Agnikarma Vidhi Adhyaya (Thermal Cautery) – 12th Chapter of Sushruta Samhita

Introduction

Sushruta Samhita Sutrasthana Chapter 12, titled Agnikarma Vidhi Adhyaya, outlines the ancient principles and surgical applications of thermal cautery. Regarded by Sushruta as superior to chemical cautery and surgical excision because diseases treated with it rarely recur, this chapter details the instruments, proper heating temperatures, and specific therapeutic indications for cauterization. It categorizes burns according to the underlying tissues involved and establishes rigorous post-procedural wound management protocols. Furthermore, the chapter emphasizes careful assessment of the patient’s condition before performing the procedure.

अथातोऽग्निकर्मविधिमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We shall now expound the chapter entitled Agnikarma-Vidhi (The Prescribed Methodology and Rules for Thermal Cautery / Agnikarma Procedure).As revealed and spoken by the venerable Lord Dhanvantari.

The Paramount Value And Therapeutic Eminence Of Agnikarma

क्षारादग्निर्गरीयान् क्रियासु व्याख्यातः, तद्दग्धानां रोगाणामपुनर्भावाद्भेषजशस्त्रक्षारैरसाध्यानां तत्साध्यत्वाच्च ||३||

Thermal cautery (Agni) is declared to be superior even to chemical cautery (Kshara) among all therapeutic surgical procedures.This supremacy is established because:

Diseases treated and burnt by thermal cautery do not recur (Apunarbhava).
Disorders that are incurable by medicinal therapies (Bheshaja), sharp instruments/surgery (Shastra), and alkaline cautery (Kshara) are successfully cured by thermal cautery.

Dahana Upakarana: The Tools And Appliances Of Agnikarma (Thermal Cauterization)

अथेमानि दहनोपकरणानि तद्यथा – पिप्पल्यजाशकृद्गोदन्तशरशलाकाजाम्बवौष्ठेतरलौहाः क्षौद्रगुडस्नेहाश्च |
तत्र, पिप्पल्यजाशकृद्गोदन्तशरशलाकास्त्वग्गतानां, जाम्बवौष्ठेतरलौहा मांसगतानां, क्षौद्रगुडस्नेहाः सिरास्नायुसन्ध्यस्थिगतानाम् ||४||

Now, the specific instruments and materials utilized for thermal cauterization (Dahana-upakaranani) are as follows: long pepper (Pippali), excrement of a goat (Aja-shakrit), cow’s tooth (Go-danta), arrow head (Shara), metallic probe (Shalaka), black plum-shaped metallic applicator (Jambavauttha), various other metals (Itara-lauha), honey (Kshaudra), jaggery/treacle (Guda), and fatty/unctuous substances such as oil and ghee (Sneha).

Among these substrates, long pepper (Pippali), goat’s excrement (Aja-shakrit), cow’s tooth (Go-danta), arrow heads (Shara), and metallic probes (Shalaka) are employed for thermal cauterization when the disease is situated in the skin (Twak-gatana). The Jambavauttha instrument and other dense metals (Itara-lauha) are utilized when the disease is located deep within the muscular tissue (Mamsa-gatana). Honey (Kshaudra), jaggery (Guda), and unctuous liquids (Sneha) are indicated for thermal application when the pathological process invades the blood vessels (Sira), tendons/ligaments (Snayu), joints (Sandhi), and bones (Asthi).

Season And Ideal Timing For Performing Agnikarma

तत्राग्निकर्म सर्वर्तुषु कुर्यादन्यत्र शरद्ग्रीष्माभ्यां; तत्राप्यात्ययिकेऽग्निकर्मसाध्ये व्याधौ तत्प्रत्यनीकं विधिं कृत्वा ||५||

Thermal cauterization (Agnikarma) may be performed in all seasons (Sarva-ritushu), with the explicit exception of the autumn (Sharad) and summer (Greeshma) seasons. However, even during these restricted seasons, if a disease is severe or life-threatening (Atyayika) and strictly treatable only by thermal cautery (Agnikarma-sadhya), the procedure may still be executed, provided that counteractive protective measures (Tat-pratyanikam vidhim)—such as cooling therapies, environmental modifications, and soothing post-procedural protocols—are systematically implemented beforehand.

