🔘 Dasha Vidha Pareeksha

Dasha Vidha Pareeksha 

👉🏻 Introduction: 

As a rule, before starting any treatment, the disease and diseased should be thoroughly checked and examined. Dasha Vidha Pareeksha or tenfold examination as explained in Ayurvedic treatises is one of the most comprehensive protocol of patient and disease examination, to the point of perfection. Dasha Vidha Pareeksha enables a physician to reach accurate diagnosis of the disease, to know the nature and strength of the disease and the diseased. It also helps in knowing the life span of the individual in question. By learning the quality and quantity of the life element in the patient, the physician can figure out if the patient fits into the treatment protocol or not. Likewise it helps in planning and determining the methods and strength of treatment which needs to be conducted and also to make a proper choice of the medicines.

👉🏻 Dasha Vidha Pareeksha comprises of examination of 10 factors are as follows; 

1.Prakriti – Dosha body type

2.Vikriti – anamoly / pathology

3.Sara – Dhatu Body Type

4.Samhanana – compactness

5.Pramana – measurements of patient

6.Satmya – Congenial things and habits of patient

7.Satva – tolerance capacity of patient toward strong medical treatments

8.Ahara Shakti – digestion capacity

9.Vyayama Shakti – exercise capacity

10.Vaya – age of the patient. 

1. Prakriti: 

Prakriti means the basic constitution (physical and mental makeup acquired at birth) of the patient or inherent characteristic features of an individual. Prakriti helps to know about the natural inheritances of an individual so that it can be differentiated from the abnormalities. It helps in knowing what is natural and normal for an individual. Kapha predominant Prakritis are strong, Pitta Prakritis carry moderate strength and Vata predominant Prakritis have less strength. Thus Prakriti is a determinant of atura bala or strength and tolerance of a patient. 

Prakruti is mainly considered as the swabhava of an individual. The Ayurvedic concepts of physiology, pathology, diagnosis, medicine, and therapeutics are based on the doctrine of the three dosha. Every dosha is believed to have inherent attributes, which are expressed in the physical, psychological, and physiological characteristics of an individual. 

2. Vikriti: 

Vikriti is opposite of Prakriti. It is the abnormal deviation from the Prakriti or imbalances occurring in the Prakriti. The abnormal changes occurring in the basic Prakriti or the morbid changes taking place in different parts of the body or mind or both in relation to Prakriti is called Vikriti. The Doshic vitiation occurring in the body is also called as Vikriti. It helps in figuring out what is abnormal to an individual. This helps in addressing the health issues. It is the Vikriti which we treat. Vikriti shows the Vyadhi bala i.e. the strength of a disease or doshas, which is important to plan a treatment protocol effective enough to abort the disease process following the strength of the disease and the doshas involved. 

If the afflicted doshas and dhatus physical constitution of patient (prakruti), desha, kala, bala, of the individual resemble that of disease in quality and the causative factors and symptoms are too strong and numerous. The disease manifested is acute and severe. In brief vikriti refers to morbidity of the susceptible individual and it is also helps to ascertain the strength of the pathogenesis 

factors responsible for the manifestation of 

disease and also helps to predict the prognosis of the disease. The vikriti pareeksha is stated for dosha Bala pramana of atura. For the assessment of vyadhi – hetu (cause), dosha, dusya, prakruti, desha, kala and Bala must be observed with their sub-types also. The vyadhiBala is assessed by the intensity of etiology (hetu), symptoms of diseases parameters. They are collectively described as the conditions namely of easily curable (sukhsadhya), moderately curable 

(krichsadhya) and in-curable (asadhya). 

3. Sara (Examination of essence of all 

dhatus): 

Sara means the status, quality, quantity and goodness of the tissues. Dhatus are building blocks of the body and also form the defense unit. Everyone has all dhatus but any one or few dhatus are predominantly strong in a given individual. Those dhatus have a natural immunity and are less susceptible to be afflicted by diseases. They stand a lesser chance to be invaded by doshas. Diseases manifest when morbid doshas invade and damage the dhatus. Saratva of dhatus indicate how strong the immunity of the tissues is in the body. If all the dhatus have good sara, it indicates optimum immunity and a good operating defense mechanism in the body. The stronger the dhatus, the stronger is the person. Thus Sara is an indicator of the atura bala or strength of an individual. This in turn helps in planning a treatment protocol according to ones tissue strength, durability and endurance. 

Importance of Sara Pareekhsa: 

Charaka has described sara examination 

under the tenfold s examination techniques. 

Charaka has emphasized that sometimes the physicians may take a wrong decision only by seeing the body of the patient such asstrong 

because of being corpulent, weak becauseof 

leanness, very weak because of possessing 

small body. But factually it is observed that 

some persons possess small body and leanness is strong. They are like ants that have small body and look emaciated but can carry too heavy a load. Big and corpulent persons may have strength than the lean and short body, like elephant having big and corpulent body possessing less strength that the lean and short bodies lion.The eight subtypes of sara may be assessed in term of relative quality i.e. sarva sara purusha, madhyama and asara or avara. 

The characteristic are as follows:

a. Sarvasara or pravara sara purusha -

These person have all the dhatus in abundance and of good quality. They are endowed with great biological strength, absolute happiness, endurance against difficulties, self confidence in all enterprises, 

inclination benevolent acts, firm and 

balanced body, well balanced gait, nature 

of voice is resonant, unctuous, serious, and 

high pitch, happiness, supremacy, wealth, 

enjoyments, honor, delay of aging, low 

degree of pathogenesis, minimum diseases, numerous offspring’s of identical qualities and longevity, presence of great respect, hope of success in all activities, capacity of withstanding troubles, wisdom and steadiness. 

b. Madhyama sara purusha- 

Moderate amount of different sara possess qualities of respective Saras in moderate degree and show characteristics of sarva Sara moderately. 

c. Asara / avara sara purusha-

These persons having least amount of different sara possess qualities of respective Sara in less degree. 

4. Samhanana (compactness): 

Samhanana means the compactness of the body. It indicates the integrity of the body components and the composure of the body. It also determines the coordination between the body and mind and their integral health and strength. Lesser the compactness more is the proneness to diseases. 

Thus Samhanana is one of the indicators of the atura or rogi bala. 

a. Pravara samhanana –

Symmetrical and well demarcated bones, well joints, well bound muscles blood, strong built , excellent strength 

b. Madhyama samhanana –

Moderately symmetrical and demarcated bones, moderately joints, moderately bound muscles blood, moderately built, moderately strength.

c. Avara samhanana – 

Weakly Symmetrical and demarcated bones, Weakly joints, Weakly bound muscles blood, Weak built, Weak strength.

