Ayurvedic treatment protocol towards some skin diseases, based on a survey conducted among ayurvedic doctors in kerala.

1. P.G Dept. of kayachikitsa
Welcomes you all

3. Treatment protocols
adopted by clinicians in
prevalent varieties of kushta
-a survey.
By
Dr.Shafi.M.S
II nd yr P.G.Scholar
Department of kayachikitsa
AAMC . MOODABIDRI

4. Under the valuable guidance of ,
Dr.Zenica D’souza
HOD and GUIDE,
Department of P.G. Studies in kayachikitsa
AAMC.Moodabidri
&
All the staff members of P.G studies in Kayachikitsa.

5. Introduction
• Diseases of the skin are a common occurrence in the clinical
OPD’s. A skin disease, as seen in the practice is often a
reaction pattern resulting from the effects of different
etiological stresses on a particular diathesis.
• Skin diseases which are selected in this presentation, are those
which are mostly handled by the clinicians on OPD as well as
IPD basis and the protocols which are clubbed in this
presentation are those which are commonly practiced with a
good success rate .
• The clinicians who were interrogated for the data collection
belong to the following places -Thiruvanthapuram, Kollam,
Changanassery,Kottayam, Tiruvalla, Nilambur, Cherthala,
Kottakkal, Trichur, Malappuram and Alva”s OPD.
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6. The following skin diseases were selected for the presentation,
as they have more incidence in the OPD as well as IPD’s of
the clinicians..
Maha kushta -- Sidhma
Ekakushta
Kshudra kushta Kitibha
Vipadika
Vicharchika
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7. Sidhma:
• श्वेतं ताम्रं तनु च तद्रुजो घॄष्टं ववमुञ्चतत ।
अलाबूपुष्पवर्णं तत सिध्मं प्रायेर्ण च उरसि || -
(च.चच.७/१९)
• अन्त स्ननग्धं रूक्षं बहि: , श्लक्ष्र्णनपर्शं , दौस्ग्धक्पुषपुष्पवत्.
(अ.हृ तन.५/२३)
• कण्ट्वास्न्वतं –(िु.तन.५/२)
• Can be correlated to the chronic plaque psoriasis.(common, well
demarcated with dry white silvery scales).
• Commonly involves elbow, knee and lower back, but also may include
scalp, nails, flexures and palms
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8. 17-05-2014 Dr.Shafi.M.S 8

9. Eka kushta :
• अस्वेदनं महावास्तु यत्मत्स्यशकलोपमम् । तदेकु ष्ठम् ॥
• कृ ष्णारुणं येन भवेच्छरीरं तदेककु ष्ठं प्रवदन्तत कु ष्ठम् ॥
• Compared to psoriasis /Ichthosis.
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10. Kitibhakushta :
• श्यावं ककर्णखरनपर्शं परुषं ककहटभं नमॄतम ॥- (च.चच.७/२२)
• स्रावी, वॄत्तं घनमुग्रकर्णडु, स्ननग्धकॄ ष्र्ण्ं - (िु.तन.५/१४)
• Compared to Erythrodermic psoriasis.
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11. Samanya Chiktsa..
• वातोत्तरेषु सन्पिविमनं श्लेष्मोत्तरेषु कु ष्ठेषु ।
न्पत्तोत्तरेषु मोक्षो रक्तस्य न्वरेचनं चाग्रे ॥ ३९ -(च.न्च.७/३९)
• बहुदोष: संशोध्य: कु ष्ठी बहुशोऽनुरक्षता प्राणान् ।
दोषे न्ह अन्तमात्रह्रुते वायुहितयादबलमाशु ॥ -(च.न्च.७/४१)
• पक्षात् पक्षात् छदिनान्न अभ्युपेया ।
तमासातमासात् स्रंसनं चऽन्प देयम् ॥
स्राव्यं रक्तं वत्सरे न्ह न्िरल्पम् ।
नस्यं दद्याश्च न्त्ररत्रान्त्ररात्रात् ॥ -(सु.न्च ९/४३)
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12. Clinicians approach to chikitsa
• Dosha chikitsa - Vatakapha / Kapha/Vata/Pitta
• Dushya chikitsa - Rasa, Rakta Prasadana.
• Avasthanusaara chikitsa - Saama / Niraama
- Naveena / Jeerna
• Vyadhi pratyaneeka chikitsa -
• Manobala vardhaka chikitsa -
• Rasayana (Naimittika) -
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13. PROTOCOL-1
• MILD SYMPTOMS
• RECENT ORIGIN (0-2 MONTHS)
• AFFLICTS A SMALL AREA
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14. CHIKITSA
1.Sadyo Virechana with Avipatti choorna - 20gm hs for 1day.
2. ( if saama lakshanas are seen - Shaddharana(5gm) / panchakola choorna)
3.Mahatiktakam kashaya - 15ml bd for 1st week
Patolamooladi kashaya - 15ml bd for 6 days
Vajrakam /patoladi kashaya - “
Punarnavadi/Manjishtadi kashaya - “
4.Vilwadi gutika/kaisoraguggulu - 1 tab bd for first week.
5.Manasamitra vataka - 1 tab bd for 2 weeks
6.Gandhaka bhasma - 100mg with honey bd (throughout)
7.Shaddharana gutika - 1 tab bd with kashaya.
8.Manibhadra guda - 12gm bd ( throughout )
9.Vitpala kera taila - external application.
10. Rakthamoksha(local) - jalouka /scalp vein set (once in 7 days)17-05-2014 Dr.Shafi.M.S 14

