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  1. 1. ‘Pada Nimajjana’ – Innovative technique in the treatment of Vipadika# Dr. O.P Sharma, ## Dr. Ananth Ram Sharma, ### Dr. Prathibha SharmaBackgroundHypertrophy of the corneous layer of the palms and soles, usually of a more or less horny andplate-like character, is well defined in Ayurveda as Vipadika1 and Hyperkeratosis Palmo-plantaris in the contemporary science. The hardening and thickening arise spontaneously without necessarily having any external factor, such as pressure, friction, etc, and is, furthermore,symmetric, and usually on palms and soles. Moreover, it is, as a rule, congenital or a hereditarycondition. While it is commonly limited to the palmar and plantar aspects, occasionally itextends somewhat beyond on to the side, and exceptionally slightly on to the dorsal surface. It iscommon to find the nails more or less affected, and tilted slightly or moderately upward by thecollection of hardened and thickened tissues.Need for the StudyVipadika is one of the Vata pradhana Kshudraroga’s2. Due to the lack of hygiene, excessivewalking etc, the rukshata in the body especially in the foot increases; which aggravates the Vataresulting in the scaling of the skin of sole and palm3. Sneha dravya is the best remedy for theVata Roga4. Abhyanga with various Sneha Dravya are commonly practiced in the treatment ofVipadika5. Instead of Abhyanga, if we dip the leg in the Sneha Dravya the amount of snehanaand the bio availability will be more. This thought lead to the development of a new techniquecalled Padanimajjana. That is why the present study was taken to assess the effect of PadaNimajjana over the commonly practiced Pada Abhyanaga.Aims and objectives To assess the efficacy of Pada abhyanaga in the Vipadika To Assess the efficacy of Pada Nimajjana in Vipadika To compare the effects of Pada Abhyanga and Pada NimajjanaMethodologySource of DataThe material for the present study was obtained from the Skin and cosmetology outpatientdepartment of Amrita school of Ayurveda, Vallikkavu (Kerala) from January 2010 to May 2010.40 cases of Vipadika of soles were included in the present study, those who were not on anyother medication.Study Design Patients were randomly grouped in to 2 group containing 20 patients each.# Associate Professor, Dept. of PG Studies in Panchakarma, NIA Jaipur## PhD scholar, Assistant professor, Dept. of Panchakarma, Amrita School of Ayurveda,Amritapuri, Kerala.### Assistant professor, Dept. of Panchakarma, Amrita School of Ayurveda, Amritapuri,Kerala. 302
  2. 2. Pada Abhyanga group (PA Group) were advised Pada Abhyanga for 30 Min daily for 14 consecutive days with a combination of Durvadi Keram6 and Jeevanthyadi Yamakam7 with 2:1 proportion. 50 ml of Sneha was taken daily in sukhoshna state. Pada Nimajjana group (PN Group) were advised Pada Nimajjana ( Dipping of the affected leg in the sneha dravya) for 30 Min daily for 14 consecutive days with a combination of Durvadi Keram and Jeevanthyadi Yamakam with 2:1 proportion. 200 ml Sneha was taken for 7 days and for the next 7 days fresh oil is used. Sukhoshnata of the Sneha dravya is maintained throughout the procedure. Both the groups were given 10 gm of Manibhadra gulam at bed time and Manjishtadi Kashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before food for a period of two weeks. Before Starting the Pada Nimajjana and Pada Abhyanga thickened lesions were neatly cut with a sterile blade and every day feet was washed thoroughly with Sukhoshna Jala and dried with a cloth.Inclusion criteria Patients between age group of 10 – 70yrs were included. Patients with the symptoms of Vipadika in Sole only.Exclusion criteria Patients with psoriasis Patients on some medication Patients with vicharchika in the foot Patients above the age group of 70 yrs and below 10 yearsAssessment criteria and Scoring Sl. No Lakshana Parameters Score 1 Cracks in the Foot No cracks – 0 0 Cracks without cavity 1 Cracks with visible cavity 2 Cracks with non visible/ deep cavity 3 2 Secretion No srava 1 Mild srava 2 Moderate srava 3 3 Pain No Pain 0 Pain during Walking even with Slippers 1 Pain during Walking without Slippers 2 Pain during rest 3 4 Itching No itching 0 Mild / occasional itching 1 Moderate (tolerable) infrequent 2 Severe itching frequently 3Statistical AnalysisThe SPSS data collection system was used for all data management and analysis. Outcomes werecalculated from paired Student’s t-tests of difference in means, testing the hypothesis that meanswere not significantly different per measure over time. Baseline was compared to outcomes afterthe 14-day procedure. The significance of change over a longer term was considered bycomparing means at baseline to means at 3 months post program. 303
