Textbook of KC-1 (Short Book) @bamsbooks

A text book of
KAYA CHIKITSA
1
Dr. Tajagna Dalsaniya

Kaya chikitsa paper 1 By: Tajagna Dalsaniya
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INDEX
Sr. No Topic Page no.
PART A 3
1. Derivation of the terms ‘Kaya’, ‘Chikitsa’ and their definitions and 4
synonyms. Definition of ‘Kayachikitsa, Definition of ‘Bheshaja’.
Types and detailed description of Bheshaja and Chikitsa, Knowledge
about Chikitsa Chatushpada, Rogi Roga Pariksha Siddhantha,
Astasthana Pariksha.
2. Importance of Kriya Kaala according to stages of Dosha and their 17
management.
3. Chikitsa sutra and Management of vriddhi (increased) and kshaya 20
(decreased) of Dosha, Dhatu and Mala, Ojo Vyapat (Kshaya,
Visramsa and Vyapat) and its management. Chikitsasutra and
Management of Sama-Nirama states, Roga-Anutpattikara Chikitsa,
Roga Prashamana Chikitsa (Doshapratyanika, Vyadhipratyanika,
Ubhayapratynika), Doshopakrama, Chikitsa sutra and Management
of Sthanantara Dosha (Ashayapakarsha, Anuloma/Pratiloma gati of
Dosha, Vimarga gamana of Dosha), Knowledge of Lina Dosha & its
management, Diagnosis, Chikitsa Sutra and Management of Avarana
and of Dhatu Pradoshaja diseases, Importance of Dosha, Dushya ,
Bala, Kaala, Agni, Prakriti, Vaya, Sattva Satmya, Desha, Ahara and
stage of diseases in treating them. Chikitsa Sutra and Management of
‘Samanyaja and Nanatmaja’ diseases.
4. Detailed description of Dvividhopakrama (Santarpana and 45
Apatarpana) and Shadavidhopakrama (Rookshana, Snehana,
Swedana, Sthambhana, Langhana and Brimhana). Detailed
description of Shodhana, Shamana and Nidana Parivarjana.
Knowledge of Aushadha matra, Sevan kaala and Anupana, Definition
and Knowledge of Pathya-Apathya with examples of diseases of
various systems.
5. Derivation of the term ‘Manas’, its sthana (place), Guna (qualities) 62
and Karma (functions). Samanya Chikitsa Siddhanta of Manasa
Roga.
6. Principles & Management of Nutritional deficiency disorders. 66
7. Management of Vardhakyajanita vikara, Indriyapradoshoja vikara, 69
Alzhiemer’s Disease, Sleep disorders, General debility.
8. General introduction and principles of Management of diseases 76
produced by Genetic, Environmental, and Iatrogenic factors.
Disorders due to drug and Food allergy and their management and
other allergic conditions.
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INDEX
Sr. No Topic Page no.
PART B 85
1. Detailed description of Chikitsa Sutra and Management of Jwara and 86
its types. Etiopathogenesis & relevant Ayurvedic and Modern
management of following types of Fevers-Typhoid, Pneumonia,
Pleurisy, Influenza, Mumps, Meningitis, Encephalitis, Tetanus,
Yellow fever, Plague, Dengue Fever, Chikun Guniya, Leptospirosis,
Viral Fever, Anthrax, Masurika (Small pox), Laghu Masurika
(Chicken pox), Romantika (Measles).
2. Chikitsa sutra and Management of the diseases of Rasavaha Srotas 119
such as – Pandu, Amavata, Madatyaya, Hridroga, Hridshoola,
Hypotension, Hypertension, Anaemia, Rheumatoid arthritis.
3. Chikitsa sutra and Management of the diseases of Raktavaha Srotas 132
such as - Raktapitta, Kamala, Kumbhakamala, Halimaka, Daha,
Mada, Murcha, Sanyasa, Vatarakta, Plihadosha, Yakrut dosha,
Haemolytic disorders, Hepatitis, Cirrhosis of Liver, Leukaemia,
Kushta, Shvitra, Visarpa, Sheetapitta, Udarda, Kotha and Kshudra
Roga.
4. Knowledge of National Health Programmes and the relevant 157
Ayurvedic Management of the following diseases enlisted by World
Health Organisation- Malaria, Filaria, Kala Azar, Leprosy,
Tuberculosis, AIDS.
5. Introduction of general principles of maintenance of health and 162
management of diseases of following systems of Medicine- Yoga,
Naturopathy, Unani, Siddha, Physiotherapy and Rehabilitation.
6. Diseases of different Endocrine Glands- such as Thyroid, 168
Parathyroid, Pituitary, Pancreas and Adrenal glands and their
management.
7. General introduction, types and Management of diseases caused by 175
Vyadhi Kshamatwa Hinata (Immuno deficiency disorders), Auto
Immune Disorders.
8. Description and Management of following Emergency Conditions- 178
Acute Haemorrhage, Hypertensive Emergencies, Acute abdominal
pain (Renal colic, Biliary colic, Gastritis, Pancreatitis, Peritonitis and
Appendicitis), Acute Abdomen, Anuria/ Oliguria, Congestive Heart
Failure, Myocardial Infarction/Angina, Shock, Syncope,
Convulsions, Hyperpyrexia, Hyperglycaemia, Hypoglycaemia, Status
Asthmaticus, Acute Respiratory distress Syndrome, Drowning and
Electric shock.
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KAYA CHIKITSA
PAPER 1
PART A
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1. Derivation of the terms ‘Kaya’, ‘Chikitsa’ and their definitions and

synonyms. Definition of ‘Kayachikitsa, Definition of ‘Bheshaja’. Types
and detailed description of Bheshaja and Chikitsa, Knowledge about
Chikitsa Chatushpada, Rogi Roga Pariksha Siddhantha, Astasthana
Pariksha.
KAYA
Definition:
चीयतेन्नादिभि: इतत काय |
The term ‘kaya’ means nourishment and building up of the body with ingested food.
चीयते प्रशस्तिोषधातुमलैरितत काय: |

Kaya or the body forms dosha, dhatu, and mala after assimilation of food.
काय: चचतप्रकृतत: |
Kaya is constitution of mind.
Synonyms:
अथ: कलेविं गात्रं वप:ु संहननं शिीि वर्षमम ववग्रह: |
कायो िे ह: क्लीव पुंषो स्त्रीयां मूततमस्तनुस्तनु ||
कलेवि → Kaya is that which develops from best shukra.
गात्र → Means which moves continuously.
वपु → Which brings the seeds of actions of other life.
संहनन → That provides compactness to the body.
शिीि → That which undergoes destruction continuously.
ववग्रहः → That which receives sukha and dukha.
िे ह → That which grows continuously.
क्लीव → That which has capacity to copulate.
परु
ु ष → Male
स्त्री → Female
तनू → That which grows and expands with proper nourishment.
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CHIKITSA
Definition:
ककत ् तनवासे िोगापनयनेन चचककत्सतत |
Chikitsa is that which removes the disease.
चचककत्सा रुक् प्रततकिया |
Chikitsa is action against pain.
चचककत्सा िोगतनिान प्रततकाि |

The action which is against the roga nidana.
चचककत्सा तत्प्रततकाि: |
Chikitsa is that which resists disease.
या किया व्यचधहिणी सा चचककत्सा तनगध्यते |
The action which removes the disease is called as chikitsa.
चतुणाां भिषगािीनां शस्तानां धातुवैकृते| प्रववृ िधामतुसाम्याथाम चचककत्सेत्यभिधीयते||
(Cha. Su. 9/5)
Employment of all the excellent four – physician etc. – in case of disorder of dhatu with the
objective of (re-establishing) their equilibrium is called “Therapeutics”.
According to the modern science treatment is the care and management of a patient to combat
diseases.
Synonyms:
चचककत्त्सतं व्याचधहिं पथ्यं साधनमौषधम ्|
प्रायत्ििं प्रशमनंप्रकृततस्थापनं दहतम ्||३||
ववद्याद्भे षजनामातन,...|४|
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Chikitsa (measures which alleviate disorders), vyadhihara (destroyer of diseases), pathya
(beneficial for the bodily channels), sadhana (instrument for therapeutic actions aushadha
(that which is prepared of herbs), prayashchitta (expiration), prashamana (pacification),
prakritisthapana (that which helps recovery to normalcy), hita (wholesome) – these are the
synonyms of bheshaja (therapeutics).
KAYA CHIKITSA
Definition:
कायचचककत्सा नाम सवामङ्गसंचितानां व्याधीनां ज्वििक्तवपिशोषोन्मािापस्मािकुष्ठमेहाततसािािीनामु
पशमनाथमम ् | (Su. Su. 1/8)
Kayachikitsa is a branch of astanga ayurveda which deals with treatment of the different
diseases like jvara, raktapitta, sosha, unmada, apasmara, kushtha, meha, atisara etc.
कायस्यान्तिग्नेत्िककत्सा कायचचककत्सा | (Cha. Su. 30/28 Chakrapani)

Treatment of the jatharagni is called kayachikitsa.
BHESHAJA
Definition:
िेषं िोग ियं जयतत िेषजम ् | (Amarkosha 2/6/50)
Which removes fear of disease is called as bheshaja.
तिे व युक्तं िैषज्यं यिािोग्याय कल्पते| (Cha. Su. 1/134)
That is the right medicine which makes for health.
TYPES OF CHIKITSA
1. Ekavidha chikitsa:
Nidana parivarjana: Removal of the cause of disease is a summarized treatment.
2. Dvividha chikitsa:
• Sheeta chikitsa & Ushna chikita
• Santarpana & Apatarpana chikitsa
• Shodhana & Shamana chikitsa
• Urjaskar & Rogaghna chikitsa
• Rashayana & Vajikaran chikitsa
• Rodaprashama & Apunarbhav chikitsa
• Dravyabhuta & Adravyabhuta chikitsa
3. Trividha chikitsa:
a. Daivavyapashraya chikitsa:
Divine or spiritual therapy.
The divine medication consists in incantation of herbal amulets, magical stone, auspicious
sacrifial offerings, oblations, vows, purificatory ritual, fasting, propitiatory invocation,
salutation and such other things.
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b. Yuktivyapashraya chikitsa:
Scientific therapy consists of the presctription of the line of dietetic regimen and medication.
c. Satvavajaya chikitsa:
Mental control consists of restraining the mind from the desire for unwholesome objects.
a. Antah parimarjana chikitsa: Internal administration of medicines.

b. Bahir parimarjana chikitsa: External application of medicines.
c. Shastra pranidhan: Shastrakarma or surgery.
a. Hetu viparita chikitsa: Opposite to etiology

b. Vyadhi viparita chikitsa: Opposite to disease
c. Ubhayarthakari chikitsa: mixed approach
Apakarshana:
a. Langhana: fasting or use of light foods such as peya, vilepi, mudgayusha. For those
patients who have alpa dohsa / bala.
b. Pachana: Along with langhana or upavasa, use of digestants such as chitraka, musta,
trikatu etc. For those patients who have madhyama dosha / bala.
c. Doshavasechana: Purificatory procedure for elimination of the aggravated dosha. For
those patients who have balwaan / bahu dohsa.
Krimi
a. Apakarshan: Expulsion of unwanted things that means to take out or remove by force.
b. Prakruti vighata: It means to break the pathogenesis of disease by means of either
external aplication or internal medicine.
c. Nidana parivarjana: Avoiding the etiology factors of the disease.
4. Chaturvidha chikitsa: By sushruta

a. Sanshodhana: Purifiaction therapy b. Sanshamana: Palliative therapy
c. Ahara: Dietric regimen
d. Achara: Good conduct of body, mind & speech
5. Panchavidha chikitsa: By charaka

a. Vamana c. Anuvasana basti e. Nasya
b. Virechana d. Niruha basti
6. Shadvidha chikitsa: (Shadvidha upakrama by charaka)

a. Langhana c. Rukshana e. Swedana
b. Brimhana d. Snehana f. Stambhana
7. Saptavidha chikitsa: (Shamana chikitsa)

a. Pachana d. Trishna g. Vyayam
b. Dipana e. Atapa sevana
c. Kshudha f. Maruta sevana
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8. Astavidha chikitsa: (Shastra karma by sushruta)

a. Chedana d. Vedhana g. Visravana
b. Bhedana e. Esana h. Seevana
c. Lekhana f. Aaharana
9. Dashavidha chikitsa: (Langhana chikitsa)

a. Vamana e. Pachana i. Maruta sevana
b. Virechana f. Upavasa j. Vyayama
c. Niruha basti g. Pipasa
d. Nasya h. Atapa sevana
10. Astadasha chikitsa: (Upashaya)

Aushadha Anna Vihara
Hetu viparita Hetu viparita Hetu viparita
Vyadhi viparita Vyadhi viparita Vyadhi viparita
Hetu-vyadhi viparita Hetu-vyadhi viparita Hetu-vyadhi viparita
Hetu viparitarthkari Hetu viparitarthkari Hetu viparitarthkari
Vyadhi viparitarthkari Vyadhi viparitarthkari Vyadhi viparitarthkari
Hetu-vyadhi viparitarthkari Hetu-vyadhi viparitarthkari Hetu-vyadhi viparitarthkari
CHIKITSA CHATUSHPADA
The prognosis of any disease – whether the disease is easily curable, difficult to cure or
incurable – depends upon its nature and the healthy combination of the four factors required
for the successful treatment.
• The physician
• The medicine
• The attendant
• The patient himself
भिषग्रव्याण्युपस्थाता िोगी पािचतुष्टयम ्|

गुणवत ् कािणं ज्ञेयं ववकािव्युपशान्तये|| (Cha. Su. 9/3)
Physician, medicine, attendant (nursing staff) and the patient, these are four components
which, all in their best of qualities are responsible for the complete cure of disease.
1. Bhishak:
िुते पयमविातत्वं बहुशो दृष्टकममता|
िाक्ष्यं शौचभमतत ज्ञेयं वैद्ये गुणचतुष्टयम ्|| (Cha. Su. 9/6)
A vaidya should possess the qualities such as proficiency in theoretical knowledge (that is
learnt), extensive practical experience, dexterity and purity (of body and mind).
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2. Dravya:
बहुता तत्रयोग्यत्वमनेकववधकल्पना|
सम्पच्चेतत चतुर्षकोऽयं रव्याणां गुण उच्यते|| (Cha. Su. 9/7)
Abundance (in availability), efficacy (with good pharmacological properties), various
pharmaceutical forms and intact qualities of drugs – these are four qualities of the ideal
medicine.
3. Paricharaka:
उपचािज्ञता िाक्ष्यमनुिागि ितमरि|
शौचं चेतत चतुर्षकोऽयं गुणः परिचिे जने|| (Cha. Su. 9/8)
Knowledge of taking care of patient (nursing) as well as preparation, dispensing and
administration of medicines and healthy recipes, dexterity, affectionate towards patient and
purity of body and mind – these are four qualities of attendant.
4. Rogi:
स्मतृ ततनमिेशकारित्वमिीरुत्वमथावप च|
ज्ञापकत्वं च िोगाणामातुिस्य गुणाः स्मत ृ ाः|| (Cha. Su. 9/9)
Good memory (to remember treatment guidelines), obedience (to follow given instructions),
fearlessness (courage to face adversities of disease) and ability to provide all information
about the disease – these are the qualities of patient.
ROGI-ROGA PARIKSHA SIDDHANTA

Examination of the patient and disease is essential for the proper diagnosis so that the disease
can be treated successfully.
Rogi pariksha:
The patient should be examined first and then the disease.
Examination of the patient can be done by following method.

1. Trividha chikitsa:
a. Darshana: Inspection – Direct observation of the patient
Varna, Rukshata, Glani, Akruti, Vairupyata etc. observed and measured by darshana
pariksha.
In pandu paleness is known by this examination.
b. Sparshana: Palpation
Body temperature, Palpitaions, Tenderness, Organomegaly, Feeling of extra growth
etc. are examined by sparshana pariksha.
In dakodara – On percussion dull note is heard and feeling like water in leather bag.
c. Prashna: Interrogation (History taken)
To know the nidana, agni, kostha, prakruti,vaya etc.
To develop and maintain doctor and patient relationship.
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2. Panchavidha pariksha: Pancha gyanendriya
a. Chakshurindriya pariksha: Prakruta & vikruta varna, chhaya, pramana, etc.
b. Twakendriya pariksha: Prakruta & vikruta varna, sheetata, ushnata etc.
c. Shrotrendriya pariksha: Antrakunjana, sandhi sphurana etc.
d. Rasnendriya pariksha: Prakruta & vikruta gandha
e. Ghranendriya pariksha: Prakruta & vikruta gandha
3. Shadvidha pariksha:
a. to e. pancha gyanendriya chikitsa
f. Prashna pariksha: Interrogation
By interrogation one should ascertain the desha, kala, jati, satmya of the particular
individual likings, dietary habits, causative factors of the diseases, pathogenesis of the
diseases, agni, kostha, proper evacuation of the vata-mutra-purisha and chronic stage
of the disease of patient.
One should arrive at a diagnosis by correlating the local signs and symptoms with
similar features of other disease on the basis of scientific principles involved.
4. Astavidha pariksha:
िोगािान्तस्य शिीिस्य स्थानातन अष्टौ तनिीक्षयेत ् |
नाडी मत्र
ू ं मलं त्जह्ां शब्िं स्पशम दृकाकृतत ||
a. Nadi pariksha:
Examination of radial pulse
1 cm below wrist joint of right hand of male patient or left hand of female patient with
the help of first three fingers of physician.
Examine the rate, rhythm, volume, tension, force of the pulse, and identify the vata,
pitta & kapha pulsation at the index, middle and ring fingers respectively.
Physician should do nadi pariksha for 3 times in a day, after feel the nadi, physician
should determine the disease by intellect.
Doshanusar / Roganusar nadi gatis are as follows.
• Vata prakopa → Jalauka or sarpa gati
• Pitta prakopa → kaak or manduka gati
• Kapha prakopa → Paravat or hamsa gati
• Vata-Pitta prakopa → Kinchita sarpa kinchita bheka gati
• Pitta-Kapha prakopa → Sarpa gati then hamsa gati means some time very fast
then slow.
• Sannipataja → kaastha kutavat
• Asadhya → First pitta then vata, kapha, whose force become slow and very
mild
• Jvara → Ushna, Vegavaan
• Kama-Krodha → Vegavaan
• Chinta-Bhaya → Ksheena
• Mandagni → manda gati
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• Dhatu ksheena → Manda
• Truptanna → Sthira
b. Mutra pariksha:
For urine examination collect the sample of urine in early morning.
Following tests are done for examination
Frequency of micturition
Stream of urine while micturition
Density of urine
Quantity, smell, colour of urine
Presence of pus
Presence of calculus
Presence of semen
Taila bindu pariksha
Observation:
Vata → pandu varna, nila, ruksha
Pitta → Rakta varna, Pita, aruna
Kapha → Fenila, snigdha, pallava vari tulya
Dvandvaja → Mixed of two doshas
Sannipataja → Krishna varna
Raktaja → Snigdha, Ushna, Rakta
Ajirna → Like rice water
Nava jvara → Dhumra varna, excessive micturition
Taila bindu pariksha:

Urine sample was collected in early morning.
Avoid the first stream of urine then put one drop of oil in it and observe the direction
of the taila bindu.
Direction → Result
East → Disease will cure immediately
West → Obtained health
North → Disease will cure definitely
South → Suffered from jvara.
Ishana → Patient will die within month
Agni / Nairutya → If hole found the certainly death
Vayavya → Death
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c. Mala pariksha (Stool Examination):
The stool should also be examined like urine.
Following tests for examination.
• Malapravruti • Gandha • Aama
• Matra • Saraktata • Nirama
• Samhanan • Sapuyata
• Varna • Sakrumi
Dosha → Lakshana
Vata → Sushka, fenila, ruksha
Pitta → Pita varna
Kapha → Sukla varna
Ama condition → Same like kapha
Ajirna → Apakva mala
Jalodara → White colour & very foul smelling
Tikshanagni → Sushka and pindita
d. Jihwa pariksha:
Tongue is examined for its varna, aakruti, ankura, liptata, sparsha, gati etc.
In agnimandhya → tongue becomes coated
In vata prakopa → Sheeta, ruksha, sphutita
In pita prakopa → Rakta, Shyama varna
In kapha prakopa → Sweta, Picchila
In tridosha prakopa → Krishna, Kantakayukta jihwa
e. Shabda pariksha:
Examination of the voice of the patient.
In vata prakopa → It becomes ruksha swara
In pita prakopa → It becomes teevra swara.
In kapha prakopa → it becomes gambheer swara
f. Sparsha pariksha:
Examination of skin of the patient.
In vata prakopa → it becomes sheeta & krishnavarna
In pitta prakopa → pitavarna & ushna twacha
In kapha prakopa → Aadra & swetavarna twacha
g. Drika patiksha:
Examination of eyes of the patient
Varna, panduta, pitata, raktata, shoka etc. should be examined.
In vata prakopa → eyes becomes ruksha, dhoomavarna
In pita prakopa → pita, dahayukta
In kapha prakopa → Snigdha, jala yukta
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h. Aakruti pariksha:
Examination of body built of the patient.
Physique of the patient is examined on the basis of krisha, sthoola, samanya, atihrshwa,
atideergha etc.
• Vata prakruti:
Hair: Dry, Rough & Dhusara varna
Talkative nature
Dislike excessive cold
Their dhriti, smriti, buddhi, gati are inconsiderable
• Pitta prakruti:
Excessive thrist & appetite
Gaura varna
Hair: pita, varna, less
Body: ushna
Adventurous nature
• Kapha prakruti:
Calm in nature
Intelligent
Sattvika
5. Dashavidha pariksha:
a. Prakriti: constitution of the patient
b. Vikruti: Strength of the disease
c. Sara: dhatus of the best quality
d. Samhanana: Compactness of the body
e. Satmya: Habitual and suitable foods etc.
f. Satva: Mental strength
g. Pramana: Measurnment of the body.
h. Ahara shakti: Strength of digestive fire is examined in 2 ways viz.
Abhyavarana shakti: Intake capacity Jarana Shakti: Digestive capacity
i. Vyayama shakti: Strength of the patient is examined by his exercising or normal
working capacity.
j. Vaya: Age group of the patient.
6. Pramana pariksha:
Trividha pariksha: Aaptopadesha, Prayaksha, Anumana
Chaturvidha pariksha: Aaptopadesha, Pratyaksha, Anumana, Yukti
a. Aaptopadesha pariksha:
Examination of the patient on basis of aaptavachana such as involvement of dosha-
dushya, aggravating factors, how the disease is manifested, prognosis, complications,
nomenclature of disease etc.
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b. Pratyaksha pariksha:
Direct observation of examination by sense organs like panchagyanendriya pariksha
or darshana-sparshana pariksha etc.
c. Anumana pariksha:
Examination of the patient with the help of inference.
e.g. examination of agni by observing pachana shakti
examination of bala by vyayama shakti
It helps to examine and diagnose those conditions which cannot be observed directly.
d. Yukti pariksha:
The physician has to use his skill and specification of circumstances such as desha,
kala, etc. to plan the treatment by observing all the tests and effect of treatment.
ROGA PARIKSHA
Roga pariksha plays important role in the diagnosis as well as treatment, with the help of
nidana pachaka the disease is examined and then treatment is planned on the basis of bheda,
bala, sadhyasadhyata etc.
Nidana panchaka:
1. Nidana 3. Rupa 5. Samprapri
2. Poorvarupa 4. Upashaya
These are called nidana panchaka because of their utility in the diagnosis and being 5 in
number.
1. Nidana (Hetu):
The causative factors of the diseases are called nidana.
It has various synonyms such as hetu, nimita, aayatana, karana etc.
It has various classifications→
Two types → a. Bahya hetu e.g. Mithya ahara vihara
b. Aabhyanta hetu e.g. Dosha-dushya samurchana
a. Utpadaka hetu: produces disease directly
b. Vyanjana hetu: Aggravating factors of disease
a. Anubandhya hetu: Primary cause
b. Anubandh hetu: Secondary cause
Three types → a. Asatmendriyartha samyoga: Improper use of sense organs

b. Pragyaparadha: Sinful acts
c. Parinama: Seasonal imbalance
Four types → a. Sannikrushta hetu: nearest cause – such as dosha prakopa according to day,
night, before & after food etc.
b. Viprakrusta hetu: distant or slow cause – such as kapha sanchaya in
hemanta rutu is responsible for kapha prakopa in vasant rutu.
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c. Vyabhichari hetu: Weak cause – the etiological factors those produce
disease when get favourable conditions.
d. Pradhanika hetu: Powerful cause – such as poison that manifests disease
immediately.
Imporatance →
Avoiding the etiological factors is the first line of treatment for all the diseases so nidana not
only helps in diagnosis but also helps in prevention and treatment of disease.
2. Poorvarupa:
पूवरू
म पं प्रागुत्पतत लक्षणं व्याधे |
Before complete manifestation of disease, the pre clinical symptoms of prodromal symptoms
are called poorvarupa.
It has two types
a. Samanya poorvarupa:
Jvara samanya poorvarupa – shrama, arati, vivarna, vairasya
b. Vishesha poorvarupa:
Jvara vishesha poorvarupa - Jrimbha in vataja jvara
Nayanadaha in pittaja jvara
Annaanabhilasha in kaphaja jvara
Importance → At the stage of sthana samshraya, the prodromal symptoms arise and indicate
the upcoming disease, so poorvarupa helps in diagnosis as well as prevention and treatment
of disease at early stage.
3. Rupa:
व्याधे: स्वरुपम ् व्यक्तं तद् रूपम ् |
Signs and symptoms of disease are called rupa.
It has two types →
a. Samanya rupa: General symptoms of disease.
b. Vishesha rupa: Specific symptoms of different types of disease – vataja, pittaja etc.
Importance →
For proper diagnosis the physician must have knowledge of clinical features of the disease.
4. Upashaya:
Therapeutic tests with use of relieving factors of the disease such as medicines, food &
activities are called upashaya. The aggravating factors are called anupashaya.
Upashaya has 18 types →
Aushadha Anna Vihara
Hetu viparita Hetu viparita Hetu viparita
Vyadhi viparita Vyadhi viparita Vyadhi viparita
Hetu-vyadhi viparita Hetu-vyadhi viparita Hetu-vyadhi viparita
Hetu viparitarthkari Hetu viparitarthkari Hetu viparitarthkari
Vyadhi viparitarthkari Vyadhi viparitarthkari Vyadhi viparitarthkari
Hetu-vyadhi viparitarthkari Hetu-vyadhi viparitarthkari Hetu-vyadhi viparitarthkari
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Importance → Both the upashaya & anupashaya helps in the diagnosis of goodha linga
vyadhi (diseases of complex symptoms).
5. Samprapti:
The mechanism by which the doshas get vitiated and pathways through which they produce
the disease are called samprapti / jati / aagati.
It has 6 types →
a. Sankhya: Number of types of disease e.g. asta jvara, pancha gulma
b. Pradhanya: Predominant dosha in particular disease denoted by tara, tama.
c. Vikalpa: Anshansh kalpana or prakupita dosha that means the aggravated qualities of
dosha such as guru – laghu, snigdha – ruksha etc.
d. Bala: Strength of the disease
e. Kala: Relation of disease with time variations such as day, night, seasonal changes,
before and after food etc.
f. Vidhi: Subtypes of disease other than number e.g. Urdhwaga & adhoga raktapita,
nava jvara, punaravartaka jvara, mruda bhakshana janya pandu etc.
As the kriyakala also gives knowledge of pathogenesis of the disease, the shad kriyakala are
also considered as types of samprapti itself.
Importance →
Treatment is nothing but to break the pathogenesis of the disease.
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2. Importance of Kriya Kaala according to stages of Dosha and their

management.
Disease is not a state; it is rather a process of changing manifestations, involving different

stages. The physician must have knowledge of different stages of a particular disease for its
prevention and cure. In Ayurveda, the diiferent stages of the pathogenesis of diseases are
described as kriyakala.
सञ्चयं च प्रकोपं च प्रसिं स्थानसंियम ् |
व्यक्क्तं िेिं च यो वेवि िोषाणां स िवेतद्भषक् || (स.ु स.ु 21/36)
There are six stages of the pathogenesis →
1. Sanchaya 3. Prasara 5. Vyakti
2. Prakopa 4. Sthanasamsraya 6. Bheda
Who has the knowledge of all these stages is called physician.
These stages (avastha) suggest the physician what action (kriya) should be taken to prevent or
cure the disease, and that is why these are called kriyakala.
1. Sanchaya:
Dosha-vriddhi in its own place is called chaya.
Accumulation of doshas first takes place in their normal seats of predominance.
Mainly two types
a. Svabhavika:
• Naimitika (Rutu janya)
• Avasthika (Ayu janya)
b. Asvabhavika:
• Asvabhavika
• Asatmendriyartha samyoga janya
As soon as this accumulation starts, it is reflected in the mind in the form of a desire for the
qualities opposite to those of the particular dosha and the patient develops hatred for
substances having similar qualities of the accumulated dosha.
Doshanushar lakshana:
Vata dosha sanchaya → Stabdhata, purnakosthata
Pitta dosha sanchaya → Pitta avabhashata, Mandoshmata
Kapha dosha snachaya → anga gauravta, aalashya
2. Prakopa (Aggravation of doshas):

‘ववलयन रूपा ववृ धः प्रकोप’ dosha vriddhi with its excitation or aggravation is called prakopa.
Doshanushar lakshanas:
Vata prakopa → Koshtha toda, vayu sancharan
Pitta prakopa → Amlodgara, pipasa, paridaha
Kapha prakopa → Aruchi, hrillash
Aggravation of doshas are of two types viz.
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Chaya purvaka prakopa
Achaya purvaka prakopa
3. Prashara (Spread of aggravated doshas):

If the earlier stage is not treated, then the aggravated doshas expand and overflow just like
starch with yeast, when socked in water for overnight, it gets fermented and rises up in its
vessel.
In prashara avashta the doshas start expanding, overflowing from their seats, and spreading to
other parts of the body.
Doshanushara prashara lakshana:
Vata prashara → Vayu vimarga gamana, aatopa
Pitta prashara → Chosha, paridaha, dhumayana
Kapha prashara → Aruchi, Angasada, chhardi
There are 15 types of prashara of aggravated dosha.
4. Sthana samshraya (localization of the aggravated doshas):

The aggravated doshas circulating in all over the body during prashara avastha, if not treated
properly, then advance to next stage and get settled or localized in a part of body, where they
find favourable condition or vitiated srotas.
This stage of disease gives rise to prodromal symptoms. (Poorvarupa).
Prakupita dosha gets sthana samshraya in different locations producing different types of
diseases.
e.g. Udara gata → Gulma, Vidradhi, Anaha etc.
Basti gata → Prameha, Ashmari, Mutradoshas etc.
Medo gata → Granthi, Apachi, Arbuda etc.
Pada gata → Shlipada, Vatarakta etc.
5. Vyakta (Manifestation of signs and symptoms of disease):

Later on dosha-dushya-samurchana gets complted and the complete manifestation of signs
and symptoms of the disease takes place.
If the disease is not treated in purvarupa avastha it advances to roopa avastha.
e.g. Jvara lakshana → Increase body temperature
Atisara lakshana → Excessive passage of watery stool
6. Bheda (Chronicity or differentiation of disease):

After some time of the disease process continues then the disease becomes chronic, and the
physician can differentiate the exact types of dosha vitiation.
If this stage is not treated properly, then complications may occur and disease becomes
incurable.
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Importance of kriyakala:
1. ‘कियाकालो चचककत्सा अवसिः’ the knowledge of stages of disease provides
opportunity to prevent it in earlier stage or treat it properly.
2. Kriyakala helps to understand the progress of dieases as well as to plan suitable
preventive measures.
3. If the physician skips the earlier stage due to any reason and disease progress to later
stage, then also he can treat the disease and stop it to progress further with the help of
kriyakala.
4. Different stages require different types of treatment measures those should be applied
to the respective stages only →
a. Sanchaya avastha → Roga anushara chikitsa
b. Prakopa avastha → Hetu viparita chikitsa
c. Prasara avastha → Hetu viparita chikitsa
d. Sthana samshraya chikitsa → dosha & dushya chikitsa
e. Vyakta avastha → Vyadhi vishista chikitsa
f. Bheda avastha → Jirna vyadhi vishista chikitsa
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3. Chikitsa sutra and Management of vriddhi (increased) and kshaya

(decreased) of Dosha, Dhatu and Mala, Ojo Vyapat (Kshaya, Visramsa
and Vyapat) and its management. Chikitsasutra and Management of
Sama-Nirama states, Roga-Anutpattikara Chikitsa, Roga Prashamana
Chikitsa (Doshapratyanika, Vyadhipratyanika, Ubhayapratynika),
Doshopakrama, Chikitsa sutra and Management of Sthanantara Dosha
(Ashayapakarsha, Anuloma/Pratiloma gati of Dosha, Vimarga gamana
of Dosha), Knowledge of Lina Dosha & its management, Diagnosis,
Chikitsa Sutra and Management of Avarana and of Dhatu Pradoshaja
diseases, Importance of Dosha, Dushya , Bala, Kaala, Agni, Prakriti,
Vaya, Sattva Satmya, Desha, Ahara and stage of diseases in treating
them. Chikitsa Sutra and Management of ‘Samanyaja and Nanatmaja’
diseases.
CHIKITSA SUTRA AND MANAGEMENT OF VRIDDHI AND KSHAYA OF

DOSHA, DHATU & MALA
Samanya nidana of dosha-dhatu-mala kshaya

सवमिा सवमिावानां सामान्यम ् ववृ धकािणम ् |
ह्रासहे तु ववशेषि ........ ||
Indulgence in the foods & activities of similar qualities results in vriddhi, whereas the foods
& activities of dissimilar qualities results in kshaya.
Dosha vriddhi kshaya lakshana avum chikitsa:

1. Vata dosha:
Vriddhi:
कार्शयमकार्षण्योर्षणकामत्वकम्पानाहशकृद्ग्रहान ्|
बलतनरे त्न्रयभ्रंशप्रलापभ्रमिीनताः||६||
Kshaya:
भलङ्गं क्षीणेऽतनलेऽङ्गस्य सािोऽल्पं िावषतेदहतम ्|
संज्ञामोहस्तथा श्लेर्षमवध
ृ युक्तामयसम्िवः||१५||
Vata upakrama:
Samanya chikitsa:
To maintain the health of a patient, the physician should increase the decreases dosha, or
decrease the increased dosha to bring the equilibrium state of dosha, with respective
treatment measures.
In case of vriddhi, the physician should use vishesha chikitsa → as the foods and activities of
dissimilar qualities of dosha, dhatu and mala cause kshaya and bring it to normal state.
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In case of kshaya, the physician should use samanya chikitsa → As the foods and activities of
similar qualities of dosha, dhatu and mala cause vriddhi and bring it to normal state.
Vishesha chikitsa:
1. For vata vriddhi:
Snehana, swedana then after mridu samshodhana
Anuvasana & niruha basti
Nasya, Gandusha, Dhumapana
Shirobasti, abhyanga
Madhur-amla-lavana rasa yukta ahara
Ushna-snigdha ahara
Vata shamaka dravya prayoga like tila taila, dashamula, rasna, eranda, nirgundi, bala,
ashwagandha etc.
2. For vata kshaya:
Katu, Tikta, Kashaya rasa yukta aahara.
Ruksha, laghu, shita ahara
Ratri jagaran, vyayama, chinta
Vatavardhaka dravya prayoga like mudga, jangal mamsarasa etc.
2. Pitta dosha:
Vriddhi:
पीतववण्मूत्रनेत्रत्वक्क्षुिड्
ृ िाहाल्पतनरताः|
वपिम ्--------------------------------|७|
Kshaya:
वपिे मन्िोऽनलः शीतं प्रिाहातनः------------|
----------------------------------------------|१६|
Pitta upakrama:
Vishesha chikitsa
1. For pitta vriddhi:
Virechana & raktamokshana
Shita pradeha, parisheka, abhyanga
Madhura, tikta, Kashaya rasa ahara
Shita dravya sevana
Kshira & ghrita prayoga like panchatikta, Chandana, ushira, hribera, mukta, pravala etc.
2. For Pitta kshaya:
Katu, amla, lavana rasa yukta ahara
Kshara, tikshana ushana virya dravya prayoga like tila, masha, kulattha, atasi, matsya mamsa
trikatu etc.
Atapa sevana, vyayama
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3. Kapha dosha:
Vriddhi:
-------श्लेर्षमाऽत्ग्नसिनप्रसेकालस्यगौिवम ्||७||
श्वैत्यशैत्यश्लथाङ्गत्वं श्वासकासातततनरताः|
Kshaya:
------------------------------------------कफे भ्रमः|
श्लेर्षमाशयानां शन्
ू यत्वं हृद्रवः श्लथसत्न्धता||१६||
Kapha upakrama:
Vishesha chikitsa:
1. For kapha vriddhi:
Svedana, vamanam shirovirechana prayoga.
Tikshna virechana
Vyayama, ruksha udvartana
Katu, Tikta, Kashaya, rasa yukta ahara
Tikshna, ushna, ruksha ahara
Kaphashamaka dravya prayoga like madhu, panchakola, trikatu, triphala, lavang, yavakshara
etc.
2. For kapha Kshaya:

Madhura, amla, lavana, rasayukta, ahara
Guru, snigdha, picchil ahara
Shita virya dravya prayoga like navanna, godhuma, ikshurasa, ksheera, dadhi, anupa mamsa
etc.
Diwaswapna
Vishrama
Harsh
Dhatu vriddhi kshaya lakshana:

