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A Clinical Evaluation of Efficacy of Khadiradi Yoga Avachurnana in Kacchu w.s.r. to genito-inguinal intertrigo, Shubha, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. …

A Clinical Evaluation of Efficacy of Khadiradi Yoga Avachurnana in Kacchu w.s.r. to genito-inguinal intertrigo, Shubha, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI


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  • 1. “A Clinical Evaluation of Efficacy of Khadiradi Yoga Avachurnana in Kacchu w.s.r. to genito-inguinal intertrigo ” By DR. SHUBHA, B.A.M.S. Dissertation submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of MASTER OF SURGERY (AYU.) In PRASUTI TANTRA AND STREE ROGA Under the guidance of Dr. MAMATHA K.V. M.D. (Ayu) Professor Dept of Prasooti Tantra and Stree Roga, S.D.M. College of Ayurveda, Udupi. Co-Guide Dr. Vidya Ballal. M.D. (Ayu) Lecturer Dept of Prasooti Tantra and Stree Roga, S.D.M. College of Ayurveda, Udupi. S. D. M. COLLEGE OF AYURVEDA, UDUPI 2008-09
  • 2. DEPARTMENT OF P. G. STUDIES IN PRASUTI TANTRA AND STREE ROGA S.D.M. COLLEGE OF AYURVEDA, UDUPI-574118 Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “A Clinical Evaluation of Efficacy of Khadiradi Yoga Avachurnana in Kachchu w.s.r. to genito-inguinal intertrigo”, is bonafide and genuine research workcarried out by me under the guidance of Dr. Mamatha K.V., Professor, Dept. ofPrasooti Tantra and Stree Roga and Co-Guide Dr. Vidya Ballal. Lecturer, Dept. ofPrasooti Tantra and Stree Roga, S.D.M. College of Ayurveda, Udupi. Dr. ShubhaDate: Dept. of Prasooti Tantra and Stree RogaPlace: Udupi
  • 3. DEPARTMENT OF P. G. STUDIES IN PRASUTI TANTRA AND STREE ROGA S.D.M. COLLEGE OF AYURVEDA, UDUPI-574118 CERTIFICATE BY THE GUIDEThis is to certify that “A Clinical Evaluation of Efficacy of KhadiradiYoga Avachurnana in Kacchu w.s.r. to genito-inguinal intertrigo”, isbonafide and genuine research work carried out by Dr. Shubha in partialfulfillment of the requirement for the degree of M.S. (Ayu) in Prasooti Tantraand Stree Roga, under my guidance. Signature of Guide Dr. MAMATHA K.V. M.D. (Ayu) Professor.Date: Dept.of Prasooti Tantra and Stree Roga, S.D.M.C.A, Udupi.Place: Udupi
  • 4. DEPARTMENT OF P. G. STUDIES IN PRASUTI TANTRA AND STREE ROGA S.D.M. COLLEGE OF AYURVEDA, UDUPI-574118 ENDORSEMENTThis is to certify that “A Clinical Evaluation of Efficacy ofKhadiradi Yoga Avachurnana in Kacchu w.s.r. to genito-inguinal intertrigo”, is bonafide and genuine research work carried outby Dr. Shubha under the guidance of Dr. Mamatha K.V., Professor, Dept. ofPrasooti Tantra and Stree Roga and Co-Guide Dr. Vidya Ballal, Lecturer Dept.of Prasooti Tantra and Stree Roga, S.D.M. College of Ayurveda, Udupi.Signature of H.O.D. Signature of PrincipalDr. V.N.K. USHA Dr.U.N. PRASAD.MD(Ayu) MD(Ayu)Dept. of Prasooti Tantra S.D.M.C.A, Udupi.and Stree Roga,S.D.M.C.A, Udupi.Date: Date:Place: Udupi Place: Udupi
  • 5. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA COPYRIGHT I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic / research purpose.Date:Place: Udupi DR. SHUBHA © Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. Acknowledgement
  • 7. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Acknolwedgement ACKNOWLEDGEMENTAt the very juncture of completing my dissertation work as a part of post graduationcurriculum, I would like to thank all the people who helped me directly or indirectly.On the occasion of completion of this work, I bow my head with utmost devotion toalmighty for blessing me with the courage to complete the post graduation.I would like to thank my parents without whom I would not have made this task and Ibow my head at their feet. I would like to thankSri. Ashok Raj Yermal, without whom, starting this task would have been a difficultone.I would like to thank Dr. D. Veerendra Hegde, who gave me the opportunity to do mymasters in his prestigious institution SDM College of Ayurveda, Udupi.I would like to express my deep gratitude towards my Honourable guide Dr. Mamatha.K. V., who is the backbone of my career as Obstetrician and who encouraged me inevery part of curriculum.I would like to thank my co-guide Dr. Vidya Ballal who supported me thorough outmy career in this institution.I express my sincere regard to Dr. VNK Usha, Dr. Krishna Bai, Dr. Ramadevi, Dr.Suchetha, and Dr. Veena for their invaluable support.I would like to pay my gratitude to Mrs. Anitha Kini, Microbiologist and Dr.Somayaji at KMC Manipal, Dr. Muralidhar Ballal, General Manager, SDM Pharmacyof Ayurveda, Dr. Chaitra, Dr. Rajalakshmi, Dr. Padmakiran, Dr. Srikanth, Dr.Niranjan, Dr. B. V. Prasanna, Dr. Muralidhara sharma, Dr. Sethumadhava, Dr.Sujatha, Mr.Harish Bhat, librarian for their timely help.Department of Prasooti Tantra and Stree Roga 2
  • 8. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” AcknolwedgementI would like thank Dr. Y.N. Shetty, and Dr. Deepak for giving me the opportunity todo my clinical trials in the hospital.I would like to thank my better half, who shouldered me in my all tasks and problems.I would like to thank my daughter and my in laws, my brothers for their love, care andsupport.I would like to thank my batch mates Dr. Sujatha, Dr. Shilpa, Dr. Sukanya, Dr. Kavyaand Dr. Vijayalakshmi for their timely help. I would like to thank my friends of otherdepartments for their timely support and help.I would like to thank hospital and pharmacy staff for their cooperation.Last but not the least my heartfelt thanks to all those people and friends who helpedme and encouraged me on the stage and off the stage.Department of Prasooti Tantra and Stree Roga 3
  • 9. Abstract
  • 10. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Abstract ABSTRACT Kachchu is a simple localised dermatological infection of the genito-inguinalregion, occurs because of unhygienic observance, manifests in the form ofinflammation followed by secondary bacterial or fungal infections and can be bestcorrelated to genito inguinal intertrigo. It is most prevalent in this costal region, obese females, pregnancy, andpuerperium and in perimenopausal women presenting with menorrhagia. In all theseconditions, improper disposal of sweat because of occlusion is the main aetiology. Even though it rarely causes systemic manifestations, its mere presence itselfis disturbing because of intractable itching and pain. It may delay the proper healingof episiotomy wound and may cause difficulty in walking because of severe pain. Candida powder is the highest selling medicine for the intertrigo as theincidence of intertrigo is as high as 40% in some particular seasons. In the Ayurvedafraternity, there is no established preparation which can be preserved, safe in all theepochs of life in females and easy to apply. After understanding the disease inayurvedic and modern medicinal system perspective Khadiradi yoga choorna-a newayurvedic formulation is prepared on the basis of stringent ayurvedic principles. Hence an attempt is made to work out the efficacy of the khadiradi yogaavachurnana in kachchu with special reference to genito inguinal intertrigo in females.Key words - Kachchu, itching. intertrigoDepartment of Prasooti Tantra and Stree Roga 5
  • 11. Abbreviations
  • 12. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Abbreviations ABBREVIATIONS i.e., that is Sha ka. Dru Shabda kalpa druma NaCl Sodium chloride Etc. Etcetra Eg Example ATP Adinosine Tri Phospate Gm Grams Da Daltons OPD Out patient department IPD In patient department HIV Human immunodeficiency virus Vg Vaginal C.S. Charaka Samhita S.S. Sushruta Samhita A.S. Astanga Sangraha A.H. Astanga hridaya R.N Raja Nighantau D.N Dhanwantara Nighantu K.N Kaiyadeva Nighantu G.N Gada Nigraha B.P Bhava Prakasha CH.D Chakra Datta % PercentageDepartment of Prasooti Tantra and Stree Roga 7
  • 13. List of Contents
  • 14. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” List of Contents LIST OF CONTENTS Sl. No Contents Page No 1 Introduction 16 2 Objectives of the study 20 3 Review of ancient literature 22 4 Review of research literature 25 5 Skin morphology 27 6 Disease review 36 7 Drug review 54 8 Concept of avachurnana 74 9 Concept of absorption 76 10 Methodology 83 11 Observations 86 12 Survey 109 13 Result of clinical study 112 14 Results of phyto chemical analysis 127 15 Results of microbiological study 133 16 Discussion 141 17 Conclusion 163 18 Summary 167 19 Bibliography 170 20 Annexure 180 LIST OF GRAPHS Graph No Description Page No. 1 Effect of treatment on pain 113 2 Effect of treatment on itching 114 3 Effect of treatment on size of the lesion 115 4 Effect of treatment on redness 117 5 Effect of treatment on discolouration of lesion 118 6 Effect of treatment on warmth 119 7 Effect of treatment on roughness 120 8 Effect of treatment on tenderness 121 9 Effect of treatment on discharge 122 10 Effect of treatment on oedema 124 11 Effect of treatment on blisters 125Department of Prasooti Tantra and Stree Roga 8
  • 15. List of Figures
  • 16. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” List of Figures LIST OF COLOUR PLATESSl.No. Description Page No. 1 Khadira-specimen and plant 73 2 Saptaparna- specimen and plant 73 3 Nimba- specimen and plant 73 4 Haridra- specimen and plant 73 5 Shirisha- specimen and plant 73 6 Amalaki- specimen and plant 73 7 Vibhitaki- specimen and plant 73 8 Haritaki- specimen and plant 73 9 Musta- specimen and plant 73 10 Dugdha pashana 73 11 Gandhaka 73 12 Khadiradi yoga choorna 73 13 Acute intertrigo 188 14 Acute intertrigo with blisters 188 15 Intertrigo with maceration 188 16 Chronic intertrigo with lichenification 188 17 Pregnancy induced hyperpigmentation 188 18 Gaping of episiotomy wound in the presence of genito-inguinal 190 intertrigo 19 Intertrigo before and after the application of khadiradi yoga choorna. 189 20 Candida albicans-culture-colonies 139 21 Candida albicans with hyphae 139 22 E coli and staphylococcus aureus 139 23 Pseudomonas auruginosa 139 24 Sensitivity tests with kahdiradi choorna incorporated into agar. 140 25 Aqueous, Chloroform and Ethanol extracts 73 Department of Prasooti Tantra and Stree Roga 10
  • 17. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” List of FiguresList of figures Sl. Description PageNo. No. 1 Age Distribution of Patients 87 2 Religion Distribution of Patients 88 3 Socio economic Status Distribution of Patients 88 4 Occupation Distribution of Patients 89 5 Education Distribution of Patients 90 6 Marital Status Distribution of Patients 90 7 Population Distribution of Married Women 91 8 Incidence of type of Diet 91 9 Incidence of Bathing Habits 92 10 Use of Clothing/Type of occlusion 93 11 Distribution of population according to Prakruti 93 12 Distribution of population according to Samhanana 94 13 Aahaarashakti 94 14 Predominant Rasa 95 15 Sweating in Patients 96 16 Micturition Frequency 96 17 Micturition – Associated complaints 97 18 Presence of Vaginal Discharge 97 19 Gestational Age 98 20 Presence of Episiotomy Wounds 99 21 Location of Episiotomy Wound – Peurperium 99 22 Mode of Onset of intertrigo 100 23 Duration of intertrigo 101 24 Nature of Area Involved 101 25 Nature of Skin involved 102 26 Presence of Vedana 103 27 Nature of Vedana 103 28 Character of Vedana 104 29 Intensity of Vedana 104 30 Presence of Kandu 105 31 Intensity of Kandu 105 32 Extension of Lesion 106 33 Discolouration of Lesion 10734-a Presence of Blisters 10834-b Size of the lesion 108Department of Prasooti Tantra and Stree Roga 11
  • 18. List of Tables
  • 19. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” List of Tables LIST OF TABLES Sl. No. Description Page No. 1 Layers of Twak according to charaka 30 2 Layers of Twak according to sushrutha 30 3 Tabulation of Kshudra roga according to different authors 43 4 Properties of Khadira as per different authors 60 5 Properties of Saptaparna as per different authors 61 6 Properties of Shireesha as per different authors 63 7 Properties of Mustaka as per different authors 64 8 Properties of Haridra as per different authors 66 9 Properties of Nimba as per different authors 67 10 Properties of Amalaki as per different authors 68 11 Properties of Haritaki as per different authors 69 12 Properties of Vibhitaki as per different authors 70 13 Clinical parameters 85 14 Incidence by age 87 15 Incidence by religion 88 16 Incidence by socio economic status 88 17 Incidence by occupation 89 18 Incidence by education 89 19 Marital status distribution of the patients 90 20 Population distribution of married women 91 21 Icidence by type of diet 91 22 Incidence of Bathing Habits 92 23 Use of Clothing/Type of occlusion 92 24 Incidence by prakruthi 93 25 Incidence by samhanana 94 26 Incidence by ahara shakti 94 27 Incidence according to the Predominant rasa 95 28 Incidence according to the Sweating in patients 96 29 Incidence according to the Micturition frequency 96 30 Incidence according to the Micturition associated complaints 97 31 Incidence according to the Presence of vaginal discharge 97 32 Incidence according to the Gestational age 98 33 Incidence according to the Presence of episiotomy wound 99 34 Incidence according to the Location of episiotomy wound 99 35 Incidence according to mode of onset 100 36 Incidence according to duration of intertrigo 100 37 Incidence according to dampness of the area 101 38 Incidence according to the nature of the skin 102 39 Incidence according to the presence of vedana 102 40 Incidence according to the nature of vedana 103 41 Incidence according to the character of vedana 103 42 Incidence according to the intensity of vedana 104 43 Incidence according to the presence of kandu 105Department of Prasooti Tantra and Stree Roga 13
  • 20. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” List of Tables 44 Incidence according to the intensity of kandu 105 45 Incidence according to the extension of lesion 106 46 Incidence according to the colour of the lesion 106 47-A Incidence according to the presence of blisters 107 47-B Incidence according to the size of lesion 108 48 Results of preliminary survey done in Gynec OPD 110 49 Effect of Khadiradi yoga choorna on the severity of pain during 113 the course of the treatment 50 Comparison of statistical results between the Test group and 114 control group on the severity of pain during the course of the treatment 51 Effect of khadiradi yoga choorna on the severity of itching during 114 the course of treatment 52 Comparison of statistical results between the Test group and 115 control group on the severity of itching during the course of treatment 53 Effect of khadiradi yoga choorna on the size of the lesion during 115 the course of the treatment- 54 Comparison of statistical results between the Test group and 116 control group on the size of the lesion during the course of the treatment 55 Effect of Khadiradi yoga choorna on the redness during the 116 course of the treatment 56 Comparison of statistical results between the Test group and 117 control group on the redness during the course of the treatment 57 Effect of khadiradi yoga choorna on the discolouration of the 118 lesion during the course of the treatment 58 Comparison of statistical results between the Test group and 118 control group on the discolouration of the lesion during the course of the treatment 59 Effect of Khadiradi yoga choorna on the warmth during the 119 course of the treatment 60 Comparison of statistical results between the Test group and 120 control group on the warmth during the course of the treatment 61 Effect of Khadiradi yoga choorna on the roughness during the 120 course of the treatment 62 Comparison of statistical results between the Test group and 121 control group on the roughness during the course of the treatment 63 Effect of Khadiradi yoga choorna on the tenderness during the 121 course of the treatment 64 Comparison of statistical results between the Test group and 122 control group on the tenderness during the course of the treatment 65 Effect of Khadiradi yoga choorna on the discharge during the 122 course of the treatment 66 Comparison of statistical results between the Test group and 123 control group on the discharge during the course of the treatment 67 Effect of Khadiradi yoga choorna on the edema during the course 124Department of Prasooti Tantra and Stree Roga 14
  • 21. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” List of Tables of the treatment 68 Comparison of statistical results between the Test group and 125 control group on the edema during the course of the treatment 69 Effect of Khadiradi yoga choorna on the blisters during the course 125 of the treatment 70 Comparison of statistical results between the Test group and 126 control group on the blisters during the course of the treatment 71 Priliminary phyto chmical analysis o Khadiradi yoga choorna 128 72 Final results of the test drug 126Department of Prasooti Tantra and Stree Roga 15
  • 22. Introduction
  • 23. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Introduction INTRODUCTION Human psyche has an innate tendency of affronting to get rid of anyillness, simple or complicated, but definitely creating the discomfort in thatperson. In this modern era, where etiquette are highlighted, people tend to be orpretend to be very neat with cultured social behaviors wherein a simple problemlike intertrigo will cause set back. Female gender is the unique creation of this universe that is present inmost of the species on this earth. Woman serves different roles in different stagesof her life and contributes to build a family and thus a society. She will undergodifferent physical and psychological changes in her life as she reaches differentstages of her life which include puberty, reproductivity, pregnancy, labour,puerperium and menopause and her responsibilities still go on. During thesestages, there will be many physiological changes. Among them one of the featurecommon in all is vaginal secretions which will vary in nature, quantity, qualityand duration. Reproductive system in females is a dynamic organization in the bodywhich regularly undergoes cyclic changes. During menstruation, there will bemenstrual discharges. During ovulation there is ovulatory mucus discharge.Pregnancy is characterised by increased vaginal secretions. Delivery of theconceptus is followed by puerperium which has different types of discharges pervaginum for longer duration. Peri-menopausal age in most of the females ischaracterised by abnormal bleeding patterns and so on. In between all thesephysiological challenges, there are pathological conditions marked by increasedvaginal secretions like-PID, vaginitis, polyps and what not. During all these stages, she has to maintain the hygiene of genital part,sometime with pads and sometime without pads. As the skin of vulva and groinare highly susceptible for the infection and hygiene playing a great role inmaintaining the normalcy and healthiness of that part, there is a high possibility ofgetting infection in the skin of the surrounding area in unhygienic susceptiblepatients.Department of Prasooti Tantra and Stree Roga 17
  • 24. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Introduction Pathological conditions associated with increased vaginalsecretions/discharges or bleeding of varied aetiology, which may or may notrequire sanitary pads, most of the times, will be commonly associated with acutaneous infection called intertrigo. If the hygiene of the genito-inguinal region isnot maintained properly along with the intertrigo, there may be furthermanifestation of super added secondary infections by bacteria and fungi. Obesity and gain in the weight during pregnancy, peri-menopausal age orotherwise also will add up to the problems as it will increase the compactness ofthe perineal region and the dampness of the part. This will trigger the onset of theinfections like intertrigo which will pose problems because of pain and itching,which sometimes becomes unbearable. Puerperal stage which is marked with lochial discharge, use of sanitarypads, increased perspiration, and many times the sedentary life of the patient willtrigger the manifestation of the infections like genito inguinal intertrigo. Thelesion may interfere in the easy and early healing of episiotomy wound inpuerperal period. Genito-inguinal intertrigo - a mild form of superficial skin inflammationmay or may not be associated with secondary bacterial or fungal infection causesdiscomfort in day-to-day activities even in menorrhagia associated with or withoutobesity. In genito-inguinal intertrigo, people feel a lot of discomfort as there isintense itching and pain which is caused due to friction, so one wants to get rid ofthe problem. Especially this costal region having high humidity and hot climate andwhere in there is severe sweating in both rainy and summer seasons predisposeintertrigo. Obesity, diabetes, sanitary pads and using tight synthetic undergarmentsare the other factors predisposing the intertrigo. In the costal regions, theincidence of genito-inguinal intertrigo in females is ranging from 28%-49%according to different researches.Department of Prasooti Tantra and Stree Roga 18
  • 25. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Introduction We get very less description regarding genito-inguinal intertrigo in the textbooks of dermatology and gynaecology. Although it is one of the most prevalentpathologies in females especially in costal region and in hot and humidatmosphere this pathology is not explored much. There is very less medical inputand least documented research is available. There are countable number ofallopathic medicines and in them candid powder is the universally used product.In Ayurveda there is no single patent product meant for that. No thesis worksbeing done exclusively on genito inguinal intertrigo in ayurvedic field. Kachchu/(Vrashana Kacchu) is explained in Sushruta Samhita withspecific cause i.e. unhygienic conditions 1. Here Vrashana refers to the anatomicallocation rather than the anatomical structure, as the etiology and disease are notgender specific. In the classics we get the utility of pralepa and kashaaya parisheka in themanagement of kacchu 2. But application of pralepa apart from interfering withday-to-day activities may cause clumsiness to the patient, as the sweatingincreases the moistness of pralepa and the kashaaya parisheka may have a shortspan of action. Hence an effort is made to use the dusting process with the objective toalleviate the inconveniences related with the patient and the preparation of themedicine, and to hasten the process of smooth recovery. The study involves the evaluation of the dusting process using selecteddrugs from kustagna, kandugna and vedanastapana gana in cases of genito-inguinal intertrigo as a gynecological complaint, during pregnancy andpuerperium.Department of Prasooti Tantra and Stree Roga 19
  • 26. Objectives of study
  • 27. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Objectives OBJECTIVES OF THE STUDYThe objectives of the study are • To carry out the conceptual study of Kachchu / genito-inguinal intertrigo. • To evaluate the clinical efficacy of Khadiradi Yoga Avachurnana in Kacchu w. s. r. to genito-inguinal intertrigo in females.Department of Prasooti Tantra and Stree Roga 21
  • 28. Historical Review
  • 29. “Clinical Efficacy of Khadiradi yoga avachoornana in Kachchu” Historical review Historical reviewIn vedic period • The word ksetriya is used for kushta 3. • The word vrushana is mentioned in atarvaveda (9-12-13). • Atarvaveda mentioned about kushta4. • Different drugs like aamala, khadira are metioned.5 • Vibaadha is used as synonym for khadira6 . • Haridra is mentioned in Rugveda.7 • External applications of drugs such as haridra are mentioned8. • Shereesha is mentioned in shaantha varga.9In Brahmana & Upanishad 10 • In jaimineeya brahmana-there is reference of paama. • The word vrushana is mentioned.In samhita kala • Among Brihat-trayis KShudra roga is explained in Sushruta samhita nidana stana 13th chapter51, Astanga Samgraha uttara tantra 36th chapter11, and Astanga Hradaya uttara tantra 31st chapter12. Charaka samhita has not explained kshudra roga in separate chapter. But in the footnote given in Astanga Hridaya says that even in Charaka Samhita these diseases have been explained but not under the heading of or the adhikara of kshudra roga, but in the context of Shotha. In Charaka Samhita these diseases are explained in Charaka Samhita sutra staana 18th chapter13 • In Sushrutha samhita we get the first reference of the word kshudra roga and a separated chapter has been attributed to that. Under the heading of kshudra roga many skin manifestations are explained and in another chapter its treatment modalities are explained. Kachchu is one of the kshudra roga first explained by Sushrutha.Department of Prasooti Tantra and Stree Roga 23
  • 30. “Clinical Efficacy of Khadiradi yoga avachoornana in Kachchu” Historical review • Similarly the treatment modalities or the treatment options are elaborated in Charaka Samhita chikitsa stana 12th chapter14, Sushruta samhita chikitsa stana 20th chapter 15Astanga Samgraha uttara tantra 37th chapter16, Astanga Hradaya uttara tantra 32nd chapter17. • Vanga sena18, Yoga Ratnaakara19,Chakra Datta20 and Madhava Nidana21 have followed Sushruta samhita. • The yoga formulated for this particular thesis contains selected drugs from kustagna gana, (khadira, amalaki, haritaki, saptaparna, haridra)22, kandugna gana (mustaka, nimba)23, vedanastapana gana (shireesha)24, vibhitaki (on pralepa imparts dahahara property)25, gandhaka26 and dugdhapaashana27 (both have twakdoshahara property) are mentioned in different classics. • The avachurnana concept is explained in Charaka Samhita28 and Sushruta Samhita29.Modern era • Pathology, clinical presentation and management of genito-inguinal intertrigo is explained in text book of Gynecology30 as well as in Text book and Atlas of Dermatology.31Department of Prasooti Tantra and Stree Roga 24
  • 31. Review of Research Literature REVIEW OF RESEARCH LITERATURE• G.K. chastd-chakramarda ka kshudrakust per prabhav. MMM Govt. Ayurvedic College, Udaipur - 1988.
