AUTO IMMUNE VASCULOPATHY AUTO IMMUNE VASCULOPATHY AND AND

SCLERODERMA SCLERODERMA AYURVEDIC PERSPECTIVEAYURVEDIC PERSPECTIVE

DR.PRASHANTH.A.SDR.PRASHANTH.A.S MD(Ay), PhD, MHA,PGMHMD(Ay), PhD, MHA,PGMH

ProfessorProfessorDepartment of Post Graduate Studies in PanchakarmaDepartment of Post Graduate Studies in Panchakarma

Ayurveda Maha VidyalayaAyurveda Maha VidyalayaHubli, Karnataka – 580024Hubli, Karnataka – 580024Telephone: 0836-2335575Telephone: 0836-2335575Mob: +91-94481-35575Mob: +91-94481-35575

Mail: Mail: drprashanthas@gmail.com

AUTO IMMUNE DISORDERS

•Autoimmune diseases are conditions in which the immune system of the body treats its own tissues as foreign And tries to destroy them

•There are more than 80 different types of autoimmune disorders. Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells.

•This may be restricted to certain organs or involve a particular tissue in different places.

CAUSECAUSE

•Normally the immune system's white blood cells help protect the body from harmful substances, called antigens and blood or tissues from another person or species. The immune system produces antibodies that destroy these harmful substances.

•In patients with an autoimmune disorder, the immune system can't tell the difference between healthy body tissue and antigens. The result is an immune response that destroys normal body tissues. This response is a hypersensitivity reaction similar to the response in allergic conditions.

• The causes may include molecular mimicry, or the presence of foetal

cells in the maternal bloodstream, and infections with some viruses and bacteria.

An autoimmune disorder may result in

•The destruction of one or more types of body tissue•Abnormal growth of an organ•Changes in organ function

Organs and tissues commonly affected by autoimmune disorders include:

• Blood vessels• Connective tissues• Endocrine glands such as the thyroid or pancreas• Joints• Muscles• Red blood cells• Skin

COMMON SIGNS AND COMMON SIGNS AND SYMPTOMSSYMPTOMSSymptoms of an autoimmune disease vary

based on the disease and location of the abnormal immune response. Symptoms that often occur with autoimmune diseases include:

• Fatigue• Fever• General ill-feeling (malaise) • Anxiety or depression• Blood sugar changes• Fatigue• Infertility or reduced sex drive (low libido)• Irritability• Weakness and stiffness in muscles and joints• Weight Changes• Low or high blood pressure

COMMON AUTO IMMUNE DISEASES

• Addison's disease• Celiac disease - Sprue • Dermatomyositis• Graves disease• Hashimoto's Thyroiditis• Multiple Sclerosis• Myasthenia Gravis• Pernicious Anemia• Reactive Arthritis• Rheumatoid Arthritis• Sjogren Syndrome• Systemic Lupus Erythematous• Type I diabetes

VASCULOPATHYVASCULOPATHY

Any disorder of theAny disorder of the blood blood vesselsvessels

VASCULITIS

• Vasculitis refers to a varied group of disorders which all share a common underlying problem of inflammation of a blood vessel or blood vessels. The inflammation may affect any size blood vessel, anywhere in the body. It may affect either arteries and/or veins.

• The inflammation may be focal, meaning that it affects a single location within a vessel; or it may be widespread, with areas of

inflammation scattered throughout a

particular organ or tissue, or even affecting more than one organ

system .

CLASSIFICATION • It can be classified by the underlying cause.

• It can be classified by the location of the affected vessels. • Vasculittis can be classified by the type or size of the blood vessels that they predominantly affect.

However, the cause of many forms of vasculitis are poorly understood. There is usually an immune component, but the trigger is often not identified. Vasculitic disorders can cause problems in any organ system, including the central (CNS) and peripheral (PNS) nervous systems.

These are characterized by the presence of inflammatory cells in and around blood vessels, and secondary narrowing or blockage of the blood vessels that nourish the brain, spinal cord, or peripheral nerves.

vasculitis is often classified by the caliber of the vessel affected. However, there can be some variation in the size of the vessels affected.

Large vesselBehçet's syndrome, Polymyalgia rheumatica, Takayasu's arteritis, Temporal arteritis.

Medium vessel Buerger's disease, Cutaneous vasculitis, Kawasaki disease, Polyarteritis nodosa.

