ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS
Dissertation submitted to the Rajiv Gandhi University of Health Sci...
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
DECLARATION BY THE CANDIDATE
I here by declare that this ...
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
CERTIFICATE BY THE GUIDE
This is to certify that the diss...
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION...
COPYRIGHT
Declaration by the Candidate
I here by declare that the Rajiv Gandhi University of health Sciences,
Bangalore,Ka...
ACKNOWLEDGEMENT I
ACKNOWLEDGEMENT
This is unforgettable movement contentment on the successful fulfillment of an ambition ...
ACKNOWLEDGEMENT II
I take this opportunity to convey my thanks to my juniors Ajisha,Harshitha.B, Deepika,
Dr.Ramya, Dr.Vid...
ABBREVIATIONS III
ABBREVIATIONS
1. Cha. : Charaka Samhita
2. Sus. : Sushruta Samhita
3. A.S. : Ashtanga Sangraha
4. A.Hr. ...
ABBREVIATIONS IV
31. ESR : Erythrocyte Sedimentation Rate
32. Hb : Hemoglobin
33. No. : Number
34. PASI : Psoriasis Area &...
ABSTRACT  V 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF P...
TABLE OF CONTENTS
CONTENTS PAGE NO.
ACKNOWLEDGEMENT I-II
ABBERAVITIONS III-IV
ABSTRACT V
LIST OF TABLES VI-X
LIST OF FIGUR...
LIST OF TABLES  VI 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEME...
LIST OF TABLES  VII 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEM...
LIST OF TABLES  VIII 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGE...
LIST OF TABLES  IX 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEME...
LIST OF TABLES  X 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEMEN...
LIST OF FIGURES XI 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEME...
LIST OF FIGURES XII 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEM...
LIST OF FIGURES XIII 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGE...
LIST OF CHARTS XIV 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAGEME...
INTRODUCTION 1
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF...
INTRODUCTION 2
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF...
OBJECTIVE OF THE STUDY  3
OBJECTIVE OF THE STUDY
To evaluate the effect of virechana karma in patients suffering from psor...
PREVIOUS WORKS DONE 4 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 5 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANA...
REVIEW OF LITERATURE 6 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANA...
REVIEW OF LITERATURE 7 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANA...
REVIEW OF LITERATURE 8 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANA...
REVIEW OF LITERATURE 9 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANA...
REVIEW OF LITERATURE 10 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 11 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 12 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 13 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 14 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 15 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 16 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 17 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 18 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 19 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 20 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 21 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 22 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 23 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 24 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 25 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 26 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 27 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 28 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 29 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 30 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 31 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 32 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 33 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 34 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 35 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 36 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 37 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 38 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 39 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 40 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 41 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 42 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 43 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 44 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 45 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 46 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 47 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 48 
 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MAN...
REVIEW OF LITERATURE 49 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 50 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI.
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 51 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 52 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 53 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 54 
Classification of Kusta According To Different Acharyas
Table No: 31 Mahakushta
No.
Types of
Kush...
REVIEW OF LITERATURE 55 
Table No: 32 Kshudrakushta
No Types of Kusta Cha Sus A.Hr B.S. M.N. B.P.
01 Ekakusta + + + + + +
...
REVIEW OF LITERATURE 56 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 57 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 58 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 59 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 60 
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI
“ROLE OF VIRECHANA KARMA IN THE MANAG...
REVIEW OF LITERATURE 61 
2. Injestion of Vidahi
food in
Vidagdhavasta
+ - - - + - -
3. Asatmya Bhojana + + - - - + -
4. Ah...
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ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS, GIRIJA.M.N, DEPARTMENT OF POST GRADUATE STUDIES IN PANCHA KARMA, S. D. M. COLLEGE OF AYURVEDA, UDUPI,

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  1. 1. ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of the regulations for the degree of DOCTOR OF MEDICINE (Ayu) In PANCHA KARMA BY DR. GIRIJA.M.N. B.A.M.S GUIDE: DR. SHREEKANTH U. M D (Ayu) G.A.U Professor, H.O.D. & Former Dean Department of Pancha Karma CO-GUIDE: DR. NIRANJAN RAO M D (Ayu) G.A.U Professor Department of Pancha Karma DEPARTMENT OF POST GRADUATE STUDIES IN PANCHA KARMA S. D. M. COLLEGE OF AYURVEDA, UDUPI 2010-2011
  2. 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore DECLARATION BY THE CANDIDATE I here by declare that this dissertation thesis entitled “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” is a bonafide and genuine research work carried out by me under the guidance of Dr.Shreekanth.U. M.D(Ayu) G.A.U, Former dean,HOD & Professor and under Co-Guidance of Dr.Niranjan Rao. M.D.(Ayu) G.A.U, Professor Dept of Pancha Karma, S.D.M.C.A, Udupi. Date: Signature of the Candidate Place: Udupi Dr.Girija.M.N. Department of Pancha Karma S.D.M.C.A.,Udupi
  3. 3. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” is a bonafide research work done by “GIRIJA.M.N.” in partial fulfillment of the requirement for the degree of Doctor of Medicine in Ayurveda, under my guidance Dr Shreekanth.U. M.D. (Ayu)GAU. Date: Signature of the Guide Place: Udupi. Dr .Shreekanth.U. M.D (Ayu) GAU Former dean,H.O.D& Professor Department of Post graduate Studies in Pancha Karma S.D.M.C.A. Udupi
  4. 4. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” is a bonafide research work done by Girija.M.N. under the guidance of Dr.Shreekanth.U. M.D (Ayu) G.A.U,Former dean ,H.OD & Professor and Co- Guidance of Dr. Niranjan Rao. M.D. (Ayu) G.A.U,Professor. Signature of H.O.D Signature of Principal Dr. Shreekanth U, M.D. (Ayu) Dr.U.N Prasad, M.D. (Ayu) Former Dean,Professor and HOD Principal Dept of panchakarma SDMCA,Udupi Date: Place: Udupi
  5. 5. COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of health Sciences, Bangalore,Karnataka shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic / research purpose. Date: Signature of the Candidate Place: Udupi Dr. Girija.M.N. B.A.M.S © Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
  6. 6. ACKNOWLEDGEMENT I ACKNOWLEDGEMENT This is unforgettable movement contentment on the successful fulfillment of an ambition & a milestone fostered for long i.e. the completion of this dissertation work. I am highly indebted to my parents Shri.S.Narasimhamurthy & Smt.Mahalakshmi played a key role in molding my thoughts towards higher studies with a constant enthusiastic & affectionate push & who are the driving forces behind this work. I am dedicating this whole work to the feet of my father Mr.S.Narasimhamurthy whose moral support & great inspiring thoughts towards me had helped me always to achieve my goals in the most toughest situations of my life. Who has made me to sail always towards success with much difficulty. It is a great pleasure for me to extend my thanks with respect to my Guide, my preacher Dr. Shreekanth U.Professor,HOD & Former dean Department of Panchakarma, SDM College of Ayurveda & Hospital Udupi. Whose scholarly suggestions, Potential direction, timely supervision & perpetual inspiration made me to complete this work. It is a great pleasure to express my gratitude to my co guide Dr. Niranjan Rao, Professor, Department of Panchakarma, and SDM College of Ayurveda & Hospital, Udupi, who supported me each & every movement of my work. It is a great pleasure to express my gratitude to Dr. Rajlaxmi, M.G, Lecturer & Dr.Padmakiran,Lecturer Department of Panchakarma, SDM College of Ayurveda & Hospital, Udupi, she supported me during my work.At the same time I would like to convey my thanks to the pharmacy staff of our hospital, they help me in preparation of my drugs. I, in this special movement, should be very much thankful to my loving brother Mr.Santosh.M.N for his great friendly advise , all-time support, generous help, not only in this work, but throughout my entirelife . My special acknowledgement to all my friends & batchmates Dr.Riyas, Dr.Greeshma, Dr. Rahul, Dr.Prakash, Dr.Pratimaadarsh,Dr.Seetharam for their wonderful co-operation during my entire course. DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” I thank to all my Seniors & Junior colleagues Dr.Raksha, Dr.vishwanath, Dr.varun, Dr.Vignesh, Dr.Shankarnarayan.
  7. 7. ACKNOWLEDGEMENT II I take this opportunity to convey my thanks to my juniors Ajisha,Harshitha.B, Deepika, Dr.Ramya, Dr.Vidya BAMS, SDMCA, Udupi. I am thankful to the Panchakarma staff, for their kind co-operation, which was indispensable for the successful completion of this work. I can’t think of the words to thank adequately all my patients for their trust and patience. If I am sailing in the wide ocean of medicine today, it is my patients who add wind to my sails. They are both my ways and my destination too. My special thanks to the Library staff, owner of Samrudhi Xerox, for their co-operation during my documentation work. I should be very thankful to all of my family members ,they always inspired me to achieve this milestone in my life. I have not been able to find words enough to express my sentiments of love, respect & gratitude for them. Lastly I acknowledge my thanks to those who have directly or indirectly extend there Support for the completion of my work. GIRIJA.M.N. DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”
  8. 8. ABBREVIATIONS III ABBREVIATIONS 1. Cha. : Charaka Samhita 2. Sus. : Sushruta Samhita 3. A.S. : Ashtanga Sangraha 4. A.Hr. : Ashtanga Hridaya 5. B.P. : Bhava Prakasha 6. M.N. : Madava nidana 7. Sha. : Sharangadhara Samhita. 8. B.S : Bhela Samhita 9. H.S. : Harita Samhita 10. Ka. : Kashyapa Samhita 11. Van. : Vangasena 12. Y.R. : Yogaratnakara 13. G.D. : GadaNigraha 14. Bhai.Rat : Bhaishajya Ratnavali 15. Nig.A. : Nighantu Adarsha 16. Su. : Sutra Sthana 17. Ni. : Nidana Sthana 18. Vi. : Vimana Sthana 19. Chi. : Chikitsa Sthana 20. K : Kalpa Sthana 21. Si. : Siddhi Stana 22. Pu. : PurvaKhanda 23. M : Madyama Khanda 24. U : UttarKhanda 25. Nig. : Nighantu 26. AT : After treatment 27. BT : Before treatment 28. Cm : Centimeters 29. d : Difference 30. DC : Differential Count DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”
  9. 9. ABBREVIATIONS IV 31. ESR : Erythrocyte Sedimentation Rate 32. Hb : Hemoglobin 33. No. : Number 34. PASI : Psoriasis Area & Severity Index 35. SD : Standard Deviation 36. SEM : Standard Error Mean 37. TC : Total Count 38. Yrs. : Years DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”
  10. 10. ABSTRACT  V    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” ABSTRACT Psoriasis is the most common dermatological condition affecting 1% of the population .It is a chronic inflammatory skin disorder clinically characterized by erythematous,sharply demarcated papules and rounded plaques, covered by silvery micaceous scale. The cause is unknown but is thought to be related to genetic and environmental factors that trigger on over production of epidermal cells. Kushta is Bahudoshaavastajanya vyadhi ,has tridosha involvement along with saptha dhatu as its dushya psoriasis may be put under the categories like kitibha, sidhma, ekakustha according to different presentations. Virechana karma is one of the sodhana karma explained for it.As tvacha is a jnanedriya ,thus by virechana karma indriya shudhi takes place. All acharayas explained that kustha is one of the virechana sadhya vyadhi.Thus virechana karma is helpfull to manage psoriasis. Aims and Objectives To evaluate the effect of virechana karma in patients suffering from psoriasis. Methodology It is Single blind clinical study with 20 patients having the sign & symptoms of Psoriasis were selected randomly irrespective sex from O.P.D. & I.P.D. sections of Panchakarma department, S.D.M. Ayurveda Hospital, Kuthpady, Udupi, were diagnosed as psoriasis and fullfilling the criteria of undergoing the process of virechana karma were selected. Patients were subjected to deepana pachana with chitrakadi vati, after proper amapachna arohana snehapana was administered with Mahatiktaka gritha till obtaining samyak snigda lakshans. Then from next day of samyak snigdha lakshana, Sarvanga Abhangya with Karanja Taila followed by Sarvanga Parisheka with Sidartaka snana choorna was performed for 4 days and during this period patient advised to avoid consumption of Kaphakara Ahara and Vihara. On 4th day depending upon the rogi & roga bala Virechana Karma was performed with Abayadimodaka with sukoshna jala as Anupana. Finally based on Shuddhi lakshana Samsarjana krama was prescribed. In all cases P.A.S.I. score, candle grease sign and Auspitz sign were noted before and after the Virechana karma. Keywords: - Virechana Karma, Psoriasis, Kushtha, P.A.S.I.
