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Monday, January 14, 2013

LEPA

External/Topical Applications in Ayurveda



                 The goal of medicine is to prevent disease, restore health and reduce suffering. Understanding and appropriately treating pain is an important component of this goal. In allopathic science analgesics are given in the form of topical applications, is said to provide the therapeutic benefits by reaching the local tissue and with minimal side effects. Apart from treating pain they are also useful in treating various skin lesions, ulcers etc…
In Ayurveda the topical applications are known as Lepas and this comes under the broad heading of Bahiparimarjana Chikitsa. Skin is the largest protective barrier in the body which prevents invasion of microorganism, foreign substances in the body. The main area of Bahiparimarjana Chikitsa is Twak and the treatments like Abhyanga, Swedana, Pradeha, Parisheka, Unmardana etc...  according to disease are known as Bahiparimarjana Chikitsa
Lepas are Just like the ‘Pastes or Plasters intended with the Ointments’ of Western Pharmacopoeias, ‘Kalimbu, Mezhugu and Vannai’ of Siddha Pharmacopoeia’, and ‘Merham and jimad of Unani system of medicine’.
Definition
द्रव्यमार्द्रं शिलापिष्टं शुष्कं वा सद्रवं तनु
    देहे प्रलेपनार्थं तत् लेप: इत्युचते बुधै: (द्र.गु.वि-यादव्जि)
Either Ardra dravyas or Sushka dravyas with water, are ground well and is made into a paste and are used for external application are called Lepas.
Synonyms
                “आलेपस्य नामानि लिप्तो लेपश्च लेपनम् (शा..-११/)
      The synonyms of Lepa are Lipta, Lepana, Alepa etc..
       In the context of Vrana lepana Bandana Vidhi Susruta tells
                “अलेप आद्योपक्रम: एष सर्वशोफानां सामान्य: प्रधानतमश्च: (सु. सू-१८/)
        First treatment to be done in sopha is lepana and it is the most important one also...
Types of Lepa
1) Acc. To Sarngadhara Samhita – 3 types (शा..-११/)
They are
Ø  दोषघ्न लेप -1/4 angula thick
Ø  विषघ्न लेप -1/3 angula thick
Ø  वर्ण्य लेप -1/2 angula thick
2) Acc. to सुश्रुत – 3 types (प्रलेप /प्रदेह/ अलेप)
a)  Pralepa: - तत्र प्रलेप: शीतस्तनुरविशोषी विशोषी वा (सु. सू-१८/)
These are applied as cold(शीत), thin(तनु) and which dries either very quickly or not (विशोषि/अविशोषि).Acharya Sarngadhara explains Pralepa as विशोषि .
b) Pradeha:-
Acharya Susruta explains this as अविशोषि  and this should be applied as Ushna ( in Vata Kapha conditions) or Seeta ( in Pitta conditions). This can be applied either Bahala or Abahu. It does Sodhana and Ropana and can be used in Vata Kapha Pradhana Sopha.
Pradeha is also known as कल्क (since used in kshata) & निरुध लेप 
               “Yastu kshateshu upayujyate sa booya kalka iti samjna labate” (A.S.u-30/7)
It removes the srava causes mridutva, does Mamsapakarshana, Vranashudhi
Acharya Sarngadhara explains this as Ardra, Ghana and Ushna
c) Alepa :-
                 मध्यमोऽत्त्रालेप: तत्र रक्तपित्त प्रसादकृत् अलेप (सु. सू-१८/६)
                The action , thickness ,etc.. will be moderate and is useful in रक्तपित्तधिक शोफ, अविदग्ध शोफ,  and this is Dahakandu rujapaha , Tridoshasamana ..  This can be used in Shodhana of diseases in Marma and Guhya Desha.  Alepa is considered to be त्वक् प्रसादनमेवाग्र्यम्
3) Acc. To Ashtanga Samgraha – 10 types
                They are Snaihika, Nirvapana, Prasadana, Sthambana, Vilayana, Pachana, Peedana, Sodhana, Ropana, Savarneekara
Pramana of Lepa
                “तस्य प्रमाणं महिषार्द्र चर्म्मोत्सेधमुपदिशन्ति(सु. सू-१८/११)
The thickness of Lepa should be of Ardra Mahisha Charma



