Bahi prayoga vicharam
Presentation on External therapies in Ayurveda by Dr. P K Sudarsan Nair in the CME program held at SV Ayurveda College Tirupati on 19/12/2019.
BAHI PRAYOGA VICHARAM (A Retroperspective on Taila prayoga)
Vaidyaratnam Ayurveda Foundation
- Dr. P K SUDARSAN NAIR, MD(Ay)
- For thousands of years, medicinal substances have been applied to the skin in the belief that they could treat diseases, and in the past 60 years, there have been considerable advances in the understanding of the mechanisms that govern the absorption of medicine/drugs through the skin.
- CLASSIFICATION OF CHIKITSA
External treatment procedures
(External application of medicine)
Parisheka unmardanadhairamayan pramarshti tat bahi parimarjanam
- Bahi sparsamashritya abhyanga sweda pradeha
- Bahyataha shudhikaram bheshajam
(Trans dermal purification)
Prakritivighata - Samsamanam
“tad bahyabhyanga sweda pradeha parishekopamardanadi”
- The residual doshas localised in thwak and mamsa dhatu after sodhana therapy
- At the initial stage of the condition where the doshas in mild nature
“Antha sareere samsudhe doshe twak mamsasamsrite
Adito va alpa doshanam kriya bahya pravakshyate”
Advantages of Bahyaprayoga
- Instant relief
- Easy to perform
- Increase peripheral circulation
- Improve skin complexion
- Antiseptic and bactericidal action
- Softness to skin
- Cosmetic importance
- Elimination of first-pass metabolism,
- Sustained drug delivery,
- Reduced frequency of administration
- Reduced side effects and improved patient compliance.
Modern view on the mechanism of absorption of medicaments applied externally
1. Application of a drug directly to the surface of the skin.
2. Drugs applied on localized area of the body or to the surface of a body part regardless of the location of the effect.
3. Trans dermal application,
Where the substance is administered on the skin but is absorbed into the body to attain systemic distribution
Generally hydrophobic chemicals, such as steroid hormones
Absorption through skin
Two principal absorption route:
- Trans-epidermal absorption
- Trans-follicular (shunt pathway) absorption
- Principally responsible for diffusion across the skin.
- The resistance encountered along this pathway mostly arises in the stratum corneum.
- Maybe trans-cellular or inter-cellular.
- The rate of drug movement across this layer depends on its concentration in the vehicle, its aqueous solubility, and the oil– water partition coefficient between the stratum corneum and the vehicle.
- Substances with both aqueous and lipid solubility characteristics are good candidates for diffusion through the stratum corneum, epidermis, and dermis.
- The stratum corneum, being keratinized tissue, behaves as a semipermeable membrane, and drug molecules penetrate by passive diffusion.
- It is the major rate-limiting barrier to transdermal drug transport.
- Once through the stratum corneum, drug molecules may pass through the deeper epidermal tissues and into the dermis.
- When the drug reaches the vascularized dermal layer, it becomes available for absorption into the general circulation.
- Trans-follicular (shunt pathway) absorption:
Routes of drug absorption through skin
Factors Affecting percutaneous Drug Absorption and Transportation
- The skin’s appendages, mainly sebaceous glands, sweat glands, hair follicles offer secondary avenues for permeation, which are considered as shunts bypassing the trans-epidermal route.
- Basic principle of permeation-initial transient stage- shunt pathway predominates, but when a steady state has been reached, diffusion through stratum corneum becomes the dominant pathway.
- Skin physiology & pathology:- hydration, blood flow, lipid content
- Physico-chemical properties of drugs and excipients:-
pratilome hi samyak oushadhi avathishshtathe
anupravisyathi cha romakoopan swedavahibhischa siramikhair veeryam prapnothi
- Drug solubility
- Particle size
- Molecular weight
- Partition coefficient
Factors influencing the process of skin absorption.
- Paste ? should be applied In direction opposite to hairs
- Thus the drug stays well, enters into hair follicles and veerya permeates through the sweat carrying vessels.
Transdermal drug absorption can significantly alter drug kinetics. The drug absorption depends on variety of factors.
Ø Site of application
Ø Thickness and integrity of the stratum corneum epidermidis
Ø Size of the molecule,
Ø Permeability of the membrane of the transdermal drug delivery system,
Ø State of skin hydration
Ø pH of the drug,
Ø Drug metabolism by skin flora,
Ø Lipid solubility,
Ø Depot of drug in skin,
Ø Alteration of blood flow in the skin by additives and body temperature,
Ø Skin thickness and amount of blood flow in the skin vary considerably with age.
