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KUSTHA CASE PRESENTATION

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Kamal Sharma

This document presents a case study of a 37-year-old female patient named Mrs. Shashikala suffering from a skin condition for 3 years. She experiences burning and itching on her palms and all over her body. On examination, she has lesions on her hands and healed marks from previous lesions. The proposed treatment includes snehana, swedana, virechana, herbal medicines both internal and external, and a pathya-apathya diet. The differential diagnosis is determined to be kustha with vipadika or psoriasis with irritant contact dermatitis.

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1 CASE PRESENTATION VINAY TIWARI FINAL P.G. SCHOLAR DEPARTMENT OF P.G. STUDIES IN KAYACHIKITSA SKAMCH&RC BANGALORE
PREMILINARY DATA OF PATIENT  Name : Mrs. Shashikala  Age : 37 Years  Sex : Female  Religion : Hindu  Socio economic status : Middle class  Marital status : Married  Education status : 9th Standard  Occupation : Peon (Aaya) in school.  Date of admission : 02/07/17  Date of discharge : 09/07/17 2
 Ward : Female General Ward  Source of history : Patient  Case taken on : 07/07/17  Consultant doctor : Dr. Nayan  O.P No : E-20851  I.P. No : 2624/17  Address : # Nelamangala 3
PRADHAN VEDANA  C/O Sputhna in both hasta pradesha associated with sotha, daha, srava yukta pidakas and kandu since 3 years. 4
ANUBANDHA VEDANA  Stabhdhata in hasta pradesha when srava dries up 5
VEDANA VRUTTANTA  Patient is suffering from pidakas, all over the body associated with kandu on and off since 3 years and subside on medication. The pidakas develop any where in the body and subsides on medication. 3 months back when she resumed her work after which rashes appeared with sputhana in both hasta pradesha associated with shotha, and srava yukta pidakas with kandu since 3 years . 6
 Presently the patient has severe lesions in her both hand and itching all over the body with healed marks of previous lesions. Rashes appeared extensor surface of b/l hand and left palm with severe itching and it spreads to right palm and b/l foot region due to severe itching all fingers became oedematous and multiple fluid filled lesions appeared on the palms which burst open, oozing clear fluid which was foul smelling because of the swelling of the fingers patient is unable to do closing and opening of the fist. 7
 After the lesion bursted it was associated with burning sensation and pricking type of pain .  For the above complaints she got admitted to SKAMCH & RC 8
POORVA VYADHI VRUTTANTA  Nothing contributory.  Patient is not a k/c/o Diabetes Mellitus, Hypertension, Tuberculosis, Asthma 9
TREATMENT HISTORY IN SAPTHAGIRI HOSPITAL (12/12/16 to 24/12/16 ) 1) Inj. Avil 0-0-1 (IM) 2) Inj. Betnisol 1-0-1 (IV) 3) Clonate lotion (E/A) @ night Advice on discharge 1) Tab Teczine 0-0-1 2) Sper lotion (morning) 3) Clonate lotion (night) 10
FATHER MOTHER HUSBANDPATIENT SON KAUTAMBIKA VRUTTANTA All family members are said to be healthy. No one is suffering from similar set of complains.
VYAKTIKA VRUTTANTA  Diet : Mixed (non veg 2 to 3 times in a month)  Appetite : Moderate  Bowel : once per day (constipated)  Bladder : 4 to 5 times/day (Occasionally burning 1 to 2 times/night. Micturation)  Sleep : Disturbed  Habit : Tea / coffee 3-4 times/day Rajo vruttanta  Menarche - @ 15 years of age  Cycle – Irregular till age of 26, later said to be regular 12
 Present M.C. 3-5 days 28-30 days  L.M.P. – 27/6/17  Presentely no history of dysmennhorea  Old History 8-10 days of bleeding  Married @ the age of 26 PRASAVA VRUTTANTA  G2 P1 L1 A1 D0  P1 - FTND (Son) 13 year age  Underwent tubectomy after 3 years i.e., @ 29 years of age due to restraint relationship with her husband. 13
GENERAL PHYSICAL EXAMINATION  General Condition : Fair.  Built : Moderately built.  Nourishment : Moderately Nourished.  Pallor : Absent.  Oedema : Present over both hands  Nails : Pitting  Cyanosis : Absent.  Icterus : Absent.  Lymphadenopathy : Absent.  Pulse :78 bpm. 14
 BP :120/80 mmHg.  R/R :18/minute.  Tongue :Coated.  Height : 1.55 m  Weight : 57.5 Kgs  BMI : 23.95 15
PER ABDOMEN EXAMINATION  Inspection – Shape of abdomen – Scaphoid Umbilicus – Normal, Inverted Hyperpigmentation scars over abdomen Stria marks present Palpation – Soft , no tenderness, No organomegaly  Percussion – Tympanic sounds heard except the area of Liver dullness.  Auscultation – Peristaltic sounds heard. 16
RESPIRATORY SYSTEM  INSPECTION  Shape of chest - Bilaterally symmetrical  PALPATION  Trachea - Centrally placed  Tactile Vocal Fremitus -Normal  PERCUSSION  Resonant sounds heard except the cardiac dullness.  AUSCULTATION  Normal Vesicular Breath Sounds heard 17
CARDIO VASCULAR SYSTEM  INSPECTION - No scar, No swelling .  PALPATION - Non tender, Apex Beat felt at 5th intercostal space 9 cm from the mid sternal line.  PERCUSSION - Defined Area of cardiac dullness.  AUSCULTATION - S1 and S2 heard. No added sounds heard. No murmurs heard. 18
CENTRAL NERVOUS SYSTEM  Patient is conscious, well oriented to time, place and person.  NAD 19
INTEGUMENTARY EXAMINATION Skin Colour – Normal skin colour Lesio - Secondary Character – Size -: Small Colour -: Dark black Shape -: Asymmetrical Individual Lesion Extensor surface – Papule Palm, Soles – Flake Scales present Nature – Dry Flake 20
Itching – Present Discharge – Absent (present when new lesion occur) Distribution of lesion – Symmetrical extensor surface On exposed body parts Superficial sensation of lesion – Normal Candle grease sign – Positive Auspitz sign – Positive Koebner phenomenon - Positive 21
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DASHAVIDHA PARIKSHA 1) प्रकृ ति: –: Vata Pittaja. 2) सारतः –: Madhyama. 3) संहनि –: Madhyama. 4) प्रमाणतः –: Height - 1.55 m - : Weight – 57.5 kgs. 5) सात्म्यि –: Madhyama. 26
6) सत्मवि –: Madhyama 7) आहर शक्ति -: अभ्यवहरण शक्ति – Avara -: जरण शक्ति – Avara 8) व्यायाम शक्ति –: Avara 9) वयः –: Madhyama 10) ववकृ ति –: Pravara 27
NIDANA PANCHAKA NIDANA : Viruddhahara, mandagni, ati vyayama after snigdha bhojana, snana after bhojana in the night everyday, chinta, shoka, uses of acidic solution for cleaning in school SAMPRAPTI GHATAKA:  Dosha : Tridosha  Dushya : Twak, Mamsa, Rakta, Lasika.  Srotas : Rasa, Rakta, Annavaha 28
 Sroto dusti : Sanga  Agni : Jathragni  Ama : Jathragni  Udbhava sthana : Twak, Mamsa, Rakta, Lashika  Sanchara sthana : Sarvasarira  Vyakta sthana : Twak, Mamsa  Roga marga : Bahya  Vyadhi Svabhava : Chirakari.  Sadhya asadhyata : Krichra sadhya. 29
SAMPRAPTI Nidana sevana Tridosha prakopa Spreaded in triyak gata shiras Twak, Rakta, Mamsa, Lasika Dosha-Dushyas takes sthanshanshraya in Twak Leads to mandaloutpatti Kustha cont… 30
Kustha Viruddhopkrama or Nidana sevana Causes Flaring up of lesions Resulting to Vaipadika 31
POORVAROOPA ROOPA Sputhna in both hasta pradesha associated with sotha, daha, srava yukta pidakas and kandu.  UPASAYA : Aushadha sevana.  ANUPSAYA: Nidana sevana. 32
VYAVECHADAKA NIDANA inclusion exclusion Vaipadika pani, pada, sputhana, tevra vedana, kandu, raga, red colour pidakas Vicharchika kandu, srava in pidikas, krushna shyava varna,) Eka kustha Krushna varna, aswedana Vruna vastu Pama Rakta varna pidakas, kleda yukta srava, ati vedana, hastha , kurpara sandhi pradesha Sweta, shyama varna pidakas, nitamba pradesha, Charma dala Kandu yukta, toda Rakta varna 33
DIFFERENTIAL DIAGNOSIS Inclusion Exclusion Pustular psoriasis Nail beds, palms, soles Fever, trunk, extrimities, Echzema Primary lesions are erythematous macules, papules and vesicles than patches and plaques. Atopic dermatitis with Hand dermatitis Aggravated by repeated wetting and by washing of the hands with harsh shoaps, detergents, and disinfectants, dryness, pruritis, Nails pitting Psoriasis (plaque) Palms Well defined erythematous plaques with silvery scale, with predilection for the scalp, extensor surface, sub mammary or axillary 34
35 Palmoplantar psoriasis Scaly plaques, thickening and scaling of the entire surface of palms without redness soles Allergic dermititis Pruritic, eczematous dermatitisinitially localized to the primary site of allergen exposure,during acute phase edema, erythema and vesicle formations as the vesicles rupture oozing papules plaques appears Irritant contact dermititis Burning sensation more with above symptoms
36 Lepromatous leprosy Rash – numerous small symmetrical hypopigmented macules with normal sensation and indefinite edeges Face, extensor surface of limb and upper trunk, sparing the midline of back, axillae, groins, scalps
VYADHI VINASCHAYA  Kustha with Vipadika  Psoriasis with Irritant contact dermatitis 37
CHIKITSA VRUTTANTA DATE LAKSHANA CHIKITSA OBSERVATION 02/07/17 Burning sensation in the palm region with itiching all over the body Snehapana with aragwadadhi mahatikta ghrita 30 ml 03/07/17 Burning sensation in the palm region with itiching all over the body Snehapana with aragwadadhi mahatikta ghrita 60 ml 38
DATE LAKSHANAS CHIKITSA OUTCOME 04/07/1 7 Burning sensation in the palm region with itiching All over the body Snehapana with aragwadadhi mahatikta ghrita 90 ml Itiching Increased slightly 05/07/1 7 Burning sensation in the palm region with itiching all over the body Snehapana with aragwadadhi mahatikta ghrita 120 ml •Itiching reduced slightly 39
DATE LAKSHANA CHIKITSA OUTCOME 06/07/17 Burning sensation in the palm region with itiching all over the body Sarvanga abhyanga with suryapaki talia f/b baspa sweda day 1 07/07/17 Burning sensation in the palm region with itiching all over the body Sarvanga abhyanga with suryapaki talia f/b baspa sweda day 2 Burning sensation increased 40
DATE LAKSHANA CHIKITSA OUTCOME 08/07/17 Burning sensation in the palm region with itiching all over the body Sarvanga abhyanga with suryapaki talia f/b baspa sweda day 3 Burning sensation reduced 09/07/17 Burning sensation in the palm region with itiching all over the body Virechana karma with Trivrut avaleha 50 gm with 100 ml triphala kashaya No of vegas 16 She had 2 episodes of vomiting(reduced after taking nimbu water) 41
PROPOSED LINE OF TREATMENT  Snehapana with mahatiktaka ghrita  Sarvanga abhyanga with Marichadi taila  Virechana with Trivrut, Danti & Triphala with souveeraka  Manjisthadi kwatha  Tandula lepa  Unmatta taila for external application  Dhattura beeja kalka lepa  Kanaka bindu arista with krutmala kwatha  Tab – Arogya vardhini  Tab – Gandhak rasayana  Mustadi churna for Shotha  Bhallataka rasayan  Tuvarak rasayan (Ah.Chi.19/53)  Tuvaraka taila 10 ml for internal purpose kostha suddhi 42
PATHYA & APATHYA 43  Laghu aahara, tikta rasa pradhana, ghruta, bhallatak, triphala, nimba, purana dhanya, jangala mamsa, mudga, patola,  Laghu vyayama, Siddhartha snana, abhyanga  Viruddhara (amla, payo, dadhi, anupa mamsa, matsya, guda, tila)  Divaswapna, mala-mutra vega dharana.