Samhanana, samhati and samyojana are its 

synonyms. Evenly well-demarcated bones, 

well-bound joints, well formed muscles are 

known as compact body. Who having well 

compact body they are strong and having 

good strength. 

5. Pramana (Anthropometry-examination 

of measurement of bodily organs):

Pramana determines the measurements of the body parts. Body components should be present in the desired quantity or numbers. This is measured in terms of Anguli Pramana (dimensions, i.e. length, breadth, circumference etc of the body parts) and Anjali Pramana (quantity of body tissues) and Sankhya Shareera (number of organs, body parts and tissues). If the pramana of body components are in right proportions, the health, integrity and strength of the body is at its optimum best. Thus, Pramana of body components is an indicator of rogi bala or strength and endurance of the patient. 

For assessment it can be subdivided into

a. Pravara Pramana- standard measurement 

criteria excellently height, length and 

breadth. 

b. Madhyama pramana- standard 

measurement criteria moderately height, 

length and breadth. 

c. Avarapramana- standard measurement 

criteria lesser extent height, length and 

breadth. 

6. Satmya (Suitability or examination of 

homologation): 

Saatmya explains the compatibilities related to the patient, wholesomeness developed by habits which result in conduciveness to the health. Knowledge of Satmya tells us what is good and what is bad, what is compatible and what not to body and mind (and for maintenance of good health), what to take and what to avoid. Satmya is any food (or activity) which on consumption becomes adjustable to the body and mind. Knowing Saatmya helps in providing comprehensive medical care. 

Satmya is that which being used constantly has wholesome effect; those used to ghrita, kshera, taila, mamsa rasa, and all rasas are strong, enduring and long-lived. On the contrary, those used to irregular diet and single rasa are often weak, un-enduring, and short lived with a little means. Those having mixed suitability have medium strength. 

7. Satva (psyche-examination of mental 

faculties): 

Satva denotes mental strength, tolerance levels, emotions and moods of the patient (mental parameters). Body and mind are two sides of the same coin. The wellness of body and mind are interdependent. 

Depending upon its strength, it is of three 

types, viz. pravara, madhyama and avara satva 

depending on their mental faculties. 

a. Pravara satva: 

1. Excellent mental faculties. 

2. Able to bear the stronger therapies without 

producing any harmful effect to the body. 

3. Weak physique person having excellent 

mental faculties tolerates serious 

exogenous and endogenous diseases 

without diseases without much difficultly. 

4. Tolerates and adjusts to pain or odd 

situations well. 

b. Madhyama satva: 

1. Moderate mental faculties. 

2. Able to bear the stronger therapies without 

producing any harmful effect to the body. 

3. Weak physique person having moderate 

mental faculties tolerates serious 

exogenous and endogenous diseases with 

much difficultly. 

4. Tolerates and adjusts to pain or odd 

situations moderately. 

c. Avara satva: 

1. Inferior types of mental faculties. 

2. Neither by themselves nor through other 

can sustain their mental strength. 

3. In spite of having sound physique, they 

cannot susceptible to fear, grief, greed, 

delusion and ego. 

4. When they hear even stories describing 

wrathful, fearful, hateful, terrifying and 

ugly situation or come across visions of 

flesh or blood of an animal or man, they 

fall victims to depression, pallor, fainting, 

madness, giddiness of falling on the 

ground, such events may even lead them 

to death. 

5. These type of person are contraindicated 

to samsodhana karma 

6. Tolerates and adjusts to pain or odd 

situations very badly. 

Satva controls the body by conjunction with 

the self. 

8. Ahara shakti (Examination for intake of 

food): 

Ahara Shakti comprises of assessment of metabolism and digestion capacity of an individual (patient). Food or aahara is a vital component needed for life activities and sustenance of life. For this to happen one should be able to take proper quality and quantity of food, digest, and assimilate it to get energy and strength. Health and disease, both are dependent on what and how much we eat. Ahara Shakti also is an indicator of metabolic health and strength of the patient (atura bala) and is also helpful in planning a proper protocol for treatment since dietetics are essential part of comprehensive treatment plan up. 

This may be classified into three subtypes for the purpose of assessment are as follow: 

a. Pravara ahara shakti(excellent power of 

digestion ): 

Person having excellent power of ingestion and digestion of food are claimed to be healthy persons. These kind of person endowed with excellent strength, longevity, joy, good physique, superior mental faculties, full of essence of dhatus, power of resisting any sort of difficulties etc. digestion of food when taken in large quantity is indicative of excellent Ahara Shakti. 

b. Madhyama ahara shakti (Moderate 

digestive power): 

Individual having moderate strength of ingestion and digestion of the food are claimed to be moderately healthy. Moderate medicaments may be prescribed for the effectivemanagement. These persons possess moderate strength, longevity and immunity.

c. Avara ahara shakti(weak digestive power): 

Person is unable to digest even small quantities of food these persons suffers from diseases very often and endowed with less strength longevity, immunity and unable to sustain the stronger medicaments. Mild medicaments are required for the effective management and medicines should be administered for longer duration to recover from diseases. 

This is examined by the power of ingestion 

(abhyavaharana shakti) as well as digestion 

(Jarana shakti). Strength and life depend on 

diet, jarana shakti is assessed by Udgarasuddhi, utsaha, vegotsarga- yathocita, laghuta, ksut (appetite) and pipasa (thirst). In clinical practice assessment of agni is very important for the selection of medicine, selection of treatment modalities and fixation of dose of medicine. 

9. Vyayama shakti (capacity of exercise): 

Vyayama Shakti means exercise tolerance of the patient. Exercise is an important aspect of treatment protocols. Good exercise capacity and tolerance is an important indicator of good health and good strength and endurance. Exercise can be included as a component in the treatment protocol for these patients. 

For the assessment of vyayama shakti three parameters were selected which are breath holding exercise, stepping exercise, measurement of basal pulse rate. 

a. Pravara vyayama shakti - 

Individual possess a excellent exercise endurance. To advice rehabilitation programme person should have a good power of exercise. These persons able to do a physiotherapy technique without much difficulty, this helps for faster recovery. These kinds of individual are able to perform heavy exercise. 

b. Madhyama vyayama shakti–

Individual possess a moderate power of exercise. Person follows the physiotherapeutic technique moderately as a result it hampers the quicker relief. Moderate 

medicaments must be prescribed to gain 

desirable results. 

c. Avara vyayama shakti-

Individual possess a mild power of exercise. These people are unable to follow the physiotherapeutic technique even up to slighter extent. This hastens the slower recovery. Mild medicaments are suitable to gain good results. 

