kustha case presentation

1

CASE PRESENTATION

VINAY TIWARI

FINAL P.G. SCHOLAR

DEPARTMENT OF P.G. STUDIES IN

KAYACHIKITSA

SKAMCH&RC

BANGALORE

PREMILINARY DATA OF PATIENT

Name : Mrs. Shashikala

Age : 37 Years

Sex : Female

Religion : Hindu

Socio economic status : Middle class

Marital status : Married

Education status : 9th Standard

Occupation : Peon (Aaya) in school.

Date of admission : 02/07/17

Date of discharge : 09/07/172

Ward : Female General Ward

Source of history : Patient

Case taken on : 07/07/17

Consultant doctor : Dr. Nayan

O.P No : E-20851

I.P. No : 2624/17

Address : # Nelamangala

3

PRADHAN VEDANA

C/O Sputhna in both hasta pradesha associated with

sotha, daha, srava yukta pidakas and kandu since 3

years.

4

ANUBANDHA VEDANA

Stabhdhata in hasta pradesha when srava dries up

5

VEDANA VRUTTANTA

Patient is suffering from pidakas, all over the body

associated with kandu on and off since 3 years and

subside on medication. The pidakas develop any where

in the body and subsides on medication. 3 months

back when she resumed her work after which rashes

appeared with sputhana in both hasta pradesha

associated with shotha, and srava yukta pidakas with

kandu since 3 years .6

Presently the patient has severe lesions in her both

hand and itching all over the body with healed marks

of previous lesions. Rashes appeared extensor surface

of b/l hand and left palm with severe itching and it

spreads to right palm and b/l foot region due to severe

itching all fingers became oedematous and multiple

fluid filled lesions appeared on the palms which burst

open, oozing clear fluid which was foul smelling

because of the swelling of the fingers patient is unable

to do closing and opening of the fist.7

After the lesion bursted it was associated with

burning sensation and pricking type of pain .

For the above complaints she got admitted to

SKAMCH & RC

8

POORVA VYADHI VRUTTANTA

Nothing contributory.

Patient is not a k/c/o Diabetes Mellitus,

Hypertension, Tuberculosis, Asthma

9

TREATMENT HISTORY

IN SAPTHAGIRI HOSPITAL (12/12/16 to 24/12/16 )

1) Inj. Avil 0-0-1 (IM)

2) Inj. Betnisol 1-0-1 (IV)

3) Clonate lotion (E/A) @ night

Advice on discharge

1) Tab Teczine 0-0-1

2) Sper lotion (morning)

3) Clonate lotion (night)

10

FATHER MOTHER

HUSBANDPATIENT

SON

KAUTAMBIKA VRUTTANTA

All family members are said to be healthy.

No one is suffering from similar set of complains.

VYAKTIKA VRUTTANTA

Diet : Mixed (non veg 2 to 3 times in a month)

Appetite : Moderate

Bowel : once per day (constipated)

Bladder : 4 to 5 times/day (Occasionally burning

1 to 2 times/night. Micturation)

Sleep : Disturbed

Habit : Tea / coffee 3-4 times/day

Rajo vruttanta

Menarche - @ 15 years of age

Cycle – Irregular till age of 26, later said to be regular 12

Present M.C. 3-5 days

28-30 days

L.M.P. – 27/6/17

Presentely no history of dysmennhorea

Old History 8-10 days of bleeding

Married @ the age of 26

PRASAVA VRUTTANTA

G2 P1 L1 A1 D0

P1 - FTND (Son) 13 year age

Underwent tubectomy after 3 years i.e., @ 29 years

of age due to restraint relationship with her husband. 13

GENERAL PHYSICAL EXAMINATION

General Condition : Fair.

Built : Moderately built.

Nourishment : Moderately Nourished.

Pallor : Absent.

Oedema : Present over both hands

Nails : Pitting

Cyanosis : Absent.

Icterus : Absent.

Lymphadenopathy : Absent.

Pulse :78 bpm. 14

BP :120/80 mmHg.

R/R :18/minute.

Tongue :Coated.

Height : 1.55 m

Weight : 57.5 Kgs

BMI : 23.95

15

PER ABDOMEN EXAMINATION

Inspection – Shape of abdomen – Scaphoid

Umbilicus – Normal, Inverted

Hyperpigmentation scars over abdomen

Stria marks present

Palpation – Soft , no tenderness, No organomegaly

Percussion – Tympanic sounds heard except the area of

Liver dullness.

Auscultation – Peristaltic sounds heard. 16

RESPIRATORY SYSTEM

INSPECTION

Shape of chest - Bilaterally symmetrical

PALPATION

Trachea - Centrally placed

Tactile Vocal Fremitus -Normal

PERCUSSION

Resonant sounds heard except the cardiac dullness.

AUSCULTATION

Normal Vesicular Breath Sounds heard

17

CARDIO VASCULAR SYSTEM

INSPECTION - No scar, No swelling .

PALPATION - Non tender, Apex Beat felt at 5th

intercostal space 9 cm from the mid sternal line.

PERCUSSION - Defined Area of cardiac dullness.

AUSCULTATION - S1 and S2 heard.

No added sounds heard.

No murmurs heard.

18

CENTRAL NERVOUS SYSTEM

Patient is conscious, well oriented to time, place

and person.

NAD

19

INTEGUMENTARY EXAMINATION

Skin

Colour – Normal skin colour

Lesio - Secondary

Character – Size -: Small

Colour -: Dark black

Shape -: Asymmetrical

Individual Lesion

Extensor surface – Papule

Palm, Soles – Flake

Scales present

Nature – Dry Flake20

Itching – Present

Discharge – Absent (present when new lesion occur)

Distribution of lesion – Symmetrical

extensor surface

On exposed body parts

Superficial sensation of lesion – Normal

Candle grease sign – Positive

Auspitz sign – Positive

Koebner phenomenon - Positive21

DASHAVIDHA PARIKSHA

1) प्रकृति: –: Vata Pittaja.

2) सारतः –: Madhyama.

3) संहनि –: Madhyama.

4) प्रमाणतः –: Height - 1.55 m

- : Weight – 57.5 kgs.

5) सात्म्यि –: Madhyama.

