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
Co-Guide
Dr. C.THYAGARAJA.
M.S. (Ayu)
ASST.PROFESSOR
DEPARTMENT OF POST-GRADUATE STUDIES IN SHALYA TANTRA
AYURVEDA MAHAVIDYALAYA, HUBLI.
i
RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
Date:
Place: Hubli
ii
DEPARTMENT OF POST GRADUATE STUDIES IN
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
DEPARTMENT OF POST GRADUATE STUDIES IN
SHALYA TANTRA
AYURVEDA MAHAVIDYALAYA, HUBLI
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
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
DEPARTMENT OF POST GRADUATE STUDIES IN
SHALYA TANTRA
AYURVEDA MAHAVIDYALAYA, HUBLI
DR. MANOJ KUMAR SINGH, hereby declare that the Rajiv Gandhi
Date:
Place: Hubli
DR. MANOJ KUMAR SINGH
P.G. SCHOLAR
DEPARTMENT OF POST-GRADUATE
Studies in Shalya Tantra
AYURVEDA MAHAVIDYALAYA,
HUBLI, 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
3. Review of Literature……………………………………….. 6 - 38
Modern Review…………………………………………….... 28 - 38
PART 2
4. Methodology……………………………………………….. 39– 55
PART 3
5. Observations ………………………………………………. 56 - 82
6. Results…………………………………………………….. 83 - 92
7. Discussion………………………………………………….. 93 – 106
11. Annexure…………..……………………………………….. i – xi
ACKNOWLEDGEMENT
First I pray to the almighty God, because God is omniscient and supreme
Dhanwantari, the God of Ayurveda and add this small endeavor of my dissertation to
Express My Deep Sense Of Gratitude To My Parents Shri Lal Bahadur Singh And
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
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.
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
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
Dr.J.R.Joshi HOD of Siddhanta Dept. for his constant support in the entire
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
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
I would like to thank my juniors of all the Post Graduate Departments for their
dissertation.
PLACE: HUBLI
ABBREVIATIONS
• A. H. - Ashtanga Hrudaya
• A. K. - Amara Kosha
• A. S. - Ashtanga Sangraha
• A. T. - After Treatment
• A. V. - Atharvaveda
• B. P. - Bhavaprakasha
• B. P. N. - Bhavaprakasha Nighantu
• B. R. - Baishajyaratnavali
• B. S. - Bhela Samhita
• B. T. - Before Treatment
• C. D. - Chakradatta
• Comm. - Commentary
• Dal. - Dalhana
• J. M. - Jata Kamala
• M. N. - Madhava Nidana
• P. - Probability
• R. T. - Rasa Tarangini
• R. V. - Rigveda
• S. D. - Standard Deviation
• S. E. - Standard Error
• S. H. - Sringarahata
• S. S. - Sushruta Samhita
• S. Y. - Sahasra Yoga
• V. S. - Vangasena Samhita
• Y. M. - Yoga Mruta
• Y. R. - Yoga Ratnakara
• Y. S. - Yogaratna Samuchaya
• Y. V. - Yajurveda
ABSTRACT
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
corn caps and surgical excision. But by these procedures the results are not satisfactory as
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
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
in 7 patients. By these results it can be concluded that Agnikarma has shown better
KEY WORDS:
Kadara, Corn, Agni karma procedure, Pancha loha Shalaka, Surgical excision,
LIST OF TABLES
TABLE
NO CONTENTS PAGE NO
Table Showing kshirpa marma 9
1.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
LIST OF GRAPHS xxi
Graph showing Deha Bala wise distribution 78
18
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
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,
technique and optimum result. By this technique various diseases are treated
indicated.
Kadara is a Kshudra Roga. But gives more trouble for the patient and
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
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.
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
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
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,
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
suggest standard guidelines for this procedure. The efficacy of Agnikarma procedure
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
Summary.
The observation and results obtained from the clinical study have been
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
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,
Texts.
Ayurvedic Texts.
science.
Akola.1995.
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
For convenience, the historical review is done under the following headings:
The Vedas are the oldest recorded documents of knowledge and also
disease description is not available. Atharva Veda which has been termed as
to the bite of serpent. Perhaps this can be taken as a method of Agni karma.1
Samhita Period was the golden era for Ayurveda. In Sushruta Samhita detail
Acharya Sushrutha has explained about Kadara in 13th chapter i.e. Kshudra
Ksudraroga Vijnaniya.5
f) Madhava Nidana- Kadara roga is explained in 55th Chapter i.e. Kshudra roga
Adhyaya.14
kandakam.15
by Kina.17
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
c) Manipal Manual of Surgery –Corn signs, symptoms and treatment has been
explained.20
AYURVEDIC REVIEW
incidental and normal to routine life. Valid references in respect of Kadara are not
description of Kadara was first described in Sushruta samhitha and in the due course
these texts regarding kadara remains the same as that of Sushrutha. Since the
As Kadara occurs in Pada, before dealing with details of Kadara21, brief description of
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
NAME KSHIRPA
heart.
pain.
