Jaluka prachana vicharchika_pk018_gdg

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Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika, Prasannakumar.L Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Jaluka prachana vicharchika_pk018_gdg

  1. 1. LIST OF ABBREVATIONS01. Cha.S: CharakaSamhita02. Su s: Susrutha Samhita03. AH: Ahstangha hrudaya04. B.S: Bhela Samhita05. K.S: Kashyappa Samhita06. Y.R: Yogaratnakar07. V.S: Vangasena Samhita08. MIL: Mildly improved09. MOD: Moderately improved10. P.R.: Poor response11. G.R: Good response12. N.R: No response
  2. 2. TABLE OF CONTENTS Chapters Page No.1. Introduction 1-42. Objectives 5-63. Review of Literature 7-864. Methodology 87-1055. Observation and Results 106-1366. Discussion 137-1507. Conclusion 151-1528. Summary 153-1549. Bibliography I-XI10. Annexure A-H.
  3. 3. LIST OF TABLESSl.No. Tables Page. no.1. Classification of Raktamokshana by different Acharyas 13.2. Contraindications of Raktamokshana 143. Indications of Raktamokshana 154. Synonymous of Jalouka 205. Types of Savisha and Nirvisha Jaloukas 206. Characteristic feature of each Savisha Jalouka 217. Characteristic feature of each Nirvisha Jalouka 228. Layers of skin according to Charaka 449. Layers of skin according to Susruta 4510. Co-relation between Ayurvedic and Modern skin layers 4611. Classification of Kushta on the basis of dosic predominance 5912. Classification of Kushta on the basis of dosic predominance 5913. Aharaja Kushta Nidanas according to different acharyas 6114 Viharaja Kushta Nidanas according to different acharyas 6215 Daiva apacharaja Nidanas according to different acharyas 6316. Poorva roopas of Kushta 6517. Roopas of Kushta 7218. Chikitsa of Kushta 7419. Sapeksha Nidana for Vicharchika 7720. Drugs used in Jaloukavacharana 9021. Chemical Composition of the drugs 9122. Distribution of Patients according to age groups 10723. Distribution of Patients according to sex 10824. Distribution of Patients according to religion 10925. Distribution of Patients according to occupation 11026. Distribution of Patients by economical status 11127. Distribution of Patients by dietary habit 11228. Distribution of Patients according to Vihara 11329. Distribution of Patients by agni 11430. Distribution of Patients by koshta 11531. Distribution of Patients by Nidra 11632. Distribution of Patients by Vyasana 11733. Distribution of Patients by Dehaprakrithi 11834. Distribution of Patients by satva 11935. Distribution of Patients by satmya 12036. Distribution of Patients according to martial status 121
  4. 4. 37. Distribution of Patients according to onset 12238. Distribution of Patients according to nidana 12339. Distribution of Patients according to family history 12440. Distribution of Patients according to chronicity 12541. Distribution of Patients according treatment history 12642. Distribution of Patients according to type 12743. Master Chart-Subjective parameter-Group-A 12944. Master Chart-Subjective parameter- Group-B 13045. Master Chart-Objective parameter-Group-A 13146. Master Chart-Objective parameter-Group-B 13247. Showing statistical analysis of Group-A 13348. Showing statistical analysis of Group-A 13349. Showing statistical analysis of Group-B 13450. Showing statistical analysis of Group-B 13451. Showing comparative statistical analysis 135
  5. 5. LIST OF FLOW CHARTS Page no. 1. Showing classification of Raktamokshana 13 2. Samprapthi of Kushta according to Charaka 67 3. Samprapthi of Kushta according to Susrutha 68 4. Samprapthi of Kushta according to Vagbhata 68LIST OF FIGURES 1. Stratum Basale 51 2. Dermis 52 3. Cross section of the skin 53LIST OF PHOTOGRAPHS 1. Showing the Materials and Methods 87 2. Picture showing before and after treatment 128
  6. 6. LIST OF FIGURES1. Distribution of Patients according to age groups 1072. Distribution of Patients according to sex 1083. Distribution of Patients according to religion 1094. Distribution of Patients according to occupation 1105. Distribution of Patients by economical status 1116. Distribution of Patients by dietary habit 1127. Distribution of Patients according to Vihara 1138. Distribution of Patients by agni 1149. Distribution of Patients by koshta 11510. Distribution of Patients by Nidra 11611. Distribution of Patients by Vyasana 11712. Distribution of Patients by Dehaprakrithi 11813. Distribution of Patients by satva 11914. Distribution of Patients by satmya 12015. Distribution of Patients according to martial status 12116. Distribution of Patients according to onset 12217. Distribution of Patients according to nidana 12318. Distribution of Patients according to family history 12419 Distribution of Patients according to chronicity 12520. Distribution of Patients according treatment history 12621 Distribution of Patients according to type 12722. Over all response in both the groups 128
  7. 7. ABSTRACTBeauty is either skin deep i.e. Superficial or the purity of soul itself the later which isimplied to satwa guna is penultimate and is beyond physical afflictions. Complexion,colour etc. attributed to the healthy status of twak (skin) and the humors and theformer is mean of sensory perception and the vata dosha pervades in it. People wholive in urban areas and in climates with low humidity seen to be at increased risk fordeveloping atopic dermatitis. WHO reveals that more than 75 million people all overthe world have this disease.In review of literature part there was a detail description of Jaloukavacharana,Prachana, Vicharchika and brief description of Rakthamokshana is mentioned.Objectives of the study:(1) To evaluate the efficacy of Jaloukavacharana in Vicharchika.(2) To evaluate the efficacy of Prachana in Vicharchika.(3)To evaluate the comparative efficacy of Jaloukavacharana and Prachana in Vicharchika.Subjective Parameters:Rajyam, Kandu, Rujaha, Rooksha, Pidakas, Shyava and Daha.Objective Parameters:Sites of the lesion, size of the lesion, colour of the lesion Thick ness of the skin and srava.
  8. 8. Source of Data:Patients suffering from Vicharchika were selected from the P.G.S and R (Panchakarma)OPD and IPD of Shri D G Melmalgi Ayurvedic Medical College and Hospital, Gadag.Discussion:After the treatment result was calculated by using unpaired “t” test, and also discussedabout the disease and treatment with probable mode of action.In Group-AIn Jaloukavacharana group after 4 sittings there was a good response only for Kandu(77.55%) and Srava (77.27%). Other parameters like Colour of the lesion (71.05%), daha(56.66%), and Rookshata (51.85%) was moderately responded. The remainingparameters like Rayjam (34.28%), Ruja (42.85%), Pidakas (47.05%), Size of the lesion(24.24%), Sites of the lesion (12.90%), and Thickness of the skin (44.82%) was mildlyresponded.In Group-BIn Prachana group after 4 sittings there no good response i.e, more than 75% of relief inany Parameters.Parameters like Size of the Lesion (51.35%), Srava (58.82%), Kandu(55.55%), Ruja (51.85%), Pidakas (51.51%), Daha (61.11%) and Thickness of the skin(64.86%), was moderately responded.Conclusion:Group-A was comparatively better than the Group-B
  9. 9. Acknowledgement This work is the result of the combined effort of a good number of people whoinclude researchers, academicians, friends, colleagues, and above all the patients whocooperated with us in all aspects. Moreover it is because of Gods’ grace only the workcould be completed as per to my expectation. My deep sense of gratification is due for my parents Dr.K.Loganathan, (Retd:Medical officer) and L.Vasanthi, who are the architects of my career. The culture,discipline and perseverance, which I could imbibe, are solely because of theirpainstaking, upbringing and strong moral support. I express my deep gratitude to my respected guide and HOD Dr.G.Purushothamacharyulu, MD.(AYU) for his sympathetic, compassionate, extensiveguidance, suggestion, encouragement and kindheartedness. I am extremely happy to express my deepest sense of gratitude to my respectedco-guide Dr. Santosh N. Belavadi,MD(AYU) whose sympathetic, scholarly suggestions andablest guidance at every step have inspired me not only to accomplish this work but in allaspects. I am deeply indebted and sincerely gratefulness to my Principal, Dr. G.B. Patil, D. G. Melmalgi Ayurvedic Medical College, Gadag for their continuouscooperation and timely encouragement at various levels of my study. Indeed, the affectionate guidance of my teachers Dr. P. Shivaramudu,Dr.P.Suresh Babu, Dr.Yasmeen, and Dr.Rajasekar, will be cherished by me for long.Their invincible and radical thinking were very valuable in achieving this research workinvoking scientific spirit throughout the course of the study. I am grateful to all the PG, teachers Dr.Samudri, Dr.K.S.R.Prasad, andDr.R.V.Shettar .Dr.KuberSankh. Dr.Danappagoudar, Dr.M.C.Patil for their valuableinputs and suggestions. I extend my immense gratitude to Dr. C. S. Hiremath, Dr. S. A. Patil,Dr.B.G.Swamy, Dr.S.H.Reddar and Dr. Purad and other teaching staff who helpedduring my study. i
  10. 10. My sincere thanks are extended to my beloved teacher U.G.TeachersDr.L.Mahadevan, Ramdass, K.T.Jayakrishnan, Dr.K.P.Muralidharan, Vasudevareddy,Naraharareddy, S.Swaminathan and Venugopal. for their inspiration and valuablesuggestions. I also very much thankful to Mr and Mrs: Habib Khatib for providided meresidence at gadag. I seek privilege to extend my obligations to my seniorsP.chandramouli, A.A.N.Uday, Ratnakumar, and Ashwinidev. I cannot move further before thanking to my intimate friends Anjai,Krishnakumar, T.V.Dhanvanthri, S.E.Siva and S.G.Sundarraman, Soumya, Poompavai,Girija, Anusreedileep, Raman, Priya who helped me in each and every circumstance andgave me in depth sense of friendship. I also thank Lab-Technincian, (Tippanna), Statistician (Nandakumar) andLibrarian (Mundianamani) for their timely help. I am highly under the debt of my beloved friends Dr.Sreeja, Dr.T.S.Sajini andDr.V.Rani who have helped in all the moments during my Post Graduate studies. I take this moment to express my thanks to all my Post Graduate senior colleaguesDr. Mahantesh, Dr. Jayaraj, and my Colleagues Dr.Madhushree, Dr.Siba,Dr.Payappagouder, Dr, Budi, Dr.Ashok, Dr.Shivaleela, Dr.Kamalakshi, Dr.Sulochana,Dr.Kataraki, Dr.Shalinisharma and my junior colleagues Deepak, Jayasankar, Natraj.C,Shailej, Udayganesh, Sanath, Rajesh, Mukta, Sabareesh, sanjeev, P.Joshi and Adarsh. I bow my head with lots of prayers in my heart in front of my grandparentsSmt.Rajammal, Sunderapillai and Thaila who always shower their blessings on me. I am really grateful to my brother in law, Ashokkumar (M.Chem), and my sisterAnu who in the right time directed me to join this college for my Post Graduation. Last but not least, I thank to the patients who are pillars of my research work,Hospital staff and to all those names my memory fails to recollect. Prasannakumar.L ii