Vriddhi:
Rasa:
िसोऽवप श्लेर्षमवत ्-----------------------------|८|
Rakta:
--------------िक्तं ववसपमप्लीहववरधीन ्||८||
कुष्ठवातास्रवपिास्रगुल्मोपकुशकामलाः|
व्यङ्गात्ग्ननाशसम्मोहिक्तत्वङ्नेत्रमूत्रताः||९||
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Mamsa:
मांसं गण्डाबि
ुम ग्रत्न्थगण्डोरूििववृ धताः|
कण्ठादिर्षवचधमांसं च--------------------|१०|
Meda:
-------------------------तद्वन्मेिस्तथा िमम ्||१०||
अल्पेऽवप चेवष्टते श्वासं त्स्फक्स्तनोििलम्बनम ्|
Asthi:
अस्थ्यध्यस्थ्यचधिन्तांि------------------------|११|
Majja:
--------------------------मज्जा नेत्राङ्गगौिवम ्||११||
पवमसु स्थूलमूलातन कुयामत्कृच्राण्यरूंवष च|
Sukra:
अततस्त्रीकामतां वध
ृ ं शि
ु ं शि
ु ार्शमिीमवप||१२||
Kshaya:
Rasa:
िसे िौक्ष्यं िमः शोषो ग्लातनः शब्िासदहर्षणुता|
Rakta:
िक्तेऽम्लभशभशिप्रीततभशिाशैचथल्यरूक्षताः||१७||
Mamsa:
मांसेऽक्षग्लातनगण्डत्स्फक् ऽऽशुर्षकतासत्न्धवेिनाः|
Meda:
मेिभस क्षीणे कटयाः प्लीह्नो ववृ धः कृशाङ्गता||१८|
Asthi:
अस्थ्न्यत्स्थतोिः शिनं िन्तकेशनखादिषु|
Majja:
अस्थ्नां मज्जतन सौवषयां भ्रमत्स्तभमििशमनम ्||१९||
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Sukra:
शुिे चचिात ् प्रभसच्येत शुिं शोणणतमेव वा|
तोिोऽत्यथां वष
ृ णयोमेढ्रं धूमायतीव च||२०||
Dhatu pradoshaja vikaras:

1. Rasa pradoshaja roga:
• Asraddha → disinterestedness in • Tandra → Drowsiness
everything. • Angamarda → Pains all over the
• Aruchi → Dyspepsia body
• Aasyavairasyam → Feeling of • Jwara → Fever
some abnormal taste. • Pandu → Anaemia
• Arasajnata → Inability to realise • Srotorodha → Bronchospasm
taste of food • Klaibya → Impotence
• Hrillasa → Nausea • Saada → Extreme weakness
• Gauravama → Feeling of heaviness • Agni nasha → Emaciation
of body. • Krisha angata → indigestion
Specific treatment:
िसजानां ववकािाणां सवम लङ्घनमौषधं|
For disease caused by bad foods affecting rasa dhatu, langhana treatment should be adopted,
such as fasting, exercise etc. which brings about lightness to the body.
2. Raktapradoshaja roga:
• Kustha → Skin diseases • Kamala → Jaundice
• Visarpa → Erycepelas • Vyanga → Fungal infection of skin
• Pidika → Furunculosis • Tilakalaka → Capillary
• Raktapitta → Haemorrhagic haemorrhages
disorders • Dadru → Urticaria
• Asrigdara → Menorrhagia & DUB • Charmadala → Patchy dermatitis
• Guda medhra paka → Proctitis • Switra → Vitiligo
• Pleeha → Splenomegaly • Pama → Eczema
• Gulma → Abdominal tumours • Kotha → Allergic rash
• Vidradhi → Abscess • Rakta mandala → Subcutaneous
• Neelima → Haemangioma haemorrhages
Specific treatment:
ववचध शोणणततकेध्याये िक्तजानां भिषत्ग्जतं ||
Treatment of disease caused by the vitiation of rakta is describes in 24th chapter sutrasthana –
vidhi shoniteeya adhyaya.
Jalauka prayoga, sira vyadhana
Arsenical compounds. Sariva, Manjishtha etc.
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3. Mamsapradoshaja roga
• Adhimamsa → Excessive growth • Pooti mamsa → Gangrene
of muscular tissue • Alaji → Minor cartilaginous
• Arbuda → Tumours & cancer growth
• Charma keela → Keloid • Gala ganda → Goitre
• Gala saluki → Ranula • Ganda mala → Lymphadenitis
• Gala sundika → Tonsillitis • Upajihvika → Uvulitis
Specific treatment:
For muscle tissue disorders
Samshuddhi → Panchakarma purification treatment
Shastra karma → Surgery
Kshara karma → Application of kshara
Agnikarma → cautery treatment
4. Medopradoshaja roga:
• Atisthoulya → obesity • Krichra vyavaya → sexual
• Atisweda → Excessive sweating weakness
• Aamagandha → Offensive smell of • All mamsaja rogas → Muscular
the body disorders
• Kruchraswasa → Dyspnoea on • Prameha poorva rupas like
exertion polyuria, polydipsia, burning
sensation in hands, palms & feet.
Specific treatment:
अष्टौ तनत्न्िततकेध्याये मेिोजानां चचककत्त्सतं |
The fat tissue disorder treatment is explained in 21st chapter of sutrasthana – Ashtau
ninditeeya adhyaya.
Treatment protocol:
Sthaulyahara chikitsa
Silajit, guggulu, takra
Lasuna, kulattha, musta
Vyayama
5. Asthi pradoshaja roga:

• Adhi asthi → Exostosis • Vivarnata → Contusion
• Adhi danta → Extra tooth • Kesha roma nakha samsru roga →
• Danta vedana → Tooth ache Diseases of hair, nails, moustache
• Asthi shoola → Pain in bones &
joints
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Specific treatment:
अस्थ्याियाणां व्याधीनां पञ्चकमामणण िेषजं ||
For diseases of bone tissue, panchakarma treatment especially basti with, ghee and bitter
herbs is useful.
6. Majjapradoshaja roga:
• Parva vedana → Pain in small • Tamodarshana → Blurring the
joints vision
• Bhrama → Vertigo • Aroomshika → highly inflamed
• Moorcha → Fainting swelling
• Parvaja pidikas → Ganglion cyst
Specific treatment:
वस्तय: क्षीिसपीभस ततक्तकोपदहतातन च |
Vastikarma
Ksheera + Ghrita ana
Treated with tikta rasa dravyas
e.g., pancha tikta guggulu ghritam
7. Shukrapradoshaja roga:
• Klaibya → Impotence • Even if he gets a child, he will be
• Aharshanam → Lack of libido impotent, alpayu, kurupa.
• His wife suffers from repeated
abortions.
Specific treatment:
शुिसमुत्थानामौषधं स्वाितु तक्तक ||
Sukra sodhana
Pancha karma
Vaajikarana chikitsa
Mala vriddhi kshaya lakshana:

1. Purisha:
Vriddhi:
कुक्षावाध्मानमाटोपं गौिवं वेिनां शकृत ्|
Abdominal sounds and distension.
Kshaya:
पिु ीषे वायिु न्त्राणण सशब्िो वेष्टयत्न्नव|
कुक्षौ भ्रमतत यात्यूध्वां हृत्पाश्वे पीडयन ् िश
ृ म ्||२१||
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Air movement in gut in upward with gurgling, severe discomfort in the heart region and the
sides.
Chikitsa:
Vriddhi chikitsa → malavirechaka & vibandhahra prayoga
Kshaya chikitsa → Yava, masha, kulmasha, shaka, dhanyamla aadi malavardhaka dravya
prayoga
2. Mutra:
Vriddhi:
मूत्रं तु बत्स्ततनस्तोिं कृतेऽप्यकृतसंज्ञताम ्||१३||
Acute pain in bladder and feeling of incomplete emptying after urination.
Kshaya:
मूत्रेऽल्पं मूत्रयेत्कृच्रादद्ववणां सास्रमेव वा|
Decrease in urine output, difficulty in urination and blood in urine.
Chikitsa:
Vriddhi → gokshuradi mutrala or mutravirechaniya dravya prayoga
Kshaya → Ikshurasa, Varuni manda, drava-madhura-amla-lavana mutravardhaka dravya
prayoga
3. Sweda:
Vriddhi:
स्वेिोऽततस्वेििौगमन्ध्यकण्डूः------------------|
Bad odour and itching
Kshaya:
स्वेिे िोमच्युततः स्तब्धिोमता स्फुटनं त्वचः||२२||
Stiffness and loss of hair and breaking of skin.
Chikitsa:
Vriddhi chikitsa → pitta shamaka dravya, panchatikta ghrita guggulu prayoga
Kshaya chikitsa → abhyanga paschat swedana dravya prayoga.
OJO VYAPATA AND ITS MANAGEMENT

Ojas:
ओजस्तु तेजो धातन
ू ां शि
ु ान्तानां पिं स्मत
ृ म |
Ojas is the essence of formed of all the saptadhatu and it is formed after the sukradhatu.
It is also called chala or prakruta shleshma.
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Oja sthana → Hridaya
Oja prakara → Para oja → Asta bindu pramana & hridaya gata
Apara oja → Ardha Anjali pramana & sarva shareera gata
Oja guna → गुरु शीतं मि
ृ ु शलर्षणं बहलं मधुिं त्स्थिं |
प्रसन्नं वपत्च्िल त्स्नग्ध ओजो िशगुण स्मत
ृ म ||
Oja karma → प्राकृतस्तु बलं श्लेर्षमा |
Ojas is responsible for the natural strength of the body.
Its functions are → to nourish the body, to provide strength and immunity, to make voice and
complexion pleasant, to support life by residing in hridaya pradesha. Loss of ojas leads to
death.
Ojo dushti:
Nidana:
Ruksha & alpa ahara
Kshudha, ati-vyayama, swapna viparyaya
Chinta, krodha, shoka, bhaya
Dhatu kshaya
Abhighata
Jeerna vayu
Types:
There are three types of ojavaha sroto dusti viz.
1. Ojo visramas: Displacement of ojas from its normal.
2. Ojo vyapata: vitiation of ojas due to dusta dosha and dushya.
3. Ojo kshaya: Decrease of ojas in its normal quantity.
Ojo visramas lakshana:

Sandhi vishlesh (looseness of joints)
Gatra sadana (Weakness of body)
Dosha chyavana (Displacement of doshas)
Kriya sannirodha (Impairment of activities)
Ojo vyapada lakshana:

Stabdha guru gatrata (stiffness & heaviness in body)
Vata shoka (Swelling due to vata)
Varna bhedo (Discoloration or loss of complexion)
Glani (Exhausion)
Tandra & nidra (Drowsiness and excessive sleep)
Ojokshaya lakshana:
Murcha (fainting)
Mamsa kshaya (Muscle wasting)
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Moha (Unconsciousness)
Pralapa (Delirium)
Marana (Death)
Chikitsa:
In case of vitiation of ojovaha srotas, the physician should use hradhya & oho anukula
vishesha kriya
Madhura, snigdha, sheeta virya, laghu, jivaniya gana, balya, rasayana, ojo vardhaka dravya
prayoga
Nitya godugdha & goghrita sevana
Pathya ahara & Vihara sevana
Harsha & achinta
In ojo kshaya avastha:

Rasayana chikitsa is specific to improve ojas. After proper sodhana and snehana, swedana the
rasayanas like chyavana prash, brahmi rasayana, siddha makaradhwaja, jeevaniya dravyas,
ksheera, phala rasas etc. should be used.
The best way to improve ojas is brahma charya and achara rasayana (virtuous and pure code
of conduct)
CHIKITSA SUTRA AND MANAGEMENT OF SAMA-NIRAMA STATES

Sama-Nirama status:
Aama:
Reduced digestive activities lead to production of improper formed or uncooked first dhatu.
This undigested and harmful toxic waste product gets accumulated in stomach which is
known as aama.
Aamadosha hetu:
a. Aharaja →Abhojana, Ajeerna bhojani, Akala bhojana, Ati bhojani, Asatmya &
Viruddha ahara sevana etc.
b. Viharaja → Diwaswapna, Aalasya. Vegadharana etc.
c. Mansika → Shoka, tamoguna pradhanata etc.
d. Anya nidana → Snehana mithyayoga
Vamana-virechana mithya yoga
Rutu vishamata
Aama lakshana:
Mala vishtambha, Stambha, Anga sadana, Sirah shula, jrimbha, anga marda, Trishna, chhardi,
pravahika etc.
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Aamaja roga:
Aalasibhut aama → alashaka
Vilambita aama → Vilambika
Urdhwa adha pravruta aama → Vishuchika
Drava Bahula aama → Atisara
Kapha pradhana aama → Aamajeerna & Pravahika

Pitta pradhana aama → Vidagdhajeerna, amlapitta, bhashmaka roga
Vata pradhana aama → Vishtabdhajeerna, Grahani roga
Shesh rasajanya aama → Rasashesha jeerna
When any element of the body is associated with aama, it will be called saama.
When not associated with aama.
Sama-Nirama samanya lakshana:

Saama dosha:
स्रोतोिोधबलभ्रंशगौिवातनलमूढताः||२३||
आलस्यापक्क्ततनष्ठीवमलसङ्गारुचचक्लमाः|
भलङ्गं मलानां सामानां, तनिामाणां ववपयमयः||२४||
Saama-Nirama dosha lakshana:

Sama vaata → Vibandha, agnimandhya, tandra, aantra kunjana, vedana
Nirama vaata → Vishada ruksha vayu, nirvibandha, alpa vedana, tvaka shyamata
Sama pitta → Durgandhi, harita shyama varna, amla, ghana, pitta, hriddaha
Nirama pitta → Tamra pitta varna, katu, asthira, vigandhi, balavardhaka pitta
Sama kapha → Aavila, Tantu, Durgandhi, Kshudha nashaka

Nirama kapha → Fhenavan, pandita, pandu, agandha
Sama-Nirama dhatu lakshana:

Sama dhatu lakshana → dhatu pradoshaja vikara
Nirama dhatu lakshana →
प्रीणनं जीवनं लेपः स्नेहो धािण पूिणे |
गिोत्पािि धातन
ू ां िेष्ठ कमम िमात ् स्मत
ृ म ||
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Aama chikitsa:
Apatarpana chikitsa is best for treatment of ama pradoshaja vikaras.
Acharya charaka has mentioned three types of apatarpana treatment.
अपतपमणमवप च त्रत्रववधं – लङ्घनं पाचनं िोषावसेचनं चेतत |
1. Langhana:
Fasting, or use of light foods such as peya, vilepi, mudga yusha etc.
For those patients who have alpadosha or alpabala
2. Pachana:
Along with langhana or upavasha, use of digestant such as chitraka, musta, trikatu etc.
For those patients who have madhyama dosha or madhyama bala.
3. Doshavasechana:
Purificatory procedures for elimination of the aggravated dosha in those patients who are
balawan or having bahudosha.
Aamadosha nashaka aushadha yoga:

• Agnitundi rasa • Shankha vati
• Ajeerna kantaka rasa • Chitrakadi vati
• Panchakola churna • Rasona vati
• Trikatu churna • Dashamoolarista
• Lavanabhaskar churna • Kumaryasava
• Hingwashtaka churna • Dhanyapanchaka kwatha
• Ajamodadi vati • Chitrakadi ghrita
ROGA ANUTPATTIKARA CHIKITSA

Aayurveda prayojana:
प्रयोजनं चास्य स्वस्थस्य स्वास्थ्यिक्षणं आतुिस्य ववकािप्रशमनं च |
The aims of ayurveda are –
1. Prevention of disease
2. Cure of disease
To prevent the disease, physician should use roganutpatikara chikitsa (preventive treatment),
and to cure the disease rogaprashamana chikitsa (curative treatment).
िोगानुत्पततकि → िोग + अन ् + उत्पवि कि
The treatment that prevents the occurrence of disease is called roga anutpattikara chikitsa.
It is preventive treatment which includes
1. Sadvruta palana
2. Swasthavruta palana
3. Rasayana vajikarana prayoga
1. Sadavrutta:
To follow good conduct and avoid the sinful acts.
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2. Swasthavruta palana:
a. Dincharya palana:
To follow the daily regimen such as waking up in brahma muhurta than after shaucha karma
– dantadhavana, jihwanirlekhana, Anjana, pratimarsha nasya, gandusha – kavala, dhumapana,
abhyanga, snana, swachchha vastra dharana etc.
b. Ratri charya:
To follow night regimen such as avoiding the ahara, maithuna, nidra, Adhyayan in the
evening. And to follow right methods of bhojana and shayana in the night.
c. Rutu charya palana:
To follow the seasonal regimen such as hemanta, shishira, Greeshma, varsha, sharada
rutucharya
The physician should use seasonal purificatory procedures and advice regimens to avoid
aggravation of respective doshas.
d. Yoga:
To practice yoga, asana, pranayama, dhyana etc.
3. Rasayana & Vajikarana prayoga:

Rejuvenatives & Aphrodisiac
ROGA PRASHAMANA CHIKITSA

The imbalance of dosha and dushya is roga.
Dhatuvaishamyata or dosha vaishmya is treated by application of rogaprashaman chikitsa.
The treat disease which is produced by dhatu vaishmyata, physician must bring dosha / dhatu
samyata (i.e., equilibrium state of dosha and dhatu)
It is achieved by following measures
a. Shodhana chikitsa (purificatory treatment)
b. Shamana chikitsa (palliative or pacifying treatment)
Dosha pratyanika chikitsa in sanchaya, prakopa, prasara avastha:

e.g., Kampavata is due to the increased chala guna of vata, whereas pakshaghata is due to
margaavarodha of vaata. Atikarshya is dry to rooksha and laghu gunas of vata. Thus, the
physician must use his brain in treating the sama vata, but with three different gunas leading
to three different dosha pratyaneeka dravyas.
Chikitsa:
Nidana parivarjana
Dosha shodhana-shamana
Dushya samavastha chikitsa
Srotoshodhana
Agni samavastha by dipana pachana
Hetu viparita chikitsa
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Nanatmaja vikara chikitsa
i.g. vata hara → Taila-vastikarma, Eranda
Pitta hara → Ghrita, virechana, Usheera
Sleshma hara → Vamana, madhu, bhallataka
Vyadhi pratyanika chikitsa:

In vyakta & bheda avastha patient should treated with vyadhi pratyanika chikitsa.
Chikitsa:
Deva vyapashraya chikitsa
Satvavajaya chikitsa
Adravyabhuta chikitsa
Shalya chikitsa
Shamshaman chikitsa with rasa, bhasma, asava, arista etc.
Mahakashaya prayoga – like jwaraghna, kashaghna.
Dravya prayoga which work with prabhav like in krimija roga → Vidanga
In Kushtha → Khadira
e.g., jwara – musta, parpata
chhardi – Lajja
prameha – haridra
pandu roga – loha bhasma
pleeha roga – pippali
medo roga – guggulu
atisara – kutaja
Netra rogas – triphala
Ubhaya pratyanika chikitsa:

The physician should hit the disease from these both angles viz. dosha and vyadhi for
effectiveness of treatment.
e.g., jwara + pittahara → shadanga paniya
grahani + kapha → kravyada ras
grahani + pitta → pravala panchamritta
arsha + raktapitta → kutaja
arsha + vatakapha → bhallataka
kushtha + pitta → sariva
kushtha + kapha → bhallataka
DOSHOPAKRAMA
1. Vata dosha upakrama:
वातस्योपिमः स्नेहः स्वेिः संशोधनं मि
ृ ु |
स्वाद्वम्ललवणोर्षणातनिोज्यान्यभ्यंगमिमनम ् ||
a. Shodhana → snehana, Swedana, mrudu sanshodhana, niruha basti, anuvasana basti,
snigdha – ushna basti, matra basti, nasya karma, dhumapana, shirobasti, gandusha etc.
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b. Shamana → abhyanga, mardana, veshtana, utsadana, upanaha, ushna parisheka etc.
c. Ahara & aushadha → madhura – amla – lavana rasayukta, ushna & snigdha ahara,
dipaniya, pachaniya, vatashamaka ahara, vrushya & balya dravya sevana, mamsa rasa,
taila, godhuma, navanna, dashamula, rasna, Eranda, Nirgundi, arka, haridra, bala,
ashwagandha, lashuna etc.
d. Vihara → atapa sevana, ushna jala avagahana, pravara, mriga charma, vishmapana,
vishmarana, hemanta rutucharya palana etc.
Among all above measures, niruha basti and anuvasana basti are the best, and among all
dravyas taila is best to mitigate the prakupita vata.
2. Pita dosha upakrama:

वपतस्य सवपमषः पानं स्वािश
ु ीतैवविे चनम ् |
स्वाितु तक्तकषायाणण िोजनान्यौषधातन च ||
a. Shodhana → snehana, virechana, raktamokshana etc.
b. Shamana → shita pradeha, parisheka, abhyanga etc.
c. Ahara & aushadha → madhura – tikta – kashaya rasa pradhana & pittahara dravya
siddha ghrita prayoga, ksheera pana, shitala hradhya sugandhita ahara, jangala
mamsarasa, Pitashamaka dravya prayoga e.g., panchatikta, chandana, ushira, mukta,
pravala, yashtimadhu etc.
d. Vihara → shitala & manoanukula vihara, pradeha, parisheka, mukta mani dharana,
shita vayu sevana, bhoo gruha, chandra kirana sevana, jalashaya & udhyana vihara,
sugandhita vihara, stree sparsha, karpura chandana ushira lepa, manoanukula geeta,
vadhya yantra, sharada rutucharya palana etc.
Among all above measures, virechana karma is the best, and among all the dravyas ghrita is
best to mitigate the prakupita pitta.
3. Kaphadosha upakrama:
श्लेर्षमणो ववचधना युक्तं तीक्ष्णं वमनिे चनम ् |
अन्नं रुक्षाल्पतीक्ष्णोर्षणं कटुततक्तकषायकं ||
a. Shodhana → Swedana, tikshna – ushna sanshodhana (vamana, virechana,
shirovirechana, gandusha etc.)
b. Shamana → ruksha unmardana, ruksha udavartana, utsadana, upanaha, ushna snana
etc.
c. Ahara & aushadha → katu – tikta – kashaya rasa pradhana, tikshana, ushna, kshara,
ruksha ahara & aushadha, medoghna upachara, Kaphashamaka dravya prayoga e.g.,
madhu, panchakola, trikatu, yavakshara etc.
d. Vihara → laghu vyayama, jala avagahana, chankramana, stree sevana, upavasa
(langhana), ratri jagarana, chinta, ushna sthana nivasa, vasanta rutucharya palana etc.
Among all above measures, vamana karma is the best, and among all the dravyas madhu is
best to mitigate the prakupita kapha.
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CHIKITSA SUTRA AND MANAGEMENT OF STHANANTARA DOSHA
(ASHAYAPAKARSHA, ANULOMA/PRATILOMA GATI OF DOSHA, VIMARGA
GAMANA OF DOSHA)
Sthanantara dosha:
When aggravated, a single dosha may cause various diseases, depending upon the various
etiological factors and sites of manifestation even if the sama or prakruta dosha gets displaced
or moves to other place, under the influencer of vayu, it results in vatadi dosha vriddhi of that
place, and causes various diseases. This displaced dosha is called sthanantara dosha.
Sthanantara gata dosha chikitsa:

Generally, treatment should be adopted according to sthana.
For example,
In case of pitta sthana gata vata, treat the pitta
In kaphasthanagata pitta treat the kapha
In vata sthanagata kapha treat the vata.
Dosha gati:
Movement of dosha is called dosha gati. All the movements and activities in the body, take
place due to vata. Vata is key force behind the physiological & pathological movement of
body elements
वपतं पंगु कफं पंगु पन्गवो मल धातव: |
वायुना यत्र नीयन्ते तत्र गच्ित्न्त मेघवत ् ||
Gati of vayu is provided by its chala guna.
Gati of pitta is provided by its drava and sara guna.
Gati of kapha is inhibited by its sthira guna but can be movable at times owing to its guru
guna.
उध्वम चाधि ततयमक्च िोषाणां त्रत्रववधा गतत |

त्रत्रववधा चापिा कोष्ठशाखाममामत्स्थसत्न्धषु ||
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1. Kostha → Original abhyantara rogamarga
2. Twak & raktadi dhatus → Bahya Roga marga
3. Marma & Asthi sandhi → Madhyama roga mara
In ‘kiyanta sirsiya adhyaya’ maharshi charaka illustrated trividha dosha gati. i.e., kshaya-
sthana-vriddhi, urdhwa-adha-tiryaka, shakha- kostha-marmasthisandhi
Ayurveda aims at the prevention of health and it also aims at curing the ill health. We cannot
determine the nature of health without acknowledging the dosha gati but a minor conceptual
reflexion of dosha gati.
All gati narrated here are pointed specifically with different aspects and are related to each
other.
Urdhwa-adha-tiryaka gati is reciprocal of vriddhi gati. Tiruaka gati is like sakha
koshtha gati. Vaishyam or imbalance is defined as vriddhi and kshaya. The balance termed as
sthana. Kshaya-sthana-vriddhi gati is related to both health and unhealthy conditions.
Charaka acharya enriched ayurveda with the knowledge of doshagati.
Its diagnostic and therapeutic usefulness with entirety is mentioned in ayurvedic classics.
Health can be summarized as prakrut gati of doshas and vikruta gati defines illness.
We cannot determine the nature of health without accounting doshagati.
The proper knowledge of doshagati helps us to modify the daily & seasonal region.
Diagnosis and treatment of any disease cannot be complete without considering doshagati.
So, knowledge of doshagati is very important in present era and in practice also.
Ashayaprakarshak hetu:
Under the influence of aggravated vata displacement of movement of normal dosha to other
places, which results in manifestation of various diseases, is also called ashayaprakarshak
hetu.
Example:
Vata getting aggravated and pulls the prakrita pitta from its site and carried it all through the
body. This pitta will cause inflammation and corrosion due to its hot nature wherever it goes.
Though pitta is normal, it becomes a foreign substance while travelling and reaching another
place. Such pitta which gets pulled from its place is called ashayapakrishta pitta.
Treatment:
Controlling the vitiated vata rather than giving treatment of expel pitta when vata has been
brought under control pitta back naturally to its place.
Therefore, the key strategies of intervention as far as ashayapakarsha is concerned is – Vata
prashamana, Ashayapakrushta dosha sthapana.
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KNOWLEDGE OF LINA DOSHA & ITS MANAGEMENT, DIAGNOSIS
Lina dosha:
लीनभमतत अनुत्त्क्लष्टं |
Hidden or secretly accumulated doshas are called lina doshas.
Lina dosha are those which are stuck in their place, not showing prominent feature, and
cannot be eliminated easily by shodhana like vamana-virechana etc.
Lina doshas do not show prominent features but they produce various chronic diseases.
Lina dosha chikitsa:

Lina dosha should not be eliminated forcefully otherwise it can lead to destruction of their
sites just as extraction of juice from unripe fruit.
There doshas should be aggravated first and then eliminated with the help of suitable
purificatory procedures.
If aama is hidden in intestines, then the patient should be given purification mixed with
appetizers.
CHIKITSA SUTRA AND MANAGEMENT OF AVARANA AND OF DHATU

PRADOSHAJA DISEASES
Avarana:
Avarana is a unique concept in Ayurveda.
It is a condition which has been explained in the context of vata disorders.
Avarana means covering, enveloping or enclosing. In this condition the ‘free flowing’ and all
‘all pervading’ vata is obstructed and enveloped by pitta, kapha, tissues, food and excreta.
This obstructed vata causes many disorders. These diseases are called avaranajanya vyadhis.
Components of avarana:
Avaraka → that which covers vata and obstructs it.
Avruta → that which is covered, vata in this instance
Avarana → the entire pathological mechanism wherein an avaraka will cover and block the
avruta is called as avarana.
Mechanism:
Pitta / kapha block vata → Vata gets disturbed and it wants to escape → Being powerful and
having mobility and minuteness this vata pushes the pitta and kapha to make its way. →
These pitta and kapha are mobilized into the susceptible tissues → Pitta and kapha get lodged
in the tissue and cause pitta or kapha symptoms respectively. → But the mechanism is
initiated by vata itself. Therefore, even after being subjected to avarana, vata has control over
the pathogenesis. It is authoritative. → The vitiated vata throws the pitta and kapha here and
there i.e., into the susceptible tissues and causes the disease therein.
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Types of avarana:
Doshavruta vata → 13
Dhatu, anna, malavruta vata → 9
Anyonyavarana → 20
When vata gets obstructed by components of body inclusive of pitta, kapha, tissues, food,
urine and faeces, 22 types of avarana occur.
Pitta obstructing vata → 1
Kapha obstructing vata → 1
Obstruction of vata by tissues other than rasa i.e., by blood, muscle, fat, bone, bone marrow
and semen and by all tissues together → 7 types
Obstruction of vata by food → 1
Urine obstructing vata → 1
Faeces obstructing vata → 1
Pitta obstructing 5 vata subtypes → 5
Kapha obstructing 5 vata subtypes → 5
Examples:
Pittavruta vata:
When pitta blocks vata, the below mentioned symptoms are manifested:
Daha → Burning sensation
Trushna → Thirst
Shoolam → Pain, Colic, Spasms
Bhrama → Giddiness
Tama → Feeling as if surrounded by darkness
Sheeta kamita → Liking towards cold comforts.
Kaphavrut vata:
When vitiated kapha obstructs vata, below mentioned symptoms are manifested:
Coldness
Heaviness in body
Pain
Symptoms reduce on consumption of pungent, sour, salt tastes
Desire to starve, eat light foods, exercise, to consume dry and hot foods and comforts
Anyanya avaranas:
When one subtype of vata obstructs another subtype of vata, we get 20 types of avaranas.
Prana vata obstructing other four subtypes of vata
Udana vata obstructing other four subtypes of vata
Samana vata obstructing other four subtypes of vata
Vyana vata obstructing other four subtypes of vata.
Apana vata obstructing other four subtypes of vata.
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Examples:
Pranavruta vyana
When prana vayu obstructs or intervenes with the functions of vyana vayu, the below
mentioned symptoms are manifested.
Sarva indriyaanam shoonyatvam
Smruti kshaya
Bala kshaya
Urdhwa jatruka chikitsa should be conducted.
Vyanavruta prana:
When vyana vayu obstructs or intervenes with the functions of prana vayu, the below
mentioned symptoms are manifested:
Sweda atyartham
Lomaharsha
Twak doshaha
Sneha yukta virechana in these conditions.
Treatment:
General treatment principles:
In avarana vata is the prime causative factor so vata which is responsible for obstruction of
other dushya should be treated first.
Abhyanga, svedana, abhyantara snehapana, basti should be used.
Similarly alternate hot and cold procedures should be followed.
Anabhishyandi, unctuous diet should be given which clears the srotas.
Vatanulomaka medicines should be given which is not opposite to kapha and pitta.
Yapana basti, Madhura anuvasana basti should be given.
Rasayana like shilajatu, guggulu, chyavanprasha should be given.
Treatment of vata should be done along with the dosha involved in avarana.
Specific treatment principles:

Pitavruta vata:
Medicine curative of pitta and not antagonistic to vata.
Cold and hot lines of treatment in alternation barley, Sali rice, yapana basti, purgation,
affusion with the medicated oil or ghee or milk prepared with bala.
Kaphavruta vata:
Medicine curative of kapha and regulative of vata.
Strong dose of sudation, evacuative enema and emesis along with purgation.
Pittakaphavruta vata:
Vatavyadhivat samanya chikitsa
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DHATU PRADOSHAJA VIKARA
1. Rasadhatu pradoshaja vikara → ashraddha, aruchi, ashya vairashya, arasagyata,
hrillasa, gaurava, tandra, anga marda, jvara, tama, pandu, shrotorodha, klaibya,
krushata, agni nasha, akala valee
2. Raktadhatu pradoshaja vikara → kushtha, visarpa, pidaka, raktapitta, asrikdara,
vatarakta, gudapaka, medhra paka, mukha paka, pliha, gulma, vidradhi, nilika,
kamala, vyanga, piplu, tilakalaka, dadru, charmadala, switra, pama, kotha,
raktamandala, indralupta, arsha, arbuda, angamarda
3. Mamsa dhatu pradoshaja vikara → adhimamsa, arbuda, mamsakilaka, gala shaluka,
gala shundi, Putimamsa, alaji, galaganda, gandamala, upa jihvika, mamsa sanghata,
ostha prakopa
4. Medo dhatu pradoshaja vikara → asta nindita purusha, prameha purvarupa, granthi,
vruddhi roga, gala ganda, arbuda, medoja osthaprakopa, madhumeha, ati sweda
5. Asthi dhatu pradoshaja vikara → adhyasthi, adhi danta, danta bheda, danta shoola,
asthibheda, asthi shoola, asthi vaivarnata, danta vaivarnata, kesha – loma – nakha –
shramashu dosha, kunakha roga
6. Majja dhatu pradoshaja vikara → ruksha parvanam, bhrama, murcha, tamo darshana,
netra abhishyanda
7. Sukra dhatu pradoshaja vikara → klaibya, aharshanam, sukra ashmari, sukra meha,
sukra dosha, nishphala sukra (sukra dhatu incapable of producing garbha, if
conception occurs it leads to garbhapata or birth of alpa ayu and / or virupa santana)
Dhatu pradosha and sama dhatu are having similar lakshanas. But treatment differs for sama
and Nirama avastha.
Dhatu pradosha chikitsa:

Rasa dhatu pradosha chikitsa → langhana (upavasa)
Rakta dhatu pradosha chikitsa → raktapitta shamaka chikitsa, virechana, raktamokshana
Mamsa dhatu pradosha chikitsa → sanshodhana, shastra karma, kshara karma, agni karma
Medo dhatu pradosha chikitsa → apatarpana or karshana, sthaulya hara & kapha-mehohara
chikitsa
Asthi dhatu pradosha chikitsa → panchakarma, tikta ksheera basti, tikta ghrita prayoga
Majja dhatu pradosha chikitsa → madhura tikta dravya, vyavaya, vyayama, yatha kala
shodhana
Sukra dhatu pradosha chikitsa → sukrala dravya prayoga, shodhana, vajikarana
IMPORTANCE OF DOSHA
िोगस्तु िोशवैषम्यं, िोष साम्यमिोगता |
Disease is the effect of disequilibrium of the dosha while health is the result of equilibrium of
the dosha.
िोषा एव दह सवेषां िोगाणां एक कािणं |
Dosha is the causative factor for all diseases.
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All nija vikara do not arise except from vata, pitta and kapha. As a bird though flying all over
the day does not transcend its shadow same way disease does not occur without vitiation of
dosha.
Dosha Vardhaka rasa Shamaka rasa

Vata Katu, Tikta, Kashaya Madhura, Amla, Lavana
Pitta Amla, Lavana, Katu Madhura, Tikta, Kashaya
Kapha Madhura, Amla, Lavana Katu, Tikta, Kashaya
Medicine which contains rasa is used on the basis of vitiation of dosha e.g., in jvara guduchi,
because jvara is paitika vyadhi and guduchi has tikta rasa so it is pitta shamaka thus concept
of dosha is very important for treatment.
Doshopkrama is also general principle of treatment.