10. vaya (Examination in respect of age): 

Vaya is defined as the state of the body corresponding to the length of time that has passed since birth. Age is broadly divided into three stages – bala (childhood), madhya (middle age), jeerna (old age). Childhood is determined up to sixteen years when the dhatus are immature, sexual character are not manifested; the body is delicate, unstable with incomplete strength and predominant in kapha dosha. This again with dhatus in developing stages and unstable mind remains up to thirty years. Mild medicaments may be employed. The middle age is assessed by strength, energy, virility, acquisition, retention, recollection, speech, understanding and qualities of all dhatus having reached the normal limit, with proper physical and mental strength, without degeneration in qualities of dhatus, with predominance of pitta dhatu and is up to 60 years. Stronger medicaments may be employed to gain the success. 

Life span of individual viz. long, medium and 

short can be determined by superiority, mediocrity and inferiority of prakruti, Sara etc. except vikruti. 

For example if a person possess a prava qualities of prakruti, sara etc excepts 

vikruti then individual lives longer , madhyama qualities leads to medium life span and avara qualities leads to short life span. So depending upon the long, medium and short life span age may be divided into Bala, Madhyama, Jeerna. Age is defined as the state of body corresponding to the duration of time. Childhood is determined up to sixteen years when the dhatus are immature, sexual characters are not manifested; the body is delicate with incomplete strength and predominant of kapha dosha. This again with dhatus in developing stage and unstable mind remains up to thirty years. The middle age is characterized by strength, energy, virility, acquisition, retention, recollection, speech, understanding and qualities of all dhatus having reached the normal limit; with proper physical and mental strength, without 

degeneration in qualities of dhatus, with predominance of pitta dosha and is up to sixty years. 

Sushruta considered the Madhya vaya 

up to 70 years with four division of Madhya 

avastha. The old age is characterized by the 

gradual degeneration or decline of strength, 

organs, energy, virility, prowess, acquisition, 

retention, recollection, speech and 

understanding. Qualities of dhatus go down 

and there is predominance of vayu, during this age the measure of life span is one hundred years. 

👉🏻 Importance of Dasha Vidha Pareeksha: 

Dasha Vidha Pareeksha or tenfold examination is one of the most comprehensive formats of patient examination explained in Ayurvedic treatises. 

It is done mainly to study and analyze – 

• Rogi Bala – Strength (physical and mental) and endurance of the patient (except Vikriti) 

• Roga Bala – Strength of the disease 

• Ayu Bala – Quantity and quality of lifespan 

• Helps in planning a comprehensive treatment protocol (including diet and lifestyle recommendations) protocol 

• Helps in analyzing the normal and abnormalities related to body components, nature of morbidity, basic constitution, measurements and quantity of body components, tissues and organs, capacity to exercise and consume food, compactness and compatibilities related to body and mind and best qualities of the tissues of the body, all of which helps to know the strength of disease and diseased. 

Hence the concept of dasha vidha pareeksha described in Ayurveda is very much scientific in terms of understanding the span of life, strength of person, probable cause and strength of the disease. Before planning any treatment to the patient proper understanding of patients is required. The tenfold diagnosis process is a vital diagnostic Ayurvedic tool for assessing the current health of a patient and providing a 

basis for prognosis.

🔘 kshavathu ( Vasomotor rhinitis)

Kshavathu (vasomotor rhinitis)

👉🏻 Definition :- 

Kshavathu means sneezing. Kshavathu is thus a nasal disorder in which the patient suffers from too much sneezing. Master Vagbhata has used the term ‘Bhrsham Kshavah’ in place of Kshavathu. Bhrsham = repeated, Kshavah = sneezing.

👉🏻  Causes :- 

1. Tikshna ghranopayoga – inhalation of strong and irritating things.

2. Arka rashmisu – getting exposed to intense heat of the sun for longer duration.

3. Sutra trnadibhih – the nasal passage being irritated by inserting thread or grass / stick etc (often inserted to cleanse the nose).

4 . Vata kopaka karana - exposure to or consumption of other factors which cause aggravation of vata.

👉🏻 Pathogenesis :- 

Due to the above said causes the cartilages in the nose gets irritated. Due to this, vata gets vitiated. This vitiated vata when gets obstructed in the nose changes its course moves upwards and irritates the shrngataka marma located in the head. After striking the srngataka marma, vata reverts back and comes down towards the nasal orifices and causes plenty of sneezes frequently. This is called as Bhrsham Kshavthu.

👉🏻 Symptoms :- 

Repeated sneezing is the predominant symptom of Bhrsham Kshavah.

👉🏻 Types of Kshavathu :- 

In Mahava Nidana, quoting Sushruta, the author describes two kinds of Kshavathu.

1. Nija / Doshaja Kshavathu – 

Vata which gets vitiated in the marma located within the nasal passage gets admixed with kapha therein gets eliminated from the nose frequently producing sounds. This condition is called as Kshavathu.

Here we can see that the external factors are not involved and pathogenesis takes place due to the vitiated doshas, mainly vata getting vitiated in the marma. Vitiation of vata and irritation of marma is the chief process in the causation of frequent sneezing. The term marma here corresponds to srngataka marma.

2. Agantuja Kshavathu –

 Agantuja means that which is caused by external factors. Due to consumption of strong and irritating foods and also inhaling things of the same nature, getting exposed to heat of the sun for long duration or irritation of the phana marma located in the cartilages of the nasal passage or the cartilages of the nose or the shrngataka marma plenty of sneezes are caused frequently. This is called as Agantuja Kshavathu.

👉🏻 According to Acharya Charaka – 

‘The vayu located in the head when takes an abnormal course and touches the marma located in the nasal passage, it causes severe and frequent sneezing. This condition is called kshavathu.

👉🏻 Treatment of Kshavathu Principles of treatment :-

1. Pradhamana Nasya –

 snuffing medicated powders is beneficial. Alternatively the powders are filled in tubes and blown into the nostrils of the patient by the physician.

2 . Vataghna Sweda –

 sudation / fomentation with vata mitigating herbs is given over the head.

3. Snigdha Dhuma – unctuous fumigation is useful.

Useful formulations

4. Shuntyadi Ghrta or Taila – Ghee or oil prepared with the paste of the below mentioned herbs shall be used as oral medicines or as nasal drops –

5. Ginger

Kushta – Saussurea lappa

Pippali – Piper longum

Vidanga – Embelia ribes Raisins.

