• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Vicharchika gandhaka kc015-udp
 

Vicharchika gandhaka kc015-udp

on

  • 2,255 views

A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA IN VICHARCHIKA, By Dr. YOGEESHA ACHARYA, 2011, UDP DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S. D. M. COLLEGE OF ...

A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA IN VICHARCHIKA, By Dr. YOGEESHA ACHARYA, 2011, UDP DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S. D. M. COLLEGE OF AYURVEDA, UDUPI

Statistics

Views

Total Views
2,255
Views on SlideShare
2,249
Embed Views
6

Actions

Likes
0
Downloads
17
Comments
0

1 Embed 6

http://www.slashdocs.com 6

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Vicharchika gandhaka kc015-udp Vicharchika gandhaka kc015-udp Document Transcript

    • “A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA IN VICHARCHIKA” By Dr. YOGEESHA ACHARYA, B.A.M.SDissertation submitted to the Rajiv Gandhi University of Health Sciences,Karnataka, Bangalore in partial fulfillment of the regulations for the award of the degree of “AYURVEDA VACHASPATI” DOCTOR OF MEDICINE (Ayu) In KAYA CHIKITSA GUIDE Dr.G.SHRINIVASA ACHARYA. M.D. (Ayu) Professor & HOD Department of Post Graduate Studies in Kayachikitsa S.D.M.C.A.,Udupi DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA S.D.M. COLLEGE OF AYURVEDA, UDUPI. 2010 – 2011
    • Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATEI hereby declare that this dissertation thesis entitled “A CLINICAL STUDY TOEVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA INVICHARCHIKA” is a bonafide and genuine research work carried out by me underthe guidance of Dr.G.SHRINIVASA ACHARYA, M.D (Ayu), Professor & HOD,Dept. of P.G. Studies in Kayachikitsa, S.D.M.C.A, Udupi.Date : Signature of the CandidatePlace: Udupi Dr.Yogeesha Acharya Dept. of P.G.Studies in Kayachikitsa S.D.M.C.A, Udupi.
    • Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “A CLINICAL STUDY TOEVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA INVICHARCHIKA” is a bonafide research work done by “Dr.Yogeesha Acharya” inpartial fulfilment of the requirement for the degree of Ayurveda Vachaspati - Doctorof Medicine in Ayurveda.Date: Signature of the GuidePlace: Udupi Dr.G.Shrinivasa Acharya. M.D (Ayu) Professor & HOD Dept of P.G.Studies in Kayachikitsa S.D.M.C.A, Udupi. 
    • Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “A CLINICAL STUDY TOEVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA INVICHARCHIKA” is a bonafide research work done by Dr.Yogeesha Acharyaunder the guidance of Dr.G.Shrinivasa Acharya M.D. (Ayu), Professor &HOD.Signature of H.O.D Signature of PrincipalDr. G.Shrinivasa Acharya M.D. (Ayu) Dr.U.N Prasad, M.D. (Ayu)Professor and HOD PrincipalDept of P.G. Studies in Kayachikitsa S.D.M.C.A,S.D.M.C.A, Udupi UdupiDate: Date:Place: Udupi Place: Udupi 
    • COPYRIGHT Declaration by the CandidateI hereby declare that the Rajiv Gandhi University of Health Sciences, KarnatakaBangalore, shall have the rights to preserve, use and disseminate this dissertation inprint or electronic format for academic / research purpose.Date: Signature of the CandidatePlace: Udupi Dr.Yogeesha Acharya B.A.M.S © Rajiv Gandhi University of Health Sciences, Karnataka   
    •  
    •  
    •  
    •  
    • Acknowledgement  ACKNOWLEDGEMENT• At this amenity of successful integrating of my work, I bow my head on the feet of Goddess Mahakali.• There is hardly any task which is more pleasant than acknowledgment my gratitude to all those who have helped in so many ways in preparing this work.• I feel intense pleasure and satisfaction in expressing myself to my parents Professor A Madhava Acharya and Mrs.Gayathri M Acharya, it is because of their pain taking efforts and I have reached up to this step of life.• First of all I bow to almighty to dedicate this work to the lotus foot of my parents, beloved sisters & all my family members.• I convey my sincere thanks to Padmabhushana Dr. D. Veerendra Heggade, President S.D.M. Educational Society.• According to our culture teachers are given the immediate next importance to parents, so I thank whole Teachers who enlightened me with their sincere blessings.• I am extremely thankful to Dr. U N. Prasad, Principal, SDM college of Ayurveda, Udupi for providing all the needed backgrounds for the successful and timely completion of my critique work.• I appraise my sincere and hearty gratitude with paramount respect and affection to my guide and H.O.D, Prof .G. Shrinivasa Acharya, P.G.Dept of Kayachikitsa, SDMCA Udupi. Even the best of words will be under rated to portray my mentor. His indefatigable love, enduring help, priceless suggestions, encouraging words, enthusiasm and zeal will continue to be a great inspiration in my prospective life.• I deeply owe the favor and sincerely express my gratefulness to Dr.Shridhar Holla, Dr. Jonah S, Dr.Srilatha Kamath, Dr Lavanya, Dr.Veera Kumara, Dr.Rajalakshmi, Dr. Gopikrishna, Dr Aniruddha, Dr Vijayendra Bhat Dr.Prasanna N Mogasle, Dr. Nagaraj, Dr. Deepak S M.(Deputy Medical Superintendent), Dr. Y N. Shetty (Medical Superintendent) for their continuous cooperation and timely encouragement at various levels of the study.  VI 
    • Acknowledgement • I would also like to thank Dr. Murulidhar (Director SDM Ayurveda pharmacy) and Dr. Mohanan, for providing my thesis drug within time and helping me in this work.• I would like to remember and wholeheartedly extend my humble thanks to all my friends Dr Ravikanth, Dr Shailesh, Dr Chaitra, Dr Manu, Dr Gauhar for their valuable support and encouragement.• My special thanks extends to my beloved seniors Dr.Prashanth, Dr Chandrashekar, Dr.Murgesh, Dr.Rathod, Dr.Geetha, Dr.Vaishali for their guidelines and friendly co-operation.• I am very much thankful to my juniors Dr Prashasth, Dr Supriya, Dr Veeraj, Dr Vasundara, Dr Shreelatha for their unforgettable support. And hearty thanks to Dr Nishanth Pai for his earnest help in the completion of this dissertation work.• I am very much thankful to the staff of library, non teaching staff, pharmacy and hospital unit, Sampark Xerox and all my patients for their kind co- operation, which was requisite for the successful casing up of this work.• At last I express my thanks to each & every person who are directly or indirectly associated in the successful completion of this work.Date:Place: Dr .Yogeesha Acharya  VII 
    • List Of Abbreviations   LIST OF ABBREVIATIONSA.H. - Ashtanga HridayaA.S. - Ashtanga SangrahaAT - After TreatmentBH.S. - Bhela SamhitaBT - Before TreatmentC.S. - Charaka SamhitaDC - Differential CountESR - Erythrocyte Sedimentation RateHb - HaemoglobinH.S. - Harita SamhitaI.P.D - In-Patient DepartmentK.S. - Kashyapa SamhitaNo. - NumberO.P.D - Out-Patient DepartmentP - ProbabilityS.D.M - Shri Dharmasthala ManjunatheshvaraS.D - Standard Deviation S.E.M - Standard Error of Mean S.S. - Sushruta Samhita Tc - Total Count ‘t’ - ‘t’ test VAS - Visual Analogue Scale   VIII 
    • Abstract   ABSTRACTObjective:To study the therapeutic effect of Gandhaka Churna in patients suffering fromVicharchika.Design of Study: A single blind clinical study with pre test and post test design.Settings:SDM Hospital of Ayurveda , Udupi, Karnataka. From December 2009 to October2010Study Selection:20 patients suffering from Vicharchika / Atopic Dermatitis of either sex were selectedfor the study.Intervention:Selected patients were treated with oral administration of Gandhaka Churna, in doseof 500mg before food twice a day and the same is continued for 28 days. 100 ml milkis advised as anupana along with Gandhaka Churna.Main Outcome of Measures:The response following the intervention was assessed every week by adapting theVisual Analogue Scale and SCORAD. Further the change observed by the completionof the treatment was subjected to paired t test to know the statistical significance.Results:The administration of Gandhaka Churna proved to be effective in decreasing theseverity of symptoms. There was marked reduction in mean score of itching i.e. theseverity score before treatment which was 8.050 came down to 2.700 after treatment.The reduction in severity was also statistically significant as shown by the paired‘t’ IX   
    • Abstract  test. Discharge from the lesions before the treatment was 4.350 came down to1.350after treatment and the paired t test proved its statistical significance.The criteria discolouration showed improvement in mean score which was 7.900before treatment decreased to 5.450 after treatment, the statistical test proved itssignificance. Pidaka was reduced after therapy from mean score of 2.250 to 1.250after treatment, the paired t test confirmed statistical significance (p=<0.001). TheRuja was reduced from mean score which was 6.143 before treatment to 2.714 andwas statistically significant as p=0.009. The Daha showed improvement and themean score which was 6.00 before treatment reduced to 2.00 after treatment, thestatistical test unravelled the significance with p=<0.001. Favourable response wasleast in regards to the symptoms. Also, an overall improvement of 43.93%.wasrecorded in the present clinical trial.Key Word: Vicharchika, Gandhaka Churna, Atopic Dermatitis. X   
    • List of Contents   LIST OF CONTENTS Sl. NO. CONTENTS Page No. 1 INTRODUCTION 1-3 2 OBJECTIVES 4 3 REVIEW OF LITERATURE Chapter 1 - Historical Review 5-7 Chapter 2 - Paribhasha of Kushta and Vicharchika 8 Chapter 3 - Nidana 9-12 Chapter 4 - Samprapti and Bheda 13-18 Chapter 5 – Purvarupa 19-20 Chapter 6 – Rupa 21-23 Chapter 7 - Upadrava 24 Chapter 8 – Chikitsa 25-26 Chapter 9 - Atma Satmya Viruddha Nimittaja Vyadhi 27-31 Chapter 10 - Pathya-Apathya 32-34 DRUG REVIEW 35-38 4 METHODOLOGY Materials & Methods 39-44 Observations 45-66 5 RESULTS 67-77 6 DISCUSSION 78-87  XI   
    • List of Contents   7 CONCLUSION 88 8 SUMMARY 89-92 9 BIBLIOGRAPHIC REFFERENCE 93-105 10 ANNEXURE – PROFORMA 106-122  XII   
    • List of Tables LIST OF TABLESSl. No. Tables Page No. 1 Vicharchika Nidana 10 2 Difference between Maha Kushta & Kshudra Kushta 16 3 Types of Maha Kushta 16 4 Types of Kshudra Kushta 17 5 Ashtadasha Kushta According to Harita 18 6 Sadhya Asadhya Kushta According to Kashyapa 18 7 Kustha Purvarupa 19 8 Rupa of Vicharchika 21 9 Pathya in Vicharchika 32 10 Apathya in Vicharchika 33 11 Body Surface Area using Rule of 9 42 12 Assessment Criteria of Atopic Dermatitis 43 13 Distribution of Patients According to Age group 45 14 Distribution of Patients According to Sex 46 15 Distribution According to Religion: 47 16 Distribution According to Educational Status 48 17 Distribution According to Marital Status 49  XIII 
    • List of Tables18 Distribution According to Socio- Economic Status 5019 Distribution According to Occupation 5120 Distribution According to Habitat 5221 Distribution of Patients According to Ahara 5322 Distrtibution According to Vyasana 5423 Distribution of Patients According to Prakruti 5524 Distribution of Patients According to Sara 5625 Distribution of Patients According to Pramana 5726 Distribution of Patients According to Samhanana 5827 Distribution of Patients According to their Satva 5928 Distribution of Patients According to Satmya 6029 Distribution of Patients According to Vyayama Shakti 6130 Distribution of Patients According to Ahara- Abhyavaharana 62 and Jarana Shakti31 Distribution of Patients According to Vaya 6332 Occurrence of Symptoms of Vicharchika 6433 Nidana ofKushta Identified in 20 patients 6534 Occurrence of Purvarupa 6635 Effect on Kandu 67  XIV 
    • List of Tables36 Effect on Discharge 6837 Effect on Discoloration ( Vaivarnya) 6938 Effect on Loss of Sleep 7039 Effect on Pain 7140 Effect on Burning (Daha) 7241 Effect on Eruption of Papules ( Pidaka ) 7342 Effect on Dryness ( Ruksha) 7443 Effect on Lichenification 7544 Effect on Extent of Body Region Affected 7645 Effect on SCORAD 77  XV 
    • List of Figures   LIST OF FIGURES Sl No. Figures Page No. 1 Distribution of Patients According to Age group 45 2 Distribution of Patients According to Sex 46 3 Distribution According to Religion: 47 4 Distribution According to Educational Status 48 5 Distribution According to Marital Status 49 6 Distribution According to Socio- Economic Status 50 7 Distribution According to Occupation 51 8 Distribution According to Habitat 52 9 Distribution of Patients According to Ahara 53 10 Distrtibution According to Vyasana 54 11 Distribution of Patients According to Prakruti 55 12 Distribution of Patients According to Sara 56 13 Distribution of Patients According to Pramana 57 14 Distribution of Patients According to Samhanana 58 15 Distribution of Patients According to their Satva 59 16 Distribution of Patients According to Satmya 60 17 Distribution of Patients According to Vyayama Shakti 61 18 Distribution of Patients According to Ahara- Abhyavaharana and 62 Jarana Shakti  XVI   
    • List of Figures   19 Distribution of Patients According to Vaya 63 20 Occurrence of Symptoms of Vicharchika 64 21 Nidana ofKushta Identified in 20 patients 65 22 Occurrence of Purvarupa 66 23 Effect on Kandu 67 24 Effect on Discharge 68 25 Effect on Discoloration ( Vaivarnya) 69 26 Effect on Loss of Sleep 70 27 Effect on Pain 71 28 Effect on Burning (Daha) 72 29 Effect on Eruption of Papules ( Pidaka ) 73 30 Effect on Dryness ( Ruksha) 74 31 Effect on Lichenification 75 32 Effect on Extent of Body Region Affected 76 33 Effect on SCORAD 77 Photo Plate  XVII   
    • Introduction INTRODUCTIONSkin is man’s front-line protective barrier between internal structures and the externalenvironment. It’s tough, resilient and virtually impermeable to aqueous solutions,bacteria, or toxic compounds. It also performs many vital functions. Skin protects againsttrauma, regulates body temperature and serves as an organ of excretion and sensation.Hypersensitivity to a variety of external environmental and dietetic factors may producethe characteristic skin diseases which are chronic in nature.In Ayurvedic literatures skin diseases are elaborated under the heading of Kushta. This isa chronic relapsing disorder characteristic by discoloration of skin and loss of sensation1.Kushta is mainly manifested in 2 forms that are Maha and Kshudra. The loss of sensationis the unique presentation of Maha Kushta, remaining features more towards the KshudraKushta. Even though Vicharchika is a Kshudra Kushta it produce a great misery for theperson due to the dark discoloration of the skin, uncontrollable itching, profusedischarge2 in initial days and dryness of the skin in later conditions. Nevertheless,recurring skin rashes, redness, skin edema, itching, dryness, crusting, flaking, blistering,cracking, oozing or bleeding are the typical clinical manifestations of Atopic Dermatitis.This disease is largely idiopathic and mostly runs in families. Also the disease is notuncommon, and a survey study explored the incidence of Ten percent among the generalpopulation3. Atopic Dermatitis is the hypersensitivity disorder and it is a known fact thatcomplete cure to this illness is a remote possibility in spite of radical rational advancedtreatment of desensitization.Identical to any other Kushta, all the three Dosha are incessantly involved in theSamprapti of Vicharchika. Even then, as indicated by the clinical presentation themorbidity of Kapha4 and Pitta5 Dosha dominates the evolution of the illness. Among thedifferent other foremost causes of the illness, Viruddha Nidana is mostly emphasized inthe literature. Also Pathophysiology related to hypersensitivity of Atopic Dermatitis.Vicharchika being the illness always due to Bahudoshavastha, Punah Shodhana,Shamana, Kushtahara Rasayana and Bahirparimarjana Chikitsa forms the crux oftreatment.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 1 
    • IntroductionAyurveda has a great role in the management of skin diseases. Many researches havebeen carried out in this regards. Some of the examples areA single blind comparative randomized clinical study comprising 20 patients sufferingfrom Vicharchika was carried out. The intervention in different groups includedVirechana Karma, Jalaukavacharana and Gandhaka Rasayana. The study proved that theJalaukavacharana is more efficacious in relieving the symptoms of Vicharchika incomparison to Virechana Karma6.20 patients suffering from Vicharchika were subjected to single blind comparativeclinical study in which the intervention included oral administration of Amruta Guggulualong with external application of Vishvamitra Kapala Taila. The study was conducted inrandomly allocated two distinct groups. Maximum benefit in terms of therapeutic effectwas observed in the group that received both oral and topical medication7.A single blind, pretest posttest design clinical study, 20 patients suffering fromVicharchika were subjected to Virechana Karma. Results revealed none had completeremission of symptoms. But, 33.33% of patients had marked improvement, 53.33% hadmoderate remission and 46.67% had mild improvement8.From the fore going it is clear that different randomized clinical trials carried out atdifferent centers are aimed at comparing the therapeutic efficacy of Shodhana andShamana treatment either alone or in combination, in patients suffering from Vicharchikaand Eczema. No clinical trials were carried out emphasizing the oral medication alonewith special reference to Vicharchika and Atopic Dermatitis. Hence this clinical study isplanned to evaluate the therapeutic effect of oral medication with Gandhaka Churna9 inpatients suffering from Vicharchika/ Atopic Dermatitis.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 2 
    • IntroductionHence a sincere effort has been made to evaluate the effect of Gandhaka Churna inpatient suffering from Vicharchika. The present study entitled “A clinical study toevaluate the therapeutic effect of Gandhaka Churna in Vicharchika” was carried out withan aim to explore the therapeutic effect of Gandhaka Churna on the activity of the diseasein patients suffering from Vicharchika / Atopic Dermatitis.Assay of the literature is exploring the equation of Vicharchika and Atopic Dermatitis aswell as establishing the modality of treatment of Satmya Viruddha Nimittaja Vyadhi withspecial reference to Vicharchika.The present study has been carried out in 2 parts; Conceptual Study and Clinical Study.Conceptual study includes disease review and drug review. Derivation of Vicharchika isappear first in disease review fallowed with Nidana, Purvarupa, Rupa, Samprapti,Chikitsa, Pathya Apathya , Sadhya Asadhyata and concept of Satmya Viruddha NimittajaVyadhi and Chikitsa and comparison of Vicharchika with Atopic Dermatitis. Drugreview includes ingredients, dosage and method of preparation of Gandhaka Churna.For clinical study 20 diagnosed case of Vicharchika were taken. Each patient was givenwith capsule Gandhaka Churna 500mg with 100ml of milk as anupana before food, bothmorning and night for 28 days. Patients were assessed in terms of pratyatma lakshana ofVicharchika and SCORAD index of Atopic Dermatitis.Historical review, Review of Literatures, Methodology, Results, Discussion, Conclusionand Summary follows in the following pages.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 3 
    • Objectives   OBJECTIVES i. Assay of the literature exploring the equation of Vicharchika and Atopic Dermatitis as well as establishing the modality of treatment of Satmya Viruddha Nimittaja Vyadhi with special reference to Vicharchika. ii. To explore the therapeutic effect of Gandhaka Churna on the activity of the disease in patients suffering from Vicharchika / Atopic Dermatitis iii. To evaluate the remission of the symptoms of Vicharchika / Atopic Dermatitis in patients treated with Gandhaka Churna.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 4
