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“A comparative clinical study of ‘Siddharthaka yoga’ ‘Parisheka’ and
‘Abhyantara prayoga’ in the management of ‘Kitibha kushta’ with the
special reference to ‘Psoriasis’”.
By
Ashok M.G. Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfilment of the degree of
Ayurveda Vachaspati M.D. In
Kayachikitsa Under the Guidance of
Dr. Raghavendra V. Shettar M.D. (Ayu)
Department of Kayachikitsa Post Graduate Studies & Research Centre
D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2005-2008
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103
Certificate
This is to certify that the dissertation entitled “A comparative clinical study of
‘siddharthaka yoga’ ‘parisheka’ and ‘abhyantara prayoga’ in the management of
‘kitibha kushta’ with the special reference to ‘psoriasis’” is a bona fide research work
done by “Ashok M.G.” in partial fulfilment of the requirement for the post graduation
degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University
of Health Sciences, Bangalore, Karnataka.
Dr. Raghavendra V. Shettar
M.D. (Ayu) Guide
Asst. prof. in P.G, Dept. of kayachikitsa DGMAMC. PGS. & RC., Gadag.
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE
GADAG, 582 103
Endorsement by the H.O.D, Principal/ head of the institution
This is to certify that the dissertation entitled “A comparative clinical study of
‘siddharthaka yoga’ ‘parisheka’ and ‘abhyantara prayoga’ in the management of
‘kitibha kushta’ with the special reference to ‘psoriasis’” is a bona fide research work
done by “Ashok M.G” under the guidance of Dr. R.V Shettar, M.D. (Ayu) Asst.
professor in P.G, Dept. of kayachikitsa, DGMAMC, PGS&RC, Gadag, in partial
fulfilment of the requirement for the post graduation degree of “Ayurveda Vachaspati
M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka.
.
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date: Place:
Prof. and HOD
P.G. Dept of Kayachikitsa DGM Ayurvedic Medical College,
Gadag Date: Place:
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “A
comparative clinical study of ‘siddharthaka yoga’ ‘parisheka’ and
‘abhyantara prayoga’ in the management of ‘kitibha kushta’ with the
special reference to ‘psoriasis’” is a bona fide and genuine research work
carried out by me under the guidance of Dr. R.V. Shettar, M.D. (Ayu),
Asst. professor in post graduate department of Kayachikitsa, DGMAMC,
PGS&RC, Gadag.
Date:
Place:
(Ashok M.G)
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and disseminate
this dissertation/ thesis in print or electronic format for the academic /
research purpose.
Date:
Place:
(Ashok M.G.)
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgement
I wish to express my deepest gratitude first to my guide Dr. Raghavendra V.
Shettar, M.D. (Ayu), Asst. Prof. for his timely advises and encouragement during this
research work and for his inspirational clinical knowledge.
I express my gratefulness to my professor Dr. V. Varadacharyulu, M.D.(Ayu),
who was former H.O.D. of the department and my former guide
I express my gratitude to Prof. Dr. K. Shiva Rama Prasad, M.D. (Ay), M.A. (Jyo)
Ph.D. (Jy), for his timely advises and encouragement during the coarse of this research
work..
I express my thankfulness to my beloved principal Dr. G. B. Patil, for his
encouragement and support by providing all necessary facilities for this research work.
I extend thankfulness to my inspirational teacher Dr. M.B. Gururarja M.D. (Ayu),
who was prime reason for my academic career since my under graduation, also I thank
Dr. B.S. Shreedhar, M.D. (Ayu), prof and HOD, Dept of Panchakarma, GAMC,
Bangalore for all his supports.
I extend deepest gratitude to Dr. Jitendra Shetty, Managing Director, Prakruti
Remidies Pvt. Ltd, Karwar who has extended his support for the study whole heartedly
by providing the required trial drug free of cost. His support is appreciated at the
highest level.
I give my respect at this moment to my father Sri M.G. Chandrashekharappa,
my mother Smt G Sarvamangala for their blessings which gave me enough strngth. I
thank my elder brother Sri. Basavanagowda C.G. and Smt. Asha Basavana gowda
for thier continuous encouragement. I thank my brother Mr. Nagaraja M.G. for his
affection. I thank my brother in law Sri. Siddanagowda G.K. and his family for their
concern.
I extend my sincere thanks to Dr.B.M Mulkipatil. Dr. Kuber Sankh, Dr.
Yasmeen P., Dr. Nidagundi, and Dr. M. D. Samudri who supported me by providing
the patients, I am thankful to Dr. M.C.Patil, Dr.Danappagoudar and Dr. Jagadeesh Mitti
who provided facilities for the trial drug preparation in the college pharmacy with their
valuable suggestions.
I express my sincere thanks to Sri. Nandakumar for his help in statistical
analysis of results. I take the privilege to thank Sri. Mundinamani, Librarian. I also
extend my thanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided me
all the necessary books and time for my literary work.
I am very much thankful to Sri Tippanagowdar, and Sri. Kallanagouda, for their
help during the study. I extend my thaks to Sri Kulakarni and Mr. Manju for their
timely help.
I feel immense pleasure thank my seniors Dr. Kishore Kumar Hullatti, Dr.
Venkatakrushna, Dr. Venkaraddi, Dr. Kalmath, Dr. Satish Rao, Dr. G.G. Patil and others.
I give deepest acknowledgement to my friend Dr. Basavanth Kumar M.V.Sc. who
is kind to me since my school days. I extend my thankfulness to Dr. Abhishek N.Y. for
being so nice to me.
I thank my fellow colleagues Dr. Shivaleela Kalyani, Dr. Kamalakshi,
Dr. Sulochana, Dr. Shekhar, Dr. Ashwini, Dr. Jayashree, Dr. Madhushree, Dr. Siba, my
junior collegues Dr. Nataraj Dr. Adarsh, Dr.Joshi, Dr. Shailej, Dr. Uday, Dr. Veena
Jigalur, Dr. Sanjeev, Dr. Neeraj, Dr. Ishwar, Dr. Praveen, Dr. Vijayalaksmi, Dr. Kanti,
Dr. Bodke, Dr. Totar, Dr.Shabareesh, Dr. Rajesh and Dr. Sanath for their support.
I thank my juniors Dr. Neeraj Gupta, Dr. Vinay B.G., and internees
Mr.Basavanyappa, Mr. Rajashekhar, Mr. Vasantha Kumar, Mr. Satish Jalikal, Mr. Satish
Angadi, Mr. Sharanu, Mr. Veeresh, Mr. Siddalinga Swamy, Mr.Asif, Miss. Sunitha M,
Miss. Vidya Chandu for their support. I thank specially Mr.Santosh and Mr.Mahantesh
for their help during the trial.
Lastly I pay my deepest respect for those patients who took part in the study and I
share my success with them.
Dr. Ashok M.G.
Abbreviations used:
C.S – Charaka Samhita
S.S – Sushruta Samhita,
A.S – Ashtanga Samgraha
A.H – Ashtanga Hrudaya
B.S – Bhela Samhita
M.N – Madhava Nidana
B.P – Bhavaprakasha
Y.R – Yogaratnakara
V.S – vangasena
Abstract:
Charaka Samhita, leading from the front, states the management of kushta
disease with two distinctive types of treatment anthahaparimarjana chikitsa and
bahirparimarjana chikitsa. The disease kitibha though not life threatening makes the
life of the sufferer miserable. The ugly appearance in this disease makes the patient
psychologically stressed more than anybody. With the fear of getting dejected from
family and society adds up to misery. Itching is the other most disturbing symptom in
this disease which is more dangerous than pain as patient continues to scratch the
body even if it is causing pain. Similarity in the signs and symptoms of psoriasis and
lakshana of kitibha kushta after a primary literary review made us more convenient to
set up the criteria and to have PASI as objective criteria.
Ayurvaeda also believes for any skin diseases topical administration of the
drug is essential. One such yoga advised to use for both internally and externally is
Siddharthaka yoga, though not advised as shamanoushadha but is advised for vamana
and virechana. Here it was taken for granted that if this yoga is administered in lesser
dose it won’t cause any adverse effects. Also the prabhava of some of the ingredients
of the yoga encouraged to try this as none of the ingredients if advised were having
any systemic toxicity. So a study was planned to evaluate its comparative efficacy in
kitibha kushta under the title “A comparative clinical study of ‘siddharthaka yoga
‘parisheka and abhyantara prayoga in the management of ‘kitibha kushta’ with the
special reference to ‘psoriasis’”.
Objectives of the study:
To evaluate the efficacy of siddharthaka yoga parisheka in kitibha kushta.
To evaluate the efficacy of siddharthaka yoga abhyantara prayoga in kitibha kushta.
To evaluate the comparative efficacy of siddharthaka yoga parisheka and abhyantara
prayoga.
Materials and Methods:
A total of 30 patients were selected from O.P.D and I.P.D. of D.G.M.A.M.C &
H after fulfilling the inclusion and exclusion criteria randomly. They were divided in
to two groups Group A and Group B. 15 patients of Group A underwent parisheka for
10 days continuously. Group B patents were advised with the abhyantara prayoga of
Siddharthaka Yoga in the form of capsules in 3 divided doses per day.
Assessment of results was done by considering the base line data of subjective
and objective parameters to pre and post medication and was compared for
assessment of the results. All the results were be analysed statistically for “P” value
using Student “t” test.
Results:
The overall results of the study were as follows;
Group A: All (15(100%)) got best response in this group.
Group B: Best response – 4 (26.66%), Moderate response – 8 (53.33%),
Mild response – 2 (13.33%) and No response – (1 6.66%). Ware the results in this
group.
Statistically all the parameters in both groups have shown highly significant.
All the parameters in Group A have shown highly significance than the Group B.
Comparative efficacy: The efficacy Siddharthaka yoga bahya prayoga is more
significant than the abhyantara prayoga.
Contents Contents Page number
1. Introduction 1
2. Objectives 4
3. Literary review 5
4. Materials and methods 60
5. Observations and results 71
6. Discussion 102
7. Conclusion 124
8. Summary 126
9. Bibliography 128
List of tables. Table no. and content Page No.
Table 01, showing the layers of twacha according to Acharya Charaka 13
Table 02, showing the Layers of twacha according to Acharya Sushruta 14
Table 03, showing correlation between twacha and skin layers 14
Table 04, showing the nidanas of disease kushta mentioned in various books. 16-18
Table 05 showing the possible reason by which individual nidana causes kushta 19
Table 06, showing the Poorvaroopa of kushta 24
Table 07 showing the roopa of Kitibha Kushta 26
Table 08 showing Maha Kushta bheda according to different authors 31
Table 09 showing Kshudra Kushta bheda according to different authors 32
Table 10 showing the analysis of the individual drug of siddharthaka yoga 55
Table 11 showing the analysis of the individual drug of siddharthaka yoga 56
Table 12 showing the distribution of patients age group 72
Table 13 showing the distribution of patients according to sex 72
Table 14 showing distribution of patients by Religion 73
Table 15 showing distribution of patients by Economical status 74
Table 16 Showing distribution of patients by Occupation 75
Table 17. Showing distribution of patients by Nature of work 75
Table 18. Showing distribution of patients by Matra of ahara 76
Table 19. Showing distribution of patients by Kala of ahara 77
Table 20. Showing distribution of patients by Rasa 77
Table 21. Showing distribution of patients by Guna of ahara 78
Table 22. Showing distribution of patients Type of diet 79
Table 23. Showing distribution of patients by Vyasana 79
Table 24. Showing distribution of patients by Hygiene 80
Table 25. Showing distribution of patients by Manaska sthiti 80
Table 26. Showing distribution of patients by observed nidana in no & % 81
Table 27. Showing distribution of patients by observed poorvaroopa in the
study in Group A patients
82
Table 28. Showing distribution of patients by lakshanas observed. 82
Table 29. Showing distribution of patients by anubandha vedana observed. 82
Table 30. Showing distribution of patients by site of onset 83
Table 31. Showing distribution of patients by mode of onset of the disease 83
Table 32. Showing distribution of patients by aggravation time 84
Table 33. Showing distribution of patients by aggravation season 84
Table 34. Showing distribution of patients by Kula vruttanta 85
Table 35. Showing distribution of patients by Chikitsa vruttanta 85
Table 36. Showing distribution of patients by confirmatory signs 86
Table 37. Showing demographic data in patients of in Group A 87
Table 38. Showing demographic data in patients of in Group B 87
Table 39 Showing Lakshanas of kitibha kushta in Group A 88
Table 40 Showing Lakshanas of kitibha kushta in Group B 88
Table 41 Showing Confirmatory signs in psoriasis Group A 89
Table 42 Showing Confirmatory signs in psoriasis Group A 89
Table 43 Showing Anubandha vedana of kitibha kushta in Group A 90
Table 44 Showing Anubandha vedana of kitibha kushta in Group B. 90
Table 45 Showing the observed features of the nature of kitibha kushta in Group A 91
Table 46 Showing the observed features of the nature of kitibha kushta in Group B 92
Table 47 Showing the observed vaiktika vruttanta in Group A 93
Table 48 showing the observed vaiktika vruttanta in Group B 93
Table 49 showing the rogi pareekshain Group A 94
Table No. 50 showing the rogi pareekshain Group B 94
Table 51 showing the Nidana observed in Group A 95
Table 52 showing the Nidana observed in Group B 96
Table No. 53 showing poorvaroopas observed in Group A 97
Table 54 showing poorvaroopas observed in Group B 97
Table 55 Showing assessment of grading of subjective and objective parameter values of Group – A
98
Table 56 Showing assessment of grading of subjective and objective parameter values of Group – B
99
Table 57 Showing t Statistical analysis of parameter values of Group – A 100 Table 58 Showing t Statistical analysis of parameter values of Group – B 100 Table 59 Showing Statistical analysis of parameters values of inter Group (Group – A and Group – B)
101
Table 60 Showing the overall statement of results of Group A 119 Table 61 Showing the overall statement of results of Group B 120
List of Figure Figure Page no
Figure no 01 shows the samprapti flow chart in general. 29
figure no 2 showing the anatomy of normal skin 42
Figure no 03 showing dermal vasculature of normal skin and psoriatic skin 44
Figure no 04 showing ingredients f siddhrthaka yoga. 52
Figure no 05 showing materials used in the study 59
Figure no 06 showing step wise dhara procedure 67
Figure 07 showing distribution of patients by age 72
Figure 08 showing distribution of patients by sex 73
Figure 09 showing distribution of patients by religion 74
Figure 10 showing distribution of patients by Economical status 74
Figure 11 showing distribution of patients by occupation 75
Figure 12 showing distribution of patients by nature of work 76
Figure 13 showing distribution of patients by matra of ahara 76
Figure 14 showing distribution of patients by kala of ahara 77
Figure 15 showing distribution of patients by rasa 78
Figure 16 showing distribution of patients by gune of ahara 78
Figure 17 showing distribution of patients by type of diet 79
Figure 18 showing distribution of patients by vyasana 79
Figure 19 showing distribution of patients by hygine 80
Figure 20 showing distribution of patients by manasika sthiti 80
Figure 21 showing distribution of patients by site of onset 83
Figure 22 showing distribution of patients by mode of onset 83
Figure 23 showing distribution of patients by aggravation time 84
Figure 24 showing distribution of patients by aggravation season 85
Figure 25showing distribution of patients by kula vruttana 85
Figure 26 Showing distributions of patients by chikitsa vruttanta 86
Figure 27 showing distribution of patients by confirmatory signs 86
Figure 28 Showing the overall statement of results 118
Introduction
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
1
Introduction
Acharya Agnivesha, the all time intelligent scholar of Ayurveda, the science
of life notes down the preaching of Adhyupadeshta Punarvasu Atreya in the form of
doctrine to become popular later as Charaka Samhita after the addition from the
experience of Acharya Drudhabala and redactation of Acharya Charaka. This is the
only doctrine honored & referred over centuries. The redactor Acharya Charaka
viewed the river of medicine, raising from an obscure past, ever flowing, ever
growing and racing to the flood waters of today. He had urged us to learn from
greatest sages as well as shepherds; both are the teachers in their own way 1.
Entire Charaka samhita deals the subject keeping in mind the concept of
chikitsa. This attitude is seen from the chapter number one. He discusses the types of
chikitsa as of Antahparimarjana and Bahirparimarjana types. After dealing the entire
chapter about panchakarmaroopa anathparimarjana chikitsa, he dedicates
Aragwadeeya adhyaya 2 for bahirparimarjana chikitsa especially for the disease
Kushta. This shows the importance of treating kushta, a deergha roga 3 after its
thorough understanding. He further says performing bahirparimarjana chikitsa yields
sadhya siddhi 4.
For the first time in the entire history of medicine the disease Kitibha Kushta
is cited from Charaka Samhita 5 where choorna pradeha is advocated over the tailakta
gatra.
It is evident after going through different classical texts of Ayurveda that
Kushta, a noted mahagada 6 requires multiple route of administration of drugs. Two
such different modalities are antahparimarjana and bahirparimarjana chikitsa. One
such yoga mentioned for the use in both route is Siddharthaka snanokta aushadha
siddha kashaya.
Introduction
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
2
Kitibha kushta simulating to the disease Psoriasis in the contemporary system
of medicine results in the fear of getting dejected from the society because of the
appearance of the body. Kandu, Shyava kina and khara sparsha and scratching the
body in the public by the patient creates an enormous psychological stress over the
diseased and kandu is more miserable than the pain because patients don’t stop
scratching the body even though it causes pain so it is postulated clinically that the
itching is stronger symptom in any patient. Hence the management of kandu, shyava
kina and khara sparsha is the need of the hour in kitibha sufferer. The utility of drugs
of modern science like methotrexate, which is still of ‘gold standard’ has increased
risk of bone-marrow toxicity and hepatotoxicity. This gives an edge of advantage to
Ayurveda over the modern system of medicine to help the sufferer with its non toxic
medicament, also suffer is compelled to seek prescription from an Ayurvedic
physician.
The ingredients of Siddharthaka snana yoga was estimated to suit the demands
as the drugs of the compound are blessed with kushtaghna and kandughna property.
Most of these drugs are included in kushtaghna and kandughna gana which are set as
an example for the physician to proceed their thoughts basing on these 7. This yoga
was taken for the study to draw a comparative efficacy of the drug under the title “A
comparative clinical study of ‘siddharthaka yoga ‘parisheka and abhyantara
prayoga in the management of ‘kitibha kushta’ with the special reference to
‘psoriasis’”.
The study included a total of 30 subjects divided randomly in to two groups as
A and B. 15 patients of group A received the bahirparimarjana chikitsa in the form of
parisheka. As stressed by the all time great physician of Ayurveda Acharya Charaka
to administer external therapy for better efficacy over Tailakta gatra 8, taila was
Introduction
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
3
preapared using the same ingredients. Though snana is told in the Samhita, for
hospital supervision the procedure was modified to parisheka. The other set of 15
patients received antahparimarjana chikitsa in the form of capsules. The subjects were
selected from OPD and IPD of D.G.M.A.M.C. and hospital, Gadag.
The entire study was done to evaluate the efficacy of Siddharthaka yoga by
duly considering the clinical signs and symptoms as subjective parameter and PASI
scoring as objective parameter. The subjective and objective of base line data to pre
and post medication was compared for the assessment of the results. All the results
were analysed statistically for ‘p’ value by using un-paired test to analyse the mean
effect of two groups, and paired‘t’ test was used to compare the effect of drug by
assuming that the drug is not responsible for the changes in the observation before and
after the treatment.
Objectives
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
4
Objectives
The objectives of the study were;
1. To study kushta disease with special reference to kitibha kushta simulating
to psoriasis in detail.
2. To study the properties and mode of action of ingredients of ‘siddharthaka
yoga’ in kitibha kushta.
3. To study the therapeutic procedure parisheka and its role in the
management of kitibha kushta
4. To evaluate the efficacy of siddharthaka yoga parisheka in kitibha kushta.
5. To evaluate the efficacy of siddharthaka yoga abhyantara prayoga in
kitibha kushta.
6. To evaluate the comparative efficacy of siddharthaka yoga parisheka and
abhyantara prayoga.
Literary review
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
5
Literary review
Historical review:
Ayurvedic literature:
The science of life, Ayurveda was developed on the base of Vedas
only hence the Indian system of medicine is also devine. This auxiliary of Atharva
veda is said to be the perfect since the time of its inception. It is important to study the
subject of Ayurveda i.e. from primitive state and the recession at a particular stage – it
must be viewed as a part of our cultural history and cultural history must be studied in
relation to the social history against the background of historical evolution of India.
The reason behind development and decline will then come to our notice.
The nidana panchaka except lakshanas of kitibha kushta are not told in any of
the texts of Ayurveda. Hence the samanya nidana, poorvaroopa, upashaya and
samprapti of Kushta are considered in the entire study.
Charaka Samhita
Agnivesha samhita is now known as Charaka samhita, after the handy
contribution from Acharya Charaka, the greatest redactor in the world history of
literature. This was compiled in the second century B.C. The disease kushta is dealt
with the great importance as is evident from the fact that the treatment of kushta is
dealt in the very third chapter of the samhita where the external therapeutics are
explained for the disease.
The disease kushta is dealt in two broad headings as Maha kushta and kshdra
kushta and are told as seven and eleven types respectively. Kitibha is dealt under the
second variety of lesser important type of kushta in chikitsa sthana.
Literary review
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
6
The other parts of the book where the disease kushta is explained are as
follows;
a) Chardhi nigrahana is told to manifest the disease kushta 9
b) Kushta is told as bahya marga roga 10.
c) It is advised with madhyama matra of sneha 11.
d) Is told as nija shotha karana 12.
e) Classification of kushta is told as 713.
f) Langhana is adviced for twak dosha 14.
g) Kushta is told as santarpanottha vyadhi 15.
h) This disease is told as raktadushtijanya roga 16.
i) Kushta is told as shreshta deergha roga 17.
j) Atilavana rasa sevana leads to kushata 18.
k) Tikta rasa is told as kushtahara 19.
l) Is told as resultant of viruddhaharajanya roga 20.
m) Is counted as raktapradoshajanya vikara 21.
n) Pancha nidana of kushta is detailed with explanations of
mahakushta 22.
o) Adhishtana of kushta is told as chaturtha tamra nama twak 23.
p) Kushta arishta lakshanas are told in indriya sthana 24.
q) References of kithibha kushta lakshanas are available in chikitsa
sthana 25.
r) The dosha pradhanyata of kitibha kushta is told as vata kapha 26.
Sushruta samhita
This doctrine of Ayurvada counted under bruhatrayee was written by Acharya
Sushruta basing on the preaching of Divodasa. This is the book which has dealt both
Literary review
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
7
the types of kushta in the nidana sthana counting kitibha kushta in ksudra kushta.
Some of the references available regarding kushta are;
a) Pratisarana kshara is told for Kushta 27.
b) Kushta is told as papajanya roga28.
c) Is counted under Aupasargika roga along with jwara, shosha and
netrabhishyanda 29.
d) Saptadhatugata kushta lakshanas are told in this book 30.
e) Kushta is told as hereditary (streepumsa shukrashonitajanya) i.e.
adibala pravrutta vyadhi 31.
f) Sadhyasadhyata of the kushta is told based on the basis of dhatu
involvement 32.
g) Kushta is told as mahagada33.
h) Kushta adhishtana is told as 5th layer i.e. vedini, the thickness of
which is 1/5th of a vreehi danya 34.
i) Varjya and pathya is dealt in detail in this samhita 35.
j) The predominant dosha involved in kitibha kushta is told as pitta.
Bhela samhita:
The work of Acharya Bhela, the student of Punarvasu Atreya Bhela samhita is
lost and the presently available book is not a complete one.
a) The disease kushta is dealt in nidana sthana as well as chikitsa
sthana.
b) Like Charaka Samhita he discusses kitibha kushta in chikitsa sthana
only.
c) Hareeta shakas, Madhya and pippali are told as nidanas for kushta
apart from those told in Charaka Samhita 36.
Literary review
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
8
d) Mootra and pureesha vegadharana are told as nidana for kushta
(Bhe.Chi.6/4).
e) Vartate cha samutpannam is the extra lakshana told in this book for
kitibha kushta i.e. relapsing nature 37.
Hareeta Samhita:
Achrya Hareeta is quoted to be the other disciple of Punarvasu Atreya and a
colleague of Acharya Agnivesha.
He had also counted 18 number of kushta but he had not used the word
Kitibha, he might have used kina kushta for it 38.
Kushta is said to be papodbhava according to the author.
Kashyapa Samhita:
This book is as old as Charaka Samhita and Sushruta Samhita perhaps even
more so is obtained in mutilated form, missing preface, conclusion and some other
portions. Like Atreya in Charaka Samhita and Divodasa in Sushruta Samhita, the
original preceptor of this Samhita is Acharya Kashyapa. Young Jeevaka had
condensed the teachings of Kashyapa to be known later as Kashyapa Samhita or
Vruddha Jeevakeeya Tantra.
Kushta is dealt in kushta chikitsadhyaya of chikitsa sthana. The extra
information availed from this is pipasa as a purvaroopa of kushta.
Prashanti cha punaha utpadhyate is extra lakshana told for kitibha kushta 39.
Ashtanga Samgraha: Acharya Vagbhatta’s compilation work on the basis of
Charaka Samhita and Sushruta Samhita had dominated the readers in the recent time
as it avails the information of two different schools of thoughts in one single book.
This book gives the definition of Kushta. He mentions bahya kushta
samprapti. Both maha and kshudra kushtas are dealt in nidana sthana only. Medogata
Literary review
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
9
kushta and there after are told told as yapya and asadhya respectively. Pittaja,
dwandwaja and asra mamsagata kushta are told as krucchrasadhya. The vata kaphaja
kushta notably are told as sukhasadhya 40. The chikitsa aspect of the disease is dealt in
chikitsa sthana.
Ashtanga Hrudaya:
The other book almost consisted versions of Ashtanga samgraha out of the pen
of Laghu Vagbhatta is very famous in the southern part of the country for its poetic
way of writing.
Acharya Laghu Vagbhatta conveys krimi as nidana of kushta 41. He explains
the sequential progressive involvement of loma to tarunasthi if kushta is untreated 42.
He had followed the version of Acharya Sushruta in the context of Chikitsa sutra
explanation.
Madhva Nidana:
The worth book referred for the pathophysiology of the diseases in Ayurveda,
is the work of Acharya Madhavakara. He with little contribution of his own had
compiled mostly the versions of bruhattrayees. He had followed Charaka Samhita and
Ashtanga Samgraha for the explanation of nidana and lakshanas, while he followed
Acharya Sushruta in explaining saptadhatugata kushta.
Sharngadhara Samhita:
Damodara soota Sharngadhra’s work is the choice of book to be referred for
the pharmacology and therapeutics in Ayurveda. While dealing the classifications of
vyadhis he says kushta is of 18 types, including the kitibha kushta 43. He contributes
with new formulations for kushta disease by calling those set as kushtaghna 44.
