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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., Department of …

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., Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103


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  • 1. “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 CentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2005-2008
  • 2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103 CertificateThis 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 workdone by “Ashok M.G.” in partial fulfilment of the requirement for the post graduationdegree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi Universityof Health Sciences, Bangalore, Karnataka. Date: Dr. Raghavendra V. Shettar Place: Gadag M.D. (Ayu) Guide Asst. prof. in P.G, Dept. of kayachikitsa DGMAMC. PGS. & RC., Gadag.
  • 3. 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 institutionThis 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 workdone 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 partialfulfilment of the requirement for the post graduation degree of “Ayurveda VachaspatiM.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore,Karnataka.. (Dr. G. B. Patil) Prof. and HOD Principal, P.G. Dept of Kayachikitsa DGM Ayurvedic Medical College, DGM Ayurvedic Medical College, Gadag Gadag Date: Date: Place: Place:
  • 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “Acomparative clinical study of ‘siddharthaka yoga’ ‘parisheka’ and‘abhyantara prayoga’ in the management of ‘kitibha kushta’ with thespecial reference to ‘psoriasis’” is a bona fide and genuine research workcarried 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)
  • 5. Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminatethis dissertation/ thesis in print or electronic format for the academic /research purpose.Date:Place: (Ashok M.G.) © Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. 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 thisresearch 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 researchwork.. I express my thankfulness to my beloved principal Dr. G. B. Patil, for hisencouragement 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 thankDr. 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, PrakrutiRemidies Pvt. Ltd, Karwar who has extended his support for the study whole heartedlyby providing the required trial drug free of cost. His support is appreciated at thehighest 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. Ithank my elder brother Sri. Basavanagowda C.G. and Smt. Asha Basavana gowdafor thier continuous encouragement. I thank my brother Mr. Nagaraja M.G. for hisaffection. I thank my brother in law Sri. Siddanagowda G.K. and his family for theirconcern. 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 providingthe patients, I am thankful to Dr. M.C.Patil, Dr.Danappagoudar and Dr. Jagadeesh Mitti
  • 7. who provided facilities for the trial drug preparation in the college pharmacy with theirvaluable suggestions. I express my sincere thanks to Sri. Nandakumar for his help in statisticalanalysis of results. I take the privilege to thank Sri. Mundinamani, Librarian. I alsoextend my thanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided meall the necessary books and time for my literary work. I am very much thankful to Sri Tippanagowdar, and Sri. Kallanagouda, for theirhelp during the study. I extend my thaks to Sri Kulakarni and Mr. Manju for theirtimely 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. whois kind to me since my school days. I extend my thankfulness to Dr. Abhishek N.Y. forbeing 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, myjunior collegues Dr. Nataraj Dr. Adarsh, Dr.Joshi, Dr. Shailej, Dr. Uday, Dr. VeenaJigalur, 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 interneesMr.Basavanyappa, Mr. Rajashekhar, Mr. Vasantha Kumar, Mr. Satish Jalikal, Mr. SatishAngadi, 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.Mahanteshfor their help during the trial. Lastly I pay my deepest respect for those patients who took part in the study and Ishare my success with them. Dr. Ashok M.G.
  • 8. Abbreviations used:C.S – Charaka SamhitaS.S – Sushruta Samhita,A.S – Ashtanga SamgrahaA.H – Ashtanga HrudayaB.S – Bhela SamhitaM.N – Madhava NidanaB.P – BhavaprakashaY.R – YogaratnakaraV.S – vangasena
  • 9. Abstract: Charaka Samhita, leading from the front, states the management of kushtadisease with two distinctive types of treatment anthahaparimarjana chikitsa andbahirparimarjana chikitsa. The disease kitibha though not life threatening makes thelife of the sufferer miserable. The ugly appearance in this disease makes the patientpsychologically stressed more than anybody. With the fear of getting dejected fromfamily and society adds up to misery. Itching is the other most disturbing symptom inthis disease which is more dangerous than pain as patient continues to scratch thebody even if it is causing pain. Similarity in the signs and symptoms of psoriasis andlakshana of kitibha kushta after a primary literary review made us more convenient toset up the criteria and to have PASI as objective criteria. Ayurvaeda also believes for any skin diseases topical administration of thedrug is essential. One such yoga advised to use for both internally and externally isSiddharthaka yoga, though not advised as shamanoushadha but is advised for vamanaand virechana. Here it was taken for granted that if this yoga is administered in lesserdose it won’t cause any adverse effects. Also the prabhava of some of the ingredientsof the yoga encouraged to try this as none of the ingredients if advised were havingany systemic toxicity. So a study was planned to evaluate its comparative efficacy inkitibha kushta under the title “A comparative clinical study of ‘siddharthaka yoga‘parisheka and abhyantara prayoga in the management of ‘kitibha kushta’ with thespecial reference to ‘psoriasis’”.Objectives of the study:
  • 10. 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 abhyantaraprayoga.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 into two groups Group A and Group B. 15 patients of Group A underwent parisheka for10 days continuously. Group B patents were advised with the abhyantara prayoga ofSiddharthaka Yoga in the form of capsules in 3 divided doses per day. Assessment of results was done by considering the base line data of subjectiveand objective parameters to pre and post medication and was compared forassessment of the results. All the results were be analysed statistically for “P” valueusing 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 thisgroup.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 moresignificant than the abhyantara prayoga.
  • 11. Contents Contents Page number1. Introduction 12. Objectives 43. Literary review 54. Materials and methods 605. Observations and results 716. Discussion 1027. Conclusion 1248. Summary 1269. Bibliography 128
  • 12. List of tables.Table no. and content Page No.Table 01, showing the layers of twacha according to Acharya Charaka 13Table 02, showing the Layers of twacha according to Acharya Sushruta 14Table 03, showing correlation between twacha and skin layers 14Table 04, showing the nidanas of disease kushta mentioned in various books. 16-18Table 05 showing the possible reason by which individual nidana causes kushta 19Table 06, showing the Poorvaroopa of kushta 24Table 07 showing the roopa of Kitibha Kushta 26Table 08 showing Maha Kushta bheda according to different authors 31Table 09 showing Kshudra Kushta bheda according to different authors 32Table 10 showing the analysis of the individual drug of siddharthaka yoga 55Table 11 showing the analysis of the individual drug of siddharthaka yoga 56Table 12 showing the distribution of patients age group 72Table 13 showing the distribution of patients according to sex 72Table 14 showing distribution of patients by Religion 73Table 15 showing distribution of patients by Economical status 74Table 16 Showing distribution of patients by Occupation 75Table 17. Showing distribution of patients by Nature of work 75Table 18. Showing distribution of patients by Matra of ahara 76Table 19. Showing distribution of patients by Kala of ahara 77Table 20. Showing distribution of patients by Rasa 77Table 21. Showing distribution of patients by Guna of ahara 78Table 22. Showing distribution of patients Type of diet 79Table 23. Showing distribution of patients by Vyasana 79Table 24. Showing distribution of patients by Hygiene 80Table 25. Showing distribution of patients by Manaska sthiti 80Table 26. Showing distribution of patients by observed nidana in no & % 81Table 27. Showing distribution of patients by observed poorvaroopa in the 82study in Group A patientsTable 28. Showing distribution of patients by lakshanas observed. 82Table 29. Showing distribution of patients by anubandha vedana observed. 82Table 30. Showing distribution of patients by site of onset 83
  • 13. Table 31. Showing distribution of patients by mode of onset of the disease 83Table 32. Showing distribution of patients by aggravation time 84Table 33. Showing distribution of patients by aggravation season 84Table 34. Showing distribution of patients by Kula vruttanta 85Table 35. Showing distribution of patients by Chikitsa vruttanta 85Table 36. Showing distribution of patients by confirmatory signs 86Table 37. Showing demographic data in patients of in Group A 87Table 38. Showing demographic data in patients of in Group B 87Table 39 Showing Lakshanas of kitibha kushta in Group A 88Table 40 Showing Lakshanas of kitibha kushta in Group B 88Table 41 Showing Confirmatory signs in psoriasis Group A 89Table 42 Showing Confirmatory signs in psoriasis Group A 89Table 43 Showing Anubandha vedana of kitibha kushta in Group A 90Table 44 Showing Anubandha vedana of kitibha kushta in Group B. 90Table 45 Showing the observed features of the nature of kitibha kushta in Group A 91Table 46 Showing the observed features of the nature of kitibha kushta in Group B 92Table 47 Showing the observed vaiktika vruttanta in Group A 93Table 48 showing the observed vaiktika vruttanta in Group B 93Table 49 showing the rogi pareekshain Group A 94Table No. 50 showing the rogi pareekshain Group B 94Table 51 showing the Nidana observed in Group A 95Table 52 showing the Nidana observed in Group B 96Table No. 53 showing poorvaroopas observed in Group A 97Table 54 showing poorvaroopas observed in Group B 97Table 55 Showing assessment of grading of subjective and 98objective parameter values of Group – ATable 56 Showing assessment of grading of subjective and 99objective parameter values of Group – BTable 57 Showing t Statistical analysis of parameter values of Group – A 100Table 58 Showing t Statistical analysis of parameter values of Group – B 100Table 59 Showing Statistical analysis of parameters values of inter Group 101(Group – A and Group – B)Table 60 Showing the overall statement of results of Group A 119Table 61 Showing the overall statement of results of Group B 120
  • 14. List of FigureFigure Page noFigure no 01 shows the samprapti flow chart in general. 29figure no 2 showing the anatomy of normal skin 42Figure no 03 showing dermal vasculature of normal skin and psoriatic skin 44Figure no 04 showing ingredients f siddhrthaka yoga. 52Figure no 05 showing materials used in the study 59Figure no 06 showing step wise dhara procedure 67Figure 07 showing distribution of patients by age 72Figure 08 showing distribution of patients by sex 73Figure 09 showing distribution of patients by religion 74Figure 10 showing distribution of patients by Economical status 74Figure 11 showing distribution of patients by occupation 75Figure 12 showing distribution of patients by nature of work 76Figure 13 showing distribution of patients by matra of ahara 76Figure 14 showing distribution of patients by kala of ahara 77Figure 15 showing distribution of patients by rasa 78Figure 16 showing distribution of patients by gune of ahara 78Figure 17 showing distribution of patients by type of diet 79Figure 18 showing distribution of patients by vyasana 79Figure 19 showing distribution of patients by hygine 80Figure 20 showing distribution of patients by manasika sthiti 80Figure 21 showing distribution of patients by site of onset 83Figure 22 showing distribution of patients by mode of onset 83Figure 23 showing distribution of patients by aggravation time 84Figure 24 showing distribution of patients by aggravation season 85Figure 25showing distribution of patients by kula vruttana 85Figure 26 Showing distributions of patients by chikitsa vruttanta 86Figure 27 showing distribution of patients by confirmatory signs 86Figure 28 Showing the overall statement of results 118
  • 15. 1IntroductionIntroduction Acharya Agnivesha, the all time intelligent scholar of Ayurveda, the scienceof life notes down the preaching of Adhyupadeshta Punarvasu Atreya in the form ofdoctrine to become popular later as Charaka Samhita after the addition from theexperience of Acharya Drudhabala and redactation of Acharya Charaka. This is theonly doctrine honored & referred over centuries. The redactor Acharya Charakaviewed the river of medicine, raising from an obscure past, ever flowing, evergrowing and racing to the flood waters of today. He had urged us to learn fromgreatest 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 ofchikitsa. This attitude is seen from the chapter number one. He discusses the types ofchikitsa as of Antahparimarjana and Bahirparimarjana types. After dealing the entirechapter about panchakarmaroopa anathparimarjana chikitsa, he dedicates 2Aragwadeeya adhyaya for bahirparimarjana chikitsa especially for the disease 3Kushta. This shows the importance of treating kushta, a deergha roga after itsthorough understanding. He further says performing bahirparimarjana chikitsa yieldssadhya siddhi 4. For the first time in the entire history of medicine the disease Kitibha Kushtais cited from Charaka Samhita 5 where choorna pradeha is advocated over the tailaktagatra. It is evident after going through different classical texts of Ayurveda that 6Kushta, a noted mahagada requires multiple route of administration of drugs. Twosuch different modalities are antahparimarjana and bahirparimarjana chikitsa. Onesuch yoga mentioned for the use in both route is Siddharthaka snanokta aushadhasiddha kashaya. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 16. 2Introduction Kitibha kushta simulating to the disease Psoriasis in the contemporary systemof medicine results in the fear of getting dejected from the society because of theappearance of the body. Kandu, Shyava kina and khara sparsha and scratching thebody in the public by the patient creates an enormous psychological stress over thediseased and kandu is more miserable than the pain because patients don’t stopscratching the body even though it causes pain so it is postulated clinically that theitching is stronger symptom in any patient. Hence the management of kandu, shyavakina and khara sparsha is the need of the hour in kitibha sufferer. The utility of drugsof modern science like methotrexate, which is still of ‘gold standard’ has increasedrisk of bone-marrow toxicity and hepatotoxicity. This gives an edge of advantage toAyurveda over the modern system of medicine to help the sufferer with its non toxicmedicament, also suffer is compelled to seek prescription from an Ayurvedicphysician. The ingredients of Siddharthaka snana yoga was estimated to suit the demandsas 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 asan example for the physician to proceed their thoughts basing on these 7. This yogawas taken for the study to draw a comparative efficacy of the drug under the title “Acomparative clinical study of ‘siddharthaka yoga ‘parisheka and abhyantaraprayoga 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 asA and B. 15 patients of group A received the bahirparimarjana chikitsa in the form ofparisheka. As stressed by the all time great physician of Ayurveda Acharya Charakato administer external therapy for better efficacy over Tailakta gatra 8, taila was Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 17. 3Introductionpreapared using the same ingredients. Though snana is told in the Samhita, forhospital supervision the procedure was modified to parisheka. The other set of 15patients received antahparimarjana chikitsa in the form of capsules. The subjects wereselected 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 byduly considering the clinical signs and symptoms as subjective parameter and PASIscoring as objective parameter. The subjective and objective of base line data to preand post medication was compared for the assessment of the results. All the resultswere analysed statistically for ‘p’ value by using un-paired test to analyse the meaneffect of two groups, and paired‘t’ test was used to compare the effect of drug byassuming that the drug is not responsible for the changes in the observation before andafter the treatment. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 18. 4ObjectivesObjectives 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 19. 