Manual of Twak vikara in Kushta, visarpa, kshudra roga

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Kushta is a tridoshaja vyadhi mentioned in Ayurveda that undergoes manifestation in the bahya rogamarga. Kushta is considered a mahagada due to its durvijneya, sudustara and daruna swabhava. The samprapthi of kushta begins with the multitude of interactions of tridosa with twak, rakta, mamsa and lasika and gradually may afflict other dhathus, depending upon the strength of samprapti ghataka. Majority of the dermatological disorders have been described under the umbrella of Kushtha.

Nirukti: The word “Kushtha‟ is derived from – „Kusnishkarshane‟ + „Kta‟ which implies „to destroy‟, „to deform‟ or „to scrap out‟, by adding the suffix „kta‟ which stands for „certainty‟ or „firmness‟. Thus, the word Kushtha means that which destroys with certainty.

Vyakhya: Kushnativapuetikushtam i.e. that which disfigures the body is known as Kushtha.

Skin is an organ of complex physiology and any manifestation in skin should be explored in terms of general physical and mental health and also on the basis of the status of rasa and raktha dhatus, the physical and functional state of which is more often reflected through the skin.

Depending on the amsamsavikalpa of dosha- dushya, kushta has been classified into 7 maha kushta and 11 kshudra kushta. It also can be classified on the basis of the following:

 Vedana- nature of pain – “काऩारं तोदफहुर”ं  - based on colour-“मत ्काकणन्ततकावणं”  Samsthana- appearance -“म饃ष्मन्जह्वासंस्थानं”  Prabhava- prognosis- साध्मतासाध्मतादद  Nama – name-काऩार इत्मादद  Chikitsa visesha –treatment

NIDANA (ETIOLOGICAL FACTORS)

Nidana or the etiological factors closely linked with the manifestation, transmission and progression of the disease are broadly classified in the classical Ayurveda texts in the following categories:

1. AHARAJA NIDANA- food related etiological factors 2. VIHARAJA NIDANA- regimen related etiological factors 3. MANASIKA NIDANA- psychological etiological factors. 4. VISESHA NIDANA- an etiology that is not common in all diseases, but specifically act as hetu in this disease. 5. SAHAJA NIDANA – those factors which causes disease due to beeja bhaga avayava dushti.

aharaja

sahaja visesha nidana viharaja

manasi ka

In kushta roga, following nidans could be identified according to .

 Sannikrishta nidana –sannikrishta nidana is the chief components of roga samprapthi janana. “saptako sangraha”. The Sapta Dravya includes three Doshas viz. Vata, Pitta and Kapha and four Dushyas viz. Tvaka (Rasa), Rakta, Mansa and Ambu or Lasika.  Viprakrishta nidana – the factors that support the dosha-dusya sammurchana are included under this classification. Kushta is also considered as an adibala pravrtta vyadhi (hereditary )

Purvajanmakrta is considered as a nidana for kushta. (म्रिमते मदद कु ेन ऩुनजाातेऽपऩ ग楍छतत | नात् कतयो योगो मथा कु ं प्रकीततता भ)् su ni 5/31-32 Kushta is also considered as an upasaragaja vyadhi प्रस敍गाद्गात्रसंस्ऩर्ाान्तनासात ् सहबोजनात ् |

सहर्य्मासना楍चापऩ वस्त्रभा쥍मानुरेऩनात ् ||३३|| कु ं 煍वय र्ोष नेत्राम्रबष्मतद एव च | औऩसर्गाकयोगा स敍राभन्तत नयातनयभ(su् ni 5/34)

AHARAJA NIDANA TYPE OF NIDANA DOSHA /CATEGORY DUSHTI PARTICULAR RASA SEVANA अततरवण: Salt predominant Pitta vridhi Visyandana foods like pickles, Kapha Kleda bhelpuri, papad, visyandana vridhi chips, namkeen Raktadusht i कु ष्णातत भांसातन प्रगारमतत कु ातन अततअम्र: Fermented products, Pitta Raktadusht pickles, bhelpuri, sour abhivridhi i fruit juices, sauces Kapha Mamsa – like tomato sauce, vilapayati vidahati excess intake of Shithileeka preserved foods, curd, rana -kaya buttermilk, pickles, lemon juice, vinegar, alcohol, sauce, squashes, cold drinks, SPECIAL HABITS RELATED WITH FOOD INTAKE पव셁ाहाय: Sprouted Tridosha Rakta dushti vegetables/grains with dushti meat, milk with meat, honey with meat, black gram with meat, lotus stem with meat, muli with meat, jaggery with meat, milk or honey with leafy vegetables, curd with chicken, honey heated in any form or taken with hot water, alcohol with kheer, fish with jaggery or sugar, muli with honey or milk, pork

with jaggery, banana with milk, buttermilk or curd. Drinking milk after eating garlic or any species of tulsi, any sour taste substances such as unripe mango, badara, jambu, akshoda, jackfruit, cocunut, dadima, amla with milk, safflower with alcohol, sweet porridge with process: ghee kept in copper vessel, amount: honey and water inequal quantity, honey and ghee in equal quantity Pizza, cheese mixed Kapha गुवता नऩानभ ् foods, bakery prakopa vaigunya products, kidney (annavaha beans, paneer etc, srotodushti) food items prepared Raktavaha mainly from black srotodushti gram such as dosa, Mamsa vaha idli, vada; beef, pork; srotodushti food prepared from flour. Regular intake of meat products Intake of milk shakes, kheer etc. न्स्नग्धातनऩानभ ् Excessively oily Kapha Rasavaha foods such as prakopa srotodushti biriyani, fried oily Raktadushti foods, meatsoups, Raktavaha sweets made of srotodushti excess ghee, milk etc Agni such as kheer vaisamya Food prepared with cheese& ghee, sweets etc

द्रवातनऩानभ ् Drinking excess Kapha Agni quantity of prakopa mandya water/juices/madya/ Kleda soft drinks/ milk / janana liquid foods like Raktavaha rasam/sambhar more srotodushti than needed for the Udakavaha body srotodushti Rakta dushti स्नेहाततसेवनभ ् Excessive intake of Kapha Agni ghee for medical prakopa, vaisamya, purposes or as part of Doshotkles Kleda diet. ha janaka

नवातन: Newly harvested Kapha Kleda grains prakopa janaka

म्रभत््माहाय: Intake of food Tridosha Rakta foregoing ahara visesha vidhi ayatana असात्म्माहाय: Foods which are not Tridosha Rasa and native to the place rakta dushti such as fruits of (such food foreign origin, eating may remain food which is not indigested native to the area such and may as chinese food, pasta produce or pizza, soyabean, vidaha) olive oil, अजीणााहाय: Intake of food before Tridosha Agni the previous food is dushti dourbalya properly digested. Rasadushti Rakta dushti अजीणााध्मर्नभ ् eating food before Tridosha Rasa rakta digestion of previous dushti dushti meal or when there is Agni no appetite vaisamya अदहताम्रर्न: Fast food/junk Tridosha Agni food/excessive spicy dushti vaisamya food/excessive oily Rakta dushti food (such ahara Food taken when the might individual does not remain in

mentally prefer to koshta partake. without proper absorption and assimilation to tissues) र्चम्ररर्चभ ं ्च ऩमसा Intake of Prawns in Tridosha Rakta dushti combination with dushti karaka milk . because of its virudha swabhava (seeta-ushna etc) ग्रा륍यानूपौदकमा車सानन पयसा अशनम् Non vegetarian food Tridosha Rakta dushti with lassi, ice cream (specific along with non type of vegetarian food, milk virudha, products with meat guna eg. Dishes like butter virudha, chicken veerya virudha ) Intake of cold and hot Tridosha Agni रभं भुक्तत्वा र्ीतोष्णाहाय सेवनभ ् food together or dushti vaisamya intake of cold food Rakta dushti soon after intake of Swedavaha hot food or vice versa. sroto dushti Using cold water with (guna hot lunch/dinner. virudha Using dessert along swabhava) with hot food. Using cold milk with hot samosae etc. Taking food which Tridosha Raktadushti, रभं भुक्तत्वा र敍घनाहाय सेवनभ ् are ill nourishing and vaisamya ruksha in improper order especially janana neglecting the rules vata (ati Agni mentioned for food langhana) vaisamya intake. Kapha(ati Intake of ill- brimhana) nourishing food when body requires nourishing food etc

सततं अततभात्रं अजीणे सभत: Habit of taking Tridosha Raktadushti honey/jiggery/fish/art dushti (specific भधुपाणणतभत्स्म रकु च भूरक ocarpus lakucha/ type of काकभाची radish/solanum virudha nigrum etc in which might excessive quantity act as cause and especially when for kushta) previous food has not been properly digested. Tridosha rakatdushti ऺीयदर्धतरकोरकु रत्थभाषातसीकु सु dushti म्बस्नेहवन्तत हामनक मवक चीनकोारक कोयदषू प्रामाणी चातनातन Taking food such as Pitta- Raktadushti अहायजातं पवदग्धं अनुन्쥍रख्म Spicy and pungent predomina (prabala) पवदाहीतमभ्मवहायत: foods with more of nt dushti red chilli, pepper, with kapha kulatha, shukta, vata aaranaala, madya, involveme sprouts, fried foods nt while previously taken food is in vidagdavastha(semidi gested and acidic/chyme) and has not been eliminated by induced emesis. SPECIFIC FOOD ITEMS दर्ध: Curd in different Kapha – Abhisyandi forms such as raita, pitta dushti Kleda lassi, dahivada, mixed janaka in curry etc especially Agni after heating and in vaisamya autumn, summer and karaka spring seasons Rakta dushti karaka (ushna, amla) भत्स्म Excessive intake of Kapha- Rakta dushti

fish, regular intake of Pitta dushti (virudhas fish, various with matsya preparations is specific involving fish. causative Combination of fish factor for with milk is a kushta) causative factor for kushta भाष: Use of urad dal and Kapha pitta Raktadushti preparations such as dushti vada, idli, dosa etc Regular usage of Ama Specific भूरक: radish.(radish is mulaka- hetu for considered prakrsta pitta-kapha rakta dushti apathya) dushti *(snigdha swabhava) Suska mulaka (vatakapha gna)

Food prepared after Kapha – Raktadushti पऩातन:् grinding rice, gram pitta dushti hetu etc and preparations such as Dosha, idli, vada, dhokla etc ततर: Regular intake of Kapha – Rakta dushti Sesame especially in pitta krt the form of ladoo, chikki, gajak or as sesame itself. ऺीय Milk and milk Kapha Snigda guna products, ice creams Kleda

Use of Jaggery and Kapha – Rakta- गुड: products made with pitta-vata mamsa- jaggery regularly medo dushti karaka Krimikaraka VIHARAJA NIDANA Habit of using Tridosha Rasarakta अननुऩूर्वम ा सततऩाणाऩतऩाणाभ्मवहामा santarpana and dushti dushti

र्वमत्मासोऩसेवा apatarpana ahara- vihara simultaneously or one after other such as Heavy work out in gym soon after heavy food intake. Heavy and highly nutritive food intake soon after fasting etc Indulging in hot or Tridosha Swedavaha अननुऩूर्वम ा र्ीतोष्णर्वमत्मासोऩसेवा cold things together (type of srotodushti or one after other. virudha Rakta Eating hot and cold vihara) dushtikaraka food items together, frequent going in and out of ac room in summer, bathing in cold water just after exercise or coming from hot exterior, working or travelling in airconditioned atmosphere and then sudden exposure to hot climate outside.

bathing in cold water Virudha Swedavaha उष्णाम्रबतस्म अप्सु भ煍जनभ ् just after coming from vihara srotodushti hot exterior, Tridosha Raktadushti swimming in cold dushti water just after exercise or work आततभात्रा सौदहत्मानततयं र्वमवाम Indulgence in coitus Tridosha Sakha gati after excessive or dushti of doshas सेवनं heavy food intake Rasa rakta dushti आततभात्रा सौदहत्मानततयं र्वमामाभ/ Indulgence in Tridosha Sakha gati exercise when dushti of doshas अतत बुक्तत्वा र्वमामाभोऩसेवनभ ् stomach is full or Rasa rakta after heavy food. dushti आततभात्रा सौदहत्मानततयं संताऩ Excessive sun Tridosa Raktadushti exposure after heavy dushti

food or when stomach सेवनं/अततबुक्तत्वा is full. अततसतताऩोऩसेवनभ ् बमोऩहतस्म सहसा र्ीतोदक सेवनभ ् Drinking cold water Tridosha Raktadushti when mind is agitated dushti (karma with fear virudha) श्रभोऩहतस्म सहसा र्ीतोदक सेवनभ ् Drinking cold water Tridosha Raktadushti when body is tired dushti (karma with exertion. virudha) सतताऩोऩहतस्म सहसा र्ीतोदक Drinking cold water Tridosha Raktadushti when mind is afflicted dushti (karma सेवनभ ् with grief or stress virudha) छददा वेगधायण: Taking anti emetics, Tridosha Raktadushti habit of suppressing dushti Specific

vomiting predomina hetu for ntly kapha kushta –pitta utklesha and vata pratilomata वाततस्म र्वमामाभग्राम्मधभासेपवन:  Indulging in Tridosha Rasa rakta vyayama after (sakha dushti vomiting gamana of  Indulging in utklishta coitus after dosha ) vomiting ददवा तनद्रा Habit of indulging in Kapha pitta Rasa rakta day sleep. predomina dushti nt dosha dushti स्नेहपीतय व्यायामग्रा륍यधममसेनिन: Exercise, exertion, Utklishta Rasa rakta sexual activity after dosha dushti eating unctuous food Sakha such as ghee, butter, gamana cheese, biriyani Tridosha dushti PANCHAKARMA APACHARAJA HETU ऩ祍चकभााऩचाय  Refraining Tridosha Dhatu dushti from doing vitiation In this case, panchakarma improper  Not following virechana or pathya-apathya raktamoksha or peyadi / donot

karma during undergo and after virechana or panchakarma raktamoksha  Doing : there is panchakarma possibility without of guidance of raktadushti physician and hence kushta VISESHA HETU पवप्र धषणा भ ् Offending Karma Kushta hetu itself act as hetu for kushta Offending teachers Karmaja Karmaja गु셁 धषणा भ ् and elders hetu for kushta hetu kushta ऩाऩ कभा Indulging in sin – Karmaja Karmaja murder, rape, bribery, hetu for kushta hetu thievery, looting, any kushta crime that may harm others Offending or abusing Karmaja Karmaja साध ु तनतदा saintly people hetu for kushta hetu

kushta Murder of saintly Karmaja Karmaja साध ु वध people hetu for kushta hetu kushta अतमस्वहयण Looting or snatching Karmaja Karmaja things from others for hetu for kushta hetu personal benefit kushta

SYMPTOMATOLOGY OF KUSHTA

Ayurveda acharyas has classified kushta into mahakushta and ksudra kushta .

ICD code -ED-4-kushta

Purvarupa : कु -ऩूव셂ा ऩभ-् ED-4.1

स्ऩर्ााऻत्वभ ् Inability to perceive touch sensation अततस्वेद् Excessive sweating

अस्वेद् Anhidrosis/lack of sweating वैवर्णमभा /्पववणाता Discolouration of skin कोठानाभ ्उतनतत् Raised reddish patches. रोभहषा् Horripilation Itching कर्णडू् तोद् Pricking pain श्रभ् Exhaustion/fatigue क्तरभ् Exhaustion without exertion Excessive pain in the wounds व्रणानाभर्धकं र्ूरभ ् र्ीघ्रोत्ऩपत् Sudden onset of skin lesions without any apparent reason र्चयन्स्थतत् Lesions and wounds remain unhealed for long time. दाह् Burning sensation Loss of sensation of body parts/affected सुा敍गता area अततक्ष्णस्ऩर्ा् Excessive smoothness of skin अततखयस्ऩर्ा् Excessive roughness of skin 셂ढानाभपऩ 셂ऺत्वभ ् Improper healing of wounds तनम्रभते अ쥍ऩे अपऩ कोऩनभ ् Aggravation of skin lesions/healed wounds by minor causative factors Blackish colour of blood असजृ ् काष्र्णमभा ्

भहाकु ्- ED-4.2

ED-4.2.1: कऩार्/अ셁ण-कु ्/वाततककु ्-कु ( skin affliction) with lesions resembling black clay pot fragments/अ셁ण (reddish) patches

셂ऺ Dryness of skin lesion and/ surrounding area अ셁ण् reddish colour of skin over the lesion ऩ셁ष् rough/dry appearing lesion uneven spreading lesion पवषभपवसतृ ् खयऩमातत् rough margins of the lesion

Thin skin over lesion/atrophied skin/thin तनू lesion raised outer margins of the lesions उृतफदहस्तनु loss of touch sensation/numbness over the सुवत्सु् lesion 셃पषतरोभार्चत् Lesion covered with raised hairs Excessive pricking pain over lesion. तनस्तोदफहुर् With minimal or absent itching compared अ쥍ऩकर्णडू with other skin conditions अ쥍ऩदाह् Less/minimal burning sensation Minimal/less/absent pus discharge अ쥍ऩऩूम् अ쥍ऩरसीका Absent /Minimal/less watery discharge Rapid spreading lesion आर्ुगतत् Rapid onset of lesion. आर्ुसभुत्थान् sudden onset of complications/rupture of आर्ुबेदद lesion blackish discoloration of overlying and कृ ष्णवण ा surrounding skin अ셁णवणा् slightly reddish discoloration of overlying skin कऩारवणा्/कऩाराबभ ् Discoloration/hue or appearance similar to that of earthen vessel पवसपऩाणण्/र्ीघ्रसपऩा् rapid spreading nature

ED4.2.2 : काऩारककु भ ्

कृ ष्णकऩाम्ररकाप्रकार्् -resembling black earthen vessel

ED-4.2.3: उदम्ु फय-कु ्/ऩैपतक-कु ्

ताि् coppery coloured lesion तािनख् copper coloured nails ताियोभयाजीम्रबयनव् Lesion covered with copper coloured hairs फहरातन copious discharge excessive pus discharge फहुऩूम् excessive bloody discharge फहुयक्त् excessive watery discharge फहुरसीका thick pus discharge फहरऩूम् फहरयक्त् thick bloody discharge फहररसीका thick watery discharge Itching कर्णडू् क्तरेद् moistening /saddening of lesion कोथ् Putrefaction of skin and muscle दाह् burning sensation ऩाक् inflammation/suppuration rapid spreading lesions आर्ुगतत् rapid onset of skin lesions आर्ुसभुत्थान् sudden onset of complications/rapid suppuration आर्ुबेदद् and rupture ससंताऩ् associated with elevated temperature over the lesion associated with worms सकृ म्रभ् ऩक्तवौदम्ु फयपरवण्ा /उदम्ु फयपराबासभ ् resembling the ripe fruit of उदम्ु फय् गौयम्रसयार्चतभ ् with whitish veins over the lesion 셁जाकयभ ् Painful lesions sudden onset of putrefaction/cracking आर् ु अवदयणभ ् यागभ ् redness/congestion of lesion and surrounding area रोभपऩ祍जयभ ् tawny brownish coloured hairs

ED-4.2.4-भर्णडरकु ्/कपजकु ्-कु ( skin affliction) with lesions resembling maNDala (circular skin) lesions

न्स्नग्ध् smooth/unctuous /oily appearing skin ldesions Heaviness over the lesion or surrounding skin गु셁 उत्सेध् Raised lesion (papule/patch) क्ष्णऩमातत् glossy margins of lesion न्स्थयऩमातत् Hard/rigid margins ऩीतऩमातत् yellowish margins whitish appearance or hue र्ुक्तरावबासी यक्तावबासी reddish appearance or hue Lesion covered with whitish hairs र्ुक्तरयोभयाजीसततत्

excessive/copious discharge फहुस्राव् फहरस्राव् profuse discharge पऩन्楍छरस्राव् slimy discharge excessive moistness/saddening फहुक्तरेद् excessive itching फहुकर्णडू excess worms फहुकृ म्रभ् सक्तगतत् slow spread slow onset सक्तसभुत्थान् सक्तबेदी slow onset of complications/rupture

