KUSTHA CASE PRESENTATION
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Transcript of KUSTHA CASE PRESENTATION
1
CASE PRESENTATION
VINAY TIWARI
FINAL P.G. SCHOLAR
DEPARTMENT OF P.G. STUDIES IN
KAYACHIKITSA
SKAMCH&RC
BANGALORE
PREMILINARY DATA OF PATIENT
Name : Mrs. Shashikala
Age : 37 Years
Sex : Female
Religion : Hindu
Socio economic status : Middle class
Marital status : Married
Education status : 9th Standard
Occupation : Peon (Aaya) in school.
Date of admission : 02/07/17
Date of discharge : 09/07/172
Ward : Female General Ward
Source of history : Patient
Case taken on : 07/07/17
Consultant doctor : Dr. Nayan
O.P No : E-20851
I.P. No : 2624/17
Address : # Nelamangala
3
PRADHAN VEDANA
C/O Sputhna in both hasta pradesha associated with
sotha, daha, srava yukta pidakas and kandu since 3
years.
4
ANUBANDHA VEDANA
Stabhdhata in hasta pradesha when srava dries up
5
VEDANA VRUTTANTA
Patient is suffering from pidakas, all over the body
associated with kandu on and off since 3 years and
subside on medication. The pidakas develop any where
in the body and subsides on medication. 3 months
back when she resumed her work after which rashes
appeared with sputhana in both hasta pradesha
associated with shotha, and srava yukta pidakas with
kandu since 3 years .6
Presently the patient has severe lesions in her both
hand and itching all over the body with healed marks
of previous lesions. Rashes appeared extensor surface
of b/l hand and left palm with severe itching and it
spreads to right palm and b/l foot region due to severe
itching all fingers became oedematous and multiple
fluid filled lesions appeared on the palms which burst
open, oozing clear fluid which was foul smelling
because of the swelling of the fingers patient is unable
to do closing and opening of the fist.7
After the lesion bursted it was associated with
burning sensation and pricking type of pain .
For the above complaints she got admitted to
SKAMCH & RC
8
POORVA VYADHI VRUTTANTA
Nothing contributory.
Patient is not a k/c/o Diabetes Mellitus,
Hypertension, Tuberculosis, Asthma
9
TREATMENT HISTORY
IN SAPTHAGIRI HOSPITAL (12/12/16 to 24/12/16 )
1) Inj. Avil 0-0-1 (IM)
2) Inj. Betnisol 1-0-1 (IV)
3) Clonate lotion (E/A) @ night
Advice on discharge
1) Tab Teczine 0-0-1
2) Sper lotion (morning)
3) Clonate lotion (night)
10
FATHER MOTHER
HUSBANDPATIENT
SON
KAUTAMBIKA VRUTTANTA
All family members are said to be healthy.
No one is suffering from similar set of complains.
VYAKTIKA VRUTTANTA
Diet : Mixed (non veg 2 to 3 times in a month)
Appetite : Moderate
Bowel : once per day (constipated)
Bladder : 4 to 5 times/day (Occasionally burning
1 to 2 times/night. Micturation)
Sleep : Disturbed
Habit : Tea / coffee 3-4 times/day
Rajo vruttanta
Menarche - @ 15 years of age
Cycle – Irregular till age of 26, later said to be regular 12
Present M.C. 3-5 days
28-30 days
L.M.P. – 27/6/17
Presentely no history of dysmennhorea
Old History 8-10 days of bleeding
Married @ the age of 26
PRASAVA VRUTTANTA
G2 P1 L1 A1 D0
P1 - FTND (Son) 13 year age
Underwent tubectomy after 3 years i.e., @ 29 years
of age due to restraint relationship with her husband. 13
GENERAL PHYSICAL EXAMINATION
General Condition : Fair.
Built : Moderately built.
Nourishment : Moderately Nourished.
Pallor : Absent.
Oedema : Present over both hands
Nails : Pitting
Cyanosis : Absent.
Icterus : Absent.
Lymphadenopathy : Absent.
Pulse :78 bpm. 14
BP :120/80 mmHg.
R/R :18/minute.
Tongue :Coated.
Height : 1.55 m
Weight : 57.5 Kgs
BMI : 23.95
15
PER ABDOMEN EXAMINATION
Inspection – Shape of abdomen – Scaphoid
Umbilicus – Normal, Inverted
Hyperpigmentation scars over abdomen
Stria marks present
Palpation – Soft , no tenderness, No organomegaly
Percussion – Tympanic sounds heard except the area of
Liver dullness.
Auscultation – Peristaltic sounds heard. 16
RESPIRATORY SYSTEM
INSPECTION
Shape of chest - Bilaterally symmetrical
PALPATION
Trachea - Centrally placed
Tactile Vocal Fremitus -Normal
PERCUSSION
Resonant sounds heard except the cardiac dullness.
AUSCULTATION
Normal Vesicular Breath Sounds heard
17
CARDIO VASCULAR SYSTEM
INSPECTION - No scar, No swelling .
PALPATION - Non tender, Apex Beat felt at 5th
intercostal space 9 cm from the mid sternal line.
PERCUSSION - Defined Area of cardiac dullness.
AUSCULTATION - S1 and S2 heard.
No added sounds heard.
No murmurs heard.
18
CENTRAL NERVOUS SYSTEM
Patient is conscious, well oriented to time, place
and person.
NAD
19
INTEGUMENTARY EXAMINATION
Skin
Colour – Normal skin colour
Lesio - Secondary
Character – Size -: Small
Colour -: Dark black
Shape -: Asymmetrical
Individual Lesion
Extensor surface – Papule
Palm, Soles – Flake
Scales present
Nature – Dry Flake20
Itching – Present
Discharge – Absent (present when new lesion occur)
Distribution of lesion – Symmetrical
extensor surface
On exposed body parts
Superficial sensation of lesion – Normal
Candle grease sign – Positive
Auspitz sign – Positive
Koebner phenomenon - Positive21
22
23
24
25
DASHAVIDHA PARIKSHA
1) प्रकृति: –: Vata Pittaja.
2) सारतः –: Madhyama.
3) संहनि –: Madhyama.
4) प्रमाणतः –: Height - 1.55 m
- : Weight – 57.5 kgs.