THANK YOU 44
 Su su 9/6  Ubhaya gata shodhana  Twak gata – alepa chikitsa by shodhana  Shonita gata – Samshodhana, kashaya pana, shonitavsechana  Mamsa gata – Shodhana, aalepana, kashayapana, rakta mokshana, arista prayoga, mantha prayoga, prasha prayoga  Medo gata – Bhallataka, shilajita, swarna makshika, guggulu, agaru, tuvaraka, khadira, asana, ayaskriti,  Later dhatus it become asadhya so no chikitsa 45
46 Kapala Kustha Vata dosha pradhanata Krushna-aruna varna Ruksha Parusha Tanu Toda vahula Alpa kandu Alpa daha Alpa puya Audambara Kustha Daha Kandu Ruja Redness Kapila varna Pakva phala sannibham Mandala kustha Sweta and rakta varna Sthira Styana Snigdha Mandala akriti (coin shaped) Kruchrounnata Hrushyajihwa kustha Karkasha Shyava Vedana yukta Rakta varna over edeges Hrushya jihva sannibham
Pundarika kustha Sweta varna yukta Red 47
VEDANA VRUTTANTA Patient was apparently healthy 3 years back suddenly she developed rashes over the face associated with itching sensation. She also noticed blackish discolouration of upper lip and there was thickening of skin along with itching for this she consulted Adarsh clinic and was prescribed with some oral medication and topical applications (details are not known) After 3-4 days of taking them she developed severe itching in both eyes and ears and also rashes spread to whole body. 48
She also developed ulcers in the mouth and cracking of the angle of the mouth bilaterally which was very painful. For this she consulted another clinic there they suggested some investigation all was in normal. Than prescribed some medication and ointments for 3 months. Initially symptoms relieved after taking medication for 1 month later suddenly developed a fluid filled lesion over her right arm in flexor aspect which spread to forearm within 20 days associated with severe itching, pricking type of pain and foul smell and clear liquid oozing from it. 49
Meanwhile she got loose stools on and off with a gap of about 8-10 days three times. No of episodes of watery loose stools was 10 – 20 times. She used to take tab Eldopar everytime it occurred and get relief. Pt felt that she is getting loose stools because of the oral medications which was given for the rashes so she discontinued after few days her symptoms like itching sensation all over the body and in eyes, ears, buttocks got aggravated. Thus for the above she got admitted in Saptagiri hospital for 10 days. 50
They did some blood investigations and injectable were given. She found moderate relief as the ulcer over the right forearm completely healed, itching in the eyes and ears reduced. But itching sensation all over the body still persisted (on itching she used to get rashes) after 4 months , (rashes appeared extensor surface of b/l hand and left palm on severe itching. And it spreads to right palm and b/l foot region due to severe itching all fingers became oedematous and multiple fluid filled lesions appeared on the palms which burst open , oozing clear fluid which was foul smelling because of the swelling of the fingers pt is unable to do closing and opening of the fist.) 51
 After the lesion bursted it was associated with burning sensation and pricking type of pain . For the above complaints she got admitted to skamc h&rc 52
 Tiktashatpalak ghruta (ch.chi.7/140-143)  Mahatiktaka ghruta (ch.chi.7/144-150)  Mahakhadira ghruta (ch.chi.7/152-156)  Khadira, nimba, darvi ghruta (ch.chi.7/135)  Sarvakushta- By bhallataka taila, tuvaraka taila etc. (Su.Chi.9/7)  Kusthaghna hitakar taila (ch.chi.7/119)  Vipadika hara ghruta-taila (ch.chi.7/120,121)  Swetakarveradh taila  Swetakarverapallavadh taila  Tiktekshvakadi taila  Kanakakshiri taila  Vipadikaya dhatturbija taila  Aarogyavardhini vati (R.RS.)  Saptasama gutika  Triphala gutika  Gandhaka rasayana  Panchatiktaghrita guggulu Marichaditailam, Somarajitaila,  Chitraka rasayan  Bhallataka rasayan  Tuvarak rasayan (Ah.Chi.19/53)  Bhallatakavaleha, 53
CONTENTS Introduction  Shodhana  Shamana  Rasayana  Kustha  Kustha bheda  Mahakustha  Kshudrakustha  Vamana  Virechana  Basti  Nasya  Raktamokshana  Samanya chikitsa  Rasayana chikitsa  Conclusion 54
INTRODUCTION  Skin that covers the major part of the body when it is diseased causes social stigma. It is important to maintain the health of skin in order to ward off various skin diseases explained under the heading of ‘Kushta’.  Any disease in Ayurveda is managed with Shodhana, Shamana & Rasayana chikitsa.  The same is true for Kushta.  It is important to understand the concept, indication and appropriate use of these to get optimum results 55
SHODHANA  यदीययदहहदोषान ्पन्चधा शोधनं च िि ्। तनरुहो वमन ्ं कायशशरोरेकोस्त्रववस्त्रुति: ॥  Shodhana is the process by which vitiated doshas are eliminated from the body through the nearest orifice. (अ.ह्.सू 14/5)  स्त्थानाद् बहहनेयेदूर्धवयमर्धयो वा मलसंचयम । देह्ंंस्त्ंशोधनं ित्मस्त्याद् ॥(शा. स.पू.4/9)  Drugs which dislodge the body wastes from their places and expel them forcibly either in upward or downward direction are deha samshodhana. 56
TYPES 1. तनरुह् 2. वमन 3. ववरेचन 4. शशरोववरेचन् 5. रतत्ममोक्षण् 57
SODHANA -INDICATION  अववपाक  अरुचच  स्त्थौल्य  पाण्डुिा  गुरुिा  तलम  वपडका  कोठ कण्डू  अतिय  आलस्त्य  श्रम  दौबयल्य  अतिदुगन्ध  अवसाद्  कफवपत्त उत्मतलेशो  अतनद्रा  अतितनद्रा  िन्द्रा  तलैब्य  अबुचधत्मव  अप्रशस्त्ि स्त्वप्न दयशनम्  बलवणयप्रणाशश्र्च िृप्यिो बृंहणैरवप
 BENEFITS :-  एवं ववशुर्धद् कोष्ठस्त्य कायक्ननराशिवधयिे । .............िस्त्माि् स्त्ंशोधन्ं काले युक्तियुति ्ं वपवेन्नरे ॥(च.सु16/17- 19)  Charaka while elaborating the effects of Samshodhana says that it enhances Kayagni, Upashamana of vyadhi & health returns to normal.  Indriya, Manas, Buddhi, Varnas become clear & acquires bala, pusthi, apatya, vrishata. His aging is retarded & he lives a long life free of diseasea. Hence he emphasized to take Samshodhana at a proper time & skillfully administered. 59
 IMPORTANCE :-  दोषा कदचचि कु प्यक्न्ि क्जिा लंघनं पाचने । क्जिा स्त्ंशोधनेयय िु न िेषां पुनरुर्धव ॥ (च.सू.16/20)  Charaka has said that the doshas controlled by Samshamana are having the possibility of reprovocation while there is no such probability in case of the control of the doshas by Samshodhana. 60
SHAMANA  न शोधयति यदोषान् समान्नोदीरयत्मयवप । समीकरोति ववषमान् शमन्ं िच्च सप्त्मधा ॥ पाचनं दीपन्ं क्षुत्तड्वव्यायामािपमारुिा । ब्रंह्ंण्ं शमन्ं त्मवेव्ं वायो वपत्ततनलस्त्य च ॥ (अ.ह्.सू.14/6,7)  The process by which vitiated doshas are pacified or nullified is called Shamana.  न शोधयति न द्वेक्ष्ि समान्दोषांस्त्िथोर्धदिान्। समीकरोति ववषमाव्यशमन्ं िधथास्त्रुिा ॥ (शा.पू. 4) Drugs which bring down the increased dosha to normal without expelling them out and not interfering with the dosha which are normal are called shamana (palliatives) . 61
RASAYANA  लािोपायो हह शस्त्िानां रसदीनां रसायनम ्। (च.चच.1/1/8)  यज्जरा व्याचध ववक्र्धव्ंस िेषज्ं िद रसायनम ॥(शा.pu 4/14)  Benefit  दीघाययु स्त्रतिय मेधामारोनय्ं िरुण्ं वय् ।  प्रिावणयस्त्वरौदयं देहेक्न्द्रयबल्ं परम्॥  वाक्तसक्र्धद प्रणतिं काक्न्िं लििे ना रसायनाि्। (च.चच.1/1/7,8) 62
Types  कु हिप्रावेशशक चरक (च.चच. 1/1/16)  वािािवपका वानिट् (अ.ह्.उ.39/5)  का्य (बल-बुक्र्धद-व्रक्र्धद)  नेमेवत्तक् (व्यचध नष्ट्) (dalhana सु.चच27/3)  आजाक्स्त्रक (दुनध-घ्रुि सेवन्ओज व्रुक्र्धद)  स्त्ंशोधन्  स्त्ंशमन् 63
 वय् स्त्थेययकराणांमयन्ं लािोपायो रसायनम्; वधयक्ं स्त्थापकमप्राप्िमापक्ं वेत्मयथय (ड्वल्हण्)  Before administring any rasayan first do kostha suddhi with Haritakyadi choorna along with ushna jala. (च.चच.1/1/25-28)  Rasayana should be used in युवा & मर्धयमवस्त्था as the colour not look good on malina vastra so as the rasayana can not be beneficial in the asudha sarira (सु.चच.27/3,4), (अ.ह्.उ.39/11) 64
RASAYANA SEVANAAYOGYA PURUSHA  Anatmavaan  Aalaso  Daridra  Pramadi  Vyasani  Papakrud  Bheshajaapmanani (सु.चि.30/4) 65
KUSTHA  कुष्णाचत च ःशेषेण् चवलेख ््ं करोचत अ्ंग् प्रत्यङ्च इचत कुष्ठम् ॥ (चसद्धान्त् कौचमचि)  कुष्ठ is a condition in which different body organs , dhatus, updhatus, are destroyed & contempted.  त्मवच कु वयक्न्ि वेवण्य्ंय दुष्िां कु ष्ठमुशाक्न्ि िि । One which produces discolouration over skin region is said to be kustha. कालेनोपेक्षक्षि्ं यस्त्मात्मसवं कु ष्णाति िद् वपु ॥ During the lapse of time, it makes the entire body look ugly. (अ.ह्.तन.14/3) 66
कु ष्ठ िेद  कु ष्ठातन सप्िववधान्यष्िादशववधान्यपररसंख्येयववधातन च । (च.तन.5/4 ) 67 सप्िववधा अष्टादशविधा अपररसंख्ये महाकु ष्ठ 7 क्षुद्र कु ष्ठ 11 अष्िादश कु ष्ठ
महाकु ष्ठ महाकुष्ठ लक्षण िोष प्रधान्यत कापाला कृष्ण, अरुण, कपालाभ, रुक्ष, परुष, त ु, अचततोि, चवषम्ं स्मृतम. वातज औदुम्बर िाह, राग, कण्डुयुक्त,रुक, परीत, रोमचपञ्जरम, उिुम्बरफलाभास. चपत्तज मण्डल श्व्वेत, रक्तवणण, चस्िर, स्त्या , चस् ग्ध, उत्सन् मण्डलम, कृच्छ्र् साध्य. कफज ऋष्यजिह्व वेि युक्त, रक्तपयणन्तमन्त:श्वयाव, यदृष्यचजह्व स्ंस्िा ्ं. वतचपत्तज पुजण्िक श्वेताभ , रक्तपयणन्त like पुचण्िकिल, उन् त , िाह युक्त. चपत्तकफज जिध्म श्वेत, ताम्र, त ु lesions, usually situated on the उरु from which scales like अलाबूपुष्पवणं fall off on rubbing वातकफज काकण गुञ्ज वणण, सपाक, चतव्र वेि , असाध्य. चििोषज 68
