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RATIONAL APPROACH TO DIAGNOSIS AND MANAGEMENT OF PAITTIKA SKIN DISEASES IN AYURVEDA: A REVIEW

Authors:
  • Chaudhary Brahm Prakash Ayurved Charak Sansthan, New Delhi
  • Ch Brham Prakash Ayurved Charak Sansthan

Abstract and Figures

The physiology of body is mainly governed by dosha (body humors), dhatu(tissue factors) and mala (metabolic wastes). Three doshas are known a vata, pitta and kapha. Pitta dosha is made up of fire and water dominant pachmahabhuta (elements) but fire being more dominant.
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RATIONAL APPROACH TO DIAGNOSIS AND MANAGEMENT OF PAITTIKA SKIN
DISEASES IN AYURVEDA: A REVIEW
1*Dr. Yogesh Kumar Pandey, 2Dr. Abhilasha Jareda, 3Dr. Pooja Sabharwal and 4Prof. M.B. Gaur
1Associate Professor, PG Departmnt of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi-
110073.
2PG Scholar, PG Departmnt of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi-110073.
3Assistant Professor, PG Departmnt of Rachna Shareer, Ch. Brahm Prakash Ayurved Charak, Sansthan, New Delhi-
110073.
4Professor & Head of Department, PG Departmnt of Kriya Shareer, Ch. Brahm Prakash Ayurved Charak Sansthan,
New Delhi-110073.
Article Received on 20/09/2018 Article Revised on 10/10/2018 Article Accepted on 31/10/2018
INTRODUCTION
The physiology of body is mainly governed by dosha
(body humors), dhatu(tissue factors) and mala
(metabolic wastes). Three doshas are known a vata, pitta
and kapha. Pitta dosha is made up of fire and water
dominant pachmahabhuta (elements) but fire being more
dominant.
In Ayurveda, Twacha word is used for skin. Twacha is
derived from tvac dhatu, which means the „cover‟.[1]
The origin of the twacha result from heat generated in
the process of union of shukra (sperm) shonita (ovum) in
intra uterine life just like a cream on the surface of milk
after cooling it post boiling.[2] According to the Astanga
Hardyam, The skin originates from rakta dhatu in 6th
month of embryo[3] by the same process.[4] Skin formed
with the help of heat of pitta dosha. Composition of the
rakta dhatu (~blood) is also similar to pitta composition
like fire and water elements. The pitta which is situated
in twacha is known as bhrajaka pitta. It digests the oil,
ointment, medicated ghee applied over the skin. Pitta
dosha is also responsible of skin colour and temperature.
Pitta dominance in skin makes it more sensitive for
chemicals, sun exposure and humidity. As per Ayurvedic
literature imbalance of tridosha and dhatus is responsible
for skin disease.
Large community prevalence studies have demonstrated
that between 20-30% of the population have various skin
problems requiring attention.[5] Most of the skin diseases
are mentally agonising and have negative impact on
quality of life.
Description of skin diseases is spread over various
samhitas in many chapters. Two broad categories in
which skin diseases are mentioned are kustha roga and
ksudra roga. Other common headings wherein skin
disease are mentioned are visarpa, nanatmaj vyadhi,
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*Corresponding Author: Dr. Yogesh Kumar Pandey
Associate Professor, PG Departmnt of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi-110073.
ABSTRACT
Skin functions as antimicrobial and chemical barrier, mechanical support and protects body from a number of
external hazards. In Ayurveda, skin diseases are described in various classical texts. Cause of the skin disease is
vitiation of tridosha and dhatus. Out of total 166 skin diseases are described in brihattrayi, 24 are pitta prominent
skin diseases. Although most of skin diseases are described under the kushtha and shudraroga but description of
some of other skin diseases is scattered throughout samhitas. A compilation and critical analysis of skin diseases in
Charak samhita, Shusruta samhita samhita, Vagbhatta, Chakradatta, Sharangdhar, Vangsen samhita and Bhela
samhita is presented in this study. Pittaja skin diseases are udumabar kushtha, vivrutaa, palita, kaksha and jala-
gardabha, neelika, charma dalana, ati sweda, davathu and pitta dominant visarpa, vidhradi, arbuda, upadansha
etc. It is observed that basic therapeutic protocol is Virechana (~purgation), raktmokshan (~bloodletting) with
internal use of tikta rasa dominant medicated ghee and parishek for all pitta dominant skin diseases. Virechana
(elimination of doshas through per rectal route) and raktmokshana (bloodletting) are best therapies for elimination
of pitta dosha. Ghee is the best shaman (pacification) treatment for all pitta predominant diseases. Compilation
and critical analyses of the all pitta predominant skin diseases in this paper emphasizes the fact that all pitta
predominant skin diseases have almost similar therapeutic approach. Pitta dominant skin diseases can be properly
diagnosed and treated with the help of this critical analysis.
