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JOURNALJOURNAL
PRESENTATIONPRESENTATION
DEPARTMENT OF SAMHITADEPARTMENT OF SAMHITA
PRESENTERPRESENTER
Dr. S. KAMALAKARDr. ...
Journal of Ayurveda & Integrative
Medicine
| October-December 2014 | Vol 5 |
Issue 4
C A S E RE PORT
SUBCUTANEOUS INTRALES...
AIM OF THE ARTICLEAIM OF THE ARTICLE
• Different types of warts treated with intralesional
infiltration of Apamarga Ksharo...
AUTHOR LANGUAGE STYLE AND EXPRESSIONAUTHOR LANGUAGE STYLE AND EXPRESSION
Very simple,
Easily understandable language
Gr...
INTRODUCTIONINTRODUCTION
 Warts, also known as Verrucae, is a common dermatological
condition caused by the Human Papilloma Virus (HPV)
 Charmaki...
WHYWHY
KSHARODHAKAKSHARODHAKA
 Ksharasutra (thread smeared with Kshara) is tied around the
warts for removal. However, these methods require multiple
s...
 Animal studies of AK injection have reported it to be safe at
different dose levels, to as high as 2000 mg/kg.
 The dur...
PREPARATION OFPREPARATION OF
KSHARAKSHARA
• The dried pieces of medicinal plant are put in an earthen pot
and burnt to ash.
• After cooling the ash, water is added ...
CASE REPORTSCASE REPORTS
•2.5 g of Apamarga Kshara was thoroughly mixed in 10 mL of
distilled water and kept for 15 min. The supernatant solution, ...
CASE 1CASE 1
• Case 1
• A 73 year old male with a known case of diabetes mellitus‑ ‑
and hypertension (well controlled with allopathic ...
•AK was injected at the base of a flat wart on the right cheek,
three filliform warts on the right side of the neck and th...
BT AI AT
CASE 2CASE 2
• A 54 year old, apparently healthy female presented with‑ ‑
multiple painless warts on the right side of the neck region ...
CASE 3CASE 3
• Case 3
• A 30 year old female presented with a flat, skin colored‑ ‑ ‑
wart of approximately 0.5 cm diameter in size on ...
CASE 4CASE 4
• Case 4
• A 60 year old female presented with a dry, rough,‑ ‑
brown colored wart on the face above the right eye, near t...
•Here, the base of the wart was small; hence, a 26 number needle
was used.
•She complained of pain at the site of the inje...
CONCLUSIONCONCLUSION
• Kshara possess caustic properties resulting in excision of
unwanted tissues.
• It works like a sclerosant agent locally ...
FURTHER
UNDERSTANDING
Introduction:
Charmkeela is a most commonly encountered problem in the
routine practice, which deserves special attention ...
DERIVATION OF KSHARA
• ‘Kshara’ - The root “Char” (to remove) or
“Kshana”(violence).
• Kshara - Destroys fleshy mass eithe...
KSHARA KARMA
Kshara Pradhana tama
• Chedya Bhedya Lekhya karanatwat
• Tridoshaghnatwat
• Vishesha kriya avacvharanaat
• Superior most among the sharp and subsidiary instruments -
performing Chedana (Excision), Lekhana (Scraping) and destroy...
• Warts are common Benign epithelial hyperplasia due to
infection with Human Papilloma Virus
• Papilloma viruses or double...
• COMMON WARTS:
• These present as dome shaped papules with verrucous
surface commonly on the hands and feet
• They are ro...
• FLAT WARTS (PLANE WARTS)-
• They are slightly elevated, smooth papules, that are less than
5mm.
• They may be flesh colo...
• PLANTAR WARTS-
• These are small shiny horney papules and located beneath the
pressure point i.e. soles of the feet.
• I...
• Genital warts(Sexually transmitted):
• They may be either hyperplastic, sessile (papular), Verruca
vulgaris like or flat...