  11. 11. Introduction... 1 INTRODUCTION Beauty is either skin deep i.e. Superficial or the purity of soul itself the laterwhich is implied to satwa guna is penultimate and is beyond physical afflictions.Complexion, colour etc. attributed to the healthy status of twak (skin) and the humors andthe former is mean of sensory perception and the vata dosha pervades in it.Brajaka pitta vis a vis twak RogaBrajaka pitta resides in the twak and is responsible for the complexion and helps in bioutilization of Lepa (Pastes), anointed oils (Taila) etc. applied on the skin. There are 7layers twak has been enumerated and are the substratum for various kushtha (Skindiseases).Disease considerations A. Physical considerations B. Psychological considerations C. Social considerations D. Economic considerationsA. Physical considerationsVicharchika is a variety of kushtha and is classified under 11 types of skin diseases(Kshudra Kushtha). It is having the predominance of vata & kapha dosha. The signs andsymptoms of it include, Atikandu, Vartiruja, Ruksha, Rajyam, etc. Which are incomparison to that of eczema in contemporary Medicine.By means of Nidana sevana the dosha gets vitiated and results in Vicharchika as an effectof Dosha dushya Sammurchana. It brings an alteration in the beauty of an individual byafflicting the twak and in due course becomes a cosmetic concern. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  12. 12. Introduction... 2B. Psychological considerationsAs described earlier it is a cosmetic concern, which results in stress and reflects in psychof that individual.C. Social considerationsIt is true in case of Vicharchika as the diseased out of cosmetic concern and thinkingabout the act of itching in social places tries to avoid social interaction and mingling withco-workers.These entities Vicharchika will even have its effect over inter personal relationships.Thus have a say over the family relationships.D. Economic considerationsDue to the disease the dejected and stressed individual will not work up to his ability,which affects his economy and the economy of the nation in turn. These physical andpsychological concerns bring out gross changes in his personality, social relationshipsand working abilities ultimately becomes a psychosomatic concern.Twak vis a vis Mamsa dhatuIt has been stated in classics that twak (skin) is the Upadhatu of mamsa. Just as a layer ofcream forms on the milk when it is being cooked, similarly Twak gets formed at the timeof formation of Shukra and rajas. This happens during foetus formation inside the uterus.Twak Vis a Vis Rakta dhatuDuring the transformation healthy Rakta Dhatu accounts for the genesis of healthymamsa Dhatu. And the later has twak as Upadhatu. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  13. 13. Introduction... 3At this juncture we can infer that the ill formation or abnormalities in Raktadhatu canbring out an alteration in Mamsa dhatu, which is reflected in skin. Thus there is aconcomitant relationship between Twak and rakta dhatu, which shouldn’t be neglected.Immunity vis a vis Rakta dhatuLack of immunity in general is attributed to any skin diseaes, which in turn is dependenton Rakta Dhatu and Ojus. Pitta dosha even shares a unique relation ship with Sweda andRakta dhatu because of ashraya Ashrayi bhava.Spread of diseases –relation ship with treatmentDiseases are Uthana (superficial) or Gambhira (deep seated). The former afflicts thesuperficial dhatu’s i.e. Rasa rakta etc. and the later afflict deeper dhatu’s i.e. MamsaMedas etc.The mode of spread and the roga marga involved influences the prognosis of anydiseases. The involvement of dhatus gives us a clue about the treatment modalities, whichhas to be under taken i.e. either shamana in case of superficial manifestations orShodhana in case of deep-seated manifestations.Among these Shodhana is considered as the best as it treats the disease from its root andaccounts for the complete remission of the ailments.Importance of Panchakarma-in kushtha managementPanchakarma the specialty of Ayurveda is a boon to the suffering humanity as it is themean of shodhana and thus accounts for regression of diseases, which is considered evenin the treatment aspects of degenerating ailments. The later implies to its capacity torecreate or regenerate the ill tissues. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  14. 14. Introduction... 4Importance of Raktha mokshana in VicharchikaAlmost all the Acharyas has mentioned that Raktamokshana should be done once in 6months. Acharya Susruta has emphasized the significant importance of Rakta Dhatu ashe went up to an extent and considered it as a Dosha. The best treatment for the vitiatedrakta is Rakthamokshana, as stressed by both Acharyas Susruta and Charaka.Raktamokshana includes Prachana and Jalaukavacharana out of theses the former is forlocalized area and the later is in case of Pitta associations of Rakta.Right from the ancient days leeches are used in medical practices and are used to treatemboli and thrombus as the leech contains Hirudin and is safer anti coagulant.Leeches are even used in the patients of chronic ulcers, bedsores and cellulites etc. as theleeches by sucking the blood improves the circulation of the effected area and helps infaster healing. Leech sucks only impure blood is described in Ayurveda.Prachana is the procedure by which the impure blood of the localized region is let out.Thus by taking in to consideration of magnanimity and ill effects of the diseaseJaloukavacharana and Prachana are the simple techniques; can be practiced very easily,Also, these are indicated in the management of Vicharchika and has less adverse effects.Hence it is the intended to study the effect of Raktamokshana in the management ofVicharchika and to compare the efficacy of Jaloukavacharana and Prachana inVicharchika. So the present study “EVALUATION OF THE COMPARATIVEEFFICACY OF JALOUKAVACHARANA AND PRACHANA IN VICHARCHIKAwas undertaken. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  15. 15. Objectives… 5Need for the study: Panchakarma is one of the important therapeutic procedures in Ayurveda,with different treatment modalities. Raktamokshana is one of the major Panchashodhana procedures, which is exclusively indicated in Raktaja and PittajaVyadhis1 .As increase in pitta in the body causes accumulation of toxic productsresults in several diseases to expel these vitiated doshas Shodhana is required. It isof two types (1) Sthanika (2) Sarvadahika. Hence to expel out the shakashritadoshas in Kushta, Raktamokshana is the only procedure, Depending on the vyadhithey are planned and adopted to normalise the vitiated pitta and rakta. Skin is oneof the largest organ of the body, is prone to get affected by various disorders. Useof Ayurvedic treatment for various skin disorders have increased enormously orthere is no much effective treatment in other systems of medicine. The disease is sufficiently high enough in incidence in order to plan aneffective management. Atopic dermatitis is often referred to as “eczema” which isvery common; it affects males and females equally and accounts for 10-20% ofthe total world’s population2, People who live in urban areas and in climates withlow humidity seen to be at increased risk for developing atopic dermatitis. WHOreveals that more than 75 million people all over the world have this disease. In recent and past, Ayurvedic scientists at various centres with an aim tostudy the Vicharchika and to evolve safer and economical medicaments for it,have carried out with clinical studies. This study reveals that Ayurvedic treatmentComparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  16. 16. Objectives… 6 is successful to a some extent to relieve Kandu, Ruksha, Srava, shyava, Pidaka etc. So the present study was undertaken. Some of the previous work done in Vicharchika are as follows:• Pranita M.Asatkar - A Clinical study on the role of Jaloukavacharana & Virechana in the management of Kshudra Kushta w. s. r. to Dermatitis, K.C., 1995, Jamnagar.• Kethan S. Bhimani – A comparative study of Virechana karma and Jaloukavacharana in the management of Vicharchika KC, 2005, Jamnagar• Tahelramani (Ms.) A.S. – Vicharchika Mein Jaloukavacharana Evam Shamana, K.C., 1986, Ahmedabad• Shuryavanshi M.N. – Vicharchika Roga Mein Jaloukavacharana ka Chikitsatmaka Adhyatana, S.S., 1993, Ahmedabad• Manoj Kumar Sharma – The efficacy of Jaloukavacharana & Laghu Manjishthadi Kwatha (Ghanavati) w.s.r. to Vicharchika (Eczema), S.T., 2002, Ahmedabad. Objectives of the study (1) To evaluate the efficacy of Jaloukavacharana in Vicharchika. (2) To evaluate the efficacy of Prachana in Vicharchika. (3) To evaluate the comparative efficacy of Jaloukavacharana and Prachana in Vicharchika. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  17. 17. RAKTAMOKSHANAINTRODUCTION: The Raktamokshana procedure is considered one among the Panchashodanas3. Raktamokshana is a process of letting the vitiated blood out of the body asa treatment procedure in disease caused by Rakta or pitta and carried out either byusing sharp surgical instruments or by means of parasurgical measures, in selectedpersons with quantity only. Siravyadhana a variety of Raktamokshana is considered to be the halftreatment of Shalya tantra where as Vasti in Kayachikitsa4. The Word “Raktam” from the root “Ranaj” and the word “Mokshana” fromthe root “Moksha” meaning “to relieve or to let out.” The literal meaning of the word“Mokshana” is to shed or to cause to flow out5.Historical Review: According to our classics, the first record of the systematic knowledge is fromVedas. So it is hard to tense any pre Vedic references regarding indigenous, medicalpractices of any kind, so also Raktamokshana.Vedic period: Raktamokshana (Process of Blood Letting) can be traced back to Vedic periodonly and not beyond that. In the Koushika sutra of Atharvaveda, references ofRaktamokshana by leech application are available6. During the period of Buddha, thisprocess was in regular practice, which could be easily understood from Pilindavachha,a patient of Buddha in whom he did Raktamokshana by Shringa for parvavata.