KEYWORDS: Pitta, kushtha, skin diseases, dermatological manifestations.
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bahya vidhradhi, shukadosha, prmeha-pidika, granthi,
apachi, arbuda, upadansh, shilipada,and shoth. Present
article is a compilation and critical analysis of the pitta
predominant skin diseases described in three major
ayurvedic treatise of Ayurveda namely charaka samhita
(6thcentury BC), Shusruta samhita samhita (3rd century
BC), Vagbhatta (2nd century AD) and some other
popular texts such as Vangsan samhita, Sharngdhar
samhita (8th century AD) and Chakradatta(8th century
AD).
OBSERVATION
In ayurveda, major skin diseases have been described
under kushtha. Literary meaning of kushtha is “kushnati
vapuh eti kushtham” which means any disease which
deforms or disfigures the skin is known as kushtha. The
kushtha is generally described as tridoshaja vyadhi
(arising due to vitiation of all the three corporeal humors)
but types of the kushtha depend upon predominance of
particular dosha. There are two type of kushtha;
Mahakushtha & kshudrakustha. Mahakustha is further
classified into seven subtypes and kshudr-kushtha is
further classified into eleven subtypes. The term
mahakustha implies chronicity of the disease and
severity of their symptoms. Less severe skin diseases are
described in kshudra-kushtha. Udumbar is pitta
predominant mahakushtha.
Remaining skin diseases are enumerated in kshudraroga
which is described in a separate chapter in Shusrut
samhita. Kshudra roga is derived of two words i.e.
kshudra and roga. Kshudra means alpa or short/ small/
minor and roga means disease. So kshudraroga‟s nidan
(etiology), lakshan (clinical features) and chikitsa
(treatment) are described in brief. According to Shusruta
samhitaa, kshudraroga are 44 in numbers while
vagbhatta has mentioned 36 ksudra-rogas. Out of these,
rudhgud is not skin disease so 35 kshudrrogas are skin
diseases. Out of 44 ksudra-rogas described in Shusruta
samhita 42 are skin diseases while two diseases namely
Gudabhransha and sannirudhgud may not be included
in skin diseases. Among ksudrarogas Vivrutaa, palita,
kaksha and Jala-gardabha are Pitta predominance
diseases. But according to Vagbhata, kaksha roga is
vata- pitta dominant skin disease.[6]
In Maharoga Adhyaya (20th chapter ) of sutrasthana of
charak samhita, endogenous diseases (Nija vyadhi) are
two type; Samayaja vyadhi- caused by vata, pitta and
kapha in different combinations and Nanatmaja vyadhi-
specific diseases caused by individual Doshas- vata,
pitta and kapha. Nanatmajvyadhi of Pitta dosha are
enumerated as 40 types of diseases.[7] Out of this 40
diseases, 12 are skin diseases namely neelika,
haaridratva, haritatva, charma dalana, rakta mandala,
rakta vishota, twag vadarana, twak daha, ati sweda,
amsa dadha, davathu and daha.[8]
According to Shusruta samhita, when Pitta
predominance tridoshas vitiates twacha, rakta, mansa,
meda in some regions of body it produces a troublesome
swelling which is bulging up rapidly, deep routed,
painful and round. It is known as Pittaja bahaya
vidhradhi.[9] Abscess is pus-filled painful swelling so
symptoms of vidhradhi symptoms are akin to abscess.
