Vamana And Virechana In The Treatment Of Kushta

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Kushta is a term which includes many skin disorders. According to Ayurveda there are 18 types of kushta. All types of kushtas are caused due to aggravation of all three doshas. In spite of all three doshas being involved in the causation of kushtas one or the other doshas will be predominant. Due to severe aggravation of doshas in the pathogenesis of kushta, cleansing therapies should be administered frequently since there will be chances of recurrences. This is achieved by skillful administration of Panchakarma therapies depending on the predominance of doshas in the causation of the disease. Vamana is one among the five therapies of Panchakarma and is preferred in diseases caused by predominant aggravation of kapha. Vamana is also a preferred treatment in Kushtas caused by predominant vitiation of kapha.
Read – Maha Kushta: Major Skin Diseases, Symptoms, Prognosis

Vamana In The Treatment of Kushta

Vamana in Kapha predominant Kushta
Vamana i.e. therapeutic emesis has been said to be the treatment of choice in the skin disorders caused by vitiated kapha. Broadly two conditions are explained pertaining to administration of vamana in Kushta by Master Charaka.

1. In kapha predominant kushta
As a rule vamana – therapeutic emesis shall be administered as the first line of treatment in kapha predominant kushtas. It is the best therapy for kapha predominant kushtas. Repeated emesis therapy will also prevent the recurrence of kapha predominant kushta and provide immunity against the disease. Therefore, precise diagnosis of kapha predominant kushtas by recognizing the symptoms manifested therein is very important from physician’s perspective.

Where to get the formulations for emesis from?
Master Charaka tells that the formulations for emesis as mentioned and explained in Kalpa Sthana section (of Charaka Samhita) shall be chosen for emesis therapy. Though there are 6 chapters dedicated for emesis therapies and formulations in Kalpa Sthana section there are only finger count formulations in which ‘kushta’ has been mentioned as an indication. They are as below mentioned.

a. Use of Ikshvaku – Lagenaria siceraria
The pulp of Iksvaku is mixed with whey and taken by the patient suffering from obstinate skin diseases including leprosy. The same formulation is also advised for patients of anemia and toxicities.
Read – Leprosy Awareness: Early Detection Is Important

b. Use of Krtavedhana – Luffa acutangula
Krtavedhana is exceedingly pungent, sharp and hot in nature. It is useful in deep seated diseases, mainly kushta vis-à-vis obstinate skin diseases including leprosy. Krtavedhana is also effectively used in the treatment of diseases including anemia, splenic disorders, edema, phantom tumors and toxicosis.

Can other herbs mentioned in Kalpa Sthana also be used in treatment of Kushta?
Other herbs can also be used though kushta has only been mentioned in the context of Ikshvaku and Krtavedhana. Since emesis is administered in kapha predominant kushta all emetics mentioned in Kalpa Sthana section will be useful and the physician shall use them as per the need and in absence of availability of ikshvaku or krtavedhana.
Read – Vamanopaga Gana: Emesis Aiding Herbs: Review, Benefits, Formulations

2. In Kushtas manifesting in upper parts of the body
In case of Kushtas manifesting in the upper parts of the body, when there is aggravation of doshas mainly kapha in the chest, emesis should be administered using shitarasa (cold decoction / juice) or pakvarasa (processed / hot decoction) of the below mentioned herbs mixed with the juice of neem –

• Kutajaphala / Indrayava – fruit or seeds of Holarrhena antidysenterica
• Madanaphala – fruits of Randia dumetorum
• Madhuka – Glycyrrhiza glabra
• Patola – Trichosanthes dioica

Honey and Licorice are also used as effective emetics in this condition.
Read – Rules For Vamana and Virechana Treatment- Charak Samhita Sutrasthan 15

Kapha predominant Kushtas

1. Kushtas caused by only kapha vitiation
Kapha is predominantly vitiated in the below mentioned Kushtas –

• Mandala Kushta – Maha Kushta (major skin disease)
• Vicharchika – Kshudra Kushta (minor skin disease)

2. Kushtas caused by association of kapha with other doshas –
In these conditions emesis is given only if kapha is more dominant in comparison to the other associated dosha and if the condition reflects the need of emesis and if the patient is eligible to undergo the same. Though this has not been mentioned in the classics, here we have mentioned this to give an expanded vision and field of usage of emesis in the treatment of kapha predominant kushtas. The choice to administer emesis or not is totally left out to the skillful decision of the physician treating these conditions.

