Vaidya. Vilas Nanal
AVP
Introduction: The idea behind writing this article is to present the Ayurvedic perspective about a group of skin diseases called collectively Kusht`ha in Ayurveda. It is true that the aim of all the health care delivery systems is to alleviate human suffering and re-establish health. The means adopted by each of them differ considerably. This is due to the differences in the basic tenets of each of them. It is a fact that skin disorders are difficult to eradicate totally. Hence we find diversity in the management approach. Ayurveda has a positive input to give on all the stages I.e. from the formation of skin, its structure, function and the causative factors, Symptomatologyand the manifold unique treatment approach that includes Panchakarma. We have tried to present this difference from the contemporary medicine viewpoint, while keep in the Ayurvedic terminology intact and interpreting it in a manner that is the closest in meaning. We do hope that it will generate an interest in his branch of indigenous knowledge system and eliminate the misconception of its being oriental and therefore mystical and exotic; instead of being a logical reproducible, with a sound cause and effect structure.
Ayurvedic concept of skin formation
At the time of fertilization the Sperm (Pitrija Bhaava) and the Ovum (Maatrija Bhaava) along with other contributing factors come together in the Fallopian Tube, to enter the uterine cavity (Trutiya Aavarta of Grabhaas`hayya). The act of penetration of the cell wall of the Ovum is responsible for a lot of events. It begins with formation of the primordial space (Srotas / representative of Aakaas`ha / space) in it. The first lining is the precursor of all the internal linings (Kalaa). The unified nucleus forms the seat of spirit (Aatman), mind (Manas) and sensory-motor apparatus (Indriyaan`i). The intercellular space is occupied by the nutrient fluid (Rasa). The outer covering is formed by skin (Tvachaa). This is formed in layers like those on a pot of milk on a low fire. The fetal blood (S`hon`ita) is slowly converted by the digestive fire of the fetus (Jaat`haraagni of Garbha). The more is the density of the fetal blood dense/thicker is the resulting skin layer.
The slowly converting blood forms progressively thicker layers of skin as well as the outer layers of various internal organs. These layers are as under
Vreehi is a rice corn and is used to measure the thickness levels of different skin layers.
- Avabhaasinee: The first and outermost, thinnest layer of skin measuring 1/18th of a Vreehi. The root word in an Avabhaasineeis Bhasin, which means to show, to reflect, and to enlighten. Thus it is the one which reflects the Chhaayaa (aura)
Conditions like Sidhma Padmineekan`t`aka originate in this layer. Charaka mentions this as Udakadharaa. Udaka + Dharaa which means which holds the aqueous tissue (Lasikaa) within. If this layer is slightly scratched then a watery, yellowish, warm fluid oozes. The one layer, which holds this fluid, is Udakadharaa. Like the first thin layer on slowly heated milk, retains heat under the surface and hastens the process of separation of the cream from the bulk of fluid. This layer of skin is also responsible for retaining the fluids and nourishes the lower layers. In so doing it secretes the unctuous sweat and sebaceous material from the pores (Sveda). In cases of abrasion on the skin a warm, yellowish fluid is secreted is Lasikaa. This layer is the site of all the oozing, weeping lesions. - Lohitaa: This is the second in sequence. It is as thick as 1/16th of a Vreehi i.e. slightly thicker than Avabhaasinee. Conditions characterized by various colored lesions on the skin like Nevi, polyps, warts (Tila Vyanga, Nyachha, Kaalaka) etc. originate here. This has a red hue due to the presence of various peripheral blood vessels in it. Hence Charaka mentions the second layer as As`rukdharaa. It is the one, which holds As`ruk (blood) in the body I.e. if it is injured then bleeding occurs.
- S`hvetaa: This is third layer and is s thick as 1/12th of a Vreehi. Conditions like Psoriasis characterized by scaling, raising various flaccid hanging growths (Charmadala, Ajagallikaa, Mashaka) originate in this layer.
- Taamraa: The fourth layer and is as thick as 1/8th of Vreehi. Different types of lesions characterized by a copper colored discoloration and rich capillary network, worsening on exposure to sunlight (Kusht`ha, Kilaasa) originate in this layer.
- Vedinee: The root word in Vedineeis Vedin means to know, to perceive. Thus we can say that this is the true skin, which is responsible for perception of sensation. It is as thick as 1/5th of a Vreehi. Different conditions like Kusht`ha, Visarpa etc. spread their roots within this layer. Thus symptoms like loss of sensation develop. The post herpes (Visarpa) burning is because of erosion of this layer.
- Rohin`ee: The pre Maamsadharaalayer is sixth in hierarchy. It is as thick as 1 Vreehi and actually forms a covering to many organs along with underlying Maamsadharaalayer. The conditions occurring in this layer are much graves e.g. various kinds of tumors, mumps, S`hleepada, Arbuda_s. These stages many a time require surgical intervention, some kind of Kshaara karma, Agnikarma etc. this is the last layer mentioned by Charaka. He says this is crucial layer and if injured seriously then it becomes difficult to cure.
- Maamsadharaa: The last and innermost layer, which has a thickness of 2 Vreehi. The term can be understood as Maamsa + Dharaa. Maamsa is the muscle / Maamsadhaatu. Dharaa is one, which holds or imparts support. So these two meanings imply that it is mostly the covering facial /layer, which is adhering to the muscles. Diseases that originate here are Bhagandara, Ars`ha, different varieties of Vidradhi. This layer is not considered by Charaka.