ED-4.2.5: ऋष्मन्जह्वक् - कु ( skin affliction) with lesions resembling tongue of RuShya type of deer Lesion looks like a tongue of a antelope ऋष्मन्जह्वाकृ तीतन/ऋष्मन्जह्वाप्रकार्् ऩ셁ष् rough/dry lesion अ셁णवणा् slightly reddish coloured appearence फदहयतत्श्माव् Blackish appearance- internal and external नीराबास् bluish tinge to lesion ऩीतावबास् yellowish tinge to lesion तािावबास् coppery hue to the lesion rapid spreading lesion आर्ुगतत् rapid onset आर्ुसभुत्थान् Less/mild itching अ쥍ऩकर्णडु अ쥍ऩक्तरेद् less /mild soddening only Less possibility of worm infestation अ쥍ऩकृ म्रभ excessive burning sensation दाहफहुर् severe splitting type of pain बेदफहुर् excessive pricking pain तनस्तोदफहुर् Lesion having pain as if pierced with bristles र्ूकोऩहतोऩभवेदना उत्सतनभध्म् raised middle part of lesion

thin margins तनुऩमता त् ककार्पऩडकार्चत् covered with rough eruptions दीघाऩरयभर्णडर् large circular patch खय् Rough

ED-4.2.6: ऩुर्णडयीक्कु (skin affliction) with lesions resembling a white lotus

ऩुर्णडयीकस敍कार््/ऩुर्णडयीकऩत्रप्रकार्् Lesion resembling the petals of a ऩुर्णडयीक (lotus) ऩरार्स敍कार्् Lesion resembling ऩरार् flower whitish appearance of lesion र्ुक्तरावबास् यक्तावबास् reddish appearance यक्तऩमातत् reddish margins यक्तयाजीसततत् full of red streaks यक्तम्रसयासततत् associated with reddish veins उत्सेधवन्तत Raised lesion excessive pus discharge फहुऩूम् excess bloody discharge फहुयक्त्

excessive watery discharge फहुरसीका thick pus discharge फहरऩूम् फहरयक्त् thick bloody discharge फहररसीका thick watery discharge itching कर्णडू् Worm infestation कृ म्रभ् दाह् burning sensation ऩाक् inflammation/suppuration rapid spread आर्ुगतत् rapid onset आर्ुसभुत्थन् sudden onset of complications आर्ुबेदद्

ED-4.2.7: म्रसध्भ्-कु (skin affliction) with lesions resembling alAbu (bottle gourd) flower

resembling flowers of a gourd अराफुऩुष्ऩस敍कार्भ ् ऩ셁ष् rough/dry skin lesions अ셁ण् reddish in colour पवर्ीणा broken, shattered appearance of overlying skin Thin appearing skin outside फदहस्तनूतन अतत्न्स्नग्धातन unctuous inside whitish and reddish tinged lesions र्ुक्तरयक्तावबास् Numerous lesions फहूतन अ쥍ऩवेदना mild pain less itching अ쥍ऩकर्णडू अ쥍ऩदाह् less burning sensation less pus discharge अ쥍ऩऩूम् अ쥍ऩरसीका less watery discharge light onset रघुसभुत्थान् अ쥍ऩबेद् less complications less worms अ쥍ऩकृ म्रभ dust on itching घृ ं यज् ककयेत ् दौन्ग्धकऩुष्ऩवत ् resembles दौन्ग्धक flower प्रामेण ऊध्वाकामे स्मात ् usually affects upper part of the body

ED-4.2.8: काकणक्- कु ( skin affliction) with lesions resembling gu~jja (Abrus precatorius) seed

काकणान्ततकावणा्/काकणान्ततकापरस饃र्् Lesion resembling colour of काकणान्ततका सवका ु म्रर敍गसभन्तवत् with symptoms of all the कु अतीवयक्त् dark red in colour dark black in colour अतीवकृ ष्ण् तीव्रदाह् severe burning sensation severe pain तीव्र셁क्

ED-4.3: ऺुद्रकु भ:्

ED-4.3.1: एककु ् कु (skin affliction) with lesions resembling fish scales

अस्वेदनभ ् anhidrosis/lack of sweating broad based भहावस्त/ु भहाश्रमभ ् भत्स्मर्करोऩभभ ् looks like the scales of a fish

ED-4.3.2: चभका ु ् - कु (skin affliction) with lesions resembling elephant’s skin

फहरभ ् large in size हन्स्तचभवा त ् resembling the skin of elephant

खयस्ऩर्भा ् rough on touch

ED-4.3.3-ककदिब् - कु ( skin affliction) with lesions with rough surface and scar like appearance

श्मावं bluish black colour

ककणखयस्ऩर्भा ् rough on touch ऩ셁षभ ् rough/dry 셂ऺभ ् dry itching sensation कर्णडूभत ् blackish discoloration अम्रसतभ ्

ED-4.3.4: पवऩाददका: cracks in palms and soles

Cracks/fissuring in the hands ऩाणणस्पु िनभ ् Cracks/fissuring in the feet ऩादस्पु िनभ ् तीव्रवेदनभ/्तीव्रातता् severe pain on the lesion mild itching only भतदकर्णडू याग् redness/congestion पऩिकार्चत् associated with eruptions

ED-4.3.5: अरसककु ्/अरसकु ्- कु (skin affliction) with nodular skin lesions

ED-4.3.6: दद्र-ु कु ्-कु (skin affliction) with lesions elevated pimple like skin lesions

associated with itching sensation कर्णडू् याग् reddish nodules पऩडका papule/eruptions उद्गत भर्णडरभ/् उत्सतनभर्णडरा elevated ring shaped plaque दीघाप्रताना् spreading out दवू ाावत ् resembling दवू ाा, in its character of spread अतसीकु सुभ楍छपव् resembling the flower of अतसी chronic (associated over a long अनुष敍र्गणी period)

ED-4.3.7-चभादर-कु ्

यक्तभ ् Redness of over lying /surrounding skin. Itching कर्णडू् स्पोि् Blister/vesicle formation. 셁जा Pain दरनभ ् Peeling of skin स्ऩर्ाासहत्वभ/् अस्ऩर्सा हभ ् tenderness/inability to tolerate touch ऊषा burning sensation with sweating and restlessness दाह् burning sensation

ED-4.3.8: ऩाभा ( क楍छू ): कु ( skin affliction) with lesions with white, reddish, blackish- brown eruptions

ेत् whitish discoloration of lesion अ셁ण् reddish discoloration of lesion श्माव् bluish black colour of lesion Itching over the lesion कर्णडू् पऩडका papule/eruptions क्तरेद् moistening /saddening of skin 셁जा With pain Minute papular eruptions सूक्ष्भ् especially in the buttocks, hands and elbow प्राम् न्स्पक्तऩाणणकू ऩया े

O-46: पवस्पोिक-कु ् कु (skin affliction) with pustules covered with thin skin

ेताबास् whitish hue of lesion अ셁णाबास् slightly reddish hue of lesion स्पोिा् blisters thin skin तनुत्वच्

ED-4.3.9: र्ता셁-कु ्- कु ( skin affliction) with several ulcerated reddish/ blackish/ brown coloured patches

यक्तभ ् reddish ulcerative lesion श्मावभ ् bluish black colour दाह् lesion associated with burning sensation अतता् pain multiple ulcerative lesion फहुव्रण् broad based स्थूरभूरभ ् क्तरेदाढ्मभ ् excessively moist/wet/discharge जतत्वाढ्मभ ् full of worms प्रामर्् ऩवाजतभ च usually appears on joints

ED-4.3.10: पवचर्चाका- कु (skin affliction) with excessive exudation

Itching कर्णडू् पऩडका Papular eruptions श्मावा blackish discoloration excessive/copious discharge फहुस्रावा रसीकाढ्मा excessive watery discharge

ED-4.3.11: स्थूरा셁ष्क: कु (skin affliction) with hard and thick ulcers on joints broad based स्थूरातन (अ셂ंपष्) at the joints सन्तधष ु (अ셂ंपष्) अततदा셁ण (अ셂ंपष्) severe form कदठन् (अ셂ंपष्) hard eruptions

O-38: यकसा: skin affliction with non- oozing boils

itching कर्णडू् पऩडका र्यीये papule/eruptions in body संस्रावहीना् devoid of discharge

ED-4.4: धातुगतकु ्कु (skin affliction) affecting dhAtu (bodily tissues)

ED-4.4.1-त्वग्गतकु ्--कु (skin affliction) localized in यसधातु (skin)

स्ऩषाहातन् loss of tactile sensation स्वेदनत्वभ ् sweating minimal itching ईर्त ्कर्णडू वैवर्णमभा /् अ敍ग-वैवणभा ् Discolouration of skin 셂ऺबाव्/셂ऺता dryness तोद् pricking pain

ED-4.4.2: यक्तगतकु ्कु (skin affliction) localized in यक्तधातु (blood)

त्वक्-स्वाऩ् numbness at the site योभहषा् horripilation स्वेदाम्रबप्रवतना भ/्स्वेदाततप्रवतना भ/् स्वेद् excessive sweating itching कर्णडू्

putrid suppuration पवऩूमक् oedema मथु्

ED-4.4.3: भांसगतकु ्-कु (skin affliction) localized in भांसधातु (muscle)

large circular patches फाहु쥍मभ ् वक्तत्रर्ोष् dryness of mouth काका श्मभ ् roughness पऩडकोद्गभ् appearance of eruptions तोद् pricking pain स्पोिा् blisters न्स्थयत्वभ ् fixity ऩार्णमार्श्रतस्पोिा् blisters on palms ऩादार्श्रतस्पोिा् blisters on sole discharge, secretion at joint सन्तधष ु अर्धकं क्तरेद् places

ED-4.4.4: भेदगतकु ्कु (skin affliction) localized in भेदोधातु (adipose tissue)

दौगता ध्मभ ् bad odour उऩदेह् rheum pus formation ऩूम् करम्रभसंबव् production of maggots गात्राणां बेदनभ ् breaking pain in body कौर्णमभ ् falling off of the fingers and toes गततऺम् restricted movements of the limbs अ敍गानां दरनभ ् putrifaction संबेद् tearing sensation ऺतसऩणा भ ् spreading of the lesions ED-4.4.5: अन्स्थगतकु ् कु (skin affliction) localized in अन्स्थधातु (osseus tissue)

नासाब敍ग् depression of nasal bridge अक्षऺयाग्/नेत्रयाग् redness in the eyes production of maggots in the करम्रभसंबव् (ऺतेषु ) lesion स्वयोऩघात् loss of speech स्वयऺम् diminution of voice/loss of voice

ED-4.4.6: भ煍जागतकु ्कु (skin affliction) localized in भ煍जाधातु (bone marrow)

नासाब敍ग् depression of nasal bridge अक्षऺयाग् redness in the eyes production of maggots in the करम्रभसंबव् (ऺतेषु ) lesion स्वयोऩघात् loss of speech स्वयऺम् diminution of voice/loss of voice

ED-4.4.7: र्ुरगतकु ्कु (skin affliction) localized in र्ुरधातु (seminal tissue)

कौर्णमभ ् falling off of the fingers and toes गततऺम् restricted movements of the limbs अ敍गानां सम्बेद् tearing sensation of the limbs ऺतसऩणा भ ् spreading of the lesions clinical features mentioned as प्रागुक्तरऺणातन above/earlier दायाफाधनभ ् affliction to spouse अऩत्मफाधनभ/् अऩत्मं बवतत affliction to progeny कु पतभ ्

ED-4.5: असाध्मकु ्irremediable कु (skin affliction) clinical features of all types सवम्रा रगं ैमुता त्वभ ् of दोष अफरत्वभ ् lack of strength

thirst तष्ृ णा दाह् burning sensation र्ाततान्ग्न् loss of digestive power affected with worms जततुजग्धभ ् सवादोषो쥍फणता predominance of all three दोष associated with fatal signs रयोक्तरऺणमुक्तभ ् अन्स्थसभाश्रमभ ् involving अन्स्थ धातु भ煍जासभाश्रमभ ् involving भ煍जा धातु र्ुरसभाश्रमभ ् involving र्ुर धातु

ED-4.6: कु -उऩद्रव्complications of कु (skin affliction)

प्रस्रवणभ ् discharge अंगबेद् cracking of skin/body parts अंगावमवानां ऩतनभ ् suppuration, falling of body parts thirst तष्ृ णा 煍वय् fever अततसाय् diarrhoea दाह् burning sensation दौफ쥍ा मभ ् weakness अयोचक् tastelessness अपवऩाक् indigestion

ED-4.7: कु -अरय् fatal signs of कु (skin affliction)

ED-5 न्त्र्/ककरास् कु ( skin affliction) with morbid white patches on skin (i.e. vitiligo)

अऩरयस्रावी not having discharge केवरत्वग्गतत्वभ affecting only the skin

ED-5.1: वाततक-न्त्र्/ककरास् न्त्र (leucoderma) due to vitiated वात

भर्णडरभ ् circular patches अ셁णभ ् slightly reddish coloured ऩ셁षभ ् rough/dry ऩरयध्वंम्रस ruining 셂ऺभ ् dry

ED-5.2: ऩैपतक-न्त्र्/ककरास् न्त्र (leucoderma) due to vitiated पऩत

ऩऩत्रप्रतीकार्भ/् कभरऩत्रवत ् like the petals of a lotus सऩरयदाह् burning sensation

ताि् copper coloured दाह् burning sensation योभपवध्वंसनभ ् loss of hairs

ED-5.3: कपजन्त्र्/ककरास् न्त्र (leucoderma) due to vitiated कप

ेत् whitish discoloration न्स्नग्ध् smooth/unctuous /oily फहर् large in size itching कर्णडू् घन् thick and dense lesion heaviness गु셁्

ED-5.4: यक्तजन्त्र्-द셁ण् न्त्र (leucoderma) due to vitiated यक्त

यक्तवणा् red colour

ED-5.5: भांसजन्त्र्-चा셁ण् न्त्र (leucoderma) due to vitiated भांसधातु

तािवणा् coppery colour lesions

ED-5.6: भेदोजन्त्र्-ककरास् न्त्र (leucoderma) due to vitiated भेदोधातु

ेतवणा् white colour lesions

ED-5.7: असाध्मककरास Incurable न्त्र (leucoderma)

सम्फभर्णडरभ ् non overlapping lesions lesions developing on extremities, अततेजातभ ् lips etc. यक्तयोभ् in which the terminal hairs are red अन्ग्नदग्धजतमन्ववत्रभ ् those which developed after burns

VISARPA

Skin is the largest organ of the body and act as the first barrier of body against all external factors. Skin is affected by external factors as well as internal factors and by innate and adaptive immune responses. Visarpa is a group of potentially life-threatening diseases characterized by cutaneous and mucosal involvement.

Lesions maybe in the form of bullae, vesicles or swelling that rapidly spreads across body tissues and is characterized by often rather acute onset of skin lesions with often severe presentation and rather speedy progression and may often be life threatening. The site, severity, rapidity of onset and spread, extend of dhatu involvement etc decides the prognosis and progression of the disease.

According to Ayurveda the term visarpa has two parts „vi‟ and „sarpa‟ vi stands for vividha sarpa stands for sarpana meaning spreading.

Nidana –

 Aharaja  Viharaja  Agantuja

Samprapthi

 Indulgence in the nidanas leads to vitiation of 3 dosa and rakta, mamsa, twak and lasika with pitta/vata predominance  Rakta plays an important role in this disease as a dhatu and also as a medium of circulating vitiated dosha in the body  Prasara(rapid) occurs with help of rasa and rakta  Dosha- dusya sammurchana leads to sthanasamsraya in bahya or abhyantara rogamarga and produces symptoms as per amshamsa samprapthi.

NIDANA OF VISARPA Type Examples Dosa dushti Others Aharaja nidana RASA रवण- अततसेवन intake of mutra, namkeens, salted nuts, पऩतं दोषस祍चमा sauces, noodles , chips, dried fish, pappads.. कोऩमतत, यक्तं नुफतधं वधामतत Rakta dushti pitta and kapha(proka कु ष्णातत pana, भांसातन, visyandana) Specific प्रगारमतत hetu for कु ातन, पवषं visarpa. वधामतत, र्ोपान ् स्पोिमतत

आम्र अततसेवन Fermented products, pickles, bhelpuri, Pitta Raktadush sour fruit juices, sauces like tomato abhivridhi ti sauce, excess intake of preserved foods, Kapha Mamsa – curd, buttermilk, pickles, lemon juice, vilapayati vidahati vinegar, alcohol, sauce, squashes, cold Shithileek drinks arana - kaya excessive pungent food Pitta- vata rakta किु अततसेवन spicy food, ginger, garlic, asafoetida, prakopa dushti mustard,chutney, momom sauce, chilli badha- vit sauce, Chinese foods, spicy packeted mutra foods , biriyani, grilled non-vegetarian (indirectly foods prepared after marinating in causes spices, further rakta dushti) GUNA sevana उष्णअततसेवन drinking hot water, tea, coffee etc , Pitta Rakta eating food that is excessively hot, use prakopa dushti of salty, pungent , spicy food, using, Prachalita madya, visha, fish rakta prachalata

(may reduce the sanghata of rakta and increases the flow of flowing blood, may increase bleeding.) SPECIFIC ITEMS दर्ध Curd in different forms such as raita, Kapha – Abhisyandi lassi, dahivada, mixed in curry etc pitta(if Kleda especially after heating and in autumn, atyamla) janaka summer and spring seasons dushti Agni vaisamya Special karaka nidana for Rakta kushta & dushti visarpa karaka (ushna, amla) watery part of curd (abhisyandi rakta अम्र भस्तु & amla) kapha dushti,pitta prakopa ..

alcoholic preparations Teekshna, Rata dushti ushna-laghu Raktapitta Kaphaghna karam Pitta र्ुक्त prakopi Alcoholic preparation. Beer etc Vata kara Rakta Pitta dushti prakopi Medo dushti karaka Ushna - सुय amla alcoholic preparation from yava Pittakaraka Amla- ushna सौवीयक Raktadusht

i madya which is spoiled..prepared with Pittadi Raktadusht ingredients that are not good for health tridosha i र्वमाऩतन भ dushti Excessive alcohol consumption Pittadi Rakta Alcohol intake in excessive quantity tridosha prakopaka without heeding prakrti, rtu and physical dushti फहु भ health regularly याग सेवन Sour preparation made with unripe Kapha-pitta Katu-amla- mango with guda swadu- lavana

Rakta dushti ? हरयत र्ाक Regular use of Greenleafy vegetables Ruksha Palak, methi, amaranthus, dhanyaka Raktadusht patra, sigru patra… i karaka Salads prepared from this

पवदादह tridosha raktadushti ककराि Cream Kapha kara Guru Vata samana Ill formed curd Pittakrt Rakta भतदक दर्ध dushti An alcoholic preparation Pitta Rakta र्ार्णडाकक)सतधानं( dushtikara dushti ततर Gingelly Pitta vata Rakta भाष Black gram Kapha pitta Rakta Horse gram Pitta vata कु रत्थ तैर सेवन Intake of oils Kapha vata Agni dushti vaisamya Food prepared from grinded rice, black Kapha, pitta Rakta gram etc like dosha, idli, vada dushtikarak dushti पऩाहाय a Flesh of domesticated animals like ग्राम्म भांस chicken, duck Flesh of animals living in anupa region आनूऩ भांस औदक भांस Flesh of water living animals garlic Vata pitta Rakta रर्ून dushti

Intake of heavy to digest food soon after 3 dosha Agni recovery from disease dushti vaisamya. Rasa rakta dhatu र्वमार्धऺीणे गुवता न dushti Intake of amla food(with curd, juices Pitta kapha Rakta र्वमार्धऺीणे अम्र etc) while tired with disease dushti dushti Intake of unctuous food while person is 3 dosha Rasa dhatu र्वमार्धऺीणे न्स्नग्ध recovering or still fatigued with disease dushti dushti Intake of cold food while fatigued by Kapha vata Agni र्वमार्धऺीणेर्ीतरा disease dushti vaisamya हाय Heavy food after exertion Vata, pitta Agni कभाऺीणस्म गुवता न dushti vaisamya Amla rasa food after heavy exertion Pitta vata Agni कभाऺीणस्म अम्र dushti vaisamya कभाऺीणस्म Intake of unctuous food after exertion Vata di Agni dosha dushti vaisamya न्स्नग्धाहाय कभाऺीणस्म Intake of cold food after exertion Kapha pitta Agni prakopa vaisamya र्ीतराहाय Intake of heavy food after fasting 3 Agni doshotklesh vaisamya उऩवासऺीणे गुवता न a उऩवासऺीणेाम्राहा Intake of amla rasa ahara after fasting Doshotklesh Agni a karaka vaisamya य Intake of unctuous food after fasting Ama janaka, Agni उऩवासऺीणेन्स्न 3 dosha vaisamya ग्धाहाय dushti karaka Intake of cold food after fasting Vata – Agni उऩवासऺीणे kapha dushti mandyakar र्ीतराहाय a Vata pitta Rakta dushti dushti तीक्ष्णाहाय karaka Intake of excess quantity of water when Vata kapha Agni the person is tired/after exercise/ after dushti vaisamya अम्फ ु अततभात्र fasting Pitta dushti Mud, stones etc, pica (roughens the 3 dosha Agni srotases and obstructs the srotases and dushti vaisamya भतृ ् impairs digestion.

