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Study of Twak Shareera w.s.r to Vicharchika, Geeta Dolli. RACHANA SHAREERA, N.K.J. Ayurvedic Medical College & PG Centre, Bidar.

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Twak sr

  1. 1. “A Study of Twak Shareera w.s.r to Vicharchika” By Dr. Geeta Dolli. A dissertation submitted to theR a j iiv G a n d h ii U n iiv e r s iit y o f H e a llt h S c iie n c e s ,,Raj v Gandh Un vers ty of Hea th Sc ences K a r n a t a k a ,, B a n g a llo r e . Karnataka Banga ore In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI - M.D (AYURVEDA) In RACHANA SHAREERA Co-Guide GuideDr.Ashwinikumar Dr. N.G. Mulimani MD (S.R.) MD (S.R.) Post Graduate Department Of Rachana Shareera N.K.J. Ayurvedic Medical College & PG Centre, Bidar. 2010.
  2. 2. R a j iiv G a n d h ii U n iiv e r s iit y o f H e a llt h S c iie n c e s ,,Raj v Gandh Un vers ty of Hea th Sc ences K a r n a t a k a ,, B a n g a llo r e . Karnataka Banga ore Declaration by the candidate I, here by declare that this dissertation/ thesis entitled “AStudy of Twak Shareera w.s.r to Vicharchika” Is a bonafide andgenuine research work carried out by me under the guidance ofDr. N.G.Mulimani Professor & H.O.D. Department of RachanaShareera.Date: Signature of the candidate Dr. Geeta DolliPlace: Bidar
  3. 3. R a j iiv G a n d h ii U n iiv e r s iit y o f H e a llt h S c iie n c e s ,,Raj v Gandh Un vers ty of Hea th Sc ences K a r n a t a k a ,, B a n g a llo r e . Karnataka Banga ore Copyright Declaration by the candidate I here by declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall declare the rights to preserve, use anddisseminate this dissertation/ thesis in print or electronic format foracademic/ research purpose.Date: Signature of the candidatePlace: Bidar Dr. Geeta Dolli. © Rajiv Gandhi University of Health Sciences, Karnataka
  4. 4. R a j iiv G a n d h ii U n iiv e r s iit y o f H e a llt h S c iie n c e s ,, Raj v Gandh Un vers ty of Hea th Sc ences K a r n a t a k a ,, B a n g a llo r e . Karnataka Banga ore CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A Study ofTwak Shareera w.s.r to Vicharchika” is a bonafide research workdone by Dr. Geeta Dolli, in partial fulfillment of therequirement for the degree of Ayurveda Vachaspathi - M.D.(Ayurveda). Signature of the Co-Guide Signature of the Guide Dr.Ashwinikumar Dr.N.G.Mulimani MD(SR) MD(SR) Asst.Professor Professor & H.O.D., Department of Rachana Shareera Department of Rachana Shareera NKJNKJ Ayurvedic Medical College & P G Centre Ayurvedic Medical College & P G Centre Bidar – 585403 Bidar – 585403 Karnataka. Date: Date: Place: Bidar Place: Bidar
  5. 5. ENDORSEMENT BY THE HOD,, PRINCIPAL// ENDORSEMENT BY THE HOD PRINCIPAL HEAD OF THE INSTITUTION HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “A Study ofTwak Shareera w.s.r to Vicharchika” is a bonafide research workdone by Dr. Geeta Dolli under the guidance of Dr.N.G.Mulimani Prof. & H.O.D. department of RachanaShareera.Seal and signature of H.O.D. Seal and signature of the Principal/DeanDr .N.G.Mulimani. Dr.K.V.L.N Acharyalu. MD(SR) M.D. (Basic principles)Prof & H.O.D N.K.J. A.M.C. & PG Centre,Dept. Of Post Graduate Studies In Bidar – 585403 Karnataka.Rachana ShareeraN.K.J. A.M.C. & PG Centre,Bidar – 585403 Karnataka.Date: Date:Place: Bidar. Place: Bidar.
  6. 6. ACKNOWLEDGEMENT I offer my salutations to Shirdi Saibaba for giving me strength to overcome all the difficulties during this Thesis work and achievements in my life. It is beyond the words to express my gratitude towards my esteemed perents Smt.Sharanamma & Sri.Bheemrao.Dolli. For their patience cooperation. On this occasion with a great reverence I offer my gratitude to my Husband Dr. Shankar Mailare, and my kids Premsai & Preetam. I am very much thankful to Prof. K. V. L. N. Acharyulu, Principal, for hisuntiring encouragement during this work. I express my sincere gratitude to most honourable and esteemed teacher, guide Dr. N.G.Mulimani and co-guide Dr. Ashwinikumar waghmare for their unforgettable parental affection and patience cooperation to give suggestions at every step in accomplishing the present work. It is a privilege for me to express my sense of gratitude to my savant teachers Dr. S. B Kottur, Prof. P. G Bhatt, Dr. P V Savnur and for their inspiring support. My most respects to Dr.Shelly Divyadarshan, Dr.Sanjeev kumar Joteppa, Dr.Anup Bosgikar for their valuable suggestions. I converse my genuine thanks to Dr.Sapna, Dr.Brahmanand.Swamy and Dr.Somnath.Patil for their valuable guidance & honest shore up. It is a privilege for me to express my thanks to all my classmates Dr.Satyamma, Dr. Rajshekhar Tokre, Dr. Vivek, Dr.Shivsharanayya. I feel great pleasure to thanks to my friends Dr.Jyoti.Hullale Dr.Jyoti.Rajole.Dr.Geeta.Kumar. For their support. My most respect to my perental in-laws Smt.Tejamma & Sri.Sharanappa.Mailare. & my thanks to my brother Mr Amarnath Dolli, Mrs.Vijaylakshmi & sister Mrs.Sangeeta, brother in low Mr.Gurunath Mudhale for their encouragement. My deepest gratitude to all my seniors and juniors for their support. I sincerely thank all those who have directly or indirectly contributed to the successful completion of this thesis work. Dr.Geeta.Dolli.
