E-ISSN:2456-3110

Research Article

Rakta Vridhi

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 7 July
Publisherwww.maharshicharaka.in

Sharir Kriyatamak study of role of Rakta Vridhi in Vyanga and its treatment with Asriksravnam Purva Baladi Lepam

Sharma S.1*, Sharma M.2, Jamwal A.3
DOI: http://dx.doi.org/10.21760/jaims.8.7.3

1* Sourabh Sharma, Post Graduate Scholar, Department of Kriya Sharir, Jammu Institute of Ayurveda and Research, Jammu, India.

2 Manu Sharma, Associate Professor, Department of Kriya Sharir, Jammu Institute of Ayurveda and Research, Jammu, India.

3 Aakriti Jamwal, Post Graduate Scholar, Department of Kriya Sharir, Jammu Institute of Ayurveda and Research, Jammu, India.

Background: In Ayurveda all skin ailments are mostly mentioned in Kustha and Kshudra Roga. The disease Vyanga is a type of Kshudra Roga. It may manifest with various sign and symptoms like Mandalam Visrijati, Niruja, Tanu, Shyava lesion over face. In the pathogenesis various Nidanas like Krodha, Shoka, Shrama etc. are responsible for disease Vyanga. In Ayurveda, for the treatment of this disease so many remedies as internal and external applications, Shodhana therapy like Raktamokshana are described. Aim: Sharir Kriyatamak study of role of Rakta Vridhi in Vyanga and its treatment with Asriksravnam Purva Baladi Lepam. Study design: The Study was single arm, open clinical trial. Sample size: Total number of patients taken for the study was 30 excluding dropouts. Intervention: Asriksravnam followed by local application of Lepa consisting Bala, Atibala, Madhuka, Haridra. Procedure was repeated after every 7 days for 10 sittings. Duration: 70 days Follow up: After every 7 days following procedure. Observations and Results: The observations recorded in the clinical trials were assessed and results were drawn which shows the treatment given to the patients. Overall response is found to be significant for some parameters. Conclusion: Clinical response of the treatment Asriksravnam Purva Baladi Lepam have given best results for parameters like Daha, Kandu, Shyava Varna.

Keywords: Vyanga, Kshudra Roga, Melasma, Asriksravnam, Baladi Lepa

Corresponding Author How to Cite this Article To Browse
Sourabh Sharma, Post Graduate Scholar, Department of Kriya Sharir, Jammu Institute of Ayurveda and Research, Jammu, , India.
Email: 		Sourabh Sharma, Manu Sharma, Aakriti Jamwal, Sharir Kriyatamak study of role of Rakta Vridhi in Vyanga and its treatment with Asriksravnam Purva Baladi Lepam. J Ayu Int Med Sci. 2023;8(7):11-18.
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https://jaims.in/jaims/article/view/2521

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-05-27 2023-05-29 2023-06-05 2023-06-12 2023-06-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Sourabh Sharma, Manu Sharma, Aakriti Jamwaland 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

Ayurveda i.e., the knowledge of life is one of the world's oldest systems of health care and healing. Ayurveda not only compiles the remedial measures but also the preventive regime of healthy living.

Among the personality damaging disorder or disbeautifying conditions, Vyanga is such a condition which affects the beauty as well as personality, and has a great cosmetic importance. Now-a-days, Vyanga has become a common problem of the society and many people are suffering from Vyanga today. Among them women are commonly found due to changes occurring during pregnancy and use of cosmetics supplements. Men are also suffering due to occupational hazards. Vyanga harms beauty of the face so person may suffer from inferiority complex, anxiety, isolation etc. Thus, Vyanga is a painless condition for body but it is painful for mind. It requires a proper treatment and therapy.

Vyanga is a skin disease which has been mentioned under Kshudra Rogas. Acharya Sushruta has given a detailed and separate description of the disease Vyanga in the 13th chapter Kshudra Roga Nidana in Sushruta Samhita Nidana Sthana. According to Acharya Sushruta, the Nidana like Krodha, Ayasa lead to vitiation of Vata and Pitta, which lodge in the Tvacha of Mukha Pradesha i.e. skin of the face, producing Niruja, Tanu, and Shyava mandalas which is termed as Vyanga,[1] which literally mean spottted, a blot or blemish. Acharya Vagbhatta in Sutrasthan has mentioned Vyanga as Raktavridhi janya Vikara.[2] According to Acharya Vagbhatta, Vridhi in Rakta Dhatu is the root cause for many diseases including Vyanga.

