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Padanimajjana
‘Pada Nimajjana’ – Innovative technique in the treatment of Vipadika
# Dr. O.P Sharma, ## Dr. Ananth Ram Sharma, ### Dr. Prathibha Sharma

Background
Hypertrophy of the corneous layer of the palms and soles, usually of a more or less horny and
plate-like character, is well defined in Ayurveda as Vipadika1 and Hyperkeratosis Palmo-
plantaris in the contemporary science. The hardening and thickening arise spontaneously with
out necessarily having any external factor, such as pressure, friction, etc, and is, furthermore,
symmetric, and usually on palms and soles. Moreover, it is, as a rule, congenital or a hereditary
condition. While it is commonly limited to the palmar and plantar aspects, occasionally it
extends somewhat beyond on to the side, and exceptionally slightly on to the dorsal surface. It is
common to find the nails more or less affected, and tilted slightly or moderately upward by the
collection of hardened and thickened tissues.

Need for the Study
Vipadika is one of the Vata pradhana Kshudraroga’s2. Due to the lack of hygiene, excessive
walking etc, the rukshata in the body especially in the foot increases; which aggravates the Vata
resulting in the scaling of the skin of sole and palm3. Sneha dravya is the best remedy for the
Vata Roga4. Abhyanga with various Sneha Dravya are commonly practiced in the treatment of
Vipadika5. Instead of Abhyanga, if we dip the leg in the Sneha Dravya the amount of snehana
and the bio availability will be more. This thought lead to the development of a new technique
called Padanimajjana. That is why the present study was taken to assess the effect of Pada
Nimajjana over the commonly practiced Pada Abhyanaga.


Aims and objectives

       To assess the efficacy of Pada abhyanaga in the Vipadika
       To Assess the efficacy of Pada Nimajjana in Vipadika
       To compare the effects of Pada Abhyanga and Pada Nimajjana

Methodology

Source of Data

The material for the present study was obtained from the Skin and cosmetology outpatient
department of Amrita school of Ayurveda, Vallikkavu (Kerala) from January 2010 to May 2010.
40 cases of Vipadika of soles were included in the present study, those who were not on any
other medication.

Study Design

       Patients were randomly grouped in to 2 group containing 20 patients each.

# Associate Professor, Dept. of PG Studies in Panchakarma, NIA Jaipur
## PhD scholar, Assistant professor, Dept. of Panchakarma, Amrita School of Ayurveda,
Amritapuri, Kerala.
### Assistant professor, Dept. of Panchakarma, Amrita School of Ayurveda, Amritapuri,
Kerala.




                                               302
Pada Abhyanga group (PA Group) were advised Pada Abhyanga for 30 Min daily for 14
       consecutive days with a combination of Durvadi Keram6 and Jeevanthyadi Yamakam7
       with 2:1 proportion. 50 ml of Sneha was taken daily in sukhoshna state.
       Pada Nimajjana group (PN Group) were advised Pada Nimajjana ( Dipping of the
       affected leg in the sneha dravya) for 30 Min daily for 14 consecutive days with a
       combination of Durvadi Keram and Jeevanthyadi Yamakam with 2:1 proportion. 200 ml
       Sneha was taken for 7 days and for the next 7 days fresh oil is used. Sukhoshnata of the
       Sneha dravya is maintained throughout the procedure.
       Both the groups were given 10 gm of Manibhadra gulam at bed time and Manjishtadi
       Kashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before food for
       a period of two weeks.
       Before Starting the Pada Nimajjana and Pada Abhyanga thickened lesions were neatly cut
       with a sterile blade and every day feet was washed thoroughly with Sukhoshna Jala and
       dried with a cloth.

Inclusion criteria

       Patients between age group of 10 – 70yrs were included.
       Patients with the symptoms of Vipadika in Sole only.

