diploma ayurvedic practitioners course · 2019-10-25 · ayurveda institute uk 3 charma roga...

AYURVEDA INSTITUTE UK

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Diploma

Ayurvedic Practitioners Course

Module 2

26th & 27th October 2019

Course Materials


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Charma Roga (kushta)

Skin disorders


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Charma Roga (Kushta) (skin disorders) – the allopathic perspective The following italicized passages are taken from the NHS online service which provides information and advice to the public on the causes, symptoms and treatment of these disorders. It is useful to review the allopathic understanding of the disorder and the approach taken to treatment both for comparative purposes and in order to better explain to the patient. Please note that not all information provided is replicated here.

Atopic eczema

Atopic eczema, also known as atopic dermatitis, is the most common form of eczema and makes your skin itchy, red, dry and cracked. It's a long-term condition in most people, although it can improve over time, especially in children, who often grow out of it. It can affect any part of the body, but most commonly affects:

• the backs or fronts of the knees • outside or inside the elbows • around the neck, hands, cheeks or scalp

Treatment, which includes using moisturisers and topical steroids, can help relieve symptoms. Symptoms of atopic eczema Atopic eczema causes the skin to become itchy, dry, cracked, sore and red. Some people only have small patches of dry skin, but others may experience widespread red, inflamed skin all over the body. Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children. People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups). Areas of skin affected by eczema may also turn temporarily darker or lighter after the condition has improved more noticeable in people with darker skin. It's a "footprint" of old inflammation and eventually returns to its normal colour.


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Signs of an infection Occasionally, areas of skin affected by atopic eczema can become infected. Signs of an infection can include:

• your eczema getting a lot worse • fluid oozing from the skin • a yellow crust on the skin surface or small yellowish-white spots appearing in the eczema • the skin becoming swollen and sore • a high temperature (fever) and generally feeling unwell

Causes of atopic eczema The exact cause of atopic eczema is unknown, but it's clear it is not down to one single thing. Atopic eczema often occurs in people who get allergies – "atopic" means sensitivity to allergens. It can run in families, and often develops alongside other conditions, such as asthma and hay fever. The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema. You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. Treating atopic eczema Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time. However, there's currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally. There's also an increased risk of skin infections. Many different treatments can be used to control symptoms and manage eczema, including:

• self care techniques, such as reducing scratching and avoiding triggers • emollients (moisturising treatments) – used on a daily basis for dry skin • topical corticosteroids – used to reduce swelling, redness and itching during flare-ups

Other treatments include: • topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler

treatment • antihistamines for severe itching • bandages or special body suits to allow the body to heal underneath • more powerful treatments offered by a dermatologist (skin specialist)

Self care As well as the treatments mentioned above, there are things you can do yourself to help ease your symptoms and prevent further problems. Try to reduce the damage from scratching You could try gently rubbing your skin with your fingers instead. If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin.


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Keep your nails short and clean to minimise damage to the skin from unintentional scratching. Keep your skin covered with light clothing to reduce damage from habitual scratching. Avoid triggers Once you know your triggers, you can try to avoid them. For example:

• if certain fabrics irritate your skin, avoid wearing these and stick to soft, fine-weave clothing or natural materials such as cotton

• if heat aggravates your eczema, keep the rooms in your home cool, especially the bedroom

• avoid using soaps or detergents that may affect your skin – use soap substitutes instead Dietary changes Some foods, such as eggs and cows' milk, can trigger eczema symptoms. But you shouldn't make significant changes to your diet without first speaking to your GP. It may not be healthy to cut these foods from your diet, especially in young children who need the calcium, calories and protein from these foods. If your GP suspects a food allergy, you may be referred to a dietitian (a specialist in diet and nutrition). Topical corticosteroids If your skin is sore and inflamed, your GP may prescribe a topical corticosteroid which can reduce the inflammation within a few days. They can be prescribed in different strengths, depending on the severity:

• very mild (such as hydrocortisone) • moderate (such as clobetasone butyrate) • even stronger (such as mometasone)

Side effects Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them. In rare cases, they may also cause:

• thinning of the skin – especially if the strong steroids are used in the wrong places, such as the face, for too long (for example, several weeks)

• changes in skin colour – usually, skin lightening after many months of using very strong steroids, but most lightening after eczema is a "footprint" of old inflammation and nothing to do with treatments

• acne (spots) – especially when used on the face in teenagers • increased hair growth

Most of these side effects will improve once treatment stops. Antihistamines Antihistamines are a type of medicine that block the effects of a substance in the blood called histamine. They can help relieve the itching associated with atopic eczema. They can either be sedating, which cause drowsiness, or non-sedating.