Dried mamsa intake Vata dushti व쥍रूय Intake of excessive hot food or food Pitta dushti Rakta which is having ushna virya like karaka dushti उष्णाहाय maricha, red chilly, ginger Intake of rough food such as oats, Vata Agni 셂ऺ आहाय biscuits, namkeen etc dushti Pittja visarpa, kaphaja visarpa Pitta Rakta prakopa, dushti kapha अम्रार्न utklesha Cause only for kaphaja visarpa Kapha Rasa dushti, agni स्वाद ु vaisamya Cause only for kaphaja visarpa Kapha Rasa dushti, agni न्स्नग्ध vaisamya Cause only for kaphaja visarpa Kapha Rasa dushti agni गु셁 vaisamya

असम्मक आहाय पवर्ध Food which has started decaying (with Vatadi Agni excessive kleda) tridosha vaisamya Food kept overnight dushti karaka Rakta rasa प्रन्क्तरतन बोजन dushti Food that is not conducive to the prakrti, Vatadi Rasa rakta desha or kala of the person tridosha dushti असात्म्म बोजन dushti पव셁 बोजन Intake of food while previous food has Doshotklesa Rasa, rakta अजीणा बोजन not been properly digested (3 dosha) Excessive intake of food without due Tridosha Rasa, rakta अध्मर्न consideration to agni dushti Excessive food intake while fatigued Tridosha Rasa rakta र्वमार्धऺीणे with disease dushti agni अततभात्राहाय vaisamya Excessive food intake while fatigued Tridosha Rasa rakta कभाऺीनस्म after exertion dushti agni अततभत्राहाय vaisamya Excessive food intake after fasting Tridosha Rasa rakta उऩवासऺीणे dushti agni

अततभात्राहाय vaisamya

Day sleep Kapha – Rasa dushti ददवास्वप्न pitta dushti Excessive sun Pitta vata rakta घभााततसेवन dushti dushti Excessive exertion Vata कभाततसेवन prakopa Excessive indulgence in coitus Vata अततभैथुन prakopa Excessive walking Vata ऩदे अततगभन prakopa Excessive jolting due to travelling in Vata मान ऺोब vehicles prakopa Skipping sleep at night Vata जागयण prakopa Abhyantara visarpa Vatadi Rakta tridosha dushti वेगानं पवषभप्रवतानं kopa In pittaja visarpa Pitta kopa Rakta उष्णोऩचाय dushti AGANTU ऺत Injury Pitta vata Rakta ऺतफतध Bandaging over injury Pitta vata Rakta प्रऩतन Fall Pitta , vata Rakta पवष Poisons 3 doshas Rakta वात दोष Wind and exposure to winds Vata Abhyantara visarpa 3 dosha Raktadi dusti dhatu भभााघात vitiation अमनानां पवघट्टन Abhyantara visarpa Abhigataja visarpa Vp (3 dosha Rakta अम्रबघात is possible) र्स्त्र楍छेद Abhigataja visarpa 3 doshas rakta र्स्त्र बेद Abhigataja visarpa 3 doshas rakta र्स्त्र ऺत Abhigataja visarpa 3 doshas rakta दहभातनर Abhigataja visarpa Vata kapha

उदध्मतनर Abhigataja visarpa Vata pitta ब쥍रातक यस Abhigataja visarpa 3 dosha Rakta Abhigataja visarpa Pitta vata Rakta कपऩक楍छु र्ुक kapha NIDANARTHAKARA ROGA

त्रत्रष्णाततमोग Vata pitta Rasa rakta

ED-10: पवसऩा् disease charactarized by quick spreading akin to erysipelas/spreading cellulitis Classified into 3 major types based on the rogamarga and site of sthanasamsraya ED-10.1 फाह्याश्रम पवसऩा पवसऩा (erysipelas/spreading cellulitis) affecting र्ाखा: ED-10.2 आभ्मततय पवसऩा : पवसऩा ( erysipelas/spreading cellulitis) affecting आततया (internal organs) ED-10.3 उबमाश्रम-पवसऩा् पवसऩा ( erysipelas/spreading cellulitis) affecting र्ाखा and अततया (internal organs) ED-10.4: वातजपवसऩा् पवसऩा (erysipelas/spreading cellulitis) due to vitiated वात

भ्रभ् giddiness or dizziness

दवथु् burning sensation of eye पऩऩासा thirst तनस्तोद् pricking type of pain र्ूर् severe pain अ敍गभदा् generalised bodyache उेनभ ् cramps कम्ऩ् tremors 煍वय् fever तभक् black outs कास् cough अन्स्थबेद् breaking/splitting type of pain in the bones सन्तधबेद् breaking/splitting pain in joints

अन्स्थपवेषणभ ् feel of loosening in bones सन्तधपवेषणभ ् loosening /dislocation of joints वेऩनभ ् shivering/tremors अयोचकभ ् tastelessness अपवऩाक् indigestion चऺुषो् आकु रत्वभ ् querulous eyes अस्रागभनभ ् bleeding अ敍गेषु पऩऩीम्ररका इव स祍चाय् tingling sensation श्मावाबासर्ोथ् geyish coloured oedema अ셁णाबासर्ोथ् slightly reddish coloured oedema अततभात्रं बेद् excessive tearing sensation अततभात्रं आमाभ् excessive stretching अततभात्रं स敍कोच् excessive contracture अततभात्रं हषा् horripilation अततभात्रं स्पु यणभ ् excessive twitching वात煍वयसभर्वमथा- constitutional features as in वातज fever

ऩक्तवम्रबतने वातव्रणोत्ऩपत् wound/ulcer formation after rupture of ripened (absess)

ED-10.5 : पऩतजपवसऩा् पवसऩा (erysipelas/spreading cellulitis) due to vitiated पऩत

煍वय् fever thirst तष्ृ णा

syncope/attacks of swooning भूछाा भोह् confusion/delirium छददा् vomiting/emesis अयोचक् tastelessness अ敍गबेद् breaking pain in body अततभात्रं स्वेद् excessive perspiration अततदााह् burning sensation inside the body प्रराऩ् excess talking/irrelevant speech/incoherent speech म्रर्यो셁क् headache querulous eyes चऺुषोयाकु रत्वभ ् अस्वप्नभ ् insomnia/sleeplessness अयतत् distress/dicontent/restlessness भ्रभ् giddiness or dizziness र्ीतवारयतषा् अततभात्रभ ् excessive desire for cold water र्ीतवाततषा् अततभात्रभ ् excessive desire for cold air हरयतनेत्रत्वभ ् greenish tint in eyes/excessive icterus green coloured urine हरयतभूत्रत्वभ ् हरयतवचस्ा त्वभ ् greenish tint in stool हरयत셂ऩदर्ना भ ् greenish vision (of patient) हारयद्रनेत्रत्वभ ् yellow coloured eyes yellowish discoluration of urine हारयद्रभूत्रत्वभ ् हारयद्रवचस्ा त्वभ ् excess yellow tint to stool हारयद्र셂ऩदर्ना भ ् yellowish vision (of patient) पवसऩमा ुक्तावकार्स्म ताित्वभ ् pinkish colouration of पवसऩा affected area पवसऩमा ुक्तावकार्स्म हरयतत्वभ ् greenish colouration of पवसऩा affected area पवसऩमा ुक्तावकार्स्म हारयद्रत्वभ ् yellowish colouration of पवसऩा affected area पवसऩमा ुक्तावकार्स्म नीरत्वभ ् bluish colouration of पवसऩा affected area पवसऩमा ुक्तावकार्स्म कृ ष्णत्वभ ् blackish colouration of पवसऩा affected area पवसऩमा ुक्तावकार्स्म यक्तत्वभ ् redness of पवसऩा affected area

उत्सेद् local swelling अततभात्रं दाह् severe burning sensation अततभात्रबेदनभ ् excessive breaking pain eruption with pinkish discharge तािस्रावमुक्तस्पोि् eruption with greenish discharge हरयतस्रावमुक्तस्पोि् eruption with yellowish discharge हारयद्रस्रावमुक्तस्पोि् eruption with blueish discharge नीरस्रावमुक्तस्पोि् eruption with blackish discharge कृ ष्णस्रावमुक्तस्पोि् eruptions with bloody discharge/with bleeding यक्तस्रावमुक्तस्पोि् speedy/quick/swift gait द्रतु गतत् अततरोदहत्(ऩीडका) furuncle with deep red colour पऩत煍वयम्रर敍ग् constitutional features of पऩतज fever ऩक्तवम्रबतने पऩतव्रणोत्ऩपत् पऩत dominant wound formation in ripened and ruptured (abscess)

ED-10.6: कपजपवसऩा् पवसऩा (erysipelas/spreading cellulitis) due to vitiated कप

र्ीतक् chills

र्ीत煍वय् fever with chills गौयवभ ् heaviness तनद्रा sleep ततद्रा drowsiness/lassitude अयोचकभ ् tastelessness sweet taste in mouth भधुयास्मत्वभ ् आस्मोऩरेऩ् sticky feel in mouth तनीपवका sputum/expectoration छददा् vomiting आरस्मभ ् lethargy स्तैम्रभत्मभ ् a sensation of being covered with wet clothes अन्ग्ननार्् loss of अन्ग्न(digestive power) दौफ쥍ा मभ ् weakness affected area of body with swelling over it मथुभान ्अवकार्् affected area of body with pallor over it ऩार्णडु-अवकार्् नाततयक्तावकार्् affected area of body without much redness on it स्नेहान्तवतावकार्् area of body with unctuousness affected area of body with numbness सुप्त्मन्तवतावकार्् स्तम्बान्तवतावकार्् affected area of body with stiffness गौयवान्तवतावकार्् area of body with heaviness अ쥍ऩवेदनावकार्् affected area of body with mild pain eruption which is difficult to ripen कृ 楍रऩाकीस्पोि् र्चयकायीस्पोि्/अर्ीघ्रऩाक् eruption which is late to ripen eruption covered with thick skin फहरत्वगुऩरेऩमुक्तस्पोि् ेतस्पोि् whitish colored eruption blisters with pallor ऩार्णडुस्पोि् प्रम्रबतने ेतभास्राव् whitish discharge after burst (abscess/eruption) प्रम्रबतने पऩन्楍छरभास्राव् sticky discharge after burst (abscess/eruption) fibrous discharge after burst (abscess/eruption) प्रम्रबतने तततुभदाश्राव्

प्रम्रबतने घनभाश्राव् thick discharge after burst (abscess/eruption) clotted discharge after burst (abscess/eruption) प्रम्रबतने अनुफभाश्राव् प्रम्रबतने न्स्नग्धभाश्राव् unctuousdischarge after burst (abscess/eruption) covered with thick and heavy netted appearance in ऊध्वाकामे गु셁न्स्थयजारावतत् upper body ..(ref needed for proper context) covering of thick and unctuous skin न्स्नग्ध-फहुरत्वक् उऩरेऩ् chronic (associated over a long period) अनुषंगी ेतनखभ ् white nails ेतनमनभ ् white eyes ेतवदनभ ् whitish face ेतत्वक् whitish skin whitish urine ेतभूत्रभ ् ेतवचा् whitish stool भतद्सयणभ ् slow (forward) movement अ쥍ऩ셁क् mild pain excessive itching उग्रकर्णडू associated with itching कर्णडूमुत् न्स्नग्ध् smooth/unctuous /oily कप煍वय-सभान셁क् constitutional features (or pain )as in a case of कपज fever ऩक्तवम्रबतने कपव्रणोत्ऩपत् कप dominant wound formation in rippened and ruptured (abscess)

ED-10.7 अन्ग्नपवसऩा् / वातपऩतजपवसऩा् / अन्ग्नदाहज: पवसऩा ( erysipelas/spreading cellulitis) due to vitiated वात and पऩत

छददा् vomiting

अततसाय् diarrhoea syncope/attacks of swooning भू楍छाा दाह् burning sensation भोह् confusion/delirium 煍वय् fever तभक् respiratory distress अयोचक् tastelessness अन्स्थबेद् breaking/splitting type of pain in the bones सन्तधबेद् breaking/splitting pain in joints अगं ायैरयवाकीमभा ानभ ् feels as if burnt with heated charcoal thirst त絍ृ र्ाततांगायप्रकार्भ ्अततयक्तभ ् area becomes as cool down coal as black or red अन्ग्नदग्ध इव स्पोि् blisters as after a thermal burn with quick speed र्ीघ्रगतत-मुत् associated with or progressing towards vital भभाानुसायी points(भभा) ED-10.8 भभागत-अन्ग्नपवसऩभा ् associated with or progressing towards vital भभाानुसायी points(भभा) म्रबनपत अ敍गातन breaks down the organs/tissues संऻा प्रभोहमतत takes away the conciosness or alertness दहक्तकाासौ जनमतत generates hiccups and dyspnoea तनद्रानार्् insomnia disoriented with insomnia प्रभूढसंऻा (तनद्रानार्े सतत) र्वमर्थतचेत् (तनद्रानार्े सतत) disturbed mind with insomnia unhappy and having insomnia न सुख ं उऩरबते ( तनद्रानार्े

सतत) अयततऩयीत् (तनद्रानार्े सतत) severe distress/dicontent/restlessness स्थानादासनं आसनात ् र्य्मां changes positions due to restlessness राततुम्रभ楍छतत falls asleep while caught in complex condition न्क्तरबूतम् आर्ु तनद्रां बजतत दीांगायावकीणवा त ् like burning coal र्ाततांगायाम्रसत् white like burnt coal नीर् bluish यक्त् red/blood accumulates/grows quickly आर् ु चीमते

ED-10.9 ग्रन्तथपवसऩा्/वातकपजपवसऩा् पवसऩा (erysipelas/spreading cellulitis) due to vitiated वात and कप कपार्मे कृ 楍रऩाकी ग्रन्तथभारा a series of slow ripening nodules in कप dominant region a series of nodules associated in region with vessels, म्रसयास्नामुभांसत्वगार्श्रतग्रतथीनां muscles,skin भारा तीव्र셁जा severe pain large/small neolasm/growth स्थूर /अणु ग्रन्तथ elongated/round growth/neoplasm दीघा /वतृ ग्रन्तथ यक्तवणाग्रन्तथ red colored neoplasm/growth 煍वय् fever अततसाय् diarrhoea

कास् cough दहक्तका hiccup ास् breathlessness/difficult breathing र्ोष् dryness/wasting/emaciation भोह् confusion/delirium वैवर्णमभा ् discolouration अयोचक् tastelessness अपवऩाक् indigestion प्रसेक् excessive salivation छददा् vomiting syncope/attacks of swooning भू楍छाा अंगबंग् breaking type of pain in body तनद्रा sleep अयतत् distress/dicontent/restlessness अन्ग्नसदनभ ् diminution of अन्ग्न( digestive power) खयग्रन्तथ् rough nodules भ्रभ् giddiness or dizziness

ED-10.10 कदाभपवसऩा्/पऩतकपजपवसऩा पवसऩा (erysipelas/spreading cellulitis) due to vitiated पऩत and कप

र्ीत煍वय् fever with chills heavyness of head म्रर्योगु셁त्वभ ् दाह् burning sensation स्तैम्रभत्मभ ् a sensation of being covered with wet clothes अ敍गावसाद् fatigue तनद्रा sleep ततद्रा drowsiness/lassitude भोह् confusion/delirium अतनेष् aversion to food प्रराऩ् excess talking/irrelevant speech/incoherent speech अन्ग्ननार््अन्ग्नहातन् loss of अन्ग्न(digestive power) दौफ쥍ा मभ ् weakness अन्स्थबेद्- breaking/splitting type of pain in the bones syncope/attacks of swooning भू楍छाा पऩऩासा thirst स्रोतसां प्ररेऩ् feeling of wrapped of स्रोतस जाड्मभ ्इन्तद्रमाणाभ ् dullness/inactiveness/sluggishness of sense organs प्रामोऩवेर्नभ ् defecation of stools with आभ अगं पवऺेऩणभ ् convulsive movements of body अंगभदा् generalized bodyache अयतत् distress/dicontent/restlessness anxious curiosity औत्सुक्तमभ ् प्राम् आभार्मे पवसऩातत अरसक् predominantly in आभार्म region एकदेर्ग्राही affecting specific organ/region/body part यक्तपऩडकावकीणाावकार््रोदहत area comprised of red nodules ऩीतपऩडकावकीणाावकार््अततऩीत् area comprised of yellowish nodules

area comprised of whitiish nodules ऩार्णडुपऩडकावकीणाावकार््ऩार्णडुय् भेचकाबपऩडकावकीणाावकार्् area comprised of भेचक(as like eyes of peacocks tail or collyrium) nodules कारपऩडकावकीणाावकार्् area comprised of blackish nodules भम्ररनावकार्् misty /unclean area न्स्नग्धावकार्् unctuous area area with excessive heat फहूष्भावकार्् heaviness गु셁 न्स्तम्रभतवेदना heavy and wet feeling with pain oedematous मथुभान ् गम्बीयऩाक् deep seated suppuration तनयास्राव् without any discharge र्ीघ्रक्तरेद् getting moist very quickly न्स्वतनभांसभ ् soft tissue and muscles with sweat न्क्तरतनभांसभ ् soft tissue and muscles with moisture न्स्वतनत्वक् skin with sweat न्क्तरतनत्वक् moist skin ऩूततभांस putrifaction of भांस putrid smell ऩूतत त्वक् रभेणा쥍ऩ셁क gradual mild pain breaks down on touch and feel like muddy, slushy ऩयाभृ ो अवदीमाते कदाभ इव अवऩीडडतो अततयं प्रम楍छतत falls down after suppuration (on pressure) foul smelling n moist soft tissue उऩन्क्तरतनऩूततभांसत्मागी (अवऩीडडते) blood vessels and soft tissue/muscles are visible म्रसयास्नामुसंदर्ी cadaveric smell कू णऩगन्तध् संजाहातन् loss of conciousness dementia स्भतृ तहातन् स्तम्ब् rigidity/stiffness

