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TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS - A COMPARATIVE STUDY
By
Dr. SRINIVAS RAO, B. A. M. S.
Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore for partial fulfillment of the degree
AYURVEDA VACHASPATI
DOCTOR OF MEDICINE (AYURVEDA) IN
PANCHAKARMA.
Under the guidance of
Dr. SHALINI.C.ELI. M.D. (AYU),D.N.Y.
Professor and H.O.D. Department of Post Graduate Studies in Panchakarma,
Government Ayurvedic Medical College.
DEPARTEMENT OF POST GRADUATE STUDIES IN
PANCHAKARMA. GOVERNMENT AYURVEDIC MEDICAL COLLEGE DHANWANTARI ROAD BANGALORE- (56009),
2010 - 2011.
TO EVA
LUA
TE THE EFFIC
AC
Y OF VIR
ECH
AN
A W
ITH K
AR
AVELLA
KA
PATR
A
SWA
RA
SA A
ND
AB
HA
YAD
I MO
DA
KA
IN EK
A K
USH
TA W
.S.R.TO
PSOR
IASIS -
A C
OM
PAR
ATIVE STU
DY
Dr. SR
INIVA
S RA
O
2010 - 2011
CERTIFICATE BY THE GUIDE RTIFICATE BY THE GUIDE
DDeeppaarrttmmeenntt ooff PPoosstt GGrraadduuaattee SSttuuddiieess iinn PPaanncchhaa KKaarrmmaa DGGoovveerrnnmmeenntt AAyyuurrvveeddiicc MMeeddiiccaall CCoolllleeggee G
BBaannggaalloorree.. B
2010-2011 2010-2011
Deeppaarrttmmeenntt ooff PPoosstt GGrraadduuaattee SSttuuddiieess iinn PPaanncchhaa KKaarrmmaa Goovveerrnnmmeenntt AAyyuurrvveeddiicc MMeeddiiccaall CCoolllleeggee
Baannggaalloorree..
This is to certify that the Dissertation entitled “TO EVALUATE THE
EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA
AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R. TO PSORIASIS –
A COMPARATIVE STUDY” is a bonafide research work done by
Dr.SRINIVAS RAO in partial fulfillment for the degree of Ayurveda
Vachaspathi, Doctor of Medicine (Ayurveda) in Pancha Karma of the Rajiv
Gandhi University of Health Sciences, Bangalore.
I recommend this dissertation for the above degree to the University for
Assessment and approval.
Guide: Dr.Shalini.C.Eli. M.D. (Ayu),DNY.
Date: Professor and H.O.D,
Place: Department of Postgraduate Studies in Panchakarma.
Government Ayurvedic Medical College, Bangalore.
Department of Post Graduate Studies in Pancha Karma GGoovveerrnnmmeenntt AAyyuurrvveeddiicc MMeeddiiccaall CCoolllleeggee
BBaannggaalloorree..
ENDORSEMENT BY THE HOD &
PRINCIPAL
This is to certify that the Dissertation entitled “TO EVALUATE THE
EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND
ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS.A COMPARATIVE
STUDY” is a bonafide research work done by Dr.SRINIVAS.RAO under the guidance
of Dr.SHALINI.C.ELI. Professor and H.O.D Department of Postgraduate Studies in
Panchakarma, Government Ayurvedic Medical College, Bangalore.
Dr Shalini C. Eli. M.D. (Ayu),D.N.Y.
Professor & HOD Principal,
Department of P. G Studies in Pancha Karma Govt.Ayurvedic Medical College
Govt.Ayurvedic Medical College, Bangalore.
Bangalore.
Date: Date:
Place: Place:
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled, “TO EVALUATE THE EFFICACY
OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI
MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS. - A COMPARATIVE STUDY”
is a bonafide and genuine research work carried out by me under the guidance of
Dr. SHALINI.C.ELI. Professor and H.O.D.Department of PG studies in Pancha Karma,
Govt. Ayurvedic Medical College, Bangalore.
Date: Signature of the candidate
Place: Bangalore Dr. SRINIVAS RAO.
COPYRIGHT
DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University of health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation in print or
electronic format for academic/ research purpose.
Date: Signature of the candidate
Place: Dr. SRINIVAS RAO.
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
‘At times our own light goes out and is rekindled by a spark from another person.Each of
us has cause to think with deep gratitude of those who have lighted the flame within
us”.Albert Schweitzer.
At this juncture of successful accomplishment of my work I bow my head to almighty
with whose blessings I am able to fulfill my duties.
I am short of vocabulary to express my deepest sense of gratitude towards my beloved
Dr.Shalini.C.Eli.for her maternal affection,timely advise,constant indefeasible guidance
and overall supervision which has moulded and enlightened my tiny work.
I will always remain obliged to Dr.Shridhar B.S. for his dynamism,support,suggestion
throughout the study.
I again express immense gratitude to Dr.Shalini.C.Eli, Professor & H.O.D,Department
of P.G.Studies in Panchakarma G.A.M.C Bangalore for her encouragement and kind co-
operation.
I owe my sincere regards to Dr.S.G.Mangalgi,Principal,G.A.M.C,Bangalore for his
valuable support.
My heartfelt gratitude to the faculty members of the Department Dr.Shylaja kumara.R.,
Dr.Janaki Y.S.,Dr.Santosh Yedahalli,Dr.V.M.Hugar,Dr.Shaila Gurappa for their
timely guidance & support during my study.
I am highly indebted to all my homeland teachers for the imponderable knowledge and
blessings, I received throughout my career. It needs a special mention of Dr.Nirmala.N.,
Dr.Vijay Laxmi, Dr.Srinivas.J., Dr.R.Deshmukh & Dr.Veena.
Mere words cannot express my feelings of gratitude towards my mom Smt.Sulochana
and my father Sri Ranappa Bannurkar,who are the motivation and inspiration for me to
pursue higher studies.
I also thank all my sisters and my jiju for their moral support and inspiration.
My heartfelt thanks to my seniors Dr.Divya Kini.,Dr.Somanath.G.,Dr.Ashwini K.,
Dr.Smina, Dr.Sandeep & Dr.Rajani & all others for the support and co-operation I
received from them.
I whole heartedly thank to my colleagues Dr.Vijaya.V, Dr.Basava jyoti, Dr.Sumit
Patil,Dr.Ravi Patil, and Dr.Pooja.B.A. for their support and encouragement.
My heartiest gratitude’s to my junior friends Dr.Manjunath Kanthi, Dr.ShridharL,
Dr.Mukund, Dr.Nandkishore, Dr.Rashmi Rao & Dr.Vanishree for their help and
support.
I take this opportunity to specially thank my senior Dr.Divya Kini for her moral support,
guidance, and valuable suggestions rendered throughout my course.
I extend my gratitudeness to my close friends for their constant support and
encouragement in every part of my life Manjunath K., Dr.Shilpa Raga, Dr.Anand.
I will be lacking in my duty without thanking the non-teaching staff of our department &
hospital staffs for their help and service rendered during my study.
All my patients need special mention, without whose co-operation the entire study would
be stalemated.
I express my thanks to each and everyone who helped me directly or indirectly with
apologies for my inability to identify them individually.
With Heartfelt Gratitude.
Dr.SRINIVAS RAO.
Bangalore.
ABSTRACT
Psoriasis is one of the top listed dermatological problems of present day. It is affecting
the 2% of the world’s population. Though this disorder is not a contagious but it is often
source of social embarrassment. Patients often isolate themselves from the fear of
rejection from the society.
For this agony Ayurveda has better answer. Shodhana a long recognized therapeutics of
Ayurveda plays a pivotal role in the management of this condition. Virechana is one the
Shodhana modality which is playing very important part in treating stubborn disorders
like this.
Though in Ayurveda many Virechaka drugs are mentioned but only few are in practice.
There is an intense need to know the efficacy of the other drug mentioned in classics.In
Sushruta Samhita Karavellaka Swarasa is mentioned as best Swarasa Virechaka, but it is
hardly in use as Virechaka Drug.
Objectives of the study:
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in Ekakushta.
To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta.
To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka as
Virechaka Yogas.
Study design: Patients of Eka Kushta were randomly recruited to 2 groups.
Group A: Patients of this group was treated with Abhayadi modaka for virechana.
Group B: Patients of this group was treated with Karavellaka patra swarasa for
virechana.
Effect of treatment is assessed using P A S I Scale. In Abhayadi group before treatment
mean P A S I Scale was 29.8 which got reduced to 7.32 after treatment. In Karavellaka
group before treatment mean P A S I Scale was 24.7 which got reduced to 5.04 after
treatment.
It was concluded that Virechana with both the drugs is highly efficient in management of
Eka Kushta.
Key words :Eka Kushta, Psoriasis,Virechana, Abhayadi Modaka, Karavellaka Patra
Swarasa
ABBREVIATIONS.
Aruna Datta Commentary A.C Ashtanga Hrudaya A. Hr Ashtanga Sangraha A. Sa Bhaishajya Ratnavali B.R Bhava Prakasha B. P. Bhela Samhita B.S. Chakra Datta Cha. Da Chakrapani Commentary C.C Charaka Samhita Cha. Sa. Dalhana Commentary D.C Gangadhara Commentary G.C Gada Nigraha G.N Harita Samhita H.S. Kashyapa Samhita K.S Madava Nidana M. N. Sharanghadhara Samhita Sha. Sa Sushruta Samhita Su. Sa Vanga Sena V.S Yoga Ratnakara Y. R.
CONTENTS
Chapters Page no
1. Introduction……………………………………. 1 - 2
2. Objectives of the study………………………… 03
3. Review of literature
Procedure Review………………………. 5-49
Disease Review…………………………. 50-97
Drug Review…………………………….. 98-102
4. Clinical study……………………………………. 103-112
5. Observations and Results………………………... 113-132
6. Discussions……………………………………… 133-139
7. Conclusion………………………………………. 140-141
8. Scope for further study………………………….. 141
9. Summary………………………………………… 142-144
LIST OF TABLES
Table
No.
Headings Pg. no
1 Chapters & contents related to Virechana in Charaka Sutra Sthana 6
2 Chapters & contents related to Virechana in Charaka Vimana Sthana 6
3 Chapters & contents related to Virechana in Charaka Kalpa Sthana 7
4 Chapters & contents related to Virechana in Charaka Siddhi Sthana 7
5 Chapters & contents related to Virechana in Sushruta Sutra Sthana 7
6 Chapters & contents related to Virechana in Sushruta Chikitsa Sthana 8
7 Chapters & contents related to Virechana in Kashyapa Siddhi Sthana 8
8 Chapters & contents related to Virechana in Kashyapa Khila Sthana 8
9 Chapters & contents related to Virechana in Ashtanga Sangraha Sutra 8
10 Chapters & contents related to Virechana in Ashtanga Sangraha Kalpa 9
11 Chapters & contents related to Virechana in Ashtanga Hrudaya Sutra 9
12 Chapters & contents related to Virechana in Ashtanga Hrudaya Kalpa 9
13 Chapters & contents related to Virechana in Bhela Siddhi Sthana 9
14 Chapters & contents related to Virechana in Chakra Datta 9
15 Chapters & contents related to Virechana in Sharanghadara Purva
Khanda
10
16 Chapters & contents related to Virechana in Sharanghadara
UttaraKhanda
10
17 Chapters & contents related to Virechana in Vangasena. 10
18 Chapters & contents related to Virechana in Bhava Prakasha. 10
19 Classification of Virechaka dravyas acc to different acharyas. 14
20 Virechaka dravyas according to the parts used. 15
21 Virechaka dravyas mentioned in Sushruta samhita. 16
22 Virechana dravyas according to Sharangdhara. 20
23 245 Virechana kalpas. 21
24 Formulations of Virechana. 22
25 Virechana kalpas according to sharangdhara. 22
26 Virechana dravyas as per dosha. 23
27 Virechana Yogya. 24
28 Virechana Ayogya. 25
29 Sneha matra. 28
30 Sneha draya and anupana 28
31 Sneha Jeeryamana and jeerna lakshanas. 29
32 Samyak snigdha lakshanas. 30
33 Asnigdha lakshanas. 30
34 Atisnigdha lakshanas 30
35 Dose of Virechana in its different forms. 32
36 Criteria for Maniki,Vegiki,Antiki shuddhi of virechana. 35
37 Samyak yoga lakshanas of Virechana. 36
38 Ayoga lakshanas of Virechana. 36
39 Atiyoga lakshanas of Virechana. 37
40 Shuddhi according to Kashyapa 38
41 Peyadi Samsarjana Krama 40
42 Rasa Samsarjana 41
43 Ayoga and Atiyoga lakshanas of Vyapat 42
44 Virechana Vyapat according to acharyas. 42
45 Virechana Vyapat with their treatment 43
46 Layers of Twak according to different acharyas 50
48 Skin layers and disease concerned to it according to Charaka 51
49 Showing Sapta Twacha and Disease Relation. 51
50 Classification of Maha Kushta. 62
51 Kshudrakushtha according to different acharyas 62
52 Kashyapokta Kushta Types. 63
53 Kushtha and Dosha Relation. 63
54 Difference between Mahakushtha and KshudraKushtha 64
55 Doshic predominance in individual type of kushta. 64
56 Showing Samanya laxana of kushta based on particular dosha. 64
57 Nidanas according to different acharyas. 66
58 Mithya Ahara Hetu for Kushta 67
59 Mithya vihar Hetu for Kushta. 68
60 Achara Hetu for Kushta. 69
61 Lakshanas according to Predominance of the Doshas. 73
62 Lakshanas according to Dhatu dushti 74
63 Lakshanas according to Srotas 74
64 Purvaroopa according to different acharyas 77
65 Sadhya-Asadhyata. 80
66 Pathya-Apatha. 85
67 Ingredients of Chitrakadi Vati. 98
68 Ingredients of Guduchi Ghrita. 99
69 Ingredients of Madhuyashti taila. 99
70 Showing Ingredients of Abhayadi Modaka 101
71 Showing age wise distribution 113
72 Showing Sex wise distribution 114
73 Showing occupation wise distribution 114
74 Showing Religion wise distributio 114
75 Showing socio-economic status 114
76 Showing diet wise distribution 115
77 Showing marital status 115
78 Showing Region wise distribution 115
79 Showing Sleep Pattern 115
81 Showing Addiction 116
82 Showing Koshta of Patients 116
83 Showing Prakruti of Patients 116
84 Showing Satwa of the Patients 117
85 Showing Satmya of the Patients 117
86 Showing presence of family history of Psoriasis. 117
87 Showing mental stress as triggering factor 118
88 Showing seasonal factor 118
89 Showing food as aggravating factor 118
90 Showing Drugs as aggravating factor 119
91 Showing infection as triggering factor 119
92 Showing chronicity 119
93 Showing Distribution of area 119
94 Showing details of Itching 120
95 Showing details of Erythema 120
96 Showing details of area involvement - Head 120
97 Showing details of area involvemet - Trunk 120
98 Showing details of area involvement - Upper limb 121
99 Showing details of area involvement- Lower limb 121
100 Showing details of Auspitz’s Sign + 121
101 Showing details of Candle Grease Sign + 122
102 Showing number of days of Sneha Pana 122
103 Showing Samyak Snighdha Lakshanas 122
104 Showing Samyak Swinna Lakshana 123
105 Showing Time required manifesting first Virechana Vega 123
106 Showing Virechana Vegas 123
107 Showing Time required for completion of procedure 124
108 Showing Laingiki Shuddhi 124
109 Showing Statistical analysis is done using Shapiro-Wilk Test 125
LIST OF GRAPHS
Graph no. Headings
1 Showing age wise distribution
2 Showing Sex wise distribution
3 Showing Religion wise distribution
4 Showing socio-economic status
5 Showing diet wise distribution
6 Showing Marital Status
7 Showing occupation wise distribution
8 Showing region
9 Showing history of diwa swapna
10 Showing history of ratri jagarana.
11 Showing Prakruti of the patients
12 Showing Satva of the Patients
13 Showing Satmya of the Patients
14 Showing Addictions
15 Showing Koshta
16 Showing family History.
17 Stress as aggravating factor
18 Season as aggravating factor
19 Food as aggravating factor
20 Drug as aggravating factor
21 Infection as aggravating factor
22 Grading of Itching
23 Grading of Erythema
24 Area involvement in Head
25 Area involvement in Trunk
26 Area involvement in Upper Limb
27 Area involvement in Lower limb
29 Auspitz Sign
30 Candlegreeze Sign
31 Days of Snehapana
32 Samyak snigdha lakshanas
33 Samyak swinna lakshanas
34 Time taken for initiation of Vega
35 Number of Vegas
36 Time taken for completion
37 Laingiki shuddhi.
Introduction
INTRODUCTION
Ayurveda an ancient system of Health care is a result of India’s quest for
disease free living. The amazing journey of Āyurveda from its divine origin to
the present day gives us the hint about the enormous potential this science
possessing. Its successful existence since time immemorial itself proves its
scientific approach of treatment that has remained unchanged till date. One of
such unique line of treatment is Shodhana Karma.
Shodhana is a procedure, where if Roga janaka doshas are in prabhuta
avastha they are expelled through the nearest route. Virechana karma is one of
the shodhana modality which is performed to eliminate vitiated pitta dosha
from the body. Though virechana is agrya shodhana for vitiated pitta dosha ,
we find references that it also eliminates vitiated kapha and vata doha.3
Virechana is a line of treatment in many chronic and stubborn disorders and
one of such disorder is Kushta. In Ayurveda many of the skin disorders are
brought under one umbrella called Kushta. Acharyas had faith in virechana to
put control over disease causing morbid factors. Eka kushtha , one of the
Ksudhra kushtha can be treated with Virechana karma.
The signs and symptoms of Eka kushtha mentioned in ayurvedic classics
resembles to that of Psoriasis. Psoriasis is a very common disease and affects
one to two per cent of the population in all geographic regions
Psoriasis is a chronic inflammatory and proliferative disorder of the skin
clinically manifested as well-circumscribed, erythematous papules and plaques
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 1
Introduction
covered with silvery scales typically located over the extensor surfaces and
scalp. While specific systemic and environmental factors are known to
influence the disease, it is unpredictable in its course and usually pursue
spontaneously with improvement and exacerbations of lesions without
discernable cause. Immune system dysfunction in the background of a genetic
predisposition is believed to be at the core of the disease process.
In classics we find reference about administration of virechana using different
parts of the drug, among which Karavellaka patra swarasa for the virechana is
the best type of aushadha kalpana. In Chakradutta and Sharangadhara samhita
we get reference about Abhayadi modaka as a virechaka yoga in Kushtha.
So with the motto of evaluating the efficacy of both the virechana yogas in
Eka Kushtha work has been carried out under the heading,
“TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA
SWARASA AND ABHAYADI MODAKA IN EKA KUSHTHA W.S R. TO PSORIASIS:-A
COMPARATIVE CLINICAL STUDY.
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 2
Introduction
OBJECTIVES OF THE STUDY
1. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in
Ekakushta.
2. To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta.
3. To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka as
Virechaka Yogas.
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 3
Introduction
PREVIOUS WORK DONE
“Effect of Vamana and Virechana in Psoriasis” by Dr. Shankar Babu A. on 1988
at Govt. Ayurvedic college, Kerala University, Trivendrum
Effect of vamana and virechana in Psoriasis by DrA.Shankar Babu,Govt
Ayurvedic College,Trivendrum(1990).
Concept of Kitibha (Psoriasis) in Ayurveda and Modern medicine and its
treatment with Strikutaja a further study”. By Anken on 1991 at Banaras Hindu
University, Varanasi
“The effect of Vamana and Virechana in Psoriasis”,By Dr.Rekha, GAMC,
Mysore, Mysore University.(1995)
Role of Virechana with and without shamana in the management of Psoriasis
( Eka kushta )” by Dr. Ruparel.S.J on 1999 at Gujarat Ayurveda University,
Jamanagar.
“Comparative study of Virechana karma and Nitya rechana in the management of
Ekakushta”, by Dr.Praveen B.S.,S D M College of Ayurveda, Hassan,
RGUHS.(2005)
Role of Virechana with and without Shamana in the management of Eka kushtha
(Psoriasis) ” by Ruparel on 1999 at Gujarat Ayurveda University, Jamanagar.
Role of Virechana Karma in management of Psoriasis” by Dr.Praveen
V..Devarushi,Udupi(2008-09).
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 4
Procedure Review Of Literature
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 5
HISTORICAL REVIEW
Historical review of virechana karma:
Vedas are the oldest source of information regarding the disease and its
treatment A close review of the history of various systems of medicinal
science reveals the fact that the treatments was prevalent from time
immemorial, but only very few references are available about Virechana in
Vedic times.
PURANA KALA
Agnipurana1: .
Agni purana has stated virechana as best treatment for the diseases caused due
to Pitta.Trivrth as best virechaka dravya. It is indicated in urdhwaga rakta
pitta, jwara, hridroga.But detail description of Virechana was not found.
In Manu smrithi, it is told that snana is done after the completion of vamana
and virechana2.
Vinayapitaka(Buddha literature):3
In the text Vinaya pittaka, Buddha period, virechana was given to Bhagwan
Buddha by inhaling some powder spread over uthplapatra.
PROCEDURE REVIEW
Procedure Review Of Literature
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 6
Kasika4
It was explained that Panchakarma was common method of treatment which
prescribed Poorvakarma such as Snehana, Swedana and Panchakarma,
Annasamsarjana etc.
SAMHITA KALA:
1.CHARAKA SAMHITA
Sutra Sthana: Table No.1
Vimana Sthana:
Table No.2
Ch. no Name of the Chapter Content 08 Rogabhishagjiteeya Vimana
adhyaya. Virechana dravya Kalpa
Sangraha.
Ch.no Name of the Chapter Content
1 Deerghanjeeviteeya Adhyaya Moolinis and Phalinis used for Virechana
2 Apamaargatanduleeya Adhayaya Important purgative drugs
4 Shat virechana Shatashrateeya Adhyaya
Virechanopaga drugs
15 Upakalpaneeya Adhayaya Sambhara Sangraha, Dose of Virechana , Yogya,Ayoga, Atiyoga laxanas, virechana vidhi and its benefits.
16 Chikitsaprabrutiya adhyaya Complications & its management.
20 Maharoga Adhayaya Utility of Virechana karma in Nanatmaja pittajaVikaras.
Procedure Review Of Literature
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 7
Kalpa sthana:
Table No.3
Ch. no Name of the Chapter Content 07. Shyama trivrit Kalpa Adhyaya Different formulations of
shyamatrivrit.
08. Chaturangula Kalpa Adhyaya Different formulations of chaturangula.
03. Tilwaka Kalpa Adhyaya Different formulations of tilwaka. 09. Sudha Kalpa Adhyaya Formulations of Sudha. 10. Saptala shankini Kalpa Adhyaya Different formulations of
saptalashankini 11. Danti dravanti Kalpa Adhyaya Different formulations of
dantidravanti.
Siddhi Sthana: Table No.4
Ch. no Name of the Chapter Content
01. Kalpana Siddhi
Virechana purva ahara,samyog,heena & atiyoga laxanas,Samsarjana krama, Shuddhi are described.
02. Panchakarmeeya Siddhi Virechya and Avirechya are described.
06. Vamana Virechana Vyapad Siddhi.
Complication manifested due to Ayoga and Atiyoga and its
Management.
2. SUSHRUTA SAMHITA
Sutra Sthana: Table No.5
Ch. no Name of the Chapter Content
38. Dravyasangrhaniya adhyaya Description of Virechana dravyas.
39. Samshodhana samshamaniya. Adho bhaga dosha hara dravyas are mentioned.
41. Dravya Vishesha Vignaneeya Adhyaya
Described the Adhobhaga Prabhava of Virechaka drugs.
44. Virechana Dravya Vikalpaneeya Adhyaya
Different formulations for the Virechana karma.
Procedure Review Of Literature
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 8
Chikitsa Sthana:- Table No.6
3.KASHYAPA SAMHITA:
Siddhi Sthana: Table No.7
Ch no Name of the Chapter Content
03. Vamana Virecahna Adhyaya Detailed discription of Virechana Karma Heena, Madhyama, Uttama Shuddhis, Regimen to be followed
after Virechana, utility of Virechana Karma in Bala roga, Vyapat of
Virechana.
07. Pancha Karmeeya Siddhi Yogya Ayogya for Virechana.
Khila sthana: Table No.8
Ch.no Name of the Chapter Content
07. Samshuddhi Visheshaneeya Adhyaya
Virechana Karma and Samsarjana Krama.
4. ASTHANGA SANGRAHA:
Sutra sthana: Table No.9
Ch. no Name of the Chapter Content
Ch.no Name of the Chapter Content
33. Vamana Virechana Sadhya Upadrava Chikitsitam Adhyaya
Virechana process, Phamacodynamics of virechana, , Ayoga, Atiyoga and Samyak yoga of Virechana,Virechya –Avirechya,
importance of dosha nirhana.
34. Vamana Virechana Vyapat Chikitsitam
Complication of Virechana karma.
39. Aturopadrava Chikitsitam Adhyaya
Samsarjana Krama is described.
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27. Vamana Virechana Vidhi Adhyaya
Detailed description of Virechana Karma, Pharmacological actions of
Virechana dravyas,Virechya, Avirecya are mentioned.
Kalpa sthana:- Table No.10
Ch no Name of the Chapter Content 02. Virechana kalpa Adhyaya. Different formulations of Virechana
Karma. 03. VamanaVirechana Vyapat
Siddhi. Vyapat and its Management.
5. ASHTANGA HRIDAYA:
Sutra sthana: Table No.11
Ch.no Name of the Chapter Content
18. Vamana Virechana Vidhi Adhyaya
Detailed description of Virechana Karma
Kalpa sthana: Table No.12
Ch. no Name of the Chapter Content 02. Virechanaa Kalpa Adhyaya. Detailed description of Virechana
process. 03. Vamana Virechana Vyapat
Adhyaya. Virechana Vyapat with its
treatment.
7. BHELA SAMHITA:
Kalpa sthana: Chapters deal with preparations of
Chaturangula.
Dantiphala.
Shankini.
Shyamatrivrit.
Siddhi Sthana: Table No.13
Ch. no Name of the Chapter Content
01. Vamana virechana siddhi It deals with samyak,ayog & atiyoga laxanas of virechana.
04. Vamana Virechana Siddhi Adhyaya.
Detailed description of Virechana Karma is available.
8. CHAKRADATTA: Table No.14
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Ch.no Name of the Chapter Content 71. Virechana adhikara. Detailed description of Virechana
Karma.
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9. SHARANGADHARA SAMHITA:
Poorva kanda: Table No.15
Chapter Name of the Chapter Content
04. Deepana Pachana Adhyaya. Description of four types of virechana dravya laxanas.
Uttara kanda:- Table No.16
Chapter Name of the Chapter Content 04. Virechana Vidhi Adhyaya Virechana karma described in detail
10. VANGASENA:
Table No.17
Chapter Name of the chapter Content
89. Virechana adhikara Adhyaya. Detailed description of Virechana karma and virechana yogas.
11. BHAVA PRAKASHA
Table No.18
Virechana in western medicine.5
In Mesopotamian Civilization Physicians of Mesopotamia were using Virechana to
treat pain abdomen.
In seventeen century Handersn has written in his book that it was customary to use
Purgatives.
Chapter Name of the Chapter Content 06. Mishra Prakarana Adhyaya Details regarding virechana and Pathya
and Apathya during Virechana karma.
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VIRECHANA
The process by which the vitiated doshas are eliminated through the adhobhaga ie
guda marga, is called ‘Virechana.This is widely used shodana therapy, is less stressful
with least complication.Virechana in broader term denotes both vamana and
virechana.6
Etymology:-
(1) Virechana7 :V+Rich+ Nich , lytu-malade: nissernam ......(Vachaspathyam).
(2)Virechanaha8 :V+Rich+Nich, lytu-Visheshena rechathete ...... (Shabdakalpadruma)
The Vircehana word is derived from the ‘Rich’ dhatu ,‘Nich’ &’Lyut’ pratyaya &
with ‘Vi’ upasarga.
It also means Maladehe nissaranam i.e. expelling out the malas.
"Ricir" - evacuation.
"Ric" - Viyojana (separation).
Virechana word is derived from the ‘Rich’ dhatu, ‘Rich’ meaning – To empty ,
evacuate, leave, give up.9
The root ‘Rich’ is also very important to understand the systemic action of Virechana.