क्षुद्र कु ष्ठ क्षुद्र कु ष्ठ लक्षण िोष प्रधान्यत एककु ष्ठ चमायख्यं स्त्वेदरहहि, मस्त्यशकलोपमम, महावास्त्िु . बहलं , हक्स्त्िचमयवि . वाि-कफ वाि-कफ ककहिि श्यावं, ककण्खरस्त्पशय, परुषं, ककहििं स्त्मृिम ्. वाि-कफ वैपहदकं पाणणपादस्त्फु िनं, तिव्रवेदना. वाि-कफ अलसक कण्डुयुति, सरागैश्र्च, गण्डैरलसक्ं वाि-कफ दद्रुमण्डलं कण्डु, राग, मुदगावि वपडडका वपत्त-कफ 69
क्षुद्र कु ष्ठ लक्षण िोष प्रधान्यत चमयदल कण्डु, स्त्फोि, रतिवणय, सशूल, असहहष्णुिा, रुग. वपत्त-कफ पामा श्वेि, अरुण शयाव वणय , कण्डुयुति वपडका वपत्त-कफ ववस्त्फोि िनु, त्मवकयुति, श्याव अरुण वणायत्ममक वपडका वपत्त-कफ शिारु रतिश्याव वणायत्ममक, दाहयुति, बहुव्रणी कु ष्ठ . वपत्त-कफ ववचचचयका सकण्डु, श्याव वणय वपडक, बहुस्राव कफ 70
कु ष्ठगि दोष लक्षण  वातज : रौक्ष्य्ं,शोष, तोि, शूल, स्ंकोि ्ं, पारुष्य्ं, खरा भाव, हषण, श्वयाव अरुण्ं .  चपत्तज : िाह, राग, पररस्राव,पाक, चवस्रगचन्ध, क्लेि, अ्ंगपत ्ं.  कफज : श्र्वेत्य, शैत्य,कण्डु, स्िैय, उत्सेध, गौरव, स् ेह, क्लेि, जन्तुचभरचभक्षण्ं (ि.चि. ७/३४-३६) 71
कु ष्ठोत्मपवत्तकर दोष - दूष्या 1) वाि 2) वपत्त त्ररदोष 3) कफ 4) त्मवक 5) रति दूष्य 6) मांस 7) लशसका When these seven dravyas are got affected than they will cause for कु ष्ठोक्त्मप्त्त. 72
सप्िधात्मवश्र्य कु ष्ठ लक्षणा  त्मवक्: - Toda, Vaivarnyam, Rukshatwa  रति: - Rakta: Sweda, Swapa, Swayathu.  मांस्: - Sphota in pani & pada, kledatwa in joints.  मेदस: - Kounyam & gatikshaya for angas, dalana of angas.  अक्स्त्थ & मज्जा:- Nasa bhanga, netra raga, swarakshaya, krimis in kshatas.  शुक्र:- Swadara paktya badhanam. (A.H.Ni.14) 73
धािुगि लक्षणा  स्त्पशयहातन स्त्वेदनत्मवमीषत्मकण्डुस्त्च ्जायिे ।  वेवण्य ्ंय रुक्षिावस्त्च ्कु ष्ठे त्मवचच समचश्रिे ॥  त्मवतस्त्वापो रोमहषयस्त्च ्स्त्वेदस्त्याशिप्रवत्मनयम्।  कण्डूववयपूयकस्त्चेव ्कु ष्ठे शोणणिसंचश्रिे॥  बाहुल्यं वतरशोषस्त्च ्काकय स्त्य ्ं वपड्वकोद्गम् ।  िोद स्त्फोि क्स्त्थरत्मवं च कु ष्ठे मांससमाचश्रिे ॥ 74
 दौगयन्र्धयमुपदेहस्त्च्पूयोथ कक्र्यस्त्था ।  गारणां िेदनं चावप कु ष्ठे मेद समचश्रिे ॥  नासािंडोक्षक्षरागस्त्च्क्षिे च कक्रशमस्िव ।  िवेि्स्त्वरोपघािस्त्च्हक्स्त्थमज्जसमचश्रिे ॥  कौण्यं गतिक्षयोन्डानां स्िेद् क्षिसपयणम ्।  शुक्रस्त्थान्गिे शलन्डे प्रागुतिातन िथेव च ॥ (सु.तन.5/21-26) 75
सामान्य चचककत्मसा  सवं त्ररदोषजं कु ष्ठं दोषाणां िु बलाबलम ्। यथास्त्वेलयक्षणेबुयर्धद्वा कु ष्ठानां कक्रयिे कक्रया ॥ दोषस्त्य यस्त्य पश्येि ्कु ष्ठेषु ववशेक्ष्लन्नरुद्ववति ्ं । िस्त्येव ्शमं कु यायत्मत्त ् पर्ं चानुबन्र्धस्त्य ॥ (च.चच.7/31,32) All kustha are tridosaja so they should be treated by knowing there doshobala abala & lakshnas. First do samana in those kusthas who are having there increased doshas than treat apradhan doshas. 76
धािुगिानुसार् चचककत्मसा  त्मवक् प्राप्िे- Shodhanam, Alepanam.  शोणणि्प्राप्िे- Shodhanam, Alepanam, Kashayapanam, Shonitavasechanam.  मांसप्राप्िे- Shodhanam, Alepanam, Kashayapanam, Shonithavasechanam, Arishtapana, Manthaprayoga, Prasaprayoga.  मेदसप्राप्िे- Shodhanam, Shonithavasechanam, Bhallathaka, Shilajatu, Dhatumakshikam, Guggulu, Agaru, Tuvaraka, Ayaskriti.  From अक्स्त्थ onwards- असार्धय.  Rest of all dhatugata condition of kustha should be considered incurable and left untreated. (सु.चच.9/6) 77
CHIKITSA SUTRA  वािोत्तरेषु सवपयवयमनं श्लेष्मोत्तरेषु कु ष्ठेषु । वपत्तोत्तरेषु मोक्षो रतिस्त्य ववरेचनं चाग्रे । वमनववरेचनयोगा: कल्पोतिा: कु क्ष्ठनां प्रयोतिव्या । प्रच्छनमल्पे कु ष्ठे महति च शस्त्िं शसराव्यधम ् । बहुदोष: संशोर्धय: कु ष्ठी बहुशो अनुरक्षिा प्राणान ्। दोषे ह्ंयतिमारहृिे वायुहयन्यादबलमाशु । स्त्नेहस्त्य पानशमष्िं शुद्धे कोष्ठे प्रवाहहिे रतिे । वायुहहय शुद्धकोष्ठं कु क्ष्ठनमबलं ववशति शीग्रम ्। (च.चच. 7/39- 42) 78
 Vata - Sarpi  Kapha - Vamana  Pitta - Raktamokshana, Virechana Chakrapani Commentary  अग्रे इति सवपयराहदषु योज्यं; िेन वािोत्तराहदषु सवपयराहद प्रथमं कियव्यं अग्र means it is the foremost and the best to be done. After that only any other treatment should be adopted 79
SHODHANA IN KUSTHA  पक्षाि्पक्षाच्छदयनान्यभ्युपेयाद् मासान्मासाि् स्त्रसनं चावप देयम्।  स्त्राव्यं रतिं वत्मसरे हह द्ववरल्प्ं नस्त्यं दधाच्च त्ररराराक्त्मरराराि्॥ (सु.चच.9/43),(अ.ह्.चच.19/96)  Vamana- Pakshatpakshat. (15 – 15)days  Virechana- Masanmasan.(1 – 1)month  Rakta mokshanam- Shashte shashte masya. (6 – 6)months  Nasya- Triratrat triratrat. (3 – 3)days  Basti 80
VAMANA  िरदोषहरण्. उर्धवय िाग्ं वमन्स्त्ंञक्ं ॥ (च.क.1/4)  अपतववपत्त्शश्लेष्मणौ बलार्धव्ंय नयेिु यि वमन्ं िचध ववननेय्ं ॥ (शा.पू.ख्.4)  INDICATION  कफे ववद्र्धयाद्व्मन्ं स्त्ंयोगे वा कफाल्बणे ।  नवज्वरातिसाराध् वपत्तास्रगा जयक्षक्षमण् ॥  कु ष्ठमेहापचीग्रक्न्थश्ली पदोन्मादकाशसन् ।  श्वासहल्लासवी सपयस्त्त्मन्यदोषोर्धवयरोचगण ॥ (अ.ह्.सू.18/1-3) 81
 Contraindication  Garbhini, sukumar, rooksha, kshudita, shokarta, krusha, durbala.  Diseased condition  Vataprakopaja – Udavarta, Gulma, Vatavyadhi  Marmaja vyadhi – Hridroga, Mutragata, Timira  Maharoga – Arsas, Udara (अ.ह्.सू.18/3-5), Kala  In vasant rutu (च.शस 8) 82
 दोषोक्त्मतलष्िे ह्रदये वा्य् कु ष्ठेषु चोर्धवयिागेषु । कु िजफलमदनमधुके सपिोलेतनय्बरसयुतिे ॥ शीिरस पतकरसो मधूतन मधुकं च वमनातन । (च.चच.7/43,44) Vamana in श्लेष्मोत्तरेषु कु ष्ठेषु . Vamana Yogas  Kutajaphala,Madhanaphala,Yastimadhu churna + Patola and Nimba rasa yukta  Sheetha rasa(शीिरस: शीि कषाय:) with madhu + yastimadhu churna. 83
VIRECHANA िर दोषहरण ्ं अधोिाग ्ं ववरेचन संझा | उिय ्ं वा शरीरमल ववरेचनाि ्ववरेचन स्त्ंझा ॥ (च ्.क.1/4) INDICATION Kustha, jvara,...........................pitta vyadhi vishesed rogadhayayoktasch (ch.si.2/13) Virechana is best for pitta & rakta pradosaja 84
 CONTRAINDICATION  Avirechyastu  Subhag kshata  Durbalendriya  Durbalendriya  Alpagni  Kamadivyagra  Ajirna  Navajvara  Madatya  Aadhmana  Salyardita  Garbhini  Kshatkshen  Atisthoola  Atikrusha  Bala  Vruddha  Durbala  Upavasa  Maithun  Chinta  Vyayama (च.शस.2/11) 85
 कु ष्ठेषु त्ररव्रिा दन्िी त्ररफला च ववरेचने शस्त्िा ।  सौववरक्ं िुषोदकमालोडनमासवास्त्च ्सीधूतन ॥  श्ंसन्त्मयधोहराणां यथाववरेक्ं क्रमस्त्ष्चेष्ि । (च.चच.7/44,45)  VIRECHANA YOGAS Trivrut, Danti & Triphala with souveeraka, tushodaka, alodana & sidhu 86
BASTI  बक्स्त्िना दीयिे इति बक्स्त्ि ॥(अ.ह्.सू.19/1)  बक्स्त्िशिदीयिे यस्त्माि्िस्त्माि्बक्स्त्िररति स्त्रि ॥ (शा.उ.ख्5/1)  Acc. To Vruhattrayi Niruha & Anuvasana basti is contraindicated in kustha. (च.शस.२/14), (सु.चच. 35/21), (अ.ह्.सु 19/4-6)  दाववयब्रहिीसेव्ये पिोलवपचुमदयमदनक्रिमाले ।  सस्त्नेहेरास्त्थाप्य कु क्ष्ठ सकशलंडेयवमुस्त्िे ॥  वािोल्बण्ं ववररति्ं तनरुढ्मनुवासनाहयमालक्ष्य्।  फलमधुकतन्बकु िजे सपिोले साधयेत्मस्त्नेहम ॥(च.चच.7/46,47) 87
 If there is excess of vata even after shodhana – asthapana & anuvasana  Sneha – madanaphala, madhuka, nimba, kutaja, patola  नास्त्थाप्या: कु क्ष्ठन: (च.शस.२) Cakrapani Commentary िथास्त्थापनानुवासनैक सार्धयायां अवस्त्थायां कियव्ये एव: In excessive vitiation of vata – no alternative - basti  प्रवृवत्ततनवृवत्त लक्षण सयोगे िु गुरुलाघवं संप्रधायय स्यगर्धयवस्त्येि् (च.वव.८/१३४) If there is lakshana which is simultaneously responsive and irresponsive to a given chikitsa – vaidya can decide the chikitsa – lakshana – guru or laghu 88
NASYA  उर्धवय जरुववकारेषु ववशेषस्त्य शमष्यिे ।  नासाहह शशरसो द्वार्ं िेन्िदव्याप्य क्ह्ंंि िाि्॥ (अ.ह्.सु 20/1)  औषधम्औषध्शसर्धद्ं स्त्नेहो वा नाशसकाभ्यां दीयिे इति नस्त्यम् ॥ (सु.चच.40/21) 89
 INDICATION  Manyastambha  Galagraha  Hanugraha  Pinasa  Vyanga  Apatanaka etc (च्.शस.2/22)  CONTRAINDICATION  Ajirna  Bhuktavata sneha, madhya, jala  Snata sirasa  Snanachisirasa  Navajvara  Garbhini etc (च्.शस.2/21) 90
 सेन्धवदन्िीमररचं फणणञझक वपक्प्पली करन्ज्फलम्।  नस्त्यं स्त्यात्मसववडंग कक्रशमकु ष्ठकफप्रकोपघ्नम्॥  वेरेचतनके धूयमे श्लोकस्त्थानेररिे प्रशा्यक्न्ि ।  क्रमय कु ष्ठककलासा प्रयोक्जिेरुत्त्शमांड्वस्त्था ॥ (च.चच.7/48,49) Saindhava, Danti, Maricha, Phanijjhaka, Pippali, Karanjaphala, Vidanga – Kapha pradhana kushta with krimi anubandha 91
 च.सू ५/२६-२७  Vairechanika dhumapana  श्वेिा ज्योतिष्मति चैव हररिालं मन:शशला । गन्धाश्च अगरुपरार्धया धूमं मूधयववरेचने । 92
RAKTAMOKSHANA Raktamokshana is mainly two types  1)SASTRA  A) Pracchana  B) Siravyadha (venesection)  2) ASASTRA  A) jaloukavacarana – application of leeches (pitta dosha)  B) Sringavacharana – application of cow’s horn (vata dosha)  C) Alabu avacharana – aplication of gourd (kapha dosha) 93
INDICATION (SU.SU.25/12-15) (A.H.SU.27/3-5)  Apachi  Asyapaka  Arsa  Daha  Dantapupputa  Dantavesta  Dustartava  Granthi  Sopha  Galasula  Karnapali roga  Putigraha  Raktadimantha  Raktapitta  Sitada  Raktarsha  SoushiraJihva kantaka  Krimi dantaka  Kshudra roga  Kustha  Ostaroga  Pidaka etc. 94