Exclusion criteria

       Patients with psoriasis
       Patients on some medication
       Patients with vicharchika in the foot
       Patients above the age group of 70 yrs and below 10 years

Assessment criteria and Scoring

      Sl. No    Lakshana                Parameters                                 Score
      1         Cracks in the Foot      No cracks – 0                              0
                                        Cracks without cavity                      1
                                        Cracks with visible cavity                 2
                                        Cracks with non visible/ deep cavity       3
      2         Secretion               No srava                                   1
                                        Mild srava                                 2
                                        Moderate srava                             3
      3         Pain                    No Pain                                    0
                                        Pain during Walking even with Slippers     1
                                        Pain during Walking without Slippers       2
                                        Pain during rest                           3
      4         Itching                 No itching                                 0
                                        Mild / occasional itching                  1
                                        Moderate (tolerable) infrequent            2
                                        Severe itching frequently                  3

Statistical Analysis
The SPSS data collection system was used for all data management and analysis. Outcomes were
calculated from paired Student’s t-tests of difference in means, testing the hypothesis that means
were not significantly different per measure over time. Baseline was compared to outcomes after
the 14-day procedure. The significance of change over a longer term was considered by
comparing means at baseline to means at 3 months post program.




                                               303
Observations and Result
Effect of Pada Abhyanga on various symptoms of Vipadiaka

20 Patients of Vipadika were treated with Pada Abhyanga done with Durvadi Keram and
Jeevanthyadi Yamakam combination. 50 ml of Taila was taken daily for Abhyanga in sukhoshna
state. Each patiets were administered 10 gm of Manibhadra gulam at bed time and Manjishtadi
Kashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before food
throughout the course of treatment. Pada abhyanga was started only after removing the thickened
skin and thorough wash with Sukhoshna Jala.

                                           Table No:1
       Table showing the Effect of Pada Abhyanga on Selected variables of Vipadika

Variables      Level of study      Mean Score        % relief   SD      SE      ‘t’     P
Cracks on      Base line           2                 -          -       -       -
foot           After Nimajjana     1.2               60         0.834   0.186   6.452   <0.001
               After 3 months      1.85              27.5       0.511   0.114   4.825   <0.001
Secretion      Base line           2.1               -          -       -       -
               After Nimajjana     1.25              47.62      0.587   0.131   4.472   <0.001
               After 3 months      1.8               14.29      0.733   0.164   1.829   >0.05
Pain           Base line           1.8               -          -       -       -
               After Nimajjana     1                 58.33      0.944   0.211   4.976   <0.001
               After 3 months      1.15              36.11      0.875   0.196   3.316   <0.01
Itching        Base line           2.1               -          -       -       -
               After Nimajjana     1.25              40.48      0.587   0.131   6.489   <0.001
               After 3 months      1.95              7.14       0.671   0.15    1.00    >0.1


At baseline the mean score of Cracks on the foot was 2 and after Pada Abhyanga it reduced to
1.2. After the follow up period of 3 months the relief was reduced from 60% to 27.5% with ‘t’
value 4.825 and found statistically significant (P <0.001).
Mean score of Secretion at baseline was found relief with 47.62% reduced later to 14.29% after
the follow up period. After the course of treatment of 14 days the Pada Abhyanga was found
statistically highly significant but later after the follow up reduced to Mildly significant with P
>0.05.
From the above table Pada Abhyanga on the Pain was found statistically significant at P <0.001.
But after the 3months period the relief was reduced to 36.115 from an initial relief of 58.33%.
Itching was found reduced after the 14 days treatment with statistically significant P value
<0.001. There was a drastic drop in the relief with 7.14% with ‘t’value 1 and found statistically
insignificant.



Effect of Pada Nimajjana on various symptoms of Vipadiaka

20 Patients of Vipadika were treated with Pada Nimajjana with a combination of Durvadi Keram
and Jeevanthyadi Yamakam. Patients were asked to dip the affected area of leg in 200 ml of
sukhoshna Taila for 30 min. New oil is taken after the 7 days treatment. Each patient were
administered 10 mg of Manibhadra gulam at bed time and Manjishtadi Kashayam 20 ml mixed
with 60 ml of boiled and cooled water twice daily before food throughout the course of
treatment. Pada Nimajjana was started only after removing the thickened skin and through wash
with Sukhoshna Jala.