  7. 7. List of Tables 1. Showing names of Twacha in different Samhitas 132. Showing layer wise distribution of skin diseases 14 Showing the comparison of thickness of Twacha according3. to Sushruta and Dalhana 154. Showing twach and Panchabhuta relation 165. Showing the Sign and symptoms of Vicharchika 316. Showing the Clinical features of Eczema and Vicharchika 727. Showing the Varna of the Vicharchika 768. Showing the Lakshanas of the Vicharchika 77 Showing the sex of the Vicharchika patients9. 7810. Showing the age of the Vicharchika patients 7911. Showing the prakruti of the Vicharchika patients 8012. Showing diet of the Vicharchika Patients 8113. Showing occupation of the Vicharchika Patients 8213. Showing Areas of the Vicharchika patients. 83
  8. 8. List of Graphs1. Showing the Varna of the Vicharchika 762. Showing the Lakshanas of the Vicharchika 773. Showing the sex of the Vicharchika 784. Showing the age of the Vicharchika patients 795. Showing the prakruti of the Vicharchika patients 806. Showing diet of the Vicharchika Patients 817. Showing Occupation of the Vicharchika patients 828. Showing Areas of the Vicharchika Patients 83
  9. 9. List of figures 1. Showing Anatomy of the skin2. Showing Melanocyte and Melanin3. Showing Langerhans cells4. Showing Layers of Epidermis5. Showing Irritant Eczema6. Showing Atopic Infantal Eczema7. Showing Seborrheic eczema of scalp8. Showing Dishydrotic Eczema9. Showing Nummular Eczema10. Showing Allergic Eczema11. Showing Histology of Eczema
  10. 10. Contents 1. INTRODUCTION 1–32. OBJECTIVES 43. REVIEW OF LITERATURE 5-68A) AYURVEDIC REVIEW 5-32 a) Historical Review of Twak 5-7 b) Twak Shareer 8-23 c) Disease Ayurvedic Review of Vicharchika 24-32B) MODERN REVIEW 33-68 a) Anatomy of skin 33-56 c) Disease Eczema review 57-684. METHODOLOGY 69-715. OBSERVATIONS & RESULTS 72-836. DISCUSSION 84-957. CONCLUSION 96-978. SUMMARY 98-999. REFERENCES 100-10710. BIBLIOGRAPHY 108-11711. ANNEXURE I – IV I] MASTER CHART I II] MODEL CASE SHEET PROFORMA II – IV
  11. 11. Abbreviation ABBREVIATIONS 1. Cha. - Charaka samhita 2. Su. - Sushruta samhita 3. A.S. - Astanga sangraha 4. Su (Dalhana) - Dalhana tika on Sushruta samhita 5. A.H. - Astanga hridayam 6. Sha. Pra. - Sharangadhara Prathama kanda 7. Ayu. Sha. - Ayurveda Shareera rachana 8. B.P. Pu. - Bhavaprakasha Purvarda 9. M.Ni. - Madhava Nidana 10. Vi. - Vimanasthana 11. Sha - Shareera 12. Ni - Nidanasthana 13. Chi. - Chikitsasthana 14. Ut. - Uttarasthana 15. B.P.ma.kh - Bhavaprakasha.Madhyama khanda 16. Ka.chi. - Kashyapa chikitsa.                              “A Study of twak Shareera w.s.r to Vicharchika”   
  12. 12. ABSTRACT Ayurveda is an ancient medical science which has given importance to thePancha Gnyanendriyas among them Twagindriya or Spershanendriya is importantone. The Sparshanendriya is the Sense organ which is meant for the sense of touch. Itcovers and protects the surface of the body from the heat, cold and external infectionsetc. Most of the diseases which are exclusively exhibited on the skin are termed as‘kustha’ in Ayurveda. Kustha is one among the astha-mahagadas because there is achange in the structural appearance of the skin. Two types of kusthas has beenenvisaged in ayurvedic classics i.e. Mahakustha and Kshudra kustha.Among 18kusthas 7 are mahakusthas and 11 are kshudra kusthas.Vicharchika is a type ofkshudra kustha. According to Acharyas symptoms of Vicharchika like-.sakandu, pidika,shyava, bahusrava, raji, arti, and ruksha.and are found in tamra and vedini layers oftwak. Objective of this study were complete literary review on twak shareera withmodern, And Vicharchika with Eczema. To know the structural changes invicharchika is based on clinical and histopathological studies. Finally, the correlationof vicharchika and eczema is done on the basis of symptoms and results ofhistopathological investigations. Literary study will be undertaken from different Samhitas,Modernscience,Journals and websites.Diagnosed patients of Vcharchika are clinicallyexamined for signs and symptoms.Structural abnormalities are observed inhistopathological study. So, after the histopathological study changes are found in the epidermal anddermal layers.The symptoms of Vicharchika and Eczema show tremendous similaritywith each other.Key words: Twak shareera, Kustha, Vicharchika, Twacha varna, Erythema, Eczema,Acanthosis, Lichenification,Parakeratosis,Hyperkeratosis.
  13. 13. Introduction INTRODUCTION Ayurveda is one of the most reliable medical sciences. The principles of otherscience have changed from time to time, but the basic principles of ayurveda have notchanged. Beyond this acharyaSusruta is specially honored for his outstanding study inshareera i.e. Anatomy. Acharya Susruta states that the aim of describing “shareera sthanam” is to acquire acomplete knowledge of the shareera . This is necessary for vaidya. For the vaidya, thereasons are clearly stated in the ayurvedic literature (Su.Su 3/16). If the vaidya wants to be an expert in ayurveda he should learn the shareerathoroughly all his doubts he should perform the practical i.e. treat the patients. Acharya charaka stated that the vaidya who has good knowledge of sharira i.eanatomy can only understand the people are human best (Cha.sha.6/9). Above words of acharya charaka clearly mentions the importance of study ofshareera. It mentioned earlier susruta samhita has its special importance. Susruta makesthe knowledge of Ayurveda more practicle & useful. His great contribution to ayurvedicsharira includes description & classification of various body structures like sira,Dhamani,Snayu , Asthi,Twacha etc. Twak shareera is very elaborately explained in our classics.We can find descriptionregarding layers of skin in Brihatrayi and Laghutrayi. Acharya Sushruta has mentioned inthe shareera sthana about the formation of twak at the level of embryogenesis and hasgiven the simily to the formation of cream on the milk. He has also described thethickness of each layer & several diseases which manifest in different layers of the twak.                                         “A Study of Twak Shareera w.s.r to Vicharchika”   1  
  14. 14. Introduction Human skin is a biological marvel. It is the protective covering of the body. It’ssoft, pliable, strong, waterproof and self repairing. It is like a large container, without itall our delicate insides would spill right out. Structurally integumentary system is most complex structure & highly specialized,hence it is grouped in the sense organ.This is most extensive organ system has theaccessory structures, including hair, nails, glands, and specialized nerve receptors forstimuli such as touch, cold, heat, pain, and pressure Its functions include protection of internal structures, prevention of entry ofdisease-causing microorganisms, temperature regulation, excretion through perspiration,pigmentary protection against ultraviolet sunrays, and production of vitamin D. The bodystores about half of its fat in the underlying hypodermis. Kustha vyadhi is a major disease affecting the community. In Bruhatrayi’s, Kusthais mentioned as Astha mahagadas. Kustha is socially as well as structurally givesdemarcation in the body. Vicharchika is very old disease mentioned in ancient science among the kustha, andis catagorised in different ways i.e.kshudra kustha, ksudra roga & sadhya kustha. Allkustha are having tridoshaja origin so, vicharchika can be said in same way i.e. kapha isresponsible for kandu, pitta is responsible for srava & shyava indicates the presence ofvata. Despite of its tridosha origin various acharyas mentioned different dominancy invicharchika. It also suggests specific symptoms complexes. As per symptomatology & pathogenesis, vicharchika have been directly correlatedwith eczema in modern science, i.e.sakandu (excessive itching), pidika                                         “A Study of Twak Shareera w.s.r to Vicharchika”   2  