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Bandages and wet wraps In some cases, your GP may prescribe special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema. Corticosteroid tablets Corticosteroid tablets are rarely used to treat atopic eczema nowadays, but may occasionally be prescribed for short periods of 5 to 7 days to help bring particularly severe flare-ups under control. Seeing a specialist In some cases, your GP may refer you to a specialist in treating skin conditions (dermatologist). A dermatologist may be able to offer the following:

• allergy testing • topical calcineurin inhibitors – creams and ointments that suppress your immune system,

such as pimecrolimus and tacrolimus • very strong topical corticosteroids • bandages or wet wraps • phototherapy – ultraviolet (UV) light that reduces inflammation • immunosuppressant tablets – to suppress your immune system, such as azathioprine,

ciclosporin and methotrexate • alitretinoin – medicine to treat severe eczema affecting the hands in adults • dupilumab – a medicine for adults with moderate to severe eczema that may be tried

when other treatments haven't worked Complementary therapies Some people may find complementary therapies such as herbal remedies helpful in treating their eczema, but there's little evidence to show these remedies are effective. If you're thinking about using a complementary therapy, speak to your GP first to ensure the therapy is safe for you to use. Other types of eczema Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:

• discoid eczema – a type of eczema that occurs in circular or oval patches on the skin • contact dermatitis – a type of eczema that occurs when the body comes into contact with

a particular substance • varicose eczema – a type of eczema that most often affects the lower legs and is caused

by problems with the flow of blood through the leg veins • seborrhoeic eczema – a type of eczema where red, scaly patches develop on the sides of

the nose, eyebrows, ears and scalp • dyshidrotic eczema (pompholyx) – a type of eczema that causes tiny blisters to erupt

across the palms of the hands


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Psoriasis

Psoriasis typically causes flaky red patches of skin covered in silver scales. The patches usually appear on the elbows, knees and the lower back, and can be itchy or sore. For some people, psoriasis is just a minor irritation, but for others it can have a major impact on their quality of life.People with psoriasis usually have periods when they have no or mild symptoms, followed by periods when symptoms are more severe. Psoriasis affects around 2% of people in the UK. It can start at any age but most often develops in adults under 35 years old, and affects men and women equally. Why it happens People with psoriasis have an increased production of skin cells. Skin cells are normally made and replaced every 3 to 4 weeks, but in psoriasis this process only takes about 3 to 7 days. The resulting build-up of skin cells is what creates the patches associated with psoriasis. Although the process isn't fully understood, it's thought to be related to a problem with the immune system. The immune system is your body's defence against disease and infection, but for people with psoriasis, it attacks healthy skin cells by mistake. Psoriasis can run in families, although the exact role genetics plays in causing psoriasis is unclear. Many people's psoriasis symptoms start or become worse because of a certain event, known as a "trigger". Possible triggers of psoriasis include an injury to your skin, throat infections and using certain medicines. How psoriasis is diagnosed A GP can often diagnose psoriasis based on the appearance of your skin. In rare cases, a small sample of skin, called a biopsy, will be sent to the laboratory for examination under a microscope. This determines the exact type of psoriasis and rules out other skin disorders, such as seborrhoeic dermatitis, lichen planus, lichen simplex and pityriasis rosea. If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a doctor who specialises in arthritis (rheumatologist).


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Treating psoriasis There's no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches. In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids. Phototherapy involves exposing your skin to certain types of ultraviolet light. In severe cases, where the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body.

Cold sores

Cold sores are small blisters that develop on the lips or around the mouth, caused by the herpes simplex virus. They often start with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip. Cold sores usually clear up without treatment within 7 to 10 days, but antiviral creams are available from pharmacies over the counter. Hives (urticaria)


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Urticaria – also known as hives, weals, welts or nettle rash – is a raised, itchy rash. It may appear on one part of the body or be spread across large areas. In many cases, you don't need any treatment because the rash gets better within a few days. If the itchiness is uncomfortable, antihistamines can help and are available over the counter at pharmacies. Impetigo

Impetigo is a very contagious skin infection that causes sores and blisters. There are two types:

• non-bullous impetigo – typically affects the nose and mouth • bullous impetigo – typically affects the trunk

It's more common in children, but can affect anyone. The infection is likely to clear up by itself within three weeks, but it's a good idea to see your GP for a diagnosis as the symptoms are similar to other, more serious conditions. Your GP can also prescribe antibiotic cream or tablets to get rid of it quickly. Itching Itching can affect any area of the body. Mild, short-lived itching is common, but it can sometimes be severe and frustrating to live with. There are things you can do that may help, including:

• patting or tapping the itchy area, rather than scratching • cooling the area with a cold compress, such as a damp flannel • bathing or showering in cool or lukewarm water • using unperfumed personal hygiene products • avoiding clothes that irritate your skin, such as wool or man-made fabrics • using a moisturiser if your skin is dry or flaky

Antihistamine and steroid cream may help relieve itching caused by certain skin conditions.


