From,

ABHIJEET J. BHARAMGONDA. B.A.M.S.

Preliminary M.D (Ayu) Scholar,

Dept. of P.G. Studies in Kaumarabhritya,

S.D.M.College of Ayurveda & Hospital,

Hassan -573201.

To,

The Registrar,

RajivGandhiUniversity of Health Sciences, Karnataka,

Bangalore.

Through,

The Principal and Head of The Department of Kaumarabhritya.

S.D.M.College of Ayurveda and Hospital, Hassan.

Subject: Submission of completed proforma for Registration of Subject for Dissertation.

Respected sir,

I hereby request you kindly to register the mentioned subject against my name for the submission of Dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore for partial fulfillment of M.D. (Ayu).

Title of the Dissertation: “A CLINICAL STUDY ON THE MANAGEMENT OF VICHARCHIKA (ECZEMA) BY BRIHAT HARIDRAKHANDA AND LEPA OF ARKA TAILA IN CHILDREN.”

Here with I am enclosing completedproforma of synopsis for registration of subject for dissertation.

Thanking you.

Date : 31-10-2007. Yours faithfully

Place: Hassan

Abhijeet J. Bharamgonda

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE - II
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.NAME OF THE CANDIDATE: ABHIJEET J. BHARAMGONDA AND ADDRESS PRELIMINARY M.D.(AYU)

SCHOLAR

DEPT. OF P.G. STUDIES IN KAUMARABHRITYA,

S. D. M COLLEGE OF AYURVEDA & HOSPITAL, HASSAN -573201.

PERMANENT ADDRESS : S/OJAMBUKUMAR BHARAMGONDA PLOT NO. 175, DR.J.J.MAGDUM HOUSING SOCIETY, JAYSINGPUR. TAL - SHIROL, DIST- KOLHAPUR,

MAHARASHTRA 416101.

2. NAME OF INSTITUTION : S.D.M.COLLEGE OF AYURVEDA HOSPITAL, HASSAN,

KARNATAKA.

3. COURSE OF STUDY IN SUBJECT:M.D. (Ayu) in KAUMARABHRITYA

4. DATE OF ADMISSION OF : 25thMAY 2007.

COURSE

5. TITLE OF THE TOPIC : “A CLINICAL STUDY ON THE MANAGEMENT OF VICHARCHIKA (ECZEMA) BY BRIHAT HARIDRAKHANDA AND LEPA OF ARKATAILAIN CHILDREN.”

6. BRIEF RESUME OF INTENDED WORK:

6.1 Need for the study:

Disorders of Skin occur in all age groups, which may cause various problems like discomfort, interrupted sleep due to itching, embarrassment and withdrawal from society due to disfigurement.

Eczema is a skin disorder, also called as dermatitis.1a It clinically manifests by pruritus, erythema, oedema, papules, vesicles and oozing in acute stage whereas itching, scaling, dryness and lichenification occur in chronic stage2. This disorder mostly occurs on face, neck fold, elbow, wrist, ankle and cubital regions.2 Many types of eczema occur in children the most common being atopic dermatitis. The other relatively common types are Seborrheic dermatitis, allergic and contact dermatitis, nummular eczema and dyshidrosis.3

The features of eczema are somewhat similar with that of“Vicharchika” mentioned in Ayurveda.

Charka describes ‘Vicharchika’ under Kshudrakustha with the lakshanas Kandu, Shyavapidaka and Bahusrava having Kapha pradhana.4 Authors like Yogratnakara, Madhavkara and Vangasena too referred the same features. Charkas description of VICHARCHIKA simulates wet eczema.

According to Sushruta the lakshanas are Rajyo, Atikandu, Ruja, and Rukshata involving the domination of Pitta5 which correlates dry eczema.

The commentator Shrikanthdatta mentions Vicharchika as of Tridosha Pradhana in which Kapha produces Kandu, Bahustrava due to Pitta and Shyavata due to Vata6.

Bhaishajratnavali indicates “Brihat Haridrakhanda” (orally) for the management of Vicharchika7. It mainly contains Haridra, Trivrutta, Haritaki which are generally having Kaphaghna,Pittarechaka,Kushtaghna,Kandughn & Shothahara actions and the Prakshepaka dravyas like Daruharidra, Musta, Chitraka, Chavya, Pippali, Shunthi, Guduchi, Vasa, Kustha, Ajamoda, Dhanyaka, Amalaki, Bibhitaki, Twaka, Ela, Shwetajiraka, Lohabhasma, and Abharakabhasma are also known for its action on Kushtaand Twakvikara. It can be easily acceptable by children due to its sweetness of sugar.

Yogaratnakar mentioned the indication of external application ofArka taila in Vicharchika8a which contains Arka, Haridra and Sarshapa.

Thus there exists a necessity to find out some Ayurvedic formulation against Eczema in pediatric practice. The preparations selected in the instance both for oral and topical administration are classically acceptable, relatively economical, known for effective actions besides ‘zero’ complications. Hence this is clinical study.