  • 32. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Review of Research Literature • L.N. Sharma-Aargvadh ka prabhavaatmaka Adhyayana on kshudrakust. MMM Govt. Ayurvedic College, Udaipur - 2001.Department of Prasooti Tantra and Stree Roga 26
  • 33. Twak Sharira
  • 34. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak Sharira Twak Shaarira Twak or the skin is the site of vaata, domain for rasa and rakta. It covers thewhole body, surrounds the orifices which are meant for the excretory process. Itprotects the internal structures and organs. It also acts as the barrier for the externalpathological causes like trauma, chemicals, radiation, pathogens. It acts as theplatform for the manifestation of symptoms of various diseases like jwara and kamalaand thus helps in the diagnosis of the disease. Sometimes it is a major part of thedisease process as in dermatological conditions. It plays a major role in the externalappearance of the person and thus his or her personality. Thus twak has multifacetedfunction. When it gets diseased, or when it is in trouble, naturally it needs attention asthese physiological functions are likely to be getting affected with varying severity. Kachchu/intertrigo is one of the localised cutaneous skin disorders. Tounderstand the skin diseases or kushta, it becomes essential to understand thetwakshaarira elaborately as it is involved in each and every step of samprapti andsamprapti vighatana i.e., starting from the aetiopathogenesis till the mode of action ofthe drug used to cure it.Twak 32“iuÉMçü CÌiÉ, iuÉÍcÉÌiÉ, iuÉcÉÉÇ xÉÇuÉÉUhÉå”Means that which covers. “Twak, charma, vestana” etc words are used in the Ayurvedic classics indifferent contexts. These words are used in the meaning of covering something orenveloping some parts of the body or surrounding a particular structure or organ. Twak is the domain of vaata (vaatastaana). It is the seat of sparshanendriya(sense of tactile) It is the place for the rasa and rakta . In many instances it is seen thattwak is used as an analogue for the rasa dhaatu.Twak nirmaana 33 According to charaka it is the upadhaatu of mamsa .Twak is one of themaatruja bhava, which is very essential for the formation of garbha 34.Department of Prasooti Tantra and Stree Roga 28
  • 35. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak Sharira According to sushruta, - once the garbha is formed, it gets nourished by thetridoshas and grows very fast in the favourable environment. During its developmenttwak is formed in the form of 7 layers. Sushruta has explained it with a beautifulsimile that, as the layers of the cream is formed on the top of the boiling milk in thesame way the twak is formed during the formation of garbha35. According to Vaagbhata- Twak is formed by rakta dhaatu during the paaka ofraktadhaatu by its corresponding dhaatwagni.36 Panchamahabhuta siddanta and tridosha siddanta are the fundamentals ofdiagnosis and treatment of ayurveda.According to basic concept of ayurveda, all theanga pratyangas are made up of panchamahabhuta but in varying proportions. So,twak is also made up of five mahabhutas.It is the seat of sparshanendriya attributed to vayu mahabhuta.It is having brajaka pitta, -attributed to agniIt is the seat of rasa and rakta-attributed to aapIt occupies the avakasha and space is there in sweat glands -attributed to aakashaIt is having stira swabhava –attributed to pratwi. The panchamahabhutas combine with each other in different proportions andform three doshas. Dosha saamyatha is considered as health and their derangement orvitiation is called as disease. It applies to the whole body i.e., sarvadaihika vyadhi orto a local organ/part ie., eka deshothita vyadhi. So homeostasis of each and every partof the body is maintained by normalcy of the doshas. So, it is the seat of vaata /sparshanendriya-atrributed to vaata. It is the seat of bhrajaka pitta-attributed to pitta.It is having snigdha guna- attributed to kapha. It is the platform for the movement of rasa and rakta. It is the upadhatu ofmamsa. Through the skin the sweat is excreted out of the body which is the mala ofmeda37. It covers all parts of the body and the forms the protective layer.Department of Prasooti Tantra and Stree Roga 29
  • 36. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak ShariraLayers of twakAccording to Charaka38Table No-1Layers Diseases/symptomsudakadhara Bahya twakAsrakdhara3rd layer Sidhma, kilasa4th layer Dadrukusta5th layer Alaji, vidradhi6th layer Tama pravesha First two layers are given the names, but the disease is not mentioned. Forother four layers the possible diseases that might occur in the particular layer ismentioned. For the 6th layer, they have mentioned that if it is injured, person willfaint.According to Sushruta39Table No-2Layers Thickness (in vrihi pramans DiseasesAvabhasini 1/18th Sidma, padma kantakaLihita 1/16th Tilakalaka,vyanga, nyachchaShwetha 1/12th Charmadala, ajagallika, mashakaTaamra 1/8th Vividha kilasa kushtaVedini 1/5th Kusta visapraRohini 1 Granthi, apachi, arbuda, shlipada, galagandaMamsadhara kala 2 Bhagandhara, vidradhi, arshaDepartment of Prasooti Tantra and Stree Roga 30
  • 37. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak ShariraAnatomy of skin 40Synonyms-integument, cutis, skin It is an anatomically and physiologically specialized boundary laminaessential to life. It is a major organ of the body forming 8% of its total mass andhaving an area of between 1.2-2.2m2. Thickness ranges 1.5-4.0mm. Skin covers theentire external surface of the body and is continuous with the mucosae of thealimentary, respiratory and uro-genital tracts at their respective orifices. Structurally it is complex and highly specialized. It is formed as an intimateassociation between keratinized stratified squamous epithelium superficially-theepidermis, a deeper layer of moderately dense connective tissue- the dermis. Becauseof this it is within the most effective barrier against microbial invasion anddehydration and against mechanical, chemical, osmotic, thermal and photic damage. It limits and regulates heat loss, is a major sensory surface with elaboratesystems of varied receptor types, is capable of limited excretion and absorption andcarries out many specialized biochemical functions including the formation of vitaminD3, from precursor steroids under the action of ultraviolet light. Normal hormonal changes can affect the appearance and function of specificareas of the skin. Health age and disease aspect are reflected in the skin. Theappearance of the skin is affected by pigmentation, hair, distribution of follicles, andpresence of sudorific glands. These are changed according to age, metabolic changes,pregnancy and local pathologies.Microscopic structure of the skinThe Epidermis - Is composed of keratinized stratified squamous epithelium. In thistissue there is a continuous replacement of cells, a mitotic layer at the base replacingcells shed at the surface. As they move they differentiate into keratinocytes. They alsoinclude pigment forming melanocytes, phagocytic Langerhans cells and neurallyassociated Merkel cells.Department of Prasooti Tantra and Stree Roga 31
  • 38. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak ShariraEpidermis is divided into - stratum basale, - stratum spinosum, - stratum granulosum, - stratum lucidum and - stratum corneum. The first three layers are metabolically active and grouped as germinative zoneor stratum Malpighii. The more superficial strata of cells having terminalkeratinisation constitute the cornified zone. In addition it is also having epidermalappendages including glands-sebaceous, sudorific, apocrine ceruminous etc, hairfollicles, hairs and nails.The stratum basale - includes single layer of cells which lies in contact with thebasal lamina,. It constitutes stem cells, keratinocytes of various stages and nonkeratinocytes. The majority of basal cells are columnar to cuboidal and are attached tohemidesmosomes to the basal lamina. Melanin granules are also present in many ofthese cells.The stratum spinosum - contains more mature keratinocytes several layers deep, thecells packed closely and inter digitating by means of numerous projections andindentations at their surfaces which are linked by many desmosomes. Internally thesecells possess large number of keratin filament bundles. Since the sells are anchoredtogether, this stratum provides much tensile strength and coherence to the surface ofthe skin. The melanin is derived from epidermal melanocytes , the granules are mostnumerous in the deeper parts of this stratum and are gradually degraded by thekeratinocytes so that in the surface layers they are usually absent.The stratum granulosum - Here the cells become flattened and acculumate manylarge, dense, basophilic granules. Nuclei and other organells disintegrate. Cellscontain densely staining keratinohyalin granules , carbohydrate, lipids and hydrolyticenzymes in the form of transverse or obliquely oriented lamellae. These eventuallydischarge their contents into the intercellular spaces of the upper layers of this stratumDepartment of Prasooti Tantra and Stree Roga 32
  • 39. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak Shariracreating a thick, waterproof layer of lamellar cement, rich in neutral lipids, betweenthe cells of the stratum corneum.The stratum lucidum - Here the cells are more keratinized.The stratum conreum - It has closely packed layers of flattened, dead keratinocytes.In thin skin this stratum is only few cells deep. The intercellular space is filled with athick layer of lipidic cement.Epidermal dendritic cells - They are regularly scattered throughout the epidermis.Langerhans Cells - Their cell bodies are situated in the base of the stratum spinosumand their extensively branched dendrites are insinuated between the surrounding cells.The cytoplasm contains many mitochondria, granular endoplasmic reticulum and awell developed Golgi Complex. Langerhans cells have similar features of connectivetissue macrophages, including immunochemical reactivity with macrophage-specificmonoclonal antibodies.The dermis The dermis consists of irregular, moderately dense, soft connective tissue. Itsmatrix consists of an interwoven collagenous meshwork, with a varying content ofelastin fibres, proteoglycans (the glycosaminoglycans being predominantly hyaluronicacid and dermatan sulphate, with some chondroitin- 6 sulphate) fibronectin and othermatrix components, blood vessels, lymphatic vessels and nerves. Nonstriatedmyocytes occur in the dermis as arrector pili. Mechanically dermis providesconsiderable strength to the skin by virtue of the numbers and arrangement of itscollagen fibres and it also has elastic recoil because of its elastin content.The dermis can be divided into two distinct zones – Narrow superficial- papillary layer – Deeper- reticular layer.Department of Prasooti Tantra and Stree Roga 33
  • 40. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak ShariraThe papillary layer - it is immediately deep to the epidermis and is specialized toprovide mechanical anchorage, metabolic support and tropic maintenance to theoverlying tissue, as well as housing rich networks of sensory nerve endings and bloodvessels. Its superficial surface is marked by numerous papillae which inter digitatewith recesses in the base of the epidermis and form the dermo-epidermal junction attheir interface. In thin skin, especially in the regions with little mechanical stress andminimal sensitivity, papillae are few and very small while in the thick skin of theflexor aspects of the hands and feet they are much larger, closely aggregated andarranged in curved parallel lines following the pattern of ridges and grooves typical ofthese surfaces.The reticular layer - merges with the deep aspect of the papillary layer. Its bundlesof collagen fibres are thicker than those in the papillary layer and interlace with themand with each other to form a strong yet deformable three dimensional lattice, inwhich many of the fibres are parallel to each other and within which lays a variablenumber of elastic fibres.Sebaceous glands - are small saccular structure lying in the dermis and present overthe whole body except the thick hairless skin of palms, soles etc. They secrete an oilysubstance –sebum over the skin surface and onto hairs. In ano-rectal surfaces there arelarge individual glands. Sebum is a complex mixture of di and triglycerides, free fattyacids with smaller proportions of wax esters, squalene, cholesterol esters andcholesterol.The free fatty acids content of the sebum has antibacterial and antifungal actions.Thus it prevents the infection of the skin by bacteria and fungi.The lipid nature of the sebum keeps the skin smooth and oily. It protects the skin fromunnecessary desquamation and injury caused by dryness.The lipids of the sebum prevent heat loss from the body.Sudorific/Sweat glands - They are of two types- – eccrine glands, numerous and present over almost all of the body surface – apocrine glands, confined to few restricted areasDepartment of Prasooti Tantra and Stree Roga 34
  • 41. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Twak ShariraEccrine sweat glands - are long un-branched tubular structures, highly coiled, withwider secretory portion situated deep in the dermis or hypodermis. They are absentfrom labia minora, glans penis, glans clitoris, nipple, margins of lips etc. They secrete a clear odourless fluid, hypotonic tissue fluid and containingsmall quantities of many substances, predominantly sodium and chloride ions but alsoureas, lactate, amino acids, immuno-globulins and other proteins, bicarbonate,calcium ions etc. When initially secreted, the fluid is similar in composition to tissuefluid but is modified as it passes along the duct by the action of its lining cells, whichresorb sodium and chloride and some water too. The hormone aldosterone enhancesthis activity. Secretion is stimulated chiefly by temperature rise, but in certain areas ofthe body the gland reacts most strongly to emotional stimuli.Apocrine sweat glands - are particularly large glands of the dermis or hypodermis.They typically discharge into the apical regions of hair follicles. They are present onlyin a few areas of the body, namely axillae, peri-anal region, areolae, peri-umbilicalskin, prepuce, scrotum, mons pubis and labia minora. Here their secretory region iswide. Apocrine sweat glands are non functional till puberty and start functioningonly at the time of puberty. In old age the function of these glands gradually declines.The secretions within these glands are a proteinaceous, thick milky fluid which atfirst is sterile and odourless but undergoes bacterial metabolism to generate potentodorous compounds musky or urinous in smell.It is also added up by the growth ofthe micro organisms. It includes short chain of fatty acids etc.Pheromones - Apocrine glands are believed to secrete a group of chemical substancescalled pheromones. It is mostly present in the urine and vaginal secretions and othersecretions of the body. They are often odourless and are considered as air born chemosignals.Department of Prasooti Tantra and Stree Roga 35
  • 42. Disease Review
  • 43. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewÌlÉÂÌ£ü & mÉËUpÉÉwÉÉ 79 • uÉÚwÉhÉ – qÉÑwMüÉå AÇQûMüÉåvÉÉå uÉÚwÉhÉ uÉÚwÉÑ xÉåcÉlÉå 26 Vrushana is derived from the root vashu sechane which means andakosha, and isalso called as mushka. MücNÒû-MücduÉÉÇ iÉÑ mÉÉqÉÉ ÌuÉcÉÍcÉïMüÉÇ 80 • MüwÉ ÌWûÇxÉÉrÉÉqÉç • MüwÉå¶É cÉ -AqÉU MüÉåvÉ27 • The word kachhu is derived from the root word “kasha himsaayaam” which means that which causes violence or that which troubles like anything or that which tortures may be at somatic or psychological level. Such a feature is found in diseases like paama, kachchu and vicharchika. In these diseases the symptom which troubles the patient most is the intense itching. MücNû-MåülÉ eÉsÉålÉ YuÉOûhÉÉÌiÉ SÏmrÉiÉå CÌiÉ | 81 • -eÉsÉmÉëÉÇiÉÈ • MücNû-AlÉÔmÉÉå SåvÉ: eÉsÉmÉëÉrÉÇ AlÉÔmÉÇ xrÉÉiÉç mÉÑÇÍxÉ MücN: iÉjÉÉÌuÉkÉ: | • MücNÕû – MüÇQÕû -vÉ. Mü. SìÓÓ.28 The word kacchu is derived from the root word “kachcha” means that which isrelated with water or water sites, and it has been further clarified as “jalapranta” i.e.,the site of water, or water reservoir, or the place where the water is in abundantquantity, or the area in which the water content is more. The word “kachcha” is related with “anupa desha”. It has been described that theareas with excessive water is called as anupa desha or in other way it is told that inkachcha pradesha the water content is more. Gujarat is called as kachcha pradesha asthe humidity is more in that region.Department of Prasooti Tantra and Stree Roga 37
  • 44. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review Kachchu is related with kandu i.e., itching or pruritis. In the places where there ismore water content, the people are more prone to suffer from itching, or the severityof itching is more. And if we apply this to sharira desha we can understand that theitching is more in moist areas, or the parts of the body with dampness are prone tosuffer from the itching. Even though in the classics, the word vrushana kachhu is explained, the disease isnot specific to the male gender. The nidanas that are explained like- absence of bathor not maintaining the hygiene etc. are same for both sexes. The samprapti explainedcan happen in both male and female genders. The symptoms explained in the texts aresame for both male and female. By seeing above criteria, here by the word vrushanawe can/should consider the anatomical location/region rather than anatomical part.Probably it suggests the more compactness of the scrotal region in between the thighs.Even in obese female patients the perineal part is the prone place for the infection andinflammation because of its compactness and excessive sweating and occlusionspredispose the onset of kachchu.Twak vikara Twak or the skin is the site of vaata, adhishtana for rasa and rakta. It is themain organ that creates the impression of the physical/external personality. So, whenDepartment of Prasooti Tantra and Stree Roga 38
  • 45. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Reviewit gets diseased or when it suffers naturally it drags the attention and the person seeksthe treatment to get rid of the ailments.The manifestation of dermatological symptom has got 2 aspectsa) Manifestation in the form of symptom, but the pathology is somewhere else. Theskin acts as a platform for the exhibition of the symptoms. They are labelled asdermatological symptoms. Eg-Santapa in jwara Pitavabhasatha in kamala Pandutwa in pandub) The disease itself manifests in the skin and they are labelled as purelyDermatological diseases. Eg-skin eruptions in masurika, visarpa -sidma kustaDepending on the extent of the lesion, whether they are localised or generalised, thediseases can be divided into 2 aspects-a)Sarva daihika –generalised dermatological disorders eg-masurika, visarpab)Ekadeshoththita-localized dermatological disorders eg- vrashana kachchu orpaadadari Depending on the severity of the leison the dermatological diseases can beclassified into a)Incurable or curable with difficulty-like visarpa or mahakusta b)Easily curable –vrushana kachchu, youvana pidika. If all the above aspects are considered, the skin manifestation ordermatological disorders are considered as or under the heading of kushta inayurveda. In the classics depending on the severity of symptoms and the nidanas the skindisorders are explained under the kushtaadhikara or in kshudra roga and in kushta thediseases are classified as mahakushta and kshudra kushtaKushtaDepartment of Prasooti Tantra and Stree Roga 39
  • 46. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewMüÉsÉålÉ xÉuÉïÇ uÉmÉÑÈ –zÉUÏUÇ MÑüwhÉÉÌiÉ iÉxqÉÉiÉç iÉiÉç MÑü¸ÇCÌiÉ EcrÉiÉå |41 Kushta is a pathological entity, which in the broad term encompasses anydiscolouration or disfiguration to the skin. The diseases range from grave diseases likemaha kushta to minor and even non painful but mildly discolouring lesions likevyanga or nilika Kushta is pathological condition where in there is discolouration of the skin orthe skin manifestation at some stage of the pathological condition. It is theunderstanding of the literature that the skin diseases need the involvement of raktaand kledadhikyatha for the completion of samprapti.Kachchu is explained in kshudraroga adhyaya. In this pathology - the disease manifests in the skin and the pathology proper is in the skin. - there is discolouration of the skin in the form of redness, maceration or blackish discolouration. - even the doshic involvement told for the kachchu is kapha and rakta. - the disease needs kledadikyatha for the manifestation of the symptoms. As the pathology of kachchu is fulfilling the criteria needed to be under theheading of kushta, it can be considered under the broad heading of kushta.Kshudra rogaDepartment of Prasooti Tantra and Stree Roga 40
  • 47. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review¤ÉÑS ì- AkÉqÉ, AsmÉ The word kshudra means low level, little, small, which does not need muchconsideration.82UÉåaÉ-ÂeÉÌiÉ CÌiÉ UÉåaÉçÈ -ÂMçü xÉÉqÉÉlrÉÉiÉç UÉåaÉÈ Roga is a condition which is predominated with pain, or unpleasant sensationor feeling. The condition or the stage that hurts or pains the body or mind is calledroga. Because of invariable presence of pain as a symptom the diseased conditions ingeneral are called as roga.¤ÉÑSìUÉåaÉ-xuÉsmÉ urÉÉÍkÉ 43 Kshudra roga is a pathological condition which develops in the body with lessseverity. Or it is the disease with less severity or less painful symptoms, or whichcauses less morbidity or which disturbs the day to day activities to least extent, orwhich will get cured with easy treatment modalities or which will stay for shorter timewith less discomfort. The diseases categorised under kshudra roga having swalpa or less nidana, lesssymptoms or less treatment or simplier treatment modalities exception beingagnirohini and valmika. Hence they are called kshudra roga The diseases like guda bramsha and kunakha are adhama to look at or looksalpa ie, dirty or low. So, they are included in the group of kshudra roga. The diseases listed under kshudra roga are said to be advitiya i.e., there are nosubtypes of the diseases like vaataja or pittaja or kaphaja depending on the doshas orrasaashrita or raktashrita depending on the dushyas. But the involvement of doshasand dushyas are told for each and every kshudra roga but no sub categories.SynonymsThe synonyms are-xuÉsmÉ, AkÉqÉ ¢ÔüU -uÉæeÉrÉÇÌiÉDepartment of Prasooti Tantra and Stree Roga 41
  • 48. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewSwalpa-little, less, small, minorAdhama-low level, less significiant,Krura- related with violence,Depending on the feature of the disease again they are classified into- -swlpa- diseases with less severity. Eg- mashaka, vyanga, or tilakalaka etc. -adhama-dirty diseases like Eg- gudhdha guda, sharkararbuda, kunakha etc. -Krura-more severe diseases or that which cause trouble or discomfort to the patient. Eg- masurika, visphota, agnirohini etc.Another classification of kshudra rogas available depending on the severity is -laghu kshudra roga –eg-tilakalaka -tikshna kshudra roga-eg- agnirohini and valmika In Sushruta samhita it is said that the kshudra rogas are explained afterexplaining the mahavyadhi, adhika vyadhi and madhyama vyadhis like vidradhi. These set of pathological entities are grouped under the heading of kshudraroga as they have swalpa nidana i. e., minimal number of causes or causes with lessseverity. Further clarifying it is said that because of alpatwa of hetu, lakshana andchikitsa these pathologies are grouped under kshudra roga which indirectly representtheir nature. But it also includes rohini and valmikadi tridhoshaja vyadhis. Thesediseases have baahulyatha of hetu i.e., multiple causes leading into complexpathologies and they are asadhya.The below chart shows kshudra rogas mentioned by differentauthors.44,45,46,47,48,49,50,51,52Department of Prasooti Tantra and Stree Roga 42
  • 49. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review Table No-3Name of the disease Charaka Sushruta Astanga Astanga Yoga Chakra Vanga Baishajya Bhava samhita samhita Samgraha Hradaya Ratnakara Datta sena ratnavali prakashaAjagallika + + + + + + + +Yavaprakhya + + + + - + + +Andhaalaji Alaji + Alaji - + Antra Antra + antraalaji Alaji alajiVivruta + + + + - + +Kachchapika + Kachchapi Kachcha + - + + + piValmika + + + + + + + +Indravrudda + - - + - Indra + vruddaPanasika + + + + - + + PanasaPaashana + + + + - + + +GardabhaJaala + + + + + + + + +GardabhaKakshaa + + + + + - + + +Visphotaka + + Visphota Visphota + - - + Department of Prasooti Tantra and Stree Roga 43
  • 50. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewAgnirohini + + + + - + + +Chippa + Chipya Chipya + + + + +Kunakha + + + + - + + +Anushayi + - - Anushayya + + + +Vidaarika + + Vidaari Vidaari + + + + +Sharkara + + + - + + +ArbudaPaama + - - - - - +Vicharchika + - - - - - +Rakasa + - - - - - +Paadadaarika + - - Paadadaari Paada Paada + Daari dari DariKadara + + + + + + + +Alasa + + + + alsaka + + +Indralupta + - - + + + + +Daarunaka + - - + + + + +Arumshika + - - + + + + +Palita + - - + - + + +Masurika + + + + - - - +Youvana + - - + +/ - + Department of Prasooti Tantra and Stree Roga 44
  • 51. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewPidika taarunya pidakaPadmini + Padma Padma + + + + +Kantaka Kantaka KantakaJatumani + + + + - + + +Mashaka + Masha Mashaa Maasha - Maasha + MashakaCharmakila + + + - + + +Tilakaalaka + + + + - - + +Nyachcha + - - + - + + +Vyanga + + + + Mukha + + + + vyangaParivartika + - - + Pari Pari + + kartika vartikaAvapatika + - - + + + + +Virudhdha prakasha + - - + + + + +Sannirudhdha + Ruddha Ruddha + - + + +Guda guda gudaAhiputana + - - + + + + +Vrushana + - - + + + + +KachchuGudabramsha + - - + + + + + Department of Prasooti Tantra and Stree Roga 45
  • 52. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewMukha - + + - - + -DushikaPitika Pidaka - - + - - - -Gandhana - + + + - + - GandhaaRaajika - - + - - - -Gaardabhi - + + Gaardabhik - Gaarda - Gaardabhi a bhika kaErivellika - + + + - + - +Lanchana - + + - - - -Nilika + - - + + - + - +Prasupti - + + - - - -Utkota - + + - - - -Vidhda - + - - - - - Indra viddhaAraajika - + - - - - -Shukara - - - + + + - +DamshtraKhalli - - - - + - -Paadadaaha - - - - + - -Kota - + - - - - -Romantika + - - - - - - - Department of Prasooti Tantra and Stree Roga 46
  • 53. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewKhalitya - - - - - + - -Sharkara - - - - - - + -Shyavapidika - - - - - - - - +Glaani - - - - - - - - -Udgaara - - - - - - - - - Department of Prasooti Tantra and Stree Roga 47
  • 54. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewKachchu First enumeration of kshudra roga is available in Sushruta samhita. Here thediseases included range from those which are completely painless but cosmeticallyimportant and never cause systemic involvement (eg-tilakalaka) to grave diseases (eg-agnirohini) which can be fatal. Kachchu comes somewhere in the middle of thisrange. This disease is a minor skin pathology, localised, but painful, partially affectsthe day to day activities, can be cured by simple treatment modalities. Kachchu is one type of dermatological disease that develops in the vrushanapradesha wherein the vrashana pradesha refers to the anatomical location rather thanthe anatomical organ.Nidana-Snaana utsadana hinathaKanduyanath The specific nidana told for the kachchu is unhygienic condition and followedby scratching that area by the person.The other nidanas told in the text that can be included under nidana are-PrasangaatGaatra samsparshatSaha vastra dharana These are some of the causitive factors told in the list of etiological factors ofoupasargika roga53 like kushta can be considered for kachchu also. Since kachchu can be considered under the broad heading of kushta, evenkushta saamanya nidanas can be considered. But the specific nidanas are told for thekachchu act as precipitating cause.Snaana-It is explained as an important regime explained in dinacharya.54 Takingsnana (bath) regularly is said to be urjaa bala prada i.e., it rejuvenates and impartsstrength to the body. It increases the capacity of the body and enables the body toDepartment of Prasooti Tantra and Stree Roga 36
  • 55. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Reviewwork. It also acts as dipana, vrushya and ayushya i.e., It increases the agni, acts asaphrodisiac, and increases the longevity.It removes mala and sweda. It relieves kandu and daaha.It takes off shrama. ie., fatigue. It is also said to be paapahara. In the commentary while commenting on the word dipana it has been toldspecifically that bath will enhance the pitta namely bhrajaka pitta that is present in thetwak. So, snana is designated as dipana. It increases the agni that is present in thetwak locally. Bhrajaka pitta is said to be important to impart the lusture to the skin and isresponsible for the metabolism of the drugs applied to the skin in various forms.Utsaadana-55 In Sushrutha samhita , acharya Jejjata while commenting tells that thereare 3 types of procedures-udvarthana, uthsadana, and udgarshana. Udgharshana with sasneha kalka is called uthsadana. Rubbing the body partswith unctuous pastes is called uthsadana. Both udvarthana and uthsadana dilate the sira mukhas, increases the agnipresent in that part of the twak and acts as varnya i.e., imparts normal colour andlusture to the skin. Probably it is acting on both brajak and ranjaka pitta. Especially uthsadana is indicated in females as they are considered as delicatepersonalities. It is also ideal to do in delicate body parts like genito-inguinal region. Ifinstead of unctuous paste if dry paste is used it my damage the skin.Its uses are--It does the kapha shamana-Strenghthens and stabilizes the body parts-Liquifies the medas-Acts as twak prasadana – nurtures the skin in all aspects.-It does the vaata shamana-It acts as varnya-It relieves the siramukha avarodhaDepartment of Prasooti Tantra and Stree Roga 37
  • 56. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review-It auguments the twakgata agni, there by it helps to absorb and metabolize themedicaments applied to the body in various parts.-Relieves from the bad odour of the body-Reduces the itching.- Removes the mala that are caused and accumulated due to sweating.-Brings lightness to the body.Mala-In ayurveda mala is the excretory product of the body. They are purisha, mutraand sweda.56 Other malas include kha malas ie., the waster products or the productsthat are to be excreted out of the body like akshi mala, naasa mala, grana mala etc.Mala or the kitta bhaga is also explained at the dhatu’s level like kapha is the kittabhaga rasa and sweda is the mala of meda and so on. In the context of kachchu, mala is described as twak upalepa. The coating ofthe skin that is present over it which is meant for discarding or wearing off ordesquamating is called as mala. In other words the mala will be present on the skin inthe form of a layer. Dead cells are present over the skin in the form of a layer and during a span oftime they get desquamated and removed. If it is not cleaned properly, it may getaccumulated especially in the inguino-perineal region. Bath and mild scrubbing will remove the layer of exfoliated cells present onthe surface of the body presence of which is the main cause of the manifestation ofintertrigo. The snaana and utsaadana i.e., rubbing with fine powder for the exfoliation ofthe dead cells is told in the classics to remove the layer of dead cells that is formingthe outermost covering. Without the presence of the water, the rubbing may causescratches or may cause minute trauma which will manifest in the form of rashes.Only bath with water without rubbing will not fulfil the purpose of hygiene as themere water splashing will not remove the dead layer as it need some smooth physicalagent like fine powder.Department of Prasooti Tantra and Stree Roga 38
  • 57. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review As a prophylactic measure snana and uthsadana removes mala and sweda thatgets accumulated in the genital region. They also relieve the kandu, which is both theeffect and cause of kachchu. Taking bath and uthsadana are the nidana parivarjana chikitsa. After themanifestation of the disease, the snana etc. act as kandugna. They increase the brajakapitta, and help in the metabolism of the medicaments applied to the genital region.Thus they help to cure the condition.Swedat praklidyate57-The sweat even though is considered as mala, it is required forthe maintenance of the moistness and oilyness of the skin. Being the mala of meda, ithas the property of sneha and being a part of the kleda, it has the property of kleda.When the quantity and quality of the sweda mala is normal, it maintains the normalcyof the body and reflects the healthiness of the person. If it gets altered in its quantityor quality, either it will produce the disease pathology or it reflects the symptom ofthe disease pathology. Ati sweda causes kandu and sharira dourgandhya. The sweat is composed of the secretions of the sweat glands, sebaceousglands, and the secretions of the other glands that are present in the particular localregions. Sweating encompasses the complex mechanisms of body response like vasoconstriction and vaso dilatation, secretory functions of the different glands. It is also associated with local immune system of the skin in particular part,including macrophages and many other unknown body tissue defence mechanism.Gaatra samsarshat and saha vastra dharana-These two are the etiologies listed in thecausative factors for the oupasargika rogas like kushta. These nidanas can also beconsidered for the kachchu as kachchu is a form of kushta. Even in intertrigo, wearing new synthetic undergarments without washing andcontracting the intertrigo from the husband are documented.Department of Prasooti Tantra and Stree Roga 39
