kitibha kc040 gdg

“A comparative clinical study of ‘Siddharthaka yoga’ ‘Parisheka’ and

‘Abhyantara prayoga’ in the management of ‘Kitibha kushta’ with the

special reference to ‘Psoriasis’”.

By

Ashok M.G. Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfilment of the degree of

Ayurveda Vachaspati M.D. In

Kayachikitsa Under the Guidance of

Dr. Raghavendra V. Shettar M.D. (Ayu)

Department of Kayachikitsa Post Graduate Studies & Research Centre

D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2005-2008

Ayurmitra

TAyComprehended

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103

Certificate

This is to certify that the dissertation entitled “A comparative clinical study of

‘siddharthaka yoga’ ‘parisheka’ and ‘abhyantara prayoga’ in the management of

‘kitibha kushta’ with the special reference to ‘psoriasis’” is a bona fide research work

done by “Ashok M.G.” in partial fulfilment of the requirement for the post graduation

degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University

of Health Sciences, Bangalore, Karnataka.

Dr. Raghavendra V. Shettar

M.D. (Ayu) Guide

Asst. prof. in P.G, Dept. of kayachikitsa DGMAMC. PGS. & RC., Gadag.

Date:

Place: Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE

GADAG, 582 103

Endorsement by the H.O.D, Principal/ head of the institution

This is to certify that the dissertation entitled “A comparative clinical study of

‘siddharthaka yoga’ ‘parisheka’ and ‘abhyantara prayoga’ in the management of

‘kitibha kushta’ with the special reference to ‘psoriasis’” is a bona fide research work

done by “Ashok M.G” under the guidance of Dr. R.V Shettar, M.D. (Ayu) Asst.

professor in P.G, Dept. of kayachikitsa, DGMAMC, PGS&RC, Gadag, in partial

fulfilment of the requirement for the post graduation degree of “Ayurveda Vachaspati

M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka.

.

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place:

Prof. and HOD

P.G. Dept of Kayachikitsa DGM Ayurvedic Medical College,

Gadag Date: Place:

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “A

comparative clinical study of ‘siddharthaka yoga’ ‘parisheka’ and

‘abhyantara prayoga’ in the management of ‘kitibha kushta’ with the

special reference to ‘psoriasis’” is a bona fide and genuine research work

carried out by me under the guidance of Dr. R.V. Shettar, M.D. (Ayu),

Asst. professor in post graduate department of Kayachikitsa, DGMAMC,

PGS&RC, Gadag.

Date:

Place:

(Ashok M.G)

Copy right

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 the academic /

research purpose.

Date:

Place:

(Ashok M.G.)

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement

I wish to express my deepest gratitude first to my guide Dr. Raghavendra V.

Shettar, M.D. (Ayu), Asst. Prof. for his timely advises and encouragement during this

research work and for his inspirational clinical knowledge.

I express my gratefulness to my professor Dr. V. Varadacharyulu, M.D.(Ayu),

who was former H.O.D. of the department and my former guide

I express my gratitude to Prof. Dr. K. Shiva Rama Prasad, M.D. (Ay), M.A. (Jyo)

Ph.D. (Jy), for his timely advises and encouragement during the coarse of this research

work..

I express my thankfulness to my beloved principal Dr. G. B. Patil, for his

encouragement and support by providing all necessary facilities for this research work.

I extend thankfulness to my inspirational teacher Dr. M.B. Gururarja M.D. (Ayu),

who was prime reason for my academic career since my under graduation, also I thank

Dr. B.S. Shreedhar, M.D. (Ayu), prof and HOD, Dept of Panchakarma, GAMC,

Bangalore for all his supports.

I extend deepest gratitude to Dr. Jitendra Shetty, Managing Director, Prakruti

Remidies Pvt. Ltd, Karwar who has extended his support for the study whole heartedly

by providing the required trial drug free of cost. His support is appreciated at the

highest level.

I give my respect at this moment to my father Sri M.G. Chandrashekharappa,

my mother Smt G Sarvamangala for their blessings which gave me enough strngth. I

thank my elder brother Sri. Basavanagowda C.G. and Smt. Asha Basavana gowda

for thier continuous encouragement. I thank my brother Mr. Nagaraja M.G. for his

affection. I thank my brother in law Sri. Siddanagowda G.K. and his family for their

concern.

I extend my sincere thanks to Dr.B.M Mulkipatil. Dr. Kuber Sankh, Dr.

Yasmeen P., Dr. Nidagundi, and Dr. M. D. Samudri who supported me by providing

the patients, I am thankful to Dr. M.C.Patil, Dr.Danappagoudar and Dr. Jagadeesh Mitti

who provided facilities for the trial drug preparation in the college pharmacy with their

valuable suggestions.

I express my sincere thanks to Sri. Nandakumar for his help in statistical

analysis of results. I take the privilege to thank Sri. Mundinamani, Librarian. I also

extend my thanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided me

all the necessary books and time for my literary work.

I am very much thankful to Sri Tippanagowdar, and Sri. Kallanagouda, for their

help during the study. I extend my thaks to Sri Kulakarni and Mr. Manju for their

timely help.

I feel immense pleasure thank my seniors Dr. Kishore Kumar Hullatti, Dr.

Venkatakrushna, Dr. Venkaraddi, Dr. Kalmath, Dr. Satish Rao, Dr. G.G. Patil and others.

I give deepest acknowledgement to my friend Dr. Basavanth Kumar M.V.Sc. who

is kind to me since my school days. I extend my thankfulness to Dr. Abhishek N.Y. for

being so nice to me.

I thank my fellow colleagues Dr. Shivaleela Kalyani, Dr. Kamalakshi,

Dr. Sulochana, Dr. Shekhar, Dr. Ashwini, Dr. Jayashree, Dr. Madhushree, Dr. Siba, my

junior collegues Dr. Nataraj Dr. Adarsh, Dr.Joshi, Dr. Shailej, Dr. Uday, Dr. Veena

Jigalur, Dr. Sanjeev, Dr. Neeraj, Dr. Ishwar, Dr. Praveen, Dr. Vijayalaksmi, Dr. Kanti,

Dr. Bodke, Dr. Totar, Dr.Shabareesh, Dr. Rajesh and Dr. Sanath for their support.

I thank my juniors Dr. Neeraj Gupta, Dr. Vinay B.G., and internees

Mr.Basavanyappa, Mr. Rajashekhar, Mr. Vasantha Kumar, Mr. Satish Jalikal, Mr. Satish

Angadi, Mr. Sharanu, Mr. Veeresh, Mr. Siddalinga Swamy, Mr.Asif, Miss. Sunitha M,

Miss. Vidya Chandu for their support. I thank specially Mr.Santosh and Mr.Mahantesh

for their help during the trial.

Lastly I pay my deepest respect for those patients who took part in the study and I

share my success with them.

Dr. Ashok M.G.

Abbreviations used:

C.S – Charaka Samhita

S.S – Sushruta Samhita,

A.S – Ashtanga Samgraha

A.H – Ashtanga Hrudaya

B.S – Bhela Samhita

M.N – Madhava Nidana

B.P – Bhavaprakasha

Y.R – Yogaratnakara

V.S – vangasena

Abstract:

Charaka Samhita, leading from the front, states the management of kushta

disease with two distinctive types of treatment anthahaparimarjana chikitsa and

bahirparimarjana chikitsa. The disease kitibha though not life threatening makes the

life of the sufferer miserable. The ugly appearance in this disease makes the patient

psychologically stressed more than anybody. With the fear of getting dejected from

family and society adds up to misery. Itching is the other most disturbing symptom in

this disease which is more dangerous than pain as patient continues to scratch the

body even if it is causing pain. Similarity in the signs and symptoms of psoriasis and

lakshana of kitibha kushta after a primary literary review made us more convenient to

set up the criteria and to have PASI as objective criteria.

Ayurvaeda also believes for any skin diseases topical administration of the

drug is essential. One such yoga advised to use for both internally and externally is

Siddharthaka yoga, though not advised as shamanoushadha but is advised for vamana

and virechana. Here it was taken for granted that if this yoga is administered in lesser

dose it won’t cause any adverse effects. Also the prabhava of some of the ingredients

of the yoga encouraged to try this as none of the ingredients if advised were having

any systemic toxicity. So a study was planned to evaluate its comparative efficacy in

kitibha kushta under the title “A comparative clinical study of ‘siddharthaka yoga

‘parisheka and abhyantara prayoga in the management of ‘kitibha kushta’ with the

special reference to ‘psoriasis’”.

Objectives of the study:

To evaluate the efficacy of siddharthaka yoga parisheka in kitibha kushta.

To evaluate the efficacy of siddharthaka yoga abhyantara prayoga in kitibha kushta.

To evaluate the comparative efficacy of siddharthaka yoga parisheka and abhyantara

prayoga.

Materials and Methods:

A total of 30 patients were selected from O.P.D and I.P.D. of D.G.M.A.M.C &

H after fulfilling the inclusion and exclusion criteria randomly. They were divided in

to two groups Group A and Group B. 15 patients of Group A underwent parisheka for

10 days continuously. Group B patents were advised with the abhyantara prayoga of

Siddharthaka Yoga in the form of capsules in 3 divided doses per day.

Assessment of results was done by considering the base line data of subjective

and objective parameters to pre and post medication and was compared for

assessment of the results. All the results were be analysed statistically for “P” value

using Student “t” test.

Results:

The overall results of the study were as follows;

Group A: All (15(100%)) got best response in this group.

Group B: Best response – 4 (26.66%), Moderate response – 8 (53.33%),

Mild response – 2 (13.33%) and No response – (1 6.66%). Ware the results in this

group.

Statistically all the parameters in both groups have shown highly significant.

All the parameters in Group A have shown highly significance than the Group B.

Comparative efficacy: The efficacy Siddharthaka yoga bahya prayoga is more

significant than the abhyantara prayoga.

Contents Contents Page number

1. Introduction 1

2. Objectives 4

3. Literary review 5

4. Materials and methods 60

5. Observations and results 71

6. Discussion 102

7. Conclusion 124

8. Summary 126

9. Bibliography 128

List of tables. Table no. and content Page No.

Table 01, showing the layers of twacha according to Acharya Charaka 13

Table 02, showing the Layers of twacha according to Acharya Sushruta 14

Table 03, showing correlation between twacha and skin layers 14

Table 04, showing the nidanas of disease kushta mentioned in various books. 16-18

Table 05 showing the possible reason by which individual nidana causes kushta 19

Table 06, showing the Poorvaroopa of kushta 24

Table 07 showing the roopa of Kitibha Kushta 26

Table 08 showing Maha Kushta bheda according to different authors 31

Table 09 showing Kshudra Kushta bheda according to different authors 32

Table 10 showing the analysis of the individual drug of siddharthaka yoga 55

Table 11 showing the analysis of the individual drug of siddharthaka yoga 56

Table 12 showing the distribution of patients age group 72

Table 13 showing the distribution of patients according to sex 72

Table 14 showing distribution of patients by Religion 73

Table 15 showing distribution of patients by Economical status 74

Table 16 Showing distribution of patients by Occupation 75

Table 17. Showing distribution of patients by Nature of work 75

Table 18. Showing distribution of patients by Matra of ahara 76

Table 19. Showing distribution of patients by Kala of ahara 77

Table 20. Showing distribution of patients by Rasa 77

Table 21. Showing distribution of patients by Guna of ahara 78

Table 22. Showing distribution of patients Type of diet 79

Table 23. Showing distribution of patients by Vyasana 79

Table 24. Showing distribution of patients by Hygiene 80

Table 25. Showing distribution of patients by Manaska sthiti 80

Table 26. Showing distribution of patients by observed nidana in no & % 81

Table 27. Showing distribution of patients by observed poorvaroopa in the

study in Group A patients

82

Table 28. Showing distribution of patients by lakshanas observed. 82

Table 29. Showing distribution of patients by anubandha vedana observed. 82

Table 30. Showing distribution of patients by site of onset 83

Table 31. Showing distribution of patients by mode of onset of the disease 83

Table 32. Showing distribution of patients by aggravation time 84

Table 33. Showing distribution of patients by aggravation season 84

Table 34. Showing distribution of patients by Kula vruttanta 85

Table 35. Showing distribution of patients by Chikitsa vruttanta 85

Table 36. Showing distribution of patients by confirmatory signs 86

Table 37. Showing demographic data in patients of in Group A 87

Table 38. Showing demographic data in patients of in Group B 87

Table 39 Showing Lakshanas of kitibha kushta in Group A 88

Table 40 Showing Lakshanas of kitibha kushta in Group B 88

Table 41 Showing Confirmatory signs in psoriasis Group A 89

Table 42 Showing Confirmatory signs in psoriasis Group A 89

Table 43 Showing Anubandha vedana of kitibha kushta in Group A 90

Table 44 Showing Anubandha vedana of kitibha kushta in Group B. 90

Table 45 Showing the observed features of the nature of kitibha kushta in Group A 91

Table 46 Showing the observed features of the nature of kitibha kushta in Group B 92

Table 47 Showing the observed vaiktika vruttanta in Group A 93

Table 48 showing the observed vaiktika vruttanta in Group B 93

Table 49 showing the rogi pareekshain Group A 94

Table No. 50 showing the rogi pareekshain Group B 94

Table 51 showing the Nidana observed in Group A 95

Table 52 showing the Nidana observed in Group B 96

Table No. 53 showing poorvaroopas observed in Group A 97

Table 54 showing poorvaroopas observed in Group B 97

Table 55 Showing assessment of grading of subjective and objective parameter values of Group – A

98

Table 56 Showing assessment of grading of subjective and objective parameter values of Group – B

99

Table 57 Showing t Statistical analysis of parameter values of Group – A 100 Table 58 Showing t Statistical analysis of parameter values of Group – B 100 Table 59 Showing Statistical analysis of parameters values of inter Group (Group – A and Group – B)

101

Table 60 Showing the overall statement of results of Group A 119 Table 61 Showing the overall statement of results of Group B 120

List of Figure Figure Page no

Figure no 01 shows the samprapti flow chart in general. 29

figure no 2 showing the anatomy of normal skin 42

Figure no 03 showing dermal vasculature of normal skin and psoriatic skin 44

Figure no 04 showing ingredients f siddhrthaka yoga. 52

Figure no 05 showing materials used in the study 59

Figure no 06 showing step wise dhara procedure 67

Figure 07 showing distribution of patients by age 72

Figure 08 showing distribution of patients by sex 73

Figure 09 showing distribution of patients by religion 74

Figure 10 showing distribution of patients by Economical status 74

Figure 11 showing distribution of patients by occupation 75

Figure 12 showing distribution of patients by nature of work 76

Figure 13 showing distribution of patients by matra of ahara 76

Figure 14 showing distribution of patients by kala of ahara 77

Figure 15 showing distribution of patients by rasa 78

Figure 16 showing distribution of patients by gune of ahara 78

Figure 17 showing distribution of patients by type of diet 79

Figure 18 showing distribution of patients by vyasana 79

Figure 19 showing distribution of patients by hygine 80

Figure 20 showing distribution of patients by manasika sthiti 80

Figure 21 showing distribution of patients by site of onset 83

Figure 22 showing distribution of patients by mode of onset 83

Figure 23 showing distribution of patients by aggravation time 84

Figure 24 showing distribution of patients by aggravation season 85

Figure 25showing distribution of patients by kula vruttana 85

Figure 26 Showing distributions of patients by chikitsa vruttanta 86

Figure 27 showing distribution of patients by confirmatory signs 86

Figure 28 Showing the overall statement of results 118

Introduction

Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta

1

Introduction

Acharya Agnivesha, the all time intelligent scholar of Ayurveda, the science

of life notes down the preaching of Adhyupadeshta Punarvasu Atreya in the form of

doctrine to become popular later as Charaka Samhita after the addition from the

experience of Acharya Drudhabala and redactation of Acharya Charaka. This is the

only doctrine honored & referred over centuries. The redactor Acharya Charaka

viewed the river of medicine, raising from an obscure past, ever flowing, ever

growing and racing to the flood waters of today. He had urged us to learn from

greatest sages as well as shepherds; both are the teachers in their own way 1.

Entire Charaka samhita deals the subject keeping in mind the concept of

chikitsa. This attitude is seen from the chapter number one. He discusses the types of

chikitsa as of Antahparimarjana and Bahirparimarjana types. After dealing the entire

chapter about panchakarmaroopa anathparimarjana chikitsa, he dedicates

Aragwadeeya adhyaya 2 for bahirparimarjana chikitsa especially for the disease

Kushta. This shows the importance of treating kushta, a deergha roga 3 after its

thorough understanding. He further says performing bahirparimarjana chikitsa yields

sadhya siddhi 4.

For the first time in the entire history of medicine the disease Kitibha Kushta

is cited from Charaka Samhita 5 where choorna pradeha is advocated over the tailakta

gatra.

It is evident after going through different classical texts of Ayurveda that

Kushta, a noted mahagada 6 requires multiple route of administration of drugs. Two

such different modalities are antahparimarjana and bahirparimarjana chikitsa. One

such yoga mentioned for the use in both route is Siddharthaka snanokta aushadha

siddha kashaya.

Introduction


2

Kitibha kushta simulating to the disease Psoriasis in the contemporary system

of medicine results in the fear of getting dejected from the society because of the

appearance of the body. Kandu, Shyava kina and khara sparsha and scratching the

body in the public by the patient creates an enormous psychological stress over the

diseased and kandu is more miserable than the pain because patients don’t stop

scratching the body even though it causes pain so it is postulated clinically that the

itching is stronger symptom in any patient. Hence the management of kandu, shyava

kina and khara sparsha is the need of the hour in kitibha sufferer. The utility of drugs

of modern science like methotrexate, which is still of ‘gold standard’ has increased

risk of bone-marrow toxicity and hepatotoxicity. This gives an edge of advantage to

Ayurveda over the modern system of medicine to help the sufferer with its non toxic

medicament, also suffer is compelled to seek prescription from an Ayurvedic

physician.

The ingredients of Siddharthaka snana yoga was estimated to suit the demands

as the drugs of the compound are blessed with kushtaghna and kandughna property.

Most of these drugs are included in kushtaghna and kandughna gana which are set as

an example for the physician to proceed their thoughts basing on these 7. This yoga

was taken for the study to draw a comparative efficacy of the drug under the title “A

comparative clinical study of ‘siddharthaka yoga ‘parisheka and abhyantara

prayoga in the management of ‘kitibha kushta’ with the special reference to

‘psoriasis’”.

The study included a total of 30 subjects divided randomly in to two groups as

A and B. 15 patients of group A received the bahirparimarjana chikitsa in the form of

parisheka. As stressed by the all time great physician of Ayurveda Acharya Charaka

to administer external therapy for better efficacy over Tailakta gatra 8, taila was

Introduction


3

preapared using the same ingredients. Though snana is told in the Samhita, for

hospital supervision the procedure was modified to parisheka. The other set of 15

patients received antahparimarjana chikitsa in the form of capsules. The subjects were

selected from OPD and IPD of D.G.M.A.M.C. and hospital, Gadag.

The entire study was done to evaluate the efficacy of Siddharthaka yoga by

duly considering the clinical signs and symptoms as subjective parameter and PASI

scoring as objective parameter. The subjective and objective of base line data to pre

and post medication was compared for the assessment of the results. All the results

were analysed statistically for ‘p’ value by using un-paired test to analyse the mean

effect of two groups, and paired‘t’ test was used to compare the effect of drug by

assuming that the drug is not responsible for the changes in the observation before and

after the treatment.

Objectives


4

Objectives

The objectives of the study were;

1. To study kushta disease with special reference to kitibha kushta simulating

to psoriasis in detail.

2. To study the properties and mode of action of ingredients of ‘siddharthaka

yoga’ in kitibha kushta.

3. To study the therapeutic procedure parisheka and its role in the

management of kitibha kushta

4. To evaluate the efficacy of siddharthaka yoga parisheka in kitibha kushta.

5. To evaluate the efficacy of siddharthaka yoga abhyantara prayoga in

kitibha kushta.

6. To evaluate the comparative efficacy of siddharthaka yoga parisheka and

abhyantara prayoga.

Literary review


5

Literary review

Historical review:

Ayurvedic literature:

The science of life, Ayurveda was developed on the base of Vedas

only hence the Indian system of medicine is also devine. This auxiliary of Atharva

veda is said to be the perfect since the time of its inception. It is important to study the

subject of Ayurveda i.e. from primitive state and the recession at a particular stage – it

must be viewed as a part of our cultural history and cultural history must be studied in

relation to the social history against the background of historical evolution of India.

The reason behind development and decline will then come to our notice.

The nidana panchaka except lakshanas of kitibha kushta are not told in any of

the texts of Ayurveda. Hence the samanya nidana, poorvaroopa, upashaya and

samprapti of Kushta are considered in the entire study.

Charaka Samhita

Agnivesha samhita is now known as Charaka samhita, after the handy

contribution from Acharya Charaka, the greatest redactor in the world history of

literature. This was compiled in the second century B.C. The disease kushta is dealt

with the great importance as is evident from the fact that the treatment of kushta is

dealt in the very third chapter of the samhita where the external therapeutics are

explained for the disease.

The disease kushta is dealt in two broad headings as Maha kushta and kshdra

kushta and are told as seven and eleven types respectively. Kitibha is dealt under the

second variety of lesser important type of kushta in chikitsa sthana.

Literary review


6

The other parts of the book where the disease kushta is explained are as

follows;

a) Chardhi nigrahana is told to manifest the disease kushta 9

b) Kushta is told as bahya marga roga 10.

c) It is advised with madhyama matra of sneha 11.

d) Is told as nija shotha karana 12.

e) Classification of kushta is told as 713.

f) Langhana is adviced for twak dosha 14.

g) Kushta is told as santarpanottha vyadhi 15.

h) This disease is told as raktadushtijanya roga 16.

i) Kushta is told as shreshta deergha roga 17.

j) Atilavana rasa sevana leads to kushata 18.

k) Tikta rasa is told as kushtahara 19.

l) Is told as resultant of viruddhaharajanya roga 20.

m) Is counted as raktapradoshajanya vikara 21.

n) Pancha nidana of kushta is detailed with explanations of

mahakushta 22.

o) Adhishtana of kushta is told as chaturtha tamra nama twak 23.

p) Kushta arishta lakshanas are told in indriya sthana 24.

q) References of kithibha kushta lakshanas are available in chikitsa

sthana 25.

r) The dosha pradhanyata of kitibha kushta is told as vata kapha 26.

Sushruta samhita

This doctrine of Ayurvada counted under bruhatrayee was written by Acharya

Sushruta basing on the preaching of Divodasa. This is the book which has dealt both

Literary review


7

the types of kushta in the nidana sthana counting kitibha kushta in ksudra kushta.

Some of the references available regarding kushta are;

a) Pratisarana kshara is told for Kushta 27.

b) Kushta is told as papajanya roga28.

c) Is counted under Aupasargika roga along with jwara, shosha and

netrabhishyanda 29.

d) Saptadhatugata kushta lakshanas are told in this book 30.

e) Kushta is told as hereditary (streepumsa shukrashonitajanya) i.e.

adibala pravrutta vyadhi 31.

f) Sadhyasadhyata of the kushta is told based on the basis of dhatu

involvement 32.

g) Kushta is told as mahagada33.

h) Kushta adhishtana is told as 5th layer i.e. vedini, the thickness of

which is 1/5th of a vreehi danya 34.

i) Varjya and pathya is dealt in detail in this samhita 35.

j) The predominant dosha involved in kitibha kushta is told as pitta.

Bhela samhita:

The work of Acharya Bhela, the student of Punarvasu Atreya Bhela samhita is

lost and the presently available book is not a complete one.

a) The disease kushta is dealt in nidana sthana as well as chikitsa

sthana.

b) Like Charaka Samhita he discusses kitibha kushta in chikitsa sthana

only.

c) Hareeta shakas, Madhya and pippali are told as nidanas for kushta

apart from those told in Charaka Samhita 36.

Literary review


8

d) Mootra and pureesha vegadharana are told as nidana for kushta

(Bhe.Chi.6/4).

e) Vartate cha samutpannam is the extra lakshana told in this book for

kitibha kushta i.e. relapsing nature 37.

Hareeta Samhita:

Achrya Hareeta is quoted to be the other disciple of Punarvasu Atreya and a

colleague of Acharya Agnivesha.

He had also counted 18 number of kushta but he had not used the word

Kitibha, he might have used kina kushta for it 38.

Kushta is said to be papodbhava according to the author.

Kashyapa Samhita:

This book is as old as Charaka Samhita and Sushruta Samhita perhaps even

more so is obtained in mutilated form, missing preface, conclusion and some other

portions. Like Atreya in Charaka Samhita and Divodasa in Sushruta Samhita, the

original preceptor of this Samhita is Acharya Kashyapa. Young Jeevaka had

condensed the teachings of Kashyapa to be known later as Kashyapa Samhita or

Vruddha Jeevakeeya Tantra.

Kushta is dealt in kushta chikitsadhyaya of chikitsa sthana. The extra

information availed from this is pipasa as a purvaroopa of kushta.

Prashanti cha punaha utpadhyate is extra lakshana told for kitibha kushta 39.

Ashtanga Samgraha: Acharya Vagbhatta’s compilation work on the basis of

Charaka Samhita and Sushruta Samhita had dominated the readers in the recent time

as it avails the information of two different schools of thoughts in one single book.

This book gives the definition of Kushta. He mentions bahya kushta

samprapti. Both maha and kshudra kushtas are dealt in nidana sthana only. Medogata

Literary review


9

kushta and there after are told told as yapya and asadhya respectively. Pittaja,

dwandwaja and asra mamsagata kushta are told as krucchrasadhya. The vata kaphaja

kushta notably are told as sukhasadhya 40. The chikitsa aspect of the disease is dealt in

chikitsa sthana.

Ashtanga Hrudaya:

The other book almost consisted versions of Ashtanga samgraha out of the pen

of Laghu Vagbhatta is very famous in the southern part of the country for its poetic

way of writing.

Acharya Laghu Vagbhatta conveys krimi as nidana of kushta 41. He explains

the sequential progressive involvement of loma to tarunasthi if kushta is untreated 42.

He had followed the version of Acharya Sushruta in the context of Chikitsa sutra

explanation.

Madhva Nidana:

The worth book referred for the pathophysiology of the diseases in Ayurveda,

is the work of Acharya Madhavakara. He with little contribution of his own had

compiled mostly the versions of bruhattrayees. He had followed Charaka Samhita and

Ashtanga Samgraha for the explanation of nidana and lakshanas, while he followed

Acharya Sushruta in explaining saptadhatugata kushta.