Table No. 2 : TALA HRIDAYA
plantea arch.
both sides.
AND TYPE
manibandha snadhi
AND TYPE
iron probe.
{vettiveria zizianoides}
KADARA DESCRIPTION
NIRUKTI / PARIBHASHA
Vyutpatti:
Nirukti:
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
Kannada - Ani
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 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
Ayurveda, Nidana have been given it most importance because the first line of
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
Pashana - Stone
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
dhatus. With the involvement of these Doshas and dhatus a hard swelling is
NIDANA
AGHATA TO PADA
GRATHANATA IN PADA
KADARA
SAMPRAPTI GHATAKA
Agni :
Jatargni: Manda
Dhatwagni: Manda
Roga-Marga : Bahya
Adhisthana : Pada
Vyaktasthana : Pada
ROOPA OF KADARA
The symptoms of Kadara mentioned in the texts can be enlisted as following:
Vedana – Painfull.
According toBhoja Kadara can occur both in hands and feet equally.34
SADYA SADYATA
parts of water and reduced to ¼, this quatha can be used for massaging
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
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 18
AGNI-KARMA
Agnikarma:
That which has the course of action in the upward direction is Agni.39
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
Since Vedic period, Agni Karma is in practice to treat various human ailments.
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
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 19
Superiority of Agni Karma:
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
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
The different Dahanaupakaranas mention in various texts are Shown in the Table
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 20
Table No.6: Showing different Dahanaupakarana as mentioned in various texts:
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) - - + -
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 21
18 Hema (Gold) - + + -
19 Tamra (Copper) - - + -
20 Rajata (Silver) - - + -
21 Kansya (Bronze) - - + -
22 Varti - - - +
23 Suryakanta - - + -
Acharya Sushruta has advised the use of dahanaupakarna according to the site
of diseases.45
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
swaroopa of the diseases. The different shapes produced as a result of the Agni Karma
are as follows46.
be of pointed tip.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 22
5. Ardhchandra - Crescent shape.
directions.
the diseases in which Agni karma indicated, as mentioned in various texts are
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 - + + -
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 23
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 - - + +
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 24
42 Mushaka Visha - - + +
43 Gridhrasi + - - -
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 - - + +
65 Sotha + - - -
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 25
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.
strength
Unsuitable dushya Rakta and Pitta. As Agni, pitta and Rakta are having
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
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 26
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
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
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
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.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
CHIKITSA VIVECHANA 27
Hina Agni dagdha lakshana:-53
The Hina Agni dagdha lakshana are discolouration of the skin, severe burning
sensation feeling of hot fumes coming out, pain, destruction of veins, thirst,
Paschatkarma:55
After completion of Agni Karma the part where Agni Karma has done should
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.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
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
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
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.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
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
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,
All muscles originating on the lower leg except the popliteus muscle are
aponeurosis)---
¾ Abductor digiti minimi(this muscle lies along the lateral border of foot)
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
MODERN REVIEW 30
lateral side)
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.)
The chief Arteries of the sole are the medial and lateral planter artery. They are
1. The chief nerves of the sole are the medial and lateral planter nerves. They are
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
3. The medial plantar vessels and nerve lie between the abductor hallucis the
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.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
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
injury from trauma as it is particularly evident from the palms and soles.
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
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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
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
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
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
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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
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
finger of a violinist.66
Callosities and corns are caused by pressure and friction due to faulty weight
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.
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
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
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MODERN REVIEW 34
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
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
chiefly where the normal skin is thin. Corns are found particularly on the 4th toe and
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
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MODERN REVIEW 35
COMMON SITES
Corn commonly involves the skin on the hand, feet and knees. The area of
¾ Antero lateral
¾ Antero medial
¾ Medial
¾ Lateral
¾ Postero lateral
¾ Postero medial
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MODERN REVIEW 36
CORN CALLOSTY
layer, usually over bony areas such as by repeated pressure and irritation.
toe joints.
hard center on the feet and toes. seen on the feet and the hands.
granulosum.
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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
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
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
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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
properly.
