WhatsApp Discussion Series:18- "Xanthelasma" An Ayurveda Perspective by Prof. Sanjay Lungare, Vd. Anupama Patra, Vd. Trivendra Sharma, Vd. Bharat Padhar & others

[20/06 15:57] Khyati Sood Vd. KC: 

white elevated patches on eyelid....... Age 35 yrs... no itching.... no burning.......... What could be the probable diagnosis and treatment according Ayurveda..?

[20/06 16:07] J K Pandey Dr. Lukhnau: 

Its tough to name it in ayu..it must fall pakshmgat rog or wartmgat rog..

but I doubt any pothki aklinn vartm aur klinn vartm or any kafaj vydhi can be correlated to xanthelasma..coz it doesnt itch or pain..

So Shalakya experts may hav a say in ayurvedic dignosis of this

[20/06 16:23] Gururaja Bose Dr: 

It is xantholesma, some underline liver and cholesterol pathology will be there.

[20/06 16:28] Sudhir Turi Dr. Nidan Mogha: 

Its xantholesma..

[20/06 16:54] J K Pandey Dr. Lukhnau: 

I think madam khyati has asked for ayur dignosis..

[20/06 16:55] J K Pandey Dr. Lukhnau: 

Its xanthelasma due to cholestrolemia..bt here we r to diagnose it on ayurvedic principles.

[20/06 17:12] Anupma Patra AIMS AYU: 

Please any dravyaguna specialist tell me what is kumbhika veeja?

[20/06 17:20] Ranga prasad Ji Vd. Chennai:

 Kumbhika beeja = pomegranate seeds

[20/06 17:25] Trivendra Sharma Jpr: 

Rakta dushti mankar treat kiya jaaye.

[20/06 17:26] Anupma Patra AIMS AYU:

  sir i search it in net results come  careya arboria and its seed is like the shape of xanthelesmia so it can be compared as  vartmarog kumbhika.

And its treatment is chedan then lekhan. In initial stage swedan, then lepa of sothahar drugs or shadhan can be done.

[20/06 17:32] Trivendra Sharma Jpr:

 I think kumbhika ------ aadmapayanti bhinna ya---, bhedan karne pr jisme dobara fluid bhar jaaye.

So can't. Compare

I think, there is no pidaka.

Only slightly elevation and discolouration.

[20/06 17:45] Ranga prasad Ji Vd. Chennai: 

In the same above context Dalhana clarifies that kumbhika is dadimaphala aakaara.

[20/06 17:54] Trivendra Sharma Jpr: 

Pothki  Mein secretion hoga itching hogi.

[20/06 18:21] Ranga prasad Ji Vd. Chennai: 

Trivendra Sir, pothaki  image was presented for kumbhika bija query and not for xanthelasma. 

[20/06 18:44] Anupma Patra AIMS AYU:

 I will give my detail input later, sorry

 Trivendra sir the local elevation can be called as pidica. I hope kumbhiveeja explained by Dalhana (dadima veej) not appropriate one. Careya arborea may be appropriate one. Requesting dravyaguna specialist to clear it .

The description of kumbhika is most appropriate one as per description of disease and treatment point of view. Recurrence 

is common in xanthelesmia also after excision like that of kumbhika.

[20/06 19:05] dr. pradip jain MP: 

Sephalika patra se gharshan 

Evm lepa of tankana

And shankh bhasma with  ghee

May helpful for xanthalasma

Internally hypolipidaemic drugs

[20/06 22:03] Trivendra Sharma Jpr: 

Til  Massa elevated hote hain lekin pidika nahi hote.  Aur hum  sirf us rogi pr discussion Kr rahe hain ki us patient Ke rog ko kya naam dein. Mera kahana sirf itna hai ki bo nato pothaki hai aur na he kumbhika.

[20/06 22:11] Prof. D. S. Mishra Sir: 

आप इस रोगी का LFT और KFT करवा लें

[20/06 22:18] khyati sood kc jamngr: 

Yes sir surely i will... 

[20/06 22:26] Anupma Patra AIMS AYU:

  thank u pradeep sir. If u ve tried please give some little detailed about it. 