  18. 18. Review of Raktamokshana…. 8Samhita period:Sushruta and Vagbhata focused on the Raktamokshana in detail. In Sushruta Samhitaand Ashtanga sangrahas, separate chapters on Siravyadha and Jaloukavacharana aredescribed Charaka, the renowned physician of ancient school of medicine (not givenmuch importance to surgery), also gives brief description on this topic.Sangraha period:Bhavamishra and Sharangdhara have discussed Siravyadha vidhi, while describing themanagement of various diseases.Fifth century B.C:The usefulness of bloodletting was found to be in controversy.Seventeenth century:The use of bloodletting was very popular for the treatment of hysteria in England.Eighteenth and nineteenth centuries:Bloodletting experienced a great vogue because, the beliefs about Swasthya andVyadhi in the eighteenth century were based on those held by the ancient Greeks.In 18th century blood letting was practiced as the last therapy for those patients inwhom all the other treatments fails.Venesection is often mentioned in connection with Anglo-Saxon leechcraft. There isalso explanation of cupping7.The word "Phlebotomy" is now, in the modern day, defined as the practice ofremoving or "letting" blood for diagnostic, rather than therapeutic reasons 8,9By reading all these together, it can be understood that the art of Raktamokshana waswidely practiced globally since long back. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  19. 19. Review of Raktamokshana…. 9 DESCRIPTION OF RAKTA The word Rakta is derived from the root ‘Rraj’ meaning to give colour to thebody. “Rajathe Angam Iti anena Iti Raktam”10Synonyms: Raktam, Rudhiram, Rohotam, Asruk, Shonitam, Lihitam, Aswam,Angagam, Swajam, Twagjam, Keetajam, Rangakam11.Importance of rakta: Rakta is stated to be the moola or root of the body, as it causesDharana, hence it is known as dhatu. Thus Rakta needs to be cared of and wellprotected as it is as important as jeeva and it is one of the pranayatana12. Shuddharakta is responsible for Bala, Varna, Sukha and Ayushya13.Formation of rakta: The subtle liquid principle known as Rasa, while circulating inthe body, when reaches Yakrut, Pleeha attains red colour due to Tejas and will beknown as Rakta, which keeps the bodily tissues in healthy condition14. By the administration of proper regimen, with due regard to the place, timeand habit, pure blood is formed in human beings.Panchabhoutikata of rakta:Human body is made up of five Mahabutha (primordial elements) such as Akasha,Vayu, Teja, Jala and Pruthvi. The Gandha, Dravata, Ragata, Sarata and Laghuta gunasof rakta represents Pruthvi, Jala, Agni, Vayu and Akasha respectively15.Characteristics features of Shuddha rakta:The Shuddha rakta should be known to the colour of Indragopa (bright red colour likethat of cochineal insect) and should neither be Asamhata (too thick) nor Avivarna(discoloured) 16. Slightly Madhura & Lavana in rasa, neither Atiushna nor Athisheetaand Askandhita. Suddharakta can be linked to Hema(gold) (Purified with Fire),Padma or Gunja.17 Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  20. 20. Review of Raktamokshana…. 10Characteristics features of person having shuddha rakta: Snigdha raktavarnata of Karna, Akshi, Mukha, Jihwa, Nasa, Oshta,Panipadatala, Lalata, Mehana and Srimadbrajishnu (he will have pleasant glow). He isgifted with Sukha, Medha, Manas, Saukumarya, Anatibala, Kleshasahishnu andUshna asahishnu18.Raktavaha srotas: There are two raktavaha srotas. Yakruth, Pleeha and Raktavahadhamanies are its Moolas19.Rakta dusti karana: Vidahiannapana, Dravasnigdhoshna guru ahara, Ajeerna,Viruddha, Adhyashana, Divaswapna, Krodha, Anala, Shrama, Abhighata and Atapa20.Rakta dusti lakshanas: The above aetiological factors are responsible for thetridosha vitiation which ultimately leads to Rakta dushti. Following are the features ofvitiated rakta due to dosha dushti. Vata dushta rakta – Phenila, Aruna, Krishna, Parusha, Tanu, which does’tget Skandha immediately21, Rooksha, Kashayanurasa, Lohagandhi, Vegasravi,Sheeta21 and Suchinisthoda22. Pitta dushta rakta – Neela, Peeta, Harita, Shyava, Pipilika Makshika Anista,gets Skandhana immediately23, Ushnata, Sachandrika(glistening particles), looks likeGomutra, Harita & Matsya Gandhi24. Kapha dushta rakta – Looks like Gairikodaka, Snigdha, Sheetala, Bahala,Picchila, Chirasravi, Mamsapeshi25, Kovidara, Tantumad, Lavana rasa, VasaGandhi25. The change in rakta vitiated by two doshas or all the three doshas together area combination of all the changes mentioned above. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  21. 21. Review of Raktamokshana…. 11RAKTAJA ROGA26: The following diseases occur due to vitiation of rakta –Signs & Symptoms: Agnisada, Pipasa, Gurugatrata, Santapa, Atidaurbalya, Aruchi,Shiroruk, Vidaha annapanasya, Tiktamlodgara, Klama, Kroda prachuta, BuddiSammoha, Lavanasyata, Sweda, Shareera dourgandya, Mada, Kamapa, Swarakshaya,Tandra, Nidratiyoga, Tamasatidarshanam.ENT disorders: Mukhapaka, Akshiroga, Puthigrana, Putiasya gandhita.Systemic disorders: Gulma, Upakusha, Raktapitta, Prameelaka, Vidradi, Raktameha,Pradara, Vatashonita.Skin disorders: Vaivarnya, Kandu, Kota, Pidaka, Kusta, Charmadala, Visarpa.Raktaja roga chikitsa sutra: The treatment principles like Virechana, Upavasa, Raktamokshana &treatment principles of Raktapitta are to be followed27 RAKTHA MOKSHANA Raktamokshana is formed by two words.Rakta: ‘Rang’ or ‘Rage” dhatu with ‘Kta’ suffix which means to dye, to colour. Insanguine vita, “man’s life is in his blood” – Bible. The blood is carrier of life –Hunter. Blood is most peculiar juice – Mephistopheles. Thus, blood has been one of the powerful weapons of the man againstdiseases. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  22. 22. Review of Raktamokshana…. 12Mokshana: “Moksha – Avasun” Dhatu with suffixed ‘Yu’ which means that to release, tolet, to separate, to expel, to drive out, to live, to pass, to deplet (Amarkosha part II). So combined meaning is that a process in which the vitiated blood is expelledout from the body. It means “Rudhirasravana”28. Letting out impure blood from the body is known as RaktamokshanaMOKSHANA: Liberating or emancipating or shedding or causing to flow29Synonyms of Raktamokshana: Asravisravana, Shonithamokshana, Rakthanirharana, Rakthasravana,Rakthaharana29. Venesection, Phlebotomy30Importance of Raktha mokshana Raktamokshana is the ideal treatment when the doshas are vitiated in dhatuantargata31. In raktaja rogas only raktamokshana can provide benefit which is equal tothe combined effect of all other treatment modalities32. The disease which cannot becured either by snigdha or rooksha and sheeta or ushna chikitsa then raktamokshana isthe ultimate therapy for such conditions33. Even Siravyadha is considered as ardhachikitsa as vasti in Kaya Chikitsa.Classification of Raktha mokshanaI According Shastra: It is mainly of two types a. Sashstra – Siravyadhana & Pracchana34 b. Anushartram – Shrunga, Alabhu, Jalouka, ghatee yantra35. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  23. 23. Review of Raktamokshana…. 13Table no.1: Showing the classification of Raktamokshana according to different Acharyas. Charaka36 Sushrutha37 Vagbhata38 Sarangadhara39Shrunga Shrunga Shrunga ShrungaJalouka Jalouka Jalouka JaloukaAlabu Alabu Tumbi AlabuSuchi Prachana Prachana SiravyadhaPrachana Siravyadha Siravyadha -Siravyadha Vigharshana Ghatiyantra - FLOW CHART NO.1 SHOWING CLASSIFICATION OF RAKTAMOKSHANA Sastra Visravana Anusatra Vidhi Sira Vyadhana PrachanaJalouka Sringa Ghatee yantra AlabuAccording to modern science three types i.e40, a. Spring loaded lancet method. b. Cupping c. Leeching methodII According to Dosha means of rakta srava: Vatha Pradhana - Shrunga Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  24. 24. Review of Raktamokshana…. 14 Pitta Pradhana - Jalouka Kapha Pradhana – Alabhu / GhatiyantraIII According to Depth of Lesion41 Uttana - Prachana Avaghada - Jalouka Twakstitha – Alabu / Ghatiyantra Sarvadaihika - SiravyadhanaIV According to Limit of Area of Dosha nirharana42: Dhashangula - Shrunga Hastamatra - Jalouka Dwadashangula – Alabu. The suitable method for Rakta sravana has to beadopted considering the above various factors. INDICATIONS & CONTRAINDICATIONS Table no.2:Showing the contraindications43 of Raktamokshana Shodana: Snehapeeta, Vamita, Virikta, Astapita, Anuvasita Physiological Garbini, Bala, Bhiru, Parishrantha,Upavasa, Pipasa conditions: Jagarita, KrushaDiseased Swasa, Kasa, Shosha, Moorchita, Pravrudha jwara, Stavira,conditions: Akshepaka, Pakshaghata, Sarvanga shopha, Pandu, Rooksha Strikarshita, Madyapana(mada), Kleeba, Arshas(Bleeding piles) Udara(Jalodara, vatodara, pittodara) Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  25. 25. Review of Raktamokshana…. 15 Table no: 3 Showing the contraindications44a,44b of Raktamokshana. Vaya: 16-70yrs Ritu: Sharath Twak vikaras: Sarvakusta &Visarpa Ajagallika, Arumshika, Chippa, Kunakha, Yavanapidikas, Kshudrarogas: Nyaccha, Vyanga, Alaji, Nilika, Padadari, Alasa, Indralupta, Darunaka, Shleepada, Upadamsha Vranashotha __________ Udara Plehodara, Yakruttodara Pramehapidakas _________ Vidradi All types except sarvaja Gridrasi, Avabhahuka, Vatashonitha, Koshtukasheersha, Vatavyadhi: Kanja, Pangu, Bahushosha, Vishvachi Sthanaroga _______________ Mootra vruddi ______________ Parshvashoola _____________ Jwara: Tritiyaka & Chaturtaka Manasa roga: Unmada & Apasmara Shukra roga ___________Shulayukta pravahika ____________ Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  26. 26. Review of Literature…. 