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Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta, ANIL KUMAR BACHA, Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, …

Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta, ANIL KUMAR BACHA, Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

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  • 1. ACKNOWLEDGEMENT I express my deep sense of gratitude to my respectedguide Prof. Dr. Varadacharyulu Vangeepuram M.D (Ayu) Head of Departmentof Kayachikitsa, D. G. M Ayurvedic medical college and Post GraduateStudies and Research Center, Gadag. He has been very kind to guide me inthe preparation of thesis and for whose extraordinary efforts, tremendousencouragement and most valuable thoughts provoking advice made me tocomplete this work. I am also grateful to my respected co-guide Dr.Shashidhar.H.Doddamani M.D (Ayu.) lecturer in Kayachikitsa, Post GraduateStudies and Research Center, D.G.M Ayurvedic medical college, Gadag, forpatiently going through the draft of thesis and correcting with preciousremarks which have been very useful. I am thankful to Dr. G. B. Patil principal, D. G. MAyurvedic medical college and Post Graduate Studies and Research Center,Gadag, providing all necessary facilities for this research work. I wish to convey thanks to my teacher Dr. Siva RamaPrasad Kethamaka, M.D (Ayu.), Reader in Kayachikitsa, Post GraduateStudies and Research Center, D. G. M Ayurvedic medical college, Gadag. Forbeing kind and affectionate through his valuable suggestions and advises asand when approach. It gives me pleasure to expresses my gratitude to Dr. A.K. Panda M.D (Ayu) lecturer in Kayachikitsa, Post Graduate Studies andResearch Center, D.G.M Ayurvedic medical college, Gadag, for kind co-operation during my study.
  • 2. I acknowledge the valuable help given to me by Dr.Raghavendra. V. Shettar, M.D (Ayu.) lecturer in Kayachikitsa, Post GraduateStudies and Research Center, D.G.M Ayurvedic medical college, Gadag, fortheir guidance and encouragement during my Post Graduate Study. I am ever grateful to Dr. S. A. Patil for their constant co-operation. I wish to convey thanks to all U.G lecturers of D. G. MAyurvedic medical college, for their help and suggestions during my PostGraduate Study. I sincerely thank my beloved classmates Dr. B. M.Mulkipatil, Dr. V. N. Kulkarni, Dr. Sitaram Prasad and Dr. G. S. Hiremath, fortheir deep co-operation and involvement in the P.G Study. I am also thankful to all my post graduate colleagues Dr.C. V. Rajashekar, Dr. Shyal kumar, Dr. R. D. Suresh, Dr. S. K. Tiwari, Dr. J. I.Hiremath, Dr. I. V. Kotturshetty, Dr. A. S. Patil, Dr. S. S. Hiremath, Dr. G. S.Hadimani, Dr. Srinivas Reddy, Dr. Yasmin A. P, Dr. Santmangesh, Dr. B. G.Swamy, Dr. Shankergouda Sankadal, Dr. Shyju. O, Dr. Chanbassappa.Hanmanthgouda, Dr.Vanitha, and Dr. U. V. Purad for their co-operation andhelp. I wish to convey my thanks to beloved Dr. Chandrakant.M. Halli, for their encouragement and help throughout my career. I wish to convey my thanks to beloved Librarian Sri. V. M.Mundinmani and S. B.Sureban for supplying me essential references in thestudy. I am thankful to Sri. B. S. Tippangouda; Lab. Technician also extendedhis co-operation in Investigations.
  • 3. I wish to thank the Physicians, House surgeons, Hospitalstaff, Nurses and Non- teaching staffs for their timely assistance in completionof this work. I thanks to Mr. P. M. NandaKumar for his help in thestatistical evaluate. Let me express my thanks to all patients, those are onthe trial for their consent for enrolling in this clinical study and obedience toadvises. I am highly indebted to my beloved parents, Sri.Pandharinath Bacha and Smt. Chandrakala Bacha, Sisters Smt. Sunita, Smt.Rajani and beloved Brother Mr. Chandrashekar Bacha and all other familymembers for their love and affection rendered throughout my career. I am ever thankful to Mr. Vinay kumar Katta and Mr.Bheemgopal Shanbhogar for their constant moral support, encouragementand help throughout my career. I am thankful to Wise Computers Gadag, in bringing outthe computer print of my thesis in such an elegant way. I express my thanks to all the persons who have helpedme directly and indirectly with apologies for my inability to identify themindividually. Lastly I pay my deep homage and tribute to myGrandparents Smt. and Sri Sambayya Bacha for their love and affectionsrendered throughout my career. ANIL KUMAR BACHA.
  • 4. List of PhotographsPhotograph – 1 Structure of the SkinPhotograph – 2 TilaPhotograph – 3 TriphalaPhotograph – 4 TrikatuPhotograph – 5 BhallatakaPhotograph – 6 SitaPhotograph – 7 MadhuPhotograph – 8 GhritaPhotograph – 9 KushtaPhotograph – 10 SarshapaPhotograph – 11 Moolakabeeja
  • 5. Photograph – 12 PriyanguPhotograph – 13 HaridraPhotograph – 14 NagakesharaPhotograph – 15 Before TreatmentPhotograph – 16 After TreatmentPhotograph – 17 Before TreatmentPhotograph – 18 After Treatment
  • 6. List of GraphsGraph number –1 Sex incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –2 Age incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –3 Occupation incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –4 Marital Status incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –5 Religion incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –6 Chronicity incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”
  • 7. Graph number –7 Family history incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –8 Food habits incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –9 Treated and fresh cases incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –10 Socio-economic status incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –11 Prakruti incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –12 Signs incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”
  • 8. Graph number –13 Symptoms incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –14 Sthana incidence in “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Graph number –15 Result of the “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”
  • 9. List of ChartsChart number – 1 Demographic Data of “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Chart number – 2 Laboratory Investigation of “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Chart number – 3 Assessment of “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”Chart number – 4 Statistical assessment for the “Evaluation of the effect of Saptasamayoga (Internal) and Kushtadilepa (External) in Sidhma Kushta”
  • 10. INTRODUCTION Ayurveda is an ancient Indian medical science reminded by LordBrahma. The main aim of this Ayurvedic medical science is to protect thehuman beings from various diseases following by rules and regulations ofswasthavritta and to have disease free human beings to have a healthysociety. Perfection cannot be achieved if only one science is studied. Disease is nothing but, life under altered conditions. These alteredconditions in fact manifest themselves through the agency of doshas, dhatusand mala in the body. Ayurveda, the science of life aims at the prevention of health. This isthe gift of almighty, prevention and curing of diseases. In day today practice aclinician is confronted with various skin conditions, which are complicated totreat as well as to cure, and they require prolonged line of treatment. The present day unwholesome food habits are influencing deficienciesof vital nutrients and leads to disorders. The skin is the largest organ of thebody invisible. Skin is the one of the contributory factors towards the beauty ofthe body, and it also it acts as principle organ of attraction. Seasonalvariations, intake of unwholesome food and infections leads to many skindisorders. In contemporary medicine a separate branch known asdermatology has been dealt. It is a part of general medicine. Diseases of theskin are a common occurrence. Our ancient Acharyas also vividly dealt theskin disorders under Kushta roga. Among the various chronic diseases that have been pesteringhumanity- women and men was an alike, skin disease having a uniqueposition. Irrespective of times and climes, such diseases spread all over the
  • 11. universe, due to various reasons in undeveloped countries. Constant use ofplastics, rubber, paints, perfumes and beautifying articles of inferior quality,consumption of improper or incompatible food materials, influx of civilization,pollution of water, air and sound and usage of certain particular items ofmodern medicines are some of the important factors that accelerate the attackof skin diseases. Due to economic backwardness, the masses in undevelopedand under-developed regions in the world could not either have sufficientnutritious items of food or lead hygienic lives individually as well ascollectively. Above all these, they take food materials, which vitiate thetridosha and consequently are victimized by various kinds of diseases. The food habits of the people accustomed to food having katu, amlaand lavana rasa and consumption of incompatible items of food like milk andfish are responsible for the high rate of skin disease. Dermatology is an essential part of general medicine since the skin isnot, by any means, foreign to body, which it covers. Diseases of the skin are acommon occurrence. There are not many statistics to prove the exactfrequency of skin diseases in this country. However according to studyconducted at the skin clinic of the school of Tropical medicine, Calcutta in theyear1977, it was observed, that around 4% people were affected by theSidhma i.e., Pityriasis Versicolor, which is fungal infestation namelyMalassezia Furfur. Ayurveda considered Kushta as an important disease and hascategorized it as a “MAHAROGA”. Though curative and preventive measuresare in full swing and though under the auspices of the W.H.O. and theCentral and State Governments, several measures are being pursued for
  • 12. warding off Kushta if carefully scrutinized the grim reality would be revealedthat all steps already taken and are still in progress are quite insufficient forimmunizing this dreaded disease. In the circumstance along with Ayurvedicscientists and physicians, practitioners of Unani, Siddha and other alliedsystems of treatment should also raise equal to the occasion and work wholeheartedly and with a dedicated spirit for eradicating this dreaded disease formthe world permanently. The Sidhma is most uncared disease among the people as well asphysician, even though it causes itching, burning, pricking pain, scaling,soreness, etc., which patient experiences silently i.e., Sidhma patient is asilent sufferer. In addition to the physical discomfort, it inflicts great injury onthe patients mind. Especially the subject if happens to be fair sex, as it masksthe beauty of the individual. Even though beauty is skin deep, yet its significance in modern world isgreater. The vast turnover of beauty aid products is it is a clear pointer todisfact. Therefore Sidhma requires special attention in view of the above. As such a careful selection of natural remedies like Tila, Triphala,Trikatu, Bhallataka, Sita, Madhu and Ghrita internally and Kushta,Moolakabeeja, Sarshapa, Haridra, Priyangu, and Nagakeshara externally areselected keeping in view of the tenderness of the twak. Fortunately aformulation named as Saptasamayoga was found in Chakradutta,Kushtachikitsadhyaya, for internal intake in Kushtas and same has beentaken for the present clinical study along with the external application i.e.,Lepa, Kushtadilepam, a skin preparation from Chakradutta, a popular treatyand Ayurvedic therapeutics. This combination of Anthahparimarjana and
  • 13. Bahihparimarjana proved to be a safest in treating Sidhma and other alliedconditions of fungal origin, for which unfortunately there is no propermedication in the modern medicine. The results and other observations madeduring the study are mentioned in the clinical study section. One of the important aspects of the study is that, it is 100% safe, sinceno irritation or caustic agents were used in the preparation. Moreover, timetested beauty promoting agents like Tila, Bhallataka, Triphala, Trikatu, Ghrita,etc., not only helps in pathological clearance, but also acted asRaktashodhaka. “Raktam Jeevamiti” i.e., rakta itself is life. So once rakta ispurified by the raktashodhakas naturally it boosts up the beauty.
  • 14. REVIEW OF LITERATURE The Ayurveda is the oldest system of medicine and philosophy inworld. All the diseases and treatment aspects concerned to the medicine areavailable from ancient time to the present era in different manners; historicalaspects play an important role in determining various diseases and theirtreatment. The prevalence of “Twak rogas” is described, since Vedic period, manysuch references regarding skin diseases are clearly mentioned in Vedas. The description of Sidhma Kushta is found in the context of kushta inBrihatrayee and Laghu trayee. Symptomatology of Sidhma Kushta describedin the classics has lot of variation causing spectisicium among the disciplesfollowing the Ayurvedic principles. As Sidhma Kushta explained under thecontext of kushta, the historical review of the kushta becomes necessarily tobe dealt along with Sidhma Kushta.Rigveda: In this period lord Indra was said to be a great physician who treatedpersons called Aphala, Ghosha and Shyava who had kushta and cured themgiving normal health1.Atharvanaveda: In this Veda various drugs references are available for Twak rogas,Viz, Kilasa, Dulitha, and Sidhma etc. were treated with Nakthaamala, Krishna,and etc2. Harina sringa (horn of a Deer) possessing the property ofTwakrogahara3. Changala Koshta is said to be having kushta roga haraproperty and also many drugs are indicated in Twak vikaras
  • 15. In Atharvanaveda description about skin and its physiological conditionwere explained among the saptadhatu vitiated rakta is responsible for thetwak vikaras. The disease Sidhma Kushta is mentioned under the twakvikaras and its treatment.Yajurveda: In 10th Shuktha of Shukla Yajurveda, we find a quotation about Twakrogas and number of kushta roga and their list of drugs are also available4.Garuda Purana: In various chapters of Garuda purana description about Twak disordersexplained Viz, Kushta, Sidhma Kushta, etc. description about the SidhmaKushta and its management also being explained in period of Garuda Purana.Panini (700 B.C): In Asthaadhaya of Panini grammatically literature about the diseasesare explained. Diseases like Atisara, Arshas, and Kushta major diseases havebeen explained the diseases caused by Anuvamshika doshaja vyadies arebeing explained and Mahakushta consider under that category referenceabout the Pama, Sidhma and other types of kushta are also narrated.Kaushika Sutra: The references of kushta and its treatment is mentioned in Kaushikasutra (this was made on mantra samhita), like chanting mantras,Aushadhayukthajala (Medicated Water), external application with the pastemade up of drug like Bhringaraja, Haridra, Indravarunya & Neelikapushpa forthe diseases like kushta are explained.
  • 16. Thithariya Brahamana and Vajaineeya Samhitha: The terms of Sidhma or Sidhmala a variety of Twakroga are seen inVajaineeya samhita5 and Thithariya Brahamana6 also.Skanda Purana: The disease Sidhma that is also a variety of Twakroga is mentioned inSkanda. The Lakshana of this are Aruna, Sweta and Shyava, associated withPidakas, Rajoyukta, and kandu, particularly observed during summer due toexcessive sweating etc7.Mahabharata: The references of Twakrogas are available in Mahabharata also. TheShyantanu’s elder brother of Devaki was the victim of Twakrogas thatprevented him in becoming the king8.Samhita Kala: Since Vedic period, the description of Twak rogas and their treatmentwas available, which later on continued in the Ayurvedic texts. The descriptionof Twakrogas according to Atreya sampradaya and Dhanvantari sampradayais an ample of proof in existence of these diseases.Charaka Samhitha (400-500B.C): Charaka samhitha has been narrated as best among chikitsa we finddetailed explanation of kushta rogaadhyaya along with its utpatti. Kushtaroganidana is explained in nidana 5th chapter and chikitsasthana 7th chapterenumarating Sidhma Kushta under Maharoga. Charak samhita hasmentioned its lakshanas separately and samanya chikitsa sutra also.
  • 17. Sushruta Samhitha (800-700B.C): In Sushruta samhita also elaborative description of kushta roga hasbeen presented in nidanasthana 5th chapter and chikitsasthana 9and10thchapter respectively. Kushta dhatugatathwa has been mentioned in Sushrutasamhita only. Sushruta explained Sidhma Kushta under Kshudra Kushta.Ashtanga Hridaya (500A.D): In Ashtanga Hridaya, Vagbhata has given explanation about kushtaroga in the 14th chapter of nidanasthana and treatment is explained underchikitsasthana 19th chapter. Vagbhata also explained Sidhma Kushta underKshudra Kushta only.Madhava Nidana (800A.D): In Madhavanidana 49th chapter detailed explaination about Sidhmakushta in the context of Mahakushta along with dhatugatatwa and sadhyaasadhyata.Bhavaprakasha: In Bhavaprakasha madhyamakanda 54th chapter complete informationof kushta is given, in the same chapter Sidhma kushta is explained inMahakushta.Sharangadhara: In Sharangadhara Samhita explained about the Sidhma Kushta inpoorvakanda of Kushtarogaganana in 7th chapter.Bhela Samhita (800-700B.C): In this samhita, 5th and 6th chapter of nidana and chikitsasthana kushtaroga has been explained.
  • 18. Yogaratnakara: In Yogaratnakara uttaradha information of kushta is given, in the samechapter nidana, chikitsa and sadhyaasadhyatwa of Sidhma Kushta isexplained. Yogaratnakara has explained Sidhma Kushta under Mahakushtaas like Charaka explained.Kashyapa Samhita: In Kashyapa Samhita detailed explanation about Sidhma kushta underkushta chikitsa adhyaya.Bhaishajyaratnavali: In Bhaishajyaratnavali 54th chapter many kushtarogaharayogas areexplained in treatment aspect.Chakradatta: In Chakradatta 50th chapter, the kushtaroga detailed treatmentschedule is given Sidhma Kushta is also explained in this chapter.Vangasena: Vangasena also explained about Sidhma Kushta in Kushtaadhikarachapter. Rasaratna Samuchaya: In 3rd chapter while explaining Gandhakagunas, he mentioned that it isuseful in kushtavyadhies and other skin diseases like Sidhma, Dadru, Visarpa,also.
  • 19. Rasatarangini: In Gandhakaprakarna, Gandhakataila is indicated in Mahakustha andother skin diseases9. It is interesting to note here that Kubera was suffering from kusthasince he was not using Takra in his regimens. Majority of classical textbooks of Ayurveda including Brihatrayeediscussed kushta in detail as Mahagada.
  • 20. NIRUKTIDerivation: “KUSHNAATI ROGAM! KUSH + HANI ITITHANI”10 In the term of kushta, the word “Kush” is added to HANI to form, whichgives a meaning i.e., gives an ugly look to the body.Kushta: “Kushta” the word is derived from the root “Kush” which means thatwhich comes out the inner part to outer part.“KUSHNATI AKSAHITA NIRASTU VET NIRAKOSHITH”NIRAKOKASHAT CHUKOSH NISHKARSHA CHEVRIHAYATAPARICHEDAH MADHYASTITASYA VASTUNOBAHIRNIHSAARANASCHA”11 The word “Kushta” is derived from dhatu “Kush” meaning the morbidfactors mainly rakta is drawn towards the region of twak so as to causeKushta.Paribhasha of Kushta (Definition):“SHARIRAM KUSHNATI TASMATAT KUSHTAM ITHYUCCHYATA”12 According to Arunadatta kushta is defined as that which causesdisfigurement to the body.SIDHMA KUSHTA NIRUKTI: “SIDHYATHI AASU BHESHAJENA ITI SIDHMA”13The word Sidhma has been defined as variety of Kushta and Superficialpathological lesion that can be treated rapidly. ‘SIDHMA’ is a variety of Kushtaroga according to all the authors of theBrithatrayee and Laghutrayee. However Charaka Archarya described it is adisease purely related to the superficial skin and classified under Mahakushta
  • 21. and other Acharyas like Sushruta and Vagbhata, brought it underKshudrakushta. Eventhough the classification differs the symptometology of SIDHMA ismore or less same. The great Aacharya Charaka has explained the symptomof SIDHMA as follows. SIDHMA is a type of Kushta, the sign’s and symptoms are Ruksha,Shukla, and Raktavarna in colour. In the periphery it is fissured and thin incenter; it is smooth, white and red shade. It appears in large number andthere is less pain, itching, burning sensetion, puya, lasika, srava i.e. pus andserous discharge. Its causation and ulceration are sluggish and less of germinfestation. It appears like flower of ALABU14. According to Acharya Sushruta explained the “SIDHMA” a pathologicalstate frequently occurring in the summer with severe itching, whitish in colourand naturally disappears in winter season, generally the disease occur abovethe NABHI, i.e URDHWAKAYA15. According to Vagbhata the Sidhma Kushta appears to be externallydry, internally it is moist in nature and while scratching scales like dust will beseen. It is smooth on touch, which is very light and it looks like“Daugdhikapushpa” with the colour of whitish brown16. According to Bhavaprakasha Sidhma Kushta laxanas like skin colour,which is white, copper colour, followed by the scales and appears likeALABUKUSUMOPAMAM. This variety of symptometology appears in Sidhma.Lesions are mainly seen over VAKSHASTHALA. It is also develop on theother parts of the body17.