6. Sikthakadi Dhuma – 

Smoke emitted from burning together on fire the combination of Siktha – wax, Guggulu – Commiphora mukul and Ghee is useful.

👉🏻 According to modern : Vasomotor Rhinitis 

Kshavathu or Bhrsham Kshavah is compared to Vasomotor Rhinitis associated with Rhinorrhea explained in the modern texts due to closer resemblance of symptoms in both conditions.

👉🏻 Introduction :- 

Rhinitis and Rhinorrhea are the terms used for running nose. While rhinorrhea is a clear watery discharge from the nose, rhinitis is the inflammation of nasal tissues and membranes probably caused by irritants or allergen. Rhinitis can lead to rhinorrhea. Therefore rhinorrhea may often be a symptom of rhinitis.

👉🏻 Vasomotor rhinitis: 

 Many times there is no specific cause like irritant or allergen for inflammation. Such rhinitis is called as vasomotor rhinitis. It is also called as non-allergic rhinitis or idiopathic rhinitis. 

The symptoms of this condition can be uncomfortable but are not serious. It is more common after 20 years of age but can also affect children and adults.

Non-allergic rhinitis involves chronic sneezing or congested and running nose with no apparent cause. Though the symptoms resemble those of allergic rhinitis, evidence of allergy or allergic reaction is not present in this condition.

👉🏻 Causes of vasomotor rhinitis:- 

Vasomotor rhinitis is caused due to dilatation of blood vessels located in the nose. Dilatation of blood vessels consequently produces swelling leading to congestion and drainage of mucus from the nose. The other cause may be the hypersensitiveness or hyper-responsiveness of the nerve endings in the nose.

 - Common causes or triggers which might produce a reaction which leads to dilatation of blood vessels in the nasal cavity –

- Dust, smoke, smog, perfumes, strong odors, chemical fumes etc

Temperature / humidity changes often trigger the nasal membranes to swell and cause running nose. Dry weather to be precise is an important cause.

- Infections – Cold or flu and viral infections associated with these conditions.

- Hot or spice foods / drinks, drinking alcoholic beverages.

- Excessive use of nasal decongestant sprays

Medications – aspirin, ibuprofen, beta-blockers, antidepressants, oral contraceptives, some sedatives.

-Hypothyroidism

-Stress

-Hormonal changes associated with menstruation and pregnancy.

- Sleeping on your back, sleep apnea and acid reflux .

👉🏻 Risk Factors :-

Exposure to irritants – smog, exhaust fumes, tobacco smoke etc

Being older than 20 years of age

Prolonged use of decongestant nasal drops or sprays.

Being female – due to hormonal changes, nasal congestion gets worse often during menstrual cycles or pregnancy.

Occupational exposure to fumes – like construction materials, solvents, chemicals and fumes from decomposing organic material (compost) etc.

Certain health problems – Hypothyroidism, chronic fatigue syndrome etc may cause or worsen rhinitis.

Stress – physical or emotional stress may trigger the condition in some people.

👉🏻 Symptoms of Vasomotor Rhinitis :-

- Rhinitis

- Runny nose

- Stuffy nose

- Postnasal drip

- Mucus congestion in     the throat

- Sneeze

- Cough

These symptoms may keep coming and going all through the year. They may also be constant or even last for many weeks.

Vasomotor rhinitis is typically marked by the absence of itching in the nose, eyes or throat and watering of eyes. On the contrary these symptoms are generally found in allergic rhinitis. This condition is caused by allergy and vasomotor rhinitis is not caused by allergy.

👉🏻 Complications :-

- Nasal Polyps

- Sinusitis

- Middle ear infections

- Interruption of daily activities – less productivity at work or school, sickness,  absenteeism etc

👉🏻 Diagnosis of Vasomotor Rhinitis:-

This condition can be diagnosed when other causes of the symptoms are ruled out. Tests for allergy will help to rule out allergy as a cause of rhinitis. A skin test to identify allergies or a blood test to check if the immune system is good enough or not will help in diagnosis and differential diagnosis of this condition. Nasal endoscope or CT scan of sinuses may help in checking if sinus problems are causing rhinitis. If no evident cause for rhinitis is found, vasomotor rhinitis may be diagnosed.

👉🏻  Prevention  :- 

It is possible to prevent vasomotor rhinitis if the causes are identified.

Avoid overusing nasal decongestants. They often tend to worsen thesymptoms of the disease after having provided a short-term relief in the early part of their usage.

Studies suggest that children who consumed oily fish or certain polyunsaturated fatty acids are less prone to develop non-allergic or allergic rhinitis.

👉🏻 If you already have vasomotor rhinitis, you may take all steps which would reduce your symptoms, recurrences or flare-ups. These include –

- Avoid triggers

- Not overusing nasal - decongestants

👉🏻 Main principles of treating this condition includes –

- Over the counter saline nasal sprays

- Over the counter decongestants

- Over the counter nasal sprays

- Medications are given when symptoms are severe or if OTC medications produce side effects or no effects. Corticosteroids, antihistamine nasal sprays or anticholinergic nasal sprays or mix and match of these will come in for help to relieve the symptoms of vasomotor rhinitis.

 Surgery is rarely needed to treat the symptoms, especially if there are underlying health problems which intensify the symptoms inclusive of nasal polyps or a deviated nasal septum.

👉🏻 Home Remedies:- 

Home remedies shall be tried only when milder symptoms persist, to relieve symptoms and discomfort.

1. Nasal Rinse – Bulb syringe, neti pot or specially designed squeeze bottles shall be used to irrigate your nasal passages. This can be done at home and is called as nasal lavage. It helps in keeping your nose free of irritants. You may use filtered, boiled and cooled or distilled water for this purpose. This helps in prevention of infection. Often clean and sterilize your equipment.

2 . Nose Blowing – Blow your nose gently and regularly. This will help in clearing the mucus and irritants.

3. Humidification – Set up a humidifier at your work place or in your bed room if the air in your home or office is dry. Regularly cleanse your humidifier. Alternatively you may also breathe in the steam from a warm shower.

4. Hydration – Drink plenty of liquids, including water, juice and caffeine free tea. This will help in loosening the mucus in your nose. You may avoid caffeinated beverages.

🔘 Ventous Delivery

VENTOUS DELIVERY:-

👉🏻 Definition:-

- Ventouse is an instrumental device designed to assist delivery by creating a vacuum between it and foetal scalp.