  15. 15. Introduction(pappules,vesicles,pustules), shyava (erythema with discoloration), bahusrava (profusedischarge,oozing), raji (thickening,lichenification of skin), arti (pain) ,ruksha (dry lesion).SELECTION OF TOPIC: Now a days, modern science reached top of the hill by great advance particularly indermatology as topic is concerned & also availability of powerful antibiotics, antifungals,antihistaminics, steroids ect, but better management could not be searched out till today.Few drugs are available for symptomatic relief only there indiscriminate is mostundesirable. Skin diseases like eczema get a suitable atmosphere specially in developingcountries, because of fast life style, industrial & occupational hazards, repeated use ofchemical additives ect. Disease of skin makes much more handicap in society becausewith an ugly skin presence no one wants to touch them & forbidden by everyone &beauty & personality loss, which leads to under stress. There is a popular adage that “skin patients are never cured & never die" & hardlyeven constitute an emergency. The patients with skin disease is unemployable i.e. any jobin which he or she is in the public eye or involved in food preparation (catering). 60%has a significant skin condition including psyche involvement. So now adays vicharchika disease is largely spread in the human beings. Whilediagnosing the patients of vicharchika there is difficulty regarding the identification ofstructural deformity, hence need is felt to study the vicharchika & twak shareera inparticular.                                         “A Study of Twak Shareera w.s.r to Vicharchika”   3  
  16. 16. Aims and Objectives  AIMS AND OBJECTIVES 1) To make comprehensive study on Twak Shareera with modern (Skin). 2) To give appropriate and elaborate description on vicharchika. 3) To study structural changes in Twacha in vicharchika with modern correlation.  “A Study of Twak Shareera w.s .r to Vicharchika” 4
  17. 17. Ayurvedic Review   HISTORICAL REVIEW History informs us about the past time; it helps to reveal hidden ideas of therelated subject. The word Twak as well as its abnormalities due to disease.Vedic period:Rigveda: 63 In the rigveda mentioned that runs the chariot of the body with soul andmentioned as one among the seven organs.Atharvaveda: 64 While describing indriyas, we find reference regarding twak in different diseaseslike kushta, Halima, kilasa etc.Post vedic period This period has various medical and non medical literatures in the form ofsamhita, brahmana, purana and unpunished etc. In the agnipurana described that in the 5th month of embryonic life there will beformation ofskin and blood65.Samhita kala: Ayurveda was well developed at the time of samhita kala, it was known as goldenera of ayurveda. This kala gives a great knowledge about twak shareera and its relateddiseases.                                      “A Study of Twak Shareea w.s.r to Vicharchika”   5  
  18. 18. Ayurvedic Review  Charaka samhita: In the 7th chapter of shareera sthana acharya charaka has explained about thelayers of the skin and the diseases which occur in each layers9.Sushruta samhita: Susrutachrya has explained about skin very minutely, he has describedembryological development of skin and its layers .He has described the pramana &characters of each layer of twak8.Astanga sangraha: Vrudha Vagbhata has compiled the description of susruta and charaka aboutformation of skin and layers of the skin in shareera sthana 5th chapter. Also we getreferences about formation of skin in the same chapter17.Astanga hrudaya: Acharya vagbhata in astanga hrudya he mentioned the embryologicaldevelopment of twak in 3rd chapter4.Kaashyapa samhita: References regarding twak are available in shareera, sankulya shareera adhyaya.while explaining the sara purushas he explained that twak sarapurusha will be freefrom skin disease 66                                      “A Study of Twak Shareea w.s.r to Vicharchika”   6  
  19. 19. Ayurvedic Review  Sharangadhara samhita He has followed susrutas view sharangadhra given detailed description aboutseven layers of skin in the 5th chapter of poorva khanda also he explained about thediseases related to the different layers of the skin67.Bhela samhita: In the shareera sthana 7th chapter he has followed charakas view and explainedabout skin layers 68.Hareeta samhita: He has described the role of doshas in determining the varna of garbhasta shishuin shareera sthana and also included twak as one of the vayaviya dravyas51.Bhavaprakasha: Bhavamishra has the same view like susruta. He explained the 7 layers of skin & its embryological development as susruta&also mentioned twak as one of the pittasthana19.                                      “A Study of Twak Shareea w.s.r to Vicharchika”   7  
  20. 20. Material and Methods  MATERIAL AND METHODSINCLUSIVE CRITERIA: 1) Diagnosed patients of Vicharchika. 2) Patients of both sex irrespective of age group.EXCLUSIVE CRITERIA: 3) Systemic disorders. 4) Burn. 5) LeprosySTUDY DESIGN; The study of twak shareera with special reference to Vicharchika has beendesigned as follows 1) Literary study. 2) Clinical study. 3) Histopathalogical study.1) Literary study: All the information regarding “Twacha” collected from Brihatrayi,Laghutrayi and other classics of Ayurveda. Definition of Twacha its etymologygenesis and synonyms are compiled from different texts. Compilation of numbernames and Vyadhis occurring to the layers of Twacha is done and their comparativestudy is done. Comparative study of thickness of Twacha told by Sushruta andDalhana is done. Also relation of Twacha with other factors like Doshas, Dhatus, Malas,Upadhatu, Srotas, Varna, Prakruti, Sara and Indriya is studied.                                       “A Study of Twak Shareera w.s.r to Vicharchika”   69  
  21. 21. Material and Methods  In case of modern aspect of “Twacha” all the information regarding anatomyof skin is compiled from textbooks of anatomy. Study of embryology of skin. Itslayers, functions and appendeges of skin is done. Also study of Vicharchika Vyadhi from all the Samhitas is done. Thecausative factors of vicharchika, its symptoms dosha Pradhanya and classification isstudid. Compilation of information regarding eczema is done form the textbooks ofdermatology. This compilation includes study of causative factors, pathogenesissymptoms. Clinical features and investigations. Finally, the correlation of Vicharchika and Eczema is done on the basis ofsymptoms and results of histopathological investigations.2) Clinical Study: This study is done at various skin clinics under the guidance ofDermatologists. Already diagnosed 30 patients of eczema were examined for theclinical study of the disease. The morphology of lesions, nature of symptoms, andarea of predilection were studied. The patients were convinced for the biopsy of skin to rule out the cellularchanges in this disease. So only eight patients were accepted to take skin biopsy hasbeen studied. That biopsy report has been enclosed in this thesis.                                       “A Study of Twak Shareera w.s.r to Vicharchika”   70  
  22. 22. Material and Methods 3) Histopathological study: The histopathological study can be done by skin biopsy.A) Skin biopsy: There are different methods of skin biopsy like shave biopsy, scalpel biopsy,punch biopsy and scissor biopsy etc. But we done skin biopsy by scalpel skin biopsy(Elliptical excision) method because this method provides enough tissue for thehistopathologist to see the overall pattern of the lesion, which is critical for diagnosis,it is most commonly used and even also need only one or two stitches needed to closethe wound. This is helpful for cosmetic purpose. In other types of biopsy we cannotget enough tissue. Procedure: The skin in cleansed and local anesthesia is administered. A smallellipse of tissue is taken by the use of scalpel in the region of the full thickness of theskin .The tissue is preserved in Formalin, & send to lab.B) Laboratory experiment: It includes Tissue fixation, Examination. First tissue fixation is done by using 95% concentrated ethyl alcohol (ethanol) &paraffin, Then tissue is processed by automated tissue processor, it cut into sections ofsize 6-8 microns. Then this section is mounted on glass slide & stained by H & E(Hematoxylin & eosin), then it is covered by a cover slip. This Preparation isexamined under 10X and 40X microscope.                                       “A Study of Twak Shareera w.s.r to Vicharchika”   71  