  • 58. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewProne persons or predisposing factors-The person in whom there is excessive perspiration-The physiological or pathological condition in which there is excessive perspiration-The local condition in which the perspiration is not disposed properly because ofsome other reasons which will simulate the condition of excessive perspiration. In a person who is not following the hygienic measures like snana andutsadana, the mala that is accumulated in the vrushana pradesha, gets moistened bythe sweat and produces intense itching. When the person scratches that areaimmediately there is manifestation of blisters and discharges. This condition is calledas kachchu. This pathology occurs mainly because of kapha and rakta.SymptomsKandu-this symptom is directly attributed to the kapha dosha57. In Kachchu one ofthe vitiated dosha is kapha and kandu is the predominant feature. Kandu is also afeature of atisweda pravruti which indicates the swedavaha srotodushti58. In suchcondition kandu is associated with bad odour of the skin. Even in the pathogenesis ofkachchu it is said that when the accumulated waste products in the vrushana region, itgets moistened by excessive sweating, it produces itching. In the genito-inguinal intertrigo, because of the accumulation of sweat in theskin folds there will be maceration, which will produce intense itching.Sphota- It is attributed to the kapha and pitta59. As rakta is having the features of pittawhen pitta gets vitiated it vitiates rakta. When both the vitiated doshas get lodged inthe space in between the twak and mamsa, they produce various forms of eruptivedisorders, which may manifest as a symptom or as a separate specific pathologicalentity. In kachchu the doshas are localised and are not involving the gambhira dhatusas in kusta vyadhi. In kachchu it is said, itching is responsible for the manifestationsof the eruptions.Department of Prasooti Tantra and Stree Roga 40
  • 59. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review In genito-inguinal intertrigo friction in the form of itching or friction withcloths or opposite skin surfaces act as the triggering factor for the formation ofblisters.Srava-discharges are attributed to pitta60. It may be associated with kotha or maymanifest without kotha. According to the doshas involved and diseases in which it ismanifesting, the nature of the srava changes. In kachchu, because of pitta/raktavitiation, there are discharges from the genito-inguinal area. Its manifestation istriggered by the process of itching. The discharges in intertrigo will be in the form of oozing, having wateryconsistency. Dampness which is already present in the genito-inguinal part, secretionsof the sebaceous glands and excessive sweating, all these contribute to the discharges.Samprapti ghataka • Dosha-kapha, pitta • Dushya-rakta, sweda,meda • Srotas-raktavaha,swedavaha,medavaha • Dustiprakara-atipravrati • Udbhava stana-amashaya • Sancharastana-sarvashareera • Adhistana-vankshana • Vyaktastana-twak • Rogamarga-baahya • Vyadiprakara-saadya.Nidaana-snaana utsaadana hinata, kledadikyathaPoorva rupa-swedadikyatha.Rupa-kandu, sphota, srava We do not get the direct reference of upashaya and upadrava in the classics.Since the snana uthsadana hinata are considered as the causes, proper advocation ofsnana uthsadana can be considered as upashaya.Department of Prasooti Tantra and Stree Roga 41
  • 60. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review If the nidanas are continued there will be blister formation, which may extendupto buttock region, causing kachchu mentioned in kshudra kushta. Or once thevranas are formed from the sphota, vrana upadrava can be considered.Since it is considered under the broad heading kushta kushta nidana, purva roopa,upashaya and upadrava can also be considered.Samprapti/Pathogenesis A person who is having excessive perspiration due to various causes, if doesnot maintain the local hygiene properly especially in the inguino-perineal or genito-inguinal region, then there will be kledana of that part. Kledana which occurs becauseof excessive perspiration causes dampness of genito-inguinal area. It has beenspecified in the literature that the mala that is present in the vrushana pradesha getsaffected by the kleda or the mala will get moistened. In such condition the itchingstarts in that particular local area. When the person scratches then there will bemanifestation of blisters or sphotas associated with or followed by srava. Thiscondition is called as (vrushana) kachchu i.e., kachchu occurring in vrushanapradesha. This occurs mainly because of kapha and rakta prakopa.Treatment of kachchu 61-udvartana with choorna prepared out of sarjambu, kusta, saindhava, and sita-tiphala kola khadira kashaya for vrana ropana-badaritwak and saindave pralepana-kapaala tutta choorna prayoga externally-paama roga chikitsa and ahiputanavat chikitsa-pralepa with kaasisa, tutta, haritaala, rasanjana with amlapistaTreatment of ahiputana62-samshodana and vrana prakshalana with triphala khadira kwatha.-lepa with shanka, souvira yasti-Grita paana –ghrita made out of patola patra, triphala rasanjana.-kasisa, gorochana, tutta, haritaala, rasanjana with amla kanji applied externally-jalouka avacharana-karanja triphala tiktaka ghrita-Sarpi paana with ghrita made out of karanja, triphala tiktaDepartment of Prasooti Tantra and Stree Roga 42
  • 61. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review-lepana with karanja,triphala tiktaka siddha ghrita-rasaanjanla lepaPaama kandvadi chikitsa-siduradi lepa-contains sindura, jiraka dvaya, haridra, daru haridra, manashila,maricha, kajjali (gandhaka+paarada) mixed with ghrita and externally applied in theform of lepa-saindhavadi lepa-contains saindhava, chakramarda, sarshapa, pippali mixed withkanji and externally applied.-jiraka taila-brahat sinduradi taila-brhat marichadi taila-maaheshwara ghrita-maamsyadi kandunaashaka gana lepa-contains jataamaamsi, raktachandana,shamyaaka, karanja patra, nimba patra, sarshapa, yashti, kutaja, daaruharidra,-baakichi bija, kaasamarda, chakramarda, haridra, daaruharidra, saindhava lavanamixed with kaani and applied externally-arka taila.Pathyapathya 63 Kshudra rogas resemble the diseases explained generally in other contexts (i.e.saamanya rogas). Kshudra rogas also manifest due to dosha dushya sammurchana likeother diseases. It is the responsibility of the physician to decide the pathyapathyas consideringthe vaataadi doshas, rasaadi dushyas, roga bala, rogi bala, the avasta of the diseaseand to advice the patient.So when we apply this rule the pathya pathya arePathya-snana, uthsadana, sheetala dravyas, varnya , swedaghna dravyas, dourgandhyahara dravyas, kapha pittahara dravas, not exposing to hot environment etc.Apathyas-ushna, tikshna abhishyandhi ahara, unhygienic conditions, kapha pittakaraahara vihara, rakta prakopaka ahara vihara etc.Department of Prasooti Tantra and Stree Roga 43
  • 62. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewDifferential diagnosis of intertrigoTenia cruris- It is a dermatophyte infection of the groins. It is less common infemales. It is localized to groins, thighs and buttocks. Clinically it presents as bilateralsymmetrical, itchy, half-moon shaped or small circumscribed, well defined, multiplescaly plaques, papulo-vesicular lesions at the active border, with central clearance isoften incomplete. Borders are raised. Chronic scratching may lead to lichenification.Secondary bacterial infection may supervene. Weeping maceration and areas ofpostulation may also occur.Hyper-pigmentation of pregnancy-A generalized increase in skin pigmentation isseen during pregnancy. The hyper-pigmentation is most marked over the nipples,areola and external genitalia. Sometimes the axillae, the area around the neck and themedial surface of the thighs become pigmented. The pigmentation usually fades awayafter the delivery. The hyper-pigmentation may be due to the hormonal changes occurring duringpregnancy, and women also have a genetic and racial predisposition.Seborrheic dermatitis-It involves the hair bearing skin of the labia majora, extendsto perineum and natal cleft. Secondary infection may occur with scratching and resultsinto scaling and fissures.Psoriasis-It is a genetically determined, chronic relapsing and remitting inflammatorydermatosis characterized by scaling pink plaques in a symmetrical distribution.Clinically presents with symmetrical pinkish-red plaques covered with silvery scaleon the pubis, labia, peri-anal region and natal cleft.Lichen simplex chronicus-It is the end stage of many inflammatory skin diseases. Inthe active phase many skin diseases will be having itching and therefore subjected torepeated friction by scratching. Here the skin is thickened with exaggerated skinmarkings (lichenification). Scaling is present and excoriation due to recent scratchingcan be seen within the thickened or erythematous areas.Department of Prasooti Tantra and Stree Roga 44
  • 63. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewLichen sclerosis-It is an inflammatory skin disease associated with autoimmunedisorders such as vitiligo, pernicious anemia, thyroid disease. Mostly seen in postmenopausal women. The surface is wrinkled and atrophic, thickened and slightlywarty. It may be associated with haemorrhagic blisters. There is severe intractable itchin the night. There may be associated dysuria or constipationCutaneous pattern of Lichen planus-It is an inflammatory disease of the skin andthe mucus membrane. There may be papules, plaques or follicular papules with apurplish/red appearance. There is severe itching and excoriationDifferential diagnosis of kachchuDadru-It is one of the maha kustas explained in the Sushrutha samhita. It ischaracterised by pidakas having the colour like atasi pushpa or taamara varna and isvisarpini. According to charaka it is (sita kushta) considered under alpa kushta.It ischaracterised by sakandu pidika, vrutta bahala, mandala and udgatha. Here its place isnot limited to genito inguinal region. It does not need the nidanas like snaana utsadanahinatha and kanduyanatha.kachchoo-It is considered as kshudra kusta as per Sushruta. It is characterized bysphota, daaha and may be seen in sphik, paani and paada. Here its place is not limitedto genito inguinal region. It does not need the nidanas like snaana utsadana hinathaand kanduyanatha.Ahiputana-It is also considered as one of the kshudra roga. It occurs in the childrenbecause of improper disposal or cleaning of urine and feaces. It occurs because ofkapha and rakta prakopa. Because of swedana and mala kledana there well bemanifestation of kandu. Because of kandu there is immediate manifestation of sphotaand srava and some times vrana. It is a ghora or daruna vyadhi.Department of Prasooti Tantra and Stree Roga 45
  • 64. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewIntertrigo64 Definition: It is an inflammatory dermatitis involving the skin folds (inflammation of opposed skin surfaces). It is a common clinical condition manifested in the skin. It is more common in hot humid climates and in obese persons where there are added factor of occlusion. Sweating caused by heat and moisture and friction of opposing skin surfaces are the primary causative factors.Obesity and Diabetes Mellitus predispose the condition. In obese patients the abdominal folds may also involved. Tight fitting clothes particularly underwear and sanitary pads are also contributory. Lesions can occur in groins (genito-inguinal region), retro-auricular, axillae, under pendulous breasts, inter-digital, inter-toe and inter-gluteal folds. Chronic bacterial or candidial infection eventually supervenes. Streptococcus pyogenes is the commonest offender. Intertriginous areas are readily colonized and infected by a variety of microorganisms such as staph. Aureus, strep. Pyogenes, c. albicans, less commonly by e. coli, Proteus epp. and occasionally pseudomonas aeruginosa.Main Features: Heat, moisture, friction and sweat retention induce maceration andinflammation of these areas. Chronic bacterial or candidial infection eventuallysupervenes. Usually starts as bilateral or unilateral symmetrical well marginated,erythematous areas confined to the folded skin areas in apposition such as the genito-crural, genito-inguinal, infra-mammary, and axillary folds. Subsequently sweatretention induces maceration and inflammation of these areas leading to erythematouslesions. However maceration is confined to the central skin.Department of Prasooti Tantra and Stree Roga 46
  • 65. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review Initially the skin is red and slightly macerated. The folds when separated showerythema of contiguous surfaces, covered by a macerated horny layer forming a sortof smegma, usually with a deep fissure. In the advanced stages, there may becomplete denudation of the surface. Itching, burning, pain, exudation and offensiveodour are the common symptoms. On examination-erythematous, raw, moist, macerated and eroded areas with well-defined fringed edge can be seen. Intertrigo with massive colonization occurscommonly in obese individuals of either sex. It may show a sharp margin, but thisedge is usually a simple curve where the opposed skin surfaces meet. There is anupward extension from the groin as well as down the thigh. In severe cases, painfulerosions, fissures exudation, crusting, scaling and sometimes pustulation develop. In candidial intertrigo satellite pustules are characteristic. Coryneforms add to thedamage by their proteolytic action that generates an offensive odor.Skin infections and immunity during pregnancy- Skin diseases get modified duringpregnancy. Dermatoses may either worsen or improve or remain unchanged andunpredictable during pregnancy. The cell mediated immunity is depressed. Certaininfections like candidiasis worsen. Candidia, genital warts and herpes simplex can betransmitted to the baby during child birth.Complications: Secondary impetigo, cellulitis. Superimposed secondary c.albicans infectionTreatment: – Prompt the dryness by removing occlusive conditions and by use of compresses and absorbing powders. – Aluminium acetate solution for wet oozing leisons. – A soothening powder during day and a cream at bedtime are advisable.Department of Prasooti Tantra and Stree Roga 47
  • 66. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review – Antibacterial and antifungal drugs should be used if there is such infection. – If inflammation is severe, mild topical steroid application for a short period with above measures. – Avoid fluorinated steroids. – Ventilation of the area is very important. – Attend the predisposing factors like obesity, DM, friction with clothing and excessive physical activity.Histopathological features in intertrigo65 The term dermatitis and eczema are usually as synonyms and refer to aninflammation of the skin. Dermatitis may be acute, subacute or chronic. Spongiosis is an important finding in most cases of dermatitis and the termspongiotic dermatitis is occasionally used with eczema. Spongiosis refers to theaccumulation of edema fluid between epidermal keratinocytes, which may progress toform vesicle or bulla. Spongiotic dermatitis may be classified into- 1. Acute spongiotic dermatis a. Stratum corneum is normal b. Epidermis is of normal thickness c. Variable spongiosis with intraepidermal vesiculation d. Papillary dermis is edematous e. A lympho-histiocytic infiltrate is present around the superficial plexus of blood vessels with exocytosis of lymphocytes into spongiotic foci. 2. Subacute spongiotic dermatitis a. Stratum corneum shows parakeratosis and crust formed of coagulated plasma,lymphocytes and neutrophils. b. Epidermis shows moderate acanthosis c. Mild to moderate spongiosis with microvesicualtion d. Papillary dermis shows edema e. Superficial perivascular lympho-histiocytic infiltrate is less prominent.Department of Prasooti Tantra and Stree Roga 48
  • 67. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Review 3. Chronic dermatitis a. Hyperkeratosis with parakeratosis and hypergranulosis b. Moderate to marked acanthosis c. Minimal spongiosis d. Prominent papillary dermal fibrosis is a characteristic feature seen as vertical streaks of collagen in the papillary dermis. e. Sparse dermal inflammatory infiltrate.Allergic contact dermatitisEarly stage- Spongiosis is most prominent in the lower epidermis. Spongiosis resultsin vesicles at different horizontal and vertical levels of the epidermis in a very orderlypattern. Mild to moderately heavy infiltrate of lymphocytes, macrophages andLangerhans’ cells with accentuation around the superficial plexus is seen in the upperdermis. Eosinophils in small numbers are usually present in the infiltrate.Exocytosis of lymphocytes and sometimes of eosinophils is seen.Well established lesions are characterized by--slight epidermal hyperplasia-Marked edema of papillary dermis-Scale crust in the stratum corneum-Spongiosis in discrete foci; if marked, vesciles appear-Mounds of parakeratosis-Superficial, perivascular and interstitial infiltrate of lymphocytes may containeosinophils in variable numbers.Chronic lesions are characterized by--Compact orthokeratosis, with occasional subtle scale-crust formation-mild spongiosis-uneven focal hypergranulosis-Psoriasiform hyperplasia of epidermis-Coarse bundles of collagen in vertical streaks in a thickened papillary dermis.Department of Prasooti Tantra and Stree Roga 49
  • 68. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewIrritant contact Dermatitis-The histopathological findings depend upon the natureand concentration of the irritant.Very strong irritants produce-Marked ballooning of deratinocytes in the upper dermis-Necrosis of epidermal cells-Spongiosis in the areas adjacent to necrotic epidermis-neutrophils in areas of ballooning and necrosisMild to moderately strong irritants show-Epidermal spongiosis-Superficial dermal edema.-Superficial predominantly perivascular infiltrate of lymphocytes.Pustular lesions seen in irritant contact dermatitis show--subcorneal vescicles with neutrophils-cellular debris-Fibrinous exudateDermatophytosis/Superficial fungal infections-means superficial infection of the skin, hair, nails due to a group of relatedfilamentous fungi, the dermatophytes. They are ketatiniphilic and normally invadeonly the dead keratinized tissues of the stratum corneum of the skin. They generateproteases that digest keratin.Histopathology-stratum corneum shows the presence of neutrophils which is suggestive but notdiagnostic of tines corporis.-Sandwitch sign refers to the presence of fungal organisms in stratum corneumsandwitched between two zones of cornified cells, the upper being othokeratotic andthe lower consisting partially of parakeratotic cells.-Other histopathologic fatures are those of acute, subacute or chronic spongioticdermatitis depending upon the degree of reaction of skin to the presence of fungi.-The diagnostic histopathologic feature is the demonstration of fungal hyphae andspores in the horny layer by special stain.Department of Prasooti Tantra and Stree Roga 50
  • 69. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewCandidiasisMay cause Acute superficial candidiasis, Genital candidiasis etc.Histopathology in case of superficial candidiasis-Orthokeratosis and parakeratosis-Neutrophils scattered within the epidermis-Spongiform and sub-corneal pustules-Oedema of the papillary dermis-Superficial perivascular and interstitial mixed cell infiltrate of lymphocytes aroundvenules and neutrophils mostly in the interstitium-Pseudohyphae in cornified layer which appears as dark blue streaks oriented nearlyperpendicular to the skin surface-Epidermis may be hyperplastic in chronic cases-Neutrophils penetrate the entire thickness of the skin-Demonstration of the causative organism in the stratum corneum.Difficulties in diagnosis 66 Three main factors render both clinical and histological diagnosis of vulvarskin disease extremely difficult. They are- Women are naturally reluctant to seek medical attention when vulvarsymptoms first appear. Often specialist medical attention is sought only when thelesion persists and has failed to respond to, or has been exacerbated by selfmedication, which also modifies the histological changes, rendering diagnosisdifficult. The vulva, as with other covered flexural sites, is a warm, moist area thatexperiences friction from skin surfaces and clothing. These physical factors changeboth the clinical and histopathological appearances of the original skin disorders suchthat characteristic features can sometimes be modified or lost. Because of theenvironment, bacterial, yeast and fungal infections can thrive, especially if theunderlying skin disease, friction, or scratching weakens the continuity of the skinsurface. The presence of the specialized skin structures such as terminal hair follicles,Department of Prasooti Tantra and Stree Roga 51
  • 70. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease Reviewapocrine and vestibular glands adds to the range of disorders that affects the vulva andperineal area. Pruritus is the most frequent symptom associated with vulvar skin diseases.Patients find it impossible to desist from scratching the lesions, even unknowingly.This persistent frictional trauma produces loss of the surface epidermis in the initialphases, with the production of numerous excoriations. In the logn term it produceschronic thickening of the epidermis (lichenification) and fibrosis of the underlyingdermis, which can mask the initial causative disorder.Common dermatosis that commonly affect the vulva are Acute and chronic dermatitis (eczemas)-All forms of endogenous andexogenous dermatitis can affect the vulva, and may present in an acute or chronicphase.Acute dermatitis of vulva Clinically acute dermatitis is characterized by redness and vesiculation of skin.As vesicles rupture onto the surface, the area shows exudation, the exuded vesiclefluid forming a crust on the skin surface on drying. Histologically the epidermisshows variable focal spongiosis, frequently with parakeratosis overlying it, and theremay be a range of inflammatory cells in small numbers within the spongiotic area ofepidermis. Larger spongiotic areas form into spongiotic vesicles, which rupture toproduce the clinically apparent exudate lesion. The dermis shows a perivascularlymphocytic infiltrate and there may by associated dermal edema as manifest byseparation of of collagen fibres and the presence telangiectatic lym phatics and dilatedcapillaries. This is modified by the effect of scratching mainly in the form of acuteexcoriation, and non specific thickening of the epidermis and fibrosis of the dermis ifthe scratching has been long standing.Chronic dermatitis of vulva Clinically the skin is reddened or hyperpigmented with excoriations where thesurface has been traumatized. Lichenification with thickening and exaggeration ofskin markings is often present secondary to chronic rubbing and scratching.Department of Prasooti Tantra and Stree Roga 52
  • 71. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Disease ReviewHistologically there is variable thickening of the epidermis and overlyinghyperketratosis. The thickened epidermis shows elongated rete ridges and there isfibrosis of papillary dermis with thickening of capillary walls. Increased numbers ofchronic inflammatory cells mainly lymphocytes are found around upper dermalvessels. In many cases that clinically have the appearances of a chronic dermatitis,histological examination reveals features of a more acute inflammation, namelyepidermal spongiosis. It is also called sub acute dermatitis to imply that the chronicskin inflammation is still active and not quiescent or inactive.Exogenous vulvar dermatitis.They are contact irritant dermatitis and contact allergic dermatitis.Contact irritant dermatitis of vulva- Of the vulva in children is seen in the form of napkin dermatitis due to theirritant effects of urine on the vulvar skin. This can also occur later in life if there isstress incontinence. Ii clinically presents with sharply delineated itchy soreerythematous papules and plaques that may be weeping and eroded if acute orlichenified in chronic cases. Contact allergic dermatitis is a type 4 delayed hypersensitivity reaction inwhich sensitized lymphocytes respond to a specific allergen that has penetrated theskin. The skin has been previously exposed to allergen for sensitization to occur,occasionally by a single previous exposure. Clinically it presents with eroded weepingerythematous patches.Department of Prasooti Tantra and Stree Roga 53
  • 72. Drug Review
  • 73. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review Bheshaja is one of the four limbs of maha chikitsa chatushpaada67. Henceequal importance is given to the treatment modalities as well as drugs used in curingailment as vaidya i.e., physician and rogi i.e., patient. While explaining the characteristics of an ideal drug it has been enumeratedthat the drug should possess good qualities or multiple qualities so that it can be usedin multiple conditions or in a patient with multiple pathologies. It should have goodqualities in rich proportions. It should be suitable to the patient, i.e., compatible to thepatient. It should retain its properties even in different forms of preparations68. Retention of its properties or its active principles in different form ofpreparations as a characteristic of an ideal drug is told as some drugs cannot beconverted into some specific forms, and all the preparations are not ideal for all theregions and all types of pathology. Depending on the disease the symptoms may manifest in any one part of thebody or in multiple parts. In ayurveda this is explained in the form of differentrogamargas. Depending on the pathologies an herb can be given in different forms. Ifthe pathology is in the kosta, one can go for vati, kashaya or oil based preparationsdepending on the dosha. If it is in twak, along with internal medications, even topicalapplications are advised. For bahudoshavasta, line of treatment includes shodhana with panchakarmafollowed by shamana medications.For alpadoshavasta, like vrushana kachchu externalapplication with specific drugs is told. The treatment changes depending on the rogi bala. In sukumara patients, whocannot tolerate the treatment shamana oushadi is advised. Even though in the classicswe get the reference of ghrita preparation for internal medication in case of kachhu, itcannot be given in garbhini presenting with kachchu. Here the topical application isthe line of treatment.Department of Prasooti Tantra and Stree Roga 55
  • 74. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review Administration of internal medication in the form of swarasa, kalka, kwatha,choorna, vati, ghrita, arista depends on the strength of the kostagni and the pathology.Application of the medicines over the surface of the body is disease specific, andayurveda gives preference to the consideration of the involved doshas.Depending on the pathology, the external application are told in different forms - dry preparations-choorna-udvarthana, udgarshana, avachoornana - wet preparations-with water-pralepa,alepa pradeha - with oil - oily preparations-grita or taila lepana - multiple liquid preparations-madhugrita lepana - In ayurveda for the selection of each formulation specific guidelines are told andinsisted to select the patient depending on the clinical presentation.The medicinalpreparations told for kachchu in the classics contain saindhava or the preparations arein the form of kashaya. Even ghee prepared out of specific herbs is told for internalmedication. This costal region has high percentage of humidity, so salts absorb moisture fromthe atmosphere and get liquefied. So, powder preparations having salts cannot bepreserved for long and the drug powder will become a semisolid paste or get spoiledbecause of dampness. Advising kashaya parisheka in pregnancy involves a tedious job of preparing thekashaya everyday as kashaya should be used in fresh form. This is having thepractical problem that many patients will not be ready for this tedious work.Ghritawhich is told for the internal administration contains drugs which are not best suitedfor pregnancy and during purperium. So, khadiradi yoga is formulated and selected for a very prevalent conditions likekachchu which is easy to administer/apply and can be preservable.Department of Prasooti Tantra and Stree Roga 56
  • 75. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewCriteria for the selection of drugs and the form of the drug i.e., powder form(choorna) - It should be economical - It should be easily available - It should be a botanically identified plant. It should not be a controversial drug - It should not be in the list of endangered species. So, while collecting the drug we will not be destroying the species. - Collection of the drug/part of the drug should not hamper its propagation. - It should be convertible into the finest powder form as it is the desired form - It should have a long shelf life in the powder form especially in the high humid environment of the costal region. - It should not react with co-drugs or the other components of the final product physically or chemically to form a final product which forms other than powder form. eg: slumping, sticking, absorbing the moisture forming a paste etc. which ultimately hampers the free flow the drug. - It should not be irritant to the skin, i.e. , as far as possible it should be hypo allergic. - It should be safe during ovulation, pregnancy, puerperium and lactation. - It should not have any teratogenic properties. - If it enters vagina it should not produce any unwanted symptoms. - It should be easy for preparation and application - It should not delay wound healing or impair wound healing. To formulate a new drug Acharyas have given the guidelines that, a physicianshould consider the doshas involved in the samprapti and every attempt should bemade for the samprapti vighatana. So, the drug should be selected on the basis of theirdoshagnata and their prabhava as well as rogi and vyadhi bala which is thefundamental principal of Ayurveda.Khadiradi yoga choornna Accordingly the drugs of khadiradi yoga is selected which contains khadira,triphala, saptaparna, shirisha, nimba, haridra, musta, gandhaka and dugda pashana.Department of Prasooti Tantra and Stree Roga 57
  • 76. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review It is the formulated yoga. Here the drugs are having the property ofkaphapittahara guna, kustagna, kandugna, vedanastapana, shoola prashamana anddaha prashamana gunas. Acharya Madhava in his work Madhava Nidhana told the methodology ofnaming a formulation. He said that in a formulation with many herbs the name of theformulation should be after the 1st mentioned drug69. Accordingly the formulateddrug powder is named after the name of the 1st herb i.e., khadira. The word “aadi”suggests etc. or in other words the formulation contains other drugs starting withkhadira.Quantity of each herb in the yoga Acharya Maadhava has told that, if in the classics the dose of the ingredients isnot specified then it is the rule that one should take the drugs in equal parts70. Eventhough this rule is told for the classical preparations we used this rule to determine thequantity of each ingredient except dugdha pashana. As per this rule, except dughapaashana, all the other drugs are taken in equal quantities.Criteria to select the dose of dugda pashana All the drugs except dugda pashana are taken in equal quantity in powder formand mixed together thoroughly. This powder is divided into 3 groups of 5 sampleseach. To the 1st group 50% dugdha paashana powder is added. To 2nd group 25% ofpowder of dugda paashana is added and to the 3rd group 10 % dugda paashana powderis added. A clinical pilot study was done for 15 patients divided into three groupshaving 5 patients in each group. Here in 1st group where in the drug has 50% dugdapaashana did not show much relief, 2nd group showed marked relief and the 3rd groupcomplained about roughness of powder and little burning sensation.On the basis of this pilot study, the quantity of the ingredient is fixed as follows. • The yoga formulated for this particular thesis contains selected drugs fromDepartment of Prasooti Tantra and Stree Roga 58
