IAM DR AJITH KUMAR PRACTICING DERMATOLOGY SINCE 3 YEARS THIS IS MY SMALL CONTRIBUTION TO OUR NEW GENERATION WHO ARE COMING FEOM AYURVEDIC SCIENCE.

1. Bahirparimarjana Chikitsa In
DifferentAvastha Of Kustha
Dr Ajith Kumar
M.D (A.M), DCP
Fellowship in Infectious Disease

2. Introduction
• Skin is the largest protective barrier in the body which
prevents invasion of foreign substances
• The main area of external or topical application/
measures is the twacha and
• Procedure like abhyanga, swedana, pradeha, pariseka,
udwartana etc as per disease are known as
bahirparimarjana chikitsa
• Twachashrita bhrajaka pitta helps in the pachana and
absorption of these treatment modalities which ever
applied over the skin
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3. Introduction
• Kushta roga is considered as one of the mahagada and also
as one of the disease due to paapakarma
• It is a raktapradoshaja vyadhi
• Different varieties of kushta have been explained, Acharya
Charaka said kushta are ‘n’ in number
• Involvement of tridosha and twakadi dushya are
mandatory in the manifestation of kushta roga
• Various treatment modalities have been explained based on
the involvement dosha and dushya
• Here, an effort has been made to discuss the
bahirparimarjana chikitsa in kushta roga
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4. Kushta
क्र
ु ष्णाप्यंगमिमिक
ु ष्टि्।क्र
ु त्स्नििं मिष्टिीमि। (A. H. Ni 14)
One which produces discolouration over skin region
is said to be Kustha
क
ु ष्णामिसर्वं र्वपु:इमिक
ु ष्टि्।(चक्रपामि)
That which does विक्र
ु वि in शरीर is called as Kushta
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5. Dosha dushya sammurchana in Kushta
KUSTA
TRIDOSHA
TWAK/
RASA
RAKTA
MAMSA
LASIKA
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Bahirparimarjana Chikitsa in Kushta

6. Samprapti of Kushtaroga
Nidana sevana
Agnimandya
Amotpatti
Tridosha prakopa
Tiryak gata sira prapti
Sthanasamshraya in twak ,rakta ,mamsa, ambu
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7. Conti..
Doshadushya sammurchana
Shithilata in twagadi dhatus
Srotodusti
(Rasavaha, Raktavaha, Mamsavaha, ambhuvaha)
Laxana pradurbava
Kushtaroga
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Bahirparimarjana Chikitsa in Kushta

8. Types of kushta
• Dosha predominance
• Dhatugatatva
• Mahakushta
• Kshudrakushta
8
23-01-2023 Bahirparimarjana Chikitsa in Kushta

9. Vata dosha
Subjective symptoms Character of lesion Discolouration
Toda Roukshya Shyava
Shoola Parushya Aruna
Aayama Sankocha
Harsha Shosha
Khara
रौक्ष्य शॊषस्तोदःशूलसंकोचनं िथा।
पारुष्यं खरभािो हषष:शयािरुणत्वं च।
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10. Pitta dosha
Subjective symptoms Character of lesion Discolouration
Daha Parisrava Aruna
Anga patana Visragandhi
Raga Paka
Kleda
क
ु ष्टेषु िािवलंगम्;दाहो राग;पररस्रि:
विस्रोगंध ;क्लेद;िथा अंगपािनं चावपत्तक्रि्।
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11. Kapha dosha
Subjective symptoms Character of lesion Discolouration
Kandu Sthairya Shvaitya
Gourava Utseda
Shaitya Sneha
Kleda
श्वैत्यं शैत्यं क
ं ण्डु :स्थैर्य्ंचोत्सेधगौरिं स्नेहा:
क
ु ष्टेषु कफवलंगं जंिुवभरभख्शणं क्लेद:।
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12. Involvement of Twak
• Angavaivarnya
• Roukshya
• Twak swapa
• Sweda atipravartana
• Romaharsha
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Bahirparimarjana Chikitsa in Kushta

13. Involvement of Rakta
• Kandu
• Pooya
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Bahirparimarjana Chikitsa in Kushta

14. Involvement of mamsa
• Vaktra shosha
• Karkasha
• Pidakodgama
• Toda
• Sphota
• Sthiratva
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Bahirparimarjana Chikitsa in Kushta

15. Involvement of meda
• Kounyam gatikshaya
(confined body motions)
• Anga sambheda
(disintegration of body parts)
• Kshata sarpana
(progressive ulcers)
• Delayed healing
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Bahirparimarjana Chikitsa in Kushta

