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|title=Apamarga Tanduliya Adhyaya

|title=Aragvadhiya Adhyaya

|titlemode=append

|titlemode=append

|keywords=Aragvadha, churnapradeha, pradeha, lepa, pralepa, kushtha, skin diseases, external applications, external cleansing, Ayurveda, Indian system of medicine, charak samhita.  

|keywords=Aragvadha, cassia, churnapradeha, pradeha, lepa, pralepa, kushtha, skin diseases, external applications, external cleansing, Ayurveda, Indian system of medicine, charak samhita, carak samhita, charaka samhita, formulations, external purification.

|description=Sutra Sthana Chapter 3.Aragvadha(cassia) and other medicines

|description=Sutra Sthana Chapter 3.Aragvadha(cassia) and other medicines

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<big>'''Sutra Sthana Chapter 3. Aragvadha(cassia) and other medicines '''</big>

<big>'''Sutra Sthana Chapter 3. Aragvadha(cassia) and other medicines '''</big>

{{Infobox

{{Infobox

|data5 = [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data5 = [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|label6 = Translator and commentator

|label6 = Translator and commentator

|data6 = Dubey S.D., Sen B., Deole Y. S.

|data6 = Dubey S.D., Sen B., [[Yogesh Deole|Deole Y. S.]]

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Jani D., Sirdeshpande M.

|data7  = Jani D., Sirdeshpande M.

|label8 = Editor

|label8 = Editors

|data8  = Jani D.

|data8  = Jani D., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10  =  

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

|label11 = DOI

}}

}}

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

 

<p style='text-align:justify;'>While the preceding chapter (Apamarga Tanduliya) dealt with internal application of therapies in the form of Panchakarma, this chapter deals with the external application of medications. Thirty two types of external applications are enlisted in this chapter. The important indication is Kushtha (Skin diseases). These are systemic disorders considered as major disease (maharoga). They require internal cleansing and purification treatments prior to external treatments – and hence, the sequence of the chapters. Without prior internal treatment, local treatments have limited efficacy.  </p>

<div style="text-align:justify;">While the preceding chapter (Apamarga Tanduliya) dealt with internal application of therapies in the form of Panchakarma, this chapter deals with the external application of medications. Thirty two types of external applications are enlisted in this chapter. The important indication is Kushtha (Skin diseases). These are systemic disorders considered as major disease (maharoga). They require internal cleansing and purification treatments prior to external treatments – and hence, the sequence of the chapters. Without prior internal treatment, local treatments have limited efficacy.  </div>

'''Keywords''': ''Aragvadha, churnapradeha, pradeha, lepa, pralepa, kushtha'', skin diseases, external applications, external cleansing.

'''Keywords''': ''Aragvadha, churnapradeha, pradeha, lepa, pralepa, kushtha'', skin diseases, external applications, external cleansing.

This chapter includes thirty-two types of formulations in the form of powder or paste (''churna/pradeha''). The paste is prepared by mixing the powder with oil, ''ghrita'' (ghee, or clarified butter), milk, butter milk or cow urine etc. Occasionally, oil smearing in the affected part is a pre-requisite for such application of powder (''avachurnana'' and ''udvartana''), so that the drug used gets in contact with the oily surface and enhances the rate of penetration. Different kinds of skin diseases and conditions like ''shopha'' (swelling), pain in the abdomen, head and flanks, ''vatarakta'' (painful inflammation of joints), etc. are discussed here for external cleansing treatments.  

This chapter includes thirty-two types of formulations in the form of powder or paste (''churna/pradeha''). The paste is prepared by mixing the powder with oil, ''ghrita'' (ghee, or clarified butter), milk, butter milk or cow urine etc. Occasionally, oil smearing in the affected part is a pre-requisite for such application of powder (''avachurnana'' and ''udvartana''), so that the drug used gets in contact with the oily surface and enhances the rate of penetration. Different kinds of skin diseases and conditions like ''shopha'' (swelling), pain in the abdomen, head and flanks, ''vatarakta'' (painful inflammation of joints), etc. are discussed here for external cleansing treatments.  

The three types of external applications viz. ''pralepa, pradeha'' and ''alepa'' are mentioned in this chapter. ''Pralepa'' is a form which is applied cold, in a thin layer irrespective of its absorbability. It is indicated in vitiation of ''pitta'' and ''rakta dosha''.''Pradeha'' is thick and it is generally applied in the form of bolus. It is applied in cold in case of ''pitta-rakta'' vitiation and hot in cases of ''vata-kapha'' vitiation. ''Alepa'' is the medium form which is neither too thin nor too thick. Thus the thickness or thinness of paste application determines its specific effect. Temperature of paste also plays role in determining effect of application. The underlying mechanism may be due to absorption through sweat pores.

The three types of external applications viz. ''pralepa, pradeha'' and ''alepa'' are mentioned in this chapter. ''Pralepa'' is a form which is applied cold, in a thin layer irrespective of its absorbability. It is indicated in vitiation of ''[[pitta]]'' and ''[[rakta]] [[dosha]]''.''Pradeha'' is thick and it is generally applied in the form of bolus. It is applied in cold in case of ''[[pitta]]-[[rakta]]'' vitiation and hot in cases of ''[[vata]]-[[kapha]]'' vitiation. ''Alepa'' is the medium form which is neither too thin nor too thick. Thus the thickness or thinness of paste application determines its specific effect. Temperature of paste also plays role in determining effect of application. The underlying mechanism may be due to absorption through sweat pores.

