Critical review of samprapti and shatkriyakal in kitibha kushtha (psoriasis) Anita Sinha ijamscr@gmail.com M.D. Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, India. India 14 08 2020 14 08 2020

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Critical review of samprapti and shatkriyakal in kitibha kushtha (psoriasis)

Anita Sinha 1 , NC Dash 2 , Rajan Nelson Munzni 3 , Gaurav 4

1 M.D. Kayachikitsa , Gopabandhu Ayurveda Mahavidyalaya , Puri , India .

2 Prof. & H.O.D., dept. of Kayachikitsa , Gopabandhu Ayurveda Mahavidyalaya , Puri , India .

3 M. D., Panchakarma , I.P.G.T. & R.A., Jamnagar & PH.D., Panchakarma , N.I.A., Jaipur, India .

4 MD, Assistant prof. Dept of Rasashashtra and bhaishjya kalpana , Gov. Ayurved collage, Patna, India

*Corresponding Author:Anita Sinha

<bold>ABSTRACT</bold>

Twak is formed like the Sansthanika over the boiling milk. (The same manner in which the layer are formed and deposited on the surface of milk). In the uterus during the course of development of Garbha differentiation of the layers of the skin takes place and is caused by all three Doshas, Particularly by the pitta Dosha. Twak is said to be an Upadhatu of mamsa. The description of "Kushtha roga" in texts covers almost all skin diseases including "Kitibha". The word "Kushtha" is a broad term which involves a whole community of skin diseases. Kushtha is in the one which causes vitiation as well as discoloration of the skin. The clear cut description regarding the layers of skin in relation to Katibha not given in Ayurvedic classics but the site of Tamra twak to be the layer or skin can be taken as the site or Kitibha. In Kushtha the provoked doshas setting themselves in vitiated body elements and after getting localized generate skin lesions. If treatment is not available at this stage dosha further vitiates to all the Sapta dhatus. Like Rasa, Rakta, Mamsa, Meda, Asthi, Maja and Sukra and produce Krimis, which produces decay of Mamsa, Asthi etc.

Keywords: Psoriasis, Twak roga, Kitibha, Kushtha.

 <bold>Introduction</bold>

The condition in which different body organs, Dhatus, Updhatus are destroyed is known as "Kushtha". Kushtha is in the one which causes vitiation as well as discoloration of the skin. In the Samprapti of Kushtha, commentator Gayadas specifies that Mandalotpatti is common symptom in all types of Kushtha [1]. In short it shows that "Kushtha" means which comes out from the inner part to the outer part i.e from the internal part of the body to the surface of skin.

Acharya Charak & Sushruta noted that Tridosha, Twacha, Rakta, Mansa & Lasika, 4 Dushyas makes the skin kutsita (Deformed) [2]. If it is neglected the normal condition of whole body may be affected therefore it is called Kushtham. Two types of Kushtha have been dead in Ayurvedic classics[3]. MahaKushtha (Major), and Ksudra Kushtha (Minor). Kshudra Kushtha comprises some of the obstinate forms of skin diseases where w Maha Kusta Includes conditions corresponding sally with different benign and malignant forms of leprosy, The Kitibha is described under Maha Kushtha. Kushtha and its entities have been classified under 'Adibalapravritta Vyadhi, which according to modern medicine pertains to the genetic origin Adibalapravritta diseases have their origin at the time of the union of the sperm and ovum of the parents. Familial individual's response to the endogenous and exogenous etiological factor is determined by their certain constitutional factors. Which follows inheritance from the parents. It is certainly a very unique observation of Ayurveda that Kushtha and their entities can also be influenced by genetically and hereditary factor. Susruta has also said that the children of Kushtha patients are also suffer from Kushtha [4]. Acharya Sushruta has mentioned Kushtha as 'Aupasargika rogas with jwara (fever), Netrabhisyandi (conjunctivitis) etc. that implies that they are infections in nature which are communicated from infected person to the other through sexual contact, physical contact, respiration (droplet), sharing food and drunk, sleeping on patient bed. Charaka has indicated that Raktaja Krimi one type of krimi can produce Kushtha like lakshana [5]. Sushruta has emphasized the presence of Krimi along with the three dosas in the Pathogenesis of all type of Kushtha [6]. He further state a variety of Raktaj Krimi termed as Kushthaj Krimi which leads to various Raktaj disorders like Kushtha etc [7].

 <bold>Aims and objective </bold>

To explore the detail Samprapti of Kitibha Kushtha

To study different stages of Shatkriyakal in Kitibha Kushtha

 <bold>Symptoms of </bold> <bold>Kitibha</bold>

According to charaka Dry wound like lesion, which is bluish in colour rough and hard to touch, is known as Kitibha [8]. According to Vagbhata the Kitibha is dry, rough in touch like dry wound, itchy, hard to touch, blackish in colour [9]. According to Madhav Nidan the lesion, which is shyava (blackish), in colour, rough on touch, like dry wound, and hard to touch is known as Kitibha [10].

Shayava - Acharya Charak, Sushruta, Madhav, Vagbhata has described this symptoms of Kitibha. This shyavata occurs due to the predominance of vata dosha. Sushruta said this as Krishna (blackish) [11].

2 Kina kharasparsha- All Acharyas has described this symptom except Acharya Sushruta. The word 'jina' means dry wound like eruption kharata is the quality of vata dosha. So due to vata dosha predominance, the Kitibha is like rough & dry to touch [12].

Parusham- Acharya Charak and Madhav has said this symptom Parushata means rough and hard to touch. This happens due to vata vridhi [13].

Sravi - Maharsi Sushruta has opined this symptom which causes due to pitta dosha srava means discharge & this condition occurs when the eruption gets & the slummy secretion comes out. The whole process happens due to pitta dosha because paka is the karma of pitta [14].

Vrutta - According to Sushruta the eruption of Kitibha look like circular in shape which is otherwise known as vruttam ie popular in shape. It happens due to the predominance of kapha dosha.

Ghanam - The eruptions are Ghana or thick to look. Ghana is the quality of kapha doshas.

Ugrakandu - (pruritus) - When kapha dosha vridhi is there kandu or itching occurs, when excessive itching is there i.e known as pruritus or ugra kandu. Simply kandu (itching) is described by vagbhata.

Snigdha - Maharshi sushruta says the eruptions are smooth to touch or snigdha in the quality of kapha dosha. So due to kapha dosha Kitibha seems to be smooth in touch

Ruksham - Rukshata is the quality of vata dosha. Kitibha is said by Vagbhata.

According to above symptoms it is the disease of kapha vridhi (6), vata vridhi (5) & pitta vridhi (1). Charaka indicates it is a vata-kapha vyadhi & Susruta says it is a pitta dominance vyadhi.

 <bold>DISCUSSION </bold> <bold>Samprapti</bold> <bold> (Pathogenesis)</bold> <bold>[15]</bold>

There all above mentioned causative factors are responsible for vitiation o all three doshas viz. vata, pitta and kapha which in turn vitiate Twak (skin or rasa dhatu), Rakta (blood), Mamsa (muscle tissue) and Ambu (body fluid like tissue fluid, lymph and serum). These taken together constitute the seven fold pathogenic substance of Kushtha and types of Kushtha are cured by all of them. All types of Kushtha are Tridoshaj and none of the Kushtha is produce by only one dosha. The provoked doshas setting themselves in vitiated body elements and after getting localized generate skin lesions. If treatment is not available at this stage dosha further vitiates to all the sapta dhatus, Like Rasa, Rakta, Mamsa, Meda, Asthi, Maja and sukra and produce krimis, which produces decay of mamsa, asthi etc. All the three doshas after provocation produces lesion first in the skin and after negligence if doshic imbalance are not brought in to normally, they penetrate deeper and deeper into all other dhatus in the entire body. After involvement of three dhatus eighteen types of Kushtha are produced. In fact they may be innumerable. The vitiated doshas become morbid and the effect of 'dravatvaguna' of pitta and kleda guna of Kapha on agni leads to agnimandya which impair the digestion and in turn results in formation of Ama ahara rasa and consequently excessive formation of ama takes place. Vyan vyau is real mediator in the spread of doshas in body. The vitiated vata forces the 'ama' rasa through "Triyak siras" in to different parts of body and much of it accumulates to the surface of skin. The accumulation leads to 'sroto rodha' which finally results in the accumulation of vitiated dosha in the particular part of the skin. Due to their predominance they produce different sign and symptoms respectively.When the four dushyas are provoked by vitiated three doshas in different varieties of kushtha takes place.The combination of these seven dravya's called 'sapta dravya sangraha' of Kushtha and none of the kushtha can cause by any one of seven- body elements alone.

 <bold>The pathogenesis of </bold> <bold>Kushtha</bold> <bold> as a whole can be represented as [16]</bold>

Dosha-Vata, Pitta, Kapha

Dushya-Twak, Rakta, Mansa, Lasika.

Srotas-Rasavaha, Raktvaha, Mamsvaha and Ambuvaha.

Agni-Jathragni or Dhatwagnimandya.

Udbhavasthan-Amasaya.

Adhisthan-Whole body (specially twak)

Rogmarg-Bahya

Sancaya-At the own sites of vata, pitta and kafa.

Prakopa-At the own sites of vata, pitta and kafa.

Prasara-Through the triyagga siras to the sakha.