5) सात्म्यि –: Madhyama.
26
6) सत्मवि –: Madhyama
7) आहर शक्ति -: अभ्यवहरण शक्ति – Avara
-: जरण शक्ति – Avara
8) व्यायाम शक्ति –: Avara
9) वयः –: Madhyama
10) ववकृति –: Pravara
27
NIDANA PANCHAKA
NIDANA : Viruddhahara, mandagni, ati vyayama after
snigdha bhojana, snana after bhojana in the
night everyday, chinta, shoka, uses of acidic solution
for cleaning in school
SAMPRAPTI GHATAKA:
Dosha : Tridosha
Dushya : Twak, Mamsa, Rakta, Lasika.
Srotas : Rasa, Rakta, Annavaha28
Sroto dusti : Sanga
Agni : Jathragni
Ama : Jathragni
Udbhava sthana : Twak, Mamsa, Rakta, Lashika
Sanchara sthana : Sarvasarira
Vyakta sthana : Twak, Mamsa
Roga marga : Bahya
Vyadhi Svabhava : Chirakari.
Sadhya asadhyata : Krichra sadhya.29
SAMPRAPTI
Nidana sevana Tridosha prakopa
Spreaded in triyak gata shiras
Twak, Rakta, Mamsa, Lasika
Dosha-Dushyas takes sthanshanshraya in Twak
Leads to mandaloutpatti
Kustha cont…30
Kustha
Viruddhopkrama or Nidana sevana
Causes Flaring up of lesions
Resulting to Vaipadika
31
POORVAROOPA
ROOPA
Sputhna in both hasta pradesha associated with sotha,
daha, srava yukta pidakas and kandu.
UPASAYA : Aushadha sevana.
ANUPSAYA: Nidana sevana.
32
VYAVECHADAKA NIDANA
inclusion exclusion
Vaipadika pani, pada, sputhana, tevra
vedana, kandu, raga, red
colour pidakas
Vicharchika kandu, srava in pidikas,
krushna shyava varna,)
Eka kustha Krushna varna,
aswedana
Vruna vastu
Pama Rakta varna pidakas,
kleda yukta srava, ati
vedana, hastha , kurpara
sandhi pradesha
Sweta, shyama varna
pidakas, nitamba
pradesha,
Charma dala Kandu yukta, toda Rakta varna
33
DIFFERENTIAL DIAGNOSIS
Inclusion Exclusion
Pustular psoriasis
Nail beds, palms, soles
Fever, trunk, extrimities,
Echzema Primary lesions are
erythematous macules,
papules and vesicles
than patches and
plaques.
Atopic dermatitis with
Hand dermatitis
Aggravated by repeated
wetting and by washing
of the hands with harsh
shoaps, detergents, and
disinfectants, dryness,
pruritis, Nails pitting
Psoriasis (plaque) Palms Well defined
erythematous plaques
with silvery scale, with
predilection for the
scalp, extensor surface,
sub mammary or axillary
folds
34
35
Palmoplantar psoriasis Scaly plaques, thickening
and scaling of the entire
surface of palms without
redness
soles
Allergic dermititis Pruritic, eczematous
dermatitisinitially localized
to the primary site of
allergen exposure,during
acute phase edema,
erythema and vesicle
formations as the vesicles
rupture oozing papules
plaques appears
Irritant contact dermititis Burning sensation more
with above symptoms
36
Lepromatous leprosy Rash – numerous small
symmetrical
hypopigmented macules
with normal sensation and
indefinite edeges
Face, extensor surface of
limb and upper trunk,
sparing the midline of
back, axillae, groins,
scalps
VYADHI VINASCHAYA
Kustha with Vipadika
Psoriasis with Irritant contact dermatitis
37
CHIKITSA VRUTTANTA
DATE LAKSHANA CHIKITSA OBSERVATION
02/07/17 Burning sensation in the palm
region with itiching all over the
body
Snehapana with
aragwadadhi mahatikta
ghrita 30 ml
03/07/17 Burning sensation in the palm
region with itiching all over the
body
Snehapana with
aragwadadhi mahatikta
ghrita 60 ml
38
DATE LAKSHANAS CHIKITSA OUTCOME
04/07/1
7
Burning sensation in the
palm region with itiching
All over the body
Snehapana with aragwadadhi
mahatikta ghrita 90 ml
Itiching Increased
slightly
05/07/1
7
Burning sensation in the
palm region with itiching
all over the body
Snehapana with aragwadadhi
mahatikta ghrita 120 ml
•Itiching reduced
slightly
39
DATE LAKSHANA CHIKITSA OUTCOME
06/07/17 Burning sensation
in the palm region
with itiching all
over the body
Sarvanga abhyanga with
suryapaki talia f/b baspa sweda
day 1
07/07/17 Burning sensation
in the palm region
with itiching all
over the body
Sarvanga abhyanga with
suryapaki talia f/b baspa sweda
day 2
Burning sensation
increased
40
DATE LAKSHANA CHIKITSA OUTCOME
08/07/17 Burning sensation in the palm
region with itiching all over
the body
Sarvanga abhyanga
with suryapaki talia f/b
baspa sweda day 3
Burning sensation
reduced
09/07/17 Burning sensation in the palm
region with itiching all over
the body
Virechana karma with
Trivrut avaleha 50 gm
with 100 ml triphala
kashaya
No of vegas 16
She had 2
episodes of
vomiting(reduced
after taking nimbu
water)
41
PROPOSED LINE OF TREATMENT
Snehapana with mahatiktaka ghrita
Sarvanga abhyanga with Marichadi taila
Virechana with Trivrut, Danti & Triphala with souveeraka
Manjisthadi kwatha
Tandula lepa
Unmatta taila for external application
Dhattura beeja kalka lepa
Kanaka bindu arista with krutmala kwatha
Tab – Arogya vardhini
Tab – Gandhak rasayana
Mustadi churna for Shotha
Bhallataka rasayan
Tuvarak rasayan (Ah.Chi.19/53)
Tuvaraka taila 10 ml for internal purpose kostha suddhi42
PATHYA & APATHYA
43
Laghu aahara, tikta rasa
pradhana, ghruta,
bhallatak, triphala, nimba,
purana dhanya, jangala
mamsa, mudga, patola,
Laghu vyayama,
Siddhartha snana,
abhyanga
Viruddhara (amla, payo,
dadhi, anupa mamsa, matsya,
guda, tila)
Divaswapna, mala-mutra
vega dharana.