अयोचक् tastelessness भ्रभ् giddiness or dizziness इन्तद्रमगौयवभ ् dulling of senses आभोऩवेर्न् defecation of stools with आभ गम्बीयऩाक् deep seated suppuration friable to touch as it is sodden स्ऩृ ् न्क्तरतनोऽवदीमाते| ऩ敍कव楍छीणाभांस् appears like mud due to muscles being decayed exposed ligamentstendons and the vascular bundles स्ऩस्नामुम्रसयागण्- र्वगतध् cadaveric smell

ED-10.11 सान्तनऩातजपवसऩा् पवसऩा ( erysipelas/spreading cellulitis) due to all the three vitiated दोष

ED-10.12 ऺतजपवसऩा्: पवसऩा (erysipelas/spreading cellulitis) due to trauma

श्मावर्ोपभ ् grey colored oedema रोदहतर्ोपभ ् red colored oedema 煍वय् fever दाह् burning sensation ऩाकभ ् inflammation/suppuration कु रत्थस饃र्् स्पोि् कु रत्थ seed like vescicles अम्रसतस्पोि् blackish eruptions 셁जा pain

ED-10.13 असाध्म-पवसऩा् irremediable पवसऩा (erysipelas/spreading cellulitis)

भभाागतभ ् that which affects भभा र्ीणभा ांसभ ् withering of भांस withering of sinews र्ीणस्ा नामु र्ीणाम्रसया withering of veins प्रन्क्तरतन् weeping र्वगतध् cadaveric smell

ED-10.14 पवसऩा-उऩद्रव् complications of पवसऩा (erysipelas/spreading cellulitis)

煍वय् fever अततसाय् diarrhea vomiting वभथु त्वक् दयणं breaking and withering of skin भांस दयणं breaking and withering of muscle-tissue क्तरभ् exhaustion without exertion अयोचक् tastelessness अपवऩाक् indigestion

ED-10.15: पवसऩा-अरय् fatal signs of पवसऩा (erysipelas/spreading cellulitis

ICD – O: Kshudra roga

O-1: अन्ग्नयोदहणी(vesicles arising in axilla)

Vesicles with internal burning sensation अततदााह् मुक्त स्पोिा् Vesicles in axilla कऺाबागेषु स्पोिा् 煍वय् fever दीऩावकसन्तनब् स्पोिा्(अग्तमाबा) Vesicles resemble blazing of fire भांस दायण (दा셁ण) स्पोिा् Vesicles burrowing muscle

O-2: अजगन्쥍रका(greengram like papules in children)

ग्रर्थत पऩदिका hard nodular/papular lesions नी셁ज पऩदिका painless nodule nodule of the size of green gram भुद्ग सन्तनब्पऩदिका त्वक सवणा पऩदिका skin coloured nodule न्स्नग्ध पऩदिका waxy/ unctuous lesion O-3: अनुर्मी: (deep rooted abscess in foot)

अ쥍ऩ संयम्ब पऩदिका less inflammed nodules गम्बीय पऩदिका deep routed lesion अतत् प्रऩाक् lesion with tendency to suppurate internally त्वक् सवण ा पऩदिका skin coloured nodule उऩरयन्स्थता् (भस्तकोऩरय) पऩदिका located in scalp/ head

O-4: आतत्रारजी/ आतधारजी(elevated papule)

Lesion with small amount of pus or with less tendency अ쥍ऩ ऩूम मुक्त पऩडका to suppurate

अवक्तत्र पऩडका lesion without punctum उतनत ऩरयभर्णडर पऩडका raised circular lesion घन पऩडका thick and firm lesion lesion resembling unripe fig fruit आभ उदम्ु फय संकार् पऩडका

O-6: अरस्(Interdigital inflammation)

pain in the interdigital areas of feet ऩाद अ敍गु쥍मततया 셁जा

itching in the interdigital areas of feet ऩाद अ敍गु쥍मततया कर्णडु sticky moistness of interdigital areas of feet ऩादअ敍गु쥍मततया क्तरेद्न्क्तरतनता/ burning sensation of interdigital areas of feet ऩाद अ敍गु쥍माततया दाह्

O-7: अ셁ंपषका(eruptions on head having multiple openings)

wet papules on scalp क्तरेद फहुर पऩदिका् /)कऩारे( फहु क्तरेदीतन

scalp lesions with multiple openings कऩारे फहुवक्तत्राणण पऩदिका म्रसाथातनब पऩदिका lesion resembling the size and shape and colour of mustard seed lesion resembling the size and shape of jyotishmati क敍गुतनब पऩदिका seeds (celastrus paniculata)

O-8: इतद्रपवा(Lotus pod lesion)

numerous papular lesions conglomerated to give the ऩकणणका वत)् ऩऩुष्कयवत(् / appearance of lotus flower thalamus भध्मे पऩदिका

O-9: उत्कोठ्(multiple pruritic rashes)

कोठ् सानुफतधस्तु उत्कोठ् कोथ that recur again and again

O-10: कोठ्

यागवन्तत भर्णडर् reddish circular rash multiple circular lesions or rashes फहूतन भर्णडर् lesions associated with excessive itching अततकर्णडू भर्णडर्

O-11: इरयवेन्쥍रका

煍वयान्तवत पऩदिका occurrence of lesion associated with fever

Papular lesion that occur in supra-clavicular region उतभा敍गस्तुजत्रूध्व/ा पऩदिका circular lesion वतृ पऩदिका उग्र셁जा पऩदिका papular lesion associated with severe pain

O-12: कऺा्(Axillary or inguinal abscess)

vesicular lesions in upper arm फाहुप्रदेर्े स्पोिा्

vesicular lesions in and around flanks ऩाेषु स्पोिा् vesicular lesions in peri-axillar regions कऺासतनेषुकऺे स्पोिा् / अंस देर्े स्पोिा् vesicular lesions in shoulder black coloured vesicular lesions कृ ष्ण स्पोिा् सवेदना स्पोिा् painful vesicles

minute papular/vesicular lesions सूक्ष्भा पऩदिका राजोऩभा पऩदिका lesions that appear like राजा (parched paddy) घन पऩदिका lesions that are thick and dense

O-13: क楍छपऩका(Testudinal lesion)

ग्रर्थत् र्ोथ् hard nodular swelling क楍छऩोतनत)र्ोथ्( tortoise shell like swelling which is elevated in the middle

ऩ祍चष絍/ 5 or 6 in number O-14: कदय्(corn / callosity)

कोरवत ्उत्सतन ग्रन्तथ swelling resembling the size and shape of indian jujube (कोर) कीरवत ् उत्सतन ग्रन्तथ् swelling that appear like nail

O-15: कु नख्

खय नख rough appearance and texture of nails अम्रसत नख blackish coloured nails 셂ऺ नख dry nails

FA-2: खम्ररत्मभ/् खरतत (baldness)

O-16: गतधनाभा /गतधभारा: (Solitary large black vesicle)

स्पोि सन्तनब् पऩदिका lesion resembling vesicles

एकं one in number single vesicular lesion in upper arm फाहु देर् े स्पोि सन्तनब् एक पऩदिका अंस देर्े स्पोि सन्तनब् एक single vesicular lesion in the shoulder region पऩदिका ऩाा देर्े स्पोि सन्तनब् एक single vesicular lesion in the flanks पऩदिका

कऺा देर्े स्पोि सन्तनब् एक single vesicular lesion in the axillary region पऩदिका भहती पऩदिका large vesicular swelling राज स饃र् पऩदिका vesicle/lesions resembling parched paddy

O-17: गदाम्रबका

सयक्त पऩडकार्चतभ ् सयाग् / main lesion surrounded by reddish many small lesions पऩदिकार्चता भर्णडराकाय पऩडका rounded eruptions rounded lesions वतृ पऩडका उत्सतन पऩडका elevated lesions 셁जाकयी पऩडका lesions associated with severe pain abundant papular lesions पवऩरु पऩडका

O-19: चभाकीर् (wart)

त्वचो फदह् कीरोऩभभ ् nail like projection from skin surface न्स्थयभ ् fixed projection खयभ ् rough textured projection त्वचो फदह् अर्ा् pile mass like projection from skin surface भषभ्े मततू नततया more elevated than भर् म्रसता whitish projection

अम्रसत blackish projection

O-19.1: वाततक-चभाकीर् projection associated with pricking pain तोद मक्तु कीर्

roughness/dryness ऩा셁ष्म मक्तु ्

O-20: र्चप्मभ ् /अऺता /उऩनख(whitlow) नख वेष्ट्क भांस दाह् burning sensation in lateral wall of eponychium नख वेष्ट्क भांस ऩाक् pus formation in the lateral wall of eponychium intense burning sensation in the area between nails and skin चभ ा नखाततये बर्ृ दाह् underneath the nails intense burning sensation in the area between nails and skin चभ ा नखाततये बर्ृ ऩाक् underneath the nails

煍वय् fever नख भांस 셁क pain over and under nails

O-21: जतभु णण् (birthmark-reddish)

नी셁जं भर्णडर् painless circular lesion

उत्सतन भर्णडर् slightly elevated from skin surface minute lesion सभं )सक्ष्ू भ( ईषत यक्तभर् ोदहतभ ् / भर्णडर् reddish or reddish tinged ऺण smooth textured lesion चभका ीरवत ् appear like चभाकीर सहज present since birth / congenital

O-22: जारगदाब् (non suppurating cellulitis)

भतद पवसऩाण र्ोप् slow spreading swelling

अऩाक र्ोप् swelling with less tendency to suppurate little swelling तन ु र्ोप् ताि वणा र्ोप् copper coloured swelling associated with fever 煍वयकृ त

O-23: ततरक् / ततरकारक(sesamum – eruption)

Black coloured lesion localized on skin surface त्वकस्थ् कृ ष्ण वणा ा

ततरभात्राणण sesame sized lesion नी셁ज् painless lesion त्वक सभ् macular lesion/unelevated from skin

FA-3: दा셁णभ:् (dandruff)

Scalp becomes fissured के र्बम्रू भ् प्रऩा絍मते hard surface (scalp) दा셁ण)के र्बम्रू भ्( itching of scalp कर्णडुय)के र्बम्रू भ्( dryness of scalp 셂ऺ)के र्बम्रू भ्(

O-24: तम楍छ्(Birth mark-bluish)

गात्रदेर्े भर्णडरभ ् circular patches on body भहत ् भर्णडरभ ् large sized patches अ쥍ऩ भर्णडरभ ् small sized patches श्माभ भर्णडरभ ् bluish black coloured patches अम्रसत भर्णडरभ ् blackish coloured patches तन셁जं painless patches

O-26: नीम्ररका(black patch)

Black coloured cicular lesion on body गात्रे कृ ष्णा भर्णडर् Black coloured circular lesion on face भखु े कृ ष्णा भर्णडर् नी셁ज भर्णडर् painless circular lesion thin lesion over body or face तनकु ं

O-28: प्रसतु ्(hypoesthesia)

mild or no itching अ쥍ऩ कर्णडु pale coloured skin त्वक् ऩार्णडुता numbness प्रसुत् रभेण पवचेतना )त्वक( gradual loss of tactile sensation in skin अपवक्तरेद् absence of oozing and moistness

O-29: ऩतनीकर्णिक्(Papules-lotus thorn)

कर्णिकै यार्चतभ ् Thorny projections

circular elevated lesions वतृ भर्णड्रभ ् associated with itching कर्णडूभत ् ऩतनी कर्णिकवत thorny projections that appear like lotus नी셁ज् painless whitish projection ेत्ऩार्णडु

ABB-21: ऩम्ररत्(Premature greying hair)

O-31: ऩाददायी: (Cracked plantar sole)

ऩाद् तर दायण fissuring and cracking of feet

स셁ज् associated with pain

O-33: भषक्(Blackgram-spots)

painless round lesions in the body अवेदना भर्णडर् गात्रषे ु

भाषवत ्भर्णडर् lesion that appear like भाष (black gram) blackish coloured lesion कृ ष्ण भर्णडर् उत्सतन भर्णडर् elevated from the skin surface

O-34: मवप्रख्मा: (barley seed-macule)

ग्रर्थत पऩडका knotted lesions

भांस संर्श्रत पऩडका lesions located in muscle tissue मवाकाय् पऩडका barley shaped lesions (thin rimed thick in the middle) very hard lesions सुकदठन पऩडका

O-35: मुवानपऩडका (भुखदपू षका)( pimples)

र्ा쥍भरी कर्णिकाकाय पऩडका lesion resembling the prickles of silk cotton tree occurs in the face of young people मूनं वक्तत्र े स셁ज् associated with pain घन् thick and dense lesion भेदोगबा् presence of fatty pultaceous material inside the lesion

O-36: यान्जका: mustard seed-eruptions

यान्जका वणा संस्थान प्रभाण papules resembling the shape size and appearance of mustard seed पऩदिका घन पऩदिका lesions that are thick and dense स셁ज पऩदिका associated with pain

O-37: रा祍छनभ(् congenital black /white patch)

black coloured patch कृ ष्णं भर्णडर

म्रसत भर्णडर white coloured patch सभ भर्णडर unelevated patch

O-38: यकसा

itching कर्णडू्

स्रावहीन पऩडका papule without discharge

O-39: 셂ह्या/ इतद्ररु्(aloepecia)

प्र楍मावतत योभाणण fall of hairs अतमेषाभ ् असम्बव् absence of hair regrowth in that area

Manual of clinical proforma for examination of Twak vikara in Ayurveda

A dermatologic history is similar to that in other fields of medicine and includes:

• Chief complaint

• History of present illness (HPI)

• Past medical history (PMH)

• Medications

• Allergies

• Family history

• Health-related behaviours

• Social history

• Review of systems

The examination of skin should include

 Inspection of skin, scalp, hair and nails (as the symptoms manifest in these areas)  Palpation of skin, scalp, hair and nails  Inspection and palpation of mucosa of oral cavity, rectum etc

It should have two aspects.

. Local examination of lesion . Systemic examination of the person to identify whether the condition is caused by dushti in bahya rogamarga or secondary to systemic illness

Diseases can be generally included in any of the following categories if it complies to the following

Kushta :

. The manifestation is almost always dermatological . The onset of the disease may be gradual in most of the cases . The lesions may run a chronic course . There will be remissions and relapses . Direct link can be established between causative factors (ahara/vihara/manasika) with the exacerbations. . Only few conditions are designated as asadhya and fatality is low

Visarpa :

. A disease characterised by manifestation of cutaneous and systemic signs simultaneously

. Rapid onset and rapidly spreading lesion . Fatality is more . Systemic symptoms should also be considered along with dermatological signs and symptoms . Nature of lesion is sopha/granthi/pidaka/sphota

Ksudra roga

. As the name suggests, the etiology and symptoms are minor and doesnot affect the quality of patients life . The severity is less . Often localised and does not spread

I. EXAMINATION OF LESION

1. Externally visible lesions: Present/Absent

The first manifestation of a skin lesion such as kushta and ksudra roga is almost always a skin lesion which may or may not point towards a specific disease. In visarpa, often the systemic symptoms precede or succeed the manifestation of skin symptoms.

If a dermatological manifestation is present, then only it will be included in this context.

2. Type of lesion/स्वबाव्

The type of lesion may be included in this context. Majority of the lesions may follow any of the following pattern

 ग्रन्तथ् / पऩडका / र्ोप् / स्पोि् /भर्णडर / त्वक् स्पु िनभ ् /गर्णड/व्रण/फहर चभा/ के र्बूम्रभ प्रऩािनं / न्त्र /त्वक् वैवर्णमा / ऩाम्ररत्मं / इतद्ररु ं / खय 셂ऺ नख / नख भांस ऩाक / सुत खाम्ररत्म (baldness) /others ग्रन्तथ (nodular eruption that is elevated from skin level)

An example of granthi

ग्रन्तथ(भार)- ग्रन्तथ पवसऩा ( In granthi visarpa, multiple nodular swellings may be visible over the affected area and the speed of onset and spread may be used as an indicator of diagnosis as kaphaja visarpa ) कोरवत ग्रन्तथ – कदय (manifestation of nodular swelling the size of jujube fruit in any area without any systemic implication is diagnostic of kadara ) अणुम्रब: ग्रन्तथ ( ऩाणण/ऩाद)– व쥍भीक( in this context, this feature is characteristic of the disease valmika, where numerous nodular eruptions with minute openings will be observed and may be considered diagnostic )

Multiple nodular swellings with openings

पऩडका

Papular eruptions with excessive discharge pidakavakeerna

Kilopama pidaka avaktra pidaka

Bahuvaktra pidaka Siddhartha sadrsa pidaka (kapale)

Yavakara mamsastha pidaka salmali kantaka sadrsa pidaka ककार् पऩडकार्चतं – ऋश्मन्जह्व (karkasa pidakachita here implies manifestation of numerous rough papular eruption over the affected area ) सयक्त पऩडकार्चतं- पवऩाददक( reddish papular eruptions over the affected area with pain is Characteristic of vipadika) याग पऩडका(कर्णडुर)- दद्र ु (reddish papular eruptions associated with excessive itching over affected area) पऩडका(ेता셁णश्मावा्)- ऩाभा( whitish/slightly reddish/grayish coloured papular eruptions in the affected area)

पऩडक(फहुस्रावमुक्त) – पवचर्चाका(papular eruptions with excessive discharge )

पऩदकावाकीणा- अन्ग्न पवसऩा- (afflicted area covered with popular eruptions) यक्तऩीतऩार्णडुपऩडकावकीण ा अवकार्: - कदाभपवसऩा(the afflicted area covered with numerous eruptions ) उत्सतन पऩडक-गदाम्रबक( pidaka which is much elevated above skin level ) Salmali kantaka ककरोऩभ पऩडक – चभाकीर(nail like eruptions on skin ) अवक्तत्र पऩडक- अतत्रारन्ज(eruption without any opening )

फहुवक्तत्र पऩडक – अ셁ंपषक(eruption with multiple openings) वतृ उग्र셁ज पऩडक- इरयवेन्쥍रक(circular eruptions with intense pain ) कदठन पऩडक(मवाकाय) – मवप्राख्मा (hard barley sized eruption )

र्ा쥍भम्ररकर्णडकाकाय पऩडक – मुवानऩीडडक(hard eruptions which resemble thorn of salmali tree) यान्जका वणा संस्थान प्रभाण पऩदिका-यान्जका(eruptions that appear in colour and size to that of Brassica Juncea) स्रावहीन पऩडका- याकस( papular eruptions without discharge)

ऩक्तवोदम्ु फय सन्तनब पऩडक(पववतृ आनन)-पववतृ ा(eruption which appear like ripe fig and with open surface)

Pakwa udumbara pakwodumbara sankasha pidaka with vivruta anana

ऩकणणाकवत पऩडक- पव-( lesions characterised by multiple eruptions from skin level with space in between)

Pidaka resembling padmakarnika receptacle of lotus(padmakarnika)

पवदायी कतदवत पऩडक- पवदारयका( broad based lesion which appear like tuber of vidari)

Vidari kanda lesion resembling vidari kanda

सूक्ष्भ पऩडक(राजोऩभ) { फाहु/कऺ/अंसदेर्)- कऺ ( numerous small eruptions in the axilla which resembles parched grain(laaja)

Laaja condition with manifestation of numerous eruptions in axilla

स्पोि सन्तनब् पऩदिका(फाहु/अंस/ऩाा/कऺ)- गतधनाभ( blister like eruptions over upper limb/shoulder/side of thorax/axilla)

भर्णडराकाय पऩडका(सयक्त पऩडकार्चतभ)् —गदाम्रबक (circular elevated lesion surrounded by small red eruptions )

Mandala sadrsa vikara surrounded by sarakta pidaka

सूक्ष्भा फहु् पऩदिका(न्स्िक्/ऩाणण/कू ऩया )-ऩाभा( numerous small papular eruption over buttocks/palms/elbow etc)

Numerous small eruptions over buttocks

घन पऩदिका- कऺ (single dense pidaka in axilla)