                                               304
Table No: 2
       Table showing the Effect of Pada Nimajjana on Selected variables of Vipadika

Variables     Level of study       Mean Score         % relief   SD      SE      ‘t’     P
Cracks on     Base line            2.5                -          -       -       -       -
Foot          After Nimajjana      0.65               74         1.014   0.227   8.149   <0.001
              After 3 months       0.5                80         0.973   0.218   9.174   <0.001
Secretion     Base line            2.1                -          -       -       -       -
              After Nimajjana      1.1                48         0.725   0.162   6.173   <0.001
              After 3 months       1.05               50         0.686   0.153   6.830   <0.001
Pain          Base line            1.85               -          -       -       -       -
              After Nimajjana      0.35               81.08      0.946   0.212   7.075   <0.001
              After 3 months       0.2                89.19      1.082   0.242   6.818   <0.001
Itching       Base line            2                  -          -       -       -       -
              After Nimajjana      0.2                90         0.834   0.186   9.677   <0.001
              After 3 months       0.15               92.5       0.875   0.196   9.439   <0.001


At baseline the mean score on Cracks on the foot was 2.5 which later after treatment reduced to
0.65 and again reduced to 0.5 after the follow up period. Effect of Pada Nimajjana on Cracks on
the foot was found statistically significant at P <0.001.
Pada Nimajjana has shown 48% reduction on Secretion. The effect is statistically significant at
the level of P<0.001. After the follow up period there was a reduction of 50%. This effect is also
statistically significant P<0.001.
The mean score at baseline on pain was 1.85, which is reduced to 0.35 showing a reduction of
81.08%. After the follow up period the score was 0.2 by a reduction of 89.19%. Both these
effects were statistically significant at the level of P<0.001.
After Pada Nimajjana there was 90% reduction in itching. Mean score on Itching at baseline 2
reduced to 0.2. The effect is statistically significant at the level of P<0.001. After the follow up
period the reduction in Itching was 92.5% and the effect was statistically significant (P<0.001).



                                           Table No: 3
       Overall Effect of Pada Abhyanga and Pada Nimajjana on on selected variables

                                          % of Relief in Symptoms
                             Pada Abhyanaga Group           Pada Nimajjana Group
         Variables        After Treatment Follow up After Treatment Follow up
       Cracks on foot     60               27.5         74                80
         Secretion        47.62            14.29        48                50
            Pain          58.33            36.11        81.08             89.19
          Itching         40.48            7.14         90                92.5


Above table (Table No.9) shows the comparative effect of the Pada Abhyanaga and Pada
Nimajjana on various symptoms of Vipadika. Even though both the therapies are statistically
significant in reducing the symptoms Pada Nimajjana showed more % of Relief on various
symptoms. Apart from this the result obtained by the Padanimajjana was improved further in the
follow up period while the results were reduced in the Pada Abhyanga group after the period of
follow up.




                                                305
Discussion

Vipadika

Vipadika is mentioned as one of the Kshudra roga’s where we can find the Cracks over the
Palms and soles. The dosha involved in Vipadika is Vata. Because of the excessive friction or
pressure over the skin Vata gets vitiated locally. Due to the increase in the rukshata of Vata the
skin gets dry and becomes thickened. This results in the cracks. The condition may further
worsen due to the absence of personal hygiene.

Selection of the Patients

Hygiene plays an important role in the pathogenesis and Management of Vipadika. During the
management of Vipadika, if the patient doesn’t keep the affected area clean, one can’t achieve
the better results. In children below 10 years age it is very difficult to maintain the hygiene of the
extremities. That is the reason children are avoided in the study.

Effect of the drugs

Durvadi keram is one of the drugs of choice in the management of Vrana. Most of the Vipadika
cases exhibit secretion associated with cracks and Durvadi keram due to its Vranahara property
will take care of the condition. Similarly Jeevanthyadi yamakam is one of the suitable drugs for
the Vata pradana Kushtha’s especially indicated in Vipadika. Due to the presence of Brumhana
Dravya like Jeevanthi it will do the shamana of the Vata8. As it is one of the Yamaka sneha it
will do more snehana when compared to single Sneha9. This Yamaka Sneha will reduce the Vata
locally and also will soften the dry thickened skin.