Literary review
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kusta
10
Basavarajeeyam:
The author who hails from south India is very special because he gives a list of
herbo-mineral formulations for every disease. He had added kandu as a lakshana of
kitibha to the version of Acharya Charaka. He is the first author to indicate
formulations for individual types kushta. He advocates Vajrapani rasa for kitibha
kushta 45.
Vaidhya Jeevanam:
The poet cum Ayurveda Acharya is special because of his contributions of
effective yogas and poetic explanation of their efficacy. One eg of such yoga is found
in 4th Vilasa 18th shloka 46.
Bhavaprakasha:
Bhavamishra son of Latakana Mishra had written a book concentrating more
of the herbs explaining their properties. He also had written Chikitsa of various
vyadhis prevalent in madhyama kala. He followed Acharya Charaka in explaining
kushta, in addition he told arishta lakshanas47, includes nisha in the pathya sevana 48
and he advises kaishora guggulu for kushta 49.
Sahasra yoga:
The book written by an anonymous author belonging to Kerala state is an
important asset. The entire book comprises only the formulations for various diseases
in different forms. In each prakarana there are kushtaghna yogas. The therapeutic
index of this book is undoubtedly a part and parcel of the prescription in the
practitioners of this part of the country.
Nirukti
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
11
Nirukti and paribhasha of kushta:
The word kushta is originated from kush – katana (kuda pratyaya) 47 means; to
deform the twacha (kusha nishkarsha), to change the colour of twacha
(kushnatyangam), to discontinue the integrity of twacha (kutsitam tishtati). Also the
etymology of the word kushta is from the root ‘kush’ meaning; that which comes
from inner part, after adding hani to kush it becomes kushta 48. The meaning can be
concluded as the condition in which there is hani to the twacha especially to its
appearance as the factors like rakta, laseeka, ambu and tridoshas from inner part of the
body reach the outer most part of the body being skin which exactly matches with the
samprapti of kushta.
Ashtangakaras were first to define kushta as “twacha kurvanti vaivarnya
dushtaha kushtamushanti tat ||” 49, meaning the condition in which there is
discolouration and dushti of twacha. The discontinuity of the twacha is resulted in this
disease.
Further the same author says; once the condition is allowed to lapse by time, it
makes the entire body to look ugly. It spreads to all the dhatus, resulting in the
increase of the kleda in the body because of which sankotha of twacha occurs leading
to utpatti of sookshma krimi inturn. These krimis later invade loma, twak, snayu,
dhamani and tarunasthi in an order 50.
Nirukti
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
12
Nirukti and paribhasha of kitibha kushta:
The word meaning of kitibha is kesha keeta 51. Shri Kavirama Umeschandra
says it as kesha koti 52. Kitibha in English is a louse (a parasitic insect, pediculus
humanus, infecting the human hairs and skin and transmitting various diseases) and a
kind of exanthema 53. Condensing all these, the definition of kitibha can be
summerised as ‘a diseased condition in which the twacha gets discoloured like kesha
keeta (blackish brown), or a condition in which the skin gets afflicted with kesha
keeta.’ The same meaning is also told by Shri Tarakanath as, kitiriva bhati
krushnatwat i.e. a condition where the skin gets krushna varna like kiti, the kesha
keeta 54. As for as the present understanding of the disease kitibha kushta is known,
the first explanation of similarity in the colour of the kesha keeta holds good where as
we don’t find any krimi affecting the twacha as per the second opinion.
Twacha shareera
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
13
Twacha Shareera.
Twak is the simulating term used for skin in the modern anatomy. It
invaginates and covers the entire structures of human body. Covering the entire body,
has a surface area of 1.5 2 sq. m., weighs about 4-5 kg making almost 7% of the total
body weight. Thus it is told as sthira and bahala by Ayurveda 55.
The twak is upadhatu of mamsa produced in the intrauterine life 56. Twacha is
the moola of mamsavaha srotas 57. The 7 layers of twak are formed when shukra and
shonita are subjected for the paka by doshas and the layers are formed just like the
formation of santanika after boiling the ksheera 58. But Ashtanga samgrahakara says
that the 6 layers of twacha are formed out of processing of asruk 59. Twak is the place
for tactile sensation 60 and is made up of vayu mahabhuta predominantly 61, 62 this is
also the site of bhrajaka pitta, the factor responsible for the digestion of the external
application of medicaments 63, 64, the seven and six laters according to Acharya
Charaka and Acharya Sushruta are shown in table no. 01 and 02 indicating their
features.
Table 01 showing the layers of twacha according to Acharya Charaka 65
Sl.no. Layer Features
01 Udakadhara Bahya twacha, protects the jaleeyamsha
02 Asrugdhara Holds the rakta
03 Truteeya Adhishthana of sidma, and kilasa kushta.
04 Chaturtha Adhishthana of dadru kushta.
05 Panchamee Adhishthana of alaji and vidradhi.
06 Shashtee If incised it causes severe pain and leads to tamah pravesha.
Causes sthula moola arumshikas over sandhis which are
asadhya to treat.
Twacha shareera
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
14
Table 02 showing the Layers of twacha according to Acharya Sushruta 66
Sl.no. Layer Measurement Features 01 Avabhasini 1/18th vreehi Varna and chaya prakashaka, sidma and
padmakantaka rogadhisthana 02 Lohita 1/16th vreehi Tilakalaka, vyanga and nyaccha roga
adhishthana. 03 Shweta 1/12th vreehi Charmadala, ajagallika & mashaka
rogadhishtana. 04 Tamra 1/8th vreehi Vividha kilasa kushtadi rogadhishtana. 05 Vedinee 1/5th vreehi Kushta visarpa adhishtana. 06 Rohinee Vreehi
pramana Granthi, apachee, arbuda, shleepada and galaganda.
07 Mamsadhara Vreehi dwaya Bhagandhara, vidradhi and arsha rogadhishtana.
Dr. Bhaskar Govind Ghanekar has written hindi commentary over Sushruta
Samhita by name ‘Ayurveda Rahasya Deepika’ which is best referred for the
comparison of Ayurveda shareera to the modern anatomy. He is honored so much
because he himself has studied both modern science and Ayurveda academically. His
correlations are shown in the table no. 03.
Table 03, showing correlation between twacha and skin layers 67
Sl.no. Layer Comparison of twacha to skin layer of modern anatomy
Twacha(skin layer)
01 Avabhasini Horney layer Bahya twacha
(epidermis) 02 Lohita Stratum lucidum 03 Shweta Stratum granulosum 04 Tamra Molphigian layer
Antah twacha (dermis)
05 Vedinee Papillary layer 06 Rohinee Reticular layer 07 Mamsadhara Subcutaneous tissue and muscular layer Relation between twacha and dosha, dhatu and mala:
Dosha: Vata: sparshanendriya is the adhishtana vata 68, 69 and samana vata is present
in swedavaha srotas 70 which in turn is present in twacha.
Pitta: bhrajaka pitta is present in twak digesting the external applications and
reflecting chaya in the skin 71.
Twacha shareera
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
15
Kapha: No direct reference is available regarding the presence of kapha in
twacha, but is believed to contribute the snigdhata and mardavata to the skin.
Dhatu: Rasa: the sara of rasa dhatu is assessed by looking in to the skin and the
romas 72, twak roukshata is the sign manifested in the rasa kshaya 73, shaithya is
generated as a result of rasa dhatu vruddhi 74 hence it is postulated that twacha is
nourished by rasa dhatu and it is responsible for the maintenance of the temperature of
the body in its normalcy.
Rakta: varna prasada and sparsha gnana 75 are told as the karma of rakta
hence rakta is also present both physiologically and anatomically in the twacha. After
going through rakta rogas a notion can be evolved that whenever there is rakta dushti
the site of manifestation is twacha, the rogas like kushta, visarpa, pidaka, mashaka,
neelika, tilakalaka etc. manifest. Hence it is concluded that there is definitely a
relation of dependency between twak and rakta.
Mamsa: 6 layers of twacha formation takes place from the prasada bhaga of
mamsa dhatu along with the formation of vasa and are said as upadhatus 76.
Mala: Sweda: it is said as udaka swaroopa maladravya which gets nishpatana from
the romakoopa and twak randra 77. The karya of sweda is told as maintenance of
shareera ardrata and twak soukumaryata. 78. The kshaya and vruddhi lakshanas of
sweda are manifested in the twacha only.
Nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
16
Nidana of kushta:
Study of Nidana, the cause in any research has got its importance in
understanding the disease process, and planning the treatment as nidana parivarjana
plays major part in chikitsa. It is also essential to study the literary part of nidana so as
to revalidate them to the present day and to add if some new nidanas are observed in
the course of study. In the present study the nidanas are depicted in the tabular form
and an attempt is made to quote the possible reason by which these nidanas manifest
the disease kushta. However separate nidanas are not told for kitibha kushta. The
general kushta nidanas are considered in the present study.
Table 04 showing the nidanas of disease kushta mentioned in various books79 to 87 S.N. Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S
1 Mithyahara vihara + - + + + + + + +
2 Sheetoshna vyatyasa
Santarpanaapataprpana
vyatyasa
+ - - - - + + + +
3 Madhu + - - - - + - + -
4 Fanita + - - - - + - + -
5 Matsya + - - - - + + + +
6 Lakucha + + - - - + - + -
7 Moolaka alone and or with
guda
+ + - - - + + + +
8 Kakamachi + + - - - + - + -
9 Atimatrahara + - - - - + - + -
10 Chilichima(matsya vishesha)
+ payas
+ - - - - + - + -
Nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
17
S.N Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S
11 Hayanaka,yavaka,
Chinaka,uddhalaka,
koradusha +ksheera,
dadhi,takra,kola,kulattha,
masha, atasi,kusumbha
+ - - - - + - + -
12 Vyayama, vyavaya, santapa
after consuming above said.
+ - - - - + +
13 Sheetodaka avatarana after
bhaya, shrama, santapa &
chardi,
+ - + - - + + + +
14 Aticharana of sneha + - - - - + - + -
15 Drava, snigdha , guru ahara. + - + - - - + - +
16 Vyayama after bhojana + - - - - - + - +
17 Panchakrma apachara + - - - - - + - +
18 Navanna + - - - - - + - +
19 Dadhi and other Milk
products
+ - + - - - + - +
20 Tila and tila taila + - + - - - + - +
21 Masha + - + - - - + - +
22 Madhura, amla, lavana rasa
atisevana
+ - - - - - + - +
23 Pishtanna + - - - - - - - -
24 Diwaswapa + - - - - - + - +
25 Vipra, guru, sadu gharshna
and ninda
+ - + + + - + - +
26 Papakarma + - + + - - + - +
27 Chardi vega dharana + + + - - - - - -
28 Vatayu with payas - + - - - - - - -
29 Payas with nimbu - + - - - - - - -
30 Pippali - + - - - - - - -
31 Mootra and pureesha vega
dharana
- + - - - - - - -
Nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
18
S.N. Nidana C.S B.S S.S A.S A.H M.N B.P Y.R V.S
32 Mamsa sevana alone and
with milk
- + + - - - - - -
33 Paya sevana after Madhya
and amla sevana
- + - - - - - - -
34 Ushnahara sevana after
madhu and Madhya sevana
- + - - - - - - -
35 Maithuna, vyayama &
ahitashana after sneha or
ayatharambha sneha pana
- - + - - - - - -
36 Purakruta karma - - + - - - - - -
37 Valmika roga - - - - - - - - +
Other nidanas:
Some of the other factors are also said to cause kushta in different
contexts apart from kushta nidana and kushta chikitsa chapters in the samhitas. Some
of those are compiled here under;
Acharya Laghu Vagbhatta 88 and Acharya charaka 89 says krimi as nidana of
kushta. Kushta is counted under Aupasargika roga along with jwara, shosha and
netrabhishyanda 90 so it spreads one to other on contact etc. Kushta is told as of
hereditary (streepumsa shukrashonitajanya) origin i.e. adibala pravrutta vyadhi 91.
Kushta disease is resultant of sneha vibhrama 92. When dushita rakta is made
sthambha by advising sthambhana chikitsa in raktarsha it leads to kushta 93,
sthambhana is contraindicated in raktapitta when dosha is in utklishta avastha, if it is
done in this condition it leads to kushta 94. If sangrahaka aushadha is given in
amatisara state then it leads to kushta with other diseases 95. Those who are using river
water flowing from paariyaatra, or vindhya and sahya area have always fear of getting
kushta along with shiroroga and hrudroga, 96.
Nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
19
In nidanas, the major part is occupied by the viruddha factors in terms of both
ahara and vihara. It is already cited that the disease kushta is told as
viruddhaharaviharajanya roga. In the analysis of the reason guna, karma, veerya,
vipaka, prabhava and the type of viruddha are taken in to the account. The reasons are
linked with the samprapti ghatakaslike doshas, dhatus, agni, ams, srotas etc here under
Table 05 showing the possible reason by which individual nidana causes kushta Nidana Possible reason for the manifestation of
kushta
Mithyahara vihara Is desha kala prakrutyadi viruddha & samyoga
viruddha ahara 97
Sheetoshna vyatyasa
Santarpanaapataprpana vyatyasa
Is karma viruddha, avastha viruddha & veerya
viruddha 98
Fanita Guru, abhishyandi and tridoshakrut 99
Matsya Snigdha, bahudoshakaraka, guru, ushna and
madhura 100.
Lakucha Is tridoshakara 101, samyoga viruddha with
payas dadhi mashasupa guda ghruta.102
Moolaka alone and or with guda Is jati virodhi 103, Kushtakara if milk is taken
after its consumption 104, apakwa moolaka is
tridoshakara.
Kakamachi Though shaka is kushtahara if taken with guda
it becomes ahita 105 Paryushita kakamachi is
visha which is avastha vishesha.
Atimatrahara Leads to ama dosha 106, causes durvipaka.
Chilichima + payas Causes raktaja roga, veerya viruddha107 both
are abhishyandhi 108
Vyayama, vyavaya, santapa after
consuming above said and bhojana
Karma viruddha 109
Nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
20
Nidana Possible reason for the manifestation of kushta
Sheetodaka
avatarana after
bhaya, shrama,
santapa, chardi,
Karma viruddha, vyadhi avastha viruddha. 110
Aticharana of sneha Parihara viruddha, causes kushta 111, mithya snehapana causes
kushta 112
Drava, snigdha, and
guru ahara.
Drava does prakledana i.e. increases the kledata113.kledana
shakti is snigdha so increases the sama.114, guru- guru vipaka
and upalepakaraka 115 i.e. srrotorodhaka
Panchakrma
apachara
In terms of consumption of nishiddha vishayas 116 leads to
doshotklesha
Navanna Is abhishyandhi,increases the kledata in the dosha dhatu mala
and srotas 117
Dadhi and other
Milk products
Dadhi sevana during ratri, nitya sevana, after heating, without
mudgasoopa, kshoudra, ghruta, sitopala and amalaka will
cause kushta 118
Madhura, amla,
lavana rasa atisevana
Madhra – Atyartha upayoga of madhura rasa causes so many
rogas affecting the mamsa,rasavaha srotas and other rogas by
increasing the abhishyandhi guna 119. Lavana –atiyoga causes
dhatu shithilata specially mamsa and shonita120, kota utpatti 121. Amla rasa – its atisevana causes kapha vilayana, pitta
abhivardhana, rakta dushti,mamsa vidaha, kaya shithilata122
Pishtanna Is guru than the shali 123 so kaphakaraka
Diwaswapa It increases the kandu. Srava 124
Vipra, guru, sadu
gharshna and ninda
Is prabhavajanya.
Masha Shleshma janaka 125.
Papakarma Is prabhavajanya.
Chardi vega dharana Kushtakaraka 126
Vatayu (Harina
mamsa) with payas
Samyoga viruddha
Nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
21
Nidana Possible reason for the manifestation of kushta
Payas with nimbu Samyoga viruddha 127
Pippali Pippali though told as kushtahara as a bheshaja used as
rasayana in vardhamana manner. It is said to cause kushta if
used in the form of annasamskara in excess and
continuously128 as it is guru and prakledi.
Mamsa sevana alone
and with milk
Samyoga viruddha
Paya sevana after
Madhya and amla
sevana
Viruddha 129
Ushnahara sevana
after madhu and
Madhya sevana
Samyoga viruddha 130
Maithuna, vyayama,
ahitashana after
sneha or
ayatharambha sneha
pana
Parihara viruddha 131
Purakruta karma Prabhavajanya
Tila & tila taila Panabhyasa of tila taila is twak dushtikaraka132
Poorvaroopa
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
22
Poorvaroopa:
The sets of signs and symptoms appearing prior to the disease proper
which gives a hint of forth coming disease are called as poorvaroopa. The disease
kushta also manifest completely after hinting about its complete manifestation.
These are resulted out of the dosha dushya sammurchana at the level of
sthanasamshraya of vyadhikriyakala. The advantage of the knowledge of
poorvaroopa enables the physician to be ready with the measures to combat the
forthcoming disease in advance. The table 06 shows poorvaroopa of the disease
kushta, but specific explanation of poorvaroopas of kitibha kushta are however not
explained in any of the texts.
Some of the poorvaroopas are searched for the reason for their
manifestation and are stated below;
Aswedana and Atiswedana – vata chalagunataha (swedovaha sroto avarodha and )
Parushyata – vata kharagunataha
Atishlakshanata – kapha shlakshna gunataha
Vaivarnya – rakta gunataha
Kandu – kapha karmataha
Nistoda – vata karmataha
Suptata – vata kapha – sheeta gunataha
Paridaha – pitta – ushnagunataha
Pariharsha – vata – sheeta gunataha
Lomaharsha – vata – sheeta gunataha
Kharatwa - vata kharagunataha
Ushnata – pitta ushna gunataha
Gourava – kapha – gurugunataha
Poorvaroopa
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
23
Shwayathu – kapha – srotorodha
Visarpa – vata pitta
Pradeha of mala, Sheegrotpatti chirasthiti – vata
Kota Unnati/ pidakodaya – rakta
Krushnata of asruk – vata roopataha
Shrama – vata karmataha
Adhika shoola in vrana – vata – karmataha
Klama – vata karmataha
Raga – pitta roopataha and
Pipasa – pitta.
Poorvaroopa
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
24
Table 06, showing the Poorvaroopa of kushta 133 to 141
S.N. Poorvaroopa C.S B.S S.S A.S A.H M.N B.P Y.R V.S
1 Aswedana + - + + + + + + +
2 Atiswedana + + + + + + + + +
3 Parushyata + - + - - - - - -
4 Atishlakshanata + - - + + + + + +
5 Vaivarnya + + - + + + + + +
6 Kandu + - + + + + + + +
7 Nistoda + - - + + + + + +
8 Suptata + + + + + + + + +
9 Paridaha + + - + + + - - -
10 Pariharsha + - - + - + - - -
11 Lomaharsha + + + - + - + + +
12 Kharatwa + - - + + + + + +
13 Ushnata + + - - - - - - -
14 Gourava + + - - - - - - -
15 Shwayathu + - - - - - - - -
16 Visarpa + - + - - - - - -
17 Pradeha of mala + - - - - - - - -
18 Kota Unnati/ pidakodaya
+ + - + + + + + +
19 Sheegrotpatti chirasthiti
+ - - + + + + + +
21 Krushnata of asruk - - + + + + + + +
22 Shrama + - - + + + - + +
23 Adhika shoola in vrana
+ - - + + + + + +
24 Klama + - - - - + - -
25 Raga - + - - - - - - -
26 Pipasa - + - - - - - - -
27 Dourbalya - + - - - - - - -
Roopa
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
25
Roopa:
Lakshana, roopa os linga are some of the synonyms used to denote the signs
and symptoms of any disease in Ayurveda. These are coming to the picture in a
disease scenario during the vyakta avastha of the vyadhikriyakala. The lakshanas and
the intensity of them depend on strength of dosha dushya sammurchana. The
lakshanas of the kitibha kushta are compiled from all the reliable classical texts of
Ayurveda and are shown in table number 07, page no. 27. Some of the lakshanas are
interpreted with the dosha amshamsha kalpana, basic cause of all vyadhis where ever
possible and are;
Shyava varna kina – Shyava (ishat krushna varna) kina (vranasthana) 142 is seen. So
the lesion is brownish red in kitibha kushta.
Khara sparsha of kina – the lesion is, karkasha sparsha, kathina, amrudu. The khara
word must have been used to indicate the lekhana guna 143 which scrapes out the skin
in this context.
Parushata of kina – rookshata of the twacha is always there in the kitibha kushta
because of the vata dosha.
Srava – is flow of exudates from the vrana sthana.
Vrutta – is circular shape of the vrana
Ghana / drudha – is the sthairya, kathinyata character of the vrana in kitibha kushta.
Ugra kandu – is extensive itching in the sufferers of the kitibha.
Vartate cha samutpannam – is the recurrence of the disease after its complete
disappearance.
Snigdha – is the sparsha here. But khara, parusha and rooksha is told as other signs
by rest of the Acharyas, it is therefore a contradictory statement which requires to be
understood as whenever excessive kleda guna is there at that time the snigdha sparsha
Roopa
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
26
can be elicited as kledana is the karma of none other than snigdha guna. Also when
there is relative predominance of kapha dosha in the kitibha than the vata, this may be
observed.
Krushna – is the varna of the kina again.
Rooksha – is again the dryness of the kina.
Prashantani cha punaha utpadhyate – is again the typical nature of the disease
which reoccurs completely after its disappearance.
Doshas responsible for individual lakshanas:
Shyava varna kina – vata dosha
Khara sparshata of kina – vata dosha khara gunataha.
Parushata of kina – vata kharagunataha
Srava – pitta roopataha
Ugra kandu – kapha karmataha
Snigdha – kapha snigdhagunataha
Krushna varna – vata dosha.
Rookshan – vata gunataha
Table 07 showing the roopa of Kitibha Kushta 144 to 153 S.N. Roopa C.S B.S S.S A.S A.H M.N B.P Y.R V.S K.S1 Shyava varna kina + - - - - + + + + + 2 Khara sparsha of
kina + - - + + + + + + +
3 Parushata of kina + - - + + + + + + + 4 Srava - + + - - - - - - + 5 Vrutta - - + - - - - - - - 6 Ghana / drudha - + + - - - - - - - 7 Ugra kandu - + + + + - - - - - 8 Vartate cha
samutpannam - + - - - - - - - -
8 Snigdha - - + - - - - - - - 9 Krushna - - + - - - - - - + 10 Rooksha - - - + + - - - - - 11 Prashantani cha
punaha utpadhyate - - - - - - - - - +
Samprapti
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Samprapti of kushta:
For any disease to manifest, it requires two basic things namely dasha and dhatu. The
earlier acquires later to generate certain sets of signs and symptoms. The whole process starts
with a cause as is required for any action. The understanding of this whole process is as
important as giving a prescription to the sufferer. The planning of chikitsa is told as immature
if the sutra is not followed in accordance with the samprapti ghtakas.
In the manifestation of kushta all the tridoshas are almost inevitable, further it is
believed that this disease never occurs with a single dosha involvent 154. However kushta is
classified on the basis of amshamshakalpana of dosha, samana dosha dushya prakruti. These
subtype of kushtas are told to have the predominance of either one or two dosha, rarely
tridoshas. The sapta dravyas of kushta are tridoshas, twak, mamsa, shonita and laseeka 155.
The involvement of these seven factors are seen in all the 18 types of kushta.
Acharya Charaka gives two samprapti in two different contexts one in nidana sthana
and the other in the chikitsa sthana. He explains the nidana sevana leading to tridosha prakopa
(sanchaya and prakopa of dosha) after this the doshas gets ashraya in twak, mamsa, shinita
and laseeka (prasara and sthana samshraya) causing the shaithilyata in them leading to the
manifestation of kushta (vyakta avstha of vyadhikriyakala) 156. He further says in chikitsa
sthana that vatadi tridoshas gets prakopa and does dushti of twak, rakta, mamsa and ambu
dushti leading to seven or eleven types of maha and ksudra kushta respectively 157.
According to Acharya Sushruta, vata dosha plays a major role in the manifestation of
kushta. First the vata dosha prakopa occurs later it takes increased pitta and kapha in to the
tiryag sira covering and visiating the bahya marga i.e. twak, mamsa, rakta and laseeka. After
visiating these, doshas produce mandalas whenever they get vikshepana and nissarana, further
if the condition is not managed with proper medication they invade the gambheera dhatus
resulting in the dushti 158.
Samprapti
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Acharya Bhela considers the role of ushma sannirodha in kushta samprapti. This
ushma sannirodha leads to vata dushti which later becomes cause for other dosha sanchaya.
These sthanika doshas move in to the siras to cause rakta dushti and avarodha of rakta and
mamsa. At last tridoshas causes the dushti of rakta and mamsa generating the kushta in ashu
gati. Notably Acharya Bhela does not include laseeka in the dushyas in the context of
samprapti 159.
Acharya Vruddha Vagbhatta has given samprapti in detail when compared to all the
other. Mala vriddhi takes place because of nidana sevana, these doshas then invade tiryaggata
sira visiating twacha, laseeka, asruk and mamsa. After some time tridoshas cause shlata of
twacha, laseeka, asruk and mamsa spreading inward out. At this stage there will be twacha
vaivarnya and dushti. After this stage if left untreated invade dhatus increasing the kleda
inside the body. Kleda and sweda in combination causes sankotha and utpatti of krimi
followed by bhakshana by them, this bhakshana by krimi will occur from loma, twacha,
snayu, dhamani and tarunasthi in sequence 160.
The samprapti ghatakas of kushta are mentioned here under;
Name of Samorapti ghatakas Involed Samorapti ghatakas Sthanika dosha: shleshma, pitta-vata 161. Dushya: twak, laseeka, shonita and mamsa 162. Udbhava sthana: shakha (first in twacha) 163. Sanchara sthana: tiryag sira 164. Ashaya: twak (bahya), laseeka, rakta and mamsa
165. Avayava: kevala shareera 166. Srotodushti:
raktavaha, mamsavaha and rasavaha sratas 167.
Rogamarga: bahya rogamarga 168. Roga prakruti: deerga roga 169.
All the authors have considered the involvement of samprapti ghatakas at various
levels with differences. Figure no 01 shows the samprapti flow chart in general.
Samprapti
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
29
Nidana sevana
Tridosha prakopa
Tridoshas enter in totiryaksira and make sanchara
in the dhatus
Tridosha get ashraya in twak, mamsa, shonita and
laseeka (bahya marga) causes shlata
Vikshepana and nissarana of dosha
Twacha vaivarnya
Increases kledain the body
Kleda and swedacauses sankotha
Ushma sannirodha
Vata prakopa
Dosha sanchaya
Vruddha vayu takes pitta & kapha to
tiryak sira
Tridosha moves to siras causing
raktadushti
Avarodha of rakta & mamsa
Kushta utpatti
Kushta bheda
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Kushta bheda:
All the Acharyas of bruhatrayee unanimously have accepted the
numerology of kushta as 18. Though Acharya Charaka is the first to notify the
innumerable number of kushta because of their vikara vikalpa 170 but he
classifies it as of seven and eleven respectively as maha and kshudra kushta
for the perpose of chikitsa vishesha on the basis of dosha amshamsha vikalpa,
anubandha, sthana vibhaga, vedana, varna, samsthana and prabhava 171. The
details of explanations of kushta bheda with their dosha involvement is shown
in the table no ????