  • 22. Madhavakara, Yogaratnakara, Vangasena also explained the sign’sand symptoms like as Acharya Charaka18. Acharya Bhela emphasized the sign’s and symptoms of the SidhmaKushta in 5th chapter of Kushta Nidana & 6th Chapter of Kushta Chikitsaadhyaya19. Acharya Kashyapa also explained Sidhma Kushta in the chikitsasthana of 6th chapter20.
  • 23. DESCRIPTION ACCORDING TO MODERN SCIENCEPITYRIASIS VERSICOLORDefinition: It is an opportunistic infection caused by pityrosporum orbiculare (syn.Malassezia furfur) that affects mainly the stratum corneum in the form of scalyhypo or hyperpigmented macules and rarely papules. This variation in colourgives the name versicolor.Aetiopathogenesis: The yeast llike organism malassezia to distinguish it from themicrosporum species of dermatophytes. Malassezia furfurand pityrosporumorbiculare have beeen found to be the same organism by immunologic andultrastructural studies. Pityrosporum orbiculare is a dimorphic lipophilic organism that grows invitro only with the addition of medium chain fatty acids (C12-C24). Theorganism is culturable from normal as well as lesional skin and can be amember of the normal skin flora. Under favourable conditions such as warmhumid environment, diabetes, corticosteriod therapy, immunosuppression orand inherited predisposition, this saprophytic yeast converts to the pathogenicmycelial phase and presents as clinical disease.Immunology: The host-parasite interaction has two major components, viz.colonization of the host by the parasite and response of the host to thiscolonization. In tinea virsocolor, the host response to fungal colonization isminimal and there is seldom any inflammatioin. Immunological data, however,is insufficient and variable. Elevated specific antibody titres are seen in
  • 24. patients and also in age-matched normal controls. A defect in lymphokineproduction by patients with chronec tinea versicolor has been demonstrated.Complement activation via the alternative pathway has been demonstrated invitro with pityrosporum orbiculare but the significance of this finding remainsunclear.Clinicals Features: The trunk, proximal extremities and the neck are affected and lesscommonly the abdomen, back and face. The scalp and genitalia are rarelyinvolved. The inverse type of tinea versicolor is usually seen in the axillae.The characteristic scale of tinea versicolor is described as dust like orfurfuraceous. It can be seen by lightly scraping the fingernail over the involvedarea (the fingernail sign are Coup d’ongle sign). Pityrosporum orbiculare mayalso colonize follicular structures and hence a high rate of recurrence is seen. It is characterized by hyper or hypopigmented tiny scaly lesionsbecoming larger by coalescence. The hypopigmentation is due to smaller andfewer melanosomes in melanocytes and irregularly dispersed melanosomeswhich are markedly decreased in number within the keratinocyte.Histochemical studies with dopa reaction reveal a normal number ofmelanocytes. Dopa reaction shows an identical picture both in affected andunaffected skin. The hypopigmentation may be due to UVL – screening effect of theskins, blockage of transfer of melanosomes from melanocytes tokeratinocytes, and inhibition of tyrosine activity by azelaic acid formed byfungal enzyme acting upon unsaturated fatty acids in the skin.
  • 25. Hyperpigmented lesions of pityriasis versicolor are particularly found inpigmented individuals. The pigmented is due to an increase in themelanosome size and a change in its epidermal distribution from theaggregated to the non- aggregated form. The fungus is also a low infectivityand it is unusually for the disorder to be transmitted to another person21. On dark skin, they often appear as hypopigmented areas, while on lightskin, they are slightly hyperpigmented. In some darkly pigmented individuals,they may only appear as scaling patches22.
  • 26. SHAREERA All the authours like, Charaka, Sushruta, and Vagbhata says thekushta is one of the skin diseases.Derivation of Twacha: The word Twacha is derived from the root “Twacha- Samvarnane”means, which covers. It can be defined as the body substance that covers theinternal tissues like rakta, mamsa, medas and other dhatus. Modern medicalscience defines skin is the out protective covering of the body consisting ofcorium and the epidermis.Synonyms of Twacha: Twak Charma Raktadhara Asrgdhara Sparshanendriya etc.Embrological development of Twacha: The development of twacha follows the fertilization of streebeeja andpumbeeja and entry of the Atma into it. After joining the chetana dhatu twachastarts to develop during the fourth month of the garba. The different layer oftwacha is formed and all tridoshas and particularly Pittadosha cause thisformation. The formation of twacha and its layers are identical to the formation oflayers of Santanika on the surface of the boiled milk. The Santanika becomesthicker and thicker, as creamy layer multiply. Similarly the layers formed in thedevelopment stage of the embryo and form the twak23.
  • 27. Dhatu Parinama: The term dhatu is derived from Sanskrit root word, which meansdharana to support and poshana i.e., to nourish. It means that which supports,those are Rasa, Rakta, Mamsa, Medha, Ashti, Majja, and Shukra are calledas dhatu These sapta dhatus are promotes the growth of shareera. They areconstantly formed, destroyed and reformed from poshaka dravya. Dhatu alsoare of two kinds those are, 1) Sthayee 2) Asthayee. The Asthayee dhatu, which is nourishes the former dhatu i.e., poshya dhatus. Jatharagni and Bhutagnipaka activate the qualities potentially presentin Aharadravyas in the final stage of digestive process. In pittashaya theaharadravya are being utilized in dhatupaka. All these events including theabsorption of sarabhaga take place in the amashaya. Dhatwagni refers to the agni (pitta) concerned with the pakas ofaharadravyas; these dhatwagnies mediate further metabolic transformation ofthe nutrient substances before they are made available to the sapta dhatusthrough their specific srotases for being assimilated by them. Dhatwagnipaka is stated to have two aspects: 1. Prasada paka 2. Kitta paka, the end products of prasada paka are utilized for the nourishment of dhatus and formation of upadhatus, whereas that of the
  • 28. Kittapaka provides the materials for the formation of excretion such as Sweda,Mootra, and Pureesha etc. Rasa is purviewed to dhatu through distinctchannels. These srotases carry nutrient materials specific to each dhatu24.Upadhatu25: As per Charaka and Vagbhata the upadhatus are 7 in numbers they are, 1. Sthanya 2. Arthava 3. Sira 4. Khandara 5. Vasa 6. Twak 7. Snayu. These are produced in prasada paka from dhatus. Upadhatus are formed as the byproducts of dhatwagni vyapara. Poshakadhatus are utilized for the formation of Sthiradhatus. The kitta bhaga is utilizedfor the contribution of such structures as Hairs, Nails, Sweat and Excretion ofthe Eyes, Ears etc., or they will come out from the body that is Mootra,Pureesha and Sweda. These are utilized in the production of supportingstructure in the body. Dhatu Upadhatu Rasadhatu Sthanya and Arthava Raktadhatu Sira and Khandara Mamsadhatu Vasa and Twacha Medadhatu Snayu Twacha is the upadhatu of mamsadhatu in addition to the Vasa26.
  • 29. So twacha can be considered as a maternal element. Ashtanga Hridayaexplained formation of twak is in the sixth month of gestation27.Rachana of Twacha: According to “Sushruta” twacha is composed of 7 layers and six layersby Charaka and Vagabhata Acharyas. Sushruta described the thickness ofeach layer taking “One Vrihi” as standard for total skin, where as Charakadoes not mention the thickness of layers. The above Acharyas have described the diseases that manifestation ineach layer. But they have difference of opinion about the layer in which theSidhma occurs.Kriya of Twacha: 1. Bhrajaka pitta sthana28 2. Sparshanendriya sthana 3. Sthana for Swedagranthi29 4. Absorption area of Abhyanga, Lepa, Parisheka etc30. In Sidhma the cardinal symptoms are accepted as hypopigmentation. Thus the study regarding the factors responsible for Varna as per Ayurveda is essential.Production of colour during embryonic stage: Tejobhuta is the main factor in the formation of skin colour and amongthe doshas, Pitta is said to be responsible for the normal as well as abnormalcolour of the skin. The colour of the Shukra dhatu and its Panchamahabhautikapredominance, the food habits of Mother, Desha and Kala are the factorsinfluencing the Varna of an individual in the embryonic stage.
  • 30. Sushruta further says during transformation of Shukra and Shonita togarbha, the predominance of each panchamahabhutas are determine thecolour of the garbha as mentioned below, Tejas + AP - > Gaura Varna Tejas + Prithvi -> Krishna Varna Tejas + Akasha - > Krishan shyama Tejas + AP + Akasha - > Shyama Charaka describes prakruta varnas are four in number those are,Krishna, Krishnashyama, Shyamaavadata and Avadata31. Acharaya Charaka and Vagbhata differs regarding the Shyama varna which isarises out of the combination of all the panchamahabhutas32. Beside this Atikrishna and Atigourava are among the Ashtaninditasmentioned in charaka sutrasthana33.Chaya and Prabha: The factors, which are having, close relation to the skin colour. Chayamakes the Varna, while Prabha improves the brightness of the Varna. Chayacan be appreciated from close vision, while Prabha is visible from distance34. Tejobhuta is the basic of all types Prabha. The Prabha is classified intoseven viz., Rakta, Peeta, Sita, Shyava, Harita, Pandu and Asita35. Varna is normal in permanent from birth to death; Chaya may alter dueto arishta (Asanna mrityu laxana) while Prabha changes according to thetemporary state of health.
  • 31. Chaya nirupana (Panchabhuta sambandha) 36 No. Type Lakshanas 1 Nabhasi Nirmala, Neelavarna, Snehayukata, Saprabha 2 Vayavi Ruksha, Syavavarna, Hatahprabha 3 Agneya Vishudharakta, Deeptabha, Darshanapriya 4 Apya Shudha, Vaidurya Vimala, Susnigdha 5 Parthiva Sthira, Snigdha, Ghana, Shyama, SwetaTWACHA VIVECHANA Twacha is the largest organ of the body and is considered as one ofthe sapta dravya responsible for the manifestation of kushta. The descriptionof rachana and kriya of twacha becomes important, according to Charaka andVagbhata, twacha is divided into six layers, and where as Sushruta Acharya’sdescription of twacha includes seven layers. Twacha is considered asMatrujabhava and Upadhatu of mamsadhatu, it is also considered as one ofthe jnanendriya, Vayu and Akasha are the Indriya dravya as present intwacha, sparsha is indriyartha, sparshajnana is indriya buddi, among all thedosha twak is the seat of brajaka pitta. During the process of shukra andshonita and after the formation of garbha, twak and all other dhatu begin toform, just as the cream of milk being formed during boiling of milk. The thickness of twacha is not uniform all over the body and variesdepending upon the functions and performance.
  • 32. LAYERS OF THE TWAK AND MANIFESTING DISEASESCharaka 37 No. Layer Diseases 1 Udakadara - 2 Raktadara - 3 Triteeya “Sidhma”, Kilasa 4 Chaturtha Dadru, Kustha 5 Panchama Alaji, Vidradhi 6 Shashta Arsha, BhagandharaSushruta38 No. Layer Diseases 1 Avabhashini “Sidhma”, Padmakanataka 2 Lohita Tilakalaka, Nyacha 3 Sweta Vyanga, Ajagallika, Mashaka 4 Tamra Kilasa 5 Vedhini Kusta, Visarpa 6 Rohini Grandhi, Apachi, Arbudha, Galaganda 7 Mamsadhara Bhangandhara, Arsha, Vidradhi
  • 33. COMPARATIVE AND CO-ORDINATIVE TABLE OF ANCIENT AND MODERN LAYERS OF SKINNo. Sushruta Charaka Vagbhata Thickness in Vrihi Modern Name1 Avabhasini Udakadhara Udakadhara 1 / 18th Stratum Corneum2 Lohita Ashrgdhara Ashrgdhara 1 / 16th Stratum Lucidum3 Sweta - - 1 / 12th Stratum Granulosum4 Tamra - - 1 / 8th Stratum Malphigi5 Vedini - - 1 / 5th Papillary layer6 Rohini - - 01 Pecticular layer7 Mamsadhara - - 02 Subcutaneous layer I) LAYER OF TWACHA: AVABHASINI Sushrutacharaya names the first or outer most layer of twacha as Avabhasini. Charakaacharya and Vagbhataacharya are named as Udakadhaara. The thickness of this layer is said to be 1/18th vrihi pramana, Chaya and Varna of individual depend on this layer, in vikrutavasta of this layer, Sidhma, Padmakantaka manifest in this twacha. The name udakadhara indicates that this layer regulates the fluid and maintains the fluid balance. This layer is correlated to horny layer of epidermis, which also called as stratum cornieum. II) LAYER OF TWACHA: LOHITA This layer is next to the outer most layers and is named as Lohita by Sushrutacharya and Asrgdhara by Charaka and Vagbhata. The thickness of this layer is said to be 1/16th of vrihi pramana. The diseases, which occur in
  • 34. this layer, are Tilakalaka, Nechya, and vyanga. This layer is correlated tostratum lucidium.III) LAYER OF TWACHA: SWETA Charaka and Vagbhata have not given any name for this layer. Sidhmaand Kilasa diseases are said to occur in this layer, where as Sushrutacharayanaming it as Sweta has said that it measures 1/12thvrihi pramana inthickness. The diseases, which occur in this layer according to Sushruta, areCharmadala. Ajagallika and Mashaka. This layer is compared to stratumgranulosum of epidermis.IV) LAYER OF TWACHA: TAMRA Sushrutacharya has named this layer as Tamra. Where as Charakaand Vagbhatacharya have not given any name. According to Sushruta thethickness of this layer is said to be 1/8th vrihi pramana and it is said to be theadhisthana of Kilasa kushta. Charakacharya says that Dadru kushta occurs inthis layer but Vagbhatacharya says that all types of kushta are produced inthis layer. As the adhisthana of Sidhma kushta is not mentioned by any acharyaand considering Vagbhata’s opinion that fourth layer of twacha is theadhistana of various types of kushta. This layer is correlated to stratummalphigium.V) LAYER OF TWACHA: VEDINI Kushta and Visarpa are said to occur in this layer, designated as vedinitwacha by Sushrutacharaya and said to be 1/5thvrihi pramana. Alaji and
  • 35. Vidradhi are said to occur in this layer for which Charaka and Vagbhata giveno name. This layer is compared to papillary layer of dermis.VI) LAYER OF TWACHA: ROHINI Granthi, Apachi, Arbuda, Sleepada, Galaganda are said to occur in thislayer, termed as Rohini and thickness of which is said to be 1 vrihi pramanaby Sushruta. Vagbhata as termed it as pranadhara. Charaka has not givenany name for this layer. Both these Acharya have not listed any specificdiseases that occur in this layer, but say that trauma to this layer leads tomoorcha. This layer is correlated to reticular layer of dermis.VII) LAYER OF TWACHA: MAMSADHARA Sushrutacharya is the only author who has described the 7th layer oftwacha as Mamsadhara, measuring about 2vrihi pramana. Bhaghandara,Vidradhi and Arshas are said to occur in this layer. This is compared tocutaneous tissues and muscles.IMPORTANT FUNCTION OF SKIN:1 The most important function of skin is to maintain an effective barrier for theloss of water, electrolytes and macromolecules, which are the function ofUdhakadhara twacha.2 It avoids the external injuries, physical, chemical and microbiologicalsubstances into the internal involvement of the body, which is function ofbahya srotas.3 Skin is a prime sense organ for touch, temperature pain and itch, which arethe functions of Twagendriya.
  • 36. 4 Skin plays the most important role in the regulation of body temperature,through sweating and cutaneous vasoconstriction and vasodilation. Which arefunctions of Bhrajaka pitta.5 The flexibility, elasticity and roughness of skin allow motions and provideshape and form of the body.6 The skin surface has antibacterial and antifungal properties.7 Changes in its vascular bed affect the regulation of blood pressure.8 Skin is a secretory organ by virtue of its apocrine sweat and sebaceousglands.9 Skin produces keratinized structures such as hair, nails and Stratumcornieum, which are the functions of the Rohini twacha.10 Skin is a reservoir of electrolytes, water, vitamins, fats, carbohydrates,proteins and other materials, which are the functions of Udakadhara andPranadhara twacha.11 Processes in the skin (melanin function, vasodilation and keratanization)play an important role in detecting the colours of the individuals. This is thefunction of Avabhasini twacha.12 The skin functions in a limited way as an excretory organ.13 Vitamin D is produced in the skin.14. Finally the appearance of skin is valuable to the physician as a mirror orindicator of internal processesRAKTA VIVECHANA: Rakta is one among the kushta karaka sapta dravya. While describingrakta pradoshaja vyadhies, Charaka mentions kushta as one among them. Healso mentions some specific varieties of kushta like Sidhma, Dadru,
  • 37. Charmadala, and Switra etc. but has not mentioned Sidhma kushta being avariety of kushta can be considered as a rakta pradoshaja vyadhi. Rakta is common morbid factor in all varieties of the kushta along withtwak, mamsa and laseeka39. While mentioning raktajakrimi, it has beenmentioned to produce kushta. Vagbhata expresses the same opinion in thechapter on kushta. It is very important to note here that rakta plays animportant role in the vitiation and maintenance of most of the diseases40.MAMSA VIVECHANA: Mamsa is also one among the sapta dravya which cause kushta,twacha is the sarabhaga of mamsadhatu, meda pushti and mala pushti arethe functions of mamsa dhatu. When mamsa dhatu is involved inpathogenesis, the skin disorders can also manifest Sidhma kushta.LASEEKA VIVECHANA: It is a kind of udakamsha and is included among the sapta dravyaresulting in kushta. It is the mala of rasadhatu and stays in twak41. Laseeka isa piccha bhaga of udaka. According to Dalhana, it is Dravya exudation fromswinna mamsa by pitta42.Twacha varna and Bhrajaka pitta: Bhrajakapitta is stated to be located in the skin and to impart to thisstructure its characteristic colour and luster. It has also been stated that itgoverns the normal and abnormal temperature of the body. Acharya Charaka has not described this pitta as a separate entity buthe has included the functions attributed to it among those of pitta in general.He has stated that the production of normal and abnormal temperature of thebody, as well as the normal and abnormal colour of the skin is due to pitta43.