THANK
YOU44
Su su 9/6
Ubhaya gata shodhana
Twak gata – alepa chikitsa by shodhana
Shonita gata – Samshodhana, kashaya pana,
shonitavsechana
Mamsa gata – Shodhana, aalepana, kashayapana,
rakta mokshana, arista prayoga, mantha prayoga,
prasha prayoga
Medo gata – Bhallataka, shilajita, swarna makshika,
guggulu, agaru, tuvaraka, khadira, asana, ayaskriti,
Later dhatus it become asadhya so no chikitsa 45
46
Kapala Kustha
Vata dosha pradhanata
Krushna-aruna varna
Ruksha
Parusha
Tanu
Toda vahula
Alpa kandu
Alpa daha
Alpa puya
Audambara Kustha Daha
Kandu
Ruja
Redness
Kapila varna
Pakva phala sannibham
Mandala kustha Sweta and rakta varna
Sthira
Styana
Snigdha
Mandala akriti (coin
shaped)
Kruchrounnata
Hrushyajihwa kustha Karkasha
Shyava
Vedana yukta
Rakta varna over edeges
Hrushya jihva sannibham
Pundarika kustha Sweta varna yukta
Red
47
VEDANA VRUTTANTA
Patient was apparently healthy 3 years back suddenly she
developed rashes over the face associated with itching
sensation. She also noticed blackish discolouration of
upper lip and there was thickening of skin along with
itching for this she consulted Adarsh clinic and was
prescribed with some oral medication and topical
applications (details are not known) After 3-4 days of
taking them she developed severe itching in both eyes
and ears and also rashes spread to whole body.
48
She also developed ulcers in the mouth and cracking of the
angle of the mouth bilaterally which was very painful.
For this she consulted another clinic there they suggested
some investigation all was in normal. Than prescribed
some medication and ointments for 3 months. Initially
symptoms relieved after taking medication for 1 month
later suddenly developed a fluid filled lesion over her
right arm in flexor aspect which spread to forearm within
20 days associated with severe itching, pricking type of
pain and foul smell and clear liquid oozing from it.49
Meanwhile she got loose stools on and off with a gap of
about 8-10 days three times. No of episodes of watery
loose stools was 10 – 20 times. She used to take tab
Eldopar everytime it occurred and get relief. Pt felt that
she is getting loose stools because of the oral medications
which was given for the rashes so she discontinued after
few days her symptoms like itching sensation all over the
body and in eyes, ears, buttocks got aggravated. Thus for
the above she got admitted in Saptagiri hospital for 10
days.
50
They did some blood investigations and injectable were given. She
found moderate relief as the ulcer over the right forearm
completely healed, itching in the eyes and ears reduced. But itching
sensation all over the body still persisted (on itching she used to get
rashes) after 4 months , (rashes appeared extensor surface of b/l
hand and left palm on severe itching. And it spreads to right palm
and b/l foot region due to severe itching all fingers became
oedematous and multiple fluid filled lesions appeared on the palms
which burst open , oozing clear fluid which was foul smelling
because of the swelling of the fingers pt is unable to do closing and
opening of the fist.)
51
After the lesion bursted it was associated with burning
sensation and pricking type of pain . For the above
complaints she got admitted to skamc h&rc
52
Tiktashatpalak ghruta (ch.chi.7/140-143)
Mahatiktaka ghruta (ch.chi.7/144-150)
Mahakhadira ghruta (ch.chi.7/152-156)
Khadira, nimba, darvi ghruta (ch.chi.7/135)
Sarvakushta- By bhallataka taila, tuvaraka taila etc.
(Su.Chi.9/7)
Kusthaghna hitakar taila (ch.chi.7/119)
Vipadika hara ghruta-taila (ch.chi.7/120,121)
Swetakarveradh taila
Swetakarverapallavadh taila
Tiktekshvakadi taila
Kanakakshiri taila
Vipadikaya dhatturbija taila
Aarogyavardhini vati (R.RS.)
Saptasama gutika
Triphala gutika
Gandhaka rasayana
Panchatiktaghrita guggulu
Marichaditailam,
Somarajitaila,
Chitraka rasayan
Bhallataka rasayan
Tuvarak rasayan (Ah.Chi.19/53)
Bhallatakavaleha, 53
CONTENTS Introduction
Shodhana
Shamana
Rasayana
Kustha
Kustha bheda
Mahakustha
Kshudrakustha
Vamana
Virechana
Basti
Nasya
Raktamokshana
Samanya chikitsa
Rasayana chikitsa
Conclusion 54
INTRODUCTION
Skin that covers the major part of the body when it
is diseased causes social stigma. It is important to
maintain the health of skin in order to ward off
various skin diseases explained under the heading of
‘Kushta’.
Any disease in Ayurveda is managed with Shodhana,
Shamana & Rasayana chikitsa.
The same is true for Kushta.
It is important to understand the concept, indication
and appropriate use of these to get optimum results
55
SHODHANA यदीययदहहदोषान ्पन्चधा शोधनं च िि ् ।
तनरुहो वमन ्ं कायशशरोरेकोस्त्रववस्त्रतुि: ॥ Shodhana is the process by which vitiated doshas are eliminated
from the body through the nearest orifice.
(अ.ह्.सू 14/5)
स्त्थानाद् बहहनेयेदरू्धवयमर्धयो वा मलसंचयम ।देह्ंंस्त्ंशोधनं ित्मस्त्याद् ॥(शा. स.पू.4/9)
Drugs which dislodge the body wastes from their places and
expel them forcibly either in upward or downward direction are
deha samshodhana.