CLASSIFICATION OF KSHARA
On the basis of Administration
1. Pratisaaraneeya Kshara
2. Paaneeya Kshara
METHOD OF PREPARATION OF PANEEYA KSHARA
Dried Apamarga Plant
Burnt
Apamarga Ash
Add 6 times of water
Filtered 21 times thr...
PROPERTIES OF KSHARA
 RASA - Katu
 VEERYA - Ushna
 VARNA - Shukla
 GUNA - Thiksna, Agneya
 DOSHAGNA - Tridoshagna
 K...
METHOD OF PREPARATION OF PRATISARANEEYA KSHARA
Dried Apamarga Plant (5 kg)
Burnt
500 gms of Apamarga Ash
Add 6 times of wa...
CONCLUSION
Ksharodhaka procedure very effective in Charmakila
Simple technique
Less time
Sometimes it will shows adver...
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
Ksharodhaka injection....treatment of warts...charmakila
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Ksharodhaka injection....treatment of warts...charmakila

  1. 1. JOURNALJOURNAL PRESENTATIONPRESENTATION DEPARTMENT OF SAMHITADEPARTMENT OF SAMHITA PRESENTERPRESENTER Dr. S. KAMALAKARDr. S. KAMALAKAR 22ndnd YEAR PGYEAR PG
  2. 2. Journal of Ayurveda & Integrative Medicine | October-December 2014 | Vol 5 | Issue 4 C A S E RE PORT SUBCUTANEOUS INTRALESIONAL KSHARODAKA INJECTION: A NOVEL TREATMENT FOR THE MANAGEMENT OF WARTS MANOHAR S. GUNDETI, R.GOVIND REDDY, JANGLE VIDYA MURALIDHAR Raja Ramdeo Anandilal Podar Ayurveda Cancer Research Institute (CCRAS, Department of AYUSH, GoI), Department of ShalyaTantra, RA Podar Medical (Ayu) College, Mumbai, Maharashtra, India Downloaded free from http://www.jaim.in
  3. 3. AIM OF THE ARTICLEAIM OF THE ARTICLE • Different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK)
  4. 4. AUTHOR LANGUAGE STYLE AND EXPRESSIONAUTHOR LANGUAGE STYLE AND EXPRESSION Very simple, Easily understandable language Grammatically correct, straight to point Has systematically arranged the information under proper headings
  5. 5. INTRODUCTIONINTRODUCTION
  6. 6.  Warts, also known as Verrucae, is a common dermatological condition caused by the Human Papilloma Virus (HPV)  Charmakila are the hard, rough, nail like projections over the‑ skin caused due to vitiation of Vyanavayu and Kapha  Ayurveda recommends a holistic approach for treating the Warts, such as oral medications, external application of Kshara, Agnikarma or Surgical excision.
  7. 7. WHYWHY KSHARODHAKAKSHARODHAKA
  8. 8.  Ksharasutra (thread smeared with Kshara) is tied around the warts for removal. However, these methods require multiple sittings with a longer duration for shedding off of the Wart with limitations to use in smaller Warts.  In Ksharodhaka observed that all these Warts took a minimum of 2–6 days to shed off in one sitting and leaving minor scars. There were no adverse reactions.
  9. 9.  Animal studies of AK injection have reported it to be safe at different dose levels, to as high as 2000 mg/kg.  The duration of follow up was until the 14th day of the study‑ and the Authors concluded that the formulations were safe.
  10. 10. PREPARATION OFPREPARATION OF KSHARAKSHARA
  11. 11. • The dried pieces of medicinal plant are put in an earthen pot and burnt to ash. • After cooling the ash, water is added in a ratio of 1:6, i.e. one part ash and six parts water, and mixed well. • This is then strained through a piece of cloth for two or three times till a clear liquid is obtained. • This liquid is then put in an iron or earthen vessel and heated over a moderate fire till the water evaporates, leaving a solid salty white substance that is known as Kshara.