Agnikarma Vidhi: Operational Protocol And Surgical Procedure Of Thermal Cautery

सर्वव्याधिष्वृतुषु च पिच्छिलमन्नं भुक्तवतः कर्म कुर्वीत; मूढगर्भाश्मरीभगन्दरोदरार्शोमुखरोगेष्वभुक्त-वतः ||६||

In all general diseases and across all permissible seasons, the procedure of thermal cauterization (Agnikarma) should be performed only after the patient has consumed a meal comprising slime-forming/unctuous and demulcent food (Picchila-annam bhuktavatah). However, in specific conditions—namely obstructed labor/malpresented fetus (Mudha-garbha), urinary calculus (Ashmari), fistula-in-ano (Bhagandara), abdominal enlargement/ascites (Udara), hemorrhoids (Arsha), and diseases of the oral cavity (Mukha-roga)—the procedure must strictly be performed on an empty stomach (Abhuktavatah).

Agnikarma Bheda: Categorization Of Thermal Cautery Techniques

तत्र द्विविधमग्निकर्माहुरेके – त्वग्दग्धं, मांसदग्धं च I इह तु सिरास्नायुसन्ध्यस्थिष्वपि न प्रतिषिद्धोऽग्निः ||७||

Some authorities assert that thermal cauterization (Agnikarma) is of two types—namely, cauterization limited to the skin (Twak-dagdha) and cauterization extending into the muscular tissue (Mamsa-dagdha). However, according to the Dhanvantari school of surgery, the application of Agnikarma is not restricted to the skin and muscles. It may also be performed on Sira (blood vessels), Snayu (ligaments and tendons), Sandhi (joints), and Asthi (bones), as described in the classical Ayurvedic texts.

Signs Of Cauterization In Different Body Tissues (Dagdha Lakshana)

तत्र, शब्दप्रादुर्भावो दुर्गन्धता त्वक्सङ्कोचश्च त्वग्दग्धे I कपोतवर्णताऽल्पश्वयथुवेदना शुष्कसङ्कुचितव्रणता च मांसदग्धे I कृष्णोन्नतव्रणता स्रावसन्निरोधश्च सिरास्नायुदग्धेI
रूक्षारुणता कर्कशस्थिरव्रणता च सन्ध्यस्थिदग्धे ||८||

Regarding the characteristic clinical features (Lakshana) of appropriately performed thermal cauterization at different tissue depths:

When cauterization is confined to the skin (Twak-dagdha), it is characterized by the production of a cracking sound (Shabda-pradurbhava), an offensive odor (Durgandhata) resulting from burning tissue, and localized contraction or shriveling of the skin (Twak-sankocha).
When cauterization extends into the muscular tissue (Mamsa-dagdha), it exhibits a pigeon-gray discoloration (Kapota-varnata), mild localized edema (Alpa-shvayathu), slight pain (Alpa-vedana), and a dry, contracted lesion (Shushka-sankuchita-vranata).
When cauterization involves blood vessels and tendons/ligaments (Sira-Snayu-dagdha), it is characterized by a charred black, elevated lesion (Krishna-unnata-vranata) accompanied by complete arrest or cessation of discharge/bleeding (Srava-sannirodha).
When thermal cauterization reaches the joints and bones (Sandhi-Asthi-dagdha), it presents with a unctuous-less/dry, reddish-brown discoloration (Ruksha-arunata) along with a rough, firm, and stable elevated scar (Karkasha-sthira-vranata).

Body Sites Suitable For Agnikarma (Thermal Cauterization)

तत्र शिरोरोगाधिमन्थयोर्भ्रूललाटशङ्खप्रदेशेषु दहेत्, वर्त्मरोगेष्वार्द्रालक्तकप्रतिच्छन्नां दृष्टिं कृत्वा वर्त्मरोमकूपान् ||९||

In cases of severe head diseases (Shiro-roga) and acute glaucoma or severe inflammatory eye conditions (Adhimantha), thermal cauterization should be executed over the regions of the eyebrows (Bhru), forehead (Lalata), and temporal regions (Shankha-pradesha). Furthermore, in diseases affecting the eyelids (Vartma-roga), the cauterization should be precisely targeted at the roots of the eyelash follicles (Vartma-romakupa), only after thoroughly shielding and protecting the pupillary zone and cornea (Drishti) with a wet pad or moist protective swab (Aardra-alaktaka-pratichchhanna).

