A COMPARATIVE AND COMBINED CLINICAL STUDY ON
SHODHANA AND ALEPANA(EXTERNAL APPLICATION) IN
VICHARCHIKA
BY
Dr.SAVITA WALI
DISSERTATION SUBMITTED TO THE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE.
IN THE PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
AYURVEDA VACHASPATI
(Doctor of Medicine) IN
PANCHAKARMA
UNDER THE GUIDANCE OF
Dr. A.S.DONGARGAON. M.D (Ayu)
DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA,
DR.B.N.M.E.T’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND
RESEARCH CENTRE
BIJAPUR
NOVEMBER 2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation thesis entitled “A COMPARATIVE AND
COMBINED CLINICAL STUDY ON SHODHANA AND ALEPANA (EXTERNAL
APPLICATION) IN VICHARCHIKA” is a bonafide and genuine research work
carried out by me under the guidance of Dr. A.S.DONGARGAON. M.D (Ayu) Asst.Prof,
Dept. of PANCHAKARMA, Shri Mallikarjuna Swamiji Post Graduate and Research
Centre, Bijapur.
Date: Signature of the Candidate Place: Bijapur.
Dr.SAVITA WALI
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
Dr. B. N. M. E. T’s
SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH
CENTRE, BIJAPUR.
DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A COMPARATIVE AND
COMBINED CLINICAL STUDY ON SHODHANA AND ALEPANA (EXTERNAL
APPLICATION) IN VICHARCHIKA.” is a bonafide research work done by
Dr.SAVITA WALI in partial fulfillment of the requirement for the degree of
AYURVEDA VACHASPATI (Doctor of Medicine).
Date: Signature of Guide:
Place: Bijapur Dr.A.S.DONGARGAON. M.D (Ayu) Asst.Professor and Guide Dept. of Panchakarma Shri Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE
Dr. B. N. M. E. T’s
SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH
CENTRE, BIJAPUR.
DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA
ENDORSEMENT BY THE H.O.D, PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A COMPARATIVE AND
COMBINED CLINICAL STUDY ON SHODHANA AND ALEPANA (EXTERNAL
APPLICATION) IN VICHARCHIKA.” is a bonafide research work done by
Dr.SAVITA WALI under the guidance of Dr.R.N.GENNUR.M.D(Ayu) Prof. Dept. of
PANCHAKARMA, Shri Mallikarjuna Swamiji Post Graduate and Research Centre,
Bijapur.
Seal & Signature of the HOD Seal & Signature of the Principal Dr.R.N.Gennur M.D (Ayu) Dr.R.N.Gennur M.D (Ayu) Date: Date: Place: Bijapur. Place: Bijapur.
COPYRIGHT
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 academic/research purpose.
Date: Signature of the Candidate Place: Bijapur.
Dr.SAVITA WALI
© Rajiv Gandhi University of Health Sciences, Karnataka.
i
ACKNOWLEDGEMENT While penning the acknowledgement of the present work, I remember the
moments when I needed someone desperately to come upon for the help. It was the
LORD who always transformed silent strengths in me by his blessing. I cordially
salute to the SHRI SIDDHARUDHA SWAMIJI for standing behind me in each &
every hurdle of life.
This is an unforgettable moment of contentment on the successful fulfillment
of an ambition fostered for long. I offer my salutations to loving my mother Smt.
Shanta.S.Wali. for suffering great agony to bring me up to this position. I am highly
obliged for their blessing support and sacrifice which have always been constant
sources of inspiration in my life. I express my gratitude towards my brothers Veeresh
and Shivaraj, who with thier support enabled me to complete this difficult task.
Words cannot express the deep sense of respect & love for my father in-law
Shri.Shrishail.Kokatnur, mother in-law Smt.Parvati.Kokatnur whose support has
proved to be in par with parents. I would like to share these moments with my brother
in-law Anand. Kokatnur & sister in-law Smt. Jyoti. Kokatnur.
I would like to convey my heartiest thanks to my beloved husband,
Dr.Santosh.Kokatnur, who is the prime source of encouragement for me to achieve
this target of my life. He shared my responsibilities & has worked very hard to see our
dreams come true.
I express my gratitude to the Chairman, Dr.K.B.Nagur M.D. (Ayu), management
committee of Dr.B.N.M.E.T’s Shri.Mallikarjuna Swamiji PostGraduate and Research
Centre, for giving me the opportunity to pursue my post graduation at this institution.
I sincerely thank Principal and Department Head Dr.R.N.Gennur M.D. (Ayu)
Dept. of Panchakarma, for his support and guidance through out my period of research
work.
It gives me an immense pleasure to express my sincere gratitude to my guide
Dr.A.S.Dongargaon M.D. (Ayu) for his expert guidance, supervision, co-operation
extended throughout my dissertation work.
I express my gratitude to Dr.C.S.Hiremath for her support and guidance while
preparing my synopsis.
I express my sincere thanks to my Departmental staff Dr. Uma Patil M.D. (Ayu),
ii
Dr.I.P.Ugar M.D. (Ayu), Dr.P.R.Vastrad M.D. (Ayu), Dr.L.M.Biradar M.D. (Ayu), and
Dr.Rajeshwari.Biradar M.D. (Ayu) for thier valuable suggestions. I express my profound gratitude to screening committee members
Dr.B.S.Tamagond M.D. (Ayu), and Dr.J.C.Huddar M.D. (Ayu)
I express my special thanks to Dr.B.G.Patil, M.D. (Ayu) Dr.Anita Patil M.D. (Ayu), and
Dr.P.B.Savalagi M.D. (Ayu), for their timely guidance and help.
I acknowledge with sincere thanks for their kind co-operation and great
pleasure for me, to my gratitude with profound respect to all P.G Staff.
I express my sincere thanks to Pharmacy of B.V.V.S Ayurvedic Medical
college, Bagalkot for providing all the medicines for my research work.
I would like to thank Dr.Shrinivas Vadeyar M.D. (Ayu) for his valuable
suggestions and Shri Tapshetty M.Sc (stat) for helping me with the Statistical Analysis
of the study results.
Its my pleasure to recall here the timely co-operation from my departmental seniors
Dr.Rajeshwari, Dr.Mallappa, Dr.Pargonde, my collegues Dr.Gopu and Dr.Prakash
and my juniors Dr.Sunil P.V, Dr.Sunil.Nagare and Dr.Pankaj and also I would like to
thank Dr.Rajarajeshwari and Dr.Deepa for their help during my work.
It is beyond my reach of language to inscribe profound co-operation and
friendly help rendered by Dr.Gopu and Dr.Hosamani during my work.
I sincerely thank my P.G. colleagues Dr.Parashuram, Dr.Masule,
Dr.Padashetti Dr.Rehaman, Dr.Policepatil, Dr.Suchitra, Dr.Sushant, Dr.Geeta,
Dr.Santosh, Dr.Mahesh, Dr.Manish, Dr.Gourav, and Dr.Priyanka for their help
during my work.
I sincerely thank my Panchakarma Hospital staff, my patients and Paramedical
staff for their kind co-operation during my clinical trials.
I would like to thank Shri R.G.Dolli office supertendent and other office staff
of our college, Mr.Satish, Smt.Jatti and Mr.Biradar for their support & co-
operation. I thank Mr Swamy, librarian of Shri B.N.M.E Trust and Research center, I
also thank other library staff Mr Bellary for all the help they provided.
I thank Preeti computers for their printing of my dissertation work.Lastly I
thank each and everyone who stood behind me, directly or indirectly in completing my
dissertation work.
Date: Dr. SAVITA.WALI
Place :
iii
ABBREVIATIONS
A.H – Ashtanga Hrudaya
A.S – Ashtanga Samgraha
A.T – After Treatment
B.S – Bhela Samhita
B.R – Bhaishajya ratnavali
B.P – Bhava Prakasha Nighantu
B.T – Before Treatment
Ch.S – Charaka Samhita
C.D – Chakra Dutta
F.U – Follow Up.
K.S – Kashyapa Samhita
M.N – Madhava Nidana
Su.S – Sushruta Samhita
Sh.S – Sharangadhara Samhita
S.D – Standard Deviation
iv
ABSTRACT
BACK GROUND AND OBJECTIVES:
Before going into the real work, a glance on that gives an idea about the
contents.
Kustha is tridoshaja vyadhi where Rasa, Rakta, Mamsa and Ambu are the
dushyas. The word Kustha indicates its reaproaching nature, which destroys the
beauty of the skin.
Vicharchika, one of the most common but miserable twak vikar affecting all
the age of population still stands as a challenge to different medical systems. Many
research works have been done on skin disorders in modern medical science but no
drug has yet been claimed to cure skin diseases completely. No one can prevent
recurrence. Ayurveda has given prime important on two types of treatment, i.e.,
Shodhana and Shamana.
Doshadushya sammurchana reveals pathological involvement of pitta and
rakta in the manifestation of Vicharchika. Among Shodhana procedures for pitta
pradhana dosha and rakta pradhana dusti ‘Virechana’ is the choice of treatment.
According to Sushruta if doshas are located in twak, rakta, mamsa first Shodhana
should be done and then go for Alpena, etc. Sharangadhara has mentioned the
effectiveness of Arka taila in Vicharchika. As Arka taila is Kapha–pitta shamaka,
raktashodhaka, rakta stambhaka and kusthaghna properties it is used for external
application.
Hence the present study was undertaken to compare the efficacy of Shodhana
by means of Virechana karma and Shamana by means of Alepana (external
application) and also the combined effect in Vicharchika.
v
METHODS:
For the present study, 30 patients diagnosed as Vicharchika were randomly
selected from Dr. B.N.M.E Trust’s S.M.S. PG and RC, Bijapur and special camps
conducted in Bijapur city by the institute. Patients thus selected were randomly
allocated in three groups.
Group A – Virechana karma
Group B – Alepana (External application) with Arka taila and
Group C - Virechana karma and Alepana
Patients were assessed for the severity of symptoms subjectively and
objectively before, after and at the end of follow up of the treatment. Data were
collected in the same protocol and statistically analyzed.
INTERPRETATIONS AND CONCLUSIONS:
After the course of interventions,
Group A i.e., Virechana karma showed highly significant result after treatment in
Kandu, Raji, Vaivarnya and Ruja variables and maintained same after follow up.
Group B i.e., Alepana (External application) with Arka taila showed highly
significant result after treatment in Kandu, Raji, Vaivarnya and Ruja variables. But
after follow up Raji, Vaivarnya and Ruja remained only significant.
Group C i.e., Both Virechana karma and Alepana showed highly significant results
after treatment in Kandu, Raji, Vaivarnya and Ruja variables and maintained same
after follow up.
In Rukshata Group C showed better result than Group A and Group B
KEY WORDS: Vicharchika, Shodhana, Virechana, Arka taila and Alepana
vi
CONTENTS
• List of Tables
• List of Flow charts
• List of Graphs
Page No.
1. Introduction 1-2
2. Objectives 3
3. Review of Literature 4-55
4. Materials and Methods 56-63
5. Observations and Results 64-101
6. Discussion 102-135
7. Conclusion 136
8. Recommendations for future study 137
9. Summary 138-139
10. Bibliography 140-150
11. Annexure –
Classical Reference I- IV
Case Proforma V- vi
Photographs
vii
LIST OF TABLES
TableNo Table Title PageNo
01 Historical Review in veda kala.(Virechana) 04 02 Historical Review in Charaka samhita. 04-05 03 Historical Review in Sushruta samhita. 06 04 Historical Review in Kashyapa Samhita. 07 05 Historical Review in Astanga samgraha. 07-08 06 Historical Review in Astanga hrudaya. 08 07 Historical Review of Bhela Samhita 08 08 Historical Review in Sharangadhara samhita. 09 09 Historical Review in Nighantu. 09 10 Classification of Virechana dravya acc to Upayukta anga. 12-14 11 Classification of Virechana dravya acc to Rutu. 15 12 Guna of virechana dravyās. 16 13 Indication’s of virechana. 16-17 14 Contra-Indication’s of virechana. 18 15 Dosage of Virechana according to sharangadhara. 20 16 Aushadha jeernaajeerna lakshanas. 23 17 Virechana vega vinirnaya. 24 18 Samyak Lakshana of Virechana karma. 24 19 Ayoga lakshanas of Virechana. 25 20 Atiyoga lakshanas of Virechanas. 25 21 Virechana Vyapat lakshana. 26 22 Peyadi Samsarjana karma. 27 23 Historical Review in veda kala.(Kustha) 30-31 24 Historical Review in Charaka samhita. 31
25 Historical Review in Sushruta samhita. 31
26 Historical Review in Astanga samgraha and Astanga hrudaya.
32
27 Historical Review in Bhela Samhita and Harita Samhita. 32
28 Historical Review in Madhava Nidana. 32
29 Historical Review in B.R, Y.R and Sh.S. 32-33
30 Classification of mahakustha according to different acharyas.
34
31 Classification of Kshudrakustha according to different acharyas.
34
32 Classification of Kustha on the basis of Doshic predominance.
35
33 Nidan according to different acharyas. 37-38
34 Purvarupa according to different acharyas. 39 35 Rupa according to different acharyas. 40 36 Number of kalas and manifestation of kustha. 42 37 Kalas, thickness of twacha and reflection of disease. 42
viii
38 Different layers of twacha according to different acharyas.
43
39 Differential Diagnosis. 48 40 Pathya according to different acharyas. 52 41 Apathya according to different acharyas. 52 42 Properties of Shunti churna. 53 43 Properties of ingredients of Panchatiktaka ghrita. 53-54 44 Properties of Tila 54 45 Properties of Drugs used for virechana karma(Triphala
kashaya). 54
46 Properties of ingredients of Arka Taila. 55 47 Distribution of patients according to Age. 65 48 Distribution of patients according to Sex. 66 49 Distribution of patients according to Religion. 67 50 Distribution of patients according to Occupation. 68 51 Distribution of patients according to Socio-economic
status. 69
52 Distribution of patients according to Diet. 70 53 Distribution of patients according to Vyasana. 71 54 Distribution of patients according to Kula vrittanta. 72 55 Distribution of patients according to Chronicity of
vyadhi. 73
56 Distribution of patients according to Prakruti. 74
57 Distribution of patients according to Agni pareeksha. 75
58 Distribution of patients according to Kostha. 76 59 Distribution of patients according to Site of lesion. 77
60 Required days for Samyak snehana. 78
61 Distribution of the patients according to Vaigiki criteria. 79
62 Distribution of the patients according to Manaki criteria. 80 63 Distribution of the patients according to Antaki criteria. 81 64 Distribution of the patients according to Laingiki criteria. 82 65 Distribution of patients of Vicharchika based on the
presence of clinical symptoms
83
66 Distribution of patients according to presence of Kandu before treatment.
84
67 Distribution of patients according to presence of Raji before treatment.
84
68 Distribution of patients according to presence of Vaivarnya before treatment.
84
69 Distribution of patients according to presence of Ruja before treatment
85
70 Distribution of patients according to presence of Rukshata before treatment.
85
71 Results of Group A after treatment. 88 72 Results of Group A after follow up. 89 73 Results of Group B after treatment. 90
ix
74 Results of Group B after follow up. 91 75 Results of Group C after treatment. 92 76 Results of Group C after follow up. 93 77 Result related observations for individual groups based on
observational criteria. 98
78 Statistical analysis of group A result in Kandu. 99 79 Statistical analysis of group A result in Raji. 99 80 Statistical analysis of group A result in Vaivarnya. 99 81 Statistical analysis of group A result in Ruja. 99 82 Statistical analysis of group B result in Kandu. 100 83 Statistical analysis of group B result in Raji. 100 84 Statistical analysis of group B result in Vaivarnya. 100 85 Statistical analysis of group B result in Ruja. 100 86 Statistical analysis of group C result in Kandu. 101 87 Statistical analysis of group C result in Raji. 101 88 Statistical analysis of group C result in Vaivarnya. 101 89 Statistical analysis of group C result in Ruja. 101
LIST OF FLOW CHARTS Serial. No Title Page.No
01 Virechana aushadha karmukata. 29 02 Samprapti according to Charak. 45 03 Samprapti according to Sushruta. 46 04 Samprapti according to Vagbhata. 46 05 Kustha Raktapradoshaja vyadhi 47 06 Samprapti. 04
x
LIST OF GRAPHS
Graph No Graph Title Page No 01 Distribution of patients according to age. 65 02 Distribution of the patients according to the sex. 66 03 Distribution of the patients according to the religion. 67 04 Distribution of the patients according to the occupation. 68 05 Distribution of patients according to Socio-economic status. 69 06 Distribution of the patients according to Diet. 70 07 Distribution of the patients according to Vyasana. 71 08 Distribution of the patients according to Kula vrittanta. 72 09 Distribution of the patients according to Chronicity of vyadhi. 73 10 Distribution of the patients according to Prakruti. 74 11 Distribution of the patients according to Agni pareeksha. 75 12 Distribution of the patients according to Kostha. 76 13 Distribution of patients according to site of Lesion. 77
14 Required days for Samyak snehana. 78
15 Distribution of the patients according to Vaigiki criteria. 79
16 Distribution of the patients according to Manaki criteria 80 17 Distribution of patients according to Antaki criteria. 81 18 Distribution of the patients according to Laingiki criteria. 82 19 Distribution of patients of Vicharchika based on the presence
of clinical symptoms 83
20 Response of clinical symptoms after treatment in Group A. 88 21 Response of clinical symptoms after follow up in Group A. 89 22 Response of clinical symptoms after treatment in Group B. 90 23 Response of clinical symptoms after follow up in Group B. 91 24 Response of clinical symptoms after treatment in Group C 92 25 Response of clinical symptoms after follow up in Group C 93
Introduction
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 1
INTRODUCTION
In human being skin is the most exposed and protective part which remains
continuously in direct touch with foreign bodies and outer atmosphere. Many factors like
allergens, microbes, foreign bodies are much responsible to disturb the structural and
functional unit of skin and ultimately it leads to skin diseases.
Skin disorders are having prevalence rate of about 15% of world’s population.
Indian medical science reveals that skin diseases were considered as one of the major
problem which is evident from its description under the broad heading of ‘Kustha’ which
is further divided into ‘Mahakustha’ and ‘Kshudrakustha’. Vicharchika is one type of
Kshudrakustha having dominancy of Pitta-Kapha dosha. Healthy skin is a cosmetic
value, therefore any disease pertaining to it will seriously affect the luster and
complexion of the individual, hence the patients are disliked by society. Due to its wide
spectrum prevalence, its chronicity, lack of effective drug, it attracts the researchers to
look the suitable remedy for the disease.
Though various treatments are available in the contemporary science ,they are still
not effective in preventing its reoccurrence. It can give just symptomatic relief.
Shodhana and shamana are the line of treatment that are adopted for vicharchika. It is
well known that the vitiated doshas of the body need to be eliminated radically before
going for Shamana Chikista. Shodhana strikes at the root of Malas and eradicates them
and as such the disease cured by Shodhana therapy will not resurface.
Among the Shodhana Karma Virechana karma is the best for Pitta and Rakta
Pradoshaja Vikara. as the Vicharchika is Rakta Pradoshaja vyadhi, so Virechana is
indicated. On the other hand Shodhana in combination with Shamana aushadhis naturally
Introduction
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 2
uproots the disease. Sharangadhara has mentioned Arka taila for Alepana in Vicharchika.
It is having ruksha, ushna, teekshna properties and mainly acts as kusthaghna.So its
specific property of kusthaghna make it perfect remedy for Vicharchika as an Alepana.
Hence the present study is undertaken as “A comparative and combined clinical
study on Shodhana and Alepana (External application) in Vicharchika.”
Objectives
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 3
OBJECTIVES
1. Detail study of Virechana Karma.
2. Detail study of Vicharchika.
3. To compare the effect of Virechana Karma and Alepana with Arka taila in
Vicharchika.
4. To assess the combined effect of Virechana Karma and Alepana with Arka taila in
Vicharchika.
Review of Literature
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 4
VIRECHANA KARMA
HISTORICAL REVIEW:
Table No.01 : Showing Historical Review in VEDA KALA
Veda Context
Rigveda Eranda was used for bowel evacuation.
Some of mantras which suggest the principle of evacuations
like “Yatah Sannam Vinirharet” meaning to excrete from the
nearest orifice.
Vinaya pitaka (Buddha period)
Vaidya Jeevaka had treated Buddha by Greya virechaka yoga.
(Inhaling some powder spread over utpalapatra).
Purana Context Garuda purana Agni purana
We can find traditional method of diagnosis along with
Panchakarma chikitsa.
Manu smruti
Certain procedures like ghrita which has been administered
orally after completion of Vamana, Virechana & Snana has
been found.
Upanishad Scattered references regarding Shodhana followed by Shamana
therapy for the normalcy of doshas has been found.
SAMHITA KALA :
Table No.02 : Showing Historical Review in CHARAKA SAMHITA :
Sthana Adhyaya Context 2.Aragwadiya Adhyaya Some Virechana dravyas are quoted.
4.Shadvirechana
shathashritiya Adhyaya
245 Virechanadravyas,10 Bhedaniya,10
Virechanopaga dravyas are stated.
6.Tasyashitiya Adhyaya Administration of Virechana acc to rutu.
Sutra
8. Roga Bhishagjeeviya Virechana dravyas
Review of Literature
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 5
15. Upakalpaniya
Adhyaya
Collection of required equipments Process of Virechana Symptoms produced due to Ayoga and
Atiyoga. Complications produced due to faults of
physician, drugs, nurse and patient. Samsarjana krama with its importance.
16 Chikitsa Prabutiya Adhyaya.
Samyak yoga,Atiyoga, Heena yoga laxanas & chikitsa.
17.Kiyanta shirashiya Yogya and Ayogya.
20. Maharogadhyaya. Dosha chikitsa.
24. Vidhi shonitiya Adhaya. Indication of Virechana.
25.Yadpurushee Adhyaya. Virechana Dravyas.
1. Madanaphala
kalpadhyaya
Defn of Virechana, Guna of Virechana
dravya, Mode of action of Virechana
dravya, pramukha dravya used for the
Virechana purpose.
Kalpa
7th to 12th Chapter Detail explanation of different types of
Virechana yogas ,Indications of yogas
acc to rutu.
Siddhi 1. Kalpanasiddhiradhyaya
Samsarjana krama and its importance to
increase Agni
Pradhana, Madhyama, Hina Shuddhi
lakshanas along with Ayoga, Atiyoga and
Samyak yoga.
2. Pancakarmiya siddhi Yogya and ayogya for Virechana
6.Vamana Virechana
Vyapad siddhiradhyaya
Samyak Virechana lakshana
Heena, Atiyoga lakshanas and its
chikitsa.
Chikitsa Several adhyaya regarding the treatment of diseases
In different stages of disease, the administration of Virechana has been told.
Review of Literature
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 6
Table No 03: Showing Historical Review in SUSHRUTA SAMHITA :
Sthana Adhyaya Contents Sutra 37.Bhumipravibhagiya. Collection of virechana yogas.
33. Vamana Virechana
Sadhyopadrava Chikitsitam
Adhyaya
Pharmacological action of Virechana
drugs.
Kaphahara diet.
Ayoga, Atiyoga, samyak yoga of
Virechana Karma.
Indications, Contraindications
34. Vamana Virechana
Vyapat chikitsitam Adhyaya
Complications produced after
Virechana.
Chikitsa
39. Aturopadrava
Chikitsitam Adhyaya
Samsarjana krama followed after
Virechana Karma to increase Agni.
Kalpasthana 1 Annapana Raksha kalpam Indications acc to rogavastha.
5.Mahavatavyadhi. Dosha chikitsa
33Vamana virechanopaga
sadhya chikitsitam
Kostha chikitsa, Dosha chikitsa,
Explained Virechana procedure in
detail also avirechya, virechya,
samyak yoga, ayoga, and atiyoga
explained.
34 Vamana virechana
vyapat chikitsitam.
Virechana vyapat and chikitsa.
Chikitsa
36 Netrabasthi vyapat
chikitsitam
Virechana karma sukta kala.
Uttartantra Reference regarding line of
treatment
In several stages of the disease
Review of Literature
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 7
Table No 04: Showing Historical Review in Kashyapa Samhita :
Sthana Adhyaya Contents 22. Snehadhyaya.
Administration of virechana dravya like
Draksha, Pilu, Triphala,are mentioned for
Mrudukosthi.
Sutra
27. Rogadhyaya Pitta chikitsa. Role of panchakarma in
individual doshas.
2.Trilakshana
adhyaya.
Benefits of Virechana karma.
Indication of Virechana.
Ayoga, Atiyog has been explained.
3. Vamana Virechana
Adhyaya
Process of Virechana
Heena, Madhyama, Uttama Shuddhis.
Regimen to be followed after Virechana
Importance of Virechana in Balaroga.
Virechana Vyapad.
Siddhi
Sthana
7. Panchakarmiya
Siddhi
Indications and Contradications of Virechana
Karma.
Khila
Sthana
7.Samshuddhi
Visheshaniya Adhyaya
Virechana process in detail with Samsarjana
krama.
Table No 05: Showing Historical Review in ASTANGA SAMGRAHA: Sthana Adhyaya Contents
04. Rutucharya adhyaya. Administration of virechana dravyas acc to rutus
06. Dravadravya vijnaniya
Adhyaya.
Virechana dravyas.