Kapha-Pittaja Kushtas – Kapha associated with pitta in –

Vata-Kaphaja Kushtas – Kapha vitiated with vata in –

Sanskrit Verses

Virechana In The Treatment Of Kushta

Vamana or virechana – therapeutic purgation or a combo of both are administered to eliminate the morbid doshas and treat the kushtas comprehensively. Virechana is preferred in the diseases caused by predominant aggravation of pitta. Purgation is also a preferred treatment in skin diseases caused by predominant vitiation of pitta.
Read – Virechana Therapy – Right Method, Side Effects, Management

Virechana in Pitta predominant Kushta

As a rule virechana – therapeutic purgation shall be administered as the first line of treatment in pitta predominant kushtas. Purgation is the best therapy for morbid pitta as well as curative of pitta predominant kushtas. Recurrence of pitta predominant kushta can be prevented by repeated administration of purgation therapy. It also would provide immunity against the disease. Therefore, precise diagnosis of pitta predominant kushtas by recognizing the symptoms manifested therein is very important from the physician’s perspective. Apart from virechana, raktamokshana is also mentioned as one of the treatment choices in the treatment of pitta predominant kushtas. Therefore purgation and bloodletting are the best treatments for pitta predominant kushtas and shall be selectively administered.

Where to get the formulations for purgation from?
Master Charaka tells that the formulations for purgation (and also emesis) as mentioned and explained in Kalpa Sthana section (of Charaka Samhita) shall be chosen for purgation therapy. There are 6 chapters dedicated for purgation therapies and related formulations in Kalpa Sthana section, there are only few formulations in which ‘kushta’ has been mentioned as an indication. They are as below mentioned.

Trivrt – Operculina turpethum
Trivrt is one of the ingredients of Kalyanaka Guda, a formulation explained in chapter 7 of Kalpa Sthana of Charaka Samhita. This formulation has been indicated as a purgative in many disorders. Among the indications Kushta – skin disorders has also been mentioned.

Maha-Vrksha / Sudha – Euphorbia neriifolia
Sudha is one of the best purgative remedies and has been indicated in many diseases. It is said that if properly administered Sudha quickly eliminates the doshas even if they are excessively accumulated. Among the indications for the usage of Sudha, kushta – obstinate skin disorders including leprosy has been mentioned.

Saptala and Shankini – Euphorbia pilosa and Euphorbia dracanculoides
Kushta – skin disorders has been mentioned amongst the indications for administration of saptala and shankini as purgative.

Can other herbs mentioned in Kalpa Sthana (purgative herbs and formulations prepared from the same) also be used in treatment of Kushta?
The other herbs mentioned in Kalpa Sthana can also be used for administering purgation though kushta has only been mentioned in the context of Kalyanaka Gudam (Trivrt), Mahavrksha, Saptala and Shankini. Since purgation is administered in pitta predominant kushta all purgatives mentioned in Kalpa Sthana section is useful and the physician shall use them as per the need and in absence of availability of the mentioned herbs.

Pitta predominant Kushtas

1. Kushtas caused by only pitta vitiation
Pitta is predominantly vitiated in Audumbara / Udumbara Kushta – Maha Kushta (major skin disease)

2. Kushtas caused by association of pitta with other doshas
In these conditions virechana is given if pitta is predominant in comparison to the other associated dosha and if the condition reflects the need of purgation and if the patient is eligible to undergo the same. This has not been mentioned in the classics, here it is mentioned to give an expanded vision of usage of purgation in the treatment of pitta predominant kushtas.

Kapha-Pittaja Kushtas – Kapha associated with pitta in –

Vata-Pittaja Kushtas – Pitta vitiated with vata in –

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