Solitary lesion in axilla

ग्रर्थत पऩडका(भांस संर्श्रत)- मवप्रख्मा( papular eruption that is deep seated{ the lesion might be fixed to muscle tissue and hence rigid and immovable}) मवाकाय पऩडका- मवप्रख्मा (papule resembling the shape and size of barley)

(भस्तकोऩरय) पऩदिका – अनुर्ातम – elevated lesion on head

स्पोि ( vesicle/bullous eruption )

र्ीघ्रबेदै: स्पोि – वातज पवसऩा( vesicles/bullae that rupture easily is a symptom of vataja visarpa) स्पोि: उऩचीमते र्ोि: - पऩतज पवसऩा( the area afflicted by visarpa will be edematous and might be studded with numerous vesicular/bullous lesions)

फहुरत्वगुऩरेऩमुक्त स्पोि- कपज पवसऩा ( thick walled vesicles )

अन्ग्नदग्द प्रकाय स्पोि – अन्ग्न पवसऩा (

Agni dagda sphota agni dagdha prakara sphota in body

स्पोि (दरतत च मत)् ) – चभादर ( vesicular/bullous lesion that ruptures with exfoliation of skin

(ेता셁णाबासो) स्पोि- पवस्पोि ( vesicle like eruptions which are white or sanguineous color ) क्षऺप्र स्पोि – वषृ ण क楍छु ( Rapid onset of vesicles in the scrotal region) गुदे स्पोि – आदहऩूतना( manifestation of vesicles in the perianal region in children)

सूक्ष्भ स्पोि(फाहु/कऺ/अंसदेर्)- कऺ (numerous minute vesicular eruption over upper limbs/axilla/shoulder ) दीऩावकसन्तनब् स्पोिा्(अग्तमाबा) कऺ देर्े- अन्ग्न योदहणण

Eruptions in the axilla which resembles. Deeptha pavaka burning embers र्ोि – edema उत्सेध(दाह संबेदन ऩयीत) – वातज पवसऩा (area affected by vataja visarpa will be swollen, often associated with burning sensation and intense pain. ) मथभु ान अवकार् ( श्मावा셁णाबास्)- वातज पवसऩा (area affected by vataja visarpa will have blackish or reddish-orange hue ) क楍चऩोतनत र्ोि- क楍छपऩक(swelling which is elevated and like the back of a turtle) स्पोिकै : उऩचीमते र्ोि – पऩतज पवसऩा (swelling studded with vesicles/bullae)

ऩार्णडु न अततयक्त र्ोि – कपज पवसऩा (swelling which is pale or not overly red) भतद पवसऩाण र्ोि(अऩाक) –जारगदाब (swelling which spreads with delay and doesnot undergo suppuration ) मथभु ान ् (गम्बीयऩाको)- कदाभ पवसऩा (swelling with deep and intense suppuration tendency) उत्सेधं(ऩुर्णडयीकदरोऩभभ)् – ऩुर्णडयीक कु ं( elevated lesion with edema and resembles lotus flower in colour)

भर्णडरं

उत्सतन भर्णडरं- भर्णडर कु ं( skin lesion which is circular and elevated from skin level ) उद्गत भर्णडरं- दद्र ु ( elevated circular lesion ) अ셁ण भर्णडरभ-् वाततक-न्त्र्( hypo pigmented lesion with reddish/reddish orange hue ) ऩऩत्रप्रतीकार्भ/् कभरऩत्रवत ्भर्णडरं- ऩैपतक-न्त्र्( hypo pigmented skin lesion which is skin level and resembles the colour of lotus petal) ेत् भर्णडरभ-् कपजन्त्र्(hypo pigmented pale skin lesion )

यक्तवणा् भर्णडरं – यक्तजन्त्र्(reddish coloured hypo pigmented circular lesion) तािवणा् भर्णडरं – भांसजन्त्र्( coppery coloured circular lesion) ेतवणा् भर्णडरं – भेदोजन्त्र्( hypo pigmented pale circular lesion ) सम्फभर्णडरभ ्– असाध्मककरास(overlapping circular lesions )

फहु यागवन्तत भर्णडर्(अतत कर्णडु) – कोठ( multiple reddish circular lesions with severe itching) चभाकीरवत उत्सतन भर्णडरं(ईषत यक्त) – जतुभणण ( slightly reddish elevated skin lesion which is similar to charmakeela in its character) गात्रदेर्े भर्णडरभ(् अम्रसत/श्माव)- तम楍छ्( hypo/hyper pigmented patches in body )

तनइ셁जा कृ ष्ण भर्णडर(गात्र/भुख)- नीम्ररक( painless black patches on body and or face) भाषवत ् कृ ष्ण भर्णडर्- भषक(black elevated skin lesion which resembles blackgram in shape and size) त्वक् सभा (कृ ष्ण/म्रसत) भर्णडर – रा祍छनभ(् unelevated black/white patch in skin ) भुख े श्माव भर्णडरभ-् र्वम敍ग्( hyper pigmentation/blackish patches over skin of face)

स्पु िन/ं प्रऩािनं

ऩाणण /ऩाद स्पु िनं – पवऩाददक ( fissuring/flaking and cracking of skin of palms/soles /both) के र्बुम्रभ प्रऩािनं- दा셁णक( cracking and fissuring of scalp ) ऩाद् तर दायण- ऩाददारय( fissuring /cracking of sole )

घृ ं यज: ककयेत –म्रसध्भं( flaking of scales on rubbing )

चभादरनं

चभादरनं- चभादर ( exfoliation of skin)

गर्णड:

यक्तगर्णडै् (कर्णडूमुतै) र्चतं – अरसकं ( covered with reddish bubble like lesions associated with itching )

फहर/ घन त्वक्

हन्स्तचभावत फहर त्वक् – चभा कु ं( thick/keratinized skin which resembles elephant skin in texture) ककण खय त्वक् – ककदिब कु ं( skin which is rough textured like callus) फहर त्वक् उऩरेऩमुक्त स्पोि – कपज पवसऩा( vesicle/bullae with thick crust)

योभ 楍मवनं

योभ प्र楍मावनं – इतद्ररुभ(falling् of hair ) तनरोभ – खाम्ररत्मभ(् baldness/no hair at all)

भत्स्म र्कर संन्तनब – एक कु ं( fish scale like skin lesion )

व्रण

(स्थरू भूरं) फहु व्रण – र्ता셁(multiple broad based ulcers ) घोय व्रण ( स्पोि: एकीबुतात) गुद देर्े – अदहऩूतनक्( blister like lesions which bursts, then coalesces to form ulcers at guda region)

A. संख्मा (Number of characteristic lesions)

: एक / फहु / अनेक /भार 셂ऩेण/ अतम

फहुव्रण – र्ता셁( multiple ulcers will be seen in sataru) ग्रन्तथभार – ग्रन्तथ पवसऩा( numerous nodular lesions which resembles garland) ऩ祍च/ष絍 – क楍छपऩका( 5 or 6 elevated hard lesions ) एक पऩडक – गतधनाभ( single ) सयक्त पऩडकार्चतभ(् covered by numerous reddish papular eruptions)- गदाम्रबका स्पोिकै셁ऩचीमते र्ोि – पऩतज पवसऩा( swelling studded with numerous small eruptions.) अन्ग्नदग्धप्रकायै स्पोिै셁ऩचीमते – अन्ग्न पवसऩा( covered by vesicles and bullae which resembles blisters formed with burn) यक्तऩीतऩार्णडुपऩडकावकीण ा – कदाभ पवसऩा( studded with red/yellow eruptions)

B. स्वबाव(Nature of the lesion ) (any specific feature that may point to a particular disease)

:

ककार् – ऋश्मन्जह्व (karkasha means hard and rough on touch and appearance) अग्तमाब स्पोि(कऺ)- अन्ग्न योदहणण (vesicle which resembles burning ember)

ग्रर्थत पऩदिका(भुद्ग संतनबा)- अजगन्쥍रक(nodular lesion resembling size and shape of green gram) अवक्तत्र घन पऩडका – आतत्रारजी( skin lesion which is dense on palpation and without any opening) ऩकणणका वत/(् ऩऩुष्कयवत)् भध्मे पऩदिका – इतद्रपवा ( papular lesion surrounded by numerous small eruptions) राजोऩभा पऩदिका(कऺे) – कऺा्( lesions resembling the size and shape of parched grain ) ग्रर्थत् र्ोथ् – क楍छपऩका( swelling which is hard and dense ) कोरवत ्उत्सतन ग्रन्तथ – कदय( swelling which resembles jujube fruit in shape and size)

खय 셂ऺ नख – कु नख( rough, hard and dense nail) कीरोऩभभ ्– चभाकीर (( skin lesion which is elevated from skin level and resembling nail in its appearance)

3. स्थान/र्वमात/Distribution of lesion: सवभा 敍गभ/् कपार्मे /म्रसया आर्श्रत/ स्नामुआर्श्रत/ भांसत्वगार्श्रत/ एकदेर्ग्रादह/ ग्रन्तथभारा/ ऊध्वजा त्र/ु न्स्पक्तऩाणणकू ऩया / ऩाणण- ऩाद / ऩाणण/ ऩाद/

के र्बूम्रभ/ नख /नखाततय/अतगु쥍मततय/ फाहु(hands)/सन्क्तथ/ न्स्पक्/ कऺ /कऺासतन देर्षे ु /अंसदेर्/ ऩाा देर् सन्तध/ गात्र देर्/भुखभ/् अतम

4. स्व셂ऩ (Pattern of lesion): This describes the pattern in which the lesion is spread, single lesion, multiple lesions interconnected, entire area covered with numerous skin eruptions.

i. पऩडकावकीणाावकार्् (area covered by numerous small eruptions) ii. ग्रन्तथ भार (a series of nodules arranged like garland) iii. अतम (others)

5. गतत: (Onset of disease):

i. र्ीघ्र (quick onset)/ द्रतु (rapid onset) [onset from seconds to hours) ii. नैवतत र्ीघ्र नैवातत भतद: (neither too slow nor too fast onset- {weeks} ) iii. भतद (slow onset – months ) iv. अतत भतद ( very slow onset- years) v. अतम others Nature of spread Time Dosha Tendency to be disease Sheegra gati Rapid spread within Pitta/p-v/pitta Visarpa (if rapid minutes/ hrs to 1-2 tridosha manifestation of days dermatological and systemic symptoms) Druta gati Rapid spread within Pitta / Vata/vata- Either visarpa or minutes/ hrs to 1-2 pitta/ pitta- kapha pitta pradhana days kushta / p-v ksudra kushta Manda gati Spread will take Kapha/kapha-vata Possibility for weeks/ months kushta is more Neither ati manda/ ati Days to weeks Kapha or kapha tama Kushta vikara / drutha conditions kshudra kushta Chira gati Months or years.

a. द्रतु गतत – it is the character of visarpa, and also in conditions with pitta involvement (pitta/pittavata) उष्णं च मपऩ न साऺाातजनकं तथाऽपऩ 셂ऺसम्फतधादष्ु णं वातं कयोतत

द्रतु गतत – पऩतज पवसऩा र्ीघ्रगतत- अन्ग्न पवसऩा र्ीघ्रक्तरेद्- अन्ग्न पवसऩा b. भतदसयणं

भतदसयणं – कपज पवसऩा भतद पवसऩाण र्ोप् -जारगदाब् The onset of symptoms can be rapid or chronic. The speed of onset of symptoms and the speed of spread of the symptoms and also the onset of complications has been explained by acharyas in the context of various diseases.

It can be observed that drutagati (rapid onset of symptoms, rapid spread and rapid onset of complications such as suppuration, ulceration, gangrene etc) is mainly seen with conditions involving

 Pitta dosha /vata- pitta/pitta-rakta

Mandagati can be considered in conditions with kapha predominance

 Kapha/vata-kapha/pitta kapha

However the gati may be affected by other conditions such as patient‟s prakrti, sahaja bala & samhanana, extend of vitiation of dhatus, vayas, satwa, nature and duration of nidana , and other samprapthi ghatakas

सभुत्थान/onset-

आर्ु सभुथान – वाततक कु ं,पऩतज कु ं,ऋश्मन्जह्व,ऩुर्णडयीक( pitta kapha) Rapid onset of skin conditions is seen with pitta/vata/vp/pk(not common) अनार्ुगभ ्– कपज कु ं

When the doshas are not vitiated enough to spread rapidly, or when samprapthi ghatakasa are not strong enough to produce tivra gati, or due to chira swabhava of kapha, the lesion may spread slowly c. आर् ु अवदयणभ ्– ऋश्मन्जह्व d.आर् ु बेदद –ऩुर्णडयीकं

6. पवसऩाण: ( Speed of spread): once the disease manifests, the spread of lesion may be assessed to analyse the doshic status and extend of spread of disease. when the onset is druta, the possibility of the skin condition to be visarpa is more.

i. र्ीघ्र (quick onset)/ द्रतु (rapid onset) [onset from seconds to hours) ii. नैवतत र्ीघ्र नैवातत भतद: (neither too slow nor too fast onset- {weeks} ) iii. भतद (slow onset – months ) अतत भतद ( very slow onset- years) iv. अतम others 7. स्पोिात्व्रणोत्ऩपत (speed of rupture of sphota to form vrana) – In certain conditions, the disease includes the bhedas stage where there might be rupture of sphota/sotha/pidaka to form ulcers or so. In this case also, dosha assessment should be done. i. आर्ु (quick rupture of sphota to form vrana) ii. भतद (slow rupture of sphota to form vrana) iii. कृ 楍र (very difficult to rupture or hardly rupture)

iv. अतम (others) 8. र्चयकारयता (Chronicity of disease) : kushta is by nature chirakari except few, while visarpa is not. Kshudra roga may not be chronic and severe as the name itself suggests i. अर्चय न्स्थर्थ(acute) ii. र्चय न्स्थतत (chronic) iii. अनुष敍गी(associated over a long period without symptomatic relief in response to treatment ) iv. ऩुनयावतत ा ( recurrence) अनुष敍गी – दद्र,ु कपज पवसऩा (the term anushangi conveys that the lesions may carry a chronic course.Chronicity may also imply association with kapha dosha ) व्रणानाभ ् र्चयन्स्थतत – कु ऩूव셁ा ऩ (in kushta purvarupa, vrana takes time to heal and also may remain for a long time because of existent rakta dushti, vitiation of twak (in sukshma level)

9. दा셁णत्व (Severity of disease) i. भदृ ु (mild ) ii. दा셁ण(severe) iii. अ쥍ऩ उऩद्रवमुक्त (associated with less complications/ no systemic symptoms ) iv. फहु उऩद्रव मुक्त(associated with many local and systemic complications) v. अरय मुक्त (associated with fatal symptoms) vi. अतम (others)

कदाभ पवसऩा : said as asadhya (which indirectly indicates its severity) अन्ग्न पवसऩा : ग्रन्तथ पवसऩा :

काकण कु ं : सन्तनऩात पवसऩा/ कु ं(उऩद्रवमुक्त – असाध्म(implies severity) सावधा ातु गत कु ं It should be understood that by nature itself, visarpa is more severe than kushta. Visarpa caused by samsarga and sannipata is much more severe than that of ekadoshaja. Kushta caused by sannipata involvement is more severe. When the dosha dushti in kushta pervades all dhatus it becomes asadhya. Following are the factors that regulate the severity of disease. Multiple dhatu involvement Tridosha involvement

Roga swabhava ( visarpa is more severe) Multiple rogamarga and doshagati Impaired bala Age

The extend and severity of lesions and extend of systemic symptoms can be combined to assess the prognosis of the disease.

10. फाह्य स्व셂ऩ (Morphology of Lesion) a. 셂ऩ सा饃श्म:(Morphological resemblance ) Morphological resemblance means the resemblance of the lesion to any known comparable object and is explained as such by acharayas which may help in a direct diagnosis. कऩाराबं- वाततक कु ं( the appearance of lesion is like earthern vessel, wirth depression in the middle and everted edges) कृ ष्ण कऩाम्ररक वणं- वाततक कु ं(lesion resembles that of earthern vessels) उदम्ु फयपराबासं – उदम्ु फय कु ं( the appearence of fruit is similar to that of ripe fig) ऋश्मन्जह्वाकृ तत – ऋश्मन्जह्व कु ं( the appearance of lesion resembles that of antelope tongue (pale grayish blue colour with elevated rough papillae) ऩुर्णडयीक स饃र् - ऩुर्णडयीक कु ं(resembles that of lotus(pinkish petals with red tips) ऩरार् ऩुष्ऩ स饃र्:- ऩुर्णडयीक कु ं( lesion resembles that of palasha pushpa (butea monosperma) which are bright orangish red) अराफु ऩुष्ऩ - म्रसध्भं ( the lesion in sidhma resembles to that of Lagenaria siceraria(alabu) ie, whitish coloured. दौन्ग्धकऩुष्ऩ – म्रसध्भं-(lesion is whiteish in colour like gourd flower) काकणान्ततक- काकणं- (the lesions in kakana resembles that of seed of abrus precatarius with black and reddish colours.) भत्स्म र्कर- एक कु ं- in this, skin lesions resembles the scales on fish. हन्स्तचभा – चभा कु ं- (in this thje lesions will be thick hard and appear like keratinized skin. ) दवु ाावत ्– दद्र(theु spread of lesions will be like durva, ie, spread along adjoining skin) अतसीकु सुभ – दद्र-ु (appears pale bluish white like the colour of flower of atasi[linum usitassimum] दीा敍गायावकीणवा त-् भभागत अन्ग्न पवसऩा (lesion resembles that of red hot embers-orange red) र्ातथा敍गायवत-् भभागत अन्ग्न पवसऩा(appearance is similar to that of cooled ember after burning, ie grayish black)