56
TYPES
1. तनरुह्2. वमन3. ववरेचन4. शशरोववरेचन ्5. रतत्ममोक्षण ्
57
SODHANA -INDICATION
अववपाक अरुचच स्त्थौल्य पाण्डुिा गुरुिा तलम वपडका कोठ कण्डू अतिय आलस्त्य
श्रम दौबयल्य अतिदगुन्ध अवसाद् कफवपत्त उत्मतलेशो अतनद्रा अतितनद्रा िन्द्रा तलैब्य अबुचधत्मव अप्रशस्त्ि स्त्वप्न दयशनम ् बलवणयप्रणाशश्र्च िपृ्यिो
बृंहणरैवप
BENEFITS :-
एवं ववशरु्धद् कोष्ठस्त्य कायक्ननराशिवधयिे ।.............िस्त्माि ् सं्त्शोधन ्ं काले युक्तियुति ्ं वपवेन्नरे ॥(च.सु16/17-
19)
Charaka while elaborating the effects of Samshodhana says
that it enhances Kayagni, Upashamana of vyadhi & health
returns to normal.
Indriya, Manas, Buddhi, Varnas become clear & acquires
bala, pusthi, apatya, vrishata. His aging is retarded & he lives
a long life free of diseasea. Hence he emphasized to take
Samshodhana at a proper time & skillfully administered.
59
IMPORTANCE :-
दोषा कदचचि कुप्यक्न्ि क्जिा लंघनं पाचने ।क्जिा सं्त्शोधनेयय िु न िेषां पुनरुर्धव ॥ (च.सू.16/20)
Charaka has said that the doshas controlled by
Samshamana are having the possibility of reprovocation
while there is no such probability in case of the control of
the doshas by Samshodhana.
60
SHAMANA
न शोधयति यदोषान ् समान्नोदीरयत्मयवप । समीकरोति ववषमान ् शमन ्ं िच्चसप्त्मधा ॥ पाचनं दीपन ्ं क्षुत्तड्वव्यायामािपमारुिा । बं्रह्ंण ्ं शमन ्ं त्मवेव ्ं वायो वपत्ततनलस्त्य च ॥ (अ.ह्.स.ू14/6,7)
The process by which vitiated doshas are pacified or nullified is
called Shamana.
न शोधयति न द्वेक्ष्ि समान ्दोषांस्त्िथोर्धदिान ् ।
समीकरोति ववषमाव्यशमन ्ं िधथास्त्रुिा ॥ (शा.पू. 4)
Drugs which bring down the increased dosha to normal without
expelling them out and not interfering with the dosha which are
normal are called shamana (palliatives) . 61
RASAYANA
लािोपायो हह शस्त्िानां रसदीनां रसायनम ् । (च.चच.1/1/8)
यज्जरा व्याचध ववक्र्धव्ंस िेषज ्ं िद रसायनम ॥(शा.pu 4/14)
Benefit
दीघाययु स्त्रतिय मेधामारोनय ्ं िरुण ्ं वय ् । प्रिावणयस्त्वरौदयं देहेक्न्द्रयबल ्ं परम ्॥ वाक्तसक्र्धद प्रणतिं काक्न्िं लििे ना रसायनाि ् । (च.चच.1/1/7,8)
62
Types
कुहिप्रावेशशक चरक (च.चच. 1/1/16)
वािािवपका वानिट् (अ.ह्.उ.39/5)
का्य (बल-बुक्र्धद-व्रक्र्धद)
नेमेवत्तक् (व्यचध नष्ट्) (dalhana स.ुचच27/3)
आजाक्स्त्रक (दनुध-घ्रुि सेवन ्ओज व्रुक्र्धद)
स्त्ंशोधन ् स्त्ंशमन ्
63
वय ् स्त्थेययकराणांमयन ्ं लािोपायो रसायनम;् वधयकं्स्त्थापकमप्राप्िमापकं् वेत्मयथय (ड्वल्हण)्
Before administring any rasayan first do kostha suddhi
with Haritakyadi choorna along with ushna jala.
(च.चच.1/1/25-28)
Rasayana should be used in युवा & मर्धयमवस्त्था as the
colour not look good on malina vastra so as the
rasayana can not be beneficial in the asudha sarira
(स.ुचच.27/3,4), (अ.ह्.उ.39/11)
64
RASAYANA SEVANA AYOGYA
PURUSHA
Anatmavaan
Aalaso
Daridra
Pramadi
Vyasani
Papakrud
Bheshajaapmanani (स.ुचि.30/4)
65
KUSTHA कुष्णाचत च ःशषेणे् चवलेख ््ं करोचत अ्ंग् प्रत्यङ्च इचत कुष्ठम् ॥ (चसद्धान्त्
कौचमचि)
कुष्ठ is a condition in which different body organs , dhatus, updhatus,
are destroyed & contempted.
त्मवच कुवयक्न्ि वेवण्य ्ंय दषु्िां कुष्ठमुशाक्न्ि िि ।One which produces discolouration over skin region is said to
be kustha.
कालेनोपेक्षक्षि ्ं यस्त्मात्मसवं कुष्णाति िद् वपु ॥During the lapse of time, it makes the entire body look ugly.
(अ.ह्.तन.14/3)
66
कुष्ठ िेद कुष्ठातन सप्िववधान्यष्िादशववधान्यपररसखं्येयववधातन च ।
(च.तन.5/4 )
67
सप्िववधाअष्टादशविधा
अपररसंख्ये
महाकुष्ठ7
क्षुद्रकुष्ठ11
अष्िादश
कुष्ठ
महाकुष्ठमहाकुष्ठ लक्षण िोष प्रधान्यत
कापाला कृष्ण, अरुण, कपालाभ, रुक्ष, परुष, त ,ु अचततोि, चवषम्ं स्मतृम. वातज
औदुम्बर िाह, राग, कण्डुयकु्त,रुक, परीत, रोमचपञ्जरम, उिमु्बरफलाभास. चपत्तज
मण्डल श्व्वेत, रक्तवणण, चस्िर, स्त्या , चस् ग्ध, उत्सन् मण्डलम, कृच्छ्र् साध्य. कफज
ऋष्यजिह्व वेि यकु्त, रक्तपयणन्तमन्त:श्वयाव, यदृष्यचजह्व स्ंस्िा ्ं. वतचपत्तज
पुजण्िक श्वेताभ , रक्तपयणन्त like पचुण्िकिल, उन् त ,
िाह यकु्त.