26

6) सत्मवि –: Madhyama

7) आहर शक्ति -: अभ्यवहरण शक्ति – Avara

-: जरण शक्ति – Avara

8) व्यायाम शक्ति –: Avara

9) वयः –: Madhyama

10) ववकृति –: Pravara

27

NIDANA PANCHAKA

NIDANA : Viruddhahara, mandagni, ati vyayama after

snigdha bhojana, snana after bhojana in the

night everyday, chinta, shoka, uses of acidic solution

for cleaning in school

SAMPRAPTI GHATAKA:

Dosha : Tridosha

Dushya : Twak, Mamsa, Rakta, Lasika.

Srotas : Rasa, Rakta, Annavaha28

Sroto dusti : Sanga

Agni : Jathragni

Ama : Jathragni

Udbhava sthana : Twak, Mamsa, Rakta, Lashika

Sanchara sthana : Sarvasarira

Vyakta sthana : Twak, Mamsa

Roga marga : Bahya

Vyadhi Svabhava : Chirakari.

Sadhya asadhyata : Krichra sadhya.29

SAMPRAPTI

Nidana sevana Tridosha prakopa

Spreaded in triyak gata shiras

Twak, Rakta, Mamsa, Lasika

Dosha-Dushyas takes sthanshanshraya in Twak

Leads to mandaloutpatti

Kustha cont…30

Kustha

Viruddhopkrama or Nidana sevana

Causes Flaring up of lesions

Resulting to Vaipadika

31

POORVAROOPA

ROOPA

Sputhna in both hasta pradesha associated with sotha,

daha, srava yukta pidakas and kandu.

UPASAYA : Aushadha sevana.

ANUPSAYA: Nidana sevana.

32

VYAVECHADAKA NIDANA

inclusion exclusion

Vaipadika pani, pada, sputhana, tevra

vedana, kandu, raga, red

colour pidakas

Vicharchika kandu, srava in pidikas,

krushna shyava varna,)

Eka kustha Krushna varna,

aswedana

Vruna vastu

Pama Rakta varna pidakas,

kleda yukta srava, ati

vedana, hastha , kurpara

sandhi pradesha

Sweta, shyama varna

pidakas, nitamba

pradesha,

Charma dala Kandu yukta, toda Rakta varna

33

DIFFERENTIAL DIAGNOSIS

Inclusion Exclusion

Pustular psoriasis

Nail beds, palms, soles

Fever, trunk, extrimities,

Echzema Primary lesions are

erythematous macules,

papules and vesicles

than patches and

plaques.

Atopic dermatitis with

Hand dermatitis

Aggravated by repeated

wetting and by washing

of the hands with harsh

shoaps, detergents, and

disinfectants, dryness,

pruritis, Nails pitting

Psoriasis (plaque) Palms Well defined

erythematous plaques

with silvery scale, with

predilection for the

scalp, extensor surface,

sub mammary or axillary

folds

34

35

Palmoplantar psoriasis Scaly plaques, thickening

and scaling of the entire

surface of palms without

redness

soles

Allergic dermititis Pruritic, eczematous

dermatitisinitially localized

to the primary site of

allergen exposure,during

acute phase edema,

erythema and vesicle

formations as the vesicles

rupture oozing papules

plaques appears

Irritant contact dermititis Burning sensation more

with above symptoms

36

Lepromatous leprosy Rash – numerous small

symmetrical

hypopigmented macules

with normal sensation and

indefinite edeges

Face, extensor surface of

limb and upper trunk,

sparing the midline of

back, axillae, groins,

scalps

VYADHI VINASCHAYA

Kustha with Vipadika

Psoriasis with Irritant contact dermatitis

37

CHIKITSA VRUTTANTA

DATE LAKSHANA CHIKITSA OBSERVATION

02/07/17 Burning sensation in the palm

region with itiching all over the

body

Snehapana with

aragwadadhi mahatikta

ghrita 30 ml


region with itiching all over the

body

Snehapana with

aragwadadhi mahatikta

ghrita 60 ml

38

DATE LAKSHANAS CHIKITSA OUTCOME

04/07/1

7

Burning sensation in the

palm region with itiching

All over the body

Snehapana with aragwadadhi

mahatikta ghrita 90 ml

Itiching Increased

slightly

05/07/1

7

Burning sensation in the

palm region with itiching

all over the body

Snehapana with aragwadadhi

mahatikta ghrita 120 ml

•Itiching reduced

slightly

39

DATE LAKSHANA CHIKITSA OUTCOME

06/07/17 Burning sensation

in the palm region

with itiching all

over the body

Sarvanga abhyanga with

suryapaki talia f/b baspa sweda

day 1

07/07/17 Burning sensation

in the palm region

with itiching all

over the body

Sarvanga abhyanga with

suryapaki talia f/b baspa sweda

day 2

Burning sensation

increased

40

DATE LAKSHANA CHIKITSA OUTCOME


region with itiching all over

the body

Sarvanga abhyanga

with suryapaki talia f/b

baspa sweda day 3

Burning sensation

reduced


region with itiching all over

the body

Virechana karma with

Trivrut avaleha 50 gm

with 100 ml triphala

kashaya

No of vegas 16

She had 2

episodes of

vomiting(reduced

after taking nimbu

water)

41

PROPOSED LINE OF TREATMENT

Snehapana with mahatiktaka ghrita

Sarvanga abhyanga with Marichadi taila

Virechana with Trivrut, Danti & Triphala with souveeraka

Manjisthadi kwatha

Tandula lepa

Unmatta taila for external application

Dhattura beeja kalka lepa

Kanaka bindu arista with krutmala kwatha

Tab – Arogya vardhini

Tab – Gandhak rasayana

Mustadi churna for Shotha

Bhallataka rasayan

Tuvarak rasayan (Ah.Chi.19/53)

Tuvaraka taila 10 ml for internal purpose kostha suddhi42

PATHYA & APATHYA

43

Laghu aahara, tikta rasa

pradhana, ghruta,

bhallatak, triphala, nimba,

purana dhanya, jangala

mamsa, mudga, patola,

Laghu vyayama,

Siddhartha snana,

abhyanga

Viruddhara (amla, payo,

dadhi, anupa mamsa, matsya,

guda, tila)

Divaswapna, mala-mutra

vega dharana.