Round knot like swelling is called granthi.[10] Symptoms
of granthi are similar to cyst which is a fluid filled sac.
Pitta predominant granthi is called Pittaja granthi.
Round immovable deep seated and non-suppurating
painless swelling is called Arbuda.[11] Symptoms of
Arbud are similar to tumour. Tumour is a swelling of a
part of the body without inflammation, caused by an
abnormal growth of tissue. Symptoms of Shlipad are
similar to elephantiasis. Symptoms of Updansh are
similar to syphilis.
Visarpa is an acute inflammatory dermatological
manifestation. It spreads very quickly like sank (visarpa)
in various directions.[12] It is characterized by clinical
features such as aashu- anunnatashopha (aggravating
and subsiding quickly), daha (burning sensation), jawara
(fever), vedana (pain). Nature of sphota, pidika
(vesicles) are so specific that it is described as
agnidagdavat (likewise intense burning sensation).[13]
Based on dosha predominance, they are seven types as
per charak. According to Sushrit Samhita, it has five
variants. One type of the visarpa is pittaja visarpa. In
terms of similarities visarpa is similar to erysipelas and
herpes.
Total one hundred sixty six skin diseases described in
brihattrayi. Out of these one hundred sixty six skin
diseases, twenty four are Pitta prominent skin diseases.
(See in the table no 1).
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Table 1: Identification of all Pittaja skin diseases in Ayurveda.
S. No.
Name of Disease
Group of Disease
Site
Clinical Features
1
Udumbar
Maha-kushtha
Anywhere on
body
Reddish nodules appear with excessive
brownish hair, burning pain and itching.
Its looks like ripe fruit of cluster fig
tree.[14-15]
2
Pattik bahaya vidradhi
Bahya vidradhi
Anywhere on
body
Abscess looks like a ripe fruit of cluster
fig tree. Fever and burning sensation is
present in abscess.
Discharge is yellowish.[16]
3
Vivrutaa
(~bullous pemphigoid)
Kshudra - roga
Anywhere on
body
Tense bulla and eruptions (open blisters)
with severe burning sensation. Bulla
color is similar to the ripe fruit of
cluster fig tree and surrounding area is
inflamed.[17-18]
4
Jala-gardabha
(~lymphangitis)
Kshudra-roga
Anywhere on
body
Suppurated swelling spreads like
herpes.[19,20]
5
Kaksha
(~Herpes zoster)
Kshudra-roga
Arm, later part
of trunk and
axilla
Reddish Black painful vesicular
eruption.[21,22]
6
Palita (~premature
grey of hair)
Kshudra-roga
Hairs
Graying of hairs[23]
7
Pittaja visarpa
Visarpa
-
The part where the disease spreads
becomes either coppery, green-yellowish,
reddish-black or bluish in color. This
space becomes full pustules along with
swelling. Burning sensation and breaking
pain are present in affected area. These
pustules suppurate very quickly.
Other associated symptoms are fever,
thirst, faint, confusion, vomiting, and
excessive sweating.[24]
8
Neelika
Pittaja nanatajmak
Anywhere on
body
Blue moles
8
Haaridratva
Pittaja nanatajmak
All over body
Yellowish
9
Haritatva
Pittaja nanatajmak
Skin, eyes
Greenish and yellowish
10
Rakta Mandala
Pittaja nanatajmak
Anywhere on
body
Red wheals
11
Rakta visphota
Pittaja nanatajmak
All over body
Red vesicles
12
Twagavadarana
Pittaja nanatajmak
All over body
Cracking of skin
13
Charma daalana
Pittaja nanatajmak
All over body
Itching of skin
14
Tvak Daaha
Pittaja nanatajmak
All over body
Burning sensation in skin
15
Ati sweda
Pittaja nanatajmak
All over body
Excessive sweating
16
Amsa dadha
Pittaja nanatajmak
Shoulder
Burning sensation
17
Davathu
Pittaja nanatajmak
In sense organs
Boiling
18
Daha
Pittaja nanatajmak
All over body
Burning
20
Pittaj granthi
Granthi
(cyst)
Anywhere on
body
This cyst has burning and sucking Pain. It
is red yellowish in color, forms pus
quickly and exudes a flow of extremely
hot blood on bursting.[25,26]
21
Pittaj Arbud
Arbud
Anywhere on
body
A tumor whose symptoms are similar to
the pittaj granthi.[27]
22
Pitta upadansh
Upadansh
(~syphilis)
Male genital
organ
Swollen resembles a ripe fruit of cluster
fig tree (red- yellowish) with fever,
burning and sucking pain, forms pus
quickly. Sometime wounds appear on
penis.[28]
23
Pittaj shilipad
Shlipada
(elephantiasis)
leg, arm, ear,
nose, lips,
Swollen part becomes soft with yellowish
hue and is often accompanied with fever
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eyelid
and burning sensation.[29,30]
24
Pittaj shoth
Sotha
(swelling)
Anywhere on
body
Swelling color- yellow reddish with
coppery hair.