16. Involvement ofAsthi majja
• Naasa bhanga
• Akshiraga
• Swaropaghata
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Bahirparimarjana Chikitsa in Kushta

17. Involvement of Shukra
• Kushta bahulyat dushta shonita shukra
• Give birth to a deformed baby
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Bahirparimarjana Chikitsa in Kushta

18. Mahakushta
Type of
kushta
Lesion type Associated
symptoms
Site
Kapala Aruna, khara Ati toda, alpakandu Thin skin area
Audumbar Tamra, ashutthana Ati daha, vedana
Mandala Snigdha, sweta Ati srava, ati kandu
Rishajivha Bear tongue Ati toda, daha cover
with pidaka
Pundarika Redness with
peeta
Kandu, daha
Sidhma Tanu Akastakari, kandu Upper body
part
Kakanaka Many varna Ati daha, vedana +
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19. Kshudra kushta
Type of
kushta
Lesion type Associated symptoms Site
Eka Fish scales Big & Ext localization Ab of perspiration
Charma Khara Hastichamatva
Kitibha Ruksha Kandu, ativarna
Vipadika Raji, ruksha Kandu, daha, ruja Pada
Alasaka Kandu Cover with vesicles
Charmadala Raga Kandu, osa, cosa Hasta, pada, tala
Dadru Raga Mandalodgama, kandu
Pama Shweta, aruna, syava Kandu, bahu pidaka Spika, pani, pada
Visphota Shweta, aruna Thin skin area
Shataru Raga Daha, vedana with vrana Parva
Vicharchika Raji, rukshata Kandu, arti, ruja Gatra, pani, pada
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20. Dosha dominancy of all Kushta
Vata Pitta Kapha Vatapitta Pittakaph Vatakapha Tridosh
a
Kapal
a
Audumbar Mandala
Vicharchi
k
Rishyajivh
a
Dadru
Charmadal
a
Pama
Vispota
Shataru
Pundarika Sidhma
Eka
Charmadal
a
Kitibha
Vipadika
Alasaka
Kakanak
a
Sukha sadhya Kashta sadhya Sukha
sadhya
Asadhya
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21. Management of Kushta
 Kushta management is based on assesment of :
 Dosha
 Dooshya
 Avastha anusara
 Vyadhipratyanika
 Manobala vardhaka
 Rasayana
 Acharya Charaka explains, although Kushta are tridoshaja and of
various types, the treatment to be planned depends on the
predominance of doshas as understood by their features
सिं विदोशजं क
ु ष्टं दोषाणां िु बलाबलं।
यथास्वे :लक्षणे:बुद्द
् ििाक
ु ष्टानां वक्रयिे वक्रया॥
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Bahirparimarjana Chikitsa in Kushta

22. Samanya chikitsa
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Avastha Chikitsa
Vata Internally oleation
Pitta Virechana + Raktamokshana
Kapha Vamana
Twak gata Kushta Shodhana & Alepa
Raktagata Kushta Shodhana, Shamana, Raktamokshana and
alepa
Mamsagata Kushta Suitable Asava, Arishta, Mantha + Topical
application
Medashrita Kushta All above + Bhallataka prayoga + agaru,
khadira, guggulu, asana, shilajatu,
tuvaraka, ayaskriti
Bahirparimarjana Chikitsa in Kushta

23. Bahirparimarjana chikitsa
Is instantaneously efficacious only after Shodhana and
Rakta mokshana therapies
• Abhyangadi karma:
• Abhyanga
• Lepa
• Udwartana
• Pariseka
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24. Formulations
Vataja Pittaja Kaphaja
Jeevantyadi Durvadi taila Gandhaka
malahara
Rasottamadi lepa Mahatiktaka Rasottamada lepa
Mahatiktaka Shatadhouta ghrita Sindhooradi lepa
Nyagrodhadi lepa Marichyadi taila
Somaraji taila
Edagajadi
Manahshiladi
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25. Lakshanika
Condition Dravya
Kandu Karanja taila, marichyadi taila
Daha Chandanadi ghrita, shatadhouta ghrita
Srava Dashanga lepa
Vrana Triphala kashaya pariseka f/b
- Vrana ropana taila
- Jathyadi taila
- Panchatikta ghrta guggulu
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Avastha Taila Indications
Kandu, srava,
pidaka
Sikthakaadi taila Vicharchika
Kandu Arka taila Pama , vicharchika
Kandu, srava, daha,
visarpa
Doorvaadya taila Pama, vicharchika
Tuvaraka taila Kushta
Kandu Manjishtaadya
suryapaka taila
Pama
Krimi, kandu Kanakaksheeri taila Mandala
Kandu, visarpa,
daha, toda
Nalpamaradi taila Kushta, shwitra
Somaraji taila Kushta
Kandu, visarpa Adityapaki taila Pama