According to Charaka, the Virechana drugs first get digested in Amashaya, then
reaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body and
reach the site where Doshas are accumulated.10
Virechana drugs soften the compactness (Sanghata) of the Doshas and break the
bigger molecules to smaller ones. This process occurs in a proper way by separation
(Viyojana) and combination (Samparchana) of doshas.
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Up to this stage the action of Virechana is known as its systemic effect and it is
obviously governed by Viyojana and Samparchana components of Virechana dravya.
Definition:
iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉ
xÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....|11
The act of expelling Doshas through Adhobhaga is known as Virechana. Here the
meaning of Adhobhaga is ‘Guda’ as commented by Chakrapani.
ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉ
ÌlÉ:xÉÉUhÉÇ ...|12
The procedure in which the drug is administered orally, acts on morbid Doshas,
specifically on Pitta and expels them out through anal route.
ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |UåcÉirÉÌmÉ
iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||13
The procedure where the morbid Dosha is expelled out in the form of Drava either
pakva or apkva state.
ÌmɨÉå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ
zsÉåwqÉhÉÏÌiÉ |14
urÉMÑüsÉÉlÉç xÉͳÉmÉÉiÉÉåijÉÉlÉç mÉæ̨ÉMüÉlÉç MüTü
ümÉæ̨ÉMüÉlÉç |
xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç
||15
Even though Virechana is best line of treatment modality for pittadosha16it can act on
kaphasamsrusta pitta or pittasthanagat kapha.
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And moreover in case of vatasyopakrama mridu shodhana indicated which refers to
mridu Virechana karma17.
So Virechana is major line of treatment for morbid pittadosha & also it act on morbid
kapha and vata dosha. Thus action of Virechana is seen on all tridosha.
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Paryaya:
Instead of word Virechana the following terms were used in different context, these
all can be consider as synonyms for virechana,
Vireka,
Rechana,
Adhobhagahara.
Anulomana 18
Praskandana.
According to the Sanskrit – English dictionary the different meanings are- Purgative,
Cathartic, Evacuant and Aperient.
IMPORTANCE OF VIRECHANA:-
Virechana is a sovereign procedure for elimination of Pitta Dosha19,20 Indu explains
that in the vitiation of Kevala Pitta, Pitta associated with Kapha and in Pittasthana
Gata Kapha Virechana is the obvious treatment procedure to be followed21.
Charaka explains that Virechana drug after entering Amashaya dislodges the vitiated
Pitta Dosha and henceforth pacifies all Pitta Vikara of the body22.
Virechana also cleanses sense organs i.e. improves their function. Just as removal of
water from its reservoir destroys various organisms and plants residing in it, in the
similar manner removal of excessive Pitta destroys the various symptoms caused due
to it23
Virechana is mentioned as Shodhana procedure in Dusthi of Rasa,Rakta, Mamsa,
Asthi, Majja & Shukra Dhatus. Hence in majority of the Dhatupradoshaja Vikaras
Virechana is the better option .
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Virechana dravya guna karma:
The guna of virechana dravya are ushna, tikshna, sukshma, vyavayi, vikashi, these
qualities are common in vamana aoushadam, but virechana dravya has adhobagahara
prabhavam.
Virechana dravya has jala and prithwi mahabootha predominance.24
CLASSIFICATION OF VIRECHANA DRUGS:--
The drugs which produce Virechana are known as Virechaka dravyas. According to
references available Virechana drugs may be classified in following 6 groups,
Table.no.19
I) Virechana Dravyas According to their origin & parts used
a) Animal origin b) Plants origin c) Miscellaneous
II) According to the mode of action a) Anulomana b) Samsrana c) Bhedana d) Rechana
III) According to the intensity of action a) Mrudu b) Madhyama c) Tikshna
IV) According to the Rukshata & Snigdhata view. V) Virechana drugs according to the seasons
V
I R
E C
H A
N A
D R
A V
Y A
S
VI) Virechana drugs according to kalpanas
A.Virechana drugs according to their origin and parts used:
a) Animal origin:
∗ Urine.25,26
∗ Milk 27
∗ Takra 28
b) Plant Origin:
c) Miscellaneous:
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Classification of virechana dravyas based on parts used.
Table no:20.
Sl.no.
Part of the plant used for
virechana.
Charaka 29
Sushruta 30
Vagbhata 31
1. Mulini virechana dravya.
Hastidanti Shyama Trivrit Adhoguda Saptala Danti Gavakshi Vishanika Ajagandha Dravanti Avartaki
Trivrit,Shyama Danti Dravanti Saptala Shankhini Vishanika Gavakshi Chitraka Kush, Kasha Kinahi
Danti,Kumbha (Trivrit) Gavakshi Shankhini
2. Phalini virechana dravya
Shankhini Vidanga Anupa Sthalaja Prakeerya Udakeerya Abhaya Anthakotrapuspi Kampillaka Aragwada
Kampillaka Puga Eranda,Haritaki Bibhitaki, Amalaki Neelini Aragwada
Neelini Triphala Kampillak
3. Ksheera virechana dravya.
Snuhi ksheera Arka
Mahavriksh Saptachala Swarna ksheeri
Snuhi Swarna ksheeri Godugdha
4. Twak virechana dravya
Tilwaka
Tilwaka Patala Ramyaka
Tilwaka Ramyaka
5. Patra virechana dravya
Swarna patri Aragwada
Putika Aragwada Karavellaka
Aragwada
D) Based on Parts of the Dravya used:
Sushruta describes the following drugs with priority for Virechana
Karma32.
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Classification of virechana dravyas based on parts used and agraoushda
Table no.21
Mula Virechana Shyama Trivrith Phala Virechana Haritaki Twak Virechana Tilwaka
Swarasa Virechana Karvellaka Dugdha Virechana Snuhi
Taila Erandam d) Miscellaneous:
As Madya, Dhanyamla33,Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some
minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna,
Samudraphena also have Sara properties.
B. Virechana drugs according to their mode of action by Sharangadhara
Acharya Sharangdhara has classified according to the action of the Virechana
dravyas.
a) Anulomana 34 :
M×üiuÉÉ mÉÉMÇü qÉsÉÉlÉÉÇ rÉiÉç ÎpÉiuÉÉ oÉlkÉqÉkÉÉå lÉrÉåiÉç
|iÉŠÉlÉÑsÉÉåqÉlÉÇ ¥ÉårÉÇÇ mÉëÉå£üÉ WûUÏiÉMüÐ ||
These drugs will digest the Apakwa (undigested material) malas and bring them to
adhomarga for defecation process. That is these drugs will facilitate the defecation
process.
eg: Hareetaki (Terminalia Chebula).
Sushruta considers Sara as the synonym of Anulomana. According to Dalhana
Anulomana causes expulsion of Vata and Kapha35.
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According to Raja Nighantu, Bhoutika composition of Anulomana drugs is similar to
that of Virechana drugs i.e. Prithvi and Aap Mahabhuthas.
b) Sramsana 36 :
mÉ£üurÉÇ rÉSmÉ£üurÉÇ ÎvsÉ¹Ç MüÉã¹ã qÉsÉÉÌSMüqÉç |
lÉrÉirÉkÉ:xÉëÇxÉlÉÇ iÉSè rÉjÉÉ xrÉÉiÉç ¢üiÉqÉÉsÉMüqÉç|
The drugs which expel the malas adhered to the lumen of intestines in to the rectum
without digesting (Paka) them. eg: Aragwada (Casia Fistula).
In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates the
Pitta and Kapha situated in Pakwashaya 37.
c) Bhedana 38:
qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:|
ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉ
The drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or
‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into it and then
evacuating through the lower gut, is known as Bhedana. eg. Katuki.
Bhedana is a process in which Shareera Mala Nirharana is brought about. 39.
Charaka has described a group named as ‘Bhedaneeya’. This includes Shyama
(Trivrit), Arka, Urubuka (Eranda), Agnimukhi (Kalikari), Chitra (Danti), Chitraka,
Chirabilva, Shankhini, Sakuladani (Katuki) and Swarnaksiri.40
d) Rechana 41:
ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |
UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||
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The drug which eliminates digested (Pakwam) and undigested (Apakwam) Malas
or Doshas by making them watery through the lower gut is known as ‘Rechana’
eg: Trivrit.
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Virechanopagas:
There are certain drugs which help in enhancing the action of Virechana Dravyas
is known as Virechanopaga. The drugs described are Draksha, Gambari, Parushaka,
Abhaya, Amalaka, Vibhitaka, Kuvala Badara, Karkandhu, and Pilu42
C) Virechana drugs according to intensity of action:
According to the degree of potency of the drugs, the Virechana may be classified
into the following categories.
A) Mridu Virechana:43
The drugs which are Mridu in Veerya or when combined with opposite Veerya or
given in low dosage, given to the Ruksha patient and causes less purgation is known
as Mridu Virechana. Those drugs are specifically indicated in weak patients having
mild natured diseases. These drugs may also be given to the patients who have been
Shodhita previously or having Alpa Dosha or whose Koshta is unknown. Charaka is
of the view that the physician should not hesitate to use Mridu Virechana drugs in
weak patients having more Doshas because even repeated elimination of Doshas in
small quantity may cure the disease44
The patient who have not taken Virechana drugs in past and whose Koshta is
unknown in such persons Sushruta recommends the use of Mridu Virechana drugs
in the beginning and after knowing the Koshta required drug may be prescribed 45
Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta
(eg. Draksha, Milk, Caster oil, Warm water etc.). 46Drugs effective in Mridu Koshta
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are Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari,
Triphala, Pilu and Taruna Madya47.
B) Madhya Virechana:
The drugs which are moderate in qualities are known as Madhya Virechana drugs.
The drugs are specifically indicated in the patients having Madhya Roga (disease
with moderate symptoms). The administration of these drugs in Balavan rogi is
useless because, they are unable to eliminate Dosha completely48.Sharangdhara
recommends the use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit,
Katuki and Aragvadha49.
C) Teekshna Virechana :
The drugs, which cause severe motions (Mahavega) and eliminates the Doshas in
large quantity by quick (Kshipra) and gentle (Sukha) purgation without causing either
much depression (Glani), is known as Teekshna Virechana.
According to Charaka, the drug which has been kept away from water, heat and
organisms, cultivated in proper Desha and Kala and which has been given Bhavana
with the drugs of same Veerya acquires the Teekshna properties. This type of drugs
having all the required properties, when given in prescribed dosage to the patient who
has been well Snehita and Swedita, then it causes Teekshna Virechana50.Sharangdhara
recommends use of Teekshna Virechana drugs in Krura Koshta persons.
Charaka recommends the use of these drugs in the strong (Balavan) patients all the
symptoms of the diseases i.e. Teekshna Vyadhi51.It has been further mentioned that
the use of these drugs should be avoided in Durbala (weak), Shodhita, and patient
having Alpa Dosha and whose Koshta is unknown, otherwise it may cause untoward
effects of these patients. Sushruta is of the view that Teekshna drugs given in Mridu
Koshta having Deeptagni, passes out quickly without eliminating Doshas
properly52,Snuhi Kshira is considered as the best amongst these drugs53.More over
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Sharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in
Krura Koshta may also be included in this group.
D) Classification based on guna of drug:
In many places in Ayurveda, the uses of Sneha Virechana and Ruksha Virechana
have been recommended.
The drug used in the form of oil or the preparation containing Sneha is known as
Sneha Virechana, eg: Eranda Taila. Vagbhata recommends the use of Sneha
Virechana in all patients except Snigdha patients 54. The use of Sneha Virechana in the
patients who have been given higher dosage of Sneha is contraindicated because, due
to this, the moving Doshas may again adhere in the Srotas55. Sneha Virechana should
be administered in Sama-Shitoshma Kala 56.
The preparations, which do not contain Sneha, may be known as Ruksha Virechana.
Its use has been recommended in the Snigdha patients who have been comparatively
taken more Sneha 57.
E. Virechana drugs according to seasons 58
Table no:22 Showing Virechana drugs according to seasons.
Varsha Sharad
Shishira /Vasanta
Greeshma Hemanta All seasons
Preparation Beeja Trivrit Kutaja Pippali Shunthi
Shyama Trivrit Duralabha Musta Sharkara Udichya Shweta Chandana
Shyama Trivrit Pippali Nagara Sindhu Aruna Trivrit
Shyama Trivrit
Trivrit Chitraka Patha Ajaji Sarala Vacha Hemakshiri churna
Trivrit Danti Hapusha Saptala Katuki Swarnaksiri
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Adhamalla in Sharangdhara commentary mentioned that the drugs for Virechana in
Shishira, Vasanta and Hemanta Rutu are same. Kasiram Vaidya in his commentary
opined that Saindhava, Vriddhadaru, Shyama and Trivrit are to be used for Virechana
in Hemanta Rutu. Charaka mentions Trivrit Chitraka, Patha, etc. to be used for
Virechana in Hemanta Rutu.
F.According to Kalpana:
Different forms of yogas are prepared to help in enhancing the potency, shelflife and
convenience. According to Sushruta following 8 preparations are useful.
i) Ghrita yoga ii) Taila yoga iii) Kshira yoga
iv) Madya yoga v) Mutra yoga VI) Mamsarasa yoga
vii) Bhaksanna yoga viii) Avaleha yoga
Kshira, Rasa, Kalka, Kashaya, Kwatha and Sita are respectively Laghu.
Table no:23. Showing 245 Virechana kalpas according to Charaka.59
Kalpana Trivrth Argvada Tilvaka Sudha Saptala Shankini
Danti Dravanti
Amla kanji 2 1 1 1 1 1 Mutra 22 - 1 - - -
Tushodaka 2 - - 1 1 1 Maireya 2 - - - 1 - Yusha 2 - - 1 - 2
Kwatha 1 2 1 - 11 - Churna 32 - - 1 1 6 Tarpana 8 - - 1 - - Ksheera 2 - - - - -
Mamsa ras 2 - - 4 - 6 Ikshu ras 1 - - - - 1 Swarasa 6 2 1 2 - -
Leha 1 1 3 1 3 6 Modhaka 7 - - - - -
Raga shadava 4 - - - - - Sura Madhya 3 1 2 2 5 4
Souvira 2 1 1 1 1 1 Sidhu - 1 1 - 1 1
Uthkarika 1 - - - - 1
Anupana Draksha Rasa and madhu
Yasti madhu in Draksha Swarasa or Draksha Swarasa only
Honey Sugar Warm Water
Bhavana with cow ‘s urine
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Gritha 4 2 4 4 8 6 Taila - - - - 6 2
Chatusneha - - - - - 1 Asavarishta - 1 1 - - 5
Greya - - - 1 - - Yavagu - - - - - 1
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G.Specific formulations for Virechana6
Tabe no:24. Showing Formulations for virechana based on dosha involvement.
Vata Pradhana Trivrit + Saindhava + Shunthi + Kanji or Mamsasara
Pitta Pradhana Trivrit Choorna + Draksha Kvatha Kapha Pradhana Triphala Kvatha, Gomutra, Trikatu Children between the Age group of 4-12 years61 Draksha rasa+ Aragvadha phala majja
H. Dosage of Virechana drugs according to Matra and Kosta:
Matra of the Virechana drug should be in such a quantity, that the desired effect of
Shodhana may be achieved and may be able to avoid Atiyoga. This should be decided
according to Dosha, Atura Bala, Bheshaja, Kala, Desha, Agni, Koshta, Shareera,
Ahara, Satmya, Satwa, Prakriti, Vaya, Sama Avastha and Vikara 62.
Table no.25: Virechana kalpas according to Sharangadhara. 63
Kalpana Heena for Mridu Koshta
Madhyama for Madhyama Koshta
Uttama for Krura Koshta
Kwatha 8 tolas 4 tolas 2 tolas
Kalka, Choorna Modaka 4 tolas 2 tolas 1 tola According to Sushruta64:
1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshta
respectively.
I. Nature of Koshta and Virechana65:
qÉ×²Ï qÉɧÉÉ qÉ×SÒMüÉå¸å qÉkrÉMüÉå¸å cÉ qÉkrÉqÉÉ |
¢ÔüUå iÉϤhÉÉ qÉiÉÉ SìurÉæqÉ×ïSÒqÉkrÉqÉiÉϤhÉMæü: ||
Acharya Sharangdhara opines that – for the person Mridu Kostha, Virechana drugs
must be mild and their dose should be minimum; for the Madhyama medium dose and
for Krura Kostha persons, the Virechana drugs should be Tikshna and its dose is
minimum.
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J. Virechana Drugs According to Dosha 66:
Table no:26 Virechana Dravyas used as per the Dosha.
Sl. No. Dosha Virechana Dravyas 1. Vataja Vikara Snigdha, Ushna virya with Lavana 2. Pittaja Vikara Kashaya, Madhura Rasa Pradhana 3. Kaphaja Vikara Katu Rasa Pradhana
VIRECHANA VIDHI:--
Virechana Vidhi can be studied under 3 main headings:
Purva Karma (Pre Therapeutic Procedure)
Pradhana Karma (Therapeutic Procedure)
Paschat Karma(Post Therapeutic Procedure)
A) PURVAKARMA:
1) Sambhara Samgraha
2) Aatura Pariksha
3) Aatura Siddhata
4) Matra Vinishchaya
Sambhara Samgraha:-67
Ahara: Shali.Mudga,Maasha,Yava,Tila,Dugdha,GrithaUshana jala,
Mamsa etc.
Aushadha: Deepananeeya,Paachaneeya,Upashamaneeya,Vatahara,
Sneha,Swedana ,Virechana drugs like Draksha, Triphala, Suoveerak
etc.
Equipments: Achamani,Udaka koshta , Sharava,Darvi, Tula,
Manabhanda,Dhumanetra,Sutra,Karpasa etc.ghata,etc.
Atura Pariksha:68 Before performing Virechana karma it is necessary
to know patient fitness in terms of his/her Dosha, Dushya, Atura Bala
kala, Desha, Agni, koshta, Sharir & Ahara Satma, Satva etc. for proper
adminstration of Verchana karma..
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Virechana Yogya and Ayogya. Table no:27: Showing Virechana Yogya
Virechana Yogya Ch.Si69 Sus.Chi70 A.S.71 A.Hr.72 K.Si.73 Sha.S.U74 Pranavaha srotoduhti vikara
Shwasa + - - - - - Kasa + - - - - - Parshvaruja + - - - - -
Annavaha srotoduhti vikara Aruchi + + + - - + Avipaka + - + - - - Visuchika + + + - - + Alasaka + + + - - - Chardi + + + + - +
Udakavaha srotoduhti vikara Udara + + + + - +
Rasa pradoshaja vikara Pandu + + - - + + Jwara + + + + - + Aruchi + + - - - + Avipaka + - + - - - Hridroga + + - - + +
Rakta pradoshaja vikara Kamala + - - + + - Vidradhi - + + + - + Netradaha + + - - - + Aasyadaha + + - - - + Vatarakta + + + + - + Kustha + + - + + + Paittika vyadhi + + + - - - Visarpa + + - - + - Pliha + + + + - + Vyanga + - + + - - Nilika + - - + - - Urdva Raktapitta + + + + + -
Mamsa pradoshaja vikara
Arbuda + + - - - - Galaganda + - - - - -
Meda pradoshaja vikara Prameha + + - + + + Yoni Dosha + + + + - + Retodosha + - + + - -
Mootravaha srotoduhti vikara Mutraghata + + + + - +
Purishavaha srotoduhti vikara Arsha + + + + + + Bhagandara + + + - - + Udavarta + - + + + Vibhandha - + + + + - Pakvashaya shoola + + + + - -
Other Visphota - - - - + + Vatavyadhi - - - - + + Garavisha - + + + + +
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Some other indications for Virechana are:
a)In Swastha.75,76
b)Utkleshita Pitta.
Pitta Sthanagata Alpa Kapha
Kapha Sthanagata Bahu Pitta77
Pakwashayagata Pitta or Kapha Pitta78
Pittavrita Vata
Kaphavrita Vata79
Shonita Roga80
a) As Purvakarma in Rasayana and Vajikarana81,82
TABLE NO:28 Showing Virechana Ayogya
Virechana Ayogya Ch.Si83 Sus.Chi84 A.S.85 A.Hr.86 K.Si. 87 Sha.S.U88 Physiological condition
Langitha + - + - - - Upavasita + - - - - -
Durbalendriya + - - - - - Durbala + - - - + - Alpagni + + + + - + Shranta + + - - - + Pipasita + + - - - +
Karmabharadhvahata + + - - - - Daruna koshtha + - + + - -
Kshama + - - - - - Kamadivyagra + + - - - -
Bhakta + + - - - - Sukumara - - - - + -
Navaprasuta - + - - - + Rathri Jagarana - - + - - -
Atiruksha + - + - - + Bhayoptapta - + - - - +
Chinta prasaktha + - - - - - Maithuna prasaktha + - - - - -
Adhyayana prasaktha + - - - - - vyayama prasaktha + + - + - -
Garbhini + + - - - - Age related condition
Vriddha + + - - + Bala + + - - +
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Pathological condition Kshatkshina + + - - - +
Atikrisha + - - - + - Atisthula + + - - + +
Muktanala + - + - - - Atisara - - + + - -
Adhoga Raktapitta + + + + - - Shosha - - - - - -
Rajayakshma - - + - - - Urustambha - - - - + - Madatyaya + + + - - + Talushosha - - - - + - Hridroga - - - - + -
Traumatic condition Abhighata + - - - - - Subhaga + - - - - -
Kshataguda + + + - - - Shalyardita + + + + - +
Saama condition Nava Jwara + + + + - +
Nava Pratishyaya - + - - - - Some vataroga condition
Kevala Vataroga - - - - + - Hanugraha - - - - + -
Ardita - - - - + - Purvakarma related conditions.
Nirudha + - + - - - Atisnigdha + + + + - +
Anupasnigdha - - - - + - Pakshahata - - - - + -
Atura Sidhata:-
Pachana and deepana:-
Ama is considered as one among the etiological factor in most of disease, &
Shodhana in ama state is said to be contraindication. If Samshodhana medicine is taken
in the condition of Ajirna, it will lead to Vibandha and Glani. If the Doshas are in Ama
conditions and anybody tries to remove these Dosha forcefully then it will destroy the
body. If the condition of patient is associated with Ama then Shodhana can only be done
after the Pachana of Ama by Deepana, Pachana So it is necessary to administer deepan
& pachana drugs before the virechana to attain nirama state.89
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Snehana & Swedana:
Snehana includes both Abhyantara (oral ingestion of unctuous material) and Bahya
Snehana (external application of unctuous material) .Abhyantara Snehapana followed
by Sarvanga Abhyanga along with Sarvanga Sweda (Whole body sudation) are
performed prior to Virechana.
Snehapana procedure is to be followed after observing Nirama Lakshanas. The
required Sneha should be administered early in the morning at Suryodayakala after
observing Jeerna Ahara Lakshanas of the previous meal and when the patient is empty
stomach. The duration of Sneha Pana should be 3 to 7 days90,91.
Importance: -
Action of Snehana and Swedana prior to shodhana explained by Charaka in following
way.Due to Snehana there will be further vriddhi of doshas, and increase in
fluidity(Vishyandana) and due to Swedana dosha paka along with removal of
obstruction at the enterance of the channels.Because of this the doshas leave the
Shakha and comes to the Koshta.92
Sushrutha says Samshodana given without oleation and fomentation will destroy the
body like the dry wood.93
Abhyantara Snehapana:
Shodhananga Snehapana is done untill the attainment of ‘Samyak Snigdha
Lakshanas’ which can be achieved in 3, 5 and 7 days in Mrudu, Madhyama, and
Krura Koshta respectively.
Thus, Shodhananga Snehapana can be carried out for a maximum period of 7 days
otherwise it will create Sneha Satmyata94, 95. However, if Samyak snigdha lakshanas
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are not achieved with in 7 days then it can be continued after one day interval96. Dose
of Sneha for shodhana mentioned in various classics is as follows.97-99.
Table No.29 Showing Sneha matra.
Madhyama Matra
(Dose which digests in 12 hours)
Charaka Samhita , Ashtanga Sangraha
Uttama Matra (Dose which digests in 24 hours)
Ashtanga Hrudaya.
Uttama & Madhyama Matra Chakarapani
Shodhananga Snehapana can be administered in 2 methods:
a) Arohana Snehapana
b) Sadyo Snehapana
a) Arohana Snehapana:
Kalyanakaraka first mentioned about increasing dose schedule. He clearly mentioned
that Shodhanartha Abhyantara Sneha pana has to be taken in increasing order
(“Krama Vardhitam Pibet”). Vangasena also followed Kalyanakaraka’s
Vardhamana dose schedule.
b) Sadyo Snehapana: Sadyo Snehapana involves administration of large quantity of
Sneha to achieve Snigdha Lakshana immediately or within short duration. It is
generally indicated in Bala, Vriddha, Balaheena, Mrudu koshta, Alpa dosha, Raja,
Raja samipya, Sneha parihara asahishnushu.100
Table No.30 . Showing Sneha Dravya and Anupana: 101
Sneha Anupana
Ghrta Ushnodaka
Taila Yusha
Vasa & Majja Manda
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Bhallataka & Tuvaraka Taila Shita Jala
In general Ushnodaka can be administered as Anupana for all Sneha.
Sneha dravya can be administered in 2 ways,
(!)Accha Peya102 – denotes consumption of Sneha without mixing with other food
articles.
(2) Pravicharana 103– denotes administering Sneha by mixing with food articles
either in the form of Odanadi (24 in number) or Rasa Pravicharana (64 in number).
Among them, Accha Peya is considered as superior for the purpose of Shodananga
Snehapana.
Administration of Sneha for Shodhana: 104
On the day of Snehapana, when the raising sun has attained golden yellow colour,
individual exhibiting Jeerna ahara lakshana (symptoms of digested food of the
previous night) except kshudha (hunger), after performing auspicious rituals,
Snehapana is done.
After snehapan individual should be observed for Sneha Jeeryamana (symptoms of
Sneha undergoing digestion) and Sneha Jeerna (symptoms of digested Sneha)
Lakshanas.
Table No.31 Showing Sneha Jeeryamana and Jeerna Lakshana: 105
Sneha Jeeryaman Lakshana Sneha Jeerna Lakshana
Shiroruja Shirorujadi Jeeryamana Lakshana prashamana
Bhrama Vatanulomana Nisthiva Swasthyata Murcha Kshut Sada Trishna Arati Udgara shuddhi Klama, Trishna, Daha Laghuta
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Table no:32 Showing Samyak Snigdha Lakshana: 106-109
Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Vatanulomana + - + +
Deepta agni + - + + Snigdha varcha + - + +
Asamhatha Varcha + - + + Angha Mardava + - + +
Snigdha anga + - + + Snigdha twak - + - - Vit Shaithilya - + - -
Glani - + - + Angha laghava - + - +
Adhastat sneha darshana - + - - Snehodwega - + - + Vimalendriya - - - +
Table No:33 . Showing Asnigdha Lakshana. 110-113
Table No.34 . Showing Atisnigdha Lakshana.. 114-117
Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Pandutha + - - - Gaurava + - - - Jadya + - - - Avipakwa Purisha + + - - Tandra + - - - Aruchi + + - - Utklesha + - - -
Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Grathitha purisha + + - -
Ruksha purisha + + - - Agnimandya + + - - Vayu pratiloma + + - - Khara Gatra + _ - -
Ruksha Gatra + - - - Uro vidaha _ + - - Daurbalya _ + - - Dur varna - + - - Krichrat anna Pachana _ + - - Susnigdha Lakshana Viparyaya _ _ + +
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Mukha srava + + + + Guda srava - + + - Ghrana srava - + - Guda daha + + - + Bhakta dwesha - + - + Pravahika - + - + Purishaati pravritti - + - -
Bahya Snehana & Swedana: 118
After attainment of Samyak Snigdha Lakshanas, Abhyanga and Swedana should be
advised for either once or twice on the rest day(vishrama kala) and just prior to
Pradhana karma on the day of Virechana.
SWEDANA:-
Dosha Vilayana’ takes place through the Swedana. According to Vagbhata, by the
action of Snehana and Swedana, the morbid Doshas are liquefied, dissolved and are
brought to koshta119.
Dalhana also mentions that the Dosha which are lodged in Shakha are made to move
towards to Koshta by Snehana and Swedana. Vagbhata mentions that the waste
products are removed from the shakhas by these two procedures of Snehana and
Swedana in the same fashion as dirt of cloth is removed by soap and water120.
