E-ISSN:2456-3110

Review Article

Kamala

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Conceptual study of Kamala and understanding the concept of Kamale Tu Virechane w.s.r. to Jaundice

Raheena B.1*, Smita S.2, Priyadarshini.3
DOI:

1* B Raheena, Post Graduate Scholar, Department of Panchakarma, Government Ayurveda Medical College, Bangalore, Karnataka, India.

2 Sanganor Smita, Professor, Department of Panchakarma, Government Ayurveda Medical College, Bangalore, Karnataka, India.

3 Priyadarshini, Assistant Professor, Department of Panchakarma, Government Ayurveda Medical College, Bangalore, Karnataka, India.

The concept of Varna (colour) has been explained in our classics with great details. It has been classified broadly in two categories 1. Prakruta Varna 2. Vaikruta Varna, in the present disease Kamala, the important finding in clinical examination is the Vikruta Varna i.e., Haridra Netra, Twak, Mutra etc. Kamala is Pittaja Nanatmaja and Raktapradoshaja Vikara. Charakacharya considered Kamala as advanced stage of Pandu Roga. Sushrutacharya considered Kamala as separate disease and also may be due to further complication of Panduroga, whereas Vagbhatacharya described Kamala as a separate disease. Ayurveda is traditionally skilful in treating liver diseases since centuries. Although named Jaundice as liver disorder was not mentioned in Ayurveda literature but on the basis of similarity of symptoms like yellowish discolouration of skin (Twak Pitata), Sclera (Netra), Urine (Mutra), Stool (Purisha) it can be correlated with jaundice. In Kamala Vyadhi all Acharyas in Ayurveda texts have explained about Virechana Karma. Modern science has its own limitation in treating Kamala Vyadhi (jaundice) but Ayurveda literature clearly explained pathology and treatment of Kamala Vyadhi which shows the specificity of Ayurveda. The line of management i.e., Virechana Karma and Shamana Chikitsa are successful in management of Kamala by removing toxic waste from the body and by correction of Agni (digestive fire).

Keywords: Kamala Vyadhi, Virechana Karma, Jaundice

Corresponding Author How to Cite this Article To Browse
B Raheena, Post Graduate Scholar, Department of Panchakarma, Government Ayurveda Medical College, Bangalore, Karnataka, India.
Email: 		B Raheena, Sanganor Smita, Priyadarshini, Conceptual study of Kamala and understanding the concept of Kamale Tu Virechane w.s.r. to Jaundice. J Ayu Int Med Sci. 2022;7(1):109-115.
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https://jaims.in/jaims/article/view/1714

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-22 2022-01-24 2022-01-31 2022-02-07 2022-02-13
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© 2022by B Raheena, Sanganor Smita, Priyadarshiniand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Rakta is considered as Jiva (Prana) of living creature. In its Prakruta Avastha, it endows with strength, complexion, happiness and longevity. When vitiated causes disease such as Pandu, Kamala etc.[1] In Kamala Roga, there will be derangement of normal colour and complexion of the skin, alteration in Mala Pravrutti and accumulation of excess Mala Roopi Pitta take place.

The word Kamala is derived from the root word Kamu which means Kaanthi. The term Lunathi means Nasha. And Kaanthim Lunathi means, a pathological condition in which normal colour of a skin is lost. In this Vyadhi, the hunger and appetite for food is diminished, all Malas get vitiated and discoloured (Peeta, Haridra, Harithadi)[2]

Liver disorders and their treatment modalities are very well described under the heading of “Kamala Vyadhi”. It can be correlated with “jaundice” of modern medical science. Kamala and other Liver diseases are considered as one of the speciality area in the field of Ayurveda, this feeling is spread so deep among the people that almost all the patients suffering from this, prefers Ayurvedic treatment as first line therapy. In Ayurveda, Kamala is the disease related with Pitta Dosha. It is included under Pittaja Nanatmaja Vyadhi[3] and Raktajapradoshaja Vyadhi.[4] In Ayurvedic classics, Kamala is considered as Raktapradoshaja Vyadhi. It is a disease of Raktavaha Srotas. Yakrut (liver) and Pleeha (spleen) are the Moola of Raktavaha Srotas[5] and Virechana is the first line of treatment for Raktavaha Srotas Vyadhi.[6]  Acharya Charaka has mentioned “Kamali Tu Virechanama” as Chikitsa Sutra.[7] He also considered Kamala as an advance stage of Pandu Vyadhi. When Pandu Rogi or patient who cured from Pandu continues to take Pitta Vardhak Ahara then this causes excessive aggravation of Pitta Dosha and gives rise to Kamala.[8] Acharya Sushruta has considered Kamala as separate disease and also may be due to further complication of Panduroga. when patient of Panduroga or person affected with other diseases consumes Amla, Tikshna etc. Pitta Vardhak Ahara, that may lead to initiation of Kamala.[9] Whereas Acharya Vagbhata has described Kamala as a separate disease. He takes Kamala as middle course and says that it may be either as a sequel to Pandu or without it independently like Pramehapidika.[10]Ranjaka Pitta