THANK

YOU44

Su su 9/6

Ubhaya gata shodhana

Twak gata – alepa chikitsa by shodhana

Shonita gata – Samshodhana, kashaya pana,

shonitavsechana

Mamsa gata – Shodhana, aalepana, kashayapana,

rakta mokshana, arista prayoga, mantha prayoga,

prasha prayoga

Medo gata – Bhallataka, shilajita, swarna makshika,

guggulu, agaru, tuvaraka, khadira, asana, ayaskriti,

Later dhatus it become asadhya so no chikitsa 45

46

Kapala Kustha

Vata dosha pradhanata

Krushna-aruna varna

Ruksha

Parusha

Tanu

Toda vahula

Alpa kandu

Alpa daha

Alpa puya

Audambara Kustha Daha

Kandu

Ruja

Redness

Kapila varna

Pakva phala sannibham

Mandala kustha Sweta and rakta varna

Sthira

Styana

Snigdha

Mandala akriti (coin

shaped)

Kruchrounnata

Hrushyajihwa kustha Karkasha

Shyava

Vedana yukta

Rakta varna over edeges

Hrushya jihva sannibham

Pundarika kustha Sweta varna yukta

Red

47

VEDANA VRUTTANTA

Patient was apparently healthy 3 years back suddenly she

developed rashes over the face associated with itching

sensation. She also noticed blackish discolouration of

upper lip and there was thickening of skin along with

itching for this she consulted Adarsh clinic and was

prescribed with some oral medication and topical

applications (details are not known) After 3-4 days of

taking them she developed severe itching in both eyes

and ears and also rashes spread to whole body.

48

She also developed ulcers in the mouth and cracking of the

angle of the mouth bilaterally which was very painful.

For this she consulted another clinic there they suggested

some investigation all was in normal. Than prescribed

some medication and ointments for 3 months. Initially

symptoms relieved after taking medication for 1 month

later suddenly developed a fluid filled lesion over her

right arm in flexor aspect which spread to forearm within

20 days associated with severe itching, pricking type of

pain and foul smell and clear liquid oozing from it.49

Meanwhile she got loose stools on and off with a gap of

about 8-10 days three times. No of episodes of watery

loose stools was 10 – 20 times. She used to take tab

Eldopar everytime it occurred and get relief. Pt felt that

she is getting loose stools because of the oral medications

which was given for the rashes so she discontinued after

few days her symptoms like itching sensation all over the

body and in eyes, ears, buttocks got aggravated. Thus for

the above she got admitted in Saptagiri hospital for 10

days.

50

They did some blood investigations and injectable were given. She

found moderate relief as the ulcer over the right forearm

completely healed, itching in the eyes and ears reduced. But itching

sensation all over the body still persisted (on itching she used to get

rashes) after 4 months , (rashes appeared extensor surface of b/l

hand and left palm on severe itching. And it spreads to right palm

and b/l foot region due to severe itching all fingers became

oedematous and multiple fluid filled lesions appeared on the palms

which burst open , oozing clear fluid which was foul smelling

because of the swelling of the fingers pt is unable to do closing and

opening of the fist.)

51

After the lesion bursted it was associated with burning

sensation and pricking type of pain . For the above

complaints she got admitted to skamc h&rc

52

Tiktashatpalak ghruta (ch.chi.7/140-143)

Mahatiktaka ghruta (ch.chi.7/144-150)

Mahakhadira ghruta (ch.chi.7/152-156)

Khadira, nimba, darvi ghruta (ch.chi.7/135)

Sarvakushta- By bhallataka taila, tuvaraka taila etc.

(Su.Chi.9/7)

Kusthaghna hitakar taila (ch.chi.7/119)

Vipadika hara ghruta-taila (ch.chi.7/120,121)

Swetakarveradh taila

Swetakarverapallavadh taila

Tiktekshvakadi taila

Kanakakshiri taila

Vipadikaya dhatturbija taila

Aarogyavardhini vati (R.RS.)

Saptasama gutika

Triphala gutika

Gandhaka rasayana

Panchatiktaghrita guggulu

Marichaditailam,

Somarajitaila,

Chitraka rasayan

Bhallataka rasayan


Bhallatakavaleha, 53

CONTENTS Introduction

Shodhana

Shamana

Rasayana

Kustha

Kustha bheda

Mahakustha

Kshudrakustha

Vamana

Virechana

Basti

Nasya

Raktamokshana

Samanya chikitsa

Rasayana chikitsa

Conclusion 54

INTRODUCTION

Skin that covers the major part of the body when it

is diseased causes social stigma. It is important to

maintain the health of skin in order to ward off

various skin diseases explained under the heading of

‘Kushta’.

Any disease in Ayurveda is managed with Shodhana,

Shamana & Rasayana chikitsa.

The same is true for Kushta.

It is important to understand the concept, indication

and appropriate use of these to get optimum results

55

SHODHANA यदीययदहहदोषान ्पन्चधा शोधनं च िि ् ।

तनरुहो वमन ्ं कायशशरोरेकोस्त्रववस्त्रतुि: ॥ Shodhana is the process by which vitiated doshas are eliminated

from the body through the nearest orifice.

(अ.ह्.सू 14/5)

स्त्थानाद् बहहनेयेदरू्धवयमर्धयो वा मलसंचयम ।देह्ंंस्त्ंशोधनं ित्मस्त्याद् ॥(शा. स.पू.4/9)

Drugs which dislodge the body wastes from their places and

expel them forcibly either in upward or downward direction are

deha samshodhana.

56

TYPES

1. तनरुह्2. वमन3. ववरेचन4. शशरोववरेचन ्5. रतत्ममोक्षण ्

57

SODHANA -INDICATION

अववपाक अरुचच स्त्थौल्य पाण्डुिा गुरुिा तलम वपडका कोठ कण्डू अतिय आलस्त्य

श्रम दौबयल्य अतिदगुन्ध अवसाद् कफवपत्त उत्मतलेशो अतनद्रा अतितनद्रा िन्द्रा तलैब्य अबुचधत्मव अप्रशस्त्ि स्त्वप्न दयशनम ् बलवणयप्रणाशश्र्च िपृ्यिो

बृंहणरैवप

BENEFITS :-

एवं ववशरु्धद् कोष्ठस्त्य कायक्ननराशिवधयिे ।.............िस्त्माि ् सं्त्शोधन ्ं काले युक्तियुति ्ं वपवेन्नरे ॥(च.सु16/17-

19)

Charaka while elaborating the effects of Samshodhana says

that it enhances Kayagni, Upashamana of vyadhi & health

returns to normal.