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Ringworm

Ringworm is not a worm, but a contagious fungal infection that typically appears on the arms and legs, although it can appear almost anywhere on the body. It causes a red or silvery scaly rash in the shape of a ring. Anyone can get ringworm, but it's more common in children. You can treat ringworm with antifungal creams, powders or tablets, which are available over the counter from a pharmacy. Scabies

Scabies is a contagious skin condition caused by tiny mites that burrow into the skin. The main symptoms are intense itching that gets worse at night, and a rash of tiny red spots. See your GP if you think you have scabies. It's not usually serious, but treatment – normally a cream or lotion – is needed to kill the scabies mites.


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Vitiligo

Vitiligo causes pale white patches on the skin that vary in size and can occur anywhere. They are more noticeable on areas that are exposed to sunlight, such as the face and hands, and on dark or tanned skin. Vitiligo on the scalp can make your hair go white. Vitiligo is a long-term condition. It's not contagious. Treatment aims to improve your skin's appearance, and includes:

• disguising the patches with coloured creams • steroid creams • treatment with light (phototherapy)


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Charma Roga (Kushta) (skin disorders) – the Ayurvedic perspective


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According to Ayurveda, there are eighteen types of skin disorders – major skin disorders

(7) and minor skin disorders (11)

Maha kushta (major)

1. Kapala kushta – vata dominant

2. Udumbara kushta – kapha dominant

3. Mandala kushta – pitta dominant

4. Saushra griva (deer’s tongue) - vata/pitta dominant

5. Puncharike – pitta dominant

6. Sidhma – vata/kapha dominant

7. Kanaka – vata/pitta/kapha dominant

Shudhra kushta (minor) skin disorders

1. Aka kushta – vata/kapha dominant

2. Charma kushta – vata/kapha dominant

3. Kitibhaya – vata/kapha dominant

4. Viyapatika – vata/kapha dominant

5. Alasaka - vata/kapha dominant

6. Dadhruma – pitta/kapha dominant

7. Charmadhala - pitta/kapha dominant

8. Parmar - pitta/kapha dominant

9. Visporta - pitta/kapha dominant

10. Shataruwa – pitta/kapha dominant

11. Vicharchika – kapha dominant


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Kushta and its connection with dosha imbalance

Every kushta or skin disorder involves tri-doshic imbalance. According to the strength of

the individual signs and symptoms, a practitioner can identify the disorder and

administer the appropriate treatment.

When it appears to be more than one dosha imbalance, the symptom causing the most

suffering or discomfort to the patient is the one to be treated first. This is one of the very

few examples where in Ayurveda treats symptomatically at first. For example, if a patient

presents with a skin disorder where dryness is prominent and

the dryness is the greatest source of discomfort to them, this is the symptom which must

be addressed first. In this example, the patient might be prescribed a topical cream such

as Dermaved, or oils or dhooma to address the discomfort of the dryness first.

Nidhana (causative factors) of skin disorders

1. Incompatible food and drink (Virrudha anna pana)

2. Excessive consumption of high water content food e.g. melon, cucumber

(Drava)

3. Excessive consumption of oily foods (Snigdha)

4. Excessive consumption of heavy foods – wheat and yam (Guru)

5. Yawning, hunger, thirst, vomiting, hiccups (Vega avarodha)

6. Excessive exercising (Viyayama)

7. Excessive worrying or feeling sadness (ati santapa)

8. Overeating (Ati bojya)

9. Overtiredness (Shrama)

10. Excessive feelings of fear and insecurity (Bhaya)


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11. Cold water or cold drinks (Sheetambu)

12. Cold and hot food eaten together (Sheeta / ushna virya)

13. Incorrect or excessive fasting (Langana)

14. Certain methods of food preparation (Karma Sanskarana Bhojana)

15. Indigestion (Ajeerna)

16. Eating before last meal is fully digested (Adyasana)

17. Incorrect Pancha Karma (detox) treatment (Panchakarma apachari)

18. Inappropriate or excessive consumption of raw food (Navanna)

19. Excessive consumption of yoghurt (Dhadi)

20. Excessive consumption of red fish (Mathsya)

21. Excessive consumption of root vegetables (Mansa mulaka)

22. Excessive consumption of sour and salty food (Amla Lavana)

23. Excessive consumption of high wheat and carbohydrate content food

(Pishta)