Effect of the therapies

Pada abhyanga is the commonly used therapeutic procedure for the management of Vipadika,
where the suitable taila will be applied to the area and abhyanaga is done for 30 to 40 minutes.
On the other group in Pada Nimajjana the affected area is dipped in the Sukhoshna Taila for
certain period. Unlike in Pada Abhyanga here in Nimajjana we are achieving the Snehana along
with Swedana. Application of Snehana and Swedana together will provide the Shamana of
Vata10 very easily. In Nimajjana the continuous contact of warm with the skin will enhance the
Bio-availability of the drug.

Conclusion

Statistical analysis of the obtained Data shows that,

       Pada Nimajjana is more effective in reducing the symptoms of Vipadika
       The results obtained was sustained or even better in the Pada Nimajjana Group when
       compared to the Pada abhyanga.
       Pada Abhyanga was not effective in managing itching as it was seen worsened after the
       follow up period
       The Taila used for the total course of Pada Nimajjana was less than the taila used for the
       Abhyanaga. This helps us to reduce the cost of the treatment. Also in the Nimajjana the
       physical effort for the treatment is very less.




                                                 306
Limitations

The result may not be very significant as the sample size is very small. It was the limitation of
the study that 2 of the selected symptoms (Pain and Itching) were subjective and we have to
depend on the patients completely to assess the results.

Scope for further Study

Same study can be repeated with a large number of populations with various objective
assessment criteria’s.

Bibliographic references

   1. Caraka Samhita, Chikitsa Sthana 7/22
   2. Sushruta, Samhita. Nidana Sthana 13/29
   3. Sushruta, Samhita. Nidana Sthana 13/29
   4. Ashtanga. Hrudaya, Sutrasthana 1/25
   5. Sushruta, Samhita. Chikitsa Sthana 20/19
   6. Sahasrayoga- Taila prakarana
   7. Ashtanga. Hrudaya, Chikitsa Sthana 19/78
   8. Dravyaguna Vijnana- P.V Sharma
   9. Ashtanga. Hrudaya. Sutrasthana 16/4
   10. Caraka Samhita, Sutrasthana 14/4