Indriya, Manas, Buddhi, Varnas become clear & acquires

bala, pusthi, apatya, vrishata. His aging is retarded & he lives

a long life free of diseasea. Hence he emphasized to take

Samshodhana at a proper time & skillfully administered.

59

IMPORTANCE :-

दोषा कदचचि कुप्यक्न्ि क्जिा लंघनं पाचने ।क्जिा सं्त्शोधनेयय िु न िेषां पुनरुर्धव ॥ (च.सू.16/20)

Charaka has said that the doshas controlled by

Samshamana are having the possibility of reprovocation

while there is no such probability in case of the control of

the doshas by Samshodhana.

60

SHAMANA

न शोधयति यदोषान ् समान्नोदीरयत्मयवप । समीकरोति ववषमान ् शमन ्ं िच्चसप्त्मधा ॥ पाचनं दीपन ्ं क्षुत्तड्वव्यायामािपमारुिा । बं्रह्ंण ्ं शमन ्ं त्मवेव ्ं वायो वपत्ततनलस्त्य च ॥ (अ.ह्.स.ू14/6,7)

The process by which vitiated doshas are pacified or nullified is

called Shamana.

न शोधयति न द्वेक्ष्ि समान ्दोषांस्त्िथोर्धदिान ् ।

समीकरोति ववषमाव्यशमन ्ं िधथास्त्रुिा ॥ (शा.पू. 4)

Drugs which bring down the increased dosha to normal without

expelling them out and not interfering with the dosha which are

normal are called shamana (palliatives) . 61

RASAYANA

लािोपायो हह शस्त्िानां रसदीनां रसायनम ् । (च.चच.1/1/8)

यज्जरा व्याचध ववक्र्धव्ंस िेषज ्ं िद रसायनम ॥(शा.pu 4/14)

Benefit

दीघाययु स्त्रतिय मेधामारोनय ्ं िरुण ्ं वय ् । प्रिावणयस्त्वरौदयं देहेक्न्द्रयबल ्ं परम ्॥ वाक्तसक्र्धद प्रणतिं काक्न्िं लििे ना रसायनाि ् । (च.चच.1/1/7,8)

62

Types

कुहिप्रावेशशक चरक (च.चच. 1/1/16)

वािािवपका वानिट् (अ.ह्.उ.39/5)

का्य (बल-बुक्र्धद-व्रक्र्धद)

नेमेवत्तक् (व्यचध नष्ट्) (dalhana स.ुचच27/3)

आजाक्स्त्रक (दनुध-घ्रुि सेवन ्ओज व्रुक्र्धद)

स्त्ंशोधन ् स्त्ंशमन ्

63

वय ् स्त्थेययकराणांमयन ्ं लािोपायो रसायनम;् वधयकं्स्त्थापकमप्राप्िमापकं् वेत्मयथय (ड्वल्हण)्

Before administring any rasayan first do kostha suddhi

with Haritakyadi choorna along with ushna jala.

(च.चच.1/1/25-28)

Rasayana should be used in युवा & मर्धयमवस्त्था as the

colour not look good on malina vastra so as the

rasayana can not be beneficial in the asudha sarira

(स.ुचच.27/3,4), (अ.ह्.उ.39/11)

64

RASAYANA SEVANA AYOGYA

PURUSHA

Anatmavaan

Aalaso

Daridra

Pramadi

Vyasani

Papakrud

Bheshajaapmanani (स.ुचि.30/4)

65

KUSTHA कुष्णाचत च ःशषेणे् चवलेख ््ं करोचत अ्ंग् प्रत्यङ्च इचत कुष्ठम् ॥ (चसद्धान्त्

कौचमचि)

कुष्ठ is a condition in which different body organs , dhatus, updhatus,

are destroyed & contempted.

त्मवच कुवयक्न्ि वेवण्य ्ंय दषु्िां कुष्ठमुशाक्न्ि िि ।One which produces discolouration over skin region is said to

be kustha.

कालेनोपेक्षक्षि ्ं यस्त्मात्मसवं कुष्णाति िद् वपु ॥During the lapse of time, it makes the entire body look ugly.

(अ.ह्.तन.14/3)

66

कुष्ठ िेद कुष्ठातन सप्िववधान्यष्िादशववधान्यपररसखं्येयववधातन च ।

(च.तन.5/4 )

67

सप्िववधाअष्टादशविधा

अपररसंख्ये

महाकुष्ठ7

क्षुद्रकुष्ठ11

अष्िादश

कुष्ठ

महाकुष्ठमहाकुष्ठ लक्षण िोष प्रधान्यत

कापाला कृष्ण, अरुण, कपालाभ, रुक्ष, परुष, त ,ु अचततोि, चवषम्ं स्मतृम. वातज

औदुम्बर िाह, राग, कण्डुयकु्त,रुक, परीत, रोमचपञ्जरम, उिमु्बरफलाभास. चपत्तज

मण्डल श्व्वेत, रक्तवणण, चस्िर, स्त्या , चस् ग्ध, उत्सन् मण्डलम, कृच्छ्र् साध्य. कफज

ऋष्यजिह्व वेि यकु्त, रक्तपयणन्तमन्त:श्वयाव, यदृष्यचजह्व स्ंस्िा ्ं. वतचपत्तज

पुजण्िक श्वेताभ , रक्तपयणन्त like पचुण्िकिल, उन् त ,

िाह यकु्त.

चपत्तकफज

जिध्म श्वेत, ताम्र, त ु lesions, usually situated on the उरु from which

scales like अलाबपूषु्पवणं fall off on rubbing

वातकफज

काकण गञु्ज वणण, सपाक, चतव्र वेि , असाध्य. चििोषज 68

क्षुद्र कुष्ठक्षुद्र कुष्ठ लक्षण िोष प्रधान्यत

एककुष्ठ

चमायख्यं

स्त्वेदरहहि, मस्त्यशकलोपमम, महावास्त्िु .