                              Do’s & Don’ts while applying Lepa
1) Do Lepa in the pratiloma direction (सु.सू-१८/४)
      तत्र प्रतिलोममालिम्बेत् - प्रतिलोमे हि सम्यक् औषधमवतिष्ट्ते
      अनु प्रविश्यति च रोमकूपान् स्वेदवहिबिश्च सिरमुखै:वीर्यम् प्रप्नोति”
By doing Lepa in the Pratiloma direction it helps the Oushadha to remain there properly and allows it to enter the romakoopas and thereby veerya entering svedavahi srotas
      “प्रतिलोममालिम्बेत् इति लोमाबिमुखमालिम्बेत् (डल्हण)
2) Never allow Lepa to get dry (सु.सू-१८/५)
       “न च शुष्यमाणमुपेक्षेत अन्यत्र पीटयितव्यात् शुष्कोह्यपार्थको रुक् करन्ज
Only allowed to dry for vrana Peedana otherwise it will have less effect & causes pain
3) Don’t do Lepa at night
 “न चालेपं रात्रौ प्रयुन्जीत,मा भूच्छैत्य विहितोष्णस्तदनिर्गमात् विकार प्रवर्तिरिति (सु.सू-१८/१२)
          If applied at night due to the Seeta svabhava of rathri kala the ooshma gets rodha and it will lead to Rogavridhi
    Lepa can  be applied in night, in conditions like Apakwa Sopha, Gambheera Sopha, Rakta Sleshma Samudbava
4) Don’t apply Lepas which are old
   न च पर्यूषितं लेपं कदाचित् अवचरयेत् (सु.सू-१८/१४)
5) Never apply Lepa on & on without removing the earlier one
उपरि उपरि लेपं न कदाचित् प्रदपयेत्  ऊष्माणं वेदनां दाहं घनत्वात् जनयेत् सहि(सु.सू-१८/१५)
                 If applied so causes rise in temp., vedana, daha & ghanatva
6) If a Lepa once becomes Sushka –Don’t use again as it becomes Nirveerya
7) A Lepa once applied becomes Sushka it should be removed only after making it Ardra
 तमार्द्रयित्वापनयेत् तत् अन्ते अभ्यंगमचरेत्  (अ.ह्र.सू-२२/१५)
                 Once removed apply a little oil & do a slight massage

                     Prayojana of Lepa-Benefits of Lepa
यथा अम्बुभि: सिच्यमान: शान्तिमग्निर्नियश्चति
 दोषाग्निरेवं सहसा प्रलेपाध्यै: प्रयोजितै: (अ.सं.उ-३०/५)
Just like Agni getting shantha after putting water, Dosha also gets pacified after lepana….
“यथा प्रज्ज्वलिते वेश्मन्यम्भसा परिषेचनं
क्षिप्रं प्रशमयत्यग्निमेवालेपनं रुज:
प्रह्लादने शोधने च शोफस्य हरने तथा
उत्सादने रोपणे च लेप: स्यत्तु तदर्थक्रित् (सु.चि.१/१५-१६)
Lepa cures pain & causes happiness and is also useful in Shodhana, sophahara, does utsadana and ropana of vrana…
MUKHALEPA
Acharya Vaghbata explains about Mukhalepa Mukham in Malayalam means face and Lepa, lepana means application of a paste. The herbal pack contains different herbs made into a paste. Now a days this has been used more in the cosmetic aspects across the globe and different kinds of Lepas for face are available. Vaghbata explains to use warm (उष्ण) Mukhalepa in Vata Kapha diseases and in Pitta conditions and all other conditions as अत्यन्त शीतल
He explains 3 kinds of Mukhalepa as namely  1) Doshahara 2) Vishahara 3) Varnakrit
Indications of Mukhalepa
Vaghbata says to use Mukhalepa in conditions like अकालपलित (Premature greying of hair) , व्यन्ग (Blackish pigmentation of the skin) , वली (Wrinkles of facial skin) , तिमिर (Progressive cataract) नीलिक (Bluish discolouration)  and यौवन पिडका (Acne vulgaris)
Contra Indications of Mukhalepa
It is contraindicated in पीनस (Chronic Rhinitis), अजीर्ण (Indigestion), दत्त नस्य (Immediately following Nasya Karma), हनुग्रह (Lockjaw) , अरोचक (Tastelessness ), जागरित (Keeping awake at Night)


After Mukhalepa-Avoid
After Mukhalepa one must avoid the following things like दिवास्वप्न  (Sleeping in day time), अतिबाष्य  (Excessive talk), अग्नि &आतप (Exposure to fire and Sunlight), शोक & शोक (Grief & Anger)
                                    Arunadatta further explains
अह:स्वप्नादि सेवनात् कण्डु त्वक्शोष पीनस द्रुष्ट्युपघातादिभयं स्यात् (अरुण दत्त)
DRUGS FOR MUKHALEPA IN VARIOUS SEASONS
v  Hemanta -Kolamajja, Vrishamoola, Sabara, Gourasarshapa
v  Sisira - Simhimoola, Krishnatila, Darvitvak, Nistusha Yava
v  Vasanta- Darbhamoola, Chandana, Useera, Sireesha, Misi, Tandula
v  Grishma- Kumuda, Utpala, Kalhara, Doorva, Madhuka, Chandana
v  Varsha - Kaliyaka,  Tila, Useera, Mamsi, Tagara, Patimukha
v  Sarat - Taleesapatra, Gundra, Pundrahva, Yashtimadhu, Kasa, Nata, Aguru