 CONTRAINDICATION  अववस्त्राव्या सवांग्शोफ क्षीणस्त्य चा्लिोजने तनशमत्ता ।  पांडु रोनयश्य सोदरर शोवष गशियणीणां च श्वयथव् (सु.सू 14/24) KALA  व्यिे वषायषु ववर्धयेत्तु ग्रीष्मकाले िु शीिले ।  हेमन्ि्काले मर्धयान्हे शस्त्रकालास्त्रय् स्त्रिा ॥ (सु. शा.8/10) 95
 RAKTAMOKSHANA IN KUSTHA  क्स्त्थरकहठनमण्ड्वलानां क्स्त्वन्नानां प्रस्त्िरप्रणाडीशि ।  कू चेववघट्हििानां रतिौत्मतलेशोपनेिव्य् ॥  आनूपवाररजानां मांसानां पोट्ट्ले सुखोष्णेस्त्च्।  क्स्त्वन्नौत्मसन्नं ववशलखेि्कु ष्ठं िीक्ष्णेन्शस्त्रेण्॥  रुचधरगमाथयमथवा स्रुन्गालाबूतन योज्येि्कु ष्ठे ।  प्रक्च्छिमल्पं कु ष्ठं ववरेचयेद्वा जलौकोशि ॥ (च.चच.7/50-52)  Kushta – Sthira, Katina and Mandala – Nadi & Prastara sweda  Rub with Kurcha  Rakta nirharana with Srunga / Alabu / Jalouka 96
SHAMANA YOGAS  There are innumerable shamana yogas mentioned for kushta in the form of churna, vati, lehya, kashaya, asavarista, rasoushadha, lepa, taila, gritha. It is important to know when to use what to get good results. 97
CHIKITSA YOGAS Darvi kalka or chorna with gomutra  Rasanjana with gomuta  Abhaya, vyosha, guda, tila taila for one month.  Patoladi kwatha  Lelitaka (sulphur) with jati (amalaki) swarasa mixed with honey internally intake.  Vajrashilajatu with jati swarasa  Yogaraj with jati swarasa  Kusthakuthara rasa 98
GHRUTA Vatakushta- Ghrita prepared of meshasringi, guduchi, swadamshtra, sarngeshta, dwipanchamuli.  Pittakushta- By ghrita prepared of Dhava, aswakarna, kakubha, palasa, pichumarda, parpataka, madhuka, lodhra, samanga  Kaphajakushta- By ghrita prepared of priyalasala, aragwadha, nimba, saptaparna, chitraka, maricha, vacha, kushta, bhallataka, abhaya, vidanga 99
 In pitta & Rakta- Tikta Ghritas externally & internally. Eg:  Tiktashatpalak ghruta (ch.chi.7/140-143)  Mahatiktaka ghruta (ch.chi.7/144-150)  Mahakhadira ghruta (ch.chi.7/152-156)  Khadira, nimba, darvi ghruta (ch.chi.7/135) 10 0
TAILAS  Vatakushta- Taila prepared of meshasringi, guduchi, swadamshtra, sarngeshta, dwipanchamuli.  Kaphajakushta- By taila of priyalasala,aragwadha, nimba, saptaparna, chitraka, maricha, vacha, kushta, bhallataka, abhaya, vidanga.  Sarvakushta- By bhallataka taila, tuvaraka taila etc. (Su.Chi.9/7)  Kusthaghna hitakar taila (ch.chi.7/119)  Vipadika hara ghruta-taila (ch.chi.7/120,121)  Swetakarveradh taila  Swetakarverapallavadh taila  Tiktekshvakadi taila  Kanakakshiri taila  Vipadikaya dhatturbija taila 10 1
KASHAYA  Sonitha prapta & Mamsa prapta.  Tikta kashayas; For kaphaja, pithaja & Raktaja kushtas. Eg: Laghu Manjishtadi, Madhyama Manjishtadi, Brihat Manjishtadi Kashayas, Patolamuladikwatha 10 2
CHURNA  Mustadi churna(ch.chi7/65-67)  Triphaladi churna (in numbness of skin) (ch.chi.7/68,69)  Swarnamakshika churna with gomutra (ch.chi.7/70-72)  Gandhapashana churna  Somraji chorna  Vaguji chorna 10 3
ARISTHA, ASAVA, MANTHA,PRASA  Mamsa prapta kushta. Eg: Khadirarishta,Madhwasava, Kanakabindwarishta, Triphalasava  Madvaasava in kustha & kilasa  Kanakavinduristha  Triphalasava  Kashayas made of rasanjan, aragbadha patra, kutaja, patola mula, nimba bark, khadirsara, triphala  We can use of above said drugs in the form of ghruta and taila in kustha samanartha 10 4
ALEPANA  Nirhrita asradosha  Samsodhitasayanam (Cha.Chi.7/53)  Twak prapta  Shonita prapta  Mamsa prapta (Su.Chi.9/6) Eg: Eladilepa, Kushtadilepa, Lodhrabijadilepa, Mamsyadilepa. 10 5
LEPAS  Sidhma nasak lepa (ch.chi.7/117,118)  Mandala kustha nashak taila (ch.chi.7/122-127)  Pittakusthan nashak lepa (ch.chi.7/130,131)  Vidangadi lepa  Dadrurvaadou durvadi lepa (chakradatta)  Manashiladi lepa  Dadrugajendra pralepa  Chakramardobijadi pralepa  Tranak pradeha  Kaasmarda pralepa  Molakabeej pralepa  Gandhapashad pralepa 10 6
 Karanjabijadi patra pralepa  Amaltaaspatra pralepa  Sidhma kustha gandhapashan pralepa  Sidhma kasmarda pralepa  Sidhma sarjasaadi praleepa  Siddh kusthadi lepa  Chatrahadi lepa  Edgajadi lepa  Vicharchikaya bhrustasarsapaka kalka  Vicharchika grah dhoom lepa  Tandula pralepa  Sarjasaadi lepa  Avalgujadi lepa  Sinduradi lepa  Bhallatakadi lepa 10 7
VATI  Aarogyavardhini vati (R.RS.)  Saptasama gutika  Triphala gutika  Gandhaka rasayana 10 8
GUGGULU PREPARATIONS Amrita guggulu Ekavimsatika guggulu Panchatiktaghrita guggulu 10 9
UDVARTANA  Kusthadh udvartanam churna  Nishadyaudvartanam 11 0
RASALEPA: Pashana churna + Yavakshara+ Mustard oil/ Gandhapashana+ Katu taila exposed the mixture to sunrays. 11 1
KSHARA PRAYOGA  येषु न शस्त्रं क्रमेि ्स्त्पशेक्न्द्रयनाशनातन यातन स्त्यु । िेषु तनपात्मय ् क्षारो रतिं दोष ्ं च ववस्त्राव्य ॥ (च.चच.7/54) 1) Kushtas where sastra karma is contraindicated. 2) In Sparsanendriyanasa 3) Nipatya 4) After visravana 11 2
AGADA PRAYOGA  पाषाणकहठनपरुषे सुप्िे कु ष्ठे क्स्त्थरे पुराणे च ।  पीिागदस्त्य कायो ववषे प्रदेहोगदेस्त्चानु ॥  स्त्िब्धातन सुप्िसुप्िान्यस्त्वेदनकण्डुलातन कु ष्ठातन।  कू चेदयक्न्ित्ररव्रिाकरवीरकरन्जकु िजानाम्॥  जात्मयकय तन्ब्जेवाय परे शस्त्रे समुद्रफे नेवो ।  घ्रष्िातन गोमयेवाय िि् प्रदेहे प्रदेहातन ॥ (च.चच.7/55-57) 11 3
SNANOPYOGI DRAVYAS  Ch.chi7/129,130  Siddharthaka snana churna  Darvi kwatha  Patola  Nimba  Khadirasara  Karanja  Aragwadha 11 4
ABHYANGA: Vajrakatailam, Mahavajrakatailam, Adityapaka tailam (B.P,mad.), Marichaditailam, Somarajitaila, Swetakaranjaditaila 11 5
दाहयुतिकु क्ष्ठ स्त्नान प्रयोगा  रोध्राररष्िं पद्मकं रतिसार् सप्िाहाक्षौ व्रक्षको बीजकस्त्च्।  योज्या स्त्नाने दहमानस्त्य जन्िो पेया वा स्त्याि्क्षौद्रयुतिा त्ररिण्डी ॥ (सु.चच.9/50) 11 6
RASAYAN YOGAS  Navayasa rasayana (chakradatta)  Brahmiaadi rasayan  Chitraka rasayan  Bhallataka rasayan  Tuvarak rasayan (Ah.Chi.19/53)  Medo prapta kushta  Yapya kushta  All kushtas Eg:Tuvarasthi, Bhallataka, Bakuchi, Chitrakamulam, Silajatu (Ah.Chi.19/53 11 7
GUDA  Manibhadra guda (A.H.chi.19/31,32) Modaka  Triphala modaka AVALEHA Bhallatakavaleha, Sashangavaleha, Dhatryadyavaleha 11 8
CONCLUSION  Selection of chikitsa for kushta depends on predominant of doshas  Repeated shodhana is essential for bahu doshavastha other than trying to eliminate it all at once since it weakens the patient  In excessive vata aggravated condition, basti chikitsa can be adopted  Nasya is indicated in kapha pradhana kushta and dhumapana in kushta affecting jatrurdwa  If doshas are in alpavastha we can treat with shaman line of treatment. 11 9
120 THANK YOU

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Sipra Biswas
 

KUSTHA CASE PRESENTATION

  • 1. 1 CASE PRESENTATION VINAY TIWARI FINAL P.G. SCHOLAR DEPARTMENT OF P.G. STUDIES IN KAYACHIKITSA SKAMCH&RC BANGALORE
  • 2. PREMILINARY DATA OF PATIENT  Name : Mrs. Shashikala  Age : 37 Years  Sex : Female  Religion : Hindu  Socio economic status : Middle class  Marital status : Married  Education status : 9th Standard  Occupation : Peon (Aaya) in school.  Date of admission : 02/07/17  Date of discharge : 09/07/17 2
  • 3.  Ward : Female General Ward  Source of history : Patient  Case taken on : 07/07/17  Consultant doctor : Dr. Nayan  O.P No : E-20851  I.P. No : 2624/17  Address : # Nelamangala 3
  • 4. PRADHAN VEDANA  C/O Sputhna in both hasta pradesha associated with sotha, daha, srava yukta pidakas and kandu since 3 years. 4
  • 5. ANUBANDHA VEDANA  Stabhdhata in hasta pradesha when srava dries up 5
  • 6. VEDANA VRUTTANTA  Patient is suffering from pidakas, all over the body associated with kandu on and off since 3 years and subside on medication. The pidakas develop any where in the body and subsides on medication. 3 months back when she resumed her work after which rashes appeared with sputhana in both hasta pradesha associated with shotha, and srava yukta pidakas with kandu since 3 years . 6
  • 7.  Presently the patient has severe lesions in her both hand and itching all over the body with healed marks of previous lesions. Rashes appeared extensor surface of b/l hand and left palm with severe itching and it spreads to right palm and b/l foot region due to severe itching all fingers became oedematous and multiple fluid filled lesions appeared on the palms which burst open, oozing clear fluid which was foul smelling because of the swelling of the fingers patient is unable to do closing and opening of the fist. 7
  • 8.  After the lesion bursted it was associated with burning sensation and pricking type of pain .  For the above complaints she got admitted to SKAMCH & RC 8
  • 9. POORVA VYADHI VRUTTANTA  Nothing contributory.  Patient is not a k/c/o Diabetes Mellitus, Hypertension, Tuberculosis, Asthma 9
  • 10. TREATMENT HISTORY IN SAPTHAGIRI HOSPITAL (12/12/16 to 24/12/16 ) 1) Inj. Avil 0-0-1 (IM) 2) Inj. Betnisol 1-0-1 (IV) 3) Clonate lotion (E/A) @ night Advice on discharge 1) Tab Teczine 0-0-1 2) Sper lotion (morning) 3) Clonate lotion (night) 10
  • 11. FATHER MOTHER HUSBANDPATIENT SON KAUTAMBIKA VRUTTANTA All family members are said to be healthy. No one is suffering from similar set of complains.
