Diagnosis of Twak Roga (Skin Diseases) & Treatment Protocol in Ayurveda

Abstract

Twak roga or skin disorders are the most recurrent and common human health affiliation. Skin conditions are affecting around 900 million people world wide at any time. In India, the percentage of people with skin disease varies according to geographical areas. It is in between 7.9% to 60%. Skin and subcutaneous diseases are responsible for significant morbidity worldwide but they don't get due importance in national health planning and policies in several countries. As the diseases related to skin or twaka are becoming common and allopathic science does not have a handful of drugs to get rid of them, many of the population is searching and getting relief from Ayurvedic preparations. In this article we will be discussing how Ayurveda understands skin disorders and what are the ways through which skin conditions are diagnosed in Ayurveda.

Introduction

Before jumping on to the diagnostic ways Ayurveda suggests for Twak roga, one should understand what is skin according to Ayurveda. Skin or twak is one among the five gyane indriya (Sensory faculties) of the body. This is also considered as updhatu of mansa dhatu and has a function to analyse sensation of touch. The skin is also the ashrey sthana or location of sweat channels. These sweat channels are named as swedo vahi srotas in Ayurveda. Ayurveda acharaya had mentioned that twak has seven layers and every layer has its different thickness. There are some diseases in Ayurveda which are mentioned to be specific in certain layers of skin.

Now moving forward let's dig deeper into the concept of Twak roga according to Ayurveda.

Common Skin Problems explained in Modern vs. Ayurveda

Skin diseases as mentioned above are becoming common world wide. Whether children or adults, all age groups are suffering. Modern science explains skin disease as in the form of rashes, viral infections, bacterial infections, fungal infections, parasitic conditions, pigmentation disorders, wrinkles, spider veins, varicose veins and many others.

But Ayurveda has mentioned all skin conditions under a single category that is kushtha. Kushtha has two subtypes maha kushtha and shudra kushtha. Maha kushtha has seven types and shudra kushtha has 18 types. It is even mentioned that kushtha can be of innumerable types. All of the modern explained skin conditions may not have clear cut correlation with kushtha types but according to dosha vitiation and dhatu involvement a very good management of skin conditions can be done in Ayurveda.

Ayurveda suggests a wide range of causes for dermatological diseases as well. Mainly the Nidana or causative factors include the following:

• Aharaja Nidana: Food related causes
• Viharaja Nidana: Regimen related causes
• Manasika Nidana: Specific psychological causes
• Vishesha Nidana: Some etiological factors that are specific to this condition and do not exist in other conditions
• Sahaja Nidana: The factors that cause disease due to beeja bhaga avyava dushti or genetic cause

Most of the skin diseases or dermatological conditions are the results of wrong food habits, not so good lifestyle, unhygienic habits and certain psychological factors.

The most important in all of the mentioned causes is Faulty diet. But how is the diet responsible? That's the question. The answer of this question is as following:

Taking of heavy meals, taking of meals before the previous meal is being digested or consumption of unwholesome foods, taking milk along with meat or fish, bathing while feeling hot like after being exposed to sunlight, suppression of urges of vomiting etc. All these factors vitiate pitta and kapha dosha which gets mixed up with vata dosha. Thus the spread of these tridosha over the body tissue happens resulting in patches, itching, inflammation wherever doshas get stagnant.

As we know the basics of Twak roga as per Ayurveda, now let's discuss the most important part of this article and that is diagnostic indices of twak roga.

Diagnostic Indices of Twak Roga (Skin Diseases)

The diagnosis of the skin diseases depends on the sign and symptoms the patient usually presents with.

The usual symptoms associated with twak roga are itching, pain and disturbed sensations in the nature of crawling, sense of heat, stinging, no sensation or hyperaesthesia that is excessive sensitivity.

On the other hand the patient also presents with some signs which are called as Vrana or primary lesion. The primary lesions which are usually noticed are as follows:

1. Macules (Vaivarnya)

Macule is a small sized, not so raised circumscribed lesion with alteration in colour. The macules are generally of two types: Erythematous like in dermatitis, psoriasis, leprosy etc

Pigmentary macules are further divided into three types:

1. Hyperpigmentary: Chloasma, freckles
2. Hypopigmentary: Leprosy, tinea versicolor
3. Depigmented: Vitiligo, leucoderma

2. Papule (Pidika)

It is a solid , raised lesion about the size of a split pea or smaller. A papule can be static or can be transient as well. An endemic papule is usually superficial, dry, solid and flesh coloured. The dermic papule is deeper, elastic and radish. The common causes of papules are warts, eczema, psoriasis, lichen, acne, chicken pox, syphilis, drug eruption etc. The examples of nodules are neurofibromatosis, leprosy, skin cancer, syphilis etc.