Sthansamsraya-In the sithilibhuta Twak, Rakta Mansa and Lasika, (Purvarupa utpatti)

 <bold>SATKRIYAKALA</bold>

The basic philosophy behind the concept of Kriyakala is to emphasise the need of early detection of a disease and an appropriate timely therapeutic intervention so that the disease process may be reversed towards normalcy. The main triggering factor which is responsible to precipitate the kriyakala among all the various metabolic fire of the body. This agni when becomes weak, number of unwanted incomplete byproducts of digestion and metabolism start forming and accumulating in the body at different from gross to the molecular level, from local GI (gastrointestinal) tract to the systemic levels, at the tissue and cellular as Ama which acts as toxic, antigenic materials, which leads to increasing impermeability and sluggishness of the srotasas. In case of Kitibha the various etiology factors mentioned under nidan, leads to impairment of the agni producing Ama state in the body. This further leads to aggravation of Kapha dosha and vitiation of Rakta dhatu. The entire pathological process can be explained as follows

Sanchaya (Stage of Accumulation): This is the initial stage of the disease in which accumulation or stagnation of the dosha in its own location takes place owing to some nidan (etialogical) factors. In Kitibha the various etiological factors engender increase in Kapha and vata dosha in the amashaya. Their attributes impairs the normal digestion and metabolism producing imbalance in the functioning of these two doshas further leading to their excess accumulation. The vata dosha being the force of movement transportation actuates the other two doshas in the further stage of pathogenesis. Particular food habits assigned as etiological; factor of Kitibha, like, amla lavana madhura viruddha ahara are capable for accretion of kapha & vata dosha vigorously.17

Prakopa (Stage of aggravation )18: This second stage is provocation or excitation of the accumulated doshas in its own location, thus preventing it from free circulation on repeated exposure to etiological factor this leads to further aggravation of vata & kapha dosha. There occurs increase in the real mediator in the spread of vata and kapha dosha particularly. The pitta dosha also gets aggravated due to this imbalance or directly due to nidan like suppression of natural urges etc. The factors which aggravate pitta also tend to aggravate the rakta dhatu. In case of Kitibha certain exogenous etiological factors cause aggravation of doshas instantaneously without the stage of accumulation ( Sanchaya ) Thus there is "Asanchita prakopa" of dosha along with vata dosha which give rise to immediate prakopa and dislodgment of doshas in the srotasas body channels Producing the pathogenesis with short span of time after exposure to etiological factors which can be simulated with hypersensitive condition to allergens.

Prasara( Spreading or overflow)19: In this stage the aggravated doshas owing to the action of vata dosha over flows from its own seat. The aggravated pitta and kapha doshas in predominance is carried by vata through the tiryak sira in the Bahya marga. This bahyaroga marga denotes twacha, rakta, lasika and mamsa. As rasa dhatu is the carrier of vitiated doshas they tend to vitiate the rasa and rakta dhatu on the basis of Ashraya- asharayi bhava. The consequence terminates in to reaching of doshas to the site of dushya particularly the blocked channels accommodating the dhatu.

Sthansamshraya (Localization): The deranged doshas tend to localize at the specific site this stage during the health and harmonious working in the body there is a friendly relationship between the doshas, dhatus and mala. This relationship is known as ashraya ashrayi bhava. So long as the doshas are in normal balance state they do not harm the host, but when they get vitiated by nidan factors they tend to become aggressive and harmful. In this further stage of samprapti this distributed relationship is known as 'Dosha-dushya samurchana'.20 The aggravated Kapha and vata dosha vitiated rasa, rakta lasika and mamsa and get lodge at particular site in the twacha which is either weakened previously or weakened by the doshas itself.

Vyakti (manifestation): At this stage the clinical feature of Kitibha starts to manifest. The feature Kandu and Rukshta are produced due to localized Kapha and vata doshas out of which Kapha dosha begets clinical features, Kandu and Ruksham, those are the natural features incorporating to Kapha. At the same time feature like shravi and its ugra Kandu in further stage are due to vitiation of rakta dushya. The vitiated pitta when effects the rakta dhatu and twacha it manifest as swelling with erythema termed as kina khara sparsha. Shyavata a feature of discolouration of skin is mostly possible due to vata dosha.21

Bheda (complications): In this final stage there is interruption of the disease by natural forces or aggravation in to chronicity. The disease is either arrested that is subsides having its course or is interrupted by natural forces of body or becomes chronic and complicated. In the former case there is no development of disease where as in the later case the disease may turn out to be incurable with complication unless properly treated.

 <bold>CONCLUSION</bold>

Skin disorders are one of the burning problems of modern scientific era. Kushtha includes wide spectra of skin diseases. Kitibha is described under the heading of ksudra kustha by the Acaryas. Kitibha is similar to the psoriasis due to its maximum similarity in chief symptoms. This disease occurs due to vitiation of Tridosha caused by viruddha Ahara and vihar. This disease cause trouble to the patient by producing discolouration of the skin, itching and sometimes burning. It also stands as a cosmetic problem due to continuous scaling leading to ugliness. Study of Samprapti and Shatkriyakala plays a vital role in understanding the pathophysiology of disease. It is useful for vaidyas for making diagnosis of the disease and it helps them to prevent the further progression of the disease.

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