The disease kitibha is placed under the kshudra variety of kushta by all
the Acharyas. Only difference found is regarding the involvement of dosha in
kitibha kushta, as Acharya Charaka and Acharya Vagbhatta says it as due to
vata and kapha involvement but Acharya Sushrutha says it as pittaja.
Kushta bheda
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Table 08 showing Maha Kushta bheda according to different authors 172-174
Mahakushtan Charaka samhita Sushruta samhita Ashtanga samgraha
Sl. No. Name Dosha Name Dosha
Name Dosha
01 Kapala Vata Kapala Pitta Kapala Vata 02 Oudumbara Pitta Udumbara Pitta Oudumbara Pitta 03 Mandala Kapha Aruna Vata Mandala Kapha 04 Rushajihwa Vatapitta Rushajihwa Pitta Rushajihwa Vatapitta 05 Pundareeka Kaphapitta Pundareeka Kapha Pundareeka Kaphapitta 06 Sidma Vatakapha Dadru Kapha Dadru Kapha 07 Kakana Tridosha Kakana Kapha Kakana Tridosha
Table 09 showing Kshudra Kushta bheda according to different authors 175-177
Kshudra kushta Charaka samhita Sushruta samhita Ashtanga samgraha Sl. Name Dosha Name Dosha
Name Dosha
01 Ekakushta Vatakapha Ekakushta Kapha Ekakushta Vatakapha 02 Charmakushta Vatakapha Sthularushka Kapha Charmakushta Vatakapha 03 Kitibha Vatakapha Kitibha Pitta Kitibha Vatakapha 04 Vipadika Vatakapha Mahakushta Kapha Vipadika Vatakapha 05 Alasaka Vatakapha Visarpa Putta Alasaka Vatakapha 06 Dadru Pittakapha Parisarpa Vata Sidma Vatakapha 07 Charmadala Pittakapha Charmadala Pitta Charmadala Pittakapha 08 Pama Pittakapha Pama Pitta Pama Kaphapitta09 Visphota Pittakapha Sidma Kapha Visphota Kaphapitta 10 Shataru Pittakapha Rakkasa Kapha Shataru Kaphapitta 11 Vicharchika Kapha Vicharchika Pitta Vicharchika Kapha
Sadhyasadhyata & arishta lakshana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Sadhyasadhyata of kushta:
For any physician success matters more than any thing, this is termed
as yasha in the texts of Indian system of medicine. The great pioneer of
Ayurveda Acharya Agnivasha and Acharya Charaka have devoted a separate
section in their book for the explanation of fatal signs and symptoms of every
disease and diseased, namely Indriya Sthana comprising 12 chapters. This
whole section gives a comprehensive hint for the physicians to disagree
patient from handling. Always the success of the chikitsa depends on which
condition the patient has approached a doctor. This is the shortest time in
which doctor has to decide whether to treat the patient or not. Our immortal
Acharyas have made our job easy by narrating the concept of sadhyasadhyata
of vyadhi. Before the start of explanation of chikitsa or after, they have briefed
about the chances of curability and incurability of a disease by citing the signs
and symptoms and giving due consideration to various facts like dosha, dhatu,
agni, bala etc.
The sadhyasadhyata of the kushta is explained as well, but however the
explanation of sadhyasadhyata of kitibha is not told separately.
Sadhya kushta: ekadosholbana kushta, vatakapha prabala kushtas are
always have a great chance of good recovery. Also if the patient is atmavan
and if the doshas have only invaded twak, mamsa and rakta there is always a
hope 178-180.
Kruchrasadhya kushta: if the dosha is vyamishra kapha pitta and
vata pitta and lone pitta, the chance of cure is always with great efdorts.
Yapya kushta: if the doshas have occupied the fourth dhatu being
meda, then patient can be free from the sufferings as long as he is taking the
Sadhyasadhyata & arishta lakshana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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medicine and following pathyahara, the moment he breaks this rule he will get
relapse of the vyadhi.
Asadhya kushta: the incurable kushta is noted by features like sarva
lingayukta kushta, sarva dosholbana, abala rogi, if has trushna, daha and
mandagni, if the lesions are krimiyukta, arishta lakshanayukta and lastly if the
doshas have reached the asthi, majja and shukra dhatus the condition should
be thought as out of our reach and treating this type of patient will always
have the risk of loosing the yasha.
Kushta arishta lakshanas: 181
The arishta lakshanas are said as pre monitory signs of death, the
observation of these in the patient of kushta disease will end the life very soon.
If a kushta rogi gets vranotpatti even on slightest injury like with grass
piece, and if that vrana is not responding to any treatment then should be
thought as prana ghataka lakshana. If he dreams as if doing yagna and yaga
after anointing with the ghruta in a place where there is no fire actually will
end his life very soon. Also if the kushta rogi dreams as if lotus flower has
grown over his uras then also the person is not going to survive for long time.
Vyavacchedaka nidana
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Vyavacchedaka nidana
Diagnosis of any disease becomes difficult when one or more diseases
mimic each other. The same is with kitibha kushta also. Our Acharyas have thus
evolved concept of vyavacchedaka nidana to overcome this confusion. They have
urged us to learn the art of differentiating the diseases on the basis of clinical
picture available. Here is an attempt made to differentiate the diseases which some
time confuse the diagnosis of kitibha kushta. Keeing some of the signs and
symptoms as criteria vyavacchedaka nidana of kitibha kushta is done.
Ekakushta: is most frequently told as psoriasis and accepted but the
absence of kandu in this disease excludes its diagnosis from kitibha vis-à-vis
psoriasis. Mahavastu, large surfaced lesion is the other which is very rarely seen
in kitibha, the psoriasis.
Alasaka: though said to have kandu differs in the colour of lesion as raga
is found in alasaka.
Dadru kushta: is also having kandu with raga and mandala is said to be
utsanna which is not so in kitibha, the psoriasis.
Charmadala: presents with kandu, sphota but has osha and chosha as
lakshana.
Pama: is said to have kandu, visphota, paridaha and appears in specific
sites as in sphik, pani, pada and kurpara i.e flexural area. Kitibha kushta does not
appear in specific sites is thus differentiated from pama.
Sidma: is another skin disease which has kandu but it appears specifically
in urdwa kaya.
Vipadika: is restricted to pani and pada.
Vyavacchedaka nidana
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Vicharchika: is said to have ruja along with simulating lakshana like
kandu and ghana of kitibha kushta. Also bahusrava is found in vicharchika which
is not found in kitibha kushta.
Chikitsa
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Kushta chikitsa
Any kushta which is manifested by the involvement of single dosha or vata
kapha involvement is amenable to treatment. All other types of kushtas are difficult to
treat. As discussed already, kushta disease can not occur without the involvement of
all the three doshas. Keeping this point strongly in the consideration our Acharyas
have told the line of treatment giving wide scope for panchakarma. The kushta
manifested by vata always mandates the consumption of ghruta and that by kapha
dosha requires vamana and that by pitta needs virechana therapy. All these should be
done by using those drugs which have kushtahara and respective doshaghna property.
Periodical advice of these procedures indicates the extent of dosha visiation in the
disease kushta.
Chikitsa is told as of three types. Antahparimarjana chikitsa is the internal
administration of the medicines in the form of aushadha and ahara in accordance with
the disease. Bahirparimarjana chikitsa is the chikitsa given to the sparshanendriya i.e.
twacha, this includes abhyanga, sweda, pradeha, parisheka, unmardhana etc therapies.
The last type is shastra praneedana including vedana, bhedana, vyadhana, dharana,
lekhana, utpatana, pracchanna, seevana, eshana, kshara and jalouka application. The
snana can also be included in the external therapy according to the definition.
The use of external therapy is always dealt with great importance, the utility of
applications, taila abhyanga, snana etc. procedures are almost inevitable in this
disease. This is because the sthana samshraya of the doshas are seen in the twacha and
the vyaktha sthana of kushta is also twacha. The treatment to the vyakta sthana is also
dealt in Ayurveda. Ayurveda believes complete treatment as; reversal of the
samprapti. Skin being the outer most part of the body is always told to be taken care
by the utility of abhyanga, udwarthana, snana, lepa, gandha dharana, maala dharana
Chikitsa
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etc. The importance of external therapy will be explained in the drug review chapter
again with special reference to the parisheka. Looking in to the large number of yogas
given by different Acharys one can understand the importance of external therapy in
the prescription of kushta. Soon after the explanation of the shamanoushadhas and
pathyapathya as many as 68 number of lepa, taila and snana yogas are explained in
the kushta chikitsa by Acharya Charaka 182 this trend of explanation is seen in all the
texts.
Pathyapathya
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Pathyapathya in kushta:
Pathtya is patho anapeta, that which is not against the srotas and priya to
manas 183. Srotas is always an important integral part of samprapti of a disease, which
needs to be corrected by the means of chikitsa. Pathya sevana along with the medicine
proper will always reduce the recovery phase of a disease. Acharya Lolimbaraja who
was known as the best poet physician was the first to explain the significance of
pathya in his work Vaidhya Chintamani. He feels that if a person knows all about
pathya then there is no necessity of taking the oushadha for the disease 184.
Pathya: the list of pathyas for a kushta are; purana shali, shastika shali, yava,
mudga, godhooma, koradoosha, shyamaka, uddhalaka, yusha prepared out of mudga
and adhaki alone or mixing with nimba patra and arushkara or with mandukaparni
avalguja, atarushaka or with sarpi and sarshapa taila or with tikta varga dravya.
Amedaska jangal mamsa if the patient is habituated to eat mamsa. Vajraka
tailabhyanga. Aragwadadi kashaya gana oushadha utsadana. For pana, parisheka and
avagaha khadhira kashaya is advised. Also neecha roma, neecha nakha, vishranta,
hitashana, oushadhatatpara, and who is yoshita, mamsa and sura varjee 185. Acharya
Charaka says the utility of tikta shakhas, laghu anna, ahara dravya processed with
bhallataka, triphala and nimba, purana dhanya, jangala mamsa yusha prepared with
mudga and patola186. Jatiphala, kakamachi, punarnava, bruhati, bhallataka,
nagapushpa, lashuna, go, khara, ushtra, mahisha mootra are the pathyas contributed
by Acharya Vishwanath Sen 187.
Apathya: Acharya Sushruta says the apathya as varjya in the context of kushta 188
Mamsa, vasa, dugdha, dadhi, taila, kulattha, masha, nishpava, ikshu, pishtavikara,
amla, viruddha, adhyashana, ajeerna, vidahi and abhishyandhi are said as varjya.
Acharya Charaka says guru, amla, payas, dadhi, anupa mamsa, matsya, guda and tila
as apathya in kushta 189.
Anatomy and physiology
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Anatomy and physiology of skin190
Knowledge of the structure, physiology, chemistry and function are essential
to understand the pathology of skin disease and also essential prerequisite to
understand the nature of disease and to plan proper treatment. Every square cm. of
skin contains 70cm. of blood vessels, 55 cm. of nerves, 100 sweat glands, 15 oil
glands, 230 sensory receptors and about half a million cells that are constantly dying
and being replaced. Thickness of the skin varies from 1.5 – 4mm. or more in different
parts.
The skin is composed of two distinct regions; 1) Epidermis and
2) Dermis.
Epidermis is a cellular layer and dermis is a connective tissue.
Epidermis has four cell type; 1.Kerationocyte (constitute 70% of tota epidermis)
2. Melanocytes
3. Langerhans cells and
4. Markel cells.
Dermis contains undifferentiated connective tissue consisting of ground
substances and collagen and elastic fibers.
Epidermis is derived from ectoderm. It is keratinizing stratified squamous
epithelium from which arises the continuous appendages i.e. pilo sebaceous follicles,
nails, apocrine and ecrine glands.
From below upwards the cellular layer of epidermis can be divided in to 4
layers or strata as basal, spinous, granular, corneal layer. These layers are considered
as successive stages of maturation of germinative keratinocytes into fully cornified
keratinocytes.
Anatomy and physiology
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
40
Dermis is strong flexible connective tissue layer. The cell type found here are
typical of those found in any connective tissue proper; fibroblasts, microphages and
occasional mast cells and WBCs. Its semi fluid matrix is embedded with collagen,
elastin and reticular fibers. The dermis binds the entire body together like body
shocking. The dermis is again two layered; papillary layer and reticular layer.
Psoriasis is a disease dealt in the diseases of keratinization in the leading
dermatological text books; hence the same is dealt in detail.
Keratinization:
The basal cells are germinative cells of the epidermis. The basal cell layer is a
rapidly dividing one. In mitosis approximately 50% of daughter cells contribute to the
growth of the epidermis (Mcka PH. Pathology of skin, 1st ed. Philadelphia: JB
Lippancott). Keratinocyte produces keratin, the fibrous protein helps give the
epidermis its protective property. They are tightly connected to one another by
desmosomes. The keratinocytes arise in the deepest part of the epidermis from a layer
of cells (stratum basale) that undergo almost continuous mitosis. As the keratinocytes
are pushed towards the skin surface by the production of new cells beneath them, they
manufacture the keratine that eventually dominates their cell contents. By the time the
keratinocytes reach the free surface of the skin they are dead. Scale like structure that
are little more than keratin filled plasma membranes, millions of these dead cells rub
off every day, giving the body a totally a new epidermis 25 - 45 days – the time from
birth of keratinocyte to its final wearing away. In healthy skin, the production of new
cell balances cell loss at the skin surface.
The kinetic of epidermal proliferation and maturation are complex.
Keratinization is a dynamic process going on at a regular speed. This process may get
Anatomy and physiology
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
41
accelerated or decelerated by injury to the dermoepidermal junction and papillary
vascular damage.
Kinetics of epidermal proliferation and maturation;
M
G1
S1
N-2 hrs N-10-20hrs
Interphase
Mitosis
N-7 hrs
G2
N-2 hrs
Psoriasis
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Psoriasis:
Greek word used to describe itchy, scaly, scabby disease of the skin 191. The
disease psoriasis is a disorder of keratinization. The roman sage Auralius Cornelious
Celsus is credited with the first clinical description of psoriasis 192. Galen first to use
the term psoriasis and Robert Willian (1808) specifically distinguished and described
psoriasis as a recognizable entity 193. Lepra vulgaris described by Willian was a
variety of psoriasis. In 1841, Hebra definitively distinguished the clinical picture from
the leprocy.
Definition:
Psoriasis is chronic non infectious, inflammatory dermatosis. Is included
under chronic inflammatory dermatosis, a condition where desquamation or shedding
of abnormal scale or salmon colored plaque is seen.
Incident rate:
Psoriasis is the most frequently cosulted case in dermatology clinic. A total of
0.1 – 3 % of the world population is estimated to suffer from this disease 194 and its
hospital prevalence was about 6% 195. In India studies reveal incidence of psoriasis
attending clinic and hospital range from 0.8 – 5.6 does not however reveal the true
prevalence in the general population 196.
Age of onset:
The onset of this disease is commonly seen in the second, third and fourth
decade of life, though it can appear soon after the birth and at old age. About 8.5 % of
Indian children were psoriatic 197. A study in Punjab showed that the age of onset
varied from 18 months to 52 years with the highest incidence in the age group of 11 to
21 years 198. The highest incidence in two other studies was in reproductive age group
Psoriasis
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44
(15 – 45 years and 11 – 40 years) 199. In a recent study, the mean age of onset for
females was found as 29.34±15.10 and in men 36.9 ± 15.10 years 200.
Familial occurrence:
A high familial occurrence of psoriasis is suggestive that the genetic factor is
key in its etiology. Thirty six per cent 2,144 psoriatics had a family history (Ferber et
al.1968) in an Indian study by Kaur et al. out of 782 patients seven per cent had
positive family history.
Sex ratio:
Its prevalence is almost equal, but it is higher in males (2.4%) than females
(0.8%) 201.
Aetiology:
The etiology of the psoriasis is poorly understood. In 1963, Gunnar Lomholtz,
a pioneer in the epidemiology of psoriasis, stated in his classic thesis that the disease
‘is capricious and refuses to part with its innermost secret’, but also wrote: ‘that is
genetically conditioned is beyond doubt’ 202. There is clearly a genetic component in
the psoriasis. Psoriasis has been linked to HLA-Cw6. Evidences also indicate a role of
T cells in the pathology of psoriasis 203.
The other important sets of causes attributed are environmental factors.
Usually when there is upper respiratory tract and streptococcal infection the disease is
precipitated. Other factors include drugs, lithium and antimalarials, and physical or
psychological stress. Excessive alcohol consumption is also associated with disease
deterioration making the management more difficult 204.
Triggering factors205:Trauma, infection (β-haemolitic streptococcal throat infection),
season especially during winter, rarely sunlight, drugs (anti malarial, β-
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
45
adrenoreceptors (βblockers), lithium) and emotions are some proved triggering factors
of paoriasis.
Pathophysiology:
Scaling, thickening and inflammation are the cardinal signs of psoriasis. These
clinical features are mirror the characteristic pathophysiological events that occur in a
lesion.
Expansion of dermal vasculature: In the early stage capillary in superficial
part of dermis are dilated with edema and perivascular exudates of lymphocytes and
macrophages that extend in to the basal part of the epidermis. The expansion of the
dermal vasculature accounts for vivid red colour of active plaques, expanded dermal
vasculature is shown in figure206.
Figure no 03 showing dermal vasculature of normal skin and psoriatic skin
Epidermal hyperproliferation: There an increase in the number of
proliferating keratinocytes in the basal layer the epidermis. This together with loss of
differentiation is responsible for the thick, silvery scale seen clinically. The growth
rate of psoriatics is up to 10 times that of normal epidermis 207. This high mitotic rate
in active lesion with prominent parakeratosis reflects the rate of replication of
epidermal cells. Normally it takes 13 days for a newly formed basal cell in the
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
46
epidermis to differentiate and travel to the surface, where it sheds off; in active
psoriasis it takes 5 days. In the normal epidermis a basal cell takes 200 hours for the
cycle; in psoriasis it takes 100 hours 208.
Accumulation of inflammatory cells: the inflammatory cells – neutrophols
and T lymphocytes in particular – accumulates in both the dermal and epidermal layer
of the skin. In evolving lesions , the lymphocytes infiltrate early in to the skin, prior to
epidermal and other changes. Psoriasis is associated with certain HLA antigens,
particularly HLA-Cw6 and HLA-B57, which are cell surface molecules critical to the
regulation of T-lymphocytefunction 209. Stimulation of immune function with
cytokines such as IL-2 has been associated with abrupt worsening of preexisting
psoriasis, and bone marrow transplantation has resulted in clearance of psoriasis 210.
Clinical features:
Psoriasis is charecterised by the devolopement of erythematous, well-defined,
dry, scaly papules and plaques of varying size. Lesions have a full rich red (salmon)
colour in the skin of Caucasians 211. Scaling, thickness and induration are varying
cardinal characteristics of all lesions. The classic symmetry, silvery scale and vivid
reddish purple color of lesion allow psoriasis to be distinguished from other skin
disorders in the majority of the cases 212. The scales are loose dry and silvery white or
micaceous due to the presence of air trapped in between the layers of the scales. On
guttate, characteristic coherence of the scales can be seen as if one scratches a wax
candle is called as candle grease sign (‘signe de la tache de bougie’), when the scales
are further scratched in those lesions where free scaling is not there will result in
capillary bleeding and the sign is called as Auspitz sign. This sign is because of
parakeratosis, intracellular edema of epidermal cells. Koebner phenomenon is
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
47
development of new fresh lesion from the site of physical trauma, the sign named
after Heinrich Koebner in 1878 213.
Classification of paoriasis: 214.
Guttate psoriasis: usually seen in children and follows an upper respiratory
infection or tonsillitis due to streptococci. Multiple ‘drop like’ lesions are typically
distributed on trunk, frequently involving natal cleft.
Plaque psoriasis: most common type is distributed bilaterally. The lesions are
stable and remain unchanged for long period. Commonly manifested areas are;
extensor surface, the elbow, knee, lumbosacral area and back. Sudden fluctuation is
observed in this type of psoriasis.
Exfoliative psoriasis: Erythema and scaling are universal and generalized.
Edema of legs may be there. Hypoalbuminaemia, increased capillary permeability and
increased central venous pressure contributes to its development.
Pustulara psoriasis: when the lesion is studded with tiny superficial, sterile
pustules, it is valled so. It is precipitated by over treatment with coal tar, anthralin or
potent steroids. Foci of infection and pregnancy and hypocalcemia may also
precipitate.
Psoriasis Ungis: the involvent of the nail in psoriatics is called so. The
common changes are pitting of nail plate, onycholy, subungual hyperkeratosis and
crumbling of nail plate. Oil drop sign is noted.
Mucous membrane lesions in psoriasis: rarely, lesions may occur on the
gingival and ventral lingual mucosa. Involvement of mucous membrane is not seen as
these epithelial surfaces are normally as rapidly proliferative as psoriatic skin.
Psoriatic arthritis: an inflammatory arthritis associated psoriasis, usually a
negative test for rheumatoid factor. It occurs in about 5-10% of patients of psoriasis.
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
48
Sites of disease involvement:
Scalp, Ears, Face, Trunk, Extremities, Genitalia and Nails are the
common sites to be examined for the lesions in psoriasis, though the whole
body skin area has to be evaluated.
Differential diagnosis: 215.
Although the diagnosis of psoriasis is straight forward, a good number
of other dermatological entities can confuse causing inconvenience for the physician.
A careful history and thorough physical examination would enable the final diagnosis.
Candidiasis: in flexural areas, peripheral pustules are characteristic of candida
infection. The presence yeast and pseudo-hyphae in Gram-stained microscopy
specimen will conferm infection.
Tinea:
Tinea capitis: hair thinning is observed,well demarketed areas of hair
loss are highly unusual in psoriasis.
Tinea corporis: lack of symmetry in the lesions, presence of
peripheral scaling and central clearing confirms tinea corporis diagnosis
Tinea cruris: cenral clearing with advanced edge. Lesions are non
silvery extends more on left than the right side.
Tinea pedis: clear vesicles are noted.
Tinea manum: fine powdery scaling in the ring worm infection of
hands along with asymmetrical presentation.
Secondary syphilis: guttate type may mimic. Search for primary syphilitic
lesion, together with lymphedenopathy, mucosal lesions in syphilis will exclude it.
Eczema: more pruritic, lack of silvery scales, skin biopsy, lack of
psoriasis elsewhere in the body.
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Neoplasms: superficial basal cell carcinoma and Bowen’s disease
(squamous cell carcinoma in situ) may appear highly suggestive of psoriasis. These
neoplasms occur singly or are fewer in number, never symmetrical and do not scale
silvery plaqyes.
Pityriasis rosea: is acute in onset, self limiting over a period 8-12
weeks produsing multiple scaly oval lesions typically in Christmas tree distribution on
trunk following rib line.
Treatment of psoriasis: 216.
Factors to consider when treating psoriasis patients
Patient perception of disease severity
Objective measures of the pattern, extent and severity of the disease.
Total amount of time the patient is devoting to therapy.
Previous details of treatments for psoriasis.
Co existing medical problems.
Topical therapy
Topical corticosteroids:
Potent topical corticosteroids (group I-V) are extremely useful. These are
applied once daily. These should not be used regularly for more than 4 weeks, potent
steroids should not be continued for more than 10 days at a stretch. Patient should be
under continuous supervision. Less than 100 g moderate or higher potency
preparations should be used per month. Corticosteroids should be used alternatively
with non steroidal therapies.
Vitamin D3 analogs: are widely used in European countries and UK as first
line of treatment in chronic plaque psoriasis. Calcipotriol ointment or cream once or
twice daily 100 g/week avoiding face and flexures is advisable. Tacalcitol ointment
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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once daily 10 g/day, for all sites is applicable. Calcitrol ointment twice daily about 30
g/day for all sited lesions yields good result.
Coal – tar: is produced by destructive distillation of coal tar. This may
suppress DNA synthesis there by reducing the epidermal hyperproliferation. Use of
coal – tar 5% solution is very effective. However coal tar of 5-15 % in combination
with topical corticosteroid such as betamethasone valerate (0.025%) is a useful topical
preparation. As this therapy produces a distinctive smell, which some patients feel
unpleasant and has got poor cosmetic acceptability. Oncogenic risk of using coal tar is
always there.
Dithronol (anthralin): is used in UK with success since last 80 years.
Dithranol mixed in zinc oxide paste of 0.1-6% and combination with other products,
such as corticisteroids.
Tezarotense: a topical retinoid (0.05% or 0.1%) is used in gel form.
Local injection of a corticosteroid: such as triamcinolone acetonide (10
mg/mL) may be given around matrix and nail bed, if nail involvement is there.
Phtotherapy:
Exposure of whole body to artificial sources of UV radiation is called
phototherapy. Phototherapy is used for the treatment of extensive psoriasis resistant to
topical therapy. Two sources of UV radiation are used to administer UVB phtotherapy
(emission spectrum of 270-350 nm).
Photochemotherapy (PUVA):
The use of photosensitizing drug, methoxsalen (0.3-0.4 mg/kg), in combination with
long-wave UVA (320-400 nm) was first reported in 1974 and this therapy is called as
PUVA. This therapy is also advised in psoriasis resistant to topical therapy. PUVA is
more beneficial for more localized type of psoriasis. Short term risk of PUVA include
Psoriasis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
51
nausea, itching and phototoxic reaction. Long term risk of PUVA includes premature
skin and skin cancer.
Systemic therapy:
If the psoriasis covers more than 10-15% of the body surface area, if it is of
severe inflammatory form, poor or no response to topical and UVB phototherapy and
PUVA the systemic therapy is advisable.
Methotrexate: has been used for more than 40 years and remains ‘gold
standard’. Complete blood count hepatitis B and C serologies, RFT, chest radiograph,
if one has received within the previous year are essential before the administration of
methotrexate. The same has to be repeated after a 7 days of test dose (5 mg). if the
result is satisfactory, the initial dose regimen for 10-15 mg/week. In UK it is usually
given in a single weekly dose. The dose can be adjusted up to 25 mg/week if result is
encouraging. The dose has to be then tapered slowly.
Systemic retinoids: etritinate and acitretin
Cyclosporine
Hydroxycarbamide
6-tioguanine
Drug affecting T-cell function: azathioprin, 6-marcaptopurin, micofinalate
mofetil and other ciclosporin-like drugs
Drug reciew
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Drug review:
Siddharthaka yoga:s
Siddharthaka yoga 217 is a unique yoga mentioned in most of the texts for
snana and internal use. The kashaya prepared out of this yoga is said to be used for
snanartha and for vamana and virechana. The ingredients of the yoga are musta,
madanaphala, triphala, karanja, aragwada, kalingayava, darvee and saptaparna. The
phalashruti of this yoga are; twagdoshahara, kushtahara, shopha hara and
pandurogaghna. The mode of its utility is in the form of kashaya for snana and
vamana and virechana, for udgharshanathe the yoga is told to be used in the chorna
form.