Sharngadhara Samhita:

Damodara soota Sharngadhra’s work is the choice of book to be referred for

the pharmacology and therapeutics in Ayurveda. While dealing the classifications of

vyadhis he says kushta is of 18 types, including the kitibha kushta 43. He contributes

with new formulations for kushta disease by calling those set as kushtaghna 44.

Literary review


10

Basavarajeeyam:

The author who hails from south India is very special because he gives a list of

herbo-mineral formulations for every disease. He had added kandu as a lakshana of

kitibha to the version of Acharya Charaka. He is the first author to indicate

formulations for individual types kushta. He advocates Vajrapani rasa for kitibha

kushta 45.

Vaidhya Jeevanam:

The poet cum Ayurveda Acharya is special because of his contributions of

effective yogas and poetic explanation of their efficacy. One eg of such yoga is found

in 4th Vilasa 18th shloka 46.

Bhavaprakasha:

Bhavamishra son of Latakana Mishra had written a book concentrating more

of the herbs explaining their properties. He also had written Chikitsa of various

vyadhis prevalent in madhyama kala. He followed Acharya Charaka in explaining

kushta, in addition he told arishta lakshanas47, includes nisha in the pathya sevana 48

and he advises kaishora guggulu for kushta 49.

Sahasra yoga:

The book written by an anonymous author belonging to Kerala state is an

important asset. The entire book comprises only the formulations for various diseases

in different forms. In each prakarana there are kushtaghna yogas. The therapeutic

index of this book is undoubtedly a part and parcel of the prescription in the

practitioners of this part of the country.

Nirukti

Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta

11

Nirukti and paribhasha of kushta:

The word kushta is originated from kush – katana (kuda pratyaya) 47 means; to

deform the twacha (kusha nishkarsha), to change the colour of twacha

(kushnatyangam), to discontinue the integrity of twacha (kutsitam tishtati). Also the

etymology of the word kushta is from the root ‘kush’ meaning; that which comes

from inner part, after adding hani to kush it becomes kushta 48. The meaning can be

concluded as the condition in which there is hani to the twacha especially to its

appearance as the factors like rakta, laseeka, ambu and tridoshas from inner part of the

body reach the outer most part of the body being skin which exactly matches with the

samprapti of kushta.

Ashtangakaras were first to define kushta as “twacha kurvanti vaivarnya

dushtaha kushtamushanti tat ||” 49, meaning the condition in which there is

discolouration and dushti of twacha. The discontinuity of the twacha is resulted in this

disease.

Further the same author says; once the condition is allowed to lapse by time, it

makes the entire body to look ugly. It spreads to all the dhatus, resulting in the

increase of the kleda in the body because of which sankotha of twacha occurs leading

to utpatti of sookshma krimi inturn. These krimis later invade loma, twak, snayu,

dhamani and tarunasthi in an order 50.

Nirukti


12

Nirukti and paribhasha of kitibha kushta:

The word meaning of kitibha is kesha keeta 51. Shri Kavirama Umeschandra

says it as kesha koti 52. Kitibha in English is a louse (a parasitic insect, pediculus

humanus, infecting the human hairs and skin and transmitting various diseases) and a

kind of exanthema 53. Condensing all these, the definition of kitibha can be

summerised as ‘a diseased condition in which the twacha gets discoloured like kesha

keeta (blackish brown), or a condition in which the skin gets afflicted with kesha

keeta.’ The same meaning is also told by Shri Tarakanath as, kitiriva bhati

krushnatwat i.e. a condition where the skin gets krushna varna like kiti, the kesha

keeta 54. As for as the present understanding of the disease kitibha kushta is known,

the first explanation of similarity in the colour of the kesha keeta holds good where as

we don’t find any krimi affecting the twacha as per the second opinion.

Twacha shareera


13

Twacha Shareera.

Twak is the simulating term used for skin in the modern anatomy. It

invaginates and covers the entire structures of human body. Covering the entire body,

has a surface area of 1.5 2 sq. m., weighs about 4-5 kg making almost 7% of the total

body weight. Thus it is told as sthira and bahala by Ayurveda 55.

The twak is upadhatu of mamsa produced in the intrauterine life 56. Twacha is

the moola of mamsavaha srotas 57. The 7 layers of twak are formed when shukra and

shonita are subjected for the paka by doshas and the layers are formed just like the

formation of santanika after boiling the ksheera 58. But Ashtanga samgrahakara says

that the 6 layers of twacha are formed out of processing of asruk 59. Twak is the place

for tactile sensation 60 and is made up of vayu mahabhuta predominantly 61, 62 this is

also the site of bhrajaka pitta, the factor responsible for the digestion of the external

application of medicaments 63, 64, the seven and six laters according to Acharya

Charaka and Acharya Sushruta are shown in table no. 01 and 02 indicating their

features.

Table 01 showing the layers of twacha according to Acharya Charaka 65

Sl.no. Layer Features

01 Udakadhara Bahya twacha, protects the jaleeyamsha

02 Asrugdhara Holds the rakta

03 Truteeya Adhishthana of sidma, and kilasa kushta.

04 Chaturtha Adhishthana of dadru kushta.

05 Panchamee Adhishthana of alaji and vidradhi.

06 Shashtee If incised it causes severe pain and leads to tamah pravesha.

Causes sthula moola arumshikas over sandhis which are

asadhya to treat.

Twacha shareera


14

Table 02 showing the Layers of twacha according to Acharya Sushruta 66

Sl.no. Layer Measurement Features 01 Avabhasini 1/18th vreehi Varna and chaya prakashaka, sidma and

padmakantaka rogadhisthana 02 Lohita 1/16th vreehi Tilakalaka, vyanga and nyaccha roga

adhishthana. 03 Shweta 1/12th vreehi Charmadala, ajagallika & mashaka

rogadhishtana. 04 Tamra 1/8th vreehi Vividha kilasa kushtadi rogadhishtana. 05 Vedinee 1/5th vreehi Kushta visarpa adhishtana. 06 Rohinee Vreehi

pramana Granthi, apachee, arbuda, shleepada and galaganda.

07 Mamsadhara Vreehi dwaya Bhagandhara, vidradhi and arsha rogadhishtana.

Dr. Bhaskar Govind Ghanekar has written hindi commentary over Sushruta

Samhita by name ‘Ayurveda Rahasya Deepika’ which is best referred for the

comparison of Ayurveda shareera to the modern anatomy. He is honored so much

because he himself has studied both modern science and Ayurveda academically. His

correlations are shown in the table no. 03.

Table 03, showing correlation between twacha and skin layers 67

Sl.no. Layer Comparison of twacha to skin layer of modern anatomy

Twacha(skin layer)

01 Avabhasini Horney layer Bahya twacha

(epidermis) 02 Lohita Stratum lucidum 03 Shweta Stratum granulosum 04 Tamra Molphigian layer

Antah twacha (dermis)

05 Vedinee Papillary layer 06 Rohinee Reticular layer 07 Mamsadhara Subcutaneous tissue and muscular layer Relation between twacha and dosha, dhatu and mala:

Dosha: Vata: sparshanendriya is the adhishtana vata 68, 69 and samana vata is present

in swedavaha srotas 70 which in turn is present in twacha.

Pitta: bhrajaka pitta is present in twak digesting the external applications and

reflecting chaya in the skin 71.

Twacha shareera


15

Kapha: No direct reference is available regarding the presence of kapha in

twacha, but is believed to contribute the snigdhata and mardavata to the skin.

Dhatu: Rasa: the sara of rasa dhatu is assessed by looking in to the skin and the

romas 72, twak roukshata is the sign manifested in the rasa kshaya 73, shaithya is

generated as a result of rasa dhatu vruddhi 74 hence it is postulated that twacha is

nourished by rasa dhatu and it is responsible for the maintenance of the temperature of

the body in its normalcy.

Rakta: varna prasada and sparsha gnana 75 are told as the karma of rakta

hence rakta is also present both physiologically and anatomically in the twacha. After

going through rakta rogas a notion can be evolved that whenever there is rakta dushti

the site of manifestation is twacha, the rogas like kushta, visarpa, pidaka, mashaka,

neelika, tilakalaka etc. manifest. Hence it is concluded that there is definitely a

relation of dependency between twak and rakta.

Mamsa: 6 layers of twacha formation takes place from the prasada bhaga of

mamsa dhatu along with the formation of vasa and are said as upadhatus 76.

Mala: Sweda: it is said as udaka swaroopa maladravya which gets nishpatana from

the romakoopa and twak randra 77. The karya of sweda is told as maintenance of

shareera ardrata and twak soukumaryata. 78. The kshaya and vruddhi lakshanas of

sweda are manifested in the twacha only.

Nidana


16

Nidana of kushta:

Study of Nidana, the cause in any research has got its importance in

understanding the disease process, and planning the treatment as nidana parivarjana

plays major part in chikitsa. It is also essential to study the literary part of nidana so as

to revalidate them to the present day and to add if some new nidanas are observed in

the course of study. In the present study the nidanas are depicted in the tabular form

and an attempt is made to quote the possible reason by which these nidanas manifest

the disease kushta. However separate nidanas are not told for kitibha kushta. The

general kushta nidanas are considered in the present study.

Table 04 showing the nidanas of disease kushta mentioned in various books79 to 87 S.N. Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S

1 Mithyahara vihara + - + + + + + + +

2 Sheetoshna vyatyasa

Santarpanaapataprpana

vyatyasa

+ - - - - + + + +

3 Madhu + - - - - + - + -

4 Fanita + - - - - + - + -

5 Matsya + - - - - + + + +

6 Lakucha + + - - - + - + -

7 Moolaka alone and or with

guda

+ + - - - + + + +

8 Kakamachi + + - - - + - + -

9 Atimatrahara + - - - - + - + -

10 Chilichima(matsya vishesha)

+ payas

+ - - - - + - + -

Nidana


17

S.N Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S

11 Hayanaka,yavaka,

Chinaka,uddhalaka,

koradusha +ksheera,

dadhi,takra,kola,kulattha,

masha, atasi,kusumbha

+ - - - - + - + -

12 Vyayama, vyavaya, santapa

after consuming above said.

+ - - - - + +

13 Sheetodaka avatarana after

bhaya, shrama, santapa &

chardi,

+ - + - - + + + +

14 Aticharana of sneha + - - - - + - + -

15 Drava, snigdha , guru ahara. + - + - - - + - +

16 Vyayama after bhojana + - - - - - + - +

17 Panchakrma apachara + - - - - - + - +

18 Navanna + - - - - - + - +

19 Dadhi and other Milk

products

+ - + - - - + - +

20 Tila and tila taila + - + - - - + - +

21 Masha + - + - - - + - +

22 Madhura, amla, lavana rasa

atisevana

+ - - - - - + - +

23 Pishtanna + - - - - - - - -

24 Diwaswapa + - - - - - + - +

25 Vipra, guru, sadu gharshna

and ninda

+ - + + + - + - +

26 Papakarma + - + + - - + - +

27 Chardi vega dharana + + + - - - - - -

28 Vatayu with payas - + - - - - - - -

29 Payas with nimbu - + - - - - - - -

30 Pippali - + - - - - - - -

31 Mootra and pureesha vega

dharana

- + - - - - - - -

Nidana


18

S.N. Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S

32 Mamsa sevana alone and

with milk

- + + - - - - - -

33 Paya sevana after Madhya

and amla sevana

- + - - - - - - -

34 Ushnahara sevana after

madhu and Madhya sevana

- + - - - - - - -

35 Maithuna, vyayama &

ahitashana after sneha or

ayatharambha sneha pana

- - + - - - - - -

36 Purakruta karma - - + - - - - - -

37 Valmika roga - - - - - - - - +

Other nidanas:

Some of the other factors are also said to cause kushta in different

contexts apart from kushta nidana and kushta chikitsa chapters in the samhitas. Some

of those are compiled here under;

Acharya Laghu Vagbhatta 88 and Acharya charaka 89 says krimi as nidana of

kushta. Kushta is counted under Aupasargika roga along with jwara, shosha and

netrabhishyanda 90 so it spreads one to other on contact etc. Kushta is told as of

hereditary (streepumsa shukrashonitajanya) origin i.e. adibala pravrutta vyadhi 91.

Kushta disease is resultant of sneha vibhrama 92. When dushita rakta is made

sthambha by advising sthambhana chikitsa in raktarsha it leads to kushta 93,

sthambhana is contraindicated in raktapitta when dosha is in utklishta avastha, if it is

done in this condition it leads to kushta 94. If sangrahaka aushadha is given in

amatisara state then it leads to kushta with other diseases 95. Those who are using river

water flowing from paariyaatra, or vindhya and sahya area have always fear of getting

kushta along with shiroroga and hrudroga, 96.

Nidana


19

In nidanas, the major part is occupied by the viruddha factors in terms of both

ahara and vihara. It is already cited that the disease kushta is told as

viruddhaharaviharajanya roga. In the analysis of the reason guna, karma, veerya,

vipaka, prabhava and the type of viruddha are taken in to the account. The reasons are

linked with the samprapti ghatakaslike doshas, dhatus, agni, ams, srotas etc here under

Table 05 showing the possible reason by which individual nidana causes kushta Nidana Possible reason for the manifestation of

kushta

Mithyahara vihara Is desha kala prakrutyadi viruddha & samyoga

viruddha ahara 97

Sheetoshna vyatyasa

Santarpanaapataprpana vyatyasa

Is karma viruddha, avastha viruddha & veerya

viruddha 98

Fanita Guru, abhishyandi and tridoshakrut 99

Matsya Snigdha, bahudoshakaraka, guru, ushna and

madhura 100.

Lakucha Is tridoshakara 101, samyoga viruddha with

payas dadhi mashasupa guda ghruta.102

Moolaka alone and or with guda Is jati virodhi 103, Kushtakara if milk is taken

after its consumption 104, apakwa moolaka is

tridoshakara.

Kakamachi Though shaka is kushtahara if taken with guda

it becomes ahita 105 Paryushita kakamachi is

visha which is avastha vishesha.

Atimatrahara Leads to ama dosha 106, causes durvipaka.

Chilichima + payas Causes raktaja roga, veerya viruddha107 both

are abhishyandhi 108

Vyayama, vyavaya, santapa after

consuming above said and bhojana

Karma viruddha 109

Nidana


20

Nidana Possible reason for the manifestation of kushta

Sheetodaka

avatarana after

bhaya, shrama,

santapa, chardi,

Karma viruddha, vyadhi avastha viruddha. 110

Aticharana of sneha Parihara viruddha, causes kushta 111, mithya snehapana causes

kushta 112

Drava, snigdha, and

guru ahara.

Drava does prakledana i.e. increases the kledata113.kledana

shakti is snigdha so increases the sama.114, guru- guru vipaka

and upalepakaraka 115 i.e. srrotorodhaka

Panchakrma

apachara

In terms of consumption of nishiddha vishayas 116 leads to

doshotklesha

Navanna Is abhishyandhi,increases the kledata in the dosha dhatu mala

and srotas 117

Dadhi and other

Milk products

Dadhi sevana during ratri, nitya sevana, after heating, without

mudgasoopa, kshoudra, ghruta, sitopala and amalaka will

cause kushta 118

Madhura, amla,

lavana rasa atisevana

Madhra – Atyartha upayoga of madhura rasa causes so many

rogas affecting the mamsa,rasavaha srotas and other rogas by

increasing the abhishyandhi guna 119. Lavana –atiyoga causes

dhatu shithilata specially mamsa and shonita120, kota utpatti 121. Amla rasa – its atisevana causes kapha vilayana, pitta

abhivardhana, rakta dushti,mamsa vidaha, kaya shithilata122

Pishtanna Is guru than the shali 123 so kaphakaraka

Diwaswapa It increases the kandu. Srava 124

Vipra, guru, sadu

gharshna and ninda

Is prabhavajanya.

Masha Shleshma janaka 125.

Papakarma Is prabhavajanya.

Chardi vega dharana Kushtakaraka 126

Vatayu (Harina

mamsa) with payas

Samyoga viruddha

Nidana


21

Nidana Possible reason for the manifestation of kushta

Payas with nimbu Samyoga viruddha 127

Pippali Pippali though told as kushtahara as a bheshaja used as

rasayana in vardhamana manner. It is said to cause kushta if

used in the form of annasamskara in excess and

continuously128 as it is guru and prakledi.

Mamsa sevana alone

and with milk

Samyoga viruddha

Paya sevana after

Madhya and amla

sevana

Viruddha 129

Ushnahara sevana

after madhu and

Madhya sevana

Samyoga viruddha 130

Maithuna, vyayama,

ahitashana after

sneha or

ayatharambha sneha

pana

Parihara viruddha 131

Purakruta karma Prabhavajanya

Tila & tila taila Panabhyasa of tila taila is twak dushtikaraka132

Poorvaroopa


22

Poorvaroopa:

The sets of signs and symptoms appearing prior to the disease proper

which gives a hint of forth coming disease are called as poorvaroopa. The disease

kushta also manifest completely after hinting about its complete manifestation.

These are resulted out of the dosha dushya sammurchana at the level of

sthanasamshraya of vyadhikriyakala. The advantage of the knowledge of

poorvaroopa enables the physician to be ready with the measures to combat the

forthcoming disease in advance. The table 06 shows poorvaroopa of the disease

kushta, but specific explanation of poorvaroopas of kitibha kushta are however not

explained in any of the texts.

Some of the poorvaroopas are searched for the reason for their

manifestation and are stated below;

Aswedana and Atiswedana – vata chalagunataha (swedovaha sroto avarodha and )

Parushyata – vata kharagunataha

Atishlakshanata – kapha shlakshna gunataha

Vaivarnya – rakta gunataha

Kandu – kapha karmataha

Nistoda – vata karmataha

Suptata – vata kapha – sheeta gunataha

Paridaha – pitta – ushnagunataha

Pariharsha – vata – sheeta gunataha

Lomaharsha – vata – sheeta gunataha

Kharatwa - vata kharagunataha

Ushnata – pitta ushna gunataha

Gourava – kapha – gurugunataha

Poorvaroopa


23

Shwayathu – kapha – srotorodha

Visarpa – vata pitta

Pradeha of mala, Sheegrotpatti chirasthiti – vata

Kota Unnati/ pidakodaya – rakta

Krushnata of asruk – vata roopataha

Shrama – vata karmataha

Adhika shoola in vrana – vata – karmataha

Klama – vata karmataha

Raga – pitta roopataha and

Pipasa – pitta.

Poorvaroopa


24

Table 06, showing the Poorvaroopa of kushta 133 to 141

S.N. Poorvaroopa C.S B.S S.S A.S A.H M.N B.P Y.R V.S

1 Aswedana + - + + + + + + +

2 Atiswedana + + + + + + + + +

3 Parushyata + - + - - - - - -

4 Atishlakshanata + - - + + + + + +

5 Vaivarnya + + - + + + + + +

6 Kandu + - + + + + + + +

7 Nistoda + - - + + + + + +

8 Suptata + + + + + + + + +

9 Paridaha + + - + + + - - -

10 Pariharsha + - - + - + - - -

11 Lomaharsha + + + - + - + + +

12 Kharatwa + - - + + + + + +

13 Ushnata + + - - - - - - -

14 Gourava + + - - - - - - -

15 Shwayathu + - - - - - - - -

16 Visarpa + - + - - - - - -

17 Pradeha of mala + - - - - - - - -

18 Kota Unnati/ pidakodaya

+ + - + + + + + +

19 Sheegrotpatti chirasthiti

+ - - + + + + + +

21 Krushnata of asruk - - + + + + + + +

22 Shrama + - - + + + - + +

23 Adhika shoola in vrana

+ - - + + + + + +

24 Klama + - - - - + - -

25 Raga - + - - - - - - -

26 Pipasa - + - - - - - - -

27 Dourbalya - + - - - - - - -

Roopa


25

Roopa:

Lakshana, roopa os linga are some of the synonyms used to denote the signs

and symptoms of any disease in Ayurveda. These are coming to the picture in a

disease scenario during the vyakta avastha of the vyadhikriyakala. The lakshanas and

the intensity of them depend on strength of dosha dushya sammurchana. The

lakshanas of the kitibha kushta are compiled from all the reliable classical texts of

Ayurveda and are shown in table number 07, page no. 27. Some of the lakshanas are

interpreted with the dosha amshamsha kalpana, basic cause of all vyadhis where ever

possible and are;

Shyava varna kina – Shyava (ishat krushna varna) kina (vranasthana) 142 is seen. So

the lesion is brownish red in kitibha kushta.

Khara sparsha of kina – the lesion is, karkasha sparsha, kathina, amrudu. The khara

word must have been used to indicate the lekhana guna 143 which scrapes out the skin

in this context.

Parushata of kina – rookshata of the twacha is always there in the kitibha kushta

because of the vata dosha.

Srava – is flow of exudates from the vrana sthana.

Vrutta – is circular shape of the vrana

Ghana / drudha – is the sthairya, kathinyata character of the vrana in kitibha kushta.

Ugra kandu – is extensive itching in the sufferers of the kitibha.

Vartate cha samutpannam – is the recurrence of the disease after its complete

disappearance.

Snigdha – is the sparsha here. But khara, parusha and rooksha is told as other signs

by rest of the Acharyas, it is therefore a contradictory statement which requires to be

understood as whenever excessive kleda guna is there at that time the snigdha sparsha

Roopa


26

can be elicited as kledana is the karma of none other than snigdha guna. Also when

there is relative predominance of kapha dosha in the kitibha than the vata, this may be

observed.

Krushna – is the varna of the kina again.

Rooksha – is again the dryness of the kina.

Prashantani cha punaha utpadhyate – is again the typical nature of the disease

which reoccurs completely after its disappearance.

Doshas responsible for individual lakshanas:

Shyava varna kina – vata dosha

Khara sparshata of kina – vata dosha khara gunataha.

Parushata of kina – vata kharagunataha

Srava – pitta roopataha

Ugra kandu – kapha karmataha

Snigdha – kapha snigdhagunataha

Krushna varna – vata dosha.

Rookshan – vata gunataha

Table 07 showing the roopa of Kitibha Kushta 144 to 153 S.N. Roopa C.S B.S S.S A.S A.H M.N B.P Y.R V.S K.S1 Shyava varna kina + - - - - + + + + + 2 Khara sparsha of

kina + - - + + + + + + +

3 Parushata of kina + - - + + + + + + + 4 Srava - + + - - - - - - + 5 Vrutta - - + - - - - - - - 6 Ghana / drudha - + + - - - - - - - 7 Ugra kandu - + + + + - - - - - 8 Vartate cha

samutpannam - + - - - - - - - -

8 Snigdha - - + - - - - - - - 9 Krushna - - + - - - - - - + 10 Rooksha - - - + + - - - - - 11 Prashantani cha

punaha utpadhyate - - - - - - - - - +

Samprapti


27

Samprapti of kushta:

For any disease to manifest, it requires two basic things namely dasha and dhatu. The

earlier acquires later to generate certain sets of signs and symptoms. The whole process starts

with a cause as is required for any action. The understanding of this whole process is as

important as giving a prescription to the sufferer. The planning of chikitsa is told as immature

if the sutra is not followed in accordance with the samprapti ghtakas.

In the manifestation of kushta all the tridoshas are almost inevitable, further it is

believed that this disease never occurs with a single dosha involvent 154. However kushta is

classified on the basis of amshamshakalpana of dosha, samana dosha dushya prakruti. These

subtype of kushtas are told to have the predominance of either one or two dosha, rarely

tridoshas. The sapta dravyas of kushta are tridoshas, twak, mamsa, shonita and laseeka 155.

The involvement of these seven factors are seen in all the 18 types of kushta.

Acharya Charaka gives two samprapti in two different contexts one in nidana sthana

and the other in the chikitsa sthana. He explains the nidana sevana leading to tridosha prakopa

(sanchaya and prakopa of dosha) after this the doshas gets ashraya in twak, mamsa, shinita

and laseeka (prasara and sthana samshraya) causing the shaithilyata in them leading to the

manifestation of kushta (vyakta avstha of vyadhikriyakala) 156. He further says in chikitsa

sthana that vatadi tridoshas gets prakopa and does dushti of twak, rakta, mamsa and ambu

dushti leading to seven or eleven types of maha and ksudra kushta respectively 157.

According to Acharya Sushruta, vata dosha plays a major role in the manifestation of

kushta. First the vata dosha prakopa occurs later it takes increased pitta and kapha in to the

tiryag sira covering and visiating the bahya marga i.e. twak, mamsa, rakta and laseeka. After

visiating these, doshas produce mandalas whenever they get vikshepana and nissarana, further

if the condition is not managed with proper medication they invade the gambheera dhatus

resulting in the dushti 158.

Samprapti


28

Acharya Bhela considers the role of ushma sannirodha in kushta samprapti. This

ushma sannirodha leads to vata dushti which later becomes cause for other dosha sanchaya.

These sthanika doshas move in to the siras to cause rakta dushti and avarodha of rakta and

mamsa. At last tridoshas causes the dushti of rakta and mamsa generating the kushta in ashu

gati. Notably Acharya Bhela does not include laseeka in the dushyas in the context of

samprapti 159.

Acharya Vruddha Vagbhatta has given samprapti in detail when compared to all the

other. Mala vriddhi takes place because of nidana sevana, these doshas then invade tiryaggata

sira visiating twacha, laseeka, asruk and mamsa. After some time tridoshas cause shlata of

twacha, laseeka, asruk and mamsa spreading inward out. At this stage there will be twacha

vaivarnya and dushti. After this stage if left untreated invade dhatus increasing the kleda

inside the body. Kleda and sweda in combination causes sankotha and utpatti of krimi

followed by bhakshana by them, this bhakshana by krimi will occur from loma, twacha,

snayu, dhamani and tarunasthi in sequence 160.

The samprapti ghatakas of kushta are mentioned here under;

Name of Samorapti ghatakas Involed Samorapti ghatakas Sthanika dosha: shleshma, pitta-vata 161. Dushya: twak, laseeka, shonita and mamsa 162. Udbhava sthana: shakha (first in twacha) 163. Sanchara sthana: tiryag sira 164. Ashaya: twak (bahya), laseeka, rakta and mamsa

165. Avayava: kevala shareera 166. Srotodushti:

raktavaha, mamsavaha and rasavaha sratas 167.

Rogamarga: bahya rogamarga 168. Roga prakruti: deerga roga 169.

