For Paper KC-II Theory Faculty: Dr. K. Shiva Rama Prasad Date: Time: Prof/ Batch 3rd Prof. 2005 Instructional aids / tools needed: Oral, black board and explanatory mode Topic:Introduction to Kshudra Kusta (11) & Vicharchika with its management Objectives:To understand the minor skin ailments and Vicharchika (eczema) in specific Subject points (include Reference, flow diagrams & tables): Etymology: Kusta derived from Mw lwMw lwMw oWlxxUhq ; Mslmi rxqi xu Mwhi im: (A x l 24/) Mwhi Mixi MUi (iQU) - Mixi MUi um: Ci M: -; The Nishkarsha means expelling out; the disease expelled out through the skin is the understanding. The Kushna explains as the skin becomes ugly. The ugliness of the skin is said as Kusta.As over all understanding is that any disease that reflects in the skin and makes the deformity or ugliness is called as Kusta. The Kshudra defines as small and the Kusta as skin ailment. The further statement of Vagbhata is that any disease delayed with treatment or long association reflects its symptoms in skin. (Astanga Hridaya Nidana 14/4-6) Ex{Ii i Ehi iu{&* |{t vix{xi& x K t Si**4** nK nlx Ex Ix nhx* iCvxihlx & Gi**5** ISjc Eni** Ex v n & {lR& Mi&**6** Astanga Hridaya Nidana 14/4-6 Sapta Dravya of Kusta: Kusta is manifested with 7 factors viz. Vata, Pitta and Kapha as Dosha and Twak (skin), Mamsa (Muscle), Shonita (Blood) and Lasika (Lymph). The importance of the sequence is that initially the disease manifest in skin and later it deep routes in to the body. As it becomes Gambheera the disease pacification becomes difficult. When it deep routes ultimately spreads and destroys the Roma-Ropakoopa (hair and hair root), Snayu (ligaments), Dhamani (blood vessels) and ultimately to the Tarunasthi (cartilage). (Charaka Nidana 5/3) j n i{kh:, |E{hEi:, n viiRhiEiv n {PiEi <i * Bii x viEiVxx Ex, +i:|hxixx E {i{xi **3** Charaka Nidana 5/3 Pre disease symptoms: Kusta express the pre disease symptoms as - over sweating or no sweating, over smooth or very dry, skin colour changes, itching, numbness, burning sensation, horripilation, roughness, local temperature, heaviness, oedema and has nature of spreading all the way. There will a persisting feeling of untidiness all over the body and associated with non healing ulcers. There will be much pain for a simple injury and the ulcers dont heal and may leads to get gangrened. (Charaka Nidana 5/7) +nxinx {iIhi h Ehbxin: i {n: { : Jih M l{MxIh S E ESUp {n: {FnMvnM- Ii{Jiij nx {x{ S hx nh Si **7** Charaka Nidana 5/7 Kusta is a Sankramika Roga: Ayurveda defines the contaminated diseases. The spread of the diseases happens as the person indulges in to an unethical sexual (physical) contact or body touching. The inhalation of the breath, eating together or sitting and usage of the cosmetics of others also makes the person susceptible of transmission of diseases. |j{zi Vxi ** xc{ x {xi **33** E V xjxn B S ** +{MEM Gxi xz **34** Susruta Chikitsa 5/33-34 AmxaMUa: zisMSr: (uwcM, qxUM, uxm, EmSz, TUa)- SsWh- The enlisted diseases are Kusta (Skin diseases), Jwara (fevers), Shosha (Tuberculosis) and Netrabhishyanda (eye infections). Apart from these Dalhana comments for Aupasargika Roga as Sheeta, A lesson by Dr. K. Shiva Rama Prasad (09633552646/09290566566) doctorksrprasad@gmail.com 1 etc. The other diseases told are Vishuchika, Masurika, Visarpa, Upadamsha, Phiranga. At the present context we undertake the Sexually transmitted diseases viz. Syphilis, Gonorrhea, Lymphohranuloma Inguinale, Lymphogranuloma