The literary meaning of the word siddharthaka is not told in the context. But
Acharya Charaka has used the word siddhi for the success yielded by the physicians
on administrating the proper panchakarma 218. Acharya Chakrapani, the chaturaanana
of Caraka says the meaning of siddhi as ‘vyapatsadhanani beshajani’ meaning the
oushadha that can relieve the complication 219. Acharya Charaka uses the word to
indicate the samyak parinama and saphalyam 220, the term is used also meaning
chikitsa 221. Acharya Dalhana says the meaning of siddhi as sadhana 222. Acharya
Vagbhatta has told siddhi as a agrya guna of a vaidhya, indicating rationale thinking
of a doctor as a an important quality which will bring success in him. The other word
used here is artha is used as a means. So altogether the word meaning if siddharthaka
is the means to get the success in the management of kushta, oushadha used to get rid
of the complication of the disease kushta and as a best vailable medicine to combat
kushta disease.
The fact whether the useful part of and aragwada remains same for external
therapy and internal use for vamana and virechana is not clear. All the commentators
Drug reciew
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are silent about this fact. Also the quantity of madanaphala and aragwada in the
formulation is also not specified for these two different routes of administration. The
only author who had written about this is Dr. Brahmananda Tripathi223 in Chandrika
Vyakhya commentary. According to him for snana the patra of aragwada should be
used and for virechanartha its phalamajja has to be used. The quantity of madanaphala
in the siddharthaka yoga for vamanartha should be 4 masha when compared to 2-2
masha of all the rest ingredients. For virechanartha aragwada phalamajja of 4 masha
quantity and 2-2 masha of other ingredients are advised. Further he commenting about
the same verse he says; for udgharshanartha the coarse powder should be used mixing
with sarshapa taila, for varnaka effect the sookshma choorna should be applied by
mixing with dugdhaand, for snanartha the yavakuta choorna should be immersed in
the water in the previous evening in the water and the water should be boiled and the
patient shiuld be asked to take bath with thus prepared hot water, and for snanartha all
the ingredients should be taken in 1-1 tola.
Drug reciew
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Table 10 showing the analysis of the individual drug of siddharthaka yoga 224 Sl.no Name of the
drug
Botanical
name
Family Rasa Guna Karma Veerya Vipaka Pryojyanga
01 Musta Cyperus
rotundus
Cyperaceae Tikta,katu and
kashaya
Laghu, ruksha,
grahi, teekshna
Kaphapitta shamaka,
asruk rogas hara, kruminashini,
kushtaghna.
Sheeta Katu Phala.
Patra, dugdha,
beeja
02 Madanaphala Randia dometorum
Rubiacea Madhura tikta Lekhana, laghu,
rooksha
Kaphavatahara, pratishyaya,
jwara, kushtaghna, vidradhi
and vrana hara.
Ushna Katu Phala
03 Amalaki Emblica
offcinale.
Euphorbiaceae Amla, katu
madhura,
kashaya.
Laghu. Tridoshahara, hararasayana Sheeta Madhura Phala
04 Vibhhetaki Terminalia
bellerica
Combretaceae Kashaya Sheeta
sparsharooksha,
laghu
Pitta kapha nashaka, bhedana Ushna Madhura Phala
05 Hareetaki Terminalia
chebula
Combretaceae Lavana varjita
pancharasa
Rooksha, laghu Tridoshahara, kushtaand
vaivarna hara, krumihara,
vibandhara
Ushna Madhura Phala
Drug reciew
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Table 11 showing the analysis of the individual drug of siddharthaka yoga Sl.no Name of the
drug
Botanical name Family Rasa Guna Karma Veerya Vipaka Pryojyanga
06 Karanja Pongamia
pinnata
Leguminosae Katu, tikta,
kasaya.
Laghu,
teekshna
Pittala, kaphavata shamaka,
kushtaghna,kandughna,krimi,shotha and
arshahara.
Ushna Katu Twak, patra,
beeja.
07 Aragwada Cassia fistula Leguminosae Tikta,
madhura
Guru,
sheeta,
Tridoshahara. Jwara, gulma, udara, vrana and
pramehahara
Patra-shoshana
of kapha, medas.
08 Kalinga yava Holerrhena
antidysentrica
Apocynaceae Tikta,
katu,
Grahi ,
rooksha,
anushna
Trisoshahara, kushtaghna, jwara, visarpa
hara.
Sheeta Katu Twak, beeja.
09 Daruharidra Berberis aristata
Berberidaceae Tikta,
kashaya
Laghu,
rooksha,
ushna.
Kaphapittahara, kandu, twagdosha, meha,
vrana hara.
Ushna Katu Moola, kanda,
phala.
10 Saptaparna Alstonia
scholaris
Apocynacea Tikta,
kashaya.
Laghu,
snigdha.
Kapha pitta shamaka, kushtaghna,vrana,
krimihara,raktaja rogas.
Usna Katu Twak and patra
Parisheka
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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Parisheka:
The word parisheka denotes snana 225. Acharya Sushruta uses the word repeatedly
to indicate snana by dugdha, kashaya etc. in swabhava vyadhi pratishedeeyadhaya where
rasayana is dealt in detail. Parisheka is also the term used as an equivalent word for
parisechana in the context of Shashtivranopakrama 226. This is also told as one among the
thirteen type of sweda according to Acharya Charaka 227. The procedure is detailed in the
same chapter as; the swedana dravyas like moola etc. are used for kashaya preparation
and this kashaya is then taken in a kumbha or varshanika or pranadi. This procedure is
said to yield the result when it is done after the gatra abhyanga with yathartha siddha
sneha. Acharya Chakrapani, ‘charaka chaturanana’ says that this procedure of sweda is
very much beneficial in vatakapha diseases, varshanika as alpa ghata, a small pot,
varshanika as sahasra dhara and pranadi as venunalanadyadhya 228. Acharya Vagbhatta
includes this parisheka in drava sweda along with avagaha sweda. Acharya Indu a noted
commentator of Ashtanga Samgraha says this procedure is done with the kwatha over
sarvanga or ekanga according to the need, he says pranalika as urdhwatavishta bhanda
which is a instrument used for the purpose of parisheka which is generally known as dhar
patra now a days 229. However both the authors have advised to do the parisheka after
making acchadana of gatra by vastra. The reason and the advantage are not spoken by
any author. Parisheka word is used equivalent to dhara in many of the contexts 230. The
inclusion of parisheka in the vranopakrama is used to substantiate the utility of parisheka
in kitibha kushta as kina is vrana sthana accoding to Acharya Charaka. A similarity is
given in Sushruta to convey the mode of action and utility of parisheka as; parisheka
subsides the dosha and agni responsible for paka very similarly like how ambu sinchana
Parisheka
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
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results in agni shanti 231. This statement made by the Acharya signifies the importance of
parisheka, a local treatment to avoid dosha accumulation, vrana paka and to accelerate
vrana ropana.
Materials
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
60
Materials and methods
Materials used for the study:
The materials used for the study were
1. Siddharthaka snanokta dravya siddha kashaya – for parisheka.
2. Siddharthaka snanokta dravya siddha taila – for application before parisheka.
3. Siddharthaka yoga capsules – for abhyantara prayoga.
Siddharthaka snanokta dravya siddha kashaya –
The 10 ingredients of the siddharthaka yoga; root nodules of musta, fruits of
madanaphala with seeds, fruits of amalaki (nirbeeja), vibheetaki (nirbeeja), hareetaki
(nirbeeja), karanja patra, aragwada patra, kalingayava (seeds of kutaja), daruharidra
kanda and saptaparna patra were supplied by Prakruti Remedies private limited,
Karwar, Karnataka in the raw form. The drugs were checked with the criteria
mentioned in the classical Ayurvedic texts and modern botanical parameters with
experts before using them in the study.
An approximate of 4 liters of kashaya was prepared for the parisheka daily, for
which 1 kg of yava kuta choorna was used. For this100 gram of yavakuta choorna of
each ingredient was weighed and packed for the preparation of kashaya for one day
for the convenience.
The kashaya was prepared according to Sharngadhara Samhita reference 232. A
total of 16 liters of water was taken and 1 kg of siddharthaka yoga yavakuta choorna
was added and boiled to get 4 liters of kashaya. This was then filtered and made ready
to be used for parisheka. The kashaya was prepared in the panchakarma theatre of the
hospital daily. For dhara karma, dhara patra of 4 liter capacity was used.
Materials
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
61
Siddharthaka snanokta dravya siddha taila:
A total of 15 liter of taila was prepared in the department of Rasashastra and
Bhaishajya kalpana, D.G.M.A.M.C. and H. Gadag. The taila was prepared according
to Sharngdhara Samhita 233. For this a total of 17 liters taila was taken, 68 liters of
kashaya prepared out of Siddharthaka yoga, 4.25 kg of Siddharthaka yoga kalka was
used. For the preparation of kashaya for tailapaka 17 kg of Siddharthaka yoga
yavakuta choorna, 272 liters of water was used to get 68 liters of kashaya. In a span of
two days the taila paka was completed and got approximately 15 liters of
Siddharthaka taila. This was then packed in 750 ml bottle to be used for individual
patients separately to avoid soiling.
Siddharthaka yoga capsules:
Basically the usage of Siddharthaka yoga is in the form of kashaya for
vamanartha and virechanartha. But for the present study it was modified in to capsule
form for easy dispensing and acceptability and accurate dose maintenance. A total of
2 kg (each ingredient weighing 200 g.) of vastragalita choorna was taken and
approximately 3 liters of Siddharthaka yoga kashaya was used for each bhavana (750
g. of yavakuta choorna for one bhavana), (total of 5250g. of choorna for seven
bhavanas)). It was completed in a span of seven days. The choorna was again made
vastra galita and 500 mg capsules were filled using capsule filling machine in college
pharmacy. 90 Capsules were packed in a plastic cover and were dispensed to the
patients. Patients were advised to take 2 capsules thrice daily with plane water
preferably boiled and cooled. Patients were dispensed with the other 90 capsules on
the second consultation i.e. 15 days after the first consultation.
Methods
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
62
Methods:
Type of study:
The study was a comparative clinical study of siddharthaka yoga Bahya and
abhyantara prayoga in kitibha kushta with special reference to psoriasis.
Source of data:
The minimum numbers of patients included for the study were 30. Patients of
either sex were selected from the O.P.D. and I.P.D. of D.G.M.A.M.C. and Hospital after
screening. The inclusion and exclusion criteria were duly considered before including the
patient for the study.
Selection of patients:
After fulfilling the criteria set in the form of inclusion and exclusion criteria, 30
patients were randomly distributed in to two groups.
Group – A: 15 patients were advised with Bahya prayoga of Siddharthaka by subjecting
them for parisheka.
Group – B: 15 patients were included for abhyantara prayoga of Siddharthaka yoga in
the form of capsules.
Inclusion criteria:
Patients were seen for signs and symptoms of kitibha kushta those told by
different Acharyas. Signs like Shyavavarna Kina, Krishnavarna Kina, Parusha
Kina, Ghana, Khara sparsha, Snigdha sparsha of kina and symptom Ugra kandu
were appreciated in all patients before their inclusion.
The age limitation for the study was kept to a minimum of 15 years and maximum
of 60 years.
Methods
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
63
Patients belonging to both the gender were included in the study.
Patients suitable for the procedure parisheka were included. For Group A patients,
parisheka procedure was explained and the consent was taken and those who
refused to undergo were convinced for the participation in the Group B of the
research work.
Exclusion criteria:
Chronic cases of more than 5 years were refused to be the part of trial.
Patients with the secondary systemic involvement like psoriatic arthritis etc were
excluded.
Patients with secondary systemic diseases like diabetes and hypertension were
excluded from the study.
Patients with psoriatic lesions over genitalia were excluded from the Group A as
parisheka with hot kashaya is contraindicated.
Pregnant women and lactating mothers were not considered for the study.
Diagnostic criteria:
The above mentioned clinical signs and symptoms of kitibha kushta were used as
diagnostic tools. Also the signs and symptoms of psoriasis were seen for. Patchy
circumscribed skin lesions with erythematous, well defined, dry, silvery scaly papules
and plaques were appreciated before their inclusion in the study. Patients were also seen
for ‘Candle grease sign’ and ‘Auspitz sign’.
Posology:
The posology for either bahya prayoga or abhyantara prayoga is not mentioned in
the context by Acharya Charaka. Hence the amount of kashaya sufficient to use for the
Methods
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
64
parisheka was known by conducting pilot study and 4 liter of kashya was found as
sufficient to perform parisheka of whole body. But the dose for abhyantara prayoga was
purely postulated by duly considering the safety factors.
For parisheka: four liters of kashaya was used for most of the patients and if the
lesions were confined to local part then sufficient quantity (less) of kashaya was taken.
For abhyantara prayoga: two 500 mg. capsules thrice daily were advised with
plain water or boiled and cooled water.
Study duration:
Parisheka: Parisheka was done for ten days continuously. The actual follow up of
the study was 30 days.
Abhyantara prayoga: Capsules were administered for 30 days continuously with
a follow up of 30 days.
Assessment of results:
Assessments of results were done on the basis of readings of subjective and
objective parameters before and after the treatment. The outcome of the observations
were analysed statistically for ‘p’ value using unpaired Student‘t’ test.
Subjective parameters:
Shyava krushna varna, Parushata, Ghanatwa, Kharasparsha and Kandu were set as
subjective parameters. The grading was given as follows;
Sl. no.
Subjective parameter
Score0 Score 1 Score 2 Score 3 Score 4
01 Shyava krushna varna No Mild Moderate Severe Extensive02 Parushata No Mild Moderate Severe Extensive03 Ghanatwa No Mild Moderate Severe Extensive04 Kharasparsha No Mild Moderate Severe Extensive05 Kandu No Mild Moderate Severe ExtensiveThe readings before and after the treatment were compared to assess the result.
Methods
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
65
Objective parameter:
PASI 234
Sl.No Head Upper extremities
Trunk Lower extremities
a Redness + b Thickness + c Scaling + Sum of rows of 1, 2
and 3
d Area score e Score of
row 4x row 5 x the area multiplier
row 4 x row 5 x 0.1
row 4 x row 5 x 0.2
row 4 x row 5 x 0.3
row 4 x row 5 x 0.4
f Sum row 6 for each column for PASI score
Steps in generating PASI score:
(a) Divide body into four areas: head, arms, trunk to groin, and legs to top of buttocks.
(b) Generate an average score for the erythema, thickness, and scale for each of the 4
areas (0 = clear; 1–4 = increasing severity).
(c) Sum scores of erythema, thickness, and scale for each area.
(d) Generate a percentage for skin covered with psoriasis for each area and convert that to
a 0–6 scale (0 = 0%; 1 =10%; 2 = 10–30%; 3 = 30–50%; 4 = 50–70%; 5 = 70–90%; 6 =
90–100%).
(e) Multiply score of item (c) above times item (d) above for each area and multiply that
by 0.1, 0.2, 0.3, and 0.4 for head, arms, trunk, and legs, respectively.
(f) Add these scores to get the PASI score.
Erythema, induration and scale are measured on a 0–4 scale (none, slight, mild, moderate,
severe)
Methods
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
66
Area scoring criteria (score: % involvement)
0: 0 (clear)
1: 0 - 10%
2: 10 –30%
3: 30–50%
4: 50–70%
5: 70–90%
6: 90–100
Assessment of results by objective criteria (PASI)
Complete remission – PASI score 0 after treatment.
Marked improvement – reduction of PASI score more than 75% after treatment.
Moderate improvement – reduction of PASI score between 50-75% after treatment.
Minimal improvement – reduction of PASI score less than 50% after treatment.
No improvement – no reduction in PASI score after treatment.
Procedure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
68
Procedure:
Group A (Parisheka):
Requirements:
1. Dhara patra (of 4 liter capacity)
2. 4 liters of kashaya
3. Taila – 100 ml approximately
4. Bowl of 150 ml capacity for taila dispensing.
5. 2 Vessels of 5 liter capacity (1 liter more than the dhara patra capacity)
6. 1 – Wide mouthed vessel for indirect heating of kashaya.
7. Gas stove
8. 2 – Cotton pads as eye packs.
9. 2 – Small cotton swabs dipped in oil for closing the ear.
10. 2 – Dry and clean towels.
11. Drinking water if patient demands.
12. Cold water for sprinkling if any complications are observed.
13. Rubber gown to wear and gloves if there is bleeding (positive Auspitz
sign).
14. 1 Helper to assist for changing the kashaya.
Previous day patients were examined and explained about the parisheka briefly
and were asked to bring the extra clothing, napkin, towel etc. Preferably the time chosen
was morning hour for the convenience of the patients who, most of them were working.
Also as there is no specific time mentioned in Ayurveda for parisheka morning hour was
preferred for the convenience. In the cold and cloudy climate the time of procedure was
Procedure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
69
changed accordingly i.e. when sun was bright, the procedure was done. Patients were first
asked to apply taila for them selves as it was experienced during the trial that abhyanga
caused bleeding from the lesions (Auspitz sign) so it was avoided and were asked to just
apply without any pressure. It was noted that the amount of taila required gone on
reducing day by day as the dryness of the skin was reducing. 15 – 20 minutes after the
application of taila patients underwent the parisheka procedure for fifty minutes to one
hour daily if it was the whole body. The lower limb was done parisheka for 10 min to
each anterior and posterior part. Parisheka was then done to anterior and posterior part of
trunk and abdomen for 10 minutes each. Both upper limbs were done parisheka for 10
minutes totally and the scalp psoriasis patients underwent parisheka for 10 minutes.
However in between this also kashaya was poured often to the whole body to avoid
coldness to the patient. If it was a local lesion then a minimum of 30 minutes procedure
was done daily. Each day fresh kashaya was prepared and used. The amount of kashaya
used was 4 liters per day if the whole body was involved and if local involvement was
there then according to the surface area of involvement the kashaya was prepared.
The kashaya was heated to the tolerable temperature (app.40-42° C) indirectly. It
was heated indirectly to avoid excessive heating and fast heating. By this method the
kashaya gets hot very slow so that it is ready for the replacement once the dhara patra
becomes empty. Parisheka was done approximately from about 6 inches height. However
low temperature kashaya was used for the shiras as the hot water bath and swedana are
contraindicated. The hrudaya pradesha (cardiac region) and vrushanas (genitalia) were
avoided as these places are also contraindicated for swedana. After the procedure was
over the patients were asked to wipe the body with clean and dry towel. After this they
Procedure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
70
were allowed to perform their normal activities and participate in their normal work. It
was advised to avoid excess exposure to the sun with the presumption that it may causes
burning sensation. Patients were advised to take bath if interested 6-8 hours after the
procedure i.e. in the evening hours. Patients were strictly advised to avoid the use of soap
and shampoo during the study duration. Readings were noted every alternative day.
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
71
Observation
The observation of the patients and the disease was done by providing the
questionnaire to those patients who can fill the case sheet and from those who can’t
fill; the information was collected by translating the questions in the local language.
The case sheet is attached in the appendix. All the patients were examined thoroughly
before their inclusion in the study. The observation was done by considering the
subjective and objective parameters strictly.
The observations were done in the following heading and are depicted in form
and graphs are used where ever necessary;
1. Observation of demographic data.
2. Observation of the patient.
3. Observation of the disease.
4. Observation of the data related to the response of the patient.
5. Observation of the statistical out comes of the study.
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
72
Observation of demographic data:
Table 12 showing the distribution of patient’s age group Age group No of patients and percentage
Group A Group B Total No. of patients % No. of patients % No. of patients %
15-25 02 13.3 02 13.3 04 13.3 26-35 01 6.6 04 26.6 05 16.6 36-45 06 40 04 26.6 10 33.3
46-60 06 40 05 33.3 11 36.6 Group A: out of fifteen patents 02 (13.3%) were belonging to 15-25 age group, 01
(6.6%) was from 26-35 age group, 06 (40%) were 36-45 aged and 06 (40%) were 46-
60 years aged.
Group B: out of fifteen patents 02 (13.3%) fell under 15-25 age group, 04 (26.6%)
were from 26-35 age group, 04 (26.6%) were again from 26-35 age group and 05
(33.3%) were from 46-60 age group.
Overall: out of thirty patents 04 (13.3%) were from 15-25 group, 05 (16.6%) from
26-35 age group, 10 (33.3%) from 36-45 group and 11 (36.6%) were from 46-60
group.
Figure 07 showing distribution of patients by age
Table 13 showing the distribution of patients according to sex Sex Group A no. and
% Group B no. and %
Group A and B no. and %
Male 12 (80%) 09 (60%) 21 (70%) Female 03 (20%) 06 (40%) 09 (30%)
21
6 6
2
4 45
45
1011
0
2
4
6
8
10
12
Group A Group B Total
15-2526-3536-4546-60
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
73
Group A: Among 15 numbers of patients 12 (80%) were males and 03 (20%) were
females.
Group B: Among 15 numbers of patients 09 (60%) were males and 06 (40%) were
females.
Overall: distribution of sex was; male – 21 (70%) and females were 09 (30%) in 30 patients. Figure 08 showing distribution of patients by sex
Table 14 showing distribution of patients by Religion Religion
Group A no. and %
Group B no. and %
Group A and B no. and %
Hindu 13 (86.6%) 12 (80%) 25 (83.3%) Muslim 02 (13.3%) 02 (13.3%) 04 (13.3%) Christian 00 (00%) 01 (6.6%) 01 (3.3%) Others 00 (00%) 00 (00%) 00 (00%) Group A: out of fifteen patients 13 (86.6%) were Hindus, 02 (13.3%) were Muslims
and none were Christians and others
Group B: out of fifteen patients 12 (80%) ere Hindus, 02 (13.3%) were Muslims, 01
(6.6%) was Christian, and none were from other caste.
Overall: Hindus were 5 (83.3%), 04 (13.3%) were Muslims, 01 (3.3%) was Christian
and none were from other category among thirty total number of patients.
12
3
9
6
21
9
0
5
10
15
20
25
Group A Group B Total
MaleFemale
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
74
Figure 09 showing distribution of patients by religion
Table 15 showing distribution of patients by Economical status Economical status Group A no. and
% Group B no. and %
Group A and B no. and %
Poor 03 (20%) 00 (00%) 03 (10%) Middle class 10 (66.6%) 15 (100%) 25 (83.3%) Rich 02 (13.3%) 00 (00%) 02 (6.6%) Group A: out of fifteen patients 03 (20%) were belonging to poor status, 10 (66.6%)
were of middle class and 02 (13.3%) were rich.
Group B: out of fifteen patients none were belonging to poor status, all 15 (100%)
were of middle class and none were from rich status
Overall: out of thirty patients 03 (10%) were poor, 25 (83.3%) were of middle class
and 02 (6.6%) were rich
Figure 10 showing distribution of patients by Economical status
13
20 0
12
21 0
25
41
00
5
10
15
20
25
Group A Group B Total
Hindu Muslim Christian Others
3
10
20
15
0
3
25
2
0
5
10
15
20
25
Group A Group B Total
Poor Middle class Rich
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
75
Table 16 Showing distribution of patients by Occupation Occupation
Group A no. and %
Group B no. and %
Group A and B no. and %
Student 1 (6.6%) 02 (13.3%) 03 (10%) Labor 7 (46.6%) 06 (40%) 13 (43.3%) Executive 1 (6.6%) 00 (00%) 01 (3.3v) Sedentary 5 (33.3%) 01 (6.6%) 06 (20%) Group A: out of fifteen patients 1 (6.6%) was student, 7 (46.6%) were labors, 1
(6.6%) was executive and 5 (33.3%) were sedentary by occupation
Group B: out of fifteen patients 02 (13.3%) were students, 06 (40%) were labors,
none were executives and 01 (6.6%) was of sedentary by occupation.
Overall: out of thirty patients 03 (10%) were students, 13 (43.3%) were labors, 01
(3.3%) was executive and 06 (20%) were belonging to sedentary category.
Figure 11 showing distribution of patients by occupation
Table No. 17. Showing distribution of patients by Nature of work Nature of work
Group A no. and %
Group B no. and %
Overall
Stressful 7 (46.6%) 06 (40%) 13 (43.3%) Near heat 3 (20%) 01 (6.6%) 04 (13.3%) Traveling 4 (26.6%) 00 (00%) 04 (13.3%) Group A: out of fifteen patients 7 (46.6%) were working stressfully, 3 (20%) were
working near heat and 4 (26.6%) were having traveling nature of work.
Group B: out of fifteen patients 06 (40%) were working stressfully, 01 (6.6%) were
working near heat and, none were from traveling category.
Overall: out of thirty patients 13 (43.3%) were working stressfully, 04 (13.3%) were
working near heat and 4 (26.6%) were having traveling nature of work.
1
7
1
5
2
6
01
3
13
1
6
0
2
4
6
8
10
12
14
Gro up A Gro up B T o tal
Student Labor Executive Sedentary
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
76
Figure 12 showing distribution of patients by nature of work
Vaiyaktika vruttanta of the patients:
Table No. 18. Showing distribution of patients by Matra of ahara Bahu Madhyama Alpa Group A 08 (53.3%) 06 (40%) 01 (6.6%) Group B 04 (26.6%) 09 (60%) 02 (13.3%) Overall 12 (40%) 15 (50%) 03 (10%) Group A: 08 (53.3%) patients were taking bahu matra ahara, 06 (40%) were taking
madhyama matra and 01 (6.6%) was taking alpa matra ahara.
Group B: 04 (26.6%) patients were taking bahu matra ahara, 09 (60%) were taking
madhyama matra ahara and 02 (13.3%) were taking alpa matra ahara.
Overall: out of thirty patients 12 (40%) were taking bahu matra ahara, 15 (50%) were
taking madhyama matra ahara and 03 (10%) were taking alpa ahara.
Figure 13 showing distribution of patients by matra of ahara
7
34
6
10
13
4 4
0
2
4
6
8
10
12
14
Group A Group B Total
Stressful Near heatTraveling
8
6
1
4
9
2
12
15
3
0
2
4
6
8
10
12
14
16
Group A Group B Total
BahuMadhyamaAlpa
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
77
Table No. 19. Showing distribution of patients by Kala of ahara Regular Irregular Group A 11 (73.3%) 04 (26.6%) Group B 14 (93.3%) 01 (6.6%) Overall 25 (83.3%) 05 (16.6%) Group A: out of fifteen patents 11 (73.3%) were taking food at regular time, 04
(26.6%) were taking irregularly and 01 (6.6%) was taking food twice daily and 14
(93.3%) were taking thrice daily.
Group B: out of fifteen patents 14 (93.3%) were taking food regularly, 01 (6.6%) was
taking irregularly and 02 (13.3%) were taking it twice a day and 13 (86.6%) were
taking food thrice a day.
Overall: out of thirty patents 25 (83.3%) were taking it regularly, 05 (16.6%) were
not taking regularly and 03 (10%) were taking for two times a day and 27 (90%) were
having thrice a day.