</div>

</div>

</div></div>

</div></div>

''Pradeha'' made of hot ''veshavara'' (a preparation of meat) prepared with ''anupamatsyamisha'' (meat of marshy fish) subsides ''vata''. Similarly, four types of ''sneha, dashamula'' and ''gandhaushadha,'' when mixed together, make a ''vata'' alleviating ''pradeha''. [19]

''Pradeha'' made of hot ''veshavara'' (a preparation of meat) prepared with ''anupamatsyamisha'' (meat of marshy fish) subsides ''[[vata]]''. Similarly, four types of ''sneha, dashamula'' and ''gandhaushadha,'' when mixed together, make a ''[[vata]]'' alleviating ''pradeha''. [19]

===Yavadi formulation ===

===Yavadi formulation ===

</div></div>

</div></div>

''Yavachurṇa'' mixed with ''takra,'' heated and added with ''kshara'' serves as an abdominal pain relieving drug. ''Kushtha, shatahva, vacha,'' and ''yavachurna'' - mixed with ''taila'' and ''amla'' - is indicated in ''vata'' related disorders. [20]

''Yavachurṇa'' mixed with ''takra,'' heated and added with ''kshara'' serves as an abdominal pain relieving drug. ''Kushtha, shatahva, vacha,'' and ''yavachurna'' - mixed with ''taila'' and ''amla'' - is indicated in ''[[vata]]'' related disorders. [20]

=== Shatavhadi formulation ===

=== Shatavhadi formulation ===

== Vidhi Vimarsha (Applied Inferences) ==

== Vidhi Vimarsha (Applied Inferences) ==

<div style="text-align:justify;">

<div style="text-align:justify;">

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) ''mahakashaya''. ''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'' (Tinospora 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 anti-platelet 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) ''mahakashaya''. ''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'' (Tinospora cordifolia) preparations help in correcting those deficiencies. The use of ''atasi'' (flax) poultice has anti-inflammatory and analgesic effect in ''vatavyadhi''. ''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 anti-platelet 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]

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''Alepa'' has been given due importance as an initial treatment for all types of ''shopha'' (swelling). Among the remedies applied internally and externally, it is superior to others because it alleviates pain instantaneously. [Dalhana on Su.Sa.Sutra Sthana 18/3]

''Alepa'' has been given due importance as an initial treatment for all types of ''shopha'' (swelling). Among the remedies applied internally and externally, it is superior to others because it alleviates pain instantaneously. [Dalhana on Su.Sa.Sutra Sthana 18/3]<ref name=Susrutha>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005</ref>

Types of ''lepa'' (external application):[Su.Sa.Sutra Sthana 18/6]

Types of ''lepa'' (external application):[Su.Sa.Sutra Sthana 18/6]<ref name=Susrutha/>

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-

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-

| rowspan="1" style="text-align: center;" | Indications

| rowspan="1" style="text-align: center;" | Indications

| rowspan="1" style="text-align: center;" | --

| rowspan="1" style="text-align: center;" | --

| rowspan="1" style="text-align: center;" | Pacifies ''vata-kapha'', cleanses, heals and alleviates inflammatory swelling and pain''

| rowspan="1" style="text-align: center;" | Pacifies ''[[vata]]-[[kapha]]'', cleanses, heals and alleviates inflammatory swelling and pain''

| rowspan="1" style="text-align: center;" | Normalizes ''rakta'' and ''pitta''

| rowspan="1" style="text-align: center;" | 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) <ref>Ibidem Chakrapanidatta (2), Chikitsa Sthana 7/84-96.</ref>

''Lepa'' is of four types, viz. ''avachurnana'' (dusting), ''udvartana'' (anointing), ''jalapishtalepana'' (paste made by mixing with water), and ''rasakriyalepana'' (by mixing with semisolids). [Chakrapanidatta Chikitsa Sthana 7/84-96]<ref name=Cakrapani>Chakrapanidatta, Cakradatta (Chikitsasangraha). Edited by Priya Vrat Sharma. 3rd ed. Varanasi: Chaukhambha publishers; 2002</ref>

==== Method of application ====

==== Method of application ====

The method of use, quantity, time of application and other pharmaco-therapeutic 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''). [Su.Sa.Sutra Sthana 18/4]

The method of use, quantity, time of application and other pharmaco-therapeutic 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''). [Su.Sa.Sutra Sthana 18/4]<ref name=Susrutha/>

==== Quantity and thickness of application ====  

==== Quantity and thickness of application ====  

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 moist skin of a buffalo. [Su.Sa.Sutra Sthana 18/11]  In current times, the thickness measures around 4-5 millimetre. <ref name="Patil lepa"> Patil S, Chaudhary AK. Topical dosages forms (Lepa Kalpana) of Ayurveda: An unexplored treasure. Int J Green Pharm. 2015;9(4):12. Accessed on June 1,2020.Available from https://www.greenpharmacy.info/index.php/ijgp/article/viewFile/579/492 </ref>