Taila used for the formulations
Gingelly oil(Tila Taila)
- Taila mainly used are:
- Tila taila
- Kera taila
- Eranda taila
- Sarshapa taila
Sesame seeds contain significant amounts of lignans, sesamin, sesaminol etc
- Sesaminol ---antioxidative activity.
- Sesamin is highly hydrophobic.
Research has shown that the topical use of sesame oil might attenuate oxidative stress by inhibiting the production of xanthine oxidase and nitric oxide in rats
Tailam swayonivat tatra mukhyam teekshnam vyavayi cha
Twakdoshakridachakshushyam sukshmoshnam kaphakrit na cha
- Tila taila gunas
- Thwak doshakrut
- Not Kaphakrut,
- Properties of drugs will be absorbed on preparation with taila and action in the body accordingly
Nalikerodbhavam thailam brimhanam balavardhanam
Kesyam pithanila haram madhuram rasapakayo
Hridyam ruchyam navam proktham, puranam guruvathanut
Tiktham suhridyam madhuram kandukushtaharam param
Swadupakarasam rakthapithaghnam kaphanasanam
Relevence of Sneha(Taila)
- Acid components of coconut oil is monolaurin
- Monolaurin is a monoglyceride derived from lauric acid. It comprises nearly 50% of coconut’s fat content.
- Monolaurin displays antimicrobial activity by disintegrating the lipid membrane of lipid-coated bacteria.
- Coconut oil in concentrations of 5% to 40% (w/w) exhibited bactericidal activity against Pseudomonas aeruginosa, Escherichia coli, Proteus vulgaris, and Bacillus subtilis
- Cellular studies have also shown that monolaurin exhibits antiviral and antifungal activity
- Nalikera taila
Snehagunas and its effect
- Sneho Apam Gunaviseshah
- Pridhvi Ambu Gunabhuyishtah sneha
- Yasya kledane sakthi sah snighdhah
- Sneha mardavakrith snigdho Bala Varnakarah thadha
Relevance of Abhyanga
Twak gatha vatha
Twakruksha sphutitha suptha krusa krishnascha tudyate
Aathanyate sa ragascha parva ruk twak sthithe anile
Swedabhyangani sasthani hridyam cha anna twagasraye (AH CHI 21)
Swedabhyanga avagahascha hridyam cha annam twagasrithe
(Cha chi 28)
Sarvanga kupithe vathe gathra sphurana bhanjanam
Vedanapi pareethascha sphutantheevasya sandhaya:
Sarvanga kupithe abhyango vasthaya: sanuvasana
Thailam sankuchite abhyango masha saindhava saditham
Bahyabhyantarata: snehairasthimajjagatham jayet
Relevence of Sneha vis- a- vis Vata
Sareerajanam doshanam kramena paramoushadham
vasthirvirekovamanam tatha thailamgritham madhu
Vathasyopakrama snehasweda samsodhanam mridu
Abhyanga macharet nithyam sajarasramavataha
Drishtiprasadapushtyas swapna suthwakthadartyakrut
Bahyaprayoga and rogamarga
Rakthadaya twak cha masavyangagandalajyarbudadaya:
sirohridayavasthyadimarmanyasthnam tu sandhaya:
tannibadha sirasnayukandaradyascha madhyama:
- Snigdha -
- Guru -
- Seetha -
- Mrudu -
- Drava -
- Picchila -
- Manda -
- Sookshma -
- Sara -
- Effect of bahyasneha on dosha
1. Vatha hara
2. Pithanubandha vathahara
HOW CAN WE FIND OUT THE APPROPRIATE AREA OF APPLICATION OF THE TAILA PREPARATION?