15. PROTOCOL-2
• MODERATE SYMPTOMS.
• HISTORY OF 2-6 MONTHS.
• AFFLICTED TO A LARGER AREA.
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16. CHIKITSA
1.SadyoVirechana with Avipatti choorna - 20gm hs for 1st week.
2.Patolamooladi kashaya - 15ml bd X 6 days only.
Tiktatrayam /tiktakam kashaya - 15ml bd X 2 weeks
Aaragvadhadi /nimbadi kashaya - “ “
( if saama lakshanas are seen - 5-6gm shaddharana choorna /gutika)
3.Vilwadi gutika - 1 tab tds X 2 weeks
4.Gandhaka bhasma - 100mg with honey (throughout)
5.Arogya vardhini gutika - 1 tab tds X 15 days
6.Manibhada gula /madhusnuhi - 12gm bd X 15days.
7. Haridrakhandam -12gm bd X 15 days
8.Aragvadhamahatiktakam ghrutha -15 gm bd X 15 days
Mahatiktakam/ Aragvadhadi/ Vajrakam ghrutha
9.Rakthamoksha with jalouka/scalp vein set. - Weekly once.17-05-2014 Dr.Shafi.M.S 16

17. CHIKITSA
External treatments
8. Vitpala kera taila(+ bakuchi seeds) , guggulumarichadi taila.
9. Aragvadha twak + nalpamara kashaya - kshalana/bath.
10.Sidharthaka snana choorna.
11.Takra dhaara (musta,amalaki)
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18. PROTOCOL-3
• SEVERE SYMPTOMS.
• HISTORY OF 6 MONTHS AND MORE.
• SPREADED TO EXTENSIVE AREAS.
• WITH SEVERE MENTAL STRESS.
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19. CHIKITSA
Starting with the previous protocol according to the bala, avastha of Roga and
Rogi, moving on to the additional treatments.
1. Rookshana – Takra dhaara(musta,triphala,aragwadhadi)/ Triphala kashaya.
2. Deepana-pachana -Panchakola churna wth takra/usna jala.
3. Snehapana -Aragvadhamahatiktaka ghrutha –dose acc. to agni bala.
(Mahatiktakam ghrutha/ Tiktatrayam ghruta/guggulutiktakam ghruta)
4. Abhyangam - vitpala
5. Swedana - usna jala snana
6. Nasya - shadbindu taila
7. Vamana - madana,vacha,yashti,pippali+madhu
8. Virechana - avipatti choorna/ trivrut leha
9. Raktamoksha - Siravyadha
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20. CHIKITSA
न्सध्म/न्कन्िभ/एक
External Treatments:
1.Takra dhaara - ( musta, amalaki)
2.Sarvanga dhaara - with Aragvadhadi gana kashaya
3.Sidharthaka snana choorna for snana.
4.Aaragvadha twak + naalpamara twak -for snana.
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21. Follow up:
Need of Rasa-Rakta prasadana - Manobala vardhaka -Rasayana chikitsa.
Rasa-Rakta parasadana :
1.Mahamanjishtadi kashaya. 15ml bd X 1 month
2.Nimbadi kashaya with bakuchi seed powder 15ml bd X 1month
3.Saarivaadyasava 20ml bd after food X 1 month.
4.Krumighna vati 1 hs X 7days, krumisodhini vati 1hs X 8th day.
5.Dooshivishari gutika 1 bd X 1 month
6.Vilwadi gutika 1 bd X 1 month
7.Vamana / Virechana
Manobala vardhaka chikitsa
1.Manasamitra vataka 1bd X 1 month.
2.Kalayana ghrutha 12gm hs X 1month.
Rasayana chikitsa
1.Madhusnuhi rasayana 12gm bd hs X 1 month.
2.Gandhaka Rasayana 1tab bd17-05-2014 Dr.Shafi.M.S 21