  • 12. VYAKTIKA VRUTTANTA  Diet : Mixed (non veg 2 to 3 times in a month)  Appetite : Moderate  Bowel : once per day (constipated)  Bladder : 4 to 5 times/day (Occasionally burning 1 to 2 times/night. Micturation)  Sleep : Disturbed  Habit : Tea / coffee 3-4 times/day Rajo vruttanta  Menarche - @ 15 years of age  Cycle – Irregular till age of 26, later said to be regular 12
  • 13.  Present M.C. 3-5 days 28-30 days  L.M.P. – 27/6/17  Presentely no history of dysmennhorea  Old History 8-10 days of bleeding  Married @ the age of 26 PRASAVA VRUTTANTA  G2 P1 L1 A1 D0  P1 - FTND (Son) 13 year age  Underwent tubectomy after 3 years i.e., @ 29 years of age due to restraint relationship with her husband. 13
  • 14. GENERAL PHYSICAL EXAMINATION  General Condition : Fair.  Built : Moderately built.  Nourishment : Moderately Nourished.  Pallor : Absent.  Oedema : Present over both hands  Nails : Pitting  Cyanosis : Absent.  Icterus : Absent.  Lymphadenopathy : Absent.  Pulse :78 bpm. 14
  • 15.  BP :120/80 mmHg.  R/R :18/minute.  Tongue :Coated.  Height : 1.55 m  Weight : 57.5 Kgs  BMI : 23.95 15
  • 16. PER ABDOMEN EXAMINATION  Inspection – Shape of abdomen – Scaphoid Umbilicus – Normal, Inverted Hyperpigmentation scars over abdomen Stria marks present Palpation – Soft , no tenderness, No organomegaly  Percussion – Tympanic sounds heard except the area of Liver dullness.  Auscultation – Peristaltic sounds heard. 16
  • 17. RESPIRATORY SYSTEM  INSPECTION  Shape of chest - Bilaterally symmetrical  PALPATION  Trachea - Centrally placed  Tactile Vocal Fremitus -Normal  PERCUSSION  Resonant sounds heard except the cardiac dullness.  AUSCULTATION  Normal Vesicular Breath Sounds heard 17
  • 18. CARDIO VASCULAR SYSTEM  INSPECTION - No scar, No swelling .  PALPATION - Non tender, Apex Beat felt at 5th intercostal space 9 cm from the mid sternal line.  PERCUSSION - Defined Area of cardiac dullness.  AUSCULTATION - S1 and S2 heard. No added sounds heard. No murmurs heard. 18
  • 19. CENTRAL NERVOUS SYSTEM  Patient is conscious, well oriented to time, place and person.  NAD 19
  • 20. INTEGUMENTARY EXAMINATION Skin Colour – Normal skin colour Lesio - Secondary Character – Size -: Small Colour -: Dark black Shape -: Asymmetrical Individual Lesion Extensor surface – Papule Palm, Soles – Flake Scales present Nature – Dry Flake 20
  • 21. Itching – Present Discharge – Absent (present when new lesion occur) Distribution of lesion – Symmetrical extensor surface On exposed body parts Superficial sensation of lesion – Normal Candle grease sign – Positive Auspitz sign – Positive Koebner phenomenon - Positive 21
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  • 26. DASHAVIDHA PARIKSHA 1) प्रकृ ति: –: Vata Pittaja. 2) सारतः –: Madhyama. 3) संहनि –: Madhyama. 4) प्रमाणतः –: Height - 1.55 m - : Weight – 57.5 kgs. 5) सात्म्यि –: Madhyama. 26
  • 27. 6) सत्मवि –: Madhyama 7) आहर शक्ति -: अभ्यवहरण शक्ति – Avara -: जरण शक्ति – Avara 8) व्यायाम शक्ति –: Avara 9) वयः –: Madhyama 10) ववकृ ति –: Pravara 27
  • 28. NIDANA PANCHAKA NIDANA : Viruddhahara, mandagni, ati vyayama after snigdha bhojana, snana after bhojana in the night everyday, chinta, shoka, uses of acidic solution for cleaning in school SAMPRAPTI GHATAKA:  Dosha : Tridosha  Dushya : Twak, Mamsa, Rakta, Lasika.  Srotas : Rasa, Rakta, Annavaha 28
  • 29.  Sroto dusti : Sanga  Agni : Jathragni  Ama : Jathragni  Udbhava sthana : Twak, Mamsa, Rakta, Lashika  Sanchara sthana : Sarvasarira  Vyakta sthana : Twak, Mamsa  Roga marga : Bahya  Vyadhi Svabhava : Chirakari.  Sadhya asadhyata : Krichra sadhya. 29
  • 30. SAMPRAPTI Nidana sevana Tridosha prakopa Spreaded in triyak gata shiras Twak, Rakta, Mamsa, Lasika Dosha-Dushyas takes sthanshanshraya in Twak Leads to mandaloutpatti Kustha cont… 30
  • 31. Kustha Viruddhopkrama or Nidana sevana Causes Flaring up of lesions Resulting to Vaipadika 31
  • 32. POORVAROOPA ROOPA Sputhna in both hasta pradesha associated with sotha, daha, srava yukta pidakas and kandu.  UPASAYA : Aushadha sevana.  ANUPSAYA: Nidana sevana. 32
  • 33. VYAVECHADAKA NIDANA inclusion exclusion Vaipadika pani, pada, sputhana, tevra vedana, kandu, raga, red colour pidakas Vicharchika kandu, srava in pidikas, krushna shyava varna,) Eka kustha Krushna varna, aswedana Vruna vastu Pama Rakta varna pidakas, kleda yukta srava, ati vedana, hastha , kurpara sandhi pradesha Sweta, shyama varna pidakas, nitamba pradesha, Charma dala Kandu yukta, toda Rakta varna 33
  • 34. DIFFERENTIAL DIAGNOSIS Inclusion Exclusion Pustular psoriasis Nail beds, palms, soles Fever, trunk, extrimities, Echzema Primary lesions are erythematous macules, papules and vesicles than patches and plaques. Atopic dermatitis with Hand dermatitis Aggravated by repeated wetting and by washing of the hands with harsh shoaps, detergents, and disinfectants, dryness, pruritis, Nails pitting Psoriasis (plaque) Palms Well defined erythematous plaques with silvery scale, with predilection for the scalp, extensor surface, sub mammary or axillary 34
  • 35. 35 Palmoplantar psoriasis Scaly plaques, thickening and scaling of the entire surface of palms without redness soles Allergic dermititis Pruritic, eczematous dermatitisinitially localized to the primary site of allergen exposure,during acute phase edema, erythema and vesicle formations as the vesicles rupture oozing papules plaques appears Irritant contact dermititis Burning sensation more with above symptoms
  • 36. 36 Lepromatous leprosy Rash – numerous small symmetrical hypopigmented macules with normal sensation and indefinite edeges Face, extensor surface of limb and upper trunk, sparing the midline of back, axillae, groins, scalps
  • 37. VYADHI VINASCHAYA  Kustha with Vipadika  Psoriasis with Irritant contact dermatitis 37
  • 38. CHIKITSA VRUTTANTA DATE LAKSHANA CHIKITSA OBSERVATION 02/07/17 Burning sensation in the palm region with itiching all over the body Snehapana with aragwadadhi mahatikta ghrita 30 ml 03/07/17 Burning sensation in the palm region with itiching all over the body Snehapana with aragwadadhi mahatikta ghrita 60 ml 38
  • 39. DATE LAKSHANAS CHIKITSA OUTCOME 04/07/1 7 Burning sensation in the palm region with itiching All over the body Snehapana with aragwadadhi mahatikta ghrita 90 ml Itiching Increased slightly 05/07/1 7 Burning sensation in the palm region with itiching all over the body Snehapana with aragwadadhi mahatikta ghrita 120 ml •Itiching reduced slightly 39
  • 40. DATE LAKSHANA CHIKITSA OUTCOME 06/07/17 Burning sensation in the palm region with itiching all over the body Sarvanga abhyanga with suryapaki talia f/b baspa sweda day 1 07/07/17 Burning sensation in the palm region with itiching all over the body Sarvanga abhyanga with suryapaki talia f/b baspa sweda day 2 Burning sensation increased 40
  • 41. DATE LAKSHANA CHIKITSA OUTCOME 08/07/17 Burning sensation in the palm region with itiching all over the body Sarvanga abhyanga with suryapaki talia f/b baspa sweda day 3 Burning sensation reduced 09/07/17 Burning sensation in the palm region with itiching all over the body Virechana karma with Trivrut avaleha 50 gm with 100 ml triphala kashaya No of vegas 16 She had 2 episodes of vomiting(reduced after taking nimbu water) 41
  • 42. PROPOSED LINE OF TREATMENT  Snehapana with mahatiktaka ghrita  Sarvanga abhyanga with Marichadi taila  Virechana with Trivrut, Danti & Triphala with souveeraka  Manjisthadi kwatha  Tandula lepa  Unmatta taila for external application  Dhattura beeja kalka lepa  Kanaka bindu arista with krutmala kwatha  Tab – Arogya vardhini  Tab – Gandhak rasayana  Mustadi churna for Shotha  Bhallataka rasayan  Tuvarak rasayan (Ah.Chi.19/53)  Tuvaraka taila 10 ml for internal purpose kostha suddhi 42
  • 43. PATHYA & APATHYA 43  Laghu aahara, tikta rasa pradhana, ghruta, bhallatak, triphala, nimba, purana dhanya, jangala mamsa, mudga, patola,  Laghu vyayama, Siddhartha snana, abhyanga  Viruddhara (amla, payo, dadhi, anupa mamsa, matsya, guda, tila)  Divaswapna, mala-mutra vega dharana.
