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‘Agni karma’, also known as ‘dahan karma’, is a process used in Ayurveda for various benign diseases that are characterised by pain or bleeding. In this process, the heated rods of gold, silver, iron, copper and pancha dhatu (five metals) are applied directly on the skin at the affected site. The temperature varies according to the process used and is lowest for gold and highest for silver. The ‘agni karma’ is not recommended for arbuda (tumour/malignancy). Here the authors present two cases of soft tissue sarcoma of lower extremity where ‘agni karma’ was tried in vain by traditional healers at their local village. Both the patients presented with progressive disease that was treated with wide excision and limb conservation, and the whole of the overlying skin scarred by previous healed burns of various degrees had to be sacrificed making a simple surgery difficult.
The process of eliciting intentional therapeutic burns is called ‘agni (fire) karma’ or dahan (burn) karma. The methods are commonly used for joint pain, head ache, abdominal cramps and convulsive disorders like epilepsy, schizophrenia and psychosomatic disorder.1 It is reported that it is indicated for diseases not responding to medicine, surgery or kshaar karma (alkali treatment).2 It is reported that this process cures the diseases forever and a second application is very seldom required; thus, the diseases cured do not recur.3 The agni karma is reported to be better then kshaar karma (alkali cauterisation) and has also been used in treatment of uterine cervical erosions.4
The agni karma uses the heat carrying capacity of various materials like metals and seeds. The metals are gold, silver, iron and panch dhatu (five metals). The metal object can be in the form of coins, rings or rods while the seeds of Piper longum, Glycerrhiza glabra, Linn and Curcuma longa can be used. The treatment is not recommended for malignant tumours (arbud rogam). Here we report two cases of lower extremity sarcoma unsuccessfully treated by intentional heat burns.
A young man presented with 6×6 cm swelling on the left lateral thigh. Examination showed intentional heat burn scars on the overlying skin; the healed scars were circular with the central scar being larger and deeper than the peripheral scars (figure 1). Biopsy of the lesion showed spindle cell sarcoma and metastatic work-up failed to show disease elsewhere. A modified compartmental excision with overlying skin was carried out. The patient is disease free 6 months after the surgery.
Another young man presented with a slow growing swelling in the calf of 6 months’ duration. On examination a 8×4 cm swelling was present in the calf with burn marks on the overlying skin. The burn marks were linear (figure 2). When asked, the patient gave a history of being treated by a traditional healer by burning with heated iron rods. The swelling has continued to progress despite this, which made him come to a tertiary centre. A detailed metastatic work-up failed to show disease elsewhere and core needle biopsy confirmed the presence of spindle cell sarcoma. A wide excision including the overlying skin was carried out. The patient is disease free after 18 months.
Although rare, intentional heat burns are still practiced by traditional healers in rural India. Though reported to be effective in the control of bleeding, pain, over granulated wounds and inflammation it can be compared to hot fomentation and cauterisation in some of its properties. Ayurveda believes that every tissue has its own fire (dhatvagni) and when this tissue fire becomes low diseases manifest.1 Agni karma cures them by supplementing fire from external sources.
The choice of material used for agni karma depends on the extent of heat required. Among the metals, the lowest temperature is reported to be of gold (62 °C) while highest is silver (350 °C). Copper and iron has intermediate temperatures in the range of 210–230 °C. When seeds are used the temperature is usually low and range from 40–55°C.1
The burning can be done in various ways–for example, linear (vilekhea), dots (bindu), circular (valaya), half moon or crescent (ardha chandra) or as a star with eight appendages (ashta paada),3 5 and so forth. In our cases, the burns were dots in linear and circular forms all over the lesion. Presence of burn scars over the lesion can make the decision to save skin difficult as it is impossible to know whether the skin fixity (situations where the overlying skin is not freely movable over the lesion) is due to burns or the disease. It is always safer to excise the skin in these cases, which makes primary skin closure difficult and reconstruction may be required. These are first case reports of agni karma being practiced for the treatment of soft tissue sarcoma in English literature without benefits.
Competing interests None.
Patient consent Not Obtained.