- The pulling force is dragging the cranium in forceps while in Ventouse, the pulling force is directly transmitted to the base of the skull.

👉🏻 Instrumentation Components:-

- A suction cup with four sizes (30mm, 40mm 50mm, 60mm)

- Metal cup

- Soft cup

- Elastic cup

- Rigid plastic cup

- Vacuum pump

- Traction tubing

👉🏻 Indications:-

1. Maternal indications:-

- Maternal distress, exhaustion after a long, painful labour, due to inefficient uterine contractions.

- Prolonged second stage of labour.

- (Nulliparous: >3hrs with regional analgesia >2hrs without regional analgesia Parous: >2hrs with regional analgesia >1 hr without regional analgesia).

- Maternal medical disorders such as heart disease, hypertensive disorders and moderate to severe anaemia.

- Previous caesarean section or genital prolapse repair.

- Intra partum infection, certain neurological conditions.

2. Foetal indications:-

- Prolapse of umbilical cord

- Premature separation of placenta

- Non reassuring foetal heart rate pattern

- Foetal distress

- Non rotated heads or occipito-transverse positions

- The Occipito posterior position

👉🏻 Contraindications:-

- Operator inexperience

- Inability to assess foetal position

- Suspicion of CPD

- Foetal coagulopathy Preterm babies due to risk of foetal intraventricular haemorrhage

- Macrosomia (≥4 kg)

- Soft tissues obstruction in the pelvis

- Breech presentation and face presentation.

👉🏻 Procedure:-

1. Preoperative:-

- The woman's bladder should be empty.

- The patient is placed in the lithotomy position.

- Vaginal examination to check pelvic capacity, cervical dilatation, presentation, position, station and degree of flexion of head and that the membranes are ruptured.

- Determination of flexion point

- Informed consent with prior clear explanation

- Pudendal block or perineal infiltration with 1% lignocaine, in parous women applied even without anaesthesia.

+ The instrument should be assemble and the vacuum is tested prior to its application.

2. Operative:-

Step-1: Application of the cup:-

- The largest possible cup according to the dilatation of the cervix is to be selected.

- The cup is introduced after retraction of the perineum with two fingers of the other hand.

- The cup is placed against the foetal head nearer to the occiput (flexion point) with the knob of the cup pointing towards the occiput.

- Betadine solution is applied to the rim of the metal cup.

- A check is made using the fingers round the cup to ensure that no cervical or vaginal tissue is trapped inside the cup.

- The pressure is gradually raised at the rate of 0.1kg/cm² per minute until the effective vacuum of 0.8kg/cm² is achieved in about 10 minutes time

- The scalp is sucked into the cup and an artificial caput succedaneum is produced, which disappears within few hours.

- Instrument handle is grasped, and initiation of traction.

Step-2: Traction:-

- Traction is initiated by using a two-handed technique, i.e the fingers of one hand are placed against the suction cup, while the other hand grasps the handle of the instrument.

- Traction must be at right angle to the cup

- Traction directed initially downward then progressively extended upward as head emergy

- Traction should be synchronous with the uterine contractions; released in 

between the contractions.

- Once head is extracted, vacuum pressure is relieved; cup is removed; vaginal delivery followed.

👉🏻 Time:-

- The total time from the application until delivery should not exceed 20 minutes.

- If >20 minutes, the risk of foetal scalp trauma and intracranial damage increases.

- Many pulls to achieve progress should not be done

- The operator should be willing to abandon the procedure if it does not proceed easily or if the cup dislodges >3 times

👉🏻 Complications:-

1. Foetal:-

- Scalp laceration and bruising

- Sloughing of the scalp

- Cephalohematoma

- Intracranial haemorrhage - Interventricular and cerebral haemorrhages

- Retinal and sub-conjunctival haemorrhages

- Neonatal jaundice

- Hypoxia

- Foetal death

2. Maternal:-

- Soft tissues injuries such as cervical tears, annular detachment of the cervix, vaginal tears, perineal lacerations and tears, extension of episiotomy, vaginal wall and perineal hematomas.

- Traumatic postpartum haemorrhages

- Infection

- Genital prolapse.

🔘 Kshara Karma

KSHARA KARMA:-

👉🏻 Introduction:-

- Among all the yantras, upayantras, shastras, anushastra and

medicines (oushadhas) the kshara is the supreme, because it is

most effective and acts immediately.

- There are many diseases which are not curable with medicine or

drugs or are not so much effectively treated such as,

• Skin diseases

• Some allergic condition

• Bhagandra (Fistula in ano)

• Nadi Vrana (Sinuses)

• Arbuda (Cancer)

• Arsha (Piles)

• Dusta Vrana (chronic or non healing ulcers)

• CharmaKila (wart)

• Tilkalaka (Melanomas)

• External abscess

• Disease of Mouth

• Some tumor of oral cavity

- These are notorious diseases where use of medicine as well performing surgery also are difficult and has a lot of complication like, infection, disfigurement, difficulty to approach etc.

- The diseased portion should hould be removed or killed but it is observed that many a time, drug fail to do its work.

- Surgery is always feared by even those who advocate it.

- Many a time, patients are not fit to undergo surgical operation.

- Under such condition the alternative measure for advancing the result of surgery is always welcome.

- The external application of Kshara are used in various diseases further it can bring about the same result as a surgical operation

without its pain agony, mortifying tissue by less degree may give rise to less effusion of blood and less agony than operation.

- Its use is not confined to surgical disease only or local applications but also advocated in medical disease.

- Such as urinary calculus, for oral administration another advantage of application of Kshara is that it can be applied to the people of delicate temperament and age Kshana can also be used even in the vishamavastha (dangerous condition) of disease.

- Ksharas are more effective than other methods of treatment because they can be administered both internally as paneeya

ksharas and externally as pratisaraneeya ksharas.

- Kshara is tridoshahara, hence a single drug, it acts all the three doshas.

👉🏻 Definition:-

- It is called kshara since it destroys (the vitiated tissues and

makes the fall off of since it torments (harms) the tissue.

- The word 'kshara' derived from the root char-- to remove or satan destruction or kshana violence.

- It literally means that which destroys fleshy mass either healthy or unhealthy.

- In charaka kshara is one which scrapes the abnormal tissue from its location and destroys it after dissolving it because of

its corrosive nature.

• तत्र क्षरणात् क्षणनाद्वा क्षारः ||

- क्षणन means himsana - twak mamsadi himsana.

- क्षरण means shodhana - kshara act as a shodana both internally and externally.