According to modern science it can be correlated with Melasma. Melasma is a common acquired, Symmetrical hypermelanosis characterized by grey/dark, brownish maculae on sun exposed areas especially the face, forehead and more rarely on the nose, eyelids, chin, and upper lips.[3]

Aim and Objectives

This study Asriksravnam Purva Baladi Lepam was undertaken to evaluate the efficacy of the above mentioned treatment with the following Aim and Objectives:


Aim: Sharir Kriyatamak study of role of Rakta Vridhi in Vyanga and its treatment with Asriksravnam Purva Baladi Lepam

Objectives

1. To study about Ayurvedic approach in the field of Cosmetology.

2. To study the disease Vyanga with its Etiopathology according to Ayurvedic and modern literature.

3. To assess the role of Rakta Vridhi in

4. To assess the effect of Asriksravnam Purva Baladi Lepam in Vyanga.

Hypothesis

Null Hypothesis (H0) - There is no significant effect of Asriksravnam Purva Baladi Lepam on Vyanga.

Alternate Hypothesis (H1) - There is a significant effect of Asriksravnam Purva Baladi Lepam on Vyanga.

Materials and Methods

Plan of study: For the present study, 30 patients having the classical signs and symptoms of Vyanga more than normal limit were selected from OPD of Jammu Institute of Ayurveda and Research Hospital, Jammu and Shri Sain Charitable Trust and Hospital, Urban Wing, Janipur.

Medical Camps were conducted for the study.

The patients were taken on the basis of inclusion criteria.

Inclusion Criteria

1. Patients in the age group of 10-40 years.

2. Chronicity less than 5 years.

3. Shyava Varna Yukta, Niruja, Tanu Mandalas present over the face.

Exclusion Criteria

1. Age less than 10 years and more than 40 years.

2. Vyanga caused due to any systematic disease like Addison's disease, Cushing's syndrome, Systemic lupus erythematous etc.

3. Vyanga caused since birth like Nevus of ota etc.


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4. Vyanga caused by tumour like malignant melanoma.

5. Inflammatory

6. Acne vulgaris.

7. Patients having abnormality regarding CT, BT and Diabetes.

Treatment Protocol

Study: Single group study

Sample size: 30 patients

Procedure: Raktavisravana (Pracchanna) followed by local application of Bala, Atibala, Madhuka, Haridra Lepa

Procedure was repeated after every 7 days for 10 sittings

Duration: 70 days

Follow up: After every 7 days following procedure.

Assessment Criteria: The effect of therapy would be assessed on the basis of:

1. Subjective criteria before and after treatment

2. Objective criteria i.e., Hb% before and after treatment

Subjective Parameters: It includes the area of the patches, no. of Shyamvarni Mandala, skin texture (dry or oily), size of the patches. Surface area of face was calculated using graph paper. Chart containing skin colour shades was prepared to know the change in the discolouration present in the patients having Vyanga. A grading system would be adopted for assessment:

  • Colour of Mandala
  • Size of Mandala
  • Number of Mandala
  • Daha
  • Kandu
  • Snigdhta
  • Rukshata

Grading of Assessment Criteria

1. Colour of Mandala:  Colour of the lesion was graded from 1 to 7 by using self-prepared colour grading scale.

Table 1: Assessment criteria for colour of Mandala

Colour of Mandala Grade Score
Grade 1 1
Grade 2 2
Grade 3 3
Grade 4 4
Grade 5 5
Grade 6 6
Grade 7 7

2. Size of Mandalas: Size of Mandala were measured using Graph paper

Table 2: Assessment criteria for Size of Mandala

G1 Total disappearance of the Mandalas
G2 ½ to 2 sq.cm.
G3 2 to 5 sq.cm.
G4 > 5 sq. cm.

When the lesions are multiple, the size of the largest lesion is taken into consideration.