                                              307

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Padanimajjana

  • 2. ‘Pada Nimajjana’ – Innovative technique in the treatment of Vipadika # Dr. O.P Sharma, ## Dr. Ananth Ram Sharma, ### Dr. Prathibha Sharma Background Hypertrophy of the corneous layer of the palms and soles, usually of a more or less horny and plate-like character, is well defined in Ayurveda as Vipadika1 and Hyperkeratosis Palmo- plantaris in the contemporary science. The hardening and thickening arise spontaneously with out necessarily having any external factor, such as pressure, friction, etc, and is, furthermore, symmetric, and usually on palms and soles. Moreover, it is, as a rule, congenital or a hereditary condition. While it is commonly limited to the palmar and plantar aspects, occasionally it extends somewhat beyond on to the side, and exceptionally slightly on to the dorsal surface. It is common to find the nails more or less affected, and tilted slightly or moderately upward by the collection of hardened and thickened tissues. Need for the Study Vipadika is one of the Vata pradhana Kshudraroga’s2. Due to the lack of hygiene, excessive walking etc, the rukshata in the body especially in the foot increases; which aggravates the Vata resulting in the scaling of the skin of sole and palm3. Sneha dravya is the best remedy for the Vata Roga4. Abhyanga with various Sneha Dravya are commonly practiced in the treatment of Vipadika5. Instead of Abhyanga, if we dip the leg in the Sneha Dravya the amount of snehana and the bio availability will be more. This thought lead to the development of a new technique called Padanimajjana. That is why the present study was taken to assess the effect of Pada Nimajjana over the commonly practiced Pada Abhyanaga. Aims and objectives To assess the efficacy of Pada abhyanaga in the Vipadika To Assess the efficacy of Pada Nimajjana in Vipadika To compare the effects of Pada Abhyanga and Pada Nimajjana Methodology Source of Data The material for the present study was obtained from the Skin and cosmetology outpatient department of Amrita school of Ayurveda, Vallikkavu (Kerala) from January 2010 to May 2010. 40 cases of Vipadika of soles were included in the present study, those who were not on any other medication. Study Design Patients were randomly grouped in to 2 group containing 20 patients each. # Associate Professor, Dept. of PG Studies in Panchakarma, NIA Jaipur ## PhD scholar, Assistant professor, Dept. of Panchakarma, Amrita School of Ayurveda, Amritapuri, Kerala. ### Assistant professor, Dept. of Panchakarma, Amrita School of Ayurveda, Amritapuri, Kerala. 302
  • 3. Pada Abhyanga group (PA Group) were advised Pada Abhyanga for 30 Min daily for 14 consecutive days with a combination of Durvadi Keram6 and Jeevanthyadi Yamakam7 with 2:1 proportion. 50 ml of Sneha was taken daily in sukhoshna state. Pada Nimajjana group (PN Group) were advised Pada Nimajjana ( Dipping of the affected leg in the sneha dravya) for 30 Min daily for 14 consecutive days with a combination of Durvadi Keram and Jeevanthyadi Yamakam with 2:1 proportion. 200 ml Sneha was taken for 7 days and for the next 7 days fresh oil is used. Sukhoshnata of the Sneha dravya is maintained throughout the procedure. Both the groups were given 10 gm of Manibhadra gulam at bed time and Manjishtadi Kashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before food for a period of two weeks. Before Starting the Pada Nimajjana and Pada Abhyanga thickened lesions were neatly cut with a sterile blade and every day feet was washed thoroughly with Sukhoshna Jala and dried with a cloth. Inclusion criteria Patients between age group of 10 – 70yrs were included. Patients with the symptoms of Vipadika in Sole only. Exclusion criteria Patients with psoriasis Patients on some medication Patients with vicharchika in the foot Patients above the age group of 70 yrs and below 10 years Assessment criteria and Scoring Sl. No Lakshana Parameters Score 1 Cracks in the Foot No cracks – 0 0 Cracks without cavity 1 Cracks with visible cavity 2 Cracks with non visible/ deep cavity 3 2 Secretion No srava 1 Mild srava 2 Moderate srava 3 3 Pain No Pain 0 Pain during Walking even with Slippers 1 Pain during Walking without Slippers 2 Pain during rest 3 4 Itching No itching 0 Mild / occasional itching 1 Moderate (tolerable) infrequent 2 Severe itching frequently 3 Statistical Analysis The SPSS data collection system was used for all data management and analysis. Outcomes were calculated from paired Student’s t-tests of difference in means, testing the hypothesis that means were not significantly different per measure over time. Baseline was compared to outcomes after the 14-day procedure. The significance of change over a longer term was considered by comparing means at baseline to means at 3 months post program. 303