24. Excessive consumption of sesame (Tilla)

25. Excessive consumption of milk / dairy products (Sheera)

26. Excessive consumption of sweet food (Guda)

27. Sexual intercourse too soon after eating (Viya vaya)

28. Sleeping at incorrect time / incorrect sleeping patterns (Nidra jagera)

29. Insulting your guru (Guru apachari)

30. Karma (Papa karma)


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Purva rupa & rupa (signs and symptoms)

• Translucent or shiny skin (Ati slaksha)

• Rough (Karasparsha)

• Pale (Swetha)

• Pale turning darker (Vivarna)

• Excessive sweating (Sweda)

• Hot / burning sensation (Daha)

• Itchy (Kandu)

• Piercing pain (Thoda)

• Dizziness / giddiness (Ati brama)

• Bumpy skin (Tawasvapa)

• Dark colouration (Varuna)

• Constant pain (Shula)

• Quick onset of symptoms (Seegra utpathi)

• Roughness, embarrassment, discomfort, depression,

impatience – negative feelings of the mind and body (Rukshushva)

• Easily triggered / irritated (Kopana)

• Prickly heat / shiver (Romaharsha)

• Black discolouration (Krushna)


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Samprapti (pathogenesis)

- Consumption / experience one or more causative factors

- All 3 doshas can become imbalanced

- This creates ama

- The imbalanced dosha circulates through all dhatus, mostly staying in rasa, rakta

and mansa dhatu

- This creates a skin disorder

- Vata type skin disorders stay more in the rasa dhatu and show up in superficial layer

of skin

- Pitta skin disorders tend to reside in the blood tissue

- Kapha skin disorders stay in the muscular tissue

Dosha & skin disorders

- Eczema

o Vata symptoms

§ Dry (shosha), rough (ruksha)

§ pinching / insect bite feeling (thoda)

§ pain (shula)

§ contraction of the skin (sankosha) shrivelling, creaking, cracking sounds

(ayama)

§ sound of dry scratching (parosha)

§ coarseness / crustiness (kara)

§ prickly heat / shivers (harsha)

§ black / brown / pink colouration (krushna varuna)


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o Pitta symptoms

§ Hot (daha)

§ Red (raga)

§ Oozing (parishrava)

§ Inflamed (paka)

§ Fishy smell (vishra gandha)

§ Wet (kleda)

§ Peeling skin / scabs falling off (anga patana)

o Kapha

§ Pale colour (swetha)

§ Cold (sheetha)

§ Itchy (kandu)

§ Bumpy (situlya)

§ Stagnant (utseda)

§ Deep (guru)

§ Soft (snehana)

§ Pus (snehana)

§ Rotten appearance (snehana)

§ Insects like to bite it (jantuji)


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Chikitsa

Ama pachana, agni deepana, shodana, shamana is common to all

• Vata – drinking ghee / oleation

• Pitta – virechana (purgative) / rakta mokshana (blood letting)

• Kapha – vamana (vomiting) / ama pachana

Herbs

• Neem

• Manjistha

• White sandalwood

• Red sandalwood

• Ajwain

• Ghee

• Khadira

• Amla

• Mustha

• Triphala

• Chitraka

• Patola

• Brahmi

• Bhunimba

• Daru haridhra

• Venivel

• Haridhra

• Camphor


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• Moringa

• Acacia

Mineral

• Shelarjit

• Gandaka

Animal products

• Honey

• Ghee

Arishta

• Kadira arishta

• Triphala kwatha

• Dashamoola arishta

• Ashoka arishta

Taila

• Neem oil

• Pinda oil

• Visarpahara oil

• Neelyadi oil

• Sarshapadi oil

• Seethodaka oil

• Kumari oil


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Shodhana

• Panchavalkana

• Neem bark

• Jasmine water

• Clove

• Triphala

Dhooma

• Neem – 5 parts of neem plant crushed and mixed with neem oil

• Coconut leaves

• Steam inhalation with lemon grass, mint leaves or eucalyptus oil

Alepa

• Triphala paste

• Dashanga lepa

• Neem paste

• Dermaved

• Charma lepa

Vasti

• Castor oil

• Triphala oil

• Mahanarayana oil

• Neelyadi oil


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Formulated choorna

• Triphala

• Dhatri

• Hinguashtaka

• Nimbhadi

• Sitopaladi

• Avipathikara

• Paaka choorna

• Manibadhra

• Chandanadi

• Chopachini

• Pittahara

• Amahara

diploma ayurvedic practitioners course · 2019-10-25 · ayurveda institute uk 3 charma roga...

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