3. Number of Mandalas

Table 3: Assessment criteria for Number of Mandala

G1 Absence of Mandalas
G2 1 to 2
G3 2 to 5
G4 > 5

4. Daha (Burning Sensation)

Table 4: Assessment criteria for Daha

  Score
No burning sensation 0
Mild burning sensation - Occasional burning sensation mostly when patient undergoes to sun exposure 1
Moderate Burning sensation - Frequent burning sensation which increases when patient undergoes to sun exposure 2
Severe Burning sensation - Continuous burning sensation with or without sun exposure 3

5. Kandu (Itching)

Table 5: Assessment criteria for Kandu

  Score
No Itching 0
Mild Itching - Occasional itching but does not disturb routine activity 1
Moderate Itching - Frequent itching, disturbs routine activity but does not disturb sleep 2
Severe Itching - Frequent itching that disturbs activity as well as sleep 3



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6. Snigdhata (Oily skin)

Table 6: Assessment criteria for Snigdhta

  Score
Normal 0
Mild Oiliness - Not seen with naked eye, Oiliness feel by touch no need to wash face frequently (only 1-2 times a day) 1
Moderate Oiliness - Oiliness is visible on skin, need to wash face frequently (3-4 times a day) 2
Severe Oiliness - Excessive Oiliness, formation of Acne, need to wash face more frequently (>4 times a day) 3

7. Rukshata (Dry skin)

Table 7: Assessment criteria for Rukshata

  Score
Normal 0
Mild Dryness - Not seen but felt by touch 1
Moderate Dryness - Stretching of the skin that person feels 2
Severe Dryness - Visible dryness (Chapping of the skin) & hardness of the Skin 3

Objective Parameter

Hb%

Procedure for Asriksravnam (Pracchana)

Procedure was done after

  • Detailed explanation of procedure to patients.
  • After taking Consent from patients.

Poorva Karma[4]

1. All the equipment’s required for procedure like spirit swab, cotton, 26-G needle, betadine solution, gloves etc. were collected.

2. Vitals were checked and found to be stable.

3. CT, BT were checked and found to be in normal limit.

4. Mild Snehan and Svedan of the affected area was done.

Pradhana Karma

1. The patient was made to lie down on table in comfortable supine position.

2. Hands were properly cleaned after washing with soap and water and dried with single use towel.

3. The site or affected area on the face of patient was identified and cleaned with betadine solution.

4. Under all aseptic conditions multiple, small, superficial pricks using fine needle were made in such a pattern of neither too deep nor too superficial, so that the whole affected area should be covered.

5. Precautions should be taken to avoid the procedure over Marmassthalas, Snayu, Sandhis as it may cause fatal outcomes if done on such site.[5]

6. The blood oozed out of the incisions and stopped on its own after few minutes.

Paschata Karma: After the stoppage of bleeding, the area was cleaned with sterile cotton balls, and then Lepa was applied.

Methods of Application of Lepa

1. Patients were advised to mix the above prepared drug with sufficient amount of water to obtain it in a paste (Lepa) form at the time of application.

2. Classical reference of Doshaghna Lepa as per Acharya Sharangdhara states it thickness to be ¼ Angula which roughly corresponds to 4.5 mm. However, it was not clinically feasible to apply such a thick Therefore, Patients were advised to apply Lepa on face in a sufficient quantity, so as to cover the affected areas (moderate thickness i.e 1 mm) effectively.[6]

3. Patients were advised to always apply freshly prepared Lepa, twice daily (morning and evening) and not at night time and wash the face with water and were instructed not to go to sun light during the period of treatment.

Statistical Analysis: The clinical data gathered from the patients was subjected for statistical analysis. The data was analyzed statistically in terms of Mean score, Percentage of relief, Standard Deviation (S.D), Standard Error (S.E) and ‘t’ test. The Paired ‘t’ test was carried out at the level of 0.05, 0.01, 0.001 of ‘p’ value. P values of < 0.05 was considered as statistically significant and P value < 0.01 and < 0.001 were considered as highly significant. Level of significance was noted and interpreted accordingly.

Results

Table 8: Effect of Asriksravnam Purva Baladi Lepam on Subjective Parameters.

