MANAGEMENT OF SKIN DISORDERS Dr HARISH BHAKUNI M

MANAGEMENT OF SKIN DISORDERS Dr. HARISH BHAKUNI M. D. (Ay. MED. ) ASSISTANT PROFESSOR NATIONAL INSTITUTE OF AYURVEDA JAIPUR

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Line of management � Avoidance of causative factors (nidāna parivarjana) � Samsodhana therapy (Ca. Ci. 7/39) � Snehapāna in vāta predominant kuṣtha � Virecana and raktamoksna in pitta predominant kuṣtha � Vamana in kapha predominant kuṣtha � Repeated samsodhana (Ca. Ci. 7/41) � Nasya

Contd…. �Samsamana treatment �Treatment of predominant Doṣa and after that secondary Doṣa should be treated (Ca. Ci. 7/31 -32) �Internal use of medicine �External application of different lepas and ksāra.

Contd…. According to involvement of dhātu � Tvakgata – sodhana, lepana � Raktagata – samsodhana, lepana, kasāyapāna, and raktamoksana. � Māṃsagata – sodhana, ālepana, kasāyapāna, raktamoksana and use of āsava, arista and avleha. � Medogata – use of Bhallataka, Shilajatu, Guggulu, Agara, Tuvaraka, Khadira, Asana & Ayaskriti followed by Samsodhana & Raktamokshna. � iapea u. Soksidzesr

Contd… � Raktamoksana (Ca. Ci. 7/40, 42) � Pracchānna followed by sringa or alābu application if localized disease. � Siravedhana if disease involves the deeper levels of the skin. � Snehapāna followed after raktamokshna to avoid vāta vitiation. � Rakataśodhana � Pitta predominant kuṣtha – use of ghrita processed in tikta rasa predominant herbs (Ca. Ci. 7/59). � Ingestion of gomūtra in the condition where there is maggots in lesions with associated loss of skin and phalanges (Ca. Ci. 7/157). � Use of agads in dry, hard and chronic lesions associated with loss of sensation (Ca. Ci. 7/55).

Management as per Doshika predominance �Initially Snehapana �In Vata predominant – Ghrita Processed with Meshashringi, Kakatikta, Guduchi, Vrihati & laghupanchmula. �In Pitta Predominanant – Ghirta processed with Nimba, Arjuna, Parpataka, Madhuyasthi, Lodhra & Manjistha. �In Kapha Predominant - Ghirta processed with Priyal, Aragvadha, Nimba, Saptaparna, Shala, Chitraka, Maricha, Vacha & Kustha.

Drugs Used in Management of Kustha � Tuttha – Specially in Mandala, Shwitra & Dadru for local application. � Vanga – Vanga bhasma with Bakuchi churna with the anupana of Nirgundi Swarasa – Specially in Asthimajjagata Kustha. � Malla - Specially in itching, scaling & papule dominant kustha. � Swarnamakshika – Pitta & Kapha pitta predominant Kustha. � Hartala – Kapha & Vata Kapha Predominant Kustha. Useful in Chronic Skin disorders, Vatarakta and Updamsa. � Lauha Bhasma – Pitta Predominant Kustha.

Contd…. . �Ashtamurti Rasayana – Asthigata Kustha, Jirna roga. �Rasasindoor – Kapha predominant conditions. �Tala Sindoor – Vata Kaphaja Kustha. �Vyadhiharana Rasayana – Asthi majjagata Kustha, chronic conditions. �Talakeshwar Rasa – Mandala & Kakadaka Kustha. �Mahatalkeshwar Rasa – Vata Predominant Kustha.

Contd…. �Arogya Vardhini Vati – � Vata & Vata Kapahaja Kustha �Raktastha & mamastha Kustha �Kathina, mandala, ruksha, Sphutita kustha �In kandu & pidika use with Gandhaka Rasayana along with Sarivadyasava. �Kamdudha Rasa – In Pitta Predominant conditions. �Kustha Kuthara Rasa – chronic skin disorders, Galita Kustha & Skin disorders with loss of sensation.

Contd…. �Kustha Kalanal Rasa – used as Rasayana �Gandhaka Rasayana – esp. in Pitta dominant Kustha. Skin disorders having burning sensation. �Chandrakala Rasa – pitta & vata pitta predominant Kustha. �Rasamanikya – vata kapahaja Kustha, in conditions like vipadika, vicharchika, pundarika, charmadala & mandala Kustha. �Sutshekahra Rasa – pitta vata Predominant Kustha.

Contd…. . �Samsamani vati – pitta predominant kustha. �Panchatikta ghan vati – pitta dominant kustha and in deeper tissue involvement. �Guduchyadi lauha – pitta / vata pitta predominant kustha. �Tapyadi lauha – pitta / vata pittaja disorders �Dhatri lauha – vata pittaja & kapha pittaja Kustha.