चपत्तकफज
जिध्म श्वेत, ताम्र, त ु lesions, usually situated on the उरु from which
scales like अलाबपूषु्पवणं fall off on rubbing
वातकफज
काकण गञु्ज वणण, सपाक, चतव्र वेि , असाध्य. चििोषज 68
क्षुद्र कुष्ठक्षुद्र कुष्ठ लक्षण िोष प्रधान्यत
एककुष्ठ
चमायख्यं
स्त्वेदरहहि, मस्त्यशकलोपमम, महावास्त्िु .
बहलं , हक्स्त्िचमयवि .
वाि-कफ
वाि-कफ
ककहिि श्यावं, ककण्खरस्त्पशय, परुषं, ककहििं स्त्मिृम ् .वाि-कफ
वैपहदकं पाणणपादस्त्फुिन,ं तिव्रवेदना. वाि-कफ
अलसक कण्डुयुति, सरागैश्र्च, गण्डरैलसकं् वाि-कफ
दद्रमुण्डलं कण्डु, राग, मुदगावि वपडडका वपत्त-कफ 69
क्षुद्र कुष्ठ लक्षण िोष प्रधान्यत
चमयदल कण्डु, स्त्फोि, रतिवणय, सशलू, असहहष्णुिा, रुग. वपत्त-कफ
पामा श्वेि, अरुण शयाव वणय , कण्डुयुति वपडका वपत्त-कफ
ववस्त्फोि िनु, त्मवकयुति, श्याव अरुण वणायत्ममक वपडकावपत्त-कफ
शिारु रतिश्याव वणायत्ममक, दाहयुति, बहुव्रणी कुष्ठ . वपत्त-कफ
ववचचचयका सकण्डु, श्याव वणय वपडक, बहुस्राव कफ70
कुष्ठगि दोष लक्षण वातज : रौक्ष्य्ं,शोष, तोि, शलू, स्ंकोि ्ं, पारुष्य्ं,
खरा भाव, हषण, श्वयाव अरुण्ं .
चपत्तज : िाह, राग, पररस्राव,पाक, चवस्रगचन्ध, क्लेि, अ्ंगपत ्ं.
कफज : श्र्वेत्य, शतै्य,कण्डु, स्िैय, उत्सेध, गौरव, स् ेह, क्लेि,
जन्तचुभरचभक्षण्ं
(ि.चि. ७/३४-३६)
71
कुष्ठोत्मपवत्तकर दोष - दषू्या1) वाि2) वपत्त त्ररदोष3) कफ
4) त्मवक5) रति दषू्य6) मांस7) लशसका
When these seven dravyas are got affected than they will cause for कुष्ठोक्त्मप्त्त.
72
सप्िधात्मवश्र्य कुष्ठ लक्षणा त्मवक्: - Toda, Vaivarnyam, Rukshatwa
रति: - Rakta: Sweda, Swapa, Swayathu.
मांस:् - Sphota in pani & pada, kledatwa in joints.
मेदस: - Kounyam & gatikshaya for angas, dalana of
angas.
अक्स्त्थ & मज्जा:- Nasa bhanga, netra raga,
swarakshaya, krimis in kshatas.
शुक्र:- Swadara paktya badhanam.
(A.H.Ni.14)
73
धािगुि लक्षणास्त्पशयहातन स्त्वेदनत्मवमीषत्मकण्डुस्त्च ्जायिे ।
वेवण्य ्ंय रुक्षिावस्त्च ् कुष्ठे त्मवचच समचश्रिे ॥
त्मवतस्त्वापो रोमहषयस्त्च ् स्त्वेदस्त्याशिप्रवत्मनयम ् ।
कण्डूववयपूयकस्त्चेव ् कुष्ठे शोणणिसंचश्रिे॥
बाहुल्यं वतरशोषस्त्च ्काकय स्त्य ्ं वपड्वकोद्गम ्।
िोद स्त्फोि क्स्त्थरत्मवं च कुष्ठे मांससमाचश्रिे ॥74
दौगयन्र्धयमपुदेहस्त्च ्पूयोथ कक्र्यस्त्था ।
गारणां िेदनं चावप कुष्ठे मेद समचश्रिे ॥
नासािडंोक्षक्षरागस्त्च ्क्षिे च कक्रशमस्िव ।
िवेि ्स्त्वरोपघािस्त्च ्हक्स्त्थमज्जसमचश्रिे ॥
कौण्यं गतिक्षयोन्डानां स्िेद् क्षिसपयणम ् ।
शुक्रस्त्थान्गिे शलन्डे प्रागतुिातन िथेव च ॥(स.ुतन.5/21-26)
75
सामान्य चचककत्मसासवं त्ररदोषजं कुष्ठं दोषाणां िु बलाबलम ् ।
यथास्त्वेलयक्षणेबुयर्धद्वा कुष्ठानां कक्रयिे कक्रया ॥दोषस्त्य यस्त्य पश्येि ् कुष्ठेषु ववशके्ष्लन्नरुद्ववति ्ं ।िस्त्येव ्शमं कुयायत्मत्त ् पर ्ं चानुबन्र्धस्त्य ॥ (च.चच.7/31,32)
All kustha are tridosaja so they should be treated by
knowing there doshobala abala & lakshnas.
First do samana in those kusthas who are having
there increased doshas than treat apradhan doshas.
76
धािगुिानुसार ् चचककत्मसा त्मवक् प्राप्िे- Shodhanam, Alepanam.
शोणणि ्प्राप्िे- Shodhanam, Alepanam, Kashayapanam,
Shonitavasechanam.
मांसप्राप्िे- Shodhanam, Alepanam, Kashayapanam,
Shonithavasechanam, Arishtapana, Manthaprayoga,
Prasaprayoga.
मेदसप्राप्िे- Shodhanam, Shonithavasechanam, Bhallathaka,
Shilajatu, Dhatumakshikam, Guggulu, Agaru, Tuvaraka, Ayaskriti.
From अक्स्त्थ onwards- असार्धय.
