A COMPARATIVE AND COMBINED CLINICAL STUDY ON …

A COMPARATIVE AND COMBINED CLINICAL STUDY ON

SHODHANA AND ALEPANA(EXTERNAL APPLICATION) IN

VICHARCHIKA

BY

Dr.SAVITA WALI

DISSERTATION SUBMITTED TO THE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

IN THE PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

AYURVEDA VACHASPATI

(Doctor of Medicine) IN

PANCHAKARMA

UNDER THE GUIDANCE OF

Dr. A.S.DONGARGAON. M.D (Ayu)

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA,

DR.B.N.M.E.T’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND

RESEARCH CENTRE

BIJAPUR

NOVEMBER 2009

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation thesis entitled “A COMPARATIVE AND

COMBINED CLINICAL STUDY ON SHODHANA AND ALEPANA (EXTERNAL

APPLICATION) IN VICHARCHIKA” is a bonafide and genuine research work

carried out by me under the guidance of Dr. A.S.DONGARGAON. M.D (Ayu) Asst.Prof,

Dept. of PANCHAKARMA, Shri Mallikarjuna Swamiji Post Graduate and Research

Centre, Bijapur.

Date: Signature of the Candidate Place: Bijapur.

Dr.SAVITA WALI

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

Dr. B. N. M. E. T’s

SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH

CENTRE, BIJAPUR.

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A COMPARATIVE AND


APPLICATION) IN VICHARCHIKA.” is a bonafide research work done by

Dr.SAVITA WALI in partial fulfillment of the requirement for the degree of

AYURVEDA VACHASPATI (Doctor of Medicine).

Date: Signature of Guide:

Place: Bijapur Dr.A.S.DONGARGAON. M.D (Ayu) Asst.Professor and Guide Dept. of Panchakarma Shri Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

Dr. B. N. M. E. T’s

SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH

CENTRE, BIJAPUR.

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA

ENDORSEMENT BY THE H.O.D, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A COMPARATIVE AND


APPLICATION) IN VICHARCHIKA.” is a bonafide research work done by

Dr.SAVITA WALI under the guidance of Dr.R.N.GENNUR.M.D(Ayu) Prof. Dept. of

PANCHAKARMA, Shri Mallikarjuna Swamiji Post Graduate and Research Centre,

Bijapur.

Seal & Signature of the HOD Seal & Signature of the Principal Dr.R.N.Gennur M.D (Ayu) Dr.R.N.Gennur M.D (Ayu) Date: Date: Place: Bijapur. Place: Bijapur.

COPYRIGHT

DECLARATION BY THE CANDIDATE

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic/research purpose.

Date: Signature of the Candidate Place: Bijapur.

Dr.SAVITA WALI

© Rajiv Gandhi University of Health Sciences, Karnataka.

i

ACKNOWLEDGEMENT While penning the acknowledgement of the present work, I remember the

moments when I needed someone desperately to come upon for the help. It was the

LORD who always transformed silent strengths in me by his blessing. I cordially

salute to the SHRI SIDDHARUDHA SWAMIJI for standing behind me in each &

every hurdle of life.

This is an unforgettable moment of contentment on the successful fulfillment

of an ambition fostered for long. I offer my salutations to loving my mother Smt.

Shanta.S.Wali. for suffering great agony to bring me up to this position. I am highly

obliged for their blessing support and sacrifice which have always been constant

sources of inspiration in my life. I express my gratitude towards my brothers Veeresh

and Shivaraj, who with thier support enabled me to complete this difficult task.

Words cannot express the deep sense of respect & love for my father in-law

Shri.Shrishail.Kokatnur, mother in-law Smt.Parvati.Kokatnur whose support has

proved to be in par with parents. I would like to share these moments with my brother

in-law Anand. Kokatnur & sister in-law Smt. Jyoti. Kokatnur.

I would like to convey my heartiest thanks to my beloved husband,

Dr.Santosh.Kokatnur, who is the prime source of encouragement for me to achieve

this target of my life. He shared my responsibilities & has worked very hard to see our

dreams come true.

I express my gratitude to the Chairman, Dr.K.B.Nagur M.D. (Ayu), management

committee of Dr.B.N.M.E.T’s Shri.Mallikarjuna Swamiji PostGraduate and Research

Centre, for giving me the opportunity to pursue my post graduation at this institution.

I sincerely thank Principal and Department Head Dr.R.N.Gennur M.D. (Ayu)

Dept. of Panchakarma, for his support and guidance through out my period of research

work.

It gives me an immense pleasure to express my sincere gratitude to my guide

Dr.A.S.Dongargaon M.D. (Ayu) for his expert guidance, supervision, co-operation

extended throughout my dissertation work.

I express my gratitude to Dr.C.S.Hiremath for her support and guidance while

preparing my synopsis.

I express my sincere thanks to my Departmental staff Dr. Uma Patil M.D. (Ayu),

ii

Dr.I.P.Ugar M.D. (Ayu), Dr.P.R.Vastrad M.D. (Ayu), Dr.L.M.Biradar M.D. (Ayu), and

Dr.Rajeshwari.Biradar M.D. (Ayu) for thier valuable suggestions. I express my profound gratitude to screening committee members

Dr.B.S.Tamagond M.D. (Ayu), and Dr.J.C.Huddar M.D. (Ayu)

I express my special thanks to Dr.B.G.Patil, M.D. (Ayu) Dr.Anita Patil M.D. (Ayu), and

Dr.P.B.Savalagi M.D. (Ayu), for their timely guidance and help.

I acknowledge with sincere thanks for their kind co-operation and great

pleasure for me, to my gratitude with profound respect to all P.G Staff.

I express my sincere thanks to Pharmacy of B.V.V.S Ayurvedic Medical

college, Bagalkot for providing all the medicines for my research work.

I would like to thank Dr.Shrinivas Vadeyar M.D. (Ayu) for his valuable

suggestions and Shri Tapshetty M.Sc (stat) for helping me with the Statistical Analysis

of the study results.

Its my pleasure to recall here the timely co-operation from my departmental seniors

Dr.Rajeshwari, Dr.Mallappa, Dr.Pargonde, my collegues Dr.Gopu and Dr.Prakash

and my juniors Dr.Sunil P.V, Dr.Sunil.Nagare and Dr.Pankaj and also I would like to

thank Dr.Rajarajeshwari and Dr.Deepa for their help during my work.

It is beyond my reach of language to inscribe profound co-operation and

friendly help rendered by Dr.Gopu and Dr.Hosamani during my work.

I sincerely thank my P.G. colleagues Dr.Parashuram, Dr.Masule,

Dr.Padashetti Dr.Rehaman, Dr.Policepatil, Dr.Suchitra, Dr.Sushant, Dr.Geeta,

Dr.Santosh, Dr.Mahesh, Dr.Manish, Dr.Gourav, and Dr.Priyanka for their help

during my work.

I sincerely thank my Panchakarma Hospital staff, my patients and Paramedical

staff for their kind co-operation during my clinical trials.

I would like to thank Shri R.G.Dolli office supertendent and other office staff

of our college, Mr.Satish, Smt.Jatti and Mr.Biradar for their support & co-

operation. I thank Mr Swamy, librarian of Shri B.N.M.E Trust and Research center, I

also thank other library staff Mr Bellary for all the help they provided.

I thank Preeti computers for their printing of my dissertation work.Lastly I

thank each and everyone who stood behind me, directly or indirectly in completing my

dissertation work.

Date: Dr. SAVITA.WALI

Place :

iii

ABBREVIATIONS

A.H – Ashtanga Hrudaya

A.S – Ashtanga Samgraha

A.T – After Treatment

B.S – Bhela Samhita

B.R – Bhaishajya ratnavali

B.P – Bhava Prakasha Nighantu

B.T – Before Treatment

Ch.S – Charaka Samhita

C.D – Chakra Dutta

F.U – Follow Up.

K.S – Kashyapa Samhita

M.N – Madhava Nidana

Su.S – Sushruta Samhita

Sh.S – Sharangadhara Samhita

S.D – Standard Deviation

iv

ABSTRACT

BACK GROUND AND OBJECTIVES:

Before going into the real work, a glance on that gives an idea about the

contents.

Kustha is tridoshaja vyadhi where Rasa, Rakta, Mamsa and Ambu are the

dushyas. The word Kustha indicates its reaproaching nature, which destroys the

beauty of the skin.

Vicharchika, one of the most common but miserable twak vikar affecting all

the age of population still stands as a challenge to different medical systems. Many

research works have been done on skin disorders in modern medical science but no

drug has yet been claimed to cure skin diseases completely. No one can prevent

recurrence. Ayurveda has given prime important on two types of treatment, i.e.,

Shodhana and Shamana.

Doshadushya sammurchana reveals pathological involvement of pitta and

rakta in the manifestation of Vicharchika. Among Shodhana procedures for pitta

pradhana dosha and rakta pradhana dusti ‘Virechana’ is the choice of treatment.

According to Sushruta if doshas are located in twak, rakta, mamsa first Shodhana

should be done and then go for Alpena, etc. Sharangadhara has mentioned the

effectiveness of Arka taila in Vicharchika. As Arka taila is Kapha–pitta shamaka,

raktashodhaka, rakta stambhaka and kusthaghna properties it is used for external

application.

Hence the present study was undertaken to compare the efficacy of Shodhana

by means of Virechana karma and Shamana by means of Alepana (external

application) and also the combined effect in Vicharchika.

v

METHODS:

For the present study, 30 patients diagnosed as Vicharchika were randomly

selected from Dr. B.N.M.E Trust’s S.M.S. PG and RC, Bijapur and special camps

conducted in Bijapur city by the institute. Patients thus selected were randomly

allocated in three groups.

Group A – Virechana karma

Group B – Alepana (External application) with Arka taila and

Group C - Virechana karma and Alepana

Patients were assessed for the severity of symptoms subjectively and

objectively before, after and at the end of follow up of the treatment. Data were

collected in the same protocol and statistically analyzed.

INTERPRETATIONS AND CONCLUSIONS:

After the course of interventions,

Group A i.e., Virechana karma showed highly significant result after treatment in

Kandu, Raji, Vaivarnya and Ruja variables and maintained same after follow up.

Group B i.e., Alepana (External application) with Arka taila showed highly

significant result after treatment in Kandu, Raji, Vaivarnya and Ruja variables. But

after follow up Raji, Vaivarnya and Ruja remained only significant.

Group C i.e., Both Virechana karma and Alepana showed highly significant results

after treatment in Kandu, Raji, Vaivarnya and Ruja variables and maintained same

after follow up.

In Rukshata Group C showed better result than Group A and Group B

KEY WORDS: Vicharchika, Shodhana, Virechana, Arka taila and Alepana

vi

CONTENTS

• List of Tables

• List of Flow charts

• List of Graphs

Page No.

1. Introduction 1-2

2. Objectives 3

3. Review of Literature 4-55

4. Materials and Methods 56-63

5. Observations and Results 64-101

6. Discussion 102-135

7. Conclusion 136

8. Recommendations for future study 137

9. Summary 138-139

10. Bibliography 140-150

11. Annexure –

Classical Reference I- IV

Case Proforma V- vi

Photographs

vii

LIST OF TABLES

TableNo Table Title PageNo

01 Historical Review in veda kala.(Virechana) 04 02 Historical Review in Charaka samhita. 04-05 03 Historical Review in Sushruta samhita. 06 04 Historical Review in Kashyapa Samhita. 07 05 Historical Review in Astanga samgraha. 07-08 06 Historical Review in Astanga hrudaya. 08 07 Historical Review of Bhela Samhita 08 08 Historical Review in Sharangadhara samhita. 09 09 Historical Review in Nighantu. 09 10 Classification of Virechana dravya acc to Upayukta anga. 12-14 11 Classification of Virechana dravya acc to Rutu. 15 12 Guna of virechana dravyās. 16 13 Indication’s of virechana. 16-17 14 Contra-Indication’s of virechana. 18 15 Dosage of Virechana according to sharangadhara. 20 16 Aushadha jeernaajeerna lakshanas. 23 17 Virechana vega vinirnaya. 24 18 Samyak Lakshana of Virechana karma. 24 19 Ayoga lakshanas of Virechana. 25 20 Atiyoga lakshanas of Virechanas. 25 21 Virechana Vyapat lakshana. 26 22 Peyadi Samsarjana karma. 27 23 Historical Review in veda kala.(Kustha) 30-31 24 Historical Review in Charaka samhita. 31

25 Historical Review in Sushruta samhita. 31

26 Historical Review in Astanga samgraha and Astanga hrudaya.

32

27 Historical Review in Bhela Samhita and Harita Samhita. 32

28 Historical Review in Madhava Nidana. 32

29 Historical Review in B.R, Y.R and Sh.S. 32-33

30 Classification of mahakustha according to different acharyas.

34

31 Classification of Kshudrakustha according to different acharyas.

34

32 Classification of Kustha on the basis of Doshic predominance.

35

33 Nidan according to different acharyas. 37-38

34 Purvarupa according to different acharyas. 39 35 Rupa according to different acharyas. 40 36 Number of kalas and manifestation of kustha. 42 37 Kalas, thickness of twacha and reflection of disease. 42

viii

38 Different layers of twacha according to different acharyas.

43

39 Differential Diagnosis. 48 40 Pathya according to different acharyas. 52 41 Apathya according to different acharyas. 52 42 Properties of Shunti churna. 53 43 Properties of ingredients of Panchatiktaka ghrita. 53-54 44 Properties of Tila 54 45 Properties of Drugs used for virechana karma(Triphala

kashaya). 54

46 Properties of ingredients of Arka Taila. 55 47 Distribution of patients according to Age. 65 48 Distribution of patients according to Sex. 66 49 Distribution of patients according to Religion. 67 50 Distribution of patients according to Occupation. 68 51 Distribution of patients according to Socio-economic

status. 69

52 Distribution of patients according to Diet. 70 53 Distribution of patients according to Vyasana. 71 54 Distribution of patients according to Kula vrittanta. 72 55 Distribution of patients according to Chronicity of

vyadhi. 73

56 Distribution of patients according to Prakruti. 74

57 Distribution of patients according to Agni pareeksha. 75

58 Distribution of patients according to Kostha. 76 59 Distribution of patients according to Site of lesion. 77

60 Required days for Samyak snehana. 78

61 Distribution of the patients according to Vaigiki criteria. 79

62 Distribution of the patients according to Manaki criteria. 80 63 Distribution of the patients according to Antaki criteria. 81 64 Distribution of the patients according to Laingiki criteria. 82 65 Distribution of patients of Vicharchika based on the

presence of clinical symptoms

83

66 Distribution of patients according to presence of Kandu before treatment.

84

67 Distribution of patients according to presence of Raji before treatment.

84

68 Distribution of patients according to presence of Vaivarnya before treatment.

84

69 Distribution of patients according to presence of Ruja before treatment

85

70 Distribution of patients according to presence of Rukshata before treatment.

85

71 Results of Group A after treatment. 88 72 Results of Group A after follow up. 89 73 Results of Group B after treatment. 90

ix

74 Results of Group B after follow up. 91 75 Results of Group C after treatment. 92 76 Results of Group C after follow up. 93 77 Result related observations for individual groups based on

observational criteria. 98

78 Statistical analysis of group A result in Kandu. 99 79 Statistical analysis of group A result in Raji. 99 80 Statistical analysis of group A result in Vaivarnya. 99 81 Statistical analysis of group A result in Ruja. 99 82 Statistical analysis of group B result in Kandu. 100 83 Statistical analysis of group B result in Raji. 100 84 Statistical analysis of group B result in Vaivarnya. 100 85 Statistical analysis of group B result in Ruja. 100 86 Statistical analysis of group C result in Kandu. 101 87 Statistical analysis of group C result in Raji. 101 88 Statistical analysis of group C result in Vaivarnya. 101 89 Statistical analysis of group C result in Ruja. 101

LIST OF FLOW CHARTS Serial. No Title Page.No

01 Virechana aushadha karmukata. 29 02 Samprapti according to Charak. 45 03 Samprapti according to Sushruta. 46 04 Samprapti according to Vagbhata. 46 05 Kustha Raktapradoshaja vyadhi 47 06 Samprapti. 04

x

LIST OF GRAPHS

Graph No Graph Title Page No 01 Distribution of patients according to age. 65 02 Distribution of the patients according to the sex. 66 03 Distribution of the patients according to the religion. 67 04 Distribution of the patients according to the occupation. 68 05 Distribution of patients according to Socio-economic status. 69 06 Distribution of the patients according to Diet. 70 07 Distribution of the patients according to Vyasana. 71 08 Distribution of the patients according to Kula vrittanta. 72 09 Distribution of the patients according to Chronicity of vyadhi. 73 10 Distribution of the patients according to Prakruti. 74 11 Distribution of the patients according to Agni pareeksha. 75 12 Distribution of the patients according to Kostha. 76 13 Distribution of patients according to site of Lesion. 77

14 Required days for Samyak snehana. 78

15 Distribution of the patients according to Vaigiki criteria. 79

16 Distribution of the patients according to Manaki criteria 80 17 Distribution of patients according to Antaki criteria. 81 18 Distribution of the patients according to Laingiki criteria. 82 19 Distribution of patients of Vicharchika based on the presence

of clinical symptoms 83

20 Response of clinical symptoms after treatment in Group A. 88 21 Response of clinical symptoms after follow up in Group A. 89 22 Response of clinical symptoms after treatment in Group B. 90 23 Response of clinical symptoms after follow up in Group B. 91 24 Response of clinical symptoms after treatment in Group C 92 25 Response of clinical symptoms after follow up in Group C 93

Introduction

A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 1

INTRODUCTION

In human being skin is the most exposed and protective part which remains

continuously in direct touch with foreign bodies and outer atmosphere. Many factors like

allergens, microbes, foreign bodies are much responsible to disturb the structural and

functional unit of skin and ultimately it leads to skin diseases.

Skin disorders are having prevalence rate of about 15% of world’s population.

Indian medical science reveals that skin diseases were considered as one of the major

problem which is evident from its description under the broad heading of ‘Kustha’ which

is further divided into ‘Mahakustha’ and ‘Kshudrakustha’. Vicharchika is one type of

Kshudrakustha having dominancy of Pitta-Kapha dosha. Healthy skin is a cosmetic

value, therefore any disease pertaining to it will seriously affect the luster and

complexion of the individual, hence the patients are disliked by society. Due to its wide

spectrum prevalence, its chronicity, lack of effective drug, it attracts the researchers to

look the suitable remedy for the disease.

Though various treatments are available in the contemporary science ,they are still

not effective in preventing its reoccurrence. It can give just symptomatic relief.

Shodhana and shamana are the line of treatment that are adopted for vicharchika. It is

well known that the vitiated doshas of the body need to be eliminated radically before

going for Shamana Chikista. Shodhana strikes at the root of Malas and eradicates them

and as such the disease cured by Shodhana therapy will not resurface.

Among the Shodhana Karma Virechana karma is the best for Pitta and Rakta

Pradoshaja Vikara. as the Vicharchika is Rakta Pradoshaja vyadhi, so Virechana is

indicated. On the other hand Shodhana in combination with Shamana aushadhis naturally

Introduction


uproots the disease. Sharangadhara has mentioned Arka taila for Alepana in Vicharchika.

It is having ruksha, ushna, teekshna properties and mainly acts as kusthaghna.So its

specific property of kusthaghna make it perfect remedy for Vicharchika as an Alepana.

Hence the present study is undertaken as “A comparative and combined clinical

study on Shodhana and Alepana (External application) in Vicharchika.”

Objectives


OBJECTIVES

1. Detail study of Virechana Karma.

2. Detail study of Vicharchika.

3. To compare the effect of Virechana Karma and Alepana with Arka taila in

Vicharchika.

4. To assess the combined effect of Virechana Karma and Alepana with Arka taila in

Vicharchika.

Review of Literature


VIRECHANA KARMA

HISTORICAL REVIEW:

Table No.01 : Showing Historical Review in VEDA KALA

Veda Context

Rigveda Eranda was used for bowel evacuation.

Some of mantras which suggest the principle of evacuations

like “Yatah Sannam Vinirharet” meaning to excrete from the

nearest orifice.

Vinaya pitaka (Buddha period)

Vaidya Jeevaka had treated Buddha by Greya virechaka yoga.

(Inhaling some powder spread over utpalapatra).

Purana Context Garuda purana Agni purana

We can find traditional method of diagnosis along with

Panchakarma chikitsa.

Manu smruti

Certain procedures like ghrita which has been administered

orally after completion of Vamana, Virechana & Snana has

been found.

Upanishad Scattered references regarding Shodhana followed by Shamana

therapy for the normalcy of doshas has been found.

SAMHITA KALA :

Table No.02 : Showing Historical Review in CHARAKA SAMHITA :

Sthana Adhyaya Context 2.Aragwadiya Adhyaya Some Virechana dravyas are quoted.

4.Shadvirechana

shathashritiya Adhyaya

245 Virechanadravyas,10 Bhedaniya,10

Virechanopaga dravyas are stated.

6.Tasyashitiya Adhyaya Administration of Virechana acc to rutu.

Sutra

8. Roga Bhishagjeeviya Virechana dravyas



15. Upakalpaniya

Adhyaya

Collection of required equipments Process of Virechana Symptoms produced due to Ayoga and

Atiyoga. Complications produced due to faults of

physician, drugs, nurse and patient. Samsarjana krama with its importance.

16 Chikitsa Prabutiya Adhyaya.

Samyak yoga,Atiyoga, Heena yoga laxanas & chikitsa.

17.Kiyanta shirashiya Yogya and Ayogya.

20. Maharogadhyaya. Dosha chikitsa.

24. Vidhi shonitiya Adhaya. Indication of Virechana.

25.Yadpurushee Adhyaya. Virechana Dravyas.

1. Madanaphala

kalpadhyaya

Defn of Virechana, Guna of Virechana

dravya, Mode of action of Virechana

dravya, pramukha dravya used for the

Virechana purpose.

Kalpa

7th to 12th Chapter Detail explanation of different types of

Virechana yogas ,Indications of yogas

acc to rutu.

Siddhi 1. Kalpanasiddhiradhyaya

Samsarjana krama and its importance to

increase Agni

Pradhana, Madhyama, Hina Shuddhi

lakshanas along with Ayoga, Atiyoga and

Samyak yoga.

2. Pancakarmiya siddhi Yogya and ayogya for Virechana

6.Vamana Virechana

Vyapad siddhiradhyaya

Samyak Virechana lakshana

Heena, Atiyoga lakshanas and its

chikitsa.

