**1. Introduction**

According to Sushruta, *Agnikarma* (intentional therapeutic heat burns) is a superior *Anu-shastra Karma* (para-surgical procedure), and in patients treated with the *Agnikarma* (cauterization) procedure, the disease usually did not recur [1]. Depending on the disease, different materials heated at different temperatures are used for *Agnikarma*; that is, depending upon the disease and its predominant doshas (body humors), different materials and temperatures are selected for the treatment; for example, in the case of *Agnikarma* on the skin, less hot *shalakas* (probes) are used [2, 3].

*Snigdha Agnikarma* is cauterization with the help of heated liquids, semi-liquids, or fats, while *Ruksha Agnikarma* is cauterization with the help of heated metal [4]. Local *Agnikarma (sthanika)* is done at the disease site, such as skin disorders, and distant *Agnikarma (sthanantriya)* is done away from the actual diseased area.

Four kinds of shape of the *Agnikarma* are described in Ayurveda classics: *Valay –* circular, *Bindu –* dotted with a pointed object, *Vilekha –* linear, and *Pratisarana –*produced

by the rubbing of a heated object upon the site up to the desired extent (Acharya Sushruta) [5]. Three additional shapes of *Agnikarma* are: *Ardhachandra* – semilunar or crescent shaped, *Swastika* – cross shaped, and *Ashtapada* – having eight arms or limbs (Acharya Vagbhata) [6].

According to the depth and tissue involved, four kinds of *Agnikarma* are *Twak Dagdha, Mamsa Dagdha, Sira snayu Dagdha,* and *Sandhi Asthi Dagdha* [7].

### **1.1 Indications of** *Agnikarma*

A number of diseases and conditions belonging to the musculo-skeletal system, eyes, ENT, hernias, sciatica, elephantiasis, hemorrhoids, sinuses and fistulae, headache, and benign neoplasms have been explained in texts where *Agnikarma* is indicated as a therapeutic measure [8].

The above statement is based on the indications mentioned in the Ayurveda text, that is, in *Sushruta Samhita*. On the basis of this concept, some clinical trials are conducted in Ayurveda research institutes and published in the PubMed indexed journals. The clinical pieces of evidence in the context of *Agnikarma* in the management of musculo-skeletal disorders are Tennis elbow [9], lumbar spondylosis [10], osteoarthritis of the knee joint [11, 12], sciatica [13, 14], migraine [15], and benign growths like warts [16, 17].

The clinical pieces of evidence in the context of *Agnikarma* in musculo-skeletal disorders with doi numbers are review articles [18, 19], trigger finger [20], calcaneal spur [21], de Quervain's tenosynovitis [22], plantar fasciitis [23], cervical erosion [24], gynecomastia [25], and mucocele [26].

The clinical pieces of evidences other than PubMed-indexed journals in the context of *Agnikarma* in the management of musculo-skeletal disorders are corn [27, 28], direct inguinal hernia [29], osteoarthritis of the knee joint [30, 31], cervical spondylosis [32, 33], planter fasciitis (calcaneum spur) [34, 35], and sciatica [36].

#### **1.2 Contra-indications of** *Agnikarma*

It should not be done in *Pitta Prakriti* (*Pitta-*dominating body constitution), *Bhinna kosthas* (abdominal perforations), *Dourbalya* (general debility), *Vriddha* (old age), *Baala* (children), *Bheeru* (fearful or bogey man), a person afflicted with a large number of *Vrana* (multiple wounds), *Antah shonita* (internal hemorrhage) [37], and a person who is unfit for *svedana* (unfit for hot fomentation) (Anuddhrita Shalya) [38]. According to Acharya Charaka, *Agnikarma* should not be done in the *vrana* of *snayu* (tendon or ligament injuries), *marma* (vital parts), *Netra* (eyes), *kushtha* (leprosy), and *vrana with visha and Shalya* (wounds with poison or retained foreign body) [39].

#### **1.3 Suitable time or** *Ritu* **(Season) for** *Agnikarma*

*Agnikarma* can be done during all the seasons except *Grishma* (summer) and *Sharad* (extreme winters) [40]. It is because in *Sharad*, there is vitiation of *Pitta* and *Agnikarma* also aggravates *Pitta*, and it may lead to further *Pitta* vitiation. During *Grishma* season, there is increase in environmental temperature and *Bala* (vital force) of the patient remains weak. Even in these seasons, in emergent conditions that are amenable only to *Agnikarma*, it may be used after taking appropriate countermeasures to protect the patients from the complications.