3. Vesicle (Sphota)

This is a circumscribed serum or plasma containing elevation of the integument. When ruptured, the contains ooze out. The size of the vesicle varies from the size of a pin head to that of a small pea. A similar lesion but larger in size is called a bulla. Usually, vesicles are transitory and of short duration. They either rupture or ooze, or their contents usually coagulate to form crusts, or enlarge to form bullae, or transform to pustules. Their roof can also get rubbed off to leave behind a moist and raw surface. On the palm of the hands they are situated rather deeply, hence their content is discharged with difficulty. On the mucous membrane their roofs get rubbed off very easily producing erosion. The common causes of vesicles are - eczema, scabies, chicken pox, herpes zoster, insect bites etc. The common causes of bullae are: impetigo, pemphigus, dermatitis and herpetiformis etc.

4. Wheal (Mandala)

It is flat, evanescent swelling on the skin which is due to the local dilatation of blood vessels. The increased permeability results in localised edema. Wheal disappears without leaving any trace of tain, scars or atrophy. A wheal is usually pale in the centre and red at the periphery, but it may be uniformly whitish or reddish. Occasionally, it may be surmounted by vesicles. The common examples of wheals are: urticaria, drug rashes, insect bites etc.

5. Pustule (Puya pidaka)

This differs from a vesicle or a bulla in the nature of its content. The pustules are fluid containing elevation. This may arise as such or may be a transformation from a papule. Pustules terminate by rupture or desiccate to form irregular yellow crusts. Common examples are furunculosis, scabies, acne, chickenpox, carbuncle, impetigo etc.

In some other cases there are presence of secondary lesions as well. Secondary lesions are the result of modification of the primary lesion either by the individual with the lesion or through the natural evolution of the lesion in the environment.

Secondary lesions which are generally present in skin conditions are as follows:

1. Scales or Squama

It is a dry exfoliation of the skin. This is due to the increased or abnormal formation of stratum corneum (hyper or parakeratosis). This results from the erythema or inflammation of the skin or increase in dryness. The conditions which result in formation of scales are: psoriasis, tinea corporis, pityriasis versicolor, seborrheic dermatitis, eczema, exfoliative dermatitis, tinea capitis, pityriasis rosea, lupus erythematosus etc.

2. Crust or Scab

This represents a dried up mass of oozing and other products of inflammatory tissue which is particularly epithelial debris. Scabs from on vesicles, pustules, bullae or ulcers erosions and excoriations. The crusts are common in herpes zoster, eczema, dermatitis, impetigo, ulcer, seborrhoeic dermatitis.

3. Excoriations

They are superficial, linear lesions which are characterised by the removal of the epidermis by scratching or by abrasion. An excoriation may be superficial or deep. This gets covered by a crust. The crust is simple, with blood or impeti. Excoriations is an evidence of pruritus.

4. Fissure

It is a linear crack in the integrity of the skin reaching down to the papillary layer of the dermis or deeper. It has length but has no breath. A fissure is usually accompanied by pain which interferes with the movement of a particular part. Common examples of fissure are fissure-in-ano, chronic eczema in the palms and soles, angular stomatitis, chapping of hands as in extreme dryness, syphilitic fissure.

5. Ulcer

Ulcer is the circumscribed lesion starting from a break in the skin, reaching up to the level of dermis. It has a definite length as well as breath. The ulcers are commonly caused due to traumatic, pyogenic, varicose ulcer, peripheral vascular disorders, metabolic disorders etc.

6. Scar

Scar represents a healed destructive lesion of the dermis and deeper parts. Whenever any inflammatory or traumatic lesion destroys the basal layer of the epidermis and the underlying corium, a scar is formed. Superficial epidermal lesions heal without scarring. The most common causes of scarring are traumatic burns, chickenpox, herpes, varicose ulcer, neoplasm, leprosy etc.

These are the general signs which are observed in a patient by the doctor to diagnose the condition. But there is also significance of dosha predominance in the skin conditions.

Following chart shows predominant clinical features of the skin conditions according to dosha dominance.

Vataj Pradhanta	Pittaj Pradhanta	Kaphaj Pradhanta
Roukshyata (roughness)	Daha (Burning sensation)	Shweta (white in colour)
Parushya (Hardness)	Raga (redness)	Saityata (cold in touch)
Toda (Pricking pain)	Srava (Suppuration)	Kandu (itching)
Sankocha (Constriction)	Visra gandha (Smell like raw meat)	Gaurava (Heaviness)
Shyava varna (Blackish in color)	Anga patna (Sloughing of limbs)	Jantubhi abhibhakshana (Maggot formation)
Arjunvarna (Reddish in color)		Kleda (Stickiness)

So, that's all about the diagnosis of tawk roga. Once you have analysed the type of lesion and the dosha involved, then only after that you will be able to give the treatment.