and its Sthana Yakrut are also involved in its Samprapti. Ranjaka refers to bile pigments. Pitta refers to bile salts. Bile salts have choleretic action that stimulates the secretion of bile from liver. It is this Ranjaka Pitta, which provides an exceedingly valuable tool for the diagnosis of both Koshthashrita Kamala as well as Shakhashrita Kamala. Kamala is a term used in Ayurveda to describe a disease which resembles Jaundice. Pandu is said to be Nidanarthakara for Kamala, i.e. when Pandu is not treated properly it can lead to Kamala. Thus, Kamala can be considered as an effect of untreated Pandu or Pandu which runs a chronic cause. When the patients who is suffering from Pandu, during the process of recovery or after getting cured, consumes Pitta aggravating foods and life activities in excess, the blood gets severely aggravated and burns the muscles.[11] The Panchakarma therapy is essentially designed to restore the integrity of Srotas system in the body in health and disease. Virechana is indicated in multiple conditions like Pitta Pradhana Vyadhi’s like Pandu and Kamala, Rakta Pradoshaja Vyadhi.[12] Virechana drugs are having Ushna, Tikshna, Sukshma, Vyavayi, Vikasi properties and Adhobhagahar Prabhava. Due to the Veerya and above properties of the Virechana drugs, there is softening, disintegration, liquification of endogenic metabolic products, and are brought to the Koshta for elimination.[13]

Critical review of Nidana of Kamala: Nidana also varies depending upon the types of Kamala, the entire Nidana aspect of Kamala can be broadly divided into 4 types

  1. Specific Nidana of Koshtashakashrita Kamala[14]
  2. Specific Nidana of Shakashrita Kamala[15]
  3. Kamala as a Nidanarthakara Vyadhi of Pandu and other diseases[16]
  4. Indirect Nidanas of Kamala

Table 1: Kamala Nidana

Bahupittakamala Hetu
Aharaja Nidana Viharaja Nidana Manasika Nidana
Excessive Kshara, Amla, Lavana Ativyayama Kama
Viruddha Anna Atimaituna Chinta
Vidagdha Anna Diwaswapna Bhaya
Asatmya bhojana Vegadharana Krodha
Nishpava, Masha, Pinyaka, Tila Taila   Upahata chesta
Ruddhapatha Kamala Hetu
Excessive intake of Ruksha Guna Ahara Ativyayama  
Sheeta, Guru, Madhura Rasa Ahara Vega Dharana   

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Kamala as a Nidanarthakara Vyadhi of Pandu and other disease

Acharya Charaka considered Pandu Roga one of the causes for Kamala.

For e.g. Santarpana and Viruddhaharas are capable of producing Pandu which intern act as Nidana for Kamala.

Indirect Nidanas of Kamala

Acharya Charaka and Vagbhatta have stated that Kamala is Rakta Pradoshaja Vyadhi and is due to Rakta Vaha Sroto Dusti respectively.

Etiological factors which causes Raktadusti like Ushna, Vidahi, Dadhi, Taila, Snigdha, Kshara, Anupa Mamsa Sevana, Krodha and Sharat Kala etc. are almost similar to that Pitta Prakopas, which causes Kamala.

The above mentioned Nidanas causes Pitta Prakopa and Rakta Dushti, when Rakta is vitiated the Srotases through which it circulates also gets vitiated ultimately leading to vitiation of Mulasthanas i.e., Yakrit and Pliha and causing kamala. Thus, the Nidanas of Rakta Dusti also causes Kamala indirectly.