Subjective Parameter Mean d % SD t p- value
BT AT BT AT
Colour of Mandala 4.07 2.33 1.74 42.75 0.944 0.606 5.53 <0.05(S)
Size of Mandala 3.27 1.27 2 61.11 0.450 0.000 3.87 <0.05(S)
Number of Mandala 3.44 2.23 1.21 35.17 0.568 0.430 3.11 <0.05(S)
Daha 0.30 0.00 0.30 100 0.466 0.000 3.11 <0.001(HS)
Kandu 0.40 0.00 0.40 100 0.407 0.000 3.76 <0.001(HS)
Snigdhta 1.73 1.63 0.10 5.78 0.660 0.120 1.93 0.25(NS)
Rukshata 2.57 0.20 2.37 92.21 0.610 0.110 8.93 <0.05(S)

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Table 9: Effect of Asriksravnam Purva Baladi Lepam on Hb%

Mean d % S.D t P-Value
BT AT 0.62 5.27 BT AT 1.03 <0.05(S)
11.75 11.13     1.693 1.692    

Table 10: Shows overall effect of treatment

SN Assessment Criteria Percentage Improvement Statistical Significance
1. Colour of Mandala 42.75% S
2. Size of Mandala 61.11% S
3. Number of Mandala 35.11% S
4. Daha 100% HS
5. Kandu 100% HS
6. Snigdhta 5.78% NS
7. Rukshata 92.21% S
8. HB% 5.27% S

S - Significant, HS - Highly Significant, NS - Non Significant.

Discussion

This present research work aimed at Sharir Kriyatmak study of role of Rakta Vridhi in Vyanga and its treatment with Asriksravnam Purva Balaadi Lepam. Acharya Sushruta has described Nidana like Krodha, Shoka, Aayasa, Shrama etc. which act as the causative or aggravating factors for the disease. No any other particular Nidana has been mentioned in the text but all the factors like Vataprakopaka, Pittaprakopaka and Raktaprakopaka Nidana are the causative factors for the disease Vyanga.

The clinical features of Vyanga are Mandala (shape of the lesion), Tanutva (thickness of the lesion), Nila, Shyava, Krishna Varna (colour of the lesion) and Niruja (painless). While describing the etiological factors of Vyanga, Acharya has given special emphasis towards psychological factors like Krodha, Shoka and Shrama, which are commonly found in most of the patients.[7] In Samprapti of Vyanga, Acharya Charaka has mentioned that the aggravation of Pitta along with Rakta is the chief culprit for initiation of the pathology. Vyanga is a Rakta Pradoshaja Vyadhi, hence the very first Dosha affected is Rakta Dhatu.[8]

Dosha Prakopaka Hetus like Krodha, Shoka and Shrama are mainly Tama (Manasika Dosha), Pitta and Vata (Shareerika Dosha) dominant which vitiate Agni. Agni resides in Rasa and initiates the pathogenesis of Vyanga.

Here Ranjaka Pitta is responsible for the conversion of Rasa Dhatu into Rakta Dhatu which results in the formation of normal skin colour.

However due to Krodha and Shoka, Pitta & Rakta Prakopaka Nidana mainly Pitta vitiation takes place which in turn affects the Jatharagni and normal functioning of Ranjaka Pitta i.e., Varnotpatti. Based on Ashraya-Ashrayee Bhavas, the derangement of Teekshna, Ushna, Laghu, Visra, Sara, Drava Guna of Pitta Dosha leads to abnormality of Teekshna, Ushna, Laghu, Visra, Sara, Drava Guna of Rakta Dhatu which leads to Rakta Vridhi. Shrama and Shoka will lead to Udana Vata vitiation.

Thus, vitiated Udana Vata as well as Vriddh Rakta Dhatu travel in body through Dhamanis and get Sthana Samshraya in Mukhagata Twacha and due to Ashraya-Ashrayee Bhavas Vriddh Rakta Dhatu causes vitiation of Mukhagata Bhrajaka Pitta giving rise to discoloration of the skin.[9]

The effect of Asriksravnam Purva Baladi Lepam on the selective parameters was assessed. After the trial period of 70 days, the following results were noticed.

Effect of therapy on colour of Mandala

Mean score for the colour of Mandala before treatment was 4.07, which reduced to 2.33 after treatment with mean difference 1.74, showing 42.75% improvement. Statistical analysis shows that the improvement was significant at P < 0.05.