Role of Rasa in skin physiology and Pathology:
The food after its first and second stage digestion reaches the heart (Hridaya) for circulation. The primordial nutrient fluid is capable of nourishing all the body constituents. When it is received at various sites of tissue metabolism (Srotas Moola) it is selectively absorbed and processed further to yield the final products of metabolism. In the case of Rasa, the Aahaara Rasa on reaching the heart is taken up by the Rasa Tissue Agni (Dhaatvaagni) for processing. This goes on for the next twenty-four hours.
This process of tissue conversion from the nutrient fluid goes on to yield five by products Rasa proper this is the main tissue that is responsible for the functions of reaching nourishment, maintain the fluidity of internal environment, subtle Rakta (Sookshma Rakta) this is utilized in cases of acute or chronic vitiation, depletion of the Rakta to act as a seed around which newer tissue could be built, waster Kapha (Dhaatu, Mala, Kapha) this is the fluid found around the lungs and the heart responsible for the smooth function of these organs, Tissue sub-type (Upadhaatu) these are the subtypes that are designated to carryout specific functions but they are terminal in the sense that they do not yield any new product, menstrual bloods (Raja) failure to conceive leads to liquefaction of the Endometriallining that flows as menstruation and Breast milk (Stanya) in case of a lactating mother and finally contribution to Ojus. Rasa is only tissue that harbors all three Dosha_sand the movement of all the constituents is through the agency of Rasa, the Ayurvedic management is incomplete without the appropriate Rasaayana / rejuvenation therapy.
Rasa the lymph / nutrient fluid circulates all over the body providing nourishment maintaining fluid balance in the internal milieu. It provides the essential passage to Dosha_sto move along its vessels enabling them to perform their respective functions. Thus it controls the fluid balance, body temperature, nourishment of tissues, enhances the softness, color and complexion of skin. Thus Rasa has an important role to play in maintaining the equilibrium of various body constituents and a state of well being health.
Role of Rasa in skin pathology:
Whenever a causative factor (Hetu) is in contact with the human body, it depending upon its nature and intensity sets a chain of events into motion. This finally culminates in manifestation of disease of slow onset psoriasis, ringworm and eczema (Kusht`ha) or acute onset herpes (Visarpa) or a similar syndrome. Most of the intrinsic disorders are a direct result of abnormal Agni activity resulting in Aama formation, vitiated Dosha_s, but before that can take place the Rasa gets contaminated and then the specific cause causes vitiation of the Dosha_sand contamination of other Dhaatu_s. All the movements of the vitiated or normal Dosha_sare through Rasa as vehicle, as Dosha_sdo not have a specific Srotas attributed to them.
Role of blood in skin disease:
In the intra uterine life, the skin is formed as progressive thick layers from slowly converting fetal blood. This has an important role in the formation of various body constituents. No organ can be formed without the participation of blood in some form or other. With this background Sus`hruta the great surgeon of ancient times equates blood with life itself. In later life after delivery the nourishment of skin, is done by nourishing first fluid tissue (Rasa) and muscle tissue (Maamsa).
Ayurveda has made an interesting observation that it attributes a confirmatory tactile perception to blood (Asams`haya Sparsha Dnyaana) along with sustaining life. This explains the various tactile Parasthesiasfound in skin disease like itching (Kand`oo), burning (Daaha), pricking sensation (Toda) etc. therefore the advice for bloodletting in the management of skin disorders is sound and is practiced extensively by the Ayurvedic fraternity.
Role of muscle tissue in skin disease:
The skin formed of the blood in the intrauterine life, in later life is nourished by muscle tissue. Both have the same function of covering the body and various organs by forming an external wall. As seen before the innermost skin layer is made up of muscle and it supports various vessels that carry various fluids within them. Other important function of the muscle is to bring about various movements in the body like ambulation, circulation. This it does by a series of controlled and rhythmic contraction and relaxation of opposing groups of muscles with the help of synergistic muscles. Arteries, veins, organ walls and even the cell walls are made up of muscle tissue. Some of the more grave conditions like Herpes (Visarpa) do involve the muscular layer; some other conditions like Fistula in ano(Bhagandara), causes deep situated eruptions (Visphot`a) etc.
Role of reproductive tissue (S`hukra) in skin disorders:
Ayurveda considers reproductive activity at two levels. First is the reproductive proper and the second is regenerative activity, capacity to create a similar body constituent. Various factors like Vaayu, Pitta and Kapha also pitch in the act, but the main factor is the S`hukra. Hence the membrane bringing about this phase transition of AAahaara Rasa to S`hukra is spread all over the body (S`hukradharaa Kalaa). This is the reason most of the rejuvenating agents (Rasaayana) are potent aphrodisiacs (Vrishya). Normal skin color, luster and skin glow is due to proper S`hukra. Hence in conditions that are characterized by discoloration consideration to S`hukra is important.