  • 77. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review • kustagna gana, (khadira, amalaki, haritaki, saptaparna, haridra.). • kandugna gana (mustaka, nimba). • vedanastapana gana (shireesha). • Dahahara (vibhitaki). • twakdoshahara (shudda gandhaka., dugdhapaashana ) • All the drug powders except dugdhapaashana are taken in equal parts/quantities. • To this 25% Dughapaashana is added.Yoga paribhasha The word yoga is derived from the root word “yuj samadhou, yujir yoge, yujsamyamane” which means to get incorporated in, mixing up, being together,shuffling, putting together, being together, planning, idea and according toamarakosha it also suggests bheshaja. So, yoga is a formulation made up of several ingredients mixed together. Asper this definition, since the selected drug is a mixture of several ingredients it can becalled as yoga. Hence this formulation is named as Khadiradi yoga choorna. All the herbal ingredients are collected and dried in sun. Then they arepowdered in the micropulvariser and the floating particles are collected to obtainvastra gaalitha choorna. The particle size will be approximately No. 100-120 (Therewill be 100-120 pores in 1 square inch). Gandhaka is purified by heating it and pouring it into hot milk sieving throughthe cloth and finally washing with hot water properly. This is powdered and mixed tothe above mixture. To the above mixture powdered 25% dugdha paashana is added.After addingall the ingredients the resultant mixture is mixed using doubling up methods.The final product is packed in specially arranged pre-holed containers with net weightbeing 50gm.Department of Prasooti Tantra and Stree Roga 59
  • 78. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewKhadira • Botanical Name: Acacia catechu. • Family: Mimosideae • Syn: gaayatri, raktasaara, kantaki, baalapatra, yajneeya, dantadhavana • Rasa: Tikta, Kashaya, • Guna: Laghu, rooksha, • Veerya: sheeta • Vipaka: Katu • Karma:Kapha-pitta shaamaka • Gana: Charaka- kustagna, Kashaya skandha Sushrutha –Saalasaaradi. Raja nighantu-shalmalyadi varga Bhava prakasha-vataadi varga Khadira is listed in agroushadha and is the drug of choice in kustagna. It isalso having the properties like krimigna, kushtagna and acts as sarva twak naashana.It also cures conditions like pittasra, shotha, kandu and vrana.For differentdermatological conditions khadira can be used in various types of treatmentmodalities like snana, pana, ashana lepa or pralepa avachurnana udvartana etc. Bark is useful as an astringent. It is also used in skin diseases. Its extractshows antibacterial and fungicidal action.Bark is also bitter and acrid. It cures itching,ulcers, boils and inflammation. It is also useful in many types of vaginal discharges.Table no-4 C. S S.S A.H R.N K.N D.N B.P CH.DKrimighna + +Shwithragna - +Kustagna + + + + + + + +kandugna - + + +Vranagna + + + +Medagna - +Sarva twak + + +doshagnaShotha +Department of Prasooti Tantra and Stree Roga 60
  • 79. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewSaptaparna • Botanical Name: Alstonica scholaris • Family: Apocyanaceas • Syn: vishala, suparnaka,vishamachchada, sharada, shalmali patraka, vishala twak, saptachchada • Rasa: Tikta, Kashaya • Guna: Laghu, snigdha • Veerya: Ushna • Vipaka: Katu • Karma: Kapha-pitta shaamaka, Tridoshahara • Gana: Charaka-kustagna, udarda prashamana, tikta skandha,Kashaya skandha, Sushruta &Vaagbhata- aaragwadadi, laakshadi, adhobhagahara. Saptaparna is one of the drug listed in shatkashaya yogas and in the classics itsuse is enumerated in different forms like snana, paana and avachurnana etc.Internal and external administration use of saptaparna in various forms will said tocure kushta, vrana and krimi. Saptaparna kalka lepa is advised in dustavrana. It alsosaid to alleviate to shoola and ruja. The alchoholic extract of bark is found active against streptomyces aureus. C.S S.S A.H R.N K.N D.N B.P CH.D G.NKustagna + + + + + + + +Krimighna + + + + + + + + +Dustavarna + + + + + + + +Shoola - - - - - - - - +Ruja - - - - - - - - + Table No-5Department of Prasooti Tantra and Stree Roga 61
  • 80. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewShereesha • Botanical Name: Albizzia lebbeck • Family: Mimosideae • Syn: Shukapriya • Rasa: Kashaya, Tikta, Katu • Guna: Laghu, rooksha, Tikshna • Veerya: Eshad ushna • Vipaka: Katu • Karma: Kapha-pitta shaamaka (tridoshahara) varnya • Gana: Chrakaa- vishagna, vedanastapana Kashaya skandha Sushruta - Saalasaaradi It is one of the constituents of dashangalepa which is mainly used ininflammatory conditons of skin with swelling and in many other skin pathologies. Itacts as shothagna.External application of shirisha with ghrita is explained in theconditions like visarpa and shirisha twak lepana is said to relieve the kushta. It is alsohaving vranagna and daaha shaamaka properties when used with other suitable drugs.It is having kandugna and can be used in dermatological conditions like paama.Udvartana using shirisha with other suitable drugs will check the impurities of skinand reduces excessive perspiration especially in medoroga. Acharya Sushrutha said that shirisha can be safely used in soothika. He alsosaid that it is safe even in females who underwent mooda garbha aaharana and shatrakarma. Bark is bitter and cures skin diseases, relieves itching excessive perspirationinflammation and blisters.The alchoholic extract of stem bark contains cardenolideglycosides of digitoxin nature and anthraquinone glycosides. The 1st group ofglycosides has antidermatpphytic activity and the 2nd group has antibacterial activity.They also showed activity against other aerobes, yeast and some specific protozoans.Department of Prasooti Tantra and Stree Roga 62
  • 81. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review Table No-6 C.S S.S A.H R.N D.N K.N B.P G.N CH.DKustagna + + + + + + + +Shothagna + + +Vedanastapana + +Varnya +Raktashodhaka + +Vishagna + +Pamaagna + +Vranaropana +kandugna + +Daha nashana +Mustaka • Botanical Name: Cyperus rotundus • Family: Cyperaceae • Syn: musta, vaarida • Rasa: Tikta,katu, Kashaya, • Guna: Laghu, rooksha, • Veerya: sheeta • Vipaka: Katu • Karma:Kapha-pitta shaamaka • Gana:Charaka-truptighna,trashnaanigrahana,lekhaneeya, kandughna,stanya shodhana Sushruta –mustadi, vachaadi.Musta lepana will cure agantuja vranas and is useful in kapha pittaja vyadhis and willdestroy the jantus.Its tubers are credited with anti-inflammatory properties. Drug is rich in Cu, Fe, Mgand Ni. B-sitosterol isolated from the tubers exhibits significant anti-inflammatoryactivity in rats and this activity is comparable to hydrocortisone and phenylbutazone.Methanolic extract of plant stimulates the production of melanin in culturedmelanocytes.Department of Prasooti Tantra and Stree Roga 63
  • 82. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewTable No-7 C.S S.S A.H R.N D.N K.N G.N B.P CH.DKustagnaKandugna +Vranagna +VedanastapanaJantugna +Haridra • Botanical Name: Curcuma longa • Family: Scitaminaceae • Syn: nishaa, kaanchani, varaparnini, peevari, peeta, nishaakya, krumighna, yoshitpriya, varunavarnini, • Rasa: Tikta, katu • Guna: ruksha, laghu • Veerya: ushna • Vipaka: katu • Karma: kapha-vaata shamaka, pitta rechaka shamaka • Gana: Charaka-kustaghna, lekhaneeya, kandughna, vishaghna Sushruta– haridradi, mustadi, shleshma prasaadana It is one of the content of dashanga lepa and rakta shodhaka and cures manyskin diseases. It is kaphapittahara, rakta shodhaka, kushtagna, kandugna, shothagna,beneficial in conditions like vranagna. It imparts good lusture to the skin and hence it is included in under varnyadravyas. In sthoulya udvartana with haridra said to alleviate the deha dourgandhya,i.e., bad odour of the body caused due to excessive perspiration caused due to obesity. Haridra kalka prayoga is beneficial in kushta chikitsa especially to treat theconditions like paama and kachchu. The utility of udvartana with nishadi choorna inpathologies like paama etc charma vikaras is explained in classics.Department of Prasooti Tantra and Stree Roga 64
  • 83. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review The juice of fresh rhizome is used as antiparasitic for skin diseases. Externalapplication is done in ulcers and inflamed areas. Oil of turmeric, distilled from dryrhizomes has antiseptic properties. Curcumin, one of the active principles of haridra has anti inflammatoryactivity in both exudative and proliferative inflammation. The extracts show thepresence of steroids and it is likely that steroids are responsible for anti inflammatoryaction. Water extract is more potent and is similar to that of hydrocortisone. Petroliumether extract is good analgesic and similar to that of indomethacin. Alchoholic extract and essential oil showed bactericidal activity. Curcuminacts as bacterio-static agent with respect to staphylococci. Oil acts against bacteriaand fungi including human pathogens i.e., it has potent antimicrobial activity. Turmeric oil is said to inhibit the in vitro activity of hyaluronidase, an enzymeconsidered to be involved in the development of the inflammation. It inhibitsexperimentally induced edema. The oil exhibited marked bactericidal activity againstboth gram +ve and gram –ve bacteria especially against the species of staphylococcusand klebsilla. It also showed anti-fungal activity. The extract of turmeric exhibited antibacterial activity. The extract along withthe extract of Emblica officinalis showed better antibacterial activity compared toindividual ingredients. Curcumin in vivo acts as anti inflammatory by exhibiting cyclo-oxygenaseactivities in human platelets. The rhizomes have curcumin related phonolics whichpossesses antioxidant and anti inflammatory action. paste of turmeric with astringents, bitters and aromatics is applied externallyto bruises, sprains and indolent ulcer. This paste is also applied in skin afflictions suchas prurigo, ringworm, scabis and in eczema. Rarely does it act as allergic to causecontact dermatitis.Department of Prasooti Tantra and Stree Roga 65
  • 84. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review It also has anti inflammatory action with respect to inhibition of activatedproteases responsible for acute inflammatory processes. The volatile oil is found toinhibit trypsin as well as hyaluronidase enzymes. Alchoholic extract showedantimicrobial activity.Table No-8 C.S S.S A.S R.N D.N K.N B.P G.N CH.DKustagna + + + +Kandugna + +Krimigna +Vishagna +Varnya + +Vragna + + +shothagna +paamagna +Nimba • Botanical Name: Azadirachta indica • Family: Meliaceae • Syn: pichumarda, tiktaka, arishta, paribhadra, hinguniryasa • Rasa: tikta, kashaya • Guna: laghu • Veerya: sheeta • Vipaka: katu • Karma: kapha-pitta shaamaka • Gana: Charaka - kandughna, tikta skandha Sushruta – Aaragwadadi, guduchyadi, laakshaadi Bhava prakasha-guduchyadi varga Nimba can be used in different forms for internal administration and also forexternal local application in the form of lepana or snaana. External application willreduce the burning sensation.Department of Prasooti Tantra and Stree Roga 66
  • 85. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review It is useful in diseases caused to due to kaphapitta and acts as kustagna,kandugna, krimigna and shothagna. Its efficacy in curing the kusta is emphasized andexplained that it does cure kushta within a span of a month. Praising the qualities ofnimba it has been said that it is useful even in “pralepa maatrean” and “prashamamyaati vegatah” i.e., just by the external application it can cure conditions like paama,dadru, vicharchika, kandu etc, skin diseases and efficacy can be seen quickly becauseof fast action. It is also beneficial in the treatment of vrana as it does the paachana of apakvavrana and vishodhana of pakva vrana. It also acts as vrana shodhaka and vranaropaka. Bhavamishra added grahi guna in the list of properties of nimba. Nimba isused as shodhaka dravya in pathological conditions where there is purulent dischargefrom the yoni and explained in yoni roga. Nimbatwak dhopana and nimba kwathaprakshalana is used to get rid of paichchilya dosha of yoni. It is supposed tostrengthen the yoni. Nimba kwatha avagahana is beneficial in conditions involvingshotha.Bark contains many active ingredients including tannin, B-sitosterol etc. Almost everypart of the tree is bitter and all the parts are having B-sitosterol. Plant extracts areshown to have antibacterial properties. Bark is also having astringent property and isuseful in cutaneous diseases. The strong decoction of leaf and bark is antiseptic.The extracts shown to inhibit the activity of Micrococcus pyogenus vas aureus and isalso having prominent fungicidal activity. Ethanolic extract of stem bark exhibitedmarked antibacterial and antifungal activity against Bacillus megaterium andAspergillus niger. Terpenoids of the plant part extracts exhibit antibacterial, antibioticand insecticidal property.Table No-9 C.S S.S A.S R.N D.N K.N B.P G.N CH.DKustagna + + + + + + +Kandugna + + +Krimigna + + + + +Shothagna +Vranagna + + + + + + +Department of Prasooti Tantra and Stree Roga 67
  • 86. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewAmalaki • Botanical Name: Emblica officinalis • Family: Euphorbiaceae • Syn: dhaatri, vayasta, vayasya, abhaya, amritha,vrushya • Rasa: amla pradhana lavana varjita pancha rasa • Guna: laghu, ruksha, sheeta • Veerya: sheeta • Vipaka: madhura • Karma: tridoshahara, pitta shamaka, ayahstaapana, rasaayana • Gana: Charaka -vayahstapana, virechanopaga Sushruta –triphala, parushakadi It acts as shothagna and daha prashamaka. Fruits are rich sources of vit C. Fruit, leaves and barks are rich in tannin. Fruithas tannic acid, gallic acid, resinous matter etc. It also acts on dermatosis and ishaving anti inflammatory property.Table No-10 C.S S.S A.S R.N D.N K.N B.P G.N CH.DkandugnaKustagnaVedanaStapanaShothagna + +KrimignaHareetaki • Botanical name: Terminalia chebula • Family: Combretaceae • Syn: pathya, vijaya, shiva, amrita, abhaya, vayastha, jaya, haimaavathi • Rasa: kashaya pradhana lavanavarjitha pancharasa • Guna: laghu, rukshaDepartment of Prasooti Tantra and Stree Roga 68
  • 87. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review • Veerya: ushna • Vipaka: madhura • Karma: Tridhoshahara, anulomana, rasaayana, lekhana • Gana: Charaka- prajaastapana, jvaraghna,kustaghna, kasaghna, arshoghna Sushruta –triphala, amalakyadi, parushakadi, trivritadi It is having kushtagna, kandugna, and shothagna properties and is said as“twak amayagni”.On external application this drug will relieve the srotovibandha i.e.,it will cleanse the srotas and removes the blockade. In sthoulya, the utility of haritaki is mentioned and said that it will be useful toreduce swedadikyatha and sharira dourgandhya (bad body odour due to excessiveperspiration) In such conditons and in medo roga, haritaki udvartana followed bysnana is indicated. Its use is advised even if the sthoulyatha is complicated withpidikas.In kushta the usefulness of pathyadilepa is explained. Flesh of dried fruit is rich in tannin. It contains around 30-32% of tannin.A fraction obtained by treating the 80% alcoholic extract of fruits with HCL andextracting with ether showed reasonably high activity against a number of bacteriaand fungi.Fruit pulp used in different forms, show anti inflammatory action. Fruits are useful inskin diseases, itching and pain. Even in yunani system it is said as blood purifier.External application of the paste is good for burns and scalds.Table No-11 C.S S.S A.S R.N D.N K.N B.P G.N CH.DKustagna + +Kandugna +Shothagna +VedanastaPanaDepartment of Prasooti Tantra and Stree Roga 69
  • 88. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewVibheetaki • Botanical Name: Terminalia bellerica • Family: Combretaceae • Syn: akshaphala, kaalidruma, karshaphala • Rasa: kashaya • Guna: laghu,ruksha • Veerya: ushna • Vipaka: madhura • Karma: kapha-pittahara, bhedana • Gana: Charaka- jvarahara, virechanopaga Sushruta- triphala, mustadi Vibhitaki phala majja lepa will reduce the burning sensation and is useful inall painful conditions. It also destroys the krimi. Fruits have 21.4% tannin-both condensed and hydrolysable types, B-sitosterol,gallic acid etc. The extract of fruit possesses antibacterial properties againstmicrococcus pyogenes and aureus. Bark is useful in skin diseases. Fruit is bitter andrelieves inflammation. Table No-12 C.S S.S A.S R.N D.N K.N B.P G.N CH.Ddaahahara +KustagnaKandugnakrimigna +Gandhaka • Syn: gandha paashana, putigandha, shulvari, Gandhi, rasagandhaka, sugandhika, gandhika, gandha, shougandhika, atigandha, pamari, kitanaashana, bali, balirasa, kushtari, sharabhumija, navanita, daityendra, gandhamaadana, kitaghna, kruragandha • Swarupa: nirmala, rajanisamaprabha, diptimana, navanitakomala • Rasa: katuDepartment of Prasooti Tantra and Stree Roga 70
  • 89. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review • Guna: laghu, snigda • Veerya: ushna • Vipaka: madhura • Karma:twak doshaghna, paachaka, atyanta rasayana • Types: according to tantrantara-swetha, raktha, pita, krishanaAshodita gandhaka dosha-It increases body temperature, produces brashachittavibrama (CNS symptoms secondary to toxic levels) raktaja vyadhi. It destroysprasannata(healthy status) surupatha(good physical outlook which reflects goodhealth), sharirabandhana (integrity of the body), prabha (lusture), and bala(strength).Types of gandhaka shodhana • Ghee is made liquid on low fire and equal amount of gandhaka powder is added. When gandhaka dissolves properly it is sieved through a clean cloth into milk. Then it is washed thoroughly with hot water. The same procedure is repeated for three times. • Milk is taken in a vessel and ghee is added. The mouth of the vessel is closed with a clean cloth. Gandhaka powder is spreaded over it and it is closed with another mud lid (Sharava). Edges are sealed. Then it is kept in a pit and upalas are burnt over the lid. The gadhaka melts and drops into milk. When the vessel is cooled the gadhaka is removed and washed with hot water. • Gandhaka is heated with sarshapa taila, tilataila or kusamba taila and is sieved through the cloth into the milk. Later it is washed with hot water. • It is heated with bringaraja swarasa and sieved into milk for seven times. • It is heated with chornodaka and lavana dravaka and sieved into milk for seven times.Qualities of Shuddha gandhaka-It removes garavisha, cures kshudra kushta, kasa,shwasa, dadru, relieves from shaaririka and manasika dosha and cures ama. It is goodfor eyes and rasayana when used judiciously. It increases the qualitites of parada.It is having kustagna, kandugna properties. It is indicated in dermatological conditionslike dadru, visarpa, kshudra kusta, paama etc. It also removes ama and does shoshana(dries up).Department of Prasooti Tantra and Stree Roga 71
  • 90. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewSome of the preparation of gandhaka that are indicated in different skin pathologiesare as follows-When it is used with ripened kadaliphala it cures skin diseases.-Gadhaka with karpura, soubhagya, mruddarasringa mixed with coconut oil appliedexternally cures even daruna pama.-Gandhaka with soubhagya, shalaniryasa, sphatika and nimbu swarasa cures dadru.-Gandhaka lepa, prakshalana and internal administration with tilataila is useful inpama, kandu, vicharchika etc. skin diseases.-Shuddha gandhaka given internally with madhy relieves dadru, charmadala andpaama.Some of the well known preparations of gandhaka are- -Dadruvidravana malahara -Gandhakadhya malahara -Gandhaka tailaDugda paashaana • Syn:dugdi, dugdapaashanika, ksheerashiva, dugdha shila, diptika, soudha, vajraabha, dugdha, gomedasannibha. • Rasa: madhura • Guna: ruksha • Veerya: sheeta/alpa ushana • Vipaka:katu • Karma:pitta shamaka, twakdaaha prashamana, grahi, vranaropaka It reduces pitta and acts as twak daaha shaamaka. It is having kustagna property and its external application is indicated in skin diseases like sidma. It is also having vrana ropaka property.Department of Prasooti Tantra and Stree Roga 72
  • 91. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review Acacia catechu/khadira Alstonica scholaris/saptaparna Albizzia lebbeck/shirisha Cyperus rotundus/mustaka Curcuma longa/Haridra Azadirachta indica/nimba Emblica officinalis/amalaki Terminalia chebula/haritaki Terminalia bellerica/vibhitaki Gandhaka Dugda pashana Khadiradi yoga aqueous chloroform ethanol Choorna extract extract extractDepartment of Prasooti Tantra and Stree Roga 73
  • 92. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewConcept of Avachurnana The word avachoornana 78contains 2 words- ava+choorna The word ava is derived from the root “mvaadim-param-set”.Means gatou,praptou, praveshe, aadane 76i.e., to obtain, to enter, to borrow, to move The word choorna77 is derived from the root “chrnyate pishyate yat” and“sampeshnena jaata rajah” which means “pesha chornikaranam” i.e., the productwhich is got from the act of pounding or the very fine dust got from pounding thedrug. Its characteristics are explained as follows71-It is the dust or the powder whichis got from properly pounding the very dry drug or completely dried drug and sievedthrough the cloth. Fine powders will retain their complete potency till paksha traya paryanthai.e., for about 1and1/2 months.In shabda kalpa druma –ava+choorna+karmaani77 -choornikrita dravyam Acharya Charaka has explained the procedure of avachoornana as“choornasya vikiranam” The process of spreading or dusting the very fine drugpowder over the lesion is called avachoornana. In charaka while explaining the treatment for kushta, it is said that theShatkashaya yogas can be used for snana (bath), paana (oral medication), aalepana(external application), pragharshana (rubbing on the leison) and for avachurnana(dusting on the leison)72 In Sushruta samhita the avachoornana procedure is defined as “vranooparichoornaprakshepa”.73 i.e.,the depositing the fine drug powder over the lesion is callDepartment of Prasooti Tantra and Stree Roga 74
  • 93. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Reviewavachoornana Here it is told in the list of shasti upakramas i.e., as a measure of”vranopakrama.”74It is used for two purposes –shodhanaartha75 -ropanaartha If the lesion is having foul smelling discharge or ooze if the lesion is moist, ormore dampness is there in and around the leison or mucoid secretions are there theninitially drugs having shodhana property should be used for different types ofexternal applications like washing with kashaya or dusting with choorna etc.If the lesion is devoid of above features or if the lesion appears shudda (shudda vrana)then for different types of external application drugs having ropana property should beused.LepaSynonyms-aalepa, lepa, lipta, lepanaTypes of application-Depending on the thickness of the local application ofmedicines especially pastes (lepas) Acharya Sharngadhara classified the lepas asfollowsPralepa- It is having the qualities like – shita (cool), tanu (thin), avishoshi (dry). It isuseful in diseases caused because of pitta dosha.Pradeha- It is having the qualities like – arda (moist), Ghana (solid), and ushna(hot/warm), and is beneficial in diseases caused by shleshma and vaataTypes of powderCoarse powder-18-20 No. sieveFine powder- No. 60 sieveVatra gaalita powder (very fine powder)-No. 100 -120sieveDepartment of Prasooti Tantra and Stree Roga 75
  • 94. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewAbsorption and availability of a locally applied drug Skin has many essential function, including protection, thermoregulation,immune responsiveness, biochemical synthesis, sensory detection and social andsexual communication. Therapy to correct dysfunction in any of these activities mayemploy chemical agents that can be delivered systemically, intra-lesionally ortopically and physical agents to which the skin can be exposed. A unique aspect of dermatological pharmacology is the direct accessibility ofthe skin as a target organ for the diagnosis and treatment. In most of thedermatological conditions topical agents are employed alone or in conjunction withphototherapy and/or systemic medications in the management. Therapeutic agents can reach epidermal keratinocytes and immuno-competentcells in the epidermis and the underlying dermis that are involved in the pathogenesisof numerous cutaneous diseases. Topical agents can be applied directly to the skin butmust penetrate into the tissue to achieve efficacy. Appropriate use of topical agentsrequires an appreciation of the factors that influence percutaneous absorption.Skin and topical application Skin acts as a two way barrier to prevent absorption or loss of water andelectrolytes. This barrier resides in the outermost layer of the epidermis, the stratumcorneum, as evidenced by approximately equal rates of penetration of chemicalsthrough isolated stratum corneum or whole skin. Having lost their nuclei andcytoplasmic organelles, the corneocytes of the stratum corneum are nonviable. Thecells are flattened, and the fibrous keratins are aligned into disulfide cross-linkedmacro-fibers in association with filaggrin, the major protein component of thekeratohyalin granule. Each cell develops a cornified envelope resulting from cross-linking ofinvolucrin and keratohyalin, forming and insoluble exoskeleton that acts as a rigidscaffold for the internal keratin filaments. The intercellular spaces are filled withhydrophobic lamellar lipids derived from membrane coating granules.Department of Prasooti Tantra and Stree Roga 76
  • 95. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review The combination of hydrophilic cornified cells in hydrophobic intercellularmaterial provides a barrier to both hydrophilic and hydrophobic substances. Indermatological diseases, the thickened epidermis may further diminish the penetrationof pharmacological agents into the dermis.Types of local applicants are- - Dusting powder, - paste, - lotion, - drops, - Ointments etc.Types of local applicationTranscutaneous-Here galvanic current allows the penetration of drugs applied to theskin into deeper tissues.Inunctions-Drugs are rubbed into the skin.Adhesive units- Here drugs are delivered to the affected desired site slowly.Absorption and bioavailability1)Simple or passive diffusion-Here molecules of the solvent and solute areconstantly in random motion and those that reach the lipid bilayer of cell membraneget dissolved in it and rapidly transported across it through membrane down theconcentration gradient. Eg.: Water-carries water and water soluble substances of small molecular weight <700 like urea and alcohol.Hydrophobic lipid soluble molecules-(O2 N2 ) molecules of unionized ,lipid soluble drugs, small uncharged hydrophilic molecules are transported like this.2)Facilitated diffusion-Carrier protein carries the molecules from an area of higherconcentration to lower concentration3)Active transportation-Here the molecules are carried against the gradient by usingthe ATP.Department of Prasooti Tantra and Stree Roga 77
  • 96. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewRate of absorption is needed to - to determine the frequency of administration - to ascertain the duration of effective action - predict the onset of desired or undesired effects of the drug. The route of administration determines the biological lag (i.e., the time betweenadministration and the development of the response)Bioavailability-It is the amount or % of the drug that is absorbed from a given dosageforms and reaches the systemic circulation following non-vascular administration.Bioassay-It is used to measure the concentration of a specific active ingredient in thegiven sample.Principles of drug administration ensures that-The drug must enter the skin in adequate concentration.-It should be able to provide high concentration with minimal systemic absorption. Drugs are applied to the skin in the form of various formulations in a varietyof pharmacologically inactive vehicles. Their effects depend upon thepharmacological properties of the active drug/drugs and physical properties of thevehicle.Principles of absorption-Drug entry into the skin is determined by absorption of thedrugs into the skin-which depends on the following factors.Partition co-efficient of the drug- It is the rate of diffusion of the drug from thevehicle to the skin surface. Again this is dependent on the qualities of the vehicle.It occurs between the vehicle and corneum stratum, which again depends upon thelipid solubility of the drugs. Partitioning of the drug between the vehicle and stratumcorneum is the specific physiochemical feature of the individual drug.State and Degree of the hydration of the stratum corneum- Hydration reducesresistance to diffusion of drug. Increased hydration increases the drug penetration.Drug absorption is increased with hydration, defined as an increase in the waterDepartment of Prasooti Tantra and Stree Roga 78
  • 97. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Reviewcontent of the stratum corneum that is produced by inhibiting in trans-epidermal lossof water. Methods of hydration include occlusion with an impermeable film,application of- lipophilic occlusive vehicles such as ointments and soaking dry skinbefore occlusion.The drug concentration-As the concentration of a particular ingredient increases inthe particular drug the absorption of that ingredient increases proportionately to acertain level.Regional anatomic variation-Thickness of the skin- Skin thickness depends on the age of the person, and thelocation in the body. Thicker the skin, lower the drug absorption.Permeability generally is inversely proportional to the thickness of stratum corneum.Drug penetration is higher on the face, in intertriginous areas and especially in theperineum. Consequently the skin in these regions may be more susceptible to irritantand allergic contact reactions. Skin sites that are naturally occluded by apposingsurfaces, such as the axillae, groin and infra-mammary areas, also may be vulnerableto drug related toxicity such as atrophy from potent glucocorticoids.In soles the thickness is more and the absorption is less. In genitals and in eyelids theskin is thin and the absorption is comparatively more.Aging/aged skin- is less permeable to the drugs.Area/Site of the lesion-scrotal and vulval absorption is very highQuantity of the preparations applied-Quantity again depends on the extent of thelesion or the size of the lesion. The quantity is described and indicated for oneapplication for one specified and indicated area in the body of adults. As per this rulethe specified quantities are as follows - -Face, head, hand, ano-genital area -2-4gm - Anterior and posterior trunk-3-5gm - Legs-around 4-8gm - Entire body - 25-30gm (approximately 30 g is required to cover the body surface)Department of Prasooti Tantra and Stree Roga 79
  • 98. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug ReviewAltered barrier function- In some dermatological conditions because of theabnormality of stratum corneum the drug absorption may be increased or decreased. - Presence of inflamed skin-Inflammation changes the tissue permeability, and the oedema provides the liquid medium. These two mechanisms allow higher penetration of the drug. - Use of occlusive dressing-It increases the penetration of the drug by 10 folds - Absorption of the drug also depends on presence and the quality of the vehicle.Application frequency-Topical agents are often are applied twice daily. The stratumcorneum may act as a drug reservoir that allows gradual penetration into the viableskin layers over a prolonged period.Vehicle-Treatment of skin ailments is usually topical. Usually the topical preparation has twoparts.-The active ingredients - The vehicles (liquids, powders, oils and creams) Many factors influence the rate and extent to which topical medications areabsorbed. Most topical medications are incorporated into bases or vehicles that areapplied directly to the skin. The chosen vehicle can influence drug absorption andprovide therapeutic efficacy. They act by- - They form a reservoir for the active ingredient. - They allow local release of suitable amounts of the active drug. - They provide a reasonably safe infrastructure for practical applications. Many vehicles are used for their physical actions-soothening, lubricating, coolingdrying, moistening, softening, hydrating and protecting effects.Topical preparations-Powders/ Dusting powder - They act by their physical property of absorbing moisture.Department of Prasooti Tantra and Stree Roga 80