All the authors have considered the involvement of samprapti ghatakas at various

levels with differences. Figure no 01 shows the samprapti flow chart in general.

Samprapti


29

Nidana sevana

Tridosha prakopa

Tridoshas enter in totiryaksira and make sanchara

in the dhatus

Tridosha get ashraya in twak, mamsa, shonita and

laseeka (bahya marga) causes shlata

Vikshepana and nissarana of dosha

Twacha vaivarnya

Increases kledain the body

Kleda and swedacauses sankotha

Ushma sannirodha

Vata prakopa

Dosha sanchaya

Vruddha vayu takes pitta & kapha to

tiryak sira

Tridosha moves to siras causing

raktadushti

Avarodha of rakta & mamsa

Kushta utpatti

Kushta bheda


30

Kushta bheda:

All the Acharyas of bruhatrayee unanimously have accepted the

numerology of kushta as 18. Though Acharya Charaka is the first to notify the

innumerable number of kushta because of their vikara vikalpa 170 but he

classifies it as of seven and eleven respectively as maha and kshudra kushta

for the perpose of chikitsa vishesha on the basis of dosha amshamsha vikalpa,

anubandha, sthana vibhaga, vedana, varna, samsthana and prabhava 171. The

details of explanations of kushta bheda with their dosha involvement is shown

in the table no ????

The disease kitibha is placed under the kshudra variety of kushta by all

the Acharyas. Only difference found is regarding the involvement of dosha in

kitibha kushta, as Acharya Charaka and Acharya Vagbhatta says it as due to

vata and kapha involvement but Acharya Sushrutha says it as pittaja.

Kushta bheda


31

Table 08 showing Maha Kushta bheda according to different authors 172-174

Mahakushtan Charaka samhita Sushruta samhita Ashtanga samgraha

Sl. No. Name Dosha Name Dosha

Name Dosha

01 Kapala Vata Kapala Pitta Kapala Vata 02 Oudumbara Pitta Udumbara Pitta Oudumbara Pitta 03 Mandala Kapha Aruna Vata Mandala Kapha 04 Rushajihwa Vatapitta Rushajihwa Pitta Rushajihwa Vatapitta 05 Pundareeka Kaphapitta Pundareeka Kapha Pundareeka Kaphapitta 06 Sidma Vatakapha Dadru Kapha Dadru Kapha 07 Kakana Tridosha Kakana Kapha Kakana Tridosha

Table 09 showing Kshudra Kushta bheda according to different authors 175-177

Kshudra kushta Charaka samhita Sushruta samhita Ashtanga samgraha Sl. Name Dosha Name Dosha

Name Dosha

01 Ekakushta Vatakapha Ekakushta Kapha Ekakushta Vatakapha 02 Charmakushta Vatakapha Sthularushka Kapha Charmakushta Vatakapha 03 Kitibha Vatakapha Kitibha Pitta Kitibha Vatakapha 04 Vipadika Vatakapha Mahakushta Kapha Vipadika Vatakapha 05 Alasaka Vatakapha Visarpa Putta Alasaka Vatakapha 06 Dadru Pittakapha Parisarpa Vata Sidma Vatakapha 07 Charmadala Pittakapha Charmadala Pitta Charmadala Pittakapha 08 Pama Pittakapha Pama Pitta Pama Kaphapitta09 Visphota Pittakapha Sidma Kapha Visphota Kaphapitta 10 Shataru Pittakapha Rakkasa Kapha Shataru Kaphapitta 11 Vicharchika Kapha Vicharchika Pitta Vicharchika Kapha

Sadhyasadhyata & arishta lakshana


32

Sadhyasadhyata of kushta:

For any physician success matters more than any thing, this is termed

as yasha in the texts of Indian system of medicine. The great pioneer of

Ayurveda Acharya Agnivasha and Acharya Charaka have devoted a separate

section in their book for the explanation of fatal signs and symptoms of every

disease and diseased, namely Indriya Sthana comprising 12 chapters. This

whole section gives a comprehensive hint for the physicians to disagree

patient from handling. Always the success of the chikitsa depends on which

condition the patient has approached a doctor. This is the shortest time in

which doctor has to decide whether to treat the patient or not. Our immortal

Acharyas have made our job easy by narrating the concept of sadhyasadhyata

of vyadhi. Before the start of explanation of chikitsa or after, they have briefed

about the chances of curability and incurability of a disease by citing the signs

and symptoms and giving due consideration to various facts like dosha, dhatu,

agni, bala etc.

The sadhyasadhyata of the kushta is explained as well, but however the

explanation of sadhyasadhyata of kitibha is not told separately.

Sadhya kushta: ekadosholbana kushta, vatakapha prabala kushtas are

always have a great chance of good recovery. Also if the patient is atmavan

and if the doshas have only invaded twak, mamsa and rakta there is always a

hope 178-180.

Kruchrasadhya kushta: if the dosha is vyamishra kapha pitta and

vata pitta and lone pitta, the chance of cure is always with great efdorts.

Yapya kushta: if the doshas have occupied the fourth dhatu being

meda, then patient can be free from the sufferings as long as he is taking the

Sadhyasadhyata & arishta lakshana


33

medicine and following pathyahara, the moment he breaks this rule he will get

relapse of the vyadhi.

Asadhya kushta: the incurable kushta is noted by features like sarva

lingayukta kushta, sarva dosholbana, abala rogi, if has trushna, daha and

mandagni, if the lesions are krimiyukta, arishta lakshanayukta and lastly if the

doshas have reached the asthi, majja and shukra dhatus the condition should

be thought as out of our reach and treating this type of patient will always

have the risk of loosing the yasha.

Kushta arishta lakshanas: 181

The arishta lakshanas are said as pre monitory signs of death, the

observation of these in the patient of kushta disease will end the life very soon.

If a kushta rogi gets vranotpatti even on slightest injury like with grass

piece, and if that vrana is not responding to any treatment then should be

thought as prana ghataka lakshana. If he dreams as if doing yagna and yaga

after anointing with the ghruta in a place where there is no fire actually will

end his life very soon. Also if the kushta rogi dreams as if lotus flower has

grown over his uras then also the person is not going to survive for long time.

Vyavacchedaka nidana


34


Diagnosis of any disease becomes difficult when one or more diseases

mimic each other. The same is with kitibha kushta also. Our Acharyas have thus

evolved concept of vyavacchedaka nidana to overcome this confusion. They have

urged us to learn the art of differentiating the diseases on the basis of clinical

picture available. Here is an attempt made to differentiate the diseases which some

time confuse the diagnosis of kitibha kushta. Keeing some of the signs and

symptoms as criteria vyavacchedaka nidana of kitibha kushta is done.

Ekakushta: is most frequently told as psoriasis and accepted but the

absence of kandu in this disease excludes its diagnosis from kitibha vis-à-vis

psoriasis. Mahavastu, large surfaced lesion is the other which is very rarely seen

in kitibha, the psoriasis.

Alasaka: though said to have kandu differs in the colour of lesion as raga

is found in alasaka.

Dadru kushta: is also having kandu with raga and mandala is said to be

utsanna which is not so in kitibha, the psoriasis.

Charmadala: presents with kandu, sphota but has osha and chosha as

lakshana.

Pama: is said to have kandu, visphota, paridaha and appears in specific

sites as in sphik, pani, pada and kurpara i.e flexural area. Kitibha kushta does not

appear in specific sites is thus differentiated from pama.

Sidma: is another skin disease which has kandu but it appears specifically

in urdwa kaya.

Vipadika: is restricted to pani and pada.



35

Vicharchika: is said to have ruja along with simulating lakshana like

kandu and ghana of kitibha kushta. Also bahusrava is found in vicharchika which

is not found in kitibha kushta.

Chikitsa


36

Kushta chikitsa

Any kushta which is manifested by the involvement of single dosha or vata

kapha involvement is amenable to treatment. All other types of kushtas are difficult to

treat. As discussed already, kushta disease can not occur without the involvement of

all the three doshas. Keeping this point strongly in the consideration our Acharyas

have told the line of treatment giving wide scope for panchakarma. The kushta

manifested by vata always mandates the consumption of ghruta and that by kapha

dosha requires vamana and that by pitta needs virechana therapy. All these should be

done by using those drugs which have kushtahara and respective doshaghna property.

Periodical advice of these procedures indicates the extent of dosha visiation in the

disease kushta.

Chikitsa is told as of three types. Antahparimarjana chikitsa is the internal

administration of the medicines in the form of aushadha and ahara in accordance with

the disease. Bahirparimarjana chikitsa is the chikitsa given to the sparshanendriya i.e.

twacha, this includes abhyanga, sweda, pradeha, parisheka, unmardhana etc therapies.

The last type is shastra praneedana including vedana, bhedana, vyadhana, dharana,

lekhana, utpatana, pracchanna, seevana, eshana, kshara and jalouka application. The

snana can also be included in the external therapy according to the definition.

The use of external therapy is always dealt with great importance, the utility of

applications, taila abhyanga, snana etc. procedures are almost inevitable in this

disease. This is because the sthana samshraya of the doshas are seen in the twacha and

the vyaktha sthana of kushta is also twacha. The treatment to the vyakta sthana is also

dealt in Ayurveda. Ayurveda believes complete treatment as; reversal of the

samprapti. Skin being the outer most part of the body is always told to be taken care

by the utility of abhyanga, udwarthana, snana, lepa, gandha dharana, maala dharana

Chikitsa


37

etc. The importance of external therapy will be explained in the drug review chapter

again with special reference to the parisheka. Looking in to the large number of yogas

given by different Acharys one can understand the importance of external therapy in

the prescription of kushta. Soon after the explanation of the shamanoushadhas and

pathyapathya as many as 68 number of lepa, taila and snana yogas are explained in

the kushta chikitsa by Acharya Charaka 182 this trend of explanation is seen in all the

texts.

Pathyapathya


38

Pathyapathya in kushta:

Pathtya is patho anapeta, that which is not against the srotas and priya to

manas 183. Srotas is always an important integral part of samprapti of a disease, which

needs to be corrected by the means of chikitsa. Pathya sevana along with the medicine

proper will always reduce the recovery phase of a disease. Acharya Lolimbaraja who

was known as the best poet physician was the first to explain the significance of

pathya in his work Vaidhya Chintamani. He feels that if a person knows all about

pathya then there is no necessity of taking the oushadha for the disease 184.

Pathya: the list of pathyas for a kushta are; purana shali, shastika shali, yava,

mudga, godhooma, koradoosha, shyamaka, uddhalaka, yusha prepared out of mudga

and adhaki alone or mixing with nimba patra and arushkara or with mandukaparni

avalguja, atarushaka or with sarpi and sarshapa taila or with tikta varga dravya.

Amedaska jangal mamsa if the patient is habituated to eat mamsa. Vajraka

tailabhyanga. Aragwadadi kashaya gana oushadha utsadana. For pana, parisheka and

avagaha khadhira kashaya is advised. Also neecha roma, neecha nakha, vishranta,

hitashana, oushadhatatpara, and who is yoshita, mamsa and sura varjee 185. Acharya

Charaka says the utility of tikta shakhas, laghu anna, ahara dravya processed with

bhallataka, triphala and nimba, purana dhanya, jangala mamsa yusha prepared with

mudga and patola186. Jatiphala, kakamachi, punarnava, bruhati, bhallataka,

nagapushpa, lashuna, go, khara, ushtra, mahisha mootra are the pathyas contributed

by Acharya Vishwanath Sen 187.

Apathya: Acharya Sushruta says the apathya as varjya in the context of kushta 188

Mamsa, vasa, dugdha, dadhi, taila, kulattha, masha, nishpava, ikshu, pishtavikara,

amla, viruddha, adhyashana, ajeerna, vidahi and abhishyandhi are said as varjya.

Acharya Charaka says guru, amla, payas, dadhi, anupa mamsa, matsya, guda and tila

as apathya in kushta 189.

Anatomy and physiology


39

Anatomy and physiology of skin190

Knowledge of the structure, physiology, chemistry and function are essential

to understand the pathology of skin disease and also essential prerequisite to

understand the nature of disease and to plan proper treatment. Every square cm. of

skin contains 70cm. of blood vessels, 55 cm. of nerves, 100 sweat glands, 15 oil

glands, 230 sensory receptors and about half a million cells that are constantly dying

and being replaced. Thickness of the skin varies from 1.5 – 4mm. or more in different

parts.

The skin is composed of two distinct regions; 1) Epidermis and

2) Dermis.

Epidermis is a cellular layer and dermis is a connective tissue.

Epidermis has four cell type; 1.Kerationocyte (constitute 70% of tota epidermis)

2. Melanocytes

3. Langerhans cells and

4. Markel cells.

Dermis contains undifferentiated connective tissue consisting of ground

substances and collagen and elastic fibers.

Epidermis is derived from ectoderm. It is keratinizing stratified squamous

epithelium from which arises the continuous appendages i.e. pilo sebaceous follicles,

nails, apocrine and ecrine glands.

From below upwards the cellular layer of epidermis can be divided in to 4

layers or strata as basal, spinous, granular, corneal layer. These layers are considered

as successive stages of maturation of germinative keratinocytes into fully cornified

keratinocytes.



40

Dermis is strong flexible connective tissue layer. The cell type found here are

typical of those found in any connective tissue proper; fibroblasts, microphages and

occasional mast cells and WBCs. Its semi fluid matrix is embedded with collagen,

elastin and reticular fibers. The dermis binds the entire body together like body

shocking. The dermis is again two layered; papillary layer and reticular layer.

Psoriasis is a disease dealt in the diseases of keratinization in the leading

dermatological text books; hence the same is dealt in detail.

Keratinization:

The basal cells are germinative cells of the epidermis. The basal cell layer is a

rapidly dividing one. In mitosis approximately 50% of daughter cells contribute to the

growth of the epidermis (Mcka PH. Pathology of skin, 1st ed. Philadelphia: JB

Lippancott). Keratinocyte produces keratin, the fibrous protein helps give the

epidermis its protective property. They are tightly connected to one another by

desmosomes. The keratinocytes arise in the deepest part of the epidermis from a layer

of cells (stratum basale) that undergo almost continuous mitosis. As the keratinocytes

are pushed towards the skin surface by the production of new cells beneath them, they

manufacture the keratine that eventually dominates their cell contents. By the time the

keratinocytes reach the free surface of the skin they are dead. Scale like structure that

are little more than keratin filled plasma membranes, millions of these dead cells rub

off every day, giving the body a totally a new epidermis 25 - 45 days – the time from

birth of keratinocyte to its final wearing away. In healthy skin, the production of new

cell balances cell loss at the skin surface.

The kinetic of epidermal proliferation and maturation are complex.

Keratinization is a dynamic process going on at a regular speed. This process may get



41

accelerated or decelerated by injury to the dermoepidermal junction and papillary

vascular damage.

Kinetics of epidermal proliferation and maturation;

M

G1

S1

N-2 hrs N-10-20hrs

Interphase

Mitosis

N-7 hrs

G2

N-2 hrs

Psoriasis


43

Psoriasis:

Greek word used to describe itchy, scaly, scabby disease of the skin 191. The

disease psoriasis is a disorder of keratinization. The roman sage Auralius Cornelious

Celsus is credited with the first clinical description of psoriasis 192. Galen first to use

the term psoriasis and Robert Willian (1808) specifically distinguished and described

psoriasis as a recognizable entity 193. Lepra vulgaris described by Willian was a

variety of psoriasis. In 1841, Hebra definitively distinguished the clinical picture from

the leprocy.

Definition:

Psoriasis is chronic non infectious, inflammatory dermatosis. Is included

under chronic inflammatory dermatosis, a condition where desquamation or shedding

of abnormal scale or salmon colored plaque is seen.

Incident rate:

Psoriasis is the most frequently cosulted case in dermatology clinic. A total of

0.1 – 3 % of the world population is estimated to suffer from this disease 194 and its

hospital prevalence was about 6% 195. In India studies reveal incidence of psoriasis

attending clinic and hospital range from 0.8 – 5.6 does not however reveal the true

prevalence in the general population 196.

Age of onset:

The onset of this disease is commonly seen in the second, third and fourth

decade of life, though it can appear soon after the birth and at old age. About 8.5 % of

Indian children were psoriatic 197. A study in Punjab showed that the age of onset

varied from 18 months to 52 years with the highest incidence in the age group of 11 to

21 years 198. The highest incidence in two other studies was in reproductive age group

Psoriasis


44

(15 – 45 years and 11 – 40 years) 199. In a recent study, the mean age of onset for

females was found as 29.34±15.10 and in men 36.9 ± 15.10 years 200.

Familial occurrence:

A high familial occurrence of psoriasis is suggestive that the genetic factor is

key in its etiology. Thirty six per cent 2,144 psoriatics had a family history (Ferber et

al.1968) in an Indian study by Kaur et al. out of 782 patients seven per cent had

positive family history.

Sex ratio:

Its prevalence is almost equal, but it is higher in males (2.4%) than females

(0.8%) 201.

Aetiology:

The etiology of the psoriasis is poorly understood. In 1963, Gunnar Lomholtz,

a pioneer in the epidemiology of psoriasis, stated in his classic thesis that the disease

‘is capricious and refuses to part with its innermost secret’, but also wrote: ‘that is

genetically conditioned is beyond doubt’ 202. There is clearly a genetic component in

the psoriasis. Psoriasis has been linked to HLA-Cw6. Evidences also indicate a role of

T cells in the pathology of psoriasis 203.

The other important sets of causes attributed are environmental factors.

Usually when there is upper respiratory tract and streptococcal infection the disease is

precipitated. Other factors include drugs, lithium and antimalarials, and physical or

psychological stress. Excessive alcohol consumption is also associated with disease

deterioration making the management more difficult 204.

Triggering factors205:Trauma, infection (β-haemolitic streptococcal throat infection),

season especially during winter, rarely sunlight, drugs (anti malarial, β-

Psoriasis


45

adrenoreceptors (βblockers), lithium) and emotions are some proved triggering factors

of paoriasis.

Pathophysiology:

Scaling, thickening and inflammation are the cardinal signs of psoriasis. These

clinical features are mirror the characteristic pathophysiological events that occur in a

lesion.

Expansion of dermal vasculature: In the early stage capillary in superficial

part of dermis are dilated with edema and perivascular exudates of lymphocytes and

macrophages that extend in to the basal part of the epidermis. The expansion of the

dermal vasculature accounts for vivid red colour of active plaques, expanded dermal

vasculature is shown in figure206.

Figure no 03 showing dermal vasculature of normal skin and psoriatic skin

Epidermal hyperproliferation: There an increase in the number of

proliferating keratinocytes in the basal layer the epidermis. This together with loss of

differentiation is responsible for the thick, silvery scale seen clinically. The growth

rate of psoriatics is up to 10 times that of normal epidermis 207. This high mitotic rate

in active lesion with prominent parakeratosis reflects the rate of replication of

epidermal cells. Normally it takes 13 days for a newly formed basal cell in the

Psoriasis


46

epidermis to differentiate and travel to the surface, where it sheds off; in active

psoriasis it takes 5 days. In the normal epidermis a basal cell takes 200 hours for the

cycle; in psoriasis it takes 100 hours 208.

Accumulation of inflammatory cells: the inflammatory cells – neutrophols

and T lymphocytes in particular – accumulates in both the dermal and epidermal layer

of the skin. In evolving lesions , the lymphocytes infiltrate early in to the skin, prior to

epidermal and other changes. Psoriasis is associated with certain HLA antigens,

particularly HLA-Cw6 and HLA-B57, which are cell surface molecules critical to the

regulation of T-lymphocytefunction 209. Stimulation of immune function with

cytokines such as IL-2 has been associated with abrupt worsening of preexisting

psoriasis, and bone marrow transplantation has resulted in clearance of psoriasis 210.

Clinical features:

Psoriasis is charecterised by the devolopement of erythematous, well-defined,

dry, scaly papules and plaques of varying size. Lesions have a full rich red (salmon)

colour in the skin of Caucasians 211. Scaling, thickness and induration are varying

cardinal characteristics of all lesions. The classic symmetry, silvery scale and vivid

reddish purple color of lesion allow psoriasis to be distinguished from other skin

disorders in the majority of the cases 212. The scales are loose dry and silvery white or

micaceous due to the presence of air trapped in between the layers of the scales. On

guttate, characteristic coherence of the scales can be seen as if one scratches a wax

candle is called as candle grease sign (‘signe de la tache de bougie’), when the scales

are further scratched in those lesions where free scaling is not there will result in

capillary bleeding and the sign is called as Auspitz sign. This sign is because of

parakeratosis, intracellular edema of epidermal cells. Koebner phenomenon is

Psoriasis


47

development of new fresh lesion from the site of physical trauma, the sign named

after Heinrich Koebner in 1878 213.

Classification of paoriasis: 214.

Guttate psoriasis: usually seen in children and follows an upper respiratory

infection or tonsillitis due to streptococci. Multiple ‘drop like’ lesions are typically

distributed on trunk, frequently involving natal cleft.

Plaque psoriasis: most common type is distributed bilaterally. The lesions are

stable and remain unchanged for long period. Commonly manifested areas are;

extensor surface, the elbow, knee, lumbosacral area and back. Sudden fluctuation is

observed in this type of psoriasis.

Exfoliative psoriasis: Erythema and scaling are universal and generalized.

Edema of legs may be there. Hypoalbuminaemia, increased capillary permeability and

increased central venous pressure contributes to its development.

Pustulara psoriasis: when the lesion is studded with tiny superficial, sterile

pustules, it is valled so. It is precipitated by over treatment with coal tar, anthralin or

potent steroids. Foci of infection and pregnancy and hypocalcemia may also

precipitate.

Psoriasis Ungis: the involvent of the nail in psoriatics is called so. The

common changes are pitting of nail plate, onycholy, subungual hyperkeratosis and

crumbling of nail plate. Oil drop sign is noted.

Mucous membrane lesions in psoriasis: rarely, lesions may occur on the

gingival and ventral lingual mucosa. Involvement of mucous membrane is not seen as

these epithelial surfaces are normally as rapidly proliferative as psoriatic skin.

Psoriatic arthritis: an inflammatory arthritis associated psoriasis, usually a

negative test for rheumatoid factor. It occurs in about 5-10% of patients of psoriasis.

Psoriasis


48

Sites of disease involvement:

Scalp, Ears, Face, Trunk, Extremities, Genitalia and Nails are the

common sites to be examined for the lesions in psoriasis, though the whole

body skin area has to be evaluated.

Differential diagnosis: 215.

Although the diagnosis of psoriasis is straight forward, a good number

of other dermatological entities can confuse causing inconvenience for the physician.

A careful history and thorough physical examination would enable the final diagnosis.

Candidiasis: in flexural areas, peripheral pustules are characteristic of candida

infection. The presence yeast and pseudo-hyphae in Gram-stained microscopy

specimen will conferm infection.

Tinea:

Tinea capitis: hair thinning is observed,well demarketed areas of hair

loss are highly unusual in psoriasis.

Tinea corporis: lack of symmetry in the lesions, presence of

peripheral scaling and central clearing confirms tinea corporis diagnosis

Tinea cruris: cenral clearing with advanced edge. Lesions are non

silvery extends more on left than the right side.

Tinea pedis: clear vesicles are noted.

Tinea manum: fine powdery scaling in the ring worm infection of

hands along with asymmetrical presentation.

Secondary syphilis: guttate type may mimic. Search for primary syphilitic

lesion, together with lymphedenopathy, mucosal lesions in syphilis will exclude it.

Eczema: more pruritic, lack of silvery scales, skin biopsy, lack of

psoriasis elsewhere in the body.

Psoriasis


49

Neoplasms: superficial basal cell carcinoma and Bowen’s disease

(squamous cell carcinoma in situ) may appear highly suggestive of psoriasis. These

neoplasms occur singly or are fewer in number, never symmetrical and do not scale

silvery plaqyes.

Pityriasis rosea: is acute in onset, self limiting over a period 8-12

weeks produsing multiple scaly oval lesions typically in Christmas tree distribution on

trunk following rib line.

Treatment of psoriasis: 216.

Factors to consider when treating psoriasis patients

Patient perception of disease severity

Objective measures of the pattern, extent and severity of the disease.

Total amount of time the patient is devoting to therapy.

Previous details of treatments for psoriasis.

Co existing medical problems.

Topical therapy

Topical corticosteroids:

Potent topical corticosteroids (group I-V) are extremely useful. These are

applied once daily. These should not be used regularly for more than 4 weeks, potent

steroids should not be continued for more than 10 days at a stretch. Patient should be

under continuous supervision. Less than 100 g moderate or higher potency

preparations should be used per month. Corticosteroids should be used alternatively

with non steroidal therapies.

Vitamin D3 analogs: are widely used in European countries and UK as first

line of treatment in chronic plaque psoriasis. Calcipotriol ointment or cream once or

twice daily 100 g/week avoiding face and flexures is advisable. Tacalcitol ointment

Psoriasis


50

once daily 10 g/day, for all sites is applicable. Calcitrol ointment twice daily about 30

g/day for all sited lesions yields good result.

Coal – tar: is produced by destructive distillation of coal tar. This may

suppress DNA synthesis there by reducing the epidermal hyperproliferation. Use of

coal – tar 5% solution is very effective. However coal tar of 5-15 % in combination

with topical corticosteroid such as betamethasone valerate (0.025%) is a useful topical

preparation. As this therapy produces a distinctive smell, which some patients feel

unpleasant and has got poor cosmetic acceptability. Oncogenic risk of using coal tar is

always there.

Dithronol (anthralin): is used in UK with success since last 80 years.

Dithranol mixed in zinc oxide paste of 0.1-6% and combination with other products,

such as corticisteroids.

Tezarotense: a topical retinoid (0.05% or 0.1%) is used in gel form.

Local injection of a corticosteroid: such as triamcinolone acetonide (10

mg/mL) may be given around matrix and nail bed, if nail involvement is there.

Phtotherapy:

Exposure of whole body to artificial sources of UV radiation is called

phototherapy. Phototherapy is used for the treatment of extensive psoriasis resistant to

topical therapy. Two sources of UV radiation are used to administer UVB phtotherapy

(emission spectrum of 270-350 nm).

Photochemotherapy (PUVA):

The use of photosensitizing drug, methoxsalen (0.3-0.4 mg/kg), in combination with

long-wave UVA (320-400 nm) was first reported in 1974 and this therapy is called as

PUVA. This therapy is also advised in psoriasis resistant to topical therapy. PUVA is

more beneficial for more localized type of psoriasis. Short term risk of PUVA include

Psoriasis


51

nausea, itching and phototoxic reaction. Long term risk of PUVA includes premature

skin and skin cancer.