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Avastha Taila Indications
Jeerna Guggulyaadi taila Purana kushta
Kandu, srava Shatbindu taila Kushta, especially
vicharchika
Kapha vata Kasisadi ghrita Pama, vicharchika,
dadru
Kandu, pidaka, kota Kushtadi taila
Kapha pitta Eladi taila
Pitta kapha Nimbadi taila Pama, vispota,
charmadala
Kandu, alpa pitta Marichyadi taila Dadru, shwitra,
kushta
Shoola, cracks Datturabeeja taila Vipadika

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Avastha Lepa Indications
Vatapitta Aragwadhapatra lepa Dadru, kitibha, sidhma
Kandu, ruja Durvadi pralepa Dadru (3 days)
Vidangadi lepa Dadru
Kathina, ruksha,
shyava
Manahshilaadi lepa Kushta, visarpa,
kitibha
Padasputana Sarjarasaadi lepa Vipadika
Kathina, ruksha,
shyava
Karanjaadi lepa Kushta
Sparshajyana hani,
kathina
Vishanashaka lepa Twak gata
Vedana, kandu, daha,
puya
Kadali kshara +
haridra
Sidhma
Vedana, kandu, daha,
puya
Gandhapashana lepa Sidhma

29. Avastha Udwartana
Kushta Khadirodaka churna
Vata kapha Siddhartaka snana churna
Vata kapha Sarshapadi churna
Pitta kapha Nimbadi churna
Kapha Dhatriphaladi churna
Kandu, pidaka, kotha,
sotha
Kusthadya udwarttana
Vata Eladi churna
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30. • Srava: triphala kwath prakshalana
• Vrana: tankana
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31. Mode of action
• Abhyanga : twak acts as a reservoir and allow gradual
penetration of a drug into the viable skin layers over a
prolonged period of time, vatahara
• Lepa : pacifies the provoked sthanika dosha and
acts as shodhana, utsadana, ropana, pralhadana. It
enters into romakupa and further gets absorbed
through swedavaha leading to desired effects
• Udwartana : causes dilatation of siramukha and
increases bhrajaka pitta
• Pariseka : dravashoshaka, eliminates ama due to
prabhava of dravya used
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32. Other modalities
• Nidana parimarjana
• Abhyangadi karma
• Rakta mokshana
• Satvavajaya
• Daivavyapashraya
• Achara Rasayana
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33. Limitations
• Cost and inconvenience may prohibit the use of topical
therapy repeatedly over large surface
• Most formulation have short self life and thus need to
be prepared fresh each time
• The rate of absorption is low if the base is not
appropriately selected as per dosha
• Comparatively expensive
• Most of the treatment procedures need hospitalization
and skilled therapist
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34. Conclusion
• Bahirparimarjana chikitsa is a convenient method of
treatment, but its efficacy depends on understanding
the barrier function of the skin
• It can be used directly or after abhyantara shodhana
based on the condition and stage of the disease
• Use after shodhana is recommended
• Inspite of the limitations, mild modifications in
treatment procedure may help in giving desired results
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35. • Manahshiladi lepa – vata
• Karanjabijadi lepa – vata
• Chaturanguladi pralepa – pitta
• Gandha pashana lepa- sidhma
• Aragwadadhya shat churna pradeha- vatapitta
• Manahshiladyashtanga lepa- pitta
• Bhagottara dhatryadi lepa
• Vidangadi lepa- dadru
• Durvadi pralepa- dadru, kandu, ruja 3days
• Sarjadi pralepa- dadru
• Chakramarda beeja pralepa- dadru, kushta
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36. • kathina, sthira, round: prastara/ nadi sweda: pracchana- dosha
utklishta: anupa aubida pasupakshi pottali dwara sukoshna
swedana
• Shrunga/ alabu/ jalauka
• Kushta: stabdhata, shunyata, asweda, kandu – pracchana, trivrit,
danti, karanja, kutaja, jati, arka ,nimba, samudraphena – lepa
• Kshara: shastra contra, sparsha hani, after koshta shuddhi-
kshara
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THANK
YOU…..