Chikitsa Several adhyaya regarding the treatment of diseases

In different stages of disease, the administration of Virechana has been told.



Table No 03: Showing Historical Review in SUSHRUTA SAMHITA :

Sthana Adhyaya Contents Sutra 37.Bhumipravibhagiya. Collection of virechana yogas.

33. Vamana Virechana

Sadhyopadrava Chikitsitam

Adhyaya

Pharmacological action of Virechana

drugs.

Kaphahara diet.

Ayoga, Atiyoga, samyak yoga of

Virechana Karma.

Indications, Contraindications

34. Vamana Virechana

Vyapat chikitsitam Adhyaya

Complications produced after

Virechana.

Chikitsa

39. Aturopadrava

Chikitsitam Adhyaya

Samsarjana krama followed after

Virechana Karma to increase Agni.

Kalpasthana 1 Annapana Raksha kalpam Indications acc to rogavastha.

5.Mahavatavyadhi. Dosha chikitsa

33Vamana virechanopaga

sadhya chikitsitam

Kostha chikitsa, Dosha chikitsa,

Explained Virechana procedure in

detail also avirechya, virechya,

samyak yoga, ayoga, and atiyoga

explained.

34 Vamana virechana

vyapat chikitsitam.

Virechana vyapat and chikitsa.

Chikitsa

36 Netrabasthi vyapat

chikitsitam

Virechana karma sukta kala.

Uttartantra Reference regarding line of

treatment

In several stages of the disease



Table No 04: Showing Historical Review in Kashyapa Samhita :

Sthana Adhyaya Contents 22. Snehadhyaya.

Administration of virechana dravya like

Draksha, Pilu, Triphala,are mentioned for

Mrudukosthi.

Sutra

27. Rogadhyaya Pitta chikitsa. Role of panchakarma in

individual doshas.

2.Trilakshana

adhyaya.

Benefits of Virechana karma.

Indication of Virechana.

Ayoga, Atiyog has been explained.

3. Vamana Virechana

Adhyaya

Process of Virechana

Heena, Madhyama, Uttama Shuddhis.

Regimen to be followed after Virechana

Importance of Virechana in Balaroga.

Virechana Vyapad.

Siddhi

Sthana

7. Panchakarmiya

Siddhi

Indications and Contradications of Virechana

Karma.

Khila

Sthana

7.Samshuddhi

Visheshaniya Adhyaya

Virechana process in detail with Samsarjana

krama.

Table No 05: Showing Historical Review in ASTANGA SAMGRAHA: Sthana Adhyaya Contents

04. Rutucharya adhyaya. Administration of virechana dravyas acc to rutus

06. Dravadravya vijnaniya

Adhyaya.

Virechana dravyas.

11. Matrashitiya adhyaya. Virechana dravyas.

12.Vividoushadhi vijnaniya

adhyaya.

Virechana dravyas.

Sutra

13. Agrasangrahaniya. Virechana dravyas.



14.Shodhanadigana sangraha

adhyaya.

Virechana dravyas.

15. Mahakashaya sangraha

adhyaya.

Virechana dravyas.

21.Doshopakramaniya adhyaya. For Pitta dosha Virechana karma is indicated.

27.Vamana Virechana Vidhi Adhyaya

Detailed Virechana process. Properties of virechana drugs along

with their pharmacological action. Indications & Contraindications. Shuddhi Lakshanas.

28.Basthi vidhi adhyaya. Time of administration.

2. Virechana kalpa Virechana dravyas. Kalpa

3. Vamana Virechana

Vyapada Siddhi Adhyaya

Complications of Virechana karma

with their treatment.

Table No .06: Showing Historical Review in ASTANGA HRUDAYA: Sthana Adhyaya Contents Sutra 18.Vamana Virechana vidhi

Adhyaya Detailed Virechana process

Kalpa

3. Vamana Virechana

Vyapad Adhyaya

Complications regarding Virechana

process with treatment.

Table No.07: Showing Historical Review in BHELA SAMHITA:

Sthana Adhyaya Contents 21. No name for this Adhyaya Virechana Yogya Sutra

23.Ghadapurusheeya Vamana Virechana anahras

7.Dantiphalakalpa Virechana Yogas 8.Shankhini kalpa Virechana Yogas

Kalpa 9.Shyama Trivritt Kalpa Virechana Yogas

Siddhi

2. Vamana Virechana Siddhi Idea regarding diet on the previous day of Virechana, dose of decoction, Expulsion of Kapha, Pitta, Vata and Rakta respectively



Table No.08: Showing Historical Review in SHARANGADHARA SAMHITA: Khanda Adhyaya Contents Uttara 13. Vamana Vidhi

Adhyaya Definition of Virechana. Collection of

virechana dravyas, time of administration,

virechya, avirechya, virechana dravya

gunakarma, Rutu anusara virechana dravyas,

Degree of shodhana, ayoga & atiyoga

lakshanas are explained & it’s chikitsa.

Table No.09: Showing Historical Review in NIGHANTU: Name Contents

1. Dhanvantari Nighantu.

2. Kaideva Nighantu.

3. Nighantu Adarsha.

4. Priya Nighantu.

5. Bhavaprakash Nighantu.

Dravyas which are useful for Virechana

karma.



ETYMOLOGY:

Virechana – Vi + Rich + Lyut – ‘Malade nissaranam’ (Vachaspathyam.) 1

Virechana – Vi + Rich + Lyut – ‘Visheshena rechayati’ (Shabdhakalpadruma) 2

Virechana word is derived from the ‘Rich’ dhatu after applying ‘Nich’ & ‘Lyut’ pratyaya

& with‘Vi’ upasarga. giving the meaning Maladehe nissaranam i.e. expelling out the

malas and Visheshena Rechayatee

DEFINITION:

Tatradoshaharanam Adhobhagam Virechana Sanjnyakam | (Ch.K 1/4)

The process of elimination of morbid doshas through adhobhaga is said to be Virechana. Doshaharanamurdhva bhagam vamanakhyam| adhobhagam virechanakhyam |

ubhayam va malavirechanaadvirechana mithyuchyathe || (A Sa Su27/2)

Elimination of dosha from mukha marga ie urdhva bhaga is Vamana, Elimination of

dosha through adho bhaga is known as Virechana. And if the doshas expelled through the

both routes is also reffered as Virechana.

Yatyadho doshamaadaya pacchamanam virechanam

Gunothkarshaadrajathyurdhvampakvam vamanam punaha || (Su Chi 33/34)

Virechana expels the doshas in downword direction after getting digested (or during their

digestion) by the increase of their properties, while Vamana expels the doshas in upword

direction before getting digested.

Vireko mukhapeetam guda margenanta sthetastha /

Doshasya nissaranam pittasya paramaushadham// (A.H.Su.1/25 - Arunadatta)

Virechana is the procedure in which orally administered dravya acts on internally situated

doshas especially on pitta and expels the doshas out through the gudamarga.



PARYĀYA3:

Praskandana, Rechana.

QUALITIES OF VIRECHAKA DRAVYAS4:

They are having Ushna, Teekshna, Sukshma,Vyavayi & Vikasi guna. But the

Virechaka dravyas mostly act by virtue of their Prabhava.

Virechana dravyas are having predominance of Prithvi and Aap mahabhuta.

CLASSIFICATION OF VIRECHANA5 :

Virechana has no classification however Sharangadhara had classified as per the

gradation of Virechana which are dependant on action, potency of drug, onset, consistency of

excretory product.

1) Anulomana : The drug which does the digestion of malas & breaks its compactness &

later expels out through adhobhaga is known as Anulomana. Eg: Haritaki.

2) Sramsana : The drug which expels half digested & sticky malas without prior

digestion is known as Sramsana. Eg: Kritamala.

3) Bhedana : The drug which breaks abaddha, baddha & pindita malas & eliminates

through anus are called as Bhedana. Eg: Katuki.

4) Rechana : The drug which expels both digested & undigested malas after making

them watery, through Gudamarga is known as Rechana. Eg: Trivritt.

Anulomana & Sramsana are the mild types of Virechana, whereas Bhedana &

Rechana are of moderate type.

KARYAKSHETRA OF VIRECHANA:

This can be explained on the basis of its effect on dosha, dushya, srotas, agni & ama.

Dosha: Virechana is said to be beneficial for Pitta dosha, since it eliminates vitiated Pitta



from its root. According to Vagbhata, Virechana is helpful even in Pitta combined with

Kapha or Kapha in Pitta sthana 6.

Dushya: Virechana is mentioned as Shodhana procedure in dusti of Rasa, Rakta, Mamsa,

Asthi, Majja & Shukra dhatus. Hence in majority of the dhatupradoshaja vikaras

Virechana is the better option 7.

Srotas: Since on the above mentioned dushyas Virechana is helpful, we can say that it is

beneficial in Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha & Shukravaha

srotodushti also.

Agni: In the Samyak virikta lakshana, deeptagni is mentioned. Hence Virechana

improves the mandagni state also8.

Ama: Since langhana is done for amapachana, Virechana is mentioned under Shodhana

langhana, hence it is even beneficial in ama state. And also Virechana karma is indicated

as a chikitsa for Amaja vikara 9.

CLASSIFICATION OF VIRECHANA DRAVYA :

According to the Utpatti10:

1.Sthavara: Trivritt, Triphala, Danthi, Vacha,

2. Jangama : i) Mutra- Mahisha, Aja, Ushtra

ii) Dugda- Mastu, Dadhi, Takra, Ghrita, Paya, Snuhiksheera

According to the Upayukata anga:

Table No: 10 Showing the virechana dravya acc to Upayukata anga.

Dravyās Ch.S11 Su.S12 A.S13

Mulini

Hasthidanti(nāgadanti) Shyāmā(mula)(kāla) Trivritt(shweta) Sapthala(Charmakāsha)

Trivritt Shyāmā Danti Dravanti

Danti Trivritt Gavākshi Shankhini



Pratyagshreni(danti) Gavākshi(indrayan) Vishānikā(avarthini) Ajagandha(fokandi) Dravanti(danti type) Adhoguda(vidari)

Saptala Shankhini Vishānikā Gavākshi Chitraka Kusha Kāsha Kinahi Tilwaka

Dravanti Shyāmā Saptalā Ajagandha Ajashringi Vachā Swarnaksheeri Chitraka Kinihi Punarnava PālanKāsha Vāsthuka Shāla

Phalini

Shankhini(shwetabunna) Vidanga(vayuvidanga) Anupa(muleti) Sthalaja(muleti grown on earth) Prakeerya (karanjadwayam) Udakeerya(diyakaranj) Abhayā(haritaki) Antahkotarpushpi (neelabughna) Kampillaka(kabila) Āragwadha(āmlatās)

Kampillaka Puga Eranda Harithaki Vibhitaki Āmalaki Neelini Aragwada

Neelini Haritaki Amalaki Vibhitaki Pilu Kampillaka Priyalu Kuvala Badara Karkandu Kashmarya Parushaka Drākshā Klitanaka Udakirya Vidanga Puga Panchangula

Ksheerini

Snuhi ksheera Arka Ashmantaka

Mahāvruksha Sapthachala Swarnaksheeri

Snuhi Swarnaksheeri Godugda Mahāvruksha Saptachada Jotishmati

Twak

Thilwaka Thilwaka Patala Ramyaka

Thilwaka Ramyaka Kampillaka



Patali Patra Swarnapatri

Āragwadha Putika Āragwadha Kāravellaka

Āragwadha Putika

Lavana Saindhava Sauvarchala

According to the karmukata14:

a) Mrudu - The dravyās which are manda in veerya, given in low dosage, given into the

ruksha vyakti, and causes less virechana Vega is known as mrudu Virechana.

E.g Āragwadha, Guda, Ikshu rasa, Dadhi.etc

Indication: Durbala, shodhita, alpa doshayukta, aparijnyatha kostha

b) Madhyama - The dravyās which are moderate in qualities are known as madhyama

virechana.

eg. Trivritta moola, Kutaki, Aragwadha,etc

Indication: madhyama roga laxanas, madhyama kostha

c) Teekshna - The Dravyās which produces mahāvegas & eliminates the doshās in large

quantities by kshipra guna without causing much glāni or dehydration are known as

teekshna virechana. eg. Snuhi ksheera

Indication: Usage of these dravyās in the balavan rogi who is having all the laxanas of

the vyādhi.

According to gunas of dravyās15:

a) Snigdha virechana- The dravyās used in the form of oil or the preparation containing

sneha are known as sneha Virechana.

eg. ;Eranda taila.

Indication: Visha, Abhighata, Pidaka, Kustha, Shopha, Visarpa, Kāmalā, Pāndu,Prameha



b) Ruksha virechana- The yoga which do not contain sneha is known as ruksha

virechana, its use has been recommended in the snigdha patients who have been

comparatively taken more sneha

eg. Snuhikshira, Danti

Indication: Strong patients, presenting all signs and symptoms of the disease.

According to Rutu16:

Sharangadhara & Bhava mishra has mentioned some of the drugs & their preparations.

Table No.11 Showing the classification of Virechana dravyās acc. to Rutu

VIRECHANOPAGA DRAVYĀS:

The dravyās which helps for samyak virechana or which will synergies the action

of virechana dravyās is known as virechanopaga dravya.

Draksha, kashmarya, parushaka, abhaya, malaki, bibithaki, kuvala, badara, karkandu, pilu

are the ten virechanopaga dravyās17.

Rutu Drugs Anupana Varsha Trivritt, Kutaja beeja, Pippali,

Shunti

Draksha Swarasa,

Kshoudra

Sharad Trivritt, Duralabha, Musta,

Sharkara, udichya, Chandana

Draksha kwatha

With Yastimadhu

Hemanta Trivritt, Chitraka, Patha, Jivaka,

Sarala, Vacha, Hemakshiri

Ushnambu

Shishir/Vasanta Trivritt, Pippali, Shunti,Saindhava,

Shyama (Sariva)

Madhu

Greeshma Trivritt

Sharkara

Sarvaritu

Trivritt, Hapusha, Danti, Saptala,

Katuki, Swarnaksheeri

Bhavana with

Gomutra



VIRECHANA DRAVYA GUNAS:

Table No: 12 Showing the Guna of virechana dravyās.

Guna Ch.S18 A.S19

Saratva Ushnatva Teekshnatva Sukshmatva Vyavāyi Vikāsi

VIRECHANA YOGYA AND AYOGYA :

As a first step in Virechana vidhi, one has to observe whether the patient is

fit for Virechana karma or not. For this Virechana yogyas and Virechana ayogya criteria

is given in the classics.

Table No: 13 Showing the Indications of Virechana (Yogya).

Indication Ch.S20 Su.S21 A.H 22

Arsha + + + Arbuda + + - Ālasaka + + - Asyādāha + + - Aruchi + + - Apachi + + + Apasmāra + - - Avipāka + + - Akshipāka + - - Abhishyandi - + + Anāha - + - Bhagandara + + + Chardi + + + Dustha Vruna - + + Gulma + + + Gala ganda + - - Granthi + + + Gara - + +



Guda dāha - + - Hrullasa + - + Halimaka + - + Hrudroga + + - Jwara + + + Kustha + + + Krimikostha + + + Kāsa + - + Kāmalā + - + Murcha - + + Mutraghata + + + Medhra dāha - + - Nasadāha - + - Nāsa srāva + - - Netra srāva + - - Nilika + - - Netradāha + + - Pakwāshayaruja - + + Pārshva shoola + - - Plihadosha + + + Prameha + + + Pandu + + + Stanya dosha - - + Sleepada - - + Shwayathu - - + Shwāsa + - + Timira + + + Udara + + + Urdhwaga Rakta Pitta + + + Visuchika + + - Visarpa + + + Vyanga + - + Vātarakta + + + Visphota + + + Vibandha - + + Vidradi - + + Yonidosha + + + Rakta dosha + + + Shiraha Shoola + + +



CONTRA INDICATIONS (AYOGYA) : Table No: 14 Showing the Contra-Indications of Virechana.

Contra-Indication Ch.S 20 Su.S 21 A.H 22

Adhogaraktapitta + + + Alpāgni + + + Ajeerna + + + Ādhmāna + - + Atisnigdha + + + Atiruksha + + + Atisthoola + + + Atisāra - - + Bala-Vruddha + + + Chintāprasakta + - - Durbala + + + Durbalendriya + - - Garbhini + + + Hrudrogi - - + Kshudhita + - + Langhita + - - Madātyaya + + + Maithuna praskta + - - Nityadukhita - - + Nava pratishyaya - + - Navaprasoota - + - Navajwara + - + Pipāsita + + - Rājayakshma - - + Shalyadrita + - + Upavasita + + - Vyayamaprasakta + - -



PROCEDURE OF VIRECHANA :

Procedure of Virechana can be classified under three headings

1. Purvakarma

2. Pradhanakarma

3. Paschatkarma

1. PURVA KARMA:

A.Sambhara Sangraha.

B.Atura pareeksha

C.Oushadhi mātra vinischaya

D.Atura siddhata

A. Sambhara sangraha: Charaka says regarding collection of some of the drugs to

manage the complications, which may occur during main procedure & also certain

necessary equipments which helps to handle the emergency 23. Drugs necessary for

deepana, pachana such as trikatu, panchakola etc has to be collected & sufficient

quantities of sneha dravyas required for abhyantara snehapana has to be collected.

Certain virechaka drugs like Trivritt, eranda taila, aragwadha, Icchabhedi rasa,

jalodarari rasa, abhayadi modaka has to be stored. CertainVirechanopaga drugs like

draksha, triphala, parushaka etc are also should be collected.

To combat certain complications like atiyoga medicines like kutaja ghan vati,

karpura rasa, jatiphaladi churna, sanjeevani vati, bilwadi churna, piccha basti are to be

collected. And dietary articles required for samsarjana krama are also to be collected.

B. Atura pariksha: Vaidya should decide whether the patient is fit for Virechana therapy

or not, if fit then different matra of virechaka oushadhi should be decided. One should



even assess samyak snigdha lakshanas in a patient before administering the virechana

karma. Such examination includes dosha, bheshaja, desha, kala, bala, shareera, ahara,

satmya, satva, prakriti and vaya 24.

It is highly essential to consider the snigdha or ruksha state of the person, i.e. if in

cases like ruksha, bahu anila, krura kostha, habituated with vyayama & deeptagni

conditions the administered medicine will be digested without causing virechana, hence

in those individuals initially basti should be given followed by snigdha virechana 25.

C. Matra vinischaya : In general while explaining the matra of Vamanaoushadhi

Charaka says that, the medicine which results in removal of vaikarika doshas, without

causing ati, ayoga or any other complications is said to be the proper matra for

shodhana26.

It is highly necessary to assess the kostha of a patient to decide the nature & matra

of the Virechaka dravya. For that purpose certain drugs like guda, draksha, ksheera etc, in

excess quantity are given, if it causes Virechana, then kostha is mridu & bahu pittavastha

is confirmed. If normal stool is passed, then it is madhyama kostha, even with tikshna

Virechaka medicines if Virechana occurs occasionally, then Krura kostha is confirmed 27.

TableNo.15 Showing the dosage of Virechana28

Kalpana Heena Matra Madhyama Matra Uttama Matra

Kwatha 2 tolas 4 tolas 8 tolas Kalka, Choorna

Modaka 1 tolas 2 tolas 4 tolas



4) Āthura siddhatā29:

In the āthura siddhatā the patient is made prepare with the followings:

a) Deepana Pāchana

b) Snehana

c) Swedana

d) Bhojanādi vichāra

a) Deepana Pāchana 30:

Before going to the pradhāna karma as well as snehana and swedana, the Deepana

dravyās are to be given to increase the agni and Pāchana dravyās for āmā pāchana. This is

done still the appearance of nirām laxanas. Eg. Shunti churna, Chitrakadi vati.

The medicine will act in the body like a nector when there is niramavastha. Hence

with deepana & pachana such state can be achieved.

bb)) Snehana:

Snehapana should be followed in arohana vidhi till the appearance of samyak

snigdha laxanas 31. The duration of snehapāna should be 3, 5, or maximum 7 days, for

mrudu, madhyama and krura kostha respectively 32.

It is an essential part in Panchakarma treatment, which helps in dislodging the

harmful substances from the body tissues.

c) Swedana:

Swedana is done after Snehana which liquefies the leena doshās in the body 33. By

swedana the klinna doshās liquefy and come to kostha which easily goes out of shareera

by shodhana. Here Sarwanga Bhashpa swedana should be adopted.



d) Bhojanadi vichara:

Before Virechana such a diet is preffered, which does not increase kapha,

otherwise vamana may occur. Jangala mamsarasa, yusha & diet with snigdha, laghu,

ushna quality & kapha avriddhikara aharas are necessary, since manda kapha state is

required during Virechana 34.

PRADHANA KARMA:

It starts from intake of medicines upto completion of Vegas. i.e

A.Virechana yoga sevana.

B.Atura paricharya and Nirikshana.

C.Vega nirnaya.

D.Observation of samyak yoga, ayoga and atiyoga lakshanas.

E.Virechana vyapat and Pratikara.

A) Virechana yoga sevana 35:

Before the administration of virechana yoga the physician must examine

the patient’s physical and mental health once again. Patient must have digested, the food

taken on previous day and must have got sound sleep on the previous night.

Shleshma kaale Gate Jnyatwa Koshta Samyak Virechayet (A H Su 18/33)|

According to Vagbhata, the patient has to take virechana karma just after

shlesmakala. It can be understood as the time is so adjusted that the virechana should be

started during pittakala. The dose of the virechana dravya should be decided depending

upon the koshta and agnibala of the patient36. Ushna or sheeta jala can be used as

anupana in accordance with Virechana yoga.



B) Atura paricharya and Nirikshana37 :

Due to oushadha gandha, utkleshakaraka state, chardi may occur. Hence to avoid

it, soon after the intake of medicine, cold water should be sprinkled over face, gargle with

hot water, asked to smell fragrance of flowers.

The vaidya must observe the lakshans of Jeernoushadha, Ajeernaoushadha, Hrit

dosha and vyapat.

i) Aushadha Jeerna-Ajeerna Lakshana38

Table No. 16 Showing Aushadha jeerna-ajeerna lakshanas.