  • 38. Chakrapanidatta in his commentary on the above has stated that theregulation or otherwise of the body heat and variations in the colour of thebody are the functions of Bhrajakapitta, which is located in the skin. Sushruta,Bhela and Vaghbahta have on the other hand, made separate and mentionthis pitta, including the functions ascribed to it. Bhrajakapitta, which is located in the skin, is spoken as Bhrajakagni asmuch as it enables the digestion of substances used for “Abhyanaga”,“Parisheka”, “Avagaha”, “Lepana” etc. it eradicates the glow of one’s naturalcomplexion. Commenting on above Dalhana observes by Twacha isunderstood the Bahyatwacha known as Avabhasini, by Abhyanga etc., ismeant the dravyas employed for the kriya and karma etc. According to Bhela, Bhrajakapitta is that which is responsible formanifestation of the specific characteristic of body, it emphasizes itsimportance, creates different prabhas (hues) of the head, hands, feet, sides,back, abdomen, thighs, face, nails, eyes and hair. It also brightens them. “Vaghbhata” mentioned Bhrajakapitta is located in the skin. It is socalled because it imparts luster to the skin and makes it radiate.“Arunadatta” commenting on Ashtanga Hridaya, he mentions Bhrajakapittabecause it performs deepana and pachana of substances used for abhyanga,lepa, parisheka etc44. Twak is one of the seats of jyanendriya, it is made up of two mainbhoutika components, they are Akasha and Vayu are the indriya dravya ofsparsha is indriyaartha and sparsha is indriyabuddhi45.
  • 39. ANATOMY AND PHYSIOLOGY OF SKIN ACCORDING TO MODERN SCIENCE Derivation: The epidermis and its appendages are developed from the ectoderm; the corium or true skin is of mesodermal origin. About the fifth week of foetal development the epidermis consist of two layers of cells, the deeper one corresponding to the ratemucosum. The subcutaneous fat appears about the fifth month, and the papillae of the true skin about the sixth month. A considerable desquamation of epidermis takes place during foetal life, and this desquamated epidermis mixed with sebaceous secretion constitutes the vernix caseosa The nails are formed at the third month and begin to protect from epidermis by the sixth month. The hairs appear between the third and fourth month in the form of solid, down growths of the deeper layer of the epidermis. The central cells of the solid down growth undergo alteration to form the hair, while the peripheral cells are retained to form the living cells of the hair follicle. About the fifth month of the foetal life hairs appear first on the head and then on the other parts, they drop after birth and give place to permanent hairs. The cellular structure of the sudoriferous and sebaceous glands is formed from the ectoderm where as the connective tissues and blood vessels are derived from the mesoderm. All the sweat glands are fully formed at birth; they begin to develop as early as the fourth month. Anatomy of the skin: - Skin acts as a protective covering for the body minimizing loss of water from the body tissues. Various sensory nerve endings on the skin help to
  • 40. protect the body from injury by invoking appropriate response to nexionsstimuli. The skin also plays an important role in temperature regulation46. The skin or intugement is an anatomical and physiologically specializedboundary lamine, which is of major importance in the life of an individual. Itforms the entire external surface and is continuous with the mucosal surfacesof the respiratory, in alimentary and urogenital tracts at their respectiveorifices, where the modified skin of the muco-cutaneous junctions occurs. Italso lines the external auditory meatus, covers the lateral aspect of thetympanic membrane and is continuous with the conjunctiva at the margin ofthe eyelids and with the lining of the lacrimal candiculi at the lacrimal puncta. The skin is adapted to serve many different roles, since it is majorinterface between the body and its environment. The skin is a major sensorysurface, containing the receptive fields of a variety of somatic sensory nerveendings. It is capable of limited absorption and excretion, and provides asurface for the conversion of precursor compounds into vitamin D by theaction of ultraviolet light, it posses at its surface good frictional properties,enhancing locomotion and manipulation by its texture and physical structure. Skin also provides a major pathway for social communication, by virtueof vascular responses associated with signaling of emotional states andmuscular response of expression, creating a complex sign language and bythe equally subtle possibilities of tactile communication47. The skin is not only a covering of the body tissues and organs but alsobeing composed of epithelial, mesenchymal, glandular and neuromuscularelements, is part of the corporate system. It helps in the maintenance of thewastes of body metabolism, besides having its own active cellular activity. In
  • 41. this process it is exposed to and influenced by both endogenous andexogenous factors. It is the inter action of the skin with external influencessuch as the climate, physical, chemical and biological agents and socio-culture and economic factors in relation to skin disease. All living organisms are sustained by vital and basic life supportprocesses such as air, water and proper nutrition. They also possess agenetic code and memory of the living cells by which they guided for theirlongevity and adaptability to the environment. In the process of survival of thefittest, man realized the need to now the influence of natural forces and theenvironment on his health. He began to alter and modify his environment tosuit his basic needs of existence of and life style48.Structure and functions of the skin: The skin is a complex organ of the body consisting of cellular epidermisand an underlying dermis of connective tissue, subcutaneous fat lies beneaththe dermis. The skin is dynamic organ knowledge of its structure, physiology,chemistry and functions is essential to understand the pathology of skindisorders and also an essential prerequisite to understand the nature of thedisease and to plan proper treatment. The skin varies in thickness from less then 1mm on the eyelid to upto4mm over the back. The epidermis varies in thickness from 0.04mm oneyelids to 1.6mm on the palms. The thickest skin is of course, the skin overthe palm and soles. The epidermis has 4 types of cells, viz. keratinocytes(which constitute 70% of total epidermal cells), melanocytes, langerhans cellsand mercer cells. The dermis predominantly contains undifferentiated
  • 42. connective tissues are blood and lymph vesselss, nerves, muscles,sebaceous, eccrine and apocrine glands, and hair follicles. The dermis is 15-40 times thicker than the epidermis. The skin covers the exterior of the body and is continuous with themucous membranes lining the body orifices. The skin over the palms andsoles is called glabrous (smooth) skin, whereas the skin over the rest of thebody is hair bearing. The structure of the skin varies at different sites of thebody. These anatomical variations must be known to accurately interpretclinical and histopathological variations49.Structure: Two main layers 1) Epidermis 2) DermisEpidermis: It is the most superficial layer and is composed of stratifiedsquamous type of epithelium. The epidermis is derived from the ectoderm. Itis keratinizing stratified squamous epithelium from which arise the cutaneousappendage, i.e., pilose baceous follicles, nails and apocrine and eccrineglands. Epidermal keratinocytes are transformed from undifferentiated basalcells to fully differentiated, fully keratinized cells. The dividing basal cells giverise to a progeny of cells, which migrate upwards until they die and are castaway. The cellular epidermis can be divided into four layers or stratadepending on the state of differentiation at each layer. From below upwardthey are basal, spinous, granular and corneal layers. These cellular layers ofskin should be considered as successive stages of maturation of germsinative
  • 43. keratinocytes into fully cornified keratinocytes. From outside inward stratifiedepithelium may be divided into 5 layers50.A) Stratum corneum: It is most superficially placed. The cells arekeratinised. The cell outlines are indistinct and the nuclei are absent. Thislayer is thickest at the sole and the palm and thinnest at the lip, hairs, loops,nails, feathers, scales etc, are special outgrowth of this layer.B) Stratum lucidum: This is a thin more or less transparent layer 3-5 cellsdeep placed below the stratum corneum. The cell outlines are indistinct andthe nuclei are absent. The cell contains droplets of ‘eleidin’, which is precursorof keratin.C) Stratum Granulosum: It is situated below the stratum lucidum andconsists of 3-5 layers of flattened polyhedral cells filled with keratohyalingranules, which take a deep stain with haematoxylin.D) Stratum basale: stratum basale consists of a single layer of columnarcells. Their cytoplasm contains tonofibrils. Which pass towards the basementmembrane uniting them to the dermis. It is in thin layer and stratum spinosumthat new cells are produced to replace the cells constantly being worn awayfrom the surface process, which is stimulated by the removal of the superficiallayers.E) Stratum spinosum: It consists of several layers of irregularly shaped cells,which tend to become more flattened as the stratum granulosum isapproached. These cells are readily separated by shrinkage except whereadhesion plaques or desmosomes attaches them to each other hence theyhave a spiny appearance in many histological preparations51.
  • 44. Dermis: The dermis or corium supports the epidermis and is composed of thefibrous connective tissue components, collagen and elastic fibres in intimateassociation with the ground substance. It is very thick in the palms and soles of the feet, thicker on theposterior than on the anterior aspect of the body and on the lateral than on themedial sides of the limbs. It is exceeding thin and delicate in the eyelids,scrotum and penis52.MICROSCOPIC STRUTURE OF THE DERMIS The dermis consists of the two layers viz. 1) The upper papillary dermis. 2) The lower reticular dermis. The papillary dermis is bounded superiorly by the epidermis, laterallyby the epidermal ridges and inferiorly by the superficial vascular plexus andreticular dermis. The reticular dermis lies between the papillary dermis and thesubcutaneous fat. While account for the clevage lines, the highly irregularpapillary dermis accounts for the complex arrangement of whorls, loops, andarches. The dermis gives support to the epidermal appendages, bloodvessels and nerves, and also has cellular components like mast cells,fibroblasts and macrophages and a muscle component in the form of arrectorpili53.
  • 45. Appendages:Hairs: Hairs or pili are growth of the epidermis variously distributed over thebody. Their primary function is protection. Although the protection is limited,hairs on the head guard the scalp from injury and sun’s rays. It alsodecreases heat loss, eyebrows and the eyelashes protect the eyes fromforeign particles. Hair in the nostrils protects against inhaling insects andforeign particles. Hairs serve a similar protective function in the external earcanal. Touch receptors associated with hair follicles are activated whenever ahair is even slightly moved. Normally hair loss is an adult scalp is about 70-100 hairs per day. Both the rate of growth and the replacement cycle may bealtering by illness, diet, high fever, surgery, bloodloss or severe emotionalstress. Rapid weight-loss diets that severely restrict calories or proteinsincrease hair loss. An increase in the rate of shedding can also occur for 3-4months after childbirth.Nails: Nails are plates of tightly packed hand-keratinized cells of theepidermis. The cell from a clear, solid covering over the dorsal surfaces of theterminal portions of the fingers and toes. The average growth in the length ofthe fingernails is about 1mm (0.04in.) per week. The growth rate is somewhatslower in the nails. Nails growth is faster in the summer and on most-usedhand. Functionally, nails help us grasp and manipulate small objects invarious ways and provide protection against trauma to the ends of the digitsand allow us to scratch various parts of the body.
  • 46. Sweat glands: 3-4 million sweat glands empty their secretions onto the skin surface.They are divided into two principal types,1) Eccrine2) Apocrine, based on their structure, location and the type of secretion. Eccrine sweat glands are much more common than apocrine sweatglands. They are distrisbuted throughout the skin except for the margins of thelips, nailbeds of the fingers and toes, glans penis, glans clitoris, labia minoraand eardrum. Eccrine sweat glands are most numerous in the skin of thepalms and the soles; their density can be as high as 450sq.cm. in the palms.The secretory portion of eccrine sweat glands is frequently located in thesubcutaneous layer, and the excretory duct extents outward through thedermis and epidermis. It ends as a pore at the surface of the epidermis. Apocrine sweatglands are found mainly in the axilla (armpit), pubic region and areolae of thebreasts. The Secretion portion of the apocrine sweat glands is located in thedermis and the excretory duct opens into hair follicles. Apocrine sweat glandsbegin to function at puberty and produce a more viscous secretion thaneccrine sweat glands. They are stimulated during emotional stresses andsexual excitement and the secretions are commonly known as a “cold sweat”. Sweat is the fluid produced by sweat glands. Most comes from eccrinesweat glands because they are so much more numerous. Sweat is a mixtureof water, ions (mostly Na+ and Cl-), urea, uric acid, amino acids, ammonia,glucose, lactic acid, and ascorbic acid. Its principal function is to help regulate
  • 47. the body temperature by providing a cooling mechanism. Sweat alsoeliminates a small amount of wastes from the body.Sebaceous glands: Sebaceous glands are connected to hair follicles. The secretingportions of the glands lie in the dermis and open into the necks of hair folliclesor directly onto a skin surface (lips, glans penis, labia minora and tarsalglands of the eyelids). Absents in palms and soles, sebaceous glands vary insize and shape in other regions of the body. They are small in most areas ofthe trunk and limbs, but large in skin of the breast, face, neck and upperchest. Sebaceous glands secrete an oily substance called sebum, which is amixture of fats, cholesterol, proteins and inorganic salts. Sebum helps keephair from drying and becoming brittle, prevents excessive evaporation ofwater from the skin, keeps the skin soft and pliable and inhibits the growth ofcertain bacteria. When sebaceous glands of the face become enlargedbecause of accumulated sebum, blackheads develop. The colour of theblackheads is due to melanin and oxidized oil, not dirt. Since sebum isnutritive to certain bacteria, pimples or boils often result54.Skin colour: Three pigments contribute to skin colour: Melanin, Carotene, andHaemoglobin. Of these, only melanin is made in the skin. Melanin, a polymermade of tyrosine amino acids, ranges in colour from yellow to reddish-brownto black. Its synthesis depends on an enzyme in melanocytes called tyrosineand, as noted earlier, it passes from melanocytes to the basal keratinocytes.Racial differences in skin colouring reflect the relative kind and amount of
  • 48. melanin made. Melanocytes of black-and brown skinned people producemuch more and darker melanin than those of fair-skinned individuals, andtheir keratinocytes retain it longer. Freckles and pigmented moles are localaccumulations of melanin. Melanocytes are stimulated to greater activity whenwe expose our skin to sunlight. Prolonged sun exposure causes a substantialmelanin buildup, which helps protect DNA of viable skin cells from UVradiation. Indeed, the initial signal for speeding up synthesis seems to be anincreased rate of repair of photodamaged DNA. In all but the darkest people,this response causes visible darkening of the skin. Despite melanin’s protective effects, excessive sun exposureeventually damages the skin.Carotene: It is a yellow to orange pigment found in certain plant productssuch as carrots. It tends to accumulate in the stratum corneum and in fattytissue of the hypodermis. Its colour is most obvious in the palms and soles,where as stratum corneum is thickest and most intense when large amountsof carotene-rich foods are eaten. However the yellowish tinge of the skin ofsome Asian peoples is due to variations in melanin not to carotene. The pinkish hue of fair skin reflects the crimson colour ofoxygenated haemoglobin in the red blood cells circulating through the dermalcapillaries. Since caucasion skin contains only small amount of melanin, theepidermis is nearly transparent and allows haemoglobin’s colour to showthrough. When haemoglobin is poorly oxygenated, both the blood and theskin of light-skinned people appear blue. This condition is called cyanosis. In
  • 49. dark skinned individuals, the skin does not appear cyanotic because of themasking effects of melanin, but cyanosis is apparent in their mucousmembranes and nail beds55.Functions of Skin: Skin serves several function those are,1) Protection: The skin covers the body and provides a physical better thatprotects underlying tissues from physical abrasion, bacterial invasion anddehydration and ultraviolet radiation. Hair and nails also have protectivefunction.2) Sensation: The skin contains abundant nerve endings and receptors thatdetect stimuli related to temperature, touch, pressure and pain.3) Excretion: Besides removing heat and some water from the body, sweatalso is the vehicle for loss of a small quantity of ions and several organiccompounds.4) Immunity: Certain cells of the epidermis are important components of theimmune system, which fends off foreign invaders.5) Blood reservoir: The dermis houses extensive networks of blood vesselsthat carry 8-10% of the total blood flow in a resting adult. In moderateexercise, skin blood flow may increase, which helps dissipate heat from thebody. During strenuous exercise, however, skin blood vessels constrictsomewhat, which allows more of the blood to circulate through contractingmuscles.6) Synthesis of vitamin D: It begins with activation of a precursor moleculein the skin by ultraviolet rays in sunlight. Enzymes in the liver and kidneysthen modify the molecule; finally providing calcitrial contributes to the
  • 50. homeostasis of body fluids by aiding absorption of calcium in foods from thedigestive tract into the blood. Thus vitamin D is a hormone, since it isproduced in one location in the body transported by the blood and then exertsits effect in another considered an endocrine organ.7) Regulation of body temperature: In response to high environmentaltemperature or strenuous exercise, the evapouration of sweat from the skinsurface helps lower an elevated body temperature to normal. In response tolow environmental temperature, production of sweat is decreased, whichhelps conserve heat. Change in the flow of blood to the skin also helpsregulate body temperature56.