Rest of all dhatugata condition of kustha should be considered
incurable and left untreated. (सु.चच.9/6)77
CHIKITSA SUTRA वािोत्तरेषु सवपयवयमनं श्लेष्मोत्तरेषु कुष्ठेषु ।
वपत्तोत्तरेषु मोक्षो रतिस्त्य ववरेचनं चागे्र ।
वमनववरेचनयोगा: कल्पोतिा: कुक्ष्ठनां प्रयोतिव्या ।
प्रच्छनमल्पे कुष्ठे महति च शस्त्िं शसराव्यधम ् ।
बहुदोष: संशोर्धय: कुष्ठी बहुशो अनुरक्षिा प्राणान ् ।
दोषे ह्ंयतिमारहृिे वायुहयन्यादबलमाशु ।
स्त्नेहस्त्य पानशमष्िं शुद्धे कोष्ठे प्रवाहहिे रतिे ।
वायुहहय शुद्धकोष्ठं कुक्ष्ठनमबलं ववशति शीग्रम ् । (च.चच. 7/39-
42)78
Vata - Sarpi
Kapha - Vamana
Pitta - Raktamokshana, Virechana
Chakrapani Commentary
अगे्र इति सवपयराहदषु योज्यं; िेन वािोत्तराहदषु सवपयराहद प्रथमंकियव्यं
अग्र means it is the foremost and the best to be done.
After that only any other treatment should be adopted
79
SHODHANA IN KUSTHA पक्षाि ् पक्षाच्छदयनान्यभ्युपेयाद् मासान्मासाि ्
स्त्रसनं चावप देयम ् । स्त्राव्यं रतिं वत्मसरे हह द्ववरल्प ्ं नस्त्यं दधाच्च त्ररराराक्त्मरराराि ्॥
(स.ुचच.9/43),(अ.ह्.चच.19/96)
Vamana- Pakshatpakshat. (15 – 15)days
Virechana- Masanmasan.(1 – 1)month
Rakta mokshanam- Shashte shashte masya.
(6 – 6)months
Nasya- Triratrat triratrat. (3 – 3)days
Basti80
VAMANA िरदोषहरण.् उर्धवय िाग ्ं वमन ्स्त्ंञकं् ॥ (च.क.1/4)
अपतववपत्त्शश्लेष्मणौ बलार्धव ्ंय नयेिु यि वमन ्ं िचध ववननेय ्ं ॥(शा.पू.ख.्4)
INDICATION
कफे ववद्र्धयाद्व्मन ्ं स्त्ंयोगे वा कफाल्बणे ।
नवज्वरातिसाराध ् वपत्तास्रगा जयक्षक्षमण ् ॥
कुष्ठमेहापचीग्रक्न्थश्ली पदोन्मादकाशसन ् ।
श्वासहल्लासवी सपयस्त्त्मन्यदोषोर्धवयरोचगण ॥ (अ.ह्.स.ू18/1-3)
81
Contraindication
Garbhini, sukumar, rooksha, kshudita, shokarta, krusha,
durbala.
Diseased condition
Vataprakopaja – Udavarta, Gulma, Vatavyadhi
Marmaja vyadhi – Hridroga, Mutragata, Timira
Maharoga – Arsas, Udara (अ.ह्.स.ू18/3-5),
Kala
In vasant rutu
(च.शस 8)
82
दोषोक्त्मतलष्िे ह्रदये वा्य ् कुष्ठेषु चोर्धवयिागेषु ।कुिजफलमदनमधुके सपिोलेतनय् बरसयुतिे ॥शीिरस पतकरसो मधूतन मधुकं च वमनातन । (च.चच.7/43,44)
Vamana in श्लेष्मोत्तरेषु कुष्ठेषु .Vamana Yogas
Kutajaphala,Madhanaphala,Yastimadhu churna + Patola
and Nimba rasa yukta
Sheetha rasa(शीिरस: शीि कषाय:) with madhu +
yastimadhu churna.
83
VIRECHANAिर दोषहरण ्ं अधोिाग ्ं ववरेचन संझा |
उिय ्ं वा शरीरमल ववरेचनाि ् ववरेचन स्त्ंझा ॥
(च.्क.1/4)
INDICATION
Kustha, jvara,...........................pitta vyadhi
vishesed rogadhayayoktasch
(ch.si.2/13)
Virechana is best for pitta & rakta pradosaja 84
CONTRAINDICATION
Avirechyastu
Subhag kshata
Durbalendriya
Durbalendriya
Alpagni
Kamadivyagra
Ajirna
Navajvara
Madatya
Aadhmana
Salyardita
Garbhini
Kshatkshen
Atisthoola
Atikrusha
Bala
Vruddha
Durbala
Upavasa
Maithun
Chinta
Vyayama(च.शस.2/11)
85
कुष्ठेषु त्ररव्रिा दन्िी त्ररफला च ववरेचने शस्त्िा ।सौववरकं् िुषोदकमालोडनमासवास्त्च ्सीधूतन ॥
श्ंसन्त्मयधोहराणां यथाववरेकं् क्रमस्त्ष्चषे्ि ।(च.चच.7/44,45)
VIRECHANA YOGAS Trivrut, Danti & Triphala
with souveeraka, tushodaka, alodana & sidhu
86
BASTI बक्स्त्िना दीयिे इति बक्स्त्ि ॥(अ.ह्.स.ू19/1)
बक्स्त्िशिदीयिे यस्त्माि ्िस्त्माि ्बक्स्त्िररति स्त्रि ॥(शा.उ.ख ्5/1)
Acc. To Vruhattrayi Niruha & Anuvasana basti is
contraindicated in kustha. (च.शस.२/14), (सु.चच. 35/21), (अ.ह्.सु19/4-6)
दाववयब्रहिीसेव्ये पिोलवपचुमदयमदनक्रिमाले । सस्त्नेहेरास्त्थाप्य कुक्ष्ठ सकशलडंयेवमुस्त्िे ॥ वािोल्बण ्ं ववररति ्ं तनरुढ्मनुवासनाहयमालक्ष्य ् । फलमधुकतन्बकुिजे सपिोले साधयेत्मस्त्नेहम ॥(च.चच.7/46,47)
87
If there is excess of vata even after shodhana – asthapana &
anuvasana
Sneha – madanaphala, madhuka, nimba, kutaja, patola
नास्त्थाप्या: कुक्ष्ठन: (च.शस.२)
Cakrapani Commentary
िथास्त्थापनानुवासनैक सार्धयायां अवस्त्थायां कियव्ये एव:
In excessive vitiation of vata – no alternative - basti
प्रववृत्ततनववृत्त लक्षण सयोगे िु गरुुलाघवं सपं्रधायय स्यगर्धयवस्त्येि ्(च.वव.८/१३४)
If there is lakshana which is simultaneously responsive and
irresponsive to
a given chikitsa – vaidya can decide the chikitsa – lakshana –
guru or laghu
88