Understanding of Samprati[17]

 Koshtashrita Kamala


jaims_1714_01.JPG




Shakashrita Kamala:[18]

jaims_1714_02.JPG

Samprapti Ghataka of Kamala


  1. Dosha:

Pitta: Ranjaka Pitta, Bhrajaka Pitta, Pachaka Pitta

Vata:  Vyana Vayu

Kapha: Koshtastha Kapha (Kledaka)


  1. Dushya: Rasa, Rakta, Mamsa, Twak.
  2. Agni: Jataragnimandya, Dhatuagni and Bhootagni
  3. Srothas: Raktavaha Srothas, Rasavaha Srotas and Mamsavaha Srotas, Purishvaha Srotas
  4. Srotodushti: Atipravritti, Sanga, Vimarga gamana
  5. Udbhava Sthana: Amashaya

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  1. Vyaktha Sthana: Netra, Twak, Mala, Mootra, Nakha
  2. Adhisthana: Kostha (Mahasrotasa) and Shakha.
  3. Marga: Bahya and Abyantara Roga Marga

Rupa of Kamala

 1) Koshtashrita Kamala


SN Lakshana Charaka Samhita[19] Sushruta Samhita[20] Ashtanga Hridaya[21]
1. Haridra Netra + - +
2. Haridra Twacha + - +
3. Haridra Mukha + - +
4. Haridra Nakha + - +
5. Haridra Mutra + - +
6. Rakta Peeta Mutrata - - -
7. Rakta peeta mala - - -
8. Daha + - +
9. Avipaka + - +
10. Doubalya - - -
11. Sadana - - -
12. Aruchi - - -
13. Krusha - - -
14. Tandra - + -
15. Balakshaya - + -
16. Trishna + - +
17. Indriyadaubalya + - +
18. Bhekavarnata + - +
19. Panduvadana - + -
20. Haridra Mala - - -

2) Lakshana of Shakashrita Kamala[22]

  • Haridra Netra, Twak, Mutra
  • Sweta Varchas/Tila Pishta Varchas
  • Atopa
  • Vishtambha
  • Hrudaya Guruta
  • Daurbalya
  • Alpagni
  • Parshwa Arti
  • Hikka Swasa
  • Aruchi, Jwara

3) Lakshana of Kumba Kamala:[23]

Kumba Kamala develops as a complication or an advanced stage of Koshtashakasrita Kamala,


  1. Khari Bhuta
  2. Maha Sopha
  3. Parvabheda
  4. Krishnapeeta Twak, Mootra, Sakrith and Netra

4) Haleemaka Lakshana[24]

It is caused by deranged Vata and Pitta.


  1. Haritha Syava Peeta Varna
  2. Utasaha Kshaya
  3. Bala Kshaya
  4. Tandra
  5. Mandagni
  6. Mridu Jwara
  7. Angamarda
  8. Daha
  9. Trishna
  10. Aruchi
  11. Brama

Sadhya-Asadhyata[25]

According to Charaka Samhita


  • Sadhya: Initial stage of Kamala is Sadhya. On long standing becomes Kriccha Sadhya and Kumba Kamala
  • Asadhya: Kumba Kamala presents with further symptoms like Krushna-Pita Shakruth, Mutra, Raktamutra, Shotha, Rakta Mukha, Rakta Chardi, Daha, Aruchi Trushna, Anaha, Moha, Nashtagni is Asadhya


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Chikitsa

Samanya Chikitsa Sutra of Kamala explained in different classics


  • Acharya Charaka[26] has classified Kamala under Pittaja Nanatmaja Vyadhi, where he suggests to treat on the principle of Paittika Vikara “Virechanam Tu Sarvakramabhyam Pitta Pradhanatamam Manyate Bishajah” and He also quotes “Shamshodhyo Mrudubitiktastya Kaamale Tu Virechane”
  • Acharya Vagbhatta[27] opines to adopt Pittahara Chikitsa that is not antagonist to Pandu. Swedana is contraindicated in kamala. He also advised about Anjana Chikitsa.
  • Acharya Sushruta [28] has considered Kamala as Paryaya of Pandu, Hence Chikitsa of Pandu is followed in Kamala.
  • Yogaratnakara described Snehapana, Virechana, Nasya and

Vishesha Chikitsa Sutra of Kamala

Virechana is one of the procedures (Karma) of Panchakarma. It is a process by which the Doshas are made to pass through Adhomarga i.e., Guda.