22. Some folklore tips…
• Patola choorna 10gm + honey – bd before
food
• Vilwadi gutika 1 + Eswaramooli swarasa.
• Patola + Punarnava –
• Visaala choorna + Triphala(5gm)
• Patola + Nimba twak choorna(10gm) + honey
• Haridra churna(5gm) +milk(50ml) -morning -
3 months
• Use saindhava .
For blood
purification:
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23. Pathya
• The foremost thing which is to be followed is to maintain pathya for a
minimum of 3 months to control symptoms and relapse..
• Ahara :Avoid Virudha, vidaahi , guru , abhishyandi, navaanna,
matsya, anupa mamsa, kanda varga.
: reduce the use of lavana
: include more haridra, rasona, pepper in the diet.
: avoid pickles, dadhi at night ,fermented food items.
: avoid bakery items (maida), oily and spicy foods.
: strictly avoid egg,beef and pork.
: Avoid ready to cook items, tinned foods etc.
: avoid re-cooking refrigerated foods.
• Vihaara : Avoid Aatapa, vyayama, vyavaaya..
: preferably avoid exposure to direct sunlight.
: maintain hygiene in all aspects.
: practice Achara rasayana.
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24. Vipaadika
• Vata kapha pradhana kushta.
• वैपान्दकं पान्णपाद स्फु िनं तीव्रवेदनम् ॥ (च.न्च.७/२२)
-..तीव्रात्यो मतदकण्िुश्च सरागन्पिकान्चता ॥ (अ.हृ.न्न १४/२३)
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25. CHIKITSA
न्वपान्दका
आभ्य
ततर
1. Avipatti choorna/ Trivrut leha 5gm hs X 1st week
2. Sataavari chinnaruhadi kashaya 15ml bd X
Guducyadi /Drakshadi kashaya “ “
Tiktakam / Vajrakam kashaya “ “
4. Khadirarishta /aaragvadharista 20ml bd X 2 weeks
5. Kaisora guggulu 1 bd with coc.milk (throughout)
6. Guggulutiktakam/mahatiktakam ghrutha - 10ml hs X 1 month.
7. Guggulu panchapalm choorna 5gm with honey.
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26. 17-05-2014 Dr.Shafi.M.S 26
CHIKITSA
न्वपान्दका
बाह्य
External application
1. Nimbaharidradi choorna + takra
2. Rasothamadi lepa + warm water
3. Nalpamara kwatha- kshalana - Jeevantyadi yamaka.
4. Mahatiktakam lepa.
5.Gopadmajadi kera + pinda taila– external application.