  • 51. CLASSIFICATION OF KUSHTA Different Acharya have mentioned different classification of kushta,Sidhma Kushta is mentioned in Mahakushta according to Charaka andKshudrakushta according to Sushruta and Vagbhata. The same type of causative factors produces all the varieties of kushta,depending upon the permutation and combination of the various fractions ofdosha and their locations in the body. In the name and treatment of the various types of kushta, there isvariation in the nature of colour, pain, and specific manifestations. Accordingto one classification they are of 7types and according to another classificationthere are eighteen types. According to some, kushta is of innumerablevarieties57. However a compiled list of Kushta varieties is given here. CLASSIFICATION OF MAHAKUSHTAName of the disease Cha. Su. A.Hr. M.N. B.S. B.P. Ka.S. Kapala + + + + + + + Audumbara + + + + + + + Mandala + _ + + + + + Aruna _ + _ _ _ _ _ Rushyajihwa + + + + + + + Dadru _ + + _ _ _ _ Kakanaka + + + + + + + Sidhma + _ _ + + + + Pundarika + + + + + + +
  • 52. CLASSIFICATION OF KSHUDRAKUSHTAName of the disease Ch. Su. A.Hr. M.N. B.P. B.S.Eka-kushta + + + + + +Charmakushta + _ + + + +Kitibha + + + + + +Dadru + _ + + + +Alasaka + _ + + + _Vipadika + _ + + + +Charmadala + + + + + _Vispotaka + _ + + + _Pama + + + + + +Shataru + _ + + + +Vicharchika + + + + + +Sthularushka _ + _ _ _ SthularuMahakushta _ + _ _ _ _Visarpa _ + _ _ _ _Parisarpa _ + _ _ _ _Sidhma _ + + _ _ _Rakasa _ + _ _ _ _Kacchu _ _ _ _ + _Switra _ _ _ _ _ +Vishaja _ _ _ _ _ +Gajacharma _ _ _ _ + _
  • 53. NIDANA Specific nidana of Sidhma kushta are not described in Ayurvedicclassics, as Sidhma kushta is one among the 18 types of kushta, some of thenidanas mentioned in the context of kushta holds good for Sidhma kushtaalso. “Sidhma Kushta” is a variety of “Kshudra Kushta” according toSushruta and Vagbhata Acharya. There is no specific nidana factor forSidhma kushta. As such the causative factors attributed to kushtas are to betaken as causative factors for Sidhma kushta also. However Acharya Charaka has included “Sidhma Kushta” underMahakushta and causative factors are the same for the both types of kushtas,as such there is no controversy about nidanic factors. The nidanas mentioned for the causation of kushta can be broadlyclassified and studied under the following five headings. 1) Aaharaja 2) Viharaja 3) Daivapacharaja 4) Chikitsa sambandhi 5) Sankramika
  • 54. AHARAJA NIDANA OF SIDHMA KUSHTASl.No. NAME Cha. Su. A.H. B.S. Ha.S. 1 Virudhahara + + + + + 2 Ajeerna, Adhyasana + + - + - 3 Matsyati sevana + + - + - 4 Dugdati sevana + + - - + 5 Amlati sevana + - - - + 6 Guru ahara + - - - + 7 Gramyodaka with Anupamamsa - + - + - sevana 8 Dadhi sevana + - - + - 9 Snehati sevana + - - + - 10 Lakucha and Kakamachi + - - + - 11 Matsya with Payasa + - - + - 12 Ahitashana - + - - - 13 Drava, Snigdhahara sevana + - - - - 14 Uddalaka, Kusumba + - - - - 15 Navanna, Yavaka, Kulatha + - - - - 16 Lavana, Hayanaka, Atasi + - - - - 17 Moolaka, Satatamadhu sevana + - - - - 18 Tilapishta, Guda + - - - - 19 Chilichima with Milk + - - - - 20 Madyamladravya with Milk - - - + - 21 Guda with Milk - - - + - 22 Matsya, Nimba with Milk - - - + - 23 Mamsa with Madhu - - - + - 24 Papodaka (dushta jala) - - - - + 25 Pippali, Haritashakha, - - - + - Vidagdhahara sevana 26 Guda with Moolaka - - - + - 27 Haviprashana (Ghrita type) + - - - -
  • 55. VIHARAJA NIDANA OF SIDHMASl.No. NIDANA Cha. Su. A.H. B.S Ha.S. 1 Chardinigraha + + - + - 2 Vegavarodha + + - + - 3 Sheetambusnana after atapa sevana + + - + - 4 Divaswapna + - - + + 5 Ratri jagarana - - - - + 6 Mithya vihara - + + - - 7 Vyayamam atisantapa bhuktopa sevanam + - - - - 8 Shrama bhayartanam sheetambu sevana + - - - - 9 Ajeernapi vyayamam + - - - - 10 Sneha pitasya vantasyava vyayamam - + - - - 11 Vyavaya after vidahi ahara sevana - - - + - 12 Gramyadharma sevana - + - - -
  • 56. DAIVAPACHARAJA NIDANA OF KUSTHA58Sl.No. NIDANA Cha. Su. A.H. Ha.S. 1 Vipran Guruna garshayatam + + + - 2 Papakarma + + + - 3 Poorvakruta Karma + + + - 4 Killing of Female and Elders - + + + 5 Use of money or material aquired - + + - through theft 6 Sadhuninda, Apamana, and Vadha - - + - 7 Gohatya - - - +
  • 57. USAGE OF IMPROPERLY PURIFIED RASA AUSHADHI1) Parada Mercury Kushta utpatti (A.P.19 Rasarnva)2) Abraka Mica Kushta utpatti (A.P.2/1003)3) Roupya Copper Kushta utpadaka, Mandala makshika pyrate utpatti, Krimiroga utpatti (A.P.4/11)4) Gandhaka Sulphur Kushta utpadaka (A.P.2/18)5) Haritala Arsenic Spotha utpadaka6) Tamra Copper Kushtadhi rakta vikara (R.R.S.6/47)7) Vanga Tin Kushta, Kilasa utpadaka (R.T.28/7)8) Hiraka Diamond Kushta utpatti (A.P.5/74)9) Vaikranta Tourmaline Kilasa, Kushta utpatti A.P.5/16010) Manashila Realgar Twacha vaivarnata11) Loha Iron Kushta utpadaka (A.P.3/224) ROLE OF AHARAJA NIDANA IN SIDHMA KUSHTA
  • 58. NIDANA DUSHTIViruddhahara Pitta and RaktadushtiAjeerna, Adhyashana AmlotpattiMatsya KaphadoshavriddhiDugdhati sevana Kaphavriddhi, Rasa and MedovriddhiAmlati sevana Kapha and Pittavriddhi, RaktadushtiGuru ahara Kapha and MedovriddhiDadhi sevana Kaphavriddhi, Medovriddhi and RasadushtiSneha Vatavriddhi, KledakarakaLakucha and Kakamachi Sleshmavriddhi, Kledakaraka, Rakta and PittaMatsya with Payasa Pitta, Raktadushti, KledakarakaAhitashana Kaphavriddhi and KledakarakaDrava, Snigdhahara Kaphakaraka and KledakarakaUddalaka, Kusumba Kaphakaraka, Medovriddhi and KledakarakaNavanna, Yavaka, Kulatta Kaphakaraka, Medovriddhi and KledakarakaLavana, Hayanaka, Atasi Raktakopaka, Kledakaraka and PittakarakaMoolaka, Satatamadhu sevana VatavardhakaTilapishta, Guda Kapha and Pittakaraka, RaktadushtiChilichima with milk Pitta and Rakta dushtiMadyamla, Dravya with Milk Pitta and Rakta dushti, KledakarakaGuda with milk Pitta and Rakta dushti, KledakarakaMatsya, Nimba with milk Pitta and Rakta dushti, KledakarakaMamsa with Madhu KaphapittavardhakaPapodaka Pitta and RaktadushtiPippali, Haritashakha, Vatakaphavardhaka and Raktautkleshakara.Vidagdha ahara sevanaGuda with Moolaka Krimiutpatti, TridoshakopakaHaviprashana Kaphakaraka and Kledakaraka
  • 59. ROLE OF VIHARAJA NIDANA IN KUSHTA NIDANA DUSHTIChardinigraha Kushta, Visarpa, Kandu utpattiVegavarodha Vatakaphavriddhi and KushtakarakaSheetambusevana after atapa Ashrugdhara sroto dushti, Kledakarakasevana, Divaswapna kaphautkleshakarakushta, Kota, Pidaka, and kandu utpatti.Mithya vihara Tridoshavriddhi, KushtakarakaVyayama, Atisantapa, Bhuktopasevana Rasadidhatukshaya, Vataprakopaka and Kushtakaraka.Shrama bhayartana Sheetambu Rasadidhatukshaya, Vatavriddhi, Kushtasevana utpattiRatrijagarana, Ajeernepi, Vyayama Vatavriddhi, Amlotpatti, Kushtadiroga utpattiSneha peetasya vantasya, vyayamam Vatavriddhi, Kledakaraka, Raktadushti KushtakarakaVyavaya after vidahi ahara sevana Tridoshavriddhi, Rasa and RaktadushtiGramya Dharma Sevana Pitta, Raktadushti
  • 60. AHARA SAMBHANDHI NIDANAi) Rasa sambhandhi: Excessive and regular intake of food articles, which havepredominance of amla and lavana rasa act in two ways, firstly, they causedosha dushti and secondly, they cause Rakta dushti. The resultant kushta is acombined effect of both. This is evident from the statement of Charaka Acharya stated thatexcessive intake of amla rasa causes kapha vilayana and pitta vriddhi. Healso indicates that it causes rakta dushti. Thus the excessive intake of amlarasa acts as ubhaya hetu; the same is true with lavana rasa also.Viruddhahara sambhandhi: According to Acharya Charaka, viruddha ahara influences on theequilibrium states of dosha, dushya, mala, and srotas, these may becomeresponsible factors for the manifestation of the diseases. In the same context he has mentioned that along with many diseases,which are caused due to viruddha ahara, kushta roga is also one amongthem. Among hetus mentioned in the list of ahara a few are capable to vitiaterakta directly and other vitiates only dosha59. Intake of chilichima or all varieties of matsya with milk directly vitiaterakta. Because both ksheera and matsya will have the qualities of madhurarasa, madhura vipaka and abhishyandhi, but they are opposite to their Veeryai.e., milk has got sheeta Veerya and matsya has got unsnap Veerya, by thisquality (guna) they directly vitiate rakta and cause morbidity in it. BothKsheera and Matsya combinedly cause obstruction in channels due to their
  • 61. abhishyandhi quality hence this hetu may be considered as vyadhi hetu.Since they are directly vitiates rakta and cause shithilatha in it, which in turnleads to kushta.Vishesha nidana: The other hetu such as intake of food mostly containing Hayanaka,Moolaka, Kakamachi, etc. are only competent enough in producingaggravation of dosha. But as an exception the eaten Kakamachi directly maycause kushta by vitiating rakta since Acharya Charaka considers it asviruddha. Hetu listed under ahara and koshtasthithi; generally impair the processof digestion. This ultimately leads to excessive production of ama dosha.II) Viharaja nidana60: The causative factors, which are enlisted in the ahara and viharajanyacategory, affect the process of digestion. Ultimately utpatti of ama leads toaggravation of doshas. Among the nidanic factors categorized under viharajanya nidanas,shareerika vegadharana plays an important role. In them chardi vegadharanaacts as a vyadhi hetu. Where as the suppression of the other Vegas serve asdosha hetu. Chardi manifests when kapha and pitta move upwards with the help ofudana and vyana vayu. By suppressing this urge kapha and pitta get settled.The aggravated kapha and pitta cause kushta by the exposure of theindividual to excessive physical activities (Vyayamadi).
  • 62. III) Daivapaacharaja61 The exact role of some of the nidanas mentioned such as Papakarma,Gohatya, etc. in the causation of kushta is difficult to understand and analyse.However these can be taken as vyadhi hetu or vishesha hetus of kushta.Gandhadhar commentator of Charaka also supports this view. Vagbhataconsiders these nidana as Adrushtakarmaja vyadhihetu.IV) Chikitsa sambandhi nidana: The hetu listed under chikitsa sambandhi are usually vyadhihetus.Panchakarma mityapachara is considered as a nidana for kushta inBrihatrayee. The vyapath of shodhana is a cause for kushta. That too, ayogaof vamana and virechana is a stronger cause for kushta than atiyoga of theseprocedures. The panchakarma procedures are adopted to eliminate the aggravateddoshas, but improper application of panchakarma measures will causeadverse effects. By the ayoga of vamana and virechana, doshas that aresupposed to be eliminated from the body will not be completely eliminated.There will be residual doshas in the body, which again get localized oraccumulated in shakhadi margas, ultimately leading to the manifestation ofkushta by causing shithilatha in the dhatus. If snehakarma is continued evenafter samyak sneha it causes sneha vyapath. Then it leads to shithilatha andklinnatha of dhatus. This excessive sneha leads to kotha and causes kushta. Similarly the continuation of brimhana therapy even after the exhibitionof samyak brimhana lakshana causes increase of kapha dosha and rasadidhatu with their kledatvadi vruddhi resulting in the shithilatha, which ultimatelyleads to manifestation of disease kushta.
  • 63. V) Sankramika nidana62: Sushrutacharya is an only author who has mentioned the categorynature of kushta, even though he has not mentioned these in the context ofexplaining the causative factors of kushta. All the modes of communicating acontagious and infectious disease such as inhalation, physical contacts,including sexual contacts, contamination of food etc. have been mentioned. The diseases manifesting, due to sankramika hetu can be termed asbhootabhishangaja, here bhoota refers to krimi. In krimi prakarana while explaining about the raktajakrimi has been toldwhile clearly justifies the role of krimi in kushta.
  • 64. SAMPRAPTHI OF SIDHMA KUSHTA All the classical textbooks of Ayurveda have elaborated one commonsamprapthi for kushta. Even though kushta is classified into Mahakushta andKshudrakushta, any author has not emphasized the separate samprapthi ofthese two types, not even the samprapthi of individual variety of kushta also.Naturally a separate samprapthi for Sidhma kushta is not available in any ofthe Brihatrayee or in the works of later authors. The common samprapthi of kushta according different authors is asfollows. According to Charaka Acharya, the vitiated sapta dravyas areconsidered as sannikrishta karanas for kushta. The vitiated doshas vitiatetwacha, mamsa, rakta, and lasika and the combination of these sapta dravyasleads to the disease process. The morbid sapta dravyas will be localized inbetween twak and mamsa and may produce different varieties of lesions atdifferent sites over the skin. They are named differently based on the site andnature of the lesions63. According to Vagbhata, by the said nidanas the doshas get vitiatedthen spread to tiryak siras. They vitiate twacha, lasika, and ashrg. Thisproduces shithilikarana and vaivarnya of bahya twacha. The disease kushtamanifests wherever the morbid doshas get lodged64. Madhavakara description of kushta samprapthi is similar to that ofCharaka Samhita, however there are some manifestations. The morbidtridoshas vitiate twacha, rakta, mamsa, and ambu. These sapta dravyas areconsidered as sannikrishta karanas, which are responsible for producing
  • 65. seven Mahakushtas and eleven kshudrakushtas. He has used the term ambuin the place of lasika among the sapta dravyas65. Bhavaprakasha and Yogaratnakara have followed the descriptions ofCharaka Acharya66. The samprapthi described in Bhela Samhitha focuses on the vitiation ofthe vata dosha. The state of mandagni gives rise to the provocation of vata.The provocated vata vitiates the other doshas in their sanchayavastha.Depending on the rutus, the tridoshas get lodged in rakta and vitiates rudhirafollowed by mamsa. The combination of tridoshas along with rakta, mamsagives rise to 18 types of kushtas depending on the etiological factors67. The description of kushta samprapthi available in Harita Samhitha issimilar to the Charaka samhitha with special emphasis on lasika as amamsatwakantara udakadhatu. The samprapthi described in Sushrutha Samhitha is as follows, thevata aggravated by the nidanas in combination with the aggravated pitta andkapha enter into the siras, which are transversely spread over the surface ofthe body. Thus the enraged vayu deposits the pitta and kapha on the skinthrough the medium of their channels and spreads them over the surface ofthe body. The areas of the skin in which the morbid doshas are depositedbecause marked with mandalas or skin patches (Mandalani pradurbhavanthi).The doshas thus lodged in the skin continue to aggravate and having beenneglected at the out seat tend to enter into the deeper tissues and furthervitiates the dhatus68. After going through the samanya samprapthi of kushta according todifferent authors, the samprapthi described by Sushrutacharya seems to be
  • 66. elaborate and accurate denoting samprapthi of both Mahakushta andKshudrakushta. But Kshudrakushta samprapthi is to be limited to the stage ofMandalani pradurbhavanthi. The further stage of pathogenesis described bySushruthacharya has to be restricted to Mahakushta. Among sapta dravyas of kushta mentioned for the causation of kushta,the tridoshas viz. vata, pitta, kapha, and two dushyas namely rasa and raktaseems to play an important role in the manifestation of “Sidhma Kushta”. Therole of mamsa and lasika seems to be less. Among the tridoshas Charaka has stressed the role of vata and kaphaby classifying “Sidhma Kushta” under the heading of vatasleshmatmakakushtas on the other hand Sushruta has stressed the role of kapha in thepathogenesis Sidhma Kushta. However these two opinions need not be taken as contradictory toeach other, because all these doshas take part in pathogenesis at differentstages of the manifestation of the disorders. Classical textbooks of Ayurveda mentioned kushta as a Janmabalapravruta vyadhi, “Sidhma Kushta” being one among them. In the geneticallypredisposed persons the intake of pitta and kapha karaka nidanas results inthe vitiation of kleda initiating the process of pathogenesis. Both Mahakushtaand Kshudrakushta are sankleda pradana vyadhies. The nidanas vitiate pitta and kapha dosha and cause the shithilatha ofbahya twacha. These doshas cause marghavarodha of vata dosha in turnleading to vata vriddhi. This vitiated vata carries the vitiated pitta, kapha, andlasika into tiryak siras and lodge them in the udakadhara, raktadhara, andmamsadhara twacha. Among with tridoshas kleda plays an important role in
  • 67. the pathogenesis of any variety of pitta including “Sidhma Kushta”. Both pittaand kapha being dravadhatus are considered as kledakaraka sannikrishtakaranas. The Siddhanta explained in the classics suggest that usually ifinitially the vitiation of kapha in predominant with the predominance of sneha,sheeta and picchila gunas, then the vitiation of kleda occurs. On the otherhand if initially the vitiation of pitta is predominant with predominance of itsgunas i.e. sneha dravya then also kleda gets accumulated. The accumulation of kleda results in the srotorodha and leads vatavriddhi. Because of the combined effect of vata vriddhi and srotorodha, therasadhatu does not properly enter the srotas. Twacha being entirelydependent on rasa for its manifestation becomes heena satwa resulting inshaithilya of twacha. There will be abhava of snigdha guna of rasa in thetwacha resulting in further vata vriddhi. Twacha becomes shyava Varnabecause of vata vriddhi. At the same time due to ushna guna of pitta,dravamsha of kleda escapes through sweda. Due to the loss of thisdravamsha, the kleda that remains in the twacha will be ghanibhuta kleda. In“Sidhma Kushta”, this affects the twacha and parushata, kharaparushata.