Role of incompatible attributes, food articles, regimen indulgence in manifestation of skin disorders (Viruddha Aahaara Vihaara)
This is an important contribution to the field of pathogenesis of almost all the intrinsic disorders. Some substances are wholesome singly but on combination with one or more of other equally wholesome substances, the combination more often than not proves harmful to the body. The combination on coming in contact with the Agni proves beyond its capacity, hence it is not converted in the alimentary canal to Aahaara Rasa but it leads to generation of a toxic sticky material called Aama. It is partially processed metabolite hence the molecular size is much large than the normal nutrient fluid. It is sticky, dense, cold, slimy, and unctuous. It leads to obstruction of various channels, vessels. This results in deprived nourishment to other physiologically more distally situated tissues. Again depending upon the specific combination the resultant vitiation varies. Fish and milk, when consumed together lead to manifestation of skin diseases characterized by oozing. Strong sauna or steam bath repeatedly followed by ice cold shower leads vitiation of sweat metabolism (Svedavaha Srotas) culminating in deranged fat metabolism and sometimes skin diseases.
Causative factors (Hetu):
A variety of factors have been identified as causative factors of skin disorders. Since there is impairment of skin as discoloration, ulceration, scaling, oozing, pus formation, raising and selling these are collectively called Kusht`ha.
The causative factors for skin disorders are as follows consumption of incompatible food combinations (Viruddha Aahaara) e.g. improper use of honey, molasses, jaggery, fish, raddish, beans, (Dolichoslablab Linn) jackfruit, barley, black gram (Phaseolus mungo Linn), horse gram (DolichosBiflorusLinn), improperly set Yogurt/curds, food articles made from fine mesh flour white bread, pasta, noodles, paste of sesame, peanuts. Milk with alcohol (Rum punch), fish (Fish chowder), salty (salted biscuits), sour substances (lemon ice cream, sour cream), fruit (pineapple milk shake); use of oils from rapeseed, Saffflower, sesame seed (Sesamum indicum), suppression of vomit (Chhardi Nigraha), improper administration of purificatorymeasures (Panchakarma Apchaara), mental factors like fear (Bhaya) fatigue / lassitude (S`hrama), anger (Krodha), fatty / grease rich food persistently and in significant amounts, vegetable / hydrogenated oils, excessive indulgence in sex (Ati Vyavaaya), exercise (Vyaayaama), repeated exposure to strong sun (Aatapa Sevaa), excessive water intake more than 2000 ml / day excessive fat intake more than 20 gm / day sudden and extreme change of temperature sauna / steam bath followed by ice cold shower, consuming cold water before hot beverage, dousing eyes with cold after exposure to sun etc. consuming food in spite of persistent indigestion (Ajeern`a Bhojana).
Pathogenesis (Sampraapti)
These factors on coming in contact with the body affect the Agni function adversely resulting in generation of Aama instead of Rasa. This is a metabolite that is contaminating in nature since it is gross (Sthoola), slimy / sticky (Pichchhila), cold (S`heeta), heavy (Guru) and slow (Manda) in attributes. It is partly or incompletely converted hence is incapable of nourishing but highly contaminating and occluding in nature. Since it has access to all the sites and channels of Rasa it can have a varied and generalized spread of its signs and symptoms. Since the skin is the main site that represents the status of Rasa in the body the majority of them manifest themselves on the skin causing disfigurement. These can be localized like scabies, ringworm, bullae, macuels, paules, pustules etc. to generalized manifestation like psoriasis, leprosy, (Galat Kusht`ha / Mahaa Kusht`ha), vitiligo(S`hvitra), herpes zoster(Visarpa).
Prodromal signs and symptoms (Kusht`ha Poorva Roopa) of skin disease. The imminent skin conditions indicate them by producing some Prodromalsigns and symptoms. They are as follows, either lack or excessive sweating (Asvedanam Atisvedanam Vaa), hardness or excessive smoothness of skin (Parushyam Ati S`hlakshn`ata Vaa), discoloration (Vaivarn`ya), itching, Pruritus(Kan`d`oo), pricking pain (Nistoda / Toda) diminished or lack of sensation (Suptata), generalized burning sensation (Paridha), Hyperaesthesia (Pariharsha), Horripilation (Romaharsha), roughness of skin (Karatvam), release of heat like a wave (Ushmaayanam), thickening, subjective heaviness (Gauravam), Oedema (S`hvayathu / S`hotha), repeated and acute episode of eruptions on skin (Visarpa Aagamanam Abhikshn`am), discharge from body orifices (Kaayaa Chhidra Upadeha), excruciation pain in previous lesions, burns, bites, stings, traumatic wounds, ulcers, fractures etc (Pakva Dagdha Dasht`a Bhagna Kshata and Skhalita Ati Maatra Vedanaa), putrefaction and non healing of even smaller wounds (Svalpa Vran`aanaam Api Dusht`i Asamrohan`am cha)
Types of Kusht`haand their probable equivalents in Allopathy
Give English name first and Samskrita name in parenthesis () do it for all the names below (this chapter is to put forth the Ayurvedic thinking about skin disorders hence I think the Ayurvedic terminology has to precede the possible allopathic equivalent and not vice versa)
- Kapaala Rupiodpsoriasis (hyper keratotic, cone shaped, grayish brown lesions mainly on the extremities) lichen planuswith wickhamsstriae(hyper keratotic, hyper granular, vacuolar degenerationof the basal cell layer and a band of Lymphohistiocytesin the upper dermis) Vaata Pitta predominant (the dermiclesions are dry, reddish, hard, uneven spread with rough and thin edges, elevated externally, numbed to anaesthetic. They may be covered with bristly hair, afflicted with piercing pain, have little pain, pruritus, burning, suppuration or discharge. The onset and spread is acute, tends to ulcerate and be infested with parasites quickly. They resemble a piece of broken black earthen pot in most respects.