  3. 3. Observations and ResultEffect of Pada Abhyanga on various symptoms of Vipadiaka20 Patients of Vipadika were treated with Pada Abhyanga done with Durvadi Keram andJeevanthyadi Yamakam combination. 50 ml of Taila was taken daily for Abhyanga in sukhoshnastate. Each patiets were administered 10 gm of Manibhadra gulam at bed time and ManjishtadiKashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before foodthroughout the course of treatment. Pada abhyanga was started only after removing the thickenedskin and thorough wash with Sukhoshna Jala. Table No:1 Table showing the Effect of Pada Abhyanga on Selected variables of VipadikaVariables Level of study Mean Score % relief SD SE ‘t’ PCracks on Base line 2 - - - -foot After Nimajjana 1.2 60 0.834 0.186 6.452 <0.001 After 3 months 1.85 27.5 0.511 0.114 4.825 <0.001Secretion Base line 2.1 - - - - After Nimajjana 1.25 47.62 0.587 0.131 4.472 <0.001 After 3 months 1.8 14.29 0.733 0.164 1.829 >0.05Pain Base line 1.8 - - - - After Nimajjana 1 58.33 0.944 0.211 4.976 <0.001 After 3 months 1.15 36.11 0.875 0.196 3.316 <0.01Itching Base line 2.1 - - - - After Nimajjana 1.25 40.48 0.587 0.131 6.489 <0.001 After 3 months 1.95 7.14 0.671 0.15 1.00 >0.1At baseline the mean score of Cracks on the foot was 2 and after Pada Abhyanga it reduced to1.2. After the follow up period of 3 months the relief was reduced from 60% to 27.5% with ‘t’value 4.825 and found statistically significant (P <0.001).Mean score of Secretion at baseline was found relief with 47.62% reduced later to 14.29% afterthe follow up period. After the course of treatment of 14 days the Pada Abhyanga was foundstatistically highly significant but later after the follow up reduced to Mildly significant with P>0.05.From the above table Pada Abhyanga on the Pain was found statistically significant at P <0.001.But after the 3months period the relief was reduced to 36.115 from an initial relief of 58.33%.Itching was found reduced after the 14 days treatment with statistically significant P value<0.001. There was a drastic drop in the relief with 7.14% with ‘t’value 1 and found statisticallyinsignificant.Effect of Pada Nimajjana on various symptoms of Vipadiaka20 Patients of Vipadika were treated with Pada Nimajjana with a combination of Durvadi Keramand Jeevanthyadi Yamakam. Patients were asked to dip the affected area of leg in 200 ml ofsukhoshna Taila for 30 min. New oil is taken after the 7 days treatment. Each patient wereadministered 10 mg of Manibhadra gulam at bed time and Manjishtadi Kashayam 20 ml mixedwith 60 ml of boiled and cooled water twice daily before food throughout the course oftreatment. Pada Nimajjana was started only after removing the thickened skin and through washwith Sukhoshna Jala. 304
  4. 4. Table No: 2 Table showing the Effect of Pada Nimajjana on Selected variables of VipadikaVariables Level of study Mean Score % relief SD SE ‘t’ PCracks on Base line 2.5 - - - - -Foot After Nimajjana 0.65 74 1.014 0.227 8.149 <0.001 After 3 months 0.5 80 0.973 0.218 9.174 <0.001Secretion Base line 2.1 - - - - - After Nimajjana 1.1 48 0.725 0.162 6.173 <0.001 After 3 months 1.05 50 0.686 0.153 6.830 <0.001Pain Base line 1.85 - - - - - After Nimajjana 0.35 81.08 0.946 0.212 7.075 <0.001 After 3 months 0.2 89.19 1.082 0.242 6.818 <0.001Itching Base line 2 - - - - - After Nimajjana 0.2 90 0.834 0.186 9.677 <0.001 After 3 months 0.15 92.5 0.875 0.196 9.439 <0.001At baseline the mean score on Cracks on the foot was 2.5 which later after treatment reduced to0.65 and again reduced to 0.5 after the follow up period. Effect of Pada Nimajjana on Cracks onthe foot was found statistically significant at P <0.001.Pada Nimajjana has shown 48% reduction on Secretion. The effect is statistically significant atthe level of P<0.001. After the follow up period there was a reduction of 50%. This effect is alsostatistically significant P<0.001.The mean score at baseline on pain was 1.85, which is reduced to 0.35 showing a reduction of81.08%. After the follow up period the score was 0.2 by a reduction of 89.19%. Both theseeffects were statistically significant at the level of P<0.001.After Pada Nimajjana there was 