  • 4. Observations and Result Effect of Pada Abhyanga on various symptoms of Vipadiaka 20 Patients of Vipadika were treated with Pada Abhyanga done with Durvadi Keram and Jeevanthyadi Yamakam combination. 50 ml of Taila was taken daily for Abhyanga in sukhoshna state. Each patiets were administered 10 gm of Manibhadra gulam at bed time and Manjishtadi Kashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before food throughout the course of treatment. Pada abhyanga was started only after removing the thickened skin and thorough wash with Sukhoshna Jala. Table No:1 Table showing the Effect of Pada Abhyanga on Selected variables of Vipadika Variables Level of study Mean Score % relief SD SE ‘t’ P Cracks on Base line 2 - - - - foot After Nimajjana 1.2 60 0.834 0.186 6.452 <0.001 After 3 months 1.85 27.5 0.511 0.114 4.825 <0.001 Secretion Base line 2.1 - - - - After Nimajjana 1.25 47.62 0.587 0.131 4.472 <0.001 After 3 months 1.8 14.29 0.733 0.164 1.829 >0.05 Pain Base line 1.8 - - - - After Nimajjana 1 58.33 0.944 0.211 4.976 <0.001 After 3 months 1.15 36.11 0.875 0.196 3.316 <0.01 Itching Base line 2.1 - - - - After Nimajjana 1.25 40.48 0.587 0.131 6.489 <0.001 After 3 months 1.95 7.14 0.671 0.15 1.00 >0.1 At baseline the mean score of Cracks on the foot was 2 and after Pada Abhyanga it reduced to 1.2. After the follow up period of 3 months the relief was reduced from 60% to 27.5% with ‘t’ value 4.825 and found statistically significant (P <0.001). Mean score of Secretion at baseline was found relief with 47.62% reduced later to 14.29% after the follow up period. After the course of treatment of 14 days the Pada Abhyanga was found statistically highly significant but later after the follow up reduced to Mildly significant with P >0.05. From the above table Pada Abhyanga on the Pain was found statistically significant at P <0.001. But after the 3months period the relief was reduced to 36.115 from an initial relief of 58.33%. Itching was found reduced after the 14 days treatment with statistically significant P value <0.001. There was a drastic drop in the relief with 7.14% with ‘t’value 1 and found statistically insignificant. Effect of Pada Nimajjana on various symptoms of Vipadiaka 20 Patients of Vipadika were treated with Pada Nimajjana with a combination of Durvadi Keram and Jeevanthyadi Yamakam. Patients were asked to dip the affected area of leg in 200 ml of sukhoshna Taila for 30 min. New oil is taken after the 7 days treatment. Each patient were administered 10 mg of Manibhadra gulam at bed time and Manjishtadi Kashayam 20 ml mixed with 60 ml of boiled and cooled water twice daily before food throughout the course of treatment. Pada Nimajjana was started only after removing the thickened skin and through wash with Sukhoshna Jala. 304
  • 5. Table No: 2 Table showing the Effect of Pada Nimajjana on Selected variables of Vipadika Variables Level of study Mean Score % relief SD SE ‘t’ P Cracks on Base line 2.5 - - - - - Foot After Nimajjana 0.65 74 1.014 0.227 8.149 <0.001 After 3 months 0.5 80 0.973 0.218 9.174 <0.001 Secretion Base line 2.1 - - - - - After Nimajjana 1.1 48 0.725 0.162 6.173 <0.001 After 3 months 1.05 50 0.686 0.153 6.830 <0.001 Pain Base line 1.85 - - - - - After Nimajjana 0.35 81.08 0.946 0.212 7.075 <0.001 After 3 months 0.2 89.19 1.082 0.242 6.818 <0.001 Itching Base line 2 - - - - - After Nimajjana 0.2 90 0.834 0.186 9.677 <0.001 After 3 months 0.15 92.5 0.875 0.196 9.439 <0.001 At baseline the mean score on Cracks on the foot was 2.5 which later after treatment reduced to 0.65 and again reduced to 0.5 after the follow up period. Effect of Pada Nimajjana on Cracks on the foot was found statistically significant at P <0.001. Pada Nimajjana has shown 48% reduction on Secretion. The effect is statistically significant at the level of P<0.001. After the follow up period there was a reduction of 50%. This effect is also statistically significant P<0.001. The mean score at baseline on pain was 1.85, which is reduced to 0.35 showing a reduction of 81.08%. After the follow up period the score was 0.2 by a reduction of 89.19%. Both these effects were statistically significant at the level of P<0.001. After Pada