Veneram, Chancroid, Human Immuno deficiency Virus (HIV) that lead to AIDS (Acquired Immuno Deficiency Syndrome) and Hepatitis B. Classification of Kshudra Kusta (Charaka Nidana 5, Susruta Nidana 5, Astanga sangraha Nidana 14) Charaka Vagbhata Susruta Eka Eka Eka Charma Charma - Kitibha Kitibha Kitibha Vipadika Vipadika - Alasaka Alasaka Visarpa Charmadala Charmadala Charmadala Pama Pama Pama Vicharchika vicharchika Vicharchika Visphota Visphota - Shataru Shataru - Dadru - - - Sidhma Sidhma - - Rakasa Vagbhata told Sidhma instead of Parisarpa - - Dadru told by Charaka Stularushka - Mahakusta Susruta brought forward Rakasa, Parisarpa, Sthularushka and Mahakusta 4 along with Vagbhata told Sidhma. The difference between Charaka and Vagbhata is with one Kshudra Kusta and where in for Susruta is 5 terms. Susruta differs with Vagbhata with only 4 Kshudra Kusta nomenclatures. Vicharchika: (Charaka Chikitsa 7/26, Susruta Chikitsa 5/23, Astanga Hridaya Nidana 14/18) The symptoms of the Vicharchika are kandu (itching), Shyava Varna (blackish brown), Pidika (pustules), either strayed (Raaji) dry (Rooksha) (Susruta) or oozing (Cha &AH) and painful (Ruja). As we see the symptoms we compare these to either dry eczema or weeping eczema. Ehb: {bE SSE **26** Charaka Chikitsa 7/26 V%iEhbiV: I xi Mj SSE ** Susruta Chikitsa 5/23 Ehb{]E Ef SSE* Astanga Hridaya Nidana 14/18 Eczema: Generic term for inflammatory conditions of the skin, particularly with vesiculation in the acute stage, typically erythematous, edematous, papular, and crusting; followed often by lichenification and scaling and occasionally by duskiness of the erythema and, infrequently, hyperpigmentation; often accompanied by sensations of itching and burning; the vesicles form by intraepidermal spongiosis. Sometimes referred to colloquially as tetter, dry tetter, scaly tetter. Atopic dermatitis: Dermatitis characterized by the distinctive phenomena of atopy, including infantile and flexural eczema. Syn: atopic eczema. Atopic dermatitis is most commonly seen among young children, but severe cases persist into adulthood. In more than 80% of the patients, the disease starts before the age of 5 years. The prevalence has been estimated at between 15 and 23%. Patients usually present with xerosis, erythematous scaly patches, small vesicles, excoriations, crusting, and, not infrequently, impetiginization (In Fig - Note the erythema, excoriation, and lichenification.). With chronic scratching and rubbing, hyperpigmentation and lichenification occur. Commonly affected sites include the periorbital area and flexor areas such as the neck, antecubital fossa, and popliteal fossa. In severe cases, the entire skin surface may be involved. Diagnosis is made by the typical morphologic features and by the distribution of the lesions, as well as by a family and personal history of atopy. A lesson by Dr. K. Shiva Rama Prasad (09633552646/09290566566) doctorksrprasad@gmail.com 2 Atopy: A genetically determined state of hypersensitivity to environmental allergens. Type I allergic reaction is associated with the IgE antibody and a group of diseases, principally asthma, hay fever, and atopic dermatitis. The therapeutic ladder consists of the following: (1) over-the-counter emollients; (2) topical corticosteroid ointments (e.g., triamcinolone ointment, 0.1% twice daily for 1 to 2 weeks), or topical calcineurin inhibitors (tacrolimus ointment, 0.1% for 3 to 4 weeks, or pimecrolimus cream, 1% for 