Swelling increase and subside quickly.
Foul smell present.
Other symptoms- fever, burning
sensation, diarrhea.[31]
Table 2: Various type of cutaneous lesions with their represent diseases as per Ayurveda.
Skin lesion
Description
Example
Nodule
Elevated palpable lesion >1cm in diameter with greater depth
than its height or width.
Udumbar kushtha
Vesicle
Elevation with clear fluid lesion <0.5 cm in diameter.
Kaksha shudraroga
Bulla
Large vesicle, >0.5
Vivrutaa, Davathu
Pustule
Papule with pus.
Visarpa, Rakta vishotha
Wheal
Erythematous, edematous, itchy lesion
Rakta mandala
Cyst
Nodule with fluid
Granthi
Prognosis: Pitta predominant skin disease is easily
curable if it is not compounded with vitiation of other.
Treatment
In kushtha disease, first of all predominant dosha should
be treated followed by treatment of other doshas.[32]
Skin disease is treated with medicated ghrit (ghee)[33]
with predominance of tikta (pungent) and kashaya
(astringent) drugs in taste.[34]
Ayurveda give special importance on three fold
therapeutic management of the disease viz. Shodhana
(~bio- purification), Samshamana (~pacification) and
Nidana parivarjana (avoiding causative factors) for all
types of disease including skin diseases.
Shodhan (bio-purification) therapy is indicated when
body accumulates excessive amount of the doshas
(toxins) and body is unable to excrete these toxins
naturally.
Samshamana (~pacification) therapy is used when there
is a small amount of vitiated doshas in body.
Samshamana is also used after shodhana therapy to
mitigate for small amount of doshas.
In shodhan therapy; the principle for the management of
pitta predominant skin disease is virechana (~purgation)
and raktmokshan (~bloodletting).[35] Local application is
used on affected skin after bloodletting.[36] Virechan
must be repeated every month for few months depending
on general condition of patient and severity of disease.
Bloodletting is indicated once in 6 months.[37]
1. Shodhana therapy (~bio-purification)
S.No.
Disease
Treatment
Specification
1.
Udumbar
kushtha
Snehana
(~lubrication)
Ghee made of bitter herbal drugs is used externally and orally.[38] i.e.
panchtikta ghrit
Virechan
(~purgation)
Trivata, root of danti, triphala powder[39]
Raktmokshan
(~bloodletting)
Bloodletting with the help of Horn/ cupping/ leach[40] should be done
after swedana when the patches are hard and stable.
Sneha pana
(~lubrication)
After the elimination of doshas by virechan and Raktmookshan, the
patient should be given sneha (ghee) to drink.[41]
2.
Pittaja
nanatajmak
Sneha pana
Sheeta virya (drugs with cool potency), madhur (sweet), tikta (bitter)
and kashaya (astringent) herbs are used[42] i.e. Tiktaghrit, karanjadi
ghrit for lubrication.
Virechana
Triphala powder, haritaki powder and kutaki powder
3.
Pittaja
bahaya
vidradhi[43]
Local application
A paste of mixture of sugar, mulathi, khasa, chandana and sariva made
with milk is applied on the abscess.