Additional Conditions Suitable For Agnikarma

त्वङ्मांससिरास्नायुसन्ध्यस्थिस्थितेऽत्युग्ररुजि वायावुच्छ्रितकठिनसुप्तमांसे व्रणे ग्रन्थ्यर्शोऽर्बुदभगन्दरापचीश्लीपदचर्मकीलतिलकालकान्त्रवृद्धिसन्धिसिराच्छेदनादिषु नाडीशोणितातिप्रवृत्तिषु चाग्निकर्म कुर्यात् ||१०||

Thermal cauterization (Agnikarma) is explicitly indicated in the following clinical conditions: when aggravated Vata pain of an excruciating nature (Atyugra-ruj) resides deeply within the skin (Twak), muscular tissue (Mamsa), blood vessels (Sira), tendons and ligaments (Snayu), joints (Sandhi), or bones (Asthi); in ulcers or wounds characterized by elevated, indurated, hyper-granulated, or anesthetic/numb muscle tissue (Uchchrita-kathina-supta-mamsa Vrana); in benign benign glandular swellings (Granthi), hemorrhoids (Arsha), malignant or benign neoplasms/tumors (Arbuda), fistula-in-ano (Bhagandara), chronic cervical lymphadenitis (Apachi), elephantiasis/filariasis (Shleepada), hyperkeratotic skin growths/warts (Charma-kila), moles or pigmented nevi (Tila-kalaka), and inguinal/abdominal hernias (Antra-vriddhi); during surgical excisions or transections of joints and blood vessels (Sandhi-sira-chhedana); and finally, in sinus tracts/fistulae (Nadi) as well as in acute conditions involving severe, uncontrollable hemorrhage (Shonita-atipravritti).

Patterns Of Thermal Cauterization (Agnikarma Akriti)

तत्र वलय-बिन्दु-विलेखा-प्रतिसारणानीति दहनविशेषाः ||११||
भवति चात्र –रोगस्य संस्थानमवेक्ष्य सम्यङ्नरस्य मर्माणि बलाबलं च |
व्याधिं तथर्तुं च समीक्ष्य सम्यक् ततो व्यवस्येद्भिषगग्निकर्म ||१२||

Among these, the specific geometrical configurations and modes of thermal cauterization (Dahana-visheshah) are fourfold: circular ring/spiral (Valaya), dot/punctiform (Bindu), linear/streak (Vilekha), and surface-sweeping/smearing or friction application (Pratisarana).

Thoroughly evaluate the morphological configuration of the disease (Rogasya sansthanam), the exact anatomical location of vital vulnerable spots/vital junctions (Marmani), the overall strength and vitality of the patient (Bala-abalam), the specific nature of the pathological condition (Vyadhim), and the prevailing seasonal environment (Ritum), the intelligent physician shall judiciously undertake the procedure of thermal cauterization (Agnikarma).

Post-Procedure Care After Agnikarma

तत्र सम्यग्दग्धे मधुसर्पिर्भ्यामभ्यङ्गः ||१३||

Following the successful and proper execution of thermal cauterization (Samyak-dagdha), the cauterized site should immediately be anointed and treated with an application of honey (Madhu) and ghee (Sarpi).

Clinical Contraindications And Patient Exclusion Criteria For Agnikarma

अथेमानग्निना परिहरेत्- पित्तप्रकृतिमन्तःशोणितं भिन्नकोष्ठमनुद्धृतशल्यं दुर्बलं बालं वृद्धं भीरुमनेकव्रणपीडितमस्वेद्यांश्चेति ||१४||

The following categories of individuals and clinical conditions must be strictly excluded and protected from thermal cauterization (Agnikarma-Varjya): persons possessing a Pitta-predominant constitution (Pitta-prakriti); individuals suffering from internal hemorrhage (Antah-shonita); patients with a perforated or ruptured abdominal cavity (Bhinna-koshtha); cases with un-extracted or retained foreign bodies (Anuddhhrita-shalya); individuals who are debilitated (Durbala), infants/children (Bala), the elderly (Vriddha), or fearful and faint-hearted (Bhiru); patients afflicted with multiple or widespread ulcers (Aneka-vrana-peedita); and all those patients who are categorized as unfit for sudation/fomentation therapies (Asvedya).