बहलं , हक्स्त्िचमयवि .

वाि-कफ

वाि-कफ

ककहिि श्यावं, ककण्खरस्त्पशय, परुषं, ककहििं स्त्मिृम ् .वाि-कफ

वैपहदकं पाणणपादस्त्फुिन,ं तिव्रवेदना. वाि-कफ

अलसक कण्डुयुति, सरागैश्र्च, गण्डरैलसकं् वाि-कफ

दद्रमुण्डलं कण्डु, राग, मुदगावि वपडडका वपत्त-कफ 69

क्षुद्र कुष्ठ लक्षण िोष प्रधान्यत

चमयदल कण्डु, स्त्फोि, रतिवणय, सशलू, असहहष्णुिा, रुग. वपत्त-कफ

पामा श्वेि, अरुण शयाव वणय , कण्डुयुति वपडका वपत्त-कफ

ववस्त्फोि िनु, त्मवकयुति, श्याव अरुण वणायत्ममक वपडकावपत्त-कफ

शिारु रतिश्याव वणायत्ममक, दाहयुति, बहुव्रणी कुष्ठ . वपत्त-कफ

ववचचचयका सकण्डु, श्याव वणय वपडक, बहुस्राव कफ70

कुष्ठगि दोष लक्षण वातज : रौक्ष्य्ं,शोष, तोि, शलू, स्ंकोि ्ं, पारुष्य्ं,

खरा भाव, हषण, श्वयाव अरुण्ं .

चपत्तज : िाह, राग, पररस्राव,पाक, चवस्रगचन्ध, क्लेि, अ्ंगपत ्ं.

कफज : श्र्वेत्य, शतै्य,कण्डु, स्िैय, उत्सेध, गौरव, स् ेह, क्लेि,

जन्तचुभरचभक्षण्ं

(ि.चि. ७/३४-३६)

71

कुष्ठोत्मपवत्तकर दोष - दषू्या1) वाि2) वपत्त त्ररदोष3) कफ

4) त्मवक5) रति दषू्य6) मांस7) लशसका

When these seven dravyas are got affected than they will cause for कुष्ठोक्त्मप्त्त.

72

सप्िधात्मवश्र्य कुष्ठ लक्षणा त्मवक्: - Toda, Vaivarnyam, Rukshatwa

रति: - Rakta: Sweda, Swapa, Swayathu.

मांस:् - Sphota in pani & pada, kledatwa in joints.

मेदस: - Kounyam & gatikshaya for angas, dalana of

angas.

अक्स्त्थ & मज्जा:- Nasa bhanga, netra raga,

swarakshaya, krimis in kshatas.

शुक्र:- Swadara paktya badhanam.

(A.H.Ni.14)

73

धािगुि लक्षणास्त्पशयहातन स्त्वेदनत्मवमीषत्मकण्डुस्त्च ्जायिे ।

वेवण्य ्ंय रुक्षिावस्त्च ् कुष्ठे त्मवचच समचश्रिे ॥

त्मवतस्त्वापो रोमहषयस्त्च ् स्त्वेदस्त्याशिप्रवत्मनयम ् ।

कण्डूववयपूयकस्त्चेव ् कुष्ठे शोणणिसंचश्रिे॥

बाहुल्यं वतरशोषस्त्च ्काकय स्त्य ्ं वपड्वकोद्गम ्।

िोद स्त्फोि क्स्त्थरत्मवं च कुष्ठे मांससमाचश्रिे ॥74

दौगयन्र्धयमपुदेहस्त्च ्पूयोथ कक्र्यस्त्था ।

गारणां िेदनं चावप कुष्ठे मेद समचश्रिे ॥

नासािडंोक्षक्षरागस्त्च ्क्षिे च कक्रशमस्िव ।

िवेि ्स्त्वरोपघािस्त्च ्हक्स्त्थमज्जसमचश्रिे ॥

कौण्यं गतिक्षयोन्डानां स्िेद् क्षिसपयणम ् ।

शुक्रस्त्थान्गिे शलन्डे प्रागतुिातन िथेव च ॥(स.ुतन.5/21-26)

75

सामान्य चचककत्मसासवं त्ररदोषजं कुष्ठं दोषाणां िु बलाबलम ् ।

यथास्त्वेलयक्षणेबुयर्धद्वा कुष्ठानां कक्रयिे कक्रया ॥दोषस्त्य यस्त्य पश्येि ् कुष्ठेषु ववशके्ष्लन्नरुद्ववति ्ं ।िस्त्येव ्शमं कुयायत्मत्त ् पर ्ं चानुबन्र्धस्त्य ॥ (च.चच.7/31,32)

All kustha are tridosaja so they should be treated by

knowing there doshobala abala & lakshnas.

First do samana in those kusthas who are having

there increased doshas than treat apradhan doshas.

76

धािगुिानुसार ् चचककत्मसा त्मवक् प्राप्िे- Shodhanam, Alepanam.

शोणणि ्प्राप्िे- Shodhanam, Alepanam, Kashayapanam,

Shonitavasechanam.

मांसप्राप्िे- Shodhanam, Alepanam, Kashayapanam,

Shonithavasechanam, Arishtapana, Manthaprayoga,

Prasaprayoga.

मेदसप्राप्िे- Shodhanam, Shonithavasechanam, Bhallathaka,

Shilajatu, Dhatumakshikam, Guggulu, Agaru, Tuvaraka, Ayaskriti.

From अक्स्त्थ onwards- असार्धय.