  23. 23. Observation  OBSERVATIONS 1) There is some controversy regarding number of Twacha. Some Acharyas have told six types of Twacha while some have told seven types. 2) Acharya Charaka and Acharya Sushruta both have told different Vyadhis in different layers of Twacha. e.g.Sushruta told Vicharchika in fourth & fifth layer. 3) Measurement of thickness of Twacha told by Sushruta is near about same which is quoted in modern textbooks. The measurement of Dalhana doesn’t matches with the modern measurement. 4) The symptoms of Vicharchika and Eczema show tremendous similarity with each other.Table No. 6. Showing the Clinical features of Eczema and VicharchikaSl.No. Title Vicharchika Eczema Epidermis And papillary layer 1. Location Tamra &Vedini of dermis. Reddish & blackish brown 2. Colour Rakta & Shyava colour Excessive itching, papules, Kandu, pidika, shyava, erythema, discharge/dry lesion, 3. Symptom bahusrava/ruksha, arti, pain, lichenification raji. (thickening). Both Palms and Soles, hands, Areas 4. Pani, pada mainly. legs, scalp, trunk & folding of Predilection body.5) After histopathological study the spongiosis (inter cellular oedema) with acanthosis(thickening), parakeratosis, hyperkeratosis & cellular infiltration were seen undermicroscope. After histopathological reports of skin biopsy epidermis is affected inmost of the patients and dermis is affected in few patients.                              “A Study of Twak Shareera w.s.r to Vicharchika”   72 
  24. 24. Observation                               “A Study of Twak Shareera w.s.r to Vicharchika”   73 
  25. 25. Observation                               “A Study of Twak Shareera w.s.r to Vicharchika”   74 
  26. 26. Observation                               “A Study of Twak Shareera w.s.r to Vicharchika”   75 
  27. 27. Observation  Diagnosed 30 patients of eczema compared with vicharchika were selectedrandomly for the thesis work. All the selected patients were thoroughly examined andselected based on exclusive and inclusive criteria. The assignment revealed thefollowing statistics, Presented in the tables and graphs and they are self explanatoryhence no further descriptions are given.Tabular Representation: A) Varna of “Vicharchika” Table No. 7. Showing the Varna of the Vicharchika Varna No. of Patients Percentage Shyava 12 40% Rakta 13 43% Sweta 05 17% Shyava-rakta 1 3% Shyava-sweta 0 0% Rakta-sweta 1 3%  Graph No.1. Showing the varna of vicharchika                              “A Study of Twak Shareera w.s.r to Vicharchika”   76 
  28. 28. Observation  B) Lakshanas of Vicharchika: Table No. 8. Showing the Lakshanas of the Vicharchika Lakshana No. of Patients Percentage Vedana 20 66% kandu 20 66% Daha 23 76% Vedana-kandu 9 30% Vedana-daha 16 53% Kandu- daha 13 43% Graph No.2. Showing the lakshanas of vicharchika                              “A Study of Twak Shareera w.s.r to Vicharchika”   77 
  29. 29. Observation  C) Sex-wise Distribution: Table No. 10. Showing the sex of the Vicharchika patients Sex No. of Patients Percentage Male 19 63% Female 11 37% Graph No.3. Showing the sex of vicharchika patients                              “A Study of Twak Shareera w.s.r to Vicharchika”   78 
  30. 30. Observation D) Age-wise Distribution: Table No. 11. Showing the age of the Vicharchika patients Age Patients Per% 10-20 4 13% 20-30 3 10% 30-40 9 31% 40-50 10 33% 50-60 1 3% 60-70 2 7% 70-80 1 3% Graph No.4. Showing the age of vicharchika patients                              “A Study of Twak Shareera w.s.r to Vicharchika”   79 
  31. 31. Observation E) Prakruti – Wise Distribution: Table No. 12. Showing Prakruti of the Vicharchika Patients Prakruti Patients Per% Vatapittaja 14 47% Vatakaphaja 4 13% Pittakaphaja 5 16% Tridoshaja 7 23% Graph No.5. Showing the prakruti of vicharchika patients                              “A Study of Twak Shareera w.s.r to Vicharchika”   80 
  32. 32. Observation  F) Diet – Wise Distribution: Table No. 13. Showing Diet of the Vicharchika Patients Diet Patients Per% Vegetarian 8 27% Regularly mixed 8 26% Irregularly mixed 14 47% Graph No.6. Showing the diet of vicharchika patients                              “A Study of Twak Shareera w.s.r to Vicharchika”   81 
  33. 33. Observation  G) Occupation – Wise Distribution: Table No. 13. Showing Occupation wise Patients Occupation Patients Per% Labours 16 53% House wife 8 27% Other 6 20% Graph No.7. Showing the occupation of vicharchika patients                              “A Study of Twak Shareera w.s.r to Vicharchika”   82 
  34. 34. Observation  H) Areas of Predilection: Table No. 9. Showing the areas of the Vicharchika Areas No. of Patients Percentage Face/scalp 7 23% Hands 10 33% Legs 13 43% Foot 7 24% Palms 2 7% Trunk 1 3% Foldings of body 8 27% Graph No.8. Showing the areas of vicharchika patients                              “A Study of Twak Shareera w.s.r to Vicharchika”   83 
  35. 35. Discussion   DISCUSSIONDiscussion on Historical review The study of twak shareera w.s.r to Vicharchika can be discussed as follows. Ayurveda is an ancient medical science which has given importance to thePancha Gnyanendriya in that Spershanendriya as one of important, which covers &protects the surface of the body from external heat, cold & infections. Most of thedisease which are exclusively exhibited on the skin & under the category of kustha &is one among the astha-mahagadha because of the change in the structural appearanceof the skin. If we go through historical review of literature pertaining to twak mentionedRigveda as one among the seven organs & in Atharvaveda while describing indriyatwak as Spershanendriya & different diseases like kustha,halimaka,kilasa etc. Duringpost vedik period various medical & non medical literatures are available inSamhita,Brahman Upanishad,puranas etc.In agni purana described that in fifth monthembryonic period there will be formation of skin & blood. In Samhita kala, it was golden era of ayurveda gives great knowledge abouttwak shareera & their related diseases. In Charaka Samhita explained six layers of the skin & diseases which occurs ineach layer.In Susruta explained the twak shareera in very minute level & itsembryogenesis, layers, pramana & characters of each layer of twak. Astanga sangraha& hrudaya also its layers & embryological development explained. There is references are available in kashyapa samhita explained sara purushalaxanas & twak sara purusha is free from skin disease . In Sharangadhara samhita                                          “A Study of Twak Shareera w.s.r to Vicharchika”   84  