Nimajjana there was 90% reduction in itching. Mean score on Itching at baseline 2 reduced to 0.2. The effect is statistically significant at the level of P<0.001. After the follow up period the reduction in Itching was 92.5% and the effect was statistically significant (P<0.001). Table No: 3 Overall Effect of Pada Abhyanga and Pada Nimajjana on on selected variables % of Relief in Symptoms Pada Abhyanaga Group Pada Nimajjana Group Variables After Treatment Follow up After Treatment Follow up Cracks on foot 60 27.5 74 80 Secretion 47.62 14.29 48 50 Pain 58.33 36.11 81.08 89.19 Itching 40.48 7.14 90 92.5 Above table (Table No.9) shows the comparative effect of the Pada Abhyanaga and Pada Nimajjana on various symptoms of Vipadika. Even though both the therapies are statistically significant in reducing the symptoms Pada Nimajjana showed more % of Relief on various symptoms. Apart from this the result obtained by the Padanimajjana was improved further in the follow up period while the results were reduced in the Pada Abhyanga group after the period of follow up. 305
  • 6. Discussion Vipadika Vipadika is mentioned as one of the Kshudra roga’s where we can find the Cracks over the Palms and soles. The dosha involved in Vipadika is Vata. Because of the excessive friction or pressure over the skin Vata gets vitiated locally. Due to the increase in the rukshata of Vata the skin gets dry and becomes thickened. This results in the cracks. The condition may further worsen due to the absence of personal hygiene. Selection of the Patients Hygiene plays an important role in the pathogenesis and Management of Vipadika. During the management of Vipadika, if the patient doesn’t keep the affected area clean, one can’t achieve the better results. In children below 10 years age it is very difficult to maintain the hygiene of the extremities. That is the reason children are avoided in the study. Effect of the drugs Durvadi keram is one of the drugs of choice in the management of Vrana. Most of the Vipadika cases exhibit secretion associated with cracks and Durvadi keram due to its Vranahara property will take care of the condition. Similarly Jeevanthyadi yamakam is one of the suitable drugs for the Vata pradana Kushtha’s especially indicated in Vipadika. Due to the presence of Brumhana Dravya like Jeevanthi it will do the shamana of the Vata8. As it is one of the Yamaka sneha it will do more snehana when compared to single Sneha9. This Yamaka Sneha will reduce the Vata locally and also will soften the dry thickened skin. Effect of the therapies Pada abhyanga is the commonly used therapeutic procedure for the management of Vipadika, where the suitable taila will be applied to the area and abhyanaga is done for 30 to 40 minutes. On the other group in Pada Nimajjana the affected area is dipped in the Sukhoshna Taila for certain period. Unlike in Pada Abhyanga here in Nimajjana we are achieving the Snehana along with Swedana. Application of Snehana and Swedana together will provide the Shamana of Vata10 very easily. In Nimajjana the continuous contact of warm with the skin will enhance the Bio-availability of the drug. Conclusion Statistical analysis of the obtained Data shows that, Pada Nimajjana is more effective in reducing the symptoms of Vipadika The results obtained was sustained or even better in the Pada Nimajjana Group when compared to the Pada abhyanga. Pada Abhyanga was not effective in managing itching as it was seen worsened after the follow up period The Taila used for the total course of Pada Nimajjana was less than the taila used for the Abhyanaga. This helps us to reduce the cost of the treatment. Also in the Nimajjana the physical effort for the treatment is very less. 306
  • 7. Limitations The result may not be very significant as the sample size is very small. It was the limitation of the study that 2 of the selected symptoms (Pain and Itching) were subjective and we have to depend on the patients completely to assess the results. Scope for further Study Same study can be repeated with a large number of populations with various objective assessment criteria’s. Bibliographic references 1. Caraka Samhita, Chikitsa Sthana 7/22 2. Sushruta, Samhita. Nidana Sthana 13/29 3. Sushruta, Samhita. Nidana Sthana 13/29 4. Ashtanga. Hrudaya, Sutrasthana 1/25 5. Sushruta, Samhita. Chikitsa Sthana 20/19 6. Sahasrayoga- Taila prakarana 7. Ashtanga. Hrudaya, Chikitsa Sthana 19/78 8. Dravyaguna Vijnana- P.V Sharma 9. Ashtanga. Hrudaya. Sutrasthana 16/4 10. Caraka Samhita, Sutrasthana 14/4 307