A paste of mulethi, Giloya and black seed oil may also be applied.[44]
Parisheka
(~shower)
Decoction of mulethi, khasa, chandana and sariva.
Ghee medicated with drugs of of jeevniya gana or
Nyagrodhadi gana[45]
Raktmokshana
Leech
Ropana
(local application for
Poultice of manjistha, mulethi, khasa and haridra mixed with milk[46]
and butter are applied on wound after washing the wound.
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healing)
Pure butter cooked with prapaundarika, manjishtha, yashthimadhu,
ushira, padmaka, haritki and milk may also be used.
4.
Pittaja
visarpa
Langhana and
rukshana[47]
Dieting and non-unctuous diet.
Raktmokshan[48]
Leech therapy.
Vamana[49]
(~emetic)
Powder of Madana fruit with honey.
Virechana[50,51]
Purgative ghee i.e. triphala ghrit
5.
Pittaj bahaya
granthi[52]
(~cyst)
Raktmokshana
Leech[53,54]
Parisheka
Milk and plain water
If the pus is formed, it should be removed by incision on the gland and letting pus out. After that
it should be washed with the help of decoction of the bark of vata, pippal, gulara etc or sesamum
and yashthi madhu. At last, it should be treated with the help drugs of the kakoliyadi gana.
6.
Pittaja
bahaya
Arbuda[55]
Swedana
Mild fomentation on affected area.
Raktamokshan
Mild bloodletting should be done by rubbing with the help of udumabar
leaves, varuna leaves and sehunda leaves on tumor.
Upanaha (~poutices)
After bloodletting, some paste should be applied on effected area.
Composition of the paste is Aragvadha, shakhotaka, somalata and
nishotha.
Composition of another paste is rala, priyangu, lodhra, anajana and
mulethi mixed with honey.
Virechana
(~purgation)
Trivrita, root of danti, triphala powder.
7.
Pittaja[56]
baahya
shotha
Sneha pana[57]
Upanaha
Intake of cow ghee cooked with Nyagrodhadi gana, or tilvaka ghrit
Tikshan Virechana
Trivruta powder
Asthapan basti
(~enema)
Decoction of nyagrodhadi gana
8.
pittaja
upadansha[58]
Snehana
Local application of ghee i.e. Karanjadi ghrit.
Swedana
Mild fomentation with steam.
Raktmokshana
Bloodletting on mid part of the male genital part by puncturing.
Parisheka
(~shower)
Ghee, milk, sharbata, sugarcane juice, honey are combined with water.
9.
pittaja
shilipada
Snehana[59]
local lubrication i.e. Karanjadi ghrit.
Swedana[60]
Mild fomentation with steam.
Upanaha[61]
Poutice of manjishthaadi lepa.
Raktmokshana[62-63]
puncture the vein below the ankle joint
Medicinal remedies of pittaja shilipada are similar to
arbuda and visarpa.[64,65] Treatment of the vivrutaa,
jaalagardabha and kakshaa= are similar to the pittaja
visarpa and if appear the wound in these disease; wash
and full fill of the wound by medicated oil made by
kakolyadi gana.[66,67]
2. Samshamana (~pacification)
S.No.
Disease
Medicinal formulations
Contains
Dose/ Anupana
1
Udumabar
kushtha
Pitta kushthahar
kashayam[68]
Mulethi, lodhra, patol, padmaka, nimba, rakta-
chandana
For bath and oral
use
Mahatikta ghrita[69]
Kutaki, amaltasa, haritki, bibhitki, amala,
ativisha, patha, nimba, nagarmotha, guduchi,
traaymaana, indraayan, vacha, haridra etc.
30 ml BD orally
Tiktak ghrit[70]
Patol, kutaki, daruharidra, patha, durlabha,
trayamana, chirayata, lalachandana, cow ghee
30 ml BD orally
Pitta kushthahar lepa[71]
Priyangu, renuka, indrajo, khasa, ateesa,
raktachandana, kutaki
Local
application
2
Palitta
Bhringraja tailam[72]
Bhringraja, amlaki, haritaki, bibhitak, sariva,
lauha bhasma
Head massage
Mahanila tail[73]
Manjishtha, katsareya, bhrignraj, makoya,
mulethi, devdaru, tulsi, aamala, haritaki,
bibhitaka
Head massage
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Kashmaryadi tail[74]
Gambhari, flower of mango, iron, ketaki,
bharangi, black seed oil, amala, haritaki,
bibhitak.