  11. 11. TABLE OF CONTENTS CONTENTS PAGE NO. ACKNOWLEDGEMENT I-II ABBERAVITIONS III-IV ABSTRACT V LIST OF TABLES VI-X LIST OF FIGURES/GRAPHS XI-XIII INTRODUCTION 1-2 OBJECTIVES 3 PREVIOUS WORKS DONE 5 PART 1 CONCEPTUAL STUDY 5-99 PART 2 DRUG REVIEW 100-108 PART 3 METHODOLOGY 109-114 PART 4 OBSERVATIONS 115-137 PART 5 RESULTS 138-146 PART 5 DISCUSSION 147-157 PART 6 CONCLUSION 158 PART 7 SUMMARY 159-161 BIBLIOGRAPHY 162-181 ANNEXURE
  12. 12. LIST OF TABLES  VI    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” SL. NO TABLE OF CONTENTS PAGE NO. 1. Detail description regarding Virechana in different samhithas 6-7 2. Classification of virechana drugs 11 3. Classification of virechana dravayas based on parts used 12 4. Classification of Virechana dravayas based on parts used & agraoushda 13 5. Showing virechana drugs according to seasons 16 6. Showing virechana kalpas according to charaka 18 7. Showing formulations for virechana based on dosha involvement 19 8. virechana kalpas according to sharangadhara 19 9. Virechana dravyas used as per the dosha 19 10. Showing Virechana yogya 21-22 11. Showing Virechana ayogya 23-24 12. Showing sneha matra 26 13. Showing sneha dravya and anupana 27 14. Showing sneha Jeeryamana and Jeerna lakshana 28 15. Showing Samayak snigdha lakshana 28 16. Showing Asnigdha lakshana 29 17. Showing Atisnigdha lakshana 29 18. Dose of virechana drug in its different form 31 19. Showing criteria for Antiki,Vegiki & Maniki shuddhi of Virechana karma 34 20. Laingiki shuddhi 35 21. Showing ayoga lakshnas of virechana karma 35 22. Showing Atiayoga lakshnas of virechana karma 36
  13. 13. LIST OF TABLES  VII    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 23. Showing the diet regimen 36 24. Showing Rasa Samsarjana 40 25. Showing the Ayoga and Atiyoga Lakshanas of Vyapath. 41 26. Showing the Virechana Vyapath According to different Acharyas. 41 27. Showing virechana vyapat with their treatment. 42 28. Showing layers of Twak according to different Acharyas 49 29. Showing Sapta Twacha and Disease Relation. 50 30. Explanation of kustha in different samhithas. 52 31. Showing Maha kushtha according to different acharyas. 54 32. Showing Kusdra kushtha according to different acharyas. 55 33. Kashayapokta kustha types. 56 34. Showing Kusta dosha relation 56 35. Showing difference b/w Mahakustha & Kusdra Kustha 57 36. Showing Nidana of Kustha according to different acharyas. 58-63 37. Showing poorvaroopa of kushtha according to different acharyas. 64 38. Showing kushtha Roopa according to different acharyas. 65-66 39. Showing Sadya-Asadyadtha of kustha 68 40. Showing Pathya-Apathya of kustha . 71-72 41. Differential diagnosis of Psoriasis. 83-84 42. Classification of psoriatic arthritis. 86 42a. Showing PSAI Coverage area score. 96 43. Showing features of different types of kushta in relation to psoriasis. 98 44. Rasa panchaka of Chitrakadi Vati 101-102
  14. 14. LIST OF TABLES  VIII    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 45. Rasa panchaka of Mahatikthaka ghritha 103 46. Rasa panchaka of Kranja taila 105 47. Rasa panchaka of sidarthaka snana choorna 105 48. Rasa panchaka of Abhyadimodaka 106 49. Age group Incidence of patients 108 50. Sex Incidence of patients 115 51 Religion wise distribution of patient 115 52. Marital status of patients 116 53. Education level of patients 116 54. Analysis of Psoriasis onset site 117 55. Seasonal impact on Psoriasis 117 56. Addiction wise Incidence 118 57. Dietary habits 118 58. Family history of Psoriasis 119 59. Prakruti of patients 119 60. Desha of patients 120 61. Koshta wise distribution of patient 120 62. Satva 121 63. Satmya 121 64. Samhanana 122 65. Sara 122 66. Ahara-Abhyavaharana Shakti 123 67. Ahara- Jarana Shakti 123 68. Pachakagni 124 69. Vyayama Shakti 124 70. Vaya 125 71. Dehabala 125 72. Analysis of Candle Grease Sign 126 73. Analysis of Auspitz Sign 126
  15. 15. LIST OF TABLES  IX    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 74. Involvement of Nails 127 75. Analysis of Scaling 127 76. Analysis of Thickness 128 77. Analysis of Itching 128 78. Analysis of Discharge 129 79. Type of Kushta 129 80. Analysis of samyak snigdha lakshana appearance day 130 81. Analysis of Total amount of abyantara sneha 131 82. Analysis of samyak snigdha lakshana 132 83. Analysis of samyak Swinna lakshana 133 84. Analysis of latency period 133 85. Analysis of Duration of Virechana 134 86. Analysis of Vaigiki Shuddhi 134 87. Analysis of Manaki of Virechana 135 88. Analysis of Anthiki of Virechana 135 89. Analysis of Laingiki Lakshana of Virechana 136 90. Effect on Itching over head 137 91. Effect on Erythema over head 138 92. Effect on Scaling over head 138 93. Effect on Thickness of Skin over head 139 94. Effect on Itching over Trunk 139 95. Effect on Erythema over Trunk 140 96. Effect on Scaling over Trunk 140 97. Effect on Thickness over Trunk 141 98. Effect on Itching over Upper limbs 141 99. Effect on Erythema over Upper limbs 142 100. Effect on Scaling over Upper limbs 143 101. Effect on Thickness of Skin over Upper limbs 143
  16. 16. LIST OF TABLES  X    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 102. Effect on Itching over Lower limbs 144 103. Effect on Erythema over Lower limbs 144 104. Effect on Scaling over Lower limbs 145 105. Effect on Thickness of Skin over Lower limbs 145 106. Effect on mean PASI Scoring 146
  17. 17. LIST OF FIGURES XI    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” LIST OF FIGURES SL. No. FIGURES PAGE No. 1. Age group Incidence of patients 115 2. Sex Incidence of patients 115 3. Patients according to their religion 116 4. Marital status of patients 116 5. Education level of patients 117 6. Analysis of site of onset of Psoriasis 117 7. Seasonal impact on Psoriasis 118 8. Addiction wise distribution of patients Incidence 118 9. Diet wise distribution of patient 119 10. Family history of Psoriasis 119 11. Prakruti of patients 120 12. Desha of patients 120 13. Koshta of Patients 121 14. Satva 121 15. Satmya 122 16. Samhanana 122 17. Sara 123 18. Ahara-Abhyavaharana Shakti 123 19. Ahara- Jarana Shakti 124 20. Pachakagni 124 21. Vyayama Shakti 125 22. Vaya 125 23. Dehabala 126 24. Analysis of Candle Grease Sign 126 25. Analysis of Auspitz Sign 127 26. Involvement of Nails 127 27. Analysis of Scaling 128
  18. 18. LIST OF FIGURES XII    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 28. Analysis of Thickness 128 29. Analysis of Itching 129 30. Analysis of Discharge 129 31. Type of Kushta 130 32. Analysis of samyak snigdha lakshana appearance day 131 33. Analysis of Total amount of abhyantara Sneha 132 34. Analysis of samyak snigdha lakshana 133 35. Analysis of samyak Swinna lakshana 134 36. Analysis of latency period 134 37. Analysis of Duration of Virechana 135 38. Analysis of Vaigiki Shuddhi 135 39. Analysis of Manaki of Virechana 136 40. Analysis of Anthiki of Virechana 137 41. Analysis of Laingiki Lakshana of Virechana 138 42. Effect on Itching over head 138 43. Effect on Erythema over head 139 44. Effect on Scaling over head 139 45. Effect on Thickness of Skin over head 140 46. Effect on Itching over Trunk 140 47. Effect on Erythema over Trunk 141 48. Effect on Scaling over Trunk 141 49. Effect on Thickness over Trunk 142 50. Effect on Itching over Upper limbs 142 51. Effect on Erythema over Upper limbs 143 52. Effect on Scaling over Upper limbs 143 53. Effect on Thickness of Skin over Upper limbs 144 54. Effect on Itching over Lower limbs 144 55. Effect on Erythema over Lower limbs 145
  19. 19. LIST OF FIGURES XIII    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 56. Effect on Scaling over Lower limbs 145 57. Effect on Thickness of Skin over Lower limbs 145 58. Effect on mean PASI Scoring 146
  20. 20. LIST OF CHARTS XIV    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” LIST OF CHARTS SL.NO CHARTS PAGE NO. 1. Mode of Action of Virechana karma 44 2. Kushtha Samprapti 67 3. Pathology of Psoriasis 77 4. Schematic of treatment ladder Psoriasis 89
  21. 21. INTRODUCTION 1   DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” INTRODUCTION MÑüwhÉÉÌiÉ uÉmÉÑ CÌiÉ MÑü¸Ç || MÑwhÉÉÌiÉ uÉmÉÑ MÑü¸Ç ||( A.Hr.Ni 14/4)) The above definitions does explain the importance of skin from the point of cosmetology. Disfiguration (MÑüwhÉÉÌiÉ), blackening or changes in normal colour (üMÑwhÉÉÌiÉ) are the two main impacts of any of the kushta. In Ayurveda importance of Skin had been highlighted by identifying it as one of the seat of Jnanendriya(Cha.Su.8/10) and moreover comparing to all other seats of Jnanendriya’s, Skin envelope most part of body surface. In other words to say, remaining Netradi four Indriyas have their seat on restricted parts of body surfaces like Netra is seat for Chakshurindriya, Jivha is seat for Rasanedriya etc. but Sparshanendriya has its seat in Twacha which covers all most all the body surface area (Cha.Su. 11/38). From the origin point of view Tvak is considered as Upadhatu of mamsa dhathu, Tvak is having direct relationship with Rasa dhatu owing to its nourishment and maintenance(Cha.Chi15/17).However in the context of Dashavidha pariksha Charak identified TwakSara instead of RasaSara (Cha.Vi.8/102-103).Thus healthy status of Rasadhatu is most essential to maintain the proper structure and functions of Tvak. Psoriasis is one of the most common dermatologic disorder and a chronic skin disorder marked by periodic flare-ups of sharply defined red patches, covered by a silvery, flaky surface. About the 3% of the world’s population have some form of psoriasis. The main disease activity leading to psoriasis occurs in the epidermis, the top five layers of the skin. In persons with psoriasis, the keratinocytes multiply very rapidly and travel from the basal layer to the surface in about 4 days. The skin cannot shed these cells quickly enough, so they build up, leading to thick, dry patches, or plaques. Silvery, flaky areas of dead skin build up on the surface of the plaques before being shed. The underlying skin layer (dermis), which contains the nerves and blood and lymphatic vessels, becomes red and swollen1(a) .
  22. 22. INTRODUCTION 2   DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” Kushta is Bahudoshaavastajanya vyadhi ,has tridosha involvement along with saptha dhatu as its dushya psoriasis may be put under the categories like kitibha, sidhma, ekakustha according to different presentations Virechana karma is one of the sodhana karma explained for it.As tvacha is a jnanedriya ,thus by virechana karma indriya shudhi takes place (cha.su.8/10). All acharayas explained that kustha is one of the virechana sadhya vyadhi.Thus virechana karma is helpfull to manage psoriasis. Moreover Charaka identified Kushta as one among Dheergakaalena roga (Cha.Su.25/40). Hence the present study was chosen as administration of Virechana Karma in Psoriasis. It is Single blind clinical study with 20 patients having the sign & symptoms of Psoriasis were selected and were screened with Haematological tests to rule out other underlying pathologies and to void possible complications. All the patients were administered with preliminary Deepana –Pachana with Chitrakadivati. Snehana was achieved by internal administration of Mahatiktaka Gritha followed by Abhyanaga with karanja taila and Parisheka with sidartaka snana choorna kashaya . Main course of the treatment i.e. Virechana was administered with Abhyadimodaka with Sheeta jala as Anupana. Depending upon Suddhi Paschat karma was designed. Dosage & duration of all the procedures were in accordance with Doshabala, Agni bala, Koshta etc. Results: On an average on the 3rd day patients attained samyak snigdha lakshana. i.e. maximum of 45% patients attained samyak snigdha lakshana on the third day itself. In maximum number of patients the total amount of Abhyantara Sneha required during the whole course of Snehapana was ranging between 100-400 ml. Maximum of maximum of 20(100%) of patients had Swedapradurbhava and 18(90%) of patient had Tvak mardavata by Sidarthaka snana choorna kashya Parisheka. Maximum of 31-60 min. Latency period was in found 08(40%) of patients. By Virechana karma there is 49.03% improvement in total PASI Scoring .