ऩंकवत ् र्ीणाभांस- कदाभ पवसऩा ( the skin appears withered like sludge and the skin gives way on palpation) कु रत्थ स饃र्- ऺतज पवसऩा ( appear like dolichos biflorus – elevated from skin surface and localized to the area of kshata with brownish colour) दीऩावकसन्तनब् स्पोिा्(अग्तमाबा)- अन्ग्न योदहणण ( bullae that appear like that of burning ember) भद्गु सन्तनब्- अजगन्쥍रका( lesions with size and shape of green gram ) आभ उदम्ु फय सकं ार् पऩडका – आतत्रारन्ज (the lesion will be round and elevated like unripe fig fruit) म्रसाथातनब पऩदिका- अ셁ंपषक( lesions that resember mustard seed on scalp) क敍गतु नब पऩदिका- अ셁ंपषक( lesion resembling kangu(seed of celastrus paniculatus in shape and size on the scalp) ऩकणणका वत/् (ऩऩष्ु कयवत)् भध्मे पऩदिका- इतद्रपवा(resembles that of the thalamus of lotus with numerous thorny projections) कीरवत ्उत्सतन ग्रन्तथ्/ कोरवत ्उत्सतन ग्रन्तथ- कदय्( lesion that is elevated from skn surface with nail like appearance / jujube) त्वचो फदह् कीरोऩभभ-् चभाकीर् – (nail like elongated projection from the surface of skin) चभका ीरवत ्(ईषत यक्तभ ्/रोदहतभ ्) – जतभु णण्( slightly reddish projection from skin surface ) ऩतनी कर्णिकवत – ऩतनीकर्णिक्( lesions resembling thorny projections in lotus, on skin) भाषवत ् भर्णडर्- भषक्( skin lesion which is slightly elevated from skin surface resembling the colour and appearance of black gram) मवाकाय् पऩडका- मवप्रख्मा( skin lesion which is similar to barley) र्ा쥍भरी कर्णिकाकाय पऩडका - मवु ानपऩडका (भखु दपू षका) यान्जका वणा संस्थान प्रभाण पऩदिका- यान्जका(lesions resembling colour, size and shape of rajika – mustard ) व쥍भीकवत ् अणुम्रब्भखु ै्ग्रन्तथ्- व쥍भीक्( lesion characterised by minute numerous opening on the skin surface) पवदायीकतदवत ् वतृ ् पऩडका - पवदारयका( hard elevated lesion which resembles size and shape of pueraria tuberosa) ऩक्तवोदम्ु फय सन्तनबाभ ् – पववतृ ा( lesion resembling ripe fig –open surface and reddish tallow in colour) Others b. ऩरयभाण: (Size of individual lesions)

i. सूक्ष्भं (minute) ii. भहावस्तु (occupying large area) iii. भुद्ग सन्तनब (resembling green gram) iv. स्थरू भूर (occupying large base)

v. भहत (large sized) vi. यान्जकवत ्(resembling mustard seeds) vii. कीरवत ्(resembles nail like projection) viii. कोरवत ्(resembles size and shape of Indian jujube) ix. अतम (others) फहरभ ्– चभा कु ं( thick lesion [thickening of skin]) भहावस्तु /भहाश्रमं –एक कु ं( involving whole of the body or large part of body,which means the character of skin itself is altered.) दीघाप्रतान – दद्र(ु spreading along skin in an elongated manner) स्थरू भूर व्रण – र्ता셁( large based ulcers over joints) सूक्ष्भ पऩडक- ऩाभा( minute eruptions) भद्गु सन्तनब्पऩदिका-अजगन्쥍रका( small sized) फहूतन भर्णडर्-कोठ् – multiple circular lesions वतृ पऩदिका-इरयवेन्쥍रका(circular lesion) सक्ष्ू भा पऩदिका- कऺा्( minute eruptions in kaksha etc) राजोऩभा पऩदिका-कऺा्( lesions resembling parched paddy) भहती पऩदिका- गतधनाभा /गतधभारा (single large vesicular lesion) पवऩरु पऩडका- गदाम्रबका( abundant papular lesions ) भषेभ्मतूतनततया-चभाकीर्( lesion more elevated than mashaka) सूक्ष्भ उत्सतन भर्णडर्-जतुभणण्(minute but slightly elevated lesion ) तनु र्ोप्- जारगदाब्( slight swelling ) ततरभात्राणण- ततरकारक अ쥍ऩ भर्णडरभ-् तम楍छ्(small circular lesion) सूक्ष्भा फहु् पऩदिका-ऩाभा( numerous minute eruptions) भाषवत ्भर्णडर्- भषक्( lesion the size of black gram) यान्जका प्रभाण पऩदिका- यान्जका( lesion the size of black mustard) वतृ ्पऩडका(पवदायीकतदवत)् - पवदारयका( circular large lesion )

c) आकृ तत (Shape of lesion):

i. वतृ ं (round) ii. दीघा (long) iii. अतम (others)

दीघाग्रन्तथ् – ग्रन्तथपवसऩा

वतृ ग्रन्तथ् - ग्रन्तथपवसऩा d) औतनत्मभ ्(level of lesion with that of skin) –

i. त्वक् सभं (at the level of skin) ii. उतनतं (elevated) iii. तनभग्न (depressed) iv. पवषभभ ्(irregularly elevated) v. अतम (others )

दीघा ऩरयभर्णडरं– ऋष्मन्जह्वा

उत्सतन भर्णडरं– दद्र ु उतनत ऩरयभर्णडर पऩडका- आतत्रारजी

फहूतन भर्णडर्- कोठ् वतृ ् पऩडका(पवदायीकतदवत)् - पवदारयका( circular lesion) वतृ पऩदिका- इरयवेन्쥍रका क楍छऩोतनत(र्ोथ्)- क楍छपऩका उत्सतन ग्रन्तथ- कदय

भर्णडराकाय पऩडका/ वतृ पऩडका- गदाम्रबका उत्सतन पऩडका- गदाम्रबका कीरोऩभभ-् चभाकीर

उत्सतन भर्णडर्- जतुभणण् त्वक सभ्- ततरकारक

भहत ् / अ쥍ऩ भर्णडरभ ् (श्माभ/ अम्रसत)- तम楍छ्

गात्रे/ भुखे कृ ष्णा भर्णडर्- नीम्ररका वतृ भर्णड्रभ(् कर्णिकै यार्चतभ)-् ऩतनीकर्णिक् भाषवत ् भर्णडर्(गात्रषे ु)- भषक् e. योग अर्धान आबा/ वणा (colour):

i. ेत (white) ii. ेतावबास: (whitish)

iii. ऩार्णडु (pale or hypopigmented) iv. ऩीत(yellow) v. ऩीताबास: (yellowish) vi. अततऩीत(dark yellow) vii. ईषत यक्त (slightly red) viii. यक्त (red) ix. यक्तावबास(reddish) x. अततयक्त (intense red) xi. नीर(blue) xii. नीरबास(bluish) xiii. हरयतं (green) xiv. हरयद्र वणा(turmeric yellow) xv. ताि(copper coloured) xvi. तािावबस (slight copper coloured) xvii. श्माव: (bluish black) xviii. श्माभ: (dark grey)

xix. कृ ष्ण (black) xx. अततकृ ष्ण (deep black) xxi. भेचकाब- (colour like eye of peacocks feather) xxii. अ셁ण (reddish brown) xxiii. भम्ररन (unclear/ discoloured) xxiv. कऩाराब: (discoloration similar to that of earthen vessels- brownish red) xxv. अतम (others)

र्क्तु रावबाम्रस- कप कु ं यक्तावबाम्रस – कप कु ं, ऩर्णु डयीक कु ं नीराबास: - ऋष्मन्जह्वा

नीरं – पऩतज पवसऩा / अन्ग्न पवसऩा हरयतं - पऩतज पवसऩा हारयद्रं - पऩतज पवसऩा ऩीताबास: - ऋष्मन्जह्वा ऩीत – कदाभ पवसऩं अततऩीत – कदाभ पवसऩं

ऩार्णडु – कपज पवसऩं/ कदाभ पवसऩं तािावबास - ऋष्मन्जह्वा

र्क्तु रावबास: - ऩर्णु डयीक कु ं र्क्तु रयक्तावबास ं – म्रसध्भं अ셁णं – वात कु /ं ऋष्मन्जह्वा / म्रसध्भं / ऩाभा कृ ष्णभ ्- वात कु ं, कऺा्, ततरकारक, नीम्ररका, भषक्, रा祍छनभ,् पऩतज पवसऩं, कऩारवणा/काऩाम्ररका वणं- वात कु ं ताि- पऩत कु ं, जारगदाब् श्माव: - ऋष्मन्जह्वा / ककदिबं/ ऩाभा / र्ता셁: / पवचर्चाक/ र्वम敍ग् यक्तं – चभादर / र्ता셁: / पऩतज पवसऩा / अन्ग्नपवसऩा / ग्रन्तथ पवसऩा / कदाभ पवसऩा ेतं – ऩाभा, ऩतनीकर्णिक् अतीवयक्त: - काकणं

अतीव कृ ष्ण - काकणं त्वक सवणा – अजगन्쥍रका, अनर्ु मी, कपज-चभाकीर्, अम्रसत- कु नख्/अन्ग्नपवसेऩा/ऺतज पवसऩा म्रसता / अम्रसत – चभाकीर्, रा祍छनभ ्

ईषत यक्तभ/् रोदहतभ-् जतभु णण् श्माभ/ अम्रसत- तम楍छ् रोदहतं – कदाभ पवसऩा अतत रोदहतं – पऩतज पवसऩा

भेचकाब - कदाभ पवसऩं कार - कदाभ पवसऩं वैवर्णमं – ग्रन्तथपवसऩा त्वक् वण ा – in some lesions, the colour is not changed. अतत् श्मावं- ऋष्मन्जह्वं

Avabhasa indicates the variations of colour( dominant wavelength of colour irrespective of intensity) and varna represents the gross colour of the lesion.

f. याग/ Redness - presence of redness would indicate the role of pitta and rakta in the samprapthi.

g. संताऩभ/् फहु ऊष्भा: elevated temperature on the lesion which is ascertained by palpation and by interrogation.

Santapa is a symptom felt by the patient(might express it as a sensation of burning or stifling in the area of lesion) and examined by the physician by palpation as elevated temperature . It is due to pitta involvement.

फहु ऊष्भा said in the context of kardama visarpa indicates elevated temperature within the lesion which is a sign and symptom and can be explained as a feeling of excess heat emanating from the lesion

h. पवसतृ त (Symmetry)

i. सभ पवसतृ त (symmetrical) ii. पवषभ पवसतृ त (asymmetrical) iii. अतम (others)

i. स्ऩर्ोऩरब्धता (Feel on touch)

i. तन ु (thin) ii. 셂ऺं (dry) iii. ऩ셁षं (coarse) iv. खयं (rough) v. कदठनं (hard and thick) vi. न्स्नग्धं (unctuous) vii. ऺण (smooth) viii. न्स्थयं (static/ immobile) ix. न्स्नग्ध–अवकार्( lesion and surrounding area is unctuous) x. 셂ऺ अवकार् ( lesion and surrounding area is rough) xi. (अतम (others)

xii. स्ऩृ ्न्क्तरतनोऽवदीमता े (friable to touch as it is sodden) xiii. साधायणभ ्( no change with that of surrounding skin) xiv. अवऩीडडतोऽततयं प्रम楍छतत (on palpation with finger, the skin squelches and goes inside) xv. अतम (others) Skin is the seat of vata and the manifestation of khara a, parusha etc helps us to understand the anubandha dosha in this type of condition.  अततर्रऺण – कु ऩूव셁ा ऩ  अततखय स्ऩर्ा- कु ऩूव셁ा ऩ  셂ऺ: - वात कु ं, कीदिबं  ऩ셁ष - वात कु ं, ऋष्मन्जह्वं, म्रसध्भं, कीदिबं  तनु – वात कु ं  न्स्नग्ध: - कपकु  खय: - ऋष्मन्जह्वं, चभा कु ं  फदहस्तनूतन- म्रसध्भं  अतत: न्स्नग्ध:- म्रसध्भं  ककणखय स्ऩर्भा ्– कीदिबं

 कदठन:- स्थरू ा셁ष्क: Normal skin is soft, slightly unctuous and supple. Normal appearance of skin occurs when there is equilibrium of all doshas in the skin. The appearance of the lesion is to understood both by darshana and sparshana pareeksha. Snigdha appearance is because of kaphadika dosha and ruksha/khara/parusha are because of vata predominance. Mridutwam of lesions when compared with surrounding skin is because of pitta involvement. Identification of associated dosha is necessary to understand the doshic predominance in twak vikara.

셂ऺ sparsha indicates rough and dry appearance of skin on touch and also on visual inspection. Rookshata is specifically a character of vata dosha Parusha twak means skin which is rough and coarse to touch. It is also predominantly vata, but with mild kapha anubandha Khara should be assessed as due to vata-kapha predominance and ought to be understood as rough and hard to touch (roughness due to vata and hardened skin due to kapha ), which is similar to condition of hyperkeratosis.

Katina indicates kapha – vata predominance which is produced as a result of thickening of skin by kapha and reduced unctuousness leading to dryness and roughness by vata. It can be likened to the condition of lichenification Snigdhata to skin is induced by kapha.In conditions of kapha prakopoa there will be increased unctuousness giving the skin a waxy or shiny appearance. Kinakhara sparsha in kitibha can also be understood as due to kapha- vata involvement . Rooksha  parusha  khara katina Vata v+k v+k2+ v+ k 3+ j. अतमोतम संसक्त (coalescence of lesions): anyonya samsakta is the feature seen in mandala kushta which is a kaphadika kushta. k. घषाण ऩयीऺा((Exfoliation of skin on scratching/ rubbing) l. म्रसयास्नामु दर्ानभ ् (visible veins and tendons)

11. ऩमातत ऩयीऺा (Margins of lesion: the margin represents the outermost rim of the lesion from where the normal skin starts) a) दर्ान ऩयीऺा: (On observation):

i. उतनतं(elevated) ii. तनम्नं(depressed) iii. सभं(uniform/ regular) iv. पवषभं (irregular)

v. उतृ फदह (protruded outside) vi. अतम (others)

 खयऩमातत: - कऩारकु ं  तन-ू कऩारकु ं

 उतृ फदह- कऩारकु ं  क्ष्णऩमातत- भर्णडरकु ं  न्स्थयऩमातत- भर्णडरकु ं  ऩीतऩमातत- भर्णडरकु ं  तनऩु मता त – ऋष्मन्जह्व  यक्तऩमातत- ऩर्णु डयीककु ं

b) स्ऩर्ना ् ऩयीऺा(On touch):

i. तनु (thin) ii. 셂ऺं (dry) iii. ऩ셁षं(rough) iv. खयं(rough) v. कदठनं(hard) vi. न्स्नग्धं(unctuous) vii. ऺण(smooth)/ viii. न्स्थयं(immobile) ix. साधायणभ(normal)

x. अतम (others) c) वणा ऩयीऺा: / Colour

i. ेत (white) ii. ेतावबास: (whitish)

iii. ऩार्णडु (pale or hypopigmented) iv. ऩीत(yellow) v. ऩीताबास: (yellowish) vi. अततऩीत(dark yellow) vii. ईषत यक्त (slightly red) viii. यक्त (red) ix. यक्तावबास(reddish) x. अततयक्त (intense red) xi. नीर(blue) xii. नीरबास(bluish) xiii. हरयतं (green) xiv. हरयद्र वणा(turmeric yellow)

xv. ताि(copper coloured) xvi. तािावबस (slight copper coloured) xvii. श्माव: (bluish black) xviii. श्माभ: (dark grey)

xix. कृ ष्ण (black) xx. अततकृ ष्ण (deep black) xxi. भेचकाब- (colour like eye of peacocks feather) xxii. अ셁ण (reddish brown) xxiii. भम्ररन (unclear/ discoloured) xxiv. कऩाराब: (discoloration similar to that of earthen vessels- brownish red) xxv. अतम (others)

Aruna varna, shyava varna, shyama varna and kala/ varna is characteristic of vata predominant conditions Rakta- haridra-harita-neela- peeta varna is characteristic of pitta predominant conditions) mainly White coloured or creamy white colour is characteristic of kaphaja visarpa Dual combinations of colour may also be evident in samsargaja conditions. d) भध्म बाग ऩयीऺा (Middle part of lesion):

i. सभं(regular/uniform) ii. उतनतं (elevated) iii. तनम्नं(depressed) iv. अतम (others)

 उत्सतनभध्मा- ऋष्मन्जह्व

12. प्रत्मात्भ रऺण / पवम्रर् रऺण (cardinal signs) : In this context, any symptom that has helped you in diagnosis ought to be considered and written. For eg:

भम्ररनावकार््(musty /unclean/sloughy appearence) - कदाभपवसऩा्

अतमोतमसंसक्तं - lesions fused with each other - भर्णडरकु ं घृ ं यज: पवभु祍चतत (exfoliation of scaly or powdery skin on scratching)- म्रसध्भं

ऩयाभृ ोऽवदीमता े (skin breaks down on touch and feel like muddy slush)- कदाभपवसऩा ऩूततभांसत्मागी - gangrene/necrosis of putrefied tissue- कदाभपवसऩा्

13. ऩरयत् त्वच स्वबाव: (Character of surrounding skin)

i. प्रन्क्तरतन्(association of क्तरेद, excessively moist or sodden appearence) ii. न्स्नग्ध (unctuous)

iii. मथ ु (swelling/edema in the surrounding area) iv. स्तम्ब् (rigid) v. गौयवभ ्(heaviness )

vi. गु셁न्स्थयजाराततह् (appearing as if covered with thick and heavy netted capillary network) vii. कोथ: (necrosis or putrefaction) viii. 셃पषत रोभार्चत(horripilation) ix. 셂ऺ (dryness)

x. सुत (hypoesthesia) xi. पऩडकार्चतं (studded with numerous papular eruptions)

xii. तनु त्वक् (thin skin) xiii. ऩ셁ष त्वक् (rough skin) xiv. रोभ楍मवनं( loss/ fall of hair) xv. म्रसयाजार (covered with vascular plexus/capillary network/visible vascularity) xvi. अततस्वेद (excessive sweating) xvii. अस्वेद (absence of sweating) xviii. त्वक् दरनं (peeling of skin) xix. र्ातता敍गायप्रकार्: - skin appearing like burnt charcoal xx. अन्ग्नदग्धप्रकायै स्पोिै셁ऩचीमते : studded with burn like vesicular lesions

xxi. ऩूतत भांस (putrid flesh) xxii. ऩूतत त्वक् (putrid skin) xxiii. त्वच: प्रभाण वैऩमाम (Change in thickness from that of surrounding areas)

xxiv. अतम (others)  प्रन्क्तरतन– असाध्म पवसऩा  न्स्नग्ध– कपज पवसऩा  मथु - कपज पवसऩा  स्तम्ब: - कपज पवसऩा  सुतयवकार्: - कपज पवसऩा  गौयवभ ् - कपज पवसऩा  गु셁न्स्थय जारातत: कपज पवसऩा  मथुभान ् अवकार्:- वातज पवसऩा  तनुम्रब: स्पोिकै : उऩचीमते - वातज पवसऩा  मन्स्भंावकार्े पवसऩोऽनुसऩता त सोऽवकार्स्तािहरयतहारयद्रनीरकृ ष्णयक्ताना ं वणाानाभतमतभं ऩुष्मतत:- वातज पवसऩा

 स्पोिकै셁ऩचीमते अवकार््-(तािहरयतहारयद्रनीरकृ ष्णयक्ताना)ं - पऩतज पवसऩा  उत्सेधैाततभात्रं – पऩतज पवसऩा  मथुभान ् अवकार्: - कपज पवसऩा

 फहुरत्वगुऩरेऩै्स्पोि: (ेत/ऩार्णडु)- कपज पवसऩा  गु셁म्रब् न्स्थयैजाारावततै्- कपज पवसऩा  अन्ग्नदग्धप्रकायै स्पोिै셁ऩचीमते – अन्ग्न पवसऩा  र्ातता敍गायप्रकार्ोऽततयक्तो अवकार््- अन्ग्न पवसऩा  मन्स्भंावकार्े पवसऩो पवसऩातत सोऽवकार्ो यक्तऩीतऩार्णडुपऩडकावकीण ा इव- कदाभ पवसऩा  भेचकाब्- कदाभ पवसऩा  न्स्वतनभांसत्वक्- कदाभ पवसऩा  न्क्तरतनभांसत्वक्- कदाभ पवसऩा - कदाभ पवसऩा  ऩूततभांसत्वक्- कदाभ पवसऩा  कदाभ इवावऩीडडतोऽततयं प्रम楍छतत- कदाभ पवसऩा

 उऩन्क्तरतनऩूततभांसत्मागी- कदाभ पवसऩा  म्रसयास्नामुसतदर्ी- कदाभ पवसऩा

14. स्राव (Discharge from lesion) :

Srava in kushta is attributed to involvement of pitta. The drava guna of pitta is the guna responsible for this and in some cases association of kapha is also seen. Usually the discharge from lesions may be classified as follows.

 Serous- This type of drainage is plasma that‟s thin, clear and watery.  Sanguineous- fresh blood  Serosanguineous- thin and watery, colour may vary from pink to dark red.  Purulent- generally thick and colour may vary from whitish creamy to yellow or green

Thin and watery discharge (tanu-vishada lasika srava)

Blood discharge (sanguinous discharge/rakta srava )

Ghana puya srava

Shweta picchila srava

Laseekadya (Ghana bhoori laseeka) a) स्राव प्रकाय (Type of srava):

i. जर स्राव (watery discharge) ii. रसीक स्राव (serous discharge ) iii. यक्त स्राव (bloody discharge) iv. ऩूम स्राव (pus discharge) v. ऩूमयक्त स्राव(pus-blood mixed discharge) vi. ऩूमयक्त रसीक स्राव (pus-blood-serous mixed discharge) vii. अतम (others)

Type of srava describes the type of discharge- laseeka srava, puya srava, raktasrava etc.