- Audumbara Chronic Discoid Lupus erythematosus(hyperkeratosiswith follicular plugging, irregular atrophy if the stratum malpighii, liquefactivedegeneration of basal cell layer, periappandagle lymphyocyticinfiltration) Pitta Kapha predominant (the dermiclesions are copper colored wit rows or rough copper colored hair, distributionis dense with purulent, bloody or serious discharge. Strong itching followed by burning, moisture, sloughing and suppuration. Onset, maturity and suppuration is acute, parasite infestation is quick. Resemblance to ripe fruit of Ficus glomeratais striking)
- Mand`ala The dermiclesions are glossy, large, raised, smooth, and stable with swollen and yellowish edges with a red tinge, covered with white hair. Thick white discharge, very moist, strong, itching, slow, sluggish onset spread. Round merging to form a large lesion
- Rishya Jihvaa / Rushya Jihvaa Kusht`ha Lichen planopilarisor pityaris rosea. Vaata Pitta predominant. The dermiclesions are rough, nodular, blackish blue like the tongue of a deer or cow. They are more common on the joint. They are dry, no itching, discharge sometimes pricking pain.
- Pund`arika Pitta Kapha predominant. Tinea corporiswell defined oval lesion with active border and a clear center. Kapha Pitta predominant. The dermiclesions are pink to reddish in color, rich in red veins, raised borders, serosanguineous, purulent or serous discharge. Strong pruritus. Acute onset and spread. Resemble pink lotus flower petal.
- Siddhma Kusht`ha Pityriasisversicolor Kapha Vaata predominant. The dermiclesions are mostly distributed on the chest. They are rough, bluish white; on rubbing they release powder, no pain, burning or secretion, chronic onset and limited spread. Resemble flowers of Alaabu (LagenariaSiceraria Standl)
- Kakanaka Kusht`ha HistiocytosisX letterer siwedisease, rare, proliferative, histiocytosisof unknown origin, three phases acute letterer siwedisease, transitional hand schullerchristian disease and chronic, benign and localized (eosinophilic granulomaof the bone). The dermiclesions resemble the seeds of Gunjaa (Arbus precatorius Linn) bright red and smooth initially but acquire a variety of colors and bizarre symptoms indicating involvement of all the three Dosha_s
- Eka Kusht`ha Psoriasis common paulo-squamousdisorder of world wide distribution, generally among young adults but can affect any age group, both sexes, genetic predisposition; multifactorialinheritance, trauma, infections, climatic change, emotional upsets precipitate attacks. Knees elbows, palms, scalp, lumbosacralregion commonly affected but could be generalized. Asymptomaticor mildly itchy red, scaly papules or plaques, sharply defined, covered with white scales, overlying translucent membranous scale removal of latter reveals punctuate bleeding spots. Unpredictable course, worse either in winter or summer, has spontaneous relapse and remissions. Kapha predominant. The dermiclesions are dry, rough, covered with scales like fish, itching and extensive spread. icthyosis, exfoliativedermatitis and scabies crustosaetc.
- Charmaakhya or Dry eczema Lichen simplex chronicus Kapha Pitta predominance localized, raised, bluish black, dry rough resembles elephant skin. Xerodermia pigmentosa, keratosis follicularis, sclerodermatitis, senile and seborrhic keratosis, hyperkeratotic eczema and erysipelas etc
- Kit`ibha Kusht`ha some equate it with psoriasis. Vaata Kapha predominant. Localized round, weeping, solid glossy and dark, has intense itching. Psoriasis, Psoriasis diffusa, pityriasis versicolor, occupational melanosis etc.
- Vipaadikaa Kusht`ha Tinea pedis diffuse hyperkeratosiswith mild scaling? Tuberculous verrucosa cutis Keratoticlesions on sole. Vaata Kapha predominant. Mainly found in soles and palms. May be with deep ridges, fissures and bleeding. Tylosis, keratoderma palmaris et plantaris, keratoderma climactericum etc.
- Alasaka Kusht`ha – In this the skin gets covered with erythematousitchy nodules. Lichen planus, pityriasis rosea, dermatitis herpetiformis an eczema poplosum
- Dadru Kusht`ha – Red colored lesions appears on skin. Thee are round and with red Macule. Itching is present. Ringworm (TineaCircinata), eczema and pustularringworm etc.
- Charmadala Kusht`ha Gape, painful, red colored eruptions develop. These are tender to the touch and are painful also. Excoriations, seborrhiceczema, Varicose eczema, erythema intertrigo and pustular erysipelas etc
- Paama Kusht`ha – White reddish and black papules appear on skin. Patient presents severe itching. Scabies, eczema rubrumand erysipelas etc.