Small vessel Churg–Strauss syndrome, cutaneous vasculitis, Henoch–Schönlein purpura, Microscopic polyangiitis, Wegener's granulomatosis.

CLASSIFICATION

SYMPTOMS

General symptoms: Fever, weight loss Skin:- Palpable purpura, livedo reticularis Muscles and joints:- Myalgia or myositis, arthralgia or arthritis Nervous system:- Mononeuritis multiplex, headache, stroke, tinnitus, reduced visual acuity, acute visual loss

Heart and arteries:- Myocardial infarction, hypertension, gangrene

Respiratory tract:- Nose bleeds, bloody cough, lung infiltrates

GI tract:- Abdominal pain, bloody stool, perforations

Kidneys:- Glomerulonephritis

ANCA VASCULITIS•ANCA vacuities is a type of autoimmune swelling caused by autoantibodies.•ANCA stands for Anti-Neutrophil Cytoplasmic Autoantibody.•Autoantibodies are abnormal antibodies that attack one’s own cells and tissues (autos = self). ANCAS are autoantibodies that attack the inside (cytoplasm) of a certain type of white blood cells called neutrophils.•When ANCAs attack these neutrophils, they cause the white blood cells to attack the walls of small vessels in different tissues and organs of the body. This causes vacuities.

SCLERODERMA (SYSTEMIC SCLEROSIS)

• The word “scleroderma” comes from two Greek words: “sclero” meaning hard, and “derma” meaning skin.

• Scleroderma is a disease affecting the skin and other organs of the body. Scleroderma is one of the autoimmune rheumatic diseases, meaning that the body’s immune system is acting abnormally.

• The main finding in scleroderma is thickening and tightening of the skin, and inflammation and scarring of many body parts leading to problems in the lungs, kidneys, heart, intestinal system and other areas.

• The condition affects adults and children, but it is most common in women aged 30 to 50.

The Two Main Types Of Scleroderma AreLocalized scleroderma,•which usually affects only the skin, although it can spread to the muscles, joints and bones. It does not affect other organs. In some cases, this type of scleroderma is just a cosmetic problem. Symptoms include discolored patches on the skin (a condition called morphea); or streaks or bands of thick, hard skin on the arms and legs (called linear scleroderma). When linear scleroderma occurs on the face and forehead, it is called en coup de sabre.

Systemic scleroderma, •which is the most serious form of the disease, affects the skin, muscles, joints, blood vessels, lungs, kidneys, heart and other organs.

SIGNS AND SYMPTOMS

Skin symptoms•systemic sclerosis causes hardening and scarring. The skin may appear tight, reddish or scaly. Blood vessels may also be more visible.

MusculoskeletalThe first joint symptoms non specific joint pains, which can lead to arthritis

Patients may develop muscle weakness, or myopathy.

Lungs•Some impairment in lung function with diffuse scleroderma on pulmonary function testing;•Progressive pulmonary hypertension, or elevation in the pressures of the pulmonary arteries. This can be lead to right sided heart failure.•The earliest manifestation of this may be a decreased diffusion capacity on pulmonary function testing.

Digestive tract

•Reflux esophagitis,•Dysphagia, pseudo-obstruction or ischemic colitis•upper gastrointestinal bleeding or iron deficiency anemia •Malabsorbtion

• Blood vessels that can be affected include the tiny arterioles of the finger tips, toes, and elsewhere.

• These vessels can have a tendency to spasm when the areas are exposed to cold, leading to blueness, whiteness, and redness of involved fingers, toes, and sometimes nose or ears.

• These color changes are referred to as Raynaud's phenomenon

RAYNAUD'S PHENOMENON

It refers to the spasm of the tiny artery vessels supplying blood to the fingers, toes, nose, tongue, or ears. These areas turns blue, white, then red after exposure to extremes of cold, or even sometimes with extremes of heat or emotional upset. This can lead to tiny areas of Damage to the tips of the fingers (digital ulcers) or larger areas of dead skin on the ends of the fingers.