Besides all these conventional techniques the main treatment for corn lies in
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
¾ Daily massage with 10% salicylic acid in Vaseline for two or three weeks to
POSSIBLE COMPLICATIONS
Corn if not treated properly will lead to change of gait. This will result into pain in
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MATERIALS AND METHODS 39
MATERIALS AND METHODS
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
3. Jatyadi Ghruta.59
4. Betadine Solution.60
The brief description of the above said materials and drugs are described in the
following paragraphs.
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%.
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MATERIALS AND METHODS 40
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
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MATERIALS AND METHODS 41
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.
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
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,
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MATERIALS AND METHODS 42
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.
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MATERIALS AND METHODS 43
JATYADI GHRUTA
The Ingredients of the Jatyadi Ghruta along with their details are tabulated in
Serial Name Botanical name Parts used Rasa Guna Viry Vipaka Doshagataka
no. a
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
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.
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
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MATERIALS AND METHODS 44
13 Madhuchissti Madhura Snigdha Sita Madhura Kapha Pittahara
Medohar
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
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MATERIALS AND METHODS 45
The Jatyadi ghruta was prepared as per the standard method of Ghruta preparation.
Jatyadi Ghruta is hailed as one of the best Shodhana and Ropana dravya. It is
BETADINE
1. A solution, sold over-the-counter (OTC) for cleaning minor wounds and used
Povidone-iodine in water.
OTC as a skin cleaner and disinfectant hand wash and used for cleansing
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
It was first sold in 1955, and has since become the universally preferred iodine
antiseptic.
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MATERIALS AND METHODS 46
Properties
polyethylene glycol, and glycerol. Its stability in solution is much greater than that of
range of microbicidal activity against bacteria, fungi, protozoa, and viruses. Slow
release of iodine from the PVPI complex in solution minimizes iodine toxicity
Uses
broadly used for the prevention and treatment of skin infections, and the treatment of
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
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MATERIALS AND METHODS 47
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
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
countries for minor aches and pains and fever associated with common infections.
History
was first introduced in the UK in 1979. Recent research (2010) has linked use of
Mechanism of action
The exact mechanism of action is not entirely known, but it is thought that the
making it more sensitive to corrosion by gastric acid. This is also the main side-effect
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MATERIALS AND METHODS 48
of diclofenac. Diclofenac has a low to moderate preference to block the COX2-
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.
evidence that diclofenac inhibits the lipoxygenase pathways, thus reducing formation
additional actions may explain the high potency of diclofenac – it is the most potent
molecular targets of diclofenac that could contribute to its pain-relieving actions have
Medical uses
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MATERIALS AND METHODS 49
treatment of acute migraines. Diclofenac is used commonly to treat mild to moderate
Contraindications
• Third-trimester pregnancy
• Recently, a warning has been issued by the FDA not to use for the treatment of
trigger attacks
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MATERIALS AND METHODS 50
METHODOLOGY
Source of Data:
of Ayurveda Mahavidyalaya Hospital Hubli, who were fit for the study as per
2. Patients were registered and details were recorded in specially designed Case
Sheet Proforma.
Inclusion Criteria:
Exclusion Criteria:
4. Patients with infective conditions like HIV and HbsAg were excluded.
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MATERIALS AND METHODS 51
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)
5. Recurrence.
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MATERIALS AND METHODS 52
Raktasrava (Bleeding):
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:
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
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MATERIALS AND METHODS 53
¾ 12 days - 4
¾ 14 days - 5
Sparsana: After healing the site was examined for the presence of Mruduta and
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
Sample size: Minimum of 30 patients were selected randomly and categorized into
Group A:
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.
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MATERIALS AND METHODS 54
Group B:
Locally: Sterile dressing once in a day with Betadine solution for 15 days.
INTERVENTIONS:
Pancha loha shalaka was made red hot over Agni and was applied over the Kadara till
ASSESSMENT CRITERIA:
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MATERIALS AND METHODS 55
B. Overall assessment was done on the comparison of subjective and objective
symptom score index between the groups, which were subjected for statistical
analysis.
application. The significance is discussed on the basis of the mean score, percentage,
Level of significance:
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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
i) Subjective parameters.
1) Demographic Data:
Age incidence
Table No.13: Showing Age wise distribution:
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
Sex incidence
Table No.14: Showing Sex wise distribution:
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:
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:
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.
Education
Table No.17: Showing Education wise distribution:
Occupation
Table No.18: Showing Occupation wise distribution:
Service classes, and 06 (20%) subjects were House wife’s, and 11 (36.67%) subjects
were students.