Contd…. � Amritadi Guggulu – vata pitta predominant & vata predominant � Ekvinshanti Guggulu – vata predominant kustha along with blakish discoloration, dry and itchy lesions. � Kanchnara Guggulu – vata kaphaja kustha � Kaishore guggulu – dry, secretory skin disorders � Triphala guggulu – pustular, abscess � Panchtikta ghrita guggulu – in deeper tissue involvement. � Saptavinshati Guggulu – ulcerative and discharging pathology

Contd…. �Amrita Bhallataka – Auto immune skin disorders, kapha predominant skin disorder & vata kaphaja kustha. �Amalaki murabba – pitta dominant �Chopchini paka – updamsa, dhatugata kustha �Haridra khanda – itching, kapha dominant skin disorders. �Panchatikta Ghrita – Vata Pittaj Kustha �Mahatiktaka Ghrita – Sarva kustha

Contd…. � Chopchinyadi Churna – vrana, mandala, dadru kustha. � Giloya sattva – pitta predominant kustha � Madayantika churna – pama kacchu � Nimbadi churna – vata predominant kustha � Ushirasava – pitta dominant conditions � Khadirarishta – Kapaha dominant skin disorders � Sarivadyasava – pitta dominant conditions � Manjistharishta – pitta dominant conditions

Decoctions �Guduchyadi kwatha – vata pittaja �Patolamuladi kwatha – pitta kaphaja �Manjisthadi kwatha – pittaja �Nimbadi kwatha – vata pittaja �Panchtikta kashaya – sarva kustha �Kiratiktadi kwatha – pitta dominant

Taila � Tuvaraka taila – pigmentary disorders � Vrihata marichyadi taila – itching � Bakuchi taila – hypopigmentary disorders � Nimba taila – nadi vrana � Arka taila – kaphaja kustha � Sweta karviradya taila – ulcerative lesions � Kanaksheeri taila – dry scaly lesions

Lepa �Lepa should be applied after swedana, lekhana and raktamokshana. �Lepa described in Aragvadhiya adhyaya of charaka sutra. �Application of Ksharaagada in supta, sthira, kathina & parusha kustha �Dadruhara lepa – saindhava, chakramarda beeja, guda, nagkesara, rasanjana. �Sidhartaka snana – good in dry squamous lesions & Eczema eq. Lrda enua f=Qyk djatkj. Xo/kdfyax; ok% A nkoh. Z ll. Iri. kk. Z Lukua fl)k. Fk. Zda uke AA

Use of Rasayana � Kustha is chronic disorders so it is mendatory to use Rasyana especially in kustha with remissions and aggravations. Some of the Rasayanas are – � Vidanga Tandula Rasyana � Amalaki Rasayana � Bhringaraja Rasayana � Amrita Bhallataka � Gudhuchyadi Rasayana � Gomutra

Herbs �Aragvadha �Khadira �Haridra �Daruharidra �Triphala �Bakuchi

Contd…. � Nimba � Bhallataka � Vidanga � Sariva � Shigru � Manjistha � Chirabilva � Tuvaraka

Miscellaneous � Conditions where shastrakarma is C/I application of kshara. � In darunaka – amra majja, bala harad with milk for LA � In kunakha – tankana mixed with water for LA � In vyanga – jayaphala mixed with milk for LA � Mukhpidika – Kaparda bahsm mixed with nimbu rasa for LA � Warts – Swarna vanga � Planae – shorak drava for LA

References �Ashtang Hridayam: Commentator – Kaviraj Atri Dev Gupta, 15 th Edition 1975 �Ashtang Hridyam: Sarvanga Sundari Commentator – Arun Dutta, Chaukhamba Krishna Dev Academy Varanasi, 2000 �Ayurveda Deepika: Commentary by Chakrapani Dutta, 4 th Edition, Vikrami Samvat 2051 �Charaka Samhita – ‘Vidyotini’ hindi commentary by Pt. Kasi Nath Shastri & Dr. Gorakh Nath Part Ι- 21 st edition 1995, part ΙΙ, 22 nd edition 1996. �Charaka Samhita, commentary Chakrapanidutta Ed. R. K. Sharma, Bhagwan Das Chaukhamba sanskrita series, Varanasi, 1984. �Compendium of Indian medicinal plants – by Ram P. Rastogi, BN Malhotra vol Ι to. V (1990 -1994).

References contd…. � Illustrated synopsis of Dermatology and sexually transmitted diseases by Dr. Neena Khanna reprint, Peepee publisher and Distributors (P) Ltd, 2007. � Illustrated Text Book of Dermatology by Dr. J. S. Pasricha & Dr. Ramji Gupta 2 nd Edition reprint, Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, 2001. � Imamdar N. C. & Raja Ram Rao M. R. - Studies in plants of T. Chebula, J. Scien. India, 1962. � Indian medicinal plants – A compendium of 500 species Orient Longeman vol. І to VΙ. � Introduction to Kayachikitsa by Dr. C. Dwarkanath � Kayachikitsa by Dr. R. H. Singh 1 st edition, Chaukhamba Sanskrit Pratisthan, Varanasi 2001. � Kayachikitsa by Dr. Shivcharana Dhyani � Kayachikitsa by Dr. Subhash Ranade, reprint, Chaukhamba Sanskrit Pratisthan, Varanasi 2006. � Pharmacognostical Investigations of certain medicinal plants and compound formulations used in Ayurveda & Siddha- Malhotra S. C; C. C. R. A. S. New Delhi, 1996.

Still needs lots of effort to elaborate Thanks