[20/06 22:48] Janardan Hebbar Dr:

 Xantholesma gets relieved once cholesterol gets under control. A liver tonic along with Triphala kwatha eye wash is also very useful. I have treated this via kaphahara line Rx.

[20/06 23:04] Manju Mishra MO UP: 

axi tarpan with go grut with gogrut nasya...only high dose of aamalki churn x 7 days

Netra tarpan n anjan has good results

Triphala grita,

amalki rasayan

Mukta pisti

Saptamrut lauh

About 3 month regularlly

[20/06 23:11] Prof. D. S. Mishra Sir: 

It is not disease  of eyes

[20/06 23:24] shekhar singh MP: 

[20/06 23:24] Ranga prasad Ji Vd. Chennai: 

[20/06 23:29] Janardan Hebbar Dr: 

But still Triphala lukewarm eye wash would loosen the xantholesma patches.

[20/06 23:30] Anupma Patra AIMS AYU:

 Can any body please tell me about the defination or meaning of pidika?

[20/06 23:31] Sanjay Lungareg Dr:

8

सही कहा शर्मा सर जी,

ना पिडका के शोथ, राग जैसे प्रत्यात्म लिंग है ना वर्त्मगत रोगों के सम्प्राप्ति घटक जैसे मांस या रक्त का सहभाग है ।

कुम्भीका बीज प्रतिमा यानी बीज वर्ण भी नही है फीर भी व्यर्थ चर्चा ।

[20/06 23:33] Anupma Patra AIMS AYU: 

Thank u sir, i think this shape are exactly similar with xanthelesmia.

[20/06 23:38] Sanjay Lungareg Dr: 

यस्य पित्तं प्रकुपितं त्वचि रक्तेअवतिष्ठते।

शोथं सरागं जनयेत पिडका तस्य जायते । च सू १८/१०

[20/06 23:44] Manju Mishra MO UP: 

Pidika me shoth sthir  rahta  hai. visharp  me shoth  spread karta.....

[20/06 23:45] Sanjay Lungareg Dr:

 कुम्भीका दाडीमाकारफला स्थलकुम्भी ।

वर्त्मजा इति बहुवचनाद् बाह्या एव भवन्ति ।

अर्थापत्ति से ज्यादातर आभ्यंतर ही कहा है ।

क्या xanthelasma आभ्यंतर ही होता है ।??

If yes then think .

[20/06 23:47] Anupma Patra AIMS AYU: 

Sorry  Lungare sir ! i am not getting that reference. Is it in trishathiya adhyaya?

Sir abhyantar hona jaruri nahin.

[20/06 23:47] Sanjay Lungareg Dr: 

Sorry

विपर्यय तन्त्रयुक्ति

It is च सू १८/२४

विपर्यय तन्त्रयुक्ति से विरुद्ध अर्थ ले।

यानी आभ्यंतर ।

[20/06 23:56] Anupma Patra AIMS AYU: 

Thank u sir, i will go through the pidika as per sushrut then only i take a conclusion. Sir if u ve any ref of pidika from sushrut then kindly give me. Again thank u very much.

Lungare sir, before yesterdays discussion i  also use to think xanthelesmia as a skin problem (name not given in shastra). But when i see the  exact seed of kumbhika i start thinking about it in relation to xanthelesmia. Accordind to sushrut perhaps sotha and raga like cardinal features are not essential for pidika because there r many description of pidika r there without sotha and raga. ex.- arsha vartma, vartmasharkara etc. The seat of Xanthelesmia is varma only.  I think there is no need to compare colour of kumbhika veej ,if done no much difference also. (Lens is like masuradal matra but colour are completely different) Kumbhika is also symptomless like xanthelesmia. Treatment point of view is also similar having high recurrence rate (adhmapayanti bhinnaja) so lekhan is indicated after chedan. I think we should not hesitate to compare the both.

Hiper cholesterol is a factor for this but not always. In initial stage of all these pidika swedan,lepan and shadhan also may be helpful.