27. Pathya
• Ahara :Avoid Virudha, vidaahi , guru , abhishyandi, navaanna,
matsya, anupa mamsa, kanda varga.
: reduce the use of lavana, amla rasa.
: include more haridra, rasona, pepper in the diet.
: avoid pickles, dadhi at night ,fermented food items.
: avoid refined flours like Maida and corn flour.
: avoid re-cooking refrigerated foods.
: use cow ghee as well as tila taila in the diet.
• Vihaara : padaabhyanga.
: Avoid prolonged standing.
: Avoid Walking bare foot for long distances.
: Avoid thin soled shoes or footwear and open backed shoes
: practice Achara rasayana.
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28. Some folklore tips…
• Coconut tree root -
• Dried aloe vera pulp.
• Kupilu twak + nalpamara twak
• Aloe vera pulp + bee wax
• Satavari+bala+sundi+coconut root
• Bee wax
• inflorescence of arecanut-bhasma(Paale)
vipaadika
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29. Vicharchika
•स कण्डू पिटका श्यावा बहुस्रावा पवचपचिका ॥ (च.न्च. ७/२६)
•राज्योऽपिकण्ट्वापििरुज: सरूक्षा (िु.चच.५/१३)
• Can be compared to eczema dry/wet.
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30. CHIKITSA
न्वचन्चिका
FOR MILD TO MODERATE SYMPTOMS
आभ्य
ततर
1.Amrutotharam kashaya 15ml bd X first week
2.Aaragvadhaadi kashaya 15ml bd X second week.
Punarnavaadi / drakshadi “ “
Mahamajishtadi kashaya “ “
MahaTiktakam kashaya “ “
4.Amrutadya guggulu 1 tds ( throughout)
5.Panchanimbadi gulika 1 bd (throughout)
6.Guggulupanchapalam churna 10gm bd + honey throughout
7.Vilwadi gutika 1 bd first 2 weeks ( with anupana)
8.Dooshivishaari gutika 1 bd first week (with anupana)
9.Raktamoksha - jalouka/prachanna (once in a week)17-05-2014 Dr.Shafi.M.S 30

31. CHIKITSA
बाह्य 1.For wet: Triphala churna + Nalpaamara churna kashaya – kshalana., then
avachoornana done with eladi choorna.
2.For dry: Aaragvadha patra + Nimbapatra kalka lepa.
2.Doorvadi kera/ Pamantaka taila/ Parantyadi kera.
3.For inflammed + redness : Kupilu + Nalpamara twak kashaya Kshalana,
then dhara with Parantyadi kera(10ml), then it is wiped off immediately.
4.For big wounds : Jatyadi taila application.
5.For discolouration :Nalpamaradi taila E/A
6.For itching : Vicharchikadi lepa.
7.Burn vacha and the ash is mixed with coconut oil and applied.
17-05-2014 Dr.Shafi.M.S 31

32. CHIKITSA
FOR SEVERE SYMPTOMS
Starting with the previous protocol according to the bala, avastha of Roga and
Rogi, moving on to the additional treatments.
1. Rookshana – Triphala kashaya. 30-50ml
2. Deepana-pachana -Panchakola churna (5g)with takra/usna jala.
3. Snehapana - ghrutha –dose acc. to agni bala.
(Mahatiktakam ghrutha/ Tiktatrayam ghruta/guggulutiktakam ghruta)
4. Abhyangam - Eladi kera / doorvadi kera.
5. Swedana - usna jala snana
6. Vamana - madana,vacha,yashti,pippali+madhu
7. Virechana -trivrut leha .
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33. 17-05-2014 Dr.Shafi.M.S 33
Pathya
• The foremost thing which is to be followed is to maintain pathya for a
minimum of 3 months to control symptoms and relapse..
• Ahara :Avoid Virudha, vidaahi , guru ,dugdhsa,abhishyandi,
navaanna, matsya, anupa mamsa, kanda varga.
: reduce the use of amla, lavana, egg.
: include more haridra, rasona, pepper in the diet.
: avoid pickles, dadhi at night, fermented food items.
: Avoid masha, tila, guda, cilicima.
: Include tikta saaka, laghvanna, yava, godhooma ..
Vihaara : Avoid Aatapa, vyayama, vyavaaya..
: maintain hygiene in all aspects.
: practice Achara rasayana.