Systemic therapy:

If the psoriasis covers more than 10-15% of the body surface area, if it is of

severe inflammatory form, poor or no response to topical and UVB phototherapy and

PUVA the systemic therapy is advisable.

Methotrexate: has been used for more than 40 years and remains ‘gold

standard’. Complete blood count hepatitis B and C serologies, RFT, chest radiograph,

if one has received within the previous year are essential before the administration of

methotrexate. The same has to be repeated after a 7 days of test dose (5 mg). if the

result is satisfactory, the initial dose regimen for 10-15 mg/week. In UK it is usually

given in a single weekly dose. The dose can be adjusted up to 25 mg/week if result is

encouraging. The dose has to be then tapered slowly.

Systemic retinoids: etritinate and acitretin

Cyclosporine

Hydroxycarbamide

6-tioguanine

Drug affecting T-cell function: azathioprin, 6-marcaptopurin, micofinalate

mofetil and other ciclosporin-like drugs

Drug reciew


53

Drug review:

Siddharthaka yoga:s

Siddharthaka yoga 217 is a unique yoga mentioned in most of the texts for

snana and internal use. The kashaya prepared out of this yoga is said to be used for

snanartha and for vamana and virechana. The ingredients of the yoga are musta,

madanaphala, triphala, karanja, aragwada, kalingayava, darvee and saptaparna. The

phalashruti of this yoga are; twagdoshahara, kushtahara, shopha hara and

pandurogaghna. The mode of its utility is in the form of kashaya for snana and

vamana and virechana, for udgharshanathe the yoga is told to be used in the chorna

form.

The literary meaning of the word siddharthaka is not told in the context. But

Acharya Charaka has used the word siddhi for the success yielded by the physicians

on administrating the proper panchakarma 218. Acharya Chakrapani, the chaturaanana

of Caraka says the meaning of siddhi as ‘vyapatsadhanani beshajani’ meaning the

oushadha that can relieve the complication 219. Acharya Charaka uses the word to

indicate the samyak parinama and saphalyam 220, the term is used also meaning

chikitsa 221. Acharya Dalhana says the meaning of siddhi as sadhana 222. Acharya

Vagbhatta has told siddhi as a agrya guna of a vaidhya, indicating rationale thinking

of a doctor as a an important quality which will bring success in him. The other word

used here is artha is used as a means. So altogether the word meaning if siddharthaka

is the means to get the success in the management of kushta, oushadha used to get rid

of the complication of the disease kushta and as a best vailable medicine to combat

kushta disease.

The fact whether the useful part of and aragwada remains same for external

therapy and internal use for vamana and virechana is not clear. All the commentators

Drug reciew


54

are silent about this fact. Also the quantity of madanaphala and aragwada in the

formulation is also not specified for these two different routes of administration. The

only author who had written about this is Dr. Brahmananda Tripathi223 in Chandrika

Vyakhya commentary. According to him for snana the patra of aragwada should be

used and for virechanartha its phalamajja has to be used. The quantity of madanaphala

in the siddharthaka yoga for vamanartha should be 4 masha when compared to 2-2

masha of all the rest ingredients. For virechanartha aragwada phalamajja of 4 masha

quantity and 2-2 masha of other ingredients are advised. Further he commenting about

the same verse he says; for udgharshanartha the coarse powder should be used mixing

with sarshapa taila, for varnaka effect the sookshma choorna should be applied by

mixing with dugdhaand, for snanartha the yavakuta choorna should be immersed in

the water in the previous evening in the water and the water should be boiled and the

patient shiuld be asked to take bath with thus prepared hot water, and for snanartha all

the ingredients should be taken in 1-1 tola.

Drug reciew


55

Table 10 showing the analysis of the individual drug of siddharthaka yoga 224 Sl.no Name of the

drug

Botanical

name

Family Rasa Guna Karma Veerya Vipaka Pryojyanga

01 Musta Cyperus

rotundus

Cyperaceae Tikta,katu and

kashaya

Laghu, ruksha,

grahi, teekshna

Kaphapitta shamaka,

asruk rogas hara, kruminashini,

kushtaghna.

Sheeta Katu Phala.

Patra, dugdha,

beeja

02 Madanaphala Randia dometorum

Rubiacea Madhura tikta Lekhana, laghu,

rooksha

Kaphavatahara, pratishyaya,

jwara, kushtaghna, vidradhi

and vrana hara.

Ushna Katu Phala

03 Amalaki Emblica

offcinale.

Euphorbiaceae Amla, katu

madhura,

kashaya.

Laghu. Tridoshahara, hararasayana Sheeta Madhura Phala

04 Vibhhetaki Terminalia

bellerica

Combretaceae Kashaya Sheeta

sparsharooksha,

laghu

Pitta kapha nashaka, bhedana Ushna Madhura Phala

05 Hareetaki Terminalia

chebula

Combretaceae Lavana varjita

pancharasa

Rooksha, laghu Tridoshahara, kushtaand

vaivarna hara, krumihara,

vibandhara

Ushna Madhura Phala

Drug reciew


56

Table 11 showing the analysis of the individual drug of siddharthaka yoga Sl.no Name of the

drug

Botanical name Family Rasa Guna Karma Veerya Vipaka Pryojyanga

06 Karanja Pongamia

pinnata

Leguminosae Katu, tikta,

kasaya.

Laghu,

teekshna

Pittala, kaphavata shamaka,

kushtaghna,kandughna,krimi,shotha and

arshahara.

Ushna Katu Twak, patra,

beeja.

07 Aragwada Cassia fistula Leguminosae Tikta,

madhura

Guru,

sheeta,

Tridoshahara. Jwara, gulma, udara, vrana and

pramehahara

Patra-shoshana

of kapha, medas.

08 Kalinga yava Holerrhena

antidysentrica

Apocynaceae Tikta,

katu,

Grahi ,

rooksha,

anushna

Trisoshahara, kushtaghna, jwara, visarpa

hara.

Sheeta Katu Twak, beeja.

09 Daruharidra Berberis aristata

Berberidaceae Tikta,

kashaya

Laghu,

rooksha,

ushna.

Kaphapittahara, kandu, twagdosha, meha,

vrana hara.

Ushna Katu Moola, kanda,

phala.

10 Saptaparna Alstonia

scholaris

Apocynacea Tikta,

kashaya.

Laghu,

snigdha.

Kapha pitta shamaka, kushtaghna,vrana,

krimihara,raktaja rogas.

Usna Katu Twak and patra

Parisheka


57

Parisheka:

The word parisheka denotes snana 225. Acharya Sushruta uses the word repeatedly

to indicate snana by dugdha, kashaya etc. in swabhava vyadhi pratishedeeyadhaya where

rasayana is dealt in detail. Parisheka is also the term used as an equivalent word for

parisechana in the context of Shashtivranopakrama 226. This is also told as one among the

thirteen type of sweda according to Acharya Charaka 227. The procedure is detailed in the

same chapter as; the swedana dravyas like moola etc. are used for kashaya preparation

and this kashaya is then taken in a kumbha or varshanika or pranadi. This procedure is

said to yield the result when it is done after the gatra abhyanga with yathartha siddha

sneha. Acharya Chakrapani, ‘charaka chaturanana’ says that this procedure of sweda is

very much beneficial in vatakapha diseases, varshanika as alpa ghata, a small pot,

varshanika as sahasra dhara and pranadi as venunalanadyadhya 228. Acharya Vagbhatta

includes this parisheka in drava sweda along with avagaha sweda. Acharya Indu a noted

commentator of Ashtanga Samgraha says this procedure is done with the kwatha over

sarvanga or ekanga according to the need, he says pranalika as urdhwatavishta bhanda

which is a instrument used for the purpose of parisheka which is generally known as dhar

patra now a days 229. However both the authors have advised to do the parisheka after

making acchadana of gatra by vastra. The reason and the advantage are not spoken by

any author. Parisheka word is used equivalent to dhara in many of the contexts 230. The

inclusion of parisheka in the vranopakrama is used to substantiate the utility of parisheka

in kitibha kushta as kina is vrana sthana accoding to Acharya Charaka. A similarity is

given in Sushruta to convey the mode of action and utility of parisheka as; parisheka

subsides the dosha and agni responsible for paka very similarly like how ambu sinchana

Parisheka


58

results in agni shanti 231. This statement made by the Acharya signifies the importance of

parisheka, a local treatment to avoid dosha accumulation, vrana paka and to accelerate

vrana ropana.

Materials


60

Materials and methods

Materials used for the study:

The materials used for the study were

1. Siddharthaka snanokta dravya siddha kashaya – for parisheka.

2. Siddharthaka snanokta dravya siddha taila – for application before parisheka.

3. Siddharthaka yoga capsules – for abhyantara prayoga.

Siddharthaka snanokta dravya siddha kashaya –

The 10 ingredients of the siddharthaka yoga; root nodules of musta, fruits of

madanaphala with seeds, fruits of amalaki (nirbeeja), vibheetaki (nirbeeja), hareetaki

(nirbeeja), karanja patra, aragwada patra, kalingayava (seeds of kutaja), daruharidra

kanda and saptaparna patra were supplied by Prakruti Remedies private limited,

Karwar, Karnataka in the raw form. The drugs were checked with the criteria

mentioned in the classical Ayurvedic texts and modern botanical parameters with

experts before using them in the study.

An approximate of 4 liters of kashaya was prepared for the parisheka daily, for

which 1 kg of yava kuta choorna was used. For this100 gram of yavakuta choorna of

each ingredient was weighed and packed for the preparation of kashaya for one day

for the convenience.

The kashaya was prepared according to Sharngadhara Samhita reference 232. A

total of 16 liters of water was taken and 1 kg of siddharthaka yoga yavakuta choorna

was added and boiled to get 4 liters of kashaya. This was then filtered and made ready

to be used for parisheka. The kashaya was prepared in the panchakarma theatre of the

hospital daily. For dhara karma, dhara patra of 4 liter capacity was used.

Materials


61

Siddharthaka snanokta dravya siddha taila:

A total of 15 liter of taila was prepared in the department of Rasashastra and

Bhaishajya kalpana, D.G.M.A.M.C. and H. Gadag. The taila was prepared according

to Sharngdhara Samhita 233. For this a total of 17 liters taila was taken, 68 liters of

kashaya prepared out of Siddharthaka yoga, 4.25 kg of Siddharthaka yoga kalka was

used. For the preparation of kashaya for tailapaka 17 kg of Siddharthaka yoga

yavakuta choorna, 272 liters of water was used to get 68 liters of kashaya. In a span of

two days the taila paka was completed and got approximately 15 liters of

Siddharthaka taila. This was then packed in 750 ml bottle to be used for individual

patients separately to avoid soiling.

Siddharthaka yoga capsules:

Basically the usage of Siddharthaka yoga is in the form of kashaya for

vamanartha and virechanartha. But for the present study it was modified in to capsule

form for easy dispensing and acceptability and accurate dose maintenance. A total of

2 kg (each ingredient weighing 200 g.) of vastragalita choorna was taken and

approximately 3 liters of Siddharthaka yoga kashaya was used for each bhavana (750

g. of yavakuta choorna for one bhavana), (total of 5250g. of choorna for seven

bhavanas)). It was completed in a span of seven days. The choorna was again made

vastra galita and 500 mg capsules were filled using capsule filling machine in college

pharmacy. 90 Capsules were packed in a plastic cover and were dispensed to the

patients. Patients were advised to take 2 capsules thrice daily with plane water

preferably boiled and cooled. Patients were dispensed with the other 90 capsules on

the second consultation i.e. 15 days after the first consultation.

Methods


62

Methods:

Type of study:

The study was a comparative clinical study of siddharthaka yoga Bahya and

abhyantara prayoga in kitibha kushta with special reference to psoriasis.

Source of data:

The minimum numbers of patients included for the study were 30. Patients of

either sex were selected from the O.P.D. and I.P.D. of D.G.M.A.M.C. and Hospital after

screening. The inclusion and exclusion criteria were duly considered before including the

patient for the study.

Selection of patients:

After fulfilling the criteria set in the form of inclusion and exclusion criteria, 30

patients were randomly distributed in to two groups.

Group – A: 15 patients were advised with Bahya prayoga of Siddharthaka by subjecting

them for parisheka.

Group – B: 15 patients were included for abhyantara prayoga of Siddharthaka yoga in

the form of capsules.

Inclusion criteria:

Patients were seen for signs and symptoms of kitibha kushta those told by

different Acharyas. Signs like Shyavavarna Kina, Krishnavarna Kina, Parusha

Kina, Ghana, Khara sparsha, Snigdha sparsha of kina and symptom Ugra kandu

were appreciated in all patients before their inclusion.

The age limitation for the study was kept to a minimum of 15 years and maximum

of 60 years.

Methods


63

Patients belonging to both the gender were included in the study.

Patients suitable for the procedure parisheka were included. For Group A patients,

parisheka procedure was explained and the consent was taken and those who

refused to undergo were convinced for the participation in the Group B of the

research work.

Exclusion criteria:

Chronic cases of more than 5 years were refused to be the part of trial.

Patients with the secondary systemic involvement like psoriatic arthritis etc were

excluded.

Patients with secondary systemic diseases like diabetes and hypertension were

excluded from the study.

Patients with psoriatic lesions over genitalia were excluded from the Group A as

parisheka with hot kashaya is contraindicated.

Pregnant women and lactating mothers were not considered for the study.

Diagnostic criteria:

The above mentioned clinical signs and symptoms of kitibha kushta were used as

diagnostic tools. Also the signs and symptoms of psoriasis were seen for. Patchy

circumscribed skin lesions with erythematous, well defined, dry, silvery scaly papules

and plaques were appreciated before their inclusion in the study. Patients were also seen

for ‘Candle grease sign’ and ‘Auspitz sign’.

Posology:

The posology for either bahya prayoga or abhyantara prayoga is not mentioned in

the context by Acharya Charaka. Hence the amount of kashaya sufficient to use for the

Methods


64

parisheka was known by conducting pilot study and 4 liter of kashya was found as

sufficient to perform parisheka of whole body. But the dose for abhyantara prayoga was

purely postulated by duly considering the safety factors.

For parisheka: four liters of kashaya was used for most of the patients and if the

lesions were confined to local part then sufficient quantity (less) of kashaya was taken.

For abhyantara prayoga: two 500 mg. capsules thrice daily were advised with

plain water or boiled and cooled water.

Study duration:

Parisheka: Parisheka was done for ten days continuously. The actual follow up of

the study was 30 days.

Abhyantara prayoga: Capsules were administered for 30 days continuously with

a follow up of 30 days.

Assessment of results:

Assessments of results were done on the basis of readings of subjective and

objective parameters before and after the treatment. The outcome of the observations

were analysed statistically for ‘p’ value using unpaired Student‘t’ test.

Subjective parameters:

Shyava krushna varna, Parushata, Ghanatwa, Kharasparsha and Kandu were set as

subjective parameters. The grading was given as follows;

Sl. no.

Subjective parameter

Score0 Score 1 Score 2 Score 3 Score 4

01 Shyava krushna varna No Mild Moderate Severe Extensive02 Parushata No Mild Moderate Severe Extensive03 Ghanatwa No Mild Moderate Severe Extensive04 Kharasparsha No Mild Moderate Severe Extensive05 Kandu No Mild Moderate Severe ExtensiveThe readings before and after the treatment were compared to assess the result.

Methods


65

Objective parameter:

PASI 234

Sl.No Head Upper extremities

Trunk Lower extremities

a Redness + b Thickness + c Scaling + Sum of rows of 1, 2

and 3

d Area score e Score of

row 4x row 5 x the area multiplier

row 4 x row 5 x 0.1

row 4 x row 5 x 0.2

row 4 x row 5 x 0.3

row 4 x row 5 x 0.4

f Sum row 6 for each column for PASI score

Steps in generating PASI score:

(a) Divide body into four areas: head, arms, trunk to groin, and legs to top of buttocks.

(b) Generate an average score for the erythema, thickness, and scale for each of the 4

areas (0 = clear; 1–4 = increasing severity).

(c) Sum scores of erythema, thickness, and scale for each area.

(d) Generate a percentage for skin covered with psoriasis for each area and convert that to

a 0–6 scale (0 = 0%; 1 =10%; 2 = 10–30%; 3 = 30–50%; 4 = 50–70%; 5 = 70–90%; 6 =

90–100%).

(e) Multiply score of item (c) above times item (d) above for each area and multiply that

by 0.1, 0.2, 0.3, and 0.4 for head, arms, trunk, and legs, respectively.

(f) Add these scores to get the PASI score.

Erythema, induration and scale are measured on a 0–4 scale (none, slight, mild, moderate,

severe)

Methods


66

Area scoring criteria (score: % involvement)

0: 0 (clear)

1: 0 - 10%

2: 10 –30%

3: 30–50%

4: 50–70%

5: 70–90%

6: 90–100

Assessment of results by objective criteria (PASI)

Complete remission – PASI score 0 after treatment.

Marked improvement – reduction of PASI score more than 75% after treatment.

Moderate improvement – reduction of PASI score between 50-75% after treatment.

Minimal improvement – reduction of PASI score less than 50% after treatment.

No improvement – no reduction in PASI score after treatment.

Procedure


68

Procedure:

Group A (Parisheka):

Requirements:

1. Dhara patra (of 4 liter capacity)

2. 4 liters of kashaya

3. Taila – 100 ml approximately

4. Bowl of 150 ml capacity for taila dispensing.

5. 2 Vessels of 5 liter capacity (1 liter more than the dhara patra capacity)

6. 1 – Wide mouthed vessel for indirect heating of kashaya.

7. Gas stove

8. 2 – Cotton pads as eye packs.

9. 2 – Small cotton swabs dipped in oil for closing the ear.

10. 2 – Dry and clean towels.

11. Drinking water if patient demands.

12. Cold water for sprinkling if any complications are observed.

13. Rubber gown to wear and gloves if there is bleeding (positive Auspitz

sign).

14. 1 Helper to assist for changing the kashaya.

Previous day patients were examined and explained about the parisheka briefly

and were asked to bring the extra clothing, napkin, towel etc. Preferably the time chosen

was morning hour for the convenience of the patients who, most of them were working.

Also as there is no specific time mentioned in Ayurveda for parisheka morning hour was

preferred for the convenience. In the cold and cloudy climate the time of procedure was

Procedure


69

changed accordingly i.e. when sun was bright, the procedure was done. Patients were first

asked to apply taila for them selves as it was experienced during the trial that abhyanga

caused bleeding from the lesions (Auspitz sign) so it was avoided and were asked to just

apply without any pressure. It was noted that the amount of taila required gone on

reducing day by day as the dryness of the skin was reducing. 15 – 20 minutes after the

application of taila patients underwent the parisheka procedure for fifty minutes to one

hour daily if it was the whole body. The lower limb was done parisheka for 10 min to

each anterior and posterior part. Parisheka was then done to anterior and posterior part of

trunk and abdomen for 10 minutes each. Both upper limbs were done parisheka for 10

minutes totally and the scalp psoriasis patients underwent parisheka for 10 minutes.

However in between this also kashaya was poured often to the whole body to avoid

coldness to the patient. If it was a local lesion then a minimum of 30 minutes procedure

was done daily. Each day fresh kashaya was prepared and used. The amount of kashaya

used was 4 liters per day if the whole body was involved and if local involvement was

there then according to the surface area of involvement the kashaya was prepared.

The kashaya was heated to the tolerable temperature (app.40-42° C) indirectly. It

was heated indirectly to avoid excessive heating and fast heating. By this method the

kashaya gets hot very slow so that it is ready for the replacement once the dhara patra

becomes empty. Parisheka was done approximately from about 6 inches height. However

low temperature kashaya was used for the shiras as the hot water bath and swedana are

contraindicated. The hrudaya pradesha (cardiac region) and vrushanas (genitalia) were

avoided as these places are also contraindicated for swedana. After the procedure was

over the patients were asked to wipe the body with clean and dry towel. After this they

Procedure


70

were allowed to perform their normal activities and participate in their normal work. It

was advised to avoid excess exposure to the sun with the presumption that it may causes

burning sensation. Patients were advised to take bath if interested 6-8 hours after the

procedure i.e. in the evening hours. Patients were strictly advised to avoid the use of soap

and shampoo during the study duration. Readings were noted every alternative day.

Observation


71

Observation

The observation of the patients and the disease was done by providing the

questionnaire to those patients who can fill the case sheet and from those who can’t

fill; the information was collected by translating the questions in the local language.

The case sheet is attached in the appendix. All the patients were examined thoroughly

before their inclusion in the study. The observation was done by considering the

subjective and objective parameters strictly.

The observations were done in the following heading and are depicted in form

and graphs are used where ever necessary;

1. Observation of demographic data.

2. Observation of the patient.

3. Observation of the disease.

4. Observation of the data related to the response of the patient.

5. Observation of the statistical out comes of the study.

Observation


72

Observation of demographic data:

Table 12 showing the distribution of patient’s age group Age group No of patients and percentage

Group A Group B Total No. of patients % No. of patients % No. of patients %

15-25 02 13.3 02 13.3 04 13.3 26-35 01 6.6 04 26.6 05 16.6 36-45 06 40 04 26.6 10 33.3

46-60 06 40 05 33.3 11 36.6 Group A: out of fifteen patents 02 (13.3%) were belonging to 15-25 age group, 01

(6.6%) was from 26-35 age group, 06 (40%) were 36-45 aged and 06 (40%) were 46-

60 years aged.

Group B: out of fifteen patents 02 (13.3%) fell under 15-25 age group, 04 (26.6%)

were from 26-35 age group, 04 (26.6%) were again from 26-35 age group and 05

(33.3%) were from 46-60 age group.

Overall: out of thirty patents 04 (13.3%) were from 15-25 group, 05 (16.6%) from

26-35 age group, 10 (33.3%) from 36-45 group and 11 (36.6%) were from 46-60

group.

Figure 07 showing distribution of patients by age

Table 13 showing the distribution of patients according to sex Sex Group A no. and

% Group B no. and %

Group A and B no. and %

Male 12 (80%) 09 (60%) 21 (70%) Female 03 (20%) 06 (40%) 09 (30%)

21

6 6

2

4 45

45

1011

0

2

4

6

8

10

12

Group A Group B Total

15-2526-3536-4546-60

Observation


73

Group A: Among 15 numbers of patients 12 (80%) were males and 03 (20%) were

females.

Group B: Among 15 numbers of patients 09 (60%) were males and 06 (40%) were

females.

Overall: distribution of sex was; male – 21 (70%) and females were 09 (30%) in 30 patients. Figure 08 showing distribution of patients by sex

Table 14 showing distribution of patients by Religion Religion

Group A no. and %

Group B no. and %


Hindu 13 (86.6%) 12 (80%) 25 (83.3%) Muslim 02 (13.3%) 02 (13.3%) 04 (13.3%) Christian 00 (00%) 01 (6.6%) 01 (3.3%) Others 00 (00%) 00 (00%) 00 (00%) Group A: out of fifteen patients 13 (86.6%) were Hindus, 02 (13.3%) were Muslims

and none were Christians and others

Group B: out of fifteen patients 12 (80%) ere Hindus, 02 (13.3%) were Muslims, 01

(6.6%) was Christian, and none were from other caste.

Overall: Hindus were 5 (83.3%), 04 (13.3%) were Muslims, 01 (3.3%) was Christian

and none were from other category among thirty total number of patients.

12

3

9

6

21

9

0

5

10

15

20

25


MaleFemale

Observation


74

Figure 09 showing distribution of patients by religion

Table 15 showing distribution of patients by Economical status Economical status Group A no. and

% Group B no. and %


Poor 03 (20%) 00 (00%) 03 (10%) Middle class 10 (66.6%) 15 (100%) 25 (83.3%) Rich 02 (13.3%) 00 (00%) 02 (6.6%) Group A: out of fifteen patients 03 (20%) were belonging to poor status, 10 (66.6%)

were of middle class and 02 (13.3%) were rich.

Group B: out of fifteen patients none were belonging to poor status, all 15 (100%)

were of middle class and none were from rich status

Overall: out of thirty patients 03 (10%) were poor, 25 (83.3%) were of middle class

and 02 (6.6%) were rich

Figure 10 showing distribution of patients by Economical status

13

20 0

12

21 0

25

41

00

5

10

15

20

25


Hindu Muslim Christian Others

3

10

20

15

0

3

25

2

0

5

10

15

20

25


Poor Middle class Rich

Observation


75

Table 16 Showing distribution of patients by Occupation Occupation

Group A no. and %

Group B no. and %


Student 1 (6.6%) 02 (13.3%) 03 (10%) Labor 7 (46.6%) 06 (40%) 13 (43.3%) Executive 1 (6.6%) 00 (00%) 01 (3.3v) Sedentary 5 (33.3%) 01 (6.6%) 06 (20%) Group A: out of fifteen patients 1 (6.6%) was student, 7 (46.6%) were labors, 1

(6.6%) was executive and 5 (33.3%) were sedentary by occupation

Group B: out of fifteen patients 02 (13.3%) were students, 06 (40%) were labors,

none were executives and 01 (6.6%) was of sedentary by occupation.

Overall: out of thirty patients 03 (10%) were students, 13 (43.3%) were labors, 01

(3.3%) was executive and 06 (20%) were belonging to sedentary category.

Figure 11 showing distribution of patients by occupation

Table No. 17. Showing distribution of patients by Nature of work Nature of work

Group A no. and %

Group B no. and %

Overall

Stressful 7 (46.6%) 06 (40%) 13 (43.3%) Near heat 3 (20%) 01 (6.6%) 04 (13.3%) Traveling 4 (26.6%) 00 (00%) 04 (13.3%) Group A: out of fifteen patients 7 (46.6%) were working stressfully, 3 (20%) were

working near heat and 4 (26.6%) were having traveling nature of work.

Group B: out of fifteen patients 06 (40%) were working stressfully, 01 (6.6%) were

working near heat and, none were from traveling category.

Overall: out of thirty patients 13 (43.3%) were working stressfully, 04 (13.3%) were

working near heat and 4 (26.6%) were having traveling nature of work.