In this Karma, the Doshas from the Amashaya (stomach) are taken to the Pakwashaya (large gut) and they are removed through Gudamarga.  Acharya Charaka has described about Mrudu Virechana Chikitsa for Bahupitta Kamala.

In Kamala Pitta Dosha is vitiated by its Ushna, Tikshna Guna and leads to Rakta Dhatukshaya. Along with this because of Drava Guna accumulation (Sanchaya) of Pitta Dosha occur. In this state if we give Tikshna Shodhana, it leads to vitiation of Vayu. So, there is need to eliminate Sanchita Dosha and to avoid Dhatukshaya Mrudu Shodhana i.e., Mrudu Virechana (mild purgation) is useful in Bahupitta Kamala.

Here treatment of choice for Kamala is Mrudu-Virechana as Virechana is best therapeutic procedure for Pittadosha. Virechana is a specific treatment for Pitta Doshas and Pitta Samsarga Doshas. Virechana Dravyas will have properties of Ushna, Tikshna, Sukshma, Vyavayi and Vikasi Guna. These drugs consist of Prithvi and Jala Mahabhutas. Virechana drugs have a specific property of removing the Doshas from lower part of the body (Adhobhaga).[29]

Probable mode of action of Virechana [30]

jaims_1714_03.JPG

Discussion

In today’s era of industrialization and life threatening competition, the life style of mankind has been hugely changed. This has unknowingly changed the previous healthy eating habits to overeating of spicy food, excessive use of food like Samosa, Poha and alcohol consumption tendency, smoking also increasing day by day. In industries, the worker on changing duty hours are irregular in their eating habits and sleep hour. The whole situation leads to eating outside with increased risk of contaminated food and water.

Koshthasrita Kamala which occurs as a result of Pitta Vridhi in Rakta Dhatu after the use of its aggravating causes has similarity with the mechanism of pre hepatic jaundice or Haemolytic jaundice in which more bilirubin is found in blood due to excessive destruction of R.B.C and is not excreted. Adequately by liver resulting in hyperbilirubinemia responsible for various symptoms like yellow discoloration of eye, skin etc. Shakhashrita Kamala is produced when obstructed Pittavaha Srotas is vitiated with the aggravated Kapha Dosha due to which it vitiates Vata Dosha


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which results in Pitta Vridhi in Shakha (Twacha, Rasa, Rakta etc). In obstructive jaundice, there is same mechanism in which the bile ducts are obstructed by gall stone or other causes and bile is accumulated in liver, resulting in elevation of blood bilirubin level responsible for yellowness of eye, skin, mucous membrane and stool becomes clay colored due to lack of bile in the intestine.[31]

For the management of Kamala, Virechana is considered as most important procedure. Fecal route is considered as the most important route for excretion of bile and biliary products. By the use of Ayurvedic medicine, Virechana enhances fecal route of bile excretion by increasing bowel motility and also hampering its enterohepatic circulation of bilirubin.

Conclusion

In Ayurvedic text Kamala Vyadhi is thoroughly described. It helps us to understand the disease pathology very clearly. In the treatment part that is in Chikitsa Sutra of Shakashrita Kamala, Acharya Charaka has explained Mrudu Virechana Karma. During Virechana Karma, there is relaxant action of sphincter of Oddi. Thus, excessive bile enters into 2nd part of duodenum through ampulla of vater and gets eliminated during purgation. Basic idea is to ‘reduced hepatic load’ by eliminating excessive bilirubin in the form of stercobilin and reduces hyperbilirubinemia.  Modern science has limitation in treating the Kamala Vyadhi (jaundice) but Ayurvedic literature clearly explained pathology and treatment of Kamala Vyadhi which shows the specificity of Ayurveda. But Shakhashrita Kamala needs different principle of management, Virechana is not effective in it. So, by giving the medicines which alleviates Kapha, Vata and Pitta is brought in Koshta then Pittahara Chikitsa should be given.