CLASSIFIED INTO TWOCLASSIFIED INTO TWO1. Primary Raynauds phenomenon or Raynauds

disease (idiopathic)2. Secondary Raynauds phenomenon or

Raynauds syndrome

Commonly seen in..• Seen inCollagen vascular disease eg:

scleroderma, SLE, RA• Neurological disorders eg: IVDP,

syringomyelia, CTS• Trauma

PRIMARY RAYNAUDS PRIMARY RAYNAUDS PHENOMENONPHENOMENON

• Raynaud's disease• Women affected 5 times than men• Age – 20-40yrs• Finger more than toes• Initially one or two fingers,may include all fingers in later

stages• Toes affected in 40% of cases

SECONDARY RAYNAUDS SECONDARY RAYNAUDS PHENOMENON PHENOMENON

• Raynauds syndrome • Occurs in 80 to 90% pts with

scleroderma• Ischemic finger ulcer may develop • Progress to gangrene and auto

amputation

ATHEROSCLEROSISATHEROSCLEROSIS• Atherosclerosis is a progressive inflammatory disorder of the arterial wall that is characterized by focal lipid rich deposits of atheroma. • Arteries are blood vessels that carry oxygen and nutrients

from heart to the rest of the body. Healthy arteries are flexible,

strong and elastic.• Over time, however, too much pressure in the arteries can

make the walls thick and stiff — sometimes restricting blood flow to

the organs and tissues. This process is called arteriosclerosis.

FORMATION OF ATHEROMAS IN FORMATION OF ATHEROMAS IN ARTERIESARTERIES

RISK FACTORSRISK FACTORS

• Age and sex• Family history• Smoking• HTN• Hyperlipidaemia• DM• Physical activity• Obesity• Alcohol• Diet• Personality

ATHEROSCLEROSIS ATHEROSCLEROSIS

Early atherosclerosis• Fatty streaks tends to occur at the site of arterial shear

stress• Abnormal endothelial function• Receptors expressed by endothelial cells• Monocytes binds to the receptors• Migrate to intima • Take up oxydised LDL from plasma• Macrophages• Cytokines and growth factors by macrophages• Smooth muscle cell migrate to the intima• Stabilizes the atherosclerotic lesion

STABLE ATHEROSCLEROTIC PLAQUE

Early And Advanced

Advanced Atherosclerosis

• Macrophages mediate inflammation• Smooth muscle promote repair• Inflammation predominates• Plaque become active or unstable• Ulceration• Cytokine production by macrophages• Intimal smooth muscle thinning• Protective fibrous cap thinning

BUERGER'S DISEASE (TAO)BUERGER'S DISEASE (TAO)•Thromboangitis obliterans is a rare disease in which blood vessels of the hands and feet become obstructed. •TAO is inflammatory thrombosis of small and medium-sized arteries and some perficial veins, causing arterial ischemia in distal extremities and superficial thrombophlebitis. Tobacco use is the risk factor.•Thromboangiitis obliterans (Buerger's disease) is caused by vasculitis (inflammation of the blood vessels).•The blood vessels of the hands and feet are especially affected, becoming constricted or totally blocked. This reduces blood flow to the hand and foot tissues, resulting in pain and eventually damage.

CHURG STRAUSS SYNDROME (CSS) CHURG STRAUSS SYNDROME (CSS)

• CSS is a vasculitic disease that involves inflammation of small- to medium-sized blood vessels. •CSS is characterized by asthma and the proliferation of eosinophil's, a type of white blood cell. • Damage to sinuses, lungs, heart, skin, gastrointestinal tract, nerves, and occasionally kidneys and joints may occur. • Asthma is one of the

cardinal features of CSS.• It leads to

vasculitis,eosinophilia,• numbess, shooting pains,

and severe muscle wasting/powein the hands or feet.

CRITICAL LIMB ISCHEMIACRITICAL LIMB ISCHEMIA

• Defined as rest (night) pain with or without tissue loss.

• Continuous pain, aching in type • Changes in the somatic nerves-

cry of dying nerves• Painful part become very sensitive

and any movement or pressure causes acute exacerbation

• Multiple level• Risk of loosing their limb or life • End stage disease• Elderly-multi system co-morbidity

MYOSITIS MYOSITIS • Myositis is a rare disease in which the immune system

chronically inflames the body's own healthy muscle tissue. Persistent inflammation progressively weakens the muscles.

Inflammatory Conditions Causing Myositis.