👉🏻 Importance of Kshara:-

• शस्त्रानुशस्त्रेभ्यः क्षारः प्रधानतमः,

छेद्यर्भेद्यलेख्यकरणात् त्रिदोषघ्नत्वाद्विशेषक्रियावचारणाच्च|| 

(Su.Su. 11/3)

1. Kshara is any caustic chemical, alkaline/acidic in nature

obtained from the ashes of medical plants

2. It is a milder procedure compared to sastra & Agni karma.

3. It is mentioned among anusastra & upayantra

4. It is most potent among the sharpd subsidiary instruments because of performing chedana (exicision), bhedana (incision), and lekhana (scraping).

5. It destroy all thridoshaja vyadhis

6. It is versatile because even such places which are difficult in approach by ordinary measures can be treated by kshara karma.

7. Ksharakarma is more effective than the other because they can be administered both internally & externally.

8. Ksharakarma is a substitute of surgical instruments because they can be used safely on the patients who are afraid of surgery.

9. Kshara can safely be used even in vishamavastha of a disease eg gulma, udaara etc.

10.The alkali used properly by an intelligent person cures even dreadful disease quickly.

- In the same way alkali administered by a person of poor intelligence will be like the effect of poison, fire, sharp weapon, thunder.

- So it should be used wisely.

👉🏻 Kshara Karma:-

• नानौषधिसमवायात्रिदोषघ्नः, शुक्लत्वात् सौम्यः; तस्य सौम्यस्यापि सतो दहनपचनदारणादिशक्तिरविरुद्धा, आग्नेयौषधिगुणभूयिष्ठत्वात् कटुकउष्णस्तीक्ष्णः पाचनो विलयनः शोधनो रोपणः शोषणः स्तम्भनो लेखनः कृम्यामकफकुष्ठविषमेदसामुपहन्ता पुंस्त्वस्य चातिसेवितः।

(Su.su. 11/4)

1. Thridoshagnata - Kshara is made up of several drugs in their most concentrated and subtle forms, and hence effective over all the doshas.

2.Soumya - kshara is considered to be soumya in nature, mainly due to the white colour of the substance, which is indicative of satwa guna and soumyatwa.

- The major reason for attributing kshara, its soumya guna is that it is completely harmless, as it acts only over the deranged and unnecessarily grown and hypertrophied structures.

- As a whole its better to say kshara is soumya in nature but theekshina in action.

3. Daahana-In contrary to the soumya guna kshara also possess agneya property, which helps it to induce paaka, puyothpathy (suppuration) in cases of external application like vidhradhi, arbuda etc, and agnideepana when used internally.

4. Aparutihata shakti (uncompromising action in pachana, darana etc.):-

- Any new growth or inflammatory swelling requires pachana followed by darana subsequently.

- Pachana is a process which encourages the body forces(antibodies) to fight against the (antigens pathogens) if the body forces gain access over pathogenic forces, the inflammation subsides

- In case the pathogens over power then a pocket of pus will be formed then darana helps in opening or rupture of abscess without operation.

- Ksharas were used in inflammations and new growths through their dual action, the pachana and darana

- When taken internally they do aama pachana and break down clogged elements (granthi bhutha doshas) obstructing sources sama pachana and Sroto shodhana bring about dosha samantha or swasthana annayana of doshas.

5. Sodhana - Kshara has got ushna and tikshna guna which help in desquamation sloughs (debridement) and draining of pus when

used externally.

6. Ropana - Kshara helps in ropana or healing process because of their cleansing antiseptic properties.

- Healing requires new vascularisation, granulation tissue formation.

7. Sthambana (hemostasis)

8. Lekhana (chemical debridement)

9. Shoshana (exudates)

10. Vilayana (swellings)

👉🏻 Ideal qualities of kshara (Uttama kshara lakshanas):-

1. Natitikshna-should not be too corrosive

2. Natimrudu-should not be too mild

3. Shukhla-white ash

4. Natislakshna-should not be too smooth

5. Natipichila-should not be too sticky

6. Avishyandi-should not be too slippery

7. shiva- saumya guna.

8. shighra – effective 

👉🏻 Kshara dosha:-

1. Too mild

2. Too white

3. Too hot

4. Too sharp

5. Too slimy

6. Too spreading

7. Too thick

8. Un cooked (not well prepared)

9. Less potencey

👉🏻 Types of Kshara:-

- Kshara is made by burning whole of the plants or parts of it.

- These kshara type according to use / on the basis of administration are:-

1. Paneeya Kshara - for internal use

2. Pratisarniya kshara - for external application

- According to preparation:-

1. Uttama

2  Madhyama

3. Adhama

- According to Ashtanga Samgraha:-

1. Bahya parimarjana (extternal application)

2. Antah parimarjana (oral intake)

👉🏻 Indications:-

1) Paneeya kshara acts:-

- By neutralizing the gastric acidity

- By stimulating the production of digestive enzymes

- By alkalizing the blood.

- Arshas-hemorrhoids

- Agnisadhyam-indigestion

- Ashmari-calculus.

- Gulma-internal tumor/abscess

- Udara- ascites

- Gara-food poison

- Ajeerna-indigestion

- Arochaka-anorexia

- Anaha-flatulence

- Sarkara-gravel in urine/type of urinary calculus

- Anthar vidhradi-internal abscess

- Krimi-intestinal worms

2) Pratisaraniya Kshara:-

- Masaka-elevated mole

- Bahyarsa-external piles

- Supthi-loss of sensation

- Arbuda-tumour

- Dushta vrunna non healing ulcer.

- Kitibha-skin disease

- Mandala kushta-skin disease/patchy dermatitis

- Charma keela-keloid

- Swithram-leukoderma

- Bhagandharam-fistula in ano

- Graanthi-benign tumor

- Nadi vruna-sinus

- Thilakalaka-phyrynoderma

👉🏻 Mode of action of pratisaraniya kshara:-

- Since it has chedana, bhedana and lekhana gunas kshara can be used as substitute for sastra and it serves three of the eight sastra karma purposes.

- It is made of several herbs, it is tridosha hara and thus shows miraculous effect in diseases like arbuda, granthi etc. which are otherwise incurable.

- It is both soumya and theekshna due to its

visheshakriyavacharana and prabhava.

- Eventhough corrosive it can be used orally with safety in some extra ordinary conditions

- The kshara cause coagulation of the vessels (cauterization of hypergranulation ), necrosis of tissues followed by fibrosis of

plexus, adhesion of mucosal, sub mucosal coat helps in prevention of further dilation of veins. which is ceased by the sclerosing effect of the kshara by it coagulating property of protein.