NASYA उर्धवय जरवुवकारेषु ववशेषस्त्य शमष्यिे । नासाहह शशरसो द्वार ्ं िेन ्िदव्याप्य क्ह्ंंि िाि ् ॥
(अ.ह्.सु 20/1)
औषधम ्औषध ् शसर्धद्ं स्त्नेहो वा नाशसकाभ्यां दीयिे इति नस्त्यम ्॥ (स.ुचच.40/21)
89
INDICATION
Manyastambha
Galagraha
Hanugraha
Pinasa
Vyanga
Apatanaka etc
(च.्शस.2/22)
CONTRAINDICATION
Ajirna
Bhuktavata sneha,
madhya, jala
Snata sirasa
Snanachisirasa
Navajvara
Garbhini etc
(च.्शस.2/21)
90
सेन्धवदन्िीमररचं फणणञझक वपक्प्पली करन्ज्फलम ् ।नस्त्यं स्त्यात्मसववडगं कक्रशमकुष्ठकफप्रकोपघ्नम ्॥ वेरेचतनकेधूयमे श्लोकस्त्थानेररिे प्रशा्यक्न्ि ।क्रमय कुष्ठककलासा प्रयोक्जिेरुत्त्शमांड्वस्त्था ॥
(च.चच.7/48,49) Saindhava, Danti, Maricha,
Phanijjhaka, Pippali, Karanjaphala, Vidanga – Kapha
pradhana kushta with krimi anubandha
91
च.सू ५/२६-२७ Vairechanika dhumapana
श्वेिा ज्योतिष्मति चैव हररिालं मन:शशला ।गन्धाश्च अगरुपरार्धया धूमं मधूयववरेचने ।
92
RAKTAMOKSHANARaktamokshana is mainly two types
1)SASTRA
A) Pracchana
B) Siravyadha (venesection)
2) ASASTRA
A) jaloukavacarana – application of leeches (pitta dosha)
B) Sringavacharana – application of cow’s horn (vata
dosha)
C) Alabu avacharana – aplication of gourd (kapha dosha)
D) Gati yantravacarana – appliication of Gati yantra
93
INDICATION (SU.SU.25/12-15)
(A.H.SU.27/3-5)
Apachi
Asyapaka
Arsa
Daha
Dantapupputa
Dantavesta
Dustartava
Granthi
Sopha
Galasula
Karnapali roga
Putigraha
Raktadimantha
Raktapitta
Sitada
Raktarsha
SoushiraJihva kantaka
Krimi dantaka
Kshudra roga
Kustha
Ostaroga
Pidaka etc.
94
CONTRAINDICATION
अववस्त्राव्या सवांग ्शोफ क्षीणस्त्य चा्लिोजने तनशमत्ता ।
पांडु रोनयश ्य सोदरर शोवष गशियणीणां च श्वयथव ्
(स.ुसू 14/24)
KALA
व्यिे वषायषु ववर्धयेत्तु ग्रीष्मकाले िु शीिले ।
हेमन्ि ्काले मर्धयान्हे शस्त्रकालास्त्रय ् स्त्रिा ॥
(स.ु शा.8/10)
95
RAKTAMOKSHANA IN KUSTHA
क्स्त्थरकहठनमण्ड्वलानां क्स्त्वन्नानां प्रस्त्िरप्रणाडीशि ।
कूचेववघट्हििानां रतिौत्मतलेशोपनेिव्य ् ॥
आनूपवाररजानां मांसानां पोट्ट्ले सुखोष्णेस्त्च ् ।
क्स्त्वन्नौत्मसन्नं ववशलखेि ् कुष्ठं िीक्ष्णेन ्शस्त्रणे ् ॥
रुचधरगमाथयमथवा स्रुन्गालाबूतन योज्येि ् कुष्ठे ।
प्रक्च्छिमल्पं कुष्ठं ववरेचयेद्वा जलौकोशि ॥ (च.चच.7/50-52)
Kushta – Sthira, Katina and Mandala – Nadi & Prastara sweda
Rub with Kurcha
Rakta nirharana with Srunga / Alabu / Jalouka
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SHAMANA YOGASThere are innumerable shamana yogas
mentioned for kushta in the form of churna,
vati, lehya, kashaya, asavarista,
rasoushadha, lepa, taila, gritha. It is
important to know when to use what to get
good results.
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CHIKITSA YOGAS
Darvi kalka or chorna with gomutra
Rasanjana with gomuta
Abhaya, vyosha, guda, tila taila for one month.
Patoladi kwatha
Lelitaka (sulphur) with jati (amalaki) swarasa
mixed with honey internally intake.
Vajrashilajatu with jati swarasa
Yogaraj with jati swarasa
Kusthakuthara rasa
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GHRUTA Vatakushta- Ghrita prepared of meshasringi,
guduchi, swadamshtra, sarngeshta, dwipanchamuli.
Pittakushta- By ghrita prepared of Dhava,
aswakarna, kakubha, palasa, pichumarda,
parpataka, madhuka, lodhra, samanga
Kaphajakushta- By ghrita prepared of priyalasala,
aragwadha, nimba, saptaparna, chitraka, maricha,
vacha, kushta, bhallataka, abhaya, vidanga
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In pitta & Rakta- Tikta Ghritas externally &
internally.
Eg:
Tiktashatpalak ghruta (ch.chi.7/140-143)
Mahatiktaka ghruta (ch.chi.7/144-150)
Mahakhadira ghruta (ch.chi.7/152-156)
Khadira, nimba, darvi ghruta (ch.chi.7/135)
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TAILAS Vatakushta- Taila prepared of meshasringi, guduchi, swadamshtra,
sarngeshta, dwipanchamuli.
Kaphajakushta- By taila of priyalasala,aragwadha, nimba, saptaparna, chitraka, maricha, vacha, kushta, bhallataka, abhaya, vidanga.
Sarvakushta- By bhallataka taila, tuvaraka taila etc.