16 JALOUKADefinition: “An aquatic creature which is employed to expel out the vitiated blood45.” “A creature whose life is water46” “A creature having its habitat and life as water47.”Etymology: The word Jalouka is a with two components Jala (Water)+ Oka (Housing place)i.e. animals having water as its housing place. The word Jalayu is a compound word with two components Jala (Water)+ Ayu(Life) i.e. animals having water as the life.Historical Review of Jaloukavacharana: The knowledge of Jaloukavacharana is as old as the Ayurveda. Reference regarding the eradication of the disease form “Usniha” (arteries) is mentioned in Rigveda. This process mostly refers to Raktamokshana48. (R. V. 10/16,4,2) The method of application of leech for blood letting is mentioned in Kaushika Sutra (4/26/8) which is a sutragrantha of Atharvaveda49. Acharya Charka has enumerated Raktaja Roga and their treatment by Shonitavasechana50 and various means of Raktamokshana is also mentioned51. Acharya Susruta has dealt in detail with Raktamokshana and its type. He described special chapter for Jaloukavacharana.52 the types of Jalouka, their habitat etc. has been described first time in detailed in this chapter. All text mentioned Raktamokshana and Jaloukavacharana with a detail description53. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  27. 27. Review of Literature…. 17The first medicinal uses of leeches probably look play around 100 BC ancient Indiabut it was not for another 1200 years that Roman physician Galen tried to put amedicinal gloss on blood sucking. Galen believed that removing bad blood by leechescould restore the balance in body hum ours.There is evidence of therapeutic blood letting among ancient, Egyptians, Aztec,Babylonians and Hindus although the first written records of the practice is found inthe corpus hippocraticum. Hippocrates believed that disease was caused by imbalanceof the four humours (blood, phlegm, black bile and yellow bile) and that blood lettingplayed a central part in restoring balance. Hippocrates, gallon had mentioned theprocess of blood letting through leech in his book – “Edito Princeps”. He alsomentioned the process of blood letting by venisections among the modern author, 200B.C. Dr. Appolo was the first physician to describe in regard to the leech.Hirodumedicinalis may have first entered the first formulary in the second centuryB.C. A significant bio-medical advance leeches not only inflicted less pain thanlancets or sacrifiers, but removed a more predictable quantity of blood.The famous English poet Words Worth, wrote a poem, “The leech gatherer” based onthe medicinal use of leeches. The use of leeches in Ayurvedic medical practice inIndia is very ancient. Even now some native medical man employs them. They areused as a drug to prevent loss of growing of hair and other symptoms of old age.Many people were engaged in leech collecting or leech farming. It is estimated that25,000,000 leeches were used in France alone in 1856. Leeches have long ahead aplace in the doctor medical kit. 5000 years ago Egyptian Medicos believed that lettinga leech sip a sick patients blood could help cure everything from fever to flatulence Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  28. 28. Review of Literature…. 18 and in medieval Europe, leeches were so closely associated with doctors called leeches. They used millions of the parasites annually to treat the patients. Unani medicine aims at restoring the equilibrium of the various elements and faculties of the human body. It also presumes the presence of a “medicatrix nature” (self-healing capacity of the body) in the human system and attempts to call it into action to restore normal health.Regimental Therapy: As far as possible, Unani physicians tries to use simple physical means of curing adisease. But for certain specific and complicated disease it applies special techniques likeas – Fasd (venesection), Mahajm (cupping), Tariq (diaphoresis), Dalak (massage), Qui(vomiting), Ishal (purging), Taleeq (leeching) etc. According to them, a leech application is a unique method for removal of toxicmatter form the blood. It is useful in skin disease. Due to the great demand for leeches for medicinal use that are suitable species were even cultured. Nachtrieb (1912) states that around 1850 A.D., one American leech farm disposed of as many as 1000 or more leeches daily. About 7 million in London and 5- 6 million leeches were used in Paris hospital in 1863. According to “Genuineness World Record - 2002 page 23” the lifespan of 27 years has been reliably recorded for the species Hirudo Medicinalis. Leeches are now used in around thirty countries world wide. Prevention from leech at collection: Leeches are best removed with a few drop of briny alcohol or strong vinegar. Their incidents can be lesson by wearing knee high waterproof leather boot Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  29. 29. Review of Literature…. 19 and closely woven trousers in leech infested area. The best preventive for aquatic leeches is to strain or boil the suspected drinking water.Hirudo medicinalis54 Phylum: Annelida Kingdom: Animelia Division: Bilateria Grade: Annelida Sub-Kingdom: Metazoa Order: H.Oligochaeta Family: Hirudinae Genus: Hirudinaria Species: H. medicinalisPhylum: annelida55 A leech is a worm like creature; it had been used for a long time and in differentways for medical purposes in Europe.It includes the familiar leeches, earth worms. Includes elongate, vermiform animal andwhose body is divided into similar rings or segments. This phylum includes the 500species of leeches, flattened, predacious or parasitic annelids equipped with suckers usedfor creeping. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  30. 30. Review of Literature…. 20SYNONYMS: Table no.4 showing various synonyms of Jalouka Jalayuka Jaluka Jaalalauka Jaloka Jalatani Jalaua Jalaluka Jalita Jalaua Jalaukas Jalaukasu Jalasuchi Jalasarpini Raktapata Ruktapa Raktapayini Vanini Vedhini Venika TaleeqClassification The Jaloukas are mainly classified in two types’ i.e., savisha and nirvisha. Thesetwo groups again contain six types of Jaloukas in each. On the basis of sex they are againclassified into male and female56, 57. Table no.5 showing the types of savisha & nirvisha Jaloukas Sl.no Savisha Jaloukas Nirvisha Jaloukas 1 Krishna Kapila 2 Karbura Pingala 3 Algarda Sankumukhi 4 Indrayudha Mushika 5 Samudrika Pundarikamukhi 6 Gochandana Savarika Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  31. 31. Review of Literature…. 21According to Modern science, Leeches are divided into 2 types, 1. Marine & certain fresh water leeches: which are devoid from jaws and have colourless blood. 2. Terrestrial Leeches; which have 3 jaws and red coloured blood. As regards the venomous and non-venomous, it is studied that leeches are neitherpoisonous nor are any definitely known to be intermediate hosts of human parasites, buttheir habits make them potential carriers of infective agents. Table no: 6 showing the Characteristic feature of each savisha Jalouka58Sl.no. Savisha Jaloukas Laxanas of Savisha Jaloukas1. Krishna It resembles black in colour like that of anjana. It has prutu (big) head.2. Karbura It resembles vartha matsya(snake like fish). Its kukshi has elevations and depressions.3. Alagarda It has maha parshva, its body is romasha and has Krishna mukha.4. Indrayudha It looks like that of rainbow. There are many striations or lines on its body.5. Samudrika Its colour resembles slightly asithapitika. It has dotted skin and resembles many flowers.6. Gochandana Its end part resembles like that of govrushana. Its body has marked bifurcating lines and has anumukhi. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  32. 32. Review of Literature…. 22 Table no: 7 showing the Characteristic feature of each Nirvisha Jaloukas59Sl.no. Nirvisha Jaloukas Laxanas of Nirvisha Jaloukas1. Kapila It has manahshila coloured strations at its body sides. Its dorsal surfaces are snigdha and color resembles like Mudga Dhanya.2. Pingala Its body shape is vrutta, its colour matches to rakta and it has ashu gati.3. Shankumukhi Resembles yakrudvarna, it is sheegra payini, has dheerga kaya and has shankha mukha.4. Mushika Its colour & shape resembles like that of mushika and emits a foetid smell from the body.5. Pundarikamukhi Its mukha resembles like that of pundarika and its colour matches with the color of mudga dhanya (greenish black).7. Savarika It has padmapatra varna and measures astadashangula in length.External features:Shape & size: ♦ Leeches are small, soft, invertebrate vermiform worm like structure ♦ Elongated, dorso-ventrally flattened, Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  33. 33. Review of Literature…. 23 ♦ Almost cylindrical when contracted and ribbon shaped when extended ♦ 7 to 15 cm is the length having 6 longitudinal reddish or brown stripes. ♦ Broadest at near the posterior end & narrowest at near the anterior end ♦ Dorsal surface is some what convex and ventral surface is more or less plane ♦ Transverse outline almost oval. ♦ Dorsal surface brightly olive green and ventral surface is orange yellow or black & yellow. ♦ Black stripe marks on median longitudinal at dorsal side of the body.Suckers: Hollow muscular organs on each end of the body are known as sucker.(1)ANTERIOR SUCKER (ORAL SUCKER) (CEPHALIC SUCKER): Comprised ofcup like hollow, pre oral chamber and the mouth. It contains 3 jaws with sharply serratededges, which are used like circular saws, and on them are about 100 horny teeths used toincise the host.(2)POSTERIOR SUCKER (ANAL SUCKER): It’s highly muscular disc like structure,formed by fusion of 7 body segments (26th to 33rd).CHEMICAL CONSTITUENTS OF SALIVA: The leech produces a number of important substances which contribute to thespecial property of the bite, including an anticoagulant, a local vasodilator and localanesthetic. Like Hirudin, Hyaluronidase, Hementin etc. A study has found that high antithrombin activity was maintained in starvedleech12. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  34. 34. Review of Literature…. 