Socioeconomic status
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
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, 10 (33.33%) subjects were Rural
area, and 20 (66.67%) subjects were Urban area related.
(56.67%) were of Vata pitta prakruti and 08 (26.67%) were of Pitta- Kapha prakruti
were having Mrudu Koshtha and 01(3.33%) subject was having Kroora Koshtha.
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 .
22(73.34%) were having Madhyam Sara, 07(23.33%) were having Pravara Sara and
17(56.66%) were having Madhyam Satwa, 08 (26.67%) were having Pravara Satwa
20(66.67%) were of Pravara Satmya, while 07 (23.33%) were of avara Satmya and
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
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.
1 Present 30 100%
2 Absent 00 00
Out of 30 subjects taken for clinical trial, all patients were suffering from pain
(100%).
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%
were having Mild pain, and 08 (53.33%) subjects were having Discomforting pain, and
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
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
2.34 00
The average McGill pain index score on day 1 in Group A was 2.33 and at the
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
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.
B) Objective Parameter
a) Raktasrava during Agnikarma/ Surgical Excision:
No Swab – 0 15 100% 00 00
6 -8 Swab - 4 00 00 7 46.64%
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,
Moderate 00 00 3 20
Severe 00 00 00 00
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%)
6 days 1 6.66% 00 00
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.
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
Prasent 00 00 7 46.67%
Out of 30 subjects taken for clinical trial, in Group A 15(100%) subjects had no
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
RESULTS
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
showed relief of pain of 65.81% which was statistically highly significant at the level
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.
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.
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.
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).
Group A Group B
There was no bleeding in Group A and in Group B there was Raktasrava (bleeding)
Table No.47: Showing the comparative Raktasrava at the end of the 15 days
treatment in the groups.
Mean
Groups S.D. S.E. ‘t’ ‘p’ Remarks
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
which was statistically highly significant at the level of p < 0.001 (t = 11.20) and the
Table No.48: Showing overall Rakta srava at the end of 15 days of treatment in
Group A & Group B after Agnikarma/ Surgical Excision.
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
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
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
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
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 %
Groups S.D. S.E. ‘t’ ‘p’ Remarks
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)
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 <
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.
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 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
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.
Table No.56: Showing Analysis of variance in Ropana kala in Group A & Group
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
Recurrence 00 7
% 00 46.66
Recurrence.
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 12.5
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 4.7 shows a significant difference between
Betadine and Diclofenac Sodium had complete relief in 8 patients (53.34%) mild
DISCUSSION
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
Kadara has been described as one of the Kshudra roga in Sushruta Samhita.
Bhavaprakash and Sharangadhara. Even though the description of Kadara in all these
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
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
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
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.
tried by several scholars (Surgical excision of Kadara with Agni karma procedure).
Agnikarma has been indicated in Kadara, etc. Agni is possessed with important
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.
Kadara has been reviewed which has elucidated that Kadara is Vata, Kapha
trauma by stone, cut injury or repeated pressure over the foot during barefoot
walking. In Kadara the local skin attains thickness, dryness, hardness and
(utsanna).
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
basal layers.
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,
these pancha loha retains agni for longer period. This facilitates proper Agni karma
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
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,
Agnikarma increases local dhatwagni and thus helps curing disease as well as
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.
Tab Triphala guggulu taken internally also relieves pain & swelling. It reduces
moisture, prevents paka and minimizes discharge & smell (Chakradatta vrana shotha
chikitsa).
Madhura rasa acts as Rasayana and helps in tissue repair, by amlarasa which is rich in
in Tridosha Shamana & pippali by its katu rasa & tikshana guna acts as deepana &
Jatyadi gruta:
(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
in vital points), Kledi Vrana (Oozing/weeping ulcer), Gambhira Vrana (Deep 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
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
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
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
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
Religion:
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
Marital status:
unmarried. Marital status doesn’t have any relation with incidence of the disease.
Education:
Occupation:
More incidences may be due to playing and other activities where in chances of
Socio-economic status:
in poor class. Equal distribution of socio-economic status shows that disease has equal
Dietary habits:
Habitat wise:
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:
Prakriti wise:
In the present study, all the patients were belonging to Dwandaja Deha
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
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:
and 02(6.67%) patients having Avara Samhanana. These findings are inconclusive in
the present study.
Satwa:
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.
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:
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 .
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
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
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
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
Average healing time in group A was 9.86 days and group B was 11.46 days.
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 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
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
Recurrence.
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 12.5 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 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.