Anyatha Dagdha- Clinical Assessment Of Accidental Thermal Injuries

अत ऊर्ध्वमितरथादग्धलक्षणं वक्ष्यामः |
तत्र, स्निग्धं रूक्षं वाऽऽ(चा)श्रित्य द्रव्यमग्निर्दहति; अग्निसन्तप्तो हि स्नेहः सूक्ष्मसिरानुसारित्वात्त्वगादीननुप्रविश्याशु दहति; तस्मात् स्नेहदग्धेऽधिका रुजो भवन्ति ||१५||

The signs of abnormal burns (Itaratha-adagdha).
Thermal energy burns tissues via either unctuous (Sneha) or dry (Ruksha) media. Heated unctuous substances, due to their extreme subtlety and mobility (Sukshma-sira-anusaritvat), rapidly infiltrate the micro-channels of the skin and deeper tissues. Consequently, burns caused by hot oily substances (Sneha-dagdha) produce far more severe and agonizing pain (Adhika Ruj).

Classification And Grading Of Thermal Burn Injuries (Dagdha Bheda)

तत्र प्लुष्टं दुर्दग्धं सम्यग्दग्धमतिदग्धं चेति चतुर्विधमग्निदग्धम् |
तत्र यद्विवर्णं प्लुष्यतेऽतिमात्रं तत् प्लुष्टं; यत्रोत्तिष्ठन्ति स्फोटास्तीव्राश्चोषदाहरागपाकवेदनाश्चिराच्चोपशाम्यन्ति तद्दुर्दग्धं; सम्यग्दग्धमनवगाढं तालवर्णं सुसंस्थितं पूर्वलक्षणयुक्तं च; अतिदग्धे मांसावलम्बनं गात्रविश्लेषः सिरास्नायुसन्ध्यस्थिव्यापादनमतिमात्रं ज्वरदाहपिपासामूर्च्छाश्चोपद्रवा भवन्ति, व्रणश्चास्य चिरेण रोहति, रूढश्च विवर्णो भवति |
तदेतच्चतुर्विधमग्निदग्धलक्षणमात्मकर्मप्रसाधकं भवति ||१६||

Thermal burn injuries (Agni-dagdha) are categorized into four distinct types: scorched or singed burn (Plushta-dagdha), improperly or partially burnt (Durdagdha), properly or perfectly cauterized (Samyak-dagdha), and excessively cauterized or over-burnt (Atidagdha).

Among these, a burn characterized by severe localized skin discoloration (Vivarna) and superficial scorching or singeing (Plushyate atimatram) is designated as Plushta.
A burn where prominent blisters (Sphota) arise, accompanied by intense localized burning sensation (Chosha), heat (Daha), redness (Raga), tissue suppuration (Paka), severe pain (Vedana), and which subsides only after a prolonged duration (Chirach cha upashamyanti), is termed Durdagdha.
A burn that is properly executed (Samyak-dagdha) is un-deep or superficial in depth (Anavagadha), assumes the color of a ripe palmyra fruit (Tala-varna—dark yellow to brownish-black), exhibits a well-demarcated contour (Susansthita), and displays all the specific tissue-layer characteristics previously described.
In an excessively burnt injury (Atidagdha), there is hanging or sloughing of muscle tissue (Mamsa-avalambana), severe structural destruction or functional impotence of the limb (Gatra-vishlesha), extensive destruction of blood vessels, tendons, joints, and bones (Sira-snayu-sandhi-asthi vyapadanam), along with severe systemic complications including high fever (Jvara), intense burning sensation (Daha), unquenchable thirst (Pipasa), and fainting or syncope (Moorchha); furthermore, such a wound heals with extreme slowness and leaves behind a permanently discolored, hypertrophic scar .

These four types of burn characteristics serve as precise diagnostic indicators that illuminate the exact nature and outcome of thermal exposure .