  23. 23. OBJECTIVE OF THE STUDY  3 OBJECTIVE OF THE STUDY To evaluate the effect of virechana karma in patients suffering from psoriasis. Conceptual study of Virechana Karma & Psoriasis   DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”
  24. 24. PREVIOUS WORKS DONE 4    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” PREVIOUS WORKS DONE ON PSORIASIS 1. Babu Shankar.A “Effect of Vamana and Virechana in Psoriasis” Govt. Ayurvedic college, Kerala University, Trivendrum – 1988. 2. Anken “Concept of Kitibha (Psoriasis) in Ayurveda and Modern medicine and its treatment with Strikutaja a further study”. Banaras Hindu University, Varanasi - 1991. 3. Ruparel.S.J “Role of Virechana with and without Shamana in the management of Eka kushtha (Psoriasis) ” by Ruparel on 1999 at Gujarat Ayurveda University, Jamanagar- 1999. 4. Jagadeesh.G “Role of Vamana karma in the management of Psoriasis- A clinical study S.D.M. College of Ayurveda, kuthpady Udupi, RGUHS, Karnataka - 2007 . 5. Praveen.V.Devarushi . “Role of Virechana karma in the management of psoriasis ” S.D.M. College of Ayurveda , Kuthpady Udupi RGUHS, Karnataka- 2009.
  25. 25. REVIEW OF LITERATURE 5    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  PROCEDURE REVIEW HISTORICAL REVIEW PURANA KALA Agnipurana1 : . Agni purana has stated virechana as best treatment for the diseases caused due to Pitta.Trivrth as best virechaka dravya. It is indicated in urdhwaga rakta pitta, jwara, hridroga.But detailed description of Virechana was not found. In Manu smrithi, it is told that snana is done after the completion of vamana and virechana. Vinayapitaka(Buddhist literature): In the text Vinaya pittaka from Buddha period description of administration of virechana was given to Bhagwan Buddha by inhaling powder spread over uthplapatra is available. Kasika2 It is explained that Panchakarma was common method of treatment which prescribed Poorvakarma such as Snehana, Swedana and Panchakarma, Annasamsarjana etc.
  26. 26. REVIEW OF LITERATURE 6    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  SAMHITA KALA: Table no :1 showing description of virechana in different samhithas DRUGS   BOOK       STHANA  VIRECHAN  DRUG  (Chapters/  Sholka)  VIRECHAN  KALPA/ YOGA  (Chapters/  Sholka)    PROCEDURE,  BENEFITS  (Chapters/    Sholka)    COMPLICATIO NS &  TREATMENT  Chapters/Sholka    Sutrasthana  1/77,75 ;  2/9,10; 4/13  15/7;  25/40      ‐      15/ 17,18,16,  22;  16/ 17‐19    15/ 13 ;  16/ 5‐10 ,   22‐26  Vimanasthana  8/136  ‐  ‐  ‐  Kalpasthana  1/6   7‐12   1/3, 4,5. ;  12   12             Charak  samhita  Siddhisthana  ‐  ‐  1; 2/11,12,13.  6               Sutrastana   38/30 ;   39/ 4  44     ‐  ‐ Sushruta   Samhita  Chikitsasthan  ‐  ‐  33/19‐47  34   Sutrastana   15/2  ‐  18   18    Astanga   Hridaya  Kalpasthana  ‐  2   ‐  3      Astanga  Sutrasthana  13/2;14/3‐ 4;15/6  ‐  27   27  
  27. 27. REVIEW OF LITERATURE 7    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  sangraha  Kalpasthana  ‐  2   ‐  3   Sutrasthana   ‐  ‐  4 ; 21 ; 23;25  ‐  Kalpasthana  ‐  7 ; 8 ; 9.   ‐  ‐        Bhela  samhita  Siddhisthana  ‐  ‐  ‐  1 ; 4   purvakhanda  4   ‐  ‐  ‐ Sharang‐ adhara  samhita  Uttarakhanda                              Detail about virechana karma   Vangas‐ ena  samhita    Virechanadhik ara     Detail about virechana karma   Bhavaprak asha  Nighantu Part  ‐  5   5   5   Chakra – datta  ‐  ‐  71  71   71   Sutrasthana   ‐  ‐  24   ‐  Siddhisthana  ‐  ‐  2 ; 3 ; 7  ‐    Kashyapa  samhita  Khilasthana  ‐  ‐  7   7  
  28. 28. REVIEW OF LITERATURE 8    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  VIRECHANA The process by which the vitiated doshas are eliminated through the adhobhaga ie guda marga, is called ‘Virechana.This is widely used shodana therapy, is less stressful with least complication.Virechana in broader term denotes both vamana and virechana.3 Etymology:- (1) Virechana4 :Vi+Rich+ Nich , lytu-malade: nissernam ......(Vachaspathyam). (2)Virechanaha5 :Vi+Rich+Nich, lytu-Visheshena rechathete ...... (Shabdakalpadruma) The Vircehana word is derived from the ‘Rich’ dhatu ,‘Nich’ &’Lyut’ pratyaya & with ‘Vi’ upasarga. It also means Maladehe nissaranam i.e. expelling out the malas. "Rich" - evacuation. "Rich" - Viyojana (separation). ‘Rich’ meaning – To empty , evacuate, leave, give up.6 The root ‘Rich’ is also very important to understand the systemic action of Virechana. According to Charaka, the Virechana drugs first get digested in Amashaya, then reaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body and reach the site where Doshas are accumulated.7 Virechana drugs soften the compactness (Sanghata) of the Doshas and break the bigger molecules to smaller ones. This process occurs in a proper way by separation (Viyojana) and combination (Samparchana) of doshas. Up to this stage the action of Virechana is known as its systemic effect and it is obviously governed by Viyojana and Samparchana components of Virechana dravya.
  29. 29. REVIEW OF LITERATURE 9    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Definition: iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉ xÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....|8    The act of expelling Doshas through Adhobhaga is known as Virechana. Here the meaning of Adhobhaga is ‘Guda’ as commented by Chakrapani. ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉ ÌlÉ:xÉÉUhÉÇ ...|9 The procedure in which the drug is administered orally, acts on morbid Doshas, specifically on Pitta and expels them out through anal route. ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç | UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||10 The procedure where the morbid Dosha is expelled out in the form of Drava either pakva or apkva state. ÌmɨÉå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ zsÉåwqÉhÉÏÌiÉ |11 urÉMÑüsÉÉlÉç xÉͳÉmÉÉiÉÉåijÉÉlÉç mÉæ̨ÉMüÉlÉç MüTü ümÉæ̨ÉMüÉlÉç | xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç ||12 Even though Virechana is best line of treatment modality for pittadosha13 it can act on kaphasamsrusta pitta or pittasthanagat kapha. And moreover in case of vatasyopakrama mridu shodhana indicated which refers to mridu Virechana karma14 . So Virechana is major line of treatment for morbid pittadosha & also it act on morbid kapha and vata dosha. Thus action of Virechana is seen on all tridosha.
  30. 30. REVIEW OF LITERATURE 10    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Paryaya: Instead of word Virechana the following terms were used in different context, these all can be consider as synonyms for virechana, • Vireka, • Rechana, • Adhobhagahara. • Anulomana 15 • Praskandana. IMPORTANCE OF VIRECHANA:- Virechana is a sovereign procedure for elimination of Pitta Dosha16,17 Indu explains that in the vitiation of Kevala Pitta, Pitta associated with Kapha and in Pittasthana Gata Kapha Virechana is the obvious treatment procedure to be followed18 . Charaka explains that,Virechana drug after entering Amashaya dislodges the vitiated Pitta Dosha and henceforth pacifies all Pitta Vikara of the body19 . Virechana also cleanses sense organs i.e. improves their function. Just as removal of water from its reservoir destroys various organisms and plants residing in it, in the similar manner removal of excessive Pitta destroys the various symptoms caused due to it20 . Virechana is mentioned as Shodhana procedure in Dusthi of Rasa,Rakta, Mamsa, Asthi, Majja & Shukra Dhatus. Hence in majority of the Dhatupradoshaja Vikaras Virechana is the better option. Vatasyopakrama snehaswedaha samsodhane mridu (A sa su 21/2) Virechana dravya guna karma: The guna of virechana dravya are ushna, tikshna, sukshma, vyavayi, vikashi, these qualities are common in vamana aoushadam, but virechana dravya has adhobagahara prabhavam.Virechana dravya has jala and prithwi mahabootha predominance.21
  31. 31. REVIEW OF LITERATURE 11    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  CLASSIFICATION OF VIRECHANA DRUGS:-- The drugs which produce Virechana are known as Virechaka dravyas. According to references available Virechana drugs may be classified in following 6 groups, Table.no.02 I) Virechana Dravyas According to their origin & parts used a) Animal origin b) Plants origin c) Miscellaneous II) According to the mode of action a) Anulomana b) Samsrana c) Bhedana d) Rechana III) According to the intensity of action a) Mrudu b) Madhyama c) Tikshna IV) According to the Rukshata & Snigdhata view. V) Virechana drugs according to the seasons VIRECHANADRAVYAS VI) Virechana drugs according to kalpanas I.Virechana drugs according to their origin and parts used:  a) Animal origin: ∗ Urine.22,23 ∗ Milk 24 ∗ Takra 25 b) Plant Origin:
  32. 32. REVIEW OF LITERATURE 12    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Classification of virechana dravyas based on part of the plant used. Table no: 03. Sl.no. Part of the plant used for virechana. Charaka 26 Sushruta 27 Vagbhata 28 1. Mulini virechana dravya. Hastidanti Shyama Trivrit Adhoguda Saptala Danti Gavakshi Vishanika Ajagandha Dravanti Avartaki Trivrit,Shyama Danti Dravanti Saptala Shankhini Vishanika Gavakshi Chitraka Kush, Kasha Kinahi Danti,Kumbha (Trivrit) Gavakshi Shankhini 2. Phalini virechana dravya Shankhini Vidanga Anupa Sthalaja Prakeerya Udakeerya Abhaya Anthakotrapuspi Kampillaka Aragwada Kampillaka Puga Eranda,Haritaki Bibhitaki, Amalaki Neelini Aragwada Neelini Triphala Kampillak 3. Ksheera virechana dravya. Snuhi ksheera Arka Mahavriksh Saptachala Swarna ksheeri Snuhi Swarna ksheeri Godugdha 4. Twak virechana dravya Tilwaka Tilwaka Patala Ramyaka Tilwaka Ramyaka 5. Patra virechana dravya Swarna patri Aragwada Putika Aragwada Karavellaka Aragwada Based on Parts of the Dravya used: Sushruta describes the following drugs with priority for Virechana Karma29 .
  33. 33. REVIEW OF LITERATURE 13    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Classification of virechana dravyas based on main part of the plant used Table no.04 Mula Virechana Shyama Trivrith Phala Virechana Haritaki Twak Virechana Tilwaka Swarasa Virechana Karvellaka Dugdha Virechana Snuhi Taila Erandam c) Miscellaneous: As Madya, Dhanyamla30 ,Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena also have Sara properties. II. Virechana drugs according to their mode of action by Sharangadhara Acharya Sharangdhara has classified according to the action of the Virechana dravyas. a) Anulomana 31 : M×üiuÉÉ mÉÉMÇü qÉsÉÉlÉÉÇ rÉiÉç ÎpÉiuÉÉ oÉlkÉqÉkÉÉå lÉrÉåiÉç | iÉŠÉlÉÑsÉÉåqÉlÉÇ ¥ÉårÉÇÇ mÉëÉå£üÉ WûUÏiÉMüÐ || These drugs will digest the Apakwa (undigested material) malas and bring them to adhomarga for defecation process. These drugs will facilitate the defecation process. eg: Hareetaki (Terminalia Chebula). Sushruta considers Sara as the synonym of Anulomana. According to Dalhana Anulomana causes expulsion of Vata and Kapha32 . b) Sramsana 33 : mÉ£üurÉÇ rÉSmÉ£üurÉÇ ÎvsÉ¹Ç MüÉã¹ã qÉsÉÉÌSMüqÉç | lÉrÉirÉkÉ:xÉëÇxÉlÉÇ iÉSè rÉjÉÉ xrÉÉiÉç ¢üiÉqÉÉsÉMüqÉç| The drugs which expel the malas adhered to the lumen of intestines in to the rectum without digesting them. eg: Aragwada (Casia Fistula). In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates the Pitta and Kapha situated in Pakwashaya 34 .
