BAHIR PARIMARJANA CHIKITSA IN AYURVEDA
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IAM DR AJITH KUMAR PRACTICING DERMATOLOGY SINCE 3 YEARS THIS IS MY SMALL CONTRIBUTION TO OUR NEW GENERATION WHO ARE COMING FEOM AYURVEDIC SCIENCE.
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BAHIR PARIMARJANA CHIKITSA IN AYURVEDA
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 2
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 3
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 4
- 5. Dosha dushya sammurchana in Kushta KUSTA TRIDOSHA TWAK/ RASA RAKTA MAMSA LASIKA 23-01-2023 5 Bahirparimarjana Chikitsa in Kushta
- 6. Samprapti of Kushtaroga Nidana sevana Agnimandya Amotpatti Tridosha prakopa Tiryak gata sira prapti Sthanasamshraya in twak ,rakta ,mamsa, ambu 23-01-2023 Bahirparimarjana Chikitsa in Kushta 6
- 7. Conti.. Doshadushya sammurchana Shithilata in twagadi dhatus Srotodusti (Rasavaha, Raktavaha, Mamsavaha, ambhuvaha) Laxana pradurbava Kushtaroga 23-01-2023 7 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। 23-01-2023 Bahirparimarjana Chikitsa in Kushta 9
- 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। 23-01-2023 Bahirparimarjana Chikitsa in Kushta 10
- 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:। 23-01-2023 Bahirparimarjana Chikitsa in Kushta 11
- 12. Involvement of Twak • Angavaivarnya • Roukshya • Twak swapa • Sweda atipravartana • Romaharsha 23-01-2023 12 Bahirparimarjana Chikitsa in Kushta
- 13. Involvement of Rakta • Kandu • Pooya 23-01-2023 13 Bahirparimarjana Chikitsa in Kushta
- 14. Involvement of mamsa • Vaktra shosha • Karkasha • Pidakodgama • Toda • Sphota • Sthiratva 23-01-2023 14 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 23-01-2023 15 Bahirparimarjana Chikitsa in Kushta
- 16. Involvement ofAsthi majja • Naasa bhanga • Akshiraga • Swaropaghata 23-01-2023 16 Bahirparimarjana Chikitsa in Kushta
- 17. Involvement of Shukra • Kushta bahulyat dushta shonita shukra • Give birth to a deformed baby 23-01-2023 17 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 + 23-01-2023 Bahirparimarjana Chikitsa in Kushta 18
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 19
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 20
- 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॥ 23-01-2023 21 Bahirparimarjana Chikitsa in Kushta
- 22. Samanya chikitsa 23-01-2023 22 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 23
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 24
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 25
- 26. 23-01-2023 Bahirparimarjana Chikitsa in Kushta 26 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
- 27. 23-01-2023 Bahirparimarjana Chikitsa in Kushta 27 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
- 28. 23-01-2023 Bahirparimarjana Chikitsa in Kushta 28 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 29
- 30. • Srava: triphala kwath prakshalana • Vrana: tankana 23-01-2023 Bahirparimarjana Chikitsa in Kushta 30
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 31
- 32. Other modalities • Nidana parimarjana • Abhyangadi karma • Rakta mokshana • Satvavajaya • Daivavyapashraya • Achara Rasayana 23-01-2023 Bahirparimarjana Chikitsa in Kushta 32
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 33
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 34
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 35
- 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 23-01-2023 Bahirparimarjana Chikitsa in Kushta 36
- 37. 23-01-2023 Bahirparimarjana Chikitsa in Kushta 37 THANK YOU…..