1

7

1

5

2

6

01

3

13

1

6

0

2

4

6

8

10

12

14

Gro up A Gro up B T o tal

Student Labor Executive Sedentary

Observation


76

Figure 12 showing distribution of patients by nature of work

Vaiyaktika vruttanta of the patients:

Table No. 18. Showing distribution of patients by Matra of ahara Bahu Madhyama Alpa Group A 08 (53.3%) 06 (40%) 01 (6.6%) Group B 04 (26.6%) 09 (60%) 02 (13.3%) Overall 12 (40%) 15 (50%) 03 (10%) Group A: 08 (53.3%) patients were taking bahu matra ahara, 06 (40%) were taking

madhyama matra and 01 (6.6%) was taking alpa matra ahara.

Group B: 04 (26.6%) patients were taking bahu matra ahara, 09 (60%) were taking

madhyama matra ahara and 02 (13.3%) were taking alpa matra ahara.

Overall: out of thirty patients 12 (40%) were taking bahu matra ahara, 15 (50%) were

taking madhyama matra ahara and 03 (10%) were taking alpa ahara.

Figure 13 showing distribution of patients by matra of ahara

7

34

6

10

13

4 4

0

2

4

6

8

10

12

14


Stressful Near heatTraveling

8

6

1

4

9

2

12

15

3

0

2

4

6

8

10

12

14

16


BahuMadhyamaAlpa

Observation


77

Table No. 19. Showing distribution of patients by Kala of ahara Regular Irregular Group A 11 (73.3%) 04 (26.6%) Group B 14 (93.3%) 01 (6.6%) Overall 25 (83.3%) 05 (16.6%) Group A: out of fifteen patents 11 (73.3%) were taking food at regular time, 04

(26.6%) were taking irregularly and 01 (6.6%) was taking food twice daily and 14

(93.3%) were taking thrice daily.

Group B: out of fifteen patents 14 (93.3%) were taking food regularly, 01 (6.6%) was

taking irregularly and 02 (13.3%) were taking it twice a day and 13 (86.6%) were

taking food thrice a day.

Overall: out of thirty patents 25 (83.3%) were taking it regularly, 05 (16.6%) were

not taking regularly and 03 (10%) were taking for two times a day and 27 (90%) were

having thrice a day.

Figure 14 showing distribution of patients by kala of ahara

Table No. 20. Showing distribution of patients by Rasa Madhura Amla Lavana Katu Tikta Kashaya Group A 09 (60%) 10 (6.6%) 01 (6.6%) 10(66.6%) 00 (00v) 00 (00%) Group B 09 (60%) 02(13.3%) 03(13.3%) 10(66.6%) 00 (00%) 00 (00%) Overall 18 (60%) 12 (40%) 04 (10%) 20(66.6%) 00 (00%) 00 (00%) Group A: out of fifteen patents 09 (60) were liking madhura rasa, 10 (6.6) were

liking amla rasa, 01 (6.6%) was liking lavana and 10 (66.6%) were liking katu rasa.

None liked tikta.and kashaya rasa.

Group B: out of fifteen patents patents 09 (60%) were liking madhura rasa, 02

(13.3%) were liking amla rasa, 03 (20%) liked lavana and 10 (66.6%) were like katu

rasa. None liked tikta and Kashaya rasa

11

4

14

1

25

5

0

5

10

15

20

25


RegularIrregula

Observation


78

Overall: out of thirty patents18 (60%) were fond of madhura, 12 (40%) were fond of

amla, 04 (13.33%) liked lavana and 20 (66.6%) were fond of katu rasa and none liked

katu and kashaya rasa.

+

Table No. 21. Showing distribution of patients by Guna of ahara Laghu Guru Rooksha Snigdha Group A 01 (6.6%) 08 (53.3%) 12 (80%) 03 (20%) Group B 09 (60%) 06 (40%) 09 (60%) 04 (26.6%) Overall 10 (33.3%) 14 (46.6%) 21 (70%) 07 (23.3%) Group A: out of fifteen patents 01 (6.6%) use to take laghu ahara, 08 (53.3%) use to

take guru ahara, 12 (80%) used rooksha and 03 (20%) were using snigdha ahara.

Group B: out of fifteen patents 09 (60%)were taking laghu ahara, 06 (40%) were

taking guru ahara, 09 (60%) were taking rooksha and 04 (26.6%) were taking snigdha

ahara.

Overall: out of thirty patents10 (33.3%) were taking laghu, 14 (46.6%) were taking

guru, 21 (70%) taking rooksha ahara and 07 (23.3%) were taking snigdha.

Figure 16 showing distribution of patients by gune of ahara

910

1

10

0 0

9

23

10

0 0

18

12

4

20

0 00

2

4

6

8

10

12

14

16

18

20


MadhuraAmlaLavanaKatuTiktakashya

1

8

12

3

9

6

9

4

10

14

21

7

0

5

10

15

20

25


LaghuGuruRookshaSnigdha

Observation


79

Table No. 22. Showing distribution of patients Type of diet Vegetarian Mixed Group A 05 (33.3%) 10 (66.6%) Group B 07 (46.6%) 08 (53.3%) Overall 12 (40%) 18 (60%) Group A: out of fifteen 05 (33.3%) were vegetarians and 10 (66.6%) were mixed diet

Group B: out of fifteen 07 (46.6%) were vegetarians and 08 (53.3%) were mixed diet

Overall: out of thirty patents 12 (40%) were vegetarians and 18 (60%) were of mixed diet Figure 17 showing distribution of patients by type of diet

Table No. 23. Showing distribution of patients by Vyasana Alcohol Tobacco

chewing Smoking Tea/coffee

Group A 05 (33.3%) 01 (6.6%) 03 (20%) 01 (6.6%) Group B 05 (33.3%) 04 (26.6%) 02 (13.3%) 03 (20%) Overall 10 (33.3%) 05 (16.6%) 05 (16.6%) 04 (13.3%) Group A: out of fifteen patents 05 (33.3%) were alcoholics, 01 (6.6%) was tobacco

chewer, 03 (20%) were smokers and 01 (6.6%) was taking excess tea/ coffee.

Group B: out of fifteen patents 05 (33.3%) were alcoholics, 04 (26.6%) were tobacco

chewers, 02 (13.3%) were smokers and 03 (20%) were taking excess tea/ coffee.

Overall: out of thirty patents 10 (33.3%) were alcoholics, 05 (16.6%) were tobacco

chewers, 05 (16.6%) were smokers and 04 (13.3%) were taking excess tea/ coffee.

Figure 18 showing distribution of patients by vyasana

5

1

3

1

54

23

10

5 54

0

1

2

3

4

5

6

7

8

9

10


AlcoholTobacco chewingSmokingTea/Coffee

5

107 8

12

18

0

2

4

6

8

10

12

14

16

18


VegetarianMixed

Observation


80

Table No. 24. Showing distribution of patients by Hygiene Good Fair Poor Group A 07 (46.6%) 07 (46.6%) 01 (6.6%) Group B 07 (46.6%) 08 (53.3%) 00 (00%) Overall 14 (46.6%) 15 (50%) 01 (3.3%) Group A: out of fifteen patents 07 (46.6%) were maintaining good hygiene, 07

(46.6%) were of fair and 01 (6.6%) was poorly hygienic.

Group B: out of fifteen patents 07 (46.6%) were maintaining good hygiene, 08

(53.3%) were of fair and none poorly hygienic.

Overall: out of thirty patents 14 (46.6%) were maintaining good hygiene, 15 (50%)

were of fair and 01 (3.3%) was poorly hygienic.

Figure 19 showing distribution of patients by hygine

Table No. 25. Showing distribution of patients by Manaska sthiti Chinta Shoka Bhaya Group A 12 (80%) 12 (80%) 12 (80%) Group B 12 (80%) 12 (80%) 12 (80%) Group A and B 24 (80%) 24 (80%) 24 (80%) Group A: out of fifteen patents 12 (80%) were suffering from chinta, shoka bhaya.

Group B: out of fifteen patents 12 (80%) were suffering from chinta, shoka bhaya.

Overall: out of thirty patents 24 (80%) were suffering from chinta, shoka and bhaya.

Figure 20 showing distribution of patients by manasika sthiti

7 7

1

78

0

14 15

10

2

4

6

8

10

12

14

16


GoodFairPoor

12 12 12 12 12 12

24 24 24

0

5

10

15

2 0

2 5


ChintaShokaBhaya

Observation


81

Table No. 26. Showing distribution of patients by observed nidana in no & % Nidana Group

A Group B

Overall Nidana Group A

Group B

Overall

Milk with fish

08 (53.3%)

07 (46.6%)

15 (50%)

Excess snigdha

03 (20%)

01 (6.6%)

04 (13.3%)

Milk with mamsa

08 (53.3%)

07 (46.6%)

15 (50%)

Raw moolaka alone or with dugdha

14 (93.3%)

13 (86.6%)

27 (90%)

Milk with acidic foods

01 (6.6%)

01 (6.6%)

02 (6.6%)

Ati ashana

05 (33.3%)

01 (6.6%)

06 (20%)

Excess madhura rasa

05 (33.3%)

08 (53.3%)

13 (43.3%)

Ati jala sevana after gharma

01 (6.6%)

00 (00%)

01 (3.3%)

Excess amla rasa

09 (60%)

02 (13.3%)

11 (36.6%)

Masha 06 (40%)

05 (33.3%)

11 (36.6%)

Excess lavana rasa

01 (6.6%)

03 (20%)

04 (13.3%)

shrama, bhaya

00 (00%)

00 (00%)

00 (00%)

Dadhi other milk products

15 (100%)

13 (86.6%)

28 (93.3%)

Guda 14 (93.3%)

14 (93.3%)

28 (93.3%)

Navanna 00 (00%)

00 (00%)

00 (00%)

Pishta vikara

04 (26.6%)

10 (66.6%)

14 (46.6%)

Matsya, 10 (66.6%)

08 (53.3%)

18 (60%)

Vyayama after bhojana

03 (20%)

03 (20%)

06 (20%)

Mamsa 10 (66.6%)

08 (53.3%)

18 (60%)

Diwa swapna

09 (60%)

05 (33.3%)

14 (46.6%)

Observation


82

Table No. 27. Showing distribution of patients by observed poorvaroopa in the study in Group A patients Sl. No Poorva roopa Group A Group B Over all 01 Twak parushata 14 (93.3%) 09 (60%) 23 (76.6%)02 Akasmad romaharsha 00 (00%) 00 (00%) 00 (00%) 03 Swedabahulya 01 (6.6%) 01 (6.6%) 02 (6.6%) 04 Asweda 04 (26.6%) 03 (20%) 07 (23.3%)05 Anga pradesha swapa 00 (00%) 00 (00%) 00 (00%) 06 Vaivarnya 15 (100%) 15 (100%) 30 (100%) 07 Kandu 15 (100%) 15 (100%) 30 (100%) 08 Suptata 00 (00%) 00 (00%) 00 (00%) 09 Nistoda 00 (00%) 00 (00%) 00 (00%) 10 Ati shlakshnata 00 (00%) 00 (00%) 00 (00%) 11 Gourava 08 (53.3%) 06 (40%) 14 (46.6%)12 Mala pradeha over kaya 00 (00%) 01 (6.6%) 01 (3.3%) 13 Kshata visarpa (spreads on injury), 04 (26.6%) 03 (20%) 07 (23.3%)14 Paridaha 00 (00%) 00 (00%) 00 (00%) Table No. 28. Showing distribution of patients by lakshanas observed. Sl. no Lakshana Observed in

number of patients and % in Group A

Observed in number of patients and % in Group B

Observed in number of patients and % in Group A and B

01 Shyava kina 15 (100%) 15 (100%) 30 (100%) 02 Krishnavarna

kina 15 (100%) 14 (93.30%) 29 (96.6%)

03 Parushata of kina

15 (100%) 15 (100%) 30 (100%)

04 Ghana 14 (93.3%) 13 (86.6%) 27 (90%) 05 Khara sparsha 15 (100) 13 (86.6%) 28 (93.3%) 06 Snigdha

sparsha 00 (00%) 00 (00%) 00 (00%)

07 Ugra kandu 15 (100%) 15 (100%) 30 (100%) Table No. 29. Showing distribution of patients by anubandha vedana observed. Sl. No. Anubandha

vedana Group A Group B Overall

01 Daha 07 (46.6%) 04 (26.6%) 11(36.6%) 02 Raga 03 (20%) 00 (00%) 03 (10%) 03 Srava 00 (00%) 00 (00%) 00 (00%) 04 Vedana 02 (13.3%) 00 (00%) 02 (6.6%) 05 Shaitya 02 (13.3%) 04 (26.6%) 06 (20%) 06 Kleda 00 (00%) 00 (00%) 00 (00%) 07 Anga gourava 05 (33.3%) 12 (80%) 17 (56.6%)

Observation


83

Table No. 30. Showing distribution of patients by site of onset Site of onset Scalp Knee Elbow Ear lobe Group A 04 (26.66%) 07 (46.6%) 02 (13.3%) 02 (13.3%) Group B 07 (46.6%) 04 (26.6%) 02 (13.3%) 02 (13.3%) Overall 12 (40%) 11 (36.6%) 04 (13.3%) 04 (13.3%) Group A: out of fifteen patents 04 (26.66%) got origin from scalp, 07 (46.6%) from

knee, 02 (13.3%) from elbow and 02 (13.3%) from ear lobe.

Group B: out of fifteen patents 07 (46.6%) got the first lesion on scalp, 04 (26.6%) in

knee, 02 (13.3%) in elbow and 02 (13.3%) in ear lobe.

Overall: out of thirty patents12 (40%) observed lesion first in scalp, 11 (36.6%) in

knee, 04 (13.3%) in elbow and 04 (13.3%) patients observed first in ear lobe

Figure 21 showing distribution of patients by site of onset

Table No. 31. Showing distribution of patients by mode of onset of the disease Mode of onset

Sudden Gradual After injuryGroup A 03 (20%) 11 (73.3%) 01 (6.6%) Group B 01 (6.6%) 14 (93.3%) 00 (00%) Overall 04 (13.3%) 25 (83.3%) 01 (3.3%) Group A: out of fifteen patents 03 (20%) got sudden onset while 11 (73.3%) got

gradual onset and 01 (6.6%) got onset of lesion after injury.

Group B: out of fifteen patents 01 (6.6%) got lesions suddenly, 14 (93.3%) got it

gradually and none got after injury in this group.

Overall: out of thirty patents 04 (13.3%) got it suddenly, 25 (83.3%) got gradual

onset and 01 (3.3%) got it after injury.

Figure 22 showing distribution of patients by mode of onset

4

7

2 2

7

4

2 2

1211

4 4

0

2

4

6

8

10

12


Scalp

Knee

Elbow

Ear lobe

3

11

1 1

14

0

4

25

10

5

10

15

2 0

2 5


Sudden

Gradual

After injury

Observation


84

Table No. 32. Showing distribution of patients by aggravation time Aggravation

Day Night Group A 03 (20%) 12 (80%) Group B 00 (00%) 15 (100%) Overall 03 (10%) 27 (90%) Group A: out of fifteen patents, in 03 (20%) aggravation was during day, in 12 (80%)

during night, in 04 (26.6%) it was in summer, none observed aggravation in rainy

season and in 11 (73.3%) aggravation was in winter.

Group B: out of fifteen patents, none got aggravation in day time, 15 (100%) got in

night, 01 (6.6%) in summer season, 01 (6.6%) in rainy season and 12 (80%) got

aggravation in winter season.

Overall: out of thirty patents, 03 (10%) got aggravation in day time, 27 (90%) got in

night, 05 (16.6%) in summer season01 (3.3%) in rainy season and 23 (76.6%) got

aggravation in winter season.

Figure 23 showing distribution of patients by aggravation time

Table No. 33. Showing distribution of patients by aggravation season

Aggravation Summer Rainy Winter

Group A 04 (26.6%) 00 (00%) 11 (73.3%) Group B 01 (6.6%) 01 (6.6%) 12 (80%) Overall 05 (16.6%) 01 (3.3%) 23 (76.6%) Group A: out of fifteen patents, in 03 (20%) aggravation was during day, in 12 (80%)

during night, in 04 (26.6%) it was in summer, none observed aggravation in rainy

season and in 11 (73.3%) aggravation was in winter.

Group B: out of fifteen patents, 01 (6.6%) in summer season, 01 (6.6%) in rainy

season and 12 (80%) got aggravation in winter season.

3

12

0

15

3

27

0

5

10

15

20

25

30


Day

Night

Observation


85

Overall: out of thirty patents, 05 (16.6%) in summer season01 (3.3%) in rainy season

and 23 (76.6%) got aggravation in winter season.

Figure 24 showing distribution of patients by aggravation season Table No. 34. Showing distribution of patients by Kula vruttanta

Maternal Parental Group A 00 (00%) 00 (00%) Group B 01 (6.6%) 01 (6.6%) Overall 01 (3.3%) 01 (3.3%) Group A: out of fifteen patents none had family history.

Group B: out of fifteen patents 01 (6.6%) maternal reported family history and 01

(6.6%) reported with parental history.

Overall: out of thirty patents01 (3.3 %) maternal reported family history and 01

(3.3%) reported with parental history.

Figure 25showing distribution of patients by kula vruttana

Table No. 35. Showing distribution of patients by Chikitsa vruttanta

Chikitsa vruttanta Ay Al O

Group A 03 (20%) 15 (100%) 00 (00%) Group B 03 (20%) 15 (100%) 00 (00%) Overall 06 (20%) 30 (100%) 00 (00%) Group A: out of fifteen patents all have taken the allopath treatment 15 (100%), 03

(20%) Ayurveda treatment and none of them had got treatment from other medicine.

0 0

1 1 1 1

0

1

2

3


Maternal

Parental

4

0

11

1 1

12

5

1

23

0

5

10

15

20

25


Summer

Rainy

Winter

Observation


86

Group B: out of fifteen patents 03 (20%) had treatment history of Ayurveda, all had

allopath treatment history positive and none reported with other medicine history.

Overall: out of thirty patents all have taken the allopath treatment 30 (100%), 06

(20%) Ayurveda treatment and none of them had got treatment from other medicine

Figure 26 Showing distributions of patients by chikitsa vruttanta

Table No. 36. Showing distribution of patients by confirmatory signs

Confirmatory sign Auspitz sign Candle grease sign Koeber’s sign. Group A 15 (100%) 15 (100%) 04 (26.6%) Group B 15 (100%) 15 (100%) 07 (46.6%) Overall 30 (100%) 30 (100%) 11 (36.6%) Group A: out of fifteen patents all were reported with Auspitz sign and Candle grease

sign 15 (100%) each and 04 (26.6%) patients reported with positive Koeber’s sign.

Group B: out of fifteen patents all were reported with Auspitz sign and Candle grease


Overall: out of thirty patents all were reported with Auspitz sign and Candle grease


Figure 27 showing distribution of patients by confirmatory signs

3

15

0

3

15

0

6

3 0

00

5

10

15

2 0

2 5

3 0

Gr oup A Gr oup B Tot a l

Ay ur v e da

Al l opa t h

Ot he r

15 15

4

15 15

7

30 30

11

0

5

10

15

20

25

30


Auspitz signCandle grease signKoeber's sign

Statistical observation


87

Table No. 37. Showing demographic data in patients of in Group A Group OPD

No. Age Sex Religion Economical

status Occupation Nature

of work M F H M C O P M R S L E S S N T

A 3634 46 - + + - - - + - - - + - - + + - A 235 38 + - + - - - - + - - + - - - - +A 538 40 - + + - - - - + - - + - - - + - A 309 42 + - + - - - + - - - + - - - - +A 613 40 + - + - - - - + - - - - + + - - A 1427 40 - + + - - - + - - - - - - - - - A 1715 50 + - + - - - - + - - + - - + + - A 502 44 + - + - - - - + - - - - + - - +A 3073 56 + - - + - - - + - - - - + + - - A 3089 59 + - + - - - - + - - - - + - - - A 3069 55 + - - + - - - + - - + - - + - - A 3220 50 + - + - - - - + - - - - + + - - A 3413 23 + - + - - - - + - - + - - - - - A 4023 35 + - + - - - - - + - - + - + - +A 4370 20 + - + - - - - - + + - - - - - -

TOTAL 12 3 13 2 0 0 3 10 2 1 7 1 5 7 3 4 Table No. 38. Showing demographic data in patients of in Group B Group OPD

No. Age Sex Religion Economical

status Occupation Nature

of work M F H M C O P M R S L E S S N T

B 1846 45 + - + - - - - + - - + - - + + - B 1968 60 + - - + - - - + - - + - - + - - B 2851 50 - + + - - - - + - - - - - - - - B 2758 45 - + + - - - - + - - - - - - - - B 3216 40 + - + - - - - + - - + - - + - - B 3217 35 + - + - - - - + - - + - - + - - B 3556 15 + - - - + - - + - + - - - - - - B 3591 50 + - - + - - - + - - + - - + - - B 3849 32 + - + - - - - + - - + - - + - - B 4006 18 - + + - - - - + - + - - - - - - B 4039 35 - + + - - - - + - - - - - - - - B 4279 60 + - + - - - - + - - - - - - - - B 4284 45 - + + - - - - + - - - - - - - - B 4228 51 + - + - - - - + - - - - + - - - B 4426 28 - + + - - - - + - - - - - - - -

TOTAL 9 6 12 2 1 0 0 15 0 2 6 0 1 6 1 0 Abbreviations used: Sex: M – male, F – female, Religion: H- Hindu, M – Muslim, C – Christian, O – others, Economical status: P – poor, M – middle class, R – rich, Occupation: St – student, L – labor, E – executive, S – sedentary, Nature of work: S – stressful, N – near heat, T – traveling



88

Table No. 39 Showing lakshanas of kitibha kushta in Group A Group OPD

No. Shyava

kina Krishnavarna

kina Parushata

of kina Ghana Khara

sparsha Snigdha sparsha

Ugra kandu

A 3634 + + + + + - + A 235 + + + + + - + A 538 + + + + + - + A 309 + + + + + - + A 613 + + + - + - + A 1427 + + + + + - + A 1715 + + + + + - + A 502 + + + + + - + A 3073 + + + + + - + A 3089 + + + + + - + A 3069 + + + + + - + A 3220 + + + + + - + A 3413 + + + + + - + A 4023 + + + + + - + A 4370 + + + + + - +

Total 15 15 15 14 15 0 15 Table No. 40 Showing lakshanas of kitibha kushta in Group B Group OPD

No. Shyava

kina Krishnavarna

kina Parushata

of kina Ghana Khara

sparsha Snigdha sparsha

Ugra kandu

B 1846 + + + + + - + B 1968 + + + + + - + B 2851 + + + + - - + B 2758 + + + + + - + B 3216 + + + + + - + B 3217 + + + + - - + B 3556 + + + - + - + B 3591 + + + + + - + B 3849 + - + + + - + B 4006 + + + - + - + B 4039 + + + + + - + B 4279 + + + + + - + B 4284 + + + + + - + B 4228 + + + + + - + B 4426 + + + + + - +

Total 15 14 15 13 13 0 15



89

Table No. 41 Showing Confirmatory signs of psoriasis in Group A Group OPD no. Confirmatory sign

Auspitz sign Candle greace sign Koeber’s sign. A 3634 + + - A 235 + + - A 538 + + + A 309 + + + A 613 + + - A 1427 + + - A 1715 + + + A 502 + + - A 3073 + + - A 3089 + + - A 3069 + + - A 3220 + + - A 3413 + + - A 4023 + + - A 4370 + + +

TOTAL 15 15 04 Table No. 42 Showing Confirmatory signs of psoriasis in Group A Group OPD no. Confirmatory sign

Auspitz sign Candle greace sign Koeber’s sign. B 1846 + + - B 1968 + + + B 2851 + + - B 2758 + + + B 3216 + + + B 3217 + + - B 3556 + + + B 3591 + + - B 3849 + + - B 4006 + + + B 4039 + + - B 4279 + + - B 4284 + + - B 4228 + + + B 4426 + + +

TOTAL 15 15 07



90

Table No. 43 Showing Anubandha vedana of kitibha kushta in Group A. Group OPD

No. Daha Raga Srava Vedana Shaitya Kleda Anga

gourava A 3634 + - - + - - + A 235 + - - - - - - A 538 + - - - - - - A 309 - - - + + - + A 613 - + - - - - - A 1427 + - - - - - + A 1715 - - - - - - - A 502 + - - - - - - A 3073 + - - - - - - A 3089 - + - - - - - A 3069 - - - - + - + A 3220 - + - - - - - A 3413 + - - - - - - A 4023 - - - - - - - A 4370 - - - - - - +

Table No. 44 Showing Anubandha vedana of kitibha kushta in Group B. Group OPD

No. Daha Raga Srava Vedana Shaitya Kleda Anga

gourava B 1846 - - - - + - + B 1968 - - - - - - - B 2851 - - - - + - + B 2758 - - - - - - + B 3216 - - - - + - + B 3217 - - - - - - + B 3556 - - - - - - + B 3591 + - - - - - + B 3849 + - - - - - - B 4006 + - - - - - - B 4039 - - - - - - + B 4279 - - - - - - + B 4284 - - - - + - + B 4228 + - - - - - + B 4426 - - - - - - +


Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 91

Table No. 45 Showing the observed features of the nature of kitibha kushta in Group A Group OPD No. Site of onset Mode of onset Aggrevation

Kula vruttanta Chikitsa vruttanta

S K E EL S G AI D N S R W M P AY AL O A 3634 + - - - - + - - + + - - - - - + - A 235 + - - - - + - + - - - + - - - + - A 538 - + - - + - - - + - - + - - - + - A 309 + - - - + - - - + - - + - - - + - A 613 - + - - - + - + - + - - - - - + - A 1427 - + - - + - - - + - - + - - - + - A 1715 - - + - - + - - + + - - - - - + - A 502 + - - - - + - - + + - - - - - + - A 3073 - + - - - + - - + - - + - - - + - A 3089 - - - + - + - - + - - + - - - + - A 3069 - + - - - + - - + - - + - - - + - A 3220 + - - - - + - - + - - + - - - + - A 3413 - + - - - + - + - - - + - - + + - A 4023 - + - - - - + - + - - + - - + + - A 4370 - - + + - + - - + - - + - - + + -

Total 05 07 02 02 03 11 01 03 12 04 00 11 00 00 03 15 00 Abbreviations used Site of onset: S – Scalp, K – Knee, E – Elbow, El – Ear lobe. Mode of onset: S – Sudden, G – Gradual, AI –After injury. Aggravation: D – Day, N – Night, S – summer, R – rainy, W – winter. Kula Vruttanta: M – Maternal, P – parental, Chikitsa vruttanta: Ay – Ayurveada, Al – Allopath, O – Others.


Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 92

Table No. 46 Showing the observed features of the nature of kitibha kushta in Group B Group OPD No. Site of onset Mode of onset Aggravation

Kula vruttanta Chikitsa vruttanta

S K E EL S G AI D N S R W M P AY AL O B 1846 + - - - - + - - + - - + - - + + - B 1968 + - - - - + - - + - - + - - - + - B 2851 - + - - - + - - + - - + - - - + - B 2758 + - - - - + - - + - - + - - - + - B 3216 - - - + - + - - + - - + - - - + - B 3217 - + - - - + - - + - - + - - + + - B 3556 + - - - + - - - + - - - - - - + - B 3591 - + - - - + - - + + - - - - - + - B 3849 - - + - - + - - + - - + - - - + - B 4006 - - - + - + - - + - + + - + - + - B 4039 + - - - - + - - + - - + + - - + - B 4279 - - + - - + - - + - - - - - - + - B 4284 - + - - - + - - + - - + - - - + - B 4228 + - - - - + - - + - - + - - + + - B 4426 + - - - - + - - + - - + - - - + -

Total 07 04 02 02 01 14 00 00 15 01 01 12 01 01 03 15 00 Abbreviations used Site of onset: S – Scalp, K – Knee, E – Elbow, El – Ear lobe. Mode of onset: S – Sudden, G – Gradual, AI – After injury. Aggravation: D – Day, N – Night, S – summer, R – rainy, W – Winter. Kula Vruttanta: M – Maternal, P – parental. Chikitsa vruttanta: Ay – Ayurveada, Al – Allopath, O – others.



93

Table No. 47 Showing the observed vaiktika vruttanta in Group A Group OPD

No. Ahara Vihara

Matra Kala Rasa Guna Type Vyasana Hygine Manas A 3634 A R MA LR M T/C G CS A 235 B R MKA GR M A G - A 538 M I KAL GR M - F CB A 309 B I MA GS M A,S P CB A 613 B I MK GR M A,T F C A 1427 M R MK R M - F C A 1715 B R KA R V - F - A 502 B I MK R V - G - A 3073 B R KA GS M S F C A 3089 M R KA R V - G C A 3069 B R KA GR M S F C A 3220 M R M R V - G CB A 3413 B R K R M A F C A 4023 M R MA GR M A G C A 4370 M R MA GS V - G CB

Table No. 48 Showing the observed vaiktika vruttanta in Group B Group OPD

No. Ahara Vihara

Matra Kala Rasa Guna Type Vyasana Hygine Manas B 1846 B R M GS M A G C B 1968 B R MK GS M S G C B 2851 M R MA G V T G CSB B 2758 M R MK LR V T G CS B 3216 B R MA GS M A F CB 3217 B R K LR V A F C B 3556 M R M GS M - F B B 3591 M I K LR M T F C B 3849 M R MK LR M A F C B 4006 A R KL LR V - G CSB B 4039 M R KL LR M T F CS B 4279 M R K LR V T/C F C B 4284 M R KL LR V T/C F C B 4228 M R MK G M A,S G C B 4426 A R M LR V T/C F C

Ahara: Matra – Bahu, Madhyama, Alpa, Kala – Regular, Irregular, Rasa – M-Madhura, A-Amla, L-Lavana, K-Katu, T-Tikta, Ks-Kashaya, Guna – G-Guru, L-Laghu, S-Snigdha, R-Ruksha. Type – V – vegetarian, M - mixed Vihara: Vyasana – A-Alcohol, T-Tobacco Chewing, S-Smoking, T/C-Tea coffee, Hygiene – G-Good, F-Fair, P-Poor. Manas – C-chinta, S-shoka, B-bhaya



94

Table No. 49 showing the rogi pareekshain Group A G opd

no Prakruti Sara Samhanana Satmya Satva Ahaa

shakti Vyama shakti

Vaya

A 3634 VP MS M R M M M M A 235 VK MS S S P P P M A 538 VK MeS S V A M M M A 309 VK A S V A P P M A 613 V A S V M P M M A 1427 VP T S V A M A M A 1715 VP MeS M V P P P M A 502 VP MS S V P P P M A 3073 VK R M V M P M M A 3089 VK A S V M M M M A 3069 VK M M V P P M M A 3220 VP MjS S V M M M M A 3413 PK S S V M P P B A 4023 VK M S V P M M M A 4370 VP S S V M M M B Table No. 50 showing the rogi pareekshain Group B opd no

Prakruti Sara Samhanana Satmya Satva Ahara shakti

Vyama shakti

Vaya

B 1846 MS S V P P P M B 1968 A S V P P M M B 2851 R M V A M M M B 2758 Mes M V A M M M B 3216 A M V M P M M B 3217 R M V A P M M B 3556 A M V A M M M B 3591 A M R P M P M B 3849 MS M V M M M M B 4006 T A V A A A M B 4039 MS M V M M M M B 4279 A S V M M A V B 4284 MS M V M M M M B 4228 A M V M M M M B 4426 MeS S V A A A M

Abbreviations used: Prakruti: V – vataja, VP – vatapittaja, VK – vatakaphaja, PK – pittakaphaja. Sara: T – twak sara, R – raktasara, MS – mamsasara, MeS – medasara, A – asthisara, MjS – majjasara, S shukrasara Samhanana: S – susamhata, M – madhyama, A – asamhata. Satmya: S – sarvarasa, R – rooksha, V – vyamishra. Stawa: P – prvara, M – madhyama, A – avara. Ahaa shakti: P – prvara, M – madhyama, A – avara. Vyamashakti: P – prvara, M – madhyama, A – alpa. Vaya: B – bala, M – madhyama, V – vruddha.



95

Table No. 51 showing the Nidana observed in Group A

Abbreviations used. 01-Milk with fish, 02-Milk with mamsa, 03-Milk with acidic foods, 04-Excess madhura rasa, 05-Excess amla rasa, 06-Excess lavana rasa, 07-Dadhi other milk products, 08-Navanna, 09-Matsya, 10-Mamsa, 11-Excess snigdha, 12-Raw moolaka alone or with dugdha, 13-Adhyashana, 14-Ati jala sevana after gharma, shrama, bhaya, 15-Masha 16-Tila, 17-Guda, 18-Pishtavikara, 19-Vyayama after bhojana, 20-Diwaswapna

roup OPD No.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

A 3634 + + - - + - + - + + - + - - - - + - + - A 235 + + - - + - + - + + - + - - + - + - + - A 538 + + + - + + + - + + - + - - - - - + - + A 309 + + - + + - + - + + - + + - + - + + - + A 613 - - - - - - + - + + - + + - - - + - - - A 1427 + + - + - - + - + + - + - - - - + - - + A 1715 - - - - + - + - - - - + + + + - + - - - A 502 - - - + + - + - - - - + + - - - + - + - A 3073 + + - - - - + - + + + - - - - - + - - + A 3089 - - - - - - + - - - - + - - + - + - - + A 3069 + + - - + - + - + + + + - - - - + - - + A 3220 - - - + - - + - - - - + - - - - + - - + A 3413 - - - - - - + - + + - + + - + - + + - - A 4023 + + - - + - + - + + - + - - - - + - - + A 4370 - - - + + - + - - - + + - - + - + + +

Total 08 08 01 05 09 01 15 00 10 10 03 14 05 01 06 00 14 04 03 09



96

Table No. 52 showing the Nidana observed in Group B

Abbreviations used. 01-Milk with fish, 02-Milk with mamsa, 03-Milk with acidic foods, 04-Excess madhura rasa, 05-Excess amla rasa, 06-Excess lavana rasa, 07-Dadhi other milk products, 08-Navanna, 09-Matsya, 10-Mamsa, 11-Excess snigdha, 12-Raw moolaka alone or with dugdha, 13-Adhyashana, 14-Ati jala sevana after gharma, shrama, bhaya, 15-Masha 16-Tila, 17-Guda, 18-Pishtavikara, 19-Vyayama after bhojana, 20-Diwaswapna

Group OPD No.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

B 1846 - - - + - - + - + + - + + - + - + - + - B 1968 + + - - - - + - + + - + - - - - + - - + B 2851 - - + + + - + - - - - + - - + - + + - + B 2758 - - - + - - + - - - - + - - + - + - - - B 3216 + + - + + - + - + + - + - - - - + + + - B 3217 - - - - - - + - - - - + - - + - + + - - B 3556 + + - + - - - - + + + - - - - - + + - - B 3591 + + - - - - + - + + - + - - - - + - + - B 3849 + + - + - - + - + + - + - - - - + - - - B 4006 - - - - - - + - - - - + - - - - + + - - B 4039 + + - - - + + - + + - + - - - - + + - + B 4279 - - - - - - + - - - - + - - + - - + - - B 4284 - - - - - + + - - - - + - - - - + + - + B 4228 + + - + - + - - + + - - - - - - + + - - B 4426 - - - + - - + - - - - + - - - - + + - +

TOTAL 07 07 01 08 02 03 13 00 08 08 01 13 01 00 05 00 14 10 03 05



97

Table No. 53 showing poorvaroopas observed in Group A Group OPD

No. 01 02 03 04 05 06 07 08 09 10 11 12 13 14

A 3634 + - - + - + + - - - + - - - A 235 + - - + - + + - - - + - - - A 538 + - + - - + + - - - + - + - A 309 + - - + - + + - - - + - + - A 613 + - - + - + + - - - + - - - A 1427 + - - - - + + - - - - - - - A 1715 + - - - - + + - - - + - + - A 502 + - - - - + + - - - + - - - A 3073 + - - - - + + - - - - - - - A 3089 + - - - - + + - - - + - - - A 3069 - - - - - + + - - - - - - - A 3220 + - - - - + + - - - - - - - A 3413 + - - - - + + - - - - - - - A 4023 + - - - - + + - - - - - - - A 4370 + - - - - + + - - - - - + -

TOTAL 14 00 01 04 00 15 15 00 00 00 08 00 04 00 Table No 54 showing poorvaroopas observed in Group B Group OPD

No. 01 02 03 04 05 06 07 08 09 10 11 12 13 14

B 1846 + - - + - + + - - - + + - - B 1968 - - - - - + + - - - + - - - B 2851 + - - + - + + - - - + - - - B 2758 + - - - - + + - - - + - + - B 3216 + - - - - + + - - - + - - - B 3217 + - - - - + + - - - + - - - B 3556 + - + - - + + - - - - - + - B 3591 + - - - - + + - - - - - - - B 3849 - - - - - + + - - - - - - - B 4006 - - - + - + + - - - - - + - B 4039 + - - - - + + - - - - - - - B 4279 - - - - - + + - - - - - - - B 4284 + - - - - + + - - - - - - - B 4228 - - - - - + + - - - - - - - B 4426 - - - - - + + - - - - - - -

TOTAL 09 00 01 03 00 15 15 00 00 00 06 01 03 00 Abbreviations used: 01-Twak parushata, 02-Akasmadromaharsha, 03-Swedabahulya, 04-Asweda, 05-Anga pradesha swapa, 06-Vaivarnya, 07-Kandu, 08-Suptata, 9-Nistoda, 10-Atishlakshnata, 11-Gourava, 12-Mala pradeha over kaya, 13-Kshata visarpa (spreads on injury), and 14-Paridaha



98

Table No. 55 Showing assessment of grading of subjective and objective parameter values of Group – A

Sl. No.

OPD no.

Subjective parameter Objective parameter Shyava krushna varna Parushata Ghanatwa Kharasparsha Kandu PASI

B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T

01 3634 3 1 3 0 3 0 2 0 4 0 4 0.2 02 235 4 1 3 0 3 1 3 1 4 0 30. 3.5 03 538 4 1 3 0 3 1 2 0 4 0 33. 1.4 04 309 4 1 4 0 4 0 4 0 4 0 55.6 3.4 05 613 3 0 3 0 1 0 2 0 4 0 2.0 0.2 06 1427 4 1 3 0 2 0 2 0 4 0 10.8 0.8 07 1715 3 1 3 0 3 1 3 0 4 0 16.6 1.8 08 502 3 1 3 0 2 0 2 0 4 0 5.9 0.7 09 3073 2 1 3 0 2 0 3 0 2 0 2.8 0.2 10 3089 3 1 2 0 1 0 1 0 4 0 8.8 2.4 11 3069 2 1 3 0 2 1 3 0 4 0 11.8 2.3 12 3220 3 1 3 0 3 1 3 0 4 0 14.8 1.4 13 3413 3 0 3 0 2 1 3 1 4 0 15 0.7 14 4023 3 1 3 0 2 1 3 0 4 0 6.4 0.8 15 4370 3 1 3 0 3 1 3 0 4 0 26.2 1.9



99

Table No. 56 Showing assessment of grading of subjective and objective parameter values of Group – B

Sl. No.

OPD no.

Subjective parameter Objective parameter Shyava krushna

varna Parushata Ghanatwa Kharasparsha Kandu PASI

B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T 01 1846 4 1 3 1 3 1 3 1 4 0 36 5 02 1968 4 2 4 1 4 3 2 1 4 0 34.4 7.2 03 2851 3 2 3 1 3 2 2 1 4 2 14.4 8 04 2758 2 1 2 1 2 1 3 2 4 1 11.7 5.6 05 3216 4 1 3 1 3 1 2 1 4 0 8.4 1.2 06 3217 4 2 3 1 0 0 0 0 4 1 10.4 5 07 3556 1 0 3 0 2 1 1 0 3 0 12.2 1.7 08 3591 3 2 3 1 3 1 4 2 4 1 6.4 1.6 09 3849 2 1 3 1 2 1 2 1 4 1 22 1.8 10 4006 4 3 2 1 2 1 3 1 4 1 12.4 4.5 11 4039 3 2 3 2 2 2 2 1 4 0 24.5 11.1 12 4279 3 1 2 2 3 2 2 1 4 2 3.2 1.6 13 4284 2 1 3 2 2 1 2 1 4 1 3.5 1.2 14 4228 4 2 3 1 3 1 3 2 4 0 32.2 14.2 15 4426 2 2 3 2 3 3 2 2 4 3 21.3 19.6

Statistical analysis


100

Table No. 57 Showing Statistical analysis of parameter values of Group – A Sl.

No.

Parameters Mean S.D S.E t-

value

p-

value

Remarks

01 Shyava krushna

varna

2.266 0.7037 0.1817 12.474 <0.001 H.S.

02 Parushata 3.00 0.3779 0.0975 30.769 <0.001 H.S.

03 Ghanatwa 1.866 0.8338 0.2152 8.673 <0.001 H.S.

04 Kharasparsha 2.4666 0.743 0.1918 12.860 <0.001 H.S.

05 Kandu 3.8666 0.516 0.1333 29.00 <0.001 H.S.

06 PASI 14.803 13.755 3.551 4.168 <0.001 H.S.

In Group A, mean of observed values after treatment was calculated and standard

deviation, standard error, ‘t’ values were calculated and was then referred for p-value

which was <0.001. According to this, all the parameters i.e. Shyavakrushna varna,

parushata, ghanatwa, kharasparsha, kandu (subjective parameters) and PASI

(Objective parameter) shown highly significance.

Table No. 58 Showing Statistical analysis of parameter values of Group – B Sl.

No.

Parameters Mean S.D S.E t-

value

p-

value

Remarks

01 Shyava krushna

varna

1.466 0.833 0.215 6.821 <0.001 H.S.

02 Parushata 1.666 0.816 0.2108 8.255 <0.001 H.S.

03 Ghanatwa 1.066 0.703 0.1817 5.8668 <0.001 H.S.

04 Kharasparsha 1.066 0.5936 0.153 6.971 <0.001 H.S.

05 Kandu 3.0666 0.8837 0.2281 13.444 <0.001 H.S.

06 PASI 10.913 9.225 2.382 4.581 <0.001 H.S.

In Group B, mean of observed values after treatment was calculated and standard

deviation, standard error, ‘t’ values were calculated and was then referred for p-value

which was <0.001. According to this, all the parameters i.e. Shyavakrushna varna,

parushata, ghanatwa, kharasparsha, kandu (subjective parameters) and PASI

(Objective parameter) shown highly significance.

Inter group statistical analysis


101

Table No. 59 Showing Statistical analysis of parameters values of inter group (Group – A and Group – B)

Sl. No. Parameter Group Mean S.D S.E P.S.E t-value p-value Remarks

01 Shyava krushna varna A 0.866 0.351 0.0908 0.212 3.146 <0.005 H.S.

B 1.533 0.743 0.191

02 Parushata A 0.00 - - 0.144 8.33 <0.005 H.S.

B 1.2 0.5606 0.144

03 Ghanatwa A 0.5333 0.516 0.133 0.251 3.425 <0.005 H.S.

B 1.4 0.828 0.213

04 Kharasparsha A 0.133 0.351 0.0908 0.1885 5.305 <0.005 H.S

B 1.133 0.639 0.165

05 Kandu A 0.00 0.00 0.00 - - <0.005 H.S

B 0.8666 0.915 0.236 0.236 3.669

06 PASI A 1.446 1.089 0.281 1.423 3.167 <0.005

B 5.953 5.404 1.395

Discussion


102

Discussion:

Discussion is the most important part of any research where the observations

are discussed and given reasons by the researcher. Here researcher conveys the

practical experience with special reference to textual explanations. The significant

results and insignificant results will be discussed in the same section with reasons.

Hence it becomes important to discuss the clinical study in detail.

The discussion is done in the following headings;

1. Discussion on the disease kushta with special reference to kitibha kushta.

2. Discussions on the materials and methods.

3. Discussion on clinical study.

4. Discussions on the patients of kitibha kushta who underwent the trial.

5. Discussions on observations made on results during the trial work. Under two

subheadings as Group A and Group B.

6. Discussion on results.

7. Probable mode of action of the therapy and drug respectively in both groups.

1. Discussion on the disease kushta with special reference to kitibha kushta:

Kushta is a very obnoxious disease which can be compared to various skin

diseases in the modern day science. Kushta is said as deergha roga to indicate the

importance of counseling and preparation of the patient for long time coarse of

treatment. The chikitsa of kushta evenly poised as it may give good fame if treated

and at the same time patients may give a gift in terms of bad fame if it is not cured.

Our sages have cautioned us not to assure the results to the patient and never give the

time by which the disease may be cured by our treatment. The quotation is very

significant as it is told in the agrya prakarana by Acharya Charaka and Acharya

Vagbhatta, meaning of which is this disease kushta holds the first rank when

Discussion


103

chronicity of the disease is considered. Hence one should avoid false promise to the

patient regarding the cure of the disease.

a. Nidana of kushta: regular and excessive consumption of meat is the first

nidana and the predisposing factor noticed in the study. Consumption of raw moolaka

is very common in all most all the houses in this part. Consumption of moolaka used

in sambhar and curry form was used mixing with dugdha and dadhi in most of the

patients. As all the patients were belonging to this local area where the temperature is

very high, the use of dadhi is very much seen that they use to take at night also. Vada

is a special dish simulating to mashandari prepared out of masha pishata mentioned in

Ayurveda was found as positive history in most of the patients. Madhura rasa

atisevana in excess was found positive in the form of consumption of guda mixed

with ghruta with roti and chapatis in this area. Pishtanna was understood as all the

bakery items which are largely prepared using different floors vis-à-vis pishta, also a

special curry is prepared out of chanaka pishta for regular use with roti and chapatti.

Dugdha with amla rasa as a nidana was understood as milk shakes where milk is

mixed with fruit juices which are actually almost amla in rasa along with madhura

rasa. Most of the patients were accustomed to use dadhi and dugdha along with non

vegetarian curries when they take it with rice. Sheeta ushna vyatyasa karma is taken

as exposure to the sun after working in an air conditioned room or taking cold water

bath soon after exposure to sun for longer time and consumption of ice creams after

having food predominantly prepared with katu rasa (ushna in nature). Vyayama after

food is understood as walking for long distance like formers walking to their fields

soon after having food or even cycling, bearing heavy load etc were considered while

taking history. Bhaya Chinta Shoka ref from nidana notes. At last the most important

line to remember is nidana parivarjana is half the treatment for any disease.

Discussion


104

b. Poorvaroopa: most of the patients were having the disease for more than

two years, so they have forgotten the poorvaroopas but when the questionnaire was

given to them or translated in the local language they have given some poorvaroopas

as positive in them which is difficult to accept in any research. Kandu, parushata and

vaivarnyata were most frequently observed poorvaroopas in the present study.

c. Roopa: the reasons because of which patient of kitibha approach a clinician

are kandu and ugly look of the skin. Itching (kandu), dry scaling (parushata and

rookshata) and erythema (krushna and shyava varna), thickness (ghanatwa) of the

lesion (kina) are the most commonly combated signs and symptoms in psoriasis vis-à-

vis kitibha kushta, in the present study also the leading complaints of the patients

remained same. Snigdhata was not found in any case of the study. Srava seems to

have appeared in the initial stages as per the information given by the patient when

asked about history of onset etc. Vartate cha samutpannam or prashantani cha

samutpannam are other frequent roopas observed in the study which means waxing

and waning of the disease without any specific reasons.

d. Samprapti: sapta dravyua samgraha is very important in disease kushta

irrespective of its subtypes. In the literary review it is already discussed under various

headings like nidana, poorvaroopaand roopa to understand the involvement of sapta

dravyas in kushta. Clinically they were experienced. Acharya Vagbhatta was first to

notice the importance of vata in the manifestation of kushta vyadhi. It is interpreted

that vata as is responsible always for vibhajana of garbha is understood as increased

cell division evident in the form of increased mitosis in psoriasis (hyperkeratosis).

The scales are loose dry and silvery white or micaceous due to the presence of air

trapped in between the layers of the scales in psoriasis can be told as the

predominance of vata dosha in kitibha kushta resulting in the parushta, kharatwa and

Discussion


105

rookshata of the vrana sthana. It is said that in the early stage of psoriasis capillaries

in superficial part of dermis are dilated and tortuous which accounts for vivid red

colour of active plaques in psoriasis and there is stasis of blood in turn which is

compared to sanga seen in the rakta and mamsa. Though aetiology of psoriasis is

poorly understood, the involvement of genetics can not be ignored, notably kushta is

told as adibala pravrutta vyadhi involving dushta shukra and shonita. The deeds of

poorvajanma leading to kushta may be interpreted as understanding the entry of atma

in to the garbha through the shukra told by Acharya Charaka in Sahreera Sthana as the

involvement of genetic factors told by the modern science as quoted already in the

psoriasis context.

e. Sadhyasadhyata of kushta: all the Acharyas have told that the vata kapha

pradhana kushta is sadhya. According to this statement kitibha kushta must be sadhya

to treat but its lakshana vartate cha samutpannam told by Acharya Bhela does not

match the sadhya lakshana of a vyadhi. Also the other author Acharya Kashyapa who

says the lakshana as prashantani cha punaha utpadhyate does not match the present

context. Further detailed study and proper understanding of the lakshana will

illuminate us.

f. Arishta lakshanas: in the present study none of the patients were reported

with the arishta lakshanas told in the texts. And the features of dreams got by the

patient were felt to difficult to analyse during the study as they are purely subjective.

g. Kushta chikitsa: After going through the literary search of kushta disease it

was found that the treatment of kushta can be broadly classified as anthahparimarjana

and bahirparimarjana chikitsa. Among this a great importance is given to the first one.

It must be because of the idea that the drug reaches the site of pathology directly. This

concept reaching the site of pathology was followed by modern pharmacologists as

Discussion


106

they say, for most of the dermatological conditions skin is readily available for the

application of the medicine. Most of the topical medication has negligible systemic

absorption and, therefore, few side effects and drug/drug reaction is rare because of

the same reason 235, this makes the advantage of this route. Ayurveda Acharyas have

noted that the result out of this type of the therapy can only be got if it is applied over

the tailakta gatra. This was well followed by the contemporary system of medicine.

They say that few drugs readily penetrate the intact skin. Absorption of those that do

is dependent on their lipid solubility since the epidermis behaves as a lipid barrier.

They also opine that the absorption of the drug through the skin can be enhanced

suspending the drug in an oily vehicle and rubbing the resulting preparation in to the

skin 236. This signifies the utility of taila preparation and utility of abhyanga in the

management of kushta disease, the cutaneous hydration is also said to increase the

rate of absorption of the trans dermal applications, this cutaneous hydration is best

maintained by the application of oil preferably 237. The inability of the

shamanoushadha to reach the vyakta sthana i.e. twacha with in short span of time to

heal the vrana makes the bahirparimarjana chikitsa superior in the context of kushta

chikitsa.

h. Pathyapathya: most of the part of nadana is occupied by the viruddhahara

hence one must be very keen to explain the type of viruddhahara and their adverse

effects. The advice is incomplete if the method of padamshu karma explained by

Acharya Charaka and Chakrapani to leave the apathyas and to adopt the pathya is not

briefed to the patient 238. The utility of tikta shakha is an important tip to the skin

diseased. The pathyahara are almost those which are opposite to the nidanas

mentioned. Patient must keep himself away from all type of non vegetarian dishes

Discussion


107

especially fish as it aggravates the disease so fast that some times it becomes difficult

bring the doshas to normalcy as the disease itself is a bahudoshavasthajanya vyadhi.

i. Vyavacchedaka nidana: there are two schools of thoughts, one saying

kitibha as psoriasis and the other saying ekakushta as psoriasis. The vyavacchedaka

nidana are explained the literary context. The reason for making the comparison is

explained in the same section later.

2. Discussions on the materials and methods:

Drugs used in the trial work were;

a. Siddharthaka snanokta dravya siddha kashaya – for parisheka.

