Management of tennis elbow by Agnikarma
A 38-year-old female patient of vata kaphaja prakriti visited asthi sandhi marmaghat Unit of Shalya Tantra Department on 6th March 2012 with complaints of shoola (severe pain), stambha (stiffness), restricted movement in lateral part of right karpura. Sandhi (elbow joint), and hasta, anguli paradesha (palm) for 08 months. There was no obvious history of trauma, except lifting of water bucket by the patient for house hold work. On examination, it was elicited that the patient was unable to hold the object properly by the affected hand and maximum tenderness was noticed at the lateral epicondylar region of humerus with no obvious swelling noticed at right elbow joint. Further, it was observed that on full extension of right elbow and resisted extension of right wrist joint, maximum pain was experienced by the patient. There was a history of treatment for tennis elbow under a private orthopedic surgeon for last 08 months with no significant relief. Routine blood investigations including RA (Rheumatoid arthritis) factor and X-ray examination of hand were done by the surgeon and all investigations were found within normal range. On the basis of these, the patient was diagnosed as a case of tennis elbow by the surgeon.\nAfter careful assessment and examination, patient was treated with Agnikarma and oral medication of Ashwagandha powder 4 g, and Navajivana Rasa 250 mg, twice a day with luke warm water for 03 weeks. With this short duration of treatment protocol, patient got relief from pain and increased the strength of gripping power in affected hand without any untoward effect.\nAfter taking written informed consent, Agnikarma was done. The affected part was applied with Triphala Kasaya and wiped up with sterilized gauze piece. Agnikarma in the form of samyak twak dagdha (therapeutic superficial skin burn) was done by making a vilekha dahana vishesa (multiple dots in a three straight lines) with red hot pancha dhatu shalaka [] covering about 05 cm length with dotted spot of burn by sparing gap of 0.5 cm between two dots. Another two lines of the same vilekha dahana vishesa were made, 0.5 cm apart from and parallel to the first line. During entire procedure, a swab soaked in Kumari Swarasa (fresh pulp of Aloe vera) was applied just after making each dot. Appropriate precaution was taken not to produce asamyak dagdha vrana (neither superficial nor too deep burn). After completion of the procedure, wound was covered with Haridra powder dusting []. The entire procedure was repeated three times at the interval of 7 days. Patient was advised to apply the paste of Haridra powder mixed with coconut oil at bed time. Vata vardhak ahara-vihar (diet and activities which aggravate vata dosha) was also restricted during the treatment and follow-up period.