90% reduction in itching. Mean score on Itching at baseline 2reduced to 0.2. The effect is statistically significant at the level of P<0.001. After the follow upperiod the reduction in Itching was 92.5% and the effect was statistically significant (P<0.001). Table No: 3 Overall Effect of Pada Abhyanga and Pada Nimajjana on on selected variables % of Relief in Symptoms Pada Abhyanaga Group Pada Nimajjana Group Variables After Treatment Follow up After Treatment Follow up Cracks on foot 60 27.5 74 80 Secretion 47.62 14.29 48 50 Pain 58.33 36.11 81.08 89.19 Itching 40.48 7.14 90 92.5Above table (Table No.9) shows the comparative effect of the Pada Abhyanaga and PadaNimajjana on various symptoms of Vipadika. Even though both the therapies are statisticallysignificant in reducing the symptoms Pada Nimajjana showed more % of Relief on varioussymptoms. Apart from this the result obtained by the Padanimajjana was improved further in thefollow up period while the results were reduced in the Pada Abhyanga group after the period offollow up. 305
  5. 5. DiscussionVipadikaVipadika is mentioned as one of the Kshudra roga’s where we can find the Cracks over thePalms and soles. The dosha involved in Vipadika is Vata. Because of the excessive friction orpressure over the skin Vata gets vitiated locally. Due to the increase in the rukshata of Vata theskin gets dry and becomes thickened. This results in the cracks. The condition may furtherworsen due to the absence of personal hygiene.Selection of the PatientsHygiene plays an important role in the pathogenesis and Management of Vipadika. During themanagement of Vipadika, if the patient doesn’t keep the affected area clean, one can’t achievethe better results. In children below 10 years age it is very difficult to maintain the hygiene of theextremities. That is the reason children are avoided in the study.Effect of the drugsDurvadi keram is one of the drugs of choice in the management of Vrana. Most of the Vipadikacases exhibit secretion associated with cracks and Durvadi keram due to its Vranahara propertywill take care of the condition. Similarly Jeevanthyadi yamakam is one of the suitable drugs forthe Vata pradana Kushtha’s especially indicated in Vipadika. Due to the presence of BrumhanaDravya like Jeevanthi it will do the shamana of the Vata8. As it is one of the Yamaka sneha itwill do more snehana when compared to single Sneha9. This Yamaka Sneha will reduce the Vatalocally and also will soften the dry thickened skin.Effect of the therapiesPada abhyanga is the commonly used therapeutic procedure for the management of Vipadika,where the suitable taila will be applied to the area and abhyanaga is done for 30 to 40 minutes.On the other group in Pada Nimajjana the affected area is dipped in the Sukhoshna Taila forcertain period. Unlike in Pada Abhyanga here in Nimajjana we are achieving the Snehana alongwith Swedana. Application of Snehana and Swedana together will provide the Shamana ofVata10 very easily. In Nimajjana the continuous contact of warm with the skin will enhance theBio-availability of the drug.ConclusionStatistical analysis of the obtained Data shows that, Pada Nimajjana is more effective in reducing the symptoms of Vipadika The results obtained was sustained or even better in the Pada Nimajjana Group when compared to the Pada abhyanga. Pada Abhyanga was not effective in managing itching as it was seen worsened after the follow up period The Taila used for the total course of Pada Nimajjana was less than the taila used for the Abhyanaga. This helps us to reduce the cost of the treatment. Also in the Nimajjana the physical effort for the treatment is very less. 306
  6. 6. LimitationsThe result may not be very significant as the sample size is very small. It was the limitation ofthe study that 2 of the selected symptoms (Pain and Itching) were subjective and we have todepend on the patients completely to assess the results.Scope for further StudySame study can be repeated with a large number of populations with various objectiveassessment criteria’s.Bibliographic references 1. Caraka Samhita, Chikitsa Sthana 7/22 2. Sushruta, Samhita. Nidana Sthana 13/29 3. Sushruta, Samhita. Nidana Sthana 13/29 4. Ashtanga. Hrudaya, Sutrasthana 1/25 5. Sushruta, Samhita. Chikitsa Sthana 20/19 6. Sahasrayoga- Taila prakarana 7. Ashtanga. Hrudaya, Chikitsa Sthana 19/78 8. Dravyaguna Vijnana- P.V Sharma 9. Ashtanga. Hrudaya. Sutrasthana 16/4 10. Caraka Samhita, Sutrasthana 14/4 307