- Visphot`a Kusht`ha – White blisters with reddish tinge appear on skin. The skin becomes very thin and gets luster. Boils, pimpetigo, bullae pemphigus, dermatitis herpetiformis, pemphigoid, erysipelas bullosum and bullous dermatitis etc
- S`hataaru Kusht`ha – Presents as multiple ulcers with burning and pain. erythema multiforme, rupia erythema, ecthyma, eczema paracitucum and dermatitis herpetiformis etc.
- Vicharchikaa Kusht`ha – skin has dark eruptions and itching and discharge from eruptions. Eczema, pustulardermatitis and weeping eczema etc.
Other conditions than those described above are:
(Visarpa) herpes of various types including conditions like pemhigusof various types, (S`hvitra/ Kilaasa) Leucoderma/ Vitiligo, (Romaantikaa) chicken pox, (S`hitalikaa) small pox, Prameha Pid`akaa (carbuncles of diabetes mellitus), (Vran`a S`hotha) etc.
Management of skin diseases (Kusht`ha Chikitsaa)
S`hodhana purificatory management (Panchakarma)
Since the pathology is accumulating and occluding in nature the aim of management is on purification (S`hodhana / Panchakarma). If properly administered, this cleanses the internal environment and improves Agni function while getting the vitiated Dosha_sphysically out of the system. But if administered improperly or is inadequate, the result is aggravation of the disease for which it was done. Since the main factor is Agni and the resultant Rasa Nutrients: S`hodhana has to be done repeatedly and diligently.
Since most of the constituents involved in the pathogenesis are represented in the various skin layers the relationship between Rasaand skin is that of host and subject. It is very important that optimum purity and functionality of Rasabe maintained at all times. The movement of Dosha all over the body is through the medium of Rasa. These Dosha_sare generated in the gut as result of the first stage digestion. From there they are secreted in the vessels and carried to heart for circulation. In order to purify the Rasa and purify the internal environment the trend from gut to the constituents is to be reversed. They have to be bought to the gut to be eliminated from the nearest orifice.
(Vamana) English Word GIRSTmedically administered vomiting. This is administered to rid the Kapha dominant Dosha, from the stomach (Aamaas`haya).
In the preceding week a patient is given a combination of herbs in the form of medicated ghee (Mahaa Tiktaka Ghrita), in increasing doses till he shows symptoms of saturation of the internal environment with ghee (Samyak Snigdha Lakshan`a).
During this time he is advised a certain regimen (Sneha Parihaara). He is given a whole body massage either with sesame oil or medicated oil with base of Azadiracta indica(Nimba / Neem seed oil or Neem oil), or Pongamia pinnata see oil (Karanja Taila).
Sudation (Svedana) is done be steam using the same herbs. On the previous night the patient is given a specific diet aimed at precipitating the Dosha. It contains fish, jaggery, black gram (Phaseolus mungo), and sesame seeds / paste, Yogurt, bananaetc.
On the day of Vamana, in the morning, just prior to the main procedure (Pradhaana karma), he is given a mixture of Yogurt, banana and common salt or Yogurt, banana and jaggeryto drink. This is followed by massage to the whole body, followed by fomentation by steam. Then a paste in honey of Randia spinosaseed powder (Madana Phala Pippalee), Acorus calamus (Vachaa) rhizome powder and powder of Glycyrrhiza glabraroot (Yasht`imadhu) is give. On symptoms of impending vomiting a decoction (Kvaatha) of neemleaves is given till the yellow bile is expelled.
Depending upon the end result of vomiting, the dietary restrictions are imposed and a graded diet is followed till the normal diet is allowed. This is known as post Vamana regimen (Paschaata Karma)
Like Vamana English word after the normal diet the patient is again given Mahaatiktaka Ghrita in increasing doses till saturation and on the third day after the Oleation (Snehana) is finished a therapeutic purging (Virechana) is done to eliminate Dosha from the small intestine (Pachyamaanaas`haya). The day between Oleation and purging, the patient is asked to consume a weak infusion (Phaant`a / Siddha Jala) of Cassia fistula (Aaragvadha), Vitis vinifera(Draakshaa / black resins)
The purging medication is administered around 0930 hrs. The common herb used is Operculum turpethum(Trivruta), Cassia fistula (Aaragvadha) or a combination of some herbs called Avipattikara Choorn`a. The bouts of loose motions continue till a white jelly like mucus is passed. Depending upon the amount of Dosha_sevacuated the dietary regimen is followed for another five to nine or twelve days. In case of Vaayupredominance, medicated enemata (Basti of decoctions (Nirooha) or oils for retention (Anuvaasana) are administered. For the enema decoction five bitter barks (Pancha Tikta Kvaatha Nirooha Basti with sesame oil, rock salt) is given just after sunrise. The retention enema is given in the late afternoon immediately after a snack. For both enemata the patient is in a left lying position after previous oleationand sudation are along with other purificatorymeasures.
Sometimes the Dosha_sare harboring (Leena Dosha Avasthaa) in the Dhaatu_sand the attempts to precipitate them (Dosha Utkles`hana) and bring them back to the alimentary canal (Kosht`ha Aanayana) are not plausible. Sometimes a correctly diagnosed disease does not respond to the appropriate treatment adopted. There the affliction should be considered as arising out of vitiated blood and blood letting (Rakta Mokshan`a– As`ra Visruti) should be carried out. In case of local lesion depending upon the Dosha predominance, various methods like application of Leeches (Jalaukaa Avacharan`a) taking incisions (Prachchhaana Karma), sucking by cupping with carved bullock horn (S`hrunga). Prior oleation, fomentation and precipitation are done as usual. The dietary regimen restriction on behavior, remain the same as in other measures.