Sadhyashdhyata of the disease can be decided based on dosha.
IMPORTANCE OF DUSHYA
While treating the disease proper attention should be given towards dhatusamya. Weak dhatu
causes reoccurrence of the diseases.
Physician who minutely examines and determines the condition of dushya and then decides
the aggravated dosha and its appropriate treatment.
IMPORTANCE OF BALA
According to roga and rogi bala dose of the medicine, shodhana and shamana chikitsa are
decided.
If the patient has good bala he can resist the disease easily and disease will be treated easily
e.g., in rajyakshma shodhana is mentioned but it depends on patient’s bala.
In udara roga virechana is line of treatment but it is given after accessing patient’s bala.
Bala is the key factor which can resist disease.
IMPORTANCE OF KALA
For the use of a drug when the proper time has gone by or when it has not come yet does not
effective. It is the opportunities of time that brings about success of the administration of
drug.
Kala Pratiksha is one type of treatment upakrama. In jvara kala itself is a treatment.
Accumulation aggravation of dosha takes place according to the day, night, season, age etc.
considering all these factors treatment protocol should be decided.
Virechana is given in sharada rutu based on this fact.
Chronicity of the disease also depends on the kala.
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IMPORTANCE OF AGNI
The life span, complexion, vitality, good health, enthusiasm, glow, vital essence, lustre, heat
and the life breathe are derived from agni.
When this agni is extinguished man dies; when a man is endued with it adequately, he lives
long in good health. When it is deranged, he begins to ill. Therefore, the agni is said to be the
main stay of life.
शमप्रकोपौ िोषाणां सवेषामत्ग्नसंचितौ |
Strength, health, longevity, and the vital breath are dependent on the state of digestive fire
and the digestive fire burns, fed by the fuel of food and drink when deprived of them.
The sedation and the provocation of all the humors depend on the condition of the agni.
Hence one should always take care to protect the agni and avoid the causative factors of its
disturbance.
IMPORTANCE OF PRAKRITI
Vata, pitta and kapha individual are sadatura while normalcy of all is healthy one.
To understand causative factor of the disease
To understand by which guna the pathogenesis of the disease occurs.
To decide the medicine, their dosage & anupana.
IMPORTANCE OF VAYA
Bala → Sukumara, shleshma dhatu dominant
Madhya → Good strength, paurausa, parakrama, sarvadhatu yukta, klesha saha
Jirna → Decrease the strength, dhatu, paurusa etc.
According to acharya sharangadhara childhood, growth, colour and complexion, skin health,
vision, semen, physical capacity and life these get lost or diminished in successive decades of
life.
IMPORTANCE OF SATTVA
Those of high psychic quality are the psychic nature as described in the perfect tone of
psychic element. Though possessed of small bodies, and despite being affected by severe
ailments or either exogenous or endogenous type, they look unaffected, owing to the high
tone of their psychic quality.
Knowledge of pravara, avara, and sattva is helpful in treatment. The persons who have
pravara sattva their resistance power is good. They can tolerate procedures like agnikarma,
kshara, surgery and panchakarma.
Before any surgery assessment of sattva is useful.
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IMPORTANCE OF SATMYA
As regards homologation (satmya), means which has become agreeable to person by constant
use.
Those who have milk, ghee, mamsarasa and all tastes satmya have pravara bala.
Those who has one rasa satmya has alpa bala and cannot resist to the disease.
Combination of these two has madhyama bala.
IMPORTANCE OF DESHA
The examination of the place may be either for the knowledge of the patient or for the
knowledge of the drug.
Habitat of the patient and the type of constitution both must be considered during treatment.
The place where patient is living, where disease manifests, are the important for the
treatment. The physician should use the medicines which have opposite quality to that place.
Desha is considered as one of the important environmental factors responsible for the
causation of epidemic diseases.
For the collection of the medicine suitable desha should be decided.
IMPORTANCE OF AHARA
Proper diet and dietary habits are very important for maintenance of health and life we must
follow ahara matra, ahara vishesha ayatana etc.
Food causes immediate nourishment, strength and support to the body.
It increases the expectancy of life, brilliance, enthusiasm, vital essence and digestive
capacity.
Ahara is prana for body if it is consumed properly otherwise it creates disorders.
Strength, health, longevity, and the vital breath are dependent on the state of digestive fire,
and the digestive fire fed by the fuel of food.
CHIKITSA SUTRA AND MANAGEMENT OF ‘SAMANYAJA AND NANATMAJA’

DISEASES
Samanyaja & Nanatmaja vikara:
Samanyaja vikara:
Samanyaja vikara are those diseases which are produced by vitiated doshas either individual
or in combinations of two or three. They may…
Ekadoshaja → (vataja/pittaja/kaphaja)
Dwidoshaja → (sansargaja)
Tridoshaja → (sannipataja)
Examples:
8 types of udara, mutrakriccha, shukradosha
7 types of kustha, prameha pidika, visarpa
5 types of atisara, udavarta, gulma, pliha, kasa, swasa, hikka, Trishna, chhardi, hridroga,
pandu, unmada
4 types of netra roga, pratishyaya, grahani roga, mada, shosha
3 types of shotha, kilasa, raktapitta
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2 types of jwara, vrana, gridhrasi, kamala, amadosha, vatarakta, arsha
1 type of urustambha, sanyasa
20 types of krimiroga, prameha, yonivyapat
Nanatmaja vikara:
The diseases which cannot be produced without involvement of the pradhana dosha
(predominant dosha) i.e., only one dosha is responsible for such disease, whereas other
doshas may be involved as apradhana dosha (associated doshas)
For example:
Vatavyadhi is produced by vata dosha, in which pitta & kapha may or may not be involved as
associated doshas and the vatavyadhi cannot be produced without involvement of vata, hence
it is a nanatmaja vikara.
Vataja nanatmaja vikara → 80

Pittaja nanatmaja vikara → 40
Kaphaja nanatmaja vikara → 20
Vataja nanatmaja vikara:

Examples:
Ardita, Ekangavata, Sarvangavata, pakshaghata, akshepaka, gridhrasi, padashula,
manyastambha, badhirya, hikka etc.
Pittaja nanatmaja vikara:

Example:
Daha, antardaha, atisweda, raktapitta, kamala, mukhapaka, gudapaka, jivadan, putimukha,
raktakotha etc.
Kaphaja nanatmaja vikara:

Example:
Tandra, nidradhikya, gurugatrata, alasya, hridayopalepa, galaganda, atistaulya, mandagni,
udardha, shwetavabhasata etc.
Samanyaja & Nanatmaja vikara chikitsa:

These diseases are produced by imbalance of vitiation of doshas; therefore, they can be
treated by balancing the dosha. (i.e., bringing about dosha samyata)
Nidana parivarjana
Brimhana of kshina dosha
Shamana of kupita dosha
Shodhana of vriddha dosha
Paripalana of sama dosha are the general line of treatments for bringing about equilibrium
state of dosha.
Treatment is given with consideration of rogi-roga bala & dosha balabala.
Doshopakrama → for nanatmaja vikara, specific treatments for respective doshas should be
adopted.
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4. Detailed description of Dvividhopakrama (Santarpana and Apatarpana)

and Shadavidhopakrama (Rookshana, Snehana, Swedana, Sthambhana,
Langhana and Brimhana). Detailed description of Shodhana, Shamana
and Nidana Parivarjana. Knowledge of Aushadha matra, Sevan kaala
and Anupana, Definition and Knowledge of Pathya-Apathya with
examples of diseases of various systems.
DETAILED DESCRIPTION OF DVIVIDHOPAKRAMA AND

SHADAVIDHOPAKRAMA
Dvividhopakrama
Acharya vagbhata has mentioned two types of therapies viz.
1. Santarpana → Tonifying or nourishing therapy.
2. Apatarpana → Making the body light or reducing therapy.
Santarpana means nourishment, and apatarpana means under nourishment.

Indications of santarpana chikitsa are apatarpana janya vyadhi such as kshaya, shosha,
vyadhi-vata etc. Whereas indications of apatarpana are aamadoshajanya & santarpan janya
vyadhi such as sthaulya, medovikara, kushtha etc.
Dvividha upakrama also includes six types of therapies.
Langhana → Rookshana, Swedana, → Apatarpana
Brimhana → Snehana, Stambhana → Santarpana
Santarpana:
Word tarpana means sense of wellbeing it is a function of rasa dhatu. Food substances and
herbs that increase rasa dhatu and subsequently kapha are all grouped under santarpana.
Nidana of santarpana vyadhi:

Excessive intake of heavy, sweet, unctuous diet.
Alcohol intake
Meat
Excessive intake of jaggery
Lack of exercise
Day time sleep
Santarpanjanya roga:
Prameha, Kushtha, Klebya, Sthaulya, Gaurava, Srotorodha, Kandu, Jwara, Ama dosha,
Shopha
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Chikitsa of santarpanajanya vyadhi:
Vamana, Virechana, Raktamokshana, vyayama, upavasa, sudation
Intake of abhaya with honey, dry food, churna and pralepa which are recommended in
itching.
Formulations like triphala Kashaya, Mustakadi Kashaya, Kusthadi churna
Apatarpana:
Under nutrition – Regimen which leads to emaciation of the body, viz. Panchakarma,
Upavasa, Ati vyayama
This therapy includes langhana chikitsa

3 types of apatarpana viz.
1. Langhana
2. Langhana – pachana
3. Doshavasechana
2 types of langhana chikitsa viz.
1. Shodhana
2. Shamana
10 types of langhana chikitsa viz.
1. Vamana 6. Upavasas
2. Virechana 7. Pipasa
3. Niruha basti 8. Atapa sevana
4. Shirovirechana 9. Maruta sevana
5. Pachana 10. Vyayama
Nidana of apatarpanjanya vyadhi:

Ruksha annapana sevana
Langhana
Kriyatiyoha
Shoka, chinta, bhaya
Vega nigraha
Ati shrama
Ati maithuna
Apatarpanajanya roga:
Agninasha, jwara, balahani, daurbalya, kasa, parshwa shula, hridaya vyatha, sandhibheda,
urdhwa vata, unmada
Chikitsa of apatarpanajanya vyadhi:

This therapy includes brimhana chikitsa that is treatment with dhatupushtikara & brimhana
aushadha ahara-vihara.
It is indicated for apatarpanajanya roga.
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Santarpana chikitsa is classified as following –
1. Sadhya santarpana:
Administration of therapies and drugs, those provide nourishment to the body and dhatu
immediately is known as Sadhya santarpana.
For example: Brimhana basti prayoga
Brimhana dravya prayoga like draksha, kharjura, parushaka, dadima etc.
2. Abhyasha santarpana:
Nourishing therapy that includes brimhana dravya prayoga and dhatu pushtikara ahara-vihara
sevana continuously for longer duration, is known as abhyasa santarpana.
For example: Dugdha & Ghrita nitya sevana mamsarasa.
Madhura, amla, shita, snigdha, mrudu gunayukta ahara, abhyanga, anuvasana
basti etc.
Importance of apatarpana in chikitsa / importance of langhana / rookshana / swedana

in chikitsa
General treatment protocols (Doshopakrama)
All kapha doshopakrama are langhana in pitta upakrama only virechana upakrama denotes
langhana. In vata upakrama it depends on stage as upastambhit where swedana, mrudu
samsodhana, Deepana, pachana can be given. If langhana is used in contraindicated people or
nirupa stambhita vyadhi awastha it will cause kshaya. Vaidhya can safely use langhana in
kapha and pitta dominance but in vata dominance langhana must be used with precaution and
never in nirupastambhit avastha.
In shishira rutu in late winter, langhana can be given even after for vata vyadhi or where
langhana is contraindicated otherwise.
Treatment protocols of each srotas:

Rasavaha → All types of langhana are the remedy for disorders of rasa.
Raktavaha → In raktavaha srotas diseases one should adopt the treatment which evacuates
blood and pitta such as purgation fasting and bloodletting.
Mamsavaha → treated with shodhana
Medovaha → treatment of sthaulya is started as apatarpana
Annavaha → Langhana is useful for annavaha srotas and amashayotha vyadhi
Langhana is not indicated in asthi, majjavaha srotas as routine treatment.
In specific disease condition:

Jwara: Langhana is indicated in all types of jwara except for 4 types where langhana is
contraindicated. Also, langhana is advised in purvarupa avastha of jwara. Langhana helps in
dosha kshaya, agni is kindled consequently thus apyrexia, lightness occurs and appetite
increases.
In ama janya vikara → Langhana is indicated. Langhana is a choice of therapy in diseases
originating from amashaya. These can be enlisted as atisara, pravahika, grahani, ajirna,
chhardi.
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Prameha is the disease where apatarpana and santarpana both are indicated depends upon
type and physique of patient whether he is obese, strong or lean and weak.
Indication of langhana according to types:

Kshudha nigraha → Indicated in the diseases of annavaha srotas where agnimandhya or
formation of ama is initial cause.
Trushna nigraha → Indicated in udara vyadhi. Acharya sushruta indicated in arochaka,
pratishyaya, sotha, agnimandhya, udara, kushtha etc.
Deepana → Indicated where agnimandhya is the cause in the triad of arsha, atisara, grahani
Pachana → In some individuals pachana is required prior to snehana swedana as purvakarma

of shodhana. Pachana is indicated in sama taruna jwara, amavastha of atisara, in amlapitta
when patient is not fit for shodhana.
Vyayama →
It is a treatment in medoroga.
In prameha type of physical exercise is advised. Physiotherapy for different vatavyadhi can
be considered as vyayama.
Atapa →
Indicated in shwitra
In phakka sun rays are rich source of vit D so for rickets atapa sevana is useful.
Ultra violet rays therapy indicated in psoriasis.
Maruta sevana
A walk in non-polluted air along with goats can be considered as maruta sevana.
Rookshana →
Rookshana produces roughness, dryness, non-sliminess.
Properties are ruksha, laghu, khara, tikshna, ushna, sthira helps in rukshana.
Some Vaidya use rukshana as a part of purvakarma before snehana swedana.
Indications are urustambha, medoroga, visarpa.
It is indicated in condition where kledadhikya is present so can be used in kustha, prameha
also.
Swedana →
Drugs possessing stambha, gourava properties which produces sweat and alleviated stiffness,
heaviness and cold.
Swedana has ushna property, it reduces pain.
Indications are disease condition includes stambha, shoola, gaurava, supti.
It is well known purvakarma for shodhana but while considering in dvividhopakrama if the
patient is of pitta prakriti or contraindicated for swedana then he should be given mrudu
swedana.
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Due to swedana grathit shleshma dissolves, srotas got soften and samprapti bhanga takes
place.
Swedana as pradhanakarma is useful in many vatavyadhi, especially in pakshawadha also in
diseases like hikka, shwasa, amavata.
In arsha and mutrakruccha, avagaha sweda is indicated.
Apatarpana upakrama helps to mitigate the drastic problem arised due to abnormality of
tridoshas in the body like langhana mitigates kapha-pitta abnormality rukshana decrease the
kapha & pitta swedana is vata kapha hara.
Importance of santarpana in chikitsa / Importance of brimhana / snehana / stambhana

in chikitsa
Santarpana upakrama is aimed to improve the nutrition level of the body.

In santarpana upakrama there are 3 types of therapies included – Brimhana, snehana,
stambhana.
Brimhana:
The treatment which increases body size or cause nourishment of the body is considered
brimhana chikitsa.
Brimhana dravyas have the properties of guru, shita, mridu, snigdha, bahula, picchila, manda,
sthira and slakshna.
These drugs act at the level of Dhatvagni and thus helps in proper nourishment of dhatu.
Those patients who are krish and kshaya-janyavyadhiyukta such as OA, impotency,
infertility, azoospermia etc. are treated with the use of brimhana chikitsa.
Snehana:
The treatment that causes oiliness, moistness, fluidity and softness in the body is termed as
snehana.
It can be used in vata vyadhi like osteo arthritis, stress, headache, backache, insomnia and
other.
Aabhyantara snehana can be done in the form of snehapana for the purpose of shodhana
anuvasanabasti, matrabasti and Sneha with meal in the form of ghee.
This chikitsa provides nourishment, strength and relaxation to the affected body parts. It
helps to remove out the toxic effects and improve the metabolism of the cells.
Stambhana:
The treatment that prevents mobility and the flow of body substances and fluid is known as
stambhana chikitsa.
Dravya with stambhana capability contain laghu, sheeta, mridu, drava, slakshna, ruksha,
sukshma and sthira properties.
Picchha basti and avapeeda nasya are the examples of stambhana treatment.
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Santarpana upakrama helps to mitigate the drastic problem arised due to abnormality of
tridosha in the body like brimhana act as vata pittahara. Snehana is vatapittahare and
stambhana eliminates the pitta and vatta.
The target achieved by upakama is dosha saamyata. It is attained through balancing the
gunas, ultimately by achieving the panchabhautika stability.
Shadvidhopakrama:
लङ्घनं बंह
ृ णं कालं रुक्षणं स्नेहनं तथा |
स्वेिनं स्तम्िनं जानीते यः स वै भिषक् ||
According to acharya charaka, those who have the knowledge about all six types of therapies
are called bhishaka or vaidhya. These therapies are langhana, brimhana, rukshana, snehana,
swedana, stambhana
1. Langhana:
Reducing therapy - that which brings lightness in the body.
Types of langhana:
चतर्षु प्रकािा संशवु ध: वपपासा मारुतातपौ |
पाचनान्युपवासि व्यायामिेतत लङ्घनं ||
Ten types viz.
1. Vamana 6. Upavasa
2. Virechana 7. Pipasa
3. Niruha basti 8. Aatapa sevana
4. Nasya 9. Maruta sevana
5. Pachana 10. Vyayama
Two types:
1. Shodhana: Vamana, Virechana, Nasya. Raktamokshana, Basti
2. Shamana: Pachana, Deepana, Kshudha, Trushna, Vyayama
Indication: Amadoshajanya vikara

Santarpanajanya vikara
Sthaulya, prameha, kustha etc.
Contraindication: Vatavriddhi, krush purusha, apatarpanajanya vyadhi
Samyaka langhana lakshana: Sharira laghuta

Aamapachana & Agnideepana
Hridaya, kantha, mukha suddhi
Samyaka mala mutra tyaga
Santarpanotha roga prashamana
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Ati langhana lakshana: Angamardana, Parvabheda, Kasa, Shwasa, Jrimbha utpati,
Kshudhanasha, dehs & agnibala nasha, aruchi, trushnadhiya,
chitta vibhramsha
2. Brimhana:
Nourishing therapy – increases the musculature or bulk of the body.
Indication: Apatarpanajanya roga, vata vyadhi, kshatah, kshina, stri madya nityasevi,
grishmakala
Contraindication: Santarpanajanya roga, Amadosha, Atisnigdha, Urustambha, Kaphavriddhi

etc.
Samyaka brimhana lakshana: Sharira & dhatu Pushti

Bala vruddhi
Krushata dosha nasha
Atarpanottha roga prashamana
Ati brumhana lakshana: Sharira sthulata
Sthaulya astadosha utpatti
Santarpanottha roga utpatti
3. Rukshana:
Drying therapy – brings dryness, roughness and non-sliminess
Indication: Abhishyandajanya roga, mahadosha, marmasthana gata roga, urustambha etc.
4. Snehana:
Oleation therapy – brings unctuousness, sliminess, softness & moisture.
Snehana bheda:
Chaturvidha Sneha:
1. Ghrita
2. Taila
3. Vasa
4. Majja
Based on Sneha yoni:

1. Sthavara Sneha
2. Jangama Sneha
Based on Sneha matra:

1. Hrisiyasi matra – 3 hours
2. Hrashwa matra – 6 hours
3. Madhyama matra – 12 hours
4. Uttama matra – 24 hours
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Based on Sneha paka:
1. Mridu paka
2. Madhyama paka
3. Khara paka
Based on snehana prayoga:

1. Bahya snehana
2. Abhyantara snehana
Based on snehayoga:
1. Acchapeya: Sneha without mixing.
2. Pravicharana: Sneha long with various preparations.
3. Yamaka Sneha: combination of any 2 of chaturvidha Sneha
4. Trivrut Sneha: combination of any 3 sneha
5. Maha Sneha: combination of all 4 sneha.
Indication:
स्वेध्या: शोधतयतव्याि रूक्षा वातववकारिण: |
व्यायाममद्यस्त्रीतनत्या: स्नेहा स्युयै च चचन्तका ||
Contraindication: Amadosha, Nava jwara, mandagni, murccha, garbhini etc.
Samyaka snigdha lakshana:

Vaanulomana
Agnideepana
Snigdha & asamhata varcha
Mardavata
Snigdhata
Atisnigdha lakshana:
Panduta
Gauravata
Jadyata
Purishasya apakvata
Tandra
Aruchi
Utklesha
5. Svedana:
Sudation – removes stiffness, heaviness, coldness, induces sweating.
Types:
According to charaka
1. Ekanga sweda → Svedana to one part of body.
2. Sarvanga sweda → Svedana all over the body.
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1. Snigdha sveda → e.g., shastika shali pinda sveda

2. Ruksha sveda → e.g., valuka sveda
1. Sagni sveda → Direct contact with agni

2. Niragni sveda → No direct contact with agni
13 types of sagni sveda:

1. Sankara sveda → Pinda sveda with or without pottali
2. Prastara sveda → Svedana with stone slab
3. Nadi sveda → Svedana with vapours through a pipe.
4. Parisheka sveda → Pouring of warm oil over the body.
5. Avagaha sveda → Hot tub bath
6. Jentaka sveda → Sudatorium
7. Ashmaghna sveda → preheated slab of stone
8. Karshu sveda → Trench containing large space inside
9. Kuti sveda → Svedana on the round shaped hut
10. Bhoo sveda → Svedana on the ground
11. Kumbhika sveda → Svedana with help of kumbha
12. Kupa sveda → Svedana with the help of kupa.
13. Hollaka sveda → A bed is prepared over the burnt smokeless & hot dung.
10 types of niragni sveda:

1. Vyayama → Exercise
2. Ushna sadana → Warm room
3. Guru pravarana → Covering with thick blankets
4. Kshudha → Hunger
5. Bahupaan → Excessive alcohol
6. Bhaya → Fear
7. Krodha → Anger
8. Upanaha → Poultice
9. Aahava → Wrestling
10. Aatapa → Sun bath
Indications: Pratisyaya, kasa, hikka, svarabheda, sarvanga vata, shoola, granthi etc.
Contraindication: Garbhini, Raktapitta, Pittaja roga, Kshaya etc.
Samyaka snigdha lakshana Atisnigdha lakshana

Reduction of cold Aggravation of pitta dosha
Reduction of pain Unconsciousness
Relief from stiffness Lassitude
Softness of body Excessive thirst
Sweating Burning sensation
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6. Stambhana:
Astringent therapy – that which stops the flow of doshas.
Indication: Pitta prakruti, kshara-agni-dagdha, chhardi, atisara, srotodushti etc.
Samyaka stambhana lakshana: Roga shanti & Bala Prapti

Atistambhana lakshana: Shyavata, Stabdha gatrata, hanugraha, varchagraha etc.
Importance of shadvidha upakrama:

Shadvidha upakrama helps to mitigate the drastic problem arised due to abnormality of
tridoshas in the body like langhana mitigates kapha pittaja abnormalities. Brumhana act as
vata-pittahara, Rukshana decrease the kapha and pitta. Snehana vata-pittahara. Swedana is
vata-kaphahara and stambhana eliminates the pitta and vata dosha.
The target achieved by any form of uparama is dosha saamyata. It is attained through
balancing the gunas, ultimately by achieving the panchabhautika stability.
As per Ayurvedic texts shadvidha upakrama is a brief description of ayurvedic basic
principles of chikitsa.
Shadvidha upakrama works on the principles of samanya vishesha siddhanta and act by
balancing the proportion and based on the combination of panchabhautas in the body.
It can be very beneficial if the assessment of the dosha. Roga and rogi is done carefully
therefore it can be considered yuktivyapashraya chikitsa. It can be used in prevention and
management of the lifestyle disorders.
DETAILED DESCRIPTION OF SHODHANA, SHAMANA AND NIDANA

PARIVARJANA
Shodhana:
Shodhana means cleansing or evacuatory treatments. These treatments are preferred to throw
away the unwanted metabolic wastes and tissue toxins out of the body.
To tolerate this treatment, the patient needs to be stronger. Thus, shodhana treatment is given
for people who shave more bala and mamsa. It should be thought of only in the presence of
‘bahu dosha’ excessive morbidity.
Those are five in numbers; hence they are called as panchakarma.
Indication: Bahudosha avastha, Avipaka, Aruchi, Sthaulya, Panduta, Gaurava, kandu etc.
Contraindication: Aparicharaka, chanda, asuyaka, atikshina bala mamsa etc.
Importance of shodhana:
Rutu anushar shodhana (Roganutpatikara chikitsa):
E.g., Vamana in vasant, Virechana in sharada, Raktamokshana also in sharada, basti in varsha
rutu to prevent the diseases.
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Rasayana vajikarana purva shodhana:
Acharya has mentioned that ‘as dirty clothes cannot be coloured, patients without shodhana
cannot be coloured properly, patients without shodhana cannot get the proper result of
rasayana & vajikarana.
िोषा: किाचचत कुप्यत्न्त त्जता लङ्घनपाचनै: |

त्जता: संशोधनैयेषु न तेषां पुनरुद्भव ||
The diseases, treated with shamana chikitsa like langhana-pachana may recur but the diseases
treated with shodhana chikitsa do not occur.
Shamana:
Shamana means pacificatory or palliative form of treatment. Shamana treatment is opposite
of shodhana chikitsa. This should be considered in those patients who are not fit to undergo
shodhana chikitsa.
Thus, shamana chikitsa is administered in the patients who have less bala and mamsa. It is
also thought of in the presence of heena or madhyama quantity of morbidity.
There are 7 types of shamana chikitsa including 2 dravyabhoota & 5 adravyabhoota chikitsa
1. Pachana → Using digestant e.g., chitraka, musta
2. Deepana → Using appetizers e.g., trikatu
3. Kshudha → Fasting or intake of less food.
4. Trishna → Intake of less or no water.
5. Aatapa sevana → Exposure to sun rays.
6. Maruta sevana → Exposure to fresh air.
7. Vyayama → Exercise
Indication: Madhyama & alpa dosha avastha, vriddha, bala, garbhini, durbala, mandagni,
hridroga etc.
Contraindication: Achikitsaya purusha
Importance of shamana:
This chikitsa does not affect the root of the disease; hence it can never result in complete
removal of disease. The approach, however, reverses the damage caused by the disease.
It focuses on altering the body’s roga balance through the administration of right combination
of medicines, change in diet & lifestyles.
In common diseases such as jvara, pratishyay, atisara, and other mild conditions, the roga
imbalance does not require any stringent approach hence here the shamana chikitsa acts as
the primary mode of care.
Nidana parivarjana:
Avoiding the etiological factors is itself a treatment. Nidana parivarjana is having utmost
importance in Ayurvedic treatment.
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Importance of nidana parivarjana:
Nidana parivarjana refers to avoiding etiological factors by patient and treating the etiological
factors by patient and also treating the etiological factors of vata dosha are to be avoided by
patient, and the physician has to treat vata prakopa.
Various diseases can be cured with nidana parivarjana only, while all the ayurvedic
treatments are incomplete without nidana parivarjana.
If a patient continuous nidana sevana, physician cannot treat him successfully, or if the
disease subsides due to shodhana & shamana but patient continues nidana sevana, it leads to
relapse or recurrence of disease that can advance to chronic or complicated stage.
To avoid relapse or recurrence of any disease, patient must avoid the etiological factors even
after successful treatment.
Nidana parivarjana not only helps in treatment but it also helps in prevention of the disease.
E.g., in rutucharya palana the etiological factors of the respective accumulating doshas should
be avoided to prevent their aggravation such as during vasant rutu one should avoid
kaphavardhaka ahara vihara sevana.
KNOWLEDGE OF AUSHADHA MATRA, SEVAN KAALA AND ANUPANA
Aushadha matra:
There is no fix dose for every individual it has been decided as per kala, agni, vaya, bala,
prakruti, dosha, desha.
Agni → Mandagni / samagni / tikshnagni / vishmagni

Vaya → Bala / Madhyama / vruddha
Bala → Avara / madhyama / pravara
Dosha → Vata / pitta / kapha / sansarga / sannipataja
Prakruti → Vataja / pittaja / kaphaja / dwandwaja / sama (tridoshaja)
Desha → Bhoomi desha & aatura (dashavidha pariksha)
Kala → Rutu / Aushadha sevana kala (Pratah / sayam)
Balanusara aushadha matra:

Inadequate or less dose of a medicine is unable to cure a disease just as less quantity of water
is unable to stop a fire.
Overdose of a medicine may lead to adverse effects and complications just as the excess rain
destroys the crops.
Therefore, dose of a medicine should neither be less nor be more and it should be decided
with proper assessment of doshabala, vyadhibala, Rogibala
Balyavastha anusara aushadha matra:

Medicines should be given in drava or leha, rupa to children. Shurna or kalka should be
licked with ghrita-madhu. Vati or Gutika should not be given.
According to acharya sushruta, up to 16 years of age there is balyavastha and the balyavastha
is having three subtypes viz.
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1. Ksheerapa:
The children of 1 month to 1 year of age and those consume breastmilk only are called
ksheerapa. If medicines must be given to these children, then it should be given to the nursing
mother and the medicine can also be coated on nipple of mother in the quantity of anguli
parva dvaya matra.
2. Ksheerannada:
Those children who consume breastmilk and foods are called ksheerannada. They are 1 to 2
years of age. Churna or Kalka in dose of kolasthi matra should be given to them.
3. Annada:
Those children who consume foods only are called annada. They are of 3 to 16 years of age.
Kolamatra aushadha should be given to them.
The kalka, churna, avaleha, doses according to age –

Age Matra
1 month 1 Ratti
2 months 2 Ratti
4 months 4 Ratti
6 months 6 Ratti
9 months 9 Ratti
12 months 12 Ratti
2 years 2 Masha
16-17 years 16 Masha
For kwatha this does is four times more.
Aushadha matra samanya (Adult dose):

Aushadha kalpa Aushadha matra
Rasa, Bhasma, Lauha, Pishti 1 to 3 Ratti 125 to 375 mg
Parpati 2 to 4 Ratti 250 to 500 mg
Vati ½ to 1 Taula 500 mg to 1 gm
Swarasa ½ pala 24 ml
Kalka 1 karsha 12 gm
Kwatha 1 to 2 pala 48 to 96 ml
Churna 1 karsha 6 to 12 gm
Avaleha paka ½ pala 12 to 24 gm
Aushadha sevana kala:

Time of administration of medicine depends upon rogiroga / avastha.
For successful treatment, administration of medicine with proper dose is essential.
Acharya vagbhata has mentioned 11 types of aushadha sevana kala.

1. Abhakta → Empty stomach
Intake of medicine empty stomach is useful in kapha prakopa & in case of balwana rogi.
2. Purvabhakta → Before bhojani
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The medicine given at this time digest fast and imparts strength to the body.
Useful in apana vayu vikaras such as vibandha, udavarta, ashmari, mutrakruchha, pradara etc.
3. Madhyabhakta → In between the intake of food.
After intake of half of the food, administration of medicine and then intake of remaining food
is called madhyabhakta.
It is useful in samana vayu vikaras such as grahani, annadravashula, parinama shula, atisara,
pravahika etc.
4. Sabhakta / saanna → Mixed with foods
Intake of medicine mixed with food is useful in aruchi.
5. Adhobhakta → After food
Intake of medicine just after food is useful in vyana vayu such as uchcha raktachap & in
udana vayu vikara such as swara bheda etc.
6. Samudga → Pre and post prandial
Intake of medicine before and after food is useful in kapma, aksheepaka, hikka etc.
7. Bhaktantara → Repeatedly in between meals
Intake of medicine frequently in between meals is useful in aruchi etc.
8. Sagrasha → with every bite of meal
Intake of medicine with every morsel is useful in pranavayu vikara such as shwasa etc.
9. Grasantara / Kavalantara → In between two morsels
Intake of medicines in between two morsels is useful in pranavayu vikaras.
10. Muhur muhur → Frequent intake of medicine
Frequent intake of medicine is useful in visha vikara, chhardi roga, hikka, swasha etc.
11. Nishi → At night
Intake of medicine at night is useful in urdhvajatrugata vikaras.
Importance of aushadha kala:

Just as food becomes poison when taken in improper time but the same food becomes an
amruta when taken in time, so does the aushadha, in non-time becomes a poison but in the
proper time, becomes an amruta.
When bheshaja is administered beyond the time or before the time will not be effective. Kala
is the reason for the medicine to act effectively kala brings the yogyata to the bhesaja.
Even though these kalas have been mentioned there are some specified times for certain
conditions for example, avapeedaka Sneha in mutra vikaras, good muhurta for the drug
administration, raktaja gulma should be treated after tenth month.
Hence to utilize the aushadha to its optimum level, Bhaishajya kaalas have been quoted
depending on the predominance of the doshas, seat of disease, frequency of the doshas, seat
of disease, frequency of attack etc.
Aushadha kala are the essential tools for administration of aushadha, negligence may lead to
the grave deficit in the treatment.
Evaluation of vaya, jeernalinga, ritu, vyadhi dooshya, desha plays a pivotal role in context of
aushadha kala.
Vata dosha has given prime importance in context of aushadha kaala, though pitta and kapha
are considered at some places.
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Anupana:
Anupana refers to substances taken with or after diet and drugs.
The best anupanas have properties opposite to the dhatus.
Anupana is considered as half medicine in ayurveda because it provides nourishment to the
dhatus, help in digestion of food, digestion & absorption of administered drugs etc. Anupana
acts as vehicle for drugs which help in the body, and hence enhances the efficacy of drugs.
Sushruta describing the qualities of the shreshta anupana – water, says by virtue of its
toyatmakatva and presence of sarvarasa, it is most favourable anupana.
Examples:
Ushnata: Pitta vikara Sheeta jala (anupana)
Raktaja vikara
Vidaha
Sheetata: Vataja vikara Ushna jala (anupana)

Kaphaja vikara
Tridoshaja vikara: Adraka svarasa + madhu
Importance of anupana:
Anupana is a factor which helps in absorption as well as in the efficacy of the drug.
The potency of the medicine gets enhanced and brings about the desired effect when given
with suitable anupana.
Anupana provide a medium of administration of drugs with acceptability & palatability.
Anupana brings about pleasure, energy, nourishment satisfaction and steadiness in the food
eaten. It helps in breaking down, softening, moistening, digestion, assimilation and instant
diffusion of food and drugs taken.
DEFINITION AND KNOWLEDGE OF PATHYA-APATHYA WITH EXAMPLES OF

DISEASES OF VARIOUS SYSTEMS
Pathya-Apathya
Pathya is said as the one which is suitable for the srotomaya shareera and for the manas. So,
the ahara which is suitable for shareera and manas is called as pathya and vice-versa.
As the word path refers to doshas, dhatus etc. so the whole shareera itself can be considered
as path, so the one which is beneficial for the shareera is called as pathya.
Pathyapathya depends upon following 6 factors –
1. Matra
2. Kala
3. Kriya
4. Bhoomi
5. Deha
6. Dosha
Consideration of all these six factors is essential before deciding pathyapathya, because use
of proper pathya can act as a treatment itself, while improper use of pathya can act as
apathya.
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Ashtavidha ahara vidhi vishesha ayatana:

1. Prakruti → Natural quality of dravya
2. Karana → Processing of dravyas
3. Samyoga → Combinations of various dravyas
4. Rashi → Quantity of food
5. Desha → Place of origin of the dravyas.
6. Kala → Rutu & dosha & roga avastha
7. Upyoga samsthana → Dietetic rules
8. Upyokta → Consumer must take food as per his satmya.
Apathya:
Those ahara or aushadha which dislodge the dosha from their normal sites and aggravate
them but do not eliminate them from body, are called viruddha ahara, and these are harmful
or apathya.
There are 18 types of apathya
Rutu anusara dosha prakopaka ahara is also apathya that must be avoided for prevention of
several diseases.
Examples of pathyapathya
Pathyapathya for vataja vikara
Pathya Apathya
Ahara Ghrita, taila, godhuma, shali, Chanaka, mudga, jambu, puga,
draksha, jangala mamsa shushka mamsa
Vihara Jala krida, abhyanga, samvahana, Ratrijagarana, shrama, chinta,
brimhana maithuna
Pathyapathya for kaphaja vikara
Pathya Apathya
Ahara Madhu, yava, mudga, shali, Navanna, godhuma, guda, kshira,
trikatu, chitrak, ushna-ruksha- ikshurasa, anupa mamsa, guru-
tikshna ahara snigdha ahara
Vihara Laghu vyayama, udavartana, Diwaswapna, avyayama,
vamana vegadharana
Importance of pathyapathya:
Pathya is sustainer of all living beings. Food sustains the life of all living beings, complexion,
clarity, good voice, longevity, intellect is all conditioned by pathyakara ahara itself.
It is said in this verse that vaidhya without having vyakarana and dhanurdhara without
practicing becomes laughing material hence the knowledge of pathya apathya also important
to rule out the disease.
Ayurveda considered dietetics as not only a science of nutrition but holy ‘yajna karma’ in
reality.
To avoid the ayoga, atiyoga & mithyayoga of shareera and manas is the Shrestha pathya.
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It is said by charaka while explaining the agrya dravyas that the Shrestha apathya is ayaasa
(strenuous activities).
To show the importance of the pathya it is said by vaidhya jeevana, it is said that if a patient
is following the pathya then why he needs the treatment and if he is not following the pathya
then what is the use of treatment.
The whole body is dependent of ahara, nidra, brahmacharya in that ahara has got prime
importance and all the body components are made up of ahara only but rogas also occurs
because of ahitahara. Hence the pathyahara is the best regimen to protect health.
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5. Derivation of the term ‘Manas’, its sthana (place), Guna (qualities)

and Karma (functions). Samanya Chikitsa Siddhanta of Manasa Roga.
DERIVATION OF THE TERM ‘MANAS,’ ITS STHANA, GUNA AND KARMA
Manas:
Definition:
मन्यते बध्
ु यतेअनेतनतत मनः |
An internal organ of body which is responsible for the valid cognition of an object is known
as mana.
Synonyms:
• Atindriya • Chetas • Chitta
• Sattva • Hridaya • Svanta
Sthana of mana:
Heat is the place of mana.
Guna of mana:
Thinking, analysing, reasoning, meditating, determination whatever perceived by mind is its
object. These are the chief function of mana.
After those procedures confirm and real knowledge of an object gets derived.
1. Chintya → Whether to do or not to do is being decided by mana is known as
chintyam.
2. Vicharya → To accent or to reject a thing on the base of its qualities and inferiorities
is called as vicharya.
3. Uhya → Uhya is logical assumption regarding any phenomenon like this will be
happened in this way.
4. Dhyeya → Dhyeya is object for which one has attachment or attention.
5. Sankalpa → Object of affirmative knowledge decided on the base of its merits and
demerits.
6. Jneyam → Without the help of indriya whatever the cognition of an object perceived
by mana is called as mansajneyam.
Control over senses, self-restraint, reasoning, analysing.