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
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
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
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
Table no: 61. Comparison between agnikarma and surgical excision of kadara
CONCLUSION
rogas.
this disease in both Ayurvedic and Modern Medical Science are all most
the same.
5. In the present study one group was treated with Agnikarma, Triphala
Guggulu and Jatyadi ghruta and Second group with Excision Therapy
satisfactory sample size in a short term Research work. All the patients
7. Triphala Guggulu and Jatyadi ghruta are used in the present study.
The following are the advantages of the Agni Karma with Pancha Lauha
Less painful
No Raktasrava
Mild or no infection
Procedure is easy to do
Quick to perform.
procedure.
SUMMARY
a clinical trial. The introductory part gives the brief picture of the contents and the
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
The literary review reveals that Kadara has been first described by Sushruta.
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
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
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
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
relieved 65.81%.
In Group A had nil to mild Sankarmana i.e. 93.34% subjects and in Group B had
In Group A subjects healing period was 9.86 days, whereas in Group B subjects
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
procedure.
Historical Review
1. A. V.II - 10/4/26
2. Su. Nhi. S. - 13/30/31
3. Su. Su. S. - 12/3/4
4. A. S. Su. S. - 40/16
5. A. S. U. S. - 36/21
6. As. H. U. S. - 31/6
7. As. H. U. S. - 32/10
8. As. H. U. S. - 30/42
9. Sa. S. - 7/93
10. Y. R. - 26
11. Y. R. - 93
12. Bh. P. N. - 61/127
13. Bh. P. N. - 61/128
14. Ma. Ni. - 52/26
15. Bh. S.
16. S. H. - 93
17. J. M. - 25/9
18. Bailey and Love’s
19. S. Das
20. Manipal of Manual of Surgery
Ayurvedic Review
21. Su. S. Su. S. - 13/31
22. Su. S. Sa. S. - 5/19
23. Su. Sa. S. - 6/6
24. Sabda Kalpa Druma
25. Sabda Kalpa Druma
26. Su. Ni. S. - 13/30
Bh.S.
Nidana
27. Su. Ni. S. - 13/30
28. As. H. - 36/21
29. Ma. Ni. - 55/26
30. Bh. P. U. II - 61/127
31. G. Ni. - 10/26
Samprapti
32. Su. Ni. S. - 13/30
33. G. N. - 14/126
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
REFERENCES 114
Roopa of Kadara
34. Bh. S.
Chikitsa Vivechana
35. Su. S. Chi. - 20/23
A. H. U. - 32/11
C. D. - 55/18
36. Y. K. K. Chi. - 58
37. Y. K. K. Chi. - 56
38. Y. R. S. Chi. - 25
Agni Karma
39. Sabda Kalpa Druma
40. Sabda Kalpa Druma
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
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.
“A CRITICAL ANALYSIS OF AGNI KARMA W.S.R TO MANAGEMENT OF KADARA”
BIBLIOGRAPHY 115
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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.
CASE SHEET
Vedana:
Raktasrava:
DETAILS OF LAKSHANA:
Vedana - Present / Absent
Duration -
Mode of Onset -
Aggravating factor -
Relieving factor -
KULA VRITTANTA:
VAIYAKTIKA VRUTTANTA:
VYAVASAYA VRUTTANTA:
Nature of Work - Sedentary /Moderate /Laborious /Traveling /Sitting /H/W
Working hours -
SYSTEMIC EXAMINATIN:-
*R.S. - *Urinary -
*C.V.S. - *Genital -
DASHAVIDHA PAREEKSHA:-
1. Prakruti -V / P / K / VP / VK / PK / Tridoshaja
-Dushya-Rasa/Rakta/Mamsa/Meda/Asthi/Majja/Sukra
3. Sara -
7. Satmya -
-Jarana – P / M / A
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:
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 -
Vyadhi vinischaya:
TREATMENT PROCEDURE:
Poorva Karma:
Pradhana Karma:
Paschat Karma:
BEFORE
TREATMENT 0 - No pain
1 - Mild pain
SANKRAMANA (INFECTION)
BEFORE
TREATMENT
AFTER
TREATMENT
BEFORE
TREATMENT
AFTER
TREATMENT
RAKTASRAVA (BLEEDING)
BEFORE
TREATMENT
AFTER
TREATMENT
SPARSHASAHISHNUTA(TENDERNESS)
BEFORE
TREATMENT
AFTER
TREATMENT
5. RECURRENCE
Triphala Guggulu
Jatyadi gruta
Betadine Solution
SURGICAL EXCISION PROCEDURE
SURGICAL EXCISION
BEFORE TRETMEANT AFTER TRETMEANT