The palliative (S`hamana Chikitsaa) is done after the purificatorytreatment and consists of conversion. Conversion of undigested or partly digested food residue (Aama Pachana). This includes use of medicinal herbs, fasting, or a particular kind of diet, hot or prepared water using herbs like Acacia catechu (Khadira), Cassia toraseeds (Chakramarda), the Three myrobalans Terminalia chebula(Haritakee), Terminalia bellerica(Bibhitaka), Emblica officinalis(Aamalaki). Minerals like sulphur(Gandhaka) and some animal products too, in appropriate form and dosage with its vehicle (Anupaana) see the list of herbs next page.
Since the main involved constituent is the skin it is important to treat the lesions locally by application anointing the area with various herbs. This process is called Lepa. In case of generalized spread a more rigorous treatment by applying (Abhyanga) / pouring (Dhaaraa) mediated oils (Taila Dhaaraa) or buttermilk (Takra Dhaaraa) which is prepared using herbs like Cyperus rotundus rhizome, N. Jatamamsi root and Emblica officinalisfruit powder. The milk for making curds with these powders is set and then buttermilk is prepared from the set curds. This is used after the whole body massage for a period of 45 minutes (one Muhurta). The unctuousness of oil and buttermilk is removed using herbal powder (Udvartana) like Azadiracta indicaleaves, Acacia catechu, three myrobalans, Phaseolus mungoetc. to reduce sweating and contamination it is advised to fumigate the clothes of a person suffering, with powders of Acorus calamus, Azadiracta indica leaves, Brassica / mustard seeds, olio resin from Commiphora mukul, roxb. (Guggulu).
Role of Ghrita in the management of skin disorders:
As seen before the main function of the skin is to retain moisture in the body and secrete the unctuousness sebum out of the pores to maintain the control on Vaayuand Vaata activity. Fluid and unctuous are two attributes of Jala Mahabhoota or water element, one of the five elements but they have strikingly different functions in the body. The fluid is responsible for the fluid balance; adequate movement of nutrients while the unctuous is responsible for maintaining the lubrication chain in the internal environment. Both have differing physical attributes and cannot mix freely, the one factor responsible for keeping them in an emulsion / miscible form is the digestive power (Agni) of the individual. Ghrita an end product of milk, is an ideal substance that has a unique action on the body constituents, it has a beneficial soothing effect on the unctuous chain (Dhaatu Sneha Paramparaa) of the tissues. It also has a facilitatoryeffect on digestive fire and tissue conversion. It also is comparable to the sublime and pure essence of tissues (Ojus). It controls the physiological metabolism of the tissues and ensures smooth and optimum function for sustenance of life. Ghrita is important at various levels of management. In the purificatorystage it helps remove the vitiated Dosha from the tissue without causing damage to them. In the palliative phase it ensures optimum digestive function and reduces the chances of Aamaformation. It also ensures an adequate supply of unctuous, lubricant, material for various physiological processes to continue. After the condition is cured it is advisable to follow the seasonal purification regime as preventive management. After the purification one has to ensure that the disease does not recur on provocation. Towards this end no Ayurvedic treatment is complete without proper rejuvenation (Rasaayana).
For skin disorders use of Ghrita is a good rejuvenator along with herbs that are Rasaayana like Glyceriza Glabra, Hemidesmus indicus, and three Myrobalansetc.
A list of some herbs used in Kusht`haManagement from the texts.
| No | Name of Herb (Latin) | Dose / Oral External | Part of the plant | Reference |
| 1 | Azadirectaindica | Paste of local applicationBark decoction for ghee | Leaves, Bark | Charaka Samhitaa |
| 2 | Trichosanthes | Decoction for ghee Mahaatiktaka Ghrita 20 ml b d | Whole plant | Charaka Samhitaa |
| 3 | Holarrhena antidysenterica | Decoction for Ghee 20 ml twice a day Decoction for Vamana | Dried root bark seed powder with honey for Vamana | Charaka SamhitaaAsht`aanga Hridaya |
| 4 | Berberis aristata | Bark Powder external paste for cows urine, decoction for oil, ghee internal 50 ml twice a day | Ghana Saara (Whole plant) | Charaka Samhitaa |