  • 45.  Su su 9/6  Ubhaya gata shodhana  Twak gata – alepa chikitsa by shodhana  Shonita gata – Samshodhana, kashaya pana, shonitavsechana  Mamsa gata – Shodhana, aalepana, kashayapana, rakta mokshana, arista prayoga, mantha prayoga, prasha prayoga  Medo gata – Bhallataka, shilajita, swarna makshika, guggulu, agaru, tuvaraka, khadira, asana, ayaskriti,  Later dhatus it become asadhya so no chikitsa 45
  • 46. 46 Kapala Kustha Vata dosha pradhanata Krushna-aruna varna Ruksha Parusha Tanu Toda vahula Alpa kandu Alpa daha Alpa puya Audambara Kustha Daha Kandu Ruja Redness Kapila varna Pakva phala sannibham Mandala kustha Sweta and rakta varna Sthira Styana Snigdha Mandala akriti (coin shaped) Kruchrounnata Hrushyajihwa kustha Karkasha Shyava Vedana yukta Rakta varna over edeges Hrushya jihva sannibham
  • 47. Pundarika kustha Sweta varna yukta Red 47
  • 48. VEDANA VRUTTANTA Patient was apparently healthy 3 years back suddenly she developed rashes over the face associated with itching sensation. She also noticed blackish discolouration of upper lip and there was thickening of skin along with itching for this she consulted Adarsh clinic and was prescribed with some oral medication and topical applications (details are not known) After 3-4 days of taking them she developed severe itching in both eyes and ears and also rashes spread to whole body. 48
  • 49. She also developed ulcers in the mouth and cracking of the angle of the mouth bilaterally which was very painful. For this she consulted another clinic there they suggested some investigation all was in normal. Than prescribed some medication and ointments for 3 months. Initially symptoms relieved after taking medication for 1 month later suddenly developed a fluid filled lesion over her right arm in flexor aspect which spread to forearm within 20 days associated with severe itching, pricking type of pain and foul smell and clear liquid oozing from it. 49
  • 50. Meanwhile she got loose stools on and off with a gap of about 8-10 days three times. No of episodes of watery loose stools was 10 – 20 times. She used to take tab Eldopar everytime it occurred and get relief. Pt felt that she is getting loose stools because of the oral medications which was given for the rashes so she discontinued after few days her symptoms like itching sensation all over the body and in eyes, ears, buttocks got aggravated. Thus for the above she got admitted in Saptagiri hospital for 10 days. 50
  • 51. They did some blood investigations and injectable were given. She found moderate relief as the ulcer over the right forearm completely healed, itching in the eyes and ears reduced. But itching sensation all over the body still persisted (on itching she used to get rashes) after 4 months , (rashes appeared extensor surface of b/l hand and left palm on severe itching. And it spreads to right palm and b/l foot region due to severe itching all fingers became oedematous and multiple fluid filled lesions appeared on the palms which burst open , oozing clear fluid which was foul smelling because of the swelling of the fingers pt is unable to do closing and opening of the fist.) 51
  • 52.  After the lesion bursted it was associated with burning sensation and pricking type of pain . For the above complaints she got admitted to skamc h&rc 52
  • 53.  Tiktashatpalak ghruta (ch.chi.7/140-143)  Mahatiktaka ghruta (ch.chi.7/144-150)  Mahakhadira ghruta (ch.chi.7/152-156)  Khadira, nimba, darvi ghruta (ch.chi.7/135)  Sarvakushta- By bhallataka taila, tuvaraka taila etc. (Su.Chi.9/7)  Kusthaghna hitakar taila (ch.chi.7/119)  Vipadika hara ghruta-taila (ch.chi.7/120,121)  Swetakarveradh taila  Swetakarverapallavadh taila  Tiktekshvakadi taila  Kanakakshiri taila  Vipadikaya dhatturbija taila  Aarogyavardhini vati (R.RS.)  Saptasama gutika  Triphala gutika  Gandhaka rasayana  Panchatiktaghrita guggulu Marichaditailam, Somarajitaila,  Chitraka rasayan  Bhallataka rasayan  Tuvarak rasayan (Ah.Chi.19/53)  Bhallatakavaleha, 53
  • 54. CONTENTS Introduction  Shodhana  Shamana  Rasayana  Kustha  Kustha bheda  Mahakustha  Kshudrakustha  Vamana  Virechana  Basti  Nasya  Raktamokshana  Samanya chikitsa  Rasayana chikitsa  Conclusion 54
  • 55. INTRODUCTION  Skin that covers the major part of the body when it is diseased causes social stigma. It is important to maintain the health of skin in order to ward off various skin diseases explained under the heading of ‘Kushta’.  Any disease in Ayurveda is managed with Shodhana, Shamana & Rasayana chikitsa.  The same is true for Kushta.  It is important to understand the concept, indication and appropriate use of these to get optimum results 55
  • 56. SHODHANA  यदीययदहहदोषान ्पन्चधा शोधनं च िि ्। तनरुहो वमन ्ं कायशशरोरेकोस्त्रववस्त्रुति: ॥  Shodhana is the process by which vitiated doshas are eliminated from the body through the nearest orifice. (अ.ह्.सू 14/5)  स्त्थानाद् बहहनेयेदूर्धवयमर्धयो वा मलसंचयम । देह्ंंस्त्ंशोधनं ित्मस्त्याद् ॥(शा. स.पू.4/9)  Drugs which dislodge the body wastes from their places and expel them forcibly either in upward or downward direction are deha samshodhana. 56
  • 57. TYPES 1. तनरुह् 2. वमन 3. ववरेचन 4. शशरोववरेचन् 5. रतत्ममोक्षण् 57
  • 58. SODHANA -INDICATION  अववपाक  अरुचच  स्त्थौल्य  पाण्डुिा  गुरुिा  तलम  वपडका  कोठ कण्डू  अतिय  आलस्त्य  श्रम  दौबयल्य  अतिदुगन्ध  अवसाद्  कफवपत्त उत्मतलेशो  अतनद्रा  अतितनद्रा  िन्द्रा  तलैब्य  अबुचधत्मव  अप्रशस्त्ि स्त्वप्न दयशनम्  बलवणयप्रणाशश्र्च िृप्यिो बृंहणैरवप
  • 59.  BENEFITS :-  एवं ववशुर्धद् कोष्ठस्त्य कायक्ननराशिवधयिे । .............िस्त्माि् स्त्ंशोधन्ं काले युक्तियुति ्ं वपवेन्नरे ॥(च.सु16/17- 19)  Charaka while elaborating the effects of Samshodhana says that it enhances Kayagni, Upashamana of vyadhi & health returns to normal.  Indriya, Manas, Buddhi, Varnas become clear & acquires bala, pusthi, apatya, vrishata. His aging is retarded & he lives a long life free of diseasea. Hence he emphasized to take Samshodhana at a proper time & skillfully administered. 59
  • 60.  IMPORTANCE :-  दोषा कदचचि कु प्यक्न्ि क्जिा लंघनं पाचने । क्जिा स्त्ंशोधनेयय िु न िेषां पुनरुर्धव ॥ (च.सू.16/20)  Charaka has said that the doshas controlled by Samshamana are having the possibility of reprovocation while there is no such probability in case of the control of the doshas by Samshodhana. 60
  • 61. SHAMANA  न शोधयति यदोषान् समान्नोदीरयत्मयवप । समीकरोति ववषमान् शमन्ं िच्च सप्त्मधा ॥ पाचनं दीपन्ं क्षुत्तड्वव्यायामािपमारुिा । ब्रंह्ंण्ं शमन्ं त्मवेव्ं वायो वपत्ततनलस्त्य च ॥ (अ.ह्.सू.14/6,7)  The process by which vitiated doshas are pacified or nullified is called Shamana.  न शोधयति न द्वेक्ष्ि समान्दोषांस्त्िथोर्धदिान्। समीकरोति ववषमाव्यशमन्ं िधथास्त्रुिा ॥ (शा.पू. 4) Drugs which bring down the increased dosha to normal without expelling them out and not interfering with the dosha which are normal are called shamana (palliatives) . 61
  • 62. RASAYANA  लािोपायो हह शस्त्िानां रसदीनां रसायनम ्। (च.चच.1/1/8)  यज्जरा व्याचध ववक्र्धव्ंस िेषज्ं िद रसायनम ॥(शा.pu 4/14)  Benefit  दीघाययु स्त्रतिय मेधामारोनय्ं िरुण्ं वय् ।  प्रिावणयस्त्वरौदयं देहेक्न्द्रयबल्ं परम्॥  वाक्तसक्र्धद प्रणतिं काक्न्िं लििे ना रसायनाि्। (च.चच.1/1/7,8) 62
  • 63. Types  कु हिप्रावेशशक चरक (च.चच. 1/1/16)  वािािवपका वानिट् (अ.ह्.उ.39/5)  का्य (बल-बुक्र्धद-व्रक्र्धद)  नेमेवत्तक् (व्यचध नष्ट्) (dalhana सु.चच27/3)  आजाक्स्त्रक (दुनध-घ्रुि सेवन्ओज व्रुक्र्धद)  स्त्ंशोधन्  स्त्ंशमन् 63
  • 64.  वय् स्त्थेययकराणांमयन्ं लािोपायो रसायनम्; वधयक्ं स्त्थापकमप्राप्िमापक्ं वेत्मयथय (ड्वल्हण्)  Before administring any rasayan first do kostha suddhi with Haritakyadi choorna along with ushna jala. (च.चच.1/1/25-28)  Rasayana should be used in युवा & मर्धयमवस्त्था as the colour not look good on malina vastra so as the rasayana can not be beneficial in the asudha sarira (सु.चच.27/3,4), (अ.ह्.उ.39/11) 64
  • 65. RASAYANA SEVANAAYOGYA PURUSHA  Anatmavaan  Aalaso  Daridra  Pramadi  Vyasani  Papakrud  Bheshajaapmanani (सु.चि.30/4) 65