Rest of all dhatugata condition of kustha should be considered

incurable and left untreated. (सु.चच.9/6)77

CHIKITSA SUTRA वािोत्तरेषु सवपयवयमनं श्लेष्मोत्तरेषु कुष्ठेषु ।

वपत्तोत्तरेषु मोक्षो रतिस्त्य ववरेचनं चागे्र ।

वमनववरेचनयोगा: कल्पोतिा: कुक्ष्ठनां प्रयोतिव्या ।

प्रच्छनमल्पे कुष्ठे महति च शस्त्िं शसराव्यधम ् ।

बहुदोष: संशोर्धय: कुष्ठी बहुशो अनुरक्षिा प्राणान ् ।

दोषे ह्ंयतिमारहृिे वायुहयन्यादबलमाशु ।

स्त्नेहस्त्य पानशमष्िं शुद्धे कोष्ठे प्रवाहहिे रतिे ।

वायुहहय शुद्धकोष्ठं कुक्ष्ठनमबलं ववशति शीग्रम ् । (च.चच. 7/39-

42)78

Vata - Sarpi

Kapha - Vamana

Pitta - Raktamokshana, Virechana

Chakrapani Commentary

अगे्र इति सवपयराहदषु योज्यं; िेन वािोत्तराहदषु सवपयराहद प्रथमंकियव्यं

अग्र means it is the foremost and the best to be done.

After that only any other treatment should be adopted

79

SHODHANA IN KUSTHA पक्षाि ् पक्षाच्छदयनान्यभ्युपेयाद् मासान्मासाि ्

स्त्रसनं चावप देयम ् । स्त्राव्यं रतिं वत्मसरे हह द्ववरल्प ्ं नस्त्यं दधाच्च त्ररराराक्त्मरराराि ्॥

(स.ुचच.9/43),(अ.ह्.चच.19/96)

Vamana- Pakshatpakshat. (15 – 15)days

Virechana- Masanmasan.(1 – 1)month

Rakta mokshanam- Shashte shashte masya.

(6 – 6)months

Nasya- Triratrat triratrat. (3 – 3)days

Basti80

VAMANA िरदोषहरण.् उर्धवय िाग ्ं वमन ्स्त्ंञकं् ॥ (च.क.1/4)

अपतववपत्त्शश्लेष्मणौ बलार्धव ्ंय नयेिु यि वमन ्ं िचध ववननेय ्ं ॥(शा.पू.ख.्4)

INDICATION

कफे ववद्र्धयाद्व्मन ्ं स्त्ंयोगे वा कफाल्बणे ।

नवज्वरातिसाराध ् वपत्तास्रगा जयक्षक्षमण ् ॥

कुष्ठमेहापचीग्रक्न्थश्ली पदोन्मादकाशसन ् ।

श्वासहल्लासवी सपयस्त्त्मन्यदोषोर्धवयरोचगण ॥ (अ.ह्.स.ू18/1-3)

81

Contraindication

Garbhini, sukumar, rooksha, kshudita, shokarta, krusha,

durbala.

Diseased condition

Vataprakopaja – Udavarta, Gulma, Vatavyadhi

Marmaja vyadhi – Hridroga, Mutragata, Timira

Maharoga – Arsas, Udara (अ.ह्.स.ू18/3-5),

Kala

In vasant rutu

(च.शस 8)

82

दोषोक्त्मतलष्िे ह्रदये वा्य ् कुष्ठेषु चोर्धवयिागेषु ।कुिजफलमदनमधुके सपिोलेतनय् बरसयुतिे ॥शीिरस पतकरसो मधूतन मधुकं च वमनातन । (च.चच.7/43,44)

Vamana in श्लेष्मोत्तरेषु कुष्ठेषु .Vamana Yogas

Kutajaphala,Madhanaphala,Yastimadhu churna + Patola

and Nimba rasa yukta

Sheetha rasa(शीिरस: शीि कषाय:) with madhu +

yastimadhu churna.

83

VIRECHANAिर दोषहरण ्ं अधोिाग ्ं ववरेचन संझा |

उिय ्ं वा शरीरमल ववरेचनाि ् ववरेचन स्त्ंझा ॥

(च.्क.1/4)

INDICATION

Kustha, jvara,...........................pitta vyadhi

vishesed rogadhayayoktasch

(ch.si.2/13)

Virechana is best for pitta & rakta pradosaja 84

CONTRAINDICATION

Avirechyastu

Subhag kshata

Durbalendriya

Durbalendriya

Alpagni

Kamadivyagra

Ajirna

Navajvara

Madatya

Aadhmana

Salyardita

Garbhini

Kshatkshen

Atisthoola

Atikrusha

Bala

Vruddha

Durbala

Upavasa

Maithun

Chinta

Vyayama(च.शस.2/11)

85

कुष्ठेषु त्ररव्रिा दन्िी त्ररफला च ववरेचने शस्त्िा ।सौववरकं् िुषोदकमालोडनमासवास्त्च ्सीधूतन ॥

श्ंसन्त्मयधोहराणां यथाववरेकं् क्रमस्त्ष्चषे्ि ।(च.चच.7/44,45)

VIRECHANA YOGAS Trivrut, Danti & Triphala

with souveeraka, tushodaka, alodana & sidhu

86

BASTI बक्स्त्िना दीयिे इति बक्स्त्ि ॥(अ.ह्.स.ू19/1)

बक्स्त्िशिदीयिे यस्त्माि ्िस्त्माि ्बक्स्त्िररति स्त्रि ॥(शा.उ.ख ्5/1)

Acc. To Vruhattrayi Niruha & Anuvasana basti is

contraindicated in kustha. (च.शस.२/14), (सु.चच. 35/21), (अ.ह्.सु19/4-6)

दाववयब्रहिीसेव्ये पिोलवपचुमदयमदनक्रिमाले । सस्त्नेहेरास्त्थाप्य कुक्ष्ठ सकशलडंयेवमुस्त्िे ॥ वािोल्बण ्ं ववररति ्ं तनरुढ्मनुवासनाहयमालक्ष्य ् । फलमधुकतन्बकुिजे सपिोले साधयेत्मस्त्नेहम ॥(च.चच.7/46,47)

87

If there is excess of vata even after shodhana – asthapana &

anuvasana

Sneha – madanaphala, madhuka, nimba, kutaja, patola

नास्त्थाप्या: कुक्ष्ठन: (च.शस.२)

Cakrapani Commentary

िथास्त्थापनानुवासनैक सार्धयायां अवस्त्थायां कियव्ये एव:

In excessive vitiation of vata – no alternative - basti

प्रववृत्ततनववृत्त लक्षण सयोगे िु गरुुलाघवं सपं्रधायय स्यगर्धयवस्त्येि ्(च.वव.८/१३४)

