DIPLOMA Ayurvedic Practitioners Course Module 2 26 th

DIPLOMA Ayurvedic Practitioners Course Module 2 26 th & 27 th October 2019 2

Charma Roga(kushta) Skin disorders

Charma Roga (Kushta) The Allopathic perspective

Atopic eczema

Structure of the skin

Atopic eczema • Atopic eczema (atopic dermatitis) most common form of eczema • itchy, red, dry and cracked • “It's a long-term condition in most people, although it can improve over time, especially in children, who often grow out of it” Most commonly affects: • the backs or fronts of the knees • outside or inside the elbows • around the neck, hands, cheeks or scalp

Atopic eczema - signs of infection • • • eczema getting a lot worse fluid oozing from the skin a yellow crust or small yellowish-white spots skin becoming swollen and sore a high temperature (fever) and generally feeling unwell

Causes of atopic eczema “The exact cause of atopic eczema is unknown, but it's clear it is not down to one single thing. ” • people who get allergies • can run in families • develops alongside other conditions, such as asthma and hay fever • Triggers eg. soaps, detergents, stress, weather • food allergies, especially in young children with severe eczema • Food diaries can be helpful to identify trigger

Treatment of atopic eczema “Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time. However, there's currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally. ” • • self care techniques, eg. reducing scratching / avoiding triggers emollients topical corticosteroids – reduce swelling, redness and itching topical pimecrolimus or tacrolimus antihistamines for severe itching bandages or special body suits more powerful treatments offered by a dermatologist (skin specialist)

Dietary changes for atopic eczema “Some foods, such as eggs and cows' milk, can trigger eczema symptoms. But you shouldn't make significant changes to your diet without first speaking to your GP” • Referral to a dietitian (a specialist in diet and nutrition).

Treatment of atopic eczema Topical corticosteroids • very mild (such as hydrocortisone) • moderate (such as clobetasone butyrate) • even stronger (such as mometasone) Side effects • mild stinging sensation for less than a minute • thinning of the skin • changes in skin colour • acne (spots) – especially when used on the face in teenagers • increased hair growth Most of these side effects will improve once treatment stops.

Treatment of atopic eczema Antihistamines • block the effects of histamine in the blood called • help relieve the itching • can either be sedating or non-sedating Bandages and wet wraps • special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema. Corticosteroid tablets • rarely used to treat atopic eczema nowadays Seeing a specialist • allergy testing • topical calcineurin inhibitors – creams and ointments that suppress your immune system • bandages or wet wraps • phototherapy – ultraviolet (UV) light that reduces inflammation • immunosuppressant tablets – to suppress your immune system

Treatment of atopic eczema “Some people may find complementary therapies such as herbal remedies helpful in treating their eczema, but there's little evidence to show these remedies are effective. If you're thinking about using a complementary therapy, speak to your GP first to ensure therapy is safe for you to use”

Psoriasis

Psoriasis causes flaky red patches of skin covered in silver scales usually appear - elbows, knees and the lower back can be itchy or sore can be minor irritation or severe usually periods when no or mild symptoms & periods when symptoms are more severe • affects 2% of people in the UK • can start at any age • most often develops in adults under 35 years old • • •

Cause of psoriasis “Although the process isn't fully understood, it's thought to be related to a problem with the immune system … for people with psoriasis, it attacks healthy skin cells by mistake” • increased production of skin cells • cells normally replaced every 3 to 4 weeks – reduced to 3 to 7 days • can run in families • certain events can trigger including, injury to your skin, throat infections and using certain medicines

Treating psoriasis “There's no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches” • topical treatment, eg. vitamin D analogues or topical corticosteroids • Phototherapy (exposing skin to ultraviolet light) • In severe cases, oral or injected medicines

Charma Roga (kushta) The Ayurvedic perspective

Structure of the skin

Charma Roga (kushta) Skin disorders 18 types of skin disorder in Ayurveda: • 7 Maha kushta (major) • 11 Shudhra kushta (minor)

Maha kushta (major) Skin disorders 1. 2. 3. 4. 5. 6. 7. Kapāla kushta – vata Udumbara kushta – kapha Mandala kushta – pitta Saushra griva (deer’s tongue) – vata/pitta Puncharike – pitta Sidhma – vata/kapha Kanaka – vata/pitta/kapha

Shudhra kushta (minor) Skin disorders 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Aka kushta – vata/kapha Charma kushta – vata/kapha Kitibhaya – vata/kapha Viyapatika – vata/kapha Alasaka - vata/kapha Dadhruma – pitta/kapha Charmadhala - pitta/kapha Parmar - pitta/kapha Visporta - pitta/kapha Shataruwa – pitta/kapha Vicharchika – kapha