  36. 36. Discussion  followed the sushrutas view & given detailed description of seven layers & diseasesrelated to different layers of the skin. Bhela samhita followed the charakas view &diseases of each layers of skin. In Harita samhita described the role of doshas indetermining the varna of garbhastha shishu & included twak as one of the vayaviyadravya. Bhavaprakasha has the same view of sushruta, he explained the seven layersof skin & its embryological development as similar to that of sushruta & mentionedthat twak one of the pitta sthana.Discussion on Twak shareera The external covering of the body is called twacha. It is also called as“Twagindriya or Spershanendriya” which is responsible for sense of touch or sparsha.It covers the surface of the body, holds the blood inside, illuminates the complexion &protects from the heat, cold, & external infections etc. Etymology of twacha is samvarane meaning is covering of the body.Twacha,charma,chhavi,chhadini,sparshana & asrukdhara are the synonyms of theskin. Acharya Charaka described six types of twacha namely udakadhara holdsrasadhatu & lasika inside and prevents loss from the body. Asrukdhara which holdsthe numerous blood vessels. Then he mentioned in numbers like Trutiya, Chaturtha,Panchami & Shasti and narrated the sidhma, kilasa in trutiya,dadru in chaturtha,Alaji,vidradhi in panchami, hence loss of consciousness in excision of shastidhara.Acharya Vagbhata also same view of charaka & also regarding vyadhis occurring indifferent layers. Sushruta, Sharangadhara, Bhavaprakasha have mentioned sevenlayers of twacha and same view regarding vyadhis occurring in different layers.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   85  
  37. 37. Discussion   The organogenesis of twacha occur during paka of Shukra & Shonita by Agni,just like while heating of the milk cream is formed on its surface. ModernEmbryology also supports this view. Embryologically the Integumentary system isnot derived from a single layer. Different cells of the skin & its appendages havedifferent origin.From the different sites they migrate to the skin. According to modern view Epidermis of skin is outermost layer and an averageadult carries around about 2kg of dead skin, billions of tiny fragments of skin are lostevery day. Hair follicle, arrector pilli muscle, nails & skin glands are formed bySurface Ectoderm. Dermis is formed by mesenchyme (mesoderm) derived fromdermatomes of somites. Twacha is a Matruja Bhava due to its soft nature & it is having predominanceof vayu mahabhoota & spersha as visista guna.In all Indriya, spershanendriya is suchan entity that occupies all other indriya also. Layers of the Twak : There is some controversy regarding the number of Twacha in variousayurvedic texts. Acharya Sushruta tells seven types of Twacha (twacha sapta) whileCharaka and Vagbhata tell six types, and also regarding Vyadhis occurring indifferent layers. Though we cannot exactly correlate these layers with that mentionedin modern science, the following comparisons can be made with the contemporaryscience on the basis of colour, appearance, and structural involvement of the layers.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   86  
  38. 38. Discussion  Avabhasini & Lohita . . . . . . . Stratum corneum Avabhasini is the first layer of skin.This layer illuminates the varna of the skinand the five types of chaya (avabhasanyati varna, chaya iti avabhasini). Lohita -Second layer of skin.The name indicates that this layer is also pigmented and thediseases occurring in this are pigmentation disorders. Stratum Corneum contains cells that are completely filled with keratin &melanin units.Skin colour is mainly due to amount of pigment the melanocytes canproduce and transfer to the keratinocyte.It is told that the tanning of the skin is due toincreased production of melanin as well as its transfer to keratinocyte. This tanning ofskin is lost when melanin i.e. Keratin units are shed off from Stratum Corneum ie.The colour of skin is reflected in this layer. Avabhasini and Lohita can be compared with Stratum Corneum.The diseasesmanifested in these layer are mostly pigmentation related disorders.i.e.padmakantaka,Tilakalaka, vyanga etc. Sweta . . . . . . . Stratum lucidum Sweta is the third layer of skin.The name implies that it is clear (white) layer.The diseases are mentioned as Mashaka, Charmadala, Ajagallika which occurs due todefects in pigmentation. The Stratum Lucidium is also called the clear layer as it is highly refractive.Itcontains droplets of intermediate substance eledin, which is eventually transformed tokeratin.The diseases which occurs due to the localized overgrowth of melanocytes andmelanin.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   87  
  39. 39. Discussion  Tamra . . . . . . . Stratum spinosum and Stratum granulosum . Tamra is the fourth layer. Kilasa & Kushta are diseases that are likely to occurin this layer. Stratum Spinosum contains keratinocytes with bundles oftonofilaments.Melanocytes and Langerhans cells are present in this layer At sites ofallergic dermatitis langerhans cells are believed to take up antigen and present itlymphocytes in a form to which they can react by generation of antibodies.StratumGranulosum contain darkly stained protein granules keratohyaline which convertstonofilaments into keratin. Tamra varna of the skin may be due to keratohyaline pigment.Themelanocytes & langerhans cells present in stratum spinosum and granulosum maybe responsible for kilasa and kushta respectively.Vedini . . . . . . . Stratum basale and papillary dermis. Vedini is the fifth layer of skin.It forms adhishtana of Visarpa and Kushta.Thename suggests the presence of sensory receptors in this layer. Stratum Basale and papillary dermis contain merkels disc which serves asmechanoreceptors.Papillary dermis contains tactile receptors, Meissner corpuscles&free nerve endings that give rise to sensations of pain, warmth, tickling etc. StratumBasale also contains langerhans cells and keratinocytes. The sensory receptors in this layer are responsible for vedana or pain. Pain is seenin the diseases of this layer. In Visarpa along with skin manifestations pain is also apredominant feature. In some kushta (skin diseases) also pain is experienced.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   88  
  40. 40. Discussion  Rohini . . . . . . . Reticular dermis Rohini is the sixth layer.The word meaning of Rohini is that which is growingor ascending. The diseases present in this layer also presents abnormalgrowth.Granthi, Apachi, Sleepada , Galaganda are likely to occur in this layer. The reticular dermis contains fibroblasts, collagen, reticular fibres and a fewadipose cells. This region possesses rich lymphatic and vascular supply. Adnexaltumours,adipose tumours are likely to occur in this layer. Twak is not involved in the samprapti of diseases mentioned in this layer.Itmay due to the presence of adipose tissue , rich lymphatic and vascular supply thesediseases are considered in this layer.Mamsadhara . . . . . . Superficial fasciaMamsadhara is the seventh layer. Bhagandara ,Vidradhi, Arsas are likely to occur inthis layer. Arshas,Bhagandara, Vidradhi as the samprapti of all these disorders will notspecify the role of twak, but the vyakta sthana of all manifestations are clearlyobserved through the twak onlyPramana of twak (Thickness): Acharya Susruta has explained the pramana of each layer of skin as havingthickness of 1/18 th,1/16th, 1/12th, 1/8 th ,1/5 th , 1& 2 vreehi or yava.Here the totalthickness of skin is 3.5 yavs.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   89  
  41. 41. Discussion   Dalhana clarifies that the measurement is to be taken as parts of 1/20th ofvreehi.The thickness of each layer will be 18/20, 16/20, 12/20, 5/20, 1 & 2 vreehis,thetotal thickness being 5.95 yavas. According to Susruta the measurement of thickness of twacha is broadlyapplicable for the rich muscular parts & cannot be considered in the region of scalp orless fleshy areas. If we want to compare this measurement with modern measurement (skinthickness =1.5 to 4 mm).then Susruta seems to be perfect & more accurate in tellingthickness of skin. Considering relation of doshas with twacha, vata dosha especially prana haveclose relation with twacha, Pranavayu is responsible for the perception of touchsensation. Udanavayu produces Varna and if it gets vitiated then there will bediscolouration of the skin. If pitta dosha is considered, Bhrajaka Pitta is situated inTwacha which maintains Teja of Twacha. It is responsible for absorption of drugsexternally in the form of massage, oils, paste etc. kapha dosha is having Snigdhaguna. If Snigdha guna decreases then Twacha will be dry and cracky in nature. Considering relation of dhatus with Twacha. Rasa dhatu is present in Twachaand it gives nourishment to it for its well being. Twacha is supplied by numerousRaktavahi dhamanis and Raktadhatu is present in these Dhamanis. Also there isrelation of Twacha with other Dhatus.Among malas Twacha is mainly related tosweda. This is excreted through innumerable openings on it.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   90  