5Literary reviewLiterary reviewHistorical review:Ayurvedic literature: The science of life, Ayurveda was developed on the base of Vedasonly hence the Indian system of medicine is also devine. This auxiliary of Atharvaveda is said to be the perfect since the time of its inception. It is important to study thesubject of Ayurveda i.e. from primitive state and the recession at a particular stage – itmust be viewed as a part of our cultural history and cultural history must be studied inrelation 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 ofthe texts of Ayurveda. Hence the samanya nidana, poorvaroopa, upashaya andsamprapti of Kushta are considered in the entire study.Charaka Samhita Agnivesha samhita is now known as Charaka samhita, after the handycontribution from Acharya Charaka, the greatest redactor in the world history ofliterature. This was compiled in the second century B.C. The disease kushta is dealtwith the great importance as is evident from the fact that the treatment of kushta isdealt in the very third chapter of the samhita where the external therapeutics areexplained for the disease. The disease kushta is dealt in two broad headings as Maha kushta and kshdrakushta and are told as seven and eleven types respectively. Kitibha is dealt under thesecond variety of lesser important type of kushta in chikitsa sthana. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 20. 6Literary review The other parts of the book where the disease kushta is explained are asfollows; 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 AcharyaSushruta basing on the preaching of Divodasa. This is the book which has dealt both Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 21. 7Literary reviewthe 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 islost 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 22. 8Literary review 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 acolleague of Acharya Agnivesha. He had also counted 18 number of kushta but he had not used the wordKitibha, 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 evenmore so is obtained in mutilated form, missing preface, conclusion and some otherportions. Like Atreya in Charaka Samhita and Divodasa in Sushruta Samhita, theoriginal preceptor of this Samhita is Acharya Kashyapa. Young Jeevaka hadcondensed the teachings of Kashyapa to be known later as Kashyapa Samhita orVruddha Jeevakeeya Tantra. Kushta is dealt in kushta chikitsadhyaya of chikitsa sthana. The extrainformation 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 ofCharaka Samhita and Sushruta Samhita had dominated the readers in the recent timeas it avails the information of two different schools of thoughts in one single book. This book gives the definition of Kushta. He mentions bahya kushtasamprapti. Both maha and kshudra kushtas are dealt in nidana sthana only. Medogata Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 23. 9Literary reviewkushta and there after are told told as yapya and asadhya respectively. Pittaja,dwandwaja and asra mamsagata kushta are told as krucchrasadhya. The vata kaphajakushta notably are told as sukhasadhya 40. The chikitsa aspect of the disease is dealt inchikitsa sthana.Ashtanga Hrudaya: The other book almost consisted versions of Ashtanga samgraha out of the penof Laghu Vagbhatta is very famous in the southern part of the country for its poeticway of writing. 41 Acharya Laghu Vagbhatta conveys krimi as nidana of kushta . He explainsthe 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 sutraexplanation.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 hadcompiled mostly the versions of bruhattrayees. He had followed Charaka Samhita andAshtanga Samgraha for the explanation of nidana and lakshanas, while he followedAcharya Sushruta in explaining saptadhatugata kushta.Sharngadhara Samhita: Damodara soota Sharngadhra’s work is the choice of book to be referred forthe pharmacology and therapeutics in Ayurveda. While dealing the classifications ofvyadhis he says kushta is of 18 types, including the kitibha kushta 43. He contributeswith new formulations for kushta disease by calling those set as kushtaghna 44. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 24. 10Literary reviewBasavarajeeyam: The author who hails from south India is very special because he gives a list ofherbo-mineral formulations for every disease. He had added kandu as a lakshana ofkitibha to the version of Acharya Charaka. He is the first author to indicateformulations for individual types kushta. He advocates Vajrapani rasa for kitibhakushta 45.Vaidhya Jeevanam: The poet cum Ayurveda Acharya is special because of his contributions ofeffective yogas and poetic explanation of their efficacy. One eg of such yoga is foundin 4th Vilasa 18th shloka 46.Bhavaprakasha: Bhavamishra son of Latakana Mishra had written a book concentrating moreof the herbs explaining their properties. He also had written Chikitsa of variousvyadhis prevalent in madhyama kala. He followed Acharya Charaka in explainingkushta, in addition he told arishta lakshanas47, includes nisha in the pathya sevana 48and he advises kaishora guggulu for kushta 49.Sahasra yoga: The book written by an anonymous author belonging to Kerala state is animportant asset. The entire book comprises only the formulations for various diseasesin different forms. In each prakarana there are kushtaghna yogas. The therapeuticindex of this book is undoubtedly a part and parcel of the prescription in thepractitioners of this part of the country. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
  • 25. Nirukti 11Nirukti and paribhasha of kushta: The word kushta is originated from kush – katana (kuda pratyaya) 47 means; todeform the twacha (kusha nishkarsha), to change the colour of twacha(kushnatyangam), to discontinue the integrity of twacha (kutsitam tishtati). Also theetymology of the word kushta is from the root ‘kush’ meaning; that which comesfrom inner part, after adding hani to kush it becomes kushta 48. The meaning can beconcluded as the condition in which there is hani to the twacha especially to itsappearance as the factors like rakta, laseeka, ambu and tridoshas from inner part of thebody reach the outer most part of the body being skin which exactly matches with thesamprapti of kushta. Ashtangakaras were first to define kushta as “twacha kurvanti vaivarnya 49dushtaha kushtamushanti tat ||” , meaning the condition in which there isdiscolouration and dushti of twacha. The discontinuity of the twacha is resulted in thisdisease. Further the same author says; once the condition is allowed to lapse by time, itmakes the entire body to look ugly. It spreads to all the dhatus, resulting in theincrease of the kleda in the body because of which sankotha of twacha occurs leadingto utpatti of sookshma krimi inturn. These krimis later invade loma, twak, snayu,dhamani and tarunasthi in an order 50. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 26. Nirukti 12Nirukti and paribhasha of kitibha kushta: 51 The word meaning of kitibha is kesha keeta . Shri Kavirama Umeschandra 52says it as kesha koti . Kitibha in English is a louse (a parasitic insect, pediculushumanus, infecting the human hairs and skin and transmitting various diseases) and a 53kind of exanthema . Condensing all these, the definition of kitibha can besummerised as ‘a diseased condition in which the twacha gets discoloured like keshakeeta (blackish brown), or a condition in which the skin gets afflicted with keshakeeta.’ The same meaning is also told by Shri Tarakanath as, kitiriva bhatikrushnatwat i.e. a condition where the skin gets krushna varna like kiti, the kesha 54keeta . 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 aswe don’t find any krimi affecting the twacha as per the second opinion. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 27. Twacha shareera 13Twacha Shareera. Twak is the simulating term used for skin in the modern anatomy. Itinvaginates 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 totalbody 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 isthe moola of mamsavaha srotas 57. The 7 layers of twak are formed when shukra andshonita are subjected for the paka by doshas and the layers are formed just like the 58formation of santanika after boiling the ksheera . But Ashtanga samgrahakara saysthat the 6 layers of twacha are formed out of processing of asruk 59. Twak is the place 60 61, 62for tactile sensation and is made up of vayu mahabhuta predominantly this isalso the site of bhrajaka pitta, the factor responsible for the digestion of the external 63, 64application of medicaments , the seven and six laters according to AcharyaCharaka and Acharya Sushruta are shown in table no. 01 and 02 indicating theirfeatures.Table 01 showing the layers of twacha according to Acharya Charaka 65Sl.no. Layer Features01 Udakadhara Bahya twacha, protects the jaleeyamsha02 Asrugdhara Holds the rakta03 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 28. Twacha shareera 14Table 02 showing the Layers of twacha according to Acharya Sushruta 66Sl.no. Layer Measurement Features01 Avabhasini 1/18th vreehi Varna and chaya prakashaka, sidma and padmakantaka rogadhisthana02 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 Granthi, apachee, arbuda, shleepada and pramana galaganda.07 Mamsadhara Vreehi dwaya Bhagandhara, vidradhi and arsha rogadhishtana. Dr. Bhaskar Govind Ghanekar has written hindi commentary over SushrutaSamhita by name ‘Ayurveda Rahasya Deepika’ which is best referred for thecomparison of Ayurveda shareera to the modern anatomy. He is honored so muchbecause he himself has studied both modern science and Ayurveda academically. Hiscorrelations are shown in the table no. 03.Table 03, showing correlation between twacha and skin layers 67Sl.no. Layer Comparison of twacha to Twacha(skin layer) skin layer of modern anatomy01 Avabhasini Horney layer02 Lohita Stratum lucidum Bahya twacha03 Shweta Stratum granulosum (epidermis)04 Tamra Molphigian layer05 Vedinee Papillary layer Antah twacha06 Rohinee Reticular layer (dermis)07 Mamsadhara Subcutaneous tissue and muscular layerRelation between twacha and dosha, dhatu and mala:Dosha: Vata: sparshanendriya is the adhishtana vata 68, 69 and samana vata is presentin swedavaha srotas 70 which in turn is present in twacha. Pitta: bhrajaka pitta is present in twak digesting the external applications andreflecting chaya in the skin 71. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 29. Twacha shareera 15 Kapha: No direct reference is available regarding the presence of kapha intwacha, 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 72 73romas , twak roukshata is the sign manifested in the rasa kshaya , shaithya is 74generated as a result of rasa dhatu vruddhi hence it is postulated that twacha isnourished by rasa dhatu and it is responsible for the maintenance of the temperature ofthe body in its normalcy. 75 Rakta: varna prasada and sparsha gnana are told as the karma of raktahence rakta is also present both physiologically and anatomically in the twacha. Aftergoing through rakta rogas a notion can be evolved that whenever there is rakta dushtithe site of manifestation is twacha, the rogas like kushta, visarpa, pidaka, mashaka,neelika, tilakalaka etc. manifest. Hence it is concluded that there is definitely arelation of dependency between twak and rakta. Mamsa: 6 layers of twacha formation takes place from the prasada bhaga ofmamsa 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 77the romakoopa and twak randra . The karya of sweda is told as maintenance of 78shareera ardrata and twak soukumaryata. . The kshaya and vruddhi lakshanas ofsweda are manifested in the twacha only. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 30. Nidana 16Nidana of kushta: Study of Nidana, the cause in any research has got its importance inunderstanding the disease process, and planning the treatment as nidana parivarjanaplays major part in chikitsa. It is also essential to study the literary part of nidana so asto revalidate them to the present day and to add if some new nidanas are observed inthe course of study. In the present study the nidanas are depicted in the tabular formand an attempt is made to quote the possible reason by which these nidanas manifestthe disease kushta. However separate nidanas are not told for kitibha kushta. Thegeneral kushta nidanas are considered in the present study.Table 04 showing the nidanas of disease kushta mentioned in various books79 to 87S.N. Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S1 Mithyahara vihara + - + + + + + + +2 Sheetoshna vyatyasa + - - - - + + + + Santarpanaapataprpana vyatyasa3 Madhu + - - - - + - + -4 Fanita + - - - - + - + -5 Matsya + - - - - + + + +6 Lakucha + + - - - + - + -7 Moolaka alone and or with + + - - - + + + + guda8 Kakamachi + + - - - + - + -9 Atimatrahara + - - - - + - + -10 Chilichima(matsya vishesha) + - - - - + - + - + payas Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 31. Nidana 17S.N Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S11 Hayanaka,yavaka, + - - - - + - + - Chinaka,uddhalaka, koradusha +ksheera, dadhi,takra,kola,kulattha, masha, atasi,kusumbha12 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 + - + - - - + - + products20 Tila and tila taila + - + - - - + - +21 Masha + - + - - - + - +22 Madhura, amla, lavana rasa + - - - - - + - + atisevana23 Pishtanna + - - - - - - - -24 Diwaswapa + - - - - - + - +25 Vipra, guru, sadu gharshna + - + + + - + - + and ninda26 Papakarma + - + + - - + - +27 Chardi vega dharana + + + - - - - - -28 Vatayu with payas - + - - - - - - -29 Payas with nimbu - + - - - - - - -30 Pippali - + - - - - - - -31 Mootra and pureesha vega - + - - - - - - - dharana Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 32. Nidana 18S.N. Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S32 Mamsa sevana alone and - + + - - - - - - with milk33 Paya sevana after Madhya - + - - - - - - - and amla sevana34 Ushnahara sevana after - + - - - - - - - madhu and Madhya sevana35 Maithuna, vyayama & - - + - - - - - - ahitashana after sneha or ayatharambha sneha pana36 Purakruta karma - - + - - - - - -37 Valmika roga - - - - - - - - +Other nidanas: Some of the other factors are also said to cause kushta in differentcontexts apart from kushta nidana and kushta chikitsa chapters in the samhitas. Someof those are compiled here under; Acharya Laghu Vagbhatta 88 and Acharya charaka 89 says krimi as nidana ofkushta. Kushta is counted under Aupasargika roga along with jwara, shosha andnetrabhishyanda 90 so it spreads one to other on contact etc. Kushta is told as ofhereditary (streepumsa shukrashonitajanya) origin i.e. adibala pravrutta vyadhi 91.Kushta disease is resultant of sneha vibhrama 92. When dushita rakta is madesthambha by advising sthambhana chikitsa in raktarsha it leads to kushta 93,sthambhana is contraindicated in raktapitta when dosha is in utklishta avastha, if it isdone in this condition it leads to kushta 94. If sangrahaka aushadha is given inamatisara state then it leads to kushta with other diseases 95. Those who are using riverwater flowing from paariyaatra, or vindhya and sahya area have always fear of gettingkushta along with shiroroga and hrudroga, 96. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 33. Nidana 19 In nidanas, the major part is occupied by the viruddha factors in terms of bothahara and vihara. It is already cited that the disease kushta is told asviruddhaharaviharajanya 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 arelinked with the samprapti ghatakaslike doshas, dhatus, agni, ams, srotas etc here underTable 05 showing the possible reason by which individual nidana causes kushtaNidana Possible reason for the manifestation of kushtaMithyahara vihara Is desha kala prakrutyadi viruddha & samyoga viruddha ahara 97Sheetoshna vyatyasa Is karma viruddha, avastha viruddha & veeryaSantarpanaapataprpana vyatyasa viruddha 98Fanita Guru, abhishyandi and tridoshakrut 99Matsya Snigdha, bahudoshakaraka, guru, ushna and madhura 100.Lakucha Is tridoshakara 101, samyoga viruddha with payas dadhi mashasupa guda ghruta.102Moolaka 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 108Vyayama, vyavaya, santapa after Karma viruddha 109consuming above said and bhojana Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 34. Nidana 20Nidana Possible reason for the manifestation of kushtaSheetodaka Karma viruddha, vyadhi avastha viruddha. 110avatarana afterbhaya, shrama,santapa, chardi,Aticharana of sneha Parihara viruddha, causes kushta 111, mithya snehapana causes kushta 112Drava, snigdha, and Drava does prakledana i.e. increases the kledata113.kledanaguru ahara. shakti is snigdha so increases the sama.114, guru- guru vipaka and upalepakaraka 115 i.e. srrotorodhakaPanchakrma In terms of consumption of nishiddha vishayas 116 leads toapachara doshotkleshaNavanna Is abhishyandhi,increases the kledata in the dosha dhatu mala and srotas 117Dadhi and other Dadhi sevana during ratri, nitya sevana, after heating, withoutMilk products mudgasoopa, kshoudra, ghruta, sitopala and amalaka will cause kushta 118Madhura, amla, Madhra – Atyartha upayoga of madhura rasa causes so manylavana rasa atisevana 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 shithilata122Pishtanna Is guru than the shali 123 so kaphakarakaDiwaswapa It increases the kandu. Srava 124Vipra, guru, sadu Is prabhavajanya.gharshna and nindaMasha Shleshma janaka 125.Papakarma Is prabhavajanya.Chardi vega dharana Kushtakaraka 126Vatayu (Harina Samyoga viruddhamamsa) with payas Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 35. Nidana 21Nidana Possible reason for the manifestation of kushtaPayas with nimbu Samyoga viruddha 127Pippali 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 Samyoga viruddhaand with milkPaya sevana after Viruddha 129Madhya and amlasevanaUshnahara sevana Samyoga viruddha 130after madhu andMadhya sevanaMaithuna, vyayama, Parihara viruddha 131ahitashana aftersneha orayatharambha snehapanaPurakruta karma PrabhavajanyaTila & tila taila Panabhyasa of tila taila is twak dushtikaraka132 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 36. Poorvaroopa 22Poorvaroopa: The sets of signs and symptoms appearing prior to the disease properwhich gives a hint of forth coming disease are called as poorvaroopa. The diseasekushta also manifest completely after hinting about its complete manifestation.These are resulted out of the dosha dushya sammurchana at the level ofsthanasamshraya of vyadhikriyakala. The advantage of the knowledge ofpoorvaroopa enables the physician to be ready with the measures to combat theforthcoming disease in advance. The table 06 shows poorvaroopa of the diseasekushta, but specific explanation of poorvaroopas of kitibha kushta are however notexplained in any of the texts. Some of the poorvaroopas are searched for the reason for theirmanifestation and are stated below;Aswedana and Atiswedana – vata chalagunataha (swedovaha sroto avarodha and )Parushyata – vata kharagunatahaAtishlakshanata – kapha shlakshna gunatahaVaivarnya – rakta gunatahaKandu – kapha karmatahaNistoda – vata karmatahaSuptata – vata kapha – sheeta gunatahaParidaha – pitta – ushnagunatahaPariharsha – vata – sheeta gunatahaLomaharsha – vata – sheeta gunatahaKharatwa - vata kharagunatahaUshnata – pitta ushna gunatahaGourava – kapha – gurugunataha Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 37. Poorvaroopa 23Shwayathu – kapha – srotorodhaVisarpa – vata pittaPradeha of mala, Sheegrotpatti chirasthiti – vataKota Unnati/ pidakodaya – raktaKrushnata of asruk – vata roopatahaShrama – vata karmatahaAdhika shoola in vrana – vata – karmatahaKlama – vata karmatahaRaga – pitta roopataha andPipasa – pitta. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 38. Poorvaroopa 24Table 06, showing the Poorvaroopa of kushta 133 to 141S.N. Poorvaroopa C.S B.S S.S A.S A.H M.N B.P Y.R V.S1 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/ + + - + + + + + + pidakodaya19 Sheegrotpatti + - - + + + + + + chirasthiti21 Krushnata of asruk - - + + + + + + +22 Shrama + - - + + + - + +23 Adhika shoola in + - - + + + + + + vrana24 Klama + - - - - + - -25 Raga - + - - - - - - -26 Pipasa - + - - - - - - -27 Dourbalya - + - - - - - - - Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 39. Roopa 25Roopa: Lakshana, roopa os linga are some of the synonyms used to denote the signsand symptoms of any disease in Ayurveda. These are coming to the picture in adisease scenario during the vyakta avastha of the vyadhikriyakala. The lakshanas andthe intensity of them depend on strength of dosha dushya sammurchana. Thelakshanas of the kitibha kushta are compiled from all the reliable classical texts ofAyurveda and are shown in table number 07, page no. 27. Some of the lakshanas areinterpreted with the dosha amshamsha kalpana, basic cause of all vyadhis where everpossible and are;Shyava varna kina – Shyava (ishat krushna varna) kina (vranasthana) 142 is seen. Sothe lesion is brownish red in kitibha kushta.Khara sparsha of kina – the lesion is, karkasha sparsha, kathina, amrudu. The kharaword must have been used to indicate the lekhana guna 143 which scrapes out the skinin this context.Parushata of kina – rookshata of the twacha is always there in the kitibha kushtabecause of the vata dosha.Srava – is flow of exudates from the vrana sthana.Vrutta – is circular shape of the vranaGhana / 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 completedisappearance.Snigdha – is the sparsha here. But khara, parusha and rooksha is told as other signsby rest of the Acharyas, it is therefore a contradictory statement which requires to beunderstood as whenever excessive kleda guna is there at that time the snigdha sparsha Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 40. Roopa 26can be elicited as kledana is the karma of none other than snigdha guna. Also whenthere is relative predominance of kapha dosha in the kitibha than the vata, this may beobserved.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 diseasewhich reoccurs completely after its disappearance.Doshas responsible for individual lakshanas:Shyava varna kina – vata doshaKhara sparshata of kina – vata dosha khara gunataha.Parushata of kina – vata kharagunatahaSrava – pitta roopatahaUgra kandu – kapha karmatahaSnigdha – kapha snigdhagunatahaKrushna varna – vata dosha.Rookshan – vata gunatahaTable 07 showing the roopa of Kitibha Kushta 144 to 153S.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 + - - + + + + + + + kina3 Parushata of kina + - - + + + + + + +4 Srava - + + - - - - - - +5 Vrutta - - + - - - - - - -6 Ghana / drudha - + + - - - - - - -7 Ugra kandu - + + + + - - - - -8 Vartate cha - + - - - - - - - - samutpannam8 Snigdha - - + - - - - - - -9 Krushna - - + - - - - - - +10 Rooksha - - - + + - - - - -11 Prashantani cha - - - - - - - - - + punaha utpadhyate Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 41. Samprapti 27Samprapti of kushta: For any disease to manifest, it requires two basic things namely dasha and dhatu. Theearlier acquires later to generate certain sets of signs and symptoms. The whole process startswith a cause as is required for any action. The understanding of this whole process is asimportant as giving a prescription to the sufferer. The planning of chikitsa is told as immatureif 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 154believed that this disease never occurs with a single dosha involvent . However kushta isclassified on the basis of amshamshakalpana of dosha, samana dosha dushya prakruti. Thesesubtype of kushtas are told to have the predominance of either one or two dosha, rarely 155tridoshas. The sapta dravyas of kushta are tridoshas, twak, mamsa, shonita and laseeka .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 sthanaand 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, shinitaand laseeka (prasara and sthana samshraya) causing the shaithilyata in them leading to the 156manifestation of kushta (vyakta avstha of vyadhikriyakala) . He further says in chikitsasthana that vatadi tridoshas gets prakopa and does dushti of twak, rakta, mamsa and ambudushti 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 ofkushta. First the vata dosha prakopa occurs later it takes increased pitta and kapha in to thetiryag sira covering and visiating the bahya marga i.e. twak, mamsa, rakta and laseeka. Aftervisiating these, doshas produce mandalas whenever they get vikshepana and nissarana, furtherif the condition is not managed with proper medication they invade the gambheera dhatusresulting in the dushti 158. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 42. Samprapti 28 Acharya Bhela considers the role of ushma sannirodha in kushta samprapti. Thisushma 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 andmamsa. At last tridoshas causes the dushti of rakta and mamsa generating the kushta in ashugati. Notably Acharya Bhela does not include laseeka in the dushyas in the context ofsamprapti 159. Acharya Vruddha Vagbhatta has given samprapti in detail when compared to all theother. Mala vriddhi takes place because of nidana sevana, these doshas then invade tiryaggatasira visiating twacha, laseeka, asruk and mamsa. After some time tridoshas cause shlata oftwacha, laseeka, asruk and mamsa spreading inward out. At this stage there will be twachavaivarnya and dushti. After this stage if left untreated invade dhatus increasing the kledainside the body. Kleda and sweda in combination causes sankotha and utpatti of krimifollowed 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 ghatakasSthanika 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 variouslevels with differences. Figure no 01 shows the samprapti flow chart in general. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 43. Samprapti 29 Nidana sevana Tridosha prakopa Ushma sannirodha Tridoshas enter in totiryak Vata prakopa sira and make sanchara in the dhatus Dosha sanchaya Tridosha get ashraya in twak, mamsa, shonita and Vruddha vayu takes laseeka (bahya marga) pitta & kapha to causes shlata tiryak sira Vikshepana and nissarana of dosha Tridosha moves to siras causing raktadushti Twacha vaivarnya Avarodha of rakta & mamsa Increases kleda Kushta utpatti in the body Kleda and sweda causes sankotha Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 44. 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 170 innumerable number of kushta because of their vikara vikalpa 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, 171 anubandha, sthana vibhaga, vedana, varna, samsthana and prabhava . 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 45. Kushta bheda 31Table 08 showing Maha Kushta bheda according to different authors 172-174 Mahakushtan Charaka samhita Sushruta samhita Ashtanga samgrahaSl. No. Name Dosha Name Dosha Name Dosha01 Kapala Vata Kapala Pitta Kapala Vata02 Oudumbara Pitta Udumbara Pitta Oudumbara Pitta03 Mandala Kapha Aruna Vata Mandala Kapha04 Rushajihwa Vatapitta Rushajihwa Pitta Rushajihwa Vatapitta05 Pundareeka Kaphapitta Pundareeka Kapha Pundareeka Kaphapitta06 Sidma Vatakapha Dadru Kapha Dadru Kapha07 Kakana Tridosha Kakana Kapha Kakana TridoshaTable 09 showing Kshudra Kushta bheda according to different authors 175-177 Kshudra kushta Charaka samhita Sushruta samhita Ashtanga samgrahaSl. Name Dosha Name Dosha Name Dosha01 Ekakushta Vatakapha Ekakushta Kapha Ekakushta Vatakapha02 Charmakushta Vatakapha Sthularushka Kapha Charmakushta Vatakapha03 Kitibha Vatakapha Kitibha Pitta Kitibha Vatakapha04 Vipadika Vatakapha Mahakushta Kapha Vipadika Vatakapha05 Alasaka Vatakapha Visarpa Putta Alasaka Vatakapha06 Dadru Pittakapha Parisarpa Vata Sidma Vatakapha07 Charmadala Pittakapha Charmadala Pitta Charmadala Pittakapha08 Pama Pittakapha Pama Pitta Pama Kaphapitta09 Visphota Pittakapha Sidma Kapha Visphota Kaphapitta10 Shataru Pittakapha Rakkasa Kapha Shataru Kaphapitta11 Vicharchika Kapha Vicharchika Pitta Vicharchika Kapha Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 46. 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 47. 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 48. Vyavacchedaka nidana 34Vyavacchedaka nidana Diagnosis of any disease becomes difficult when one or more diseasesmimic each other. The same is with kitibha kushta also. Our Acharyas have thusevolved concept of vyavacchedaka nidana to overcome this confusion. They haveurged us to learn the art of differentiating the diseases on the basis of clinicalpicture available. Here is an attempt made to differentiate the diseases which sometime confuse the diagnosis of kitibha kushta. Keeing some of the signs andsymptoms as criteria vyavacchedaka nidana of kitibha kushta is done. Ekakushta: is most frequently told as psoriasis and accepted but theabsence of kandu in this disease excludes its diagnosis from kitibha vis-à-vispsoriasis. Mahavastu, large surfaced lesion is the other which is very rarely seenin kitibha, the psoriasis. Alasaka: though said to have kandu differs in the colour of lesion as ragais found in alasaka. Dadru kushta: is also having kandu with raga and mandala is said to beutsanna which is not so in kitibha, the psoriasis. Charmadala: presents with kandu, sphota but has osha and chosha aslakshana. Pama: is said to have kandu, visphota, paridaha and appears in specificsites as in sphik, pani, pada and kurpara i.e flexural area. Kitibha kushta does notappear in specific sites is thus differentiated from pama. Sidma: is another skin disease which has kandu but it appears specificallyin urdwa kaya. Vipadika: is restricted to pani and pada. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 49. Vyavacchedaka nidana 35 Vicharchika: is said to have ruja along with simulating lakshana likekandu and ghana of kitibha kushta. Also bahusrava is found in vicharchika whichis not found in kitibha kushta. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 50. Chikitsa 36Kushta chikitsa Any kushta which is manifested by the involvement of single dosha or vatakapha involvement is amenable to treatment. All other types of kushtas are difficult totreat. As discussed already, kushta disease can not occur without the involvement ofall the three doshas. Keeping this point strongly in the consideration our Acharyashave told the line of treatment giving wide scope for panchakarma. The kushtamanifested by vata always mandates the consumption of ghruta and that by kaphadosha requires vamana and that by pitta needs virechana therapy. All these should bedone by using those drugs which have kushtahara and respective doshaghna property.Periodical advice of these procedures indicates the extent of dosha visiation in thedisease kushta. Chikitsa is told as of three types. Antahparimarjana chikitsa is the internaladministration of the medicines in the form of aushadha and ahara in accordance withthe 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. Thesnana 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 ofapplications, taila abhyanga, snana etc. procedures are almost inevitable in thisdisease. This is because the sthana samshraya of the doshas are seen in the twacha andthe vyaktha sthana of kushta is also twacha. The treatment to the vyakta sthana is alsodealt in Ayurveda. Ayurveda believes complete treatment as; reversal of thesamprapti. Skin being the outer most part of the body is always told to be taken careby the utility of abhyanga, udwarthana, snana, lepa, gandha dharana, maala dharana Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 51. Chikitsa 37etc. The importance of external therapy will be explained in the drug review chapteragain with special reference to the parisheka. Looking in to the large number of yogasgiven by different Acharys one can understand the importance of external therapy inthe prescription of kushta. Soon after the explanation of the shamanoushadhas andpathyapathya as many as 68 number of lepa, taila and snana yogas are explained in 182the kushta chikitsa by Acharya Charaka this trend of explanation is seen in all thetexts. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 52. Pathyapathya 38Pathyapathya in kushta: Pathtya is patho anapeta, that which is not against the srotas and priya tomanas 183. Srotas is always an important integral part of samprapti of a disease, whichneeds to be corrected by the means of chikitsa. Pathya sevana along with the medicineproper will always reduce the recovery phase of a disease. Acharya Lolimbaraja whowas known as the best poet physician was the first to explain the significance ofpathya in his work Vaidhya Chintamani. He feels that if a person knows all aboutpathya 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 mudgaand adhaki alone or mixing with nimba patra and arushkara or with mandukaparniavalguja, atarushaka or with sarpi and sarshapa taila or with tikta varga dravya.Amedaska jangal mamsa if the patient is habituated to eat mamsa. Vajrakatailabhyanga. Aragwadadi kashaya gana oushadha utsadana. For pana, parisheka andavagaha khadhira kashaya is advised. Also neecha roma, neecha nakha, vishranta, 185hitashana, oushadhatatpara, and who is yoshita, mamsa and sura varjee . AcharyaCharaka says the utility of tikta shakhas, laghu anna, ahara dravya processed withbhallataka, triphala and nimba, purana dhanya, jangala mamsa yusha prepared withmudga and patola186. Jatiphala, kakamachi, punarnava, bruhati, bhallataka,nagapushpa, lashuna, go, khara, ushtra, mahisha mootra are the pathyas contributedby Acharya Vishwanath Sen 187. 188Apathya: Acharya Sushruta says the apathya as varjya in the context of kushtaMamsa, 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 tilaas apathya in kushta 189. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 53. Anatomy and physiology 39Anatomy and physiology of skin190 Knowledge of the structure, physiology, chemistry and function are essentialto understand the pathology of skin disease and also essential prerequisite tounderstand the nature of disease and to plan proper treatment. Every square cm. ofskin contains 70cm. of blood vessels, 55 cm. of nerves, 100 sweat glands, 15 oilglands, 230 sensory receptors and about half a million cells that are constantly dyingand being replaced. Thickness of the skin varies from 1.5 – 4mm. or more in differentparts.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 squamousepithelium 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 4layers or strata as basal, spinous, granular, corneal layer. These layers are consideredas successive stages of maturation of germinative keratinocytes into fully cornifiedkeratinocytes. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 54. Anatomy and physiology 40 Dermis is strong flexible connective tissue layer. The cell type found here aretypical of those found in any connective tissue proper; fibroblasts, microphages andoccasional mast cells and WBCs. Its semi fluid matrix is embedded with collagen,elastin and reticular fibers. The dermis binds the entire body together like bodyshocking. The dermis is again two layered; papillary layer and reticular layer. Psoriasis is a disease dealt in the diseases of keratinization in the leadingdermatological text books; hence the same is dealt in detail.Keratinization: The basal cells are germinative cells of the epidermis. The basal cell layer is arapidly dividing one. In mitosis approximately 50% of daughter cells contribute to thegrowth of the epidermis (Mcka PH. Pathology of skin, 1st ed. Philadelphia: JBLippancott). Keratinocyte produces keratin, the fibrous protein helps give theepidermis its protective property. They are tightly connected to one another bydesmosomes. The keratinocytes arise in the deepest part of the epidermis from a layerof cells (stratum basale) that undergo almost continuous mitosis. As the keratinocytesare pushed towards the skin surface by the production of new cells beneath them, theymanufacture the keratine that eventually dominates their cell contents. By the time thekeratinocytes reach the free surface of the skin they are dead. Scale like structure thatare little more than keratin filled plasma membranes, millions of these dead cells ruboff every day, giving the body a totally a new epidermis 25 - 45 days – the time frombirth of keratinocyte to its final wearing away. In healthy skin, the production of newcell 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 55. Anatomy and physiology 41accelerated or decelerated by injury to the dermoepidermal junction and papillaryvascular damage. Kinetics of epidermal proliferation and maturation; N-2 hrs Mitosis M N-2 hrs G1 N-10-20hrs G2 Interphase S1 N-7 hrs Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 56. Psoriasis 43Psoriasis: 191 Greek word used to describe itchy, scaly, scabby disease of the skin . Thedisease psoriasis is a disorder of keratinization. The roman sage Auralius Cornelious 192Celsus is credited with the first clinical description of psoriasis . Galen first to usethe term psoriasis and Robert Willian (1808) specifically distinguished and described 193psoriasis as a recognizable entity . Lepra vulgaris described by Willian was avariety of psoriasis. In 1841, Hebra definitively distinguished the clinical picture fromthe leprocy.Definition: Psoriasis is chronic non infectious, inflammatory dermatosis. Is includedunder chronic inflammatory dermatosis, a condition where desquamation or sheddingof abnormal scale or salmon colored plaque is seen.Incident rate: Psoriasis is the most frequently cosulted case in dermatology clinic. A total of 1940.1 – 3 % of the world population is estimated to suffer from this disease and its 195hospital prevalence was about 6% . In India studies reveal incidence of psoriasisattending clinic and hospital range from 0.8 – 5.6 does not however reveal the trueprevalence in the general population 196.Age of onset: The onset of this disease is commonly seen in the second, third and fourthdecade of life, though it can appear soon after the birth and at old age. About 8.5 % of 197Indian children were psoriatic . A study in Punjab showed that the age of onsetvaried from 18 months to 52 years with the highest incidence in the age group of 11 to21 years 198. The highest incidence in two other studies was in reproductive age group Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 57. Psoriasis 44 199(15 – 45 years and 11 – 40 years) . In a recent study, the mean age of onset forfemales 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 iskey in its etiology. Thirty six per cent 2,144 psoriatics had a family history (Ferber etal.1968) in an Indian study by Kaur et al. out of 782 patients seven per cent hadpositive 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 202genetically conditioned is beyond doubt’ . There is clearly a genetic component inthe psoriasis. Psoriasis has been linked to HLA-Cw6. Evidences also indicate a role ofT 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 isprecipitated. Other factors include drugs, lithium and antimalarials, and physical orpsychological stress. Excessive alcohol consumption is also associated with diseasedeterioration 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- Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 58. Psoriasis 45adrenoreceptors (βblockers), lithium) and emotions are some proved triggering factorsof paoriasis.Pathophysiology: Scaling, thickening and inflammation are the cardinal signs of psoriasis. Theseclinical features are mirror the characteristic pathophysiological events that occur in alesion. Expansion of dermal vasculature: In the early stage capillary in superficialpart of dermis are dilated with edema and perivascular exudates of lymphocytes andmacrophages that extend in to the basal part of the epidermis. The expansion of thedermal vasculature accounts for vivid red colour of active plaques, expanded dermalvasculature is shown in figure206.Figure no 03 showing dermal vasculature of normal skin and psoriatic skin Epidermal hyperproliferation: There an increase in the number ofproliferating keratinocytes in the basal layer the epidermis. This together with loss ofdifferentiation is responsible for the thick, silvery scale seen clinically. The growthrate of psoriatics is up to 10 times that of normal epidermis 207. This high mitotic ratein active lesion with prominent parakeratosis reflects the rate of replication ofepidermal cells. Normally it takes 13 days for a newly formed basal cell in the Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 59. Psoriasis 46epidermis to differentiate and travel to the surface, where it sheds off; in activepsoriasis it takes 5 days. In the normal epidermis a basal cell takes 200 hours for thecycle; in psoriasis it takes 100 hours 208. Accumulation of inflammatory cells: the inflammatory cells – neutropholsand T lymphocytes in particular – accumulates in both the dermal and epidermal layerof the skin. In evolving lesions , the lymphocytes infiltrate early in to the skin, prior toepidermal and other changes. Psoriasis is associated with certain HLA antigens,particularly HLA-Cw6 and HLA-B57, which are cell surface molecules critical to the 209regulation of T-lymphocytefunction . Stimulation of immune function withcytokines such as IL-2 has been associated with abrupt worsening of preexistingpsoriasis, 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) 211colour in the skin of Caucasians . Scaling, thickness and induration are varyingcardinal characteristics of all lesions. The classic symmetry, silvery scale and vividreddish purple color of lesion allow psoriasis to be distinguished from other skindisorders in the majority of the cases 212. The scales are loose dry and silvery white ormicaceous due to the presence of air trapped in between the layers of the scales. Onguttate, characteristic coherence of the scales can be seen as if one scratches a waxcandle is called as candle grease sign (‘signe de la tache de bougie’), when the scalesare further scratched in those lesions where free scaling is not there will result incapillary bleeding and the sign is called as Auspitz sign. This sign is because ofparakeratosis, intracellular edema of epidermal cells. Koebner phenomenon is Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 60. Psoriasis 47development of new fresh lesion from the site of physical trauma, the sign namedafter Heinrich Koebner in 1878 213.Classification of paoriasis: 214. Guttate psoriasis: usually seen in children and follows an upper respiratoryinfection or tonsillitis due to streptococci. Multiple ‘drop like’ lesions are typicallydistributed on trunk, frequently involving natal cleft. Plaque psoriasis: most common type is distributed bilaterally. The lesions arestable and remain unchanged for long period. Commonly manifested areas are;extensor surface, the elbow, knee, lumbosacral area and back. Sudden fluctuation isobserved in this type of psoriasis. Exfoliative psoriasis: Erythema and scaling are universal and generalized.Edema of legs may be there. Hypoalbuminaemia, increased capillary permeability andincreased central venous pressure contributes to its development. Pustulara psoriasis: when the lesion is studded with tiny superficial, sterilepustules, it is valled so. It is precipitated by over treatment with coal tar, anthralin orpotent steroids. Foci of infection and pregnancy and hypocalcemia may alsoprecipitate. Psoriasis Ungis: the involvent of the nail in psoriatics is called so. Thecommon changes are pitting of nail plate, onycholy, subungual hyperkeratosis andcrumbling of nail plate. Oil drop sign is noted. Mucous membrane lesions in psoriasis: rarely, lesions may occur on thegingival and ventral lingual mucosa. Involvement of mucous membrane is not seen asthese epithelial surfaces are normally as rapidly proliferative as psoriatic skin. Psoriatic arthritis: an inflammatory arthritis associated psoriasis, usually anegative test for rheumatoid factor. It occurs in about 5-10% of patients of psoriasis. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 61. 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 numberof 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 candidainfection. The presence yeast and pseudo-hyphae in Gram-stained microscopyspecimen will conferm infection. Tinea: Tinea capitis: hair thinning is observed,well demarketed areas of hairloss are highly unusual in psoriasis. Tinea corporis: lack of symmetry in the lesions, presence ofperipheral scaling and central clearing confirms tinea corporis diagnosis Tinea cruris: cenral clearing with advanced edge. Lesions are nonsilvery extends more on left than the right side. Tinea pedis: clear vesicles are noted. Tinea manum: fine powdery scaling in the ring worm infection ofhands along with asymmetrical presentation. Secondary syphilis: guttate type may mimic. Search for primary syphiliticlesion, together with lymphedenopathy, mucosal lesions in syphilis will exclude it. Eczema: more pruritic, lack of silvery scales, skin biopsy, lack ofpsoriasis elsewhere in the body. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 62. Psoriasis 49 Neoplasms: superficial basal cell carcinoma and Bowen’s disease(squamous cell carcinoma in situ) may appear highly suggestive of psoriasis. Theseneoplasms occur singly or are fewer in number, never symmetrical and do not scalesilvery plaqyes. Pityriasis rosea: is acute in onset, self limiting over a period 8-12weeks produsing multiple scaly oval lesions typically in Christmas tree distribution ontrunk 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 areapplied once daily. These should not be used regularly for more than 4 weeks, potentsteroids should not be continued for more than 10 days at a stretch. Patient should beunder continuous supervision. Less than 100 g moderate or higher potencypreparations should be used per month. Corticosteroids should be used alternativelywith non steroidal therapies. Vitamin D3 analogs: are widely used in European countries and UK as firstline of treatment in chronic plaque psoriasis. Calcipotriol ointment or cream once ortwice daily 100 g/week avoiding face and flexures is advisable. Tacalcitol ointment Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 63. Psoriasis 50once daily 10 g/day, for all sites is applicable. Calcitrol ointment twice daily about 30g/day for all sited lesions yields good result. Coal – tar: is produced by destructive distillation of coal tar. This maysuppress DNA synthesis there by reducing the epidermal hyperproliferation. Use ofcoal – tar 5% solution is very effective. However coal tar of 5-15 % in combinationwith topical corticosteroid such as betamethasone valerate (0.025%) is a useful topicalpreparation. As this therapy produces a distinctive smell, which some patients feelunpleasant and has got poor cosmetic acceptability. Oncogenic risk of using coal tar isalways 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 (10mg/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 calledphototherapy. Phototherapy is used for the treatment of extensive psoriasis resistant totopical 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 withlong-wave UVA (320-400 nm) was first reported in 1974 and this therapy is called asPUVA. This therapy is also advised in psoriasis resistant to topical therapy. PUVA ismore beneficial for more localized type of psoriasis. Short term risk of PUVA include Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 64. Psoriasis 51nausea, itching and phototoxic reaction. Long term risk of PUVA includes prematureskin and skin cancer.Systemic therapy: If the psoriasis covers more than 10-15% of the body surface area, if it is ofsevere inflammatory form, poor or no response to topical and UVB phototherapy andPUVA the systemic therapy is advisable. Methotrexate: has been used for more than 40 years and remains ‘goldstandard’. Complete blood count hepatitis B and C serologies, RFT, chest radiograph,if one has received within the previous year are essential before the administration ofmethotrexate. The same has to be repeated after a 7 days of test dose (5 mg). if theresult is satisfactory, the initial dose regimen for 10-15 mg/week. In UK it is usuallygiven in a single weekly dose. The dose can be adjusted up to 25 mg/week if result isencouraging. 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 65. Drug reciew 53Drug review:Siddharthaka yoga:s 217 Siddharthaka yoga is a unique yoga mentioned in most of the texts forsnana and internal use. The kashaya prepared out of this yoga is said to be used forsnanartha and for vamana and virechana. The ingredients of the yoga are musta,madanaphala, triphala, karanja, aragwada, kalingayava, darvee and saptaparna. Thephalashruti of this yoga are; twagdoshahara, kushtahara, shopha hara andpandurogaghna. The mode of its utility is in the form of kashaya for snana andvamana and virechana, for udgharshanathe the yoga is told to be used in the chornaform. The literary meaning of the word siddharthaka is not told in the context. ButAcharya Charaka has used the word siddhi for the success yielded by the physicians 218on administrating the proper panchakarma . Acharya Chakrapani, the chaturaananaof Caraka says the meaning of siddhi as ‘vyapatsadhanani beshajani’ meaning the 219oushadha that can relieve the complication . Acharya Charaka uses the word to 220indicate the samyak parinama and saphalyam , the term is used also meaning 221 222chikitsa . Acharya Dalhana says the meaning of siddhi as sadhana . AcharyaVagbhatta has told siddhi as a agrya guna of a vaidhya, indicating rationale thinkingof a doctor as a an important quality which will bring success in him. The other wordused here is artha is used as a means. So altogether the word meaning if siddharthakais the means to get the success in the management of kushta, oushadha used to get ridof the complication of the disease kushta and as a best vailable medicine to combatkushta disease. The fact whether the useful part of and aragwada remains same for externaltherapy and internal use for vamana and virechana is not clear. All the commentators Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 66. Drug reciew 54are silent about this fact. Also the quantity of madanaphala and aragwada in theformulation is also not specified for these two different routes of administration. Theonly author who had written about this is Dr. Brahmananda Tripathi223 in ChandrikaVyakhya commentary. According to him for snana the patra of aragwada should beused and for virechanartha its phalamajja has to be used. The quantity of madanaphalain the siddharthaka yoga for vamanartha should be 4 masha when compared to 2-2masha of all the rest ingredients. For virechanartha aragwada phalamajja of 4 mashaquantity and 2-2 masha of other ingredients are advised. Further he commenting aboutthe same verse he says; for udgharshanartha the coarse powder should be used mixingwith sarshapa taila, for varnaka effect the sookshma choorna should be applied bymixing with dugdhaand, for snanartha the yavakuta choorna should be immersed inthe water in the previous evening in the water and the water should be boiled and thepatient shiuld be asked to take bath with thus prepared hot water, and for snanartha allthe ingredients should be taken in 1-1 tola. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 67. Drug reciew 55Table 10 showing the analysis of the individual drug of siddharthaka yoga 224Sl.no Name of the Botanical Family Rasa Guna Karma Veerya Vipaka Pryojyanga drug name01 Musta Cyperus Cyperaceae Tikta,katu and Laghu, ruksha, Kaphapitta shamaka, Sheeta Katu Phala. rotundus kashaya grahi, teekshna asruk rogas hara, kruminashini, Patra, dugdha, kushtaghna. beeja02 Madanaphala Randia Rubiacea Madhura tikta Lekhana, laghu, Kaphavatahara, pratishyaya, Ushna Katu Phala dometorum rooksha jwara, kushtaghna, vidradhi and vrana hara.03 Amalaki Emblica Euphorbiaceae Amla, katu Laghu. Tridoshahara, hararasayana Sheeta Madhura Phala offcinale. madhura, kashaya.04 Vibhhetaki Terminalia Combretaceae Kashaya Sheeta Pitta kapha nashaka, bhedana Ushna Madhura Phala bellerica sparsharooksha, laghu05 Hareetaki Terminalia Combretaceae Lavana varjita Rooksha, laghu Tridoshahara, kushtaand Ushna Madhura Phala chebula pancharasa vaivarna hara, krumihara, vibandhara Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 68. Drug reciew 56Table 11 showing the analysis of the individual drug of siddharthaka yogaSl.no Name of the Botanical name Family Rasa Guna Karma Veerya Vipaka Pryojyanga drug06 Karanja Pongamia Leguminosae Katu, tikta, Laghu, Pittala, kaphavata shamaka, Ushna Katu Twak, patra, pinnata kasaya. teekshna kushtaghna,kandughna,krimi,shotha and beeja. arshahara.07 Aragwada Cassia fistula Leguminosae Tikta, Guru, Tridoshahara. Jwara, gulma, udara, vrana and Patra-shoshana madhura sheeta, pramehahara of kapha, medas.08 Kalinga yava Holerrhena Apocynaceae Tikta, Grahi , Trisoshahara, kushtaghna, jwara, visarpa Sheeta Katu Twak, beeja. antidysentrica katu, rooksha, hara. anushna09 Daruharidra Berberis aristata Berberidaceae Tikta, Laghu, Kaphapittahara, kandu, twagdosha, meha, Ushna Katu Moola, kanda, kashaya rooksha, vrana hara. phala. ushna.10 Saptaparna Alstonia Apocynacea Tikta, Laghu, Kapha pitta shamaka, kushtaghna,vrana, Usna Katu Twak and patra scholaris kashaya. snigdha. krimihara,raktaja rogas. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 69. Parisheka 57Parisheka: The word parisheka denotes snana 225. Acharya Sushruta uses the word repeatedlyto indicate snana by dugdha, kashaya etc. in swabhava vyadhi pratishedeeyadhaya whererasayana is dealt in detail. Parisheka is also the term used as an equivalent word forparisechana in the context of Shashtivranopakrama 226. This is also told as one among thethirteen type of sweda according to Acharya Charaka 227. The procedure is detailed in thesame chapter as; the swedana dravyas like moola etc. are used for kashaya preparationand this kashaya is then taken in a kumbha or varshanika or pranadi. This procedure issaid to yield the result when it is done after the gatra abhyanga with yathartha siddhasneha. Acharya Chakrapani, ‘charaka chaturanana’ says that this procedure of sweda isvery much beneficial in vatakapha diseases, varshanika as alpa ghata, a small pot, 228varshanika as sahasra dhara and pranadi as venunalanadyadhya . Acharya Vagbhattaincludes this parisheka in drava sweda along with avagaha sweda. Acharya Indu a notedcommentator of Ashtanga Samgraha says this procedure is done with the kwatha oversarvanga or ekanga according to the need, he says pranalika as urdhwatavishta bhandawhich is a instrument used for the purpose of parisheka which is generally known as dhar 229patra now a days . However both the authors have advised to do the parisheka aftermaking acchadana of gatra by vastra. The reason and the advantage are not spoken by 230any author. Parisheka word is used equivalent to dhara in many of the contexts . Theinclusion of parisheka in the vranopakrama is used to substantiate the utility of parishekain kitibha kushta as kina is vrana sthana accoding to Acharya Charaka. A similarity isgiven in Sushruta to convey the mode of action and utility of parisheka as; parishekasubsides the dosha and agni responsible for paka very similarly like how ambu sinchana Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 70. Parisheka 58results in agni shanti 231. This statement made by the Acharya signifies the importance ofparisheka, a local treatment to avoid dosha accumulation, vrana paka and to acceleratevrana ropana. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 71. Materials 60Materials and methodsMaterials 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 ofmadanaphala with seeds, fruits of amalaki (nirbeeja), vibheetaki (nirbeeja), hareetaki(nirbeeja), karanja patra, aragwada patra, kalingayava (seeds of kutaja), daruharidrakanda and saptaparna patra were supplied by Prakruti Remedies private limited,Karwar, Karnataka in the raw form. The drugs were checked with the criteriamentioned in the classical Ayurvedic texts and modern botanical parameters withexperts before using them in the study. An approximate of 4 liters of kashaya was prepared for the parisheka daily, forwhich 1 kg of yava kuta choorna was used. For this100 gram of yavakuta choorna ofeach ingredient was weighed and packed for the preparation of kashaya for one dayfor the convenience. The kashaya was prepared according to Sharngadhara Samhita reference 232. Atotal of 16 liters of water was taken and 1 kg of siddharthaka yoga yavakuta choornawas added and boiled to get 4 liters of kashaya. This was then filtered and made readyto be used for parisheka. The kashaya was prepared in the panchakarma theatre of thehospital daily. For dhara karma, dhara patra of 4 liter capacity was used. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 72. Materials 61Siddharthaka snanokta dravya siddha taila: A total of 15 liter of taila was prepared in the department of Rasashastra andBhaishajya kalpana, D.G.M.A.M.C. and H. Gadag. The taila was prepared according 233to Sharngdhara Samhita . For this a total of 17 liters taila was taken, 68 liters ofkashaya prepared out of Siddharthaka yoga, 4.25 kg of Siddharthaka yoga kalka wasused. For the preparation of kashaya for tailapaka 17 kg of Siddharthaka yogayavakuta choorna, 272 liters of water was used to get 68 liters of kashaya. In a span oftwo days the taila paka was completed and got approximately 15 liters ofSiddharthaka taila. This was then packed in 750 ml bottle to be used for individualpatients separately to avoid soiling.Siddharthaka yoga capsules: Basically the usage of Siddharthaka yoga is in the form of kashaya forvamanartha and virechanartha. But for the present study it was modified in to capsuleform for easy dispensing and acceptability and accurate dose maintenance. A total of2 kg (each ingredient weighing 200 g.) of vastragalita choorna was taken andapproximately 3 liters of Siddharthaka yoga kashaya was used for each bhavana (750g. of yavakuta choorna for one bhavana), (total of 5250g. of choorna for sevenbhavanas)). It was completed in a span of seven days. The choorna was again madevastra galita and 500 mg capsules were filled using capsule filling machine in collegepharmacy. 90 Capsules were packed in a plastic cover and were dispensed to thepatients. Patients were advised to take 2 capsules thrice daily with plane waterpreferably boiled and cooled. Patients were dispensed with the other 90 capsules onthe second consultation i.e. 15 days after the first consultation. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 73. Methods 62Methods:Type of study: The study was a comparative clinical study of siddharthaka yoga Bahya andabhyantara prayoga in kitibha kushta with special reference to psoriasis.Source of data: The minimum numbers of patients included for the study were 30. Patients ofeither sex were selected from the O.P.D. and I.P.D. of D.G.M.A.M.C. and Hospital afterscreening. The inclusion and exclusion criteria were duly considered before including thepatient for the study.Selection of patients: After fulfilling the criteria set in the form of inclusion and exclusion criteria, 30patients were randomly distributed in to two groups.Group – A: 15 patients were advised with Bahya prayoga of Siddharthaka by subjectingthem for parisheka.Group – B: 15 patients were included for abhyantara prayoga of Siddharthaka yoga inthe 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 74. 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 asdiagnostic tools. Also the signs and symptoms of psoriasis were seen for. Patchycircumscribed skin lesions with erythematous, well defined, dry, silvery scaly papulesand plaques were appreciated before their inclusion in the study. Patients were also seenfor ‘Candle grease sign’ and ‘Auspitz sign’.Posology: The posology for either bahya prayoga or abhyantara prayoga is not mentioned inthe context by Acharya Charaka. Hence the amount of kashaya sufficient to use for the Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 75. Methods 64parisheka was known by conducting pilot study and 4 liter of kashya was found assufficient to perform parisheka of whole body. But the dose for abhyantara prayoga waspurely postulated by duly considering the safety factors. For parisheka: four liters of kashaya was used for most of the patients and if thelesions were confined to local part then sufficient quantity (less) of kashaya was taken. For abhyantara prayoga: two 500 mg. capsules thrice daily were advised withplain water or boiled and cooled water.Study duration: Parisheka: Parisheka was done for ten days continuously. The actual follow up ofthe study was 30 days. Abhyantara prayoga: Capsules were administered for 30 days continuously witha follow up of 30 days.Assessment of results: Assessments of results were done on the basis of readings of subjective andobjective parameters before and after the treatment. The outcome of the observationswere analysed statistically for ‘p’ value using unpaired Student‘t’ test.Subjective parameters:Shyava krushna varna, Parushata, Ghanatwa, Kharasparsha and Kandu were set assubjective parameters. The grading was given as follows;Sl. Subjective Score0 Score 1 Score 2 Score 3 Score 4no. parameter01 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 76. Methods 65Objective parameter:PASI 234Sl.No Head Upper Trunk Lower extremities extremitiesa Redness +b Thickness +c Scaling + Sum of rows of 1, 2 and 3d Area scoree Score of row 4 x row 4 x row 5 row 4 x row 4 x row 5 row 4x row 5 x the row 5 x x 0.2 row 5 x 0.3 x 0.4 area multiplier 0.1f Sum row 6 for each column for PASI scoreSteps 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 4areas (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 toa 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 thatby 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) Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 77. Methods 66Area scoring criteria (score: % involvement)0: 0 (clear)1: 0 - 10%2: 10 –30%3: 30–50%4: 50–70%5: 70–90%6: 90–100Assessment 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 78. Procedure 68Procedure: 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 brieflyand were asked to bring the extra clothing, napkin, towel etc. Preferably the time chosenwas 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 waspreferred for the convenience. In the cold and cloudy climate the time of procedure was Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 79. Procedure 69changed accordingly i.e. when sun was bright, the procedure was done. Patients were firstasked to apply taila for them selves as it was experienced during the trial that abhyangacaused bleeding from the lesions (Auspitz sign) so it was avoided and were asked to justapply without any pressure. It was noted that the amount of taila required gone onreducing day by day as the dryness of the skin was reducing. 15 – 20 minutes after theapplication of taila patients underwent the parisheka procedure for fifty minutes to onehour daily if it was the whole body. The lower limb was done parisheka for 10 min toeach anterior and posterior part. Parisheka was then done to anterior and posterior part oftrunk and abdomen for 10 minutes each. Both upper limbs were done parisheka for 10minutes 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 avoidcoldness to the patient. If it was a local lesion then a minimum of 30 minutes procedurewas done daily. Each day fresh kashaya was prepared and used. The amount of kashayaused was 4 liters per day if the whole body was involved and if local involvement wasthere 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. Itwas heated indirectly to avoid excessive heating and fast heating. By this method thekashaya gets hot very slow so that it is ready for the replacement once the dhara patrabecomes empty. Parisheka was done approximately from about 6 inches height. Howeverlow temperature kashaya was used for the shiras as the hot water bath and swedana arecontraindicated. The hrudaya pradesha (cardiac region) and vrushanas (genitalia) wereavoided as these places are also contraindicated for swedana. After the procedure wasover the patients were asked to wipe the body with clean and dry towel. After this they Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 80. Procedure 70were allowed to perform their normal activities and participate in their normal work. Itwas advised to avoid excess exposure to the sun with the presumption that it may causesburning sensation. Patients were advised to take bath if interested 6-8 hours after theprocedure i.e. in the evening hours. Patients were strictly advised to avoid the use of soapand shampoo during the study duration. Readings were noted every alternative day. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 81. Observation 71Observation The observation of the patients and the disease was done by providing thequestionnaire to those patients who can fill the case sheet and from those who can’tfill; 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 thoroughlybefore their inclusion in the study. The observation was done by considering thesubjective and objective parameters strictly. The observations were done in the following heading and are depicted in formand 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 82. 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 age12 11 1010 8 15-25 6 6 6 26-35 5 5 36-45 4 4 4 46-60 4 2 2 2 1 0 Group A Group B Total 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%) Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 83. 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 sex25 212015 12 Male10 9 9 Fem ale 65 30 Group A Group B Total Table 14 showing distribution of patients by Religion Religion Group A no. and Group B no. and Group A and 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 84. Observation 74 Figure 09 showing distribution of patients by religion 25252015 13 Hindu 12 Muslim10 Christian Others5 4 2 2 1 1 0 0 0 00 Group A Group B Total Table 15 showing distribution of patients by Economical status Economical status Group A no. and Group B no. and Group A and 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 25 25 20 15 15 Poor 10 Middle class 10 Rich 5 3 2 3 2 0 0 0 Group A Group B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 85. Observation 75 Table 16 Showing distribution of patients by Occupation Occupation Group A no. and Group B no. and Group A and 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 occupation14 131210 Student8 7 6 Labor6 6 5 Executive4 3 Sedentary 22 1 1 1 1 00 G ro up A G ro up B T o tal 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 86. Observation 76 Figure 12 showing distribution of patients by nature of work14 1312108 7 Stressful 66 Near heat4 4 4 4 Traveling 32 1 00 Group A Group B Total 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 16 15 14 12 12 10 9 8 8 Bahu 6 6 Madhyama 4 4 3 Alpa 2 2 1 0 Group A Group B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 87. Observation 77Table No. 19. Showing distribution of patients by Kala of ahara Regular IrregularGroup 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%) wastaking irregularly and 02 (13.3%) were taking it twice a day and 13 (86.6%) weretaking food thrice a day.Overall: out of thirty patents 25 (83.3%) were taking it regularly, 05 (16.6%) werenot taking regularly and 03 (10%) were taking for two times a day and 27 (90%) werehaving thrice a day.Figure 14 showing distribution of patients by kala of ahara 25 25 20 15 14 11 Regular 10 5 Irregula 5 4 1 0 Group A Group B TotalTable No. 20. Showing distribution of patients by Rasa Madhura Amla Lavana Katu Tikta KashayaGroup 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) wereliking 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 katurasa. None liked tikta and Kashaya rasa Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 88. Observation 78Overall: out of thirty patents18 (60%) were fond of madhura, 12 (40%) were fond ofamla, 04 (13.33%) liked lavana and 20 (66.6%) were fond of katu rasa and none likedkatu and kashaya rasa.+20 2018 1816 Madhura1412 12 Amla10 9 10 10 9 10 Lavana 8 6 Katu 4 4 3 Tikta 2 2 1 0 0 0 0 0 0 0 kashya Group A Group B TotalTable No. 21. Showing distribution of patients by Guna of ahara Laghu Guru Rooksha SnigdhaGroup 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 totake 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%) weretaking guru ahara, 09 (60%) were taking rooksha and 04 (26.6%) were taking snigdhaahara.Overall: out of thirty patents10 (33.3%) were taking laghu, 14 (46.6%) were takingguru, 21 (70%) taking rooksha ahara and 07 (23.3%) were taking snigdha.Figure 16 showing distribution of patients by gune of ahara25 212015 Laghu 14 12 Guru 1010 8 9 9 Rooksha 7 65 4 Snigdha 3 10 G roup A G roup B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 89. Observation 79Table No. 22. Showing distribution of patients Type of diet Vegetarian MixedGroup 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 dietGroup B: out of fifteen 07 (46.6%) were vegetarians and 08 (53.3%) were mixed dietOverall: out of thirty patents 12 (40%) were vegetarians and 18 (60%) were of mixeddietFigure 17 showing distribution of patients by type of diet 18 18 16 14 12 12 10 10 8 Vegetarian 8 7 6 5 Mixed 4 2 0 Group A Group B TotalTable No. 23. Showing distribution of patients by Vyasana Alcohol Tobacco Smoking Tea/coffee chewingGroup 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 tobaccochewer, 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 tobaccochewers, 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 tobaccochewers, 05 (16.6%) were smokers and 04 (13.3%) were taking excess tea/ coffee.Figure 18 showing distribution of patients by vyasana10 10 9 8 7 6 Alcohol 5 5 5 5 5 Tobacco chewing 4 4 4 3 3 3 Smoking 2 2 Tea/Coffee 1 1 1 0 Group A Group B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 90. Observation 80Table No. 24. Showing distribution of patients by Hygiene Good Fair PoorGroup 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 16 14 15 14 12 10 8 Good 8 7 7 7 6 Fair 4 Poor 2 1 1 0 0 Group A Group B TotalTable No. 25. Showing distribution of patients by Manaska sthiti Chinta Shoka BhayaGroup 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 25 24 24 24 20 15 Chinta 12 12 12 12 12 12 10 Shoka Bhaya 5 0 Group A Group B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 91. Observation 81Table No. 26. Showing distribution of patients by observed nidana in no & %Nidana Group Group Overall Nidana Group Group Overall A B A BMilk 08 07 15 Excess 03 01 04with fish (53.3%) (46.6%) (50%) snigdha (20%) (6.6%) (13.3%)Milk 08 07 15 Raw 14 13 27with (53.3%) (46.6%) (50%) moolaka (93.3%) (86.6%) (90%)mamsa alone or with dugdhaMilk 01 01 02 Ati 05 01 06with (6.6%) (6.6%) (6.6%) ashana (33.3%) (6.6%) (20%)acidicfoodsExcess 05 08 13 Ati jala 01 00 01madhura (33.3%) (53.3%) (43.3%) sevana (6.6%) (00%) (3.3%)rasa after gharmaExcess 09 02 11 Masha 06 05 11amla (60%) (13.3%) (36.6%) (40%) (33.3%) (36.6%)rasaExcess 01 03 04 shrama, 00 00 00lavana (6.6%) (20%) (13.3%) bhaya (00%) (00%) (00%)rasaDadhi 15 13 28 Guda 14 14 28other (100%) (86.6%) (93.3%) (93.3%) (93.3%) (93.3%)milkproductsNavanna 00 00 00 Pishta 04 10 14 (00%) (00%) (00%) vikara (26.6%) (66.6%) (46.6%)Matsya, 10 08 18 Vyayama 03 03 06 (66.6%) (53.3%) (60%) after (20%) (20%) (20%) bhojanaMamsa 10 08 18 Diwa 09 05 14 (66.6%) (53.3%) (60%) swapna (60%) (33.3%) (46.6%) Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 92. Observation 82Table No. 27. Showing distribution of patients by observed poorvaroopa in thestudy in Group A patientsSl. No Poorva roopa Group A Group B Over all01 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 Observed in Observed in number of number of number of patients and % patients and % patients and % in in Group A in Group B Group A and B01 Shyava kina 15 (100%) 15 (100%) 30 (100%)02 Krishnavarna 15 (100%) 14 (93.30%) 29 (96.6%) kina03 Parushata of 15 (100%) 15 (100%) 30 (100%) kina04 Ghana 14 (93.3%) 13 (86.6%) 27 (90%)05 Khara sparsha 15 (100) 13 (86.6%) 28 (93.3%)06 Snigdha 00 (00%) 00 (00%) 00 (00%) sparsha07 Ugra kandu 15 (100%) 15 (100%) 30 (100%)Table No. 29. Showing distribution of patients by anubandha vedana observed.Sl. No. Anubandha Group A Group B Overall vedana01 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%) Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 93. Observation 83Table No. 30. Showing distribution of patients by site of onset Site of onset Scalp Knee Elbow Ear lobeGroup 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%) fromknee, 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%) inknee, 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%) inknee, 04 (13.3%) in elbow and 04 (13.3%) patients observed first in ear lobeFigure 21 showing distribution of patients by site of onset 1212 1110 8 7 7 S calp 6 Knee 4 4 4 4 4 Elbow 2 2 2 2 2 Ear lobe 0 Group A Group B TotalTable 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%) gotgradual 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 itgradually and none got after injury in this group.Overall: out of thirty patents 04 (13.3%) got it suddenly, 25 (83.3%) got gradualonset and 01 (3.3%) got it after injury.Figure 22 showing distribution of patients by mode of onset 25252015 14 S udden 1110 Gradual 5 4 After injury 3 1 1 0 1 0 Group A Group B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 94. Observation 84Table No. 32. Showing distribution of patients by aggravation time Aggravation Day NightGroup 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 rainyseason and in 11 (73.3%) aggravation was in winter.Group B: out of fifteen patents, none got aggravation in day time, 15 (100%) got innight, 01 (6.6%) in summer season, 01 (6.6%) in rainy season and 12 (80%) gotaggravation in winter season.Overall: out of thirty patents, 03 (10%) got aggravation in day time, 27 (90%) got innight, 05 (16.6%) in summer season01 (3.3%) in rainy season and 23 (76.6%) gotaggravation in winter season.Figure 23 showing distribution of patients by aggravation time30 272520 1515 12 Day10 Night 5 3 3 0 0 Group A Group B TotalTable No. 33. Showing distribution of patients by aggravation season Aggravation Summer Rainy WinterGroup 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 rainyseason 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 rainyseason and 12 (80%) got aggravation in winter season. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 95. 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 season25 232015 12 S ummer 1110 Rainy Winter 5 5 4 1 1 1 0 0 Group A Group B Total 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 3 2 Maternal 1 1 1 1 Parental 1 0 0 0 Group A Group B Total 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 96. 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 30 30 25 20 15 15 A y ur v e d a 15 Al l opa t h 10 Ot h e r 6 5 3 3 0 0 0 0 Gr o up A Gr o up B To t a l 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 sign 15 (100%) each and 07 (46.6%) patients reported with positive Koeber’s sign. Overall: out of thirty patents all were reported with Auspitz sign and Candle grease sign 30 (100%) each and 11 (36.6%) patients reported with positive Koeber’s sign. Figure 27 showing distribution of patients by confirmatory signs 30 30302520 15 15 15 15 Auspitz sign15 Candle grease sign 11 Koebers sign10 7 5 4 0 Group A Group B Total Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 97. Statistical observation 87Table No. 37. Showing demographic data in patients of in Group AGroup OPD Age Sex Religion Economical Occupation Nature No. status 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 4Table No. 38. Showing demographic data in patients of in Group BGroup OPD Age Sex Religion Economical Occupation Nature No. status 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 0Abbreviations 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 98. Statistical observation 88Table No. 39 Showing lakshanas of kitibha kushta in Group AGroup OPD Shyava Krishnavarna Parushata Ghana Khara Snigdha Ugra No. kina kina of kina sparsha sparsha 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 15Table No. 40 Showing lakshanas of kitibha kushta in Group BGroup OPD Shyava Krishnavarna Parushata Ghana Khara Snigdha Ugra No. kina kina of kina sparsha sparsha 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 99. Statistical observation 89Table No. 41 Showing Confirmatory signs of psoriasis in Group AGroup 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 04Table No. 42 Showing Confirmatory signs of psoriasis in Group AGroup 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 100. Statistical observation 90Table No. 43 Showing Anubandha vedana of kitibha kushta in Group A.Group OPD Daha Raga Srava Vedana Shaitya Kleda Anga No. 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 Daha Raga Srava Vedana Shaitya Kleda Anga No. 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
  • 101. Statistical observationTable No. 45 Showing the observed features of the nature of kitibha kushta in Group AGroup 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 91
  • 102. Statistical observationTable No. 46 Showing the observed features of the nature of kitibha kushta in Group BGroup 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 92
  • 103. Statistical observation 93Table No. 47 Showing the observed vaiktika vruttanta in Group AGroup OPD Ahara Vihara No. 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 CBTable No. 48 Showing the observed vaiktika vruttanta in Group BGroup OPD Ahara Vihara No. 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 C B 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 CAhara: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 - mixedVihara: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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 104. Statistical observation 94Table No. 49 showing the rogi pareekshain Group AG opd Prakruti Sara Samhanana Satmya Satva Ahaa Vyama Vaya no shakti shaktiA 3634 VP MS M R M M M MA 235 VK MS S S P P P MA 538 VK MeS S V A M M MA 309 VK A S V A P P MA 613 V A S V M P M MA 1427 VP T S V A M A MA 1715 VP MeS M V P P P MA 502 VP MS S V P P P MA 3073 VK R M V M P M MA 3089 VK A S V M M M MA 3069 VK M M V P P M MA 3220 VP MjS S V M M M MA 3413 PK S S V M P P BA 4023 VK M S V P M M MA 4370 VP S S V M M M BTable No. 50 showing the rogi pareekshain Group Bopd Prakruti Sara Samhanana Satmya Satva Ahara Vyama Vayano shakti shakti 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 MAbbreviations 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 shukrasaraSamhanana: 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 105. Statistical observation Table No. 51 showing the Nidana observed in Group Aroup OPD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 No. 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 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 95
  • 106. Statistical observationTable No. 52 showing the Nidana observed in Group BGroup OPD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 No. 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 05Abbreviations used.01-Milk with fish, 02-Milk with mamsa, 03-Milk with acidic foods, 04-Excess madhura rasa, 05-Excess amla rasa, 06-Excess lavanarasa, 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 sevanaafter gharma, shrama, bhaya, 15-Masha16-Tila, 17-Guda, 18-Pishtavikara, 19-Vyayama after bhojana, 20-Diwaswapna Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 96
  • 107. Statistical observation 97Table No. 53 showing poorvaroopas observed in Group AGroup OPD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 No. 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 00Table No 54 showing poorvaroopas observed in Group BGroup OPD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 No. 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 00Abbreviations used:01-Twak parushata, 02-Akasmadromaharsha, 03-Swedabahulya, 04-Asweda, 05-Angapradesha 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 108. Statistical observationTable No. 55 Showing assessment of grading of subjective and objective parameter values of Group – A Subjective parameter Objective parameter Shyava krushna varna Parushata Ghanatwa Kharasparsha Kandu PASI Sl. No. OPD no. 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 98
  • 109. Statistical observationTable No. 56 Showing assessment of grading of subjective and objective parameter values of Group – B Subjective parameter Objective parameter Shyava krushna Parushata Ghanatwa Kharasparsha Kandu PASI Sl. No. OPD no. varna 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 99
  • 110. Statistical analysis 100 Table No. 57 Showing Statistical analysis of parameter values of Group – ASl. Parameters Mean S.D S.E t- p- RemarksNo. value value01 Shyava krushna 2.266 0.7037 0.1817 12.474 <0.001 H.S. varna02 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 standarddeviation, standard error, ‘t’ values were calculated and was then referred for p-valuewhich 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 – BSl. Parameters Mean S.D S.E t- p- RemarksNo. value value01 Shyava krushna 1.466 0.833 0.215 6.821 <0.001 H.S. varna02 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 standarddeviation, standard error, ‘t’ values were calculated and was then referred for p-valuewhich 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 111. Inter group statistical analysisTable 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 101
  • 112. Discussion 102Discussion: Discussion is the most important part of any research where the observationsare discussed and given reasons by the researcher. Here researcher conveys thepractical experience with special reference to textual explanations. The significantresults 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 skindiseases in the modern day science. Kushta is said as deergha roga to indicate theimportance of counseling and preparation of the patient for long time coarse oftreatment. The chikitsa of kushta evenly poised as it may give good fame if treatedand 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 thetime by which the disease may be cured by our treatment. The quotation is verysignificant as it is told in the agrya prakarana by Acharya Charaka and AcharyaVagbhatta, meaning of which is this disease kushta holds the first rank when Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 113. Discussion 103chronicity of the disease is considered. Hence one should avoid false promise to thepatient regarding the cure of the disease. a. Nidana of kushta: regular and excessive consumption of meat is the firstnidana and the predisposing factor noticed in the study. Consumption of raw moolakais very common in all most all the houses in this part. Consumption of moolaka usedin sambhar and curry form was used mixing with dugdha and dadhi in most of thepatients. As all the patients were belonging to this local area where the temperature isvery high, the use of dadhi is very much seen that they use to take at night also. Vadais a special dish simulating to mashandari prepared out of masha pishata mentioned inAyurveda was found as positive history in most of the patients. Madhura rasaatisevana in excess was found positive in the form of consumption of guda mixedwith ghruta with roti and chapatis in this area. Pishtanna was understood as all thebakery items which are largely prepared using different floors vis-à-vis pishta, also aspecial 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 ismixed with fruit juices which are actually almost amla in rasa along with madhurarasa. Most of the patients were accustomed to use dadhi and dugdha along with nonvegetarian curries when they take it with rice. Sheeta ushna vyatyasa karma is takenas exposure to the sun after working in an air conditioned room or taking cold waterbath soon after exposure to sun for longer time and consumption of ice creams afterhaving food predominantly prepared with katu rasa (ushna in nature). Vyayama afterfood is understood as walking for long distance like formers walking to their fieldssoon after having food or even cycling, bearing heavy load etc were considered whiletaking history. Bhaya Chinta Shoka ref from nidana notes. At last the most importantline to remember is nidana parivarjana is half the treatment for any disease. Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 114. Discussion 104 b. Poorvaroopa: most of the patients were having the disease for more thantwo years, so they have forgotten the poorvaroopas but when the questionnaire wasgiven to them or translated in the local language they have given some poorvaroopasas positive in them which is difficult to accept in any research. Kandu, parushata andvaivarnyata were most frequently observed poorvaroopas in the present study. c. Roopa: the reasons because of which patient of kitibha approach a clinicianare kandu and ugly look of the skin. Itching (kandu), dry scaling (parushata androokshata) and erythema (krushna and shyava varna), thickness (ghanatwa) of thelesion (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 patientsremained same. Snigdhata was not found in any case of the study. Srava seems tohave appeared in the initial stages as per the information given by the patient whenasked about history of onset etc. Vartate cha samutpannam or prashantani chasamutpannam are other frequent roopas observed in the study which means waxingand waning of the disease without any specific reasons. d. Samprapti: sapta dravyua samgraha is very important in disease kushtairrespective of its subtypes. In the literary review it is already discussed under variousheadings like nidana, poorvaroopaand roopa to understand the involvement of saptadravyas in kushta. Clinically they were experienced. Acharya Vagbhatta was first tonotice the importance of vata in the manifestation of kushta vyadhi. It is interpretedthat vata as is responsible always for vibhajana of garbha is understood as increasedcell 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 airtrapped in between the layers of the scales in psoriasis can be told as thepredominance of vata dosha in kitibha kushta resulting in the parushta, kharatwa and Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 115. Discussion 105rookshata of the vrana sthana. It is said that in the early stage of psoriasis capillariesin superficial part of dermis are dilated and tortuous which accounts for vivid redcolour of active plaques in psoriasis and there is stasis of blood in turn which iscompared to sanga seen in the rakta and mamsa. Though aetiology of psoriasis ispoorly understood, the involvement of genetics can not be ignored, notably kushta istold as adibala pravrutta vyadhi involving dushta shukra and shonita. The deeds ofpoorvajanma leading to kushta may be interpreted as understanding the entry of atmain to the garbha through the shukra told by Acharya Charaka in Sahreera Sthana as theinvolvement of genetic factors told by the modern science as quoted already in thepsoriasis context. e. Sadhyasadhyata of kushta: all the Acharyas have told that the vata kaphapradhana kushta is sadhya. According to this statement kitibha kushta must be sadhyato treat but its lakshana vartate cha samutpannam told by Acharya Bhela does notmatch the sadhya lakshana of a vyadhi. Also the other author Acharya Kashyapa whosays the lakshana as prashantani cha punaha utpadhyate does not match the presentcontext. Further detailed study and proper understanding of the lakshana willilluminate us. f. Arishta lakshanas: in the present study none of the patients were reportedwith the arishta lakshanas told in the texts. And the features of dreams got by thepatient 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 itwas found that the treatment of kushta can be broadly classified as anthahparimarjanaand 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. Thisconcept reaching the site of pathology was followed by modern pharmacologists as Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 116. Discussion 106they say, for most of the dermatological conditions skin is readily available for theapplication of the medicine. Most of the topical medication has negligible systemicabsorption and, therefore, few side effects and drug/drug reaction is rare because of 235the same reason , this makes the advantage of this route. Ayurveda Acharyas havenoted that the result out of this type of the therapy can only be got if it is applied overthe 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 dois 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 enhancedsuspending the drug in an oily vehicle and rubbing the resulting preparation in to the 236skin . This signifies the utility of taila preparation and utility of abhyanga in themanagement of kushta disease, the cutaneous hydration is also said to increase therate of absorption of the trans dermal applications, this cutaneous hydration is best 237maintained by the application of oil preferably . The inability of theshamanoushadha to reach the vyakta sthana i.e. twacha with in short span of time toheal the vrana makes the bahirparimarjana chikitsa superior in the context of kushtachikitsa. h. Pathyapathya: most of the part of nadana is occupied by the viruddhaharahence one must be very keen to explain the type of viruddhahara and their adverseeffects. The advice is incomplete if the method of padamshu karma explained byAcharya Charaka and Chakrapani to leave the apathyas and to adopt the pathya is not 238briefed to the patient . The utility of tikta shakha is an important tip to the skindiseased. The pathyahara are almost those which are opposite to the nidanasmentioned. Patient must keep himself away from all type of non vegetarian dishes Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 117. Discussion 107especially fish as it aggravates the disease so fast that some times it becomes difficultbring the doshas to normalcy as the disease itself is a bahudoshavasthajanya vyadhi. i. Vyavacchedaka nidana: there are two schools of thoughts, one sayingkitibha as psoriasis and the other saying ekakushta as psoriasis. The vyavacchedakanidana are explained the literary context. The reason for making the comparison isexplained 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 wasits 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 asthe main complaint of kitibha kushta is ugrakandu. These drugs are well placed in therespective dashemani gana as in these ganas 10 best and potent drugs are given asexamples. The drugs were kashya tikta rasa pradhana which is very important to healthe kina (vrana), excess kleda and the kapha dosha in the kitibha kushta. The laghurooksha guna also is helpful for drying the excess amount of kleda present in thebody. Most of the drugs were having vata kaphahara or tridoshahara property whichsuits to the demands in kushta chikitsa. This was used in the method as alreadyexplained. b. Siddharthaka snanokta dravya siddha taila – for application beforeParisheka: before kashya parisheka it is important to apply the yathartha rogaharasiddha taila as told by Acharya Charaka. This is also to maintain the cutaneoushydration so that the active principles present in the kashaya are well absorbed via the Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 118. Discussion 108skin. This taila was asked to apply by self, assisting them by applying taila to backregion where patient can not apply by himself. The pressure during the applicationwas avoided as fear of bleeding is always there (Auspitz sign). Patient was advised tosit/sleep quietly on the dhara table for at least 15-20 min as the penetration of the drugthrough the dermal route is always great because of hydration when compared to the 239dry skin . The duration of treatment was about 50-60 min daily for 10 days. Thereis no specification for the total time duration and the days for the parisheka, so it wasdecided to do it for 50-60 min after calculating the time required for each part of thebody individually as discussed in the materials and methods section.c. Siddharthaka yoga capsules – for abhyantara prayoga: the siddharthaka yogamentioned for bahorparimarjana were analysed for the toxic effects and none weretoxic, but were used for the same disease in one or the other form. The advice of thissame kashaya for vamanartha and virechanartha encouraged us to try this yogainternally. When the form of drug to be dispensed was considered it was kashaya. Butfor the present trial the vastra galita choorna was taken and given bhavana 7 times withthe kashya prepared out of the same ingredients. The reason to choose capsule was; foreasy 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 befixed which is mandatory in any research work, the easy way of dispensing andpatients can easily carry these capsules with them all the time so that there no chanceof missing the dose. Because of the above said reasons capsule form were chosen overkashaya. For the purpose of potency the drug was given bhavana. When the bhavanawas given the total weight of the powder was increased indicating that the particleswere becoming heavier by each bhavana.3. Discussion on clinical study. Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 119. Discussion 109 Inclusion of the patients in the study was in accordance with the criteria set asinclusion and exclusion criteria. Patients irrespective of the sex from 15-60 year ofage were included. Cases which were more than for 5 years were excluded from thestudy. Those who were having the lesions over genitalia were also excluded as swedais contraindicated. Those who were having other systemic diseases were notconsidered for the study as the treatment of that systemic disease becomes moreimportant and the assessment becomes difficult as the general condition of the patientwill not be good. Pregnant ladies and lactating mothers were not considered for thestudy as the safety of the therapy and drug in these are not proved before. For GroupA 4 liter of or sufficient quantity of kashaya was used and the study duration was 10days. Posology was fixed as 3 grams/day and study duration of thirty days in GroupB. For both the groups a follow up of 30 days was fixed. However in Group Apatients the lakshanas started in the third week but was minimal, this may be becauseno medication or placebo was given during this follow up period. In group B norelapse of symptoms ware noted. Totally 34 patients got registered out of which 4discontinued the trial. All the four were from Group B only the reason for thediscontinuity was not known as the patient did not consult even after contacting themby phone. Patients were divided randomly in to two groups. Laboratory investigations: Though there is no significance of the laboratoryinvestigations 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 toexclude the other systemic diseases. Also in research when a new form of medicationwhich is not in practice earlier has to look for adverse reactions on normalhomeostasis of the body, the only method to assess adverse reactions is by assessingthe blood picture. In the present study no significant changes were noticed apart Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 120. Discussion 110decimal variations in the readings before and after the treatment which may bebecause of human errors. The safety of the drug thus internally is proved with the helpof 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 notmatch with the earlier researches and is difficult to draw any conclusion by this studyinvolving 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 therakta of stree becomes shuddhi every month as dushta rakta is expelled out in theform of raja srava, so the incidence of dermatological problems are comparativelylesser 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 withpsoriasis.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 wereof sedentary occupation. The inclusion of all field workers (formers) doing heavyworks in this group must have influenced. Nature of work: maximum patients were from stressful workingenvironment. The reason must be the manasika karana as hetu and precipitating factorof the disease. Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 121. Discussion 111 Ahara (matra and kala): most of the patients reported with madhyama matraahara. Next were taking bahu matra ahara which is again told as nidana of the vyadhiand few were consuming alpahara who were females. Most of the patients were takingahara at regular time. Those who were not taking at regular time were occupationallydisturbed. Rasa: people of this part of Karnataka are accustomed of using more katurasa. The next predominant rasa used was madhura in the form as discussed in thenidana context under the same heading. Guna of ahara: most of the patients used dry type of food without ghee orbutter. This may be the reason that the vata got aggravated to lead to the diseasekushta as clarified by Acharya Vagbhatta. Type of ahara: most of the patients were of mixed diet which once againshows the significance of mamsa and matsya in the manifestation of kushta. Howeveronce after being diagnosed as kitibha kushta either they have reduced the intake orstopped completely. Hygiene: most of the patients have maintained fair hygiene and only one wasof poor hygiene who underwent parisheka for 10 days and he was explained theimportance of good hygiene in maintaining the health. Manaska sthiti: patients were suffering from chinta bhaya and shoka becauseof the ugly appearance of the skin and the fear of dejection by the society. Theimportance of manas has already been discussed in the nidana context earlier. TheCNS innervates dendritic cells in the lymph nodes and spleen, langarhans cells in theskin and other antigen presenting cells. The nerve endings release neurotransmittersthat exaggerate and enhance local immune responses. For this reason some skin Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 122. Discussion 112conditions such as psoriasis aggravates when person is under stress (Martini,Fundamentals of anatomy and physiology, by: Frederic H. martin, William C. Oberetc, 4th edition, Page no 808, Prince hall Upper Saddle river, New Jersey 07548,1998). This simulates the quotation by Acharya Charaka as ‘Vishado rogavardhananam’(Cha.Su.25/40) holds good for every disease especially to the kushtadisease. Nidana: mostly observed nidana in the patients were mamsa and matsyasevana, 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 diseasekushta 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. Haviprashana (madhura bhakshyas prepared with excessive ghruta during yagnya) asquoted by Acharya Charaka in the context of mythological oregine of the disease inthe nidana sthana last chapter as use of excess snigdha ahara in the present era Poorvaroopa: patients were unable to recollect what first had happened totheir skin as the disease was manifested long ago. But most patients revealed that theyhad kandu, twak parushyata and vaivarnyata then piakodbhava which later invadedthe 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 asshyava varna. The changes in the colour may be because of the predominance of thedoshas. Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 123. Discussion 113Table no showing the similarity between kitibha kushta and psoriasis. Kitibha PsoriasisShayava, krushna and aruna varna ErythemakinaKhara sparsha of the kina (lekhana is Dry lesion, scalingthe karma of this guna)Parushata Dryness and scalingSrava 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/ The disease may aggravate without anyPrashantani cha punaha utpadhyate apparent cause as discussed already or flare up of psoriasis can occur randomly240Site of onset: most of the trial patients got the onset in their scalp followed by itsspread to the whole body, in only one patient since one year the lesion from head hasnot spread to the other part of the body. Time/season of aggravation and mode of onset: in maximum patients thetime of aggravation was during night hours. The season was winter. Patient dulyconsidered the kandu in to the account. Few were getting aggravation in the day timemay be because of the irritation due to the exposure to sun. In most, the disease wasgradually manifested. Evaluation of Efficacy of Siddharthaka Yoga in KitibhaKushta
  • 124. Discussion 116 Kula vruttanta: only one patient was observed to have kulavruttanta whichdoes not appear to match with the earlier data available as the numbers of samples aretoo 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 theincreased awareness in them about the adverse effects of steroid therapy. Confirmatory signs: all the patients were reported with positive candle greasesign and Auspitz sign. Koebner sign was reported in few. This must be because of thefact that we have not included patients suffering with this disease for more than 5years.5. Discussions on observations made on results during the trial work: Assessment of the results was done by considering the subjective criteria andobjective criteria. Totally 5 subjective criteria were taken and grading from 0-4 wasgiven for no, mild, moderate, severe and extensive respectively. PASI scoring wasconsidered as objective parameter. The efficacy any drug is important to convey to themodern world is by conducting the trial works drawing the statistical significance andcalculating the % of improvement by taking the readings after giving them universallyacceptable grading. The statistical result showing the significance has already beendiscussed in the observation part. Here % of improvement is calculated to know theefficacy and net improvement in the condition. For this purpose the values were observed numerically which are given thegrading from 1 to 4.Step1 – All the values of before treatment of subjective and objective parameters wereadded to get the sum. Now this is the condition in which the patient had approachedus, so it becomes the base line data. This is taken as 100%. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 125. Discussion 117Step2 – The readings of after treatment was then added to get the sum, which is thestatus of the patient after the treatment.Step3 – Now the % of the condition after the treatment is calculated by dividing thisnumber with the base line data obtained by the step 1. This should then multiply by100 to get the % after the treatment.Step4 – the % of improvement is calculated by subtracting the value got by step 3 by100 will yield the net improvement in the disease.Step5 – this value was referred for the table postulated to declare the results and thetable 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 responseDeclaration of the result by above method:Group ASl.No. Impression No. of patients % of patients1 Best response 15 100In this group the result was very quick to show. On the second day of the treatmentitself the chief compliant kandu was reduced to 50 % or even more. Three days afterthe dhara total relief from kandu was noted. The sign parushata and rookshata wereobserved to decrease slowly; on the fifth or sixth day complete absence of rookshatawas noted. Ghanatwa was relieved after five or six days of dhara. The colour of theskin was last to become normal approximately on the 8th day. Patients were satisfiedtotally with the treatment as kandu was suddenly relieved. The additional effect of thedhara was found to induce good sleep as told by the patients voluntarily. In the follow Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 126. 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 results20 191816 151412 C o m ple t e re m is s io n B e s t re s po ns e10 M o de ra t e re s po ns e 8 8 8 M ild re s po ns e 6 N o re s po ns e 4 4 2 2 2 1 1 0 0 0 0 G ro up A G ro up B T o tal 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 127. Results 119Table 60 Showing the overall statement of results of Group AGroup A Subjective parameters PASI Overall improvementOPD B.T A.T Net B. A.T Net improvement Impressionno. Improvement T Score % Score % Score % Score % Score Score % Mean of net improvement of subjective & objective parameter3634 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 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 128. Results 120Table 61 Showing the overall statement of results of Group B Subjective parameters PASI Overall improvementOPD B.T A.T Net B.T A.T Net improvement Mean of netno. Improvement Impression improvement Score % Score % Score % Score % Score % Score % of subjective & objective parameter1846 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.R2851 15 8 53.33 7 46.67 14.4 100 8 55.55 6.4 44.45 45.56 Mi.R2758 13 6 46.15 7 53.85 11.7 100 5.6 47.86 6.1 52.14 52.995 M.R3216 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.R4006 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.R4279 14 8 57.14 6 42.86 3.2 100 1.6 50 1.6 50 46.43 Mi.R4284 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.R4426 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 % Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 129. Discussion 121Conclusion on statistical analysis: To compare the mean effect of the two groups after the treatment, thestatistical analysis was done by using un-paired test, by assuming that the mean effectafter 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 theparameters parushata and kandu, the mean effect is zero, it shows there is a completecure in these parameters (by comparing p-value and t-value). To compare the effect of the drug before and after the treatment, the statisticalanalysis was done by using paired-t test, by assuming that the drug is not responsiblefor changes in the observations before and after the treatment. Here all parametershave shown highly significant in both the Group (by comparing p-value). But in Group A, all most all the parameters had shown more highly significantthan Group B (by comparing t-value). In parameters shyava krushna varna, parushata and kandu were more highlysignificant 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 morevariation than the Group B (by comparing mean and S.D.), but parameterkharasparsha in Group A shown more net mean effect with more variations than theGroup B (by comparing mean and S.D.). Parameter PASI in Group A shown less more significant than the Group B, butthere is more net mean effect in Group A than in Group B and variation was less inGroup B Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 130. Discussion 122Mode of action of the medicine/therapy: Group A – Parisheka: As stated alreadythe drug applied over the skin directly reaches the site of pathology being skin. Asdiscussed earlier in the same section of discussion the absorption of the medicineincreases by causing cutaneous hydration. The utility or anointing the body before theparisheka as told by the Acharyas is to promote easy absorption through the skinwhich provides the cutaneous hydration, by this the drug easily comes in contact withthe twachasthita bhrajaka pitta after its successful absorption. Once the activeingredient of medicine reaches the level of bhrajakagni, the drug is made sajateeya atthis level. This will then bring back the normalcy in the skin. Moreover the Seers havetold us to use the yathartha siddha taila for application so the active ingredient of themedicine also gets in to the body through the skin in this manner as it is said alreadythat the drug entry through the skin may be made easy by suspending in the oilymedia. The drugs were chiefly of the tikta and kashaya in rasa which have got readilythe vrana ropana guna. The guna of these drugs are also opposite to kapha, the maindosha for kandu to manifest. The dosha karmas of these drugs are told already askaphavatahara and some as tridoshahara, this yoga is estimated to bring down theincreased dosha at the site of pathology. The cumulative effect of triphala is told asvranaropaka, this when used in the form of parisheka may yield this effect. The mainpathology told in psoriasis is increase in the rate of mitosis of keratinocytes which isinterpreted as increased vata guna and karma. Also as swedana is the choice oftreatment for the vata, the siddharthaka yoga kashya parisheka is expected to decreasevata by the swedana effect. The taila application before the sweda will also help theprocess but the snehana can not alone impart the result if swedana is not followedafter. So the swedana effect also plays a major role in kitibha kushta chikitsa. It can bestated that anga gourava, a poorvaroopa of kushta might get relieved by the virtue of Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 131. Discussion 123swedana effect. The other pathology of kushta is told as retention of excessive kledain the body because of swedavaha sroto avarodha, this avarodha can be relieved byswedana as the phalashruthi of sweda is swedakaraka. The last is the cumulativeeffect of the yoga spoken in the context of mode of action of any drug; here some ofthe ingredients of this yoga are blessed with the prabhava of kushtaghna andkandughnata in them, so it is important to end discussion of mode of action ofSiddharthaka yoga parisheka by saying that its effect is because of prabhava of theyoga. It is important to recall the statement; ‘patients with less than 15% body surfacearea involvement can be treated effectively with topical agents alone’241. Meaning ofwhich says all nothing more than the significance of external therapy in the diseasepsoriasis. 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 arekushtaghna and kandughna as already stated and are estimated to relieve the disease.On dosha, the drugs have vata kaphahara and tridoshahara effect so these areinterpreted as bringing the doshas to the normal state. The guna of the drugs likemusta and kalingayava have got grahee guna in them which are drava shoshaka i.e. inthis context it is taken as kledashoshana, rooksha guna present in musta, hareetaki,kalingayava and daruharidra is said to perform the kledashoshana of the present inexcess in kushta rogi. Madanaphala etc. drugs have got vranahara, kapha vataharaTripahalas are used for virechanartha as stated by Acharya Charaka in first chapterwhich help in taking the doshas, this effect is of minimal extent. Acharya Sushrutasays 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 isproper nourishment of the twacha and they avoid the excessive kleda formation. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 132. Conclusion 124Conclusion: 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 133. 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. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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  • 153. Bibliography 147202. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health pressOxford 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 pressOxford 2004, Page no.9.205. Nicholas A Boon, Nicki R. Colledge et.al, Davidson’s Principle & Practice ofMedicine, 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 ofMedicine, 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 pressOxford 2004, Page no.9.208. A.C.Ritchei, Boyd’s text book of pathology, 9th ed., vol 2, chapter 62, K.M. VarghesCompany, PB no.7119Bombay 400031, 1990, page no. 1985-1986209. Alan Menter MD et al. Fast Fact Psoriasis, , Chapter 1,. Health press Oxford, secondedition, 2004, page no.9.210. 203. Eugine Braunwald, Stephen L. Hauser, Anthony S. Fauc et.al.Vol-1, chapter56, 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, secondedition, Bhalani publishing house, Bombay, 1994, Page no. 714.212. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health pressOxford 2004, Page no.14.213 R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, secondedition, Bhalani publishing house, Bombay, 1994, Page no. 714.214. R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, secondedition, Bhalani publishing house, Bombay, 1994, Page no. 714.215. Alan Menter MD et al., Fast Fact Psoriasis, second edition Chapter 3, Health pressOxford 2004, Page no.25-30.216. Alan Menter MD et al. Fast Fact Psoriasis, second edition. Chapte4, Health pressOxford 2004. Page no.31-69, Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 154. Bibliography 148217. 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, Chapter21, 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. 715218. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 15, shloka no. 4, editedby 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, chapter13, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha SanskritSansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Pageno. 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 RupalalajiVasya, Part-1, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandirlane, Varanasi (UP), reprint, 2004, Page no. 243, 77, 10, 9, 7, 350, 68, 346, 119, 546. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 155. 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, NewDelhi- 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 KruegerDownloaded from ard.bmj.com on 4 May 2007 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 156. Bibliography 150235. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacologicalbasis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical PublishingDivision, New Delhi.)236Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basisof therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical PublishingDivision, 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, NewDelhi, page no. 300238. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Sutra sthana, chapter 7,shloka no. 36-37, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha SanskritSansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Pageno. 51-52.239. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacologicalbasis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical PublishingDivision, New Delhi.240. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacologicalbasis of therapeutics, Chapter 65, page 1804, 10th edition, McGraw-Hill, MedicalPublishing Division, New Delhi.241. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacologicalbasis of therapeutics, Chapter 65, page 1804, 10th edition, McGraw-Hill, MedicalPublishing Division, New Delhi. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 157. Summary 126Summary: The present study entitled “A comparative clinical study of ‘siddharthaka yoga‘parisheka and abhyantara prayoga in the management of ‘kitibha kushta’ with the specialreference to ‘psoriasis’ was taken for the trial in search of the route of administration ofthe for the effective treatment of kitibha kushta vis-à-vis psoriasis. The drug was same forboth antahaparimarjana and bahirparimarjana chikitsa so that the result will not influenceby the change of medicines.The objectives of this trial was to evaluate the efficacy of siddharthaka yoga parisheka inkitibha kushta, to evaluate the efficacy of siddharthaka yoga abhyantara prayoga inkitibha kushta, to evaluate the comparative efficacy of siddharthaka yoga parisheka andabhyantara prayoga in kitibha kushta. For the convenience of the study snana wasmodified to parisheka and kashaya to capsules. The patients were selected from O.P.Dand I.P.D. of D.G.M.A.M.C & H. they were examined for their inclusion and exclusionin the study. Totally 30 number of patients were divided in to two groups. 15 patients ofGroup A underwent Parisheka for 10 days and 15 patients of Group B received 3 gramsof 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 treatmentwere noted and were calculated for statistical significance using paired and un-pairedStudent-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%). Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 158. Summary 127 The result was best response in all (100%) patients of Group A than those ofGroup 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 highlysignificant results than the abhyantara prayoga of Siddharthaka yoga. Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 159. 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 Co - Guide: Dr. Raghavendra V. Shettar M.D. (Ayu) M.D. (Ayu) Prof. & Head, P.G. Dept Of Kaya chikitsa. Asst. Prof. P.G. Dept Of Kaya chikitsa. D.G.M.A.M.C. Gadag. 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 amexercising my free will, to participate in above study as a subject. I have been informed to mysatisfaction, by the attending physician the purpose of the clinical evaluation and nature of the drugtreatment. I am also aware of my right to opt out of the treatment schedule, at any time during thecourse of the treatment.EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÉÒ¬ÄAzÀPÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÀÛ£É. gÉÆÃV0iÀÄ gÀÄdÄ / Patients Signature Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 160. Annexure 2 Pradhana vedana:Sl.No. Pradhana Vedana Present Absent Kala prakarsha1. Shyavavarna Kina2. Krishnavarna Kina3. Parushata Kina4. Ghana5. Khara sparsha6. Snigdha sparsha7. Ugra kandu Anubandha vedanaSl.No. Vedana Present Absent Kala prakarsha1. Daha2. Raga3. Srava4. Vedana5. Shaitya6. Kleda7. GauravaAdhyatana vyadhivrittanta if any Site of onsetScalp Knee Elbow Ear lobe Mode of onsetSudden Gradual After injury AggravationAggravating time Day NightAggravating season Summer Rainy WinterContact with chemicalsAnti malarial medicine Nature of workStressful Near heat TravelingPurva vyadhi vrittantaif any Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 161. Annexure 3 Kula vrittantaMaternal Parental Chikitsa vrittantaAyurveda Allopathic Homeopathy Unani NaturopathyDetails if any Vaiyaktika vrittanta AharaMatra Bahu Madhyama AlpaKala Regular Irregular 2 3 times timesRasa Madhura Amla Lavana Katu Tikta KashayaGuna Guru Laghu Snigdha RukshaType Vegitarian Mixed ViharaVyasana Type Alcohol Tobacco Smoking Tea/ Chewing coffee ParticularsNidra Type In hours Diwaswapa RatriHygiene Good Fair PoorOccupation Student Labor Executive Sedentary Samanya PareekshaGeneral Blood Pressure(in Temperature (oF)condition mm of Hg)Pulse / min Weight in kgs Height in cms. Vital Systemic ExaminationC.V.S. S1 , S2 MurmursR.S. Lung FieldLocomotor Psoriatic arthritisPer abdomen Soft Tender Organomegaly Dashavidha pareekshaPrakruti SatmyaVikruti SatwaSara Ahara shaktiSamhanana Vyayama shaktiPramana Vaya Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 162. Annexure 4 Ashtavidha pareekshaNadi Rate ShabdaMala Varna Consistency Sparsha Times/dayMootra Varna Druk Times/dayJihwa Akruti Manasika pareelksha Chinta Shoka Bhaya VYADHI VISHESHA PAREEKSHA Twak parrekshaKinah pareeksha - DarshanaShyava varna Krishna varna SravaVritta SnigdhaSite % Site % Site %Upper limb Lower limb: Head/ NeckRt. Anterior Rt – Anterior ScalpRt.Posterior Rt – Posterior FaceLt. Anterior Lt – Anterior NeckLt.Posterior Lt – PosteriorChest: Abdomen CtrunkPosterior Posterior PosteriorPosterior Posterior PosteriorSparshanaKharatwa Parushata GhanaDry Moist GreasyDosha lakshanas:VataPittaKaphaConfirmatory signs (subjective):Candle grease signAuspitz signKoebnar phenomenaObjective parameter: Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 163. Annexure 5Vikruti pareeksha: Hetu: Aharaja:Milk with fish Milk with fleshMilk with acidic foods Excess madhura rasaExcess amla rasa Excess lavana rasaDadhi Ikshu vikaraNavanna MatsyaMamsa Excess snigdhaRaw moolaka or with milk AdhyashanaPishtavikara Ati jala sevana after gharma shrama, bhayaMasha TilaViruddha if any other Guda ViharajaChardi vega dharana Cold bath / swimming soon after sunbathVyayama/vyavaya/santapa after Diwaswapnabhojana or during ajeernaPanchakarma apachara Sneha aticharanaPapa karma Vipra guru gharshata PurvaroopaTwak parushata AkasmadromaharshaKandu SwedabahulyaAsweda Anga pradesha swapaParushyata VaivarnyaNistoda AtishlakshnataGourava Mala pradeha over kayaKshata visarpa (spreads on injury) Paridaha UpashayaSamprapti ghatakasVata Shyava Aruna Ruksha Khara VedanaPitta Daha Raga SravaKapha Kleda Ghana Snigdh Kandu Shaitya Gaurava a Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 164. Annexure 6DushyaTwak Sparshahan Swedana Ishatkand Vaivarna Ruksha i uRAKTA TwakSwap Romaharsha Sweda kandu Drgandha a abhinirvar / tana VipuyakaMAMS Bahulya Vaktra shosha Karkasha Pidakodga Toda sphota sthiraA maMEDA Dourgandy Upadeha puya Krimi Gatra a (Malavriddhi) bhedaASTHI Nasabang akshiraga Krimi at Swaropag& a Kshata hataMAJJASHUKR Jata Kounya (karaA Kushti bhanga)AgniManda Teekshna Vishama SamaAmaSraotasRasavahaRaktavahaMamsavahaSrotadushti prakaraUdvhava sthanaVyakta stahanaAdhishtanaRoga margaVyadhi vinischayaRoga Kashta Yapya Anupakramaprakruti sadyaUpadrava ifany Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 165. Annexure 7 Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 166. Annexure 8 CHIKITSA: GROUP – A (Bahya)Started on: Completed on: Follow up:Sl. Subjective Parameter B.T 2nd day 4 day 6th day 8th day 10th A.TNo.1 Shyava krushna varna2 Parushata3 Ghanatwa4 Kharasparsha5 KanduPASI Before treatmentSl.No Head Upper Trunk Lower extremities extremities1 Redness +2 Thickness +3 Scaling +4 Sum of 1,2 and 35 Area score6 Score of row 4Xrow row 4 X row 4 X row row 4 X row 4 X row 5Xthe area multiplier row 5 X 5 X 0.2 row 5 X 5 X 0.4 0.1 0.37 Sum row 6 for each column for PASIPASI Before treatmentSl.No Head Upper Trunk Lower extremities extremities1 Redness +2 Thickness +3 Scaling +4 Sum of 1,2 and 35 Area score6 Score of row 4Xrow row 4 X row 4 X row row 4 X row 4 X row 5Xthe area multiplier row 5 X 5 X 0.2 row 5 X 5 X 0.4 0.1 0.37 Sum row 6 for each column for PASI Before treatment After treatmentPASI Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 167. Annexure 9 CHIKITSA: GROUP – B (Abhyanara)Started on: Completed on: Follow up:Sl. Subjective B.T First Second Third After theNo. Parameter week week week treatment1 Shyava krushna varna2 Parushata3 Ghanatwa4 Kharasparsha5 KanduPASI Before treatmentSl.No Head Upper Trunk Lower extremities extremities1 Redness +2 Thickness +3 Scaling +4 Sum of 1,2 and 35 Area score6 Score of row 4Xrow row 4 X row 4 X row row 4 X row 4 X row 5Xthe area multiplier row 5 X 5 X 0.2 row 5 X 5 X 0.4 0.1 0.37 Sum row 6 for each column for PASIPASI Before treatmentSl.No Head Upper Trunk Lower extremities extremities1 Redness +2 Thickness +3 Scaling +4 Sum of 1,2 and 35 Area score6 Score of row 4Xrow row 4 X row 4 X row row 4 X row 4 X row 5Xthe area multiplier row 5 X 5 X 0.2 row 5 X 5 X 0.4 0.1 0.37 Sum row 6 for each column for PASI Before treatment After treatmentPASI Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
  • 168. Annexure 10Sl. No. Laboratory Before treatment After treatment investigations1 Hb%2 Tc3 Dc E B N M LLaboratory investigations Investigator’s note:Signature of the Scholar Signature of the guide Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta