Karappan: National Institute of Siddha

NATIONAL INSTITUTE OF SIDDHA
(THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY)

Chennai - 47
A Study on
KARAPPAN
(DISSERTATION SUBJECT)
for
the partial fulfillment of the requirement to the
degree of
DOCTOR OF MEDICINE (SIDDHA)

BRANCH III–SIRAPPU MARUTHUVAM
SEPTEMBER - 2007
Acknowledgement
First of all the author is extremely grateful to Lord
Almighty who empowered her with his blessings and grace to
complete this dissertation work successfully.
It is a great pleasure for the author to acknowledge the
deep sense of gratitude to the Vice- Chancellor, The Tamilnadu
Dr.M.G.R Medical University, Chennai for permitting to do this
dissertation work.
The author wishes to express grateful thanks to
Dr.V.Arunachalam M.D.(S), Director, National Institute of

Siddha, Chennai, for granting permission to undertake a study in
this dissertation topic and also for providing all the basic facilities
in order to carry out this work.
The author owe special gratitude to Dr.G.Thiagarajan
M.D.(S), Head of the Department of Sirappu Maruthuvam,
National Institute of Siddha, Chennai, for rendering his valuable
suggestion, guidance and encouragements in all aspects from
time to time.
The author is very much grateful to Dr.R.S.Ramaswamy
M.D.(S), Associate Professor, Department of Sirappu
Maruthuvam, National Institute of Siddha, Chennai, for his
valuable guidance and support in this dissertation work.
The author is grateful to Dr.T.R.Siddque Ali M.D (s),
Lecturer, Department of Sirappu Maruthuvam, National Institute
of Siddha, Chennai, for his guidance regarding this studies.
The author expresses her thanks to Mr.P.Jayabal,
Assistant Professor (Statistics), National Institute of Siddha,
Tambaram Sanatorium, Chennai -47.
The author expresses her thanks to Mr.M.Kalaivanan,
M.Sc,M.Phil, Lecturer, Department of Pharmagology,

Government Siddha Medical College, Palayamkottai in carrying
out the pharmacological analysis of the trail drugs needs special
mention and appreciation.
The author expresses her thanks to Mr.Mathan, Mettex
laboratories of India, Guindy, Chennai-32 for his help in
evaluating the trial drugs.
The author thanks to her colleagues and other staff
members who helped in this dissertation work.
The author wishes to extend her special thanks to
Dr.S.Natarajan, Dr.K.Krishnakumar and Dr.K.Saravanan
who have rendered their memorable support in successfully
completing this dissertation work.
The author is now in the position to thank her dear husband
Dr.M.Arun, her brother in law Mr.M.Anand and her lovable
daughter Kayaloviya, who supported her in all aspects not only
in this study but also in every moment of life.
And finally the author bends her head to all the patients
who were cooperated with her throughout this study without any
hesitations and made this work a most valuable one.

Introduction
Health is a state which not only keeps the body sound but also the
mind.Today’s modern industrialization imbalances the eco system which
paves way for many diseases. To uproot the diseases there should be a
system of medicine, which goes hand in hand with the nature.
Siddha medicine, a native medicine of Tamilnadu, is the first system

to emphasize health as the perfect state of physical, psychological, social
and spiritual components of human being.
As siddhi means perfection, the practitioners of siddha medicine

aimed at perfection of health.Disease is caused not only by imbalance of
physical constituents, the mind is also responsible for health or illness. To
diagnose the disease we have eight types of examining methods.To treat
both the body and mind, we have 3 methods of treatment called Mani,
Manthiram and Aushatham.
In the stream of Sirappu maruthuvam we exclusively treat the mind

by Yogam which includes Asanas & Pranayamam .They not only cure the
disease but also help for rejuvenation.The physical illnesses are cured by
Varmam and Thokkanam along with internal medicine.
The author is very much grateful to the Lord Almighty, for being in
this field and has chosen the skin disease called KARAPPAN (ECZEMA),
as the topic for dissertation subject.
1
Aim and Objectives
Among chronic skin diseases, Karappan is the most

common disease affecting all age groups .
An estimated one in 10 people are affected at some point in

their lives. World statistics shows, approximately 10 percent to
20 percent of the world population affected by this disease.
So the author is much interested in choosing this disease as

the topic for dissertation and treating the same with the help of
“Karuncheeraga churanam” internally and “Brahmathandu
thylam” externally.
2
The objectives of this dissertation are:
1) To study the incidence of the disease with respect to age,

gender, socio-economic status, habit and family history.
2) To ascertain that according to the mukkutram theory,
karappan’s effect varies with respect to body constitution
(prakriti), taste (suvai) and seasonal variation
(Paruvakalam).
3) Relevant evidence from various Siddha literature and other
system of medicine to be attached.
4) To know the correlation of aetiology, signs and symptoms
of karappan in Siddha aspect with eczema in modern
aspect.
5) To have essential clinical investigations.
6) To evaluate the biochemical and pharmacological efficacy
of trial drug.
7) To pave way for further research work in future.
8) Siddha system of medicine should reach the mass of the
masses.
3
SIDDHA LITERATURE
Siddhars, spiritual scientists explored and explained the

reality of nature and its relationship to man by their yogic
awareness. According to Siddha philosophy, man is nothing but a
miniature world containing the five basic elements.
Universe originally constituted of atoms which contributed to

the five basic elements (Panchaboothas) namely, Earth, Water, Fire,
Air and Ether which corresponds to five senses of human body and
they were the fundamentals of all human body and all the corporal
things.
The Earth (kz;) gives shape to the body and release its energy.
Bones, muscles, nerves represent it in the body.
The Water (ePh;) makes the earth supple and helps in the
transmission of energy. Serum, lymph, saliva, etc., represent it in
the body.
The Fire (jP) makes the form of the body steady and gives
vigour and stimulation. Digestion and circulation represent it in the
body.
The Air (tsp) ignites the fire and works as a life carrier and is
the support of all contact and exchange. Respiratory and nervous
system represent it in the body.
The Ether (Mfhak;) is the creator of life itself in the body.
A harmonious combination and function of these five elements

in the body produce a healthy life.
4
Man has gross physical body (];Àyk;) and subtle physical
body(R+f;Fkk;). The life force which is different from material energy
derived from food, pervades gross physical through the subtle
physical.
The food we eat has six tastes namely Sweet(,dpg;G), Sour(Gspg;G),

Salt(cg;G), Bitter(ifg;G), Pungent(fhh;gG
; ), Astringent(Jth;g;G).
Each of it’s a mixture of two basic elements.
,dpg;G - kz; + ePh;

Gspg;G - kz; +jP
cg;G - ePh; + jP
ifg;G - fhw;W + Mfhak;
Jth;g;G - kz; + Mfhak;
fhh;g;G - fhw;W + jP
Panchaboothas are the foundations for Mukkutram (Vaatham,

Piththam, Kabam) which are the pillars that support our body
structure.
• Vayu constitute Vaatham

• Theyu constitute Piththam
• Appu constitute Kabam
Any alteration in the level of mukkutram affects the normal

functions of the body. This is obvious from the verses,
5
kpfpDk; FiwapDk; Neha;nra;Ak; E}Nyhh;
tspKjyh vz;zpa %d;W.
- jpUf;Fws;
The normal values of the mukkutram are in the ratio

Vaatham: Piththam: Kabam = 1:1/2:1/4
toq;fpa thjk; khj;jpiu nahd;whfpy;

joq;fpa gpj;jk; jd;dpyiu thrp
moq;Fq; fge;jhdlq;fpNa fhNyhby;
gpwq;fpa rPth;f;Fg; gpr nfhd;Wkpy;iyNa
- Fzthflk;.
Alterations in this ratio produce disease. The signs and symptoms

are produced according to the particular deranged thodam.
Karappan
DEFINITION
Karappan is a skin disease characterized by clinical features of

itching, formation of vesicles, oozing, crusting and scaling.
Neha; tUk; top!(Aetiology)
“Vohd fug;ghdpd; cw;gj;jpf; Nfsha;
Vw;wkha; khkprq;fs; Grpf;fahYk;

$ohd fk;G jpid tuF rhikf;
nfhbjhd fpoq;F tifaWe;jyhYk;
ghohd ngz;khia jd;dpw;rpf;Fk;
6
ghq;fhd tpufj;jhy; Kaw;rpahYk;
jhohd gz;lq;fs; rikj;Jj; jpd;dy;
jhf;FNk fug;ghd; rhay;jhNd”
“rhayha;;j; jdf;Fj;jhd; %j;jg; ngz;izj;
jhtpNdhh; jho;r;rpahQ; rhjp jd;dpy;

fhayha; fye;Jz;Nlhh; fyfk; nra;Njhh;
fw;Gila kq;ifaiuf; fUjpNdhh;fs;
thayha; tho;kuj;ij ntl;bNdhh;fs;
…………………………………………
$ayha; nfhlhNjhh;fs; FUepe;jpe;j
nfhLk;ghtp fug;ghdpd; Fwpnfhs;thNu”
- a+fp itj;jpa rpe;jhkzp

!
• Excessive intake of fish, mutton and unhygienic food
substances.
• Meat, varagu, thinai, brinjal, tomato, rhizomes, pollens, tubers
of some vegetables.
• Excessive sexual indulgence.
• Sex with aged women and all the anti-social activities results in
psychic disturbances.
7
In Siddha Maruthuvam Sirappu:-
“ngUFQ; Nrhs kpWFk; ngUq; fk;G

tuF fhUld; thioapd; fhnahL
ciunfhs; ghfw; nfspw;WkPd; cz;bby;
tphptjha;f; fug;ghD kpFe;jNj”
• Intake of karappan foods like Cholam, Kambu, Varagu,
Kararisi, Vazhakkai, Brinjal, Fish, Mutton.
In Pararasa Sekaram:-
“thjgpj;jq; fgkpit %d;wth;
NwJ thy;ntsp thy;kpb ahtpdh;

Nfhij ahh;ba ghh;itah; thw;Fsph;
Ngj ephpit ahYd NgRNfs;
Ntff; fhw;wjpdh; gid nty;yj;jhy;
ghf kpf;fyhd; Nkjpg; ghnta;ayhy;
jhfkhdp tUf;f jprhh;jyhy;
Nghf thio tOjiy Ks;spf;fha;
fhAk; gy;yplj; jhw;Ruj; jhw;fdpy;
vypAk; tz;nlyp ahy;tUNk Jntsp
Fb ey;ywpthd vUtpdhh;
aha khd fug;ghd; tiffNs”
- guuhr Nrfuk; rpuNuhf gFjp
8
• Living in torrid climate
• Excessive sexual indulgence
• Living in cold weather
• Drinking contaminated water
• Airborne infection
• Excessive intake of jaggery, fish, mangoes, wheat
• Poisonous bites are the factors that may cause the disease.
In Gurunaadi Nool:-
“ rq;ifapy; tplf; fug;ghd; tUkhNwJ
rhuKld; fpUkp tpOe;j jd;ik NaJ

cl;bzNk Mhpyk; tUkpjphpa Nghfe;jh
YDJUfpa j;jpapNy ntNtnfhz;L
el;ldkha; nte;jnthU kr;irjd;dpy;
ehl;lkpl;l fpUkpa JaitUk; NghJ
kl;LlNd fpUkpnay;yhk; gwe;jq; Nfwp
tifAlNd khq;fprj;ij Jisj;J NkTk;
jpl;lKld; tpl fug;ghd; gwe;JNkNy
jpdTLNd guguj;ijr; nrhwpAz;lhNk
tay;jdpNy g+whf ky;iye;jhNd
tUe;jpaJ gj;JNghy; tj;ijahFk;
gapy;nkhopaPh; jpNufj;jpy; fpUkpjhNd
gue;Jutp Fl;lk; Nghy; Gs;sp fhZk;
kay JTk; fpUkpAe;jhd; ele;J Gf;fy;
9
NkdpaJ rurnud ntbj;Jg; Gz;zhFk;
fay; ngUFk; Foy; gltPh; nrhy;yh; NfsPh;
fufuj;Jr; nrhwp ngUq; fug;ghd; jhNd”
- FUehb E}y;
• Due to excessive lust piththa kutram may be raised and this in
turn will affect the udal kattugal like kozhuppu and thasai .
• Worms and micro organism enter into the body, through these
affected udal kattugal and causing the disease.
Classification
Karappan is classified into 7 types according to Yugi vaidhya
chinthamani
“Mnkd;w fug;ghd;jhd; VOtpjkhFk;
mlq;fhj thjj;jpd; fug;ghNdhL

fhnkd;w fz;lkha; fug;ghdhFk;
fUfpa Njhh; twl;rpahq; fug;gNdhL
Njnkd;w jpkph;thj fug;ghd; ehYk;
rpurpdpNy ngUf khyf; fug;ghd;
Nghnkd;w gpj;jkhq; fug;ghNdhL
nghpa Nrl;Lkf; fug;ghd; ngah;jhNdNo”
1. Vaatha karappan
2. Piththa karappan
3. Kaba karappan
4. Thimir vaatha karappan

10
5. Kanda karappan
6. Kabaala karappan
7. Varatchi karappan
In Agathiar 2000 Part III
Karappan has been classified into six varieties. They are,
1. Vaatha karappan
2. Sori karappan
3. Varal karappan
4. Silethuma karappan
5. Mandai karappan
6. Varatchi karappan
In Pathinen Siddhar Bala Vaakada Thirattu:-
` The karappan has been classified into 18 types. They are,
“nrq;fug;ghd; mdy;fug;ghd; jhDk; kz;ilr;
rpuq;F Gz;Zk; mhpfug;ghd; nghhpfug;ghd;

mq;fkjp nyOfug;ghd; jhDkpf;f
msuhk; cjpuf;fug;ghd; fl;bNahL
nghq;fkha; tPq;fpa fug;ghDe;jhd;
Gfyhpa rl;iljb ntb fug;ghd;
rpq;fKf Vhpfug;ghd; thj tpj;jr;
Nrj;k Njhl fug;ghd; gjpndl;lhNk”
- ghythflk; - fug;ghd; tFg;G

11
1. Vaatha karappan 10.Oodu karappan
2. Piththa karappan 11. Karung karappan
3. Sethuma karappan 12. Seng karappan
4. Ari karappan 13. Kothi karappan
5. Oodhu karappan 14. Thoda karappan
6. Soolai karappan 15. Vaalai karappan
7. Vedi karappan 16. Varal karappan
8. Mandai karappan 17. Veenku karappan
9. Sattai karappan 18. Pori karappan
In Siddhar Aruvai Maruthuvam:-
Diseases of the head are 46. Above this karappan has been
classified into 6 types.
1. Vaatha karappan
2. Piththa karappan
3. Kaba karappan
4. Veng karappan
5. Seng karappan
6. Karun karappan
12
General Signs And Symptoms Of Karappan:-
“vz;gJ fug;ghd; jd;ik apak;gpLkhW NfsPh;
ed;gpLk; thjk; gpj;jk; eyq;nfl;Lj; jhsk; tPq;Fk;

Gz;gLq; fuq;fs; re;J Giye;jply; fOj;J NehFk;
td;ikAld; ntbj;Jr; #iy tUtJ uzkPjd;Nd”
“cidQ;RNk tapWjhd; rPjq;fhZk;
cl;bzkha; %f;fpue;jh KWq;fp tPOk;

midQ;RNk aq;fnky;yk; nrhhpAz;lhk;
mothf ntJk;gyha;f; fhf;f fhNahTk;
GifQ;r Nkdpq;fj;jpw; Gz;Nghy; Uf;fpg;
nghbg; nghbaha; Rz;zhk;Gf; fw;Nghy; tPOk;
fisQ;RNk ePNuhL kyKQ;rpf;Fk;
frpANk fug;ghdhk;”
- mfj;jpah; tpuzE}y;
• Swelling all over the body
• Pain in the joints
• Itching all over the body
• Appearance of vesicles, oozing bullae, papules
• Constipation.
13
Details About The Types Of Karappan Are:-
thjf; fug;ghd;
“ nfhs;sNt clk;ngy;yhk; ntJg;gha; nehe;J
File;JNk kpfr;Rue;J tPf;fkhFk;

tps;sNt Njfnky;yhk; Gz;Nghy; nehe;J
ntbj;JNk Gz;zhFk; tpuy;fs; re;J
Ks;sNt Klq;fpNa euk;G jhDk;
nkhopfs; gf;f kpf;f ,lkpfTyh;e;J
ks;sNt NkdpaJ twz;L fhZk;
thjkhq; fug;ghd;wd; tz;ikjhNd”
• Severe body pain.
• Cracks and ulcers.
• Pain in all joints and fingers.
gpj;jf;fug;ghd;
“jhdhff; fz;J}q;fp eLT ce;jp
jshe;JNk cl;fhh;e;J ntJg;Gz;lhFk;

J}zhff; fpWfpWf;F KlyhQ; NrhUk;
nrhhpe;JNk clk;G kQ;rspf;Fk;
Ntzhf td;dj;ij ,wq;nfhl;lhJ
kpLf;fhd jPgke; jpj;Jg; NghFk;
Ngdhf CUtJ Nghyf; fhZk;
gpj;j fug;ghd; Fz;j;jpd; ntw;wpahNk”
14
• Sleeping sickness
• Itching over the affected area
• Yellow colouration of the skin
• Difficulty in swallowing
• Loss of appetite
• A sensation like head lice crawling along the scalp
Nrj;Jkf;fug;ghd;
“ngw;wpaha;r; rhPukJ ntspwpf; fhZk;
Ngr;Rj;jhd; fk;kyha; jhdpUf;Fk;

Gj;jpaha; thh;j;ijaJ nghWf;fpr; nrhy;Yk;
gpugye;jhd; kpfg;;Ngrp %r;Rz;lhFk;
vj;jpaha;r; rfyiuANkty; nfhs;Sk;
<isapUky; %r;Rf; fhjpiur;ry;
Kj;jpaha; Nkhl;r top KiwikahFk;
Kjph; Nrl;g fug;ghdpd; %h;f;fe;jhNd”
• Pale discoloration of the skin
• Hoarseness of voice
• Cough
• Tinnitus in the ear.
15
fghy fug;ghd;
“fhzNt fhnjy;yhk; jpdTz;lhFk;
fhz; jpdthk; fz;le;jhd; fufuf;Fk;

g+zNt fz;zPUk; gPisAz;lhFk;
Ngr;Rke;j %f;fjdpy; ePNughAk;
NjhdNt rpuRjdph; nrhhpjYh;lhw;
Jk;gy; kpfTz;lhFe; Jbf;Fk; new;wp
MzNt mz;zf;fp oYz;lhFk;
myq;fhj fghy fug;ghd;wd; FzkhNk!”
• Itching over the ear lobes and eye lids
• Watery and white discharge from the eyes
• Running nose
• Sore throat
• Itching over the head
fz;l fug;ghd;
“jspuhfr; rpunkq;F kpff; fdj;Jj;
jiyfhJ kz;ilnay;yhe; jbj;J NehFk;

espuhf tUj;jp tpf;Fk; ehj;Jbf;Fk;
eykhd clk;Gjdph; nrhhpAkhFk;
Fspuhff; Fsph;e;JNk kaph;f; $r;rhFk;
$g;gpl;lhy; kpfg; gaf;Fk; $Rq;fz;jhd;
fspuhf Kl;Nghy fz;le;jd;dpy;
fwfwf;Fk; fz;lfkhq; fug;ghdhNk”
16
• Headache
• Swelling and pain in the head and ear
• Chillness with shivering
• Roughness of the body
twl;rpf; fug;ghd;
“fz;lkha; KftPq;Fk; Fj;jYz;lhk;
fdkhf clk;ngq;Fk; kpfNt CWk;

Jz;lkhAlk; gijj;Jr; nrhhpjYz;lhk;
NrhUNk nae;Neu kaf;fj;jhNy
tz;lfe;jh dpy;yhk Ylk;G tw;Wk;
khWghlha;g; gpjw;wp kWFk; thh;j;ij
gpz;lkhf;fp le;Jz;L GyhNy ehWk;
ngUtul;rp fug;ghd;wd; NghpjhNk”
• Swelling and pain over the affected area
● Unpleasant smell in the body
jpkph;thj fug;ghd;
“ tz;ikahd Al;fhh;e;J vOk;Gk; NghJ
tUj;jkha; fhy;iffsp ypLg;Gr; re;J

jpz;ikaha;j; jpkph;j;JNk fuL fl;Lk;
nrayope;J tPq;fpNa ntbj;Jg; Gz;zhFk;
17
jd;ikaha;r; rlnkq;F %jyhFk;
jz;zPh;jhd; kpfj; fLj;Jj; jdpr; #Lz;lhk;
cz;ikaha; Nkdpnaq;Fk; cisr; rYz;lhk;
cjWNk jpkph;thjf; fug;ghDNk”
• Pain in the knee, elbow, wrist, hip, shoulder and fingers during
sitting and standing
• Swelling of the joints which burst to form ulcers
• Pain all over the body
• Lethargy
rhj;jpak; - mrhj;jpak;; (Prognosis of karappan)
“%h;f;fkhk; rhj;jpaj;ij nkhopaf; Nfsha;
nkhopfpd;w thj fug;ghd;wd;NdhL

Ch;f;fkhk; gpj;j fug;ghDkhFk;
cah;fpd;w twl;rpaha; fghy fug;ghd;
jhh;f;fkh apJ ehYQ; rhj;jpakhk;
jSf;fhd jpkph;thj fug;ghd; fz;lk;
jPh;f;fkhQ; Nrl;g fug;ghd wd;NdhL
nrg;gpaNjhh; ,J %d;Wk; mrhj;jpakhNk
- a+fp itj;jpa rpe;jhkzp
Types of curables
1. Vaatha karappan 3. Varatchi karappan
2. Piththa karappan 4. Kabaala karappan
18
Types of incurables
1. Thimir Vaatha karappan 2.Kanda karappan
2. Sethuma karappan
Kf;Fw;wk;
thjj;jpd; tiffs;
gpuhzd;:
%r;R tpLjYk; thq;FjYk; nra;Ak;.
mghdd;:
ky ryj;ijf; fPo; Nehf;fp js;Sk;
tpahdd;:
clypYs;s mirAk; nghUs;> mirahg; nghUs; vd;Dk;
,uz;bYkpUe;J cWg;Gfis ePl;lTk;> klf;fTk; nra;Ak;.
cjhdd;:
the;jpia vor;nra;Ak;.
rkhdd;;:
kw;w thAf;fis kpQ;r nthl;lhky; nra;Ak;.
ehfd;:
vy;yhf; fiyfisAk; fw;Fk;gb mwpitnaOg;Gk;. fz;fis
,ikf;Fk;gb nra;Ak;.
$h;kd;:
nfhl;lhtp tplr; nra;Ak;. thia %lg;gz;Zk;. ,ikiaf;
nfhl;Ltpf;Fk;. fz;fSf;F nghUl;fisf; fhz;gpf;Fk;.
19
fpUfud;:
ehtpw;frpT> ehrpf;frpT kpf;f grp> Jk;ky;> ,Uky; Mfpatw;iw
cz;lhf;Fk;.
Njtjj;jd;:
Nrhk;giyAk; J}f;fj;ijAk; tUtpf;Fk;. rz;il nfhs;sy;> ju;f;fk;
Ngry;> kpf;f Nfhgk; Mfpatw;iw cz;lhf;Fk;.
jdQ;nrad;:
clk;G KOikAk; tPq;fg;gz;Zk.; ,we;Jtpbd;> fhw;nwy;yhk; ntspg;gl;l
gpd;dh; %d;whtJ ehspy; jiyntbj;j gpd; ntspr;nry;Yk;.
fug;ghdpy; tpahdd;> rkhdd; ghjpg;gile;Js;sJ.
gpj;jj;jpd; tiffs;
mdw; gpj;jk;:
cz;l czTg; nghUs;fisr; nrhpf;Fk;gb nra;Ak;.
,uQ;rfg; gpj;jk;:
cztpypUe;J gphpe;Jz;lhd rhw;Wf;Fr; nre;epwj;ijj; jUk;.
rhjfg; gpj;jk;:
tpUg;gkhd njhopiyr; nra;J Kbf;Fk;.
gpuhrfk;:
NjhYf;F xspiaf; nfhLf;Fk;.
MNyhrfk;:
fz;fSf;Fg; nghUs;fisj; njhptpf;Fk;
fug;ghdpy; ,uQ;rfk;> gpuhrfk; ghjpg;gile;Js;sJ.
20
fgj;jpd; tiffs;
mtyk;gfk;:
ehd;F tif Iaq;fl;Fk; gw;Wf; NfhlhapUf;Fk;.
fpNyjfk;:
cz;zg;gl;l czTnghUs;> ePh; Kjypaitfis <ug;gLj;jp
nkj;njdr; nra;Ak;.
Nghjfk;:
cz;Zfpw Ritfis mwptpf;Fk;.
jw;gfk;:
fz;fSf;Ff; Fsph;r;rpiaj; jUk;.
re;jpfk;;:
G+l;Lfspy; epd;W ,aw;ifaha; vy;yhf; fPy;fisAk; xd;Nwhnlhd;W
nghUj;jpj; jsur; nra;Ak;;.
fug;ghdpy; fgk; vJTk; ghjpg;gilatpy;iy.
VO clw;jhJf;fs;:
rhuk;:
cliyAk;> kdj;ijAk; Cf;fKwr; nra;Ak;.
nre;ePh;:
mwpT> td;ik> xsp> nrUf;F> xyp ,itfis epiyf;fr; nra;Ak;.
21
Cd;:
clypd; cUtj;ij mjd; njhopw;fpzq;f mikj;J tsh;f;Fk;.
nfhOg;G:
cWg;GfSf;F nea;;g;Gg; gira+l;b fbdkpd;wp ,aq;fr; nra;Ak;.
vYk;G:
nkd;ikahd cWg;Gfis ghJfhj;jy; cly; mirtpw;F
mbg;gilahapUf;Fk;.
%is:
vd;Gf;Fs; epiwe;J mitfSf;F td;ikAk; nkd;ikAk; jUk;.
Rf;fpyk;;/RNuhzpjk;:
fUTw;gj;jpf;F JizGupAk;.
fug;ghdpy; rhuk;> nre;ePh; ghjpg;gile;Js;sJ.
Kf;Fw;w NtWghL:
“thjkyhJ Nkdp nflhJ”
vDk; Njudpd; $w;wpw;fpzq;f tspf; Fw;wk; (tpahdd;) Kjypy;

NfLw;W jdf;F Jizahf moy; Fw;wj;ijAk; (,uQ;rfk;) Iaf; Fw;wj;ijAk;
NfLwr; nra;J fug;ghd; Nehiag; gpwg;gpf;fpwJ
22
gpzpawp Kiwik (Diagnosis)
Piniyari muraimai is the methodology of diagnosing the disease
in Siddha science.
The phrase “Noi nadal Noi mudhal Nadal indicate the approach
to the process of diagnosis.Noi nadal means the approach to the
disease and Noi mudhal nadal means determination of the aetiology.
The Siddhars looked at the body and disease together to arrive
at a conclusion regarding the condition of the diagnosis.This
conclusion is essential pre requisite for the treatment.
Diseases are disgnosed mainly with the help of signs and
symptoms.In addition there are eight important parameters which
help in finding out the disease and the imbalanced life factors.
"Siddhars had a unique method of diagnosis called Enn vagai
thervugal".
! 'ehb ];ghprk; eh> epwk;> nkhop> tpop

kyk; %j;jpukpit kUj;JtuhAjk;"
23
EIGHT PARAMETERS FEATURES TO BE OBSERVED FEATURES IN KARAPPAN
eh Colour, character, No abnormal changes
condition
epwk; Signs of mukkutram Hyper pigmentation
Colour,cyanosis,
Pallor , yellowish
Discolouration
nkhop Pitch,coherence,tone No abnormal changes
tpop Motor and sensory No abnormal changes
functions , colour
kyk; Signs of mukkutram No abnormal changes
colour and consistency
rpWePh; Colour, No abnormal changes

ePh;f;Fwp
odour,deposit,frequency
Specific gravity
nea;f;Fwp Slowly spread
ehb Mukkutram signs
];ghprk; Warm or cold Hypersensitivity ,
Itching, ulcers and
rashes
24
NAADI NADAI
'jhdKs;s Nrj;Jke; jhdpsfpy; ntg;G

rakPis ,Uky; ke;jhu fhrk;
<dKWQ; rd;dp tpl Njhlk; tpf;fy;
apUj;Nuhfk; fug;ghd; tpuz Njhlk;
khdidaPh; R+iy jpus thA tPf;fk;
tUQ; rj;jp Rthrk; neQ;rilg;G J}f;fk;
VdKWq; fhkhiy ghz;L Nrhig
vO Ruq;fs; gy Jf;fk; tplKz;lhNk"
- rjf ehb
!
'rpwg;ghd thjj;jpy; cl;bze;jhNd
Nrh;e;jpLfpyjprhu Kisr;ry;
ciug;ghd nghUkNyhL mf;fpdp ke;jk;
cz;lhFk; ePh; rptg;G gpuNkfq;fs;
gpwg;NghL kjfhp ePh; fug;ghd; uj;jk;”
- rjf ehb
Naadi is the vitiating element of the body, which is vaatham,
piththam and kabam, is otherwise called as uyir thathukkal or
mukkutram.
Naadi is felt as vaatham, pittham, kabam respectively with the
tip of index, middle and ring fingers over the lower end of the
radius.
25
The three uyir thathukkal are formed by the combination of
Edakalai + Abaanan = Vaatham
Pinkalai + Praanan = Piththam
Suzhumunai + Samaanan = Kabam
The ratio between Vaatham, Piththam and Kabam is 1 : 1/2: 1/4
respectively.
In karappan the following types of naadi are seen commonly.
1. Vaatha kapham
2. Kaba vatham
3. Vaatha vuttinam
26
Neha; tUk; top – Kf;Fw;w ghjpg;G
czthjpnray;;fs;;
tsp;
moy; Njhy; Iak;
fug;ghd;
27
Treatment
The treatment of Siddha system incudes not only the removal
of signs and symptoms of a disease but also in also in total
uprootment of the disease.
This is achieved by normalizing the vitiated mukkutram there

by retaining body’s natural health.The recurrence of the disease is
prevented by the practice of Yoga and Praayanaama.
In Karappan,the deranged vaatham is brought to its normal

state by purgation(tpNurdk;;)
“tpNurdj;jhy; thje;jhOk;”
2 tablet of Meganatha kuligai is given with warm water early

morning(single dose) before starting the treatment .
1.Karuncheeraga churanam: 1 gm thrice daily given with hot
water.
2.Brahmathandu thylam : external application over the affected
area.
28
Diet restriction for karappan patients
DONT’S
Millet
Maize
Unriped banana
Bitter guard
Fish
Dry fish
Pumpkin
Brinjal
Egg
Tomato
Ladies finger
Tamarind
Chicken
Spices
Milk and milk products
Artificial Food colours
Additives
Alcohol
Narcotic drugs
Medications like penicillin etc.
Using soaps,detergents.
29
Environmental allergens
House dust, mite etc.

Smoke
Cold air
Fume
Occupational allergens
Chemicals
Paints
Fertilizers
Do’s
¾ Avoid stress and strain

¾ Adapt regular yogic exercise, meditation and pranayama
¾ Keep regular bowel movement
¾ Use green gram powder or nalanguma powder for bath.
¾ Use warm water for taking bath.
30
SIRAPPU MARUTHUVAM
For the treatment of Karappan, Sirappu Maruthuvam is advised

to reduce the recurrence of the disease and also enhances the
general health of the body.
In the line of Sirappu maruthuvam, Yogic exercise ,Meditation

and Praanayaama places a vital role.
In the stream of Yogic exercise , Modified Sethubanthaasanam

and Savasanam are advised for the patients.
Modified Sethubanthaasanam is preferred because, in this

posture it increases the venous return from the lower limbs and
thereby prevents the recurrence of the disease, who have the
lesions particularly in lower limbs.
Savasanam is preferred to make the body and mind itself in

relaxation .
As stress and strain plays a vital role in prevailing the skin

disease, especially Karappan ,Meditation and Praanayaama are
advised to reduce the stress and strain.
Meditation and Pranayama when practiced regularly lowers the

stress and strain thereby reduce recurrence of the disease .
31
ECZEMA
Definition:
Eczema is a non-contagious inflammation of the skin,
characterized by erythema, scaling, oedema, vesiculation and
oozing. The term “Eczema” is a Greek word (Ec – means out, and
Zeo – means ‘to boil’). The whole word implies ‘boil out’. Eczema is a
specific type of allergic cutaneous manifestations of antigen-
antibody reaction.
Aetiology:
Basically two factors that cause eczema are
1.An allergic (or) a sensitive skin.
2.Exposure to an allergen (or) an irritant.
The history of eczema is diagrammatical representation is as

follows.
Itching
Erythema
Vesicles
Papules
Epidermo-spongio Oedema
Papules with oedema
Vesicles
Weeping, crusting, pustules Lichenification
Scaling
Healthy skin without scars
32
Common types of Eczema
Exogenous Endogenous Other
Atopic dermatitis Lichen

Infective
Nummular planus
Eczematoid
dermatitis Varicose
dermatitis
Pompholyx
dermatitis
Contact dermatitis
Allergic contact Primary irritant

dermatitis dermatitis
Common types of Eczema
Types:
1. The morpho-clinical classification:
a. Acute stage.
b. Sub-acute stage.
c. Chronic stage.
a. Acute stage:
This stage is characterized by itching, erythema followed

by oedema, papules, vesicles, oozing and crusting. Most of the
typical eczemas of moderate intensity start with these morphological
features. This last only couple of weeks and lesions start to heal.
33
b. Sub-acute stage:
It is between the acute and chronic stages characterized

by papules and scaling with moderate oedema and erythema. Acute
eczema may pass through this stage before it heals completely or
becomes chronic.
c. Chronic stage:
These lesion lasts for months to years. The integument

appears thickened and pigmented with prominent criss-cross
marking (Lichenification).
Predisposing factors:
1 Age – common in infants, puberty and menopause.
2 Familial predisposition.
3 Allergic history, history of asthma, eczema, hay fevers,
urticaria.
4 Debility – which lowers the resistance of the individual.
5 Climate – extreme heat, dampness and severe cold.
6 Psychological factors trigger an episode of eczema.
7 The frequent use of soaps and other cleaning products that
tend to give lack of normal shiny of the skin.
8 Direct contact with pet and domestic animals (especially
their saliva or fur) and indirect contact with animal dander.
9 Rough, scracy, tight clothing, especially clothes made of
wool (or) stiff fabrics.
10 Acute sensitization.
34
Aggravating factors:
Factors responsible for causation of eczema:
1 Irritants – Physical, chemical (or) electrical.

2 Drugs - given for the disease (or) otherwise.
3 Infections – Streptococci, staphylococci, fungus.
4 Mind – Strain, stress, emotional status.
5 Sensitisers – Plants, cosmetics, clothing, medicaments.
6 State of local (or) general nutrition.
7 Focal sepsis.
8 Trauma.
9 Diet.
10 Climate – Temperature and humidity.
Types
A. ENDOGENOUS ECZEMA
I. Atopic eczema:
Synonym: Asthma-eczema syndrome, Benjerls, Prurigo.

Definition:
This is very common, externally itchy disorder of

unknown cause, that characteristically but not invariably affects the
face and flexures of infants, children, adolescents and young adults.
Aetiology:
1. Emotional status by psychiatric evaluation of the patients
home, parents occupation and other environments.
2. Allergic – Diet, external contacts, inhalants.
35
Clinical features:
Clinical picture of atopic eczema varies with the age of the

patient and occurs in three stages, namely,
1. Infantile type (Infantile eczema)
2. Childhood type (Flexural eczema)
3. Adult type (Besnier’s prurigo)
Infantile atopic eczema:
This begins the third month of life on the cheeks, soon

spreading to the forehead and chin, but sparing the skin around the
mouth, nose and eyes. It may extend to the scalp, limbs and trunk.
The affected skin is red and rough with minute cracks oozing serum.
The itching is great and rubbing and scratching quickly tend to loss
of horny layer and exposure of a weeping surface. In the majority of
cases the condition clears up towards the end of third year.
Atopic eczema of the childhood:
It starts follow from infantile eczema, may appear a few years

of complete freedom, lesions appear in a antecubital fossa of the
wrists and popliteal fossa of the knees, front of the ankles and groin.
First the eruptions is slightly erythematous, papules and scaly .
Later it becomes lichenified and pigmented, most commonly it
disappears at puberty.
Adolescent and adult eczema:
This state may follow with (or) without an intervening period.

The limb flexures are again affected but the eruptions also affect the
36
face, neck and upper half of the trunk. The physical signs consist of
papulations, lichenification and pigmentation. The itching may be
severe. The affected skin is pale.
Treatment:
It consists of
1. Insist awareness about the etiological factors – the
allergic, psychogenic and inborn weakness of his skin.
2. Advice about the climate and occupation.
3. General palliative treatment.
Prognosis:
The course of atopic eczema through all stages is marked by
spontaneous cures, remissions and exacerbations, seasonal variation
in autumn and spring, by pollens, summer and monsoon, by heat
and high humidity. Besides eczema, asthma, hay fever and another
allergies may be present at the same time or may alternate with
eczema. Lately attention has been drawn to ophthalmic changes in
connection with atopic dermatitis; they are conjunctivitis, keratitis
and juvenile cataracts. The pathogenisis of these are not
understood. It may also be associated with other ectodermal
defects. If there is a constitutional susceptibility to different
stresses, the blood count shows eosinophilia.
General instructions for atopic eczema patients:
1. The patient should have a warm starch water bath in winter

and a cold condy’s bath in summer. After the bath, he should blot
37
himself with a smooth towel and avoid rubbing. Olive oil or lanoline
cream may be applied on the dry, thickened skin after the bath.
2. Moderate temperature suits these patient’s best, and so
they should avoid extremes of climates. Where it is not possible to
change the place of residence, air conditioning is the answer.
3. The patient should be restricted to avoid scratching by
keeping his nail short. In resistant cases, particularly in children
measures for physical restraint by splints should be employed and
sedatives given at night.
4. The diet should not be loaded i.e. simple. The exact
composition of diet depends upon the history of the patient, the diet
diary and the results of the allergy tests. Allergenic food items
should be avoided.
5. The patient must be given an instruction, that healthy
hobbies and play should be encouraged. They help to divert
attention and speed up recovery regarding paediatrics.
6. Any side effect while taking medication should be reported
to the physician. Local medicaments should be properly employed.
7. The attenders must be advised to respect the patient’s
weakness of the skin and his sensitiveness.
8. The patient should learn to live within the limits of his
physical and mental strength, knowing his inborn weakness. It is a
chronic but not a serious disease.
38
II Nummular Eczema:
Synonym: Discoid eczema
Definition:
It is characterized by circular coin-shaped plagues of papules,

vesicular and crusting, distributed bilaterally and symmetrically on
the dorsum of fingers and hands, the forearm, the arms, the legs
and the thighs.
Aetiology and pathogenisis:
Psychogenic stress Alcohol

Focal sepsis General debility
Food allergies Cold weather
Clinical features
Slightly raised, pink red scales discs, varying in diameter from

1cm to 4 cms appear on the arms and legs and less frequently on
the trunk.
Itching of the skin (pruritis).
Skin lesions that may be macules, papules, vesicles or
patches.
Nummular (coin shaped).
Primarily located on the arms and legs.
Spreading to the trunk.
Oozing, crusting over.
Scaly on excoriated (raw) skin.
Skin redness or inflammation.
39
Signs and tests:
Nummular eczema is diagnosed based on the appearance of

the skin and on personal and family history.
Treatment:
Treatment is focused on relief of symptoms. Anything that

aggravates the symptoms is to be avoided whenever possible.
Frequent bathing and eating foods rich in bromides and iodides are
not advised. Other possible allergens are to be avoided, including
foods and environmental irritants such as wool and lanolin.
Complication:
Secondary infection to the skin.
III Seborrhoeic dermatitis
Definition:
A Common eczematous disorder that characteristically occurs
in hairy areas, both in the flexures and on the central part of the
trunk.
Common sites:
Scalp, eyebrows, eyelids, nasolabial crease, lips, ears, axilla,

submammary folds, umbilicus, groins and gluteal crease.
Aetiology
The aetiology of this disease is the hypersecretion of sebum.

An inborn seborrhoeic diathesis may be a familiar trait. Emotional
stress and high fat intake may also be the cause.
40
Clinical features:
Reddened itching patches appear at the affected sites and also

erupt suddenly and cause exudative lesions in the flexures.
1. Cradle cap at the time of birth, seborrhoeic dermatitis

afterwards.
2. Child is usually healthy and happy otherwise.
3. Starts from scalp, posterior auricular folds, and involves
neck and trunk. On the trunk it is seen like a flat macular
erythematous low hypopigmented and scaly rash. In some
cases, it manifests as diaper dermatitis.
4. Crusting more and the areas have a dirty appearance.
5. Family history of seborrhoeic disorders.
6. Itching mild to moderate.
7. Recurrence mostly seasonal i.e. summer and monsoon at
times in winter too.
8. Comparatively better response.
IV Pompholyx:
Pompholyx may occur in children, but is most common in the

first half of adult life (20 – 40 years). This is a eczema of hands and
feet. If this type of eczema occurs on the sides and front of the
fingers and palms it is known as cheir pompholyx and if it occurs on
the toes or feet it is podo pompholyx.
41
V Lichen simplex chronicus:
Synonyms:
Circumscribed neuro dermatitis.
This may appear more commonly in neurotic people. This

condition may be defined as the lichenification process resulting
from chronic scratching and rubbing of the skin under stress and
anxiety.
Clinical features:
There may be one or several localized patches. The integument

becomes thickened, infiltrated and pigmented, the criss-cross
markings become more prominent and margins are irregular but
usually well defined.
Areas are the nape of neck, arms, ano–genital area, scrotum,
back of the knees, legs and ankles. Prognosis is good if the primary
emotional conflict can be resolved satisfactorily.
Pathology and pathogenesis:
Histologically there may be striking hypertrophy of the

epidermis, which in extreme cases may resemble epitheliomatous
change (pseudo epitheliomatous hyperplasia). There is also
hyperkeratosis and variable amount of inflammation in the sub-
epidermal zone. There is a marked increase in the role of epidermal
cell production accounting for the hypertrophy and it is believed that
the persistent trauma of scratching and rubbing is responsible for
this.
42
VI Varicose eczema:
This is also associated with complicating varicose veins or

ulcers of the legs. The predisposing factors are chronic congestion
and stasis, which lower the local resistance.
Itching in varicose legs may start eczema by excoriation,
secondary infection and by the chronic use of medicaments. The
eczema has the features of the exciting cause, which may be
traumatic, chemical or infective. It may become disseminated due to
auto sensitization. It is very chronic and persistent condition.
B. EXOGENOUS ECZEMA
I. Contact Dermatitis
Synonym: Chemical eczema
Eczematous rash developing as a result of contacting

injurious materials. These materials may injure by a direct toxic on
the skin or may induce an immunological reaction of delayed
hypersensitivity type.
The former is known as a primary contact dermatitis and
the later is allergic contact hypersensitivity.
II Primary Irritant Dermatitis
Definition:
Primary irritant dermatitis is an eczematous rash that results

from direct contact with toxic irritating materials.
43
Pathology and pathogenesis:
The condition can be thought as a kind of ‘Epidermal failure’, in

which after prolonged minor injury from one or several substances
the epidermis responds by developing an eczematous reaction.
Causes:
This commonly occurs in builders, mechanics, hair dressers,

cooks and laundry workers. Contact with organic solvents,
detergents, cement, bleaches, ammonia preparations, dye, drain
pipe cleaners, alkalis, acids such as HCl, H2SO4, HNO3, Oxalic acid,
Hydrofluoric acid and Phenol are often responsible.
Clinical features:
Scaly red and fissured ulcers appear on the irritated skin.

Hands are most frequently affected. The effect is less vulnerable in
dry skin. The effect is evident within minutes to hours.
III Allergic Contact Dermatitis:
Definition:
Allergic contact dermatitis is an eczematous rash that develops

after contact with an agent due to delayed cellular hypersensitivity.
Aetiology (Allergens)
They are classified into two groups,

1. Non-Proteins – Dyes, oils, resins, coal tar derivatives,
rubber, cosmetics and chemicals.
2. Proteins – Bacterial products, fungi and parasites are
included in this group.
44
3. Most common cause of contact dermatitis are poison ivy,
oak, paraphenylenediamine, nickel, rubber compounds,
dichromates, mercury dichloride, potassium dichromate,
nickel sulphate, turpentine oil, formaldehyde solution etc.,
Pathophysiology:
Allergic contact dermatitis results from a specific acquired

hypersensitivity of the delayed type also known as cell mediated
hypersensitivity (or) immunity. Occasionally dermatitis may be
induced upon a sensitized area of skin when the allergen is taken
internally and this occurs with substances such as anti-histamines or
sulphonamides.
Persons may be exposed to allergens for years before finally
developing hypersensititvity. The sensitized area although usually
generalized may be strictly localized.
Clinical features:
Rash develop at the sites of the skin contact. The vigor and
speed of the reaction vary and may depend on the particular
individual.
Effects do not localize but disseminate symptoms present even
after removal of allergen.
Diagnosis:
Correct history taking is important to learn of possible

contactants. Diagnosis can be confirmed by patch test, which can
detect hypersensitivity to a given substance, which is in contact with
the skin.
45
IV Infective Eczematoid Dermatitis:
Infectious eczematoid dermatitis is regard as an example of

auto-sensitization. The skin becomes sensitized to bacterial or tissue
chemical substance contained in the exudate. The disease spread
from a local site by peripheral extension and by autoinoculation.
Aetiology:
It may develop
¾ Discharging abscess
¾ Ulcers
¾ Chronic otitis media
¾ Bedsore
¾ Fistula
¾ Discharge from the eyes, nose and vagina
¾ Eczematous eruptions
¾ Acute stages of radio dermatitis
Predisposing factors:
¾ Poor hygiene
¾ Scratching
¾ Sweating
¾ Chemical trauma
Sites:
Scalp, pubis, feet, lower legs, ear, around arms and around
varicose ulcers.
46
Clinical features:
9 Well-defined margin.
9 Erythema, vesiculation, profuse exudate, crusting, creasy
moist scales are appeared.
9 Small pustules at the advancing stage.
9 Pruritis present.
9 Ulcer.
Immunology of eczema:
Atopic type of eczema is entirely immune mediated reaction.

Sensitization develops when a different clone of ‘T’ lymphocytes
activated. The sensitized ‘T’ lymphocytes yield two sub-populations
of lymphocytes. They are
1. Memory cells:
That is responsible for the persistence of contact allergy.
2. Efferent cells:
These cells initiate the allergic response when
appropriately challenged.
1. Reaction time:
It is the time taken by a sensitized individual to manifest
a clinical reaction following contact with a known sensitizer. It is
usually 12-24 hours. But may vary from one to 120 hours. The
reaction time is inversely proportional to the severity of the
allergy.
47
2.Dissemination reaction:
It is a fleeting, erythematous macular reaction involving the

face and flexures, seen in some cases of contact dermatitis. There is
some evidence that dissimination reaction is caused by the escape of
lymphokinins in the circulation resulting in vasodilation at a distant
site.
Flare reaction:
In contact dermatitis, reaction of a previously healed site of a

contact dermatitis reaction or a positive patch test reaction followed
renewed challenge or exposure to the same allergen at another site.
This is because of persistence of sensitized lymphocytes of the site
of earlier reaction, which react to minute amounts of antigen that
sometimes escape into the circulation from the new site and find its
way to the old site. Langerhans cells are responsible for antigen
processing in contact allergy.
HISTOPATHOLOGY OF ECZEMA
The histopathological features of eczema reflect dynamic

sequence of changes resulting inflammation of the epidermis and
vary the indulging dermal structures. These vary with the intensity
and stage of eczematous process, and are frequently modified by
secondary events such as trauma and infection.
Spongiosis is an intercellular epidermal oedema that leads to

stretching and eventual rupture of the intercellular attachments with
the formation of vesicles. Increased epidermal meiotic activity leads
48
to acanthosis, but if spongiosis is intense disintegration of the
suprapapillary epidermis may cause clefts to form exposing the
underlying dermis.
In the sub acute stage, spongiosis diminishes and increasing

acanthosis is associated with formation of a parakeratotic horny
layer. This often contains layers of dried-up serum and pyknotic
nuclei of inflammatory cells. Later the ridges become elongated and
broadened and hyperkeratosis replaces [arakeratosis]. The changes
are then those of lichenification.
The infiltrate is predominantly lymphocytic, through

polymorphs and eosinophils are particularly common in eczematous
dry eruption. In the presence of infection, polymorphs may invade
the epidermis.
Prognosis in eczema:
The outlook rests on correct elicitation and the complete

eradication of the causes. It is regrettable that potential sensitizer
are sold so freely in the market for the public to purchase. The skin
is the superficial subject and so it is easily accessible to over -
treatment and ill treatment.
Dermatitis and eczema are, as a rule, curable conditions.

Eczemas are non infective except when they are inpetiginized and of
the infective variety. They do not leave scars. The patient needs
reassurance on these points. It must be remembered that epidermis
is an ecto-dermal structure and so, takes time to health patience
49
must be the watch word; energetic treatment is to be strongly
discouraged. Once warned the patient will readily to cooperate.
Acute eczemas heal readily in about 1 - 4 weeks, with proper

treatment. Chronic eczemas, in which anatomical and fractional
changes set in, take time to disappear. Disseminated and
generalized eczemas are not only slow to heal, but are accompanied
by ill health also. Infantile and atopic eczemas are trouble some and
uncomfortable.
The former lasts till the age of 25 or even throughout the life.
Its course is marked by spontaneous remissions and exacerbations.
Climate extremes, psychogenic stresses and poor health aggravate
dermatitis and eczema. The cure of these conditions is retarded in
tropical countries, by heat, humidity and the prevalent unhygienic
conditions.
Treatment:
It consists of
Reassuring the patient and his relatives about the disease
being curable, non-infectious and non-scarring. Tactful bedside
psychotherapy pays dividends in all cases.
Elimination of predisposing, exciting and complicating cause. In

one individual, more than a single cause may be at play. To prevent
recurrence, advice should be given to the patient regarding
exposure to causes. Anyone suffering from contact eczema, for
instance, should be advised against any exposure to the possible
50
sources of the causative allergens and allergo-immunologically
related substances. Patients with infective eczemas are requested to
treat infection by suitable antibiotic regarding the sources of
infection. Improving the general state of nutrition is also important.
Palliative treatment must be properly carried out to effect a

complete cure. Their life style should be strictly free from cosmetics.
51
COMMON TYPES OF ECZEMA
Types Synonyms Frequency/Age group Remarks
Atopic dermatitis Neroudermatitis, Very common, mostly Cause unknown, but

Infantile eczema, occur in infants and appear to be
Besner’s prurigo very young. immunologically
mediated.
Seborrhoeic dermatitis Infectious eczematoid Very common, all age Probably has microbial
groups. cause with over growth
of normal skin flora
being responsible.
Discoid eczema Nummular eczema Uncommon-mainly in Cause unknown.

middle aged individuals.
Lichen simplex Circumscribed neuro Quite common, mainly Initial cause appears to
chronicus dermatitis in young and middle be a localized
aged adults.
Eczema craguelee Ateratotic eczema Uncommon- restricted Low humidity and
to elderly vigourous washing seem
responsible.
52
Varicose eczema Stasis dermatitis, Common in the age Multiple causes, a
Gravitational eczema group that has common variety is
gravitational syndrome. allergic contact
dermatitis to
medicaments used.
Common in all adult age Delayed hypersensitivity
Allergic contact - groups same as the response to a specific
dermatitis very old. agent.
Primary irritant contact Occupational dermatitis, Very common in adult Both mechanical and
dermatitis house-wives eczema age groups same the chemical trauma
very elderly. responsible.
Photosensitivity eczema - Not common – mainly in Both photo toxic and
adults. photo allergic adults
Roxburgh’s common skin diseases – Ronald Marks.
53
54
PROTOCOL
AN OPEN TRIAL OF KARUNCHEERAGA CHURANAM

AND
BRAHMATHANDU THYLUM FOR THE TREATMENT OF
ECZEMA
I. BACKGROUND
Eczema is a specific type of allergic cutaneous

manifestation of antigen-antibody reaction. It is a common problem
all over the world. Its prevalence is 2-3% of all medical problems seen
in practice. The prevalence of Eczema is increasing and has increased
between 2-5 folds over the last 3 decades.
In Athma Rakshamirtham text, there is a preparation for

Eczema, which is not in common practice, whose efficacy is 90% for
all types of Eczema. So, we try to prove it in a open clinical trial in our
OPD and IPD patients.
II. a) Primary aim
To find out the efficacy of Karuncheeraga Churanam

(Internal) and Brahmathandu Thylam (External) in Karappan
(Eczema) patients.
b) Secondary aim:
To find out the side effects or adverse reactions, if any.
54
III. POPULATION & SAMPLE
i. The Population consists of all patients with Eczema.

ii. The trial will be a single centric, open clinical trial.
iii. The Participating centre is,”AYOTHI DOSS PANDITHAR
HOSPITAL” OF NATIONAL INSTITUTE OF SIDDHA,
CHENNAI – 47.
IV. SAMPLE SIZE
The trial size will be 60 patients.
v. a) INCLUSION CRITERIA
1) Patients who are having classical symptoms of Eczema.
2) Disease not more than 15 years.
3) Aged 20 years and above.
4) Willing to give specimen of blood for the investigation when
required.
5) Willing to be admitted as In-patient in our ward for minimum 25
days and continue the remaining treatment in OPD or Willing to
attend OPD once in 8 days for 48 days.
55
b) EXCLUSION CRITERIA
A patient is not eligible for admission to the trial if any of the following
is applicable
I. Any history of trauma, Hyper Tension, cardiac disease,
alcoholism.
II. Use of intravenous (or) oral narcotic drugs.
III. Pregnancy.
IV. Lactation.
V. Patients with any other serious illnesses.
c) WITHDRAWL CRITERIA
1. Any drastic changes occurring in haematological
findings during treatment period.
2. Development of any severe irritability.
3. Occurrence of any serious illness.
d) TRIAL DRUG & DURATION
1.PURGATIVE - MEGANATHA KULIGAI-2 tabs in

early morning
( with hot water before starting
treatment)
2.INTERNAL DRUG - KARUNCHEERAGA CHURNAM

1gm thrice in a day, after food with
hot water.
56
3.EXTERNAL DRUG - BRAHMATHANDU THYLUM
15-30ml twice application / day
4.TRIAL PERIOD - 48 days
V. TESTS & ASSESSMENT
a) ASSESSMENT BY CLINICAL FEATURES
I. Itching
II. Erythematous lesions with oedema
III. Presence of Macule / Papule / Vesicle / Pustule
IV. Oozing, scaling, Lichenification of Skin
V. Hyper / Hypo / De- Pigmentation
b)INVESTIGATIONS
Routine investigations – TC, DC, ESR, Hb, Blood sugar, Serum

cholesterol, Urine- sugar, Albumin, Deposits, Stools- ova, cysts, occult
blood etc will be carried out.
VI. CONDUCT
a. Eczema patients satisfying inclusion and exclusion criteria will be

eligible for admission to the trial.
b. Informed consent will be obtained from the patients.
57
c. A day before starting trial treatment, cleaning of mukkutras by
purgation will be carried out.
d. Photos will be taken and tests will be carried out before

treatment ,during treatment and at the end of the treatment.
e. All the evidence will be documented.
VII. FORM
9 FORM I – Selection Proforma

It is used before admission of the patients to the trial.
9 FORM II – Assessment Form

It is used once in 8 days during treatment.
VIII.ANALYSIS
1) Paired Chi- Square (x²) test for the difference in proportions.
2) Paired t-test for the difference in means.
58
Observations and Result
1.Gender distribution
Gender Cases
No. Percentage %
Male 42 70.0
Female 18 30.0
Total 60 100.0
70
60
50
40 Male
%
30 Female
20
10
Figure 1.Bar Diagram For Gender Distribution.
59
2.Age distribution
Age(years) Cases
No. Percentage %
≤20 2 3.3
21-30 4 6.7
31-40 6 10.0
41-50 18 30.0
51-60 14 23.3
61-70 10 16.6
71+ 6 10.0
Total 60 100.0
3.Kaalam distribution :
90% of cases reported during Koothir kaalam and 10% of

cases during Mudhuvenil kaalam.
4.Occupational distribution:
Occupation Cases
No. Percentage %
House wives 12 20.0
Mason 6 10.0
Stress oriented 12 20.0
employees
Employees exposed 7 11.7
to chemicals
Coolie 7 11.7
Miscellaneous 16 26.6
Total 60 100.0
60
5.Diet distribution
Diet Cases
No. Percentage %
Vegetarian 5 8.3
Non - vegetarian 55 91.7
Total 60 100.0
100
90
80
70
60
Veg
% 50
40 Non - veg
30
20
10
0
Figure 2.Bar Diagram For Diet Distribution.
61
6.Socio economic distribution.
Income Cases
No. Percentage %
Low income 32 53.4
Middle income 26 43.3
High income 2 3.3
Total 60 100.0
60
50
40
Low income
% 30 Middle income
High income
20
10
Figure 3.Bar Diagram For Socio Economic Distribution.
62
7.Kaalam
Kaalam Cases
No. Percentage %
Vaatha kaalam 7 11.7
(0-33 yrs)
Pitha kaalam 45 75.0
(34-66 yrs)
Kapha kaaam 8 13.3
(67-100 yrs)
Total 60 100.0
8.Thinai
100% of cases reported from the Neithal Thinai.
9.Gunam
100% of cases reported were under Rasatha gunam.
63
10.Yakkai distribution
Yakkai Cases
No. Percentage %
Vatha udal 0 0.0
Vatha pitha udal 32 53.3
Vatha kapha udal 11 18.3
Pitha udal 0 0.0
Pitha vatha udal 8 13.3
Pitha kapha udal 5 8.3
Kapha udal 0 0.0
Kapha vatha udal 2 3.3
Kapha pitha udal 2 3.3
Total 60 100.0
11.Mode of onset .
Onset Cases
No. Percentage %
Acute 17 28.3
Subacute 6 10.0
Gradual 37 61.7
Total 60 100.0
64
12.Etiological distribution.
Etiology Cases
No. Percentage %
Hereditary 2 3.3
Allergic exposure 17 28.3
Occupational 21 35.0
Stress induced 13 21.7
Diet 3 5.0
Insect bite 4 6.7
Total 60 100.0
13.Associate history
History Cases
No. Percentage %
Bronchial asthma 6 10.0
Hay fever 0 0.0
Utricaria 1 1.7
Diabetes 4 6.7
Hypertension 2 3.3
Total 13 22.7
65
14.Mukkutram distribution.
a) Vaatham
Vaatham Cases
No. Percentage %
Praanan 4 6.7
Abaanan 9 15.0
Vyaanan 60 100.0
Udhanan,Samanan, Nagan, Koorman, Kirukaran, Devathathan,

Dhananjeyam are not affected .
b)Piththam
Piththam Cases
No. Percentage %
Ranjagam 60 100.0
Prasaham 60 100.0
Anar pitham, Alosoham, Sathagam are not affected .
c)Kabam
Kabam Cases
No. Percentage %
Avalambagam 6 10.0
Santhiham 10 16.7
Kiletham, Pothagam, Tharpagam are not affected.
66
15.Udal thathukal distribution
Udal thakkukal Cases

No. Percentage %
Saaram 60 100.0
Senneer 60 100.0
Oonn, Kozhuppu, Enbu, Moolai, Sukkilam/Suronitham are not

affected.
16.Envagai thervu distribution
Envagai thervu Cases

No. Percentage %
Niram 60 100.0
Sparism 60 100.0
Naa, Mozhi, Vizhi, Malam, Moothiram are not affected.
67
17.Naadi
Naadi Cases
No. Percentage %
Vatham 0 0.0
Vatha pitham 19 31.7
Vatha kapham 07 11.7
Kapham 0 0.0
Kapha vatham 1 1.7
Kapha pitham 2 3.3
Pitham 0 0.0
Pitha vatham 21 35.0
Pitha kapham 10 16.7
Total 60 100.0
18. Gnanenthriyam
Mei is affected in 100% of cases. But Vaai, Kann, Mokku and Sevi
are not affected.
19.Kanmenthriyam
Kanmenthriyam Cases
No. Percentage %
Kai 1 1.7
Kaal 8 13.3
Vaai 0 0.0
Karvaai 0 0.0
Eruvaai 4 6.7
68
20.Neikuri
Nei kuri Cases

No. Percentage %
Vatha neer 1 1.7
Pitha neer 0 0.0
Kapha neer 21 35.0
Others
a)fastly spread 2 3.3
b)slowly spread 36 60.0
Total 60 100.0
21.Duration of illness
Duration (years) Cases

No Percentage %
<2 36 60.0
2- 8 13.3
4- 8 13.3
6- 2 3.3
8- 4 6.7
10+ 2 3.4
Total 60 100.0
69
22.Clinical features
Before treatment After treatment

Symptoms Cases
No. % No. %
Itching 60 100.0 9 15.0
Wheal 0 0.0 0 0.0
Erythema 21 35.0 0 0.0
Macule 10 16.7 0 0.0
Papule 4 6.7 0 0.0
Pustule 16 26.7 0 0.0
Blister 7 11.7 0 0.0
Vesicle 57 95 0 0.0
Oozing 58 96.7 0 0.0
Crusting 56 93.3 2 3.3
Scaling 46 76.7 3 5.0
Lichenification 58 96.7 15 25.0
Hyper 59 98.3 26 43.0
pigmentation
Ulceration 23 38.3 0 0.0
Pain & 7 11.7 0 0.0
burning
sensation
Bad odour 6 10 0 0.0
70
23.Results
Results Cases
No. Percentage %
Cured 39 65.0
Improved 20 33.3
No change 1 1.7
Total 60 100.0
70
60
50
40 Cured
% Improved
30
No change
20
10
0
Figure 4.Bar Diagram For Result of Treatment.
71
HAEMATOLOGICAL INVESTIGATIONS
Blood Blood
TC Hb
DC (Cumm) Blood sugar (mgs%) urea cholesterol ESR (mm)
Sl IP (Cumm) (mg/dl)
(mgs%) (mgs%)
No. No.
BT AT BT(%) AT(%) BT AT BT AT BT AT BT AT BT AT
P L E M P L E M F PP F PP ½hr 1hr ½hr 1hr
1. 352 7400 7500 50 44 06 - 46 40 04 - 13.4 12.8 315 370 104 150 41 40 246 240 06 12 04 08
2. 366 8600 8100 62 32 06 - 60 38 06 - 11.2 12.3 89 100 104 122 36 40 240 240 14 28 10 12
3. 106 7100 7500 60 36 02 02 68 34 02 - 12.0 12.0 93 126 93 120 35 40 240 242 08 16 6 12
4. 374 7400 8000 58 38 04 - 60 36 04 - 12.0 13.2 89 189 92 170 40 36 210 215 20 42 06 12
5. 384 6700 7100 60 38 02 - 62 34 02 - 12.0 12.0 78 137 80 120 36 40 174 180 04 08 04 08
6. 118 7400 7600 58 40 02 - 56 42 02 - 12.0 13.0 96.2 107.4 100 120 36 35 204 196 04 08 04 08
7. 463 7800 7400 50 46 02 - 48 50 02 - 13.0 13.8 111.1 133.3 106 120 36 32 150 140 35 72 10 12
8. 465 8800 9400 62 32 02 - 56 42 02 - 10.0 9.6 104 130 96 139.2 34 32 148 138 12 24 10 20
9. 473 9300 9600 66 30 04 - 60 38 02 - 11.6 12.3 96.2 108 94 106 18 25 187 195 24 50 10 18
10. 499 7900 8200 60 36 04 - 60 38 02 - 9.6 10.1 83 104 84 110 24 23 260 256 09 18 06 10
11. 445 7900 7800 52 44 04 - 50 48 02 - 12.2 14.0 40 96 70 99 23 21 207 207 10 20 04 08
12. 285 7800 6800 54 44 02 - 60 38 02 - 11.0 11.6 80 100 82 106 16 20 175 180 26 48 10 14
13. 239 7000 6700 56 40 04 - 53 45 02 - 10.2 12.0 87 103 89 104 24 27 138 207 26 56 10 22
14. 521 9000 8600 58 40 02 - 56 42 02 - 13.0 13.4 93 173 90 104 26 23 173 165 04 08 02 04
15. 523 8300 8200 56 38 06 - 54 44 02 - 12.2 12 71 114 78 124 17 20 - 170 04 08 02 06
16. 524 8900 9100 56 38 06 - 58 40 02 - 12.4 12.0 71 90 72 104 71 20 178 184 20 40 10 12
17. 242 7300 8100 56 40 04 - 54 46 - - 10.4 12.2 130 285 121 150 21 26 138 150 12 26 10 14
18. 526 8800 8600 60 38 02 - 58 42 - - 12.8 12.0 70 93 72 101 16 17 174 170 10 20 06 08
19. 244 7900 7400 48 48 04 - 46 50 04 - 11.8 11.6 67 96 66 88 18 21 178 176 08 16 04 08
20. 528 8200 8200 52 46 02 - 58 40 02 - 11.6 12.0 82 108 80 104 24 24 173 182 08 14 02 06
72
Sl OP TC DC (Cumm) Hb Blood sugar (mgs%) Blood Blood ESR (mm)
No. No. (Cumm) (mg/dl) urea cholesterol
(mgs%) (mgs%)
21 S1575 8100 8600 60 34 06 - 50 48 02 - 11.2 12.8 115 156 110 130 30.2 32 224 178 03 06 07 14
22. S1613 6600 890 46 48 06 - 60 35 05 - 10.4 12 80 89 82 96 31.3 28 194 187 20 40 08 16
23. S2219 7800 7600 58 40 02 - 60 38 02 - 12.6 13.2 68 108 78 100 29 26 180 170 08 16 04 12
24. S2496 9600 7800 50 40 10 - 56 40 04 - 12.8 12 64 207.4 - - 40 - 226 - 56 120 40 80
25. S3802 8800 7800 58 40 02 - 56 42 02 - 10 11 93 100 100 110 28.1 29 200.2 200.6 07 14 06 10
26. S3383 7700 7900 54 40 06 - 60 38 02 - 13.6 12 81.4 159.2 80 136 27 28 274 256 10 22 02 04
27. S4451 8200 8400 58 40 02 - 56 42 02 - 10.2 11 84 96 82 100 40 41 139 130 30 62 12 16
28. S4525 7800 7300 56 40 04 - 53 40 07 - 12.4 11 76 156 84 123 29 32 184 193 04 08 02 06
29. S4543 7900 7600 60 38 02 - 58 40 02 - 12 12 88 96.2 84 110 30 31 189 192 04 08 02 06
30 S4788 8400 8200 58 40 02 - 56 42 02 - 12 13 68 96.2 74 108 32 34 196 184 02 04 02 04
31 S5084 7800 8100 54 44 04 - 52 48 02 - 11.8 12.6 80 84 92 110 32 30 184 196 02 06 02 04
32. S5181 7800 6900 58 40 02 - 56 40 04 - 11.8 12 88 100.2 92 106 36 19 200 159 04 06 08 16
33. S5221 7000 7200 60 36 04 - 62 36 02 - 12.6 13.1 76 116 80 121 32 34 193 154 05 12 02 06
34. S5805 9000 8800 60 40 02 - 58 42 02 - 12 12.8 88 104 92 106 22.2 26 186.2 190 07 14 04 08
35. S5914 8900 9100 50 40 10 - 54 44 02 - 12.8 13.1 104 168 100 154 29 30 171 178 06 12 04 08
36. S6230 8300 7000 50 46 04 - 56 40 04 - 11.8 9.4 82.1 114.2 183 120 40.2 19 172.2 160 06 12 12 24
37. S6326 7400 7600 54 44 02 - 52 46 02 - 12.6 13 79 99 82 101 41 39 214 206 08 16 04 08
38. S7114 7000 7100 56 42 02 - 54 44 02 - 10.6 11 78 96.2 82 100 38 38 133 148 12 24 08 12
39. S7171 7300 7400 56 40 04 - 58 40 02 - 12.4 13.2 98 107.3 101 110 39 40 189 174 13 26 06 08
40. S7258 7600 6700 52 44 04 - 55 41 04 - 12 12.2 89 115 117 130 31 16 211 212 60 128 30 60
41. S7511 8200 8100 48 46 06 - 50 48 02 - 12 13 102 122 98 126 39 38 207 189 16 24 04 08
42. S7584 7400 7600 50 48 02 - 50 48 02 - 12.6 13 84 96.2 88 103 39 38 155.4 160 08 16 04 08
43. S7724 7400 7600 48 48 04 - 50 48 02 - 13.6 14 94 100 96 103 35 37 155 168 10 20 06 14
44. S8502 8800 9000 52 42 06 - 53 42 05 - 13.8 12.8 86 104 89 100 20.2 17 145 193 07 14 05 10
73
Sl OP TC DC (Cumm) Hb Blood sugar (mgs%) Blood Blood ESR (mm)
No. No. (Cumm) (mg/dl) urea cholesterol
(mgs%) (mgs%)
45. S8812 8800 9000 52 42 06 - 54 44 02 - 08 10 79 93 80 96 21 20 179 176 12 26 06 10

46. S9851 8000 8100 36 44 - - 58 42 - - 13.2 13.8 68 98 70 96 18 20 248 236 06 12 04 08
47. S9843 7900 8200 52 46 02 - 50 48 02 - 12 13.7 74 114 80 110 19 18 234 230 12 26 08 12
48. S10000 7100 7600 56 44 - - 58 40 02 - 12 13.6 82 103 83 106 17 18 156 150 06 12 04 08
49. T126 7900 8900 54 42 04 - 58 38 04 - 13 12.2 85 104 89 110 18 23 214 262 05 10 12 24
50 T527 8200 8100 60 40 - - 58 42 - - 12 12.9 83 98 91 104 18 19 207 220 25 50 18 22
51. T595 8200 8400 60 40 - - 56 42 02 - 11.6 12.3 91 139 98 136 16 20 150 148 04 08 02 04
52. T598 7800 8200 60 32 08 - 58 40 02 - 10.8 12 98 110 96 112 21 23 184 176 12 26 06 10
53. T635 7800 8200 54 40 06 - 52 46 02 - 10.6 11.2 94 100 90 110 16 17 143 148 10 22 04 08
54. T2031 7200 7400 56 40 04 - 58 40 02 - 11.2 12.3 74 87 76 92 23 22.1 179 183 20 40 10 20
55. T2235 8900 9000 52 46 02 - 50 48 02 - 12 12.7 178 226 148 190 19 21 234 216 06 12 02 04
56. T2427 8200 8600 56 40 04 - 56 44 02 - 12.2 13.1 78 126 81 120 21 21 182 191 02 04 02 04
57. T3130 7600 7900 50 44 06 - 52 46 02 - 12.4 12.9 99 85 98 110 31 30 187 191 04 08 04 06
58. T3482 8200 7900 50 46 04 - 50 48 02 - 11.2 10 71 110 79 126 30 29 141 133 02 04 05 10
59. T4417 7300 9800 50 48 02 - 61 35 04 - 09 10.2 80 89 78 86 21 20 147 136 10 22 18 40
60. T4817 7600 10000 52 46 02 - 64 34 02 - 12 10.8 76 88 72 94 30.2 25 155 148 09 20 10 22
74
URINE AND MOTION ANALYSIS
Before treatment After treatment Before treatment After treatment

Si.No IP No. Occult Occult
Albumin Sugar Deposits Albumin Sugar Deposits Ova Cyst Ova Cyst
blood blood
1. 352 Trace +++ 6-8 PC, 4-6 EC Nil + 1-2 PC,2-4 EC Nil Nil Nil Nil Nil Nil
2. 366 Nil Nil 2-4 PC, 2-4 EC Nil Nil 2-4 PC,2-4 EC Nil Nil Nil Nil Nil Nil
5. 384 Trace Nil 1-2 PC, 1-2 EC Nil Nil 1-2 PC,1-2 EC Nil Nil Nil Nil Nil Nil
6. 118 Nil Nil 1-2 PC, 1-2 EC + Nil 1-2 PC,2-4 EC Nil Nil Nil Nil Nil Nil
7. 463 Nil Nil 2-3PC, 2-3EC Nil Nil 1-2 PC,1-2 EC Nil Nil Nil Nil Nil Nil
10. 499 Nil Nil 4-6 PC, 4-6 EC Nil Nil 2-4PC,2-4 EC Nil Nil Nil Nil Nil Nil
11. 445 Nil Nil 4-6 PC ,3-4 EC Nil Nil 1-2 PC,1-3 EC Nil Nil Nil Nil Nil Nil
12. 285 Nil Nil 4-6 PC ,2-4 EC Nil Nil 1-2 PC,2-4 EC Nil Nil Nil Nil Nil Nil
18. 526 - - - Nil Nil 1-2 PC,1-2 EC Nil Nil Nil Nil Nil Nil
19. 244 - - - Nil Nil 2-3 PC,2-3 EC Nil Nil Nil Nil Nil Nil
20. 528 - - - Nil Nil 1-3PC,1-3EC + + Nil Nil Nil Nil
*PC- Pus Cells, EC-Epithelial Cells
75
OP
Sl.No Occult Occult
No. Albumin Sugar Deposits Albumin Sugar Deposits Ova Cyst Ova Cyst
blood blood
21 S1575 Nil Nil 1-2 PC, 1-2 EC Nil Nil 2-4 PC, 2-4 EC Nil Nil Nil Nil Nil Nil
22. S1613 Nil Nil 3-4 PC, 2-3 EC Nil Nil 2-4 PC, 2-4 EC Nil Nil Nil Nil Nil Nil
25. S3802 Nil Nil 2-4 PC, 2-4 EC Nil Nil 2-4 PC, 1-2EC Nil Nil Nil Nil Nil Nil
27. S4451 Nil Nil 2-4 PC, 2-4 EC Nil Nil 1-4 PC,1-2 EC Nil Nil Nil Nil Nil Nil
28. S4525 Nil Nil 1-2 PC, 1-2 EC Nil Nil 4-6 PC, 4-6EC Nil Nil Nil Nil Nil Nil
33. S5221 Nil Nil 1-2 PC,1-2 EC Nil Nil 1-3 PC,2-4 EC Nil Nil Nil Nil Nil Nil
37. S6326 Nil Nil 1-2 PC, 1-2 EC Nil Nil 1-3 PC,2-4 EC + + Nil + + Nil
38. S7114 Nil Nil 2-4 PC, 1-2 EC Nil Nil 1-3 PC, 1-4 EC + + Nil Nil Nil Nil
41. S7511 Nil Nil 1-3 PC, 1-3 EC Nil Nil 2-4 PC, 2-4 EC + + Nil Nil Nil Nil
76
OP
Sl.No Occult Occult
No. Albumin Sugar Deposits Albumin Sugar Deposits Ova Cyst Ova Cyst
blood blood
49. T126 Nil Nil 2-4 PC, 1-2 EC Nil Nil 1-2 PC, 1-2 EC Nil Nil Nil Nil Nil Nil
50 T527 Nil Nil 4-6 PC, 2-4 EC Nil Nil 2-4 PC,1-2 EC Nil Nil Nil Nil Nil Nil
53. T635 Nil Nil 3-4 PC, 3-4 EC Nil Nil 1-2 PC,1-2 EC Nil Nil Nil Nil Nil Nil
54. T2031 Nil Nil 1-2 PC, 1-2 EC Nil Nil 1-2 PC,2-4 EC Nil Nil Nil Nil Nil Nil
55. T2235 Nil ++ 2-4 PC, 1-2 EC Nil Nil 2-4 PC, 1-2 EC Nil Nil Nil Nil Nil Nil
57. T3130 Nil Nil 2-3 PC, 2- EC Nil Nil 1-2 PC, 1-2 EC Nil Nil Nil Nil Nil Nil
59. T4417 Nil Nil 1-2 PC,1-2EC Nil Nil 3-4 PC, 1-2EC Nil Nil Nil Nil Nil Nil
60. T4817 Nil Nil 2-4PC,1-2EC Nil Nil 3-4PC,1-2 EC Nil Nil Nil Nil Nil Nil
77
MJTU!PG!JQ!QBUJFOUT!
!
!
!
!
No. of
IP.
S. No. Name Age/sex D. O. A D. O. D days Result
No.
treated
1. 352 Periera 84/m 08/07/06 24/08/06 48 C
2. 366 Gothandapani 50/m 17/07/06 02/09/06 48 C
3. 106 Susan 52/f 27/07/06 12/09/06 48 I
4. 374 Kannan 62/m 26/07/06 11/09/06 48 I
5. 384 Shanmugavelu 65/m 03/08/06 19/09/06 48 C
6. 118 Poosam 55/f 04/08/06 20/09/06 48 C
7. 463 Arumugam 64/m 29/10/06 15/12/06 48 I
8. 465 Appadurai 85/m 31/10/06 20/12/06 48 C
9. 473 Subramanian 80/m 02/11/06 20/12/06 48 NC
10. 499 Ranganathan 55/m 26/11/06 12/01/07 48 C
11. 445 Muthu 52/m 25/11/06 11/01/07 48 I
12. 285 Mohana 60/f 09/12/06 25/01/07 48 I
13. 239 Palaniammal 60/f 14/12/06 30/01/07 48 C
14. 521 Vadivel 50/m 17/12/06 02/02/07 48 I
15. 523 Dhanasekaran 45/m 12/12/06 30/01/07 48 I
16. 524 Govindan 47/m 17/12/06 02/02/07 48 C
17. 242 Rani 60/f 18/12/06 03/02/07 48 C
18. 526 Anumanthan 73/m 18/12/06 03/02/07 48 C
19. 244 Kavitha 18/f 18/12/06 03/02/07 48 C
20. 528 Bharadhan 72/m 22/12/06 07/02/07 48 C
C – Cured
NC – No change
I – Improved
D. O. A. – Date of admission
D. O. D. – Date of discharge
! 89
LIST OF OP PATIENTS
!
No. of
OP
S. No. Name Age/sex D. O. A D. O. D days Result
No.
treated
1. S1575 Rajamani 63/m 04.11.06 21.12.06 48 C
2. S1613 Viswanathan 50/m 17.11.06 04.01.07 48 C
3. S2219 S.Munusamy 56/m 03.11.06 20.12.06 48 C
4. S2490 Vasantha 56/f 12.11.06 29.12.06 48 C
5. S3802 Dhanalakshmi 42/f 09.11.06 26.12.06 48 C
6. S3383 Krishnamoorthy 65/m 02.11.06 19.12.06 48 I
7. S4451 Karuppaiya 65/m 11.11.06 28.12.06 48 C
8. S4525 Radhakrishnan 68/m 08.11.06 25.12.06 48 I
9. S4543 Ramu 42/m 04.11.06 21.12.06 48 I
10. S4788 Gajalakshmi 32/f 14.11.06 31.12.06 48 C
11. S5084 G.Subramanian 50/m 14.11.06 31.12.06 48 C
12. S5181 L.Subramani 43/m 21.11.06 02.01.07 48 C
13. S5221 V.Munusamy 45/m 13.11.06 30.12.06 48 I
14. S5805 M.Saravanan 21/m 13.11.06 30.12.06 48 I
15. S5914 Perumal 34/m 22.11.06 03.01.07 48 I
16. S6230 Pandiyan 45/m 14.11.06 31.12.06 48 C
17. S6326 Jeyanthi 38/f 20.11.06 05.01.07 48 C
18. S7114 Vijayasankarappan 77/m 28.11.06 03.01.07 48 C
19. S7171 Usharani 40/f 28.11.06 03.01.07 48 C
20. S7258 Kasturi 58/f 25.11.06 11.01.07 48 C
!
!
!
! 8:
No. of
S. No. OP No. Name Age/sex D. O. A D. O. D days Result
treated
21. S7511 Arulmurugan 27/m 22.11.06 08.01.07 48 I
22. S7584 B.Baskaran 36/m 27.11.06 13.01.07 48 C
23. S7724 Ramachandran 27/m 23.11.06 09.01.07 48 I
24. S8502 Athikesavan 55/m 29.11.06 09.01.07 48 C
25. S8812 Lalitha 16/f 30.11.06 16.01.07 48 C
26. S9851 Govindharaju 42/m 23.11.06 09.01.07 48 C
27. S9843 Guruvammal 45/f 22.11.06 08.01.07 48 C
28. S10000 Beulah 42/f 22.11.06 08.01.07 48 C
29. T126 Kabali 48/m 28.11.06 14.01.07 48 C
30. T527 Murugesan 53/m 24.11.06 10.01.07 48 C
31. T595 C.K.Saravanan 65/m 29.11.06 15.01.07 48 C
32. T598 Maryrajam 45/f 28.11.06 14.01.07 48 C
33. T635 Ponni 52/f 28.11.06 14.01.07 48 C
34. T2031 Kanniammal 60/f 30.11.06 16.01.07 48 C
35. T2235 Muthupandi 42/m 30.11.06 16.01.07 48 I
36. T2427 B.Saravanan 53/m 01.12.06 17.01.07 48 I
37. T3130 Jonesimmanuvel 55/m 02.12.06 18.01.07 48 I
38. T3482 Ramamoorthi 61/m 06.12.06 22.01.07 48 C
39. T4417 Ponraj 36/m 04.12.06 20.01.07 48 I
40. T4877 Baasha 67/m 06.12.06 22.01.07 48 I
C – Cured.
NC – No change.
I – Improved.
D. O. A. – Date of admission.
D. O. D. – Date of discharge.
! 91
DISCUSSION
As per the protocol 60 patients with unique signs and

symptoms related to karappan are itching, epidermo-spongio
oedema, vesicles, oozing, thickening and hyperpigmentation of the
skin were admitted into the trial under the department of Sirappu
Maruthuvam, National Institute of Siddha,Chennai-47.
All the patients were subjected to preliminary routine

investigation, which include haematological and urine examination
on the date of admission and at the time of discharge.
Laboratory investigations of blood ( TC, DC, ESR, Hb, Sugar ,

Urea, Cholestrol),Urine (Albumin, sugar, deposit) &Motion(Ova Cyst,
Occult blood ) has been done for all the 60 cases.
To normalize the altered mukkutram purgation was given to

the patients on the day before starting the treatment. The trial
medicines Karuncheeraga churanam (internal) and Brahmathandu
thylam (external) were administered for 48 days. All the patients
were told to take the trial drug karuncheeraga churanam with hot
water as an adjuvant, three times a day.
81
All the patients were strictly instructed to follow diet
restriction and hygienic life style, in a healthy surrounding.
As said in the siddha textbooks the signs and symptoms of
karappan were compared with those of eczema mentioned in the
modern texts. Observation was made during the first day of
treatment , every 8th day of treatment and at the end of treatment.
The bio chemical study was done in Mettex laboratories of
India, Chennai-32 and the pharmacological study of the trial drug
was tested in the pharmacological laboratory of Government siddha
medical college hospital, palayamkottai.The results were
documented and interpreted for the prognosis of the disease.
Based on various criterias, the datas were collected and
tabulated.
Gender distribution
In the study among the 60 cases 42 were male and 18 cases
were female. According to the text books there is no apparent sex
pre-dilection in karappan but the major vulnerability of males may
be due to their occupational indifferences, mental strain and
mechanical life.
Age distribution
During the entire study the prevalence of karappan was a very
common one affecting the adult age group from 40-70 years (i.e.
42 patients) in both male and in female.
82
Kaalam distribution
75.0% of the cases belonged to piththa kaalam
11.7% of the cases belonged to vaatha kaalam
13.3% of the cases belonged to kaba kaalam
More number of cases were found in piththa-kaba kaalam, as
this stage progresses to the kaba kaalam, and this is the declining
phase of one’s life cycle.
Occupational status
An individual’s occupation is the provocative and aggravating
factor for karappan. It is almost true in all cases,as their
occupational history show some relevance.
Diet preference
According to the Yugi vaithya chinthamani, the non-vegetarian
diet is one of the exacerbating factor for reccurrence of karappan.
In the trial 91.7% of patients were non-vegetarian.
Thinai reference
100% of the cases were belonged to Neithal nilam .The study
was conducted in and around the Chennai.
Socio-economic condition
Out of 60 patients 2 were belonged to high income group, 26
were middle group and 32 were low income group. Poor hygienic
conditions and malnutrition are prevail and persistent exposure to
polluted atmosphere, lowered immune responses made them more
prone to the disease.
83
Mode of onset
During the study 61.7% of the cases were observed of chronic
onset, 28.3% were acute cases and 10.0% cases were subacute.
Incomplete treatment, failure to follow medical instructions
regarding diet restriction and hygiene, psychological strain and
change of routine life style inevitably were observed to be the
reasons for this disease to become chronic, generally all the skin
diseases, usually have a recurrent nature.
Etiological reference
All type of aetiological factors were observed, during the study
of karappan as it is one of the immunological disorders , which may
affect the subsequent generations. Here positive family history was
found in 2 cases only, occupationally relevant karappan was
observed in 21 cases,17 were caused by allergy, Incompatible diet
in 3 cases, insect bite in 4 cases and psychological stress in 13 cases
were also noted.
Mukkutram reference
Among the 60cases, 6 of the cases had associated with
bronchial asthma i.e. derangement of praanan. Habitual
constipation in 9 cases and all the 60 cases had derangement of
vyanan and samanan were noted. The affected Vaatha kuttram in
due course disrupt to the two humors namely piththam and kabam
causing itching, oedema, oozing, loss of skin complexion with
thickening and lichenification.
84
Among the five types of piththam, ranjagam & prasagam were
affected in all the cases, as loss of natural colour with thickening and
lichenification were noted in all of them.
Udal kattugal reference

Among the seven udal kattugal roughness of the skin was
reported in all the cases. Dryness of the skin, vesicles, hyper
pigmentation of skin,erythema and ulcers (saram & senneer
affected) were found in all the 60 cases.
Ennvagai thervugal
As per the skin lesions of the karappan, Niram(colour) and
sparisam (sensation) were affected in all the 60 cases, there was
dryness, roughness, thickness, hyper pigmentation of the skin were
similarly found out.
Naadi
Majority of 35% of patients were pittha vaatha naadi,31.7%
were vaatha piththa naadi,16.7% were pittha kaba naadi,11.7%
were vaatha kaba naadi , 3.3% of kabapittha naadi, 1.7% were
kabavaatha naadi.
Udal
Among the 60 patients 53.3% were vaathapiththa body
constitution.
85
Neikkuri
Majority of 35%patients had kaba neer.
The major clinical symptoms was reported to be itching,

hyper pigmentation, vesicle , oozing , crusting & scaling . They were
almost none after the treatment.
Out of 60 cases six were found to have bronchial asthma,

four cases were diabetic & two were hypertensive. These patients
continued their drugs which they were taking previously along with
the trial drug .
There were moderate decreases in E.S.R and Eosinophil

count after the treatment.
It is a pleasure to say that there was no report of adverse

effects during the entire course of treatment in any cases.
86
Summary
The Siddha description about the types of karappan are found

in yugi and Agathiar’s text.
Twenty patients from the inpatient department and forty

patients from the outpatient department from both sexes were
selected after thorough evaluation of history, clinical findings and
laboratory results. Ennvagai thervugal were used for the diagnostic
purpose.
Majority of the patients were male (70%) and particularly

above 40 years and 53.3% from poor socio-economical background.
87
The disease was observed to occur mostly in piththa kaalam.
Biochemical analysis revealed the drug karuncheeraga

churnam has calcium and ferrous iron.
Pharmacologically,
Karuncheeraga churanam (internal drug) has
9 Moderate anti-inflammatory(acute &chronic)action,
9 Significant antihistamine action and
9 Moderate analgesic action.
Brahmathandu thylam (external drug) has
9 Moderate anti-histamine action and
9 Mild anti inflammatory action
In an average of 48 days treatment majority of the patients

shown good recovery from signs and symptoms and their laboratory
investigation results were encouraging after the treatment, as
illustrated in the tabular columns.
None of them developed any adverse effects. The progress

exhibited was quite encouraging.
88
Conclusion
The treatment with Karuncheeraga churanam and Brahmathandu

thylam showed remarkable improvement in karappan patients.
Along with medication the patients were advised over their

dietary habits and hygienic routines.
There was appreciable clinical improvement of the disease and

also enhancement of general health.
The cost of trial medicines were less economical and can

affordable by patients below poverty line.
The raw materials of the drug are available in almost all season
and preparation of the drug is also very simple.
No adverse side effects like aggravation of itching were reported

during the entire course of treatment.
Hereby the author concludes that the treatment with

Karuncheeraga churanam and Brahmathandu thylam for
Karappan is very effective in point of efficacy and safety.
89
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Shanmugavelu.
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NATIONAL INSTITUTE OF SIDDHA

(THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY)

DOCTOR OF MEDICINE (SIDDHA)

First of all the author is extremely grateful to Lord

Almighty who empowered her with his blessings and grace to

complete this dissertation work successfully.

It is a great pleasure for the author to acknowledge the

deep sense of gratitude to the Vice- Chancellor, The Tamilnadu

Dr.M.G.R Medical University, Chennai for permitting to do this

The author wishes to express grateful thanks to

Dr.V.Arunachalam M.D.(S), Director, National Institute of

in order to carry out this work.

The author owe special gratitude to Dr.G.Thiagarajan

M.D.(S), Head of the Department of Sirappu Maruthuvam,

National Institute of Siddha, Chennai, for rendering his valuable

suggestion, guidance and encouragements in all aspects from

The author is very much grateful to Dr.R.S.Ramaswamy

M.D.(S), Associate Professor, Department of Sirappu

Maruthuvam, National Institute of Siddha, Chennai, for his

valuable guidance and support in this dissertation work.

The author is grateful to Dr.T.R.Siddque Ali M.D (s),

Lecturer, Department of Sirappu Maruthuvam, National Institute

of Siddha, Chennai, for his guidance regarding this studies.

The author expresses her thanks to Mr.P.Jayabal,

Assistant Professor (Statistics), National Institute of Siddha,

Tambaram Sanatorium, Chennai -47.

The author expresses her thanks to Mr.M.Kalaivanan,

M.Sc,M.Phil, Lecturer, Department of Pharmagology,

out the pharmacological analysis of the trail drugs needs special

mention and appreciation.

The author expresses her thanks to Mr.Mathan, Mettex

laboratories of India, Guindy, Chennai-32 for his help in

evaluating the trial drugs.

The author thanks to her colleagues and other staff

members who helped in this dissertation work.

The author wishes to extend her special thanks to

Dr.S.Natarajan, Dr.K.Krishnakumar and Dr.K.Saravanan

who have rendered their memorable support in successfully

completing this dissertation work.

The author is now in the position to thank her dear husband

Dr.M.Arun, her brother in law Mr.M.Anand and her lovable

daughter Kayaloviya, who supported her in all aspects not only

in this study but also in every moment of life.

hesitations and made this work a most valuable one.

Siddha medicine, a native medicine of Tamilnadu, is the first system

As siddhi means perfection, the practitioners of siddha medicine

In the stream of Sirappu maruthuvam we exclusively treat the mind

Among chronic skin diseases, Karappan is the most

An estimated one in 10 people are affected at some point in

So the author is much interested in choosing this disease as

1) To study the incidence of the disease with respect to age,

Siddhars, spiritual scientists explored and explained the

Universe originally constituted of atoms which contributed to

A harmonious combination and function of these five elements

The food we eat has six tastes namely Sweet(,dpg;G), Sour(Gspg;G),

Each of it’s a mixture of two basic elements.

,dpg;G - kz; + ePh;

Panchaboothas are the foundations for Mukkutram (Vaatham,

• Vayu constitute Vaatham