Head massage
Manjishthadha tail[75]
Manjishtha, laxa, bijora lemon, mulathi, goat
milk
Head massage
Varnaka ghrit[76]
mulethi, raktachandan, mastard seed, haridra,
lodhra
Head massage
Bhringapushpadi
lepa[77]
bhringraj and japa pushpa, bhed milk
Head massage
Neema tail[78]
Nasal drops
3
Pittaja
nanatajmak
Sheeta virya, madhur (sweet), tikta (bitter) and kashaya (astringent)
dominant herbal drugs are used[79] i.e. Kakolyadi group Sarivadi pralepa,
Udumbaradi lepa.
Parisheka
Massage
Ointment[80]
4
Pittaja
bahaya
visarpa
Sarivadi pralepa[81]
Anantmoola, kamal keshar, khasa, neelkamal,
manjishtha, chandana, lodhra, haritki
Local
application
Udumbaradi lepa[82]
Udumbar bark, mulethi, kamal-keshara,
neelkamala, nagakeshara, priyangu, cow ghee
Nyagrodhadi lepa[83]
Vata, soft part of banana stem, taproot of lotus
Paste of nyagrodhadi
group
Udumbara, asvattha, plaksa, madhuka, kapitana,
kakubha, amra, kosamra, corakapatra
Paste of paddhotpaladi
group[84]
Padmaka, prapauddarika, vanshlochana
Mahatikta ghrita[85]
Per Orally
5
Pittaja
bahaya
vidradhi
Karanjadi ghrita[86]
Karanja, chameli, parvala, nimba, haridra,
daruharidra, mulathi, kutki, priyangu, chandana,
khasa and sariva
Internal and
local application
Pittajavidradhighn
lepa[87]
Mulethi, sariva, durva, lalchandan cow milk
Local
application
6
Pittaja shotha
Ghee made of Nyagrodhadi gana and tilvak ghrit[88]
Per Orally
7
Pittaja
shilipada
Manjishthadi lepa[89]
Manjishtha, mulathi, rasna, hinsra, punarnava
Local
application
Saureshvara ghrit[90]
Tulasi, devdaru, haritaki, aamala, bibhitak,
pippali, maricha, soatha
Per orally
8
Pittaja
upadansha
Upadanshahar lepa[91]
Gairika, rasota, mulethi, khasa, paddhakha,
chandana and lotus
Local
application
9
Pittaja
bahaya
granthi[92]
Decoction of Kakolyadi
gana
kakoli, ksheerkakoli, jeevaka, rishbhaka,
mugadaparni
with the addition
of sugar
Pittaja granthihar lepa
Arjuna, vetasa, jambu, madhuka powder
Local
application
Kakolyadi gana: Kakoli (Lilium polyphyllum),
ksheerkakoli (Fritillaria roylei), jeevaka (Microstylis
wallichii), rishbhaka (Microstylis ridley), mugdaparni
(Vigna trilobata), mashaparni, meda (Polygonatum
verticillatum), mahameda (Polygonatum cirrhifplium),
giloya (Tinospora cordifolia), kakdasinghi (Rhus
succedanea), vanshlochana (Bambusa arundinacea, swet
kamal (Nelumbo nucifera), draksha (Vitis vinifera),
riddhi (Habenaria edeworthii), vriddhi (Habenaria
intermediz), jivanti (Leptadenia reticulate) and mulathi
(Glycyrrhia glabra).[93]
Nyagrodhadi gana: Nyagrodha (Shorea robusta),
udumbara (Ficus racemosa), asvattha (Ficus religiosa),
plaksa (Ficus lacor), madhuka (Glycyrrhiza gllabra),
kapitana (Albizia lebbeck), arjun (Terminalia arjuna),
amra (Spondias mombin), koshamra, corakapatra
(Persicaria odorata) and jambu (Syzygium cumuni),
priyala (Buchanania latifolia), rohini (katphala), vetasa
(Homonoria riparia), kadamba (Neolamarckia cadamba)
etc.[94]
Paddhakadi gana: padma (Kaprunus cerasoides), swet
kamal (Nelumbo nucifera), vanshlochana (Bambusa
arundinacea), guduchi (tinospora cordifolia), riddhi
(habenaria edeworthii), vriddhi (Habenaria intermediz),
jivanti (Leptadenia reticulate), kakdasingi (Rhus
succedanea).[95]
3 Nidana varivarjana (avoiding causative factors)
Pathya (does) - rice, barley, wheat, mudga, masura
seeds, bitter vegetables, desert animals meat.[96]
Apathya (don‟t) - sour, salty, pungent, curds, milk,
jiggery, oil, meat of animals of marshy land.[97]
Yogesh et al. European Journal of Pharmaceutical and Medical Research
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DISCUSSION
According to Ayurvedic texts, properties of pitta dosha
are unctuous, hot, sharp, liquid, sour taste, fluidity,
pungent.[98] Burning pain is aggravated of pitta dosha.