24Availability: Since the time of Samhita, Jaloukas are available in Indian country at the sea-coast regions. As per the Sushruta Samhita’s ref. habitat of Jalouka may be seen in manyparts of ancient India also. Yavana ( Turka sthana) Pandya ( South region country – Deccan ) Sahya ( Tract of land traversed by the Ghat mountains ) Pautana (Modern time of Mathura ) etc are the places for leech origination.Habitat of Savisha Jaloukas The water polluted with savisha matsya, keeta, dardura, mootra, pureesha etc.Habitat of Nirvisha Jaloukas The ponds where padma, utpala, kumuda, sougandhika, kuvalaya, pundareekagrows and pure water. The medicinal leech is amphibious, needing both land and water. Generally, it isfound in watery region, swims in sweet scented water, live in the dark and oozy bed ittakes shelter under stones, plants & other objects in shallow water, also in fresh water,ponds, lakes, tanks, swamps and sometimes in still water in rice fields too.Yogya Jalouka: Nirvisha Jaloukas.Ayogya Jalouka: Savisha Jaloukas, those with stulamadya, pariklista, pruthyvo,mandavichestatha and agrahini.Savisha Jalouka damsta laxana61 Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  35. 35. Review of Literature…. 25 Shotha, kandu, moorcha, jwara, daha, vamana, paka, visarpa, switra etc.Management: Pitta rakta hara kriya62.Actions and medicinal uses: Dosha: Pitta shamaka Usefull in grathita or avagada sthana. A medicinal leech is a small “factory” of manufacture of biologically activesubstances. ♦ Normalization and improvement of capillary circulation. ♦ Expressed anti inflammatory effect. ♦ Anti stressful and adaptogenic effects. ♦ Blood purification effect by expelling out the vitiated blood. ♦ Immune stimulation and immune modulating effects. ♦ Improvement of an endocellular exchange. ♦ Early wound healing effect. ♦ Reduces the high blood pressure and blood viscosity. ♦ Positive haemopoetic effect. ♦ Anaesthesia; Anticoagulation; Antibacterial effect. ♦ Leeches are useful in removing the blood from areas where tissue has been transplanted or reattached.Collection and Preservations of Jalouka63:Time: The best time for collecting Jaloukas is sharad ritu (autumn). The Jaloukas can be caught with a piece of wet leather, in tanks, streams and where there are lotuses, it can be collected by applying fresh meat of dead animals, Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  36. 36. Review of Literature…. 26 on the thigh of human being himself by keeping the leg in water for some time. When Jaloukas gets attracted and stick to thigh, remove them by sprinkling saindhava over its mouth and collect. Poisonous leeches must be thrown out.Preservation of Jalouka64: After collecting the Jaloukas, they should be kept in a wide and new earthen pot.The pure water of tank with lotus should be filled into the pot. On every third day thewater should be changed and feeding should be dropped inside the pot. After five orseven days the pot should be changed.Nutrition: Powdered dry meat, stem of lotus, aquatic plants can be given as nutrition. Grassand small leaved aquatic plants are kept in the bottom of the vessel to provide the bed forthem65.Preparation of Jalouka for Jaloukavacharana: Jalouka of good quality is taken and kept in rajani & sarshapakalkodaka. By thisprocedure Jaloukas become activated and get rid of exhaustion66.Paschat karma for Jaloukas after Jaloukavacharana: As soon as the Jalouka is free from sucking, a paste of tandula kana is to beapplied over its body and a mixture of taila and saidava lavana is smeared on its mouth.Then with the help of thumb and small finger of left hand, the tail end of the Jalouka is tobe caught. The body of Jalouka is squeezed with the fingers of right hand towards itsface. These maneuvers will induce vomiting of the sucked blood. This is continued untilthe signs of proper vomiting are found. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  37. 37. Review of Literature…. 27 After that, the Jalouka is kept in a vessel containing water. If the Jalouka moves inthe container actively then it is suggestive of proper emesis. If it is lethargic and is settledin the bottom of the vessel emesis should be once again performed. If it still does notvomit the whole blood gets a disease called indramada or raktamada where that leechshould not be used in future for blood letting. After proper vomiting, Jalouka is kept in the earthen pot, containing water.Jalouka once applied should not be reapplied until seven days.After proper vomiting, the Jalouka regains activities and becomes strong. If too much ofvomiting, it becomes very weak or even may die. If vomiting is improper, it becomesintoxicated or lazy.They should be transformed from one pot to another pot filled with good mud and thewater is also changed in order to prevent the putrefaction of its saliva. If this is notproperly maintained Jalouka becomes poisonous with such contact67.ADDITIONAL INFORMATION ABOUT LEECHES68:Leeches (Phylum Annelida, Class Hirudinea) Leeches are blood sucking, hermaphroditic egg laying annelids which havingelongated annulated bodies. They attach themselves to leaves, rocks, or the host by aposterior sucker containing the mouth armed with three radially arranged jaws whichmake a Y-shaped incision. Blood is sucked out by the action of muscular pharynx, toprevent blood clotting, the saliva contains a histamine like vasodilator and anticoagulants,such as hirudin from the medicinal leech (Hirudo Medicinalis) which inhibits thrombinand factor XIa, Haementin from the Haementeria ghillanii which is directly fibrynolytic, Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  38. 38. Review of Literature…. 28and Haementerin from H.depressa a plasminogen activator. Other enzymes includeesterases, antitrypsin, antiplasmin, and antielactase. Recombinant Hirudin is nowproduces as therapeutic anti coagulant. The medcinal leech is still used by plasticsurgeons to reduce haematomas under skin grafts; the wound may become infectedAeromonus hydrophila which live symbiotically in the leech’s gut.Two groups of leeches cause human morbidity and even mortality in tropical countries.LAND LEECHES: Species of the genera Haemadipsa and phyrobdella are 1 to 8 cm long. Theyinfest, often in enormous numbers, the dump, leafy floor and low. Vegetation of rainforests, choosing the game trails and watering places. By standing on the posterior suckerand waving the anterior sucker, they can sense their pray with amazing efficiency. Theydrop on the prey or pursue with looping or lashing motion. These leeches usually attachthemselves to the lower legs or ankles and are adept at penetrating clothing, even longtrousers tucked into socks and lace-up boots. The bite is usually painless and the infestedperson may not realize what has happened until he bears a squelching sound, that his feetare warm and wet and sees blood welling over the tops of the boots, land leeches ingests1ml of blood in hand then drop off, but the wound continues to bleed for some time andforms a fragile clot.AQUATIC LEECHES: These species may be followed by these who drink neither stagnant water noreven mountain stream water or they may attack bathers, entering the mouth, nostrils,eyes, vulva, vagina, urthera or anus. The enormous brightly coloured buffalo leech(Hirudinaria manillenis of South East Asia, is up to 16 cm, long and can ingest 1ml of Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  39. 39. Review of Literature…. 29blood in 10 mins. Limnatis nilotica occurs around the Mediterraean, Middle East, andNorth Africa and L.Paluda in the Middle East. Myxobdella Africans occurs in EastAfrica, Dinobdella ferox (5cm long) occurs in Asia. Some aquatic leeches are very slowfeeders and may remain attached for days or even weeks.CLINICAL FEATURES: The main affect is blood loss, but other symptoms include pain caused by the bite,secondary infection, residual itching, and phobia. Ingested aquatic leeches usually attachto the nose or pharynx but may penetrate the trachea, bronchi or oesophagus. Hiridinarialmonillenis entering through anus can reach the recto sigmoid junction of the bowelcausing perforation and peritonitis. Patients with a leech in the pharynx often havefeelings of movements at the back of the throat with cough, hoarseness, stridor,breathlessness, epistaxis, heamoptysis, haematemesis, and severe anaemia. Fatal upperairway obstruction may result. Bleeding may persists for up to a week after the leech haddropped off. In rural Thailand, a vaginal bleeding in girls who have swam in ponds orcanals is often attribute to infestation by aquatic leeches. Sexual abuse may be wronglyinferred if this diagnosis is not considered. Transmission of rinderpest and other viruses,leptospirosis, and trypanosomes cruzi has been suggested but not proved. Secondaryinfection of medicinal leech bites by aeromonas hydrophilid has been described.TREATMENT: Leeches will detach if a gain of salt, a lighted matched or a cigarette, alchocol,turpentine or vinegar are applied. Local bleeding can be stopped by applying a styptic,such as silver nitrate or a firm dressing. Aquatic leeches which have penetrated the Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  40. 40. Review of Literature…. 30respiratory, upper gastrointestinal or genito urninary tracts, or the rectum must beremoved by endoscope. Spraying with 30 percent cocaine 10 percent tartaric acid ordilute (1:1, 00,000) adrelaine makes the leech detach in the Naso pharynx, larynx, tracheaor oesophagus, while irigation with concentrated salt solution may be effective in thegenitourinary tract and rectum. Leeches should not be pulled off so roughly that themouth parts are left in the wound at this will lead to a chronic infection. Antimicrobialtreatment of secondary bacterial infections (eg., of Aeronomas hyudropholia withcenfuroxime or a quinolone) may be required. JALOUKAVACHARANA The Jaloukavacharana is a method of raktamokshana where jaloukas are used asanushastras for letting rakta.Importance of Jaloukavacharana: Jaloukavacharana is such a method of raktamokshana that it can be applied evento parama sukumaras69. “The physician who knows all about the Jaloukas habitat, their method ofcollection, varieties, storage and method of application is successful in treating thedisease amenable to them70.”Indications:Personalities: Nrupa, Adhya, bheeru, sukumara, bala, sthavira, nari, parama sukumaras.Diseased Conditions: Vatarakta71, Visarpa72, Kusta73, Visha74.Following are some of other conditions where Jaloukavacharana can be performed. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  41. 41. Review of Literature…. 31 Venous illness, acute phlebitis, varicose veins (Thrombo phlebitis, postthrombotic syndrome, phlebothrombosis), acute gout attack infections, otitis media,mastoiditis, glaucoma, high blood pressure and “praeapoplex” piles, Eczema etc75.Contra-indication:Absolute-haemophilia,Relative-pregnancy, anaemia and hypotonia.Diet for patient after jalaukaavacharana After bloodletting intake of foods and drinks, which are neither too hot nor toocold, light and stimulants of digestion are recommended. Mamsarasa of black deer,rabbit, goat, deer, milk or milk with shastikashali.Pathya apathya: The pathya- apathyas are same as that of any type of rakta mokshana. Exercise,sexual intercourse, cold bath, day sleep, exposure to breeze, food having kshara, amla,katu rasa, and shoka should be avoided till body gets original strength.Tips For The Leech Application Leech should be kept in fresh water, cool, shady and calm place in a large glass and refill daily by low mineral water. Actually the application of leeches demands sometimes (passion), place and silence. The patient should be placed on a rubber towel. Wash the part in question with natural odorless soap, rinse it cleanly, don’t use any perfume in skin area. If needed be shaved the eventually marked bite area and slit it a bit with a haemo lancet. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  42. 42. Review of Literature…. 32Take leech out of the jar with the help of a blunt tweezers and put it with its handonto the small wound.After fall of put into a fixed lockable containers and set them free at best in a clearwater or at a damp place in the forest. Eventually kill them with the help ofconcentrated acetic acid. Leeches may only be used once and have to be disposedafter doing so.Morning is the best time for application, without emergency it should not be put atevening. There may be chance of secondary hemorrhage and want of properattendance.Secondary hemorrhage may occur after removing leech. An excessive loss of bloodvarious haemostatic are used such as burnt cotton, desiccated alum, copper sulphate,tannin, turmeric, burnt rage, cobweb, scrapped lint etc. Pressure with the finger overthe bite may be useful. In obstinate cases solution of the prechloride of iron is usedwith benefit. Even a very fine point of caustic nitrate of silver is inserted into thewound with benefit. Touching the bite with the point of a red hot middle or applyinga ligature or pressure by lint and bandage has also been tried with success.Apply a bandage with lot of absorbent cotton wool after approximately seven hours –mostly in the evening. Until then the patient must holds still while lying. Change thebandage after 24 hours and remove it three days later. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  43. 43. Review of Literature…. 33 PRACHANAIn vedas there is much description about the Raktamokshana and Jaloukavacharana butthere is no description about this particular kriya.vÉx§É ÌuÉxÉëÉuÉlÉqÉç ̲kÉqÉç – mÉëcNûÉlÉqÉ ÍxÉUurÉkÉlÉqÉç cÉ || Letting out blood using sharpInstruments76 is of 2 kinds (1) Prachanam (2) SiravyadhanammÉëcNûÉlÉqÉçç qÉsmÉå MÑü¹å || Acharya Charaka77 has mentioned Prachana is for Alpa kushtas.Based on this description available in classics it appears that in Prachana, rakta is drainedalong with stagnated rasa and lasika rich with the de-arranged doshas. Every cut that ismade in the skin drains the area of about one angula around it.Description of the word Prachana:The word Prachana is derived from the "CHHO" Dhatu with the "PRA" upasarga and"LYUT" Pratyaya. The literal meaning of the word Prachana is to bleed by makingincisions or cut the skin.SYNONYMS(1) Pada(2) Shastra Pada(3) KuttanaIt means so many fine cuttings on the peripheral blood vessels of the skin. Comparative efficacy of Jaloukavacharana and Prachana inVicharchika
  44. 44. Review of Literature…. 34 Prachana is a technique of letting the vitiated blood out of the body from alocalized lesion in the superficial layer of the skin through the artificially made cutwounds with the help of a sharp, pointed surgical instrument.78Prachana is indicated when there is mild congregation of vitiated doshas, with raktam, ina single or localised region of the skin and when the blood is stagnated and coagulated inthe layers of skin etc., In Prachana blood is drained along with the stagnated fluids (Rasa and Laseeka)rich with the deranged doshas. Every cut that is made in the skin drains the area of abouton Angula around it.HISTORICAL REVIEW OF PRACHANA:SAMHITA KALA: In our classics no authors has mentioned about the Poorvakarma, Pradhanakarma,and Paschat karma of Prachana. But other procedures of Raktamokshana like,Siravyadhanam, Jaloukavacharana, have given much importance.Charaka samhita: In Charaka Samhita, Charaka was not given much importance to the Prachanakriya. Charaka even though he has given much importance to oushadha chikitsa hasexplained Prachana in certain context of chikitsa. Charaka emphasizes Prachana is to bedone in ALPA kushtas. The context is as follows: (1) In kaphaja kushta (with limited number of patches) elimination of rakta is done by Prachana.79 Comparative efficacy of Jaloukavacharana and Prachana inVicharchika
  45. 45. Review of Literature…. 35 (2) In raktaja arshas, if rakta doesn’t comes out on its own then the vitiated rakta should be removed by doing Prachana repeatedly.80 (3) In Dwivraneeya Chikitsitham, it is said to scarify (Prachana) in case of vatarakta, granthi, yavana pitaka, sheeta pitta, twak vikaras, shotha and vranas.81 (4) In vatashonita vayu having obstructed, the passage of rakta enters into the sandhies of pada-paani and covering mutually takes away the life. In this case also Prachana is indicated.82 (5) Prachana is indicated in disorders which are shifting from place to place.83 (6) Rather than in chikitsa context, Prachana is also mentioned in the six types of shastra karma.84Susruta Samhita: Susruta being the father of Shalya Tantra, by observing the doshic Swabhava ofrakta considered rakta as the chaturtha dosha and thus said raktamokshana among thePancha Shodhana. In the following contexts Prachana is mentioned. (1) In the context of Jaloukavacharana, Prachana is said to let out the little quantity of rakta to make Jalouka catch the affected part of the patient.85 (2) In the Shonita Vraneeya adhyaya, two kinds of raktavisravana are said as Prachana and Siravyadhana.86 (3) The method of doing prachana was explained by susrutha.87 (4) In case of cessation of karnavardhana, if the development does not occur by doing snehana, swedana, udwartana, and abhyanga then finally Prachana is said in Apanga Pradesha.88 Comparative efficacy of Jaloukavacharana and Prachana inVicharchika
  46. 46. Review of Literature…. 36Vagbhata Samhita: Vagbhata the author of Ashtangha Samgraha and Ashtangha Hrudaya followedthe view of Susruta and thus considered Raktamokshana among the Pancha shodhana.Ashtangha Samgraha: (1) The rakta which has got localized in a place should be removed by prachana.89 (2) Prachana may be used when the rakta has become clotted.90 (3) Prachana is mentioned in the chikitsa of vatashonitha, if the vedana is spreading from place to place.91Ashtanga hrudaya: (1) In Shastra Vidhi adhyaya “while explaining the “shastrakaryani” Prachana is said as one among the karyas of shastra.92 (2) In kushta chikitsa, if the kushta is of kshudra kushta (minor variety) then Prachana should be performed.93 (3) Prachana is said in the chikitsa of vata shonita, if the disease is spreading.94 (4) The method of doing Prachana is explained in shastra vidhi adhyaya.95 (5) Rakta accumulated in the localised area can be removed by Prachana and also Prachana should be done when rakta is solidified.96, 97Sangraha kala:Sharangadhara Samhita: In case of vitiation by two or all the tridoshas together Prachana is adopted forletting out the rakta.98 Comparative efficacy of Jaloukavacharana and Prachana inVicharchika
  47. 47. Review of Literature…. 37Bhavaprakasha: In the context of vata vyadhi, Prachana is to be resorted when the vyadhi isspreading from place to place.99 Raktavisravana is adopted in shotha which are discoloured, hard, black, havingulcer with mild pain.100Yogaratnakara: He has explained the adoption of Prachana in the context of “Raktasruthi”For the elimination of rakta vitiated by two or all the tridoshas together.101Bhela samhita: In case where the kushta has broken out very feebly, prachana102 is advisable andalso while explaining the shastra karmas of vrana103; Prachana is said as one of theprocedure.Vangasena Samhita/Chikitsa Sara Samgraha: Prachana is done in case of arsha, if the arshankuras are katine, shophayukta, andfilled with rakta for letting out the rakta.104 Prachana was mentioned in Vata Rakta adhikara when the vyadhi is foundspreading from place to place.105 The patient having profuse impurity of rakta should undergo raktamokshana byPrachana.106 The procedure of doing Prachana like Poorvakarma, Pradhanakarma andPaschatkarma is clearly explained in methodology of this dissertation. Comparative efficacy of Jaloukavacharana and Prachana inVicharchika
  48. 48. Review of Literature…. 39 VYADHI HISTORICAL REVIEW ABOUT VICHARCHIKA01. Vedic Period Vedas are considered as the oldest and the first available literature of the world.The history of Indian medicine starts with Vedas, so the history of Twak rogas beginsfrom vedic period. Many references regarding kushta are found in Vedas. A. Rigveda107 – In Rigveda there is no complete description of kushta. But somedescription indicates that kushta was prevalent in that period also. The Charmaroga of Aapala was cured by the Lord Indra. Ghosa was suffering from Kushta roga. She was disliked by her husband becauseof her ugly looks due to kushta roga. By administration of proper medication she gotcured and ultimately accepted by her husband. B. Yajurveda108 – Shukla Yajurveda mentioned various medicines having kushtanashahara properties. C. Atharvana Veda109 – In Atharvana veda, the various sites for vyadhi havebeen described and amongst them twak has been described as one of the chief site of thevyadhi. The nama of the various vyadhis have been illustrated where by kushta has beendescribed as Kshatriya roga. There is description of some herbs like Rama, Neeli, Asaru,Shyama, etc. for the treatment of kushta. Shringa i.e. Horn of deer possessing a propertyof twak rogahara has been mentioned. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  49. 49. Review of Literature…. 4002. Purana Kala A. Mahabharata – It is mentioned that the person suffering from twak dosha isnot fit to be a king. This reference highlights that at that time people suffering fromkushta were looked down by the society. B. Agni Purana – Kushtahara medicines are mentioned under the heading ofNanarogahara aushadhani. C. Garuda Purana – In various chapters of Garuda purana description aboutTwak roga has been explained viz. Kushta, Sidhma kushta, etc. D. Panini – In Ashtadhyaya of Panini grammatical literature about the vyadhi isexplained. The diseases like Atisara, Arsha, Kushta have been explained and also thevyadhis caused by Anuvamshika doshas and vyadhis has been explained. E. Kaushika Sutra – The reference of Kushta and its treatment is mentioned inKaushika Sutra like chanting Mantras, external application of paste made up of drugs likeBhringaraj, Haridra, Indravaruni, Neelika pushpa, etc.03. Samhita kala A. Charaka Samhita – Charaka described in detail for the first time, a long rangeof twak vyadhis with their nidana, samprapti, and bhedas under the heading of Kushta.Charaka has described eighteen types of kushta. Seven types of kushtas have beendescribed under the category of Mahakushta in Nidanasthana110. In Chikitsasthana111eighteen types of Kushta have been classified under seven Mahakushta and elevenKshudra kushta. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  50. 50. Review of Literature…. 41Apart from these; description of kushta is available in the following chapters – Kushta is a sankramika Vyadhi, and it comes mainly due to sukra-shonitha doshas.The following descriptions about kushta in various contexts are as follows. 01. Kushta is described as samanya hetu of Nija shotha112. 02. Kushta is considered as a Santarpanajanya vyadhi113. 03. It is included as one of the vyadhi caused by the rakta114 04. Use of stamabana dravyas in the initial stage of Raktapitta, Raktarsha, and Amatisara leads to kushta. 05. Kushta is noted in Lekhana yogya and Prachana yogya vyadhis115 Agni karma is contraindicated in kushtaja vrana.116B. Sushruta Samhita – Acharya Sushruta, for the first time clearly described theAnuvamshika (Hereditary) and Krimija (Infectious), nidanas as a causative factors forkushta117. Kushta has been included in Aupasargika roga which may spread from oneperson to other118. He also explained dhatugatatwa and uttarottara dhatu pravesha ofkushta roga119. The number of kushta rogas described by Sushruta is the same as that ofCharaka, but Dadru has been mentioned under Mahakushta and Siddhma under kshudrakushtaC. Ashtanga Hridaya – Vagbhata has followed Sushruta regarding classification ofMahakushta and Kshudrakushta120. But Vicharchika has been mentioned underkshudrakushta with some lakshanas as described by Charaka121.D. Bhela Samhita122 – Bhela Samhita has described kushta roga in both nidana andchikitsasthana. He has mentioned that polluted water is the main nidana of kushta. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  51. 51. Review of Literature…. 4204. Sangraha Kala A. Madhava Nidana123 – Madhavakara has described Nidana panchaka of kushtaaccording to Charaka and Vagbhata. While the dhatugatatwa, sadhyasadhyata andSankramakata (contagious) have been described according to Sushruta. B. Sharangadhara Samhita124 – Classification of kushta has been described inPoorvakhanda. He describes Tamra which is the fourth layer of twak is the site for alltypes of kushtas. C. Bhavaprakasha125 – Bhavamishra has given a detail description of kushtaroga. He has followed Charaka for classification and namakarana of kushta. Thedhatugatatwa and sahdyasadhyata are compiled form Sushruta. D. Yogaratnakara126 – Yogaratnakara describes kushta according to the earlierclassics, contagious aspect of kushta is also described by him.RACHANA SHAREERA OF TWAK Beauty is an important part of human experience. Beauty without perfect blemish lessskin is incomplete. Clean skin suggests absence of acquired or inherited health disorders.Hence, people spend much time and money to restore skin to a more normal or youthfulappearance.Ayurvedic View In Ayurveda, the word “Twacha” or “Charma” is used for skin127. Twacha is derivedfrom “Twacha Samvarne” dhatu means – the covering of body. It can be defined as body Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  52. 52. Review of Literature…. 43substance that covers the Abhyantara dhatus like Rakta, Mamsa, Medas, and otherdhatus.Synonyms of TwachaTwak, Twacha, Charma, Sparshanendriya, etc.Formation of the skin Sushruta described the process of formation of twacha in the developing foetus. Hesays that after formation of the ovum twacha develops just like a cream on the surface ofthe milk128. In the Garbhashaya during the course of development of garbhadifferentiation of the layers of the twacha takes place and is produced by all three doshasparticularly by pitta dosha. Twacha develops consecutively in seven layers by thesynchronized peculiar action of dosha. Vagbhata described the formation of twacha due to paka of raktadhatu by itsdhatwagni in the foetus. After paka, it dries up to form twacha just like the deposition ofthe cream over the surface of the boiled milk129.Layers of the Twacha: There are differences of opinion regarding the layers of twak Charaka hasdescribed six layers of the twak. Out of these six he has given names to the first andsecond layer. The rest four layers have been described in terms of the vyadhi130. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  53. 53. Review of Literature…. 44TABLE NO. 08. SHOWING LAYERS OF TWAK ACCORDING TO CHARAKA. No. Layer Twak 01. Udakadhara - 02. Raktadhara - 03. Triteeya - 04. Chaturtha Dadru, Kushta 05. Panchama Alaji, Vidradi. 06. Shashta Arsha, BhagandharaB. Sushruta has described seven layers of the twak along with the specific names. He has also mentioned the thickness of each layer along with the disease, which are prone to that layer131. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  54. 54. Review of Literature…. 45 Table No. 09: Showing the layer of the Twak According to Sushruta.No. Name Thickness Vyadhi01. Avabhasini 1/18th of Vrihi (0.05-0.06 Sidhma, Padmakantaka mm)02. Lohita 1/16th of Vrihi (0.06- Tilakalaka, Nyachya, 0.07mm) Vyanga03. Shweta 1/12th of Vrihi (0.08-0.9 Charmadala, Mashaka, mm) Ajagallika.04. Tamra 1/8th of Vrihi (0.12-0.50 Kilasa, Kushta. mm)05. Vedini 1/5th of Vrihi (0.2- Kushta, Visarpa 0.3mm)06. Rohini 1 Vrihi (1-1.1mm) Shleepada, Arbuda, Granthi, Apachi, Galaganda07. Mamasadh 2 Vrihi (2-2.1 mm) Arsha, Bhagandara, ara VidrudhiC. Vagbhata has described seven layer of twak without naming them. CommentatorsArunadutta and Hemadri named them according to Sushruta132. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  55. 55. Review of Literature…. 46D. Sharangadhara has also mentioned seven layers of the twak along with theprobable onset of vyadhi. The names of the six are layers of the twak same asSushruta but seventh layer is named as Sthula, which is the site of Vidradhi133.Dr. Ghanekar, the commentator of Sushruta shareerasthana has co-related the layersof the twak with the latest modern anatomy.Table No. 10. Showing the correlation between the Ayurvedic & Modern skin layers. No. Ayurvedic Modern Terminology Types of Terminology Skin 01. Avabhasini Stratum corneum Epidermis 02. Lohita Stratum lucidum Epidermis 03. Shweta Stratum granulosum Epidermis 04. Tamra Malpighian layer Epidermis 05. Vedini Papillary layer Dermis 06. Rohini Reticular layer Dermis 07. Mamsadhara Subcutaneous tissue & Dermis Muscular layer Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  56. 56. Review of Literature…. 47Kriya Shareera of twak The Kriya Shareera of the twak can be understood by knowing its relation withthe dosha, dhatu, mala which are the basic structural and functional units of the body.Twak & Tridosha – Twacha is said to be one of the sites of Vata and Pitta dosha134.Twacha & Vata Dosha – Charakacharya has described Twacha as thesparshanendriya adhishtana. Sparsha i.e. touch sense is the subject of sparshanendriyawhich is performed by Vata dosha135.Twacha & Pitta dosha – Bhrajaka pitta, which is located in the Twacha is responsiblefor the luster of the skin. It is also called as Bhrajakagni. Charaka did not specified about the types of pitta, but he has said that theproduction of normal and abnormal temperature as well as the normal and abnormalcolour of the twacha is due to the pitta dosha. Commenting on this Chakrapani saysthat body heat regulation and variation in the colour of the body are the functions ofthe bhrajaka pitta136. Sushruta describes it as a bhrajakagni and it enables the digestion and utilizationof substances used through Abhyanga, Pariseka, Alepa, Avagaha, etc. It indicates theglow of one’s natural complexion137. According to Bhela bhrajaka pitta is that which is responsible for themanifestation of the specific characteristics of the body. It emphasizes its importancein creating different prabhas (Hues) of the head, hand, feet, sides, back, abdomen,thighs, face, nails, eyes and hair. It also brightens them138. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  57. 57. Review of Literature…. 48 Vagbhata mentioned bhrajaka pitta is situated in the skin. It is so called because itimparts lusture to the skin and makes it radiate. Arunadutta says it is so called becauseit performs deepana-pachana of substances used for abhyanaga, lepa, pariseka, etc.Twacha & Kapha dosha – The Snigdhata, Shlakshnata, Mriduta, Sheetata, Prasannataare the attributes to the presence of kapha dosha in the skin. Ropana karma i.e. selfhealing process is also one of the function of kapha dosha.Twacha & Saptadhatu –Rasa dhatu – In Several places twacha has been used as synonym of rasa dhatu likeTwakasara purusha, etc. Sushruta mentioned that in early stages Kushta is situated onlyin Twacha. Dalhana commented on that and says it as Twachashrita i.e. Rasashritakushta139.According to Chakrapani, Udakadhara which is the first layer of skin maintains watercontent of the body. Rasadhatu is jalamahabhoota pradhana in its panchabhautikaconstitution. This declares the relation between rasadhatu and twacha.Twacha and raktadhatu – Sushruta has described varnaprasadana as one of thefunctions of raktadhatu i.e. it imparts the colour to skin. Raktadhatu is also responsiblefor the proper conduction of tactile sensation of the skin140. Twak and Mamsa dhatu –Twacha is an upadhatu of Mamsa dhatu. Development and nourishment of twacha isdepending on the dhatupakavastha of Mamsa dhatu141.Twacha and Trimala – Mala, Mutra and Sweda are the three main malas are theoutcome of sarakitta vibhajana process during dhatwagni viparyaya. The kitta part isexcreted out from the body. The sweda is the mala of Medo dhatu, which is excreted Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  58. 58. Review of Literature…. 49out from the swedavahi strotas of twacha. Sweda maintains luster and humidity of theskin142.According to our science nails and hairs are the mala of asthi dhatu and twachagatsneha is the mala of Majja dhatu143.Kustha involve morbidity of seven dravyas. They are Tridosha and four Dhatus (Rasa,Rakta, Mamsa and Lasika). So from above description one can easily understand theimportance of these units. The Vikruti of these seven essentials leads to the occurrenceof many skin diseases i.e. Occurrence of many Kustha Rogas.Modern View – Anatomy of Skin144 Skin is one of the largest organ in the body in surface area and weight. In adultsthe skin covers an area of about two square metres and weights 4.5-5 kgs. It ranges inthickness from 0.5-4.0 mm. depending on location. From all the body’s organs none ismore easily inspected or more exposed to infection, disease and injury than the skinbecause of its visibility. Skin reflects our emotions some aspects of normalphysiological process, which are held in our body. All the constituents are derived from ectoderm or mesoderm.01. The epithelium structure i.e. epidermis pilosebaceous / apocrine units, eccrine sweat units and nail units are ectodermal derivations.02. Melanocytes, nerves and specialized sensory receptors arise from the neuro- ectoderm.03. The other elements in the skin i.e. Langer Han’s cells, macrophages, mast cells, fibroblasts, blood vessels, lymph vessels, muscles and lipocytes originate from mesoderm. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  59. 59. Review of Literature…. 50Microanatomy of Skin Structurally the skin consists of two principle parts –A. The superficial thinner portion, which is composed, of epithelial tissue is called epidermis.B. The epidermis is attached to the deeper thicker connective tissue called dermis.C. Deep to the dermis there is a subcutaneous layer, which is called superficial fascia or hypodermis, which consists areolar and adipose tissue.Epidermis The epidermis is defined as squamous epithelium, which is about 0.1 greater up to0.8-1.4 mm on the palm and sole. Its prime function is to act as a protective barrier. Keratinocyte is the main cell of this layer, which produces a protein keratin. Thefour layers of the epidermis represent the stages of maturation of keratin bykeratinocytes.01. Basal layer – Stratum basale.02. Prickle cell layer – Stratum spinosum.03. Granular layer – Stratum granulosum. and Stratum lucidum04. Horny layer – Stratum corneum. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  60. 60. Review of Literature…. 51Stratum Basale – The basal cell layer of the epidermis is comprised mostly of keratinocytes which are either dividing or non dividing. The cells contains keratin, tonofibrins are secured to basement membrane by hemidesmosomes. Melanocytes make up 05-10% of the basal cell population. These cells synthesismelanin and transfer it via denritic process to neighboring keratinocytes. Melanocytesare most numerous on the face and other exposed sites and are of neural crust origin.Merkel cells are also found a bit frequently in the basal cell layer. These cells areclosely associated with terminal filaments of cutaneous nerve and seem to have a rolein sensation. Their cytoplasm contains neruopeptide granules as well asneurofilaments and keratin.Stratum spinosum – Daughter basal cells migrates upwards to form these layer ofpolyhedral cells, which are interconnected by dermosomes. Keratin tonofibrils form asupportive mesh in the cytoplasm of these cells. Langer Hans cells are mostly foundin this layer.Stratum granulosum – Cells become flattened and loose their nuclei in the granularcell layer. Keratohyalin granules are seen in the cytoplasm together with membranecoating granules, which expel their lipid contents into the intercellular space.Stratum lucidum – Normally only thick skin of the palms and the soles has this layer.It consists of 3-5 rows of clear flat dead cells that contains droplet of an intermediatesubstance that is formed from keratohyalin and is eventually transformed to keratin. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  61. 61. Review of Literature…. 52Stratum corneum – The end result of keratinocytes maturation can be found in thehorny layer which is comprised of sheets of overlapping polyhedral cornified cellswith no nuclei (corneocytes). The layer is several cells thick on the palms and thesoles but less thick else where. The corneocyte cells envelop is broadened and thecytoplasm is replaced by keratin tonofibrils in a matrix formed from the keratohyalingranules cells which are struck together by a lipid glue which is partly derived frommembrane coating granules.DermisThe dermis is derived as a tough supportive connective tissue matrix containing specialized structures found immediately below and intimately connected with epidermis. It varies in thickness being thin 0.6 mm on the eyelids and thicker more than 3 mm on palm and soles. The dermis chiefly consists of white fibroustissue, elastic fibres and non-striped muscles and contains blood vessels, nerves, hair,sweat gland, sebaceous glands and nerve corpuscles. The outer portion of dermis isabout 1/5th of the thickness of the total layer and is named as papillary region. Thedeeper portion of the dermis is called as reticular region. It consists of dense irregularconnective tissues containing interlacing bundles of collagen and coarse elastic fibers. Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  62. 62. Review of Literature…. 53 The reticular region is attached with underlying organs such as bone and musclesby the subcutaneous layer also called as hypodermis or superficial fascia. Picture showing the cross section of the skinPHYSIOLOGY OF SKIN145 The skin is metabolically active organ with vital functions including theprotection and maintaining homeostasis of the body.Functions of the skin 01. Regulation of the body temperature. 02. Protection 03. Immunity 04. Sensation 05. Excretion 06. Blood reservoir 07. Synthesis of vitamin D Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika
  63. 63. Review of Literature…. 54Keratin Maturation The differentiation of basal cells into dead but functionally important coenocytesis a unique feature of the skin. The horny layer is important in preventing all types ofagents from entering the skin including microorganisms, water and a particularmatter. The epidermis also prevents the body fluids from getting out.Epidermal cells undergo the following sequence during keratinocyte maturation.01. Undifferentiated cells in the basal layer immediately above divide continuously. Half of these cells remain in place and half progress upwards and differentiate.02. In the prickle cell layer cells change from being columnar to polygonal. Differentiating keratinocytes synthesize keratin, which aggregate to form tonofilaments. The dermatomes connecting keratinocytes are condensation of ton filaments. Dermatomes distribute structural stresses throughout the epidermis and maintain a distance of 20 mm between advancement cells.03. In the granular layer enzymes induce degradation of nuclei and organelles. Keratinohyalin granules mature the keratin and provide an amorphous protein matrix for the tonofilaments. Membrane coating granules attach to the cell membrane and release an impervious lipid containing cement which contributes to cell adhesion and to the horny layer.04. In the horny layer, the dead flattened corneocytes have developed thickened cell envelops encasing a matrix of keratin tonofibrils. The disulfide bonds of the keratin provide strength to the stratum corneum but the layer is also flexible Comparative efficacy of Jaloukavacharana and Prachana in Vicharchika

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