Reference

  1. Agnivesha, Charaka Samhita, Sutrasthana, Chapter24, verse 04, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no.124.
  2. Raja Radhakantadev Bahuddur. Shabdakalpadruma volume 4, Naga Publication. Dehli. Edition- 1987 Page no.60.
  1. Agnivesha, Charaka Samhita, Sutrasthana, Chapter20, verse 14, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no. 89.
  2. Agnivesha, Charaka Samhita, Sutrasthana, Chapter28, verse 11-12, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no.179.
  3. Agnivesha, Charaka Samhita, Vimanasthana, Chapter05, verse 08, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 152.
  4. Agnivesha, Charaka Samhita, Sutrasthana, Chapter24, verse 18, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no 130.
  5. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 40, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016 Page No:528.
  6. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 34-38, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no:527.
  7. Sushruta Samhita, Uttaratantra, Chapter 44, verse 03, Nibandha sangraha commentary by Dalhanacharya, Edited by, Vaidya Yadavaji Trikamaji Acharya, Chaukhambha orientalia, Varanasi, Edition 2014. Page No:729.
  8. Vagbhata, Ashtanga Hridaya, Nidana Sthana Chapter 13 verse 17 Sarvanga Sundara and Ayurveda rasayani commentary of Arunadatta and hemadri Pandit hari sadashiv Shastri Paradkar, Chaukhambha Surabharati Prakshan. Varanasi. Edition 2016. Page No: 519.
  9. Agnivesha, Charaka Samhita,

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)114
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  1. Chikitsa Sthana, Chapter16, verse 34, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 527.
  2. Agnivesha, Charaka Samhita, Siddhi Sthana, Chapter02, verse 13, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no 968.
  3. Agnivesha, Charaka Samhita, Kalpa Sthana, Chapter01, verse 05, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page no: 752.
  4. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 34, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 528.
  5. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 125, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016  Page No: 562.
  6. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 34, Ayurveda deepika Commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 528.
  7. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 34, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 528.
  8. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 125-127, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016 Page No: 562.
  9. Agnivesha, Charaka Samhita,
  1. Chikitsa Sthana, Chapter16, verse 34, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No:528.
  2. Sushruta Samhita, Uttaratantra, Chapter 44, verse 10-11, Nibandha sangraha commentary by Dalhanacharya, Edited by, Vaidya Yadavaji Trikamaji Acharya, Chaukhambha orientalia, Varanasi, Edition 2014. Page No: 729.
  3. Vagbhata, Ashtanga Hridaya, Nidana Sthana Chapter 16 verse 16, Sarvanga Sundara and Ayurveda rasayani commentary of Arunadatta and hemadri Pandit hari sadashiv Shastri Paradkar, Chaukhambha Surabharati Prakshan. Varanasi. Edition 2016. Page No: Page No 519.
  4. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 126-127, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016 Page No: 565.
  5. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 37-38, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 530.
  6. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 132-133, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 570.
  7. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 36-37, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 532.
  8. Agnivesha, Charaka Samhita, Chikitsa Sthana, Chapter16, verse 40, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 530.
  9. Vagbhata, Ashtanga Hridaya, Chikitsa Sthana Chapter 16 verse 40 Sarvanga Sundara

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)115
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  1. and Ayurveda rasayani commentary of Arunadatta and hemadri Pandit hari sadashiv Shastri Paradkar, Chaukhambha Surabharati Prakshan. Varanasi. Edition 2016.
  2. Sushruta Samhita, Uttaratantra, Chapter 44, verse 06, Nibandha sangraha commentary by Dalhanacharya, Edited by, Vaidya Yadavaji Trikamaji Acharya, Chaukhambha orientalia, Varanasi, Edition 2014. Page No: 724.
  3. Agnivesha, Charaka Samhita, Kalpa Sthana, Chapter01, verse 05, Ayurveda deepika commentary by Chakrapanidatta. Editor: Yadavaji Trikamaji Acharya. Chaukhamba Surabharati Prakashana Varanasi. Edition 2016. Page No: 752.
  4. Smina P,B, GAMC Bengaluru, “ A comparative clinical study of virechana yogas in Koshtashakashrita kamala w.s.r to infective hepatitis” thesis submitted to RGUHS, Bengaluru.
  5. Harrisons Principles of internal medicine 19th edition volume -1 section 3, Chapter 42, Page No:183.

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