  • 68. SAMPRAPTHI GHATAKA As told earlier samprapthi is nothing but series of changes, which takesplace inside the body, from the day of consumption of nidana to vyaktavasta.Here it becomes very essential to know all the factors involved directly orindirectly in the manifestation of Sidhma Kushta. In Charaka it is mentioned as samprapthi vighatana meva chikitsai.e., to say, “Systemic breaking of samprapthi is chikitsa”. This shows that theproper knowledge of all the samprapthi ghataka is very important. There areabout 12ghataka. This plays role in the manifestation of “Sidhma Kushta”.They are dealt as follows, 1) Dosha : - Vata, Pitta, and Kapha 2) Dushya : - Rasa, Rakta, Mamsa, and Lasika 3) Agni : - Jataragni 4) Ama : - Jataragni janya ama 5) Srotas : - Rasa, Rakta, and udakawaha srotas 6) Srotodushti prakara : - Sanga 7) Udhbhavasthana : - Amashaya and Pakwashaya 8) Sancharasthana : - Rasayanee 9) Adhisthana : - Twacha 10) Vyakta sthana : - Sarvadehika (Twacha) 11) Rogamarga : - Bahya 12) Rogavastha : - Chirakari
  • 69. VISHESHA SAMAPRAPTHI IN SIDHMA KUSHTA An attempt is made to understand Sidhma Kushta according thevarieties of samprapthi as follows, 1) Sankya samprapthi: -Sidhma Kushta is one in number. 2) Pradhanya samprapthi: -According to Charaka and Vagbhata Sidhma is VataKaphaja and according to Sushruta Sidhma is Kapha doshaja. 3) Vidhi samprapthi: -Sidhma is adibala pravruta vyadhi. 4) Vikalpa samprapthi: -The vikalpa samprapthi of Sidhma Kushta is as follows,Dosha Gunataha Vridhis Karmataha Vridhi Dravyataha VridhiVata Rukshata, Parushata Vedana RajogrishtamPitta Ushna Guna Daha -Kapha Snigdha, Picchila Kandu, Sweta Varana Srava 5) Bala samprapthi: Sidhma is Dwidoshaja Pradhana according toCharaka and Vagbhata and Ekadoshaja according to Sushruta andEkamargaja. 6) Kala samprapthi: Sidhma gets flared up due to the exposure inGreeshma rutu.1) DOSHA: Kushta is caused due to the involvement of all the tridosha. Among thistridosha, Vata and Kapha play major role. The predominance of tridosha individually is understood by theirfactors. In Sidhma vatadhikya features are seen such as ruksha, parusha and
  • 70. vedana. Feature like daha are suggestive to pitta dosha predominance.Features like kandu, picchila and sweta varna are suggestive of kapha doshapredominance. According to Charaka and Vagbhata Sidhma Kushta is Vataand Kapha dosha pradhana and according Sushruta Kapha dosha pradhanavyadhi.Vata dosha: Among tridosha vata and kapha dosha plays major role and isresponsible for carrying, pitta dosha to other parts of the body. Charaka hasmentioned very clearly that the seat of vyana vata is sarva shareera.Transportation of rasadi dhatu is done by vyana vata only. Because ofvitiation of vata dosha, snigdhata of twacha is deranged there by vrikruti in thetwacha is seen this shows the involvement of vata dosha.Pitta dosha: The involvement of pitta dosha is ascertained by the presence offeatures like vaivarnata, daha etc, twacha vaivarnata is indicative of brajakapitta dushti. The vitiation of brajaka pitta vitiates the prakruta karma of twacha.Because of nidana sevana, pachaka pitta is deranged this inturn vitiates otheragni, because pachaka pitta present in amashaya nourishes the other pitta.Ranjaka pitta does the ranjana karma. All the nidana of kushta are raktaprakopaka, there is close relation between rakta and ranjaka pitta andtherefore whenever rakta dushti takes place ranjaka pitta dushti also takesplace. The above said description indicates the involvement of trividha pitta.Kapha dosha:
  • 71. According to Charaka and Vagbhata, kapha dosha plays a major role in the manifestation of Sidhma Kushta. The snigdhata is because of kapha dosha, which is vitiated due to nidana sevana; this is probably due to vitiation of kledaka kapha. 2) DUSHYA: Charaka has mentioned dushti of saptadravya in the manifestation ofkushta roga. Among this saptadravya twak, rakta, mamsa and lasika are the4dushya. Among these four dushyas twak and lasika are predominantlyaffected and these features concerned are sarvadehika in nature. After twak,rakta, mamsa and ambu dushti takes place. The nidana of kushta vitiate bodilydosha especially vata and kapha dosha, this vitiates rakta and producesSidhma.3) AGNI: In Ayurvedic classics it is mentioned as rogaha sarvepe mandagni i.e.,almost all the diseases are cause due to mandagni only. In kushta agni plays role. Jataragni gets vitiated due to nidana sevana. Normaly dhatwagni are nourished by jataragni. The vitiated jataragni, vitiate dhatwagni. As jataragni mandyata is present in kushta, dhatwagni mandata is also produced. 4) AMA: Normalcy of jataragni is mandatory for normal health. Any variation tojataragni can give rise to diseases. As due to nidana sevana jataragni is vitiatedand jataragni janya ama is produced. If jataragni is vitiated, dhatwagni also getsvitiated and dhatwagni janya ama is produced. 5) SROTAS:
  • 72. Rasavaha (twak) Raktavaha Udakavaha (sweda) In kushta there is involvement of twacha (rasadhatu), rakta and lasika(ambu). Hence we have to consider rasavaha, raktavaha and udakavahasrotas. Features related to the dushti of respective srotas are clearly seen. Wehave to consider rasa, rakta and udaka srotodushti based on their respectivelaxana and chikitsa adopted for Sidhma Kushta.6) SROTODUSHTI PRAKARA: Sanga When the morbid dosha along with ama are traveling all over the body,sanga takes place and these dosha are revitiated, and these revitiated doshathrough the tiryakgamana sira, go to other parts of the body, such as twacha,mamsa which are not places of their own.7) UDBHAVA STHANA: Amashaya and Pakwashaya Amashaya is considered as udbhava sthana because after nidanasevana jataragni gets vitiated then ama utpatti takes place, then dosha arevitiated, then vyadhi utpatti takes place. Vata also plays major role in the manifestation of kushta roga. Thepakwashaya is the sthana of vata dosha hence amashaya and pakwashayaare considered to be udbhava sthana of Sidhma Kushta.
  • 73. 8) SANCHARA STHANA: Rasayanee Rasayanee are to be considered as sanchara sthana as these playsrole of transportation for transporting the ama and morbid dosha to other partsof the body.9) ROGADHISTHANA: Twacha The morbid dosha such as vata, pitta and kapha take shelter in twachasthana along with morbid rasa, rakta, ambu etc, and produced kushta.Acharya Charaka potentiates the claim of twacha being adhistana of kushtaroga.10) VYAKTA STAHANA: Sarvadehika (Twacha) Kushta is a twacha vikara, which is caused due to rasaraktadi dushya.Majority of the laxana is exhibited over the skin only hence sarvadehika isvyakta sthana.11) ROGA MARGA: Shaka marga (Bahya) In Ayurveda classics, it has been mentioned that the roga marga arethree. Some of the diseases belong to one roga marga; some of the diseasesbelong to two-roga marga. Some of the diseases belong to three-roga marga.Normaly the roga marga is considered based upon adhistana, vyakta sthanaand laxana. Particularly in Sidhma Kushta, twacha is the adhistana andvyakta sthana and the schikitsa also aimed at twacha only, therefore rogsamarga is bahya (shaka marga).
  • 74. 12) VYADHI SWABHAVA: Chirakari Kushta roga manifestation is incidious and slows in onset. Thetimetaken for the manifestation of Sidhma Kushta from the day of exposure tonidana till vyakatavastha is considerably more. Normally we do not find acutepresentation of Sidhma Kushta. POORVAROOPA OF SIDHMA KUSHTA There is no specific mention of poorvaroopa of “Sidhama kushta”.However so many poorvaroopa of kushta is mentioned, this poorvaroopa canalso be considered for Sidhma kushta. The general principles that “TESHAM AVYAKTHA LAXANAM EVAMPOORVAROOPAM” holds good for Sidhma Kushta. The generalpoorvaroopa of kushta can be taken as poorvaroopa of “Sidhma kushta”. Poorvaroopa is laxana or groups of laxanas that indicates the diseaseto be manifest. Poorvaroopa precipitate due to the dosha-dushyasammurchana in the sthana samshraya stage. The general laxanas of Sidhma Kushta when appeared in mild formthose are considered as poorvaroopa of Sidhma Kushta.
  • 75. ROOPA OF SIDHMA KUSHTA69 The roopa of Sidhma kushta explained by the authors like Charaka,Sushruta, and Vagbhata opinions appears to be same. But the AcharyaSushruta and Vagbhata added the few symptoms and described in details,they are 1. Externally Sidhma seems to be ruksha with aruna Varna, in the center of the scale is snigdha. 2. Sidhma does not pain much that is alpavedana will be there. 3. The colour of the Sidhma is generally raktavarna or swethavarna to the nacked eye. 4. There may be lasika srava expected in prolonged untreated cases and few asatmya karanas would cause the increase of srava. 5. The affect of Sidhma on the skin produces alpakandu and associated with daha in many cases. 6. Sidhama appears like “Alabu Pushpa sankasa” that is the flower of bottle guard. 7. Sidhma effects only on urdhwakaya.
  • 76. SYMPTOMS PRODUCED BY INDIVIDUAL DOSHAS VATA DOSHA PITTA DOSHA KAPHA DOSHA Rukhsa Daha Sweta varna Shaodya Raga Utcheda Toda Parishravi Shaithya Shula Paka Kandu Sankocha Visragandha Sthairya Ayama Kleda Gaurava Parushya Angapaatana Snigdhata Kharata - Kledata Lomaharsha - Jantukrimi utpatti Shyava, Aruna varna - - Kandu: Kandu occurs in Sidhma Kushta by kapha dosha. Kashyapa samhitaconsidered the involvement of ambu dushti. It can be inferred that kanduresults from the predominance of kapha vitiation twanged ambu. In Sidhmathe person is having the desire of itching. Due to nidana sevana agnimandyais produced and due to this amotopatti take place. This ama latter on behaveslike visha. Thus ama vitiates rasadhatu and produce sanga in rasavahasrotas. The same rasa, which is produced due to rasagni mandyata also,circulates all over the periphery. Due to srotosanga vyanavata sanchara isreduced, due to this same roopa rasa stays in the periphery because of thissort of irritation is created in the area, which results in kandu. Twacha is theadhishtana for kandu.
  • 77. Vedana: Charaka has told Vedana. Vedana is usually karmataha vriddhi of vatadosha, as there is involvement of all tridosha, especially vata doshapredominance. Due to nidana sevana the vitiated vatadi dosha, vitiating rasa, rakta,mamsa, and lasika take shelter in twacha. These sanchita dosha dushya issuggestive srotorodha, due to which vata is revitiated. Because of this vitiatedvata (karmata), vitiated rasa and rakta etc. kshoba is produced in the affectedpart gives rise to vedana. The movement of vata may be affected by theshithilatha of Vedini, Ashrgdhara and mamsadhara twacha result inmanifestation of various types of pain.Swethavarna: Brajaka pitta is responsible for prakruta Varna of twacha. Wheneverthis brajaka pitta is disturbed due to morbid dosha and rakta usuallyswethavarna is produced, which is indicative of kapha dushti.Daha: Daha is due to swedovaha srotodushti; there will be a qualitativeaggravation of pitta dosha in affected area. The ushnaguna of pittadosha isthe one, which causes daha; ushnaguna is also a result of the same that isushnaguna of pitta affected Ashrgdhara twacha.Rajogrishtam: Rajogrishtam occurs in Sidhma Kishta by vatadosha vitiation due to theinvolvement of ruksha guna, rajogrishtam is produced.
  • 78. SIGNS AND SYMPTOMS OF SIDHMA Characters of sidhma Cha. Su. A.H. K.S. Bh.Sam. Parusha Twak + - - - - Aruna Varna + - - - - Visheerna + - - - - Bahihstanu + + - - + Ati Snigdha + - + - - Shukla Raktavabhisini + - - - + Bahu + - - - - Alpa Vedana + - - - - Alpa Kandu + + - - - Alpa Daha + - - - - Alpa puyalasika sravi + - - - - Laghu Samuthani + - - - - Alpa Bhedhi + - - - - Alpa Krimi + - - - - Alabu Pushpavat + - - + + Sweta + + - - - Apaka - + - - + Prayasa Urdhwakaya + + + - -Varuni Pushpi Pushpavat - - - + - Samhitha - - - - + Uttita Twak - - - - + Ruksha Mandalani - - - - + Rajogrishtam + - + + - Nissravi - + - - - Bahiruksha - - + - - Shlakshnasparsha - - + - - Dougdhikapushpawat - - + - - Picchila - - - - +
  • 79. SADHYA ASADHYATA OF SIDHMA KUSHTA Almost all Acharyas have dealt about sadhya asadhyata. Howeverthese opinions are almost same. Charaka samhita discusses the prognosis of kushta on the basis ofinvolvement of doshas also. A wise physician is to be avoided, if the weakperson of kushta having the symptoms along with complication of trushna,daha, mandagni, infested with krimi. If the person suffers from Sidhma Kushtawith deranged vata and kapha or from one of the doshas it is easily curable.But on the other hand in which there is predominance of either kapha–pitta orvata–pitta are difficult to cure70. Based on the involvement of dhatus Acharya Sushruta explained, theperson who has full control over his sense organs and the kushta in whichonly twak, rakta, and mamsa are affected are sadhya varieties. If it reachesdeeper dhatus they should be considered as asadhyata71. As per Madhavakara has accepted the version of Sushruta, but hasconsidered those varieties of kushta in which medha, Asti, and majjadhatu areinvolved as yapya72. Sidhma is variety of kushta vyadhi, which is sadhya vyadhi, i.e. easilycurable, since the main vikriti lies in the superficial dhatus like rasadhatu andtwak. This it has been stressed by Acharyas. All authors have opined that the Sidhma Kushta is sadhya vyadhi. Bhavamishra also explained that kushta vikriti seated in twak andmamsa are sadhya, similarly kushta produced by the predominance of vataand sleshma is also sadhya.
  • 80. CHIKITSA There is no specific line of treatment i.e. chikitsa sutra for “Sidhmakushta.” As Sidhma kushta is one of the varieties of Mahakushta according toAcharya Charaka and Kshudrakushta according to Sushruta and VagbhataAcharya. Whatever is told in concerned with kushta should be adopted forSidhma Kushta that means the chikitsa sutra told for kushta hold well forSidhma Kushta also. Sidhma i.e., pityriasis versicolour is a variety of kushta and is asuperficial disorder, creating slight physical and more cosmetic problem.Since it is spread over rasa, twak, as such it can be considered as an uttanavyadhi. The dosha involved in the samprapthi of Sidhma are mainly vata andkapha. However a role of pitta is also seen, by virtue of presence of Brajakapitta in the skin layers, like Avabhasini, Swetha, were the disease originatesand incidentally these layers are the main seats of Brajaka pitta. Therefore the line of treatment has to be formulated, keeping in viewthe tridoshas, and rasa, rakta dhatus and twak (upadhatu), another importantfactor to be viewed is to strengthen and purify rakta dhatu also. The following line of treatment advocated in Ayurveda by differentAcharyas in their respective manner. 1) Samanya chikitsa 2) Vishesha chikitsa Samanya chikitsa: The general line of treatment was described isaccording to doshas involvement. Which is in vouge for all the diseases is to
  • 81. be undertaken in the disease Sidhma also, and also said that it should betreated according to the Charma dosha samanyaVishesha chikitsa: The planning of treatment depends on the predominanceof doshas involved in a given variety of kushta. If the disease predominance isvatajakushta – Sarpee i.e. ghee is advocated, Virechana and Raktamokshanaare recommended if the disease is pitta predominant and Vamana is indicatedin the predominance of kapha dosha73. Sushruta has advocated kushta treatment with particular period of time,such as every fifteen days Vamanakarma, every month Virechanakarma,every six months Raktamokshana and every third day Nasyakarma74. Sushruta other than this also recommends dhatugata kushta chikitsai.e. if it is in purvarupavastha vamana and virechana are to be adopted. Inrasagata (twacha) kushta lepa, in raktagata samshodhana, lepa,kashayapana and raktamokshna, in mamsagata samshodana, alepana,kashayapana, raktamokshana, and arishtaprayoga, mantha, prasha etc. Here Sushruta recommends shodhana and raktamokshana along withuse of certain preparations of Khadira, Bhallataka, Ayaskriti, Shilajitu,Guggulu are to be taken. In Asti and Majjagata kushta, Acharya haveexplained as asadhya vyadhi75. In Ashtanga Hridaya vatapradhana kushta Dashamooladi thaila, inpittapradhana Mahatiktaka grita, in kaphapradhana Nimbadi grita should beused. However Vagbhata insists snehapana in all types of kushta76. Keeping in view of the above information the present study with thedrugs SAPTASAMA YOGA (Internal), and KUSHTADI LEPAM (External) isundertaken with positive hope.
  • 82. PATHYA APATHYA OF SIDHMA KUSHTA77 Pathyaapathya has got a special place in Ayurveda, it believed thatwithout pathyaapathya vivechana treatment should not be given, if given it willbe a failure. All the Acharyas have seconded Pathyaapathya theory. Charakain sutra sthana 25th chapter deals about pathyaapathya. He has consideredhitakara ahara as pathya and ahitakara ahara as apathya. Without pathya and apathya treatment should not be planned. InBrihatrayee pathya apathya has been very clearly mentioned. The disease, Sidhma kushta is a variety of kushta vyadhi (roga), whichdoes not have separate pathya apathyas in any context. Even though it isunderstood that the pathya apathyas mentioned in kushta rogas taken intoconsideration, which are generally related to “Sidhma kushta” also.PATHYAAPATHYA: The diet regimen explained in the context of management of Sidhmakushta is as follows:PATHYA:Annavarga : - Puranashali, Shashtikashali, Kora, Godhuma, Uddalaka, Shyamaka, Yava etc.Yushavarga : - MudgaShaka and Phalavarga : - Tiktapatola, Nimba, Mandukaparni, Bhallataka, Khadhira, Triphala etc.Snehavarga : - Samskarithagrita, Sarshapatailaetc.Mamsavarga : - JangalamamsaJalavarga : - Khadirodaka
  • 83. Rasa : - TiktarasaVihara : - Vratha, Dana, Seva, Tyaga, Dwija, Guru, Surapuja, Bhaskaraaradhana, Maithree.APATHYA : - Kulatha, Masha, Nishpava, Snigdha, Abhishyadhi, Guru, Ushna, Amla, Lavana, Vidhahi, Anupamamsa, Vasa, Majja, Guda, Dugdha, Dadhi, Tila, Ikshuvikara, Pishtavikara, Sura, Virudhasana, Adhyasana, Vyayama Ajeernasana, Diwaswapna, etc.
  • 84. TILALatin name: – Sesamum indicum Linn.Family: – PedaliaceaeHindi: – TilKannada: – YelluTelagu: – NuvvuluEnglish: – Sesamum78Habitate: – This small bush is indigenous to India and extensively cultivatedin the warmer regions.Chemical Composition: - Seeds contains fixed oil 50-60 %(White variety 48%, black and red variety about 46%) Moisture OilBlack til 2-5.2% 44.6-56.9%Red til - 45.7-55.5%White til 2-4.4% 44.9-58.2%Seeds also contain proteids 22%, carbohydrates 15%, Mucilage 4%, Woodyfibre 4%, Ash%, oil contain 70% of liquid fats consisting of the glycerides ofoleic and linoleic acids and 12-14% of solid fats, stearin, palmitin andmyristin79.
  • 85. Medicinal properties: -Rasa: - MadhuraAnurasa: - Kashaya, TiktaGuna: - Guru, SnigdhaVeerya: - UshnaVipaka: - MadhuraPart used: - Beeja, TailaAction and Uses: - Tridoshashamaka, Seeds are especially useful in Arshas,Grahani and Malabaddata, Twakrogahara80.