Aggravation Of Rakta And Pitta In Burn Injuries

भवन्ति चात्र –
अग्निना कोपितं रक्तं भृशं जन्तोः प्रकुप्यति [८] |
ततस्तेनैव वेगेन पित्तमस्याभ्युदीर्यते ||१७||
तुल्यवीर्ये उभे ह्येते रसतो द्रव्यतस्तथा |
तेनास्य वेदनास्तीव्राः प्रकृत्या च विदह्यते ||१८||
स्फोटाः शीघ्रं प्रजायन्ते ज्वरस्तृष्णा च बाधते |१९|

When a living being is exposed to excessive thermal heat (Agni), the blood (Rakta) becomes severely aggravated and excited (Bhrisham prakupyati). Simultaneously, due to the intense momentum of this thermal insult, the Pitta humor within the individual is rapidly aroused and surged forward (Pittam asya abhyudeeryate).
Because both blood (Rakta) and Pitta share identical potency (Tulya-veerye), taste profile, and intrinsic elemental properties (Rasato dravyatas tatha), they act synergistically to intensify the pathological combustion within the body.
Consequently, the individual experiences agonizing, excruciating pain (Vedanah teevrah) and widespread tissue inflammation (Vidahyate). Prominent blisters (Sphota) rapidly surge across the site of injury, accompanied by systemic manifestations such as high fever (Jvara) and severe, unquenchable thirst (Trishna).

Therapeutic Management Of Burn Injuries

Therapeutic Management of Superficial Scorched Injuries Plushta Dagdha

दग्धस्योपशमार्थाय चिकित्सा सम्प्रवक्ष्यते ||१९||
प्लुष्टस्याग्निप्रतपनं कार्यमुष्णं तथौषधम् |
शरीरे स्विन्नभूयिष्ठे स्विन्नं भवति शोणितम् ||२०||
प्रकृत्या ह्युदकं शीतं स्कन्दयत्यतिशोणितम् |
तस्मात् सुखयति ह्युष्णं ननु शीतं कथञ्चन ||२१||

In cases of superficial, scorched burns (Plushta-dagdha), application of mild external warmth (Agni-pratapana) and the administration of hot/warming topical and systemic therapies should be performed. In a body subjected to intense heat, the circulating blood becomes excessively heated and liquefacted . Cold water by its inherent nature, drastically congeals, stagnates, and thickens such overheated blood.Therefore, warm measures afford comfort and relief (Sukhayati ushnam), whereas cold applications should never be utilized under any circumstances in this specific state.

Therapeutic Management Of Durdagdha (Blistered Burns)

शीतामुष्णां च दुर्दग्धे क्रियां कुर्याद्भिषक् पुनः |
घृतालेपनसेकांस्तु शीतानेवास्य कारयेत् ||२२||

In cases of improperly or partially burnt injuries (Durdagdha), the intelligent physician should administer a combined therapeutic regimen comprising both cooling and warming measures (Sheetam ushnam cha kriyam). However, regarding topical applications—such as medicated ghrita ointments (Ghrita), pastes (Alepa), and therapeutic pouring or drenching liquids (Seka)—these must strictly be cold in temperature.

Therapeutic Management Of Samyak Dagdha (Properly Burnt)

सम्यग्दग्धे तुगाक्षीरीप्लक्षचन्दनगैरिकैः |
सामृतैः सर्पिषा स्निग्धैरालेपं कारयेद्भिषक् ||२३||
ग्राम्यानूपौदकैश्चैनं पिष्टैर्मांसैः प्रलेपयेत् |
पित्तविद्रधिवच्चैनं सन्ततोष्माणमाचरेत् ||२४||

In cases of properly and therapeutically executed thermal cauterization (Samyak-dagdha), the attending physician should apply a smooth, unctuous ointment (Alepa) composed of Tugakshiri (Bambusa bambos / Bambusa arundinacea), Plaksha (Ficus infectoria), Chandana (Santalum album), Gairika (Red Ochre), and Amrita / Guduchi (Tinospora cordifolia), processed and churned thoroughly with clarified butter/ghee (Sarpi).

Furthermore, if the cauterized site exhibits persistent, continuous, or intense burning heat (Santata-ushma), the physician should apply a poultice consisting of finely ground raw meat paste derived from domestic (Gramya), marshy/wetland (Aanupa), or aquatic (Audaka) animals. In such severe persistent heat conditions, the management protocol should strictly parallel the therapeutic regimen prescribed for a Pitta-type deep internal abscess (Pitta-Vidradhi).