(Su.Chi.9/7)
Kusthaghna hitakar taila (ch.chi.7/119)
Vipadika hara ghruta-taila (ch.chi.7/120,121)
Swetakarveradh taila
Swetakarverapallavadh taila
Tiktekshvakadi taila
Kanakakshiri taila
Vipadikaya dhatturbija taila
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1
KASHAYASonitha prapta & Mamsa prapta.
Tikta kashayas; For kaphaja, pithaja & Raktaja
kushtas.
Eg: Laghu Manjishtadi, Madhyama
Manjishtadi, Brihat Manjishtadi Kashayas,
Patolamuladikwatha
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CHURNA
Mustadi churna(ch.chi7/65-67)
Triphaladi churna (in numbness of skin)
(ch.chi.7/68,69)
Swarnamakshika churna with gomutra
(ch.chi.7/70-72)
Gandhapashana churna
Somraji chorna
Vaguji chorna
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ARISTHA, ASAVA, MANTHA,PRASA
Mamsa prapta kushta.
Eg: Khadirarishta,Madhwasava, Kanakabindwarishta, Triphalasava
Madvaasava in kustha & kilasa
Kanakavinduristha
Triphalasava
Kashayas made of rasanjan, aragbadha patra, kutaja, patola mula, nimba bark, khadirsara, triphala
We can use of above said drugs in the form of ghruta and taila in kustha samanartha
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4
ALEPANA
Nirhrita asradosha
Samsodhitasayanam (Cha.Chi.7/53)
Twak prapta
Shonita prapta
Mamsa prapta (Su.Chi.9/6)
Eg: Eladilepa, Kushtadilepa,
Lodhrabijadilepa, Mamsyadilepa.
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LEPAS
Sidhma nasak lepa (ch.chi.7/117,118)
Mandala kustha nashak taila (ch.chi.7/122-127)
Pittakusthan nashak lepa (ch.chi.7/130,131)
Vidangadi lepa
Dadrurvaadou durvadi lepa (chakradatta)
Manashiladi lepa
Dadrugajendra pralepa
Chakramardobijadi pralepa
Tranak pradeha
Kaasmarda pralepa
Molakabeej pralepa
Gandhapashad pralepa
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Karanjabijadi patra pralepa
Amaltaaspatra pralepa
Sidhma kustha gandhapashan pralepa
Sidhma kasmarda pralepa
Sidhma sarjasaadi praleepa
Siddh kusthadi lepa
Chatrahadi lepa
Edgajadi lepa
Vicharchikaya bhrustasarsapaka kalka
Vicharchika grah dhoom lepa
Tandula pralepa
Sarjasaadi lepa
Avalgujadi lepa
Sinduradi lepa
Bhallatakadi lepa 10
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VATI
Aarogyavardhini vati (R.RS.)
Saptasama gutika
Triphala gutika
Gandhaka rasayana
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GUGGULU PREPARATIONS
Amrita guggulu
Ekavimsatika guggulu
Panchatiktaghrita guggulu
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UDVARTANA
Kusthadh udvartanam churna
Nishadyaudvartanam
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0
RASALEPA:
Pashana churna + Yavakshara+ Mustard oil/
Gandhapashana+ Katu taila exposed the mixture to
sunrays.
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1
KSHARA PRAYOGA
येषु न शस्त्रं क्रमेि ्स्त्पशके्न्द्रयनाशनातन यातन स्त्यु ।िेषु तनपात्मय ् क्षारो रतिं दोष ्ं च ववस्त्राव्य ॥
(च.चच.7/54)
1) Kushtas where sastra karma is
contraindicated.
2) In Sparsanendriyanasa
3) Nipatya
4) After visravana
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2
AGADA PRAYOGA
पाषाणकहठनपरुषे सपु्िे कुष्ठे क्स्त्थरे पुराणे च । पीिागदस्त्य कायो ववषे प्रदेहोगदेस्त्चानु ॥ स्त्िब्धातन सपु्िसपु्िान्यस्त्वेदनकण्डुलातन कुष्ठातन। कूचेदयक्न्ित्ररव्रिाकरवीरकरन्जकुिजानाम ्॥ जात्मयकय तन्ब्जेवाय परे शस्त्रे समदु्रफेनेवो । घ्रष्िातन गोमयेवाय िि ् प्रदेहे प्रदेहातन ॥ (च.चच.7/55-57)
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SNANOPYOGI DRAVYAS
Ch.chi7/129,130
Siddharthaka snana churna
Darvi kwatha
Patola
Nimba
Khadirasara
Karanja
Aragwadha
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ABHYANGA:
Vajrakatailam,
Mahavajrakatailam,
Adityapaka tailam (B.P,mad.),
Marichaditailam,
Somarajitaila,
Swetakaranjaditaila
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5
दाहयतुिकुक्ष्ठ स्त्नान प्रयोगा रोध्राररष्िं पद्मकं रतिसार ् सप्िाहाक्षौ व्रक्षको बीजकस्त्च ् । योज्या स्त्नाने दहमानस्त्य जन्िो पेया वा स्त्याि ्क्षौद्रयुतिा
त्ररिण्डी ॥ (स.ुचच.9/50)
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RASAYAN YOGAS
Navayasa rasayana (chakradatta)
Brahmiaadi rasayan
Chitraka rasayan
Bhallataka rasayan
Tuvarak rasayan (Ah.Chi.19/53)
Medo prapta kushta
Yapya kushta
All kushtas
Eg:Tuvarasthi, Bhallataka, Bakuchi,
Chitrakamulam, Silajatu (Ah.Chi.19/53
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GUDA
Manibhadra guda (A.H.chi.19/31,32)
Modaka Triphala modaka
AVALEHA
Bhallatakavaleha,
Sashangavaleha,
Dhatryadyavaleha
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CONCLUSION
Selection of chikitsa for kushta depends on predominant of doshas
Repeated shodhana is essential for bahu doshavasthaother than trying to eliminate it all at once since it weakens the patient
In excessive vata aggravated condition, basti chikitsacan be adopted
Nasya is indicated in kapha pradhana kushta and dhumapana in kushta affecting jatrurdwa
If doshas are in alpavastha we can treat with shaman line of treatment.
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THANK
YOU