- Hence there was no chance of bleeding during kshara application.

- The chance of infection is least due to the sustained action of the anti-microbial property of kshara.

- Application of kshara is found to be safe, efficacious and cost effective method for management of internal 1st, 2nd and 3rd

degree haemorrhoids.

👉🏻 Contraindication of Kshara Karma:-

- Disease like:- Raktapitta, Jwara,

- Pittaprakruti patients

- According to physical & mental status-

children, aged debilitated etc.

- According to site- arteries, joints vital parts, cartilages, testis, penis, eye except eyelid etc.

- According to season in summer, autumn and claudy seasons.

- Neither of two forms should be made use of during aggravation of pitta and rakta and dimished vata in fevers, diarrhoea, diseases of heart and head anaemia, blindness, in those who have been administered purifactory therapies.

- Who have swelling all over the body,

who are pregnant, the menstruating woman,

woman who has difficult menstrual flow. when food remains undigested, for infants and old persons.

- On places of the body such as arteries, joints,vulnerable spots, cartilages,veins tendons, nerves, sutures, throat umbilicus,

places,which are poor of musles, testis, penis, orifices, passages, interior of the nails, in diseases of the eye, during cold, rainy and hot seasons and on days when sun is not seen.

👉🏻 Ksara anarha:-

- Cauteisation by alkali should not be done for persons such as,

• debilitated

• children

• old aged

• fearful

• suffering from swelling all over body

• enlargement of abdomen

• bleeding diseases

• pregnant lady

• woman during menstruation

• advanced stage of fever

• injury to chest(lungs),

• emaciation injury

• thirst,

• fainting

should be deemed unfit for cauterized with alkalies.

- More over their application not to be sanctioned over vital spots

veins, ligaments, joints, cartilagers, sutures, arteries, throat,

umbilicus, genitals, nailbed, places, with less muscles and in

diseases of eyes, except those which affect the eyelids.

- Kshara may produce in excess proportion causing harmful

effect on the hair, eyes, heart as well as virility.

- Therefore kshara should not be taken in excess.

It is agreed upon all that kshara should not be used in pitta and

rakta by people of weak mind and constitute.

- It should also not be used on organ of the body which is delicate

in nature such as in arterial disease, marasmus, joints, ear lobule,

and vein, and ligament, umbilicus, in part of body relatively with

less muscle and in texture.

👉🏻 Pakya kshara/tikshna kshara:-

- Danti dravanthi chitraka laangali putika, bida,suravacika, kanakakshiri, hingu, vacha and ativisaall or as many as available, each equal in quantity of one sukti (20g) are made into fine powder and added;this is prativapa (addition of extra drug to enhance the properties).

- When kshara (alkali) is prepared with prativapa it is called pakya kshara or the teekshna kshara of strong potency.

- According to vagbhata it should be used after a lapse of seven days.

👉🏻 Indication of tikshna kshara and madhyama kshara:- 

• क्षारतीक्ष्णोऽनिललेष्मेदाजोवर्बुदादिषु । (A.H.Su. 30/12)

- Vata kapha medhodushti rogas 

- Yapya and asadhya rogas like arbudas etc

👉🏻 Indication of mrudu kshara:-

• अन्यः पित्तासगुदजन्मसु II     (A.H..Su. 30/13)

- Disease due to increasd pitha rakta, heamorroids are indicated

👉🏻 Drugs for making kshara:-

- Apamarga

- Snuhi

- Palasha

- Putheeka 

- kutaja

- Aragvadha

- Agnimantha 

- Nimba 

- Paribadra 

- Tilvaka 

- Patala 

- Kadali

- Asvamaraka 

- Kosathaki 

- Arka

- Naktamala 

- Chitrak

- Gunja

• For madhyama kshara

- Bhasma 

- Sharkara 

- Shukthi

- Sudhasma bhamsa

- Sankha nabhi

• For teekshna kshara:-

- Danti 

- Sajakshara 

- Ativisha

- Langali 

- Drawlvanti

- Karanja 

- Hingu 

- Swarnaksheeri

- Bida lavana

- vacha

👉🏻 Definitions of Samvyuhana / mrudu and Pakya/tikshna Kshara:-

1) Samvyuhima kshara/ Mrudu kshara:-

- The kshara itself if prepared without prativapa (adding paste of other drugs/with only kshara- ash) is called as samhvyuhima or mrudukshara.(alkali of mild potency).

2) Pakya kshara/ Teekshna kshara:-

- Danti dravanti etc are the prativapa, when kshara is prepared with this prativapa it is called pakya kshara/teekshana kshara.

- These mrudu and teekshana are to be used according to the strength of the disease.

• Element:-

- sodium, potassium, calcium, magnesium. iron,aluminum, carbon, sulphur, silica, phosphorus etc.

• pH Value:-

1. Mridu 8.4

2. Madya 9.2

3. Tikshna 9.4

• Properties of kshara:-

- Rasa: Katu

- Veerya: Ushna

- Varna:Sukla

- Guna: Soumaya, teekshana, Agneya

- Doshagna: Tridoshagna

- Karma: Dahana, pachana, darana, vilayana, shodhana, ropana,

shoshana, lekhana, bedana, chedana

- Colour of ash: greyish white

- pH is the negative logarithm of hydrogen ion concentration in an

aqueous solution.

- A neutral solution has a ph of 7,

where is any acidic solution has ph of less than 7 and

 for alkaline solution the ph is more than 7.

- Ph meter used to analyse and measure pH.

👉🏻 Procedure of Kshaara Karma (pratisarana):-

(1) Poorva karma (Preoperative Preparation)

(2) Pradhana karma (Operative Procedure)

(3) Paschat karma (Post Operative Procedure)

1. Purva Karma:-

- During the poorva karma the physian chooses the place (the place should be devoid of breeze and sunlight), where Kshara Karma can be applied.

- The place should be closed, it should have much space.

- He makes sure that all the appliances necessary for Kshara Karma are there in proper condition or not.

2. Pradhana karma:-

- The physician first examines the case thoroughly & decide the dosha and dushya of disease.

- Later on

• lekhana for vata

• gharsana for pitta and

• prachhana for khapha dosa is given and with the help of rod ,darvi or brush, Kshara is applied.

- After the application, one must count the hundred numbers (approximately one minute).

- Kshara is applied with shalaka which has been cemented with gauze or cotton.

3. Paschat karma:-

- If physician is satisfied after the application that proper dagdha (burning) has been made; he should wash out the kshara by amla (acid) dravya.