Figure 14 showing distribution of patients by kala of ahara
Table No. 20. Showing distribution of patients by Rasa Madhura Amla Lavana Katu Tikta Kashaya Group A 09 (60%) 10 (6.6%) 01 (6.6%) 10(66.6%) 00 (00v) 00 (00%) Group B 09 (60%) 02(13.3%) 03(13.3%) 10(66.6%) 00 (00%) 00 (00%) Overall 18 (60%) 12 (40%) 04 (10%) 20(66.6%) 00 (00%) 00 (00%) Group A: out of fifteen patents 09 (60) were liking madhura rasa, 10 (6.6) were
liking amla rasa, 01 (6.6%) was liking lavana and 10 (66.6%) were liking katu rasa.
None liked tikta.and kashaya rasa.
Group B: out of fifteen patents patents 09 (60%) were liking madhura rasa, 02
(13.3%) were liking amla rasa, 03 (20%) liked lavana and 10 (66.6%) were like katu
rasa. None liked tikta and Kashaya rasa
11
4
14
1
25
5
0
5
10
15
20
25
Group A Group B Total
RegularIrregula
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
78
Overall: out of thirty patents18 (60%) were fond of madhura, 12 (40%) were fond of
amla, 04 (13.33%) liked lavana and 20 (66.6%) were fond of katu rasa and none liked
katu and kashaya rasa.
+
Table No. 21. Showing distribution of patients by Guna of ahara Laghu Guru Rooksha Snigdha Group A 01 (6.6%) 08 (53.3%) 12 (80%) 03 (20%) Group B 09 (60%) 06 (40%) 09 (60%) 04 (26.6%) Overall 10 (33.3%) 14 (46.6%) 21 (70%) 07 (23.3%) Group A: out of fifteen patents 01 (6.6%) use to take laghu ahara, 08 (53.3%) use to
take guru ahara, 12 (80%) used rooksha and 03 (20%) were using snigdha ahara.
Group B: out of fifteen patents 09 (60%)were taking laghu ahara, 06 (40%) were
taking guru ahara, 09 (60%) were taking rooksha and 04 (26.6%) were taking snigdha
ahara.
Overall: out of thirty patents10 (33.3%) were taking laghu, 14 (46.6%) were taking
guru, 21 (70%) taking rooksha ahara and 07 (23.3%) were taking snigdha.
Figure 16 showing distribution of patients by gune of ahara
910
1
10
0 0
9
23
10
0 0
18
12
4
20
0 00
2
4
6
8
10
12
14
16
18
20
Group A Group B Total
MadhuraAmlaLavanaKatuTiktakashya
1
8
12
3
9
6
9
4
10
14
21
7
0
5
10
15
20
25
Group A Group B Total
LaghuGuruRookshaSnigdha
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
79
Table No. 22. Showing distribution of patients Type of diet Vegetarian Mixed Group A 05 (33.3%) 10 (66.6%) Group B 07 (46.6%) 08 (53.3%) Overall 12 (40%) 18 (60%) Group A: out of fifteen 05 (33.3%) were vegetarians and 10 (66.6%) were mixed diet
Group B: out of fifteen 07 (46.6%) were vegetarians and 08 (53.3%) were mixed diet
Overall: out of thirty patents 12 (40%) were vegetarians and 18 (60%) were of mixed diet Figure 17 showing distribution of patients by type of diet
Table No. 23. Showing distribution of patients by Vyasana Alcohol Tobacco
chewing Smoking Tea/coffee
Group A 05 (33.3%) 01 (6.6%) 03 (20%) 01 (6.6%) Group B 05 (33.3%) 04 (26.6%) 02 (13.3%) 03 (20%) Overall 10 (33.3%) 05 (16.6%) 05 (16.6%) 04 (13.3%) Group A: out of fifteen patents 05 (33.3%) were alcoholics, 01 (6.6%) was tobacco
chewer, 03 (20%) were smokers and 01 (6.6%) was taking excess tea/ coffee.
Group B: out of fifteen patents 05 (33.3%) were alcoholics, 04 (26.6%) were tobacco
chewers, 02 (13.3%) were smokers and 03 (20%) were taking excess tea/ coffee.
Overall: out of thirty patents 10 (33.3%) were alcoholics, 05 (16.6%) were tobacco
chewers, 05 (16.6%) were smokers and 04 (13.3%) were taking excess tea/ coffee.
Figure 18 showing distribution of patients by vyasana
5
1
3
1
54
23
10
5 54
0
1
2
3
4
5
6
7
8
9
10
Group A Group B Total
AlcoholTobacco chewingSmokingTea/Coffee
5
107 8
12
18
0
2
4
6
8
10
12
14
16
18
Group A Group B Total
VegetarianMixed
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
80
Table No. 24. Showing distribution of patients by Hygiene Good Fair Poor Group A 07 (46.6%) 07 (46.6%) 01 (6.6%) Group B 07 (46.6%) 08 (53.3%) 00 (00%) Overall 14 (46.6%) 15 (50%) 01 (3.3%) Group A: out of fifteen patents 07 (46.6%) were maintaining good hygiene, 07
(46.6%) were of fair and 01 (6.6%) was poorly hygienic.
Group B: out of fifteen patents 07 (46.6%) were maintaining good hygiene, 08
(53.3%) were of fair and none poorly hygienic.
Overall: out of thirty patents 14 (46.6%) were maintaining good hygiene, 15 (50%)
were of fair and 01 (3.3%) was poorly hygienic.
Figure 19 showing distribution of patients by hygine
Table No. 25. Showing distribution of patients by Manaska sthiti Chinta Shoka Bhaya Group A 12 (80%) 12 (80%) 12 (80%) Group B 12 (80%) 12 (80%) 12 (80%) Group A and B 24 (80%) 24 (80%) 24 (80%) Group A: out of fifteen patents 12 (80%) were suffering from chinta, shoka bhaya.
Group B: out of fifteen patents 12 (80%) were suffering from chinta, shoka bhaya.
Overall: out of thirty patents 24 (80%) were suffering from chinta, shoka and bhaya.
Figure 20 showing distribution of patients by manasika sthiti
7 7
1
78
0
14 15
10
2
4
6
8
10
12
14
16
Group A Group B Total
GoodFairPoor
12 12 12 12 12 12
24 24 24
0
5
10
15
2 0
2 5
Group A Group B Total
ChintaShokaBhaya
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
81
Table No. 26. Showing distribution of patients by observed nidana in no & % Nidana Group
A Group B
Overall Nidana Group A
Group B
Overall
Milk with fish
08 (53.3%)
07 (46.6%)
15 (50%)
Excess snigdha
03 (20%)
01 (6.6%)
04 (13.3%)
Milk with mamsa
08 (53.3%)
07 (46.6%)
15 (50%)
Raw moolaka alone or with dugdha
14 (93.3%)
13 (86.6%)
27 (90%)
Milk with acidic foods
01 (6.6%)
01 (6.6%)
02 (6.6%)
Ati ashana
05 (33.3%)
01 (6.6%)
06 (20%)
Excess madhura rasa
05 (33.3%)
08 (53.3%)
13 (43.3%)
Ati jala sevana after gharma
01 (6.6%)
00 (00%)
01 (3.3%)
Excess amla rasa
09 (60%)
02 (13.3%)
11 (36.6%)
Masha 06 (40%)
05 (33.3%)
11 (36.6%)
Excess lavana rasa
01 (6.6%)
03 (20%)
04 (13.3%)
shrama, bhaya
00 (00%)
00 (00%)
00 (00%)
Dadhi other milk products
15 (100%)
13 (86.6%)
28 (93.3%)
Guda 14 (93.3%)
14 (93.3%)
28 (93.3%)
Navanna 00 (00%)
00 (00%)
00 (00%)
Pishta vikara
04 (26.6%)
10 (66.6%)
14 (46.6%)
Matsya, 10 (66.6%)
08 (53.3%)
18 (60%)
Vyayama after bhojana
03 (20%)
03 (20%)
06 (20%)
Mamsa 10 (66.6%)
08 (53.3%)
18 (60%)
Diwa swapna
09 (60%)
05 (33.3%)
14 (46.6%)
Observation
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82
Table No. 27. Showing distribution of patients by observed poorvaroopa in the study in Group A patients Sl. No Poorva roopa Group A Group B Over all 01 Twak parushata 14 (93.3%) 09 (60%) 23 (76.6%)02 Akasmad romaharsha 00 (00%) 00 (00%) 00 (00%) 03 Swedabahulya 01 (6.6%) 01 (6.6%) 02 (6.6%) 04 Asweda 04 (26.6%) 03 (20%) 07 (23.3%)05 Anga pradesha swapa 00 (00%) 00 (00%) 00 (00%) 06 Vaivarnya 15 (100%) 15 (100%) 30 (100%) 07 Kandu 15 (100%) 15 (100%) 30 (100%) 08 Suptata 00 (00%) 00 (00%) 00 (00%) 09 Nistoda 00 (00%) 00 (00%) 00 (00%) 10 Ati shlakshnata 00 (00%) 00 (00%) 00 (00%) 11 Gourava 08 (53.3%) 06 (40%) 14 (46.6%)12 Mala pradeha over kaya 00 (00%) 01 (6.6%) 01 (3.3%) 13 Kshata visarpa (spreads on injury), 04 (26.6%) 03 (20%) 07 (23.3%)14 Paridaha 00 (00%) 00 (00%) 00 (00%) Table No. 28. Showing distribution of patients by lakshanas observed. Sl. no Lakshana Observed in
number of patients and % in Group A
Observed in number of patients and % in Group B
Observed in number of patients and % in Group A and B
01 Shyava kina 15 (100%) 15 (100%) 30 (100%) 02 Krishnavarna
kina 15 (100%) 14 (93.30%) 29 (96.6%)
03 Parushata of kina
15 (100%) 15 (100%) 30 (100%)
04 Ghana 14 (93.3%) 13 (86.6%) 27 (90%) 05 Khara sparsha 15 (100) 13 (86.6%) 28 (93.3%) 06 Snigdha
sparsha 00 (00%) 00 (00%) 00 (00%)
07 Ugra kandu 15 (100%) 15 (100%) 30 (100%) Table No. 29. Showing distribution of patients by anubandha vedana observed. Sl. No. Anubandha
vedana Group A Group B Overall
01 Daha 07 (46.6%) 04 (26.6%) 11(36.6%) 02 Raga 03 (20%) 00 (00%) 03 (10%) 03 Srava 00 (00%) 00 (00%) 00 (00%) 04 Vedana 02 (13.3%) 00 (00%) 02 (6.6%) 05 Shaitya 02 (13.3%) 04 (26.6%) 06 (20%) 06 Kleda 00 (00%) 00 (00%) 00 (00%) 07 Anga gourava 05 (33.3%) 12 (80%) 17 (56.6%)
Observation
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83
Table No. 30. Showing distribution of patients by site of onset Site of onset Scalp Knee Elbow Ear lobe Group A 04 (26.66%) 07 (46.6%) 02 (13.3%) 02 (13.3%) Group B 07 (46.6%) 04 (26.6%) 02 (13.3%) 02 (13.3%) Overall 12 (40%) 11 (36.6%) 04 (13.3%) 04 (13.3%) Group A: out of fifteen patents 04 (26.66%) got origin from scalp, 07 (46.6%) from
knee, 02 (13.3%) from elbow and 02 (13.3%) from ear lobe.
Group B: out of fifteen patents 07 (46.6%) got the first lesion on scalp, 04 (26.6%) in
knee, 02 (13.3%) in elbow and 02 (13.3%) in ear lobe.
Overall: out of thirty patents12 (40%) observed lesion first in scalp, 11 (36.6%) in
knee, 04 (13.3%) in elbow and 04 (13.3%) patients observed first in ear lobe
Figure 21 showing distribution of patients by site of onset
Table No. 31. Showing distribution of patients by mode of onset of the disease Mode of onset
Sudden Gradual After injuryGroup A 03 (20%) 11 (73.3%) 01 (6.6%) Group B 01 (6.6%) 14 (93.3%) 00 (00%) Overall 04 (13.3%) 25 (83.3%) 01 (3.3%) Group A: out of fifteen patents 03 (20%) got sudden onset while 11 (73.3%) got
gradual onset and 01 (6.6%) got onset of lesion after injury.
Group B: out of fifteen patents 01 (6.6%) got lesions suddenly, 14 (93.3%) got it
gradually and none got after injury in this group.
Overall: out of thirty patents 04 (13.3%) got it suddenly, 25 (83.3%) got gradual
onset and 01 (3.3%) got it after injury.
Figure 22 showing distribution of patients by mode of onset
4
7
2 2
7
4
2 2
1211
4 4
0
2
4
6
8
10
12
Group A Group B Total
Scalp
Knee
Elbow
Ear lobe
3
11
1 1
14
0
4
25
10
5
10
15
2 0
2 5
Group A Group B Total
Sudden
Gradual
After injury
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
84
Table No. 32. Showing distribution of patients by aggravation time Aggravation
Day Night Group A 03 (20%) 12 (80%) Group B 00 (00%) 15 (100%) Overall 03 (10%) 27 (90%) Group A: out of fifteen patents, in 03 (20%) aggravation was during day, in 12 (80%)
during night, in 04 (26.6%) it was in summer, none observed aggravation in rainy
season and in 11 (73.3%) aggravation was in winter.
Group B: out of fifteen patents, none got aggravation in day time, 15 (100%) got in
night, 01 (6.6%) in summer season, 01 (6.6%) in rainy season and 12 (80%) got
aggravation in winter season.
Overall: out of thirty patents, 03 (10%) got aggravation in day time, 27 (90%) got in
night, 05 (16.6%) in summer season01 (3.3%) in rainy season and 23 (76.6%) got
aggravation in winter season.
Figure 23 showing distribution of patients by aggravation time
Table No. 33. Showing distribution of patients by aggravation season
Aggravation Summer Rainy Winter
Group A 04 (26.6%) 00 (00%) 11 (73.3%) Group B 01 (6.6%) 01 (6.6%) 12 (80%) Overall 05 (16.6%) 01 (3.3%) 23 (76.6%) Group A: out of fifteen patents, in 03 (20%) aggravation was during day, in 12 (80%)
during night, in 04 (26.6%) it was in summer, none observed aggravation in rainy
season and in 11 (73.3%) aggravation was in winter.
Group B: out of fifteen patents, 01 (6.6%) in summer season, 01 (6.6%) in rainy
season and 12 (80%) got aggravation in winter season.
3
12
0
15
3
27
0
5
10
15
20
25
30
Group A Group B Total
Day
Night
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
85
Overall: out of thirty patents, 05 (16.6%) in summer season01 (3.3%) in rainy season
and 23 (76.6%) got aggravation in winter season.
Figure 24 showing distribution of patients by aggravation season Table No. 34. Showing distribution of patients by Kula vruttanta
Maternal Parental Group A 00 (00%) 00 (00%) Group B 01 (6.6%) 01 (6.6%) Overall 01 (3.3%) 01 (3.3%) Group A: out of fifteen patents none had family history.
Group B: out of fifteen patents 01 (6.6%) maternal reported family history and 01
(6.6%) reported with parental history.
Overall: out of thirty patents01 (3.3 %) maternal reported family history and 01
(3.3%) reported with parental history.
Figure 25showing distribution of patients by kula vruttana
Table No. 35. Showing distribution of patients by Chikitsa vruttanta
Chikitsa vruttanta Ay Al O
Group A 03 (20%) 15 (100%) 00 (00%) Group B 03 (20%) 15 (100%) 00 (00%) Overall 06 (20%) 30 (100%) 00 (00%) Group A: out of fifteen patents all have taken the allopath treatment 15 (100%), 03
(20%) Ayurveda treatment and none of them had got treatment from other medicine.
0 0
1 1 1 1
0
1
2
3
Group A Group B Total
Maternal
Parental
4
0
11
1 1
12
5
1
23
0
5
10
15
20
25
Group A Group B Total
Summer
Rainy
Winter
Observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
86
Group B: out of fifteen patents 03 (20%) had treatment history of Ayurveda, all had
allopath treatment history positive and none reported with other medicine history.
Overall: out of thirty patents all have taken the allopath treatment 30 (100%), 06
(20%) Ayurveda treatment and none of them had got treatment from other medicine
Figure 26 Showing distributions of patients by chikitsa vruttanta
Table No. 36. Showing distribution of patients by confirmatory signs
Confirmatory sign Auspitz sign Candle grease sign Koeber’s sign. Group A 15 (100%) 15 (100%) 04 (26.6%) Group B 15 (100%) 15 (100%) 07 (46.6%) Overall 30 (100%) 30 (100%) 11 (36.6%) Group A: out of fifteen patents all were reported with Auspitz sign and Candle grease
sign 15 (100%) each and 04 (26.6%) patients reported with positive Koeber’s sign.
Group B: out of fifteen patents all were reported with Auspitz sign and Candle grease
sign 15 (100%) each and 07 (46.6%) patients reported with positive Koeber’s sign.
Overall: out of thirty patents all were reported with Auspitz sign and Candle grease
sign 30 (100%) each and 11 (36.6%) patients reported with positive Koeber’s sign.
Figure 27 showing distribution of patients by confirmatory signs
3
15
0
3
15
0
6
3 0
00
5
10
15
2 0
2 5
3 0
Gr oup A Gr oup B Tot a l
Ay ur v e da
Al l opa t h
Ot he r
15 15
4
15 15
7
30 30
11
0
5
10
15
20
25
30
Group A Group B Total
Auspitz signCandle grease signKoeber's sign
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
87
Table No. 37. Showing demographic data in patients of in Group A Group OPD
No. Age Sex Religion Economical
status Occupation Nature
of work M F H M C O P M R S L E S S N T
A 3634 46 - + + - - - + - - - + - - + + - A 235 38 + - + - - - - + - - + - - - - +A 538 40 - + + - - - - + - - + - - - + - A 309 42 + - + - - - + - - - + - - - - +A 613 40 + - + - - - - + - - - - + + - - A 1427 40 - + + - - - + - - - - - - - - - A 1715 50 + - + - - - - + - - + - - + + - A 502 44 + - + - - - - + - - - - + - - +A 3073 56 + - - + - - - + - - - - + + - - A 3089 59 + - + - - - - + - - - - + - - - A 3069 55 + - - + - - - + - - + - - + - - A 3220 50 + - + - - - - + - - - - + + - - A 3413 23 + - + - - - - + - - + - - - - - A 4023 35 + - + - - - - - + - - + - + - +A 4370 20 + - + - - - - - + + - - - - - -
TOTAL 12 3 13 2 0 0 3 10 2 1 7 1 5 7 3 4 Table No. 38. Showing demographic data in patients of in Group B Group OPD
No. Age Sex Religion Economical
status Occupation Nature
of work M F H M C O P M R S L E S S N T
B 1846 45 + - + - - - - + - - + - - + + - B 1968 60 + - - + - - - + - - + - - + - - B 2851 50 - + + - - - - + - - - - - - - - B 2758 45 - + + - - - - + - - - - - - - - B 3216 40 + - + - - - - + - - + - - + - - B 3217 35 + - + - - - - + - - + - - + - - B 3556 15 + - - - + - - + - + - - - - - - B 3591 50 + - - + - - - + - - + - - + - - B 3849 32 + - + - - - - + - - + - - + - - B 4006 18 - + + - - - - + - + - - - - - - B 4039 35 - + + - - - - + - - - - - - - - B 4279 60 + - + - - - - + - - - - - - - - B 4284 45 - + + - - - - + - - - - - - - - B 4228 51 + - + - - - - + - - - - + - - - B 4426 28 - + + - - - - + - - - - - - - -
TOTAL 9 6 12 2 1 0 0 15 0 2 6 0 1 6 1 0 Abbreviations used: Sex: M – male, F – female, Religion: H- Hindu, M – Muslim, C – Christian, O – others, Economical status: P – poor, M – middle class, R – rich, Occupation: St – student, L – labor, E – executive, S – sedentary, Nature of work: S – stressful, N – near heat, T – traveling
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
88
Table No. 39 Showing lakshanas of kitibha kushta in Group A Group OPD
No. Shyava
kina Krishnavarna
kina Parushata
of kina Ghana Khara
sparsha Snigdha sparsha
Ugra kandu
A 3634 + + + + + - + A 235 + + + + + - + A 538 + + + + + - + A 309 + + + + + - + A 613 + + + - + - + A 1427 + + + + + - + A 1715 + + + + + - + A 502 + + + + + - + A 3073 + + + + + - + A 3089 + + + + + - + A 3069 + + + + + - + A 3220 + + + + + - + A 3413 + + + + + - + A 4023 + + + + + - + A 4370 + + + + + - +
Total 15 15 15 14 15 0 15 Table No. 40 Showing lakshanas of kitibha kushta in Group B Group OPD
No. Shyava
kina Krishnavarna
kina Parushata
of kina Ghana Khara
sparsha Snigdha sparsha
Ugra kandu
B 1846 + + + + + - + B 1968 + + + + + - + B 2851 + + + + - - + B 2758 + + + + + - + B 3216 + + + + + - + B 3217 + + + + - - + B 3556 + + + - + - + B 3591 + + + + + - + B 3849 + - + + + - + B 4006 + + + - + - + B 4039 + + + + + - + B 4279 + + + + + - + B 4284 + + + + + - + B 4228 + + + + + - + B 4426 + + + + + - +
Total 15 14 15 13 13 0 15
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
89
Table No. 41 Showing Confirmatory signs of psoriasis in Group A Group OPD no. Confirmatory sign
Auspitz sign Candle greace sign Koeber’s sign. A 3634 + + - A 235 + + - A 538 + + + A 309 + + + A 613 + + - A 1427 + + - A 1715 + + + A 502 + + - A 3073 + + - A 3089 + + - A 3069 + + - A 3220 + + - A 3413 + + - A 4023 + + - A 4370 + + +
TOTAL 15 15 04 Table No. 42 Showing Confirmatory signs of psoriasis in Group A Group OPD no. Confirmatory sign
Auspitz sign Candle greace sign Koeber’s sign. B 1846 + + - B 1968 + + + B 2851 + + - B 2758 + + + B 3216 + + + B 3217 + + - B 3556 + + + B 3591 + + - B 3849 + + - B 4006 + + + B 4039 + + - B 4279 + + - B 4284 + + - B 4228 + + + B 4426 + + +
TOTAL 15 15 07
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
90
Table No. 43 Showing Anubandha vedana of kitibha kushta in Group A. Group OPD
No. Daha Raga Srava Vedana Shaitya Kleda Anga
gourava A 3634 + - - + - - + A 235 + - - - - - - A 538 + - - - - - - A 309 - - - + + - + A 613 - + - - - - - A 1427 + - - - - - + A 1715 - - - - - - - A 502 + - - - - - - A 3073 + - - - - - - A 3089 - + - - - - - A 3069 - - - - + - + A 3220 - + - - - - - A 3413 + - - - - - - A 4023 - - - - - - - A 4370 - - - - - - +
Table No. 44 Showing Anubandha vedana of kitibha kushta in Group B. Group OPD
No. Daha Raga Srava Vedana Shaitya Kleda Anga
gourava B 1846 - - - - + - + B 1968 - - - - - - - B 2851 - - - - + - + B 2758 - - - - - - + B 3216 - - - - + - + B 3217 - - - - - - + B 3556 - - - - - - + B 3591 + - - - - - + B 3849 + - - - - - - B 4006 + - - - - - - B 4039 - - - - - - + B 4279 - - - - - - + B 4284 - - - - + - + B 4228 + - - - - - + B 4426 - - - - - - +
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 91
Table No. 45 Showing the observed features of the nature of kitibha kushta in Group A Group OPD No. Site of onset Mode of onset Aggrevation
Kula vruttanta Chikitsa vruttanta
S K E EL S G AI D N S R W M P AY AL O A 3634 + - - - - + - - + + - - - - - + - A 235 + - - - - + - + - - - + - - - + - A 538 - + - - + - - - + - - + - - - + - A 309 + - - - + - - - + - - + - - - + - A 613 - + - - - + - + - + - - - - - + - A 1427 - + - - + - - - + - - + - - - + - A 1715 - - + - - + - - + + - - - - - + - A 502 + - - - - + - - + + - - - - - + - A 3073 - + - - - + - - + - - + - - - + - A 3089 - - - + - + - - + - - + - - - + - A 3069 - + - - - + - - + - - + - - - + - A 3220 + - - - - + - - + - - + - - - + - A 3413 - + - - - + - + - - - + - - + + - A 4023 - + - - - - + - + - - + - - + + - A 4370 - - + + - + - - + - - + - - + + -
Total 05 07 02 02 03 11 01 03 12 04 00 11 00 00 03 15 00 Abbreviations used Site of onset: S – Scalp, K – Knee, E – Elbow, El – Ear lobe. Mode of onset: S – Sudden, G – Gradual, AI –After injury. Aggravation: D – Day, N – Night, S – summer, R – rainy, W – winter. Kula Vruttanta: M – Maternal, P – parental, Chikitsa vruttanta: Ay – Ayurveada, Al – Allopath, O – Others.
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta 92
Table No. 46 Showing the observed features of the nature of kitibha kushta in Group B Group OPD No. Site of onset Mode of onset Aggravation
Kula vruttanta Chikitsa vruttanta
S K E EL S G AI D N S R W M P AY AL O B 1846 + - - - - + - - + - - + - - + + - B 1968 + - - - - + - - + - - + - - - + - B 2851 - + - - - + - - + - - + - - - + - B 2758 + - - - - + - - + - - + - - - + - B 3216 - - - + - + - - + - - + - - - + - B 3217 - + - - - + - - + - - + - - + + - B 3556 + - - - + - - - + - - - - - - + - B 3591 - + - - - + - - + + - - - - - + - B 3849 - - + - - + - - + - - + - - - + - B 4006 - - - + - + - - + - + + - + - + - B 4039 + - - - - + - - + - - + + - - + - B 4279 - - + - - + - - + - - - - - - + - B 4284 - + - - - + - - + - - + - - - + - B 4228 + - - - - + - - + - - + - - + + - B 4426 + - - - - + - - + - - + - - - + -
Total 07 04 02 02 01 14 00 00 15 01 01 12 01 01 03 15 00 Abbreviations used Site of onset: S – Scalp, K – Knee, E – Elbow, El – Ear lobe. Mode of onset: S – Sudden, G – Gradual, AI – After injury. Aggravation: D – Day, N – Night, S – summer, R – rainy, W – Winter. Kula Vruttanta: M – Maternal, P – parental. Chikitsa vruttanta: Ay – Ayurveada, Al – Allopath, O – others.