The reason behind choosing the Siddharthaka yoga for the present study was

its ingredients. The ingredients of the medicines were chiefly having kushtaghna

(abhaya, amalaka, saptaparna and aragwada) and kandughna (krutamala, naktamala,

kutaja, daruharidra and musta ) property which encouraged us to take for the trial as

the main complaint of kitibha kushta is ugrakandu. These drugs are well placed in the

respective dashemani gana as in these ganas 10 best and potent drugs are given as

examples. The drugs were kashya tikta rasa pradhana which is very important to heal

the kina (vrana), excess kleda and the kapha dosha in the kitibha kushta. The laghu

rooksha guna also is helpful for drying the excess amount of kleda present in the

body. Most of the drugs were having vata kaphahara or tridoshahara property which

suits to the demands in kushta chikitsa. This was used in the method as already

explained.

b. Siddharthaka snanokta dravya siddha taila – for application before

Parisheka: before kashya parisheka it is important to apply the yathartha rogahara

siddha taila as told by Acharya Charaka. This is also to maintain the cutaneous

hydration so that the active principles present in the kashaya are well absorbed via the

Discussion


108

skin. This taila was asked to apply by self, assisting them by applying taila to back

region where patient can not apply by himself. The pressure during the application

was avoided as fear of bleeding is always there (Auspitz sign). Patient was advised to

sit/sleep quietly on the dhara table for at least 15-20 min as the penetration of the drug

through the dermal route is always great because of hydration when compared to the

dry skin 239. The duration of treatment was about 50-60 min daily for 10 days. There

is no specification for the total time duration and the days for the parisheka, so it was

decided to do it for 50-60 min after calculating the time required for each part of the

body individually as discussed in the materials and methods section.

c. Siddharthaka yoga capsules – for abhyantara prayoga: the siddharthaka yoga

mentioned for bahorparimarjana were analysed for the toxic effects and none were

toxic, but were used for the same disease in one or the other form. The advice of this

same kashaya for vamanartha and virechanartha encouraged us to try this yoga

internally. When the form of drug to be dispensed was considered it was kashaya. But

for the present trial the vastra galita choorna was taken and given bhavana 7 times with

the kashya prepared out of the same ingredients. The reason to choose capsule was; for

easy acceptance by patient, to overcome the astringent and bitter taste of the kashaya,

the advantage of perfect dosage calculation over kashaya so that a uniform dose can be

fixed which is mandatory in any research work, the easy way of dispensing and

patients can easily carry these capsules with them all the time so that there no chance

of missing the dose. Because of the above said reasons capsule form were chosen over

kashaya. For the purpose of potency the drug was given bhavana. When the bhavana

was given the total weight of the powder was increased indicating that the particles

were becoming heavier by each bhavana.

3. Discussion on clinical study.

Discussion


109

Inclusion of the patients in the study was in accordance with the criteria set as

inclusion and exclusion criteria. Patients irrespective of the sex from 15-60 year of

age were included. Cases which were more than for 5 years were excluded from the

study. Those who were having the lesions over genitalia were also excluded as sweda

is contraindicated. Those who were having other systemic diseases were not

considered for the study as the treatment of that systemic disease becomes more

important and the assessment becomes difficult as the general condition of the patient

will not be good. Pregnant ladies and lactating mothers were not considered for the

study as the safety of the therapy and drug in these are not proved before. For Group

A 4 liter of or sufficient quantity of kashaya was used and the study duration was 10

days. Posology was fixed as 3 grams/day and study duration of thirty days in Group

B. For both the groups a follow up of 30 days was fixed. However in Group A

patients the lakshanas started in the third week but was minimal, this may be because

no medication or placebo was given during this follow up period. In group B no

relapse of symptoms ware noted. Totally 34 patients got registered out of which 4

discontinued the trial. All the four were from Group B only the reason for the

discontinuity was not known as the patient did not consult even after contacting them

by phone. Patients were divided randomly in to two groups.

Laboratory investigations: Though there is no significance of the laboratory

investigations in the psoriasis disease routine blood investigations like Hb%, T.C.,

D.C. and E.S.R. were done to assess the general condition of the patient and to

exclude the other systemic diseases. Also in research when a new form of medication

which is not in practice earlier has to look for adverse reactions on normal

homeostasis of the body, the only method to assess adverse reactions is by assessing

the blood picture. In the present study no significant changes were noticed apart

Discussion


110

decimal variations in the readings before and after the treatment which may be

because of human errors. The safety of the drug thus internally is proved with the help

of blood picture.

4. Discussions on the patients of kitibha kushta who underwent the trial.

Age: Maximum numbers of patients were from 46-60 years age group.

Though there is no clear explanation regarding age of onset, these observations do not

match with the earlier researches and is difficult to draw any conclusion by this study

involving minimum number of patients.

Sex: males dominated the attendance in the study when compared to females.

This supports the earlier research works. Some scholars of recent times opine that the

rakta of stree becomes shuddhi every month as dushta rakta is expelled out in the

form of raja srava, so the incidence of dermatological problems are comparatively

lesser than males.

Religion: in the present study maximum patients were from Hindu religion.

But there are no references of earlier research works interpreting the religion with

psoriasis.

This particular observation may be because of Large Hindu dominated region.

Economical status: in the study most patients were from middle class status.

The reason must be the inclusion of labors whose earning is good enough in this class.

Occupation: in the present study most were from labor class. The next were

of sedentary occupation. The inclusion of all field workers (formers) doing heavy

works in this group must have influenced.

Nature of work: maximum patients were from stressful working

environment. The reason must be the manasika karana as hetu and precipitating factor

of the disease.

Discussion


111

Ahara (matra and kala): most of the patients reported with madhyama matra

ahara. Next were taking bahu matra ahara which is again told as nidana of the vyadhi

and few were consuming alpahara who were females. Most of the patients were taking

ahara at regular time. Those who were not taking at regular time were occupationally

disturbed.

Rasa: people of this part of Karnataka are accustomed of using more katu

rasa. The next predominant rasa used was madhura in the form as discussed in the

nidana context under the same heading.

Guna of ahara: most of the patients used dry type of food without ghee or

butter. This may be the reason that the vata got aggravated to lead to the disease

kushta as clarified by Acharya Vagbhatta.

Type of ahara: most of the patients were of mixed diet which once again

shows the significance of mamsa and matsya in the manifestation of kushta. However

once after being diagnosed as kitibha kushta either they have reduced the intake or

stopped completely.

Hygiene: most of the patients have maintained fair hygiene and only one was

of poor hygiene who underwent parisheka for 10 days and he was explained the

importance of good hygiene in maintaining the health.

Manaska sthiti: patients were suffering from chinta bhaya and shoka because

of the ugly appearance of the skin and the fear of dejection by the society. The

importance of manas has already been discussed in the nidana context earlier. The

CNS innervates dendritic cells in the lymph nodes and spleen, langarhans cells in the

skin and other antigen presenting cells. The nerve endings release neurotransmitters

that exaggerate and enhance local immune responses. For this reason some skin

Discussion


112

conditions such as psoriasis aggravates when person is under stress (Martini,

Fundamentals of anatomy and physiology, by: Frederic H. martin, William C. Ober

etc, 4th edition, Page no 808, Prince hall Upper Saddle river, New Jersey 07548,

1998). This simulates the quotation by Acharya Charaka as ‘Vishado roga

vardhananam’(Cha.Su.25/40) holds good for every disease especially to the kushta

disease.

Nidana: mostly observed nidana in the patients were mamsa and matsya

sevana, excess madhura and amla rasa intake, raw moolaka, excess use of masha,

guda, dadhi and pishta vikara. The reason by which these nidanas manifest the disease

kushta has been already depicted in the tabular form in the literary review section.

The method of collection and interpretation of all these nidanas are dealt earlier. Havi

prashana (madhura bhakshyas prepared with excessive ghruta during yagnya) as

quoted by Acharya Charaka in the context of mythological oregine of the disease in

the nidana sthana last chapter as use of excess snigdha ahara in the present era

Poorvaroopa: patients were unable to recollect what first had happened to

their skin as the disease was manifested long ago. But most patients revealed that they

had kandu, twak parushyata and vaivarnyata then piakodbhava which later invaded

the whole body.

Roopa: all the lakshanas were observed in the patients except snigdha sparsha,

the colour of the kina was some times seen as krushna and some times appeared as

shyava varna. The changes in the colour may be because of the predominance of the

doshas.

Discussion


113

Table no showing the similarity between kitibha kushta and psoriasis.

Kitibha Psoriasis Shayava, krushna and aruna varna kina

Erythema

Khara sparsha of the kina (lekhana is the karma of this guna)

Dry lesion, scaling

Parushata Dryness and scaling Srava Flow of exudates from lesion in early

stage of psoriasis206 (Boyd’s pathology/)

Vrutta Rounded plaques (Harrison, vol, 311). Ghana Thickness of the lesion. Stable plaque

(Harrson, vol, 311). Ugra kandu Lesions are variably pruritic

(Harrison, vol, 311). Vartate cha samutpannam/ Prashantani cha punaha utpadhyate

The disease may aggravate without any apparent cause as discussed already or flare up of psoriasis can occur randomly240

Site of onset: most of the trial patients got the onset in their scalp followed by its

spread to the whole body, in only one patient since one year the lesion from head has

not spread to the other part of the body.

Time/season of aggravation and mode of onset: in maximum patients the

time of aggravation was during night hours. The season was winter. Patient duly

considered the kandu in to the account. Few were getting aggravation in the day time

may be because of the irritation due to the exposure to sun. In most, the disease was

gradually manifested.

Discussion


116

Kula vruttanta: only one patient was observed to have kulavruttanta which

does not appear to match with the earlier data available as the numbers of samples are

too small to draw a conclusion.

Chikitsa vruttanta: all the patients approached have taken allopath treatment,

notably they approached us because they were not satisfied with the results and the

increased awareness in them about the adverse effects of steroid therapy.

Confirmatory signs: all the patients were reported with positive candle grease

sign and Auspitz sign. Koebner sign was reported in few. This must be because of the

fact that we have not included patients suffering with this disease for more than 5

years.

5. Discussions on observations made on results during the trial work:

Assessment of the results was done by considering the subjective criteria and

objective criteria. Totally 5 subjective criteria were taken and grading from 0-4 was

given for no, mild, moderate, severe and extensive respectively. PASI scoring was

considered as objective parameter. The efficacy any drug is important to convey to the

modern world is by conducting the trial works drawing the statistical significance and

calculating the % of improvement by taking the readings after giving them universally

acceptable grading. The statistical result showing the significance has already been

discussed in the observation part. Here % of improvement is calculated to know the

efficacy and net improvement in the condition.

For this purpose the values were observed numerically which are given the

grading from 1 to 4.

Step1 – All the values of before treatment of subjective and objective parameters were

added to get the sum. Now this is the condition in which the patient had approached

us, so it becomes the base line data. This is taken as 100%.

Discussion


117

Step2 – The readings of after treatment was then added to get the sum, which is the

status of the patient after the treatment.

Step3 – Now the % of the condition after the treatment is calculated by dividing this

number with the base line data obtained by the step 1. This should then multiply by

100 to get the % after the treatment.

Step4 – the % of improvement is calculated by subtracting the value got by step 3 by

100 will yield the net improvement in the disease.

Step5 – this value was referred for the table postulated to declare the results and the

table is

Sl. No. Range of net improvement % Remarks 1 100% CR- complete remission 2 75-99% BR- best response 3 50-74% MR-moderate response 4 25-49 % MiI- mild response 5 <25% NR- no response

Declaration of the result by above method:

Group A

Sl.No. Impression No. of patients % of patients 1 Best response 15 100

In this group the result was very quick to show. On the second day of the treatment

itself the chief compliant kandu was reduced to 50 % or even more. Three days after

the dhara total relief from kandu was noted. The sign parushata and rookshata were

observed to decrease slowly; on the fifth or sixth day complete absence of rookshata

was noted. Ghanatwa was relieved after five or six days of dhara. The colour of the

skin was last to become normal approximately on the 8th day. Patients were satisfied

totally with the treatment as kandu was suddenly relieved. The additional effect of the

dhara was found to induce good sleep as told by the patients voluntarily. In the follow

Discussion


118

up period slight itching was noted in three cases where as none other lakshanas

relapsed. The last lesion to disappear or present even after the treatment in this group

of patients was that present in the low back (sacral region).

Group B

Sl.No. Impression No. of patients % of patients 1 Complete remission 0 00.00 2 Best response 4 26.66 3 Moderate response 8 53.33 4 Mild response 2 13..33 5 No response 1 6.66 Figure 28 showing the overall statement of results

Patients of Group B were not relieved by the signs and symptoms like those in Group

B. No relief was found in kandu and other symptoms and signs up to one week after

this the patient started getting relieved from all the lakshanas steadily. The additional

effect of the drug was said to improve the digestive capacity of the patients. During

the follow up none of the lakshanas were noted to appear in any cases.

0

15

0

4

8

21

0

19

8

21

0

2

4

6

8

10

12

14

16

18

20

Gro up A Gro up B T o tal

C o mplete remissio nB est respo nseM o derate respo nseM ild respo nseN o respo nse

Results


119

Table 60 Showing the overall statement of results of Group A Group A

Subjective parameters PASI Overall improvement OPD no.

B.T A.T Net Improvement

B. T

A.T Net improvement

Impression

Score % Score % Score % Score % Score Score % Mean of net improvement of subjective & objective parameter

3634 15 100 1 6.6 14 93.34 4 100 0.2 5 95 94.17 B.R. 235 17 100 3 17.64 14 82.36 30. 100 3.5 11.51 88.49 85.425 B.R. 538 16 100 2 12.5 14 87.5 33. 100 1.4 4.21 95.79 91.645 B.R. 309 20 100 1 5 19 95 55.6 100 3.4 6.11 93.89 94.445 B.R. 613 13 100 0 00 00 100 2.0 100 0.2 10 90 95 B.R. 1427 15 100 1 6.6 14 93.34 10.8 100 0.8 7.40 92.6 92.97 B.R. 1715 16 100 2 12.5 14 87.5 16.6 100 1.8 10.84 89.16 88.33 B.R. 502 14 100 1 7.14 13 92.86 5.9 100 0.7 11.86 88.14 90.5 B.R. 3073 12 100 1 8.3 11 91.67 2.8 100 0.2 7.14 92.86 92.265 B.R. 3089 11 100 1 9.01 10 91 8.8 100 2.4 27.27 72.73 81.865 B.R. 3069 14 100 2 14.2 13 85.72 11.8 100 2.3 19.49 80.51 83.115 B.R. 3220 16 100 2 12.5 14 87.5 14.8 100 1.4 9.45 90.55 89.025 B.R. 3413 15 100 2 13.33 13 86.67 15 100 0.7 4.66 95.34 91.005 B.R. 4023 15 100 2 13.33 13 86.67 6.4 100 0.8 12.5 87.5 87.085 B.R. 4370 16 100 2 12.5 14 87.5 26.2 100 1.9 7.25 92.75 90.125 B.R. Range of net improvement % - 100%-CR- complete remission, BR- best response-75-99%, MR-moderate response-50-74%, MiR- mild response-25-49 % Group B

Results


120

Table 61 Showing the overall statement of results of Group B

Subjective parameters PASI Overall improvement OPD no.

B.T A.T Net Improvement

B.T A.T Net improvement Mean of net

improvement

of subjective

& objective

parameter

Impression

Score % Score % Score % Score % Score % Score %

1846 17 4 23.52 13 76.48 36 100 5 13.88 31 86.12 81.3 B.R. 1968 18 7 38.88 11 61.12 34.4 100 7.2 20.93 27.2 79.07 70.095 M.R 2851 15 8 53.33 7 46.67 14.4 100 8 55.55 6.4 44.45 45.56 Mi.R 2758 13 6 46.15 7 53.85 11.7 100 5.6 47.86 6.1 52.14 52.995 M.R 3216 16 4 25 12 75 8.4 100 1.2 14.28 7.2 85.72 80.36 B.R. 3217 11 4 36.36 7 63.64 10.4 100 5 48.07 5.4 51.93 57.785 M.R. 3556 10 1 10 9 90 12.2 100 1.7 13.93 10.5 86..7 90 B.R3591 17 7 41.17 10 58.83 6.4 100 1.6 25 4.8 75 66.915 M.R. 3849 13 5 38.46 8 61.54 22 100 1.8 8.18 20.2 91.82 76.68 B.R 4006 15 7 46.66 8 53.34 12.4 100 4.5 36.29 7.9 63.71 58.525 M.R. 4039 14 7 50 7 50 24.5 100 11.1 45.30 13.4 54.7 52.35 M.R 4279 14 8 57.14 6 42.86 3.2 100 1.6 50 1.6 50 46.43 Mi.R 4284 13 6 46.15 7 53.85 3.5 100 1.2 34.28 2.3 65.72 59.785 M.R. 4228 17 6 35.29 11 64.71 32.2 100 14.2 44.09 18 55.91 60.31 M.R 4426 14 12 85.71 2 14.29 21.3 100 19.6 92.01 1.7 7.99 11.14 N.R. Range of net improvement % - 100%-CR- complete remission, BR- best response-75-99%, MR-moderate response-50-74%, MiR- mild response-25-49 %

Discussion


121

Conclusion on statistical analysis:

To compare the mean effect of the two groups after the treatment, the

statistical analysis was done by using un-paired test, by assuming that the mean effect

after the treatment in two groups. Here all the parameters shown highly significant i.e.

the mean effect of the treatment is not same in both the groups. In Group A the

parameters parushata and kandu, the mean effect is zero, it shows there is a complete

cure in these parameters (by comparing p-value and t-value).

To compare the effect of the drug before and after the treatment, the statistical

analysis was done by using paired-t test, by assuming that the drug is not responsible

for changes in the observations before and after the treatment. Here all parameters

have shown highly significant in both the Group (by comparing p-value).

But in Group A, all most all the parameters had shown more highly significant

than Group B (by comparing t-value).

In parameters shyava krushna varna, parushata and kandu were more highly

significant in Group A than Group B, with high net mean effect and less variations

(by comparing mean and variance).

Parameter ghanatwa in Group A shown more net mean effect with more

variation than the Group B (by comparing mean and S.D.), but parameter

kharasparsha in Group A shown more net mean effect with more variations than the

Group B (by comparing mean and S.D.).

Parameter PASI in Group A shown less more significant than the Group B, but

there is more net mean effect in Group A than in Group B and variation was less in

Group B

Discussion


122

Mode of action of the medicine/therapy: Group A – Parisheka: As stated already

the drug applied over the skin directly reaches the site of pathology being skin. As

discussed earlier in the same section of discussion the absorption of the medicine

increases by causing cutaneous hydration. The utility or anointing the body before the

parisheka as told by the Acharyas is to promote easy absorption through the skin

which provides the cutaneous hydration, by this the drug easily comes in contact with

the twachasthita bhrajaka pitta after its successful absorption. Once the active

ingredient of medicine reaches the level of bhrajakagni, the drug is made sajateeya at

this level. This will then bring back the normalcy in the skin. Moreover the Seers have

told us to use the yathartha siddha taila for application so the active ingredient of the

medicine also gets in to the body through the skin in this manner as it is said already

that the drug entry through the skin may be made easy by suspending in the oily

media. The drugs were chiefly of the tikta and kashaya in rasa which have got readily

the vrana ropana guna. The guna of these drugs are also opposite to kapha, the main

dosha for kandu to manifest. The dosha karmas of these drugs are told already as

kaphavatahara and some as tridoshahara, this yoga is estimated to bring down the

increased dosha at the site of pathology. The cumulative effect of triphala is told as

vranaropaka, this when used in the form of parisheka may yield this effect. The main

pathology told in psoriasis is increase in the rate of mitosis of keratinocytes which is

interpreted as increased vata guna and karma. Also as swedana is the choice of

treatment for the vata, the siddharthaka yoga kashya parisheka is expected to decrease

vata by the swedana effect. The taila application before the sweda will also help the

process but the snehana can not alone impart the result if swedana is not followed

after. So the swedana effect also plays a major role in kitibha kushta chikitsa. It can be

stated that anga gourava, a poorvaroopa of kushta might get relieved by the virtue of

Discussion


123

swedana effect. The other pathology of kushta is told as retention of excessive kleda

in the body because of swedavaha sroto avarodha, this avarodha can be relieved by

swedana as the phalashruthi of sweda is swedakaraka. The last is the cumulative

effect of the yoga spoken in the context of mode of action of any drug; here some of

the ingredients of this yoga are blessed with the prabhava of kushtaghna and

kandughnata in them, so it is important to end discussion of mode of action of

Siddharthaka yoga parisheka by saying that its effect is because of prabhava of the

yoga. It is important to recall the statement; ‘patients with less than 15% body surface

area involvement can be treated effectively with topical agents alone’241. Meaning of

which says all nothing more than the significance of external therapy in the disease

psoriasis. Stress and other psychological factors are going to worsen the condition

(Vishado rogavardhananam), so to overcome this, dhara would be a better choice.

Mode of action of Siddharthaka capsules: The ingredients of the medicine are

kushtaghna and kandughna as already stated and are estimated to relieve the disease.

On dosha, the drugs have vata kaphahara and tridoshahara effect so these are

interpreted as bringing the doshas to the normal state. The guna of the drugs like

musta and kalingayava have got grahee guna in them which are drava shoshaka i.e. in

this context it is taken as kledashoshana, rooksha guna present in musta, hareetaki,

kalingayava and daruharidra is said to perform the kledashoshana of the present in

excess in kushta rogi. Madanaphala etc. drugs have got vranahara, kapha vatahara

Tripahalas are used for virechanartha as stated by Acharya Charaka in first chapter

which help in taking the doshas, this effect is of minimal extent. Acharya Sushruta

says the cumulative effect of triphala as kushta and meha hara and also vranaropaka.

The deepana pachana property of the drugs corrects the dhatu paka so that there is

proper nourishment of the twacha and they avoid the excessive kleda formation.

Conclusion


124

Conclusion:

All the texts of Ayurveda have explained kitibha kushta in kshudra kushta, and

dosha predominance as vata kapha except Acaharya Sushruta who says it as due

to pitta.

Samanya nidana, poorvaroopa and samprapti of kushta are accepted for the

kitibha kushta also as separate explanation regarding kitibha kushta nidana,

pooraroopa and samprapti are not available in kushta chikitsa adhyayas.

Kitibha with its lakshanas simulates to psoriasis of modern science and was

considered for the convenience of this study.

Shyava krushna varna of kina, parushta and ugra kandu are the lakshanas in

kitibha kushta rogi making their life miserable.

Administration of bahirparimarjana chikitsa is inevitable in the skin diseases

especially in kitibha kushta.

For the hospital supervision and assessment snana was modified in to parisheka in

this study.

Siddharthaka yoga parisheka is effective in kitibha kushta in controlling shyava

krushna varna, parushata, ghanatwa, kharasparsha and kandu. It reduced the PASI

scoring remarkably.

Last lesion to disappear was from the low back (sacral region).

No adverse effects were reported after parisheka in the present study.

Taila application/abhyanga before parisheka is a must.

Siddhrtha yoga capsule is effective in the management of kitibha kushta.

Conclusion


125

Reduction in shyava krushna varna, parushata and kandu were more highly

significant in psoriatic after parisheka than those administered with the

Siddharthaka yoga capsules.

No adverse reactions were reported in this study by the administration of

Siddharthaka yoga capsules.

The efficacy Siddharthaka yoga bahya prayoga is more significant than the

abhyantara prayoga.

Limitations of the study:

Sample size was very small to universalize the results.

Sample selection was random in the present study.

It was difficult to assess exact mode of action of Siddharthaka yoga as it is a

compound preparation containing as many as 10 ingredients.

Recommendations for the future study:

The same study can be taken for the study including large number of samples.

Study can be done to evaluate the efficacy of parisheka after shodhana.

Study can be done on cumulative effect of bahya and abhyantara prayoga of

Siddharthaka yoga.

Efficacy of parisheka can be studied with and without the taila application.

Bibliography


128

Bibliography: 1. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 1, shloka no. 120, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no, 22. 2. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), , reprint, 2004, Page no. 27-29. 3. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no.40 , edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no, 132. 4. Acharya Agnivesha, Chakrapani, Charaka Samhita, Sootra sthana, chapter, 3, shloka no.1 , edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 27 5. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 3, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 27. 6. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 33, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 144. 7. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 4, shloka no. 8/13-14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 33. 8. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 3, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.28. 9. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 7, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 28. 10. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 11, shloka no. 49, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP) reprint, 2004,, Page no. 77. 11. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 13, shloka no. 35, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.84.

Bibliography


129

12. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 18, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 160. 13. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 19, shloka no. 4/2, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 110. 14. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 22, shloka no. 24, reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 121. 15. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 23, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 122. 16. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 24, shloka no. 16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 124. 17. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 132. 18. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 42/3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 144. 19. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter, 26, shloka no. 42, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 144. 20. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 103, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 151. 21. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 28, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 179 22. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 219.

Bibliography


130

23. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter, 7 shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 337. 24. Acharya Agnivesha, Charaka Samhita, Indriya sthana, chapter 5, shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 119 25. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 26. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 29, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no, 451. 27. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 11, Shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 146. 28. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 30, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 29. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 34, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 289. 30. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 22-25, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 31. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 28, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 32. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 29, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 33. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 33, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 144.

Bibliography


131

34. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 4, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 355. 35. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 442. 36. Acharya Bhela, Bhela Samhita, Nidana Sthana, Chapter 5, Shloka no. 1-4, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 150. 37. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 24-25, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 330. 38. Acharya Harita, Harita Samhita, third sthana, chapter 39, edited by Ramavalamba Shastri, Prachya prakashan, 74-A, Jagatganj, Varanasi-221002, first edition, 1985, page no. 367-374. 39. Acharya Vruddha Jeevaka, Kashyapa Samhita, Chikitsa Sthana, Chapter Kushta chikitsa, pandit Hemaraja Sharma, edited by Sri Satyapal Bhishagacharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2006, Page no. 116. 40. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 139-146. 41. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 4, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524. 42. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 6, collected by Dr. Anna Moreshwar Kunte and Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 43. Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 2nd Chapter, Shloka No.136-142, edited by Pandit Parushurama Shastri, Vidyasagar, , Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition 1983, Page No.162.

Bibliography


132

44. Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 2nd Chapter, Shloka No.87-90, edited by Pandit Parushurama Shastri, Vidyasagar, , Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd Edition 1983, Page No.98. 45. Acharya Basavaraja, Basavarajeeyam, 13th prakarana, Sri Govardhana Sharma Changani, 1987, page no. 215. 46 Acharya Lolimbaraja, Vaidhyajeevanam, foorth vilasa, 18th shloka commentator Dr. Indradeva Tripathi, , Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition, 2005, Page no. 51. 47. Sri. Tarakanath, Tarka Vachaspatya, vol 3, Chowkhambha Series, 1970, page no. 2154 page. 48. Sri Haragovinda Shastri, Amarakosha, 3/6/54, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K. 37/16, Gopal Mandir lane, Varanasi (UP), 4th edition, 2001, Page no. 283. 49. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 2, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 139. 50. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 3-4, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 109. 51. Raja Radha Kantha deva, Shabda Kalpadhruma, Chowkhambha Sanskrit series, P.B.8, Varanasi, 3rd edition, Page no.126, 52. Shri. Kavirama Umeschandra, Vaidhyaka Shabdha Sindhu, , Chowkhambha Orientalia P.B.32, Varanasi, 2nd edition 1983. page no.272. 53. Sanskrit English dictionary, Sir. Monier Monier – Williams, Mittal Banarsidas Publishars Pvt. Ltd., Varanasi, 221001, reprint 1993, Page no. 282, 54. Sri. Tarakanath, Tarka Vachaspatya, vol 3, Chowkhambha Series, 1970, page no. 2046 page. 55. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 8, shloka no. 51, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 350.