Ayurveda is no doubt a very deep science and yes according to dosha dushya and appearance a skin disorder can be easily diagnosed. But you must be very accurate because this will decide what type of treatment you are going to advise.

The following chart is based on the assessment of the dosha and how various stages are decided according to that.

Dosha	Stage	Treatment
Vata - Pitta	Acute	Ghrita
Pitta - Kapha	Sub Acute	Churna/Kashaya
Kapha - Vata	Chronic	Aasav, arishta, lavana or kshara

This is basically an overview of how various formulations in Ayurveda are used in skin conditions.

But obviously, internal and external both types of treatment are necessary for severe conditions.

So what is the treatment protocol in ayurveda for Twak vikara or skin disorders?

The line of treatment in this Twak vikara starts from:

• Diagnosing: The diagnosis must be accurate and quick to get complete results.
• Secondly, if the condition seems chronic then shodhana must be done. Shodana is detoxification of human body using various panchakarma procedures.
• If the condition is acute then using herbal preparations according to dosha predominance can help. One can also use rasayan aashadi along with sanshaman aushadhi (Internal medication) as well.
• In most of the skin disorders virechana is preferred. The reason is, it expels out excessive pitta dosha in the body. Rakata and pitta dosha are in an inseparable relation as pitta is the mala od rakata dhatu. As excessive pitta gets out of the body the purification of blood takes place. That's how the subsiding of the conditions takes place.
• Raktamokshana is also done as a pradhan karma in skin conditions.
• After rakat mokshana and virechana, ghritpana (internal intake of medicated ghrit) is advised to avoid prakopa or aggravation of vata dosha.
• Lepa is also applied after shodhana or rakta mokshana.

After diagnosis and treatment one should also follow some pathya and apathya. These are basically the changes one should introduce in diet and lifestyle. Pathya are the things which are to be consumed or followed. On the other hand apathya are the things which can be abstained from diet and lifestyle as well.

Pathya for Diet and Lifestyle in Twak Roga

So, here the question arises what exact role diet plays in all of these?

Diet is really important to follow as we are what we eat. Salty, spicy foods along with incompatible food combinations like meat with milk or fish with milk, fast foods, junkfood, cold drinks etc generally aggravates the symptoms. Also non veg, tea or coffee, amla and guru dravya (Heavy to digest food) along with navin anna (freshly harvested grains), masha (black lentils), mulaka (radish), curd and dairy products also plays an important role in aggravation of symptoms.

Now what should be eaten? To answer this question following are some tips that are to be followed by a twak roga patient very strictly:

• The diet should be balanced and wholesome
• Sattwik diet is very essential in twak roga. Satwik here means a diet which is having only natural food articles like vegetables, fruits, legumes, sprouts and dairy only when the cow is fed and milked properly.
• Light diet, not too oily and not too dry.
• Periodic fasting is also to be done.
• Maintain adequate hydration by drinking enough amounts of water.
• Tikta dravya, old shali, yava, godhuma (wheat), mudga, adhaki, old ghee, mustard oil, tila oil, go mutra etc can be consumed.

Pathya Lifestyle

• One should wake up early in the morning and should go to bed early as well.
• Try to meditate for 15 minutes in a day. This will helps in getting rid of stress.
• Do yoga or exercise in fresh cool air as it stimulates natural skin restoration, Mild sun light is also good for skin.
• Clothing should be proper as well.
• Bathing should be done regularly.
• Digestion should be observed on regular basis.

Apathya Diet and Lifestyle in Twak Roga

• Avoid food articles which are Salty, pungent and spicy.
• The concept of virudha should be understood and must be followed.
• Only freshly prepared vegetables and legumes must be eaten.
• Sprouts and plant based protein must be preferred.
• Excessive stress is dangerous as it can aggravate symptoms.
• Anger, greed, excessive sexual activities must be abstained.
• Exposure to excessive cold and excessive heat can aggravate symptoms.
• Sedentary lifestyle is to be Avoided.
• Late night sleeping is to be avoided.
• Diet cheat is not to be done.

So these are the pathya and apathya which are to be followed in the Twak roga.

Twak roga in ayurveda is a very vast topic and needs a deep understanding of dosha and dushya. The management in some cases also becomes tough as patient cooperation with diet and lifestyle is needed highly.

Conclusion

As mentioned before twak roga, if to be managed with Ayurveda needs high patient corporations and will power as well. The patient is asked to abstain from things for his or her own benefits. Obviously disease management comes with a price and that price is paid by the patient by following the rules of abstinence. Twak roga can be very difficult to manage sometimes when there is involvement of all three dosha and the condition is chirkaliya which means from a long time. No doubt herbs and herbal formulation help a lot but the contribution from the side of the patient is must. In case of any queries kindly visit www.PlanetAyurveda.com