- Falling of the diseased part and development of black colour at the site are the signs of good cauterization.

- Later on honey and ghee should be applied after that it should be washed out with amlavarga like milk. dahi and kanji in the

last wound healers drugs should be given with ghee.

- Teekshna (Strong) kshara should be applied in disease as Arbuda and in disease originating from vata kapha and medo roga.

👉🏻 Kshara Dagdha lakshana/signs of burning (cauterization):-

1. Samyak dagda (proper cauterisation):- 

• तत्र सम्यग्दग्धे विकारोपशमो लाघवमनास्त्रावश्च ।

- Mitigation of the disease (subsiding of symptoms like pain, swelling etc.),

- feeling of lightness of the diseased part) and

stoppage of exudations are the symptoms of samyak dagdha (proper cauterisation).

2. Heena dagda lakshana (inadequate cauterization):-

• हीनदग्धे तोदकण्डुजाड्यानि व्याधिवृद्धिश्च  ।

- Pricking pain.

- Itching,

- loss of movement and increase of the disease (aggravation of symptoms) are the symptoms of heena dagdha lakshana.

3. Atidagdha (faulty/complicated cauterization):-

• अतिदग्ये दाहपाकारागस्रावाङ्गमर्दक्लमपिपासामूच्च्छाः स्यूमरणं वा ।

- In case of athidagda there will be burning sensation,ulceration, and redness, exudation, twisting pain in the body part, exhaustion,

severe thirst, fainting and even death

👉🏻 Kshara karma in piles:-

- Those which are soft, broad deep seated and bulged up are to be treated with kshara.

- Piles with vata kapha are treated with agni karma &/ teekshna kshara and piles with pitta rakta treates with mrudu kshara.

✓ Kshara dagda lakshana in piles:-

1. Samyak dagdha:-

- Downward movements of flatus

- desire for food,

- increase of hunger

- feeling of lightness,

- restoration of strength and blissful in mind are symptoms of

samyakdagda.

2. Atidagdha:-

- Tear in the anus

- burning sensation

- fainting

- fever

- thirst

- heavy bleeding and

complications consequent to it are the symptoms.

3. Heena dagdha:-

- Pile mass becoming black

- developing a small wound

- itching

- irregularity of vata (pratiloma vayu)

- absence of calmness of the sense organs and (indriya aprassanata)

- non mitigation of the disease (vikara ashanti) are the symptoms of heena dagdha

- For grahani- paneya kshara

👉🏻 Action of kshara karma:-

- Coagulation of protein disintegration of haemoglobin-haem &

globin-blackish brown discharge-sloughing-re epithelialization.

- In cauterization-necrosis-slough out-fibrosis-scar formation-

obliteration haemorroidal vein complete healing.

👉🏻 Complication of kshara karma /atidagdha:-

- Bleeding, fainting, burning sensation, fever etc are the

symptoms of atidagdha.

- In anus athidagdha especially produces obstruction or passing

of faeces and urine or their excess elimination, loss of muscular

and sexual power and death surely by the destruction of the

rectum.

- In case of nose, there will be severe burning sensation, loss of

sense of smell, similar is the case of ear.

👉🏻 Treatment for atidagda / complication with kshara:-

- In the atidagda dhara with amla (sour fluids) rasa dravya and

lepana with honey, ghee and tila as well as vata pitha shamana

procedures are applicable

- As amla which is sheeta (cold) to touch when combines with

alkali attain the pr operties of madura taste

👉🏻 Kshara modern view:-

- In modern medicine kshara alkali can be used

1. To reduce the gastric secretion before food intake

2. To act as antacid in peptic ulcer etc.

3. To protect the gastric mucosa

4. To increase ph of blood in ketosis, acidosis

5. As diuretic

6. As mucolytic expectorant in bronchial asthma

7. Antiflatulant and carminative

👉🏻 Ksharasutra application:-

- Probing, incision, caustic alkali, and thermo cautery are mentioned as the general line of treatment in chakradhatta.

- Caustic ligature (Ksharsutra) is mentioned in a major text books on ayurveda like Sushruta Samhita, ashtanga samgraha etc.

- Today it has proved to be equally effective or perhaps even more effective than available modern methods of management in sinus & fistula in ano.

✓ Indication:-

• कृशदुर्बल भीरुणां नाड़ी मर्माश्रिता च या ।

क्षारसूत्रेण तां च्छिन्द्यान्न तु शस्त्रेण ।

(Su.chi. 17/29)

- In persons who are emaciated, weak and frightful and if the ulcer is present in vital organs, the wise physician should cut open the sinus by using kshrasutra and not using sharp instruments.

✓ Method of preparation:-

- Thread that coated with latex of Euphorbia, haridra & Kshara (Apamarga) 7 times respectively for total of 21 times in 21 days.

- The thread which is non dissolvable acts as drainage, thus the wound kept clean.

- Cutting also take place with tightening of the thread due to the help of kshara & snuhi ksheera, antimicrobial & anti inflammatory action by haridra gives cutting and healing simultaneously.

- In reference text of cutting seton chemical cautery using an ayurvedic method known in india as kshara sutra, in which a specially prepared seton thread burns through the enclosed circle.

✓ Method of application:-

- The sinus is probed with help of a probe (malleable or copper), then introduce the needle (blunt part) having the alkali thread (at another end/ distal end) till the end of the sinus is reached the needle is then lifted up, the end (front tip) of the thread is pulled out and tight knot tied.

- After considering the strength of the alkali, another thread soaked/smeared with alkali may inserted (after removing the first one by rail. rode method) by the physician till the sinus gets cut.

👉🏻Collection of kshara herb:-

- In sharada ritu

- Madhyam aayu aushadha

- 1st day abhimantrita mantra

- 2nd day collection in small pieces in dry storage

- Burnt whole panchanga with lime stones and tila nala

- After burn separate all ash (kshara)

👉🏻 Making of kshara:-

- Kshara (1 drone) dilute with 6 drona water / cow urine (tikshna kshara)

- 21 times cloath filtration

- Kshara paka till a slimy (Nirmala),reddish, clear and penetrating alkline material obtained

- In case of making madhyam kshara, kata sharkara, bhasma sharkara, jala shukti, shankh naabhi added in kshara jala (after

red hot powder process)

• In the case of tikshna kshara prativapa should be add i.e. danti, drawanti, chitraka, langali, pootika, bid lavana, suvarchika,

kanaka kshiri, hingu, vacha , ativisha.