तरुणी च अल्पसंरम्भा पीड़क वाह्य वर्त्मजा

विदितवैता प्रशमएत स्वेद लेपन शोधनै। (सु.उ.-13/18) so some results may come due to swedan effect in tarpan and other kaphahar treatment in early stage. Sir here vahya vartma mentioned so external manifestation in vartmarog is possible.

In case of too hard, small and copper colour (su.U.-13/17)  here tamra colour mention which is also seen in old xanthelesmia there  it is advised ist to try for paaka then bhedan then lekhan should done.

So now i am confirm xanthelesmia is nothing but kumbhika. Though i ve tried a lot previously to compare xanthelesmia in vartmarog i failed due to erroneous comparison of Dalhana about kumbhika veej as pomegranate veej. That is why i never belief 100% on these commentry. Thank u khyati madem to raise this question.

[21/06 15:01] Sanjay Lungareg Dr: 

*We only see what we want to see; we only hear what we want to hear. Our belief system is just like a mirror that only shows us what we believe.*

Don Miguel Ruiz

1. You said that, 

'according to sushrut perhaps sotha and raga like cardinal features are not essential for pidika .'

*For this please go through सु नि ६/१४

कच्छपिका, मसूरिका, विदारिका आदि पिडकायें क्षुद्ररोग नि १३/३ मे भि बतलाई गयी है ।

अर्थापत्ति तन्त्रयुक्ति से इसका मतलब यह हुआ की प्रमेह के बिना भी पिडका उत्पती होती है ।

डल्हण ने भी यही बात दोहराई है । यथा,

एताः सराविकाद्याः प्रमेहपिडकाः प्रमेहं विनापि भवन्ति ।------

इसी कारण प्रमेह और पिडका का चिकित्सासूत्र तथा सम्प्राप्ति लक्षण ऐक है। डल्हण ने प्रसंग तन्त्रयुक्ति से विश्लेषित किया है । यथा,

पिडकाचिकित्सितेअपि प्रमेहचिकित्सितमुक्तं अथवा प्रमेहचिकित्सितेनैव पिडकोपशमो भवतीति।

इसी प्रसंग मे सु चि १२/४ मे पिडका लक्षण तथा चिकित्सा बतलाई है । यथा,

एवमकुर्वतस्तस्य दोषाः प्रवृद्धाः *मांसशोणितं* प्रदूष्य *शोफं* जनयन्त्युपद्रवान् 

*शोफो वृद्धोअतिमात्ररूजो* *विदाहमापद्यते*

उत्तरावस्था मे *पूयो अभ्यन्तरमवदार्योत्सड़ग महान्तमवकाशं* यह लक्षण भी बताया है, 

अपक्वानां पिडकानां *शोफवत्* प्रतिकारः। 

सु चि १३/९

यहां अर्थापत्ति तन्त्रयुक्ति से *शोथ* की सिद्धी होती है ।

So how can we say that sotha and raga are not cardinal features of pidika according to sushrut?

2. You said that there is no need to compare colour.

संहिता मे कुम्भीक बीज प्रतिमा शब्द आया है ना की कुम्भीक बीज, तो प्रतिमा से वर्ण इंगित होता है ।

3. आध्मापयन्ति भिन्ना याः कुम्भीकपिडकास्तु ताः।

आध्मापनम् अक्षिषु मुखमारुतस्य प्रापणम्।

तो xanthelasma मे अक्षिषु मुखमारुतस्य प्रापणम से भेदन होता है क्या?

4. वर्त्मजा इति बहुवचनाद् बाह्या एव भवन्ति ।

तो xanthelasma वर्त्म आभ्यंतरतः संभव है क्या?

5. You said that Dalhana made erroneous comparison about kumbhika beej as pomegranate beej.

My humble request to you that, first you have to read commentary, understand it's meaning and if he is wrong then blame.