Bhojana Vyavastha:
During the procedure of Abhyanga and Swedana, Snigdha, Drava,Ushna bhojana,
Mamsarasa,Pramanayukta,Anabhishandhi,NatiSnighdha,Asankeerna,Odana, Amla
rasa Phala is recommended.121.
Before pradhana karma the diet should be such that, it does not increase ‘Kapha’
otherwise Vamana may occur122.
‘Manda Kapha’ term is used for the state of Kapha, which is desired for the proper
Virechana.
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MATRA VINISCHIYA:
1. The dose of Virechana Yoga should be decided according to Vyadhibala,
Aturabala and Agnibala123. If the dose given more than Vyadhibala, may cause
another Vyadhi. If it is more than Agnibala it may cause Ajeerna, Vishtambha, and
if it is more than Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose
should be in Sama Pramana only and also the dose of Virechana drug of an
individual is, one which expels only morbid Dosha out of the body without
manifesting any complication.124
Table.no.35 . DOSE OF VIRECHANA DRUG IN ITS DIFFERENT FORM125-128.
Form Of Medicine Koshta Dose Sus125,126 Sha127 Van128
Krura Uttama Tikshana Tikshana 1 pala Madhyam Madhyam Madhya Madhya ½ pala
1
Any form Mrudu Heena Mrudu Mrudu 1 Karsha Krura Uttama 8 Karsha
Madhyam Madhyam 4 Karsha 2
Kwatha Mrudu Heena
1 Anjali (4 pala) 2 Karsha
2 pala
Krura Uttama - 2 Karsha Madhyam Madhya 1 Karsha 1 Karsha
3
Churna Mrudu Heena
1 Karsha
- ½Karsha Krura Uttama - 8 Karsha
Madhyam Madhyam - 4 Karsha 4
Svarasa Mrudu Heena - 2 Karsha
1 pala
Krura Uttama - - Madhyam Madhyam
1 Karsha 1 Karsha
5
Kalka
Mrudu Heena - - Krura Uttama - - -
Madhyam Madhyam - 1 Karsha - 6
Modaka
Mrudu Kaneeya - - - Krura Uttama 8 Karsha -
Madhyam Madhyam 4 Karsha - 7 Hima&
phanta Mrudu Heena
1 Anjali (4 pala) 2 Karsha -
- - - - - - - -
2 Karsha or1 pala
8
Sneha
- - - - Mrudu - - - 2 pala
9 Ushna jala as
Anoopan Madhyam - - - 4 pala
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PRADHANA KARMA:
This includes:-
1) Administration of Virechana Yoga.
2) Observations : a) Aushadi Jeerna-Ajeerna Lakshana.
b) Hritadosha Lakshana.
3) Shuddhi Lakshana.
4) Management of Vyapada.
1.Administration of Virechana yoga:
Before administering the Virechana yoga, the physician must confirm regarding
the following: The diet taken by the patient on the previous day must be digested.
Patient is in mentally balanced state, i.e., without any passions like angry, fear etc.
It should be kept in mind that whether the patient got sound sleep on the previous
night or not. Because at the time of drug administration patient must not be
drowsy/ sleepy.
After confirming diet taken by the patient on the previous day have been digested,
patient has to offer oblations and worships before taking the drug.129
If patient is fit for Virechana karma on the day of Virechana karma, after
performing the Sarvanga sweda patient is advised to be in empty stomach.130
Virechana drugs are administered in ‘Shleshma kale gate’ i.e. after
Shleshma kala has passed, in appropriate dose and with appropriate anupana131.If
drug is adminsterd in shelma kala and/or after consuming food then, kaphadosha
may cause avarana over grahani resulting in mandagni, gourava, Shula,Admana &
even Vamana may produced as a complication132.
Anoopan Krura - - - 8 pala
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Measures after virechaka Oushadha sevana:
Just after administration of Virechana Yoga, cold water should be sprinkled on the
face to avoid vomiting.
Patient is asked to rinse mouth with hot water and asked to smell the fragrance of
jambeera or Surabhi etc.whichever he/she likes.
Pateint is advised that neither to induce Vegas nor to suppress them.
Advise to stay in Nirvata place, be in comfort position and avoid sleep,
suppression of natural urges; consume hot water little by little.133
Vega pravartanopaya:
For Vatanulomana and Yogavahi action lukewarm water is taken. Ifmedicine
composed of Jayapala is given then hot water is contraindicated. If VirechnaVega is
not initiated then Tapa Sweda with help of palm over abdominal region which
may help to stimulate peristaltic movement.134
OBSERVATIONS:
A) Aushadha Jeerna Lakshana:
The following signs and symptoms of Virechana are to be observed –
Vatanulomana, Swasthya, Khsudha,Trishna,Urjamanaswita, Indriya Laghuta and
Udgara Shuddhi135
Once Jeerna Lakshana appears but still only small amount of morbid doshas are
expelled or not yet all, then Physician should administer one more dose of
Virechan drug depending on patient bala136
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B) Ajeerna Aushadha Lakshana:
If the drug is not digested it will produce some painful symptoms such as Klama,
Daha, Angasadam, Bhrama, Murcha and Shiroruja.
In this case the Virechana drug should not be repeated immediately, as the drug
may produce severe purgation. In some cases if the drug is digested but proper
elimination of doshas didn’t occurred, then next day again Virechana drug should
be given.
C) Hritadosha Lakshana:
The Virechana is considered as Kaphanta and Hritadosha, when Vata, Pitta and
Kapha come out in succession. Gatra Daurbalya and Laghuta are the associated
symptoms. If Virechana persists even after manifestation of Hritadosha
lakshanas, then vamana should be given.137
If Aushadhi Jeerna Lakshanas are manifested, but Hritadosha Lakshanas are not
found, then Virechana Yoga should be given next day. Even then Virechana does
not occur then Snehana and Swedana should be done again and thereafter
Virechana drug should be administered after 10 days138.
A) Shuddhi Lakshana:139-143
Finally shuddhi lakshana must assess in terms of Subjective parameters like
Laingiki & Antiki & Objective Parameters like Vaigiki &Manaki. But among
these more importance should be given to Laingiki Shuddhi144.
Table no:36 . Showing Criteria for Antiki, Vegiki and Maniki Shuddhi of
Virechana Karma.
Shuddhi Pravara Madhyama Avara
Vegiki 30 Vegas 20 Vegas 10 Vegas
Maniki 4 Prastha 3 Prastha 2 Prastha
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Antiki Kaphanta Kaphanta Kaphanta Vegiki shuddhi:
The number of Vegas should be counted after leaving the first 2-3 Vegas, as it
contain only fecal matter. Then it should be counted till the Kapha comes out.
Maniki Shuddhi:
While narrating the Avara, Madhyama,and Pravara Shuddhi, Charaka mentioned
the quantities of the same as two, three and, four prastha respectively.
In the context of Vamana, Virechana and Rakta mokshana, prastha should be
taken as 13½ pala145
Antiki Shuddhi:
The word anthiki means final or terminal
The symptoms which indicate the end process of Virechana can be considered
"Antiki Lakshana,.kaphanta is the desired antiki lakshana.
Table No :37. Samyak Yoga Lakshanas Of Virechana Karma
Lakshanas146-148 C.S S.S Va Sroto Vishuddhi + - -
Indriya Prasadana + + - Shareera Laghuta + + -
Agnivriddhi + - - Anamayatwa + + -
Kramataha Vit Pitta Kaphagamana + + - Vatanulomana - + -
Absence of Ayoga Lakshanas - - +
Table no:38. Showing Ayoga Lakshanas of Virechana karma.
Lakshanas C.S S.S Va Kapha Prakopa + + + Pitta Prakopa + + + Vata Prakopa + - - Agnimandya + + -
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Table no :39
Atiyoga
lakshanas of Virechana karma
Lakshanas Charaka Sushruta Vagbhata Kapha Kshaya Vikara + + - Pitta Kshaya Vikara + - - Vata Kshaya Vikara + - - Supti + - - Angamarda + - - Klama + - - Vepathu + - - Nidra + - - Balabhava + - - Tamah Pravesha + - - Unmada + - - Hikka + - - Murcha - + - Guda Bhramsha - - - Kapha Pitta rahita Shweta Udaka Nihssarana
- - +
Kapha Pitta rahita Lohita Udaka Nihssarana
- - +
Mamsa Dhavana vat udaka srava
- - +
Medokhandavat Srava - - + Trishna - - + Bhrama - - + Netra praveshanam - - + Raktakshayaja Vikara + - -
Chakrapani explains though Ayoga, Atiyog and Mithyayoga are described
everywhere accordingly in the text, but in case of vaman & virechan there is
no need to consider Mithyayoga as a separate entity.
Gaurava + + - Pratishyaya + - + Tandra + - - Chardi + - - Aruchi + + + Vata Pratilomana + - Vatagraha Daha - + + Hridaya Ashuddhi - + + Kukshi Ashuddhi - + + Kandu - + + Vit Sanga + + + Mutrasanga - + - Peedika - - +
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In these procedures, expulsion occur in 4 different ways
• Atipravrutii – Excessive expulsion.
• Asamyak pravrutii – Expulsion by improper way.
• Apravrutii – Cessation of process of expulsion or improper elimination.
• Alpapravrutii – Expulsion in lesser quantity.
Here apravrutti & alpa pravrutii are included in ayoga. As asamyak Pravrutii
means expulsion through opposite route, it indicates that expulsion of vitiated
Dosha is not in a quantity, which is expected, so it must be considered under the term
of ayoga and not mithyayoga149.
Kashyapa Acharya being Paediatrician, to practise Virechana Karma specially for
Bala he has been identified Mrudu and/ Sukha type of virechana and Manaki &
Vaigiki parameters.150.
Table No: 40
PASCHAT KARMA:151-154
Pariharya Vishaya: ‐
Once it is confirmed that Virechana Vegas are stop, then advise patient to wash
hands, feet and face155.And advise to avoid ashta mahadosha bhavas
i.e.1.Ucchabhashana, 2.Rathakshobha, 3.Atichankramana, 4.Atiasana, 5.Adhyashana,
6.Ahita bhojana, 7.Diwaswapna, 8.Maithuna156.Based on shuddui lakshana especially
Vaigiki advise patient to follow Samsarjana karma.
Shuddhi Pravara Madhyama Avara Vaigiki 3 2 1 Maniki 3Prastha 2 Prastha 1 Prastha
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Regimens to be adopted after Virechana karma till the patient able to take normal
diet are termed as Paschat karma. As the Virechana karma eliminates dushita Pitta
dosha, the patient shouldn’t be allowed to take heavy diet, because there is
derangement in power of jatharagni. In this condition if heavy diet is given, it will
suppress the digestion power further and causes the vitiation of Agni. So to prevent
such condition, samsarjana karma is adopted.
a) Samsarjana Krama :
As said above, to restore the strength of agni.The patient has to be given the
following varieties of diets, from the same day evening or from the next day
morning157
After Samshodhana Karma, Agnimandya occurs because the Doshas reach the
Amashaya (Jejjata), so Peyadi Krama is recommended to increase the Agni gradually
up to the normal level.
According to Chakrapani the elimination therapy diminishes the doshas as well as
Dhatus, that’s why patient need immediate Dhatu Vardhaka Ahara in terms of
Peyadi Samsarjana karma.
Acharya Charaka gives beautiful example to explain this, just as the agni flares up by
the fuel like dry grass,cow dung,etc.The person who has undergone shodana karma
,agni will gradually gets improved by following samsarjana krama.158,159.Hence it is
decided according to shudhi. i.e. for pravara shuddhi, madhyama shuddhi and avara
shuddhi, samsarjana krama is done for 3,5,7 days respectively160
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Table no :41 Showing the Diet Regimen161
ÌSlÉ MüÉsÉ A³ÉMüÉsÉ
mÉëkÉÉlÉ vÉÑkSÏ
qÉkrÉqÉ vÉÑkSÏ
ÌWûlÉ vÉÑkSÏ
mÉëjÉqÉ mÉëÉiÉ:
xÉÉrÉÇ
1
- mÉårÉÉ
- mÉårÉÉ
- mÉårÉÉ
̲iÉÏrÉ mÉëÉiÉ:
xÉÉrÉÇ
2 3
mÉrÉÉ mÉårÉÉ
mÉårÉÉ ÌuÉsÉåmÉÏ
ÌuÉsÉåmÉÏ M×üiÉÉM×üi
É rÉÔwÉ iÉ×iÉÏrÉ mÉëÉiÉ
: xÉÉrÉÇ
4 5
ÌuÉsÉåmÉÏ ÌuÉsÉåmÉÏ
ÌuÉsÉåmÉÏ AM×üiÉ rÉÔwÉ
M×üiÉÉM×üiÉ
qÉÉÇxÉUxÉ xÉÉqÉÉlrÉ pÉÉåeÉlÉ
cÉiÉÑjÉï mÉëÉiÉ:
xÉÉrÉÇ
6 7
ÌuÉsÉåmÉÏ AM×üiÉ rÉÔwÉ
M×üiÉ rÉÔwÉ AM×üiÉ
qÉÉÇxÉUxÉ
- -
mÉÇcÉqÉ
mÉëÉiÉ:
xÉÉrÉÇ
8 9
M×üiÉ rÉÔwÉ M×üiÉ rÉÔwÉ
M×üiÉ qÉÉÇxÉUx
É xÉÉqÉlrÉ pÉÉåeÉlÉ
- -
wɸ mÉëÉiÉ:
xÉÉrÉÇ
10 11
AM×üiÉ qÉÉÇxÉUx
É M×üiÉ
qÉÉÇxÉUxÉ
- -
- -
xÉmiÉqÉç
mÉëÉiÉ:
xÉÉrÉÇ
12 13
M×üiÉ qÉÉÇxÉUx
É xÉÉqÉÉlrÉ pÉÉåeÉlÉ
- -
- -
Instead of Peyadi Krama, Sushruta mentions Kulatha, Aadhaki and Jangala
Mamsarasa162. Dalhana clarifies, Sushruta however agrees Peyadi Krama and he says
that incase of Ksheena Kapha, Peya should be given. Mamsarasa should be given to
Vata pradhana patients having Deeptagni. If Kapha dominance is there according to
Dosha and Prakriti, then Kulatha Yusha should be given. The Peyadi Krama ends on
7th day of Pradhana Shuddhi patient.Acharya Sushrutha has opined samsarjana krama
in respect to bala of the patient163. For the individuals having good strength, three
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annakala are advised, 2 annakala for madhyama bala and one annakala for lesser
strength person.
b)Tarpana :
In case of ayoga of Virechana (insufficient elimination of vitiated doshas) associated
with predominance of Kapha, Pitta, if the doshas still retained in the body and if the
patient is having habit of taking alcohol, he shouldn’t be given Peyadi Samsarjana
Krama. Instead he must be given Tarpana i.e., thin or thick soup prepared with
Deepana and Pachana drugs like, Pippali, Dadima etc.
In Tarpana, Swaccha Tarpana in place of Peya and Ghana Tarpana in place of Vilepi
should be given, according to Chakrapani164. Jejjata mentions Mudga, Yusha and
Mamsarasa in place of Peya. Arunadatta recommends Laja Saktu, Jirnashalyodana
and Mamsarasa for 3 Annakalas.
Rasa samsarjana krama:
To maintain the normal status of Dosha especially in Amaashaya & Pakvashya,
rasasamsarjana krama is identified in classics. Here particular Rasaatmaka food
articles are given to patient with proper order & this can be consumed along with
Peyadi Samsarjana karma or after it.
Table no: 42 Table showing Rasa Samsarjana.
Author Rasa Effect on Dosha ÎxlÉakÉ,AÉqsÉ,xuÉÉSÒ mÉYuÉÉvÉrÉ ÎxjÉiÉ uÉÉiÉmÉëvÉqÉlÉÉjÉï AÉqsÉ, sÉuÉhÉ EkuÉïÎxjÉiÉ AÎalÉ xÉÇkÉѤÉhÉÉjÉï xuÉÉSÒ, ÌiÉ£ü ÌmɨÉvÉqÉlÉÉjÉï
Charaka165
MüwÉÉrÉ, MüOÒû ÌmɨÉÉåkuÉïÎxjÉiÉMüTü mÉëvÉqÉlÉÉjÉï xuÉÉSÒ, ÌiÉ£ü mÉëuÉ×kSÉÎalÉWåûiÉÑuÉÉiÉÌmɨÉxjÉÉuÉeÉrÉÉjÉïqÉalÉå
xÉqÉÏMüUhÉÉjÉï ÎxlÉakÉ,AqsÉ,sÉuÉhÉ,MüOÒû uÉÉiÉMüTüÉuÉeÉrÉÉjÉïqÉalÉå:xÉlkÉѤÉhÉÉjÉï
Sushruta166 xuÉÉSÒ, ÌiÉ£ü ÌmɨÉuÉÉiÉÉuÉeÉrÉÉjÉï
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Acharya Charaka and Sushrutha has given a special sequence of rasa intake in
samsarjana krama to be followed to avoid the chances of vitiation of doshas167.
Acharya Charaka has advised to take madhura, amla and hridhya ,snigdha ahara to
pacify vata.Amla lavana to increase agni,Madhura and tikta rasa to pacify pitta
dosha,kashaya and katu rasa to pacify kapha dosha168.
Acharya Sushrutha opined that rasa should be started with Madhura and Tiktha to
increase the agni and to pacify vata pitta. Then snigda,amla,lavana and katu rasa to
reduce vata,kapha dosha followed by madhura tikta rasa to pacify vata pitta
dosha,thereafter kashaya katu rasa to pacify kapha pitta.169.This is followed to do
sarva rasa abyasa for the patient during samsarjana krama.
VYAPATH 170-172
Vyapath are the complications occurring due to improper handling of shodana
karma.Acharaya Charaka has explained 10 vyapath, Chakrapani has divided this 10
Vyapada in two groups i.e. Ayoga and Atiyoga
Table No.43 Showing the Ayoga and Atiyoga Lakshanas of Vyapath.
Ayoga Atiyoga
Adhamana Hritgraha
Gatragraha Kandvadi Vibhramsha
Upadrava Klama
Srava Jivadana
Vibramsha Gudabramsha
Sanjnabhramsha
Table no.44. Showing the Virechana Vyapath According to Acharyas.
Vyapath Charaka Sushrutha Vagbhatta Adhmana + + +
Parikartika + + + Parisrava + + + Hrdgraha + - +
Gatragraha + - Sarvangagraha Jivadana + + +
Vibhramsha + - Guda Vibhramsha
Stambha + - - Klama + - -
Upadrava + - -
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Vamana - + + Savashesha Aushadhitva - + +
Jirna Aushadhitva - + + Hina Aushadhitva - + -
Vata Shula - + Vedana Ayoga - + +
Atiyoga - + + Hridaya-Upasarana - + -
Vibandha - + - Pravahika - + +
Visamjnata - - +
Table.no.45. Showing virechana vyapat with their treatment.
Vyapada Lakshana Chikitsa Adhmana Adhmana UdavartaNabhi, Prustha,
Parshva, Shiroruja, Shvasa, Vit Mutra, Vata Sanga
Abhyanga, Sveda, Phalavarti, Niruha, Anuvasana,
Udavartahara Chikitsa Parikartika
Gud Parikartana
Tivrashula, Piccha, Rakta, Mala Pravritti
Langhana, Pachana, Ruksha, Ushna Bhojana Yashtimadhu
,Snehabasti Parisrava Alpa Mala Pravritti, Kandu, Shopha,
Kustha, Gaurava, Agnimandya, Staimitya, Aruchi, Panduta
Vamana, Virechana, Grahani Chikitsa. Asava, Arishta
Hridgraha Hikka, Shvasa, Kasa, Parshvashula, Lalasrava, Akshivibhrama, Shula, Dantatikitkitayana, Jihva, Khodati
Sangyanasha
Snigdha Lavana, Sveda, Yasti Taila, Anuvasana, Tikshna Nasya, Vamana,
Basti Angagraha Stambha, Vepathu, Toda
Pindikodveshtana, Manthanavat Pida
Vatahara Snehana Svedana
Jivadana Rakta Chandrika, Udakasrava, Guda Bhransha, Trishna, Murchha, Mada
Pittahara, Raktapana, Raktabasti, Piccha Basti,
Ghrita Manda, Anuvasana Vibhransh
a. Guda b. Sanjya c.Kandu,
Only Mala Excreted not Doshas, Gudabhransha, Sanjna Bransha,
Kandu, Pidika, Kustha, Roga
Kashaya Lepa, Snehana Mridu Sveda
Manonukula Chikitsa Tikshna Shodhana After
Snehapana Stambha Vatavarodha, Gudastambha,
Gudshula, Alpalpa Mala Pravritti Langhana, Pachana, Tikshna
Basti, Virechana Upadrava Stambha, Sula, Gatragraha,
Sarvanga Vedana Snehana, Svedana Vataghna Chikitsa
Klama Tandra, Gaurava, Klama, Daurbalya, Angasada
Langhana, Pachana, Sneha, Tikshna, Shodhana
Vamana by virechana
Yoga
Vamana Snehana, Svedana, Virechana
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Ayoga Vibhransha, Hikka, Pindikodveshtana, Kandu, Urusada,
Vaivarnyata
Roganusara Chikitsa Gomutra Niruha
Atiyoga Ativirechana Mridu Vamana, Raktapitta vat Chikitsa
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MODE OF ACTION OF VIRECHANA:173
Action of Virechana Karma can be understood in the following two ways.
1. Systemic – By which it brings down the morbid Doshas, particularly Pitta from the
periphery to Amashaya or Pakwashaya.
2. Local evacuant – This is concerned with the evacuation of these doshas in the
form of mala from the gut by Adhobhaghahara property.
Both the action and related factors are being described here in detail -
a) Virechana yoga gets absorbed and due to Veerya, it reaches to the Hridaya, then the
Dhamanis and thereafter it reaches to Sthula and Anu Srotas i.e. macro and micro
channels of the body.
b) The Vyavayi Guna, drug is responsible for quick absorption.
c) The Vikashi Guna causes softening and loosening of the bond by Dhatu (Shaithilya
Karma).
d) Due to Ushna Guna, the Dosha Sanghata (compactness) is disintegrated
(Vishyandana).
e) Action of Teekshna Guna is to break the Mala and Dosha in micro form. According
to Dalhana it is responsible for quick transmission (Dosha Sravana Karatwa).
f) Due to Sookshma Guna by reaching in micro channels, disintegrates androgenic
toxins which are then excreted through micro channels (Anupravana Bhava).
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g) Mainly due to Prabhava, Prithwi-Jala constitution and presence of Sara Guna
Virechana occurs. This is the evacuant action.
MODE OF ACTION OF VIRECHANA KARMA
ADMINISTRATION OF VIRECHANA DRAVYA
Vitiated Dosha comes to Koshta by snehapana &
Bahya Snehana , Swedana
Ushna, Agni guna- Liquefy the dosha
Tikshna guna-‘Sanghatabhedana’
Sukshma guna-dilated the channels
Vyavayi quick spreading to
all part of the body
Vikashi loosening the morbid
Dosha comes to Amashaya due to Anupravana Bhava
Expel out through Anal route
Due to Prithwi & jala Mahabhoota dominancy, Adhobhagahara Prabhava
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Acharya Charaka has given brief description how Virechana dravya acts in the body
which is as follows. The drugs which are Ushna, Tikshna, Shukshma, Vyavayi and
Vikashi reach to the heart by virtue of their potency and circulate through the large
and small Srotas due to its Sukshma and Vyavayi properties and pervade entire body.
Then they liquefies the morbid elements by virtue of their Agneya Guna and crumbles
them by virtue of its Tikshna Guna. Then this liquefies and crumbled mass Looses
contact with the wall and the channels in the unctuous body, just like the honey, not
adhered to the unctuous vessel. This morbid mass now passes through the minute
capillaries and moves towards Kostha by virtue of the Anu, Pravana Bhava of the
drug and ultimately reaches the Amashaya. From here it forces the morbid factors
through the anal route due to the Bhautika predominancy of Jala and Prithvi and
Adhobhaga Prabhava174
CATHARTICS - MODERN VIEW175
The terms laxatives, cathartics, purgatives, aperients and evacuants often are used
interchangeably. However, there is distinction between Laxation and catharsis.
Laxation means – the evacuation of formed fecal material from the rectum, whereas
Catharsis means – the evacuation of unformed, usually watery fecal material from the
entire colon. Most of the commonly used agents promote Laxation but some actually
are cathartics.
Classification of Cathartics:
These drugs are usually classified according to their mechanism of action. The
purgatives available for use mainly act in one of the following three ways-
• By increasing the volume of intestinal contents, thus distending the bowel
and eliciting the peristaltic reflex.
• By liquefying and lubricating the intestinal mass.
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• By direct irritation of the bowel.
Hence they are classified in the following manner-
1. Stimulant or Irritant Cathartics.
2. Osmotic Cathartics.
3. Bulk laxatives.
4. Emollient laxative or Lubricant Cathartics.
1. Stimulant or irritant laxatives:
In this group, mainly 3 types of drugs are identified.
i) Anthraquinone group ii) Diphenylmethane derivatives iii) Ricinoleic acid
Anthraquinone group:
These are derivatives of plants such as aloe, cascara and senna.
These agents can produce giant migrating colonic contractions as well as
induce water and electrolyte secretion. They are poorly absorbed in the small
bowel, but because they require activation in the colon the laxative effect is
not noted until 6 to 12 hours, after ingestion.
Diphenylmethane derivatives:
Examples in this group are: Bisacodyl, Phenolphthalein.
Pharmacological section is not shown clearly but drug acts as a stimulant
mainly on the large bowel after 6 hours and produces soft semi liquid stools
associated with a little gripping.
Ricinoleic acid:
Important among Ricinoleic acid is caster oil. Ricinoleic acid acts as an irritant
and produces purgation. As Ricinoleic acid acts on small intestine, it produces
copious, liquid stool with associated fluid loss. The action is quicker than
Anthraquinone and is evident within 2 to 3 hours.
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2. Osmotic Purgatives:
The osmotic purgative consists of salts, which though highly soluble, are poorly
absorbed from the alimentary tract. Such preparations exert an osmotic effect and,
thus retain water in sufficient amount to form an isotonic solution in the lumen of the
bowel. This distends the bowel and stimulates peristalsis, as well as liquefying the
bowel contents, making evacuation more rapid. The efficacy of the saline Cathartics
is, thus related to the osmotic activity exerted by the unabsorbed fraction within the
intestinal lumen.
These preparations will act both on small and large intestines, and therefore,
produces watery evacuation within 3-6 hours. Because of their quick consent of
action, they are early in the morning before breakfast. Patients should be instructed
to take plenty of water along with these drugs.
2. Bulk forming laxatives:
These are various natural or semi synthetic polysaccharide and cellulose
derivatives. eg. Bran, Psyllium preparation, methyl cellulose, Calcium
polycarbophil. These agents absorb water and swell-up, thus providing the stimulus
of mechanical distinction for evacuation. Their action is mild and is usually seen 12
to 36 hours after ingestion.
3. Stool Wetting Agents and Emollient laxatives:
The best examples are liquid paraffin, Olive oil, Docusate salts, etc. By oral
administration it is not significantly absorbed and exerts softening and lubricating
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effects on feces. These laxatives are mild in action and usually seen 1 to 3 days
after ingestion and itself does not initiate peristalsis.
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General mechanisms of action:-
Laxatives generally have been thought to act in one of the following ways:
1. Retention of intraluminal fluid, by hydrophilic or osmotic mechanisms.
2. Decreased net absorption of fluid, by effects on small and large bowel fluid and
electrolyte transport.
3. Effects on motility by either inhibiting segmenting (non-propulsive) Scontractions
or stimulating propulsive contractions.
Classification according to the site of action -
a) Purgatives acting on the small intestine eg. Castor oil
b) Purgatives acting on the large intestine eg. Anthraquinone group
c)Purgatives acting on both large and small intestine eg. Saline laxatives
C. Classification according to source -
a) Vegetable purgatives. eg. Castor oil, Olive oil, Croton oil, Oleos, Senna,
Cascara sagrada, etc.
b) Mineral purgatives. eg. Saline purgatives, liquid paraffin, etc.
c) Synthetic purgatives. eg. Phenolphthale
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SKIN
Anatomical consideration of skin:
The word “Twak” is derived from “Twak Samvarane”, Means that which covers1.
Twak the seat of Sparshnendriya is very extensive among all five Jnanendriyas.
According to Ayurveda Twak is the seat of Vayu, which is responsible for tactile
sensation.