    • Historical Review HISTORICAL REVIEWChallenging disorder for the mankind from many decades is skin diseases, whichmanifest in variety of forms. Skin diseases are even traced from the Vedic literatures.VEDIC PERIODVeda is the oldest literature of the world. Much information about skin diseases areavailable in these literatures. In Rig-Veda skin disorders are mentioned with typicalfeature of Vaivarnya and Romashatana. The word Kushta is appearing in some areas ofRig-Veda as medicinal plant rather than the skin disease. Kilasa and Palitya are citedterminology for the skin disease. Lord Indra has managed the Charma Roga of Apala.During this period people were disliked the persons who are suffering from charmarogadue to the ugly look. In Atharva Veda, Shyma Trivrit is considered to be very effectivedrug in the management of Kushta. Pama, Apachi, Gandamala are the few terminologiesto mention in relation to skin disorders10.PURANAIn Agnipurana Nana Rogahara Aushadhani includes Kushtaghna preparation. There is anelaboration of Khadira as internal medicine and Haratala and Manahshila as externalmedicament in the treatment of Kushta. In Garudapurana, Karma Vipaka is a chapterwhich contained causative factors of Kushta along with its management.MANU SMRITIKushta is differentiated from Svitra and considered as a serious problem. Kushta,Rajayakshma are the disorders where familial marriage was not encouraged. Avoidingpapakarma is advised as a management of Kushta.MAHABHARATADuring this period person who is suffering from Tvak dosha is unfit to become a king.SAMHITAKALAUnderstanding of Kushta reaches its height during Samhita kala. Vicharchika termappeared first time during this era.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 5 
    • Historical ReviewCharaka SamhitaAcharya Charaka categorizes the Kushta as 7 Maha and 11 Kshudra Kushta. Vicharchikais included under Kshudra Kushta11. The detailed description of Kushta is available inNidana 5th and Chikitsa 7th chapter. Other than this there is description of Kushta in theSamhita. Rakta Pradoshaja Vikara includes the Kushta12. Initial management in the formof Sthambhana in Raktapitta, Amatisara and Raktarsha produce the Kushta. Kushta is oneof the outcomes of Viruddha Ahara and Achara13.Sushruta SamhitaHere Paapakarma, Krimi, Oupasargika were highlighted as unique causative factor ofdisorder Kushta14. Symptamatalogy of uttarottara dhatu anugata Kushta elaborated firsttime in nidana 5th chapter. He included Vicharchika under Kshudra Kushta. He alsoidentified genetic pre disposition of the disease. Management of Kushta has beenexplained in Kushta and Maha Kushta Chikitsa Adhyaya.Asthanga Sangraha and Asthanga HridayaKushta is classified into 7 types according to Dosha15. Vicharchika has been mentionedunder Kshudra Kushta and said to be Kapha pradhanya Kushta with discharge in the formof Lasika. Remaining explanation is fallows the Sushruta Samhita.Bhela SamhitaIn Bhela Samhita Kushta has been described in Sutra, Nidana & Chikitsa Sthana. InChikitsa Sthana chapter 6th Vicharchika is included in the category of Sadhya Kushta.Bhela opines it as a moist or oozing lesion with dark red discolouration which is deeprooted16.Harita SamhitaThe description of Kushta is available in 3rd Sthana in Harita Samhita & ‘Vicharchika’ ismentioned as one of its varieties. Harita emphasises Vata and Rakta are important factorsfor the production of Vicharchika and named as kandu. He considers it as a multiple pinhead sized eruptions with ulceration & itching17.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 6 
    • Historical ReviewKashyapa SamhitaKushta Chikitsadhyaya is a chapter in which Kashyapa categorize Kushta into 18 varietyas Sadhya and Asadhya, in which Vicharchika is come under Sadhya Kushta. Paka andVrana is the unique symptamatalogy of Vicharchika explained by Kashyapa18.Madhava NidanaExplanation of the Kushta simulates with the elaboration of Charaka in etiopathogenisis.Sharangdhara SamhitaThe description of Kushta is available in Madhyama Khanda along with its treatment.The bheda of Kushta is also told in 7th chapter of Purva Khanda.VangasenaSome special causes of Kushta had been described including Tila, Kulatha, Valmikaroga, Vruntaka.BhavaprakashaDescription of Kushta by Bhavamishra is simulates with Charaka and Dhatugatatva &Sadhyasadhyata in lines with Sushruta. Arishta lakshana of Kushta has also beendescribed which were similar to that of Asadhya lakshana by Sushruta19 .Bhaishajya ratnavaliIn the 54th chapter the detail treatment of Kushta is given.GadanigrahaVaidya Shodhal has described Kushta roga in cha.36 of Dvitiya Khanda. Itsclassification is as per Charaka (7-Maha Kushta & 11-Kshudra Kushta) whiledhatugatatva is described as per Sushruta20.In a nut shell from Vedic literatures until up to the Laghutrayi there appears ofprogressive inclusion of information in relation to obstinate skin disorders. Theinformation available is limited to Vaivarya and Romashatana in Rig-Veda, addition ofmore information of Charma Roga in Atharva Veda. Role of sinful activity in causationof Kushta is cited in literatures of Purana. Concrete description of etiology; clinicalmanifestation; types; prognosis and treatment in Bhrahatrayi and Laghutrayi unraveledthe understanding of Kushta/Vicharchika.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 7 
    • Paribhasha  Etymology of KushtaThe word Kushta is derived from the Sanskrit root Kus Nishkarshane by adding thesuffix Tka to it, which means to destroy with certainty.Paribhasha of Kushta “Kushnati Sharirastha Shonitam Vikrute.Morbid Dosha provoke the four body elements. Collectively this derangement of theSeven Dravya if not cared to, leads to the establishment of the disease that make theskin Kutsit or contemptible. Consequently, the whole body becomes despised;therefore it is called "Kushtham"21.Kushta is that which responsible for the vitiation as well discolouration of skin.Etymology of VicharchikaThe word Vicharchika is derived from Sanskrit origin "Charch" dhatu by using theprefix Vee to it and suffixed by Navul22; the word Vicharchika is of feminine gender.The Charch word refers to "Adhyane" has two syllables Adhi which means aboveand Ayane means to spread out. Another meaning of Charchya is “to be repeated”23.Needless to say by derivation we can say that Vicharchika is a relapsing disorder withspreading nature which has Sukshma Sphota over skin and said to be a Svalpa Kushta.This Vichar denotes the eruptions over the skin with Pruritus.Vicharchika Paribhasha Vicharchika means the disease which has relapsing nature coats/covers the skin inparticular manner and causes cracking of skin of hands & feet mainly.24 Anotherdefinition unravels the Vicharchika as a disorder which has dark pigmentation of skinalong with profuse discharge with itching25. Yet another definition says Vicharchikais a disorder in which skin become dry with marked linings associated with intenseitching and pain manifested mainly over Gatra Pradesha. If same character isappeared over feet is said to be Vaipadika26. Etymology of EczemaThe Greek word ‘Ec’ means out and ‘Zeo’ means boil. Thus, whole word ‘Ekzein’means, to boil out.Atopic Dermatitis (Type of Eczema) is an inflammatory, chronically relapsing, non-contagious and pruritic skin disorder. Acute Eczema may be weeping, crusting andvesicle formation and Subacute or Chronic may be dryness, scaling, fissuring andlichenification. “A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 8 
    • Nidana    NIDANAKarya Karana Siddhanta is emphasized in classics for each and every subject. Onecan predict the Karana (cause) by observing the Karya (production) and vice versaalso. There is even true in regards to Kushta. By observing the Nidana one can predictthe forthcoming Kushta and by observing Kushta can assess the Nidana27. Nidana inKushta is given more importance, because little involvement of Nidana producesdisease Kushta. If the Vatadi Dosha becomes virulent other than the Kushta JanakaHetu then there is no production of the Kushta. The unique Nidana for the Kushta isPapakarmaja,Atma SatmyaViruddha and the Inheritance28is highlighted in literatures.Vicharchika is a Kshudra Kushta and has the Nidana of Kushta in general. All schoolsof thought emphasise that Nidana of Kushta itself is responsible for the Vicharchika.In literatures Kushta Nidana are elaborated under different categories as listed below. Aharaja Nidana Viharaja Nidana Acharaja Nidana Oupasargika NidanaAharaja Nidana –Viruddha Annapana is said to be the main Nidana for theproduction of Kushta. Viruddha is the one which causes vitiation of Dosha and doesnot eliminate the vitiated Dosha from the body. Consequently this in turn predisposesto development of different diseases. Kushta is one such major disorder with similaroccurrence. Contrary to this, every person who indulges in Viruddha may not sufferfrom Kushta. One who has Deeptagni and Dhatu Sara may not have deleteriousimpact due to theViruddha29. It is worth mentioning here that, the etiopathogenisis ofAtma Satmya Viruddha is akin to the role of idiosyncrasy and hypersensitivity in thecausation of Atopic Dermatitis.Mithyahara is the second important dietetic cause for Vicharchika. Not fallowing thehealthy codes of the food consumption is meant by the term Mithyahara30. Outcomeof the Mithyahara is improper digestion, absorption of the ahara rasa which in turnproduces the disease Kushta. Dermatitis due to the mal absorption and improperingestion of the food is highlighted in parallel science.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 9 
    • Nidana   Viharaja Nidana –Viruddha Vihara are listed as the Nidana of Kushta. Exposure tosunlight and partaking in heavy work immediately after meals may precipitate theKushta. Sheetoshna Vyatyasa in the form of intake of cold material immediately afterexposure to hot; habitual intake of hot and cold foods alternatively may also producethe Kushta. Needless to say excessive heat (especially with humidity) and coldnessare known to provoke outbreaks of Atopic Dermatitis as well as sudden and extremetemperature swings. Vega Vidharana is another Viharaja Nidana for Kushta.Acharaja Nidana – This is related with behaviour of a person. If person indulges inany variety of Papakarma it may contribute to the occurrence of Vicharchika.Oupasargika Nidana – Spreading of disease from person to person by differentmedia is considered as Samsarga Prabhava Vyadhi in which Kushta stands first. Table No-1 Vicharchika Nidana Nidana CS31 SS32 AS33 AH34 BHS35 HS36 Aharaja Nidana Viruddha Ahara   + - + + + + Chilachima with milk Intake of food containing Hayanaka, Yavaka, Chinaka, Uddalaka & Koradusha alongwith + - - - - - Ksheera, Dadhi, Takra, Kola, Kulattha, Masha, Atasi, Kusumbha & Sneha Intake of Mulaka & Lashuna with - - - - + - Ksheera Continuous intake of Gramya, Audaka & Anupa Mamsa with - + - - + - Ksheera Use of Pippali, Kakmachi, Lakucha - - - - + - with Dadhi & Sarpisha“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 10 
    • Nidana    Use of Mulaka with Guda + - - - + - Excessive use of alcohol & milk - - - - + - Intake of articles having sour taste with milk - - - - + - Excessive use of green vegetables - - - - + - with milk Intake of honey & meat after - - - - + - taking hot diet & vice-versa Use of fish, citrus & milk together - - - - + - Matsya,Ksheera & Nimbu together - - - - + - Mithya Ahara + + + + - Excessive use of Navanna, Dadhi, Matsya, Amla & Lavana + - - - + - Excessive use of Tila, Ksheera & + - - - - - Guda Drava, Snigdha, Guru aharanam + - - - - + atyartha sevanam Continuous & excessive use of + - - - - - Madhu & Phanita Intake of food that would cause + - - - + - burning sensation Intake of food during indigestion + + - - + - Adhyashana + + - - + - Asatmya Ahara - + - - - - Intake of polluted water - - - - - + Vihara Hetu Mithya Hetu To do physical exercise & to take + - - - - - sun bath after heavy meals To perform sexual act during + + - - + - indigestion To do exercise/sexual act after - + - - - - Snehapana & Vamana“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 11 
    • Nidana    Sheetoshna Vyatyasa + - - - - - Sudden change from Santarpana to Apatarpana & vice-versa + - - - - - Entering or intake cold water immediately after one is affected + + - - + - with fear, exhaustion & sunlight Mithya samsarga Sevana - - - - + - Vega Vidharana Withholding of the natural urges i.e. Mutra & Purisha Vega, etc. - + - - + - Suppression of the urge of Emesis + + - - + - Panchakarmapcharaj Panchakarma Kriyamane Nishidha Sevana + - - - - - Improper administration of + + - - - - Snehapana Achara Hetu Insulting acts to Brahmins, Teachers & other respectable persons + + + + - + Indulgence in sinful activities in present or past life + + + + + + Use of money or material acquired by unfair means - - + + - - Censuring or killing virtuous - + + + - + persons“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 12 
    • Samprapti   SAMPRAPTISamprapti or pathogenesis is the process of evolution of the disease, right from theindulgence in the causative factors, to the manifestation of the disease in its fullform37. Samprapti has an important role in understanding the disease as well asmanagement of the same. In literature elaborated explanation of development ofKushta is available. Those Samprapti is more towards the manifestation of MahaKushta; but also this is applied to the Kshudra Kushta. As Vicharchika is one of theKshudra Kushta Samprapti of Kushta can be applied. In some of literature VisheshaSamprapti of Vicharchika is elaborated. Samanya Samprapti of Kushta as fallows.By various causative factors as mentioned in Kushta Nidana mainly Viruddha Aharaand Vihara Dosha assume the state of Sanchaya in their own site. As the Nidana arecontinued, all the three Dosha are simultaneously provoked and at the same time thefour Dushya namely Tvacha, Rakta, Mamsa & Lasika attain Shithilatva. Then theprovoked Dosha tend to localise in these deranged four Dushya in the ensuing Prasaraand Sthana Samshraya stage. This is responsible for the further vitiation of theSaptaka Dravya (Tridosha;Tvak,Rakta,Mamsa and Lasika ) and so produce thedisease Kushta. The quality of Sthirata is essential for the morbid Dosha localised in 4Dushya to produce the Kushta. If localised Dosha are having the quality of Saranathen will produce the disease Visarpa. As the Saptakao Dravya Sangraha of Visarpaand Kushta are similar so one should differentiate the both38. Involvement of the whole body in Kushta is possible. When the morbid Doshamainly Vata Dosha along with remaining 2 other Dosha enter into the Tiryak Sira andthen thrown to all over the body and manifests as circular patches which is known asKushta39. In Kushta, the involvement of the 4 Dushya is mandatory. Maha Kushta aswell as Kshudra Kushta will be manifested by the derangement of the all the four. TheUttarottara Anupravesha in Kushta is referred as involvement of the Medadi Dhatu bythe vitiated Dosha. This unique feature is present only in Maha Kushta and not inKshudra Kushta40. In the Vishesha Samprapti of Vicharchika, the Dosha, after being aggravated, vitiatethe Tvak & Mamsa to produce Pidaka which is accompanied by Daha & Kandu.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”  13  
    • Samprapti  The condition wherein, the skin cracks, becomes dry, coarse and if it manifests itselfall over the body, then is known as Vicharchika. If the same Symptamatalogy islimited to the feet, then is called as Vaipadika42.Samprapti Ghataka of Vicharchika Dosha : Tridosha Dushya : Tvak, Rakta, Mamsa, Lasika (Ambu) Srotas : Rasa, Rakta, Mamsa Srotodushti Lakshana: Atipravrutti Udbhava Sthana : Amapakvashaya Sanchara Sthana : Sarva Shareera Adhishthana : Tvacha (Fourth layer /Fifth layer) Rogamarga : Bahya Saddhyasadhyata : KrichrasadhyaDosha : The Kushta is the outcome of compulsory provocation of Tridosha.Identifying the predominance of Dosha in a given patient of Kushta, aids in thediagnosis of type of Kushta Roga he is suffering from. Vicharchika is a KshudraKushta and even though this is a Tridoshajanya Vyadhi, literature emphasised thepredominance of specific Dosha in the manifestation of Vicharchika. According todifferent schools of thought, it is either Kapha or Pitta Dosha predominates theSamprapti of Vicharchika. Further to add, invariable involvement of Tridosha isreflected in the clinical presentation. Shyavata, Bahusrava and Kandu indicate theinvolvement of Vata Pitta and Kapha Dosha respectively.Dushya: Tvak, Rakta, Mamsa and Lasika are the 4 Dushya involved in themanifestation of the disease. These 4 Dushya are mandatory for the production ofKushta42. About another opinion about Dushya, it is said that Twak is involved first inany variety of Kushta; then progressive involvement of the remaining 3 Dushya.Involvement of the Dushya beyond the Mamsa Dhatu is absent as per Kshudra Kushtain general and Vicharchika in particular43.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”  14  
    • Samprapti  Srotas : Kushta is enlisted under Raktavaha Sroto Vyadhi. But also there isinvolvement of other Srotas in the manifestation of the disease. Vaivarnya is anoutcome of Raktavaha Srotas; Pidakodgama justify the Mamsavaha Srotas andBahusrava and Rukshya justifies the Rasavaha Srotas.Classification of KushtaKushta is mainly classified into Maha Kushta and Kshudra Kushta. The exactdifferentiation of the both is based on variation in occurrence of Purvarupa as well asprogression on the disease involving deeper Dhatu44. The Symptamatalogy of MahaKushta is more similar to the clinical presentation of the Hansen’s disease. All theMaha Kushta can explain under the heading of Leprosy. The predominant symptomof Leprosy is loss of sensation, and the same is highlighted as a premonitory symptomof the Maha Kushta. Both The hypo as well as hyper pigmentation of Leprosy is alsoelaborated in Maha Kushta. The symptoms of Leprosy are mostly confined to the skinand peripheral nerves. The skin lesions are anaesthetic, hypaesthesic and anhidrotic45.This is also true to Maha Kushta and its Purvarupa. In Leprosy clinical manifestationis confined to the peripheral nervous system, skin, eyes, testis and upper respiratorytract. This is even true for the Maha Kushta. The Symptamatalogy explained due tothe involvement of deeper Dhatu like that of Nasabhanga, Krimi46 involvement etc aremore towards the Hansen’s disease.Kshudra Kushta are considered to be less severe in comparison to that of MahaKushta. The manifestation of Kshudra Kushta is without Purvarupa of Kushta andabsence of involvement of deeper Dhatu. Any of skin disease manifested with scalyappearance included under the heading of Eka Kushta which has feature simulatingMatsya Shakala. Disorder manifested with thickening of skin is correlated to that ofCharmakhya Kushta which has the symptom identical to Hasticharma. The cardinalfeature of Weeping is related to Vicharchika and has Bahusrava. Thin layered bullouseruption with clear fluid is compared to that of Visphota.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”  15  
    • Samprapti  The difference between Maha Kushta & Kshudra Kushta can be tabulated as below. Table No- 2 Difference between Maha Kushta & Kshudra Kushta MahaKushta Kshudra Kushta 1 Bahu Doshavastha with Dosha Bahu Doshavastha with alpa Dosha lakshana bahulyat47 lakshanatvat47 2 Atyartha peeda Absent Athyartha peeda 3 Uttarottara dhatu anupravesha Uttarottara dhatu ananupravesha 4 Presence of Purvarupa Absence of Purvarupa 5 Mahati Chikitsa48 Alpa Chikitsa48 6 Chronic Less chronic 7 Tvaka Svapa is compulsory Tvaka Svapa is not compulsory 8 Possible - Adibala Pravratatva 49 Absent - Adibala Pravrattatva 49Classification According to Different Acharyas Table No-3 Types of Maha Kushta Name C.S50 S.S51 A.H52 BHS53 Kapala + + + + Udumbar + + Audumbara Audumbara Mandala + - + + Rishyajihva + + Rukshakhya + Pundarika + + + + Sidhma + - - Alabu Kakanaka + + + + Dadru - + + - Aruna - + - -“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”  16  
