Psoriasis virechana, pk
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VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS, SRINIVAS RAO, PANCHAKARMA, GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI ROAD BANGALORE

VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS, SRINIVAS RAO, PANCHAKARMA, GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI ROAD BANGALORE

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Psoriasis virechana, pk Psoriasis virechana, pk Document Transcript

  • SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS -TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS - A COMPARATIVE STUDY By Dr. SRINIVAS RAO, B. A. M. S. A COMPARATIVE STUDY Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore for partial fulfillment of the degree AYURVEDA VACHASPATI DOCTOR OF MEDICINE (AYURVEDA) IN PANCHAKARMA. Under the guidance of Dr. SHALINI.C.ELI. M.D. (AYU),D.N.Y. Professor and H.O.D. Department of Post Graduate Studies in Panchakarma, Government Ayurvedic Medical College. Dr. SRINIVAS RAO DEPARTEMENT OF POST GRADUATE STUDIES IN 2010 - 2011 PANCHAKARMA. GOVERNMENT AYURVEDIC MEDICAL COLLEGE DHANWANTARI ROAD BANGALORE- (56009), 2010 - 2011.
  • Department of Post Graduate Studies in Pancha Karma Government Ayurvedic Medical College Bangalore. 2010-2011 CERTIFICATE BY THE GUIDE RTIFICATE This is to certify that the Dissertation entitled “TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADI MODAKA IN EKA KUSHTA W.S.R. TO PSORIASIS – A COMPARATIVE STUDY” is a bonafide research work done by Dr.SRINIVAS RAO in partial fulfillment for the degree of Ayurveda Vachaspathi, Doctor of Medicine (Ayurveda) in Pancha Karma of the Rajiv Gandhi University of Health Sciences, Bangalore. I recommend this dissertation for the above degree to the University for Assessment and approval. Guide: Dr.Shalini.C.Eli. M.D. (Ayu),DNY.Date: Professor and H.O.D,Place: Department of Postgraduate Studies in Panchakarma. Government Ayurvedic Medical College, Bangalore.
  • Department of Post Graduate Studies in Pancha Karma Government Ayurvedic Medical College Bangalore. ENDORSEMENT BY THE HOD & PRINCIPAL This is to certify that the Dissertation entitled “TO EVALUATE THEEFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA ANDABHAYADI MODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS.A COMPARATIVESTUDY” is a bonafide research work done by Dr.SRINIVAS.RAO under the guidanceof Dr.SHALINI.C.ELI. Professor and H.O.D Department of Postgraduate Studies inPanchakarma, Government Ayurvedic Medical College, Bangalore.Dr Shalini C. Eli. M.D. (Ayu),D.N.Y.Professor & HOD Principal,Department of P. G Studies in Pancha Karma Govt.Ayurvedic Medical CollegeGovt.Ayurvedic Medical College, Bangalore.Bangalore.Date: Date:Place: Place:
  • DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled, “TO EVALUATE THE EFFICACYOF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABHAYADIMODAKA IN EKA KUSHTA W.S.R.TO PSORIASIS. - A COMPARATIVE STUDY”is a bonafide and genuine research work carried out by me under the guidance ofDr. SHALINI.C.ELI. Professor and H.O.D.Department of PG studies in Pancha Karma,Govt. Ayurvedic Medical College, Bangalore.Date: Signature of the candidatePlace: Bangalore Dr. SRINIVAS RAO.
  • COPYRIGHT DECLARATION BY THE CANDIDATEI hereby declare that the Rajiv Gandhi University of health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation in print orelectronic format for academic/ research purpose.Date: Signature of the candidatePlace: Dr. SRINIVAS RAO. © Rajiv Gandhi University of Health Sciences, Karnataka
  • ACKNOWLEDGEMENT‘At times our own light goes out and is rekindled by a spark from another person.Each ofus has cause to think with deep gratitude of those who have lighted the flame withinus”.Albert Schweitzer.At this juncture of successful accomplishment of my work I bow my head to almightywith whose blessings I am able to fulfill my duties.I am short of vocabulary to express my deepest sense of gratitude towards my belovedDr.Shalini.C.Eli.for her maternal affection,timely advise,constant indefeasible guidanceand overall supervision which has moulded and enlightened my tiny work.I will always remain obliged to Dr.Shridhar B.S. for his dynamism,support,suggestionthroughout the study.I again express immense gratitude to Dr.Shalini.C.Eli, Professor & H.O.D,Departmentof P.G.Studies in Panchakarma G.A.M.C Bangalore for her encouragement and kind co-operation.I owe my sincere regards to Dr.S.G.Mangalgi,Principal,G.A.M.C,Bangalore for hisvaluable support.My heartfelt gratitude to the faculty members of the Department Dr.Shylaja kumara.R.,Dr.Janaki Y.S.,Dr.Santosh Yedahalli,Dr.V.M.Hugar,Dr.Shaila Gurappa for theirtimely guidance & support during my study.
  • I am highly indebted to all my homeland teachers for the imponderable knowledge andblessings, I received throughout my career. It needs a special mention of Dr.Nirmala.N.,Dr.Vijay Laxmi, Dr.Srinivas.J., Dr.R.Deshmukh & Dr.Veena.Mere words cannot express my feelings of gratitude towards my mom Smt.Sulochanaand my father Sri Ranappa Bannurkar,who are the motivation and inspiration for me topursue higher studies.I also thank all my sisters and my jiju for their moral support and inspiration.My heartfelt thanks to my seniors Dr.Divya Kini.,Dr.Somanath.G.,Dr.Ashwini K.,Dr.Smina, Dr.Sandeep & Dr.Rajani & all others for the support and co-operation Ireceived from them.I whole heartedly thank to my colleagues Dr.Vijaya.V, Dr.Basava jyoti, Dr.SumitPatil,Dr.Ravi Patil, and Dr.Pooja.B.A. for their support and encouragement.My heartiest gratitude’s to my junior friends Dr.Manjunath Kanthi, Dr.ShridharL,Dr.Mukund, Dr.Nandkishore, Dr.Rashmi Rao & Dr.Vanishree for their help andsupport.I take this opportunity to specially thank my senior Dr.Divya Kini for her moral support,guidance, and valuable suggestions rendered throughout my course.I extend my gratitudeness to my close friends for their constant support andencouragement in every part of my life Manjunath K., Dr.Shilpa Raga, Dr.Anand.I will be lacking in my duty without thanking the non-teaching staff of our department &hospital staffs for their help and service rendered during my study.
  • All my patients need special mention, without whose co-operation the entire study wouldbe stalemated. I express my thanks to each and everyone who helped me directly or indirectly withapologies for my inability to identify them individually. With Heartfelt Gratitude. Dr.SRINIVAS RAO.Bangalore.
  • ABSTRACTPsoriasis is one of the top listed dermatological problems of present day. It is affectingthe 2% of the world’s population. Though this disorder is not a contagious but it is oftensource of social embarrassment. Patients often isolate themselves from the fear ofrejection from the society.For this agony Ayurveda has better answer. Shodhana a long recognized therapeutics ofAyurveda plays a pivotal role in the management of this condition. Virechana is one theShodhana modality which is playing very important part in treating stubborn disorderslike this.Though in Ayurveda many Virechaka drugs are mentioned but only few are in practice.There is an intense need to know the efficacy of the other drug mentioned in classics.InSushruta Samhita Karavellaka Swarasa is mentioned as best Swarasa Virechaka, but it ishardly in use as Virechaka Drug.Objectives of the study:To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in Ekakushta.To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta.To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka asVirechaka Yogas.Study design: Patients of Eka Kushta were randomly recruited to 2 groups. Group A: Patients of this group was treated with Abhayadi modaka for virechana.Group B: Patients of this group was treated with Karavellaka patra swarasa forvirechana.Effect of treatment is assessed using P A S I Scale. In Abhayadi group before treatmentmean P A S I Scale was 29.8 which got reduced to 7.32 after treatment. In Karavellakagroup before treatment mean P A S I Scale was 24.7 which got reduced to 5.04 aftertreatment.It was concluded that Virechana with both the drugs is highly efficient in management ofEka Kushta.Key words :Eka Kushta, Psoriasis,Virechana, Abhayadi Modaka, Karavellaka PatraSwarasa
  • ABBREVIATIONS.Aruna Datta Commentary A.CAshtanga Hrudaya A. HrAshtanga Sangraha A. SaBhaishajya Ratnavali B.RBhava Prakasha B. P.Bhela Samhita B.S.Chakra Datta Cha. DaChakrapani Commentary C.CCharaka Samhita Cha. Sa.Dalhana Commentary D.CGangadhara Commentary G.CGada Nigraha G.NHarita Samhita H.S.Kashyapa Samhita K.SMadava Nidana M. N.Sharanghadhara Samhita Sha. SaSushruta Samhita Su. SaVanga Sena V.SYoga Ratnakara Y. R.
  •                 CONTENTS    Chapters Page no 1. Introduction……………………………………. 1-2 2. Objectives of the study………………………… 03 3. Review of literature Procedure Review………………………. 5-49 Disease Review…………………………. 50-97 Drug Review…………………………….. 98-102 4. Clinical study……………………………………. 103-112 5. Observations and Results………………………... 113-132 6. Discussions……………………………………… 133-139 7. Conclusion………………………………………. 140-141 8. Scope for further study………………………….. 141 9. Summary………………………………………… 142-144
  • LIST OF TABLESTable Headings Pg. noNo.1 Chapters & contents related to Virechana in Charaka Sutra Sthana 62 Chapters & contents related to Virechana in Charaka Vimana Sthana 63 Chapters & contents related to Virechana in Charaka Kalpa Sthana 74 Chapters & contents related to Virechana in Charaka Siddhi Sthana 75 Chapters & contents related to Virechana in Sushruta Sutra Sthana 76 Chapters & contents related to Virechana in Sushruta Chikitsa Sthana 87 Chapters & contents related to Virechana in Kashyapa Siddhi Sthana 88 Chapters & contents related to Virechana in Kashyapa Khila Sthana 89 Chapters & contents related to Virechana in Ashtanga Sangraha Sutra 810 Chapters & contents related to Virechana in Ashtanga Sangraha Kalpa 911 Chapters & contents related to Virechana in Ashtanga Hrudaya Sutra 912 Chapters & contents related to Virechana in Ashtanga Hrudaya Kalpa 913 Chapters & contents related to Virechana in Bhela Siddhi Sthana 914 Chapters & contents related to Virechana in Chakra Datta 915 Chapters & contents related to Virechana in Sharanghadara Purva 10 Khanda16 Chapters & contents related to Virechana in Sharanghadara 10 UttaraKhanda17 Chapters & contents related to Virechana in Vangasena. 1018 Chapters & contents related to Virechana in Bhava Prakasha. 1019 Classification of Virechaka dravyas acc to different acharyas. 1420 Virechaka dravyas according to the parts used. 1521 Virechaka dravyas mentioned in Sushruta samhita. 1622 Virechana dravyas according to Sharangdhara. 2023 245 Virechana kalpas. 2124 Formulations of Virechana. 2225 Virechana kalpas according to sharangdhara. 22
  • 26 Virechana dravyas as per dosha. 2327 Virechana Yogya. 2428 Virechana Ayogya. 2529 Sneha matra. 2830 Sneha draya and anupana 2831 Sneha Jeeryamana and jeerna lakshanas. 2932 Samyak snigdha lakshanas. 3033 Asnigdha lakshanas. 3034 Atisnigdha lakshanas 3035 Dose of Virechana in its different forms. 3236 Criteria for Maniki,Vegiki,Antiki shuddhi of virechana. 3537 Samyak yoga lakshanas of Virechana. 3638 Ayoga lakshanas of Virechana. 3639 Atiyoga lakshanas of Virechana. 3740 Shuddhi according to Kashyapa 3841 Peyadi Samsarjana Krama 4042 Rasa Samsarjana 4143 Ayoga and Atiyoga lakshanas of Vyapat 4244 Virechana Vyapat according to acharyas. 4245 Virechana Vyapat with their treatment 4346 Layers of Twak according to different acharyas 5048 Skin layers and disease concerned to it according to Charaka 5149 Showing Sapta Twacha and Disease Relation. 5150 Classification of Maha Kushta. 6251 Kshudrakushtha according to different acharyas 6252 Kashyapokta Kushta Types. 6353 Kushtha and Dosha Relation. 6354 Difference between Mahakushtha and KshudraKushtha 6455 Doshic predominance in individual type of kushta. 6456 Showing Samanya laxana of kushta based on particular dosha. 64
  • 57 Nidanas according to different acharyas. 6658 Mithya Ahara Hetu for Kushta 6759 Mithya vihar Hetu for Kushta. 6860 Achara Hetu for Kushta. 6961 Lakshanas according to Predominance of the Doshas. 7362 Lakshanas according to Dhatu dushti 7463 Lakshanas according to Srotas 7464 Purvaroopa according to different acharyas 7765 Sadhya-Asadhyata. 8066 Pathya-Apatha. 8567 Ingredients of Chitrakadi Vati. 9868 Ingredients of Guduchi Ghrita. 9969 Ingredients of Madhuyashti taila. 9970 Showing Ingredients of Abhayadi Modaka 10171 Showing age wise distribution 11372 Showing Sex wise distribution 11473 Showing occupation wise distribution 11474 Showing Religion wise distributio 11475 Showing socio-economic status 11476 Showing diet wise distribution 11577 Showing marital status 11578 Showing Region wise distribution 11579 Showing Sleep Pattern 11581 Showing Addiction 11682 Showing Koshta of Patients 11683 Showing Prakruti of Patients 11684 Showing Satwa of the Patients 11785 Showing Satmya of the Patients 11786 Showing presence of family history of Psoriasis. 11787 Showing mental stress as triggering factor 118
  • 88 Showing seasonal factor 11889 Showing food as aggravating factor 11890 Showing Drugs as aggravating factor 11991 Showing infection as triggering factor 11992 Showing chronicity 11993 Showing Distribution of area 11994 Showing details of Itching 12095 Showing details of Erythema 12096 Showing details of area involvement - Head 12097 Showing details of area involvemet - Trunk 12098 Showing details of area involvement - Upper limb 12199 Showing details of area involvement- Lower limb 121100 Showing details of Auspitz’s Sign + 121101 Showing details of Candle Grease Sign + 122102 Showing number of days of Sneha Pana 122103 Showing Samyak Snighdha Lakshanas 122104 Showing Samyak Swinna Lakshana 123105 Showing Time required manifesting first Virechana Vega 123106 Showing Virechana Vegas 123107 Showing Time required for completion of procedure 124108 Showing Laingiki Shuddhi 124109 Showing Statistical analysis is done using Shapiro-Wilk Test 125
  • LIST OF GRAPHSGraph no. Headings 1 Showing age wise distribution 2 Showing Sex wise distribution 3 Showing Religion wise distribution 4 Showing socio-economic status 5 Showing diet wise distribution 6 Showing Marital Status 7 Showing occupation wise distribution 8 Showing region 9 Showing history of diwa swapna 10 Showing history of ratri jagarana. 11 Showing Prakruti of the patients 12 Showing Satva of the Patients 13 Showing Satmya of the Patients 14 Showing Addictions 15 Showing Koshta 16 Showing family History. 17 Stress as aggravating factor 18 Season as aggravating factor 19 Food as aggravating factor 20 Drug as aggravating factor 21 Infection as aggravating factor 22 Grading of Itching 23 Grading of Erythema 24 Area involvement in Head 25 Area involvement in Trunk 26 Area involvement in Upper Limb
  • 27 Area involvement in Lower limb29 Auspitz Sign30 Candlegreeze Sign31 Days of Snehapana32 Samyak snigdha lakshanas33 Samyak swinna lakshanas34 Time taken for initiation of Vega35 Number of Vegas36 Time taken for completion37 Laingiki shuddhi.
  • Introduction       INTRODUCTION   Ayurveda an ancient system of Health care is a result of India’s quest for disease free living. The amazing journey of Āyurveda from its divine origin to the present day gives us the hint about the enormous potential this science possessing. Its successful existence since time immemorial itself proves its scientific approach of treatment that has remained unchanged till date. One of such unique line of treatment is Shodhana Karma. Shodhana is a procedure, where if Roga janaka doshas are in prabhuta avastha they are expelled through the nearest route. Virechana karma is one of the shodhana modality which is performed to eliminate vitiated pitta dosha from the body. Though virechana is agrya shodhana for vitiated pitta dosha , we find references that it also eliminates vitiated kapha and vata doha.3 Virechana is a line of treatment in many chronic and stubborn disorders and one of such disorder is Kushta. In Ayurveda many of the skin disorders are brought under one umbrella called Kushta. Acharyas had faith in virechana to put control over disease causing morbid factors. Eka kushtha , one of the Ksudhra kushtha can be treated with Virechana karma. The signs and symptoms of Eka kushtha mentioned in ayurvedic classics resembles to that of Psoriasis. Psoriasis is a very common disease and affects one to two per cent of the population in all geographic regions Psoriasis is a chronic inflammatory and proliferative disorder of the skin clinically manifested as well-circumscribed, erythematous papules and plaques To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 1 
  • Introduction  covered with silvery scales typically located over the extensor surfaces and scalp. While specific systemic and environmental factors are known to influence the disease, it is unpredictable in its course and usually pursue spontaneously with improvement and exacerbations of lesions without discernable cause. Immune system dysfunction in the background of a genetic predisposition is believed to be at the core of the disease process. In classics we find reference about administration of virechana using different parts of the drug, among which Karavellaka patra swarasa for the virechana is the best type of aushadha kalpana. In Chakradutta and Sharangadhara samhita we get reference about Abhayadi modaka as a virechaka yoga in Kushtha. So with the motto of evaluating the efficacy of both the virechana yogas in Eka Kushtha work has been carried out under the heading, “TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRASWARASA AND ABHAYADI MODAKA IN EKA KUSHTHA W.S R. TO PSORIASIS:-ACOMPARATIVE CLINICAL STUDY. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 2 
  • Introduction  OBJECTIVES OF THE STUDY 1. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in Ekakushta. 2. To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta. 3. To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka as Virechaka Yogas. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 3 
  • Introduction PREVIOUS WORK DONE “Effect of Vamana and Virechana in Psoriasis” by Dr. Shankar Babu A. on 1988 at Govt. Ayurvedic college, Kerala University, Trivendrum Effect of vamana and virechana in Psoriasis by DrA.Shankar Babu,Govt Ayurvedic College,Trivendrum(1990). Concept of Kitibha (Psoriasis) in Ayurveda and Modern medicine and its treatment with Strikutaja a further study”. By Anken on 1991 at Banaras Hindu University, Varanasi “The effect of Vamana and Virechana in Psoriasis”,By Dr.Rekha, GAMC, Mysore, Mysore University.(1995) Role of Virechana with and without shamana in the management of Psoriasis ( Eka kushta )” by Dr. Ruparel.S.J on 1999 at Gujarat Ayurveda University, Jamanagar. “Comparative study of Virechana karma and Nitya rechana in the management of Ekakushta”, by Dr.Praveen B.S.,S D M College of Ayurveda, Hassan, RGUHS.(2005) Role of Virechana with and without Shamana in the management of Eka kushtha (Psoriasis) ” by Ruparel on 1999 at Gujarat Ayurveda University, Jamanagar. Role of Virechana Karma in management of Psoriasis” by Dr.Praveen V..Devarushi,Udupi(2008-09).                       To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 4 
  •  Procedure Review Of Literature  PROCEDURE REVIEW HISTORICAL REVIEW Historical review of virechana karma: Vedas are the oldest source of information regarding the disease and its treatment A close review of the history of various systems of medicinal science reveals the fact that the treatments was prevalent from time immemorial, but only very few references are available about Virechana in Vedic times. 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 detail description of Virechana was not found. In Manu smrithi, it is told that snana is done after the completion of vamana and virechana2. Vinayapitaka(Buddha literature):3 In the text Vinaya pittaka, Buddha period, virechana was given to Bhagwan Buddha by inhaling some powder spread over uthplapatra. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 5
  •  Procedure Review Of Literature  Kasika4 It was explained that Panchakarma was common method of treatment which prescribed Poorvakarma such as Snehana, Swedana and Panchakarma, Annasamsarjana etc. SAMHITA KALA: 1.CHARAKA SAMHITASutra Sthana: Table No.1 Ch.no Name of the Chapter Content 1 Deerghanjeeviteeya Adhyaya Moolinis and Phalinis used for Virechana 2 Apamaargatanduleeya Adhayaya Important purgative drugs 4 Shat virechana Shatashrateeya Virechanopaga drugs Adhyaya 15 Upakalpaneeya Adhayaya Sambhara Sangraha, Dose of Virechana , Yogya,Ayoga, Atiyoga laxanas, virechana vidhi and its benefits. 16 Chikitsaprabrutiya adhyaya Complications & its management. 20 Maharoga Adhayaya Utility of Virechana karma in Nanatmaja pittajaVikaras.Vimana Sthana: Table No.2 Ch. no Name of the Chapter Content 08 Rogabhishagjiteeya Vimana Virechana dravya Kalpa adhyaya. Sangraha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 6
  •  Procedure Review Of Literature Kalpa sthana: Table No.3 Ch. no Name of the Chapter Content 07. Shyama trivrit Kalpa Adhyaya Different formulations of shyamatrivrit. 08. Chaturangula Kalpa Adhyaya Different formulations of chaturangula. 03. Tilwaka Kalpa Adhyaya Different formulations of tilwaka. 09. Sudha Kalpa Adhyaya Formulations of Sudha. 10. Saptala shankini Kalpa Adhyaya Different formulations of saptalashankini 11. Danti dravanti Kalpa Adhyaya Different formulations of dantidravanti.Siddhi Sthana: Table No.4 Ch. no Name of the Chapter Content 01. Kalpana Siddhi Virechana purva ahara,samyog,heena & atiyoga laxanas,Samsarjana krama, Shuddhi are described. 02. Panchakarmeeya Siddhi Virechya and Avirechya are described. 06. Vamana Virechana Vyapad Complication manifested due to Siddhi. Ayoga and Atiyoga and its Management. 2. SUSHRUTA SAMHITASutra Sthana: Table No.5 Ch. no Name of the Chapter Content 38. Dravyasangrhaniya adhyaya Description of Virechana dravyas. 39. Samshodhana samshamaniya. Adho bhaga dosha hara dravyas are mentioned. 41. Dravya Vishesha Vignaneeya Described the Adhobhaga Prabhava Adhyaya of Virechaka drugs. 44. Virechana Dravya Vikalpaneeya Different formulations for the Adhyaya Virechana karma. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 7
  •  Procedure Review Of Literature  Chikitsa Sthana:- Table No.6Ch.no Name of the Chapter Content 33. Vamana Virechana Sadhya Virechana process, Phamacodynamics of Upadrava Chikitsitam Adhyaya virechana, , Ayoga, Atiyoga and Samyak yoga of Virechana,Virechya –Avirechya, importance of dosha nirhana. 34. Vamana Virechana Vyapat Complication of Virechana karma. Chikitsitam 39. Aturopadrava Chikitsitam Samsarjana Krama is described. Adhyaya 3.KASHYAPA SAMHITA:Siddhi Sthana: Table No.7 Ch no Name of the Chapter Content 03. Vamana Virecahna Adhyaya Detailed discription of Virechana Karma Heena, Madhyama, Uttama Shuddhis, Regimen to be followed after Virechana, utility of Virechana Karma in Bala roga, Vyapat of Virechana. 07. Pancha Karmeeya Siddhi Yogya Ayogya for Virechana.Khila sthana: Table No.8 Ch.no Name of the Chapter Content 07. Samshuddhi Visheshaneeya Virechana Karma and Samsarjana Adhyaya Krama. 4. ASTHANGA SANGRAHA:Sutra sthana: Table No.9 Ch. no Name of the Chapter Content To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 8
  •  Procedure Review Of Literature  27. Vamana Virechana Vidhi Detailed description of Virechana Adhyaya Karma, Pharmacological actions of Virechana dravyas,Virechya, Avirecya are mentioned.Kalpa sthana:- Table No.10Ch no Name of the Chapter Content 02. Virechana kalpa Adhyaya. Different formulations of Virechana Karma. 03. VamanaVirechana Vyapat Vyapat and its Management. Siddhi. 5. ASHTANGA HRIDAYA:Sutra sthana: Table No.11 Ch.no Name of the Chapter Content 18. Vamana Virechana Vidhi Detailed description of Virechana Adhyaya KarmaKalpa sthana: Table No.12 Ch. no Name of the Chapter Content 02. Virechanaa Kalpa Adhyaya. Detailed description of Virechana process. 03. Vamana Virechana Vyapat Virechana Vyapat with its Adhyaya. treatment. 7. BHELA SAMHITA: Kalpa sthana: Chapters deal with preparations of Chaturangula. Dantiphala. Shankini. Shyamatrivrit.Siddhi Sthana: Table No.13 Ch. no Name of the Chapter Content 01. Vamana virechana siddhi It deals with samyak,ayog & atiyoga laxanas of virechana. 04. Vamana Virechana Detailed description of Virechana Siddhi Adhyaya. Karma is available.8. CHAKRADATTA: Table No.14 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 9
  •  Procedure Review Of Literature  Ch.no Name of the Chapter Content 71. Virechana adhikara. Detailed description of Virechana Karma. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 10