Therapeutic management of Atidagdha (Severe or Deep Burns)

अतिदग्धे विशीर्णानि मांसान्युद्धृत्य शीतलाम् |
क्रियां कुर्याद्भिषक् पश्चाच्छालितण्डुलकण्डनैः ||२५||
तिन्दुकीत्वक्कपालैर्वा घृतमिश्रैः प्रलेपयेत् |
व्रणं गुडूचीपत्रैर्वा छादयेदथवौदकैः ||२६||
क्रियां च निखिलां कुर्याद्भिषक् पित्तविसर्पवत् |२७|

In excessively burnt injuries (Atidagdha), the physician must first excise and debride all sloughed, necrotic muscle tissue (Vishirnani mamsani uddhhritya), followed immediately by cooling interventions .
The wound (Vrana) should be anointed with a paste (Pralepa) of powdered red rice bran (Shali-tandula-kandana), or crushed Tinduki bark and potsherd powder (Kapala) mixed with ghee (Ghrita-mishrai).
It should then be covered (Chhadayet) with fresh leaves of Guduchi or aquatic plants (Audaka-patra).
Finally, the entire treatment protocol (Kriyam nikhilam) must be executed following the management of Pitta-type erysipelas/spreading cellulitis (Pitta-Visarpa).

Madhucchistadi Ghrita

मधूच्छिष्टं समधुकं रोध्रं सर्जरसं तथा ||२७||
मञ्जिष्ठां चन्दनं मूर्वां पिष्ट्वा सर्पिर्विपाचयेत् |
सर्वेषामग्निदग्धानामेतद्रोपणमुत्तमम् ||२८||
स्नेहदग्धे क्रियां रूक्षां विशेषेणावचारयेत् |२९|

A medicated clarified butter (Ghrita) should be systematically processed and cooked (Vipachayet) by incorporating the fine pastes of beeswax (Madhuchchhishta), Yashtimadhu (Madhuka — Glycyrrhiza glabra), Lodhra (Lodhra — Symplocos racemosa), Sarjarasa (Vateria indica resin), Manjistha (Rubia cordifolia), Chandana (Santalum album), and Murva (Marsdenia tenacissima). This specific lipid formulation serves as the supreme healing ointment (Uttama Ropana) for all categories and depths of thermal burn injuries (Sarvesham Agni-dagdhanam). Furthermore, in burns specifically caused by hot unctuous or fatty substances (Sneha-dagdha), the physician must strictly administer dry, non-unctuous therapeutic measures (Ruksha Kriya).

Clinical Features Of Smoke Suffocation (Dhumopahata Lakshana)

अत ऊर्ध्वं प्रवक्ष्यामि धूमोपहतलक्षणम्
श्वसिति क्षौति चात्यर्थमप्याधमति कासते |
चक्षुषोः परिदाहश्च रागश्चैवोपजायते ||२९||
सधूमकं निश्वसिति घ्रेयमन्यन्न वेत्ति च |
तथैव च रसान् सर्वान् श्रुतिश्चास्योपहन्यते ||३०||
तृष्णादाहज्वरयुतः सीदत्यथ च मूर्च्छति |
धूमोपहत इत्येषः शृणु तस्य चिकित्सितम् ||३१||

The signs and symptoms of a person affected by smoke inhalation (Dhumopahata) are described as follows:

The patient exhibits severe dyspnea and rapid breathing (Shvasiti), excessive paroxysmal sneezing (Kshauti cha atyartham), abdominal distension or respiratory distress (Aadhamati), and persistent coughing (Kasate). There is intense ocular burning sensation (Chakshushoh paridahas) accompanied by severe conjunctival redness and congestion (Ragas cha eva upajayate).
The individual exhales breath laden with a distinct smoky odor (Sadhumakam nishvasiti), loses the olfactory capacity to perceive environmental odors (Ghreyam anyan na vetti cha), loses all gustatory sense perception (Tatha eva cha rasan sarvan), and suffers impairment or suppression of auditory function (Shrutis cha asya upahanyate).
Furthermore, the patient is afflicted with intense thirst (Trishna), widespread systemic burning sensation (Daha), high fever (Jvara), severe exhaustion or prostration (Seedati), and episodes of fainting or syncope (Moorchhati). Such a patient is recognized as one afflicted by smoke inhalation (Dhumopahata).