    • Samprapti   Table No-4 Types of Kshudra Kushta Name C.S54 S.S55 A.H56 BHS57 Eka Kushta + + + + Charmakhya + _ + CharmaKushta Kitibha + + + + Vipadika + _ + Vaipadika Alasaka + _ Alasa - Dadru + _ _ + Charmadala + + + _ Pama + + + + Visphotaka + _ Visphota _ Shataru + _ Shatarushi Shatarushka Vicharchika + + Vicharchi + Sthularushka - + _ Sthularu Mahakushta - + _ _ Visarpa - + _ _ Parisarpa - + _ _ Sidhma - + + _ Rakasa - + _ _ Gajacharma - _ _ _ Svitra - _ _ + Vishaja - _ _ +“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”  17  
    • Samprapti  Classification According to Harita Harita classified Kushta as Sadhya and Asadhya category. Name of AsthadashaKushta are tabulated below Table No-5 Ashtadasha Kushta According to Harita 1 Kapalaka 10 Vaipadika 2 Udumbara 11 Charmadala 3 Dadru 12 Visphotaka 4 Mandala 13 Bahuvrana 5 Visarpaka 14 Kandu 6 Hastibala 15 Vicharchi 7 Kina 16 Karmaja 8 Gojihvaka 17 Pandura ( Doshaja) 9 Lohitamandala 18 Sahaja Kashyapa as well as Bhela has classified the 18 types of Kushta as 9 Sadhya and9 Ashadhya kushta. Table No-6 Sadhya Asadhya Kushta According to Kashyapa Sadhya Kushta Asadhya Kushta Sidhma Pundarika Vicharchika Svitra Pama Rishyajivha Dadru Shatarushka Kitibha Oudumbara Kapala Kakanaka Sthularushka CharmaKushta Mandala Ekakushta Vishaja VaipadikaIn a nutshell Tridosha Dusti along with vitiation of the Tvak, Rakta, Mamsa andLasika over the Gatra Pradesha produces Vicharchika. The manifestation ofVicharchika is without Purvarupa of Kushta in most of the occasions, andVicharchika comes under Sadhya Kushta.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”  18  
    • Purvarupa   PURVARUPAIn the course of manifestation of the disease the signs and symptoms which are appearbefore the actual manifestation of the disease is Purvarupa58. Purvarupa is one whichis manifest in 4th stage of Shat Kriyakala. Management of any disease become easy ifdiagnosed in this stage. This is the stage were initiation of Dosha DushyaSammurchana will begin. Purvarupa as per Kushta is concerned has an important roleto differentiate Maha from that of Kshudra Kushta. Kshudra Kushta are manifestedwithout Purvarupa where as Maha Kushta has Purvarupa in their course ofmanifestation. Another important point appears in Sadhyasadhyta in which all thePurvarupa appear then Kushta is Asadhya for the management. Table No-7 Kushta Purvarupa Purvarupa CS59 SS60 AH61 AS62 BHS63 KS64 Aswedanam + + + + + + Atiswedanam + + + + + + Parushyam + + - - - - Atishlakshnata + - + + - + Vaivarnyam + + + + + + Kandu + + + + - - Nistoda + + + + - + Suptata + + + + + - Paridaha + + + + + - Pariharsha + - - - - - Lomaharsha + + + + + + Kharatwam + - + + - + Ushmayanam + - - - + - Gauravam + - - - + + Shwayathu + - - - - -“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 19  
    • Purvarupa   Visarpagamanam abhikshanam cha kaye + + - - - + Kaya chhidreshu upadeha + - - - - - Pakva-dagdha-dashta- bhagna-kshata-upashkha- + - - - - + liteshu ati-matram vedna Svalpa api vrananam dusti + - + - - - Svalpana api vrananam + + + - - - asamrohanam Kothonnati + - + + - - Shrama + - + + - - Klama + - - - + - Vrananam sheeghrotpatti + - + - - - chirasthiti Sparsha ajnatva + + - - - - Raga - - - - + + Pipasa - - - - + + Dourbalya - - - - + + Davathu - - - - + - Purvarupa that are enlisted above is more pertinent to Leprosy. The Symptamatalogyexplained in Purvarupa may continue in the Rupa stage and is even true to Leprosy.Leprosy is one in which depigmented patches are the common manifestation inassociation with variation in sensory perception.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 20  
    • Rupa   RUPA Kushta is one of the Rakta Pradoshaja Vikara. Rakta Pradosha will produce widerange of Symptamatalogy like that of discoloration of the skin up to the loss ofconsciousness as in discussed under the title Shonita Dusti65. Kushta comes under thecategory of discoloration of the skin along with alteration in touch sense perception.Kushta is Tridoshaja Vikara where all the three Dosha are responsible for theproduction of the disease. But this has an exception when considering the KshudraKushta. Alterations in touch sense perception is remote possibility as per KshudraKushta and also have the minimum symptoms of the Tridosha involvement.Symptamatalogy of Vicharchika almost simulates that of Atopic Dermatitis.Wet Eczema and Dry Eczema are the two distinct presentations of Atopic Dermatitis.Wet Eczema is characterised by profuse discharge. Contrary to this, Dry Eczemapresents with absence of discharge and has Lichenified skin66. Vicharchika also havesimilar manifestation in the form of Bahusrava to that of Raji (Lichenification).Chronic illness of skin eruptions, itching and oozing characterizes Vicharchika.Nevertheless, Recurring skin rashes, redness, skin oedema, itching, dryness, crusting,flaking, blistering, cracking, oozing, or bleeding are the typical clinical manifestationsof Atopic Dermatitis. Rupa of Vicharchika according to different Acharyassummarised below. Table No-8 Rupa of Vicharchika Rupa CS67 SS68 AS69 AH70 KS71 BHS72 HS73 Vedana VisheshaKandu + + + + - - +Vedana - - - - + - -Ati ruja - + - - - - -Daha - + - - - - - Colour of PidakaShyava + - + + - + -Lohita - - - - + + -Shveta - - - - - - +Shyama - - - - + - -“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    21  
    • Rupa   Nature of Skin and PidakaRuksha - + - - - - -Khara - + - - - - -Daalyate Tvak - + - - - - -Raji - + - - - - - Character of DischargeBahusrava + - - - + - -Lasikadhya - - + + - - -Praklinnata - - - - - + - Special FeaturePaakavati - - - - + - -Bahuvrana - - - - + - +Mamsena upachita - - - - - + -Visphota sannibha - - - - - - +Kandu (Itching): This is the cardinal feature of Vicharchika. Due to the vitiation ofthe Kapha Dosha there is development of Kandu. Even the vitiation of Vata Doshaproduces Kandu in the body. Severity of the itching is maximum in AtopicDermatitis. Hypersensitivity reaction will produce the histamine which is responsiblefor the itching in Atopic Dermatitis.Pidaka (Papulation): When vitiated Pitta localised in Tvacha along with Raktaproduce Pidaka which has discolouration74. Initiation of the Atopic Dermatitis in theform of maculo-papular lesions over the skin and then they start to group together.Srava (Weeping): Involvement of Pitta and Kapha Dosha in Vicharchika produceSrava. The Srava which is profuse may be watery. Manifestation of Atopic Dermatitisin wet form is characterized by discharge which is usually watery and occasionallyblood mixed.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    22  
    • Rupa  Vaivarnya(Erythema and Discoloration): Vicharchika is characterised withdiscoloration in the form of Shyava to that of Rakta(Redness). Redness may becompared with that of Erythema which is due to the vascular dilatation. Shyava is thepigmentation of the skin. Needless to say Rakta Vaivarnya is seen in Wet AtopicEczema and Shyava in Dry Atopic Eczema. Nature of Skin: Atopic Dermatitis is one in which there is possibility of blockage ofsweat gland. So there is development of dry skin. Dry skin is responsible for theitching. Due to continuous itching there is development of cracking of skin andincreased thickening of the skin along with prominent skin appendages. In a courseof Vicharchika there is development of Rukshata intern produce Kharat to the skin. Ifsame continues for longer duration it will produce Tvak Vidarana and appearance ofRaji similar to that of the Lichenification.Vedana: In Vicharchika symptom of Vedana vary from burning sensation to painover the involved skin. Atopic Dermatitis is characterised by erosion of skin andaberration of the skin. The pain receptors known as nociceptors that are free nerveendings are widely spread in superficial layer of the skin. Tissue irritation willproduce prostaglandin, which in turn stimulate the nociceptors. In Atopic Dermatitisthere may be the chronic pain and referred as burning or aching.Special Features : These are the features usually absent in typical non complicatedAtopic Dermatitis. If the Atopic Dermatitis is along with Stasis Dermatitis there ispossibility of development of Vrana and Paka. So the overall manifestation of Vicharchika simulates the manifestation of AtopicDermatitis. In wet dermatitis Weeping, Itching is the cardinal feature which iscoherent with the Bahusrava and Atikandu. If Atopic Dermatitis attains chronicity,then is characterised by dry skin, erosion of the skin, lichenification and pain.Rukshata, Vidarana of Tvak, Raji, Atiruja explains the same in Vicharchika.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    23  
    • Upadrava  UPADRAVAThe Symptamatalogy which appear after complete manifestation of the primary disease isconsidered to be Upadrava75. In any of the disease if Upadrava are manifested then isindicative of more difficulty in its management. The Upadrava that are enlisted in Kushtais applied to the Maha Kushta rather than the Kshudra Kushta. All of these Upadrava arealso seen in Hansen’s disease rather than any other skin manifestation. Upadrava ofKushta which are enlisted includes Prasravana, Angabheda, Angapatana, Trishna, Jvara,Atisara, Daha, Daurbalya, Arochaka & Avipaka76. Vicharchika is a Kshudra Kushta andis probably devoid of Kushta Upadrava.SADHYA-ASADHYATA OF VICHARCHIKARegarding prognosis, classics have stated that the disease of Kushta appearing in aperson, who has full control over his sense organs and confined only to Tvacha, Raktaand Mamsa Dhatu of the body, involving Vata and Kapha Dosha should be regarded ascurable and can be eradicated completely77. If Kushta is manifested with the involvementof Meda Dhatu is Yapya, Yapya requires palliative treatment and is never rooted out. In acase when Kushta shows its manifestation in Asthi, Majja & Shukra or any Kushtahaving the complications as described above are all incurable78. As Tvacha, Rakta andMamsa Dhatu are generally vitiated in the disease Vicharchika, so it may be countedunder the category of "Sadhya Kushta". The improper regimen leads curable diseases toincurability79; hence proper measures should be carried out at the early stages of the skindiseases.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   24  
    • Chikitsa   CHIKITSAThe modality through which the Vighatana of Dosha Dushya Sammurchana andthereby attainment of normal functioning of Dosha Dushya and Mala is considered asChikitsa80. Daiva Vyapashraya and Yukti Vyapashraya are the main 2 categories ofChikitsa and both are emphasised in literatures. As Kushta is a disorder which has aPapakarma as a Nidana; and hence the Daiva Vyapashraya Chikitsa has an importantrole to play in the effective management. In contrast to this, Yukti VyapashrayaChikitsa is also equally important in the treatment of Kushta81. The different principleof management elaborated in Kushta Chikitsa is more towards the Maha Kushta.Kshudra Kushta do not have the tendency of Uttarottara Dhatu Anupravesha and thusmilder therapeutic approach is rational.Even though Vicharchika is a Kshudra Kushta, it is characterised by BahudoshaAvastha, and hence all the management of Kushta should be carried out inVicharchika. Shodhana, Shamana, Kushtahara Rasayana, Bahirparimarjana Chikitsaforms the useful modes of the treatments. Punah Shodhana is the main line oftreatment for Kushta. Depending on the involvement of the Dosha Sarpipana isindicated in Vata pradhanya Kushta, Vamana in Kapha pradhanya Kushta, andVirechana in Pitta pradhanya Kushta82. Vamana may be administered once in every15 days, Virechana may be administered once in every 30 days, Nasya may be doneonce in every 3 days and Siramokshana is to be done once in every 6 months.Shodhana is even indicated in Purvarupa of the Kushta and during the UttarottaraDhatu involvement83.Shamana is the other principle of management which includes Antaparimarjana andBahirparimarjana measures. Shamana therapy with Tikta and Kashaya Dravya afteradministration of proper Shodhana is advised84. It pacifies remnant Dosha. More toadd, Shaman is advised for Bala, Vruddha, Sukumara and Garbhini in whomShodhana is contraindicated. The main principle of Shamana therapy is to normalizeand to maintain the levels of all three Dosha and purification of Rakta as well asRaktavaha Srotas. For the purpose of Shamana, many drugs and formulations havebeen described. As Bahirparimarjana Shamana is the purification of the skin by theexternal application of the medicament.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    25    
    • Chikitsa  Mode of Bahirparimarjana includes Lepa, Parisheka and Avachurnana85 etc. Out ofthis Lepa has been given importance so that it should be repeated in every 3days86.Rasayana also has importance in Chikitsa of Kushta. Vicharchika is a chronicrelapsing disorder in which vitiation of Tridosha along with accumulation of the samein Tvak, Rakta, Mamsa and Ambu. Relapse of the Vicharchika occurs when theVyadhikshamtva of the Dhatu become poor. Hence to enhance the Vyadhikshamatvaof the Dhatu different Naimittika Rasayana are elaborated in the classics. Bhallataka,Tuvaraka, Bakuchi, Shilajatu. Guggulu, Khadira Rasayana are indicated asKushtahara Rasayana87. Even though there are different principles of management; combination of Shodhana,Shamana and Rasayana in a proper way restricts the recurrence of the disease Kushta.Needless to say Vicharchika is well managed by the above said crux of treatment.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    26    
    • Atma Satmya Viruddha Nimittaja Vyadhi   ATMA SATMYA VIRUDDHA NIMITTAJA VYADHIThe skin is the first organ which is in contact with the different environmental factors.The dust, smoke and variation in the climate are the common happening of theenvironment. The food which is consumed by the person is also having an impact onskin. In general the people are capable of tolerating the environmental changes as wellas some of the food which are said to be allergen for the others. The people who aresuffering from the Atopic Dermatitis or Vicharchika, the above factors are consideredto be the triggering factor of the same. The people who are asymptomatic ofVicharchika may develop the episodes and who are has an episode of the disease mayexhibit increase in Symptamatalogy. This happening is not present in every person.Person who are suffering from the disease of Vicharchika / Atopic Dermatitis arehaving this type of unique manifestation due to hypersensitivity to the particularallergen. Atopic Dermatitis is one which is triggered by the dietetic as well asenvironmental causes. Such type of allergic manifestation is best explained throughAtma Asatmya as well as Atma Satmya Viruddha Nimittaja Vyadhi. Satmya and Asatmya are the terminology used in literature for the body response tothe variety of external factor. It includes different environmental factors and dietetichabits. The response which is wholesome to the body after exposure to variety ofexternal factor is known as Satmya88. Person may accustom to any factor from birthor later life, if they have a wholesome effect to the body then termed as Satmya. SoSatmya may be innate or acquired. Even though literature explains Ekanta Hita orSatmya, they will change depending upon the different entity. The body responsewhich is unwholesome to the health when they expose to the particular external factoris known as Asatmya. Asatmya also varies according to the different entity. In otherword to say, Satmya helps in building of the body where as Asatmya will destroys thebody. Prakruti, Vaya, Rutu, Desha, Kala, Vyadhi are the modulating factor of Satmyaand Asatmya89. For example Ghee is said to be wholesome to all person as explainedin our literatures. Depending upon the different factor there is possibility ofunwholesome effect of Ghee. Intake of Ghee during Vasanta rutu; Ghrita preparedwith Viruddha Dravya; administration of Ghrita in Anupa area and finally intake ofGhrita in Kapha Dosha predominant and Obese person is said to be Asatmya eventhough in general Ghee is Satmya to every person90.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   27    
    • Atma Satmya Viruddha Nimittaja Vyadhi   Prakruti is the natural body constitution depending upon the dominance of the Doshaduring conception. Each Prakruti has its own unique characteristic features. Thosecharacters remain same throughout the life. For each and every Prakruti there aresome harmonising as well as destroying factors exist. Say for example Vyayama isconsidered to be harmonising to the person who is having Kapha Prakruti . This isknown as Prakruti Satmya. Any of the activity which is deteriorating the health of theperson is Prakruti Asatmya. For example Vyayama to the Vata Prakruti person is notideal and are Prakruti Asatmya.Satmya and Asatmya related to Vaya, Rutu, Desha ,Kala ,Vyadhi can be explained assame that of the Prakruti . These are common far those person belonging to the samecategory. It does not vary from person to person. Apart from these variety of Satmyaand Asatmya there is little variation from the general rule of Oka Satmya and AtmaSatmya.Habitual consumption of some food or habitual to the particular activity makes theperson to get adopt to the same. This is known as Oka Satmya. Oka Satmya may becomplimentary to the health or derogatory to the health. This is a unique variety ofSatmya; in which derogatory factor may not prove harmful to the health. Such type ofhabituation leading to favourable adaptation is regarded as Oka Satmya91.Another concept of Satmya and Asatmya which does not fallow any of above saidprinciple is termed as Atma Satmya. Atma Satmya is one which differs from person toperson92. The favourable and unfavourable factors are unique to that individual only.Some factors which are complimentary to the individual may not for another. Thisimplies towards the Atma Satmya. Some material generally considered to be goodmay produce derogatory effect in some person. In such derogatory manifestationincludes skin manifestation and respiratory Symptamatalogy. Person who has TamakaShvasa exposure to raja may trigger the condition. Same way person who has havingthe skin manifestation may enhanced by the intake of fish, pea nut, shellfish, egg etc.This is referred as Atma Asatmya. This is referred as idiosyncrasy or hypersensitivityin modern literatures. Consequence of Atma Asatmya may be producing the differentdisorder. Coming paragraphs elaborate the same.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   28    
    • Atma Satmya Viruddha Nimittaja Vyadhi  Asatmya refers to exposure to against once Satmya. That means Asatmya termed asSatmya Viruddha. So exposure against to Atma Satmya is referred as Atma SatmyaViruddha. Viruddha is of different variety which includes even Satmya Viruddha. Thedifferent disorders produce by the Viruddha. So an outcome of Atma SatmyaViruddha is comes under vast category of the illness produced by the Viruddha. Inother word to say the disease produced by the Atma Asatmya may be narrated asAtma Satmya Viruddha Nimittaja Vyadhi.Viruddha is one in which vitiation of Dosha with not expelling out of the body. Dueto this vitiated Dosha reaches to its peak of provocation and in term produce differentdisorders. In literature Visarpa, Kushta, Kilasa, Sheetapitta, Udarda etc are enlisted asoutcome of Viruddha. Viruddha in the form of food and activity will precipitate thedisease Vicharchika. Intake of milk with fish or sour food may precipitate the skinmanifestation. Same way sudden variation of environmental temperature also triggersthe Vicharchika and other skin manifestation. Viruddha Ahara Sevana in the form ofabove said is considered to be unique for the manifestation of the skin disorder. Thisis explained as Atma Satmya Viruddha. If the person is having Atma Asatmya andexposure to the different triggering factor may land up in any one of the skinmanifestation. Intensity of Atma Satmya Viruddha Nimitta Vyadhi is depending up onthe different entity that includes Vaya, habituate to that of Atma Asatmya, 93 etc.As Vicharchika belongs to the disease produced by the Viruddha Nimittaja; soprinciples of management of the same is applicable to the Vicharchika. Thoseprinciple are the Avoiding the Atma Asatmya factor and gradual removal of the Atma Asatmya factor. Adaptation of Atma Asatmya factor. Shaman Chikitsa suppressing the Atma Satmya Viruddha response. Shodhana Chikitsa preventing the Atma Satmya Viruddha response. Rasayana Chikitsa to enhance the Vyadhikshamatva against the Atma Satmya Viruddha response.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   29    