Sl No Aushadha jeerna lakshana Aushadha ajeerna lakshana 01. Vatanulomana Dourbalya 02. Swasthya Daha 03. Kshut Angasada 04. Pipasa Bhrama 05. Mana prasannata Moorchha 06. Indriya prasannata 07. Shuddha udgar

If ayoga occurs due to ajeerna of oushadhas, in that state second time medicine

should not be administered, since it may cause atiyoga. Jeerna oushadhi state if hrit dosha

laxanas are not obtained, then diet is given on the same day & on next day

Virechanoushadhi should be given. Even then if Virechana doesn’t occur, then after a gap

of 10 days again snehana & swedana is done later Virechana is administered 39.

ii) Hrit dosha lakshana 40

Apart form the above lakshanas the hrit dosha lakshanas should also be taken into

consideration. In proper Virechana there will be expulsion of mala, pitta , kapha and Vata

in sequence, “Kaphantam Virechana” and appearance of daurbalyata and laghuta

indicates that doshas have properly eliminated.



If virechana persists even after manifestation of Hrit dosha lakshanas then

Vamana should be performed 41. If the Virechana Vega does not occur then

instantaneously the ushna jala pana, and swedana must be performed on pani, pada and

udara 42 .

C) Vega Vinirnaya:

For the purpose of observation of pravara, madhyama and avara shuddhi,

Chakrapni has given four types of criteria i.e. Laingiki, Antiki, Vegiki and Maniki, but

importance should be given to Laingiki shuddhi43. For vega vinirnaya the physician have

to leave the first two-three malayukta vegas, then counting should be done till

kaphantam44.

TableNo.17 showing the Virechana vega vinirnaya.45,46

Sl. Vega vishaya Pravara Madhyama Avara 01. Vegiki 30 Vegas 20 Vegas 10 Vegas 02. Maniki 4 Prastha 3 Prastha 2 Prastha 03. Antaki Kaphantam 04. Laingiki Samyak Virechana Lakshanas

D) Observation Of Samyak Yoga, Ayoga And Atiyoga Lakshanas :

Table No. 18 Showing the Samyak Lakshana of Virechana karma.

Sl. Virechana Samyak Lakshana Ch.S47 Su.S48 A.H49 01. Srotovishuddhi + - - 02. Indriya prasada + + - 03. Laghuta + + - 04. Agnideepti + - - 05. Anamayatwa + - - 06. Kramat Vit, Pitta, Kapha and Vata Nissarana + + - 07. Vatanulomana - + - 08. Absence of Ayoga, Atiyoga lakshanas - - +



Table No. 19. Showing the Ayoga lakshanas of Virechana

Sl. Lakshana Ch.S47 Su.S48 A.H49 01 Kapha prakopa + + + 02 Pitta prakopa + + + 03 Vata prakopa + - - 04 Agnimandya + + - 05 Gourava + + - 06 Pratishyaya + - + 07 Tandra + - - 08 Chardi + - - 09 Aruchi + + + 10 Vata pratilomata + - - 11 Daha - + + 12 Hridaya ashuddhi - + + 13 Kukshi ashuddhi - + + 14 Kandu - + + 15 Vitsangha - + + 16 Mutrasangha - + - 17 Pidaka - - +

Table No. 20. Showing the Atiyoga lakshanas of Virechana.

Sl. Lakshana Ch.S47 Su.S50 A.H49 01 Kaphakshayaja vikara + + + 02 Pittakshayaja vikara + - - 03 Vatakshayaja vikara + - - 04 Supti + - - 05 Angamarda + - - 06 Klama + - - 07 Vepathu + - - 08 Nidra + - - 09 Hikka + - - 10 Murcha - - - 11 Gudabramsha - - - 12 Shula - + - 13 Kapha,Pittarahita,shweta,lohita,udaka nissaranam - - + 14 Mamsadhavanavat udakasrava - - + 15 Medakhandavat - - + 16 Trishna - - + 17 Dourbalya + - - 18 Tamapravesha + - - 19 Bhrama - - + 20 Netra praveshanam - - +



E) Virechana Vyapats:

Table No 21 Showing Virechana Vyapat lakshana:

PASCHAT KARMA 54 :

Regimens to be adopted after Virechana Karma till the patient is able to take

normal diet is known as paschat karma. Soon after the samyak Virechana karma the agni

will be in imbalance state. Hence, the patient is not allowed to take normal diet, which

can cause further vitiation of agni. Hence, the peyadi samsarjana krama should be

followed in order to bring back the equilibrium in the state of agni.

SL NO Virechana Vyapat Ch.S51 Su.S52 A.H 53 1 Adhmana + + + 2 Parikartika + + + 3 Parisrava + + + 4 Hrudgraha + - + 5 Angagraha + + + 6 Jeevadana + + - 7 Vibramsha + - - 8 Stamhba + - - 9 Upadrava + - - 10 Klama + - - 11 Pravahika - + + 12 Pratikulagati - - + 13 GudaPaka - - + 14 Grathita Purish - - + 15 Gourava - - + 16 Utklesha - - + 17 Dathusrava - - + 18 VirechanasyaUrdhvagamana - + - 19 Savashesha aushadathva - + - 20 Jeernoushadathva - + - 21 Heenadoshaphartrutwa - + - 22 Vatashoola - + - 23 Ayoga - + - 24 Atiyoga - + - 25 Hrudayopasarana - + -

26 Vibandha - + -



Three to seven days samsarjana krama is followed by administrating peya, vilepi,

akrita- krita yusha and akrita- krita mamsarasa depending upon the shuddhi achieved. But

in following conditions Tarpana should be administered instead of samsarjana viz.

01. Pitta kapha parisrava. 02. Madatyaya. 03. Vatapitta prakriti 55.

In Tarpna, Swaccha Tarpana, in place of Peya and Ghana Tarpana in place of

Vilepi should be used according to Chakrapani 56.

Peyadi samsarjana krama:

Table. No. 22 Showing Peyadi Samsarjana Krama

Day Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi 1st Morning Evening

Peya

Peya

Peya

2nd Morning Evening

Peya Peya

Peya Vilepi

Vilepi Yusha

3rd Morning Evening

Vilepi Vilepi

Vilepi Akruta yusha

Mamsarasa Normal diet

4th Morning Evening

Vilepi Akruta yusha

Kruta yusha Akruta mamsarasa

5th Morning Evening

Kruta yusha Kruta yusha

Kruta mamsarasa Normal diet

6th Morning Evening

Akruta mamsarasa Kruta mamsarasa

7th Morning Evening

Kruta mamsarasa Normal diet

Parihārya vishayas57 :

After Virechana karma. Uccha bhashana, Ratha kshobha, Atichankramana, Atyasana,

Ajeerne bhojana, Ahita bhojana, Diwaswapna, Maithuna, Mithyaahara, Adhyashana,

Vishamashana, Akāla bhojana, krodha, shoka, atapa, vegasandharana etc should be

avoided.



VIRECHANA AUSHADHA KARMUKATA58:

The vamana and virechana dravyas posses similar properties like ushna, teekshna,

sukshma, vyavayi and vikashi gunas. Drugs will reach the hridaya by its veerya thereby it

enters into dhamanis, sthula and anu srotas of the body.

Action of ushna guna: Ushna guna has agneya property & hence Vishyandana occurs.

Hence it facilitates movement of morbid doshas towards kostha.

Tikshna guna: Due to this they breaks up the doshas, from larger to smaller molecules.

Sukshma guna : Due to sukshma guna it will open micro channels & makes the doshas

to move towards kostha.

Vyavayi guna: Due to this, drugs spreads quickly throughout the body & starts their

action before its digestion.

Vikasi guna : Vikasi drugs loosens the dhatu bandhana. It creates the dhatu shaithilyata.

Hence drugs initiates their action without being digested.

From all these properties doshas are driven to kostha. The presence of prithvi &

Aap bhuta in virechana drug & the adhobhaga prabhava, the doshas are eliminated out

through guda.



Flow chart No.1 Showing Virechana aushadha karmukata

VIRECHANA AUSHADHA KARMUKATA

Virechana drugs having the Gunas like Ushna, Tikshna, Sukshma, Vyavayi, Vikasi

and with their 'Swavirya'

Move to 'Hrudaya'

From there, through various 'Dhamanis'

Leads to micro and macro channels in the body

Acts over the vitiated Doshas in the body

(i)With ushna guna - liquifies the Doshas

(ii) With 'Tikshna guna ' - Break down into several particles

Liquified matter then glides through various unctous or

smooth channels towards Koshta

Enters 'Pakwashaya' and is then stimulated by 'Apana vayu"

Having the dominance of 'Prithvi' and 'Jala' Mahabhutas in the constitution along with

self desposition (Prabhava)

Move in downward direction towards Rectum

Expelled to outside through Anus

VIRECHANA



REVIEW ON KUSTHA

NIRUKTI 59:

Kushnaati Rogam! Kush+hani kusheeti iti kathan (shabdakalpadruma) ‘KUSH’ word

added to ‘HANI’ to form kustha, which means it gives ugly look to the body.

• Kushnati shareerasya shonitam vikrute iti! Nishkarshaarthakasya kushadhato

atra vikaaraarthatwam bodhyate dhatunaam nekarthatwat!

The kush word derived from dhatu ‘kush’ meaning, the morbid factors mainly

rakta is drawn towards the region of twak so as to cause Kustha.

PARIBHASHA (DEFINITION) OF KUSTHA60:

Shareeram kushnaati tasmat tat kustha mityuchyate! (Arundatta over A. H. NI 14/4)

Arunadatta defined Kustha as that which causes disfigurement of body.

HISTORICAL REVIEW :

In Veda and Purana description regarding Kustha is available but not about Vicharchika.

Table No.23 : Showing historical Review in VEDA KALA

Veda Context

Rigveda Ashwinis treated a lady named by ‘Ghosha’ who was suffering

with kustha and was relieved from the disease.

Some characteristic features like vivarnata and lomaharsha are

described.

Yajurveda When there was kandu etc laxanas on the twacha, the people

were inferring about the kustha in future.

Atharvaveda Atharvaveda defines the word “kustha” as ‘kulshita Rupavarna’ Trivritt has advocated as a special drug for Management of

kustha. Some new terms for skin disorders are described as pama,

vidradhi, etc



Purana Context

Garuda purana

Causative factors of Kustha are mentioned under the chapter of

karma vipaka along with its management.

Agni purana Kustha and its treatments are mentioned.

Internal uses of khadira and external uses of Haratala and

manashila have been mentioned.

SAMHITA KALA : Table No.24 : Showing Historical Review in CHARAKA SAMHITA : Sthana Contents

Sutra sthana

(24th chapter)

Kustha has been considered among raktaja vikara

Nidana sthana

(5th chapter)

Only seven types of Kustha has been described based on

doshik predominance.

Chikitsa sthana

(7th chapter)

Mahakustha and kshudra kustha are delt in detail, where

the lakshanas and treatment have been discussed.

Table No 25: Showing Historical Review in SUSHRUTA SAMHITA :

Sthana Contents

Nidana sthana

(5th chapter)

Kustha has been described as anuvanshika (hereditary) and

krimija (infectious) vyadhi.

Explanation regarding dhatugatatva of Kustha (uttar dhatu

pravesha of Kustha)

Chikitsa

sthana

(9th chapter)

He has mentioned separate chapters under the heading of

Kustha and Mahakustha and explained the criteria for

differentiation between them.



Table No 26: Showing Historical Review in ASTANGA SAMGRAHA

And ASTANGA HRUDAYA:

Samhita Contents

Astanga

sangraha

(14th chapter)

In Nidana sthana Kustha has been mentioned as 18 types

depending on the involvement of dosha and Vicharchika has

been defined as kaphapradhana Kustha.

Astanga

hrudaya

(25th chapter)

In Sutra sthana Kustha is mentioned as one of the dushita

Raktajanya vikara

Table No.27: Showing Historical Review in BHELA SAMHITA AND HARITA

SAMHITA :

Samhita Contents

Bhela samhita

Chikitsa sthana

(6th chapter)

Vicharchika is included under the sadhya kustha.

He described it as moist lesion with dark red colouration

which is deep rooted

Harita Samhita

Triteeya sthana

(39th ch)

He described that in Vicharchika kandu is produced due to

dushita rakta

Table No.28: Showing Historical Review in MADHAVA NIDANA :

Uttarardha Contents 49th chapter He mentioned Vicharchika as vatapitta dominant disease.



Table No.29: Showing Historical Review in BHAISHAJYA RATNAVALI,

YOGARATNAKAR AND SHARANGADHAR SAMHITA :

References Contents

Bhaishajyaratnavali (54th chapter)

Chikitsa and pathyapathya has been mentioned and

also mentioned combinations which are used both

externally and internally.

yogaratnakar

(uttarardha)

Kachhu, rakasa and shwitra have been added to the

11 varieties of kshudra kustha of Charaka Samhita.

Sharangadhara samhita (madhyamakhand)

He has mentioned external application of Arka taila

for Vicharchika.

CLASSIFICATION OF KUSTHA:

Acharyas explained the common NIDANA or causative factors for the production

of Kustha disease. It is produced invariably by the vitiation of seven factors ie three

dosha, twak, rakta, mamsa and ambu61.

Kustha is divided in to two categories, they are – Mahakustha and kshudra kustha.

These are catagorised on the basis of involvement of dosha and lakshanas. In Kshudra

kustha involvement of dosha is in uttana dhatu, where as in mahakustha involvement of

dosha is in gambheera dhatu62. And also Kshudra kustha has alpa lakshanas in

comparision to Mahakustha.

Mahakustha:

In the classification of mahakustha there is a variation among different classical

authors.

Sharangadhara has described eighteen types of Kustha rogas in prathama khanda

7th chapter. He has not classified in to mahakustha and Kshudra Kustha63.



Table No. 30: Classification of Mahakustha according to different Acharyas

Nameof disease Ch.S64. Su.S65. A.H66 B.S67. M.N68. B.P69. Kapal + + + + + + Audambara + + + + + + Mandala + - + + + + Rushyajivha + + + + + + Pundarika + + + + + + Sidma + - - + + + Kaakanaka + + + + + + Dadru - + + - - - Aruna - + - - - -

Kshudrakustha:

Difference of opinion also exists in the classification of kshudrakustha regarding

names, characters and classifications among acharyas Charka, Sushruta, Vagbhat,

Madhavkar, Bhavmishra and Bhela.

Table No. 31: Classification of Kshudrakustha according to different Acharyas

Name of disease Ch.S64 Su.S.65 A.H66 B.S67. M.N68. B.P69. Ekakustha + + + + + + Charmakustha + - + + + - Kitibha + + + + + - Dadru + - + + + - Alasaka + - + - + - Vipadika + - + + + - Charmadala + + + - + - Visphotaka + - + - + - Paama + + + - + - Shataru + - + + + - Vicharchika + + + + + - Sthularushaka - + - + + - Mahakustha - + - Sthularu - - Visarpa - + - - - - Parisarpaa - + - - - - Sidhma - + - - - - Rakasa - + - - - - Kacchu - - - - - - Shwitra - - - + - - Vishaja - - - + - -



Even though all the authors have accepted that there are only eleven types of

Kshudra kusthas and seven types of Mahakusthas but the total number is higher. This

numerical difference is only because of different nomenclature adopted by different

acharyas.

Table No. 32: Classification of kustha on the basis of doshic predominance :

Dosha Ch.S64 Su.S.65 A.H66

Vata Kapala Aruna Kapala

Pitta Audumbara Rushyajivha,

Audumbara,

Charmadala, Visarpa,

Kapala, Vicharchika,

Kitibha, Kakanaka,

Paama.

Audumbara

Kapha Mandala,

Vicharchika

Pundarika, Dadru,

Arushaka, Ekakustha,

Mahakustha, Sidhma,

Rakkasa

---

Vata-Kapha Sidhma, Ekkustha,

Alasaka,

Charmakhya,

Kitibha, Vipadika.

---

Sidhma,Ekkustha,Alasaka,

Charmakhya, Kitibha,

Vipadika.

Vata-Pitta Rushyajivha --- Rushyajivha

Kapha-Pitta Pundarika, Dadru,

Charmadala,

Paama,

Visphotaka,

Shataru.

---

Pundarika,

Dadru,Charmadala,

Paama,Visphotaka,

Shataru.

Vata-Pitta-

Kapha

Kakanaka --- Kakanaka



VICHARCHIKA

ETYMOLOGY 70:

Vicharchika word is derived from “Charcha” dhatu, Vee–prefix and Navul –

suffix. It means a type of Svalpa (minor type) Kustha.

NIRUKTI 71 :

Shabdakalpadruma described two cardinal features for introduction of Vicharchik,

i.e. cracking of the skin mainly occurs on the skin of hands and legs.

DEFINITION:

Marked lining, excessive itching and pain with dry lesion on the body called

Vicharchika 72.

The skin lesion with kandu, pidaka, shyavavarnata and bahusrava is called

as Vicharchika73. Vagbhata mentioned lasikadhya instead of bahusrava 74.

NIDANA PANCHAKA:

NIDANA:

As Vicharchika is one type of Kustha, so the samanya nidanas described for Kustha

can be taken as nidana of Vicharchika.

Nidanas mentioned in classics may be classified as

1. Aharaja Hetu

2. Viharaja Hetu

3. Bijadoshaja



Table No. 33: Nidana according to different Acharyas: Ahara hetu:

Sl.No. Viruddha ahaar Ch.S.75 Su.S.76 A.H.77 B.S.78 M.N79

1. Chilchimam cha payasa + - - - -

2. Atimatra of ahara containing

hayanaka, yavaka, chanaka,

uddalaka & Koradusha along with

ksheer, dadhi, takra, kola, matsya,

atasi, kusumbha & sneha.

+

-

-

-

-

3. Madhu, Phanit, Matsya, Lakucha,

Kakamachi-satata atimatra sevan

+ - - - -

4. Excessive intake of drava guru

and snigdhaanna.

+ - - - -

5. Navanna, dadhi, matsya, tila,

lavana, amla-atyadhika sevan.

- - - - +

6. Continuous use of gramya, anupa,

aoudak, mamsa with milk.

- + - - -

7. Taking excessive use of madya,

shaka after milk.

- - - + -

8. Taking hot diet after taking

madya, madhu

- - - + -

Sl.No. Mithya Aahar Ch.S. Su.S. A.H. B.S. M.N

10. Excessive use of tila, ksheera & guda + - - + -

11. Adhyashana – over eating even though

having ajirna.

+ + - + +

12. Sneha atisevana + - - - -

13. Asatmya aahar - + - - -

14. Excessive use of madhu & phanita + - - - -

15. Taking vidahi aahar in vidagda condition + - - - -



Sl.No. Vihara hetu Ch.S Su.S A.H B.S M.N 16. Sudden change from cold to hot & hot to

cold climate

+ + - - -

17. Santarpana-apatarpanaabhyavaharya

vyatyasa

+ - - - -

18. Entering in cold water after one affected

with bhaya, santapa, shrama.

+ - - - -

19. Not undergoing vamana in vidagdha

condition

+ - - - -

20. Doing vyayama and vyavaya after sneha

pana and vamana.

- + - - -

21. Divaswapna - - - - +

Sl.No. Vegadharana Ch.S Su.S A.H B.S M.N

22. Suppressing natural urges of mutra,

purisha

+ + - + -

2. Suppressing chardi vega + + - + -

Sl.No. Panchakarmapacharaja Ch.S. Su.S. A.H. B.S. M.N

23. Panchakarma kriya mane nishiddha

sevana

+ - - - -

24. Improper administration of snehapana + - - - -

Sl.No. Anya hetu Ch.S. Su.S. A.H. B.S. M.N

25. Papa karma + + + + +

26. Guru tiraskara + - - - -

27. Purvakrita karma + + - -

28. Sadhu ninda, apamana and vadha - + + - -

29. Struggle with guru and vipra + + + - -

Sl.No. Bijadoshaja Ch.S. Su.S. A.H. B.S. M.N

1. Dusta shukra-shonita - + - - -



B) PURVARUPA:

Purvarupa is prodromal stage of the disease. Acharya Sushruta has explained this

is the forth kriyakal in which sthanasamshraya of the vitiated doshas takes place.

There is no specific mentioned of purvarupa of Vicharchika but purvarupa of

kustha as a whole are given in many samhitas which are applicable to Vicharchika.

Table No. 34: Purvarupa according to different Acharyas

Sl.No Purvarupa Ch.S80 Su.S81 A.H82 B.S83 M.N84 B.P85

1. Atiswedanam + + + + + +

2. Lomaharsha + + + + + +

3. Aswedanam + + + + + -

4. Vaivarnya + - + + + +

5. Suptata + + + + + +

6. Atishlakshnatwam + - + - + +

7. Kandu + + + - + +

8. Kharatwam + - + - + +

9. Paridaaha + - + + + +

10. Kothonnati + - + - + +

11. Nistoda + - + - + +

12. Nimitte alpe api kopanam

- - + - + +

13. Gouravam + - - + - -

14. Ushmayana + - - + - -

15. Shrama + - + - - -

16. Klama + - - + - -

17. Parushyam + + - - - -

18. Swalpanam api

vrananam arohanam

+ - - - - -

19. Shwayathu + - - - - -

20. Visarpanam abhikshnatam

+ - - - - -



C) RUPA :

In the ayurvedic classics almost similar lakshanas of Vicharchika have been

described but some lakshanas are different like acharyas Charaka and Vagbhata given

srava as lakshana but acharya Sushruta explained as Rukshata as lakshana.

So it suggests that vicharchika is of two types dry & wet.

Table No. 35: Rupa according to different acharyas

Sl.No. Rupa Ch.S86 Su.S87 A.H88 B.S89 K.S90 M.N91 B.P92

1. Srava + - + + + + +

2. Kandu + + + - - + +

3. Shyavata + - + + - + +

4. Pidika + - + - - + +

5. Ruja - + - - + - -

6. Raktata - - - + + - -

7. Pariklinnata - - - + - - -

8. Paka - - - - + - -

9. Vrana - - - - + - -

10. Rajyo - + - - - - -

11. Rukshata - + - - - - -



TWACHA RACHANA SHAREERA

Before going to Samprapti of disease, first we have to understand the

fundamentals of twacha by reviewing its Rachana and Kriya shareera. Because twacha is

considered as one of the sapta dravyas responsible for the manifestation of kustha. Along

with Twacha rachana shareera the description of Rakta is also necessary, as Vicharchika

is considered as Raktapradoshaja vikara.

According to Charaka and Vagbhata twak is divided into six layers, whereas

Sushrutacharya’s description of twacha includes seven layers. It is considered as one of

the Jnanendriya. Vayu and Akash are the indriya dravyas present in twacha and sparsh is

indriyartha. Among all the doshas twak is seat of Bhrajak pitta.