  12. 12. CASE REPORTSCASE REPORTS
  13. 13. •2.5 g of Apamarga Kshara was thoroughly mixed in 10 mL of distilled water and kept for 15 min. The supernatant solution, i.e. Apamarga Ksharodaka (AK), was used for the procedure. •AK was drawn into a disposable syringe having a number 24 gauze needle •slowly injected underneath the warts keeping the syringe parallel to the skin surface with the bevel facing upward
  14. 14. CASE 1CASE 1
  15. 15. • Case 1 • A 73 year old male with a known case of diabetes mellitus‑ ‑ and hypertension (well controlled with allopathic medicines) was having multiple warts of varying sizes on his face, neck, axilla and groin regions. • The warts on the face and neck were of varying size and shape, painless and soft in consistency.
  16. 16. •AK was injected at the base of a flat wart on the right cheek, three filliform warts on the right side of the neck and thigh with a disposable syringe using a 24 number hypodermic needle in the dose of 0.1 cc each. •On the next day, mild inflammation was seen at the base of the warts. •The hardness and darkness in color of the wart got increased every day but the patient was not having any complains. On the seventh day, the warts shed off . •.
  17. 17. BT AI AT
  18. 18. CASE 2CASE 2
  19. 19. • A 54 year old, apparently healthy female presented with‑ ‑ multiple painless warts on the right side of the neck region (as filliform warts), left shoulder and in the right axillary region. • She was subjected for an intralesional AK injection at a dose of 0.4cc. This patient complained of burning at the site of the injection during the procedure. • On the next day, all the warts turned harder, darker and subsequently shed off, leaving a small wound Case 2
  20. 20. CASE 3CASE 3
  21. 21. • Case 3 • A 30 year old female presented with a flat, skin colored‑ ‑ ‑ wart of approximately 0.5 cm diameter in size on the scalp just behind the left ear at the hairline on the mastoid region. • 0.2 cc of AK was injected at the base of the wart using disposable syringe with a 24 number needle. • She complained of pain and burning at the site of the injection during and after the procedure for 1h. • The wart shed off on the fourth day with a slight wound that healed leaving a minimal scar at the site within 7 days
  22. 22. CASE 4CASE 4
  23. 23. • Case 4 • A 60 year old female presented with a dry, rough,‑ ‑ brown colored wart on the face above the right eye, near the‑ medial end of the eyebrow as a filliform wart measuring • approximately 0.1 cm. • 0.2 cc of AK was infiltrated at the base of the wart using a disposable syringe with a 26 number needle.
  24. 24. •Here, the base of the wart was small; hence, a 26 number needle was used. •She complained of pain at the site of the injection during the procedure. •Mild inflammation was seen at the base of the wart on the next day with no obvious pain and burning sensation. •On Day 5, the wart shed off
  25. 25. CONCLUSIONCONCLUSION
  26. 26. • Kshara possess caustic properties resulting in excision of unwanted tissues. • It works like a sclerosant agent locally and creates sterile inflammation at the base of the wart. • Subsequently, the process of sclerosis takes place and the wart falls off. • Kshara has dual properties of cutting and healing locally. Apamarga has been a drug of choice for preparation of Kshara, and it has been used in the management of hemorrhoids, warts, etc.
  27. 27. FURTHER UNDERSTANDING
  28. 28. Introduction: Charmkeela is a most commonly encountered problem in the routine practice, which deserves special attention on account of its cosmetic importance. Samprapti (Pathogenesis): The vitiated Vyanavata in association with Kapha produces firm and nail shaped projections externally which are known as Charmakila (Warts).  In those Warts pain is produced due to Vayu, while color and nodularity are due to Slesma.  Pitta and Shonita produces dryness, blackness, glossiness and excessive roughness over the entire surface of the Charmakila.
  29. 29. DERIVATION OF KSHARA • ‘Kshara’ - The root “Char” (to remove) or “Kshana”(violence). • Kshara - Destroys fleshy mass either healthy or unhealthy . • Kshara - one which scrapes the abnormal tissue from its location & destroys it after dissolving it, because of its corrosive nature.