  • 66. KUSTHA  कुष्णाचत च ःशेषेण् चवलेख ््ं करोचत अ्ंग् प्रत्यङ्च इचत कुष्ठम् ॥ (चसद्धान्त् कौचमचि)  कुष्ठ is a condition in which different body organs , dhatus, updhatus, are destroyed & contempted.  त्मवच कु वयक्न्ि वेवण्य्ंय दुष्िां कु ष्ठमुशाक्न्ि िि । One which produces discolouration over skin region is said to be kustha. कालेनोपेक्षक्षि्ं यस्त्मात्मसवं कु ष्णाति िद् वपु ॥ During the lapse of time, it makes the entire body look ugly. (अ.ह्.तन.14/3) 66
  • 67. कु ष्ठ िेद  कु ष्ठातन सप्िववधान्यष्िादशववधान्यपररसंख्येयववधातन च । (च.तन.5/4 ) 67 सप्िववधा अष्टादशविधा अपररसंख्ये महाकु ष्ठ 7 क्षुद्र कु ष्ठ 11 अष्िादश कु ष्ठ
  • 68. महाकु ष्ठ महाकुष्ठ लक्षण िोष प्रधान्यत कापाला कृष्ण, अरुण, कपालाभ, रुक्ष, परुष, त ु, अचततोि, चवषम्ं स्मृतम. वातज औदुम्बर िाह, राग, कण्डुयुक्त,रुक, परीत, रोमचपञ्जरम, उिुम्बरफलाभास. चपत्तज मण्डल श्व्वेत, रक्तवणण, चस्िर, स्त्या , चस् ग्ध, उत्सन् मण्डलम, कृच्छ्र् साध्य. कफज ऋष्यजिह्व वेि युक्त, रक्तपयणन्तमन्त:श्वयाव, यदृष्यचजह्व स्ंस्िा ्ं. वतचपत्तज पुजण्िक श्वेताभ , रक्तपयणन्त like पुचण्िकिल, उन् त , िाह युक्त. चपत्तकफज जिध्म श्वेत, ताम्र, त ु lesions, usually situated on the उरु from which scales like अलाबूपुष्पवणं fall off on rubbing वातकफज काकण गुञ्ज वणण, सपाक, चतव्र वेि , असाध्य. चििोषज 68
  • 69. क्षुद्र कु ष्ठ क्षुद्र कु ष्ठ लक्षण िोष प्रधान्यत एककु ष्ठ चमायख्यं स्त्वेदरहहि, मस्त्यशकलोपमम, महावास्त्िु . बहलं , हक्स्त्िचमयवि . वाि-कफ वाि-कफ ककहिि श्यावं, ककण्खरस्त्पशय, परुषं, ककहििं स्त्मृिम ्. वाि-कफ वैपहदकं पाणणपादस्त्फु िनं, तिव्रवेदना. वाि-कफ अलसक कण्डुयुति, सरागैश्र्च, गण्डैरलसक्ं वाि-कफ दद्रुमण्डलं कण्डु, राग, मुदगावि वपडडका वपत्त-कफ 69
  • 70. क्षुद्र कु ष्ठ लक्षण िोष प्रधान्यत चमयदल कण्डु, स्त्फोि, रतिवणय, सशूल, असहहष्णुिा, रुग. वपत्त-कफ पामा श्वेि, अरुण शयाव वणय , कण्डुयुति वपडका वपत्त-कफ ववस्त्फोि िनु, त्मवकयुति, श्याव अरुण वणायत्ममक वपडका वपत्त-कफ शिारु रतिश्याव वणायत्ममक, दाहयुति, बहुव्रणी कु ष्ठ . वपत्त-कफ ववचचचयका सकण्डु, श्याव वणय वपडक, बहुस्राव कफ 70
  • 71. कु ष्ठगि दोष लक्षण  वातज : रौक्ष्य्ं,शोष, तोि, शूल, स्ंकोि ्ं, पारुष्य्ं, खरा भाव, हषण, श्वयाव अरुण्ं .  चपत्तज : िाह, राग, पररस्राव,पाक, चवस्रगचन्ध, क्लेि, अ्ंगपत ्ं.  कफज : श्र्वेत्य, शैत्य,कण्डु, स्िैय, उत्सेध, गौरव, स् ेह, क्लेि, जन्तुचभरचभक्षण्ं (ि.चि. ७/३४-३६) 71
  • 72. कु ष्ठोत्मपवत्तकर दोष - दूष्या 1) वाि 2) वपत्त त्ररदोष 3) कफ 4) त्मवक 5) रति दूष्य 6) मांस 7) लशसका When these seven dravyas are got affected than they will cause for कु ष्ठोक्त्मप्त्त. 72
  • 73. सप्िधात्मवश्र्य कु ष्ठ लक्षणा  त्मवक्: - Toda, Vaivarnyam, Rukshatwa  रति: - Rakta: Sweda, Swapa, Swayathu.  मांस्: - Sphota in pani & pada, kledatwa in joints.  मेदस: - Kounyam & gatikshaya for angas, dalana of angas.  अक्स्त्थ & मज्जा:- Nasa bhanga, netra raga, swarakshaya, krimis in kshatas.  शुक्र:- Swadara paktya badhanam. (A.H.Ni.14) 73
  • 74. धािुगि लक्षणा  स्त्पशयहातन स्त्वेदनत्मवमीषत्मकण्डुस्त्च ्जायिे ।  वेवण्य ्ंय रुक्षिावस्त्च ्कु ष्ठे त्मवचच समचश्रिे ॥  त्मवतस्त्वापो रोमहषयस्त्च ्स्त्वेदस्त्याशिप्रवत्मनयम्।  कण्डूववयपूयकस्त्चेव ्कु ष्ठे शोणणिसंचश्रिे॥  बाहुल्यं वतरशोषस्त्च ्काकय स्त्य ्ं वपड्वकोद्गम् ।  िोद स्त्फोि क्स्त्थरत्मवं च कु ष्ठे मांससमाचश्रिे ॥ 74
  • 75.  दौगयन्र्धयमुपदेहस्त्च्पूयोथ कक्र्यस्त्था ।  गारणां िेदनं चावप कु ष्ठे मेद समचश्रिे ॥  नासािंडोक्षक्षरागस्त्च्क्षिे च कक्रशमस्िव ।  िवेि्स्त्वरोपघािस्त्च्हक्स्त्थमज्जसमचश्रिे ॥  कौण्यं गतिक्षयोन्डानां स्िेद् क्षिसपयणम ्।  शुक्रस्त्थान्गिे शलन्डे प्रागुतिातन िथेव च ॥ (सु.तन.5/21-26) 75
  • 76. सामान्य चचककत्मसा  सवं त्ररदोषजं कु ष्ठं दोषाणां िु बलाबलम ्। यथास्त्वेलयक्षणेबुयर्धद्वा कु ष्ठानां कक्रयिे कक्रया ॥ दोषस्त्य यस्त्य पश्येि ्कु ष्ठेषु ववशेक्ष्लन्नरुद्ववति ्ं । िस्त्येव ्शमं कु यायत्मत्त ् पर्ं चानुबन्र्धस्त्य ॥ (च.चच.7/31,32) All kustha are tridosaja so they should be treated by knowing there doshobala abala & lakshnas. First do samana in those kusthas who are having there increased doshas than treat apradhan doshas. 76
  • 77. धािुगिानुसार् चचककत्मसा  त्मवक् प्राप्िे- Shodhanam, Alepanam.  शोणणि्प्राप्िे- Shodhanam, Alepanam, Kashayapanam, Shonitavasechanam.  मांसप्राप्िे- Shodhanam, Alepanam, Kashayapanam, Shonithavasechanam, Arishtapana, Manthaprayoga, Prasaprayoga.  मेदसप्राप्िे- Shodhanam, Shonithavasechanam, Bhallathaka, Shilajatu, Dhatumakshikam, Guggulu, Agaru, Tuvaraka, Ayaskriti.  From अक्स्त्थ onwards- असार्धय.  Rest of all dhatugata condition of kustha should be considered incurable and left untreated. (सु.चच.9/6) 77
  • 78. CHIKITSA SUTRA  वािोत्तरेषु सवपयवयमनं श्लेष्मोत्तरेषु कु ष्ठेषु । वपत्तोत्तरेषु मोक्षो रतिस्त्य ववरेचनं चाग्रे । वमनववरेचनयोगा: कल्पोतिा: कु क्ष्ठनां प्रयोतिव्या । प्रच्छनमल्पे कु ष्ठे महति च शस्त्िं शसराव्यधम ् । बहुदोष: संशोर्धय: कु ष्ठी बहुशो अनुरक्षिा प्राणान ्। दोषे ह्ंयतिमारहृिे वायुहयन्यादबलमाशु । स्त्नेहस्त्य पानशमष्िं शुद्धे कोष्ठे प्रवाहहिे रतिे । वायुहहय शुद्धकोष्ठं कु क्ष्ठनमबलं ववशति शीग्रम ्। (च.चच. 7/39- 42) 78
  • 79.  Vata - Sarpi  Kapha - Vamana  Pitta - Raktamokshana, Virechana Chakrapani Commentary  अग्रे इति सवपयराहदषु योज्यं; िेन वािोत्तराहदषु सवपयराहद प्रथमं कियव्यं अग्र means it is the foremost and the best to be done. After that only any other treatment should be adopted 79
  • 80. SHODHANA IN KUSTHA  पक्षाि्पक्षाच्छदयनान्यभ्युपेयाद् मासान्मासाि् स्त्रसनं चावप देयम्।  स्त्राव्यं रतिं वत्मसरे हह द्ववरल्प्ं नस्त्यं दधाच्च त्ररराराक्त्मरराराि्॥ (सु.चच.9/43),(अ.ह्.चच.19/96)  Vamana- Pakshatpakshat. (15 – 15)days  Virechana- Masanmasan.(1 – 1)month  Rakta mokshanam- Shashte shashte masya. (6 – 6)months  Nasya- Triratrat triratrat. (3 – 3)days  Basti 80
  • 81. VAMANA  िरदोषहरण्. उर्धवय िाग्ं वमन्स्त्ंञक्ं ॥ (च.क.1/4)  अपतववपत्त्शश्लेष्मणौ बलार्धव्ंय नयेिु यि वमन्ं िचध ववननेय्ं ॥ (शा.पू.ख्.4)  INDICATION  कफे ववद्र्धयाद्व्मन्ं स्त्ंयोगे वा कफाल्बणे ।  नवज्वरातिसाराध् वपत्तास्रगा जयक्षक्षमण् ॥  कु ष्ठमेहापचीग्रक्न्थश्ली पदोन्मादकाशसन् ।  श्वासहल्लासवी सपयस्त्त्मन्यदोषोर्धवयरोचगण ॥ (अ.ह्.सू.18/1-3) 81
  • 82.  Contraindication  Garbhini, sukumar, rooksha, kshudita, shokarta, krusha, durbala.  Diseased condition  Vataprakopaja – Udavarta, Gulma, Vatavyadhi  Marmaja vyadhi – Hridroga, Mutragata, Timira  Maharoga – Arsas, Udara (अ.ह्.सू.18/3-5), Kala  In vasant rutu (च.शस 8) 82
  • 83.  दोषोक्त्मतलष्िे ह्रदये वा्य् कु ष्ठेषु चोर्धवयिागेषु । कु िजफलमदनमधुके सपिोलेतनय्बरसयुतिे ॥ शीिरस पतकरसो मधूतन मधुकं च वमनातन । (च.चच.7/43,44) Vamana in श्लेष्मोत्तरेषु कु ष्ठेषु . Vamana Yogas  Kutajaphala,Madhanaphala,Yastimadhu churna + Patola and Nimba rasa yukta  Sheetha rasa(शीिरस: शीि कषाय:) with madhu + yastimadhu churna. 83
  • 84. VIRECHANA िर दोषहरण ्ं अधोिाग ्ं ववरेचन संझा | उिय ्ं वा शरीरमल ववरेचनाि ्ववरेचन स्त्ंझा ॥ (च ्.क.1/4) INDICATION Kustha, jvara,...........................pitta vyadhi vishesed rogadhayayoktasch (ch.si.2/13) Virechana is best for pitta & rakta pradosaja 84
  • 85.  CONTRAINDICATION  Avirechyastu  Subhag kshata  Durbalendriya  Durbalendriya  Alpagni  Kamadivyagra  Ajirna  Navajvara  Madatya  Aadhmana  Salyardita  Garbhini  Kshatkshen  Atisthoola  Atikrusha  Bala  Vruddha  Durbala  Upavasa  Maithun  Chinta  Vyayama (च.शस.2/11) 85
  • 86.  कु ष्ठेषु त्ररव्रिा दन्िी त्ररफला च ववरेचने शस्त्िा ।  सौववरक्ं िुषोदकमालोडनमासवास्त्च ्सीधूतन ॥  श्ंसन्त्मयधोहराणां यथाववरेक्ं क्रमस्त्ष्चेष्ि । (च.चच.7/44,45)  VIRECHANA YOGAS Trivrut, Danti & Triphala with souveeraka, tushodaka, alodana & sidhu 86
  • 87. BASTI  बक्स्त्िना दीयिे इति बक्स्त्ि ॥(अ.ह्.सू.19/1)  बक्स्त्िशिदीयिे यस्त्माि्िस्त्माि्बक्स्त्िररति स्त्रि ॥ (शा.उ.ख्5/1)  Acc. To Vruhattrayi Niruha & Anuvasana basti is contraindicated in kustha. (च.शस.२/14), (सु.चच. 35/21), (अ.ह्.सु 19/4-6)  दाववयब्रहिीसेव्ये पिोलवपचुमदयमदनक्रिमाले ।  सस्त्नेहेरास्त्थाप्य कु क्ष्ठ सकशलंडेयवमुस्त्िे ॥  वािोल्बण्ं ववररति्ं तनरुढ्मनुवासनाहयमालक्ष्य्।  फलमधुकतन्बकु िजे सपिोले साधयेत्मस्त्नेहम ॥(च.चच.7/46,47) 87
  • 88.  If there is excess of vata even after shodhana – asthapana & anuvasana  Sneha – madanaphala, madhuka, nimba, kutaja, patola  नास्त्थाप्या: कु क्ष्ठन: (च.शस.२) Cakrapani Commentary िथास्त्थापनानुवासनैक सार्धयायां अवस्त्थायां कियव्ये एव: In excessive vitiation of vata – no alternative - basti  प्रवृवत्ततनवृवत्त लक्षण सयोगे िु गुरुलाघवं संप्रधायय स्यगर्धयवस्त्येि् (च.वव.८/१३४) If there is lakshana which is simultaneously responsive and irresponsive to a given chikitsa – vaidya can decide the chikitsa – lakshana – guru or laghu 88