  • 99. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review - They contain ingredients like-talc, starch, chalk,talc cellulose, zinc magnesium stearate and magnesium silicate. - They can also provide a cooling effect by increasing the effective surface area of the skin. - They protect skin surfaces by reducing friction by their lubricating action especially in the intertriginous areas such as axillae, groins and in the skin folds under female breasts. - Magnesium silicate if gets into the wounds or body cavities it may cause granulomas.Wet dressings- - They are used to treat sub acute inflammation, after severe exudation is stopped. Evaporation of the water from the lotion imparts the cooling effect. - The residual dry powder acts as protective. But sometimes they cause excessive drying.Lubricating preparations- - Include oils, - Indicated for dry and scaling disorders. - All the water based formulations must contain preservatives. - Lotions are contra indicated if they form crusts or sometimes they excessively dry the skin.Counter-irritant and rubefacient- are irritant, that stimulate nerve endings in the intactskin to relieve pain in the skin. Their precise mode of action is not known.In case of localized pruritus- covering the lesion and minimal pressure by medicinesmay help.Drug delivery in dermatological diseases-In case of topical preparations, the molecules can penetrate the skin by three routes.They are-through –intact stratum corneum -sweat ducts -sebaceous folliculiDepartment of Prasooti Tantra and Stree Roga 81
  • 100. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Drug Review The surface of the stratum corneum presents more than 99% of the total skinsurface available for percutaneous drug absorption. Passage through this outer mostlayer is the rate-limiting step for percutaneous absorption. Preferable characteristics of topical drugs include low molecular mass(600Da), adequate solubility in oil and water and a high partition coefficient. Except for very small particles, water soluble ions and polar molecules do notpenetrate intact stratum corneum.Metabolism The stratum corneum, i.e., the superficial keratin layer is both principal barrierto penetration of drugs into the skin and it also acts as a reservoir for drugs. After the adsorption depending upon the specific composition of the drug itmay be stored in the skin for prolonged periods. A drug readily diffuses from the stratum corneum unto epidermis and then intodermis, where it enters capillary circulation and thus into the systemic circulation.There may be a degree of pre-systemic (1st pass) metabolism in the epidermis anddermis, a desirable feature to the extent that it limits the systemic effects. The major steps involved in percutaneous absorption include the establishmentof a concentration gradient, which provides the driving force for drug movementacross the skin; release of drug from the vehicle (partition coefficient); the drugdiffusion across the layers of he skin(diffusion coefficient). The viable epidermis contains a variety of enzyme systems capable ofmetabolizing drugs that reach this compartment including epoxide hydrolase,transferases such as N-acetyl-transferases, and sulfatases. They influence the influxand efflux of certain chemicals. Here substrate turnover is considerably less.Department of Prasooti Tantra and Stree Roga 82
  • 101. Material and Methods
  • 102. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Material and MethodsMaterial and Methods:Sources of data for the clinical study Minimum of 60 female patients suffering from genito-inguinal intertrigo wereselected from OPD and IPD of SDM Hospital of Ayurveda and taken for the study.Method of collection of the data for the clinical study It was a single blind clinical study, with pre-test and post-test design, wherein60 diagnosed female patients of genito-inguinal intertrigo of age group 20-55 yearswere selected & made into 2 groups of 30 patients each. One group was given candidpowder (a proved drug as control) & the other group was given khadiradi yogachurna. A special proforma was prepared with all points of history taking, symptoms,physical signs and lab investigations as mentioned in our classics and allied sciences.The parameters of signs and symptoms were scored on the basis of standard methodof statistical analysis.INTERVENTION:The drug powder was dusted to the affected area twice daily aftercleaning the part with pre boiled water and drying the area with clean gauze.DOSE: Approximately 5gm of the powder was dusted on the surface of the affectedskin twice in 24 hours.DURATION OF ADMINISTRATION: 5 days to 3 weeks.FOLLOW-UP: One week later, after the medication is stopped.INVESTIGATIONS: Routine investigation if needed.Inclusion Criteria:- Patient aged 20-50 years.-Diagnosed cases of genito-inguinal intertrigo/kacchu in otherwise healthy femalepatients.-Genito-inguinal intertrigo/kacchu with gynecological conditions whereinadministered drugs do not have an action on the lesion.- Diagnosed cases of genito-inguinal intertrigo/kacchu in pregnancy in all threetrimesters.-Diagnosed cases of genito-inguinal intertrigo/kacchu in puerperal state.Department of Prasooti Tantra and Stree Roga 84
  • 103. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Material and MethodsExclusion criteria:- Patients with intertrigo with other skin diseases.- Chronic intertrigo with atrophic changes.-Intertrigo with complications like septicemia.-Patients with systemic diseases like diabetes, HIV and immuno compromised state.-Patients on steroid treatment.-Intertrigo in locations other than genito-inguinal region.-Intertrigo with gynecological conditions wherein administered drugs have an actionon the lesion.Assessment Criteria:The assessment was made on the basis of changes in the following subjective andobjective parameters.Table No-13 Subjective parameters Pain Itching Objective parameters Area of the lesion Redness (Sign of Inflammation) Discoloration Warmth Edema Roughness Discharge Tenderness BlistersResults obtained were given as: • Completely cured. • Mildly reduced. • Not reduced but status quo maintained. • Aggravated. • Association of complications if any.Department of Prasooti Tantra and Stree Roga 85
  • 104. Observations
  • 105. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Following observations are made during the study. Observations are made before,during and after the treatment.60 patients fulfilling the inclusion criteria of kachchu andintertrigo are taken.Incidence observation1) Table No 14 Age Distribution of Patients Age Number of Patients % Test Control Total Group Group 18-23 8 7 15 25.00% 24-29 11 13 24 40.00% 30-35 5 5 10 16.67% 36-41 3 1 4 6.67% 42-47 1 2 3 5.00% 48-53 2 2 4 6.67% Total 30 30 60 Figure No-1 Age Distribution 15 10 5 Test Group Control Group 0 18‐23 24‐29 30‐35 36‐41 42‐47 48‐53 Age In the present study out of 60 patients 40 % women belonged to age group 24-29years, 25% females belonged to age group 18-23 years, 16.67% females of 30-35 years agegroup and 6.67% females were of age group 36-41years. Rest of them was between 42-53years.Department of Prasooti Tantra and Stree Roga 87
  • 106. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations2) Table No-15 Religion Distribution of Patients Number of Patients % Religion Test Control Total Group Group Hindu 17 20 37 61.67% Muslim 8 6 14 23.33% Christian 5 4 9 15.00% Total 30 30 60 Figure No-2 Religion Distribution 20 15 10 Test Group 5 Control Group 0 Hindu Muslim Christian Religion In this study out of 60 patients 61.67% of females were Hindus, 23.33% females wereMuslims and rest 15.00% women were Christians.3) Table No-16 Socio economic Status Distribution of Patients Social Status Number of Patients % Test Control Total Group Group Lower 4 5 9 15.00% Middle 20 18 38 63.33% Upper 6 7 13 21.67% Total 30 30 60 Figure No-3 S o c i a l S t a t u s 20 15 10 T e s t G r o u p 5 C o n tr o l G r o u p 0 Lower M id d le Upper S o c ia l  S t a t u sDepartment of Prasooti Tantra and Stree Roga 88
  • 107. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Out of 60 patients 63.33% women were belonging to middle socio economic status,15.00% women were belonging to lower class and 21.67% women were belonging to uppersocio economic status.4) Table No-17 Occupation Distribution of Patients Occupation Number of Patients % Test Control Total Group Group House Wife 24 21 45 75.00% Others 1 3 4 6.67% Bidi Worker 4 6 10 16.67% Social Worker 1 0 1 1.67% Total 30 30 60 Figure No-4 Occupation Distribution 40 20 Test Group 0 Control Group Occupation In this present study, 75.00% of women were housewives and 16.67% women belong toother professionals.5) Table No-18 Education Distribution of Patients Education Number of Patients % Test Control Total Group Group Primary 5 4 9 15.00% High School 14 15 29 48.33% College 4 4 8 13.33% Graduate 5 6 11 18.33% Illiterate 2 1 3 5.00% Total 30 30 60Department of Prasooti Tantra and Stree Roga 89
  • 108. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Figure No-5 Education Distribution 15 10 Test Group 5 Control Group 0 Education In the present study, 45.00% women completed high school level education, 18.33%women completed graduation, 15.00% women completed primary level education, 5 %women completed PUC, and 5 % women were illiterate.6) Table No-19 Marital Status Distribution of Patients Marital Status Number of Patients % Test Control Total Group Group Married 27 30 57 95.00% Unmarried 3 0 3 5.00% Total 30 30 60 Figure No-6 Marital Status 30 20 Test Group 10 Control Group 0 Married Unmarried Marital Status In the present study 95.00% women were married and 5.00% were unmarried.Department of Prasooti Tantra and Stree Roga 90
  • 109. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations7) Table No-20 Population Distribution of Married Women Distribution Number of Patients % Test Control Total Group Group Married - non pregnant 4 6 10 17.54% Pregnant 15 15 30 52.63% Peri Menopausal 1 2 3 5.26% Puerperium 7 7 14 24.56% Total 27 30 57 Figure No-7 Distribution of Married Women 15 10 5 Test Group Control Group 0 Married ‐ non  Pregnant Perimenopausal Peurperium pregnant Married Women In the present study, 52.63% females were pregnant, 24.56% females were puerperium,17.54% females were married but not pregnant and 5.26% females were in the peri-menopausal age.8) Table No-21 Incidence by type of Diet Diet Number of Patients % Test Control Total Group Group Mixed 26 24 50 83.33% Vegetarian 4 6 10 16.67% Total 30 30 60 Figure No-8 Aahara ‐ Diet 30 20 Test Group 10 Control Group 0 Mixed Vegetarian DietDepartment of Prasooti Tantra and Stree Roga 91
  • 110. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Out of 60 patients 83.33% women were having mixed diet and 16.67% women werehaving vegetarian diet.9) Table No-22 Incidence of Bathing Habits Bathing Habits Number of Patients % Test Control Total Group Group Once in 2 days 6 6 12 20.00% Once in 3-4days 3 4 7 11.67% Daily 21 20 41 68.33% Total 30 30 60 Figure No-9 Bathing Habits 30 20 Test Group 10 Control Group 0 Once in 2 days Once in 3‐4days Daily Bathing Habits In this study out of 60 patients, 68.33% females were having daily bath, 20.00% of femaleswere having bath once in 2 days and 11.67% females were having bath once in 3-4 days.10) Table No-23 Use of Clothing/Type of occlusion Clothing Number of Patients % Test Control Total Group Group Heavy clothing 4 6 10 16.67% Pads 11 13 24 40.00% Synthetic undergarments 15 11 26 43.33% Total 30 30 60Department of Prasooti Tantra and Stree Roga 92
  • 111. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Figure No-10 U s e  o f  C lo th in g 15 10 T e s t G r o u p 5 C o n tr o l G r o u p 0 C lo th in g Out of 60 females registered for this study, 43.33% women were using syntheticundergarments, 40.00% females gave the history of using sanitary pads and 16.67% femaleswere wearing heavy clothing.11) Table No-24 Distribution of population according to Prakruti Prakruti Number of Patients % Test Control Total Group Group Kapha 3 4 7 11.67% Kapha + Pitta 17 15 32 53.33% Kapha + Vata 7 9 16 26.67% Pitta + Vata 3 2 5 8.33% Grand Total 30 30 60 Figure No-11 Prakruti 20 15 10 Test Group 5 Control Group 0 Kapha Kapha +  Kapha +  Pitta +  Pitta Vata Vata Prakruti Out of 60 patients 45.00%, 8.33% females were having kapha pitta and pitta kaphaprakruti respectively.21.67% females were having kapha vaata prakruti, 11.67% females werehaving kapha prakruti, and 5.00% females were having vaata kapha prakruti, 5.00% femaleswere having vaata pitta prakruti and 3.33% females were having pitta vaata prakruti.Department of Prasooti Tantra and Stree Roga 93
  • 112. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations12) Table No-25 Distribution of population according to Samhanana Samhanana Number of Patients % Test Control Total Group Group Avara 1 2 3 5.00% Pravara 13 10 23 38.33% Madhyama 16 18 34 56.67% Total 30 30 60 Figure No-12 Samhanana 20 15 10 Test Group 5 Control Group 0 Avara Pravara Madhyama Samhanana Out of 60 patients 56.67% women were having madhyama samhanana, 38.33% femaleswere having pravara samhanana and 5.00% women were having avara samhanana.13) Table No- 26 Aahaarashakti Aahaarashakti Number of Patients % Test Control Total Group Group Avara 4 6 10 16.67% Madhyama 16 13 29 48.33% Pravara 10 11 21 35.00% Total 30 30 60 Figure No-13 Aahaarashakti 20 15 Test Group 10 Control Group 5 0 Avara Madhyama Pravara AahaarashaktiDepartment of Prasooti Tantra and Stree Roga 94
  • 113. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations In the study 48.33% women were having madhyama ahara shakti, 35.00% females werehaving pravara ahara shakti and 16.67% women were having avara ahara shakti.14) Table No-27 Predominant Rasa Rasa Number of Patients % Test Control Total Group Group amla katu 5 3 8 13.33% amla lavana 2 1 3 5.00% amla madhura 4 6 10 16.67% katu 5 5 10 16.67% katu amla lavana 1 2 3 5.00% katu lavana 3 4 7 11.67% katu madhura 3 5 8 13.33% lavana 1 1 2 3.33% lavana madhura 3 1 4 6.67% madhura 3 2 5 8.33% Total 30 30 60 Figure No-14 Predominant Rasa 6 4 Test Group 2 Control Group 0 Rasa In the present study 16.67% women were preferring katu, and amla madhura rasa,13.33% women used to like katu madhura and amla katu, 11.67% women were using katulavana ahara.Department of Prasooti Tantra and Stree Roga 95
  • 114. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations15) Table No-28 Sweating in Patients Sweating Number of Patients % Test Control Total Group Group Excessive 24 25 49 81.67% Normal 6 5 11 18.33% Total 30 30 60 Figure No-15 Sweating in Patients 40 Test Group 20 Control Group 0 Excessive Normal Sweating In this present study out of 60 patients 81.67% women had excessive sweating and18.33% women had normal sweating.16) Table No-29 Micturition Frequency Frequency Number of Patients % Test Control Total Group Group 4 - 5/day 3 1 4 6.67% Increased frequency 27 29 56 93.33% Grand Total 30 30 60 Figure No-16 Frequency  Of Micturition 30 20 Test Group Control Group 10 0 4 ‐ 5/day Increased frequency FrequencyDepartment of Prasooti Tantra and Stree Roga 96
  • 115. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations In the present study, out of 60 patients 93.33% women had increased frequency ofmicturition and 6.67% had normal frequency.17) Table No-30 Micturition – Associated complaints Associated Pain Number of Patients % Test Control Total Group Group Stress incontinence 2 2 4 6.67% Urge incontinence 9 11 20 33.33% None 19 17 36 60.00% Total 30 30 60 Figure No-17 Micturition ‐ Associated Complaints 20 15 10 Test Group Control Group 5 0 Stress  Urge  None incontinence incontinence Associated Complaint Out of 60 patients 26.67% women had urge incontinence, 6.67% women had stressincontinence and 60.00% women had not micturition associated problems.18) Table No-31 Presence of Vaginal Discharge Presence of Vaginal Number of Patients % Discharge Test Control Total Group Group Vg discharge 20 21 41 68.33% Menorrhagia 2 0 2 3.33% Lochia 3 4 7 11.67% No Discharge 5 5 10 16.67% Total 30 30 60 Figure No-18Department of Prasooti Tantra and Stree Roga 97
  • 116. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Presence of Vaginal Discharge 25 20 15 10 Test Group 5 Control Group 0 Presence In this present study, out of 60 patients, 68.33% women had vaginal discharge, 3.33%women had increased p/v bleeding, 11.67%women had lochial discharge and there was novaginal discharge in 16.67% women.19) Table No-32 Gestational Age Gestational Number of Patients % Age Test Control Total Group Group 17w - 22w 1 1 2 6.67% 23w - 28w 1 2 3 10.00% 29w - 33w 2 3 5 16.67% 34w - 39w 11 9 20 66.67% Total 15 15 30 Figure No-19 Gestational Age 15 10 Test Group Control Group 5 0 17w ‐ 22w 23w ‐ 28w 29w ‐ 33w 34w ‐ 39w Age In the present study, out of pregnant women population, 66.67%pregnant patients were in34-39 weeks, 16.67% pregnant patients were in 29-33 weeks, 10.00% were in 23-28 weeksand 6.67% women were in 17-22 weeks.Department of Prasooti Tantra and Stree Roga 98
  • 117. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations20) Table No-33 Presence of Episiotomy Wounds Presence of Number of Patients % Episiotomy Test Control Total wounds Group Group Present 7 7 14 87.50% Absent 1 1 2 12.50% Total 8 8 16 Figure No-20 Presence of Episiotomy Wound 10 Test Group 5 Control Group 0 Present Absent Presence In the study, out of 16 puerperal women, 87.50% women had episiotomy wound andthere was no episiotomy wound in 12.50% women.21) Table No-34 Location of Episiotomy Wound - Peurperium Location Number of Patients % Test Control Total Group Group Not on the lesion 2 3 5 35.71% On the lesion 5 4 9 64.29% Total 7 7 14 Figure No-21 Location of Episiotomy Wound ‐ Puerperium 6 4 Test Group Control Group 2 0 Not on the lesion On the lesion LocationDepartment of Prasooti Tantra and Stree Roga 99
  • 118. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations In the present study, out of puerperal women population, in 64.29% women the intertrigowas on the episiotomy lesion and in 35.71% women the intertrigo was not on the episiotomylesion.22) Table No-35 Mode of Onset of intertrigo Mode Number of Patients % Test Control Total Group Group Gradual 3 4 7 11.67% Recurrent 12 14 26 43.33% Sudden 15 12 27 45.00% Total 30 30 60 Figure No-22 Mode of Onset 15 10 Test Group 5 Control Group 0 Gradual Recurrent Sudden In the current study, out of 60 patients, 45.00% women had sudden onset, 43.33% womenhave recurrent onset and 11.67% women had gradual onset.23) Table No-36 Duration of intertrigo Duration Number of Patients % Test Control Total Group Group 1 day - 3 days 8 6 14 23.33% 4 days - 7 days 13 11 24 40.00% 8 days - 15 days 5 7 12 20.00% 16 days - 29 days 1 2 3 5.00% 30 days - 60 days 2 2 4 6.67% > 60 days 1 2 3 5.00% Total 30 30 60Department of Prasooti Tantra and Stree Roga 100
  • 119. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Figure No-23 Duration of Intertrigo 15 10 Test Group 5 Control Group 0 Duration In this study, in 40.00% women the intertrigo started 4-7days back, in 23.33% females -1-3days back, in 20.00% women – 8-15 days back and in 5.00% women about 30 days and60 days each.24) Table No-37 Nature of Area Involved/dampness Nature of Number of Patients % Area Test Control Total Group Group Dry 6 8 14 23.33% Moist 24 22 46 76.67% Total 30 30 60 Figure No-24 Nature of Area Involved 40 20 Test Group Control Group 0 Dry Moist NatureDepartment of Prasooti Tantra and Stree Roga 101
  • 120. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations In this present study, in 76.67% women the genito inguinal area was moist and in 23.33%women the genito inguinal area was dry.25) Table No-38 Nature of Skin involved Nature of Number of Patients % Skin Test Control Total Group Group Rough 8 10 18 30.00% Smooth 22 20 42 70.00% Total 30 30 60 Figure No-25 Nature of Skin Involved 30 20 Test Group 10 Control Group 0 Rough Smooth Nature In this present study, in 70.00% females the skin of the genito-inguinal area was smoothand in 30.00% females the skin of the genito inguinal area was rough.26) Table No-39 Presence of Vedana Presence Number of Patients % of Vedana Test Control Total Group Group Present 30 30 60 100.00% Total 30 30 60 Figure No-26Department of Prasooti Tantra and Stree Roga 102
  • 121. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Presence of Vedana 30 20 Test Group 10 Control Group 0 Present In the current study all the 100% women had pain.27) Table No-40 Nature of Vedana Nature of Number of Patients % Vedana Test Control Total Group Group Continuous 9 12 21 35.00% Intermittent 21 18 39 65.00% Total 30 30 60 Figure No-27 Nature of Vedana 30 20 Test Group 10 Control Group 0 Continuous Intermittent Nature In the present study, 65.00% women had intermittent pain and 35.00% women hadcontinuous pain.28) Table No-41 Character of Vedana Character Number of Patients % of Vedana Test Control Total Group Group Burning 11 12 23 38.33% Dull 3 3 6 10.00% Numbness 1 2 3 5.00% Pricking 15 13 28 46.67% Total 30 30 60Department of Prasooti Tantra and Stree Roga 103
  • 122. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Figure No-28 Charactre of Vedana 15 10 Test Group 5 Control Group 0 Burning Dull Numbness Pricking Character In this current study, 46.67% females were complaining of acute pricking pain, 38.33%females were complaining of burning pain, 10.00% females were complaining of dull painand 5.00% females were complaining of numbness.29) Table No-42 Intensity of Vedana Intensity Number of Patients % of Vedana Test Control Total Group Group Mild 6 8 14 23.33% Moderate 10 8 18 30.00% Severe 14 14 28 46.67% Total 30 30 60 Figure No-29 Intensity of Vedana 15 10 Test Group 5 Control Group 0 Mild Moderate Severe Intensity In the current study, out of 60 patients 46.67% women were complaining of severe pain,30.00% females were complaining of moderate pain and 23.33% women said that pain ismild.Department of Prasooti Tantra and Stree Roga 104
  • 123. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations30) Table No-43 Presence of Kandu Presence Number of Patients % Test Control Total Group Group Present 30 30 60 100.00% Total 30 30 60 Figure No-30 Presence of Kandu 30 20 Test Group 10 Control Group 0 Present Nature In the current study all the 100% women had pain.31) Table No-44 Intensity of Kandu Intensity Number of Patients % Test Control Total Group Group Mild 1 2 3 5.00% Moderate 4 2 6 10.00% Severe 25 26 51 85.00% Total 30 30 60 Figure No-31 Intensity of Kandu 30 20 Test Group 10 Control Group 0 Mild Moderate Severe Intensity Out of 60 patients 85.00% women presented with severe kandu, 10.00% womenpresented with moderated kandu and 5% women presented with mild kandu.Department of Prasooti Tantra and Stree Roga 105
  • 124. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations32) Table No-45 Extension of Lesion Extension Number of Patients % Test Control Total Group Group Vulva 18 17 35 58.33% Thigh 10 12 22 36.67% Lower abdomen 1 1 2 3.33% Buttocks 1 0 1 1.67% Total 30 30 60 Figure No-32 Extension of Lesion 20 15 10 Test Group 5 Control Group 0 Vulva Thigh Lower  Buttocks abdomen Regions In the present study out of 60 patients in 58.33% women the intertrigous lesion wasextended up to vulva, in 36.67% women the lesion was extended to thighs, in 3.33% womenthe lesion was extended to lower abdomen and in 1.67% women it was extended to buttocks.33) Table No-46 Discolouration of Lesion Colour Number of Patients % Test Control Total Group Group Black 6 5 11 18.33% Blackish red 7 8 15 25.00% Macerated 12 14 26 43.33% Red 5 3 8 13.33% Total 30 30 60 Figure No-33Department of Prasooti Tantra and Stree Roga 106
  • 125. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations Discolouration of Lesion 14 12 10 8 6 Test Group 4 Control Group 2 0 Black Blackish  Macerated Red red Colour In the present study, out of 60 patients 43.33% women had macerated lesion, 25.00%women had blackish red lesion, 18.33% women had blackish lesion and13.33% women hadred coloured lesion.34) Table No-47-A Presence of Blisters Presence of Number of Patients % Blisters Test Control Total Group Group No 24 26 50 83.33% Yes 6 4 10 16.67% Total 30 30 60 Figure No-34-a Presence of Blisters 30 25 20 Test Group 15 Control Group 10 5 0 No Yes Presence Out of 60 patients only16.67% women had the development of blisters and 83.33%women never had blisters.Department of Prasooti Tantra and Stree Roga 107
  • 126. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Observations35) Table No-47-B Size of Lesion Size of Lesion Number of Patients % Test Control Total Group Group No Lesion 0 0 0 0.00% 0 - 2 cm 0 0 0 0.00% 2 - 4 cm 2 0 2 3.33% Greater than 4 cm 28 30 58 96.67% Total 30 30 60 Figure No-34-b Size of Lesion 30 25 20 15 Test Group 10 Control Group 5 0 No Lesion 0 ‐ 2 cm 2 ‐ 4 cm Greater  than 4 cm Size Out of 60 patients, 96.67%women had lesion bigger than 4 cm and 3.33% women hadlesion of 2-4cm size.Department of Prasooti Tantra and Stree Roga 108
  • 127. Survey
  • 128. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Survey A preliminary survey was done to know the incidence of the inguinal intertrigo in patients seeking treatment in prasoothi and stree roga department. Here 1st entering 100 patients are considered for the survey. Here three sets were considered. They are- – First 100 patients entering OPD irrespective of their complaints-whether obstetric or gynaecological – First 100 obstetric patients entering OPD irrespective of their gestational ages or obstetrical outcomes. – First 100 gynaecological patients entering OPD irrespective of their parity or other details. The survey was done in Rainy season-July Winter season-December Summer season-May Three rutusandi kalas - sharad and varsha-september -shishira and hemantha-march -grishama and varsha-june. Results are as follows- Table No-48 May July December June September MarchIntertrigo 21 30 6 26 33 15Tenia cruris/eczema 1 3 2 1 3 0Hyperpigmentation 10 12 8 10 21 8Obstetric patientsIntertrigo 17 18 4 19 18 10Tenia cruris/eczema 1 1 0 3 2 0Hyperpigmentation 6 6 5 8 18 11Gynec patientsIntertrigo 5 10 2 6 14 8Tenia cruris/eczema 0 0 0 0 1 1Hyperpigmentation 6 7 3 4 9 6 Department of Prasooti Tantra and Stree Roga 110
  • 129. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” SurveyIn the Survey highest incidence of patients were noted in the month of July and inSeptember. They two periods are considered as rutu sandhi kala.Most of the patients were belonging to obstetric group which includes pregnant andpuerperal women.In most of the pregnant women, intertrigo was seen co-existing with thehyperpigmentation.Department of Prasooti Tantra and Stree Roga 111
  • 130. Results
  • 131. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsThe effects of Khadiradi yoga avachoornana in kachchu with special reference tointertrigo is given below. The statistical analysis was done based on the observationsdone before treatment and after treatment.Statistical results for Khadiradi yoga choornaTable no- 49 Effect of Khadiradi yoga choorna on the severity of pain duringthe course of the treatment-a) Attribute: Pain Test: Paired t-Test Sample size: 30 Effect of drug on PainGroup BT Test AT d % SD SE t P Mean MeanTest 2.145 AT1 0.345 1.80 83.92% 0.848 0.114 15.748 <0.001Group AT2 0.0545 2.091 97.48% 0.800 0.108 19.387 <0.001 AT3 0.0364 2.109 98.32% 0.809 0.109 19.333 <0.001Control 2.313 AT1 0.688 1.625 70.26% 0.806 0.202 8.062 <0.001Group AT2 0.438 1.875 81.06% 0.719 0.180 10.434 <0.001 AT3 0.250 2.063 89.19% 0.772 0.193 10.688 <0.001Graph No-1 Pain 2.5 2 1.5 Test Group 1 Control Group 0.5 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for pain before thetreatment was 2.145 for the test group and 2.313 for the control group which gotreduced to 0.0364 in test group and to 0.250 in control group after the treatment(P<0.001). The change that occurred with the treatment in Test Group is greater thanwould be expected by chance; there is a statistically significant change (P =<0.001).The change that occurred with the treatment in Control Group is greater thanwould be expected by chance; there is a statistically significant change (P = <0.001).Department of Prasooti Tantra and Stree Roga 113
  • 132. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsTable no-50 Comparison of statistical results between the Test group andcontrol group on the severity of pain during the course of the treatmentb) Attribute: Pain Test: Unpaired t-Test Comparison on Pain Test Group Control d SD SE t P Mean Group mean0.145 0.459 0.313 0.220 0.127 -1.940 0.124 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is no statisticallysignificant difference between the input groups (P = 0.124).Conclusion Both the drugs have almost the same effect on PainTable no-51 Effect of khadiradi yoga choorna on the severity of itching duringthe course of treatment-c) Attribute: Itching Test: Paired t-Test Sample size: 30 Effect of drug on ItchingGroup BT Test AT d % SD SE t P Mean MeanTest 2.800 AT1 0.418 2.382 85.07% 0.686 0.102 23.320 <0.001Group AT2 0.0727 2.727 97.39% 0.592 0.0798 34.180 <0.001 AT3 0.0545 2.745 98.04% 0.645 0.0869 31.588 <0.001Control 2.938 AT1 1.063 1.875 63.82% 0.806 0.202 9.603 <0.001Group AT2 0.625 2.313 78.73% 0.946 0.237 9.773 <0.001 AT3 0.563 2.375 80.84% 1.025 0.256 9.271 <0.001Graph No-2 Itching 3.5 3 2.5 2 Test Group 1.5 Control Group 1 0.5 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for itching before the treatmentwas 2.800 for the test group and 2.938 for the control group which got reduced to 0.0545 intest group and to 0.563 in control group after the treatment (P<0.001).Department of Prasooti Tantra and Stree Roga 114
  • 133. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Results The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant difference (P = <0.001).Table no-52 Comparison of statistical results between the Test group andcontrol group on the severity of itching during the course of treatmentd) Attribute: Itching Test: Unpaired t-Test Comparison on Itching Test Group Control d SD SE t P Mean Group mean0.182 0.750 0.569 0.273 0.157 -2.889 0.045 The difference in the mean values of the two groups is greater than would beexpected by chance; there is a statistically significant difference between the input groups (P= 0.045).Conclusion The test drug is more effective in treating the Itching among patientsTable no-53 Effect of khadiradi yoga choorna on the size of the lesion duringthe course of the treatment-e) Attribute: Size Test: Paired t-Test Sample size: 30 Effect of drug on Size Group BT Test AT d % SD SE t P Mean MeanTest 2.964 AT1 1.891 1.073 36.20% 0.658 0.0893 12.006 <0.001Group AT2 1.236 1.727 58.27% 0.781 0.105 16.409 <0.001 AT3 0.745 2.218 74.83% 0.686 0.0924 23.995 <0.001Control 3.000 AT1 2.125 0.875 59.17% 0.619 0.155 5.653 <0.001Group AT2 1.688 1.313 43.77% 0.704 0.176 7.456 <0.001 AT3 1.375 1.625 54.17% 0.885 0.221 7.344 <0.001Graph No-3 Size 3.5 3 2.5 2 Test Group 1.5 Control Group 1 0.5 0 BT AT1 AT2 AT3Department of Prasooti Tantra and Stree Roga 115
  • 134. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Results The statistical analysis revealed that the mean score for size before the treatment was2.964 for the test group and 3.000 for the control group which got reduced to 0.745 in testgroup and to 1.375 in control group after the treatment (P<0.001). The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant difference (P = <0.001).Table no-54 Comparison of statistical results between the Test group andcontrol group on the size of the lesion during the course of the treatmentf) Attribute: Size Test: Unpaired t-Test Comparison on Size Test Group Control D SD SE t P Mean Group mean1.291 1.729 0.439 0.377 0.217 -1.105 0.331 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not a statisticallysignificant difference between the input groups (P = 0.331).Conclusion Both the drugs have similar effect on treating the Size of the lesionTable no-55 Effect of Khadiradi yoga choorna on the redness during thecourse of the treatment-g) Attribute: Redness Test: Paired t-Test Sample size: 30 Effect of drug on Redness Group BT Test AT d % SD SE t P Mean MeanTest 0.709 AT1 0.0182 0.691 97.46% 0.466 0.0659 10.987 <0.001Group AT2 0.000 0.709 100.00% 0.458 0.0618 11.473 <0.001 AT3 0.0182 0.691 97.46% 0.466 0.0659 10.987 <0.001Control 0.563 AT1 0.0625 0.500 88.81% 0.632 0.158 3.162 0.006Group AT2 0.0625 0.500 88.81% 0.516 0.159 3.873 0.002 AT3 0.188 0.375 66.61% 0.619 0.155 2.423 0.059Department of Prasooti Tantra and Stree Roga 116
  • 135. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsGraph No-4 Redness 0.8 0.7 0.6 0.5 0.4 Test Group 0.3 Control Group 0.2 0.1 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for redness before the treatmentwas 0.709 for the test group and 0.563 for the control group which got reduced to 0.0182 intest group and to 0.188 in control group after the treatment (P<0.001). The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant change (P = 0.002).Table no-56 Comparison of statistical results between the Test group andcontrol group on the redness during the course of the treatmenth) Attribute: Redness Test: Unpaired t-Test Comparison on Redness Test Group Control d SD SE t P Mean Group mean0.0121 0.104 0.0922 0.0725 0.0418 -2.181 0.095 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not a statisticallysignificant difference between the input groups (P = 0.095).Conclusion Both the drugs have similar effect on treating the Redness of the lesionDepartment of Prasooti Tantra and Stree Roga 117