Some Lepa Yogas acc. To Ashtanga Hridaya
In Arshas  Chikitsa Acharya explains to use the Lepa with drugs mentioned in Pippalyadi Anuvasana thailam(Pippali, Madana, Vilwa, Satahwa, Madhuka, Vacha, Kushta, Shunti, Pushkaramoola ,Chitraka, Devadaru). He Also explains the use of Snuk Ksheera along with Nisa and Peelumoola, Vilwa and Hingu as Lepa
In Kushta Chikitsa also many Lepa Yogas are told. The famous Jeevanthyadi Yamaka is told here.The use of Guggulu Marichadi Choornam with Chakrikathailam is explained in this context.
Also Snuhyadi Lepa is explained in  Visarpa .For the preparation of Snuhyadi Lepa, thick stems of Snuhi Should be taken. After removing the thorns, its pulp should be taken out with knife and the hollow space thus obtained should be filled with coarse powder of seeds of yellow Sarshapa and pulp of Snuhi. It should be then kept in an oven at fixed temperature(800C) for about 4 to 5 days, till it become dry powder. Thereafter  it should be  taken from oven, made in the form of powder and then filtered through sieve. To this powder, Sarshapa oil was added in the ratio of 1:4 and filled in cleaned bottles with tight lid. Before using it should be mixed well.
In Svitra Avalguja beejadi choorna (Avalgujabeeja-4pala, Harithala-1/4th)- Gavam moothrena pishtam as Lepa. Another prayoga of Avalgujabeeja in Gajamootra is also told. Another teekshna Lepa of  Bhallataka ,Dweepi, Sudha, Arkamoola, GunjaPhala, Tryooshana, Sankhachoorna, Tutha, Kushta, Panchalavana, Ksharadvayam, Langalika in Snuk,  Arka Dugda should be applied with Salaka only.
In VataVyadhi also Lepas with Grihadhoomadi Choorna is mentioned.  Other commonly used Lepas include Jadamayadi Choorna, Eladi Choorna, Kottamchukkadi Choorna, Rasnadi Choorna, Kumkumadi Lepa, Kachooradi Choornam etc…

Acc. To Charaka Samhita
                Charaka exclusively describes 32 choorna pradehas in the 3rd chapter of Sutrasthana- Aragwadeeyam. The Chapter Starts with a pradeha containing Aragwadha in Gopitta to be used in various Kushtas and hence the name. Kolakulathadi Choorna is told in this Chapter.
                Some of the Yogas include
v  Kushtahara:- Manasila +Harithala +Maricha + Arkapaya
v  VataRaktahara:-GodhoomaChoorna+Ajapaya+Ajaghritam
v  Vishahara:-Sireesham,Sindhuvara
v  Jatararthi:-Yavachoorna+Yavakshara+Takra
v  Shirorukhara:- Natholpalam+Chandana+Kushta+Ghrita
v  Sareeradourgandhyahara:- Patra+Ambu+Lodhra+Abhaya+Chandana

Lepas in Visha Chikitsa
                Lepa is one among the Chaturvimshadi Vishopakrama acc. To Charaka. The Yogas include Dashanga Lepa, Nagaradi Lepa, Hingwadi Gulika etc…

POSSIBLE MODE OF ACTION OF LEPA
                                In the Chapter Dhamani Vyakarana Adhyaya Susruta explains dhamanis which are Oordhwagata ,Adhogata and Tiryakgata. Here he explains 4 Tiryakgami Siras. Out of these 4,each divides gradually hundred and thousand times and thus become innumerable: by these the body  is covered like network, bound and pervaded their openings are attached to hair follicles which carry sweat and replenish rasa inside and outside (“Swedamabhivahanti  Rasam chabhitarpayanthi Antharbahischa…..”) ; through them only the veerya of abhyanga, snana and lepa enter the body after being transformed in skin; the same also carry the sensation of touch pleasant or otherwise.
                                The physico chemical properties of a drug in a topical dosage form affects that drug’s trans-dermal delivery and topical bioavailability. The molecules of the formulation after penetrating through the stratum corneum and hence, into viable epidermis and dermis produces its characteristic pharmacological response through receptors even before the blood and lymph circulations remove it ,in which case it may set in a cascade of systemic effects .Though the horny layer is very impermeable to most chemicals, contributing the rate limiting step in transdermal absorption because of its high diffusional resistance, providing a small fractional area of 0.1 % only as permeable appendageal shunt route. Besides this route the drug molecules may penetrate through the hair follicles and sebaceous glands or through sweat ducts also.

CONCLUSIONS
                Ayurveda has addressed transdermal use of medicines in versatile conditions from neurological affections to rheumatological conditions and also for skin ailments in various modes and methods since time immemorial. Lepa done externally through skin is only one example. Though the Lepas described in our texts are effective, they are less used and less known. Knowledge of different varieties of Lepas available in different forms may help future research scholars and physicians to use it in an appropriate way

Prepared by
Dr.Sanjay.M
09448467075
drsanjayjayaraj@gmail.com

1 comment:

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