  •  Procedure Review Of Literature   9. SHARANGADHARA SAMHITA: Poorva kanda: Table No.15 Chapter Name of the Chapter Content 04. Deepana Pachana Adhyaya. Description of four types of virechana dravya laxanas. Uttara kanda:- Table No.16 Chapter Name of the Chapter Content 04. Virechana Vidhi Adhyaya Virechana karma described in detail 10. VANGASENA: Table No.17 Chapter Name of the chapter Content 89. Virechana adhikara Adhyaya. Detailed description of Virechana karma and virechana yogas. 11. BHAVA PRAKASHA Table No.18Chapter Name of the Chapter Content 06. Mishra Prakarana Adhyaya Details regarding virechana and Pathya and Apathya during Virechana karma. Virechana in western medicine.5 In Mesopotamian Civilization Physicians of Mesopotamia were using Virechana to treat pain abdomen. In seventeen century Handersn has written in his book that it was customary to use Purgatives. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 11
  •  Procedure Review Of Literature  VIRECHANAThe process by which the vitiated doshas are eliminated through the adhobhaga ieguda marga, is called ‘Virechana.This is widely used shodana therapy, is less stressfulwith least complication.Virechana in broader term denotes both vamana andvirechana.6 Etymology:-(1) Virechana7 :V+Rich+ Nich , lytu-malade: nissernam ......(Vachaspathyam).(2)Virechanaha8 :V+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. "Ricir" - evacuation. "Ric" - Viyojana (separation).Virechana word is derived from the ‘Rich’ dhatu, ‘Rich’ meaning – To empty ,evacuate, leave, give up.9The root ‘Rich’ is also very important to understand the systemic action of Virechana.According to Charaka, the Virechana drugs first get digested in Amashaya, thenreaches to Hridaya, Dhamani, macro and micro channels (srotases) of the body andreach the site where Doshas are accumulated.10Virechana drugs soften the compactness (Sanghata) of the Doshas and break thebigger molecules to smaller ones. This process occurs in a proper way by separation(Viyojana) and combination (Samparchana) of doshas. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 12
  •  Procedure Review Of Literature Up to this stage the action of Virechana is known as its systemic effect and it isobviously governed by Viyojana and Samparchana components of Virechana dravya.Definition: iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉxÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....|11    The act of expelling Doshas through Adhobhaga is known as Virechana. Here themeaning of Adhobhaga is ‘Guda’ as commented by Chakrapani. ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉÌlÉ:xÉÉUhÉÇ ...|12 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 |UåcÉirÉÌmÉiÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||13The procedure where the morbid Dosha is expelled out in the form of Drava eitherpakva or apkva state.ÌmɨÉå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉzsÉåwqÉhÉÏÌiÉ |14  urÉMÑüsÉÉlÉç xÉͳÉmÉÉiÉÉåijÉÉlÉç mÉæ̨ÉMüÉlÉç MüTüümÉæ̨ÉMüÉlÉç | xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç||15Even though Virechana is best line of treatment modality for pittadosha16it can act onkaphasamsrusta pitta or pittasthanagat kapha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 13
  •  Procedure Review Of Literature And moreover in case of vatasyopakrama mridu shodhana indicated which refers tomridu Virechana karma17.So Virechana is major line of treatment for morbid pittadosha & also it act on morbidkapha and vata dosha. Thus action of Virechana is seen on all tridosha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 14
  •  Procedure Review Of Literature Paryaya:Instead of word Virechana the following terms were used in different context, theseall can be consider as synonyms for virechana, Vireka, Rechana, Adhobhagahara. Anulomana 18 Praskandana.According to the Sanskrit – English dictionary the different meanings are- Purgative,Cathartic, Evacuant and Aperient.IMPORTANCE OF VIRECHANA:-Virechana is a sovereign procedure for elimination of Pitta Dosha19,20 Indu explainsthat in the vitiation of Kevala Pitta, Pitta associated with Kapha and in PittasthanaGata Kapha Virechana is the obvious treatment procedure to be followed21.Charaka explains that Virechana drug after entering Amashaya dislodges the vitiatedPitta Dosha and henceforth pacifies all Pitta Vikara of the body22. Virechana also cleanses sense organs i.e. improves their function. Just as removal ofwater from its reservoir destroys various organisms and plants residing in it, in thesimilar manner removal of excessive Pitta destroys the various symptoms caused dueto it23Virechana is mentioned as Shodhana procedure in Dusthi of Rasa,Rakta, Mamsa,Asthi, Majja & Shukra Dhatus. Hence in majority of the Dhatupradoshaja VikarasVirechana is the better option . To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 15
  •  Procedure Review Of Literature  Virechana dravya guna karma:The guna of virechana dravya are ushna, tikshna, sukshma, vyavayi, vikashi, thesequalities are common in vamana aoushadam, but virechana dravya has adhobagaharaprabhavam.Virechana dravya has jala and prithwi mahabootha predominance.24CLASSIFICATION OF VIRECHANA DRUGS:--The drugs which produce Virechana are known as Virechaka dravyas. According toreferences available Virechana drugs may be classified in following 6 groups, Table.no.19 I) Virechana Dravyas According to their a) Animal origin DRAVYAS origin & parts used b) Plants origin c) Miscellaneous II) According to the mode of action a) Anulomana b) Samsrana c) Bhedana d) Rechana VIRECHANA 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 VI) Virechana drugs according to kalpanas A.Virechana drugs according to their origin and parts used:  a) Animal origin: ∗ Urine.25,26 ∗ Milk 27 ∗ Takra 28 b) Plant Origin: c) Miscellaneous: To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 16
  •  Procedure Review Of Literature  To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 17
  •  Procedure Review Of Literature Classification of virechana dravyas based on parts used. Table no:20. Part of the Sl.no. plant used for Charaka 29 Sushruta 30 Vagbhata 31 virechana. 1. Mulini Hastidanti Trivrit,Shyama virechana Shyama Danti Danti,Kumbha dravya. Trivrit Dravanti (Trivrit) Adhoguda Saptala Gavakshi Saptala Shankhini Shankhini Danti Gavakshi Vishanika Vishanika Gavakshi Ajagandha Chitraka Dravanti Kush, Kasha Avartaki Kinahi 2. Phalini Shankhini Kampillaka Neelini virechana Vidanga Puga Triphala dravya Anupa Eranda,Haritaki Kampillak Sthalaja Bibhitaki, Prakeerya Amalaki Udakeerya Neelini Abhaya Aragwada Anthakotrapuspi Kampillaka Aragwada 3. Ksheera Snuhi ksheera Mahavriksh Snuhi virechana Arka Saptachala Swarna ksheeri dravya. Swarna ksheeri Godugdha 4. Twak Tilwaka Tilwaka Tilwaka virechana Patala Ramyaka dravya Ramyaka 5. Patra virechana Swarna patri Putika Aragwada dravya Aragwada Aragwada KaravellakaD) Based on Parts of the Dravya used: Sushruta describes the following drugs with priority for Virechana Karma32. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 18
  •  Procedure Review Of Literature Classification of virechana dravyas based on parts used and agraoushdaTable no.21 Mula Virechana Shyama Trivrith Phala Virechana Haritaki Twak Virechana Tilwaka Swarasa Virechana Karvellaka Dugdha Virechana Snuhi Taila Erandamd) Miscellaneous: As Madya, Dhanyamla33,Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena also have Sara properties.B. Virechana drugs according to their mode of action by Sharangadhara Acharya Sharangdhara has classified according to the action of the Virechanadravyas.a) Anulomana 34 :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 toadhomarga for defecation process. That is these drugs will facilitate the defecationprocess.eg: Hareetaki (Terminalia Chebula). Sushruta considers Sara as the synonym of Anulomana. According to DalhanaAnulomana causes expulsion of Vata and Kapha35. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 19
  •  Procedure Review Of Literature According to Raja Nighantu, Bhoutika composition of Anulomana drugs is similar tothat of Virechana drugs i.e. Prithvi and Aap Mahabhuthas.b) Sramsana 36 :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 rectumwithout digesting (Paka) them. eg: Aragwada (Casia Fistula).In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates thePitta and Kapha situated in Pakwashaya 37.c) Bhedana 38:   qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:| ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉThe drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into it and thenevacuating through the lower gut, is known as Bhedana. eg. Katuki. Bhedana is a process in which Shareera Mala Nirharana is brought about. 39.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.40d) Rechana 41: ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç | UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ || To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 20
  •  Procedure Review Of Literature  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. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 21
  •  Procedure Review Of Literature  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 Pilu42 C) 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:43 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 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 disease44 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 45 Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta (eg. Draksha, Milk, Caster oil, Warm water etc.). 46Drugs effective in Mridu Koshta To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 22
  •  Procedure Review Of Literature   are Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala, Pilu and Taruna Madya47.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 completely48.Sharangdhara recommends the use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and Aragvadha49.C) Teekshna Virechana : The drugs, which cause severe motions (Mahavega) and eliminates the Doshas in large quantity by quick (Kshipra) and gentle (Sukha) purgation without causing either much depression (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 Virechana50.Sharangdhara recommends use of Teekshna Virechana drugs in Krura Koshta persons. Charaka recommends the use of these drugs in the strong (Balavan) patients 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 effects of 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 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 23
  •  Procedure Review Of Literature   Sharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in Krura Koshta may also be included in this group.D) Classification based on guna of drug: In many places in Ayurveda, the uses of Sneha 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. E. Virechana drugs according to seasons 58 Table no:22 Showing Virechana drugs according to seasons.  Shishira   Varsha Sharad /Vasanta Greeshma Hemanta All seasonsPreparation Beeja Shyama Shyama Shyama Trivrit Trivrit Trivrit Trivrit Trivrit Trivrit Chitraka Danti Kutaja Duralabha Pippali Patha Hapusha Pippali Musta Nagara Ajaji Saptala Shunthi Sharkara Sindhu Sarala Katuki Udichya Aruna Vacha Swarnaksiri Shweta Trivrit Hemakshiri Chandana churna To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 24
  •  Procedure Review Of Literature  Anupana Draksha Yasti Honey Sugar Warm Bhavana with Rasa and madhu in Water cow ‘s urine madhu Draksha Swarasa or Draksha Swarasa only 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, Shyama and Trivrit are to be used for Virechana in Hemanta Rutu. Charaka mentions Trivrit Chitraka, Patha, etc. to be used for Virechana in Hemanta Rutu. F.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. Table no:23. Showing 245 Virechana kalpas according to Charaka.59 Kalpana Trivrth Argvada Tilvaka Sudha Saptala Danti Shankini 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 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 25
  •  Procedure Review Of Literature   Gritha 4 2 4 4 8 6 Taila - - - - 6 2Chatusneha - - - - - 1Asavarishta - 1 1 - - 5 Greya - - - 1 - - Yavagu - - - - - 1 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 26
  •  Procedure Review Of Literature   G.Specific formulations for Virechana6 Tabe no:24. Showing Formulations for virechana based on dosha involvement.Vata Pradhana Trivrit + Saindhava + Shunthi + Kanji or MamsasaraPitta Pradhana Trivrit Choorna + Draksha KvathaKapha Pradhana Triphala Kvatha, Gomutra, TrikatuChildren between the Age group of 4-12 years61 Draksha rasa+ Aragvadha phala majja H. Dosage of Virechana drugs according to Matra and 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 62. Table no.25: Virechana kalpas according to Sharangadhara. 63 Heena for Mridu Madhyama for Uttama for Kalpana Koshta Madhyama Koshta Krura Koshta Kwatha 8 tolas 4 tolas 2 tolas Kalka, Choorna Modaka 4 tolas 2 tolas 1 tola According to Sushruta64: 1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshta respectively. I. Nature of Koshta and Virechana65: 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. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 27
  •  Procedure Review Of Literature J. Virechana Drugs According to Dosha 66: Table no:26 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 PradhanaVIRECHANA 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:-67 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,Dhumanetra,Sutra,Karpasa etc.ghata,etc. Atura Pariksha:68 Before performing Virechana karma it is necessary to know patient fitness in terms of his/her Dosha, Dushya, Atura Bala kala, Desha, Agni, koshta, Sharir & Ahara Satma, Satva etc. for proper adminstration of Verchana karma.. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 28
  •  Procedure Review Of Literature  Virechana Yogya and Ayogya. Table no:27: Showing Virechana YogyaVirechana Yogya Ch.Si69 Sus.Chi70 A.S.71 A.Hr.72 K.Si.73 Sha.S.U74 Pranavaha srotoduhti vikaraShwasa + - - - - -Kasa + - - - - -Parshvaruja + - - - - - Annavaha srotoduhti vikaraAruchi + + + - - +Avipaka + - + - - -Visuchika + + + - - +Alasaka + + + - - -Chardi + + + + - + Udakavaha srotoduhti vikaraUdara + + + + - + Rasa pradoshaja vikaraPandu + + - - + +Jwara + + + + - +Aruchi + + - - - +Avipaka + - + - - -Hridroga + + - - + + Rakta pradoshaja vikaraKamala + - - + + -Vidradhi - + + + - +Netradaha + + - - - +Aasyadaha + + - - - +Vatarakta + + + + - +Kustha + + - + + +Paittika vyadhi + + + - - -Visarpa + + - - + -Pliha + + + + - +Vyanga + - + + - -Nilika + - - + - -Urdva Raktapitta + + + + + - Mamsa pradoshaja vikaraArbuda + + - - - -Galaganda + - - - - - Meda pradoshaja vikaraPrameha + + - + + +Yoni Dosha + + + + - +Retodosha + - + + - - Mootravaha srotoduhti vikaraMutraghata + + + + - + Purishavaha srotoduhti vikaraArsha + + + + + +Bhagandara + + + - - +Udavarta + - + + +Vibhandha - + + + + -Pakvashaya shoola + + + + - - OtherVisphota - - - - + +Vatavyadhi - - - - + +Garavisha - + + + + + To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 29
  •  Procedure Review Of Literature   Some other indications for Virechana are: a)In Swastha.75,76 b)Utkleshita Pitta. Pitta Sthanagata Alpa Kapha Kapha Sthanagata Bahu Pitta77 Pakwashayagata Pitta or Kapha Pitta78 Pittavrita Vata Kaphavrita Vata79 Shonita Roga80 a) As Purvakarma in Rasayana and Vajikarana81,82 TABLE NO:28 Showing Virechana AyogyaVirechana Ayogya Ch.Si83 Sus.Chi84 A.S.85 A.Hr.86 K.Si. 87 Sha.S.U88 Physiological condition Langitha + - + - - - Upavasita + - - - - - Durbalendriya + - - - - - Durbala + - - - + - Alpagni + + + + - + Shranta + + - - - + Pipasita + + - - - +Karmabharadhvahata + + - - - - Daruna koshtha + - + + - - Kshama + - - - - - Kamadivyagra + + - - - - Bhakta + + - - - - Sukumara - - - - + - Navaprasuta - + - - - + Rathri Jagarana - - + - - - Atiruksha + - + - - + Bhayoptapta - + - - - + Chinta prasaktha + - - - - -Maithuna prasaktha + - - - - -Adhyayana prasaktha + - - - - - vyayama prasaktha + + - + - - Garbhini + + - - - - Age related condition Vriddha + + - - + Bala + + - - + To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 30
  •  Procedure Review Of Literature   Pathological condition Kshatkshina + + - - - + Atikrisha + - - - + - Atisthula + + - - + + Muktanala + - + - - - Atisara - - + + - -Adhoga Raktapitta + + + + - - Shosha - - - - - - Rajayakshma - - + - - - Urustambha - - - - + - Madatyaya + + + - - + Talushosha - - - - + - Hridroga - - - - + - Traumatic condition Abhighata + - - - - - Subhaga + - - - - - Kshataguda + + + - - - Shalyardita + + + + - + Saama condition Nava Jwara + + + + - +Nava Pratishyaya - + - - - - Some vataroga conditionKevala Vataroga - - - - + - Hanugraha - - - - + - 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.89 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 31
  •  Procedure Review Of Literature Snehana & Swedana:Snehana includes both Abhyantara (oral ingestion of unctuous material) and BahyaSnehana (external application of unctuous material) .Abhyantara Snehapana followedby Sarvanga Abhyanga along with Sarvanga Sweda (Whole body sudation) areperformed prior to Virechana.Snehapana procedure is to be followed after observing Nirama Lakshanas. Therequired Sneha should be administered early in the morning at Suryodayakala afterobserving Jeerna Ahara Lakshanas of the previous meal and when the patient is emptystomach. The duration of Sneha Pana should be 3 to 7 days90,91.Importance: -Action of Snehana and Swedana prior to shodhana explained by Charaka in followingway.Due to Snehana there will be further vriddhi of doshas, and increase influidity(Vishyandana) and due to Swedana dosha paka along with removal ofobstruction at the enterance of the channels.Because of this the doshas leave theShakha and comes to the Koshta.92Sushrutha says Samshodana given without oleation and fomentation will destroy thebody like the dry wood.93Abhyantara Snehapana:Shodhananga Snehapana is done untill the attainment of ‘Samyak SnigdhaLakshanas’ which can be achieved in 3, 5 and 7 days in Mrudu, Madhyama, andKrura Koshta respectively.Thus, Shodhananga Snehapana can be carried out for a maximum period of 7 daysotherwise it will create Sneha Satmyata94, 95. However, if Samyak snigdha lakshanas To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 32
  •  Procedure Review Of Literature are not achieved with in 7 days then it can be continued after one day interval96. Doseof Sneha for shodhana mentioned in various classics is as follows.97-99. Table No.29 Showing Sneha matra. Madhyama Matra Charaka Samhita , Ashtanga Sangraha (Dose which digests in 12 hours) Uttama Matra (Dose which digests Ashtanga Hrudaya. in 24 hours) Uttama & Madhyama Matra ChakarapaniShodhananga Snehapana can be administered in 2 methods: a) Arohana Snehapana b) Sadyo Snehapanaa) Arohana Snehapana:Kalyanakaraka first mentioned about increasing dose schedule. He clearly mentionedthat Shodhanartha Abhyantara Sneha pana has to be taken in increasing order(“Krama Vardhitam Pibet”). Vangasena also followed Kalyanakaraka’sVardhamana dose schedule.b) Sadyo Snehapana: Sadyo Snehapana involves administration of large quantity ofSneha to achieve Snigdha Lakshana immediately or within short duration. It isgenerally indicated in Bala, Vriddha, Balaheena, Mrudu koshta, Alpa dosha, Raja,Raja samipya, Sneha parihara asahishnushu.100Table No.30 . Showing Sneha Dravya and Anupana: 101 Sneha Anupana Ghrta Ushnodaka Taila Yusha Vasa & Majja Manda To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 33
  •  Procedure Review Of Literature  Bhallataka & Tuvaraka Taila Shita Jala In general Ushnodaka can be administered as Anupana for all Sneha. Sneha dravya can be administered in 2 ways, (!)Accha Peya102 – denotes consumption of Sneha without mixing with other foodarticles. 103 (2) Pravicharana – denotes administering Sneha by mixing with food articleseither 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 ShodanangaSnehapana. Administration of Sneha for Shodhana: 104On the day of Snehapana, when the raising sun has attained golden yellow colour,individual exhibiting Jeerna ahara lakshana (symptoms of digested food of theprevious night) except kshudha (hunger), after performing auspicious rituals,Snehapana is done.After snehapan individual should be observed for Sneha Jeeryamana (symptoms ofSneha undergoing digestion) and Sneha Jeerna (symptoms of digested Sneha)Lakshanas. Table No.31 Showing Sneha Jeeryamana and Jeerna Lakshana: 105 Sneha Jeeryaman Lakshana Sneha Jeerna Lakshana Shiroruja Shirorujadi Jeeryamana Lakshana prashamana Bhrama Vatanulomana Nisthiva Swasthyata Murcha Kshut Sada Trishna Arati Udgara shuddhi Klama, Trishna, Daha Laghuta To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 34
  •  Procedure Review Of Literature  Table no:32 Showing Samyak Snigdha Lakshana: 106-109 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 - - - + Table No:33 . Showing Asnigdha Lakshana. 110-113Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.SGrathitha purisha + + - -Ruksha purisha + + - -Agnimandya + + - -Vayu pratiloma + + - -Khara Gatra + _ - -Ruksha Gatra + - - -Uro vidaha _ + - -Daurbalya _ + - -Dur varna - + - -Krichrat anna Pachana _ + - -Susnigdha Lakshana Viparyaya _ _ + +Table No.34 . Showing Atisnigdha Lakshana.. 114-117 Lakshana Ch. Sa. Su. Sa. As. Hr. Sh.S Pandutha + - - - Gaurava + - - - Jadya + - - - Avipakwa Purisha + + - - Tandra + - - - Aruchi + + - - Utklesha + - - - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 35
  •  Procedure Review Of Literature  Mukha srava + + + + Guda srava - + + - Ghrana srava - + - Guda daha + + - + Bhakta dwesha - + - + Pravahika - + - + Purishaati pravritti - + - -Bahya Snehana & Swedana: 118After attainment of Samyak Snigdha Lakshanas, Abhyanga and Swedana should beadvised for either once or twice on the rest day(vishrama kala) and just prior toPradhana 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 koshta119. 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 waste products 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 water120.Bhojana Vyavastha:During the procedure of Abhyanga and Swedana, Snigdha, Drava,Ushna bhojana,Mamsarasa,Pramanayukta,Anabhishandhi,NatiSnighdha,Asankeerna,Odana, Amlarasa Phala is recommended.121.Before pradhana karma the diet should be such that, it does not increase ‘Kapha’otherwise Vamana may occur122.‘Manda Kapha’ term is used for the state of Kapha, which is desired for the properVirechana. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 36
  •  Procedure Review Of Literature MATRA VINISCHIYA:1. The dose of Virechana Yoga should be decided according to Vyadhibala, Aturabala and Agnibala123. 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.124Table.no.35 . DOSE OF VIRECHANA DRUG IN ITS DIFFERENT FORM125-128. Form Of Medicine Koshta Dose Sus125,126 Sha127 Van128 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 1 Anjali 4 Karsha 2 pala 2 Kwatha Mrudu Heena (4 pala) 2 Karsha Krura Uttama - 2 Karsha Madhyam Madhya 1 Karsha 1 Karsha 1 Karsha 3 Churna Mrudu Heena - ½Karsha Krura Uttama - 8 Karsha Madhyam Madhyam - 4 Karsha 1 pala 4 Svarasa Mrudu Heena - 2 Karsha Krura Uttama - - 5 Kalka Madhyam Madhyam 1 Karsha 1 Karsha Mrudu Heena - - Krura Uttama - - - 6 Modaka Madhyam Madhyam - 1 Karsha - Mrudu Kaneeya - - - 7 Hima& Krura Uttama 8 Karsha - phanta Madhyam Madhyam 1 Anjali 4 Karsha - Mrudu Heena (4 pala) 2 Karsha - - - - - 2 Karsha 8 Sneha - - - - or1 pala - - - - Ushna Mrudu - - - 2 pala 9 jala as Anoopan Madhyam - - - 4 pala To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 37
  •  Procedure Review Of Literature  Anoopan Krura - - - 8 palaPRADHANA 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 passions 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/ sleepy. 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.129 If patient is fit for Virechana karma on the day of Virechana karma, after performing the Sarvanga sweda patient is advised to be in empty stomach.130 Virechana drugs are administered in ‘Shleshma kale gate’ i.e. after Shleshma kala has passed, in appropriate dose and with appropriate anupana131.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 complication132. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 38
  •  Procedure Review Of Literature Measures after virechaka Oushadha sevana: 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 nor to suppress them. Advise to stay in Nirvata place, be in comfort position and avoid sleep, suppression of natural urges; consume hot water little by little.133Vega pravartanopaya: 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.134OBSERVATIONS:A) Aushadha Jeerna Lakshana: The following signs and symptoms of Virechana are to be observed – Vatanulomana, Swasthya, Khsudha,Trishna,Urjamanaswita, Indriya Laghuta and Udgara Shuddhi135 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 Virechan drug depending on patient bala136 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 39