  34. 34. REVIEW OF LITERATURE 14    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  c) Bhedana 35 :   qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:| ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉ The drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or ‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into it and then evacuating through the lower gut, is known as Bhedana. eg. Katuki. Bhedana is a process in which Shareera Mala Nirharana is brought about. 36 . Charaka has described a group named as ‘Bhedaneeya’. This includes Shyama (Trivrit), Arka, Urubuka (Eranda), Agnimukhi (Kalikari), Chitra (Danti), Chitraka, Chirabilva, Shankhini, Sakuladani (Katuki) and Swarnaksiri.37 d) Rechana 38 : ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç | UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ || The drug which eliminates digested (Pakwam) and undigested (Apakwam) Malas or Doshas by making them watery through the lower gut is known as ‘Rechana’ eg: Trivrit. Virechanopagas: There are certain drugs which help in enhancing the action of Virechana Dravyas is known as Virechanopaga. The drugs described are Draksha, Gambari, Parushaka, Abhaya, Amalaka, Vibhitaka, Kuvala Badara, Karkandhu, and Pilu39 III. Virechana drugs according to intensity of action: According to the degree of potency of the drugs, the Virechana may be classified into the following categories. A) Mridu Virechana:40 The drugs which are Mridu in Veerya or when combined with opposite Veerya or given in low dosage, given to the Ruksha patient and causes less purgation is known as Mridu Virechana. Those drugs are specifically indicated in weak patients having mild natured diseases. These drugs may also be given to the patients who have been
  35. 35. REVIEW OF LITERATURE 15    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Shodhita previously or having Alpa Dosha or whose Koshta is unknown. Charaka is of the view that the physician should not hesitate to use Mridu Virechana drugs in weak patients having more Doshas because even repeated elimination of Doshas in small quantity may cure the disease41 The patient who have not taken Virechana drugs in past and whose Koshta is unknown in such persons Sushruta recommends the use of Mridu Virechana drugs in the beginning and after knowing the Koshta required drug may be prescribed 42 Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta (eg. Draksha, Milk, Caster oil, Warm water etc.). 43 Drugs effective in Mridu Koshta are Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala, Pilu and Taruna Madya44. B) Madhya Virechana: The drugs which are moderate in qualities are known as Madhya Virechana drugs. The drugs are specifically indicated in the patients having Madhya Roga (disease with moderate symptoms). The administration of these drugs in Balavan rogi is useless because, they are unable to eliminate Dosha completely45 .Sharangdhara recommends the use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and Aragvadha46. C) Teekshna Virechana : The drugs, which cause Mahavega and eliminates the Doshas in large quantity by quick Kshipra and Sukha purgation without causing much Glani, is known as Teekshna Virechana. According to Charaka, the drug which has been kept away from water, heat and organisms, cultivated in proper Desha and Kala and which has been given Bhavana with the drugs of same Veerya acquires the Teekshna properties. This type of drugs having all the required properties, when given in prescribed dosage to the patient who has been well Snehita and Swedita, then it causes Teekshna Virechana47 .Sharangdhara recommends use of Teekshna Virechana drugs in Krura Koshta persons. Charaka recommends the use of these drugs in the strong (Balavan) patients with all the symptoms of the diseases i.e. Teekshna Vyadhi51 .It has been further mentioned that the use of these drugs should be avoided in Durbala (weak), Shodhita, and patient having Alpa Dosha and whose Koshta is unknown, otherwise it may cause untoward
  36. 36. REVIEW OF LITERATURE 16    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  effects to these patients. Sushruta is of the view that Teekshna drugs given in Mridu Koshta having Deeptagni, passes out quickly without eliminating Doshas properly52 ,Snuhi Kshira is considered as the best amongst these drugs53 .More over Sharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in Krura Koshta may also be included in this group. IV.Classification based on guna of drug: In many places in Ayurveda, the uses of Snigdha Virechana and Ruksha Virechana have been recommended. The drug used in the form of oil or the preparation containing Sneha is known as Sneha Virechana, eg: Eranda Taila. Vagbhata recommends the use of Sneha Virechana in all patients except Snigdha patients 54 . The use of Sneha Virechana in the patients who have been given higher dosage of Sneha is contraindicated because, due to this, the moving Doshas may again adhere in the Srotas55 . Sneha Virechana should be administered in Sama-Shitoshma Kala 56 . The preparations, which do not contain Sneha, may be known as Ruksha Virechana. Its use has been recommended in the Snigdha patients who have been comparatively taken more Sneha 57 .eg: Danti dravanti V. Virechana drugs according to seasons 58 Table no:05 Showing Virechana drugs according to seasons.      Varsha Sharad Shishira /Vasanta Greeshma Hemanta All seasons Virechana drug Beeja Trivrit Kutaja Pippali Shunthi ShyamaTri vrit Duralabha Musta Sharkara Udichya Shweta Chandana Shyamatr ivrit Pippali Nagara Sindhu Aruna Trivrit Shyamatrivrit Trivrit Chitraka Patha Ajaji Sarala Vacha Hemakshiri churna Trivrit Danti Hapusha Saptala Katuki Swarnaksiri Anupana Draksha Rasa and madhu Yasti madhu in Draksha Swarasa or Draksha Swarasa only Honey Sugar Warm Water Bhavana with cow ‘s urine
  37. 37. REVIEW OF LITERATURE 17    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Adhamalla in Sharangdhara commentary mentioned that the drugs for Virechana in Shishira, Vasanta and Hemanta Rutu are same. Kasiram Vaidya in his commentary opined that Saindhava, Vriddhadaru, Shyamatrivrit are to be used for Virechana in Hemanta Rutu. Charaka mentions Trivrit Chitraka, Patha, etc. to be used for Virechana in Hemanta Rutu. VI.According to Kalpana: Different forms of yogas are prepared to help in enhancing the potency, shelflife and convenience. According to Sushruta following 8 preparations are useful. i) Ghrita yoga ii) Taila yoga iii) Kshira yoga iv) Madya yoga v) Mutra yoga VI) Mamsarasa yoga vii) Bhaksanna yoga viii) Avaleha yoga Kshira, Rasa, Kalka, Kashaya, Kwatha and Sita are respectively Laghu.
  38. 38. REVIEW OF LITERATURE 18    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table no:06. Showing 245 Virechana kalpas according to Charaka.59 Kalpana Trivrth Argvada Tilvaka Sudha Saptala Shankini Danti Dravanti Amla kanji 2 1 1 1 1 1 Mutra 22 - 1 - - - Tushodaka 2 - - 1 1 1 Maireya 2 - - - 1 - Yusha 2 - - 1 - 2 Kwatha 1 2 1 - 11 - Churna 32 - - 1 1 6 Tarpana 8 - - 1 - - Ksheera 2 - - - - - Mamsa ras 2 - - 4 - 6 Ikshu ras 1 - - - - 1 Swarasa 6 2 1 2 - - Leha 1 1 3 1 3 6 Modhaka 7 - - - - - Raga shadava 4 - - - - - Sura Madhya 3 1 2 2 5 4 Souvira 2 1 1 1 1 1 Sidhu - 1 1 - 1 1 Uthkarika 1 - - - - 1 Gritha 4 2 4 4 8 6 Taila - - - - 6 2 Chatusneha - - - - - 1 Asavarishta - 1 1 - - 5 Greya - - - 1 - - Yavagu - - - - - 1
  39. 39. REVIEW OF LITERATURE 19    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Specific formulations for Virechana Tabe no:07. Showing Formulations for virechana based on dosha involvement. Vata Pradhana Trivrit + Saindhava + Shunthi + Kanji or Mamsasara Pitta Pradhana Trivrit Choorna + Draksha Kvatha Kapha Pradhana Triphala Kvatha, Gomutra, Trikatu Children between the Age group of 4-12 years60 Draksha rasa+ Aragvadha phala majja Virechana Drugs According to Dosha 65 : Table no:09 Virechana Dravyas used as per the Dosha. Sl. No. Dosha Virechana Dravyas 1. Vataja Vikara Snigdha, Ushna virya with Lavana 2. Pittaja Vikara Kashaya, Madhura Rasa Pradhana 3. Kaphaja Vikara Katu Rasa Pradhana Dosage of Virechana drugs according Kosta: Matra of the Virechana drug should be in such a quantity, that the desired effect of Shodhana may be achieved and may be able to avoid Atiyoga. This should be decided according to Dosha, Atura Bala, Bheshaja, Kala, Desha, Agni, Koshta, Shareera, Ahara, Satmya, Satwa, Prakriti, Vaya, Sama Avastha and Vikara 61. Table no.08: Virechana kalpas according to Sharangadhara. 62 Kalpana Heena for Mridu Koshta Madhyama for Madhyama Koshta Uttama for Krura Koshta Kwatha 8 tolas 4 tolas 2 tolas Kalka, Choorna Modaka 4 tolas 2 tolas 1 tola
  40. 40. REVIEW OF LITERATURE 20    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  According to Sushruta63 : 1, 2 and 3 Tolas is mentioned for Mridu, Madhyama and Krura Koshta respectively. I. Nature of Koshta and Virechana64 : qÉ×²Ï qÉɧÉÉ qÉ×SÒMüÉå¸å qÉkrÉMüÉå¸å cÉ qÉkrÉqÉÉ | ¢ÔüUå iÉϤhÉÉ qÉiÉÉ SìurÉæqÉ×ïSÒqÉkrÉqÉiÉϤhÉMæü: || Acharya Sharangdhara opines that – for the person Mridu Kostha, Virechana drugs must be mild and their dose should be minimum; for the Madhyama medium dose and for Krura Kostha persons, the Virechana drugs should be Tikshna and its dose is minimum. VIRECHANA VIDHI:-- Virechana Vidhi can be studied under 3 main headings: • Purva Karma (Pre Therapeutic Procedure) • Pradhana Karma (Therapeutic Procedure) • Paschat Karma(Post Therapeutic Procedure) A) PURVAKARMA: 1) Sambhara Samgraha 2) Aatura Pariksha 3) Aatura Siddhata 4) Matra Vinishchaya Sambhara Samgraha:-66 Ahara: Shali.Mudga,Maasha,Yava,Tila,Dugdha,GrithaUshana jala, Mamsa etc. Aushadha: Deepananeeya,Paachaneeya,Upashamaneeya,Vatahara, Sneha,Swedana ,Virechana drugs like Draksha, Triphala, Suoveerak etc. Equipments: Achamani,Udaka koshta , Sharava,Darvi, Tula, Manabhanda,Sutra,Karpasa etc. Atura Pariksha:67 Before performing Virechana karma it is necessary to examine the patient fitness in terms of his/her Dosha, Dushya, Atura Bala kala, Desha, Agni, koshta, Sharir & Ahara Satma, Satva etc. for proper adminstration of Virechana karma.