ETYMOLOGY:

1) Twachati samvrunoti Sarvashareeramiti 93.

2) Twachati samvrunoti va Deham 94.

It means covering of the body.

DEFINITION:

Twacha samvarne tuda shonitadik miti! (Shabdakalpadruma)

One of the indriyaadhisthana which completely covers meda, shonita and all other

dhatus of the body. It is considered as a seat of vata 95.

FORMATION OF TWACHA:

Twak is upadhatu of mamsa so, ultimately twak is formed by mamsa and it is

among the Matrujabhava because it is coming from ovum. Twak has developed after the

fertilization of ovum. At the time of fertilization Shukra, Shonita and Atma become

united for the manifestation of garbha. Its growth is rapid and nourished by tridosha.



Twak is formed by paka of rakta by its dhatwagni and rakta becomes dry in the form of

skin like the deposition of cream on the surface of boiling milk96. Thus twak is also called

as rakta santanika.

PANCHABHOUTIKATVA97:

As Shareera is made up of panchamahabhoot hence twacha is also consists of

panchamahabhoot.

LAYERS OF TWACHA:

There are some different opinions regarding the number of the layers of the

twacha among the ancient acharyas. Acharya Charaka has mentioned six layer of twacha,

but only first two layers are named rest of the four layers are counted as producing

diseases98.

Table No. 36 Number of Kalas and manifestation of kustha

Sl. No. KALA CONTAINS 1. Udakadhara - 2. Asrukdhara - 3. 3rd Manifestation of sidhma and kilas 4. 4th Manifestation of dadru and kustha 5. 5th Manifestation of Alaji and vidradhi 6. 6th Manifestation of Arunshi

Acharya Sushruta has mentioned seven layers of twacha along with their specific

name, thickness and prone origination of the disease99.

Table No. 37 Kalas, thickness of twacha and reflection of disease

Sl. No. Layers Thickness (in Vreehi)

Reflection of Disease

1. Avabhashini 1/18th Sidhma, Padminikantaka 2. Lohita 1/16th Tilakalaka, Vyanga, Nyachha. 3. Shweta 1/12th Charmadala, Ajagallika, Mashaka



4. Tamra 1/18th Kilas, Kustha. 5. Vedini 1/5th Kustha, Visarpa. 6. Rohini 01 Granti, Apachi, Arbuda, Sleepada, Galagand 7. Mamsadhara 02 Bhagandara, Vidradhi, Arsha.

Sharangadhara has also mentioned seven layer of the twacha along with probable

onset of disease. The name of first six layers is same as Sushruta, but 7th layer is called

sthula which is the site of vidradhi 100.

Vagbhata has also described seven layers of twacha but names are not mentioned.

Commentator Arunadatta and Hemadri have named them according to nomenclature

given by Sushruta101.

Table No. 38 Different layers of twacha according to different acharyas

Su.S Ch.S A.H. Sh. S B.S

Avabhashini Udakadhara Udakadhara Avabhashini Udakadhara

Lohita Asrukdhara Asrukdhara Lohita Asrukdhara

Shweta 3rd 3rd Shweta 3rd

Tamra 4th 4th Tamra 4th

Vedini 5th 5th Vedini 5th

Rohini 6th 6th Rohini 6th

Mamsadhara - - Sthula -

Thus, fundamentally there is no difference in the number of the layers said by the

various Acharyas.

KRIYA SHAREER OF TWAK:-

Twacha and dosha:

Twacha has been considered as sparshanendriya adhisthana102 which is function

of vata. Bhrajaka pitta is located in the twak for giving luster and colour. The drugs used



for abhyanga, parisheka, lepa, avagaha, etc are absorbed with the help of Bhrajaka

pitta103. Snigdhata, Shlakshanata, Mruduta, Sheetata are attributed to kapha. 104

Twacha and Dhatu:

Rasa: In the context of twak sara purusha lakshanas it has been also said as rasa sara. 1st

layer of twacha, Udakadhara also contains rasa so it can be easily understood that there is

a relation between twacha and rasa105.

Rakta: Among its functions one is varna prasadan means which gives colour 106

Mamsa: Twak is upadhatu of mamsa107.

Majja: Twakgata sneha is the mala of majja dhatu108

Twacha and mala:

Sweda – It is mala of meda which is excreted by twacha, sweda maintain the luster and

humidity of twacha109.

RAKTA

According to Acharyas Kustha is said to be Raktaja vyadhi. So Rakta is also an

important factor in manifestation of Kustha. Hence its description becomes necessary.

ETYMOLOGICAL DERIVATION:

The term Rakta is derived from the root ‘Range rage’ with the meaning of colour.

It is suffixed by taddhita pratyaya forming the word Rakta110.

DEFINITION: Rakta is that form of rasa influenced by the action of ranjaka teja111.

Rakta is the convertion of rasa formed by the intake of food material ingested by

the individual in accordance with desha satmya, kala satmya and oka satmya112.

FORMATION: Embryologically rakta is matruja bhava. Rasa after attaining proper

transformation in yakrit and pliha attains the state of rakta according to Acharya



Sushruta113.

PANCHABHAUTIKATA: ‘Jeeva rakta’ is said to be ‘panchabhautika’ in composition.

The qualities of pancha mahabhutas present in rakta are enumerated in Sushruta Samhita

as follows:

Prithvi→ Visrata, Aap → Dravata, Teja→Raga

Vayu→ Spandana, Akasha→Laghuta.

D) SAMPRAPTI:

All acharyas have mentioned Samprapti for Kushtha, but neither Samhitas nor

commentaries mentioned exact Samprapti of Vicharchika. So Samprapti of Kushtha can

be accepted as a Samprapti of Vicharhika.

ACC TO CHARAKA114:

Flow chart No.2 Showing Samprapti of Vicharchika acc. Charaka

Nidana Sevana

Tridosha Prakopa

Reaches to twak, rakta, mamsa, ambu and produces shaithilya

Further vitiation of doshas occurs

These doshas gets enlodged at the place of dhatu shaithilya

Produces Vicharchika



ACC TO SUSHRUTA115:

Flow chart No.3 Showing Samprapti of Vicharchika acc. Sushruta

Nidana Sevana

Pitta and kapha prakopa

Aggrevation of vata due to Avarana by pitta and kapha

Aggrevated vata carries prakupita pitta and kapha

Enters in to the bahya roga marga and spreads throughout body by tiryak sira

Doshas get lodged in bahya roga marga

Produces Mandala (Kustha)

Vitiation of blood

Vicharchika ACC TO VAGBHATA116:

Flow chart No.4 Showing Samprapti of Vicharchika acc. Vagbhata

Nidana Sevana

Tridosha Prakopa

Spreads to tiryak gati

Vitiates twak, rakta, mamsa and lasika, produces

Shaitilyata and vaivarnya of bahir twacha

The doshas gets enlodged at the place of dhatu shaithilya

Produces Vicharchika



Flow chart No.5 Showing KUSTHA-RAKTA PRADOSHAJA VYADHI 117:

Nidana Sevana

Vitiation of blood

Kustha

SAMPRAPTI GHATAKA

Dosha : Tri – Dosha

Dushya : Twak, Rakta, Mamsa, Lasika, Tridosha

Agni : Jatharagnimandya, Dhatvagnimandya

Srotas : Rasavaha, Raktavaha, Mamsavaha, swedavaha.

Srotodusti Prakara : Vimargagamana, sanga

Udbhava Sthana : Amashaya

Adhisthana : Shareera

Rogamarga : Bahya

Vyakta sthana : Twacha

Sanchara sthana : Tiryak sira



DIFFERENTIAL DIAGNOSIS:

There are some particular diseases having almost nearer to same cardinal

symptoms like Vicharchika which are counted under differential diagnosis Viz, Kacchu,

Pama.

Table No. 39: Showing Differential Diagnosis:

Roga Pareeksha Vicharchika Kacchu Pama Variety of Lesion Pidika

Pitika

Sphota Anubhi, Pidikabhi, Sukshma Bahya pidika, Arushmati, Sasphota.

Colour of Lesion Rakta, Shyava and Lohita.

-- Shweta, Aruna, Shyava.

Site Gatra, Gatreshu iti, Panipadeshu.

Pani – Pada – Sphik, Prayena sphik, pani, Kurpara.

Kandu Sakandu, Atikandu. Kandu. Kandvadhikya, Sakandu, Kandu, Kandumati.

Srava Bahusrava Sravavati, Srava. Sasrava, Adhika kleda

Ruja Ruja, Vedana. -- Rujadhikya, Toda, Daha Daha. Daha. Daha. Paka Paka Paka -- Raji Rajyo. -- --

UPADRAVA118:

Upadravas of Vicharchika have not been described separately in the classics.

However upadravas of Kustha are described by acharya Charka which are applicable for

Vicharchika as it is a type of Kustha.

1. Prasravana 2. Angabheda

3. Angapatana 4. Trishna

5. Jwara 6. Atisara

7. Daha 8. Daurbalya

9. Arochaka 10. Avipaka



SADHYASADHYATA119:

Sukha Sadhya : - Ekadoshaja, Vata-kaphaja, twakashrita, naveena

Kricchra Sadhya : - Kapha pittaja, vata-pittaja, rakta and mamsashrita

Yapya : - Medogata

Asadhya : - Tridoshaja, Purana, asthi, majja and shukrashrita

CHIKITSA:

The term Chikitsa means ‘Ruk Pratikriya’120i.e. to counteract the causative factors

of a disease. Acharya Sushruta says ‘measures calculated to the removal of the causative

factors of disease is Chikitsa.” In general it is an accepted fact that the skin diseases are

time consuming as far as the treatment is concerned i.e. not easily cured, long standing &

require patience in treatment. Generally there are 2 types of treatment i.e. Shodhana

Chikitsa & Shamana Chikitsa121. Besides the classical references the treatment of Kustha

can be broadly classified into three main methods of management viz.

A) Nidana Parivarjana

B) Shodhana

C) Shamana

Nidan parivarjana – It means to avoid etiological factors122. Nidana Parivarjana stops

the further progression of the disease, by restricting vitiation of Doshas.

Shodhana - Means purification. It comprise of 3 measures123 viz. –

1. Antaha parimarjana

2. Bahi Parimarjana

3. Shastra pranidhana



Shamana -The therapies which subside the morbid Doshas without removing it from the

body is known as Shamana 124.

Sodhana Chikitsa in Kustha :

According to most of Ayurvedic texts, all types of Kustha have been considered

as ‘Rakta Pradoshaja’Vikara 125. Further Vicharchika is stated to be Tridoshaja with the

dominance of Kapha-Pitta Dosha & Bruhatrayi have mentioned the Chikitsa as Shodhana

followed by Lepana for Kustha. Among Shodhanas, Virechana is best for the Pitta &

Rakta Pradoshaja Vikara & some extent of Kapha126,127 , which are the main Doshas of

Vicharchika. When the morbid Doshas are expelled out by the process of Shodhana i.e.

Virechana from its root, then the chances of recurrences are negligible 128. It occurs in the

same way as when tree is uprooted, then the possibility of its re-growing is nil.

Acharya Charaka has specified that in Vata predominant Kustha Ghrita should be

prescribed, similarly, where the Kapha is dominant,Vamana Karma & in the dominancy

of Pitta, Virechana Karma & Raktamokshana should be instituted129.

Sushruta described the line of treatment of Various kusthas in some what similar

to Charaka’s description. He says that Vamana for Kaphadhika Kustha in every fortnight,

Virechana for the elimination of vitiated Pitta should be undertaken every month.

Raktamokshana for the expulsion of Dushita Rakta should be done twice in a year &

Nasya karma should be carried out on every 3rd day 130 .

Sushruta has added one more principle for the treatment of Kustha i.e.

In Twakgata (Rasagata), Kustha Shodhana drugs should be applied as external

application. In Raktagata Kustha, Shodhana karma, Kashayapana, Raktamokshana & in

Mamsagata Kustha Shodhana karma, Alepana(external application) Kashayapana,



Raktamokshana, Asava-Arista sevana, Mantha kalpana & Avaleha preparations have

been indicated131.

Shamana (Alepana) chikitsa in Kustha:

Shamana therapy is also an important part of the treatment of Kushtha. After completing

the Shodhana Karma, Shamana Chikitsa is indicated to subside the remaining Doshas. Shamana

Chikitsa is very useful in those patients who are unable to undergo or contraindicated for

Samshodhana. Charaka has advised Shamana therapy with Tikta and Kashaya Dravyas after

administration of proper Shodhana 132 . Charaka has also indicated several other drugs &

formulations of Shamana therapy in 7th chapter of Chikitsa Sthana.

Acharya Sushruta also advocated that if samprapti occurs in twak, rakta, mamsa it

should be managed by Shodhana, Alepana, Kashaya pana, Raktamokshana etc..

So for Kustha the drugs having properties like katu, ushna and tikta rasa should be

used for removing the morbidity. So in the present clinical study Shodhana particularly

with Virechana and Shamana in the form of teekshna Alepana with Arka taila has been

selected.

PATHYA – APATHYA:

Nidana sevana results in to various pathological changes in the body that creates a

disease. Nidana parivarjana will stop further pathogenesis in the body. There fore Pathya

and Apathya have a great role with each disease.



Table No. 40: Pathya according to different acharyas

Sl.No. Pathya dravya Ch.S133 Su.S134 A.H135

1. Laghu anna + - - 2. Tikta shakha + - + 3. Bhallataka + + + 4. Triphala + - + 5. Nimba + + + 6. Purana dhanya + + - 7. Jangala mamsa + + + 8. Mudga + - + 9. Patola + - + 10. Ghrita + - + 11. Shastika shali, yava, godhuma, koradusha,

shyamaka, uddalaka - + +

12. Audaka - + + 13. Pana, Parisheka, avagaha of khadira kashaya + + + 14. Masoora - - + 15. Mandooka parni - + - 16. Avalguja - + - 17. Atarushaka - + -

Table No. 41: Apathya according to different acharyas:

Sl.No. Apathya dravya Ch.S133 Su.S134 A.H136 1. Guru anna + - + 2. Dugdha + + - 3. Amlarasa + + + 4. Dadhi + + + 5. Anupa mamsa + - + 6. Matsya + - - 7. Guda + + + 8. Tila - + - 9. Mamsa, vasa - + + 10. Taila - + - 11. Kulattha - + - 12. Vidahi anna - + + 13. Ikshuvikara - + - 14. Abhishyandi anna - + - 15. Lavana + - + 16. Maithuna - + -



DRUG REVIEW

The following drugs are used in present study -

1) Shunti churna – for Deepana-Pachana

2) Panchatiktaka ghrita – for Snehapana

3) Murchita Tila taila – for Abhyanga

4) Triphala kashaya with Danti – for Virechana

And Trivritt churna as prakshepaka dravya

5) Arka Taila – for Alepana

Table No. 42: Showing the properties of Shunti churna

Table No. 43: Showing the properties of ingredients of Panchatiktaka Ghrita 138

Dravya Nama

Rasa Guna Veery Vipaka Doshaghnata

Karma

Gogritha139 Madhura

Guru Snigdha

Sheeta Madhura Vata Pitta Ojovardhaka

Nimba140 (Azadiracta indica)

Tikta

Laghu Sheeta Katu Kapha Pitta

Kusthaghna Kandughna Grahi

Patola141 (Trichosantes dioica Roxb)

Tikta Laghu Snigdha

Ushna Katu Tridosha Agnideepaka,paachak

Kantakari142 (Solanum xanthocarpum)

Tikta Katu

Sara Ruksha Laghu

Ushna Katu Kapha Vata

Krimighna Rakta shodhaka

Guduchi143 (Tinospora cordifolia)

Katu Tikta, Kashaya

Laghu Ruksha

Ushna Madhura

Tridosha Rasayana Kusthaghna Deepana Pachana

Dravya Nama

Rasa Guna Veerya

Vipaka Doshaghnata

Parts Used

Karma

shunthi137 (Zingiber Officinate)

Katu Laghu, SnigdhTeekshna

Ushna Madhura Kapha Vata

Kanda

Pachana Agnideepana,Bhedana,Vatanulomana



Vasaka144 (Adathoda vasica)

Tikta kashaya

Laghu Ruksha

Sheeta Katu

Kapha Pitta

KusthaghnaHridhya Rakta shodhaka

Table No 44: Showing the properties of Tila

Table No 45: Showing the properties of Drugs which are used for Virechana

Karma - Triphala kashaya146

Dravya Nama

Rasa Guna Veerya Vipaka Doshaghnata

Parts Used

Karma

Tila145 Katu Tikta Madhura kashaya

Snigdha Guru Grahi

Ushna Katu Madhura

Vata Beeja Srotoshodhana, vatanulomana, Balya.

Dravya Nama


Karma

Haritaki 147 Terminalia chebula

Lavana rahita panchrasa (kashaya pradhana )

Laghu ruksha

Ushna

Madhura

Tridosha

Rasayana Mrudu virechaka. Kusthahara

Bibhitaki 148 terminalia belerika

Kashaya

Laghu rukshya

Ushna

Madhura

Tridosha

Malabedhana Krumihara, Shothaghna

Amalaki149 emblika ribes

Lavana rahita panchrasa(amlapradhana)

Laghu rukshya

Shita

Madhura

Tridosha

Rasayana Deepana anulomana

Danti 150 Baliospermm momentum

Katu

Guru tikshna

Ushna

Katu

Kapha Pitta

Teekshna virechana Shothahara, kusthahara

Trivritta151 (Operculina terpenthelum

Tikta katu

Laghu Ruksha

Ushna

Katu

Kapha pitta

Rechaka,Bhedana,Sukhavirechaka



Table No.46: Showing the properties of ingredients of Arka Taila152

Dravya Nama


Karma

Arka153 Calotropis procera

Katu Tikta

Laghu ruksha Teekshna

Ushna

Katu

Kapha Vata

Kusthaghna Swedajanana Vedanasthapana

Haridra154 Curcuma longa

Tikta Katu

Laghu ruksha

Ushna

Katu

Tridosha

Kusthaghna Kandughna Varnya

Sarshapa155 Brassica alba

Katu Tikta

Ruksha Teekshna Snigdha

Ushna

Katu

Vata Kapha

Kusthaghna Varnya Jantughna

Materials and Methods


MATERIALS AND METHODS

MATERIAL TAKEN FOR STUDY WERE;

A) Drugs: Shunti churna, Panchatiktaka Ghrita, Tila taila, Triphala kwatha(Trivritt

churna, and Danti churna as a prakshepaka dravya) and Arka taila.

These drugs were selected for Deepana-Pachana, Snehapana , Abhyanga, Virechana

karma and for Alepana.

B) Instruments: Measuring glasses, Bed pan, vessels

C) Patients: 30 Patients diagnosed as Vicharchika.

COLLECTIONS OF MATERIALS:

Panchatiktaka Ghrita, Murchita Tila taila, Triphala kwatha churna and Arka taila

were prepared as per the classical reference at Pharmacy of B.V.V.S Ayurvedic Medical

college, Bagalkot.

And other drugs are also taken from that pharmacy only.

PREPARATION OF MEDICINE:

Preparation of Panchatiktaka Ghrita:

The Panchatiktaka Ghrita wsa prepared as per ghrita paka vidhi as explained in

classics.

Preparation of Arka taila:

The ingredients of Arka taila are Arkapatra swarasa, Haridra and Sarshapa taila.

The Arka taila was prepared as per taila paka vidhi as explained in Sharangadhara

Samhita.

Preparation of Triphala kashaya for Virechana :

It was prepared by adding 4 times water in Triphala Yavakuta Churna and by keeping



1/4 th (Chaturthamsha) of it as it is after boiling. Then it was filtered through cloth and

added Danti and Trivritta churna as a prakshepaka dravya to it.

STUDY DESIGN: The size of sample was 30 excluding dropouts. In the study the

patients were assigned in to 3 groups. i.e, Group A, Group B and Group C, comprising of

10 patients in each group. Grouping was made by random sampling procedure and it is a

comparative study.

SOURCE OF DATA:

Literary Data: The literary source of data of present study was obtained from classical

texts of Ayurveda, , published articles in reputed journals and related source of Internet.

Clinical data: The patients of Vicharchika within the age group of 16 yrs–70 yrs were

selected randomly from OPD, IPD of Dr. B.N.M.E Trust’s Shri Mallikarjuna Swamiji Post

Graduate and Research centre, Bijapur and special camps conducted in Bijapur city by the

institute irrespective of their sex, occupation and socio – economical status.

INCLUSIVE CRITERIA: 1. Patients presenting with classical signs and symptoms of Vicharchika explained in

Sushruta samhita.

2. Patients of either sex between the age group of 16 yrs – 70 yrs.

3. Patients fit for Virechana karma.

4. Patients fit for Alepana.

EXCLUSIVE CRITERIA: 1. Patients presenting with sravayukta Vicharchika associated with any other systemic

disorders.

2. Patients below the age group of 16yrs and above the 70yrs.

3. patients associated with other type of kustha.



DIAGNOSTIC CRITERIA:

Based on classical signs and symptoms as per the case proforma attached in annexure.

Assessment criteria:

1. Comparative assessment of signs/symptoms before and after treatment was the

main criteria.

2. Photographs of local (affected) lesion of Vicharchika were taken before and after

treatment in most of the patients.

SAMPLING METHOD:

Randomly selected patients from OPD, IPD and camps conducted by

Dr.B.N.M.E.T’s Shri. Mallikarjuna Swamiji Post Graduate Research Centre, Bijapur. 10

patients were allotted in each group by random sampling method.

INTERVENTIONS:

GROUP A

Sample Size : 10 Patients

Method : Virechana Karma

i) Purva Karma :

Pachana - Shunti churna 3-6gm will be given

with ushnodaka in divided dose until

niramavastha.

Snehapana - Panchatiktaka ghrita

Arohana krama snehapana

acc. to Kostha

Sarvanga Abhyanga - Tila Taila



And Swedana - Sarvanga Sweda

ii) Pradhan Karma : Virechana Karma

Drug - Triphala Kwatha –Prakshepaka

dravya: Danti and Trivritt Churna

Dose - acc. to Kostha

iii) Paschath Karma : Samsarjana krama will be followed acc.

to shuddhi

Duration of Treatment : 18days

Post treatment follow up : On 33rd day

Group ‘B’


Material : Arka Taila

Method : Alepana on affected area.

Dose : As required

Kala : Morning and Evening

Duration of Treatment: 18 Days

Follow up : On 33rd day

Group ‘C’


Method : Virechana Karma followed by Alepana

i) Purva Karma :

Pachana - Shunti churna 3-6gm will be given with ushnodaka in divided dose until niramavastha.