  42. 42. Discussion   Twak as sense organ: Twak is said to be one of the gnyanendriya concerned with sensation oftouch according to our classics. Charaka has given prime importance to spasanendriyaby quoting that tactual contacts and mental contacts are the 2 types of contacts. In the contemporary sciences also the skin is considered as a organ ofsensation. An array of cutaneous receptors carry information concerning variousstimuli, The highly branched myelinated & nonmyelinated free terminals which endwith in the dermis and lower layer of epidermis acts as an important sensorycomponent. They may be mechano, chemo, thermo & nociceptors in all types of skinVarna of twak Rakta dhatu is varna prasadana ie it enhances the colour of the skin. Bhrajakapitta also have a role in regulation of skin colour. In the modern science colour of theskin depends upon the Melanocytes, Keratinocytes & Hemoglobin present in theblood.The role of Twak in Thermo regulation Chakrapani opines that the regulation of body heat and variations in the colourof the twak are the functions of Brajaka pitta. Skin plays a significant role in thethermo regulation of the body. The skin contributes to thermoregulation, the homeostatic regulation of bodytemperature in two ways, by liberating sweat at its surface & by adjusting the flow ofblood in the dermis.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   91  
  43. 43. Discussion  Discussion on Vicharchika Vicharchika is a type of Kushtha which occurs in ‘Tamra & Vedini’ Twachaaccording to Sushruta. It is tridoshaja vyadhi having predominance of pitta, & Kapha.It is characterized by blackish brown eruptions associated with itching sensation, pain& excessive exudation/dry lesion.It occurring all over the body,but more on hands &legs.Discussion on Eczema Eczema is affects epidermal layers & papillary layer of dermis. It ischaracterized by excessive itching, pain, papules, Erythematic with discoloration,profuse discharge/drylesion, on the skin of all parts of body, Eg.legs, hands, Palms,soles, trunk, scalp, face &,folding of the body. Eczema and Vicharchika : It is difficult to say what Eczema is in terms of Ayurveda.There is no disease inAyurveda, which can exactly be correlated with Eczema. Many research workers havetried to attribute eczema with one or other type of kustha. All the workers includedeczema under kshudra kustha, but on co-relation with specific type they differed.Some correlated it with Vicharchika & others with pama kustha .Here, Vicharchikasign & symptoms are correlated as Eczema because the description & characteristicfeatures of the disease are co-inciding with description of eczema than any other typeof kustha. In vicharchika the lesions are having Kandu, Pidika, Shyava, Bahusrava,Raji, arti, & ruksha. But in Eczema the lesions are having Exessive itching after itmay/may not produce burning, Papules/vesicles or pustules, Erythema withdiscoloration, profuse discharge, Thickening or Lichenification of skin, Pain & Dry in                                          “A Study of Twak Shareera w.s.r to Vicharchika”   92  
  44. 44. Discussion  nature, on the skin of all parts of body, Eg. Legs, hands,Palms,soles,trunk scalp, face&,folding of the body. The description & characteristic features of Vicharchika are very closely matchedwith the description of Eczema.Vicharchika --- Eczema Kandu – Exessive itching it may/may not produce burning. Pidika – Papules / Vesicles / pustules. Shyava – Erythema with discoloration. Bahusrava – profuse discharge. Raji – Thickening. Arti – Pain. Ruksha – Dry lesion. Discussion on Histology: It is based on biopsy reports of histopathological examination of the skin. Afterhistopathological study the spongiosis with acanthosis (thickening),parakeratosis,hyperkeratosis & cellular infiltration were seen under microscope. So that structuralchanges are found in the Epidermis & Dermis layers of the skin. • Spongiosis: Intercellular oedema with associated lymphocyte exocytosis.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   93  
  45. 45. Discussion   • Acanthosis: Increased thickness of prickle cell layer, the results of hyperplasia, (often with hypertrophy) of the prickle cell. • Hyperkeratosis: Excessive formation of keratin, resulting the horny layer being thicker than is normal for the skin of the area affected. • Parakeratosis: An abnormal form of Keratinization in this condition granular layer of the epidermis is disappear. Discussion on Observation Age: Out of 30 patients, 10 patients are of 40 – 50 age group & 9 patients are 30-40 age group, remaining are related to different age group. So Vicharchika can occur in any age. But more in thirty to fifty age group in my study. Sex: Out of 30 patients, 19 male patients & 11 female patients, so it shows that males are more affected than the females, in my observational study. Diet: Out of 30 patients 22 patients are mixed diet taking persons & 8 patients are Vegetarians,and the persons are habituated with virudha ahara ,dietic allargies are important role in causation of disease. Occupation: Out of 30 patients, 16 patients are labours, 8 patients are house wives, 6 patients related to other fields .This is also important in causing vicharchika. The labours are more prone to expose sunlight and various chemical contacts, fertilizers, plants etc. Prakruti: Out of 30 patients 14 patients are assessed as vata pittaja prakruti, 7 tridoshaja, 5 pittakaphaja, 4 vatakaphaja prakruti patients. So vatapittaja prakruti persons are more prone to suffer from vicharchika.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   94  
  46. 46. Discussion   Varna: Among 30 patients, Rakta varna is observed in 13 patients, Shyava varna in 12 patients & Sweta varna in 5 patients. And more rakta varna patients are seen. Sites of Eczema: Among 30 patients, the vicharchika found on legs /foot in 13 patients, 10 patients on hands/palms, 7 patients on face/scalp & folding, 1 patient all over the body.                                          “A Study of Twak Shareera w.s.r to Vicharchika”   95  
  47. 47. Conclusion  Conclusion The following conclusions can be drawn by the observations based on literary &Histopathological study & discussion.Twacha is one of the sensory organ of the body which covers surface and protectsagainst heat, cold,infection etc. 1. Acharya Sushruta opines that ,there are seven types of twacha & out of these seven twacha Vicharchika occurs in fourth & fifth layer of twacha i.e. Tamra & Vedini. 2. Acharya Sushruta,s measurement regarding thickness of twacha is seems to be more accurate. His measurement of thickness of all the layers of twacha expressed in modern units is very much similar to the thickness of skin given in modern text books of Anatomy. 3. Vicharchika is a type of Kustha & Eczema is a type of skin disease has most of the same symptoms which are correlated on the basis of literary, histopathological & clinical observationalstudy of both Ayurveda & modern science. 4. On the bases of signs and symptoms and histopathological report findings, Vicharchika can be correlated with allergic eczema 5. The Histopathological reports shows, structural changes are found in Epidermis & Dermis layers of the skin. 6. The present study is carried out on 30 patients, so which is a small sample. The patients selected were having different types of eczema.                                        “A Study of Twak Shareera w.s.r to Vicharchika”  96  