Pitta dosha gets aggravated by use of diet and activities
that are similar to the properties of pitta in high amount
for a long time. And when this aggravated pitta vitiate
into the skin then the skin disease is produced. It‟s also
called pitta predominance kushtha disease. According to
Bhela samhita, pitta predominant kushtha is
characterised by copper- red patches or papules are arise
and subside quickly and other associated symptoms are
burning sensation and fever.[99]
S. no
Disease
Skin lesion
Symptoms
Secretion
1
Udumbar kushtha
Nodules
Look like ripe fruit of
cluster fig tree
Burning
pain
Absent
2
Pittaja vidradhi
Abscess
Look like ripe fruit of
cluster fig tree
Burning
pain
Present
3
Vivrutaa
Bulla
Look like ripe fruit of
cluster fig tree
Burning
pain
Absent
4
Pittaja upadansha
Swollen
Look like ripe fruit of
cluster fig tree
Burning
pain
Pus secretion
All pitta predominant skin diseases are also similar to
each other due to aggravation of pitta dosha in clinical
presentation such as the formation of pus in most of
diseases. Color of the lesion are red-yellow bluish.
Burning type pain is characteristic of these lesions. These
lesions spread very quickly. Despite a lot of similarities
in manifestations there is some variation in morphology
of their lesions due to the involvement of different dhatu
and site, such as bulla, nodules, abscess, cyst etc. Some
pitta predominant skin disease shows some extra
symptoms except pitta dosha due to involvement of
vitiated other doshas and dhatu.
Kushtha is tridoshaj vyadhi. Therefore, all doshas are
taken into consideration at time of planning the
treatment. But predominant dosha is treated first. So
pitta dosha is treated in pitta predominant skin disease.
After that, other doshas may be treated according to
conditions. In some of skin diseases such as Neelika,
Rakta Manda and other pittaja nanatajmak, only pitta
dosha is treated.
In most of the pitta predominant skin diseases, it has
been observed that basic treatment protocol is virechana
(~purgation), raktmokshana (~bloodletting), internally
use of tikta rasa dominant medicated ghee and parishek
made by decoction. The best pacification treatment in
pitta predominant skin disease is medicated ghee while
the best bio-purification treatment is virechana.[100]
1. Virechana (purgation)
The location of the pitta dosha is between heart and
umbilicus.[101] Liver, gall bladder and small intestine also
situated between heart and umbilicus therefore the place
of pitta dosha can be called liver, gallbladder and small
intestines. Virechana (Purgation) is best process for the
purification of the small intestine so that virechana
therapy is best in elimination of pitta dosha. Some of the
drugs are used for nitya virechana (form of mitigation
therapy)are kutaki, indrayava.
2. Raktmookshan (bloodletting)
Raktamokshan is the best purification process for blood
cleansing and detoxification. The qualities of rakta dhatu
are very similar to the pitta dosha. According to all
ayurveda acharya, pitta is mala (waste) part of rakta
dhatu; which has originated from the rakta dhtau
therefore raktmokshana therapy is useful for aggravated
pitta dosha.
3. Bitter taste dominant medicated ghee
These diseases arise due to aggravation of pitta dosha
which should be balanced by the medicines with
opposite to its inherent qualities. Madhur (sweet), tikta
(bitter), kashaya (astringent) rasa and Sheeta virya are
opposite quality of pitta doshas. As per ayurvedic texts,
ghee is the best pacification treatment for pitta dosha.
Tikta rasa itself is kusthaghna (able to cure
dermatological afflictions), vishaghna (antidote to
endogenous toxins), kandughna (anti-pruritic), twak-
mamsasathiarakar (stabilizers of skin and muscles)[102]
and kashaya rasa is raktashodhak (blood purification).
Therefore, bitter- astringent ghee is mainly used in pitta
predominant skin disorders. Sneha pana (ghee per orally)
is administered before and after purification. After the
elimination of doshas by virechan and Raktmookshan,
the patient should be given sneha to drink, because vata
get aggravated and the patient become weak after the
elimination therapy.[103]
Drugs mentioned in table 3 can be used in pitta
dominant skin diseases.
Yogesh et al. European Journal of Pharmaceutical and Medical Research
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556
Table 3: Mitigation drugs of pittaja skin diseases.
S. no.
Drug
Latin name
Rasa (taste)
Virya
1
Rakta chandan
Pterocarpus santalinus
Madhur (sweet), tikta
(bitter)
Sheeta
2
Sweta sariva
Hemidesmus indicus
Tikta
Sheeta
3
Khasa
Chrysopogon zizanioides
Tikta
Sheeta
4
Priyangu
Aglaia elaeagnoidea
Kashaya (astringent)
Sheeta
5
Nimb
Azadirachta indica
Tikta
Sheeta
6
Manjishtha
Rubia cordifolia
Madhu, tikta, kashaya
Ushana
7
Mulathi
Glycyrrhiza glabra
Madhu
Sheeta
8
Giloya
Tinospora cardifolia
Tikta, kashaya
Ushana
9
Mahua
Madhuca longifolia
Madhu, kashaya
sheeta
10
Hribera/sugandhabala
Pavonia odorate
Sheeta
11
Gambhari
Gmelia Arborea
Madhu, tikta, kashaya
Ushana
CONCLUSION
One hundred sixty six skin diseases are described in
bruhattryi. There are twenty four pitta prominent skin
diseases. These are udumabar kushtha, vivrutaa, palita,
kaksha and jala-gardabha kshudraroga, neelika,
haaridratva, haritatva, charma dalana, rakta mandala,
rakta vishota, twag vadarana, twak daha, ati sweda,
amsa dadha, davathu and daha pitta nanatmaja twak
roga and pitta predominant visarpa, vidhradi, granthi,
arbuda, upadansha, shilipada, shotha.
All twenty four pittaja skin diseases show symptoms
similar to the pitta dosha such as red- yellow rashes,
burning sensation etc. The specific characteristics of the
all skin disorder depend on extent of vitiation of
properties of pitta dosha, various dushyas (tissue factors)
and adhishthans (site). Some pitta predominant skin
diseases are present with additional symptoms in
addition to pitta dosha due to involvement of vitiated
doshas and dhatu such as abscess, nodules, bulla,
pustules, swelling.
In most of the pitta predominant skin diseases, it has
been observed that basic treatment protocol is
administration of virechana (~purgation), raktmokshana
(~bloodletting), tikta / kashaya rasa dominant medicated
ghee. Raktmokshana and virechana are prime therapies
in elimination of aggravated pitta dosha. Most of the
herbal compounds used in mitigation therapy for pitta
predominant skin disease are sheeta virya (potently
cold), madhur (sweet), tikta (bitter) and kashaya
(astringent) dominant.
All pitta predominant skin diseases are described
according to the dosha, site and symptoms and these
classics treatment are in tabulated form in this article so
that diagnosis and classical management of the pittaja
skin disease can be approached easily.
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