    • Atma Satmya Viruddha Nimittaja Vyadhi  Avoiding the Atma Asatmya factor and gradual removal of the Atma Asatmyafactor.First treatment modality of any disease is avoiding the causative factor. That iselaborated as Nidana Parivarjana. One can identify the Atma Asatmya and that shouldbe avoided. Another modality is gradual removal of Atma Asatmya. Asatmya whichis derogatory to the body gradually removed and Satmya to that person should bestarted. This is more applicable to the Ahara Asatmya of that particular person94.Adaptation of Atma Asatmya factor If there is not possible of avoiding the Atma Asatmya; then the next principle isconsidered to be adaptation of Atma Asatmya. Adaptation is referred to make theAtma Asatmya to Atma Satmya by different therapeutic measures. The adaptationtechnique is mainly elaborated in management of Viruddha. Literatures explain thatmake the Abhisamskrita to the body against Viruddhanna or those Dravya whichproduces the derogatory effect. This possible by the continuous usage of the same.The adaptation may be by natural or by therapeutic measures95. As per skinmanifestation is concerned milk , fish, peanut are considered to be the Atma AsatmyaSo one can continuously use those in minimal quantity will produce the Atma Satmyaagainst the same. Literatures highlighted that Satmya to that particular Viruddha doesnot produce any manifestation. By the Abhisamskara; Shareera will get resistanceagainst Atma Asatmya or get saturated to the body96. The concept of Abhisamsakarais explained as immunotherapy in modern literatures. Shamana Chikitsa suppressing the Atma Satmya Viruddha ResponseShamana is another line of treatment tackling the Atma Satmya Viruddha NimittajaVyadhi. Shamana is one which makes the normalcy of vitiated Dosha and maintainsthe normal Dosha. This is the treatment which can apply for each and every person.The administration of the Shaman medicine before the episodes of Atma AsatmyaVyadhi is beneficial97. Needless to say administration of Shamana prior to the diseasemanifestation will check the sequence of pathological events. There are lots ofShamana medication enlisted for Atma Satmya Viruddha Nimitta Kushta Vyadhi.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   30    
    • Atma Satmya Viruddha Nimittaja Vyadhi   Shodhana Chikitsa preventing the Atma Satmya Viruddha Response. Shodhana is another line of treatment for the Satmya Viruddha Nimittaja Vyadhi. Asthe disease of Atma Asatmya occurring in episodic nature so Shodhana is best duringsymptom free period. This will eliminate the morbid Dosha out of the body andmaintains the normalcy of the Dosha. Once the Dosha attains the normalcy there isenhancement of the Vyadhikshamatva and episodes of the Atma Asatmya Vyadhi willbe decreased98.Rasayana Chikitsa to enhance the Vyadhikshamatva against the Atma SatmyaViruddha Response Rasayana is a treatment which enhances the Vyadhikshamatva of an individual. Aimof the Rasayana is reduce the recurrence of any disease and maintenance andimprovement of the functioning capacity of Dosha and Dhatu. As per the disease andRasayana in literature particular Rasayana are elaborated for the every disease. TheseRasayana are termed as Vyadhihara Rasayana. These Vyadhihara Rasayana areimportant for the reconditioning the body against the Atma Satmya ViruddhaNimittaja Vyadhi99. These Rasayana will work on the initial pathology of a diseasethat is Kha Vaigunya and Sroto Dusti. Rasayana has its maximum effect ifadministered after the Shodhana. So that body will capable of withstanding againstthe Atma Satmya Viruddha Ahara or Vihara. In literatures there are many KushtaVyadhihara Rasayana are explained; it includes Tuvaraka Rasayana, BhallatakaRasayana, Bakuchi Rasayana etc.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   31    
    • Pathya-Apathya   PATHYA-APATHYAPathya Apathya in VicharchikaObservance of Pathya and Apathya is equally important in Kushta as any otherdisease. As cited earlier Atma Satmya Viruddha is one of the cause for disease andhence the necessity of knowing about Pathya and Apathya. As the Vicharchika is aform of Kshudra Kushta, the Pathya Apathya of the disease Kushta is applicable toVicharchika. The main Nidana like that of Viruddha Ahara and Viruddha Vihara areconsidered to be the Apathya and those maintain the normal functions of the Tridoshaare considered as Pathya in literatures. Knowledge of this helps to avoid the AtmaSatmya Viruddha factors even. Enlist of Pathya in literature view is tabulated below. Table No-9 Pathya in Vicharchika Sl. No. Pathya Dravya References 1. Laghu Anna CS100 2. Tikta Shaka CS,AH 101 3. Bhallataka CS,SS102,AH 4. Triphala CS,AH 5. Nimba CS,SS,AH 6. Purana Dhanya CS,SS 7. Jangala Mamsa CS,SS,AH 8. Mudga CS,AH 9. Patola CS,AH 10 Ghrita CS,AH 11. Shashtika Shali, Yava, Godhuma, SS,AH Karadush, Shyamaka, Uddalak. 12. Adhaka SS,AH“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   32   
    • Pathya-Apathya   13. Pana-Parisheka Avagaha of Khadir CS,SS,AH Kashaya. 14. Masura AH 15. Mandukaparni SS 16. Avalguja SSAPATHYAAny Ahara or Vihara which hampers the normal functioning of the Tridosha andcause/ aggravate the disease is known as Apathya. The Nidana described for Kushtamay generally be regarded as Apathya for Vicharchika. Besides this the Acharyashave described some other factors which should be avoided as they may cause skindiseases and Vicharchika as well. These are described in a tabular form below. Table No-10 Apathya in Vicharchika Sl.No. Apathya Dravya References 1. Guru Anna CS103 2. Dugdha CS,SS104,AH 3. Amla Rasa CS,SS,AH105 4. Dadhi CS,SS,AH 5. Anupa Mamsa CS,SS,AH 6. Matsya CS 7. Guda CS,SS,AH 8. Tila CS,AH 9. Mamsa & Vasa SS“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   33   
    • Pathya-Apathya   10. Taila SS 11. Kulatha SS 12. Masha SS,AH 13. Vidahi Anna SS,AH 14. Abhishyandi Anna SS 15. Ikshu Vikara SS 16. Lavana CS,AH 17. Maithuna SS“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   34   
    • Drug Review  DRUG REVIEWIn the present study the Gandhaka Churna is orally administered in patient’s sufferingform Vicharchika as Shamana medicine. The detail of the same is given below.Composition of Gandhaka Churna (Sahasra Yoga) 106 Shodhita Parada :1 Part (80grams) Shudha Gandhaka :6 Part (480grms) Shodhita Bakuchi(Seeds) Churna :7 Part (560grms) Kakamachi Panchanga :Svarasa 480grms per bhavana,total 3.5kg Bhringaraja Panchanga :Svarasa 480grms per bhavana,total 3.5kgIndication : Ashtadasha KushtaMatra : The dosage of Kajjali in skin manifestation (Vidhradhi) is 1gm per day.By implication the same dosage is taken for the Gandhaka Churna.Method of PreparationSeven Bhavana of Kaakmaachi Svarasa (Svarasa obtained by 480grms ofKakamachi per Bhavana) and followed by Seven Bhavana of Bhringaraja Svarasa(Svarasa obtained by 480grms of Bhringaraja per Bhavana ) should be given toShuddha Gandhak seperately. Then Kajjali Should be prepared by adding the sameGandhaka and Shuddha Parada. The Kajjali should then be dried and Bakuchi Churnashould be added to it. Fine powder of the mixture should then be prepared and then itshould be capsuled.BAKUCHI107Latin name : Psoralia corylifoliaFamily : PapilionaceaeSynonyms : Somaraji, Kushtagni, Kusthanashini, Putiphala, Shashilekha.Vernacular names : Hindi : Babachi English : Psoralia seed, Bawachan seed Kannada : Bavanchi“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   35   
    • Drug Review Rasa Panchaka : Rasa : Tikta, Katu, Madhura Guna : Ruksha, Sara Virya : Sheeta Vipaka : Katu Doshaghnata : Kapha Vata Shamaka Karma : Rasayana, Ruchya, Visthambhini, Hrudya. Rogaghnata : Kushta, Krimi,Asrapitta,Svasa,Meha,Jwara,Tvakdosha. Part Used : Bija Bakuchi seed : Vatakapha Kushta hara,Keshya and Tvachya.Chemical Constituents: Essentialoil, Psoralen, Isopsoralen, Resin, Terpenoidoil, Bavanchin, Psoralen, Isopsoralen and Essential oil are the Active Constituents.Pharmacognasy:Anti bacterial: Seed oil has Antistreptococcal infection. Essential oil has a powerfulselective effect against skin Streptococci. Analgesic: Bavanchin has mild Analgesiceffect. Seed extracts has Antihelminthic activity and Bavanchin hasAntiinflommatory activity.Clinical ReportsEthno botanical studies showed powered seeds if given orally were beneficial inEczema. Essential oil used internally for leaucoderma and leprosy.Kakamachi108Latin Name : Solanum nigrumFamily : SolanaceaeVernacular Names : Hindi : Makoy, Gurkamai. English : Black Nightshade. Kannada : Kakehannu, KarekanchiClassification : Sakavarga, Tikta Skanda,Shatavaryadi Varga.Rasa Panchaka : Rasa : Tikta ,Katu Guna : Laghu,Snigdha Virya : Ushna“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   36   
    • Drug Review  Vipaka : Katu Doshaghnata: Tridoshaghna Karma :Svarya, Vrusya, Rasayana, Hrudya,Netryam Rogaghnata : Kushta, Shopha, Arsha,Jvara, Meha,Hikka,Hrudroga,Kandu Part Used : PancangaChemical Constituents: Root and Stem: Tigogenin,Uttronin,Uttrosides. Berries: Steroidal glycosides and steroidal alkaloidsPharmacognasy: Anti Hepatotoxic and AntitumorBhringaraja109Latin name : Eclipta albaFamily : AsteraceaeSynonyms : Markava, Kesharaja, Mahanila, Angaraka, Pitrapriya, AjagaraVernacular Names : Hindi : Bhangra Kannada : GargaRasa Panchaka : Rasa : Katu, Tikta Guna : Ruksha, Tikshna Virya : Ushna Vipaka : Katu Doshaghnata : Kaphanashaka Karma : Amanashaka, Dantya, Rasayana, Tvachya, Balya, Chakshushya. Rogaharatva : Sopha,Arsha, Pandu,Hridroga, Visa, Kushta,Kasa, Svasa. Part Used : PancangaChemical Constituents: Coumstans,Wadelectone,Dimethyl wadelectone,Thiophene Derivitives, Alkaloids. Aerial parts: Apigenin, CynarosidePharmacognasy:Antibacterial, Anti viral, Analgesic, Anti pyretic, Antihepatotoxic Antihyperglysemia,Anti inflammatory, Anti Diarrheal, Anti tumor, Anti convulsing.Clinical Reports: Powder of Bhringaraja cured 100% patients from InfectiveHepatitis. Paste containing seed of Psoralea corylifolia and Eclipta alba leaf juiceexhibited Significant Anti Leprotic action.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   37   
    • Drug Review Gandhaka110Vernacular Names: English Name : Sulphur, Brime Stone Sulphur Samskrta : Gandhaka Hindi : GandhakaSynonyms: Navanita, Gandhaka, Kruragandha, Kitaghna, Lekhi, Kitanasana, Kushtari, PamariClassification: Suvarnadi varga, Candanadi varga, Dhatu varga, Uparasa vargaRasa Panchaka: Rasa : Katu, Tikta, Kashaya, Madhura. Guna : Ushna, Snigdha, Sara. Veerya : Ushna. Vipaka : Madhura. Karma : Deepana,Pachana, Krimihara, Rasayana, Yogavahi.VyadhiPrabhava : Kandu,Kushta,Visarpa,Dadhru,Krimidosha.Doshaghnata : Vatakapha Shamaka, Rakta ShodhakaPrabhava : Twakavikaranashaka, Kushtanashaka. Dose : Rasatarangini : 1-8 Ratti Anupana : Pakwa Kadalipatra in Skin diseaseParada111Vernacular Names : Samskrta :Parada Hindi : Parada Latin : Hydrargyrum English : Mercury, Quick silverRasa PanchakaRasa : Sad RasaGuna : Snigdha, Sara, GuruVirya : UsnaVipaka : MadhuraKarma : Yogavahi, Rasayana, Balya, Vrsya etc.Dosha Prabhava: TridosaghnaVyadhi Prabhava: Krmi,Kustha, Vataroga,Valipalita roga etc.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   38   
    •                                                                                                  Methodology   MATERIALS AND METHODSAims and Objectives of the Study: Assay of the literature exploring the equation of Vicharchika and Atopic Dermatitis as well as establishing the modality of treatment of Satmya Viruddha Nimittaja Vyadhi with special reference to Vicharchika. To explore the therapeutic effect of Gandhaka Churna on the activity of the disease in patients suffering from Vicharchika / Atopic Dermatitis. To evaluate the remission of the symptoms of Vicharchika / Atopic Dermatitis in patients treated with Gandhaka Churna.Source of Data:20 patients diagnosed as Vicharchika / Atopic Dermatitis fulfilling the Diagnostic/Inclusion and Exclusion Criteria was selected irrespective of their sex and religionand was recruited for the study after getting a written consent from every patient. Methods of Collection of Data:A special proforma was prepared incorporating all the clinical manifestation andAssessment Criteria including laboratory investigation findings of the Vicharchika /Atopic Dermatitis. Complete clinical data was collected from all the selected patientsas per this proforma before the intervention and every week following this until thecompletion of the study. Results obtained were statistically analyzed by adapting thepaired t test.Design of Study:Single blind clinical study of pre test post test design.Intervention:Oral administration of Gandhaka Churna in dose of 500mg before food twice a dayand is continued for 28 days. 100ml milk is advised as anupana along with GandhakaChurna.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    39   
    •                                                                                                  Methodology  Duration of the Study:28 days of medication followed by another 28 days of follow up Diagnostic Criteria: Presence of symptoms of Vicharchika that include Kandu, Pidaka, Bahusrava, Ruja and Ruksha. Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis. Inclusion Criteria: Patients fulfilling the criteria of diagnosis with no restriction of sex and religion. Patients aged between 16 – 70 years.Exclusion Criteria: Patient with any other systemic illness like Diabetes Mellitus. Patient suffering from allergic manifestation like Bronchial Asthma. Children and elderly patients beyond the age group of 16 to 70 years.Assessment Criteria: Kandu, Ruja, Bahusrava, Pidaka, Vaivarnya, Rukshata, Daha were assessed by adapting Visual Analogue Scale. SCORAD Index for Severity Scoring of Atopic Dermatitis.Investigations: Hematological Routine investigation: Hb%, TC, DC, ESR. Fasting and Random blood sugar where ever necessary. Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis:Stages:Infantile stage (up to 2 years of age): (a) highly pruritic, scaly, red and crusted patcheson both cheeks of the face and on the extensor portions of the extremities, (b)eczematous changes of the scalp, (c) wheal formation.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    40   
    •                                                                                                  Methodology  (2) Childhood stage (2 - 12 years of age): (a) papules on the flexural areas, (b) thickened plaques showing Lichenification and excoriation, (c) in Blacks the presence of follicular papular lesions and changes in pigmentation (hyper or hypo)(3) Adult stage (puberty onward): may have no signs or may have a chronic, relapsing condition. If lesions present, (a) Lichenification hands, ankles, fingers, feet may occur in the flexural areas, (b) facial involvement may occur, (c) wrists, and toes may be involved. Major (basic) Criteria - 3 or more of the following Pruritis Typical morphology and distribution (flexural Lichenification or linearity in adults; facial and extensor involvement in infants and children) Chronic or chronically-relapsing Dermatitis Personal or family history of Atopy (Asthma, Allergic Rhinitis, Atopic Dermatitis)Minor Criteria - 3 or more of the following (in addition to major criteria) Xerosis (presence of generalized dry skin) Ichthyosis , Palmar Hyperlinearity or Keratosis Pilaris Immediate (type 1) skin test reactivity Increased serum IgE levels Early age of onset Tendency toward Cutaneous infections (especially staphylococcus aureus and herpes simplex) or impaired cell-mediated immunity Tendency toward nonspecific hand or foot dermatitis Nipple Eczema Cheilitis Recurrent Conjunctivitis Keratoconus Anterior Subcapsular Cataracts Orbital darkening Facial pallor or Facial Erythema“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    41   
    •                                                                                                  Methodology   Pityriasis Alba Anterior neck folds Itch when sweating Intolerance to wool and lipid solvents Perifollicular accentuation Food intolerance Course influenced by environmental or emotional factors White dermographism or delayed blanch The SCORAD Index for Severity Scoring of Atopic Dermatitis:The SCORAD Index is based on 3 sub scores:(1) A (extent score based on body surface area)(2) B (intensity score based on 6 clinical findings in atopic dermatitis)(3) C (subjective symptoms)A: extent score = SUM (body surface area involved, using rule of 9) Table No-11 Body Surface area using rule of 9: Body Region percent BSA if < 2 years percent BSA if >= 2 years of age of agehead, anterior 8.5 4.5head, posterior 8.5 4.5trunk, anterior 18 18trunk, posterior 18 18Genitals 1 1left arm anterior 4.5 4.5“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    42   
    •                                                                                                  Methodology  left arm posterior 4.5 4.5right arm anterior 4.5 4.5right arm posterior 4.5 4.5left leg anterior 9 9left leg posterior 6 9right leg anterior 9 9right leg posterior 6 9 B: intensity score = SUM (points for 6 criteria) Table No-12 Assessment Criteria of Atopic DermatitisCriteria 0 = Absent 1 = Mild 2 = Moderate 3 = SevereErythemaEdemaor papulationOozing or CrustingExcoriationLichenificationDrynessWhere:• Intensity is based on the average intensity in a representative area.• Dryness is evaluated in uninvolved areas.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    43   
    •                                                                                                  Methodology  C = subjective symptoms of Pruritis and sleep loss == (score for Pruritis from 0 to 10) + (score for sleep loss from 0 to 10)Where:• Pruritis and sleep loss are graded on a Visual Analog Scale ranging from 0 (none) to 10 (extreme)• The severity is based on the average extent for the last 3 days or nights. SCORAD index = (A / 5) + (7 * B / 2) + C“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    44   
    • Observation      OBSERVATION In the present study, 20 Patients fulfilling Diagnostic Criteria as well as the InclusionCriteria of Vicharchika were studied. Patients were observed before, during and afterthe treatment. Following pages contain the descriptive statistical analysis of thePatients studied along with the observations.Distribution of 20 Patients According to Different Age groupAmong the 20 Patients taken for the study 30% of the Patients belonged to the agegroup of 46-55 years. This is followed by 20% of the Patients in the 16 -25 age group.Distribution of the Patients According to the age group is depicted in the followingtable (Table no.13) and pie diagram (fig no.-1). Table no.-13 Distribution of Patients According to Age group Age (in years) No. of Patients % 16-25 4 20% 26-35 3 15% 36-45 2 10% 46-55 6 30% 56-65 3 15% 66 and more 2 10% Figure no.-1 Distribution of Patients According to Age group AGE 16‐25 26‐35 36‐45 46‐55 56‐65 66‐75 10% 15% 20% 15% 30% 10%“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    45   
    • Observation  Distribution of Patients According to SexIn the sample taken for the study, 70% were males in contrast to 30% of females.Details are shown in the table (Table no. 14) and pie diagram (fig no.-2) Table no.-14 Distribution of Patients According to Sex Sex No. of Patients % Male (M) 14 70% Female (F) 6 30% Figure no.-2 Distribution of Patients According to Sex“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    46   
    • Observation  Distribution of 20 Patients According to ReligionOut of 20 Patients 80% of Patients were Hindus, Muslims and Christians were 10%each. The same is detailed in the table (Table no. 15) and pie diagram (fig no.-3). Table No.-15 Distribution According to Religion Religion No. of Patients % Hindu (H) 16 80% Muslim (M) 2 10% Christian (Ch) 2 10% Figure no.-3 Distribution According to Religion“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    47   