  48. 48. Conclusion  Here suggestion is given for the further study to conduct on large number of patients concentrating on particular types of Eczema in multi- centers, after which a clear conclusion can be drawn.                                        “A Study of Twak Shareera w.s.r to Vicharchika”  97  
  49. 49. Summary  SUMMARY The dissertation entitled “A STUDY OF TWAK SHAREERA W.S.R TOVICHARCHIKA” comprises of 8 chapters namely Introduction, Objectives, Reviewof literature, Methodology, Observation, Discussion, Conclusion & Summary.1. Chapter : General idea regarding Ayurveda, Rachana shareera,Twak shareera, &Vicharchika (Eczema) has been covered in the introduction part of dissertation alongwith need of this study in the present scenario has been highlighted.2. Chapter: Gives an idea about Aims & Objectives of the study.3. Chapter : Review of literature is subdivided in to Historical review, Ayurvedic review & Modern review. Historical review section comprises of references pertaining to Twak. In Ayurvedic review the layers of skin along with its measurement &diseases that are likely to occur in each layer, its relation with dosha, dhatu,malapanchamahabhuta its importance as sense organ, Varna of twak is depends onpredominant dosha at the time of conception is mentioned in detail. Also there isnidana samprati lakshanas of vicharchika were discussed. In the first part of modern review detail anatomy of skin has been explained.In the second part eczema, its types, causes, features & histopathology were discussed& photo plates of types of eczema were also presented in this chapter.4. Chapter: Methodology explains about the method of data collection,inclusion Criteria,exclusion and assessment criteria                                     “A Study of Twak Shareera w.s.r to Vicharchika”   98  
  50. 50. Summary 5. Chapter: The signs and symptoms of vicharchika and eczema and histipathological Studies are presented in the observation chapter. 6. Chapter: It comprises the details of comparison of the collected data with those mentioned in the ancient literature & modern science.7. Chapter: Conclusion drawn from various sections of the work are given.8. Chapter: Summarizes the entire work.                                     “A Study of Twak Shareera w.s.r to Vicharchika”   99  
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  54. 54. Bibliography  31. Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 5632. Prof.Srikanth Murthy K.R.Sushruta samhita chaukambha,Varanasi,U.P.vol-1,2nd edition 2004,pp28933. . Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 74.34. Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738;35. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 19236. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956.37. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 19238. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 10139. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 194                                     “A Study of Twak Shareera w.s.r to Vicharchika”   111   
  55. 55. Bibliography  40. Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 8041.  Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi Reprint 2005; Pp: 956; Page No.: 183.42. Sharma P.V. Agnivesha Charaka Samhita by Charaka and Dridabala,Chaukambha surabharati prakashana,Varanasi,.U.P.Vol.2nd,8thedition 2007,pp87943. Sharma P.V. Agnivesha Charaka Samhita by Charaka and Dridabala,Chaukambha surabharati prakashana,Varanasi,.U.P.Vol.2nd,8thedition 2007,pp87944. Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary o f Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 25045. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 15246. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 15247. Agnivesha,Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 27848. Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 77 49. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 107                                     “A Study of Twak Shareera w.s.r to Vicharchika”   112   
  56. 56. Bibliography   50. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8thedition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 348 51. Hareetha, Hareetha Samhita, edited and compiled by Pandit Hariharaprasad Tripati, 1st edition; Chaukambha Krishnadas Acadamy; Varanasi; Pp- 524 Page520 52. Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page342.53. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 19454. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 6855. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 6856. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 18357. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri Paradakara Vaidya; 9th edition; Chaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 18358. Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by Bhisagacharya Harisastri                                     “A Study of Twak Shareera w.s.r to Vicharchika”   113   
  57. 57. Bibliography   Paradakara Vaidya; 9th editionChaukambha Orientalia; Varanasi; Reprint 2005; Pp: 956; Page No.: 18559. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 9560.  Agnivesha, Charaka Samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya; Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 528.61. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.: 283 62. Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of Dalhanacharya and Nyaya Chandrika Panjika commentary of Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya; 8thedition; Chaukambha Orientalia; Varanasi; 2005; Pp: 824; Page No.:285 63. Rig Veda Samhitha Edited byK.L.Joshi ,1st edition; Chaukambha Orientalia; Varanasi; Pp: 520; Page No.: 416. 64.  Atharva Veda Samhitha 1st Part with Hindi commentary by Pandit Shriram Sharma;Edited by Pandit Shriram Sharma; 1st edition; Brahmavarchas;Haridwar; Pp: 520; Page No.: 77,258 65. Agni Purana; Edited by Acharya Baladeva Upadhyaya; 1st edition; Chaukambha Sanskrit Series; Varanasi; 1966; Pp: 563; Page No.: 519 66. Vruddha Jivaka, Kashyapa Samhitha with Vidyotini Hindi commentary by Sri. Satyapala Bishagacharya; Edited by Sri. Satyapala Bishagacharya; 10th edition; Chaukambha Sanskrit Sansthana; Varanasi; 2005; Pp: 364; Page No.: 54,72 67. Pandit Sarangadharacharya, Sarangadhara Samhitha with Dipika commentary of Adhamalla and Gudhartha Dipika commentary of Kasirama; Edited by Pandit Parasurama Saatri, 6th edition; Chaukambha Orientalia; Varanasi; 2005; Pp: 398; Page No.: 49                                     “A Study of Twak Shareera w.s.r to Vicharchika”   114   
  58. 58. Bibliography 68. Bhela, Bhela Samhitha; Edited by Girijadayalu Suklah; Chaukambha Bharati Academy; Varanasi; Reprint 1999; Pp: 285; Page No.: 9969. Don .W.Foucett & Ronald P. Jenson, Concise Histology, 2nd edition2002 , Arnold Publishers; Pp 360 Page No.: 165.70. Chaurasia B. D., General Anatomy; 4th edition 2009; CBS Publishers and distributors; New Delhi; Pp: 262; Page No.:175.71. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page. No.:38172. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:38173. . Don.W.Foucett & Ronald P. Jenson, Concise Histology, 2nd edition2002 , Arnold Publishers; Pp 360 Page No.: 166.74. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:38875. Don.W.Foucett & Ronald P. Jenson, Concise Histology, 2nd edition2002 , Arnold Publishers; Pp 360 Page No.: 16776. Don.W.Foucett & Ronald P. Jenson, Concise Histology, 2nd edition2002 , Arnold Publishers; Pp 360 Page No.: 16777. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:382                                    “A Study of Twak Shareera w.s.r to Vicharchika”   115  