  • 86. TRIPHALA HARITAKILatin name: - Terminalia chebula Retz.Family: - CombretaceaeHindi: - HaradKannada: - AlalekaiTelagu: - KarakkayaEnglish: - Chebulic myrobalanGana: - Triphala, Amalakyadi, Parushakyadi, Prajasthapana, Jwargna,Kushtaghna, Kasaghna, Arshoghna81.Synonyms: - Abhaya, Pathya, Vayastha, Amrutha, Vijaya, Haimavati,Jeevanti, Kayastha, Shreyasi, Shiva, Rohini82.Habitate: - This tree is wild in the forests of northern India, central provincesand Bengal, common in Madras, Mysore and in the southern part of theBombay presidency. In general myrobalans are oval in shape, and about twoinches long and are of dull yellow colour. There are 4 varities: - 1) Survariharade, 2) Rangari harade 3) Bala harade and 4) Java haradeChemical Composition: - Myrobalans contained Tannin (tannic acid) 45pc,and a large amount of Gallic acid, Lucilaga a brownish yellow colouringmatter. Chebulinic acid which when heated in water splits up into Tannic andGallic acids83.
  • 87. Medicinal Properties: -Rasa: - Pancharasa (Lavanvarjita) Kashaya pradhanaGuna: - Laghu, RukshaVeerya: - UshnaVipaka: - MadhuraPrabhava: - TridoshaharaPart Used: - PhalaAction and Uses: - Tridoshahara, especially Vatashamakam, Shothaharam,Vedanasthapanam, Vrishyam, Kusthaghnam, Rasayanam, Jwarghnam,Mruduvirechanam84. VIBHITAKILatin name: - Terminalia belerica Roxb.Family: - CombretaceaeHindi: - BahedaKannada: - TarikaiTelagu: - TadiEnglish: - Belliric myrobalaGana:-Jwarahara, Triphalagana, Mustadigana, Virechanopaga85Synonyms:-Vibhitaki, Aksha, Karshaphala, Kalidruma, Bhootavastata,Kaliyugalayah86Habitate: - A tree common in Indian forests and plains.Chemical Composition:- It consists of Gallo-tannic acid; colouring matter,resins, and greenish yellow oil 25%87
  • 88. Medicinal properties: -Rasa: - kashayaGuna: - Laghu, RukshaVeerya: - UshnaVipaka: - MadhuraPart Used: - PhalaAction and Uses: -Tridoshaharam specially Kaphaharam, Shothaharam,Vedanasthapanam, Vajikaranam, Dhatuvardhakam88. AMALAKILatin name: -Emblica officinalis Geartn.Family: -EuphorbiaceaeHindi: - AovlaKannada: - NellikayeeTelagu: - UsirkayeeEnglish: - Emblic myrobalanGana: -Vayahsthapana, virechanopagah, triphala, parushakadi89.Synonyms: -Vayasya, Amalaki, Vrushya, Jatiphalarasa, Shivam,Dhatriphalam, Shriphala, Amrutaphala90.Habitate: - The Deccan, the sea-coast districts and Kashmir. ThroughoutTropical and sub-tropical, India wild or planted in Ceylon, china, Malay Island.Chemical Composition: - The chemical content in the fruit of embilicaofficinalis is gallicacid, tannicacid, glucose, albumin, cellulose, and mineral
  • 89. calcium etc, vitamin C. Water constituents 1-2% protein 5%, Fat 1%, mineral7%, Fi0bres 3.7%, carbohydrate 14.1% calcium 0.05% phosphorus 0.02%ferrous 1.2%91.Medicinal properties: -Rasa: – Pancharasa, Amalapradhana (Lavanarahita)Guna: – Guru, Laghu, and SheetaVeerya: – SheetaVipaka: – MadhuraPart Used: – PhalaAction and Uses: – Tridoshaharam especially Pittashamakam,Dahaprashamanam, Hrudhyam, Vrushyam, Kushtaghnam, Rasayanam,Balyam, Medhyam, Keshyam92.
  • 90. TRIKATU MARICHALatin Name: - Piper nigrum Linn.Family: - PiperaceaeHindi: - KalimirchKannada: - MenasuTelagu: - MiriyaluEnglish: - Black pepperGana: - Deepaneeya, Shoolaprashamana, Krimighna (Cha), Pippalyadigana,Trushnagna (Su) 93.Synonyms: - Maricha, Krishna, Ushna, Dharmapattana, Vellaja94Habitate: - This perennial climbling sherb is indigenous to Malabar andTravancore coasts i.e., Western coast of India.Chemical Composition: - This perennial 5-9%, Piperidin 5%, Balsamicvolatile oil 1-2%, Fat 7%, Masocarp contain Chavicin, Starch, Ligin, Gum,Proteids7% as containing organic matter 5%95.Medicinal properties: -Rasa : - KatuGuna : - Laghu, TikshnaVeerya: - UshnaVipaka: - KatuPart Used: - PhalaAction and Uses:- VataKaphaharam, Deepaneeyam, Lekhaneeyam,Balyam, Krimighnam, Pachanam, Swedajananam, Kusthaghnam,Jwarghnam96
  • 91. PIPPALILatin name: - Piper longum Linn.Family: - PiperaceaeHindi: - PipalKannada: - HipliTelagu: - PippalluEnglish: - Long pepperGana: - Kasahara, Hikkanigrahana, Shirovirechana, Vamana, Deepaneeya,Truptighana, Shulaprashamana (Cha), Pippalyadi, Urdhwabhagahara,Shiruvirechana (Su) 97.Synonyms: - Magadhi, Krishna, Vaidhehi, Chapala, Kana, Upakulya, Ushna,Kola, Saundi, Tikshnatandula98.Habitate: - This plant is indigenous to Northeastern and southern India andCeylon and cultivated in Eastern Bengal.Chemical Composition: - Resin, Volatile oil, Starch, Gum, Fatty oil,Inorganic matter and an alkaloid piperine 1-2%99.Medicinal properties: -Rasa: - KatuGuna: - Laghu, Snigdha, TikshnaVeerya: - AnushnasheetaVipaka: - MadhuraPart Used: - Phala, MoolaAction and Uses: - VataKaphaharam, Rasayanam, Vrishyam,Deepaneeyam, Swasam, Kasaharam, Gulmaharam, Shulaharam,
  • 92. Krimiharam, Vrishyam, Yakrututtejakam, Vatanulomanam, Kusthaghnam,Jwarghnam, Medhyam, Mruduvirechanam, Raktashodhakam, Jantughnam,Shulaprashanam Shirovirechanam100. SHUNTHILatin name: - Zingiber officinale, Roscoe.Family: - ZingiberaceaeHindi: - AdarakhaKannada: - SuntiTelagu: - AllamuEnglish: - Green gingerGana:-Truptighna, Arshoghna, Deepaneeya, Shulaprashamana,Trushnanigrahana (Ch), Pippalyadi, Trikatu (Su), Panchakola, Shadushna(B.P) 101.Synonyms: - Adraka, Shringavera, Katubhadra, Ardrika102.Habitate: - It is cultivated in many parts of India on a large scale in the warm,moist regions, chiefly in Madras, Cochin and Travancore and to somewhatless extent in Bengal and the Punjab.Chemical Composition: - Volatile oil 1-5% of light yellow colour having acharacteristic odour and containing camphene, phellandrene, zingiberine,cineol and borneol, gingerol a yellow pungent body and ole resin-gingerin theactive principle, other resins and starch, k-oxalata the essential and resin towhich ginger owes its pungent flavour, occur just beneath the skin. Thepungent principles of ginger are not volatile in steam to any appreciable extentand one therefore not found in the volatile oil. It has however been isolated
  • 93. and been named gingerol, but its true chemical nature has not yet been finallysettled103.Medicinal Properties: -Rasa: - KatuGuna: - Laghu, SnigdhaVeerya: - UshnaVipaka: - MadhuraPart Used: - KhandaAction and Uses:- KaphaVatashamaka, Raktashodhaka, Shothahara,Deepanam, Vedanasthapanam, Vatanulomanam, Shulaprashamanam,Swasaharam, Kaphaghnam, Vrushyam, Pachaneeyam, Jwarghnam,Truptighnam, Arshoghnam, Sheetaprashamanam and Uttamaamapachanam104.
  • 94. BHALLATAKALatin name: - Semicarpus anacardium, Linn.Family: - AnacardiaceaeHindi: - BhilawaKannada: -KerubeejaTelagu: - JeedivittuluEnglish: - Marking nutGana : - Kusthagna, Deepaneeya, Mootrasangraneeya (Cha),Nyagrodhadi, Mustadi (Su) 105.Synonyms:-Aruska, Arushkara, Agnika, Agnimukhi, Bhalli, Viravriksha,Shophakrita106.Habitate: - This tree is found growing on the Sub-Himalayan and tropicalparts of India as Far East as Assam.Chemical Composition: - It contains small quantity of sweet oil, tarry oilconsisting of 90% of an oxy-acid named as anacardic acid and 10% of ahigher, non-volatile alcohol called cardol. It also contains vesicating oil32%107.Medicinal properties: -Rasa: - Katu, Tikta, KashayaGuna: - Laghu, Snigdha, Tikshna.Veerya: - UshnaVipaka: - MadhuraPart Used: - Phala
  • 95. Action and Uses: - KaphaVatashamaka, Kushtaharam, Krimiharam andimproves agni in Kushtam, Jwarghnam, Vishaghnam, Medhyam,Swedajanakam, Vrishyam108. SITAVarga: - IkshuvargaVarna: - Sweta varnaRasa: - MadhuraGuna: - SnigdhaVeerya: - SheetaVipaka: - Madhura109Action and Uses:- Vatapittahara, Raktapittahara, Jwaraghna, Vatanulomana,Trushnaghna, Dahaprashamana, Vrushyam, Rasayanam, Chakshushyam. All the sugars are curing the Burning sensation, Thirst, Vomiting,Fainting and Bleeding disease110.
  • 96. MADHUSanskrit: - MakshikaHindi: - ShahadTelagu: - TeeneEnglish: - HoneyKannada: - JenutuppaSynonyms:-Madhu, Makshika, Makshi, Kshaudra, Makshikavanta,Varativanta, Pushpavasodhbhavam, Bhrungavantam111.Habitate:- Honey is secreted by honeybees, which belongs to the classHymenoptera. Beehive comb where it is deposited by Honeybees deposit it.It occurs in the nectors of flowers where from it is sucked by the bees andthen stored up in the comb, the finest honey is the virgin honey, which drainsitself from the hive. Honey sold in market is derived from the honeycomb byseveral species of bees.Chemical composition of Honey:- Most of the elements found in thehuman body are also found in small proportions present in honey. Nector isessentially a solution in water of a number of sugars, together with traces ofprotein, salts, vitamins, acids, and enzyme and aromatic substances. Honeyis mainly a mixture of dextrose and levolose.Characters of honey: - It is viscid, saccharine substances, semitranslucent liquid of a lightyellowish brown colour of an aromatic colour and of acrid taste. After a time itcomes opaque and crystalline. Old honey is specially mentioned as amedicine and anupana with jala to reduce the fat due to its excessivedepletion property. Honey more than one year old is considered to be Purana
  • 97. by Ayurvedic scholars. The old honey is always preferred to new one for allmedicinal purposes that is for anupana; preparation of Lehya, Asavarishta,and Gutikas etc. old honey should be used112.Medicinal Properties:Rasa - MadhuraAnurasa: - KashayaGuna: - Laghu, RukshaVeerya: - SheetaVipaka: - MadhuraAction and Uses: - Vatakaphaharam, Chakshyushyam, Deepaneeyam,Varnyam, Swaryam, Lekhaneeyam, Medhyam, Vrushyam, Kushtaghnam,Vranashodhanam113.
  • 98. GRHITAHindi: -GhiKannada: -TuppaTelagu: -NeyaeSynonyms: – Ghruta, Ajya, havis, sarpi.Medicinal Properties: -Rasa: – MadhuraGuna: – Guru, SnigdhaVeerya: – SheetaVipaka: – Madhura114 In Bhavaprakasha it is mentioned that, grhita is Rasayana, good for theeye, stimulate for digestion, supports glow and beauty, enhance memory andstamina, promotes longevity and protects body from varies diseases. Clarified milk fat or butter fat is known as ghruta. It is prepared byheating butter to just over 1000C to remove water content by the evaporation.The residue is filtered is out as pure ghruta. The composition of ghrutaresidue obtained from Indian cow is as follows, moisture 14.4%, fat 32.4%,protein 36.0%, lactose 12.0%, and ash 5.2%. The colour of the ghruta is yellowish white depending upon thecarotene content. Ghruta contains approximately 8% lower saturated fattyacids, which makes it easily digestable. These lower saturated fatty acids arethe most edible fat and which are not found in any other edible oil or fat.Ghruta also contain vitamin A, D, E, and K. vitamin A and K is antioxidantand is helpful in preventing oxidative injury to the body. No other edible fat oroil contains vitamin A except fusg iuk vitamin A keeps epithelial tissue of the
  • 99. body infact keeps the outer lining of the eyeball moist and preventsblindness. Ghruta also contains 4.5% linoleic acid, essential fatty acids,which promote proper growth of human body. The melting point of ghruta is 350C, which is less than the normaltemperature of the body. Its digestibility coefficient or rate of absorption is96%, which is highest of all oils and fats. Most Ayurvedic preparation is made with the ghruta. Digestion,absorption and delivery to target organ systems are crucial in obtaining themaximum benefit from any formulation. This is facilitated by ghruta. Sinceactive ingredients are mixed with ghruta, they are easily digested andabsorbed. Lipophilic action of ghruta facilitates transportation to a target organand final delivery, inside the cell, because cell membrane also contain lipid.This lipophilic nature of ghruta facilitates enter of the formation into the celland its delivery to the mitochondria, microsome and nuclear membrane115.Action and uses: – Tridoshamaka, kushtaghnam, deepaneeyam, vrushyam,medhyam, vatanulomanam, rasayanam, kantyam, andshoolaprashamanam116.
  • 100. KUSHTAMLatin name: - Saussure lappa, Clarke.Family: - CompositaeHindi: - KushtaKannada: - koshtaTelagu: - KostuEnglish: - CostusGana: -Shukrashodhana, Lekhaneeya, Asthapanopaga (Ch), Eladi (Su) 117.Synonyms: - Kustha, Rogahvaya, Vapya, Paribhavya, Utphala118.Habitate: - These herbs grow abundantly on the Himalayas and valley ofKashmir.Chemical Composition: - Roots contain odorous principal composed of twoliquid resins, an alkaloid, a solid resin, salt of valeric acid, camphene 0.04%,phellandrene 0.4% terpene alcohol 0.2%, A – costene 6%, B- costene 6%,aplotaxene 20%, costol 7%, di-hydrocostus lactone 15% costos lactone 10%,costic acid 14%119.Medicinal properties: -Rasa: - Tikta, Katu, MadhuraGuna: - Laghu, Ruksha, TikshnaVeerya: - UshnaVipaka: - katuPart Used: - moolaAction and Uses: - Kaphavataharam, Raktavikarahara, Kasaharam,Visarpam, Kushtaharam, Jantughnam, Durgandhanashanam,Vedanasthapanam, Varnyam, Vrishyam, Swedajananam120.
  • 101. SARSHAPALatin name: - Brassica campestris Linn.Family: - CruciferaeHindi: - SarsonKannada: - SasviTelagu: - AavaluEnglish: - Mustard121Synonyms:- Katuka, Sneha, Tuntubha, Kadamabaka, and Gaurasarshapa122.Habitate:- Belong to cabbage species. Two varieties are grown in theBombay presidency one called “Gaj Sareb” has white seeds and the other“Karo Sareb” has black seeds and hairly leaves. The variety sarson oil yieldedby seeds of this on pressure is largely used in cookery. Oil and B.rapa is alsocalled Rubsen oil though the seeds of B.Campestris, B.rapus and B.rapa arevery similar in shape and colour cloze seeds yield a greater proportion of oil.Chemical composition: -About 35% of oil is obtained by expression fromseeds. Green tops contain potash, crude rape oil is dark brown in colour, butis refined into clear yellow oil that possesses a characteristics harsh taste123.Medicinal properties: -Rasa: – Katu, TiktaGuna: – Tikshna, Ruksha, (Shakha), Snigdha (seed and oil)Veerya: – UshnaVipaka: – KatuPart Used: – Beeja, TailaAction and Uses: - Kaphavataharam, Kushtaghnam, Krimighna,Jantughnam, Vedanasthapanam, Mootrajananam, Plehanashana124.
  • 102. MOOLAKABEEJALatin name: – Raphanus sativas Linn.Family: – CruciferaeHind: – MulliKannada: – MoolangiTelagu: – MoolangiEnglish: – RadishSynonyms:– Visra, Salamrakataka, Saleya, Marushambhava, TikshnamMulakapotika, Chanakyamoolaka125.Habitate:– Cultivated all throughout India in gardens and plains for culinarypurposes.Chemical Composition: – Fresh vegetable contains 91% moisture and thecompletely dried material contains Ether extract 4%, albuminoids 18%,soluble carbohydrates 52-66% woody fibre 9.34% and ash 16%, seeds androot contain fixed oil, essential oil, a sulphurretted volatile oil resemblingmustard seed oil, oil contains sulphur and phosphoric acid.Medicinal properties: -Rasa: – Katu, TiktaGuna: – LaghuVeerya: –UshnaVipaka: – KatuPart Used: – Beeja, Khanda and PatraAction and Uses: -1) Moolaka seeds acts as kaphanissaraka. 2) It is useful in pachana, andacts as Mootrala. 3) It is a best vatanulomana and acts as laxative126.
  • 103. PRIYANGULatin name: – Callicarpa macrophylla vahl.Family: – VerbenaceaeHindi: - PriyanguBengal: – MatharaPunjabi: - SumaliGana:–Mootraveerayajaneeya, Pureeshasanghrahaneeya (Ch),Priyangawadi, Anjanadi (Su), Karpuradi varga (B.M) 127Synonyms:– Priyangu, Phalini, Kanta, Lata, Mahilahvaya, Gundra,Gandhaphala, Syama, Visvaksena and Anganapriya128.Chemical Composition:– The root contains a sugandhithataila,gandahpriyangu contains a hydroxynic acid129.Medicinal properties: -Rasa: - Tikta, Kashaya, MadhuraGuna: - Guru, RukshaVeerya: - SheetaVipaka: - KatuPart used: - PushpaAction and uses :- Tridoshashamaka especially Vatapittashamaka,Dahaprashamanam, Durgandhanashanam, Vedanasthapanam,Kushtaghanam130.
  • 104. HARIDRALatin name: - Curcuma longa Linn.Family: - ZingiberacaeHindi: - HaldiKannada: - ArashinaTelagu: - PasapuEnglish: - TurmericGana:- Kushtaghna, Kandughna, Lekhaneeya, Vishaghna, Tiktaskanda,Shirovirechana (Cha), Haridradi, Mustadi, Sleshmasamshamana (Su) 131.Synonyms: - Kanchani, Peeta, Nishakhya, Varavarni, Krimighna, Haladi,Yoshitpriya, Hattavilasini, Gouri132.Habitate: - Extensively cultivated all over India. In Bombay presidency thereare two varieties with hard rich coloured oval rhizomes, chiefly used in dyeingknown as lokhadhi “halad” and the other with softer, larger, lighter-colouredlong rhizomes which are usually used for eating.Chemical composition: - Contains essential oil, resin, an alkoloid, Curcumimthe yellow colouring matter, turmeric oil or termenol, Termeric oil is a thick,yellow viscid oil133.Medicinal properties: -Rasa: - Tikta, KatuGuna: - Ruksha, LaghuVeerya: - UshnaVipaka: - KatuPart used: - Khanda
  • 105. Action and Uses:– Kaphavatashamaka, Varnyam, Shothaharam,Kushtaghnam, Vranaropanam, Vranashodhanam, Vishaghnam,Vedanasthapanam134. NAGAKESHARALatin name: - Mesua ferrea Linn.Family: - GuttiferaeHindi: - NagakesaraKannada: - Nagakeshara.Telagu: - NagachampakamuEnglish: - MesuaGana: - Eladi, Priyangwadi (Su), Chatrujata (Bh) 135Synonyms: - Nagapushpa, Nagakeshra, Kesara, Champeya, Nagakinjalka,Kanchanahvaha136Habitate: - Commonly on the Eastern Himalayas, East Bengal and Assam,Eastern Ghats and Western Ghats up to above 5000ft, Burma and theAndaman, it is cultivated in gardens.Chemical Composition: - Young fruit contains an oleo-resin from which anessential oil is obtained, seeds contain a fixed oil. Hard pericarp containstannin. Resin is in tears it dissolves in benzol. Essential oil is very fragrant,pale yellow and has the odour of flowers. The drug also contains two bitterprinciples137.
  • 106. Medicinal properties: -Rasa: - Kashaya, TiktaGuna: - Laghu, RukshaVeerya: - UshnaVipaka: - KatuPart Used: - PumkesharaAction and Uses:- Kaphapittaharam, Vedanasthapana,Durgandhanashanam, Kushtaghnam, Balyam, Krimighnam, Swedajananam,Kandughnam, Visarpam138.
  • 107. MATERIALS AND METHODSMaterials: All the literatures about Sidhma Kushta in Ayurveda from D.G.M.Ayurvedic medical college, library. Corresponding literature about thePityriasis Versicolour from Modern texts, updated Journals and Website. The Materials taken for the clinical study were, 1) Saptasamayoga for internal and 2) Kushtadilepam for external application1391. Saptasamayoga: - The ingredients of Saptasamayoga are, a. Tila 1Part b. Triphala ” c. Trikatu ” d. Bhallataka ” e. Sita ” f. Madhu ” g. Gritha ” are taken in equal quantity and yoga was prepared according toclassical procedure in our college pharmacy.2. Kushtadilepam: - The ingredients of Kushtadilepam are: a. Kushta 1Part b. Sarshapa ” c. Moolakabeeja ” d. Priyangu ” e. Haridra ” f. Nagakeshara ”
  • 108. are taken in equal quantity and lepa was prepared according to classicalprocedure in our college pharmacy.Collection of drug: The medicinally useful parts of the plants of Saptasamayoga andKushtadilepam were purchased from local market.Method of preparation: The collected drugs were prepared for preparation by removingphysical and chemical impurities. All the ingredients were mixed and madeinto powder then mixed with Gritha and Madhu and stored in the form of vati.For lepam made into fine powder and stored in the form of powder form only. Before preparation of the vati, Bhallataka shodhana was done in theNarikelajala for 2hours. After purification the Bhallataka was mixed with theabove ingredients140.CLINICAL TRIALMETHODS:Selection of sample: 30 patients were selected incidentally from the freecamp conducted at Post Graduate and Research Center of O.P.D. DGMAyurvedic Medical College Hospital Gadag.Inclusive criteria: The selection of patients for the clinical study was done with followingcriteria, 1) Patients were selected between the age group of 16-50years. 2) Patients of both sexes were selected. 3) The patients of Sidhma Kushta diagnosed according to classical features and dermatological studies were included.
  • 109. Exclusive criteria:1) The patients with any other systemic disorders other than the SidhmaKushta were excluded.2) Pregnant women and lactating mother were excluded.Criteria for diagnosis and selection of patients:1) Sidhma Kushta was diagnosed amongst patients reported to hospitalbased on classical features and were selected irrespective of sex, occupation,duration and religion. Patients of age group between 16-50years wereselected for study.2) The diagnosis of the disease Sidhma Kushta was made after thoroughexamination of the patient. A case proforma was prepared which givescomplete information about the history physical findings and laboratoryfindings.3) It is clinical studies on Sidhma Kushta 30 patients suffering from sidhmakushta were selected from O.P.D of P.G.A.R.C of D.G.M.A.M.C.HoapitalGadag for the study. And administered Saptasamayoga (int.) andKushtadilepam (ext.).Study design: It was a prospectus clinical study.Duration of the treatment: Duration of the treatment: - one month with one-month follow up.
  • 110. Matra (posology): Internal and external application:1 vati thrice daily i.e., 1500mg/day followed by lepam on the affected part.Methods of Study:30 patients were examined clinically in O.P.D and registered, the findingswere recorded in the special case sheet, and then patients were taken for theclinical trail after investigation.Diet: During the treatment patients were advised to follow the strickt diet asmentioned in Ayurvedic classics.
  • 111. Method of Selection of Subjective Criteria1. Varna:a) When the lesions are sweta varna then the scoring will be 3.b) When the lesions are swetatamra varna then the scoring will be 2.c) When the lesions are tamra varna then the scoring will be 1.d) When the lesions are changes to normal colour then the scoring will be 02. Kandu:a) When the kandu is severe then the scoring will be 3.b) When the kandu is moderate then the scoring will be 2.c) When the kandu is mild then the scoring will be 1.d) When the kandu is completely absent then the scoring will be 0.3. Daha:a) When the daha is severe then the scoring will be 3.b) When the daha is moderate then the scoring will be 2.c) When the daha is mild then the scoring will be 1.d) When the daha is completely absent then the scoring will be 0.4. Vedana:a) When the vedana is severe then the scoring will be 3.b) When the vedana is moderate then the scoring will be 2.c) When the vedana is mild then the scoring will be 1.d) When the vedana is completely absent then the scoring will be 0.
  • 112. 5. Rajogrishtan:a) When the scaling is severe and if it is present in all the patches then the scoring will be 3b) When the lesions is limited to any 2 areas then the scaling will be moderate then the grading will be 2c) When the lesions is present in one area then the scaling will be mild, grading is 1d) When the scaling is absent in all area then the grading is 06. Sthana:a) When the lesions are not seen in any area then the scoring will be 0b) When the lesions is present in one area then the scoring will be 1c) When the lesions is present in two area then the scoring will be 2d) When the lesions is present in three area then the scoring will be 3e) When the lesions is present in more then three areas then the scoring will be 4
  • 113. OBSERVATION AND RESULTS For the clinical study 45 patients were taken up, out of these 15patients are discontinued and 30 patients completed the clinical trial. Among these patients 25 were Male and 5 were Female.1) Table showing sex incidences of patients Sex No. of Cases Percentage Male 25 83.33% Female 05 16.67% From the above table it is clearly understood that male are prone forthis Sidhma Kushta and of 30patients, 25 patients are Male compared toFemale. Thus the Male to Female ratio is 5:1. Sex Incidence 30 20 Series1 10 Series2 0 1 2 3 4 5 Graph number-1
  • 114. 2) Table showing the age incidence and Sex of patients Age group in years Sex No. of patients Percentage M F 10-20 08 01 09 30% 21-30 12 03 15 50% 31-40 03 00 03 10% 41-50 02 01 03 10% It was observed from the study as mentioned earlier Male is dominatedand compared with the age group more incidences are seen in 21-30,yearage group. In later period of life i.e., 31-50years the prevalence of disease islow. 15 AGE GROUP 15 9 10 No of patients 3 3 5 0 11-20 21-30 31-40 41-50 Graph Number -2
  • 115. 3) Table showing the occupational history of patients Occupation No. of cases Percentage Student 15 50% Agriculturist 06 20% Business 05 16.67% Housewives 03 10% Service 01 3.33% Occupational wise distributions of Sidhma Kushta is15patients (50%)are students, followed by 3patients are housewives, 6patients areagriculturist, 5patients are businessmen and only1 patient is in service. Service Occupational History 3% House Wifes 10% Student Business Agriculturist 17% Student Business 53% House Wifes Agriculturist 17% Service Graph number- 3
  • 116. 4) Table showing the marital status of patients Marital status No. of Patients Percentage Unmarried 23 76.67% Married 07 23.33% The prevalence of disease is more in the age group in 21-30year, thusand observed in major groups of unmarried patients i.e., (76.67%) andMarried patients i.e., (23.33%). Marital Status Married 23% Unmarried Married Unmarried 77% Graph number-4
  • 117. 5) Table showing the Religion of patients Religion No. of cases Percentage Hindu 27 90% Muslim 03 10%The above table showing the incidence of Hindu patients i.e., (90%) is morethan the Muslim patients i.e., (10%). Religion of Patient Muslim 10% Hindu Muslim Hindu 90% Graph number- 5
  • 118. 6) Table showing Chronicity of disease Chronicity in Year No. of cases Percentage 0-1 06 20% 2-5 18 60% 6-10 03 10% 11-15 02 6.67% 16-20 01 3.33% The chronicity of Sidhma Kushta is very much in between 2-5years i.e.,(60%) there are total 18 no. of patients comes in this category, most of themare having history of relapse and followed by in 1year, 6 patients i.e., (20%),in 6-10years, number of patients are 3 i.e., (10%), in 11-15years, the numberof cases are 2 i.e., (6.67%) and in 16-20years, the numbers of patients are 1i.e., (3.33%). Chronicity of Disease 7% 3% 20% 0-1 10% 2-5 6-10 11-15 60% 16-20 Graph number- 6
  • 119. 7)Table showing Family history of disease Family history No. of cases Percentage Absent 20 66.67% Present 10 33.33% 2/3rd of patients does not having any family background i.e., 66.67%,whereas 1/3rd of the patient have a familial history i.e., 33.33%. Family History Present 33% Absent Present Absent 67% Graph number- 7
  • 120. 8) Table showing the Food habits Food habits No. of cases Percentage Vegetarian 16 53.33% Mixed /Non-vegetarian 14 46.67% It is observed that 14 patients were non-vegetarian/mixed i.e., 46.67%and 16 patients were vegetarians i.e., 53.33%. Food Habits Mixed Vegeterian 47% Vegeterian 53% Mixed Graph number- 8
  • 121. 9) Table showing Treated and fresh cases No. of cases Percentage Fresh 23 76.67% Treated 07 23.33% As we observed from the table No.6 many patients are having achronicity of 2-5years; in those 7patients (23.33%) are received the treatmentfrom contemporary medical science, and other 23patients (76.67%) are notreceived any kind of treatment. Treated 23% Fresh Treated Fresh 77% Graph number-9
  • 122. 10) Table showing socio-economic status Socio-economic status No. of cases Percentage Higher 11 36.67% Middle 17 56.66% Poor 02 6.67% The above table showing socio-economic status of the patientsrevealed that the majority of the patients (11 cases) belongs to higher class,17 cases belongs to middle class and 2 cases were belonging to poor class. socio-economic status 20 15 10 No of cases 5 0 Higher Middle Poor Graph number- 10
  • 123. 11) Table showing the prakruti of patients Prakruti No. of cases Percentage Vatapitta 06 20% Vatakapha 14 46.67% Pittakapha 10 33.33% The above table is showing the maximum No. of patients are havingthe prakruti of Vatakaphaja is in 14patients, 10patients are having Pittakaphaprakruti and 6patients are having Vatapitta prakruti. Prakruti of Patients Vatapitta Pittakapha 20% 33% Vatapitta Vatakapha Vatakapha Pittakapha 47% Graph number- 11
  • 124. 12) Table showing the distribution of signs of Sidhma Kushta Signs No. of cases Percentage Sweta 23 76.67% Tamra 05 16.67% Swetatamra 02 6.67% There are differenrt types of colour skin lesion references in classicsaccording to them Sweta discolouration of skin is observed in more i.e.,23patients out of 30cases, 2cases were Swetatamra and 5cases were Tamradiscolouration. Distribution of Signs 25 20 15 No of cases 10 23 5 2 5 0 Sweta Tamra Swetatam ra Graph number- 12
  • 125. 13) Table showing the distribution of symptoms of Sidhma Kushta Symptoms No. of cases Percentage Rajogrishtam 30 100% Kandu 28 93.33% Vedana 25 83.33% Daha 23 76.67% According to different classics the above said four symptoms aremostly seen in many patients other than these symptoms are not observed inany patients, 28cases are having Kandu out of 30cases, 30patients arehaving Rajogrishtam, 23patients are having Daha and 25cases are havingVedana. Distribution of Symptoms Rajogrishtam Daha 22% Rajogrishtam 28% Kandu Vedana Vedana Kandu 24% Daha 26% Graph number- 13
  • 126. 14) Table showing Prevalence of Sthana Sthana No. of cases Percentage Uraha 18 60% Prushta 21 70% Greeva 23 76.67% Anya 19 63.33% The above table explains that the most affected area is Greeva i.e.,23cases, followed by 18cases shows lesions over Urahasthana, 21caseswere affected over Prushta area and 19 cases were affected over other areai.e., upper arm and abdomen. Prevalence of Sthana Uraha Greeva 22% Greeva 29% Prushta Anya Anya Prushta Uraha 23% 26% Graph number-14
  • 127. DISCUSSION “Sidhma” is one amongst the Ekadasha Kshudra Kushtas described bySushruta and Vagbhata in their Samhithas. Where as Charaka in hissamhitha described Sidhma in the classification under Sapta Maha Kushtas,which included with same signs and symptoms, but Charaka has describedan extra symptom i.e., ‘Srava’ and also concluded as “Asadhya”. LaterSushruta, Vagbhata and others considered it as ‘Sadhya’ and classified underthe variety of Kshudra kushtas, which is in tune with practical realities. Apart from these realities and references such cases are selected forthe present clinical study, those who are afflicated with Sidhma alone.SIDHMA is the disease commonly seen in all the seasons, but in general itsaggravation can be seen in greeshma rutu (summer), and more prone tooccur in the humid climate. Since the incidence of this disease is common and relapsing in naturei.e., ‘PUNARBHAVAKARA’. These made us to under take the study of thesecases for the clinical trial with the drug “SAPTASAMAYOGA” (Internal) 1Vatithrice daily with ushnajala before meals and “KUSHTADI LEPAM” (External)with water for 4-8 weeks. The line of treatment in all the texts recommends the usage of externalas lepa as well as internal administration of Kushtahara dravyas also, keepingin view both the above chikitsa sutra integrated and this work is under takenfor its clinical assessment. The “Saptasamayoga” is prepared in vati form in our college pharmacywith the ingredients mentioned. Kushtadi lepam is also administered to thepatients in the form of lepa with water, as described in classics. Most of the
  • 128. patients are selected from the O.P.D. of the Post Graduate and ResearchCenter of D.G.M. Ayurvedic Medical College Hospital, Gadag. The clinicalsigns and symptoms described in the classics are taken as criteria for thediagnosis of the disease, mainly “ALABUKUSUMOPAMA SADRUSHA” beingthe deciding sign. The detailed history pertaining to the disease has been beforetreatment, which is recorded in the special case sheets. In Charaka Samhitha Sutrasthana, the description of the line oftreatment for all the diseases in general i.e., ANTHAHPARIMARJANA andBAHIHPARIMARJANA CHIKITSA is described141. Anthahparimarjana includes, the drug, which is used for treating thediseases related with Aharajana Vyadhies. The Bahihparimarjana chikitsa isadministered through twak in the form of Abhyanga, Pradeha, Sweda,Parisheka, Unmarda etc., which treats the diseases based on the above linesthe preparations Saptasamayoga (Internal) and Kushtadilepam (External) aretaken for clinical trial for both internal and external administration. With thelines of treatment general to be followed and systematically observed and it isalso found to be more effective.SAMPRAPTHI VIGHATANA Since the cases of Sidhma are often seen in day-to-day practice, it hasbecome necessary to find the suitable and successful treatment. Thepreparation i.e., Saptasamayoga (Int.) and Kushtadilepam (Ext.) are taken forclinical trial works in this disease by possessing samprapthi vighatana. 1) Since dushyas- Twak, Rakta, Mamsa, Lasika are vitiated in thecausation of the disease Sidhma, the drug Saptasamayoga (Internal) and
  • 129. Kushtadilepam (External) by virtue of its vatasleshmahara (qualities)interferes and reverses the process. 2) While describing the samprapthi of this disease Twak, Rakta, etc.,vitiation are said to be the responsible factors. The main function of Rakta isJeevana, Bala, Varnaprasadana, and Mamsapushthi, which are important inthis context. The drugs, which are the ingredients of Saptasamayoga, containmainly Vata-Kaphaharatwa properties and also it’s possessed the property ofRaktashodaka, Kushtaharatwa qualities and also improves the colour andtexture or complexion of the skin. 3) Kushtadilepam when administered externally it improves the varnaof the twak by decreasing the eruptions of the “Alabukusumopamasadrusham” of urdhwakaya. 4) Internal and external medication was given with Saptasamayogaand Kushtadilepam simultaneously. These are helping to improve the normalcondition of the individual. 5) Saptasamayoga (Int.) was described in the text of Chakradattahighlights the effects as “KUSHTAMHANTI SUDARUNANYAPI” and also actsas varnaprasadanam. 6) When Kushtadilepam applied on the skin as lepa over the affectedarea of the twak relieves the scaling, Itching, Daha, Vedana anddiscolouration of the skin, inturn it potentiates the skin condition and acts asjantughna by its krimiharatwa property. 7) Saptasamayoga contains Tila, Triphala, Trikatu, Bhallataka, Sita,Madhu, and Ghrita. Vatakapha are the predominant doshas involved in the
  • 130. manifestation of Sidhma. The ingredients collectively and individually areeffective by there vatakaphaharatwa properties. Therefore the drug Kushtadilepam and saptasamayoga whenadministered orally and in the form of lepa helps in combating the disease atall levels and prevents further spreading. Sidhma is the disease where in vitiation of vatakapha takes place. Allthe ingredients of internal drug of Saptasamayoga collectively and individuallypossess the property of vatakaphaharatwam and also all the drugs are havingthe main property of Kushtaharatwa also. Hence it is proved in the presentclinical study that Saptasamayoga and Kushtadilepam (Internal and External)are useful for the samprapthi vighatana of the disease and it is justifiable to bea best Sidhmahara or vatakaphara aushadha. Though there is mentioning of Saptasamayoga and Kushtadilepam(Internal and External) in the treatment of Sidhma and Kushta. It may beinterested to note that all the ingredients of the preparation have gotsignificant role in the treatment of Sidhma. Here it is once again interested to note that our medical ancestor whiledescribing the treatment of Sidhma collectively relieves the kushta of theaffected part. Hence it is inferred that affected parts of the twak becomesvivarnatwa during the effect of Sidhma. In view of the above discussion, it is presumed that the preparationSaptasamayoga and Kushtadilepam togetherly gives much scope in thetreatment of Sidhma. Since Alabukusumopama sadrusha i.e., sweta varna isalso a common symptom along with other symptoms. It is to be taken note ofgiving kushtahara drugs and hence it is proved in the treatment that the