  •  Procedure Review Of Literature 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 Vata, Pitta and Kapha come out in succession. Gatra Daurbalya and Laghuta are the associated symptoms. If Virechana persists even after manifestation of Hritadosha lakshanas, then vamana should be given.137 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 days138.A) Shuddhi Lakshana:139-143 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 Shuddhi144.Table no:36 . Showing Criteria for Antiki, Vegiki and Maniki Shuddhi ofVirechana Karma. Shuddhi Pravara Madhyama Avara Vegiki 30 Vegas 20 Vegas 10 Vegas Maniki 4 Prastha 3 Prastha 2 Prastha To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 40
  •  Procedure Review Of Literature  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 same as two, three and, four prastha respectively. In the context of Vamana, Virechana and Rakta mokshana, prastha should be taken as 13½ pala145 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. Table No :37. Samyak Yoga Lakshanas Of Virechana Karma Lakshanas146-148 C.S S.S Va Sroto Vishuddhi + - - Indriya Prasadana + + - Shareera Laghuta + + - Agnivriddhi + - - Anamayatwa + + - Kramataha Vit Pitta Kaphagamana + + - Vatanulomana - + - Absence of Ayoga Lakshanas - - + Table no:38. Showing Ayoga Lakshanas of Virechana karma. Lakshanas C.S S.S Va Kapha Prakopa + + + Pitta Prakopa + + + Vata Prakopa + - - Agnimandya + + - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 41
  •  Procedure Review Of Literature   Gaurava + + - Pratishyaya + - + Tandra + - - Chardi + - - Aruchi + + + Vata Pratilomana + - Vatagraha Daha - + + Hridaya Ashuddhi - + + Kukshi Ashuddhi - + + Kandu - + + Table Vit Sanga + + + no :39 Mutrasanga - + -Atiyoga Peedika - - +lakshanas of Virechana karma Lakshanas Charaka Sushruta Vagbhata Kapha Kshaya Vikara + + - Pitta Kshaya Vikara + - - Vata 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 + - - Chakrapani explains though Ayoga, Atiyog and Mithyayoga are described everywhere accordingly in the text, but in case of vaman & virechan there is no need to consider Mithyayoga as a separate entity. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 42
  •  Procedure Review Of Literature  In these procedures, expulsion occur in 4 different ways • Atipravrutii – Excessive expulsion. • Asamyak pravrutii – Expulsion by improper way. • Apravrutii – Cessation of process of expulsion or improper elimination. • Alpapravrutii – Expulsion in lesser quantity. Here apravrutti & alpa pravrutii are included in ayoga. As asamyak Pravrutii means expulsion through opposite route, it indicates that expulsion of vitiatedDosha is not in a quantity, which is expected, so it must be considered under the termof ayoga and not mithyayoga149. Kashyapa Acharya being Paediatrician, to practise Virechana Karma specially for Bala he has been identified Mrudu and/ Sukha type of virechana and Manaki & Vaigiki parameters.150. Table No: 40 Shuddhi Pravara Madhyama Avara Vaigiki 3 2 1 Maniki 3Prastha 2 Prastha 1 PrasthaPASCHAT KARMA:151-154       Pariharya Vishaya: ‐  Once it is confirmed that Virechana Vegas are stop, then advise patient to wash hands, feet and face155.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.Maithuna156.Based on shuddui lakshana especially Vaigiki advise patient to follow Samsarjana karma. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 43
  •  Procedure Review Of Literature  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 morning157 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. 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.158,159.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 respectively160 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 44
  •  Procedure Review Of Literature  Table no :41 Showing the Diet Regimen161 ÌSlÉ MüÉsÉ A³ÉMüÉs mÉëkÉÉlÉ qÉkrÉqÉ ÌWûlÉ É vÉÑkSÏ vÉÑkSÏ vÉÑkSÏmÉëjÉqÉ mÉëÉiÉ - - - : 1 mÉårÉÉ mÉårÉÉ mÉårÉÉ xÉÉrÉÇ Ì²iÉÏrÉ mÉëÉiÉ 2 mÉrÉÉ mÉårÉÉ ÌuÉsÉåmÉÏ : 3 mÉårÉÉ ÌuÉsÉåmÉÏ M×üiÉÉM×üi xÉÉrÉÇ É rÉÔwÉ iÉ×iÉÏrÉ mÉëÉiÉ 4 ÌuÉsÉåmÉÏ ÌuÉsÉåmÉÏ M×üiÉÉM×üi : 5 ÌuÉsÉåmÉÏ AM×üiÉ É xÉÉrÉÇ rÉÔwÉ qÉÉÇxÉUxÉ xÉÉqÉÉlrÉ pÉÉåeÉlÉ cÉiÉÑjÉï mÉëÉiÉ 6 ÌuÉsÉåmÉÏ M×üiÉ - : 7 AM×üiÉ rÉÔwÉ - xÉÉrÉÇ rÉÔwÉ AM×üiÉ qÉÉÇxÉUx É mÉÇcÉq mÉëÉiÉ 8 M×üiÉ M×üiÉ - É : 9 rÉÔwÉ qÉÉÇxÉUx - xÉÉrÉÇ M×üiÉ É rÉÔwÉ xÉÉqÉlrÉ pÉÉåeÉlÉ wɸ mÉëÉiÉ 10 AM×üiÉ - - : 11 qÉÉÇxÉUx - - xÉÉrÉÇ É M×üiÉ qÉÉÇxÉUx É xÉmiÉqÉ mÉëÉiÉ 12 M×üiÉ - - ç : 13 qÉÉÇxÉUx - - xÉÉrÉÇ É xÉÉqÉÉlrÉ pÉÉåeÉlÉInstead of Peyadi Krama, Sushruta mentions Kulatha, Aadhaki and JangalaMamsarasa162. Dalhana clarifies, Sushruta however agrees Peyadi Krama and he saysthat incase of Ksheena Kapha, Peya should be given. Mamsarasa should be given toVata pradhana patients having Deeptagni. If Kapha dominance is there according toDosha and Prakriti, then Kulatha Yusha should be given. The Peyadi Krama ends on7th day of Pradhana Shuddhi patient.Acharya Sushrutha has opined samsarjana kramain respect to bala of the patient163. For the individuals having good strength, three To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 45
  •  Procedure Review Of Literature   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 Chakrapani164. 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: 42 Table showing Rasa Samsarjana. Author Rasa Effect on Dosha ÎxlÉakÉ,AÉqsÉ,xuÉÉSÒ mÉYuÉÉvÉrÉ ÎxjÉiÉ uÉÉiÉmÉëvÉqÉlÉÉjÉï AÉqsÉ, sÉuÉhÉ EkuÉïÎxjÉiÉ AÎalÉ xÉÇkÉѤÉhÉÉjÉïCharaka165 xuÉÉSÒ, ÌiÉ£ü ÌmɨÉvÉqÉlÉÉjÉï MüwÉÉrÉ, MüOÒû ÌmɨÉÉåkuÉïÎxjÉiÉMüTü mÉëvÉqÉlÉÉjÉï xuÉÉSÒ, ÌiÉ£ü mÉëuÉ×kSÉÎalÉWåûiÉÑuÉÉiÉÌmɨÉxjÉÉuÉeÉrÉÉjÉïqÉalÉå xÉqÉÏMüUhÉÉjÉïSushruta166 ÎxlÉakÉ,AqsÉ,sÉuÉhÉ,MüOÒû uÉÉiÉMüTüÉuÉeÉrÉÉjÉïqÉalÉå:xÉlkÉѤÉhÉÉjÉï xuÉÉSÒ, ÌiÉ£ü ÌmɨÉuÉÉiÉÉuÉeÉrÉÉjÉï To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 46
  •  Procedure Review Of Literature Acharya Charaka and Sushrutha has given a special sequence of rasa intake insamsarjana krama to be followed to avoid the chances of vitiation of doshas167.Acharya Charaka has advised to take madhura, amla and hridhya ,snigdha ahara topacify vata.Amla lavana to increase agni,Madhura and tikta rasa to pacify pittadosha,kashaya and katu rasa to pacify kapha dosha168.Acharya Sushrutha opined that rasa should be started with Madhura and Tiktha toincrease the agni and to pacify vata pitta. Then snigda,amla,lavana and katu rasa toreduce vata,kapha dosha followed by madhura tikta rasa to pacify vata pittadosha,thereafter kashaya katu rasa to pacify kapha pitta.169.This is followed to dosarva rasa abyasa for the patient during samsarjana krama.VYAPATH 170-172Vyapath are the complications occurring due to improper handling of shodanakarma.Acharaya Charaka has explained 10 vyapath, Chakrapani has divided this 10Vyapada in two groups i.e. Ayoga and Atiyoga Table No.43 Showing the Ayoga and Atiyoga Lakshanas of Vyapath. Ayoga Atiyoga Adhamana Srava Hritgraha Jivadana Gatragraha Vibramsha Kandvadi Vibhramsha Gudabramsha Upadrava Sanjnabhramsha Klama Table no.44. Showing the Virechana Vyapath According to Acharyas. Vyapath Charaka Sushrutha Vagbhatta Adhmana + + + Parikartika + + + Parisrava + + + Hrdgraha + - + Gatragraha + - Sarvangagraha Jivadana + + + Vibhramsha Guda + - Vibhramsha Stambha + - - Klama + - - Upadrava + - - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 47
  •  Procedure Review Of Literature  Vamana - + + Savashesha Aushadhitva - + + Jirna Aushadhitva - + + Hina Aushadhitva - + - Vata Shula - + Vedana Ayoga - + + Atiyoga - + + Hridaya-Upasarana - + - Vibandha - + - Pravahika - + + Visamjnata - - + Table.no.45. Showing virechana vyapat with their treatment. Vyapada Lakshana Chikitsa Adhmana Adhmana UdavartaNabhi, Prustha, Abhyanga, Sveda, Phalavarti, Parshva, Shiroruja, Shvasa, Vit Niruha, Anuvasana, Mutra, Vata Sanga Udavartahara Chikitsa Parikartika Gud Parikartana Langhana, Pachana, Ruksha, Tivrashula, Piccha, Rakta, Ushna Bhojana Yashtimadhu Mala Pravritti ,Snehabasti Parisrava Alpa Mala Pravritti, Kandu, Shopha, Vamana, Virechana, Grahani Kustha, Gaurava, Agnimandya, Chikitsa. Asava, Arishta Staimitya, Aruchi, Panduta Hridgraha Hikka, Shvasa, Kasa, Parshvashula, Snigdha Lavana, Sveda, Lalasrava, Akshivibhrama, Shula, Yasti Taila, Anuvasana, Dantatikitkitayana, Jihva, Khodati Tikshna Nasya, Vamana, Sangyanasha Basti Angagraha Stambha, Vepathu, Toda Vatahara Pindikodveshtana, Manthanavat Snehana Pida Svedana Jivadana Rakta Chandrika, Udakasrava, Guda Pittahara, Raktapana, Bhransha, Trishna, Murchha, Mada Raktabasti, Piccha Basti, Ghrita Manda, Anuvasana Vibhransh Only Mala Excreted not Doshas, Kashaya Lepa, Snehana a. Guda Gudabhransha, Sanjna Bransha, Mridu Sveda b. Sanjya Kandu, Pidika, Kustha, Roga Manonukula Chikitsa c.Kandu, Tikshna Shodhana After Snehapana Stambha Vatavarodha, Gudastambha, Langhana, Pachana, Tikshna Gudshula, Alpalpa Mala Pravritti Basti, Virechana Upadrava Stambha, Sula, Gatragraha, Snehana, Svedana Sarvanga Vedana Vataghna Chikitsa Klama Tandra, Gaurava, Klama, Daurbalya, Langhana, Pachana, Sneha, Angasada Tikshna, Shodhana Vamana by Vamana Snehana, Svedana, virechana Virechana Yoga To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 48
  •  Procedure Review Of Literature  Ayoga Vibhransha, Hikka, Roganusara Chikitsa Pindikodveshtana, Kandu, Urusada, Gomutra Niruha Vaivarnyata Atiyoga Ativirechana Mridu Vamana, Raktapitta vat Chikitsa To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 49
  •  Procedure Review Of Literature  MODE OF ACTION OF VIRECHANA:173 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 by 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). To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 50
  •  Procedure Review Of Literature g) Mainly due to Prabhava, Prithwi-Jala constitution and presence of Sara Guna Virechana occurs. This is the evacuant action. MODE OF ACTION OF VIRECHANA KARMA Vitiated Dosha comes to  Koshta by snehapana &  Bahya Snehana , Swedana  ADMINISTRATION OF VIRECHANA DRAVYA Ushna, Agni guna- Liquefy the dosha Vyavayi quick spreading to Tikshna guna-‘Sanghatabhedana’ all part of the body Sukshma guna-dilated the channels Vikashi loosening the morbid Dosha comes to Amashaya due to  Anupravana Bhava  Due to Prithwi & jala Mahabhoota  dominancy, Adhobhagahara Prabhava  Expel out through Anal route To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 51
  •  Procedure Review Of Literature Acharya Charaka has given brief description how Virechana dravya acts in the bodywhich is as follows. The drugs which are Ushna, Tikshna, Shukshma, Vyavayi andVikashi reach to the heart by virtue of their potency and circulate through the largeand 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 crumblesthem by virtue of its Tikshna Guna. Then this liquefies and crumbled mass Loosescontact with the wall and the channels in the unctuous body, just like the honey, notadhered to the unctuous vessel. This morbid mass now passes through the minutecapillaries and moves towards Kostha by virtue of the Anu, Pravana Bhava of thedrug and ultimately reaches the Amashaya. From here it forces the morbid factorsthrough the anal route due to the Bhautika predominancy of Jala and Prithvi andAdhobhaga Prabhava174 CATHARTICS - MODERN VIEW175The terms laxatives, cathartics, purgatives, aperients and evacuants often are usedinterchangeably. However, there is distinction between Laxation and catharsis.Laxation means – the evacuation of formed fecal material from the rectum, whereasCatharsis means – the evacuation of unformed, usually watery fecal material from theentire colon. Most of the commonly used agents promote Laxation but some actuallyare cathartics.Classification of Cathartics:These drugs are usually classified according to their mechanism of action. Thepurgatives 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. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 52
  •  Procedure Review Of Literature  • 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 acidAnthraquinone 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.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. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 53
  •  Procedure Review Of Literature  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 early in the morning before breakfast. Patients should be instructed to take plenty of water along with these drugs.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 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 54
  •  Procedure Review Of Literature  effects on feces. These laxatives are mild in action and usually seen 1 to 3 days after ingestion and itself does not initiate peristalsis. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 55
  •  Procedure Review Of Literature 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 andelectrolyte transport.3. Effects on motility by either inhibiting segmenting (non-propulsive) Scontractionsor 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 laxativesC. 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 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 56
  • Review Of Literature   SKIN                                              Anatomical consideration of skin:The word “Twak” is derived from “Twak Samvarane”, Means that which covers1.Twak the seat of Sparshnendriya is very extensive among all five Jnanendriyas.According to Ayurveda Twak is the seat of Vayu, which is responsible for tactilesensation. Skin formation:Sushtura described the process of formation of Tvacha in the developing foetus. Hesays that after fertilization of ovum Tvacha develops just like a cream on the surfaceof milk 2. During development of Garbha differentiation of the layers of the skin takesplace.Charaka described Tvacha as the Matruja Bhava (Maternal factor) which is one of thesix Bhavas essential in the development of foetus3 .Vagbhata described the formation of Tvacha due to Paka of Rakta Dhatu by itsDhatvagni in the foetus. After Paka, it dries up to form Tvacha, just like thedeposition of cream over the surface of boiled milk4.Table no.475,6,7,8. Showing layers of Twak according to different Acharyas Sushruta Charaka Sharangadhara Arundatta Avabhasini Udakadhara Avabhasini Bhasini Lohita Asrukdhara Lohita Lohita Sweta 3rd Sweta Sweta Tamra 4th Tamra Tamra Vedini 5th Vedini Vedini Rohini 6th Rohini Rohini Mamsadhara Sthula Mamsadhara To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 50 
  • Review Of Literature  Acharya Gangadhara 9 (Ch. Sha. 7/3 Gangadhara Tika) has clarified the difference inopinion between Charaka and Sushruta on the basis of the different opinionsregarding the layers of Tvacha. He explained the third layer of Charaka counting astwo parts –Superficial& deep. The superficial part is considered as third layer (Shweta) while thedeep part as a fourth layer (Tamra) as mentioned by Sushruta.Table no.48 Skin layers and disease concerned to it according to Charaka10 Name Diseases Udakadhara - Asruk dhara 3rd Sidma, Kilasa 4th Dadru, Kushta 5th Alaji, Vidradhi 6th If this layer is injured person trembles And enters darknessAcharya Susrutha explained about seven layers in relation with origin of disease asfollows:- Table no. 49 Showing Sapta Twacha and Disease Relation11. 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 Mansadhara 2 Vrihi Bhagandara, Vidradhi, Arsha Sharangdhara12 has also mentioned seven layers of skin along with the probable onset of diseases. The names of first six layers are same as Sushruta but a seventh layer is named as “Sthula” which is the site of Vidradhi. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 51 
  • Review Of Literature   KRIYA SHARIRA OF TWAKTvacha And Dosha :Tvacha is one of the sites of Vata and Pitta. Skin has been considered asSparshanendriya, Adhisthana13 which is function of Vata. Bhrajaka Pitta is located onthe Tvacha for giving luster and color. Snigdhata, Slakshanata, Mruduta, Sthirata,Sheetata, Prasannata, Snigdha Varnata are the attributed to Kapha.Tvacha And Dhatu :Rasa: In the context of Twak Sara Purusha Lakshana it has been also said as RasaSara. 1st layer of Tvacha, Udakadhara also contains Rasa. So, it can be easilyunderstood that there is a relation between Tvacha and Rasa.Rakta: Among its functions Varna Prasadana (provide color of skin) and MamsaPushti have been mentioned14.Mamsa : Twak is Upadhatu of Mamsa.15Tvacha and Mala:Sweda: It is Mala of Meda which is excreted by Tvacha. Sweda maintain the lusterand humidity of skin.16MODERN VIEW17,18Skin is one of the largest organs of the body in surface area and weight. In adults, theskin covers an area of about 2 square meters and weighs 4.5 to 5 kg. It ranges inthickness from 0.5 to 4.0 mm, depending on location.Embryological Description:The skin is developed from the surface ectoderm and its Underlying mesenchyme(mesodermal cells). To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 52 
  • Review Of Literature  1) Surface ectoderm gives rise to the Keratinizing general surface epidermis and itsappendage, the pilosebaceous units, sudariferous glands and nail units at about 8 – 10weeks of gestation.2) Malacocites, nerves and specialized sensory receptors arise from theneuroectoderm.3) Dermis and its other elements in the skin i.e. Langerhans cells, macrophages, masscells, fibroblasts, blood vessels, connective tissue, lymph vessels, muscles andlipocytes originate from the mesoderm. ANATOMY:The skin consists of two principal parts. The outer, thinner portion, which iscomposed of epithelium, is called the epidermis. The epidermis is attached to theinner, thicker, connective tissue part called the Dermis. The dermis is a subcutaneouslayer. This layer, also called the superficial fascia or hypodermis, consists of areolarand adipose tissue. The subcutaneous layer, in turn, attaches to underlying tissues andorgans.(A) Epidermis:It is a compound tissue consisting mainly of a continuously self-replacing keratinizedstratified Squamous epithelium. It varies in thickness from 0.04mm on the eyelid, to0.16mm on the palms and 0.1mm is average thickness. It takes 28 days for thekeratinocytes to move from the stratum basal to stratum corneum. The five layers,from the deepest to the most superficial are as follows: 1) Stratum basal or germinativum : 2) Stratum spinosum or Malpighi layer: 3) Stratum granulosum : 4) Stratum Lucidum : 5) Stratum corneum : To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 53 
  • Review Of Literature  (B) Dermis:The dermis chiefly consists of white fibrous tissue, elastic fibers and non-strippedmuscles and contains blood vessels, nerves, hair, sweat gland and sebaceous glandsand nerve corpuscles. The outer portion of the dermis, about one fifth of the thicknessof the total layer, is named the papillary region. The deeper portion of the dermis iscalled the reticular region. It consists of dense irregular connective tissue containinginterlacing bundles of collagen and coarse elastic fibers.Blood supply of skin:There are two horizontal and parallel systems of plexuses, which supply the skin.Theplexus or network of blood vessels exists between the dermis and the subcutaneoustissue.Nerve supply:The nerve supply of the skin is very complicated. The varied sensations arising fromskin are derived from a diverse population of cutaneous nerve endings or receptors,thus tactile, temperature and pain sensations are each sub served by different Groupsof receptors.Functions of the skin:The skin is a metabolically active organ with vital functions including the protectionand homeostatic of the body. Regulation of body temperature: Protection Sensation Immunity Excretion Blood reservoir Synthesis of Vitamin – D  To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 54 
  • Disease Review Review Of Literature       DISEASE REVIEW HISTORICAL REVIEW OF KUSHTA Prevedic & Vedic Period The study of Indian classics reveals that skin disorders are afflicting the human being since time immemorial. Utpatti1:- During the destruction of Yajna of Daksha raja different diseases have been emerged out, amongst them kushta is the one which has taken birth due to the Haviprasha (intake of ghee). Which was supposed to be used for the Yajna. Agnipurana2:- There is a reference regarding the internal use of Khadir. Kushtaghna drugs are first described in Agnipurana Koutilya Arthashastra3: In the chapter, on secret means a number of diseases are mentioned such as Kushta.Unmaada, Apasmaara, Prameha etc. Yadjnya valkalsmriti 4: Kushta is known as paprog and is chronisity in nature. & Mandala and Sidma are kinds of Leprosy. Brahma Samhita4:. SSìÓeÉÉ CuÉ vÉÑwMümɧÉmÉëMüUÉM×ü̹ÍpÉ:| Dadru is a disease where affected people used to itch the skin with dry leaves. Kasika5: Incurable diseases were called Kshetriya and Kushta is one among this category. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 55 
  • Disease Review Review Of Literature      Kathadi Gana6: Kushta and Kushtavid are mentioned together which shows the prevalence of the disease and existing of specialists treating the same.Bhana bhatta:According to him consider Kushta is one of 52 variety of Sharirika disease VEDAKALA (1000 to 500BC)The history of Kushta can be traced back since vedic era.Rigveda7:There is no complete description about the disease Kushta, however there areinstances which depicts that Kushta was prevalent in that period also. 1) Lord Indra cured the Charmaroga of Apala 82) Ghosa, the daughter of Kakshivati who was suffering from ‘Kushta Roga’ had anugly look and was therefore disliked by her husband. She was treated with propermedication and got cured and was ultimately accepted by her husband9Yajurveda10: In Shukla Yajurveda medicines having capacity of curing Kushta, Hridroga, Arsha,etc. have been mentioned and their virtues praised.Atharvaveda11:In Atharvaveda, the various sites for diseases have been described. Amongst themskin has been described as one of the chief sites of the diseases. The names of variousdiseases have been illustrated, whereby Kushtha has been described as Kshetriya To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 56 
  • Disease Review Review Of Literature      Roga. There is description of some herbs like Rama, Nili, Asuri, Shyama etc. for thetreatment of Kushtha.From the above references it can be said that Kushta was prevalent in Veda kala andthe physicians of that period had studied the disease and were able to cure the Kushtasuccessfully.Mahabharata12:-In Mahabharata, it has been mentioned that the person suffering from ‘Tvaka Dosha’is not fit to be a king. This reference highlights the fact that people suffering from‘Kushta’ were looked down by the society at that time. They were neglected and evenprinces were not allowed to become king. SAMHITA KALACharaka Samhita:Charaka described a long range of skin diseases with their etiology, pathogenesis &specific classification under the heading of Kushtha for the first time. Charaka hasdescribed 18 types of Kushtha. Seven types of Kushtha have been described as aMaha Kushtha in Nidana Sthana. In the Chikitsa Sthana eighteen types of Kushthahave been classified under 7 Maha Kushtha & 11 Kshudra Kushtha. Apart from thedescription of Kushtha in Nidana Sthana and Chikitsa Sthana there are some otherreferences that are related to Kushtha are available in Charaka Samhita, some of themare as follows: Kushtha is described as the Samanya Hetu of Nija Shotha13. Kushtha is considered as a Santarpanajanya Vyadhi14. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 57 
  • Disease Review Review Of Literature       It is included as one of the disease caused by Rakta15. Use of Stambhana Dravyas in the initial stage of Raktapitta, Raktarsha & Amatisara leads to Kushtha. Kushtha is noted in Lekhana Yogya & Prachhana Yogya Vyadhi16. Agnikarma is contraindicated in Kushthaja Vrana. 17Sushruta Samhita: Sushruta is the first one to clearly describe the Anuvamshika (hereditary) factor as causation of Kushta Roga. He has also described Krimi as a causative factor of Kushta18.In Nidana Sthana, Sushruta explains the Dhatugatatva and Uttarottar Dhatu Pravesh of Kushta19. Sushruta has explained skin disorders in two chapters under the heading of Kushta and Maha Kushta. Rasayana drugs like Guggulu, Shilajita, and Shveta Bakuchi are mentioned and indicated in the Chikitsa of Kushtha by Sushruta20Ashtanga Sangraha:- Kushta has been mentioned to be of 7 types depending on the Dosha involved and Eka kushta has been defined as Vata Kapha Pradhana Kushta21.Ashtanga Hridaya: Vagbhata has followed Sushruta regarding classification of Maha Kushtha & Kshudra Kushtha22. But Eka Kushtha has been mentioned under Kshudra Kushtha with same Lakshanas as described by Charaka.Bhela Samhita23:- Bhela has described Kushtha Roga in both Nidana and Chikitsa Sthana. He specially considered polluted water as an etiological factor of Kushtha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 58 
