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EVALUATION OF THE EFFICACY OF KAKODUMBARADIGHANAVATI (INTERNAL) AND AYORAJADILEPA (EXTERNAL) IN THE MANAGEMENT OF SWITRA, By BASAVARADDI.H.VENKARADDIYAVAR, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103
Citation preview
“EVALUATION OF THE EFFICACY OF KAKODUMBARADIGHANAVATI (INTERNAL) AND
AYORAJADILEPA (EXTERNAL) IN THE MANAGEMENT OF SWITRA” By
BASAVARADDI.H.VENKARADDIYAVAR Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial
Ayurved
KUnd
Dr. V.
Dr
DepartmPost Graduate S
D.G. MELMALAGI AYUR
fulfillment of the degree of
a Vachaspati M.D. In
ayachikitsa er the Guidance of Varadacharyulu
M.D. (Ayu) (Osm)
. R.V. Shettar M.D. (Ayu)
ent of Kayachikitsa tudies & Research Center VEDIC MEDICAL COLLEGE, GADAG
2003-2006
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF
KAKODUMBARADIGHANAVATI (INTERNAL) AND AYORAJADILEPA (EXTERNAL) IN
THE MANAGEMENT OF SWITRA” is a bonafide research work done by
BASAVARADDI.H.VENKARADDIYAVAR in partial fulfillment of the requirement for the post
graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi
University of Health Sciences, Bangalore, Karnataka.
Dr. V. VARADACHARYULUM.D. (Ayu) (Osm)
GuideProfessor & HOD
Dept. of Kayachikitsa
PGS&RC
Date:
Place: Gadag
Dr. R. V. Shettar
M.D. (Ayu)
Co- Guide
Lecturer in Kayachikitsa
DGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
Endorsement by the H.O.D, principal/ head of the institution
This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF
KAKODUMBARADIGHANAVATI (INTERNAL) AND AYORAJADILEPA (EXTERNAL) IN
THE MANAGEMENT OF SWITRA” is a bonafide research work done by BASAVARADDI. H.
VENKARADDIYAVAR under the guidance of Dr. V. Varadacharyulu M.D. (Ayu) (Osm),
Professor & HOD and Co- Guidance of Dr. R. V. Shettar, M.D. (Ayu) Lecturer in
Kayachikitsa, in partial fulfillment of the requirement for the post graduation degree of
“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health
Sciences, Bangalore, Karnataka.
.
DP
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date: Place:
(Dr. V. Varadacharyulu)Professor & HOD
Dept. of Kayachikitsa PGS&RC
ate: lace: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “EVALUATION OF THE EFFICACY OF
KAKODUMBARADIGHANAVATI (INTERNAL) AND AYORAJADILEPA (EXTERNAL) IN
THE MANAGEMENT OF SWITRA” is a bonafide and genuine research work carried out by
me under the guidance of Dr. V. Varadacharyulu M.D.(Ayu) and Co - Guidance of Dr.R. V.
Shettar Lecturer, in Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date
Place
BASAVARADDI.H.VENKARADDIYAVAR
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation/ thesis in print or electronic
format for the academic / research purpose.
Date
Place
BASAVARADDI.H.VENKARADDIYAVAR
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgement
At the onset, my devotional pranamas to his Holiness Sri. Jagadguru Abhinava
Shivanada Swamiji, Shivananda math, Gadag whose blessings gave me enough strength to
complete this work as per my expectations.
I express my deep gratitude to my guide Dr. V. Varadacharyulu M.D.(Ayu), Gold
Medalist, Professor & H.O.D., for his timely advises and encouragement in every step of my
success.
I express my gratefulness to my co-guide Dr. R.V. Shettar, M.D (Ayu) lecturer in
Kayachikitsa, for his time to time help and critical suggestions associated with expert
guidance at the completion of this dissertation.
I express my thankfulness to beloved principal Dr. G. B. Patil, Principal for his
encouragement as well as providing all necessary facilities for this research work.
I lay my deep love and affection to my respected parents Shri Hanamaraddi
Venkaraddiyavar, Smt Lakshmidevi who are the prime reasons for my success.
I express my sincere thanks to Dr. K. Shiva Rama Prasad, Dr. M.C. Patil, Dr.
Shashidar. H. Doddamani, Dr. P. Shivaramudu, Dr. Danappagoudar, Dr. Mulkipatil Dr.
Kuber Sankh, Dr. Santhosh Belavadi, Dr. Jagadish Mitti. Dr.Shashidhar Nidagundi. and Mr.
Nandakumar for his help in statistical analysis of results.
I express my sincere thanks to Dr.Jagadish Shirol MD(Gen med.) and Dr.Ravindra
Wadoni (MD, Dermatology) for their valuable suggestions at times. I pay my tribute to late
Dr. Sarangmath whose inspiration made me to do post graduation studies.
I extend my immense gratitude to Dr.M.V.Malagoudar, Dr.G.S.Hiremath,
Dr.R. K.Gacchinmath, Dr.S.A.Patil, Dr.B. G. Swami, Dr.Reddar, Dr.Yarageri(RMO)
Dr.K.S. Paraddi, Dr.U.V. Purad and other teaching staff who helped me during my work.
I am gratefull to my brothers, Brother in law Dr. B.LYaragatti and other family
members. I express my deep affectionate love to my wife Smt. Dr. Aruna who co-operated
me throughout this work. I also extend my gratitude towards Sri. Kencharaddy, Smt.
Susheela, and Mr. Dayanand
I would like to express my sincere thanks to Mr. V. M. Mundinamani, Librarian and
Asst. Mr. S. B. Sureban for providing valuable books in time throughout the study and
Mr.Tippanagouda, Lab Technician for his support.
I take this moment to express my thanks to my friends and Prashanth Gokhale.
Basavaraj Channappagoudar, Kariyappa, Manju, Basavaraj for their moral support. And all
my Post Graduate Seniors Koteshwar, D.P. Joshi, Santoji, Jaggal, V.S. Hiremath,
Pattanashetty, Santosh, Subin, Febin, Satheesh, Chetan, Mangala, and my Colleagues
Kalmath, Udaykumar, Ratnakumar, Menakshi, Shaila, Hugar, Chandramouli, Jayaraj,
Shakuntala, Kendadmath, Ganti, Pradeep, Bingi, Sajjan, Lingareddi, Jagadeesh, Vijay, Akki,
Hakkandi, Ashwin, Umesh,.Gavi, Krishna, Sarvi, Ashok, Siba, Sharanu, Suvarna, Anitha
and others. I am very much thankful to Smt. P. K. Belavadi, Mr. M. M. Joshi, Mr. Sarvi, Mr.
Shankar, Mr. Biradar, Mr. Kallanagoudar, Mr. Dasar and Smt. Sarangamath.
And most sincere thanks to my patients who cooperated at my dissertation; with out
whom the study was not possible.
Place: Date:
Basavaraddi.H.Venkaraddiyavar
Kakodumbaradighanavati (internal) and
Ayorajadilepa (external) in Switra – Abstract Switra is most blemishing disease compared to other dermatological problems, is
a medico-social problem since the time immemorial in India. Switra is characterised by
Aparisravi swetha varna mandala i.e. non exudative skin lesions which are hypo-
pigmentary disease. Vitiligo lesions over face, particularly embracing and cause
frustration. Last decade has witnessed an increasing interest in psychological affect of the
various skin diseases, and quality of life in patients suffering from disease.
Twak (Skin) is indicator of status of Rasa Dhatu. Ayurveda suggested good
remedies like kushtagna and varnya drugs to cure the disease. All patients advised to
exposure to sunlight after the local application. The trial drug Kakodumbaradi Ghanavati
internal and Ayorajadilepa external are considered for the evaluation in Switra. The
clinical study was undertaken on 30 patients in a single group. Ayurveda emphasized diet
as an important etiological factor in Switra.
The hypothesis on the action of Kakodumbaradi Ghanavati (internal) has
Kushtagna, krimighna, varnya, Switraghna prabhava along with deepana, pachana,
Bruhana, Balya and Vrushya properties and Ayorajadilepa is verified its external action
to introduce potentially melanin pigmentation in this observational study. To assess the
effect of treatment, color, number of mandalas, VASI Score, hyper-pigmentation of
margin and serum copper levels were considered.
The results of the study are based upon the assessment of the subjective and
objective criteria considered in the study. Mainly the objective parameters are considered
to show the evidences of the relief in the study. The result encourages the Ayurvedic
fraternity even though the cure is only 6.67% (2 Patients) in the time bound study. Study
reveals well responded listed as 26.66% (8) patients along with the 37.66% of moderately
responded patients. In the study many causes made hindrances of the melanin re-
pigmentation and 8 i.e. 26.66% patients fall under poor response. Only one patient i.e.
3.34% noticed as the no response patient in the entire study. Subjective parameters viz.
“Rookshata, Parusha, Daha, Kandu, Guruta” are not significant in the study but all
objective parameters are highly significant as par statistical evaluation.
“EVALUATION OF THE EFFICACY OF
KAKODUMBARADIGHANAVATI (INTERNAL) AND
AYORAJADILEPA (EXTERNAL) IN THE MANAGEMENT OF
SWITRA”
By
BASAVARADDI.H.VENKARADDIYAVAR
Chapter Content Pages
1 Introduction 1 to 8
2 Objectives 9 to 13
3 Review of literature 14 to 76
4 Methodology 77 to 88
5 Results 89 to 118
6 Discussion 119 to 131
7 Conclusion 132 to 132
8 Summary 133 to 134
9 Bibliographic References 1 to 7
10 Annex – Case sheet 1 to 8
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Contents
1
Tables of
“EVALUATION OF THE EFFICACY OF
KAKODUMBARADIGHANAVATI (INTERNAL) AND
AYORAJADILEPA (EXTERNAL) IN THE MANAGEMENT OF SWITRA”
By
BASAVARADDI.H.VENKARADDIYAVAR
SNo Topic Page
1 Skin layers according to Charaka, Susruta and Vagbhata 23
2 Skin layers comparison according to Dr. Ghanekar 24
3 Skin colour according to Vagbhata 28
4 Chaya nirupana - Panchabhuta sambandha 29
5 Classification of Viruddha Ahara by different authors 37
6 Mithya Ahara Hetu for Kushtha 38
7 Mithya Vihara Hetu for Kushtha 39
8 Achara Hetu for Kushtha 40
9 Poorvaroopa according to different authors 44
10 Depicting lakshana according to Dosha 45
11 Clinical features according to various texts 46
12 Colouration of skin as Dosha dislodged in Dhatu 47
13 Switra bhedas - various authors 48
14 Switra and Kushta lakshana sadharmya and vaidharmyata 49
15 Causes of localized hypo pigmentation 56
16 Clinical criteria for classification of Vitiligo 60
17 Pharmacological properties of Kakodumbaradi Ghanavati 76
18 Pharmacological properties of Ayourajadi lepa 76
19 Demographic Data of trail in Switra with Kakodumbaradi Ghanavati &
Ayorajadilepa
90
20 Distribution of patients by Age- gender in Switra with Kakodumbaradi 91
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Contents
2
Ghanavati & Ayorajadilepa
21 Result of patients by Age in Switra with Kakodumbaradi Ghanavati &
Ayorajadilepa
92
22 Distribution and Result of patients by Gender in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
93
23 Distribution & Results of patients by Religion in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
95
24 Distribution & Result of patients by occupation in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
96
25 Distribution and Results of patients by Economic status in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
98
26 Distribution and Result of patients by diet in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
99
27 Data of patients by presenting complaints in study 100
28 Distribution of patients by presenting complaints in Switra 101
29 Distribution and Result of patients by Mode of onset in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
102
30 Distribution and Result of patients by Family history in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
104
31 Distribution and Result of patients by Chronicity in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
105
32 Distribution and Result of patients by Incidence of initial site of onset in Switra
withKakodumbaradi Ghanavati and Ayorajadilepa
106
33 Distribution and Result of patients by Incidence of distribution of lesions in
Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
107
34 Distribution and Result of patients by Incidence of clinical type of disease in
Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
109
35 Distribution of patients by Ahara Nidana in Switra Kakodumbaradi Ghanavati
and Ayorajadilepa
110
36 Distribution of patients by Vihara Nidana in Switra Kakodumbaradi Ghanavati 111
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Contents
3
and Ayorajadilepa
37 Assessment of Subjective parameters in Switra 113
38 Assessment of Objective parameters in Switra 113
39 Results in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa 114
40 Subjective parameter Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
115
41 Objective parameter Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
116
42 Distributional (Head & Neck) Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
116
43 Distributional (Trunk) Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
117
44 Distributional (Upper Extremities) Statistical analysis in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
117
45 Distributional (Lower Extremities) Statistical analysis in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
118
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Contents
4
Figures of
“EVALUATION OF THE EFFICACY OF
KAKODUMBARADIGHANAVATI (INTERNAL) AND
AYORAJADILEPA (EXTERNAL) IN THE MANAGEMENT OF SWITRA”
By
BASAVARADDI.H.VENKARADDIYAVAR
SNo Topic Page
1 Components of the integumentary system 25
2 Structure of Melanocyte 35
3 Schematic Representation of Samprapti 43
4 Autoimmune theory of vitiligo showing both cell-mediated and humoral
autoimmune
51
5 Showing pituitary – MSH – Melanocytes axis 54
6 Causes of Tyrosinase Tyrosine DOPA melanin 55
7 Ingredients of Kakodumbaradi Ghanavati and Ayorajadilepa 66
8 Estimating the Degree of Depigmentation for the VASI 88
9 Distribution of patients by Age- gender in Switra with Kakodumbaradi
Ghanavati & Ayorajadilepa
92
10 Distribution and Result of patients by Gender in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
94
11 Distribution & Results of patients by Religion in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
95
12 Distribution of patients by Occupation in trail 96
13 Result of patients by occupation in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
97
14 Distribution of patients by Economic status in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
98
15 Distribution of patients by diet in Kakodumbaradi Ghanavati and Ayorajadilepa
in Switra
99
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Contents
5
16 Distribution of patients by presenting complaints in Kakodumbaradi Ghanavati
and Ayorajadilepa in Switra
102
17 Distribution and Result of patients by Mode of onset in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
103
18 Distribution and Result of patients by Family history in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
104
19 Distribution and Result of patients by Chronicity in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
105
20 Distribution and Result of patients by Incidence of initial site of onset in Switra
with Kakodumbaradi Ghanavati and Ayorajadilepa
107
21 Distribution and Result of patients by Incidence of distribution of lesions in
Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
108
22 Distribution and Result of patients by Incidence of clinical type of disease in
Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
109
23 Distribution of patients by Ahara Nidana in Switra Kakodumbaradi Ghanavati
and Ayorajadilepa
111
24 Distribution of patients by Vihara Nidana in Switra Kakodumbaradi Ghanavati
and Ayorajadilepa
112
25 Results in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa 114
26 Improvement of the patients with Kakodumbaradi Ghanavati and Ayorajadilepa 119
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Contents
6
Chapter - 1 Introduction
How many of the sun-lovers who crowd the beaches on a warm day ever stop to
consider the contributions and sacrifices made by their skin? This remarkable structure
absorbs ultraviolet radiation, prevents dehydration, preserves normal body temperature, and
tolerates the chafing and abrasion of the sand. Although few of us think of it in these terms,
the skin is an organ—the largest organ of the body 1.
Skin is the index of the health. We spend much time to look better always. But some
times either because of our internal environment or atmospheric effects change subjects us to
many more skin problems. The developed countries are affected more with skin problems
than that of the other organic diseases. It is true that the discoloration of the skin indexes
individual subjected for social stigma. The black, white, yellowish cream or any Asian
colours differentiate individual and small changes in it cause much mental agony.
Acharyas of Ayurveda well recognised the effects of such skin changes towards the
mental attitudes and included many diseases in the classifications of mental tortuous physical
deformities. Thus it is told by the faculty of Yoga, to practice “Surya Namaskara” i.e. Sun
salutations every day in the morning, which prevents the individual from skin problems.
Vitiligo is such a common chronic and progressive skin disease characterised by the
lack of melanin pigments producing skin patches with sharp and often hyper pigmented
edges. This disease affects approximately 1% of the world-wide population 2.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
1
The aetio-pathogenesis of Vitiligo is still unknown to date, even though the multi-
factorial character of its clinical expression is quite clear. There are three classical pathogenic
theories 3:
1. Immunologic theory
2. Neurologic theory and
3. Self-destruction hypothesis
Possible hereditary factors and psychosomatic issues should undoubtedly be taken
into account as well. The clinical expression of the disease also varies between individual
patients, according to personal characteristics, and between patches, according to the partial
or total lack of pigments. The prognosis of this skin disease is thoroughly benign, even
though the psychological and social implications following up the aesthetic modifications
due to the appearance of patches may be very serious and disabling.
Since the etiological cause of Vitiligo may not be removed, medicine may only act on
symptoms by means of therapies aimed at restoring the lost colour uniformity. However it is
not always easy to suggest to a patient a treatment being effective, long lasting and free of
side effects at the same time. The most widely used therapy in the last thirty years was the
PUVA therapy (UVA + trimethylpsoralen), with results ranging from 25% to 50%. This
therapy requires a careful assessment of the patient's general conditions and clinical picture,
as well as the identification of the correct drug dose to be administered and patient
monitoring throughout the treatment period.
As a border organ, the skin is crucial for the body's homeostasis, to which it
contributes through a number of particles specialized in receiving stimuli and forwarding
them to the central organs of the nervous system. Along with these, there is a special family
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
2
of receptors, the melanocytes, whose task is to react to the light stimulus by synthesizing a
special protein, melanin, constituting the most important skin-protection factor. Evaluation of
the role of immunogenetic factors and trace elements (copper) in pathogenesis of Vitiligo
provided the basis for the improvement of its photochemotherapy by using Cupir and T-
activin. This yielded an opportunity for a better management of this dermatosis. Results of
the one study suggests that the indications for the use of T-activin (immunomodulator) and
Cupir (copper-containing product) in the treatment of Vitiligo 4.
As Vitiligo is a relatively common skin disorder, in which white spots or patches
appear on the skin. These spots are caused by destruction or weakening of the pigment cells
in those areas, resulting in the Melanin pigments being destroyed or no longer produced.
Melanin is a dark brown pigment of skin and hair in animals. It is synthesized by special cells
called Melanocytes, which store the melanin. In most cases, Vitiligo is believed to be an
autoimmune-related disorder. In Vitiligo, only the colour of the skin is affected but texture
and other skin qualities remain normal.
Vitiligo is not contagious. If it were, many more people in the world, including
doctors who treat Vitiligo and family members of those with Vitiligo, would have the
condition.
Most patients with Vitiligo undergo emotional trauma related to their looks and social
image, especially the young. They should be reassured and supported well. The treatment in
most cases is effective and should be continued till the desired results are obtained.
Most people with Vitiligo have neither parents, nor children, nor siblings with
Vitiligo. Many have no other relatives with Vitiligo. Vitiligo does appear to be hereditary,
that is, it can run in families. No questions of Children whose parents have the disorder are
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
3
more likely to develop Vitiligo. However, most children will not get Vitiligo even if a parent
has it, and most people with Vitiligo do not have a family history of the disorder.
People who develop Vitiligo usually first notice white patches or spots (de-
pigmentation) on their skin. The skin remains of normal texture, and there are usually no
itching or other symptoms. These patches are more obvious in sun-exposed areas, including
the hands, feet, arms, legs face, and lips. Other common areas for white patches to appear are
the armpits and groin and around the mouth, eyes, nostrils, navel, and genitals. Vitiligo
generally appears in one of three patterns. In one pattern (focal pattern), the de-pigmentation
is limited to one or only a few areas. Some people develop de-pigmented patches on only one
side of their bodies (segmental Vitiligo). But for most people who have Vitiligo, de-
pigmentation occurs on different parts of the body (generalized Vitiligo), often similar on
each side of the body. In addition to white patches on the skin, some people with Vitiligo
may experience white hair growing in on the scalp, eyelashes, eyebrows, and beard. In
extremely rare cases, Vitiligo can affect eye colour or the pigment of the retina 5.
If a doctor suspects that a person has Vitiligo, he or she usually begins by asking the
person about his or her medical history. Important factors in a person's medical history are a
family history of Vitiligo; a rash, sunburn, or other skin trauma at the site of Vitiligo 2 to 3
months before de-pigmentation started; stress or physical illness; and premature greying of
the hair (before age 35). In addition, the doctor will need to know whether the patient or
anyone in the patient's family has had any autoimmune disorders and whether the patient is
very sensitive to the sun 6.
The doctor will then examine the patient to rule out other medical problems. The
doctor may take a small sample (biopsy) of the affected skin. He or she may also take a blood
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
4
sample to check the blood-cell count and thyroid function. Most certainly, the doctor will
examine your skin with a special black light called a Woods Light, which illuminates areas of
Vitiligo. This also helps the doctor rule out other conditions. For some patients, the doctor
may recommend an eye examination to check for uveitis (inflammation of part of the eye). A
blood test to look for the presence of antinuclear antibodies (a type of autoantibody) may also
be done. This test helps determine if the patient has any other autoimmune conditions.
Today, there is more research and more treatments options available than ever before.
In addition to the traditional therapies such as the PUVA system and steroid creams, new
technologies have been developed, including narrow-band UVB, Pseudocatalase cream,
excimer lasers, skin grafting and pigment transplantation, topical psoralens, and potentially,
the use of immunomodulators.
There is no one treatment that works for everyone. Different therapies work better for
different people. While one person may respond extremely well to PUVA, another may
respond better to narrow band UVB or immunomodulators. For this reason, many Vitiligo
experts will try different therapies on a patient until they find what works best for that
person.
There is no definite method by which Vitiligo can be prevented. However, some
measures may be taken to minimise its effects. People with or without the condition should
always use sunscreen lotions or sun-blocks with a sun protection factor (SPF) of 15 or more
to protect the skin against the harmful effects of UV rays. This should especially be the case
after participating in outdoor sports like swimming 7.
Since condition is cosmetic one, the social effects of Vitiligo may cause more
hardships than the physical limitation. Indian society place great emphasis physical
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
5
appearance especially, on white discoloration of skin. In Vedic period person suffering from
the Switra and their progeny are disqualified for the wedlock 8.
Need for the study:
‘Switra’ is a disease pertaining to Twak 9 which turns the normal colour of the skin to
white. It can be equated to that of Vitiligo in contemporary medicine which is an achromatic
macular de-pigment condition, resulting from loss of ‘melanin’ pigment 10. This condition
affects about 1-2% of the world’s population 11 and 3-4% in India. All the races and both sexes
are equally affected.
The cardinal symptoms of Switra are the appearance of ‘Aparisravi shweta varna
mandalas, on the skin that is depigmented patches or macules. These patches are more
common in sun-exposed areas including the hands, Feet, arms, face and lips 12. Switra
(Vitiligo) is a cosmetic problem. The change in appearance caused by this condition can affect
a person’s emotional and psychological well being. The person with this condition feels
ashamed and depressed.
Though the contemporary medical science tries to treat this condition with different
types of re-pigmentation therapies, they fail to offer satisfactory results. Ayurvedic treatment in
this concern through holistic approach, can improves the patient’s appearance and restore the
normal pigmentation of the skin.
The tendency of many doctors to trivialize and its consequences was one of the most
difficult problems encountered by patients. Though Vitiligo is cosmetic problem, it may have
profound effect on a patients self esteem and social relationships. So Vitiligo must not be
ignored by the physician.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
6
Of the various treatment approaches offered by conventional medicine, from the good
old PUVA therapy, to using corticosteroids, to epidermal grafts or cell culture techniques none
is completely effective in all presentation of Vitiligo.
Further some of conventional approaches have unacceptable side effects or either
unaffordable or not easily accessible in all parts of the country. Since Vitiligo affects
irrespective of poor and rich and as well as children and adults, A clinical study was planned to
access the efficacy of an indigenous preparations based on the Ayurvedic principles.
Thus the ‘Kakodumbaradi Ghanavati and Ayorajadilepa mentioned in Sahasrayoga
and Yogaratnakara are selected for internal and external application respectively, as the
contents of these drugs are easily available, economic and good result oriented. So the present
study “Evaluation of the efficacy of ‘Kakodumbaradi ghanvati’ and ‘Ayourajadi lepa” are
undertaken, which are with Switraghna and Varnaya properties.
Previous work done on Switra:
Recent research works taken place regarding Switra are as follows 13;
1. Ameen A.M. Switra vimarsh (Bhallataka sidha ghrita yoga), 1967, Jamnagar:
2. Dahiya J .Studies on the Switra and its management,1983, Jamnagar:
3. Patil A K Survey of Switra in Jamanagar and vicinity in reference to its
nidan and chikitsa.,1984, Jamnagar:
4. Sardar C L. A clinical study of Switra (Leucoderma), and its management with
Kakodumbar, and manishiladi lepa1993. Jamnagar:
5. Thakore S R Kakodumbara Prayoga in Switra 1989, Amadabad
6. Ansari ZA Efficacy of certain Ayurvedic drugs in the managements of Vitiligo
(Switra), 1985, Banaras Hindu University, Varanasi
7. Upadhya RK. Therapeutic assessment of some Ayurvedic drugs in the treatment of
Vitiligo 1988, Banaras Hindu University, Varanasi
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
7
8. Prithivraj .The concept of Switra and its management in Ayurveda, Banaras Hindu
University, Varanasi
9. Sharma ( Smt ) M. – Switra Roga par Aylagujadi Gutika ( Bhaya Prayogarth )Evam
Khadira ( Abhyantara Prayoga ) karmukata Ka Adhyana, Jaipur
10. Sheelaratna M.V -- Switra Roga and its management, Mysore: Govt College of
Indian Medicine
11. Shrikantbabu – Evaluation of Kakumbadaradi Yoga in the management of Switra,
Mysore : Govt College of Indian Medicine
12. Mishra .S – A clinical trial of some indigenous drugs on Switra (Vitiligo), Gopa
Bandu Ayurvedic Mahavidyalaya, Puri
13. Burman S – A clinical study on the therapeutic effect of Tuthyadi Lepa on Switra
(Vitiligo), Gopa Bandu Ayurveda Mahavidyalaya, Puri
14. Lahari .P.K – Clinical studies and management of Switra kushtha ( Leucodermia )
with Ayurveda, Gopa Bandu Ayurvedic Mahavidyalaya, Puri
15. Tiwari SK, Evaluation of the efficacy of Dhatryadi Yoga (internal) and Avalgukadi
lepa (External) along with and with out Shodhana (Vamana) in Switra (W.S.R. to
Vitiligo), 2001, DGM AMC, RGUHS, Bangalore.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Introduction
8
Chapter – 2 Objectives
The present study is intended to focus on the disease evolution that is Switra-vis-
à-vis Vitiligo and the management with Kakodumbaradi Ghanavati internally and
Ayorajadilepa externally application. 30 patients from OPD of Postgraduate studies and
Research centre of DGM Ayurvedic Medical College and Hospital, where scrutinized and
undertaken for the study.
Kakodumbaradi kwatha mentioned in Shashrayoga with switraghna and Varnya
properties as a reference to the management of Switra is prepared in the form of tablet for
the convenience of distribution. In further Vati is easy to consume and convenient to
preserve the drug for longer duration.
Ayorajadilepa mentioned in Yogaratnakara is selected as the external application
and prepared in the form of Varti (5 mg). The compound of lepa has photosensitizing
property in association with sunlight and there by local action facilitates the rapid local
pigmentation. In this regard the objectives proposed in the study are discussed as under.
To evaluate the efficacy of Kakodumbaradi Ghanavati (internal) and Ayorajadilepa
(external) in the management of Switra
Vitiligo affects 1 to 2% of the population. It may be triggered by any kind of
damage to the skin (Koebner Phenomenon). It takes the form of skin white spots with a
sharp margin and a milk white color. The normal texture and sensation of the skin are
preserved. No scaling occurs. Vitiligo spots need to be differentiated from other skin
discolorations, including Tinea Alba and versi color caused by fungus. Vitiligo may
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Objectives
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Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Objectives
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either remain static for years or progress gradually, sometimes extending rapidly over a
period of several months.
Vitiligo is believed to be an autoimmune disorder with a genetic basis. An
autoimmune disorder is any condition in which a person's immune system reacts against
the body's own tissues or organs attacking them. In the case of Vitiligo, the immune
system attacks and damages or destroys melanocytes. Melanocytes are specialized skin
cells that produce melanin. Melanin is the pigment that gives the skin its natural color.
Treatment is based both on a large body of information that supports the
autoimmune theory associated to a genetic defect that makes the melanocytes susceptible
to injury. Current knowledge about how the skin pigmentation process occurs is also
helping to design better Vitiligo treatments.
Treatment may have different targets 14:
1. Limiting or stopping the autoimmune reaction against melanocytes (ex.
corticosteroids).
2. Protecting melanocytes from a group of harmful products called "free radicals",
which are the results of the autoimmune reaction that causes de-pigmentation (ex.
vitamins, pseudo-catalase).
3. Stimulating melanocytes to regenerate and/or produce melanin (ex. UVA, UVB,
PUVA, controlled sunlight exposure).
4. Replacing melanocytes (a modality of surgical treatment) by transplanting grafts
from uninvolved skin into the affected areas.
5. A combination of several of the above mechanisms.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Objectives
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Thus the Switra is a condition, which affects the skin with “Aparisravi
swethavarna mandala” i.e. non exudative white circular patches with out changing the
morphology of skin. Switra may have its managements through various methods, such as
Sramsamana, Bhahiparimarjana, Kushtaghna and Varnya etc, mentioned in classics. Out
of all Ayorajadilepa, which is used here as external application and Kakodumbaradi
Ghanavati internally helps to understand the different mechanisms put forth for pacifying
the disease. The present study under takes the treatment under the following headings of
hypothesis.
1. Role of Dosha and its pacification in Switra by Kakodumbaradi Ghanavati
internally and Ayorajadilepa externally
Switra is a Tridoshaja Vyadhi. By indulgence and practice of aetiological factors
vitiation of tridosha takes place. They occupy Rakta, Mamsa and Medo Dhatu to produce
disease in situ. As the Dosha- Dooshya sammurchana of these manifests the Switra, it is
essential to combat the disease based on the ground of Dosha pacification. Hence, the
ingredients of Kakodumbaradi Ghanavati ingredients are scrutinized for want of
pacification of the involved Dosha, i.e. Dosha pratyaneeka Chikitsa is under taken.
The ingredients consist of katu Rasa, rooksha and laghu guna, ushna veerya along
with katu vipaka, by which they act as Kapha hara. The herb with Tikta and kashaya
Rasa, sheeta veerya pacifies the Pitta. The ushna veerya of the drug acts on Vata to
pacify.
The topical application locally acts to relieve the obstructions of the normal
situation maintenance and regulates the Dosha concern such as Bhrajakapitta.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Objectives
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2. Protecting skin from "free radicals" vis-à-vis Ama by Kakodumbaradi Ghanavati
internally and Ayourajadi lepa externally
Ayurveda suggests of regular cleansing of the body i.e. purification of the body,
through the day to day activities. Deranged digestion is rectified as the first step of the
treatment, which is possible through Kakodumbaradi Ghanavati inducing free defecation,
considered as the Nitya Shodhana or other wise Koshta Shuddi. The free radicals are the
effective disease producing chemical agents which are produced at the end of the
reactions occurring as a part of metabolism in the body. The Ama according to Ayurveda
mimics the above theory is also cared about in the study. Ayurveda suggests that
regulating the Agni is the treatment. Thus at this juncture the Deepana and Pachana
qualities embedded in the Kakodumbaradi Ghanavati regulates the free radical inflow i.e.
Ama and enhances the effect of the trail drug.
3. Stimulating melanocytes to enrich re-pigmentation by Kakodumbaradi Ghanavati
internally and Ayorajadilepa externally
Switra is a disease of hypo-pigmentation. Thus the enhancing melanin production
becomes a task at the study. For such development the Ayorajadilepa local action is more
beneficial. The internal Kakodumbaradi Ghanavati as it acts to regulate Dosha and the
disease producing factors locally Ayorajadilepa implants counter irritation and regulation
of the Bhrajakapitta. So far it is known that Bakuchi is the only drug that has a dual
action i.e. Action on both Rouget's cells and the melanoblastic cells of the skin. In
leucoderma the malanoblastic cells are not functioning properly and their stimulation by
the oil leads them to form and exude pigment which gradually diffuses into the
decolorized area (chopra).
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – Objectives
13
4. Producing long term tissue building effect in the Body through Rasayana effect of
Kakodumbaradi Ghanavati internally and Ayorajadilepa externally
Rasayana is a unique method of protective and nourishing the tissues against the
natural calamities and time bound degeneration. The Ayurvedic medicines will have an
embedded effect of Rasayana in them. The Kakodumbaradi Ghanavati consists of the
Bakuchi, which is said to be a best Twak Rasayana. Switra on the other hand of
contemporary medical specialists is an autoimmune disorder and the management has to
be suppression of free radicals and enhancing immuno-modulation, other wise inducting
Rasayana.
Kakodumbaradi Ghanavati cumulative effect is Rasayana, Brumhana and Balya.
Thus the above said trial drug will repair the tissues deranged and long term tissue
building effect. Rasayana effect could be estimated in four ways viz.-
1) Cell maintenance and nourishment
2) Enhancing the cell growth
3) Expelling the free radicals and
4) Inducting immuno-modulation effect.
The topical preparation i.e. Ayorajadilepa is Twachya (skin promoter) and
Keshya (Hair promoter). So these compounds certainly enhance the tissue
building and pacify the hypo-pigmented patches of Switra.
Chapter – 3 Literary Review
Switra i.e. Vitiligo is an important skin disease having major impact on quality of life
of patients, many of whom feel distressed and stigmatized by their condition. Society greets
Vitiligo patients in much the same way as it does any one else who appears to be different.
They are started at or subjected to whispered comments, antagonism, insult or isolation. The
chronic nature of disease, long term treatment, lack of uniform effective therapy and
unpredictable course of disease is usually very demoralizing for patients suffering from
Vitiligo. It is important to recognize and deal with psychological components of this disease
to improve their quality of life and to obtain a better treatment response 15.
In India and perhaps elsewhere also men, women and children with Vitiligo face
severe psychological and social problems. It is more acute in the case of young women and
children. The first prime minister of India, Pt Jawaharlal Nehru ranked Vitiligo as one of
three major medical problems of India the other two being leprosy and malaria. In India
Vitiligo commonly known as leucoderma is unfortunately associated with some religious
beliefs 16.
In some Indian religious texts where reincarnation is believed, it is said that a person
who did "Guru Droha" in his previous life suffers from Vitiligo in this life. Thus people
suffering from Vitiligo in India have more social problems than in other countries. This is
seriously felt among young unmarried women. This is so because of arranged marriages.
Thus a young woman with Vitiligo has little chance of getting married. A married women
developing Vitiligo after marriage shall have marital problems perhaps ending in divorce.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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Since ancient times patients with Vitiligo suffered the same mental abuses as lepers.
In actual fact Vitiligo was referred as Sweta Kustha meaning "White leprosy". Vitiligo is
disfiguring in all races but particularly more so in dark skinned people because of strong
contrast. Many Vitiligo patients feel distressed and stigmatized by their condition. They
attract undue attention from the general public some times whispered comments, antagonism
and ostrisisam. The self image of the Vitiligo patients drops considerably and may lead to
depression. These patients often develop negative feeling about it, which are reinforced by
their experiences over a number of years. Most patients of Vitiligo report feelings of
embarrassment, which can lead to a low self-esteem and social isolation 17.
Vitiligo lesions over face may be particularly embarrassing and the frustration of
resistant lesions over exposed part of hands and feet can lead to anger and disillusionment
particularly in teenagers, mood disturbances including irritability and depression are
common. Patients with Vitiligo are very sensitive to the way other perceives them and they
will often withdraw, because they anticipate being rejected. Sometimes, strangers and even
close friends can make extremely hurtful and humiliating comments. The impact of such
factors is profound subjecting them to emotional distress, interference with their
employment, or use tension-lessoning, producing substances such as alcohol 18.
Severe depression has been known to lead to suicide attempts 19. Last decade has
witnessed an increasing interest in psychological effects of various skin diseases and quality
of life in patients suffering from these diseases 20. A healthy normal skin is essential for a
person's physical and mental well being. It is an important aspect of their sexual
attractiveness, a sense of well being and a sense of self confidence 21. The skin is the largest
and most visible organ of the human body 22. Hence any blemish on the skin visibly affects
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
15
the onlooker and thus the person affected profoundly 23. Vitiligo is an acquired de-
pigmentation disorder of great concern affecting 1–4% of the world population 24.
Vitiligo is an important skin disease having major impact on the quality of life of
patients suffering from Vitiligo. Appearance of skin condition is an individual self-image,
and any pathological alteration can have psychological consequences 25. Vitiligo has a
profound effect on the quality of life of patients and so the patients go to any extent in getting
it treated although it is not life threatening. The dermatologists should treat it as serious
disease with the various treatment modes now available and not dismiss simply because of
not having a completely successful treatment. Improving the physician's interpersonal skills
with the Vitiligo patients increases patient's satisfaction and consequently may have a
positive effect on adherence to treatment protocol and better out come of treatments.
For such an attempt a through knowledge of the Switra in terms of its etiology,
progression of disease and methods of managements are studied. The study should have
comparison of the ancient told literature to compare and study under the limelight of the
contemporary medical parlance.
HISTORICAL REVIEW
It is the past that has created the present. The study of the past history gives us the
picture of origin of diseases, our ancestor’s knowledge about them and their contribution
towards combating the diseases. Many historical facts are available regarding the disease
Switra since Vedic period. For the sake of convenience the knowledge of Ayurveda can be
divided as follows.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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Vedic Period (2500BC – 1000BC)
The Vedas establish many subtle links with the hymns and charms. The literature of
many epochs serves as valuable sources of information in understanding the disease Switra.
Rigveda, Yajurveda, Samaveda and Atharvaveda are four Vedas. References regarding
Ayurveda are found in Rigveda and Atharvaveda.
In Rigveda 26 relevant reference regarding Switra is found. A story is narrated where
Shweta Kushta is mentioned. Ghosha, the daughter of Kakshavati was refused by her
husband when Shweta Kushta inflicted her. Ashwini kumaras the pioneers in medical
profession treated and cured her disease, which made to regain her marital status. In Rigveda
Kilasa is the name used to describe the spotted deer, which has striking resemblance with the
disease Switra where the hypo pigmentary patches are diffused over the body without ulcers.
In Athrvaveda the term Switra is not directly described. But the terms like Kilasa,
Palita are used in place of Switra 27. In Koushika Sutra of Atharvaveda Rama, Krishna,
Asikni are the medicinal herbs described as the remedy for the malady Kilasa. Darila, a
commentator says Bringaraja, Indravaruni and Neeli are the drugs described as the drugs
Rama, Krishna and Asikni respectively. The fourth drug appreciated in maintenance of the
colour is Rajani or turmeric 28.
In Yajurveda there is a reference mentioning that Chandra or moon is affected with
the disease Switra 29. According to Taittariya Brahmana, the students suffering from the
following diseases were not acceptable by the guru. ‘ Switri chaiva galatkushti netra rogi cha
vamane kunakha shyavadantavascha’ - Persons suffering from Switra and their progeny are
disqualified for wedlock as per the direction of Manu 30.
In Panini Vyakarana Sutras also references regarding Switra roga are found 31.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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Samhita Period : (1000 BC – 100AD)
Samhita period is considered as golden era of Ayurveda as maximum contribution is
given in this period.
Charaka describes Switra roga with Kushta chikitsa, specified its dhatugatatwa up to
medodhatu and also mentioned about its specific nidanas 32.
Sushruta also mentioned about Switra roga in Kushta rogadhyaya and dealt its types
as vataja, pitta and kaphaja Switra 33.
Bhela has also described Switra in brief 34.
Kashyapa Samhita has also dealt about Switra in Kushta chapter itself and defined its
cardinal symptom as twacha Shwetata.35
In Ashtanga Sangraha 36 and Ashtanga Hridaya 37, the description of Nidana, Bheda,
samprapti and Chikitsa is available. He has stated that Switra more bheebhatsa than that of
Kushata. So the prognosis of Switra defends on early diagnosis and prompt treatment.
Madyamakala (800 AD – 1700 AD)
Important treatise of this period is Madhava Nidana 38, Bhava Prakasha 39,
Sharangadhara Samhita 40. These books compiled and reproduced the scattered information
of Samhitas in an order. All acharyas of this period follows opinion of Bhritries, very
specifically of Acharya vagbhata. Acharya Sharangadhara has given numerical data and
prescriptions for Switra.
Adhunika Kala : (1700AD onwards)
This started after the entrance of the foreigners. Here especially during recent decades
there has been tremendous and marvellous development in the field of medicines. Becker and
Obermayor reported Vitiligo cases in 1937 and Buckley and Lobitz in 1953. Afterwards
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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A.B.Lerner (1959), Fitz Patric (1974), Parish J.A.(1976), P.N. Behl(1980) and Roxburghii
(1980) have done in depth studies on Vitiligo 41.
NIRUKTI :
Switra:
The term Switra belongs to feminine gender. It is derived from the verb root ‘Swith’
i.e. Shweta varna, meaning white color. When the suffix ‘ rik’ is added to the verb root
‘Swith’ by the rule ‘It Sansnya’ the letter ‘ka’ is deleted, ultimately it becomes the word
‘Switra’ 42.
Swith + Ra = Switra
Vitiligo:
The origin of the term Vitiligo is obscure like the disease itself. Some believe that it is
derived from the Latin word ‘vitelius’ meaning vale i.e., pale pink flesh of a calf, while
others originated from the word ‘vitium’ meaning blemish 43.
Stedman’s dictionary 44 defines Vitiligo as - The appearance on otherwise normal
skin of non-pigmented white patches of varied sizes, often symmetrically distributed and
usually bordered by hyper pigmented areas; hair in the affected areas is usually, but not
always, white.
Epidermal melanocytes are completely lost in depigmented areas by an autoimmune
process. Synonyms of Vitiligo are acquired leukoderma, acquired leukopathia and
leukasmus. Leukoderma is defined as - An absence of pigment, partial or total, in the skin.
PARIBHASHA:
Ayurvedic authors have defined Switra in different ways but all definitions carry the
“Shwetate iti Switram” same meaning.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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In Amarkosha 45 Gurabala prabhohini the term Switra defined as “Swetate
twaganena Switram” means by which the colour of skin turns to white
. In Shabdhakalpadruma 46 as –“ Shwetate ithi”
In Kashyapa Samhita 47, as ‘ Shwetabhavamichchanti Switram ’.
All above references from the various texts and classics of Ayurveda support the
meaning of the Switra as white discolouration of the skin. The cardinal symptom of the
Vitiligo is milky white macules on the skin. All the above-mentioned definition gives support
to Vitiligo and its cordinal symptom perfectly.
Vitiligo is progressive, chronic pigment anomaly of the skin manifested by
hypo pigmented white patches that may be surrounded by a hyper-pigment border.
PARYAYA
The synonyms of Switra present a typical picture in relation to its symptoms.
Switram 48: ‘Swetate iti Switram’ – that which produces morbid whiteness.
Kilasa 49: ‘Kila varnam yasyati ksheeyati vikruti karoti iti yat ’ – that which
gives vikruta varna to the skin.
Shweta kushtam 50: Shwetate anena iti shweta kushtam’ means the skin
disease which causes whiteness of the skin.
Charuna 51: Reddish brown, tiny, the color of the morning opposed to the
darkness, i.e., the dawn.
Daruna 52: If disease is untreated became Asadya
Synonyms:
Achromoderma, Hypomelanosis, Leukopathia and Leukopathy are the synonyms of
Vitiligo.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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Role of skin in the Switra
It is very much essential to know and understand the role of skin in the Switra
pathogenesis with its physiological and anatomical considerations.
The skin is the body's largest organ. Knowing its function and how it is related to the
nervous system helps understand how stress can trigger or worsen Vitiligo. It is also
important to know the close relation between the nervous system and the system of defense
i.e. immune system.
Skin functions in general 53
1. It is a barrier to protect the body against the entry of toxic environmental chemicals.
2. It prevents loss of essential body fluids and dehydration.
3. The skin protects the body against invasion by micro-organisms.
4. The skin contributes to the body's supply of vitamin D. Vitamin D3 (cholecalciferol)
is produced in the skin by the action of ultraviolet light on dehydrocholesterol.
5. Melanin, the natural pigment of the skin protects against damage from excessive
ultraviolet radiation.
6. The skin is a part of the body's temperature regulation system, protecting us against
hypothermia (excessive cold) and hyperthermia (excessive heat).
7. The skin is also a huge sensory organ with receptors for heat, cold, pain, touch,
pressure, and tickle.
The skin and the nervous system originate from the same structure during early fetal
development. This is one of the reasons why emotional life may affect the skin either
positively or negatively. The skin has great psychological importance at all ages. It is an
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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organ of emotional expression and a site for the discharge of anxiety. For example, caressing
favors emotional development, learning and growth of newborn infants.
Skin (Twak) in Ayurveda
The term "TWAK" derives from the root "twacha - samvarne" (which cover). It can
be defined as substance of the body, which covers the internal tissues like Rakta, Mamsa etc.
Synonymous of Twak:
1. Twak
2. Charma
3. Sparsanedriya
Skin formation:
The layer of Twak forms in the stages garbhavstha as layer of scum-formation on the
surface of boiling milk 54.Later in the stage of dhatu parinam, Twak forms as an upadhatu
from prasada paka of Mamsa Dhatu. Twak is the mridu bhava of garbha, which can be
considered as Matruja Bhava (Maternal factor) 55. According to Vagbhata Twak is formed
in sixth month of gestation 56.
Layers of the skin:
According to Susruta 57 Twak is composed of seven layers and six layers by
"Charaka". Susruta described the thickness of each layer taking one "vreehi" as standard for
total skin, where as Charaka does not mention the thickness of layers. The above Acharyas
have described the diseases that manifest in each layer. But they have got difference in
opinion of layer, in which the "Switra" occurs. Charaka considered it as third, while Susruta
in the fourth layer. Regarding the number of layers of skin there are some difference of
opinion between the ancient authors; for instance - Charaka 58 described six layers of skin but
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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while elaborating one these layers he has named only two layers the rest four layers have
been described in terms of the diseases. Susruta has described seven layers of skin along with
the specific names. He has also mentioned the thickness of each layer along with the
diseases, which are prone to that layer.
The comparative tabular form of skin layers are depicted as under.
Table – 1
Skin layers according to Charaka, Susruta and Vagbhata
S.No Charaka Disease according to Charaka
Susruta Thickness according to Susruta
Disease according to Susruta
Vagbhata
1 Udakadar - Avabhasini 1/18 vreehi (0.05-0.06mm)
Sidma, padakantaka
Udakadhara
2 Raktadar - Lohita 1/16 vreehi
(0,06-0.07mm)
Tilakalaka, nyacha.
Asrukdhara
3 Triteeya Sidhma, kilasa
Sweta 1/12 vreehi (0.08-0.09mm)
Vyanga, ajagalika, mashaka.
Third layer
4 Chaurth Dadru, kushta
Tamra 1/8 vreehi (0.12-0.15)
Kilasa, Fourth layer
5 Pachama Alaji, vidradi
Vedini 1/5 vreehi (0.2-0.3mm)
Kusta, visara. Fifth layer
6 sashta Arasha, baganhara
Rohini 1 vreehi (1-1.1mm)
Granti, apachi, arbuda, galaganda.
Pranadhara
7 Mamsadhara 2 vreehi (2-2.1mm)
Bhagandara, arsha, vidradi.
Not told
Vagbhata 59 has described seven layers of skin similar to Susruta. He has not given
any description. Sharangdhara 60 has also mentioned seven layers of skin along with the
probable onset of diseases. The names of first six layers are same as Susruta but seventh
layers are named as “Sthula” which is the site of Vidradhi.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review
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Dr. Ghanekar has written commentary on Susruta Shareera. He has correlated the
layers of skin mentioned by Susruta with the latest anatomy of skin as under 61.
Table – 2
Skin layers comparison according to Dr. Ghanekar
S.No Ayurvedic nomenclature Contemporary nomenclature
1 Avabhasini Stratum corneum
2 Lohita Stratum Lucidum
3 Sweta Stratum Granulosum
4 Tamra Malpighian Layer
5 Vedini Papillary Layer
6 Rohini Reticular Layer
7 Mamsader Subcutaneous tissue and muscular layer
Surface Anatomy of skin 62:
Chakrapani commenting on Charaka Chikitsa, 15th chapter stated that before
proceeding to the study of vikruti one should have the complete knowledge of its prakruti.
Switra is a hypo pigment disorder affecting the Twak, the most exposed part of the body. A
description regarding anatomy and physiology of skin is necessary to understand completely
the cause, nature and the treatment of this disease.
Within this area the basic studies of the materials that make up the skin and its cells,
how they are assembled into the structure that we see under the light and electron
microscope. In further skin cells interact with one anther via cell to cell signalling and
attachment how the skin protects itself from the external environment has to be studied in
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detail. And how that protection can breach in a controlled manner to apply drugs to treat skin
and systemic diseases, we have to study skin elaborately.
Figure -1
Components of the integumentary system
St
us
th
ep
sy
wh
ructure of Epidermis: The epidermis is formed of nonvascular stratified epithelium. Its
ual thickness is in between 0.07mm and 0.12 mm. But in certain parts like the soles of
e feet and the palms of the hands it is very thick ranging from 0.8 mm to 1.4 mm. The
idermis is mainly divided into two main systems namely keratinizing or malpighian
stem (keratinocytes) which forms the bulk and the pigmentary system (melanocytes)
ich produces the pigments. Melanin is transferred to the keratinocytes through the
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dendrites of melanocytes. The following are the main layers of the epidermis from above
downwards.
1. Stratum Corneum – This is the most superficial layer, the outer surface of which is
exposed to the atmosphere. It consists of many layers of non-nucleated, flattened
cornified cells. This layer is thickest on the palms of the hands and soles of the feet.
But thinnest on the outer aspects of the lips and the glans penis and the eyes.
2. Stratum Lucidum – This is below the Stratum Corneum and is the pale wavy looking
layer. It is formed by many layers of flattened and closely packed cells whose outline
have become quite indistinct and the nuclei have disappeared. This layer contains
refractile droplets of eleidin.
3. Stratum Granulosum – This layer is composed of flat fusiform cells, which are one to
three layers thick. These cells contain irregular granules of keratohyalin.
4. Stratum Malpighi or the prickle cells layer – This layer is composed of several layers
of polyhydral cells connected to each other by intercellular bridges. Surface of this
layer is covered with minute spines known as prickle cells. As the cells move towards
the surface keratin is synthesized with in them. Melanin pigment is more distinct in
this layer.
5. Stratum Germinativum – This is the deepest portion of the epidermis and is composed
of columnar cells placed perpendicular to the skin surface. The whole of the
epidermis germinates from the stratum hence the name stratum germinativum. The
basal layer contains many mitotic figures signifying the occurrence of cellular
multiplication. More and more cells are formed and pushed of to the superficial
layers. Some of the cells of the stratum germinativum contain granules of pigments
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called melanin. Besides melanoblasts or melanocytes are found in this layer. These
have branching processes ramifying between other layers. These appear non-
pigmented.
Structure of Dermis: This layer consists of bundles of collagen and elastic fibers arranged
in the reticular fashion. It is profusely supplied with blood vessels. Superficially the
dermis is condensed into a dense fibrous network, the basement membrane to which are
attached the epidermal cells. Its deeper parts merge imperceptibly into the hypodermis.
Beneath the basement membrane are distributed many blood vessels forming a capillary
network, which sends up, loops into the dermal papillae. Thickness of dermis varies from
1 to 3 mm. Other structures found in the dermis include blood vessels, lymphatics,
nerves, nerve endings and receptors, Dartose muscle in the scrotum, appendageal glands
and their accessories, eg. Erector pilli muscles.
Shareera Kriya of Twak:
In Switra the cardinal symptom is accepted as depigmentation. Thus the study
regarding the factors responsible for 'varna' (pigment) as per Ayurveda is essential apart from
the other functions narrated by the Ayurvedic authors’ viz. Sparsnedriya stana, Bhrajakapitta
stana, Sweda gati stana, Absorption area for abhyanga, parisaka and alepa etc.
VARNA OF TWAK:
"Tejobhuta" is the main factor in formation of Twak varna and among the Dosha,
"Pitta" is said to be responsible for the normal as well as abnormal coloration of the skin. The
specific "Bhrajakapitta" is located in Twak. During the garbhavasta, with the predominance
of tejobhuta the colour formation in foetal skin is accepted as below.
• Tejas + Ap -> Goura
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• Tejas + Prithvi -> Krishna
• Tejas + Akasha -> krishna-shyama
• Tejas + Ap + Akasha -> Shyama.
"Charaka" described 63 prakrita varnas are four in number, those are krisna, krisna
syama, syamavadata and avadata. Beside these are atikrisna and atigoura who are "ninditas"
mentioned in Charaka Samhita Sutra Sthana. Factors responsible for normal skin colour
according to Vagbhata 64 are –
Table – 3
Skin colour according to Vagbhata
S.N colour Sukra varna Garbhini ahara & vihar
Mahambhuta samyoga
Desa kala anuruti
1 Goura Shukla/Ghritabha varna
Ksheeradi madhur
Teja+jala+akash
2 krishna Taila Tiladi vidhahi annasevana
Teja+prithvi+vayu
3 Shyava Madhu Mishara ahara Sarva bhuta sanyoga
Chaya and prabha:
These are the factors, which are having close relation with skin colour. Chaya masks
the varna, while prabha brightens the varna chaya can be appreciated from close vision, while
prabha is visible from distance 65.
Tejobhuta is the basic of all types of prabha. The prabha is classified into seven, viz.
rakta, peeta, sita, syava, harita, pandu and asita 66.
Varna in normal is permanent from birth to death, chaya may alter due to "rishta"
(asanna mrityu lakshana), while prabha changes according to the temporary state of health.
The normal colour of the body is the outcome of these three only.
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Table -4
Chaya nirupana - Panchabhuta sambandha 67
Type Lakshnas
1 Nabhasi Nirmala, neelavarna, snehayukta, saprabha
2 Vayavi Ruksha, syavavarna, hatahprabha
3 Agneya Visudharakta, deeptabha, darsanapriya
4 Apya Shudha, vaiduryavimala, susnigdha
5 Parthiva Sthira, snigdha, ghana, syama, sweta
Bhrajaka Pitta and skin colour
Bhrajakapitta is stated to be located in the skin and to impart to this structure its
characteristic colour and luster. It has also been stated that it governs the normal and
abnormal temperature of the body.
'Charaka' has not described this Pitta as a separate entity but he has included the
functions attributed to it among those of Pitta in general. He has stated that the production of
normal and abnormal temperature of the body, as well as the normal and abnormal colour of
the skin due to Pitta 68.
Chakrapani, in his commentary on the above, has stated that the regulation or
otherwise of the body heat and variations in the colour of the body are the functions of
Bhrajakapitta which is located in the skin. Susruta 69, Bhela and Vagbhata have, on the other
hand, made separate and mention this Pitta, including the functions ascribed to it.
Bhrajakapitta, which is located in the skin is spoken of as Bhrajakagni, in as much as,
it enables the digestion (utilization) of substances used for "Abhyanga", "parisheka",
"avagaha", "lepana" etc. it irradiates the glow of one's natural complexion. Commenting on
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above "dashana" observes by Twak is understood the bahya twak, known as avabhasini, by
Abhyanga etc. is meant the dravyas employed for the kriya (preparation) and karma (action)
etc.
"Bhela":
Bhrajaka Pitta is that which is responsible for the manifestation of the specific
characteristic of body, it emphasises its importance, creates different prabhas (hues) of the
head, hands, feet, sides back, abdomen, thighs, face, nails, eyes and hair. It also brightens
them.
"Vagbhata" observes:
Bhrajaka is located in the skin. It is so called because it imparts lustre to the skin and
makes it radiate. Commenting on the above 70,
"Arunadutta" observes:
It is known as Bhrajaka because it performs dipana and pachana of (substances used
for) abhyanga, lepa, parisheka etc.
It will be seen from the citations above that,
Bhrajaka belongs to a larger species of substances described in Ayurveda as Pitta.
It is located in the bahya twak, in its layer known as avabhasini (Dalhana)
Its functions are state to be
The production of normal and abnormal heat of the body (Charaka)
The production of normal and abnormal colour of the skin, as whole , and parts
and structures of the body viz. Hands, feet, sides, back etc., (Bhela)
The absorption and digestion of substances used together with oils, decoctions
used for sprinkling over the body etc.(Dalhana & Arunadutta)
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It may be stated, in general, that Bhrajaka Pitta may represent the factor or factors present in
the body, which is or are responsible for the colour of the skin and other structures.
Rakta and skin colour:
The color and the functioning of the sparshanendriya depend on the quality of Rakta
Dhatu 71. Further this can be substantiated by the reference that the skin of the Raktasara
person possesses good kanti.
Relation with Dosha:
Vagbhata and Susruta have stated that the seat of Vata is Twak. While describing the
function of Pranavata Vagbhata states it as ‘indriya chitta drik’, that is to say, it keeps all the
indriyas alert and helps them to perform their functions normally. The color of the Twak is
dependent on the functioning of Udanavata. In classics it has been stated that the Udanavata
which is situated mainly in urah stana while circulating in its own channels does the
functions like vakpravrutti, bala, smruti and varnakara 72.
Vyanavata helps in the expulsion of sweda from antahmarga to bahya. The same
Vyanavata helps for the absorption of snehadi dravys that are applied externally.73
Like Vata Twak also is the seat of Pitta. The Pitta, which is located in the skin,
designated as bhrajakagni is responsible for the digestion and absorption of the substances
used for abhyanga, parisheka, avagaha, lepana etc. It is responsible for the glow of one’s
complexion in the normal state. This Bhrajakapitta located in the Twak manifests the color in
Avabhasini layer 74.
Relation with Dhatu:
Twak is considered as the upadhatu of Mamsa Dhatu 75. Twak is nourished by Rasa
Dhatu. The nutrition to it is supplied by innumerable rasavahinis. If there is any vikruti in the
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Rasa Dhatu, it certainly affects the Twak as the preceding is being nourished by it. Further in
rasasara person it has been mentioned that their Twak will be snigdha, shlakshna etc. By
these references the saying that the Twak is nourished by Rasa can be confirmed 76.
Relation with Mala:
Twak expels Kleda i.e. vidhruti 77 Sweda is an eliminative material from sweda vaha
Srotas which is a mala of medo Dhatu.
Pigmentation of the Skin according to contemporary medical science 78:
Color of the human skin is derived from a variety of chemical and physical properties
associated with the skin structure. Normal skin color is dependent on hemoglobin, both in
oxygenated and reduced state, carotinoids and melanin pigment. Five pigments are known to
influence the skin color. They are -
1. Melanin, is a pigment found more in stratum malpighi. Melanin contributes
color and quality to the skin and protects the organism (human) from the
ultraviolet rays. It is in the form of granules, which vary from light brown to
black in color. Melanin is formed from the amino acid tyrosine by the action
of the enzyme tyrosinase and copper protein complex. Hence it is clear that
copper ions are essential for normal pigmentation of the skin.
2. ‘Melanoid’ is supposed to be a degradation product of melanin and is diffused
through out the epidermis. Melanoid has a different absorption band of visible
light.
3. ‘Carotene’ is yellow orange pigment present in lipid rich areas like stratum
corneum, subcutaneous fat etc. This adds yellow color to the skin of women
that men.
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4. ‘Oxy hemoglobin’ imparts reddish hue to the skin color and it is evident in
areas where there is rich arterial supply like face, neck, palm, soles and
nipples.
5. ‘Reduced hemoglobin’ contributes bluish or purple character to skin color and
is more evident in lower areas of the trunk.
Two types of melanin pigmentation occur in man. The first ‘constructive’ skin color,
that is the amount of melanin pigmentation, which is genetically determined in the absence of
sun exposure and other influences. The other ‘facultative’ or inducible skin color or ‘tan’
which results from sun exposure.
Variation in the thickness of the skin may modify the skin color. Subjects with thin
epidermis have a ruddier color complexion and with a thicker epidermis look yellower.
Thicker epidermis is less transparent than the thin one. As the transparent stratum corneum
scatters light slightly, the deeper layer appears blue.
The skin remains light when the pigment is appeared in the center of the
melanophores and dark when it is dispersed to their periphery.
Three different mechanisms may be involved in the control of color change. Firstly,
the pigment cell may act as an independent effect or respond directly to the stimulus of light.
There is evidence that this can occur in some fish and amphibians and the tanning of human
skin both immediate and delayed can be considered as analogous process. Secondly, the
movement of pigment with the melanophore may be under the nervous control. Thirdly, the
activity of pigment cells or melanocytes may be under hormonal influence. Pituitary
hormone causes expansion of melanophores or promotes the formation of melanin in
epidermal melanocytes. Diagrammatically it is expressed as -
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tyrocinase Dopa oxydase
Tyrosine ------------------------ DOPA -------------------------- melanin
+ Copper
Reduced melanin ---------------------------------------- Oxidised melanin
Structure of Melanocytes 79:
Melanocytes form a network of dendritic cells in the basal layer of epidermis. They
are also found in the external hair root sheaths and in the bulbs of the hair follicles. It is these
secretory melanocytes which behave as unicellular glands producing melanosomes which are
transferred to the surrounding epidermal keratinocytes, a cytocrine activity.
The transfer of melanocytes involves the insertion of a tip of the dendrite of the
melanocyte that becomes embedded in the cytoplasm of the keratinocyte. The end becomes
pinched off and a package of melanosomes is transferred to the keratinocyte that acts as a
phagocyte. The melanosomes are packaged according to size, the larger ones as single units,
and the smaller ones as complexes of two or more.
Melanocytes are distinguishable from the karatinocytes by the lack of desmosomes
and tonofibrils and by a more lucent cytoplasm. The characteristic feature of the cell is the
presence of special cytoplasmic organelles, the melanosomes on which melanin is formed by
the action of the enzyme tyrocinase. The developing melanosomes show varying degree of
electron density, the more fully melanized being very dense.
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Figure – 2
Structure of Melanocyte
F
Ka
our stages of melanosomal antagony are recognized.
• Stage one is a membrane bounded spherical vesicle may show tyrocinase
activity. According to classical theory, tyrocinase is produced on
membrane bound ribosome and transferred via the endoplasmic reticulam
to the golgi where it accumulates in vesicles that are derived from the
golgi.
• In Stage two melanosomes are oval in shape and show numerous melano
filaments with and without cross-linking.
• In stage three the internal structure of the melanosomes is partially
obscured by the deposition of melanin.
• In Stage four, the mature melanosome appear electron dense.
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Panchalakshana Nidana
A) Nidana of Switra
Nidana plays an important role in the manifestation of a disease. In classics Nidana is
defined as the factors which lead to the disease by deranging the equilibrium of the doshas in
the body 80. The knowledge of Nidana is essential for the understanding of Samprapti and to
determine the sadhyasadhyata and Chikitsa. In Ayurveda, Nidana have been given utmost
importance because the first line of treatment is Nidana parivarjana.
Coming to the subject proper, i.e., dealing with the aetiological factors of Switra let
us proceed to their study according to the different classical texts. Etiological factors for
Switra are described only by Charaka. It has been regarded as a type of Kushta in Susruta
Samhita 81. Further Vagbhata also states that the etiological factors, which are held
responsible for the causation of Kushta, hold good for Switra also.
Hence it is better to know the etiological factors of Kushta initially under samanya
Nidana before going to the specific etiological factors of Switra. They are discussed under
the headings of 1) Ahara, 2) Vihara and 3) Achara
1) Ahara Hetu :
Ayurveda offers more importance to Ahara, as samyak yojita ahara leads to indriya
prasadana and varna prasada. But asamyak yojita ahara may lead to several diseases.
Hence Twagindriya is also influenced by aharaja Nidana 82.
I) Viruddhahara: It is considered as major nidana for Kushta. Commentator Dalhana
mentions that viruddhahara is the vyadhi hetu for Kushta 83. Charaka opines that the
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consumption of viruddhahara continuously causes nindita Vyadhi 84. Vagbhata has
compared Viruddha Ahara with Visha and has also given the symptoms occurring due
to Viruddha Ahara in the body. According to Vagbhata Viruddha Ahara can
sometimes become fatal just like the poison & in some case it may become Gara
Visha in long run 85. The different factors related to Viruddha Ahara may be
summarized in two major groups viz. 1) Gunatah Viruddha and 2) Samyoga
Viruddha. The tabular forms of Ahara Nidana told by different authors are as follows.
Table 5 Classification of Viruddha Ahara by different authors
Viruddha Ahara CS SS AS AH BS HS MN BP
(A)Gunatah Viruddha
Intake of Mulaka, Lashuna etc. with milk
+ - - - - - - -
Gramya,Anupa,
Audaka, Mamsa with milk
+ + - - - - - -
Intake of Chilchim fish with milk + - - - - - - -
Milk with Nimb - - - - - - - -
(B) Samyoga Viruddha
- Intake of food mostly containing Hayanka, Yavaka, Chinaka, Uddalaka along with Ksheer , Dadhi, Takra, Kola, Kulattha, Masha, Atasi, Kusumbha, Sneha
+ - - - - - - -
Pippali, Kakamachi, Lakucha with Dadhi and Ghee
- - - - + - - -
Mulaka with Guda - - - - + - - -
Excessive Alcohol and green vegetables with milk.
- - - - + - - -
Articles having sour taste or meat of deer with milk
- - - - - - - -
Honey and meat after taking hot diet and vice versa
- - - - + - - -
Use of fish, Nimba and milk together.
- - - - + - - -
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II) Mithya Ahara:
Mithya Ahara means improper diet. According to Vijayrakshita, the diet
opposite to ‘Ashta Ahara Vidhi Visheshayatanani’ is designated as ‘Mithya Ahara’.
Charaka has described eight factors determining the quality of food they are called as
‘Aharvidhi Visheshayatanani’. They are Prakruti, Karan, Samyoga, Rashi, Desha,
Kala, Upyoga Samstha and Upayokta 86.
Table: 6 Mithya Ahara Hetu for Kushtha
Mithya Ahara CS
SS
AS
AH
BS
HS
MN
BP
Adhyashana + + - - - + + +
Vishamashana + + - - - - - -
Atyashana + + - - - - - -
Asatmya Ahara - + - - - - - -
Intake of food during indigestion + + - - - - + +
Continuous and excessive use of Madhu, Phanita, Matshya, Lakucha, Mulaka, Kaakmachi and intake of above substances while having Ajirna
+ - - - - - - -
Excessive Snehana + - - - - - - -
Vidahi Ahara without emesis of undigested food
+ - - - + + - -
Dravyataha
Excessive intake of Gramya, Anupa, Audaka Mamsa
- - - + - - -
Navanna, Dadhi, Masa, Matshya, Mulaka, Tila, Pishtanna,Kshira, Guda,
+ - - - - - + +
Dushivisha - + - - - - - -
Polluted water - - - - - + - -
Gunatah
Excessive Drava, Snigdha Ahara + - - - - + + +
Guru Ahara + + - - - - + +
Rasatah
Excessive Amla & Lavana Rasa + - - - - - + +
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These eight factors give rise to beneficial or harmful effects. Habitual intake of things in
proper way may more useful but in improper way they are always harmful. So they should be
avoided. Types of Mithya Ahara which are known to be responsible in the manifestation of
Switra are illustrated in the above Table.
2) Vihara Hetu :
All kinds of activities done physically, vocally or mentally are considered as Vihara.
Mithya Vihara means improper activities. The activities opposite to ‘Svasthavrita’ is the
‘Mithya Vihara’. The Mithya Vihara is the chief causative factor of many diseases but it has
been considered as main cause for the Kushtha. The factors related to Mithya Vihara by
various Acharyas have been tabulated in table 7.
Table 7 Mithya Vihara Hetu for Kushtha
Mithya Vihara CS SS AS AH BS HS MN BP
Shitoshna Vyatyasa Sevana and Anupurvya
Sevana
+ - - - + - - +
Use of Santarpana and Apatarpana diet
without sequence
+ - - - - - - +
Sudden diving in cold water or drinking
cold water after fear, exhaustion & coming
from sunlight
+ + - - - - + +
Practice of physical exercise & sunbath
after heavy meals.
+ - - - - - + +
Mithya Samsarga - - - - + - - -
Sex indulgence in Ajirna + - - - + - + +
Suppression of Chhardi, Mutra, Purisha
like Vegas
+ + - - + - + +
Kupathya in Panchakarma + + - - - - + -
Divasvapna after lunch + - - - + - - -
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3) Achara Hetu :
Those diseases, in which no clinical improvement is obtained even after the best
treatment, are considered as Papa Karmaja Vyadhi. Both Charaka 87 and Susruta 88 have
described a Kushta as Papa Karma Vyadhi. Achara hetu by various authors have been
tabulated in table 8.
Table 8
Achara Hetu for Kushtha
Achara Hetu CS SS AS AH BS HS MN BP
Papa Karma + + + + + + + +
Vipra Guru Tiraskara + - - - - - + -
Sadhu Ninda - - + + - - - -
Use of money & material acquired by
unfair means
- - + + - - - -
Killing the virtuous persons. - - + + - - - -
Vishishta Nidana of Switra
Bhaluki considers Switra as Sahaja vyadhi. Specific causative factors for Switra are
mentioned only in Charaka Samhita. Acharya Charaka stresses more on papakarma,
kritaghnabhava, guru gharshana, poorvakrita karma and viruddha Ahara 89.
Viruddha ahara or incompatible diet is mentioned as the prime cause of Kushta in
general and Switra roga in particular. Charaka has described 18 types of incompatible diets.
On consuming such foods a person is susceptible for nindita vyadhi. Chakrapani commenting
on nindita vyadhi considers Kushta and Switra both as nindita vyadhis 90. This vitiates pitta
pradhana tridoshas, which in turn cause rakta dushti and causes Kushta and Switra. Also
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Charaka mentions Switra as one of the viruddhahara janya Vyadhi 91. Acharya Sushruta is of
the opinion that the viruddha bhojana causes indriya dourbalya, which can be considered as
incompatibility of indriya and its adhishtana 92.
One of the veerya viruddha foods explained as nidana for Kushta is Matsya with
payasa. Bhadrakapya opines that especially Chilachima variety of fish with milk vitiates the
tridosha and cause shonita diseases 93. Vrana is mentioned as one of the causative factor for
Switra. It is also told that mithyopachara of vrana causes Switra 94.
Para samskara, which is interpreted as para samsparshadi means coming into contact
with an affected person of Switra through touch and other intimacies is also a cause for
Switra 95. If ‘Douhrida apachara’ is done during the state of pregnancy, i.e., intake of
excessive kaphakara ahara, then the Switra is said to appear in the baby as a complication 96.
When Jaloukavacharana is done by poisonous jalouka, Switra occurs at the site of the bite.
This is a special contribution by Astanga Sangraha 97.
2) Switra Samprapti
Samprapti is essential for the proper knowledge of a disease entity. This factor is
having more importance than the others as this is a process involving all the other four
factors in producing the disease in particular. This process begins from the time of
consumption of nidanas till the end stage of the disease 98. The reason for this factor to gain
importance is that the treatment procedure is mainly targeted on the Samprapti vighatana.
The initiation of pathogenesis occurs only after consuming the etiological factors. Thus after
considering the nidanas primarily it is necessary to give a detail description on the
pathogenesis.
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The Samprapti of Switra is not mentioned separately in the classics. Vagbhata
considers both Kushta and Switra are having same causative factors and treatment 99 and
even Susruta 100 opines that the Switra is a type of Kushta, it can be said that the Samprapti of
Kushta holds good for both.
A foresaid Nidana cause vitiation of the Pitta pradhana tridoshas and also cause
Agnimandya. Then the same doshas move in tiryakgata siras and lodged in tamra layer of
twacha and cause sanga or obstruction to the local rasavaha and raktavaha srotas. The reason
behind dosha-dushya sammurchana in tamra layer of twacha is due to the presence of
khavaigunya in the respective areas of twacha. This leads to the Kshaya of local
Bhrajakapitta and causes Twak shwetata.
Further the Samprapti continues and the deeper dhatus like mamsa and medas are also
involved. The involvement of each Dhatu exhibits specific discoloration on the lesion.
Doshas settled in Rakta Dhatu produces Rakta varna, Mamsa dhatu produses Tamra varna
and Shweta varna when settled in medo Dhatu 101.
Though all the three doshas are involved mainly vitiated Udanavata and Bhrajakapitta
are held responsible because these two maintain the color of Twak. The functioning of
Vyanavata can not be neglected as it is the main motivating force behind the movement of
dushta Dosha along with Rasa.
Samprapti Ghataka of Switra:
Dosha – Pitta pradhana tridosha
Dushya – Rasa, Rakta, mamas, Medas
Agni – Jataragni
Ama – Jataragni mandya janya
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Udbhava Sthana – Amapakvashaya
Sanchara Sthana – Tiryakgata siras
Srotas – Rasavaha, Raktavaha / Mamsavaha / Medovaha (sthanika)
Srotodushti prakara – Sanga
Adhishtana – Tamra layer of Twak
Vyakta Sthana – Twak
Rogamarga – Bahya
Vyadhi Swabhava - Chirakari.
Figure – 3
Schematic Representation of Samprapti
Abhyantara Nidana Sevana Vrana janya Vitiation of doshas Agnimandya
Formation of Ama
Dushta dosha sanchara in tiryakgata siras
Srotosanga
Sthanika Bhrajakapitta kshaya
Sweta Twak
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3) Poorvaroopa
Poorvaroopa are the premonitory symptoms that occur before the actual disease
manifestation 102. The knowledge of premonitory symptom is essential in assessing the
prognosis of the disease, in differential diagnosis and in the treatment. Also they provide a
clue to the ensuing disease. In classics there is no reference regarding separate poorvaroopa
of Switra. Considering the Acharya Vagbhata’s statement ‘Kushtaika sambhavam Switram’
poorvaroopa of Kushta can be considered for Switra also. Poorvaroopa explained in the
classics are as shown in the Table.
Table – 9 Poorvaroopa according to different authors
Sl No Poorvaroopa CS 103 SS 104 AS 105
1 2 3 4 5 6 7 8 9 10 11
12 13 14 15 16 17 18 19 20 21 22 23 24 25
Aswedana Atiswedana Kandu Lomaharsha Suptata Atishlakshnata Kharatwa Kotha Nistoda Paridaha Pakwa,dagdha,dashta,bhagna,kshatopaskalita ativedana Shrama Vaivarnya vrananam dushtirasamrohanam Pariharsha Parushya Visarpa gamana Gourava Kayachidreshu upadeha Klama Kshudravraneshu dushti Shwayathu Ushmayana Asrija krishnata Rookshata
+ + + + + + + + + + + + + + + + + + + + + + + _ _
+ + + + + _ _ _ _ _ _ _ _ _ + + + _ _ _ _ _ _ + _
+ + + + + + + + + + + + + + _ _ _ _ _ _ _ _ _ _ +
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4) Lakshana (Roopam) of Switra
It is the stage of a disease where the signs and symptoms of a manifested disease
exposed clearly. In Switra the general symptom is the appearance of swetha varna mandalas
that is depigmented patches or macules. The lakshanas mentioned in various texts, according
to Dosha involved.
Table -10
Depicting lakshana according to Dosha
Text Dosha Lakshana
Vata Mandala, aruna, parusa, paridwamsi
Pitta Padmapatra varna, daha
S.S
Kapha Swetha, snigdha, bahala, kandu
A.S Vata Rooksha, aruna
A.H B.P Pitta Tamravarna, daha, romadwamsi
M.N Kapha Swetha, ghana, guru, kandu
(S.S - Sushruta samhita, A.H - Ashtaga hridaya, A.S - Astanga sangraha,
B.P- Bhava prakasha, M.N - Madhava nidana)
Charaka does not differentiate the particular Dosha lodged in each Dhatu, even
though variability in degree of vitiation is mentioned. In Hareeta Samhita rupa of Switra
explained according to Sadhaya and Asadhya bhedas of Switra. Lakshana mentioned based
on the Dhatus in which Dosha are lodged 106.
Rakta dhatu - rakta varna
Mamsa dhatu - tamra varna
Medo dhatu - sweta varna
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Asadhya lakshana - Eeshad rakta panduta, sarvanga chira, snigdha.
Sadhya lakshana - peetachavi, pandu, ruksha
Table - 11
Clinical features according to various texts
S.No Lakshana C.S S.S A.H B.P M.N H.S
1 Sweta varna + + + + + +
2 Rakta varna + + + + + +
3 Tamra varna + + + + + -
4 Rookshata - + + + + +
5 Parusha - + - - - -
6 Daha - + + + + -
7 Kandu - + + + + -
8 Romadwamsi - + + + + -
9 Ghanam - + + + + -
10 Bahalam - + - - - -
(C.S - Charaka Samhita, S.S - Susrutha Samhita,A.H - Ashtanga Hridaya
B.P - Bhava Prakasha, M.N - Madhava Nidana, H.S - Harita Samhita)
Classification of Switra
Vitiligo is an organ specific autoimmune disease of the skin characterized by the
development of well-circumscribed white macules associated with local melanocyte loss 107.
Most of the authors in Ayurveda mentioned the Switra varieties as three only. All the
authors of Brihatrayee and Laghutrayee mentioned three types of Switra. But according to
Kasyapa it is of five types. Bhoja described two types, doshaja and vranaja.
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Classification by Charaka is based on the colour that in turn is depending on the
Dhatugata – Dosha 108. Charaka opines that daruna, Aruna and Switra are the synonyms of
Switra and also are three types it self, tri-discordance in origin.
Table – 12
Colouration of skin as Dosha dislodged in Dhatu
When Dosha dislodged in Rakta Rakta varna Daaruna
When Dosha dislodged in Rakta
Mamsa
Tamra varna Aruna
When Dosha dislodged in Rakta
Medas
Sweta Switra
Vagbhata classified the Switra with direct relation of Doshas with Dhatu 109. Susruta
110 followed the classification of Charaka with Tridosha predominance. Bhoja 111 describes
as Dohsaja and vranaja groups of classification, in which Doshaja has been further classified
into Atmaja - vitiation of the Vatadi Dosha as a result of the indulgences of the person
himself and paraja - by the contact with others in whom the entity already exists. Varanaja
refers to the discoloration that is introduced in to the normal skin as a result of a scar tissue
due to the healing of a wound or as a result of burns - cicatrix.
Since long time researching several medicinal plants and their active principles I
picked-up those that could help in the toxins elimination, but also those that could achieve
balance in the function of organs that are responsible for metabolism and excretion of these
toxins.
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Table – 13
Switra bhedas - various authors
S.no Text Verities Names
1 Charaka Samhita 3 Daruna Aruna Switra
2 Susruta Samhita 3 Vataja Pittaja Kaphaja
3 Astanga Hridaya 3 Vataja Pittaja Kaphaja
4 Harita Samhita 2 Sadhya Asadya
5 Kashyapa Samhita 5
6 Madhava Nidana 2 Doshaja Vranaja
7 Bhava Prakasha 3 Vataja Pittaja Kaphaja
8 Sarngadhara
Samhita
3 Vataja Pittaja Kaphaja
Switra according to Bhoja
Doshaja Vranaja
Paraja Atmaja
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5) Vyavachedaka Nidana of Switra
Though the Nidana are same for the disease Switra and Kushta 112, the lakshanas
differ, and hence they are given in a tabular form.
Table – 14
Switra and Kushta lakshana sadharmya and vaidharmyata
Switra Kushta
1 Usually one dosha predominates All the three doshas are involved
2 Only three dhatus(rakta,mamsa,and
medo)are affected
All the dhatus may affected
3 Confines to the skin only (tamra-4th layer) Confines to the fifth layer of the
skin(vedhini)
4 It is of krimirahita Krimisahitam (may be)
5 It is non-infectious and non-contagious It is contagious on prolong contact
6 No destruction of dhatus occurs Destruction of dhatus may occurs
7 No loss of sensation in the lesion There may be loss of sensation in
8 No secretion occurs Often secretion is present
9 It is non-hereditary Found occasionally hereditary
SADYASADYATA
The disease Switra is told as krichrasadhya roga in most of the texts and as asadhya in
only the text "Kashyapa Samhita". The krichratva becomes more and more in Raktagata,
Mamsagata and medogata respectively 113.
In early stages, where the hairs on the patches are not extensive and not turned into
white colour. Not compound and not caused by burns are told as 'sadhya'. Patches opposite
to these conditions and which are appeared in genital area, palms, soles and lips, even if they
are not short duration or of long duration are mentioned as "Asadhya".
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Vitiligo Modern view
There are several diseases marked by a lack of pigment in the skin that are grossly
referred to as leukoderma; some are caused by an inability of melancocytes to produce
melanin, while others are caused by melanocytes either not being present or being destroyed.
The latter are the pathology of the disease Vitiligo.
Vitiligo is a progressive disease in which the melanocytes are gradually destroyed
causing depigmentation of the skin. The exact etiology of Vitiligo is unknown, but four main
theories exist to explain it. These are -
1). autoimmune hypothesis,
2). neural hypothesis,
3). self-destruct hypothesis, and
4). growth factor defect hypothesis.
It is believed that Vitiligo is a polygenic trait and that a convergence theory,
combining elements of different theories across a spectrum of expression is the most accurate
aetiology.
Autoimmune Theory:
There is great anecdotal evidence that an autoimmune disorder causes the destruction
of melanocytes, and this theory is now generally accepted as the common cause of Vitiligo. It
is known Vitiligo appears in conjunction with several other autoimmune disorders, such as
juvenile diabetes mellitus, Addison's disease, and pernicious anemia, and additionally organ-
specific antibodies can often be seen in patients with Vitiligo. If the immune system raises
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antibodies or cytotoxic T cells to damage melanocytes, the mode of action the cells take
against the melanocytes could be apoptosis induction directly against melanocytes or Ig
induced complement-both are demonstrated in figure-4 114.
Proving this theory, there is histological evidence in Vitiligo patients that apoptosis is
occurring in the un-pigmented skin lesions: there is damage to the melanocytes and
keratinocytes in these areas, and the melanocytes exhibit nuclear shrinking, vacuolization,
loss of dendrites, and detachment. If antibodies do cause Vitiligo, some research suggests the
Ig’s may bind to tyrosinase related proteins 1 and 2, which are important for melanogenesis,
instead of Ig's targeting the melanocytes directly (Huang et al. 2002) responses.
Figure 4
Autoimmune theory of Vitiligo showing both cell-mediated and humoral autoimmune
.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Literary Review 51Neural Theory:
There is also evidence that peripheral nerve endings may secrete a substance that is
cytotoxic to melanocytes and causes their destruction. This is supported by the segmental
variety of Vitiligo, which occurs in specific dermatomes, indicating the skin is possibly only
being affected by the nerves of that specific dermatome. Additionally, Vitiligo appears with
certain neurological disorders such as encephalitis, and trauma that causes peripheral nerve
damage. Nerve endings in depigmented areas were seen to produce abnormal neuropeptides
and nerve growth factors, and displayed axonal degeneration-these abnormal chemicals may
be toxic to melanocytes. Additionally, depigmented areas showed some abnormal autonomic
function, such as increased adrenergic tone, increased norepinephrine, and an increased
concentration of catecholamines. These data then suggest that neurotransmitter release could,
directly or indirectly, have an affect on melanocyte destruction and depigmentation.
Self-Destruct Theory:
It is known that some of the intracellular pre-melanogenesis metabolites are toxic to
melanocytes, such as dopa and dopachrome. Normally melanocytes possess cellular
measures to counteract these toxic substances, but it is believed that cells may lose the ability
to counteract these toxic metabolites and are destroyed by leakage of metabolites into the
cytoplasm and eventually cell lyses. There is evidence that points to this in that certain
hydroquinone derivatives that are similar to these intra-cellular metabolites causeVitiligo
experimentally.
Growth Factor Defect Hypothesis:
A study in the 1980's found that melanocytes in lesions from Vitiligo patients
contained melanocytes, but that these cells exhibited "defective growth and passage
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capacities." The researchers then noted that the growth defects of the melanocytes were
partially corrected by adding a growth factor to their culture, additionally suggesting that
growth defects may be part of the pathology of Vitiligo. In depigmented areas, cellular
analysis showed that there were melanocytes but that they grew poorly. These data suggest
that, whether a primary or secondary cause, growth defects appear to play a role in
leukoderma and Vitiligo 115.
Genetic Influences:
A positive family history has been reported in about 20% of patients and it has been
found in monozygotic twins. Studies have shown that Vitiligo does not progress via a simple
Mendelian pattern, but more likely is coded polygenically and can be expressed across a
spectrum. There has been some evidence both proving and disproving the involvement of the
HLA system in the occurrence of Vitiligo. So, it is believed that genetic factors probably play
a key role in the pathogenesis of Vitiligo, but the exact cause is unknown.
Convergence Theory:
Following genetic studies, researchers have begun to lean towards a multi-faceted
etiology for Vitiligo that combines components of the aforementioned theories and genetics.
This theory states that genetic influences have a role in causing Vitiligo in addition to other
elements, such as stress, accumulation of toxic compounds, infection, autoimmunity,
mutations, and impaired melanocyte proliferation.
Other Causative Factors:
1) Nutritional deficiency
• . The diet poor in Proteins particularly the essential amino acid L-
phenylalanine can contribute to the causation of Vitiligo.
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• Deficiency of B- complex factors especially Thiamine, Riboflavin,
Pyridoxine, Pantothenic acid, Folic acid and Biotin is usually related with
Vitiligo.
2).Achlorhydria
There are stray reports that indicating stomach malfunction, with partial or
complete lack of hydrochloric acid and pepsin production to be cause Vitiligo.
3) Amoebiosis
Amoebiosis and intestinal parasites are said to be responsible for Vitiligo by
interfering with the absorption of nutrients and by producing toxin.
4) Endocrinal cause
• Amongst endocrinal factors, anterior pituitary is possibly the most important.
Intermediate lobe of pituitary secretes melanocyte-stimulating hormone.
(M.S.H.) stimulates melanin formation and melanin dispersal.
• ACTH and MSH have some structural similarity and slight functional
overlapping.
Figure – 5 - Showing pituitary – MSH – Melanocytes axis
Anterior Pituitary
Pancreas Thyroid MSH Adrenal Gonads Para Cortex Thyroids
Melanocytes
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• Oestrogen increases melanin synthesis and the quantity of free melanin.
Progesterone is supposed to potentate pigmentary action of Oestrogen.
5) Trauma
Many Vitiligo patients develop color loss at local sites of skin-damaging
injury or trauma.
6) Drugs and chemicals
Drugs and chemicals, like quinines, qunofuracin, amylphenol, chlothizide,
broad-spectrum anbiotics, and chlroquin may initiate vitiligo.
7) Miscellaneous factors
Constant rubber friction, pressure, and trauma tight clothing can precipitate
the lesions of Vitiligo.
These various factors are enumerated and discussed in order of their sequence
in the pathogenesis are as follows.
a. Deficiency of MSH
b. Other hormonal factors
c. Heredity d. Copper deficiency
Figure – 6 Causes of Tyrosinase Tyrosine DOPA melanin
a. Nutritional deficiency b. B – Complex deficiencyc. Amoebiasis d. Liver function
deficiency
Neural concept melatonin
Tyrosinase Tyrosine DOPA
melanin
Self destruction of melanocytes
♦ Rubber friction ♦ Chemicals
Autoimmune
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Table – 15
Causes of localized hypo pigmentation
Disorders Distinguishing features Vitiligo Destruction of melanocytes, common, acquired, multiple sharply
defined non-pigmented patches anywhere. Pityrias isverscicolor Superficial fungus infection leading to disturbance in pigment
production, common, multiple pale scaling patches on trunk. Pityriasisalba Mild patchy eczema of the face in children causing a disturbance in
pigment reductions. Leprosy One or several paler macules on trunk or limbs that are hypoaesthetic. Albinism Congenital stationary disorder, distribution may complete or partial.
Hairs and eyes may be affected. White macules of tuberous sclerosis
Uncommon development of anomaly affecting CNS connective tissue and skin, several maple leaf shaped hypo pigmented macules.
Post inflammatory After inflammatory skin disease (often eczema) or trauma to the skin, irregular in shape and in depth of pallor.
Naevus anaemicus Rare developmental solitary white patch usually on trunk thought to have a vascular basis.
Chemical toxicity May took very like Vitiligo, seen in workers in the rubber industry exposed to paratertiary benzyltoluene.
PATHOLOGY:
a) A defect in enzyme tyrosinase is held responsible for Vitiligo. According to some,
"melatonin" a substance secreted at nerve endings inhibits tyrosinase, thus interfering
in pigment formation.
b) The Vitiligo appears to be due to an immunological attack on the melanocytes. This
would suggest that Vitiligo is an autoimmune disorder.
Clinical forms of Vitiligo
a) Focal
b) Segmental
c) Acrofacial
d) Generalized
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Common lesions seen on the body are -
a) scalp
b) retro-auricular folds
c) upper eye lids
d) lips
e) finger tips, palms
f) nipple
g) waist
h) scrotum, glands
i) legs
j) Toe tips and soles.
Often the depigmented patches are symmetrical, especially when the disorder is
distributed over the peripheral parts of the limbs and the face.
CLINICAL FEATURES: APPEARANCE
Completely depigmented macules and patches of varying sizes and shapes
characterize it. Besides loss of colours, there is no other structural change. The depigmented
areas are paling white or slightly pink and ill defined at the start of the disorder. In doubtful
cases, the pigmentation can be made to appear more distinct by pressing the patch with a
glass side. This pressure momentarily obliterates the blood supply and hence the
depigmentation stands out more prominently. In early doubtful cases examination under
"woods lamp" is also helpful.
Often the depigmented patches are symmetrical, especially when the disorder is
distributed over the peripheral parts of the limbs and the face.
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The border: A rim of hyper pigmentation generally lines the border of the depigmented
patch. It looks as the pigment is removed from the patch and is thrown at the periphery.
Hair on the patch: Hair may or may not become depigmented in vitilliginous areas. Presence
of depigmented hairs (leucotrichia) or a patch is a strong point in favour of the diagnosis of
Vitiligo.
Distribution - lesions: Distribution of the lesions is determined by the supply and demand
behaviors of the pigment commodity. Whenever there is scarcity of any commodity two
diagonally opposite areas suffer most thus;
1) Peripherally situated, badly supplies areas, which are even normal at a critical
level of supply with little or no stored material, suffer commonly. Hence
mucocutaneous junctions. Finger tips, palms, soles and toe lips are commonly
involved in any extensive Vitiligo.
2) Areas where the consumption rate is normally very high suffer most in any
scarcity or pigment commodity. Pigmented like nipples, scrotal skin, scalp
(because of hair) and moles are also commonly involved in any extensive
Vitiligo.
Classification of Vitiligo:
Vitiligo has been divided into three stages
A) Localized Vitiligo:
1) Focal: One or more macules in one area, but not clearly in a segmental or
Zosteriform distribution.
2) Segmental: One or more macules involving a unilateral segment of the
body that is fault of the face, fault of the trunk, and extremity.
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3) Mucosal: Vitiligo of the mouth and mucus membrane and the genital.
B) Generalized Vitiligo
1) Acrofacial : Distal parts of the extremities and face .
2) Vulgaris: Scattered macules.
3) Mixed : Accrofacial and Vulgaris or segmental and accrofacial and / or
Vulgaris
C) Universal Vitiligo
Complete or nearly complete depigmentation
Second Classification 116 considering the aspects of progression of disease, prognosis
and treatment.
a) Segmental (Unilateral)
b) Non-segmental. (Bilateral)
I) Focal
II) Mucosa
III) Accrofacial
IV) Vulagaris and
V) Universal
c) Mixed , Segmental and Non –Segmental
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Table -16
Clinical criteria for classification of Vitiligo
Stages of Vitiligo Clinical feature
Active stage 1 New lesions developing
2 Lesions increasing in size
3 Border ill - defined
Quiscent stage 1 No new lesions developing
2 Lesion stationary in size
3 Border hyperpigmented and well defined
Improving stage 1 Lesions decreasing in size.
2 No new lesions developing
3 Border defined and signs of repigmentation
(follicular and peripheral)
Zosteriform Vitiligo 1 Unilateral distribution of lesions, preferably
along the course of nerves.
Clinical associations - Vitiligo:
1. Cutaneous
a) premature graying of hair
b) halo naevi
c) alopecia areata
2. Systemic
a) thyroid disorders
b) Diabetes mellitus.
c) Addisons disease
d) Pernicious anemia
e) Multi endocrinopathy syndrome
f) Oculo and auditory abnormalities
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Differential diagnosis of Vitiligo
Causes for localized de pigmentation of skin: In many countries the fear of leprosy
makes differential diagnosis of a "white patch" an urgent and vitally important issue.
Examination of the skin in long wave UVR helps distinguish whether these is total de
pigmentation (as in Vitiligo) or not. It may also detect areas of depigmentation not easily
seen in ordinary daylight as well as detecting a lemon-yellow fluorescence seen in some
cases of pityriasis versicolor.
Zosteriform Vitiligo –
Lesions develop along the distribution of a peripheral nerve. Halo neavus (sutton's
nevus) - a related disorder in which the depigmentation begins around one or a few
compound naevi.
Occupational Vitiligo (Oliver):
It is seen on the dorsum of the hands of tannery workers caused by the use of rubber
gloves containing agerite Alba. Monobenzyl ether of hydroquinone (MBEH), The chemical
gets dissolved by sweat and acts on the melanocytes in such away as to interfere with the
formation of malanin. In early cases, depigmentation may disappear spontaneously.
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Switra
Chikitsa The description and various treatments for Switra mentioned in almost all the
Ayurvedic texts along with kushtas. Same general principles of treatment for Kushta and
Switra are similar. But the number of special preparations only for Switra is available in
many texts.
Switra is more complicated disorder than all types of kushtas, which becomes
incurable within small period of duration. The Chikitsa is advised as soon as possible in this
disorder, which is compared with a - "Burning building" which needs a fast management.
Switra is a dosha-karmaja vyadhi. With this fact the treatment methods for switra can
be adopted under three headings - Daivavyapasraya, Yuktivyapasraya, and Satvavajaya
Chikitsa.
Daivavyapashraya Chikitsa
In Vagbhata along with other Chikitsa karmas daivavyapasraya Chikitsa (which
relieves the effect of papakarmas) mentioned for good prognosis. The mentioned
diavavyapasraya Chikitsa for Kushta and Switra are - practice of vrata-dana-yama,
tyagasheelata, friendship and mercy to all kinds of beings, worship of brahmins-devas-guru,
shiva and bhaskara aradhana etc, which cure the effect of papakarmas 117.
Satwavajaya Chikitsa:
Controlling of the manas from ahita indriyarthas i.e., from causative aharas and
viharas for Switra. It is also named as Nidana parivarjana, which also plays a key role in
Chikitsa.
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Yuktivyapasraya Chikitsa 118
The person is made to undergo all types of shodhanas. Then once again is made to
drink malapurasa with guda to his capacity, which is preceded by oleation and then made to
expose to sunrays (suryapada santapam) as long as he can. This drink will have a purging
action. The procedure is repeated for three consecutive days.
The blisters so formed should be punctured with badara kantaka and the fluid allowed
oozing out completely. When undergoing this line of treatment he must be given to drink the
decoction prepared out of bark of malapu, asana, priyangu and satapushpa taken in equal
quantities, or palasa kshara along with phanita taken according to his capacity.
Whatever else non-curative of Kusta in general is beneficial if taken with
khadirodaka. Internal usage of only khadirodaka is like wise beneficial 119. The patient
should expose to sunrays and when a blister forms he advised to take food with takra
(nirlavana). Vagbhata also tells internal administration of gomutrarista 120.
Bahiparimarjana Chikitsa
There are so many topical lepas prescribed in various texts. Some of them are as
below -
1. manahsiladilepa - manahsila, vidanga, kasisa, rochana, kanakapushpi and
saindavam.
2. Kadalikshara+burnt bone of donkey in cow’s blood.
3. Nilotpala, Kusta and saindavam in elephant urine.
4. Mulaka beeja and bakuchi-paste.
5. Kakodumbara, bakuchi seeds and chitraka in cow’s urine.
6. Manahsila in peacock bile.
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7. Udayadityarasa.
8. Putikaranjadilepa.
9. Bakuchi with one fourth of talaka in cow’s urine.
10. Bringaraja, haridra, doorva, ajaji, vidanga, tila, chitraka, harichandana in cows
urine.
11. Bakuchi, karanja, jyothishmati taila in equal quantities.
12. Bakuchi seeds, laksha, cow-bile, anjanadwaya, long piper and kalaloharajah.
Shastrapranidhana Chikitsa
In Vagbhata the raktamokshana is mentioned as a part in treatment of Switra. The
above mentioned shonitamokshana supports the Switra as Rakta dushti janyaroga 121.
Even though vamanarechanadi shodhanas, shonitamokshana, virukshana and intake
of saktu are done carefully, swithra can become sadhya only to those persons whose effect of
papakarmas are cured completely with vrata, dana, dharmadi karmas.
PATHYA & APATHYA IN SWITRA
As the Nidana factors mentioned it for both the Kushta and Switra in almost all
Ayurvedic texts. Hence the pathya apathyas for both disorders may appear similar (almost)
with each other 122.
Apathya in Kushta
a) Ahara : Atilavana - atiamla padartha sevana, dadhi, ksheera, guda, anupamamasa, tila,
masha, vasa, kulutha, nishpava, lkshu, pistavikara, virudha - adhayasana, ajeerna, vidaha
- abisyandahara etc.,
b) Vihara : Diwaswapna and vyavayam
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Above mentioned dravyas and causative factors mentioned for Switra are said to be
apathyas in kishta as well as in Switra.
Pathyas in Kushta:
The following are indicated as usual ahara, achara - vibhaga for are who suffers from
Kusta.
♦ Ahara: Shashtika shali, koradushaka, uddalak, mudga, adaki, peya, tiktasaka, jangala
mamasa, saktu sevana, pachagavya sataa sevana.
♦ Ausadha: Avalguja, nimba, arushkara, aragwada, chakramarda, palasakshara, atarusha,
mandukaparni and khadira - their various preparations.
♦ Vihara: Vrata, dwija-sura-gurupuja, bhaskararadhana, ravivaravrata, dana dharma,
tyagasheelata, goseva and satyadharmata etc.
COURSE AND PROGNOSIS
Variable and some what unpredictable, may remain static, spread or re-pigment. But
usually the condition is gradually progressive, sometimes extending rapidly over a period of
several months and then remaining quiescent for many years. Spontaneous re-pigmentation is
noted in about 10-20% of patients. 1) Factors indicating good prognosis for regimentation
are: Recent onset < 6 months, in a young individual on the facial area. 2) Conversely factors
which indicate an unfavorable prognosis are: Late onset in life, long-standing persistent
lesions, located on the extremities and on the lips. 3) Re-pigmentation begins within the
affected area from the hair follicles where there may be residual melanocytes; or else they
occur from the normal pigmented skin immediately adjacent to the vitiliginous area. Once re-
pigmentation begins it tends to continue, albeit slowly and sometimes trivial.
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Figure - 7
Drug Review
In the present study the drug for study choose is - Kakodumbaradi Ghanavati
internally and Ayorajadilepa externally possess the following proportions in it.
1) The combination and proportion of Kakodumbaradi Ghanavati is as follows.
S.No Drug & Botanical Name Proportion
1 KAKODUMBAR TWAK (Ficus hispida) 123 One part
2 VIDANGA (Emblia ribes) 124 One part
3 BAKUCHI BEEJA (Psoralia corylifolia) 125 One part
2) The combination and proportion of Ayorajadilepa is as follows
S.No Drug & Botanical Name Proportion
1 AYORAJA (Ferrum) 126 One part
2 KRISHNATILA (Sesamum indicum) 127 One part
3 RASANJANA (beriberi extract) 128 One part
4 BAKUCHI BEEJA (Psoralia corylifolia) One part
5 AMALAKI (Emblica officinalis) 129 One part
6 BHRINGARAJA (Eclipta alba) 130 One part
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All the drugs are well identified and collected from local areas. Good manufacturing
practice will be followed for the preparation of Yogas. The Kakodumbaradi kwatha which is
mentioned in kwatha kalpana is taken in the form of Ghanavati because of its palatability
form. The individual drugs are discussed as under.
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1) KAKODUMBAR TWAK (Ficus hispida) 131
Description
It is 5 meter tall tree grown all over India.
Useful part:
Bark, root bark, latex, Fruit
Chemical constituents
β-Sitosterol, Hispidin, Phenanthraindolizidine alkaloid, Bergapten, Psoralen.
A new norisoprenoid, ficustriol (1), and the known phenanthroindolizidine alkaloid
O-methyltylophorinidine (2), were isolated from a CHCl3 extract of the leaves and twigs of
Ficus hispida. O-Methyltylophorinidine showed potent cytotoxic activity when tested against
a small panel of human cancer cells, while ficustriol was inactive. The structure and
stereochemistry of 1 were determined using chemical and spectral methods 132.
Action and uses
Kapha Pitta hara, Sukrala, Grahi, Brumhana, Switra hara, Vrana hara, kamala hara,
Pandughna, Arshoghna and Atisara hara.
2) VIDANGA (Emblia ribes - Myrsinaceae) 133
Description
These climbing herbs are found in India, Central and lower Himalayas, Sri Lanka and
Singapore
Useful part
Berries (fruit), leaves, root bark
Chemical constituents
Embelin, Christembine, Homoembelin, Homorapanone, Vilangine, Quercitol, etc.
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Action and uses
Vidanga is used to destroy parasites, intestinal peristalsis and flora, and for blood and
liver detoxification. This herb is pungent and has decongestant, carminative, anti-helminthes,
antibacterial, diuretic, stimulant, alterative, and anti-inflammatory properties 134.
Vidanga is one of the most effective treatments for expelling tape worms. It is used as
a laxative and is helpful in reducing flatulence. This herb can also be used to treat E. coli,
dyspepsia, piles, toothache, fungus, pneumonia, and sore throat. Vidanga can also be applied
to the chest area for lung diseases, and rubbed onto the head for headache relief, and it can be
used on children who are experiencing habitual constipation and acute capillary bronchitis.
When combined with ginger, it can be used topically for the treatment of ring worm and
internally for parasitic infections.
Alternative, anti-helminthes, carminative, stimulant, abdominal disorders
constipation, fungus, gas, indigestion, headache, heart disease, hemorrhoids, insanity,
lung disease, mouth ulcers, obesity, pneumonia, sore throat, toothache, worms. Decoction of
the roots given in insanity and heart diseases.
3) BAKUCHI BEEJA (Psoralia corylifolia - Papilionaceae) 135
Description:
This is an Ayurvedic herb. It is found in many parts of India.
Useful part:
Babchi Seeds,
Constituents
The chief active principle of the seeds is an essential oil; and a fixed oil, a resin, and
traces of a substance of alkaloidal nature. The seeds of psoralea coryfolia contains essential
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oil (in pericarp to the extent of about 0.05 - 0.12%), a fixed oil, a resin, a volatile terpenoid
oil and two crystelline principles psoralen (c11 H6 o3)m.p 162 c. Iso - psoralen m.p 112c. A
crystelline substance called psorolidin (c16 H14 o4)m.p 315c has been isolated from the
pericarp. Psoralin and Iso-psoralen are oil soluble furocoumrins.
Actions and Uses:
This herb is so effective in the treatment of leprosy that it was given the name of
'Kushtanashini'. Seed powder is used to treat leprosy and leucoderma internally. It is also
applied in the form of paste or ointment externally. The unsaponified oil has been used with
success in case of leucoderma and psoriasis.
It was shown to improve the color of skin (including removing white spots), hair, and
nails. For instance, an ointment made by combining one part of an alcoholic extract of the
seeds with two parts of chaulmugra oil and two parts of lanoline has been found to be
effective in treating leucoderma, white leprosy, psoriasis, and other inflammatory skin
diseases and febrile conditions. The oil can be used either internally or as a simple ointment
externally. Gently rub the oil once or twice daily. The proportion of the active ingredients
may be increased if needed. Seeds are also used for scorpion sting, and snake-bite. Bakuchi is
Aromatic, anthelmintic, antibacterial, antifungal, diuretic, diaphoretic, laxative, stimulant,
and aphrodisiac 136.
4) AYORAJA (Ferrum)
Description
Ayoraja is fine powder of kantaloha and it is dark reddish brown in colour
Useful part
Powder of kantaloha
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Chemical constituents
Fe3O4 (Magnatite)
Action and uses
Tridoshadhara, rasyana, keshya, and pandu hara pramehahara, gulmahara,
pleharogahara, yakrit rogahara, kandu hara, externally it is used for Alopecia areata 137
5) KRISHNATILA (Sesamum indicum - Pedaliaceae) 138
Description:
It is an annual herb growing up to 1 meter bering white or light pink couloured
flowers. It is mainly cultivated in the temperate regions of India.
Parts used
Seeds
Chemical composition:
It contains protein carbohydrate, minerals, phosphorous; oil contains 70p.c of liquid
fats consisting of the glycerides of oleic and linoleic acid Properties and used
Uses: It is having vatahara, Madhya, pain-relieving property (soola prasaman) Balya
Action and uses
It is a Vata hara, Twachya, Balya, Keshya, Sukralam. It is considered best in
Bahumootra and paste is used in Bhagandhara.
6) RASANJANA (Berberis Aristata (Daruharidra) extract) 139
Description
A genus of shrubs or small trees, distributed in the temperate and sub-tropical parts of
Asia, Europe and America. About 77 species are recorded from India. Commonly known as
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BARBERRY (Vern.-Kashmal, kinjosa), several species are grown in gardens for their
ornamental leaves and bunches of succulent, acidic, edible barries. They are also planted in
hedges due to their straggling habit. The roots of these species are collected in fairly large
quantities in Chamba district of Himachal Pradesh and in Tehri-Garhwal of Uttar Pradesh
during Aug-Sept and are sold in drug markets of Chamba, Dehra Dun and Hardwar.
Daruharidra is yellowish brown, cylindrical, more or less knotty, hard and tough.
With the bark intact they are cut into pieces of varying length and a maximum diameter of 45
mm. The bark is internally dark brown and soft, breaking away into a powdery mass 140.
Part Used
Extract -
Chemical composition
The roots of Daruharidra were chemically analysed to afford a protoberberine
alkaloid named as karachine which was characterised 141 and the sructure was confirmed by
synthesis 142 taxilamine was also isolated 143.
The berberine content of 2.65% was observed in the dried powder samples analyzed.
The method can be used for the detection, monitoring, and quantification of berberine in B.
aristata 144.
The roots and stembark contain a number of alkaloids of which the chief active
alkaloid is berberine, its concentration being higher in plants growing at lower altitudes.
Berberine (C20H18O4N, m p 145°) forms yellow needles which are soluble in water but are
less soluble in alcohol 145.
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Alkaloids of the isoquinoline type, Mainly berberine, Berbamine and derivatives,
Berberrubine, Bervulcine, Columbamine, Isotetrandrine, Jatrorrhizine, Magnoflorine,
Oxycanthine and Vulvracine o Miscellaneous, including Chelidonic acid, resin, tannin etc.
Actions and Uses:
Cholagogue, hepatic, anti-emetic, bitter, laxative Diuretic, Antibilious, Refrigerant,
Stomachic, Bitter tonic, Antiperiodic, Alterative, Antipyretic. Used for the treatment as an
Antibiotic, Immune Stimulant, for treating pinkeye, High blood pressure.
For bile and urinary conditions, Pitta detoxification, and congestion of abdomen and
pelvic, cavities; rheumatism, scarlet fever, brain disorders, heat, thirst, nausea; small
amounts- tonic; large doses-purgative; excellent herb for jaundice, during pregnancy, mild
laxative, periodic neuralgia, fevers, skin diseases, vomiting in pregnancy; fruit-mild
laxative/purgative for children, fevers, blood purifier, malaria, gastric and duodenal ulcers;
sores, jaundice, enlarged liver and spleen, and regulates liver functioning, diabetes, and
toxins/.Amla (with twice as much turmeric); destroys toxins, reduces body fat (with
turmeric); renal calculi, abdominal and pelvic congestion; G.I. stimulant, reduces blood
pressure.
7) AMALAKI (Emblica officinalis)
Description:
A small or medium-sized deciduous tree with smooth, greenish grey, exfoliating bark.
Leaves of smaller dimensions, distichous . Branches looking like pinnetely compound leaves.
Flowers greenish yellow in axillary fascicles, unisexual.
Fruits depressed globose, 1-3 cms in diameter, fleshy and obscurely 6-lobed, breaking
into three crustaceous cocci, each containing two trigonous seeds. The tree is common in the
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mixed deciduous forests of India ascending to 1,500 meter on the hills. It is often cultivated
in gardens and homeyards. A type bearing comparatively larger fruits than the wild plant is
known in cultivation.
Parts used
Dried fuit, the nut or seed, leavesroot, bark and flowers. Ripe fruits used generally fresh
dry also used.
Chemical composition
Chemical investigation of the fruits of Amalaki afforded trigalloylglucose, terchebin,
corilagin and ellagic acid 146 preparation of salts of phyllembic acid and structural studies
were reported 147. Seed fat contained linoleic acid (64.8%) and closely resembled linseed oil
148 ellagic acid and lupeol were reported from roots 149. Fresh fruit pulp contains vitamin C
up to 720 mg./100 g. and press juice contains 921 mg./100 cc. The fruit is a rich source of
pectin 150. Proteolytic and lipolytic enzymes are present in the seeds 151.
Actions and uses –
Fresh fruit is refrigent diuteric and laxative. Green fruit is exceding acid. Fruit is also
carminative and stomachic. Dried fruit is sour and astringent. Flowers are colling and
apreient. Bark is astringent. Rasa all except lavana, kashyam dominates, setha veeryam,
mathura viprakam, tridosha haram, Rasayana, increases sukram. Raktapittam, prameham,
vata-raktam, giddiness, and vertigo. Extrnal use: in method disorders as a paste and tailum to
head. 'Tara-dravam'.
8) BHRINGARAJA (Eclipta alba)
Description:
This herb is found throughout India and the southwestern U.S.
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Parts Used:
Herb, roots, leaves
Actions and uses:
Alterative, antipyretic, hemostatic, laxative, nervine, rejuvenative, tonic, vulnerary,
Roots and leaves are cholagogues, Root is tonic, alterative, emetic, purgative. Leaf juice is
hepatic tonic and deobstruent aging. The herb maintains and rejuvenates hair, teeth, bones,
memory, sight, and hearing. Cirrhosis, ear aches are relieved. Used as Hair tonic - oil
removes graying, balding, makes the hair darker. Make hair oil by boiling leaf juice in
coconut oil. This is useful to remove gray hair and balding. Remunerative for kidneys, and
liver. It improves complexion and useful in skin disorders.
sleep - oil promotes deep sleep.
Preparation of Kakodumbaradi Ghanavati
Ingredients of Kakodumbaradi 152 Ghanavati identified and collected are undertaken
for preparation by Sharangadhara mentioned Raskriya vidhi. Ghanavati was prepared at
Khajarekar pharmacy of Belagum for purpose of study.
Prescribed quantity of Bakuchi is taken and soaked in to gomootra for purification for
7 days. Everyday fresh gomootra is used. Then the Bakuchi is dried under the shade. Equal
quantity of Vidanga and Kakodumbara Twak were taken and physically purified for
unwanted materials. After words 240 liters of water were added and boiled on constant
regulated heat till it reduces to one forth. This padava shesita kashaya was filtered and
reheated to semisolid form on mild fire. Then 500mg vati is prepared and stored in glass
container.
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Advantages of vati preparation
They are easy to carry and swallow and patient doesn’t experience unpleasant taste.
Vati do not require any measure cups and is convenient to preserve for long duration.
Preparation of Ayorajadilepa
Prescribed quantities of Bakuchi were taken and soaked into gomootra for 7 days for
purification. Everyday fresh gomootra is used. Prescribed quantity of Kantaloha were taken
and heated to red hot and dipped into Triphala kwatha for sodhana. This was repeated for
seven times then shodita loha made as fine powder. Later equal quantities of purified
Krishnatila, Rasanjana and Amalaki from physical impurities and made into fine powder.
All the above drugs were thoroughly added along with shodita Bakuchi and Kanta
loha and grind with Bhringaraja swarasa. As the paste grinded is soft and with out any hard
particles of additives, Chakrika were prepared and dried under sun shade. The Chakrikas
were kept in Sharawa samputa and subjected to lughu puta in Rasa shala. After cooling the
contents are subjected to Bhavana with Bhringaraja swarasa till it becomes as fine paste. The
paste made as a vatri (Sticks) of 5 mg each and dried under shade. Finally prepared medicine
is packed in tight glass jars and offered for trial patients.
POSOLOGY
Internal Kakodumbaradi Ghanavati
3 gms/day in three divided doses or 50 mg / kg body weight per day in 3 divided
doses
External application
Ayourajadi Lepa -- QS
Table - 17
Pharmacological properties of Kakodumbaradi Ghanavati
S.N Drug Name & Latin Name Rasa Guna Veerya Vipaka Doshaghnata Karma1 KAKODUMBAR TWAK
(Ficus hispida) Tikta
Kashaya Rooksha Laghu
Sheeta Katu Kapha Pittahara
Sthmbhaka, Vrana shodhaka, Kustaghna
2 VIDANGA (Emblia ribes)
Katu LaghuTeekshna
Ushna Katu Kapha Vatahara
Krimighna, Adhmana Vibandha hara
3 BAKUCHI BEEJA(Psoralia corylifolia)
Katu Tikta
Laghu Rooksha
Ushna Katu Kapha Vatahara
Twachya, Kandughna, Krimighna, Switra hara
Table - 18
Pharmacological properties of Ayourajadi lepa
1 AYORAJA (Ferrum)
Tikta UshnaSnigdha
Sheeta - Tridoshahara Rasayana, Keshya,Twachya,
2 KRISHNATILA(Sesamum indicum)
Madhura Kashaya
Guru, Snigdha
Ushna Madhura Vatahara Twachya, Keshya
3 RASANJANA (beriberi extract)
Katu, Tikta,
Kashaya
Laghu Rooksha
Ushna Katu Kapha Vatahara
Kandughna, Varnya
4 BAKUCHI BEEJA(Psoralia corylifolia)
Katu Tikta
Laghu Rooksha
Ushna Katu Kapha Vatahara
Twachya, Kandughna, Krimighna, Switra hara
5 AMALAKI (Emblica officinalis)
Amla, Madhura,
Katu, Tikta,
Kashaya
Laghu Rooksha Sheeta
Sheeta Madhura Tridoshahara Rasayana, Vrushya,Kustaghna
6 BHRINGARAJA(Eclipta alba)
Katu Tikta
Laghu Rooksha
Ushna Katu Kapha Vatahara
Keshya, Twachya, Krimihara
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Chapter – 4 Methodology
The methods adopted in the study are discussed as under.
A) Source of data:-
a) Patients suffering from Switra are selected from P.G.S.A.R.C. Dept of
Kayachikitsa OPD of D.G.M. Ayurvedic Medical College and Hospital by Preset
Inclusion and exclusion criteria.
b) Literary: - Literary aspects of study are collected from classical Ayurvedic and
contemporary texts and updated with recent Medical Journals.
B) Method of collection of data:-
a. Study Design: Prospective clinical trail.
b. Sample size : A minimum of 30 patients are taken in randomized selection
c. Study duration :60 days – treatment schedule
d. Follow up: 30 days
e. Administration of Drug:
Internally Kakodumbaradi Ghanavati 3 grams / day in divided doses or 2 tabs of
500 mg thrice daily after the food with water
Externally Ayourajadi lepa Q.S. rubbed in water to paste and applied all over the
effected skin for 30 minutes exposed in the sun light
C) Exclusion criteria:-
1. Patients below 10 years irrespective of sex are excluded: because the
children under the age of 10 may not be co-operative and also are not
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accepted for any trail. Thus the below 10 years of age children are
excluded.
2. Patients above 60 years of age, irrespective of sex are excluded:
because the old age people are of Vata ages and above the age of 60
may not be accepted as they are under the influence of degeneration.
Thus the above 60 years of age people are excluded.
3. Pregnant women and lactating women are excluded: because the drug
may be placental barrier, thus pregnant women and lactating women
are excluded.
4. Patients suffering from other systemic disease are excluded: Because
the other systemic diseases may mask the disease original and the
effect of the trail drug may not elicited perfect. Thus the Patients
suffering from other systemic disease are excluded.
5. Patients with Burnt areas are excluded: Because the burnt area skin
loses permanently melanocytes and scar is formed, which is a
irreversible white patch mimics the Vitiligo. Thus the Patients with
Burnt areas are excluded.
6. The patches over lips and mouth angulations are excluded: The
patches over lips are excluded because the application over the area is
not possible as it is a cornified tissue. Thus the people with such
lesions are excluded.
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7. The genital area patches are excluded: Because, after the application as
generally asked to expose for the sun light which is not possible. Thus
such cases are excluded in the study.
D) Inclusion criteria:-
1. All the Patients other than that of exclusive criteria are included in the
study.
2. Patients with classical symptoms of Switra as explained in Ayurvedic
classics and diagnosed case of Vitiligo according to the contemporary
diagnostic system are included.
F) Method of Diagnosis:
1. Medical history:
Evaluation and diagnosis of Vitiligo require obtaining the following information:
i. The age of onset of the white spots; Vitiligo rarely begins before the age
of 6 months.
ii. Family history of Vitiligo and early greying of the hair (i.e., significant
loss of hair colour before the age of 30 years)
iii. Inflammation, irritation, or rash preceding the white sports.
iv. Potential precipitating events including emotional stress, physical illness,
sunburn, or other forms of cutaneous forms occurring within 2 to 3 months
prior to the onset of de pigmentation.
v. Personal stress to the patient resulting from the disease
vi. Ocular or auditory dysfunction.
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vii. Previous forms of therapy, either systemic or topical, how the therapy was
prescribed, and the effects or toxicity of the treatment.
viii. Stability or progression of the disease.
ix. Allergies and personal family history of atopy.
x. Occupational hazards and hobbies to define chemical exposures that might
be responsible for chemically induced Vitiligo.
xi. Personal or family history of associated diseases including thyroid
disorders, premature graying, alopecia areata, diabetes mellitus, collagen
vascular diseases, permicious anaemia, and addision’s disease; personal
history of other disorders aggravated by photo exposure or of
photosensitivity.
2. Physical examination
The diagnosis of Vitiligo is based exclusively on the clinical examination of the
patient. The physical examination includes the following findings; the presence of
acquired asymptomatic depigmented macules or patches, usually without clinical signs of
inflammation. Hypopigmented lesions may coexist with depigmented lesions. Such
trichrome lesions are often observed in individuals with darker skin. Trichrome Vitiligo
is characterized by depigmented, hypopigmented, and normally pigmented skin. About
2% to 5% of patients may exhibit one or more depigmented lesions with dermatitic
/inflamed borders.
Vitiligo lesions may be found in any area of the body. The initial lesions are
frequently found on the hands, forearms feet, face and lips. The borders of the lesions are
usually discrete and well defined.
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The distribution of skin lesions, the number, and the approximate surface area of the
integument involved by de pigmentation should be determined in order to establish the
baseline extent of the disease. Some investigators classify Vitiligo into two groups —
generalized and segmental. Others subclass generalized Vitiligo into three subcategories;
a) Generalized: Symmetric macules or patches occurring in a random
distribution over much of the body; acral / acrofacial depigmented
macules or patches confined to the extremities and /or face; focal/localized
isolated macules or patches on one or two sites of the body.
b) Segmental: Vitiligo restricted to one portion of the body such as one leg,
one portion of the trunk, or the face. The lesions are rarely if ever
distributed in a dermatomal pattern.
Other important physical findings include acquired depigmented hairs within a
vitiliginous region and poliosis of scalp hair, eyelashes, eyebrows, and/or beard hair.
Areas of hypopigmentation and hyperpigmentation of the choroid and retinal pigment
epithelium may be evident by ophthalmologic examination. The presence or absence of
uveitis also should be determined. This examination is best done by an ophthalmologist.
Referral to an ophthalmologist is of particular importance if the patient has complaints of
photophobia, decreasing visual acuity, or poor night vision.
For patients with fair skin, such as those with skin types I and II, detection of
depigmented or hypopigmented patches of Vitiligo may require the use of a wood’s lamp
to delineate the areas of involvement. In-patients with darker skin, a wood’s lamp
examination also can be helpful to assess the degree of hypopigmentation or
depigmentation in individual lesions.
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3) Diagnostic tests
In most instances the diagnosis of Vitiligo is based on the history and physical
examination. However, I some instances additional diagnostic tests may be indicated to
differentiate Vitiligo from conditions that may mimic it clinically. These conditions
include piebaldism, nevus depigmentosus, nevus anemicus, postinflammatory
depigmentation hypopigmentation, pityriasis alba, tinea versicolor, discoid lupus
erythematosus, and scleroderma. In addition, certain tests are sometimes helpful to detect
the presence of associated systemic disorders such as thyroid disease, pernicious anemia,
diabetes, or Addison’s disease. Some useful tests include the following.
a) Biopsy from the border stained with fontana Masson technique to differentiate
Vitiligo from some of the aforementioned conditions. Melanocytes are decreased in
the early stages of Vitiligo. As the disease progresses, they are completely absent.
Other changes include basilar vascuolopathy, exocytosis of lymphocytes, spongiosis,
and lymphohistiocytic infiltrates, especially in inflammatory Vitiligo. For most
patients a biopsy is not necessary
b) Baseline blood chemistry may include a complete blood count, a differential with
erythrocyte sedimentation rate, and thyroid function studies including thyroid
stimulating hormone. In addition, tests for antiparietal cell, antithyroid (thyroglobulin
and microsomal), and antinuclear antibodies are frequently indicated. These tests are
more important if signs or symptoms of endocrine disease or collagen vascular
disease are present. Abnormal test values should be followed clinically or by
laboratory examination as indicated.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Methodology
83
c) If patients are to undergo photo chemotherapy, a baseline ophthalmologic
examination and antinuclear antibody determination are advisable. Some physicians
recommend a repeat of these tests at 6- month intervals. Other at 12 month intervals
while on PUVA therapy.
Inappropriate diagnostic tests include serum alpha-MAS levels, serum ACTH
levels, hair analyses, and trace metal analyses.
G) Assessment of result
Subjective and objective parameters will be assessed for result.
I) Subjective parameter: Signs and symptoms as designed in classical texts.
1. Rukshata: becoming skin dryness at depigmented surface is identified as
different grades are as follows –
Grade 0 – Normal skin dryness
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
2. Parushata: becoming skin roughness at depigmented surface is identified as
different grades are as follows –
Grade 0 – Normal skin roughness
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
3. Paridwamshi: getting dusty skin at depigmented surface is identified as different
grades are as follows –
Grade 0 – Normal dusty skin Grade 1 – Mild - Grade 2 – Moderate – Grade 3 – Severe -
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Methodology
84
4. Daha: getting burning sensation of skin at depigmented surface is identified as
different grades are as follows –
Grade 0 – No Burning sensation
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
5. Roama Patana: getting hair falling at depigmented surface is identified as
different grades are as follows –
Grade 0 – No hair fall
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
6. Kandu: getting itching at depigmented surface is identified as different grades are
as follows –
Grade 0 – No itching
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
7. Kleda: getting moisture skin at depigmented surface is identified as different
grades are as follows –
Grade 0 – Normal skin
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Methodology
85
8. Srava: getting discharge at depigmented surface is identified as different grades
are as follows –
Grade 0 – Normal skin
Grade 1 – Mild -
Grade 2 – Moderate –
Grade 3 – Severe -
II) Objective parameter
For the assessment of results the following objective parameter were consider
i) Colour
ii) Margin
iii) Number
iv) VASI score.
To assess the effect number and VASI score were consider as they are without
grading before and after treatment. To assess the improvement in colour and margin the
following grading were given.
1. Colour: The colour of your skin is due to an interaction between –
(1) Pigment composition and concentration and
(2) The dermal blood supply. The grades are as follows –
Grade 0 – Normal skin colour
Grade 1 – Non-unified normal skin
Grade 2 – Pigmentation is more than depigmentation
Grade 3 – Depigmentation equal or more than pigmentation
Grade 4 – Depigmentation more than pigmentation
Grade 5 – Complete Depigmentation
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Methodology
86
2. Margin: margins of the lesions are enumerated as grades are as follows.
Grade 0 – Normal skin colour attributed
Grade 1 – Hyper pigmented thick broad width graduated margin
Grade 2 – Hyper pigmented broad width graduated margin
Grade 3 – Hyper pigmented well defined margin
Grade 4 – Hyper pigmented thin edge margin
Grade 5 – Ill defined margin
3. VASI score:
When patients or physicians try to determine how well a particular treatment
works for Vitiligo, it is often difficult to compare different treatment options. There is no
standardized measure for the amount of Vitiligo someone has and how it responds to
treatment. There is a standard for psoriasis known as the PASI (psoriasis Area and
Severity Index) score, which has been quite helpful in comparing different treatment
options in numerical terms. The PASI has been the basis for the FDA in its evaluation of
the rapid increase in new psoriasis treatments. This is not the case for vitiligo. Presently,
when a patient wants to determine how well Narrow Band UVB (NBUVB) may work for
their Vitiligo they are given the statistic that is often not intuitive.
The first step of the VASI is to divide the patient into various body regions such
as the arms, trunk, legs, hands and feet. Then, using the assumption that a palm of the
hand is equivalent to 1% of the body surface, the physician determines how much of the
skin is affected by Vitiligo. Then the physician determines what percent of the skin is
depigmented by referring back to standardized pictures of various degree of pigmentation
(see attached pictures) 153.
Sum of value of product of palm units X Extent of depigmentation VASI = Total Body surface area II) Over all assessment
Over all assessment of the results are done considering the cumulative effect of
subjective and objective parameters. The disease is not totally manageable with in the
scheduled time, the grades of assessment of results made as under.
1) Cured:
Colour – Normal skin colour
Margin – Normal or No margins
Number –100% reduction
VASI – VASI score is “Zero”
2) Well Responded:
Colour – non unified normal skin colour
Margin – hyper pigmented thick broad width graduated margin
Number – more than 75% reduction
VASI – more than 75% reduction
3) Moderately Responded:
Colour – pigmentation equal to depigmentation
Margin – hyper pigmented broad width graduated margin
Number – more than 50% reduction
VASI – more than 50% reduction
4) Poorly Responded:
Colour – depigmentation is more than pigmentation
Margin – hyper pigmented well defined margin
Number – less than 50% reduction
VASI – less than 50% reduction
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Methodology
87
5) Not responded:
Colour – No pigmentation developed
Margin – No changes in margin
Number – No reduction
VASI – No reduction
Figure - 8 Estimating the Degree of Depigmentation for the VASI
Kako
dumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –Methodology 88
CHAPTER-5
RESULTS
Present study registers 35 patients, out of 40 approached patients. The percentages of
patients undertaken from the scrutinised are 87.5%. Out of the 35 patients of Switra 33
(94.28%) patients were undertaken for the study. Out of 33 patients 3 (9.09%) patients were
discontinued hence their data has not been included in the assessment. The remaining 30
(90.9%) patients of Switra viz. Vitiligo, fulfilling the criteria of diagnosis and inclusive
criteria were included in the study. Vitiligo area scoring index (VASI) is considered as a
specific objective parameter for the assessing patients in the present study.
All the patients were examined before and after the trail, according to the case sheet
format given in the annex. Both the subjective and objective criteria were recorded. The data
recorded are presented under the following headings.
A. Demographic data
B. Evaluating disease Data
C. Result of the Kakodumbaradighanavati & Ayorajadilepa in Switra and
D. Statistical analysis of the subjective (clinical) and objective parameters
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 30 patients are as
follows.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 89
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 90
Table – 19
Demographic Data of trail in Switra with Kakodumbaradi Ghanavati & Ayorajadilepa
SN OPD Age Gender Religion Occupation Economical status
Food habits
Result
1 5327 41 M H ACT MID VEG MR 2 5517 16 F H ACT MID VEG PR
3 5524 37 F H ACT MID VEG MR
4 5589 16 F H ACT HMC VEG PR 5 5650 30 F H ACT MID VEG PR 6 16 10 F MU ACT MID MIX WR
7 209 13 F H ACT MID VEG WR
8 272 10 M H ACT POOR MIX WR 9 281 16 M H ACT MID VEG WR
10 485 28 M H ACT MID VEG WR 11 495 11 F H ACT HMC VEG MR 12 496 17 F H ACT MID VEG WR
13 599 43 F H ACT HMC VEG MR 14 145 12 M H ACT MID VEG PR
15 906 40 F H ACT MID VEG CUR
16 1186 28 M H LAB POOR MIX PR
17 1223 45 M H ACT HMC VEG WR
18 1435 38 M H LAB POOR MIX PR
19 2352 18 F H ACT MID VEG WR 20 2370 12 F MU ACT HMC MIX NR 21 2438 24 M H ACT MID VEG MR
22 2439 28 F H ACT MID VEG CUR
23 2485 22 F H ACT MID MIX MR
24 2570 27 M H SED MID MIX MR
25 2628 30 F MU ACT MID MIX MR
26 2653 21 M H ACT MID VEG WR
27 2744 19 M H ACT MID VEG PR
28 2804 13 F H ACT HMC VEG WR
29 2892 15 M H ACT MID VEG MR
30 2898 18 M MU LAB POOR MIX PR
M =Male, F = Female, H = Hindu, Mu = Muslim, ACT = Active, SED = sedentary, LAB = Labour, POOR = poor, MID = Middle class, HMC = Higher Middle Class,
VEG = Vegetarian, MIX = Mixed diet, CUR = cured, WR = Well Responded, MR = Moderately Responded, PR = Poorly Responded, NR = Nor Responded
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 91
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 30 patients is as
follows.
A1) Distribution of patients by Age – gender
Intervals of 10 have considered from the ages 10 to 50 as discussed in the methods. In
the study it is revealed that skin discoloration is continued from the ages of 10 and even less
ages and as the age advances the samples are settled to have Vitiligo. At the older age group
of 40-50 only 3 (10%) patients are reported. Where in 30-40 age group reported with 3 (10%)
and 5 patients in each group of male and female in total 10 (33.3%) reported from the ages of
20-30. larger sample age group 10-20 reported with the 14 (46.7%) patients with the
symptoms of Switra vis-à-vis Vitiligo. The tabulation is depicted as under.
Table- 20
Distribution of patients by Age- gender in Switra with
Kakodumbaradi Ghanavati & Ayorajadilepa
Male patients Female patients Total patients Age
Number % Number % Number %
10 - 20 6 20 8 26.67 14 46.7
20 – 30 5 16.66 5 16.67 10 33.3
30 - 40 1 3.33 2 6.67 3 10
40 – 50 2 6.67 1 3.33 3 10
Totals 14 46.66 16 53.34 30 100
Here in this study an attempt is made to understand the male female responses to the
management with respect to that of the age groups.
Figure – 9
Distribution of patients by Age- gender in Switra with
Kakodumbaradi Ghanavati & Ayorajadilepa
Kakodumba
Result of p
Age
Tot
al n
o of
10 - 20 15
20 – 30 9
30 - 40 3
40 – 50 3
Total 30
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 92
68
55
1
22
1
0 2 4 6 8
20-Oct
20 – 30
30 - 40
40 – 50
DISTRIBUTION OF PATIENTS BY AGE - GENDER
Female 8 5 2 1
Male 6 5 1 2
20-Oct 20 – 30 30 - 40 40 – 50
Table- 21
atients by Age in Switra with Kakodumbaradi Ghanavati & Ayorajadilepa
pati
ents
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
50 0 0 6 20 2 6.66 6 20 1 3.33
30 1 3.33 2 6.66 4 13.3 2 6.66 0 0
10 1 3.33 0 0 2 6.66 0 0 0 0
10 0 0 0 0 3 10 0 0 0 0
100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 93
Observations of result in the study are good as the cured (6.66%) and well responded
are 8 (26.6), in total is 33.33% of the patients included in the study. As the observations are
expressed the early age groups are responded well and the late ages are not. Thus the age
impact is observed in the study as this disease of depigmentation is well tackled at the early
ages than that of late ages.
A2) Distribution of patients by Gender
Table- 22
Distribution and Result of patients by Gender in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Gender
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Male 14 46.6 0 0 4 13.3 6 20 4 13.3 0 0
Female 16 53.4 2 6.66 4 13.3 5 16.7 4 13.3 1 3.33
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
The male female ratio in the study is 7:8 patients. The percentage of the distribution
does not show any gender differentiation to get this skin disease, except a small lean towards
Female population. The observations are 14 Patients i.e. (46.6%) male and 16 patients i.e.
(53.4%) were female. As the results observed, out of 14 (42.86%) males much are distributed
between well to moderate response but no body got cure. Out of 16 female patients, 2 cured
and 9 patients well and moderately responded show that the disease regression with the
present trail is relevant for the female population. The tabulation shown above is pictorially
expressed below.
Figure - 10
Distribution and Result of patients by Gender in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
A3) dist
F
Christia
commun
Muslim
(6.66%)
moderat
group o
commun
Kak
Distribution of patients by Gender in Switra
Male46.67%
Female 53.33%
ribution of patients by Religion
or the convenience of the study, the religion groups are noted as Hindu, Muslim,
n and Others. The maximum number of patients are noticed from the Hindu
ity as the ratio of community at the study area is more i.e. 26 (86.67%) along with
patients 4 (13.33%). At the results observed, out of 26 (86.66%) of Hindu patients, 2
patients cured, 7 (23.33%) patients’ well responded and 10 (33.33%) patients
ely responded. 7 (23.33%) patients poorly responded and no patients are from the
f not responded reported. On the other hand the results observed at Muslim
ity are, out of 4 (13.33%), one patient (3.33%) in each group of well responded,
odumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 94
moderately responded, poorly responded and not responded are observed. The tabulation and
graphical representation is as under.
Table- 23 Distribution & Results of patients by Religion in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
Religion
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Hindu 26 86.7 2 6.66 7 23.3 10 33.4 7 33.3 0 0
Muslim 4 13.3 0 0 1 3.33 1 3.33 1 3.33 1 3.33
Christian 0 0 0 0 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0 0 0
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure – 11 Distribution & Results of patients by Religion in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
Kak
odumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 95
Graph – 13 Distribution of patients by religion in Switra
Christian 0.00% Hindu
86.67%Muslim13.33%
Others0.00%
A4) Distribution of patients by Occupation
Table- 24
Distribution & Result of patients by occupation in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Occupation
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Sedentary 1 3.33 0 0 0 0 0 0 1 3.33 0 0
Active 26 86.7 2 6.66 8 26.6 11 36.6 4 13.7 1 3.33
Labour 3 10 0 0 0 0 0 0 3 10 0 0
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure - 12
Distribution of patients by Occupation in trail
Kakodu
PATIENTS BY OCCUPATION
Active86.67%
Sedentary3.33%
Labour10.00%
mbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 96
The distribution of the patients in the occupational groups are enlisted and pictorially
presented above. It clearly expresses that the patients those whoa re more active are prone to
get this skin disease Switra which is said as the anxiety prone. A very high number of 26
(86.7%) of the patients are recorded in this group. As the results are observed, out of 26
(86.7%) of active patients, 2 (6.66%) cured, 8 (26.66%) patients are well responded, 11
(36.66%) patients moderately responded, 4 (13.66%) patients poorly responded and 1
(3.33%) patient not responded to the treatment.
Figure – 13
Result of patients by occupation in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
Kakodu
A5) Distrib
As t
20 (66.66%
(6.66%) cu
mbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 97
ution of patients by economic status
Result of patients by occupation in Switra
0
0
0
1
0
2
8
11
4
1
0
0
0
3
0
0 2 4 6 8 10 1
Cured
WR
MR
PR
NR
2
Labour
Active
Sedentary
he distributions are observed, out of 30 patients a maximum of middle class i.e.
) are witnessed. As the results are encourage in the trail for middle class people 2
red, 6 (20%) well responded, 8 (26.66%) moderately responded, 4 (13.33%)
patients poorly responded and no patient of not responded reported. Out of the 4 poor
patients only one (3.33%) well responded and rest of 3 (10%) poorly responded. From the
higher middle group one each in the well, poor and not responded along with 3 (10%) in
moderately responded. The tabulation and graph are given below.
Table- 25 Distribution and Results of patients by Economic status in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa Economic
status
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Poor 4 13.3 0 0 1 3.33 0 0 3 10 0 0
Middle 20 66.6 2 6.66 6 20 8 26.6 4 13.3 0 0
Higher Middle
6 20 0 0 1 3.33 3 10 1 3.33 1 3.33
Higher 0 0 0 0 0 0 0 0 0 0 0 0
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure - 14 Distribution of patients by Economic status in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Kakodumbar
adighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 98
4
20
6
00
5
10
15
20
25
Poor Middle Higher Middle Higher
Patients by economical status
Patients
A6) Distribution of patients by diet in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
Table- 26 Distribution and Result of patients by diet in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
Diet consumption
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Vegetarian 21 70 2 6.66 6 20 7 23.3 6 20 0 0
Mixed diet 9 30 0 0 2 6.66 4 13.3 2 6.66 1 3.33
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure –15
Distribution of patients by diet in Kakodumbaradi Ghanavati and Ayorajadilepa in Switra
Kakodumba
The die
Out of 21 (70%
6 (20%) patien
(3.33%) not res
well responded
PATIENTS BY DIET CONSUMPTION
Vegetarian 70.00%
Mixed diet30.00%
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 99
t variances in the Switra with distributions and results observed are as under.
) of vegetarian patients, all most all are responded to the management except
ts who are poorly responded. On the other hand mixed diet consumers 1
ponded, 2 (6.66%) poorly responded and no one cured apart from 2 (6.66%)
and 4 (13.33%) patients moderately responded, is as described above in table.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 100
B) Data related to the disease.
B1) Presenting complaints
Table-27 - Data of patients by presenting complaints in study SN
OPD
Tw
ak
Shw
etat
a
Rom
a V
ivar
nata
Ruk
shat
a
Par
usha
ta
Par
idw
ams
hi
Dah
a
Roa
ma
Pat
ana
Kan
du
Kle
da
Sra
va
1 5327 + + 2 5517 +
3 5524 +
4 5589 + 5 5650 + + + + 6 16 + +
7 209 +
8 272 + 9 281 + + + +
10 485 + 11 495 + + 12 496 +
13 599 + 14 145 +
15 906 +
16 1186 + +
17 1223 +
18 1435 + +
19 2352 + 20 2370 + + + 21 2438 +
22 2439 +
23 2485 +
24 2570 +
25 2628 +
26 2653 + +
27 2744 + + +
28 2804 +
29 2892 +
30 2898 + +
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 101
Table -28
Distribution of patients by presenting complaints in Switra
Presenting complaints Patients Before Percentage
Twak Shwetata 30 100
Roma Vivarnata 3 10
Rukshata 5 16.66
Parushata 2 6.66
Paridwamshi 0 0
Daha 2 6.66
Roama Patana 0 0
Kandu 5 16.66
Kleda 0 0
Srava 0 0
Guruta 2 6.66
As the above table explains about the different symptoms evaluated at the study under
the heading of Switra vis-à-vis Vitiligo with the presenting complaints put forth here. The
first and fore most complaint is hypo-pigmentation i.e. Twak Swetata (100%) patients in the
study is reported. The next most common complaint is Roma Vaivarnyata i.e. hair
discoloration with 3 patients (10%) reported. The third complaint is kandu – itching with the
Rookshata – dryness is found in each 5 (16.66%) patients. Daha and Parushyata found only
in 2 (6.66%) patients each in the study. The graphical representation is as under.
Figure – 16
Distribution of patients by presenting complaints in Kakodumbaradi Ghanavati and
Ayorajadilepa in Switra
B2) Mode
Mode o
Onset
Gradual
Sudden
Total
Kakod
Distribution by Presenting Complaints in Asthigata Vata
Kleda, 0
Srava, 0
Kandu, 5
Daha, 2
Roama Patana, 0Paridwamshi, 0
Roma Vivarnata, 3
Rukshata, 5Twak Shwetata, 30
Parushata, 2
0
5
10
15
20
25
30
35
of Onset
Table- 29
Distribution and Result of patients by Mode of onset in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
f
Tot
al n
o of
pa
tien
ts
% C
ured
% Wel
l R
espo
nded
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
28 93.3 1 3.33 8 26.6 11 36.7 7 23.3 1 3.33
2 6.67 1 3.33 0 0 0 0 1 3.33 0 0
30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
umbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 102
Figure –17
Distribution and Result of patients by Mode of onset in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
The m
only 2 patient
in the pathoge
one patient h
responded to
B3) Family h
The fa
history and o
hereditary fac
of categories
Only one pati
are gradually
Kakodum
Mode of Onset
Gradual 93.33%
Sudden6.67%
ode of onset is studied here is observed as more (28) patients of gradual and
s of sudden in nature, suggests the gradual mode of onset with causative factors
nesis of Switra. Each one of sudden and gradual onset got cured in total. Only
ad poor response in the gradual group. All other patients are gradually
the treatment depicted in the above table and graph.
istory
mily history is studied here is observed as more (25) patients of no family
nly 5 patients of family history in nature, suggests the disease may not be with
tors related but the dietetic causative factors in the pathogenesis of Switra. Each
has the poor responses, but non family history patients show cure in the study.
ent of no response is in the non family history patient group. All other patients
responded to the treatment depicted in the below table and graph.
baradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 103
Table- 30
Distribution and Result of patients by Family history in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Family
history
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Present 5 16.6 0 0 3 10 0 0 2 6.66 0 0
Absent 25 83.3 2 6.66 5 16.6 11 36.6 6 20 1 3.33
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure –18
Distribution and Result of patients by Family history in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Kakodumba
Family history
Present16.67%
Absent83.33%
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 104
B4) Chronicity
Table- 31
Distribution and Result of patients by Chronicity in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Chronicity in
years
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
< 1 year 10 33.3 2 6.66 5 16.6 2 6.66 1 3.33 0 0
1 to 2 years 12 40 0 0 3 10 4 13.3 5 16.6 0 0
3 to 4 years 5 16.6 0 0 0 0 4 13.3 1 3.33 0 0
5 & above 3 10 0 0 0 0 1 3.33 1 3.33 1 3.33
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure –18
Distribution and Result of patients by Chronicity in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Kakodumba
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 105
Chronicity
3 to 4 years16.67%
< 1 year33.33%
1 to 2 years40.00%
5 & above 10.00%
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 106
The chronicity history is studied here is observed as more (10+12) patients are of less
than 2 years of history and only 8 patients are of longer duration, suggests the disease may
be with long non curative. Each of categories has the poor responses, but more than 5 years
of history (one) patient show no response in the study. The cured patients are of from less
than 1 year duration. All other patients are gradually responded to the treatment depicted in
the below table and graph.
B5) Incidence of initial site of onset
Table- 32 Distribution and Result of patients by Incidence of initial site of onset in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Incidence of initial site of
onset
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Head & Neck 7 23.3 1 3.33 2 6.66 3 10 1 3.33 0 0
Trunk 6 20 0 0 1 3.33 3 10 2 6.66 0 0
Upper Extremities
13 43.3 1 3.33 4 13.3 3 10 4 13.3 1 3.33
Lower Extremities
4 13.3 0 0 1 3.33 2 6.66 1 3.33 0 0
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
The Incidence of initial site of onset history is studied here is observed as more
(7+13) patients are of either to head neck or upper extremities history and only 6 patients are
of trunk exposure along with 4 patients on lower extremities, suggests the disease may be
with much on exposed parts. Each of categories has the poor responses, but one patient
shows no response in the study had lesions on upper extremities. The cured patients are one
each of from head & neck and upper extremities groups. All other patients are gradually
responded to the treatment depicted in the above table and below graph.
Figure –19
Distribution and Result of patients by Incidence of initial site of onset in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
B6) Incidence o
Distribution
distribution of lesions
Symmetrical
Asymmetrical Total
Kakodumba
Incidence of initial site of onset
Upper Extremities
43.33%
Head & Neck23.33%
Trunk20.00%
Lower Extremities
13.33%
f distribution of lesions
Table- 33 and Result of patients by Incidence of distribution of lesions in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Tot
al n
o of
pa
tien
ts
% C
ured
% W
ell
Res
pond
ed
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
22 73.3 1 3.33 4 13.3 9 30 7 23.3 1 3.33
8 26.6 1 3.33 4 13.3 2 6.66 1 3.33 0 0
30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 107
The Incidence of distribution of lesions history is studied here is observed as more
patients (22) are observed that symmetrical, and the rest (8) are asymmetrical in nature. The
symmetrical distributaries patients show 1 (3.33%) cure, 4 (13.33%) well response, 9 (30%)
moderate response, 7 (23.33%) patients of Poor response along with one patient of no
response. From the other category 1 (3.33%) cure, 4 (13.33%) well response, 2 (6.66%)
moderate response and 1 patient of poor response is observed. All other patients are
gradually responded to the treatment depicted in the above table and below graph.
Figure –20
Distribution and Result of patients by Incidence of distribution of lesions in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Incidence of distribution of lesions
Asymmetrical, 8Symmetrical , 22
0 5 10 15 20 25
B7) Incidence of clinical type of disease
The Incidence of clinical type of disease with lesions history is studied here is
observed as more patients (23) are observed that generalized, and the rest (7) are localised in
nature. The localized distributaries patients show 2 (6.66%) cure, 2 (6.66%) well response, 2
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 108
(6.66%) moderate response, 1 (3.33%) patients of Poor response along with no patient of any
response. From the other category of generalized no cure, 6 (20%) well response, 9 (30%)
moderate response and 7 (23.33%) patients of poor response is observed. One patient of this
category is not responded to the treatment. The data is depicted in the below table and graph.
Table- 34 Distribution and Result of patients by Incidence of clinical type of disease in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
clinical type of disease
Tot
al n
o of
pa
tien
ts
% C
ured
% Wel
l R
espo
nded
%
Mod
erat
e R
espo
nded
%
Poo
r R
espo
nded
% Not
R
espo
nded
%
Localized 7 23.3 2 6.66 2 6.66 2 6.66 1 3.33 0 0
Generalized 23 76.6 0 0 6 20 9 30 7 23.3 1 3.33
Universal 0 0 0 0 0 0 0 0 0 0 0 0
Total 30 100 2 6.66 8 26.6 11 36.7 8 26.6 1 3.33
Figure –21 Distribution and Result of patients by Incidence of clinical type of disease in Switra with
Kakodumbaradi Ghanavati and Ayorajadilepa
Kakodumba
Incidence of clinical type of disease
23
0
7
0 5 10 15 20 25
Localized
Generalized
Universal
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 109
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 110
B8) Distribution of patients by according to Ahara Nidana in Kakodumbaradi Ghanavati and
Ayorajadilepa in Switra
Table- 35
Distribution of patients by Ahara Nidana in Switra Kakodumbaradi Ghanavati and Ayorajadilepa
Ahara Nidana Total no of patients
%
Anashana 4 13.33
Adhyassana 13 43.33
Ajeernadhyasana 2 6.66
Atilavana 3 10
Ati amla 2 6.66
Kulatha 0 0
Masha 0 0
Dadhi 5 16.66
Ati drava 5 16.66
Navanna 0 0
Ati snigdha 0 0
Ati guru 4 13.33
Taila 6 20
Viruddha Ahara 30 100
Mamsa 9 30
The Nidana observed in the Switra are as above. Out of 30 patients maximum of
Nidana observed is viruddha Ahara (100%) along with 13 (43.33%) patients of Adhyasana.
No patients are reported with Kulutha, Masha, Moolaka, Navanna and Atisnigdha Ahara. The
table shown above and graph below as here.
Figure – 22
Distribution of patients by Ahara Nidana in Switra Kakodumbaradi Ghanavati and
Ayorajadilepa
B9) Distributio
Ghanavati and A
Distributio
Vihara N
Vegadh
Diwasw
Ativyavaya &
Sheeta jal
Atapa se
Kakodumba
Patients by Ahara Nidana
Atilavana, 3Ati amla, 2
Kulatha, 0Masha, 0
Dadhi, 5
Ati guru, 4
Viruddha Ahara, 30
Mamsa, 9
Anashana , 4
Adhyassana, 13
Ati drava, 5
Navanna, 0Atisnigdha, 0
Taila, 6
Ajeernadhyasana, 2
n of patients by according to Vihara Nidana in Switra Kakodumbaradi
yorajadilepa
Table- 36 n of patients by Vihara Nidana in Switra Kakodumbaradi Ghanavati and
Ayorajadilepa
idana Total no of patients
%
arana 4 13.33
apna 5 16.66
Papa Karma 0 0
a snana 3 10
vana 0 0
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 111
Figure – 23
Distribution of patients by Vihara Nidana in Switra Kakodumbaradi Ghanavati and
Ayorajadilepa
The vih
of Nidana obse
(13.33%) patien
table and graph
Kakodumba
Patients by Vihara Nidana
Sheeta jala snana, 3
Vegadharana, 4
Diwaswapna, 5
Ativyavaya & Papa Karma,
0
Atapa sevana, 0
0
1
2
3
4
5
6
ara Nidana observed in the switra are as above. Out of 30 patients maximum
rved is of 5 patients’ diwaswapna (16.66%) along with 4 Vegasandharana
ts and 3 (10%) of sheeta jala snana after undergoing shrama and bhaya. The
are shown above.
radighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 112
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 113
C) Result in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
C1) Assessment of Subjective parameters in Switra
Table- 37
Subjective parameters Patients Before
Patients After
Patients Changed
Changed %
Rookshata 5 1 4 80
Parusha 2 1 1 50
Daha 2 1 1 50
Kandu 4 2 2 50
Guruta 1 0 1 100
C2) Assessment of Objective parameters in Switra
Table -38
Objective parameters Mean Before Mean After Mean Difference Colour 4.06 1.866 2.0194
Margin 4.133 1.866 2.266
Number 13.76 9.76 3.99
VASI 1.174 0.579 0.595
Serum Copper 160.37 167.26 6.93
The subjective parameters which are considered here show marked response with
good percentage of relief. At the objective parameters all has shown the variances on the
positive declination in the study.
C3) Results in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
Table-39 Results in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa Result Number of patients Percentage
Cured 2 6.67
Well Responded 8 26.66
Moderately Responded 11 36.67
Poor Responded 8 26.66
Not Responded 1 3.34
Total 30 100
Figure – 24
Results in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
Kakodu
The
criteria cons
Results in Switra with Kakodumbaradi Ghanavati and Ayorajadilepa
Poor Responded26.67%
Well Responded26.67%
Cured6.67%
Moderately Responded
36.67%
Not Responded3.33%
mbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 114
results of the study are based upon the assessment of the subjective and objective
idered in the study. Mainly the objective parameters are considered to show the
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 115
evidences of the relief in the study. The result encourages the Ayurvedic fraternity even
though the cure is only 6.67% (2 Patients) in the time bound study. Many patients are at
virtue of getting relief is grouped as well responded listed as 26.66% (8) patients along with
the 37.66% of moderately responded patients. In the study many causes made hindrances of
the melanin re-pigmentation and 8 i.e. 26.66% patients fall under poor response. Only one
patient i.e. 3.34% noticed as the no response patient in the entire study. The tabulations and
graphical expressions are shown as above.
D) Statistical analysis of the clinical and objective parameters
D1) Subjective parameter Statistical analysis in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
Table -40
Subjective parameters Mean SD SE t-Value p-Value
sign
ific
ance
Rookshata 0.266 0.52 0.095 2.804 >0.05 NS
Parusha 0.066 0.365 0.066 1.0 >0.05 NS
Daha 0.1 0.402 0.073 1.36 >0.05 NS
Kandu 0.3 0.65 0.118 2.523 >0.05 NS
Guruta 0.13 0.434 0.079 1.68 >0.05 NS
HS = Highly Significant, ID = Insufficient Data
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 116
D2) Objective parameter Statistical analysis in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
Table -41
Objective parameters Mean SD SE t-Value p-Value
Sig
nifi
canc
e
Colour 2.2 0.961 0.175 12.53 <0.001 HS
Margin 2.26 1.04 0.191 11.84 <0.001 HS
Number 4.06 5.686 1.03 3.94 <0.001 HS
VASI 0.296 0.435 0.079 3.72 <0.001 HS
Serum Copper 33.2 19.36 3.535 9.39 <0.001 HS
HS = Highly Significant
D3) Distributional (Head & Neck) Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
Table -42
Head and Neck Mean SD SE t-Value p-Value
Sig
nifi
canc
e Colour 2.58 0.792 0.228 11.28 <0.001 HS
Margin 2.33 0.778 0.224 10.38 <0.001 HS
Number 2.66 3.66 0.971 2.74 <0.02 HS
VASI 0.081 0.138 0.039 2.085 > 0.05 NS
HS = Highly Significant, NS = Not Significant
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 117
D4) Distributional (Trunk) Statistical analysis in Switra with Kakodumbaradi Ghanavati and
Ayorajadilepa
Table -43
Trunk Mean SD SE t-Value p-Value
Sig
nifi
canc
e
Colour 1.72 0.786 0.237 7.28 <0.001 HS
Margin 0.19 0.943 0.284 6.708 <0.001 HS
Number 1.9 3.11 0.938 2.03 >0.05 NS
VASI 0.1662 0.249 0.075 2.216 > 0.05 NS
HS = Highly Significant, NS = Not Significant
D5) Distributional (Upper Extremities) Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
Table -44
Upper Extremities Mean SD SE t-Value p-Value
Sig
nifi
canc
e Colour 1.77 0.83 0.27 6.4 <0.001 HS
Margin 2.11 0.781 0.26 8.1 <0.001 HS
Number 1.66 1.93 0.645 2.58 <0.05 HS
VASI 0.194 0.296 0.098 1.97 > 0.05 NS
HS = Highly Significant, NS = Not Significant
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Results 118
D6) Distributional (Lower Extremities) Statistical analysis in Switra with Kakodumbaradi
Ghanavati and Ayorajadilepa
Table -45
Lower Extremities Mean SD SE t-Value p-Value
Sig
nifi
canc
e
Colour 2.05 1.08 0.26 7.8 <0.001 HS
Margin 1.88 1.11 0.269 6.98 <0.001 HS
Number 2.94 3.69 0.89 3.27 <0.01 HS
VASI 0.263 0.305 0.07 3.55 <0.01 HS
HS = Highly Significant, NS = Not Significant
Individually all the objective parameters show high significance by comparing p
value. The parameter colour, margin, S. Copper show high significance than the other
parameters (By comparing t value). The parameter S. Copper show more net mean effect,
with more variations, where as VASI show less mean effect with less variation (by
comparing mean and SD). In the head and neck the parameters colour and margin show high
significance than the number. Where as VASI show non significance (by comparing p & t
values). In the trunk region the parameters colour and margin shows high significance, but
the parameters number and VASI are not significant (by comparing p & t values). In upper
limb the parameters margin and colour show high significance than number. The parameter
VASI is not significant in upper extremities (by comparing p & t values). In the lower
extremities the parameters colour and margin show high significance but the parameters
number and VASI show moderate high significance (by comparing p & t values).
CHAPTER-6
Discussion
The skin is the largest and most visual organ of the human body. Hence any blemish
on the skin visible effects onlooker and the person affected profoundly. Switra is most
blemishing disease compared to other dermatological problems.
It is being told that Vitiligo only a cosmetic problem. Unfortunately poor fellow
suffering from not scared by the disease but also the social stigma and scorn of the society
make their life miserable. In India Switra has been medico-social problem since the time
immemorial. The first prime minister of India Pandirt Jawahar Lal Nehru ranked Vitiligo
(Switra) as one of the three major medical problems of India, other being leprosy and
Malaria.
Switra is characterised by Aparisravi swetha varna mandala i.e. non exudative skin
lesions. It can be equated that of Vitiligo in contemporary science which is hypo-pigmentary
disease. It affects about 1-2% of world population. All the races and both genders are
equally affected by the disease.
In India and perhaps elsewhere also men, women and children with Vitiligo face
severe psychological and social problem. It is the most acute in the case of young women
and children.
Vitiligo lesions over face, particularly embracing and cause frustration. The lesions
over exposed parts such as hands feet and can lead to anger and disillusion, particularly in
teenage. Patients with Vitiligo are very sensitive to the way other pursue them and they will
often withdraw, because they anticipate being rejected. The impact of such factors is
profound subjecting them to emotional distress. Such severe depression been known to lead
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
119
suicide attempts. Last decade has witnessed an increasing interest in psychological affect of
the various skin diseases, and quality of life in patients suffering from disease.
Keeping the above facts in view it was decided to go through knowledge of Switra of
its aetiology progression of the disease and methods of managements are studied according
to Ayurvedic literature.
Acharyas suggested good remedies like kushtagna and varnya drugs to cure the
disease. Thus Kakodumbaradi Ghanavati internal and ayorajadi lepa external were selected
for conducting clinical observation as switragna oushadhi in single group. All patients
advised to exposure to sunlight after the local application. Such an effect is likely to give
some useful information for the perfect treatment of Switra.
Discussion on demographic data
The efficacy of any drug can not be proved unless it is subjected to clinical trial and
analyzed statistically. The trial drug Kakodumbaradi Ghanavati internal and Ayourajadi lepa
external are considered for the evaluation in Switra. The clinical study was undertaken on 30
patients in a single group. In the foregone pages observation were made systematically
presented.
Relevancy of age
Vitiligo may appear any time from shortly after birth to senescence although on
onset between 5 and 30 years of age is most common. In the present study, it is found as the
age group below 30 years age more than 80% (10-20 age group -50% and 20-30 age group -
30%) the rest of the age group are 20% (30-40 and 40-50 age group) perhaps the cosmetic
values commenced in the Vitiligo might be dragged more youth than that of aged people.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
120
Disease long term association and incurability would have disappointed the elder groups not
to attend the treatment schedule.
Gender
The percentage of distribution of gender does not shows any differentiation to get the
Switra (Vitiligo), except small lean towards female population is 53.4% and 46.6% male.
According to the literature prevalence is equal in between males and females.
Religion
Religion does not play any major role in the causation of the disease though in the
present study the percentage of Hindu patients are more.
Occupation
This is done under three categories. It seems that active patients have high incidence
of Vitiligo. This is mainly because active people are over exerted and excited. The
psychological intervention can not be ruled out, as it is a psychosomatic disorder.
Economical status
In the present study highest numbers of patients reported were from lower middle
class, probably they undergo insecurity feeling or crave for the higher status. For the above
the reason they strain and stress themselves and get captured into the clenches of Vitiligo.
Diet
Viruddha Ahara is explained as prime causative factor for the Switra. In present
study salt, pickles, milk, mixed with food is more practiced in this area may be the causative
factor for the disease.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
121
Discussion on disease Switra
Nidana
Ayurveda emphasized diet as an important etiological factor. Because samyak yojita
Ahara leads to indriya prasadana and varna prasadana. But asamyak yojita Ahara leads to
several diseases. Hence Twak is also influenced by aharaja Nidana, recent studies have been
shown significant role of food as possible etiological factor in cause the disease.
Viruddha Ahara i.e., incompatible diet is mentioned as the prime causative factor of
Kushta in general and Switra in particular. These incompatible foods are responsible for the
formation of Ama (exogenous antigen source). Ama may interfere with absorption nutrients
which accepted as one of the etiological factor for Vitiligo. Ama can also be generated
within the body by virtue of excessively vitiated doshas (auto immune antibody production,
free radicals mediated tissue injury) those are postulated as the etiological factors of the
Vitiligo. (Dr. R.H singh)
Charaka also opines that the papakarma, guruninda, unlawful acts, are also causes
Switra. There is no logic which can be put forth regarding involvement of these Nidana. But
these may induce stress in the patients and become vyanjaka hetu triggering of further
depigmentation.
Vrana including agnidagdha or injury like cuts crapes can be destroy pigment cell
resulting in Vitiligo Lesions to develop in trauma prone areas, a Koebner’s reaction is
observed. In present study salt, wheat, floor, curd and milk mixed with foods which are
more practiced in this area may common causative factor of this disease.
Poorvaroopa
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
122
A wide range of poorvaroopa for Kushta has been listed in the classics though none
of mentioned especially for Switra. No poorva roopa could be elicited in the present study.
Roopa
Samanya lakshana of Switra are aparisravi sweta varna mandala found in almost all
patients. Rookshata, parushata, paridwashi, roma patina, daha, roma vivarnata, and srava are
told as samanya lakshana of Switra. But srava, romavidweshi are not found in any of the
patient. Kandu and rookshata were found in five patients and daha and guruta found in two
patients. In classics specific colours are described to denote the Dhatu gatatwa of Switra.
But colours could not be differentiated in patients’ skin. Also specific symptoms of doshaja
verities were not found in any of the patients. In the present clinical study except aparisravi
sweta mandala other lakshanas were not observed in much of the patients. As this trial is
limited all can only be observed more in large samples.
Samprapti
Switra is a Pitta pradhana tridoshaja Vyadhi. Bhrajakapitta is responsible for the
normal pigmentation of skin. Pitta and Rakta got asrayaasrayee sambandha i.e., the
pathogenecity of Rakta means pathogenecity of Pitta. Involvement of Pitta is inevitable in
Switra which is said to be Rakta pradoshaja Vyadhi. But along with these factors Agni, Rasa
and Mamsa also influence the mechanism of pigmentation. This is so because food that the
individual consumes is first digested by Agni and converted into Ahara Rasa. This Ahara
Rasa is for the metabolized by the succeeding dhatwagni’s to produce respective dhatus. The
skin receives the nourishment by Rasa, Rakta and Mamsa Dhatu. So hypo function of
Jataragni and dhatvagni affects the pigmentation of the skin. Pachakapitta is said to be
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
123
nourish the rest of the Pitta like Bhrajakapitta and Ranjakapitta etc., hence Pachakapitta
dushti may also lead to dushti of other Pitta.
Viruddha Ahara, mithya Ahara and papakarama has been explained to great detail in
causation of Kushta. This etiological factors cause the vitiation of tridosha and production of
Ama. But do not propel out of the body. So these Dosha undergo sthana samshraya in Twak
and results in hypo pigmentation of the skin.
Treatment principle
Chakrapani commenting on Switra Chikitsa opines that treatment of Kushta holds
good even for the Switra. Switra is Dosha karmaja Vyadhi. With this fact the treatment of
Switra can be adopted in three headings.
1. Daivavyapasraya Chikitsa
2. Yuktivyapasraya Chikitsa and
3. Satvavyajaya Chikitsa
Daivavyapasraya Chikitsa
Switra roga has been discussed as a separate entity in Ayurvedic classics. Switra
roga pigmented macular plaque seen in skin and mucus membrane. Actual etiological factor
has not been identified by the modern medicine. The pathophysiology has been proposed by
certain hypothesis. Autoimmune phenomenon has been considered as the prime pathology
facilitated into destruction of melanocytes. The main cause behind the triggering of
autoimmune phenomena is not known. In western modern medicine this is called as an
idiopathic state, meaning that the cause is unidentified. One of the causes described for
Switra roga by Ayurvedic classics is Poorvajanmakrutapapam (sinful acts of past life). The
system of Ayurveda accepted the theory of birth and rebirth cycle. It also states that many
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
124
things are unperceived to sensory organs; such are infinite in number. We attribute these
factors under the word daivam. Daivam is etymologically defined as 'Daivam adrushtam
evam purvajanmakruta karmam'. The factors, which are unidentified and unperceivable, are
called idiopathic and can be rationally explained under papakarmas. That is the reason why
daivavyapasraya Chikitsa has become the first and the foremost therapeutic module in many
diseases like Switra. Though the principles remain unchanged, the perception has been
changed. The western medicine calls it as idiopathic and Ayurveda considers it as
purvajanmakruta karma, which makes no significant difference 154.
Yukti vyapashra Chikitsa
In this treatment Charaka specially mentioned person to make to undergo all types
Shodhana. Then once again is made to drink malapurasa with guda to his capacity and then
may to exposure to sunrays as long as he can. And same has been followed in western
system of medicine in the topic of tanning.
It is astonishing fact the ancestor had good awareness about the pigmentory action of
sunlight. The bhaskara dhana surya namaskara ravivara vrata etc., daiva vyapashraya
Chikitsa are directly related to exposure to sunlight, also explained in the management of
Switra.
Satwavajaya Chikitsa:
Controlling of the manas from ahita indriyarthas i.e., from causative aharas and
viharas for Switra. It is also named as Nidana parivarjana, which also plays a key role in
Chikitsa.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
125
Discussion on Results:
The hypothesis on the action of Kakodumbaradi Ghanavati (internal) and Ayourajadi
lepa is verified by this observational study. Both treated and untreated cases of Switra were
taken for the study and the treatment was administered on OPD basis. Observations were
made before, during and after the treatment in two follow ups. To assess the effect of
treatment decrease in the color, number of mandalas, VASI Score, hyper-pigmentation of
margin and increase in serum copper level were considered.
Serum copper:
The tyrosinase is a copper containing enzyme responsible for synthesis of melanin.
In literature it has been mentioned that lesser percentage of serum copper causes Vitiligo.
But in present study total 35 patients (included and excluded) were subjected for lab
investigation not a single case shown lesser percentage of serum copper. Majority of patients
expressed normal level of serum coppers viz. 100-200 micro grams per dl. There it can be
consider that serum copper have no specific role in the manifestation of Vitiligo.
The major improvement was observed in colour and maragin of the mandala. The
cure rate was observed 6.66% in all the parameter. Well response was found in 33.33% of
patients in the colour, 46.66% in the margin, 26.66% VASI score and 0% in the number of
mandala. Moderate response was noticed in 36.66%of the patients in the colour.16.66% in
the margin and 36.66% in the number and 23.33% in VASI score of mandala. Poor response
was observed in 16.66% in the colour, 26.66% in both margin and number and 40% of
patients in VASI score of the mandala.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
126
Probable mode of action:
For any disease to manifest Dhosha-Dosha Samurchana is must, that is nothing but
what we say as Samprapti. This having maximum attention as Samprapti vighatan itself is
the basic thought of treatment in any disease. So to understand probable mode of action of
yoga we have to think how the quality of individual drugs of the yoga will act against the
Samprapti ghatakas.
Dosha and its pacification:
As already explained Switra is a Tridosha Vyadhi. The ingredients of
Kakodumbaradi Ghanavati act over tridoshas and pacify them.
Kakodumbara: By its tikta, kashaya rasa acts as kapha-pitta shamaka,
kushtaghna and kandughna.
Vidanga: By its ushna veerya acts as vata shamaka. By katu rasa and katu
vipaka acts as kapha shamaka, and srotoshodhaka.
Bakuchi: By its katu, tikta rasa, laghu-rooksha guna, and ushna veerya acts as
srotoshodhaka, kapha-pitta shamaka and krimighna.
Ayourajadi lepa having ushana,teekshana and srotoshodaka properties the veerya
of lepa reaches the siramuka of swedava srotash and reach the deeper layer twak and it act
locally to relive the sanga. By this the samapurana of Bhrajaka pitta takes place and hence
normal function is noticed.
Action on Agnimandya and Ama:
Agnimandya is the prime causative factor in manifestation of any disease. This is
well appreciated in Switra also. Here Dosha involved is Pitta mainly i.e. in terms of Kshaya
of Bhrajaka and Ranjaka. These are dependent over Pachakapitta. Each drug of this yoga are
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
127
said to be Deepan, which is estimated to regulate Pachakapitta indirectly influencing
Bhrajakapitta and Ranjakapitta.
Ama is inevitable factor in causation of Kushta in general and Switra in particular.
The regulation of Agni is the treatment thus at this juncture Deepana and Pachana properties
embedded in the Kakodumbaradi Ghanavati helps in reliving the Ama.
Role of Rasayana:
Twak is indicator of status of Rasa Dhatu. This Rasa Dhatu if not properly formed
then there will be vikruti in terms of its appearance, colour, and luster etc, because Rasa
Dhatu nourishes the Twak. So treatment should also target for the correction of Rasadhatu.
The Kakodumbaradi Ghanavati possesses the properties of deepana, pachana, Bruhana,
Balya and Vrushya properties which help in increasing the quality of Rasa and succeeding
Dhatus later. According to modern science Vitiligo is an autoimmune disorder, the drugs
used in this study being Rasayana etc. specific gunas play an effective role in protecting or
correcting or toning the immune system of the body and thus may result in curing the
Vitiligo. Psoralens are the active principles of Bakuchi. When ingested the seeds are
believed to facilitate amino acid transport across the intestinal mucosa and induce
pigmentation (Chakraborty D.P. et al). Seeds are having anti fungal, anti protozoan activity
and are also used in intestinal amoebasis (Gogate V.M, D.C.P). The pharmacological
action of this compound drug is mainly seen as Kushtagna, krimighna, varnya. The
Kushtaghna and Switraghna prabhava of this compound is responsible for relieving the
lesions of the skin. Thus the drugs act by relieving the toxins or checking the absorption of
toxic substances from the gut and facilitate the amino acid transport across the intestinal
mucosa and induce pigmentation.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
128
Stimulation of melanocytes to enrich re pigmentation
Vitiligo is a condition in which only active (melanin-producing) melanocytes
destroyed and the inactive melanocytes in the (ORS) outer root sheath of normal hair
follicles are preserved and serve as the only source for the re pigmentation Recovery of
Vitiligo is initiated by the proliferation of these inactive melanocytes, followed by the
upward migration of inactive melanocytes to the nearby epidermis to form peri-follicular
pigment islands 155. Regimentation also begins with shrinking of patches from periphery to
the center. But these inactive melanocytes dose not synthesis melanin under normal
circumstances. They need stimulation to synthesis melanin. In such condition topical
application Ayourajadi lepa stimulate inactive melanocytes. Thus stimulated melanocytes
release melanin which gradually diffuse into de pigmented area and results in re
pigmentation
Topical preparation Ayourajadi lepa consist Bakuchi, Ayoraja, Krishn tila, Rasanjana,
Amalaki and Bhringaraja. The essential oil of Bakuchi is able to permeate through the
epidermis to the prickle cells of the lymphocytes and so it finds it way to sub capillary area,
which is dilated so that plasma is increased in that area. The skin becomes erythemic and
melanocytes are stimulated (Chopra 1958). This is also well supported by the rest of the
ingredients of the preparation like Ayoraja, Krishn tila, Rasanjana, Amalaki and Bhringaraja
because of their ushna teekshna lekhana and kshareeya guna. Amalaki which is known for
its anti oxidant property may help in the rejuvenation of the melanocytes. Bringaraja etc
which are otherwise known to have keshya effect, here this property may be thought to
strengthen the hair root which is said to be the reservoir of inactive melanocytes would
regularize the synthesis.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
129
The Bakuchi and Kakodumbara contain active principle psoralin, when
Kakodumbaradi Ghanavati is administered internally this psoralin gets absorbed into the
systemic circulation and reaches the inactive melanocytes getting concentrated into the
cytoplasm which then increases the photosensitivity of the inactive melanocytes. Further this
helps in synthesis of melanin pigment which is deficient in Vitiligo.
Exposure to Sunlight:
In the present clinical study exposure to sunlight was advised to follow after the local
application early in the mornings to patients. Both the Psoralens and sunlight stimulate
tyrosinase enzyme which is responsible for the merlanin synthesis. The sunlight being
radiant energy it may potentiates the action of external application. Thus may results in
perfect permeability of drug through epidermis and which result in perfect stimulation of the
melanocytes for their normal function melanogenesis. This increases the production of
facultative melanin. By reviewing qualities and actions of Kakodumbaradi Ghanavati, and
Ayourajadi lepa, we may conclude that, systematic correction with internal preparation and
the local stimulation by external application may appear effective in this disease.
General Observations:
During the course of the study, it has been observed that some patients developed
visphota and the improvement was found to be fast in these patients. Some other patients
developed erythema and itching where fast improvement was also observed. During re-
pigmentation process, two patterns were observed. First pattern was re-pigmentation of the
lesions from the periphery to centre which showed delay in reduction of size. Second pattern
was peri-folliculor, later configurating into the normal skin colour. During the initial
improvements, the size of the dark spots increases and subsequently coalescence to form
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
130
large pigmented patches. The smaller patches will disappear and the larger ones will
decrease in size significantly. In some case re- pigmented areas may be hyper- pigmented
and thus appear darker than the surrounding normal skin. Lesions on hairy areas respond
better to treatment than when it appears on non-hairy parts like the Palm and foot. In the
recent studies shown that, the lesions on the face had quick resolution when compared to
other areas. No particular observation in any area regarding quick response was found in the
present study.
No increase in the size and number of the mandala was seen in any of the patients
during follow up except in one patient where little increase in the size due to unknown
reasons was noticed.
Limitation of the study
1. The sample size was small
2. Limited to that of one particular geographical area
3. The period of study was limited
4. Longer follow up was not done
Recommendation for future study:
The following recommendations are made on the basis of observations and
conclusions made in the study, as guidelines for the further studies, which are made in future
to over come, the limitations listed.
1) Same study can be repeated by taking a large number of samples and longer duration
2) Comparative study between Shamana Oushadhi and lepa is required to assess the
effect of the individual preparation.
3) The effect lepa along with and without Rasayana can be studied.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Discussion
131
CHAPTER-7
Conclusion
Based on the discussion of this study it is fairly concluded that -
1. Switra is a Pitta pradhana tridoshaja twak vikara.
2. Switra is a disease which effectively represents Vitiligo.
3. The varna of doshaja varieties of Switra were unable to identify and differentiate in
the patients.
4. Switra is more prevalent between the age group of 10-30 years.
5. Family history of Vitiligo is observed in 16.66% of patients.
6. The mental state of the patient as something that could influence the outcomes. Those
who are able to remain calm and mentally stable are thought to have a good chance of
success, while those who are anxious or depressed and who are not having patience
with the treatment are expected to have a poor chance. Indeed, the latter group of
patients may experience treatment failures due to noncompliance with the regimen, as
much as any psychophysical adverse effects of the mental state on their skin
condition.
7. Some physician emphasizes the topical treatment, others emphasize the internal
treatment, but both appear important to the prompt and complete resolution of Switra.
8. Finally it can be very safely concluded that the above mentioned drug combination
has positive role in the management of Switra.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Conclusion
132
CHAPTER-8
Summary
The present study was under taken to evaluate the effect of lepa along with
shamanoushadhi in the management of Switra.
Lepa Chikitsa, a cognate therapy is included under bahi parimarjana chikitsa. This
therapy is specially meant for the twakgata vikaras. The lepa Chikitsa also facilitates the
expulsion of the doshas locally. Ayorajadi lepa is selected according to Yogaratnakar
explanation. The lepa contains Bakuchi which is the drug of choice in Switra. Other
ingredients of lepa like Ayoraja, Krshanatila, Rasanjana, Amalaki, and Bhringaraja are
having the properties Twachya, Keshya, and kuthaghna as mentioned in classics.
Kakodumbaradi Ghanavati was selected because of the presence of Bakuchi along
with Kakodumbara and vidanga which are said to be tridosha shamaka and also having
Switra hara prabhava.
The research design was pre-test and post test design with an observation study of 30
patients who were incidentally selected for the study. Patients were diagnosed on the
symptomatolgy explained in classics and with modern description.
The historical review, nirukti, paribhasha, bheda, nidana panchaka, sadhyasadhyata
and chikitsa of Switra according to the classics were reviewed. Detailed available
information about drugs and also latest research on these individual drugs was searched.
The observations were done on the factors like age, sex, religion, marital status, ,
socio economic status, occupation, food habits, family history, , chronicity, type of Vitiligo,
age and sites of first onset, color, margin, number and VASI score of the mandalas.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Summary
133
Recorded observation were analyzed, it reveled that the most of the patients are from
less than 30 years of age, Hindu, middle class and active.
The complete cure was observed, 6.66% i.e.2 patients, who are having small lesion
and recent onset. The remaining patients were also relieved moderately, from their
symptoms.
Clinical and statistical analysis reveals that the systemic corrections can be done with
internal preparation and the local stimulation by synthesis of melanin through external
application may be effective in the management of Switra vis-à-vis Vitiligo.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra –– Summary
134
Bibliographic References
1) Kevin Barry, Body works version 6, CD ROM, The learning company Medical Library, 1997, TLC properties Inc., Orem, Utah, 84058
2) Sidarth N shaha. API Text book of medicine, 23rd chapter, 7th edition, 2003, publisher the Association of Physician of India Mumbai, page no 1322.
3) 3 .R G Vallia, IADVL,Text book and Atlas of dermatology, volume 2,1st edition, Bhalani pulishing house, Bombay. Page no 518.
4) Seung-Kyung Hann and James J, Norland, Vitiligo, 1st chapter, 1st edition, 2000, Panthaer publishers’ private limited, Bangalore, page no 3.
5) DoctorNDTV team, Dr. Rishi Parashar, Consultant Dermatologist, Sir Ganga RamHospital, New Delhi http://www.doctorndtv.com/topics/detailtopics.asp?id=302#q61554447
http://www.doctorndtv.com/reg, 05102006 6) Ibid, 7) Ibid 8) R G Madana shastri, Vedome Ayurveda, Manusmriti, 3-7, Mohanlal Ayurvedic trust
Delli, 1956. 9) Ambikadatta Shastri,Susruta Samhita,Nidanastana,5th chapter,17th sloka,15th
edition,2002,Chokamba Sanskrit samstana, Varanasi, page no 249. 10) Seung-Kyung Hann and James J, Norland, Vitiligo, 1st chapter, 1st edition, 2000,
Panthaer publishers’ private limited, Bangalore, page no 3. 11) Ambikadatta Shastri,Susruta Samhita,Nidanastana,5th chapter,17th sloka,15th
edition,2002,Chokamba Sanskrit samstana, Varanasi, page no 29. 12) 12..Http/www.nimas.nih.gov/Index.htm. 13) Dr. M S Bhagel, Research in Ayurveda, 1st edition, Mridu Ayurvedic publication and
sales, India. 14) D/05102006/dermo best, Inc-what is Vitiligo.htm. (http://www.dermabest.com/) 15) Davinder Parsad , Sunil Dogra and Amrinder Jit Kanwar, Department of
Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India, Quality of life in patients with Vitiligo, Health and Quality of Life Outcomes 2003,1:58 doi:10.1186/1477-7525-1-58 (http://www.hqlo.com/content/1/1/58 Published 23 October 2003 © 2003 Parsad et al; licensee BioMed Central Ltd
16) Fitzpatrick TB: The scourage of vitiligo. Fitzpatrick's J Clin Dermatol 1993, 68-69. (http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B7)]
17) Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R: Psychiatric morbidity in vitiligo: prevalence and correlates in India. J Eur Acad Dermatol Venereol. 2002, 16:573-578. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B6].
18) Ginsburg IH: The psychological impact of skin diseases: An overview. Clin 1996, 14:473-484. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B9].
19) Cotterill JA, Cunliffe WJ: Suicide in dermatological patients. Br J Dermatol 1997, 137(2):246-250. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B10].
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 1
20) Lerner AB: Vitiligo. J Invest Dermatol 1959, 32:285-310. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B1
21) Lerner AB, Nordlund JJ: Vitiligo. What is it? Is it important? JAMA 1978, 239:1183-1187. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B2
22) Bolognia JL, Pawelek JM: Biology of hypopigmentation. J Am Acad Dermatol 1988, 19:217-255. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B3
23) Handa S, Kaur I: Vitiligo: clinical findings in 1436 patients. J Dermatol 1999, 26:653-657. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B4
24) Handa S, Dogra S: Epidemiology of childhood vitiligo: a study of 625 patients from North India. Ped Dermatol 2003, 20:207-210. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B5].
25) Savin J: The hidden face of dermatology. Clin Exp Dermatol 1993, 18:393-395. http://www.hqlo.com/sfx_links.asp?ui=1477-7525-1-58&bibl=B8].
26) R G Madana shastri, Vedome Ayurveda, Rigveda,1-117-7,Mohanlal Ayurvedic trust Delli,1956.
27) R G Madana shastri, Vedome Ayurveda, Atarvaveda, 5-53-1, Mohanlal Ayurvedic trust Delli, 1956.
28) R G Madana shastri, Vedome Ayurveda, Atarvaveda, 1-23-1, Mohanlal Ayurvedic trust Delli, 1956.
29) R G Madana shastri, Vedome Ayurveda, Yesurveda, 30-21, Mohanlal Ayurvedic trust Delli, 1956.
30) R G Madana shastri, Vedome Ayurveda, Manusmriti, 3-7, Mohanlal Ayurvedic trust Delli, 1956.
31) R G Madana shastri, Vedome Ayurveda, Paninivyakarna, 5-2-120, Mohanlal Ayurvedic trust Delli, 1956.
32) Satyanarayana Shastri,Charaka samhita, Chikitsa sthana,7th chapter, sloka 173-177,1st edition,2001,Choukambha bharati Academmy,Varanasi,page no 274-275.
33) Ambikadatta Shastri,Susruta Samhita,Nidanastana,5th chapter,17th sloka,15th edition,2002,Chokamba Sanskrit samstana, Varanasi, page no 249.
34) Girijadayala Shukla,Bhela samhita,Chitsa Sthana,6th chapter, 29th sloka,1st edition,1959,Choukamba vidyabhavana,Varnasi, page no150.
35) Satyapal Bhishagacharya, Kashapa Samhita,Chikitsa stana,chpter,sloka,4th edition,1988, ,Chokamba Sanskrit samstana, Varanasi, page no 115.
36) Shrikanta murthy,Astnga Sangraha,Nidanastana,14th chapter, sloka 39-40,1st edition,1996, Chokamba Orientalia, Varanasi, page no 239-240.
37) 37.Hari Sadashiva shastri Parashara,Astanga Hrudaya, Nidana stana,14th chapter,sloka 37-40,1st edition,2002, , Chokambha Surabharati prakashan, Varanasi, page no 527-528.
38) 38.Yadunandan Upadhyaya, Madavanidana, Madukosha commentary,vol II,49th
chapter,37-40 sloka,26th edition,1996, Chokamba Sanskrit samstana, Varanasi, page no 164-166.
39) Brahamashankar mishra,Bhavaprakasha,Chikitsa prakarna,Kushata rogadhikara,54th chapter,46th sloka,5th edition,1969, Chokamba Sanskrit samstana, Varanasi, page no 2037.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 2
40) Shridara Krishana Parasher,Sharangadara Samhita, Purvakhanda,7th chapter,90th sloka,3rd edition, 1984, Bhaidhyanath Ayurvedia Bhavana Limited, Nagapur, page no 148.
41) 41. Seung-Kyung Hann and James J, Norland, Vitiligo, 3rd chapter, 1st edition, 2000, Panthaer publishers’ private limited, Bangalore, page no 16.
42) Radhakanta deva,Shabdakalpa Dhruma,5th part,3rd edition,1967, Chokamba Sanskrit series office, Varanasi, page no 180.
43) R G Vallia,IADVL,Text book and Atlas of dermatology, volume II,1st edition, Bhalani pulishing house, Bombay. Page no 518.
44) Stedmen’s Stedmins medical dictionary, vol 4, 22nd edition, 1974, Williams Wilkins company Battimore publishing, page no –
45) Viswanath Jha, Amarakosha, 2nd edition, Motilal Bamarasidar, Pune, page no 283. 46) Radhakanta deva,Shabdakalpa Dhruma,5th part,3rd edition,1967, Chokamba Sanskrit
series office, Varanasi, page no 180. 47) Satyapal Bhishagacharya, Kashapa Samhita,Chikitsa stana,chpter,sloka,4th
edition,1988, ,Chokamba Sanskrit samstana, Varanasi, page no 115. 48) Radhakanta deva,Shabdakalpa Dhruma,5th part,3rd edition,1967, Chokamba Sanskrit
series office, Varanasi, page no 180. 49) Radhakanta deva,Shabdakalpa Dhruma,5th part,3rd edition,1967, Chokamba Sanskrit
series office, Varanasi, page no 180. 50) Viswanath Jha, Amarakosha, 2nd edition, Motilal Bamarasidar, Pune, page no 283. 51) Monier-williams, Sanskrit English Dictionary, 1st edition, 2003, Asian Educational
service, New-Delli, page no 393. 52) Veni madhava Shatri Joshi, Ayurvediya shabdakosha, 1st vol,1968, Maharastra
Rajya sahitya and Sanskrit mandala, Mumbai, page no 397. 53) D:\05102006\ Derma Best, Inc -Vitiligo & Skin functions.htm 54) Ambikadatta Shastri,Susruta Samhita,Sharirastana,4th chapter,4th sloka,15th
edition,2002,Chokamba Sanskrit samstana, Varanasi, page no 28 55) Bramanand Tripati, Charaka samhita,Sharira stana, 3th chapter, 6th sloka, 6th edition,
1999, Chokamba Sanskrit surabharati, prakashan, Varanasi, page no 862. 56) Hari Sadashiva shastri Parashara,Astanga Hrudaya,Sharira stana,1th chapter,57th
sloka, 1st edition,2002, , Chokamba hurabharati prakashan, Varanasi, page no 527-528.
57) Ambikadatta Shastri,Susruta Samhita,Sharirastana,4th chapter,4th sloka,15th edition,2002,Chokamba Sanskrit samstana, Varanasi, page no 28-29.
58) Bramanand Tripati, Charaka samhita, Sharira stana, 7th chapter, 4th sloka, 6th edition, 1999, Choukamba Sanskrit surabharati, prakashan, Varanasi, page no919.
59) Shrikanta murthy,Astnga Sangraha,Nidanastana,5th chapter, 7th sloka, 1st edition,1996, Chokamba Orientalia, Varanasi, page no 62.
60) Shridara Krishana Parasher,Sharangadara Samhita, Purvakhanda,5th chapter, sloka 37-40, 3rd edition, 1984, Bhaidhyanath Ayurvedia Bhavana Limited, Nagapur, page no 77.
61) Bhashkar Govinda Ghanekar, Susruta Samhita, Sharirastana, 4th chapter, 4th sloka, 17th edition, 2004, Lakshmandas publications, Newdelli, page no 107.
62) Martion Fundamentals of Anatomy and Physiology, 4th edition, 1998, Prentice Hall Inc (pub) New Jersey, page no 147-162.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 3
63) Bramanand Tripati, Charaka samhita,Indriya stana,1st chapter, 8th sloka, 6th edition, 1999, Chokamba Sanskrit surabharati, prakashan, Varanasi, page no 989.
64) Shrikanta Murthy,Astnga Sangraha,Shrirastana,1st chapter, sloka 39-40,1st edition,1996, Chokamba Orientalia, Varanasi, page no 15.
65) Bramanand Tripati, Charaka samhita,Indriya stana,7th chapter, 16th sloka, 6th edition, 1999, Chokamba Sanskrit surabharati, prakashan, Varanasi, page no 1021-1022.
66) Bramanand Tripati, Charaka samhita,Indriya stana,7th chapter, 14-15 sloka, 6th edition, 1999, Chokamba Sanskrit surabharati, prakashan, Varanasi, page no 1021.
67) Bramanand Tripati, Charaka samhita,Indriya stana,7th chapter, 10-13 sloka, 6th edition, 1999, Chokamba Sanskrit surabharati, prakashan, Varanasi, page no 1021
68) 68. Bramanand Tripati, Charaka samhita,Sutra stana,12th chapter, 11th sloka, 6th edition, 1999, Chokamba Sanskrit surabharati, prakashan, Varanasi, page no 259.
69) Ambikadatta Shastri,Susruta Samhita,Sutraastana,21st chapter,10th sloka,15th edition,2002,Chokamba Sanskrit samstana, Varanasi, page no 89.
70) 70.Hari Sadashiva Shastri Paradakar, Astangahrudaya,Sutrastana, 12th chapter,14th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 194.
71) Bhramananda Tripati, Charaka samhita, Vimana stana, 8th chapter, 104th sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 764.
72) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Sutrastana, 12th chapter,6th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 193.
73) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 28th chapter, 38th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 459.
74) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Sutrastana, 12th chapter,14th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 194.
75) Satyanarayana Shastri, Charka samhita, Chikitsa stana, 15th chapter, 17th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 456
76) Bhramananda Tripati, Charaka samhita, Vimana stana, 8th chapter, 104th sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 764.
77) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Sutrastana, 11th chapter,5th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 193.
78) Mortin, Fudamenatls of Anatomy and physiology, 4th edition, 1998, Prentice Hall Inc (pub), New Jersey, page no 157.
79) Mortin, Fundamentals of Anatomy and physiology, 4th edition, 1998, Prentice Hall Inc (pub), New Jersey, page no 151.
80) Yadunanda, Upapadya, Madavanidana, Vol 1,1st chapter, 4th sloka, 26th edition, 1996, choukamba Sanskrit samsthan, Varanasi, page no 8.
81) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 17th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 249.
82) Satyapal Bhisagacharya, Kasyapa samhta,Khilastana, 5th chapter, 3rd sloka, 4th edition,1988, choukamba Sanskrit samsthan, Varanasi, page no 255.
83) Yadavaji Trikamaji Acharya,Susrita samhita,Dallana commentary, Nidanastana, 5th chapter, 3rd sloka, 8th edition,2005, choukamba Orientalia, Varanasi, page no 283.
84) Bhramananda Tripati, Charaka samhita, Vimana stana, 25th chapter, 40th sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 453.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 4
85) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Sutrastana, 7th chapter,29th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 133.
86) Bhramananda Tripati, Charaka samhita, Vimana stana, 1st chapter, 21st sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 662-663.
87) Bhramananda Tripati, Charaka samhita, Vimana stana, 25th chapter, 39th sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 662-663.
88) Ambikadatta Shastri,Susharut samhita,Uttaratantra, 40th chapter, 163rd sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 234.
89) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 177th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 275.
90) Bhramananda Tripati, Charaka samhita, Vimana stana, 25th chapter, 40th sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 453
91) Bhramananda Tripati, Charaka samhita, Vimana stana, 7th chapter, 103 sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 598-599.
92) Ambikadatta Shastri,Susharut samhita,Sutrastana, 20th chapter, 16th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 85.
93) Bhramananda Tripati, Charaka samhita, Vimana stana, 7th chapter, 83 sloka, 6th edition, 1999, choukamba surabharati prakashan, Varanasi, page no 996.
94) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 17th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 249.
95) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 17th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 249.
96) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Nidanastana, 14th chapter,37th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 527.
97) Srikantamurty, Astanga-Sangrha, Sutrastana, 35th chapter, 3rd sloka, 1st edition, 1996, choukamba Orientalia, Varanasi, page no 571.
98) Srikantamurty, Astanga-Sangrha, Sutrastana, 22nd chapter, 89th sloka, 1st edition, 1996, choukamba Orientalia, Varanasi, page no 391.
99) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Nidanastana, 14th chapter,37th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 527.
100) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 17th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 249.
101) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 174th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 274.
102) Yadunanda, Upapadya, Madavanidana, Vol 1,1st chapter, 5th sloka, 26th edition, 1996, choukamba Sanskrit samsthan, Varanasi, page no 9.
103) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 12th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 249.
104) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 4th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 247.
105) Srikantamurty, Astanga-Sangrha, Nidanastana, 14th chapter, 12-13 sloka, 1st edition, 1996, choukamba Orientalia, Varanasi, page no 236.
106) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 174th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 274
107) R G VALLIA,IADVL,Text book and Atlas of dermatology, volume 2,1st edition, Bhalani pulishing house, Bombay. Page no 518.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 5
108) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 174th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 274
109) Hari Sadashiva Shastri Paradakar, Astangahrudaya,Nidanastana, 14th chapter,38th sloka,7th edition, 2002, choukamba surabharati prakashan, Varanasi, page no 527.
110) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 4th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 247.
111) Ambikadatta Shastri,Susharut samhita,Nidanastana, 5th chapter, 4th sloka, 15th edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 247.
112) Yadunandan Upadhyaya, Madavanidana, Madukosha commentary,vol II,49th
chapter,37-40 sloka,26th edition,1996, Chokamba Sanskrit samstana, Varanasi, page no 164-166.
113) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 175th sloka, 1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 275.
114) http://www-emm.cbcu.cam.ac.uk/01003398h htm. 115) http://www-emm.cbcu.cam.ac.uk/01003398h htm. 116) Seung-Kyung Hann and James J, Norland, Vitiligo, 6th chapter, 1st edition, 2000,
Panther publishers’ private limited, Bangalore, page no 39-43. 117) Hari Sadashiva shastri Parashara,Astanga Hrudaya, Chikitsa stana,20th chapter, 1st
sloka,1st edition,2002, Chokambha Surabharati prakashan, Varanasi, page no 718. 118) Hari Sadashiva shastri Parashara,Astanga Hrudaya, Chikitsa stana,20th chapter,25th
sloka,1st edition,2002, Chokambha Surabharati prakashan, Varanasi, page no 719. 119) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 166th sloka,
1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 273. 120) Hari Sadashiva shastri Parashara,Astanga Hrudaya, Chikitsa stana,20th chapter, 18th
sloka,1st edition,2002, Chokambha Surabharati prakashan, Varanasi, page no 718. 121) Satyanarayana Shastri, Charaka samhita, Chikitsa stana, 7th chapter, 172nd sloka,
1st edition, 1999, choukamba bharati Acadamy, Varanasi, page no 275. 122) Ambikadatta Shastri,Susharut samhita,Chikitsastana, 9th chapter, 45th sloka, 15th
edition,2002, choukamba Sanskrit samsthan, Varanasi, page no 53. 123) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 550. 124) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 478. 125) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 1019. 126) K.M Nadakarni, Indian Materia Medica, Vol II, 3rd edition, popular prakashan,
Bombay, 1996, Page 54. 127) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 1126. 128) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 187. 129) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 480. 130) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan,
Bombay, 1996, Page 169.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 6
131) Dr. J L N Shastry,Drayaguna Vijnana, vol II, 1st edition,2004, Choukhambha Orientalia,Varanasi,page no 950-951.
132) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11859479&query_hl=4&itool=pubmed_docsum
133) Dr. J L N Shastry,Drayaguna Vijnana, vol II, 1st edition,2004, Choukhambha Orientalia,Varanasi,page no 318-319.
134) http://shop.store.yahoo.com/herbal-remedies-usa/index.html 135) Dr. J L N Shastry,Drayaguna Vijnana, vol II, 1st edition,2004, Choukhambha
Orientalia,Varanasi,page no184-186. 136) http://www.holistic-online.com/herb_home.htm 137) Gulbaraj Sharama Mishra, Ayurveda prakasha. 3rd chapter, 1999, 218-222 sloka,
Choukhambha Bharati Acodamy, Varanasi,page no 362. 138) Dr. J L N Shastry,Drayaguna Vijnana, vol II, 1st edition,2004, Choukhambha
Orientalia,Varanasi,page. 139) Dr. J L N Shastry,Drayaguna Vijnana, vol II, 1st edition,2004, Choukhambha
Orientalia,Varanasi,page. 140) I.P., 90; Uniyal & Issar, Indian For , 1967, 93 , 107; Gupta, ibid , 1964, 90 , 454;
I.P.C.,40 141) J. Am. Chem. Soc. 1982, 104, 2039 142) Chem. Commun. 1983,1425 143) Heterocycles 1982, 19, 257 144) Indian Drugs, 35(8), 468,1998; Chem Abstr 129:335838 145) Lu, S.H.; Natural Medicines, 52(4), 310, 1998 146) Leather Sci. 1968, 15, 337; Chem. Abstr. 1969, 71, 10285 b 147) Bull. Res. Inst. Univ. Kerala 1959, 6, 21; Chem. Abstr. 1960,54,16746 e 148) J. Oil Technol. Assoc. India 1973, 5, 8; Chem. Abstr. 1973, 78, 156602 a 149) Indian J. Chem. 1977,15B, 291 150) Hlth Bull ., 23, 1951, 38; Nature, 1944, 153, 684; Proc.Indian Acad. Sci., 1949, 29B,
155 151) J. Sci. Industr. Res., 1951, 10B, 88; Annu. Progr. Rep., CDRI, Lucknow , 1951-52 152) Shridara Krishana Parasher,Sharangadara Samhita, Madhyamakhanda,8th chapter,1st
sloka,3rd edition, 1984, Bhaidhyanath Ayurvedia Bhavana Limited, Nagapur, page no 306.
153) Dr Harvey Lui. Reference: Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H Parametric Modeling of Narrow Band UVB Phototherapy for Vitiligo with a Novel Quantitative Tool: the VASI Score Archives of Dermatology June: 140; 677-683, Update on Clinical research for Vitiligo: The VASI score, By Iltefat Hamzavi, MD, Clinical Assistant Professor, Department of Dermatology, Wayne State University
154) R G Vallia, IADVL,Text book and Atlas of dermatology, volume I,1st edition, Bhalani pulishing house, Bombay. Page no 52-56.
155) Seung-Kyung Hann and James J, Norland, Vitiligo, 8th chapter, 1st edition, 2000, Panthaer publishers’ private limited, Bangalore, page no 112.
Kakodumbaradighanavati (internal) and Ayorajadilepa (external) in Switra – References 7
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSASHRI. D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG.
SPECIAL CASE SHEET FOR SWITRA
Guide : Dr. V. Varadacharyulu Scholar : Venkareddiyavar B. H.
Co-Guide : Dr. R. V. Shetter
01. Name of the Patient :
02. Father’s Name / Husband’s Name :
03. Age : Years
04. Sex :
05. Religion :
06 Educational Status :
07. Economical Status :
08. Marital Status :
09. Occupation :
10. Address :
11. Selection :
12. Result :
13. Consent :I is fully aware of the fact that
am a part of clinical trial. The investigator has explained me in detail about the out-comes of the trail in the language I understand. I voluntary submit myself to the trail andgive my consent to be one of his trial case.
SIGNATURE OF THE SCHOLAR SIGNATURE OF THE PATIENT
M. D. ScholarM. D. (Ayu) (OSM)
M. D. (Ayu)
Sl. No. :OPD No. :IPD No. :SCHEDULEInitiation :Complition :Male Female
Hindu Muslim Christain Other
Poor Middle class Higher class
Married Unmarried
Sedentary Active Labour
-----------------------------------------------
----------------------------------------------------
---------------- Pin. ------------ Ph. (---------------)------------------
Included Excluded
Cured Well resp. Not resp. Discontinued
11111
Moderate resp.
A. PRADHANA VEDANA:
Sl. Complaints Duration Before After
01 Twak Shwetata
02 Roma Vivarnata
03 Rukshata
04 Parushata
05 Paridwamshi
06 Daha
07 Roama Patana
08 Kandu
09 Kleda
10 Srava
B. ANUBANDHI VEDANA :
Sl. Associated Complaints Duration Before After
01 Vruna
02 Pandu
03 Shareera Gauravata
C. VYADHI VRITTANTA :
a. How it was noticed ? Intentional / Accidental. b. Mode of Onset Sudden / Gradual. c. Initial site of lesion d. H/O any physical injury
Burn : (What sort of it?)
Direct heat Thermal Sun Electrical Chemical
Trauma : (What sort of it?)
Accident Abrasion Scratches of itch Post surgery
2
Other factors: Shoes Gloves Bind’s Tight clothing
e. Natural causes
Pregnancy Parturition
f. Psychotic traumas –
i. Cause
ii. After what time patch appear
g. Pt. Suffering form any systemic disease
h. Any skin disorders reported
i. H/O of Heredity
Maternal Paternal.
D. CHIKITSA VRITTANTA:
E. VAYAKTIKA VRITTANTA:
Ahara Vegetarian Mixed
Rasa preferred M A L Kt Tk Ks
Vyasana Tea / Coffee Tobacco Smoking
Nidra Sound Disturbed
Mootra pravritti Normal Polyuria Micturia
Mala pravritti Normal Loose Constipated
Rajaha Regular Irregular Menopause
3
F. SAMANYA PAREEKSHA:
01. Pulse 02. B.P. 03. Temperature
04. Res. Rate 05. Weight 06. Height
07. Dashavidha & Ashtasthana Pariksha
Prakruti V P K VP VK PK VPK
Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya
Nadi Dosha Pravrutti
Gati Varna
Purnata Gandha
Spandana Kathinya
Mutra
Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa
Mala
Shabda Sparsha Sheeta Ushna
Ast
asth
ana
Drik Akruti G. SPECIAL EXAMINATION OF SKIN:
a. Site of the lesion – Area of lesion in % Sl. Part Right Left
B A 01. Arm 02. Forearm 03. Palm 04. Thigh 05. Leg 06. Foot 07. Trunk front 08. Back 09. Neck 10. Face 11. Cheeks 12. Lips 13. Genitals
4
Distribution – Symmetrical Asymmetrical
Number –
Size – Smaller Small Big Gross
(0.1-1.0cm) (1-5cm) (5-15cm) (>15cm)
Colour – Red Coppery red White
Surface – Dry Moist
Margin – Thin Thick Extending Nondifferencible
Hairs – Krishna Tamra Shweta Alomata
Any system involved –
H. Evaluation of Ayurvedic etiology:
I. Nidana -
A. Ahara sambhi nidana -
Mithya ahara Anashana Adhaysahana Ajeerna adhyashana
Dravyata Navanna Gunata Atidrava Atisnigdha Atiguru Rasa pradhanyata
Atilavana Atiamla
Dhanya Chanaka Masha Yava Kulathya Shaka varga Moolaka Mamsa varga Matsya Taila Tila taila Kusumbha taila Ksheera vikriti Dadhi Takra Virushha ahara Dadhivada Dudgha and
Lavana Dadhi & ghrita /
taila.
B. Vihara sambandhi nidana –
Vega dharana Divaswapna Ativyavaya
Atapasevana Sheeta jalasnana and pana after shrama and Bhaya
C. Manasika samabandhi nidanas – Dharma viruddha Shastra viruddha Nyaya viruddha Guru nindaneeya
5
III. Poorvaroopa
IV. Roopa
Poorvaropa P/A When it was observed
Atisweda
Asweda
Atislakshna
Parusha
Vivarnata
Kandu
Daha
Romaharsha
Rookshata
Krishnata
Sl. Laxana Present / Absent
01. Twak Arunata
02. Tamra varna
03. Shweta varna
04. Rooskhata
05. Parusha
06. Paridwamshi
07. Roma vidhwamshi
08. Paridaha
09. Ghana
10. Guru
11. Kandu
V. Vinischaya
a. Doshaja b. Vranaja
VI. Sadhyasadhyata
VII. Arishta laxana
6
K. Laboratorial investigations
A. Objective criteria Sl. Investigations Before After
01. Serum copper µmole/lit. µmole/lit.
B. Exclusion criteria
Investigations Values
RBS Mg/dl.
TC Cells/cubinmm
DC – Polymorphs
- Lymphocytes
- Monocytes
- Basophils
- Eosnophil
ESR mm /1st Hour
Hb % Gm/dl
VIII. CHIKITSA KARMA:
INTERNAL YOGA – Kakodumbaradighana Vati
Posology – 3 gms per day in divided dosage.
ANUPNA –
EXTERNAL – Ayorajadi lepa (Q.S.):
Sl. Schedule Investigator’s Observations01. Day 1 02. Day 15 03. Day 30 04. Day 45 05. Day 60 06. Day 75 07. Final follow up 90th day
7
IX. ASSESSMENT OF RESULTS:
Sl. Patch area Before After Difference01. Colour 02. Number 03. Margine 04. VASI score
Investigator’s note:
Signature of scholar Signature of supervisor
GRADING CHART Colour – Grade 0 – Normal skin colour
Grade 1 – Non-unified normal skin Grade 2 – Pigmentation is more than depigmentation Grade 3 – Depigmentation equal or more than pigmentation Grade 4 – Depigmentation more than pigmentation Grade 5 – Complete Depigmentation
Margin – Grade 0 – Normal skin colour attributed Grade 1 – Hyper pigmented thick broad width graduated margin Grade 2 – Hyper pigmented broad width graduated margin Grade 3 – Hyper pigmented well defined margin Grade 4 – Hyper pigmented thin edge margin Grade 5 – Ill defined margin
VASI – Area (Palm units) x Extent of de-pigmentation in % Total body surface area
8
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