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
93
Table No. 47 Showing the observed vaiktika vruttanta in Group A Group OPD
No. Ahara Vihara
Matra Kala Rasa Guna Type Vyasana Hygine Manas A 3634 A R MA LR M T/C G CS A 235 B R MKA GR M A G - A 538 M I KAL GR M - F CB A 309 B I MA GS M A,S P CB A 613 B I MK GR M A,T F C A 1427 M R MK R M - F C A 1715 B R KA R V - F - A 502 B I MK R V - G - A 3073 B R KA GS M S F C A 3089 M R KA R V - G C A 3069 B R KA GR M S F C A 3220 M R M R V - G CB A 3413 B R K R M A F C A 4023 M R MA GR M A G C A 4370 M R MA GS V - G CB
Table No. 48 Showing the observed vaiktika vruttanta in Group B Group OPD
No. Ahara Vihara
Matra Kala Rasa Guna Type Vyasana Hygine Manas B 1846 B R M GS M A G C B 1968 B R MK GS M S G C B 2851 M R MA G V T G CSB B 2758 M R MK LR V T G CS B 3216 B R MA GS M A F CB 3217 B R K LR V A F C B 3556 M R M GS M - F B B 3591 M I K LR M T F C B 3849 M R MK LR M A F C B 4006 A R KL LR V - G CSB B 4039 M R KL LR M T F CS B 4279 M R K LR V T/C F C B 4284 M R KL LR V T/C F C B 4228 M R MK G M A,S G C B 4426 A R M LR V T/C F C
Ahara: Matra – Bahu, Madhyama, Alpa, Kala – Regular, Irregular, Rasa – M-Madhura, A-Amla, L-Lavana, K-Katu, T-Tikta, Ks-Kashaya, Guna – G-Guru, L-Laghu, S-Snigdha, R-Ruksha. Type – V – vegetarian, M - mixed Vihara: Vyasana – A-Alcohol, T-Tobacco Chewing, S-Smoking, T/C-Tea coffee, Hygiene – G-Good, F-Fair, P-Poor. Manas – C-chinta, S-shoka, B-bhaya
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
94
Table No. 49 showing the rogi pareekshain Group A G opd
no Prakruti Sara Samhanana Satmya Satva Ahaa
shakti Vyama shakti
Vaya
A 3634 VP MS M R M M M M A 235 VK MS S S P P P M A 538 VK MeS S V A M M M A 309 VK A S V A P P M A 613 V A S V M P M M A 1427 VP T S V A M A M A 1715 VP MeS M V P P P M A 502 VP MS S V P P P M A 3073 VK R M V M P M M A 3089 VK A S V M M M M A 3069 VK M M V P P M M A 3220 VP MjS S V M M M M A 3413 PK S S V M P P B A 4023 VK M S V P M M M A 4370 VP S S V M M M B Table No. 50 showing the rogi pareekshain Group B opd no
Prakruti Sara Samhanana Satmya Satva Ahara shakti
Vyama shakti
Vaya
B 1846 MS S V P P P M B 1968 A S V P P M M B 2851 R M V A M M M B 2758 Mes M V A M M M B 3216 A M V M P M M B 3217 R M V A P M M B 3556 A M V A M M M B 3591 A M R P M P M B 3849 MS M V M M M M B 4006 T A V A A A M B 4039 MS M V M M M M B 4279 A S V M M A V B 4284 MS M V M M M M B 4228 A M V M M M M B 4426 MeS S V A A A M
Abbreviations used: Prakruti: V – vataja, VP – vatapittaja, VK – vatakaphaja, PK – pittakaphaja. Sara: T – twak sara, R – raktasara, MS – mamsasara, MeS – medasara, A – asthisara, MjS – majjasara, S shukrasara Samhanana: S – susamhata, M – madhyama, A – asamhata. Satmya: S – sarvarasa, R – rooksha, V – vyamishra. Stawa: P – prvara, M – madhyama, A – avara. Ahaa shakti: P – prvara, M – madhyama, A – avara. Vyamashakti: P – prvara, M – madhyama, A – alpa. Vaya: B – bala, M – madhyama, V – vruddha.
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
95
Table No. 51 showing the Nidana observed in Group A
Abbreviations used. 01-Milk with fish, 02-Milk with mamsa, 03-Milk with acidic foods, 04-Excess madhura rasa, 05-Excess amla rasa, 06-Excess lavana rasa, 07-Dadhi other milk products, 08-Navanna, 09-Matsya, 10-Mamsa, 11-Excess snigdha, 12-Raw moolaka alone or with dugdha, 13-Adhyashana, 14-Ati jala sevana after gharma, shrama, bhaya, 15-Masha 16-Tila, 17-Guda, 18-Pishtavikara, 19-Vyayama after bhojana, 20-Diwaswapna
roup OPD No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
A 3634 + + - - + - + - + + - + - - - - + - + - A 235 + + - - + - + - + + - + - - + - + - + - A 538 + + + - + + + - + + - + - - - - - + - + A 309 + + - + + - + - + + - + + - + - + + - + A 613 - - - - - - + - + + - + + - - - + - - - A 1427 + + - + - - + - + + - + - - - - + - - + A 1715 - - - - + - + - - - - + + + + - + - - - A 502 - - - + + - + - - - - + + - - - + - + - A 3073 + + - - - - + - + + + - - - - - + - - + A 3089 - - - - - - + - - - - + - - + - + - - + A 3069 + + - - + - + - + + + + - - - - + - - + A 3220 - - - + - - + - - - - + - - - - + - - + A 3413 - - - - - - + - + + - + + - + - + + - - A 4023 + + - - + - + - + + - + - - - - + - - + A 4370 - - - + + - + - - - + + - - + - + + +
Total 08 08 01 05 09 01 15 00 10 10 03 14 05 01 06 00 14 04 03 09
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
96
Table No. 52 showing the Nidana observed in Group B
Abbreviations used. 01-Milk with fish, 02-Milk with mamsa, 03-Milk with acidic foods, 04-Excess madhura rasa, 05-Excess amla rasa, 06-Excess lavana rasa, 07-Dadhi other milk products, 08-Navanna, 09-Matsya, 10-Mamsa, 11-Excess snigdha, 12-Raw moolaka alone or with dugdha, 13-Adhyashana, 14-Ati jala sevana after gharma, shrama, bhaya, 15-Masha 16-Tila, 17-Guda, 18-Pishtavikara, 19-Vyayama after bhojana, 20-Diwaswapna
Group OPD No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
B 1846 - - - + - - + - + + - + + - + - + - + - B 1968 + + - - - - + - + + - + - - - - + - - + B 2851 - - + + + - + - - - - + - - + - + + - + B 2758 - - - + - - + - - - - + - - + - + - - - B 3216 + + - + + - + - + + - + - - - - + + + - B 3217 - - - - - - + - - - - + - - + - + + - - B 3556 + + - + - - - - + + + - - - - - + + - - B 3591 + + - - - - + - + + - + - - - - + - + - B 3849 + + - + - - + - + + - + - - - - + - - - B 4006 - - - - - - + - - - - + - - - - + + - - B 4039 + + - - - + + - + + - + - - - - + + - + B 4279 - - - - - - + - - - - + - - + - - + - - B 4284 - - - - - + + - - - - + - - - - + + - + B 4228 + + - + - + - - + + - - - - - - + + - - B 4426 - - - + - - + - - - - + - - - - + + - +
TOTAL 07 07 01 08 02 03 13 00 08 08 01 13 01 00 05 00 14 10 03 05
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
97
Table No. 53 showing poorvaroopas observed in Group A Group OPD
No. 01 02 03 04 05 06 07 08 09 10 11 12 13 14
A 3634 + - - + - + + - - - + - - - A 235 + - - + - + + - - - + - - - A 538 + - + - - + + - - - + - + - A 309 + - - + - + + - - - + - + - A 613 + - - + - + + - - - + - - - A 1427 + - - - - + + - - - - - - - A 1715 + - - - - + + - - - + - + - A 502 + - - - - + + - - - + - - - A 3073 + - - - - + + - - - - - - - A 3089 + - - - - + + - - - + - - - A 3069 - - - - - + + - - - - - - - A 3220 + - - - - + + - - - - - - - A 3413 + - - - - + + - - - - - - - A 4023 + - - - - + + - - - - - - - A 4370 + - - - - + + - - - - - + -
TOTAL 14 00 01 04 00 15 15 00 00 00 08 00 04 00 Table No 54 showing poorvaroopas observed in Group B Group OPD
No. 01 02 03 04 05 06 07 08 09 10 11 12 13 14
B 1846 + - - + - + + - - - + + - - B 1968 - - - - - + + - - - + - - - B 2851 + - - + - + + - - - + - - - B 2758 + - - - - + + - - - + - + - B 3216 + - - - - + + - - - + - - - B 3217 + - - - - + + - - - + - - - B 3556 + - + - - + + - - - - - + - B 3591 + - - - - + + - - - - - - - B 3849 - - - - - + + - - - - - - - B 4006 - - - + - + + - - - - - + - B 4039 + - - - - + + - - - - - - - B 4279 - - - - - + + - - - - - - - B 4284 + - - - - + + - - - - - - - B 4228 - - - - - + + - - - - - - - B 4426 - - - - - + + - - - - - - -
TOTAL 09 00 01 03 00 15 15 00 00 00 06 01 03 00 Abbreviations used: 01-Twak parushata, 02-Akasmadromaharsha, 03-Swedabahulya, 04-Asweda, 05-Anga pradesha swapa, 06-Vaivarnya, 07-Kandu, 08-Suptata, 9-Nistoda, 10-Atishlakshnata, 11-Gourava, 12-Mala pradeha over kaya, 13-Kshata visarpa (spreads on injury), and 14-Paridaha
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
98
Table No. 55 Showing assessment of grading of subjective and objective parameter values of Group – A
Sl. No.
OPD no.
Subjective parameter Objective parameter Shyava krushna varna Parushata Ghanatwa Kharasparsha Kandu PASI
B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T
01 3634 3 1 3 0 3 0 2 0 4 0 4 0.2 02 235 4 1 3 0 3 1 3 1 4 0 30. 3.5 03 538 4 1 3 0 3 1 2 0 4 0 33. 1.4 04 309 4 1 4 0 4 0 4 0 4 0 55.6 3.4 05 613 3 0 3 0 1 0 2 0 4 0 2.0 0.2 06 1427 4 1 3 0 2 0 2 0 4 0 10.8 0.8 07 1715 3 1 3 0 3 1 3 0 4 0 16.6 1.8 08 502 3 1 3 0 2 0 2 0 4 0 5.9 0.7 09 3073 2 1 3 0 2 0 3 0 2 0 2.8 0.2 10 3089 3 1 2 0 1 0 1 0 4 0 8.8 2.4 11 3069 2 1 3 0 2 1 3 0 4 0 11.8 2.3 12 3220 3 1 3 0 3 1 3 0 4 0 14.8 1.4 13 3413 3 0 3 0 2 1 3 1 4 0 15 0.7 14 4023 3 1 3 0 2 1 3 0 4 0 6.4 0.8 15 4370 3 1 3 0 3 1 3 0 4 0 26.2 1.9
Statistical observation
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
99
Table No. 56 Showing assessment of grading of subjective and objective parameter values of Group – B
Sl. No.
OPD no.
Subjective parameter Objective parameter Shyava krushna
varna Parushata Ghanatwa Kharasparsha Kandu PASI
B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T 01 1846 4 1 3 1 3 1 3 1 4 0 36 5 02 1968 4 2 4 1 4 3 2 1 4 0 34.4 7.2 03 2851 3 2 3 1 3 2 2 1 4 2 14.4 8 04 2758 2 1 2 1 2 1 3 2 4 1 11.7 5.6 05 3216 4 1 3 1 3 1 2 1 4 0 8.4 1.2 06 3217 4 2 3 1 0 0 0 0 4 1 10.4 5 07 3556 1 0 3 0 2 1 1 0 3 0 12.2 1.7 08 3591 3 2 3 1 3 1 4 2 4 1 6.4 1.6 09 3849 2 1 3 1 2 1 2 1 4 1 22 1.8 10 4006 4 3 2 1 2 1 3 1 4 1 12.4 4.5 11 4039 3 2 3 2 2 2 2 1 4 0 24.5 11.1 12 4279 3 1 2 2 3 2 2 1 4 2 3.2 1.6 13 4284 2 1 3 2 2 1 2 1 4 1 3.5 1.2 14 4228 4 2 3 1 3 1 3 2 4 0 32.2 14.2 15 4426 2 2 3 2 3 3 2 2 4 3 21.3 19.6
Statistical analysis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
100
Table No. 57 Showing Statistical analysis of parameter values of Group – A Sl.
No.
Parameters Mean S.D S.E t-
value
p-
value
Remarks
01 Shyava krushna
varna
2.266 0.7037 0.1817 12.474 <0.001 H.S.
02 Parushata 3.00 0.3779 0.0975 30.769 <0.001 H.S.
03 Ghanatwa 1.866 0.8338 0.2152 8.673 <0.001 H.S.
04 Kharasparsha 2.4666 0.743 0.1918 12.860 <0.001 H.S.
05 Kandu 3.8666 0.516 0.1333 29.00 <0.001 H.S.
06 PASI 14.803 13.755 3.551 4.168 <0.001 H.S.
In Group A, mean of observed values after treatment was calculated and standard
deviation, standard error, ‘t’ values were calculated and was then referred for p-value
which was <0.001. According to this, all the parameters i.e. Shyavakrushna varna,
parushata, ghanatwa, kharasparsha, kandu (subjective parameters) and PASI
(Objective parameter) shown highly significance.
Table No. 58 Showing Statistical analysis of parameter values of Group – B Sl.
No.
Parameters Mean S.D S.E t-
value
p-
value
Remarks
01 Shyava krushna
varna
1.466 0.833 0.215 6.821 <0.001 H.S.
02 Parushata 1.666 0.816 0.2108 8.255 <0.001 H.S.
03 Ghanatwa 1.066 0.703 0.1817 5.8668 <0.001 H.S.
04 Kharasparsha 1.066 0.5936 0.153 6.971 <0.001 H.S.
05 Kandu 3.0666 0.8837 0.2281 13.444 <0.001 H.S.
06 PASI 10.913 9.225 2.382 4.581 <0.001 H.S.
In Group B, mean of observed values after treatment was calculated and standard
deviation, standard error, ‘t’ values were calculated and was then referred for p-value
which was <0.001. According to this, all the parameters i.e. Shyavakrushna varna,
parushata, ghanatwa, kharasparsha, kandu (subjective parameters) and PASI
(Objective parameter) shown highly significance.
Inter group statistical analysis
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
101
Table No. 59 Showing Statistical analysis of parameters values of inter group (Group – A and Group – B)
Sl. No. Parameter Group Mean S.D S.E P.S.E t-value p-value Remarks
01 Shyava krushna varna A 0.866 0.351 0.0908 0.212 3.146 <0.005 H.S.
B 1.533 0.743 0.191
02 Parushata A 0.00 - - 0.144 8.33 <0.005 H.S.
B 1.2 0.5606 0.144
03 Ghanatwa A 0.5333 0.516 0.133 0.251 3.425 <0.005 H.S.
B 1.4 0.828 0.213
04 Kharasparsha A 0.133 0.351 0.0908 0.1885 5.305 <0.005 H.S
B 1.133 0.639 0.165
05 Kandu A 0.00 0.00 0.00 - - <0.005 H.S
B 0.8666 0.915 0.236 0.236 3.669
06 PASI A 1.446 1.089 0.281 1.423 3.167 <0.005
B 5.953 5.404 1.395
Discussion
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Discussion:
Discussion is the most important part of any research where the observations
are discussed and given reasons by the researcher. Here researcher conveys the
practical experience with special reference to textual explanations. The significant
results and insignificant results will be discussed in the same section with reasons.
Hence it becomes important to discuss the clinical study in detail.
The discussion is done in the following headings;
1. Discussion on the disease kushta with special reference to kitibha kushta.
2. Discussions on the materials and methods.
3. Discussion on clinical study.
4. Discussions on the patients of kitibha kushta who underwent the trial.
5. Discussions on observations made on results during the trial work. Under two
subheadings as Group A and Group B.
6. Discussion on results.
7. Probable mode of action of the therapy and drug respectively in both groups.
1. Discussion on the disease kushta with special reference to kitibha kushta:
Kushta is a very obnoxious disease which can be compared to various skin
diseases in the modern day science. Kushta is said as deergha roga to indicate the
importance of counseling and preparation of the patient for long time coarse of
treatment. The chikitsa of kushta evenly poised as it may give good fame if treated
and at the same time patients may give a gift in terms of bad fame if it is not cured.
Our sages have cautioned us not to assure the results to the patient and never give the
time by which the disease may be cured by our treatment. The quotation is very
significant as it is told in the agrya prakarana by Acharya Charaka and Acharya
Vagbhatta, meaning of which is this disease kushta holds the first rank when
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103
chronicity of the disease is considered. Hence one should avoid false promise to the
patient regarding the cure of the disease.
a. Nidana of kushta: regular and excessive consumption of meat is the first
nidana and the predisposing factor noticed in the study. Consumption of raw moolaka
is very common in all most all the houses in this part. Consumption of moolaka used
in sambhar and curry form was used mixing with dugdha and dadhi in most of the
patients. As all the patients were belonging to this local area where the temperature is
very high, the use of dadhi is very much seen that they use to take at night also. Vada
is a special dish simulating to mashandari prepared out of masha pishata mentioned in
Ayurveda was found as positive history in most of the patients. Madhura rasa
atisevana in excess was found positive in the form of consumption of guda mixed
with ghruta with roti and chapatis in this area. Pishtanna was understood as all the
bakery items which are largely prepared using different floors vis-à-vis pishta, also a
special curry is prepared out of chanaka pishta for regular use with roti and chapatti.
Dugdha with amla rasa as a nidana was understood as milk shakes where milk is
mixed with fruit juices which are actually almost amla in rasa along with madhura
rasa. Most of the patients were accustomed to use dadhi and dugdha along with non
vegetarian curries when they take it with rice. Sheeta ushna vyatyasa karma is taken
as exposure to the sun after working in an air conditioned room or taking cold water
bath soon after exposure to sun for longer time and consumption of ice creams after
having food predominantly prepared with katu rasa (ushna in nature). Vyayama after
food is understood as walking for long distance like formers walking to their fields
soon after having food or even cycling, bearing heavy load etc were considered while
taking history. Bhaya Chinta Shoka ref from nidana notes. At last the most important
line to remember is nidana parivarjana is half the treatment for any disease.
Discussion
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104
b. Poorvaroopa: most of the patients were having the disease for more than
two years, so they have forgotten the poorvaroopas but when the questionnaire was
given to them or translated in the local language they have given some poorvaroopas
as positive in them which is difficult to accept in any research. Kandu, parushata and
vaivarnyata were most frequently observed poorvaroopas in the present study.
c. Roopa: the reasons because of which patient of kitibha approach a clinician
are kandu and ugly look of the skin. Itching (kandu), dry scaling (parushata and
rookshata) and erythema (krushna and shyava varna), thickness (ghanatwa) of the
lesion (kina) are the most commonly combated signs and symptoms in psoriasis vis-à-
vis kitibha kushta, in the present study also the leading complaints of the patients
remained same. Snigdhata was not found in any case of the study. Srava seems to
have appeared in the initial stages as per the information given by the patient when
asked about history of onset etc. Vartate cha samutpannam or prashantani cha
samutpannam are other frequent roopas observed in the study which means waxing
and waning of the disease without any specific reasons.
d. Samprapti: sapta dravyua samgraha is very important in disease kushta
irrespective of its subtypes. In the literary review it is already discussed under various
headings like nidana, poorvaroopaand roopa to understand the involvement of sapta
dravyas in kushta. Clinically they were experienced. Acharya Vagbhatta was first to
notice the importance of vata in the manifestation of kushta vyadhi. It is interpreted
that vata as is responsible always for vibhajana of garbha is understood as increased
cell division evident in the form of increased mitosis in psoriasis (hyperkeratosis).
The scales are loose dry and silvery white or micaceous due to the presence of air
trapped in between the layers of the scales in psoriasis can be told as the
predominance of vata dosha in kitibha kushta resulting in the parushta, kharatwa and
Discussion
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105
rookshata of the vrana sthana. It is said that in the early stage of psoriasis capillaries
in superficial part of dermis are dilated and tortuous which accounts for vivid red
colour of active plaques in psoriasis and there is stasis of blood in turn which is
compared to sanga seen in the rakta and mamsa. Though aetiology of psoriasis is
poorly understood, the involvement of genetics can not be ignored, notably kushta is
told as adibala pravrutta vyadhi involving dushta shukra and shonita. The deeds of
poorvajanma leading to kushta may be interpreted as understanding the entry of atma
in to the garbha through the shukra told by Acharya Charaka in Sahreera Sthana as the
involvement of genetic factors told by the modern science as quoted already in the
psoriasis context.
e. Sadhyasadhyata of kushta: all the Acharyas have told that the vata kapha
pradhana kushta is sadhya. According to this statement kitibha kushta must be sadhya
to treat but its lakshana vartate cha samutpannam told by Acharya Bhela does not
match the sadhya lakshana of a vyadhi. Also the other author Acharya Kashyapa who
says the lakshana as prashantani cha punaha utpadhyate does not match the present
context. Further detailed study and proper understanding of the lakshana will
illuminate us.
f. Arishta lakshanas: in the present study none of the patients were reported
with the arishta lakshanas told in the texts. And the features of dreams got by the
patient were felt to difficult to analyse during the study as they are purely subjective.
g. Kushta chikitsa: After going through the literary search of kushta disease it
was found that the treatment of kushta can be broadly classified as anthahparimarjana
and bahirparimarjana chikitsa. Among this a great importance is given to the first one.
It must be because of the idea that the drug reaches the site of pathology directly. This
concept reaching the site of pathology was followed by modern pharmacologists as
Discussion
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106
they say, for most of the dermatological conditions skin is readily available for the
application of the medicine. Most of the topical medication has negligible systemic
absorption and, therefore, few side effects and drug/drug reaction is rare because of
the same reason 235, this makes the advantage of this route. Ayurveda Acharyas have
noted that the result out of this type of the therapy can only be got if it is applied over
the tailakta gatra. This was well followed by the contemporary system of medicine.
They say that few drugs readily penetrate the intact skin. Absorption of those that do
is dependent on their lipid solubility since the epidermis behaves as a lipid barrier.
They also opine that the absorption of the drug through the skin can be enhanced
suspending the drug in an oily vehicle and rubbing the resulting preparation in to the
skin 236. This signifies the utility of taila preparation and utility of abhyanga in the
management of kushta disease, the cutaneous hydration is also said to increase the
rate of absorption of the trans dermal applications, this cutaneous hydration is best
maintained by the application of oil preferably 237. The inability of the
shamanoushadha to reach the vyakta sthana i.e. twacha with in short span of time to
heal the vrana makes the bahirparimarjana chikitsa superior in the context of kushta
chikitsa.
h. Pathyapathya: most of the part of nadana is occupied by the viruddhahara
hence one must be very keen to explain the type of viruddhahara and their adverse
effects. The advice is incomplete if the method of padamshu karma explained by
Acharya Charaka and Chakrapani to leave the apathyas and to adopt the pathya is not
briefed to the patient 238. The utility of tikta shakha is an important tip to the skin
diseased. The pathyahara are almost those which are opposite to the nidanas
mentioned. Patient must keep himself away from all type of non vegetarian dishes
Discussion
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107
especially fish as it aggravates the disease so fast that some times it becomes difficult
bring the doshas to normalcy as the disease itself is a bahudoshavasthajanya vyadhi.
i. Vyavacchedaka nidana: there are two schools of thoughts, one saying
kitibha as psoriasis and the other saying ekakushta as psoriasis. The vyavacchedaka
nidana are explained the literary context. The reason for making the comparison is
explained in the same section later.
2. Discussions on the materials and methods:
Drugs used in the trial work were;
a. Siddharthaka snanokta dravya siddha kashaya – for parisheka.
The reason behind choosing the Siddharthaka yoga for the present study was
its ingredients. The ingredients of the medicines were chiefly having kushtaghna
(abhaya, amalaka, saptaparna and aragwada) and kandughna (krutamala, naktamala,
kutaja, daruharidra and musta ) property which encouraged us to take for the trial as
the main complaint of kitibha kushta is ugrakandu. These drugs are well placed in the
respective dashemani gana as in these ganas 10 best and potent drugs are given as
examples. The drugs were kashya tikta rasa pradhana which is very important to heal
the kina (vrana), excess kleda and the kapha dosha in the kitibha kushta. The laghu
rooksha guna also is helpful for drying the excess amount of kleda present in the
body. Most of the drugs were having vata kaphahara or tridoshahara property which
suits to the demands in kushta chikitsa. This was used in the method as already
explained.
b. Siddharthaka snanokta dravya siddha taila – for application before
Parisheka: before kashya parisheka it is important to apply the yathartha rogahara
siddha taila as told by Acharya Charaka. This is also to maintain the cutaneous
hydration so that the active principles present in the kashaya are well absorbed via the
Discussion
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108
skin. This taila was asked to apply by self, assisting them by applying taila to back
region where patient can not apply by himself. The pressure during the application
was avoided as fear of bleeding is always there (Auspitz sign). Patient was advised to
sit/sleep quietly on the dhara table for at least 15-20 min as the penetration of the drug
through the dermal route is always great because of hydration when compared to the
dry skin 239. The duration of treatment was about 50-60 min daily for 10 days. There
is no specification for the total time duration and the days for the parisheka, so it was
decided to do it for 50-60 min after calculating the time required for each part of the
body individually as discussed in the materials and methods section.
c. Siddharthaka yoga capsules – for abhyantara prayoga: the siddharthaka yoga
mentioned for bahorparimarjana were analysed for the toxic effects and none were
toxic, but were used for the same disease in one or the other form. The advice of this
same kashaya for vamanartha and virechanartha encouraged us to try this yoga
internally. When the form of drug to be dispensed was considered it was kashaya. But
for the present trial the vastra galita choorna was taken and given bhavana 7 times with
the kashya prepared out of the same ingredients. The reason to choose capsule was; for
easy acceptance by patient, to overcome the astringent and bitter taste of the kashaya,
the advantage of perfect dosage calculation over kashaya so that a uniform dose can be
fixed which is mandatory in any research work, the easy way of dispensing and
patients can easily carry these capsules with them all the time so that there no chance
of missing the dose. Because of the above said reasons capsule form were chosen over
kashaya. For the purpose of potency the drug was given bhavana. When the bhavana
was given the total weight of the powder was increased indicating that the particles
were becoming heavier by each bhavana.
3. Discussion on clinical study.
Discussion
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109
Inclusion of the patients in the study was in accordance with the criteria set as
inclusion and exclusion criteria. Patients irrespective of the sex from 15-60 year of
age were included. Cases which were more than for 5 years were excluded from the
study. Those who were having the lesions over genitalia were also excluded as sweda
is contraindicated. Those who were having other systemic diseases were not
considered for the study as the treatment of that systemic disease becomes more
important and the assessment becomes difficult as the general condition of the patient
will not be good. Pregnant ladies and lactating mothers were not considered for the
study as the safety of the therapy and drug in these are not proved before. For Group
A 4 liter of or sufficient quantity of kashaya was used and the study duration was 10
days. Posology was fixed as 3 grams/day and study duration of thirty days in Group
B. For both the groups a follow up of 30 days was fixed. However in Group A
patients the lakshanas started in the third week but was minimal, this may be because
no medication or placebo was given during this follow up period. In group B no
relapse of symptoms ware noted. Totally 34 patients got registered out of which 4
discontinued the trial. All the four were from Group B only the reason for the
discontinuity was not known as the patient did not consult even after contacting them
by phone. Patients were divided randomly in to two groups.