3 to 4 weeks). The latter have been given a black box warning by the U.S. Food and Drug Administration for their potential association with the development of malignant disease; therefore, continuous prolonged use (i.e., >2 to 3 months) should be minimized; (3) oral antihistamines (e.g.,fexofenadine,180mgeverymorning,andhydroxyzine,25to50mgatbedtime,asneeded); (4) NB-UVB phototherapy; and (5) PUVA. In patients with recalcitrant cases, oral prednisone (0.5 to 1 mg/kg/day), cyclosporine (3 to 5 mg/kg/day), and mycophenolate mofetil (1 to 2 g/day) have been successful. (Goldman: Cecil Medicine, 23rd ed.) Management of Kusta: As we start treating Kusta patient unction (Snehapana) has to be undertaken either as Shodhana (eliminative part) or Shamana (palliative method). All the Shodhana is undertaken from the stage of pre disease state. It is stated as to undertake periodical Shodhana for Kusta. The process told as once in 15 days Vamana, monthly once the Virechana, at least twice in a year Raktamokshana and for every 3 days once the Nasya. This process of periodical elimination doesnt allow the Dosha to accumulate. Later, in addition to the Shodhana, the Shamana is undertaken. When the Kosta Shodhana or Raktamokshana is undertaken the Vata provocation may kill the patient, thus the Snehapana is done after the Shodhana. Charaka specifically points out that the only bahudoshi is meant for Shodhana.(Cha.Chi7/41) {Ii {ISUn xx{xxi x S{ n ** H i u{ x ntc jji jji **43** Susruta Chikitsa 9/43 ij {{i: vxi * ij iC| vx{xx, hi| vx{xE{xhiSxx, | vx{xE{xhiSxxl|:, SilEMh| {ii: vxi, ij vxSU hiSxcv iViviIEMMMM- iEJnxEivxi, { x{Gi **6** ij |l Ex {xvxx{{ni * Susruta Chikitsa 9/6-7 If the Kusta is in Twak: Shodhana, Alepana If the Kusta is in Rakta: Shodhana, Alepana, Kashayapana, Raktamokshana If the Kusta is in Mamsa: Shodhana, Alepana, Kashayapana, Raktamokshana, Arista, Mantha, Prasha If the Kusta is in Medas: The Kusta cited in Mamsa is incurable, so it has to be maintained if at all the person is strong enough. Patient has to undergo with Shodhana and Raktamokshana first. Later Bhallataka / Khadira Rasayana or Ayaskriti is administered. Some of Ghrita for Sneha: Mahatiktaka Ghrita, Mahakhadira Ghrita, Tikta shatphala Ghrita, Pancha Tikta Guggulu Ghrita, Somaraji Ghrita, Aragwadhadi Ghrita Some of Taila for Bahya prayoga: Kustadya Taila, Sweta karaveeradya Taila, Tuvaraka taila, Karanja taila, Brihanmarichadi Taila, Manjistadi taila, Eladi taila Some of Churna: Pancha Nimba churna, Saptasama churna, Mustadi churna, Salasaradi Gana churna, Nyagrodhadi gana churna, Aragwadhadi gana churna, Eladi gana churna, Some of Kwatha: Manjistadi, Patoladi kwatha, Nimba patola patradi kwatha, Brihatyadi kwatha Some of Asava & Arista: Panchatiktarista, Putikdyarista, Madhwasava, Tripahalasava, Sharibarista or asava, Nyagrodhadi sura, Some of Rasa: Rasamanikya, Kusta kuthara ras, sarweshwara ras, Talakeshwara ras, All medicines are used discriminatively. Many of these are even useful in other skin conditions. Assignment: 1) Recall the 7 layers of twak 2) Read what is allergen and role of IgE and Histamine in causing allergy 3) What is the relationship between skin and lung disease (embryological) 4) Look for skin asthma Model questions: All headings are as short questions 1) Define and write the Kshudra Kusta classification and symptoms of Vicharchika with management. A lesson by Dr. K. Shiva Rama Prasad (09633552646/09290566566) doctorksrprasad@gmail.com 3