Skin formation:
Sushtura described the process of formation of Tvacha in the developing foetus. He
says that after fertilization of ovum Tvacha develops just like a cream on the surface
of milk 2. During development of Garbha differentiation of the layers of the skin takes
place.
Charaka described Tvacha as the Matruja Bhava (Maternal factor) which is one of the
six Bhavas essential in the development of foetus3 .
Vagbhata described the formation of Tvacha due to Paka of Rakta Dhatu by its
Dhatvagni in the foetus. After Paka, it dries up to form Tvacha, just like the
deposition of cream over the surface of boiled milk4.
Table no.475,6,7,8. Showing layers of Twak according to different Acharyas
Sushruta Charaka Sharangadhara Arundatta
Avabhasini Udakadhara Avabhasini Bhasini
Lohita Asrukdhara Lohita Lohita
Sweta 3rd Sweta Sweta
Tamra 4th Tamra Tamra
Vedini 5th Vedini Vedini
Rohini 6th Rohini Rohini
Mamsadhara Sthula Mamsadhara
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Acharya Gangadhara 9 (Ch. Sha. 7/3 Gangadhara Tika) has clarified the difference in
opinion between Charaka and Sushruta on the basis of the different opinions
regarding the layers of Tvacha. He explained the third layer of Charaka counting as
two parts –
Superficial& deep. The superficial part is considered as third layer (Shweta) while the
deep part as a fourth layer (Tamra) as mentioned by Sushruta.
Table no.48 Skin layers and disease concerned to it according to Charaka10
Name Diseases Udakadhara - Asruk dhara 3rd Sidma, Kilasa 4th Dadru, Kushta 5th Alaji, Vidradhi 6th If this layer is injured person trembles
And enters darkness
Acharya Susrutha explained about seven layers in relation with origin of disease as
follows:-
Table no. 49 Showing Sapta Twacha and Disease Relation11.
Name Thickness Diseases Avabhasini 1/18th Vrihi Sidhma & Padmakantaka
Lohita 1/16th Vrihi Tilakalaka, Nyachcha & Vyanga Sweta 1/12th Vrihi Charmadala, Ajagallika & Mashaka Tamra 1/8th Vrihi Kilasa & Kustha Vedini 1/5th Vrihi Kustha & Visarpa Rohini 1 Vrihi Granthi, Arbuda, Galaganda, Apachi,
Sleepada Mansadhara 2 Vrihi Bhagandara, Vidradhi, Arsha
Sharangdhara12 has also mentioned seven layers of skin along with the
probable onset of diseases. The names of first six layers are same as Sushruta
but a seventh layer is named as “Sthula” which is the site of Vidradhi.
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KRIYA SHARIRA OF TWAK
Tvacha And Dosha :
Tvacha is one of the sites of Vata and Pitta. Skin has been considered as
Sparshanendriya, Adhisthana13 which is function of Vata. Bhrajaka Pitta is located on
the Tvacha for giving luster and color. Snigdhata, Slakshanata, Mruduta, Sthirata,
Sheetata, Prasannata, Snigdha Varnata are the attributed to Kapha.
Tvacha And Dhatu :
Rasa: In the context of Twak Sara Purusha Lakshana it has been also said as Rasa
Sara. 1st layer of Tvacha, Udakadhara also contains Rasa. So, it can be easily
understood that there is a relation between Tvacha and Rasa.
Rakta: Among its functions Varna Prasadana (provide color of skin) and Mamsa
Pushti have been mentioned14.
Mamsa : Twak is Upadhatu of Mamsa.15
Tvacha and Mala:
Sweda: It is Mala of Meda which is excreted by Tvacha. Sweda maintain the luster
and humidity of skin.16
MODERN VIEW17,18
Skin is one of the largest organs of the body in surface area and weight. In adults, the
skin covers an area of about 2 square meters and weighs 4.5 to 5 kg. It ranges in
thickness from 0.5 to 4.0 mm, depending on location.
Embryological Description:
The skin is developed from the surface ectoderm and its Underlying mesenchyme
(mesodermal cells).
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1) Surface ectoderm gives rise to the Keratinizing general surface epidermis and its
appendage, the pilosebaceous units, sudariferous glands and nail units at about 8 – 10
weeks of gestation.
2) Malacocites, nerves and specialized sensory receptors arise from the
neuroectoderm.
3) Dermis and its other elements in the skin i.e. Langerhans cells, macrophages, mass
cells, fibroblasts, blood vessels, connective tissue, lymph vessels, muscles and
lipocytes originate from the mesoderm.
ANATOMY:
The skin consists of two principal parts. The outer, thinner portion, which is
composed of epithelium, is called the epidermis. The epidermis is attached to the
inner, thicker, connective tissue part called the Dermis. The dermis is a subcutaneous
layer. This layer, also called the superficial fascia or hypodermis, consists of areolar
and adipose tissue. The subcutaneous layer, in turn, attaches to underlying tissues and
organs.
(A) Epidermis:
It is a compound tissue consisting mainly of a continuously self-replacing keratinized
stratified Squamous epithelium. It varies in thickness from 0.04mm on the eyelid, to
0.16mm on the palms and 0.1mm is average thickness. It takes 28 days for the
keratinocytes to move from the stratum basal to stratum corneum. The five layers,
from the deepest to the most superficial are as follows:
1) Stratum basal or germinativum :
2) Stratum spinosum or Malpighi layer:
3) Stratum granulosum :
4) Stratum Lucidum :
5) Stratum corneum :
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(B) Dermis:
The dermis chiefly consists of white fibrous tissue, elastic fibers and non-stripped
muscles and contains blood vessels, nerves, hair, sweat gland and sebaceous glands
and nerve corpuscles. The outer portion of the dermis, about one fifth of the thickness
of the total layer, is named the papillary region. The deeper portion of the dermis is
called the reticular region. It consists of dense irregular connective tissue containing
interlacing bundles of collagen and coarse elastic fibers.
Blood supply of skin:
There are two horizontal and parallel systems of plexuses, which supply the skin.The
plexus or network of blood vessels exists between the dermis and the subcutaneous
tissue.
Nerve supply:
The nerve supply of the skin is very complicated. The varied sensations arising from
skin are derived from a diverse population of cutaneous nerve endings or receptors,
thus tactile, temperature and pain sensations are each sub served by different Groups
of receptors.
Functions of the skin:
The skin is a metabolically active organ with vital functions including the protection
and homeostatic of the body.
Regulation of body temperature:
Protection
Sensation
Immunity
Excretion
Blood reservoir
Synthesis of Vitamin – D
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HISTORICAL REVIEW OF KUSHTA
DISEASE REVIEW
Prevedic & Vedic Period
The study of Indian classics reveals that skin disorders are afflicting the
human being since time immemorial.
Utpatti1:-
During the destruction of Yajna of Daksha raja different diseases have been
emerged out, amongst them kushta is the one which has taken birth due to the
Haviprasha (intake of ghee). Which was supposed to be used for the Yajna.
Agnipurana2:-
There is a reference regarding the internal use of Khadir. Kushtaghna drugs
are first described in Agnipurana
Koutilya Arthashastra3:
In the chapter, on secret means a number of diseases are mentioned such as
Kushta.Unmaada, Apasmaara, Prameha etc.
Yadjnya valkalsmriti 4:
Kushta is known as paprog and is chronisity in nature. & Mandala and Sidma
are kinds of Leprosy.
Brahma Samhita4:.
SSìÓeÉÉ CuÉ vÉÑwMümɧÉmÉëMüUÉM×ü̹ÍpÉ:|
Dadru is a disease where affected people used to itch the skin with dry leaves.
Kasika5:
Incurable diseases were called Kshetriya and Kushta is one among this
category.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 55
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Kathadi Gana6:
Kushta and Kushtavid are mentioned together which shows the prevalence of
the disease and existing of specialists treating the same.
Bhana bhatta:
According to him consider Kushta is one of 52 variety of Sharirika disease
VEDAKALA (1000 to 500BC)
The history of Kushta can be traced back since vedic era.
Rigveda7:
There is no complete description about the disease Kushta, however there are
instances which depicts that Kushta was prevalent in that period also.
1) Lord Indra cured the Charmaroga of Apala 8
2) Ghosa, the daughter of Kakshivati who was suffering from ‘Kushta Roga’ had an
ugly look and was therefore disliked by her husband. She was treated with proper
medication and got cured and was ultimately accepted by her husband9
Yajurveda10:
In Shukla Yajurveda medicines having capacity of curing Kushta, Hridroga, Arsha,
etc. have been mentioned and their virtues praised.
Atharvaveda11:
In Atharvaveda, the various sites for diseases have been described. Amongst them
skin has been described as one of the chief sites of the diseases. The names of various
diseases have been illustrated, whereby Kushtha has been described as Kshetriya
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Roga. There is description of some herbs like Rama, Nili, Asuri, Shyama etc. for the
treatment of Kushtha.
From the above references it can be said that Kushta was prevalent in Veda kala and
the physicians of that period had studied the disease and were able to cure the Kushta
successfully.
Mahabharata12:-
In Mahabharata, it has been mentioned that the person suffering from ‘Tvaka Dosha’
is not fit to be a king. This reference highlights the fact that people suffering from
‘Kushta’ were looked down by the society at that time. They were neglected and even
princes were not allowed to become king.
SAMHITA KALA
Charaka Samhita:
Charaka described a long range of skin diseases with their etiology, pathogenesis &
specific classification under the heading of Kushtha for the first time. Charaka has
described 18 types of Kushtha. Seven types of Kushtha have been described as a
Maha Kushtha in Nidana Sthana. In the Chikitsa Sthana eighteen types of Kushtha
have been classified under 7 Maha Kushtha & 11 Kshudra Kushtha. Apart from the
description of Kushtha in Nidana Sthana and Chikitsa Sthana there are some other
references that are related to Kushtha are available in Charaka Samhita, some of them
are as follows:
Kushtha is described as the Samanya Hetu of Nija Shotha13.
Kushtha is considered as a Santarpanajanya Vyadhi14.
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It is included as one of the disease caused by Rakta15.
Use of Stambhana Dravyas in the initial stage of Raktapitta, Raktarsha &
Amatisara leads to Kushtha.
Kushtha is noted in Lekhana Yogya & Prachhana Yogya Vyadhi16.
Agnikarma is contraindicated in Kushthaja Vrana. 17
Sushruta Samhita:
Sushruta is the first one to clearly describe the Anuvamshika (hereditary) factor as
causation of Kushta Roga. He has also described Krimi as a causative factor of
Kushta18.In Nidana Sthana, Sushruta explains the Dhatugatatva and Uttarottar
Dhatu Pravesh of Kushta19. Sushruta has explained skin disorders in two chapters
under the heading of Kushta and Maha Kushta. Rasayana drugs like Guggulu,
Shilajita, and Shveta Bakuchi are mentioned and indicated in the Chikitsa of
Kushtha by Sushruta20
Ashtanga Sangraha:-
Kushta has been mentioned to be of 7 types depending on the Dosha involved and
Eka kushta has been defined as Vata Kapha Pradhana Kushta21.
Ashtanga Hridaya:
Vagbhata has followed Sushruta regarding classification of Maha Kushtha &
Kshudra Kushtha22. But Eka Kushtha has been mentioned under Kshudra Kushtha
with same Lakshanas as described by Charaka.
Bhela Samhita23:-
Bhela has described Kushtha Roga in both Nidana and Chikitsa Sthana. He
specially considered polluted water as an etiological factor of Kushtha.
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Kashyapa Samhita24:-
Kashyapa Samhita has described 18 types of Kushtha as Charaka, except that
Shvitra,
Vishaja Kushtha & Sthularuksha instead of Charmkushtha, Alasaka &
ka.Kashyapa has given the classification of Kushtha on the basis of its
ther 9 are
Asadhya.
SANGRAHA KALA.
Visphota
Sadhyaasadhyata. Thereby 9 Kushtha are described as Sadhya while o
Madhava Nidana25:-
Madhava has described Ni ha according to the Charaka &
Vagbhata. While Dhatugatatva, Sadhya-Asadhyata & Sankramakata (contagious)
d similar to that of Sushruta Samhita.
Sha
dana Panchaka of Kusht
have been describe
rangdhara Samhita26:
Classification of Kushtha has been described in Purvakhanda. According to
Sharangdhara, Tamra, which is the fourth layer of the skin, is the site of all types
Va
of Kushtha.
ngasena27:
Vangasena has mentioned 7 types of special causes of Kushtha that is Tila Taila,
Kulattha, Valmika, Linga Roga, Mahisha Dugdha, Mathita Dadhi and Vruntaka27.
Basavarajiyam:
etc in Basavarajeeyam apart from the normal.
Bhava Prakasha
Some other types of Kushtha are described like Prasuti Kushtha, Galat Kushtha
28:
ription of Kushtha Roga. He has
followed Charaka for classification & nomenclature of Kushtha. The Dhatugatatva
Bhava Prakasha has described a detail desc
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yata are compiled from Sushruta. Arishta Lakshana of Kushta
Yo
& Sadhya-Asadh
has also been described. But differs with Sushruta in which these were Asadhya
Lakshanas.
ga Ratnakara29:
Yoga Ratnakara describes the Kushtha according to the earlier classics.
Contagious aspect of Kushtha is also described in the Kushtha chap.
Raja Martanda30:
Bhojaraja has described the treatment of Kushta in chapter 8. Some recipes
KUSHTA
increase the luster of skin and to get rid of body odour has also been described.
All dermatological disorders are coming under the term Kushtha as per Ayurvedic
texts. Kushtha produces psychological and physical discomforts due to the
blemished skin which itself is proved by the name.
ETYMOLOICAL DERVATION OF KUSHTHA31:
The word ‘Kushtha’ is a broad term which includes almost all skin diseases.
MÑüwÉç ÌlÉwMüwÉåï +WûÉÌlÉ MÑüÌwÉÌiÉ || EhÉÉÇ 2/2/ CÌiÉ
In S
Sansk
it the Prat r certainty, the word Kushtha is
MüjÉlÉç ...(zÉoSMüsmÉSìÓqÉ )
anskrit language, the word ‘Kushtha’ is derived form the ‘Kush nishkarshane’
rit root, It means that ‘to destroy’, ‘to scarp out’ or ‘to deform’. By adding to
yaya ‘Kta’ which stands for firmness o
derived. Thus the word Kushtha means that which destroys with certainty.
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DEFINITION:
MÑüwhÉÉiÉÏ ÌlÉzÉãwÉhÉ MüUÉãiÉÏ ÌuÉsÉãZÉÇ AÇaÉmÉëirÉÇaÉÉlÉÏ CÌiÉ MÑü¹Ç||
(SiddhantaKaumudi)
The condition in which different Angapratyanga are destroyed is known as Kushta.
MÑüwhÉÉiÉÏ zÉÉUÏUÉxjÉÉ zÉÉãÍhÉiÉqÉ ÌuÉM×üiÉã || (Halayudha Kosha)
Which means that vitiated Rakta leads to destruction of body so it is called ’Kushta’.
Commentator Arundatta mentioned that –
1. rÉiÉç uÉæuÉhrÉïÇ MÑüuÉïÎliÉ iÉiÉç MÑü¸qÉÑzÉÎliÉ |
This means that, Kushtha is the one which causes vitiation as well as discoloration
of the skin.32
2. MÑüwhÉÉirÉ….qÉç |
MÑüÎixÉiÉÇ ÌiɹÌiÉ |
One which has capacity of spreading nature & leads to deformity of skin in the
form of discoloration is known as Kushta33.
3. MÑüwhÉÉÌiÉ iÉxqÉÉiɨÉç MÑü¸ÍqÉirÉÑcrÉiÉå
According to Vaghbhatacharya, if hetu upekshana has been done and is not treated
properly at right time then it spreads all over the body hence is called as Kushta.
All the above definitions implies to various types of skin disorders & not to a single
entity. Acharya’s have opined that the Kushtha is first located in the Tvak, later it
progressively involves deeper Dhatu’s. This clearly indicates that in all Kushtha the
skin compulsorily get involved at first.
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A SYNONYMS: KUSHTH
Y
Vyap yah, Gadantakam.
vadhini, Kutsitam, Vajivrajam, Apyam, Adavaham, Nirujam, Gadah, Ruja
am, Pakalam, Hashuram, Kakalam, Ama
Classification of Kustha According To Different Acharyas34-39
Table No:50 Showing classification of Mahakushtha.
Table no.51 Showing Kshudrakushtha according to different acharyas.
SuNo. Types of
Kushtha
Ch. s.
A.Hr
B.S.
M.N.
B.P.
1. Kapala + + + + + + 2. + + + Audumbara + + + 3. + + + Mandala + - + 4. Rushyajihv + + + + + + 5. + Pundarika + + + + + 6. Sidhma + - - + + + 7. Kakanaka + + + + + + 8. Dadru - + + - - - 9. Aruna - + - - - -
No Sus A.Hr B.S. M.N. B.P.Types of Kustha Cha
0 + + + + + + 1 Ekakustha
02 Kitibha + + + + + +
03 Charmadala + + + - + +
04 Pama + + + + + +
0 + + 5 Vicharchika + + + +
06 Charmakhya + - + + + +
07 Vipadika + - + - + +
08 Alasaka + - + - + +
09 Dadru + - - + + +
10 Visphotaka + - + + + +
11 Shataru + - + + + +
12 Sidhma - + + - - -
13 Sthularushka - + - - - -
14 Mahakustha - + - - - -
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type of Ku . It is
more useful for diagnostic and treatm of the disease, which are as follows42.
The word ‘Kushta’ is a broad term, which covers almost all the skin diseases.
u iate ith in 43.
d of n, colo shape, specific ma estatio tc. i.e.
edana shesha g.Kapa kushta T a babu
arna V hesha- . Kakan kushta Gunja b ja.varn
to
t
a Vish a - E Kaka kush is Asa ya due t s
;
a Vishesha- Eg. kapala etc. are found in Kushtha because of
akalp a of Dosh 44
According to Charaka, Kushthas are in fact erable types, but for systemic
study are cla to two m or gr ps 7 M a Ku tha & Kshud
Kusht
There is no difference of opinion between e total number of
Kushtha, but difference of opinion in sym ms & names of some Kushtha exists46.
Chakr i ha t, in K udra ushth he sy ptoms f Mahakushta are
manife in . According to comm ator yadas ere is se re and
1 + - - - - 5 Visarpa -
16 Parisarpa - + - - - -
17 Raksha - + - - - -
18 Shvitra - - - - + -
19 Vishaja - - - + - -
20. Kachhu - - - - + +
All These s shta are further classified based on Doshic predominance
ent
K shtha is assoc d w variably by ‘Saptako drvya Sangraha
But ifferent types pai ur, nif n e
V vi - E la od l;
V is Eg aka is ee a;
Samsathana Vishesha - Eg. Rushyajivha kushta is resembles
that of deer ongue;
Prabhav esh g. na ta dh o it
Prabhava
Naam
Anshansh an the as
of innum
they ssified in aj ou ah sh 11 ra
ha 45
any Acharya about th
pto of
apan s clarified tha sh K a t m o
milder form48 ent Ga th vested
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extens vitiati shas fr the very beginning, in Mahakushtha, which
penetr he de and ca e Ma
vitiation of Doshas occurs in the KshudraKushtha from the beginning49.
Charaka included Sidma kushta in Mahakushta and Sushruta included in kshudra
idhma
2.Pushp
Kshudr atas by
Sush Asita is
considered as a h 50
Table no 5 51
52
Sl.No Predominant Dosa
Symptoms
ive on of Do om
ate t eper tissues us hakushtha. But no such severe and extensive
kushta.
Dalhana clearing this doubt said that, sidhma are two types 1.S
ikasidhma. Pushpikasidhma is Sadhya hence considered under
akushta. In the same way dadru is included under Mahakush
rutacharya because amongst two types of dadru i.e 1.Sita 2. Asita,
sad ya.
.5 Showing Doshic predominance in individual type of kushta
Sl No Doshic Predominance Name of Kushta 1 Vata Kapala 2 Pitta Audumbara 3 Kapha Mandala, Vicarcika 4 VataKapha Sidhma,EkaKushta, Alasaka
Carmakhya, Kitibha.Vipadika, 5 VataPitta Rusyajihva 6
Pama, Visphotaka, Shataru KaphaPitta Pundarika,.Dadru.Carmadala ,
7 Kakanaka VataPittaKapha
Table no.56. Showing Samanya laxana of kushta based on particular dosha
1 Vata Ruksata, Sosa, Toda, Sula,
Harsa, Syava-Arunata Samkoca, Ayama, Parusya, Kharata,
2 Pitta Daha,Raga,Parisrava, Paka,Visragandha, Kleda, Angapatana
3 Kapha Svaitya, Saitya, Kandu, Sthairya, Utsedha, Gaurava, Sneha, Kleda
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ha is one of the Kshudra Kushtha. Bhava Prakasha mentions that because it
is the prime among the Kshudra Kushtha, thus it is called Ekakustha.
an also determine the nidanas of kushta.48.
it
being a variety of Kshudrakushtha, some of the etiological factors of Kushtha are to
be acce the Ekakustha
Ayurvedic texts have described general causative factor a Nidana for all
type of Kushtha instead of specific Nidana for specific type of Kushtha. The
etiologica actors of Kushtha, which includ d into
following groups:
(A hara Hetu
(C) A e
(D) Other Nidanas
A. Ahara Hetu:-
e core c factors o Mitya
Ahara:
If one can not able to diagnose a particular type of kushta, then the
samanya laxanas mentioned in the table above should be looked after to diagnose the
predominance of dosha.
EKA KUSHTHA.
Eka Kust
“Kshudrakushtha Mukhyatvata Ekakushtamiti”.
1.NIDANA53:-
The nidanas are determined on the basis of specific manifestation of kushta and from
manifested Kushta; one c
There is no specific description about etiological factors of the disease Ekakusth but
pted as etiological factors of the too.
s i.e. Samany
l f es Ekakustha, may be classifie
) A
(B) Vihara Hetu
chara H tu
Th ausative f Kushta are Viruddha Ahara and
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airodhika54
55’
Desha, Kala, Agni, Matra, Satmya, Dosha, Samskara, Virya, Koshtha, Krama,
Parihara, Apachara, Paka, Sa 56..
According to Vagbhata Viruddha Ahara can sometimes become fatal just like the
when it is of Alpa Viryata in long run .
59-64
No.
AH
AS
B
S HS
MN
BP
Viruddha Ahara:
Acharya Charaka has stated that the substances acting antagonistic to
‘Dehadhatu’ are V
The diet which is opposite to Ashtau Ahara Vidhi Visheshayatanani
Charaka has mentioned 18 types of Viruddha Ahara, which are Viruddha to
myoga, Hridaya, Sampada and Vidhi
poison when it is of Adhika Virya, and in some case it may become Gara Visha
57,58
Table No:57 Showing Nidanas according to different acharyas
NIDANA C
S SS
A AHARA HETU (a) + Viruddha Ahara + + + + + + + 1. - Intake of Chilchm fish with milk. + - - - - - - 2. Intake of food mostly containing Hayanaka,
sheera, Dadhi, Takra, Kola, asha, Atasi, Kusumbha
+ - - - - - - - Yavaka, Chinaka, Uddalaka and Koradusa along with K
Kulattha, M3. ashuna with Ksheera. + - - - - - - - Intake of Mulaka and L4. of Gramya, Audaka and
Anupa Mamsa with Ksheera. - + - - + - - - Continuous intake
5. Use ith Dadhi and Sarpi.
- - - - + - - - of Pippali Kakmachi, Likucha w
6. f deer with milk. - - - - + - - - Use of Meat o7. - - - - + - - - Use of Mulaka with Guda. 8. ilk. - - - - + - - - Excessive use of alcohol with m9. Intake of articles having sour taste with milk. - - - - + - - -
11. Excessive use of green vegetables with milk. - - - - + - - - 11. and meat after taking hot diet
and vice-versa. - - - - + - - - Intake of honey
12. Use of - fish Nimbu and milk together. - - - - + - -
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arious types of food is a common complaint now a day. Decreased
immun
foods, which are prepared with innovative methods and combination, may be the
predisposing factors.
Mit
Mit
‘As .. Types of
Mit
tabl
Ahara Hetu for Kushta
Mit .N B.P
Incompatibility to v
ity, changed environment factors like temperature, pollution and consuming
hya Ahara:
hya Ahara means improper diet. According to Vijayrakshita, the diet opposite to
hta Ahara Vidhi Visheshayatanani’ is designated as ‘Mithya Ahara’
hya Ahara which are known to be responsible in the manifestation of Kushtha in
e
Table no.58 Showing Mithya
hya Ahara C. S S S A.S A.H Bh.S H.S M
Adhyashana + + - - - + + +
Vishamashana + + - - - - - -
Asatmya A + - - - hara - - - -
Intake - + of food during + + indigestion
- - - +
ContinuMadh
Lakucha, M in
w
- - - - - - ous and excessive use of u, Phanita, Matsya,
ulaka, Kakamachi
+ -
and take of above substances hile having Ajirna
Excessi - - - - - - - ve Snehana +
Vidahundig
+ - - i Ahara without emesis of + - - ested food
- +
Dravyataha
ExceAn
+ - ssivupa, Audaka Mamsa
- e intake of gramya, - - - - -
N - + avanna, Dadhi, Masha + - - - - +
DushiVisha + - - - - - - -
P - - - olluted water - - - + -
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Gunatah
Excessive Drava, Snigdha + - - - - + + +
Guru Ahara + + - - - - + +
Rasatah
Ex a Rasa + - - - - - + + cessive Amla & Lavan
:
but it has been considered as main cause for the Kushtha.
The factors related to Mithya Vihara by various Acharyas have been tabulated in table
no.59
RA HET
(B) Vihara Hetu
All kinds of activities done physically, vocally or mentally are considered as Vihara.
Mithya Vihara means improper activities. The activities opposite to ‘Svasthavrita’ are
the ‘Mithya Vihara’. The Mithya Vihara is the chief causative factor of many diseases
(B)VIHA (a) ithya Vihar M a (1 sical exerci nd t
eals. - + - - - + ) To do phy
take sun bath after heavy mse a o - +
(2 sexual intercourse indigesti
+ + - + + + ) To performduring on.
- +
(3) regular nap in the day. + + - - - + + + To have a(4) To do exercise or
sexual intercourse afSnehapana and
to formter
Vamana.
+ - - - - - per - -
(5) Sudden change fromor heat to cold
judiciously fo
cold to heat without
llowing the rules of al change
+ + - - + - - +
gradu . (6) Sudden Change fro
to Aptarpam S tarpa
n and vice – versa. + - - - - + an n - -
(7) Entering into cold wateimmediately after one is aff
ustio nd ight.
- - + - + + r ected
+ -
with fear exhasunl
n a
(8) Mithya sansargase a - - - - + - van - - (b) Vega-Vidharan a (1) ing of the natu l urg
nd Purisha ga et- + - + - - Withhold ra es
i.e. Mutra a Ve c. - +
(2 sion of the u e of + + - + - + ) Suppres rg - +
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(C) Achara Hetu65-67:
'Sadvirtta' chapter. As the after effects of bad deeds he suffers from diseases like
Krodha and Soka also cause Dusti of Swedavaha Srotas.57 Chinta causes Dusti
of Rasavaha Srotas.
Those diseases, in which no clinical im rov
treatment, rmaja Vyadhi. Both Charaka 8 and
Su acha m c ic dise e a
lik va ud it e e t ap a
Acha He fo us a:
Achara A B S
This is a very important factor and has been mentioned by all the Acharyas.
Behavioural misconduct, antisocial activities, sinful activities and other punishable
activities are considered under this heading. It has been mentioned that good morals
are also necessary for a man to be healthy, a detailed description of which is given in
Kushta. Brhatrayi have mentioned Cinta, Bhaya, Krodha as Vata Prakopa Nidana and
Bhaya,
p
are considered as Papa Ka
ement is obtained even after the best 5
shrut rya have described Kushta as a ost hron as nd other Acharyas
e Bha misra and Madhavakara have incl ed to b du o P a K rma.
Table No: 60 Showing ra tu r K ht
Hetu CS SS S AH HS MN BP
Pa + + + + + + pa Karma + +
VipraG - +uru Tiraskara + - - - -
Sadh - -u N inda - - + + - -
Use of mo
acquired by u
+ + - - - - ney and material
nfair means
- -
Killing the virt + - - uous person - - + - . -
(D r re s
are re fo ws
emesis.
