi
STHANIKA PAREEKSHA:
I) Inspection:
Site -
Size -
Shape - ovoid/pear /kidney/irregular shaped
Surface -
Edge - indistinct/sessile
Number -
II) Palpation:
Tenderness - present /absent
Extent -
III) Auscultation:
Laboratory Investigation:
Specimen Name of Test Observed value

1. BLOOD Hb%
B.T
C.T
R.B.S
HIV 1 and 2
HbsAg

CASE SHEET vii
INTERPRETATION:
1. Hetu:
2. Poorva roopa:
3. Roopa:
4. Upashaya / Anupashaya:
5. Samprapti:
Samprapti Ghataka:
a. Dosha -
b. Dushya -
c. Agni -
d. Ama -
e. Srotas -
f. Dusti prakara -
g. Udbhava sthana -
h. Vyakta sthana -
i. Adhisthana -
j. Roga marga -

CASE SHEET viii
Vyadhi vinischaya:
TREATMENT PROCEDURE:
Poorva Karma:
Pradhana Karma:
Paschat Karma:

CASE SHEET ix
OVERALL ASSESSMENT AND RESULTS:
PARAMETERS AND OBSERVATION:
VEDANA -- McGill PAIN INDEX SCORE
BEFORE
TREATMENT 0 - No pain
1 - Mild pain
DURING TREATMENT (IN DAY’S) 2 - Discomforting pain

ST ND
1 2 3RD 4TH 5TH 6TH 7TH 3 - Distressing pain
4 - Horrible pain
AFTER 5 - Excrutiating pain
TREATMENT
SANKRAMANA (INFECTION)
BEFORE
TREATMENT
DURING TREATMENT (IN DAY’S)

1ST 2ND 3RD 4TH 5TH 6TH 7TH
AFTER
TREATMENT
ROPANA KALA (HEALING TIME)
BEFORE
TREATMENT

ST ND
1 2 3RD 4TH 5TH 6TH 7TH
AFTER
TREATMENT

CASE SHEET x
RAKTASRAVA (BLEEDING)
BEFORE
TREATMENT

AFTER
TREATMENT
SPARSHASAHISHNUTA(TENDERNESS)
BEFORE
TREATMENT

AFTER
TREATMENT
5. RECURRENCE
CRITERIA FOR ASSESSMENT:

Assessment
a. For Symptoms:
* Complete relief - 100%
* Marked relief - 75 – 100%
* Moderate relief - 50 – 75%
* Mild relief - 25 – 50%
* No relief - < 25%

Master Chart Group ‐ B xiv
NO OF PTS PAIN RAKTASRAVA SANKRAMANA ROPANA KALA
BT AT DT AT DT AT DAYS
1 2 2 3 1 14
0 0
2 2 0 4 0 8
0 0
3 3 2 2 2 14
0 0
4 2 0 1 0 12
0 0
5 3 0 3 0 10
0 0
6 2 1 4 1 12
0 0
7 4 2 2 1 14
0 0
8 2 0 3 0 10
0 0
9 3 2 4 2 12
0 0
10 2 0 3 0 10
0 0
11 2 0 4 0 12
0 0
12 2 0 3 0 10
0 0
13 3 2 4 2 12
0 0
14 1 0 4 0 8
0 0
15 2 1 4 1 15
0 0
Drugs photo

Triphala Guggulu
Jatyadi gruta
Betadine Solution
Tab - Diclofenac Sodium

AGNI KRMA PROCEDURE

SURGICAL EXCISION PROCEDURE

AGNI KARMA
BEFORE TREATMENT AFTER TREATMENT

SURGICAL EXCISION
BEFORE TRETMEANT AFTER TRETMEANT

Agnikarma Criticle Review

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A CRITICAL ANALYSIS OF AGNIKARMA W.S.R.

MASTER OF SURGERY (Ayurveda)

Dr. SRINIVAS K. BANNIGOL.

PROFESSOR AND HEAD

DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA

DECLARATION BY THE CANDIDATE

DR. MANOJ KUMAR SINGH

DEPARTMENT OF POST GRADUATE STUDIES IN

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A CRITICAL

CERTIFICATE BY THE CO-GUIDE

This is to certify that the dissertation entitled “A CRITICAL

ANALYSIS OF AGNIKARMA W.S.R. TO

MANAGEMENT OF KADARA” is a bonafied research work

done by DR. MANOJ KUMAR SINGH in partial fulfillment of the

requirement for the degree of DOCTOR OF SURGERY

(AYURVEDA) in SHALYA TANTRA.

AYURVEDA MAHAVIDYALAYA, HUBLI

This is to certify that the dissertation entitled “A CRITICAL

ANALYSIS OF AGNIKARMA W.S.R. TO

MANAGEMENT OF KADARA” is a bonafied research work

done by DR. MANOJ KUMAR SINGH under the guidance of DR. S.

K.BANNIGOL in PROFESSOR AND H.O.D Department of Post Graduate

Studies Shalya Tantra, Ayurveda Mahavidyalaya, Hubli.

COPYRIGHT DECLARATION BY THE

University of Health Sciences, Karnataka shall have the rights to

preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

© Rajiv Gandhi University of health sciences, Karnataka

2. Objectives and Previous work done……………………… 4–5

HISTORICAL REVIEW……………………………………. 6–7

8. Conclusion…………………………………………………. 107 – 109

9. Summary…………………………………………………… 110– 112

“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”

10. Bibliographic References…………………………………... 113- 118

“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”

power. Who is all-pervading the opportunity to me. I offer my prayer to Lord

the ever green knowledge of Ayurveda.

Parents Are The Representatives Of God On Earth. First And Foremost I

My Mother Mrs.Savitri Singh And Also To My small Brother Dr.Manish Kumar

Could Earn A Drop Of Knowledge It Is Solely Because Of Their Meticulous

Background And Strapping Moral Support.

At this landmark of thesis completion. The unfathomable world of medicine with

as many possibilities and immeasurable boundaries poses an un-navigable path to a

I am really grateful to my Co-Guide Dr C.Thyagaraja for his untiresome guidance

throughout the study.

I wish to propose my sincere thanks to Dr.S.J.Deshapande Principal,

Ayurveda Mahavidyalaya, Hubli, for the encouragement and support.

“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”

I thank to Dr S.A.Patil, Dr. Prabhu, Dr.Deepak, Dr.Srivatas,Dr.

interpretation of statistical data.

My Heartiest gratitude to my beloved and revered teachers

Dr.P.G.Subbanagouda, Head of K.C Dept, Dr.M.A. Hullur and Dr.A. S

encouragement given to me and rectifying my mistakes. My sincere thanks to

research work. I am extremely grateful to Dr. B. B. Joshi, and Dr.Pradeep

Agnihotri, and Dr. Anita, for there valuable guidance.

supportive guidance helped me a lot to overcome the device of hindrances in my

research work, let it be physical or intellectual.

I need to thank my esteemed colleagues, Dr. Alok, Dr. Ragavendran, Dr.

rendered throughout my research study, which is worth to be enumerated or repaid.

supportive nature, especially to Dr.Paritosh Bhatt for his valuable inputs in

“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”

It is my pleasure to thank Mr.Rajashekar Librarian, PG Library Mr

Prashanth Librarians of UG Library, Mr.Kolyal, Lab technician and nonteaching