  • 136. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsTable no-57 Effect of khadiradi yoga choorna on the discolouration of the lesionduring the course of the treatment-i) Attribute: Discolouration Test: Paired t-Test Sample size: 30 Effect of drug on Discolouration Group BT Test AT d % SD SE t P Mean MeanTest 2.236 AT1 0.909 1.327 59.35% 0.818 0.110 12.037 <0.001Group AT2 0.545 1.691 75.63% 0.900 0.121 13.933 <0.001 AT3 0.218 2.018 90.25% 1.027 0.139 14.570 <0.001Control 1.875 AT1 1.063 0.813 43.36% 0.655 0.164 4.961 <0.001Group AT2 0.563 1.313 70.03% 0.704 0.176 7.456 <0.001 AT3 1.000 0.875 46.67% 1.147 0.287 3.050 0.008Graph No-5 Discolouration 2.5 2 1.5 Test Group 1 Control Group 0.5 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for discolouration before thetreatment was 2.236 for the test group and 1.875 for the control group which got reduced to0.218 in test group and to 1.000 in control group after the treatment (P<0.001). The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant difference (P = <0.001).Table no-58 Comparison of statistical results between the Test group andcontrol group on the discolouration of the lesion during the course of thetreatmentj) Attribute: Discolouration Test: Unpaired t-Test Comparison on Discolouration Test Group Control D SD SE t P Mean Group mean0.557 0.875 0.318 0.272 0.157 -1.252 0.279Department of Prasooti Tantra and Stree Roga 118
  • 137. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Results The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not a statisticallysignificant difference between the input groups (P = 0.279).Conclusion Both the drugs have similar effect on treating the discolouration of the lesionTable no-59 Effect of Khadiradi yoga choorna on the warmth during thecourse of the treatment-k) Attribute: Warmth Test: Paired t-Test Sample size: 30 Effect of drug on Warmth Group BT Test AT d % SD SE t P Mean MeanTest 0.782 AT1 0.109 0.673 86.06% 0.474 0.0639 10.536 <0.001Group AT2 0.0182 0.764 97.70% 0.459 0.0578 13.208 <0.001 AT3 0.0182 0.764 97.70% 0.459 0.0578 13.208 <0.001Control 0.750 AT1 0.375 0.375 50.00% 0.619 0.155 2.423 0.059Group AT2 0.188 0.563 75.07% 0.512 0.128 4.392 <0.001 AT3 0.188 0.563 75.07% 0.659 0.157 3.576 0.003Graph No-6 Warmth 0.9 0.8 0.7 0.6 0.5 Test Group 0.4 0.3 Control Group 0.2 0.1 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for warmth before the treatmentwas 0.782 for the test group and 0.750 for the control group which got reduced to 0.0182 intest group and to 0.188 in control group after the treatment (P<0.001). The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant difference (P = <0.001).Department of Prasooti Tantra and Stree Roga 119
  • 138. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsTable no-60 Comparison of statistical results between the Test group andcontrol group on the warmth during the course of the treatmentl) Attribute: Warmth Test: Unpaired t-Test Comparison on Warmth Test Group Control D SD SE t P Mean Group mean0.0485 0.250 0.202 0.108 0.0623 -2.913 0.044 The difference in the mean values of the two groups is greater than would beexpected by chance; there is a statistically significant difference between the input groups (P= 0.044).Conclusion The test drug has better effect in reducing the WarmthTable no-61 Effect of Khadiradi yoga choorna on the roughness during thecourse of the treatment-m) Attribute: Roughness Test: Paired t-Test Sample size: 30 Effect of drug on Roughness Group BT Test AT d % SD SE t P Mean MeanTest 0.364 AT1 0.0182 0.345 94.78% 0.517 0.0697 4.955 <0.001Group AT2 0.000 0.364 100.00% 0.522 0.0704 5.164 <0.001 AT3 0.000 0.364 100.00% 0.522 0.0704 5.164 <0.001Control 0.375 AT1 0.0625 0.313 83.47% 0.479 0.120 2.611 0.020Group AT2 0.0625 0.313 83.47% 0.479 0.120 2.611 0.020 AT3 0.0625 0.313 83.47% 0.479 0.120 2.611 0.020Graph No-7 Roughness 0.4 0.35 0.3 0.25 0.2 Test Group 0.15 Control Group 0.1 0.05 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for Roughness before thetreatment was 0.364 for the test group and 0.375 for the control group which got reduced to0.000 in test group after the treatment (P<0.001) and to 0.0625 in control group after thetreatment ( P =0.020).Department of Prasooti Tantra and Stree Roga 120
  • 139. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Results The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant difference (P = <0.001).Table no-62 Comparison of statistical results between the Test group andcontrol group on the roughness during the course of the treatmentn) Attribute: Roughness Test: Unpaired t-Test Comparison on Roughness Test Group Control D SD SE t P Mean Group mean0.00607 0.0625 0.0564 0.0105 0.00607 -9.302 <0.001 The difference in the mean values of the two groups is greater than would beexpected by chance; there is a statistically significant difference between the input groups (P= <0.001).Conclusion The test drug has better effect in reducing the RoughnessTable no-63 Effect of Khadiradi yoga choorna on the tenderness during thecourse of the treatment-o) Attribute: Tenderness Test: Paired t-Test Sample size: 30 Effect of drug on Tenderness Group BT Test AT d % SD SE t P Mean MeanTest 1.836 AT1 0.609 1.527 83.17% 0.879 0.119 12.888 <0.001Group AT2 0.0545 1.782 97.06% 0.937 0.126 14.107 <0.001 AT3 0.0545 1.782 97.06% 0.994 0.134 13.591 <0.001Control 1.813 AT1 0.500 1.313 72.42% 0.793 0.198 6.619 <0.001Group AT2 0.188 1.625 89.63% 0.719 0.180 9.043 <0.001 AT3 0.188 1.625 89.63% 1.025 0.256 6.343 <0.001Graph No-8 Tenderness 2 1.8 1.6 1.4 1.2 1 Test Group 0.8 Control Group 0.6 0.4 0.2 0 BT AT1 AT2 AT3Department of Prasooti Tantra and Stree Roga 121
  • 140. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Results The statistical analysis revealed that the mean score for tenderness before thetreatment was 1.836 for the test group and 1.813 for the control group which got reduced to0.0545 in test group and to 0.188 in control group after the treatment (P<0.001).` The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is greater than would be expected by chance;there is a statistically significant difference (P = <0.001).Table no-64 Comparison of statistical results between the Test group andcontrol group on the tenderness during the course of the treatmentp) Attribute: Tenderness Test: Unpaired t-Test Comparison on Tenderness Test Group Control d SD SE t P Mean Group mean0.239 0.292 0.0527 0.180 0.104 -0.248 0.816 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not a statisticallysignificant difference between the input groups (P = 0.816).Conclusion Both the drugs have similar effect on TendernessTable no-65 Effect of Khadiradi yoga choorna on the discharge during thecourse of the treatment-q) Attribute: Discharge Test: Paired t-Test Sample size: 30 Effect of drug on Discharge Group BT Test AT d % SD SE t P Mean MeanTest 0.745 AT1 0.127 0.618 82.95% 0.490 0.0661 9.350 <0.001Group AT2 0.000 0.745 100.00% 0.440 0.0593 12.575 <0.001 AT3 0.000 0.745 100.00% 0.440 0.0593 12.575 <0.001Control 0.813 AT1 0.438 0.375 46.13% 0.719 0.180 2.087 0.054Group AT2 0.188 0.625 76.88% 0.619 0.155 4.038 0.001 AT3 0.250 0.563 69.25% 0.512 0.128 4.392 <0.001Department of Prasooti Tantra and Stree Roga 122
  • 141. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsGraph No-9 Discharge 0.9 0.8 0.7 0.6 0.5 Test Group 0.4 0.3 Control Group 0.2 0.1 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for discharge before thetreatment was 0.745 for the test group and 0.813 for the control group which got reduced to0.000 in test group and to 0.250 in control group after the treatment (P<0.001). The change that occurred with the treatment in Test Group is greater than would beexpected by chance; there is a statistically significant difference (P = <0.001).The change thatoccurred with the treatment in Control Group is not great enough to exclude the possibilitythat the difference is due to chance (P = 0.054)Table no-66 Comparison of statistical results between the Test group andcontrol group on the discharge during the course of the treatmentr) Attribute: Discharge Test: Unpaired t-Test Comparison on Discharge Test Group Control d SD SE t P Mean Group mean0.0423 0.292 0.250 0.130 0.0752 -2.894 0.044 The difference in the mean values of the two groups is greater than would beexpected by chance; there is a statistically significant difference between the input groups (P= 0.044).Conclusion The test drug has better effect in reducing the DischargeDepartment of Prasooti Tantra and Stree Roga 123
  • 142. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsTable no-67 Effect of Khadiradi yoga choorna on the edema during the courseof the treatment-s) Attribute:Edema Test: Paired t-Test Sample size: 30 Effect of drug on EdemaGroup BT Test AT d % SD SE t P Mean MeanTest 0.600 AT1 0.0364 0.564 94.00% 0.501 0.0675 8.352 <0.001Group AT2 0.0182 0.582 97.00% 0.498 0.0671 8.668 <0.001 AT3 0.000 0.600 100.00% 0.494 0.0667 9.000 <0.001Control 0.563 AT1 0.0625 0.500 88.81% 0.516 0.159 3.873 0.002Group AT2 0.000 0.563 100.00% 0.512 0.128 4.392 <0.001 AT3 0.125 0.438 77.80% 0.512 0.128 3.416 0.004Graph No-10 Edema 0.7 0.6 0.5 0.4 Test Group 0.3 Control Group 0.2 0.1 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for edema before thetreatment was 0.600 for the test group and 0.563 for the control group which gotreduced to 0.000 in test group and to 0.125 in control group after the treatment(P<0.001). The change that occurred with the treatment in Test Group is greater thanwould be expected by chance; there is a statistically significant difference (P =<0.001). The change that occurred with the treatment in Control Group is greater thanwould be expected by chance; there is a statistically significant difference (P =<0.001).Department of Prasooti Tantra and Stree Roga 124
  • 143. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” ResultsTable no-68 Comparison of statistical results between the Test group andcontrol group on the edema during the course of the treatmentt) Attribute:Edema Test: Unpaired t-Test Comparison on Edema Test Group Control d SD SE t P Mean Group mean0.0182 0.0625 0.0443 0.0625 0.0361 -1.179 0.304 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not a statisticallysignificant difference between the input groups (P = 0.304).Conclusion Both the drugs have similar effect on treating the EdemaTable no-69 Effect of Khadiradi yoga choorna on the blisters during thecourse of the treatment-u) Attribute: Blisters Test: Paired t-Test Sample size: 30 Effect of drug on Blisters Group BT Test AT d % SD SE t P Mean MeanTest 0.127 AT1 0.000 0.127 100.00% 0.336 0.0454 2.806 0.007Group AT2 0.000 0.127 100.00% 0.336 0.0454 2.806 0.007 AT3 0.000 0.127 100.00% 0.336 0.0454 2.806 0.007Control 0.313 AT1 0.0625 0.250 79.87% 0.447 0.112 2.236 0.041Group AT2 0.0625 0.250 79.87% 0.447 0.112 2.236 0.041 AT3 0.125 0.188 60.06% 0.544 0.136 1.379 0.188Graph No-12 Blisters 0.35 0.3 0.25 0.2 Test Group 0.15 Control Group 0.1 0.05 0 BT AT1 AT2 AT3 The statistical analysis revealed that the mean score for blisters before thetreatment was 0.127 for the test group and 0.313 for the control group which gotreduced to 0.000 in test group and to 0.125 in control group after the treatment(P<0.001).Department of Prasooti Tantra and Stree Roga 125
  • 144. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Results The change that occurred with the treatment in Test Group is greater thanwould be expected by chance; there is a statistically significant difference (P =0.007).The change that occurred with the treatment in Control Group is not greatenough to exclude the possibility that the difference is due to chance (P = 0.188)Table no-70 Comparison of statistical results between the Test group andcontrol group on the blisters during the course of the treatmentv) Attribute: Blisters Test: Unpaired t-Test Comparison on Blisters Test Group Control d SD SE t P Mean Group mean0.000 0.0833 0.0833 0.0361 0.0208 -4.000 0.016 The difference in the mean values of the two groups is greater than would beexpected by chance; there is a statistically significant difference between the input groups (P= 0.016).Conclusion The test drug has better effect in reducing the BlistersFinal Results of the Test drugTable No-72 Parameter No. of patients cured % of cure completely Pain 29 96.67% Itching 29 96.67% Size 20 66.67% Redness 29 96.67% Colour 27 90.00% Warmth 29 96.67% Redness 30 100% Tenderness 29 96.67% Discharge 30 100% Swelling 29 96.67% Blisters 30 100% Average 94.24%-30 patients had over all cure rates of 94.24%.-None of the patient encountered complications solely due to the drug.-None of the patients had aggravation of symptoms.Department of Prasooti Tantra and Stree Roga 126
  • 145. Phytochemical Analysis
  • 146. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Phytochemical AnalysisPreliminary Phyto-chemical analysis of khadiradi yoga choorna This was a preliminary study of the thesis drug. It is a qualitative analysiswhere in we will come to know about the basic chemical ingredient of the compound.This analysis was carried out in three media-aqueous, chloroform and ethanol media. Five grams of the drug powder was taken in 3 glass containers. For the firstcontainer 100 ml of distilled water was added, for the second container 100 ml ofchloroform was added and for the third container 100 ml of ethanol was added. Allthe three containers were covered with a glass lid and kept undisturbed overnight.Next day morning the contents of all the three containers sieved through the sievingpapers and the solutions are collected in the separated containers.Organoleptic charactersAqueous solution –colour- orangeWith ethanol-brownWith chloroform-yellowThen the preliminary phyto-chemical analysis of the solutions was carried as per theguidelines. The results were as follows-Table No-71 Preliminary phyto-chemical analysis of khadiradi yoga choornaA) Proteins Aqueous solution chloroform EthanolBiuret test -ve -ve -veNinhydrin test -ve -ve -veXanthoprotein test +ve -ve +veHopkin-cole test +ve +ve -veSulphur test -ve + +ve veXantho protein test showed that there is nitro derivatives of aromatic amino acids andsodium salts of nitroderivatives of amino acids in ethanol extract.Department of Prasooti Tantra and Stree Roga 128
  • 147. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Phytochemical AnalysisHopkin-cole test showed that in aqueous extract and in choloroform extract there areIndole group of tryptophan.Sulphur test-Sulphaur containing aminoacids of proteins are present in choloroformextract and ethanol extract.B) Carbohydrates Aqueous solution chloroform EthanolMolisch’s test +ve +ve +veIodine test -ve -ve +veFehling’s test +ve +ve +veBenedict’s test +ve -ve +veFehling’s test and Benedict’s test -reducing sugars are present in all three extractsNon reducing sugars such as sucrose Aqueous solution chloroform EthanolBenedict’s test -ve -ve -veNon reducing sugars are absent in all the three extractsTannins Aqueous solution chloroform EthanolGelatin +ve +ve +veAnthocyanins Aqueous solution chloroform EthanolAcqueous NaOH -ve -ve -vetestConcentrated -ve +ve +veH2So4 TestDepartment of Prasooti Tantra and Stree Roga 129
  • 148. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Phytochemical AnalysisGlycosides Aqueous solution chloroform EthanolMolisch’s test +ve +ve +veConcentrated +ve +ve +veH2SO4 TestKeller Kiliani test +ve +ve +veSaponin Aqueous solution chloroform EthanolFoam test +ve -ve -veFlavanoid Aqueous solution chloroform EthanolFlavanoid test +vePew’s test -ve -ve -ve(Zn/HCl) fordihydroflvanonolsShinoda test -ve -ve -ve(Mg/HCl)Aqueous NaOH -ve +ve +vetest solutionConcentrated +ve +ve +veH2SO4 testPhenols Aqueous solution chloroform Ethanolphenol +ve -ve +veSteroids Aqueous solution chloroform EthanolSalkowski test +ve +ve +veDepartment of Prasooti Tantra and Stree Roga 130
  • 149. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Phytochemical AnalysisAlkaloids Aqueous solution chloroform EthanolMayer’s test -ve -ve +veDragendroff’s test -ve -ve -veInterpretations of the phyto chemical analysis of Khadiradi yoga choorna Khadiradi yoga choorn is used in the powder form. It is dusted over the skinlesions and the clinical efficacy is seen. There it is thought to act in the dampenvironment of the genito-inguinal region, which is inflamed. So, from the preliminary phyto chemical study, the results of the acqueoussolution is used to give the interpretation. Here only those test results are interpretedin which the aqueous media has showed positive results.Aqueous solution can be used in two forms-Hot extract. eg- Decoctions - Cold extract eg-dissolving the drug in thedistilled water or in normal saline in room temperature.Depending on the above results hypothetically we can say that the cold aqueousextract of Khadiradi yoga choorna is having the following properties.Proteins - Proteins are helpful to kill some of the germs. They also help to dry up thelocal area and restrict the growth of the micro organisms.Carbohydrates - They are the energy producers. They may help the localized cells byproviding them the nutrients and thus help to fight against the organisms.Carbohydrates are the energy source for even the bacteria but only in the dampenvironment. When the proteins dry up the skin surface, the organisms will not get thenutrients to grow and colonize.Glycosides - They are known to be anti bacterial and anti fungal. They directly act onthe organisms and reduce their growth and actually kill the bacteria.Saponins - Act as cleansers. It may regulate in the controlling the growth byrestricting the further growth of the bacteria.Department of Prasooti Tantra and Stree Roga 131
  • 150. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Phytochemical AnalysisPhenols - They act as detergents. It removes slough and helps in debridement.Steroids - They are known as potent anti inflammatory agents and helpful to reducethe inflammation.Tannins - They dry up the skin. They are also known to constrict the peripheral microvaso circulation. Because of vaso constriction the oozing decreases. Most of thebacteria and fungi are known to derive their nutrients in the damp environment andmultiply. Because of the dryness of the skin there reduction of nutrient supply to thebacteria. When the skin dries up the other chemicals present in the drug like phenols,proteins, carbohydrates and steroids act against the micro organisms, Over all we can hypothetically say that the steroids, phenols, glycosides, andproteins present in the Khadiradi yoga choorna, will collectively act both at the hosttissue level and even at the organism level. The drugs present in the Khadiradi yogachoorna collectively act and induce the dryness, reduce the oozing, cleanse the debris,cut short the nutrient supply to the micro organisms, there by restrict theirmultiplication and growth. They may also act as bacteriocidal and fungicidal. Wecannot also rule out the possibility of nullification of the toxins released by theorganisms. When we see the properties of the above ingredients, and the results of thechloroform and ethanol extracts, in which some of the main contents are not seen, wecan definitely say that the aqueous extract of the drug is more efficacious than ethanoland chloroform extracts.Department of Prasooti Tantra and Stree Roga 132
  • 151. Microbiological Study
  • 152. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological StudyMicrobiological study Research work done in the clinical field will always get strength if it issupported by the in vitro study. So, Microbiological tests done to identify theorganisms in the smear taken from the patient and to see the sensitivity of Khadiradiyoga choorna on those organisms. Intertrigo is primarily an inflammatory condition of the skin folds which willeventually gets infected by superadded secondary opportunistic fungal or/andbacterial infections.Cutaneous Infections of the genital area- It comprises of two main organisms- Bacteria and fungus. In fungus groupthere are two groups. They are - candida and dermatophytes. In candida group,candida albicans is the main culprit, but other types like candida globrata can also beinvolved. In Bacteria group- there may be streptococcus pyrogens, staphylococcusaureus, E. coli and pseudomonas aeruginosa. Candida albicans, staphylococcus aureus, E. coli and pseudomonas aeruginosaare commensal and pathogen. Commensal is an organism which is seen in the healthyliving body without causing any pathology. Pathogen is an organism which will causepathology in the living body-may be systemic or local, superficial or deep. When the host tissue immune drops they will turn into pathogen and willcause opportunistic infection. So, they are more prevalent in immuno-compromisedpatients like who are on long term antibiotics, after organ transplantation, long termsteroid therapy and in HIV patients. In all these patient there are chances of systemicfungal infection. When there is lack of hygiene in the genital parts, along with obesity andexcess sweating, inflammation of the skin occurs. When there is drop in the hosttissue immune level particularly cellular immunity due to inflammation, candidaDepartment of Prasooti Tantra and Stree Roga 134
  • 153. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological Studyalbicans and other bacteria acquires pathogenicity by changing its gene structure andcauses infection. For changing the gene structure it needs warmth, dampness, andparticular level of pH etc. When the candida acquires pathogenicity, hyphae start growing and they causecolonies in that area. Presence of hyphae, fast multiplication and high number oforganisms per colony will microbiologically decide its pathogenesis.Culture of the Candida albicans- To grow the candida in the laboratory set up the following culture media isrequired. Here two types of media are used. They are--Muller Hilton agar (MHA)-Sabourad’s dextrose agar (SDA)Agars can be manually prepared or commercial one can also be used. Theirconstitution is as follows-Peptone-1%Dextrose-4%Agar-2%Distal water-100%Depending on the physical state of the agar, its concentration changes as followsFor solid-2%Semisolid-1.5%Liquid-0% The ideal pH of the media should be 5.6. So, one should check pH beforeadding the agar. After mixing the constituents, the media is sterilized at 121.F for 15-20 minutes.Method of taking the smear- A sterile cotton swab is taken and rubbed on the intertrigous lesion. Underaseptic method, the mouth of the test tube containing the culture media is heated forDepartment of Prasooti Tantra and Stree Roga 135
  • 154. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological Studywhile in the tip of the flame to avoid contamination and the swab is introduced intothe test tube without touching the walls of the test tube. It is gently rubbed against theagar media and taken out. The test tube is closed with a sterile lid to prevent furthercontamination. -The test tube is incubated at 37.c for 2 days. After 2 days, if candidaalbicans is present, its colonies will be seen which are having the characteristicfeatures of oil paint appearance.In this method the swabs taken from 10 clinically diagnosed patients revealed thecolonies of candida albicans.Sensitivity test (AFST)-It is called as antifungal susceptibility test.Here the sample can be used in two types- in the powder form or- in the aqueous form.To get the aqueous solution broth dilution method is used and the resultant solution isused for the further tests.Broth dilution- Here the test drug is serially diluted into various concentrations inwater or normal saline and then tested for sensitivity.Anti fungal susceptibility test can be done by two methods. They are as follows. 1. Stokes’s method-Here lawn culture is done. Then the drug powder is sprinkled over the culture and it is incubated at 57.C for 18-24hours. Then the readings are taken. Results are interpreted as –whether it is susceptible or resistant. 2. Well method-Here a suspension of the drug is done initially in normal saline (5 g powder in 5 ml NS). In the centre of the media a small well of dimension 2mm*2mm is made with a red hot needle and a required amount of the drug suspension is placed and it is incubated at 37.C for 18-24 hours. Then the readings are taken. Results are interpreted as –whether it is susceptible or resistant.Department of Prasooti Tantra and Stree Roga 136
  • 155. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological Study Both Stokes’s method and Well method was adopted and the sensitivity was testedagainst Candida albicans. When the powder was used, there was no inhibition of the fungal growth.When the drug was used in the aqueous media, there was partial inhibition of thegrowth of the fungus.Bacteriological study-Culture of bacteria-For this nutrient agar is used. It is readily available in themarket or one can prepare it. It is having following ingredients.Nutrient agarContents are-Peptone-4gNacl-2gBeef extract-2gDistilled water-100ml. Mix all these thing together and check the pH. It should be 7.4.Then add 2g Agar, mix thoroughly. To prepare the commercially available agar, we have to mix the agar powder1g in 50 ml distilled water and mixed. In both the methods, then it is sterilized at121.F for 15 minutes and 15 pounds pressure. Then the agar poured into culture platesunder aseptic measures and allowed to solidify. Smear is taken in the same method astold previously and culture is done. In three patients the colonies of E coli, staphylococcus aureus and in onepatient pseudomonas aeruginosa is seen.Sensitivity test- Such 3 culture plates were prepared and lawn culture is done with E. coli,Staphylococcus aureus and pseudomonas aeruginosa to separate plates and incubatedat 37.c for 24 hours. Next day the culture of the respective bacteria are seen. AfterDepartment of Prasooti Tantra and Stree Roga 137
  • 156. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological Studyconfirming that there is no contamination, the sensitivity test is carried out byStokes’s method and as well as well method. Again these culture plates wereincubated at 37.c for 24 hours. Next day result were seen In another method, while culture media is being prepared, 10gm of the drugpowder is added to the agar mixture after confirming the pH. Mixed thoroughly andas usual sterilized at 121.F for 15 minutes and 15 pounds pressure. Then the cultureplates were prepared in the traditional method. Another three culture plates wereprepared without adding the kahdiradi choorna. To this lawn culture is done with E.coli, Staphylococcus aureus and pseudomonas aeruginosa to separate plates andincubated at 37.c for 24 hours. Next day the culture of the respective bacteria are seen.Results.1) In the powder form the drug is found ineffective against all the three bacteria.2) In the well method, the drug is found to partially inhibit the organisms in E coli,Staphylococcus aureus, and slightly Pseudomonas aeruginosa.3) In the culture plates where in the agar contains the Khadiradi choorna in it then theorganisms were inoculated, the organisms were not grown in all the three plates. Inthe control group the organisms developed in all the three plates.Confirmation of pathogenicity in microbiology-For candida -Hyphal growth, increased cell divisionFor staphylococcus aureus-Golden colour pigment production -observation of haemolytic action -+ve coagulase testPseuomonas aeruginosa-fruity smell/urgy/acrid smell -Pigment production like black or greenishDepartment of Prasooti Tantra and Stree Roga 138
  • 157. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological StudyCandida albicans-cultureE coli Staphylococcus aureusPseudomonas aeruginosaDepartment of Prasooti Tantra and Stree Roga 139
  • 158. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Micorbiological StudySensitivity test resultsStaphylococcus aureus and E coli Agar prepared with khadiradi choornaSensitivity ring seen No growth of organismsPseudomonas aeruginosaStokes method and Well methodSensitivity ring is seen No growth is seenCandida albicansStokes method growth seen Well method Sensitivity ring is seen (zig zag)Department of Prasooti Tantra and Stree Roga 140
  • 159. Discussion
  • 160. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion Discussion “Aturasya vikara prashamanam” is one of the aims of Ayurveda. Health isbeen given the utmost importance in Ayurveda whatever the severity may be. Whensystemic or local manifestations affect a person’s day to day life, he/she seeks thetreatment. Out of the many health issues, dermatological complaints have their ownplace in the field of medicine. Skin manifestations are the common problem with which a person suffersfrom one or the other day in his life time. It may be grave like leprosy or minor likeintertrigo. Viral infections with cutaneous manifestations like masurika andromanthika are included under the broad heading kushta. They may be generalized orlocalised. They may be in the exposed part or in the private parts. They may also beinvolved with systemic manifestations like fever or septicaemia or may not have anysymptoms except simple discolouration. In Ayurveda skin diseases are explained under two heading-kushta andkshudra roga. Diseases explained under kushta includes pathologies with cutaneousmanifestations along systemic symptoms, where as the diseases explained underkshudra roga comprises of moderate to minor pathologies like kachchu and nilika(exceptions being guda bramsha, agni rohini and valmika). Of many diseasesexplained under kshudra roga, kachchu is one among them. Kachchu is mentioned asa separate disease entity for the first time in Sushrutha samhita. Later books likeAstanga hridaya, Yoga ratnakara, Madhava nidhana,Chakra datta followed Sushruta.Discussion on kachchu The word kachcha refers to the region where in the humidity or water contentis more. It also refers to kandu. According to this derivation, kachchu is a pathologywhich occurs in that part of the body having more dampness and is mainly consists ofitching. Vrushana pradesha is having more dampness because of the compactness ofthe anatomical structures and is more prone for kachchu. Probably because of thisreason, the disease is named as (vrushana) kachchu. But this pathology is not specificfor males and can also be seen in females in the inguinal region.Department of Prasooti Tantra and Stree Roga 142
  • 161. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion Snana utsadana hinatha and kanduyanatha are considered as the specificnidanas for the manifestation of (Vrushana) kachchu. Because of the nidanas, theaccumulated sweda mala which is in the form of a layer over the vrushana pradesha,gets moistened by excessive perspiration and causes the symptom kandu. If the personscratches there will be manifestation of sphota and srava. This disease mainly occursbecause of kapha and rakta vitiation. Since the disease is not specific to male gender,by the word vrushana we have to consider the anatomical location than anatomicalorgan. Sweda is the mala of meda. So, in stula purusha sweda pravruti is more, andhence such patients are more prone to get this pathology. Overall we can say that kachchu occurs in such a place or site where insweating is more and local hygiene is less as in case of genito-inguinal part.Discussion on intertrigo Intertrigo is a cutaneous inflammatory disorder that mainly affects the skinfolds. For the manifestation of intertrigo occurring in the genito-inguinal regionexcessive dampness in that region, along with sweating, and unhygienic conditionsare required. Mainly unhygienic conditions like not taking bath, wearing unhygienicundergarments, new synthetic undergarments without washing them, improper dryingof the used undergarments, using the damp undergarments, heavy clothing, andfrequent washing of the genitals which makes the undergarments wet and of courseincontinence of urine and faeces will cause the intertrigo in the genito-inguinal region.In this modern era, wearing the sanitary pads for longer duration and disposal atinfrequent intervals can be considered as one of the main aetiologies. Obesity,diabetes mellitus and excessive perspiration will precipitate the pathology in thegenito inguinal region because of its compactness, occlusion, and dependent area forthe sweat flow in the body. Even though the genito-inguinal intertrigo is basically an inflammatory skindisorder it will usually be complicated by secondary bacterial or/and fungalinfections. It initially starts with inflammation of the superficial layers of the skin,sometimes followed by blister formation with or without maceration. Usually itinvolves the skin folds wherein the sweat is not disposed off properly.Department of Prasooti Tantra and Stree Roga 143