  • 131. suffering from Alabukuksumopama sadrusha in the affected region iscompletely relieved off with the clinical trial. Since the preparation posses such of the above qualities namely, 1) Twakrogaharatwa. 2) Giving colour and luster to the skin. 3) No recurrence of the disease. In view of the promising results observed in the current study, it isworth-while to design a mass based clinical study at multicenters, so as to“finalise” the positive out come.Discussion on Materials and Methods: After considering Ayurvedic view regarding Sidhma Kushta, thefollowing drugs were selected for the present study.Criteria for the selection of Saptasamayoga and Kushtadilepam: 1) It is mentioned that Saptasamayoga and Kushtadilepam arevery effective in Sidhma Kushta. 2) Saptsamayoga and Kushtadilepam are safest yogas. 3) Its ingredients are easily available in the market. 4) Method of preparation is very simple. 5) It is very easily palatable.Probable mode of action of Saptasamayoga and Kushtadilepam (Int. andExt.):
  • 132. Pharmacodynamics in Ayurveda is mainly based on thefundamental doctrines of Panchamahabhuta and Tridosha with governs thephysio-chemical and biological phenomena respectively. On assessing the ingredients of Saptasamayoga includingushnajala for anupana and Kushtadilepam for external application. Drugs arehaving VataKaphahara property and also Balya, Rasayana, Anulomana,Srotovishodaka, Deepana and Pachana. When looking into the pathogenesis of Sidhma Kushta defect inthe twak, rakta, mamsa, laseeka dhatus and fundamental defect in the twak. As explained earlier the Sidhma Kushta is VataKaphaja vyadhi,twak and rakta are the main seat. So all these parts of the samprapthi will bepacified, drugs containing Madhurarasa, Gurusnigdhaguna, Sheetaveeryaand Madhuravipaka will act on Vatadosha. Drugs containing Madhurarasa, Sheetaveerya, andMadhuravipaka will act on Pittadosha. The drug containing Katurasa, Rukshalaghuguna, Ushnaveeryaand Katuvipaka will act on Kaphadosha. Thus it acts as Tridoshahara. Trikatu does Deepana and Amapachana. Maricha isSrotoshodhaka, which removes the Khavaigunya. Haritaki does theVatanulomana and acts as Rasayana. Amlaki is Pittahara and Rasayana andVibhitaki is Kaphahara and acts as Vedanasthapana. Ghrita i.e., acts asImmunomodilizer (Rasayana) and it is Yogavahi. Bhallataka acts as anti-microbial in action and also Sukshmasrotogami,so it allivates the Krimi.Madhu is a very good srotoshodhaka and yogavahi, relieves the obstruction of
  • 133. srotas. Drugs used in the compound Saptasamayoga and Kushtadilepa arehaving antagonistic properties to kapha. Haridra, which was used for external application, acts as Varnyaand Srotoshodaka. Kushta acts as Vedanasthapana, Varnyam andSwedajananam. Sarshapa also acts as a Vedanasthapana and Krimighna.Nagakeshara acts as Daurgandhyanashana and Kandughna. Moolakabeejaacts as Mootrala.Dose: In Sidhma Kushta we have fixed the doses like Internal and External.The internal dosage of Saptasamayoga 1vati (500mg) thrice daily andexternal application of Kushtadilepam with water at night on affected area asrequired.Anupana: Ushnajala anupana was given based on the classics.Method of sampling: The patients were incidentally selected from exclusively conductedmedical check-up and O.P.D of Post Graduate and Research Center atD.G.M Ayurvedic medical College Hospital, Gadag. Method of sampling wasincidental because samples cannot be randomized in short time and MedicalCamp was conducted to get number of cases.Selection of patients: The patients of both sexes were selected for the clinical study betweenthe age group of 16-50years.Inclusive and Exclusive Criteria:
  • 134. Only Sidhma Kushta patients were selected for the clinical study whichwe can treat and other than the Sidhma Kushta is excluded.Laboratory Investigations:Blood Investigation:To rule out whether Sidhma Kushta is infected a person by secondary reason,we conducted ESR and WBC. In all skin disease Eosinophil count is raised innature, so for that we entertain to take eosinophil count in this study.Stool Examination: In skin disease most of the causes are Helmenthic infestation, so wetook stool complete analysis for Ova and Cyst.Diagnosis: Diagnosis was made on the basis of signs and symptoms which havebeen explained in classics mainly discolouration of the skin and scaling aretaken for diagnostic criteria.Observation:Dropouts: For the clinical trial 45patients were taken up. Out of these, 15patientswere discontinued the treatment, so clinical study was completed in 30cases.Availability: Most of the cases were reported in Medical Camp, some cases werereported to O.P.D of Post Graduate and Research Center of D.G.M AyurvedicMedical College Hospital, Gadag. All of them had an established diagnosisand seven of them were treated cases and 23cases of them were freshcases.Education:
  • 135. There were maximum number of patients with higher secondaryeducation and primary education. None of them were illiterates. It does notmean that illiterates are not supposed to get Sidhma Kushta. But education isdirectly linked with the students who are study all together. So in studentswhile they are studying each other they will infect by Sidhma, by some oneaffected previously. As mentioned earlier Sidhma Kushta is mainly correlating withPityriasis Versicolor infection.Occupation: 50% of patients were students, commonly who are residing in thehostel this may be due to uncleanlyness and exchange of cloths. We candraw a conclusion that uncleanlyness, exchange of cloths etc as the triggeringfactors.Sex: It is evident that males are made prone to develop Sidhma Kushta. Inthis present study also, reports say that male and female ratio is 5:1, thereason behind this may be that males are more exposed to exchange ofcloths and they are spending their life style unhyginically.Age: It is a well-known fact that majority of cases develop Sidhma Kushta inYoung-Adults, it was observed that maximum number of patients belongs to2nd and 3rd decade of life. Hence it supports the Ayurvedic priniciples, SidhmaKushta which is considered as VataKaphapradhana vyadhi.Family history:
  • 136. 10patients had family history at present; most researchers would agreethat there is a hereditary contribution in producing the Sidhma Kushta. Henceit holds well so far as this study is concerned.Religion and Marriage: Majority of the patients were Hindus. It does not mean that Hindus aremore prone to this disease because population of Hindus is very high in thisarea and this may be due to the method of sampling, patients were selectedincidentally as far as Marital status is concerned, no relation of Marital statushave been found in the Sidhma Kushta.Socio-Economic Status: It is clear that more number of patients from middle class compared toother class. This may be the reason for finding more people from middleclass, usually only the middle class people visit to O.P.D of Post Graduateand Research Center of D.G.M Ayurvedic Medical College Hospital fortreatment. This may be the reason for finding more middle class peoplecompare to other class people.Symptoms: Majority of cases had discolouration of skin along with Kandu, Daha,Vedana and Rajogrishtam.Chronicity: In this clinical study chronicity showed that 60% of the patients hadchronicity more than 1year, varying from 1-15years and patients does not hadhistory of previous treatment and 23% of the patients were on modernmedicine. This study suggests that Sidhma Kushta is chronic disease.Food Habit:
  • 137. Food plays an important role in disease development. As such salts,sour, wheat floor, curd and milk mixed with food, which are more practiced inthis area, are the common causative factors of this disease to develop. Thus itis necessary to emphasize diet regulations in the research study. Presentstudy distribution of food regulation is 16:14 to that of vegetarian and mixeddiet.Treated and Fresh Cases: 23% of patients were treated and rests of 77%cases were fresh cases.Fresh cases were more in number because Sidhma Kushta is naturallydisappeared disease. This may be the reason behind the high percentage offresh cases. Treated cases were less in number even though they received thetreatment contemporary medical science because after taking the modernmedicine people prefer to take the Ayurvedic medicine for permanent relief, ifthey are not satisfied with modern medicine. So this may be the reason thattreated cases were less in this clinical study.Involvement of Dosha: On the bases of symptoms available in Sidhma Kushta is observed thatinvolvement of VataKapha were play an important role in the manifestation ofSidhma.Deha Prakruti: The deha prakruti, those who are suffering from Sidhma Kushta wereassessed based on the physical, psychological and behavior factor mentionedin the Ayurvedic literature.
  • 138. In this study maximum number of patients were belongs toVataKaphaja prakruti rather than other doshas, none of them belongs toekadoshaja and sannipataja. In this study the rate of incidence VataKaphajaprakruti observed in the Sidhma Kushta.GENERAL OBSERVATION: During the treatment observation was made on only the Pigmentationof the skin and scaling along with these symptoms we observed Kandu, Dahaand Vedana. When the patient visited us for the first time that is considered as baseline treatment, then advised to discontinue the previous medicine. If the patient was on our treatment we have advised them to come after10days. At the 2nd visit the patient noticed about reduced the symptoms, theyare Daha, Kandu, Rajogrishtam and Vedana and slightly pigmented. Andsome cases were remained there is no discolouration of skin. On 3rd visit all symptoms like Kandu, Daha, Rajogrishtam and Vedanawere completely cured. In 2nd visit those who had unchanged pigmentationmay turn to pigmentation. In some few cases (6patients) were slightly changein pigmentation comparing to their base line treatment.Follow-up: After medication the patients were kept under observation for 30days.After 30days follow-up, the 24patients have not relapse any symptoms likeKandu, Daha, Vedana, Rajogrishtam and pigmentation, except 6 patientswere had pigmentation symptom only found but other symptoms get curedand also not relapsed.
  • 139. Results: Clinical study showed that Saptasamayoga and Kushtadilepahave a significant role in Sidhama Kushta. Assesment was made on the basis of symptomatology andlaboratory investigations. In this clinical study subjective and objectiveparameters are taken for assessment. Totally 12assesments were made before and after the treatment. Assessment of Varna after the treatment mean-2.367,S.D- 0.8087, S.E- 0.1476, t- 16.04, p- <0.001, that shows highly significant. Assessment of Kandu after the treatment Mean- 2.8, S.D- 0.7611,S.E- 0.1389, t- 20.16, p- <0.001, that shows highly significant. Assessment of Rajogrishtam after the treatment Mean- 21.00,S.D- 12.946, S.E- 2.364, t- 8.88, p-<0.001, that lshows highly significant. Assessment of Daha after the treatment Mean- 2.3, S.D- 1.291,S.E- 0.236, t- 9.75, p-<0.001, that shows highly significant. Assessment of Vedana after the treatment Mean- 2.5, S.D- 1.137,S.E- 0.21, t- 11.90, p-<0.001, that shows highly significant. Assessment of Sthana after the treatment Mean-1.667,S.D- 1.4223, S.E- 0.2596, t- 6.42, p-<0.001, that shows highly significant. Assessment of ESR after the treatment Mean- 5.633, S.D- 5.499,S.E- 1.00, t- 1.00, p->0.10, that shows not significant. Assessment of TC after the treatment Mean-1008.333,S.D- 801.95, S.E- 146.42, t- 6.88, p-<0.00, that shows highly significant. Assessment of Neutrophil after the treatment Mean- 5.367, S.D-2.988, S.E- 0.546, t- 9.83, p-<0.001, that shows highly significant.
  • 140. Assessment of Lymphocyte after the treatment, Mean- 5.033,S.D-3.439, S.E- 0.628, t- 8.01, p-<0.001, that shows highly significant. Assessment of Eosinophil after the treatment Mean- 1.8,S.D-1.448, S.E- 0.264, t- 6.82, p-<0.001, that shows highly significant. Assessment of Monocyte after the treatment Mean- 0.867,S.D-1.137, S.E- 0.208, t- 4.168, p-<0.001, that shows highly significant. Saptasamayoga (Int.) is very effective in Sidhma Kushta. Theingredients are having Kushtaghna, Kandughna, Krimighna, Vedanasthapana,Dahashamaka and VataKaphahara properties. Kushtadilepa (Ext.) is very much effective in Sidhma Kushta. Itsacts like a Kushtaghna, Kandughna, Vedanasthapana, Swedajanana, andDahashamaka, Daurgandhanashana and Varnyam. Results are drawn on the basis of subjective parameters. Sidhma,one of the 18 types of kushta, have characteristic features ofhypopigmentation of the skin, Kandu, Rajogrishtam, Daha and Vedana. Thesesigns and symptoms are taken for the assessment. Hypopigmentation andRajogrishtam are the two main characteristic features of Sidhma Kushta arepresent in all patients. Kandu, Daha and Vedana are also seen in majority ofthe patients. The Srava and Bheda are not seen in any patients. The resultsare declared according to the following criterias.1. Gradations of Varna given according to hypo and hyperpigmentation of thelesions. The change in colour of the skin compared with the normal colour ofthe skin and gradations given accordingly.
  • 141. 2. Many of patients having feature of Kandu is also assessed during and afterthe treatment, almost all the patients are get relieved after the complition ofthe treatment schedule.3. Scaling was present in all cases and after the treatment it was completelycured.4. The distribution of lesions also taken as one of the criteria in theassessment. Majority of the patients having extensive lesions mainly overchest, back, neck and in upperlimbs. The assessment was made on thebases of cured areas; many of the patients are get relieved and showsignificant changes in all areas.5. Gradation for the Daha and Vedana are given according to the severity.The above said criterias are considered while declaring the results. Category Number of Patients Percentage Cured 24 80% Improved 06 20% Responded 00 0% Not-Responded 00 0% Discontinued 00 0%
  • 142. 3025 24201510 65 0 0 00 Cured Improved Responded Not- Responded Discontinued Number of Patients Graph number-15Result of the “Evaluation of the effect of Saptasamayoga (Int.) and Kushtadilepa (Ext.) in Sidhma Kushta”
  • 143. Total Assessment: The statistical analysis of the effect of Saptasamayoga andKushtakilepam of the treatment revealed that highly significant, but theobservation revealed the internal and external medicaments were very usefulin fresh and treated cases i.e., total number of 24patients out of 30patientshad a remarkable improvement after one course of treatment, but in 6casesthose who have chronic symptoms namely kandu, daha, vedanda andrajogrishtam are completely disappear but pigmentation are present. Mostprobably because one course of medicaments may not be sufficient fortreated cases, in such cases they required long term medicaments dependingupon chronicity of vitiated doshas. The reason behind remarkable improvement in fresh and treated casesmay be due to extraneous variables such as diet, cleanliness towards thecloths and daily using of personal soap, combs etc. contributing minorly alongwith major role of Saptasamayoga and Kushtadilepam. However, it remainstrial period for research for researchers to continue on this subject.RECOMMENDATON FOR FUTURE STUDY: The following recommendations are made on the basis of observationsand conclusions for the further studies as well as to overcome the limitations.1) Same study can be repeated by taking a large number of samples.2) The effect of the Saptasamayoga and Kushtadilepam can be studied inlonger duration of the Sidhma Kushta.
  • 144. CONCLUSION After laborious and prompt theory and practical work on SidhmaKushta, following conclusion is drawn. Twak is one of contributed factortowards the beauty of the body and it also acts as principal organ of attraction.1. Sidhma is disease affects only superficial part of the beauty and also it wasexplained in the varieties of kushta.2. It was found that the nidana of Sidhma Kushta were tridosha dushtikara,especially kapha and vata dushtikara.3. The aim to restore normal structure of the skin and with a great hope ofcure for Sidhma, with Saptasamayoga (Internal) and Kushtadilepam(External) were tried in the clinical study.4. During and after clinical trial it was observed that, majority of the patientsresponded very well to the therapies adopted.5. The drug is found most affective Internal as well as External on vata-kaphapradhana twak rogas like Sidhma. The internal drug contains all theingredients, which are effective to cure vatakapha dosha alsotwakrogaharatwa property (kushtahara).6. During the period of treatment and after the treatment neither Complicationwas observed nor did the patients complain any side effects. Thus it can betermed as “Safer Drug”.7. Kushtadilepam was found to be very useful therapy local application.8. It is concluded that it is not only affective in the management of Sidhma butalso in other vatakapha pradhana dosha of twak rogas.9. The treatment of Sidhma Kushta with Saptasamayoga and Kushtalepam isproved as statistically viable also.
  • 145. 10. Saptasamayoga and Kushtadilepam tried under clinical trial on total30cases and clinical impression is that the drug can be considered aspromising addition to the current existing treatment.11. Based on the above conclusions, it can be confidently said that after thetotal clinical trial it is observed, that the success rate is 76.67% on average ofthe total cases and Good results were obtained.12. Many of the patients were happy as they were relived from the symptomslike Kandu, Daha, Rajogrishtam and Vedana which is due to Saptasamayogaand Kushtadilepam
  • 146. SUMMARY “Sidhma” is a disease, which comes across often in the hot climateregions. Hence the importance in selecting the case for clinical trial wasemphasized. In view of the manifestation of the disease, Urdhwakaya is the seat andtwak in particular is the affected part. The Introduction and detailed historicalaspect discussed in Part-I of the clinical study. Sidhma is the disease affects the Twak superficially; hence it is noticedas cosmetic disorder. In Part-II (Disease aspect), definition descriptions fromAyurvedic as well as Modern Literature is discussed. The Anatomicaldescription along with physiological functions of the skin and its importancewere discussed. It is important to know about the causative factors of the disease beforeundertaking the clinical trials. Hence the Nidana (Etiological factors) of thisdisease were also discussed in details. In Sidhama, the Dhatus (Pathological changes) such as Twak, Rakta,Mamsa and Lasika with VataKapha vitiation takes place. Therefore theimportances of these both were also stressed, along with poorva roopa andsigns and symptoms (Roopa of Sidhma) also reviewed in detail. In Ayurvedic classics all the diseases concluded with the specialPrognostic considerations. Hence this disease also lined up with a part ofsadhyasadhyatha. The line of treatment ascribed in different major classics correlate witheach other. Therefore the line of treatment undertaken here is in accordance
  • 147. with major classics. The regimen prescribed was strictly followed. The resultsthat obtained are given in tabular forms. The taxonomical, pharmacological and analytical studies of the drugtaken here i.e., Saptasamayoga (Internal) and Kushtadilepam (Externalapplication) narrated in Part-III (Drug Aspect). Finally after obtaining the results the utility of the drug and its effect onSidhma was mentioned. Clinical study was taken for one month. In this period patients werereviewed on every tenth day. Drug action and healing process are abserved inthis period. All the results are made after the follow-up period and statisticalanalysis are discussed in the Part-IV. No side effect of Saptasamayoga and Kushtadilepa was reportedduring the treatment period. There is no significance change on ESR before and after the treatment,there is much significance change in all parameter especially kandu, daha,varna, vedana and rajogrishtam as p-value is <0.001. Over all response to the drug was exceptionally best.
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