11. Matrashitiya adhyaya. Virechana dravyas.
12.Vividoushadhi vijnaniya
adhyaya.
Virechana dravyas.
Sutra
13. Agrasangrahaniya. Virechana dravyas.
Review of Literature
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 8
14.Shodhanadigana sangraha
adhyaya.
Virechana dravyas.
15. Mahakashaya sangraha
adhyaya.
Virechana dravyas.
21.Doshopakramaniya adhyaya. For Pitta dosha Virechana karma is indicated.
27.Vamana Virechana Vidhi Adhyaya
Detailed Virechana process. Properties of virechana drugs along
with their pharmacological action. Indications & Contraindications. Shuddhi Lakshanas.
28.Basthi vidhi adhyaya. Time of administration.
2. Virechana kalpa Virechana dravyas. Kalpa
3. Vamana Virechana
Vyapada Siddhi Adhyaya
Complications of Virechana karma
with their treatment.
Table No .06: Showing Historical Review in ASTANGA HRUDAYA: Sthana Adhyaya Contents Sutra 18.Vamana Virechana vidhi
Adhyaya Detailed Virechana process
Kalpa
3. Vamana Virechana
Vyapad Adhyaya
Complications regarding Virechana
process with treatment.
Table No.07: Showing Historical Review in BHELA SAMHITA:
Sthana Adhyaya Contents 21. No name for this Adhyaya Virechana Yogya Sutra
23.Ghadapurusheeya Vamana Virechana anahras
7.Dantiphalakalpa Virechana Yogas 8.Shankhini kalpa Virechana Yogas
Kalpa 9.Shyama Trivritt Kalpa Virechana Yogas
Siddhi
2. Vamana Virechana Siddhi Idea regarding diet on the previous day of Virechana, dose of decoction, Expulsion of Kapha, Pitta, Vata and Rakta respectively
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 9
Table No.08: Showing Historical Review in SHARANGADHARA SAMHITA: Khanda Adhyaya Contents Uttara 13. Vamana Vidhi
Adhyaya Definition of Virechana. Collection of
virechana dravyas, time of administration,
virechya, avirechya, virechana dravya
gunakarma, Rutu anusara virechana dravyas,
Degree of shodhana, ayoga & atiyoga
lakshanas are explained & it’s chikitsa.
Table No.09: Showing Historical Review in NIGHANTU: Name Contents
1. Dhanvantari Nighantu.
2. Kaideva Nighantu.
3. Nighantu Adarsha.
4. Priya Nighantu.
5. Bhavaprakash Nighantu.
Dravyas which are useful for Virechana
karma.
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ETYMOLOGY:
Virechana – Vi + Rich + Lyut – ‘Malade nissaranam’ (Vachaspathyam.) 1
Virechana – Vi + Rich + Lyut – ‘Visheshena rechayati’ (Shabdhakalpadruma) 2
Virechana word is derived from the ‘Rich’ dhatu after applying ‘Nich’ & ‘Lyut’ pratyaya
& with‘Vi’ upasarga. giving the meaning Maladehe nissaranam i.e. expelling out the
malas and Visheshena Rechayatee
DEFINITION:
Tatradoshaharanam Adhobhagam Virechana Sanjnyakam | (Ch.K 1/4)
The process of elimination of morbid doshas through adhobhaga is said to be Virechana. Doshaharanamurdhva bhagam vamanakhyam| adhobhagam virechanakhyam |
ubhayam va malavirechanaadvirechana mithyuchyathe || (A Sa Su27/2)
Elimination of dosha from mukha marga ie urdhva bhaga is Vamana, Elimination of
dosha through adho bhaga is known as Virechana. And if the doshas expelled through the
both routes is also reffered as Virechana.
Yatyadho doshamaadaya pacchamanam virechanam
Gunothkarshaadrajathyurdhvampakvam vamanam punaha || (Su Chi 33/34)
Virechana expels the doshas in downword direction after getting digested (or during their
digestion) by the increase of their properties, while Vamana expels the doshas in upword
direction before getting digested.
Vireko mukhapeetam guda margenanta sthetastha /
Doshasya nissaranam pittasya paramaushadham// (A.H.Su.1/25 - Arunadatta)
Virechana is the procedure in which orally administered dravya acts on internally situated
doshas especially on pitta and expels the doshas out through the gudamarga.
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PARYĀYA3:
Praskandana, Rechana.
QUALITIES OF VIRECHAKA DRAVYAS4:
They are having Ushna, Teekshna, Sukshma,Vyavayi & Vikasi guna. But the
Virechaka dravyas mostly act by virtue of their Prabhava.
Virechana dravyas are having predominance of Prithvi and Aap mahabhuta.
CLASSIFICATION OF VIRECHANA5 :
Virechana has no classification however Sharangadhara had classified as per the
gradation of Virechana which are dependant on action, potency of drug, onset, consistency of
excretory product.
1) Anulomana : The drug which does the digestion of malas & breaks its compactness &
later expels out through adhobhaga is known as Anulomana. Eg: Haritaki.
2) Sramsana : The drug which expels half digested & sticky malas without prior
digestion is known as Sramsana. Eg: Kritamala.
3) Bhedana : The drug which breaks abaddha, baddha & pindita malas & eliminates
through anus are called as Bhedana. Eg: Katuki.
4) Rechana : The drug which expels both digested & undigested malas after making
them watery, through Gudamarga is known as Rechana. Eg: Trivritt.
Anulomana & Sramsana are the mild types of Virechana, whereas Bhedana &
Rechana are of moderate type.
KARYAKSHETRA OF VIRECHANA:
This can be explained on the basis of its effect on dosha, dushya, srotas, agni & ama.
Dosha: Virechana is said to be beneficial for Pitta dosha, since it eliminates vitiated Pitta
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from its root. According to Vagbhata, Virechana is helpful even in Pitta combined with
Kapha or Kapha in Pitta sthana 6.
Dushya: Virechana is mentioned as Shodhana procedure in dusti of Rasa, Rakta, Mamsa,
Asthi, Majja & Shukra dhatus. Hence in majority of the dhatupradoshaja vikaras
Virechana is the better option 7.
Srotas: Since on the above mentioned dushyas Virechana is helpful, we can say that it is
beneficial in Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha & Shukravaha
srotodushti also.
Agni: In the Samyak virikta lakshana, deeptagni is mentioned. Hence Virechana
improves the mandagni state also8.
Ama: Since langhana is done for amapachana, Virechana is mentioned under Shodhana
langhana, hence it is even beneficial in ama state. And also Virechana karma is indicated
as a chikitsa for Amaja vikara 9.
CLASSIFICATION OF VIRECHANA DRAVYA :
According to the Utpatti10:
1.Sthavara: Trivritt, Triphala, Danthi, Vacha,
2. Jangama : i) Mutra- Mahisha, Aja, Ushtra
ii) Dugda- Mastu, Dadhi, Takra, Ghrita, Paya, Snuhiksheera
According to the Upayukata anga:
Table No: 10 Showing the virechana dravya acc to Upayukata anga.
Dravyās Ch.S11 Su.S12 A.S13
Mulini
Hasthidanti(nāgadanti) Shyāmā(mula)(kāla) Trivritt(shweta) Sapthala(Charmakāsha)
Trivritt Shyāmā Danti Dravanti
Danti Trivritt Gavākshi Shankhini
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Pratyagshreni(danti) Gavākshi(indrayan) Vishānikā(avarthini) Ajagandha(fokandi) Dravanti(danti type) Adhoguda(vidari)
Saptala Shankhini Vishānikā Gavākshi Chitraka Kusha Kāsha Kinahi Tilwaka
Dravanti Shyāmā Saptalā Ajagandha Ajashringi Vachā Swarnaksheeri Chitraka Kinihi Punarnava PālanKāsha Vāsthuka Shāla
Phalini
Shankhini(shwetabunna) Vidanga(vayuvidanga) Anupa(muleti) Sthalaja(muleti grown on earth) Prakeerya (karanjadwayam) Udakeerya(diyakaranj) Abhayā(haritaki) Antahkotarpushpi (neelabughna) Kampillaka(kabila) Āragwadha(āmlatās)
Kampillaka Puga Eranda Harithaki Vibhitaki Āmalaki Neelini Aragwada
Neelini Haritaki Amalaki Vibhitaki Pilu Kampillaka Priyalu Kuvala Badara Karkandu Kashmarya Parushaka Drākshā Klitanaka Udakirya Vidanga Puga Panchangula
Ksheerini
Snuhi ksheera Arka Ashmantaka
Mahāvruksha Sapthachala Swarnaksheeri
Snuhi Swarnaksheeri Godugda Mahāvruksha Saptachada Jotishmati
Twak
Thilwaka Thilwaka Patala Ramyaka
Thilwaka Ramyaka Kampillaka
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Patali Patra Swarnapatri
Āragwadha Putika Āragwadha Kāravellaka
Āragwadha Putika
Lavana Saindhava Sauvarchala
According to the karmukata14:
a) Mrudu - The dravyās which are manda in veerya, given in low dosage, given into the
ruksha vyakti, and causes less virechana Vega is known as mrudu Virechana.
E.g Āragwadha, Guda, Ikshu rasa, Dadhi.etc
Indication: Durbala, shodhita, alpa doshayukta, aparijnyatha kostha
b) Madhyama - The dravyās which are moderate in qualities are known as madhyama
virechana.
eg. Trivritta moola, Kutaki, Aragwadha,etc
Indication: madhyama roga laxanas, madhyama kostha
c) Teekshna - The Dravyās which produces mahāvegas & eliminates the doshās in large
quantities by kshipra guna without causing much glāni or dehydration are known as
teekshna virechana. eg. Snuhi ksheera
Indication: Usage of these dravyās in the balavan rogi who is having all the laxanas of
the vyādhi.
According to gunas of dravyās15:
a) Snigdha virechana- The dravyās used in the form of oil or the preparation containing
sneha are known as sneha Virechana.
eg. ;Eranda taila.
Indication: Visha, Abhighata, Pidaka, Kustha, Shopha, Visarpa, Kāmalā, Pāndu,Prameha
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b) Ruksha virechana- The yoga which do not contain sneha is known as ruksha
virechana, its use has been recommended in the snigdha patients who have been
comparatively taken more sneha
eg. Snuhikshira, Danti
Indication: Strong patients, presenting all signs and symptoms of the disease.
According to Rutu16:
Sharangadhara & Bhava mishra has mentioned some of the drugs & their preparations.
Table No.11 Showing the classification of Virechana dravyās acc. to Rutu
VIRECHANOPAGA DRAVYĀS:
The dravyās which helps for samyak virechana or which will synergies the action
of virechana dravyās is known as virechanopaga dravya.
Draksha, kashmarya, parushaka, abhaya, malaki, bibithaki, kuvala, badara, karkandu, pilu
are the ten virechanopaga dravyās17.
Rutu Drugs Anupana Varsha Trivritt, Kutaja beeja, Pippali,
Shunti
Draksha Swarasa,
Kshoudra
Sharad Trivritt, Duralabha, Musta,
Sharkara, udichya, Chandana
Draksha kwatha
With Yastimadhu
Hemanta Trivritt, Chitraka, Patha, Jivaka,
Sarala, Vacha, Hemakshiri
Ushnambu
Shishir/Vasanta Trivritt, Pippali, Shunti,Saindhava,
Shyama (Sariva)
Madhu
Greeshma Trivritt
Sharkara
Sarvaritu
Trivritt, Hapusha, Danti, Saptala,
Katuki, Swarnaksheeri
Bhavana with
Gomutra
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VIRECHANA DRAVYA GUNAS:
Table No: 12 Showing the Guna of virechana dravyās.
Guna Ch.S18 A.S19
Saratva Ushnatva Teekshnatva Sukshmatva Vyavāyi Vikāsi
VIRECHANA YOGYA AND AYOGYA :
As a first step in Virechana vidhi, one has to observe whether the patient is
fit for Virechana karma or not. For this Virechana yogyas and Virechana ayogya criteria
is given in the classics.
Table No: 13 Showing the Indications of Virechana (Yogya).
Indication Ch.S20 Su.S21 A.H 22
Arsha + + + Arbuda + + - Ālasaka + + - Asyādāha + + - Aruchi + + - Apachi + + + Apasmāra + - - Avipāka + + - Akshipāka + - - Abhishyandi - + + Anāha - + - Bhagandara + + + Chardi + + + Dustha Vruna - + + Gulma + + + Gala ganda + - - Granthi + + + Gara - + +
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Guda dāha - + - Hrullasa + - + Halimaka + - + Hrudroga + + - Jwara + + + Kustha + + + Krimikostha + + + Kāsa + - + Kāmalā + - + Murcha - + + Mutraghata + + + Medhra dāha - + - Nasadāha - + - Nāsa srāva + - - Netra srāva + - - Nilika + - - Netradāha + + - Pakwāshayaruja - + + Pārshva shoola + - - Plihadosha + + + Prameha + + + Pandu + + + Stanya dosha - - + Sleepada - - + Shwayathu - - + Shwāsa + - + Timira + + + Udara + + + Urdhwaga Rakta Pitta + + + Visuchika + + - Visarpa + + + Vyanga + - + Vātarakta + + + Visphota + + + Vibandha - + + Vidradi - + + Yonidosha + + + Rakta dosha + + + Shiraha Shoola + + +
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CONTRA INDICATIONS (AYOGYA) : Table No: 14 Showing the Contra-Indications of Virechana.
Contra-Indication Ch.S 20 Su.S 21 A.H 22
Adhogaraktapitta + + + Alpāgni + + + Ajeerna + + + Ādhmāna + - + Atisnigdha + + + Atiruksha + + + Atisthoola + + + Atisāra - - + Bala-Vruddha + + + Chintāprasakta + - - Durbala + + + Durbalendriya + - - Garbhini + + + Hrudrogi - - + Kshudhita + - + Langhita + - - Madātyaya + + + Maithuna praskta + - - Nityadukhita - - + Nava pratishyaya - + - Navaprasoota - + - Navajwara + - + Pipāsita + + - Rājayakshma - - + Shalyadrita + - + Upavasita + + - Vyayamaprasakta + - -
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PROCEDURE OF VIRECHANA :
Procedure of Virechana can be classified under three headings
1. Purvakarma
2. Pradhanakarma
3. Paschatkarma
1. PURVA KARMA:
A.Sambhara Sangraha.
B.Atura pareeksha
C.Oushadhi mātra vinischaya
D.Atura siddhata
A. Sambhara sangraha: Charaka says regarding collection of some of the drugs to
manage the complications, which may occur during main procedure & also certain
necessary equipments which helps to handle the emergency 23. Drugs necessary for
deepana, pachana such as trikatu, panchakola etc has to be collected & sufficient
quantities of sneha dravyas required for abhyantara snehapana has to be collected.
Certain virechaka drugs like Trivritt, eranda taila, aragwadha, Icchabhedi rasa,
jalodarari rasa, abhayadi modaka has to be stored. CertainVirechanopaga drugs like
draksha, triphala, parushaka etc are also should be collected.
To combat certain complications like atiyoga medicines like kutaja ghan vati,
karpura rasa, jatiphaladi churna, sanjeevani vati, bilwadi churna, piccha basti are to be
collected. And dietary articles required for samsarjana krama are also to be collected.
B. Atura pariksha: Vaidya should decide whether the patient is fit for Virechana therapy
or not, if fit then different matra of virechaka oushadhi should be decided. One should
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even assess samyak snigdha lakshanas in a patient before administering the virechana
karma. Such examination includes dosha, bheshaja, desha, kala, bala, shareera, ahara,
satmya, satva, prakriti and vaya 24.
It is highly essential to consider the snigdha or ruksha state of the person, i.e. if in
cases like ruksha, bahu anila, krura kostha, habituated with vyayama & deeptagni
conditions the administered medicine will be digested without causing virechana, hence
in those individuals initially basti should be given followed by snigdha virechana 25.
C. Matra vinischaya : In general while explaining the matra of Vamanaoushadhi
Charaka says that, the medicine which results in removal of vaikarika doshas, without
causing ati, ayoga or any other complications is said to be the proper matra for
shodhana26.
It is highly necessary to assess the kostha of a patient to decide the nature & matra
of the Virechaka dravya. For that purpose certain drugs like guda, draksha, ksheera etc, in
excess quantity are given, if it causes Virechana, then kostha is mridu & bahu pittavastha
is confirmed. If normal stool is passed, then it is madhyama kostha, even with tikshna
Virechaka medicines if Virechana occurs occasionally, then Krura kostha is confirmed 27.
TableNo.15 Showing the dosage of Virechana28
Kalpana Heena Matra Madhyama Matra Uttama Matra
Kwatha 2 tolas 4 tolas 8 tolas Kalka, Choorna
Modaka 1 tolas 2 tolas 4 tolas
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4) Āthura siddhatā29:
In the āthura siddhatā the patient is made prepare with the followings:
a) Deepana Pāchana
b) Snehana
c) Swedana
d) Bhojanādi vichāra
a) Deepana Pāchana 30:
Before going to the pradhāna karma as well as snehana and swedana, the Deepana
dravyās are to be given to increase the agni and Pāchana dravyās for āmā pāchana. This is
done still the appearance of nirām laxanas. Eg. Shunti churna, Chitrakadi vati.
The medicine will act in the body like a nector when there is niramavastha. Hence
with deepana & pachana such state can be achieved.
bb)) Snehana:
Snehapana should be followed in arohana vidhi till the appearance of samyak
snigdha laxanas 31. The duration of snehapāna should be 3, 5, or maximum 7 days, for
mrudu, madhyama and krura kostha respectively 32.
It is an essential part in Panchakarma treatment, which helps in dislodging the
harmful substances from the body tissues.
c) Swedana:
Swedana is done after Snehana which liquefies the leena doshās in the body 33. By
swedana the klinna doshās liquefy and come to kostha which easily goes out of shareera
by shodhana. Here Sarwanga Bhashpa swedana should be adopted.
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d) Bhojanadi vichara:
Before Virechana such a diet is preffered, which does not increase kapha,
otherwise vamana may occur. Jangala mamsarasa, yusha & diet with snigdha, laghu,
ushna quality & kapha avriddhikara aharas are necessary, since manda kapha state is
required during Virechana 34.
PRADHANA KARMA:
It starts from intake of medicines upto completion of Vegas. i.e
A.Virechana yoga sevana.
B.Atura paricharya and Nirikshana.
C.Vega nirnaya.
D.Observation of samyak yoga, ayoga and atiyoga lakshanas.
E.Virechana vyapat and Pratikara.
A) Virechana yoga sevana 35:
Before the administration of virechana yoga the physician must examine
the patient’s physical and mental health once again. Patient must have digested, the food
taken on previous day and must have got sound sleep on the previous night.
Shleshma kaale Gate Jnyatwa Koshta Samyak Virechayet (A H Su 18/33)|
According to Vagbhata, the patient has to take virechana karma just after
shlesmakala. It can be understood as the time is so adjusted that the virechana should be
started during pittakala. The dose of the virechana dravya should be decided depending
upon the koshta and agnibala of the patient36. Ushna or sheeta jala can be used as
anupana in accordance with Virechana yoga.
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B) Atura paricharya and Nirikshana37 :
Due to oushadha gandha, utkleshakaraka state, chardi may occur. Hence to avoid
it, soon after the intake of medicine, cold water should be sprinkled over face, gargle with
hot water, asked to smell fragrance of flowers.
The vaidya must observe the lakshans of Jeernoushadha, Ajeernaoushadha, Hrit
dosha and vyapat.
i) Aushadha Jeerna-Ajeerna Lakshana38
Table No. 16 Showing Aushadha jeerna-ajeerna lakshanas.
Sl No Aushadha jeerna lakshana Aushadha ajeerna lakshana 01. Vatanulomana Dourbalya 02. Swasthya Daha 03. Kshut Angasada 04. Pipasa Bhrama 05. Mana prasannata Moorchha 06. Indriya prasannata 07. Shuddha udgar
If ayoga occurs due to ajeerna of oushadhas, in that state second time medicine
should not be administered, since it may cause atiyoga. Jeerna oushadhi state if hrit dosha
laxanas are not obtained, then diet is given on the same day & on next day
Virechanoushadhi should be given. Even then if Virechana doesn’t occur, then after a gap
of 10 days again snehana & swedana is done later Virechana is administered 39.
ii) Hrit dosha lakshana 40
Apart form the above lakshanas the hrit dosha lakshanas should also be taken into
consideration. In proper Virechana there will be expulsion of mala, pitta , kapha and Vata
in sequence, “Kaphantam Virechana” and appearance of daurbalyata and laghuta
indicates that doshas have properly eliminated.
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If virechana persists even after manifestation of Hrit dosha lakshanas then
Vamana should be performed 41. If the Virechana Vega does not occur then
instantaneously the ushna jala pana, and swedana must be performed on pani, pada and
udara 42 .
C) Vega Vinirnaya:
For the purpose of observation of pravara, madhyama and avara shuddhi,
Chakrapni has given four types of criteria i.e. Laingiki, Antiki, Vegiki and Maniki, but
importance should be given to Laingiki shuddhi43. For vega vinirnaya the physician have
to leave the first two-three malayukta vegas, then counting should be done till
kaphantam44.
TableNo.17 showing the Virechana vega vinirnaya.45,46
Sl. Vega vishaya Pravara Madhyama Avara 01. Vegiki 30 Vegas 20 Vegas 10 Vegas 02. Maniki 4 Prastha 3 Prastha 2 Prastha 03. Antaki Kaphantam 04. Laingiki Samyak Virechana Lakshanas
D) Observation Of Samyak Yoga, Ayoga And Atiyoga Lakshanas :
Table No. 18 Showing the Samyak Lakshana of Virechana karma.
Sl. Virechana Samyak Lakshana Ch.S47 Su.S48 A.H49 01. Srotovishuddhi + - - 02. Indriya prasada + + - 03. Laghuta + + - 04. Agnideepti + - - 05. Anamayatwa + - - 06. Kramat Vit, Pitta, Kapha and Vata Nissarana + + - 07. Vatanulomana - + - 08. Absence of Ayoga, Atiyoga lakshanas - - +
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Table No. 19. Showing the Ayoga lakshanas of Virechana
Sl. Lakshana Ch.S47 Su.S48 A.H49 01 Kapha prakopa + + + 02 Pitta prakopa + + + 03 Vata prakopa + - - 04 Agnimandya + + - 05 Gourava + + - 06 Pratishyaya + - + 07 Tandra + - - 08 Chardi + - - 09 Aruchi + + + 10 Vata pratilomata + - - 11 Daha - + + 12 Hridaya ashuddhi - + + 13 Kukshi ashuddhi - + + 14 Kandu - + + 15 Vitsangha - + + 16 Mutrasangha - + - 17 Pidaka - - +
Table No. 20. Showing the Atiyoga lakshanas of Virechana.
Sl. Lakshana Ch.S47 Su.S50 A.H49 01 Kaphakshayaja vikara + + + 02 Pittakshayaja vikara + - - 03 Vatakshayaja vikara + - - 04 Supti + - - 05 Angamarda + - - 06 Klama + - - 07 Vepathu + - - 08 Nidra + - - 09 Hikka + - - 10 Murcha - - - 11 Gudabramsha - - - 12 Shula - + - 13 Kapha,Pittarahita,shweta,lohita,udaka nissaranam - - + 14 Mamsadhavanavat udakasrava - - + 15 Medakhandavat - - + 16 Trishna - - + 17 Dourbalya + - - 18 Tamapravesha + - - 19 Bhrama - - + 20 Netra praveshanam - - +
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E) Virechana Vyapats:
Table No 21 Showing Virechana Vyapat lakshana:
PASCHAT KARMA 54 :
Regimens to be adopted after Virechana Karma till the patient is able to take
normal diet is known as paschat karma. Soon after the samyak Virechana karma the agni
will be in imbalance state. Hence, the patient is not allowed to take normal diet, which
can cause further vitiation of agni. Hence, the peyadi samsarjana krama should be
followed in order to bring back the equilibrium in the state of agni.
SL NO Virechana Vyapat Ch.S51 Su.S52 A.H 53 1 Adhmana + + + 2 Parikartika + + + 3 Parisrava + + + 4 Hrudgraha + - + 5 Angagraha + + + 6 Jeevadana + + - 7 Vibramsha + - - 8 Stamhba + - - 9 Upadrava + - - 10 Klama + - - 11 Pravahika - + + 12 Pratikulagati - - + 13 GudaPaka - - + 14 Grathita Purish - - + 15 Gourava - - + 16 Utklesha - - + 17 Dathusrava - - + 18 VirechanasyaUrdhvagamana - + - 19 Savashesha aushadathva - + - 20 Jeernoushadathva - + - 21 Heenadoshaphartrutwa - + - 22 Vatashoola - + - 23 Ayoga - + - 24 Atiyoga - + - 25 Hrudayopasarana - + -
26 Vibandha - + -
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 27
Three to seven days samsarjana krama is followed by administrating peya, vilepi,
akrita- krita yusha and akrita- krita mamsarasa depending upon the shuddhi achieved. But
in following conditions Tarpana should be administered instead of samsarjana viz.
01. Pitta kapha parisrava. 02. Madatyaya. 03. Vatapitta prakriti 55.
In Tarpna, Swaccha Tarpana, in place of Peya and Ghana Tarpana in place of
Vilepi should be used according to Chakrapani 56.