  • 89. NASYA  उर्धवय जरुववकारेषु ववशेषस्त्य शमष्यिे ।  नासाहह शशरसो द्वार्ं िेन्िदव्याप्य क्ह्ंंि िाि्॥ (अ.ह्.सु 20/1)  औषधम्औषध्शसर्धद्ं स्त्नेहो वा नाशसकाभ्यां दीयिे इति नस्त्यम् ॥ (सु.चच.40/21) 89
  • 90.  INDICATION  Manyastambha  Galagraha  Hanugraha  Pinasa  Vyanga  Apatanaka etc (च्.शस.2/22)  CONTRAINDICATION  Ajirna  Bhuktavata sneha, madhya, jala  Snata sirasa  Snanachisirasa  Navajvara  Garbhini etc (च्.शस.2/21) 90
  • 91.  सेन्धवदन्िीमररचं फणणञझक वपक्प्पली करन्ज्फलम्।  नस्त्यं स्त्यात्मसववडंग कक्रशमकु ष्ठकफप्रकोपघ्नम्॥  वेरेचतनके धूयमे श्लोकस्त्थानेररिे प्रशा्यक्न्ि ।  क्रमय कु ष्ठककलासा प्रयोक्जिेरुत्त्शमांड्वस्त्था ॥ (च.चच.7/48,49) Saindhava, Danti, Maricha, Phanijjhaka, Pippali, Karanjaphala, Vidanga – Kapha pradhana kushta with krimi anubandha 91
  • 92.  च.सू ५/२६-२७  Vairechanika dhumapana  श्वेिा ज्योतिष्मति चैव हररिालं मन:शशला । गन्धाश्च अगरुपरार्धया धूमं मूधयववरेचने । 92
  • 93. RAKTAMOKSHANA Raktamokshana is mainly two types  1)SASTRA  A) Pracchana  B) Siravyadha (venesection)  2) ASASTRA  A) jaloukavacarana – application of leeches (pitta dosha)  B) Sringavacharana – application of cow’s horn (vata dosha)  C) Alabu avacharana – aplication of gourd (kapha dosha) 93
  • 94. INDICATION (SU.SU.25/12-15) (A.H.SU.27/3-5)  Apachi  Asyapaka  Arsa  Daha  Dantapupputa  Dantavesta  Dustartava  Granthi  Sopha  Galasula  Karnapali roga  Putigraha  Raktadimantha  Raktapitta  Sitada  Raktarsha  SoushiraJihva kantaka  Krimi dantaka  Kshudra roga  Kustha  Ostaroga  Pidaka etc. 94
  • 95.  CONTRAINDICATION  अववस्त्राव्या सवांग्शोफ क्षीणस्त्य चा्लिोजने तनशमत्ता ।  पांडु रोनयश्य सोदरर शोवष गशियणीणां च श्वयथव् (सु.सू 14/24) KALA  व्यिे वषायषु ववर्धयेत्तु ग्रीष्मकाले िु शीिले ।  हेमन्ि्काले मर्धयान्हे शस्त्रकालास्त्रय् स्त्रिा ॥ (सु. शा.8/10) 95
  • 96.  RAKTAMOKSHANA IN KUSTHA  क्स्त्थरकहठनमण्ड्वलानां क्स्त्वन्नानां प्रस्त्िरप्रणाडीशि ।  कू चेववघट्हििानां रतिौत्मतलेशोपनेिव्य् ॥  आनूपवाररजानां मांसानां पोट्ट्ले सुखोष्णेस्त्च्।  क्स्त्वन्नौत्मसन्नं ववशलखेि्कु ष्ठं िीक्ष्णेन्शस्त्रेण्॥  रुचधरगमाथयमथवा स्रुन्गालाबूतन योज्येि्कु ष्ठे ।  प्रक्च्छिमल्पं कु ष्ठं ववरेचयेद्वा जलौकोशि ॥ (च.चच.7/50-52)  Kushta – Sthira, Katina and Mandala – Nadi & Prastara sweda  Rub with Kurcha  Rakta nirharana with Srunga / Alabu / Jalouka 96
  • 97. SHAMANA YOGAS  There are innumerable shamana yogas mentioned for kushta in the form of churna, vati, lehya, kashaya, asavarista, rasoushadha, lepa, taila, gritha. It is important to know when to use what to get good results. 97
  • 98. CHIKITSA YOGAS Darvi kalka or chorna with gomutra  Rasanjana with gomuta  Abhaya, vyosha, guda, tila taila for one month.  Patoladi kwatha  Lelitaka (sulphur) with jati (amalaki) swarasa mixed with honey internally intake.  Vajrashilajatu with jati swarasa  Yogaraj with jati swarasa  Kusthakuthara rasa 98
  • 99. GHRUTA Vatakushta- Ghrita prepared of meshasringi, guduchi, swadamshtra, sarngeshta, dwipanchamuli.  Pittakushta- By ghrita prepared of Dhava, aswakarna, kakubha, palasa, pichumarda, parpataka, madhuka, lodhra, samanga  Kaphajakushta- By ghrita prepared of priyalasala, aragwadha, nimba, saptaparna, chitraka, maricha, vacha, kushta, bhallataka, abhaya, vidanga 99
  • 100.  In pitta & Rakta- Tikta Ghritas externally & internally. Eg:  Tiktashatpalak ghruta (ch.chi.7/140-143)  Mahatiktaka ghruta (ch.chi.7/144-150)  Mahakhadira ghruta (ch.chi.7/152-156)  Khadira, nimba, darvi ghruta (ch.chi.7/135) 10 0
  • 101. TAILAS  Vatakushta- Taila prepared of meshasringi, guduchi, swadamshtra, sarngeshta, dwipanchamuli.  Kaphajakushta- By taila of priyalasala,aragwadha, nimba, saptaparna, chitraka, maricha, vacha, kushta, bhallataka, abhaya, vidanga.  Sarvakushta- By bhallataka taila, tuvaraka taila etc. (Su.Chi.9/7)  Kusthaghna hitakar taila (ch.chi.7/119)  Vipadika hara ghruta-taila (ch.chi.7/120,121)  Swetakarveradh taila  Swetakarverapallavadh taila  Tiktekshvakadi taila  Kanakakshiri taila  Vipadikaya dhatturbija taila 10 1
  • 102. KASHAYA  Sonitha prapta & Mamsa prapta.  Tikta kashayas; For kaphaja, pithaja & Raktaja kushtas. Eg: Laghu Manjishtadi, Madhyama Manjishtadi, Brihat Manjishtadi Kashayas, Patolamuladikwatha 10 2
  • 103. CHURNA  Mustadi churna(ch.chi7/65-67)  Triphaladi churna (in numbness of skin) (ch.chi.7/68,69)  Swarnamakshika churna with gomutra (ch.chi.7/70-72)  Gandhapashana churna  Somraji chorna  Vaguji chorna 10 3
  • 104. ARISTHA, ASAVA, MANTHA,PRASA  Mamsa prapta kushta. Eg: Khadirarishta,Madhwasava, Kanakabindwarishta, Triphalasava  Madvaasava in kustha & kilasa  Kanakavinduristha  Triphalasava  Kashayas made of rasanjan, aragbadha patra, kutaja, patola mula, nimba bark, khadirsara, triphala  We can use of above said drugs in the form of ghruta and taila in kustha samanartha 10 4
  • 105. ALEPANA  Nirhrita asradosha  Samsodhitasayanam (Cha.Chi.7/53)  Twak prapta  Shonita prapta  Mamsa prapta (Su.Chi.9/6) Eg: Eladilepa, Kushtadilepa, Lodhrabijadilepa, Mamsyadilepa. 10 5
  • 106. LEPAS  Sidhma nasak lepa (ch.chi.7/117,118)  Mandala kustha nashak taila (ch.chi.7/122-127)  Pittakusthan nashak lepa (ch.chi.7/130,131)  Vidangadi lepa  Dadrurvaadou durvadi lepa (chakradatta)  Manashiladi lepa  Dadrugajendra pralepa  Chakramardobijadi pralepa  Tranak pradeha  Kaasmarda pralepa  Molakabeej pralepa  Gandhapashad pralepa 10 6
  • 107.  Karanjabijadi patra pralepa  Amaltaaspatra pralepa  Sidhma kustha gandhapashan pralepa  Sidhma kasmarda pralepa  Sidhma sarjasaadi praleepa  Siddh kusthadi lepa  Chatrahadi lepa  Edgajadi lepa  Vicharchikaya bhrustasarsapaka kalka  Vicharchika grah dhoom lepa  Tandula pralepa  Sarjasaadi lepa  Avalgujadi lepa  Sinduradi lepa  Bhallatakadi lepa 10 7
  • 108. VATI  Aarogyavardhini vati (R.RS.)  Saptasama gutika  Triphala gutika  Gandhaka rasayana 10 8
  • 109. GUGGULU PREPARATIONS Amrita guggulu Ekavimsatika guggulu Panchatiktaghrita guggulu 10 9
  • 110. UDVARTANA  Kusthadh udvartanam churna  Nishadyaudvartanam 11 0
  • 111. RASALEPA: Pashana churna + Yavakshara+ Mustard oil/ Gandhapashana+ Katu taila exposed the mixture to sunrays. 11 1
  • 112. KSHARA PRAYOGA  येषु न शस्त्रं क्रमेि ्स्त्पशेक्न्द्रयनाशनातन यातन स्त्यु । िेषु तनपात्मय ् क्षारो रतिं दोष ्ं च ववस्त्राव्य ॥ (च.चच.7/54) 1) Kushtas where sastra karma is contraindicated. 2) In Sparsanendriyanasa 3) Nipatya 4) After visravana 11 2
  • 113. AGADA PRAYOGA  पाषाणकहठनपरुषे सुप्िे कु ष्ठे क्स्त्थरे पुराणे च ।  पीिागदस्त्य कायो ववषे प्रदेहोगदेस्त्चानु ॥  स्त्िब्धातन सुप्िसुप्िान्यस्त्वेदनकण्डुलातन कु ष्ठातन।  कू चेदयक्न्ित्ररव्रिाकरवीरकरन्जकु िजानाम्॥  जात्मयकय तन्ब्जेवाय परे शस्त्रे समुद्रफे नेवो ।  घ्रष्िातन गोमयेवाय िि् प्रदेहे प्रदेहातन ॥ (च.चच.7/55-57) 11 3
  • 114. SNANOPYOGI DRAVYAS  Ch.chi7/129,130  Siddharthaka snana churna  Darvi kwatha  Patola  Nimba  Khadirasara  Karanja  Aragwadha 11 4
  • 116. दाहयुतिकु क्ष्ठ स्त्नान प्रयोगा  रोध्राररष्िं पद्मकं रतिसार् सप्िाहाक्षौ व्रक्षको बीजकस्त्च्।  योज्या स्त्नाने दहमानस्त्य जन्िो पेया वा स्त्याि्क्षौद्रयुतिा त्ररिण्डी ॥ (सु.चच.9/50) 11 6
  • 117. RASAYAN YOGAS  Navayasa rasayana (chakradatta)  Brahmiaadi rasayan  Chitraka rasayan  Bhallataka rasayan  Tuvarak rasayan (Ah.Chi.19/53)  Medo prapta kushta  Yapya kushta  All kushtas Eg:Tuvarasthi, Bhallataka, Bakuchi, Chitrakamulam, Silajatu (Ah.Chi.19/53 11 7
  • 118. GUDA  Manibhadra guda (A.H.chi.19/31,32) Modaka  Triphala modaka AVALEHA Bhallatakavaleha, Sashangavaleha, Dhatryadyavaleha 11 8
  • 119. CONCLUSION  Selection of chikitsa for kushta depends on predominant of doshas  Repeated shodhana is essential for bahu doshavastha other than trying to eliminate it all at once since it weakens the patient  In excessive vata aggravated condition, basti chikitsa can be adopted  Nasya is indicated in kapha pradhana kushta and dhumapana in kushta affecting jatrurdwa  If doshas are in alpavastha we can treat with shaman line of treatment. 11 9