  41. 41. REVIEW OF LITERATURE 21    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Virechana Yogya and Ayogya. Table no:10: Showing Virechana Yogya Virechana Yogya Ch.Si66 Sus.Chi67 A.S.68 A.Hr.69 K.Si.70 Sha.S.U71 Pranavaha srotoduhti vikara Shwasa + - - - - - Kasa + - - - - - Parshvaruja + - - - - - Annavaha srotoduhti vikara Aruchi + + + - - + Avipaka + - + - - - Visuchika + + + - - + Alasaka + + + - - - Chardi + + + + - + Udakavaha srotoduhti vikara Udara + + + + - + Rasa pradoshaja vikara Pandu + + - - + + Jwara + + + + - + Aruchi + + - - - + Avipaka + - + - - - Hridroga + + - - + + Rakta pradoshaja vikara Kamala + - - + + - Vidradhi - + + + - + Netradaha + + - - - + Aasyadaha + + - - - + Vatarakta + + + + - + Kustha + + - + + + Paittika vyadhi + + + - - - Visarpa + + - - + - Pliha + + + + - +
  42. 42. REVIEW OF LITERATURE 22    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Vyanga + - + + - - Nilika + - - + - - Urdva Raktapitta + + + + + - Mamsa pradoshaja vikara Arbuda + + - - - - Galaganda + - - - - - Meda pradoshaja vikara Prameha + + - + + + Yoni Dosha + + + + - + Retodosha + - + + - - Mootravaha srotoduhti vikara Mutraghata + + + + - + Purishavaha srotoduhti vikara Arsha + + + + + + Bhagandara + + + - - + Udavarta + - + + + Vibhandha - + + + + - Pakvashaya shoola + + + + - - Other Visphota - - - - + + Vatavyadhi - - - - + + Garavisha - + + + + +
  43. 43. REVIEW OF LITERATURE 23    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Some other indications for Virechana are: a) In Swastha.72,73 b) Utkleshita Pitta. Pitta Sthanagata Alpa Kapha Kapha Sthanagata Bahu Pitta74 Pakwashayagata Pitta or Kapha Pitta75 Pittavrita Vata Kaphavrita Vata76 Shonita Roga77 a) As Purvakarma in Rasayana and Vajikarana78,79 TABLE NO:11 Showing Virechana Ayogya Virechana Ayogya Ch.Si80 Sus.Chi81 A.S.82 A.Hr.83 K.Si. 84 Sha.S.U85 Physiological conditions Langitha + - + - - - Upavasita + - - - - - Durbalendriya + - - - - - Durbala + - - - + - Alpagni + + + + - + Shranta + + - - - + Pipasita + + - - - + Karmabharadhvahata + + - - - - Daruna koshtha + - + + - - Kshama + - - - - - Kamadivyagra + + - - - - Bhakta + + - - - - Sukumara - - - - + - Navaprasuta - + - - - + Rathri Jagarana - - + - - - Atiruksha + - + - - + Bhayoptapta - + - - - + Chinta prasaktha + - - - - -
  44. 44. REVIEW OF LITERATURE 24    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Maithuna prasaktha + - - - - - Adhyayana prasaktha + - - - - - vyayama prasaktha + + - + - - Garbhini + + - - - - Age related conditions Vriddha + + - - + Bala + + - - + Pathological conditions Kshatkshina + + - - - + Atikrisha + - - - + - Atisthula + + - - + + Muktanala + - + - - - Atisara - - + + - - Adhoga Raktapitta + + + + - - Shosha - - - - - - Rajayakshma - - + - - - Urustambha - - - - + - Madatyaya + + + - - + Talushosha - - - - + - Hridroga - - - - + - Traumatic conditions Abhighata + - - - - - Subhaga + - - - - - Kshataguda + + + - - - Shalyardita + + + + - + Saama conditions Nava Jwara + + + + - + Nava Pratishyaya - + - - - - Some vataroga conditions Kevala Vataroga - - - - + - Hanugraha - - - - + -
  45. 45. REVIEW OF LITERATURE 25    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Ardita - - - - + - Purvakarma related conditions. Nirudha + - + - - - Atisnigdha + + + + - + Anupasnigdha - - - - + - Pakshahata - - - - + - Atura Sidhata:- Pachana and deepana:- Ama is considered as one among the etiological factor in most of disease, & Shodhana in ama state is said to be contraindication. If Samshodhana medicine is taken in the condition of Ajirna, it will lead to Vibandha and Glani. If the Doshas are in Ama conditions and anybody tries to remove these Dosha forcefully then it will destroy the body. If the condition of patient is associated with Ama then Shodhana can only be done after the Pachana of Ama by Deepana, Pachana So it is necessary to administer deepan & pachana drugs before the virechana to attain nirama state.86 Snehana & Swedana: Snehana includes both Abhyantara (oral ingestion of unctuous material) and Bahya Snehana (external application of unctuous material) .Abhyantara Snehapana followed by Sarvanga Abhyanga along with Sarvanga Sweda (Whole body sudation) are performed prior to Virechana87 . Snehapana procedure is to be followed after observing Nirama Lakshanas. The required Sneha should be administered early in the morning at Suryodayakala after observing Jeerna Ahara Lakshanas of the previous meal and when the patient is empty stomach. The duration of Sneha Pana should be 3 to 7 days88,89 . Shodhananga Snehapana is done untill the attainment of ‘Samyak Snigdha Lakshanas’ which can be achieved in 3, 5 and 7 days in Mrudu, Madhyama, and Krura Koshta respectively. Importance: - Action of Snehana and Swedana prior to shodhana explained by Charaka in following way.Due to Snehana there will be further vriddhi of doshas, and increase in fluidity(Vishyandana) and due to Swedana dosha paka along with removal of
  46. 46. REVIEW OF LITERATURE 26    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  obstruction at the enterance of the channels.Because of this the doshas leave the Shakha and comes to the Koshta.91 Sushrutha says Samshodana given without oleation and fomentation will destroy the body like the dry wood.92 Thus, Shodhananga Snehapana can be carried out for a maximum period of 7 days otherwise it will create Sneha Satmyata92, 93. Dose of Sneha for shodhana mentioned in various classics is as follows.94-96 . Table No.12 Showing Sneha matra. Madhyama Matra (Dose which digests in 12 hours) Charaka Samhita , Ashtanga Sangraha Uttama Matra (Dose which digests in 24 hours) Ashtanga Hrudaya. Uttama & Madhyama Matra Chakarapani Shodhananga Snehapana can be administered in 2 methods: a) Arohana Snehapana b) Sadyo Snehapana a) Arohana Snehapana: Kalyanakaraka first mentioned about increasing dose schedule. He clearly mentioned that Shodhanartha Abhyantara Sneha pana has to be taken in increasing order (“Krama Vardhitam Pibet”). Vangasena also followed Kalyanakaraka’s Vardhamana dose schedule. b) Sadyo Snehapana: Sadyo Snehapana involves administration of large quantity of Sneha to achieve Snigdha Lakshana immediately or within short duration. It is generally indicated in Bala, Vriddha, Balaheena, Mrudu koshta, Alpa dosha, Raja, Raja samipya, Sneha parihara asahishnushu.97
  47. 47. REVIEW OF LITERATURE 27    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table No.13 . Showing Sneha Dravya and Anupana: 98 Sneha Anupana Ghrta Ushnodaka Taila Yusha Vasa & Majja Manda Bhallataka & Tuvaraka Taila Shita Jala In general Ushnodaka can be administered as Anupana for all Sneha. Sneha dravya can be administered in 2 ways, (1) Accha Peya99 – denotes consumption of Sneha without mixing with other food articles. (2) Pravicharana 100 – denotes administering Sneha by mixing with food articles either in the form of Odanadi (24 in number) or Rasa Pravicharana (64 in number). Among them, Accha Peya is considered as superior for the purpose of Shodananga Snehapana. Administration of Sneha for Shodhana: 101 On the day of Snehapana, when the raising sun has attained golden yellow colour, individual exhibiting Jeerna ahara lakshana (symptoms of digested food of the previous night) except kshudha (hunger), after performing auspicious rituals, Snehapana is done. After snehapan individual should be observed for Sneha Jeeryamana (symptoms of Sneha undergoing digestion) and Sneha Jeerna (symptoms of digested Sneha) Lakshanas.
  48. 48. REVIEW OF LITERATURE 28    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table No.14 Showing Sneha Jeeryamana and Jeerna Lakshana: 102 Sneha Jeeryaman Lakshana Sneha Jeerna Lakshana Shiroruja Shirorujadi Jeeryamana Lakshana prashamana Bhrama Vatanulomana Nisthiva Swasthyata Murcha Kshuda shuddhi Sada Trishna shuddhi Arati Udgara shuddhi Klama, Trishna, Daha Laghuta Table no:15 Showing Samyak Snigdha Lakshana: 103-106 Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Vatanulomana + - + + Deepta agni + - + + Snigdha varcha + - + + Asamhatha Varcha + - + + Angha Mardava + - + + Snigdha anga + - + + Snigdha twak - + - - Vit Shaithilya - + - - Glani - + - + Angha laghava - + - + Adhastat sneha darshana - + - - Snehodwega - + - + Vimalendriya - - - +
  49. 49. REVIEW OF LITERATURE 29    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table No:16 . Showing Asnigdha Lakshana. 107-110 Table No.17 . Showing Atisnigdha Lakshana.. 111-114 Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Pandutha + - - - Gaurava + - - - Jadya + - - - Avipakwa Purisha + + - - Tandra + - - - Aruchi + + - - Utklesha + - - - Mukha srava + + + + Guda srava - + + - Ghrana srava - + - Guda daha + + - + Bhakta dwesha - + - + Pravahika - + - + Purishaati pravritti - + - - Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Grathitha purisha + + - - Ruksha purisha + + - - Agnimandya + + - - Vayu pratiloma + + - - Khara Gatra + _ - - Ruksha Gatra + - - - Uro vidaha _ + - - Daurbalya _ + - - Dur varna - + - - Krichrat anna Pachana _ + - - Susnigdha Lakshana Viparyaya _ _ + +
  50. 50. REVIEW OF LITERATURE 30    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Bahya Snehana & Swedana: 115 After attainment of Samyak Snigdha Lakshanas, Abhyanga and Swedana should be advised for 4days on the rest day(vishrama kala) and just prior to Pradhana karma on the day of Virechana. SWEDANA:- Dosha Vilayana’ takes place through the Swedana. According to Vagbhata, by the action of Snehana and Swedana, the morbid Doshas are liquefied, dissolved and are brought to koshta116 . Dalhana also mentions that the Dosha which are lodged in Shakha are made to move towards to Koshta by Snehana and Swedana. Vagbhata mentions that the doshas are removed from the shakhas by these two procedures of Snehana and Swedana in the same fashion as dirt of cloth is removed by soap and water117 . Bhojana Vyavastha: During the procedure of Abhyanga and Swedana, Snigdha, Drava,Ushna bhojana, Mamsarasa,Pramanayukta,Anabhishandhi,NatiSnighdha,Asankeerna,Odana, Amla rasa Phala is recommended.118 . Before pradhana karma the diet should be such that, it does not increase ‘Kapha’ otherwise Vamana may occur119 . MATRA VINISCHIYA: 1. The dose of Virechana Yoga should be decided according to Vyadhibala, Aturabala and Agnibala120 . If the dose given more than Vyadhibala, may cause another Vyadhi. If it is more than Agnibala it may cause Ajeerna, Vishtambha, and if it is more than Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose should be in Sama Pramana only and also the dose of Virechana drug of an individual is, one which expels only morbid Dosha out of the body without manifesting any complication.120
  51. 51. REVIEW OF LITERATURE 31    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table.no.18. DOSE OF VIRECHANA DRUG IN ITS DIFFERENT FORM121-124 . Form Of Medicine Koshta Dose Sus121,122 Sha123 Van124 Krura Uttama Tikshana Tikshana 1 pala Madhyam Madhyam Madhya Madhya ½ pala 1 Any form Mrudu Heena Mrudu Mrudu 1 Karsha Krura Uttama 8 Karsha Madhyam Madhyam 4 Karsha 2 Kwatha Mrudu Heena 1 Anjali (4 pala) 2 Karsha 2 pala Krura Uttama - 2 Karsha Madhyam Madhya 1 Karsha 1 Karsha 3 Churna Mrudu Heena 1 Karsha - ½Karsha Krura Uttama - 8 Karsha Madhyam Madhyam - 4 Karsha 4 Svarasa Mrudu Heena - 2 Karsha 1 pala Krura Uttama - - Madhyam Madhyam 1 Karsha 1 Karsha5 Kalka Mrudu Heena - - Krura Uttama - - - Madhyam Madhyam - 1 Karsha -6 Modaka Mrudu Kaneeya - - - Krura Uttama 8 Karsha - Madhyam Madhyam 4 Karsha - 7 Hima& phanta Mrudu Heena 1 Anjali (4 pala) 2 Karsha - - - - - - - - - 2 Karsha or1 pala8 Sneha - - - - Mrudu - - - 2 pala Madhyam - - - 4 pala9 Ushna jala as Anoopan Krura - - - 8 pala
  52. 52. REVIEW OF LITERATURE 32    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  PRADHANA KARMA: This includes:- 1) Administration of Virechana Yoga. 2) Observations : a) Aushadi Jeerna-Ajeerna Lakshana. b) Hritadosha Lakshana. 3) Shuddhi Lakshana. 4) Management of Vyapada. 1. Administration of Virechana yoga: • Before administering the Virechana yoga, the physician must confirm regarding the following: The diet taken by the patient on the previous day must be digested. • Patient is in mentally balanced state, i.e., without any factors like angry, fear etc. • It should be kept in mind that whether the patient got sound sleep on the previous night or not. Because at the time of drug administration patient must not be drowsy/ sleepy125 . • After confirming diet taken by the patient on the previous day have been digested, patient has to offer oblations and worships before taking the drug.125 • On the day of Virechana karma, after performing the Sarvanga sweda patient is advised to be in empty stomach.126 • Virechana drugs are administered in ‘Shleshma kale gate’ i.e. after Shleshma kala has passed, in appropriate dose and with appropriate anupana127 .If drug is adminsterd in shelma kala and/or after consuming food then, kaphadosha may cause avarana over grahani resulting in mandagni, gourava, Shula,Admana & even Vamana may produced as a complication128 Measures after virechaka Oushadha sevana129 : Just after administration of Virechana Yoga, cold water should be sprinkled on the face to avoid vomiting. • Patient is asked to rinse mouth with hot water and asked to smell the fragrance of jambeera or Surabhi etc.whichever he/she likes. • Pateint is advised that neither to induce Vegas not to suppress them. • Advise to stay in Nirvata place, be in comfort position and avoid sleep, not to suppress natural urges; consume hot water little by little.