  59. 59. Bibliography 78. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:395.79. Dr Ashok Agrawal, Histopathology of the Skin ,1st edition 2007; JAYPEE Brothers Medical Publications (P) Ltd ;New Delhi ;PP 280 ;Page no 0980. Dr Ashok Agrawal, Histopathology of the Skin ,1st edition 2007; JAYPEE Brothers Medical Publications (P) Ltd ;New Delhi ;PP 280 ;Page no 0981.  Dr Ashok Agrawal, Histopathology of the Skin ,1st edition 2007; JAYPEE Brothers Medical Publications (P) Ltd ;New Delhi ;PP 280 ;Page no 19.82. http:www.blackwell publishing .com/ skin sys- fin.html.83. Young Barbara and John W Heath; Wheater’s Functional Histology ;4th edition 2003;Churchill Livingstone Edinburg;Pp :413; Page no.:164.84. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:40185. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:409.86. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:406.87. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:405.88. I.B Singh,G.P Pal, Human Embryology 8th edition, Macmillan Publishers India ltd;2007; pp361;page 98.                                    “A Study of Twak Shareera w.s.r to Vicharchika”   116  
  60. 60. Bibliography 89. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:399.90. gray Henry, Gray’s Anatomy; Edited by Peter L. Williams, Roger Warwick, Mary Dyson and Lawrence Bannister; 38th edition; Churchill Livingstone; London; 2000; Pp: 2092; Page No.:400.91. Dr Ashok Agrawal, Histopathology of the Skin ,1st edition 2007; JAYPEE Brothers Medical Publications (P) Ltd ;New Delhi ;PP 280 ;Page no 19.92. . http:// www.net doctor.co.uk / skin.93. http:// www.net doctor.co.uk / skin.94. Principles of Anatomy and Physiology :By G.J. Tortora and S.R. Grabowski, published by Harper Collins College publishers, New Yord, 10th edition, 2003.pp1103,pg.151.95. Ronald Marks; Roxburgh common skin diseases;17th edition ;Arnold publishers,A member of Hodder Headline group; Pp: 328; Page No.: 17296. Chaurasia B. D., General Anatomy; 4th edition 2009; CBS Publishers and distributors; New Delhi; Pp: 262; Page No.:18197. P.N.Behl-Practice of dermatology ,1988,CBS Publishers.New Delhi.pg126.98. Histopathology of skin; Water.F.Lever.99. Medical Laboratory Technique, Ramnik Sood,Jaypee publications.100. Fitzpatrick’s color atlas and Synopsis of Clinical Dermatology;5thedition 2005,pp1085,pg18.                                    “A Study of Twak Shareera w.s.r to Vicharchika”   117  
  61. 61. Case sheet DEPARTMENT OF P.G. STUDIES IN RACHANA SHAREERN.K.J AYURVEDIC MEDICALCOLLEGE & PG CENTRE, BIDAR. RESEARCH CASE SHEETTITLE: A STUDY OF TWAK SHAREER W.S.R. TO VICHARCHIKA Research scholar: Dr.Geeta DolliCo-guide:Dr.Ashwinikumar .W. Guide: Dr.N.G.Mulimani.PRILIMINARY DATA:Name:Age :Sex :Religion:Occupation:Address:D.O.A.:D.O.D.:OPD/Ward/Bed:Diagnosis:Result :HISTORICAL DATA:PRADHAN VEDANA (Chief complaint):VEDANA VRITTANT (H/O Present illness):POORVA VYADHI VRITTANT (Past history):VIYAKTIKA VRITTANT (Personal history):KOUTUMBIKA VRITTANT (Family history):  
  62. 62. Case sheet SYSTEMIC EXAMINATION1) Respiratory system:2) C.V.S. : B.P.3) Abdomen:4) C.N.S.:5) Urinary system: GENERAL EXAMINATION A)ASHTAVIDHA PAREEKSHA Nadi: Shabda: Mala: Sparsha: Mutra: Druk; Jiwha: Aakruti: B)DASHAVIDHA PAREEKSHA Prakritaha: Sarataha : Samharana: Satwataha : Aharshakti: Vyayamshakti: Vayaha : Pramana : Vikrititaha pariksha: Hetu (causative factor) Poorva roopa (premonitory factor) Roopa (symptoms) C)LOCAL EXAMINATION Inspection: Palpation : Percussion : Auscultation:  
  63. 63. Case sheet SAMPRAPTIA) Udbhava sthana:B) Dosha :C) Agni :D) Sanchara :E) Adhishtana(dhatus involved) Rasa: Mamsa: Rakta: Ambu(lasika):F)VyaktasthanaINVESTIGATION Skin Biopsy Blood: TLC,DLC,ESR,Hb%,FBS,PPBS,CT,BT. Urine: Routine MicroscopicVyavacheda nidana(Differential Diagnosis):Vyadhi vinischay(Diagnosis):RESULT: Signature of the PG scholarSignature of co-guide Signature of guide  
  64. 64. Ayurvedic Review   Disease Review Most of the diseases which are exclusively exhibited on the skin are termed as‘kushta’ in Ayurveda. They are so called because these diseases account for a greatdeal of misery and suffering in the body. Owing to illiteracy, unhygienic conditionsand poverty etc. a large portion of our society is suffering from one or the other skindisease. Kushta is one among the ashta-mahagadas told by Sushruta owing to thedifficulties one has to undergo during treatment and also to the results achieved aftertreatment. Even today, Dermatologists do face problems in treating some of the skindisorders which are of recurring in nature. Hence it can be said that skin disorders‘were’ and ‘are’ troublesome for both the physician and the patient. Two types of Kushtas have been envisaged in ayurvedic classics viz. MahaKushta and kshudra kushta. Among the 18 Kushtas 7 are maha kushtas and 11 arekshudra kushta. Vicharhika is a type of kshudra kushta. VICHARCHIKAEtymology: Vicharchika word is derived from “Charcha” dhatu, Vee- prefix and ‘Navul’-suffix. It means that a type of Swalpa (Minor type) Kustha. (Vachaspatyam part 6, Pg.4896). Vicharchika is formed by “Charcha Tarjane” Dhatu by adding ‘Navul’ to it.Means a type of disease. (Shabdakalpadrum, part 4)                                     “A Study of Twak Shareera w.s.r to Vicharchika”   24 
  65. 65. Ayurvedic Review   Thus, Vicharchika is derived from “Charcha Adhyane” by adding prefix ‘Vee;to it. The word Adhyane has two syllables viz. Adhi and Ayne. Adhi means above andAyne means spread out. Thus it reads as “Visheshate Charchate Adhi Eyate AnayaSakandu Kshudrapidika Swarupena Charmani Upariti Vicharchika”, which meansKshudrapidika spreads with Kandu elevated on the surface of the skin is termed asVicharchika.Nirukti of Vicharchika Shabdakalpadrum describes two main features founded in Vicharchika i.e.cracking of the skin mainly occurs on the skin of hands & legs ‘Visheshena care-ayatepadasya Twak vidaryate Anaya iti Vicharchika’ which means the disease whichcoats/covers the skin in particular manner & causes cracking of skin of hands & feetmainly.Definition1. According to Acharya Charaka Vicharchika is defined as ‘Sa Kandu Pidika ShyavaBahu Srava Vicharchika’. (Ch.chi. 7/26) Means the skin disease where eruptions over the skin appear with darkpigmentation, itching with profuse discharge from the lesion.2. Vicharchika according to Sushruta is ‘Rajyo Atikandu Atiruja Sa Ruksha BhavantiGatreshu Vicharchikayam’. (Su.Ni. 5/13) According to Susruta the condition in which skin is dry with severe itching& marked linings present in Vicharchika. Furthermore he added that if the samecondition appears at the feet with pain, then it is known as ‘Vipadika’.                                     “A Study of Twak Shareera w.s.r to Vicharchika”   25 
  66. 66. Ayurvedic Review   Acharya Madhava, Vagbhata & Bhavamishra have described almost samedefinition as Acharya Charaka. (M.N.49/23, B.P.Ma.Kh 54/26, A.H.Ni 14/6, 17) Kashyapa describes Vicharchika as blackish brown eruption with intenseitching & pain. (Ka. Chi.9/2) While Acharya Harita considered a multiple pin head sized eruptions withulceration & itching in Vicharchika. ((Ha. Ut.4/42) Bhel narrates Vicharchika as a dark red coloured deep-rooted lesion withmoisture or oozing. (Bhel. Chi. 6/16)Nidana There is no specific description about etiological factors of the diseaseVicharchika but it is being a variety of Kshudra Kustha, the etiological factors of theKustha are to be accepted as the etiological factors of the Vicharchika. Etiological factors of Kustha and may be same factors causes Vicharchika asmentioned in different Ayurvedic texts may be classified into following groups. 1. Aaharaja Hetu (causes related to food habit) 2. Viharaja Hetu (causes of other activities) 3. Aacharaja Hetu (causes of behavior) 1. Aaharaja Hetu Aaharaja Hetu are chief responsible factors in the production of the Kustha (skin diseases). Among them Viruddha & Mithya Ahara are the main dietary factors.                                     “A Study of Twak Shareera w.s.r to Vicharchika”   26 

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