On attachment of mana with respective indriya it becomes capable to perceive the cognition
of an object.
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SAMANYA CHIKITSA SIDDHANTA OF MANASA ROGA
Manasa roga:
Manas as adhisthana of roga, vitiation of manasika dosha cause disturbance in buddhi,
Sanjna, jnana, smriti etc. is called as manasa roga.
Samanya nidana:
Alpa satva
Vitiation of manasika dosha → Raja & Tama
Emotions or manobhava
All the sharirika and manasika rogas are caused by following three types of etiological factors
viz.
1. Asatmendriyartha samyoga
2. Prajnaparadha
3. Parinama (kala)
Samanya lakshanas:
• Instability • Depression
• Tremors • Loos of enthusiasm
• Intolerance • Frustration
• Excessive perspiration • Reduced activity
• Fear • Sleeplessness
Manasa roga samanya chikitsa:

Vikara anutpattikara chikitsa → Preventive measurement
Vikarasya chikitsa → Curative measurement
Preventive aspect:
त्यागः प्रज्ञापिाधस्च
Indriya prashamana
Sadvritta palana
Curative aspect:
1. Dravya bhoot chikitsa:
Shodhana chikitsa
Shamana chikitsa
2. Adravya bhoot chikitsa:
Bandhana
Tadana
Tamograha pravesha etc.
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General principles of management:
1. Yukti vyapashraya → Shodhana & Shamana
Shodhana → Panchakarma
Vata: Basti
Pitta: Virechana
Kapha: Vamana
Shamana → Medhya rasayana dravyas
Mandukaparni swarasa Brahmi
Yastimadhu churna with milk Jyotishmati
Guduchi swarasa Ashwagandha
Shankhapushpi kalka
Rasa aushadhi → Unmadagaja kesari rasa
Vatakulantaka rasa
Manasamitra vati
Saraswatharista with gold etc.
Bahir parimarjana → Murdhi taila

Shira abhyanga
Shiro pichu
Shirodhara: In chittodwega
Shirobasti: In nidranasha
Shastra pranidhana
2. Daiva vyapashraya:
The term daiva vyapashraya is concerned with all the unknown circumstances, which are
beyond the purview of reasoning.
In ayurveda, deva has been used in the various senses like unknown past deeds etc. The evils
of past life karmas cannot be cured by the scientific methods of medicine because the
diseases so happened are related to past deeds.
Daivavyapashraya methods create confidence and remove the fear and pessimistic
tendencies. It may in some way indirectly help the patient in gathering confidence. It works at
the level of mind and there by influence the body.
The following treatment in the shape of good deeds is recommended for diseases called by
deva.
Mantra: sacred hymes hymns Niyama
Aushadha Prayaschitta: Atonement
Mani: Gems Upavasa: Fasting
Mangala: Auspicious offerings Svastyayana: Chanting mantra
Bali: Gift Pranipata: Worshiping god
Upahara: Oblations Yatragamana: Pilgrimage
Homa
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3. Satwavajaya chikitsa:
Withdrawal of mind from harmful objects is called as satvavajaya chikitsa.
Techniques:
Gnana: Adhyatma gnana
Vignana: Shastra gnana
Ohairya: Anunnati chestasam
Smruti: Anubhootartha smaranam
Samadhi: Vishayebhya niverthyatmani namaso niyamanam
Scope of satvavajaya:
By regulating the thought process (Chintya)
By replacing the ideas (Vicharya)
By channelling the presumptions (Uhya)
By polishing the objectives (Dhyeya)
By proper guidance & advice for taking right decision (Sankalpa)
Trivarga anveshana → Contemplation of three objectives of life (Dharma, Artha, Kama)

Tadvidda seva → Service of those who are well versed in the treatment of mental diseases
Aatma gnana → Self realization
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6. Principles & Management of Nutritional deficiency disorders.
Nutritional disorders:
Nutrition:
Nutrition is the science or practice of consuming and utilizing foods. It includes food intake,
absorption, assimilation, biosynthesis, catabolism and excretion.
Nutrients:
A nutrient is a substance used by humans to survive, grow and reproduce. Generally,
nutrients are classified into macronutrients and micronutrients.
Sufficient energy in the form of carbohydrates, fats and proteins.
Vitamins and minerals, which function as co-enzymes or hormones in vital metabolic
pathways or, as for the case of Ca, P as important structural components.
Main nutritional disorders:

Obesity
Kwashiorkor
Marasmus
Anorexia nervosa
Bulimia nervosa
Vitamin deficiency
Trace element deficiency
Malnutrition
The WHO defines malnutrition as ‘the cellular imbalance between supply of nutrients and the
body’s demand for them to ensure growth, maintenance and specific functions
Primary → related to diet
Secondary → related to
Nutrient metabolism
Impaired nutrient utilization or storage
Excess nutrient losses
Increased need for nutrients.
PEM:
Protein energy malnutrition
Inadequate intake of protein and calories.
Two main clinical syndromes:
1. Marasmus:
Starvation in infant with overall lack of calories
Somatic protein compartment (Skeletal muscles) affected.
2. Kwashiorkor:
Protein deprivation more severe than deficit in calories.
Visceral compartment (Protein stores in liver) affected.
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3. Anorexia nervosa:
Self-induced starvation resulting in marked weight loss.
4. Bulima nervosa:
Protein binges on food and then induces vomiting.
Management of PEM:
Prevention
Promotion of breast feeding
Development of low cast weaning
Nutritional education and promotion of correct feeding practices
Family planning and spacing of births.
Immunization
Food fortification
Early diagnosis & treatment
Treatment:
Treatment strategy can be divided into 3 stages viz.
1. Resolving life threatening conditions
2. Restoring nutritional status
3. Ensuring nutritional rehabilitation
There are 3 stages of treatment:

1. Hospital treatment:
The following conditions should be corrected.
Hypothermia, hypoglycaemia, infection, dehydration, electrolyte imbalance, anaemia and
other vitamin and mineral deficiencies.
2. Dietary management:
The diet should be from local available staple foods – inexpensive, easily digestible, evenly
disturbed throughout the day and increased number of feeding to increase the quantity of
food.
3. Rehabilitation:
The concept of nutritional rehabilitation is based on practical nutritional training for mothers
in which they learn by feeding their children back to health under supervision and using local
foods.
Obesity:
Obesity is a medical condition in which excess body fat accumulates to the extent that it may
have a negative effect on health, leading to reduced life expectancy and / or increased health
problems.
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BMI = Weight in kg / (Height in m)2 = kg/m2
In BMI <18.5 = underweight
18.5 – 24.9 = normal
25-29.9 = overweight (pre-obese)
30-34.9 = obese class 1
35-39.9 = obese class 2
.40 = obese class 3
Management of obesity:
Exercise: Extra calories should be burnt with exercise unless there is medical
contraindication.
Diet: 800 to 900 Kcal daily with restricted diet.
Bulkiness of food is important as the patient needs to be satiated. Dietary fibres, salads,
sprouts, oats, and protein rich but low carbs diet with honey-water or warm water in morning
and metabolic booster herbs.
Hormonal therapy (to treat endocrine disease, if present)
Use of appetite suppressants & psychotherapy
Surgery (if required)
Vitamin deficiency:
Vitamin Disorder Treatment
Vitamin A (Retinol) Night blindness Tab. Retinol
Xerophthalmia
Vitamin D (Cholecalciferol) Rickets & Tetany: children Inj. Vit D3
Osteomalacia: Adult Calcimax tab.
Vitamin E (Tocopherol) Muscle weakness Tocopherol acetate capsules
Ataxia
Skin erythematous
Vitamin K (K1 & K2) Haemorrhagic diathesis Inj. Vit. K
Oral vit. K
Vitamin B1 (Thiamine) Beriberi Tab. Berin
Peripheral neuropathy
Vitamin B2 (Riboflavin) Angular stomatitis Tab. Riboflavin
Vitamin B3 (Niacin) Pellagra Tab. Niacinamide
Avoid sun shine
Vitamin B12 Macrolytic anaemia Inj. Cyanocobalamin
(Cyanocobalamin) Neuropathy
Vitamin B9 (Folic acid) Megaloblastic anaemia Tab. Folic acid 5mg
Chronic diarrhoea
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7. Management of Vardhakyajanita vikara, Indriyapradoshoja vikara,

Alzhiemer’s Disease, Sleep disorders, General debility.
Vardhakyajanita vikara:
The branch of medicine dealing with the health and care of old people is known as jara
chikitsa or Geriatrics.
Acharya charaka has considered more than 60 years of age as jirna or jaravastha, while
acharya sushruta mentioned 70 years of age.
Jaravastha is vata pradhana and known as hinavastha. Jara is one among svabhavabala janya
vyadhi.
If the diet is substandard in the terms of gramya ahara and when dietary and lifestyle
regimens are not followed properly like day sleep, daily coitus without vajikarana, daily
alcohol consumption, lack of exercise, mental and emotional disturbance there is vitiation of
tridosha, which leads to various progressive pathological changes due to improper utilization
of the diet.
Following pathological changes occur in the body viz.
• Loss of compactness of the • Excessive production of meda
muscles • Failure of majja
• Looseness of joints • Failure of production of sukra
• Vitiation of rakta • Loss of oja
Symptoms:
• Lethargy • Decreased vitality
• drowsiness • Loss of memory
• Respiratory rate is increased
Vardhakyajanita vikara refers to diseases of elderly (loss of physical & mental abilities in old
age is termed as senile).
Examples:
• Indriya daurbalya (Visual and hearing impairments, Parkinson’s disease, Alzheimer’s
disease etc.)
• Khalitya (Baldness) • Kleibya (Impotency)
• Palitya (Greying of hair) • Cardiovascular diseases
• Timira or linganasha (Cataract) • Urinary incontinence
• Uchcha raktachapa (Hypertension) • Cancer
• Sandhivata (Osteoarthritis) • Type – 2 Diabetes etc.
• Asthisoushirya (Osteoporosis)
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Management of vardhakya janita vikara:
It is a natural and yapya (palliative) disease.
It is essential to deal with this period of aging properly, as it is a time of increased
vulnerability to various chronic and degenerative diseases. Vrudhavastha can be managed by
palliative treatment.
It is even possible to treat vrudhavastha according to the principles of rasayana, especially
according to svabhavavyadhi pratisedhaniya chapter.
Avoid the provocative causes of kshaya and vata for example, excessive physical and mental
work, vigorous exercise etc.
Utilization of rasayana, vajikarana and yapana basti regularly.
Follow the principles of sadvrutta and achara rasayana. Involve oneself in the supreme power
of the eternal truth by any means as it increases the level of sattva in mind.
If any disease persists take treatment accordingly.
Medicines:
• Ashwagandha • Chopachini
• Bala churna • Eranda mula kvatha
• Chyavanprasha • Brahma rasayana
• Pippali churna • Medhya rasayana
• Shatavari • Shilajatu
General principles of geriatric care:

The following principles help in caring for elder adults →
• Be patient, kind and sympathetic. Communicate effectively, demonstrate respect.
• Assist elderly to achieve emotional stability
• Provide occupational therapy
• Assist them to take care of visual, auditory and dental aid.
• Protect from injuries, falls and accidents etc.
• Ensure adequate nutrition
• Help elderly to establish good sleep patterns.
• Control of BP, weight and diabetes
• Avoid smoking and alcohol
• Regular, moderate physical exercise
• Avoidance of drug abuse and self-medication.
• Well-balanced diet with plenty of vegetables and fruits, low in saturated fats, refines
sugars and fast foods.
• Yoga exercises and medication
• Immunization against influenza, pneumonia, tetanus, hepatitis B.
• Physiotherapy, vocational therapy, psychological and social therapy depending upon
the functional capacities.
• Establishment of geriatric clinics.
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Indriya pradoshaja vikara:
When the vitiated doshas get localized in sense organs, indriyapradoshaja vikara is produced
that results in either upaghata (destruction) or upatapa (diseases) of sense organs.
1. Indriya upaghata:
Destruction or complete damage of sense organs e.g., linga nasha, ghrana nasha, badhirya,
sparsha ajnana etc.
2. Indriya upatapa:
Diseases of partial damage of sense organs. E.g., puyalas, arma, abhisyanda, karna kshveda,
karna shola, pratishyaya, nasharsha etc.
Indriya pradoshaja chikitsa:

Same as trimarmiya chikitsa.
Nidana parivarjana
Sharira shodhana
Shamana aushadhi prayoga
Sthanika chikitsa
• Pratisarana, Seka, Aschotana, Anjana, Vidalaka etc. for Netra roga
• Prakshalana, Pramarjana, karnadhupana, etc. for karna roga
• Prakshalana, nasya, dhooma, etc. for nasa roga
• Pratisarana, dhuma, kavala-gandusha etc. for jihva roga
• Pralepa, pradeha, raktamokshana etc. for twaka roga
Shastra chikitsa: like bhedana, chedana, lekhana, vyadhana
Pathyapathya palana:
Nasahi shiraso dwaram for all types of diseases of sense organs nasya karma is the best
treatment as the nostril are gateway of head region and shiras is the seat of all sense organs.
A physician should use both sarva daihika & sthanika chikitsa to cure the indriya pradoshaja
vikara.
Medicine:
• Nasya by gau ghrita and paurana • Kapikachchhu churna
ghrita (8 drops) • Balamula kvatha
• Shirodhara • Ashwagandha churna
• Shankhapushpi churna • Jatamansi churna
• Brahmi churna • Brahmarasayana
Alzheimer’s disease:
Alzheimer’s disease is a chronic, irreversible disease that affect the cells of the brain and
causes impairment of intellectual functioning.
Alzheimer’s disease is a brain disorder which gradually destroys the ability to reason,
remember, imagine and learn.
Alzheimer’s disease is the commonest type of dementia. It is neuro degenerative disease that
usually occurs after the age of 65 years, and is therefore considered senile dementia.
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Clinical features:
Cognitive symptoms → Short term memory loss
Non-cognitive symptoms → Problems with thought, disorders of perception, mis-
identification, disorientation, mood swings, aggression or depression etc.
Managements:
There is no cure for Alzheimer’s disease, available treatments offer relatively small
symptomatic benefit but remain palliative in nature.
Current treatments can be divided into pharmaceutical, psychosocial and caregiving
1. To treat the cognitive problems →
1. Acetyl-cholinesterase inhibitors:
Tacrine
Rivastigmine
Galantamine
2. NMDA receptor antagonist:
Memantine hydrochloride
2. To treat non cognitive symptoms →
a. Non pharmacological treatment, particularly if symptoms are not severe. Assessment
of clear precipitants e.g., suboptimal prompting, personal care or toileting), social
interaction, activity and exercise.
b. In depression: non tricyclic antidepressants (e.g., selective serotonin re-uptake
inhibitors, trazodone)
c. In psychosis: atypical antipsychotics
The ‘do it yourself’ approach:
Diet control
Use of exercise
Stress control
Herbal remedies
Ayurvedic aspect of Alzheimer’s disease:

Alzheimer’s disease does not find a specific mention in ayurvedic texts, but symptomatically
it can be considered under the category of smriti vibhramsha / smriti nasha and vata vyadhi
The samprapti of Alzheimer’s disease, vitiation of vata in the tissue of body and the brain,
cause it to gradually move in a stage of imbalance. Alternatively, the balance of three
manasika gunas – satvika, rajasika, tamasika gets disturbed and cause imbalance of mental
faculties
Treatment:
In ayurveda Alzheimer’s disease is considered as yapya roga.
According to modern science, management of AD is difficult and frustrating because there is
no specific treatment. Here ayurveda can offer a better care, on preventive as well as
promotive aspects of health, of the patient. Persons having familial trends of the disease can
adapt ayurvedic medication in an early adulthood itself to prevent the possibility of the
disease.
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The treatment of atatwabhinivesa can be effectively employed for the management of AD.
The patient should be undergone oleation and fomentation followed by purificatory
treatments and samsarjanakarma.
Medhya rasayanas should be administered along with symptomatic care and mental support.
The dietetics of the patients should be having Medhya qualities.
Here, rasayana therapy deserves special mention as it provides longevity, memory, intellect
freedom from diseases, youth, excellent potentiality of body and sense organs
Acharya charaka mentions mandukaparni swarasa, yastimadhu churna, guduchi swarasa,
shankhapushpi kalka as Medhya rasayanas.
Formulations such as panchagavya ghrita, brahmi rasayana, triphala rasayana can be
effectively utilized.
Jivaniya as well as ojovardhaka drugs helps in slowing down of degeneration of dhatus and
promotes immunity.
Panchakarmas including sirodhara, shirolepana, pizhichil, nasya gives excellent results.
Some formulations →
• Smriti sagar rasa • Swarna bhasma
• Saraswata arista • Jatamansi churna
• Aswagandharista • Samshamani vati
• Chyavanaprasha
• Nasya by gau ghrita and purana ghrita helps in treatment.
Sleep Disorders:
Introduction:
Sleep is a regularly recurring, rapidly reversible neurobehavioral state characterized by
quiescence, postural recumbence and reduced awareness of the environment.
Sleep is required for proper brain function.
Sleep disorder classification:

Insomnia disorder
Hypersomnolence disorder
Narcolepsy
Breathing related sleep disorders
Obstructive sleep apnea hypopnea.
Central sleep apnea
Sleep related hypoventilation
Circadian rhythm sleep wake disorders
Parasomnias
Non-REM sleep arousal disorders
Nightmare disorder and REM sleep behavior disorder.
Restless legs syndrome
Substance / medication induced sleep disorder.
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A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person. Some
sleep disorders are serious enough to interfere with normal physical, mental, social and
emotional functioning.
Insomnia disorder:
The essential feature of insomnia disorder is dissatisfaction with sleep, characterized by
difficulty falling asleep, difficulty maintaining sleep, or difficulty returning to sleep after
awakening during the night.
Quantitative criteria for insomnia disorder include frequency (at least 3 nights per week) and
duration (at least 3 months)
Treatment:
Treatment goals:
To improve qualitative and quantitative aspects of sleep, to reduce sleep related distress, and
to improve daytime function.
Somatic treatments:
Currently approved drugs include benzodiazepine receptor agonist, tricyclic drug, melatonin
receptor agonist, antihistamines and barbiturates.
Psychosocial treatments:
Stimulus control, sleep restriction therapy, relaxation training, cognitive restructuring of
irrational sleep related beliefs and sleep hygiene.
Sleep hygiene:
Promote behaviors that improve sleep, limit behavior that harm sleep:
Avoid naps
Get regular exercise
Maintain a regular sleep schedule
Avoid stimulants (caffeine, nicotine)
Limit alcohol intake
Do not look at the clock when awake in bed.
Narcolepsy:
A chronic neurological disorder, which is caused by the brains inability to control sleep and
wakefulness.
The hallmark of narcolepsy is extreme daytime sleepiness.
Treatment:
To reduce daytime sleepiness and to manage the symptoms of cataplexy, sleep paralysis and
sleep related hallucinations when present.
Monoaminergic stimulants, modafinil
Scheduling regular brief nap
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Anidra chikitsa:
Intake of milk or sugarcane juice or meat soup.
Sirobasti or karnapurana
Anga udavartana & snana
Netra tarpana
Sleeping in comfortable position in a place getting exposed to breeze from fragrant
Samvahana & sparshasukha
Massaging the body aids the wellbeing of the muscles along its associated blood supply and
skin.
General debility:
General debility (daurbalya) means the lack of strength in a person
General debility is a state of general weakness or feebleness that may be a result or an
outcome of one or more medical conditions that produce symptoms such as pain, fatigue,
cachexia and physical disability, or deficits in attention, concentration, memory, development
and/or learning.
Management:
Treat the underlying cause
Symptomatic treatment
IV fluids (to provide glucose & correct electrolyte balance)
Multivitamin capsules or syrups
Nutritional supplements
Appetizers & digestants with balanced diet should be advised.
Ayurvedic management:
Nidana parivarjana
Roga prashamana chikitsa
Madhura balya supachya dravya prayoga
Rasayana vajikarana prayoga
Abhyanga with mahanarayana taila or Chandana bala lakshadi taila
Aushadha prayoga:
• Aamalaki • Mamsarasa
• Haritaki • Ghrita
• Shatavari • Chyavanprasa
• Ashwagandha • Ashwagandha churna
• Yastimadhu • Dashamularista
• Ela • Drakshasava
• Lasuna • Kumaryasava
• Draksha • Lohasava
• Kharjur
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8. General introduction and principles of Management of diseases

produced by Genetic, Environmental and Iatrogenic factors. Disorders
due to drug and Food allergy and their management and other allergic
conditions.
GENERAL INTRODUCTION AND PRINCIPLES OF MANAGEMENT OF

DISEASES PRODUCED BY GENETIC, ENVIRONMENTAL, AND IATROGENIC
FACTORS
Genetic disorders:
A genetic disease occurs when a person has one or more abnormal genes, missing genes,
extra genes, inactivated genes, or overly active genes that lead to a medical condition.
• Genes are the building blocks of heredity. They are passed from parent from parent to
child.
• Genes are found within the cells of all organisms. An individual’s genes are present in
a large molecule called deoxyribonucleic acid (DNA).
• They hold DNA, the instruction for making proteins.
• DNA is made up of different combinations of four nucleic acid (adenine, thymine,
cytosine, guanine), which are arranged in different lengths.
• Proteins do most of the work in cells. Proteins move molecules from one place to
another, build structures, build structures, break down toxins and do many other
maintenance jobs.
• Human cells normally contain 23 pairs of chromosomes.
• One chromosome in each pair comes from father and the other from mother.
• Sometimes there is a mutation, a change in a gene or genes.
• The mutation changes the gene’s instructions for making a protein, so the patient does
not work properly or it is missing entirely. This can cause a medical condition called a
genetic disorder.
• A gene mutation is a permanent alteration in the DNA sequence that makes up a gene.
Types:
1. Acquired mutations:
Acquired mutations occurs at some times during a person’s life and are present only in
certain cells, not in every cell in the body.
Cannot passed on to the next generation.
2. Heredity mutation:
Heredity mutations are inherited from a parent and are present throughout a person’s life in
virtually every cell in the body.
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Types:
1. Single gene genetic inheritance →
Single gene inheritance, also called mendelian or monogenetic inheritance.
e.g. Cystic fibrosis
Sickle cell anaemia
Marfan syndrome
Huntington’s disease
Hemochromatosis
Single gene disorders are inherited on recognizable patterns: autosomal dominant, autosomal
recessive, x-linked.
2. Multifactorial genetic inheritance →

Multifactorial inheritance disorders (complex or polygenic inheritance), are caused by a
combination of environmental factors and mutations in multiple genes
e.g., Congenital diseases → Cleft lip, cleft palate, club foot, pyloric stenosis, congenital heart
disease, spina bifida
Adult disease → Alzheimer’s disease, Schizophrenia, cancer etc.
Multi factorial inheritance also is associated with heritable traits such as fingerprint patterns,
height, eye colour, skin colour.
Chromosome abnormalities:
Chromosomes are the carriers of the genetic material, abnormalities in chromosome number,
or structure can result in disease. Abnormalities in chromosomes typically occur due to a
problem with cell division
e.g. Down syndrome, or trisomy 21 is common disorder that occurs when a person has
three copies of chromosome 21.
Turner syndrome (45, XO)
Klinefelter syndrome (47, XXY)
Mitochondrial genetic inheritance:

This type of genetic disorder is caused by mutations in the non-nuclear DNA of
mitochondria.
e.g., An eye disease called Leber’s hereditary optic atrophy.
Myoclonic epilepsy
Management:
• Many genetic disorders result from gene changes that are present in essentially every
cell in the body. As a result, these disorders often affect many body systems, and most
cannot be cured. However, approaches may be available to treat or manage some of
the associated signs & symptoms.
• For genetic conditions, treatment and management strategies are designed to improve
signs and symptoms associated with the disorder. These approaches vary by disorder
and are specific to an individual’s health needs. For example, a genetic disorder
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associated with a heart defect might be treated with surgery to repair the defect or
with a heart transplant.
• Some genetic changes are associated with an increased risk of future health problems,
such as certain forms of cancer, one well known example is familial breast cancer
managed may include more frequent cancer screening or preventive surgery to
remove the tissues at highest risk of becoming cancerous.
• Most treatment strategies for genetic disorders do not alter the underlying genetic
mutation; however, a few disorders have been treated with gene therapy.
• Gene therapy refers to a form of treatment where a healthy gene is introduced to a
patient. This should alleviate the defect caused by a faulty gene or slow the
progression of disease.
• Stem cell treatments → Treating diseases like diabetes, osteoarthritis, various blood
cancer, sickle cell Anaemia, thalassemia etc. These genetic disease can be treated by
the transplantation of stem cells where the normal stem cell replaces the defected
cells.
Specific treatment:
• Down syndrome: Early intervention programmes with a team of therapists and special
educators who can treat each child’s specific situation are helpful in managing
Down’s syndrome.
• Cystic fibrosis: Newborn screening for early diagnosis.
• Huntington’s disease: No cure exists, but drugs physiotherapy and talk therapy can
help manage some symptoms.
• Duchenne muscular dystrophy: Corticosteroids
• Sickle cell anaemia: Treatments include medication, blood transfusion, and rarely a
bone marrow transplant.
• Hemophilia: Injections of clotting factor or plasma.
Aanuvanshika vyadhi:
In ayurveda, hereditary diseases are also explained by ancient sages, acharya sushruta termed
such diseased as aadibala pravruta, Acharya charaka mentioned kulaja vyadhi.
Examples of aadibala pravruta roga →

Kustha, arsha, prameha, shwitra, apasmara, timira, vatarakta, arbuda, medovriddhi, khand
ostha, khanda talu etc.
Environmental factors of diseases:

• Diseases and conditions caused by factors in the environment are called
environmental disease.
• Stress, physical and mental abuse, diet, exposure to toxins, pathogens, radiation and
chemicals are possible causes of a large segment of non-hereditary diseases.
• There are many different types of environmental disease including →
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• Stress related diseases such as mental health disorders, or lifestyle disease such as
cardio vascular diseases, obesity, arthritis, diseases caused by substance abuse such as
alcoholism, and smoking related diseases.
• Diseases caused by pollution such as hearing impairment due to noise pollution,
breathing problems due to air pollution, GIT problems due to water pollution etc.
• Disease caused by physical factors in the environment such as skin cancer caused by
excessive exposure to UV radiation in sunlight.
• Disease caused by exposure to toxic or irritant chemicals in the environment such as
toxic metals.
• Diseases related to heat:
Heat cramps, heat exhaustion, heat stroke
• Disease related to cold:
Hypothermia, cold stroke (frost bite)
Trench foot etc.
• Disease related to high altitude sickness:
Acute mountain sickness
High altitude cerebral oedema
Management:
Treatment includes avoidance of etiological factors and symptomatic management.
Examples of possible actions to address environmental risks include the promotion of safer
household water storage and better hygiene measures, the use of cleaner fuels and the safer,
more judicious use and management of toxic substances at home and in the workplace, as
well as occupational safety and health measures.
Specific treatment:
Related to heat: Moving the person to cool environment
Giving oral saline solution
Intravenous isotonic saline.
Related to cold: Make the person to a warm, dry place
Remove wet clothing
Cover the patient with blankets
Airway warming
Gastric lavage with warm water.
Acute mountain sickness: Mild cases → rest & analgesics
Severe cases → Descent to lower altitude.
For alcoholism: Antipsychotics are required for alcoholic hallucinations.
Prevention:
• Vaccination • Urban planning
• Environmental sanitation • Sex education and promotion of
• Vector control safe sex.
• Reduction of population growth • Testing and diagnosis
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Treatment:
• Promotion of hygiene practices • Biodiversity preservation and
• Food security and proper nutrition reduction of climate change.
• Reduction of contact with wildlife • Development of new antimicrobial
and livestock drugs.
• Reduction of social inequalities • Risk communication.
• Infectious disease surveillance
Iatrogenic disorders:
Iatrogenic disease is the result of diagnostic and therapeutic procedures undertaken on a
patient (i.e., due to the activity of a physician or therapy).
With the multitude of drugs prescribed to a single patient adverse drug reactions are bound to
occur. The physician should take suitable steps to detect and manage them.
Causes:
• Diagnostic procedures (such as • Medical error
mechanical & radiological) • Negligence
• Therapeutic regimen (drugs, • Unexamined instrument design
surgery etc.) • Faulty procedures, techniques,
• Hospitalization information, methods or
• Side effects of possible drug equipment.
interactions
Examples:
• Adverse effect of prescribed drugs
• Resistance due to over use of drugs
• Incomplete or improper diagnosis and treatment due to medical error of negligence.
• Hospital acquired infections
• Scar formation
• Other complications due to faulty procedures and surgical techniques such as post-
operative hemorrhage, nerve injuries, incisional hernia etc.
• Adverse drug reaction (ADR):
• ADR is defined by WHO as any response for a drug which is noxious, unintended and
which occurs at doses normally used for prophylaxis, diagnosis and therapy of
disease.
• ADR can be classified as predictable (side effects, toxicity, super infection, drug
interactions) and unpredictable (intolerance, idiosyncrasy and allergy or pseudo
allergy)
• Hazards of blood transfusion:
• Complications occur in 2% of blood transfusions.
• Immunological reaction: Allergic anaphylaxis, fever, hemolysis, non-cardiac
pulmonary oedema.
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• Non-immunological → Circulatory overload, thrombophlebitis and embolism,
bacterial contamination, transmission of disease like malaria, hepatitis, syphilis and
AIDS and transfusion siderosis in multiple transfusion.
Management:
• Prevention
• At least 50% of iatrogenic are preventable including >70% of events in ICUs.
• The first step is to identify patients who are at greatest risk.
• Polypharmacy
• Multiple physicians
• Multiple chronic diseases
• Extended hospital stays
• Care management
• Care managers facilitate communication among health care practitioners, ensure that
needed services are provided, and prevent duplication of services. They could be
employed by physician groups, health plans, or governmental organizations.
• Pharmacist consultation
• A pharmacist can help prevent potential complications caused by polypharmacy and
inappropriate drug use.
• Acute care for the elderly units.
• Hospital wards with protocols to ensure that elderly patients are thoroughly evaluated
for potential iatrogenic problems before those problems occur for such problems to be
appropriately managed.
• Advanced directives.
• Designation of a proxy to make medical decision and advanced directives on care.
This can help to prevent unwanted medical treatment who cannot speak for
themselves.
• Primary preventions aim to stop iatrogenic disease before it starts, usually by reducing
or eliminating risk factors. In secondary prevention, iatrogenic disease is detected and
treated at an early stage before symptoms or functional losses occur, thereby
minimizing morbidity and mortality.
• Physician should treat the patient after proper diagnosis.
• Drugs & therapeutic procedures should be used consideration of indications,
contraindications, and their side-effects.
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For avoidance of such events follow the rule of 7 rights.
1. Right medication
2. Right dose
3. Right route
4. Right time
5. Right patient
6. Right information
7. Right documentation
DISORDERS DUE TO DRUG AND FOOD ALLERGY AND THEIR MANAGEMENT

AND OTHER ALLERGIC CONDITION
Drug allergy:
A drug allergy is an allergy to a drug, most commonly a medication, and is a form of adverse
drug reaction. It is the abnormal reaction of the immune system to a medication. Any
medication – over the counter, prescription or herbal – is capable of inducing a drug allergy.
A drug allergy is not the same as a drug side effect, a known possible reaction listed on a
drug label. A drug allergy is also different from drug toxicity caused by an overdose of
medication.
Causes →
When a medication causes an allergic reaction, it is called an allergen.
The following is a short list of the most common drug allergens:
• Antibiotics • Non-steroidal anti-inflammatory
• Penicillin drugs (NSAIDs)
• Sulfa drugs • Antiseizure
• Tetracycline • Phenytoin
• Analgesics • Carbamazepine
• Codeine
Signs & symptoms of Drug allergy →

Symptoms of allergic reactions can range from mild itching to life threatening conditions.
Many drugs can also cause side effects or intolerances such as an upset stomach. These
symptoms do not always indicate a true allergy to a drug.
During an allergic reaction, histamine and other chemicals can cause symptoms that include:
• Hives • Congestion
• Skin rash • Swelling in the mouth and throat
• Itchy skin or eyes • Difficulty breathing
• Runny nose
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Anaphylaxis is a rare, life-threatening reaction to a drug allergy that causes the widespread
dysfunction of body systems. Signs and symptoms of anaphylaxis include:
• Tightening of the airways and throat, causing trouble breathing
• Nausea or abdominal cramps
• Vomiting or diarrhea
• Dizziness or lightheadedness
• Weak, rapid pulse
• Drop in blood pressure
• Seizure
• Loss of consciousness
Treatment →
Withdrawal of the drug
Injections of antihistamine and corticosteroids, e.g., Inj. Avil (Pheniramine maleate) + Inj.
Dexamethasone / Hydrocortisone
Oral antihistamine and corticosteroids
Treatment of anaphylaxis →
Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain
blood pressure and support breathing.
Food allergy:
A food allergy is an abnormal immune response to food. The signs and symptoms may range
from mild to severe. Even a tiny amount of the allergy-causing food can trigger signs and
symptoms such as digestive problems, hives or swollen airways. In some people, a food
allergy can cause severe symptoms or even a life-threatening reaction known as
anaphylaxis.
Food intolerance and food poisoning are separate conditions.
Causes →
While any food can cause an adverse reaction, eight types of food account for about 90
percent of all reactions:
• Eggs • Fish
• Milk • Shellfish
• Peanuts • Wheat
• Tree nuts • Soy
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Signs and symptoms →
Symptoms of an allergic reaction may involve the skin, the gastrointestinal tract, the
cardiovascular system and the respiratory tract.
They can surface in one or more of the following ways:
• Vomiting and/or stomach cramps
• Hives
• Shortness of breath
• Wheezing
• Repetitive cough
• Shock or circulatory collapse
• Tight, hoarse throat; trouble swallowing
• Swelling of the tongue, affecting the ability to talk or breathe
• Weak pulse
• Pale or blue coloring of skin
• Dizziness or feeling faint
Anaphylaxis, a potentially life-threatening reaction that can impair breathing and send the
body into shock; reactions may simultaneously affect different parts of the body (for
example, a stomachache accompanied by a rash)
Diagnosis →
Diagnosis is usually based on a medical history, elimination diet, skin
prick test, or blood tests for food-specific IgE antibodies.
Treatment →
• To prevent the food allergy, follow the strict diet.
• Total avoidance of the foods identified as allergens.
• If the food is accidentally ingested and a systemic reaction (anaphylaxis) occurs, then
epinephrine (adrenaline) should be used.
• A second dose of epinephrine may be required for severe reactions.
• The person should then be transported to the emergency room, where additional
treatment can be given. Other treatments include antihistamines and steroids.
[Epinephrine (arenaline) is the first-line treatment for anaphylaxis. If administered in a

timely manner, epinephrine can reverse its effects. Epinephrine relieves airway swelling
and obstruction, and improves blood circulation; blood vessels are tightened and heart
rate is increased, improving circulation to body organs.]
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KAYA CHIKITSA
PAPER 1
PART B
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1. Detailed description of Chikitsa Sutra and Management of Jwara and

its types. Etiopathogenesis & relevant Ayurvedic and Modern
management of following types of Fevers-Typhoid, Pneumonia,
Pleurisy, Influenza, Mumps, Meningitis, Encephalitis, Tetanus, Yellow
fever, Plague, Dengue Fever, Chikun Guniya, Leptospirosis, Viral
Fever, Anthrax, Masurika (Small pox), Laghu Masurika (Chicken pox),
Romantika (Measles).
DETAILED DESCRIPTION OF CHIKITSA SUTRA AND MANAGEMENT OF

JWARA AND ITS TYPES
Jwara
Introduction:
• In ayurvedic literature jvara or fever has been described as ‘sarva rogadhipati’ the
commander of all diseases in view of the following characteristics.
• Jvara is considered as the first and foremostly manifested ailment. As such it is
termed as – सवमिोगाग्रजो and बली i.e., powerful because of its intensity.
• Jvara is a wide spread disease manifesting not only in human beings, but also in living
creatures.
• Jvara elevates the body temperature considerably, causes severe pains of body, organs
and mind.
• Jvara by virtue of its nature occurs at the time of birth and death.
• It manifests as an independent disease entity, as well as a lakshana in many ailments.
Mythological references:
Jvara was originated from the hot and destructive breath of lord shiva, which was produced
from his nostrils during the paroxysms of grief and rage on the death of his wife sati.
Synonyms of jwara:
• Takma – that causes hardship and • Vyadhi
pain. • Aatanka
• Santapa • Sheersha shokam
• Vikara • Vyanga
Paribhasha:
ज्वलयतत संतापयतत िे हेत्न्रयमनांसीतत ज्विः |
This derivation explains that jwara induces tapa or pain in the body, organs & minds.
ज्विस्तु खलुएकएव संतापलक्षणः |
Santapa i.e., elevated temperature is the one and only lakshana of jwara.
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According to sushruta – a clinical condition where in – if sweda-avarodha along with
‘santapa’ and ‘sarvanga grahanam’ is specifically known as jwara.
Nidana:
• Improper or excessive application of therapeutic measures like oleation, fomentation,
emesis, purgation, two types of vasti.
• Injuries or trauma
• Ripening of abscesses, ulcer, wounds etc.
• Excessive work, emaciation of body tissues.
• Indigestion or consumption of poisonous substances.
• Asatmya foods, mithyahara and vihara.
• Seasonal changes
• Psychological causes like excessive worry, fear, lust etc.
• Graha related factors, curse etc.
• Infective causative factors (sankramika)
• Improper post-delivery care of ladies, first time milk production etc.
Prodromal symptoms (purvarupas)

• Laziness • Body aches
• Fatigue • Tastelessness
• Anorexia • Yawning
• Tears in eyes • Heaviness
• Mental fatigue • Depletion in strength
Vishesha purvaroopa:
Jrumbha → Vataja jvara
Daha → Pittaja jvara
Aruchi → Kaphaja jvara
Common symptoms (samanya roopa):

संतापः सारुचच स्तर्षृ णा साङ्गमिो ह्रदिव्यथा |
ज्विप्रिावो जन्मािौतनधने च महत्वं ||
ज्विप्रत्यात्त्मकं भलङ्गं संतापो िे हमानसः |

ज्विे णा ववशता िूतं न दह ककत्ञ्चन्न तच्यते ||
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Samprapti:
भमथ्याहािववहािाभ्यां िोषा ह्यामाशयाियाः |
बदहतनमिस्य कोस्थात्ग्नं ज्वििाः स्यू िसानुगा: ||
Nidana sevana → Tridosha prakopa (pitta dominant), combine with rasa dhatu → Agni
comes outside from the amashaya, obstruction in svedavaha srotas, spread all over the body
→ localise whole over body → manifestation of signs & symptoms → types and
complication
Jvara upadrava:
कासमूिामअरुचचच्िदिम तर्षृ णातीसािववत्ग्रहा: |
दहक्काश्वासोअन्गमेिि ज्विस्योपरवा िशा ||
Jvara mukta lakshana:

• Sweating • Stomatitis
• Lightness of body • Desire for food
• Itching sensation in head
Classification:
Shareera-manasika
According to adhisthana or location or seat of origin.
1. Shareera jwara: Shareera jwara is produced in the body as consequence of vitiation of
somatic doshas. For instance, in shareera jwara, shamana especially pittashamana
drugs are employed.
2. Manasika jvara: Rajas and tamas are afflicted initially under the influence of strong
emotional factors, and then inter spread to somatic doshas to effect ‘shareera santapa’
in addition to ‘mana tapa’.
In manasika jvara, priority is given to satvavajaya chikitsa.
Soumya – Agneya
According to causative doshas & factors
1. Saumya means cold, indicates sheetala jvara manifesting due to aggravation / vitiation
of cold causative factors.
In this fever patient likes ‘ushna ahara’
2. Agneya jvara: agneya jvara is dominated by fiery pitta dosha, with high temperature,
daha etc. and patient likes sheetala ahara-vihara.
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Antarvega and Bahirvega:
Antarvega jvara Bahirvega jvara
Antardaha Adhika santapa on body surface
Adhika Trishna Mild thirst
Pralapa Sukha Sadhya i.e., easily treatable.
Bhrama
Sandhi asthishula
Dosavarcha vinigraha
Prakruta and vaikruta jvara:

1. Prakruta jvara:
The manifestation of fever or jvara vega in spring and autumn seasons. i.e., during ‘vasanta’
and ‘sharada’ seasons is generally regarded as prakruta or seasonal fevers, as these are easily
manageable.
For example:
a. The fever caused by kapha dosha in Vasanta or spring times.
b. One caused by pitta dosha in autumn or sharad season.
2. Vaikarika jvara:
Fever caused by vata in rainy season should also regarded as prakruta fever, but it is not
because it is very difficult to treat as the treatment of fever requires – langhana or fasting
measures, which in turn further aggravates vata.
Because of this mutual contraindication between the dosha which has affected the disease and
the line of treatment, the type of jvara is difficult to treat.
Sadhya-Asadhya jvara:
1. Sadhya: In a person with strong physique, if jvara occurs by vitiation of less amount
or number of doshas, and if there is no upadrava or complication then this type of
jvara is regarded as ‘sadhya jwara’.
2. Asadhya: Asadhya jvara is regarded as asadhya and may lead to death.
Fever caused by many strong etiological factors.
Associated with many signs & symptoms.
Which destroys the sense organs immediately.
Sama – vishama jvara:

1. Sama jvara is that fever where in causative factors involved in causation are mild
(alpahetu) superficial fever without any complications, having occupied ‘ekasraya’.
This type of jvara can be manageable easily as it is laghupaki.
2. Vishama jvara:
The term vishama jvara indicates a group of fevers which have vishamarambha i.e., irregular
onset of fever and visharga i.e., remission of temperature.
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ववषमो ववष मािम्ि किया कालोअनुषन्गवान ् ||

This vishamatva irregularity is due to lack of strength of vitiated doshas, located in rasa
dhatu.
Aetiology:
Remaining of fever inside dhatus very mildly.
Sushruta attributed two factors.
1. Para → indicates infecting cause
2. Svabhava → indicates doshika factors.
Thus, vishama jvara may occur due to exogenous and endogenous causative factor resulting
in – nija vishama jvara, agantuja vishama jvara
Samprapti:
Two kinds of vishama jvara:
1. Nija vishama jvara
2. Agantuja vishama jvara
1. Nija vishama jvara

Alpadosha / Leftover dosha after remission of fever + mithya ahara vihara etc. → again dosha
vruddhi → sanchaya → production of vishamarambhaka nija vishama jvara.
2. Agantuja vishama jvara:

Para / Svabhavaja / dhatu vaisamyata → leads to production of agantuja type of vishama
jvara.
Types:
1. Santata jvara
2. Satata jvara
3. Anyedyuska jvara
4. Tritiyaka jvara
5. Chaturthaka jvara
1. Santata jvara:
The heavy dosha spread all over the body through the rasavaha srotas and stiffened give rise
to santata jvara.
In this type of vishama jvara, in which temperature does not came down to normal but
persists for seven, ten or twelve days increasing and decreasing at periodic intervals is called
‘santata jvara’.
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Treatment:
1. Virechana or vasti to clean the bowels.
2. Anti-pyrexia medicine like sahadevi, peetadaru, karavellaka, saptapatra, dronapushpi,
Tulasi, kirata tikta etc. should be singularly or in combination may be decocted and
prescribed twice daily.
3. Godanti misrana, saptaparna ghana vati are specific drugs.
4. Ayush – 64
5. Ashava kanchuki rasa – cleans the bowels and brings down temperature.
6. Jvara murari rasa is good herbomineral drug in this fever.
2. Satata jvara:
Aggravated dosha, dushya, kala and prakruti are opposite to each other so counter acting
factor causes satata jvara which rises and falls according to corresponding time.
In this type of vishama jvara, there is twice rise and fall of temperature within 24 hours. i.e.,
day & night.
When this double rise of temperature takes a chronic shape i.e., persists for a longer time and
there is much loss of rakta dhatu due to destruction of blood cells and spleen is enlarged then
it is called ‘kala-azar’.
Treatment:
1. Same treatment as mentioned in santata jvara.
2. Specific medicines are guduchyadi kvatha – 30 to 40 ml twice a day.
3. ‘Samsamani vati’ 250mg tabs four times a day is a proven one.
4. ‘Putapaka-vishama jvarantaka lauha’ should be prescribed.
5. Jayamangala rasa is also very efficious in chronic stage.
3. Anyedyuska jvara:
Anyedyushaka jvara is caused by dosha which getting support from one of the factors such as
kala, prakruti and dusya obstructs the medavaha srotas in the presence of counteracting
factor.
In this type of vishama jvara, there is rise of temperature only once in 24 hours. The rise of
temperature is always with rigour and remission precedes perspiration.
Treatment:
1. Godanti misrana, kirata ghana vati, sudarshana ghan vati are given during fever to
bring down the temperature and receive thirst, burning sensation etc.
2. Vishama jvarantaka lauha, maha sudarshana churna etc.
4. Tritiyaka jvara:
As a seed lies dormant in the soil for some time and grows up in favourable time, dosha stay
in dhatus and get vitiated in favourable time.
In this fever attacks at interval of one day i.e., every third day the rise and fall of temperature
is always accompanied with rigour and perspiration respectively.
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Treatment:
1. The treatment is just like anyedyuska jvara.
2. The specific drugs are vishamusthyadi vati
Pancha tikta ghana vati
Brhat sarva jvara lauha
5. Chaturthaka jvara:
In this, the attack of fever is often every fourth day i.e., at the interval of two days fever is
always preceded by rigour and fall of temperature is preceded by sweating.
Chaturthaka jvara has two types
a. Caused by kapha starting form leg.
b. Caused by vata starting from head.
Treatment:
1. The specific medicines are –
Vishvatapa harana rasa
Chaturthakari rasa
Putapaka vishama jvarantaka lauha
Gudhuchyamalakam musta
Common treatment:
Vatapradhana vishama jvara:
Ghee
Basti
Anuvasana basti
Unctuous and hot food and drinks
Pittapradhana vishama jvara:
Virechana
Milk
Medicated ghee
Bitter and cold things
Kaphapradhana vishama jvara
Vamana
Digestives
Langhana
Ruksha diet, astringent & hot drugs.
Treatment during vega kala

Take large quantity of madya with food then go to bed.
Asthapana basti
Anuvasana basti
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After vega:
Dhupa
Nasya
Anjana
Daivavyapasraya chikitsa
Different yogas:
Svarasa → parijata svarasa
Kalka → Lasuna kalka
Churna → sudarshana, drakshadi
Kwatha → panchatiktadi, triphaladi, guduchyadi
Vati → vishama jvaraghni vati, karanjadi vati, guduchyadi modaka
Ghrita → shatpal, dashamulashatpal
Rasaushadha → lakshminarayana, lakshmivilasa, vishveswar, tribhuvanakirti rasa,
mallasindura etc.
Bahya chikitsa:
Nasya → purana sarpi
Agatsyapatra svarasa
Anjana → saindhava + pippali + manahshila + taila
Dhupa → astanga dhupa
Maheswar dhupa
Pathyapathya →
Laghu, balya, brimhana, supachya anna
Rakta shali
Godhuma
Mudga yusha
Milk of cow or goat
Nija jvara:
Nija jvara are seven in number, such as –
1. Vataja jvara
2. Pittaja jvara
3. Kaphaja jvara
4. Vata pittaja jvara
5. Vata kaphaja jvara
6. Pitta kaphaja jvara
7. Sannipataja jvara
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1. Vataja jvara:
Lakshana:
• Irregular fever • Dryness of mouth & body
• Loss of sleep • Body ache
• Sneezing • Abdominal discomfort
Chikitsa:
Under treatment of samana jvara
However, fasting should not be imposed in vataja jvara, as it may further aggravate vata,
instead ‘langhana’ here should be considered as ‘laghu bhojana’.
Hinguleshwara rasa
Godanti misran tablets
2. Pittaja jvara:
Lakshana:
• Always high temperature. • Thirst
• Diarrhoea • Fainting
• Bitter taste in mouth • Stomatitis & rhinitis
Chikitsa:
Pittaja shamana measures should be initiated
Langhana for ama pachana
Shadanga paniya
Tiktadi kvatha
Jvara kesari
Mrityunjaya rasa
3. Kapha jvara:
Lakshana:
• Low grade fever • No desire for food, anorexia
• Sweet taste in mouth • Stiffness of body
Chikitsa:
Pippali churna with honey for ama pachana
Chaturbhadra kvatha
Kapha ketu rasa
Tribhuvana kirti rasa
Langhana for long time
Diet prepared with katu, tikta, Kashaya rasa dravya
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4. Vata pitta jvara:
Lakshana:
• Fainting • Burning sensation
• Vertigo • Headache
Chikitsa:
Mixed treatment as described in vata jvara & pitta jvara, Rasadi vati & mrityunjaya rasa
recommended in this type of fever.
Drakshadi phanta
5. Vata kapha jvara 6. Pitta kaphaja jvara

Lakshana Lakshana
Pain in all joints Bitter taste in mouth
Excessive sleep Drowsiness
Heaviness in head Cough
Cough Feeling of burning in body
Treatment Treatment
Hot water to drink Langhana
Juice of radish Bala kwatha
Surasadi phanata Kasturi bhairava rasa
Tribhuvana kirti rasa
Naradiya lakshmivilas rasa with Tulasi juice
Sannipataja jvara:
A jvara or fever is called sannipataja when all the three doshas are involved or aggravated in
manifestation of fever.
Therefore, all signs and symptoms indicative of vataja, pittaja & kaphaja jvara are found in
patient suffering from sannipataja jvara.
According to the predominance of doshas their nomenclature has been fixed in the following
13 names –
1. Vatolbana → vishkaraka
2. Pittolbana → aashukari
3. Kapholbana → kampana
4. Vata pittolbana → babhru
5. Vata kapholbana → sheeghrakari
6. Pitta kapholbana → bhallu
7. Kapholbana madhyapitta hinavata → vaidarika
8. Pitolbana madhyakapha hinavata → yamya
9. Vatolbana madhyakapha hinapitta → krukcha
10. Kapholbana madhyavata hinapitta → karkata
11. Vatolbana madhyapitta hinnakapha → sammohaka
12. Pittolbana madhyavata hinakapha → chakala
13. Tridosholbana → kuchchakala
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Treatment:
वधमनेनैकिोषस्य क्षपणेनोत्च्रतस्य वा |
कफस्थानानुपूव्याम वा सत्न्नपातज्विं जयेत ् ||
For treating sannipata jvaras where three aggravated doshas are ‘hina,’ ‘madhyama’ and
‘adhika’.
The less aggravated dosha should be increased and the one which is aggravated maximum,
should be reduced.
This means adhika, should be removed by shodhana chikitsa.
Madhyama should be removed by shamana chikitsa
Sama sannipata jvara means where in all doshas have increased equally.
Charaka advised: always treat kapha dosha and kapha sites first, as ama is produced in
amashaya. While sushruta has different opinion, he suggested to treat pitta first because in
samprapti of jvara, pitta dosha playa a key role.
However, in other sannipata jvaras, vata must be treated first.
1. Langhana → until 3, 5 or 10 nights

2. Swedana → In vataja jvara: snigdha sveda
In vata – kaphaja jvara: Ruksha valuka sveda
3. Nasya
4. Nishthivana → To extract lina kapha of throat.
Lepa of draksha, madhu & ghrita
5. Avaleha → Astanga avaleha, Chaturanga avaleha
6. Anjana → Shirishbijadi Anjana, lauhachurnadi Anjana
7. Leha → sutavishadi lepa at site of head.
8. Kwatha → Dashamoola kwatha, Bhunimbadi kwatha, Brihatakatphaladi kwatha
9. Rasaushadhis → Mrut Sanjivani vati
Jaymangal rasa
Unmatta rasa
Sannipata bhairava rasa
Hema garbha potali
Lakshami vilas rasa
Madhu nishedha
Sheetajala nishedha
Agantuja jvara:
1. Abhishangaja jvara:
This type of fever is caused by ill attachment with passion, anxiety, fear, anger & by bhuta
i.e., bacterial etc. infestation.
Types & features:
1. Kama jvara:
Produced by passion
Symptoms are lethargy, agnimandhya
Treatment – pitta shamana decoctions
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2. Shoka jvara:
Produced by anxiety
Symptoms are tears in eyes along with fever
Treatment: awaking kama & krodha
3. Bhaya jvara:
Produced by fear
Symptoms – temperature shoots up suddenly
Treatment – satvavajaya chikitsa
4. Krodha jvara:
Produced by intense anger
Symptoms – headache & tremors
Treatment – providing favoured things.
2. Abhicharaja jvara:
This type of fever is caused by exorcism i.e., mantra, tantra etc.
Symptoms – burning sensation, thirst, vertigo
Treatment – Daivavyapashraya chikitsa
3. Abhisangaja jvara:
It is caused by cursing of brahmin, teacher, saint etc. person.
It manifests abnormal characters.
It should be treated with satvika behaviour divine therapies like homa, japa, dana etc.
4. Abhighataja jvara:
It is produced either after injury, trauma, accident, burns etc. external causes.
Treatment – treat the wounds with various pastes for ropana (healing) followed by
vatashamana treatment first, then by pitta shamana drugs.
Different stages of fever:

1. Nava jvara:
Nava jvara is the fever of 1 - 7 days duration.
Taruna javara, ama jvara is synonyms.
Management:
1. Prohibitions:
Patient should avoid sleep during day time, bath, massage, heavy food, sexual intercourse,
anger, exercise.
Dhara parisheka, vamana, virechana etc. are also contraindicated.
2. Recommended:
लङ्घनं स्वेिनम ् कालो यवाग्वत्स्तक्तको िसः |
पाचनान्यववपक्वानां िोषाणां तरुणे ज्विे |
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1. Langhana
2. Swedana
3. Kala (waiting for 7 – 8 days)
4. Yavagu
5. Bitter medicines
6. Pachana drugs
Langhana is not indicated in jvaras caused by aggravation of vata, fear, anger and grief
According to doshas, fasting indicated is.
1. Vata → 1 day
2. Pitta → 3 days
3. Kapha → 6 days
For svedana purpose, ushna water should be given for drinking with drugs intake.
मुस्तपपमटकोशीिचन्िनोिीच्यनागिै : |
िूतशीतं जलं िध्यात ् वपपासाज्विशान्तये ||
Shadanga paniya drink for thirst as well as for nutrition.
Lajamanda yavagu should be given
Bitter drugs like guduchi, katuki, kiratatikta.
Samshamani vati, sudarshana ghana vati 2 tabs thrice a day with hot water or pancha tikta
kvatha is ideal one.
2. Jirna jvara:
Fever running beyond 21 days.
Mild to moderate fever
Enlargement of pliha
Dullness of jatharagni
Management:
Intake of milk is especially indicated because of its ‘tarpana’ attributes. Suitable drugs should
be added to milk in following order.
Medicinal powder 20 gms +
Milk 160 gms +
Water 640 gms
Subjected to paka, till milk remains & given
If doshas are in pakvashaya – niruha basti is suitable.

Ghrita prayoga with suitable drug is good, as it nourishes the deranged weakened body
tissues.
Abhyanga with lakshadi taila, chandanadi taila.
Virechana, vamana avoided if patient is very weak in chronic fevers.
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Different yogas:
1. Pravala pishti, Guduchi satva, Sitopaladi churna → all should be combined and given
twice a day.
2. Chausata prahari pippali 1gm with honey
3. Putapakva vishama jvarantaka lauha + shrngi bhasma twice a day, with honey for 15
days.
4. In case yakruta, pleeha are enlarged –
Yakrut plihari lauha + mukta sukti
Aaragya vardhini 250 mg tab.
Punarnavadi mandura
5. If there is severe fever → jayamangalarasa 250mg with honey four times.
Punaravartaka jvara:
If an individual who suffered from fever recently, resorts to prohibited factors like consuming
vidahi items, guru, astamya, and viruddha i.e., mutually contradictory things etc. before
gaining strength then the jvara reappears.
In some clinical instances, doshas undergo paripaka in dhatus gradually and fever subside but
their harmful effects continue as a result of which the patient suffers from ‘dinata’,
‘svayathu’, ‘glani’, ‘panduta, loss of appetite etc.
Management:
• The doshas should be eliminated through suitable procedures like –
• Yapana basti
• Yusha
• Mamasa rasa of jangala animals
• Kwatha of kirat tikta, katuki, musta, parpata, guduchi 30 ml thrice a day.
• Putapaka vishama jvarantaka lauha + pravala pisti + guduchi satva given twice a day
with honey.
• Sudarshana ghanavati 250mg, thrice a day is very effective.
Dhatugata jvara:
ज्विे िसस्ये वमनमुपवासं च काियेत ् ||
सेकप्रिे ही िक्तस्ये तथा संशमनातन च |
वविे चनं सोपवासं मांसिेिः त्स्थते दहतम ् ||
अत्स्थमज्जागते िे या तनरुहाः सानुवासनाः |
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OTHER INFECTIVE FEVERS
ANTARIKA JVARA / TYPHOID / ENTERIC FEVER
Introduction:
Typhoid fever is an acute illness associated with fever caused by the salmonella typhi
bacteria.
Salmonella typhi lives only in humans. Persons with typhoid fever carry the bacteria in their
bloodstream and intestinal tract.
Transmitted through the ingestion of food or drink contaminated by the faeces or urine of
infected people.
Causes:
Caused by the bacterium salmonella typhi. Ingestion of contaminated food or water. Contact
with an acute case of typhoid fever. Water is contaminated were inadequate sewerage
systems and poor sanitation. Contact with a chronic asymptomatic carrier. Eating food or
drinking beverages that handles by a person carrying the bacteria.
Pathogenesis:
Ingest contaminated food → ingested bacilli invade small intestinal mucosa → taken up by
macrophage & transported to regional lymph node → s. typhi multiply in intestinal lymphoid
tissue → Intact with enterocytes & ileal peyer’s patches during the 1-3 week of incubation
period (diarrhoea) → end of incubation period, bacilli enter blood stream (onset of typhoid
fever) → bacteria invade the gall bladder, biliary system & lymphatic tissue of bowel &
multiply in high number. → Then pass into the intestinal tract.
Symptoms:
Symptoms usually develop 1 – 3 weeks after exposure and may be mild or severe.
1st week:
Slowly rising of temperature for 4 - 5 days
Abdominal pain
Malaise
Headache
Constipation
End of 1st week
Rose spots may appear on the upper abdomen & on the back of sparse.
Cough
Splenomegaly
Diarrhoea
nd
2 week
Continuous high fever
Considerable weight loss
Extremely distended abdomen
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3rd week
Become delirious
Life threatening complications often develops currently
th
4 week
Improvement may come slowly during the 4th week.
Fever is likely to decrease.
Complications:
Bowel → Perforation, Haemorrhage
Septicaemic foci → Bone & joint infection, meningitis, cholecystitis
Toxic phenomena → myocarditis, nephritis
Chronic carriage → persistent gall bladder carriage
Diagnosis & investigation:

Blood culture
Specific serologic test
Identify salmonella antigens
Widal test and ELISA
Urine & stool culture (2nd & 3rd week)
Bone marrow culture
Punch biopsy samples of rose spots culture
Clot culture
Treatment:
Activity → rest is helpful
Medical care:
Antibiotics: ciprofloxacin
Ampicillin
Azithromycin
Corticosteroids (for severe typhoid fever)
Antipyretics
Diet: fluid & electrolyte should be monitored soft digestible diet is preferable in absence of
abdominal distension & ileus.
Surgical care: in case of intestinal perforation
Ayurvedic treatment: (santata jvara)

According to ayurveda typhoid is known as ‘manthar jvara’. Food and water which is
contaminated by infected mala, mutra, sweda. Eating this contaminated food and water
bacteria enters the body and starts growing in intestine & enters in intestine walls which starts
imbalance of the rasa, rakta & tridosha.
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Ayurvedic herbs and medicines for typhoid.
Bilva phala:
It increases agni and is thus a digestive stimulant.
Works in constipation, indigestion, dysentery
It also helps reduce typhoid fever when given in the early stages.
Jatamansi:
It eliminates impurities in blood.
Guduchi:
In diarrheal & feverish condition.
Symptomatic treatment:
1. For raised temperature:
Tulasi patra svarasa
Adraka svarasa
Nimbapatra Kashaya
Kiratadi sapta Kashaya
Sitopaladi churna
Sudarshana churna
Tribhuvanakirti rasas
Sanjivani vati
2. For headache: godanti + kamadudha rasa
3. For malaise: samsamani vati
Pathyapathya:
Pathya: have light meals, langhana, rest well, consume barley, mudga, old shali
Apathya: avoid eating heavy food like chickpea, don’t exercise, don’t drink contaminated
water.
SHVASSANAKA JVARA / PNEUMONIA

Pneumonia is an inflammation of the lung parenchyma of infective origin.
It is most common infectious cause of death.

It is usually characterized by consolidation.
Consolidation is a pathological process in which the alveoli are filled with a mixture of
inflammatory exudate, bacteria & WBC.
Etiology:
Bacteria: streptococcus pneumoniae
Viruses: Influenza virus, adenoviruses, rhinoviruses
Fungi: pneumocystis carini
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Types:
Lobar pneumonia: If one or more lobe involved
Bronchopneumonia: The pneumonic process has originated in one or more bronchi and
extends to the surrounding lung tissue.
Pathophysiology: 4 stages –
1. Congestion
2. Red hepatization
3. Gray hepatization
4. Resolution
Signs & symptoms:

High fever, shaking chills
Shortness of breath
Increased breathing rate
Chest pain when breathe deeply
Cyanosis
Fatigue and muscle aches
Cough, particularly cough productive of sputum
Complication:
Acute respiratory distress syndrome (ARDS)
Pleural effusion
Respiratory failure
Management:
• Don’t smoke • Antibiotic, depending on sputum &
• Practice good hygiene blood culture
• Stay rested & fit • Oxygen therapy
• Get a pneumonia vaccination • Chest physiotherapy
Ayurvedic treatment:
Fever associated with pneumonia is known to be kapha pradhana
Ayurvedic treatment aims at reduction of kapha.
For coughing:
Tulasipatra svarasa
Sitopaladi churna
Lakshmivilasa rasa
Shortness of breath: dashamula Kashaya
Chills: kanakasava
Fever: prataplankeshwar rasa, samsamani vati
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PAARHSVA SHOOLA / PLEURISY
Pleurisy refers to inflammation of both layers of the pleurae (parietal & visceral)
Pleurisy is inflammation of the pleura covering the lungs and the chest wall.
Types:
1. Dry pleurisy (Pleuritis sicca)
2. Wet pleurisy (Pleuritis exudative)
Causes:
• Pneumonia (bacterial, viral) • Upper respiratory tract infection
• TB • Pulmonary neoplasm
• Pulmonary infarction, embolism • Trauma to the chest wall
• Pulmonary abscess • After thoracotomy procedure
Investigation:
Chest x-ray
Sputum examination
Examination of pleural fluid obtained by thoracentesis for smear and culture
Pleural biopsy
Management:
• The objectives of treatment are to discover the underlying cause and to relieve the
pain.
• Treatment for the underlying primary disease (pneumonia, infarction); inflammation
usually resolves when the primary disease subsides.
• Prescribed analgesics and topical applications of heat or cold for symptomatic relief
of pain.
• Indomethacin a non-steroidal anti-inflammatory drug (NSAIDs)
• If the pain is severe, an intercostal nerve block may be required.
Ayurvedic management is same as pneumonia.
INFLUENZA / SANNIPATAJA JVARA

Influenza, commonly called ‘the flu’ is illness caused by RNA viruses of the family
Orthomyxoviridae.
The influenza viruses that infect the respiratory tract of many animals, birds and humans.
Symptoms:
Chills
Body aches, especially in throat and joints
Coughing and sneezing
Extreme fever
Fatigue, headache and nasal congestion.
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Complications:
Pneumonia, ear infections
Sinus infection, dehydration
Treatment:
Vaccine:
The ‘flu shot’ – an inactivated vaccine that is given with a needle, usually in arm.
The nasal spray flu vaccine.
Medications:
Increasing liquid intake, warm showers, and warm compresses, especially in nasal area can
reduce the body aches and reduce nasal congestion.
Nasal strips and humidifiers may help reduce congestion, especially while trying to sleep.
Fever can be treated with over-the-counter acetaminophen or ibuprofen.
Ayurvedic treatment is same as pneumonia.
MUMPS / KARNAMULAKA JVARA

Mumps is an acute viral infection of childhood that typically involves swelling of one or both
parotid glands, although many different organs can be infected.
Etiology:
Mumps virus, the cause of mumps, is an RNA virus of the genus Rubella virus in the
paramyxoviridae family.
Humans are the only natural host.
Clinical features:
Incubation period 14 – 18 days.
Parotitis in 30 – 40 %
Up to 20% of infectious asymptomatic
Complications:
• Meningoencephalomyelitis • Pancreatitis
• Orchitis • Deafness
• Epididymitis • Loss of vision to mild blurring
Treatment:
Supportive & symptomatic treatment
Anti-viral therapy: ribavirin & interferon
Dexamethasone for meningoencephalitis
Diethylstilbestrol for orchitis
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For fever:
Tulasi patra svarasa
Tribhuvanakirti rasa
Sanjivani vati
Samsamani vati
Adraka svarasa
For headache: godanti + kamadudha rasa + haritaki churna
Disease specific: kanchanara guggulu
External application: dashanga lepa paste locally on gland or kanakalepa
MENINGITIS / MASTISHKA JVARA / MASTISHKAVARANA SHOTHA

Meningitis is an acute inflammation of the meninges.
Caused by either bacteria or virus – Neisseria meningitides
Etiology:
• Bacterial infection • Cancer
• Viral infections • Trauma to head or spine
• Fungal infections
Clinical features:
• Fever • Convulsions
• Irritability • Brudzinski’s sign
• Lethargy • Kerning’s sign +ve
• Poor feeding
Pathophysiology:
Bacteria enters blood stream → enters the mucosal surface → breakdown of normal barriers
→ crosses the blood brain barrier → proliferation in CSF → inflammation of menings →
increase in ICP (Intra cranial pressure).
Complications:
• Septic shock • Hydrocephalus
• Seizures • Brain damage
• Cerebral oedema
Treatment:
Prevention:
Hemophilus vaccine (HiB vaccine) in children
Pneumococcal conjugate vaccine.
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Management:
Antibiotics for bacterial meningitis
Antibiotics are not effective in viral condition.
Other medications and intravenous fluids will be used to treat symptoms such as brins
swelling, shock, seizures
Cephalosporins antibiotics
Treatment of meningitis in ayurveda comprises of both jvara chikitsa and sotha chikitsa.
As it is mainly situated in head and neck areas, kapha dosha is involved.
When infection & fever develops, role of pitta is evident and as this disease affects the CNS.
Role of vata is obvious as this disease involve the vitiation of all three dosha.
Treatment is difficult if not treated properly, the disease will develop into paaka and cause
fatal complications.
Samana:
Mild langhana in the beginning for aama pachana.
Then agnideepana with medications and pathya diets.
Lepanam with ruksha dravyas
Swedanam
Dhoopanam
Shodhana:
Vamana, snehana, swedana
Commonly used medicines:
Varanadi kashayama
Kanchanara guggulu
Rasnadi churnam
Guggulu panchapala churnam
ENCEPHALITIS / VATAPITTAJA JVARA / CHAMKI FEVER

Encephalitis is an inflammation of the brain that is caused especially by infection with a virus
(such as herpes simplex) or less commonly by bacterial or fungal infection or autoimmune
reaction.
Acute encephalitis: Virus that pass into blood stream and then into cerebral spinal fluid
leading to destruction of neural cells and inflammation of brain parenchyma.
Post infectious encephalitis: It may result from a viral mediated inflammatory response in the
brain following an acute, systemic infection.
Clinical features:
• Fever • Seizures
• Headache • Mental status changes
• Vomiting • Focal neurologic deficits
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Emergency signs:
Respiratory distress
Shock
Severe dehydration
Treatment:
Rest
Plenty of fluids
Anti-inflammatory drugs such as acetaminophen, ibuprofen to relieve headache and fever.
Step 1 → rapid assessment & stabilization
Step 2 → clinical evaluation
Step 3 → investigation
Step 4 → empirical treatment
Step 5 → supportive care & treatment
Step 6 → prevention / treatment of complications and rehabilitation
Shadanga paniya
Guduchyadi kashayam
Praval pishti
Kumar kalyan rasa
TETANUS / DHANURVATA
Tetanus is an illness characterized by acute onset of hypertonia, painful muscular
contractions, generalized muscle spasms without other apparent medical causes.
Caused by clostridium tetani – gram +ve bacteria

Bacteria enters the body through wound.
The incubation period ranges from 3 – 21 days.
Symptoms:
Tetanic seizures
Stiffness of jaw
Contraction of facial muscles
Fast pulse, fever, sweating
Types:
1. Local tetanus
2. Cephalic tetanus
3. Generalized tetanus
4. Neonatal tetanus
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Treatment:
Antibiotics such as penicillin or tetracycline
The toxin is neutralized with shots of tetanus immune globulin
Other drugs may be given to provide relaxation to the muscles and relieve pain.
YELLOW FEVER / PITA JVARA

Yellow fever is an acute flavivirus infection spread by the bite of an infected mosquito.
Yellow fever is common in tropical and subtropical areas of south Africa & Africa
Reservoir – monkey
Symptoms:
Fever, headache, photophobia, malaise
Treatment:
Eradication of aedes mosquitoes
Patients should be hospitalized for supportive care and close observation.
PLAGUE
Plague is a bacterial infection, in which yersinia pestis is the etiological agent of this disease.
Mostly affects lungs and lymph nodes and blood vessels.
Types:
Bulbonic: swollen lymph glands
Pneumonic: lungs
Septicaemic: blood stream
Clinical features:
Sudden onset of fever
Chills, vomiting
Body ache, nausea
Treatment:
Prevention:
Environmental sanitation
Active surveillance
Rodent and vector control by using insecticides
Management:
Basic treatment is antibiotic therapy
Streptomycin is the drug of choice
Gentamycin, doxycycline
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DENGUE FEVER / DANDAKA JVARA
Introduction:
Dengue fever is also known as breakbone fever is a mosquito born tropical disease caused by
the mosquito bite.
It is caused by the female aedes aegypti mosquito bite, which transmit the dengue virus to
human.
Clinical manifestation:
Occur in 3 phases –
1. Febrile phase – 7 days
High fever 40°c
Headache
Bleeding from mucus membrane
A rash occurs in 50 – 80%
2. Critical phase – 2 days
Leukopenia
Thrombocytopenia
3. Recovery phase – 2 – 3 days
Stabilize hemodynamic status
Increase urine output
Overall clinical improvement
Occur in 4 stages:
1. Undifferentiated fever
2. Classic dengue fever
3. Dengue haemorrhagic fever (DHF)
4. Dengue shock syndrome (DSS)
Diagnosis:
Warning signs:
• Worsening abdominal pain • Mucosal enlargement
• Ongoing vomiting • High hemocrait with low platelets
• Liver enlargement • Lethargy or restlessness
Diagnostic test:
Basis on physical examination
Positive tourniquet test
Cell cultures
Nucleic acid detection by PCR
Viral antigen detection
Indirect IgG ELISA
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Treatment:
No specific therapeutic agents exist for dengue infections
Bed rest and hydration therapy
Fever control with acetaminophen. Narcotics may be necessary if headaches are very severe.
Monitoring of signs and symptoms for warning signs of DHF or DSS
Drink plenty of fluids
Prevention:
Control of and protection from the bites of the mosquito that transmits it.
Complications:
• Decreased body temperature
• Persistent abdominal pain
• Rapid breathing
• Bleeding gums
• Decrease platelet count
• Cardiomyopathy
• Seizures, encephalopathy & viral encephalitis
• Hepatic injury
• Depression
• Orchitis
Ayurvedic aspects of dengue:

Description of dengue as dandaka jvara is found in Madhava nidana.
There is no specific treatment for disease, ayurveda stresses to strengthen immune system of
the body & keeping control on hyperthermia.
Guduchi, Tulasi, sunthi, papaya are commonly available medicinal plants and used to prevent
its complications by potentiating immune system so that disease gets controlled within a
period of 4 – 8 days.
Leaves of coriander should be taken to reduce fever.
Chyavanprasha can be taken as immune booster.
Punarnava is an herb which helps in flushing out toxins through perspiration.
Amrita satva is advised in dengue fever.
Starting phase – vasa, nimba patra svarasa
CHIKUNGUNYA / SANDHIG SANNIPATTIKA JVARA

Chikungunya is a mosquito borne viral disease transmitted in human by an alpha virus that is
spread by the infected ‘Aedes aegypti’ & ‘aedes albopictus’ mosquitos.
The word ‘chikungunya’ means to become contorted as the affected person walks in a
stooped posture because of joint pain.
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Clinical features:
• Incubation 3 – 12 days
• Fever may rise to 103°f to 104°f with rigors.
• Viremia led to fever.
• Crippling joint pains.
• Lymphadenopathy
• Conjunctivitis
• Maculopapular rash
Diagnosis:
• Isolation of virus
• PCR
• Detection of IgM antibody
Treatment:
• There is no specific antiviral drug against CHIK virus, treatment is entirely
symptomatic.
• Paracetamol is the drug of choice with use of analgesics.
• Mild forms of exercise and physiotherapy are recommended in recovering persons.
Ayurvedic management / aspect of chikungunya:

Ayurveda does not recognize chikungunya as a separate entity. The symptoms can be
corelated by some of masurika and sannipata jvara
Samprapti ghataka:
Dosha: vata kapha
Dushya: rasa, rakta, mamsa, snayu
Srotas: rasavaha, raktavaha, mamsavaha
Srotodusti prakara: sanga, vimarga gamana
Adhisthana: blood stream
Vyadhisvabhava: kasthta Sadhya
Treatment:
1. Fever in chikungunya:
Tulasi leaves are very effective in reducing chikungunya fever. Bilwadi gutika, amritarishta,
sudarshanam gutika are the other commonly prescribed ayurvedic medicines for fighting the
fever.
2. Muscle & joint pain in chikungunya:
• Triphala guggulu • Vishtinguka vati
• Punarnava • Sinhanaad guggulu
• Yograja guggulu • Dashamoolarishta
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3. Neutropenia in chikungunya
There is reduction in white blood cells of blood
Suvarna parpati
Ashwagandha
Abhraka bhasma
4. Headache: godanti + kamadudha rasa + haritaki churna
5. Arthralgia:
Nirgundi ghanavati
Shallaki vati
Yogaraja guggulu
Kaisora guggulu
LEPTOSPIROSIS
Leptospirosis is an infectious disease caused by pathogenic bacteria called leptospires, that
are transmitted directly or indirectly from animal to humans. (Urine of animal)
It often peaks seasonally sometimes in outbreaks, and is often linked to climate changes to
occupation or poor urban slum communities.
Types:
1. Anicteric (most common)
2. Icteric leptospirosis (Weil’s syndrome)
Clinical features:
High fever
Headache
Jaundice
Abdominal pain
Treatment:
Leptospirosis is treated with antibiotics which should be given early in the course of disease.
Intravenous antibiotics may be required for persons with more severe symptoms.
VIRAL FEVER
Viral fever refers to a wide range of viral infections, usually characterized by an increase in
normal body temperature.
It is quite common in children and old people due to lowered immunity.
Symptoms:
• Fever • Burning sensation in eyes
• Myalgia • Headache
• Fatigue • Arthralgia
• Painful tonsils • Dizziness
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Investigation:
Blood test
Viral antigen detection test
Viral DNA / RNA detection test
Treatment:
Complete rest
Anti pyretic medicine
ANTHRAX
Anthrax is caused by the spore forming bacterium – bacillus anthracis
Zoonotic disease in herbivores follows ingestion of spores in soil.
Human infection typically acquired through contact with anthrax – infected animals or
animals’ product or atypically through intentional exposure.
Clinical forms: 3
1. Cutaneous anthrax:
Depressed black necrotic ulcer
Edema, redness
2. Inhalational anthrax:
Viral like illness, fatigue, fever
Meningitis
3. Gastrointestinal anthrax:
Abdominal distress, bloody vomiting
Oropharyngeal ulcerations
Diagnosis:
Gram stain PCR
Culture of vesicular fluid
Biopsy
Treatment:
Floroquinolones – orally
Doxycycline
Penicillin
MASURIKA
मसूिाकृततसंस्थानाः पीडकाः स्यम
ु स
म ुरिकाः |
Pidika which occurs in size of masura is known as masurika.
Masurika means coppery blisters with burning sensation, fever and pain. It occurs on all over
body & face.
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Nidana:
Excessive intake of pungent, salty, sour food
Viruddha ahara, adhyasana
Intake of nispava saka
Infections
Types: vataja – pittaja – kaphaja – raktaja – sannipataja
Samprapti:
Nidana sevana → tridosha prakopa occurs by indulgence of nidana → aggravated dosha and
rakta spread all over the body. → localised in skin → Many small pidika along with fever and
some other symptoms manifest → types & complications
Complications:
Wrist swelling
Pain & swelling at elbow joint
Treatment:
Kusthaghna lepa
Shatadhauta ghrita + dasanga lepa
Treatment of pitta kaphaja visarpa
Patient should stay in cool & clean place
Place should be fumigated by guggulu, nimba patra, jatamansi, devadaru
Take by nimba siddha jala
SMALL POX
Small pox is an acute exanthematous disease caused by infection with the poxvirus variola.
The significant clinical features include:
Three-day prodromal illness characterized by fever, headache, backache and
vomiting.
Generalized centrifugal rash that follows prodrome-
• Begin centrally then spread to the extremities and face.
• Rapid succession of papules, vesicles, pustules, umbilication and crusting over
a 14 days period.
Treatment:
Vaccination up to 4 days – exposure can prevent clinical symptoms.
Antiviral therapy
Supportive care is the mainstay of smallpox therapy.
Ensure adequate fluid intake.
Treatment of secondary infections
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Ayurvedic medicines:
Guggulu dhupana
Dashanga lepa
Chandrakala rasa
Kamadudha rasa
Nimba patra jala snana
Difference between smallpox and chicken pox