Effect of therapy on size of Mandala

Mean score for the Size of Mandala before treatment was 3.27, which reduced to 1.27 after treatment with mean difference 2, showing 61.11% improvement. Statistical analysis shows that the improvement was significant at P < 0.05

Effect of therapy on number of Mandala

Mean score for the Number of Mandala before treatment was 3.44, which reduced to 2.23 after treatment with mean difference 1.2, showing 35.17% improvement. Statistical analysis shows that the improvement was significant at P < 0.05.

Effect of therapy on Daha

Mean score for Daha before treatment was 0.30, which reduced to 0.00 after treatment with mean difference 0.30, showing 100% improvement. Statistical analysis shows that the improvement was highly significant at P < 0.001


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Effect of therapy on Kandu

Mean score for Kandu before treatment was 0.40, which reduced to 0.00 after treatment with mean difference 0.40 showing 100% improvement. Statistical analysis shows that the improvement was highly significant at P < 0.001.

Effect of therapy on Snigdhata

Mean score for Snigdhata before treatment was 1.73, which reduced to 1.63 with mean difference 0.10, showing 5.78 % improvement. Statistical analysis shows that the improvement was non-significant at P > 0.05.

Effect of therapy on Rukshata

Mean score for Rukshata before treatment was 2.57, which reduced to 0.20 after treatment with mean difference 2.37, showing 92.21% improvement. Statistical analysis shows that the improvement was significant at P < 0.05

Effect of therapy on Hb%

Mean score for the Hb% before treatment was 11.75, which reduced to 11.13 after treatment with mean difference 0.62, showing 5.27% improvement. Statistical analysis shows that the improvement was significant at P < 0.05.

Probable mode of action of Raktamokshana

Raktamokshana is one of the essential procedures among five Penta-bio purificatory procedures as per Acharya Sushruta. It is the important non-pharmacological intervention through which vitiated Rakta Dosha, along with Pitta, is eliminated through the body by using different techniques such as Sira Vedha, Jaloukavacharna, Shringa, or Prachhana.

In this study Raktamokshana via Pracchana was carried out on 30 subjects. Here in this study Prachhana Karma was done for bloodletting as Pracchana Karma is very simple method of bloodletting among other procedures for Raktamokshana.

Pitta resides in Rakta as Ashrayi (dependent). When Pitta is vitiated, it causes vitiation of Rakta that leads to Rakta Vridhi. Raktamokshana removes vitiated Pitta together with Vridh Rakta assisting in the development of Shudha Rakta and may be helpful in curing the Paitika and Dusth Rakta symptoms like Daha, Shyava Varna of Mandala in disease Vyanga.

The Sanga (obstruction) of Srotasa, which is the Dushti Prakara in Vyanga, is relieved by Rakta Mokshana which may help to cure the overall symptoms of Vyanga.

Probable mode of action of Lepa

When Bala, Atibala, Madhuka, Haridra is applied as Lepa on the skin, it enters the Romakupa, reaches the Swedavaha Srotasa and Siramukha, and thus, the Rasa Tarpana occurs and the applied drug is metabolized by the Ushnata of Bhrajaka Pitta present in the skin. Thereafter, it is subjected for Pachana by Bhrajakagni which pacifies the provocative Doshas locally and this breaks the pathogenesis cycle leading to the alleviation in the symptoms. Drugs having Ushna Virya create an adding effect on Bhrajaka Pitta and cause Sthanika Dosha Pachana. In this way, it helps to purify Rakta Dhatu. All this clears Dosha-Dushya Sammurchhana and thus helps in breaking the pathology of Vyanga.

Most of the ingredients of Balaadi Lepa are Madhura Ras, Sheeta Virya, Madura Vipaka and have Vata-Pitta Shamaka properties. As the Samprapti is suggestive of local prominent pathology, the local application in proper medium and method is also necessary.

  • Bala, Atibala, Madhuka are Madhura Rasatmaka, Laghu, Snigdha Gunatmaka and Sheeta Viryatmaka.[10]
  • Madhura Rasa subsides the Pitta Dosha which is the main cause of Vyanga.
  • Snigdha Guna alleviates the Vata Dosha and it is also responsible for Mardava and Varna Prasadana.
  • Laghu, Ruksha are the properties of Agneya Dravya, which in turn are responsible for Prabha, Prakasa, and
  • Bala, Atibala, Madhuka are of Sheeta Virya and Sheeta Virya Dravyas are endowed with Rakta Prasadana Karma and also act as
  • The selected drugs mainly are of Madhura Vipaka. Madhura Vipaka by virtue of its Snigdha Guna and Kapha Vardhana Karma is responsible for Varṇa Utkarsha.[11]
  • Haridra is described as Tikta Rasatmaka, Laghu, Ruksha Gunatmaka and Ushna Viryatmaka.
  • Tikta Rasa of Haridra encounters Pitta and Rakta Dosha.

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  • Ushna Virya pacifies Vata and Kapha Dosha. It is also having the properties of Raktadoshahara which help to pacify Sanchita Dosha locally.[12]

Conclusion

In the present study, Baladi Lepa was found more effective in relieving the signs and symptoms of the disease and during the follow up the signs were seen to reduce further. The healthy lifestyle measures both in the form of dietary and other lifestyle modifications such as eating healthy and nutritional food, regular exercises, sufficient sleep, avoidance and proper management of stress and anxiety are also important. Therefore, on the basis of results it can be concluded that Raktamokshana is very effective in Rakta Vikara like Vyanga and local application of Baladi Lepa is also found to be safe and effective and can be prescribed in disease Vyanga.

Reference

1. Sushruta Samhita of Maharishi Sushruta, edited with Ayurveda Tattva Sandipika by Kaviraja Ambikadutta Shastri, Reprint edition 2016, Chaukhambha Sanskrit Sansthan, Varanasi, Nidana Sthana 13/45/,46, pg. no. 373.

2. Ashtanga Samgraha, with Sarvanga Sundary commentary Sutra Sthanam, vyakhyakar shri Lal Chander Shashtri Vaid, published by Vaidyanath Ayurveda Bhavan pvt lt, Nag road, Nagpur, Sutra Sthana 19/7, pg. no. 591.

3. P.N Behl, A. Aggarwal, Govind Srivastav, Practice of Dermatology, 9th Edition New Delhi CBS Publishers and Distributors 2002 PP-1.

4. Sushruta. Sushruta Samhita, Sutra Sthana, Shonit Varniye Adhyaya, 14/27 page no. 70, edited by Kaviraj Ambikadatta Shastri, 14th ed., Chaukhamba Sanskrit Sansthan, Varanasi, reprint edition 2016.

5. Sushruta. Sushruta Samhita, Sutra Sthana, Shonit Varniye Adhyaya, 14/26 page no. 70, edited by Kaviraj Ambikadatta Shastri, 14th ed., Chaukhamba Sanskrit Sansthan, Varanasi, reprint edition 2016.

6. Acharya Sharanghdhar, Sharangdhar samhita, Murthy KR. 2nd edition, Varanasi: Chaukhamba Orientalia; 1995. Uttar Khanda 11/1 pg. no.424.

7. Sushruta Samhita of Maharishi Sushruta, edited with Ayurveda Tattva Sandipika by Kaviraja Ambikadutta Shastri, Reprint edition 2016, Chaukhambha Sanskrit Sansthan, Varanasi, Sushruta Sutra Sthana 14/26.

8. Agnivesha, Charaka, Dridhabala. Charaka Samhita, Sutra Sthana, Trishothiya Adhyaya, 18/25, edited by Aacharya VJ, Reprint ed. Chaukhamba Prakashan, Varanasi, 2009;107.

9. Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna Savita S. Angadi, Sumitra T. Gowda.

10. Dravy Guna Vijnana Vol II Prof PV Sharma, Chaukhamba Bharti Academy Gokul Bhawan, K.37/109. Varanasi.

11. Pallavi G., Virupaksha Gupta K.L., Shreevathsa M., Vasudev A. Chate, Balakrishna D. L., Clinical evaluation of Varnya Gana Lepa in Vyanga (melasma)

12. Tripathi Ravidatta, Ashtanga Sangraha, Su 1/36, Choukhambha Sanskrut Pratishthan, Varanasi, reprint 2005, p-15, D.N. 2008 Edition.


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