Laboratory investigations: Though there is no significance of the laboratory
investigations in the psoriasis disease routine blood investigations like Hb%, T.C.,
D.C. and E.S.R. were done to assess the general condition of the patient and to
exclude the other systemic diseases. Also in research when a new form of medication
which is not in practice earlier has to look for adverse reactions on normal
homeostasis of the body, the only method to assess adverse reactions is by assessing
the blood picture. In the present study no significant changes were noticed apart
Discussion
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
110
decimal variations in the readings before and after the treatment which may be
because of human errors. The safety of the drug thus internally is proved with the help
of blood picture.
4. Discussions on the patients of kitibha kushta who underwent the trial.
Age: Maximum numbers of patients were from 46-60 years age group.
Though there is no clear explanation regarding age of onset, these observations do not
match with the earlier researches and is difficult to draw any conclusion by this study
involving minimum number of patients.
Sex: males dominated the attendance in the study when compared to females.
This supports the earlier research works. Some scholars of recent times opine that the
rakta of stree becomes shuddhi every month as dushta rakta is expelled out in the
form of raja srava, so the incidence of dermatological problems are comparatively
lesser than males.
Religion: in the present study maximum patients were from Hindu religion.
But there are no references of earlier research works interpreting the religion with
psoriasis.
This particular observation may be because of Large Hindu dominated region.
Economical status: in the study most patients were from middle class status.
The reason must be the inclusion of labors whose earning is good enough in this class.
Occupation: in the present study most were from labor class. The next were
of sedentary occupation. The inclusion of all field workers (formers) doing heavy
works in this group must have influenced.
Nature of work: maximum patients were from stressful working
environment. The reason must be the manasika karana as hetu and precipitating factor
of the disease.
Discussion
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111
Ahara (matra and kala): most of the patients reported with madhyama matra
ahara. Next were taking bahu matra ahara which is again told as nidana of the vyadhi
and few were consuming alpahara who were females. Most of the patients were taking
ahara at regular time. Those who were not taking at regular time were occupationally
disturbed.
Rasa: people of this part of Karnataka are accustomed of using more katu
rasa. The next predominant rasa used was madhura in the form as discussed in the
nidana context under the same heading.
Guna of ahara: most of the patients used dry type of food without ghee or
butter. This may be the reason that the vata got aggravated to lead to the disease
kushta as clarified by Acharya Vagbhatta.
Type of ahara: most of the patients were of mixed diet which once again
shows the significance of mamsa and matsya in the manifestation of kushta. However
once after being diagnosed as kitibha kushta either they have reduced the intake or
stopped completely.
Hygiene: most of the patients have maintained fair hygiene and only one was
of poor hygiene who underwent parisheka for 10 days and he was explained the
importance of good hygiene in maintaining the health.
Manaska sthiti: patients were suffering from chinta bhaya and shoka because
of the ugly appearance of the skin and the fear of dejection by the society. The
importance of manas has already been discussed in the nidana context earlier. The
CNS innervates dendritic cells in the lymph nodes and spleen, langarhans cells in the
skin and other antigen presenting cells. The nerve endings release neurotransmitters
that exaggerate and enhance local immune responses. For this reason some skin
Discussion
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112
conditions such as psoriasis aggravates when person is under stress (Martini,
Fundamentals of anatomy and physiology, by: Frederic H. martin, William C. Ober
etc, 4th edition, Page no 808, Prince hall Upper Saddle river, New Jersey 07548,
1998). This simulates the quotation by Acharya Charaka as ‘Vishado roga
vardhananam’(Cha.Su.25/40) holds good for every disease especially to the kushta
disease.
Nidana: mostly observed nidana in the patients were mamsa and matsya
sevana, excess madhura and amla rasa intake, raw moolaka, excess use of masha,
guda, dadhi and pishta vikara. The reason by which these nidanas manifest the disease
kushta has been already depicted in the tabular form in the literary review section.
The method of collection and interpretation of all these nidanas are dealt earlier. Havi
prashana (madhura bhakshyas prepared with excessive ghruta during yagnya) as
quoted by Acharya Charaka in the context of mythological oregine of the disease in
the nidana sthana last chapter as use of excess snigdha ahara in the present era
Poorvaroopa: patients were unable to recollect what first had happened to
their skin as the disease was manifested long ago. But most patients revealed that they
had kandu, twak parushyata and vaivarnyata then piakodbhava which later invaded
the whole body.
Roopa: all the lakshanas were observed in the patients except snigdha sparsha,
the colour of the kina was some times seen as krushna and some times appeared as
shyava varna. The changes in the colour may be because of the predominance of the
doshas.
Discussion
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113
Table no showing the similarity between kitibha kushta and psoriasis.
Kitibha Psoriasis Shayava, krushna and aruna varna kina
Erythema
Khara sparsha of the kina (lekhana is the karma of this guna)
Dry lesion, scaling
Parushata Dryness and scaling Srava Flow of exudates from lesion in early
stage of psoriasis206 (Boyd’s pathology/)
Vrutta Rounded plaques (Harrison, vol, 311). Ghana Thickness of the lesion. Stable plaque
(Harrson, vol, 311). Ugra kandu Lesions are variably pruritic
(Harrison, vol, 311). Vartate cha samutpannam/ Prashantani cha punaha utpadhyate
The disease may aggravate without any apparent cause as discussed already or flare up of psoriasis can occur randomly240
Site of onset: most of the trial patients got the onset in their scalp followed by its
spread to the whole body, in only one patient since one year the lesion from head has
not spread to the other part of the body.
Time/season of aggravation and mode of onset: in maximum patients the
time of aggravation was during night hours. The season was winter. Patient duly
considered the kandu in to the account. Few were getting aggravation in the day time
may be because of the irritation due to the exposure to sun. In most, the disease was
gradually manifested.
Discussion
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116
Kula vruttanta: only one patient was observed to have kulavruttanta which
does not appear to match with the earlier data available as the numbers of samples are
too small to draw a conclusion.
Chikitsa vruttanta: all the patients approached have taken allopath treatment,
notably they approached us because they were not satisfied with the results and the
increased awareness in them about the adverse effects of steroid therapy.
Confirmatory signs: all the patients were reported with positive candle grease
sign and Auspitz sign. Koebner sign was reported in few. This must be because of the
fact that we have not included patients suffering with this disease for more than 5
years.
5. Discussions on observations made on results during the trial work:
Assessment of the results was done by considering the subjective criteria and
objective criteria. Totally 5 subjective criteria were taken and grading from 0-4 was
given for no, mild, moderate, severe and extensive respectively. PASI scoring was
considered as objective parameter. The efficacy any drug is important to convey to the
modern world is by conducting the trial works drawing the statistical significance and
calculating the % of improvement by taking the readings after giving them universally
acceptable grading. The statistical result showing the significance has already been
discussed in the observation part. Here % of improvement is calculated to know the
efficacy and net improvement in the condition.
For this purpose the values were observed numerically which are given the
grading from 1 to 4.
Step1 – All the values of before treatment of subjective and objective parameters were
added to get the sum. Now this is the condition in which the patient had approached
us, so it becomes the base line data. This is taken as 100%.
Discussion
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117
Step2 – The readings of after treatment was then added to get the sum, which is the
status of the patient after the treatment.
Step3 – Now the % of the condition after the treatment is calculated by dividing this
number with the base line data obtained by the step 1. This should then multiply by
100 to get the % after the treatment.
Step4 – the % of improvement is calculated by subtracting the value got by step 3 by
100 will yield the net improvement in the disease.
Step5 – this value was referred for the table postulated to declare the results and the
table is
Sl. No. Range of net improvement % Remarks 1 100% CR- complete remission 2 75-99% BR- best response 3 50-74% MR-moderate response 4 25-49 % MiI- mild response 5 <25% NR- no response
Declaration of the result by above method:
Group A
Sl.No. Impression No. of patients % of patients 1 Best response 15 100
In this group the result was very quick to show. On the second day of the treatment
itself the chief compliant kandu was reduced to 50 % or even more. Three days after
the dhara total relief from kandu was noted. The sign parushata and rookshata were
observed to decrease slowly; on the fifth or sixth day complete absence of rookshata
was noted. Ghanatwa was relieved after five or six days of dhara. The colour of the
skin was last to become normal approximately on the 8th day. Patients were satisfied
totally with the treatment as kandu was suddenly relieved. The additional effect of the
dhara was found to induce good sleep as told by the patients voluntarily. In the follow
Discussion
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118
up period slight itching was noted in three cases where as none other lakshanas
relapsed. The last lesion to disappear or present even after the treatment in this group
of patients was that present in the low back (sacral region).
Group B
Sl.No. Impression No. of patients % of patients 1 Complete remission 0 00.00 2 Best response 4 26.66 3 Moderate response 8 53.33 4 Mild response 2 13..33 5 No response 1 6.66 Figure 28 showing the overall statement of results
Patients of Group B were not relieved by the signs and symptoms like those in Group
B. No relief was found in kandu and other symptoms and signs up to one week after
this the patient started getting relieved from all the lakshanas steadily. The additional
effect of the drug was said to improve the digestive capacity of the patients. During
the follow up none of the lakshanas were noted to appear in any cases.
0
15
0
4
8
21
0
19
8
21
0
2
4
6
8
10
12
14
16
18
20
Gro up A Gro up B T o tal
C o mplete remissio nB est respo nseM o derate respo nseM ild respo nseN o respo nse
Results
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
119
Table 60 Showing the overall statement of results of Group A Group A
Subjective parameters PASI Overall improvement OPD no.
B.T A.T Net Improvement
B. T
A.T Net improvement
Impression
Score % Score % Score % Score % Score Score % Mean of net improvement of subjective & objective parameter
3634 15 100 1 6.6 14 93.34 4 100 0.2 5 95 94.17 B.R. 235 17 100 3 17.64 14 82.36 30. 100 3.5 11.51 88.49 85.425 B.R. 538 16 100 2 12.5 14 87.5 33. 100 1.4 4.21 95.79 91.645 B.R. 309 20 100 1 5 19 95 55.6 100 3.4 6.11 93.89 94.445 B.R. 613 13 100 0 00 00 100 2.0 100 0.2 10 90 95 B.R. 1427 15 100 1 6.6 14 93.34 10.8 100 0.8 7.40 92.6 92.97 B.R. 1715 16 100 2 12.5 14 87.5 16.6 100 1.8 10.84 89.16 88.33 B.R. 502 14 100 1 7.14 13 92.86 5.9 100 0.7 11.86 88.14 90.5 B.R. 3073 12 100 1 8.3 11 91.67 2.8 100 0.2 7.14 92.86 92.265 B.R. 3089 11 100 1 9.01 10 91 8.8 100 2.4 27.27 72.73 81.865 B.R. 3069 14 100 2 14.2 13 85.72 11.8 100 2.3 19.49 80.51 83.115 B.R. 3220 16 100 2 12.5 14 87.5 14.8 100 1.4 9.45 90.55 89.025 B.R. 3413 15 100 2 13.33 13 86.67 15 100 0.7 4.66 95.34 91.005 B.R. 4023 15 100 2 13.33 13 86.67 6.4 100 0.8 12.5 87.5 87.085 B.R. 4370 16 100 2 12.5 14 87.5 26.2 100 1.9 7.25 92.75 90.125 B.R. Range of net improvement % - 100%-CR- complete remission, BR- best response-75-99%, MR-moderate response-50-74%, MiR- mild response-25-49 % Group B
Results
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
120
Table 61 Showing the overall statement of results of Group B
Subjective parameters PASI Overall improvement OPD no.
B.T A.T Net Improvement
B.T A.T Net improvement Mean of net
improvement
of subjective
& objective
parameter
Impression
Score % Score % Score % Score % Score % Score %
1846 17 4 23.52 13 76.48 36 100 5 13.88 31 86.12 81.3 B.R. 1968 18 7 38.88 11 61.12 34.4 100 7.2 20.93 27.2 79.07 70.095 M.R 2851 15 8 53.33 7 46.67 14.4 100 8 55.55 6.4 44.45 45.56 Mi.R 2758 13 6 46.15 7 53.85 11.7 100 5.6 47.86 6.1 52.14 52.995 M.R 3216 16 4 25 12 75 8.4 100 1.2 14.28 7.2 85.72 80.36 B.R. 3217 11 4 36.36 7 63.64 10.4 100 5 48.07 5.4 51.93 57.785 M.R. 3556 10 1 10 9 90 12.2 100 1.7 13.93 10.5 86..7 90 B.R3591 17 7 41.17 10 58.83 6.4 100 1.6 25 4.8 75 66.915 M.R. 3849 13 5 38.46 8 61.54 22 100 1.8 8.18 20.2 91.82 76.68 B.R 4006 15 7 46.66 8 53.34 12.4 100 4.5 36.29 7.9 63.71 58.525 M.R. 4039 14 7 50 7 50 24.5 100 11.1 45.30 13.4 54.7 52.35 M.R 4279 14 8 57.14 6 42.86 3.2 100 1.6 50 1.6 50 46.43 Mi.R 4284 13 6 46.15 7 53.85 3.5 100 1.2 34.28 2.3 65.72 59.785 M.R. 4228 17 6 35.29 11 64.71 32.2 100 14.2 44.09 18 55.91 60.31 M.R 4426 14 12 85.71 2 14.29 21.3 100 19.6 92.01 1.7 7.99 11.14 N.R. Range of net improvement % - 100%-CR- complete remission, BR- best response-75-99%, MR-moderate response-50-74%, MiR- mild response-25-49 %
Discussion
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
121
Conclusion on statistical analysis:
To compare the mean effect of the two groups after the treatment, the
statistical analysis was done by using un-paired test, by assuming that the mean effect
after the treatment in two groups. Here all the parameters shown highly significant i.e.
the mean effect of the treatment is not same in both the groups. In Group A the
parameters parushata and kandu, the mean effect is zero, it shows there is a complete
cure in these parameters (by comparing p-value and t-value).
To compare the effect of the drug before and after the treatment, the statistical
analysis was done by using paired-t test, by assuming that the drug is not responsible
for changes in the observations before and after the treatment. Here all parameters
have shown highly significant in both the Group (by comparing p-value).
But in Group A, all most all the parameters had shown more highly significant
than Group B (by comparing t-value).
In parameters shyava krushna varna, parushata and kandu were more highly
significant in Group A than Group B, with high net mean effect and less variations
(by comparing mean and variance).
Parameter ghanatwa in Group A shown more net mean effect with more
variation than the Group B (by comparing mean and S.D.), but parameter
kharasparsha in Group A shown more net mean effect with more variations than the
Group B (by comparing mean and S.D.).
Parameter PASI in Group A shown less more significant than the Group B, but
there is more net mean effect in Group A than in Group B and variation was less in
Group B
Discussion
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
122
Mode of action of the medicine/therapy: Group A – Parisheka: As stated already
the drug applied over the skin directly reaches the site of pathology being skin. As
discussed earlier in the same section of discussion the absorption of the medicine
increases by causing cutaneous hydration. The utility or anointing the body before the
parisheka as told by the Acharyas is to promote easy absorption through the skin
which provides the cutaneous hydration, by this the drug easily comes in contact with
the twachasthita bhrajaka pitta after its successful absorption. Once the active
ingredient of medicine reaches the level of bhrajakagni, the drug is made sajateeya at
this level. This will then bring back the normalcy in the skin. Moreover the Seers have
told us to use the yathartha siddha taila for application so the active ingredient of the
medicine also gets in to the body through the skin in this manner as it is said already
that the drug entry through the skin may be made easy by suspending in the oily
media. The drugs were chiefly of the tikta and kashaya in rasa which have got readily
the vrana ropana guna. The guna of these drugs are also opposite to kapha, the main
dosha for kandu to manifest. The dosha karmas of these drugs are told already as
kaphavatahara and some as tridoshahara, this yoga is estimated to bring down the
increased dosha at the site of pathology. The cumulative effect of triphala is told as
vranaropaka, this when used in the form of parisheka may yield this effect. The main
pathology told in psoriasis is increase in the rate of mitosis of keratinocytes which is
interpreted as increased vata guna and karma. Also as swedana is the choice of
treatment for the vata, the siddharthaka yoga kashya parisheka is expected to decrease
vata by the swedana effect. The taila application before the sweda will also help the
process but the snehana can not alone impart the result if swedana is not followed
after. So the swedana effect also plays a major role in kitibha kushta chikitsa. It can be
stated that anga gourava, a poorvaroopa of kushta might get relieved by the virtue of
Discussion
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
123
swedana effect. The other pathology of kushta is told as retention of excessive kleda
in the body because of swedavaha sroto avarodha, this avarodha can be relieved by
swedana as the phalashruthi of sweda is swedakaraka. The last is the cumulative
effect of the yoga spoken in the context of mode of action of any drug; here some of
the ingredients of this yoga are blessed with the prabhava of kushtaghna and
kandughnata in them, so it is important to end discussion of mode of action of
Siddharthaka yoga parisheka by saying that its effect is because of prabhava of the
yoga. It is important to recall the statement; ‘patients with less than 15% body surface
area involvement can be treated effectively with topical agents alone’241. Meaning of
which says all nothing more than the significance of external therapy in the disease
psoriasis. Stress and other psychological factors are going to worsen the condition
(Vishado rogavardhananam), so to overcome this, dhara would be a better choice.
Mode of action of Siddharthaka capsules: The ingredients of the medicine are
kushtaghna and kandughna as already stated and are estimated to relieve the disease.
On dosha, the drugs have vata kaphahara and tridoshahara effect so these are
interpreted as bringing the doshas to the normal state. The guna of the drugs like
musta and kalingayava have got grahee guna in them which are drava shoshaka i.e. in
this context it is taken as kledashoshana, rooksha guna present in musta, hareetaki,
kalingayava and daruharidra is said to perform the kledashoshana of the present in
excess in kushta rogi. Madanaphala etc. drugs have got vranahara, kapha vatahara
Tripahalas are used for virechanartha as stated by Acharya Charaka in first chapter
which help in taking the doshas, this effect is of minimal extent. Acharya Sushruta
says the cumulative effect of triphala as kushta and meha hara and also vranaropaka.
The deepana pachana property of the drugs corrects the dhatu paka so that there is
proper nourishment of the twacha and they avoid the excessive kleda formation.
Conclusion
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
124
Conclusion:
All the texts of Ayurveda have explained kitibha kushta in kshudra kushta, and
dosha predominance as vata kapha except Acaharya Sushruta who says it as due
to pitta.
Samanya nidana, poorvaroopa and samprapti of kushta are accepted for the
kitibha kushta also as separate explanation regarding kitibha kushta nidana,
pooraroopa and samprapti are not available in kushta chikitsa adhyayas.
Kitibha with its lakshanas simulates to psoriasis of modern science and was
considered for the convenience of this study.
Shyava krushna varna of kina, parushta and ugra kandu are the lakshanas in
kitibha kushta rogi making their life miserable.
Administration of bahirparimarjana chikitsa is inevitable in the skin diseases
especially in kitibha kushta.
For the hospital supervision and assessment snana was modified in to parisheka in
this study.
Siddharthaka yoga parisheka is effective in kitibha kushta in controlling shyava
krushna varna, parushata, ghanatwa, kharasparsha and kandu. It reduced the PASI
scoring remarkably.
Last lesion to disappear was from the low back (sacral region).
No adverse effects were reported after parisheka in the present study.
Taila application/abhyanga before parisheka is a must.
Siddhrtha yoga capsule is effective in the management of kitibha kushta.
Conclusion
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
125
Reduction in shyava krushna varna, parushata and kandu were more highly
significant in psoriatic after parisheka than those administered with the
Siddharthaka yoga capsules.
No adverse reactions were reported in this study by the administration of
Siddharthaka yoga capsules.
The efficacy Siddharthaka yoga bahya prayoga is more significant than the
abhyantara prayoga.
Limitations of the study:
Sample size was very small to universalize the results.
Sample selection was random in the present study.
It was difficult to assess exact mode of action of Siddharthaka yoga as it is a
compound preparation containing as many as 10 ingredients.
Recommendations for the future study:
The same study can be taken for the study including large number of samples.
Study can be done to evaluate the efficacy of parisheka after shodhana.
Study can be done on cumulative effect of bahya and abhyantara prayoga of
Siddharthaka yoga.
Efficacy of parisheka can be studied with and without the taila application.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
128
Bibliography: 1. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 1, shloka no. 120, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no, 22. 2. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), , reprint, 2004, Page no. 27-29. 3. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no.40 , edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no, 132. 4. Acharya Agnivesha, Chakrapani, Charaka Samhita, Sootra sthana, chapter, 3, shloka no.1 , edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 27 5. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 3, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 27. 6. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 33, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 144. 7. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 4, shloka no. 8/13-14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 33. 8. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 3, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.28. 9. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 7, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 28. 10. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 11, shloka no. 49, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP) reprint, 2004,, Page no. 77. 11. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 13, shloka no. 35, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.84.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
129
12. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 18, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 160. 13. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 19, shloka no. 4/2, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 110. 14. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 22, shloka no. 24, reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 121. 15. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 23, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 122. 16. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 24, shloka no. 16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 124. 17. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 132. 18. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 42/3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 144. 19. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter, 26, shloka no. 42, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 144. 20. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 103, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 151. 21. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 28, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 179 22. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 219.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
130
23. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter, 7 shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 337. 24. Acharya Agnivesha, Charaka Samhita, Indriya sthana, chapter 5, shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 119 25. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 26. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 29, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no, 451. 27. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 11, Shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 146. 28. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 30, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 29. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 34, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 289. 30. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 22-25, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 31. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 28, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 32. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 29, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 33. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 33, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 144.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
131
34. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 4, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 355. 35. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 442. 36. Acharya Bhela, Bhela Samhita, Nidana Sthana, Chapter 5, Shloka no. 1-4, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 150. 37. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 24-25, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 330. 38. Acharya Harita, Harita Samhita, third sthana, chapter 39, edited by Ramavalamba Shastri, Prachya prakashan, 74-A, Jagatganj, Varanasi-221002, first edition, 1985, page no. 367-374. 39. Acharya Vruddha Jeevaka, Kashyapa Samhita, Chikitsa Sthana, Chapter Kushta chikitsa, pandit Hemaraja Sharma, edited by Sri Satyapal Bhishagacharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2006, Page no. 116. 40. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 139-146. 41. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 4, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524. 42. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 6, collected by Dr. Anna Moreshwar Kunte and Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 43. Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 2nd Chapter, Shloka No.136-142, edited by Pandit Parushurama Shastri, Vidyasagar, , Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition 1983, Page No.162.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
132
44. Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 2nd Chapter, Shloka No.87-90, edited by Pandit Parushurama Shastri, Vidyasagar, , Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd Edition 1983, Page No.98. 45. Acharya Basavaraja, Basavarajeeyam, 13th prakarana, Sri Govardhana Sharma Changani, 1987, page no. 215. 46 Acharya Lolimbaraja, Vaidhyajeevanam, foorth vilasa, 18th shloka commentator Dr. Indradeva Tripathi, , Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition, 2005, Page no. 51. 47. Sri. Tarakanath, Tarka Vachaspatya, vol 3, Chowkhambha Series, 1970, page no. 2154 page. 48. Sri Haragovinda Shastri, Amarakosha, 3/6/54, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K. 37/16, Gopal Mandir lane, Varanasi (UP), 4th edition, 2001, Page no. 283. 49. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 2, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 139. 50. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 3-4, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 109. 51. Raja Radha Kantha deva, Shabda Kalpadhruma, Chowkhambha Sanskrit series, P.B.8, Varanasi, 3rd edition, Page no.126, 52. Shri. Kavirama Umeschandra, Vaidhyaka Shabdha Sindhu, , Chowkhambha Orientalia P.B.32, Varanasi, 2nd edition 1983. page no.272. 53. Sanskrit English dictionary, Sir. Monier Monier – Williams, Mittal Banarsidas Publishars Pvt. Ltd., Varanasi, 221001, reprint 1993, Page no. 282, 54. Sri. Tarakanath, Tarka Vachaspatya, vol 3, Chowkhambha Series, 1970, page no. 2046 page. 55. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 8, shloka no. 51, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 350.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
133
56. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 15, shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 514. 57. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 5, shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 250. 58. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 4, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 355. 59. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Shareera sthhana, Chapter 2. Shloka no. 23, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 445. 60. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 8, shloka no. 10, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 56. 61. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 1, Shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 339. 62. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 4, shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 318. 63. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 12, Shloka no. 14, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 194. 64. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 21, Shloka no. 10, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no.101. 65. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 7, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.337. 66. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 4, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 355.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
134
67. Dr. Bhaskar govind Ghanekar, Sushruta Samhita Sanskrit text with Ayurveda rahasya deepika hindi commentary, Shareera sthana, 4th chapter, shloka no- 3, page no.- 104-108, reprint 1995, Meharchand Lachman Das Publication, dariaganj, New Delhi, 110002. 68. Acharya Sushruta, Sushruta Samhita, Shareera Sthana, Chapter 1, Shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 339. 69. Acharya Agnivesha, Charaka Samhita, Shareera sthana, chapter 4, shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 318. 70. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 28, shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 616. 71. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 12, Shloka no. 14, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 194 72. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 8, shloka no. 103, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 228. 73. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 11, Shloka no. 17, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 185 74. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 11, Shloka no. 7, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 183 75. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 15, Shloka no. 5(1), edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 68. 76. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 15, shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 514-515.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
135
77. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 15, shloka no 17 , edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 514-515. 78. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 15, Shloka no. 5(2), edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 68. 79. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 6, reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthanm P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no.217.
Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 4-8,
reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthanm P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 450. 80. Acharya Bhela, Bhela Samhita, Nidana Sthana, Chapter 5, Shloka no. 1-4, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 150.
Acharya Bhela, Bhela Samhita, Nidana Sthana, Chapter 6, Shloka no. 4-10, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 328. 81. charya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 13, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 286.
Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 442. 82. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 2, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 639. 83. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 1-2, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 84. Acharya Madhavakara, Madhava nidana, Chapter49, Shloka no. 1-6, revised and edoted by Sri Sudarshana Shastri, Prof Yadunandana Upadhyaya, part 2nd,
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
136
Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, page no. 153. 85. Bhavamishra, Bhavaprakasha, Part-2, chapter no. 54, shloka no. 1-6, edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 518. 86. Acharya Yoga Ratnakara, Yoga Ratnakara, kushta nidana, shloka no. 1-4, edited by Bhishagratna Sri Brahmananda Shastri, , Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 211. 87. Acharya Vangasena, vol 2, Kushta nidana chapter, shloka no. 1-5, by, Nirmal sexena, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 728. 88. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 5, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 89. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 7, shloka no. 11, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 258. 90(Su.Ni.5/34s). 91. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 27, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 92. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 13, shloka no. 75-76, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 86. 93. Acharya Agnivesha, Charaka Chikitsa sthana, chapter 14, shloka no. 179, reprint, 2004, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), Page no. 518. 94. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 4, shloka no. 27, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 430. 95. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 19, shloka no. 16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 550.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
137
96. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 27, shloka no. 212, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 164. 97. Acharya Sushruta, Acharya Dalhana, Sushruta Samhita, Chikitsa Sthana, Chapter 5, Shloka no. 13, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 424. 98. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 86-101, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 150. 99. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 45, Shloka no. 185, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 211. 100. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 27, shloka no. 82, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.158. 101. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 155, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 227. 102. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 20, Shloka no. 13, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 93. 103. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 9. Shloka no. 6, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 136. 104. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 84, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 150. 105. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 266, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 233. 106. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B n. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 131-132.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
138
107. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 83, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no 149.. 108. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 9. Shloka no. 3, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 135. 109. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 20, Shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 9 6. 110. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 96, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 151. 111. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 98, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.151. 112. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 25. Shloka no. 38, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 307. 113. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 520, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 252. 114. Acharya Laghu Vagbhatta, Acharya Hemadri, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka no. 18, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 12 115. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 46, Shloka no. 517, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 252. 116. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 450.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
139
117. Acharya Sushruta, Sushruta Samhita, Sutra Sthana, Chapter 19, Shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 17. 118. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 5, Shloka no. 31-33, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 70-71. 119. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 42, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 143. 120. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 1, shloka no. 18, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 234. 121. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 132. 122. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 42/2, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 144. 123. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 7. Shloka no. 191, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 104. 124. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 38. Shloka no. 25, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 411. 125. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 131-132. 126. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 7, shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 49. 127. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 99, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 151.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
140
128. Acharya Agnivesha, Charaka Samhita, Vimana sthana, chapter 1, shloka no. 16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 234. 129. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 9, Shloka no. 5, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 166 130. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Sutra sthhana, Chapter 9. Shloka no. 12, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 137. 131. Acharya Agnivesha, Charaka Samhita, Sootra sthana, chapter 26, shloka no. 87-88, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, reprint, 2004, Varanasi (UP), Page no. 150-151. 132. Acharya Vruddha Vagbhatta, Acharya Indu, Ashtanga Sangraha, Sutra sthhana, Chapter 6. Shloka no. 54, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 65. 133. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 218. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 11-12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 134. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 15-17, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 329. 135. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 283. 136. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 8, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
141
137. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 11-12, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 524 138. Acharya Madhavakara, Madhava nidana, Chapter 49, Shloka no. 8-9, revised and edoted by Sri Sudarshana Shastri, Prof Yadunandana Upadhyaya, part 2nd, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, page no. 156. 139. Bhavamishra, Bhavaprakasha, Part-2, chapter no. 54, shloka no. 13 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 526. 140. Acharya Yoga Ratnakara, Yoga Ratnakara, Nidana sthana, shloka no. 21, edited by Bhishagratna Sri Brahmananda Shastri, , Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 214. 141. Acharya Vangasena, vol 2, Kushta rogadhikara chapter, shloka no. 11, by, Nirmal sexena, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 730. 142. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Chkitsa sthana, chapter 7, shloka no. 22, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 143. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka no. 18, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 12. 144. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 22, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 145. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 24-25, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 330. 146. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 14, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 286.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
142
147. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 16, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 641. 148. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Nidana Sthana, Chapter 14, Shloka no. 20-21, collected by Dr. AnnaMoreshwar Kunteand Krushna RamachandraShasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 525. 149. Acharya Madhavakara, Madhava nidana, Chapter 49, Shloka no. 18, revised and edoted by Sri Sudarshana Shastri, Prof Yadunandana Upadhyaya, part 2nd, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, page no. 158. 150. Bhavamishra, Bhavaprakasha, Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 529. 151. Acharya Yoga Ratnakara, Yoga Ratnakara, Kushta nidana, shloka no. 21, edited by Bhishagratna Sri Brahmananda Shastri, , Part-2, chapter no. 54, shloka no. 33 edited by Brahmashankara Mishra and Rupalalaji Vasya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 214. 152. V.S. Ku.rogadhikara/20 V.S. Ku.Ni.1-5Acharya Vangasena, vol 2, Kushta nidana chapter, shloka no. 20, by, Nirmal sexena, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 731. 153. Acharya Vruddha Jeevaka, Kashyapa Samhita, Chikitsa Sthana, Chapter Kushta chikitsa, pandit Hemaraja Sharma, edited by Sri Satyapal Bhishagacharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2006, Page no. 116. 154. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 155. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 156. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 9, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 218.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
143
157. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 9-10, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 450. 158. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 282. 159. Acharya Bhela, Bhela Samhita, Chikitsa Sthana, Chapter 6, Shloka no. 8-10, edited by Dr. K.H. Krishnamurthy and Prof. P.V. Sharma, Chowkhambha Vishwabharati, P.B. No. 1084, K.37/109, Gopal Mandir lane, Varanasi (UP), Reprint 2005, Page no. 328. 160. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 3-5, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640. 161. Acharya Agnivesha, Charaka Samhita, NIiidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 162. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 163. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 217. 164. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 282. 165. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 6, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 217. 166. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 3, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 167. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Shareera sthhana, Chapter 6. Shloka no. 45, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no.495.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
144
168. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 11, shloka no. 48, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 77. 169. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 25, shloka no. 40, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 132. 170. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 171. Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 216. 172 Cha.Ni. 5/8, Cha.Chi.7/20 Acharya Agnivesha, Charaka Samhita, Nidana sthana, chapter 5, shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 218.
Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 20, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451. 173. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 5, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 283. 174. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 14-19, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640-641. 175. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 21-26, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 451.
176.Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 9-16, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 285-286. 177. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 12-22, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 640-642.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
145
178. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 38, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no.452. 179. Acharya Sushruta, Sushruta Samhita, Nidana Sthana, Chapter 5, Shloka no. 28, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 288. 180. Acharya Vruddha Vagbhatta, Ashtanga Sangraha, Nidana sthhana, Chapter 14. Shloka no. 31, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 643. 181. Acharya Agnivesha, Charaka Samhita, Indriya sthana, chapter 5, shloka no. 14-15, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 362. 182. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 84-161, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454-458. 183. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 25, shloka no. 45, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 133. 184 Lolimbaraja, Vaidhyajeevanam, prathama vilasa, 10th shloka, commentator Dr. Indradeva Tripathi, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition, 2005, Page no. 4. 185. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 5, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 442.
Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 72, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 448. 186. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 82-83, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454. 187 Mahamahopadhyaya Vishwanatha Sena, Pathyapathya Vinischaya, Prem Kumar and M.M. Padi, Kendreeya Ayurveda evam Siddha Anusandhana Parishad, Jawaharlal Nehru Bharateeya chikitsa evam homeopathy anusandhana bhavan, 61-65, Samsthanika kshetra, Sammuk ‘D’ block, Janakapuri, New Delhi, 110058, 1999, Page no.83.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
146
188. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 9, Shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 282. 189. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 83, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit SansthanP.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454. 190. R.G Valia, IADVL Text book and atlas of dermatology, Vol. I, Chapter 2, second edition, Bhalani publishing house, Bombay, 1994, Page no. 8-11.
R.G Valia, IADVL Text book and atlas of dermatology, Vol. I, Chapter 5, second edition, Bhalani publishing house, Bombay, 1994, Page no. 142-147. 191 A.C.Ritchei, Boyd’s text book of pathology, 9th ed., vol 2, chapter 62, K.M. Varghes Company, PB no.7119Bombay 400031, 1990, page no. 1985-1986 192. Behcet PE, Psoriasis, a brief historical review. Arch Dermatol Syphilol 1936; 33:327–334. 193. Farber EM, McClintock RP Jr. A current review of psoriasis Calif med 1968; 108: 440 – 457 194Baker H. psoriasis: a review. Dermatologica 1975; 150:16-25 195. Lane CG, Crawford GM. Psoriasis a statistical study of two hundred and thirty one cases. Arch Dermatol Syphilol 1937, 35: 1051-1061. 196. Ambady BM, Gopinath T, Nair BKH. Psoriasis. Indian J Dermatol Venereol 1961; 23: 27 – 34. 197. Bedi TR. Psoriasis in children. Indian J Dermatol Venereol 1979; 45: 410 - 413 198. Lal S. clinicalpattern in psoriasis in Punjab. Indian J Dermatol Venereol 1966; 35:5 – 12 199. Sharma T, Sepha GC. Psoriasis – a clinical study. Indian J Dermatol Venereol 1964; 30: 191 – 197 200. Kaur I, Kumar B, Sharma VK, et al. epidemiology of psoriasis in a clinic from North Indian. Indian J Dermatol VenereolLeprol 1986; 52:208 - 212. 201. Farber EM, Nall ML, Watson W. natural history of psoriasis in 61 twin pairs. Arch dermatol 1974; 109:207 – 211
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
147
202. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health press Oxford 2004, page no.8. 203. Eugine Braunwald, Stephen L. Hauser, Anthony S. Fauc et.al.Vol-1, chapter 56, McGraw- medical publishing division, 15th edition, 2001, page no. 312. 204. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health press Oxford 2004, Page no.9. 205. Nicholas A Boon, Nicki R. Colledge et.al, Davidson’s Principle & Practice of Medicine, chapter 13, Cristopher Haslett & Others, 20th Edition, Harcourts Publishers, 2006, Edinburgh, UK, Page n. 1288. 206. Nicholas A Boon, Nicki R. Colledge et.al, Davidson’s Principle & Practice of Medicine, chapter 13, Cristopher Haslett & Others, 20th Edition, Harcourts Publishers, 2006, Edinburgh, UK, Page n. 1289. 207. Fast Fact Psoriasis, second ed,Alan Menter MD et al. Chapter 1, Health press Oxford 2004, Page no.9. 208. A.C.Ritchei, Boyd’s text book of pathology, 9th ed., vol 2, chapter 62, K.M. Varghes Company, PB no.7119Bombay 400031, 1990, page no. 1985-1986 209. Alan Menter MD et al. Fast Fact Psoriasis, , Chapter 1,. Health press Oxford, second edition, 2004, page no.9. 210. 203. Eugine Braunwald, Stephen L. Hauser, Anthony S. Fauc et.al.Vol-1, chapter 56, McGraw- medical publishing division, 15th edition, 2001, page no. 312. 211. R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, second edition, Bhalani publishing house, Bombay, 1994, Page no. 714. 212. Alan Menter MD et al., Fast Fact Psoriasis, second edition, Chapter 1, Health press Oxford 2004, Page no.14. 213 R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, second edition, Bhalani publishing house, Bombay, 1994, Page no. 714. 214. R.G Valia, IADVL Text book and atlas of dermatology, Vol. II, Chapter 27, second edition, Bhalani publishing house, Bombay, 1994, Page no. 714. 215. Alan Menter MD et al., Fast Fact Psoriasis, second edition Chapter 3, Health press Oxford 2004, Page no.25-30. 216. Alan Menter MD et al. Fast Fact Psoriasis, second edition. Chapte4, Health press Oxford 2004. Page no.31-69,
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
148
217. Acharya Agnivesha, Charaka Samhita, Chikitsa sthana, chapter 7, shloka no. 92, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 454-455.
Acharya Vruddha Vagbhata, Astanga sangraha, Vol. 2, Chikitsa Sthana, Chapter 21, Shloka no.119, translated by Prof. K.R. Shrikantha Murthy, First edition, 1996, Chaukhambha Orientalia, Varsnasi, Page no.509.
Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Chikitsa Chapter 19 Shloka no.
60, collected by Dr. Anna Moreshwar Kunte and Krushna Ramachandra Shasti Nave, edited by Bishagacharya Harikrushna Shastri Paradka Vaidya, Krushnadas academy, Oriental publishers and disributers, P.B.No.1118, , K.37/118, Gopal Mandir lane, Varanasi (UP), Reprint, 2000, Page no. 715 218. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 15, shloka no. 4, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 92. 219. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Sutrasthana, chapter 13, shloka no. 7, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 79. 220. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 1, shloka no. 135, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 23.
221. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 28, shloka no. 30, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 180. 222. Acharya Sushruta, Dalhana, Sushruta Samhita, Uttra Tantra, Chapter 40, Shloka no. 166, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 166. 223. Acharya Agnivesha, Charaka Samhita, Chikitsasthana, chapter 14, shloka no. 92, edited by Dr. Brahmanand tripatyhi, Choukhamba Surabharati Prakashan, P.B no. 1129, K.37/117, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 319. 224. Bhavamishra, Bhavaprakasha, edited by Brahmashankara Mishra and Rupalalaji Vasya, Part-1, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 243, 77, 10, 9, 7, 350, 68, 346, 119, 546.
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
149
Prof. P.V. Sharma, Dravyaguna vignana, Vol-2, Chawkhambha Bharati Academy, P.B no. 1005, K.37/109, Gopal Mandir lane, Varanasi (UP), reprint, 2005, Page no. 370, 373, 758, 239, 753, 144, 170, 463, 537, 702. 225. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 29, Shloka no. 12, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 503. 226. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 1, Shloka no. 8, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 397. 227. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 14, shloka no. 19, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 90. 228. Acharya Agnivesha, Charaka Samhita, Sutra sthana, chapter 11, shloka no. 44, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan, P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 90. 229. Acharya Vruddha Vagbhatta, Acharya Indu, Ashtanga Sangraha, Sutra sthhana, Chapter 26. Shloka no. 5, edited by Dr. D.V.Pandit Rao and Vaidhya Ayodhya Pandeya, Kendreeya Ayurveda evam Siddha Anusadhna parishat, S-10, Green park extension, New Delhi- 110016, 1991, Page no. 312. 230. Acharya Sushruta, Sushruta Samhita, Uttra Tantra, Chapter 39, Shloka no. 156-157, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 684. 231. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, Chapter 1, Shloka no. 17, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Orientalia, P.B.No.1032, K.37/109, Gopal Mandir lane, Varanasi (UP), 8th edition, 2005, Page no. 399. 232. Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 2nd Chapter, Shloka No.1 & 2, Translated by Prof. K.R. Srikanta Murthy, First Edition 1984, Varanasi, Chawkambha Orientalia, Page No.56. 233 Sharangadhara, Sharangadhara Samhitha, Madyama Khanda, 9th Chapter, Shloka No.1 & 2, Translated by Prof. K.R. Srikanta Murthy, First Edition 1984, Varanasi, Chawkambha Orientalia, Page No.115. 234. PASI (Psoriasis assessment tools in clinical trials S R Feldman, G G Krueger Downloaded from ard.bmj.com on 4 May 2007
Bibliography
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
150
235. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi.) 236Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi. 237. Anthony S. and Fanci, Joseph B. Martin, etc., Harrison’s principles of medicine, Vol-l, part-2, chapter 55, 14th edition, Mc Graw Hill health publishers divisions, New Delhi, page no. 300 238. Acharya Agnivesha, Charaka Samhita, Acharya Chakrapani, Sutra sthana, chapter 7, shloka no. 36-37, edited by Vaidya Jadavaji Trikamji Acharya, Chawkhambha Sanskrit Sansthan P.B no. 1139, K.37/16, Gopal Mandir lane, Varanasi (UP), reprint, 2004, Page no. 51-52. 239. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 1, page 8, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi. 240. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 65, page 1804, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi. 241. Joel G. Hardman & Lee E. LimbridGoodman & Gilman’s The pharmacological basis of therapeutics, Chapter 65, page 1804, 10th edition, McGraw-Hill, Medical Publishing Division, New Delhi.
Summary
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
126
Summary:
The present study entitled “A comparative clinical study of ‘siddharthaka yoga
‘parisheka and abhyantara prayoga in the management of ‘kitibha kushta’ with the special
reference to ‘psoriasis’ was taken for the trial in search of the route of administration of
the for the effective treatment of kitibha kushta vis-à-vis psoriasis. The drug was same for
both antahaparimarjana and bahirparimarjana chikitsa so that the result will not influence
by the change of medicines.
The objectives of this trial was to evaluate the efficacy of siddharthaka yoga parisheka in
kitibha kushta, to evaluate the efficacy of siddharthaka yoga abhyantara prayoga in
kitibha kushta, to evaluate the comparative efficacy of siddharthaka yoga parisheka and
abhyantara prayoga in kitibha kushta. For the convenience of the study snana was
modified to parisheka and kashaya to capsules. The patients were selected from O.P.D
and I.P.D. of D.G.M.A.M.C & H. they were examined for their inclusion and exclusion
in the study. Totally 30 number of patients were divided in to two groups. 15 patients of
Group A underwent Parisheka for 10 days and 15 patients of Group B received 3 grams
of capsules in 3 divided doses for 30 days. Follow up was 1 month for both the groups.
The readings of subjective and objective parameters before and after the treatment
were noted and were calculated for statistical significance using paired and un-paired
Student-t test.
Observations made in the trial revealed the highest significance (36.6%) in the 46-
60 age group, male dominated the attendance (70%), Hindu religion were more (83.3%),
middle class patients were more (83.3%).
Summary
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
127
The result was best response in all (100%) patients of Group A than those of
Group B (26.6%). Maximum patients of Group B patients got moderate response
(53.33%).
In the present study the bahya prayoga in the form of parisheka has shown highly
significant results than the abhyantara prayoga of Siddharthaka yoga.
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
1
SRI DANAPPA GURUSIDDAPPA MELMALAGI AYURVEDIC MEDICAL COLLEGE, POST GRADUATE & RESEARCH CENTRE, GADAG.
SPECIAL CASE SHEET OF KITHIBHA KUSHTA (PSORIASIS), AS TAKEN FOR THE DISSERTATION WORK UNDER THE TITLE - “A COMPARITIVE
CLINICAL STUDY OF ‘SIDDHARTHAKA YOGA’ PARISHEKA AND ABHYANTARA PRAYOGA IN THE MANAGEMENT OF ‘KITIBHA KUSHTA’
WITH SPECIAL REFERENCE TO ‘PSORIASIS’”.
Guide: Dr. Varadacharyulu M.D. (Ayu) Prof. & Head, P.G. Dept Of Kaya chikitsa. D.G.M.A.M.C. Gadag.
Co - Guide: Dr. Raghavendra V. Shettar M.D. (Ayu) Asst. Prof. P.G. Dept Of Kaya chikitsa. D.G.M.A.M.C. Gadag.
Scholar: Ashok M.G. Name of the patient Sl. No. Father’s name/ Husband’s name OPD No. Age (in years) IPD No. Sex: Male Female Bed No. Religion Hindu Christian Muslim Others Economical Status Poor Middle cl. Rich Occupation Birth place Marital Status Case referred by Residential address: …………………………………….. …………………………………….. …………………………………….. ……………………………………..
Permanent address …………………………………….. …………………………………….. …………………………………….. ……………………………………..
Mobile ph. Number Land ph. Number INFORMED CONSENT
I Son/Daughter/Wife of am
exercising my free will, to participate in above study as a subject. I have been informed to my
satisfaction, by the attending physician the purpose of the clinical evaluation and nature of the drug
treatment. I am also aware of my right to opt out of the treatment schedule, at any time during the
course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÉÒ¬ÄAzÀ
PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ
0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.
gÉÆÃV0iÀÄ gÀÄdÄ / Patient's Signature
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
2
Pradhana vedana:
Sl.No. Pradhana Vedana Present Absent Kala prakarsha 1. Shyavavarna Kina 2. Krishnavarna Kina 3. Parushata Kina 4. Ghana 5. Khara sparsha 6. Snigdha sparsha 7. Ugra kandu
Anubandha vedana
Sl.No. Vedana Present Absent Kala prakarsha 1. Daha 2. Raga 3. Srava 4. Vedana 5. Shaitya 6. Kleda 7. Gaurava Adhyatana vyadhi vrittanta if any
Site of onset Scalp Knee Elbow Ear lobe
Mode of onset Sudden Gradual After injury
Aggravation Aggravating time Day Night Aggravating season Summer Rainy Winter Contact with chemicals Anti malarial medicine
Nature of work Stressful Near heat Traveling Purva vyadhi vrittanta if any
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
3
Kula vrittanta Maternal Parental
Chikitsa vrittanta Ayurveda Allopathic Homeopathy Unani Naturopathy Details if any
Vaiyaktika vrittanta Ahara
Matra Bahu Madhyama Alpa Kala Regular Irregular 2
times 3 times
Rasa Madhura Amla Lavana Katu Tikta Kashaya
Guna Guru Laghu Snigdha Ruksha
Type Vegitarian Mixed Vihara
Vyasana Type Alcohol Tobacco Chewing
Smoking Tea/ coffee
Particulars
Nidra Type In hours Diwaswapa Ratri
Hygiene Good Fair Poor Occupation Student Labor Executive Sedentary
Samanya Pareeksha General condition
Blood Pressure(in mm of Hg)
Temperature (oF)
Pulse / min Weight in kgs Height in cms. Vital Systemic Examination
C.V.S. S1 , S2 Murmurs R.S. Lung Field Locomotor Psoriatic arthritis Per abdomen Soft Tender Organomegaly
Dashavidha pareeksha Prakruti Satmya Vikruti Satwa Sara Ahara shakti Samhanana Vyayama shakti Pramana Vaya
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
4
Ashtavidha pareeksha Nadi Rate Shabda
Mala Varna Consistency Sparsha
Times/day
Mootra Varna Druk Times/day
Jihwa Akruti Manasika pareelksha
Chinta Shoka Bhaya VYADHI VISHESHA PAREEKSHA
Twak parreksha Kinah pareeksha - Darshana Shyava varna Krishna varna Srava Vritta Snigdha Site % Site % Site % Upper limb Lower limb: Head/ Neck Rt. Anterior Rt – Anterior Scalp Rt.Posterior Rt – Posterior Face Lt. Anterior Lt – Anterior Neck Lt.Posterior Lt – Posterior Chest: Abdomen Ctrunk Posterior Posterior Posterior Posterior Posterior Posterior Sparshana Kharatwa Parushata Ghana Dry Moist Greasy Dosha lakshanas: Vata Pitta Kapha Confirmatory signs (subjective): Candle grease sign Auspitz sign Koebnar phenomena Objective parameter:
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
5
Vikruti pareeksha: Hetu: Aharaja: Milk with fish Milk with flesh Milk with acidic foods Excess madhura rasa Excess amla rasa Excess lavana rasa Dadhi Ikshu vikara Navanna Matsya Mamsa Excess snigdha Raw moolaka or with milk Adhyashana Pishtavikara Ati jala sevana after gharma shrama,
bhaya
Masha Tila Viruddha if any other Guda Viharaja Chardi vega dharana Cold bath / swimming soon
after sunbath
Vyayama/vyavaya/santapa after bhojana or during ajeerna
Diwaswapna
Panchakarma apachara Sneha aticharana Papa karma Vipra guru gharshata Purvaroopa Twak parushata Akasmadromaharsha Kandu Swedabahulya Asweda Anga pradesha swapa Parushyata Vaivarnya Nistoda Atishlakshnata Gourava Mala pradeha over kaya Kshata visarpa (spreads on injury) Paridaha Upashaya Samprapti ghatakas Vata Shyava Aruna Ruksha Khara Vedana Pitta Daha Raga Srava Kapha Kleda Ghana Snigdh
a Kandu Shaitya Gaurava
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
6
Dushya Twak Sparshahan
i Swedana Ishatkand
u Vaivarna Ruksha
RAKTA TwakSwapa
Romaharsha Sweda abhinirvartana
kandu Drgandha/ Vipuyaka
MAMSA
Bahulya Vaktra shosha Karkasha Pidakodgama
Toda sphota sthira
MEDA Dourgandya
Upadeha (Malavriddhi)
puya Krimi Gatra bheda
ASTHI & MAJJA
Nasabanga
akshiraga Krimi at Kshata
Swaropaghata
SHUKRA
Jata Kushti
Kounya (kara bhanga)
Agni Manda Teekshna Vishama Sama
Ama Sraotas Rasavaha
Raktavaha
Mamsavaha Srotadushti prakara Udvhava sthana Vyakta stahana Adhishtana Roga marga Vyadhi vinischaya Roga prakruti
Kashta sadya
Yapya Anupakrama
Upadrava if any
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
7
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
8
CHIKITSA:
GROUP – A (Bahya) Started on: Completed on: Follow up:
PASI Before treatment Sl.No Head Upper
extremities Trunk Lower
extremities 1 Redness + 2 Thickness + 3 Scaling + 4 Sum of 1,2 and 3 5 Area score 6 Score of row 4Xrow
5Xthe area multiplier
row 4 X row 5 X 0.1
row 4 X row 5 X 0.2
row 4 X row 5 X 0.3
row 4 X row 5 X 0.4
7 Sum row 6 for each column for PASI
PASI Before treatment Sl.No Head Upper
extremities Trunk Lower
extremities 1 Redness + 2 Thickness + 3 Scaling + 4 Sum of 1,2 and 3 5 Area score 6 Score of row 4Xrow
5Xthe area multiplier
row 4 X row 5 X 0.1
row 4 X row 5 X 0.2
row 4 X row 5 X 0.3
row 4 X row 5 X 0.4
7 Sum row 6 for each column for PASI
Before treatment After treatment PASI
Sl. No.
Subjective Parameter B.T 2nd day 4 day 6th day 8th day 10th A.T
1 Shyava krushna varna 2 Parushata 3 Ghanatwa 4 Kharasparsha 5 Kandu
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
9
CHIKITSA:
GROUP – B (Abhyanara) Started on: Completed on: Follow up:
PASI Before treatment Sl.No Head Upper
extremities Trunk Lower
extremities 1 Redness + 2 Thickness + 3 Scaling + 4 Sum of 1,2 and 3 5 Area score 6 Score of row 4Xrow
5Xthe area multiplier
row 4 X row 5 X 0.1
row 4 X row 5 X 0.2
row 4 X row 5 X 0.3
row 4 X row 5 X 0.4
7 Sum row 6 for each column for PASI
PASI Before treatment Sl.No Head Upper
extremities Trunk Lower
extremities 1 Redness + 2 Thickness + 3 Scaling + 4 Sum of 1,2 and 3 5 Area score 6 Score of row 4Xrow
5Xthe area multiplier
row 4 X row 5 X 0.1
row 4 X row 5 X 0.2
row 4 X row 5 X 0.3
row 4 X row 5 X 0.4
7 Sum row 6 for each column for PASI
Before treatment After treatment PASI
Sl. No.
Subjective Parameter
B.T First week
Second week
Third week
After the treatment
1 Shyava krushna varna
2 Parushata 3 Ghanatwa 4 Kharasparsha 5 Kandu
Annexure
Evaluation of Efficacy of Siddharthaka Yoga in Kitibha Kushta
10
Laboratory investigations
Investigator’s note: Signature of the Scholar Signature of the guide
Sl. No. Laboratory investigations
Before treatment After treatment
1 Hb% 2 Tc 3 Dc
E B N M L