Case Presentation: Planto-palmer psoriasis(Vipadika) by Dr. Praveen Madikonda

[8/18, 10:57 PM] Praveen Medi Dr: 

A patient of planto-palmar psoriasis (vipadika) before therapy.

[8/18, 10:58 PM] Praveen Medi Dr: 

After 4 cycles of SnehapanYukta- Virachana ... in a span of  four months.....

[8/18, 10:59 PM] Praveen Medi Dr: 

Two principles followed in this case were....

1. बहुदोषस्य लिङ्गानि तस्मै संशोधनं हितम्

First she is eligible for sodhana, as disease was severe

2. बहुदोषः संशोध्यः कुष्ठी बहुशोऽनुरक्षता प्राणान्|   In a patient of kusta with severity of symptoms (bahu dosha) multiple cycles of sodhana is needed, while care should be taken to  protect the strength of the patient.  

which means mridu or madhya suddhi is needed for multiple number of times.

[8/18, 11:01 PM] Dr. Darshan Parmar: 

Well managed.

[8/18, 11:01 PM] Dr Himani Gour: 

Gr8 work  sir !

[8/18, 11:05 PM] Dr. Darshan Parmar: 

After repeated shodhana, should go for long rasayan for apunrbhv.

Specially rasayan for kushthi.

Like.......Khdir, Aamlki...

[8/18, 11:07 PM] Dr. Surendra A. Soni: 

Excellent work Sir !

Thanks for sharing.

[8/18, 11:12 PM] Dr Pratibha P Mahesh: 

sir in bwn  cycles  of  shodhana  hv  u  used  any  shamana  aushadhi.....

[8/18, 11:12 PM] Dr Pratibha P Mahesh: 

in  this case  which  sneha  u  hv  used  sir !

[8/18, 11:13 PM] Dr Pratibha P Mahesh: 

wt  was  the  duration  of  snehapan   ...

in bwn  each  snehayuktha  virechana   wt  was  the  gap....

[8/18, 11:26 PM] Shivam Sinwar Gngangr:

 superb

[8/18, 11:31 PM] Praveen Medi Dr: 

The type of sneha pana was.....

1.   Accha peya. (only cow ghee) 

2. As she has moderate body strength, madhyama suddhi  was planned with 7 days of sneha pana. On the first occasion samyak snigda lakshanas were considered as mandatory and observed.      

As multiple sessions of sneha pana and sodhana are required samyak snigda laksanas were not considered mandatory from next spell......

mridu and madhyama sodhana was planned. 

Gap between each sodhana was nearly one month. sansarjana krama was advised for a period of three days. 

3. Samana therapy included aragwadarista, manjistadi kashayam, and maha tiktaka gritam,  

For local application pindataila was used.

[8/18, 11:34 PM] Dr Pratibha P Mahesh: 

thank u sir

[8/18, 11:38 PM] Vd Pratibha Navani: 

Excellent work sir and thanks for sharing.

[8/18, 11:38 PM] Dr Himani Gour: 

Sir...  Is she is having  gangrene also....?

[8/18, 11:39 PM] Praveen Medi Dr: No...

[8/18, 11:39 PM] Dr Himani Gour: 

Her hand fingers are reddish black.

[8/18, 11:39 PM] Rameshwar Rao Rane:

 which shodhan was given vaman or virechan ?

[8/18, 11:40 PM] Praveen Medi Dr:

 Only virechan

[8/18, 11:40 PM] Rameshwar Rao Rane: ok sir 

[8/18, 11:41 PM] Praveen Medi Dr: 

That is because even her hands were involved..... Dr. Himani !

[8/18, 11:42 PM] Haresh Soni Dr.: 

Sir, kindly say about the Virechan Yoga you used. 

[8/18, 11:46 PM] Praveen Medi Dr: 

Trivruth churna in a dose of 15 gm.... with which patient used to get to go more than 5 toilet visits.

[8/18, 11:48 PM] Haresh Soni Dr.: 

Thanks for sharing sir. 

[8/18, 11:49 PM] Praveen Medi Dr: 

Each visit to rest room should be approximately taken as 3 to 4 vegas depending on patient's version. 

Than if we have 5 visits to rest room than number of vegas becomes any where between 15 to 20

[8/18, 11:51 PM] Praveen Medi Dr: 

There is a wrong practice of equating the number of virechana vegas with the number of visits to rest room....