Nidana (causative factors) of skin disorders • • • Incompatible food and drink (Virrudha anna pana) High water content food e. g. melon, cucumber (Drava) Oily foods (Snigdha) Heavy foods (Guru) Yawning, hunger, thirst, vomiting, hiccups (Vega avarodha) Excessive exercising (Viyayama) Worrying or feeling sadness (ati santapa) Overeating (Ati bojya) Overtiredness (Shrama) Feelings of fear and insecurity (Bhaya)

Nidana (causative factors) of skin disorders • • • Cold water or cold drinks (Sheetambu) Cold and hot food eaten together (Sheeta / ushna virya) Incorrect or excessive fasting (Langana) Certain methods of food preparation (Karma Sanskarana Bhojana) Indigestion (Ajeerna) Eating before last meal is fully digested (Adyasana) Incorrect Pancha Karma (detox) treatment (Panchakarma apachari) Inappropriate or excessive consumption of raw food (Navanna) Yoghurt (Dhadi)

Nidana (causative factors) of skin disorders Red fish (Mathsya) Root vegetables (Mansa mulaka) Sour and salty food (Amla Lavana) High wheat and carbohydrate content food (Pishta) Sesame (Tilla) Milk / dairy products (Sheera) Sweet food (Guda) Sexual intercourse too soon after eating (Viya vaya) Sleeping at incorrect time / incorrect sleeping patterns (Nidra jagera) • Insulting your guru (Guru apachari) • Karma (Papa karma) • • •

Purva rupa & rupa (signs and symptoms) • • • Translucent or shiny skin (Ati slaksha) Rough (Karasparsha) Pale (Swetha) Pale turning darker (Vivarna) Excessive sweating (Sweda) Hot / burning sensation (Daha) Itchy (Kandu) Piercing pain (Thoda) Dizziness / giddiness (Ati brama)

Purva rupa & rupa (signs and symptoms) Bumpy skin (Tawasvapa) Dark colouration (Varuna) Constant pain (Shula) Quick onset of symptoms (Seegra utpathi) Roughness, embarrassment, discomfort, depression, impatience – negative feelings of the mind and body (Rukshushva) • Easily triggered / irritated (Kopana) • Prickly heat / shiver (Romaharsha) • Black discolouration (Krushna) • • •

Samprapti (pathogenesis) Consumption one or more causative factors All 3 doshas can become imbalanced Creates ama (circulates with Ambhu Vaha Srotas) Imbalanced dosha circulates through all dhatus mostly stays in rasa, rakta and mansa dhatu

Skin disorders & dosha • Vata type rasa dhatu, show up in superficial layer of skin • Pitta type • Kapha type tissue rakta dhatu, blood tissue mansa dhatu, muscular

Eczema & dosha Vata symptoms • • Dry (shosha), rough (ruksha) pinching / insect bite feeling (thoda) pain (shula) contraction of the skin (sankosha) shrivelling, creaking, cracking sounds (ayama) sound of dry scratching (parosha) coarseness / crustiness (kara) prickly heat / shivers (harsha) black / brown / pink colouration (krushna varuna)

Eczema & dosha Pitta symptoms • • Hot (daha) Red (raga) Oozing (parishrava) Inflamed (paka) Fishy smell (vishra gandha) Wet (kleda) Peeling skin / scabs falling off (anga patana)

Eczema & dosha Kapha symptoms • Pale colour (swetha) • Cold (sheetha) • Itchy (kandu) • Bumpy (situlya) • Stagnant (utseda) • Deep (guru) • Soft (snehana) • Pus (snehana) • Rotten appearance (snehana) • Insects like to bite it (jantuji)

Chikitsa • Vata – drinking ghee / oleation • Pitta – virechana (purgative) / rakta mokshana (blood letting) • Kapha – vamana (vomiting) or ama pachana

Chikitsa HERBS • • • Neem Manjistha White sandalwood Red sandalwood Ajwain Ghee Khadira Amla Mustha Triphala • • • Chitraka Patola Brahmi Bhunimba Daru haridhra Venivel Haridhra Camphor Moringa Acacia

Chikitsa Minerals • Shelarjit • Gandaka Animal products • Honey • Ghee

Chikitsa Arishta • • Kadira arishta Triphala kwatha Dashamoola arishta Ashoka arishta Taila • • Neem oil Pinda oil Visarpahara oil Neelyadi oil Sarshapadi oil Seethodaka oil Kumari oil

Chikitsa Shodhana • • • Panchavalkana Neem bark Jasmine water Clove Triphala Dhooma • Neem – 5 parts of neem plant crushed and mixed with neem oil • Coconut leaves • Steam inhalation with lemon grass, mint leaves or eucalyptus oil

Chikitsa Alepa • • • Triphala paste Dashanga lepa Neem paste Dermaved Charma lepa Vasti • • Castor oil Triphala oil Mahanarayana oil Neelyadi oil

Chikitsa FORMULATED CHOORNA • • • Triphala Dhatri Hinguashtaka Nimbhadi Sitopaladi Avipathikara • • • Paaka choorna Manibadhra Chandanadi Chopachini Pittahara Amahara