Bibliography


133

56. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 15, shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 514. 57. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 5, shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 250. 58. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 4, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 355. 59. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Shareera sthhana, Chapter 2. Shloka no. 23, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 445. 60. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 8, shloka no. 10, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 56. 61. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 1, Shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 339. 62. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 4, shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 318. 63. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 12, Shloka no. 14, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 194. 64. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 21, Shloka no. 10, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no.101. 65. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 7, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.337. 66. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 4, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 355.

Bibliography


134

67. Dr. Bhaskar govind Ghanekar, Sushruta Samhita Sanskrit text with Ayurveda rahasya deepika hindi commentary, Shareera sthana, 4th chapter, shloka no- 3, page no.- 104-108, reprint 1995, Meharchand Lachman Das Publication, dariaganj, New Delhi, 110002. 68. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 1, Shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 339. 69. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 4, shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 318. 70. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 28, shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 616. 71. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 12, Shloka no. 14, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 194 72. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 8, shloka no. 103, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 228. 73. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 11, Shloka no. 17, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 185 74. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 11, Shloka no. 7, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 183 75. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 15, Shloka no. 5(1), edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 68. 76. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 15, shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 514-515.

Bibliography


135

77. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 15, shloka no 17 , edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 514-515. 78. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 15, Shloka no. 5(2), edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 68. 79. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 6, reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthanm P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no.217.

Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 4-8,

reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthanm P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 450. 80. Acharya Bhela, Bhela Samhita, Nidana Sthana, Chapter 5, Shloka no. 1-4, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 150.

Acharya Bhela, Bhela Samhita, Nidana Sthana, Chapter 6, Shloka no. 4-10, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 328. 81. charya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 13, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 286.

Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 442. 82. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 2, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 639. 83. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 1-2, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 84. Acharya Madhavakara, Madhava nidana, Chapter49, Shloka no. 1-6, revised and edoted by Sri Sudarshana Shastri, Prof Yadunandana Upadhyaya, part 2nd,

Bibliography


136

Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, page no. 153. 85. Bhavamishra, Bhavaprakasha, Part-2, chapter no. 54, shloka no. 1-6, edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 518. 86. Acharya Yoga Ratnakara, Yoga Ratnakara, kushta nidana, shloka no. 1-4, edited by Bhishagratna Sri Brahmananda Shastri, , Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 211. 87. Acharya Vangasena, vol 2, Kushta nidana chapter, shloka no. 1-5, by, Nirmal sexena, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 728. 88. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 5, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 89. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 7, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 258. 90(Su.Ni.5/34s). 91. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 27, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 92. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 13, shloka no. 75-76, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 86. 93. Acharya Agnivesha, Charaka Chikitsa sthana, chapter 14, shloka no. 179, reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 518. 94. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 4, shloka no. 27, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 430. 95. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 19, shloka no. 16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 550.

Bibliography


137

96. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 27, shloka no. 212, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 164. 97. Acharya Sushruta, Acharya Dalhana, Sushruta Samhita, Chikitsa Sthana, Chapter 5, Shloka no. 13, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 424. 98. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 86-101, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 150. 99. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 45, Shloka no. 185, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 211. 100. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 27, shloka no. 82, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.158. 101. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 155, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 227. 102. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 20, Shloka no. 13, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 93. 103. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 9. Shloka no. 6, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 136. 104. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 84, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 150. 105. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 266, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 233. 106. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B n. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 131-132.

Bibliography


138

107. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 83, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no 149.. 108. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 9. Shloka no. 3, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 135. 109. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 20, Shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 9 6. 110. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 96, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 151. 111. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 98, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.151. 112. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 25. Shloka no. 38, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 307. 113. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 520, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 252. 114. Acharya Laghu Vagbhatta, Acharya Hemadri, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka no. 18, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 12 115. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 517, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 252. 116. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 450.

Bibliography


139

117. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 19, Shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 17. 118. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 5, Shloka no. 31-33, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 70-71. 119. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 42, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 143. 120. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 1, shloka no. 18, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 234. 121. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 132. 122. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 42/2, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 144. 123. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 7. Shloka no. 191, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 104. 124. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 38. Shloka no. 25, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 411. 125. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 131-132. 126. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 7, shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 49. 127. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 99, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 151.

Bibliography


140

128. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 1, shloka no. 16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 234. 129. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 9, Shloka no. 5, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 166 130. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 9. Shloka no. 12, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 137. 131. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 87-88, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, reprint, 2004, Varanasi (UP), Page no. 150-151. 132. Acharya Vruddha Vagbhatta, Acharya Indu, Ashtanga Sangraha, Sutra sthhana, Chapter 6. Shloka no. 54, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 65. 133. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 218. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 11-12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 134. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 15-17, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 329. 135. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 283. 136. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 8, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640.

Bibliography


141

137. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 11-12, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 138. Acharya Madhavakara, Madhava nidana, Chapter 49, Shloka no. 8-9, revised and edoted by Sri Sudarshana Shastri, Prof Yadunandana Upadhyaya, part 2nd, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, page no. 156. 139. Bhavamishra, Bhavaprakasha, Part-2, chapter no. 54, shloka no. 13 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 526. 140. Acharya Yoga Ratnakara, Yoga Ratnakara, Nidana sthana, shloka no. 21, edited by Bhishagratna Sri Brahmananda Shastri, , Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 214. 141. Acharya Vangasena, vol 2, Kushta rogadhikara chapter, shloka no. 11, by, Nirmal sexena, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 730. 142. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Chkitsa sthana, chapter 7, shloka no. 22, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 143. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka no. 18, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 12. 144. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 22, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 145. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 24-25, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 330. 146. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 286.

Bibliography


142

147. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 16, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 641. 148. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 20-21, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 525. 149. Acharya Madhavakara, Madhava nidana, Chapter 49, Shloka no. 18, revised and edoted by Sri Sudarshana Shastri, Prof Yadunandana Upadhyaya, part 2nd, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, page no. 158. 150. Bhavamishra, Bhavaprakasha, Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 529. 151. Acharya Yoga Ratnakara, Yoga Ratnakara, Kushta nidana, shloka no. 21, edited by Bhishagratna Sri Brahmananda Shastri, , Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 214. 152. V.S. Ku.rogadhikara/20 V.S. Ku.Ni.1-5Acharya Vangasena, vol 2, Kushta nidana chapter, shloka no. 20, by, Nirmal sexena, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 731. 153. Acharya Vruddha Jeevaka, Kashyapa Samhita, Chikitsa Sthana, Chapter Kushta chikitsa, pandit Hemaraja Sharma, edited by Sri Satyapal Bhishagacharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2006, Page no. 116. 154. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 155. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 156. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 9, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 218.

Bibliography


143

157. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 9-10, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 450. 158. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 282. 159. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 8-10, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 328. 160. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 3-5, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640. 161. Acharya Agnivesha, Charaka Samhita, NIiidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 162. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 163. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 217. 164. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 282. 165. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 217. 166. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 167. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Shareera sthhana, Chapter 6. Shloka no. 45, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no.495.

Bibliography


144

168. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 11, shloka no. 48, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 77. 169. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 132. 170. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 171. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 172 Cha.Ni. 5/8, Cha.Chi.7/20 Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 218.

Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 20, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 173. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 5, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 283. 174. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 14-19, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640-641. 175. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 21-26, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451.

176.Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 9-16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 285-286. 177. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 12-22, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640-642.

Bibliography


145

178. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 38, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.452. 179. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 28, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 180. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 31, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 643. 181. Acharya Agnivesha, Charaka Samhita, Indriya sthana, chapter 5, shloka no. 14-15, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 362. 182. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 84-161, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454-458. 183. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 25, shloka no. 45, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 133. 184 Lolimbaraja, Vaidhyajeevanam, prathama vilasa, 10th shloka, commentator Dr. Indradeva Tripathi, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition, 2005, Page no. 4. 185. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 5, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 442.

Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 72, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 448. 186. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 82-83, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454. 187 Mahamahopadhyaya Vishwanatha Sena, Pathyapathya Vinischaya, Prem Kumar and M.M. Padi, Kendreeya Ayurveda evam Siddha Anusandhana Parishad, Jawaharlal Nehru Bharateeya chikitsa evam homeopathy anusandhana bhavan, 61-65, Samsthanika kshetra, Sammuk ‘D’ block, Janakapuri, New Delhi, 110058, 1999, Page no.83.

Bibliography


146

188. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 282. 189. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 83, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454. 190. R.G Valia, IADVL Text book and atlas of dermatology, Vol. I, Chapter 2, second edition, Bhalani publishing house, Bombay, 1994, Page no. 8-11.

R.G Valia, IADVL Text book and atlas of dermatology, Vol. I, Chapter 5, second edition, Bhalani publishing house, Bombay, 1994, Page no. 142-147. 191 A.C.Ritchei, Boyd’s text book of pathology, 9th ed., vol 2, chapter 62, K.M. Varghes Company, PB no.7119Bombay 400031, 1990, page no. 1985-1986 192. Behcet PE, Psoriasis, a brief historical review. Arch Dermatol Syphilol 1936; 33:327–334. 193. Farber EM, McClintock RP Jr. A current review of psoriasis Calif med 1968; 108: 440 – 457 194Baker H. psoriasis: a review. Dermatologica 1975; 150:16-25 195. Lane CG, Crawford GM. Psoriasis a statistical study of two hundred and thirty one cases. Arch Dermatol Syphilol 1937, 35: 1051-1061. 196. Ambady BM, Gopinath T, Nair BKH. Psoriasis. Indian J Dermatol Venereol 1961; 23: 27 – 34. 197. Bedi TR. Psoriasis in children. Indian J Dermatol Venereol 1979; 45: 410 - 413 198. Lal S. clinicalpattern in psoriasis in Punjab. Indian J Dermatol Venereol 1966; 35:5 – 12 199. Sharma T, Sepha GC. Psoriasis – a clinical study. Indian J Dermatol Venereol 1964; 30: 191 – 197 200. Kaur I, Kumar B, Sharma VK, et al. epidemiology of psoriasis in a clinic from North Indian. Indian J Dermatol VenereolLeprol 1986; 52:208 - 212. 201. Farber EM, Nall ML, Watson W. natural history of psoriasis in 61 twin pairs. Arch dermatol 1974; 109:207 – 211

Bibliography


147

202. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health press Oxford 2004, page no.8. 203. Eugine Braunwald, Stephen L. Hauser, Anthony S. Fauc et.al.Vol-1, chapter 56, McGraw- medical publishing division, 15th edition, 2001, page no. 312. 204. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health press Oxford 2004, Page no.9. 205. Nicholas A Boon, Nicki R. Colledge et.al, Davidson’s Principle & Practice of Medicine, chapter 13, Cristopher Haslett & Others, 20th Edition, Harcourts Publishers, 2006, Edinburgh, UK, Page n. 1288. 206. Nicholas A Boon, Nicki R. Colledge et.al, Davidson’s Principle & Practice of Medicine, chapter 13, Cristopher Haslett & Others, 20th Edition, Harcourts Publishers, 2006, Edinburgh, UK, Page n. 1289. 207. Fast Fact Psoriasis, second ed,Alan Menter MD et al. Chapter 1, Health press Oxford 2004, Page no.9. 208. A.C.Ritchei, Boyd’s text book of pathology, 9th ed., vol 2, chapter 62, K.M. Varghes Company, PB no.7119Bombay 400031, 1990, page no. 1985-1986 209. Alan Menter MD et al. Fast Fact Psoriasis, , Chapter 1,. Health press Oxford, second edition, 2004, page no.9. 210. 203. Eugine Braunwald, Stephen L. Hauser, Anthony S. Fauc et.al.Vol-1, chapter 56, McGraw- medical publishing division, 15th edition, 2001, page no. 312. 211. R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, second edition, Bhalani publishing house, Bombay, 1994, Page no. 714. 212. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health press Oxford 2004, Page no.14. 213 R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, second edition, Bhalani publishing house, Bombay, 1994, Page no. 714. 214. R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, second edition, Bhalani publishing house, Bombay, 1994, Page no. 714. 215. Alan Menter MD et al., Fast Fact Psoriasis, second edition Chapter 3, Health press Oxford 2004, Page no.25-30. 216. Alan Menter MD et al. Fast Fact Psoriasis, second edition. Chapte4, Health press Oxford 2004. Page no.31-69,

Bibliography


148

217. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 92, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454-455.

Acharya Vruddha Vagbhata, Astanga sangraha, Vol. 2, Chikitsa Sthana, Chapter 21, Shloka no.119, translated by Prof. K.R. Shrikantha Murthy, First edition, 1996, Chaukhambha Orientalia, Varsnasi, Page no.509.

Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Chikitsa Chapter 19 Shloka no.

60, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 715 218. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 15, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 92. 219. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Sutrasthana, chapter 13, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 79. 220. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 1, shloka no. 135, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 23.

221. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 28, shloka no. 30, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 180. 222. Acharya Sushruta, Dalhana, Sushruta Samhita, Uttra Tantra, Chapter 40, Shloka no. 166, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 166. 223. Acharya Agnivesha, Charaka Samhita, Chikitsasthana, chapter 14, shloka no. 92, edited by Dr. Brahmanand tripatyhi, Choukhamba Surabharati Prakashan, P.B no. 1129, K.37/117, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 319. 224. Bhavamishra, Bhavaprakasha, edited by Brahmashankara Mishra and Rupalalaji Vasya, Part-1, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 243, 77, 10, 9, 7, 350, 68, 346, 119, 546.

Bibliography


149

Prof. P.V. Sharma, Dravyaguna vignana, Vol-2, Chawkhambha Bharati Academy, P.B no. 1005, K.37/109, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 370, 373, 758, 239, 753, 144, 170, 463, 537, 702. 225. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 29, Shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 503. 226. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 1, Shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 397. 227. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 14, shloka no. 19, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 90. 228. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 11, shloka no. 44, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 90. 229. Acharya Vruddha Vagbhatta, Acharya Indu, Ashtanga Sangraha, Sutra sthhana, Chapter 26. Shloka no. 5, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 312. 230. Acharya Sushruta, Sushruta Samhita, Uttra Tantra, Chapter 39, Shloka no. 156-157, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 684. 231. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 1, Shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 399. 232. Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 2nd Chapter, Shloka No.1 & 2, Translated by Prof. K.R. Srikanta Murthy, First Edition 1984, Varanasi, Chawkambha Orientalia, Page No.56. 233 Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 9th Chapter, Shloka No.1 & 2, Translated by Prof. K.R. Srikanta Murthy, First Edition 1984, Varanasi, Chawkambha Orientalia, Page No.115. 234. PASI (Psoriasis assessment tools in clinical trials S R Feldman, G G Krueger Downloaded from ard.bmj.com on 4 May 2007

Bibliography


150

235. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi.) 236Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi. 237. Anthony S. and Fanci, Joseph B. Martin, etc., Harrison’s principles of medicine, Vol-l, part-2, chapter 55, 14th edition, Mc Graw Hill health publishers divisions, New Delhi, page no. 300 238. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Sutra sthana, chapter 7, shloka no. 36-37, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 51-52. 239. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi. 240. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 65, page 1804, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi. 241. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 65, page 1804, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi.

Summary


126

Summary:

The present study entitled “A comparative clinical study of ‘siddharthaka yoga

‘parisheka and abhyantara prayoga in the management of ‘kitibha kushta’ with the special

reference to ‘psoriasis’ was taken for the trial in search of the route of administration of

the for the effective treatment of kitibha kushta vis-à-vis psoriasis. The drug was same for

both antahaparimarjana and bahirparimarjana chikitsa so that the result will not influence

by the change of medicines.

The objectives of this trial was to evaluate the efficacy of siddharthaka yoga parisheka in

kitibha kushta, to evaluate the efficacy of siddharthaka yoga abhyantara prayoga in

kitibha kushta, to evaluate the comparative efficacy of siddharthaka yoga parisheka and

abhyantara prayoga in kitibha kushta. For the convenience of the study snana was

modified to parisheka and kashaya to capsules. The patients were selected from O.P.D

and I.P.D. of D.G.M.A.M.C & H. they were examined for their inclusion and exclusion

in the study. Totally 30 number of patients were divided in to two groups. 15 patients of

Group A underwent Parisheka for 10 days and 15 patients of Group B received 3 grams

of capsules in 3 divided doses for 30 days. Follow up was 1 month for both the groups.

The readings of subjective and objective parameters before and after the treatment

were noted and were calculated for statistical significance using paired and un-paired

Student-t test.

Observations made in the trial revealed the highest significance (36.6%) in the 46-

60 age group, male dominated the attendance (70%), Hindu religion were more (83.3%),

middle class patients were more (83.3%).

Summary


127

The result was best response in all (100%) patients of Group A than those of

Group B (26.6%). Maximum patients of Group B patients got moderate response

(53.33%).

In the present study the bahya prayoga in the form of parisheka has shown highly

significant results than the abhyantara prayoga of Siddharthaka yoga.

Annexure


1

SRI DANAPPA GURUSIDDAPPA MELMALAGI AYURVEDIC MEDICAL COLLEGE, POST GRADUATE & RESEARCH CENTRE, GADAG.

SPECIAL CASE SHEET OF KITHIBHA KUSHTA (PSORIASIS), AS TAKEN FOR THE DISSERTATION WORK UNDER THE TITLE - “A COMPARITIVE

CLINICAL STUDY OF ‘SIDDHARTHAKA YOGA’ PARISHEKA AND ABHYANTARA PRAYOGA IN THE MANAGEMENT OF ‘KITIBHA KUSHTA’

WITH SPECIAL REFERENCE TO ‘PSORIASIS’”.

Guide: Dr. Varadacharyulu M.D. (Ayu) Prof. & Head, P.G. Dept Of Kaya chikitsa. D.G.M.A.M.C. Gadag.

Co - Guide: Dr. Raghavendra V. Shettar M.D. (Ayu) Asst. Prof. P.G. Dept Of Kaya chikitsa. D.G.M.A.M.C. Gadag.

Scholar: Ashok M.G. Name of the patient Sl. No. Father’s name/ Husband’s name OPD No. Age (in years) IPD No. Sex: Male Female Bed No. Religion Hindu Christian Muslim Others Economical Status Poor Middle cl. Rich Occupation Birth place Marital Status Case referred by Residential address: …………………………………….. …………………………………….. …………………………………….. ……………………………………..

Permanent address …………………………………….. …………………………………….. …………………………………….. ……………………………………..

Mobile ph. Number Land ph. Number INFORMED CONSENT

I Son/Daughter/Wife of am

exercising my free will, to participate in above study as a subject. I have been informed to my

satisfaction, by the attending physician the purpose of the clinical evaluation and nature of the drug

treatment. I am also aware of my right to opt out of the treatment schedule, at any time during the

course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æÃªÀÄw _________________________________________________ £À£Àß ¸ÀéEZÉÒ¬ÄAzÀ

PÉÆqÀÄªÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀÄªÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ

0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.

gÉÆÃV0iÀÄ gÀÄdÄ / Patient's Signature

Annexure


2

Pradhana vedana:

Sl.No. Pradhana Vedana Present Absent Kala prakarsha 1. Shyavavarna Kina 2. Krishnavarna Kina 3. Parushata Kina 4. Ghana 5. Khara sparsha 6. Snigdha sparsha 7. Ugra kandu

Anubandha vedana

Sl.No. Vedana Present Absent Kala prakarsha 1. Daha 2. Raga 3. Srava 4. Vedana 5. Shaitya 6. Kleda 7. Gaurava Adhyatana vyadhi vrittanta if any

Site of onset Scalp Knee Elbow Ear lobe

Mode of onset Sudden Gradual After injury

Aggravation Aggravating time Day Night Aggravating season Summer Rainy Winter Contact with chemicals Anti malarial medicine

Nature of work Stressful Near heat Traveling Purva vyadhi vrittanta if any

Annexure


3

Kula vrittanta Maternal Parental

Chikitsa vrittanta Ayurveda Allopathic Homeopathy Unani Naturopathy Details if any

Vaiyaktika vrittanta Ahara

Matra Bahu Madhyama Alpa Kala Regular Irregular 2

times 3 times

Rasa Madhura Amla Lavana Katu Tikta Kashaya

Guna Guru Laghu Snigdha Ruksha

Type Vegitarian Mixed Vihara

Vyasana Type Alcohol Tobacco Chewing

Smoking Tea/ coffee

Particulars

Nidra Type In hours Diwaswapa Ratri

Hygiene Good Fair Poor Occupation Student Labor Executive Sedentary

Samanya Pareeksha General condition

Blood Pressure(in mm of Hg)

Temperature (oF)

Pulse / min Weight in kgs Height in cms. Vital Systemic Examination

C.V.S. S1 , S2 Murmurs R.S. Lung Field Locomotor Psoriatic arthritis Per abdomen Soft Tender Organomegaly

Dashavidha pareeksha Prakruti Satmya Vikruti Satwa Sara Ahara shakti Samhanana Vyayama shakti Pramana Vaya

Annexure


4

Ashtavidha pareeksha Nadi Rate Shabda

Mala Varna Consistency Sparsha

Times/day

Mootra Varna Druk Times/day

Jihwa Akruti Manasika pareelksha

Chinta Shoka Bhaya VYADHI VISHESHA PAREEKSHA

Twak parreksha Kinah pareeksha - Darshana Shyava varna Krishna varna Srava Vritta Snigdha Site % Site % Site % Upper limb Lower limb: Head/ Neck Rt. Anterior Rt – Anterior Scalp Rt.Posterior Rt – Posterior Face Lt. Anterior Lt – Anterior Neck Lt.Posterior Lt – Posterior Chest: Abdomen Ctrunk Posterior Posterior Posterior Posterior Posterior Posterior Sparshana Kharatwa Parushata Ghana Dry Moist Greasy Dosha lakshanas: Vata Pitta Kapha Confirmatory signs (subjective): Candle grease sign Auspitz sign Koebnar phenomena Objective parameter:

Annexure


5

Vikruti pareeksha: Hetu: Aharaja: Milk with fish Milk with flesh Milk with acidic foods Excess madhura rasa Excess amla rasa Excess lavana rasa Dadhi Ikshu vikara Navanna Matsya Mamsa Excess snigdha Raw moolaka or with milk Adhyashana Pishtavikara Ati jala sevana after gharma shrama,

bhaya

Masha Tila Viruddha if any other Guda Viharaja Chardi vega dharana Cold bath / swimming soon

after sunbath

Vyayama/vyavaya/santapa after bhojana or during ajeerna

Diwaswapna

Panchakarma apachara Sneha aticharana Papa karma Vipra guru gharshata Purvaroopa Twak parushata Akasmadromaharsha Kandu Swedabahulya Asweda Anga pradesha swapa Parushyata Vaivarnya Nistoda Atishlakshnata Gourava Mala pradeha over kaya Kshata visarpa (spreads on injury) Paridaha Upashaya Samprapti ghatakas Vata Shyava Aruna Ruksha Khara Vedana Pitta Daha Raga Srava Kapha Kleda Ghana Snigdh

a Kandu Shaitya Gaurava

Annexure


6

Dushya Twak Sparshahan

i Swedana Ishatkand

u Vaivarna Ruksha

RAKTA TwakSwapa

Romaharsha Sweda abhinirvartana

kandu Drgandha/ Vipuyaka

MAMSA

Bahulya Vaktra shosha Karkasha Pidakodgama

Toda sphota sthira

MEDA Dourgandya

Upadeha (Malavriddhi)

puya Krimi Gatra bheda

ASTHI & MAJJA

Nasabanga

akshiraga Krimi at Kshata

Swaropaghata

SHUKRA

Jata Kushti

Kounya (kara bhanga)

Agni Manda Teekshna Vishama Sama

Ama Sraotas Rasavaha

Raktavaha

Mamsavaha Srotadushti prakara Udvhava sthana Vyakta stahana Adhishtana Roga marga Vyadhi vinischaya Roga prakruti

Kashta sadya

Yapya Anupakrama

Upadrava if any

Annexure


7

Annexure


8

CHIKITSA:

GROUP – A (Bahya) Started on: Completed on: Follow up:

PASI Before treatment Sl.No Head Upper

extremities Trunk Lower

extremities 1 Redness + 2 Thickness + 3 Scaling + 4 Sum of 1,2 and 3 5 Area score 6 Score of row 4Xrow

5Xthe area multiplier

row 4 X row 5 X 0.1

row 4 X row 5 X 0.2

row 4 X row 5 X 0.3

row 4 X row 5 X 0.4

7 Sum row 6 for each column for PASI





row 4 X row 5 X 0.1

row 4 X row 5 X 0.2

row 4 X row 5 X 0.3

row 4 X row 5 X 0.4


Before treatment After treatment PASI

Sl. No.

Subjective Parameter B.T 2nd day 4 day 6th day 8th day 10th A.T

1 Shyava krushna varna 2 Parushata 3 Ghanatwa 4 Kharasparsha 5 Kandu

Annexure


9

CHIKITSA:

GROUP – B (Abhyanara) Started on: Completed on: Follow up:





row 4 X row 5 X 0.1

row 4 X row 5 X 0.2

row 4 X row 5 X 0.3

row 4 X row 5 X 0.4






row 4 X row 5 X 0.1

row 4 X row 5 X 0.2

row 4 X row 5 X 0.3

row 4 X row 5 X 0.4


Before treatment After treatment PASI

Sl. No.

Subjective Parameter

B.T First week

Second week

Third week

After the treatment

1 Shyava krushna varna

2 Parushata 3 Ghanatwa 4 Kharasparsha 5 Kandu

Annexure


10

Laboratory investigations

Investigator’s note: Signature of the Scholar Signature of the guide

Sl. No. Laboratory investigations

Before treatment After treatment

1 Hb% 2 Tc 3 Dc

E B N M L

kitibha kc040 gdg

Documents

kayachikitsa dgmamc

research centregadag

genuine research

ayu asst

academic research purpose

college pharmacy

management of kitibha

management ofkitibha