Small pox Chicken pox
Average: 12 – 14 days` Average: 14 – 16 days
Slow and majestic Very rapid
Scabs 10 – 14 days Scabs in 4 – 7 days
Subsides with appearance of rash, may rise Fever appears with each fresh crop of rash.
again at the pustular stage
Slow Rapid
More pocks on arms & legs More pocks on body
Not infectious until rash develops Most infections in the 48 hours before rash
develops
CHICKENPOX
Chicken pox is caused by a virus called varicella zoster.
People who get the virus often develop a rash of spot that looks like blister all over their
bodies.
The blisters are small and sit on an area of red skin that can be anywhere and they are of
varying size.
Chickenpox also known as varicella.
DNA virus
Most common in winter and spring
Stages:
Incubation period (10 – 21 days)
Prodrome (1 – 3 days)
Vesicles
Pustules
Scabs
Recovery typically 7 days after rash appears.
Symptoms:
Fever
Headache
Myalgia
Itchy, vesicular rash over trunk
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Complications:
Meningitis
Encephalitis
Glomerulonephritis
Myocarditis
Varicella pneumonia
Treatment:
For viral infection – acyclovir
Antipyretic medicine
Antihistamines
Ayurvedic treatment same as smallpox.
MEASLES
It is an acute viral infection characterized by a final stage with a maculopapular rash erupting
successively over the neck and face, trunk, arms, legs and accompanied by a high fever.
The causative agent of measles – measle virus is an RNA virus of the genus morbillivirus in
the family paramyxoviridae.
Symptoms:
High fever
Cough
Runny nose
Tiny white spots inside the mouth called koplick spot
Rash from head to toe
After a few days, the fever subsides and the rash fades.
Diagnosis:
History of fever of 3 days with 3Cs. (cough, coryza, conjunctivitis)
Koplick’s spot
Complication:
• Ear infection • Pneumonia
• Diarrhoea • Encephalitis
Treatment:
Measles vaccine
Vitamin A supplements
Good supportive care
Aragvadha phalamajja (for virechana)
Avipatikara churna
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ROMANTIKA
This is a relatively simple disease as compare to masurika, occurring in children
Rupa:
Pitta kapha dosha vitiation
Small rashes all over the body
Cough
Fever
Treatment:
Langhana
Mrudu virechana
Starting phase: Tulasi, nimba patra svarasa, maricha churna
Fever: lakshmivilasa rasa, tribhuvanakirti rasa, kanakasava, samsamani vati
Chills: adraka svarasa
Itching: application of sandal wood
Rasayana: gulkand with praval, chyavana prasha avaleha.
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2. Chikitsa sutra and Management of the diseases of Rasavaha Srotas

such as – Pandu, Amavata, Madatyaya, Hridroga, Hridshoola,
Hypotension, Hypertension, Anaemia, Rheumatoid arthritis.
PANDU
The disease in which skin of the patient becomes pallor is called pandu roga.
Nidana:
Aharaja nidana:
Amla, lavana, kshara, ati ushna, viruddha bhojana, nishpava, masha, tila, vidagdha ati sevana,
ekarasa sevana
Viharaja: ativyayama, ati maithuna, diwa swapna
Manasika: kama, chinta, vishama jvara, gulma, rajyakshma, kamala etc.
Samprapti:
Nidana sevana → pitta prakopa, localise in heart → pitta is thrown outside by vata an spread
in body through dhamani → localise between skin and mamsa → manifest pandu, haridra
varna → types and complications
Purva roopa:
Palpitation of heart burns
Roughness
Absence of sweat and exhaustion
Lakshana:
Karna kshweda – sounds in the ears
Durbala – weakness
Sadana – lethargy
Anna dwesha – aversion towards the food
Shrama – tiredness
Bhrama – giddiness
Gaurava – heaviness of body
Types:
1. Vataja
2. Pittaja
3. Kaphaja
4. Sannipataja
5. Mrida bhakshana janya pandu
Upadrava → aruchi, pipasa, jvara, agnisada, moorcha, klama
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Chikitsa:
Snehana
Tikshna vamana
Tikshna virechana
Mrudu virechana – by tikta dravya
After shodhana pathya anna pana should be given.
1. Snehana:
Panchagavya ghrita
Mahatikta ghrita
Kalyanaka ghrita
2. Virechana:
Milk + cow’s urine
Trivruta churna + sugar
Triphala churna
3. Vamana:
Yashtimadhu phanta
Milk
Doshanushara chikitsa:
Vata → Sneha
Pitta → tikta and sheetala dravya
Kapha → katu, tikta, ushna dravya
Sannipataja → mixed treatment
Treatment of mrida bhakshana janya pandu:

Tikshna shodhana should be given after accessing patient’s bala
Intake of balya aushadha siddha ghrita
Formulations:
• Samshamani vati • Dhatri lauha
• Kanyalohadi vati • Triphala ghrita
• Mandura vataka • Drakshasava
• Yogaraja guggulu • Punarnava mandura
• Navayasas lauha • Loha bhasma
• Saptamruta lauha • Mandura bhasma
Anaemia
Anaemia (an – without; emia – blood) is a decrease in the RBC count, haemoglobin and
hemocrait values resulting in a lower ability for the blood to carry oxygen to body tissues.
Decrease in RBCs, Hb, Hct level → diminished O2 carrying capacity → Hypoxia and
hypoxia induced effects on organ function → signs and symptoms
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Types:
Based on clinical picture:
1. Iron deficiency anaemia → excessive loss of iron
2. Megaloblastic anaemia → less intake of vitamin B12 & folic acid. Red bone marrow
produces abnormal RBC.
3. Pernicious anaemia → Inability of stomach to absorb vitamin B12 in small intestine.
4. Haemorrhagic anaemia → excessive loss of RBC through bleeding, ulcers,
menstruation
5. Haemolytic anaemia → RBC plasma membrane ruptures. May be due to parasites,
toxins, antidotes
6. Thalassemia → Less synthesis of haemoglobin
7. Sickle cell anaemia → abnormal, rigid, sickle shaped RBCs. Hereditary blood
disorder
8. Aplastic anaemia → destruction of red bone marrow. Caused by toxins, gamma
radiation
Symptoms:
• Easy fatigue and loss of energy • Dizziness
• Unusually rapid heart beat • Pale skin
• Shortness of breath • Insomnia
• Difficulty concentrating
Management:
Determine the cause of iron deficiency
Aim of treatment
Lifestyle management
Iron supplements:
Vitamin B12 shots
In aplastic anaemia – blood transfusions
In sickle cell anaemia – oxygen therapy
In haemolytic anaemia – immunosuppressant drugs
AMAVATA
Introduction:
The disease in which both ama and vata are aggravated and affect various kapha sthanas like
joints, heart etc. is known as amavata.
Nidana:
Viruddha ahara
Viruddha chesta
Mandagni
Nischalata
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Snigdha bhojani vyayama, consuming unctuous oily & high caloric food and immediately
getting indulges in exercises.
Samprapti:
Guru-snigdha annapana sevana → agnimandhya → amadosha utpati → aama + vata →
circulates the entire body through dhamani → sthanasamshraya at various kaphasthana (trik,
urah, hridaya, sandhi) → aamavata
Rupa:
• Body ache • Heaviness
• Loss of taste • Fever
• Thirst • Indigestion
• Laziness • Oedema on body
• Laziness
Vishesha roopa:
Vatolbana aamavata → teevra sandhishoola, nidra nasha, vibandha
Pitolbana aamavata → atidaha, pipasadhikya, moorcha
Kapholbana aamavata → gaurava, kandu, agnimandhya
Sannipataja → tridoshaja mishrita lakshana
Sadhyasadhyata:
Ekdosha → Sadhya
Dwidosha → yapya
Sarva deh achara, sannipatika, with sotha → krichchha Sadhya
Complication:
Sthayi vaikalyata (permanent deformity)
Hridaya vikruti (cardiac disorders)
Stabdhata
Gati nasha
Nidra nasha
Bahu mutrata
Chikitsa:
Langhana pachana
Haritaki + sunthi churna
Guduchi + sunthi
Ajamodadi churna
Vaisvanara churna
Trikatu churna
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Svedana:
Ruksha valuka sweda: locally for management of pain & stiffness
Nadi sweda
Sarvanga baspa sweda
Patra pinda sveda- in jirna avastha when ama removes
It should be given to reduce vata dosha.
Virechana:
Virechana should be given by following dravya:
Haritaki churna
Eranda bhrusta haritalki churna
Abhayadi modaka
Trivrutadi churna
Eranda taila
Basti:
Niruha basti
Kshara basti
Vaitarana basti
Dashamuladi niruha basti
Erandamuladi niruha basti
Snehapana:
Eranda taila should be consumed with milk mixed with jaggery
Highly praised medicine
Like a lion of forest eranda taila can make the human body free from elephant like amavata.
Samshamana chikitsa:
Rasa aushadhi → aamavatari rasa, malla sindura, godanti bhasma
Vati → Sanjivani vati, chitrakadi vati
Guggulu → sinhanada guggulu, yogaraja guggulu
Churna → pathhyadi churna, trikatu churna
Kwatha → rasnapanchaka kwatha, dashamoola kwatha, pippalyadi kwatha
Lepa → dashanga lepa, nirgundi patra lepa
Rasayana → amruta bhallataka, ashvagandha rasayana
Pathyapathya:
Pathya: sunthi, aadraka, ajamoda, karvellaka, ushnodaka, takra, eranda taila
Apathya: dadhi, matsya, guda, dugdha, viruddha ahara, ratri jagarana, vega dharana
Rheumatoid arthritis:
Rheumatoid arthritis is a chronic systemic autoimmune disease that involves inflammation in
the membrane lining of joints and often affect internal organs.
Clinical features:
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Early feature (synovitis)
Most affected MCPJ and FIPJ, wrist, tendon sheaths around the joints.
Bilateral symmetrical polysynovitis
Pain, fusiform swelling, stiffness, loss of mobility
Malaise and low-grade fever.
Late features (destructive):

Spread to other joint – wrist, ankle, knee, shoulder
Morning stiffness – improve with activity
Quality of life affected
More later (deformity):

Pain, deformity, instability
Joint deformity
Thumb: Z deformity
Finger: swan neck deformity, ulnar deviation
Wrist: radial displacement
Elbow: limited extension
Knee: swollen, flexion a vulgus
Investigations:
Anaemia – Hb % decrease
Raised ESR
Positive test for RA factors
Positive CRP (chain reactive protein)
X- ray, CT scan, MRI
Treatment:
1. General measures:
Rest
Diet: nutritious, fibrous diet
Correction of anaemia
Moderate exercise
Avoidance of cold
2. Medicines:
Analgesics: acetaminophen, tramadol
NSAIDs: ibuprofen, diclofenac
Disease modifying antirheumatic drug (DMARDs): hydroxychloroquine, methotrexate
Corticosteroids
3. Surgical treatment:
Prosthesis (joint replacement)
Synovectomy
MADATYAYA
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Dravyas with tama guna predominance, which destroys the intellect and causes mada and
madatyaya are called madya or madakari.
Madya and visha are having opposite qualities of ojas.
Improper or excessive consumption of madya causes severe disease called madatyaya.
Nidana:
Avidhipoorvaka madyapana
Matradhikya madyapana
Prakruti viparita madyapana
Alpa satva
Samprapti:
Nidana sevana → tridosha prakopa → rasavaha, raktavaha, sangnavaha srotodushti →
srotorodha → manah kshobha → sangna nasha → mada
Lakshana: smruti vibhramsha, hridaya vyatha, Trishna, parshwa shoola, nidra nasha, bhrama
Avastha bheda:
1. Prathama mada: stage of excitement
2. Dwitiya mada: stage of mental confusion
3. Madantara: stage of delirium
4. Tritiya mada: stage of coma
Complication:
Hikka, chardi, kampa, jvara, paarshwa shoola, bhrama
Chikitsa:
All types of madatyaya are tridoshaja, hence the predominant dosha is treated first.
Kapha sthana is the first dosha that must be treated, later pitta and then vata.
Shamana aushadhi:
Brihata vata Chintamani rasa
Unmada gajankusha rasa
Trikatu churna
Harshini chikitsa:
Alcohol neither cause morbid intoxication without first agitating the mind, nor without
affecting the body. Hence treatment that is mentally cheering and enlivening should be given.
Intake of milk
If madatyaya is not cured by any treatment them milk is taken. When patient strengthens milk
should be stopped and start less amount of madya so patient will not suffer from dhvamsaka
or vikshaya
HRIDA ROGA
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According to madhavakara hrida roga means the disease which occurs in heart.
Nidana:
Ati ushna, ati guru, ati amla, ati Kashaya ahara
Ati shrama, abhighata, adhyashana
Ati prasanga (ati vyavaya, sanchintana)
Vega vidharana
Gadatichara – improper or inadequate treatment of other disease.
Ama dosha – excessive ama or toxins in the body.
Samprapti:
Nidana sevana → agni mandhya → sama rasa dhatu utpatti → srotorodha dhamani pratichaya
→ uro ruja → hrida roga
Lakshana:
• Cyanosis • Polydipsia
• Fainting • Stupor
• Fever • Vomiting
• Cough • Chest pain
• Altered taste of mouth • Anorexia
Chikitsa:
• Nidana parivarjana • Dhanyakadi kashayam
• Vishrama • Mashadi kashayam
• Samanya chikitsa • Pushkarahwadi kashayam
• Effective decoctions:
Doshanusara chikitsa:
1. Vataja hridaroga chikitsa:
Vamana with dashamoola kwatha + ghrita + saindhava
Drink sukhoshna taila + sauviraka + mastu + takra + saindhava
Abhyanga with punarnavadi taila / haritakyadi ghrita
Pushkarmooladi choorna
Pushkaramooladi kwatha
2. Pittaja hrida roga:

Pralepa with sheeta virya dravya
Parisechana with sheetala aushadhi
Virechana with draksha + sita + madhu + parushaka
Pitashamaka ahara
Arjuna ksheera paka
3. Kaphaja hrida roga:
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• Swedana • Kaphashamaka ahara
• Vamana • Shilajatu rasayana
• Langhana
4. Sannipataja hrida roga:

Langhana
Tridosha shamaka ahara
Heena-madhya-ativrudha doshanusara chikitsa
5. Krimija hrida roga:

Shodhana
Krimihara chikitsa – nidana parivarjana, apakarshana, prakruti vighata
Vidangadi churna
Vidangavaleha
Arjuna ghrita
Cardiovascular diseases
Cardiovascular disease is a class of diseases that involve the heart, the blood vessels or both.
Causes:
Congenital heart defects
Coronary artery disease
High blood pressure
Diabetes
Smoking
Excessive use of alcohol or caffine
Drug abuse
Stress
Some over the counter medications, prescription medications, dietary supplements and herbal
remedies
Symptoms:
Chest pain: a sensation of pressure, tightness or squeezing in centre of your chest.
Pain in other parts of the body: it can feel as if the pain is travelling from chest to arms.
Feeling lightheaded or dizzy
Sweating
Shortness of breath
Feeling of nausea
Management:
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Lifestyle changes:
These includes eating a low fat and low sodium diet
Getting at least 30 minutes of moderate exercise on most days of the week.
Quitting smoking
Limiting alcohol intake
Managing blood pressure
Managing cholesterol
Managing weight & physical activity
Managing depression
Medication:
Medications to control heart disease.
The type of medication will depend on type of heart disease like –
Anticoagulants
Antiplatelet agents
ACE inhibitors
Angiotensin 2 receptor blocker
Beta blockers
Calcium channel blockers
Cholesterol lowering medications
Diuretics
Vasodilators
Medical procedures or surgery:

Medications are not enough, it’s possible to recommend specific procedure or surgery like –
Coronary artery bypass grafting
Maze surgery
Aneurysm repair
Heart transplant
Insertion of pacemaker or (ICD)
HRID SHOOLA / ANGINA

Shoola in the hrid pradesha due to any cause is called hrid-shoola
Nidana:
Apanavata mala mutra vegadharana
Atibhojana
Ajeerna ashana
Adhyashana
Viruddha & asatmya bhojani
Pishtana sushkamamsa sevana
Samprapti:
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Nidana sevana → kapha pitta prakopa → vayu margavrodha by kapha-pitta → kupita vayu +
rasa dhatu → sthana samsraya in hridaya → hrida shoola
Lakshana:
Chest pain in left side
Difficulty in expiration
Chikitsa:
Like vatavyadhi hridroga chikitsa, oleation and sudation should be given and then emesis
should be administered with dashamula kwatha + sneha + saindhava
Sanshodhana → snehana, swedana, vamana, shirodhara

Sanshamana → kasturi bhairava rasa, pravala pisti, arjuna churna, ajunarista
Abhyangartha → karpuradi taila, lakshadi taila
Angina pectoris
Angina pectoris is defined as pericardial pain brought on by effort, emotion or heavy meals,
and is relieved by rest.
Types:
1. Stable angina
2. Unstable angina
3. Decubitus angina
4. Variant angina
HYPOTENSION
Hypotension is low blood pressure.
A systolic blood pressure of less than 90 mmHg or diastolic of less than 60 mmHg.
Severely low blood pressure can deprive the brain and other vital organs of oxygen and
nutrients, leading to a life threating condition called shock.
Causes:
• Loss of blood from bleeding
• Low / high body temperature
• Heart muscle disease
• Severe dehydration
• Anaphylaxis
Symptoms:
• Dizziness • Blurring of vision
• Unsteadiness • Weakness
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Treatment:
• Eat a diet higher in salt
• Drink lots of non-alcoholic fluids
• Get regular exercise to promote blood flow
• Avoid heavy lifted
Ayurvedic aspect:
Bhrama – means giddiness. This is one of the main symptoms of hypotension
Vata vriddhi leading to dizziness
Kapha kshaya can also cause hypoglycaemia
Chikitsa:
• Pandu roga chikitsa
• Vata shamaka chikitsa
• Hridya aushadha
• Santarpana and balya chikitsa
• Panchakarma:
• Snehapana: saraswatha ghrita, Panchagavya ghrita, Kalyanaka ghrita
• Nasya: ksheerabala tailam
• Nitya virechana
• Shirodhara & shirobasti
Medicines:
• Sutashekhara rasa • Amritarishta
• Mukta bhasma • Amalaka churna
• Ashwagandha rasayana • Arjunarista
HYPERTENSION
Abnormally high blood pressure is called hypertension.
Normal level of blood pressure is 120 / 80 mmHg more than 140 / 90 mmHg in those who are
at risk and more than 160 / 100 mmHg in all are considered high BP.
Hypertension is caused by either
1. Increased cardiac output
2. Increased peripheral vascular resistance
Etiology:
1. Essential hypertension → 95 % of cases
2. Secondary hypertension → 5 % of cases
Renal disease
Endocrine disease
Others → pregnancy, steroids
Treatment:
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Find and treat the underlying cause
Antihypertensive drugs:
Diuretics → hydrochlorothiazide
Calcium channel blockers → levamlodipine
ACE inhibitors
Angiotensin 2 receptor antagonists
Adrenergic receptor antagonists → beta blockers, alpha blockers
Vasodilators → sodium nitroprusside
Ayurvedic aspect:
High blood pressure or hypertension is a result of abnormal functioning of vyana and udana
vayu, ranjaka pitta and avalambaka kapha including loss of their functional integrity and
coordination
Hypertension can be compared to a condition called raktagata vata
Chikitsa:
Panchakarma: virechana, basti, raktamokshana
Bahir parimarana: takra shirodhara, ksheera dhara, taila dhara
Single herbs:
• Sarpagandha • Arjuna
• Lasuna • Ashwagandha
• Sarpagandha churna • Kumaryasava
• Brahmi vati • Kalyanaka ghrita
• Guduchi satve • Pravala pishti
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3. Chikitsa sutra and Management of the diseases of Raktavaha Srotas

such as - Raktapitta, Kamala, Kumbhakamala, Halimaka, Daha, Mada,
Murcha, Sanyasa, Vatarakta, Plihadosha, Yakrut dosha, Haemolytic
disorders, Hepatitis, Cirrhosis of Liver, Leukaemia, Kushta, Shvitra,
Visarpa, Sheetapitta, Udarda, Kotha and Kshudra Roga.
Introduction of raktavaha srotas
Root: yakruta & pliha
Raktavaha srotodusti nidana:

वविाहीन्यन्न पानातन त्स्नग्धोर्षणातन रवाणण च |
िक्तवाहीतन िर्षु यत्न्त िजतां चातपानलौ ||
Intake of unctuous, hot and liquid food.
Food and drinks which causes burning sensation
Exposure to sun and fire
Raktavaha srotodushti chikitsa:

Raktapitta hara kriyam – treating on the lines of management of raktapitta
Virechanam, upavasa, rakta mokshana
RAKTAPITTA
“िक्तवत ् वपतभमतत िक्तवपतम ्” the disease in which rakta gets vitiated due to aggravated pitta is
called raktapitta.
Nidana:
Aharaja nidana → ushna, tikshna, kshara, amla, lavana and katu padartha ati sevana, vidahi
anna pana sevana, dugdha + lavana & kshara yukta shaka sevana, mulaka, sarshapa, lasuna,
sura, sauviraka atisevana
Viharaja nidana → ati atapa sevana, ati vayu sevana, ati adhva gamana, ati vyavaya
Manasika nidana → shoka – bhayadi manasika hetu
Samprapti:
Pitta vardhaka & rakta prakopaka nidana → pitta prakopa → rakta dushti by prakupita pitta
→ due to pittoshma, mamsadi dhatu vilayana & dravikarana → sravana → urdhva – adho –
ubhayamarga → raktapitta
Purvarupa:
• Anga sada • Vamana
• Sheeta kamata • Loha Gandhi nishvasa
• Kantha dhumayana
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Lakshana:
Doshanushara bheda:
Vataja raktapitta → shyava, aruna, saphena, tanu, ruksha rakta srava
Pittaja raktapitta → krishna, kashayabh, gomutra varna, mechaka, agaradhumabh, anjanabh
raktasrava
Kaphaja raktapitta → pandu, sa-sneha, sandra, picchila rakta srava
Dwandwaja → Dwidoshaja lakshana
Sannipataja → tridoshaja mishrita lakshana
Gati bheda:
Urdhwaga → kapha sansrusta, raktapravruti through mukha, nasika, netra, karna
Adhoga → vatanubandhi, raktapravruti through guda, medhra, yoni marga
Abhaya (tiryaka) → vata kapha, raktapravruti through urdhwa / adho marga / roma kupa
Sadhyasadhyata:
Sadhya → ekadoshaja raktapitta, urdhwaga raktapitta, balavana rogi, naveena & alpavega
raktapitta, upadrava rahita
Yapya → Dwidoshaja raktapitta, adhoga raktapitta
Asadhya → tridoshaja raktapitta, Ubhaya margi raktapitta, ati vega yukta raktapitta, arishta
lakshana
Upadrava:
Daurbalya, shwasa, kasa, jvara, pandu, daha, murccha, trishna, shiro abhitapa etc.
Raktapitta chikitsa sutra:

Stambhana nishedha → Initially, in a strong person (aksheena bala mamsasya), the bleeding
process should not be stopped by stambhana chikitsa.
Rakta srava stambhana janya upadrava → If bleeding is stopped it may lead to galagraha,
putinasya, murccha, aruchi, jvara, gulma, pleeha, anaha, kilasa, kushtha, visarpa, arsha,
bhagandara, mutra kriccha, varna nasha, buddhi-indriyoparodha etc.
In case of santarpanottha raktapitta, and if rogi is balavana, and in bahudosha avastha but
nirupdrava (no complication) → the patient should be treated with → sanshodhana chikitsa
Urdhwaga raktapitta → virechana
Adhoga raktapitta → vamana
Depending on rogi-roga bala, physician should administer langhana or tarpana in the

beginning.
Urdhwaga raktapitta → tarpana & virechana
Adhoga raktapitta → peya & vamana
Bala – vruddha – avamya – avirechya rogi → shamana chikitsa
In case of severe bleeding even if it is with ama, one should immediately use haemostatic
herbs (rakta stambhaka), as the blood is vital tissue in the body.
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Raktastambhaka dravya → durva, Usheera, rakta chandana, padmaka, kutaja, kanchanara,
bilwa, udumbara, vasa, lodhra, shalmali etc.
Shamana aushadhi →
Rasa aushadhi → rakta pittantaka rasa, pittantaka rasa, bola parpati, shankha bhasma, pravala
pishti
Vati → eladi vati, tikshnadi vati
Churna → laksha churna, ushiradi churna, chandanadi churna, atarushkadi churna
Kwatha / asava / arista → atarushkadi kwatha, vasakadi kwatha, Ushirasava, lodhrasava,
draksharishta
Ghrita → vasa ghrita, shatavari ghrita
Avaleha / khada → vasa khanda, vasa avaleha, udumbaravaleha
Pathya ahara – vihara:

Purana shali, laja, godhuma, mudga, masura, patola, mulaka, palandu, kushmanda, aja
dugdha, godugdha, ghrita, jangala mamsarasa, amalaki, kadali, draksha, mrudwika, mishree,
sheeta jala snana, sheeta vihara, chandana lepa, mukta mani dharana, chandra kirana sevana,
vamana virechana nasya aadi
Apathya ahara – vihara:

Tila, masha, kulattha, sarshapa, guda, dadhi, kshara, lavana, katu tikshana vidahi annapana,
matsya, atapa sevana, Swedana, vegadharana, krodha
KAMALA
Introduction:
Kamala is a term used in ayurveda to describe a disease which resembles jaundice.
Pandu and kamala are said to be the disease which are interrelated. They are also said to be
have common origin. Pandu is said to be nidanarthakara for kamala, i.e., when pandu is not
treated properly it can lead to kamala.
Thus, kamala can be considered as an effect of untreated pandu or pandu which runs a
chronic course.
Pandu and kamala thus cause and effect relationship. Pandu roga and kamala are treated on
same principles and same formulations.
Nidana:
If the patient, who is suffering from the pandu takes excessive amount of pitta vitiating diet
may develop the kamala.
Ahara
Excessive intake of salty and sour things
Excess alcohol intake
Intake of tikshana things → the blood gets severely aggravated and burns the muscle.
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Roopa:
• Haridra netra • Destruction of sense organs
• Haridra twak • Daha
• Haridra nakha • Avipaka
• Rakta peeta shakrut • Dourbalya
• Rakta peeta mutra • Sadana – tiredness
• Body looks like frog in rainy • Aruchi
season • Karshitaha – emaciation
Vishesha roopa:
Shakhashrita kamala → tila pishta nibha varcha
Kosthashrita kamala → raktapeeta shakrut mutra
Samprapti:
Samanya samprapti:
Pittavardhaka padartha sevana by pandu rogi → pitta prakopa → rakta & mamsa dhatu
dagdhata → kamala
Shakhashrita kamala:
Nidana sevana → kapha vriddhi → marga avarodha by vruddha kapha → vata prakopa →
prakupita vata throws out the pitta towards the shakha → haridra peeta twaka, netra, nakha,
mukha & Shweta varna mala → shakhashrita kamala or alpa pitta / ruddhapatha kamala
Kosthashrita kamala:
Nidana sevana → rakta varna durbalta & pitta vriddhi → vruddha pitta spread to kostha &
shakha → kosthashrita / bahupitta kamala
Chikitsa:
Pandu roga and kamala will be treated on same lines. The treatment and medicinal
formulations are applicable to only those types of pandu and kamala which are Sadhya.
Snehana followed by teekshna vamana and teekshana virechana in curable pandu disease.
Mridu tikta virechana in curable kamala.
Kaphapittahara chikitsa
Chikitsa of shakhashrita kamala:

So charaka has mentioned especially some measures to bring dosha from shakha to koshtha.
The main treatment of shakhashrita kamala needs special emphasis because malaranjaka pitta
is situated in shakha therefore virechanadi karma will not be effective till dosha are not
brought to the kostha.
When dosha comes to koshtha the same treatment given as that of kosthashrita kamala.
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Samshamana chikitsa: Done by vata kapha shamana, agnideepana
Single drugs:
• Katuki • Bhringraja
• Guduchi • Bhumyamalaki
Compound drugs:
• Arogyavardhini vati 250 mg • Navayasha loha
• Punarnavadi mandura 125 mg • Mandura vataka
• Phalatrikadi kwatha 20 – 30 ml • Panchatikta ghrita
• Triphala churna • Panchagavya ghrita
• Avipatikara churna • Kalyanaka ghrita
• Dhatyavaleha • Kumaryasava
Pathya:
• Ripened papaya fruit • Jawar
• Draksha • Ushna, tikshana, katu rasa
• Wheat • Lekhanakara ahara, bed rest
Apathya:
• Snehana & swedana karma • Madhura rasa pradhana ahara
• Raktamokshana, dhumapana, vega • Snigdha, guru, kaphakaraka ahara
dharana • Vyayama, maithuna
KUMBHAKAMALA
Introduction:
Kamala: jaundice
Kumbhakamala: complicated jaundice with abdominal complaints
Haleemaka: chlorosis / hyperchromic anaemia / chronic obstructive jaundice
Panaki: disease presenting with symptoms of both anaemia and jaundice along with raised
temperature and loose stools
The stages of kumbhakamala develops when jaundice continues for long.
Symptoms:
Very serious with dark yellow coloured urine, faeces and eyes.
Eyes become deep yellow coloured to red colour with oedema on body
Burning sensation
Hardness of bowels
Loss of power of digestion and consciousness
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Treatment:
Ghrita medicated with the juice of draksha, guduchi, and amalaka
Srotanjana + shilajatu + cow’s urine
Loha bhasma + madhu
Triphala churna
Arogyavardhini vati
Phalatrikadi kwatha
Dhatravaleha
HALIMAKA
When the body shows deep jaundice as greenish, yellowish, or bluish discolouration due to
vata and pitta, the condition is called halimaka.
Symptoms:
Yellowish green coloured body
Person loses his strength as ojas also gets vitiated.
Dyspnoea
Vertigo
Loss of appetite
Loss of sexual drive
Treatment:
Snehana: mahisha dugdha processed with guduchi svarasa.
Virechana: trivrut churna + amalaka svarasa
Ahara: Madhura rasa yukta and pitta nashaka
Basti: yapana basti, ksheera basti, anuvasana basti
Asava & arista: to improve the digestion
Use of Agastya haritaki and abhaya leha according to strength of dosha & agni.
DAHA / PERIPHERAL NEURITIS

Burning of the whole body is known as daha.
Pittaja samanya nidana
Types:
1. Pittaja
2. Raktaja
3. Trishna nirodhaja
4. Madyaja
5. Raktapurna kosthaja – asadhya
6. Dhatu kshayaja – asadhya
7. Kshataja
8. Marmabhighataja – asadhya
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Samprapti:
Pittavardhak nidana sevana → rakta dusti samanavata prakopa → spread all over body
Localised skin → burning all body
Upadrava:
• Jvara • Trushna
• Raktapitta • Svasa
• Daurbalya • Murcha
Chikitsa:
Pitta samaka chikitsa
Patient kept in cool air conditioning atmosphere
Follow grishma rutucharya
Amalaka churna
Pravala pisti
Chandrakala rasa
MADA
Mada is an excitement stage of mind.
Drugs possessing tamo guna pradhana and cause derangement of the mind are called
intoxicants. E.g., sura and other alcoholic beverages
Types: 4
1. Vataja
2. Pittaja
3. Kaphaja
4. Sannipataja
Treatment:
Snehana
Svedana
Panchakarma
MURCCHA
In persons who are emaciated, who have an excess of dosha and who take incompatible diets
habitually, particularly in those who are mentally weak, the humours aggravated by the
suppression of the natural urges and trauma involve both the external as well as the internal
sensory apparatuses and lead to fainting.
Types:
1. Vataja 3. Kaphaja
2. Pittaja 4. Sannipataja
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Purvaroopa:
Precordial pain, yawning, lassitude
Loss of sensory perception and of strength.
Roopa:
Same as apasmar symptoms
1. Vataja:
To an individual suffering from vatika type of murcha – the sky appears blue, black or red.
Thereafter he becomes unconscious but soon he recovers.
There is vepathu, angamarda, karshya, shyava arunata
2. Pittaja:
To an individual suffering from paitika type of murcha – the sky appears as red, green or
yellow.
Thereafter he becomes unconscious and recovers with sweating.
There is trishna, raga, haridra netra
3. Kaphaja:
In kaphaja type of fainting – the sky appears as if raining or as if covered by dark cloud. He
recovers after a long time.
4. Sannipataja:
In sannipataja murcha all symptoms of tridosha can be seen.
Same as apasmara difference is that in this patient falls down without disgusting movements.
Murcha → pitta + tama

Bhrama → pitta + vata + raja
Tandra → vata + kapha + tama
Nidra → kapha + tama
Treatment:
• Snehana • Seka
• Svedana • Avagaha
• Panchakarma • Mani dharana
• Raktamokshana • Exposure to wind
• Constantly keeping in touch with • Triphala with honey, ghee, sugar
noble- and strong-minded persons. • Silajatu
SANYASA
When the extremely aggravated doshas get localized at the vital centres, destroys the function
of speech, body and mind.
The patient becomes unconscious and lies down like a wood, as if dead.
This is fatal disease, causes death if not treated immediately
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Treatment:
Syncope (sanyasa), does not subside without the administration of proper medicine.
Anjana, avapeeda nasya, dhooma, pradhamana nasya
Various types of strong alcoholic drinks mixed together with other drugs of pungent taste
should be carefully put in his mouth frequently.
Matulunga svarasa along with dry ginger and sauvarchala
After the patient regaining consciousness, he should be given light diet.

Thereafter, his consciousness should be maintained by entertainment.
VATA-RAKTA
Vatarakta is a disease explained in ayurveda involving vata dosha imbalance affecting rakta
dhatu – blood tissue.
Nidana:
Excessive consumption of lavana, amla, katu, kshara, snigdha, ushna, klinna, shushka ahara
Anupa mamsa
Pinyaka
Moolaka, kulattha, mamsa, viruddha ahara
Adhyashana
Mithya ahara vihara
Samprapti ghataka:
Dosha – vata pradhana tridosha janya vyadhi
Dushya – rakta, twak, mamsa
Agni – mandagni
Udbhavasthana – pakvashaya
Sanchayasthana – sarva sharira
Vyaktasthana – sandhi
Srotas – raktavaha, asthivaha, majjavaha
Srotodushti prakara – sanga, vimargagamana
Roga marga – madhyama
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Samprapti:
Types:
Uttana vatarakta Gambhira vatarakta
Doshas seated only up to twak & mamsa Doshas penetrate to deeper dhatus and have
dhatu complex manifestation
Itching Severe burning
Coppery, red, black colour Hard swelling & ulcers
Pricking pain Painful movements
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Upadrava:
Aswapna, arochaka, shwasa, shirograha, hikka, visarpa, paka, bhrama, anguli vakrata, sphota,
daha
Sadhyasadhyata:
Ekdosha, nava → Sadhya
Dwidoshaja → yapya
Tridoshaja, with upadrava → asadhya
Chikitsa:
Aggravated vayu enters in various shakha and sandhi causing vitiation of rakta.
Looking into the nature of samprapti and chief factors involved in pathogenesis following
could be preferred treatment from ayurveda.
Raktamokshana:
Vararakta as being rakta pradoshaja vikara rakta mokshana with the help of shring, jalauka,
suchi, alabu, pracchana, siravedhana according to the dosha and body constitution would be a
preferred treatment.
Virechana:
Internal snehana followed by either snigdha virechana, ruksha, mridu virechana such as –
Dharoshna mutrayukta ksheera
Dahroshna ksheera with trivruta churna
Eranda taila with ksheera
Basti is the most appropriate procedure in vatarakta.