6.2 Review of literature:

  1. Charka mentions Vicharchika as a Kshudra kustha having lakshnas (Kandu, Shyavpidka and Bahusrava) with Kapha dosha pradhanta and its treatments.
  2. Sushruta gives explanation about Vicharchika as Kshudra Kustha with lakshnas (Rajyo, Atikandu, Atiruja and Rukshata) having Pitta dosha pradhanta.
  3. In Ashtanga Hridaya explanation about Vicharchika having lakshnas (Kandu, Shyavpitika and Lasika) with Kapha dosha pradhanta.9
  4. Kashyapa Samhita describes Vicharchika with Shyam Lohita Vrana,Vedna, Strava and Paka.10
  5. Yogratnakar explains the lakshnas of Vicharchika as (Kandu, Shyavpitika and Bahusrava) of Kapha dosha pradhanta and its management with Arka taila.8b
  6. Sharangdhara mentionsVicharchika with Kapha pradhana11a and its management with Arka taila.11b
  7. Vangasena narrates Vicharchika (Kandu, Shyavpidka and Bahusrava)12a to be of Kapha dosha and its management with Arka taila.12b
  8. In Bhaishajaratnavali there is an indication of Brihat Haridrakhand in Vicharchika.
  9. In Bhelasamhita, the lakshanas are Srava, Rakta, Samutpanna, Praklinnata, and Mansenopachita; also management of Vicharchika is described.13
  10. Nelsons text book of pediatrics explains about types of eczema in childhood.
  11. According to API book of medicine, symptoms of eczema are divided in 3 stages ie.Acute eczema shows erythema, oedema, vesicles, oozing, crusting and blister formation. Subacute eczema is characterized by diffuse erythema, oedema, scaling. Chronic stage shows severe pruritus, scaling and lichenification.14
  12. Davidson book of medicine gives explanation about eczema.
  13. Prof.Gyanendra Pande explains the Karma of the drugs as –

Haridra- Kaphaghna,Kusthaghna, Kandughna, Vednasthapana15a

Trivrutta- KaphaPitta shamaka, Shothahara,Sukhavirechana.15b

Haritaki- Tridoshahara, Shothahara,Kushtaghana.15c

Arka-Kushthaghna,Charmarogaghna.15d

Sarshapa-Kandughana,Kushthaghna.15e

Research work done at different Institutes:

  1. Singla .R Arka Tail nirmaan Evam Vicharchika par Adhyana. Govt. Ayurveda Mahavidyalaya, Patiala( 1990)
  2. Vadodkar .S.S: Amoorchita aur Moorchitataila Arka tail ka Vicharchika par Eka Adhyana. Govt Ayurveda Mahavidyalaya. Nagpur.(1991)
  3. Vadodkar Subhash: Moorchita Evam Amoorchit Arka tail ka Vicharchika par Tulnatmak Adhyana. Govt Ayurveda Mahavidyalaya.Nagpur.(1999)
  4. Rafi Mohammad: Role of Kutajghan vati & Arkataila in Vicharchika.

Dr. BRKR Govt. Ayurveda College. Hydrabad (2003).

6.3 Objective of the study:

To assess the clinical response of the children with “Vicharchika (Eczema)” to the oral administration of ‘Brihat Haridrakhand’ along with external application of Arka taila for external use.

7. MATERIALS AND METHODS

7.1 Source of data:

The cases of Vicharchika (Eczema) will be selected from Kaumarabhritya out Patient Department and in Patient Department of S.D.M.College of Ayurveda and Hospital, Hassan.

7.2 Method of collection of the data:

This is a two group study to evaluate whether the drug is more effective in the management of dry or wet type of Vicharchika (Eczema) in children.

Diagnostic criteria:

The diagnosis will mainly base on following clinical features of Vicharchika described in Ayurveda as well as of Eczema mentioned in western medicine respectively.

According to Ayurveda:

Kandu, Shyava, Pidaka, Bahustrava, Ruja, Rukshata, Rakta, Praklinna, Shyama, Vrana, Paka.

According to Modern

Pruritis, Erythema, Edema, Papules, Vesicles, Oozing, Itching, Scaling, Dryness, Lichenification

Grouping:

The patient will be divided into two groups, each consisting of a minimum of 15 patients.

Group A- Patient with dry lesions.

Group B- Patient with wet lesions.

Inclusion criteria:

  1. Patient between the age group 3 years to 10 years will be selected irrespective of sex, religion and socioeconomic status.
  2. Duration of disease less than 3 years.

Exclusion criteria:

1. The patch which is infected and having pus collection.

2. Patient with any acute or chronic systemic disorder.

3. Patient with diabetes.

Assessment criteria:

Patients will be assessed with subjective and objective features.

Subjective parameters:

Improvement of clinical features of the disease According to Ayurveda and Modern science.

Objective parameters:

  1. Photo of patch before and after treatment.
  2. Numbers and Measurements of area of patches.

Duration of the study:

The duration of study will be of two month and the clinical response of therapy will be recorded in each 15 days after treatment.

Drugs and Doses:

Medicines will be given for the said two groups respectively to make a comparative note of responses.