Snehapana - Panchatiktaka ghrita

Arohana krama snehapana

acc. to Kostha

Sarvanga Abhyanga - Tila Taila

And Swedana - Sarvanga Sweda

ii) Pradhan Karma : Virechana Karma

Drug - Triphala Kwatha –Prakshepaka

dravya: Danti and Trivritt Churna

Dose - acc. to Kostha

iii) Paschath Karma : Samsarjana krama will be followed acc.

to shuddhi

In this group after Virechana karma, Alepana with Arka taila was done for 18

days. Alepana with Arka Taila was followed as mentioned in Group ‘B’

Duration of Treatment : 12 days for Virechana and 18 days for Alepana

(12+18days)

Follow up : On 45th day

VIRECHANA VIDHI: It includes

1) Purva karma

2) Pradhanakarma

3) Paschathkarma

Purva karma

Shuntichurna minimum 3gms to max 6 gms was given daily in divided doses

(2 times), according to kostha until niramavastha.



For snehapana Panchatiktaka ghrita was given in Arohana krama according to

kostha and agni of the individual patient, until samyak snigdha laxanas were

seen.

On the day of vishramakala i.e. 3 Days. Abhyanga using tila taila followed by

sarvanga swedana (Mrudusweda) was done.

Snigdha, drava and ushna bhojana was advised to the patient.

Pradhana karma

On the next day in the empty stomach Triphala kashaya containing danti and

trivritt churna as a prakshepaka dravya was given. The patient was advised to take hot

water frequently for proper digestion of virechana oushadhi.

When the Vegas were observed, patient was advised to exclude the first two

Vegas as it contains only mala from next coming Vegas were counted.

The Vegas were calculated , lakshanika shuddhi and Ankati was also observed.

Paschath Karma:

According to type of shuddhi, Samsarjana krama was adopted. Before sending

the patients the objective parameters were recorded.

Alepana (External application): Patients have applied Arka taila on the lesion with a

sterilized cotton swab twice a day for 18 days. It was observed that the taila took about

30-60 minutes to get completely absorbed.

ASSESSMENT OF VARIABLES:

The efficacy was assessed on the basis of relief obtained by the patient after the

treatment. The clinical symptoms observed in the selected patients were graded and

changes in them are noted before and after the completion of the clinical trails.



Assessment of Subjective Variable was framed as follows.

1) Rekha

Grade 1 - No Rekha

2 - Superficial Rekha.

3 - Deep Rekha.

4 - Deep Rekha with Redness.

2) Kandu

Grade 1 - No Kandu

2 - Occasional Kandu.

3 - Intermittent Kandu.

4 - Continuous Kandu.

3) Ruja

Grade 1 - No Ruja.

2 - Occasional Ruja.

3 - Intermittent Ruja.

4 - Continuous Ruja.

4) Vaivarnya

Grade 1 - Normal colour.

2 -Brownish red discolouration.

3 - Blackish red discolouration.

4 - Blackish discolouration.



Assessment of Observational Variable was framed as follows. (Present/Slight

reduction/Complete reduction)

Variable BT AT PT F/U

Rukshata

COLLECTION OF DATA:

The data were collected from each group before treatment, after treatment and at

the end of the follow up. Scoring was given and finally the data were compared and

analyzed.

STATISTICAL ANALYSIS:

The collected data were subjected to statistical analysis by using student’s t – test

along with consultation of a bio- statistician.

ASSESSMENT OF CLINICAL IMPROVEMENT:

Clinical improvement of the disease was based on Reduction in the severity of

the symptom. Grading for clinical improvement of individual symptom is as follows.

Grading for clinical improvement for individual symptom:

1. CI-3-Excellent 3rd degree reduction in the severity against the initial score

i.e.,reduction from severe to normal.

2. CI-2-Good- 2nd degree reduction in the severity against the initial score i.e.,reduction

from Moderate to normal, Severe to Mild.

3. CI-1-Encouraging-1st degree reduction in the severity against the initial score

i.e.reduction from Mild to normal, Moderate to Mild and Severe to Moderate.

4. C.S.- Clinically stable i.e. severity score remains same as initial score.

5. C.D- Clinically deteriorated i.e., increase in severity score against the initial score.

Observations And Results


OBSERVATIONS AND RESULTS

In the present study 30 patients were studied in the following 3 Groups.

Group A – Virechana karma – 10 Patients

Group B – Arka taila for Alepana (External application) – 10 Patients

Group C – Virechana karma and Alepana of Arka taila – 10 Patients

The observations for present study were done in 3 stages.

• Generalized observation for overall patients.

• Observation for individual group.

• Result related observation for individual group.



GENERALIZED OBSERVATIONS

Table No. 47: Distribution of Patients according to Age

n = 30

Sl. No Age(Yrs) Group A Group B Group C Total %

No. of

Pts %

No. of

Pts %

No. of

Pts %

1. 16 – 26 1 3% 2 7% 3 10% 6 20%

2. 27 – 36 2 7% 1 3% 5 17% 8 26%

3. 37 – 46 5 17% 2 7% -- -- 7 24%

4. 47 – 56 1 3% 1 3% 1 3% 3 10%

5. 57 – 70 1 3% 4 13% 1 3% 6 20%

Graph No. 1: Distribution of Patients according to Age

20%

26%24%

10%

20%16-2627-3637-4647-5657-70

Out of 30 patients, 6 patients (20%) were between 16 – 26 yrs, 8 patients

(26%) were between 27 – 36 yrs, 7 patients (24%) were between 37 – 46 yrs, 3

patients (10%) were between 47 – 56 yrs, 6 patients (20%) were between 57 – 70 yrs.



Table No. 48: Distribution of Patients according to Sex

n = 30

Sl. No Sex Group A Group B Group C Total %

No. of

Pts %

No. of

Pts %

No. of

Pts %

1. Male 4 13% 5 17% 7 24% 16 53%

2. Female 6 20% 5 17% 3 10% 14 47%

Graph No. 2: Distribution of Patients according to Sex

53%

47% MaleFemale

Out of 30 patients majority were Male i.e., 16 patients (53%) and 14 patients

(47%) were Female.



Table No. 49: Distribution of Patients according to Religion

n = 30

Sl.

No Religion Group A Group B Group C Total %

No. of

Pts %

No. of

Pts %

No. of

Pts %

1. Hindu 10 33% 10 33% 8 26% 28 93%

2. Muslim -- -- -- -- 2 7% 2 7%

Graph No. 3: Distribution of Patients according to Religion

93%

7%

HinduMuslim

Out of 30 patients majority were Hindu i.e., 28 patients (93%) and 2 patients

(7%) were Muslim.



Table No. 50: Distribution of Patients according to Occupation

n = 30

Sl. No Occupation Group A Group B Group C Total %

No. of Pts

% No. of Pts

% No. of Pts

%

1. Retired persons -- -- 2 7% -- -- 2 7%

2. Agriculturists -- -- 1 3% 1 3% 2 7%

3. Lecturer/Teacher 4 13% 1 3% 1 3% 6 20%

4. Students 1 3% 2 7% -- -- 3 10%

5. Housewives 1 3% 2 7% 2 7% 5 17%

6. Others (manager,

attenders, driver) 4 13% 2 7% 6 20% 12 40%

Graph No. 4: Distribution of Patients according to Occupation

7% 7%

20%

10%17%

40%

Retired persons

Agriculturists

Lecturer/Teacher

Students

Housewives

Others (manager,attenders, driver)

Among the patients registered for the present study 12 patients (40%) were

others i.e.,manager, attender, driver etc, 6 patients (20%) were Teachers / Lecturers, 5

patients (17%) were Housewives, 3 patients (10%) were Students, and 2 patients (7%)

were Retired personals and Agriculturists each respectively.



Table No. 51: Distribution of Patients according to Socio Economic Status

n = 30

Group A Group B Group C Sl.

No

Socio

Economic

Status

No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Lower Class 2 7% 4 13% 4 13% 10 33%

2. Middle Class 5 17% 5 17% 3 10% 13 44%

3. Upper Class 3 10% 1 3% 3 10% 7 23%

Graph No. 5: Distribution of Patients according to Socio Economic Status

33%

44%

23%Lower Class

Middle class

Upper class

Majority of the patients were from the Middle Class i.e., 13 patients (44%),

Lower Class 10 patients (33%) and 7 patients (23%) from Upper Class.



Table No. 52: Distribution of Patients according to Diet

n = 30

Group A Group B Group C

Sl.No Diet No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Vegetarian 4 13% 5 17% 5 17% 14 47%

2. Mixed 6 20% 5 17% 5 17% 16 53%

Graph No. 6: Distribution of Patients according to Diet

47%

53%

Vegetarian

Mixed

Among the patients registered for the study 16 patients (53%) were mixed and

14 patients (47%) use to take Vegetarian diet.



Table No. 53: Distribution of Patients according to Vyasana

n = 30


No Vyasana No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Tobacco 1 7% 2 7% 1 7% 4 13%

2. Alcohol 1 3% 1 3% 1 3% 3 10%

3. Smoking 2 7% 1 3% 1 3% 4 13%

4. No Habits 6 20% 6 20% 7 23% 19 64%

Graph No. 7: Distribution of Patients according to Vyasana

13%

10%

13%64%

Tobacco

Alcohol

Smoking

No habits

In present study 4 patients (13%) had the habit of Tobacco, 4 patients

(13%) had the habit of Smoking; 3 patients (10%) had the habit of Alcohol and 19

patients (64%) had no habits.



Table No. 54: Distribution of Patients according to Kula Vrittanta

n = 30


No

Kula

Vrittanta No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Present 2 7% 2 7% 2 7% 6 20%

2. Absent 8 27% 8 27% 8 27% 24 80%

Graph No. 8: Distribution of Patients according to Kula Vrittanta

20%

80%

Present

Absent

In present study 6 patients (20%) were having Kula vrittanta of Vicharchika

and 24 patients (80%) were not having Kula vrittanta.



Table No. 55: Distribution of Patients according to Chronicity of Vyadhi

n = 30

Group A Group B Group C % Sl.

No Chronicity No.

of Pts%

No.

of Pts%

No.

of Pts%

Total

1. < 1 year 3 10% 2 7% 2 7% 7 23%

2. 1 -2 year 1 3% 6 20% 4 13% 11 37%

3. > 2 year 6 20% 2 7% 4 13% 12 40%

Graph No. 9: Distribution of Patients according to Chronicity of Vyadhi

23%

37%

40% < 1 yr 1-2 yr

> 2 yr

In the present study 12 patients (40%) were suffering from more than 2 years,

11 patients (37%) were from 1 – 2 years and 7 patients (23%) were suffering from

less than one year.



Table No. 56: Distribution of Patients according to Prakruti

n = 30


No Prakruti No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Vata -Pitta 2 7% 3 10% 3 10% 8 27%

2. VataKapha 1 3% 2 7% 1 3% 4 13%

3. PittaKapha 5 17% 3 10% 2 7% 10 33%

4. PittaVata -- -- 1 3% 2 7% 3 10%

5. KaphaVata 1 3% 1 3% -- -- 2 7%

6. KaphaPitta 1 3% -- -- 2 7% 3 10%

Graph No. 10: Distribution of Patients according to Prakruti

27%

13%

33%

10%

7%10% Vata Pitta

Vata Kapha

Pitta Kapha

Pitta Vata

Kapha Vata

Kapha Pitta

The patients were categorized under 6 Dwandwaja Prakruti. Among these

majority of patients i.e, 10 patients (33%) were Pitta– Kaphaja, 8 patients (27%) were

Vata– Pittaja, 4 patients (13%) were Vata– Kaphaja, 3 patients (10%) each were

Pitta– Vataja and Kapha– Pittaja respectively, and 2 patients (7%) were Kapha–

Vataja.



Table No. 57: Distribution of Patients according to Agni Pareeksha

n = 30


No

Agni

Pareeksha No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Vishama 1 3% 3 10% 1 3% 5 17%

2. Teekshana 4 13% 4 13% 4 13% 12 40%

3. Manda 5 17% 3 10% 5 17% 13 43%

Graph No. 11: Distribution of Patients according to Angi Pareeksha

17%

40%

43%Vishama

Teekshna

Manda

Among these majority i.e, 13 patients (43%) were having Mandagni, 12

patients (40%) were having Teekshna agni and 5 patients (17%) were having

Vishamagni.



Table No. 58: Distribution of Patients according to Kostha

n = 30


Sl.

No Kostha

No.

of

Pts

%

No.

of

Pts

%

No.

of

Pts

% Total %

1. Krura 1 3% 2 7% 1 3% 4 13%

2. Mridhu 5 17% 4 13% 5 17% 14 47%

3. Madhyama 4 13% 4 13% 4 13% 12 40%

Graph No. 12: Distribution of Patients according to Kostha

13%

47%

40%Krura

Mridu

Madhyama

Among these majority i.e,14 patients (47%) were having Mridhu kostha, 12

patients (40%) were having Madhyama kostha and 4 patients (13%) were having

Krura kostha.



OBSERVATIONS ACCORDING TO SPECIFIC EXAMINATIONS

Table No. 59: Distribution of Patients according to Site of Lesion and

Distribution of Lesion

n = 30

Group A Group B Group C Sl. No

Site Distribution No. of Pts

% No. of Pts

% No. of Pts

% Total %

1. Neck/face 2 7% 1 3% -- -- 3 10%Unilateral -- -- 1 3% 2 7% 3 10%

2. Upper Limb Bilateral -- -- 2 7% 1 3% 3 10%

Unilateral 4 13% 2 7% 2 7% 8 27%3.

Lower Limb Bilateral 3 10% 4 13% 3 10% 10 33%

4. Back 1 3% -- -- -- -- 1 3% 5. Wholebody -- -- -- -- 2 7% 2 7%

Graph No. 13: Distribution of Patients according to Site of Lesion and

Distribution of Lesion

10%10%

10%

27%

3%

7%3%Neck/face

Upperlimb unilateral

Upperlimb bilateral

Lowerlimb unilateral

Lowerlimb bilateral

Back

Wholebody

In the present study majority of patients i.e., 18 patients (60%) were having

Lesions on Lower limb and that too Bilateral 10 patients (33%) and Unilateral 8

patients (27%), 6 patients (20%) were having Lesions on Upper limb and that too

Bilateral 3 patients (10%) , Unilateral 3 patients (10%), 3 patients (10%) were having

Lesions on the Neck/face, 2 patients (7%) were having Lesions on Whole Body and

one patient (3%) is having Lesions on Back.



OBSERVATIONS REGARDING VIRECHANA KARMA:

Table no. 60: Showing required days for Samyak snehana

n=20

Group A Group C Days

No. of pts % No. of pts % Total %

3 Days 1 10% 1 10% 2 10%

4 Days 3 30% 2 20% 5 25%

5 Days 3 30% 4 40% 7 35%

6 Days 1 10% 1 10% 2 10%

7 Days 2 20% 2 20% 4 20%

Graph No. 14: Showing required days for Samyak snehana

10%

25%

35%

10%

20%3 days4 days5 days6 days7 days

Among these majority i.e,7 patients (35%) were obtained samyak snigdha

laxanas on 5th day, 5 patients (25%) were obtained on 4th day, 4 patients (20%) were

obtained on 7th day and 2 patients (10%) each were obtained on 6th and 3rd day

respectively.



Table no. 61 : Distribution of Patients according to Vaigiki Criteria

n=20

Group A Group C Sl.

No Vegas No. of

vegas %

No. of

vegas %

Total %

1. Uttama (21-30) 5 25% 6 30% 11 55%

2. Madhyama (11-20) 4 20% 2 10% 6 30%

3. Heena (1-10) 1 5% 2 10% 3 15%

Graph.No.15 Distribution of patients according to vaigiki criteria

55%30%

15%Uttama

Madhyama

Heena

Among these majority i.e,11 patients (55%) had Uttama vegas, 6 patients

(30%) had Madhyama vegas and 3 patients (15%) had Heena vegas.



Table no. 62 : Distribution of Patients according to Manaki Criteria

n=20

Group A Group C Sl.

No Quantity

No. of pts % No. of pts % Total %

1 Uttama (3.1-4 prasta) 5 25% 6 30% 11 55%

2 Madhyama (2.1-3 prasta) 4 20% 6 10% 6 30%

3 Heena (2 prasta) 1 5% 2 10% 3 15%

Graph.No.16 Distribution of patients according to Manaki criteria

55%30%

15%Uttama

Madhyama

Heena

Among these majority i.e,11 patients (55%) had Uttama manaki shuddhi, 6

patients (30%) had Madhyama manaki shuddhi and 3 patients (15%) had Heena

manaki shuddhi.



Table no. 63: Distribution of Patients according to Antaki Criteria

n=20

Group A Group C Sl.No

Antaki

Shuddhi No. of pts % No. of pts % Total %

1 Kaphanta 10 100% 10 100% 20 100%

Graph.No.17 Distribution of patients according to Antaki criteria

100%

Kaphanta

All the 20 patients (100%) had Kaphanta laxana.



Table no. 64 : Distribution of Patients according to Laingiki Criteria

n=20

Group A Group C

Sl. No Laingiki

Shuddhi No. of

pts %

No. of

pts %

Total %

1 Samyak Yoga 10 100% 10 100% 20 100%

2 Ayoga -- -- -- -- -- --

3 Atiyoga -- -- -- -- -- --

Graph.No.18 Distribution of patients according to Laingiki criteria

100%

0%

0%Samyakyoga

Madhyama

Heena

All the 20 patients (100%) had Samyak yoga lakshanas.



Table No. 65: Distribution of Patients of Vicharchika based on the presence of

Clinical Symptoms

n = 30

Group A Group B Group C Sl. No

Clinical Symptoms B.T % B.T % B.T %

1. Kandu 10 100% 10 100% 10 100%

2. Rekha 10 100% 9 90% 10 100%

3. Vaivarnya 10 100% 10 100% 10 100%

4. Ruja 10 100% 8 80% 9 90%

5. Rukshata 10 100% 10 100% 10 100%

Graph No. 19: Distribution of Patients of Vicharchika based on the presence of

Clinical Symptoms

0

10

2030

4050

6070

8090

100


KanduRekha RujaRukshata

In the present study out of 30 patients,

In Group A out of 10 patients all the patients were having Kandu, Rekha

Vaivarnya, Ruja and Rukshata.

In Group B all the 10 patients were having Kandu and Vaivarnya and

Rukshata and 9 patients were having Rekha and 8 patients were having Ruja.

In Group C all the 10 patients were having Kandu, Rekha, Vaivarnya and

Rukshata and 9 patients were having Ruja.



Distribution of Patients according to presence of Symptoms before treatment.

Table No. 66: a. KANDU n = 30


Sl.No Grading No. of

Pts %

No. of

Pts %

No. of

Pts %

Total %

1. Grade 1 -- -- -- -- -- -- -- --

2. Grade 2 3 10% 3 10% 2 7% 8 27%

3. Grade 3 5 17% 4 13% 4 13% 13 43%

4. Grade 4 2 7% 3 10% 4 13% 9 30%

Table No. 67: b. RAJI

n = 30

Sl.No Grading Group A Group B Group C Total %

No. of

Pts

% No. of

Pts

% No. of

Pts

%

1. Grade 1 -- -- 1 3% -- -- 1 3%

2. Grade 2 2 7% 1 3% 2 7% 5 17%

3. Grade 3 5 17% 7 23% 4 13% 16 53%

4. Grade 4 3 10% 1 3% 4 13% 8 27%

Table No. 68: c. VAIVARNYA

n = 30


No.of

Pts

% No.of

Pts

% No.of

Pts

%

1. Grade 1 -- -- -- -- -- -- -- --

2. Grade 2 4 13% 1 3% 2 7% 7 23%

3. Grade 3 3 10% 7 23% 4 13% 14 47%

4. Grade 4 3 10% 2 7% 4 13% 9 30%



Table No. 69 : d. RUJA

n = 30


No.of

Pts

% No.of

Pts

% No.of

Pts

%

1. Grade 1 -- -- 2 7% 1 3% 3 10%

2. Grade 2 3 10% 2 7% 1 3% 6 20%

3. Grade 3 5 17% 6 20% 4 13% 15 50%

4. Grade 4 2 7% -- -- 4 13% 6 20%

Table No. 70: e. RUKSHATA n = 30


No.of

Pts

% No.of

Pts

% No.of

Pts

%

1. Present 10 100% 10 100% 10 100% 30 100%

2. Absent -- -- -- -- -- -- -- --



OBSERVATIONS FOR INDIVIDUAL GROUP

Group A

1. All the Patients were presenting with varied degree of lakshanas.

2. All the patients were given shunti churna for amapachana in divided dose until

nirama avastha.

3. Patients were given panchatiktaka ghrita according to kostha in arohana krama

until samyak snigdha lakshanas were seen.

4. After attaining samyak snigdha lakshanas virechana aushadhi i,e Triphala

kashaya was administered according to kostha and observed for chaturvidha

shuddhi.

5. Out of 10 patients 2 patients had complaints like nausea and vomiting due to

excess intake of ushna jala after administration of virechana aushadhi.

6. Out of 10 patients 3 patients were dropped out from the study. The drop outs

were substituted by extra 3 patients.

7. Follow up was done on 18th, and 33rd day.

Group B

1. All the patients were presenting with varied degree of lakshanas.

2. Patients applied the Arka taila twice per day for 18 days i.e, morning and

evening on the affected lesion of Vicharchika.

3. It was observed that the taila took 30 – 60 minutes to get absorbed completely.

4. Patients were comfortable during, after treatment and after follow up.

5. No complications were observed.

6. Out of 10 patients 2 patients were dropped out from the study. The drop outs

were substituted by extra 2 patients.

7. Follow up was done on 18th and 33rd day.



Group C

1. All the patients were presenting with varied degree of lakshanas.

2. Both Virechana karma followed by Alepana with Arka taila was done in this

Group.

3. Same observations were observed as mentioned in Group A and Group B.

4. During Samsarjana krama Alepana was done for 18 days.

5. Out of 10 patients 1 patient was dropped out from the study. The drop out was

substituted by extra 1 patient.

6. Follow up was done on 30th and 45th day.



TABLES SHOWING THE RESULTS AFTER TREATMENT AND AFTER

FOLLOW UP.