CRITERIA FOR EVALUATION OF THE EFFECT OF THE PREPARATION
Properties of drug mainly influence the therapeutic effect on external application is based on GUNA &VIRYA
- Properties of the ingredients in general
- Mode of administration
- Possible action based on dosha
- Possible action on Dhatu
- Rogamarga involved
- Differentiate vata vaishamya
- Indications as per reference
- Systemic action
- The combined effect of the formulation based on the properties of the ingredients can be classifies as:
- Extreme-Vata + pitha + + +(Pithahara)
Chandanadi taila,Himasagara taila
- Moderate-Vata + + pitha + +
- Mild- Vata + + + + regenerative
- Extreme -Vata + kapha + + + (Kapha hara)
- Moderate -Vata + + kapha + +
- Mild -Vata + + + + regenerative (Vata hara)
Mode of external application of taila according to Ayurvedic reference
- PICHU- Locally
- VASTI- Locally
- Sarvanga-Whole body
Hemiplegia, quadriplegia, neurodegenerative diseases(MND, Multiple sclerosis, Parkinsons disease, myopathy)
Ksheerabala, sahacharadi, other simple taila yogas
- Rheumatological, musculoskelital
RA, Myalgia,Pain and stiffness of muscles and joints
Increase muscle tone, increase peripheral circulation, better complexion, improve eye sight, better sleep, better the sensation
- Abhyanga -Locally
- Neuro, neuromuscular
Facial palsy, brachial neuralgia, polio mylitis, paraplegia, sciatica, peripheral neuropathy, wasting disorders, varicose vein etc
ksheerabala, mashataila, shashtika taila,
panchasneha, sahacharadi, karpasasthyadi, parinathakeriksheeradi,
- Abhyanga -locally
- Rheumatological, musculoskelital
RA, OA, frozen shoulder, lumbago,sciatica,
IVDP, ankylosing spondylitis, cervical spondylosis, joint injuries, trauma
saindhava taila, mashataila,balaswa gandhadi, lakshadi panchasneha, pindataila
- ENT, Eye disease,Dantha roga –
Balaguluchyadi, asanavilwdi,Balahatadi, nirgundi taila, eldi keram, kseerabala, arimedadi, ksheerabala avarthi
- kapala rogas-Dandruff,hair fall.
malathyadi,Eladi,Bhrunga raja taila,dhurdhurapathradi
- Dermatological-eczema, psorisais
Nalpamaradi,Sudhadurvadi,Vett pala taila
- Neurological, Neromuscular,
- RA,OA,Ankylosing spondylitis,
Fig: AUTOMATED DHARA MACHINE
Fig: THAILA DHARA IN OSTEOARTHRITIS
Neurological-cerebral palsy,insomnia,demantia,problem of sense organ s, optic neuritis, neuropathy, badhrya,
- Hair fall-bhringa raj taila
- Eladi kera ,dhurdhura patradid,malathyadi keram
Neurological conditions (body/Head)
Neuro,psychological disorders- ardita,cognitive disorder,dementia
- Neurological- sciatica-
- Musculoskelital-ivdp sciatica,
- Spondylolisthesis, L.spondylolysis
- costochondritis,cardiac problems
degenerative changes in the spine, cord compression
- Medicaments for external application is basically either sneha or ruksha in properties.
- Among the sneha dravya Tila taila is most preferred
- All the external sneha prayoga with medicated oils in the form of abhyanga, seka, pichu etc are mainly vatahara.
- The medicated oil applied produces its effect locally or all over the body according to the mode of administration
- Since skin is the sensory organ neurogenic modulation may be primary action of the procedure.
- The medicines administered internally undergo jataragni paka at gastrointestinal level and the effect produces in the body based on the resa, guna,virya, vipaka and prabhava. But in the external administration of medicine the guna and virya only can be considered which is responsible for the action.
- The medicines applied externally is mostly preferred after making warm
- There are descriptions of so many taila yogas with large number of ingredients with different properties They are prescribed for internal as well as external use. A critical assessment is to be done to evaluate the effect of these preparations when it is used externally alone.
- Even though the drugs used in the yoga of different preparation differs, the guna and virya analysis shows almost same. As far as the use of external application is concerned the variation in the effect will be very narrow.
- In kuzhambu preparation along with taila ghrutha and eranda taila are also included in a specific proportion. It produces sustainable effect of snigdhata due to the colloidal (Picchila)properties over the skin and will produce strength to the underlying structures.
- In skin disease kera preparation is prefered as it is bactericidal and having ropana(antibacterial,anti inflammatory) properties. Thila taila usually produces skin irritation and flare up of complaints in dermatological conditions.
- Many taila preparations developed regionally by experts in this field using various combination of drugs and are widely used in practice such as kayathirumeni taila, murivenna, kethakimuladi taila, supthi tailam.etc other than classical references
- Certain taila preparations are indicated for internal as well as external administration (pana,navana,vasti,abhyanga).The therapeutic effect of such preparations are to be studied when used externally alone.
- Effort to evaluate the effect of taila yoga prepared with large number of costly drugs in comparison with that of simple preparations is to be taken with reference to its bahyaprayoga.
- Extensive research is to be conducted to ascertain the effect of important preparations used externally and to establish the mechanism of absorption of Ayurvedic formulations scientifically.
Request full text
- Ashtanga hridaya sutrasthana
- Ashtanga hridaya utharasthana
- Bhava prakasa nighantu
- Pharmacopia ayurveda college, Trivandrum
- Indian medicinal plants
- Ayurveda pharmacopia of india