डल्हण ने कहीं पर भी कुम्भीक बीज को दाडीम बीज नही कहा है ।

He try to say that in सु उ ३/१०

Kumbhika is plant having fruit who's shape is just like shape of fruit of  pomegranate . यथा,

कुम्भीका दाडिमाकारफला स्थलकुम्भी ।

[21/06 15:05] J K Pandey Dr. Lukhnau:

 Lungare sir cant agree more with u...being rational in any science is must.. being andhbhakt will lead u no where.. kumbhika cant be xanthelasma..xanthelasma occurs around nose above eyelid below eyelid too.

[21/06 15:10] Prof. Satyendra Ojha Sir: 

Xanthelasma (or xanthelasma palpebrarum) is a sharply demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids.While they are neither harmful nor painful, these minor growths may be disfiguring and can be removed. They are common in people of Asian origin and those from the Mediterranean region.

Because of the hereditary component, they may or may not indicate high blood levels of cholesterol. Where there is no family history of xanthelasmata, they usually indicate high cholesterol and may correlate with a risk of atheromatous disease.

A xanthelasma may instead be referred to as a xanthoma 

when becoming larger and nodular, assuming tumorous proportions. Still, xanthelasma is often classified simply as a subtype of xanthoma.

[21/06 15:12] Dr Surendra A. Soni:

 

Ojha Sir

[21/06 15:20] Sanjay Lungareg Dr: 

Sir ji ,

I am not in favour of kumbhika.

आभ्यंतरतः से मेरा मतलब inner lining of eyelids है ।

[21/06 15:21] Dr Surendra A. Soni:

 Lungare Sir

Excellent interpretation.

[21/06 15:34] Anupma Patra AIMS AYU:

 Sanjay sir,  i ve already seen the dalhan commentry.  I am sorry for that. Actually dadim veej comparison is by other vyakhyakaar. But i am not agree with ur hesitation about comparing xanthelesmia with kumbhika.

J.K.Pandey sir, xanthelasma occur on or around the eyelid. So it can be taken as vartmarog. Sir i am thinking and reading about it since yesterday as a specialist in Shalakya. Not only that i am searching a appropriate comparison for every diseases of Shalakya to publish a book on  Shalakya . I think my comparison is not wrong. If something  we hear newly against our  belief from years together our mind never accept it easily. The available comparison of kumbhika with hordeolum or meibomian cust is completebly wrong. So what is kumbhika? My request sir again u think it in my point of view.

[21/06 16:13] pawan madan Dr: 

Sanjay sir....

wonderful explanation and सटीक एवम स्पष्ट विवेचन.

Practical description...

[21/06 17:29] Anupma Patra AIMS AYU:

 Sanjoy sir, i ve mentioned sopha and raga are not essential to named as pidica. What is the wrong about it , i cannot know ? Yes some pidica are there without sopho and raaga like arshavartma,  vartmasarkara. Sir i ve also mentioned that colour is also  similar not contrast.   I ve very less knowledge about sanskrit in comparison to you.  But i think practically. 

I am just trying to give a appropriate ayurvedic diagnosis which is essential to plan a proper treatment without going haphazardly.

[21/06 18:06] Sanjay Lungareg Dr:

 

@ anupama madam ji,

सर्वप्रथम आपको ग्रंथ निर्माण कार्य के लिए बहुत बहुत शुभकामनायें देता हुं ।

यहां इस काय सम्प्रदाय मे हम सभी नये विचार का हमेशा स्वागत ही करते है । उसके लिए हमेशा उत्सुक रहते है । but according to me this or any new thought should always follow the criteria given in our shastra. Comparison should be always from past to future. It is always *retrospective* in nature. 

बहुत बार प्रत्यात्म लिंग समान होते है पर निश्चित comparison के लिए सम्प्राप्ति का सहारा लेना चाहीऐ । वरना एक गलत प्रवाह निर्माण होता है । जैसे,

*संशोधन के लिए प्रतिदिन ऐक निश्चित स्नेहमात्रा का आग्रह शास्त्रसंम्मत है पर व्यवहार मे हम वर्धमान मात्रा मे स्नेह प्रयुक्त करते है ।*

*नातिद्रवनातिसान्द्र इस तरहा का बस्तिद्रव्य शास्त्रसंम्मत है पर व्यवहार मे पानी की तरह बस्तिद्रव्य होता है ।*