Therapeutic management of Dhumopahata

सर्पिरिक्षुरसं द्राक्षां पयो वा शर्कराम्बु वा |
मधुराम्लौ रसौ वाऽपि वमनाय प्रदापयेत् ||३२||
वमतः कोष्ठशुद्धिः स्याद्धूमगन्धश्च नश्यति |
विधिनाऽनेन शाम्यन्ति सदनक्षवथुज्वराः ||३३||
दाहमूर्च्छातृडाध्मानश्वासकासाश्च दारुणाः |
मधुरैर्लवणाम्लैश्च कटुकैः कवलग्रहैः ||३४||
सम्यग्गृह्णातीन्द्रियार्थान् मनश्चास्य प्रसीदति |
शिरोविरेचनं चास्मै दद्याद्योगेन शास्त्रवित् ||३५||
दृष्टिर्विशुध्यते चास्य शिरोग्रीवं च देहिनः |
अविदाहि लघु स्निग्धमाहारं चास्य कल्पयेत् ||३६||

To induce therapeutic emesis (Vamana) in smoke inhalation injury (Dhumopahata), the physician should administer ghee (Sarpi), sugarcane juice (Ikshu-rasa), grape decoction (Draksha), milk (Paya), or sweetened water (Sharkara-ambu) prepared with sweet (Madhura) and sour (Amla) tastes. Emesis achieves gastro-respiratory purification (Koshtha-shuddhi) and eliminates the smoky odor (Dhuma-gandha).
This protocol alleviates prostration (Sadana), sneezing (Kshavathu), fever (Jvara), burning sensation (Daha), syncope (Moorchha), thirst (Trish), distension (Aadhmana), dyspnea (Shvasa), and cough (Kasa). Medicated gargles (Kavala-graha) with sweet, salty, sour, and pungent tastes restore sensory perception (Indriyartha) and mental clarity (Manas praseedati).
Next, erratic nasal therapies (Shirovirechana / Nasya) must be administered to clear visual acuity (Drishti) and restore the head and neck region (Shiro-greevam). Finally, a non-inflammatory (Avidahi), light (Laghu), and unctuous (Snigdha) diet is prescribed.

Atapadi Dagdha: Injuries Caused By Extreme Environmental Conditions, Such As Sunstroke, Excessive Cold, Rain And Cold Winds

उष्णवातातपैर्दग्धे शीतः कार्यो विधिः सदा |
शीतवर्षानिलैर्दग्धे स्निग्धमुष्णं च शस्यते ||३८||
तथाऽतितेजसा दग्धे सिद्धर्नास्ति कथञ्चन |
इन्द्रवज्राग्निदग्धेऽपि जीवति प्रतिकारयेत् |
स्नेहाभ्यङ्गपरीषेकैः प्रदेहैश्च तथा भिषक् ||३९||

In injuries caused by hot winds (Ushna-vata) or intense sunstroke (Atapa), a cooling therapeutic regimen (Sheeta vidhi) must always be instituted. Conversely, for damage or frostbite caused by extreme cold, freezing rains, or icy winds (Sheeta-varsha-anilaih), warm (Ushna) and unctuous (Snigdha) remedies are indicated.
Burns caused by hyper-intense radiant energy (Ati-tejasa) are entirely incurable (Na asti kathanchana). However, if a patient struck by lightning (Indra-vajra-agni-dagdha) survives (Jeevati), the physician must immediately administer restorative emergency measures using unctuous lipids (Sneha), therapeutic massage (Abhyanga), continuous liquid irrigation (Parisheka), and medicinal poultices (Pradeha).

इति सुश्रुतसंहितायां सूत्रस्थानेऽग्निकर्मविधिर्नाम द्वादशोऽध्यायः ||१२||

Thus concludes the 12th chapter, Agnikarma Vidhi Adhyaya, of the Sutra Sthana of Sushruta Samhita.

Conclusion

In the 12th chapter of Sushruta Samhita Sutrasthana, known as Agnikarma Vidhi Adhyaya, we studied the principles, indications, methods, and precautions of Agnikarma, a therapeutic procedure involving the application of controlled heat. The chapter explains the superiority of Agnikarma over Kshara in certain conditions, the materials used for cauterization, suitable seasons, and different types of burns based on the tissues involved. We also learned about the specific sites and diseases where Agnikarma may be performed, along with its patterns of application and post-procedure care. Additionally, the chapter describes contraindications and emphasizes careful patient assessment before performing Agnikarma.