  • 162. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion Intertrigo is not a pathology which is specific to male or female gender, or norit is specific to genital region. But still it is more prevalent in females especially in thegenito-inguinal region because of different forms of occlusion and retention ofsweating. Effects of occlusion are more marked in pregnancy, puerperium, increasedp/v bleeding or discharges and obesity. In kachchu and in Intertrigo, aetiology is accumulation of sweat in the genitoinguinal region which moistens the superficial layer of the skin which will becontaining the dead exfoliated cells. Further, the friction, which may be in the form ofscratching, will eventually be followed by the formation of blisters and maceration. With all these aetiologies and symptomatologies, the kachchu can be bestcorrelated to the dermatological disease intertrigo occurring in the genito-inguinalregion. In both cases because of etiological factors- there is itching followed by blisterformation and exudation from the inflamed skin surfaces. Scratching because ofintractable itching and friction of the skin surface with the opposite skin surface orfriction with the undergarment acts as precipitating factor.Why genito-inguinal intertrigo should be considered in OBG • Health is the ultimate goal of Medicine, whatever the branch may be and the aim should be to help the patient to get relieve from the disease. • Females do give the first preference to the gynecologists for the diseases related to genital parts. • Since obstetric and gynecological patients can also be presenting with the skin disease in the genital parts, the obstetricians should be well versed with the skin manifestations of the vulva and the surrounding region.Department of Prasooti Tantra and Stree Roga 144
  • 163. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion • The clinical and pathological features of the dermatological diseases are modified by the unique environment of the vulva. The skin of the vulva differs notably from the remaining body surface by its moist, friction-prone and bacteria-rich environment. The local condition predisposes the vulva to the development of certain dermatological disorders. The clinical and pathological manifestations of dermatosis may differ from those occurring elsewhere in the body because of the local factors. • Genital area is a damp area. The aeration is less because of the compactness and occlusion and is more prone to get the infections like intertrigo. • In gynecological conditions like increased white discharge, increased p/v bleeding etc because of increased moistness, use of sanitary pads and pre- existing infection there are every chances of developing infections in that anatomical region. • During rainy and summer season where moistness and sweating are more, every 3rd pregnant patient who is entering the OPD is having genito-inguinal intertrigo as the associated complaint. • The genito-inguinal part is expected to be healthy during labor and is also prone for infections like intertrigo because of prevailing dampness and the increased compactness of that region during pregnancy • In neglected cases, the intertrigo may extend to transverse incision in the abdomen and interfere in its healing. • In puerperium increased discharge of lochia, use of sanitary pads may precipitate this or may exaggerate the condition in prone persons. • Obesity may also act like precipitating factor. Obesity can be seen during pregnancy, perimenopausal age and in some of the gynecological diseases like PCOD.Department of Prasooti Tantra and Stree Roga 145
  • 164. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion • The rate of absorption of drugs in that area even in the non-pregnant state is higher than other parts of body, which gets further increased during pregnancy. The drugs which are used for the external application should not harm the fetus, should not interfere with the normal course of pregnancy or should not cause any unwanted results in the skin in that part, as episiotomy is the probable procedure in the future. • Drugs that are used for the local application should not interfere with the resolving infection of vagina or cervix or they should not predispose the ascending infection. • Intertrigo is explained in the text books of gynecology, in the context of infectious diseases of vulva, i.e., this pathological entity is a part of gynecology.Discussion on survey results The survey was done to know the incidence of genito inguinal intertrigo inpatients attending the Gynec OPD. It showed that around 30% of the patients seekingthe consultation from the Gynec OPD are having the manifestation of intertrigo. Italso showed that most of the patients were from obstetric group. Highest number ofpatients were in September i.e., sharad rutu. It is marked by pitta and kaphapradhanyatha. Pitta is predominant in sharad rutu, and kapha starts accumulating inhemantha rutu. Second big group is in May and June when there is rakta prakopa. As kachchuis predominated by the kapha and pitta dosha, during the starting of rainy season andending of the rainy season where there is more heat in the atmosphere, sweating ismore and also the moistness is more because of rain, kachchu is more prevalent. Intertrigo is more prevalent in hot humid season, which will precipitate theskin fold friction in the genito inguinal region. Hot humid season will also increasethe sweating and thus dampness in the genito inguinal region. Because of theDepartment of Prasooti Tantra and Stree Roga 146
  • 165. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionmechanical factor i.e., friction there occurs inflammation which will change thehomeostasis between the commensals and the host tissue immune level in the genitoinguinal region. This will trigger the onset of secondary bacterial and fungal infectionin that region. Hotness and humidity is more prevalent when summer ends and rainyseason starts, and similarly at the end of rainy season. This period is nothing but therutu sandhi kala as told in the ayurvedic literatures. Incidence of genito-inguinal intertrigo is more in third trimester gestation.This could be because of increased weight gain during third trimester, increasedperspiration as pregnancy is a hyper metabolic stage and thermogenic stage andincreased compactness of the perineal region. More over pregnancy is an immunocompromised state. In the last trimester, since the gravid uterus, particularly thepresenting part of the foetus presses against the bladder there will be increasedfrequency of micturition, stress incontinence and some times urge incontinence. Thiswill increase the dampness around the vulva and also increases the chances of frictionby wetting the undergarments. All these will contribute to the manifestation ofintertrigo in the third trimester. Second largest group is puerperium. Puerperium is marked with lochialsecretion for longer duration, sometimes there is co-existing episiotomy. Patients willuse pads. Patients will be asked to appose their thighs to have the better healing ofepisiotomy wound. In puerperium also there will be increased perspiration. Occlusionof the vulval part with sanitary pads, increased sweating and compactness of theperineal region will precipitate the manifestation of the intertrigo. Incidence of intertrigo is more in people taking katu amla and lavana pradhanaahara. Katu, Amla and lavana rasa will cause syandana of kleda and increase thesweating in the body. If it is associated with occlusion in the genito inguinal part, thenit will precipitate the disease kachchu.Discussion on treatment aspects Many treatment modalities are told in the classics, which includes, applicationof herbal powder combination having saindava or haratal as one of the constituent.Department of Prasooti Tantra and Stree Roga 147
  • 166. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” DiscussionSaindava melts in this hot humid environment, so such combination cannot bepreserved for long. Safety of haratala application to genital area during pregnancy andpuerperium is questionable. Patoladi ghrita is also mentioned which is difficult to takeduring pregnancy and puerperium. Application of pralepa may not serve the purpose as it may liquefy because ofincreased sweating. Washing with kashayas will include a tedious job of preparing thekashaya, and after application it will remain in the place for a short while and hencemay prove less efficacious. So, a new formulation is done strictly based on the ayurvedic principles and acombination of powder is prepared. The combination contains kahadira, triphala,haridra, shirisha, musta, saptaparna, nimba and gandhaka and dugda pashana. Theyhave kustagna, kandugna, vedanastapana, dahaprashaman and varnya property. Thecombination of powder is named as khadiradi choorna after the name of the first drug-khadira. All the drugs except dugha pashana are taken in equal quantity. To that 25%of dugda pashana is mixed which is based on the observations got by the pilot study.All the drugs are taken in the form of vastra galitha choorna and mixed thoroughly bydoubling up method. Concept of avachurnana is mentioned in brhatrayis. It is one of the vrunashashti upakrama. It is having both shodana and ropana property. Here the drugpowder is sprinkled over the lesion. Because of the simplicity of the procedure and asthis procedure is agreeable to all category of patients including pregnant, puerperiumand peri-menopausal patients this method is adopted. Avachoornana is also suitablefor a sthanika twakgata vyadhis like kachchu. Dusting powders having clotrimazole with out without steroids are advised forintertrigo in the contemporary modern medicine system. Clotrimazole is an imidazolebelonging to azole group of antifungals. It is widely used for topical application. It ishaving broad spectrum antifungal activity along varied range of antibiotic activity.Clotrimazole inhibits the fungal cytochrome P450 enzyme and thus impairs ergosterolsynthesis leading to a cascade of membrane abnormality of fungus. Even though it isDepartment of Prasooti Tantra and Stree Roga 148
  • 167. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionclaimed to be having 60-100% cure rate it needs 2-4weeks application. Irritation,stinging and burning sensation is experienced by some patients. If there is secondarybacterial infection in the intertrigo, proper antibiotics should be given. Steroids can beused for their anti-inflammatory property. Since in the culture study, candida albicansis got, and candid powder is a proved drug for intertrigo, it is taken as the drug for thecontrol study.Discussion on methodology, observations and results It was a single blind clinical study with a pre test and post test design. Here 60patients between the age group of 20-60 years were selected from the OPD and IPDof SDM hospital of ayurveda, udupi. The pratyatma lakshanas of kachchu andintertrigo were considered for the selection. Here for the test group comprising of 30patients, khadiradi yoga avachurnana was done and for another group of 30 patientscandid powder dusting was done. Candida is a popularly used drug for the intertrigoand its efficacy is well proved. The results were compared.Age – In this study, all patients belong to madhyama avasta i.e., between 18 -53 years.In females, during this reproductive and sexually active period, there will bemenstrual cycle, pregnancy, puerperium, menopause, and pathological states like PID,irregular bleeding p/v because of varied aetiologies. So this group is considered. Inthe present study, highest number of patients i.e., 40% females were of 24-29years.Itmay represent the age of women seeking obstetric advise, in this region.Marital status- In this study, 95% patients were married. This group comprises ofpregnant, puerperium and peri-menopausal age group patients. Patients withgynaecological disorders are also from this group. Vaginal discharge is more commonin sexually active females. Pregnancy, puerperium, or peri-menopausal bleeding aremost important stages of the life in which females where in there is need for the usageof sanitary pads. Using sanitary pads and presence of vaginal discharges are the mainprecipitating factors. So, unmarried females registered are less in this study.Distribution of the patients according to different stages- In the present study,52.63% females were pregnant, 24.56% females were puerperium, 17.54% femalesDepartment of Prasooti Tantra and Stree Roga 149
  • 168. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionwere married but not pregnant and 5.26% females were in the peri-menopausal age.This may represent the population visiting the OPD of SDM hospital as well asincreased incidence of intertrigo in pregnant patients and puerperium patients.Occupation-In this study, 75% females were housewives. As this study considersfemale patients in different stages, pregnant females in 3rd trimester and in puerperiumwill be at home leading a sedentary life. Pregnant and puerperium patients compriseof largest proportion in this study.Religion-Maximum number of patients i.e., 61.67% registered in this group isHindus. This indicates the dominance of Hindu population in the locality where in thisparticular study was undertaken.Socio-economic status-Maximum numbers of patients (63.33%) were belonging tothe middle socio-economic status. This may represent the dominance of middle classpeople attending this charitable hospital.Education-Most of the patients (45%) registered in this study were completed highschool level.Ahara- Maximum number of patients (83.33%) was having mixed diet. This willexplain the prevalent food pattern in this costal region. Non vegetarian diet is rich inproteins and fat. They help to increase in the body weight. Obesity is one of thetriggering factors in the manifestation of the intertrigo.Incidence of bathing habits- In this study out of 60 patients, 68.33% females werehaving daily bath, 20.00% of females were having bath once in 2 days and 11.67%females were having bath once in 3-4 days. Either this observation inconclusive or itneeds a study in a large population.Type of occlusion- Out of 60 females registered for this study, 43.33% women wereusing synthetic undergarments, 40.00% females gave the history of using sanitarypads and 16.67% females were wearing heavy clothing. This suggest that occlusion inDepartment of Prasooti Tantra and Stree Roga 150
  • 169. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionthe genito inguinal area which will hamper the proper disposal of the sweating in thatparticular region is acting as one of the cause or it is creating a favourableenvironment for the manifestation of the development of the intertrigo.Predominant ahahra rasa- Most of the patients were using katu, amla ,lavana andmadhura rasa.These rasas cause the pitta and kapha vitiation and amla and lavana rasawill cause syandana of kleda. So, this particular food habit may contribute to form adamp environment in the genito inguinal region in prone patients.Sweating- 81.67% patients had excessive sweating. Ati sweda pravruti causes thekandu. In kachchu it is said that, sweat moistens the mala that is present in the groinregion and causes the kandu and further manifestation of the disease. Excessivesweating in the genito inguinal region causes the friction of the skin fold because thesodium chloride in the sweat is said to cause the apposition and stickyness of the skinsurfaces. This will predispose the manifestation of the intertrigo eventually.Problems associated with micturition- 93.33%females presented with increasedfrequency of micturition and 26.67% females presented with urge incontinence. Thismay wet the undergarments, which will cause subsequent friction. It may also harbourthe organisms which will be responsible for the manifestation of intertrigo like E. coli.Both the features are seen during pregnancy, puerperium, vaginitis, and in UTI.Presence of vaginal discharge- 68.33% women had vaginitis with vaginal discharge,3.33% women had increased p/v bleeding, 11.67%women had lochial discharge andthere was no vaginal discharge in 16.67% women. Presence of discharge per vaginumeither needs pads, or they may disturb the normal eco system of organisms in thegenito inguinal area. It also increases the chances of occlusion and compactness ofthat particular region.Gestational age-In the population of pregnant patients registered for this study,66.67%pregnant patients were in 34-39 weeks. This suggests that incidence ofintertrigo is more in patients near the term. This may be due to various causes likeDepartment of Prasooti Tantra and Stree Roga 151
  • 170. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionincreased sweating, increases compactness of the genito inguinal region, change in theeco system of the genito inguinal area as a preparation for labor, etc.Presence of episiotomy wound- In the population of puerperal patients’ group whounderwent vaginal delivery, registered for this study, 87.50% women had episiotomywound. Presence of a wound in the perineal region adds to the inflammation in thatparticular region.Location of episiotomy wound in relation to intertrigo- In the present study in64.29% women the intertrigo was on the episiotomy lesion. Presence of the woundeven though intentionally created, adds to the inflammation on that particular region.The pathogens causing the intertrigo may enter into the wound, contaminate that areaand may cause wound gaping or infection. In such cases wound debridement and re-suturing may be required. In the presence of infection like intertrigo if untreated,proper healing of the episiotomy wound is either delayed or there may be some othercomplications like wound gaping.Mode of onset of intertrigo-45.00% women had sudden onset, 43.33% women haverecurrent onset and 11.67% women had gradual onset. It may suggest that acute andrecurrent onsets are very frequent.Duration of intertrigo since onset- In 40.00% women the intertrigo started 4-7daysback, in 23.33% females - 1-3days back, in 20.00% women – 8-15 days back and in5.00% women about 30 days and 60 days each respectively. In the acute onsetpatients tends to report early as there is intense itching, pain, and blisters. Once itreaches chronic stage, with little maceration, pain reduces, so patient may ignore itunless they are in pregnancy or puerperium.Nature of the area involved-In 76.67% women the genito inguinal area was moist in70.00% females the skin of the genito-inguinal area was smooth and in 30.00%females the skin of the genito inguinal area was rough. In the acute and maceratedlesions the area will be moist and smooth. In chronic lesions the area will be roughbecause of lichenification.Department of Prasooti Tantra and Stree Roga 152
  • 171. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” DiscussionPresence of pain –All the patients had pain but of varied nature. Out of them, 65.00%women had intermittent pain and 35.00% women had continuous pain. In intertrigo,continuous pain will be present in the presence of acute inflammation, andintermittent pain will be present in the vaning stage of acute inflammation, and in thepresence of intermittent friction,Character of pain-46.67% females were complaining of acute pricking pain, 38.33%females were complaining of burning pain,10.00% females were complaining of dullpain and 5.00% females were complaining of numbness. Acute pricking pain andburning pain is present in acute stage and dull pain is present in macerated stage andchronic stage may present with numbness because of lichenification. It can beinterpreted as acute phase is due to pitta and chronic phase with maceration isdominated by kapha.Intensity of pain- 46.67% women were complaining of severe pain, 30.00% femaleswere complaining of moderate pain and 23.33% women said that pain is mild. Inacute stage pain is more and in chronic stage the pain is less.Kandu- Itching is an intractable symptom which is seen in this pathology. All thepatients had itching. 85.00% women presented with severe kandu. 10.00% womenpresented with moderate kandu and 5% women presented with mild kandu. Kandu isattributed to kapha. It may be or may not be present with pain. Itching is present in thepresence of maceration.Extension of lesion- In 58.33% women the intertrigous lesion was extended up tovulva, in 36.67% women the lesion was extended to thighs, in 3.33% women thelesion was extended to lower abdomen and in 1.67% women it was extended tobuttocks. The ecosystem of inguinal region and vulva are same and both are in thecompact region. So, the lesion easily tends to spread to vulva. In fat females it mayeven spread to lower abdomen folds or thighs or even to buttocks.Disolouration of the lesion- 43.33% women had macerated lesion, 25.00% womenhad blackish red lesion, 18.33% women had blackish lesion and13.33% women hadDepartment of Prasooti Tantra and Stree Roga 153
  • 172. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionred coloured lesion. The lesion will be red during acute phase, may or may not beassociated with maceration, and as it becomes chronic the colour changes into black.Presence of blisters- Only16.67% women had the development of blisters and83.33% women never had blisters. Since the sample size is small, it is inconclusive.Prakruti-In sharira prakruti, maximum number of patients (45%) registered washaving kapha pitta prakruti. The doshas which were involved in the manifestation ofthe kachchu are kapha and pitta. So, this disease is more prevalent in the patientshaving kapha and pitta prakruti.Samhanana-Maximum number of patients (56.67%) was having madhymasamhanana. But considerable number of patients (38.33%) was having obesity. Inobese patients unhygienic measures will usually cause the genito-inguinal intertrigo.Agni-maximum number of patients were having madhyma agni.Effect of therapy-Effect of treatment on individual signs and symptomsKandu- It is an intractable feeling, which patients want to get rid off. By the 3rd weekit is reduced by 98.04%. It is caused by kapha, and in case of kachchu it is caused alsoby the accumulation of moist layer of mala which includes sweda mala also. Since thedrug contains- mustaka, nimba, haridra and gandhaka, which are known for theirkandughna property, there is marked reduction in the symptom kandu. Once thekandu is reduced, further pathology which will manifest from the act of scratchingwill also stop.Vedana-At the end of 3rd week it is reduced by 98.32%. It is caused by tridoshadepending on the stage of the disease. In acute inflamed condition it is because ofvaata and pitta, and in macerated stage it is because of kapha. This drug containsshirisha which is having vedanastapana property. Along with that the vibhitakai andtalc powder present will reduce the burning sensation present in the acute condition.Department of Prasooti Tantra and Stree Roga 154
  • 173. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” DiscussionWhen the pain reduces its corresponding sign tenderness will also reduce. There wasreduction of 97.06% after the treatment.Srava-At the end of second week itself it is reduced by 100.00%. This symptom iscaused by pitta. In kachchu it is present in the absence of kotha. The drug is dusted infine powder form. Avachurnana itself is having shoshana property. Along with thatkadhira, nimba, dugda pashana are having kashaya, tikta rasa sheeta virya. Thus italso acts as pittahara. Tannins present in the drugs are known to cause drying effect.Edema– At the end of second week there was 98% reduction and at the end of 3rdweek there was 100% reduction. Shotha is caused by vitiated kapha pitta. Most of thedrugs in Khadiradi churna are shothagna in nature. They also act as kapha shamaka.Discolouration of the lesion- At the end of the treatment there was 90.25%reduction. In some patients with chronic intertrigo, the skin colour has come back tonormal. The kachchu or the genito-inguinal intertrigo may present in three forms.They are -acute lesion with redness and without maceration, -acute lesion with or without redness but with maceration -sub acute lesion with minimal redness but blackish discolouration.The mustaka, vibhitaki, gandhaka, nimba, and dugda pashana reduce the acuteredness. Kadira, shirisha, triphala, saptaparna, gandhaka, haridra will relieve themaceration. Kadira and haridra act as varnya. They remove the blackishdiscolouration and help the skin to get normal colour.Redness- At the end of the treatment there was 97.46% reduction. It is the symptomof acute inflammation which can be attributable to pitta. Nimba, mustaka, dugdhapashana, gandhaka act as pittahara and reduce the signs and symptoms of acuteinflammation.Blisters- At the end of the treatment there was 100.00% reduction. Blisters occur dueto the action of scratching. It occurs due to the vitiated pitta and kapha. The drugs actDepartment of Prasooti Tantra and Stree Roga 155
  • 174. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionas both kapha pittahara and kustagna. Khadira, shirisha, saptaparna, mustaka andnimba act as shothagna and vranaghna.Roughness-At the end of the treatment there was 100.00% reduction. This occursbecause of lichenification due to chronic inflammation and continuous act ofscratching. The drug reduces the dampness and itching which are the triggeringfactors for the continuation of the pathology and for chronicity. Haridra and nimbahave lekhana property. They help to remove the excessively keratinized skin. Some ofthe drugs also act as varnyas. On the whole this combination help to regain the normalcolour and texture of the skin.Warmth- At the end of the treatment there was 97.70% reduction. It is a sign of acuteinflammation. It is a feature of pitta. The drug contains pitta hara drugs like nimba,haridra, mustaka, gandhaka, dugdha pashana. Thses drugs also have sheeta virya andhence reduce the warmth caused due to the infection.Size of the lesion- At the end of the treatment there was 74.83% reduction. When thevicious cycle of the pathology breaks up the body will gradually come to normalcy.When the inflammatory signs and symptoms reduce which indicate that the infectionis coming under control then automatically the size of the lesion will reduce.Gradually the peripheral regions revert to normalcy.Attribution of relief in symptoms to phyto chemical analysis Priliminary phyto chemical analysis of the drug done showed that it containsproteins, carbohydrates, tannins, saponins, phenols, glycosides and steroids in theaqueous extract. Tannins and proteins are known to cause the dryness of the skincausing the constriction of the gland ducts and minor degrees of peripheral vasoconstriction. This will reduce the oozing and because of reduction of oozing thedampness decreases and the organisms stop proliferating. Glycosides are both antibacterial and anti fungal. Steroids are known for potent anti inflammatory action.Saponins and phenols act as cleansers and detergents. They remove the slough andthus make the local area unsuitable for the growth of the micro organisms.Department of Prasooti Tantra and Stree Roga 156
  • 175. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” DiscussionDiscussion on microbiological study of khadiradi yoga Culture of the organism was done to know the type of organisms. In all thesmear of 10 patients, there was growth of candida albicans. In 3 patients there weregrowth of E. coli and Staphylococcus aureus and in 1 patient there was growth ofpseudomonas aeruginosa. As per the text books these organisms and streptococcuspyogens are detectable in the intertrigous lesion.So, sensitivity of khadiradi yoga choorna on these organisms is checked in in-vitrostudy. Here two methods were followed. They are-1) The drug was used once the organisms were cultured.2) The drug was used before the culture of the organism.In the first method, the drug was used in two forms. They are-1) In the powder form as in the clinical study, the drug was administered to the patientin the powder form.2) In the cold aqueous extract form-Here aqueous extract is done using normal saline,as in the clinical study, the drug was sprinkled on the sweaty area which will be richin NaCl.In the second method, Khadiradi yoga choorna was incorporated into the agar andculture media was prepared, and then the organisms were inoculated.Results – In experimental set up the drug did not show any inhibitory action on thecandida albicans when it was used in the powder form. But in aqueous form, itshowed partial inhibition of the candida albicans. Sensitivity study of Khadiradi choorna done to see the effect onstaphylococcus aureus, E. coli and pseudomonas aeruginosa revealed that the drugwhen sterilized at 120.c acts as bacteriostatic for all the three species. In aqueousmedia the drug partially inhibits the bacteria of all the three species. In the powderform it seldom inhibits the organisms.Probable explanation could be like this.-When the culture media is prepared without the drug, the organisms is inoculatedfirst and then the drug is added. There will not be any moisture content in it. So, in theDepartment of Prasooti Tantra and Stree Roga 157
  • 176. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionexperimental set up, the drug reaction which would be expected to take place in theaqueous media will not take place. So, micro organisms will dominate.-When we sterilize the drug powder with the agar the drug will be in the aqueousmedia. So, in that high temperature there can be possibility of chemical reactions inthe aqueous media which may work like this- -The drug may react with the agar making it unavailable or non usable for themicroorganisms - The drug may react with the organisms and may kill them - The drug may not allow the organism to multiply.In clinical study, we are applying the drug to a damp area, which is having hightemperature than rest of the body, because of the occlusion the temperature still moreincreases. Inflammation also increases the temperature. The area is having a particularpH and there is a combination of bacteria and fungi which are in the form ofcommensals. In such a condition, when the drug is applied, it will be acting in anaqueous media, in a comparatively hot area, and over the combination of the microorganisms.Mode of action of Khadiradi choorna Living body is a dynamic structure, in which innumerable numbers ofchemical reactions are going on - some are for the constructive purpose and some forthe destructive purpose, but, both the anabolic and catabolic processes will be takingplace for the maintenance of homeostasis of the body. It is also established that in theliving body there will be so many other micro organisms including bacteria andfungus living in harmony with the body. They are called commensals. They arefriendly with the living human body. But some of them will become opportunisticpathogens only when the body immune system drops. This drop in the immunesystem may be systemic or local. When we consider the local immune system like inthe genito-inguinal region, it is governed by specific combination of particulartemperature, pH, vaso motor changes and macrophages and so on. Action of manyother unknown mechanisms taking place in the skin of genito-inguinal region can notbe ruled out in the prevention of the local skin health.Department of Prasooti Tantra and Stree Roga 158
  • 177. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion Genito-inguinal region is an eco system of many bacteria and fungus. Innormalcy, there would be some homeostasis between. When the body immune systembreeches because of specific aetiological factors, the balance in between themicroorganisms’ is lost as well as the homeostasis between the genito inguinal skinand the commensals gets impaired. Thus one or the other micro organism will get thepathogenisity and multiply in number to form colonies. Presence of unwanted biological materials like exfoliated skin cells, retainedsweat and secretions of other glands present in that part (which includes sebum) mayprovide a good environment for the growth of the organisms. When the compactnessof the genito inguinal part increases, there will be improper disposal of sweat andreduced aeration. The NaCl present in the sweat causes the stickiness between theskin folds and initiates the friction. Friction between the moist sticky skin folds causesthe inflammation because of cell damage, which will cause a cascade of changes inthe host as well as in the commensals. In the host, the skin changes are typical for theinflammation. In the commensals, the total host environment causes the mutation of aparticular gene which will give them pathogenicity.Khadiradi yoga choorna is having 11 drugs selected from different ganas. They are- • kustagna gana, (khadira, amalaki, haritaki, saptaparna, haridra.). • kandugna gana (mustaka, nimba). • vedanastapana gana (shireesha). • vibhitaki (on pralepa imparts dahahara property). • shudda gandhaka. • dugdhapaashana (both have twakdoshahara property). Kachchu is a sthanika twakgata vikara having kandu, sphota and srava ascardinal symptoms. These symptoms are also associated with ruja, daha, shotha andraga invariably. The drugs in Khadiradi yoga choorna are having kushtagna, kandugna,vedanasthapana, dahaprashamana, shothagna, vranaghna and varnya property. Eachand every symptoms of the disease are combated by the drug.Department of Prasooti Tantra and Stree Roga 159