• Many of these causes are autoimmune conditions• Inflammatory conditions causing potentially severe

myositis include1.Dermatomyositis2.Polymyositis3.Inclusion body myositis

Other inflammatory conditions tend to cause myositis•Systemic lupus erythematosus (lupus)•Scleroderma•Rheumatoid arthritis

SYMPTOMS OF MYOSITISSYMPTOMS OF MYOSITIS

•The main symptom of myositis is muscle weakness. The weakness may be noticeable or it may only be detectable with testing. Muscle pain (myalgias) may or may not be present.•Dermatomyositis, polymyositis, and other inflammatory myositis conditions tend to produce weakness that gets worse slowly over weeks or months . People with dermatomyositis also have a skin rash, although it can sometimes be very mild. •The weakness affects large muscle groups, including the neck, shoulders, hips, and back. Muscles on both sides are usually affected.Juvenile Myositis (JM) •Although some children develop juvenile forms of PM and IBM, children usually get juvenile DM with symptoms of muscle weakness, skin rash and dysphagia.

DIAGNOSTIC TESTSDIAGNOSTIC TESTS

• The diagnosis of an autoimmune disease is based on an individual's symptoms,findings from a physical examination.

• A common feature of thetests is the detection of antibodies that react withhost antigens.

• An elevated amount of antibodies indicates that a humeral immune reaction is occurring.

ANA (Antinuclear Antibody) Test C-Reactive Protein

AYURVEDIC AYURVEDIC CONCEPTCONCEPT

• Most of the conditions or diseases mentioned above can be included under ‘AMAVATA , VATARAKTA AND RAKTHAVRUTA VATA’ according to Ayurveda.

• It is necessary to explain the meaning and application of both terms i.e. Ama and vata as well Vata dosha and Rakta dhatu.

• The Tridosha (Vata, Pitta and Kapha) work in coordination and cooperation. If these Tridosha are disturbed, the matter, functionally and structurally disturbed, results in disease, decay, degeneration or death.

AYURVEDIC CONCEPT

VATA KOPA NIDANAMVATA KOPA NIDANAM

RAKTHA KOPA NIDANAM

SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS • ACCORDING TO DOSHA DOMINENCE

VATA DOSHAMVATA DOSHAM

PITTA DOSHAMPITTA DOSHAM

KAPHA DOSHAMKAPHA DOSHAM

RAKTHARAKTHA

COMPLICATIONCOMPLICATION

• The Tridosha when in normal quantity, quality and function serve as Dhatu, i.e. they support the body. When slightly vitiated, they serve as Dosha and when they excessively vitiate they are termed as Mala.

• The immune bodies, when normal in quantity, quality and function support the body, but when excess or less produce disease.

Thus immune complexes serve as Ama. Based on that the majority

of the diseases of connective tissue are to be treated like Ama- Vata

and Vatarakta.

Thus it can be stated that- • Ama is undigested and un metabolized product

produced by the weakness of digestive and metabolic enzymes

(Agnimandya). 

DOSHIK CONCEPTDOSHIK CONCEPT

• Ama is also called waste matter (Mala), which should be removed from the body. If Ama mala remains continuously in the body, it is likely to cause disease and degeneration.

• Ama is Pichila (sticky) in nature

• The excess of Collagen materials, Immune bodies or Crystals like Uric acid, can be considered as Ama.

• Ama when mixes or reacts with Vata, produces Stiffness of the joints, Atheroscelerosis (Dhamani pratichaya), Deposition (Sanchaya) and dryness in the body tissue (Srotoriktata?) e.g. S.L.E. or Scleroderma or Sclerosis.

• The chief complaints generally noticed are stiffness and pain in the body, especially joint pain, swelling and muscular pain etc.

• The management involves the methods of treatment that

are directed at treating the dosha and breaking the samprapti.Depending on the basic classification of Vatarakta,Ama Vata and Rakthavrutha vata

• General line of management of Vatarakta has been advised

in the texts of Charaka, Sushruta, Vagbhata, Yogaratnakara.

• Line of treatment in the first stage removal of Ama:

• The drugs having Tikta, Katu rasa (i.e. bitter and pungent taste) and Deepaniya property (enhancing digestive ability) are Ama pachaka.

• Langhana and Swedana, Virechana, Snehapana and Vasti are to be employed to alleviate and control the ‘vitiated vata’.