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 moist skin of a buffalo. [Su.Sa.Sutra Sthana 18/11]  In current times, the thickness measures around 4-5 millimetre. <ref name="Patil lepa"> Patil S, Chaudhary AK. Topical dosages forms (Lepa Kalpana) of Ayurveda: An unexplored treasure. Int J Green Pharm. 2015;9(4):12. Accessed on June 1,2020.Available from https://www.greenpharmacy.info/index.php/ijgp/article/viewFile/579/492 </ref>

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'').[Dalhana on Su.Sa.Sutra Sthana 18/6] Thus, it is thin and thick pastes for application of ''pralepa/anulepana'' and ''pradeha'' respectively. [Dalhana on Su.Sa.Sutra Sthana 18/6]<ref>YogindraNathSen, Charak. Nidana Sthana, Cha.1 Jwara Nidana ver.36. In: YogindraNathSen, Editor. Charakopaskara Charak Samhita.1st ed. ???;?</ref>

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'').[Dalhana on Su.Sa.Sutra Sthana 18/6]<ref name=Susrutha/> Thus, it is thin and thick pastes for application of ''pralepa/anulepana'' and ''pradeha'' respectively. [Dalhana on Su.Sa.Sutra Sthana 18/6]<ref name=Susrutha/><ref>YogindraNathSen, Charak. Nidana Sthana, Cha.1 Jwara Nidana ver.36. In: YogindraNathSen, Editor. Charakopaskara Charak Samhita.1st ed. ???;?</ref>

It can be stated that the thickness of applications as pradeha(thick paste) is more than or equal to 4 to 5 mm. Pralepa (thin paste)  applications include thickness less than 4 to 5 mm. <ref name="Patil lepa"/>

It can be stated that the thickness of applications as pradeha(thick paste) is more than or equal to 4 to 5 mm. Pralepa (thin paste)  applications include thickness less than 4 to 5 mm. <ref name="Patil lepa"/>

==== Indication and contraindications ====

==== Indication and contraindications ====

Hot ''pradeha'' is indicated in ''vata'' and ''kapha'' ailments while cold ''pradeha'' in conditions due to ''pittaja'' and ''raktaja'' disorders. [Dalhana on Su.Sa.Sutra Sthana 18/6] It is also stated that ''alepa'' is indicated in non-suppurative, inflammatory swellings (''avidagdha sopha'') whereas ''pradeha/upnah'' (poultice) is used for suppurative swellings. [Dalhana on Su.Sa.Sutra Sthana 18/6-9] ''Pradeha'' could also be applied at night in case of swellings caused by ''vata'' and ''kapha''.[Dalhana on Su.Sa.Sutra Sthana 18/12-14]

Hot ''pradeha'' is indicated in ''[[vata]]'' and ''[[kapha]]'' ailments while cold ''pradeha'' in conditions due to ''pittaja'' and ''raktaja'' disorders. [Dalhana on Su.Sa.Sutra Sthana 18/6]<ref name=Susrutha/> It is also stated that ''alepa'' is indicated in non-suppurative, inflammatory swellings (''avidagdha sopha'') whereas ''pradeha/upnah'' (poultice) is used for suppurative swellings. [Dalhana on Su.Sa.Sutra Sthana 18/6-9]<ref name=Susrutha/> ''Pradeha'' could also be applied at night in case of swellings caused by ''[[vata]]'' and ''[[kapha]]''.[Dalhana on Su.Sa.Sutra Sthana 18/12-14]<ref name=Susrutha/>

Pastes should not be used at night. Stale paste, pastes applied on top of an existing layer, or repeating of used pastes are prohibited. [Su.Sa.Sutra Sthana 18/12-14]  

Pastes should not be used at night. Stale paste, pastes applied on top of an existing layer, or repeating of used pastes are prohibited. [Su.Sa.Sutra Sthana 18/12-14]<ref name=Susrutha/>

===== Cross references of external medications in [[Kushtha Chikitsa]] =====

===== Cross references of external medications in [[Kushtha Chikitsa]] =====

Regarding ''taila, sarshapa taila'' (mustard oil) is most commonly used in ''kushtha''.

Regarding ''taila, sarshapa taila'' (mustard oil) is most commonly used in ''kushtha''.

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 pot <ref>Ibidem Chakrapānidatta (2), SutraSthāna 3/3-17. </ref> [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 pot [Chakrapanidatta Sutra Sthana 3/3-17]<ref name=Cakrapani/> [15-16]

''Vesavara'' is defined as mashed boneless flesh cooked with ''jaggery'' and ''ghrita'', mixed with black pepper <ref>Ibidem Chakrapānidatta (2), SutraSthāna.3/19. </ref>

''Vesavara'' is defined as mashed boneless flesh cooked with ''jaggery'' and ''ghrita'', mixed with black pepper [Chakrapanidatta Sutra Sthana 3/19]<ref name=Cakrapani/>

 

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==References==

==References==