  30. 30. KSHARA KARMA Kshara Pradhana tama • Chedya Bhedya Lekhya karanatwat • Tridoshaghnatwat • Vishesha kriya avacvharanaat
  31. 31. • Superior most among the sharp and subsidiary instruments - performing Chedana (Excision), Lekhana (Scraping) and destroys the Tridoshaja disorders. • More effective than the other modalities of treatment - can be administered both internally and externally. • Useful as the substitute of surgical instruments - can be used safely on the patients who are afraid of surgery.
  32. 32. • Warts are common Benign epithelial hyperplasia due to infection with Human Papilloma Virus • Papilloma viruses or double standed DNA viruses • They infect squamous epithelia of the skin and mucous membrane causing cell proliferation • The virus infects the basal layer of the epethelium • But viral replication takes place in fully differentiated cells of upper Stratum Spinosum and Granulosum
  33. 33. • COMMON WARTS: • These present as dome shaped papules with verrucous surface commonly on the hands and feet • They are rough keratotic papules that may appear single or grouped on cutaneous surface. • They are commonly located on the dorsal surface of the hands, fingers and knees. Size are less than a millimeter to over a centimeter. • FILIFORM WARTS- • They appear as long slender filiform projections. •
  34. 34. • FLAT WARTS (PLANE WARTS)- • They are slightly elevated, smooth papules, that are less than 5mm. • They may be flesh coloured gray or brown and are usually located over the face, hands and legs. • Koebners phenomenon is seen frequently…new warts forming over sites of trauma •  
  35. 35. • PLANTAR WARTS- • These are small shiny horney papules and located beneath the pressure point i.e. soles of the feet. • It produce pain on walking. • Multiple plantar warts called as mosaic wart
  36. 36. • Genital warts(Sexually transmitted): • They may be either hyperplastic, sessile (papular), Verruca vulgaris like or flat warts. Occurs at the mucocutaneous junction of external genital in male & female. • Sometimes the transmission may be non veneral • High infectivity • They effect the penis in males, • perianal area in homosexuals • Vulva, perinium and vagina in females • The wart may be small or may be large cauliflower like condylomata accuminata
  37. 37. CLASSIFICATION OF KSHARA On the basis of Administration 1. Pratisaaraneeya Kshara 2. Paaneeya Kshara
  38. 38. METHOD OF PREPARATION OF PANEEYA KSHARA Dried Apamarga Plant Burnt Apamarga Ash Add 6 times of water Filtered 21 times through cloth To get clean and clear solution – Gomutra Varna (slight reddish) Filtrate Solution was boiled and evaporated Heating up to water evaporates completely leaving a solid salty white substance PANEEYA KSHARA
  39. 39. PROPERTIES OF KSHARA  RASA - Katu  VEERYA - Ushna  VARNA - Shukla  GUNA - Thiksna, Agneya  DOSHAGNA - Tridoshagna  KARMA - Dahana, Pachana, Shodana, Ropana, PH value - 13.5
  40. 40. METHOD OF PREPARATION OF PRATISARANEEYA KSHARA Dried Apamarga Plant (5 kg) Burnt 500 gms of Apamarga Ash Add 6 times of water (3 liters) Filtered 21 times through cloth To get clean and clear solution – Gomutra Varna (slight reddish) Filtrate Solution was boiled and evaporated Heating up to 2/3 remains Add Red-hot Lime stone 1/10th (50 gms) into the boiled Apamarga filtrate solution Continuous mild heating Liquid evaporates to 1/3rd of its original quantity Add 1/10th (5gms) of Chitraka Kalka PRATISARANIYA KSHARA
  41. 41. CONCLUSION Ksharodhaka procedure very effective in Charmakila Simple technique Less time Sometimes it will shows adverse reactions because of necrotising property So utmost care while injecting the ksharodhaka in unwanted tissue growths like charmakila
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KSHARODHAKA INJECTION...TREATMENT OF CHARMAKILA...WARTS

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