GENERAL LINE OF TREATMENT• AS PER CHARAKA SAMHITA

• AS PER ASHTANGA HRIDAYA

MANAGEMENT ACCORDING TO DOSHAMANAGEMENT ACCORDING TO DOSHA PRADHANYATA:PRADHANYATA:

VATADHIKA• Ghrita, Taila, Vasa, Majja prayoga as Pana,

Abhyanga and Vasti. • Sukhoshna Upanaha• Snehapana by purana ghrita • Ajaksheera + Ardra taila + Prushni parni + Madhu

or these are cooked with Shyama, Rasna etc.• Administration of taila prepared out of Kakolyadi

Gana Kalka Shatha paka Bala Taila.• Application of Yastimadhu siddha lepas.

PITTADHIKAPITTADHIKA

• Virechana, Ghrita and Ksheera pana, Parisheka, Vasti, Sheeta nirvapa, Raktamokshana.

• Kashayas prepared of, Draksha, aragvadha,Shatavari, yasti,

Patola,Guduchi kwatha. Chandanadi gana dravyas. • Lepa – Shali, shasti, lavana pasted with dhanyamla

mixed with takra and kanji and applied. • Vata rakta hara oushadhi siddha kwatha

parisheka.

RAKTHADHIKARAKTHADHIKA

• Virechana, Ghrita and Ksheera pana, Parisheka, Vasti, Sheeta nirvapa Raktamokshana

KAPHADHIKA

• Mrudu Vamana and Rookshana Langhana. • Kwathas - Amalaki and haridra with madhu or

triphala kwatha.• Guda Haritaki prayoga.• Parisheka with taila, gomutra, sura, sukta and

kaphagna oushadhi siddha kwatha.• Abhyanga - mastu, mutra, sura, sariva, padmaka

siddha gritha.• Pradeha- Tila, sarshapa, atasi yava churna mixed

with sleshmantaka; kapittha, madhu, sheegru with ksharodhaka and gomutra; swetha sarshapa kalka; tilashwagandha kalka; madhu, sheegru, punarnava kalka with ksharodaka.

Lepa- shalaparni, prushni parni, bruhati with ksheera.

ANTARPARIMARJANA CHIKITSA

Rakta Mokshana

• Raktamargavarana is the predominant pathology of Vatarakta and this leads to the accumulation of dushita rakta. Raktamookshana helps in relieving the obstruction in the path of Vayu also.

Hence Raktamokshana is considered as first line of treatment of

Vatarakta.

• Shringavacharana is the better choice if the patient of Vatarakta has symptoms like supti, kandu, chimachimayana etc

• If the illness progress with spreading, Raktamokshana by Pracchana method is the better option.

• Raktamokshana by the Jalaukavacarana method is preferred if the affected site exhibits symptoms like ruk, daha toda

and shula.

SNEHAPANASNEHAPANA• Both shodhananga sneha as well as shamananga

sneha is indicated in Vatarakta.

• As preparation of patient prior to Virechana or Vamana patient

is subjected to shodhananga sneha. • As shamana also different Ghrita Yoga and Taila

Yoga are explained

VIRECHANAVIRECHANA• According to condition both Snigdha Virechana as

well as Ruksa Virechana is indicated in Vatarakta.

• Tikshna Virechana worsens the Vata kopa, mrudu Virechana is

allways indicated in patients suffering from Vatarakta.

• In case Pittanuga and raktanuga Vatarakta Virechana is considered as better.

• Ruksaha Virechana is also ideal in patents suffering from margavarana due to kupita Kapha and Medas.

VAMANAVAMANA• Vamana is indicated as a shodhana procedure in

Vatarakta.• In Kaphanuga Vatarakta shodhana is best

achieved by Vamana.. • In snigdha person Vamana is carried out with

minimal or no prior snehapana. • In patients with rukshata in the body,

administration Vamana karma with prior snehapana is ideal.• Only mrudu Vamana is justified as tikshna Vamana

tend to increase the of Vata dosha.

VASTIVASTI

• Vasti karma includes both asthapana Vasti as well as

anuvasana Vasti.• Vatanuga Vatarakta is better treated by Vasti

chikitsa.

• The symptoms like Vasti shula, Vanksanashula, Parshvashula and Udarashula when present Vasti is the treatment of choice

• Administration of Ksheera Vasti is emphasized in all variety

of Vatarakta.• Further if the margavarana is due to

accumulation of kapha and medas Lekhana Vasti is indicated as this Vasti is capable of clearing the margavarana along with negating the detrimental effect kupita Vata Dosha.