Dose:

a) Brihat Haridrakhand: 5gms mixed with lukewarm milk; twice daily half an hour before food.

b)Arkataila: required quantity for external application twice daily; half an hour before bath & half an hour before bed time.

Follow up:

Assessment shall be made twice in a month during the phase of treatment. Follow up will be done for one more month after the completion of the treatment.

7.3 Laboratory Investigation:

Blood examination- Hb%, Total count, Differential count, Absolute eosinophils count and ESR.

7.4 Has Ethical Clearance Been Obtained From Your Institution?

YES.

8 LIST OF REFERENCE BOOK:

  1. Davidson’s principles and practice of medicine.19th edition.

Chapter 21 Page-1072.

  1. Illustrated synopsis of dermatology by Dr. Neena Khanna by Pee Pee publication chap-6 page-64.
  2. Bherham, Richard E, Kliegman, Robert M,and Jenson Hal B.(2004) Nelson Textbook of pediatrics, Saunders publications,17th edition chapter 645 Page no 2188.

4. Charka Samhita by Shri Bramhanand Tripathi published by Choukhamba Orienalia Varanasi. vol 2, 2nd Edition (2002).

Chikitsasthana 7/26 page no 305 -306.

5. Shrusuta samhitaby Prof. K.R.Shrikanthmurthy published by Choukhamba Orienalia, Varanasi, vol 1, 2nd Edition (2004).

Nidanasthana 5/13 page no: 496.

6. Madhavnidana of Shri Madhavkara with the Sannskrit commentary Maddhukosha by Vijayrakshita and Shrikantadatta edited with Vimal Madhudhara Hindi commentary and notes. Author Dr.Bramhanand Tripathi published by Choukhamba Surabharati prakashan Varanasi. Vol 2 Edition (2003).

17-22 page-206.

7. Bhaishajaratnavali by Kaviraj Ambikadatta Shastri. Published by Choukhamba Sanskrit Sansthan.Varanasi.14th Edition (2001).

Udard Shita Pitta Kotha chikitsa prakaran Shloka-18-23,page-641.

8. Yogaratnakara by Indradeva Tripathi and Dayashankara Tripathi published by Krishnadasa academy, Varanasi. 1st Edition (1998).

Kusthanidana Chikitsa prakarana

8a –Shloka no-203 page-660

8b – Shloka no-26 page -644

9. Ashtanga HridayabyProf .K.R.Shrikanthmurthy published by Krishna as academy Varanasi vol-23rdEdition (1998).

Nidanasthana 14/18 page 139

10.Kashyapa Samhitaby Prof. P.V.Tiwari with English translation commentary publishedby ChoukhambaVishwabhartiVaranasi.1st Edition (1996).

Chikitsasthana 9/2 page 197

11. Sharangdhar samhita by Shri Bahaman and Tripathi published by Choukhamba surbharti prakashan Varanasi.Edition (2004).

11a- Poorvakhanda - 7/87 page no. 106

11b-Madhyam khanda-9/147 page no. 239

12.Vangasena byKavivaryaShri. Shligramaji Vaishya Sanshodhanakarta Shri.Shankarlalji Jain publishedby Khemaraja Krishnadasa prakashana Mumbai.

Edition (2003).

Kustharogadhikar

12a-Shloka no-25 page-619.

12b Shloka no-138page 630.

13. Bhela samhita English commentary by Dr.K.H.Srikanthmurthy published by Choukhamba Vishwabharti Varanasi.

Chikitsasthana 6/25, page-330 Edition (2000).

14. API textbook of medicine 7th edition published by Association of physician of India.

Page-1310.

15.Dravya Guna Vijnana by Prof.GyanendraPande published by Krishnadas academyVaranasi.Vol-1 2nd Edition (2004).Vol-3-1stEdition (2003).

15a- Vol-1. Page no -738.

15b- Vol-3 Page no-668.

15c-Vol-1 Page no -751&752.

15d - Vol-1 Page no-208.

15e- Vol-3 Page no-417&418.

9. SIGNATURE OF THE CANDIDATE -

10. Remark of the Guide -

11. Name and Designation Of

11.1. Guide- Dr. DURGAPRASAD DASH.M.D. (Ayu)

ASSISTANT PROFESSOR, DEPARTMENT OF P. G. STUDIES IN KAUMARABHRITYA,

S.D.M.C.A. & H., HASSAN.

11.2.Signature-

11.3. CO-Guide:- Dr. SHAILAJA U. M.D. (Ayu)

PROFESSOR,.

DEPT OF P.G. STUDIES

IN KAUMARABHRITYA,

S.D.M.C.A. & H., HASSAN.

11.4. Signature-

11.5. Head OF The Department - Dr. DURGAPRASAD DASH.M.D. (Ayu)

ASSISTANT PROFESSOR, DEPARTMENT OF P. G. STUDIES IN KAUMARABHRITYA,

S.D.M.C.A. & H., HASSAN.

11.6. Signature:-

12.

12.1. Remark of Chairman -

And Principal

12.2. Signature-

1