psoriasis virechana, pk

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

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PATR

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PSOR

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Dr. SR

INIVA

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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.


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.


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).


Procedure Review Of Literature


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



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.



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


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.



Chikitsa Sthana:- Table No.6

3.KASHYAPA SAMHITA:


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


07. Samshuddhi Visheshaneeya Adhyaya

Virechana Karma and Samsarjana Krama.

4. ASTHANGA SANGRAHA:

Sutra sthana: Table No.9



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.



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


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.



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



Ch.no Name of the Chapter Content 71. Virechana adhikara. Detailed description of Virechana

Karma.



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.



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.



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.

ÌmÉ¨Éå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ

zsÉåwqÉhÉÏÌiÉ |14

urÉMÑüsÉÉlÉç xÉÍ³ÉmÉÉiÉÉåijÉÉlÉç mÉæÌ¨ÉMüÉlÉç MüTü

ümÉæÌ¨ÉMüÉlÉç |

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.



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.



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 .



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:



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.



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.



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 ||



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.



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



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



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



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



Gritha 4 2 4 4 8 6 Taila - - - - 6 2

Chatusneha - - - - - 1 Asavarishta - 1 1 - - 5

Greya - - - 1 - - Yavagu - - - - - 1



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 qÉÉ§ÉÉ qÉ×SÒMüÉå¸å qÉkrÉMüÉå¸å cÉ qÉkrÉqÉÉ |

¢ÔüUå iÉÏ¤hÉÉ qÉiÉÉ SìurÉæqÉ×ïSÒqÉkrÉqÉiÉÏ¤hÉMæü: ||

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.



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..



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 - + + + + +



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 + + - - +



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



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



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



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



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 _ _ + +



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.



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



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



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



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



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 + + -



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 - - +



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



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



Table no :41 Showing the Diet Regimen161

ÌSlÉ MüÉsÉ A³ÉMüÉsÉ

mÉëkÉÉlÉ vÉÑkSÏ

qÉkrÉqÉ vÉÑkSÏ

ÌWûlÉ vÉÑkSÏ

mÉëjÉqÉ mÉëÉiÉ:

xÉÉrÉÇ

1

- mÉårÉÉ

- mÉårÉÉ

- mÉårÉÉ

Ì²iÉÏrÉ 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

- -

wÉ¸ 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



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 xÉÇkÉÑ¤ÉhÉÉjÉï xuÉÉSÒ, ÌiÉ£ü ÌmÉ¨ÉvÉqÉlÉÉjÉï

Charaka165

MüwÉÉrÉ, MüOÒû ÌmÉ¨ÉÉåkuÉïÎxjÉiÉMüTü mÉëvÉqÉlÉÉjÉï xuÉÉSÒ, ÌiÉ£ü mÉëuÉ×kSÉÎalÉWåûiÉÑuÉÉiÉÌmÉ¨ÉxjÉÉuÉeÉrÉÉjÉïqÉalÉå

xÉqÉÏMüUhÉÉjÉï ÎxlÉakÉ,AqsÉ,sÉuÉhÉ,MüOÒû uÉÉiÉMüTüÉuÉeÉrÉÉjÉïqÉalÉå:xÉlkÉÑ¤ÉhÉÉjÉï

Sushruta166 xuÉÉSÒ, ÌiÉ£ü ÌmÉ¨ÉuÉÉiÉÉuÉeÉrÉÉjÉï



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 + - -



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



Ayoga Vibhransha, Hikka, Pindikodveshtana, Kandu, Urusada,

Vaivarnyata

Roganusara Chikitsa Gomutra Niruha

Atiyoga Ativirechana Mridu Vamana, Raktapitta vat Chikitsa



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).



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



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.



• 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.



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



effects on feces. These laxatives are mild in action and usually seen 1 to 3 days

after ingestion and itself does not initiate peristalsis.



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

Review Of Literature

To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka

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

Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 50



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.




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).



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 :



(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

Disease Review Review Of Literature


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 vÉÑwMümÉ§ÉmÉëMüUÉM×üÌ¹ÍpÉ:|

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.




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



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.



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.



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



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.



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 ÌiÉ¹ÌiÉ |

One which has capacity of spreading nature & leads to deformity of skin in the

form of discoloration is known as Kushta33.

3. MÑüwhÉÉÌiÉ iÉxqÉÉiÉ¨Éç 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.



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 - + - - - -



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



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



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



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. - - - - + - -



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 - - - + -



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 - +



(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 -



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.



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



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.



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



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



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



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






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 - - - - + - +



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



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



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



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,



• 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



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,



(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



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



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



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.



, 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.



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



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



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.



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



COMPLICATIONS:


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



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.



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.



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.

Drug review Review of literature

To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in

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


Deepana

Pippali Piper longum/ Piperaceae

Katu

Laghu,Snigdha, Tikshna

Ushna Madhura Kapha-vata hara

Deepana

Hingu Ferula narthex/ Umbelliferae.

Katu

Laghu, Snigdha,


Deepana, Pachana

DRUG REVIEW

Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore



Tikshna Ajamoda Apium

graveolans/ Umbelliferae.

Katu, Tikta Laghu,Ruksha, Tikshna


Deepana, Pachana

Chavya Piper chaba/ Piperaceae.

Katu Laghu, Ruksha


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


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.

Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 99



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.


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.




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.


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.


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.




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.


Materials and Methods


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.




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




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




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:




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:




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.




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.




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.




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.




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.


Observations


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.


Observations


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.


Observations


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.


Observations


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


Observations


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.


Observations


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.


Observations



Observations


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.


Observations


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


Observations


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.


Observations


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.


Observations


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.


Observations


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.


Results


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


Results


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


Results


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.


Results


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


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


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


Results


P <0.001 indicates highly significant reduction in Scaling after Virechana with

Abhayadi Modaka.


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


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


Z Asymp.sign (2 tailed Results -2.970a 0.001 HS


Results


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


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



-3.169a 0.002 HS

P <0.002 indicating highly significant change in area involvement in lower extremity

after Virechana with Karavellaka


Results


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.


Results


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


Results


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.


Discussion


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


Discussion


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.


Discussion


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.


Discussion


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.


Discussion


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.


Discussion


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.


Discussion


Discussion


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.


Conclusion


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.


Conclusion


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


Summary


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.


Summary


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


Summary


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.


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.


37) Ch.Sa.Chi.3/171


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

http://www.wikipedia.com/

http://www.essentialdayspa.com/

http://www.pressmediawire.com/

http://www.emedicine.com/

http://www.essentialdayspa.com/

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



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



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


BIBLIOGRAPHY

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3) Agnivesha. Charaka Samhita, revised by Maharshi Charaka and

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6) Bhavamishra. Bhava Prakasha with English Translation by

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7) Bhela. Bhela Samhita, Sutrasthana,with English Translation by

Krishnamurthy K.H., Varanasi; Chaukhambha Vishwabharati. Reprint

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Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore

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21) Satoksar R.S., Bhandarkar S.D. & Nirmala N. Grege. Pharmacology &

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Psoriasis_severity_jpg.htm

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Copy.htm chronic and relapsing disease

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Copy.htm chronic and relapsing disease.

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mailto:[email protected]

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

psoriasis virechana, pk

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