| 5 | Cyperus rotundas | Powder internally Mustaadi Choorn`a 3g TDS with honey and ghee | Dried tuber | Charaka Samhitaa |
| 6 | Solanum indicum | Oil prepared from decoction for Anuvaasana 30-60 ml | Dried roots | Charaka Samhitaa |
| 7 | Pongamia pinnata | Externally paste of seeds in cows urine Internally leaf juice, bark powder with ghee Seed oil for Anuvaasana 30 60 m | Seed, leaf, bark seed-oil | Charaka Samhitaa |
| 8 | Embelia ribes | Externally Paste in water Internally powder 3g along with Mahaatiktaka Ghrita | Dried fruit | Charaka Samhitaa |
| 9 | Acacia catechu | Drug of choice all forms and versatile use Decoction for bath, dusting | Bark, Heartwood | Charaka Samhitaa |
| 10 | Jasminum officinale | External paste in water Internal powder with Mahaa Kalyaan`aka Ghrita | Tender leaves | Charaka Samhitaa |
| 11 | Tinospora cordifolia | External Application Paste from stemInternal Aasava 30 ml BD | Whole plant | Charaka Samhitaa |
| 12 | Emblica officinalis + Terminalia chebula + Terminalia belerica | Drugs of choice all forms and versatile use Decoction for bath, dusting | Fruits | Charaka SamhitaaSus`hruta Samhitaa Asht`aanga Hridaya Asht`aanga Samgraha |
| 13 | Nerium indicum | Externally Paste form, leaves, oil prepared from leaves | Fresh leaves | Charaka Samhitaa |
| 14 | Piccrorhiza kurroa | One of the ingredients of Mahaatiktaka Ghrita 15-30 ml BD Aarogyavardhinee Rasa 250-500 mg TDS both are used internally | Dried Root | Charaka Samhitaa RasaratnaSamuchchaya |
| 15 | Gentiana Kuroo | One of the ingredients of Mahaatiktaka Ghrita dosage as above | Dried leaves | Charaka Samhitaa |
| 16 | Hemidesmus indicus | One of the ingredients of Mahaatiktaka Ghrita dosage as aboveDecoction for drinking, bathExternally Powder for dusting and paste in water | Dried Root bark | Charaka SamhitaaAsht`aanga Hridaya Sus`hruta Samhitaa |
| 17 | Rubia cordifolia | Externally paste in water ointment in bees wax decoction for bath internally decoction ghee | Stem | Charaka SamhitaaAsht`aanga Hridaya |
| 18 | Cedrusdeodara | One of the ingredients of Kalyaan`akaGhritaExternally paste in water | Root Oil for fomentation | Charaka Samhitaa Asht`aanga Hridaya |
| 19 | Alstonia scholaris | One of the ingredients of MahaatiktakaGhritaVajraka GhritaDosage as aboveDecoction for drinking, bath | Dried / fresh leaves | Charaka Samhitaa Asht`aanga Hridaya |
| 20 | Curcuma longa | One of the ingredients of Mahaa Khadira Ghrita Mahaatiktaka Ghrita dosage as above Pate in water / milk external | Rhizome fresh / dried powder | Charaka SamhitaaAsht`aanga Hridaya, Sus`hruta Samhitaa |
| 21 | Butea frondosa | External as paste of ashes of root and leaves in water / cows urine | Root, leaves | Charaka Samhitaa |
| 22 | Psoralea corylyfolia | Externally application of seed paste in cows urine | Seed | Charaka Samhitaa |
| 23 | Saussurea lappa | Externally paste in honey / water cows urine | Dried bark | Charaka Samhitaa |
| 24 | Balanitis egyptica | Seed oil locally | Seeds | Charaka SamhitaaAsht`aanga Hridaya |
| 25 | Nardostachys jatamansi | Externally application of paste in water / cows urineInternally decoction 20-30 ml b d | Roots | Asht`aanga HridayaCharaka Samhitaa Sus`hruta Samhitaa |
| 26 | Albizia lebbeck | Externally application of paste in water / cows urine | Bark | Charaka Samhitaa |
| 27 | Brassica campestris | Externally paste of seeds and oil is used both internally and externally | Seeds | Charaka Samhitaa |
| 28 | Cassia fistula | Externally paste of leaves and oil prepared from leaves is used externally for application is also the major ingredient of Mahaatiktaka Ghrita Aaragvadha Ghrita internally | Fresh leaves | Charaka Samhitaa Asht`aanga Hridaya |
| 29 | Mallotus philippinensis | External application paste in bees wax VipadikAahaara Taila | Fruit | Charaka Samhitaa |
| 30 | Cassia tora | Externally paste of seeds and oil is used both internally and externally | Seeds | Charaka Samhitaa |
Research reference on indigenous Ayurvedic herbs as reported in literature
Therapeutic plants of Ayurveda: A Review of selected clinical and other studies for 166 species By Sarah Khan M.S., M.P.S., C.N.S., and Michael J. Balick Ph.D
Institute of Economic Botany, the New York botanical garden, Bronx, NY
The journal of alternative and complementary medicine volume 7, number 5, 2001 pp 405-515 Mary Ann LiebertInc.