  53. 53. REVIEW OF LITERATURE 33    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Vega pravartanopaya130 : For Vatanulomana and Yogavahi action lukewarm water is taken. Ifmedicine composed of Jayapala is given then hot water is contraindicated. If VirechnaVega is not initiated then Tapa Sweda with help of palm over abdominal region which may help to stimulate peristaltic movement. OBSERVATIONS: A) Aushadha Jeerna Lakshana131 : The following signs and symptoms of Aushada are to be observed – Vatanulomana, Swasthya, Khsudha,Trishna,Urjamanaswita, Indriya Laghuta and Udgara Shuddhi Once Jeerna Lakshana appears but still only small amount of morbid doshas are expelled or not yet all, then Physician should administer one more dose of Virechana drug depending on patient bala132 B) Ajeerna Aushadha Lakshana: If the drug is not digested it will produce some painful symptoms such as Klama, Daha, Angasadam, Bhrama, Murcha and Shiroruja. In this case the Virechana drug should not be repeated immediately, as the drug may produce severe purgation. In some cases if the drug is digested but proper elimination of doshas didn’t occurred, then next day again Virechana drug should be given. C) Hritadosha Lakshana: The Virechana is considered as Kaphanta and Hritadosha, when Vit, Pitta, Kapha,Anila come out in succession. Gatra Daurbalya,karshya and Laghuta are the associated symptoms. If Virechana persists even after manifestation of Hritadosha lakshanas, then vamana should be given.132 If Aushadhi Jeerna Lakshanas are manifested, but Hritadosha Lakshanas are not found, then Virechana Yoga should be given next day. Even then Virechana does not occur then Snehana and Swedana should be done again and thereafter Virechana drug should be administered after 10 days133 .
  54. 54. REVIEW OF LITERATURE 34    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  A) Shuddhi Lakshana:134-137 Finally shuddhi lakshana must assess in terms of Subjective parameters like Laingiki & Antiki & Objective Parameters like Vaigiki &Manaki. But among these more importance should be given to Laingiki Shuddhi138 . Table no:19 . Showing Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana Karma. Shuddhi Pravara Madhyama Avara Vegiki 30 Vegas 20 Vegas 10 Vegas Maniki 4 Prastha 3 Prastha 2 Prastha Antiki Kaphanta Kaphanta Kaphanta Vegiki shuddhi: The number of Vegas should be counted after leaving the first 2-3 Vegas, as it contain only fecal matter. Then it should be counted till the Kapha comes out. Maniki Shuddhi: While narrating the Avara, Madhyama,and Pravara Shuddhi, Charaka mentioned the quantities of the three shuddhis as two, three and, four prastha respectively. In the context of Vamana, Virechana and Rakta mokshana, prastha should be taken as 13½ pala139 (540gms/ml) 1 prastha generally 640 ml/gm is considered as 1 prastha. Antiki Shuddhi:   The word anthiki means final or terminal  The symptoms which indicate the end process of Virechana can be considered "Antiki Lakshana,.kaphanta is the desired antiki lakshana.
  55. 55. REVIEW OF LITERATURE 35    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table No :20.LANGIKI SHUDDDHI : (Samyak Yoga) Lakshanas Of Virechana Karma Lakshanas140-142 C.S S.S Va Sroto Vishuddhi + - - Indriya Prasadana + + - Shareera Laghuta + + - Agnivriddhi + - - Anamayatwa + + - Kramataha Vit Pitta Kaphagamana + + - Vatanulomana - + - Absence of Ayoga Lakshanas - - + Table no:21 Showing Ayoga Lakshanas of Virechana karma. (Ch.si1/17-19,Su chi33/24-26,A Hr su 18/38-40)   Lakshanas C.S S.S Va Kapha Prakopa + + + Pitta Prakopa + + + Vata Prakopa + - - Agnimandya + + - Gaurava + + - Pratishyaya + - + Tandra + - - Chardi + - - Aruchi + + + Vata Pratilomana + - Vatagraha Daha - + + Hridaya Ashuddhi - + + Kukshi Ashuddhi - + + Kandu - + + Vit Sanga + + + Mutrasanga - + - Peedika - - +
  56. 56. REVIEW OF LITERATURE 36    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Table no :22 Atiyoga lakshanas of Virechana karma(Ch.si1/17-19,Su chi33/24- 26,A Hr su 18/38-40)  Lakshanas Charaka Sushruta Vagbhata Kapha Kshaya Vikara + + - Pitta Kshaya Vikara + - - Supti + - - Angamarda + - - Klama + - - Vepathu + - - Nidra + - - Balabhava + - - Tamah Pravesha + - - Unmada + - - Hikka + - - Murcha - + - Guda Bhramsha - - - Kapha Pitta rahita Shweta Udaka Nihssarana - - + Kapha Pitta rahita Lohita Udaka Nihssarana - - + Mamsa Dhavana vat udaka srava - - + Medokhandavat Srava - - + Trishna - - + Bhrama - - + Netra praveshanam - - + Raktakshayaja Vikara + - -
  57. 57. REVIEW OF LITERATURE 37    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  In these procedures, expulsion occur in 4 different ways • Atipravrutii – Excessive expulsion. • Asamyak(pratiloma) pravrutii – Expulsion by improper route. • Apravrutii – Cessation of process of expulsion or improper elimination. • Alpapravrutii – Expulsion in lesser quantity. Here apravrutti & alpa pravrutii are included in ayoga. Asamyak Pravrutii means expulsion through opposite route, it indicates that expulsion of vitiated Dosha is not in a quantity, which is expected, so it must be considered under the term of ayoga but not mithyayoga143 . Kashyapa Acharya being Paediatrician, to practise Virechana Karma specially for Bala he has been identified Mrudu and/ Sukha type of virechana144 . PASCHAT KARMA:145-147 Pariharya Vishaya: ‐  Once it is confirmed that Virechana Vegas are stopped, then advise the patient to wash hands, feet and face148 .And advise to avoid ashta mahadosha bhavas i.e.1.Ucchabhashana, 2.Rathakshobha, 3.Atichankramana, 4.Atiasana, 5.Adhyashana, 6.Ahita bhojana, 7.Diwaswapna, 8.Maithuna149. Based on shuddui lakshana especially Maniki,Vaigiki advise patient to follow Samsarjana karma. Regimens to be adopted after Virechana karma till the patient able to take normal diet are termed as Paschat karma. As the Virechana karma eliminates dushita Pitta dosha, the patient shouldn’t be allowed to take heavy diet, because there is derangement in power of jatharagni. In this condition if heavy diet is given, it will suppress the digestion power further and causes the vitiation of Agni. So to prevent such condition, samsarjana karma is adopted. a) Samsarjana Krama : As said above, to restore the strength of agni.The patient has to be given the following varieties of diets, from the same day evening or from the next day morning150 After Samshodhana Karma, Agnimandya occurs because the Doshas reach the Amashaya (Jejjata), so Peyadi Krama is recommended to increase the Agni gradually up to the normal level.
  58. 58. REVIEW OF LITERATURE 38    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  According to Chakrapani the elimination therapy diminishes the doshas as well as Dhatus, that’s why patient need immediate Dhatu Vardhaka Ahara in terms of Peyadi Samsarjana karma. Acharya Charaka gives beautiful example to explain this, just as the agni flares up by the fuel like dry grass,cow dung,etc.The person who has undergone shodana karma ,agni will gradually gets improved by following samsarjana krama.151,152 .Hence it is decided according to shudhi. i.e. for pravara shuddhi, madhyama shuddhi and avara shuddhi, samsarjana krama is done for 3,5,7 days respectively153 Table no :23 Showing the Diet Regimen154 Dina Kala Annakala Pradhana shuddhi Madyama shuddhi Hina shuddhi Pratama Prathaha sayankala 1 - Peya - Peya - Peya Dwitiya Prathaha sayankala 2 3 Peya Peya Peya Vilepi Vilepi kruthaAkrutha yusha Trutiya Prathaha sayankala 4 5 Vilepi Vilepi Vilepi Akrutha yusha kruthaAkrutha mamsa rasa Samanya bhojana Chaturtha Prathaha sayankala 6 7 Vilepi Akrutha yusha Krutha yusha Akrutha mamsarasa - - Panchama Prathaha sayankala 8 9 Krutha yusha Krutha yusha Krutha mamsa rasa Samanya bhojana - - Shasta Prathaha sayankala 10 11 Akrutha mamsarasa Krutha mamsa rasa - - - - Saptama Prathaha sayankala 12 13 Krutha mamsa rasa Samanya bhojana - - - - Instead of Peyadi Krama, Sushruta mentions Kulatha, Aadhaki and Jangala Mamsarasa155 . Dalhana clarifies, Sushruta however agrees Peyadi Krama and he says
  59. 59. REVIEW OF LITERATURE 39    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  that incase of Ksheena Kapha, Peya should be given. Mamsarasa should be given to Vata pradhana patients having Deeptagni. If Kapha dominance is there according to Dosha and Prakriti, then Kulatha Yusha should be given. The Peyadi Krama ends on 7th day ins Pradhana Shuddhi patient.Acharya Sushrutha has opined samsarjana krama in respect to bala of the patient156. For the individuals having good strength, three annakala are advised, 2 annakala for madhyama bala and one annakala for lesser strength person. b) Tarpana : In case of ayoga of Virechana (insufficient elimination of vitiated doshas) associated with predominance of Kapha, Pitta, if the doshas still retained in the body and if the patient is having habit of taking alcohol, he shouldn’t be given Peyadi Samsarjana Krama. Instead he must be given Tarpana i.e., thin or thick soup prepared with Deepana and Pachana drugs like, Pippali, Dadima etc. In Tarpana, Swaccha Tarpana in place of Peya and Ghana Tarpana in place of Vilepi should be given, according to Chakrapani157 . Jejjata mentions Mudga, Yusha and Mamsarasa in place of Peya. Arunadatta recommends Laja Saktu, Jirnashalyodana and Mamsarasa for 3 Annakalas. Rasa samsarjana krama: To maintain the normal status of Dosha especially in Amaashaya & Pakvashya, rasasamsarjana krama is identified in classics. Here particular Rasaatmaka food articles are given to patient with proper order & this can be consumed along with Peyadi Samsarjana karma or after it. Table no: 24 Table showing Rasa Samsarjana.
  60. 60. REVIEW OF LITERATURE 40    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Acharya Charaka and Sushrutha has given a special sequence of rasa intake in samsarjana krama to be followed to avoid the chances of vitiation of doshas159 . Acharya Charaka has advised to take madhura, amla and hridhya ,snigdha ahara to pacify vata.Amla lavana to increase agni,Madhura and tikta rasa to pacify pitta dosha,kashaya and katu rasa to pacify kapha dosha160 . Acharya Sushrutha opined that rasa should be started with Madhura and Tiktha to increase the agni and to pacify vata pitta. Then snigda,amla,lavana and katu rasa to reduce vata,kapha dosha followed by madhura tikta rasa to pacify vata pitta dosha,thereafter kashaya katu rasa to pacify kapha pitta.161 .This is followed to do sarva rasa abyasa for the patient during samsarjana krama. VYAPATH 162-164 Vyapath are the complications occurring due to improper handling of shodana karma.Acharaya Charaka has explained 10 vyapath, Chakrapani has divided this 10 Vyapada in two groups i.e. Ayoga and Atiyoga Table No.25 Showing the Ayoga and Atiyoga Lakshanas of Vyapath. Author Rasa Effect on Dosha Snigdha,Amla,Swadu Pakvashaya stitha vataprasamanartha Amla ,Lavana. Urdvastitha agni sandukshnartha Swadu,Tikta Pittasamanartha Charaka158 Kasaya,Katu Pitthaurdvastithakapha prasamanartha Swadu ,Tikta Pravrudha agni vata pittaastaavajayarthamagneha samikarnartha. Snigdha,Amla,Lavana,Katu Vatakaphavajayaarthamagnehasanduksnartha Sushruta159 Swadu,Tikta Pittavatavajayartha .