Peyadi samsarjana krama:
Table. No. 22 Showing Peyadi Samsarjana Krama
Day Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi 1st Morning Evening
Peya
Peya
Peya
2nd Morning Evening
Peya Peya
Peya Vilepi
Vilepi Yusha
3rd Morning Evening
Vilepi Vilepi
Vilepi Akruta yusha
Mamsarasa Normal diet
4th Morning Evening
Vilepi Akruta yusha
Kruta yusha Akruta mamsarasa
5th Morning Evening
Kruta yusha Kruta yusha
Kruta mamsarasa Normal diet
6th Morning Evening
Akruta mamsarasa Kruta mamsarasa
7th Morning Evening
Kruta mamsarasa Normal diet
Parihārya vishayas57 :
After Virechana karma. Uccha bhashana, Ratha kshobha, Atichankramana, Atyasana,
Ajeerne bhojana, Ahita bhojana, Diwaswapna, Maithuna, Mithyaahara, Adhyashana,
Vishamashana, Akāla bhojana, krodha, shoka, atapa, vegasandharana etc should be
avoided.
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 28
VIRECHANA AUSHADHA KARMUKATA58:
The vamana and virechana dravyas posses similar properties like ushna, teekshna,
sukshma, vyavayi and vikashi gunas. Drugs will reach the hridaya by its veerya thereby it
enters into dhamanis, sthula and anu srotas of the body.
Action of ushna guna: Ushna guna has agneya property & hence Vishyandana occurs.
Hence it facilitates movement of morbid doshas towards kostha.
Tikshna guna: Due to this they breaks up the doshas, from larger to smaller molecules.
Sukshma guna : Due to sukshma guna it will open micro channels & makes the doshas
to move towards kostha.
Vyavayi guna: Due to this, drugs spreads quickly throughout the body & starts their
action before its digestion.
Vikasi guna : Vikasi drugs loosens the dhatu bandhana. It creates the dhatu shaithilyata.
Hence drugs initiates their action without being digested.
From all these properties doshas are driven to kostha. The presence of prithvi &
Aap bhuta in virechana drug & the adhobhaga prabhava, the doshas are eliminated out
through guda.
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 29
Flow chart No.1 Showing Virechana aushadha karmukata
VIRECHANA AUSHADHA KARMUKATA
Virechana drugs having the Gunas like Ushna, Tikshna, Sukshma, Vyavayi, Vikasi
and with their 'Swavirya'
Move to 'Hrudaya'
From there, through various 'Dhamanis'
Leads to micro and macro channels in the body
Acts over the vitiated Doshas in the body
(i)With ushna guna - liquifies the Doshas
(ii) With 'Tikshna guna ' - Break down into several particles
Liquified matter then glides through various unctous or
smooth channels towards Koshta
Enters 'Pakwashaya' and is then stimulated by 'Apana vayu"
Having the dominance of 'Prithvi' and 'Jala' Mahabhutas in the constitution along with
self desposition (Prabhava)
Move in downward direction towards Rectum
Expelled to outside through Anus
VIRECHANA
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REVIEW ON KUSTHA
NIRUKTI 59:
Kushnaati Rogam! Kush+hani kusheeti iti kathan (shabdakalpadruma) ‘KUSH’ word
added to ‘HANI’ to form kustha, which means it gives ugly look to the body.
• Kushnati shareerasya shonitam vikrute iti! Nishkarshaarthakasya kushadhato
atra vikaaraarthatwam bodhyate dhatunaam nekarthatwat!
The kush word derived from dhatu ‘kush’ meaning, the morbid factors mainly
rakta is drawn towards the region of twak so as to cause Kustha.
PARIBHASHA (DEFINITION) OF KUSTHA60:
Shareeram kushnaati tasmat tat kustha mityuchyate! (Arundatta over A. H. NI 14/4)
Arunadatta defined Kustha as that which causes disfigurement of body.
HISTORICAL REVIEW :
In Veda and Purana description regarding Kustha is available but not about Vicharchika.
Table No.23 : Showing historical Review in VEDA KALA
Veda Context
Rigveda Ashwinis treated a lady named by ‘Ghosha’ who was suffering
with kustha and was relieved from the disease.
Some characteristic features like vivarnata and lomaharsha are
described.
Yajurveda When there was kandu etc laxanas on the twacha, the people
were inferring about the kustha in future.
Atharvaveda Atharvaveda defines the word “kustha” as ‘kulshita Rupavarna’ Trivritt has advocated as a special drug for Management of
kustha. Some new terms for skin disorders are described as pama,
vidradhi, etc
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 31
Purana Context
Garuda purana
Causative factors of Kustha are mentioned under the chapter of
karma vipaka along with its management.
Agni purana Kustha and its treatments are mentioned.
Internal uses of khadira and external uses of Haratala and
manashila have been mentioned.
SAMHITA KALA : Table No.24 : Showing Historical Review in CHARAKA SAMHITA : Sthana Contents
Sutra sthana
(24th chapter)
Kustha has been considered among raktaja vikara
Nidana sthana
(5th chapter)
Only seven types of Kustha has been described based on
doshik predominance.
Chikitsa sthana
(7th chapter)
Mahakustha and kshudra kustha are delt in detail, where
the lakshanas and treatment have been discussed.
Table No 25: Showing Historical Review in SUSHRUTA SAMHITA :
Sthana Contents
Nidana sthana
(5th chapter)
Kustha has been described as anuvanshika (hereditary) and
krimija (infectious) vyadhi.
Explanation regarding dhatugatatva of Kustha (uttar dhatu
pravesha of Kustha)
Chikitsa
sthana
(9th chapter)
He has mentioned separate chapters under the heading of
Kustha and Mahakustha and explained the criteria for
differentiation between them.
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 32
Table No 26: Showing Historical Review in ASTANGA SAMGRAHA
And ASTANGA HRUDAYA:
Samhita Contents
Astanga
sangraha
(14th chapter)
In Nidana sthana Kustha has been mentioned as 18 types
depending on the involvement of dosha and Vicharchika has
been defined as kaphapradhana Kustha.
Astanga
hrudaya
(25th chapter)
In Sutra sthana Kustha is mentioned as one of the dushita
Raktajanya vikara
Table No.27: Showing Historical Review in BHELA SAMHITA AND HARITA
SAMHITA :
Samhita Contents
Bhela samhita
Chikitsa sthana
(6th chapter)
Vicharchika is included under the sadhya kustha.
He described it as moist lesion with dark red colouration
which is deep rooted
Harita Samhita
Triteeya sthana
(39th ch)
He described that in Vicharchika kandu is produced due to
dushita rakta
Table No.28: Showing Historical Review in MADHAVA NIDANA :
Uttarardha Contents 49th chapter He mentioned Vicharchika as vata- pitta dominant disease.
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Table No.29: Showing Historical Review in BHAISHAJYA RATNAVALI,
YOGARATNAKAR AND SHARANGADHAR SAMHITA :
References Contents
Bhaishajyaratnavali (54th chapter)
Chikitsa and pathyapathya has been mentioned and
also mentioned combinations which are used both
externally and internally.
yogaratnakar
(uttarardha)
Kachhu, rakasa and shwitra have been added to the
11 varieties of kshudra kustha of Charaka Samhita.
Sharangadhara samhita (madhyamakhand)
He has mentioned external application of Arka taila
for Vicharchika.
CLASSIFICATION OF KUSTHA:
Acharyas explained the common NIDANA or causative factors for the production
of Kustha disease. It is produced invariably by the vitiation of seven factors ie three
dosha, twak, rakta, mamsa and ambu61.
Kustha is divided in to two categories, they are – Mahakustha and kshudra kustha.
These are catagorised on the basis of involvement of dosha and lakshanas. In Kshudra
kustha involvement of dosha is in uttana dhatu, where as in mahakustha involvement of
dosha is in gambheera dhatu62. And also Kshudra kustha has alpa lakshanas in
comparision to Mahakustha.
Mahakustha:
In the classification of mahakustha there is a variation among different classical
authors.
Sharangadhara has described eighteen types of Kustha rogas in prathama khanda
7th chapter. He has not classified in to mahakustha and Kshudra Kustha63.
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Table No. 30: Classification of Mahakustha according to different Acharyas
Nameof disease Ch.S64. Su.S65. A.H66 B.S67. M.N68. B.P69. Kapal + + + + + + Audambara + + + + + + Mandala + - + + + + Rushyajivha + + + + + + Pundarika + + + + + + Sidma + - - + + + Kaakanaka + + + + + + Dadru - + + - - - Aruna - + - - - -
Kshudrakustha:
Difference of opinion also exists in the classification of kshudrakustha regarding
names, characters and classifications among acharyas Charka, Sushruta, Vagbhat,
Madhavkar, Bhavmishra and Bhela.
Table No. 31: Classification of Kshudrakustha according to different Acharyas
Name of disease Ch.S64 Su.S.65 A.H66 B.S67. M.N68. B.P69. Ekakustha + + + + + + Charmakustha + - + + + - Kitibha + + + + + - Dadru + - + + + - Alasaka + - + - + - Vipadika + - + + + - Charmadala + + + - + - Visphotaka + - + - + - Paama + + + - + - Shataru + - + + + - Vicharchika + + + + + - Sthularushaka - + - + + - Mahakustha - + - Sthularu - - Visarpa - + - - - - Parisarpaa - + - - - - Sidhma - + - - - - Rakasa - + - - - - Kacchu - - - - - - Shwitra - - - + - - Vishaja - - - + - -
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Even though all the authors have accepted that there are only eleven types of
Kshudra kusthas and seven types of Mahakusthas but the total number is higher. This
numerical difference is only because of different nomenclature adopted by different
acharyas.
Table No. 32: Classification of kustha on the basis of doshic predominance :
Dosha Ch.S64 Su.S.65 A.H66
Vata Kapala Aruna Kapala
Pitta Audumbara Rushyajivha,
Audumbara,
Charmadala, Visarpa,
Kapala, Vicharchika,
Kitibha, Kakanaka,
Paama.
Audumbara
Kapha Mandala,
Vicharchika
Pundarika, Dadru,
Arushaka, Ekakustha,
Mahakustha, Sidhma,
Rakkasa
---
Vata-Kapha Sidhma, Ekkustha,
Alasaka,
Charmakhya,
Kitibha, Vipadika.
---
Sidhma,Ekkustha,Alasaka,
Charmakhya, Kitibha,
Vipadika.
Vata-Pitta Rushyajivha --- Rushyajivha
Kapha-Pitta Pundarika, Dadru,
Charmadala,
Paama,
Visphotaka,
Shataru.
---
Pundarika,
Dadru,Charmadala,
Paama,Visphotaka,
Shataru.
Vata-Pitta-
Kapha
Kakanaka --- Kakanaka
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VICHARCHIKA
ETYMOLOGY 70:
Vicharchika word is derived from “Charcha” dhatu, Vee–prefix and Navul –
suffix. It means a type of Svalpa (minor type) Kustha.
NIRUKTI 71 :
Shabdakalpadruma described two cardinal features for introduction of Vicharchik,
i.e. cracking of the skin mainly occurs on the skin of hands and legs.
DEFINITION:
Marked lining, excessive itching and pain with dry lesion on the body called
Vicharchika 72.
The skin lesion with kandu, pidaka, shyavavarnata and bahusrava is called
as Vicharchika73. Vagbhata mentioned lasikadhya instead of bahusrava 74.
NIDANA PANCHAKA:
NIDANA:
As Vicharchika is one type of Kustha, so the samanya nidanas described for Kustha
can be taken as nidana of Vicharchika.
Nidanas mentioned in classics may be classified as
1. Aharaja Hetu
2. Viharaja Hetu
3. Bijadoshaja
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Table No. 33: Nidana according to different Acharyas: Ahara hetu:
Sl.No. Viruddha ahaar Ch.S.75 Su.S.76 A.H.77 B.S.78 M.N79
1. Chilchimam cha payasa + - - - -
2. Atimatra of ahara containing
hayanaka, yavaka, chanaka,
uddalaka & Koradusha along with
ksheer, dadhi, takra, kola, matsya,
atasi, kusumbha & sneha.
+
-
-
-
-
3. Madhu, Phanit, Matsya, Lakucha,
Kakamachi-satata atimatra sevan
+ - - - -
4. Excessive intake of drava guru
and snigdhaanna.
+ - - - -
5. Navanna, dadhi, matsya, tila,
lavana, amla-atyadhika sevan.
- - - - +
6. Continuous use of gramya, anupa,
aoudak, mamsa with milk.
- + - - -
7. Taking excessive use of madya,
shaka after milk.
- - - + -
8. Taking hot diet after taking
madya, madhu
- - - + -
Sl.No. Mithya Aahar Ch.S. Su.S. A.H. B.S. M.N
10. Excessive use of tila, ksheera & guda + - - + -
11. Adhyashana – over eating even though
having ajirna.
+ + - + +
12. Sneha atisevana + - - - -
13. Asatmya aahar - + - - -
14. Excessive use of madhu & phanita + - - - -
15. Taking vidahi aahar in vidagda condition + - - - -
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Sl.No. Vihara hetu Ch.S Su.S A.H B.S M.N 16. Sudden change from cold to hot & hot to
cold climate
+ + - - -
17. Santarpana-apatarpanaabhyavaharya
vyatyasa
+ - - - -
18. Entering in cold water after one affected
with bhaya, santapa, shrama.
+ - - - -
19. Not undergoing vamana in vidagdha
condition
+ - - - -
20. Doing vyayama and vyavaya after sneha
pana and vamana.
- + - - -
21. Divaswapna - - - - +
Sl.No. Vegadharana Ch.S Su.S A.H B.S M.N
22. Suppressing natural urges of mutra,
purisha
+ + - + -
2. Suppressing chardi vega + + - + -
Sl.No. Panchakarmapacharaja Ch.S. Su.S. A.H. B.S. M.N
23. Panchakarma kriya mane nishiddha
sevana
+ - - - -
24. Improper administration of snehapana + - - - -
Sl.No. Anya hetu Ch.S. Su.S. A.H. B.S. M.N
25. Papa karma + + + + +
26. Guru tiraskara + - - - -
27. Purvakrita karma + + - -
28. Sadhu ninda, apamana and vadha - + + - -
29. Struggle with guru and vipra + + + - -
Sl.No. Bijadoshaja Ch.S. Su.S. A.H. B.S. M.N
1. Dusta shukra-shonita - + - - -
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B) PURVARUPA:
Purvarupa is prodromal stage of the disease. Acharya Sushruta has explained this
is the forth kriyakal in which sthanasamshraya of the vitiated doshas takes place.
There is no specific mentioned of purvarupa of Vicharchika but purvarupa of
kustha as a whole are given in many samhitas which are applicable to Vicharchika.
Table No. 34: Purvarupa according to different Acharyas
Sl.No Purvarupa Ch.S80 Su.S81 A.H82 B.S83 M.N84 B.P85
1. Atiswedanam + + + + + +
2. Lomaharsha + + + + + +
3. Aswedanam + + + + + -
4. Vaivarnya + - + + + +
5. Suptata + + + + + +
6. Atishlakshnatwam + - + - + +
7. Kandu + + + - + +
8. Kharatwam + - + - + +
9. Paridaaha + - + + + +
10. Kothonnati + - + - + +
11. Nistoda + - + - + +
12. Nimitte alpe api kopanam
- - + - + +
13. Gouravam + - - + - -
14. Ushmayana + - - + - -
15. Shrama + - + - - -
16. Klama + - - + - -
17. Parushyam + + - - - -
18. Swalpanam api
vrananam arohanam
+ - - - - -
19. Shwayathu + - - - - -
20. Visarpanam abhikshnatam
+ - - - - -
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C) RUPA :
In the ayurvedic classics almost similar lakshanas of Vicharchika have been
described but some lakshanas are different like acharyas Charaka and Vagbhata given
srava as lakshana but acharya Sushruta explained as Rukshata as lakshana.
So it suggests that vicharchika is of two types dry & wet.
Table No. 35: Rupa according to different acharyas
Sl.No. Rupa Ch.S86 Su.S87 A.H88 B.S89 K.S90 M.N91 B.P92
1. Srava + - + + + + +
2. Kandu + + + - - + +
3. Shyavata + - + + - + +
4. Pidika + - + - - + +
5. Ruja - + - - + - -
6. Raktata - - - + + - -
7. Pariklinnata - - - + - - -
8. Paka - - - - + - -
9. Vrana - - - - + - -
10. Rajyo - + - - - - -
11. Rukshata - + - - - - -
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TWACHA RACHANA SHAREERA
Before going to Samprapti of disease, first we have to understand the
fundamentals of twacha by reviewing its Rachana and Kriya shareera. Because twacha is
considered as one of the sapta dravyas responsible for the manifestation of kustha. Along
with Twacha rachana shareera the description of Rakta is also necessary, as Vicharchika
is considered as Raktapradoshaja vikara.
According to Charaka and Vagbhata twak is divided into six layers, whereas
Sushrutacharya’s description of twacha includes seven layers. It is considered as one of
the Jnanendriya. Vayu and Akash are the indriya dravyas present in twacha and sparsh is
indriyartha. Among all the doshas twak is seat of Bhrajak pitta.
ETYMOLOGY:
1) Twachati samvrunoti Sarvashareeramiti 93.
2) Twachati samvrunoti va Deham 94.
It means covering of the body.
DEFINITION:
Twacha samvarne tuda shonitadik miti! (Shabdakalpadruma)
One of the indriyaadhisthana which completely covers meda, shonita and all other
dhatus of the body. It is considered as a seat of vata 95.
FORMATION OF TWACHA:
Twak is upadhatu of mamsa so, ultimately twak is formed by mamsa and it is
among the Matrujabhava because it is coming from ovum. Twak has developed after the
fertilization of ovum. At the time of fertilization Shukra, Shonita and Atma become
united for the manifestation of garbha. Its growth is rapid and nourished by tridosha.
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Twak is formed by paka of rakta by its dhatwagni and rakta becomes dry in the form of
skin like the deposition of cream on the surface of boiling milk96. Thus twak is also called
as rakta santanika.
PANCHABHOUTIKATVA97:
As Shareera is made up of panchamahabhoot hence twacha is also consists of
panchamahabhoot.
LAYERS OF TWACHA:
There are some different opinions regarding the number of the layers of the
twacha among the ancient acharyas. Acharya Charaka has mentioned six layer of twacha,
but only first two layers are named rest of the four layers are counted as producing
diseases98.
Table No. 36 Number of Kalas and manifestation of kustha
Sl. No. KALA CONTAINS 1. Udakadhara - 2. Asrukdhara - 3. 3rd Manifestation of sidhma and kilas 4. 4th Manifestation of dadru and kustha 5. 5th Manifestation of Alaji and vidradhi 6. 6th Manifestation of Arunshi
Acharya Sushruta has mentioned seven layers of twacha along with their specific
name, thickness and prone origination of the disease99.
Table No. 37 Kalas, thickness of twacha and reflection of disease
Sl. No. Layers Thickness (in Vreehi)
Reflection of Disease
1. Avabhashini 1/18th Sidhma, Padminikantaka 2. Lohita 1/16th Tilakalaka, Vyanga, Nyachha. 3. Shweta 1/12th Charmadala, Ajagallika, Mashaka
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4. Tamra 1/18th Kilas, Kustha. 5. Vedini 1/5th Kustha, Visarpa. 6. Rohini 01 Granti, Apachi, Arbuda, Sleepada, Galagand 7. Mamsadhara 02 Bhagandara, Vidradhi, Arsha.
Sharangadhara has also mentioned seven layer of the twacha along with probable
onset of disease. The name of first six layers is same as Sushruta, but 7th layer is called
sthula which is the site of vidradhi 100.
Vagbhata has also described seven layers of twacha but names are not mentioned.
Commentator Arunadatta and Hemadri have named them according to nomenclature
given by Sushruta101.
Table No. 38 Different layers of twacha according to different acharyas
Su.S Ch.S A.H. Sh. S B.S
Avabhashini Udakadhara Udakadhara Avabhashini Udakadhara
Lohita Asrukdhara Asrukdhara Lohita Asrukdhara
Shweta 3rd 3rd Shweta 3rd
Tamra 4th 4th Tamra 4th
Vedini 5th 5th Vedini 5th
Rohini 6th 6th Rohini 6th
Mamsadhara - - Sthula -
Thus, fundamentally there is no difference in the number of the layers said by the
various Acharyas.
KRIYA SHAREER OF TWAK:-
Twacha and dosha:
Twacha has been considered as sparshanendriya adhisthana102 which is function
of vata. Bhrajaka pitta is located in the twak for giving luster and colour. The drugs used
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for abhyanga, parisheka, lepa, avagaha, etc are absorbed with the help of Bhrajaka
pitta103. Snigdhata, Shlakshanata, Mruduta, Sheetata are attributed to kapha. 104
Twacha and Dhatu:
Rasa: In the context of twak sara purusha lakshanas it has been also said as rasa sara. 1st
layer of twacha, Udakadhara also contains rasa so it can be easily understood that there is
a relation between twacha and rasa105.
Rakta: Among its functions one is varna prasadan means which gives colour 106
Mamsa: Twak is upadhatu of mamsa107.
Majja: Twakgata sneha is the mala of majja dhatu108
Twacha and mala:
Sweda – It is mala of meda which is excreted by twacha, sweda maintain the luster and
humidity of twacha109.
RAKTA
According to Acharyas Kustha is said to be Raktaja vyadhi. So Rakta is also an
important factor in manifestation of Kustha. Hence its description becomes necessary.
ETYMOLOGICAL DERIVATION:
The term Rakta is derived from the root ‘Range rage’ with the meaning of colour.
It is suffixed by taddhita pratyaya forming the word Rakta110.
DEFINITION: Rakta is that form of rasa influenced by the action of ranjaka teja111.
Rakta is the convertion of rasa formed by the intake of food material ingested by
the individual in accordance with desha satmya, kala satmya and oka satmya112.
FORMATION: Embryologically rakta is matruja bhava. Rasa after attaining proper
transformation in yakrit and pliha attains the state of rakta according to Acharya
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 45
Sushruta113.
PANCHABHAUTIKATA: ‘Jeeva rakta’ is said to be ‘panchabhautika’ in composition.
The qualities of pancha mahabhutas present in rakta are enumerated in Sushruta Samhita
as follows:
Prithvi→ Visrata, Aap → Dravata, Teja→Raga
Vayu→ Spandana, Akasha→Laghuta.
D) SAMPRAPTI:
All acharyas have mentioned Samprapti for Kushtha, but neither Samhitas nor
commentaries mentioned exact Samprapti of Vicharchika. So Samprapti of Kushtha can
be accepted as a Samprapti of Vicharhika.
ACC TO CHARAKA114:
Flow chart No.2 Showing Samprapti of Vicharchika acc. Charaka
Nidana Sevana
Tridosha Prakopa
Reaches to twak, rakta, mamsa, ambu and produces shaithilya
Further vitiation of doshas occurs
These doshas gets enlodged at the place of dhatu shaithilya
Produces Vicharchika
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 46
ACC TO SUSHRUTA115:
Flow chart No.3 Showing Samprapti of Vicharchika acc. Sushruta
Nidana Sevana
Pitta and kapha prakopa
Aggrevation of vata due to Avarana by pitta and kapha
Aggrevated vata carries prakupita pitta and kapha
Enters in to the bahya roga marga and spreads throughout body by tiryak sira
Doshas get lodged in bahya roga marga
Produces Mandala (Kustha)
Vitiation of blood
Vicharchika ACC TO VAGBHATA116:
Flow chart No.4 Showing Samprapti of Vicharchika acc. Vagbhata
Nidana Sevana
Tridosha Prakopa
Spreads to tiryak gati
Vitiates twak, rakta, mamsa and lasika, produces
Shaitilyata and vaivarnya of bahir twacha
The doshas gets enlodged at the place of dhatu shaithilya
Produces Vicharchika
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 47
Flow chart No.5 Showing KUSTHA-RAKTA PRADOSHAJA VYADHI 117:
Nidana Sevana
Vitiation of blood
Kustha
SAMPRAPTI GHATAKA
Dosha : Tri – Dosha
Dushya : Twak, Rakta, Mamsa, Lasika, Tridosha
Agni : Jatharagnimandya, Dhatvagnimandya
Srotas : Rasavaha, Raktavaha, Mamsavaha, swedavaha.
Srotodusti Prakara : Vimargagamana, sanga
Udbhava Sthana : Amashaya
Adhisthana : Shareera
Rogamarga : Bahya
Vyakta sthana : Twacha
Sanchara sthana : Tiryak sira
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 48
DIFFERENTIAL DIAGNOSIS:
There are some particular diseases having almost nearer to same cardinal
symptoms like Vicharchika which are counted under differential diagnosis Viz, Kacchu,
Pama.
Table No. 39: Showing Differential Diagnosis:
Roga Pareeksha Vicharchika Kacchu Pama Variety of Lesion Pidika
Pitika
Sphota Anubhi, Pidikabhi, Sukshma Bahya pidika, Arushmati, Sasphota.
Colour of Lesion Rakta, Shyava and Lohita.
-- Shweta, Aruna, Shyava.
Site Gatra, Gatreshu iti, Panipadeshu.
Pani – Pada – Sphik, Prayena sphik, pani, Kurpara.
Kandu Sakandu, Atikandu. Kandu. Kandvadhikya, Sakandu, Kandu, Kandumati.