) Other Nidanas: Some scattered
als ch a
efe nce regarding Nidana of Kushta
o found in the classics, whi as llo :
(c) Panchakarmapch n + - - - - + ara - + (1) Panchkarmani Kriy ane
iddha sevana+ - - - - - am
nis m. - -
(2) Improper administration oSnehapana therapy.
+ - - - - - - f -
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Samsargaja Hetu :
Ac ng to ta is as gik o .69 . K h
sp from rasan , Gatrasamsparsha, Nih a t,
ahabhojana etc. Bhavaprakash and Aurabhra also opines about the Aupasargikata of
cordi Susruta and Vagbhata Kush Aup ar a R ga i.e us ta
reads one man to another due to P ga shw sa
S
kushta.70
Kulaja Nidana :
Kulaja Nidana is also known as Aanuvansika Nidana i.e. due to Beejadusti. Sushruta
has mentioned Kushta as Adibalapravrtta Vyadhi 70 i.e. the original cause of the
disease is attributed to defects of Shukra and/or Shonita. Sushruta has also explained
that the children of Kushta patients may also suffer fromKushta.
Krimija Hetu:
Acharya Sushruta has mentioned that all types of Kushta originate from Vata, Pitta,
Kapha and Krimi71 Charaka has also indicated that causative factors and treatment of
Raktaja Krimi is as same as Kushta.72 So Krimi may be taken as one of the causative
factor for kushta.
Chiki janva Htsa Vibhramsa etu :
Stambhana in initial stage of disease like Raktarsha, 7 akta tta, 7 mati a 75
cau
as R ktapr osaja and Santarpanajanya Vyadhi. So the
Raktaprakopaka and Santarpaka Nidana can be attributed for the production of
3 R Pi 4 A sar
se Kushta.
Kushta has been mentioned a ad
Kushta.
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7 specific etiological factors as Tila, Taila, Kulattha, Valmika,
hya,
urdhwa gati of kapha and pitta with the
vuayu. Chardi vegavarodha if done, vataprakopa will be seen and
hen the residual pitta
ause many disorders among them kushta is the one.
upon the specific nature of the Nidana and also
ble
se77.When allow persisting for long time afflicted, these psychic
disorders viz. Kama etc. and somatic disorder like Jvara etc. may get affected with
each other78.
ychological references are available in the etiological factors of Kustha.
Blaming of good persons like saint, murder, stealing of others properties etc. have
also been mentioned as the Nidana of Kushtha79. Such antisocial and misbehaviour
Vangasena has given
Linga Roga, Mahisa Dadhi and Vruntaka for Kushta.
Charaka indicated that the water of the rivers, which are originated from Vind
Sahya and Pariyatra hills, might cause Kushta76
Chardi will be seen when there will be
influence of Udana
the residual kapha and pitta causes the kushta.
Panchakarmapachari has been mentioned in nidanas, here mainly vamana and
virechana can be considered i.e. these two procedures are done mainly to remove the
pitta and kapha dosha. If procedures are not carried out properly t
and kapha will c
Sankramaka nidanas have been mentioned by Acharyas i.e. both the internal and
external factors are highlighted in nidana. Indicating infectious and non infectious
condition of the disease.
Manasika Hetu:
Charaka mentioned that depending
specificity of the Dushya afflicted, Dosha when aggravated manifest innumera
types of disea
Direct ps
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o
ka (grief) etc. are originated by
d generation80. This observation
highlights the seriousness of psychic factors in the etiology of Kushtha.
t over worrying (Chintyanam Cha
Atichintanat) is one of the Nidana of Rasavaha Srotodushti. Rasavaha Srotodushti is
also an after effect on Ajeerna, which is also caused by the disturbed state of mind.
Eventhough food is in proper quality and wholesome it may not be get properly
digested if the person is affected by Chinta (worry), Shoka (grief), and Bhaya (fear)
etc81.
The causes of Ama include Kama (lust), Krodha (anger), Lobha (greed), Moha
(confusion) and Shoka (grief) etc82. Krodha, Shoka and Bhaya cause Svedavaha
Srotodushti which in turn leads to the manifestation of Eka Kushtha. In nutshell
s are having influence in etiopathogenesis of Eka
SAMPRAPTI
Different Acharya have explained the Samprapti in different ways. Sushruta explains
that person, who indulges in the Nidana Sevana, Tridosha will get vitiated. These
Vitiated Dosha move in the Tiryakgata Sira.Then they have Sammurchana with the
and sinful activities make serious and long-standing impact on mind of persons wh
are indulging in it. Bhaya (fear), Krodha (anger), Sho
such activities leading to vitiation of Dosha which leads to Kushtha. Nidanas like
Papakarmas even causes affliction to the secon
Rasa is mainly affected Dushya in case of Eka Kushtha. While explaining the
Srotodushti Nidanas Charaka mentions tha
various psychological factor
Kushtha.
Dushya. Then it will reach the Bahya Marga and produces the Mandala wherever it
moves83.
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Dosha in Eka Kushtha:
This is summarized as follows:
.61 Showing Lakshanas according to Predominance of the Doshas
Lakshanas Doshas
Charaka has emphasized on the importance of the Sapta Dushya like Tvak, Rakta,
Mamsa, and Ambu. He explains that whenever the Dosha Dushya Sammurchana
occurs in the Tvak then the Kushtha will be produced84.Though all the Acharyas have
explained the Samprapti in different way, involvement of the Tridosha is the common
factor which is accepted by all.
Pathology involving Shukra Dhatu gives raise to Kaunya and Gati Kshaya. The
offspring of the persons who are already suffering with the Kushtha, will also suffers
with the Kushtha due to the Dushta Shukra and Shonita which they possessed85
Though the Samprapti of the Kushtha is explained in general and no where the
specific samprapti of each of the variety is explained one can understand the specific
samprapti by looking at the involvement of the Dosha, Dushya etc of each variety.
All Kushtha are Tridosha. However, in Eka Kushtha the dominance of Vata Kapha is
mentioned by Charaka and Kapha by Sushruta. The involvement of Doshas in the
common Lakshana of Eka Kushtha is analyzed.
Table-No
Asvedanam Vata-Kapha Mahavastum Kapha
Matshyashakalopama Vata Krishna-Aruna Varna Vata
Mandala Vata-Pitta-Kapha Raktabha Pidika Pitta
Kandu Kapha Vedana Vata Bahalata Kapha
Tvak Rukshata Vata
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Mainly
are found in Eka Kushtha.
SAMPRAPTI GH
Dosha ata,kaph
Dhatu akta,
Upadhatu :Tvacha
Agni ragni, dhatwag ya.
Srotas : Rasa, rakta, mamsa
shanas Dhatu Dushti
Dushya in Eka Kushtha:
Charaka has described that seven Dravyas vitiate in Kushtha i.e. Tridosha & four
Dushyas (Tvaka, Rakta, Lasika & Mamsa).
Table no.62 Showing Lakshanas according to Dhatu dushti.
Lak
Table no.63 Showing Lakshanas according to Srotas
the Srotodushti of Rasavaha, Raktavaha, Mamsavaha and Svedavaha Srotas
ATAKA86:
:Tridosha(V a)
: Rasa, R Mamsa.
: Jata n di man
vaha
Asvedanam Rasa Mahavastum Rasa
Matshyashakalopama Rasa Krishna-Aruna Varna Rasa, Rakta
Mandala Mamsa Raktabha Pidika Rakta , Mamsa
Kandu Rasa Vedana Rasa , Mamsa Bahalata Mamsa
Lakshana Srothas Srotho dushti Asvedanam Rasavaha, Svedavaha Sanga
Mahavastama Rasavaha Sanga Matshyashakalopama Rasavaha Sanga Krishna-Aruna Varna Rasavaha,Raktavaha Vimargagamana
Mandala Mamsavaha Vimargagamana& Sanga
Raktabha Pidika Raktavaha,Mamsavaha Sanga Kandu Rasavaha Sanga
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kara : Sanga,vimarga gamana
ira
Adhisthana : Twak, rakta, mamsa, lasika
Vyakta sthana : T
Roga marga : Bahya
Swabhava : Chirakari
Sadhyasadhyata : krichsadhya
On the basis of at symptoms, 4 are due to
Vata, are due to ach ata Kapha & Tridosha.
Hence it can be con hat Eka ridosha Vyadhi with
predominance of Vata Kapha.
Srotas dushti pra
Udbhava sthana : Amapakvashaya
Sanchara sthana : Sarvashar
wak
above aid thit can be s ou ent of the t
3 Kaph ne ea and o due a, Vto Pitt
cluded t Kushtha is T
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NIDANA
Aha a Bijadoshaja
Agnimandya Tridosha Dushya Khavaigunya
Amotpatti Rasen Saha
Mishribhuya
yaga Sira G Dushya Dushti (Tvacha, Rakta, Mamsa)
Dosha – Dushya Sammurchana
SrotoDushti
(Rasavaha, Raktavaha, Mamsavaha, Svedavaha)
Lakshanotpatti
(Asvedanam ,Mahavastuma etc.) Uttarotar Dhatupravesha (Nail deformity, Psoriatic Arthritis etc.)
SAMPRAPTI OF EKAKUSHTHA
raj /Viharaja/Acharaja/Manasika
Prakopa Shaithilya
Tir amanam
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PURVARUPA:
The laxanas, which appear befor he anifestation of the disease are known
a’
pt n abo ta in the
Ksudrakushta, the Purvarupa of Kushta
may be considered as its Purvarupa. 94
o.64 Showing Purvaroopa according to different acharyas. N
me t.as Purvarup
Though there is no specific descri io ut Purvarupa of Eka kush
classical texts, but being a variety of 87-
Table nO PURVAROOPA
Cha. A.S. A.Hr. B.S. H.Sus.
0 V.
A LOCALIS D EAswedanam + + + + -
- -
+ 1.
2. Atiswedanam + + + + + - + 3. Parushyam + + - - - + - 4. Atislakshnata + - + + - - + 5. Vaivarnyam + + + + + - + 6. Kandu + + + + - + + 7. Nisht + - + + oda + - + 8. Suptata + + + + + + + 9. Pariharsha + - + + - - - 10. Lomahars + + ha + + + - +11 Kharatvam + - + + - - + 12 Usmayanam + - - - + - - 13 Gauravam + - - - + - + 14 Svayathu + - - - - - - 15 Kothonnati + - + + - - + 16 Visarpagaman
am + + - - - - -
17 SvalpamapiVrananam Dusasamrohananm
+ - + + - - + hti
18 Raaga - - - - + - + 19 Roukshyam - + - - - + - B GENERALISED 1. Shrama + - + + - - + 2. Klama + - - - + - - 3. Kayachhidresu + - - - - -
Upadeha -
4. Rakta - + + + - - + krishnatvam
5. Dourbalya - - - - + - + 6. Pipasa - - - - + - +
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RUPA OF EKAKUSHTHA
e
The detailed description of Rupa of Ekakushtha found in
Matshyashakalopama
a Va
am
S
Abhrakapatrasham esion
SADHYAS
Rupa appears during the fifth Kriyakala and this is also referred to as th
’Vyakti’ stage.
various Ayurvedic classics is being presented as here;Rupa of Ekakushtha
concluded here are as follows95-98
Asvedanam
Mahavastum
Krishna Arun rna
Vaisarpodbhav
rava
Mandala
a l .
ADHYATA
As oung cut v easi and i cutti involves excessive effort
when the tr own. So also the disease is easily curable in its primary
sta t bec le or ficult cure as and when it reaches the advanced
sta
A physician who can distinguish between Sadhya and asadhya vyadhis and
ini s treatm time w h the ll kn ledg about riou asp ts of
the pli curing the disease. On the other
hand a physician who undertakes the treatm t of incu le d ase ould
undoubtedly subject himself to the loss of Artha, Vidya, Yasha and also earn
Janapavada
a y tree can be ery ly t’s ng
ee is well gr
ge, i ome incurab dif to
ge.99
tiate ent in it fu ow e va s ec
rapies can certainly accom sh his object of
en an rab ise w
. 100
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Incurable type of kushta d but the curable ones
ove
afte
nor
trea gimen. 101
Prognostic criteria in case of kushta 102
Sadhya va
If kaph usly vitiated in the pathogenesis of the disease,
but only one of these two doshas is predominant then it is not difficult to cure.
Kashta Sad
aneous vitiation of
apha and pitta or vata and pitta is difficult to cure.
Asadhya:
1. The patient of kushta with the signs and symptoms of all the three
predominant vitiated doshas.
he patient who is Abala.
3. The patient who is suffering from Trishna and Daha
oes not overcome their incurability
rcome their curability if the patient resorts to unwholesome regimens even
r the disease. Excluding Kakanaka, six other types of these kushtas which are
mally curable may become incurable in the event of the lack of proper
tment or resort to unwholesome re
riety:
a and vata are simultaneo
hya:
The patient suffering from kushta caused by the simult
two doshas viz. k
2. T
4. The patient having Mandagni
5. The patient having Krimi in the patches of kushta
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The
.
105Kushta confined
to Tw dhya,Kushta confined Medo dhatu are
Kashta re Asadhya.
kushta is considered as one amongst Astamahagadas
and are said as Dushchikitsya. 106
SADHYA ASADHYA
summery is shown in table below
Table no.65 Showing Sadhya-Asadhyata103,104
According to the involvement of the dushyas classified as
ak, Rakta and Mamsa are Sa
sadhya,Kushta confined to Asthi, Majja, Shukra dhatu a
According to Sushrutacharya
Generalised features 1
any type of Medicine or treatment) t, Burning, Agnimandya,Alpa
balavan *Rakta netra, Hata Svaram,
Panchakarmagunatita, Prasratanga
Atmavat (Who can able to tolerate *Thirs
Localised features 2 Absence of Krimi Krimi utpatti
Predominance of Dosha 3 Vata-Kaphaja Kushtha , Kapha-Pitta or Vata-Pitta or only one
Dosha
Tridosha dominance
Involvement of Dhatu 4 , Rakta or Mamsa dhutagata
Medogata, Asthigata, Majjagata & Shukragata
Tvacha
Specific type of Kushta 1145 KaMa
Pted
pala , Audumbara, Sidhma, ndala, Aruna Rushyajihva, undarika types of Kushta
Kakanaka, When Sadhya Kushta are not treated properly in time or neglec
these becomes Asadhya Other features 6
Minimum symptoms with Absence of complication.
Kushta having all the symptoms along with complications like Angapatan,
Kushta
Jvara,Atisara etc114 Adibalapravrutta 115
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ADRAVA:UP
s, viz. ‘Upa’ meaning paschat
(afterwords) and ‘Drava’ (dravati = upaiti ) meaning to appear. 107
I e er time then Krimi will be seen
in the leda, and Sweda. These krimi vitiate the
doshas leading to complications which are des
1. Vataja: Shyava, Aruna varna, Paroosha
Ve , Stambha, Su
2. Pittaja: Daha, Sweda, Kleda, Kotha, Srava, Paka, Raga.
3. Kapha andu, S ha,
Upalepa.
4. Kri tus an
S
The word upadrava is composed of two term
f th sadhya kushtas are not treated properly at a prop
Twak, Mamsa, Shonita, Lasika, K
cribed below separately.108
ta, Rookshata, Shoola, Shosha, Toda,
pathu,. Harsha, Sankocha, Ayasa pti, Angabheda
ja: Shwaitya, Shaitya, K thairya, Goutava, Utseda, Upasne
mis affect the Twachadi four dha d Sira, Snayu, Asthi (taruna-nsasthi
ARISHTA LAXANA
A shtas are in di a
nt109.
•
a110
111
gives rise to excessive wound in the body and the
ri the symptoms produced seases suggest the definite death of
patie
Sushrutacharya says that, if sudden drastic and abnormal changes occur in the
physical and mental constitutions of a patient without any appropriate reason,
the symptoms produced by such changes may be considered as Arisht
Here the arista laxanas of kushta are mentioned as follows
• If even the slightest injury
wound do not heal up,
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• If in a dream a person nake hrita offering oblations to the fire
e dies of kushta.112
•
studded with jantu and also having Trishna, Atisara then the patient is going to
106(88)
Apart from these, other criterias have been explained as,
•
113
•
persistent sweating or its total
ain
constantly hot etc. such hout any appreciable cause are
indicative of imminent death. 114
d anointed with g
without flame,
• If in dream he has growth of lotus flower in his chest then h
If the patient having Visheerna anga, Rakta netra, Hataswara, Mandagni and
die of kushta
The poorvaroopas of the diseases are manifesting themselves excessively are
sure sign of imminent death of the patient.
Patient having the signs and symptoms related to sparsha, like feeling of
kharatwa in organs having shlakshnata,
absence, appearance of hardness, coldness in organs which normally rem
signs and symptoms wit
CHIKITSA
While explaining line of treatment for different varieties of Kushtha, Charaka has
men
carried
Dosha s ould
systemically, it is
nec a
in Kri odhana, Samasamana and Nidana Parivarjana
separately116.
tioned that all the Kushthas are caused by Tridosha, so the treatment is to be
out according to the predominance of Dosha. The predominately vitiated
should be treated first and the treatment of the other subordinate Dosha h
be undertaken afterwards115. To study the treatment of Kushtha
ess ry to look at three principles of the treatment which are described by Charaka
mi Chikitsa i.e. Samsh
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The therapy which expels out the morbid Doshas from the body is known as
’
som
use of vitiation of
Dosha in greater extent 118
According to Charaka & Vagbhata Shodhana should be carried out according to
predominance of vitiated Dosha. For instances in Vata dominance Ghritapana, in
at Mamsagata and Medogata ushtha 122.
A) SAMSHODHANA:
Shodhana117 Medicines given after Shodhana are more effective. All Acharya s
have emphasized on Shodhana therapy in the management of Kushtha due to
e basic things related to Kushtha Roga which are :
A person having Kushtha Roga is called ‘Bahu Doshi’ beca
Kushtha is considered as a Tridoshaja Vyadhi119and in Kushtha, Doshas are
‘Tiryaggami’
By nature, Kushtha is difficult to cure disease, so it is called ‘Duschikitsya’.
But by the application of Shodhana therapy, cure of the disease becomes
easier due to removal of the root cause, hence Shodhana has great
importance.
Kapha dominance Vamana and in Pitta dominance Virechana, Raktamokshana
are to be carried out 120
In excessive morbidity of the Doshas repeated Shodhana should be performed at
regular intervals i.e.Vamana Karme once in 15 days;Samsrana once in month;
Raktamokshana once in 6 months; Nasya Karma once in 3 days121.Sushruta has
advised to carry out ‘Ubhayato Samsodhana’ even at the Purvarupa condition of
Kushtha. Sushruta also advised Samsodhana in the treatment of Rasagata,
Raktag a,
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(B A :
na. Charaka has advised
Shamana therapy with Tikta and Kashaya Dravyas after administration of proper
Sham of Chikitsa Sthana.
(C) Bahya Chikitsa :
advocated. For the external app
of the Doshas from the body by Shodhana Karma and Raktamokshana. Various
forms of local application are prescribed like Udvartana, Pralepa, Parisheka,
Abhyanga, etc. Kshara Karma and Agada Karma are also prescribed in special
In short it may be said that the treatment of Kushtha may divided into three parts
i.e. treatment according to the predominance of Doshas, internal & external
purification.
(D) NIDANASYA PARIVARJANAM :
Mithya Ahara-Vihara & Viruddha Ahara so they should be avoided. Acharya
Charaka has defined ‘Pathya’ as they are the wholesome drugs and regimen
which do not adversely affect the body and mind. Those which adversely affect
) SHAMANA CHIKITS
Shamana therapy is also an important part of the treatment of Kushtha. After
completing the Shodhana Karma, Shaman Chikitsa is indicated to subside the
remaining Doshas. Shamana Chikitsa is very useful in those patients who are
unable to undergo or contraindicated for Samshodha
Shodhana 123.Charaka has also indicated several other drugs & formulation of
ana therapy in 7th chapter
124
Kushtha, being exhibited through the skin, external application are also
lication drug should be applied after elimination
condition of Kushtha
It means to avoid etiological factors. Main etiological factors of Kushtha are
them are considered to be Apathy125
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scribed for Kushtha hence for Eka Kushtha also. Following Pathya Apathya are de
PATHYAPATHYA 126,127
Table no.66 Showing Pathya-Apatha.
VARGA AHARA DRAVYA AOUSHADHA / CHIKITSA
PATHYA APATHYA PATHYA APATHYA
ShukaGodhooma, Tila
dhany Shali, Yava,
Purana dhanya.
- -
Shambidh
Adhaki, aka,
Nishpava,
aka,Chinaka, Masha
riyangu, Tuvarak
Kulattha,
Masha an-ya Mudga, Hayanaka,Yav- P
UddalMasoora
Mamsa
Anoopa mamsa, Jangala mamsa rasa Anoopa sa,
vasa varga Jangala mamsa Matsya mamsa ra
Shakha , ha
varga Patola ,Tiktka shaka,PunarnavShaka,Karvelka
Moolaka, Kakamachi,Uddalaka,Kusumb-ha Tila
Nimba,chakramardala ,Avalguja, Atarushaka, Aragvada, Khadira
AtasiLakuc
Phala varga
Triphala
Ashada phala, Jatiphala
-
Brahati phala, Koshataki, Bhallatak,
-
Gorasa rpi Ksheera,Dadhi - - varga Purana Sa Taila varga Tikta ghrita, taila of Tila taila
Sarshapa taila
Tila tail
Nimba, Ingudi, Saral Agaru, Devadaru, Shimshipa
Ikshu varga Makshika Ikshu, Guda Makshika -
Mutra varga - - Go,Khara,Ushtra,Ashva
,Mahishi mutra -
la Varga
- Sahyadriya samudJa
,Vindhbhva
nadi jala
Khadirodaka -
Lagu
Anna
Amla rasa
Vidahi,Vishtambi,drava-guru anna,Pishta vikara,Virudha pana-Ashana
Kasturika,Gandhasara;v
once in a month rechan; Nasya karma in every 90 days; Rakta mokshana once in 6 month,
Divaswaapa sweda,, Vyavaya
Other
& Hitakara Dravya, aman in every 15 days;
Kshakarma,
pAt
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Psoriasis is the one of the lon ans. A noncontagious
inflammatory skin disea atches covered with
ales.
ICAL :
PSORIASIS
gest known illnesses of hum
se characterized by recurring reddish p
silvery sc
ETYMOLOG DERIVATION
Psoriasis is der words psorian "to have the itch," from psora "itch,"
en "to r
DEFINITION:
ived from Greek
related to ps ub."
Psoriasis is an inflammatory disease that manife as
circumscribed, erythematous papules and plaques covered with silvery scales124
HISTORY:
sts most commonly well-
It is believed th sease mention in the B riasis.. I
ilar to
d classified it as a fourth varia of Impe
Psoriasis became part of the medicinal literature after Joseph Jacob Plenck of Vienna
in 1776 as scaly or s le like diseases.Robert W englis
dermatological doctor along wit an rec isease as a
independent disease. They divided it into 2 classes 1) Leprosa Graecorum, as the
n when th ale
Psora Leprosa, as the condition w e erup
In 1841, Ferdinand von Hebra ( Viennese skin specialist ) ascribed the name psoriasis
om the Greek word psora or to scratch in the English compendium. He is also the
at the tzaraat di ible is similar to Pso n
first century Cornelius Celsus ( Roman writer ) described a skin condition sim
psoriasis an nt tigo
ca illan ( 1757-1812 ), an h
h Thomas Batem ognized this d n
conditio e skin had sc s ; and
hen it becam tive.
fr
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one who described the clinical imag t is used today.It was during the
125
e of psoriasis tha
20th century that psoriasis was further differentiated into specific types .
PREVALENCE :
The prevalence of psoriasis in Western populations is estimated to be around 2-3%.
ng 7.5 million patients who were registered with a
e
ation (a US based psoriasis education and advocacy group)
found a prevalence of 2.1% among adult Americans. The study found that 35% of
people with psoriasis could be classified as having moderate to severe psoriasis125.
The prevalence of psoriasis amo
general practitioner in the United Kingdom was 1.5%. A survey conducted by th
National Psoriasis Found
ETIOLOGY:
The cause is unclear but involves immune stimulation of epidermal keratinocytes; T
cells seem to play a central role. And certain genes and HLA antigens (Cw6, B13,
Triggering factors:
Psoriasis is a skin condition characterized by flare-ups and remissions. Although these
tors which can trigger an
B17) are associated with psoriasis.
Hereditary:
About one-third of those with psoriasis have a family member with the disease. When
both parents have psoriasis, there is a 50-percent chance their child will have
psoriasis.
flare ups can occur on its own, but there are some fac
outbreak of psoriasis or may cause aggravation.
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, physical,
chemical, surgical, infective, and inflammatory). The development of psoriatic lesions
at a site of injury is known as the Koebner phenomenon.
Lithium ,withdrawal of systemic corticosteroids, beta-blockers, antimalarials, and
cause flare of the disease
ase in a small minority .
Cigarette smoking is associated with an increased risk of chronic plaque psoriasis.
Trauma –
All types of trauma can lead to the development of plaque psoriasis (eg
Infection:
An acute eruption of guttate psoriasis may be provoked by streptococcal pharyngitis.
HIV infection may be associated with increase in disease severity.
Drugs:
NSAIDs may
Sunlight:
Although sunlight is generally considered to be beneficial for most of the patients,
strong sunlight may worsen the dise
Stress:
Many patients report an increase in the psoriasis severity with psychological stress.
Smoking:
Alcohol:
Alcohol is considered a risk factor for psoriasis, particularly in young to middle-aged
males.
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PATHOLOGY
The exact immunopathogenesis of psoriasis is unknown, but immunologic factors
have been implicated in its etiology. Psoriatic plaques are characterized by epidermal
sia, presence of acute and chronic inflammatory cells vascular changes of
in
increased numbers of several different cells of the immune system,
including activated T cells, activated antigen-presenting cells (APCs), neutrophils,
al
result in induction of antigen presentation, cytokine release, and enhanced
T-cell activation and lymphokine release.. Lymphokines, in turn, produce
inflammation and hyperproliferation of epidermal cells. Accelerated epidermal cell
proliferation results from recruitment of a large proportion of resting cells into the
proliferative cycle.
Endocrine:
The disease state may fluctuate with hormonal changes. Psoriasis may begin during
puberty. Pregnancy may improve the disease. while a flare may occur during post-
partum period.
Irritation:
Irritation caused by cream, traditional herbal application, strong soap, srubs and
detergents (especially detergents for hands).
Climate:
Cold dry wintery climate, excessive sun exposure, sunburn, hot humid climate can
cause itch and other discomfort.
hyperpla
inflammation. The epidermis and dermis of an active psoriatic plaque conta
and hyperproliferating keratinocytes. The activation of APCs, keratinocytes or derm
cells may
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Provocating Factors
Exogenous/Endogenous antigens
Antigen presentation by APCs
Immune response
Secretion of cytokines
cal Lesions of psoriasis
Genetic Background
T lymphocyte- mediated
Inflammation & cellular hyperproliferation
Clini
The typical lesions of psoriasis have the following features;
scales which, on removal may reveal punctate bleeding points (Auspitz sign)
CLINICAL FEATURES:
The lesions are very well marginated with distinct border.
The lesions are raised above the surface.
The plaques usually have a diameter of one to several centimeters and have a
round or oval shape. The lesions may merge together to give rise to
geographic patterns.
The plaques typically have a rich red color and may be surrounded by a pale
halo ( the halo of Woronoff).
The lesions are covered with a silvery white, mica-like, loosely adherent
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Symmetry:
The lesions are symmetrically dispo f the body. Typical sites
of affection are the elbows, knees, shin, knuckles, sacral areas and scalp.
Uniformity:
The psoriatic plaques ten ective of site except for
certain locations like the p
Variations of lesions
Variations by morphology or shape:
Apart from the typical plaque les s, lesions may take
on a variety of m henoid, follicular,
linear, annular, figurate, gyr o describe these variants.
Variations by site:
calp: Diffusely involved. Thick scales no hair loss.
eddish plaque without scales.
Hands and feet
Sacral ay be absent.
Nails: i
Candle
sed on extensor surfaces o
d to have the same features irresp
alms and soles, and the flexors.
:
ions, guttate lesions and pustule
orphological forms and shapes. Verrucous, lic
ate are some of the terms used t
S
Penis:. Well-circumscribed, r
: Diffuse hyperkeratosis, Thick scales, fissures.
regions: thick fissures plaques, scaling m
nvolved in 25 to 50% of cases.