| Genus / Species / Family [common name] | Plant pat used preparation and dosages | Design model | Results | References |
| Aloe barbadensis | Aloe Veraextract cream 0/5% 100g of placebo or active ingredients 3x daily for 5 consecutive days per week (maximum 4 weeks) | Double blind, placebo controlled study: 60 patients with Psoriasis | Patients with slightly o moderate chronic plaque type psoriasis were treated. By the end of study, 25/30 (83.3%) were cured compared to 2/30 (6.6%) in placebo group, Psoriasis and Area and Severity index score decreased to a mean of 2.2 | Syed TA, et al management of psoriasis with aloe Veraextract in a hydrophilic cream. A placebo controlled, double blind study top med Inthealth 1996; 1(4) 505-509 |
| Azadiracta indica | Group: Azadiracta Indica Powder 4g /3 x day, paste of Arbus Precatorius and Plumbegi Zeylanica applied externally group II powder of Phyllanthus Emblica, Acacia Catechu and seeds of Psorelea Corylifolia 4g /3 x day | Random trial; 60 patients with Vitiligo | Encouraging improvement in treating Vitiligo(appearance of white patches on the skin) was noted from both groups | Naie RP, et al clinical evaluation of Ayurvedic preparations in Vitiligo J Res Ayur Siddh`987; VIII (1-2): 30-38 |
| Capsicum annuum | Capsaicin cream, 0.0025% standard therapy included 1.5 ml Betamethasone sodium phosphate, 1.5 ml Triamcinolone Acetonide | Case study | Healthy male 66 years Olspresented with herpes Zoster. After 18 months of standard treatment initiated Capsaicin treatment. Discomfort decreased within two days (4x/day) four weeks after initiating treatment patient awoke with no pain | Hawk RJ, Millikan LE. Treatment of oral post herpetic Neuraligia with topical capsaicin Int J Dermatol 1988; 27(5): 336 |
| Hemidesmus indicus (L) W.T Asclepiadaceae saarivaa | Air dried roots and simple distillation with water | Feeding in Mice | Tested on mice infected with M. Leprae. The drug may cause a delay in multiplication of organisms in the mouse foot pads | Gupta PN. Anti Leprotic action of an extract of Anantmul Lepr. India 1981; 53 (3) 323-335 |
| Curcuma longa | Ethanolic extract and ointment of Curcumin | Human trial;62 patients with externalcancerous lesions | Decrease in smell 90% and in itching in almost all cases was noted. Dry lesions were observed in 70% and 10% had a decrease in lesion size and pain | Kuttan R, et cal, Turmeric and Curcumin as topical agents in cancer therapy Tumori 1987; 73:29-31 |
| Glycyrrhiza glabra,L Leguminosae | Embelia Ribes, Glycerriza Glabra, Holorrhena Antidysentrica, N. Jat`aamaamsee, Phyllanthus Emblica, Santalum album, Terminalia Beleerica, TerminaliaChebula, Zinziber Officinalis | Single blind randomized comparative study: 49 adolescent to young adults with mild to moderate facialAcne | Each 3-treatment groups were administered different herbal mixtures successful treatments in group A and groups B proved effective against both inflammatory (pimples) and Non inflammatory (black heads and other Comedoens) lesions. The mechanism of action remains unknown | Paranjape P Evaluation of topical application of herbal formulation in Acne Vulgaris: a single blind randomized comparative Styd J med aromatic Platn Sci. 1997; 19:414-418 |
| Embelia ribes brum.f. myrsinaceae | Embelia Ribes, Glycerriza Glabra, Holorrhean Antidysentrica, N. Jat`aamaamsee, Phyllanthus Emblica, Santalum album, Terminalia Bellerica, Terminalia Chebula, Zinziber Officinalis | Single blind randomized comparative study: 49 adolescent to young adults with mild to moderate facial acne | Each 3-treatment group was administered different herbal mixtures successful treatments in group A and groups B proved effective against both inflammatory (pimples) and non- inflammatory (black heads and other comedoens) lesions. The mechanism of action remains unknown | Paranjape P Evaluation of topical application of herbal formulation in Acne Vulgaris: A single blind randomized comparative study J Med aromatic plant sci. 1997; 19:414-418 |
Bibliography
| Name of book / reference | Author / Editor | Publisher Year |
| Charmaroga | Acharya Raghuvir Prasad Trivedi editor | Shree Baidyanath Ayurved Bhaavan Nagpur India 1978 |
| Role of Haridra Khand`a in treatment of Urticaria(S`heetapitta, Udarda and Kot`ha) | Sitaram Misra and Divakar Ojha | Dept of Kayachikitsa IMS BHU Varanasi |
| Study of Snuhi Bhavita Triphala as a S`hodhana in the cases of Vicharchikaa | BD Nandurbarkar et al | Akhandanana Ayurveda college, Gujrath India |
| Effect of Nimbadi Taila on Paama(Eczema) | G Purushothamacharyulu | Govt. Ayurvedic hospital, Vijayvada AP India |
| Charaka Samhitaa commentary by Chakrapaan`idatta | Agnives`ha, Charaka, Dhrudhabala /Jadavji T Acharya | 19991 Munshiram Manoharlal Publishers Pvt Ltd Fifth edition |
| Sus`hruta Samhitaa with D`alhan`a commentary | Sus`hrutaJadavji T Acharya and Narayan Arm Acharya | Published by Pandurang Jadavji revised third edition 1938 Nirnaya Sagar Press Bombay |
| Asht`aanga Hridaya Samhitaa | Vaagbhat`a / translated by Dr. Ganesh K Garde | 7th edition 1983 published by Shree Gajanan book depot Bombay |
| Asht`aanga Samgraha Samhitaa with commentary by Vaidya Lalchandra Shastri | Vaagbhat`a | First edition 1965 published by Shree Baidyanath Ayurved Bhaavan Pvt Ltd Calcutta |
| Bhaava Prakaas`h nighan`t`u | Bhaava Mishra commentator Vaidya Vishwanath Dwivedi Shastri | 9th edition publisher Motilala Banarasidas, New Delhi |
Vaidya. Vilas Nanal
Sr.Scientist AyuSoft. Pune
Last updated on February 18th, 2021 at 06:27 am