  • Disease Review Review Of Literature      Kashyapa Samhita24:- Kashyapa Samhita has described 18 types of Kushtha as Charaka, except that Shvitra, Vishaja Kushtha & Sthularuksha instead of Charmkushtha, Alasaka & Visphotaka.Kashyapa has given the classification of Kushtha on the basis of its Sadhyaasadhyata. Thereby 9 Kushtha are described as Sadhya while other 9 are Asadhya. SANGRAHA KALA.Madhava Nidana25:- Madhava has described Nidana Panchaka of Kushtha according to the Charaka & Vagbhata. While Dhatugatatva, Sadhya-Asadhyata & Sankramakata (contagious) have been described similar to that of Sushruta Samhita.Sharangdhara Samhita26: Classification of Kushtha has been described in Purvakhanda. According to Sharangdhara, Tamra, which is the fourth layer of the skin, is the site of all types of Kushtha. Vangasena27: Vangasena has mentioned 7 types of special causes of Kushtha that is Tila Taila, Kulattha, Valmika, Linga Roga, Mahisha Dugdha, Mathita Dadhi and Vruntaka27.Basavarajiyam: Some other types of Kushtha are described like Prasuti Kushtha, Galat Kushtha etc in Basavarajeeyam apart from the normal.Bhava Prakasha28: Bhava Prakasha has described a detail description of Kushtha Roga. He has followed Charaka for classification & nomenclature of Kushtha. The Dhatugatatva To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 59 
  • Disease Review Review Of Literature       & Sadhya-Asadhyata are compiled from Sushruta. Arishta Lakshana of Kushta has also been described. But differs with Sushruta in which these were Asadhya Lakshanas. Yoga Ratnakara29: Yoga Ratnakara describes the Kushtha according to the earlier classics. Contagious aspect of Kushtha is also described in the Kushtha chap. Raja Martanda30: Bhojaraja has described the treatment of Kushta in chapter 8. Some recipes increase the luster of skin and to get rid of body odour has also been described. KUSHTA All dermatological disorders are coming under the term Kushtha as per Ayurvedic texts. Kushtha produces psychological and physical discomforts due to the blemished skin which itself is proved by the name.ETYMOLOICAL DERVATION OF KUSHTHA31: The word ‘Kushtha’ is a broad term which includes almost all skin diseases. MÑüwÉç ÌlÉwMüwÉåï +WûÉÌlÉ MÑüÌwÉÌiÉ || EhÉÉÇ 2/2/ CÌiÉ MüjÉlÉç ...(zÉoSMüsmÉSìÓqÉ ) In Sanskrit language, the word ‘Kushtha’ 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. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 60 
  • Disease Review Review Of Literature      DEFINITION: MÑüwhÉÉiÉÏ ÌlÉzÉãwÉhÉ MüUÉãiÉÏ ÌuÉsÉãZÉÇ AÇaÉmÉëirÉÇaÉÉlÉÏ CÌiÉ MÑü¹Ç|| (SiddhantaKaumudi)The condition in which different Angapratyanga are destroyed is known as Kushta.MÑüwhÉÉiÉÏ zÉÉUÏUÉxjÉÉ zÉÉãÍhÉiÉqÉ ÌuÉM×üiÉã || (Halayudha Kosha)Which means that vitiated Rakta leads to destruction of body so it is called ’Kushta’. Commentator Arundatta mentioned that – 1. rÉiÉç uÉæuÉhrÉïÇ MÑüuÉïÎliÉ iÉiÉç MÑü¸qÉÑzÉÎliÉ |This means that, Kushtha is the one which causes vitiation as well as discolorationof the skin.32 2. MÑüwhÉÉirÉ….qÉç | MÑüÎixÉiÉÇ ÌiɹÌiÉ |One which has capacity of spreading nature & leads to deformity of skin in theform of discoloration is known as Kushta33. 3. MÑüwhÉÉÌiÉ iÉxqÉÉiɨÉç MÑü¸ÍqÉirÉÑcrÉiÉåAccording to Vaghbhatacharya, if hetu upekshana has been done and is not treatedproperly 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 singleentity. Acharya’s have opined that the Kushtha is first located in the Tvak, later itprogressively involves deeper Dhatu’s. This clearly indicates that in all Kushtha theskin compulsorily get involved at first. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 61 
  • Disease Review Review Of Literature       KUSHTHA SYNONYMS: Yvadhini, Kutsitam, Vajivrajam, Apyam, Adavaham, Nirujam, Gadah, Ruja Vyapam, Pakalam, Hashuram, Kakalam, Amayah, Gadantakam. Classification of Kustha According To Different Acharyas34-39 Table No:50 Showing classification of Mahakushtha. No. Types of Kushtha Ch. Sus. A.Hr B.S. M.N. B.P. 1. Kapala + + + + + + 2. Audumbara + + + + + + 3. Mandala + - + + + + 4. Rushyajihv + + + + + + 5. Pundarika + + + + + + 6. Sidhma + - - + + + 7. Kakanaka + + + + + + 8. Dadru - + + - - - 9. Aruna - + - - - - Table no.51 Showing Kshudrakushtha according to different acharyas. No Types of Kustha Cha Sus A.Hr B.S. M.N. B.P. 01 Ekakustha + + + + + + 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 - + - - - - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 62 
  • Disease Review Review Of Literature       15 Visarpa - + - - - - 16 Parisarpa - + - - - - 17 Raksha - + - - - - 18 Shvitra - - - + - - 19 Vishaja - - - + - - 20. Kachhu - - - - + +All These types of Kushta are further classified based on Doshic predominance. It ismore useful for diagnostic and treatment of the disease, which are as follows42. The word ‘Kushta’ is a broad term, which covers almost all the skin diseases. Kushtha is associated with invariably by ‘Saptako drvya Sangraha43. But different types of pain, colour, shape, specific manifestation etc. i.e. Vedana vishesha - Eg.Kapala kushta Toda babul; Varna Vishesha- Eg. Kakanaka kushta is Gunja beeja.varna; Samsathana Vishesha - Eg. Rushyajivha kushta is resembles to that of deer tongue; Prabhava Vishesha - Eg. Kakana kushta is Asadhya due to its Prabhava; Naama Vishesha- Eg. kapala etc. are found in Kushtha because of Anshanshakalpana of the Doshas44According to Charaka, Kushthas are in fact of innumerable types, but for systemicstudy they are classified into two major groups 7 Maha Kushtha & 11 KshudraKushtha 45There is no difference of opinion between any Acharya about the total number ofKushtha, but difference of opinion in symptoms & names of some of Kushtha exists46.Chakrapani has clarified that, in Kshudra Kushtha the symptoms of Mahakushta aremanifested in milder form48. According to commentator Gayadas there is severe and To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 63 
  • Disease Review Review Of Literature      extensive vitiation of Doshas from the very beginning, in Mahakushtha, whichpenetrate the deeper tissues and cause Mahakushtha. But no such severe and extensivevitiation of Doshas occurs in the KshudraKushtha from the beginning49.Charaka included Sidma kushta in Mahakushta and Sushruta included in kshudrakushta.Dalhana clearing this doubt said that, sidhma are two types 1.Sidhma2.Pushpikasidhma. Pushpikasidhma is Sadhya hence considered underKshudrakushta. In the same way dadru is included under Mahakushatas bySushrutacharya because amongst two types of dadru i.e 1.Sita 2. Asita, Asita isconsidered as asadhya.50 Table no.55 Showing Doshic predominance in individual type of kushta51 Sl No Doshic Predominance Name of Kushta 1 Vata Kapala 2 Pitta Audumbara 3 Kapha Mandala, Vicarcika 4 VataKapha Sidhma,EkaKushta, Alasaka Carmakhya, Kitibha.Vipadika, 5 VataPitta Rusyajihva 6 KaphaPitta Pundarika,.Dadru.Carmadala , Pama, Visphotaka, Shataru 7 VataPittaKapha Kakanaka Table no.56. Showing Samanya laxana of kushta based on particular dosha52 Sl.No Predominant Symptoms Dosa 1 Vata Ruksata, Sosa, Toda, Sula, Samkoca, Ayama, Parusya, Kharata, Harsa, Syava-Arunata 2 Pitta Daha,Raga,Parisrava, Paka,Visragandha, Kleda, Angapatana 3 Kapha Svaitya, Saitya, Kandu, Sthairya, Utsedha, Gaurava, Sneha, Kleda To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 64 
  • Disease Review Review Of Literature       If one can not able to diagnose a particular type of kushta, then thesamanya laxanas mentioned in the table above should be looked after to diagnose thepredominance of dosha. EKA KUSHTHA.Eka Kustha is one of the Kshudra Kushtha. Bhava Prakasha mentions that because itis the prime among the Kshudra Kushtha, thus it is called Ekakustha. “Kshudrakushtha Mukhyatvata Ekakushtamiti”.1.NIDANA53:- The nidanas are determined on the basis of specific manifestation of kushta and frommanifested Kushta; one can also determine the nidanas of kushta.48.There is no specific description about etiological factors of the disease Ekakusth but itbeing a variety of Kshudrakushtha, some of the etiological factors of Kushtha are tobe accepted as the etiological factors of the Ekakustha too.Ayurvedic texts have described general causative factors i.e. Samanya Nidana for alltype of Kushtha instead of specific Nidana for specific type of Kushtha. Theetiological factors of Kushtha, which includes Ekakustha, may be classified intofollowing groups: (A) Ahara Hetu (B) Vihara Hetu (C) Achara Hetu (D) Other NidanasA. Ahara Hetu:- The core causative factors of Kushta are Viruddha Ahara and Mitya Ahara: To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 65 
  • Disease Review Review Of Literature        Viruddha Ahara: Acharya Charaka has stated that the substances acting antagonistic to ‘Dehadhatu’ are Vairodhika54 The diet which is opposite to Ashtau Ahara Vidhi Visheshayatanani55’ Charaka has mentioned 18 types of Viruddha Ahara, which are Viruddha to Desha, Kala, Agni, Matra, Satmya, Dosha, Samskara, Virya, Koshtha, Krama, Parihara, Apachara, Paka, Samyoga, Hridaya, Sampada and Vidhi56.. According to Vagbhata Viruddha Ahara can sometimes become fatal just like the poison when it is of Adhika Virya, and in some case it may become Gara Visha when it is of Alpa Viryata in long run57,58. Table No:57 Showing Nidanas according to different acharyas 59-64 NIDANA C S A A B H M BNo. S S H S S S N P A AHARA HETU(a) Viruddha Ahara + + + + + + + + 1. Intake of Chilchm fish with milk. + - - - - - - - 2. Intake of food mostly containing Hayanaka, + - - - - - - - Yavaka, Chinaka, Uddalaka and Koradusa along with Ksheera, Dadhi, Takra, Kola, Kulattha, Masha, Atasi, Kusumbha3. Intake of Mulaka and Lashuna with Ksheera. + - - - - - - -4. Continuous intake of Gramya, Audaka and - + - - + - - - Anupa Mamsa with Ksheera.5. Use of Pippali Kakmachi, Likucha with Dadhi - - - - + - - - and Sarpi. 6. Use of Meat of deer with milk. - - - - + - - - 7. Use of Mulaka with Guda. - - - - + - - - 8. Excessive use of alcohol with milk. - - - - + - - - 9. Intake of articles having sour taste with milk. - - - - + - - -11. Excessive use of green vegetables with milk. - - - - + - - -11. Intake of honey and meat after taking hot diet - - - - + - - - and vice-versa.12. Use of fish Nimbu and milk together. - - - - + - - - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 66 
  • Disease Review Review Of Literature        Incompatibility to various types of food is a common complaint now a day. Decreased immunity, changed environment factors like temperature, pollution and consuming foods, which are prepared with innovative methods and combination, may be the predisposing factors. Mithya Ahara: Mithya Ahara means improper diet. According to Vijayrakshita, the diet opposite to ‘Ashta Ahara Vidhi Visheshayatanani’ is designated as ‘Mithya Ahara’.. Types of Mithya Ahara which are known to be responsible in the manifestation of Kushtha in table Table no.58 Showing Mithya Ahara Hetu for Kushta Mithya Ahara C. S SS A.S A.H Bh.S H.S M.N B.P Adhyashana + + - - - + + + Vishamashana + + - - - - - - Asatmya Ahara - + - - - - - - Intake of food during + + - - - - + + indigestionContinuous and excessive use of + - - - - - - - Madhu, Phanita, Matsya, Lakucha, Mulaka, Kakamachiand intake of above substances while having Ajirna Excessive Snehana + - - - - - - -Vidahi Ahara without emesis of + - - - + + - - undigested food Dravyataha Excessive intake of gramya, - - - - + - - - Anupa, Audaka Mamsa Navanna, Dadhi, Masha + - - - - - + + DushiVisha - + - - - - - - Polluted water - - - - - + - - To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 67 
  • Disease Review Review Of Literature        Gunatah Excessive Drava, Snigdha + - - - - + + + Guru Ahara + + - - - - + + RasatahExcessive Amla & Lavana Rasa + - - - - - + + (B) Vihara Hetu: All kinds of activities done physically, vocally or mentally are considered as Vihara. Mithya Vihara means improper activities. The activities opposite to ‘Svasthavrita’ are the ‘Mithya Vihara’. The Mithya Vihara is the chief causative factor of many diseases but it has been considered as main cause for the Kushtha. The factors related to Mithya Vihara by various Acharyas have been tabulated in table no.59 (B)VIHARA HET (a) Mithya Vihara (1 ) To do physical exercise and to - + - - - - + + take sun bath after heavy meals. (2 ) To perform sexual intercourse + + - - + + + + during indigestion. (3) To have a regular nap in the day. + + - - - + + + (4) To do exercise or to perform + - - - - - - - sexual intercourse after Snehapana and Vamana. (5) Sudden change from cold to heat + + - - + - - + or heat to cold without judiciously following the rules of gradual change. (6) Sudden Change from Santarpan + - - - - - - + to Aptarpan and vice – versa. (7) Entering into cold water + - - - + - + + immediately after one is affected with fear exhaustion and sunlight. (8) Mithya sansargasevana - - - - - + - - (b) Vega-Vidharana (1) Withholding of the natural urges - + - - + - + - i.e. Mutra and Purisha Vega etc. (2 ) Suppression of the urge of + + - - + - + + To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 68 
  • Disease Review Review Of Literature       emesis. (c) Panchakarmapcharan + - - - - - + + (1) Panchkarmani Kriyamane + - - - - - - - nisiddha sevanam. (2) Improper administration of - + - - - - - - Snehapana therapy.(C) Achara Hetu65-67:This is a very important factor and has been mentioned by all the Acharyas.Behavioural misconduct, antisocial activities, sinful activities and other punishableactivities are considered under this heading. It has been mentioned that good moralsare also necessary for a man to be healthy, a detailed description of which is given inSadvirtta chapter. As the after effects of bad deeds he suffers from diseases likeKushta. Brhatrayi have mentioned Cinta, Bhaya, Krodha as Vata Prakopa Nidana andBhaya, Krodha and Soka also cause Dusti of Swedavaha Srotas.57 Chinta causes Dustiof Rasavaha Srotas.Those diseases, in which no clinical improvement is obtained even after the best 58treatment, are considered as Papa Karmaja Vyadhi. Both Charaka andSushrutacharya have described Kushta as a most chronic disease and other Acharyaslike Bhavamisra and Madhavakara have included it to be due to Papa Karma. Table No: 60 Showing Achara Hetu for Kushta: CS SS AS AH BS HS MN BP Achara Hetu Papa Karma + + + + + + + + VipraGuru Tiraskara + - - - - + - Sadhu Ninda - - + + - - - -Use of money and material - - + + - - - - acquired by unfair meansKilling the virtuous person - - + + - - - .- (D) Other Nidanas: Some scattered references regarding Nidana of Kushta are also found in the classics, which are as follows: To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 69 
  • Disease Review Review Of Literature      Samsargaja Hetu :According to Susruta and Vagbhata Kushta is Aupasargika Roga.69 i.e. Kushtaspreads from one man to another due to Prasanga, Gatrasamsparsha, Nihshwasat,Sahabhojana etc. Bhavaprakash and Aurabhra also opines about the Aupasargikata ofkushta.70Kulaja Nidana :Kulaja Nidana is also known as Aanuvansika Nidana i.e. due to Beejadusti. Sushruta 70has mentioned Kushta as Adibalapravrtta Vyadhi i.e. the original cause of thedisease is attributed to defects of Shukra and/or Shonita. Sushruta has also explainedthat the children of Kushta patients may also suffer fromKushta.Krimija Hetu:Acharya Sushruta has mentioned that all types of Kushta originate from Vata, Pitta,Kapha and Krimi71 Charaka has also indicated that causative factors and treatment ofRaktaja Krimi is as same as Kushta.72 So Krimi may be taken as one of the causativefactor for kushta.Chikitsa Vibhramsajanva Hetu :Stambhana in initial stage of disease like Raktarsha, 73 Rakta Pitta, 74 Amatisara 75cause Kushta.Kushta has been mentioned as Raktapradosaja and Santarpanajanya Vyadhi. So theRaktaprakopaka and Santarpaka Nidana can be attributed for the production ofKushta. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 70 
  • Disease Review Review Of Literature      Vangasena has given 7 specific etiological factors as Tila, Taila, Kulattha, Valmika,Linga Roga, Mahisa Dadhi and Vruntaka for Kushta.Charaka indicated that the water of the rivers, which are originated from Vindhya,Sahya and Pariyatra hills, might cause Kushta76Chardi will be seen when there will be urdhwa gati of kapha and pitta with theinfluence of Udana vuayu. Chardi vegavarodha if done, vataprakopa will be seen andthe residual kapha and pitta causes the kushta.Panchakarmapachari has been mentioned in nidanas, here mainly vamana andvirechana can be considered i.e. these two procedures are done mainly to remove thepitta and kapha dosha. If procedures are not carried out properly then the residual pittaand kapha will cause many disorders among them kushta is the one.Sankramaka nidanas have been mentioned by Acharyas i.e. both the internal andexternal factors are highlighted in nidana. Indicating infectious and non infectiouscondition of the disease.Manasika Hetu:Charaka mentioned that depending upon the specific nature of the Nidana and alsospecificity of the Dushya afflicted, Dosha when aggravated manifest innumerabletypes of disease77.When allow persisting for long time afflicted, these psychicdisorders viz. Kama etc. and somatic disorder like Jvara etc. may get affected witheach other78.Direct psychological references are available in the etiological factors of Kustha.Blaming of good persons like saint, murder, stealing of others properties etc. havealso been mentioned as the Nidana of Kushtha79. Such antisocial and misbehaviour To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 71 
  • Disease Review Review Of Literature      and sinful activities make serious and long-standing impact on mind of persons whoare indulging in it. Bhaya (fear), Krodha (anger), Shoka (grief) etc. are originated bysuch activities leading to vitiation of Dosha which leads to Kushtha. Nidanas likePapakarmas even causes affliction to the second generation80. This observationhighlights the seriousness of psychic factors in the etiology of Kushtha.Rasa is mainly affected Dushya in case of Eka Kushtha. While explaining theSrotodushti Nidanas Charaka mentions that over worrying (Chintyanam ChaAtichintanat) is one of the Nidana of Rasavaha Srotodushti. Rasavaha Srotodushti isalso an after effect on Ajeerna, which is also caused by the disturbed state of mind.Eventhough food is in proper quality and wholesome it may not be get properlydigested if the person is affected by Chinta (worry), Shoka (grief), and Bhaya (fear)etc81.The causes of Ama include Kama (lust), Krodha (anger), Lobha (greed), Moha(confusion) and Shoka (grief) etc82. Krodha, Shoka and Bhaya cause SvedavahaSrotodushti which in turn leads to the manifestation of Eka Kushtha. In nutshellvarious psychological factors are having influence in etiopathogenesis of EkaKushtha. SAMPRAPTIDifferent Acharya have explained the Samprapti in different ways. Sushruta explainsthat person, who indulges in the Nidana Sevana, Tridosha will get vitiated. TheseVitiated Dosha move in the Tiryakgata Sira.Then they have Sammurchana with theDushya. Then it will reach the Bahya Marga and produces the Mandala wherever itmoves83. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 72 
  • Disease Review Review Of Literature      Charaka has emphasized on the importance of the Sapta Dushya like Tvak, Rakta,Mamsa, and Ambu. He explains that whenever the Dosha Dushya Sammurchanaoccurs in the Tvak then the Kushtha will be produced84.Though all the Acharyas haveexplained the Samprapti in different way, involvement of the Tridosha is the commonfactor which is accepted by all.Pathology involving Shukra Dhatu gives raise to Kaunya and Gati Kshaya. Theoffspring of the persons who are already suffering with the Kushtha, will also sufferswith the Kushtha due to the Dushta Shukra and Shonita which they possessed85Though the Samprapti of the Kushtha is explained in general and no where thespecific samprapti of each of the variety is explained one can understand the specificsamprapti by looking at the involvement of the Dosha, Dushya etc of each variety.Dosha in Eka Kushtha:All Kushtha are Tridosha. However, in Eka Kushtha the dominance of Vata Kapha ismentioned by Charaka and Kapha by Sushruta. The involvement of Doshas in thecommon Lakshana of Eka Kushtha is analyzed. This is summarized as follows: Table-No.61 Showing Lakshanas according to Predominance of the Doshas Lakshanas Doshas Asvedanam Vata-Kapha Mahavastum Kapha Matshyashakalopama Vata Krishna-Aruna Varna Vata Mandala Vata-Pitta-Kapha Raktabha Pidika Pitta Kandu Kapha Vedana Vata Bahalata Kapha Tvak Rukshata Vata To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 73 
  • Disease Review Review Of Literature      Dushya in Eka Kushtha:Charaka has described that seven Dravyas vitiate in Kushtha i.e. Tridosha & fourDushyas (Tvaka, Rakta, Lasika & Mamsa). Table no.62 Showing Lakshanas according to Dhatu dushti. Lakshanas Dhatu Dushti Asvedanam Rasa Mahavastum Rasa Matshyashakalopama Rasa Krishna-Aruna Varna Rasa, Rakta Mandala Mamsa Raktabha Pidika Rakta , Mamsa Kandu Rasa Vedana Rasa , Mamsa Bahalata Mamsa Table no.63 Showing Lakshanas according to Srotas Lakshana Srothas Srotho dushti Asvedanam Rasavaha, Svedavaha Sanga Mahavastama Rasavaha Sanga Matshyashakalopama Rasavaha Sanga Krishna-Aruna Varna Rasavaha,Raktavaha Vimargagamana Mandala Mamsavaha Vimargagamana& Sanga Raktabha Pidika Raktavaha,Mamsavaha Sanga Kandu Rasavaha SangaMainly the Srotodushti of Rasavaha, Raktavaha, Mamsavaha and Svedavaha Srotasare found in Eka Kushtha. SAMPRAPTI GHATAKA86: Dosha :Tridosha(Vata,kapha) Dhatu : Rasa, Rakta,Mamsa. Upadhatu :Tvacha Agni : Jataragni, dhatwagni mandya. Srotas : Rasa, rakta, mamsavaha To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 74 
  • Disease Review Review Of Literature       Srotas dushti prakara : Sanga,vimarga gamana Udbhava sthana : Amapakvashaya Sanchara sthana : Sarvasharira Adhisthana : Twak, rakta, mamsa, lasika Vyakta sthana : Twak Roga marga : Bahya Swabhava : Chirakari Sadhyasadhyata : krichsadhya On the basis of above it can be said that out of the ten symptoms, 4 are due to Vata, 3 are due to Kapha and one each due to Pitta, Vata Kapha & Tridosha. Hence it can be concluded that Eka Kushtha is Tridosha Vyadhi with predominance of Vata Kapha. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 75 
  • Disease Review Review Of Literature       SAMPRAPTI OF EKAKUSHTHA NIDANA Aharaja/Viharaja/Acharaja/Manasika Bijadoshaja Agnimandya Tridosha Dushya Khavaigunya Prakopa Shaithilya Amotpatti Rasen Saha MishribhuyaTiryaga Sira Gamanam Dushya Dushti (Tvacha, Rakta, Mamsa) Dosha – Dushya Sammurchana SrotoDushti (Rasavaha, Raktavaha, Mamsavaha, Svedavaha) Lakshanotpatti (Asvedanam ,Mahavastuma etc.) Uttarotar Dhatupravesha (Nail deformity, Psoriatic Arthritis etc.) To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 76 
  • Disease Review Review Of Literature       PURVARUPA: The laxanas, which appear before the manifestation of the disease are known as Purvarupa’. Though there is no specific description about Purvarupa of Eka kushta in the classical texts, but being a variety of Ksudrakushta, the Purvarupa of Kushta may be considered as its Purvarupa.87-94 Table no.64 Showing Purvaroopa according to different acharyas. NO PURVAROOPA Cha. Sus. A.S. A.Hr. B.S. H.0 V. A LOCALISED 1. Aswedanam + + + + - - + - 2. Atiswedanam + + + + + - + 3. Parushyam + + - - - + - 4. Atislakshnata + - + + - - + 5. Vaivarnyam + + + + + - + 6. Kandu + + + + - + + 7. Nishtoda + - + + - + + 8. Suptata + + + + + + + 9. Pariharsha + - + + - - - 10. Lomaharsha + + + + + + - 11 Kharatvam + - + + - - + 12 Usmayanam + - - - + - - 13 Gauravam + - - - + - + 14 Svayathu + - - - - - - 15 Kothonnati + - + + - - + 16 Visarpagaman + + - - - - - am 17 SvalpamapiVr + - + + - - + ananam Dushti asamrohananm 18 Raaga - - - - + - + 19 Roukshyam - - - - + - + B GENERALISED 1. Shrama + - + + - - + 2. Klama + - - - + - - 3. Kayachhidresu + - - - - - - Upadeha 4. Rakta - + + + - - + krishnatvam 5. Dourbalya - - - - + - + 6. Pipasa - - - - + - +   To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 77 
  • Disease Review Review Of Literature       RUPA OF EKAKUSHTHA Rupa appears during the fifth Kriyakala and this is also referred to as the ’Vyakti’ stage. The detailed description of Rupa of Ekakushtha found in various Ayurvedic classics is being presented as here;Rupa of Ekakushtha concluded here are as follows95-98 Asvedanam Mahavastum Matshyashakalopama Krishna Aruna Varna Vaisarpodbhavam Srava Mandala Abhrakapatrashama lesion. SADHYASADHYATA As a young tree can be cut very easily and it’s cutting involves excessive effort when the tree is well grown. So also the disease is easily curable in its primary stage, it become incurable or difficult to cure as and when it reaches the advanced stage.99 A physician who can distinguish between Sadhya and asadhya vyadhis and initiates treatment in time with the full knowledge about various aspects of therapies can certainly accomplish his object of curing the disease. On the other hand a physician who undertakes the treatment of an incurable disease would undoubtedly subject himself to the loss of Artha, Vidya, Yasha and also earn Janapavada. 100 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 78 
  • Disease Review Review Of Literature       Incurable type of kushta does not overcome their incurability but the curable ones overcome their curability if the patient resorts to unwholesome regimens even after the disease. Excluding Kakanaka, six other types of these kushtas which are normally curable may become incurable in the event of the lack of proper treatment or resort to unwholesome regimen. 101Prognostic criteria in case of kushta 102Sadhya variety: If kapha and vata are simultaneously vitiated in the pathogenesis of the disease, but only one of these two doshas is predominant then it is not difficult to cure.Kashta Sadhya: The patient suffering from kushta caused by the simultaneous vitiation of two doshas viz. kapha and pitta or vata and pitta is difficult to cure.Asadhya: 1. The patient of kushta with the signs and symptoms of all the three predominant vitiated doshas. 2. The patient who is Abala. 3. The patient who is suffering from Trishna and Daha 4. The patient having Mandagni 5. The patient having Krimi in the patches of kushta To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 79 
  • Disease Review Review Of Literature      The summery is shown in table below Table no.65 Showing Sadhya-Asadhyata103,104 SADHYA ASADHYA 1 Generalised features Atmavat (Who can able to tolerate *Thirst, Burning, Agnimandya,Alpa any type of Medicine or treatment) balavan *Rakta netra, Hata Svaram, Panchakarmagunatita, Prasratanga 2 Localised features Absence of Krimi Krimi utpatti 3 Predominance of Dosha Vata-Kaphaja Kushtha , Kapha- Tridosha dominance Pitta or Vata-Pitta or only one Dosha 4 Involvement of Dhatu Tvacha, Rakta or Mamsa Medogata, Asthigata, Majjagata & dhutagata Shukragata 5 Specific type of Kushta114 Kapala , Audumbara, Sidhma, Kakanaka, When Sadhya Kushta are not Mandala, Aruna Rushyajihva, treated properly in time or neglected Pundarika types of Kushta these becomes Asadhya 6 Other features Minimum symptoms with Kushta having all the symptoms along Absence of complication. with complications like Angapatan, Jvara,Atisara etc114 Adibalapravrutta Kushta115. 105 According to the involvement of the dushyas classified as Kushta confinedto Twak, Rakta and Mamsa are Sadhya,Kushta confined Medo dhatu areKashtasadhya,Kushta confined to Asthi, Majja, Shukra dhatu are Asadhya.According to Sushrutacharya kushta is considered as one amongst Astamahagadasand are said as Dushchikitsya. 106 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 80 
  • Disease Review Review Of Literature       UPADRAVA: The word upadrava is composed of two terms, viz. ‘Upa’ meaning paschat(afterwords) and ‘Drava’ (dravati = upaiti ) meaning to appear. 107 If the sadhya kushtas are not treated properly at a proper time then Krimi will be seen in the Twak, Mamsa, Shonita, Lasika, Kleda, and Sweda. These krimi vitiate the doshas leading to complications which are described below separately.108 1. Vataja: Shyava, Aruna varna, Parooshata, Rookshata, Shoola, Shosha, Toda, Vepathu,. Harsha, Sankocha, Ayasa, Stambha, Supti, Angabheda 2. Pittaja: Daha, Sweda, Kleda, Kotha, Srava, Paka, Raga. 3. Kaphaja: Shwaitya, Shaitya, Kandu, Sthairya, Goutava, Utseda, Upasneha, Upalepa. 4. Krimis affect the Twachadi four dhatus and Sira, Snayu, Asthi (taruna-nsasthi ARISHTA LAXANASArishtas are the symptoms produced in diseases suggest the definite death of apatient109. • Sushrutacharya says that, if sudden drastic and abnormal changes occur in the physical and mental constitutions of a patient without any appropriate reason, the symptoms produced by such changes may be considered as Arishta110 Here the arista laxanas of kushta are mentioned as follows 111 • If even the slightest injury gives rise to excessive wound in the body and the wound do not heal up, To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 81 
  • Disease Review Review Of Literature       • If in a dream a person naked anointed with ghrita offering oblations to the fire without flame, • If in dream he has growth of lotus flower in his chest then he dies of kushta.112 • If the patient having Visheerna anga, Rakta netra, Hataswara, Mandagni and studded with jantu and also having Trishna, Atisara then the patient is going to die of kushta 106(88) Apart from these, other criterias have been explained as, • The poorvaroopas of the diseases are manifesting themselves excessively are sure sign of imminent death of the patient. 113 • Patient having the signs and symptoms related to sparsha, like feeling of kharatwa in organs having shlakshnata, persistent sweating or its total absence, appearance of hardness, coldness in organs which normally remain constantly hot etc. such signs and symptoms without any appreciable cause are indicative of imminent death. 114 CHIKITSAWhile explaining line of treatment for different varieties of Kushtha, Charaka hasmentioned that all the Kushthas are caused by Tridosha, so the treatment is to becarried out according to the predominance of Dosha. The predominately vitiatedDosha should be treated first and the treatment of the other subordinate Dosha shouldbe undertaken afterwards115. To study the treatment of Kushtha systemically, it isnecessary to look at three principles of the treatment which are described by Charakain Krimi Chikitsa i.e. Samshodhana, Samasamana and Nidana Parivarjanaseparately116. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 82 
  • Disease Review Review Of Literature       A) SAMSHODHANA: The therapy which expels out the morbid Doshas from the body is known as Shodhana117 Medicines given after Shodhana are more effective. All Acharya’s have emphasized on Shodhana therapy in the management of Kushtha due to some basic things related to Kushtha Roga which are : A person having Kushtha Roga is called ‘Bahu Doshi’ because of vitiation of Dosha in greater extent 118 Kushtha is considered as a Tridoshaja Vyadhi119and in Kushtha, Doshas are ‘Tiryaggami’ By nature, Kushtha is difficult to cure disease, so it is called ‘Duschikitsya’. But by the application of Shodhana therapy, cure of the disease becomes easier due to removal of the root cause, hence Shodhana has great importance. According to Charaka & Vagbhata Shodhana should be carried out according to predominance of vitiated Dosha. For instances in Vata dominance Ghritapana, in Kapha dominance Vamana and in Pitta dominance Virechana, Raktamokshana are to be carried out 120 In excessive morbidity of the Doshas repeated Shodhana should be performed at regular intervals i.e.Vamana Karme once in 15 days;Samsrana once in month; Raktamokshana once in 6 months; Nasya Karma once in 3 days121.Sushruta has advised to carry out ‘Ubhayato Samsodhana’ even at the Purvarupa condition of Kushtha. Sushruta also advised Samsodhana in the treatment of Rasagata, Raktagata, Mamsagata and Medogata ushtha 122. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 83 
  • Disease Review Review Of Literature       (B) SHAMANA CHIKITSA : Shamana therapy is also an important part of the treatment of Kushtha. After completing the Shodhana Karma, Shaman Chikitsa is indicated to subside the remaining Doshas. Shamana Chikitsa is very useful in those patients who are unable to undergo or contraindicated for Samshodhana. Charaka has advised Shamana therapy with Tikta and Kashaya Dravyas after administration of proper 123 Shodhana .Charaka has also indicated several other drugs & formulation of Shamana therapy in 7th chapter of Chikitsa Sthana.(C) Bahya Chikitsa124: Kushtha, being exhibited through the skin, external application are also advocated. For the external application drug should be applied after elimination of the Doshas from the body by Shodhana Karma and Raktamokshana. Various forms of local application are prescribed like Udvartana, Pralepa, Parisheka, Abhyanga, etc. Kshara Karma and Agada Karma are also prescribed in special condition of Kushtha In short it may be said that the treatment of Kushtha may divided into three parts i.e. treatment according to the predominance of Doshas, internal & external purification.(D) NIDANASYA PARIVARJANAM : It means to avoid etiological factors. Main etiological factors of Kushtha are Mithya Ahara-Vihara & Viruddha Ahara so they should be avoided. Acharya Charaka has defined ‘Pathya’ as they are the wholesome drugs and regimen which do not adversely affect the body and mind. Those which adversely affect them are considered to be Apathy125 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 84 
  • Disease Review Review Of Literature        Following Pathya Apathya are described for Kushtha hence for Eka Kushtha also. PATHYAPATHYA 126,127 Table no.66 Showing Pathya-Apatha. VARGA AHARA DRAVYA AOUSHADHA / CHIKITSA PATHYA APATHYA PATHYA APATHYA Shukadhany Shali, Yava, - - Godhooma, Tila Purana dhanya. Nishpava,Shambidhan-ya Mudga, Hayanaka,Yav- Priyangu, Tuvarak Kulattha, Adhaki, aka,Chinaka, Masha Uddalaka, Masha Masoora Anoopa mamsa, Jangala mamsa rasa Anoopa Mamsa varga Jangala mamsa Matsya mamsa rasa, vasa Shakha varga Patola ,Tiktka Moolaka, Nimba,chakramardala Atasi, shaka,Punarnav Kakamachi,Udd ,Avalguja, Atarushaka, Lakucha Shaka,Karvelka alaka,Kusumb- Aragvada, Khadira ha Tila Phala varga Ashada phala, - Brahati phala, - Jatiphala Koshataki, Bhallatak, Triphala Gorasa varga Purana Sarpi Ksheera,Dadhi - - Taila varga Tikta ghrita, taila of Tila taila Nimba, Ingudi, Saral Sarshapa taila Tila tail Agaru, Devadaru, Shimshipa Ikshu varga Makshika Ikshu, Guda Makshika - - - Go,Khara,Ushtra,Ashva - Mutra varga ,Mahishi mutra - Sahyadri,Vindh Khadirodaka - Jala Varga ya samudbhva nadi jala Lagu Amla rasa Kasturika,Gandhasara;v Other & Hitakara Dravya, aman in every 15 days; Anna Vidahi,Vishtam once in a month rechan; DivaswapAt bi,drava-guru Nasya karma in every apa sweda,, anna,Pishta 90 days; Rakta Vyavaya vikara,Virudha mokshana once in 6 pana-Ashana month, Kshakarma, To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 85 
  • Disease Review Review Of Literature       PSORIASIS Psoriasis is the one of the longest known illnesses of humans. A noncontagiousinflammatory skin disease characterized by recurring reddish patches covered withsilvery scales.ETYMOLOGICAL DERIVATION:Psoriasis is derived from Greek words psorian "to have the itch," from psora "itch,"related to psen "to rub."DEFINITION:Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales124HISTORY:It is believed that the tzaraat disease mention in the Bible is similar to Psoriasis.. Infirst century Cornelius Celsus ( Roman writer ) described a skin condition similar topsoriasis and classified it as a fourth variant of ImpetigoPsoriasis became part of the medicinal literature after Joseph Jacob Plenck of Viennain 1776 as scaly or scale like diseases.Robert Willan ( 1757-1812 ), an englishdermatological doctor along with Thomas Bateman recognized this disease as anindependent disease. They divided it into 2 classes 1) Leprosa Graecorum, as thecondition when the skin had scales ; andPsora Leprosa, as the condition when it became eruptive.In 1841, Ferdinand von Hebra ( Viennese skin specialist ) ascribed the name psoriasisfrom the Greek word psora or to scratch in the English compendium. He is also the To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 86 
  • Disease Review Review Of Literature      one who described the clinical image of psoriasis that is used today.It was during the20th century that psoriasis was further differentiated into specific types125.PREVALENCE :The prevalence of psoriasis in Western populations is estimated to be around 2-3%.The prevalence of psoriasis among 7.5 million patients who were registered with ageneral practitioner in the United Kingdom was 1.5%. A survey conducted by theNational Psoriasis Foundation (a US based psoriasis education and advocacy group)found a prevalence of 2.1% among adult Americans. The study found that 35% ofpeople with psoriasis could be classified as having moderate to severe psoriasis125.ETIOLOGY:The cause is unclear but involves immune stimulation of epidermal keratinocytes; Tcells seem to play a central role. And certain genes and HLA antigens (Cw6, B13,B17) are associated with psoriasis.Hereditary:About one-third of those with psoriasis have a family member with the disease. Whenboth parents have psoriasis, there is a 50-percent chance their child will havepsoriasis.Triggering factors:Psoriasis is a skin condition characterized by flare-ups and remissions. Although theseflare ups can occur on its own, but there are some factors which can trigger anoutbreak of psoriasis or may cause aggravation. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 87 
  • Disease Review Review Of Literature      Trauma –All types of trauma can lead to the development of plaque psoriasis (eg, physical,chemical, surgical, infective, and inflammatory). The development of psoriatic lesionsat a site of injury is known as the Koebner phenomenon.Infection:An acute eruption of guttate psoriasis may be provoked by streptococcal pharyngitis.HIV infection may be associated with increase in disease severity.Drugs:Lithium ,withdrawal of systemic corticosteroids, beta-blockers, antimalarials, andNSAIDs may cause flare of the diseaseSunlight:Although sunlight is generally considered to be beneficial for most of the patients,strong sunlight may worsen the disease in a small minority .Stress:Many patients report an increase in the psoriasis severity with psychological stress.Smoking:Cigarette smoking is associated with an increased risk of chronic plaque psoriasis.Alcohol:Alcohol is considered a risk factor for psoriasis, particularly in young to middle-agedmales. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 88 
  • Disease Review Review Of Literature      Endocrine:The disease state may fluctuate with hormonal changes. Psoriasis may begin duringpuberty. Pregnancy may improve the disease. while a flare may occur during post-partum period.Irritation:Irritation caused by cream, traditional herbal application, strong soap, srubs anddetergents (especially detergents for hands).Climate:Cold dry wintery climate, excessive sun exposure, sunburn, hot humid climate cancause itch and other discomfort. PATHOLOGYThe exact immunopathogenesis of psoriasis is unknown, but immunologic factorshave been implicated in its etiology. Psoriatic plaques are characterized by epidermalhyperplasia, presence of acute and chronic inflammatory cells vascular changes ofinflammation. The epidermis and dermis of an active psoriatic plaque containincreased numbers of several different cells of the immune system,including activated T cells, activated antigen-presenting cells (APCs), neutrophils,and hyperproliferating keratinocytes. The activation of APCs, keratinocytes or dermalcells may result in induction of antigen presentation, cytokine release, and enhancedT-cell activation and lymphokine release.. Lymphokines, in turn, produceinflammation and hyperproliferation of epidermal cells. Accelerated epidermal cellproliferation results from recruitment of a large proportion of resting cells into theproliferative cycle. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 89 
  • Disease Review Review Of Literature       Genetic Background Provocating Factors Exogenous/Endogenous antigens Antigen presentation by APCs T lymphocyte- mediated Immune response Secretion of cytokines Inflammation & cellular hyperproliferation Clinical Lesions of psoriasis CLINICAL FEATURES: The typical lesions of psoriasis have the following features; The lesions are very well marginated with distinct border. The lesions are raised above the surface. The plaques usually have a diameter of one to several centimeters and have a round or oval shape. The lesions may merge together to give rise to geographic patterns. The plaques typically have a rich red color and may be surrounded by a pale halo ( the halo of Woronoff). The lesions are covered with a silvery white, mica-like, loosely adherent scales which, on removal may reveal punctate bleeding points (Auspitz sign) To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 90 
  • Disease Review Review Of Literature      Symmetry:The lesions are symmetrically disposed on extensor surfaces of the body. Typical sitesof affection are the elbows, knees, shin, knuckles, sacral areas and scalp.Uniformity:The psoriatic plaques tend to have the same features irrespective of site except forcertain locations like the palms and soles, and the flexors.Variations of lesions:Variations by morphology or shape:Apart from the typical plaque lesions, guttate lesions and pustules, lesions may takeon a variety of morphological forms and shapes. Verrucous, lichenoid, follicular,linear, annular, figurate, gyrate are some of the terms used to describe these variants.Variations by site:Scalp: Diffusely involved. Thick scales no hair loss.Penis:. Well-circumscribed, reddish plaque without scales.Hands and feet: Diffuse hyperkeratosis, Thick scales, fissures.Sacral regions: thick fissures plaques, scaling may be absent.Nails: involved in 25 to 50% of cases.Candle-grease Sign-(Tache de bouge) When a psoriatic lesion is scratched with the point of a dissectingforceps, a candle-grease-like scale can be repeatedly produced even from the non-scaling lesions. This is called the Candle-grease Sign (Tache de bouge).Auspitz sign-The complete removal of a scale produces pin-point bleeding is called Auspitz sign.The lesions are slightly raised above the surface of the skin, but there are noindurations. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 91 
  • Disease Review Review Of Literature      Koebners phenomenon-Psoriatic lesions may develop along the scratch lines in the active phase; this is calledKoebners phenomenon (other common diseases in which Koebners phenomenonoccurs are warts and lichen planus). Types of presentations: Plaque psoriasis Gradual appearance of discrete, erythematous papules or plaques covered with thick, silvery, shiny scales Lesions that remit and recur spontaneously or with appearance and resolution of triggers Guttate psoriasis Abrupt appearance of multiple plaques 0.5 to 1.5 cm in diameter, usually on the trunk in children and young adults after streptococcal pharyngitis Erythrodermic Gradual or sudden onset of diffuse erythema, usually in psoriasis patients with plaque psoriasis (though may be the first presentation); typical psoriatic plaques are less prominent or absent Most commonly caused by inappropriate use of topical or systemic corticosteroids or light therapy Generalized Explosive onset of widespread erythema and sterile pustules pustular psoriasis Pustular psoriasis Gradual appearance of deep pustules on palms and soles of the palms and Flare-ups may be painful and disabling soles Typical psoriatic lesions may be absent Inverse psoriasis Psoriasis of inguinal, gluteal, axillary, inframammary, and (flexor Psoriasis) retroauricular folds and of the glans of the uncircumcised penis Possibly formation of cracks or fissures in the center or edge of involved areas To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 92 
  • Disease Review Review Of Literature       COMPLICATIONS: • Many of the complications (pustular psoriasis, erythroderma) are commonly due to inappropriate and aggressive therapy. • Psoriatic arthritis. • Pustular psoriasis. • Erythroderma and its metabolic complications. • Infection, particularly Staph. infections of the patches. • Eczematization due to topical agents. • Amyloidosis , rare sequel to arthropathic of pustular psoriasis. • Psychological consequences : depression, anxiety, lack of self-esteem. • Potential complications of systemic therapy should not be overlooked PROGNOSIS: • The disease rarely is life threatening, but often is intractable to treatment with relapses occurring in the majority of patients. • Both early onset and family history of disease are considered poor prognostic indicators. • Some suggest that stress also is associated with an unfavorable prognosis. TREATMENT As Psoriasis is a complex disorder that negatively impacts quality of life,So treatment strategies must address both psychosocial and physical aspects of the disease. Psoriasis can be categorized into localized and generalized forms for treatment purposes. In either case, the treatment plan should include obtaining rapid control of the disease and maintaining that control. For To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 93 
  • Disease Review Review Of Literature       localized disease, recent data support the combined use of topical corticosteroids with a non corticosteroid agent (topical calcipotriene or tazarotene). For generalized disease, UVB phototherapy is an effective treatment that permits both rapid control and long-term maintenance143. Management principles Treatment is as much guided by the patients perception of their condition as by the objective severity of it. Treatment options have to take into account the patients ability to understand and follow through with treatment (as there can be issues relating to acceptability of certain treatments). Patient education is important: it is just as important for them to know how to apply their treatment as it is for them to be clear about the management steps decided in their particular case. Associated psychological problems need to be specifically addressed and if necessary, treated in their own right. Most patients with mild or moderate plaque psoriasis responding to topical treatment can safely be managed in the community. There are three main categories of treatment: local agents, phototherapy and systemic therapy. These may be used sequentially, in combination or in rotation. No active treatment is one of the treatment options144. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 94 
  • Disease Review Review Of Literature       There can be substantial variation between individuals in the effectiveness ofspecific Psoriasis treatments. Because of this, dermatologists often use a trial-and-error approach to finding the most appropriate treatment for their patient. Thedecision to employ a particular treatment is based on the type of psoriasis, itslocation, extent and severity.The patient’s age, gender, quality of life, co morbidities, and attitude toward risksAssociated with the treatment are also taken into consideration.Medications with the least potential for adverse reactions are preferentially employed.If the treatment goal is not achieved then therapies with greater potential toxicity maybe used. Medications with significant toxicity are reserved for severe unresponsivepsoriasis. This is called the psoriasis treatment ladder. • As a first step, medicated ointments or creams are applied to the skin. This is called topical treatment. • If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This type of treatment is called phototherapy. • The third step involves the use of medications which are taken internally by pill or injection. This approach is called systemic treatment. Sulphur was fashionable as a treatment for psoriasis in the Victorian and Edwardian eras. It has recently re-gained some credibility as a safe alternative to steroids and coal tar. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 95 
  • Disease Review Review Of Literature        Treatments for Localized Psoriasis • Tar • Topical corticosteroids • Topical calcipotriene • Topical tazarotene • Anthralin (short contact therapy) • Corticosteroid tape (Cordran tape) • Intralesional triamcinolone Treatments for Generalized PsoriasisUVB Phototherapy Safe and effective for both initial clearing and long term control. Efficacy may be increased by day treatment regimens or combination with low-dose acitretin. Narrow-band UVB may be more effective than broadband.Psoralen + UVA More effective than broadband UVB but causes high risk of(PUVA) and PUVA + Cutaneous malignancy. PUVA should probably be used inacitretin (Re-PUVA) combination with oral retinoids when possible to help minimize PUVA exposure.Acitretin (Soriatane) Very effective therapy for pustular psoriasis. Less effective as a monotherapy for plaque psoriasis. Very helpful as an adjunct to phototherapy. Relatively safe as a long-term treatment.Methotrexate Highly effective therapy. Patients appreciate the simplicity of the treatment regimen. There is the risk of life-threatening hematologic toxicity at any time during therapy and both acute and chronic hepatotoxicity. Careful monitoring is essentialCyclosporine (Neoral) Very effective treatment. Especially helpful for immediate control of severe disease. Less helpful as a long-term therapy (>1 year) due to renal toxicity.Other immune • Mycophenolate mofetil- helpful in combination withinhibitors other drugs. Monitor for hematologic toxicity. • Hydroxyurea- helpful for patients with cirrhosis who require systemic therapy. Close hematologic monitoring is essential. • Leflunomide- Very long half-life; requires special protocol to speed clearance. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 96 
  • Disease Review Review Of Literature       SELF CARE Keep skin lubricated. Oils, creams and petroleum jelly preparations are suggested. Use a humidifier in the home. Get out in the sun. Be careful not to burn. Exposing only the areas of your body with active psoriasis may be optimal. Bathing in hot water may help reduce scaling. Use mild soaps or soap-free cleaners. Mild soaps such as Nivea Cream, Neutrogena Dry Skin, Dove, or Lever 2000 are recommended. Minimize stress. Protect against skin injuries and skin infections. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 97 
  • Drug review Review of literature DRUG REVIEW Drugs used for the study can be explained under following headings 1. Drug for Pachana & Deepana 2. Drug for Sneha paana 3. Drug for Abhyanga 4. Drug for Virechana Karma : Virechana dravyas. PACHANA & DEEPANA DRUG Table no.67 Showing Ingredients of Chitrakadi Vati1 Sanskrit Latin name/ Rasa Guna Veerya Vipaka Doshaghna Karma Name Family ta Chitraka Plumbago Laghu, Ushna Katu Vata- Deepana, zeylanica/ Katu Ruksha, kaphahara Pachana, Tikshna GrahiPippali Mula Piper longum/ Laghu, Ushna Katu Kapha-vata Deepana, Katu Ruksha hara Pachana,Yava Kshara Potassium Laghu, Ushna Katu Kapha-vata Deepana, carbonate Katu Snigdha, hara Pachana, SukshmaSarji Kshara Arthrocnemem Teekshna, Ushna Katu Vatahara Deepana, indicum - Katu Pachana Saindhava - Sodium Laghu, Sheeta Madhura Tridoshahara Deepana, lavana chloride Lavana Snigdha Pachana Ruchya,Souvarchala - Laghu, Ushna Madhura Vatahara Deepana, lavana Lavana Snigdha, PachanaVidalavana - Laghu, Ushna Madhura Kapha- Deepana, Lavana Teekshna, vatahara Ruchya, SukshmaOudbhidha - Laghu, Atyushna Katu Kapha- Deepana, lavana Lavana Teekshna, vatahara Bhedana Vishada, Sukshma Samudra - Snigdha Natyushna- Madhura Vatahara Deepana, lavana Lavana nati Ruchya, sheetala Bhedana Shunthi Zingiber Laghu,Ruksh Ushna Madhura Vata- Deepana, officinale/ Katu a, Tikshna kaphahara Pachana, Zingiberaceae Maricha Piper nigrum/ Laghu, Ushna Katu Kapha-vata Deepana Piperaceae Katu Tikshna hara Pippali Piper longum/ Laghu,Snigd Ushna Madhura Kapha-vata Deepana Piperaceae Katu ha, Tikshna hara Hingu Ferula narthex/ Laghu, Ushna Katu Kapha-vata Deepana, Umbelliferae. Katu Snigdha, hara Pachana To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 98
  • Drug review Review of literature Tikshna Ajamoda Apium Katu, Tikta Laghu,Ruksh Ushna Katu Kapha-vata Deepana, graveolans/ a, Tikshna hara Pachana Umbelliferae. Chavya Piper chaba/ Katu Laghu, Ushna Katu Kapha-vata Deepana, Piperaceae. Ruksha hara Pachana Matulunga Citrus Amla, Laghu,Snigd Ushna Amla Vata- Deepana medica/Rutacea Madhura ha kaphahara e Dadima Punica Kashaya, Laghu,Snigd Ushna Amla Vata- Deepana granatum/ Amla, ha kaphahara Punicaceae Madhura SNEHA PANA DRUG2: Table no.68. Showing ingredients of Guduchi Ghrita: Drug Latin name/ Rasa Guna Veery Vipak Doshaghnat Karma Family a a a Guduch Tinospora Tikta, Guru Ushna Madhur Tridosha Kushtagna, i cordifolia/ kashaya. snigdha a shamaka. krimighna. Menispermaceae . . Ghrita Madhur Snigdh Sheeta Madhur Tridosha hara Pitta a a a saraka,deepena Rasayana,sangrahi . ABHYANGA DRUG: Table no.69 Showing ingredients of Madhuyashti taila 3 Drug Latin name/ Rasa Guna Virya Vipaka Doshagn Karma Family ataYashtimadh Glycyrrhiza glabra/ Madhura Guru Sheeta Madhura Tridosha Rasayana u. Leguminosae. snigdha hara vrushya. Manjishta Rubia Tikta, Guru, Ushna Katu Kaphapitta Rakta cordifolia/Rubiaceae. kashaya ruksha shamaka prasadaka. Jivanti. Ledtademia Madhura Laghu, Sheeta Madhura Tridosha Snehana reticulate/Asclepiadacea snigdha hara anulomana. e.Shalaparni Desmodium gangetium/ Madhura, Guru, Ushna Madhura Tridosha Deepana, Leguminosae. tikta. snigdha. shamaka anulomana .Shatapushpa Foeniculum valgare/ Madhura, Laghu, Sheeta Madhura Vata pitta Deepana, Umbelliferae. tikta. snigdha. hara. pachana,vrus hya. Durva Cynodon dactylon/ Madhura, Laghu, Sheeta Madhura Tridosha Kushtaghna, Graminae. kashaya, snigdha. hara. Vrana ropana. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 99
  • Drug review Review of literature Shatavari Asparagus racemous/ Madhura, Guru, Sheeta Madhura Vatapitta Medhya,hrid Liliaceae. tikta. snigdha. shamaka. ya. Padmaka Prunus cerasoides/ Kashaya, Laghu Sheeta Katu Kaphapitta Varnya,kand Rosaceae. tikta. shamaka ughna. Chandana Santalum Tikta, Laghu, Sheeta Katu Kaphapitta Varnya,hridy album/Santalaceae. madhura. ruksha shamaka a. Sariva Hemidesmus indicus/ Madhura, Guru, Sheeta Madhura Tridosha Deepana,pac Asclepiadaceae. tikta. snigdha. shamaka. hana, anulomana.Ashwagandh Withania somnifera/ Tikta, Laghu, Ushna Madhura Kapha vata Vajikara, a Solanaceae. katu. snigdha. shamaka. krimighna Aindri Bacopamonnieri/ Tikta Laghu Ushna Katu Kaphavata Medhya,deep Scrophulariaceae. shamaka. ana, pachana. Agaru Aquilariaagallocha/ Katu,tikta Laghu, Ushna Katu Kapha vata Kushtagna, Thymelaceae. ruksha. shamaka. anulomana. Twak Cinnamon zeylanicum/ Katu,tikta Laghu,ru Ushna Katu Kapha vata Deepana, Lauraceae. madhura. ksha, shamaka. pachana. tikshna. Arjuna Terminalia Kashaya Laghu, Sheeta Katu Kapha pitta Hridya,vrana arjuna/Combretaceae. ruksha. shamaka. ropana.Jatamamsi Nordostachys Tikta,kashay Laghu, Sheeta Katu Tridosha Medhya,baly jatamansi/Valerianaceae a snigdha. hara. a. . madhura. Tamalaki Phyllanthus urinaria/ Tikta,kashay Laghu, Sheeta Madhura Kapha pitta Kushtaghna Euphorbiaceae. a ruksha shamaka. , madhura. vranaropana. Varahi Dioscorea bulbifera/ Katu,tikta Laghu, Ushna Katu Tridosha Krimighna, Dioscoreaceae. madhura. snigdha. hara. anulomana.Talisa patra Abies webbiana/ Tikta, Laghu, Ushna Katu Kapha pitta Shwashar Pinaceae. madhura. tikshna. shamaka. anulomna. Guduchi Tinospora cordifolia/ Tikta, Guru Ushna Madhura Tridosha Kushtagna, Menispermaceae. kashaya. snigdha. shamaka. krimighna. Vidari Pueraria tuberosae/ Madhura Guru Sheeta Madhura Vata pitta Varnya, Leguminosae. snigdha shamaka. hridya. Tila taila - Madhur Guru, Ushna Madhura Kaphavata Brimhana, (Kashaya Vikashi shamaka Lekhana, Tikta) Vishada, Sukshma Tvachya, Keshya, Ksheera - Madhura Guru, Sheeta. Madhura Vata pitta Prenaneeya, pichila hara. bhrimhaneey a. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 100
  • Drug review Review of literature VIRECHANA DRUG4: Table no.70 Showing Ingredients of Abhayadi Modaka. Drug Latin name/ Rasa Guna Virya Vipaka Doshagnata Karma name FamilyHaritaki Terminalia chebula/ Pancharasa, Laghu, Ushna Madhura Tridosha Anuloma Combretaceae lavana ruksha shamaka na, varjitha. Deepana, Pachana.Maricha Piper nigrum/ Katu Laghu, Ushna Katu Kapha vata Deepana Piperaceae tikshna haraShunti Zingiber Katu Laghu,ruksha, Ushna Madhura Vata kapha Deepana, officinale/Zingiberaceae tikshna hara pachanaVidanga Embelia ribes/ Kashaya, Laghu,tikshna Ushna Katu Kapha vata Krimighn Myrsinaceae Katu. shamaka a, Kushtagh na.Amalaki Emblica Pancha rasa Guru,ruksha, Sheeta Madhura Tridosha Rasayana. officinalis/Euphorbiaceae lavana sheeta. hara varjithaPippali Piper longum/Piperaceae Katu Laghu,snigdha Ushna Madhura Kapha vata Deepana. tikshna. hara. Twak Cinnamon zeylanicum/ Katu,tikta Laghu,ruksha, Ushna Katu Kapha vata Deepana, Lauraceae. madhura. tikshna. shamaka. pachana.Mustaka Cyperus rotundus/ Tikta,katu Laghu,ruksha Sheeta Katu Kapha pitta Balya, cyperaceae shamaka. medhya. Danti Baliospermum Katu Guru,tikshna Ushna Katu Kapha Virechaka montanum/ vatahara. krimighna Euphorbiaceae . KARAVELLAKA5 Latin Name: Momordica charantia Linn. Family: Cucurbitaceae. Synonyms:-Karavellam,Katillam,Karavelli. Vernacular Names : Hindi –Karela; Kannada –Hagalkayi, Karate;Telugu – Kakar,;Bengali –Karla;Marati –Kaarle;Gujrati –Kareli,;Tamil –Pavakka pakal, Malayalam-Kaipa,English Name- Bitter gourd,Carilla fruit. Gana: According charaka-Tiktaskand. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 101
  • Drug review Review of literature Botanical Description: A monoecious much branched climbing annual with angled and grooved stems and hairy or villous young parts,tendrils simple,slender and elongate. Leaves-Simple,orbicular,cordate and deeply divided into 5-7 lobes. Flowers-Unisexual,yellow on 5-10cm long penduncles. Fruit-5-15cm long,3-valved capsules,pendulous,fusiform,ribbed and beaked bearing numerous triangular,tubercles. Seeds- many or few with shining sculptured surface. Distribution: Cultivated throughout India upto an altitude of 1500cm. Chemical Constituents: Seeds contain 32% Momordicine,cathartic oil and also contains volatile oil.Carotens,glucoside and saponin. Useful Parts: Whole plant. Rasa Panchaka of Karavellka Rasa Tikta,katu. Guna Laghu, Ruksha Virya Ushna Vipaka Katu Doshagnata Kaphapitta shamaka. Karma Kushtagna,bhedana. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 102
  •                                                                               Materials and Methods CLINICAL STUDYThe development of science greatly depends upon experimentation to reveal themysteries of nature and to confirm the previous innovations. The research isincomplete without evaluating the facts clinically. Thus clinical study plays a pivotalrole in the field of research.So here is a clinical study entitled “To evaluate the efficacy of virechana withKaravellaka Patra Swarasa and AbhayadiI Modaka in Eka kushtha w.s.r toPsoriasis - A clinical study ” which is under taken with following Objectives:1. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa in Ekakushta.2. To evaluate the efficacy of Virechana with Abhayadi Modaka in Ekakushta.3. To compare the efficacy of Karavellaka Patra Swarasa and Abhayadi Modaka as Virechaka Yogas.Source of Data:The patients attending the OPD and IPD of S.J.I.I.M., Hospital, Bangalore .Methods of Collection of Data:30 patients who fulfilled the inclusion criteria were selected irrespective of sex,religion, marital status, socio economic status. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 103
  •                                                                               Materials and MethodsDiagnostic criteria:1 .Patients having classical signs and symptoms of Eka kushta supplemented withfeatures of psoriasis such as patchy circumscribed skin lesions with erythematicinfiltration, silvery scales and itching.2. Positive Auspitz’s sign.3. Positive Candle grease sign.Inclusion Criteria: a. Patients who fulfills diagnostic criteria. b. Patients between the age group of 16-70 years. c. Patients who are fit for Virechana.Exclusion criteria: a. Patients below 16 years and above 70 years. b. Patients suffering from any other systemic disorders along with psoriasis like Diabetes mellitus, Hypertension, Ischemic heart disease etc... c. Patients who are unfit for Virechana.Study Design: A Randomized Comparative Clinical Study.Sample size and grouping:30 patients who fulfilled the inclusion criteria were randomly divided into StandardGroup & Trial Group each consisting of 15 patients:Group A: Patients of this group was treated with Abhayadi modaka for virechana.Dose: 1 gm To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 104
  •                                                                               Materials and MethodsGroup B: Patients of this group was treated with Karavellaka patra swarasa forvirechana. Dose: 96ml. Poorva karma.Deepana, Pachana Chitrakadi vati 2 tid Till niramavastha is obtainedSneha Pana Guduchi Ghrita in arohana Till samyak snigdha krama lakshanas obtainedSarvanga Abhyanga With Yashti madhu Taila On 3 days vishrama kalafollowed by Drava Sweda Pradhana karma : Pradhana Karma Standard group Virechana with Abhayadi 1 course modaka Trial group Virechana with 1 course Karavellaka patra swarasa. Assessment Criteria: Assessment of virechana karma will be based on: 1. Laingiki Shudhi 2. Vaigiki shudhi 3. Antiki shudhi Assessment of improvement in Psoriatic lesions following treatment was based on a clinical evaluation and PASI Scale. Subjective Parameters Itching 0 No itching 1 Mild / occasional itching 2 Moderate frequent itching 3 Severe frequent itching To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 105
  •                                                                               Materials and Methods 4 Very severe itching, which disturbs sleep and other routine activities. 0 No scaling 1 Mild scaling by rubbing / by itching (scaling from some lesions) 2 Moderate scaling by rubbing / by itching Scaling (scaling from most of the lesions) 3 Severe scaling by rubbing / by itching (from all lesions) 4 Scaling without rubbing / by itching (From all lesions) Objective Parameters 0 No 1 Mild Erythema 2 Moderate 3 Severe 4 Very severe 4. PASI Scale: To understand overall effect of Virechana karma on Psoriasis, the Psoriasis area and severity index (P.A.S.I) scoring method was adopted as follows. For the PASI, the body is divided into four sections each of these areas is scored by Skin itself and then the four scores are combined into the final PASI. Area: For each Skin Section, measured the amount of skin involve, as a percentage of the skin just at that part of the body (not the whole body - see below), and then assign it a score from 0 to 6: To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 106
  •                                                                               Materials and MethodsCoverage Score 0% 0 < 10% 110-29% 230-49% 350-69% 470-89% 590-100% 6Severity: The severity is measured by four different parameters: Itching, Erythema(redness), Scaling and Thickness (psoriatic skin is thicker than normal skin). Again,each of these is measured separately for each Skin Section. These are measured on ascale of 0 to 4, from none to maximum, according to the following chart:Totaling Up the Index: When all 20 of the above scores are figured out, then we cancalculate PASI. For each Skin Section, add up the four severity scores, multiply thetotal by the area score, and then multiply that result by the percentage of skin in thatsection, as follows:• Head : (Ihead+Ehead+Shead+Thead) x Ahead x 0.1 = Totalhead• Arms : (Iarms+Earms+Sarms+Tarms) x Aarms x 0.2 = Totalarms• Body : (Ibody+Ebody+Sbody+T body) x Abody x 0.3 = Totalbody• Legs : (Ilegs+Elegs+Slegs+Tlegs) x Alegs x 0.4 = Totallegs Finally, the PASI is Totalhead+Totalarms+Totalbody+Totallegs. This PASI will range from 0 (no psoriasis) to 96 (covered head-to-toe, with complete itching, redness, scaling, and thickness). Thus P.A.S.I. was calculated Materials required for the study: To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 107
  •                                                                               Materials and Methods The present clinical study was conducted with the following materials: Drugs – Purva karma: 1) Chitrakadi Vati. 2) Guduchi Ghrita 3) Madhuyashti Taila Pradhana karma: a. Abhayadi modaka . b. Karavellaka patra swarasa c. Ushnodaka d. Sheet jala • Chitrakadi Vati : Chitrakadi vati is obtained from dispensing section of SJIIM Hospital B’lore was used for the purpose of Nirameekarana and Agni deepana. • Guduchi Ghrita: Guduchi ghrita was prepared at Sanjeevini Pharmaceuticals, Kengeri- Bangalore, after procuring the raw drugs from authentic wholesale dealer • Madhuyashti taila : Madhuyashti taila is obtained from dispensing section of SJIIM Hospital B’lore was used for Sarvanga abhyanga. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 108
  •                                                                               Materials and MethodsPreparation of Karavellaka patra swarasa:250gms of fresh leaves of Karavellaka are collected and the juice is extracted fromthe freshly collected plant by pounding and straining through a cloth. It was thenfiltered and given in the quantity of 96ml.Abhayadi modaka:Four tablets of 255mg of Abhayadi modaka from Zandu pharmaceuticals are takenand crushed into fine powder form and filled into the capsule of 1gm(each of 500mg)was prepared and given.Methodology of Study:- The patients who fulfilled the inclusion criteria underwent routineHaematological examination ( T C, D C, ESR AND Hb% ) .An informed consentwas taken from the patient before commencement of the treatment. Then evaluation of subjective and objective parameters was done in patientsand grading was noted.Intervention:All the patients were subjected for procedure of Virechana as follows.Poorvakarma:- All necessary equipments were arranged. All necessary are collected insufficient quantity.Pachana-Deepana was done with Chitrakadi Vati 500mg thrice daily with hot watertill appearance of nirama lakshana. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 109
  •                                                                               Materials and MethodsSnehapana:After appearance of Nirama lakshana Guduchi Ghrita was administered for thepurpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna JalaAnupana was given. The Sneha Pana was started with Hrisiyasi Matra i.e 30 ml.Then according to the symptoms presenting in the individual, the duration taken todigest the given dose of Sneha, the time of appearance of appetite in the patient , thenext day dose was decided.In this pattern Arohana karma Snehapana was followed until the appearance ofSamyak Snigda Laxanas.Patients were advised to avoid exposure to wind , sunlight, emotional upsets, heavywork, excessive talking, laughing , standing for long time , journey , intake of heavymeals, night waking , day sleep, cold comforts.Patients were properly educated about the Laxanas which may appear duringdigestion of Sneha, after digestion.Patients were advised to take only hot water in little quantity till Sneha JeernaLaxanas appears.When patient noticed strong sensation of hunger advised to take the gruel Rice, Ragi,or Rava according to their food habit.When the samyak snigdha laxanas observed, the intake of ghee was stopped.Assesment of Samyak Snighdha Laxanas: Vatanulomana- assessed by the normal expulsion of the flatus, feces. Deeptagni- Based on the time taken for digestion of sneha Asamhata Varchas- based on the consistency of the feces .i e stool will be loose in consistency. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 110
  •                                                                               Materials and Methods Snigdha varcha- confirmed based on nature of stool. Stool will be sticky or pasty , floating of feces over water, Sense of oiliness over the fingers on washing after defecation. Twak snigdhata- it is assessed by comparing the texture of the skin, before and after Sneha pana. Glani- assessed by presence of exhaustion or weakness Angalaghava- By enquiring with the patient about lightness of the body. Snehodhvega- Confirmed by the aversion of the patient towards Sneha Adastath sneha darshana-Appearance of sneha in stool without digestion. Swedana: Once Samyak snigdha lakshana appears then, from next day Sarvanga Abhangya with luke warm Madhuyashti Taila followed by Ushna jala snana as a part of parisheka sweda was performed. Thus Bhaya Snehan and Swedan was performed for 4 days and during this period patient was advised to avoid consumption of Kaphakar Ahara and Vihara. Counseling: On the previous day of Virechana patients were properly educated about the procedure which helped them to understand the procedure as well as to prepare them mentally for Virechana.On the day of virechana :-Preparation of the patient:-Patients advised to get up early in the morning and void natural urges. After that theywere subjected for Abhyanga followed by ushna jala Snana in the similar manner likethat of the previous day. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 111
  •                                                                               Materials and MethodsPreparation of Drugs:Virechana Yoga prepared.Pradhana karama:The Virechana yoga was given to patient after ascertaining about the digestion ofprevious day meal, sleep and after assessing the psychological condition of thepatient. Virechana Aoushada was given in empty stomach in the morning hours inbetween 9.30 AM – 10.00 AM.(Shlema Kalagate).Virechana with Abhayadi modaka with sheeta jala as anupana in Group A patientsand Karavellaka patra swarasa with sukoshna jala anupana in Group B patients.Before & after virechana karma, vitals like Temperature, Pulse, Respiratory rate, B.Pwere recorded & careful monitor of the patients during virechana process was done.Just after the administration of Virechana yoga cold water was sprinkled on the faceto prevent vomiting. Patient was advised to gargle with hot water and avoid exposure to direct coldwind.Patients were advised to avoid Pravahana or Vega DharanaNireekshana:Observation of the patient was made for assessing the number of Vegas, SamyakVirikta Lakshanas and Kaphanta of Virechana vega.Paschat karma:After the Virechana vega was stopped, the patients were asked to follow all theprecautions related to Virechana.After analyzing the procedure, conclusion regarding the Pravara, Madhyama, Avarashuddhi was made and accordingly the sequence of Samsarjana krama was planned. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 112
  • Observations OBSERVATIONS A total of 38 patients were screened for the study, out of which 4 patients found fit for the study. Among these 34 patients, 4 patients did not opt Virechana procedure due to various reasons. A total of 30 patients registered for the study and no drop out is seen All the patients were examined before and after the treatment according to the case sheet format. Changes in both the subjective and objective parameters were recorded. The data recorded are presented here under the following heading – I. Descriptive dataII. Data related to the diseaseIII. Data related to the intervention Descriptive Data. Table No.71 Showing age wise distribution. Age Abhayadi Karavellaka Total % Group Group 21-30 4 3 7 23.3 31-40 3 3 6 20.0 41-50 5 3 8 26.7 51-60 3 3 6 20.0 61-70 0 3 3 10.0 Out of 30 patients 7 belonged to the age group of 21-30, 6 belonged to the age group of 31-40, 8 belonged to the age of group 41-50, 6 belonged to the age group of 51-60 belonged to the age group of 61-70. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 113
  • Observations Table No.72 Showing Sex wise distribution Abhayadi group Karavellaka Group Total % Male 13 12 25 83.3 Female 2 3 5 16.7In present Study 83.3% were Males and 16.7% were Females. Table No.73 Showing Occupation Occupation Abhayadi Karavella Total % ka House wife 0 3 3 10 desk-work 8 8 16 53.3 Field work 2 0 2 6.6 Physical Labour 4 4 8 26.7In present study 10% were house wives, 53.3% occupied with desk work,6.6%occupied with field work, 26.7% occupied with Physical labour Table No.74 Showing Religion wise distributions Religion Abhayadi Karavellaka Total % Group Group Hindu 12 13 25 83.3 Muslim 3 1 4 13.3 christen 0 1 1 3.383.3% of the patients were of Hindu community and 13.3% belonged to Muslimcommunity, 3.3% were Christen. Table no.75 Showing Socio economic Status Socioeconomic Abhayadi Karavellaka Total % Status Group Group Lower middle class 12 14 26 86.7 Upper middle class 3 1 4 13.3The above table shows of patients according to the Socio economic status i.e. 86.7%from lower middle class, 13.3% from upper middle class. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 114
  • Observations Table no.76 Showing Dietary Habits Diet Abhayadi Group Karavellaka Group Total % Veg 5 1 6 20.0 Mixed 10 14 24 80.0 20% Patients were Vegetarians and 80% Patients were of mixed food Habits. Table no.77 Showing Marital status Marital Status Abhayadi Group Karavellaka Group Total % Married 12 14 26 86.7 Un-Married 3 1 4 13.3Only 13.3% patients were unmarried were as majority of the patients (86.7%) weremarried. Table no.78 Showing region. Region Abhayadi Group Karavellaka Group Total % Urban 13 13 26 86.7 Rural 2 2 4 13.390% belonged to urban area and 10 % were from rural population Table no.79 Showing Sleep pattern Abhayadi Group Karavellaka Group Total % Diwaswapna 9 9 18 60 60% of the patients are presenting with history of Diwaswapna, Table 80. Showing Sleep pattern Abhayadi Group Karavellaka Group Total % Ratri 6 2 8 26.7 jagarana 26.7% are presenting with history of Ratri Jagarana. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 115
  • Observations Table no.81 Showing Addictions. Addictions Abhayadi Karavellaka Total Group Group Only Tea / coffee 2 2 4 Only Smoking 3 - 3 Only Alcohol 1 - 1 Only tobacco 1 1 2 Tea / coffee & Smoking - 3 3 Tea / coffee & Alcohol 3 2 5 Smoking & Alcohol 2 6 8 Smoking & tobacco 1 - 1 No addiction 2 1 3In 4 patients Addictions to Tea / coffee was seen, in 4 only smoking ,1patient wasAlcoholic,2 patients were addicted to tobacco,3 Patients had addiction towards Tea/coffee & smoking, 5 Patients had addiction towards Tea /coffee & alcohol, 8 patientswere both Alcoholic & Smokers, 1 had a addiction of Smoking & Tobacco , 3 werewithout any addiction. Table no.82 Showing Koshta. Abhayadi Karavellaka Total % Group Group Kroora 2 3 5 16.6 Madhyama 13 12 25 83.3 Mridhu 0 0 0 0In Present Study maximum patients belonged to Madhyama Koshta, only 16.6%belonged to Kroora Koshta Table no.83 Showing Prakruti Prakruti Abhayadi Karavellaka Total % Group Group Vata Pitta 4 5 9 30.0 Vata Kapha 5 5 10 33.3 Pitta Kapha 5 5 10 33.3 Kapha Pitta 1 0 1 3.3 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 116
  • Observations33.3% patients were of Vata Kapha & Pitta Kapha Prakruti, 30% were of Vata PittalaPrakruti and 3.3% were of Kapha Pittala Prakruti. Table No. 84 Showing Satwa. Satwa Abhayadi Karavellaka Total % Group Group Avara 2 1 3 10 Madhyama 12 12 24 80 Pravara 1 2 3 1080% of the patients were of Madhyama Satwa and 10% of the patients belonged toPravara and Awara Satwa. Table No.85 Showing Satmya. Satmya Abhayadi Karavell Total % Group aka Group Eka Rasa Satmya 0 0 0 0 Vyamishra Satmya 14 13 27 90 Sarva Rasa Satmya 1 2 3 10 90 % were of Vyamishra Satmya and only 10% were of Sarva Rasa SatmyaData related to the disease. Table No.86 Showing presence of family History of Psoriasis Family Abhayadi Karavellaka Total % History Group Group Present 6 2 8 26.7 Absent 9 13 22 73.3In 26.7% of the patients there was family History of Psoriasis where as 73.3% of thepatients did not have any family history. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 117
  • Observations Table no. 87 Showing mental stress as triggering factor Abhayadi Karavellaka Total % Group Group Present 13 13 26 86.7 Absent 2 2 4 13.3In 86.7% of the patients stress was triggering factor of Psoriasis where as 13.3% ofthe patients did not have any such history. Table no.88 Showing seasonal factor. Abhayadi Karavellaka Total % Group Group Present 14 15 29 96.7 Absent 1 0 1 3.3 In 96.7% winter Season aggravated the condition where as 3.3% not affectedby season Table no.89 Showing food as aggravating factor. Abhayadi Karavellaka Total % Group Group Present 2 3 5 16.7 Absent 13 12 25 83.3In 83.3% food was not a aggravating factor in only 16.7% food was worsening thecondition. Table no.90 Showing Drugs as aggravating factor. Abhayadi Karavellaka Total % Group Group Present 1 0 1 96.7 Absent 14 15 29 3.3 In 3.3% drug was not a aggravating factor in only 96.7% drug wasworsening the condition. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 118
  • Observations To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 119
  • Observations Table no.91 Showing infection as triggering factor Abhayadi Karavellaka Total % Group Group Present 2 3 5 16.7 Absent 13 12 25 83.3In 83.3% infection was not a triggering factor in only 16.7% infection was worseningthe condition Table no.92 Showing chronicity. Chronicity in Abhayadi Karavellaka Total % yrs Group Group 0 to5 9 8 17 56.6 6 to 10 3 3 6 20 11 to 15 2 3 5 16.6 21 to 30 1 0 1 3.356.6% patients were having history less than 5 years, 20 % presented with the historywith in 6-10yrs, 16.6% having history in between 11-15 yrs & 3.3% having history inbetween 21-30yrs Table no.93 Showing Distribution of area Area Abhayadi Karavellaka Total % Involve Group Group ment 1 1 0 1 3.33 2 1 3 4 13.3 3 0 4 4 13.3 4 0 3 3 10 5 13 5 18 60Lesions were distributed in only one area in3.3%,2 areas 3 areas involvement is seenin 13.3%, 4 areas involvement seen in 10% & in 60% 5 areas involvement seen. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 120
  • Observations Table no.94 Showing details of Itching Itching Abhayadi Karavellaka Total % Group Group Grade 1 1 0 1 3.3 Grade 2 1 8 9 30 Grade 3 10 4 14 46.7 Grade 4 3 3 6 20Itching Grading 4 was noticed in 20% , Grade 3 itching was seen in 46.7%, 30% weree presenting with Grade 2 itching Grade 1 itching was seen in 3.3% of the patient. Table no.95 Showing details of Erythema Erythema Abhayadi Karavellaka Total % Group Group Grade 1 4 0 4 13.3 Grade 2 2 8 10 33.3 Grade 3 9 4 13 43.3 Grade 4 0 3 3 10Erythema Grade1 was noticed in 13.3% , Grade 2 was seen in 33.3%, 43.3% werepresenting with Grade 3 Erythema, Grade 4 erythema was seen in 10 % of the patient Table no.96 Showing details of area involvement - Head Head Abhayadi Karavellaka Total % Group Group Grade 1 1 3 4 13.3 Grade 2 6 6 12 40 Grade 3 8 6 14 46.7In head13.3% were having grade 1 involvement, Grade 2 category was present in40% of cases, Grade 3 variety was seen in 46.7 % of cases. Table no.97 Showing details of area involvemet - Trunk Trunk Abhayadi Karavellaka Total % Group Group Grade 0 2 0 2 6.6 Grade 1 1 3 4 13.3 Grade 2 3 6 9 30 Grade 3 1 6 7 26.7 Grade 4 7 0 7 26.7 Grade 5 1 0 1 3.3 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 121
  • ObservationsIn 2 patients involvement of trunk is not seen. 4 were having grade 1 involvement,Grade 2 category was present in 9 patients, 7 patients presented with Grade 3 &Grade 4 involvement , grade 5 involvement was seen in 1 patient. Table no.98 Showing details of area involvement - Upper limb Upper Abhayadi Karavellaka Total % Limb Group Group Grade 0 2 0 2 6.6 Grade 1 0 3 3 10 Grade 2 1 6 7 26.7 Grade 3 10 6 16 53.3 Grade 4 2 0 2 6.6In 6.6% patients involvement of upper limb is not seen. 10% were having grade 1involvement, Grade 2 category was present in 26.7% of the patients, 53.3% patientspresented with Grade 3 involvement , grade 4 involvement was seen in 6.6% patients. Table no.99 Showing details of area involvement- Lower limb Lower Abhayadi Karavellaka Total % Limb Group Group Grade 0 0 3 3 10 Grade 1 0 0 0 0 Grade 2 1 3 4 13.3 Grade 3 9 6 15 50 Grade 4 4 3 7 26.7 Grade 5 1 0 1 3.3In10% patients involvement of lower limb is not seen. 13.3% were having grade 2involvement, Grade3 category was present in 50% of the patients, 26.7% patientspresented with Grade 4 involvement , grade 5 involvement was seen in 3.3% patients. Table no.100 Showing details of Auspitz’s Sign + Abhayadi Karavellaka Total % Group Group 15 15 30 100 In all the patients Auspitz’s Sign was positive. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 122
  • Observations Table no.101 Showing details of Candle Grease Sign + Abhayadi Group Karavellaka Group Total % 15 15 30 100In all the patients Candle Grease Sign was positiveObservations Related to Treatment Observations during intervention: Table No102 Showing number of days of Sneha Pana Snehapana Abhayadi Karavellaka Total % Days Group Group 3 7 6 13 43.3 4 5 7 12 40.0 5 2 1 3 10.0 6 1 1 2 6.7In 43.3% patients Samyak Snighdha Laxana seen in 3 days, in 40% of the patientSamyak Snighdha Laxanas seen after 4 days of Sneha pana in 10% of the patientSamyak Snighdha Laxanas seen after 5 days of Sneha pana & in 6.7% of the patientSamyak Snighdha Laxanas were seen after 6 days of Sneha Pana. Table No.103 Showing Samyak Snighdha Lakshanas Samyak Snighda Abhayadi Karavellaka Total % Laxanas Group Group Vatanulomana 15 15 30 100 Deeptagni 15 15 30 100 Snigdha varcha 15 15 30 100 Asamhata varcha 13 14 27 90 Adstat sneha darshna 10 11 21 70 Snehodvega 13 14 28 93.3 Snigdha twak 10 11 21 70 Anga mardava 10 10 20 66.6 Anga laghava 12 11 23 76.6 Glani 10 9 19 63.3In all patients Vatanulomana, Agni Deepti, Snigdha varcha features are seen. Asamhatavarcha is seen in 90% of the patients Adstat sneha darshna & Snigdha twak is seen in 70%,66.6% patients had Anga mardava, 76.6% patients had Anga Laghava, 63.3% had Glani. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 123
  • Observations Table No.104 Showing Samyak Swinna Lakshana Samyak Swinna Abhayadi Karavellaka Total % Laxanas Group Group Sheeto param 10 9 19 63.3 Shoola Param 4 6 10 33.3 Stambha Nigraha 10 11 21 70 Gaurava Nigraha 11 10 21 70 Mardhavata 13 12 25 83.3 Laghuta 12 11 23 76.6 Sweda pradurbhava 15 15 30 100Sweda Pradurbhava seen in all the patients, Mardavata seen in 83.3% Laghuta seen in76.6% Stambha Nigraha & Gourava Nighraha seen in 70% Sheeto param seen in 63.3%,Shoola Param seen in 33.3% Table no.105 Showing Time required manifesting first Virechana Vega. Time in Abhayadi Karavellaka Total % minutes Group Group 1-30 1 2 3 10 31-60 7 9 16 53.3 61-90 7 4 11 36.6Time required manifesting first Virechana Vega after administration of Virechana inmaximum number of patients i.e. 53.3it was between 31-60 minute range, in 36.65 itwas in between 61-90, 10% patients between 1-30 minutes. Table no.106 Showing Virechana Vegas Vegas Abhayadi Karavellaka Total % Group Group 1-10 0 0 0 0 11-20 15 15 30 100 20-30 0 0 0 0All the patients had Vegas in between 11-20.Madhyama Shuddhi was noticed inPatients. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 124
  • Observations Table no.107 Showing Time required for completion of procedure Time in Abhayadi Karavellaka Total % minutes Group Group 101-200 5 4 9 30 201-300 8 5 13 43.3 301-400 2 3 5 16.7 401-500 0 3 3 10In 43.3% of the patient time consumed was in between 201-300 minutes,in 30% inprocedure completed in between 101-200, 16.7% procedure completed in between301-400,in 10% procedure was completed in between 401-500. Table no.108 Showing Laingiki Shuddhi No of Abhayadi Karavellaka Total % Symptoms Group Group 6 13 12 25 83.3 7 2 3 5 16.7In 83.3% percent of the patients 6 symptoms of Laingiki Shuddhi are seen and 16.7%all the Laingiki Shuddhi features are seen. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 125
  • Results RESULTS Statistical analysis of assessment of procedure Table no.109 Showing Statistical analysis is done using Shapiro-Wilk Test Shapiro-Wilk Group Statistic df Sig. Time taken for initiation Abhayaadi .957 15 .647 of vega in minutes Karavellaka .953 15 .576 Time taken for Abhayaadi .965 15 .775 completion in min Karavellaka .882 15 .051 Number of Vegas Abhayaadi .922 15 .203 Karavellaka .926 15 .241 Laingiki shudhi Abhayaadi .413 15 .000 Karavellaka .499 15 .000 a. Lilliefors Significance Correction Time taken for Time taken for initiation of completion in Number of LaingikiGroup vega in minutes min Vegas shudhiAbhayadi Mean±SD 59.3±15.6 237.33±73 16.8±2.6 6.13±0.4Karavella Mean±SD 52.20±15 281.93±125 14.00±1.4 6.20±0.4ka 95% Confidence Sig. Interval of the Difference t df (2-tailed) Lower Upper Time taken for initiation 1.276 28 .212 -4.315 18.582 of vega in minutes Time taken for -1.192 28 .243 -121.267 32.067 completion in min Number of Vegas 3.829 28 .001 1.333 4.400 Laingiki shudhi -.475 28 .638 -.354 .221 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 125
  • Results Statistical analysis of time taken for initiation of VegaThe analysis of mean effect of the parameter time taken for the initiation of Vega(Bout) between the groups indicates Non Significant Result, (as P>0.05). It impliesthat the mean effect of the parameter time taken for the initiation of Vega (Bout) issame in both the groups.Statistical analysis of Total Duration taken for the processStatistical analysis shows that mean effect of the parameter time taken for procedures hown Non significant result (as P>0.05).ie the mean effect is same in both thegroups.From the analysis, the mean effect of the parameter Laingiki shuddhi is Nonsignificant (as P>0.05).ie the mean effect is same in both the groups.Statistical analysis of Number of VegasThe analysis of mean effect of the parameter number of Vegas has shown significantresult (as P<0.05).In Abhayadi Group more Vegas seen compared to KaravellakaGroup.Statistical analysis of Laingiki ShuddhiStatistical analysis shows that mean effect of the parameter Laingiki Shuddhi hasshown Non significant result (as P>0.05).ie the mean effect is same in both the groupsThe effect of therapy on various parameters of the disease can be studied under twoheadings a) With in the group b) In between the group Tests of Normality Kolmogorov-Smirnova Shapiro-Wilk Group A ( Abhayadi) Statistic df Sig. Statistic df Sig. ITCHING B Abhayaadi .367 15 .000 .754 15 .001 T Karavellaka .326 15 .000 .749 15 .001 ITCHING A Abhayaadi .251 15 .012 .798 15 .003 T Karavellaka .402 15 .000 .694 15 .000 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 126
  • Results ERYTHEM Abhayaadi .371 15 .000 .686 15 .000 ABT Karavellaka .249 15 .013 .806 15 .004 ERYTHEM Abhayaadi .433 15 .000 .530 15 .000 AAT Karavellaka .433 15 .000 .530 15 .000 SCALING Abhayaadi .331 15 .000 .744 15 .001 BT Karavellaka .232 15 .029 .883 15 .052 SCALING Abhayaadi .485 15 .000 .499 15 .000 AT Karavellaka .449 15 .000 .614 15 .000 HEAD B T Abhayaadi .252 15 .011 .901 15 .098 Karavellaka .320 15 .000 .783 15 .002 HEAD A T Abhayaadi .214 15 .063 .930 15 .276 Karavellaka .255 15 .010 .782 15 .002 TRUNK B Abhayaadi .294 15 .001 .850 15 .017 T Karavellaka .265 15 .006 .832 15 .010 TRUNK A Abhayaadi .169 15 .200* .936 15 .335 T Karavellaka .186 15 .171 .858 15 .023 ARMS B T Abhayaadi .412 15 .000 .683 15 .000 Karavellaka .354 15 .000 .755 15 .001 ARMS A T Abhayaadi .352 15 .000 .809 15 .005 Karavellaka .263 15 .006 .868 15 .031 LOWER Abhayaadi .344 15 .000 .817 15 .006 LIMB B T Karavellaka .265 15 .006 .832 15 .010 TLOWER Abhayaadi .373 15 .000 .734 15 .001 LIMB A T Karavellaka .219 15 .052 .888 15 .063 a. Lilliefors Significance Correction *. This is a lower bound of the true significance.Within the groupThe data were found to deviate significantly from a normal distribution on ShapiroWilk,s normality tests and hence we decided to analyze the data using Wilcoxonssigned rank test for within group change. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 127
  • ResultsItching:Abhayadi group Z Asymp.sign (2 tailed) Results a -3.376 .001 HSThe P<0.001 indicating the Virechana with Abhayadi Modaka is highly effective inreducing itching.In Karavellaka Group Z Asymp.sign (2 tailed) Results a 3.460 0.001 HSP <0.001 indicating the Virechana with Karavellaka is highly effective in reducingitching..Erythema:In Abhayadi Group Z Asymp.sign (2 tailed) Results a -3.176 -001 HSP <0.001 indicates highly significant reduction in erythema after Virechana withAbhayadi Modaka In Karavellaka Group Z Asymp.sign (2 tailed Results a -3.286 0.001 HSP <0.001 indicates highly significant reduction in Erythema after Virechana withKaravellaka . Scaling: In Abhayadi Group Z Asymp.sign (2 tailed Results a -3.416 .001 HS To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 128
  • ResultsP <0.001 indicates highly significant reduction in Scaling after Virechana withAbhayadi Modaka.In Karavellaka Group Z Asymp.sig (2 tailed) Results -3.126a 0.002 HSP < 0.002 indicating highly significant reduction in Scaling after Virechana withKaravellaka.Area Involvement Head:In Abhayadi Group Z Asymp.sign(2 tailed) Results -3.207a .001 HS P <0.001 indicating highly significant reduction in area involvement in Head afterVirechana with Abhayadi ModakaIn Karavellaka Group Z Asymp.sign (2 tailed) Results -3.689 0.00 HS P <0.001 indicating highly significant reduction in area involvement in Head afterVirechana with KaravellakaTrunk:InAbhayadi Group Z Asymp.sign (2 tailed) Results -3.176a -001 HSP = 0.001 indicating highly significant change in area involvement in Trunk afterVirechana with Abhayadi Modaka In Karavellaka Group Z Asymp.sign (2 tailed Results -2.970a 0.001 HS To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 129
  • Results P< 0.001 indicating highly significant reduction in area involvement in Trunk afterVirechana with KaravellakaUpper Extremity:In Abhayadi Group Z Asymp.sign (2 tailed Results -3.071a -002 HSP <0.002 indicating highly significant change in area involvement in Upper extremityafter Virechana with Abhayadi ModakaIn Karavellaka Group Z Asymp.sign (2 tailed) Results -3.500 0.000 HSP = 0.000 indicating highly significant reduction in area involvement in Upperextremity after Virechana with KaravellakaLower Extremity In AbhayadiGroup Z Asymp.sign(2 tailed Results -3.522a .000 HSP =0.000indicating highly significant change in area involvement in lower extremityafter Virechana with Abhayadi ModakaIn Karavellaka Group Z Asymp.sign (2 tailed) Results -3.169a 0.002 HSP <0.002 indicating highly significant change in area involvement in lower extremityafter Virechana with Karavellaka To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 130
  • Results BETWEEN GROUPS: Test Statisticsb Lowerlimb Itching chn Erythema chn Scaling chn Head chn Trunk chn Arms chn chnMann-Whitney U 111.000 98.000 112.000 79.000 91.500 111.500 83.000Wilcoxon W 231.000 218.000 232.000 199.000 211.500 231.500 203.000Z -.067 -.652 -.023 -1.599 -.959 -.050 -1.364Asymp. Sig. (2-tailed) .946 .514 .982 .110 .338 .960 .172Exact Sig. [2*(1-tailed .967a .567a 1.000a .174a .389a .967a .233aSig.)]a. Not corrected for ties.b. Grouping Variable: Group If we see the P value in all parameters it is < 0.05 indicating the result obtained is statistically non significant, which means in both the group there was reduction in all parameters in equal way. This indicates virechana with both the drugs is highly efficient in eka Kushta. PASI Scale: Abhayadi Group Wilcoxon sign rank test has been put to assess the within the group changes. Test Statisticsb pasiat - pasibt Z -3.408a Asymp. Sig. (2-tailed) .001 a. Based on positive ranks. b. Wilcoxon Signed Ranks Test Here P <0.001 indicates highly significant reduction in P A S I after Virechana with Abhayadi Modaka. Karavellaka Group Here also Wilcoxon sign rank test has been put to assess the within the group changes. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in Eka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 131
  • Results Test Statisticsb pasiat - pasibt Z -3.408a Asymp. Sig. (2-tailed) .001 a. Based on positive ranks. b. Wilcoxon Signed Ranks Test Here P <0.001 indicates highly significant reduction in P A S I after Virechana with karavellaka patra Swarasa. Between groups: COMPARISON OF MEANS Report Group pasibt pasiat pasichn Abhayaadi Mean 29.8000 7.3200 22.4800 N 15 15 15 Std. 12.56077 4.04125 9.45827 Deviation Karavellaka Mean 24.7733 5.0467 19.7267 N 15 15 15 Std. 12.26647 3.07870 9.99224 Deviation Mann Whitney test has been put to assess the between the group changes Test Statisticsb pasichn Mann-Whitney U 89.500 Wilcoxon W 209.500 Z -.954 Asymp. Sig. (2-tailed) .340 Exact Sig. [2*(1-tailed .345a Sig.)] a. Not corrected for ties. b. Grouping Variable: Group To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 132
  • Results Here P> 0.05 indicating difference noticed is statistically non significant which means both the group have show changes in P A S I in similar way. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 133
  • Discussion             DISCUSSIONVirechana is one of the comprehensive tool of internal purification .It has shownmiraculous effect in many of the long standing stubborn disorders. One of suchdisorder which comes in such category is Kushta.In Ayurveda almost all skin disorders brought under one term i.e Kushta. Under thisone variety of Kshudra Kushta is Eka Kushta whose signs and symptoms co insidewith that of Psoriasis. Aswedana , Mahavastu, Mastya Shakalopama are the featurementioned by acharyas for Eka Kushta. Few supplementary explanations mentionedin Bhava prakasha gives us clear picture of its similarity with Psoriasis.Matsya Shakalopama explains scaly skin lesion. In Bhavaprakasha, the skin lesions inEka Kushtha are Chakrakara (rounded) and Abhraka Patrasama i.e. silvery like mica.These clinical features are similar as that of psoriasis.  Mahavastu refers toinvolvement of large area. Discussion on Material and Methods:-Present study is a randomized comparative clinical study, where efficacy of Trial drughas been compared with that of Standard drug.Here Abhayadi Modaka has been taken as a standard as previous works has alreadyestablished its efficacy as Virechaka in Kushta.Inclusion criteria:Reason for selecting the age group between 16-70years- as this disease may affect anyof the age group .The lower limit and upper age limit are fixed to these years as in To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 133 
  • Discussion pilot study it is noted that conducting the procedure is little difficult in age lesser ormore than it. Exclusion criteria:-The Systemic illnesses were excluded, as they would interfere with the course oftreatment.Sampling - Randomization of sampling is done to o avoid any type of bias in thestudy.Lottery method is used for Randomization because of small sample size,unavailability of all the patients at a time.Discussion on observations & results:Total 38 patients were scanned for study but 4 patients did not fulfill the inclusioncriteria. Out of 34 patient 4 patients did not apt the procedure as 1 found it as tediousprocedure, 2 patients could not make daily early morning hospital visit, for onepatient it was difficult to follow the regimens advised.30 patients registered underwent treatment and no drop out seen in between theprocedure.AGE:Out of 30 patients who underwent Virechana 23.3% belonged to the age group of 21-30, 20.0% belonged to the age group of 31-40, 26.7% belonged to the age of group41-50,20.0% were of age group between 51-60andin the age group of 61-70 10%patients were there.Though psoriasis is a disease that manifests in all the age groups, but it will be in itspeak during the third or fourth decade of life. This is also reflected in present study. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 134 
  • Discussion SEX:In present Study 83.3% were Males and only 16.7% were Females. A comparativedata from various epidemiological Studies on Psoriasis Shown that male to femaleratio is 2.46:1. Psoriasis affects the males more and same is found in present Study.RELIGION:In present study 83.3% of the patients were of Hindu community and 13.3% belongedto Muslim community, 3.3% were Christen. This may be because of the present studywas conducted in Hindu dominant area.REGION: 90% belonged to urban area and 10 % were from rural population. This study isconducted in urban area so urban population is more in this study.SOCIOECONOMIC STATUS:In present study 86.7% were from lower middle class, 13.3% from Lower middleclass family. This study was conducted in government hospital and this shows thesocio economic condition of the patients attending the OPD and IPD of this Hospital.MARITAL STATUS:-Only 13.3% patients were unmarried were as majority of the patients (86.7%) were married.DIET HABIT:Majority of the patients (80%) were of mixed food Habits& only 20% Patients wereVegetarians. Thus present study shows importance of non-vegetarian food astriggering factor for psoriasis. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 135 
  • Discussion ADDICTION:In 4 patients Addictions to Tea / coffee was seen, in 4 only smoking ,1patient wasAlcoholic,2 patients were addicted to tobacco,3 Patients had addiction towards Tea/coffee & smoking, 5 Patients had addiction towards Tea /coffee & alcohol, 8 patientswere both Alcoholic & Smokers, 1 had a addiction of Smoking & Tobacco , 3 werewithout any addiction. This shows that 90% of the patients are having one or the otheraddiction.SLEEP PATTERN:In 60% of the patients there was history of Diwaswapna in 26.7% there was history ofRatri Jagarana. This shows Sleep pattern is playing definite role in this disease.PRAKRUTI:In present study 33.3% of the patients were of Vata Kaha & Pitta Kapha Prakruti,30% were of Vata pittala Prakruti and only 3.3% were of Kapha Pittala Prakruti. Herein this study all the Patients had Dvadwa Prakruti especially Vata Pitta and VataKapha & PittaShleshmala PrakrutiFAMILY HISTORY:In present Study only 26.7% presented with the family history, 73.3% were withoutFamily history. Modern medical science accept strong genetic predisposition in thedisease. In Ayurveda, Acharya Sushruta has described Kushtha as Adibala PravritaVyadhi. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 136 
  • Discussion SEASONAL IMPACT:In 96.7% winter Season aggravated the condition where as 3.3% not affected byseason. This observation coincides with modern texts. In winter there will bedominancy of Kapha and Vata which causes increase pattern of Vata Kapha PradhanaVyadhi like psoriasis.CHRONICITY:56.6% patients were having history less than 5 years, 20 % presented with the historywith in 6-10yrs, 16.6% having history in between 11-15 yrs & 3.3% having history inbetween 21-30yrs.AREA INVOLVEMENT:Lesions were distributed in only one area in3.3%,2 areas 3 areas involvement is seenin 13.3%, 4 areas involvement seen in 10% & in 60% 5 areas involvement seen. Thisshow in this disease covers large area.Discussion on resultsProcedureTime taken for the initiation of Vega:-The analysis of mean effect of the parameter time taken for the initiation of Vega(Bout) between the groups indicates Non Significant Result, (as P>0.05). It impliesthat the mean effect of the parameter time taken for the initiation of Vega (Bout) issame in both the groups. Mean time taken by the Abhyadi Modaka is 59.3 where asMean time taken by the Karavellaka Patra Swarasa is 52.20.Karavellaka patra swarasawas little Faster in initiating Vegas. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 137 
  • Discussion Total time taken for the completion of the procedure: Difference noted in time taken for the completion procedure was statistically notsignificant which denotes both the group took similar time duration to complete theprocedure. This denotes both drugs have taken equal time duration for the completionof the procedure.Number of Vegas:-The analysis of mean effect of the parameter number of Vegas shown significantresult (as P<0.05).In Abhayadi Group mean Vegas were 16.8 where as in Karavellakagroup it is 14.This shows more Vegas seen in Abhayadi Group compared toKaravellaka Group.Laingiki ShuddhiStatistical analysis shows that mean effect of the parameter Laingiki Shuddhi shownNon significant result (as P>0.05).ie the mean effect is same in both the groups. Thisindicates though there are less Vegas in Karavellaka Group it has shown similarLaingiki Shuddhi as that of Standard drug.Effect of therapy on disease:Itching: Decrease in itching in both the groups after intervention was statistically highlysignificant. In between group comparison showed that difference was statistically nonsignificant indicating Virechana with both drugs has shown similar effect in reducingnumber of Pidakas. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 138 
  • Discussion  To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 139 
  • Discussion Erythema: There was significant reduction in erythema after intervention, and when within thegroup comparison made difference showed was statistically non significant whichshows Virechana with both drugs has similar effect in decreasing Erythema.Scaling:After intervention there was decrease in scaling in both group and statistically it ishighly significant. In between the group comparison showed difference noted isstatistically not significant showing both the group acted in similar fashion inreducing Scaling.Area Involvement:After intervention there was significant difference in area involvement in head, trunk,Upper & lower limb in both group and statistically it is highly significant. In betweenthe group comparison showed difference noted is statistically not significant showingboth the group acted in similar way in reducing area involvement.Effect of therapy on PASI scale:Both the group has shown highly significant reduction in P A S I Scale afterintervention. In Abhayadi Group mean P A SI was 29.80 before treatment which gotreduced to 7.3200 after treatment, where as in Karavellaka Group mean P A SI was24.77 before treatment which got reduced to5.04 after treatment, In between the group comparison showed, difference noted is statistically notsignificant which indicates both the group acted in similarly in reducing P A SI scale. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 140 
  •     Conclusion CONCLUSION The following conclusions can be drawn based on the analysis of the conceptual part and observations made in the clinical study. Virechaan karma is one of the radical treatments which throw the disease causing morbid Dosha out of the body. Sushruta has placed Karavellaka Swarasa as best Swarasa Virechaka yoga Abhayadi Modaka is considered as one of the efficacies of Virechka Yoga. Eka Kushta being a Kshudra Kustha hasVata Kapha dominance but involvement of tridosha is evident from its signs & symptoms. A critical literary review reveals that signs & symptoms of Eka Kushta resembles that of Psoriasis. Relapsing nature is most common in Psoriasis, which suggests that it needs intensive therapy and Virechana Karma serve this purpose well. . Treatment responses of all parameters were highly significant in both the groups which show that Virechana Procedure is efficacies in treating Eka Kushta. Statistical analysis showed that the effect shown by the trial drug is almost equal to that of the standard drug as a Virechaka. But in case of Vaigiki Shddhi slight supremacy of Standard drug was noticed. This study proved the efficacy of Karavellaka Patra Swarasa as Virechaka Dravya and thus given justice to Sushruta’s statement. Swarase Karavellakam. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 140
  •     Conclusion Limitations. With the small sample, limitation of time and facilities it is difficult to draw any conclusion. However, the results of the study are encouraging, so the therapy can be tried in a large sample with long period of follow up to check the re-occurrence of the disease. SCOPE FOR FURTHER STUDY Efficacy of other Virechaka Yogas mentioned in classics can be evaluated. Efficacy of Karavellaka Patra Swarasa as Virechaka can evaluated in other Virechana Sadhya Vyadhis To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 141
  • Summary SummaryThe dissertation entitled “To evaluate the efficacy of Virechana with KaravellakaPatra Swarasa and Abhayadi modaka in Eka Kushtha w.s r. to Psoriasis:- Acomparative clinical study was undertaken to evaluate the efficacy of KaravellakaPatra Swarasa as Virechaka Yoga and to find out its efficacy as Virechaka Yoga in Ekakushtha. As a Standard drug Abhayadi Modaka was taken.This dissertation comprises of two parts. The first part deals with review of literatureconceptual study and the second section is related to clinical trials. The first part includes♦ Introduction♦ Literary review The second part deals with,♦ Material and Methods♦ Discussion♦ Summary♦ Conclusion. The introductory part a brief account of gravity of the disease and scope for the study and the rationale behind selecting the particular drug and procedure is mentioned. Literary review is subdivided into 3 chapters namely Procedure review, Disease review and Drug review. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 142
  • SummaryProcedure review: In this chapter the historical aspect, vyutpatti, Nirukti, ofVirechana,Detailed description about Virechan is given under the headings of Poorva, Pradhanaand Paschat Karma.Disease review: Under this heading the vyutpatti, nirukti of Kushta, functionalanatomy of twak, Nidana Panchaka of Kushta with treatment is explained. Psoriasisis described in brief.Drug review: In this chapter Botanical names, Rasa Panchakas, Doshaghnata,Rogaghnata and Karma of Karavellaka, all the ingredients of Chitrakadi Vati,Guduchi Ghrita, Madhu Yashti taila and abhayadi modaka is available.The second part of the study begins with Materials and Method; where in descriptionregarding the Research design, Sampling and grouping, criteria of selection ofpatients, diagnostic criteria, details of inclusion and exclusion criteria, and assessmentcriteria for assessing the effects of the therapies has been explained. The clinical studywas done on 30 patients of both sexes, between the age group of 16-70 years. Patientswere randomly divided into Standard & Intervention Group. Standard group receivedVirechana karma with Abhayadi Modaka and Intervention Group received VirechanaKarma with Karavellaka Patra SwarasaThere after Descriptive data, Data related to disease and Data related to procedure arepresented in tabular form along with graphs. In the end the results along withstatistical analysis of the results are presented.Effect of treatment is assessed using P A S I Scale. In Abhayadi group beforetreatment mean P A S I Scale was 29.8 which got reduced to 7.32 after treatment. In To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 143
  • SummaryKaravellaka group before treatment mean P A S I Scale was 24.7 which got reducedto 5.04 after treatment.It was concluded that Virechana with both the drugs is highly efficient in managementof Eka Kushta. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka inEka Kushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore 144
  • Reference of Procedure Review1) Agni purana2) Manu Smriti3) Vinayapitaka4) Indian Medicine in the classical age.5) P.T.A6) Cha.Sa.Kalpa sthana.1/47) Vachaspatyam8) Shabakalpadruma9) Sir Monier Williams10) Cha.Sa.Kal.1/511) Cha.Sa.Kal.1/412) A.Hr.Su.1/2513) Sha.Pu.4/614) As.San.Su.27/415) Ka.Si.7.16) Cha.Sa.Su.25/4017) A.Hr.Su.13/118) Cha.Sa.Su.16/1619) Cha.Sa.Su.20/1620) A.Hr.1/25-2621) A.Sa.Su.27/422) Cha.Sa.Su.20/1623) Su.Sa.Chi.33/2824) Cha.Sa.Kal.1/525) As.San.Su.14/431) As.Sa.Su.14.26) Ch.Sa.Su.1/94-9732) Su.Sa.Su.44/1,227) Ch.Sa.Su.1/107-11433) A.Sa.Su.14/428) As.Sa.Su.14/434) Sha.Sa.Pu.Kh.4/329) Cha.Sa.Su.1/77-8535) D.C. on Su.Su.46/459.30) Su.Sa.Su.39/4.36) Sha.Sa.Pu.Kh.4/437) Ch.Sa.Chi.3/17138) Sha.Sa.Pu.Kh.4/5
  • 60) Sha.Sa.U.Kha.4/1861) Cha.Sa.Kal.8/862) Cha.Sa.Su.15/1763) Sha.Sa.U.Kha 4/1664) Su.Sa.Chi.33/2165) Sha.Sa.U.Kha 4/1366) A.Hr.Su.18/3367) D.C of Chakrapanidutta on Cha.Sa.Su 15/768) D.C of Chakrapanidutta on Cha.Sa.Su15/1769) Cha.Sa.Si 2/1370) Su.Sa.Chi.33/3271) A.Sa.27/872) A.Hr.18/8-973) Ka.Sa.Si.7
  • 90) Cha.Si.1/691) Cha.Su.13/5192) Cha.Su.28/3393) Su.Sa.Chi 32/2094) Cha.Sa.Si95)Su.Sa.Chi 31/3696)A.D.Com on 16/2997)A.Hr.Su 16/798)Su.Chi.31/25-27 99)C.C on Cha.su100)Su.Chi.31/37,44101)Cha.Su.13/22102)Ch.Su 13/26103)Ch.Su 13/23-25104)Su.Sa.Chi 31/14105)A.Sa.Su 25/27,28106)Cha.Su 13/58107)Su.Chi 31/53108)A.Hr.Su 16/30109)Sha.Sa.U.Kha 1/29
  • 120) Cha.Su 15/11,12121)Su.Chi 33/7122)Cha.Si 1/8123)Su.Su 39/10124)Cha.Su 15/10125)D.C on Su.Su 40126)D.C on Cha.Chi 15127)Sha.Sam128)Vangasen129)A.Sa.Su 27130)Cha.Su 14/80131)A.Sa.Su 27/28132)A.Sa.Su 27/31,32133) A.Sa.Su 27/36134)A.Sa.Su 27/38135)Cha.Si 6/26136)A.Sa.Indu com.137)Cha.Si.6/26138)A.Sa.Su 27/38139)Cha.Su 16/5-10140)Cha.Si 1/17-19142)Su.Chi 33/24-27143)A.Sa.Kal 3/6144)Cha.Si 1/13-14145)Sha.U.Kha 3/17146)Cha.Sa.Su 15/13147)Su.Sa.Chi 34/9
  • 150)Ka.Sam Si 3151)Cha.Si 1/12,13152)Cha.Su 15/16153)Chakrapani com on Cha.Su 16/2154)A.H Su 18/29155)Cha.Su 15/17156)Cha.Si 12/11-12 148) A.San.ka 3/20,21 Page no.595157)Cha.Si 6/57 149) Ch.Si.6/59-93 Page no.707-709158)Cha.Si ½ 150) Su.Chi.34/4-21 Page no.521-525159)A.Hr.Su 18/30 151) Ch.K.1/5 Page no.654160)Cha.Si 1/3-5 152)161)Cha.Si 1/11 153)162)Su.Sa.Chi 33 154)163)Su.Chi.39/17,18 155)164)Chakrapani com on Cha.Si 6/25 156)165)Cha.Sa.Si 12/6,7 157)166)Su.Sa.Chi 39/19,20 158)167)Su.Chi 39/19,20 159)168)Chakrapani com on Cha.Si 6/8169)Su.Chi 39/18,19170)Cha.Si 6/58-93171)Su.Chi 34/13,14172)A.Hr 3/3,4173)Satuskar RS, Bhandarkar SD, Ainapure SS. Pharmocology &Pharmacotherapeutics chapter 33. 16th ed. Mumbai: Popular PrakashanPublications.1999.174)Cha.Kal ¼ Reference of Disease Review175) Joel G Hardman and Lee E Limbird, Goodman and Gilman, Thepharmacological basis of therapeutics, , 10th ed, Mc. Graw Hill Book Company,1)Charaka samhitaHamberg: 2001.2) Maharishi Vedavyasa Agni purana3)Agni purana4)Indian Medicine in the classical Age5)History of Medicine and Indian National Science Academy
  • 26)Sha Sa.Pu.Kha 5/19-22 27)Vangasena 28)Bhava prakash 54/44;Su.Su 23 29)Yogaratnakara 30)Gada nigraha of Shri Vaidya Shodhala Part 2. 31)Shabdakalpadruma. 32)A.Hr.Ni 14/3 33)Amarakosha1) www.Wikipedia.com 34)Cha.Sa.Chi 5/21-242) www.essentialdayspa.com/ acne- myths- and -truths 35)Su.Sa.Ni 5/33) www.pressmediawire.com/ article I D 4626 36)A.Hr.of Arunadatta com4) www.emedicine.com 37)Bhela samhita.5) www.essentialdayspa.com/ acne- myths- and -truths 38)Madhava nidana madhukosha tika6) Su. Sa. Nidana Sthana 13/39 Page no.323
  • 53)Cha.Sa.Chi 7/4-854)Cha.Sa.Su 2655)Cha.Sa.Vi 156)Cha.Sa.Su 26/82-8457)A.Hr.Su 7/29-4758)Su.Su 20/8-1959)Cha.Sa.Ni 7/660)Cha.Sa.Chi 7/4-861)Su.Sa.Ni 5/362)Su.Sa.Chi 9/563)Vangasena64)Yogaratnakara.65)Cha.Sa.Vi.666)Cha.Sa.Su 5/1167)Su.Sa.Ni 668)Su.Sa.Ni 669)Bhavaprakash70)Su.Sa.Ni 6/2271) Su.Sa.Ni 6/22
  • 79)A.Hr.Ni 14/1-280)A.Hr.Ni 14/281)Cha vi 2/982)Cha vi 2/883)Cha Sa chi 7/2184)Su Sa Ni 5/1085)A.Hr.Ni 14/2086)Cha.Sa.Chakrapani tika.87)Cha .Sa.Chi 788)Su.Sa Ni 589)A.San Ni90)A.Hr Chi91) A.Hr Chi92) Bhela samhita93)Harita samhita94)Vangasena.95)Cha.Sa.Chi 7/2196)Su.Sa.Ni 5/1097)A.Hr.Ni 14/2098)Madhavakra madhukosha tika99)Cha.Sa.Ni 5100)Cha.Sa.Su 10/7101)Cha.Sa.Ni 5/9102) Cha.Sa.Ni 5/9103)Cha.Chi 7
  • 107)Cha Chi 21108)Cha.Sa Ni 5109)Cha.Sa Indriya sthana 12110)Su.Su 30111)Cha.Indriya 6112)Cha.Su 15113) Cha.Su 15114)Cha.Indriya 3115)Cha.Chi 7/37-39116)Cha.Vi 7/3117)A.Hr.14/5118)Cha.Chi 7/41119)Cha chi 7/31120)Cha.Chi 7/37-39121)Su.Chi 9/43122)Su .Chi 9/6123)Cha Chi 7/58124)A.Hr Chi 20/93125)Cha.Su 25/45,46126)Su Chi 9/5127)B.R 54/359-370
  •   Anatomy of the skin References. 1) Shabda Kalpadruma 2) Su. Sa.Sharira Sthana 4/4 3) Cha.Sa. Sharira Sthana 3/6 4) A .Hr. Sharira Sthana 3/8 5) Cha.Sa. Sharira Sthana 7/4 6) Su. Sa.Sharira Sthana 5/6 7) Sh .S. Poorva Khanda 5/19-22 8) A.D.com on A .Hr. Sharira Sthana 3/8 9) G.D.Com on Cha.Sa. Sharira Sthana 7/3 10) Cha.Sa. Sharira Sthana 7/4 11) Su. Sa.Sharira Sthana 4/4 12) Sh .S. Poorva Khanda 5/19 13) Cha.Sa. Sootra Sthana 8/10 14) Su. Sa. Sootra Sthana15/5 15) Cha.Sa. Chikitsa Sthana 15/7 16) Su. Sa. Sootra Sthana15/5 17) .F.A.P. 18) www. Wikipedea. Com Drug Review Refernces 1)B.R. 2)Sha.SamM.Kha 9/44 3)A.Hr.Chi 22/41-44 4)Sha.Sam U.Kha 4/27-33 5)Dravya guna vignyana by P.V.Sharma 298 pg.no.684.
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  • Bibliography  17) Madhavakara. Madhava Nidanam with Madhu Kosha Sanskrit commentary by Shri. Vijayarakshita and Shrikanta Datta, with the Vidyotini Hindi commentary, edited by Yadunandana Upadhaya, Varanasi, Chaukhambha Sanskrit Sansthan, Part II, reprint 2003, pp : 508 18) Raja Rajakanthadeva . Shabda Kalpa Druma – 1st ed. 3rd reprint 2006. Delhi: Naga Publishers; 2006. vol from Pa- Ma Pp 792 19) Ramji Gupta. Text Book of Dermatology , 1st edition, New Delhi: Jay Pee brothers Medicdal Publishers 2002.Pp 186 20) Sahastra Yogam, Hindi translation by Dr Ramnivas Sharma and Dr Surendra Sharma, 3rd edition, Varanasi:Chaukambha Vidhya Bhavan, 2002.Pp 318 21) Satoksar R.S., Bhandarkar S.D. & Nirmala N. Grege. Pharmacology & Pharmacotherapeutics, 19th Edition Mumbai; Popular Prakashan Pvt. Ltd; 2005. 22) Sharangadhara. Sharangadhara Samhita with Adhamalla’s Deepika and Kashiram’s Gudartha Deepika commentary, Varanasi, Krishnadas Academy, reprint 2000, pp 398. 23) Sir. Monier Monier - Williams, A sanskrit - English dictionary, 1st Indian ed. Delhi: Motilal Banarasidass; 1970,1333pp. pg 1013 24) Stedman Medical dictionary, 22nd ed. Baltimore The Williams and Wilkins Company; 1975,1533pp 25) Sushruta, Sushruta Samhita, the Nibandha Sangraha commentary by Dalhanacharya and the Nyayachandrika Panjika of Sri. Gayadasacharya on Nidana Sthana, edited by Vaidya Jadavji Trikamji Acharya and Narayanarama Acharya, Kavyatirtha, Varanasi:ChaukambhaSura bharati; reprint 2003,824pp. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore  
  • Bibliography  26) The Atharvaveda, Sanskrita text with English Translation, Devi Chandra with introductory remarks by M. C Joshi, Archeological Survey of India, New Delhi Munisharma Manoharalal Publishers Pvt. Ltd. 1997 PP 939, pg 439,442 27) The Kashyapa samhita or Vrddha jivaka tantra by vrddha jivaka revised by vatsya translation and commentary by Prof.P.V.Tewari, Varanasi, Choukambha visvabharati 1996, Pp- 792 Page.No-510 (sandy)26 28) Ugradityachaya. Kalyanakarakam, of, edited with introduction, translation, notes, index and dictionary by Vrdhamana Prashwanath Shastri, Published by Seth Govindaji Raji Doshi, 1940, pp 748 pg 586 , Pp-746 Page.No-123 29) Vruddha Jeevaka. Kashyapa Samhita, translated to English by P.V. Tiwari, 2nd ed. Varanasi: Choukambha Vishwabharathi Oriental Publishers & Distributors; 1996 30) Vaidhya Baghel M.S., Research in Ayurveda, Jamnagar, Mridu Ayurvedic Publications and Sales 2005, Pp: 318. 31) Vaidya Haridas Sridhara Kasture.Ayurvediya Panchakarma Vignana,. Calcutta: Sri Baidyanatha Ayurveda Bhavan Limited; 6th ed 1999,712pp 32) Vaghata or Vriddha Vagbhata. Ashtanga Samgraha – with the Shashilekha Sanskrit commentary by Indu, 1st ed. Varanasi: Chowkamba Sanskrit Series Office; 2006.P 33) Vaman Shivram Apte. The Practical Sanskrit-English Dictionary –Delhi: Motilal Banarasi Dass Publishers Private Limited; 2004. Pp1160 To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore  
  • Bibliography  34) Vangasena.Vangasena Samhita – with hindi commentrary from Dr. Rajiv Kumara Roy, edited by Dr. Rajiv Kumara Roy, 1st ed. Varanasi: Prachya Prakashan; 2000. 35) Vedavyasa Maharshi, Agnipurana, Acharya baladeva Upadhyaya, editor. Varanasi: Chaukhambha Sanskrit Sansthan, 2nd edition, 1998 36) Vedavyasa maharshi, Garudapurana, Ramashankar Bhattacarya, editor, with manavartha muktavali commentary, 2nd edition, Varanasi: Chaukhambha Sanskrit Sansthan, 1998 37) Virendra N Sehagal. Text book of Clinical Dermatology,4th edition, New Delhi: Jay Pee brothers Medicdal Publishers (P) Ltd, 2006.Pp 305 38) Yogaratnakar. With Vaidhya Prabha Hindi commentary, by Dr. Indradev Tripathi and Dr. Dayashankar Tripathi, Varanasi, Krishna Das Academy, 1st edition 1998, Pp : 894. 39) Psoriasis.htm 40) Psoriasis and Scaling Diseases Merck Manual Professional.htm 41) Google Image Result for http--upload_wikimedia_org-wikipedia-en- thumb-7- 75- Psoriasis_severity_jpg-400px- Psoriasis_severity_jpg.htm 42) e-medicine - Psoriasis, Plaque Article by Harvey Lui, MD, FRCPC - Copy.htm chronic and relapsing disease 43) Psoriasis Causes.htm 44) Psoriasis Causes - MayoClinic_com.htm 45) Psoriasis Symptom.htm 46) Principles of Pediatric Dermatology - Chapter 33 PSORIASIS.htm 47) National Psoriasis Foundation Plaque psoriasis.htm To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore  
  • Bibliography  48) Health Talk - Psoriasis - How does psoriasis progress.htm 49) Psoriasis epidemiology, clinical features, and quality of life -- Langley et al_ Supplement 2) ii18 -- Annals of the Rheumatic Diseases.htm 50) Plaque psoriasis_ DermNet NZ.htm 51) SkinCell Guttate Psoriasis.htm 52) National Psoriasis Foundation Pustular psoriasis.htm 53) Psoriasis and Other Papulosquamous Diseases - WiserWiki.htm 54) Google Image Result for http--www_eorthopod_com-images- ContentImages-arthritis-arthritis_psoriatic- arthritis_psoriatic_intro01_jpg.htm 55) Google Image Result for http--www_arc_org_uk-about_arth-booklets- 6029-images- 6029_1_gif.htm 56) klinnau@u.washington.edu, 57) Medicine - Psoriasis, Plaque Article by Harvey Lui, MD, FRCPC - Copy.htm chronic and relapsing disease. 58) Chronic Plaque Psoriasis - February 15, 2006 -- American Family Physician.htm 59) Advances in Psoriasis Treatment.htm 60) Management of Psoriasis.htm 61) Psoriasis Drug Therapy.htm 62) Daves Psoriasis Info - The PASI.htm. To evaluate the efficacy of Virechana with Karavellaka Patra Swarasa & Abhayadi Modaka in EkaKushtha Department of P.G Studies in Pancha Karma , G.A..M.C..Bangalore  
  • VOLANTARY CONSENT FORM I ..................... hereby willingly agree to participate in thisClinical study. I affirm that there has been no compulsion or monetary inducement inmy agreeing to be Volunteer for this study which I do on my free will. I have beenexplained the general purpose of this trial. I am convinced that it is for the benefit ofscience and mankind. I understand that the risk involved is very less. I also agree to remain under observation for long period. I can apt out of the study at any time.Signature of the investigator Signature of VolunteerSignature of the Guide
  • DEPARTMENT OF P. G STUDIES IN PANCHAKARMA G.A.M.C. BANGALORE TO EVALUATE THE EFFICACY OF VIRECHANA WITH KARAVELLAKA PATRA SWARASA AND ABAHYADI MODAKA IN EKA KUSHTHA W.S.R. TO PSORIASIS. A COMPARATIVE CLINICAL STUDY ”GUIDE:-Dr Shalini.C.Eli. P G Scholar: - Dr Srinivas RaoName of the patient:- O P Number:-Age: - I P Number:Sex: - Ward:-Religion: - Bed number:-Address:-Region:-Educational Status:-P/M/G/PGOccupation:-Socio economic status:-Poor/Lower middle class/Upper middle class/RichMarital status:-Unmarried/Married/Divorcee/Widow/WidowerChief complaints: - Duration:-Skin lesion over Scalp Neck: Upper limb: Trunk: Lower limb:Associated complaints: - Duration:-
  • Itching: Duration:-Scaling:History of present illness:-Triggering FactorsInjury to skin- Seasonal variations: - Winter/ SummerEmotional status- Infection-Drugs- Others-History of past illness:-Family history:-Treatment history: - Case: - Fresh/Treated/Under treatment Previous medication:-Allopathy/ Ayurveda/ Other Details of treatment:-Personal history:- Diet:- Type:-Veg/Nonveg/Mixed Frequency of intake of food:-
  • Time of intake of food:-Regular/ Irregular Quantity of food:-Less/ Moderate/More Rasa dominance:-Madhura/ Amla/Lavana/Katu/ Kashaya/Tikta Bowel:- Frequency:- Consistancy:- Micturition :- Frequency:- Sleep: - Sound/ disturbed H/O Divaswapna :- P/ A H/o Rathri Jagarana :- P/ A Habits: - Coffee/ Tea/ Smoking/ Tobacco/Betel chewing/ Drugs/ Alcohol/ Soft drinks/ Snuffing/ none Since:- Emotional Status: - Anxiety/ Tension/Depression/ Irritation/Anger/ Calm Type of Koshta :-Menstrual History:-Obstetric History:-General Examinations:- Built:-: Nourishment:- Pulse rate:- Respiratory rate:- Weight:- Blood pressure:- Height:- Nails:-
  • Systemic Examination:-Respiratory System :-Cardio vascular System:-Gastro intestinal System:-Central nervous System:- Examination of skin lesions:-Inspection-Type of lesion:- Primary Skin lesions Secondary Skin Lesions:- Scale /Crusts / Lichenification /Fissure/ ScarDistribution> Shape>Margin> Erythema >Palpation of skin lesion:-Surface>Moisture>Sweat>Tests – • Auspitz sign • Koebner phenomenon • Candle Greeze signPAS I SCALE: Skin Itching Erythema Scaling Thicknes Coverage % of Total sections s of Area B,S,A PAS I lesion HEAD10% B.T. A.T. ARMS20% B.T. A.T.
  • BODY30% B.T. A.T. LEGS40% B.T. A.T.Dasha Vidha Atura Pareeksha:Atura Bhoomi Desha Pareeksha:- Jangala Desha Anoopa desha Sadharana desha Jatha Samvridha Vyadhita Atura Deha Desha Pareeksha Prakrititaha:- Sarataha:- Pravara/ Madhyama/ Avara Samhananataha:-Susamhata/ Madhyama/ Asamhata Pramanataha:-Sama/ Adhika/ Heena Satmyataha;-Ekarasa/ sarvarasa/Vyamishra Satvataha;-Pravara/ Avara/ Madhyama Ahara Shakti;-Abhyavarana :-Pravara/ Madhyama/ Avara Jarana Shakti:-Pravara/ Madhyama/ Avara Vyayama Shakti:-Pravara/ Madhyama/ Avara Vayataha;- Vikrititaha: Nidana:- Ahara;-
  • Vihara:- Manasika:- Anya:-Laboratory Investigation;- Blood Investigation Hbgms%:- T C:- DC:- ES R:- CHIKITSA VIDHI Poorva Karma Deepana-Pachana: Chitrakadi vati 2 -2-2 from to before food Sneha Pana-:- Guduchi Ghrita from to Dose of sneha pana & Time taken for digestion of sneha 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day Dose Time
  • SNEHA JEERYAMANA LAKSHANAS: 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day SHIRO RUJA BHRAMA LALA SRAVA MOORCHA SADA KLAMA TRISHNA DAHA ARATISNEHA JEERNA LAKSHANA: 1st day 2nd day 3rd day 4th day 5th day 6th 7th day day JEERYAMANA LAXANA SHANTI UDGARA SHUDHI KSHUDHA PRAVRITI TRISHNA PRAVRITI VATANULOMANA SHAREERA LAGHUTA SAMYAK SNIGDHA LAXANA: 1st day 2nd day 3rd day 4th day 5th day 6th 7th day day VATANULOMANA DEEPTAGNI SNIGDHA VARCHA ASAMHATA
  • VARCHAADASTAT SNEHADARSHNASNEHODVEGASNIGDHA TWAKANGA SNIGDHATAANGA MARDAVAANGA LAGHAVAKLAMASHAITILYAGLANI SHODANANGA SWEDANA: Sarvanga Abhyanga with Yashti madhu Taila for 3 days Sweda for 3 days SAMYAK SVINNA LAXANAS: LAXANAS 1st day 2nd day 3rd day SHEETOPARAM SHOOLA PARAM STAMBHA NIGRAHA GAURAVA NIGRAHA MARDHAVATA LAGHUTA SWEDA PRADURBHAVA
  • Virechana Karma with :- Karavellaka Patra Swarasa/ Abhayadhi ModakaMatra:-Anupana:-Date of Virechana:-Time of vega Prarambha:-Time of vega Antya:- Time of Vega Number of Vegas Nature of the stools
  • Laingiki Vegiki Aantiki Sroto Shudhi Indriya Prasadhana Shareera Laghuta Agni Deepti Anamayatva vatanulomana ASSESSMENT CRITERIA B.T. A. T. Itching Erythema Scaling Body area involved Head Trunk Upper extremity Lower extremity PASI ScaleInvestigator’s Notes:-Signature of the P G scholar Signature of the guide
  •   Graph no 16 Family history Graph no17 Stress as aggravating Factor      Graph no 18 Season as aggravating Factor Graph no19 food as aggravating Factor          Graph no 20 Drugs as aggravating factor Graph no 21 Infection as aggravating factor                                                                                                                                                                                                       
  •   Graph no 1 Age wise distribution Graph No2 Sex wise distribution                   Graph No 3 Religion Graph No4 socio economic Status                   Graph no 5 Diet Graph no 6 Marital Status                  Graph no 7 Occupation         
  • Graph no 8 Region Graph no 9 History of Diwa Swapna         Graph no10 History of Ratri Jagarana Graph no 11Prakruti      Graph no12 Satwa Graph no13 Satmya               Graph No14 Addiction Graph no15 Koshta  
  •   Guduchi moola Guduchi Choorna                        Karavellaka Plant Karavellaka Patra                                           Karavellaka patra Swarasa                                  Abhayadi Modaka                              
  •   Graph no 22 Gradings of Itching Graph no 23 Gradings of erythema       Graph no24 Area involvement in Head Graph no 25 Area involvement in Trunk         Graph no 26 Area involvement in Upper limb Graph no27 Area involvement in Lower limb        Graph no 29 showing + auspitz sign Graph no 30 showing Candle Grease Sign +
  • Graph no 31 days of Sneha Pana Graph no32 Samyak Snighdha Laxanas        Graph no 33 Samyak Swinna Laxanas Graph no 34 time taken for initiation of Vega      Graph no 35 showing Number of Vega Graph no36 time taken for completion            Graph no 37 Laingiki Suddhi