    • Observation  Distribution of 20 Patients According to Educational StatusMajority of Patients comprising 50 % in this group have completed their highersecondary class education followed by graduates contributing 35%. The completedetails of the distribution of Patients According to education is detailed in the table(Table no. 16) and pie diagram (fig no.-4) Table No.-16 Distribution According to Educational Status Education No. of Patients % Uneducated (UE) 1 5% Primary school (P) 2 10% Higher secondary (HS) 10 50% Graduation (GR) 7 35% Post-graduation (PG) 0 0% Figure no.-4 Distribution According to Educational Status“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    48   
    • Observation  Distribution of 20 Patients According to Marital Status65% of Patients were married in contrast to 30% of Unmarried individuals in thepresent sample. The marital status of the 20 Patients is shown in the table (Table no.17) and pie diagram (fig no.-5) Table No.-17 Distribution According to Marital Status Marital Status No. of Patients % Married(M) 13 65% Unmarried (UM) 6 30% Divorce (D) 0 0% Widow(W) 1 5% Figure no.-5 Distribution According to Marital Status MARITAL STATUS UNMARRIED MARRIED WIDOW 5% 30% 65%“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    49   
    • Observation  Distribution of 20 Patients According to Socio- Economic StatusMajority of Patients belonged to the Middle class (60%), 20% each were in lowermiddle class and upper middle class. The distribution of Patients According to Socio-Economic Status is given in table (Table no. 18) and pie diagram (fig no.-6) Table No.-18 Distribution According to Socio- Economic Status: Socio-Economic Status No. of Patients % Lower class(L) 0 0% Lower middle class(LM) 4 20% Middle class (M) 12 60% Upper middle class(UM) 4 20% Upper class(U) 0 0% Figure no.-6 Distribution According to Socio- Economic Status“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    50   
    • Observation  Distribution of 20 Patients According to OccupationMaximum numbers of Patients were Students, farmers and housewives, each groupcontributing 20%. The distribution of 20 Patients According to their occupation isshown in the table (Table no. 19) and pie diagram (fig no.-7) below. Table no.-19 Distribution According to Occupation Occupation No. of Patients % Student 4 20% Housewife 4 20% Painter 2 10% Professional 3 15% Farmer 4 20% Others 3 15% Figure no.-7 Distribution According to Occupation“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    51   
    • Observation  Distribution of 20 Patients According to HabitatAmong the 20 Patients 85 % were from the urban area and the remaining 15 % wererural dwellers. The details of the same is shown in the table (Table no. 20) and piediagram (fig no.-8) Table no.-20 Distribution According to Habitat Habitat No. of Patients % Urban (U) 17 85% Rural (R) 3 15% Figure no.-8 Distribution According to Habitat“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    52   
    • Observation  Distribution of Patients According to AharaOut of 20 Patients, 75 % had the habit of taking both vegetarian and non-vegetarianfoods. And the remaining 25% Patients were vegetarians. Complete details of thesame is given in the table (Table no. 21) and pie diagram (fig no.-9) Table No.-21 Distribution of Patients According to Ahara Ahara No. of Patients % Vegetarian 5 25% Mixed 15 75% Figure no.-9 Distribution of Patients According to Ahara“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    53   
    • Observation  Distribution of Patients According to Vyasana 30 % of the Patients confessed the Different addictions they had and the remaining70% Patients had no. history of any addictions. Table (Table no. 22) and pie diagram(fig no.-10) show more details of the addictions in 20 Patients of Vicharchika. Table No.-22 Distribution According to Vyasana Vyasana No. of Patients % Smoking 2 10 Alcohol 2 10 Snuff 1 5 Tobacco 0 0 Pan 1 5 None 14 70 Figure no.-10 Distribution According to Vyasana“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    54   
    • Observation  Distribution of Patients According to PrakrutiA majority of Patients belonged to Pitta Kapha Prakruti (50%) and 25% belonged toVata Pitta Prakruti. The details of other incidence are shown in the table (Table no.23) and pie diagram (fig no.-11). Table No.-23 Distribution of Patients According to Prakruti Prakruti No. of Patients % Vata 1 5% Pitta 0 0% Kapha 1 5% VataPitta 5 25% VataKapha 3 15% PittaKapha 10 50% Figure no.-11 Distribution of Patients According to Prakruti PRAKRUTI VATA PITTA KAPHA VATA PITTA PITTA KAPHA KAPHA VATA 5% 0% 5% 15% 25% 50%“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    55   
    • Observation  Distribution of Patients According to Sara90% Patients exhibited Madhyama Sara, and the remaining 10 % of Patients hadAavara Sara. The complete detail of the same is shown in the table (Table no. 24) andpie diagram (fig no.-12). Table No.-24 Distribution of Patients According to Sara Sara No. of Patients % Pravara 0 0% Madhyama 18 90% Avara 2 10% Figure no.-12 Distribution of Patients According to Sara“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    56   
    • Observation  Distribution of Patients According to PramanaThe assessment of Pramana of the body in 20 Patients revealed that 95% Patients hadMadhyama Pramana as against only 5 % had Heena Pramana . Further details aremade clear in the table (Table no. 25) and pie diagram (fig no.-13). Table No. -25 Distributions of Patients According to Pramana Pramana No. of Patients % Adhika 0 0% Sama 19 95% Heena 1 5% Figure no.-13 Distribution of Patients According to Pramana“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    57   
    • Observation  Distribution of Patients According to SamhananaAmong the 20 Patients, 90% recorded Madhyama Samhanana . 5% each Patientsshowed Avara Samhanana, and Pravara Samhanana. Table (Table no. 26) and piediagram (fig no.-14) depict more details of the same. Table No.-26 Distribution of Patients According to Samhanana Samhanana No. of Patients % Pravara 1 5% Madhyama 18 90% Avara 1 5% Figure no.-14 Distribution of Patients According to Samhanana“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    58   
    • Observation  Distribution of Patients According to their SatvaThe assessment of the Satva in 20 Patients showed 65%Patients having MadhyamaSatva. Another 20 % of Patients had Pravara Satva. Remaining 15 % of Patientsrecorded Avara Satva. The details of the Satva in this sample is depicted in the table(Table no. 27) and pie diagram (fig no.-15). Table No.-27 Distribution of Patients According to their Satva Satva No. of Patients % Pravara 4 20% Madhyama 13 65% Avara 3 15% Figure no.-15 Distribution of Patients According to their Satva“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    59   
    • Observation  Distribution of Patients According to SatmyaAnalysis of Satmya revealed that 55 % had Avara Satmya, 45% had of MadhyamaSaatmya and no one exhibited Pravara Satmya. The table (Table no. 28) and piediagram (fig no.-16) show the details of the same. Table No.-28 Distribution of Patients According to Satmya Satmya No. of Patients % Pravara 0 0% Madhyama 9 45% Avara 11 55% Figure no.-16 Distribution of Patients According to Satmya“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    60   
    • Observation  Distribution of Patients According to Vyayama Shakti70% 0f the Patients had Pravara Vyayama Shakti, 25% had Madhyama VyayamaShakti and 5% had Avara Vyayama Shakti. The table (Table no. 29) and pie diagram(fig no.-17) show the complete details of the distribution of Patients According toVyayama Shakti. Table No. -29 Distribution of Patients According to Vyayama Shakti Vyayama Shakti No. of Patients % Pravara 14 70% Madhyama 5 25% Avara 1 5% Figure no.-17 Distribution of Patients According to Vyayama Shakti“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    61   
    • Observation  Distribution of Patients According to Ahara – Abhyavaharana and JaranaShakti10% Patients had Avara- Abhyavaharana and Jarana Shakti, 50% had Madhyama-Abhyavaharana and Jarana Shakti and 40 % had Pravara- Abhyavaharana and JaranaShakti. Distribution of the Patients According to Abhyavaharana Shakti is shown inthe table (Table no. 30) and pie diagram (fig no.-18). Table No.-30 Distribution of Patients According to Ahara- Abhyavaharana and Jarana Shakti Aahaara-Abhyavaharana No. of Patients % Shakti Pravara 8 40% Madhyama 10 50% Avara 2 10% Figure no.-18 Distribution of Patients According to Ahara- Abhyavaharana and Jarana Shakti“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    62   
    • Observation  Distribution of Patients According to VayaIt was observed that 65% of the Patients were of Parihani age category. Further, 20%Patients belonged to the age category of Vruddhi. 10% of Patients belonged to agecategory of Yauvana. The remaining 5% Patients were in age category of Sampurnata.The complete detail of the same is given in the table (Table no. 31) and pie diagram(fig no.-19). Table No.-31 Distribution of Patients According to Vaya Vaya No. of Patients % Vruddhi 4 20% Yauvana 2 10% Sampurnata 1 5% Parihani 13 65% Figure no.-19: Distribution of Patients According to Vaya“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    63   
    • Observation  Occurrence of Symptoms in 20 Patients of VicharchikaThe symptoms Pidaka and Vaivarnya were observed in all the Patients (100%),Kandu in 95% of Patients and Ruksha in 90% and Srava were found in 80 % ofPatients. More details of the same is depicted in the table (Table no. 32) and Bardiagram (fig no.-20) Table No.-32 Occurrence of Symptoms of Vicharchika Symptamatalogy No. of Patients % of Patients Kandu (K) 19 95% Daha (D) 3 15% Ruja (R) 6 30% Pidaka (P) 20 100% Vaivarnya(V) 20 100% Srava (S) 16 80% Ruksha(Ru) 18 90% Raji (Ra) 7 35% Relapsation(Re) 14 70% Figure no.-20 Occurrence of symptoms of Vicharchika“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    64   
    • Observation  Nidana of Kushta identified in 20 PatientsThe exploration of Nidana in 20 Patients suffering from Vicharchika revealed that80% of Patients exhibited faulty dietetic habits. Another 35% Patients showederroneous Vihara as cause of the illness. Mere 5 % of Patients exhibited Manasikafactor as Nidana. Details of the same is given in the table (Table no. 33) and Bardiagram (fig no.-21) Table No.-33 Nidana of Kushta identified in 20 Patients Nidana No. of Patients % Aharaja(A) 16 80% Viharaja (V) 7 35% Manasika (M) 1 5% Figure no.-21 Nidana of Kushta identified in 20 Patients“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    65   
    • Observation  Occurrence of Purvarupa in 20 PatientsOnly in 25 % of Patients the Purvarupa of Kushta was documented and the remaining75 % of Patients have shown no Purvarupa. Table (Table no. 34) and pie diagram (figno.-22) show the occurrence of Purvarupa. Table no.-34 Occurrence of Purvarupa Purvarupa Present 5 25% Absent 15 75% Figure no.-22 Occurrence of Purvarupa“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    66   
    • Observation  “A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    67   
    • Results   RESULTSPatients suffering from Vicharchika were treated with Gandhaka Churna in a dose of500 mg twice a day for 28 days in this single blind, pre test post test clinical trial. Theeffect of the treatment following medication was assessed periodically in regards toKandu, Srava, Vaivarnya, Loss of sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification,Extent of body region affected, SCORAD . The details of the same with statisticalanalysis adapting paired t test is elaborated in this section on results.Effect on KanduThe administration of Gandhaka Churna was found to be effective in reducing theKandu (Itching). The mean VAS score for Kandu prior to the treatment was 8.05which reduced to 2.700 after the treatment with mean difference of 5.350. Theanalysis by applying the paired‘t’ test proved the statistical significance of theimprovement as P=<0.001. Details are shown at full length in the table (Table no 35)and fig (fig no-23). Table no.-35 Effect on Kandu Mean Kandu Difference % Paired ‘t’ Test VAS score in Means BT AT S.D. S.E.M ‘t’ P (±SE) (±SE) 8.050 2.700 5.350 66.45% 2.661 0.595 =8.991 P=<0.001 (0.535) (0.341) Figure no.-23 Effect on Kandu“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   67  
    • Results  Effect on DischargeThe mean VAS score of Discharge (Srava) reduced from initial value of 4.350 to1.350 after the treatment, with a difference of 3.000. This reflects the markedremission in the symptom discharge by the medication. Also the analysis revealed thechange that occurred with the treatment is greater than would be expected by chance;and hence is a statistically significant change (P = <0.001). Details of the same isgiven in the table (Table no. 36) and fig (fig no.-24) Table no.-36 Effect on Discharge Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)4.350 1.350 3.000 68.96% 2.200 0.492 = 6.097 P=<0.001(0.654) (0.274) Figure no.-24 Effect on Discharge 6 5 4 3 BT AT28 2 1 0 DISCHARGE“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   68  
    • Results  Effect on Discoloration (Vaivarnya)The mean VAS score of Vaivarnya prior to the treatment was 7.900. After thetreatment the same reduced to 5.450. Hence the Gandhaka Churna is effective inreducing the severity of discoloration in patients of Vicharchika. Further, Thestatistical analysis by adapting paired t test showed that the change occurred with thetreatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001). In the table (Table no 37) and fig (fig no-25) thedetails of the values and statistical analysis is shown. Table no.-37 Effect on Discoloration (Vaivarnya) Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)7.900 5.450 2.450 31% 1.468 0.328 = 7.463 P(0.390) (0.344) =<0.001 Figure no-25 Effect on Discoloration (Vaivarnya)“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   69  
    • Results  Effect on Loss of SleepAn initial mean VAS sleep score was 6.400 in 20 patients suffering from Vicharchika.The value dropped to 2.950 following the treatment thus recording good improvementby the medication. Justifying the same, the paired t test also showed that theimprovement by the medication is statistically significant with t = 8.219 and p<0.001.The complete details of the sleep score is depicted in the table (Table no 38) and fig(fig no-26). Table no.-38 Effect on Loss of Sleep Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)6.40 2.95 3.450 53% 1.877 0.420 =8.219 P=<0.001(0.591) (0.478) Figure no.-26 Effect on Loss of Sleep“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   70  
    • Results  Effect on Pain (Ruja)The severity of pain reduced to a larger extent by the medication with GandhakaChurna in all the 20 patients. The mean VAS score prior to the treatment was 6.143which reduced to 2.714 with mean difference of 3.429 after treatment. The changethat occurred with the treatment is greater than would be expected by chance; there isa statistically significant change (P = 0.009). Details of the same are shown in thetable (Table no 39) and fig (fig no-27). Table no.-39 Effect on Pain (Ruja) Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)6.143 2.714 3.429 55.81% 2.370 0.896 =3.827 P=0.009(1.471) (0.837) Figure no.-27 Effect on Pain (Ruja)“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   71  
    • Results  Effect on Burning (Daha)The oral medication with Gandhaka Churna is effective in reducing the severity ofburning sensation in patients suffering from Vicharchika. The mean initial VAS scoreof Daha was 6.000 and the same dropped to 2.000 after the treatment, thus recordinga fall in severity by 4.000. This improvement in the Daha also proved to bestatistically significant as revealed by paired t test. The detail of the values at fullerlength is shown in the table (Table no 40) and fig (fig no-28). Table no.-40 Effect on Burning (Daha) Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)6.000 2.000 4.000 66.7% 0.816 0.408 =9.798 P=0.002( 0.707) ( 0.913) Figure no.-28 Effect on Burning (Daha)“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   72  
    • Results  Effect on Eruption of Papules (Pidaka)The eruption of papules reduced markedly following the treatment with GandhakaChurna. The mean score Pidaka prior to the treatment was 2.250, which reduced to1.250 with mean difference of 1.000 after treatment. The analysis by applyingpaired‘t’ test showed statistically significant change as P=<0.001 thus proving thetherapeutic efficacy of Gandhaka Churna. In the table (Table no 41) and fig (fig no-29) the details of the same is elaborated. Table no.-41 Effect on Eruption of Papules (Pidaka) Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)2.250 1.250 1.000 44.44% 0.649 0.145 =6.892 P=<0.001(0.176) (0.099) Figure no.-29 Effect on Eruption of Papules (Pidaka) 3 2.5 2 1.5 BT AT28 1 0.5 0 PAPULATION“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   73  
    • Results  Effect on Dryness (Ruksha)The severity dryness reduced from initial score of 2.158 to 1.316 with 0.842 asdifference of mean. Therefore the medication is effective against the drynesssymptom of Vicharchika. The change that occurred with the treatment is greater thanwould be expected by chance; there is a statistically significant change (P = <0.001).The mean values as well as details of statistical analysis is shown in the table (Tableno 42) and fig (fig no-30). Table no.-42 Effect on Dryness (Ruksha) Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)2.158 1.316 0.842 39% 0.602 0.138 =6.096 P=<0.001( .158) ( .110) Figure no.-30 Effect on Dryness (Ruksha)“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   74  
    • Results  Effect on LichenificationThe mean severity score of Lichenification prior to the treatment was 1.714 and thatremained same even after treatment. Oral medication with Gandhaka Churna hasshown no benefit in reducing the symptom Lichenification of Vicharchika. The detailsare shown in the table (Table no 43) and fig (fig no-31). Table no.-43 Effect on Lichenification Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)1.714 1.714 0.000 0% 0.000 0.000 0.000 P=1.000( 0.184) ( 0.184) Figure no.-31 Effect on Lichenification“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   75  
    • Results  Effect on Extent of Body Region AffectedThe administration of Gandhaka Churna was found to be effective in reducing theinvolvement of body region. The mean score prior to the treatment was 13.819 whichreduced to 9.689 with mean difference of 4.131 after treatment. The statisticalanalysis by paired t test showed significant change as P=0.011. Mean scores anddetails of the statistical analysis is shown in the table (Table no 44) and fig (fig no-32). Table no.-44 Effect on Extent of Body Region Affected Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)13.819 9.689 4.131 29.89% 6.147 1.449 =2.851 P=0.011( 3.766) ( 2.631) Figure no.-32 Effect on Extent of Body Region Affected 20 18 16 14 12 10 BT 8 AT28 6 4 2 0 BODY REGION  AFFECTED“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   76  
    • Results  Effect on SCORADThe administration of Gandhaka Churna was found to be effective in reducing theSCORAD. The mean score prior to the treatment was 47.000 which reduced to 26.350with mean difference of 20.650 after treatment. The change that occurred with thetreatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001). The different values of mean scores and statisticalanalysis are elaborated in the table (Table no 45) and fig (fig no-33). Table no.-45 Effect on SCORAD Mean Difference % Paired ‘t’ Test in MeansBT AT S.D. S.E.M ‘t’ P(±SE) (±SE)47.000 26.350 20.650 43.93% 9.773 2.185 =9.450 P=<0.001( 2.773) ( 1.943) Figure no.-33 Effect on SCORAD 60 50 40 30 BT AT28 20 10 0 SCORAD“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   77  