  61. 61. REVIEW OF LITERATURE 41    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Ayoga Atiyoga Adhamana parikartika Hritgraha Gatragraha Kandvadi Vibhramsha Stambha Upadrava Klama Srava Jivadana Vibramsha Gudabramsha Sanjnabhramsha Table no.26. Showing the Virechana Vyapath According to different Acharyas. Vyapath Charaka Sushrutha Vagbhatta Adhmana + + + Parikartika + + + Parisrava + + + Hrdgraha + - + Gatragraha + - Sarvangagraha Jivadana + + + Vibhramsha + - Guda Vibhramsha Stambha + - - Klama + - - Upadrava + - - Vamana - + + Savashesha Aushadhitva - + + Jirna Aushadhitva - + + Hina Aushadhitva - + - Vata Shula - + Vedana Ayoga - + + Atiyoga - + + Hridaya-Upasarana - + - Vibandha - + - Pravahika - + + Visamjnata - - + Table.no.27. Showing virechana vyapat with their treatment.(ch si6/31-93 )
  62. 62. REVIEW OF LITERATURE 42    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Vyapada Lakshana Chikitsa Adhmana Adhmana UdavartaNabhi, Prustha, Parshva, Shiroruja, Shvasa, Vit Mutra, Vata Sanga Abhyanga, Sveda, Phalavarti, Niruha, Anuvasana, Udavartahara Chikitsa Parikartika Gud Parikartana Tivrashula, Piccha, Rakta, Mala Pravritti Langhana, Pachana, Ruksha, Ushna Bhojana Yashtimadhu ,Snehabasti Parisrava Alpa Mala Pravritti, Kandu, Shopha, Kustha, Gaurava, Agnimandya, Staimitya, Aruchi, Panduta Vamana, Virechana, Grahani Chikitsa. Asava, Arishta Hridgraha Hikka, Shvasa, Kasa, Parshvashula, Lalasrava, Akshivibhrama, Shula, Dantatikitkitayana, Jihva, Khodati Sangyanasha Snigdha Lavana, Sveda, Yasti Taila, Anuvasana, Tikshna Nasya, Vamana, Basti Angagraha Stambha, Vepathu, Toda Pindikodveshtana, Manthanavat Pida Vatahara Snehana Svedana Jivadana Rakta Chandrika, Udakasrava, Guda Bhransha, Trishna, Murchha, Mada Pittahara, Raktapana, Raktabasti, Piccha Basti, Ghrita Manda, Anuvasana Vibhransh a. Guda b. Sanjya c.Kandu, Only Mala Excreted not Doshas, Gudabhransha, Sanjna Bransha, Kandu, Pidika, Kustha, Roga Kashaya Lepa, Snehana Mridu Sveda Manonukula Chikitsa Tikshna Shodhana After Snehapana Stambha Vatavarodha, Gudastambha, Gudshula, Alpalpa Mala Pravritti Langhana, Pachana, Tikshna Basti, Virechana Upadrava Stambha, Sula, Gatragraha, Sarvanga Vedana Snehana, Svedana Vataghna Chikitsa Klama Tandra, Gaurava, Klama, Daurbalya, Angasada Langhana, Pachana, Sneha, Tikshna, Shodhana Vamana by virechana Yoga Vamana Snehana, Svedana, Virechana Ayoga Vibhransha, Hikka, Pindikodveshtana, Kandu, Urusada, Vaivarnyata Roganusara Chikitsa Gomutra Niruha Atiyoga Ativirechana Mridu Vamana, Raktapitta vat Chikitsa MODE OF ACTION OF VIRECHANA:165
  63. 63. REVIEW OF LITERATURE 43    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Action of Virechana Karma can be understood in the following two ways. 1. Systemic – By which it brings down the morbid Doshas, particularly Pitta from the periphery to Amashaya or Pakwashaya. 2. Local evacuant – This is concerned with the evacuation of these doshas in the form of mala from the gut by Adhobhaghahara property. Both the action and related factors are being described here in detail - a) Virechana yoga gets absorbed and due to Veerya, it reaches to the Hridaya, then the Dhamanis and thereafter it reaches to Sthula and Anu Srotas i.e. macro and micro channels of the body. b) The Vyavayi Guna, drug is responsible for quick absorption. c) The Vikashi Guna causes softening and loosening of the bond between Dosha and Dhatu (Shaithilya Karma). d) Due to Ushna Guna, the Dosha Sanghata (compactness) is disintegrated (Vishyandana). e) Action of Teekshna Guna is to break the Mala and Dosha in micro form. According to Dalhana it is responsible for quick transmission (Dosha Sravana Karatwa). f) Due to Sookshma Guna by reaching in micro channels, disintegrates androgenic toxins which are then excreted through micro channels (Anupravana Bhava). g) Mainly due to Prabhava, Prithwi-Jala constitution and presence of Sara Guna Virechana occurs. This is the evacuant action. Acharya Charaka has given brief description how Virechana dravya acts in the body which is as follows. The drugs which are Ushna, Tikshna, Shukshma, Vyavayi and Vikashi reach to the heart by virtue of their potency and circulate through the large and small Srotas due to its Sukshma and Vyavayi properties and pervade entire body. Then they liquefies the morbid elements by virtue of their Agneya Guna and crumbles them by virtue of its Tikshna Guna. Then this liquefies and crumbled mass Looses contact with the wall and the channels in the unctuous body, just like the honey, not adhered to the unctuous vessel. This morbid mass now passes through the minute capillaries and moves towards Kostha by virtue of the AnuPravana Bhava of the drug and ultimately reaches the Amashaya. From here it forces the morbid factors through the anal route due to the Bhautika predominancy of Jala and Prithvi and Adhobhaga Prabhava166 (Ch. K.1/4) Chart No.01
  64. 64. REVIEW OF LITERATURE 44    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Virechana dravya                               Ushna,Tikshna,            Shukshma,     Vyavayi and Vikashi    Hridaya                                        By virtue of their potency                                               Circulate through the large and small Srotas                                                                            Through Sukshma and Vyavayi properties    Pervade entire body                                                       With help of Agneya Guna      Liquefies the morbid elements                                         Tikshna Guna    Crumbles the morbid elements                    Looses contact with the wall and the channels in the unctuous body,                           Just like the honey, not adhered to the unctuous vessel.                                                                   By Anu, Pravana Bhava of the drug                                                                                                             
  65. 65. REVIEW OF LITERATURE 45    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Passes through the minute capillaries and moves   towards Koshta ultimately reaches the Amashaya                                                               Bhautika predominancy of Jala and                                                                                        Prithvi and AdhobhagaPrabhava                      Expulsion the morbid factors through the anal route 
  66. 66. REVIEW OF LITERATURE 46    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  CATHARTICS - MODERN VIEW167 The terms laxatives, cathartics, purgatives, aperients and evacuants often are used interchangeably. However, there is distinction between Laxation and catharsis. Laxation means – the evacuation of formed fecal material from the rectum, whereas Catharsis means – the evacuation of unformed, usually watery fecal material from the entire colon. Most of the commonly used agents promote Laxation but some actually are cathartics. Classification of Cathartics: These drugs are usually classified according to their mechanism of action. The purgatives available for use mainly act in one of the following three ways- • By increasing the volume of intestinal contents, thus distending the bowel and eliciting the peristaltic reflex. • By liquefying and lubricating the intestinal mass. • By direct irritation of the bowel. Hence they are classified in the following manner- 1. Stimulant or Irritant Cathartics. 2. Osmotic Cathartics. 3. Bulk laxatives. 4. Emollient laxative or Lubricant Cathartics. 1. Stimulant or irritant laxatives: In this group, mainly 3 types of drugs are identified. i) Anthraquinone group ii) Diphenylmethane derivatives iii) Ricinoleic acid Anthraquinone group: These are derivatives of plants such as aloe, cascara and senna. These agents can produce giant migrating colonic contractions as well as induce water and electrolyte secretion. They are poorly absorbed in the small bowel, but because they require activation in the colon the laxative effect is not noted until 6 to 12 hours, after ingestion.
  67. 67. REVIEW OF LITERATURE 47    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  Diphenylmethane derivatives: Examples in this group are: Bisacodyl, Phenolphthalein. Pharmacological section is not shown clearly but drug acts as a stimulant mainly on the large bowel after 6 hours and produces soft semi liquid stools associated with a little gripping. Ricinoleic acid: Important among Ricinoleic acid is caster oil. Ricinoleic acid acts as an irritant and produces purgation. As Ricinoleic acid acts on small intestine, it produces copious, liquid stool with associated fluid loss. The action is quicker than Anthraquinone and is evident within 2 to 3 hours. 2. Osmotic Purgatives: The osmotic purgative consists of salts, which though highly soluble, are poorly absorbed from the alimentary tract. Such preparations exert an osmotic effect and, thus retain water in sufficient amount to form an isotonic solution in the lumen of the bowel. This distends the bowel and stimulates peristalsis, as well as liquefying the bowel contents, making evacuation more rapid. The efficacy of the saline Cathartics is, thus related to the osmotic activity exerted by the unabsorbed fraction within the intestinal lumen. These preparations will act both on small and large intestines, and therefore, produces watery evacuation within 3-6 hours. Because of their quick consent of action, they are given early in the morning before breakfast. Patients should be instructed to take plenty of water along with these drugs.example:Magnesium hydroxide,Magnesium citrate. 2. Bulk forming laxatives: These are various natural or semi synthetic polysaccharide and cellulose derivatives. eg. Bran, Psyllium preparation, methyl cellulose, Calcium polycarbophil. These agents absorb water and swell-up, thus providing the stimulus of mechanical distinction for evacuation. Their action is mild and is usually seen 12 to 36 hours after ingestion. 3. Stool Wetting Agents and Emollient laxatives: The best examples are liquid paraffin, Olive oil, Docusate salts, etc. By oral administration it is not significantly absorbed and exerts softening and lubricating
  68. 68. REVIEW OF LITERATURE 48    DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”  effects on feces. These laxatives are mild in action and usually seen 1 to 3 days after ingestion and itself does not initiate peristalsis. General mechanisms of action:- Laxatives generally have been thought to act in one of the following ways: 1. Retention of intraluminal fluid, by hydrophilic or osmotic mechanisms. 2. Decreased net absorption of fluid, by effects on small and large bowel fluid and electrolyte transport. 3. Effects on motility by either inhibiting segmenting (non-propulsive) contractions or stimulating propulsive contractions. Classification according to the site of action - a) Purgatives acting on the small intestine eg. Castor oil b) Purgatives acting on the large intestine eg. Anthraquinone group c) Purgatives acting on both large and small intestine eg. Saline laxatives C. Classification according to source - a) Vegetable purgatives. eg. Castor oil, Olive oil, Croton oil, Oleos, Senna, Cascara sagrada, etc. b) Mineral purgatives. eg. Saline purgatives, liquid paraffin, etc. c) Synthetic purgatives. eg. Phenolphthale.
  69. 69. REVIEW OF LITERATURE 49  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” SKIN Anatomical consideration of skin: The word “twak” is derived from “tvak samvarane168 ”. That which covers. Twak is external or outermost covering, which envelops the whole surface of body and is the seat of Sparshnendriya; it is very extensive among all five jnanendriyas. According to Ayurveda Twak is derived from Matruja bhava and is the seat of Vayu, which is responsible for tactile sensation. Regarding number of layers of twcha Susrutha mentioned seven layers while Charaka quotes six, naming the two only.   Table No. 28. Different Layers of Twacha 168,169,170,171 Sushruta Charaka Arundatta Sharangadhara Avabhasini Udakadhara Bhasini Avabhasini Lohita Asrukdhara Lohita Lohita Sweta Tritiya Sweta Sweta Tamra Chaturtha Tamra Tamra Vedini Panchami Vedini Vedini Rohini Shasti Rohini Rohini Mamsadhara Mamsadhara Sthula   Physiological consideration of skin: Charaka elaborate the formation of skin during the ebriyogenisis is 12th week of gestational age(ch sa 4/11). This formation through transformation during fetal stage by thridoshas is an activity like formation of a creamy layer over boiling milk. Further in the context of dhatuparinama explains masa dathu has saarapaka and prasaada paka. Saarapaka is medas and prasaada paka is twak and vasa. The function of dathu is stated as lepana, as the masa dahtu is getting nourished from raktha- twak also possesses porva dhatu guna. That may be the reason that vagbhata explains “
  70. 70. REVIEW OF LITERATURE 50  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A.UDUPI. “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” twak prasadat rakthasya prasada”, i.e. purity of the blood will reflect on skin. Skin is the seat of brachaka pitha, which promotes the luster of the body. Acharya Susrutha explained about seven layers in relation with origin of disease as follows Table No.29.Sapta Twacha and Disease Relation172 Name Thickness Diseases Avabhasini 1/18th Vrihi Sidhma & Padmakantaka Lohita 1/16th Vrihi Tilakalaka, Nyachcha & Vyanga Sweta 1/12th Vrihi Charmadala, Ajagallika & Mashaka Tamra 1/8th Vrihi Kilasa & Kustha Vedini 1/5th Vrihi Kustha & Visarpa Rohini 1 Vrihi Granthi, Arbuda, Galaganda, Apachi, Sleepada Mamsadhara 2 Vrihi Bhagandara, Vidradhi, Arsha  
  71. 71. REVIEW OF LITERATURE 51  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” DISEASE REVIEW HISTORICAL REVIEW OF KUSHTA Prevedic & VedicPeriod Agnipurana173 : Some of treatment modalities were explained. Eg. Kadirodaka for panaartha in Kushta, Use of Vajrka gritha, Panchagavya gritha, Panchatikta gritha etc. Koutilya Arthashastra174 : In the chapter, on secret means a number of diseases are mentioned such as Kushta. Unmaada,Apasmaara, Prameha etc. Yadjnya valkalsmriti 175 : Kushta is known as paparoga and is chronic in nature. & Mandala and Sidma are kinds of Leprosy. Brahama Samhita176 : SSìÓeÉÉ CuÉ vÉÑwMümɧÉmÉëMüUÉM×ü̹ÍpÉ:|          Dadru is a disease where affected people used to itch the skin with dry leaves. Kasika177 : Incurable diseases were called Kshetriya and Kushta is one among this category. Kathadi Gana178 : Kushta and Kushtavid are mentioned together which shows the prevalence of the disease and existing of specialists treating the same. Bhana bhatta179 : According to him Kushta is one of 52 variety of Sharirika disease.      