GROUP A

Table No. 71: Response of Clinical Symptoms After treatment

Sl.No Symptoms CI – III CI – II CI – I C.S C.D

1. Kandu -- -- 80% 20% --

2. Raji -- 10% 80% 10% --

3. Vaivarnya -- -- 80% 20% --

4. Ruja -- -- 80% 20% --

Graph No.20: Response of Clinical Symptoms After treatment

0

10

20

30

40

50

60

70

80

CI – III CI – II CI – I C.S C.D

Kandu

Raji

Vaivarnya

Ruja



Table No. 72: Response of Clinical Symptoms After Follow up

Sl. No Symptoms CI – III CI – II CI – I C.S C.D

1. Kandu -- 40% 60% -- --

2. Raji -- 20% 70% 10% --

3. Vaivarnya -- 50% 40% 10% --

4. Ruja -- 40% 50% 10% --

Graph No.21: Response of Clinical Symptoms After Follow up

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7


Kandu

Raji

Vaivarnya

Ruja



GROUP B

Table No. 73: Response of Clinical Symptoms After Treatment


1. Kandu -- 20% 70% 10% --

2. Raji -- 30% 60% 10% --

3. Vaivarnya -- -- 90% 10% --

4. Ruja -- 30% 50% 20% --

Graph No.22: Response of Clinical Symptoms After Treatment

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9


Kandu

Raji

Vaivarnya

Ruja





1. Kandu -- 20% 50% 30% --

2. Raji -- 20% 40% 40% --

3. Vaivarnya -- -- 60% 40% --

4. Ruja -- 10% 50% 40% --

Graph No. 23: Response of Clinical Symptoms After Follow up

0

0.1

0.2

0.3

0.4

0.5

0.6


KanduRajiVaivarnyaRuja



GROUP C

Table No. 75: Response of Clinical Symptoms After Treatment


1. Kandu -- 40% 60% -- --

2. Raji -- 20% 80% -- --

3. Vaivarnya -- 40% 60% -- --

4. Ruja -- -- 90% 10% --

Graph No. 24: Response of Clinical Symptoms After Treatment

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9


Kandu

Raji

Vaivarnya

Ruja




Sl. No Symptoms CI – III CI – II CI – I C.S C.D

1. Kandu 10% 70% 20% -- --

2. Raji 10% 60% 30% -- --

3. Vaivarnya 10% 70% 20% -- --

4. Ruja -- 80% 10% 10% --

Graph No.25: Response of Clinical Symptoms After Follow up

0%

10%

20%

30%

40%

50%

60%

70%

80%


Kandu

Raji

Vaivarnya

Ruja



RESULT RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS

Group A: AFTER TREATMENT

CI – III: None of the patients showed excellent response during study.

CI – II : 10% (Raji).

CI – I : 90% ( Kandu ), 80% (Raji), 80% ( Vaivarnya ), 80% ( Ruja ).

CS : 10% (Kandu), 10% (Raji), 20% ( Vaivarnya ), 20% ( Ruja ).

CD : None of the patients were observed clinically deteriorated during study.

GROUP A: AFTER FOLLOW UP


CI – II : 40% ( Kandu ), 20% (Raji), 50% ( Vaivarnya ), 40% ( Ruja ).


CS : 10% (Raji), 10% ( Vaivarnya ), 10% ( Ruja ).


GROUP B: AFTER TREATMENT


CI – II : 20% (Kandu), 30% (Raji), 30% ( Ruja ).


CS : 10% (Kandu), 10% (Raji), 10% ( Vaivarnya ), 20% ( Ruja ).


GROUP B: AFTER FOLLOW UP




CS : 30% ( Kandu ), 40% (Raji), 40% ( Vaivarnya ), 40% ( Ruja ).




GROUP C: AFTER TREATMENT

CI – III : None of the patients showed excellent response during study.

CI – II : 40% ( Kandu ), 20% (Raji), 40% ( Vaivarnya ).


CS : 10% ( Ruja ).

CD : None of the patients were observed clinically deteriorated during

study.

GROUP C: AFTER FOLLOW UP

CI – III : 10% ( Kandu ), 10% (Raji), 10% ( Vaivarnya ).



CS : 10% ( Ruja ).

CD : None of the patients were observed clinically deteriorated during

study.



RESULT RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS AFTER

TREATMENT BASED ON OBSERVATIONAL CRITERIA (RUKSHATA):

Group A:

1. Complete reduction:

Only 2 patients (20%) had showed complete reduction.

2. Slight reduction:

6 patients (60%) had showed slight reduction.

3. Stable:

2 patients (20%) had showed no response to the treatment.

Group B:


4 patients (40%) had showed complete reduction.



3. Stable:

All 10 patients had showed response to the treatment.

Group C:





3. Stable:




RESULT RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS AFTER

FOLLOW UP BASED ON OBSERVATIONAL CRITERIA:

Group A:





3. Stable:

Only one patient (10%) had showed no response to the treatment.

Group B:





3. Stable:

4 patients (40%) had showed no response to the treatment.

Group C:





3. Stable:




Table No.77: Showing Result related observations for individual groups based on

observational criteria:

Group B.T A.T A.F

No. of

pts

C.R

(100%)

S.R

(50%)

Stable

(0%)

C.R

(100%)

S.R

(50%)

Stable

(0%)

A 10 2 6 2 4 5 1

B 10 4 6 0 2 4 4

C 10 3 7 0 7 3 0



STATISTICAL ANALYSIS – RESULTS OF

GROUP A

Table No. 78: a) KANDU

Grading Mean S.D ‘T’ value ‘P’ value Remarks

B.T

A.T

2.9000

2.1000

0.7400

0.7400

6.0000

0.0002

HS

B.T

F.U

2.9000

1.5000

0.7400

0.7100

8.5732

0.0001

HS

Table No. 79: b) RAJI


B.T

A.T

3.1000

2.1000

0.7379

0.7379

6.7080

0.0001

HS

B.T

F.U

3.1000

2.0000

0.7379

0.8165

6.1280

0.0001

HS

Table No. 80: c) VAIVARNYA


B.T

A.T

2.9000

2.1000

0.8756

0.8756

6.0018

0.0001

HS

B.T

F.U

2.7000

1.5000

0.8756

0.5374

6.3317

0.0001

HS

Table No. 81: d) RUJA


B.T

A.T

2.900

2.100

0.7379

0.7379

6.000

0.0001

HS

B.T

F.U

2.900

1.600

0.7379

0.9661

6.091

0.0001

HS



GROUP B Table No. 82: a) KANDU


B.T

A.T

3.0000

1.8000

0.8254

0.7929

7.6741

0.0001

HS

B.T

F.U

3.0000

2.1000

0.8254

0.9944

3.8572

0.004

HS



B.T

A.T

2.8000

1.6000

0.7888

0.6992

6.0000

0.0001

HS

B.T

F.U

2.8000

2.0000

0.7888

0.8165

3.2070

0.0111

S



B.T

A.T

3.1000

2.2000

0.5676

0.4216

4.0249

0.0008

HS

B.T

F.U

3.1000

2.5000

0.5676

0.5270

2.4495

0.0248

S



B.T

A.T

2.4000

1.3000

0.8433

0.4840

4.7142

0.0011

HS

B.T

F.U

2.4000

1.7000

0.8433

0.6749

3.2800

0.010

S



GROUP C Table No. 86: a) KANDU


B.T

A.T

3.2000

1.8000

0.7979

0.7979

8.5732

0.0001

HS

B.T

F.U

3.2000

1.3000

0.7979

0.4834

10.5846

0.0001

HS



B.T

A.T

3.2000

2.0000

0.7989

0.8232

9.0000

0.0001

HS

B.T

F.U

3.2000

1.4000

0.7989

0.5234

9.0000

0.0001

HS



B.T

A.T

3.2000

1.8000

0.7979

0.7979

8.5732

0.0001

HS

B.T

F.U

3.2000

1.3000

0.7979

0.4834

10.5846

0.0001

HS



B.T

A.T

3.1000

2.2000

0.9989

0.7968

9.0000

0.0001

HS

B.T

F.U

3.1000

2.2000

0.9989

0.5231

7.9649

0.0001

HS

Discussion

A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 102

DISCUSSION TITLE:

The present study has been entitled as “A comparative and combined clinical

study on Shodhana and Alepana (External application) in Vicharchika.”

Vicharchika is not a life threatening disease, it makes the patient worried due to

its appearence, severe itching, disturbing the routine and its nature susceptible to be

chronic. Vicharchika is described under Kshudra kustha in Ayurvedic textual also

mentioned as a curable disease yet the relapsing nature of this disease makes it much

harassment for patient and troubles some for physicians too.

According to most of Ayurvedic texts, all types of kustha have been considered as

‘Rakta pradoshaja vikara’ and hence Vicharchika. According to Sushruta it is a pitta

pradhana tridoshaja vyadhi. The line of treatment for kustha is, Shodhana followed by

Shamana.

As Vicharchika is pitta pradhana and rakta pradoshaja vikara Virechana is most

important measure of shodhana. It is a specific modality for the elimination of pitta dosha

but it is also effective upon kapha and rakta which are the main dosha of Vicharchika. It

is less stressful procedure than Vamana and has less possibility of complications. It is

widely used as a Shodhana therapy in routine.

On the other hand Sharangadhara has mentioned Alepana (external application) of

Arka taila as an effective medicine in Vicharchika.

Taking all these points into consideration, an effort is made to compare the

efficacy of Shodhana by means of Virechana karma, Shamana by Arka taila as Alepana

and also the combined effect in Vicharchika and hence the title.

Discussion


DISCUSSION ON VICHARCHIKA

NIDANA PANCHAKA:

NIDANA:

One of the fundamental principles of Ayurveda is the Karya – Karana Siddhanta.

The Kaarya – the production of the disease is not possible without the Karana i,e Nidana

or Hetu. Ultimately the aim of the physician is to cure as well as to prevent the disease.

More over, the knowledge of Nidana is useful to provide proper guidance for therapy as

well as in the prevention of the disease. Though, there is no specific description about

etiological factors of the disease Vicharchika but it being a variety of Kshudra Kustha,

the etiological factors of the Kustha are to be accepted as the etiological factors of

Vicharchika. These are mentioned under Aharaja, Viharaja, Kulaja, and Manasika

nidana.

1. Aharaja: Aaharaja Hetus are chief responsible factors in the production of the Kustha.

Among them Viruddha & Mithya Ahara are the main dietary factors.

Excess intake of Madhura, amla, lavana rasa may aggrevate doshas and leads to

‘kha’vaigunya in twak. Madhura rasa in excess quantity may provoke kapha and rasa

dusti leads to kandu. Amla and lavana rasas directly cause raktadusti, thus causing rakta

pradoshaja vyadhi like kustha.

During this study most of the patients had the history of excess intake of dadhi,

Navanna, guda, anupa mamsa, kusumbha taila, snigdha padartha and paryushita anna.

Viruddha ahara like- msmsa- dugdha, dadhi- dugdha etc. These all might have caused

ama, agnimandya, abhishyandata, tridosha prakopa, raktadusti, srotodusti and ultimately

Vicharchika.

Discussion


2. Viharaja: Viharaja hetu also played an important role in the manifestation of kustha.

Some common vihara hetu for kustha are Mithya vihara, diwaswapna, vega dharana,

improper panchakarma procedure.

In this study some, nidanas are observed in some of the patients. Most commonly

observed nidanas are diwaswapna and vegadharana. But the other environmental factors

which cause the dosha prakopa can be considered under the nidanas like, unhygienic

conditions, patients prone to irritant chemicals.

3. Kulaja: Kustha is Adibala pravritta vyadhi, and kusthayukta shukra shonita results in

the birth of kustha shishu. So as Vicharchika is a type of kustha it can be said that it may

also manifest due to beeja dosha. Evidently during the study some of the patients were

found to have kulaja vrittanta of Vicharchika and were chirakari.

4. Manasika: Any imbalance in the mind affects the skin appearance and any

abnormalities of skin affects the mind, which forms a vicious cycle. During this

generation almost all people had stress and strain due to their busy life shedule. Probably

bhaya, chinta, krodha etc.manasika bhavas might have caused tridosha prakopa,

agnimandya and Kustha.

PURVA ROOPA:

The complaints which appear before real manifestation of the disease are known

as purva roopa. Purva roopa laxanas are seen in fourth kriyakala in which sthana

samshraya of the vitiated doshas takes place.

As Vicharchika is a type of kustha, the purva roopa of kustha can be considered

as purvaroopa of Vicharchika.

Discussion


Asweda: Asweda means complete absence of sweda or diminished sweda is due to

swedavaha srotorodha.

Atisweda: When vitiated dosha gets settled in rakta, sweda is produced.

Suptata: It means sparshahani and is due to vata or kapha dusti.

Vaivarnya: Generally every one has a typical skin colour, changing of the previous

original appearance is known as vaivarnya. Shyava, Rakta, Shveta etc are different

colours in different types of kustha. The alteration of skin colour depends on the amount

of blood circulation and melanocytes.

Kandu: It is chief complaint of Vicharchika and also can be felt as purva roopa of

kustha. Kandu is occurred mainly due to kapha dusti.

Many of the patients experienced these mild symptoms but neglected.

ROOPA:

Roopa appear during the 5th kriyakala and this is also reffered to as the ‘Vyakti’

stage during the progressive process of manifestation of the disease.

1. Kandu: Kandu may be defined as a condition of severe itching sensation in the body.

It is the most distressful symptom for the patient of Vicharchika. Acharya Sushruta has

used the adjective ‘Ati’ while Charaka has used the adjective ‘Sa’ with it. It indicates that

it is present in severe form in the patient of Vicharchika.

Kandu is the main complaint of Vicharchika and is produced by the karmataha

vriddhi of kapha dosha.

During the present study, Kandu is present in purva roopa avastha in alpa

swaroopa and present in mild to severe grade in roopa avastha in all the patients.

Discussion


2. Raji: Raji means rekha (Lining). In dry type of Vicharchika Raji may be developed due to

thickening of the lesion.

In the present study the Rekha is observed in different stages.

3. Vaivarnya: Vaivarnya means discolouration. Vicharchika may be Shyava, Rakta, and

Shweta due to dominancy of Vata, Pitta, and Kapha respectively. In early stage colour of

lesion is red due to dilatation of blood vessels with oedema, papules, vesicle, etc. At later

stage lesion becomes dark and lechenified.

In present study all most all the patients had this complaint and most of them were

having Shyava varna.

4. Ruja: As Acharya Sushruta has considered the disease as Pittaja Vikara & its

lakshanas indicate the vitiation of Vata & Pitta. Hence, Ruja can be taken as a symptom

of dry form of Vicharchika.

In present study majority of patients had this complaint in madhyama swaroopa.

5. Rukshata: Rukshata means dryness, hard and rough. It means increase in khara guna

of Vayu and decrease in snigdha, drava guna of Kapha. The word kharata and parushata

shows the degree of rukshata.

In present study all most all the patients had this complaint.

Discussion


SAMPRAPTI:

Flow chart No.6 Showing Samprapti of Vicharchika : NIDANA SEVANA

Aharaja Viharaja Manasika Bija doshaja Papakarmaja

(Vipra, Gura Gharshayatam) Viruddha Divaswapa Garistha Vegavidharana Kulaja Sahaja Asatmya Karmaja bhojana Vyadhi

Agni Tri Dosha Dhatu Kha- Mandya prakopa Shaithilya Vaigunya Ama utpatti Rasen saha mishri bhuyah Tiryak Sira Bahya Marga gamana

Dhatu Dushti (Twak, Rakta, Mamsa, Ambu)

Dosha Dushya

Sammurchhana (Gratitha Kledassanchaya)

Sroto Dushti Kushtha lakshanotapatti

VICHARCHIKA

Discussion


KUSTHA RAKTA PRADOSHAJA VYADHI:

It is clear that the aggrevating factors for rakta are same as that of pitta. Because

rakta and pitta both are having agneya guna and ashraya-ashrayee in nature.

We have seen many vitiating factors of rakta and most of the patients use to take

these nidanas. So we can say that kustha is a Rakta pradoshaja vyadhi.

SADHYA – ASADHYATA:

The sadhyasadhyata of kustha depends on various factors. When the kustha

dravyas are sthanasamshrita in superficial dhatus, it is easy to break the samprapti,

otherwise reaching to the depth becomes difficult or impossible. When the kshudra

kustha or superficial dhatugata kustha is untreated move into the next stage by the

involvement of deeper dhatus and may turn into mahakusthas. The presence of all the

tridoshaja laxanas indicates the complications and difficulty in treatment. The gambhira

dhatugata kusthas need all the chikitsa upakramas and at that chronic stage, the bala of

the patient is also reduced. Hence sarvadaihika laxanas like balahani, agnisada, krimi

utpatti etc. are seen.

UPADRAVAS:

The kustha upadravas like anga patana, avayava patana, prasravana, angabheda

etc. are produced due to the excessive kleda utpatti, sroto rodha and krimi utpatti. The

sarvadaihika laxanas like atisara, aruchi, trishna, daha, jwara, dourbalya etc. indicate the

agnidusti in great extent. More over the psychological factors also contribute to the

severity of the symptoms as the kustha becomes chronic. When the kustha is untreated,

develops both sarvadaihika and sthaanika upadravas which needs the kustha chikitsa

along with rasayana chikitsa.

Discussion


CHIKITSA:

In ayurvedic classics, we find the line of treatment for Kustha roga is Shodhana

followed by Shamana. The planning of treatment of kustha depends on the predominance

of doshas involved in a particular type of kustha if the disease predominantly is vatika,

Snehapana is advised, Virechana and Rakta mokshana are the first line of treatment for

pitta pradhana and Vamana karma should be carried out if the variety of kustha is kapha

predominant.

In my present study I have taken only Virechana karma to ascess its effect in

Vicharchika.

According to most of Ayurvedic texts all types of kustha have been considered as

‘Rakta pradoshaja vikara’. As vicharchika is a type of kustha and according to Sushruta it

is a pitta pradhana tridoshaja vyadhi, so Virechana is a first line of treatment for Rakta

pradoshaja and pitta pradhana vikaras.

After shodhana karma for remaining doshas Shamana chikitsa should be followed

in the form of lepa (External application). As vicharchika is a disease of twak, so

samprapti occurs in twacha. Hence Alepana should be carried out after shodhana. The

alepana drugs should have ushna, teekshna and katu rasa for removing the morbidity in

twacha.

Discussion


DISCUSSION ON VIRECHANA KARMA

DEFINITION OF VIRECHANA :

The process of elimination of morbid doshas through Adhobhaga is said to be

Virechana.

While telling the definition of Vamana and Virechana Acharya Charaka quotes

the same term ‘Virechana’ for the both procedures, because they expell out the doshas

from the body. But here the word ‘Virechana’ is indicated for the procedure which

expelled out doshas through guda marga which is termed as Virechana karma, while in

Vamana karma doshas are expelled out through mukha marga. So here the word

Virechana is not suit for Vamana karma.

Though Vāmaka and Virechaka dravyās possess similer properties such as Ushna,

Teekshna, Sukshma, Vyavāyi, Vikāsi, they act in a very different pattern, due to their

Panchabhautika configuration and Prabhava .

MODE OF ACTION OF VIRECHANA DRAVYĀS:

Generally when we speak about the mode of action of any Shodhana dravya, it

has been stated as the prabhāva rather than guna. In the context of Virechana , not only

prabhāva but the properties of Virechana dravyās namely Vyavāyi, Vikāsi, Sukshma,

Ushna and Teekshna plays an important role to bring the mala rupi doshās which are

adherent in the shākhās are brought back to kostha from where the doshās collected in the

kostha are eliminated by the adhobhāgāhāra property.

A hypothetical effort is made to understand the overall activity of the Virechaka

dravya.

Discussion


When Virechana dravyas are administered, the properties of dravyās are rapidly

absorbed due to the Vyavāyi guna. When the properties are rapidly absorbed and spread

all over the shareera, the Vikasi starts to produce its action by loosening the adhesions of

the doshās and dhātus for which it needs to be penetrated deep into the sukshma srotas,

for this the anutva bhāva of Sukshma guna i.e. which helps in deep penetration, supports

the action of Vikāsi guna. When the dhātu bandhana has been loosened the Teekshna and

Ushna gunas acts at the level of minute channels by fascilitating the sanghāta bhedhana

i.e. breaking up of the complex morbid matter into the simpler form, later the Ushna guna

helps in the pāka of the malās and to liquefy, which fascilitates easy drainage of the

shakhāgata liquefied malās to the kostha. Bringing back of these doshās to kostha is

actively achieved only by the ‘pravanatva bhāva’ of Sukshma guna.

Thus from the above consideration, we can understand that the gunās of

Virechana dravyas plays a major role in accompanishing the task of bringing the

shākhāgata dosha to kostha, unless and until the process of Virechana will not be

satisfactory. Hence we can state that along with the adobhāga hara prabhāva the gunas of

Virechana dravyas are very much essential.

Discussion


VIRECHANA VIDHI:

POORVA KARMA: In poorva karma Deepana-Pachana, Snehana and Swedana are to

be done.

Deepana-Pachana: In this disease doshas are in ama condition, so the patient has to be

subjected for Deepana-Pachana. It is done to enhance Agni and to attain niramavastha. So

that the sneha may be properly digested and appropriate snehana is accomplished.

For Deepana-Pachana Shunti churna was selected for the present study. It was

given up to 3-6 gms twice daily for 3-5 days till the appearance of nirama laxanas. As

Vicharchika is Santarpanajanya vyadhi where agni mandya and saama laxana can be

appreciated. It was observed that all the patients got nirama laxana within 2-3 days

Snehapana: Snehapana plays a vital role in any type of shodhana karma. Without proper

Snehapana doshas can not be eliminated from the body. Snehana has properties like

Vishyandana, and Kledana helps in dissolving the vitiated doshas.

Snehapana kala: Sneha should be taken at the time when the diet taken on previous

night has completely digested and there should be no sensation of appetite for the next

meal and there should be Suryodaya. So we can say the time of Snehapana is nearly 6.30-

7.30 a.m.

Usually the Snehapana is started with Hrasiyasi matra (25-30ml) to assess the

kostha of patient. After considering the kostha, the dose of sneha should be increased in

Arohana krama untill samyak snigdha lakshanas are observed.

As vicharchika is Kledajanya vyadhi Vagbhata advised ishat snehapana

(Natisnigdha) and Charaka and Vriddha Vagbhata advised Madhyama matra snehapana.

But Bhavamishra advised uttama matra snehapana. Though he advised uttama matra but

Discussion


samyak snigdha lakshanas are seen within 7 days because there is already klinnata in

shareera. This klinnata is refers to srava rupi vicharchika. But in ruksha vicharchika

klinnata is in grathita form. So in this condition samyak snigdha lakshanas are seen little

bit later than that of srava rupi vicharchika.

So in present study as I have taken patients of ruksha Vicharchika(Acc to

Sushruta), uttama matra snehapana was given acc to kostha in arohana krama until

samyak snigdha lakshanas were seen.

In this study after attaining niramavastha, Sneha pana ( Panchatiktaka ghrita ) was

given starting with 25-30 ml and continued for 3-7 days in arohana karma. Sneha was

digested within 6 hrs in some patients and 7-8 hrs in some patients. The dose of the

Snehapana was maximum 180ml to 210ml. Most of the patients had got samyak snigdha

lakshanas within 4-6 days, which showed that most of the patients had Madhyama

kostha. Sukhoshna jala was adviced as anupana, which is kaphahara, deepaka,

amapachaka, vatanulomaka, thus help full in proper digestion of administered sneha.

During the period of Snehapana many of the patients had the complaints of excessive

itching which is due to the doshotklesha.

Swedana: Swedana plays a major role after Snehapana. It is responsible for vilayana of

doshas. Swedana dilates the channels to produce extra flow and increases fluidity by

which srotorodha diminishes.

Snehana moistures and liquefies the doshas and swedana disintegrates them. By

the action of snehana and swedana, the morbid doshas are liquefied and dissolved in

sneha and are brought to kostha. Thus the doshas gets increased and liquefied are brought

back to kostha by reliving the adhesions of dosha and reliving the obstruction of srotas

Discussion


and brings the vimargagami vayu to swasthana.

Sarvanga abhyanga with Tila taila followed by bhashpa sweda was adopted for all

patients. In classics it has been explained that swedana is conra-indicated in kustha but to

liquefy the doshas and bring them from shakha to koshta mrudu swedana was adopted for

3 days.

In vishrama kala such a diet is preffered which doesn’t increase kapha, as that

may cause Vamana. So for this a state of manda kapha is described in Virechana.

PRADHANA KARMA: The person who has undergone samyak snehana and swedana,

who has been on laghu, ushna, and kapha avriddhikara ahara, who had good sleep on the

previous night and after the digestion of food taken of previous night only is permitted to

the administration of Virechana aushadhi.

According to classics Virechana should be administered just after sleshma kala.

Keeping this in mind it was administered in between 8.30 a.m to 9.30 a.m. The virechana

dravya matra was fixed according to kostha of the patient. For Krura kostha 100ml of

Triphala kashaya, for Madhyama kostha 50ml and for Mrudu kostha 25ml was given.

After administration of medicine one should observe the chaturvidha shuddhi.

CHATURVIDHA SHUDDHI NIRIKSHANA:

Actually all these four criteria viz. Āntiki, Māniki, Laingiki and Vaigiki have their

importance in whole process.

1) Vaigiki and 2) Maniki : After giving virechana aushadhi physician must count the

Vegās ( Except first 2-3 vegas as they contain only mala) and proportion of expelled

Doshās (Maniki) to decide the shuddhi prakara. Actually “Jaghanyadi Shuddhi” must be

decided for Samsarjana Krama and this is to be decided on the basis of Vega and Māna.

Discussion


Because the number of Vega and expelled Dosha is going to alter our body physiology

right from Agni to dhatu sāmya of all the physiological process, nourishment of body,

electrolyte balances etc. which needs to be restored by that can be planned properly based

on Vaigiki and manaki shuddhi.

In present study most of the patients had uttama vegas i.e 21-30 vegas. Though

they had uttama vega none of the patient had complained about dehydration. This showed

that there is no loss of body fluid by this Virechana karma.

2) Antiki : While carrying the process, physician’s ultimate aim should be to reach the

Āntiki condition means “Kaphāntatva” in Virechana. He should consider it as indicator of

reaching to final limit (end point). Many a times even after kaphānte laxanās are

observed, patients produces Virechana vegās which will leads in aggravation of vāta and

further lead for atiyoga janya upadravās. In order to prevent these complications one has

to be very carefull to observe the end point as kaphānta laxana and has to take appropriate

measures to cease the vegās produced after this point.

Kaphanta is a sign of Samyak Virechana. In Virechana there is sequential

elimination of Vitt, Pitta, Kapha and Vāta. Our aim is to eliminate the Pitta and up to

some extent small quantity of Kapha. That indicates the complete elimination of pitta in

an order.

All of the patients had shown kaphanta lakshana, which showed that samyak

Virechana karma was performed.

3) Laingiki: Laingiki criteria is observed to see whether our Karma has reached to our

ultimate goal of Shodhana or not, as we have to act further for treatment regimen. This

has given due importance by all Āchārya’s.

Discussion


As the Vegika and mānaki shuddi use only 3 stages with a vast difference in

between i.e 10 vegās for avara, 20 vegās for Madhya and 30 vegās for uttamā. This is a

greater chance for most of the patients to attain the samyak shuddhi with the different

number of vegās other than 10, 20 or 30, but we cannot wait upto achieving the said

number of vega or we cannot cease the vegās earlier attainment of shuddhi which may

lead for either atiyoga or ayoga. Hence it is very important to assess the patients with

laingiki shuddhi that means the Laxanas which will be developed in patients when they

attain samyak shuddhi. As Laingiki criteria is always accompanied by Antiki criteria, it is

explained immediately after the same. Acharya Chakrapani claims that Laingiki Shuddhi

is the only Shuddhi. Chakrapani and Dalhana both included Antiki criteria in Laingiki

criteria.

With this one has to decide the samyak shuddhi based only on laingika shuddhi as

other type of shuddhi Laxanās are having the different applicability for the fulfillment of

process.

In present study all the patients have manifested the features of kaphanta in 7-9

hours after administration of virechana dravya and it was noted that some patients shown

the symptoms of nausea and vomitting during virechana vega kala. It may be due to

excessive intake of luke warm water during digestion of medicine and may be due to

early administration of virechana yoga.

Discussion


PASCHAT KARMA:

SAMSARJANA KRAMA:

It is conventional to offer peyadikrama to the patient as a post-operative measure

who has undergone shodhana. During and after this process usually the Bala is reduced

and Agni becomes less. Hence usually after the Shodhana karma the normal diet is

contraindicated in order to regain the normal state of Agni and Bala of shareera.

This samsarjana krama should be started when the person feels hungry.

IMPORTANCE OF SAMSARJANA KRAMA:

Function of agni is regulated by pāchaka pitta, samāna vāyu and kledaka kapha,

which are being disturbed in shodhana process so to normalize these factors, a special

Samsarjana krama is planned. Jejjata emphasizes the need of peyādi krama by saying that

the doshas are being liquefied and reach āmāshaya. By this process of shodhana which

itself hamper the agni. The person who had undergone shodhana, the agni will gradually

increased by the peyādi krama.

In Pravara shuddhi excessive quantity of doshās are eliminated. So in this

condition agni will be weakened, which will take long time to attain normal position.

Generally in Pravara shuddhi, seven days are being considered for the normalization of

agni. Hence the Samsarjana krama is arranged in respect to type of shuddhi, means

proportion of dosha eliminated out.

Shodhana karma itself increases agni which may takes long time. It increases

systematically after following a special diet.

Discussion


PATHYA – APATHYA:

If a person follows pathya he does not need medicines at all and if a person

doesn’t follow pathya he doesn’t get benefit from any medicine.

The foodstuffs which are specially Ati- lavana, amla rasayukta, kshara and tila are

pitta prakopaka, rakta dustikara, kledakara leads for the manifestation of Vicharchika.

Ati- madhura, guru, snigdha ahara, guda, matsya, phanita, dadhi, navanna, dravanna etc;

are kaphakara, kledakara and abhishyandi leads to ajirna, ama and Vicharchika.

Paryushita bhojana is responsible for tridosha prakopa which directly leads to

Vicharchika.

Viharas like ati- atapa, vayu sevana, divaswapa, avyayama etc; vitiates tridosha.

Drinking of cold water suddenly after fear, exertion and intense heat causes sudden change in

body temperature and may cause vasodilation and skin disorders. The habit of scratching

over the lesion should be avoided.

Discussion


DISCUSSION ON MATERIALS AND METHODS

MATERIALS:

Materials: Measuring glasses, Bed pan, vessels

A) Drugs:

Shunti churna :This is a good Amadosha pachak and jataragni deepaka. Due to its

properties like katu, ushna, teekshna, laghu and agneya guna helps to digestion of ama

and also helps in restoring the agni. Hence this churna helps in attain nirama avasth,

before going to shodhana process.

It was given 3 to 6 gms twice a day before food till the appearance of nirama

laxanas

Panchatiktaka Ghrita: This is used for the purpose of Virechana purva sneha pana. Due

to sneha pana the vriddhi and vishyandana of doshas takes place.

Panchatiktaka ghrita has been selected for sneha pana in present study, because it

is specially indicated in classics for kustha. All the ingredients of it have kusthaghna

property and as it contains all tikta dravyas helps in kledashoshana, raktashodhana and in

amapachana. Ghrita is mentioned as vata pitta shamaka, rakta vikara hara, twachya etc

and has a remarkable property to assimilate the properties of other substances when are

added to it (Samskarasya Anuvarthanam). So Panchatiktaka ghrita becomes more

effective than shuddha ghrita. Considering all these points it has been selected for present

study.

Tila taila : Tila taila is twachya and kustahara so, it was used for abhyanga.

For swedana, bhashpa sweda was adopted. Though swedana is contraindicated in

Vicharchika, Mrudu swedana can be given for liquefication of the doshas. This was

Discussion


performed for 3 days during vishrama kala.

By these two procedures vilayana of doshas and srotomukha vishodhana takes

place.

Triphala kwatha: For the purpose of Virechana, Triphala kwatha was used. It also

contains Trivritta churna and Danti churna as a prakshepaka dravyas. This ideal

Virecahana preparation was exclusively mentioned in Bhaishajya ratnavali in the

treatment of kustha.

As Triphala contains Haritaki, Bibhitaki and Amalaki all these 3 helps in

Virechana karma and also Danti and Trivritta. The properties of these drugs are as follow,

Haritaki - Mrudu virechaka,

Bibhitaki - Malabhedhaka and acts on rasa, rakta and mamsa dhatu

Amalaki - Sramsana karma.

Danti - Teekshna virechaka

Trivritta - Sukha virechaka

These above said properties of each drug helps in Virechana karma. So this is an

ideal virechana dravya in Vicharchika for the purpose of Virechana karma.

The uttama matra of Triphala kashaya for virechana is 2 pala i.e 100ml,

madhyama matra is 1 pala (50ml) and heena matra is 1/2 pala (25ml). According to

kostha of the patient kashaya was administered.

All the patients were given sukhoshana jala as anupana. The action of the drug

started within 1-2 hours.

Arka taila: If doshas are located in twak, raktha and mamsa, first shodhana should be

done then go for Alepana etc. Then only Alepana acts effectively and quickly.

Discussion


Arka taila contains three ingredients – Arkapatra swarasa, Haridra churna and

Sarshapa taila. As all these three drugs are having Kustaghna property and Haridra &

Sarshapa are having Varnya property, hence it has been selected for present study.

B) Instruments: Measuring glass was used to measure the proper dose of sneha for

sneha pana

METHODS:

Aim: A Comparative and combined Clinical study on Shodhana and Alepana (External

Application) in Vicharchika.

Source of Data: In the present study, totally 30 patients of Vicharchika excluding the

dropouts were taken for the study from OPD, IPD of Dr.B.N.M.E. Trust’s S.M.S. PG and RC

Bijapur and special camps conducted in Bijapur city by the Institute.

Study Design: It is a comparative clinical study. Patients were incidentally selected with

a predetermined randomization technique and were assigned into 3 groups i.e., Group A,

Group B and Group C.

Selection of Patients: Selection of patients for the present study was done randomly.

First 30 patients fulfilling the diagnostic criteria and inclusive criteria were selected for

the study. The patients were selected irrespective of sex, caste, occupation, socio –

economical status and with the age limit of 16–70 years.

Inclusive Criteria:

Patients of Vicharchika in the age group 16–70 years were selected for the

study. The classical signs and symptoms of Vicharchika were taken as per the Sushruta

samhita because according to Sushruta Vicharchika is a pitta– vata pradhana vyadhi, so in

this age group dominancy of pitta and vata is seen. Therefore it can be said that the

Discussion


prevalence of Vicharchika is more in this age group. It is due to their occupation, stress,

environmental exposure, food habits, etc. The disease affects either sex invariably hence

the patients of either sex were selected.

Exclusive criteria: Patients presenting with sravayukta Vicharchika associated with

any other Systemic diseases were excluded.

Diagnostic criteria: In the present study the diagnosis was done based on patients

presenting with classical signs and symptoms of Vicharchika explained in Sushruta

samhita. Vaivarnya is not mentioned in Sushruta samhita but it was observed in all most

all the patients included in present study. That’s why Vaivarnya symptom was taken in

diagnostic criteria.

For the present study presence of following symptoms were selected.

1) Rekha

2) Kandu

3) Ruja

4) Rukshata

5) Vaivarnya

Sampling Method:

A pre-determined Random sampling method was adopted where in 10 cards each

marked as Group A, Group B and Group C respectively were shuffled properly. A neutral

person was asked to pick the cards one by one. The group on the card against each pick

was recorded serially from 1 to 30. After every pick the cards were reshuffled. The

patients selected randomly were assigned with serial numbers from 1 to 30. Thus the

patients corresponding to particular group which was predetermined in order were treated

Discussion


according to the interventions of particular group. The technique was adopted in order to

avoid the sampling bias.

Intervention:

Group A:

1. All 10 patients were given shunti churna 3-6gm twice daily until niramavastha.

2. According to kostha of the patient panchatiktaka ghrita was given for snehapana till samyak

snigdha laxanas were seen.

3. After snehapana abhyanga with Tila taila and mridu Bhashpa swedana was done in

vishrama kala (for 3 days)

4. Patients were advised to take laghu, ushna and kapha avriddhikara ahara in the period

of virshrama kala.

5. Next day of vishrama kala between 8-8.30a.m (after passing shleshma kala) Triphala

kashaya was administered according to kostha for Virechana karma. Then observed for

chaturvidha shuddhi.

6. Lastly Samsarjana krama was adopted according to type of shuddhi.

7. Treatment duration was 18 days and advised follow up on 18 th and 33rd day.

Group B:

1. All the 10 patients were provided with a bottle containing 100 ml of Arka taila.

2. The taila application is advised with a sterilized cotton swab on the lesion twice daily

i,e morning and evening, so that it is absorbed completely and reduces the dryness.

3. After taila application playing, atapa sevana, working in the field, etc were avoided.

4. Treatment duration was 18 days and advised follow up on 18 th and 33rd day.

Discussion


Group C:

In this Group both Virechana karma and Alepana with Arak taila was done as mentioned

above.

After giving Virechana, in the period of Samsarjana krama Alepana with Arak taila was

done. Total treatment duration of this group was 30 days and advised follow up on 30th day and

45th day.

Discussion


MODE OF ACTION OF VIRECHANA KARMA IN VICHARCHIKA: Virechana karma is one of the Pradhana karma used for the elimination of vitiated

doshas from the body through ‘Adhomarga’ i,e from anus.

Condition which are suitable for Virechana karma are-

1) In diseases where pitta is predominantly vitiated.

2) In diseases where kapha is combined with pitta.

3) In cases of kapha sthanagata pitta.

4) In cases of pitta sthanagata kapha.

5) The diseases which are produced due to Rakta dusti (Raktapradoshaja vikara).

All above said conditions are present in Vicharchika. So Virechana is the best line

of treatment for Vicharchika.

Snehapana as a Purvakarma of Virechana, it self plays a supporting role to

subside symptoms like Rukshata, Ruja and some extent of Kandu in the preparatory stage

of the treatment. Both Purvakarma i.e., Snehana & Swedana has efficacy to remove

Srotobandhana and liquefy the morbid Doshas. Similarly, Doshas which are lodged in

Shakha are made to move towards Kostha by means of oleation and fomentation.

Majority of the Sneha eg. Ghrita are of animal origin and a possibility of similarity in

chemical and physiological nature to that of the cell membrane can not be ruled out. This

thus intensifies the penetration of Sneha substances through cell membrane. Cell

membrane acts as a barrier to the passage of water soluble molecules but provides free

passage to lipid and lipid soluble substances.

It can be said that Sneha reaches deep into the body tissues causing partial

rejuvenation of cell organelles and smoothening of vitiated Dosha (stagnated metabolic

Discussion


wastes) and makes their elimination possible.

If Snehapana is not done and Shodhana is carried out then it destroys the tissues

of body.

With the help of Snehana and Swedana, Doshas are being liquefied; they dissolve

in Sneha and make the path for excretion by bringing them to Kostha. Heat which is

given in Swedana process reaches to subcutaneous region and through the blood conveys

heat to the whole body. On absorption it converts into thermal energy which brings about

vasodilation of subcutaneous blood vessels. On account of increased blood supply there

is speeding up of local metabolism, which is needful in Vicharchika. As a result of

vasodilation, there is increased flow of blood to affected area, so that necessary O2 and

nutritive materials are supplied and waste products are removed. Thus the process of

Swedana helps to melt the compact Doshas and helps in dragging them from various sites

to Kostha. This Swedana process is carried out along with Abhyanga in 3 days gap period

of Virechana.

Virechana Karma expels out the Doshas dragging them towards the Adhobhaga

through the Guda. Amashaya is the specific seat of Kapha and Pitta. Though Virechana is

a specific therapy for Pitta Dosha, it may also be used for eliminating Kapha Dosha.

Virechana drugs which are having Ushna, Teekshna, Sukshma, Vyavayi and Vikasi

property reaches the Hridaya by virtue of its Virya then following the Dhamani it spreads

the whole body through large and small Srotasa. Virechaka drugs by their property and

Prithvi + Jala Mahabhuta dominancy helps in eliminating the morbid humour from the

Shakha to Kshotha and then out of the body by rectal root.

Discussion


Vicharchika is a disease of Bahya roga marga, where vitiated dosha reaches the

twacha by circulating through Tiryakgami sira. Treatment for tiryakgami dosha according

to acharya Charaka is bringing back these morbid dosha to kostha and there after expel

them out of the body by nearest opening. This process of bringing back to dosha from

cellular level to systemic circulation and then to Amashaya is possible due to Anupravana

bhava.

Discussion


MODE OF ACTION OF ARKA TAILA:

Role of Alepana in kustha is as important as Shodhana. Acharya Charaka has described

lepana as sadhya siddhikaraka. Hence in present study Arka taila was selected for Alepana.

If doshas are located in twak, rakta and mamsa first Shodhana should be done and then

go for Alepana. Then only Alepana acts effectively and quickly.

Arka patra, Haridra, and Sarshapa due to their tikta rasa they are Pittashamaka and due to

laghu guna acts as kapha shamaka. They are also considered as kusthaghna dravyas and haridra

and sarshapa as varnya dravya.

As all drugs are having tikta rasa, they act on Rakta dhatu and also help for kleda

shoshana.

Thus Arka taila acts locally by snigdha, teekshna and ushna guna. It has given better

results in Rukshata by its snigdha guna and in Vaivarnya by its teekshna and lekhana properties

and also suppressed Kandu by providing counter irritation.

Hence the Alepana of Arka taila has provided better relief in Vicharchika.

Discussion


DISCUSSION ON OBSERVATIONS AND RESULTS:

AGE: Out of 30 patients maximum number of patients 26% (8 pts) were found in 27

– 36 yrs age group, 24% (7 pts) were in 37–46 yrs, 20% (6 pts) were in 57–70 yrs, 20%

(6 pts) were in 16–26 yrs and only 10% (3 pts) were in the age group of 47–56 yrs.

Highest incidence of Vicharchika were found in age group of 27–36 yrs and 37–

46yrs which represents the onset was more in youth and middle aged. This age is a

golden period for individuals at work when mental stress, occupation, environmental

exposure and unwholesome food were more, which are the etiological factors of

Vicharchika.

SEX: The sex wise distribution of the patients reveals that 53% (16 pts) were male

followed by 47% (14 pts) were females. But it can’t be said that the role of sex is there in

the manifestation of Vicharchika.

RELIGION: Maximum number of patients ie, 93% (28 pts) were Hindus and only 7% (2

pts) were Muslims. Geographical proportion of Hindus in the city may be the prime

reason for high incidence.

OCCUPATION: The persons from various occupations were observed in the study.

Among them others were i,e attenders, driver etc 40% (12 pts), Lecturer/Teacher were

20% (6 pts) and house wives were 17% (5 pts). This reflects that person working outside

are more exposed to environmental exposure, regular contact with allergens and lives in

polluted environment with unhygienic regimen.

SOCIO ECONOMIC STATUS: Maximum number of patients belonged to middle class

44% (13 pts) followed by lower class 33% (10 pts) and 23% were from upper class.

Discussion


Incidentally majority of the patients selected were from middle class, so far commenting

we need to study on large sample.

DIET: Out of 30 patients 53% (16 pts) were used to take mixed type of diet and and

47% (14 pts) were vegetarian. The distribution of patients in both the groups was almost

same, so any conclusion regarding diet can not be drawn on the basis of data.

VYASANA: The incidence of tobacco chewing and smoking were 13% (4 pts) each

respectively and 10% (3 pts) were addicted to alcohol. 64% (19 pts) were not addicted.

All these cause aggrevation of pitta dosha and may leads to Vicharchika.

KULA VRITTANTA: Maximum numbers of patients ie, 80% (24 pts) were not having

family history and only 20% (6 pts) were found with positive family history. This

confirms that genetic predisposition is responsible in some patients, but it should not be

the only criteria.

CHRONICITY: Maximum number of patients ie, 40% (12 pts) were found the history of

above 2 years chronicity, 37% (11 pts) were found in 1–2 yrs and 23% (7 pts) were found

less than one year chronicity.

This shows that more number of patients have neglected the premonitory symptoms

of Vicharchika. They thought those symptoms were due to some allergy or atmospheric

condition and took some symptomatic treatment. But due to the relapsing nature of the

disease 40% were suffered chronic nature. Onset was reported as gradual in maximum

number of patients. So, it can be said that Vicharchika is a chirakari roga.

PRAKRUTI: In the present study maximum patients ie, 33% (10 pts) of pitta–kapha

prakruti, vata–pitta 27% (8 pts), vata–kapha 13% (4 pts), pitta–vata and kapha-pitta 10%

(3 pts) each respectively and kapha-vata 7% (2 pts).