    • Discussion   DISCUSSIONJnana Sadhana is an outcome of Shastra Sahita Tarka112. It is the characteristics of thepresent era that there is no place for blind faith in tradition & authority of Shastra,hence only those facts established by proofs after careful investigations, observations& experiments & supported by accurate data & convincing reasoning can convincethe people about validity & even the facts requires support of statistics. A discussionbased on Shastra, over any conceptual & practical oriented study definitely gives oneor other fruitful conclusions.Review of LiteratureThe Skin Disorders are considered to be the challenging disorder from the Vedicperiod. In Ayurvedic literatures skin disorders are elaborated mainly under theheading of Kushta and Visarpa. Vicharchika is a disorder enlisted under Kushta.Altered touch sensation with discoloration of the skin is referred as Kushta in general.Ksudra Kushta are the exception for the general rule. As there is involvement ofArambhaka Dosha is lesser. Hence complete manifestation of general symptoms ofKushta lacks in Kshudra Kushta.Viruddha Ahara and Vihara are considered to be the main Nidana for the diseaseKushta in general and Vicharchika in particular. Viruddha is one which vitiate theDosha but do not expel out of the body. These vitiated Dosha acts as Visha andproduce vishavat effect that is alteration of sensorium and even may lead to thedeath113. This is true in the Anaphylitic shock due to the some drugs that are notcomplimentary to the body. This is due to the hypersensitivity reaction and same inAyurvedic literature termed as Atma Asatmya. Atopic Dermatitis is a disorder is anoutcome of hypersensitivity reaction as well as improper food ingestion stated asMithyahara in literatures. Outcome of the Mithyahara is improper digestion,absorption of the ahara rasa in tern produce disease Kushta. Dermatitis due to the malabsorption and improper ingestion of the food is highlighted in parallel science.Sheetoshna Vyatyasa in the form of intake of cold material immediately afterexposure to hot or habitual intake of hot and cold material in alternate may producethe Vicharchika.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    78   
    • Discussion  In other words to say excessive heat (especially with humidity) and coldness areknown to provoke outbreaks of Atopic Dermatitis as well as sudden and extremetemperature swings. Needless to say aetiology of Vicharchika and Atopic Dermatitisare almost similar.Vicharchika has been mentioned in almost all Ayurvedic texts, either in form ofKshudra Kushta, Kshudra Roga or Sadhya Kushta. Vicharchika is not fatal even itbecome very severe. The Doshaja Symptamatalogy is not predominant like that ofMaha Kushta and hence known as Kshudra. Various Acharyas mentionedVicharchika with different Doshic involvement along with their symptom complex.Vicharchika has a Kapha dominancy because, there is an excess Itching,Discolouration, Boil, Profuse Oozing , which also indicates its initial stages similarto that of Atopic Dermatitis in Acute and Infantile and Childhood phase. Vicharchikawhich has Vata dominancy with characteristics like Raji (marked lining) and AtiKandu (Excess Itching) and Arti (Pain) and Ruksha (Dryness) etc., which indicateChronic or later stage which similar to that of Atopic Dermatitis in adult phase withchronicity. Thus this separation may indicate the 2 different stages of Vicharchika,they are Sravi Vicharchika and Ruksha ( Asravi) Vicharchika.The Symptamatalogy of Vicharchika is similar with Eczema i.e., SaKandu (ExcessiveItching), Pidaka (Boil/Pustule/Vesicle), Shyavata (discolouration/hyperpigmentation),Bahusrava (Weeping) and later Raji (marked linings/Lichenification/Criss-crossmarking), Ruja (Pain), Saruksha (Excessive Dryness).After going through the above it can be said that Vicharchika is a clinical entity inwhich the lesion has the Shyava colour of Pidaka with excessive itching and oozing,which may develop anywhere in the body (Gatreshu), and may be either wet or dry.Atopic Dermatitis can be considered in the same category because first manifestationof Eczema is Erythema or Reddening of skin, Oedema, Vesiculation, Oozing,Crusting and later Lichenification. Due to the intra and extra environmental changeswithin the body and its reactions against them, may produce extreme stages ofVicharchika. Main place of etiopathogenisis, is in Tvak (Adhisthana), Rakta , Mamsaand Lasika.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    79   
    • Discussion  Saptako Dravya Sangraha is mandatory for the production of the Kushta. Each andevery Kushta is Tri Doshaja in nature. In literature “Kushta Visheshai Dosha” and“Dosha Visheshai Punascha Kushta” is explained. That means by seeing the vitiationof Dosha one can assume the forth coming variety of Kushta and same way byanalysing the Kushta bheda one can assume the Dosha vitiation. This highlights theKarya Karana Sambandha between Dosha as well as Kushta and said to be unique forKushta. The involvement of deeper Dhatu is absent in Kshudra Kushta this is due thevitiated Dosha are not having the character of Adibala Pravrittatva and morbidity ofVyadhi Arambhaka Dosha are in minimum intensity.Shodhana, Shamana, Vyadhihara Rasayana and Bahirparimarjana Chikitsa are thecrux of principles of treatment for Vicharchika. Repeated administration of Shodhanahas been given importance in literatures. The recurrence of Kushta is remote possibleif all modalities of management like Shodhana, Shamana, Vyadhihara Rasayana andBahirparimarjana are fallowed as treatment.The moot point in conceptual part is Atma Satmya Viruddha Nimittaja Vyadhi and itsChikitsa. Complimentary and derogatory material is almost same for every person ingeneral. That is known as Satmya and Asatmya. It may depends on Prakruti DeshaKala Vaya ect. Out of these; unique Satmya known as Atma Satmya. This is particularfor an individual. If a person exposure against once Satmya produces disease then iscalled as Atma Asatmya Vyadhi. As Asatmya refers to Viruddha to once Satmya sothe disease produced by the Atma Asatmya referred as Atma Satmya ViruddhaNimitta Vyadhi. Viruddha is one which produces different Vyadhi in which Kushta ingeneral and Vicharchika in particular remains first. Atopic Dermatitis is one which isan outcome of intake of eggs, fish etc may be possible and sudden variation ofenvironmental condition triggers the Atopic Dermatitis. This is similar to that of AtmaSatmya Viruddha called as Hypersensitivity or Idiosyncrasy. This is the mainpathology behind the Atopic Dermatitis. Management of the Atma Satmya ViruddhaNimitta Vyadhi includes avoiding the Nidana, same for Atopic Dermatitis as avoidingthe triggering factor. The second principle is adaptation of Atma Asatmya when thereare such circumstances so that avoidance is not possible. This is possible by theAbhyasa of exposure to the Nidana in smaller dosage. This is also one of the mainmanagement of Atopic Dermatitis as Immunotherapy.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    80   
    • Discussion  Remaining principle of treatment includes proper administration of Shodhana, propermanagement through Shamana and finally enhancement of Vyadhikshamatva by theKushta Vyadhihara Rasayana.Drug ReviewGandhaka Churna is a Herbomineral preparation indicated in all variety of Kushta.Shuddha Gandhaka is treated with Seven Bhavana of Kakamachi (Solanum nigrum)Swarasa, followed by another Seven Bhavana of Bhringaraja (Eclipta alba)Swarasa. Then Kajjali is prepared by adding the same Gandhaka and Shuddha Parada.Thus prepared Kajjali is then be dried and Bakuchi Churna (Psoralia corylifolia) isadded to it. Fine powder of the mixture is capsuled and used for oral administration.MethodologyThis is a single blind clinical study with a pre-test and post-test design. 20 Patientsbetween the age group of 16 to 70 years suffering from Vicharchika were taken forthe study from O.P.D and I.P.D of SDM college of Ayurveda Hospital, Udupi. ThePratyatma lakshana of Vicharchika like Kandu, Pidaka, Vaivarnya, Bahusrava, Daha,Raji, Atiruja and Rukshata were mainly considered for the diagnosis as per Ayurvedicscience and Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis inmodern point of view. As a routine, hematological investigations were carried out inall the Patients taken for the study. Once they were diagnosed as Vicharchika/ AtopicDermatitis then they should fulfil the inclusion and exclusion criteria. Even thoughShodhana is best for Kushta but that is not indicated in every person, so in the presentstudy, Gandhaka Churna as Shamana Oushadha is used. In the present study, 20Patients were registered which were subjected to oral administration of the GandhakaChurna in capsulated form with dose of 500mg twice a day before food , milk asanupana for the 28 days. During this interval weekly assessment is done by using theVisual Analogue Scale and SCORAD index. In Visual Analogue Scale subjectivecriteria are assessed, such that of Kandu, Srava, Vaivarnya, Loss of Sleep, Ruja andDaha. Remaining objective criteria are assessed through the SCORAD index.Observation and ResultsIn the present study the entire sample was grouped into 6 age groups. Among themmaximum 30% Patients were belonged to 46-55 and 20% belonged to 16-25 years of“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    81   
    • Discussion  age group. This shows the prevalence of illness in Madhyamavastha. In this agepossibility of mental stress and other exposure i.e. occupational, environmental,unwholesome food were more which leads to Dermatitis. From this one can considerthe adulthood Atopic Dermatitis.Generally Atopic Dermatitis may occur in any stage of life but most common inInfant and Puberty. In present study 2 Infants were reported but excluded from thestudy as per the exclusion criteria, as the dosage of medicine fixed in the study is foradults.The gender wise distribution of the Patients reveals that 70% of the Patients weremale while 30% Patients were female. So it can be said that in this study males aremore affected than females.Maximum number of Patients were Students, Farmers and Housewives (20%) .Students are having stress which is one of the causes for Vicharchika. Farmers alwayshave contact with different irritant substance which triggers the disease Vicharchikaor Atopic Dermatitis. Housewives are in contact with different material whichproduces usually Allergic Dermatitis or Hand Dermatitis. Professionals who includeTeacher and Engineers tend to stand for a prolonged period and hence the possibilityof Stasis Dermatitis is more rather than the Atopic Dermatitis. Other includesKuliworker, possibility of unhygienic polluted environment may be the cause forDermatitis.Majority of Patients were married (65%) and 30% were unmarried. This is observedduring the study. As per the inclusion criteria, the Patients between the age group of16 to 70 were opted, and the marriageable age of individuals falls in this age group.The same is reflected in the present sample with more numbers of marriedparticipants.Maximum number of patient’s i.e. 80% were Hindus, 10% were Muslims, and 10%were Christian. This indicates the dominance of the Hindu population in the localityof study.In this series, Majority of Patients belonged to the Middle class (60%), 20% eachwere in lower middle class and upper middle class. This trend of distribution in thissample also represents the socioeconomic state of individuals in and around Udupi.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    82   
    • Discussion  Majority of Patients were found in Higher Secondary Class (50%) and Graduates(35%). Vicharchika is also observed in uneducated as well as people having PrimaryEducation. Therefore it seems that that education does not influence the causation ofthe illness.In this series, maximum number of patient’s i.e. 85% were coming from urban area,where as 15% Patients were from rural area. So it can be said that Patients from urbanarea are more susceptible for Eczema than rural area due to unhygienic, polluted andIndustrial Environment. Or else, as the hospital from where the present sample istaken is located in the City area, this might have influenced the sample.Maximum number of patients’ i.e. 75% were mixed while rest of the Patients i.e.25% was taking Vegetarian type of Diet. The main item in mixed diet is Fish,Chicken and Black Gram item. These are considered to be Guru, Vidahi and ViruddhaAhara and hence likely to have influenced causation of Vicharchika in suchindividuals.70% of the Patients did not reveal the history of any sort of addiction. Remaining 30%confessed the addiction to Pan chewing, Alcohol, Tobacco etc. Any role of addictionseither in the causation or in perpetuation of Vicharchika could not be said from thissample of 20 Patients.A majority of Patients belonged to Pittakapha Prakruti (50%) and 25% belonged toVatapitta Prakruti. Vatakapha Prakruti was observed in 15%, Vata and Kapha in 5%each. Vicharchika is a disorder predominant of Kapha with involvement of PittaDosha (Parisrava). It may be contended that person belonging to Pittakapha Prukrutiare more prone to get Vicharchika. The same is reflected in the present sample.90% Patients were found in Madhyama Sara, 10 % were found as Avara Sara. Saraindicates the strength as well as immunity power of the person. Person who has Avaraand Madhyama Sara will suffer from the disease. In the present study, no patientrecorded Pravara Sara corroborating the fact that people having Madhyama and AvaraSara are more prone to any illness in general.In this series 90% Patients belonged to Madhyama Samhanana and 5% each hadAvara and Pravara Samhanana. Samhanana of the Patients in this study does indicatethe predilection of illness to Patients of any Samhanana.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    83   
    • Discussion  Analysis of Satmya revealed that 55 % were Avara Satmya, 45% were of MadhyamaSatmya and no one belonged to Pravara Satmya. It is said that the risk of diseases ismuch less in Patients having the habit of Pravara Satmya. Corroborating the same inthe present sample no patient recorded Pravara Satmya.65%Patients were belonged to Madhyama Satva. 20% belonged to Pravara Satva andremaining 15% belonged to Avara Satva. In general Satva indicates the mentalstability and the Pravara Satva works against disease process. Substantiating the same,in the present sample of 20 maximum number of Patients either had Madhyama Satvaor Avara Satva. Only 20 % of Patients recorded Pravara Satva.Patients having Madhyama and Avara Abhyavaharana Jarana Shakti tend to developAgnimandya and consequently Ama. Ama is the root cause of the variety of illnessincluding the Vicharchika. In the present study a total of 60 % of Patients had eitherAvara or Madhyama Abhyavaharana and Jarana Shakti. This observation agrees withthe understanding of risk of diseases due to Agnimandya and Ama Dosha.70% of the Patients had Pravara Vyayama Shakti, 25% had Madhyama VyayamaShakti and 5% had Avara Vyayama Shakti. There is no much relation between theVyayama Shakti and causation of perpetuation of Vicharchika.The analysis of Nidana reveals that 80% of the Patients has Aharaja Nidana, 35%Patients had Viharaja Nidana. 5% had Manasika Nidana . Aharaja Nidana is observedmore in the study. Intake of Viruddha Ahara in the form of Matsya and Dugdha isavailable in study. Same way Vishamashana that is intake of food in irregular time isobserved. Intake of Mithyahara in the form of intake of Vidahi Ahara ( idli, dosa andfast food) , taking hot and cold material together is observed in the study. As ViharajaNidana is concerned Vegadharana and exposure to sunlight and heavy work afterintake of food is observed. There is also available of Patients who are exposed tosunlight and then immediately enter into the Ac room. In this series, only 5% ofpatient had Manasika Nidana in the form of Chinta and Bhaya.Different types of Aharaja Nidana may be responsible for Vicharchika, diet and stateof digestion is responsible for the production of Eczema. Metabolic toxins, internalbody products, element of diet and drug may act in different ways and provoke the“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    84   
    • Discussion  Allergic reaction, which may provide internal atmosphere to Endogenous Eczema andExogenous Eczema also.Vegadharana will produce the vitiation of the Dosha intern produce the Agnimandyaand leads to the disease Kushta. Sudden environmental change may trigger the bloodcirculation as well as Endocrine System which produce Vicharchika. Needless to sayAtopic Dermatitis is triggered by the sudden environmental changes. Emotions areeffect the normal function of the Endocrine System and produce the skinmanifestation.Purvarupa was absent in 75% Patients and present in 25% of Patients. This shows thatany of Kshudra Kushta will manifested with less preponderance of Purvarupa or insome occasions without Purvarupa.The symptoms Pidaka and Vaivarnya were observed in all the Patients (100%),Kandu in 95% of Patients and Ruksha in 90% and Srava were found in 80 % ofPatients. So that it can considered that, in Sravi Vicharchika discharge along withKandu is the major symptom. In Asravi Vicharchika Rukshata is main symptom.Whereas Kandu, Pidaka, Vaivarnya may considered as common major symptoms ofSravi and Asravi Vicharchika.EFFECT OF THERAPYThis clinical work is designed to carry out a comprehensive literary study onVicharchika and also to evaluate the effect of oral medication with Gandhaka Churnain Vicharchika. Significant remission in the cardinal symptoms was observed thatincluded Kandu, Pidaka, Vaivarnya, Bahusrava, Daha and Rukshata. Improvement inSCORAD index was also recorded. The results thus obtained were statisticallysignificant.The Effect of Therapies on Individual Signs and SymptomsKandu: morbidity of Kapha Dosha as well as Vata Dosha is responsible for thesymptom Kandu in lesions of Vicharchika. Hence the regimens that alleviate thesetwo Dosha are likely to be effective in relieving the symptom Kandu. Further theabnormality of Rakta Dhatu contributes in the establishment of the Kandu inVicharchika.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    85   
    • Discussion  Needless to say, the medicaments that rectify the abnormality of Rakta Dhatu tend toaid remission of the symptom Kandu. Gandhaka Churna is said to be effective inalleviation of Kapha Vata Dosha and rectifier of Rakta Dhatu as well. The reductionin the severity of Kandu as indicated by the reduction in the severity VAS score ofKandu by 66.45% proves its efficacy in normalisation of Vata Kapha Dosha andRakta Dhatu. Added to this the Gandhaka, the major ingredient of Gandhaka Churnahas known Kandhughna effect.Srava: Morbid Pitta Dosha in association with Kapha Dosha is responsible for thedischarge from the lesions in Patients of Vicharchika. Hence forth, treatment aimed atclearing the morbidity of Pitta and Kapha Dosha in the skin should reduce or stop thedischarge from the lesions. The reduction by 68.96% in discharge from the skinlesions in 20 Patients treated with Gandhaka Churna confirms the therapeutic benefitby normalising the Pitta and Kapha Dosha. The ingredients of Gandhaka Churna likeKakamachi and Bhringaraja have the unique therapeutic effect of reducing the Srava.Vaivarnya: Aruna and Shyava coloration of the lesion is due to the morbid VataDosha in Patients suffering from Vicharchika. In contrast to this, reddish coloration isdue to the morbidity of Pitta Dosha. De- pigmentation accounts for the vitiation ofKapha Dosha in the skin. Vaivarnya is rectified by 31 % in Patients of Vicharchikatreated with Gandhaka Churna. This clearly indicates the appreciable therapeuticimprovement in regards to Vaivarnya in Patients of Vicharchika. Kakamachi andBhringaraja are known for its effect in rectifying the Vaivarnya of the skin. This isproved by this clinical study as the Patients had satisfactory correction of thesymptom Vaivarnya.Pidaka: Morbid Kapha Dosha afflicting the Mamsa Dhatu accounts for the eruptionof Pidaka in Patients suffering from Vicharchika. Thus alleviation of Kapha Dosha isthe rationale of treating Pidaka in the Vicharchika. The reduction in the symptomscore of Pidaka by 44.44% in Patients treated with Gandhaka Churna proves itsefficacy in rectifying Kapha Dosha and eventually remission of Pidaka. Further thisimprovement is statistically significant as shown by the paired t test.Daha: In the Patients of Vicharchika the morbidity of Pitta Dosha involving the RaktaDhatu is responsible for the occurrence of Daha. Reduction in the symptom Daha by“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    86   