Niruha & anuvasana basti both should be repeated simultaneously.
Bahya chikitsa:
Parisheka, abhyanga, pradeha also should be used.
Shamana chikitsa:
Many formulations have been mentioned in our classics for dosha pacification in vatarakta.
Some of them are –
1. Triphala kwatha with madhu.
2. Milk prepared from dashmoola – sadya shoola nivarana
3. Haritaki churna with guduchi swarasa – janugata vatarakta
4. Decoction of amla, haridra, musta with madhu
5. Kokilaksha kwatha
6. Guduchi kwatha with different anupana as per underlying condition.
Ghrita → in vata vikara Shunthi → amavata
Sharkara → pitta vikara Eranda taila → severe vatarakta
Madhu → kapha
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7. Dashanga lepa
8. Tagaradi lepa
In uttana vatarakta:
• Lepa • Avagahana
• Abhyanga • Upanaha
• Parisheka
In gambhira vatarakta:
• Snehapana • Anuvasana basti
• Virechana • Ksheera basti
• Asthapana basti
PLIHA DOSHA
Aggravated vata vitiates rakta and produces this disease. Spleen gets enlarged and pain is
produced in the upper left quadrant of the abdomen.
Nidana:
Over eating
Excessive travelling or jerking
Excessive activities
Lifting heavy weights
Excessive vomiting
Emaciated by other diseases
Types:
1. Vataja
2. Pittaja
3. Kaphaja
4. Raktaja
5. Sannipataja
Chikitsa:
Nidana parivarjana
Vamabahu kurpabhyantara siravyadha
Shamana aushadhi → pleehari rasa, rohitakadi vati, rohit abhaya kwatha
YAKRITA DOSHA
Yakrita dosha leads to abnormal enlargement of liver which result in palpable lump or
swelling in right hypochondrium.
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Nidana:
Over eating
Excessive travelling or jerking
Excessive activities
Lifting heavy weights
Emaciated by other diseases
Lakshana:
Tenderness and swelling in right hypochondrium
Swelling may not be visible but enlarged liver can be palpated.
Jaundice, anaemia, anorexia, vomiting etc.
Chikitsa:
Nidana parivarjana
Dakshina bahu kurpabhyantara siravyadha
Shamana aushadhi:
Bhumalaki
Kalamegha swarasa
Vardhman pippali rasayana
Hepatoprotective drugs → bhoomyamalaki, bhoo nimba, katuki, kumari, rohitaka etc.
HAEMOLYTIC DISORDERS
Bleeding disorders (Coagulopathy):
• Bleeding disorders can be inherited or acquired. Some bleeding disorders can occur
due to conditions such as thrombocytopenia, anaemia, vitamin K deficiency,
leukemia, cirrhosis of liver and HIV.
• They can also result from certain medications that are used to thin the blood,
including antiplatelet and anticoagulant medications. e.g., Aspirin, Clopidogrel
(antiplatelet), Warfarin (anticoagulant) etc.
• Examples of inherited bleeding disorders include Hemophilia A, Hemophilia B, and
von Willebrand Disease.
Clinical Features →
Bruising – Petechial bleeding – Nosebleeds (Epistaxis) – Earbleeds (Otorrhagia) – Bleeding
gums – Hematemesis – Hematuria – Melina – Menorrhagia – Excessive bleeding following
surgery etc.
Investigations →
CBC (Low platelet level – thrombocytopenia)
BT CT or Prothrombin time (increased)
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Treatment →
• Treat the basic cause of haemorrhage.
• Maintain Fluid & Electrolytes balance with IV Fluids.
• Plasma expanders or Blood transfusion (as indicated).
• Haematinic & Hematopoietic drugs.
• Injection vitamin K
HEPATITIS
Hepatitis is a broad term that means inflammation of liver.
It is most commonly caused by viruses also be caused by drugs, chemicals, auto immune
diseases and metabolic abnormalities
Five types of hepatitis have been identified: hepatitis A, B, C, D, E.
Hepatitis A is always an acute, short-term disease, while hepatitis B, C, D are most likely to
become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in
pregnant women.
Sign & symptoms:

• Fatigue • Weight loss
• Fever • Sharp pain in right upper quadrant
• Abdominal pain of abdomen.
Management:
• Rest according to patient’s level of • Antiemetic drugs
fatigue • Complications
• Hospitalization • Dehydration, hypokalemia
• Vitamin K injection if pt. is • Chronic carrier hepatitis
prolonged. • Liver cirrhosis
• IV fluid 7 electrolyte replacement. • Hepato cellular carcinoma
LIVER CIRRHOSIS
Cirrhosis of liver is a chronic progressive disease characterized by widespread fibrosis and
nodule formation
The development of cirrhosis is an insidious, prolonged course, usually after decades of
chronic liver disease.
It is a chronic disease in which where has been diffuse destruction and fibrotic regeneration
of hepatic cells.
As necrotic tissue is replaced by fibrotic tissue normal liver structure and vascular is altered,
impairing blood & lymph flow.
It results in hepatic insufficiency and portal hypertension.
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Clinical features:
Hepatomegaly
Portal hypertension
Ascites
Spider naevi around the face, neck, shoulder
Hypoalbuminemia
Terry’s nails: proximal 2/3 of the nail plate appears white with distal 1/3 red due to
hypoalbuminemia.
Gynecomastia
Hypogonadism
Splenomegaly
Bruising & bleeding resulting from decreased production of coagulation factors
Hepatic encephalopathy
Laboratory investigation:
Alkaline phosphatase – usually slightly elevated
Bilirubin – elevated
Prothrombin time – increased
Complications:
Ascites
Oesophageal varices
Hepatic encephalopathy
Spontaneous bacterial peritonitis
Management:
Antibiotic – for infections
Laxatives, such as lactulose, decrease risk of constipation
Get vaccinated against hepatitis B
Rasa & rakta dhatus are known to be intoxicated in this liver problem and in turn other dhatus
becomes weak. All the functions of pitta get affected. Functions include digestion of food,
hunger feeling, blood production and complexion of skin as well.
There are excellent herbs that are recommended in ayurveda to help in the treatment of liver
cirrhosis –
Katuki
Bhringaraja
Bhumyamalaki
Rohitaka
Punarnava
Bhoonimba are some liver tonic drugs.
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Formulations such as –
• Pippali vardhamana rasayana • Bhringaraja churna
• Katuki churna • Arogyavardhini vati
• Bhumyamalaki churna • Rohitakarista
Apart from internal medication, if there is severe imbalance of the doshas, pancha karma
treatments like virechana is prescribed to eliminate the excessive pitta dosha. Vamana may
also give in case of an aggravated kapha dosha. Expelling the excessive kapha & pitta dosha
helps in activating metabolism.
Ushnodaka basti for constipation
Patient must be on only milk diet.
LEUKAEMIA
It is a group of malignant disorder, affecting the blood and blood forming tissue of the bone
marrow lymph system and spleen.
Etiology:
Genetic and environmental factors
Chromosomal changes (down syndrome)
Chemical agents, chemotherapeutic agents
Radiation
Types:
Based on the types of WBC.
Acute myelogenous leukaemia (AML)
Acute lymphocytic leukaemia (ALL)
Chronic myelogenous leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)
Clinical features:
Symptoms may include bleeding and bruising problems, feeling tired, fever, and an increased
risk of infections.
These symptoms occur due to a lack of normal blood cells.
Diagnosis is typically made by blood tests or bone marrow biopsy
Treatment:
Some combination of chemotherapy
Radiation therapy
Bone marrow transplant
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KUSTHA
Definition:
The disease in which blood of body gets vitiated
कुष → to extract
कु → bad, ill
स्थ → being, staying
Which causes discolouration of the skin is known as kustha. After some time, body become
ugly due to kustha.
Nidana:
Intake of wrong food combinations
Suppression of the urge
Doing physical exercise in excessive heat and after a heavy meal.
Use of cold water immediately after exposure to scorching sun heat.
Intake of excess food, uncooked food and intake of food before the previous meal is digested.
Improper administration of panchakarma therapies.
Excessive intake of masha, mulaka, tila, guda
Sleep during day time
Sinful acts
Insult of brahmans and guru
Purvarupa:
Loss of sensation of touch
Excessive sweating
Discolouration of the skin
Itching, pricking pain, mental fatigue
Burning sensation & numbness
Samprapti:
Nidana sevana → tridosha prakopa which vitiates tvaka, rakta, mamsa and lasika → vitiated
dosha leave their own site and spread all over the body → localise in the skin → manifests
the symptoms → types & complication
Types:
Mahakushtha:
1. Kapala
2. Udumbara
3. Mandala
4. Rushyajihwa
5. Pundarika
6. Sidhma
7. Kakanaka
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Lakshanas:
1. Kapala kustha:
Colour – krishna, aruna
Nature – similar to broken piece of earthen pot.
Touch – ruksha, parusha, tanu
Associated symptoms – severe pain
2. Udumbara kustha:
Colour – similar to udumbara fruit
Nature – redness, hair on the patch become brown
Associated symptoms – burning sensation, pain
3. Mandala kustha:
Colour – white and red
Nature – sthira, ghana, snigdha, elevated round patches
Associated symptoms – patches are matted.
4. Rishyajihva kustha:
Colour – red in edges and brown inside
Nature – rough, it resembles the tongue of rsya.
Associated symptoms – pain
5. Pundarika kustha:
Colour – white with red edges
Nature – resembles lotus petals, elevated patches
Associated symptoms: burning sensation
6. Sidhma kustha:
Colour – white coppery, colour resembles flowers of alabu
Nature – thin
Associated symptoms – mostly on chest
Particles resembling dust are observed
7. Kakanaka kustha:
Colour – resemble gunja
Nature – does not get suppurated
Associated symptoms – pain and incurable
Kshudra kustha:
1. Eka kustha →
Looks like scales of a fish
Absence of sweating in affected area
2. Charmakhya →
Skin looks like the elephant’s skin
Spreading in the vast area.
3. Kitibha →
The colour of affected skin in dull black
Skin rough and very much dry.
4. Vipadika →
Cracking of feet or hands.
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5. Alasaka →
Skin is full of itching and red papules
6. Dadru →
It is accompanied with itching redness, pimples
Circular in shape and elevated on the bladder.
7. Charmadala →
Red with itching
Attended with eruption
Intolerance to touch
8. Pama →
Whitish, reddish or dull black rashes on the affected skin area with severe itching
Affected skin area with severe itching
9. Visphotaka →
Whitish or reddish papules with thin skin over affected skin area.
10. Shataru →
Colour of the affected skin is red or dull back
Multiple scars over affected area.
11. Vicharchika →
The affected area is dull black in colour with rashes along with profuse discharge
Prognosis:
A wise physician must not undertake the treatment of following types of patients suffering
from kustha.
1. The patient of kustha with the signs & symptoms all the 3 vitiated doshas.
2. The patient who is weak
3. The patient who is suffering from thirst, burning sensation
4. The patient having no digestion strength.
5. The patient having maggots in the patches of kustha.
Chikitsa:
All types of kustha are caused by tridosha hence the treatment is given according to
predominance of dosha.
Shodhana;
Vatapradhana kustha → ghritapana
Kaphapradhana kustha → vamana karma
Pittapradhana kustha → raktamokshana, virechana
Alpa dosha kustha → pracchana
Gambhira kustha → siravyadha
Acharya sushruta says that
Avapidana nasya once in 3 days
Vamana karma once in 15 days
Virechana karma once in 1 month
Raktamokshana once in 6 months.
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Kustha patient with more vitiated doshas is given shodhana therapies for several times with a
lot of care.
Excessive elimination of doshas might weaken the patient and the aggravated vata might
endanger patient’s life instantaneously.
After the elimination of doshas from the gastro-intestinal tract and raktamokshana from
blood, the patient is given Sneha to drink.
Vamana should be done when dosha are in utklista stage. Vamana should be done by kutaja,
madanphala, madhuka etc.
Virechana – trivruta, danti and triphala
Niruha basti – darvi + bruhati + patola + kritamala Kashaya
Anuvasana basti – after virechana and niruha basti. Madanphala + madhuka + nimba + patola
siddha sneha
Nasya – saindhava + danti + maricha
Dhumapana – vairechanika dhumapana
Raktamokshana:
The patches of kustha which are stable, hard and rounded, is subjected to prastara and nadi
type of svedana and rubbed with a surgical brush. The blood oozing out through this process
should thereafter be eliminated.
In alpadoshayukta kushtha, blood is eliminated by scratching patches and by applying horn,
alabu & jalauka.
Shamana chikitsa:
Pradhana aushadhis: gandhaka, nimba, katukapittha taila, bakuchi, hartal, khadira
1. Rasa aushadhi: talakeshwar rasa, suddha gandhaka, gandhaka rasayana,
swarnamakshika bhasma, kustha kuthar rasa
2. Vati / guggulu: aarogyavardhini vati, yogaraja guggulu
3. Churna: panchanimba churna, manjisthadi churna, triphaladi churna
4. Kwatha: mahamanjisthadi kwatha, khadirashtaka kwatha, khadirarista,
kanakabindarista
5. Ghrita / taila: panchatikta ghrita, kanakksheeri taila, mahatiktaka ghrita, karanja taila
6. Avaleha: amruta bhallataka leha, bhallatakavaleha
Bahya praoygartha:
• Kusthadhya taila • Manahshiladi lepa
• Kanakaksheeri taila • Karanjadi lea
• Sarshapa taila • Chaturvidha kusthanashaka lepa
• Khadira sara taila (shirisha twaka, karpasha pushpa,
• Kusthadi lepa aaragvadha patra, kakmachi)
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SHWITRA
Nidana
• Viruddha ahara • Navana, dadhi, matsya bhakshana
• Chardi vega dharana • Vipra guru gharshana
• Atibhojana • Papakarma
• Atyamla, lavana, Madhura, katu
rasa sevana
Lakshana:
Shvitra starts with a white patch anywhere on the body, and then it spreads gradually white
pigmentation of the skin in characteristic features of shvitra.
It is non infection and non-contagious skin disease
Types:
1. Daruna
2. Charuna
3. Kilasa
Samprapti:
Due to atisevana of asamyak ahara vihara, vitiation of tridoshas occur in association with
twakgat pitta dosha and rasa-rakta mamsa udaka dhatu. When the vitiation is significantly at
the level of rasa and rakta it results in shwitra kustha.
Prognosis:
Sadhya lakshana → newly developed and colour of hair on the patches is not changed then it
is curable.
Asadhya lakshana → chronic (more than 1 year) and lips & finger tips are affected then it is
incurable
Chikitsa:
Vamana & virechana
After snehana → kakodumbar svara with guda is given for sansrana → afterwards patient
should be exposed to sun.
Bakuchi taila, khadira kwatha, manahshiladi lepa etc.
Shvitra is considered as the disease caused by sinful acts, therefore it should also be treated
with daivavyapashraya chikitsa.
Vrata, seva, dana, dharmika anusthana, bhaskara pujana
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Shamana aushadhis:
• Talkeshwara rasa • Swarna makshika bhasma
• Switrari rasa • Aarogyavardhini vati
• Gandhaka rasayana • Kaishor guggulu
• Manjisthadi churna • Khadira kwatha
• Kusthahara taila • Kusthahara lepa
Difference between kushtha & shwitra

Kustha Switra
Srava yukta vyadhi Srava rahita asankramaka vyadhi
Also, krimijanya Krimi abhava
Tridoshaja vyadhi Mostly ekdoshaja
Rasadi saptadhatu dusti Rakta, mamsa, meda dhatu dusti
VISARPA
Visarpa means which spread in various ways or it is name as parisarpa due to its extensive
spreading.
Nidana:
• Excessive intake of sour, salty, • Divasvapna
pungent and hot things • Excessive work
• Dadhi, sukta, sura, sauviraka • Traumatic injury
• Excessive intake of tila, masha, • Due to contact with poison
kulattha • Burn in fire.
Lakshana:
• Localised spread • Burning sensation
• Painful blisters • Itching
• Malaise • Fatigue
• Jvara • Numbness
Sapta dushya:
1. Vata 3. Kapha 5. Rakta 7. Lasika
2. Pitta 4. Rasa 6. Mamsa
Types: 7
1. Vataja visarpa: ruksha, shyama, aruna varna
2. Pittaja visarpa: tamra harita peeta krishna varna
3. Kaphaja visarpa: sweta pandu, kruchchrapaki spota
4. Sannipataja visarpa: sarvadhatu vyapi
5. Aagneya visarpa: (VP) agnidagdha samana sphota
6. Kardama visarpa: (PK) kunapagandhi
7. Granthi visarpa: kruchchra paki granthimala
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Chikitsa:
Visarpa should be promptly attended by the below said measures
Langhana → to rectify metabolism
Rukshana → to remove excess and unnecessary fluidity in the body
Virechana → expelling the morbid pitta and reduce the inflammatory process in body
Vamana → expelling vitiated kapha. Reduce excess kleda & unwanted fluidiy
Lepa → recovery process and to heal lesions
Seka → sprinkling over the blisters to heal.
Raktamokshana → remove the contaminated blood.
As rakta is the site of visarpa, among all the treatments raktamokshana is the best.
Doshanusara chikitsa:
Sama dosha in kaphasthana → langhana, vamana, tiktarasa yukta aushadha
Sama dosha in pittasthana → langhana, vamana, virechana, raktamokshana
Sama dosha in kapha sthana → virukshana chikitsa
Granthi visarpa chikitsa → rukshana, pradeha, raktamokshana with siravyadha or jalauka
Shamana ausadhi:
• Gandhaka rasayana • Panchatikta ghrita
• Arogyavardhini vati • Mahatikta ghrita
• Keshor guggulu • Pancha twagadi lepa
• Chandanadi kwatha • Dashanga lepa
• Laghupanchamuladi kwatha • Karanjadi taila
• Khadirarishta
SHITA PITTA
Exposure to cold, suppression of natural urges and other reason cause vitiation of kapha and
vata. Then vitiates pitta and then produces rash on the skin, which is called as sheetapitta.
Nidana:
Sheeta vayu sparsha
Chardi vega dharana
Vamana karma ayoga
Asatmya, viruddha ahara sevana
Gandupada Mukhi upasarga
Lakshana:
• Rash on the skin with itching • Pain
• Burning sensation • Vomiting and fever
Samprapti:
Nidana sevana → kapha vata prakopa → combines with prakupita pitta → sthanasamshraya
→ shotha → sheetapitta
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Sapeksha nidana:
Sheetapitta Udarda Kotha
Vata pradhana Kapha pradhana Pitta kapha pradhana
Adhika toda Kandu & vamana Adhika kandu
Kinchit mandala utpatti Aavsthika mandal utpatti Aavasthika raktanna
mandala utpatti
Aashukari (acute) Subacute Jeerna (chronic)
Produced by consuming Appears in shishira rutu Due to ayoga of vamana
sheeta and ushna together.
Chikitsa:
Samshodhana chikitsa:
Vata: abhyanga
Pitta: virechana, raktamokshana
Kapha: vamana
Krimi, dadru and kusthanashaka treatment
Abhyanga → sarsapa taila
Svedana → usnodaka seka
Vamana → by patola, nimba, vasa
Virechana → by triphala, pippali
Udvartana → sarsapa + haridra + chakramada seeds
Intake of ajmoda along with jaggery
Rakta mokshana – after pana of mahatikta ghrita
Shamana aushadhis:
• Sutashekhara rasa • Trikatu churna
• Pravala bhasma • Panchashirisha churna
• Arogyavardhini vati • Manjistha arista
• Kaishor guggulu • Durvadi lepa
UDARDA
Vata is predominant in sheetapitta, whereas kapha is predominant in udarda. There will be
more pain in sheetapitta and more itching in udarda. (Kanduyukta shotha)
KOTHA
Kotha is caused by improper administration of vamana.
Characterized by (kanduyukta rakta sotha)
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KSHUDRA ROGA
The disease is known as kshudra roga due to their less etiological factors, symptoms and
treatment.
Sushruta Samhita – 44
Astanga hridaya – 36
Some examples:
Ajagallika → eruptions occurring in children
Yavaprakhya → barley shaped eruption in muscles
Andhalaji → big sized eruptions
Kachchhapika → hard elevated eruptions
Valmika → cystic swelling over neck
Pashanagardabha → hard swelling in lower jaw joint.
Agnirohini → eruption occurring armpit.
Chippa → painful swelling hard of nailbed
Kadara → painful hard swelling at sole of foot
Darunaka → hard eruptions over the scalp
Arunshika → small, oozing blisters at scalp
Yauvan pidika → eruptions on face
Padmini kantaka → round elevated swelling with thorny eruption
Mashaka → painless, hard, elevated mole
Tilakalaka → black coloured spots like sesame
Nyachchra → white or grey coloured spots
Avapatika → cracks appearing over foreskin of penis
Sannirudha guda → narrowing of anal passage
Guda bhramsha → prolapse of anus
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4. Knowledge of National Health Programmes and the relevant Ayurvedic

Management of the following diseases enlisted by World Health
Organisation- Malaria, Filaria, Kala Azar, Leprosy, Tuberculosis,
AIDS.
NATIONAL HEALTH PROGRAM

MALARIA
Malaria is a mosquito-borne vector disease affecting humans and other animals caused by
parasitic protozoans belonging to the plasmodium protozoans belonging to the plasmodium
type.
Eradication programme of malaria:

To combat devastating effects of malaria, the national Malaria Control Programme (NMCP)
was launched in 1953 built around three key activities.
1. Insecticidal residual spray with DDT.
2. Monitoring and surveillance of cases.
3. Treatment of patients
Within 5 years, the program helped to dramatically reduce the annual incidence of malaria.
Encouraged by this, a more ambitious National Malaria Eradication Programme (NMEP) was
launched in 1958. This further reduced the number of malaria cases and eliminated deaths
from the disease.
In 1999 the Govt. of India decided to drop the term NMEP and renamed it as national
antimalarial program (NMAP).
National Filaria Control Programme (NFCP)

The filariasis is caused by parasitic nematodes (worms) – Wuchereria bancrofti, which is
transmitted by the bites of infected mosquitoes (Culex, Anopheles & Aedes) to humans.
Filariasis is characterized by lymphangitis, lymphadenitis, and elephantiasis of genitals, legs
and arms.
1995: National filaria control programme (NFCP) was launched.
Objectives of NFCP →
• Reduction of the problem in un-surveyed areas.
• Filariasis control in urban areas through anti-larval & anti parasitic measures.
Control strategy:
• Vector control through anti-larval spray / application of appropriate larvicides at
weekly intervals.
• Biological control through larvivorous fishes.
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• Antiparasitic measures through diagnosis & treatment of microfilaria carriers and
cases.
• IEC → Information, Education & Communication to generate community awareness.
Treatment of filarial →
• DEC (diethyl carbamazine) + albendazole or Albendazole + Ivermectin
• Doxycycline
Ayurvedic management →
The lymphatic filariasis of conventional system of medicine is very near to Shlipada of
Ayurveda. Ayurvedic drugs are found effective in the prevention & cure of early cases of
filariasis →
• Nityananda rasa – 2-tab (500mg each) TID for 2 weeks
• Saptaparna ghanavati – 2-tab (500mg each) TID for 2 weeks
• Ayush-55 – 2-tab (500mg each) TID for 2 weeks
• Sudarshana churna – 3 gm TID with warm water after meal
• In order to reduce swelling, drugs like Gomutra-Haritaki, Punarnavadi guggulu,
Gokshuradi guggulu are used.
• Bloodletting with the application of Jalauka is also found effective.
KALA AZAR CONTROL PROGRAMME

Kala-azar is a chronic disorder, which is caused by an intracellular protozoan; known as
Leishmania species. It is transmitted to human by bite of female phlebotomus sandfly.
The classical presentation of Kala-azar → fever, splenomegaly and hepatomegaly associated
with anaemia, weight loss & weakness.
Post Kala-azar dermal lesions may occur after the apparent cure of systemic disease. If
untreated it may be fatal.
1990-91: Kala-azar control programme (NFCP) was launched.

2010: It was presumed that India become free from Kala-azar by the year 2010. But in
clinical set up many cases are now reported in the successive years.
Strategy for control of Kala-azar →

Interruption of transmission by reducing vector population through indoor residual
insecticides.
Early diagnosis and complete treatment of Kala-azar including PK 39 rapid diagnostic kits
and oral drug Miltefosine for their treatment.
Ayurvedic management →
The following ayurvedic drugs are helpful in prevention & cure of early cases of Kala-azar →
• Tamra bhasma – 60 mg BD with honey, after meal.
• Yakritaplihari Lauha – 150 mg with honey, after meal.
• Rohitakarishta or Amritarishta 40 ml BD with equal quantity of water, after meal.
• Drugs like Godanti bhasma, Svarna gairika, Tribhuvana kirti rasa can be used alone or
in combination with above drugs.
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National Leprosy Eradication Programme: (NLEP)
Leprosy is caused by Mycobacterium leprae. In Vedic references leprosy is mentioned as
kustha roga. It has the maximum social stigma. There are many misconceptions about disease
like past sins, hereditary and incurability etc. that causes social aversion & ostracism against
leprosy patients leading to the high deformity. Now by the scientific inventions leprosy has
been identified as infectious disease; which can be cured & eradicated.
Programme related to leprosy →

The establishment of the Indian council of British Empire leprosy relief association was in
1925, which laid the foundation of organized leprosy work in India. After Independence, this
association of renamed as Hind Kushtha Nivarana Sangha in 1974. Followings are the
Landmark of Leprosy eradication programme →
1955: National Leprosy Control Programme was established → Dapsone as monotherapy

was the back bone of NLCP.
1982: Multidrug therapy (MTP) came into use.
1983: Govt. of India launched the National Leprosy Eradication Programme (NLEP) with the
objective of eliminate leprosy as public health problem by the year 2000 AD.
Objectives of NLEP →
• Early detection and treatment
• Interrupting transmission
• Prevent deformities
• Eradicate leprosy
Treatment plan →
MDT (Rifampicin, Clofazimine, & Dapsone) is available free of cost on all working days at
all state centres, PHC, Govt. dispensaries and hospitals.
Ayurvedic management → Kustha chikitsa should be adopted with assessment of dosha and
dushya.
TUBERCULOSIS
TB is an infectious disease caused by the bacterium mycobacterium tuberculosis.
Tuberculosis generally affects the lungs, but can also affect other parts of the body.
Investigations:
Bacteriological test
Sputum cultural test
Radiological: chest X-ray
Nuclei acid amplification
Tuberculin skin test
Cell count (lymphocytes)
Protein (Rivalta tests) – ascites, pleural effusion and meningitis
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NATIONAL HEALTH PROGRAMME OF TB
In 1962, national tuberculosis control programme (NTCP) was launched.
The objectives of NTCP are as follows:
1. To deal with the program of tuberculosis through integrated health services.
2. To give priority to the reduction of pool of injection, to case detection, treatment of
cases and drug distribution.
3. To give BCG vaccination to susceptible.
In 1992, the Govt. of India, WHO and world bank together reviewed the NTP.
In 1993, Revised National Tuberculosis Control Programme (RNTCP) was introduced.
The salient features of the strategy of RNTCP are →

Achievement of at least 85% cure rate of infectious case through supervised short course
chemotherapy involving peripheral health functionaries;
Detecting 70% of the estimated cases - through quality sputum microscopy.
Involvement of NGOs; information, education and communication and improved operational
research.
Long term objectives: to reduce tuberculosis in the community to that level when it ceases to
be a public health problem.
Short term objectives: to detect maximum number of TB cases and treat them effectively to
vaccine new-born & infants with BCG
Treatment of TB:
Directly observed treatment short course (DOTS) is the name given to the TB control strategy
recommend by WHO.
Anti TB drugs:
First line:
1. Isoniazid (H) 3. Pyrazinamide (P) 5. Streptomycin (S)
2. Rifampicin (R) 4. Ethambutol (E)
Newer drugs:
• Ciprofloxacin • Ofloxacin • Azithromycin
Ayurvedic management of TB:

Tuberculosis is correlated with Rajyakshama in which ‘dhatukshaya’ is the main reason to
initiate pathogenesis and this may lead to ‘ojokshaya.’
The drugs which improve immune power, provide nutritional pool & improve agni are found
effective for its management along with ongoing conventional anti-TB drugs.
Kanchanara guggulu & Triphala guggulu are used to treat TB affecting the glands.
Chyavanaprasha avaleha to improve immunity.
Sitopaladi churna, Talishadi churna, Svarna vasant malati, Abharaka bhasma etc. are helpful
in the treatment of TB.
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AIDS
Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV /
AIDS) is a spectrum of conditions caused by infection with HIV.
AIDS is caused by HIV, a human retrovirus.
Two types – HIV 1 and HIV 2 which are genetically different but has related forms.
Investigation:
Blood donation test:
Enzyme – linked Immunosorbent Assay (ELISA)
Radio Immunoprecipitation Assay (RIP)
Polymerase Chain Reaction (PCR)
Western Blot Confirmatory test
Urine test:
• Urine western blot • Safe way to screen for HIV
• As sensitive as testing blood
Treatment:
There is currently no cure or effective HIV vaccine.
Treatment consists of highly active anti – retroviral therapy (HAART) which slows
progression of the disease.
Treatment also includes preventive and active treatment of opportunistic infections.
Initially treatment is typically a non – nucleoside reverse transcriptase inhibitor (NNRTI).
Ayurvedic management of AIDS:

The first step is to provide a healthy atmosphere to the patient.
Several ayurvedic rasayanas are given to the patient in order to boost his immunity level.
E.g., chyavanaprasha, amalaka rasayana, bhallataka rasayana.
When the patient gains some strength, sodhana techniques are used for eliminating toxins
from the body via virechana, vamana & basti. E.g., sneha basti, ksheera basti etc. Brimhana
basti.
Diet should consist of preparations made of ghee and soups.
There are several proprietary ayurvedic medicines, which help in improving the condition of
patients infected with HIV e.g., Shatavari kalpa.
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5. Introduction of general principles of maintenance of health and

management of diseases of following systems of Medicine- Yoga,
Naturopathy, Unani, Siddha, Physiotherapy and Rehabilitation.
YOGA
युज्यते अनेन इतत योग: |
That which unites atma with paramatma.
योग: चचतवतृ त तनिोध: |
Cessation of mental modifications due to mind, intellect & ego.
Types of yoga:
1. Rajayoga 5. Karmayoga
2. Hathayoga 6. Jyanayoga
3. Mantrayoga 7. Bhaktiyoga
4. Layayoga
1. Rajayoga:
One endowed with knowledge about nitya & anitya, and gains victory over chittavriti is
called Rajayoga.
2. Hathayoga:
With the help of gross body control of chittavritti by the practice of pranayama, asana etc. by
a strong person is called as Hathayoga.
3. Gyanayoga:
The person devoid of irshya, dvesha, kama, krodha etc. gets unite with paramatma by gaining
knowledge about self is Atmagyana.
4. Karmayoga:
One should always perform his duties without any expectation of fruit, it should not be
happening that one does not do any work.
Astanga yoga:
1. Yama 5. Pratyahara
2. Niyama 6. Dharana
3. Asana 7. Dhyana
4. Pranayama 8. Samadhi
1. Yama (Abstinence):
Self-control
It consists of five principles:
a. Ahimsa → nonviolence: not to kill, pain, harm to any living being. E.g., Animal
killing for eating.
b. Satya → truthfulness: always speak the truth is good and correct and also not harm
anyone’s feeling when it conveys.
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c. Asteya → non stealing: should never take anything that rightfully belongs to another.
d. Bhramhacharya → pure way of life.
e. Aparigraha → non accumulation of possessions.
2. Niyama: (observance)
Discipline
It consists of five principles:
a. Shaucha – purity
Not only external purity, but more importantly, inner purity
Our clothing, our body as well as our thoughts and feeling should be pure.
b. Santosha: contentment
Inner wealth provides more happiness than material possessions.
c. Tapa: self-control, self-discipline.
We should continue on our chosen path with firm determination
d. Svadhyaya: study of the holy scriptures
Impart valuable knowledge and provide great assistance on the path of yoga.
e. Ishvara pranidhana: devotion to God
Hand over all that you do to the divine self with pure devotion.
3. Asanas: (postures)
Asanas means which should be done in comfortable posture and gives happiness to body.
Asana in management of sthaulya:

With no side effects, it is also a natural and safe way to approach weight loss and obesity.
Here are some asanas for weight loss
1. Surya namaskara
2. Chaturanga dandasana
3. Virabhadrasana
4. Trikonasana
5. Adho mukha svanasana
6. Sarvangasana
7. Setu bandhasana
8. Parivritta utkatasana
9. Dhanurasana
Shatkarma:
1. Dhauti
2. Basti
3. Neti
4. Nauli
5. Trataka
6. Kapalabhati
Basic principles of yoga:
Yoga is a way of life.
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Yoga is a generic term for physical, mental and spiritual disciplines.
Yoga is considered a practical science with five principles forming its core.
1. Proper exercises (Asanas)
2. Proper breathing (pranayama)
3. Proper relaxation
4. Proper diet and nutrition
5. Medication and positive thinking
NISARGOPACHARA
Naturopathy is a system of man building in harmony with constructive principle of nature on
physical, mental, moral and spiritual planes of living.
It has great health promotive, disease preventive and curative as well as restorative potentials.
Naturopathy is a drugless system of healing by use of physical methods.
Principles:
All diseases, their causes and treatment are one. Except for traumatic and environmental
conditions, the cause of diseases is one i.e., accumulation of morbid matter in the body. The
treatment of all diseases is elimination of morbid matter form the body.
Nature is the greater healer. The human body itself has the heling power to prevent itself
from disease and regain health if unhealthy.
The suppressed diseases are brought to surface and are removed permanently.
Aim & objectives:

Naturopathy aims at improving the body’s inherent healing power to treat the body as a
whole, prevent diseases and protect the health by using natural methods such as
Hydrotherapy, mud therapy, fasting, diet etc.
UNANI
It is originated from unana or Greece.
It is based on the humoral therapy of Hippocratic school.
Principles of unani are similar to ayurvedic principles.
Principles:
1. Arkan (elements) → the human body contains four elements viz. air, earth, fire, water
2. Mizaj (temperature) → in the unani system, the temperature of the individual is very
important as it is considered to be unique. The temperature can be really equitable
where the four elements used are in equal quantities.
3. Akhlat (humours) → they are 4: blood, phlegm, black bile, and yellow bile.
4. Quwa (power) → these are three kinds of power.
a. Quwa tabiyah or natural power
b. Quwa nafsaniyah or psychic power
c. Quwa haywaniyah or vital power
5. Ruh (spirit) → ruh is a gaseous substance, obtained from the inspired air, it helps in
all the metabolic activities of the body.
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SIDDHA
Siddha medicine is a system of traditional medicine originating in ancient Tamilnadu in south
India.
Traditionally it is thought that the siddhas laid the foundation for this system of medication.
Siddhas were spiritual adapts who possessed the ashta siddhis, or the eight supernatural
powers.
Agastya is considered the first siddha and the guru of all siddhas; the siddha system is
believed to have been handed over to him by Murugan, son of shiva and Parvati.
Aims of siddha:
1. Deha siddhi: with the help of parada. Strengthening the body by avoiding jara, roga &
mrityu and making it immortal.
2. Lauha siddhi: with the help of metals and chemicals producing superior metals, also
called dhatuvaad.
Importance of siddha in treatment:

The drugs used by the siddhas could be classified into three groups viz.
1. Thavaram (herbal product)
2. Thadhu (inorganic substances)
3. Jangamam (animal products)
The treatment in siddha medicine is aimed at keeping the three humours in equilibrium and
maintenance of seven elements. So proper diet, medicine and disciplined regimens of life are
advised for a healthy living and to restore equilibrium of humours in diseases condition.
Treatment is classified into 3 categories viz.