-grease Sign-
de bouge) When a p(Tache soriatic lesion is scratched with the point of a dissecting
forceps -
scaling ndle-grease Sign (Tache de bouge).
Auspit
, a candle-grease-like scale can be repeatedly produced even from the non
lesions. This is called the Ca
z sign-
mplete removal of a scale produces pin-point bleeding is called Auspitz sigThe co n.
The lesions are slightly raised above the surface of the skin, but there are no
indurations.
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enomenon-Koebner's ph
phenomenon
occurs are warts and lichen planus).
thematous papules or plaques covered with thick, silvery, shiny scales
remit and recur spontaneously or with appearance and resolution of triggers
Psoriatic lesions may develop along the scratch lines in the active phase; this is called
Koebner's phenomenon (other common diseases in which Koebner's
Types of presentations:
Plaque psoriasis Gradual appearance of discrete, ery
Lesions that
Guttate psoriasis Abrupt appearance of multiple plaques 0.5 to 1.5 cm in diameter, usually on the trunk in children and young adults after streptococcal pharyngitis
Erythrodermic psoriasis patients with plaque psoriasis (though m
Gradual or sudden onset of diffuse erythema, usually in ay be the first
presentation); typical psoriatic plaques are less prominent or
te use of topical or
absent
Most commonly caused by inappropriasystemic corticosteroids or light therapy
Generalized Explosive onsetpustular psoriasis
of widespread erythema and sterile pustules
Pustular psoriasis Gradual appearance of deep pustules on palms and soles of the palms and soles
Flare-ups may be painful and disabling
Typical psoriatic lesions may be absent
Inverse psoriasis asis)
Psoriasis of inguinal, gluteal, axillary, inframammary, and retroauricular folds and of the glans of the uncircumcised
edge of involved areas
(flexor Psoripenis
Possibly formation of cracks or fissures in the center or
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COMPLICATIONS:
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 93
riate and aggressive therapy.
• Psoriatic arthritis.
• Pustular psoriasis.
rm
• Infection, particularly Staph. infections of the patches.
• Eczematizati
sis
• Psychologica
• Potential complications of systemic therapy should not be overlooked
OSIS:
• The disease rare threatening, but often is intractable to treatment with
relapses occurrin
• Both early onset and family history of disease are considered poor prognostic
As Psoriasis is a
teg of
the disease. Pso an be categorized into localized and generalized forms
for treatment p
obtaining rapid control of the disease and maintaining that control. For
• Many of the complications (pustular psoriasis, erythroderma) are
commonly due to inapprop
• Erythrode a and its metabolic complications.
on due to topical agents.
• Amyloido , rare sequel to arthropathic of pustular psoriasis.
l consequences : depression, anxiety, lack of self-esteem.
PROGN
ly is life
g in the majority of patients.
indicators.
• Some suggest tha
TREATMENT
t stress also is associated with an unfavorable prognosis.
complex disorder that negatively impacts quality of life,So
treatment stra ies must address both psychosocial and physical aspects
riasis c
urposes. In either case, the treatment plan should include
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recent data support the combined use of topical
corticosteroids with a non corticostero
taza
trea oth rapid control and long-term maintenance143.
a s
localized disease,
id agent (topical calcipotriene or
rotene). For generalized disease, UVB phototherapy is an effective
tment that permits b
M nagement principle
Treatment is as much guided by the patient's perception of their condition as
by the objective severity of it.
Treatm s ability to understand
and follow through with treatment (as there can be issues relating to
acceptability of certain treatments).
Patient education is im
reatment as it is for them to be clear about the management steps
decided in their particular case.
Associated psychological problems need to be specifically addressed and if
necessary, treated in their own right.
Most patients with mild or moderate plaque psoriasis
ent options have to take into account the patient'
portant: it is just as important for them to know how to
apply their t
responding to topical
treatment can safely be managed in the community.
There are three main categories of treatment: local agents, phototherapy and
systemic therapy. These may be used sequentially, in combination or in
rotation.
No active treatment is one of the treatment options144.
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Th
specific
ere can be substantial variation between individuals in the effectiveness of
Psoriasis treatments. Because of this, dermatologists often use a trial-and-
pproach to finding the most appropriate treatment for their patient. The
n to employ a particular treatment is based on the type of psorias
error a
decisio is, its
location, extent and severity.
The patient’s age, gender, quality of life, co morbidities, and attitude toward risks
ted with the treatment are also taAssocia ken into consideration.
Medications
If the treatm
with the least potential for adverse reactions are preferentially employed.
ent goal is not achieved then therapies with greater potential toxicity may
be used. Medications with significant toxicity are reserved for severe unresponsive
psoriasis. This is called th
• A nts
e psoriasis treatment ladder.
s a first step, medicated ointme or creams are applied to the skin. This is
• desired goal then the next step would
called topical treatment.
If topical treatment fails to achieve the
be to expose the skin to ultraviolet (UV) radiation. This type of treatment is
called phototherapy.
• The third step involves the use of medications which are taken internally by
pill or injection. This approach is called systemic treatment.
Sulphur was fashionable as a treatment for psoriasis in the Victorian and
ty as a safe alternative
to steroids and coal tar.
Edwardian eras. It has recently re-gained some credibili
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Treatments for Localized Psoriasis
• Tar
• Topical calcipotriene
• Anthralin (short contact therapy)
• Intralesiona
• Topical corticosteroids
• Topical tazarotene
• Corticosteroid tape (Cordran tape) l triamcinolone
Treatments for Generalized Psoriasis
UVB Phototherapy Safe and effective for both initial clearing and long term
may be more effective than broadband.
control. Efficacy may be increased by day treatment regimens or combination with low-dose acitretin. Narrow-band UVB
Psoralen + UVA (acitretin (Re-PUVA)
More effective than broadband UVB but causes high risk of
combination with oral retinoids when possible to help minimize PUVA) and PUVA + Cutaneous malignancy. PUVA should probably be used in
PUVA exposure.
Acitretin (Soriatane) Very effective therapy for pustular psoriasis. Less effective as a
phototherapy. Relatively safe as a long-term treatment. monotherapy for plaque psoriasis. Very helpful as an adjunct to
Meth reot xate Highly effective therapy. Patients appreciate the simplicity of the treatment regimen. There is the risk of life-threatening hematologic toxicity at any time during therapy and both acute and chronic hepatotoxicity. Careful monitoring is essential
Cyclosp ffective treatment. Especially helpful for immediate orine (Neoral) Very econtrol of severe disease. Less helpful as a long-term therapy (>1 year) due to renal toxicity.
Other iminhibitor
mbination with
ho
ide- Very long half-life; requires special
mune • Mycophenolate mofetil- helpful in cos other drugs. Monitor for hematologic toxicity.
• Hydroxyurea- helpful for patients with cirrhosis wrequire systemic therapy. Close hematologic monitoringis essential.
• Leflunomprotocol to speed clearance.
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SELF CARE
Keep skin lu s and petroleum jelly preparations are
sug s
Us
Get out in the sun. Be careful not to burn. Exposing only the areas of your
body with active psoriasis may be optimal.
Bathing in
d so m,
Neutrogena
Minimize stress.
a
bricated. Oils, cream
ge ted.
e a humidifier in the home.
hot water may help reduce scaling.
Use mil aps or soap-free cleaners. Mild soaps such as Nivea Crea
Dry Skin, Dove, or Lever 2000 are recommended.
Protect ag inst skin injuries and skin infections.
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Drugs used for the study can be explained under following headings
1. Drug for Pachana & Deepana
2. Drug for Sneha paana
3. Drug for Abhyanga
4. Drug for Virechana Karma : Virechana dravyas.
PACHANA & DEEPANA DRUG
Table no.67 Showing Ingredients of Chitrakadi Vati1
98
Sanskrit Name
Latin name/ Family
Rasa Guna Veerya Vipaka Doshaghnata
Karma
Chitraka Plumbago zeylanica/
Katu
Laghu, Ruksha, Tikshna
Ushna Katu Vata-kaphahara
Deepana, Pachana,
Grahi Pippali Mula
Piper longum/
Katu Laghu, Ruksha
Ushna
Katu Kapha-vata hara
Deepana, Pachana,
Yava Kshara Potassium carbonate
Katu
Laghu, Snigdha, Sukshma
Ushna Katu Kapha-vata hara
Deepana, Pachana,
Sarji Kshara Arthrocnemem indicum -
Katu
Teekshna, Ushna Katu Vatahara Deepana, Pachana
Saindhava lavana
- Sodium chloride
Lavana
Laghu, Snigdha
Sheeta Madhura Tridoshahara Deepana, Pachana Ruchya,
Souvarchala lavana
- Lavana
Laghu, Snigdha,
Ushna Madhura Vatahara Deepana, Pachana
Vidalavana -
Lavana Laghu,
Teekshna, Sukshma
Ushna Madhura Kapha-vatahara
Deepana, Ruchya,
Oudbhidha lavana
- Lavana
Laghu, Teekshna, Vishada, Sukshma
Atyushna Katu Kapha-vatahara
Deepana, Bhedana
Samudra lavana
- Lavana
Snigdha Natyushna-nati
sheetala
Madhura Vatahara Deepana, Ruchya, Bhedana
Shunthi
Zingiber officinale/
Zingiberaceae
Katu
Laghu,Ruksha, Tikshna
Ushna Madhura Vata-kaphahara
Deepana, Pachana,
Maricha
Piper nigrum/ Piperaceae
Katu
Laghu, Tikshna
Ushna Katu Kapha-vata hara
Deepana
Pippali Piper longum/ Piperaceae
Katu
Laghu,Snigdha, Tikshna
Ushna Madhura Kapha-vata hara
Deepana
Hingu Ferula narthex/ Umbelliferae.
Katu
Laghu, Snigdha,
Ushna Katu Kapha-vata hara
Deepana, Pachana
DRUG REVIEW
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Tikshna Ajamoda Apium
graveolans/ Umbelliferae.
Katu, Tikta Laghu,Ruksha, Tikshna
Ushna Katu Kapha-vata hara
Deepana, Pachana
Chavya Piper chaba/ Piperaceae.
Katu Laghu, Ruksha
Ushna Katu Kapha-vata hara
Deepana, Pachana
Matulunga Citrus medica/Rutacea
e
Amla, Madhura
Laghu,Snigdha
Ushna Amla Vata- kaphahara
Deepana
Dadima Punica granatum/ Punicaceae
Kashaya, Amla,
Madhura
Laghu,Snigdha
Ushna Amla Vata- kaphahara
Deepana
SNEHA PANA DRUG2:
Table no.68. Showing ingredients of Guduchi Ghrita: Drug Latin name/
Family Rasa Guna Veery
a Vipak
a Doshaghnat
a Karma
Guduchi
Tinospora cordifolia/
Menispermaceae.
Tikta, kashaya.
Guru snigdha
.
Ushna Madhura
Tridosha shamaka.
Kushtagna, krimighna.
Ghrita Madhura
Snigdha
Sheeta Madhura
Tridosha hara Pitta saraka,deepena
Rasayana,sangrahi.
ABHYANGA DRUG:
Table no.69 Showing ingredients of Madhuyashti taila 3
Drug Latin name/ Family
Rasa Guna Virya Vipaka Doshagnata
Karma
Yashtimadhu.
Glycyrrhiza glabra/ Leguminosae.
Madhura Guru snigdha
Sheeta Madhura Tridosha hara
Rasayana vrushya.
Manjishta
Rubia cordifolia/Rubiaceae.
Tikta, kashaya
Guru, ruksha
Ushna
Katu Kaphapitta shamaka
Rakta prasadaka.
Jivanti. Ledtademia reticulate/Asclepiadacea
e.
Madhura
Laghu, snigdha
Sheeta Madhura Tridosha hara
Snehana anulomana.
Shalaparni Desmodium gangetium/ Leguminosae.
Madhura, tikta.
Guru, snigdha.
Ushna Madhura Tridosha shamaka
Deepana, anulomana
. Shatapushpa Foeniculum valgare/
Umbelliferae. Madhura,
tikta. Laghu,
snigdha. Sheeta Madhura Vata pitta
hara. Deepana,
pachana,vrushya.
Durva Cynodon dactylon/ Graminae.
Madhura, kashaya,
Laghu, snigdha.
Sheeta Madhura Tridosha hara.
Kushtaghna, Vrana
ropana.
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Shatavari Asparagus racemous/ Liliaceae.
Madhura, tikta.
Guru, snigdha.
Sheeta Madhura Vatapitta shamaka.
Medhya,hridya.
Padmaka Prunus cerasoides/
Rosaceae. Kashaya,
tikta. Laghu Sheeta Katu Kaphapitta
shamaka Varnya,kand
ughna.
Chandana Santalum album/Santalaceae.
Tikta, madhura.
Laghu, ruksha
Sheeta Katu Kaphapitta shamaka
Varnya,hridya.
Sariva Hemidesmus indicus/ Asclepiadaceae.
Madhura, tikta.
Guru, snigdha.
Sheeta Madhura Tridosha shamaka.
Deepana,pachana,
anulomana. Ashwagandh
a Withania somnifera/
Solanaceae. Tikta, katu.
Laghu, snigdha.
Ushna Madhura Kapha vata shamaka.
Vajikara, krimighna
Aindri Bacopamonnieri/
Scrophulariaceae. Tikta Laghu Ushna Katu Kaphavata
shamaka. Medhya,deep
ana, pachana.
Agaru Aquilariaagallocha/ Thymelaceae.
Katu,tikta Laghu, ruksha.
Ushna Katu Kapha vata shamaka.
Kushtagna, anulomana.
Twak Cinnamon zeylanicum/
Lauraceae.
Katu,tikta madhura.
Laghu,ruksha,
tikshna.
Ushna Katu Kapha vata shamaka.
Deepana, pachana.
Arjuna Terminalia
arjuna/Combretaceae. Kashaya Laghu,
ruksha. Sheeta Katu Kapha pitta
shamaka. Hridya,vrana
ropana.
Jatamamsi Nordostachys jatamansi/Valerianaceae
.
Tikta,kashaya
madhura.
Laghu, snigdha.
Sheeta Katu Tridosha hara.
Medhya,balya.
Tamalaki Phyllanthus urinaria/ Euphorbiaceae.
Tikta,kashaya
madhura.
Laghu, ruksha
Sheeta Madhura Kapha pitta shamaka.
Kushtaghna ,
vranaropana. Varahi Dioscorea bulbifera/
Dioscoreaceae. Katu,tikta madhura.
Laghu, snigdha.
Ushna Katu Tridosha hara.
Krimighna,
anulomana. Talisa patra Abies webbiana/
Pinaceae. Tikta,
madhura. Laghu, tikshna.
Ushna Katu Kapha pitta shamaka.
Shwashar anulomna.
Guduchi Tinospora cordifolia/ Menispermaceae.
Tikta, kashaya.
Guru snigdha.
Ushna Madhura Tridosha shamaka.
Kushtagna, krimighna.
Vidari Pueraria tuberosae/
Leguminosae.
Madhura Guru snigdha
Sheeta Madhura Vata pitta shamaka.
Varnya, hridya.
Tila taila - Madhur
(Kashaya Tikta)
Guru, Vikashi Vishada, Sukshma
Ushna Madhura
Kaphavata
shamaka
Brimhana,
Lekhana,
Tvachya,
Keshya,
Ksheera - Madhura Guru, pichila
Sheeta. Madhura Vata pitta hara.
Prenaneeya,
bhrimhaneeya.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 100
Drug review Review of literature
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
VIRECHANA DRUG4:
Table no.70 Showing Ingredients of Abhayadi Modaka.
Drug name
Latin name/ Family
Rasa Guna Virya Vipaka Doshagnata Karma
Haritaki Terminalia chebula/ Combretaceae
Pancharasa, lavana
varjitha.
Laghu, ruksha
Ushna Madhura Tridosha shamaka
Anulomana,
Deepana, Pachana.
Maricha Piper nigrum/ Piperaceae
Katu Laghu, tikshna
Ushna Katu Kapha vata hara
Deepana
Shunti Zingiber officinale/Zingiberaceae
Katu Laghu,ruksha, tikshna
Ushna Madhura Vata kapha hara
Deepana, pachana
Vidanga Embelia ribes/ Myrsinaceae
Kashaya, Katu.
Laghu,tikshna Ushna Katu Kapha vata shamaka
Krimighna,
Kushtaghna.
Amalaki Emblica officinalis/Euphorbiaceae
Pancha rasa lavana varjitha
Guru,ruksha, sheeta.
Sheeta Madhura Tridosha hara
Rasayana.
Pippali Piper longum/Piperaceae Katu Laghu,snigdha tikshna.
Ushna Madhura Kapha vata hara.
Deepana.
Twak Cinnamon zeylanicum/ Lauraceae.
Katu,tikta madhura.
Laghu,ruksha, tikshna.
Ushna Katu Kapha vata shamaka.
Deepana, pachana.
Mustaka Cyperus rotundus/ cyperaceae
Tikta,katu Laghu,ruksha Sheeta Katu Kapha pitta shamaka.
Balya, medhya.
Danti Baliospermum montanum/
Euphorbiaceae
Katu Guru,tikshna Ushna Katu Kapha vatahara.
Virechaka krimighna
. KARAVELLAKA5
Latin Name: Momordica charantia Linn.
Family: Cucurbitaceae.
Synonyms:-Karavellam,Katillam,Karavelli.
Vernacular Names : Hindi –Karela; Kannada –Hagalkayi, Karate;Telugu –
Kakar,;Bengali –Karla;Marati –Kaarle;Gujrati –Kareli,;Tamil –Pavakka pakal,
Malayalam-Kaipa,English Name- Bitter gourd,Carilla fruit.
Gana: According charaka-Tiktaskand.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 101
Drug review Review of literature
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Botanical Description:
A monoecious much branched climbing annual with angled and grooved stems
and hairy or villous young parts,tendrils simple,slender and elongate.
Leaves-Simple,orbicular,cordate and deeply divided into 5-7 lobes.
Flowers-Unisexual,yellow on 5-10cm long penduncles.
Fruit-5-15cm long,3-valved capsules,pendulous,fusiform,ribbed and beaked
bearing numerous triangular,tubercles.
Seeds- many or few with shining sculptured surface.
Distribution: Cultivated throughout India upto an altitude of 1500cm.
Chemical Constituents: Seeds contain 32% Momordicine,cathartic oil and also
contains volatile oil.Carotens,glucoside and saponin.
Useful Parts: Whole plant.
Rasa Panchaka of Karavellka
Rasa Tikta,katu.
Guna Laghu, Ruksha
Virya Ushna
Vipaka Katu
Doshagnata Kaphapitta shamaka.
Karma Kushtagna,bhedana.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 102
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
CLINICAL STUDY
The development of science greatly depends upon experimentation to reveal the
mysteries of nature and to confirm the previous innovations. The research is
incomplete without evaluating the facts clinically. Thus clinical study plays a pivotal
role in the field of research.
So here is a clinical study entitled “To evaluate the efficacy of virechana with
Karavellaka Patra Swarasa and AbhayadiI Modaka in Eka kushtha w.s.r to
Psoriasis -
A clinical study ” which is under taken with following Objectives:
1. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in
Ekakushta.
2. To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta.
3. To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka as
Virechaka Yogas.
Source of Data:
The patients attending the OPD and IPD of S.J.I.I.M., Hospital, Bangalore .
Methods of Collection of Data:
30 patients who fulfilled the inclusion criteria were selected irrespective of sex,
religion, marital status, socio economic status.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 103
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Diagnostic criteria:
1 .Patients having classical signs and symptoms of Eka kushta supplemented with
features of psoriasis such as patchy circumscribed skin lesions with erythematic
infiltration, silvery scales and itching.
2. Positive Auspitz’s sign.
3. Positive Candle grease sign.
Inclusion Criteria:
a. Patients who fulfills diagnostic criteria.
b. Patients between the age group of 16-70 years.
c. Patients who are fit for Virechana.
Exclusion criteria:
a. Patients below 16 years and above 70 years.
b. Patients suffering from any other systemic disorders along with
psoriasis like Diabetes mellitus, Hypertension, Ischemic heart disease
etc...
c. Patients who are unfit for Virechana.
Study Design: A Randomized Comparative Clinical Study.
Sample size and grouping:
30 patients who fulfilled the inclusion criteria were randomly divided into Standard
Group & Trial Group each consisting of 15 patients:
Group A: Patients of this group was treated with Abhayadi modaka for virechana.
Dose: 1 gm
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 104
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Group B: Patients of this group was treated with Karavellaka patra swarasa for
virechana. Dose: 96ml.
Poorva karma.
Deepana, Pachana Chitrakadi vati 2 tid Till niramavastha is obtained
Sneha Pana Guduchi Ghrita in arohana krama
Till samyak snigdha lakshanas obtained
Sarvanga Abhyanga followed by Drava Sweda
With Yashti madhu Taila On 3 days vishrama kala
Pradhana karma :
Pradhana Karma
Standard group Virechana with Abhayadi modaka
1 course
Trial group Virechana with Karavellaka patra swarasa.
1 course
Assessment Criteria:
Assessment of virechana karma will be based on:
1. Laingiki Shudhi
2. Vaigiki shudhi
3. Antiki shudhi
Assessment of improvement in Psoriatic lesions following treatment was based on
a clinical evaluation and PASI Scale.
Subjective Parameters
0 No itching
1 Mild / occasional itching
2 Moderate frequent itching
Itching
3 Severe frequent itching
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 105
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
4
Very severe itching, which disturbs sleep
and other routine activities.
0 No scaling
1 Mild scaling by rubbing / by itching
(scaling from some lesions)
2 Moderate scaling by rubbing / by itching
(scaling from most of the lesions)
3 Severe scaling by rubbing / by itching
(from all lesions)
Scaling
4 Scaling without rubbing / by itching
(From all lesions)
Objective Parameters
0 No
1 Mild 2 Moderate 3 Severe
Erythema
4 Very severe
4. PASI Scale:
To understand overall effect of Virechana karma on Psoriasis, the Psoriasis
area and severity index (P.A.S.I) scoring method was adopted as follows.
For the PASI, the body is divided into four sections each of these areas is
scored by Skin itself and then the four scores are combined into the final
PASI.
Area: For each Skin Section, measured the amount of skin involve, as a
percentage of the skin just at that part of the body (not the whole body - see
below), and then assign it a score from 0 to 6:
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 106
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Coverage Score
0% 0
< 10% 1
10-29% 2
30-49% 3
50-69% 4
70-89% 5
90-100% 6
Severity: The severity is measured by four different parameters: Itching, Erythema
(redness), Scaling and Thickness (psoriatic skin is thicker than normal skin). Again,
each of these is measured separately for each Skin Section. These are measured on a
scale of 0 to 4, from none to 'maximum', according to the following chart:
Totaling Up the Index: When all 20 of the above scores are figured out, then we can
calculate PASI. For each Skin Section, add up the four severity scores, multiply the
total by the area score, and then multiply that result by the percentage of skin in that
section, as follows:
• Head : (Ihead+Ehead+Shead+Thead) x Ahead x 0.1 = Totalhead
• Arms : (Iarms+Earms+Sarms+Tarms) x Aarms x 0.2 = Totalarms
• Body : (Ibody+Ebody+Sbody+T body) x Abody x 0.3 = Totalbody
• Legs : (Ilegs+Elegs+Slegs+Tlegs) x Alegs x 0.4 = Totallegs
Finally, the PASI is Totalhead+Totalarms+Totalbody+Totallegs. This PASI will
range from 0 (no psoriasis) to 96 (covered head-to-toe, with complete
itching, redness, scaling, and thickness). Thus P.A.S.I. was calculated
Materials required for the study:
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 107
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
The present clinical study was conducted with the following materials:
Drugs –
Purva karma:
1) Chitrakadi Vati.
2) Guduchi Ghrita
3) Madhuyashti Taila
Pradhana karma:
a. Abhayadi modaka .
b. Karavellaka patra swarasa
c. Ushnodaka
d. Sheet jala
• Chitrakadi Vati :
Chitrakadi vati is obtained from dispensing section of SJIIM Hospital
B’lore was used for the purpose of Nirameekarana and Agni deepana.
• Guduchi Ghrita:
Guduchi ghrita was prepared at Sanjeevini Pharmaceuticals, Kengeri-
Bangalore, after procuring the raw drugs from authentic wholesale
dealer
• Madhuyashti taila :
Madhuyashti taila is obtained from dispensing section of SJIIM
Hospital B’lore was used for Sarvanga abhyanga.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 108
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Preparation of Karavellaka patra swarasa:
250gms of fresh leaves of Karavellaka are collected and the juice is extracted from
the freshly collected plant by pounding and straining through a cloth. It was then
filtered and given in the quantity of 96ml.
Abhayadi modaka:
Four tablets of 255mg of Abhayadi modaka from Zandu pharmaceuticals are taken
and crushed into fine powder form and filled into the capsule of 1gm(each of 500mg)
was prepared and given.
Methodology of Study:-
The patients who fulfilled the inclusion criteria underwent routine
Haematological examination ( T C, D C, ESR AND Hb% ) .An informed consent
was taken from the patient before commencement of the treatment.
Then evaluation of subjective and objective parameters was done in patients
and grading was noted.
Intervention:
All the patients were subjected for procedure of Virechana as follows.
Poorvakarma:-
All necessary equipments were arranged. All necessary are collected in
sufficient quantity.
109
Pachana-Deepana was done with Chitrakadi Vati 500mg thrice daily with hot water
till appearance of nirama lakshana.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Snehapana:
After appearance of Nirama lakshana Guduchi Ghrita was administered for the
purpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna Jala
Anupana was given. The Sneha Pana was started with Hrisiyasi Matra i.e 30 ml
.Then according to the symptoms presenting in the individual, the duration taken to
digest the given dose of Sneha, the time of appearance of appetite in the patient , the
next day dose was decided.
In this pattern Arohana karma Snehapana was followed until the appearance of
Samyak Snigda Laxanas.
Patients were advised to avoid exposure to wind , sunlight, emotional upsets, heavy
work, excessive talking, laughing , standing for long time , journey , intake of heavy
meals, night waking , day sleep, cold comforts.
Patients were properly educated about the Laxanas which may appear during
digestion of Sneha, after digestion.
Patients were advised to take only hot water in little quantity till Sneha Jeerna
Laxanas appears.
When patient noticed strong sensation of hunger advised to take the gruel Rice, Ragi,
or Rava according to their food habit.
When the samyak snigdha laxanas observed, the intake of ghee was stopped.
Assesment of Samyak Snighdha Laxanas:
Vatanulomana- assessed by the normal expulsion of the flatus, feces.
Deeptagni- Based on the time taken for digestion of sneha
110
Asamhata Varchas- based on the consistency of the feces .i e stool will be
loose in consistency.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Snigdha varcha- confirmed based on nature of stool. Stool will be sticky or
pasty , floating of feces over water, Sense of oiliness over the fingers on washing
after defecation.
Twak snigdhata- it is assessed by comparing the texture of the skin, before and
after Sneha pana.
Glani- assessed by presence of exhaustion or weakness
Angalaghava- By enquiring with the patient about lightness of the body.
Snehodhvega- Confirmed by the aversion of the patient towards Sneha
Adastath sneha darshana-Appearance of sneha in stool without digestion.
Swedana:
Once Samyak snigdha lakshana appears then, from next day Sarvanga
Abhangya with luke warm Madhuyashti Taila followed by Ushna jala snana
as a part of parisheka sweda was performed.
Thus Bhaya Snehan and Swedan was performed for 4 days and during this
period patient was advised to avoid consumption of Kaphakar Ahara and
Vihara.
Counseling:
On the previous day of Virechana patients were properly educated about the
procedure which helped them to understand the procedure as well as to
prepare them mentally for Virechana.
On the day of virechana :-
Preparation of the patient:-
Patients advised to get up early in the morning and void natural urges. After that they
were subjected for Abhyanga followed by ushna jala Snana in the similar manner like
that of the previous day.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 111
Materials and Methods
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Preparation of Drugs:
Virechana Yoga prepared.
Pradhana karama:
The Virechana yoga was given to patient after ascertaining about the digestion of
previous day meal, sleep and after assessing the psychological condition of the
patient. Virechana Aoushada was given in empty stomach in the morning hours in
between 9.30 AM – 10.00 AM.(Shlema Kalagate).
Virechana with Abhayadi modaka with sheeta jala as anupana in Group A patients
and Karavellaka patra swarasa with sukoshna jala anupana in Group B patients.