 फहुफहरऩूम- औदम्ु फय कु ं, ऩुर्णडयीक कु ं ( thick purulent discharge is seen in oudumbara and pundareeka kushta)

 फहुफहरयक्त- औदम्ु फय कु ं, ऩुर्णडयीक कु ं(thick bloody discharge is seen in oudumbara and pundareeka kushta)

 फहुफहररसीका- औदम्ु फय कु ं, ऩुर्णडयीक कु ं( copious serous discharge is seen in oudumbara and pundareeka kushta)

 फहुफहरर्ुक्तर स्राव – भर्णडर कु ं ( thick white discharge is seen in mandala kushta)

 रसीकाढ्मा- पवचर्चाका ( copious serous oozing is seen in vicharchika, which is a chief diagnostic feature of it)  घनबूरयरसीकासकृ ्- ऩुर्णडयीक कु ं( abundant dense discharge of laseeka and blood)  तनुपवर्दस्राव: - वातज पवसऩा ( discharge of clear and thin fluid on rupture of sphota in vataja visarpa)  न्स्नग्धभास्रावं- ेष्भपवसऩा्(unctuous discharge in kaphaja visarpa  तनयास्राव्- कदाभ पवसऩा ( no discharge is seen in kardama visarpa ) Puya srava is character of kapha, pitta or kapha-pitta predominant conditions Shweta srava is seen with kapha Rakta srava is seen with deeper dhatu involvement than the level of twak Clear discharge is seen when there is no involvement of pitta and kapha b. भात्रा (Quantity): अ쥍ऩं /फहरं /अतम (others)

 अ쥍ऩ रम्रसक/यक्त/ऩूम – म्रसध्भ ( in sidma kushta, discharge is not much evident and if present will be in mild quantity)

 फहुस्रुतत - भर्णडर कु ं( discharge in large quantity)  रसीकाढ्मा- पवचर्चाका( thick serous discharge or lesion covered with discharge)  अ쥍ऩ स्राव – वातज पवसऩा ( mild quantity )

 फहर यक्त/रसीक/ऩूम - औदम्ु फय कु ं, ऩुर्णडयीक कु ं (copious discharge of blood/laseeka/pus or mixture of these is seen in oudumbara and pundareeka kushta) The quantity of discharge is dependent on the dosha, extend of spread of doshas( superficial skin lesions may produce clear discharge, deeper may produce sanguinous or serosanguinous discharge. Dhatu paka at twak and mamsa level may produce puya. Usually in vatadhika disorders, there will be rookshata and parushata of skin and scratching produces discharge of clear serous fluid In conditions were vata is vitiated, if discharge is present , it will be of alpa( less quantity) In pittadhika conditions and kaphadika conditions there will be copious discharge. In pittadhika there will be yellowish colour ( harita-haridra-neela-rakta) and in kaphadika conditions, there will be whitish coloured dense discharge. In vata-kapha conditions, the colour of discharge will range from serous (colourless to pinkish red or white and the quantity of discharge will be more than that of pure vata condition but less than kapha-pitta condition. c. वणा (Colour): तािस्राव् /हरयतस्राव्./ हरयद्रस्राव् /नीरस्राव् /कृ ष्णस्राव् /ेतस्राव्/ etc

 अ셁णस्राव – वातज पवसऩा ( orange red discharge is seen in vataja visarpa on rupture of sphota)  ताि वणास्राव – पऩतज पवसऩा ( coppery coloured discharge in pittaja visarpa )  हरयत वणास्राव- पऩतज पवसऩा ( greenish tinged discharge seen in rupture of sphota in pittaja visarpa )  हारयद्र वणास्राव - पऩतज पवसऩा ( turmeric yellow tinged discharge seen in rupture of sphota in pittaja visarpa )  नीर वणास्राव - पऩतज पवसऩा ( bluish coloured discharge seen in rupture of sphota in pittaja visarpa )  कृ ष्ण वणास्राव - पऩतज पवसऩा ( black discharge seen in rupture of sphota in pittaja visarpa )  यक्त वणास्राव- पऩतज पवसऩा (sanguinous discharge seen in rupture of sphota in pittaja visarpa )  स्पोि् प्रम्रबतनस्तु ेत स्राव – कप: पवसऩा (whitish discharge on rupture of sphota is seen in kaphaja visarpa

Aruna varna srava and colourless discharge is characteristic of vataja conditions Rakta- haridra-harita-neela- discharge is characteristic of pitta predominant conditions) White coloured or creamy white coloured discharge is characteristic of kaphaja visarpa Dual combinations of colour may also be evident in samsargaja conditions. d. स्वबाव (Character):

घनस्राव् (प्रम्रबतने) /पऩन्楍छरस्राव् (प्रम्रबतने) /तततुभत-् स्राव्(प्रम्रबतने)/न्स्नग्धस्राव् (प्रम्रबतने)/अनुफभास्राव् (प्रम्रबतने)

 पऩन्楍छरं- कपज पवसऩा ( the discharge that occurs after rupture of sphota in kaphaja visarpa is slimy )  तततुभत ् - कपज पवसऩा(the discharge that presents from kaphaja visarpa will be thready)  अननुफ-ं कपज पवसऩा( thick and coagulated)  न्स्नग्धभास्रावं- ेष्भपवसऩा्( unctuous or oily discharge will be seen in kaphaja visarpa)

 पऩन्楍छरस्राव- भर्णडर कु ं( in mandala kushta, when there is discharge it will be slimy)  तनुपवर्दस्राव: - वातज पवसऩा ( clear and thin discharge is seen in vataja visarpa)  घनबूरयरसीकासक्तस्रावृ - ऩुर्णडयीक कु (ं thick dense discharge of blood or laseeka is seen in pundareeka kushta

 फहर ऩूम/फहु यक्त/फहु रसीक - ऩुर्णडयीक कु ं, औदम्ु फय कु ं The discharge in vatika srava will be tanu( thin) and visada( clear) In pittaja conditions, the discharge will be hot and abundant(as srava is a manifestation due to drava swabhava of pitta dosha) In kaphaja conditions, the discharge will be thick, unctuous, cold, slimy, coagulated

15. र्ोथ (swelling): . a. प्रकाय (Character of swelling)–: ekadesha swelling means doshas are localised only to that area. When there is generalised swelling along with skin manifestation, then a deep underlying pathology such as ubhayashrita visarpa should be considered.

i. एकदेर् (localised over the lesion) ii. सवांग (present in whole body) iii. अतम (others) Swelling is a manifestation in the following:

 उत्सेध – भर्णडरकु भ,् ऩुर्णडयीक कु ं,  मथभु ान ् – वातज पवसऩा , कपज पवसऩा  उत्सेधैाततभात्रं – पऩतज पवसऩा

 मथभु ान ्(गम्बीयऩाक:)- कदाभ पवसऩा  उत्सेध(दाह संबेदन ऩयीत) – वातज पवसऩा (area affected by vataja visarpa will be swollen, often associated with burning sensation and intense pain. )  मथभु ान अवकार् ( श्मावा셁णाबास्)- वातज पवसऩा (area affected by vataja visarpa will have blackish or reddish-orange hue )  क楍चऩोतनत र्ोि- क楍छपऩक(swelling which is elevated and like the back of a turtle)  स्पोिकै : उऩचीमते र्ोि – पऩतज पवसऩा (swelling studded with vesicles/bullae)

 ऩार्णडु न अततयक्त र्ोि – कपज पवसऩा (swelling which is pale or not overly red)  भतद पवसऩाण र्ोि(अऩाक) –जारगदाब (swelling which spreads with delay and doesnot undergo suppuration )  मथभु ान ् (गम्बीयऩाको)- कदाभ पवसऩा (swelling with deep and intense suppuration tendency)  उत्सेधं(ऩुर्णडयीकदरोऩभभ)् – ऩुर्णडयीक कु ं( elevated lesion with edema and resembles lotus flower in colour) Swelling is usually not seen in kushta as a major feature

Swelling is usually seen in visarpa over the entire area affected with visarpa due to the roga swabhava Swelling is a kapha predominant character and when sopha is present it should be understood as having either kapha anubandha or ama anubandha In sopha avastha, its better to opt for langhana or lepana Sopha that undergoes suppuration is due to pitta involvement and that doesnot undergo suppuration should be understood as due to kapha swabhava Sopha that undergoes rapid suppuration is because of pitta/vp involvement The colour of swelling will be consistent with that of anubandha dosha Aruna varna will be seen with vata anubandha Haridra-harita-rakta-nila varna will be seen with pitta anubandha Krishna varna will be seen with pittaanubandha in case of visarpa and otherwise in vatadhika conditions Malina varna or mechakabha varna is seen specifically in kardama visarpa

b. र्ोथवणा: (Colour of swelling) : ऩार्णडु नाततयक्त/यक्त/श्माभ/श्मावर्ोप्/ताि/कृ ष्ण/ अततकृ ष्ण /हरयत/हरयद्रा/ नीर / ऩीत/अ셁ण/अतम (others)

The doshic implication of sotha varna should be assessed from the varna of corresponding dosha.

12.क्तरेदफाहु쥍म(Presence of Kleda / soddened appearance) म्रभ्माहायपवहायेणपवर्ेषेणपवयोर्धना|साधतु नतदावधातमस्वहयणाैसेपवतै्| ऩाप्भम्रब्कभम्रा ब्स्प्राक्तनैवेरयताभरा्|म्रसया्प्रऩततय्मग्ा गास्त्वग्रसीकासगृ ाम्रभषभ|् दषू मतत्थीकृ त्मतनयततस्ततोफदह्| त्वच् कु वन्ा तत वैवर्णमं दु ा् कु भुर्न्तत तत|् प्रऩ धातून ् र्वमाप्मातत् सवना ्संक्तरे चावहेत||् A.S.Ni 14/2-4

Kleda means „ardrata‟ which means moistness which imparts a wet appearance to the lesion. In kushta and visarpa, kleda is produced from drava mala bhava of lasika and rakta generally and even may include mala bhaga of medas due to its samanya swabhava with lasika which produces a soddened wet appearance. Kleda is a kapha pitta predominant bhava

दाहोयाग्ऩरयस्रव्ऩाक्| पवस्रो गतध् क्तरेदस्तथाऽ敍गऩतनं च पऩतकृ तभ||् ३५| च र्च ७/३५

Kleda in the lesion

a) प्रबाव(character ):

i. अ쥍ऩ (small amount) ii. फहु(large amount) iii. न्क्तरतन भांस (putrid flesh ) iv. न्क्तरतन त्वक् (putrid skin) v. अतम (others)

b) स्थान (site) -

c) र्चयकारयता (Speed of onset)

i. आर्ु ii. अनार्ु/र्चय iii. अतम (others)

Kleda is present in the following conditions:

 क्तरेद- ऩुर्णडयीक कु ं, उश्मन्जह्वं(अ. स), ऩाभा :( A. S)

 फहुक्तरेद- भर्णडरकु ं  फहुरक्तरेदं- औदम्ु फय कु ं  अ쥍ऩ क्तरेद- ऋष्मन्जह्व  क्तरेदाढ्मं- र्ता셁:( A. S)  र्ीघ्रक्तरेद्- कदाभ पवसऩा

 न्क्तरतनभांसत्वक् – कदाभपवसऩा्

 अवऩीड्मते उऩन्क्तरतनऩूततभांसत्मागी – कदाभपवसऩा्  क्तरेद् सन्तधषु: -भंसग कु ं

13. कोथ उऩन्स्थतत (Presence of necrosis/Gangrene/Putrefaction)

a. प्रादबु ााव (Onset) i. Sudden (आर्ु) ii. Slow (अनार्ु ) iii. others (अतम ) kotha is a feature in the following conditions as per acharyas.

 कोथ: - औदम्ु फय कु ं  न्क्तरतनऩूततभांसत्वक्- कदाभ पवसऩा  ऩयाभृ ोऽवदीमता े- कदाभ पवसऩा  उऩन्क्तरतनऩूततभांसत्मागी- कदाभ पवसऩा

18. कृ म्रभ फाहु쥍म (Association of krimi) :

Krimi manifestation occurs secondary when visible krimi is present(often happens as infestation (myiasis)) and in kushta, raktaja krimi(which is invisible) always plays a major role ( kushta, raktadushti, nakha –loma –asthi-tarunasthi bhakshana). Presence of visible krimi should be attributed to many factors such as manifestation of kleda, dushti extending to dhatu other than rakta (mamsa & medas).

 कृ म्रभ- औदम्ु फय कु ,ं ऋष्मन्जह्वं,ऩुर्णडयीक कु ं  फहुकरभी – भर्णडरं  जततुभन्तत- kaapala kushta When presence of krimi is observed treatment should be aimed at removal of krimi(prakrti vighata) and sodhana ( which is applicable to raktaja krimi which is sookshma and sudaruna) The environment for manifestation of krimi is seen with kapha & pitta predominant dushti, excess kleda, kotha, dushti of rakta, mamsa and medas.

a. संख्मा (Quantity):

i. अ쥍ऩ ( very few in number) ii. फहु (countable in number) iii. अनेक (numerous) iv. अतम (others)  More quantity of krimi means rapid spread to deeper dhatus and prognosis will worsen 19. अवदयण प्रादबु ााव (fissuring) –

a) अवदयण प्रादबु ााव गतत (Speed of fissuring )–  आर्ुअवदयण- औदम्ु फय कु ं( अ. 셃)  ऩाणणऩाद दायणभ ् – पवऩाददक

 के र्बूम्रभ प्रऩािय्ते – दा셁णक i. भतद (slow) ii. साभातम ्(moderate) iii. र्ीघ्र(् rapid) iv. अतम (others) 20. त्वक् त्वक् ऩािन गतत (Speed of onset)

a) त्वक् ऩािन गतत (Speed of onset)

i. भतद (slow) ii. साभातम ्(moderate) iii. र्ीघ्र(् rapid) iv. अतम (others) 21. त्वक् दरन (peeling of skin) –

a) त्वक् दरन गतत (Speed of onset)– i. भतद (slow) ii. साभातम ्(moderate) iii. र्ीघ्र(् rapid) iv. अतम (others)

twak avadaranam(cracking or peeling ) is a feature of pitta and vata dosha cracking of skin without redness and pain is due to vata (kapha anubandha)

patana -exfoliation of skin (cracking )is also seen with increase of ruksha guna of vata dalana of skin is peeling of skin due to increased ushna guna of pitta with secondary pitta or kapha anubandha rapid onset of avadarana is because of involvement of pitta and vata slow splitting/cracking of skin is due to kapha peeling of skin with redness is always due to pitta-vata involvement.

22. ऩरयत् म्रसया दर्ना भ ्(Presence of siras around the lesion) – present /absent

a) म्रसया वणा (Colour of siras around the lesion) i. गौय (white) ii. ताि (copper) iii. यक्त (red) iv. अ쥍ऩयक्त (slight red) v. कृ ष्ण (black) vi. अतम (others)

Manifestation of capillary network or engorged veins in and around the lesion should be assessed When engorged veins or capillaries are present irt should be understood as a condition of rakta –pitta prakopa  गौयम्रसयार्चतं– ओदम्ु फय कु ं  यक्त म्रसयासंततं- ऩुर्णडयीकं

23. ऩरयत् केर्/योभ स्वबाव (Character of hairs on and around the lesion)-

a) स्वबाव (character of lesion) i. केर् 楍मवनं (loss of hair ) ii. केर् वणा र्वमततयेक (colour change) iii. 셃पषत योभ (horripilation) iv. स्ऩर्ा र्वमततयेक (altered texture) v. अ쥍ऩ योभ: ( less hair) vi. अतम (others)

b) पवकृ त केर् र्वमात (Distribution of abnormal hairs) i. उऩसृ त्वचोऩरय:/over the lesion

ii. उऩसृ त्वचोसभततत: /around the lesion iii. सवात:/ over and around the lesion iv. अतम others

c) केर्/योभ वणा (hair Colour):

i. र्ुक्तर(white) ii. ताि (copper coloured) iii. पववणा(discoloured) iv. अतम (others )

d) रोभ प्रभाण र्वमततयेक ( altered thickness of hair ):

i. तनु ii. खय iii. अतम others

 Tamraromaraji – ओदम्ु फय कु ं  Romapinjaram- ओदम्ु फय कु ं  Suklaromaraji- भर्णडर कु ं Colour of hair also depict the nature of dosha dushti. Tamra, pinjara etc depicts involvement of pitta White (hypopigmented hair ) may depict the involvement of kapha dosha Loss of hair is the result of many factors. Indralupta is the result of interaction of v,p,k and rakta Excessive hairfall and decreased growth is because of vata predominance( secondary p/k) Thin hair is seen with vata and pitta Rough hair is due to vata predominance (kapha kshaya)  Hrishita- horripilated hair – वातज कु ं  Tanu roma – poorvarupa of kushta  खय योभ – thick and coarse hair ( vata –kapha)  Alpa roma – reduced density of hair (vata-pitta)

24) ऩाक (Suppuration) : present/absent

a) प्रादबु ााव (Onset): i. अर्ीघ्रऩाकी (acute onset of suppuration)

ii. र्चयऩाकी (chronic onset of suppuration)

iii. कृ 楍रऩाकी (rarely suppurates) iv. अतम (others) b) गाम्बी셍ा (Severity) : i. अऩाक (no suppuration ) ii. ऩाक् ( suppuration ) iii. गम्बीयऩाक् ( intense suppurative process) iv. अतम (others)

 ऩाक – ओदम्ु फय कु ं, ऩुर्णडयीक कु ं

 ऩाक फहुरातन – ऋष्मन्जहवं  कृ 楍रऩाकी /अर्ीघ्र ऩाक – कपज पवसऩा  गम्बीयऩाक्- कदाभ पवसऩा  ऩाकभ ् – ऺतज पवसऩा  अऩाक – no tendency to suppurate at all ( predominance of kapha – vata) Tendency to suppurate is due to pitta involvement Seeghrapaka is character of pitta/pitta-vata with rakta involvement In kaphadika conditions, there will be no suppuration(कृ 楍रऩाक) In vatadhika conditions there will be less suppuration Chirapaka is because of involvement of k-p

25. र्ीणा धात/ु र्ीणत्वभ (Withering of tissues)- present/absent

a) धातु (tissues affected) i. त्वक् (skin) ii. भांस (muscles) iii. म्रसया (vessels) iv. अवमव (organ) v. अ敍गुरी (fingers) vi. अतम (others)

 र्ीणाभांसं- असाध्म पवसऩा

 र्ीणस्ा नामु्- असाध्म पवसऩा

 र्ीणाम्रसया - असाध्म पवसऩा

 म्रसयास्नामुसतदर्ी - असाध्म पवसऩा

26. गतध ्(Smell from lesion): : present/absent

 र्वगतध् – उऩद्रव

 कु णऩगतध् – कदाभ पवसऩा

27. व्रणोत्ऩपत(manifestation of wounds/ulcers )- present/absent a. दोष फाहु쥍म (Dosha involvement) – i. वातव्रणोत्ऩपत् (manifestation of vrana with symptoms of vata) ii. पऩतव्रणोत्ऩपत् (manifestation of vrana with symptoms of pitta) iii. कपव्रणोत्ऩपत्(manifestation of vrana with symptoms of kapha) b. अ셁ह्य व्रण (presence of unhealed wounds) - present/absent c. व्रण ऩुनयावपृ त (recurrent occurrence of wounds) - present/absent d. व्रण वस्तु (scars of healed skin conditions) – present/absent Presence of unhealed skin conditions, easy scarring, recurrent occurrence of skin conditions all are manifestations seen even in purvarupa of skin conditions which indicate sthanasamsaraya in twak, rakta, mamsa and laseeka. 28. Examination of nails:

a) नख वणा: i. अ셁ण(reddish brown) ii. ताि (copper colored) iii. हरयत (green) iv. नीर (bluish) v. यक्त (reddish)

vi. कृ ष्ण (blackish) vii. हारयद्र(turmeric yellow)

viii. कृ ष्ण (black) ix. ऩार्णडु (white) x. अतम (others)

b) स्ऩर्ा Texture– i. 셂ऺ (dry) ii. अतत न्स्नग्ध (unctuous) iii. साधायण (normal)

iv. स्पु दित नख (cracked nails) v. खय (rough) vi. अतम (others) c) नख भांस – i. साधायण (normal) ii. नख भांसाततय ऩाक (suppuration between nails and flesh) iii. नख भांस 셁ज: (pain in nails ) iv. अतम (others) d) नख वे भांस ( eponychium) i. साधायण (normal) ii. ऩक्तव (suppurated) iii. कोथ (necrosis/gangrene) iv. क्तरेद(association of kleda) v. अतम (others)