  72. 72. REVIEW OF LITERATURE 52  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” Table No: 30 AYURVEDA BOOK STHANA NIDANA PANCHAKA (Chapters) SADHYA- ASADHYATVA (Chapters) CHIKITSA (Chapters) Sutrasthana 20 - 1; 3; 4 ; 25 Nidanasthana 5 5 - Charaka samhita Chikitsasthana 7 7 7 Sutrasthana - - 38 Nidanasthana 5 5 -Sushrut samhita Chikitsasthana - - 9 ; 10 Nidanasthana 14 14 14 Chikitsasthana - 19 19 Astanga hridaya Sharirasthana - 5 - Sutrasthana - - 13;15 ;16 Nidanasthana 14 - - Astanga sangraha Chikitsasthana - - 21 Sutrasthana 4; Nidanasthana 5 - -Bhela samhita Chikitsasthana 6 6 6 Chakra dutta - - - 50 Chikitsasthana Kushtachikitsa adhyaya Kashyapa samhita Khilasthana 15 15 15 Harita samhita Tratiyasthana 39 39 39   
  73. 73. REVIEW OF LITERATURE 53  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” ETYMOLOICAL DERVATION OF KUSHTA: The word ‘Kushta’ is a broad term which includes almost all skin diseases. MÑüwÉç ÌlÉwMüwÉåï +WûÉÌlÉ MÑüÌwÉÌiÉ || EhÉÉÇ 2/2/ CÌiÉ MüjÉlÉç 180 ...(zÉoSMüsmÉSìÓqÉ )     In Sanskrit language, the word ‘Kushta’ is derived form the ‘Kush nishkarshane’ Sanskrit root, It means that ‘to destroy’, ‘to scarp out’ or ‘to deform’. By adding to it the Pratyaya ‘Kta’ which stands for firmness or certainty, the word Kushtha is derived. Thus the word Kushtha means that which destroys with certainty. DEFINITION Commentator Arundatta mentioned that – 1 rÉiÉç uÉæuÉhrÉïÇ MÑüuÉïÎliÉ iÉiÉç MÑü¸qÉÑzÉÎliÉ | This means that, Kushta is the one which causes vitiation as well as discoloration of the skin181 (A.Hr.Ni 14/3) 2. MÑüwhÉÉirÉ….qÉç | MÑüÎixÉiÉÇ ÌiɹÌiÉ | (AqÉUMüÉåwÉ .̲ÌiÉrÉZÉhQû –qÉlÉÑwrÉuÉaÉï-6) One which has capacity of spreading nature & leads to deformity of skin in the form of discoloration is known as Kushta182 . 3. MÑüwhÉÉÌiÉ iÉxqÉÉiɨÉç MÑü¸ÍqÉirÉÑcrÉiÉå |183 (A.Hr.Ni 14/4)  According to Vaghbhatacharya, if hetu upekshana has been done and is not treated properly at right time then it spreads all over the body hence is called as Kushta. All the above definitions implies to various types of skin disorders & not to a single entity. Acharya’s have opined that the Kushtha is first located in the Tvak, later it progressively involves deeper Dhatu’s. This clearly indicates that in all Kushtha the skin compulsorily get involved at first. KUSHTHA SYNONYMS 184 : Yvadhini, Kutsitam, Vajivrajam, Apyam, Adavaham, Nirujam, Gadah, Ruja Vyapam, Pakalam, Hashuram, Kakalam, Amayah, Gadantakam.
  74. 74. REVIEW OF LITERATURE 54  Classification of Kusta According To Different Acharyas Table No: 31 Mahakushta No. Types of Kushta Ch185(a) . Sus185(b) . A.Hr185( c) . B.S185(d) . M.N185(e) . B.P.185(f ) 1. Kapala + + + + + + 2. Audumbara + + + + + + 3. Mandala + - + + + + 4. Rushyajihv a + + + + + + 5. Pundarika + + + + + + 6. Sidhma + - - + + + 7. Kakanaka + + + + + + 8. Dadru - + + - - - 9. Aruna - + - - -   -              DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”
  75. 75. REVIEW OF LITERATURE 55  Table No: 32 Kshudrakushta No Types of Kusta Cha Sus A.Hr B.S. M.N. B.P. 01 Ekakusta + + + + + + 02 Kitibha + + + + + + 03 Charmadala + + + - + + 04 Pama + + + + + + 05 Vicharchika + + + + + + 06 Charmakhya + - + + + + 07 Vipadika + - + - + + 08 Alasaka + - + - + + 09 Dadru + - - + + + 10 Visphotaka + - + + + + 11 Shataru + - + + + + 12 Sidhma - + + - - - 13 Sthularushka - + - - - - 14 Mahakustha - + - - - - 15 Visarpa - + - - - - 16 Parisarpa - + - - - - 17 Raksha - + - - - - 18 Shvitra - - - + - - 19 Vishaja - - - + - - 20. Kachhu - - DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” - - + +
  76. 76. REVIEW OF LITERATURE 56  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” Table No: 33 KASHYAPOKTA KUSHTA TYPES186 Sadhya kushta 1) Pama 2)Mandala 3)Dadru 4) Kitibha 5)Kapala 6)Vicharchika 7) Vishaja 8)Sthularushka 9)Sidma Asadhya kushta 1)Poundarik 2)Shvitra 3)Rushyajivha 4)Shatarushka 5)Kakana 6) Oudumbara 7)Charmadala 8)Ekakushta 9)Vipadika All These types of Kushta are further classified based on Doshic predominance. It is more useful for diagnostic and treatment of the disease, which are as follows187 (Cha.Chi.7/27-30) Table No: 34 Kushta and Dosha Relation No. Doshic predominance Name of Kushta 1. Vata Kapala 2. Pitta Audumbara 3. Kapha Mandala, Vicharchika 4. VataPitta Rushyajihva,Pundarika,Sidma. 5. VataKapha Ekakushtha, Vipadika ,Kitibha, Charmakhya Alasaka. 6. PittaKapha Pama, Visphotaka, Shataru, Charmadala, Dadru. 7. VataPittaKapha Kakanaka
  77. 77. REVIEW OF LITERATURE 57  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” The word ‘Kushta’ is a broad term, which covers almost all the skin diseases. Kushtha is associated with invariably by ‘Saptako drvya Sangraha’188 (Cha.Chi.7/9). But different types of pain, colour, shape, specific manifestation etc. i.e. Vedana vishesha - Eg.Kapala kushta Toda bahula; Varna Vishesha- Eg. Kakanaka kushta is Gunja beeja varna; Samsathana Vishesha - Eg. Rushyajivha kushta is resembles to that of deer tongue; prabhava Vishesha - Eg. Kakanaka kushta is Asadhya due to its Prabhava; Naama Vishesha- Eg. kapala etc. are found in Kushtha because of Amshamshakalpana of the Doshas189 (Cha.Ni.5/4). According to Charaka, Kushtas are in fact of innumerable types, but for systemic study they are classified into two major groups 7 Maha Kushtha & 11 Kshudra Kushtha 189 (Cha.Ni.5/4). There is no difference of opinion between any Acharya about the total number of Kushta, but difference of opinion in symptoms & names of some of Kushtha exists. Table-No-35 The difference between Mahakushta and KshudraKushta 190 No Mahakushta KshudraKushta 1. Bahu Bahul Dosha Arambhata Alpa Dosha Arambhata 2. Bahulakshana Alpalakshana 3. Excessive discomfort Less discomfort 4. Tendency Penetrates into deeper Dhatu Less tendency to penetrate in deeper dhatu 5. Mahat Chikitsa Alpa Chikitsa 6. Loss of skin functions like Supti etc. Less functional skin deformities
  78. 78. REVIEW OF LITERATURE 58  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” Chakrapani has clarified that, in Kshudra Kushta the symptoms of Mahakushta are manifested in milder form191 (Cha.Ni.5/4). According to commentator Gayadas there is severe and extensive vitiation of Doshas from the very beginning, in Mahakushtha, which penetrate the deeper tissues and cause Mahakushta. But no such severe and extensive vitiation of Doshas occurs in the KshudraKushta from the beginning192 (Sus.Ni.5/5) Kushta Nidana Table No: 36 ACCORDING TO DIFFERENT ACHARYAS Nidana of Kushta Cha Ni7/ 4-8 Sus Ni 5/4 A.S. Ni 14/2 0 A.H r. Ni 14/2 0 B.S.18 5(d) H.S .190( a) M. N.19 0(b) B.P185(f) DVADASHAVIDHA AHARA A. SHOOKA DHANYA 1. Nava Anna + - - - - + 2. Tila + - - - - + + 3. Pishta vikara + + - - + + + B. SHAMI DHANYA 1. Masha + - - - - + + C. GORASAVARGA 1. Dadhi + + - - + + + 2. Sarpi + - + + + + -
  79. 79. REVIEW OF LITERATURE 59  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 3. Ksheera + - - - + + 4. Takra + - - - - - - D. HARITA VERGA 1. Moolak + + - - + + + 2. Lakucha + - - - + - - E. IKSUVARGA 1. Guda + - - - + + + 2. Continuous and excessive use of Madhu + - - - - - - 3. Continuous and excessive use of Phanita + - - - - - - F. MAMSAVARGA 1. Mastya + + + + + + + + G. AHARAYOGI VARGA 1. Ati lavana consumption + - - - - + - 2. Ati tila tailaconsumption - - + + - - + 3. Ati pippali consumption - - - - + - - VIRUDDA AHARA A. VEERYA VIRUDDHA 1. Intake of Chilchim fish with milk + + + + + + + + 2. Moolak+ Ksheera+ Guda + - - + + +
  80. 80. REVIEW OF LITERATURE 60  DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS” 3. Intake of milk after consumption of Moolak/Lashuna / Shigru / Tulasi etc + - - - - - - - 4. Excessive intake of Gramya, Anupa, Audaka Mamsa with Ksheera - + - - - - + - B. SAMYOGA VIRUDDHA 1. Mastya+ Ksheera+Nimbu - - - - + - - - 2. Continuous and excessive use of either single or mixture Madhu, Phanita, Matshya, Lakucha, Mulaka, Kaakmachi or intake of above substances while having Ajirna + - - - - - - - C. VIDHI VIRUDDHA 1. Aharan kramam muktva nishevinaam + + - - - + + D. UPACHARA VIRUDDHA 1. Snehapana with Sheet jala + + - - - - - OTHER 1. Adyashana + + - - - - + +
  81. 81. REVIEW OF LITERATURE 61  2. Injestion of Vidahi food in Vidagdhavasta + - - - + - - 3. Asatmya Bhojana + + - - - + - 4. Ahitaashana + + - - - - + 5. Excessive Drava, Snigdha, Guru, Ahara + - - - -   AHARA-VIHARA NO. Nidana of Kusta Cha Sus - + + A.S. A.Hr. B.S. H.S. M.N. B.P. 1. Divasvapna after lunch + - - - + - + + 2. Vishamashana + + - - - - + - 3. Atyashana + + - - - - - - 4. Sex indulgence in Ajirna + - - - + - + + 5. Suppression of Chhardi, Mutra, Purisha like Vegas + + - - + - + + 6. Sudden diving in to cold water or drinking cold water after fear, exhaustion & coming from sunlight + + - - + - + + 7. Improper consumption of Sheeta&Ushana food articles + - - + + + 8. Atisantapa + - - - + - 9. Mithya vihara - + + + + - - 10. Vega avarodha + + + + - + + 11. Adyashana + - - - + - DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, S.D.M.C.A. UDUPI “ROLE OF VIRECHANA KARMA IN THE MANAGEMENT OF PSORIASIS”

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