Discussion


This confirms the unvariable involment of pitta followed by kapha and vata, on

the basis of dosha affinity. Any way all the three doshas were collectively responsible for

the causation of kustha.

AGNI PAREEKSHA: Among 30 patients majority ie, 43% (13 pts) were having

mandagni followed by 40% (12 pts) of teekshnagni. This shows kapha and pitta are

responsible for mandagni and teekshnagni respectively and plays major role in the

manifestation of Vicharchika.

KOSTHA PAREEKSHA: In present study majority i,e 47% (14 pts) were had mridu

kostha, 40% (12 pts) were had madhyama kostha and 13% (4 pts) were had krura kostha.

This shows the relation of agni and kostha, their influence on each other in causing

disease. The knowledge of kostha is helpful in deciding the treatment modality.

SITE AND DISTRIBUTION OF LESION: Majority of patients ie, 60% (18 pts) were

having lesion on the lower extremities, 20% (6 pts) in upper extremities and 10 % (3 pts)

on the neck/face region, 7% (2 pts) on whole body and 3% (1 pt) was having on back.

In the present study 43% (13 pts) were reported bilateral lesion and 37% (11 pts)

reported unilateral lesion. In most of the patients lesion was found on the lower

extremities. This may be due to skin folds, less muscle distributed areas and also due to

unhygienic living condition etc.

SAMYAK SNEHANA: majority of patients i.e,7 patients (35%) were obtained samyak

snigdha laxanas on 5th day, 5 patients (25%) were obtained on 4th day, 4 patients (20%)

were obtained on 7th day and 2 patients (10%) each were obtained on 6th and 3rd day

respectively.

Discussion


It indicates that samyak snigdha lakshanas were seen according to the kostha of

the patient. The patients who had mridu kostha, the samyak snigdha lakshanas were seen

on 3rd day, in madhyama kostha on 4-5th day and in krura kostha 6-7th day.

VAIGIKI CRITERIA : Majority of patients ie, 55% (11 pts) had uttama vegas in between

21-30 vegas, 30% (6 pts) had madhyama vegas in between 11-20 and 15% (3 pts) had heena

vegas in between 1-10.

By these observation it reveals that most of the patients had Mridu kostha.

MANAKI CRITERIA : Majority of patients i,e, 85% (17 pts) had expelled out 2-4 prastha

quantity of vitiated doshas, it indicates that almost all patients having bahudoshavastha and

purva karma was adopted properly to bring the vitiated doshas from shakha to kostha.

ANTAKI CRITERIA: All the 20 patients (100%) has shown the kaphanta laxana which

indicates that methodology adopted for Virechana karma was accurate.

LAINGIKI CRITERIA: All the 20 patients (100%) has shown the samyak yoga laxana

of Virechana karma which indicates that Triphala kashaya with Trivritta and Danti

churna as a praksepaka dravya is an ideal preparation for Virechana karma adopted in

patients suffering from Vicharchika.

SYMPTOMS: All the 30 patients (100%) had Kandu, Vaivarnya and Rukshata

respectively. 29 pts (96%) had Rekha, and 27 pts (90%) had Ruja.

Here it shows that Kandu, Rekha, Vaivarnya, Ruja and Rukshata are the cardinal

symptoms and are necessary to confirm the disease Vicharchika.

Discussion


DISCUSSION ON RESULTS

DISCUSSION ON RESULT RELATED OBSERVATIONS FOR INDIVIDUAL

GROUPS:

The effects of Virechana karma, Alepana (External application) and both

Virechana karma and Alepana were assessed on each cardinal symptoms of the disease.

These symptoms were assessed on the basis of scoring pattern, which was given before,

after and follow up of the treatment. These symptoms were assessed statistically in all the

3 groups.

KANDU:

After treatment in Group A, B and C Kandu was reduced remarkably with t

values (A– 6.0000, B–7.6741, C– 8.5732 ) which was statistically highly significant.

After follow up also all 3 Groups remained highly significant with t values

(A– 8.5732, B–3.8572, C– 10.5846).

RAJI:

After treatment in Group A, B and C Raji was reduced remarkably with t values

(A– 6.7080, B– 6.000, C– 9.000 ) which was statistically highly significant.

After follow up Group C and A remained highly significant with t values (C–

9.000, A– 6.128) but group B showed only significant with t value (B- 3.207). It means in

group B due to only Alepana the disease will reoccur.

VAIVARNYA:

After treatment in Group A, B and C Vaivarnya was reduced remarkably with t

values (A– 6.0018, B– 4.0249, C– 8.5732) which was statistically highly significant.

Discussion



10.5846, A– 6.3317) but group B showed only significant with t value (B- 2.4495).

RUJA:

After treatment in Group A, B and C Ruja was reduced remarkably with t values

(A– 6.0000, B– 4.7143, C– 9.0000 ) which was statistically highly significant.


7.9649, A– 6.091) but group B showed only significant with t value (B- 3.280).

After treatment though all the 3 groups remained highly significant but variation in t

values, Group C had more effective than Group A and B and Group A had more effect than

Group B. But in case of Kandu Group B had more effect than Group A.

After follow up Group C and A remained highly significant but Group B showed only

significant. But in case of Kandu it showed highly significant result.

By seeing the above results we can conclude that, there is a recurrence of disease in

Group B due to only shamana chikitsa in the form of Alepana.

Hence it can be inferred that the combined effect i.e Virechana karma followed by

Alepana is more significant than individual groups.

OBSERVATIONS FOR INDIVIDUAL GROUPS:

Group A: After Virechana karma highly significant results were seen in Kandu, Raji

Vaivarnya and Ruja. After follow up also there was a highly significant results were seen

in all symptoms. Compared to after treatment, after follow up shown better results. But in

case of Raji after treatment shown better result than after follow up.

Discussion


Group B: After Alepana with Arka taila highly significant results were seen in Kandu,

Raji, Vaivarnya and Ruja. After follow up Raji, Vaivarnya and Ruja shown only

significant result but Kandu remained highly significant.

Group C: After both Virechana karma and Alepana with Arka taila highly significant

results were seen in Kandu, Raji, Vaivarnya and Ruja. After follow up also they remained

highly significant. Compared to after treatment, after follow up shown better results. But

in case of Ruja after treatment shown better result than after follow up.

DISCUSSION ON OBSERVATIONAL VARIABLE: (RUKSHATA)

The patients of Group A, B and C have showed better results in Rukshata. Group A and

C had showed better results after follow up where as Group B had showed after

treatment. Compared to Group A and B, Group C is more effective and Compared to

Group B, Group A is more effective in Rukshata.

Conclusion


CONCLUSION 1. For Virechana karma Triphala kwath with Trivritt and Danti churna as a prakshepaka

dravya has shown good effect in Vicharchika.

2. Both Virechana karma and Alepana are effective in Vicharchika. But compare to

Alepana Virechana is more effective in controlling the recurrence of disease.

3. Virechana karma followed by Alepana with Arka taila provides highly significant

results than individual groups.

4. Lower extremities are more prone to be affected by Vicharchika.

5. Most of the patients were reported in the chronic stage of Vicharchika. Negligence

in early stage and recurrence of Vicharchika is common phenomenon.

Recommendations For Future Study


RECOMMENDATIONS FOR FUTURE STUDY

1. A study may be undertaken with repeated shodhana by means of Virechana

karma, so as to elicit its effect in Vicharchika.

2. Similar study may be undertaken by prolonging the duration of post-treatment

follow up.

3. This study may be undertaken along with other Shodhana measures like Vamana

and Raktamokshana.

Summary


SUMMARY

The study entitled “A Comparative and Combined Clinical Study on

Shodhana and Alepana (External application) in Vicharchika” Comprises of

different sections ie, Introduction, Objectives, Review of Literature, Materials and

Methodology, Observations and Results, Discussion, Conclusion and Further

recommendation.

Introduction briefs about the prevalence of Vicharchika, reason for selecting the

procedure like Virechana karma and Alepana ( External application).

Objectives put forwarded for the study were laid down and defined.

The Review of Literature consists of – Rachana and kriya shareera of twak.

Regarding Rakta its- etymology, definition, formation, importance, shuddha rakta

lakshana, vitiating factors, dusta rakta lakshana, etc has been mentioned.

Disease review consists of historical aspect, etymology, definition, nidana

panchaka, sadhyasadhyata and chikitsa.

Karma Review consists of historical aspect of Virechana karma, Etymology,

Definition, Classification, Indications & Contra indications for Virechana and Purva,

Pradhana & Paschat karma of Virechana Karma.

Drug review consists of detailed description of the drugs which are used in

clinical study with their Rasapanchaka.

In methodology, detail description of the procedures adopted for the present

research was discussed.

This was a comparative clinical study; patients were incidentally selected with

predetermined randomized technique and were assigned into 3 groups.

Summary


Group A – Virechana karma

Group B – Alepana with Arka taila

Group C- Virechana karma and Alepana with Arka taila.

The symptoms were analyzed and assessed on the basis of prefixed index of

clinical assessment given to each symptom before treatment, after treatment and at the

end of the follow up.

The observations included, age, sex, occupation, prakruti, agni, kostha, vyasana,

kulaja-vrittanta, distribution of lesion, observations regarding Virechana karma etc. The

statistical analysis was done to all the observations and has been represented in the form

of tables and graphs.

Discussion describes the interpretation of the title of the study, vyadhi, etc in a

chronological order based on Ayurvedic principles.

Both Group A and Group C showed highly significant results compared to Group

B with their respective procedures. In Group A and Group C Kandu, Raji, Vaivarnya and

Ruja showed highly significant results in after follow up compared to after treatment..

Where as in Group B all symptoms i.e Kandu, Raji, Vaivarnya and Ruja showed highly

significant results in after treatment and remained only significant after follow up except

Kandu. In all 3 Groups, Group C showed most highly significant result compared to other

2 Groups. In Rukshata Group C showed better result.

Conclusions were drawn on the basis of discussion on disease, observations and

results with highly significant and significant effects with respective groups.

Thus the lacuna felt in the treatment of skin diseases to a certain extent can be

obliterated with the help of Virechana karma seems to have a definite place.

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III

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IV

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V

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V

CASE PROFORMA DEPARTMENT OF PANCHAKARMA

Dr. B.N.M.E.T’s Shri. Mallikarjuna Swamiji Post Graduate and Research Centre Bijapur.

Title: “ A COMPARATIVE AND COMBINED CLINICAL STUDY ON

SHODHANA AND ALEPANA ( EXTERNAL APPLICATION) IN VICHARCHIKA”.

P.G.Scholar – Dr. S.S.Wali

H.O.D – Dr. R.N. GENNUR M.D. (AYU) GUIDE – Dr. A.S. DONGARGAON M.D. (AYU) Dr. UMA. PATIL M.D. ( AYU) Dr. P.R. VASTRAD M.D. (AYU) Dr. I.P.UGAR M.D. (AYU) 1) Name of the Patient : S. No. :

2) Age : O.P.D. No. :

3) Sex : I.P.D. No. :

4) Caste : Date :

5) Occupation : Group :

6) Marital Status : Date of commencement of trial :

7) Economical status : Date of completion of trial :

8) Address :

CONCENT OF THE PATIENT I…………………………….here by willingly agree to participate in the clinical

trial on Vicharchika. I affirm that there has been no compulsion or mandatory

inducement in my agreeing to be patient of this project. Which I do on my free will. I

am convinced that it is for the benefit of science and mankind. I have been told about the

risk involved.

Signature of the Patient.

VI

1) PRADHANA VEDANA : KALAPRAKARSHA

2) ANUBANDHIVEDANA : KALAPRAKARSHA

3) ADHYATANA VYADHI VRUTTANTA :

4) PURVA VYADHI VRUTTANTA :

5) KULA VRUTTANTA :

6) VAYAKTIKA VRUTTANTA :

a. Ahara :

b. Vihara :

c. Vyasana :

d. Nidra :

e. Vyayama :

f. Rajapravrutti :

7) SAMANYA PAREEKSHA :

Dehoshma : Shvasagati :

Raktachapa : Rugna bhara :

8) SYSTEMIC EXAMINATION :

a) Respiratory system :

b) CNS :

c) CVS :

d) GIT Examination :

VII

9) ASTHA VIDHA PAREEKSHA :

a) Nadi - e) Shabda -

b) Mutra - f) Sparsha -

c) Mala - g) Drik -

d) Jihwa - h) Akriti -

10) DASHAVIDHA PAREEKSHA :

a) Prakriktaha : v/p/k/vp/vk/kp/s f) Satmyataha : pravara/madhyama/avara

b) Vikrutitaha : g) Pramanataha : pravara/madhyama/avar

c) Sarataha : pravara/madhyama/avara h) Aharashaktitaha: pravara/madhyama/avara

d) Samhanataha : pravara/madhyama/avara i)Vyayamshaktitaha pravara/madhyama/avara

e) Satvataha : pravara/madhyama/avara j) Vayataha :

11) AGNI PAREEKSHA : Manda / Teekshna / Vishama

12) KOSTHA PAREEKSH : Krura / Mrudu / Madhyama

13) SROTO PAREEKSHA :

14) STHANIKA PAREEKSHA :

i. Classical symptoms :

a) Kandu b) Raji ( Rekha)

c) Rukshata d) Ruja

e) Vaivarnya

ii.Lesion : i) Site -

ii) Distribution -

iii) Colour -

VIII

15) NIDANA PANCHAKA :

1) Hetu :

2) Purva rupa :

3) Roopa :

4)Upashaya / Anupashaya :

5) Samprapti :

a) Samprapti Ghatakas : -

i) Dosha vi) Udbhava Stana

ii) Dushya vii) Vyaktasthana

iii) Srotas viii) Vyadhi Adhisthana

iv) Srotodusti prakara ix) Vyadhi avastha

v) Rogamarga v) Sanchara Sthana

b) Samprapti :

16) VYADHI VINISCHAYA: 17) SADHYASADHYATA :

IX

GROUP-A 18) CHIKITSA KARMA : Virechana Karma A) Purvakarma -

1) Amapachana : By Shunti churna untill Niramavastha.

Dose : 3-6 gm

Assessment of Niramavastha after Amapachana ( Present (+) / Absent (-))

Sl. No.

Symptoms B T A T

1 2 3 4 5 6 7 8 9 10

Srotorodha Balabhramsha Gourava Anila Moodhata Alasya Ajeerna Nistheevana Mala sangha Aruchi Klama

2) Snehapana – By Panchatiktaka Ghrita

Days Matra Snehapana kala

Sneha Jeerna kala

Observation Samyak snigdha lakshana

B.P. Pulse Temp 1 2 3 4

5 6 7

Sneha Jeeryamana Lakshana

Day Observed Lakshana 1 2 3 4 5 6 7

Pathyapathya advised.

X

3) Sarvanga Abhyanga – By Tila taila

4) Sarvanga Swedana – By Bhaspa Sweda

Days Duration Pulse and B P

Abhyanga Swedana B T A T

1 2 3

B) Pradhana Karma :

Virechana dravya - Triphala Kwatha

Prakshepaka dravya – Danti & Trivrutta Churna

Time of administration -

Quantity -

Table showing regarding Vegas :

Observation No. of Vegas Time Pulse BP

Table showing Chaturvidha Shuddhi Lakshanas

Sl. No. Vega Vishaya Pravara Shuddhi Madhyama Shuddhi

Awara Shuddhi

1

2

3

4

Vaigiki lakshana

Manaki lakshana

Antaki lakshana

Laingiki lakshana

XI

I. Samyak Virikta Lakshanas

Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8

Laghuta Yatha Krama Vit, Pitta, Kapha, Vata Nisaranam Agni Vrudddhi Srotoshuddhi Indriya Prasad Anamayatva Vatanulomana Ayoga lakshana abhava

II. Asamyak Virikta Lakshana

Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8 9 10 11

Agnimandya Gourava Pratishyaya Tandra Chardi Aruchi Hrudaya Avishuddhi Kukshi Avishuddhi Kandu Vitsangha Mutrasangha

III. Ativirikta Lakshana

Sl.No. Symptoms Present ( +) Absent ( - )

1 2 3 4 5 6 7 8 9 10 11 12 13

Supti Angamarda Klama Vepathu Tamaha Pravesha Hikka Trushna KP rahita shweta udaka nihsarana KP rahita lohita udaka nihsarana Mamsa dhavanavat udaka srava Balabhava Murcha Bhrama

Shuddhi Prakara :

XII

c) Paschat Karma – Samsarjana Krama –

Day Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi

1st Morning

Evening

Peya

Peya

Peya

2nd Morning

Evening

Peya

Peya

Peya

Vilepi

Vilepi

Yusha

3rd Morning

Evening

Vilepi

Vilepi

Vilepi

Akruta yusha

Mamsarasa

Normal diet

4th Morning

Evening

Vilepi

Akruta yusha

Kruta yusha

Akruta mamsarasa

5th Morning

Evening

Kruta yusha

Kruta yusha

Kruta mamsarasa

Normal diet

6th Morning

Evening

Akruta mamsarasa

Kruta mamsarasa

7th Morning

Evening

Kruta mamsarasa

Normal diet

19) POST TREATMENT F/U : On 33rd day

20) PATHYA :

21) APATHYA :

22) COMPLICATIONS IF ANY :

XIII

GROUP-B

18) CHIKITSA – Alepana (External Application)

Method - Alepana

Drug - Arka taila

Time of application - Morning and Night

Duration - 18 days

19) POST TREATMENT F/U : On 33rd day

20) PATHYA :

21) APATHYA :


XIV

GROUP-C

18) CHIKITSA : After virechana karma Alepana should be followed

Virechana karma

A) Purvakarma -

1) Amapachana : By Shunti churna untill Niramavastha.

Dose : 3-6 gm

Assessment of Niramavastha after Amapachana ( Present (+) / Absent (-))

Sl. No.

Symptoms B T A T

1 2 3 4 5 6 7 8 9 10

Srotorodha Balabhramsha Gourava Anila Moodhata Alasya Ajeerna Nistheevana Mala sangha Aruchi Klama

2) Snehapana – By Panchatiktaka Ghrita

Days Matra Snehapana kala

Sneha Jeerna kala

Observation Samyak snigdha lakshana

B.P. Pulse Temp 1 2 3 4

5 6 7

Sneha Jeeryamana Lakshana

Day Observed Lakshana 1 2 3 4 5 6 7

XV

Pathyapathya advised.

3) Sarvanga Abhyanga – By Tila taila

4) Sarvanga Swedana – By Bhaspa Sweda

Days Duration Pulse and B P

Abhyanga Swedana B T A T

1 2 3

B) Pradhana Karma :

Virechana dravya - Triphala Kwatha

Prakshepaka dravya – Danti & Trivrutta Churna

Time of administration -

Quantity -

Table showing regarding Vegas :

Observation No. of Vegas Time Pulse BP

Table showing Chaturvidha Shuddhi Lakshanas

Sl. No. Vega Vishaya Pravara Shuddhi Madhyama Shuddhi Awara Shuddhi 1

2

3

4

Vaigiki lakshana

Manaki lakshana

Antaki lakshana

Laingiki lakshana

XVI

I. Samyak Virikta Lakshanas

Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8

Laghuta Yatha Krama Vit, Pitta, Kapha, Vata Nisaranam Agni Vrudddhi Srotoshuddhi Indriya Prasada Anamayatva Vatanulomana Ayoga lakshana abhava

II. Asamyak Virikta Lakshana

Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8 9 10 11

Agnimandya Gourava Pratishyaya Tandra Chardi Aruchi Hrudaya Avishuddhi Kukshi Avishuddhi Kandu Vitsangha Mutrasangha

III. Ativirikta Lakshana

Sl.No. Symptoms Present ( +) Absent ( - )

1 2 3 4 5 6 7 8 9 10 11 12 13

Supti Angamarda Klama Vepathu Tamaha Pravesha Hikka Trushna KP rahita shweta udaka nihsarana KP rahita lohita udaka nihsarana Mamsa dhavanavat udaka srava Balabhava Murcha Bhrama

Shuddhi Prakara :

XVII

c) Paschat Karma – Samsarjana Krama –

Day Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi

1st Morning

Evening

Peya

Peya

Peya

2nd Morning

Evening

Peya

Peya

Peya

Vilepi

Vilepi

Yusha

3rd Morning

Evening

Vilepi

Vilepi

Vilepi

Akruta yusha

Mamsarasa

Normal diet

4th Morning

Evening

Vilepi

Akruta yusha

Kruta yusha

Akruta mamsarasa

5th Morning

Evening

Kruta yusha

Kruta yusha

Kruta mamsarasa

Normal diet

6th Morning

Evening

Akruta mamsarasa

Kruta mamsarasa

7th Morning

Evening

Kruta mamsarasa

Normal diet

Alepana (External Application)

Method - Alepana

Drug - Arka taila

Time of application - Morning and Night

Duration - 18 days( It should be started in the period of

Samsarjana Krama)

19) POST TREATMENT F/U : On 45rh day

20) PATHYA :

21) APATHYA :


XVIII

GRADINGS FOR THE SUBJECTIVE VARIABLES :

Sl.No Scoring Assessment

Normal Grade (G1)

Mild Grade (G2)

Moderate Grade (G3)

Severe Grade (G4)

1 Kandu No kandu Occasional Kandu (+)

Intermittent Kandu (++)

Continuous Kandu (+++)

2 Rekha No Rekha Superficial Rekha (+)

Deep Rekha (++)

Deep rekha withredness (++)

3 Ruja No Ruja Occasional Ruja (+)

Intermittent Ruja (++)

Continuous Ruja (+++)

4 Vaivarnya No Vaivarnya

Brownish red Discolouration (+)

Blackish red Discolouration (++)

Blackish Discolouration (+++)

ASSESSMENT PARAMETERS WITH THEIR GRADINGS :

Sl. No. Symptoms BT AT PTFU

1 Kandu

2 Rekha

3 Rukshata

4 Ruja

ASSESSMENT OF OBSERVATIONAL VARIABLE :[present(+)/ slight

reduction(s.r)/absent(-)

Variable BT AT PT F/U

Rukshata

Signature of Scholar Signature of Staff

Group A

BEFORE TREATMENT AFTER TREATMENT

Group B


Group C


SHUNTI CHURNA PANCHATIKTAKA GHRITA

TILA TAILA TRIPHALA KWATHA

TRIVRITT CHURNA DANTI CHURNA

ARKA TAILA

Date post:	28-Dec-2021
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