29. प्रधान वेदना (Major symptom/Sensation) -

i. 셁ज(Pain) ii. दाह: (burning sensation)

iii. कर्णडु (itching) iv. सुत (numbness) v. आमाभ (stretching sensation) vi. स敍कोच (contracting sensation) vii. रोभ हषा (horripilations) viii. स्ऩतदनं (pulsations )

A. Pain : a) character of pain /वेदनास्वबाव: i. तोद (pricking pain) ii. तनस्तोद (continuos pricking pain)

iii. र्ुकोऩतोऩभ( pain as if pricked by bristles) iv. 셁ज(pain) v. न्स्तम्रभत वेदना (dull pain) vi. अतम (others )

b) अर्धान / स्थान (site of pain): c) तीव्रता (Severity) - Grades of pain severity – i. Grade 0 – no ruja/toda ii. Grade 1 – alpa/manda ruja iii. Grade 2 – ruja with moderate intensity iv. Grade 3 – tivra /ruja (intense pain ) v. Grade 4 – tivra ruja with sparshasahatwa d) वेदना प्रादबु ााव सभम (Time of onset of pain) - i. सततं (continuos) ii. कप कार( during diurnal and seasonal physiological kapha kala iii. पऩत कार during diurnal and seasonal physiological pitta kaala iv. वात कार during diurnal and seasonal physiological vata kaala v. अतम (others) e) Speed of onset of pain (वेदना गतत)–

i. आर्ु (rapid onset with or around the manifestation of skin symptoms ii. अनार्ु ( slow onset ) iii. अतम (others) f) अनुऩर्म: Aggravating factors g) उऩर्म: Relieving factors Pain is caused primarily by vata and usually is expressed as ruja, soola, bheda, toda, nistoda etc . Pain is described as a major symptom in the following conditions: तोद

तनस्तोद फहुर – वात कु ं, कष्मन्जह्वं

तनस्तोद – वातज पवसऩा

अततभात्रं वेदना(ऩक्तव/दग्ध/द/बग्न/ऺत व्रण) – कु ऩूव셂ा ऩ

बेद फहुर – कष्मन्जह्वं तीव्र셁क्/तीव्रवेदनं -काकणभ ् तीव्रातता/तीव्र वेदनं- पवऩाददका तीव्र 셁ज – ग्रन्तथ पवसऩा अतता – र्ता셁: 셁जा – ऩाभा 셁ज – ऺतज पवसऩा

셁जाकयभ/् 셁जाऩयीतभ-् औदम्ु फयं र्ुकोऩहत वेदन - कष्मन्जह्वं अ쥍ऩवेदन – म्रसध्भं सवेदन – कष्मन्जह्वं स셁क् स्पोिभ ्दरतत – चभादर अ쥍ऩ वेदन – कपज पवसऩा  Alpa /manda type of pain (vedana/ruja/arti) is a of kapha predominance  Nistoda( continuos type of pricking pain ) and toda( pricking pain is consistent with that of vata predominance  Teevra arti/ruja/vedana denotes intense vata vitiation and is seen in conditions with vata pradhana samsarga and sannipata  Pain produced by pitta will be associated with daha/paka/dalana  Grades of pain severity –  Grade 0 – no ruja/toda  Grade 1 – alpa/manda ruja  Grade 2 – ruja with moderate intensity  Grade 3 – tivra arti /ruja (intense pain )  Grade 4 – tivra ruja with sparshasahatwa

PAIN

TODA/NISTODA/SULA/RUJ SPARSHASAHA DAHATI IVA MANDA/ABSENT

VATA /VATADHIKA RAKTA + PITTA/RAKTA PITTA/PV KAPHA /kv

B. दाह (Burning Sensation) a) Character :

i. दाह फाहु쥍म(intense burning sensation) ii. दाह (burning sensation) iii. ऊष (hot sensation with restlessness) iv. अतम (others)

b) तीव्रता( severity)- Grading of burning sensation

i. Grade 0- No दाह – no burning sensation at all ii. Grade 1 - अ쥍ऩ दाह (mild burning sensation is present ) iii. Grade 2 - दाह ( burning sensation is pronounced.) iv. Grade 3 - अततभात्र दाह ( intense burning sensation)

c) दाह प्रादबु ााव कार: (Time of onset of burning sensation) –

i. सततं (continuos) ii. कप कार( during diurnal and seasonal physiological kapha kala iii. पऩत कार during diurnal and seasonal physiological pitta kaala iv. वात कार during diurnal and seasonal physiological vata kaala v. अतम (others)

d) अनुऩर्म/Aggravating factors

e) उऩर्म/ Relieving factors f) Site:

Burning Sensation- Burning sensation is produced by disequilibrium in doshic balance with a predominance of pitta dosha such as sudha pitta prakopa/ pitta- vata involvement/pittadhika tridosha ; with or without rakta dushti अततभात्र दाह – पऩतज पवसऩा

दाह – पऩतज कु ं, ऩुर्णडयीकं , चभादर, र्ता셁, असाध्म कु ं, कु ोऩद्रव ऩरयदाह – कु ऩूव셂ा ऩ

दाह फहुर- कष्मन्जह्व दाह ऩयीतं- औदम्ु फयं दाहाढ्मं – क्ष्तज पवसऩा

अ쥍ऩदाह – वाततक कु ं, म्रसध्भं तीव्र दाह - काकणकं ऊषा: - चभादर  Grading of burning sensation  Grade 0- No दाह – no burning sensation at all( can exclude the possibility of pitta predominance)  Grade 1 - अ쥍ऩ दाह (mild burning sensation is present and presence of pitta in samprapthi should be assessed. Pitta may be present with kapha or alpa prakopa of pitta in samsarga /sannipatha))  Grade 2 - दाह ( burning sensation is pronounced. Happens especially when pitta is prakupita alone or with vata)  Grade 3 - अततभात्र दाह ( intense burning sensation. Happens when the ushna- tikshna guna of pitta is augmented by vata or p-v predominant sannipatha )

C. KANDU (ITCHING ): a) कर्णडु तीव्रता (GRADING of severity of itching )

i. GRADE 0 – NO कर्णडु (no itching) ii. Grade 1 – अ쥍ऩ कर्णडु/ईषत ्कर्णडु (mild itching) iii. Grade 2 – कर्णडु (itching)

iv. Grade 3 – फहु कर्णडु (excessive itching)

b) कर्णडु प्रादबु ााव कार (Time of onset of burning sensation)

i. सततं (continuos) ii. कप कार( during diurnal and seasonal physiological kapha kala iii. पऩत कार during diurnal and seasonal physiological pitta kaala iv. वात कार during diurnal and seasonal physiological vata kaala

v. अतम (others) c) Site:

d) अनुऩर्म/Aggravating factors

e) उऩर्म/ Relieving factors Itching is a subjective and multidimensional experience. The manifestation of itching and its nature depends on many factors. The nature of skin ( twak sara has excellent skin), structural and functional integrity of swedavaha srotas, rasavaha and raktavaha srotas and koshta, the balance between vata and kapha in the body, response of the body to various nija and agantu factors etc plays major roles in the manifestation of itching. Kandu seen in kushta , visarpa are mentioned as कर्णडु – कु ऩूव셂ा ऩ,् भर्णडर, पऩतज कु ं, ऩुर्णडयीकं , चभादरं, ऩाभ, पवचर्चाक अ쥍ऩ कर्णडु- वाततक कु ं, कष्मन्जह्व, म्रसध्भं कर्णडूऩयीतं - औदम्ु फयं कर्णडूभन्त्ब: गर्णडै:- अरसं

फहु कर्णडू: - कपज कु ं ईषत ्कर्णडू – त्वग्गत कु ं कर्णडूमुत: - कपज पवसऩा भतदकर्णडु - पवऩाददक सकर्णडु- दद्र ु  Slight imbalance in doshas may provoke kandu.  Increase in twak rukshata, parushyata etc may cause itching ( vatadika)  Paka, alteration in bhrajaka pitta quality, ati sweda etc may cause itching secondary to pitta vitiation.  Vitiated kapha is a major factor that causes itching due to its snigdha (ati) swabhava.

SEVERITY OF ITCHING

 GRADING of severity of itching  GRADE 0 – NO कर्णडु  Grade 1 – अ쥍ऩ कर्णडु/ईषत ्कर्णडु  Grade 2 – कर्णडु

 Grade 3 – फहु कर्णडु

D. सुता/ Numbness

सुत – वातार्धक कु ं स्ऩर्ााऻत्वभ ्– कु रऺणं सुाङता – कु ऩूव셂ा ऩ त्वक् स्वऩनभ ्- भह कु ं सुवत ्सु: - वाततक कु ं सुत – कपज पवसऩा

E.हषा /skin paresthesia/ dysesthesia

अगं ेषु पऩऩीम्ररका इव संचाय् – वातज पवसऩा अततभात्र हषा: - वातज पवसऩा

ऩरयहषाा - कु ऩूव셂ा ऩ

F.Stretching sensation – अततभात्रामाभ् – वातज पवसऩा

G-Contracting sensation - अततभात्रसंकोच् –– वातज पवसऩा

H-Pulsating feeling: अततभात्रस्पु यणभ ् – वातज पवसऩा

In this context, it should be noted that all this sensations are produced by vata predominance and varying levels of raktadushti, with or without avarana by kapha dosha

1. अनुफतध सवाा敍गीणा रऺण आपवबााव: (Manifestation of systemic symptoms) Y/N

a) सवाा敍गीण रऺण स्वबाव( Character of systemic symptoms )

i. भदृ ु (mild symptoms with no severe consequences) ii. दा셁ण ( severe systemic manifestations together with cutaneous symptoms) iii. अतम (others )

b) सवाा敍गीण रऺण उत्बव कार (Time of manifestation of systemic symptoms )

i. त्वक् पवकयोत्ऩपत ऩूव:ा (Just before cutaneous manifestation _ ii. एक कार उत्ऩपत: (Along with cutaneous manifestation)

iii. त्वक् पवकयोत्ऩपतयनततयं (After cutaneous manifestation) iv. अब्नतमार्श्रत (No time relation)

अनुफतधर्वमार्ध् (should be included when the beginning of disease/symptom coincide with the skin manifestation.)

When generalised symptoms are present, the diagnosis of visarpa, bahya/abhyantara/ ubhaya should be considered and the extend of symptoms may give an idea about prognosis.

अनुफतधर्वमार्ध् -

煍वय्/र्ीत煍वय्/वात煍वयसभर्वमथा/पऩत煍वयसभान셁क्/कप煍वय सभान셁क्

अततसाय्/वभथ ु /छददा् /अयोचक्

कास्/दहक्तका /ास्

1. General symptoms:

अयोचक्/ अपवऩाक् / अतनेष् / स्तैम्रभत्मभ ्/ क्तरभ् / दौफा쥍म / प्रसेक् / पऩऩासा / तष्ृ णा / र्ीतक्/ भधयु ास्मत्वभ ्/ स्तैम्रभत्मभ ्/ अततदााह/ आस्मोऩरेऩ् / तनीपवका / गौयव् इन्तद्रमाणां जाड्मं / इन्तद्रमगौयवभ ्/ हरयत셂ऩदर्ना भ ्/ हरयद्र셂ऩदर्ना भ ्/ चऺुर्ोयकु रत्वभ ्/ दवध्ु म्रर्योगु셁त्व ं / म्रर्यो셁क् / अन्स्थबेद् / सन्तधबेद् / तनस्तोद् / र्ूरं अंगावसादं / अंगभदा्/ अ敍गबेद / अंगबंग / अंगपवऺेऩणं / म्रबनपत अंगातन / अन्स्थपवेषणभ ् / सन्तधपवेषणभ ्/ र्ोष्/ उेनभ ्/कम्ऩ् / / वेऩनभ ् तनद्रा / ततद्रा / भोह् / तनद्रानार्् /अस्वप्न / भू楍छाा / संऻाहातन् / स्भतृ तहातन्/ भ्रभ् / प्रराऩ् / तभक् / आरस्मभ ् / संऻां प्रभोहमतत / प्रभूढसंऻा / र्वमर्थतचेत् / अयतत्/ औत्सुक्तमभ / न्क्तरबूतम् आर् ु तनद्रां बजतत / न सुखभुऩरबते / स्थानादासनं आसनात ्र्य्मां राततुम्रभ楍छतत स्रोतसां प्ररेऩ् / आभोऩवेर्नभ/अततभात्रस्वेद / अन्ग्नसदनभ ्/ अन्ग्ननार्् ेतनमनवदनभूत्रवच:ा / हरयतनेत्रभूत्रत्वक्तवच:ा 31. Change in nature of sweating /स्वेद स्वबाव ऩरयवतान- a. देर्/ area of manifestation i. एकदेम्रर्क/local ii. सावादैदहक/systemic

b. स्वबाव/character – i. अस्वेद/absence of sweating ii. अतत स्वेद/excessive sweating iii. अतम/others 32.दोष पवक쥍ऩ रऺण/ Character of individual dosha for dosha vikalpa assessment a. वात रऺण /vata dosha lakshana i. श्माव/ bluish black discolouration- present / absent ii. अ셁णवणं / reddish brown discolouration- present / absent iii. ऩ셁षता/ coarse and rough skin- present / absent iv. यौक्ष्म/ dry and rough skin- - present / absent

v. र्ूर/ painful lesion-- present / absent vi. र्ोष/ emaciation/ atrophy of skin- present / absent vii. तोद/ pricking pain in skin- present / absent

viii. वेऩथ/ु tremor of affected area- present / absent ix. हषा/ paraesthesia- present / absent x. स敍कोच:/ contractures- present / absent xi. स्तम्ब/ stiffness of the area- present / absent

xii. सुत/ numbness - present / absent xiii. बेद/ sensation like splitting of skin- present / absent xiv. ब敍ग:/ cracking sensation- present / absent

b. पऩत रऺण /Pitta lakshana i. दाह/ burning sensation- present / absent ii. स्वेद/ excessive sweating-- present / absent iii. क्तरेद/ moistening or soddening of lesion- present / absent iv. कोथ/ gangrene- present / absent v. स्राव/ discharge- present / absent vi. ऩाक/ suppuration- - present / absent

vii. याग:/redness -- present / absent

c. कप रऺण/kapha dosha lakshana i. ैत्म:/paleness or whiteness which is generalised or localized-- present / absent

ii. र्ैत्म:/ excessive coldness- present / absent

iii. कर्णडु:/ itching- present / absent iv. स्थैमा:rigidity or fixity of skin or muscles- present / absent v. गौयव:/ localized or generalized heaviness- present / absent vi. उत्सेध:/ swelling - present / absent vii. उऩस्नेह:/ moist appearing skin- present / absent viii. उऩरेऩ:/ feeling as if anointed with something- present / absent 33. Rakta kshaya lakshana a. त्वक्तऩा셁ष्मभ ्/rough and coarse appearance of skin-- present / absent

b. स्पु दितत्वक्/cracking or fissuring of skin-- present / absent c. म्रानत्वक्/change in luster and brightness of skin/dull skin-- present / absent d. 셂ऺत्वक्/rough and dry appearance of skin-- present / absent e. अम्राम्रबराष:/desire for sour substances -- present / absent f. र्ीताम्रबराष:/preference for cold things -- present / absent g. म्रसयार्ैर्थ쥍म-/lax and unsteady vessel walls- present / absent 34. Rakta vridhi lakshana a. यक्ता敍ग्/यक्तत्वक्/ hyperemia of organs and skin-- present / absent b. यक्ताक्षऺता/यक्तनेत्रता/reddish coloured eyes, caruncle etc-- present / absent

c. म्रसयाऩूणत्ा व/ excessive fullness of vessels-- present / absent भ--् present / absent d. कु ् (skin disease )-- present / absent e. पवसऩा्/ erysipelas/ skin condition characterized by rapi onset and spread with cutaneous and systemic manifestations-- present / absent f. पऩदिका/skin eruptions -- present / absent

g. असग्ृ दय्/ menorrhagia-- present / absent h. अक्षऺऩाक्/suppuration of eyes-- present / absent

i. भुखऩाक्/oral ulcers-- present / absent j. दाह.burning sensation in body-- present / absent k. भेढ्रऩाक्/suppuration in male genitalia-- present / absent

l. गुदऩाक्/suppuration in rectum-- present / absent m. पवद्रर्ध्/abscess-- present / absent n. र्वम敍ग्/melasma-- present / absent o. अन्ग्ननार््/loss of digestive activity-- present / absent p. तभ्प्रवेर््/ fainting or appearenec of darkness in front of eyes-- present / absent q. उऩकु र््/ gingivitis-- present / absent r. काभरा/jaundice-- present / absent 35. rakta pareeksha ( examination of bloody discharge as per dosha ) I. Vatika rakta dushti lakshana – a. अ셁णाबं/ reddish brown -- present / absent b. पवर्दं यक्त्/lacking normal viscosity of blood-- present / absent c. पेतनरं यक्त्/frothy blood-- present / absent

d. तनु् यक्त्/ without normal texture-- present / absent e. कृ ष्णं यक्त्/blackish coloured-- present / absent f. अस्कन्तद यक्त्/ blood that does not coagulate-- present / absent g. श्मावं यक्त्/ bluish black blood-- present / absent h. वेगस्रापव यक्त्/increased flow owing to decreased density-- present / absent i. अ楍छं यक्त्/ clear rakta without actual components of blood-- present / absent

II. ऩैपतकयक्तदपु ् lakshana a. अम्रसतं यक्तभ/् blood which is differently coloured than white-- present / absent b. र्चयेण स्त्मामतत/ coagulates with difficulty-- present / absent c. नीरं यक्तभ/् bluish coloured blood-- present / absent d. हरयतं यक्तभ/् greenish coloured-- present / absent

e. श्मावं यक्तभ/् bluish black -- present / absent f. पवस्रं यक्तभ/् fleshy smell-- present / absent

III. न्ै ष्भकयक्तदपु ् lakshana a. ईषत्ऩार्णडु यक्तभ/् slightly pink-- present / absent b. पऩन्楍छरं यक्तभ/् slimy -- present / absent

c. तततुभत ् यक्तभ/् thready-- present / absent d. घनं यक्तभ/् thick and dense-- present / absent e. न्स्नग्ध ं यक्तभ/् extremely unctuos-- present / absent f. र्ीतरं यक्तभ/् extremely cold to touch-- present / absent g. फहरं यक्तभ/् copious quantity-- present / absent h. र्चयस्रापव यक्तभ/् delayed flow-- present / absent i. स्कन्तद यक्तभ/् rapid clotting tendency-- present / absent j. वसागन्तध यक्तभ/smell् of marrow-- present / absent IV. Sannipata dushti a. दगु ता ध ं यक्तभ/् putrid smelling blood-- present / absent b. भम्ररनं यक्तभ/् dirty appearing blood-- present / absent c. आपवरं यक्तभ/् turbulent /cloudy blood-- present / absent

All the other symptoms that has been given in this 32-35 serial numbers are to be observed to collect data regarding the dosha, dhatu dushti to analyse the supporting factors in manifestation of specific set of symptoms that is specific to each patient.