  • 178. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussion More over the drug is used in the powder form. The very pathogenesis ofkachchu starts from the kledana of the mala present in the genito inguinal region.Powder form of the drug and presence of dugda pashana and other kashaya rasa yuktadrugs impart dryness to the skin of genito inguinal region. This will also break thechain of pathogenesis causing kachchu. Most of the drugs are having the kapha pitta hara property. So, the Khadiradiyoga choorna pacifies the vitiated doshas responsible for the manifestation ofkachchu. Nimba and dugda pashana have lekhana property which will help to removethe unwanted layer in that region. More over haridra imparts lusture. All together thedrug helps the skin in the genito-inguinal region to regain the normalcy. The components of the Khadiradi yoga choorna is having proteins,carbohydrates, saponins, phenols, tannins, glycosides and steroids in the cold aqueousextract in vitro. When the drug powder is sprinkled into the genito inguinal regionwhich is damp in nature, the same chemicals (as in the cold aqueous extract) arereleased in to the aqueous media. Proteins and tannins impart dryness to the skin. Tannins constrict the openingof gland ducts and peripheral vaso constriction and reduce the oozing. Saponins andphenols act as cleansers and help in the debroidement. Steroids act as antiinflammatory and thus analgesic .Glycosides present in the drugs directly act as antibacterial and anti fungal. Powder is the preferred form of medication in intertrigo. Powder form itself ishaving the drying property and it reduces the skin fold friction. Thus even from themodern parameter also the drug proves itself in the treatment of kachchu. In the classics it is said that bhrajaka pitta/dehoshma is responsible for themetabolism of the drug applied to the skin. According to the concept vruddhihsamanaih sarvesham, during snana /bath the ushma enters inside the twak andincreases the bhrajaka pitta as ushma is one of the guna of the pitta. So, dailyDepartment of Prasooti Tantra and Stree Roga 160
  • 179. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Discussionregimens like snana and uthsadana will increase the brajaka pitta in the skin. It is saidthat even in the pathological condition brajaka pitta is responsible for the action/metabolism of the drug that is applied on the skin. The active principles of the drug may also act at the host tissue level and theymay undergo first phase metabolism in the skin itself before entering into the systemiccirculation. This first phase metabolism of the drug in the skin fold of the genitoinguinal region may aid to many changes like alteration of pH and local temperatureof that area, drying the skin of that area change in the total local atmosphere of thelocal skin that has triggered the pathogenecity of micro organisms. Once thedampness of the area reduces, there is no nutritive media for the bacteria and fungusto grow and hence their growth may be reduced. Any sophisticated experimental set up cannot simulate the living human body.Even though the drug is found to be inactive against candida albicans and otherbacteria in the power form in in-vitro study, efficacy of the drug is proved in thepatients clinically. Improvement is seen in the patients. The possible explanationcould be like this. The drug acts in the dynamic host environment particularly at host tissue level.The drug acts on the combination of organisms. There may be a synchronised sequelof events like interaction between those micro organisms with in themselves,interaction of the micro organisms with the local immune system, interactionbetween the micro organism and the host body, vaso constriction, vaso dilation, vasomotor changes, pH of that particular area-all these things may take part during theapplication of the drug. Even though the drug is applied in the powder form, some of its componentssay active principles are dissolvable in the aqueous media. The interaction of theactive principles of the drug with each other in that particular temperature and pH,with the microorganism or with the interactions of the micro organism may act tocombat the disease and help to heal the intertrigo.Department of Prasooti Tantra and Stree Roga 161
  • 180. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” DiscussionSpecial observations 1) In 4 patients using Khadiradi yoga choorna, the lichenification got completely regressed and excoriation diminished. This was not seen in any patients using candid. 2) In control group, 5 patients developed episiotomy wound dehiscence and in test group only one patient had episiotomy wound dehiscence. 3) None of the patients showed allergic reactions to Khadiradi yoga choorna. 4) In control group, in 8 patients the lesion reappeared again after a gap of 1-4 months gap. In test group, there was no such incidence. 5) The drug has not caused the formation of granulomas in the episiotomy wound. 6) It has not increased the vaginitis when intertrigo was co-existing. 7) No teratogenic effects were observed because of the use o Khadiradi yoga choorna. Scope for further study -To have further specific phyto chemical analysis of Khadiradi yoga choorna, and in different forms like kashaya, phanta etc. -To have more specific microbiological study with pre test and post test smear in same patient. -To establish the sensitivity against specific subspecies of the candida and bacteria. -To establish the sensitivity in broth dilution method -To establish the sensitivity in different temperatures. -To establish the exact action of the drug against micro organisms-whether static or cytic, if so, at what level etc. -To establish whether the drug is acting at commensal stage or at pathogenic stage -To establish active principles in Khadiradi yoga choorna. -To establish teratogenic effects of the drug. -To evaluate the efficacy of the drug with different thickness in vivo and in vitro -To establish the efficacy, conducting the trial in larger sample group and repeatedly.Department of Prasooti Tantra and Stree Roga 162
  • 181. Conclusion
  • 182. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Conclusion CONCLUSION Human being is suffered from the one or the other type of skin disease fromtime-immemorial. We can get the reference of different types of kusta in differentclassical literatures starting from vedic literature, and the treatment for the same ismentioned in them. As the science developed, description of kushta and its treatmentmodalities widened. Kachchu is a shanika twakgata vikara, manifesting in the vrushana pradesha inpersons who do not maintain hygiene of the genito inguinal region. We get the firstreference of kachchu in Sushrutha samhita. Kachchu occurs because of vitiated kapha and rakta. It manifests in thepersons who do not do snana and uthsadana regularly. In such persons, the swedamoistens the mala present in the vrushana pradesha and causes kandu. When theperson scratches, it produces sphota and srava. Since this nidana, samprapti andvyadhi can occur in both males and females by the prefix vrushana we shouldconsider the anatomical location rather than the anatomical organ. In the modern parallels genito-inguinal intertrigo occurs when the sweatingincreases the friction between the skin folds in that region. It starts as inflammationand eventually gets secondary bacterial and fungal infections and may present withitching, blisters and dampness. By seeing the etiological factors and the presentationof the disease the kachchu can be best correlated to genito-inguinal region. Genito inguinal intertrigo is more seen in pregnant and puerperal patients, asin both conditions there is increased sweating. It is more frequent in females withincreased p/v discharges and p/v bleeding. Obesity and Diabetes mellitus are theprecipitating factors. All these conditions will result in the occlusion leading toimproper disposal of sweat. Sweat retention increases friction between skin folds andthe pathology of genito inguinal starts It is also seen more in sharad-varsha rutu sandhi kala and in beginning ofgreeshama-varsha rutu sandhi kala. During these period, there is increased sweatingDepartment of Prasooti Tantra and Stree Roga 164
  • 183. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Conclusionbecause of increased atmospheric humidity and heat of summer and this predisposesthe onset of the intertrigo. In this time occlusion of the genito inguinal part by variousmeans like pads and unhygienic undergarments will precipitate the pathology. In Ayurveda, kashaya parisheka, and internal administration of ghrita areexplained to treat kachchu. Because of practical problems associated with these this inpregnancy and puerperium, from the selected drugs kustagna, kandugna and vedanasthapana gana Khadiradi choorna is prepared. It contains-kahdira, shirisha, nimba,musta, saptaparna, triphala, haridra, and shoditha gandhaka in equal quantities and25% of dugda pashana which was decided on the result of the pilot study. On thewhole Khadiradi choorna acts as kustagna, kandugna, daha prashamana, shoolaprashamana, shothagna, vrana ropana and varnya property. Avachurna is the mode of procedure adopted to administer the drug as thedisease kachchu is a sthanika twakgata vikara. Avachoornana acts as both shodanaand ropana purpose as mentioned in the classics. Since it is used in thin layer form, itdoes not produce the occlusion effect and also imparts the drying effect. The qualitative phyto chemical analysis of Khadiradi yoga choorna doneshowed the presence of proteins, carbohydrates, saponins, tannins, Glycosides andsteroids in cold aqueous media than in chloroform extract and methanol extract, andthey impart the actions like peripheral vaso constriction, drying effect, reduces theoozing, and inhibit the growth of the pathogens. Its microbiological studies indicated that the Khadiradi yoga choorna inhibitsthe growth of E. coli, Staphylococcus aureus and Pseudomonas aeruginosa, andpartially inhibits the growth of fungus. In the clinical study which was done to see the clinical efficacy of khadiradiyoga avachoornana in kachchu shows that warmth, itching, roughness, dampness andblisters respond to khadiradi choorna better than candida. On pain, tenderness,redness, warmth, colour, size of the lesion, Khadiradi choorna is having the effects asthat of the candid powder which is having the proved efficacy.Department of Prasooti Tantra and Stree Roga 165
  • 184. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Conclusion In the classical text books of Ayurveda, acharyas have explained theguidelines to identify the disease on the basis of doshas and dushyas and to formulatethe treatment modalities. The science also gives the scope for new formulationsdepending upon the concept of samprapti vighatana. Many times efficacy of theayurvedic product is difficult to prove in modern parameters even with sophisticatedinstruments and methods. It will be having its own limitations and backlogs as aliving human body cannot be simulated exactly in the experimental set up. Repeatedtrials and invention of new techniques will help to establish the facts of science andthus helps to use the science for the betterment of the mankind.Department of Prasooti Tantra and Stree Roga 166
  • 185. Summary
  • 186. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Summary SummaryThe dissertation is entitled “Evaluation of the clinical efficacy of Khadiradi yogaavachoornana in kachchu with special reference to genito inguinal intertrigo”essentially aims to evaluate the effectiveness of ayurvedic formulation in themanagement of kachchu.It consists of –Introduction -It consists of basic information regarding the disease and theformulations. It tells about the necessity of the exploration of the disease as very lessmedical input is there regarding intertrigo.Historical review - Deals with the reference of kushta in vedic literature, puranas andin samhitas. It also deals with reference of individual components of Khadiradi yogand avachoornana concept as well as the intertrigo in gynecology.Review of previous research works - mentions about the researches done in kshudrakusta.Conceptual study - of disease and the drug -comprises of ayurvedic review and modern review This starts with the twak sharira as it is the basis for the physiology,pathology and treatment of the skin disorders. Disease review proper starts with theconcept of kusta in ayurvedic classics, enumeration of skin disorders into kushta andkshudra roga, list o kshudra rogas according to different acharyas, nirukti andparibhasha of kachchu, nidana, samprapti and chikitsa of kachchu.In modern review-anatomy and physiology of skin, aetiology, aetiopathogenesis, roleof micro organisms in the causation of intertrigous lesions and treatment of intertrigoare told. Further histopathological features of intertrigous lesions and difficulties indiagnosing the lesions histopathologically are narrated.Drug review-This unravels the method of preparation of khadiradi yoga choornastarting from the selection, fixing the dose of each components, fixing clinical dose,criteria to select the drug in powder form, concept of absorption, concept ofDepartment of Prasooti Tantra and Stree Roga 168
  • 187. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Summaryavachoornana and basic information regarding each component of khadiradi yogachoorna. It also includes the phyto chemical analysis of the drug and its probableinterpretations.Observations-This section includes the different observation done on the test groupas well as the control group. It also includes the preliminary survey done in GynecOPD to know incidence of the disease.Results-It includes the statistical results of the clinical trial, preliminary phytochemical analysis of Khadiradi yoga choorna and microbiological study done.Discussion-This section includes analysis of and interpretation of conceptual study,results of clinical study, phytochemical study and microbiological study and scope forfurther research.Conclusion-This section includes the conclusion based on the study done. It alsohighlights the limitations of the modern parameters in proving the efficacy of theayurvedic medicines.Summary-This section includes the gist of the dissertation work and highlights themain content of every section.Department of Prasooti Tantra and Stree Roga 169
  • 188. Bibliography
  • 189. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliography BIBLIOGRAPHY1) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Nidhana Stana,14th adhyaya,shloka No.-49-50 Ref page-325.2) History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-263) History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-344) History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-285)History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-316)History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-447)History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-538)History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-409)History of medicine in India, edited by Dr. Priyavath Sharma, 1st print published byIndian National Science Academy, New Delhi. Pp-527, Ref No-5210)History of medicine in India, edited by Dr. Priyavath Sharma, 1st print publishedby Indian National Science Academy, New Delhi. Pp-527, Ref No-5611) Vrudda Vagbhata, Astanga Sangraha, with shashilekha Sanskrit commentary nyIndu, edited by Dr. Shivprasad Sharma, published by Choukamba Sanskrit seriesoffice, Varanasi, 1st edition, Uttara tantra 36th chapter,Pp-965, Ref page no-81312) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Uttara tantra, 31st chapter, Ref page-88713)Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thDepartment of Prasooti Tantra and Stree Roga 171
  • 190. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliographyedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738,Sutrastana, 18th chapter, Ref page-106.14) Agnivesha, Charaka Samhita, revised bt Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Chikitsastana, 12th chapter, Ref page-48215)Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824, Chikitsa Stana, 20th adhyaya, Ref page-478.16) Vrudda Vagbhata, Astanga Sangraha, with shashilekha Sanskrit commentary nyIndu, edited by Dr. Shivprasad Sharma, published by Choukamba Sanskrit seriesoffice, Varanasi, 1st edition, Uttara tantra 37th chapter,Pp-965, Ref page no-81917) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Uttara tantra, 32nd chapter, Ref page-79018) Vanga sena, commentary by kavivara Sri shaligramaji vaishya, published bychoukamba publications, Kshudra roga adhikara adhyaya, Pp-1096, Ref page-67819)Yoga Ratnakara, commentary by Dr, Indradeva Tripathi, published byKrishnadeva Academy, Varanasi, Kshudra roga nidana chikitsa prakaranam, Pp-984,Ref page-69120) Chakra Datta, edited by Dr. Priyavath Sharma, published by Choukambhapublishers, Varanasi, 55th chapter, Pp-731, Ref page-43421) Madhava Nidana with Sri Vijayarakshita, Srikantadatta virachita madhukoshavyakhya sahita, edited by, Dr. Brahmananda Tripati, published by choukambasurabharathi Prakashana, uttarardha, 55th chapter, Pp-622, Ref pg-25522) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by Choukamba chakrpanidutta, edited by vd. Yadavaji TrikamjiAcharya, 5th edition 2001, Published by Sanskrit Samstan, Varanasi, Pp-738,Sutrastana, 4th chapter, 11th shloka Ref page-33.23) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by Choukamba chakrpanidutta, edited by vd. Yadavaji TrikamjiDepartment of Prasooti Tantra and Stree Roga 172
  • 191. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” BibliographyAcharya, 5th edition 2001, Published by Sanskrit Samstan, Varanasi, Pp-738,Sutrastana, 4th chapter, 11th shloka Ref page-33.24) Agnivesha, Charaka Samhita, revised bt Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738,Sutrastana, 4th chapter, 18th shloka Ref page-34.25) Agnivesha, Charaka Samhita, revised bt Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi. Pp-738,chikitsastana, 12 th chapter, 71st shloka Ref page-489.26) Vagbhatachrya, Rasaratna Samuchchaya with suratnojjala commentary edited byAmbikadatta Shastry, 9th edition1995, Published at Chaukhambha AmarabharatiPrakashan, Varanasi, Pp-647, 3rd chapter, shloka No.17, Ref page-61.27) Sri Sadananda Sharma, Rasataranginiwith prasadini vyakya by Sri Haridattashastry, edited by Kashinath Shastry, 11th edition 2004, published by ChaukhambhaPublications, New Delhi, Pp-772, 11th Chapter, shloka No. 234, Ref page-282.28) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738,Chikitsastana, 7th chapter, 101th shloka Ref page-455.29) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824, Chikitsastana Stana,1th adhyaya,shloka No.-8 Ref page-397, 21stchapter, shloka no.-3, Ref page-481.30) - Howkins and Bourne, Shaw’s textbook of Gynecology, edited by Dr. v.Padubidri, 11th edition 1997, Published by B.I.C.L. Pvt. Ltd. Pp-569, 7th Chapter, Refpage-107-108.31) Textbook and Atlas of Dermatology-Volume I by Dr. R.G. Valia 2nd edition 2003published at Bhalani Publishing House Bombay, Pp-768, 17th Chapter, Ref page-41532)Raja Radhakanta deva, Shabda kalpa druma Edited by Shri varadaprasadvasunaand Sri haricharanavasuna; Naga publishers; Delhi; Reprint 1987, 2nd volume, Pp 926;Page No.666Department of Prasooti Tantra and Stree Roga 173
  • 192. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliography33) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Chikitsastana, 15th chapter, 19th shloka Ref page-52534) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Shariraastana, 3rd chapter, 6th shloka Ref page-310.35) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824, Sharira Stana, 4th adhyaya, shloka No.-4 Ref page-355.36) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sharira tantra, 3rd chapter, Ref page-38737) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Chikitsastana, 15th chapter, 19th shloka Ref page-52538) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Sharirastana, 7th chapter, 4th shloka Ref page-33739) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824, Sharira Stana, 4th adhyaya, shloka No.-4 Ref page-355.40) Gray’s Anatomy, edited by Peter L. Williams, 37th edition, Published byLongman Group UK, Pp-1598, Ref Page-7041) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Department of Prasooti Tantra and Stree Roga 174
  • 193. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” BibliographyPublished by Choukambha Orientalia, Pp-956, Nidana stana, 14th chapter, Ref page-52442) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, uttara tantra, 31st chapter, Ref page-77843) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, uttara tantra, 31st chapter, Ref page-77844) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738,Sutrastana, 18th chapter, Ref page-106.45)Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Nidhana Stana,14th adhyaya,shloka No.-49-50 Ref page-325.46) Vrudda Vagbhata, Astanga Sangraha, with shashilekha Sanskrit commentary nyIndu, edited by Dr. Shivprasad Sharma, published by Choukamba Sanskrit seriesoffice, Varanasi, 1st edition, Uttara tantra 36th chapter,Pp-965, Ref page no-81347) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Uttara tantra, 32nd chapter, Ref page-79048)Yoga Ratnakara, commentary by Dr, Indradeva Tripathi, published byKrishnadeva Academy, Varanasi, Kshudra roga nidana chikitsa prakaranam, Pp-984,Ref page-69149)Chakra Datta, edited by Dr. Priyavath Sharma, published by Choukambhapublishers, Varanasi, 55th chapter, Pp-731, Ref page-43450)Vanga sena, commentary by kavivara Sri shaligramaji vaishya, published bychoukamba publications, Kshudra roga adhikara adhyaya, Pp-1096, Ref page-678Department of Prasooti Tantra and Stree Roga 175
  • 194. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliography51) Kaviraja Govindadas Sen, Baishajya Ratnavali with Siddiprada hindi commentaryby Prof, Siddinandan Mishra, published by Choukamba Surabharati Prakashana, 1stedition Pp-1196, Ref Page-93252) Bhava Mishra, Bhava Prakasha, with Vidhyothini tika by Brahmashankara shastriedited by Sri Hariprasad Pandey, published by Choukambha samskruta bhavana,Varanasi, 11th edition, 61th chapter, Pp-836, Ref Page-58553) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Nidhana Stana, 5th adhyaya, shloka No.-33-34 Ref page-32554) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 2nd chapter, Ref page-1655) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Chikitsa Stana, 24th adhyaya, shloka No.-52-56, Ref page-48956) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 11nd chapter, shloka no-5Ref page-18357) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 11nd chapter, shloka no-5Ref page-18358) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 12th chapter, shloka no-53Ref page-20159) ) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Chikitsastana, 12th chapter, 8th shloka Ref page-483Department of Prasooti Tantra and Stree Roga 176
  • 195. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliography60) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 12th chapter, shloka no-52Ref page-20161)Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Chikitsa Stana, 20th adhyaya, shloka No.-57-60, Ref page-48062) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Chikitsa Stana, 20th adhyaya, shloka No.-57-60, Ref page-480 andBhava Mishra, Bhava Prakasha, with Vidhyothini tika by Brahmashankara shastriedited by Sri Hariprasad Pandey, published by Choukambha samskruta bhavana,Varanasi, 11th edition, 61th chapter, Pp-836, Ref Page-58563) Kaviraja Govindadas Sen, Baishajya Ratnavali with Siddiprada hindi commentaryby Prof, Siddinandan Mishra, published by Choukamba Surabharati Prakashana, 1stedition Pp-1196, Ref Page-95064) R. G. Valia, IADIL, Textbook ad Atlas of Dermatology, 2nd edition, volme I,published by bhalani publishing house Bombay, Pp-800, Ref page-41565) Ashokaggraval, Histopathology of skin, published by Jaypee brothers publication,New delhi, 7th chapter, Pp-280, Ref Pg-4666) Stanley J Robby, Pathology of the female reproductive system, published byChurchill Livingstone, 1st edition, Pp-929, Ref page-167) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 1st chapter, shloka no-27Ref page-1668) Vagbhata, Astanga Hrdayam, with srvangasundra commentary by Arunadatta andAyuredarasayaa by Hemdru, edited by Hrisastri Praakara Vaidya, 9th edition 2005,Published by Choukambha Orientalia, Pp-956, Sutra stana, 1st chapter, shloka no-28Ref page-17Department of Prasooti Tantra and Stree Roga 177
  • 196. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliography69) Sharangadhara Samhita with Subhodini Hindi tika by Sri Praya gadatta Sharma,published by Choukambha Amarabharathi Prakashana, 4th edition, Pp-556 shloka No-36,Pg No-1070) Sharangadhara Samhita with Subhodini Hindi commentry by Sri Praya gadattaSharma, published by Choukambha Amarabharathi Prakashana, 4th edition, Pp-556shloka No-48,Pg No-1971) Sharangadhara Samhita with Subhodini Hindi commentry by Sri Praya gadattaSharma, published by Choukambha Amarabharathi Prakashana, 4th edition, Pp-556shloka No-2,Pg No-1972) Agnivesha, Charaka Samhita, revised by Charaka and Dradabala, with AyurvedaDeepika commentary by chakrpanidutta, edited by vd. Yadavaji Trikamji Acharya, 5thedition 2001, Published by Choukamba Sanskrit Samstan, Varanasi, Pp-738, Chikitsastana, 7th chapter, shloka no-104, Ref page-45573) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Chikitsa Stana, 21st adhyaya, shloka No.-3, Ref page-48174) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Chikitsa Stana, 1st adhyaya, shloka No.-8, Ref page-39775) Sushruta, Sushruta Samhita with Nibandhasangraha of Dalhanacharya andNyayachandrika Panchika of Gayadasa,edited by Vaidya Yadavaji TrikamajiAcharya, 7th edition,2002, Published by Chaukhambha Surabharati Prakashana,Varanasi, Pp 824,Chikitsa Stana, 1st adhyaya, shloka No.-8, Ref page-39776) Raja Radhakantadeva, Shabdakalpadruma Edited by Shivaradaprasadvasuna andSriharicharanavasuna; Naga publishers; Delhi; Reprint 1987, Volume I, Pp 315, PageNo.11377)Raja Radhakantadeva, Shabdakalpadruma Edited by Shivaradaprasadvasuna andSriharicharanavasuna; Naga publishers; Delhi; Reprint 1987, Volume II, Pp926, PageNo.45878) Amara kosha, Hara govinda shaastri, Choukhambha Orientalia,Varanasi 2006, Trateeya kanda, prathama adhyaya, Pp-664, Page no.514Department of Prasooti Tantra and Stree Roga 178
  • 197. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Bibliography79) Amara kosha, Hara govinda shaastri, Choukhambha Orientalia, Varanasi 2006, dwiteeya kanda, 6th chapter, 76th shloka, Pp-664, Page no.29480) Amara kosha, Hara govinda shaastri, Choukhambha Orientalia, Varanasi 2006, dwiteeya kanda, 6th chapter, 53th shloka, Pp-664, Page no.27281) Raja Radhakantadeva, Shabdakalpadruma Edited by Shivaradaprasadvasuna andSriharicharanavasuna; Naga publishers; Delhi; Reprint 1987, Volume II, Pp926, PageNo.682) Raja Radhakantadeva, Shabdakalpadruma Edited by Shivaradaprasadvasuna andSriharicharanavasuna; Naga publishers; Delhi; Reprint 1987, Volume II, Pp926, PageNo.245Department of Prasooti Tantra and Stree Roga 179
  • 198. Annexure
  • 199. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Annexure AnnexureClinical Evaluation of Efficacy of Khadiradi Yoga Avachurnana in Kacchu w.s.r. to genito-inguinal intertrigo Dept. of Prasoothi Tantra and Stree Roga, SDMAC, Udupi. Scholar - Dr. Shubha, B.A.M.SGUIDE: Dr. Mamata K.V., M. D. CO-GUIDE: Dr. Vidya Ballal, M. S. (Ayu) Information Data1. Aatura Vivara Name OPD No Age IPD No Sex Bed No & Room No Religion D.O.A. Education D.O.D. Occupation Address Marital Status Social Status2. Vedana Samuchraya a. Pradhana vedana i. Vrana Nature of onset Sudden/gradual/recurrent Sites involved Extension of lesion Duration Colour of lesion Association with swelling Nature of area involved Dry/Moist Nature of skin involved Rough/Smooth Course of illness ii. Vedana Present/ absent/ numbness Nature Continuous/intermittent Character Burning/pricking/dull Intensity Mild/moderate/severe Duration iii. Kandu Present/ absent Duration Daytime/season/menstruation IntensityDepartment of Prasooti Tantra and Stree Roga 181
  • 200. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Annexure iv. Kleda/Srava Present/ absent Colour Consistency Smell v. Sweating (Sweda Pravrathi) - Normal/ excessive / absent vi. Presence of any blisters - b. Anubandha Vedana i. Presence of episiotomy wound/vaginal pathology etc. ii. Presence of vaginal discharge iii. Other complaints3. H/o present illness4. H/o past illness5. Family history i. Husband having genital/inguinal fungal infection ii. Others.6. Personal history i. Aahara Appetite Good/moderate/poor Diet Veg / Mixed Predominent rasa Particular food habit if any - History of adhyashana/ virudhashana/ samashana/ etc. ii. Vihaara I) Personal hygiene Bathing etc. Use/nature of Undergarments Pads Tampons Use of local applicants II) Nature of work/life style Sedentary Laborious Sitting Walking Standing Traveling III) Use of OCP/ mechanical barrier method/IUCD etc.Department of Prasooti Tantra and Stree Roga 182
  • 201. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Annexure iii. Bowels regular/ irregular/ constipated/ loose motion Frequency/day Nature of stools if specific iv. Micturition Frequency – Regular / irregular Day- night - Associated with pain/burning sensation Associated with stress incontinence/ urge incontinence Others v. Maanasika chinta/ achinta/ harsha/ shoka /kroda etc vi. Sleep sound/disturbed/irregular Day - night - vii. Addictions if anyviii. Aggravating factors Food Season Clothing Association with menstruation/vaginal discharge etc. Others ix. Relieving factors Food Season Clothing Other measures7. OBG History Patient is - Unmarried Married Puerperium Menopausal Pregnant i. Unmarried LMP Vaginal discharges Normal /excess physiological/ pathological Others ii. Married LMP - Pariety - Nulliparous/ multiparous Use of OCP/ IUCD/ mechanical barrier method/ family planning Vaginal discharge Normal/excess physiological/ pathological OthersDepartment of Prasooti Tantra and Stree Roga 183
  • 202. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Annexure iii. Pregnancy LMP - Gravida- Gestational age - H/o of genito inguinal intertrigo in previous pregnancy Vaginal discharge Normal /excess physiological/ pathological Specific condition related to Anaemia, PET, impaired GTT, Hyperemesis pregnancy gravidarum, excessive weight gain etc. iv. Puerperium Date of delivery Mode of delivery Normal delivery + episiotomy Instrumental delivery + episiotomy LSCS H/o associated complications during labour Nature of vaginal discharge Normal /excess physiological/ pathological Location of episiotomy wound with relation to lesion site Others v. Menopausal Occurrence H/o bleeding per vagina Vaginal discharges Normal /excess physiological/ pathological H/o mass per vagina Others8. Treatment history i. General Eyes Temp Resp. Rate Examinations Nails BP Nourishment Tongue Pulse Lymph nodes ii. Systemic CVS RS CNS examination GIT CVS Others iii. Dashavidha Prakruti Vyayama shakti pariksha Saara Aahara shakti Abhyavaharana Jarana Samhanana Vaya Pramana Desha Satwa Vikriti Saatmya iv. Local Examination of lesions I) Inspection No. of lesions Shape Sites involved Redness Extension Discharge Swelling Dryness/atrophyDepartment of Prasooti Tantra and Stree Roga 184
  • 203. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Annexure Colour Blisters II) Palpation Size in cm. Numbness Local warmth Roughness Tenderness Consistency of Discharge9. Samprapti Ghatakas Nidaana Dosha Dooshya- dhatu mala Strotas Srotodusti prakaara Udbhava staana Sanchara staana Vyakta staana Adhistaana Rogamarga Vyadhi prakaara Sadhya/ krachrasadhya/ asaadhya Sampraapti10. Investigations11. Sthanika chikitsa Approximately, 5 gm of drug powder is dusted on the surface of the affected skin twice in 24 hours after cleaning the part with pre-boiled water and drying the area with clean gauze.12. Assessment Criteria Scorings a. Subjective Pain Nil 0 Itching Nil 0 Mild 1 Mild 1 Moderate 2 Moderate 2 Severe 3 Severe 3 b. Objec Size No lesion 0 Color Normal 0 tive 0 - 2cm 1 Black 1 2 - 4cm 2 Red 2 Above 4cm 3 Warmth Absent 0 Swelling Absent 0 Present 1 Present 1 Tenderness Absent 0 Redness Absent 0 Mild 1 Present 1 Moderate 2 Blisters Absent 0 Severe 3 Present 1 Roughness Absent 0 Discharge Absent 0 Present 1 Present 1Department of Prasooti Tantra and Stree Roga 185
  • 204. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” Annexure13. Complications14. Results Completely cured Partially cured Not reduced but status quo maintained Aggravated Association of complications if any15. ConclusionsDate: Signature:Observation Table Symptoms D1 D7 D14 D28 Pain Itching Size Redness Colour Warmth Roughness Tenderness Discharge SwellingDepartment of Prasooti Tantra and Stree Roga 186
  • 205. Cases
  • 206. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” CasesCase 1 (after 3 weeks treatment)Case 2 (after 3 weeks treatment)Case 3 (after 1 week treatment)Case 4 (after 1 week treatment)Case 5 (after 2weeks treatment) Case 6 (after 4 days treatment)Case 7 (after 1 week treatment)Department of Prasooti Tantra and Stree Roga 188
  • 207. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” CasesCase 8(after 1 week treatment)Case 9 (after 3 weeks treatment) Case 10 (after 3 weeks treatment)Case 11 (after 3 weeks treatment)Case 12 (after 1week treatment) Case 13(after 3 weeks treatment)Gaping of the episiotomy wound in the presence of genito-inguinal intertrigoDepartment of Prasooti Tantra and Stree Roga 189
  • 208. “Clinical Efficacy of Kadiradiyogavachoornana in Kachchu” CasesAcute inflammatory stage-intertrigoMacerated stage-intertrigoIntertrigo with blistersChronic stage / Stage of lichenificationHyperpigmentation of pregnancyDepartment of Prasooti Tantra and Stree Roga 190