1. Devamathuvam (divine method)
2. Manuda maruthuvum (rational method)
3. Asura maruthuvam (surgical method)
PHYSIOTHERAPY
Physiotherapy is a system of medicine for complete health care of all age groups in modern
age.
Physiotherapy is a treatment measure of physical and electrical means to accelerate the
patient’s recovery from injuries and diseases that hazards the normal lifestyle.
Physical therapy is used to improve a patient’s quality of life through examination, diagnosis,
prognosis, physical intervention, and patient education.
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Modes of physiotherapy:
Exercise therapy
Massage
Electrotherapy
Electromagnetic therapy
Actinotherapy
Heliotherapy
Infrared therapy
Ultrasonic therapy etc.
Importance of physiotherapy:
Physiotherapy is the most commonly prescribed treatment to assist in the recovery of many
injuries and conditions.
Chronic pain, car and sports injuries and challenges with mobility can all be greatly improved
with the use of physiotherapy.
Here are just a few reasons why sticking to physiotherapy is so important:
1. Range of motion: physiotherapy patients with range of motion issues will regain their
mobility and be able to return to their usual level of activity and better care for
themselves.
2. Exercise: able to progress to complete recovery.
3. Neurological disorders: in stroke or Parkinson’s disease, physiotherapy plays a key
role in aiding with correcting the damage.
4. Cardiopulmonary conditions
5. Pain management:
According to WHO ‘physiotherapist assess plan and implement rehabilitative programs that
improve or restore human motor functions, maximize movement ability, relieve pain
syndromes, and treat or prevent physical challenges associated with injuries, disease and
other impairments.
HOMEOPATHY
Homeopathy is generally based on two main principles that a substance that causes symptoms
in healthy person can be used in diluted form to treat symptoms and illnesses; a principle
known as ‘like cures like’.
The more diluted the substance, the more potent it is, which is known as the ‘law of
infinitesimals.
Importance:
Homeopathy is safe.
Homeopathy is effective and fast acting.
Homeopathic treatments addresses disease at the root level, hence enhancing resistance to
disease.
There is no risk of toxicity or side effects.
It stimulates the body’s own healing response to disease.
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Rehabilitation:
The combines and coordinated use of medi-social, educational, and vocational measures for
training the individual to the higher level of functional ability.
It is to support the patient with an injury or disability illness to achieve maximum function.
4 ways to achieve rehabilitation:
1. Medical
2. Social
3. Psychological
4. Vocational
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6. Diseases of different Endocrine Glands- such as Thyroid,

Parathyroid, Pituitary, Pancreas and Adrenal glands and their
management.
THYROID
Hyperthyroidism:
Hyperthyroidism is hyperactivity of the thyroid gland with sustained increase in synthesis and
release of thyroid hormones.
Hypothyroidism is a set of disorders that involve excess synthesis and secretion of thyroid
hormones by the thyroid gland, which leads to the hypermetabolic condition of
thyrotoxicosis.
T3 & T4 ↑
TSH ↓
Hyperthyroidism diseases
1. Grave’s disease
2. Goitre
3. Toxic thyroid nodule
1. Grave’s disease:
Also known as toxic diffuse goitre is an autoimmune disease that affects the thyroid gland.
Sign & symptoms:

Insomnia
Heat intolerance
Weight loss
Ophthalmopathy
Treatment:
antithyroid drugs which reduces the production of thyroid hormones.
Thyroidectomy is also used in many cases.
2. Goitre
A goitre is a swelling of the neck or the larynx resulting from the enlargement of the thyroid
gland.
It may be associated with both hypothyroidism and hyperthyroidism.
Sign & symptoms:

For hyperthyroidism:
Tachycardia
Nervousness
Heat intolerance
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For hypothyroidism
Lethargy
Weight gain
Cold intolerance
Causes:
Iodine deficiency
Congenital hypothyroidism
Pituitary diseases
Thyroid cancer
Thyroid hormone insensitivity
Treatment:
It is treated according to the cause, if thyroid gland is producing too much T4 and T3,
radioactive iodine is given to the patient to shrink the gland.
3. Toxic thyroid nodule

A toxic thyroid nodule is a cause of hyperthyroidism (an overactive thyroid gland), which is a
cause of thyrotoxicosis (having an excess amount of thyroid hormones). This occurs when a
single nodule (or lump) grows in the thyroid gland and produces excess thyroid hormones.
Toxic nodules are usually benign (i.e. non-cancerous). If the increased hormone production is
coming from a single nodule in the gland, this is called a ‘toxic nodule.’ If the thyroid gland
becomes enlarged, for example due to the presence of nodules, this is called a ‘goitre.’ If
there are many nodules causing hyperthyroidism, this is referred to as a ‘toxic multinodular
goitre’.
Ayurvedic view:
Hyperthyroidism is related with high metabolism and its consequences.
In ayurveda hyperthyroidism has compared with a condition called samanvritta udana.
Samanavritta udana is a condition in which samana vata when aggravated, blocks the udana
vata located in the region of thyroid gland. The strong samana vata will surround and
envelope the udana vata and disturb its functions due to severity of samana vata, the digestive
fire in stomach too will get intense. Then kapha in the stomach will get deteriorated and lead
to heated up environment in the stomach. All these events will eventually lead to agitated
metabolism.
In avaranas the stronger and aggravated vata should be treated first. The vata causing
obstruction i.e., avaraka is said to be associated with ama.
In samanavrita udana, the samana vata which is causing obstruction of udana and hampering
its function should be treated first.
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Other strategies of treatment:
Treating excessive accumulation of pitta.
Treating kapha decrease
Treating teekshanagni
Karshya chikitsa
Treatment as per symptoms of the disease.
Treating on lines of galaganda: when goitre is present it should be treated in the lines of
galaganda treatment.
Basti chikitsa: Basti with oil or milk / decoction prepared with vata alleviating herbs should
be administered in multiple system involvement,
Balya → strengthening medicines and diet
Brimhana → bulk promoting medicines & diet
Rasayana → immunity modulating and rejuvenation therapy
Shirodhara and sarvangadhara with oil medicated with vata and pitta alleviating herbs.
Snigdha virechana → unctuous purgation recipes.
Nasya → nasya drops with oils processed with vata alleviating herbs.
Some useful formulations:

Powder of pippali in vardhamanakrama
After that eranda taila for virechana according to their kostha on next day after the
completion of vardhamana pippali regimen.
• Arogyavardhini vati • Kalyanaka ghrita
• Kanchanara guggulu • Pravala panchamrita rasa
• Ksheerabala taila • Ashwagandha churna
• Saraswata ghrita • Gau ghrita nasya (8 – 8 drops)
Important herbs in treatment of hyperthyroidism:

• Ashwagandha • Chandana • Yastimadhu
• Sariva • Ushira • Bala
Asanas for hyperthyroidism:

Bhujangasana
Setubandhasana
Matsyasana
Shirshasana
Sarvangasana
Surya namaskara
Pranayama → nadi shodhana, bhramari or sheetali pranayama
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Hypothyroidism:
Insufficiently synthesis of thyroid hormones.
Causes:
Hashimoto’s thyroiditis
Thyroid failure following radio-iodine
Surgical treatment of thyrotoxicosis
Drugs like carbimazole, amiodarone
Iodine deficiency
Symptoms:
Fatigue
Weight gain
Increased sensitivity to cold
Dry skin
Weakness in the muscles, muscle ache, tenderness and stiffness
Slow heart rate
Irregular or heavy menstrual periods
Depression
Impaired memory.
Hypothyroidism diseases
Cretinism
Myxoedema
Postpartum thyroiditis
Subacute thyroiditis
It is an auto-immune disease in which the thyroid gland is gradually destroyed.
Signs & symptoms:

Fatigue
Pale & puffy face
Dry & thinning of hair
Treatment:
Is treated with thyroid hormone replacement agents.
Cretinism:
Cretinism is a condition of severely stunted physical and mental growth due to untreated
congenital deficiency of thyroid hormone, usually due to maternal hypothyroidism.
Myxoedema:
Myxoedema is a term used synonymously with severe hypothyroidism.
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Myxoedema develops in the patient with almost total lack of thyroid hormone function.
It is generally characterized by bagginess under the eyes and swelling of the face.
Treatment:
Airway management
Thyroid hormone replacement
Gluco-corticoid therapy
Supportive measures
Ayurvedic view:
No disease explained in ayurveda can be directly correlated with hypothyroidism. When the
pathogenesis and symptoms of hypothyroidism are translated into ayurveda it can be
understood on the lines of one or more of the below mentioned conditions:
1. Udanavritta samana
2. Kaphavritta udana
3. Pathological increase of kapha
4. Medoroga
5. Agnimandhya
It is a condition in which the subtype of vata located in chest i.e., udana vata when aggravated
will envelope the samana vata, another subtype of vata located in the stomach and intestine
and causes deterioration of its functions.
Due to weakening strength of samana vata, the digestive pitta in the stomach will become
weak and there is pathological build-up of kapha. All these events will cause weakening of
metabolism.
Hypothyroidism starts from

1. The thyroid gland located in the neck region producing low thyroid hormones.
2. The low thyroid hormones causing slowing of metabolism.
Udanavrutta vata starts from
1. Aggravation of udana vata in the chest and neck, the region of thyroid gland followed
by,
2. Invasion and enveloping of samana vata in the gut by udana vata with consequential
weakening of functions of metabolism.
Therefore, this comparison of hypothyroidism with udanavrita samana seems logical.
In avaranas the aggravated vata subtype which is enveloping, the other vata subtype should
be addressed first. The vata causing obstruction is said to be associated with ama.
In udanavritta samana, udana vata is causing obstruction of samana vata. Therefore, udana
vata is associated with ama. Therefore, the ama should be dealt with first and then vata is
addressed.
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Ama pachana treatment:
Fasting, sudation, medicines, gruels and ‘light to digest’ foods prepared with ama digesting
herbs.
Treatment for strengthen weak samana vata includes administration of medicines to kindle
the digestive fire, emesis, light diet & rasayana sevana
Other strategies of treatment:

Treatment as per symptoms of disease
Treatment in accordance to related tissues and channels.
Treating on lines of galaganda.
Treating on lines of medoroga.
Basti chikitsa: basti with oil or milk / decoction prepared with vata alleviating herbs should
be administered.
Udvartana: herbal powder massage will enable to remove obstruction in the channels to
remove obstruction in the channels, to kindle digestive and tissue fire, to remove excessive
fat which has accumulated in the body and destroy morbid kapha.
Some useful formulations:

Powder of pippali in vardhamana krama
After that eranda taila for virechana according to their kostha on next day after the
completion of vardhamana pippali regimen.
Arogyavardhini vati
Kanchanara guggulu
Medohara vidangadi lauha
Varunadi Kashaya
Gaumutra haritaki
Chitrakadi vati
Important herbs in treatment of hypothyroidism

• Kanchanara • Shigru • Guggulu
• Ashwagandha • Varuna • Aragwadha
PARATHYROID
Hyperparathyroidism
Hyperparathyroidism is when parathyroid glands create high amounts of parathyroid
hormone in bloodstream.
Clinical features:
Bone cysts
Renal stones
Muscle weakness
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Complication:
Deterioration of renal function
Metabolic disturbance e.g., hypomagnesia, pancreatitis, gout or pseudo gout.
Hypertension
Peptic ulcer disease
Treatment:
A basic method of treatment of primary hyperparathyroidism is surgical.
For the fastest restoration of bone structure after operation are recommended –
• The diet fortified with calcium
• Calcium medications
• Vitamin D3
• Physiotherapy exercises
• Calcitonin
Hypoparathyroidism:
Hypoparathyroidism is an uncommon condition in which the body produces abnormally low
level of parathyroid hormone (PTH)
Clinical features:
Tetany
Hypotension
Defective dental root formation
Refractory heart failure with cardiomegaly
Treatment:
Oral calcium
Vitamin D
Parathyroid hormone replacement
Complications:
Heart problems
Mental health issues
Hardening and changes in shape of bone
Poor growth
Balance problem
Clouded vision
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7. General introduction, types and Management of diseases caused by

Vyadhi Kshamatwa Hinata (Immuno deficiency disorders), Auto
Immune Disorders.
VYADHIKSHAMTVA
The term vyadhi kshamatva is formed by two words vyadhi + kshamatva
Vyadhi → disease
Kshamatva → resistance
It is capacity of the body to resist the body.
The human body has the ability to resist almost all types of organism or toxins that tend to
damage the organs, this capacity is called immunity.
Types:
Regarding the three kinds of strength, they are natural, periodic & acquired
1. Sahaja bala: inherited strength of body and mind is called sahaja bala
2. Kalaja bala: kalaja bala is the one which is dependent on the variation in season &
age.
3. Yuktikruta bala: yuktikruta bala is, accruing from diet and exercise.
Vyadhi kshamatva reducing factors:

Acute vitiation of doshas leads to formation of strong diseases.
Infections, body contamination
Dehydration leads to imbalance in fluids, minerals and salts. Body starts to behave in
unexpected ways.
Depletion by chronic diseases.
Excessive exercise leads to excess loss of body tissue and weakness. Hence low immunity.
Excess intake of alcohol – damages liver, vascular and mental system
Keeping awake at night – increases vata dosha rapidly, increases vata means decreases
quality of body tissues, and depleted immunity.
Mental stress, fear, anger, envy etc.
Ways to increase vyadhi kshamatva:

Birth in country where people are naturally strong.
Being born at time when people naturally gain strength.
Favourable time and season
Nutritious food
Excellence of the qualities of sperm and ovum of parents.
Excellent physical strength
Excellence of mind
Favourable disposition of race & species.
Regular exercises
Optimistic, cheerful, positive disposition.
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Immunity improving measures:
1. Maintaining tripods of life → ahara, nidra, brahmacharya
2. Following sadvritta, rutucharya, din acharya
3. Use of rejuvenating therapy rasayana & vajeekarana, timely internal purificatory
procedures.
4. Maintaining proper digestive power.
5. Rasayana: it improves immunity by resisting disease both mentally and physically.
Immunity boosting herbs:

• Guduchi • Shatavari • Swarna bhasma
• Amalaka • Pippali • Rajata bhasma
• Yastimadhu • Brahmi • Swarna makshika
• Jyotishmati • Ashwagandha • Haritaki
• Chyavana prash • Triphala guggulu
• Brahma rasayana • Loha bhasma
• Arogyavardhini vati
AUTO IMMUNE DISEASE

Autoimmune diseases are caused by an overactive immune system. It is a disease in which
body’s immune system attacks its own tissue mistakenly.
Causes:
Sequestered or hidden antigens
Neo antigens
Cessation of tolerance
Cross reacting antigens
Loss of immunoregulation
Classification:
Broadly classified into 3 groups:
1. Haemolytic autoimmune diseases: clinical disorders due to destruction of blood
components, auto antibodies are formed against one’s own RBCs, platelets,
leucocytes e.g., haemolytic anaemia, leukopenia, thrombocytopenia
2. Localised autoimmune diseases: a particular organ is affected due to auto antibodies.
E.g., thyroiditis (attacks the thyroid), multiple sclerosis (attacks myelin coating of
nerve axons), myasthenia gravis (attacks nerve muscle junctions), juvenile diabetes
(attacks insulin producing cells)
3. Systemic autoimmune diseases: immune complexes accumulate in tissues and cause
inflammation and damage. Affects many organs or whole body. E.g., systemic lupus
erythematous (SLE) (Anti-nuclear antibody) harms kidney, heart, brain, lungs, skin.
Rheumatoid arthritis (anti IgG antibodies) affects joints, heart, lungs, nervous system.
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Rheumatoid fever (cross reaction between antibodies to streptococcus and auto-
antibodies.
Treatment:
Treatment depends on the type of severity of condition.
NSAIDs and immunosuppressants are often used.
Some autoimmune diseases are treated with medications that alleviate specific symptoms.
Haemolytic anaemia: treated with Vit. B12.
Thyrotoxicosis: treated with antithyroid drugs
Myasthenia gravis: treated with choline esterase inhibitors
Rheumatoid arthritis: anti-inflammatory drugs
Lupus erythematous: treated with immune suppressive or antimitotic drugs such as
corticosteroids, cyclophosphamide, azathioprine.
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8. Description and Management of following Emergency Conditions- Acute

Haemorrhage, Hypertensive Emergencies, Acute abdominal pain (Renal
colic, Biliary colic, Gastritis, Pancreatitis, Peritonitis and
Appendicitis), Acute Abdomen, Anuria/ Oliguria, Congestive Heart
Failure, Myocardial Infarction/Angina, Shock, Syncope, Convulsions,
Hyperpyrexia, Hyperglycaemia, Hypoglycaemia, Status Asthmaticus,
Acute Respiratory distress Syndrome, Drowning and Electric shock.
Management of emergency conditions:

ACUTE HAEMORRHAGE
Haemorrhage of bleeding is an escape of blood from ruptured blood vessels.
Haemorrhage can refer to blood loss inside the body, called internal bleeding or it can refer to
blood loss outside of the body, called external bleeding.
Emergency management:
Mechanical method:
Pressure
Haemostat
Sutures and ligation
Chemical methods:
Local agents: adrenaline
Thrombin
Surgical
Surgical fibrillar
Gelatine sponge
Oxycel
Microfibrillar collagen
Fibrine glue
Systemic agents: platelet rich plasma
Blood administration
Fresh frozen plasma
Thermal agents: cautery
Electrocautery
Cryosurgery
Lasers
HYPERTENSIVE EMERGENCIES
Hypertensive crisis is an umbrella term for hypertensive urgency and hypertensive
emergency.
Hypertensive urgency occurs when blood pressure spikes – blood pressure readings are
180/110mmHg or higher, but there is no damage to body’s organs.
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Hypertensive emergency means blood pressure is so high that organ damage can occur. This
is managed in ICU of hospitals.
Patients with a hypertensive emergency need admission with continuous blood pressure
monitoring.
Assess for target organ injury and start parenteral medications as needed.
IV sodium nitroprusside injection.
It is also important that the blood pressure is lowered smoothly and not too abruptly. The
initial goal in hypertensive emergencies is to reduce the pressure by no more than 25%
(within minutes to 1 or 2 hours). And then towards a level of 160/100 mmHg within a total of
2 – 6 hours. Excessive reduction in blood pressure can precipitate coronary, cerebral, or renal
ischemia and possibly infarction.
ACUTE ABDOMINAL PAIN

An acute abdomen refers to a sudden severe abdominal pain.
Several causes need surgical treatment.
Causes:
• Acute appendicitis • Ureteric colic
• Acute peptic ulcer • Renal colic
• Acute gastritis • Ruptured spleen
• Acute pancreatitis
Emergency treatment:
Hospitalization
IV or IM analgesics or sedatives to relieve pain
Antispasmodics like dicyclomine with paracetamol or mefenamic acid.
Antibiotics to treat infections
IV fluids & electrolytes
Find and treat the underlying cause
Surgery (if needed)
Lithotomy or lithotripsy in case of calculus.
Appendectomy in case of appendicitis
Cholecystectomy in case of cholecystitis or gall stone.
Herniectomy or herniorrhaphy in case of hernia.
Colectomy in case of diverticulitis etc.
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RENAL COLIC PAIN
Renal colic pain is type of pain patient gets when urinary stones block parts of his urinary
tract.
Intense pain along the side of body between ribs and hip, or in lower abdomen.
Renal colic happens when a stone gets lodged in urinary tract, often in ureter. The stone
stretches and widens the area causing intense pain.
Bed rest and hot water bag over the affected area.
Give diclofenac 75mg intramuscularly unless it is contraindicated.
A second 75mg dose may be given, after 30 minutes if necessary.
Atropine → 0.6 - 1.2 mg IM
Metoclopramide → 10 mg IM
Increased water intake
Surgery indicated if –
1. Stone is too large to pass spontaneously (>7mm)
2. Causing obstruction & impairing renal function.
3. Proximal infection combined with obstruction one of these procedures to remove
large stone and relieve renal colic.
Extracorporeal shock wave lithotripsy (ESWL)
Ureteroscopy
Percutaneous nephrolithotomy
BILIARY COLIC
Biliary colic is defined as pain in the abdomen, due to obstruction usually by stones in the
cystic duct or common bile duct of the biliary tree. It typically occurs after eating a large,
fatty meal that causes contraction of the gallbladder. Treatment of this disease is primarily
surgical, involving removal of the gallbladder, typically using a laparoscopic technique. This
activity describes the risk factors, evaluation, and management of biliary colic and stresses
the importance of the interprofessional team in caring for affected patients.
GASTRITIS
Gastritis is a general term for a group of conditions with one thing in common: Inflammation
of the lining of the stomach. The inflammation of gastritis is most often the result of infection
with the same bacterium that causes most stomach ulcers or the regular use of certain pain
relievers. Drinking too much alcohol also can contribute to gastritis.
Gastritis may occur suddenly (acute gastritis) or appear slowly over time (chronic gastritis).
In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most
people, however, gastritis is not serious and improves quickly with treatment.
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PANCREATITIS
Pancreatitis is inflammation of the pancreas. The pancreas is a long, flat gland that sits tucked
behind the stomach in the upper abdomen. The pancreas produces enzymes that help
digestion and hormones that help regulate the way your body processes sugar (glucose).
Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days.
Some people develop chronic pancreatitis, which is pancreatitis that occurs over many years.
Mild cases of pancreatitis improve with treatment, but severe cases can cause life-threatening
complications.
PERITONITIS
Peritonitis is a serious condition that starts in the abdomen. That's the area of the body
between the chest and the pelvis. Peritonitis happens when the thin layer of tissue inside the
abdomen becomes inflamed. The tissue layer is called the peritoneum. Peritonitis usually
happens due to an infection from bacteria or fungi.
There are two types of peritonitis:
• Spontaneous bacterial peritonitis. This infection is caused by bacteria. It can happen
when someone has liver disease, such as cirrhosis, or kidney disease.
• Secondary peritonitis. Peritonitis can happen due to a hole, also called a rupture,
inside an organ in the abdomen. Or it can be caused by other health conditions.
It's important to get treatment fast for peritonitis. Health care providers have ways to clear out
the infection. They also can treat any medical problem that might be causing it. Peritonitis
treatment usually involves medicines that are used for infections caused by bacteria, called
antibiotics. Some people with peritonitis need surgery. If you don't get treatment, peritonitis
can lead to a serious infection that spreads through the body. It can be deadly.
A common cause of peritonitis is a treatment for kidney failure called peritoneal dialysis.
This treatment helps get rid of waste products from the blood when the kidneys struggle to do
that job themselves. If you get peritoneal dialysis, you can help prevent peritonitis with good
hygiene before, during and after dialysis. For example, it's important to wash your hands and
clean the skin around your catheter.
APPENDICITIS
Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from
your colon on the lower right side of your abdomen.
Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins
around the navel and then moves. As inflammation worsens, appendicitis pain typically
increases and eventually becomes severe.
Although anyone can develop appendicitis, most often it occurs in people between the ages of
10 and 30. Standard treatment is surgical removal of the appendix.
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ACUTE ABDOMEN
An acute abdomen is a condition that demands urgent attention and treatment. The acute
abdomen may be caused by an infection, inflammation, vascular occlusion, or obstruction.
The patient will usually present with sudden onset of abdominal pain with associated nausea
or vomiting. This activity reviews the evaluation and treatment of patients presenting with an
acute abdomen, and highlights the role of the interprofessional team in caring for these
patients.
ANURIA / OLIGURIA
Oliguria is the low output of urine.
In humans, it is clinically classified as an output less than 400 ml/day (but more than 80
ml/day). The decreased output of urine may be a sign of dehydration, kidney failure,
hypovolemic shock, multiple organ dysfunction syndrome, urinary obstruction / urinary
retention, DKA, preeclampsia, and urinary tract infections etc.
Beyond oliguria is anuria, which represents an absence of urine, clinically classified as below
80 ml/day.
Diagnosis →
Ultrasound examination of the kidney to rule out obstructive processes.
The mechanisms causing oliguria can be categorized globally in three
different categories:
• Prerenal: in response to hypoperfusion of the kidney (e.g., as a result of dehydration
by poor oral intake, cardiogenic shock, diarrhoea, G6PD deficiency, massive bleeding
or sepsis)
• Renal: due to kidney damage (severe hypoperfusion, rhabdomyolysis, medication)
• Postrenal: as a consequence of obstruction of the urine flow (e.g., enlarged prostate,
tumour compression urinary outflow, expanding hematoma or fluid collection)
Treatment →
IV Furosemide – Catheterization – Surgical intervention (if needed) –
Treat the cause like urinary obstruction, renal insufficiency etc.
CONGESTIVE HEART FAILURE

CHF is when the heart is unable to pump sufficiently to maintain blood flow to meet the
body’s needs.
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Types of CHF →
1. Left-sided CHF is the most common type of CHF. It occurs when the left ventricle
doesn’t properly pump blood. As the condition progresses, fluid can build up in the
lungs, which makes breathing difficult. There are two kinds of left-sided heart failure:
a. Systolic heart failure occurs when the left ventricle fails to contract normally. This
reduces the level of force available to push blood into circulation. Without this force,
the heart can’t pump properly.
b. Diastolic failure, or diastolic dysfunction, happens when the muscle in the left
ventricle becomes stiff. Because it can no longer relax, the heart can’t quite fill with
blood between beats.
2. Right-sided CHF occurs when the right ventricle has difficulty pumping blood to the
lungs. Blood backs up in the blood vessels, which causes fluid retention in lower
extremities, abdomen, and other vital organs.
It is possible to have left-sided and right-sided CHF at the same time. Usually, the disease
starts in the left side and then travels to the right when left untreated.
Causes →
• Coronary artery disease
• Heart attack (occurs when a coronary artery becomes suddenly blocked, stopping the
flow of blood to the heart muscle)
• Cardiomyopathy – Valve disease – Hypertension – kidney disease – congenital heart
disease – Diabetes etc.
Symptoms →
Acute attack includes rapid or irregular heartbeat (arrhythmias) associated with shortness of
breath (dyspnoea), chest pain or tightness, weakness or fainting.
Chronic symptoms include dyspnoea at rest, chest tightness, fatigue, weakness, edema in
legs, ankles & feet etc.
Treatment →
• Resuscitation.
• Treat high blood pressure.
• Treat lipid disorders.
• Discontinue alcohol or illegal drug use.
• An ACE inhibitor or an angiotensin II receptor blocker is prescribed if patient has
coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac
conditions. Beta blockers may be prescribed if patient has high blood pressure or a
previous heart attack.
• Surgical intervention (if needed) →
Angioplasty
Open heart surgery (Valve repair)
Heart bypass surgery (Coronary Artery Bypass Grafting)
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MYOCARDIAL INFARCTION
Myocardial infarction (MI) is a clinical syndrome that results from occlusion of a coronary
artery, with resultant death of cardiac myocytes in the region supplied by that artery.
Preserve cardiac muscle fibres
Vital signs
IV assess
ECG
Bio markers
Initial management:
M → Morphine
O → Oxygen
N → Nitrates
A → Antiplatelets
Pharmacological management:
Analgesics
Morphine sulphate
Decreases preload and afterload, reduce anxiety
Nitrates
IV nitroglycerin
ACE inhibitors → increases the left ventricular function
Prevent ventricular remodelling
Beta-adrenergic blockers → decreases the contractility and myocardial oxygen demand
Cholesterol lowering agents
Stool softeners
Surgical management:
Coronary artery bypass graft (CABG): construction of new conduits between aorta or other
major arteries with help of CPB machine.
Indications: triple vessel disease
Fails medical management
Graft used: internal mammary artery
Great saphenous vein
Inferior epigastric vein
Radial artery
SHOCK
Circulatory shock, simply known as shock, is a serious, life-threatening medical condition
defined as an inadequate perfusion of tissues which is insufficient to meet cellular metabolic
needs.
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As the blood carries oxygen and nutrients around the body, reduced flow hinders the delivery
of these components to the tissues, and can stop the tissues form functioning properly.
Types:
1. Hypovolemic shock
2. Cardiogenic shock
3. Obstructive shock
4. Septic shock
5. Neurogenic shock
Treatments:
Shock requires immediate interventions to preserve life.
Therefore, the early recognition and treatment is essential even before a specific diagnosis is
made.
Most forms of shock seen in trauma or sepsis respond initially to aggressive intravenous
fluids e.g., 1 litre normal saline bolus over 10 minutes or 20ml/kg in a child).
In case of respiratory insufficiency (i.e., diminished levels of consciousness, hyperventilation
due to acid-base disturbances or pneumonia) tracheal incubation and mechanical ventilation
may be necessary
ABCDE in shock management:
Airway
Breathing
Circulation
Disability
Exposure
Drugs like –
Sedatives
Chronotropic drugs
Ionotropic drugs
Vasoconstrictor
Beta blockers
Diuretics
Anti-biotics for septic shock
Anti-histaminic & corticosteroids for anaphylactic shock.
SYNCOPE
Syncope is the medical term for fainting, a sudden usually temporary, loss of consciousness
generally caused by insufficient oxygen in the brain either through cerebral hypoxia or
through hypotension.
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Treatment:
Intravenous access
Oxygen administration
Advanced airway technique
Glucose administration
Pharmacologic circulatory support
CONVULSION
A convulsion is a medical where body muscles contract and relax rapidly and repeatedly,
resulting in an uncontrolled shaking of the body.
The term convulsion is sometimes used as a synonym of seizure.
Management:
The first aid for a seizure depends on the type of seizure occurring.
Loosen tight clothing surrounding the head or neck.
Clear away dangerous objects if person is moving.
Anti-epileptic drugs – acetazolamide, diazepam
HYPERPYREXIA
Hyperpyrexia is an extreme elevation of body temperature which, depending upon the source,
is classified as a core body temperature greater than or equal to 40.0 or 41.5 °C (104.0 or
106.7 °F).
Causes →
Intracranial haemorrhage – Viral or bacterial infections – Sepsis –
Kawasaki syndrome – Thyroid storm etc.
Management →
• A cool bath or cold, wet sponges put on the skin.
• Liquid hydration through IV Fluids or from drinking.
• Fever-reducing medications, such as dantrolene.
HYPERGLYCAEMIA
Hyperglycaemia means high blood sugar or glucose.
Insulin is a hormone that moves glucose into cells to give them energy.
Hyperglycaemia happens when body doesn’t make enough insulin or can’t use it the right
way.
Blood glucose levels can vary from day to day.
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Management:
Regular exercise is often an effective way to control blood sugar. Don’t exercise if ketones
are present in urine. This can drive blood sugar even higher.
Check blood sugar: monitor blood glucose as directed by doctor.
Recommend dietary changes
Emergency treatment for severe hyperglycaemia
Fluid replacement:
Receive fluids: either orally or through IV until patient is rehydrated. The fluid replaces those
patients has lost through excessive urination, as well as help dilute the excess sugar in blood.
Insulin therapy
Insulin reverses the processes that cause ketones to build up in blood. Along with fluids to
build up in blood, along with fluids & electrolytes. Patient will receive insulin therapy usually
through vein.
HYPOGLYCAEMIA
Hypoglycaemia is the medical term for a state produced by a lower-than-normal level of
blood glucose.
Inadequate supply of glucose to the brain, resulting in impairment of function.
Treatment:
Hypoglycaemia is treated by restoring the blood glucose level to normal by the ingestion or
administration of dextrose or carbohydrate foods.
In some circumstances it is treated by injection or infusion of glucagon.
Medication like diazoxide, octreotide or glucocorticoids, or by surgical removal of much of
the pancreas.
In hospital personnel can establish an IV and give intravenous dextrose, concentrations
varying depending on age –
• Infants → dextrose 10%
• Children → dextrose 25%
• Adults → dextrose 50%
Care must be taken in giving these solutions because they can be very necrotic if the IV is
infiltrated.
If an IV cannot be established, the patient can give 1 to 2 mg of glucagon in an IM injection.
Difference between hyperglycaemia & Hypoglycaemia

Hyperglycaemia Hypoglycaemia
Refers to an excess of glucose in the Refers to a deficiency of glucose in the
bloodstream. blood stream.
Blood sugar level rises more than 130 mg/dl Blood sugar level drops less than 70mg/dl
Can be caused by non-compliance of anti- Can be caused by excessive intake of anti-
glycaemic agents glycaemic agents beyond the prescribed
dose.
Commonest complication is hyperosmolar, Commonest complication is diabetic
hyperglycaemic non-ketotic syndrome. ketoacidosis
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STATUS ASTHMATICUS
Acute severe asthma is an acute exacerbation of asthma that does not respond to standard
treatments of bronchodilators (inhalers) and corticosteroids.
Symptoms include chest tightness, rapidly progressive dyspnoea (shortness of breath), dry
cough, laboured breathing, and extreme wheezing. On examination, the respiratory rate may
be elevated (more than 25 breaths per minute), and the heart rate may be rapid (110 beats per
minute or faster). Reduced oxygen saturation levels (but above 92%) are often encountered.
Management →
• Positive-pressure therapy, including mechanical ventilation.
• Intravenous (IV) medications (e.g., magnesium sulphate), aerosolized medications to
dilate the airways (bronchodilation) (e.g., albuterol or ipratropium bromide /
salbutamol)
• Intravenous corticosteroids and methylxanthines are often given.
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS):

ARDS is a severe lung disease caused by a variety of direct and indirect issues.
It is characterized by inflammation of the lung parenchyma leading to impaired gas exchange
with systemic release of inflammatory mediators causing inflammation, hypoxemia and
frequently resulting in multiple organ failure.
Management:
Ventilator support
Prone positioning
Sedatives
Fluid management
Extracorporeal membrane oxygenation (ECMO)
Hypoglycaemic coma & Hyperglycaemic coma:

Hypoglycaemic coma:
History:
If patient has missed his meals or undergone severe exertion, if he had sweating & hunger,
and if he has become unconscious suddenly then he is in hypoglycaemic coma.
Clinical features:
If the patient is breathing quietly, pulse is slow & bounding, then he is in hyperglycaemic
coma.
Blood sugar strips:
If available, will make the diagnosis clear.
By glucometer.
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Hyperglycaemic coma:
History:
If patient had not taken his regular tablets or insulin, if he had fever or any illness and if he
has lost consciousness gradually, then he is in hyperglycaemic coma.
Clinical picture:
If patient is febrile, looks toxic pulse is feeble & fast and breathing is rapid, deep with sweet
odour, then he is in hyperglycaemic coma.
Blood sugar strips:
If available, will make the diagnosis clear.
By glucometer.
If glucometer is not available inj. 25% glucose 25ml × 4 amps IV

If patient starts waking up 25% glucose → If patient does not wake up → refer to
10% dextrose → observe. physician.
If not fully alert give IV mannitol Managed in hospital.
In hypoglycaemia
Administration of dextrose (age wise different dose) or carbohydrate food.
Injection of glucagon → 1 – 2 mg
Medication like diazoxide, glucocorticoid
In some conditions surgical removal of pancreas
In hyperglycaemia →
Fluid replacement
Receive fluid until patient is rehydrated
Insulin therapy.
DROWNING
Drowning is defined as respiratory impairment from being in or under a liquid (submersion).
Near-drowning is a term typically used to describe almost dying from suffocating under
water; it is the last stage before fatal drowning.
Management →
• Cardiopulmonary resuscitation (CPR)
• The airway-breathing-circulation (ABC) sequence should be followed, rather than
starting with compressions as is typical in cardiac arrest, as the basic problem is lack
of oxygen.
• If the person has near-drowned in cold water, remove their wet clothes and cover
them in warm blankets or clothing to prevent hypothermia.
• Hypotension remaining after oxygenation may be treated by rapid crystalloid
infusion.
189
(9664757178)
ELECTRIC SHOCK
Electrical injury is a physiological reaction caused by electric current passing through the
(human) body. Electric shock occurs upon contact of a body part with any source of
electricity that causes a sufficient magnitude of current to pass through the victim's flesh,
viscera or hair.
Management →
• Begin CPR if the person shows no signs of circulation, such as breathing, coughing or
movement.
• Treatment of electric shock depends on the severity of the burns or the nature of other
injuries found.
• Topical antibiotic ointments and dressings are applied for minor burns. For severe
burns, surgery with skin grafting may be required. Sometimes amputation may also be
needed.
• As with conventional thermal injury, electrical injuries cause massive fluid shifts with
extensive tissue damage and acidosis; therefore, monitoring a patient's hemodynamic
is important. A Foley catheter is helpful in monitoring urine output and, therefore,
tissue perfusion.
• IV Fluids & electrolytes to maintain fluid & electrolyte balance
• Antibiotics to avoid sepsis.
• Analgesics and anti-inflammatory drugs for symptomatic relief.
190
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A text book of

Dr. Tajagna Dalsaniya

1. Derivation of the terms ‘Kaya’, ‘Chikitsa’ and their definitions and

चीयते प्रशस्तिोषधातुमलैरितत काय: |

चचककत्सा िोगतनिान प्रततकाि |

कायस्यान्तिग्नेत्िककत्सा कायचचककत्सा | (Cha. Su. 30/28 Chakrapani)

a. Antah parimarjana chikitsa: Internal administration of medicines.

a. Hetu viparita chikitsa: Opposite to etiology

4. Chaturvidha chikitsa: By sushruta

5. Panchavidha chikitsa: By charaka

6. Shadvidha chikitsa: (Shadvidha upakrama by charaka)

7. Saptavidha chikitsa: (Shamana chikitsa)

8. Astavidha chikitsa: (Shastra karma by sushruta)

9. Dashavidha chikitsa: (Langhana chikitsa)

10. Astadasha chikitsa: (Upashaya)

भिषग्रव्याण्युपस्थाता िोगी पािचतुष्टयम ्|

ROGI-ROGA PARIKSHA SIDDHANTA

Examination of the patient can be done by following method.

Taila bindu pariksha:

Three types → a. Asatmendriyartha samyoga: Improper use of sense organs

2. Importance of Kriya Kaala according to stages of Dosha and their

Disease is not a state; it is rather a process of changing manifestations, involving different

2. Prakopa (Aggravation of doshas):

3. Prashara (Spread of aggravated doshas):

4. Sthana samshraya (localization of the aggravated doshas):

5. Vyakta (Manifestation of signs and symptoms of disease):

6. Bheda (Chronicity or differentiation of disease):

3. Chikitsa sutra and Management of vriddhi (increased) and kshaya

CHIKITSA SUTRA AND MANAGEMENT OF VRIDDHI AND KSHAYA OF

Samanya nidana of dosha-dhatu-mala kshaya

Dosha vriddhi kshaya lakshana avum chikitsa:

2. For kapha Kshaya:

Dhatu vriddhi kshaya lakshana:

Dhatu pradoshaja vikaras:

5. Asthi pradoshaja roga:

Mala vriddhi kshaya lakshana:

OJO VYAPATA AND ITS MANAGEMENT

Ojo visramas lakshana:

Ojo vyapada lakshana:

In ojo kshaya avastha:

CHIKITSA SUTRA AND MANAGEMENT OF SAMA-NIRAMA STATES

Kapha pradhana aama → Aamajeerna & Pravahika

Sama-Nirama samanya lakshana:

Saama-Nirama dosha lakshana:

Sama kapha → Aavila, Tantu, Durgandhi, Kshudha nashaka

Sama-Nirama dhatu lakshana:

Aamadosha nashaka aushadha yoga:

ROGA ANUTPATTIKARA CHIKITSA

3. Rasayana & Vajikarana prayoga:

ROGA PRASHAMANA CHIKITSA

Dosha pratyanika chikitsa in sanchaya, prakopa, prasara avastha:

Vyadhi pratyanika chikitsa:

Ubhaya pratyanika chikitsa:

2. Pita dosha upakrama:

Sthanantara gata dosha chikitsa:

उध्वम चाधि ततयमक्च िोषाणां त्रत्रववधा गतत |

Lina dosha chikitsa:

CHIKITSA SUTRA AND MANAGEMENT OF AVARANA AND OF DHATU

Specific treatment principles: