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The drugs mentioned in verse 3-7 are found effective as kushthaghna (effective in skin diseases), kandughna (effective in pruritus) and arshoghna (effective in hemorrhoids) mahakashaya33. Kuṭaja is indicated in bleeding hemorrhoids while bhallataka is indicated in non-bleeding ones. By adding these two drugs of opposing action, their spectrum of action is enhanced considerably. Their ability to penetrate the affected areas is enhanced further when admixed with gopitta and mustard oil. This combination is particularly effective in treating rectal fistula and hemorrhoids. Sulfur is effective in treating most of the skin diseases and neem is a rich source of sulfur. Minerals like manahshila, kasisa and praval are used commonly for treating skin diseases because of their richness in sulfur. In psoriasis there is a deficiency of fatty acids, sulfur and immunoglobulins in the skin. Oil, ghrita, milk, neem (Azadirachta Indica) and amrita (Tenospora cordifolia) preparations help in correcting those deficiencies. The use of atasi (flax) poultice has anti-inflammatory and analgesic effect in vata vyadhi. amrita (Tinospora cordifolia) and yashtimadhu (liquorice) have anti-inflammatory and analgesic properties and are used for vatarakta. Vesavara and dashamoola are used as analgesics. Dashamoola has analgesic, anti-inflammatory and antiplatelet properties. Shirisha (Albizia lebbeck) is indicated as the best drug for treating dermal toxicity.
The drugs mentioned in verse 3-7 are found effective as kushthaghna (effective in skin diseases), kandughna (effective in pruritus) and arshoghna (effective in hemorrhoids) mahakashaya33. Kuṭaja is indicated in bleeding hemorrhoids while bhallataka is indicated in non-bleeding ones. By adding these two drugs of opposing action, their spectrum of action is enhanced considerably. Their ability to penetrate the affected areas is enhanced further when admixed with gopitta and mustard oil. This combination is particularly effective in treating rectal fistula and hemorrhoids. Sulfur is effective in treating most of the skin diseases and neem is a rich source of sulfur. Minerals like manahshila, kasisa and praval are used commonly for treating skin diseases because of their richness in sulfur. In psoriasis there is a deficiency of fatty acids, sulfur and immunoglobulins in the skin. Oil, ghrita, milk, neem (Azadirachta Indica) and amrita (Tenospora cordifolia) preparations help in correcting those deficiencies. The use of atasi (flax) poultice has anti-inflammatory and analgesic effect in vata vyadhi. amrita (Tinospora cordifolia) and yashtimadhu (liquorice) have anti-inflammatory and analgesic properties and are used for vatarakta. Vesavara and dashamoola are used as analgesics. Dashamoola has analgesic, anti-inflammatory and antiplatelet properties. Shirisha (Albizia lebbeck) is indicated as the best drug for treating dermal toxicity.
Powdered drug is used most effectively in the form of udvartana (smearing or massaging powdered drugs) on body parts smeared in oil. [8-9]
Powdered drug is used most effectively in the form of udvartana (smearing or massaging powdered drugs) on body parts smeared in oil. [8-9]
The utility of applying oil before administering powdered medication is to provide passage for lipid-soluble substances. [10-11]
The utility of applying oil before administering powdered medication is to provide passage for lipid-soluble substances. [10-11]
There are various forms of external therapies (churnapradeha, pradeha, lepa, pralepa, udvartana, avachurnana, alepana and pragharsha). Apart from kushtha, other conditions covered under the 32 types of churnapradeha are as follows:
There are various forms of external therapies (churnapradeha, pradeha, lepa, pralepa, udvartana, avachurnana, alepana and pragharsha). Apart from kushtha, other conditions covered under the 32 types of churnapradeha are as follows:
Table 1: Showing indications of 32 types of churnapradeha
Table 1: Showing indications of 32 types of churnapradeha
Indication/Actions Translation Numbers
Indication/Actions Translation Numbers
Alepa has been given due importance as an initial treatment for all types of sopha (swelling). Among the remedies applied internally and externally, it is superior to others because it alleviates pain instantaneously 18
Alepa has been given due importance as an initial treatment for all types of sopha (swelling). Among the remedies applied internally and externally, it is superior to others because it alleviates pain instantaneously 18
Types of lepa (external application): 19
Types of lepa (external application): 19
According to character and therapeutic use, alepa can be divided into three types viz., pralepa, pradeha and alepa. It could be shown as tabulated below-
Table 2: Showing character and indications of different types of alepa
Table 2: Showing character and indications of different types of alepa
Pralepa Pradeha Alepa
Pralepa Pradeha Alepa
Indications - Pacifies vata-kapha, cleanses, heals and alleviates inflammatory swelling and pain Normalizes rakta and pitta
Indications - Pacifies vata-kapha, cleanses, heals and alleviates inflammatory swelling and pain Normalizes rakta and pitta
Lepa is of four types, viz. avachurnana (dusting), udvartana (anointing), jalapishtalepana (paste made by mixing with water), and rasakriyalepana (by mixing with semisolids) 22.
Method of application
==== Method of application ====
The method of use, quantity, time of application and other pharmacotherapeutic aspects are not in scope of this chapter. However, it is to be noted that an alepa is generally advised for application against the direction of the hair growth (pratiloma) to enhance its penetration (swedavahi shira) 23.
Measurement
Measurement
The quantity, or dosage, of medication in the case of topical medicines is measured by the thickness of the layer of paste. Typically, it should be equivalent to the thickness of fresh skin of a buffalo 24. Thickness of a layer of pralepa should be equivalent to the thickness of a typical chandana (sandal paste) application. Pradeha is typically applied as a thick paste or bolus (pinda)25. Thus, it is thin and thick pastes for application of pralepa/anulepana and pradeha respectively 26,27.
The quantity, or dosage, of medication in the case of topical medicines is measured by the thickness of the layer of paste. Typically, it should be equivalent to the thickness of fresh skin of a buffalo 24. Thickness of a layer of pralepa should be equivalent to the thickness of a typical chandana (sandal paste) application. Pradeha is typically applied as a thick paste or bolus (pinda)25. Thus, it is thin and thick pastes for application of pralepa/anulepana and pradeha respectively 26,27.
Indication and contraindications
==== Indication and contraindications ====
Hot pradeha is indicated in vāta and kapha ailments while cold pradeha in conditions due to pittaja and raktaja disorders 28. It is also stated that alēpa is indicated in non-suppurative, inflammatory swellings (avidagdha sopha) whereas pradeha/upnah (poultice) is used for suppurative swellings29. Pradeha could also be applied at night in case of swellings caused by vata and kapha30.
Hot pradeha is indicated in vāta and kapha ailments while cold pradeha in conditions due to pittaja and raktaja disorders 28. It is also stated that alēpa is indicated in non-suppurative, inflammatory swellings (avidagdha sopha) whereas pradeha/upnah (poultice) is used for suppurative swellings29. Pradeha could also be applied at night in case of swellings caused by vata and kapha30.
Pastes should not be used at night. Stale paste, pastes applied on top of an existing layer, or repeating of used pastes are prohibited 31.
Pastes should not be used at night. Stale paste, pastes applied on top of an existing layer, or repeating of used pastes are prohibited 31.
Some references related to external medications in Kushtha Chikitsa32
Some references related to external medications in Kushtha Chikitsa 32
Forms References Remarks
Forms References Remarks
Avachurṇana CS.Ci.7/99, 104
Avachurṇana CS.Ci.7/99, 104
A specific procedure for obtaining pharmacologically active extract from palasha (Butea monosperma), an anti-parasitic, has been mentioned in the text as palashanirdaharasa. It is obtained by uprooting and then cutting the tree off the main root, burning off the segment above the root and collecting the resulting juices in an earthen pot79. [15-16]
A specific procedure for obtaining pharmacologically active extract from palasha (Butea monosperma), an anti-parasitic, has been mentioned in the text as palashanirdaharasa. It is obtained by uprooting and then cutting the tree off the main root, burning off the segment above the root and collecting the resulting juices in an earthen pot79. [15-16]
Vesavara is defined as mashed boneless flesh cooked with jaggery and ghrita, mixed with black pepper 81
Vesavara is defined as mashed boneless flesh cooked with jaggery and ghrita, mixed with black pepper 81
References:
=== References ===
1. Agnivesha, Charaka Samhitā with Ayurveda-Dipika commentary by Chakrapanidatta, edited by Acharya J T, Reprint edition, Chaukhamba Surbharati Prakashan, Varanasi, 2000; Sutra Sthana (Su).30/36
1. Agnivesha, Charaka Samhitā with Ayurveda-Dipika commentary by Chakrapanidatta, edited by Acharya J T, Reprint edition, Chaukhamba Surbharati Prakashan, Varanasi, 2000; Sutra Sthana (Su).30/36
2. Chakrapanidatta, commentator, Charaka Samhita, edited by Vaidya Yadavaji Trikamaji Acharya, Reprint edition, Chaukhamba Surbharati Prakashan, Varanasi, 2000, Sutra Sthana 3/1-2.
2. Chakrapanidatta, commentator, Charaka Samhita, edited by Vaidya Yadavaji Trikamaji Acharya, Reprint edition, Chaukhamba Surbharati Prakashan, Varanasi, 2000, Sutra Sthana 3/1-2.
83. Ibidem Chakrapanidatta (2), Chikitsa Sthana 25/43)
83. Ibidem Chakrapanidatta (2), Chikitsa Sthana 25/43)
Glossary of technical terms:
=== Glossary of technical terms ===
• Cūrṇapradēha (Cūrṇapradēha; चूर्णप्रदेह): External medication either in form of powder or paste
• Cūrṇapradēha (Cūrṇapradēha; चूर्णप्रदेह): External medication either in form of powder or paste
• Udvartana (Udvartana; उद्वर्तन): Application of powder drug followed by massaging
• Udvartana (Udvartana; उद्वर्तन): Application of powder drug followed by massaging