Before & after virechana karma, vitals like Temperature, Pulse, Respiratory rate, B.P
were recorded & careful monitor of the patients during virechana process was done.
Just after the administration of Virechana yoga cold water was sprinkled on the face
to prevent vomiting.
Patient was advised to gargle with hot water and avoid exposure to direct cold
wind.
Patients were advised to avoid Pravahana or Vega Dharana
Nireekshana:
Observation of the patient was made for assessing the number of Vegas, Samyak
Virikta Lakshanas and Kaphanta of Virechana vega.
Paschat karma:
After the Virechana vega was stopped, the patients were asked to follow all the
precautions related to Virechana.
After analyzing the procedure, conclusion regarding the Pravara, Madhyama, Avara
shuddhi was made and accordingly the sequence of Samsarjana krama was planned.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 112
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
OBSERVATIONS
A total of 38 patients were screened for the study, out of which 4 patients found fit for
the study. Among these 34 patients, 4 patients did not opt Virechana procedure due to
various reasons. A total of 30 patients registered for the study and no drop out is seen
All the patients were examined before and after the treatment according to the case
sheet format. Changes in both the subjective and objective parameters were recorded.
The data recorded are presented here under the following heading –
I. Descriptive data
II. Data related to the disease
III. Data related to the intervention
Descriptive Data. Table No.71 Showing age wise distribution.
Age AbhayadiGroup
Karavellaka Group
Total %
21-30 4 3 7 23.3
31-40 3 3 6 20.0
41-50 5 3 8 26.7
51-60 3 3 6 20.0
61-70 0 3 3 10.0
Out of 30 patients 7 belonged to the age group of 21-30, 6 belonged to the age group
of 31-40, 8 belonged to the age of group 41-50, 6 belonged to the age group of 51-60
belonged to the age group of 61-70.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 113
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table No.72 Showing Sex wise distribution
Abhayadi group Karavellaka Group Total % Male 13 12 25 83.3 Female 2 3 5 16.7
In present Study 83.3% were Males and 16.7% were Females.
Table No.73 Showing Occupation
Occupation Abhayadi Karavellaka
Total %
House wife 0 3 3 10 desk-work 8 8 16 53.3 Field work 2 0 2 6.6
Physical Labour 4 4 8 26.7
In present study 10% were house wives, 53.3% occupied with desk work,6.6%
occupied with field work, 26.7% occupied with Physical labour
Table No.74 Showing Religion wise distributions
Religion Abhayadi Group
KaravellakaGroup
Total %
Hindu 12 13 25 83.3 Muslim 3 1 4 13.3 christen 0 1 1 3.3
83.3% of the patients were of Hindu community and 13.3% belonged to Muslim
community, 3.3% were Christen.
Table no.75 Showing Socio economic Status
Socioeconomic Status
Abhayadi Group
Karavellaka Group
Total %
Lower middle class 12 14 26 86.7 Upper middle class 3 1 4 13.3
114
The above table shows of patients according to the Socio economic status i.e. 86.7%
from lower middle class, 13.3% from upper middle class.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no.76 Showing Dietary Habits
Diet Abhayadi Group Karavellaka Group Total %Veg 5 1 6 20.0
Mixed 10 14 24 80.0
20% Patients were Vegetarians and 80% Patients were of mixed food Habits.
Table no.77 Showing Marital status
Marital Status Abhayadi Group Karavellaka Group Total %
Married 12 14 26 86.7 Un-Married 3 1 4 13.3
Only 13.3% patients were unmarried were as majority of the patients (86.7%) were
married.
Table no.78 Showing region.
115
Region Abhayadi Group Karavellaka Group Total % Urban 13 13 26 86.7
Rural 2 2 4 13.3
90% belonged to urban area and 10 % were from rural population
Table no.79 Showing Sleep pattern
Abhayadi Group Karavellaka Group
Total %
Diwaswapna 9 9 18 60
60% of the patients are presenting with history of Diwaswapna,
Table 80. Showing Sleep pattern
Abhayadi Group Karavellaka Group Total % Ratri
jagarana 6 2 8 26.7
26.7% are presenting with history of Ratri Jagarana.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no.81 Showing Addictions.
Addictions Abhayadi Group
Karavellaka Group
Total
Only Tea / coffee 2 2 4 Only Smoking 3 - 3 Only Alcohol 1 - 1 Only tobacco 1 1 2
Tea / coffee & Smoking - 3 3 Tea / coffee & Alcohol 3 2 5
Smoking & Alcohol 2 6 8 Smoking & tobacco 1 - 1
No addiction 2 1 3 In 4 patients Addictions to Tea / coffee was seen, in 4 only smoking ,1patient was
Alcoholic,2 patients were addicted to tobacco,3 Patients had addiction towards Tea
/coffee & smoking, 5 Patients had addiction towards Tea /coffee & alcohol, 8 patients
were both Alcoholic & Smokers, 1 had a addiction of Smoking & Tobacco , 3 were
without any addiction.
Table no.82 Showing Koshta.
Abhayadi Group
Karavellaka Group
Total %
Kroora 2 3 5 16.6 Madhyama 13 12 25 83.3
Mridhu 0 0 0 0
In Present Study maximum patients belonged to Madhyama Koshta, only 16.6%
belonged to Kroora Koshta
Table no.83 Showing Prakruti
Prakruti Abhayadi
Group Karavellaka
Group
Total %
Vata Pitta 4 5 9 30.0 Vata Kapha 5 5 10 33.3 Pitta Kapha 5 5 10 33.3 Kapha Pitta 1 0 1 3.3
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 116
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
33.3% patients were of Vata Kapha & Pitta Kapha Prakruti, 30% were of Vata Pittala
Prakruti and 3.3% were of Kapha Pittala Prakruti.
Table No. 84 Showing Satwa.
Satwa Abhayadi
Group Karavellaka
Group
Total %
Avara 2 1 3 10 Madhyama 12 12 24 80
Pravara 1 2 3 10
80% of the patients were of Madhyama Satwa and 10% of the patients belonged to
Pravara and Awara Satwa.
Table No.85 Showing Satmya.
117
Satmya Abhayadi Group
Karavellaka
Group
Total %
Eka Rasa Satmya 0 0 0 0 Vyamishra Satmya 14 13 27 90 Sarva Rasa Satmya 1 2 3 10
90 % were of Vyamishra Satmya and only 10% were of Sarva Rasa Satmya
Data related to the disease.
Table No.86 Showing presence of family History of Psoriasis
Family History
Abhayadi Group
Karavellaka Group
Total %
Present 6 2 8 26.7 Absent 9 13 22 73.3
In 26.7% of the patients there was family History of Psoriasis where as 73.3% of the
patients did not have any family history.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no. 87 Showing mental stress as triggering factor
Abhayadi Group
Karavellaka Group
Total %
Present 13 13 26 86.7 Absent 2 2 4 13.3
In 86.7% of the patients stress was triggering factor of Psoriasis where as 13.3% of
the patients did not have any such history.
Table no.88 Showing seasonal factor.
Abhayadi Group
Karavellaka Group
Total %
Present 14 15 29 96.7 Absent 1 0 1 3.3
In 96.7% winter Season aggravated the condition where as 3.3% not affected
by season
Table no.89 Showing food as aggravating factor.
Abhayadi Group
Karavellaka Group
Total %
Present 2 3 5 16.7 Absent 13 12 25 83.3
In 83.3% food was not a aggravating factor in only 16.7% food was worsening the
condition.
Table no.90 Showing Drugs as aggravating factor.
Abhayadi
Group Karavellaka
Group Total %
Present 1 0 1 96.7 Absent 14 15 29 3.3
In 3.3% drug was not a aggravating factor in only 96.7% drug was
worsening the condition.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 118
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 119
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no.91 Showing infection as triggering factor
Abhayadi
Group Karavellaka
Group Total %
Present 2 3 5 16.7 Absent 13 12 25 83.3
In 83.3% infection was not a triggering factor in only 16.7% infection was worsening
the condition
Table no.92 Showing chronicity.
Chronicity in
yrs Abhayadi
Group Karavellaka
Group
Total %
0 to5 9 8 17 56.6 6 to 10 3 3 6 20
11 to 15 2 3 5 16.6 21 to 30 1 0 1 3.3
56.6% patients were having history less than 5 years, 20 % presented with the history
with in 6-10yrs, 16.6% having history in between 11-15 yrs & 3.3% having history in
between 21-30yrs
Table no.93 Showing Distribution of area
Area Involve
ment
Abhayadi Group
Karavellaka Group
Total %
1 1 0 1 3.33 2 1 3 4 13.3 3 0 4 4 13.3 4 0 3 3 10 5 13 5 18 60
Lesions were distributed in only one area in3.3%,2 areas 3 areas involvement is seen
in 13.3%, 4 areas involvement seen in 10% & in 60% 5 areas involvement seen.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 120
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no.94 Showing details of Itching
Itching Abhayadi Group
Karavellaka Group
Total %
Grade 1 1 0 1 3.3 Grade 2 1 8 9 30 Grade 3 10 4 14 46.7 Grade 4 3 3 6 20
Itching Grading 4 was noticed in 20% , Grade 3 itching was seen in 46.7%, 30% were
e presenting with Grade 2 itching Grade 1 itching was seen in 3.3% of the patient.
Table no.95 Showing details of Erythema
Erythema Abhayadi Group
Karavellaka Group
Total %
Grade 1 4 0 4 13.3 Grade 2 2 8 10 33.3 Grade 3 9 4 13 43.3 Grade 4 0 3 3 10
Erythema Grade1 was noticed in 13.3% , Grade 2 was seen in 33.3%, 43.3% were
presenting with Grade 3 Erythema, Grade 4 erythema was seen in 10 % of the patient
Table no.96 Showing details of area involvement - Head
Head Abhayadi Group
Karavellaka Group
Total %
Grade 1 1 3 4 13.3 Grade 2 6 6 12 40 Grade 3 8 6 14 46.7
In head13.3% were having grade 1 involvement, Grade 2 category was present in
40% of cases, Grade 3 variety was seen in 46.7 % of cases.
Table no.97 Showing details of area involvemet - Trunk
Trunk Abhayadi Group
Karavellaka Group
Total %
Grade 0 2 0 2 6.6 Grade 1 1 3 4 13.3 Grade 2 3 6 9 30 Grade 3 1 6 7 26.7 Grade 4 7 0 7 26.7 Grade 5 1 0 1 3.3
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 121
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
In 2 patients involvement of trunk is not seen. 4 were having grade 1 involvement,
Grade 2 category was present in 9 patients, 7 patients presented with Grade 3 &
Grade 4 involvement , grade 5 involvement was seen in 1 patient.
Table no.98 Showing details of area involvement - Upper limb
Upper Limb
Abhayadi Group
Karavellaka Group
Total %
Grade 0 2 0 2 6.6 Grade 1 0 3 3 10 Grade 2 1 6 7 26.7 Grade 3 10 6 16 53.3 Grade 4 2 0 2 6.6
In 6.6% patients involvement of upper limb is not seen. 10% were having grade 1
involvement, Grade 2 category was present in 26.7% of the patients, 53.3% patients
presented with Grade 3 involvement , grade 4 involvement was seen in 6.6% patients.
Table no.99 Showing details of area involvement- Lower limb
Lower Limb
Abhayadi Group
Karavellaka Group
Total %
Grade 0 0 3 3 10 Grade 1 0 0 0 0 Grade 2 1 3 4 13.3 Grade 3 9 6 15 50 Grade 4 4 3 7 26.7 Grade 5 1 0 1 3.3
In10% patients involvement of lower limb is not seen. 13.3% were having grade 2
involvement, Grade3 category was present in 50% of the patients, 26.7% patients
presented with Grade 4 involvement , grade 5 involvement was seen in 3.3% patients.
Table no.100 Showing details of Auspitz’s Sign + Abhayadi
Group Karavellaka
Group Total %
15 15 30 100
In all the patients Auspitz’s Sign was positive.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 122
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no.101 Showing details of Candle Grease Sign + Abhayadi Group Karavellaka Group Total %
15 15 30 100
In all the patients Candle Grease Sign was positive
Observations Related to Treatment
Observations during intervention:
Table No102 Showing number of days of Sneha Pana
Snehapana
Days Abhayadi
Group Karavellaka
Group Total %
3 7 6 13 43.3 4 5 7 12 40.0 5 2 1 3 10.0 6 1 1 2 6.7
In 43.3% patients Samyak Snighdha Laxana seen in 3 days, in 40% of the patient
Samyak Snighdha Laxanas seen after 4 days of Sneha pana in 10% of the patient
Samyak Snighdha Laxanas seen after 5 days of Sneha pana & in 6.7% of the patient
Samyak Snighdha Laxanas were seen after 6 days of Sneha Pana.
Table No.103 Showing Samyak Snighdha Lakshanas
Samyak Snighda Laxanas
Abhayadi Group
Karavellaka Group
Total %
Vatanulomana 15 15 30 100 Deeptagni 15 15 30 100
Snigdha varcha 15 15 30 100 Asamhata varcha 13 14 27 90
Adstat sneha darshna 10 11 21 70 Snehodvega 13 14 28 93.3
Snigdha twak 10 11 21 70 Anga mardava 10 10 20 66.6 Anga laghava 12 11 23 76.6
Glani 10 9 19 63.3
In all patients Vatanulomana, Agni Deepti, Snigdha varcha features are seen. Asamhata
varcha is seen in 90% of the patients Adstat sneha darshna & Snigdha twak is seen in 70%,
66.6% patients had Anga mardava, 76.6% patients had Anga Laghava, 63.3% had Glani.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 123
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table No.104 Showing Samyak Swinna Lakshana
Samyak Swinna Laxanas
Abhayadi Group
Karavellaka Group
Total %
Sheeto param 10 9 19 63.3 Shoola Param 4 6 10 33.3
Stambha Nigraha 10 11 21 70 Gaurava Nigraha 11 10 21 70
Mardhavata 13 12 25 83.3 Laghuta 12 11 23 76.6
Sweda pradurbhava 15 15 30 100
Sweda Pradurbhava seen in all the patients, Mardavata seen in 83.3% Laghuta seen in
76.6% Stambha Nigraha & Gourava Nighraha seen in 70% Sheeto param seen in 63.3%,
Shoola Param seen in 33.3%
Table no.105 Showing Time required manifesting first Virechana Vega.
Time in minutes
Abhayadi Group
Karavellaka Group
Total %
1-30 1 2 3 10 31-60 7 9 16 53.3 61-90 7 4 11 36.6
Time required manifesting first Virechana Vega after administration of Virechana in
maximum number of patients i.e. 53.3it was between 31-60 minute range, in 36.65 it
was in between 61-90, 10% patients between 1-30 minutes.
Table no.106 Showing Virechana Vegas
Vegas Abhayadi Group
Karavellaka Group
Total %
1-10 0 0 0 0 11-20 15 15 30 100 20-30 0 0 0 0
All the patients had Vegas in between 11-20.Madhyama Shuddhi was noticed in
Patients.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 124
Observations
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Table no.107 Showing Time required for completion of procedure
Time in minutes
Abhayadi Group
Karavellaka Group
Total %
101-200 5 4 9 30 201-300 8 5 13 43.3 301-400 2 3 5 16.7 401-500 0 3 3 10
In 43.3% of the patient time consumed was in between 201-300 minutes,in 30% in
procedure completed in between 101-200, 16.7% procedure completed in between
301-400,in 10% procedure was completed in between 401-500.
Table no.108 Showing Laingiki Shuddhi
No of
Symptoms Abhayadi
Group Karavellaka
Group Total %
6 13 12 25 83.3 7 2 3 5 16.7
In 83.3% percent of the patients 6 symptoms of Laingiki Shuddhi are seen and 16.7%
all the Laingiki Shuddhi features are seen.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 125
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Statistical analysis of assessment of procedure
Table no.109 Showing Statistical analysis is done using Shapiro-Wilk Test
Shapiro-Wilk Group Statistic df Sig.
Abhayaadi .957 15 .647 Time taken for initiation of vega in minutes Karavellaka .953 15 .576
Abhayaadi .965 15 .775 Time taken for completion in min Karavellaka .882 15 .051
Abhayaadi .922 15 .203 Number of Vegas Karavellaka .926 15 .241 Abhayaadi .413 15 .000 Laingiki shudhi Karavellaka .499 15 .000
a. Lilliefors Significance Correction
Group
Time taken for initiation of vega in minutes
Time taken for completion in min
Number of Vegas
Laingiki shudhi
Abhayadi Mean±SD 59.3±15.6 237.33±73 16.8±2.6 6.13±0.4 Karavellaka
Mean±SD 52.20±15 281.93±125 14.00±1.4 6.20±0.4
95% Confidence Interval of the Difference
t df
Sig. (2-tailed) Lower Upper
Time taken for initiation of vega in minutes 1.276 28 .212 -4.315 18.582
Time taken for completion in min -1.192 28 .243 -121.267 32.067
Number of Vegas 3.829 28 .001 1.333 4.400 Laingiki shudhi -.475 28 .638 -.354 .221
RESULTS
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 125
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Statistical analysis of time taken for initiation of Vega
The analysis of mean effect of the parameter time taken for the initiation of Vega
(Bout) between the groups indicates Non Significant Result, (as P>0.05). It implies
that the mean effect of the parameter time taken for the initiation of Vega (Bout) is
same in both the groups.
Statistical analysis of Total Duration taken for the process
Statistical analysis shows that mean effect of the parameter time taken for procedure
s hown Non significant result (as P>0.05).ie the mean effect is same in both the
groups.
From the analysis, the mean effect of the parameter Laingiki shuddhi is Non
significant (as P>0.05).ie the mean effect is same in both the groups.
Statistical analysis of Number of Vegas
The analysis of mean effect of the parameter number of Vegas has shown significant
result (as P<0.05).In Abhayadi Group more Vegas seen compared to Karavellaka
Group.
Statistical analysis of Laingiki Shuddhi
Statistical analysis shows that mean effect of the parameter Laingiki Shuddhi has
shown Non significant result (as P>0.05).ie the mean effect is same in both the groups
The effect of therapy on various parameters of the disease can be studied under two
headings
a) With in the group b) In between the group
126
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Group A
( Abhayadi) Statistic df Sig. Statistic df Sig.
Abhayaadi .367 15 .000 .754 15 .001 ITCHING B
T Karavellaka .326 15 .000 .749 15 .001
Abhayaadi .251 15 .012 .798 15 .003 ITCHING A
T Karavellaka .402 15 .000 .694 15 .000
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Abhayaadi .371 15 .000 .686 15 .000 ERYTHEM
A B T Karavellaka .249 15 .013 .806 15 .004
Abhayaadi .433 15 .000 .530 15 .000 ERYTHEM
A A T Karavellaka .433 15 .000 .530 15 .000
Abhayaadi .331 15 .000 .744 15 .001 SCALING
B T Karavellaka .232 15 .029 .883 15 .052
Abhayaadi .485 15 .000 .499 15 .000 SCALING
A T Karavellaka .449 15 .000 .614 15 .000
Abhayaadi .252 15 .011 .901 15 .098 HEAD B T
Karavellaka .320 15 .000 .783 15 .002
Abhayaadi .214 15 .063 .930 15 .276 HEAD A T
Karavellaka .255 15 .010 .782 15 .002
Abhayaadi .294 15 .001 .850 15 .017 TRUNK B
T Karavellaka .265 15 .006 .832 15 .010
Abhayaadi .169 15 .200* .936 15 .335 TRUNK A
T Karavellaka .186 15 .171 .858 15 .023
Abhayaadi .412 15 .000 .683 15 .000 ARMS B T
Karavellaka .354 15 .000 .755 15 .001
Abhayaadi .352 15 .000 .809 15 .005 ARMS A T
Karavellaka .263 15 .006 .868 15 .031
Abhayaadi .344 15 .000 .817 15 .006 LOWER
LIMB B T Karavellaka .265 15 .006 .832 15 .010
Abhayaadi .373 15 .000 .734 15 .001 TLOWER
LIMB A T Karavellaka .219 15 .052 .888 15 .063
a. Lilliefors Significance
Correction
*. This is a lower bound of the true significance.
Within the group
The data were found to deviate significantly from a normal distribution on Shapiro
Wilk,s normality tests and hence we decided to analyze the data using Wilcoxons
signed rank test for within group change.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 127
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Itching:
Abhayadi group
Z Asymp.sign (2 tailed) Results
-3.376a .001 HS
The P<0.001 indicating the Virechana with Abhayadi Modaka is highly effective in
reducing itching.
In Karavellaka Group
Z Asymp.sign (2 tailed) Results
3.460a 0.001 HS
P <0.001 indicating the Virechana with Karavellaka is highly effective in reducing
itching..
Erythema:
In Abhayadi Group
Z Asymp.sign (2 tailed) Results -3.176a -001 HS
P <0.001 indicates highly significant reduction in erythema after Virechana with
Abhayadi Modaka
In Karavellaka Group
Z Asymp.sign (2 tailed Results
-3.286a 0.001 HS
P <0.001 indicates highly significant reduction in Erythema after Virechana with
Karavellaka .
Scaling:
In Abhayadi Group
Z Asymp.sign (2 tailed Results -3.416a .001 HS
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 128
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
P <0.001 indicates highly significant reduction in Scaling after Virechana with
Abhayadi Modaka.
In Karavellaka Group
Z Asymp.sig (2 tailed) Results -3.126a 0.002 HS
P < 0.002 indicating highly significant reduction in Scaling after Virechana with
Karavellaka.
Area Involvement
Head:
In Abhayadi Group
Z Asymp.sign(2 tailed) Results
-3.207a .001 HS
P <0.001 indicating highly significant reduction in area involvement in Head after
Virechana with Abhayadi Modaka
In Karavellaka Group
Z Asymp.sign (2 tailed) Results -3.689 0.00 HS
P <0.001 indicating highly significant reduction in area involvement in Head after
Virechana with Karavellaka
Trunk:
InAbhayadi Group
Z Asymp.sign (2 tailed) Results -3.176a -001 HS
P = 0.001 indicating highly significant change in area involvement in Trunk after
Virechana with Abhayadi Modaka
In Karavellaka Group
Z Asymp.sign (2 tailed Results -2.970a 0.001 HS
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 129
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
P< 0.001 indicating highly significant reduction in area involvement in Trunk after
Virechana with Karavellaka
Upper Extremity:
In Abhayadi Group
Z Asymp.sign (2 tailed Results -3.071a -002 HS
P <0.002 indicating highly significant change in area involvement in Upper extremity
after Virechana with Abhayadi Modaka
In Karavellaka Group
Z Asymp.sign (2 tailed) Results -3.500 0.000 HS
P = 0.000 indicating highly significant reduction in area involvement in Upper
extremity after Virechana with Karavellaka
Lower Extremity
In AbhayadiGroup
Z Asymp.sign(2 tailed Results
-3.522a
.000
H S
P =0.000indicating highly significant change in area involvement in lower extremity
after Virechana with Abhayadi Modaka
In Karavellaka Group
Z Asymp.sign (2 tailed) Results
-3.169a 0.002 HS
P <0.002 indicating highly significant change in area involvement in lower extremity
after Virechana with Karavellaka
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 130
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
BETWEEN GROUPS:
If we see the P value in all parameters it is < 0.05 indicating the result obtained is
statistically non significant, which means in both the group there was reduction in all
parameters in equal way. This indicates virechana with both the drugs is highly
efficient in eka Kushta.
Test Statisticsb
Itching chn Erythema chn Scaling chn Head chn Trunk chn Arms chn
Lowerlimb
chn
Mann-Whitney U 111.000 98.000 112.000 79.000 91.500 111.500 83.000
Wilcoxon W 231.000 218.000 232.000 199.000 211.500 231.500 203.000
Z -.067 -.652 -.023 -1.599 -.959 -.050 -1.364
Asymp. Sig. (2-tailed) .946 .514 .982 .110 .338 .960 .172
Exact Sig. [2*(1-tailed
Sig.)] .967a .567a 1.000a .174a .389a .967a .233a
a. Not corrected for ties.
b. Grouping Variable: Group
PASI Scale:
Abhayadi Group
Wilcoxon sign rank test has been put to assess the within the group changes.
Here P <0.001 indicates highly significant reduction in P A S I after Virechana with
Abhayadi Modaka.
Test Statisticsb
pasiat - pasibt
Z -3.408a
Asymp. Sig. (2-tailed) .001
a. Based on positive ranks.
b. Wilcoxon Signed Ranks Test
Karavellaka Group
Here also Wilcoxon sign rank test has been put to assess the within the group
changes.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 131
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Test Statisticsb
pasiat - pasibt
Z -3.408a
Asymp. Sig. (2-tailed) .001
a. Based on positive ranks.
b. Wilcoxon Signed Ranks Test
Here P <0.001 indicates highly significant reduction in P A S I after Virechana
with karavellaka patra Swarasa.
Between groups:
COMPARISON OF MEANS
Report Group pasibt pasiat pasichn
Mean 29.8000 7.3200 22.4800 N 15 15 15
Abhayaadi
Std. Deviation 12.56077 4.04125 9.45827
Mean 24.7733 5.0467 19.7267 N 15 15 15
Karavellaka
Std. Deviation 12.26647 3.07870 9.99224
Mann Whitney test has been put to assess the between the group
changes
Test Statisticsb
pasichn Mann-Whitney U 89.500 Wilcoxon W 209.500 Z -.954 Asymp. Sig. (2-tailed) .340 Exact Sig. [2*(1-tailed Sig.)] .345a
a. Not corrected for ties. b. Grouping Variable: Group
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 132
Results
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Here P> 0.05 indicating difference noticed is statistically non significant
which means both the group have show changes in P A S I in similar way.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 133
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
DISCUSSION
Virechana is one of the comprehensive tool of internal purification .It has shown
miraculous effect in many of the long standing stubborn disorders. One of such
disorder which comes in such category is Kushta.
In Ayurveda almost all skin disorders brought under one term i.e Kushta. Under this
one variety of Kshudra Kushta is Eka Kushta whose signs and symptoms co inside
with that of Psoriasis. Aswedana , Mahavastu, Mastya Shakalopama are the feature
mentioned by acharyas for Eka Kushta. Few supplementary explanations mentioned
in Bhava prakasha gives us clear picture of its similarity with Psoriasis.
Matsya Shakalopama explains scaly skin lesion. In Bhavaprakasha, the skin lesions in
Eka Kushtha are Chakrakara (rounded) and Abhraka Patrasama i.e. silvery like mica.
These clinical features are similar as that of psoriasis. Mahavastu refers to
involvement of large area.
Discussion on Material and Methods:-
Present study is a randomized comparative clinical study, where efficacy of Trial drug
has been compared with that of Standard drug.
Here Abhayadi Modaka has been taken as a standard as previous works has already
established its efficacy as Virechaka in Kushta.
Inclusion criteria:
Reason for selecting the age group between 16-70years- as this disease may affect any
of the age group .The lower limit and upper age limit are fixed to these years as in
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 133
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
pilot study it is noted that conducting the procedure is little difficult in age lesser or
more than it.
Exclusion criteria:-
The Systemic illnesses were excluded, as they would interfere with the course of
treatment.
Sampling - Randomization of sampling is done to o avoid any type of bias in the
study.
Lottery method is used for Randomization because of small sample size,
unavailability of all the patients at a time.
Discussion on observations & results:
Total 38 patients were scanned for study but 4 patients did not fulfill the inclusion
criteria. Out of 34 patient 4 patients did not apt the procedure as 1 found it as tedious
procedure, 2 patients could not make daily early morning hospital visit, for one
patient it was difficult to follow the regimens advised.
30 patients registered underwent treatment and no drop out seen in between the
procedure.
AGE:
Out of 30 patients who underwent Virechana 23.3% belonged to the age group of 21-
30, 20.0% belonged to the age group of 31-40, 26.7% belonged to the age of group
41-50,20.0% were of age group between 51-60andin the age group of 61-70 10%
patients were there.
Though psoriasis is a disease that manifests in all the age groups, but it will be in its
peak during the third or fourth decade of life. This is also reflected in present study.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 134
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
SEX:
In present Study 83.3% were Males and only 16.7% were Females. A comparative
data from various epidemiological Studies on Psoriasis Shown that male to female
ratio is 2.46:1. Psoriasis affects the males more and same is found in present Study.
RELIGION:
In present study 83.3% of the patients were of Hindu community and 13.3% belonged
to Muslim community, 3.3% were Christen. This may be because of the present study
was conducted in Hindu dominant area.
REGION:
90% belonged to urban area and 10 % were from rural population. This study is
conducted in urban area so urban population is more in this study.
SOCIOECONOMIC STATUS:
In present study 86.7% were from lower middle class, 13.3% from Lower middle
class family. This study was conducted in government hospital and this shows the
socio economic condition of the patients attending the OPD and IPD of this Hospital.
MARITAL STATUS:-
Only 13.3% patients were unmarried were as majority of the patients (86.7%) were married.
DIET HABIT:
Majority of the patients (80%) were of mixed food Habits& only 20% Patients were
Vegetarians. Thus present study shows importance of non-vegetarian food as
triggering factor for psoriasis.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 135
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
ADDICTION:
In 4 patients Addictions to Tea / coffee was seen, in 4 only smoking ,1patient was
Alcoholic,2 patients were addicted to tobacco,3 Patients had addiction towards Tea
/coffee & smoking, 5 Patients had addiction towards Tea /coffee & alcohol, 8 patients
were both Alcoholic & Smokers, 1 had a addiction of Smoking & Tobacco , 3 were
without any addiction. This shows that 90% of the patients are having one or the other
addiction.
SLEEP PATTERN:
In 60% of the patients there was history of Diwaswapna in 26.7% there was history of
Ratri Jagarana. This shows Sleep pattern is playing definite role in this disease.
PRAKRUTI:
In present study 33.3% of the patients were of Vata Kaha & Pitta Kapha Prakruti,
30% were of Vata pittala Prakruti and only 3.3% were of Kapha Pittala Prakruti. Here
in this study all the Patients had Dvadwa Prakruti especially Vata Pitta and Vata
Kapha & PittaShleshmala Prakruti
FAMILY HISTORY:
In present Study only 26.7% presented with the family history, 73.3% were without
Family history. Modern medical science accept strong genetic predisposition in the
disease. In Ayurveda, Acharya Sushruta has described Kushtha as Adibala Pravrita
Vyadhi.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 136
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
SEASONAL IMPACT:
In 96.7% winter Season aggravated the condition where as 3.3% not affected by
season. This observation coincides with modern texts. In winter there will be
dominancy of Kapha and Vata which causes increase pattern of Vata Kapha Pradhana
Vyadhi like psoriasis.
CHRONICITY:
56.6% patients were having history less than 5 years, 20 % presented with the history
with in 6-10yrs, 16.6% having history in between 11-15 yrs & 3.3% having history in
between 21-30yrs.
AREA INVOLVEMENT:
Lesions were distributed in only one area in3.3%,2 areas 3 areas involvement is seen
in 13.3%, 4 areas involvement seen in 10% & in 60% 5 areas involvement seen. This
show in this disease covers large area.
Discussion on results
Procedure
Time taken for the initiation of Vega:-
The analysis of mean effect of the parameter time taken for the initiation of Vega
(Bout) between the groups indicates Non Significant Result, (as P>0.05). It implies
that the mean effect of the parameter time taken for the initiation of Vega (Bout) is
same in both the groups. Mean time taken by the Abhyadi Modaka is 59.3 where as
Mean time taken by the Karavellaka Patra Swarasa is 52.20.Karavellaka patra swarasa
was little Faster in initiating Vegas.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 137
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
Total time taken for the completion of the procedure:
Difference noted in time taken for the completion procedure was statistically not
significant which denotes both the group took similar time duration to complete the
procedure. This denotes both drugs have taken equal time duration for the completion
of the procedure.
Number of Vegas:-
The analysis of mean effect of the parameter number of Vegas shown significant
result (as P<0.05).In Abhayadi Group mean Vegas were 16.8 where as in Karavellaka
group it is 14.This shows more Vegas seen in Abhayadi Group compared to
Karavellaka Group.
Laingiki Shuddhi
Statistical analysis shows that mean effect of the parameter Laingiki Shuddhi shown
Non significant result (as P>0.05).ie the mean effect is same in both the groups. This
indicates though there are less Vegas in Karavellaka Group it has shown similar
Laingiki Shuddhi as that of Standard drug.
Effect of therapy on disease:
Itching:
Decrease in itching in both the groups after intervention was statistically highly
significant. In between group comparison showed that difference was statistically non
significant indicating Virechana with both drugs has shown similar effect in reducing
number of Pidakas.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 138
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 139
Discussion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
Erythema:
There was significant reduction in erythema after intervention, and when within the
group comparison made difference showed was statistically non significant which
shows Virechana with both drugs has similar effect in decreasing Erythema.
Scaling:
After intervention there was decrease in scaling in both group and statistically it is
highly significant. In between the group comparison showed difference noted is
statistically not significant showing both the group acted in similar fashion in
reducing Scaling.
Area Involvement:
After intervention there was significant difference in area involvement in head, trunk,
Upper & lower limb in both group and statistically it is highly significant. In between
the group comparison showed difference noted is statistically not significant showing
both the group acted in similar way in reducing area involvement.
Effect of therapy on PASI scale:
Both the group has shown highly significant reduction in P A S I Scale after
intervention. In Abhayadi Group mean P A SI was 29.80 before treatment which got
reduced to 7.3200 after treatment, where as in Karavellaka Group mean P A SI was
24.77 before treatment which got reduced to5.04 after treatment,
In between the group comparison showed, difference noted is statistically not
significant which indicates both the group acted in similarly in reducing P A SI scale.
Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 140
Conclusion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
CONCLUSION
The following conclusions can be drawn based on the analysis of the
conceptual part and observations made in the clinical study.
Virechaan karma is one of the radical treatments which throw the disease
causing morbid Dosha out of the body.
Sushruta has placed Karavellaka Swarasa as best Swarasa Virechaka yoga
Abhayadi Modaka is considered as one of the efficacies of Virechka Yoga.
Eka Kushta being a Kshudra Kustha hasVata Kapha dominance but
involvement of tridosha is evident from its signs & symptoms.
A critical literary review reveals that signs & symptoms of Eka Kushta
resembles that of Psoriasis.
Relapsing nature is most common in Psoriasis, which suggests that it needs
intensive therapy and Virechana Karma serve this purpose well.
. Treatment responses of all parameters were highly significant in both the
groups which show that Virechana Procedure is efficacies in treating Eka
Kushta.
Statistical analysis showed that the effect shown by the trial drug is almost
equal to that of the standard drug as a Virechaka. But in case of Vaigiki Shddhi
slight supremacy of Standard drug was noticed.
This study proved the efficacy of Karavellaka Patra Swarasa as Virechaka
Dravya and thus given justice to Sushruta’s statement. Swarase
Karavellakam.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 140
Conclusion
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Limitations
.
With the small sample, limitation of time and facilities it is difficult to
draw any conclusion. However, the results of the study are encouraging, so
the therapy can be tried in a large sample with long period of follow up to
check the re-occurrence of the disease.
SCOPE FOR FURTHER STUDY
Efficacy of other Virechaka Yogas mentioned in classics can be evaluated.
Efficacy of Karavellaka Patra Swarasa as Virechaka can evaluated in other
Virechana Sadhya Vyadhis
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 141
Summary
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Summary
The dissertation entitled “To evaluate the efficacy of Virechana with Karavellaka
Patra Swarasa and Abhayadi modaka in Eka Kushtha w.s r. to Psoriasis:- A
comparative clinical study was undertaken to evaluate the efficacy of Karavellaka
Patra Swarasa as Virechaka Yoga and to find out its efficacy as Virechaka Yoga in Eka
kushtha. As a Standard drug Abhayadi Modaka was taken.
This dissertation comprises of two parts. The first part deals with review of literature
conceptual study and the second section is related to clinical trials.
The first part includes
♦ Introduction
♦ Literary review
The second part deals with,
♦ Material and Methods
♦ Discussion
♦ Summary
♦ Conclusion.
The introductory part a brief account of gravity of the disease and scope for the
study and the rationale behind selecting the particular drug and procedure is
mentioned.
Literary review is subdivided into 3 chapters namely Procedure review, Disease
review and Drug review.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 142
Summary
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Procedure review: In this chapter the historical aspect, vyutpatti, Nirukti, of
Virechana,
Detailed description about Virechan is given under the headings of Poorva, Pradhana
and Paschat Karma.
Disease review: Under this heading the vyutpatti, nirukti of Kushta, functional
anatomy of twak, Nidana Panchaka of Kushta with treatment is explained. Psoriasis
is described in brief.
Drug review: In this chapter Botanical names, Rasa Panchakas, Doshaghnata,
Rogaghnata and Karma of Karavellaka, all the ingredients of Chitrakadi Vati,
Guduchi Ghrita, Madhu Yashti taila and abhayadi modaka is available.
The second part of the study begins with Materials and Method; where in description
regarding the Research design, Sampling and grouping, criteria of selection of
patients, diagnostic criteria, details of inclusion and exclusion criteria, and assessment
criteria for assessing the effects of the therapies has been explained. The clinical study
was done on 30 patients of both sexes, between the age group of 16-70 years. Patients
were randomly divided into Standard & Intervention Group. Standard group received
Virechana karma with Abhayadi Modaka and Intervention Group received Virechana
Karma with Karavellaka Patra Swarasa
There after Descriptive data, Data related to disease and Data related to procedure are
presented in tabular form along with graphs. In the end the results along with
statistical analysis of the results are presented.
Effect of treatment is assessed using P A S I Scale. In Abhayadi group before
treatment mean P A S I Scale was 29.8 which got reduced to 7.32 after treatment. In
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 143
Summary
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in
Karavellaka group before treatment mean P A S I Scale was 24.7 which got reduced
to 5.04 after treatment.
It was concluded that Virechana with both the drugs is highly efficient in management
of Eka Kushta.
Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 144
Reference of Procedure Review
1) Agni purana
2) Manu Smriti
3) Vinayapitaka
4) Indian Medicine in the classical age.
5) P.T.A
6) Cha.Sa.Kalpa sthana.1/4
7) Vachaspatyam
8) Shabakalpadruma
9) Sir Monier Williams
10) Cha.Sa.Kal.1/5
11) Cha.Sa.Kal.1/4
12) A.Hr.Su.1/25
13) Sha.Pu.4/6
14) As.San.Su.27/4
15) Ka.Si.7.
16) Cha.Sa.Su.25/40
17) A.Hr.Su.13/1
18) Cha.Sa.Su.16/16
19) Cha.Sa.Su.20/16
20) A.Hr.1/25-26
21) A.Sa.Su.27/4
22) Cha.Sa.Su.20/16
23) Su.Sa.Chi.33/28
24) Cha.Sa.Kal.1/5
25) As.San.Su.14/4
26) Ch.Sa.Su.1/94-97
27) Ch.Sa.Su.1/107-114
28) As.Sa.Su.14/4
29) Cha.Sa.Su.1/77-85
30) Su.Sa.Su.39/4.
31) As.Sa.Su.14.
32) Su.Sa.Su.44/1,2
33) A.Sa.Su.14/4
34) Sha.Sa.Pu.Kh.4/3
35) D.C. on Su.Su.46/459.
36) Sha.Sa.Pu.Kh.4/4
37) Ch.Sa.Chi.3/171
38) Sha.Sa.Pu.Kh.4/5
39) Ch.Sa.Su.4/9
60) Sha.Sa.U.Kha.4/18
61) Cha.Sa.Kal.8/8
62) Cha.Sa.Su.15/17
63) Sha.Sa.U.Kha 4/16
64) Su.Sa.Chi.33/21
65) Sha.Sa.U.Kha 4/13
66) A.Hr.Su.18/33
67) D.C of Chakrapanidutta on Cha.Sa.Su 15/7
68) D.C of Chakrapanidutta on Cha.Sa.Su15/17
69) Cha.Sa.Si 2/13
70) Su.Sa.Chi.33/32
71) A.Sa.27/8
72) A.Hr.18/8-9
73) Ka.Sa.Si.7
90) Cha.Si.1/6
91) Cha.Su.13/51
92) Cha.Su.28/33
93) Su.Sa.Chi 32/20
94) Cha.Sa.Si
95)Su.Sa.Chi 31/36
96)A.D.Com on 16/29
97)A.Hr.Su 16/7
98)Su.Chi.31/25-27
99)C.C on Cha.su
100)Su.Chi.31/37,44
101)Cha.Su.13/22
102)Ch.Su 13/26
103)Ch.Su 13/23-25
104)Su.Sa.Chi 31/14
105)A.Sa.Su 25/27,28
106)Cha.Su 13/58
107)Su.Chi 31/53
108)A.Hr.Su 16/30
109)Sha.Sa.U.Kha 1/29
120) Cha.Su 15/11,12
121)Su.Chi 33/7
122)Cha.Si 1/8
123)Su.Su 39/10
124)Cha.Su 15/10
125)D.C on Su.Su 40
126)D.C on Cha.Chi 15
127)Sha.Sam
128)Vangasen
129)A.Sa.Su 27
130)Cha.Su 14/80
131)A.Sa.Su 27/28
132)A.Sa.Su 27/31,32
133) A.Sa.Su 27/36
134)A.Sa.Su 27/38
135)Cha.Si 6/26
136)A.Sa.Indu com.
137)Cha.Si.6/26
138)A.Sa.Su 27/38
139)Cha.Su 16/5-10
140)Cha.Si 1/17-19
142)Su.Chi 33/24-27
143)A.Sa.Kal 3/6
144)Cha.Si 1/13-14
145)Sha.U.Kha 3/17
146)Cha.Sa.Su 15/13
147)Su.Sa.Chi 34/9
/20,21 Page no.595 148) A.San.ka 3
59-93 Page no.707-709 149) Ch.Si.6/
150) Su.Chi.34/4-21 Page no.521-525
151) Ch.K.1/5 Page no.654
152)
153)
154)
155)
156)
157)
158)
159)
150)Ka.Sam Si 3
151)Cha.Si 1/12,13
152)Cha.Su 15/16
153)Chakrapani com on Cha.Su 16/2
154)A.H Su 18/29
155)Cha.Su 15/17
156)Cha.Si 12/11-12
157)Cha.Si 6/57
158)Cha.Si ½
159)A.Hr.Su 18/30
160)Cha.Si 1/3-5
161)Cha.Si 1/11
162)Su.Sa.Chi 33
163)Su.Chi.39/17,18
164)Chakrapani com on Cha.Si 6/25
165)Cha.Sa.Si 12/6,7
166)Su.Sa.Chi 39/19,20
167)Su.Chi 39/19,20
168)Chakrapani com on Cha.Si 6/8
169)Su.Chi 39/18,19
170)Cha.Si 6/58-93
171)Su.Chi 34/13,14
172)A.Hr 3/3,4
173)Satuskar RS, Bhandarkar SD, Ainapure SS. Pharmocology &
Pharmacotherapeutics chapter 33. 16th ed. Mumbai: Popular Prakashan
ublications.1999. P
174)Cha.Kal ¼
175) Joel G Hardman and Lee E Limbird, Goodman and Gilman, The
sis of therapeutics, , 10pharmacological ba th ed, Mc. Graw Hill Book Company,
Hamberg: 2001.
Reference of Disease Review
1)Charaka samhita
2) Maharishi Vedavyasa Agni purana
3)Agni purana
4)Indian Medicine in the classical Age
5)History of Medicine and Indian National Science Academy
1) www.Wikipedia.com
2) www.essentialdayspa.com/ acne- myths- and -truths
3) www.pressmediawire.com/ article I D 4626
4) www.emedicine.com
5) www.essentialdayspa.com/ acne- myths- and -truths
6) Su. Sa. Nidana Sthana 13/39 Page no.323
26)Sha Sa.Pu.Kha 5/19-22
27)Vangasena
28)Bhava prakash 54/44;Su.Su 23
29)Yogaratnakara
30)Gada nigraha of Shri Vaidya Shodhala Part 2.
31)Shabdakalpadruma.
32)A.Hr.Ni 14/3
33)Amarakosha
34)Cha.Sa.Chi 5/21-24
35)Su.Sa.Ni 5/3
36)A.Hr.of Arunadatta com
37)Bhela samhita.
38)Madhava nidana madhukosha tika
39)Bhavaprakash
53)Cha.Sa.Chi 7/4-8
54)Cha.Sa.Su 26
55)Cha.Sa.Vi 1
56)Cha.Sa.Su 26/82-84
57)A.Hr.Su 7/29-47
58)Su.Su 20/8-19
59)Cha.Sa.Ni 7/6
60)Cha.Sa.Chi 7/4-8
61)Su.Sa.Ni 5/3
62)Su.Sa.Chi 9/5
63)Vangasena
64)Yogaratnakara.
65)Cha.Sa.Vi.6
66)Cha.Sa.Su 5/11
67)Su.Sa.Ni 6
68)Su.Sa.Ni 6
69)Bhavaprakash
70)Su.Sa.Ni 6/22
71) Su.Sa.Ni 6/22
72)Ch S Vi 7
79)A.Hr.Ni 14/1-2
80)A.Hr.Ni 14/2
81)Cha vi 2/9
82)Cha vi 2/8
83)Cha Sa chi 7/21
84)Su Sa Ni 5/10
85)A.Hr.Ni 14/20
86)Cha.Sa.Chakrapani tika.
87)Cha .Sa.Chi 7
88)Su.Sa Ni 5
89)A.San Ni
90)A.Hr Chi
91) A.Hr Chi
92) Bhela samhita
93)Harita samhita
94)Vangasena.
95)Cha.Sa.Chi 7/21
96)Su.Sa.Ni 5/10
97)A.Hr.Ni 14/20
98)Madhavakra madhukosha tika
99)Cha.Sa.Ni 5
100)Cha.Sa.Su 10/7
101)Cha.Sa.Ni 5/9
102) Cha.Sa.Ni 5/9
103)Cha.Chi 7
104)D Com on Su Sa Ni 5
107)Cha Chi 21
108)Cha.Sa Ni 5
109)Cha.Sa Indriya sthana 12
110)Su.Su 30
111)Cha.Indriya 6
112)Cha.Su 15
113) Cha.Su 15
114)Cha.Indriya 3
115)Cha.Chi 7/37-39
116)Cha.Vi 7/3
117)A.Hr.14/5
118)Cha.Chi 7/41
119)Cha chi 7/31
120)Cha.Chi 7/37-39
121)Su.Chi 9/43
122)Su .Chi 9/6
123)Cha Chi 7/58
124)A.Hr Chi 20/93
125)Cha.Su 25/45,46
126)Su Chi 9/5
127)B.R 54/359-370
Anatomy of the skin References.
1) Shabda Kalpadruma
2) Su. Sa.Sharira Sthana 4/4
3) Cha.Sa. Sharira Sthana 3/6
4) A .Hr. Sharira Sthana 3/8
5) Cha.Sa. Sharira Sthana 7/4
6) Su. Sa.Sharira Sthana 5/6
7) Sh .S. Poorva Khanda 5/19-22
8) A.D.com on A .Hr. Sharira Sthana 3/8
9) G.D.Com on Cha.Sa. Sharira Sthana 7/3
10) Cha.Sa. Sharira Sthana 7/4
11) Su. Sa.Sharira Sthana 4/4
12) Sh .S. Poorva Khanda 5/19
13) Cha.Sa. Sootra Sthana 8/10
14) Su. Sa. Sootra Sthana15/5
15) Cha.Sa. Chikitsa Sthana 15/7
16) Su. Sa. Sootra Sthana15/5
17) .F.A.P.
18) www. Wikipedea. Com
Drug Review Refernces
1)B.R.
2)Sha.SamM.Kha 9/44
3)A.Hr.Chi 22/41-44
4)Sha.Sam U.Kha 4/27-33
5)Dravya guna vignyana by P.V.Sharma 298 pg.no.684.
Bibliography
To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka
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thumb-7- 75- Psoriasis_severity_jpg-400px-
Psoriasis_severity_jpg.htm
42) e-medicine - Psoriasis, Plaque Article by Harvey Lui, MD, FRCPC -
Copy.htm chronic and relapsing disease
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44) Psoriasis Causes - MayoClinic_com.htm
45) Psoriasis Symptom.htm
46) Principles of Pediatric Dermatology - Chapter 33 PSORIASIS.htm
47) National Psoriasis Foundation Plaque psoriasis.htm
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Copy.htm chronic and relapsing disease.
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VOLANTARY CONSENT FORM
I ..................... hereby willingly agree to participate in this
Clinical study. I affirm that there has been no compulsion or monetary inducement in
my agreeing to be Volunteer for this study which I do on my free will. I have been
explained the general purpose of this trial. I am convinced that it is for the benefit of
science and mankind. I understand that the risk involved is very less.
I also agree to remain under observation for long period. I can apt out of the study at any time. Signature of the investigator Signature of Volunteer Signature of the Guide
DEPARTMENT OF P. G STUDIES IN PANCHAKARMA G.A.M.C. BANGALORE
TO EVALUATE THE EFFICACY OF VIRECHANA WITH
KARAVELLAKA PATRA SWARASA AND ABAHYADI MODAKA IN EKA KUSHTHA
W.S.R. TO PSORIASIS.
A COMPARATIVE CLINICAL STUDY ”
GUIDE:-Dr Shalini.C.Eli. P G Scholar: - Dr Srinivas Rao Name of the patient:- O P Number:- Age: - I P Number: Sex: - Ward:- Religion: - Bed number:- Address:- Region:- Educational Status:-P/M/G/PG Occupation:- Socio economic status:-Poor/Lower middle class/Upper middle class/Rich Marital status:-Unmarried/Married/Divorcee/Widow/Widower Chief complaints: - Duration:- Skin lesion over Scalp
Neck:
Upper limb:
Trunk:
Lower limb:
Associated complaints: - Duration:-
Itching: Duration:- Scaling: History of present illness:-
Triggering Factors Injury to skin- Seasonal variations: - Winter/ Summer Emotional status- Infection- Drugs- Others- History of past illness:- Family history:- Treatment history: - Case: - Fresh/Treated/Under treatment Previous medication:-Allopathy/ Ayurveda/ Other Details of treatment:- Personal history:- Diet:- Type:-Veg/Nonveg/Mixed Frequency of intake of food:-
Time of intake of food:-Regular/ Irregular Quantity of food:-Less/ Moderate/More
Rasa dominance:-Madhura/ Amla/Lavana/Katu/ Kashaya/Tikta
Bowel:- Frequency:- Consistancy:- Micturition :- Frequency:- Sleep: - Sound/ disturbed H/O Divaswapna :- P/ A H/o Rathri Jagarana :- P/ A
Habits: - Coffee/ Tea/ Smoking/ Tobacco/Betel chewing/ Drugs/ Alcohol/ Soft drinks/ Snuffing/ none Since:- Emotional Status: - Anxiety/ Tension/Depression/ Irritation/Anger/ Calm Type of Koshta :- Menstrual History:- Obstetric History:- General Examinations:- Built:-: Nourishment:- Pulse rate:- Respiratory rate:- Weight:- Blood pressure:- Height:- Nails:-
Systemic Examination:- Respiratory System :- Cardio vascular System:- Gastro intestinal System:- Central nervous System:- Examination of skin lesions:- Inspection- Type of lesion:- Primary Skin lesions Secondary Skin Lesions:- Scale /Crusts / Lichenification /Fissure/ Scar
Distribution> Shape>
Margin> Erythema >
Palpation of skin lesion:- Surface>
Moisture>
Sweat>
Tests – • Auspitz sign
• Koebner phenomenon
• Candle Greeze sign
PAS I SCALE:
Skin sections
Itching Erythema Scaling Thickness of lesion
Coverage
Area
% of
B,S,A
Total
PAS I
B.T. HEAD10%
A.T.
B.T. ARMS20%
A.T.
B.T. BODY30%
A.T.
B.T. LEGS40%
A.T.
Dasha Vidha Atura Pareeksha: Atura Bhoomi Desha Pareeksha:-
Jangala Desha Anoopa desha Sadharana desha
Jatha
Samvridha
Vyadhita
Atura Deha Desha Pareeksha
Prakrititaha:-
Sarataha:- Pravara/ Madhyama/ Avara
Samhananataha:-Susamhata/ Madhyama/ Asamhata
Pramanataha:-Sama/ Adhika/ Heena
Satmyataha;-Ekarasa/ sarvarasa/Vyamishra Satvataha;-Pravara/ Avara/ Madhyama
Ahara Shakti;-Abhyavarana :-Pravara/ Madhyama/ Avara
Jarana Shakti:-Pravara/ Madhyama/ Avara
Vyayama Shakti:-Pravara/ Madhyama/ Avara
Vayataha;-
Vikrititaha:
Nidana:- Ahara;-
Vihara:- Manasika:- Anya:- Laboratory Investigation;- Blood Investigation
Hbgms%:- T C:- DC:-
ES R:-
CHIKITSA VIDHI Poorva Karma
Deepana-Pachana: Chitrakadi vati 2 -2-2 from to before food
Sneha Pana-:- Guduchi Ghrita from to
Dose of sneha pana & Time taken for digestion of sneha
1st day 2nd day 3rd day 4th day 5th day 6th day 7th day
Dose
Time
SNEHA JEERYAMANA LAKSHANAS:
1st day 2nd day 3rd day 4th day 5th day 6th day 7th day
SHIRO RUJA BHRAMA LALA SRAVA MOORCHA SADA KLAMA TRISHNA DAHA ARATI
SNEHA JEERNA LAKSHANA:
1st day 2nd day 3rd day 4th day 5th day 6th day
7th day
JEERYAMANA LAXANA SHANTI
UDGARA SHUDHI
KSHUDHA PRAVRITI
TRISHNA PRAVRITI
VATANULOMANA
SHAREERA LAGHUTA
SAMYAK SNIGDHA LAXANA:
1st day 2nd day 3rd day 4th day 5th day 6th day
7th day
VATANULOMANA
DEEPTAGNI
SNIGDHA VARCHA
ASAMHATA
VARCHA ADASTAT SNEHA DARSHNA
SNEHODVEGA
SNIGDHA TWAK
ANGA SNIGDHATA
ANGA MARDAVA
ANGA LAGHAVA
KLAMA
SHAITILYA
GLANI
SHODANANGA SWEDANA:
Sarvanga Abhyanga with Yashti madhu Taila for 3 days
Sweda for 3 days
SAMYAK SVINNA LAXANAS:
LAXANAS 1st day
2nd day
3rd day
SHEETOPARAM
SHOOLA PARAM
STAMBHA NIGRAHA
GAURAVA NIGRAHA
MARDHAVATA
LAGHUTA
SWEDA PRADURBHAVA
Virechana Karma with :- Karavellaka Patra Swarasa/ Abhayadhi Modaka
Matra:-
Anupana:-
Date of Virechana:-
Time of vega Prarambha:-
Time of vega Antya:-
Time of Vega Number of Vegas Nature of the stools
Laingiki Vegiki Aantiki Sroto Shudhi
Indriya Prasadhana
Shareera Laghuta
Agni Deepti Anamayatva vatanulomana
ASSESSMENT CRITERIA B.T. A. T.
Itching
Erythema
Scaling
Body area involved Head Trunk Upper extremity Lower extremity
PASI Scale
Investigator’s Notes:- Signature of the P G scholar Signature of the guide
Graph no 16 Family history Graph no17 Stress as aggravating Factor
Graph no 18 Season as aggravating Factor Graph no19 food as aggravating Factor
Graph no 20 Drugs as aggravating factor Graph no 21 Infection as aggravating factor
Graph no 1 Age wise distribution Graph No2 Sex wise distribution
Graph No 3 Religion Graph No4 socio economic Status
Graph no 5 Diet Graph no 6 Marital Status
Graph no 7 Occupation
Graph no 8 Region Graph no 9 History of Diwa Swapna
Graph no10 History of Ratri Jagarana Graph no 11Prakruti
Graph no12 Satwa Graph no13 Satmya
Graph No14 Addiction Graph no15 Koshta
Guduchi moola Guduchi Choorna
Karavellaka Plant Karavellaka Patra
Karavellaka patra Swarasa Abhayadi Modaka
Graph no 22 Gradings of Itching Graph no 23 Gradings of erythema
Graph no24 Area involvement in Head Graph no 25 Area involvement in Trunk
Graph no 26 Area involvement in Upper limb Graph no27 Area involvement in Lower limb
Graph no 29 showing + auspitz sign Graph no 30 showing Candle Grease Sign +
Graph no 31 days of Sneha Pana Graph no32 Samyak Snighdha Laxanas
Graph no 33 Samyak Swinna Laxanas Graph no 34 time taken for initiation of Vega
Graph no 35 showing Number of Vega Graph no36 time taken for completion
Graph no 37 Laingiki Suddhi