*तिस मात्रा का बस्तिपीडन काल बतलाया है पर व्यवहार मे बस्तिपीडन कालोपरान्त भी बस्तिनेत्र लगा हुआ रहता है ।*

*हम सब DM को प्रमेह से compare करते है पर आज तक newly diagnosed DM मे आजतक मुझे 

'मूत्रवाहिस्त्रोतांस्यनुसृत्याधोगत्वा या गुरू घटक के कारण मूत्रवहस्त्रोतस मुख अवरुद्ध होने जैसी सम्प्राप्ति कहीं  नजर नही आयी।*

केवल प्रभुत या आविल मूत्रता से हम DM को प्रमेह नही कह सकते।

*तनोमाधुर्य से रक्तगत शर्करा compare नही कर सकते।*

तनो यानी blood नही ले सकते।

उसी तरह केवल

' xanthelasma occur on or around the eyelid. So it can be taken as vartmarog.

(*As you said previously*)

करने से xanthelasma वर्त्मगत रोग नही हो सकता। 

*वर्त्मगत रोग और xanthelasma की सम्प्राप्ति ऐक होनी चाहीऐ ।*

I didn't said that xanthelasma= कुम्भीक but some directions has been given by me for better comparison. If xanthelasma fulfill criteria given by our shastra like,

1 Occurrence at inner membrane of eyelids also. *वर्त्मजा इति बहुवचनाद् बाह्या एव भवन्ति*

2. Colour like seed of careya arborea. *कुम्भीक बीज प्रतिमा*

3. Rupture after mild fomentation. *आध्मापयन्ति भिन्ना*

4. Role of same samprapti ghataka. *सिरा व्याप्यावतिष्ठन्ते वर्त्मस्वधिकमूर्च्छिताः। विवर्ध्यं मांसं रक्तं च तदा वर्त्मव्यपाश्रयान्।* 

If above criteria fulfill by xanthelasma then only xanthelasma= कुम्भीक

*और अन्ततः महत्वपूर्ण बात, पुस्तक आप लिख रही है इसलिए क्या लिखना है ? क्या comparison करना है ? ये आपका स्वातन्त्र्य अधिकार है । आपको भविष्य के लिए बहुत बहुत शुभकामनायें ।*

[21/06 18:12] pawan madan Dr: 

[21/06 18:41] Bharat Padhar Vd: 

I think we can compare the xenthalmus as a Adhimans. it is mansa pradoshaj vikar ...the causative factor as well as samprapti of adhimans and xenthalmus is same... it is also bahy twacha Adhisthansth Roga...

Treatment should be shanshudhi, shastra, kshar agnikarma.. as per Ayurved in keeping in mind mansvaha srotodusti...

Respected learned Vaidyas are requested to correct me if I m wrong...

Mul of mansvaha srotas is also twacha and snayu... so first dusti symptom of mansdhatu occurs on twacha...

According to modern science cholesterol is cause of xenthalmus and the causative factors of hypercholesterolemia is mostly similar to the causative factors of mansvaha srotodusti...

[21/06 18:46] pawan madan Dr: 

[21/06 18:47] Bharat Padhar Vd: 

Modern treatment for xenthalmus is also anti hyperlipidemic treatment if it fail only surgery is option... in same way the treatment of Adhimans, a  symptom of mansvaha srotodusti is also shanshudhi, and shastra kshar agnikarma.

My view is open for discussion among learned Vaidyaa... I hope that good discussion may correct my knowledge if I'm wrong or it may explore new way of thinking.

[21/06 23:36] Prof. S. D. Pande Chandigarh: 

If there is no dislipidemia, this type of xanthelasma is probably due to blockage of lacrimal gland secretion both sides.there is no remedy except massage of both sides after closing eyes which probably improve secretion of tears and prevents from spreading of lesions.

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Above discussion held on 'Kaysampraday" a Famous WhatsApp group  of  well known Vaidyas from all over the India. 

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Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

Email: surendraasoni@gmail.com

Mobile No. +91 9408441150