Srava Bahusrava Sravavati, Srava. Sasrava, Adhika kleda
Ruja Ruja, Vedana. -- Rujadhikya, Toda, Daha Daha. Daha. Daha. Paka Paka Paka -- Raji Rajyo. -- --
UPADRAVA118:
Upadravas of Vicharchika have not been described separately in the classics.
However upadravas of Kustha are described by acharya Charka which are applicable for
Vicharchika as it is a type of Kustha.
1. Prasravana 2. Angabheda
3. Angapatana 4. Trishna
5. Jwara 6. Atisara
7. Daha 8. Daurbalya
9. Arochaka 10. Avipaka
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 49
SADHYASADHYATA119:
Sukha Sadhya : - Ekadoshaja, Vata-kaphaja, twakashrita, naveena
Kricchra Sadhya : - Kapha pittaja, vata-pittaja, rakta and mamsashrita
Yapya : - Medogata
Asadhya : - Tridoshaja, Purana, asthi, majja and shukrashrita
CHIKITSA:
The term Chikitsa means ‘Ruk Pratikriya’120i.e. to counteract the causative factors
of a disease. Acharya Sushruta says ‘measures calculated to the removal of the causative
factors of disease is Chikitsa.” In general it is an accepted fact that the skin diseases are
time consuming as far as the treatment is concerned i.e. not easily cured, long standing &
require patience in treatment. Generally there are 2 types of treatment i.e. Shodhana
Chikitsa & Shamana Chikitsa121. Besides the classical references the treatment of Kustha
can be broadly classified into three main methods of management viz.
A) Nidana Parivarjana
B) Shodhana
C) Shamana
Nidan parivarjana – It means to avoid etiological factors122. Nidana Parivarjana stops
the further progression of the disease, by restricting vitiation of Doshas.
Shodhana - Means purification. It comprise of 3 measures123 viz. –
1. Antaha parimarjana
2. Bahi Parimarjana
3. Shastra pranidhana
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 50
Shamana -The therapies which subside the morbid Doshas without removing it from the
body is known as Shamana 124.
Sodhana Chikitsa in Kustha :
According to most of Ayurvedic texts, all types of Kustha have been considered
as ‘Rakta Pradoshaja’Vikara 125. Further Vicharchika is stated to be Tridoshaja with the
dominance of Kapha-Pitta Dosha & Bruhatrayi have mentioned the Chikitsa as Shodhana
followed by Lepana for Kustha. Among Shodhanas, Virechana is best for the Pitta &
Rakta Pradoshaja Vikara & some extent of Kapha126,127 , which are the main Doshas of
Vicharchika. When the morbid Doshas are expelled out by the process of Shodhana i.e.
Virechana from its root, then the chances of recurrences are negligible 128. It occurs in the
same way as when tree is uprooted, then the possibility of its re-growing is nil.
Acharya Charaka has specified that in Vata predominant Kustha Ghrita should be
prescribed, similarly, where the Kapha is dominant,Vamana Karma & in the dominancy
of Pitta, Virechana Karma & Raktamokshana should be instituted129.
Sushruta described the line of treatment of Various kusthas in some what similar
to Charaka’s description. He says that Vamana for Kaphadhika Kustha in every fortnight,
Virechana for the elimination of vitiated Pitta should be undertaken every month.
Raktamokshana for the expulsion of Dushita Rakta should be done twice in a year &
Nasya karma should be carried out on every 3rd day 130 .
Sushruta has added one more principle for the treatment of Kustha i.e.
In Twakgata (Rasagata), Kustha Shodhana drugs should be applied as external
application. In Raktagata Kustha, Shodhana karma, Kashayapana, Raktamokshana & in
Mamsagata Kustha Shodhana karma, Alepana(external application) Kashayapana,
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 51
Raktamokshana, Asava-Arista sevana, Mantha kalpana & Avaleha preparations have
been indicated131.
Shamana (Alepana) chikitsa in Kustha:
Shamana therapy is also an important part of the treatment of Kushtha. After completing
the Shodhana Karma, Shamana Chikitsa is indicated to subside the remaining Doshas. Shamana
Chikitsa is very useful in those patients who are unable to undergo or contraindicated for
Samshodhana. Charaka has advised Shamana therapy with Tikta and Kashaya Dravyas after
administration of proper Shodhana 132 . Charaka has also indicated several other drugs &
formulations of Shamana therapy in 7th chapter of Chikitsa Sthana.
Acharya Sushruta also advocated that if samprapti occurs in twak, rakta, mamsa it
should be managed by Shodhana, Alepana, Kashaya pana, Raktamokshana etc..
So for Kustha the drugs having properties like katu, ushna and tikta rasa should be
used for removing the morbidity. So in the present clinical study Shodhana particularly
with Virechana and Shamana in the form of teekshna Alepana with Arka taila has been
selected.
PATHYA – APATHYA:
Nidana sevana results in to various pathological changes in the body that creates a
disease. Nidana parivarjana will stop further pathogenesis in the body. There fore Pathya
and Apathya have a great role with each disease.
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 52
Table No. 40: Pathya according to different acharyas
Sl.No. Pathya dravya Ch.S133 Su.S134 A.H135
1. Laghu anna + - - 2. Tikta shakha + - + 3. Bhallataka + + + 4. Triphala + - + 5. Nimba + + + 6. Purana dhanya + + - 7. Jangala mamsa + + + 8. Mudga + - + 9. Patola + - + 10. Ghrita + - + 11. Shastika shali, yava, godhuma, koradusha,
shyamaka, uddalaka - + +
12. Audaka - + + 13. Pana, Parisheka, avagaha of khadira kashaya + + + 14. Masoora - - + 15. Mandooka parni - + - 16. Avalguja - + - 17. Atarushaka - + -
Table No. 41: Apathya according to different acharyas:
Sl.No. Apathya dravya Ch.S133 Su.S134 A.H136 1. Guru anna + - + 2. Dugdha + + - 3. Amlarasa + + + 4. Dadhi + + + 5. Anupa mamsa + - + 6. Matsya + - - 7. Guda + + + 8. Tila - + - 9. Mamsa, vasa - + + 10. Taila - + - 11. Kulattha - + - 12. Vidahi anna - + + 13. Ikshuvikara - + - 14. Abhishyandi anna - + - 15. Lavana + - + 16. Maithuna - + -
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 53
DRUG REVIEW
The following drugs are used in present study -
1) Shunti churna – for Deepana-Pachana
2) Panchatiktaka ghrita – for Snehapana
3) Murchita Tila taila – for Abhyanga
4) Triphala kashaya with Danti – for Virechana
And Trivritt churna as prakshepaka dravya
5) Arka Taila – for Alepana
Table No. 42: Showing the properties of Shunti churna
Table No. 43: Showing the properties of ingredients of Panchatiktaka Ghrita 138
Dravya Nama
Rasa Guna Veery Vipaka Doshaghnata
Karma
Gogritha139 Madhura
Guru Snigdha
Sheeta Madhura Vata Pitta Ojovardhaka
Nimba140 (Azadiracta indica)
Tikta
Laghu Sheeta Katu Kapha Pitta
Kusthaghna Kandughna Grahi
Patola141 (Trichosantes dioica Roxb)
Tikta Laghu Snigdha
Ushna Katu Tridosha Agnideepaka,paachak
Kantakari142 (Solanum xanthocarpum)
Tikta Katu
Sara Ruksha Laghu
Ushna Katu Kapha Vata
Krimighna Rakta shodhaka
Guduchi143 (Tinospora cordifolia)
Katu Tikta, Kashaya
Laghu Ruksha
Ushna Madhura
Tridosha Rasayana Kusthaghna Deepana Pachana
Dravya Nama
Rasa Guna Veerya
Vipaka Doshaghnata
Parts Used
Karma
shunthi137 (Zingiber Officinate)
Katu Laghu, SnigdhTeekshna
Ushna Madhura Kapha Vata
Kanda
Pachana Agnideepana,Bhedana,Vatanulomana
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 54
Vasaka144 (Adathoda vasica)
Tikta kashaya
Laghu Ruksha
Sheeta Katu
Kapha Pitta
KusthaghnaHridhya Rakta shodhaka
Table No 44: Showing the properties of Tila
Table No 45: Showing the properties of Drugs which are used for Virechana
Karma - Triphala kashaya146
Dravya Nama
Rasa Guna Veerya Vipaka Doshaghnata
Parts Used
Karma
Tila145 Katu Tikta Madhura kashaya
Snigdha Guru Grahi
Ushna Katu Madhura
Vata Beeja Srotoshodhana, vatanulomana, Balya.
Dravya Nama
Rasa Guna Veerya Vipaka Doshaghnata
Karma
Haritaki 147 Terminalia chebula
Lavana rahita panchrasa (kashaya pradhana )
Laghu ruksha
Ushna
Madhura
Tridosha
Rasayana Mrudu virechaka. Kusthahara
Bibhitaki 148 terminalia belerika
Kashaya
Laghu rukshya
Ushna
Madhura
Tridosha
Malabedhana Krumihara, Shothaghna
Amalaki149 emblika ribes
Lavana rahita panchrasa(amlapradhana)
Laghu rukshya
Shita
Madhura
Tridosha
Rasayana Deepana anulomana
Danti 150 Baliospermm momentum
Katu
Guru tikshna
Ushna
Katu
Kapha Pitta
Teekshna virechana Shothahara, kusthahara
Trivritta151 (Operculina terpenthelum
Tikta katu
Laghu Ruksha
Ushna
Katu
Kapha pitta
Rechaka,Bhedana,Sukhavirechaka
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A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 55
Table No.46: Showing the properties of ingredients of Arka Taila152
Dravya Nama
Rasa Guna Veerya Vipaka Doshaghnata
Karma
Arka153 Calotropis procera
Katu Tikta
Laghu ruksha Teekshna
Ushna
Katu
Kapha Vata
Kusthaghna Swedajanana Vedanasthapana
Haridra154 Curcuma longa
Tikta Katu
Laghu ruksha
Ushna
Katu
Tridosha
Kusthaghna Kandughna Varnya
Sarshapa155 Brassica alba
Katu Tikta
Ruksha Teekshna Snigdha
Ushna
Katu
Vata Kapha
Kusthaghna Varnya Jantughna
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 56
MATERIALS AND METHODS
MATERIAL TAKEN FOR STUDY WERE;
A) Drugs: Shunti churna, Panchatiktaka Ghrita, Tila taila, Triphala kwatha(Trivritt
churna, and Danti churna as a prakshepaka dravya) and Arka taila.
These drugs were selected for Deepana-Pachana, Snehapana , Abhyanga, Virechana
karma and for Alepana.
B) Instruments: Measuring glasses, Bed pan, vessels
C) Patients: 30 Patients diagnosed as Vicharchika.
COLLECTIONS OF MATERIALS:
Panchatiktaka Ghrita, Murchita Tila taila, Triphala kwatha churna and Arka taila
were prepared as per the classical reference at Pharmacy of B.V.V.S Ayurvedic Medical
college, Bagalkot.
And other drugs are also taken from that pharmacy only.
PREPARATION OF MEDICINE:
Preparation of Panchatiktaka Ghrita:
The Panchatiktaka Ghrita wsa prepared as per ghrita paka vidhi as explained in
classics.
Preparation of Arka taila:
The ingredients of Arka taila are Arkapatra swarasa, Haridra and Sarshapa taila.
The Arka taila was prepared as per taila paka vidhi as explained in Sharangadhara
Samhita.
Preparation of Triphala kashaya for Virechana :
It was prepared by adding 4 times water in Triphala Yavakuta Churna and by keeping
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 57
1/4 th (Chaturthamsha) of it as it is after boiling. Then it was filtered through cloth and
added Danti and Trivritta churna as a prakshepaka dravya to it.
STUDY DESIGN: The size of sample was 30 excluding dropouts. In the study the
patients were assigned in to 3 groups. i.e, Group A, Group B and Group C, comprising of
10 patients in each group. Grouping was made by random sampling procedure and it is a
comparative study.
SOURCE OF DATA:
Literary Data: The literary source of data of present study was obtained from classical
texts of Ayurveda, , published articles in reputed journals and related source of Internet.
Clinical data: The patients of Vicharchika within the age group of 16 yrs–70 yrs were
selected randomly from OPD, IPD of Dr. B.N.M.E Trust’s Shri Mallikarjuna Swamiji Post
Graduate and Research centre, Bijapur and special camps conducted in Bijapur city by the
institute irrespective of their sex, occupation and socio – economical status.
INCLUSIVE CRITERIA: 1. Patients presenting with classical signs and symptoms of Vicharchika explained in
Sushruta samhita.
2. Patients of either sex between the age group of 16 yrs – 70 yrs.
3. Patients fit for Virechana karma.
4. Patients fit for Alepana.
EXCLUSIVE CRITERIA: 1. Patients presenting with sravayukta Vicharchika associated with any other systemic
disorders.
2. Patients below the age group of 16yrs and above the 70yrs.
3. patients associated with other type of kustha.
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 58
DIAGNOSTIC CRITERIA:
Based on classical signs and symptoms as per the case proforma attached in annexure.
Assessment criteria:
1. Comparative assessment of signs/symptoms before and after treatment was the
main criteria.
2. Photographs of local (affected) lesion of Vicharchika were taken before and after
treatment in most of the patients.
SAMPLING METHOD:
Randomly selected patients from OPD, IPD and camps conducted by
Dr.B.N.M.E.T’s Shri. Mallikarjuna Swamiji Post Graduate Research Centre, Bijapur. 10
patients were allotted in each group by random sampling method.
INTERVENTIONS:
GROUP A
Sample Size : 10 Patients
Method : Virechana Karma
i) Purva Karma :
Pachana - Shunti churna 3-6gm will be given
with ushnodaka in divided dose until
niramavastha.
Snehapana - Panchatiktaka ghrita
Arohana krama snehapana
acc. to Kostha
Sarvanga Abhyanga - Tila Taila
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 59
And Swedana - Sarvanga Sweda
ii) Pradhan Karma : Virechana Karma
Drug - Triphala Kwatha –Prakshepaka
dravya: Danti and Trivritt Churna
Dose - acc. to Kostha
iii) Paschath Karma : Samsarjana krama will be followed acc.
to shuddhi
Duration of Treatment : 18days
Post treatment follow up : On 33rd day
Group ‘B’
Sample Size : 10 Patients
Material : Arka Taila
Method : Alepana on affected area.
Dose : As required
Kala : Morning and Evening
Duration of Treatment: 18 Days
Follow up : On 33rd day
Group ‘C’
Sample Size : 10 Patients
Method : Virechana Karma followed by Alepana
i) Purva Karma :
Pachana - Shunti churna 3-6gm will be given with ushnodaka in divided dose until niramavastha.
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 60
Snehapana - Panchatiktaka ghrita
Arohana krama snehapana
acc. to Kostha
Sarvanga Abhyanga - Tila Taila
And Swedana - Sarvanga Sweda
ii) Pradhan Karma : Virechana Karma
Drug - Triphala Kwatha –Prakshepaka
dravya: Danti and Trivritt Churna
Dose - acc. to Kostha
iii) Paschath Karma : Samsarjana krama will be followed acc.
to shuddhi
In this group after Virechana karma, Alepana with Arka taila was done for 18
days. Alepana with Arka Taila was followed as mentioned in Group ‘B’
Duration of Treatment : 12 days for Virechana and 18 days for Alepana
(12+18days)
Follow up : On 45th day
VIRECHANA VIDHI: It includes
1) Purva karma
2) Pradhanakarma
3) Paschathkarma
Purva karma
Shuntichurna minimum 3gms to max 6 gms was given daily in divided doses
(2 times), according to kostha until niramavastha.
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 61
For snehapana Panchatiktaka ghrita was given in Arohana krama according to
kostha and agni of the individual patient, until samyak snigdha laxanas were
seen.
On the day of vishramakala i.e. 3 Days. Abhyanga using tila taila followed by
sarvanga swedana (Mrudusweda) was done.
Snigdha, drava and ushna bhojana was advised to the patient.
Pradhana karma
On the next day in the empty stomach Triphala kashaya containing danti and
trivritt churna as a prakshepaka dravya was given. The patient was advised to take hot
water frequently for proper digestion of virechana oushadhi.
When the Vegas were observed, patient was advised to exclude the first two
Vegas as it contains only mala from next coming Vegas were counted.
The Vegas were calculated , lakshanika shuddhi and Ankati was also observed.
Paschath Karma:
According to type of shuddhi, Samsarjana krama was adopted. Before sending
the patients the objective parameters were recorded.
Alepana (External application): Patients have applied Arka taila on the lesion with a
sterilized cotton swab twice a day for 18 days. It was observed that the taila took about
30-60 minutes to get completely absorbed.
ASSESSMENT OF VARIABLES:
The efficacy was assessed on the basis of relief obtained by the patient after the
treatment. The clinical symptoms observed in the selected patients were graded and
changes in them are noted before and after the completion of the clinical trails.
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 62
Assessment of Subjective Variable was framed as follows.
1) Rekha
Grade 1 - No Rekha
2 - Superficial Rekha.
3 - Deep Rekha.
4 - Deep Rekha with Redness.
2) Kandu
Grade 1 - No Kandu
2 - Occasional Kandu.
3 - Intermittent Kandu.
4 - Continuous Kandu.
3) Ruja
Grade 1 - No Ruja.
2 - Occasional Ruja.
3 - Intermittent Ruja.
4 - Continuous Ruja.
4) Vaivarnya
Grade 1 - Normal colour.
2 -Brownish red discolouration.
3 - Blackish red discolouration.
4 - Blackish discolouration.
Materials and Methods
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 63
Assessment of Observational Variable was framed as follows. (Present/Slight
reduction/Complete reduction)
Variable BT AT PT F/U
Rukshata
COLLECTION OF DATA:
The data were collected from each group before treatment, after treatment and at
the end of the follow up. Scoring was given and finally the data were compared and
analyzed.
STATISTICAL ANALYSIS:
The collected data were subjected to statistical analysis by using student’s t – test
along with consultation of a bio- statistician.
ASSESSMENT OF CLINICAL IMPROVEMENT:
Clinical improvement of the disease was based on Reduction in the severity of
the symptom. Grading for clinical improvement of individual symptom is as follows.
Grading for clinical improvement for individual symptom:
1. CI-3-Excellent 3rd degree reduction in the severity against the initial score
i.e.,reduction from severe to normal.
2. CI-2-Good- 2nd degree reduction in the severity against the initial score i.e.,reduction
from Moderate to normal, Severe to Mild.
3. CI-1-Encouraging-1st degree reduction in the severity against the initial score
i.e.reduction from Mild to normal, Moderate to Mild and Severe to Moderate.
4. C.S.- Clinically stable i.e. severity score remains same as initial score.
5. C.D- Clinically deteriorated i.e., increase in severity score against the initial score.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 64
OBSERVATIONS AND RESULTS
In the present study 30 patients were studied in the following 3 Groups.
Group A – Virechana karma – 10 Patients
Group B – Arka taila for Alepana (External application) – 10 Patients
Group C – Virechana karma and Alepana of Arka taila – 10 Patients
The observations for present study were done in 3 stages.
• Generalized observation for overall patients.
• Observation for individual group.
• Result related observation for individual group.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 65
GENERALIZED OBSERVATIONS
Table No. 47: Distribution of Patients according to Age
n = 30
Sl. No Age(Yrs) Group A Group B Group C Total %
No. of
Pts %
No. of
Pts %
No. of
Pts %
1. 16 – 26 1 3% 2 7% 3 10% 6 20%
2. 27 – 36 2 7% 1 3% 5 17% 8 26%
3. 37 – 46 5 17% 2 7% -- -- 7 24%
4. 47 – 56 1 3% 1 3% 1 3% 3 10%
5. 57 – 70 1 3% 4 13% 1 3% 6 20%
Graph No. 1: Distribution of Patients according to Age
20%
26%24%
10%
20%16-2627-3637-4647-5657-70
Out of 30 patients, 6 patients (20%) were between 16 – 26 yrs, 8 patients
(26%) were between 27 – 36 yrs, 7 patients (24%) were between 37 – 46 yrs, 3
patients (10%) were between 47 – 56 yrs, 6 patients (20%) were between 57 – 70 yrs.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 66
Table No. 48: Distribution of Patients according to Sex
n = 30
Sl. No Sex Group A Group B Group C Total %
No. of
Pts %
No. of
Pts %
No. of
Pts %
1. Male 4 13% 5 17% 7 24% 16 53%
2. Female 6 20% 5 17% 3 10% 14 47%
Graph No. 2: Distribution of Patients according to Sex
53%
47% MaleFemale
Out of 30 patients majority were Male i.e., 16 patients (53%) and 14 patients
(47%) were Female.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 67
Table No. 49: Distribution of Patients according to Religion
n = 30
Sl.
No Religion Group A Group B Group C Total %
No. of
Pts %
No. of
Pts %
No. of
Pts %
1. Hindu 10 33% 10 33% 8 26% 28 93%
2. Muslim -- -- -- -- 2 7% 2 7%
Graph No. 3: Distribution of Patients according to Religion
93%
7%
HinduMuslim
Out of 30 patients majority were Hindu i.e., 28 patients (93%) and 2 patients
(7%) were Muslim.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 68
Table No. 50: Distribution of Patients according to Occupation
n = 30
Sl. No Occupation Group A Group B Group C Total %
No. of Pts
% No. of Pts
% No. of Pts
%
1. Retired persons -- -- 2 7% -- -- 2 7%
2. Agriculturists -- -- 1 3% 1 3% 2 7%
3. Lecturer/Teacher 4 13% 1 3% 1 3% 6 20%
4. Students 1 3% 2 7% -- -- 3 10%
5. Housewives 1 3% 2 7% 2 7% 5 17%
6. Others (manager,
attenders, driver) 4 13% 2 7% 6 20% 12 40%
Graph No. 4: Distribution of Patients according to Occupation
7% 7%
20%
10%17%
40%
Retired persons
Agriculturists
Lecturer/Teacher
Students
Housewives
Others (manager,attenders, driver)
Among the patients registered for the present study 12 patients (40%) were
others i.e.,manager, attender, driver etc, 6 patients (20%) were Teachers / Lecturers, 5
patients (17%) were Housewives, 3 patients (10%) were Students, and 2 patients (7%)
were Retired personals and Agriculturists each respectively.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 69
Table No. 51: Distribution of Patients according to Socio Economic Status
n = 30
Group A Group B Group C Sl.
No
Socio
Economic
Status
No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Lower Class 2 7% 4 13% 4 13% 10 33%
2. Middle Class 5 17% 5 17% 3 10% 13 44%
3. Upper Class 3 10% 1 3% 3 10% 7 23%
Graph No. 5: Distribution of Patients according to Socio Economic Status
33%
44%
23%Lower Class
Middle class
Upper class
Majority of the patients were from the Middle Class i.e., 13 patients (44%),
Lower Class 10 patients (33%) and 7 patients (23%) from Upper Class.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 70
Table No. 52: Distribution of Patients according to Diet
n = 30
Group A Group B Group C
Sl.No Diet No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Vegetarian 4 13% 5 17% 5 17% 14 47%
2. Mixed 6 20% 5 17% 5 17% 16 53%
Graph No. 6: Distribution of Patients according to Diet
47%
53%
Vegetarian
Mixed
Among the patients registered for the study 16 patients (53%) were mixed and
14 patients (47%) use to take Vegetarian diet.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 71
Table No. 53: Distribution of Patients according to Vyasana
n = 30
Group A Group B Group C Sl.
No Vyasana No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Tobacco 1 7% 2 7% 1 7% 4 13%
2. Alcohol 1 3% 1 3% 1 3% 3 10%
3. Smoking 2 7% 1 3% 1 3% 4 13%
4. No Habits 6 20% 6 20% 7 23% 19 64%
Graph No. 7: Distribution of Patients according to Vyasana
13%
10%
13%64%
Tobacco
Alcohol
Smoking
No habits
In present study 4 patients (13%) had the habit of Tobacco, 4 patients
(13%) had the habit of Smoking; 3 patients (10%) had the habit of Alcohol and 19
patients (64%) had no habits.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 72
Table No. 54: Distribution of Patients according to Kula Vrittanta
n = 30
Group A Group B Group C Sl.
No
Kula
Vrittanta No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Present 2 7% 2 7% 2 7% 6 20%
2. Absent 8 27% 8 27% 8 27% 24 80%
Graph No. 8: Distribution of Patients according to Kula Vrittanta
20%
80%
Present
Absent
In present study 6 patients (20%) were having Kula vrittanta of Vicharchika
and 24 patients (80%) were not having Kula vrittanta.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 73
Table No. 55: Distribution of Patients according to Chronicity of Vyadhi
n = 30
Group A Group B Group C % Sl.
No Chronicity No.
of Pts%
No.
of Pts%
No.
of Pts%
Total
1. < 1 year 3 10% 2 7% 2 7% 7 23%
2. 1 -2 year 1 3% 6 20% 4 13% 11 37%
3. > 2 year 6 20% 2 7% 4 13% 12 40%
Graph No. 9: Distribution of Patients according to Chronicity of Vyadhi
23%
37%
40% < 1 yr 1-2 yr
> 2 yr
In the present study 12 patients (40%) were suffering from more than 2 years,
11 patients (37%) were from 1 – 2 years and 7 patients (23%) were suffering from
less than one year.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 74
Table No. 56: Distribution of Patients according to Prakruti
n = 30
Group A Group B Group C Sl.
No Prakruti No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Vata -Pitta 2 7% 3 10% 3 10% 8 27%
2. VataKapha 1 3% 2 7% 1 3% 4 13%
3. PittaKapha 5 17% 3 10% 2 7% 10 33%
4. PittaVata -- -- 1 3% 2 7% 3 10%
5. KaphaVata 1 3% 1 3% -- -- 2 7%
6. KaphaPitta 1 3% -- -- 2 7% 3 10%
Graph No. 10: Distribution of Patients according to Prakruti
27%
13%
33%
10%
7%10% Vata Pitta
Vata Kapha
Pitta Kapha
Pitta Vata
Kapha Vata
Kapha Pitta
The patients were categorized under 6 Dwandwaja Prakruti. Among these
majority of patients i.e, 10 patients (33%) were Pitta– Kaphaja, 8 patients (27%) were
Vata– Pittaja, 4 patients (13%) were Vata– Kaphaja, 3 patients (10%) each were
Pitta– Vataja and Kapha– Pittaja respectively, and 2 patients (7%) were Kapha–
Vataja.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 75
Table No. 57: Distribution of Patients according to Agni Pareeksha
n = 30
Group A Group B Group C Sl.
No
Agni
Pareeksha No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Vishama 1 3% 3 10% 1 3% 5 17%
2. Teekshana 4 13% 4 13% 4 13% 12 40%
3. Manda 5 17% 3 10% 5 17% 13 43%
Graph No. 11: Distribution of Patients according to Angi Pareeksha
17%
40%
43%Vishama
Teekshna
Manda
Among these majority i.e, 13 patients (43%) were having Mandagni, 12
patients (40%) were having Teekshna agni and 5 patients (17%) were having
Vishamagni.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 76
Table No. 58: Distribution of Patients according to Kostha
n = 30
Group A Group B Group C
Sl.
No Kostha
No.
of
Pts
%
No.
of
Pts
%
No.
of
Pts
% Total %
1. Krura 1 3% 2 7% 1 3% 4 13%
2. Mridhu 5 17% 4 13% 5 17% 14 47%
3. Madhyama 4 13% 4 13% 4 13% 12 40%
Graph No. 12: Distribution of Patients according to Kostha
13%
47%
40%Krura
Mridu
Madhyama
Among these majority i.e,14 patients (47%) were having Mridhu kostha, 12
patients (40%) were having Madhyama kostha and 4 patients (13%) were having
Krura kostha.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 77
OBSERVATIONS ACCORDING TO SPECIFIC EXAMINATIONS
Table No. 59: Distribution of Patients according to Site of Lesion and
Distribution of Lesion
n = 30
Group A Group B Group C Sl. No
Site Distribution No. of Pts
% No. of Pts
% No. of Pts
% Total %
1. Neck/face 2 7% 1 3% -- -- 3 10%Unilateral -- -- 1 3% 2 7% 3 10%
2. Upper Limb Bilateral -- -- 2 7% 1 3% 3 10%
Unilateral 4 13% 2 7% 2 7% 8 27%3.
Lower Limb Bilateral 3 10% 4 13% 3 10% 10 33%
4. Back 1 3% -- -- -- -- 1 3% 5. Wholebody -- -- -- -- 2 7% 2 7%
Graph No. 13: Distribution of Patients according to Site of Lesion and
Distribution of Lesion
10%10%
10%
27%
3%
7%3%Neck/face
Upperlimb unilateral
Upperlimb bilateral
Lowerlimb unilateral
Lowerlimb bilateral
Back
Wholebody
In the present study majority of patients i.e., 18 patients (60%) were having
Lesions on Lower limb and that too Bilateral 10 patients (33%) and Unilateral 8
patients (27%), 6 patients (20%) were having Lesions on Upper limb and that too
Bilateral 3 patients (10%) , Unilateral 3 patients (10%), 3 patients (10%) were having
Lesions on the Neck/face, 2 patients (7%) were having Lesions on Whole Body and
one patient (3%) is having Lesions on Back.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 78
OBSERVATIONS REGARDING VIRECHANA KARMA:
Table no. 60: Showing required days for Samyak snehana
n=20
Group A Group C Days
No. of pts % No. of pts % Total %
3 Days 1 10% 1 10% 2 10%
4 Days 3 30% 2 20% 5 25%
5 Days 3 30% 4 40% 7 35%
6 Days 1 10% 1 10% 2 10%
7 Days 2 20% 2 20% 4 20%
Graph No. 14: Showing required days for Samyak snehana
10%
25%
35%
10%
20%3 days4 days5 days6 days7 days
Among these majority i.e,7 patients (35%) were obtained samyak snigdha
laxanas on 5th day, 5 patients (25%) were obtained on 4th day, 4 patients (20%) were
obtained on 7th day and 2 patients (10%) each were obtained on 6th and 3rd day
respectively.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 79
Table no. 61 : Distribution of Patients according to Vaigiki Criteria
n=20
Group A Group C Sl.
No Vegas No. of
vegas %
No. of
vegas %
Total %
1. Uttama (21-30) 5 25% 6 30% 11 55%
2. Madhyama (11-20) 4 20% 2 10% 6 30%
3. Heena (1-10) 1 5% 2 10% 3 15%
Graph.No.15 Distribution of patients according to vaigiki criteria
55%30%
15%Uttama
Madhyama
Heena
Among these majority i.e,11 patients (55%) had Uttama vegas, 6 patients
(30%) had Madhyama vegas and 3 patients (15%) had Heena vegas.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 80
Table no. 62 : Distribution of Patients according to Manaki Criteria
n=20
Group A Group C Sl.
No Quantity
No. of pts % No. of pts % Total %
1 Uttama (3.1-4 prasta) 5 25% 6 30% 11 55%
2 Madhyama (2.1-3 prasta) 4 20% 6 10% 6 30%
3 Heena (2 prasta) 1 5% 2 10% 3 15%
Graph.No.16 Distribution of patients according to Manaki criteria
55%30%
15%Uttama
Madhyama
Heena
Among these majority i.e,11 patients (55%) had Uttama manaki shuddhi, 6
patients (30%) had Madhyama manaki shuddhi and 3 patients (15%) had Heena
manaki shuddhi.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 81
Table no. 63: Distribution of Patients according to Antaki Criteria
n=20
Group A Group C Sl.No
Antaki
Shuddhi No. of pts % No. of pts % Total %
1 Kaphanta 10 100% 10 100% 20 100%
Graph.No.17 Distribution of patients according to Antaki criteria
100%
Kaphanta
All the 20 patients (100%) had Kaphanta laxana.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 82
Table no. 64 : Distribution of Patients according to Laingiki Criteria
n=20
Group A Group C
Sl. No Laingiki
Shuddhi No. of
pts %
No. of
pts %
Total %
1 Samyak Yoga 10 100% 10 100% 20 100%
2 Ayoga -- -- -- -- -- --
3 Atiyoga -- -- -- -- -- --
Graph.No.18 Distribution of patients according to Laingiki criteria
100%
0%
0%Samyakyoga
Madhyama
Heena
All the 20 patients (100%) had Samyak yoga lakshanas.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 83
Table No. 65: Distribution of Patients of Vicharchika based on the presence of
Clinical Symptoms
n = 30
Group A Group B Group C Sl. No
Clinical Symptoms B.T % B.T % B.T %
1. Kandu 10 100% 10 100% 10 100%
2. Rekha 10 100% 9 90% 10 100%
3. Vaivarnya 10 100% 10 100% 10 100%
4. Ruja 10 100% 8 80% 9 90%
5. Rukshata 10 100% 10 100% 10 100%
Graph No. 19: Distribution of Patients of Vicharchika based on the presence of
Clinical Symptoms
0
10
2030
4050
6070
8090
100
Group A Group B Group C
KanduRekha RujaRukshata
In the present study out of 30 patients,
In Group A out of 10 patients all the patients were having Kandu, Rekha
Vaivarnya, Ruja and Rukshata.
In Group B all the 10 patients were having Kandu and Vaivarnya and
Rukshata and 9 patients were having Rekha and 8 patients were having Ruja.
In Group C all the 10 patients were having Kandu, Rekha, Vaivarnya and
Rukshata and 9 patients were having Ruja.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 84
Distribution of Patients according to presence of Symptoms before treatment.
Table No. 66: a. KANDU n = 30
Group A Group B Group C
Sl.No Grading No. of
Pts %
No. of
Pts %
No. of
Pts %
Total %
1. Grade 1 -- -- -- -- -- -- -- --
2. Grade 2 3 10% 3 10% 2 7% 8 27%
3. Grade 3 5 17% 4 13% 4 13% 13 43%
4. Grade 4 2 7% 3 10% 4 13% 9 30%
Table No. 67: b. RAJI
n = 30
Sl.No Grading Group A Group B Group C Total %
No. of
Pts
% No. of
Pts
% No. of
Pts
%
1. Grade 1 -- -- 1 3% -- -- 1 3%
2. Grade 2 2 7% 1 3% 2 7% 5 17%
3. Grade 3 5 17% 7 23% 4 13% 16 53%
4. Grade 4 3 10% 1 3% 4 13% 8 27%
Table No. 68: c. VAIVARNYA
n = 30
Sl.No Grading Group A Group B Group C Total %
No.of
Pts
% No.of
Pts
% No.of
Pts
%
1. Grade 1 -- -- -- -- -- -- -- --
2. Grade 2 4 13% 1 3% 2 7% 7 23%
3. Grade 3 3 10% 7 23% 4 13% 14 47%
4. Grade 4 3 10% 2 7% 4 13% 9 30%
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 85
Table No. 69 : d. RUJA
n = 30
Sl.No Grading Group A Group B Group C Total %
No.of
Pts
% No.of
Pts
% No.of
Pts
%
1. Grade 1 -- -- 2 7% 1 3% 3 10%
2. Grade 2 3 10% 2 7% 1 3% 6 20%
3. Grade 3 5 17% 6 20% 4 13% 15 50%
4. Grade 4 2 7% -- -- 4 13% 6 20%
Table No. 70: e. RUKSHATA n = 30
Sl.No Grading Group A Group B Group C Total %
No.of
Pts
% No.of
Pts
% No.of
Pts
%
1. Present 10 100% 10 100% 10 100% 30 100%
2. Absent -- -- -- -- -- -- -- --
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 86
OBSERVATIONS FOR INDIVIDUAL GROUP
Group A
1. All the Patients were presenting with varied degree of lakshanas.
2. All the patients were given shunti churna for amapachana in divided dose until
nirama avastha.
3. Patients were given panchatiktaka ghrita according to kostha in arohana krama
until samyak snigdha lakshanas were seen.
4. After attaining samyak snigdha lakshanas virechana aushadhi i,e Triphala
kashaya was administered according to kostha and observed for chaturvidha
shuddhi.
5. Out of 10 patients 2 patients had complaints like nausea and vomiting due to
excess intake of ushna jala after administration of virechana aushadhi.
6. Out of 10 patients 3 patients were dropped out from the study. The drop outs
were substituted by extra 3 patients.
7. Follow up was done on 18th, and 33rd day.
Group B
1. All the patients were presenting with varied degree of lakshanas.
2. Patients applied the Arka taila twice per day for 18 days i.e, morning and
evening on the affected lesion of Vicharchika.
3. It was observed that the taila took 30 – 60 minutes to get absorbed completely.
4. Patients were comfortable during, after treatment and after follow up.
5. No complications were observed.
6. Out of 10 patients 2 patients were dropped out from the study. The drop outs
were substituted by extra 2 patients.
7. Follow up was done on 18th and 33rd day.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 87
Group C
1. All the patients were presenting with varied degree of lakshanas.
2. Both Virechana karma followed by Alepana with Arka taila was done in this
Group.
3. Same observations were observed as mentioned in Group A and Group B.
4. During Samsarjana krama Alepana was done for 18 days.
5. Out of 10 patients 1 patient was dropped out from the study. The drop out was
substituted by extra 1 patient.
6. Follow up was done on 30th and 45th day.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 88
TABLES SHOWING THE RESULTS AFTER TREATMENT AND AFTER
FOLLOW UP.
GROUP A
Table No. 71: Response of Clinical Symptoms After treatment
Sl.No Symptoms CI – III CI – II CI – I C.S C.D
1. Kandu -- -- 80% 20% --
2. Raji -- 10% 80% 10% --
3. Vaivarnya -- -- 80% 20% --
4. Ruja -- -- 80% 20% --
Graph No.20: Response of Clinical Symptoms After treatment
0
10
20
30
40
50
60
70
80
CI – III CI – II CI – I C.S C.D
Kandu
Raji
Vaivarnya
Ruja
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 89
Table No. 72: Response of Clinical Symptoms After Follow up
Sl. No Symptoms CI – III CI – II CI – I C.S C.D
1. Kandu -- 40% 60% -- --
2. Raji -- 20% 70% 10% --
3. Vaivarnya -- 50% 40% 10% --
4. Ruja -- 40% 50% 10% --
Graph No.21: Response of Clinical Symptoms After Follow up
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
CI – III CI – II CI – I C.S C.D
Kandu
Raji
Vaivarnya
Ruja
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 90
GROUP B
Table No. 73: Response of Clinical Symptoms After Treatment
Sl.No Symptoms CI – III CI – II CI – I C.S C.D
1. Kandu -- 20% 70% 10% --
2. Raji -- 30% 60% 10% --
3. Vaivarnya -- -- 90% 10% --
4. Ruja -- 30% 50% 20% --
Graph No.22: Response of Clinical Symptoms After Treatment
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
CI – III CI – II CI – I C.S C.D
Kandu
Raji
Vaivarnya
Ruja
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 91
Table No. 74: Response of Clinical Symptoms After Follow up
Sl.No Symptoms CI – III CI – II CI – I C.S C.D
1. Kandu -- 20% 50% 30% --
2. Raji -- 20% 40% 40% --
3. Vaivarnya -- -- 60% 40% --
4. Ruja -- 10% 50% 40% --
Graph No. 23: Response of Clinical Symptoms After Follow up
0
0.1
0.2
0.3
0.4
0.5
0.6
CI – III CI – II CI – I C.S C.D
KanduRajiVaivarnyaRuja
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 92
GROUP C
Table No. 75: Response of Clinical Symptoms After Treatment
Sl.No Symptoms CI – III CI – II CI – I C.S C.D
1. Kandu -- 40% 60% -- --
2. Raji -- 20% 80% -- --
3. Vaivarnya -- 40% 60% -- --
4. Ruja -- -- 90% 10% --
Graph No. 24: Response of Clinical Symptoms After Treatment
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
CI – III CI – II CI – I C.S C.D
Kandu
Raji
Vaivarnya
Ruja
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 93
Table No. 76: Response of Clinical Symptoms After Follow up
Sl. No Symptoms CI – III CI – II CI – I C.S C.D
1. Kandu 10% 70% 20% -- --
2. Raji 10% 60% 30% -- --
3. Vaivarnya 10% 70% 20% -- --
4. Ruja -- 80% 10% 10% --
Graph No.25: Response of Clinical Symptoms After Follow up
0%
10%
20%
30%
40%
50%
60%
70%
80%
CI – III CI – II CI – I C.S C.D
Kandu
Raji
Vaivarnya
Ruja
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 94
RESULT RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS
Group A: AFTER TREATMENT
CI – III: None of the patients showed excellent response during study.
CI – II : 10% (Raji).
CI – I : 90% ( Kandu ), 80% (Raji), 80% ( Vaivarnya ), 80% ( Ruja ).
CS : 10% (Kandu), 10% (Raji), 20% ( Vaivarnya ), 20% ( Ruja ).
CD : None of the patients were observed clinically deteriorated during study.
GROUP A: AFTER FOLLOW UP
CI – III: None of the patients showed excellent response during study.
CI – II : 40% ( Kandu ), 20% (Raji), 50% ( Vaivarnya ), 40% ( Ruja ).
CI – I : 60% ( Kandu ), 70% (Raji), 40% ( Vaivarnya ), 50% ( Ruja ).
CS : 10% (Raji), 10% ( Vaivarnya ), 10% ( Ruja ).
CD : None of the patients were observed clinically deteriorated during study.
GROUP B: AFTER TREATMENT
CI – III: None of the patients showed excellent response during study.
CI – II : 20% (Kandu), 30% (Raji), 30% ( Ruja ).
CI – I : 70% ( Kandu ), 60% (Raji), 90% ( Vaivarnya ), 50% ( Ruja ).
CS : 10% (Kandu), 10% (Raji), 10% ( Vaivarnya ), 20% ( Ruja ).
CD : None of the patients were observed clinically deteriorated during study.
GROUP B: AFTER FOLLOW UP
CI – III: None of the patients showed excellent response during study.
CI – II : 20% ( Kandu ), 20% (Raji), 10% ( Vaivarnya ), 10% ( Ruja ).
CI – I : 50% ( Kandu ), 40% (Raji), 50% ( Vaivarnya ), 50% ( Ruja ).
CS : 30% ( Kandu ), 40% (Raji), 40% ( Vaivarnya ), 40% ( Ruja ).
CD : None of the patients were observed clinically deteriorated during study.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 95
GROUP C: AFTER TREATMENT
CI – III : None of the patients showed excellent response during study.
CI – II : 40% ( Kandu ), 20% (Raji), 40% ( Vaivarnya ).
CI – I : 60% ( Kandu ), 80% (Raji), 60% ( Vaivarnya ), 90% ( Ruja ).
CS : 10% ( Ruja ).
CD : None of the patients were observed clinically deteriorated during
study.
GROUP C: AFTER FOLLOW UP
CI – III : 10% ( Kandu ), 10% (Raji), 10% ( Vaivarnya ).
CI – II : 70% ( Kandu ), 60% (Raji), 70% ( Vaivarnya ), 80% ( Ruja ).
CI – I : 20% ( Kandu ), 30% (Raji), 20% ( Vaivarnya ), 10% ( Ruja ).
CS : 10% ( Ruja ).
CD : None of the patients were observed clinically deteriorated during
study.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 96
RESULT RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS AFTER
TREATMENT BASED ON OBSERVATIONAL CRITERIA (RUKSHATA):
Group A:
1. Complete reduction:
Only 2 patients (20%) had showed complete reduction.
2. Slight reduction:
6 patients (60%) had showed slight reduction.
3. Stable:
2 patients (20%) had showed no response to the treatment.
Group B:
1. Complete reduction:
4 patients (40%) had showed complete reduction.
2. Slight reduction:
6 patients (60%) had showed slight reduction.
3. Stable:
All 10 patients had showed response to the treatment.
Group C:
1. Complete reduction:
3 patients (30%) had showed complete reduction.
2. Slight reduction:
7 patients (70%) had showed slight reduction.
3. Stable:
All 10 patients had showed response to the treatment.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 97
RESULT RELATED OBSERVATIONS FOR INDIVIDUAL GROUPS AFTER
FOLLOW UP BASED ON OBSERVATIONAL CRITERIA:
Group A:
1. Complete reduction:
4 patients (40%) had showed complete reduction.
2. Slight reduction:
5 patients (50%) had showed slight reduction.
3. Stable:
Only one patient (10%) had showed no response to the treatment.
Group B:
1. Complete reduction:
2 patients (20%) had showed complete reduction.
2. Slight reduction:
4 patients (40%) had showed slight reduction.
3. Stable:
4 patients (40%) had showed no response to the treatment.
Group C:
1. Complete reduction:
7 patients (70%) had showed complete reduction.
2. Slight reduction:
3 patients (30%) had showed slight reduction.
3. Stable:
All 10 patients had showed response to the treatment.
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 98
Table No.77: Showing Result related observations for individual groups based on
observational criteria:
Group B.T A.T A.F
No. of
pts
C.R
(100%)
S.R
(50%)
Stable
(0%)
C.R
(100%)
S.R
(50%)
Stable
(0%)
A 10 2 6 2 4 5 1
B 10 4 6 0 2 4 4
C 10 3 7 0 7 3 0
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 99
STATISTICAL ANALYSIS – RESULTS OF
GROUP A
Table No. 78: a) KANDU
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
2.9000
2.1000
0.7400
0.7400
6.0000
0.0002
HS
B.T
F.U
2.9000
1.5000
0.7400
0.7100
8.5732
0.0001
HS
Table No. 79: b) RAJI
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.1000
2.1000
0.7379
0.7379
6.7080
0.0001
HS
B.T
F.U
3.1000
2.0000
0.7379
0.8165
6.1280
0.0001
HS
Table No. 80: c) VAIVARNYA
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
2.9000
2.1000
0.8756
0.8756
6.0018
0.0001
HS
B.T
F.U
2.7000
1.5000
0.8756
0.5374
6.3317
0.0001
HS
Table No. 81: d) RUJA
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
2.900
2.100
0.7379
0.7379
6.000
0.0001
HS
B.T
F.U
2.900
1.600
0.7379
0.9661
6.091
0.0001
HS
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 100
GROUP B Table No. 82: a) KANDU
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.0000
1.8000
0.8254
0.7929
7.6741
0.0001
HS
B.T
F.U
3.0000
2.1000
0.8254
0.9944
3.8572
0.004
HS
Table No. 83: b) RAJI
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
2.8000
1.6000
0.7888
0.6992
6.0000
0.0001
HS
B.T
F.U
2.8000
2.0000
0.7888
0.8165
3.2070
0.0111
S
Table No. 84: c) VAIVARNYA
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.1000
2.2000
0.5676
0.4216
4.0249
0.0008
HS
B.T
F.U
3.1000
2.5000
0.5676
0.5270
2.4495
0.0248
S
Table No. 85: d) RUJA
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
2.4000
1.3000
0.8433
0.4840
4.7142
0.0011
HS
B.T
F.U
2.4000
1.7000
0.8433
0.6749
3.2800
0.010
S
Observations And Results
A Comparative and Combined Clinical Study on Shodhana and Alepana in Vicharchika 101
GROUP C Table No. 86: a) KANDU
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.2000
1.8000
0.7979
0.7979
8.5732
0.0001
HS
B.T
F.U
3.2000
1.3000
0.7979
0.4834
10.5846
0.0001
HS
Table No. 87: b) RAJI
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.2000
2.0000
0.7989
0.8232
9.0000
0.0001
HS
B.T
F.U
3.2000
1.4000
0.7989
0.5234
9.0000
0.0001
HS
Table No. 88: c) VAIVARNYA
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.2000
1.8000
0.7979
0.7979
8.5732
0.0001
HS
B.T
F.U
3.2000
1.3000
0.7979
0.4834
10.5846
0.0001
HS
Table No. 89: d) RUJA
Grading Mean S.D ‘T’ value ‘P’ value Remarks
B.T
A.T
3.1000
2.2000
0.9989
0.7968
9.0000
0.0001
HS
B.T
F.U
3.1000
2.2000
0.9989
0.5231
7.9649
0.0001
HS
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 102
DISCUSSION TITLE:
The present study has been entitled as “A comparative and combined clinical
study on Shodhana and Alepana (External application) in Vicharchika.”
Vicharchika is not a life threatening disease, it makes the patient worried due to
its appearence, severe itching, disturbing the routine and its nature susceptible to be
chronic. Vicharchika is described under Kshudra kustha in Ayurvedic textual also
mentioned as a curable disease yet the relapsing nature of this disease makes it much
harassment for patient and troubles some for physicians too.
According to most of Ayurvedic texts, all types of kustha have been considered as
‘Rakta pradoshaja vikara’ and hence Vicharchika. According to Sushruta it is a pitta
pradhana tridoshaja vyadhi. The line of treatment for kustha is, Shodhana followed by
Shamana.
As Vicharchika is pitta pradhana and rakta pradoshaja vikara Virechana is most
important measure of shodhana. It is a specific modality for the elimination of pitta dosha
but it is also effective upon kapha and rakta which are the main dosha of Vicharchika. It
is less stressful procedure than Vamana and has less possibility of complications. It is
widely used as a Shodhana therapy in routine.
On the other hand Sharangadhara has mentioned Alepana (external application) of
Arka taila as an effective medicine in Vicharchika.
Taking all these points into consideration, an effort is made to compare the
efficacy of Shodhana by means of Virechana karma, Shamana by Arka taila as Alepana
and also the combined effect in Vicharchika and hence the title.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 103
DISCUSSION ON VICHARCHIKA
NIDANA PANCHAKA:
NIDANA:
One of the fundamental principles of Ayurveda is the Karya – Karana Siddhanta.
The Kaarya – the production of the disease is not possible without the Karana i,e Nidana
or Hetu. Ultimately the aim of the physician is to cure as well as to prevent the disease.
More over, the knowledge of Nidana is useful to provide proper guidance for therapy as
well as in the prevention of the disease. Though, there is no specific description about
etiological factors of the disease Vicharchika but it being a variety of Kshudra Kustha,
the etiological factors of the Kustha are to be accepted as the etiological factors of
Vicharchika. These are mentioned under Aharaja, Viharaja, Kulaja, and Manasika
nidana.
1. Aharaja: Aaharaja Hetus are chief responsible factors in the production of the Kustha.
Among them Viruddha & Mithya Ahara are the main dietary factors.
Excess intake of Madhura, amla, lavana rasa may aggrevate doshas and leads to
‘kha’vaigunya in twak. Madhura rasa in excess quantity may provoke kapha and rasa
dusti leads to kandu. Amla and lavana rasas directly cause raktadusti, thus causing rakta
pradoshaja vyadhi like kustha.
During this study most of the patients had the history of excess intake of dadhi,
Navanna, guda, anupa mamsa, kusumbha taila, snigdha padartha and paryushita anna.
Viruddha ahara like- msmsa- dugdha, dadhi- dugdha etc. These all might have caused
ama, agnimandya, abhishyandata, tridosha prakopa, raktadusti, srotodusti and ultimately
Vicharchika.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 104
2. Viharaja: Viharaja hetu also played an important role in the manifestation of kustha.
Some common vihara hetu for kustha are Mithya vihara, diwaswapna, vega dharana,
improper panchakarma procedure.
In this study some, nidanas are observed in some of the patients. Most commonly
observed nidanas are diwaswapna and vegadharana. But the other environmental factors
which cause the dosha prakopa can be considered under the nidanas like, unhygienic
conditions, patients prone to irritant chemicals.
3. Kulaja: Kustha is Adibala pravritta vyadhi, and kusthayukta shukra shonita results in
the birth of kustha shishu. So as Vicharchika is a type of kustha it can be said that it may
also manifest due to beeja dosha. Evidently during the study some of the patients were
found to have kulaja vrittanta of Vicharchika and were chirakari.
4. Manasika: Any imbalance in the mind affects the skin appearance and any
abnormalities of skin affects the mind, which forms a vicious cycle. During this
generation almost all people had stress and strain due to their busy life shedule. Probably
bhaya, chinta, krodha etc.manasika bhavas might have caused tridosha prakopa,
agnimandya and Kustha.
PURVA ROOPA:
The complaints which appear before real manifestation of the disease are known
as purva roopa. Purva roopa laxanas are seen in fourth kriyakala in which sthana
samshraya of the vitiated doshas takes place.
As Vicharchika is a type of kustha, the purva roopa of kustha can be considered
as purvaroopa of Vicharchika.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 105
Asweda: Asweda means complete absence of sweda or diminished sweda is due to
swedavaha srotorodha.
Atisweda: When vitiated dosha gets settled in rakta, sweda is produced.
Suptata: It means sparshahani and is due to vata or kapha dusti.
Vaivarnya: Generally every one has a typical skin colour, changing of the previous
original appearance is known as vaivarnya. Shyava, Rakta, Shveta etc are different
colours in different types of kustha. The alteration of skin colour depends on the amount
of blood circulation and melanocytes.
Kandu: It is chief complaint of Vicharchika and also can be felt as purva roopa of
kustha. Kandu is occurred mainly due to kapha dusti.
Many of the patients experienced these mild symptoms but neglected.
ROOPA:
Roopa appear during the 5th kriyakala and this is also reffered to as the ‘Vyakti’
stage during the progressive process of manifestation of the disease.
1. Kandu: Kandu may be defined as a condition of severe itching sensation in the body.
It is the most distressful symptom for the patient of Vicharchika. Acharya Sushruta has
used the adjective ‘Ati’ while Charaka has used the adjective ‘Sa’ with it. It indicates that
it is present in severe form in the patient of Vicharchika.
Kandu is the main complaint of Vicharchika and is produced by the karmataha
vriddhi of kapha dosha.
During the present study, Kandu is present in purva roopa avastha in alpa
swaroopa and present in mild to severe grade in roopa avastha in all the patients.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 106
2. Raji: Raji means rekha (Lining). In dry type of Vicharchika Raji may be developed due to
thickening of the lesion.
In the present study the Rekha is observed in different stages.
3. Vaivarnya: Vaivarnya means discolouration. Vicharchika may be Shyava, Rakta, and
Shweta due to dominancy of Vata, Pitta, and Kapha respectively. In early stage colour of
lesion is red due to dilatation of blood vessels with oedema, papules, vesicle, etc. At later
stage lesion becomes dark and lechenified.
In present study all most all the patients had this complaint and most of them were
having Shyava varna.
4. Ruja: As Acharya Sushruta has considered the disease as Pittaja Vikara & its
lakshanas indicate the vitiation of Vata & Pitta. Hence, Ruja can be taken as a symptom
of dry form of Vicharchika.
In present study majority of patients had this complaint in madhyama swaroopa.
5. Rukshata: Rukshata means dryness, hard and rough. It means increase in khara guna
of Vayu and decrease in snigdha, drava guna of Kapha. The word kharata and parushata
shows the degree of rukshata.
In present study all most all the patients had this complaint.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 107
SAMPRAPTI:
Flow chart No.6 Showing Samprapti of Vicharchika : NIDANA SEVANA
Aharaja Viharaja Manasika Bija doshaja Papakarmaja
(Vipra, Gura Gharshayatam) Viruddha Divaswapa Garistha Vegavidharana Kulaja Sahaja Asatmya Karmaja bhojana Vyadhi
Agni Tri Dosha Dhatu Kha- Mandya prakopa Shaithilya Vaigunya Ama utpatti Rasen saha mishri bhuyah Tiryak Sira Bahya Marga gamana
Dhatu Dushti (Twak, Rakta, Mamsa, Ambu)
Dosha Dushya
Sammurchhana (Gratitha Kledassanchaya)
Sroto Dushti Kushtha lakshanotapatti
VICHARCHIKA
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 108
KUSTHA RAKTA PRADOSHAJA VYADHI:
It is clear that the aggrevating factors for rakta are same as that of pitta. Because
rakta and pitta both are having agneya guna and ashraya-ashrayee in nature.
We have seen many vitiating factors of rakta and most of the patients use to take
these nidanas. So we can say that kustha is a Rakta pradoshaja vyadhi.
SADHYA – ASADHYATA:
The sadhyasadhyata of kustha depends on various factors. When the kustha
dravyas are sthanasamshrita in superficial dhatus, it is easy to break the samprapti,
otherwise reaching to the depth becomes difficult or impossible. When the kshudra
kustha or superficial dhatugata kustha is untreated move into the next stage by the
involvement of deeper dhatus and may turn into mahakusthas. The presence of all the
tridoshaja laxanas indicates the complications and difficulty in treatment. The gambhira
dhatugata kusthas need all the chikitsa upakramas and at that chronic stage, the bala of
the patient is also reduced. Hence sarvadaihika laxanas like balahani, agnisada, krimi
utpatti etc. are seen.
UPADRAVAS:
The kustha upadravas like anga patana, avayava patana, prasravana, angabheda
etc. are produced due to the excessive kleda utpatti, sroto rodha and krimi utpatti. The
sarvadaihika laxanas like atisara, aruchi, trishna, daha, jwara, dourbalya etc. indicate the
agnidusti in great extent. More over the psychological factors also contribute to the
severity of the symptoms as the kustha becomes chronic. When the kustha is untreated,
develops both sarvadaihika and sthaanika upadravas which needs the kustha chikitsa
along with rasayana chikitsa.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 109
CHIKITSA:
In ayurvedic classics, we find the line of treatment for Kustha roga is Shodhana
followed by Shamana. The planning of treatment of kustha depends on the predominance
of doshas involved in a particular type of kustha if the disease predominantly is vatika,
Snehapana is advised, Virechana and Rakta mokshana are the first line of treatment for
pitta pradhana and Vamana karma should be carried out if the variety of kustha is kapha
predominant.
In my present study I have taken only Virechana karma to ascess its effect in
Vicharchika.
According to most of Ayurvedic texts all types of kustha have been considered as
‘Rakta pradoshaja vikara’. As vicharchika is a type of kustha and according to Sushruta it
is a pitta pradhana tridoshaja vyadhi, so Virechana is a first line of treatment for Rakta
pradoshaja and pitta pradhana vikaras.
After shodhana karma for remaining doshas Shamana chikitsa should be followed
in the form of lepa (External application). As vicharchika is a disease of twak, so
samprapti occurs in twacha. Hence Alepana should be carried out after shodhana. The
alepana drugs should have ushna, teekshna and katu rasa for removing the morbidity in
twacha.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 110
DISCUSSION ON VIRECHANA KARMA
DEFINITION OF VIRECHANA :
The process of elimination of morbid doshas through Adhobhaga is said to be
Virechana.
While telling the definition of Vamana and Virechana Acharya Charaka quotes
the same term ‘Virechana’ for the both procedures, because they expell out the doshas
from the body. But here the word ‘Virechana’ is indicated for the procedure which
expelled out doshas through guda marga which is termed as Virechana karma, while in
Vamana karma doshas are expelled out through mukha marga. So here the word
Virechana is not suit for Vamana karma.
Though Vāmaka and Virechaka dravyās possess similer properties such as Ushna,
Teekshna, Sukshma, Vyavāyi, Vikāsi, they act in a very different pattern, due to their
Panchabhautika configuration and Prabhava .
MODE OF ACTION OF VIRECHANA DRAVYĀS:
Generally when we speak about the mode of action of any Shodhana dravya, it
has been stated as the prabhāva rather than guna. In the context of Virechana , not only
prabhāva but the properties of Virechana dravyās namely Vyavāyi, Vikāsi, Sukshma,
Ushna and Teekshna plays an important role to bring the mala rupi doshās which are
adherent in the shākhās are brought back to kostha from where the doshās collected in the
kostha are eliminated by the adhobhāgāhāra property.
A hypothetical effort is made to understand the overall activity of the Virechaka
dravya.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 111
When Virechana dravyas are administered, the properties of dravyās are rapidly
absorbed due to the Vyavāyi guna. When the properties are rapidly absorbed and spread
all over the shareera, the Vikasi starts to produce its action by loosening the adhesions of
the doshās and dhātus for which it needs to be penetrated deep into the sukshma srotas,
for this the anutva bhāva of Sukshma guna i.e. which helps in deep penetration, supports
the action of Vikāsi guna. When the dhātu bandhana has been loosened the Teekshna and
Ushna gunas acts at the level of minute channels by fascilitating the sanghāta bhedhana
i.e. breaking up of the complex morbid matter into the simpler form, later the Ushna guna
helps in the pāka of the malās and to liquefy, which fascilitates easy drainage of the
shakhāgata liquefied malās to the kostha. Bringing back of these doshās to kostha is
actively achieved only by the ‘pravanatva bhāva’ of Sukshma guna.
Thus from the above consideration, we can understand that the gunās of
Virechana dravyas plays a major role in accompanishing the task of bringing the
shākhāgata dosha to kostha, unless and until the process of Virechana will not be
satisfactory. Hence we can state that along with the adobhāga hara prabhāva the gunas of
Virechana dravyas are very much essential.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 112
VIRECHANA VIDHI:
POORVA KARMA: In poorva karma Deepana-Pachana, Snehana and Swedana are to
be done.
Deepana-Pachana: In this disease doshas are in ama condition, so the patient has to be
subjected for Deepana-Pachana. It is done to enhance Agni and to attain niramavastha. So
that the sneha may be properly digested and appropriate snehana is accomplished.
For Deepana-Pachana Shunti churna was selected for the present study. It was
given up to 3-6 gms twice daily for 3-5 days till the appearance of nirama laxanas. As
Vicharchika is Santarpanajanya vyadhi where agni mandya and saama laxana can be
appreciated. It was observed that all the patients got nirama laxana within 2-3 days
Snehapana: Snehapana plays a vital role in any type of shodhana karma. Without proper
Snehapana doshas can not be eliminated from the body. Snehana has properties like
Vishyandana, and Kledana helps in dissolving the vitiated doshas.
Snehapana kala: Sneha should be taken at the time when the diet taken on previous
night has completely digested and there should be no sensation of appetite for the next
meal and there should be Suryodaya. So we can say the time of Snehapana is nearly 6.30-
7.30 a.m.
Usually the Snehapana is started with Hrasiyasi matra (25-30ml) to assess the
kostha of patient. After considering the kostha, the dose of sneha should be increased in
Arohana krama untill samyak snigdha lakshanas are observed.
As vicharchika is Kledajanya vyadhi Vagbhata advised ishat snehapana
(Natisnigdha) and Charaka and Vriddha Vagbhata advised Madhyama matra snehapana.
But Bhavamishra advised uttama matra snehapana. Though he advised uttama matra but
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 113
samyak snigdha lakshanas are seen within 7 days because there is already klinnata in
shareera. This klinnata is refers to srava rupi vicharchika. But in ruksha vicharchika
klinnata is in grathita form. So in this condition samyak snigdha lakshanas are seen little
bit later than that of srava rupi vicharchika.
So in present study as I have taken patients of ruksha Vicharchika(Acc to
Sushruta), uttama matra snehapana was given acc to kostha in arohana krama until
samyak snigdha lakshanas were seen.
In this study after attaining niramavastha, Sneha pana ( Panchatiktaka ghrita ) was
given starting with 25-30 ml and continued for 3-7 days in arohana karma. Sneha was
digested within 6 hrs in some patients and 7-8 hrs in some patients. The dose of the
Snehapana was maximum 180ml to 210ml. Most of the patients had got samyak snigdha
lakshanas within 4-6 days, which showed that most of the patients had Madhyama
kostha. Sukhoshna jala was adviced as anupana, which is kaphahara, deepaka,
amapachaka, vatanulomaka, thus help full in proper digestion of administered sneha.
During the period of Snehapana many of the patients had the complaints of excessive
itching which is due to the doshotklesha.
Swedana: Swedana plays a major role after Snehapana. It is responsible for vilayana of
doshas. Swedana dilates the channels to produce extra flow and increases fluidity by
which srotorodha diminishes.
Snehana moistures and liquefies the doshas and swedana disintegrates them. By
the action of snehana and swedana, the morbid doshas are liquefied and dissolved in
sneha and are brought to kostha. Thus the doshas gets increased and liquefied are brought
back to kostha by reliving the adhesions of dosha and reliving the obstruction of srotas
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 114
and brings the vimargagami vayu to swasthana.
Sarvanga abhyanga with Tila taila followed by bhashpa sweda was adopted for all
patients. In classics it has been explained that swedana is conra-indicated in kustha but to
liquefy the doshas and bring them from shakha to koshta mrudu swedana was adopted for
3 days.
In vishrama kala such a diet is preffered which doesn’t increase kapha, as that
may cause Vamana. So for this a state of manda kapha is described in Virechana.
PRADHANA KARMA: The person who has undergone samyak snehana and swedana,
who has been on laghu, ushna, and kapha avriddhikara ahara, who had good sleep on the
previous night and after the digestion of food taken of previous night only is permitted to
the administration of Virechana aushadhi.
According to classics Virechana should be administered just after sleshma kala.
Keeping this in mind it was administered in between 8.30 a.m to 9.30 a.m. The virechana
dravya matra was fixed according to kostha of the patient. For Krura kostha 100ml of
Triphala kashaya, for Madhyama kostha 50ml and for Mrudu kostha 25ml was given.
After administration of medicine one should observe the chaturvidha shuddhi.
CHATURVIDHA SHUDDHI NIRIKSHANA:
Actually all these four criteria viz. Āntiki, Māniki, Laingiki and Vaigiki have their
importance in whole process.
1) Vaigiki and 2) Maniki : After giving virechana aushadhi physician must count the
Vegās ( Except first 2-3 vegas as they contain only mala) and proportion of expelled
Doshās (Maniki) to decide the shuddhi prakara. Actually “Jaghanyadi Shuddhi” must be
decided for Samsarjana Krama and this is to be decided on the basis of Vega and Māna.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 115
Because the number of Vega and expelled Dosha is going to alter our body physiology
right from Agni to dhatu sāmya of all the physiological process, nourishment of body,
electrolyte balances etc. which needs to be restored by that can be planned properly based
on Vaigiki and manaki shuddhi.
In present study most of the patients had uttama vegas i.e 21-30 vegas. Though
they had uttama vega none of the patient had complained about dehydration. This showed
that there is no loss of body fluid by this Virechana karma.
2) Antiki : While carrying the process, physician’s ultimate aim should be to reach the
Āntiki condition means “Kaphāntatva” in Virechana. He should consider it as indicator of
reaching to final limit (end point). Many a times even after kaphānte laxanās are
observed, patients produces Virechana vegās which will leads in aggravation of vāta and
further lead for atiyoga janya upadravās. In order to prevent these complications one has
to be very carefull to observe the end point as kaphānta laxana and has to take appropriate
measures to cease the vegās produced after this point.
Kaphanta is a sign of Samyak Virechana. In Virechana there is sequential
elimination of Vitt, Pitta, Kapha and Vāta. Our aim is to eliminate the Pitta and up to
some extent small quantity of Kapha. That indicates the complete elimination of pitta in
an order.
All of the patients had shown kaphanta lakshana, which showed that samyak
Virechana karma was performed.
3) Laingiki: Laingiki criteria is observed to see whether our Karma has reached to our
ultimate goal of Shodhana or not, as we have to act further for treatment regimen. This
has given due importance by all Āchārya’s.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 116
As the Vegika and mānaki shuddi use only 3 stages with a vast difference in
between i.e 10 vegās for avara, 20 vegās for Madhya and 30 vegās for uttamā. This is a
greater chance for most of the patients to attain the samyak shuddhi with the different
number of vegās other than 10, 20 or 30, but we cannot wait upto achieving the said
number of vega or we cannot cease the vegās earlier attainment of shuddhi which may
lead for either atiyoga or ayoga. Hence it is very important to assess the patients with
laingiki shuddhi that means the Laxanas which will be developed in patients when they
attain samyak shuddhi. As Laingiki criteria is always accompanied by Antiki criteria, it is
explained immediately after the same. Acharya Chakrapani claims that Laingiki Shuddhi
is the only Shuddhi. Chakrapani and Dalhana both included Antiki criteria in Laingiki
criteria.
With this one has to decide the samyak shuddhi based only on laingika shuddhi as
other type of shuddhi Laxanās are having the different applicability for the fulfillment of
process.
In present study all the patients have manifested the features of kaphanta in 7-9
hours after administration of virechana dravya and it was noted that some patients shown
the symptoms of nausea and vomitting during virechana vega kala. It may be due to
excessive intake of luke warm water during digestion of medicine and may be due to
early administration of virechana yoga.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 117
PASCHAT KARMA:
SAMSARJANA KRAMA:
It is conventional to offer peyadikrama to the patient as a post-operative measure
who has undergone shodhana. During and after this process usually the Bala is reduced
and Agni becomes less. Hence usually after the Shodhana karma the normal diet is
contraindicated in order to regain the normal state of Agni and Bala of shareera.
This samsarjana krama should be started when the person feels hungry.
IMPORTANCE OF SAMSARJANA KRAMA:
Function of agni is regulated by pāchaka pitta, samāna vāyu and kledaka kapha,
which are being disturbed in shodhana process so to normalize these factors, a special
Samsarjana krama is planned. Jejjata emphasizes the need of peyādi krama by saying that
the doshas are being liquefied and reach āmāshaya. By this process of shodhana which
itself hamper the agni. The person who had undergone shodhana, the agni will gradually
increased by the peyādi krama.
In Pravara shuddhi excessive quantity of doshās are eliminated. So in this
condition agni will be weakened, which will take long time to attain normal position.
Generally in Pravara shuddhi, seven days are being considered for the normalization of
agni. Hence the Samsarjana krama is arranged in respect to type of shuddhi, means
proportion of dosha eliminated out.
Shodhana karma itself increases agni which may takes long time. It increases
systematically after following a special diet.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 118
PATHYA – APATHYA:
If a person follows pathya he does not need medicines at all and if a person
doesn’t follow pathya he doesn’t get benefit from any medicine.
The foodstuffs which are specially Ati- lavana, amla rasayukta, kshara and tila are
pitta prakopaka, rakta dustikara, kledakara leads for the manifestation of Vicharchika.
Ati- madhura, guru, snigdha ahara, guda, matsya, phanita, dadhi, navanna, dravanna etc;
are kaphakara, kledakara and abhishyandi leads to ajirna, ama and Vicharchika.
Paryushita bhojana is responsible for tridosha prakopa which directly leads to
Vicharchika.
Viharas like ati- atapa, vayu sevana, divaswapa, avyayama etc; vitiates tridosha.
Drinking of cold water suddenly after fear, exertion and intense heat causes sudden change in
body temperature and may cause vasodilation and skin disorders. The habit of scratching
over the lesion should be avoided.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 119
DISCUSSION ON MATERIALS AND METHODS
MATERIALS:
Materials: Measuring glasses, Bed pan, vessels
A) Drugs:
Shunti churna :This is a good Amadosha pachak and jataragni deepaka. Due to its
properties like katu, ushna, teekshna, laghu and agneya guna helps to digestion of ama
and also helps in restoring the agni. Hence this churna helps in attain nirama avasth,
before going to shodhana process.
It was given 3 to 6 gms twice a day before food till the appearance of nirama
laxanas
Panchatiktaka Ghrita: This is used for the purpose of Virechana purva sneha pana. Due
to sneha pana the vriddhi and vishyandana of doshas takes place.
Panchatiktaka ghrita has been selected for sneha pana in present study, because it
is specially indicated in classics for kustha. All the ingredients of it have kusthaghna
property and as it contains all tikta dravyas helps in kledashoshana, raktashodhana and in
amapachana. Ghrita is mentioned as vata pitta shamaka, rakta vikara hara, twachya etc
and has a remarkable property to assimilate the properties of other substances when are
added to it (Samskarasya Anuvarthanam). So Panchatiktaka ghrita becomes more
effective than shuddha ghrita. Considering all these points it has been selected for present
study.
Tila taila : Tila taila is twachya and kustahara so, it was used for abhyanga.
For swedana, bhashpa sweda was adopted. Though swedana is contraindicated in
Vicharchika, Mrudu swedana can be given for liquefication of the doshas. This was
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 120
performed for 3 days during vishrama kala.
By these two procedures vilayana of doshas and srotomukha vishodhana takes
place.
Triphala kwatha: For the purpose of Virechana, Triphala kwatha was used. It also
contains Trivritta churna and Danti churna as a prakshepaka dravyas. This ideal
Virecahana preparation was exclusively mentioned in Bhaishajya ratnavali in the
treatment of kustha.
As Triphala contains Haritaki, Bibhitaki and Amalaki all these 3 helps in
Virechana karma and also Danti and Trivritta. The properties of these drugs are as follow,
Haritaki - Mrudu virechaka,
Bibhitaki - Malabhedhaka and acts on rasa, rakta and mamsa dhatu
Amalaki - Sramsana karma.
Danti - Teekshna virechaka
Trivritta - Sukha virechaka
These above said properties of each drug helps in Virechana karma. So this is an
ideal virechana dravya in Vicharchika for the purpose of Virechana karma.
The uttama matra of Triphala kashaya for virechana is 2 pala i.e 100ml,
madhyama matra is 1 pala (50ml) and heena matra is 1/2 pala (25ml). According to
kostha of the patient kashaya was administered.
All the patients were given sukhoshana jala as anupana. The action of the drug
started within 1-2 hours.
Arka taila: If doshas are located in twak, raktha and mamsa, first shodhana should be
done then go for Alepana etc. Then only Alepana acts effectively and quickly.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 121
Arka taila contains three ingredients – Arkapatra swarasa, Haridra churna and
Sarshapa taila. As all these three drugs are having Kustaghna property and Haridra &
Sarshapa are having Varnya property, hence it has been selected for present study.
B) Instruments: Measuring glass was used to measure the proper dose of sneha for
sneha pana
METHODS:
Aim: A Comparative and combined Clinical study on Shodhana and Alepana (External
Application) in Vicharchika.
Source of Data: In the present study, totally 30 patients of Vicharchika excluding the
dropouts were taken for the study from OPD, IPD of Dr.B.N.M.E. Trust’s S.M.S. PG and RC
Bijapur and special camps conducted in Bijapur city by the Institute.
Study Design: It is a comparative clinical study. Patients were incidentally selected with
a predetermined randomization technique and were assigned into 3 groups i.e., Group A,
Group B and Group C.
Selection of Patients: Selection of patients for the present study was done randomly.
First 30 patients fulfilling the diagnostic criteria and inclusive criteria were selected for
the study. The patients were selected irrespective of sex, caste, occupation, socio –
economical status and with the age limit of 16–70 years.
Inclusive Criteria:
Patients of Vicharchika in the age group 16–70 years were selected for the
study. The classical signs and symptoms of Vicharchika were taken as per the Sushruta
samhita because according to Sushruta Vicharchika is a pitta– vata pradhana vyadhi, so in
this age group dominancy of pitta and vata is seen. Therefore it can be said that the
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 122
prevalence of Vicharchika is more in this age group. It is due to their occupation, stress,
environmental exposure, food habits, etc. The disease affects either sex invariably hence
the patients of either sex were selected.
Exclusive criteria: Patients presenting with sravayukta Vicharchika associated with
any other Systemic diseases were excluded.
Diagnostic criteria: In the present study the diagnosis was done based on patients
presenting with classical signs and symptoms of Vicharchika explained in Sushruta
samhita. Vaivarnya is not mentioned in Sushruta samhita but it was observed in all most
all the patients included in present study. That’s why Vaivarnya symptom was taken in
diagnostic criteria.
For the present study presence of following symptoms were selected.
1) Rekha
2) Kandu
3) Ruja
4) Rukshata
5) Vaivarnya
Sampling Method:
A pre-determined Random sampling method was adopted where in 10 cards each
marked as Group A, Group B and Group C respectively were shuffled properly. A neutral
person was asked to pick the cards one by one. The group on the card against each pick
was recorded serially from 1 to 30. After every pick the cards were reshuffled. The
patients selected randomly were assigned with serial numbers from 1 to 30. Thus the
patients corresponding to particular group which was predetermined in order were treated
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 123
according to the interventions of particular group. The technique was adopted in order to
avoid the sampling bias.
Intervention:
Group A:
1. All 10 patients were given shunti churna 3-6gm twice daily until niramavastha.
2. According to kostha of the patient panchatiktaka ghrita was given for snehapana till samyak
snigdha laxanas were seen.
3. After snehapana abhyanga with Tila taila and mridu Bhashpa swedana was done in
vishrama kala (for 3 days)
4. Patients were advised to take laghu, ushna and kapha avriddhikara ahara in the period
of virshrama kala.
5. Next day of vishrama kala between 8-8.30a.m (after passing shleshma kala) Triphala
kashaya was administered according to kostha for Virechana karma. Then observed for
chaturvidha shuddhi.
6. Lastly Samsarjana krama was adopted according to type of shuddhi.
7. Treatment duration was 18 days and advised follow up on 18 th and 33rd day.
Group B:
1. All the 10 patients were provided with a bottle containing 100 ml of Arka taila.
2. The taila application is advised with a sterilized cotton swab on the lesion twice daily
i,e morning and evening, so that it is absorbed completely and reduces the dryness.
3. After taila application playing, atapa sevana, working in the field, etc were avoided.
4. Treatment duration was 18 days and advised follow up on 18 th and 33rd day.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 124
Group C:
In this Group both Virechana karma and Alepana with Arak taila was done as mentioned
above.
After giving Virechana, in the period of Samsarjana krama Alepana with Arak taila was
done. Total treatment duration of this group was 30 days and advised follow up on 30th day and
45th day.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 125
MODE OF ACTION OF VIRECHANA KARMA IN VICHARCHIKA: Virechana karma is one of the Pradhana karma used for the elimination of vitiated
doshas from the body through ‘Adhomarga’ i,e from anus.
Condition which are suitable for Virechana karma are-
1) In diseases where pitta is predominantly vitiated.
2) In diseases where kapha is combined with pitta.
3) In cases of kapha sthanagata pitta.
4) In cases of pitta sthanagata kapha.
5) The diseases which are produced due to Rakta dusti (Raktapradoshaja vikara).
All above said conditions are present in Vicharchika. So Virechana is the best line
of treatment for Vicharchika.
Snehapana as a Purvakarma of Virechana, it self plays a supporting role to
subside symptoms like Rukshata, Ruja and some extent of Kandu in the preparatory stage
of the treatment. Both Purvakarma i.e., Snehana & Swedana has efficacy to remove
Srotobandhana and liquefy the morbid Doshas. Similarly, Doshas which are lodged in
Shakha are made to move towards Kostha by means of oleation and fomentation.
Majority of the Sneha eg. Ghrita are of animal origin and a possibility of similarity in
chemical and physiological nature to that of the cell membrane can not be ruled out. This
thus intensifies the penetration of Sneha substances through cell membrane. Cell
membrane acts as a barrier to the passage of water soluble molecules but provides free
passage to lipid and lipid soluble substances.
It can be said that Sneha reaches deep into the body tissues causing partial
rejuvenation of cell organelles and smoothening of vitiated Dosha (stagnated metabolic
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 126
wastes) and makes their elimination possible.
If Snehapana is not done and Shodhana is carried out then it destroys the tissues
of body.
With the help of Snehana and Swedana, Doshas are being liquefied; they dissolve
in Sneha and make the path for excretion by bringing them to Kostha. Heat which is
given in Swedana process reaches to subcutaneous region and through the blood conveys
heat to the whole body. On absorption it converts into thermal energy which brings about
vasodilation of subcutaneous blood vessels. On account of increased blood supply there
is speeding up of local metabolism, which is needful in Vicharchika. As a result of
vasodilation, there is increased flow of blood to affected area, so that necessary O2 and
nutritive materials are supplied and waste products are removed. Thus the process of
Swedana helps to melt the compact Doshas and helps in dragging them from various sites
to Kostha. This Swedana process is carried out along with Abhyanga in 3 days gap period
of Virechana.
Virechana Karma expels out the Doshas dragging them towards the Adhobhaga
through the Guda. Amashaya is the specific seat of Kapha and Pitta. Though Virechana is
a specific therapy for Pitta Dosha, it may also be used for eliminating Kapha Dosha.
Virechana drugs which are having Ushna, Teekshna, Sukshma, Vyavayi and Vikasi
property reaches the Hridaya by virtue of its Virya then following the Dhamani it spreads
the whole body through large and small Srotasa. Virechaka drugs by their property and
Prithvi + Jala Mahabhuta dominancy helps in eliminating the morbid humour from the
Shakha to Kshotha and then out of the body by rectal root.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 127
Vicharchika is a disease of Bahya roga marga, where vitiated dosha reaches the
twacha by circulating through Tiryakgami sira. Treatment for tiryakgami dosha according
to acharya Charaka is bringing back these morbid dosha to kostha and there after expel
them out of the body by nearest opening. This process of bringing back to dosha from
cellular level to systemic circulation and then to Amashaya is possible due to Anupravana
bhava.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 128
MODE OF ACTION OF ARKA TAILA:
Role of Alepana in kustha is as important as Shodhana. Acharya Charaka has described
lepana as sadhya siddhikaraka. Hence in present study Arka taila was selected for Alepana.
If doshas are located in twak, rakta and mamsa first Shodhana should be done and then
go for Alepana. Then only Alepana acts effectively and quickly.
Arka patra, Haridra, and Sarshapa due to their tikta rasa they are Pittashamaka and due to
laghu guna acts as kapha shamaka. They are also considered as kusthaghna dravyas and haridra
and sarshapa as varnya dravya.
As all drugs are having tikta rasa, they act on Rakta dhatu and also help for kleda
shoshana.
Thus Arka taila acts locally by snigdha, teekshna and ushna guna. It has given better
results in Rukshata by its snigdha guna and in Vaivarnya by its teekshna and lekhana properties
and also suppressed Kandu by providing counter irritation.
Hence the Alepana of Arka taila has provided better relief in Vicharchika.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 129
DISCUSSION ON OBSERVATIONS AND RESULTS:
AGE: Out of 30 patients maximum number of patients 26% (8 pts) were found in 27
– 36 yrs age group, 24% (7 pts) were in 37–46 yrs, 20% (6 pts) were in 57–70 yrs, 20%
(6 pts) were in 16–26 yrs and only 10% (3 pts) were in the age group of 47–56 yrs.
Highest incidence of Vicharchika were found in age group of 27–36 yrs and 37–
46yrs which represents the onset was more in youth and middle aged. This age is a
golden period for individuals at work when mental stress, occupation, environmental
exposure and unwholesome food were more, which are the etiological factors of
Vicharchika.
SEX: The sex wise distribution of the patients reveals that 53% (16 pts) were male
followed by 47% (14 pts) were females. But it can’t be said that the role of sex is there in
the manifestation of Vicharchika.
RELIGION: Maximum number of patients ie, 93% (28 pts) were Hindus and only 7% (2
pts) were Muslims. Geographical proportion of Hindus in the city may be the prime
reason for high incidence.
OCCUPATION: The persons from various occupations were observed in the study.
Among them others were i,e attenders, driver etc 40% (12 pts), Lecturer/Teacher were
20% (6 pts) and house wives were 17% (5 pts). This reflects that person working outside
are more exposed to environmental exposure, regular contact with allergens and lives in
polluted environment with unhygienic regimen.
SOCIO ECONOMIC STATUS: Maximum number of patients belonged to middle class
44% (13 pts) followed by lower class 33% (10 pts) and 23% were from upper class.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 130
Incidentally majority of the patients selected were from middle class, so far commenting
we need to study on large sample.
DIET: Out of 30 patients 53% (16 pts) were used to take mixed type of diet and and
47% (14 pts) were vegetarian. The distribution of patients in both the groups was almost
same, so any conclusion regarding diet can not be drawn on the basis of data.
VYASANA: The incidence of tobacco chewing and smoking were 13% (4 pts) each
respectively and 10% (3 pts) were addicted to alcohol. 64% (19 pts) were not addicted.
All these cause aggrevation of pitta dosha and may leads to Vicharchika.
KULA VRITTANTA: Maximum numbers of patients ie, 80% (24 pts) were not having
family history and only 20% (6 pts) were found with positive family history. This
confirms that genetic predisposition is responsible in some patients, but it should not be
the only criteria.
CHRONICITY: Maximum number of patients ie, 40% (12 pts) were found the history of
above 2 years chronicity, 37% (11 pts) were found in 1–2 yrs and 23% (7 pts) were found
less than one year chronicity.
This shows that more number of patients have neglected the premonitory symptoms
of Vicharchika. They thought those symptoms were due to some allergy or atmospheric
condition and took some symptomatic treatment. But due to the relapsing nature of the
disease 40% were suffered chronic nature. Onset was reported as gradual in maximum
number of patients. So, it can be said that Vicharchika is a chirakari roga.
PRAKRUTI: In the present study maximum patients ie, 33% (10 pts) of pitta–kapha
prakruti, vata–pitta 27% (8 pts), vata–kapha 13% (4 pts), pitta–vata and kapha-pitta 10%
(3 pts) each respectively and kapha-vata 7% (2 pts).
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 131
This confirms the unvariable involment of pitta followed by kapha and vata, on
the basis of dosha affinity. Any way all the three doshas were collectively responsible for
the causation of kustha.
AGNI PAREEKSHA: Among 30 patients majority ie, 43% (13 pts) were having
mandagni followed by 40% (12 pts) of teekshnagni. This shows kapha and pitta are
responsible for mandagni and teekshnagni respectively and plays major role in the
manifestation of Vicharchika.
KOSTHA PAREEKSHA: In present study majority i,e 47% (14 pts) were had mridu
kostha, 40% (12 pts) were had madhyama kostha and 13% (4 pts) were had krura kostha.
This shows the relation of agni and kostha, their influence on each other in causing
disease. The knowledge of kostha is helpful in deciding the treatment modality.
SITE AND DISTRIBUTION OF LESION: Majority of patients ie, 60% (18 pts) were
having lesion on the lower extremities, 20% (6 pts) in upper extremities and 10 % (3 pts)
on the neck/face region, 7% (2 pts) on whole body and 3% (1 pt) was having on back.
In the present study 43% (13 pts) were reported bilateral lesion and 37% (11 pts)
reported unilateral lesion. In most of the patients lesion was found on the lower
extremities. This may be due to skin folds, less muscle distributed areas and also due to
unhygienic living condition etc.
SAMYAK SNEHANA: majority of patients i.e,7 patients (35%) were obtained samyak
snigdha laxanas on 5th day, 5 patients (25%) were obtained on 4th day, 4 patients (20%)
were obtained on 7th day and 2 patients (10%) each were obtained on 6th and 3rd day
respectively.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 132
It indicates that samyak snigdha lakshanas were seen according to the kostha of
the patient. The patients who had mridu kostha, the samyak snigdha lakshanas were seen
on 3rd day, in madhyama kostha on 4-5th day and in krura kostha 6-7th day.
VAIGIKI CRITERIA : Majority of patients ie, 55% (11 pts) had uttama vegas in between
21-30 vegas, 30% (6 pts) had madhyama vegas in between 11-20 and 15% (3 pts) had heena
vegas in between 1-10.
By these observation it reveals that most of the patients had Mridu kostha.
MANAKI CRITERIA : Majority of patients i,e, 85% (17 pts) had expelled out 2-4 prastha
quantity of vitiated doshas, it indicates that almost all patients having bahudoshavastha and
purva karma was adopted properly to bring the vitiated doshas from shakha to kostha.
ANTAKI CRITERIA: All the 20 patients (100%) has shown the kaphanta laxana which
indicates that methodology adopted for Virechana karma was accurate.
LAINGIKI CRITERIA: All the 20 patients (100%) has shown the samyak yoga laxana
of Virechana karma which indicates that Triphala kashaya with Trivritta and Danti
churna as a praksepaka dravya is an ideal preparation for Virechana karma adopted in
patients suffering from Vicharchika.
SYMPTOMS: All the 30 patients (100%) had Kandu, Vaivarnya and Rukshata
respectively. 29 pts (96%) had Rekha, and 27 pts (90%) had Ruja.
Here it shows that Kandu, Rekha, Vaivarnya, Ruja and Rukshata are the cardinal
symptoms and are necessary to confirm the disease Vicharchika.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 133
DISCUSSION ON RESULTS
DISCUSSION ON RESULT RELATED OBSERVATIONS FOR INDIVIDUAL
GROUPS:
The effects of Virechana karma, Alepana (External application) and both
Virechana karma and Alepana were assessed on each cardinal symptoms of the disease.
These symptoms were assessed on the basis of scoring pattern, which was given before,
after and follow up of the treatment. These symptoms were assessed statistically in all the
3 groups.
KANDU:
After treatment in Group A, B and C Kandu was reduced remarkably with t
values (A– 6.0000, B–7.6741, C– 8.5732 ) which was statistically highly significant.
After follow up also all 3 Groups remained highly significant with t values
(A– 8.5732, B–3.8572, C– 10.5846).
RAJI:
After treatment in Group A, B and C Raji was reduced remarkably with t values
(A– 6.7080, B– 6.000, C– 9.000 ) which was statistically highly significant.
After follow up Group C and A remained highly significant with t values (C–
9.000, A– 6.128) but group B showed only significant with t value (B- 3.207). It means in
group B due to only Alepana the disease will reoccur.
VAIVARNYA:
After treatment in Group A, B and C Vaivarnya was reduced remarkably with t
values (A– 6.0018, B– 4.0249, C– 8.5732) which was statistically highly significant.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 134
After follow up Group C and A remained highly significant with t values (C–
10.5846, A– 6.3317) but group B showed only significant with t value (B- 2.4495).
RUJA:
After treatment in Group A, B and C Ruja was reduced remarkably with t values
(A– 6.0000, B– 4.7143, C– 9.0000 ) which was statistically highly significant.
After follow up Group C and A remained highly significant with t values (C–
7.9649, A– 6.091) but group B showed only significant with t value (B- 3.280).
After treatment though all the 3 groups remained highly significant but variation in t
values, Group C had more effective than Group A and B and Group A had more effect than
Group B. But in case of Kandu Group B had more effect than Group A.
After follow up Group C and A remained highly significant but Group B showed only
significant. But in case of Kandu it showed highly significant result.
By seeing the above results we can conclude that, there is a recurrence of disease in
Group B due to only shamana chikitsa in the form of Alepana.
Hence it can be inferred that the combined effect i.e Virechana karma followed by
Alepana is more significant than individual groups.
OBSERVATIONS FOR INDIVIDUAL GROUPS:
Group A: After Virechana karma highly significant results were seen in Kandu, Raji
Vaivarnya and Ruja. After follow up also there was a highly significant results were seen
in all symptoms. Compared to after treatment, after follow up shown better results. But in
case of Raji after treatment shown better result than after follow up.
Discussion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 135
Group B: After Alepana with Arka taila highly significant results were seen in Kandu,
Raji, Vaivarnya and Ruja. After follow up Raji, Vaivarnya and Ruja shown only
significant result but Kandu remained highly significant.
Group C: After both Virechana karma and Alepana with Arka taila highly significant
results were seen in Kandu, Raji, Vaivarnya and Ruja. After follow up also they remained
highly significant. Compared to after treatment, after follow up shown better results. But
in case of Ruja after treatment shown better result than after follow up.
DISCUSSION ON OBSERVATIONAL VARIABLE: (RUKSHATA)
The patients of Group A, B and C have showed better results in Rukshata. Group A and
C had showed better results after follow up where as Group B had showed after
treatment. Compared to Group A and B, Group C is more effective and Compared to
Group B, Group A is more effective in Rukshata.
Conclusion
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 136
CONCLUSION 1. For Virechana karma Triphala kwath with Trivritt and Danti churna as a prakshepaka
dravya has shown good effect in Vicharchika.
2. Both Virechana karma and Alepana are effective in Vicharchika. But compare to
Alepana Virechana is more effective in controlling the recurrence of disease.
3. Virechana karma followed by Alepana with Arka taila provides highly significant
results than individual groups.
4. Lower extremities are more prone to be affected by Vicharchika.
5. Most of the patients were reported in the chronic stage of Vicharchika. Negligence
in early stage and recurrence of Vicharchika is common phenomenon.
Recommendations For Future Study
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 137
RECOMMENDATIONS FOR FUTURE STUDY
1. A study may be undertaken with repeated shodhana by means of Virechana
karma, so as to elicit its effect in Vicharchika.
2. Similar study may be undertaken by prolonging the duration of post-treatment
follow up.
3. This study may be undertaken along with other Shodhana measures like Vamana
and Raktamokshana.
Summary
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 138
SUMMARY
The study entitled “A Comparative and Combined Clinical Study on
Shodhana and Alepana (External application) in Vicharchika” Comprises of
different sections ie, Introduction, Objectives, Review of Literature, Materials and
Methodology, Observations and Results, Discussion, Conclusion and Further
recommendation.
Introduction briefs about the prevalence of Vicharchika, reason for selecting the
procedure like Virechana karma and Alepana ( External application).
Objectives put forwarded for the study were laid down and defined.
The Review of Literature consists of – Rachana and kriya shareera of twak.
Regarding Rakta its- etymology, definition, formation, importance, shuddha rakta
lakshana, vitiating factors, dusta rakta lakshana, etc has been mentioned.
Disease review consists of historical aspect, etymology, definition, nidana
panchaka, sadhyasadhyata and chikitsa.
Karma Review consists of historical aspect of Virechana karma, Etymology,
Definition, Classification, Indications & Contra indications for Virechana and Purva,
Pradhana & Paschat karma of Virechana Karma.
Drug review consists of detailed description of the drugs which are used in
clinical study with their Rasapanchaka.
In methodology, detail description of the procedures adopted for the present
research was discussed.
This was a comparative clinical study; patients were incidentally selected with
predetermined randomized technique and were assigned into 3 groups.
Summary
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 139
Group A – Virechana karma
Group B – Alepana with Arka taila
Group C- Virechana karma and Alepana with Arka taila.
The symptoms were analyzed and assessed on the basis of prefixed index of
clinical assessment given to each symptom before treatment, after treatment and at the
end of the follow up.
The observations included, age, sex, occupation, prakruti, agni, kostha, vyasana,
kulaja-vrittanta, distribution of lesion, observations regarding Virechana karma etc. The
statistical analysis was done to all the observations and has been represented in the form
of tables and graphs.
Discussion describes the interpretation of the title of the study, vyadhi, etc in a
chronological order based on Ayurvedic principles.
Both Group A and Group C showed highly significant results compared to Group
B with their respective procedures. In Group A and Group C Kandu, Raji, Vaivarnya and
Ruja showed highly significant results in after follow up compared to after treatment..
Where as in Group B all symptoms i.e Kandu, Raji, Vaivarnya and Ruja showed highly
significant results in after treatment and remained only significant after follow up except
Kandu. In all 3 Groups, Group C showed most highly significant result compared to other
2 Groups. In Rukshata Group C showed better result.
Conclusions were drawn on the basis of discussion on disease, observations and
results with highly significant and significant effects with respective groups.
Thus the lacuna felt in the treatment of skin diseases to a certain extent can be
obliterated with the help of Virechana karma seems to have a definite place.
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 140
BIBLIOGRAPHY
1. Taranath Tarkavachaspati, Vachaspatyam, Reprint ed, Varanasi,
Chaukhamba Sanskrit Series office, 2006, vol-5: 4294 pp.
2. Bahadur Radha kanta deva., Shabda Kalpa Druma, Reprint ed., Delhi, Naga
publishers, 2002, vol-4: 420 pp.
3. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 86 pp.
4. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 651 pp.
5. Shrikanthamurthy.K.R, Sharangadhara Samhita, 6th ed, Varanasi, Chaukhambha
Orientalia, 2006 : 17 pp.
6. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 203 pp.
7. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 179 pp.
8. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 680 pp.
9. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 121 pp.
10. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 20 pp.
11. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 20-22 pp.
12. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed, Varanasi: Chaukhambha Surabharati Prakashan 2003:170pp.
13. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 127 pp.
14. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 131 pp.
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 141
15. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 704 pp.
16. Shrikanthamurthy.K.R, Sharangadhara Samhita, 6th ed, Varanasi, Chaukhambha
Orientalia, 2006 : 205 pp.
17. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 33 pp.
18. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 651 pp.
19. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 202 pp.
20. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 688 pp.
21. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003:519 pp.
22. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 261 pp.
23. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 92 pp.
24. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 93 pp.
25. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 269 pp.
26. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 94 pp.
27. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 85 pp.
28. Shrikanthamurthy.K.R, Sharangadhara Samhita, 6th ed, Varanasi, Chaukhambha
Orientalia, 2006 : 205 pp.
29. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 142
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 677-688 pp.
30. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 217 pp.
31. Saxena.Nirmal, Vangasena Samhita, 1st ed, Varanasi, Chaukhamba Sanskrit
Series office, 2004, Vol-2 : 1125 pp.
32. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 677 pp.
33. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 678 pp.
34. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 678 pp.
35. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 95-96 pp.
36. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 207 pp.
37. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 208 pp.
38. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 705 pp.
39. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 267 pp.
40. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 705 pp.
41. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 705 pp.
42. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 209 pp.
43. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 679 pp.
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 143
44. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 266 pp.
45. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 679 pp.
46. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 265 pp.
47. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 680 pp.
48. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003:518 pp.
49. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 267 pp.
50. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003:523 pp.
51. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 705 pp.
52. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003:521 pp.
53. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 595 pp.
54. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 264-265 pp.
55. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 705 pp.
56. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 705 pp.
57. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 144
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 95 pp.
58. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 651 pp.
59. Bahadur Radha kanta deva., Shabda Kalpa Druma, Reprint ed., Delhi, Naga
publishers, 2002, vol-2: 161 pp.
60. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 524 pp.
61. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 216 pp.
62. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: pp.
63. Shrikanthamurthy.K.R, Sharangadhara Samhita, 6th ed, Varanasi, Chaukhambha
Orientalia, 2006 : 39 pp.
64. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 451 pp.
65. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 254 pp.
66. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 524 pp.
67. Prof.Sharma.P.V, Bhela samhita, Reprint ed, Varanasi, Chaukhamba
Vishwabharati 2003: 330 pp.
68. Yadunandana upadhyaya, Madhava nidana, Reprint ed, Varanasi, Chaukhamba
prakashana, 2007 Vol-2: 156 pp.
69. Mishra.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 522 pp.
70. Taranath Tarkavachaspati, Vachaspatyam, Reprint ed, Varanasi, Chaukhamba
Sanskrit Series office, 2006, vol-6: 4896 pp.
71. Bahadur Radha kanta deva., Shabda Kalpa Druma, Reprint ed., Delhi, Naga
publishers, 2002, vol-4: 378 pp.
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 145
72. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 285 pp.
73. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 451 pp.
74. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 409 pp.
75. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 217 pp.
76. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 282 pp.
77. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 524pp.
78. Sharma.P.V. Bhela Samhita, Reprint ed, Varanasi, Chaukhambha Vishwabharati
2003: 327 pp
79. Yadunandana upadhyaya, Madhava nidana, Reprint ed, Varanasi, Chaukhamba
prakashana, 2007 Vol-2: 153 pp.
80. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 218 pp.
81. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 283 pp.
82. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 525 pp.
83. Sharma.P.V. Bhela Samhita, Reprint ed, Varanasi, Chaukhambha Vishwabharati
2003: 329 pp
84. Yadunandana upadhyaya, Madhava nidana, Reprint ed, Varanasi, Chaukhamba
prakashana, 2007 Vol-2: 156 pp.
85. Mishra.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 526 pp.
86. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 146
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 451 pp.
87. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 285 pp.
88. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 525 pp.
89. Sharma.P.V. Bhela Samhita, Reprint ed, Varanasi, Chaukhambha Vishwabharati
2003: 330 pp
90. Prof. Tiwari.P.V, Kashyapa Samhita, Reprint ed, Varanasi, Chaukhambha
Vishwabharati 2002: 116 pp
91. Yadunandana upadhyaya, Madhava nidana, Reprint ed, Varanasi, Chaukhamba
prakashana, 2007 Vol-2: 158 pp.
92. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 528 pp.
93. Bahadur Radha kanta deva., Shabda Kalpa Druma, Reprint ed., Delhi, Naga
publishers, 2002, vol-2: 667 pp.
94. Taranath Tarkavachaspati, Vachaspatyam, Reprint ed, Varanasi, Chaukhamba
Sanskrit Series office, 2006, vol-4: 3401 pp.
95. Bahadur Radha kanta deva., Shabda Kalpa Druma, Reprint ed., Delhi, Naga
publishers, 2002, vol-2: 667 pp.
96. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 355 pp.
97. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 318 pp.
98. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 337 pp.
99. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 355 pp.
100. Shrikanthamurthy.K.R, Sharangadhara Samhita, 6th ed, Varanasi, Chaukhambha
Orientalia, 2006 : 59 pp.
101. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 147
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 386 pp.
102. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 56 pp.
103. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana,
Reprint ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 101 pp.
104. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 182 pp.
105. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 278,337 pp.
106. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana,
Reprint ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 67 pp.
107. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 514 pp.
108. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 399 pp.
109. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 515 pp.
110. Taranath Tarkavachaspati, Vachaspatyam, Reprint ed, Varanasi, Chaukhamba
Sanskrit Series office, 2006, vol-6: 4784 pp.
111. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana,
Reprint ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 101 pp.
112. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani,Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 124 pp.
113. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana,
Reprint ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 356 pp.
114. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 217 pp.
115. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 148
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 282 pp.
116. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 524 pp.
117. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 124 pp.
118. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 219 pp.
119. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 452 pp.
120. Shukla.Vidhyadhara, Textbook of Kaya chikitsa, Reprint ed, Varanasi,
Chaukhamba Sursbharati Prakashana, 2000, Part-1: 34pp.
121. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 16 pp.
122. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 597 pp.
123. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 78 pp.
124. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 223 pp.
125. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 179 pp.
126. Jyotir.Mitra, Astanga Sangraha, 1st ed, Varanasi, Chaukhamba Sanskrit Series
office, 2006 : 203 pp.
127. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 125 pp.
128. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 97 pp.
129. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 149
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 452 pp.
130. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 446 pp.
131. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 442 pp.
132. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 453 pp.
133. Acharya J.T., Charaka Samhita, Ayurveda Dipika Teeka of Chakrapani, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashan 2005: 454 pp.
134. Acharya J.T., Sushruta Samhita, Nibandha sangraha Vyakhya of Dalhana, Reprint
ed., Varanasi: Chaukhambha Surabharati Prakashana, 2003: 447-448 pp.
135. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 712 pp.
136. Paradkar.H.S.,Astanga Hridayam, Sarvanga sundara vyakhya of Arunadatta,
Ayurveda Rasayana Teeka of Hemadri, Reprint ed., Varanasi, Chaukhambha
Surabharati Prakashan, 2007: 713 pp.
137. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-1:12 pp.
138. Shastri.Ambikadutta., Bhaishajya ratnavali, 11th ed. Vranasi, Chaukhamba
Sanskrit samsthana, 1993: 633-634 pp.
139. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 775 pp.
140. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 328 pp.
141. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 686 pp.
142. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 290 pp.
143. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 269 pp.
Bibliography
A Comparative And Combined Clinical Study On Shodhana And Alepana in Vicharchika 150
144. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 320 pp.
145. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 651 pp.
146. Shastri.Ambikadutta., Bhaishajya ratnavali, 11th ed. Vranasi, Chaukhamba
Sanskrit samsthana, 1993: 618 pp.
147. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 5 pp.
148. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 9 pp.
149. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 10 pp.
150. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 399 pp.
151. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 397 pp.
152. Shrikanthamurthy.K.R, Sharangadhara Samhita, 6th ed, Varanasi, Chaukhambha
Orientalia, 2006 : 129 pp.
153. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 302 pp.
154. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 114 pp.
155. Shastri.Brahmashankar, Bhava prakash, 9th ed.Varanasi, Chaukhamba Sanskrit
bhavan, 2007, volume-2: 654 pp.
I
CLASSICAL REFERENCES ÌuÉUåcÉlÉ mÉËUpÉÉwÉÉ: 1) iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉxÉÇfÉMüqÉç,
AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇfÉMÇü EpÉrÉÇ uÉÉ vÉUÏUqÉsÉÌuÉUåcÉlÉÉ̲UåcÉlÉxÉÇfÉÉ sÉpÉiÉå || (cÉ. Mü. 1/4)
2) ÌmɨÉå iÉÑ ÌuÉUåMÇü, zvsÉåwqÉ xÉÇxÉ×¹å uÉÉiÉxjÉÉlÉ aÉiÉå uÉÉ zvsÉåwqÉÉÍhÉ CÌiÉ ||
(A.xÉÇ. xÉÔ. 27)
ÌuÉUåcÉlÉSìurÉ aÉÑhÉ-MüqÉïçqÉÉWû:- iɧÉÉåwhÉ-iÉϤhÉ-xÉÔ¤qÉ-urÉuÉÉÌrÉ ÌuÉMüÉvÉÏlrÉÉæwÉkÉÉÌlÉ xuÉuÉÏrÉåïhÉ . . . . . . xÉÍsÉsÉmÉ×ÍjÉurÉÉiqÉMüiuÉÉSkÉÉåpÉÉaÉmÉëpÉÉuÉcrÉÉæwÉkÉxrÉÉkÉ: || (cÉ. xÉÇ. Mü. 1/5) ÌuÉUåcÉlÉ mÉëMüÉU:- AlÉÑsÉÉåqÉlÉ:- M×üiuÉÉ mÉÉMüÇ qÉsÉÉlÉÉÇ cÉ ÍpÉiuÉÉ oÉlkÉqÉkÉÉålÉrÉåiÉç | iÉŠÉlÉÑsÉÉåqÉlÉÇ fÉårÉÇ rÉjÉÉ mÉëÉå£üÉ WûUÏiÉMüÐ || (vÉÉ. mÉÔ. ZÉ. 4/3) xÉëÇxÉlÉ:- mÉ£üurÉ rÉSmÉYuÉæcÉ ÎvsÉ¹Ç MüÉå¹å qÉsÉÉÌSMÇü | lÉrÉirÉkÉ: xÉëÇxÉlÉÇ iÉiÉç rÉjÉÉ mÉëÉå£üÉ WûUÏiÉMüÐ || (vÉÉ. mÉÔ. ZÉ. 4/4) pÉåSlÉ:- qÉsÉÉÌSMüqÉoÉ®èÇ rɯ®qÉç uÉÉ ÌmÉÎlQûiÉÇ qÉsÉæ | ÍpÉiuÉÉkÉ: mÉiÉrÉÌiÉ rÉSè pÉåSlÉÇ MüOÒûÌMü rÉjÉÉ || (vÉÉ. mÉÔ. ZÉ. 4/5) UåcÉlÉ:- ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç | UåcÉrÉirÉÌmÉ iÉefÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ || (vÉÉ. mÉÔ. ZÉ. 4/6)
ÌuÉUåcÉMü SìurÉÉlÉÉÇ lÉÉqÉÉÌlÉ :- 1) ̧ÉuÉ×ixÉÑZÉÌuÉUåcÉlÉÉlÉÉÇ (´Éå¹) cÉiÉÑUÇaÉÑsÉÉå qÉ×SÒÌuÉUåcÉlÉÉlÉÉÇ xlÉÑMçü mÉrÉxiÉϤhÉÌuÉUåcÉlÉÉlÉÉÇ || (cÉ. xÉÔ. 25/40) 2) AÃhÉÉpÉÇ Ì§ÉuÉ×iqÉÔsÉÇ................... .........................CÌiÉ mÉëkÉÉlrÉ xÉÇaÉëWû || (xÉÑ. xÉÔ. 44/1,2) 3) ̧ÉuÉ×iÉÉÇ Ì§ÉTüsÉÉÇ SÎliÉ ................... ............................ÌuÉUåMüÉjÉïÇ mÉërÉÉåeÉrÉåiÉç || (cÉ. xÉÔ. 2/9,10)
ÌuÉUåcÉlÉ SìurÉ qÉɧÉÉ :-
II
̲mÉsÉÇ ´Éå¹qÉÉZrÉÉiÉÇ qÉkrÉqÉÇ cÉ mÉsÉÇ pÉuÉåiÉç | mÉsÉÉkÉïÇ cÉ MüwÉÉrÉÉlÉÉÇ MülÉÏrÉxiÉÑ ÌuÉUåcÉlÉÉqÉç || (zvÉÉ.E. 4/16,17)
ÌuÉUåcÉlÉ SìurÉ xÉåuÉlÉ MüÉsÉ :- vsÉåwqÉMüÉsÉå aÉiÉå fÉÉiuÉÇ MüÉå¹Ç xÉqrÉaÉç ÌuÉUåcÉrÉåiÉç || (A. WØû. xÉÔ. 18/23)
ÌuÉUåcrÉ / ÌuÉUåcÉlÉ MüqÉÉïrÉ rÉÉåarÉ :- 1)zvÉåwÉxiÉÑ ÌuÉUåcrÉÉ: ÌuÉvÉåwÉxiÉÑ MÑü¹ euÉU .............. ...................... ÌuÉvÉåwÉåhÉ UÉåaÉkrÉÉrÉÉå£üÉ¶É || (cÉ. ÍcÉ. 2/13)
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............... ....................... uÉÉqÉÉ¶É MÑü¹qÉåWûÉkrÉÉ || (A.
WØû.xÉÔ. 18/8,9,10)
AÌuÉUåcrÉ / ÌuÉUåcÉlÉ MüqÉÉïrÉ ArÉÉåarÉÉ: :- 1) AÌuÉUåcrÉÉxiÉÑ xÉÑpÉaÉ ¤ÉiÉ aÉÑS .................... ....................... ¤ÉÉ SÉÃhÉ MüÉå¹É: ¤ÉiÉÉSrÉ¶É aÉÍpÉïhrÉÉiÉÉ:|| (cÉ. ÍxÉ. 2/11) 2) qÉlSÉalrÉÌiÉ xlÉæÌWûiÉ oÉÉsÉ .......................... ........................ ÌuÉUåcÉrÉiÉç iÉÉlÉÉÌmÉ qÉÇS qÉÇSqÉç || (xÉÑ. ÍcÉ. 33) 3) mÉëxÉ£ü uÉqÉiÉÉå: mÉÔuÉï mÉëÉrÉåhÉÉqÉeuÉUå: ÌmÉcÉ | kÉÔqÉÉliÉæ: MüqÉïÍpÉuÉerÉÉåï xÉuÉåïrÉå iÉÑ AeÉÏÍhÉïlÉ: || (A. WØû.xÉÔ.18/7) 4) xÉëÉåiÉÉåÌuÉvÉÑή: CÎlSìrÉ xÉqmÉëxÉÉSÉå sÉbÉÑiuÉÇ qÉÑeÉÉåïÅÎalÉUlÉÉqÉrÉiuÉqÉç | mÉëÉÎmiÉ¶É ÌuÉOèû ÌmÉ¨É MüTüÉÌlÉsÉÉlÉÉÇ xÉqrÉMçü ÌuÉËU£ü¶É puÉåiÉç ¢üqÉåhÉ || (cÉ.ÍxÉ.1/17) 5) aÉiÉåwÉÑ SÉåwÉåwÉÑ MüTüÉüÎluÉiÉåwÉÑ lÉÉqrÉÉsÉbÉÑiuÉå qÉlÉxɶÉcÉiÉѹÉæ | aÉiÉåÅÌlÉsÉå cÉÉmrÉÉlÉÑsÉÉåqÉpÉÉuÉÇ xÉqrÉaÉç ÌuÉU£üÇ qÉlÉÑeÉÇ urÉuÉxrÉåiÉç || (xÉÑ.ÍcÉ.33/25) 6) ....................... rÉÉåaÉÉå uÉæmÉËUirÉå rÉjÉÉåÌSiÉÉiÉç |
(A.WØû.xÉÑ.18/39)
xÉqrÉMçrÉÉåaÉ sɤÉhÉÉÌlÉ :- xÉëÉåiÉÉåÌuÉvÉÑkSÏÎlSìrÉxÉÇmÉëxÉÉSÉæ sÉbÉÑiuÉqÉÑeÉÉåïÅÎalÉUlÉÉqÉrÉiuÉqÉç ||
III
mÉëÉÎmiÉ¶É ÌuÉOèÌmɨÉMüTüÉÌlÉsÉÉlÉÉÇ xÉqrÉÎauÉËU£üxrÉ pÉuÉåiÉç ¢üqÉåhÉ || (cÉ.xÉÇ.ÍxÉ. 1/17) ArÉÉåaÉ sɤÉhÉÉÌlÉ :-
1) xrÉÉiÉç zvsÉåwqÉ ÌmɨÉÉÌlÉsÉ xÉÇmÉëMüÉåmÉ: xÉÉU: iÉjÉÉ AaÉëå: aÉÑÂiÉÉ mÉëÌiÉzrÉÉrÉ |
iÉlSìÉ iÉjÉÉ NûÌSï: AUÉåcÉMü¶É uÉiÉÉlÉÑsÉÉåprÉÇ lÉ cÉ SÒÌuÉïËU£åü || (cÉ.ÍxÉ.1/18)
2) WØûiMÑü¤É vÉÑήUÂÍcÉiMåüvÉ:zsÉåwqĘ́ÉrÉÉå| .................................. ArÉÉåaÉsɤÉhÉqÉç|| (A.WØû.xÉÔ.18/38,39)
AÌiÉrÉÉåaÉ sɤÉhÉÉÌlÉ :- 1) MüTüÉxÉë ÌmɨɤÉrÉeÉÉÌlÉsÉÉåirÉÉ: xÉÑÎmiÉ AÇaÉqÉSï YsÉqÉ
sÉåmÉlÉÉkrÉÉ: | ÌlÉSìÉ oÉsÉÉpÉÉuÉ iÉqÉ: mÉëuÉåvÉÉ: xÉÉålqÉÉS ÌWû‚¶É
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IV
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V
CASE PROFORMA DEPARTMENT OF PANCHAKARMA
Dr. B.N.M.E.T’s Shri. Mallikarjuna Swamiji Post Graduate and Research Centre Bijapur.
Title: “ A COMPARATIVE AND COMBINED CLINICAL STUDY ON
SHODHANA AND ALEPANA ( EXTERNAL APPLICATION) IN VICHARCHIKA”.
P.G.Scholar – Dr. S.S.Wali
H.O.D – Dr. R.N. GENNUR M.D. (AYU) GUIDE – Dr. A.S. DONGARGAON M.D. (AYU) Dr. UMA. PATIL M.D. ( AYU) Dr. P.R. VASTRAD M.D. (AYU) Dr. I.P.UGAR M.D. (AYU) 1) Name of the Patient : S. No. :
2) Age : O.P.D. No. :
3) Sex : I.P.D. No. :
4) Caste : Date :
5) Occupation : Group :
6) Marital Status : Date of commencement of trial :
7) Economical status : Date of completion of trial :
8) Address :
CONCENT OF THE PATIENT I…………………………….here by willingly agree to participate in the clinical
trial on Vicharchika. I affirm that there has been no compulsion or mandatory
inducement in my agreeing to be patient of this project. Which I do on my free will. I
am convinced that it is for the benefit of science and mankind. I have been told about the
risk involved.
Signature of the Patient.
VI
1) PRADHANA VEDANA : KALAPRAKARSHA
2) ANUBANDHIVEDANA : KALAPRAKARSHA
3) ADHYATANA VYADHI VRUTTANTA :
4) PURVA VYADHI VRUTTANTA :
5) KULA VRUTTANTA :
6) VAYAKTIKA VRUTTANTA :
a. Ahara :
b. Vihara :
c. Vyasana :
d. Nidra :
e. Vyayama :
f. Rajapravrutti :
7) SAMANYA PAREEKSHA :
Dehoshma : Shvasagati :
Raktachapa : Rugna bhara :
8) SYSTEMIC EXAMINATION :
a) Respiratory system :
b) CNS :
c) CVS :
d) GIT Examination :
VII
9) ASTHA VIDHA PAREEKSHA :
a) Nadi - e) Shabda -
b) Mutra - f) Sparsha -
c) Mala - g) Drik -
d) Jihwa - h) Akriti -
10) DASHAVIDHA PAREEKSHA :
a) Prakriktaha : v/p/k/vp/vk/kp/s f) Satmyataha : pravara/madhyama/avara
b) Vikrutitaha : g) Pramanataha : pravara/madhyama/avar
c) Sarataha : pravara/madhyama/avara h) Aharashaktitaha: pravara/madhyama/avara
d) Samhanataha : pravara/madhyama/avara i)Vyayamshaktitaha pravara/madhyama/avara
e) Satvataha : pravara/madhyama/avara j) Vayataha :
11) AGNI PAREEKSHA : Manda / Teekshna / Vishama
12) KOSTHA PAREEKSH : Krura / Mrudu / Madhyama
13) SROTO PAREEKSHA :
14) STHANIKA PAREEKSHA :
i. Classical symptoms :
a) Kandu b) Raji ( Rekha)
c) Rukshata d) Ruja
e) Vaivarnya
ii.Lesion : i) Site -
ii) Distribution -
iii) Colour -
VIII
15) NIDANA PANCHAKA :
1) Hetu :
2) Purva rupa :
3) Roopa :
4)Upashaya / Anupashaya :
5) Samprapti :
a) Samprapti Ghatakas : -
i) Dosha vi) Udbhava Stana
ii) Dushya vii) Vyaktasthana
iii) Srotas viii) Vyadhi Adhisthana
iv) Srotodusti prakara ix) Vyadhi avastha
v) Rogamarga v) Sanchara Sthana
b) Samprapti :
16) VYADHI VINISCHAYA: 17) SADHYASADHYATA :
IX
GROUP-A 18) CHIKITSA KARMA : Virechana Karma A) Purvakarma -
1) Amapachana : By Shunti churna untill Niramavastha.
Dose : 3-6 gm
Assessment of Niramavastha after Amapachana ( Present (+) / Absent (-))
Sl. No.
Symptoms B T A T
1 2 3 4 5 6 7 8 9 10
Srotorodha Balabhramsha Gourava Anila Moodhata Alasya Ajeerna Nistheevana Mala sangha Aruchi Klama
2) Snehapana – By Panchatiktaka Ghrita
Days Matra Snehapana kala
Sneha Jeerna kala
Observation Samyak snigdha lakshana
B.P. Pulse Temp 1 2 3 4
5 6 7
Sneha Jeeryamana Lakshana
Day Observed Lakshana 1 2 3 4 5 6 7
Pathyapathya advised.
X
3) Sarvanga Abhyanga – By Tila taila
4) Sarvanga Swedana – By Bhaspa Sweda
Days Duration Pulse and B P
Abhyanga Swedana B T A T
1 2 3
B) Pradhana Karma :
Virechana dravya - Triphala Kwatha
Prakshepaka dravya – Danti & Trivrutta Churna
Time of administration -
Quantity -
Table showing regarding Vegas :
Observation No. of Vegas Time Pulse BP
Table showing Chaturvidha Shuddhi Lakshanas
Sl. No. Vega Vishaya Pravara Shuddhi Madhyama Shuddhi
Awara Shuddhi
1
2
3
4
Vaigiki lakshana
Manaki lakshana
Antaki lakshana
Laingiki lakshana
XI
I. Samyak Virikta Lakshanas
Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8
Laghuta Yatha Krama Vit, Pitta, Kapha, Vata Nisaranam Agni Vrudddhi Srotoshuddhi Indriya Prasad Anamayatva Vatanulomana Ayoga lakshana abhava
II. Asamyak Virikta Lakshana
Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8 9 10 11
Agnimandya Gourava Pratishyaya Tandra Chardi Aruchi Hrudaya Avishuddhi Kukshi Avishuddhi Kandu Vitsangha Mutrasangha
III. Ativirikta Lakshana
Sl.No. Symptoms Present ( +) Absent ( - )
1 2 3 4 5 6 7 8 9 10 11 12 13
Supti Angamarda Klama Vepathu Tamaha Pravesha Hikka Trushna KP rahita shweta udaka nihsarana KP rahita lohita udaka nihsarana Mamsa dhavanavat udaka srava Balabhava Murcha Bhrama
Shuddhi Prakara :
XII
c) Paschat Karma – Samsarjana Krama –
Day Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi
1st Morning
Evening
Peya
Peya
Peya
2nd Morning
Evening
Peya
Peya
Peya
Vilepi
Vilepi
Yusha
3rd Morning
Evening
Vilepi
Vilepi
Vilepi
Akruta yusha
Mamsarasa
Normal diet
4th Morning
Evening
Vilepi
Akruta yusha
Kruta yusha
Akruta mamsarasa
5th Morning
Evening
Kruta yusha
Kruta yusha
Kruta mamsarasa
Normal diet
6th Morning
Evening
Akruta mamsarasa
Kruta mamsarasa
7th Morning
Evening
Kruta mamsarasa
Normal diet
19) POST TREATMENT F/U : On 33rd day
20) PATHYA :
21) APATHYA :
22) COMPLICATIONS IF ANY :
XIII
GROUP-B
18) CHIKITSA – Alepana (External Application)
Method - Alepana
Drug - Arka taila
Time of application - Morning and Night
Duration - 18 days
19) POST TREATMENT F/U : On 33rd day
20) PATHYA :
21) APATHYA :
22) COMPLICATIONS IF ANY :
XIV
GROUP-C
18) CHIKITSA : After virechana karma Alepana should be followed
Virechana karma
A) Purvakarma -
1) Amapachana : By Shunti churna untill Niramavastha.
Dose : 3-6 gm
Assessment of Niramavastha after Amapachana ( Present (+) / Absent (-))
Sl. No.
Symptoms B T A T
1 2 3 4 5 6 7 8 9 10
Srotorodha Balabhramsha Gourava Anila Moodhata Alasya Ajeerna Nistheevana Mala sangha Aruchi Klama
2) Snehapana – By Panchatiktaka Ghrita
Days Matra Snehapana kala
Sneha Jeerna kala
Observation Samyak snigdha lakshana
B.P. Pulse Temp 1 2 3 4
5 6 7
Sneha Jeeryamana Lakshana
Day Observed Lakshana 1 2 3 4 5 6 7
XV
Pathyapathya advised.
3) Sarvanga Abhyanga – By Tila taila
4) Sarvanga Swedana – By Bhaspa Sweda
Days Duration Pulse and B P
Abhyanga Swedana B T A T
1 2 3
B) Pradhana Karma :
Virechana dravya - Triphala Kwatha
Prakshepaka dravya – Danti & Trivrutta Churna
Time of administration -
Quantity -
Table showing regarding Vegas :
Observation No. of Vegas Time Pulse BP
Table showing Chaturvidha Shuddhi Lakshanas
Sl. No. Vega Vishaya Pravara Shuddhi Madhyama Shuddhi Awara Shuddhi 1
2
3
4
Vaigiki lakshana
Manaki lakshana
Antaki lakshana
Laingiki lakshana
XVI
I. Samyak Virikta Lakshanas
Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8
Laghuta Yatha Krama Vit, Pitta, Kapha, Vata Nisaranam Agni Vrudddhi Srotoshuddhi Indriya Prasada Anamayatva Vatanulomana Ayoga lakshana abhava
II. Asamyak Virikta Lakshana
Sl.No. Symptoms Present ( +) Absent ( - ) 1 2 3 4 5 6 7 8 9 10 11
Agnimandya Gourava Pratishyaya Tandra Chardi Aruchi Hrudaya Avishuddhi Kukshi Avishuddhi Kandu Vitsangha Mutrasangha
III. Ativirikta Lakshana
Sl.No. Symptoms Present ( +) Absent ( - )
1 2 3 4 5 6 7 8 9 10 11 12 13
Supti Angamarda Klama Vepathu Tamaha Pravesha Hikka Trushna KP rahita shweta udaka nihsarana KP rahita lohita udaka nihsarana Mamsa dhavanavat udaka srava Balabhava Murcha Bhrama
Shuddhi Prakara :
XVII
c) Paschat Karma – Samsarjana Krama –
Day Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi
1st Morning
Evening
Peya
Peya
Peya
2nd Morning
Evening
Peya
Peya
Peya
Vilepi
Vilepi
Yusha
3rd Morning
Evening
Vilepi
Vilepi
Vilepi
Akruta yusha
Mamsarasa
Normal diet
4th Morning
Evening
Vilepi
Akruta yusha
Kruta yusha
Akruta mamsarasa
5th Morning
Evening
Kruta yusha
Kruta yusha
Kruta mamsarasa
Normal diet
6th Morning
Evening
Akruta mamsarasa
Kruta mamsarasa
7th Morning
Evening
Kruta mamsarasa
Normal diet
Alepana (External Application)
Method - Alepana
Drug - Arka taila
Time of application - Morning and Night
Duration - 18 days( It should be started in the period of
Samsarjana Krama)
19) POST TREATMENT F/U : On 45rh day
20) PATHYA :
21) APATHYA :
21) COMPLICATIONS IF ANY :
XVIII
GRADINGS FOR THE SUBJECTIVE VARIABLES :
Sl.No Scoring Assessment
Normal Grade (G1)
Mild Grade (G2)
Moderate Grade (G3)
Severe Grade (G4)
1 Kandu No kandu Occasional Kandu (+)
Intermittent Kandu (++)
Continuous Kandu (+++)
2 Rekha No Rekha Superficial Rekha (+)
Deep Rekha (++)
Deep rekha withredness (++)
3 Ruja No Ruja Occasional Ruja (+)
Intermittent Ruja (++)
Continuous Ruja (+++)
4 Vaivarnya No Vaivarnya
Brownish red Discolouration (+)
Blackish red Discolouration (++)
Blackish Discolouration (+++)
ASSESSMENT PARAMETERS WITH THEIR GRADINGS :
Sl. No. Symptoms BT AT PTFU
1 Kandu
2 Rekha
3 Rukshata
4 Ruja
ASSESSMENT OF OBSERVATIONAL VARIABLE :[present(+)/ slight
reduction(s.r)/absent(-)
Variable BT AT PT F/U
Rukshata
Signature of Scholar Signature of Staff
Group A
BEFORE TREATMENT AFTER TREATMENT
Group B
BEFORE TREATMENT AFTER TREATMENT
Group C
BEFORE TREATMENT AFTER TREATMENT
SHUNTI CHURNA PANCHATIKTAKA GHRITA
TILA TAILA TRIPHALA KWATHA
TRIVRITT CHURNA DANTI CHURNA
ARKA TAILA