[8/19, 12:05 AM] Satish Sharma ji Dr: 

prayash vht hi sarahniya hai kintu follow up kam se kam 1 year chayiye aise case repeat bhi hote hai.

[8/19, 12:10 AM] Vd Pratibha Navani: 

Yes sir psoriasis cases relapse after vaman or virechan but their intensity and site covered reduces with every therapy patient should be under observation for atleast 3 years.

[8/19, 12:14 AM] Praveen Medi Dr:

In more than  30-40% of the cases recurrence is expected if Nidana is not eliminated. 

But it's intensity will be far too less after repeated sodhana compared to one or sodhana procedures. 

Repeated sodhana as mentioned in the above case ensures maximum cure and minimal recurrence. 

The answer for recurrence what we follow is periodical sodhana .... once in six months

[8/19, 12:46 AM] Vd. Subhash Sharma Ji Delhi: 

*excellent result & thanks 4 sharing*

[8/19, 1:22 AM] Vd Ranga Prasad Ji Chennai: 

Sounds logical.

This sounds akin to - 

A vega or bout = 1 peristaltic movement. 

[8/19, 7:37 AM] Anju Navle Dr. Puna: 

Thank you Sir for sharing and really excellent results in just 3months.

[8/19, 8:15 AM] Deepak Bassi Dr: 

Than you  for sharing

[8/19, 10:15 AM] Dr. Surendra A. Soni:

 *अवान्तस्य हि सम्यग्विरीक्तस्यापि* सतोऽधः स्रस्तः श्लेष्मा ग्रहणीं छादयति, गौरवमापादयति, प्रवाहिकां वा जनयति ।।१९।।

Sir 

Did you observe the said pattern in shared case...? Or any kind of care was taken...??

[8/19, 10:20 AM] Dr Pratibha P Mahesh: 

yes  correct  sir

specially  in  virechana...

usually   dr  asks pt  how  many  times  u  hv  vsited..

always  it end  up  in  avara  vega...

sir  why  u hv   selected  here  accha   sneha...

is    for  palatability...

[8/19, 10:22 AM] Dr Pratibha P Mahesh: 

just  I  was  thinking   even  by  dermatologist  rx  chance  of  recurrence  wl  be  more...

..how  we  r  gd in  treating  skin  ailments  compared   to  dermatologists...

fungal  infection   few  drs  prefer   to  go  for  shodhana..

how  its  useful    in  fungal   infection.

[8/19, 10:45 AM] Praveen Medi Dr: 

Yes. Very valid point raised by you Soni sir !

Virechana should be preceded by Vamana as per our classics. 

The basic reason behind this rule was, kapha Utkarsha doesn't help the cause of virechana. So only by eliminating/ subsiding kapha Dosha proper  virechana is possible. 

But for any reason we plan virechana without Vamana, than we must ensure that a state of Manda-kapha" is established. 

This can be achieved by giving adequate and extended Deepana and pachana measures.

We always take care of these principles while giving virechana without Vaman.

[8/19, 11:02 AM] Dr. Surendra A. Soni: Agree !

[8/19, 11:23 AM] Janardan Hebbar Dr: Super

[8/19, 11:50 AM] Praveen Medi Dr: 

Why Acha peya ? 

For the purpose of Sodhana, the better choice would be acchapeya, as Charaka very clearly mentioned it as Prarthana kalpana/ stresta Kalpana. 

कल्पः प्राथमकल्पिकः

प्राथमकल्पिकः, श्रेष्ठ इत्यर्थः

Samskrita grita such as Maha tikataka and other grita, owing to their drug effect to certain extent cause suppression of dosha. 

Only if the patient is unable to consume achhapeya, or if it is not  producing desired result than we may go for medicated grita pana in the subsequent sodhana procedure.

[8/19, 11:56 AM] Vd Pratibha Navani: 

Great explanation sir..

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                                                   Presented by

Dr. Praveen Kumar Madikonda, 

Associate professor,

Department of Panchakarma, 

BRKR Govt Ayurvedic College,

 Hyderabad, Tailangana, India.
Mobile Number-9849271601

Clinic-

Uma Ayurvedic Specialty Center, 
Gandhinagar, 
Hyderabad, 

Tailangana, India.

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