If there is lakshana which is simultaneously responsive and

irresponsive to

a given chikitsa – vaidya can decide the chikitsa – lakshana –

guru or laghu

88

NASYA उर्धवय जरवुवकारेषु ववशेषस्त्य शमष्यिे । नासाहह शशरसो द्वार ्ं िेन ्िदव्याप्य क्ह्ंंि िाि ् ॥

(अ.ह्.सु 20/1)

औषधम ्औषध ् शसर्धद्ं स्त्नेहो वा नाशसकाभ्यां दीयिे इति नस्त्यम ्॥ (स.ुचच.40/21)

89

INDICATION

Manyastambha

Galagraha

Hanugraha

Pinasa

Vyanga

Apatanaka etc

(च.्शस.2/22)

CONTRAINDICATION

Ajirna

Bhuktavata sneha,

madhya, jala

Snata sirasa

Snanachisirasa

Navajvara

Garbhini etc

(च.्शस.2/21)

90

सेन्धवदन्िीमररचं फणणञझक वपक्प्पली करन्ज्फलम ् ।नस्त्यं स्त्यात्मसववडगं कक्रशमकुष्ठकफप्रकोपघ्नम ्॥ वेरेचतनकेधूयमे श्लोकस्त्थानेररिे प्रशा्यक्न्ि ।क्रमय कुष्ठककलासा प्रयोक्जिेरुत्त्शमांड्वस्त्था ॥

(च.चच.7/48,49) Saindhava, Danti, Maricha,

Phanijjhaka, Pippali, Karanjaphala, Vidanga – Kapha

pradhana kushta with krimi anubandha

91

च.सू ५/२६-२७ Vairechanika dhumapana

श्वेिा ज्योतिष्मति चैव हररिालं मन:शशला ।गन्धाश्च अगरुपरार्धया धूमं मधूयववरेचने ।

92

RAKTAMOKSHANARaktamokshana is mainly two types

1)SASTRA

A) Pracchana

B) Siravyadha (venesection)

2) ASASTRA

A) jaloukavacarana – application of leeches (pitta dosha)

B) Sringavacharana – application of cow’s horn (vata

dosha)

C) Alabu avacharana – aplication of gourd (kapha dosha)

D) Gati yantravacarana – appliication of Gati yantra

93

INDICATION (SU.SU.25/12-15)

(A.H.SU.27/3-5)

Apachi

Asyapaka

Arsa

Daha

Dantapupputa

Dantavesta

Dustartava

Granthi

Sopha

Galasula

Karnapali roga

Putigraha

Raktadimantha

Raktapitta

Sitada

Raktarsha

SoushiraJihva kantaka

Krimi dantaka

Kshudra roga

Kustha

Ostaroga

Pidaka etc.

94

CONTRAINDICATION

अववस्त्राव्या सवांग ्शोफ क्षीणस्त्य चा्लिोजने तनशमत्ता ।

पांडु रोनयश ्य सोदरर शोवष गशियणीणां च श्वयथव ्

(स.ुसू 14/24)

KALA

व्यिे वषायषु ववर्धयेत्तु ग्रीष्मकाले िु शीिले ।

हेमन्ि ्काले मर्धयान्हे शस्त्रकालास्त्रय ् स्त्रिा ॥

(स.ु शा.8/10)

95

RAKTAMOKSHANA IN KUSTHA

क्स्त्थरकहठनमण्ड्वलानां क्स्त्वन्नानां प्रस्त्िरप्रणाडीशि ।

कूचेववघट्हििानां रतिौत्मतलेशोपनेिव्य ् ॥

आनूपवाररजानां मांसानां पोट्ट्ले सुखोष्णेस्त्च ् ।

क्स्त्वन्नौत्मसन्नं ववशलखेि ् कुष्ठं िीक्ष्णेन ्शस्त्रणे ् ॥

रुचधरगमाथयमथवा स्रुन्गालाबूतन योज्येि ् कुष्ठे ।

प्रक्च्छिमल्पं कुष्ठं ववरेचयेद्वा जलौकोशि ॥ (च.चच.7/50-52)

Kushta – Sthira, Katina and Mandala – Nadi & Prastara sweda

Rub with Kurcha

Rakta nirharana with Srunga / Alabu / Jalouka

96

SHAMANA YOGASThere are innumerable shamana yogas

mentioned for kushta in the form of churna,

vati, lehya, kashaya, asavarista,

rasoushadha, lepa, taila, gritha. It is

important to know when to use what to get

good results.

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CHIKITSA YOGAS

Darvi kalka or chorna with gomutra

Rasanjana with gomuta

Abhaya, vyosha, guda, tila taila for one month.

Patoladi kwatha

Lelitaka (sulphur) with jati (amalaki) swarasa

mixed with honey internally intake.

Vajrashilajatu with jati swarasa

Yogaraj with jati swarasa

Kusthakuthara rasa

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GHRUTA Vatakushta- Ghrita prepared of meshasringi,

guduchi, swadamshtra, sarngeshta, dwipanchamuli.

Pittakushta- By ghrita prepared of Dhava,

aswakarna, kakubha, palasa, pichumarda,

parpataka, madhuka, lodhra, samanga

Kaphajakushta- By ghrita prepared of priyalasala,

aragwadha, nimba, saptaparna, chitraka, maricha,

vacha, kushta, bhallataka, abhaya, vidanga

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In pitta & Rakta- Tikta Ghritas externally &

internally.

Eg:

Tiktashatpalak ghruta (ch.chi.7/140-143)

Mahatiktaka ghruta (ch.chi.7/144-150)

Mahakhadira ghruta (ch.chi.7/152-156)

Khadira, nimba, darvi ghruta (ch.chi.7/135)

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0

TAILAS Vatakushta- Taila prepared of meshasringi, guduchi, swadamshtra,

sarngeshta, dwipanchamuli.

Kaphajakushta- By taila of priyalasala,aragwadha, nimba, saptaparna, chitraka, maricha, vacha, kushta, bhallataka, abhaya, vidanga.

Sarvakushta- By bhallataka taila, tuvaraka taila etc.

(Su.Chi.9/7)

Kusthaghna hitakar taila (ch.chi.7/119)

Vipadika hara ghruta-taila (ch.chi.7/120,121)

Swetakarveradh taila

Swetakarverapallavadh taila

Tiktekshvakadi taila

Kanakakshiri taila

Vipadikaya dhatturbija taila

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1

KASHAYASonitha prapta & Mamsa prapta.

Tikta kashayas; For kaphaja, pithaja & Raktaja

kushtas.

Eg: Laghu Manjishtadi, Madhyama

Manjishtadi, Brihat Manjishtadi Kashayas,

Patolamuladikwatha

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2

CHURNA

Mustadi churna(ch.chi7/65-67)

Triphaladi churna (in numbness of skin)

(ch.chi.7/68,69)

Swarnamakshika churna with gomutra

(ch.chi.7/70-72)

Gandhapashana churna

Somraji chorna

Vaguji chorna

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3

ARISTHA, ASAVA, MANTHA,PRASA

Mamsa prapta kushta.

Eg: Khadirarishta,Madhwasava, Kanakabindwarishta, Triphalasava

Madvaasava in kustha & kilasa

Kanakavinduristha

Triphalasava

Kashayas made of rasanjan, aragbadha patra, kutaja, patola mula, nimba bark, khadirsara, triphala

We can use of above said drugs in the form of ghruta and taila in kustha samanartha

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4

ALEPANA

Nirhrita asradosha

Samsodhitasayanam (Cha.Chi.7/53)

Twak prapta

Shonita prapta

Mamsa prapta (Su.Chi.9/6)

Eg: Eladilepa, Kushtadilepa,

Lodhrabijadilepa, Mamsyadilepa.

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5

LEPAS

Sidhma nasak lepa (ch.chi.7/117,118)

Mandala kustha nashak taila (ch.chi.7/122-127)

Pittakusthan nashak lepa (ch.chi.7/130,131)

Vidangadi lepa

Dadrurvaadou durvadi lepa (chakradatta)

Manashiladi lepa

Dadrugajendra pralepa

Chakramardobijadi pralepa

Tranak pradeha

Kaasmarda pralepa

Molakabeej pralepa

Gandhapashad pralepa

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6

Karanjabijadi patra pralepa

Amaltaaspatra pralepa

Sidhma kustha gandhapashan pralepa

Sidhma kasmarda pralepa

Sidhma sarjasaadi praleepa

Siddh kusthadi lepa

Chatrahadi lepa

Edgajadi lepa

Vicharchikaya bhrustasarsapaka kalka

Vicharchika grah dhoom lepa

Tandula pralepa

Sarjasaadi lepa

Avalgujadi lepa

Sinduradi lepa

Bhallatakadi lepa 10

7

VATI

Aarogyavardhini vati (R.RS.)

Saptasama gutika

Triphala gutika

Gandhaka rasayana

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8

GUGGULU PREPARATIONS

Amrita guggulu

Ekavimsatika guggulu

Panchatiktaghrita guggulu

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9

UDVARTANA

Kusthadh udvartanam churna

Nishadyaudvartanam

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0

RASALEPA:

Pashana churna + Yavakshara+ Mustard oil/

Gandhapashana+ Katu taila exposed the mixture to

sunrays.

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1

KSHARA PRAYOGA

येषु न शस्त्रं क्रमेि ्स्त्पशके्न्द्रयनाशनातन यातन स्त्यु ।िेषु तनपात्मय ् क्षारो रतिं दोष ्ं च ववस्त्राव्य ॥

(च.चच.7/54)

1) Kushtas where sastra karma is

contraindicated.

2) In Sparsanendriyanasa

3) Nipatya

4) After visravana

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2

AGADA PRAYOGA

पाषाणकहठनपरुषे सपु्िे कुष्ठे क्स्त्थरे पुराणे च । पीिागदस्त्य कायो ववषे प्रदेहोगदेस्त्चानु ॥ स्त्िब्धातन सपु्िसपु्िान्यस्त्वेदनकण्डुलातन कुष्ठातन। कूचेदयक्न्ित्ररव्रिाकरवीरकरन्जकुिजानाम ्॥ जात्मयकय तन्ब्जेवाय परे शस्त्रे समदु्रफेनेवो । घ्रष्िातन गोमयेवाय िि ् प्रदेहे प्रदेहातन ॥ (च.चच.7/55-57)

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3

SNANOPYOGI DRAVYAS

Ch.chi7/129,130

Siddharthaka snana churna

Darvi kwatha

Patola

Nimba

Khadirasara

Karanja

Aragwadha

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4

ABHYANGA:

Vajrakatailam,

Mahavajrakatailam,

Adityapaka tailam (B.P,mad.),

Marichaditailam,

Somarajitaila,

Swetakaranjaditaila

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5

दाहयतुिकुक्ष्ठ स्त्नान प्रयोगा रोध्राररष्िं पद्मकं रतिसार ् सप्िाहाक्षौ व्रक्षको बीजकस्त्च ् । योज्या स्त्नाने दहमानस्त्य जन्िो पेया वा स्त्याि ्क्षौद्रयुतिा

त्ररिण्डी ॥ (स.ुचच.9/50)

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6

RASAYAN YOGAS

Navayasa rasayana (chakradatta)

Brahmiaadi rasayan

Chitraka rasayan

Bhallataka rasayan


Medo prapta kushta

Yapya kushta

All kushtas

Eg:Tuvarasthi, Bhallataka, Bakuchi,

Chitrakamulam, Silajatu (Ah.Chi.19/53

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7

GUDA

Manibhadra guda (A.H.chi.19/31,32)

Modaka Triphala modaka

AVALEHA

Bhallatakavaleha,

Sashangavaleha,

Dhatryadyavaleha

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8

CONCLUSION

Selection of chikitsa for kushta depends on predominant of doshas

Repeated shodhana is essential for bahu doshavasthaother than trying to eliminate it all at once since it weakens the patient

In excessive vata aggravated condition, basti chikitsacan be adopted

Nasya is indicated in kapha pradhana kushta and dhumapana in kushta affecting jatrurdwa

If doshas are in alpavastha we can treat with shaman line of treatment.

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120

THANK

YOU