Acute traumatic knee pain is a frequent musculoskeletal complaint in the elderly, commonly caused by sudden twisting injuries and characterized by severe pain, swelling, and restricted mobility. Conventional management mainly relies on non-steroidal anti-inflammatory drugs and supportive measures; however, immediate and sustained relief may not always be achieved. In Ayurveda, trauma is categorized under Agantuja Nidana and results in aggravation of Vata Dosha, described as Aghataja Vata. Severe pain (Vedana) and functional restriction (Cheshta Avarodha) indicate a Vata-dominant presentation. When intense and disabling, the condition may be considered an Atyayika Avastha, requiring urgent intervention. In the current case report, a 62-year-old female presented with acute left knee pain (VAS 10/10), swelling, and inability to lift the leg following a twisting injury. Managed as an acute Vata emergency, Agnikarma was performed at the most tender points around the knee, followed by Viddha Karma two anguli above Kshipra Marma, along with internal Vata-pacifying medicines. Pain reduced by nearly 90% within one hour (VAS 1–2/10), and complete recovery occurred within three days without adverse effects. This case was selected to highlight the rapid analgesic and functional benefits of Agnikarma and Viddha Karma in acute traumatic conditions, emphasizing their potential role in Ayurvedic emergency management.

Introduction:

Acute knee trauma is one of the most common orthopedic presentations in elderly patients. Twisting injuries during stair climbing frequently result in ligament strain, soft tissue inflammation, and acute synovitis. [1,2] Immediate pain relief is essential to prevent immobility and secondary complications.

In Ayurveda, trauma (Aghata) causes sudden aggravation of Vata Dosha, leading to intense pain (Ati Vedana), swelling (Shotha), and restricted movement (Cheshta Avarodha).[3]  If inflammation and vascular congestion are present, Rakta Dushti is suspected.[4]

Agnikarma

Described in the Sushruta Samhita Sutrasthana 12, Agnikarma is indicated in disorders dominated by Vata and Kapha and is especially effective in severe pain conditions. It provides immediate and sustained relief and prevents recurrence. [5]

Viddha Karma

Viddha Karma is a minor surgical puncturing technique recommended for relieving obstruction and vitiated rakta. Viddha two anguli above Kshipra Marma is indicated in lower limb pain disorders. [6]

The present case demonstrates the emergency application of these classical principles in acute traumatic knee pain

Case report

Presentation of patient

A 62-year-old female (OPD No. 26/G5363) presented to OPD in an acute and functionally disabling state, requiring urgent consultation. She complained of severe left knee joint pain of two days’ duration following a twisting injury sustained while stepping on stairs. The pain was sudden in onset, progressively worsening, and described as excruciating in intensity, scoring 10/10 on the Visual Analogue Scale (VAS). It was associated with visible swelling around the knee joint and marked restriction of movement. It was aggravated by walking, standing, weight-bearing, and flexion-extension movements, with minimal relief on rest.  The patient was unable to lift the affected leg properly and experienced extreme difficulty in walking, necessitating physical support. Considering the intensity of pain (ati-tivra vedana) and significant functional incapacity (cheshta avarodha), the clinical presentation was assessed as an Atyayika Vata Avastha (urgent Vata-dominant condition) requiring immediate intervention.

Past medical history

No history of diabetes, hypertension, or systemic illness

Clinical Examination

Table 1: Local Examination

Systemic Examination

Pulse: 78/min

BP: 124/80 mmHg

Samprapti Ghatak

Nidan-Aghata (trauma)

Dosha- Vata Pradhana

Dushya-Rakta, Mamsa

Srotas-Raktavaha, Mamsavaha

Adhisthana- Janu Sandhi (Knee joint)

Rogamarga- Madhyama Rogamarga

Diagnosis- Aghataja Vata vyadhi

Materials and Methods

Centre of Study: PDEA’s Ayurved Rugnalay and Snowbell Multispeciality Hospital, Nigdi, Pune

Study Design: Single case study

Therapeutic Intervention

I. Agnikarma

Instrument: Heated Rajat Shalaka

Site: Maximum tenderness points around knee

Type of Agnikarma: Bindu

Procedure: Multiple controlled thermal touches applied by conductive method of agnikarma

Rationale: According to Charaka Samhita, Vata disorders respond best to Ushna and Tikshna therapies [7]. Agnikarma provides: Immediate Vata pacification, removal of Srotorodha, enhanced local circulation and give analgesic effect

II. Viddha Karma at Kshipra Marma

Site: Two anguli above Kshipra marma (leg)

Purpose: Relieve Rakta Dushti and stimulate Vyana Vayu

Rationale: Marma stimulation regulates neuromuscular coordination and peripheral circulation.[8]

III. Table 2: Internal Medication

Outcome Measures

Table 3: Pain (VAS Score)

Table 4: Swelling

Table 5: Functional Assessment

Results

The patient showed rapid and significant clinical improvement following the intervention. Within one hour of Agnikarma and Viddha Karma, pain intensity reduced markedly. At 24 hours, pain decreased by approximately 90%, with the Visual Analogue Scale (VAS) score improving from 10/10 to 1–2/10. Functional mobility improved on the same day, and the patient was able to bear weight and ambulate without support.

Local swelling reduced progressively over the next 48 hours. By the third day, swelling had subsided significantly, joint movements were near normal, and no pain aggravation was observed.

Complete symptomatic recovery was achieved within three days, with restoration of normal gait and absence of tenderness. No adverse events or procedural complications were reported.

Discussion:

Acute trauma (Aghata) is a recognized etiological factor for sudden aggravation of Vata Dosha in Ayurveda. The twisting injury in the present case acted as an immediate Nidana, leading to localized Vata Prakopa at the Janu Sandhi. The severe pain and functional incapacity represent classical features of Aghataja Vatavyadhi. Without Vata, pain does not manifest in the body). This establishes Vata as the principal mediator of pain. The acute presentation with intense pain (ati-tivra vedana) and restricted movement (cheshta avarodha) justified management under Atyayika Chikitsa, where immediate intervention is essential to prevent progression and chronicity.

Samprapti

The sequence of pathogenesis may be described as:

Aghata → Vata Prakopa → Rakta Dushti → Srotorodha (Raktavaha & Mamsavaha Srotas) → Shotha + Vedana → Cheshta Avarodha

Trauma disrupts local vascular and muscular integrity, causing inflammatory swelling indicative of associated rakta dushti. As described in Ashtanga Hridaya, aggravated Vata localized in joints produces pain and movement restriction

Samprapti Bhanga

Role of Agnikarma[9]

Acharya Sushruta describes Agnikarma as superior among para-surgical procedures in certain conditions:

Agnikarma possesses Ushna and Tikshna properties that counteract the Sheeta and Ruksha qualities of aggravated Vata. The immediate analgesic response observed in this case is consistent with classical indications. The marked reduction in pain within one hour reflects rapid Vata Shamana, demonstrating a clear Atyayika therapeutic effect.

Modern physiological explanation suggests that localized thermal stimulation induces vasodilation, enhances circulation, and promotes endorphin-mediated analgesia.[10] Additionally, neuromodulatory effects via nociceptive pathway alteration may contribute to rapid pain reduction.[8]

Role of Viddha Karma[11]

In the present case, although the primary etiology was trauma (Aghata), the pathological events closely resemble certain components of Vatarakta Samprapti. Vatarakta is described as a condition where aggravated Vata becomes obstructed by vitiated rakta, leading to severe pain and inflammation.

Acharya Charaka describes Vatarakta as a disorder caused by the mutual vitiation of Vata and Rakta; in the present case, the Samprapti is similar, involving Rakta-induced obstruction of Vata leading to pain and inflammatory features. [12]

Aghata → Vata Prakopa → Local Rakta Kshobha → Srotorodha → Shotha + Vedana → Functional restriction

Thus, although the etiology was traumatic, the pathological sequence exhibited features comparable to Vatarakta Samprapti, particularly Vata-Rakta interaction and obstruction. Hence, Kshipra Marma—classically indicated in Vatarakta—was selected for Viddha Karma to facilitate peripheral circulation, regulate Vyana Vayu, and achieve rapid Samprapti Bhanga.

Role of Internal Medication

While Agnikarma and Viddha Karma produced immediate analgesic effects, internal Vata pacifying medications were administered to support systemic correction and prevent recurrence. Classical texts emphasize that sustained Vata disorders require internal Shamana therapy in addition to local interventions.

Thus, while the para-surgical interventions achieved rapid Atyayika relief, the internal medications contributed to stabilization of Dosha equilibrium and ensured complete symptomatic recovery within three days. The combined approach reflects a comprehensive Samprapti Bhanga strategy addressing both local and systemic components.

Modern Correlative Perspective

Distal reflex stimulation in pain disorders is comparable to neurovascular modulation principles described in acupuncture literature8. Peripheral stimulation can influence central pain pathways and improve local circulation, supporting the analgesic response observed in this case.

Conclusion:

This case demonstrates a clear Atyayika therapeutic effect, with 90% pain reduction within 24 hours, restoration of gait, and complete recovery within three days. The combined use of Agnikarma and Viddha Karma effectively addressed Vata aggravation and Rakta involvement, resulting in rapid analgesia and functional improvement. Supportive internal medication aided systemic stabilization and prevention of recurrence.

These findings suggest that classical Ayurvedic para-surgical interventions may serve as safe, cost-effective, and minimally invasive options in the emergency management of acute musculoskeletal trauma. Further controlled studies are required to substantiate these observations.

Acknowledgements: Not applicable.

Conflict of Interest: The author declares no conflict of interest.

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