34. Some folklore tips…
• Punarnava swarasa 5ml with honey.
• Punarnava swarasa+ela seed
powder + honey.
• Kupilu twak + nalpamara twak
kshalana.
• Neeli swarasa dhara.
•
Vicharchika
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35. Case study
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36. A case study on vicharchika
Male patient aged 78 years.
C/o severe itching and exudations over Rt. lower limb below knee up to ankle
joint and mild swelling over that area.
H/O angioplasty done 2yrs back, diabetic(under insulin inj. 20units 2times a day)
Was diagnosed as vicharchika /compared to weeping eczema.
With pustular eruptions with oozing.
Treatment:
As some saama lakshanas were found, for ama nirharana
1.Amruthotharam kashaya (15ml bd)was prescribed with kaisora guggulu (1 tds)
for 5 days.
Also for virechana trivruth leha of 10gms at bed time and kshalana was adviced
with triphala and nalapamaradi choorna.
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37. • On 5th day,
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38. • After 10 days,
• Itching and redness were decreased and patient felt lightness of the limb too.
• Kokilashakam kashaya (15ml bd) + Amrutadya guggulu (2tds) B/F
• Biogest tab 2 tds
• Sukumaram ghrutham 10ml at bed time with warm water.
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39. • After 15 days.
• Kashaya was stopped. continue kshalana.
• Amrutadya guggulu(3 tds).Biogest tab 3tds.
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40. • After 20 days,
• Same treatments continued with kshalana of kashaya for 15 min twice daily.
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41. • 25th day,
• Patient was feeling very fine and every exudations and itching were cleared
except one wound at posterior aspect of angle joint.
• PPbs was 245mg/dl.
• Jatyadi taila ext application on wound
• Tablets Amrutadya guggulu and biogest were brought down to 1 tds each.
17-05-2014 Dr.Shafi.M.S 41

42. Acknowledgement
• My sincere gratitude and thanks to following doctors who
participated in the survey as well as shared their experience and
views in the treatment of common skin ailments .
Name Designation
1. Dr. Radhakrishnan Asst.Director. NRIP, Cheruthurthy,Trichur.
2. Dr. Vijayachandradas Sree Sankara Ayurveda hospital, Changanassery
3. Dr. Shamjid.p Kerala Ayurvedic Clinic, Nilambur
4. Dr.Rethi B Unnithan. District Medical Officer, Kottayam
5. Dr.P.J.Sudharma. Rtd. Joint Director, ISM ,Kerala
6. Dr. Sreeja.s.Bhatt Uttama Ayueveda Hospital, Chertala
7 Dr. Abdul Saboor Malappuram
8. Dr. Sirajuddeen PKKM Ayurveda hospital, kottakkal
9. Dr. Basim.E Origin Ayurveda Hospital, Malappuram
10. Shine vaidyar Folklore practitioner , Nilambur.
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43. Conclusion
• Skin diseases can be traced to errors in one’s own conduct. i.e.
Erroneous diet & lifestyle are the examples of misconduct. Hence
encouraging the patient to follow pathya ahara-vihara is an
important aspect in the treatment of kushta.
• Prognosis of kushta ranges from krichrasadhya to yapya for
multiple reasons. Therefore sodhana plays an important role in its
management. Removal of kupita doshas from their moolasthana
help in controlling the symptoms and prevent the relapse.
• Skin diseases are somatic disorders with psychosocial
involvement. Family &social deprival and isolation increases
depression, thereby aggravating the disease. hence manobala
vardhaka chikitsa place a very important role in the management
of kushta.
17-05-2014 Dr.Shafi.M.S 43

44. • Apart from the treatments mentioned in this presentation, many
other treatments and practices were revealed by different doctors,
but due to the constraint of time, only the essence of the total
information has been summarized in the form of treatment
protocols in this presentation.
• Intension of this presentation was to put forth some of the best
approaches of management towards the most prevalent but
challenging disease-KUSHTA .
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45. 17-05-2014 Dr.Shafi.M.S 45

46. Psoriasis..in brief..
DIAGNOSIS: Skin biopsy for histopathology- most defenitive
Chronic inflammatory disease.
Well defined erythematous plaques.
Mostly on extensor surfaces.
Knee, elbow, wrist, scalp, back of ear, nails, tongue..
Affecting approximately 1-3% of the general population.
associated with recurrence and remission.
• TYPES
Chronic plaque -Common, dry with white silvery scale. Elbow,knee, scalp..
guttate -raindrop like, small circular/oval plaques,
Pustular -localized in palm, soles, rarely generalized
Erythrodermic -more than 90% of body became red & scaly.
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47. KOEBNER PHENOMENON AUSPITZ SIGN
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