BAHIPARIMARJANABAHIPARIMARJANA CHIKITSACHIKITSAPARISHEKAPARISHEKA

• Dominance of Vata dosha when present characterized by severe pain in the affected part, then ushna parisheka should be prescribed.

• Contrary to this if daha is the symptom due to predominance of Pitta dosha and Rakta dhatu, sheeta parisheka is ideal to relieve the discomfort.

• DHANYAMLA

ABHYANGAABHYANGA• Treatment with abhyanga over the affected part is

planned according to the presence of symptoms or the dominance of affected Dosha.

• In severe pain due tovata dosha warm oil processed with Vatahara dravya is used for abhynga.

• Burning sensation due to Pitta dosha or Rakta dhatu. Cold

application of the ghrita processed with pittahara dravya is ideal.

• If kandu due to Kapha dosha, taila processed with Kaphahara dravya is used for abhyanga.

• Prasarinyadi• Balaguduchyadi• Asanadi • Chandanadi.• Pinda tailam

PRADEHAPRADEHA

• Warm application of kalka (paste) is preferred if the patient suffering from sever pain due to dushita Vata dosha.

• Medicinal paste prepared by adding Ghrita applied cool on the affected part if the patient has burning sensation due to Pitta dosha.

• Medicinal paste prepared with herbs having ushna

quality is preferred if relative dominance of Kapha Dosha or Vata-Kapha dosha is identified.

• Specific herbal powder made into a paste by the addition of kanji or such other liquids is applied when warm as upanaha, and is very useful in relieving pain due to Vata dosha.

• Sarsapa kalka • Tila kalka• Eranda beeja kalka• Shatahva kalka• Vesavara + sneha + jeevaneeya gana

dravya.

UPANAHAUPANAHA

COMON DRUGS COMON DRUGS

• KASHAYAKASHAYA

Mustadi kashaya, Haritaki kashaya, Panchamoola kashaya, Variyadi kashaya, Navakarshika kashaya, Guduchyadi kashaya, Kashmaryadi kashaya, Patoladi kashaya, Laghu manjistadi kashaya, Brihat manjistadi kashaya.

• GUGGULU: GUGGULU:

Siva gulika,Kaishora guggulu, Amrita guggulu, Chandra prabhagutika, Punarnava guggulu, Samasharkara guggulu, Triphalaguggulu, Simhanada guggulu, Langalee gutika etc.

GHRITA: GHRITA:

Shatavaryadi ghrita, Shravanyadi ghrita, Bala ghrita, Amritadi ghrita, Parushaka ghrita, Mahatiktaghrita Jeevaneeya ghrita, Sthiradi ghrita, Padmakadi ghrita, Draksha ghrita etc.

TAILA: TAILA:

Madhuyastyadi taila, Sthiradi taila, Sarivadi taila, Sukumarak taila Padmakadi taila, Nagabala taila, Shatahvadi taila, Mahapadmataila, Khuddaka padmaka taila, Shatapaka madhuka taila, Guduchyadi taila, Drakshadi taila, Madhukadi taila, Shatapaka Sahasrapaka bala taila, Pinda taila, Eranda taila, Laghu marichyadya taila, Brihan marichyadya taila, Jeevakadi mahasneha taila etc:

KSHEERA:KSHEERA:

Guduchi ksheera, Dashamooladi ksheera, Drakshadi ksheera, Baladi ksheera, Jeevaneeya gana siddha ksheera.

LEPA: LEPA:

Madhukadilepa, Jeevaneeya gana lepa, Tiladi lepa, Madhuchista pralepa, Prapoundarikadi lepa, Sarshapadi lepa, Shigru lepa, Kapithadi lepa, Griha dhoomadi lepa, Tagaradi lepa, Sitopaladi lepa, Madhushigru lepa, Erandadi lepa, Shatahvadi lepa, Shatadhouta ghrita lepa etc.

SWARNA KALPASSWARNA KALPASSwarna bhasma,Swarna maha yograj guggulu,swarna malini vasantha,

RASAYANAMRASAYANAM• Bhargava Proktha Rasayanam, Silajathu Prayoga,

Kanmadam, Sudha guggulu,Chyavana prasam, Brahma rasayanam, Lasuna prayogam.

THANK YOUTHANK YOU

Dr. PRASHANTH. A. S. M.D. (Ay),(Ph.D.),MHA,PGMH

PROFESSORDEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA

AYURVEDA MAHAVIDYALAYA, HUBLI (KARNATAKA)