    • Discussion  66.70% proves the therapeutic efficacy of Gandhaka Churna in Patients sufferingfrom Vicharchika.Ruksha: Vata Dosha is invariably involved in all the Maha Kushta as well asKshudra Kushta. The morbid Vata Dosha involving he Rasa Dhatu in the Tvak leadsto Rukshata in the lesions of Vicharchika. Alleviation of Vata Dosha and normalisingthe Rasa Dhatu helps in relieving the symptom Rukshata. In the present studyreduction in the Rukshata by about 39 % proves the effect of Gandhaka Churna in thisregard in Patients suffering from the Vicharchika.In a nut shell, 20 Patients of either sex suffering from Vicharchika between the agegroup of 16 to 70 were subjected to single blind clinical study of pre test post testdesign, treated with oral medication of Gandhaka Churna in a dose of 500 mg twice aday for 28 days with an anupana of milk. The study showed statistically significantimprovement in almost all the outcome measures of Vicharchika that included Kandu,Srava, Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification, Extentof body region affected, and SCORAD. This implies that the Gandhaka Churna iseffective in the correction of all the morbidities of Vata, Pitta, Kapha, Rasa, Rakta,Mamsa and Lasika that are invariably involved in Vicharchika. Though this is thefact, it is also true that the improvement observed is not complete. As the Vicharchikais caused due to Bahu Doshavastha, Shodhana is essential to cure the illness. In thepresent study only the Shamana medication with Gandhaka Churna is tried givingpartial improvement. Needless to say the Shamana medication with Gandhaka Churnawith prior Shodhana treatment may ensure complete remission of the illnessVicharchika. On the other hand, Vicharchika is a chronic lingering disease, theGandhaka Churna is tried only for 28 days showing partial response. Therefore it maybe suggested to increase the duration of treatment until complete remission of theillness. From this discussion it can be confidently said that, Gandhaka Churna is veryeffective in the treatment of Vicharchika Roga, and for better results the pre-treatmentwith Shodhana and longer duration of Shamana with Gandhaka Churna ensures bestresults. Also this study paves for further planning of the clinical study to know theadditional effect of Shodhana treatment which is essential in the treatment of chroniclingering disease like Vicharchika.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”    87   
    • Conclusion   CONCLUSION20 patients of either sex suffering from Vicharchika between the age group of 16 to70 years who attended the SDM Ayurveda Hospital were subjected to single blindclinical trial of pre test post test design. The patients were treated with oral medicationof Gandhaka Churna in a dose of 500 mg twice a day for 28 days with an anupana ofmilk. After completion of the study the following are the conclusions drawn. Vicharchika is a Kshudra Kushta caused due to the morbidity of all the three dosha involving Tvak, Rakta, Mamsa and Lasika. Minimal or no Purvarupa and less severe Rupa characterises Ksudra Kushta and so also Vicharchika. Morbid Kapha Dosha predominates the Samprapti of Vicharchika and the same is reflected in Rupa. Viruddha Ahara and Viruddha Vihara is main cause for the disease Vicharchika. Atma Asatmya is one of the common Nidana for Vicharchika and comes under Atma Satmya Viruddha Nimittaja Vyadhi. The clinical symptoms of Vicharchika are akin to atopic dermatitis to a larger extent. Acute Atopic Dermatitis simulates the Sravi Vicharchika and Chronic Atopic Dermatitis simulates the Asravi Vicharchika. Gandhaka Churna is effective in reducing the severity of symptoms of Vicharchika. Marked reduction in the mean VAS score of outcome measures – Kandu, Srava, Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification and extent of body region affected are recorded and are mostly statistically highly significant. Gandhaka Churna effectively reduces the severity of Vicharchika. Severity of Vicharchika as assessed by SCORAD index showed statistically significant reduction. Comparatively better response may be expected if this treatment is added with Shodhana treatment or by increasing the duration of medication with Gandhaka Churna.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   88  
    • Summary   SUMMARYVicharchika is a chronic relapsing skin disorder which in reality challenge to thewhole medical field as the complete cure to this illness is a remote possibility. Nodoubt the illness is not fatal, but the illness Vicharchika pose embarrassment to thehuman community due to the intolerable itching, discoloration and disfigurement.More to add, this illness Vicharchika is one among the eleven Kshudra Kushta and ischaracterised by itching, profuse discharge, papulation with discoloration, dryness ofthe skin, cracking and pealing of skin, Lichenification and pain. Nevertheless,Recurring skin rashes, redness, skin oedema, itching, dryness, crusting, flaking,blistering, cracking, oozing, or bleeding are the typical clinical manifestations ofAtopic Dermatitis. Atopic Dermatitis is an outcome of Hypersensitivity reaction thereis no definite treatment for the same. Shodhana and Shamana measures are proved tobe efficacious in the treatment of Vicharchika. Review of previous work done revealsthat meagre numbers of clinical trials have been carried out establishing the evidenceof effect of Shamana therapy in the management of Vicharchika. Hence any attemptof clinical work in this regard is justified. With is intension the present study entitled“A clinical study to evaluate the therapeutic effect of Gandhaka Churna inVicharchika” is planned.Objective i. Assay of the literature exploring the equation of Vicharchika and Atopic Dermatitis as well as establishing the modality of treatment of Satmya Viruddha Nimittaja Vyadhi with special reference to Vicharchika. ii. To explore the therapeutic effect of Gandhaka Churna on the activity of the disease in patients suffering from Vicharchika / Atopic Dermatitis. iii. To evaluate the remission of the symptoms of Vicharchika / Atopic Dermatitis in patients treated with Gandhaka Churna.Design of StudyA single blind clinical study with pre test and post test design.Settings SDM Hospital of Ayurveda , Udupi, Karnataka.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 89 
    • Summary  Diagnostic Criteria • Presence of symptoms of Vicharchika that include Kandu, Pidaka, Bahusrava, Ruja and Ruksha. • Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis. Inclusion Criteria • Patients fulfilling the criteria of diagnosis with no restriction of sex and religion. • Patients aged between 16 – 70 years.Exclusion Criteria • Patient with any other systemic illness like Diabetes Mellitus. • Patient suffering from Allergic manifestation like Bronchial Asthma. • Children and elderly patients beyond the age group of 16 to 70 years.Outcome Measures • Kandu, Ruja, Bahusrava, Pidaka, Vaivarnya, Rukshana, Daha were assessed by adapting Visual Analogue Scale. • SCORAD Index for Severity Scoring of Atopic Dermatitis.InterventionSelected 20 patients were treated with oral administration of Gandhaka Churna withdose of 500mg twice daily before intake of food during morning and night continuedfor 28 days. 100ml milk is used as anupana along with Gandhaka Churna.Observation & Results30 % of patients of Vicharchika were in the age group 46-55; 70% were males andremaining 30% were females; 20% of patients were either students or housewives;80% were Hindu; 50% had higher secondary education; 65% of patients weremarried; 60% belonged to the middle socio economical class and 85% patients werefrom urban area.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 90 
    • Summary  It is observed that 50% of the patients presented with Pittakapha Prakruti; MadhyamaSara was recorded in 90%; Sama Pramana was identified in 95% of patients; 65% ofthem had Madhyama Satva; Avara Satmya was identified in 55%; Pravara VyayamaShakti was revealed in 70%;50% belonged to Madhyama Ahara Shakti and 70%subjects had no addiction.Exploration of nidana in 20 subjects revealed that 80% had erroneous food habits ascausative factor. Minimal number of Purvarupa of Kushta was identified in only 25 %of patients of Vicharchika. All the 20 patients presented with Vaivarnya and Pidaka asleading presenting symptom.The administration of Gandhaka Churna was found to be effective in reducing theKandu (Itching). The mean VAS score for Kandu prior to the treatment was 8.05which reduced to 2.700 after the treatment with mean difference of 5.350. Theanalysis by applying the paired t test proved the statistical significance of theimprovement as P=<0.001.The mean VAS score of Discharge (Srava) reduced from initial value of 4.350 to1.350 after the treatment, with a difference of 3.000.The mean VAS score of Vaivarnya prior to the treatment was 7.900. After thetreatment the same reduced to 5.450.An initial mean VAS sleep score was 6.400 in 20 patients suffering from Vicharchika.The value dropped to 2.950 following the treatment thus recording good improvementby the medication.The severity of pain reduced to a larger extent by the medication with GandhakaChurna in all the 20 patients. The mean VAS score prior to the treatment was 6.143which reduced to 2.714 with mean difference of 3.429 after treatment.The eruption of papules reduced markedly following the treatment with GandhakaChurna. The mean score Pidaka prior to the treatment was 2.250, which reduced to1.250 with mean difference of 1.000 after treatment.The administration of Gandhaka Churna was found to be effective in reducing theSCORAD. The mean score prior to the treatment was 47.000 which reduced to 26.350with mean difference of 20.650 after treatment.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 91 
    • Summary  All these outcome measures were analysed by paired t test and the improvementfound by the medication was statistically highly significant confirming the efficacy ofGandhaka Churna in the remission of Vicharchika.Discussion20 Patients of either sex suffering from Vicharchika between the age group of 16 to70 were subjected to single blind clinical study of pre test post test design, treatedwith oral medication of Gandhaka Churna in a dose of 500 mg twice a day for 28 dayswith an anupana of milk. The study showed statistically significant improvement inalmost all the outcome measures of Vicharchika that included Kandu, Srava,Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification, Extent ofbody region affected, and SCORAD. This implies that the Gandhaka Churna iseffective in the correction of all the morbidities of Vata, Pitta, Kapha, Rasa, Rakta,Mamsa and Lasika that are invariably involved in Vicharchika. Though this is thefact, it is also true that the improvement observed is not complete. As the Vicharchikais caused due to Bahu Doshavastha, Shodhana is essential to cure the illness. In thepresent study only the Shamana medication with Gandhaka Churna is tried givingpartial improvement. Needless to say the Shamana medication with Gandhaka Churnawith prior Shodhana treatment may ensure complete remission of the illnessVicharchika. On the other hand, Vicharchika is a chronic lingering disease; theGandhaka Churna is tried only for 28 days showing partial response. Therefore it maybe suggested to increase the duration of treatment until complete remission of theillness. From this discussion it can be confidently said that, Gandhaka Churna is veryeffective in the treatment of Vicharchika Roga, and for better results the pre-treatmentwith Shodhana and longer duration of Shamana with Gandhaka Churna ensures bestresults. Also this study paves for further planning of the clinical study to know theadditional effect of Shodhana treatment which is essential in the treatment of chroniclingering disease like Vicharchika.ConclusionGandhaka Churna is effective in reducing the severity of symptoms of Vicharchika.Marked reduction in the mean VAS score of outcome measures – Kandu, Srava,Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification and extent ofbody region affected are recorded.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 92 
    • Bibliographic References    BIBLIOGRAPHIC REFERENCES 1) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.285. 2) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451. 3) Joahne C, Kooper K. Hand out on health: Atopic dermatitis. NIAMS. 1999 [ cited 20 Oct 2010] NIH Publication No 03-4272;. Available from: URL: http// www. niams.nih.gov/Health-info/Atopic-Dermatits-hoh.pdf 4) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451. 5) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.286 6) Ketan Bhimani. Comparative study of Virechana karma and Jalaukavacharana in the management of Vicharhika.(Unpublished Doctoral Dissertation, IPGT&RA GAU,Jamnagar2005) p.241. 7) Parek Seema H. Vicharchika rog ka nidana samprapti vivechana evam amrita guggulu va vishwamitra kapala taila ka prabhavatmaka adhyayana .(Unpublished Doctoral Dissertation, IPGT&RA, GAU, Jamnagar 2001) p.135. 8) M.G Rajalaxmi. The efficacy of virechana in the management of vicharchika. (Unpublished Doctoral Dissertation, Ahmedabad 2005)p.181. 9) Pandeya Vivekanada. Sahasra yoga. New Delhi: Vangmaya anusandhana Ekak Kendreeya Ayurveda Evam Sidda Anusandhana Parishad;1990 . Pp. 621 p.181.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   93   
    • Bibliographic References    10) Dvivedi Kapila Deva, Vedon Me Ayurveda.Jnana Pura: Vishwa Bharati Anusandhana Parishat;2001.Pp.296; p.69. 11) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451. 12) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.179. 13) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.151. 14) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.288-289. 15) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.524. 16) Bhela, Bhela samhita, Edited by prof. P.V Sharma,. Varanasi: Choukhambha Vishvabharati, Reprint 2000; Pp.660; p.150. 17) Harita, Harita Samhita, with Asha Hindi commentary, Edited by Ramanath Shastri,Varanasi, Prachya Prakashan, Reprinted in 1985; Pp.456; p.366. 18) Vriddha Jivaka, Kashyapa Samhita with Vidyotini Hindi Commmentory, Edited by. Pandit Hemaraj Sharma, Varanasi: Choukhambha Sanskrit Series, Reprinted in 2000; Pp.364, p.115. 19) Bhavamishra, Bhavaprakasha, with the Vidyotini Hindi commentary Edited by bhishagratna pandit shri Brahma Shankara Mishra, volume.2, 7th Edition, Varanasi: choukhambha Sanskrit Sansthan, 2000; Pp.836, p. 53.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   94   
    • Bibliographic References    20) Shodhala, Gadanigraha, with Vidyotini Hindi Commentary by Shri Indradeva Tripathi,Part.2, Kayachikitsa khanda; 3rd Edition, Varanasi, Choukhambha Sanskrit Sansthan, 1990; Pp.871, p.758. 21) Syara Raja Radhakantdeva Bahadur, Shabdakalpadruma, Dvitiya khanda, Reprint.1988, Delhi, Nag Publishers; Pp-565;p.378. 22) Vachaspatyam, Brihat Sanskritabhidhanam compiled by Shri Taranath Tarkavachaspati, 6th Volume, Reprint.1962, Varanasi, Choukhambha Sanskrit Series; Pp.5442;p.4876.23)Amarsimha, Namalinganusasana or Amarkosha with the Ramashrami commentary of Bhanuji Dikshita and Maniprabha Hindi commentary Edited by Pandit Haragovinda Shastri, 3rd Edition,Varanasi, Choukhambha Sanskrit Sansthan, 1997; Pp.668. 24) Syara Raja Radhakantdeva Bahadur, Shabdakalpadruma, Dvitiya khanda, Reprint.1988, Delhi, Nag Publishers; Pp-565; p.378. 25) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451.26) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.285. 27) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.452. 28) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.287. 29) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.150-151.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   95   
    • Bibliographic References    30) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 31) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.217,450. 32) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.282. 33) Vriddha Vagbhata, Ashtanga sangraha with Shashilekhayakhya commentary by Indu, Edited by Dr.Shivaprasad Sharma, Varanasi, Chaukhambha Sanskrit series office, 2008; Pp.965, p.408. 34) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.524. 35) Bhela, Bhela samhita, Edited by prof. P.V Sharma,. Varanasi: Choukhambha Vishvabharati, Reprint 2000; Pp.660; p.62-63. 36) Harita, Harita Samhita, with Asha Hindi commentary, Edited by Ramanath Shastri, Varanasi, Prachya Prakashan, Reprinted in 1985; Pp.456; p.366. 37) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.443. 38) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.217-218. 39) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.282.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   96   
    • Bibliographic References    40) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.288. 41) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.286. 42) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.216. 43) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.288. 44) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.285. 45) Dr.Shah.N.Siddharth, API Text Book of Medicine, Edited by Aspi. R.Bilimoria, Sandhya . A. Kamath, Dilip R. Karnad et.al, 8th ed, vol II, Mumbai, Association of Physicains of India: 2008, Pp.1624, p.1440-1441. 46) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.288. 47) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 48) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   97   
    • Bibliographic References    Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 49) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.288. 50) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451. 51) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 52) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.525. 53) Bhela, Bhela samhita, Edited by prof. P.V Sharma,. Varanasi: Choukhambha Vishvabharati, Reprint 2000; Pp.660; p.146. 54) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451. 55) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 56) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.525.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   98   
    • Bibliographic References    57) Bhela, Bhela samhita, Edited by prof. P.V Sharma,. Varanasi: Choukhambha Vishvabharati, Reprint 2000; Pp.660; p.146. 58) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.195. 59) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.218. 60) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 61) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.525. 62) Vriddha Vagbhata, Ashtanga sangraha with Shashilekhayakhya commentary by Indu, Edited by Dr.Shivaprasad Sharma, Varanasi, Chaukhambha Sanskrit series office, 2008; Pp.965, p.408. 63) Bhela, Bhela samhita, Edited by prof. P.V Sharma,. Varanasi: Choukhambha Vishvabharati, Reprint 2000; Pp.660; p.146. 64) Vriddha Jivaka, Kashyapa Samhita with Vidyotini Hindi Commmentory, Edited by. Pandit Hemaraj Sharma, Varanasi: Choukhambha Sanskrit Series, Reprinted in 2000; Pp.364, p.115. 65) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.124. 66) Dr.Shah.N.Siddharth, API Text Book of Medicine, Edited by Aspi. R.Bilimoria, Sandhya . A. Kamath, Dilip R. Karnad et.al, 8th ed, vol II, Mumbai, Association of Physicains of India: 2008, Pp.1624, p.1381.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   99   
    • Bibliographic References    67) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.451. 68) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.285. 69) Vriddha Vagbhata, Ashtanga sangraha with Shashilekhayakhya commentary by Indu, Edited by Dr.Shivaprasad Sharma, Varanasi, Chaukhambha Sanskrit series office, 2008; Pp.965, p.409. 70) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.525. 71) ) Vriddha Jivaka, Kashyapa Samhita with Vidyotini Hindi Commmentory, Edited by Pandit Hemaraj Sharma, Varanasi: Choukhambha Sanskrit Series, Reprinted in 2000; Pp.364, p.115. 72) Bhela, Bhela samhita, Edited by prof. P.V Sharma,. Varanasi: Choukhambha Vishvabharati, Reprint 2000; Pp.660; p.151. 73) Harita, Harita Samhita, with Asha Hindi commentary, Edited by Ramanath Shastri, Varanasi, Prachya Prakashan, Reprinted in 1985; Pp.456; p.366. 74) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.107. 75) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.561. 76) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   100   
    • Bibliographic References    Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.219. 77) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.288. 78) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.218. 79) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.219. 80) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.62. 81) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.283. 82) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.452. 83) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.443,446. 84) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   101   
    • Bibliographic References    Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.453. 85) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.455. 86) Yogaratnakara, with Vidyotini Hindi commentary,Uttarardha; edited by Bhrahma Shankara shastri, Varanasi: Chaukambha Prakashan; 2007, Pp.504, p.215. 87) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.443,442. 88) Agnivesha, Charaka Samhita revised by Charaka & Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta and Jalpa Kalpa Taru Commentary By Gangadhara,Vol.3 2nd edition. Varanasi: Choukhamba Sanskrit Sansthan; 2002. Pp.3828; p.1707. 89) Vriddha Vagbhata, Ashtanga Sangraha with Shashilekhayakhya commentary by Indu, Edited by Dr.Shivaprasad Sharma, Varanasi, Chaukhambha Sanskrit series office, 2008; Pp.965, p.104. 90) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.134. 91) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.134. 92) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738;p.237.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   102   
    • Bibliographic References    93) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.151. 94) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738;p.51. 95) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005, Pp.956; p.137. 96) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.151. 97) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.151. 98) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.151. 99) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.151. 100) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.455.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   103   
    • Bibliographic References    101) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005,Pp.956; p.712. 102) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.442. 103) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.455. 104) Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana and Nyayachandrika commentary by Gayadasa, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Pp.824; p.442. 105) Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 , Pp.956; p.712. 106) Pandeya Vivekanada. Sahasra yoga. New Delhi: Vangmaya anusandhana Ekak Kendreeya Ayurveda Evam Sidda Anusandhana Parishad;1990 . Pp. 621 p.181. 107)Plants of Ayurveda(Version 1.0) , CD-R)M on Dravyaguna, Sponsered by Ministery of Environmental And Forests, Government Of India, New Delhi And RGUHS, Bangalore, Karnataka, Designed and developed by Foundation for revitalization of Local Health Traditions, Bangalore. 108) Plants of Ayurveda(Version 1.0) , CD-R)M on Dravyaguna, Sponsered by Ministery of Environmental And Forests, Government Of India, New Delhi And RGUHS, Bangalore, Karnataka, Designed and developed by Foundation for revitalization of Local Health Traditions, Bangalore. 109) Plants of Ayurveda(Version 1.0) , CD-R)M on Dravyaguna, Sponsered by Ministery of Environmental And Forests, Government Of India, New“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   104   
    • Bibliographic References    Delhi And RGUHS, Bangalore, Karnataka, Designed and developed by Foundation for revitalization of Local Health Traditions, Bangalore. 110) Sharma Sadananda, Rasa Tarangini, with Rasavijnana Hindi commentary by Kashinatha Shastri, 11th edition. Delhi: Motilal Banarasidas; 1979. Pp772; p174-182. 111) Sharma Sadananda, Rasa Tarangini, with Rasavijnana Hindi commentary by Kashinatha Shastri, 11th edition. Delhi: Motilal Banarasidas; 1979. Pp772; p71-77. 112) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.132. 113) Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2001. Pp.738; p.23.“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   105   
    • Annexure  S.D.M. COLLEGE OF AYURVEDA & HOSPITAL, UDUPI. DEPARTMENT OF P.G. STUDIES IN KAYA CHIKITSA Patient Inclusion/Exclusion Form Case Number ( ) Name: Age: Sex : M/F Address: Screening of the Patient Symptoms Kandu Sraava Vaivarnya Pidaka Rookshata Relapsing P A P A P A P A P A P ASite of lesions Scalp, Face Neck ,Trunk, Hands, Wrists, Ankles, Feet , Fingers,Toes Exclusion CriteriaDiabetic Mellitus RBS : ____ mg/dl YES NOBronchial Asthama Case : ACCEPTED REJECTED SI No: Case Number ( ) Name: Age: Sex : M/F Address: Screening of the Patient Symptoms Kandu Sraava Vaivarnya Pidaka Rookshata Relapsing P A P A P A P A P A P ASite of lesions Scalp, Face Neck ,Trunk, Hands, Wrists, Ankles, Feet , Fingers,Toes Exclusion CriteriaDiabetic Mellitus RBS : ____ mg/dl YES NOBronchial Asthama Case : ACCEPTED REJECTED SI No: “A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   106 
    • Annexure  ²æà zsÀªÀÄð¸ÀܼÀ ªÀÄAdÄ£ÁxÉñÀégÀ D0iÀÄĪÉðÃzÀ ªÀĺÁ«zÁå®0iÀÄ, PÀÄvÁàr GqÀĦ «ZÀaðPÀ gÉÆUÀzÀ ªÉÄÃ¯É UÀAzsÀPÀ ZÀÆtð ¥Àæ0iÉÆÃUÀzÀ CzsÀåAiÀÄ£À C¨sÀåyð ¸ÀªÀÄäw ¥ÀvÀæ------------------- JA§ £Á£ÀÄ F ªÉÄîÌAqÀ AiÉÆÃd£ÉAiÀÄ ¸ÁgÁA±ÀzÀ «ªÀgÀuÉ¥ÀqÉ¢zÀÄÝ, ¸Àé EZÉÒ¬ÄAzÀ F AiÉÆÃd£ÉAiÀÄ°è M¼À¥ÀqÀ®Ä M¦àzÉÝãÉ.F CzsÀåAiÀÄ£ÀzÀ°è £À£ÀߨsÁUÀªÀ»¸ÀÄ«PÉ £À£ÀUÉ ¯Á¨sÀzÁAiÀÄPÀªÁUÀzÉ EgÀ§ºÀÄzÀÄ JAzÀÄ £Á£ÀÄ w½¢zÉÝãÉ.EzÀgÀ GzÉÝñÀ¸ÁzsÀPÀ,¨ÁzsÀPÀUÀ¼À£ÀÄß £À£Àß vÀȦÛUÉ vÀPÀÌAvÉ £À£ÀUÉ «ªÀj¸À®ànÖzÉ.F ªÀÄÆ®PÀ FAiÉÆÃd£ÉAiÀÄ°èM¼À¥ÀqÀ®Ä £Á£ÀÄ ¸ÀªÀÄäw ¸ÀÆa¸ÀÄwÛzÉÝãÉ.£Á£ÀÄ AiÀiÁªÀÅzÉà PÁgÀtªÀ£ÀÄß PÉÆqÀzÉà F AiÉÆÃd£É¬ÄAzÀ AiÀiÁªÀÅzÉà ¸ÀAzÀ¨sÀðzÀ°è »AzɧgÀĪÀ D¢üPÁgÀªÀ£ÀÄß ºÉÆA¢gÀĪÀ §UÉÎ w½¢zÉÝãÉ.¢£ÁAPÀ:¸ÀÞ¼À : ªÀåQÛAiÀÄ ºÀ¸ÁÛPÀëgÀ¢£ÁAPÀ:¸ÀÞ¼À : ªÉÊzÀågÀºÀ¸ÁÛPÀëgÀ“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   107 
    • Annexure  Patient’s Consent Letter Form I ………………………………….. aged…………….. yearsR/O………………………….. is exercising my free power of choice, hereby give myconsent to be included as a trial subject in the clinical research subject ‘A clinicalstudy to evaluate the therapeutic effect of gandkaka churna in vicharchika’. Iunderstand that I may be treated with drug for the disease with which I am suffering. Ihave been informed to my satisfaction the aim, objective of the clinical trial,ingredients of the trial drug treatment and follow up including laboratoryinvestigations to monitor and safeguard my body functions as when required. I amalso aware of the right to opt out of the trial at any time during the course of mytreatment .I will not make any compensatory claim for any hazardous effects on meduring the treatment.Date…………… Patient’s signaturePatient has signed the decleration and has given consent.Signature of the research scholar……………………………………………..“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   108 
    • Annexure  SDM COLEGE OF AYURVEDA AND HOSPITAL, UDUPI DEPARTMENT OF KAYA CHIKITSA IN P.G. STUDIES RESEARCH PROFORMA FOR M.D. (AYU) THESIS “A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA IN VICHARCHIKA” Scholar:  Dr. YOGEESHA ACHARYA  Atura VivaraName- Sl.No:Age: yrs OPD/IPD:Sex: M/F Date:Religion – H/M/Ch Ward/Bed No:Education – UE/P/M/HS/GR/PG D.O.A:Marital Status – M / UM/ W / D D.O.D :Socio-economic Status : VP/ LM / M / UM / R Treatment Started on :Occupation – Treatment Completed on:Place – U / RPostal address - Vedana Samuchraya- Pradhana vedana Duration Site 1 Vedana-kandu/daha/ruja 2 Pidaka 3 Vaivarnya- shyavata/rakta/Krishna 4 Srava-tanu/gadha/bahu/alpa 5 Ruksha/kharatva 6 Raji 7 Shotha/bahalatva 8 Relapsation“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   109 
    • Annexure Anubandhi vedana-History of Present Illness-Pidaka/ Skin lesion Onset of skin lesion-Sudden/Gradual/Insidious Duration-Acute/sub acute/chronic Progress and present status- Site of onset-head&neck/face/arms/hands/wrists/trunk/legs/feet Characterof lesion-Nummular/anular/cricinate /arcuate/ gyrate/linear/grouped/ reticulateNo of lesions-At beginning/PresentExtent of the lesion: head&neck/face//trunk/arms/hands/wrists/legs/feet/fingers/ toesFactor aggravating the symptoms: chemicals/dyes/earrings/necklace/chappals/dust/pores/pollens/ spring/autumnFactor reliving the symptoms:Kandu/ Pruritis Course : Progressive / Episodic / Continuous Severity : Mild, localized, relieved spontaneously or any local measures Intense or widespread. Relieved by systemic methods or spontaneously. Intense or widespread. Poorly controlled by treatment Site : head&neck/face//trunk/arms/hands/wrists /legs/feet/fingers/ toes Aggravating Factor : Seasonal / Diurnal / Nocturnal / dust/pores/pollens/food Relieving Factor : Seasonal / Diurnal / NocturnalSrava/Discharge Onset of Discharge - Sudden/Gradual/Insidious Duration-Acute/sub acute/chronic Site of Discharge - head&neck/face/trunk/arms/hands/wrists/legs/feet/fingers/ toes“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   110 
    • Annexure  Character of Dischrge – Serous/purulent-Profuse/moderate/less Aggravating Factor : Seasonal / Diurnal / Nocturnal / dust/pores/pollens chemicals/food Relieving Factor : Seasonal / Diurnal / NocturnalVaivarnya/Discolouration Onset of Discolouration - Sudden/Gradual/Insidious Duration: Site of Discolouration: Colour: Black/Red/ShyavaVedana/Pain : Character : Ruja/ Daha : Onset : Sudden / Gradual Site : head&neck/face//trunk/arms/hands/wrists /legs/feet/fingers/ toes Course : Progressive / Episodic / Continuous Aggravating Factor :Food / spring/autumn Relieving Factor :Treatment taken so far: Type Variety Duration EffectAyurveda Shodhana/shamanaAllopathy Oral/parentalOtherHistory of past Illness-DM HTNBR.ASTHAMA Skin diseasesFamily history Family Age Living/dead Health status Allergy like asthma Allergy like eczemaFatherMotherBrother“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   111 
    • Annexure SisterSonDaughterH/WSocio economic historyPersonal History Ahara Appetite- G/M/P Diet- Nature- Veg/Mix/Non-veg Break Fast- Mid Morning- Lunch- Snacks in Evening- Habits- Samshana / Vishamashana / Adhyashana / Anashan / Pramitashan Fruits- Regular/ occasional Rasapradhana- M / A / L / K / T / KS / SR Any sp.allergy of perticular rasa/food: Supplementary Diet – tea / coffee / milk / cold drinks Water Intake – Every morning / during or After Lunch/ Dinner Day + Night – It’s TotalCold Beverages – Regular / OccasionalButter milk/Curds: Regular / OccasionalSpicy Foods- Regular / OccasionalFried Items- Regular/ OccasionalJunk Foods- Regular/ OccasionalIce Cream- Regular/ OccasionalFish/milk: Regular / OccasionalViharOccupational History- Nature of Work- Physical/ Mental/ Sedentary/ Moderate/ Heavy Time of Work- Day/ NightContact:chemicals Day-Night hrs“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   112 
    • Annexure Exercise- Regular/ Irregular/ Occasional/ Only Routine WorkVishrama- Proper/less/excessiveSleep- Sound/ Irregular/ Disturbed/ Delayed/ Staying AsleepNight- hrs Days- hrsAddictions- No Habits/ Smoking/ Tobacco/ Alcohol/ OthersBowel- Regular/ Irregular/ Constipated/ Loose SoftNo. of Frequency- /times daysMicturition- Regular/ Irregular/scanty/excessive Times/day Times/nightSnana-daily/irregularPsychological Factors-Stress Evaluation: Sadness/ Guilt/ Anxiety Somatic/ Anxiety Psychic/ Insomnia/Retardation :Work & Activities/Loss of Insight/ Decreased Appetite/Hair Loss/ Hair graying. Obstetric History- Gravida- Parity-Live- Dead-Gynecological History- Menarche : yrsMenstrual Cycle- /daysRegular/ IrregularMenopause: yrsAssociated SymptomsAtura Bala Pariksha-1. Prakruti : V/P/K/VP/PK/KV/Sama2. Vikruti :3. Sara : Pravara / Madhyama / Avara4. Pramana : Sama / Madhya / Heena5. Samhanana : Pravara / Madhyama / Avara6. Satwa : Pravara / Madhyama / Avara7. Satmya : Pravara / Madhyama / Avara“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   113 
    • Annexure 8. Vyayama Shakti : Purvakalina - Pravara / Madhyama / Avara Adhyatana - Pravara / Madhyama / Avara9. Ahara Shakti : Abhyavaharana : Purvakalina - Pravara / Madhyama /Avara Adhyatana - Pravara / Madhyama / Avara Jarana: Purvakalina - Pravara / Madhyama / Avara Adhyatana - Pravara / Madhyama / Avara10. Vaya : Vruddhi/Yauvana / Sampurnata /ParihaniAshtasthana Pareeksha- Nadi- Mala- Mootra- Jihwa- Shabda- Sparsha- Drik- Akrut-I. General Examination-1. Built-2. Nourishment-3. Nails-4. Conjunctiva-5. Cyanosis-6. Deformities-7. JVP- Normal/ Raised8. Oedema- Present/ Absent ; Pitting/ Non PittingRegion-9. Lymph Nodes- palpable/nonpalpable10. Pulse-11. Respiratory rate-12. Blood pressure- mm of Hg“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   114 
    • Annexure 13. Temperature- II. Systemic Examination- Respiratory System – Cardiovascular System – Central Nervous System – Gastrointestinal System –Skin Examination- INSPECTION: 1) Extent&Distribution-Symmetrical/asymmetrical/localized2) Color of skin: Hypo pigmentation –Hyper pigmentation – Color- Generalised/ liocalised Persistent/ Intermittent3) State of skin: Sweating- absent/increased/decreased/normal/local/generalCold & Clammy skin- P/AGreasiness- P/AWrinkling- P/ATense skin- P/AElasticity- N/I/DThickness- N/I/R Primary lesions Primary Shape Size Colour Distribution Margin Surface lesionMaculePapuleVesicleNodulePustulePlaque“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   115 
    • Annexure  Secondary lesions Secondary lesions Shape Size Colour Distribution Margin SurfaceExcoriationScalingCrustingErosionInvestigations –Hematological investigation –TC: DC: ESR: HB%: RBS: FBS:Any relevant investigation –NidanaAharajaViruddha ahara- lavana+dugdha milk+amla dravyaTila+guda+dadhi matsya+dugdhaGarishta ahara- curd,fish,fermented food,drava,guru,sneha bahula,gramya anoopauadaka mamsa sevanaFast foods – idli,dosa,pizza,burger,sandwitchAsatmya ahara- sour food like cocum,pickle,vinegar,cold drinks,backingpowder,ushna-teekshna ,vidahi ahara,mulaka,garlic,onion,excessive intake of tilalavana amla and navannapana,ViharajaVega dharana,ati vyayama after eating,Panchakarma apachara, after excersise/sunexposure/fear taking cold water Exposure to sun after heavy meal,divasvapna,Livingin polluted environment,Allergy to any substance-Manasika- bhaya,chinta shoka krodha etc“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   116 
    • Annexure  Purva roopa:Asvedanam Kharatva DahaAtisvedanam Ushmayana TvakparooshataVaivarnya Gourava RomaharshaKandu Sparsha ajanatva AngapradeshasvapaToda Unnata KrishnataAtishlakshna Kotha SheegrautpattichirasthitaSuptata Sharma NimittealpeapikopanamParidaha KlamaLomaharsha Vranadhikata RUPAVata Pitta KaphaRoukshya Daha SheetataShosha Raga Shveta varnataToda Paka UtsedaAyama Parisrava SnigdhataParushata Visragandha KanduKharata Kleda SthirataHarsha Angapatana GouravataShyava arunata Tvak swapa KledaSparsha hani Krimi utpattiPidikodgama GhanaDUSYATAHA PARIKSHARAKTA-atisveda,romaharsha,kandu,durgandha,suptiLasika – alpasveda,avila mutrata,daurgandhya,kotha,kanduTvak – sparshahani,rukshata,sveda,kandu vaivarnyaMamsa - bahala,toda,sphota, sthira, karkasha“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   117 
    • Annexure SAMPRAPTI GHATAKANidana : Aharaja/Viharaja/ ManasikaDosha : V/P/KDushya : Tvak/Rakta/mamsa/laseekaSrotas : Rasa/Rakta/MamsaSroto dusti :Agni : vishama /tikshns/manda/samaAma : Jatharagni / DhatwagniUdbhava sthana : Amasaya / Pakwasaya / Ama pakwasayaSanchara sthana :Vyakta sthana :Roga marga : BahyaVYADHI VINISCHAYAVicharchika: Ati kandu/shyava pidaka/ bahusrava/atiruja/raaji/ruksha/dahaSADHYASADHYATA :UPADRAVA :CHIKITSA: Oral administration of Gandhaka churna( capsule) 500mg bd before food. Anupana –100ml milk 28 days medicationDiet & regimen: Avoid hot oily spicy food Avoid contact with causative factor Adverse effect during treatment – yes/noFOLLOW UP INTERVIEW :“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   118 
    • Annexure  ASSESSMENT CRITERIA : SUBJECTIVESymtoms BT 7th Day 14th Day 21st Day 28th Day Fallow up period 6th week 8th weekItchingDischargeDiscolourationSleep lossPainBurning OBJECTIVESigns BT 7th Day 14th Day 21st Day 28th Day Fallow up period 6th week 8th weekPapulationDrynessLichenificationExcoriationBody region “A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   119 
    • Annexure The SCORAD Index for Severity Scoring of Atopic Dermatitis PARAMETERS POINTS BT 7thday 14thday 21s day 28th day 6th week 8th weekBody Region (A)ErythemaPapulationOozing (B)ExcoriationLichenificationDrynessPruritisLoss of sleep (C)SUMSCORAD index = (A / 5) + (7 * B / 2) + CSignature of the Guide Signature of the Scholar“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika”   120 
    • Visual Analogue Scale  Symptom        BT  7th day    14th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |          0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10          Discharge              21st day              28th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |      0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10        BT  7th day  14th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |       0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10        Itching  21st day  28th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |      0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10            BT  7th day    14th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |     Loss of   0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10        sleep              21st day              28th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |      0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10        BT  7th day  14th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |       0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  Discolouration        21  day  st 28th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |      0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10      121  
    •   Symptom        BT  7th day    14th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |        0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  Pain                       21st day              28th day      |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |         0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10        BT  7th day  14th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |       0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10        Burning  21st day  28th day    |   |   |   |   |   |   |   |   |   |  |    |   |   |   |   |   |   |   |   |   |  |      0    1   2   3   4    5    6    7  8   9   10  0    1   2   3   4    5    6    7  8   9   10     122  
    •                    Parada Gandhaka     Bakuchi               Bhringaraja Kakamachi Capsules of Gandhaka Churna